Designing and evaluating the children's developmental motor disorders system: an experience from a developing country.

BACKGROUND: Developmental disorders are a prevalent problem in the health sector of low- and middle-income countries (LMICs), and children in these countries are at greater risk. A registry system is helpful and vital to monitoring and managing this disease. OBJECTIVE: The present study aims to develop an electronic registry system for children's developmental motor disorders. METHODS: The study was conducted between 2019 and 2020 in three phases. First, the requirements of the system were identified. Second, UML diagrams were first drawn using Microsoft Visio software. Then, the system was designed using the ASP.NET framework in Visual Studio 2018, and the C# programming language was used in the NET 4.5 technology platform. In the third phase, system usability was evaluated from the users' viewpoint. RESULTS: The findings of this research included system requirements, a conceptual model, and a web-based system. The client and system server connection was established through the IP/TCP communication protocol in a university physical network. End users approved the system with an agreement rate of 87.14%. CONCLUSION: The study's results can be used as a model for designing and developing systems related to children's developmental movement disorders in other countries. It is also suggested as a valuable platform for research and improving the management of this disease.

Evaluation of anthropometric indices and their relationship with maternal nutritional literacy and selected socio-economic and demographic variables among children under 5 years old.

BACKGROUND: Considering the destructive effects of malnutrition on the growth, development, and health of children and the importance of identifying the factors affecting it, the present study aimed to investigate the status of anthropometric indices and their relationship with maternal nutritional literacy and selected socio-economic and demographic variables among children under 5 years old. METHODS: This cross-sectional study was conducted on 405 mothers with children under 5 years old in Urmia, Iran. The data collection tool consisted of two parts. The first part was the demographic and socio-economic information of mother and child and the second part was the Evaluation Instrument of Nutrition Literacy on Adults; EINLA. RESULTS: There was statistically significant relationship between maternal nutritional literacy with weight-for-age, height-for-age, and weight-for-height indices; between weight-for-age index with maternal education, gestational weight gain, and mean weight, as well as mean height of the mother; between weight-for-age and weight-for-height indices with child gender, type of milk consumed, status of starting complementary foods, and history of acute respiratory infection, as well as diarrhea; and finally between height-for-age with family income status. CONCLUSIONS: It is suggested that mothers with low nutritional literacy, mothers whose gestational weight gain was not normal, children whose family income is low, boy child, children with a history of disease, children who consume powdered milk and children who have not started complementary foods at the right time be given priority when designing and implementing educational interventions to enhance nutritional status and anthropometric indices of children.

Incidence of household catastrophic and impoverishing health expenditures among patients with Breast Cancer in Iran.

BACKGROUND: Breast cancer disease is the most common cancer among Iranian women and imposing a significant financial burden on the households. This study calculated out-of-pocket (OOP), catastrophic health expenditure (CHE), and impoverishing health spending attributed to breast cancer in Iran. METHODS: In this cross-sectional household study, clinical and financial information on breast cancer and also household information (expenditures and income) were obtained through face-to-face interviews and completing a questionnaire by 138 women with this disease in 2019. We applied three non-food expenditure thresholds of 40, 20, and 10% to defining the CHE. Disease costs included periodical visits, diagnostic services, hospitalization care, treatment and rehabilitation services, home, and informal care. Households were disaggregated into socioeconomic status quintiles based on their Adult Equivalent values standardized monthly consumption expenditures. To identify the factors affecting these indicators, we performed the two different multivariate logistic regression models. RESULTS: This study finds that each patient had a monthly average OOP payment of $US 97.87 for the requested services, leading to impoverished of 5.07% and exposed 13.77% of their households to CHE. These indicators have been mainly concentrated among the poor, as they have spent a large part of their meager income on buying the needed services, and for this purpose, most of them forced to sell their assets, borrow, or take a bank loan. CONCLUSIONS: The patients in lower SES quintiles can be protected from impoverishing and catastrophic health spending by expanding insurance coverage, providing financial risk protection programs, and increasing access to quality and effective public sector services. Alongside, expanding inpatient coverage and adding drug benefits for the poor can significantly decrease their OOP payments.

Knowledge, attitude, and practice toward Zika virus among staff of comprehensive health services centers affiliated with Tehran University of Medical Sciences in 2020.

AIM: Assessment of knowledge, attitude, and practice of healthcare providers regarding Zika virus, provides information on their ability to prevent its transmission, and emphasizes the necessity of implementing educational programs if their knowledge, attitude, and practice are low. Therefore, the present study aimed to investigate the knowledge, attitude, and practice of the staff of comprehensive health services centers affiliated with Tehran University of Medical Sciences regarding Zika Virus. METHODS: This cross-sectional study was conducted on 354 staffs of comprehensive health service centers. The researcher-made questionnaire consisted of two sections. The first section of the questionnaire was about demographic and professional characteristics of the participants and the second section was assessment of knowledge, attitude, and practice regarding Zika virus. Data analysis was performed by SPSS 16 software using descriptive and analytical statistics. RESULTS: In this study, 70.9% of the participants had poor knowledge, 24.1% had moderate knowledge, and only 5% had good knowledge about Zika virus. Regarding attitude, 10.6% of the participants had negative attitude, 45.9% had neutral attitude, and 43.5% had positive attitude toward Zika virus. Moreover, 40.6% of the participants had poor practice, 24.7% had moderate practice, and 34.7% had good practice in Zika virus. CONCLUSION: The knowledge level in participants about Zika virus was unacceptable and their attitude and practice level was relatively acceptable. Therefore, it is necessary to design and implement educational interventions aimed at promoting knowledge, attitude, and practice of the staff of comprehensive health services centers regarding Zika Virus.

