Risk factors for C-section delivery and population attributable risk for C-section risk factors in Southwest of Iran: A prospective cohort study

Background: Iran has a high C-section rate (40.6 in 2005). The objective of this study was to assess the associations and population-attributable risks (PAR) of risk factors combinations and Csection in the Southwest Iran. Methods: We performed a population-based cohort study using the reports provided by Shiraz University of Medical Sciences. The cohort included pregnant women within September 2012 and February 2013 (n=4229), with follow-up until delivery. Then, the actual delivery was recorded; i.e., C-section delivery, vaginal delivery, and miscarriage. A multiple logistic regression model was used to estimate the point and the interval probability. The adjusted population attributable risks (aPARs) were calculated through adjusted odds ratio from the final multiple logistic regression models for each variable. Results: Of 4,217 deliveries, 2,624 ones were C-section (62.2). The rate of C-section was significantly higher in healthcare departments of private clinics compared to governmental clinics. The rate increased steadily with the mother's age, marriage age, family income and education. The multiple logistic regression analysis showed that local healthcare, supplementary insurance, maternal age, age of marriage, place of birth, family income, maternal education, education of husband and occupation were the key contributing factors to choose the mode of delivery. The multiple logistic regression analysis for reproductive factors showed that parity, previous abortion and stillbirth, previous infertility, birth weight (g) and number of live births were selected risk factors for C-section. Among the exposures, family income, location of healthcare and place of birth showed the highest population attributable risks: 43.86, 19.2 and 18.53; respectively. Conclusion: In this survey, a relatively large contribution of non-medical factors was identified against the background of C-section. All of these factors influence the knowledge, attitudes and norms of the society. Thus, the attention of policymakers should be drawn to the factors associated with this mode of delivery

Survival Models in Breast Cancer Patients

Abstract Background: Breast cancer is the most prevalent malignancy among Iranian women. Five and ten year survival is one of the indicators used for evaluation of the quality of care after surgery. In this study, we used several survival models to determine risk factors, survival times and life expectancies of different types of surgery

Association Between Perceived Demands and Musculoskeletal Disorders Among Hospital Nurses of Shiraz University of Medical Sciences: A Questionnaire Survey

Excessive demands on nurses may result in high rates of musculoskeletal disorders (MSDs). This study was conducted among hospital nurses of Iran’s Shiraz University of Medical Sciences (SUMS) to determine the prevalence of MSDs and to examine the relationship between perceived demands and reported MSDs. In this study, 641 randomly selected nurses from 12 SUMS hospitals participated. The Nordic musculoskeletal disorders questionnaire and Job Content Questionnaire were used as collecting data tools.The results showed that 84.4% of the participants had experienced some form of symptoms of MSDs during the past 12 months. Lower back symptoms were found to be the most prevalent problem. Perceived physical demands were significantly associated with MSDs (OR = 1.5–2.7). No association was found between perceived psychological demands and reported symptoms. It was concluded that any intervention program for preventing MSDs among SUMS hospital nurses had to focus on reducing physical demands, particularly excessive postural demands

The effect of Benson Relaxation Technique on Anxiety Level and Qquality of Life of Patients with Irritable Bowel Syndrome

