Risk Factor Profiles of Adverse Neuromotor Outcome in Infants

ObjectiveAssessment of risk predictors for adverse neurodevelopmental outcome at 1 year of age in term and near-term infants.Material & MethodsThis case-control study was a representative sample of infants from different health-care centers of north and east of Tehran. The association betweenrisk factors and delayed motor development (developmental quotient below 70 indicating a significant delay) was analyzed using correlating risk factors;including the perinatal and neonatal data to the developmental status. The case group consisted of 143 infants whose DQ score was less than 70 and thecontrol group consisted of 140 infants who had a DQ score of more than 70.ResultsNeonatal seizures, Apgar score less than 3 after 5 minutes of birth (OR = 2.87 [95% CI; 1.68, 4.92]), low birth weight (OR = 5.86 [95% CI; 3.07, 11.18]), preterm delivery (OR =6.17 [95% CI; 3.04, 12.52]), Premature rupture of membranes (PROM)>24 hours (OR = 6.18[95% CI; 2.07, 18.51]) and hyperbilirubinemia leading to phototherapy or exchange transfusion (OR =3.75 [95% CI; 2.12, 6.65]) were associated with an increased risk for neuromotor delay on developmental examination at 1 year.ConclusionThis study identified distinct risk factors for an adverse outcome in infants. In this environment, perinatal risk predictors are most important

Parental participation and mismanagement: a qualitative study of child care in Iran.

The purpose of this study was to explore parents' and nurses' experiences of parental participation in child care in hospitals in Iran. Using thematic analysis, the data were collected through interviewing 14 parents and 11 nurses from two pediatric hospitals. The results showed that four major themes emerged, including the necessity of a parent's presence, the unplanned and informal delegation of care to the parents (which itself had five subthemes: the parents as nurses, the delegation of care without sufficient and planned parental training, informal parent-to-parent support, the continuum of parents' willingness to participate, and the neglect of parents' needs), the inconsistency of care, and the parents as informal evaluators of care. Based on the study's findings, effective communication by nurses with parents is required. Nurses need to make an ongoing assessment of parents' wishes for involvement and negotiate care accordingly, with enough support and supervision to warrant quality of care

Design and psychometric properties of the family support for older people questionnaire

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Total Healthcare Expenditures from the 2017 Iran’s National Households Income and Expenditure Survey: The Application of Two-Part Models

 Introduction: Although the precise estimates of healthcare expenditures are critical for health policy-makers, the right-skewed distribution and a substantial number of zero values of the measures of healthcare expenditure make such estimates challenging. The present study used conventional two-part (CTP) and marginalized two-part (MTP) models to handle the skewness and zero-inflation in expenditure distribution as two serious challenges. Materials and Methods: Data was used from the 2017 Households Income and Expenditure Survey (HIES; 38,252 households), a national cross-sectional study in Iran. CTP and MTP models were utilized to estimate the medical supplies, outpatient, inpatient and total medical expenditures. The rural-urban difference in total medical expenditures and other health services were also examined.   All data analyses were performed using SAS. For all tests, two-sided p-values <0.05 were interpreted as statistically significant.Results: The mean (SD) out-of-pocket spending for total healthcare was $143 ($488) per capita, and $182 ($650) and $105 ($239) for urban and rural areas, respectively. The mean (SD) medical supplies cost per capita was $48 ($240), and the mean (SD) of outpatient cost per capita and inpatient cost per capita were $61 ($245) and $34 ($294), respectively. Both CTP and MTP models suggested that urban population spent more money on total expenditures than rural populations (p<0.05). Although both models gave the same set of parameter estimates, the AIC indicated that the MTP-GG model was a more appropriate fit.Conclusion: The marginalized models provided better estimates in documenting inequalities/healthcare expenditures. Unlike the CTP model, the estimation of covariate effects on the marginal mean of the whole population via using the MTP model is straightforward. However, the MTP model may not outperform the CTP model in all cases. The applications of such models need to be considered in the future research to provide better estimates/documentations of healthcare expenditure and healthcare inequalities. In addition, these findings suggest a substantial inequality in healthcare expenditures between urban and rural areas. Considering the differences in urbanity and rurality can be of interest to health economists and policymakers.     

Struggling to create new boundaries: a grounded theory study of collaboration between nurses and parents in the care process in Iran.

AIM: To develop a substantive grounded theory of nurse-mother interaction in the care of chronically ill children in hospital setting. BACKGROUND: Interaction between nurses and parents is critical in paediatric hospital settings. This area of practice in developing countries has been under-researched. METHOD: The qualitative research design of grounded theory methodology was used to develop a theory of nurse-parent interaction within the child care. Registered Nurses (n=17) and mothers of chronically ill children (n=14) from two central paediatric hospital in Iran participated in this study. In-depth interviews with nurses and mothers were conducted using theoretical sampling between July 2007 and August 2008. The data were analysed using constant comparative analysis. FINDINGS: 'Struggling to create new boundaries' as a core variable was a dominant socio-psychological process that was manifesting itself within three stages: facing up to and perceiving the environmental pressures, balancing nurse's duties, and controlling the nurse-parent boundary in the care. CONCLUSION: It is concluded that nurses and parents need a care model, which addresses their collaboration and improved interpersonal relationship and clearly defines the boundary of their roles based on the needs of both sides while allowing parents to choose their role in these defined boundaries and providing parent education with aim to empower them for care at home

Comparison of artificial neural network, logistic regression and discriminant analysis methods in prediction of metabolic syndrome.

