Mapping 123 million neonatal, infant and child deaths between 2000 and 2017.

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.

Estimating global injuries morbidity and mortality: methods and data used in the Global Burden of Disease 2017 study.

BACKGROUND: While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria. METHODS: In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced. RESULTS: GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes. CONCLUSIONS: GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.

Global injury morbidity and mortality from 1990 to 2017: results from the Global Burden of Disease Study 2017.

BACKGROUND: Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. METHODS: We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). FINDINGS: In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). INTERPRETATION: Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.

Development and psychometric properties of a questionnaire to measure drug users' attitudes toward methadone maintenance treatment (DUAMMT) in Iran.

BACKGROUND: Assessing drug users' attitudes towards different kinds of addiction treatment is necessary to design tailored strategies. The aim of the present study is to develop and examine the psychometric properties of a new scale, called the DUAMMT, for assessing drug users' attitudes toward methadone maintenance treatment in Iran. METHODS: A multi-phase development method was applied in developing an instrument from February to December 2016. The item generation and scale development were performed through literature review, a qualitative approach, and interviews with an expert panel. Then, the psychometric properties of the scale were evaluated by means of cross-sectional studies with drug users. We performed an exploratory factor analysis, a confirmatory factor analysis, and item-scale correlations; and we tested the internal consistency of the scale. Furthermore, test-retest reliability was evaluated among an Iranian sample of drug users. RESULTS: The mean age of participants was 34.12 years. The exploratory factor analysis revealed four factors (perceived barriers, perceived concerns, methadone side effects, and perceived positive effects) containing 17 items that jointly accounted for 60.53% of the observed variance. The confirmatory factor analysis showed a model with appropriate fitness for the data. The Cronbach's alpha coefficient for the subscales ranged from .70 to .79. The intra-class correlation coefficient (ICC) ranged from .774 to .970, which is well above the acceptable threshold. CONCLUSIONS: The findings of the present study suggest that the DUAMMT is a valid and reliable instrument to measure drug users' attitudes toward methadone maintenance treatment. The DUAMMT can be applied at the start of treatment so that clinical intervention can be targeted to promote retention in treatment.

The Impact of Educational Intervention Based on Pender's Health Promotion Model on Healthy Lifestyle in Women of Reproductive Age in Iran.

Background: Lifestyle is one of the most important factors affecting women's health. Women's quality of life and health depends on their health-promoting behaviors and lifestyles. The aim of this study was to determine the impact of an educational intervention based on Pender model on healthy lifestyle in women of reproductive age in Iran. Methods: This randomized controlled trial study was carried out in women of reproductive age in Iran, from August to December 2019. The samples were divided into experimental (n = 120) and control (n = 120) groups. 6 training sessions were provided for the experimental group. The questionnaire consisted of several items including socio-demographic characteristics, health-promoting lifestyle profile-II (HPLP-II), self-efficacy, social support and constructs of Pender's health promotion model. SPSS-18 software has been applied for statistical analysis. Results: The mean age of the experimental group was 31.88±7.624 years and for the control group was 30.33±6.89 years. There was no statistically significant relationship between demographic variables such as marital status, education, employment status, age and body mass index with lifestyle in women. Lifestyle in women had a statistically significant relationship with the structure prior health-related behavior (p < 0.001). The score of women in structures of prior health-related behavior, perceived benefits, commitment to action, and social support increased after educational intervention (p < 0.001). Conclusion: Findings showed that educational intervention based on Pender health promotion model has increased the score of healthy lifestyle in women. Therefore, planning and performing educational interventions to improve health promotion behaviors based on this model is essential.

The effect of educational intervention on nutritional behavior in pregnant women based on social cognitive theory.