ABSTRACT: Introduction & Objective : Irritable bowel syndrom (IBS) is the most common functional bowel disorder which both the bowel and the brain are involved in this syndrom. Combined medical - relaxational therapy has been suggestd to decrease anxiety and relieve symptoms, make better feeling of self health and improve the quality of life in these patients.This study was designed to determine the effects of Benson relaxation technique on anxiety level and quality of life of patients with irritable bowel syndrome. Materials & Methods: In a clinical trial, 30 patients with irritable bowel syndrom were selected and randomly placed into two groups: case and control.The control group was treated by only usual medical therapy but the case group was treated by combined medical - relaxational therapy. The two groups continued therapy for three months. The anxiety of patients was measured by Spielberger test [State& Trait Anxiety Inventory (STAI)]. The quality of life of patients with regard to irritable bowel syndrome, was measured by BS-QOI with subscales 8, before intervention,1 week and 3 months after intervention in both groups. The collected data were analyzed by descriptive and Mann-whitney, repeated measurement tast and chi-square statistical methods. Results: State and trait anxiety mean of the case and control groups two weeks before and one week after intervention didn’t show any significant differences. But after three months the results showed a significant difference between the two groups(p<0.05). There wasn’t significant difference in scales of quality of life before intervention. One week after the intervention, differences of both group in four scales of dysphoria, health worry, social reaction and relationship were meaningful and the function of case group was more undesirable than that of the control group.Three months after completing the process, there wasn’t a meaningful increase in sex function in case group in comparison with the control group but there was a significant recovery in the case group in other performance scales (p<0.001). The quality of life of patients in control group compared to case group decreased or did not change significantly after 3 months. Conclusion: Performing Benson relaxation therapy is effective in reducing anxiety level coinciding with improvement quality 0f life therefore relaxation therapy can be recommended as an effective care program

Graft survival rate following renal transplantation in diabetic patients

Diabetic nephropathy is the most common cause of kidney failure needing dialysis in most countries of the world. Kidney disease occurs in one-third of diabetic patients, and signi-ficantly increases the mortality rates and treatment costs. The aim of the present study was to investigate the survival rate and to determine factors that influence survival among diabetic patients who underwent transplantation at the Shiraz Namazi Hospital Transplant Center during the years 1999 to 2009. This study is a historical cohort study, which examined the graft survival rate among 103 kidney transplant patients with diabetes. The Kaplan-Meier method was used to determine the survival rate and the log-rank test was used to compare survival curves; P-value of less than 0.05 was considered significant. The mean follow-up period of patients was 48.15 ± 31.05 months (range: 3.07-118.03 months), and the estimated nine-year graft survival rate was 84.2% (±0.045). Based on the results of the Cox regression model, age of the donor was a contributing factor to graft survival rate. In summary, the graft survival rate in our cohort is satisfactory and comparable with reports from other larger centers in the world

Non-medical factors affecting antenatal preferences for delivery route and actual delivery mode of women in southwestern Iran

Objective: Assessment of the contribution of non-medical factors to mode of delivery and birth preference in Iranian pregnant women in southwestern Iran. Study design: This cohort study used data from a structured questionnaire completed in early pregnancy and information about the subsequent delivery obtained through personal contact. Women were recruited by random sampling from antenatal clinics when scheduling visits over the course of 5 weeks from December 2012 to February 2013 and were followed-up 1 month after birth. Of the 2199 women recruited, 99.63 were eligible for the study. Results: Of the 748 women who expressed a desire to deliver their babies by cesarean section (CS) in early pregnancy, 87 had an elective cesarean section. The logistic regression analyses showed that normative beliefs (odds ratio OR 1.792, 95% confidence interval (1) 1.073�2.993), control beliefs (OR: 0.272, 95% CI: 0.162�0.459), and evaluation of outcomes (OR: 0.431, 95% CI: 0.268�0.692) favored the preference for cesarean section. The desire for delivery by elective cesarean section was associated with normative beliefs (OR: 1.138; 95% CI: 1.001�1.294), control beliefs (OR: 0.804; 95% CI: 0.698�0.927), and expectations about maternity care (OR: 0.772; 95% CI: 0.683�0.873), medical influences (OR: 1.150; 95% CI: 1.023�1.291), evaluation of outcome (OR: 0.789; 95% CI: 0.696�0.894), age, preference for cesarean section (OR: 5.445; 95% CI: 3.928�7.546), spouse educational level, and number of live births. Conclusions: A woman�s preference for delivery by cesarean section influenced their subsequent mode of delivery. Asking women in early pregnancy about their preferred mode of delivery provides the opportunity to extend their supports which might reduce the rate of elective cesarean section. This decision is affected by age, spouse educational level, number of live births, and preconceived maternal attitudes about delivery. © 2016 Taylor & Francis