Introduction: Artificial neural networks as a modern modeling method have received considerable attention in recent years. The models are used in prediction and classification in situations where classic statistical models have restricted application when some, or all of their assumptions are met. This study is aimed to compare the ability of neural network models to discriminant analysis and logistic regression models in predicting the metabolic syndrome. Materials & Methods: A total of 347 participants from the cohort of the Tehran Lipid and Glucose Study (TLGS) were studied. The subjects were free of metabolic syndrome at baseling according to the ATPIII criteria. Demographic characteristics, history of coronary artery disease, body mass index, waist, LDL, HDL, total cholesterol, triglycerides, fasting and 2 hours blood sugar, smoking, systolic and diastolic blood pressure were measured at baseline. Incidence of metabolic syndrome after about 3 years of follow up was considered a dependent variable. Logistic regression, discriminant analysis and neural network models were fitted to the data. The ability of the models in predicting metabolic syndrome was compared using ROC analysis and the Kappa statistic, for which, MATLAB software was used. Results: The areas under receiver operating characteristic (ROC) curve for logistic regression, discriminant analysis and artificial neural network models (15: 8: 1) and (15: 10: 10) were estimated as 0. 749, 0. 739, 0. 748 and 0. 890 respectively. Sensitivity of models were calculated as 0. 483, 0. 677, 0. 453 and 0. 863 and their specificity as 0. 857, 0. 660, 0. 910 and 0. 844 respectively. The Kappa statistics for these models were 0. 322, 0. 363, 0. 372 and 0. 712 respectively. Conclusion: Results of this study indicate that artificial neural network models perform better than classic statistical models in predicting the metabolic syndrome

Self-concept and self-discrepancy among the women receiving and donating oocyte

Background & Aim: One of the assisted reproductive technologies is the use of donated oocyte. Although, the data about medical aspects of this process is available, knowledge of the psychological aspect related to this therapy is limited. Each individual's psychological aspects can be assessed by the self-concept and the self-discrepancy. Therefore, the present study aimed to assess the self-concept and self-discrepancy among women receiving and donating oocyte. Methods & Materials: In this descriptive-analytical investigation, carried out in 2015, given the limited research population, 53 women referred to Royan infertility institute, were investigated in each of the donor and recipient groups using the available sampling method. The data were collected by three questionnaires including demographic questions, Rogers’s self-concept scale and self discrepancy scale (ideal-self discrepancy and ought-self discrepancy). The data were analyzed through the descriptive statistics, Chi-square and t-test using SPSS v.16. Results: Results showed that the self-concept and self-discrepancy scores were poor in both the donor group and the recipient group. Scores of the recipient women (the questionnaire was reverse scored) were more than scores of the donor women. There was no significant difference between the two groups in the mean scores of self-concept (P=0.53). There was a significant difference between the two groups in the ought-self discrepancy score (P=0.02) but no significant difference was found between the two groups in the ideal-self discrepancy score (P=0.15). Conclusion: According to the results, it should be noted that in the process of oocyte donation, only physical assessment is not enough but individuals’ psychological needs are necessary to be taken into account. So, the authorities should consider measures to assess the psychological aspects of women receiving and donating oocyte

Meaning of Respect for Older People in Family Relationships

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Well-Being and Coping Capacities of Adolescent Students with Hearing Loss in Mainstream Schools

AbstractObjectivesCoping strategies used by adolescents has an important role in Preventing or decreasing their stresses and also increasing their wellbeings.This study aimed at evaluating the coping capacity and wellbeing of adolescent students with hearing loss in mainstream schools and also the correlations between their coping strategies and positivecharacteristics of well-being (engagement, perseverance, optimism,connectedness and happiness (EPOCH).Materials & MethodsIn this correlational study, 122 adolescent students with hearing loss were randomly selected from mainstream schools. Data collection was done by EPOCH Measure of Adolescent Well-Being and the Ways of Coping Questionnaire (WAYS). The Spearman correlation coefficient was used for determining the correlations between variables.ResultsThe mean scores of using different coping strategies varied from 1.36i n problem solving to 1.44 in seeking support. Among the positive characteristics of well-being, happiness had the lowest (11.04) and connectedness showed the highest score (12.33). The findings also showed a significant correlation between all coping strategies and EPOCH, however there was a strong positive correlation between total coping strategy score and perseverance (0.648) and happiness(0.629).ConclusionBased on the results, the score of happiness in students with hearingl oss was the lowest among positive characteristics of well-being and also happiness showed a strong association with total scores in coping strategies. Accordingly, interventional studies are needed to examine whether training students with hearing loss to use coping strategies is effective in increasing their happiness and overall well-being