BACKGROUND: One of the key issues for women's health is pregnancy. Healthy nutrition during pregnancy is a reliable guarantee for proper pregnancy and childbirth. This study sought to determine the impact of an educational intervention based on social cognitive theory on the nutritional behavior of pregnant women in Iran. METHODS: This randomized controlled trial study was carried out in women of reproductive age in Iran, from February to April 2020. The samples were divided into experimental (n = 150) and control (n = 150) groups. The questionnaire included demographic questions, questions related to the structures of social cognitive theory and nutritional behavior questionnaire. The data were analyzed through the SPSS20 and AMOS23 software. RESULTS: The mean age of the women was 28.11 ± 6.54 and 28.83 ± 6.62 years in the intervention and control groups, respectively. The results of the Structural Equation Model showed that direct effect of self-efficacy, self-regulation, and mutual determinants on behavior were significant. After the educational intervention, nutritional behavior in the experimental group was increased significantly. Also, there was a significant difference between two groups in structures such as outcome expectations, outcome value, self-efficacy and knowledge. But there was no significant increase in the self-regulation and social support after educational intervention. CONCLUSION: Social cognitive theory as a theoretical framework is able to predict healthy eating behavior during pregnancy. Also educational intervention based on the structures of social cognitive theory, improved the behavior of pregnant mothers. Educational intervention based on social cognitive theory and providing simple and understandable training packages for pregnant women is recommended.

Factors Influencing Health Promoting Behaviours in Women of Reproductive Age in Iran: Based on Pender's Health Promotion Model.

INTRODUCTION: Health promotion behaviours are considered as preventives of non-communicable diseases and key determinants of maintaining and improving the health status. AIM: This study aimed to investigate and identify effective factors on health-promoting behaviours based on Pender model in women of reproductive age from February to April 2017, in Savojbolagh, Iran. METHODS: This cross-sectional study is conducted on 240 women aged between 15 to 49 years in Savojbolagh, Iran, in 2017. The questionnaire consisted of several items, including socio-demographic characteristics, health-promoting lifestyle profile-II (HPLP-II), self-efficacy, social support and constructs of Pender's health promotion model. SPSS-18 software has been applied for statistical analysis. RESULTS: The mean age of the women was 31.10 ± 7.29 years. Total HPLP-II score was 106.64 ± 11.93. The highest and the lowest mean in the subscales were belonged to nutrition and physical activity, respectively. According to the bivariate analysis, the total HPLP-II score is significantly related to prior health-related behaviour (p = 0.000). There was a statistically significant relationship between stress management and the variables including perceived benefits, perceived barriers, prior health-related behaviour, situational influences, commitment to a plan of action (p < 0.05). Also, health responsibility had a statistically significant relationship with self-efficacy (p < 0.05). CONCLUSION: According to our results, it can be inferred that there is a problem with the HPBs of women. Considering that health-promoting behaviours like physical activity had a low score, it is a necessity to plan and perform interventions for improving health promotion behaviours.

The Effect of Educational Intervention based on BASNEF Model on Decreasing the Cesarean Section Rate among Pregnant Women in Khomain Country.

OBJECTIVE: Over the past two decades, the incidence of cesarean section in most countries has increased. Cesarean section increases the risk of death and complications in the mother and fetus. Educational interventions based on behavior change models can play an important role in reduce the rate of cesarean section. The aim of our study is investigation the effect of educational intervention based on BASNEF Model on decreasing of cesarean section rate among pregnant women in Khomain County, from June to November 2013. MATERIALS AND METHODS: In this interventional study, 140 nulliparous women who were in their last trimester of pregnancy were randomly allocated to case and control groups. Data gathering instrument was a questionnaire based on BASNEF framework. Data were analyzed by SPSS 14 software. RESULTS: The scores of knowledge, attitudes, subjective norms, and enabling factors in the intervention group than the control group showed a significant difference (p < 0.001). After the study, it was found that 18 women (25.7%) in case group and 42 women (60%) in the control group underwent cesarean section. By Chi-square test showed that the difference in the type of delivery between the two groups was statistically significant (p < 0.001). CONCLUSION: Design and implement curriculum based on BASNEF can be effective in reducing elective cesarean section.