Determinants of Iran's BilateralIntra-industry Trade in Pharmaceutical Industry.

Among non-oil and in trade arena, drug has always been strategic importance and most government especially industrialized countries pay special attention to its production and trade issues. Thus, having a comprehensive view from economic perspective to this section is essential for suggesting intervention. This was a descriptive-analytical and panel study. In this study, gravity model is used to estimate Iran's bilateral intra-industry trade in pharmaceutical products in the 2001-2012 periods. To illustrate the extent of pharmaceutical's intra-industry trade between Iran and its major trading partners, the explanatory variables of market size, income, factor endowments, distance, cultural contributions, and similarities and also special trade arrangements have been applied. Analysis of factors affecting Iran's bilateral intra-industry trade in pharmaceutical industry showed that the average GDP and cultural similarities had a significant positive impact on Iran's bilateral IIT, while the difference in GDP has a negative and significant effect. Coefficients obtained for the geographical distance and the average ratio of total capital to the labor force is not consistent with theoretical expectations. Special trade arrangements did not have significant impact on the extent of bilateral intra-industry trade between Iran and its trading partners. The knowledge of the intra-industry trade between Iran and its trade partners make integration between the countries. Factors affecting this type of trade pattern underlie its development in trade relationship. Therefore, the findings of this study would be useful in helping to develop and implement policies for the expansion of the pharmaceutical trade.

Cause-specific mortality among women of reproductive age: Results from a population-based study in an Iranian community.

PURPOSE OF STUDY: This study was conducted to evaluate the levels, patterns, and causes of mortality among women of reproductive age in Northwestern Iran. METHODS: Deaths were determined for females resident in West Azerbaijan Province of Iran and who died between March 2013 to February 2014 using reproductive age mortality survey (RAMOS). Causes of death were ascertained by verbal autopsy (VA) and classified based on the International Classification of Diseases, tenth revision (ICD-10). Overall and cause-specific mortality rates (MRs) per 100,000 women with 95% confidence intervals were calculated. RESULTS: A total of 510 deaths were detected, and VA interviews were conducted with the relatives of the deceased Cases; overall MR was 56.59 per 100,000 women (95% CI: 56.49-56.69). The highest MR was observed in suicide cases (MR=10.21per 100,000women, 95% CI: 10.15-10.27), accounting for 18% of all deaths. The most common method of suicide was self-inflicted burns (45.6%), followed by deaths due to breast cancer (MR=4.22per 100,000women, 95% CI: 4.18-4.26), which accounted for the most cancer-related mortality. All-cause mortality was associated with age, area of residence, marital status, level of education, and ethnic (religious) status relationship (P<0.001). CONCLUSION: Suicide, especially self-immolation, was the main cause of death among women of reproductive age, and both suicides and breast cancer are major public health problems for this group of women.

Comparing clinical outcomes for a twelve-month trial of zotarolimus- and everolimus-eluting stents in patients with coronary artery disease: data from the THCRIC registry.

OBJECTIVES: New-generation coronary stents including zotarolimus- and everolimus-eluting stents (ZES and EES) have been shown to decrease the risk of restenosis. The purpose of this study was to compare the safety and efficacy of ZES and EES over a 12-month clinical follow up, in routine clinical practice. METHODS: This is an observational study in which 1029 consecutive patients treated with ZES (n = 669) or EES (n = 360) were enrolled. The study endpoint was major adverse cardiac events (MACE), defined as cardiac death, nonfatal myocardial infarction (MI), and target lesion or vessel revascularization at 12 months. RESULTS: Follow up was completed among 94.9% of the patients. The overall MACE occurred in 4 (0.6%) and 7 (2.0%) patients in the ZES and EES group, respectively. The occurrence of other cardiac events including nonfatal MI and target vessel or lesion revascularization was 1 (0.2%) versus 1 (0.3%) and 7 (1.1%) versus 5 (1.4%), respectively, in the ZES and EES groups of patients. Despite a slightly lower rate of MACE and cardiac death in the ZES group, the difference between these two groups was not significant (n = 0.064 for overall MACE, p = 0.129 for cardiac mortality, n = 0.999 for nonfatal MI, n = 0.468 for target vessel and n = 0.999 for target lesion revascularization). CONCLUSIONS: According to our results, it could be concluded that the difference in the rate of MACE between the ZES and EES groups was not statistically significant at 12-month follow up.

Novel restricted access to vasectomy in Iran: addressing changing trends in vasectomy clients' characteristics over 16 years in northwestern Iran.

OBJECTIVES: This study is designed to evaluate the popularity of vasectomy in Iran. The study was conducted to calculate the frequency of vasectomy over time, to compare vasectomy users' characteristics with the general population and whether these characteristics have changed over time. STUDY DESIGN: A cross-sectional study of 7864 men undergoing vasectomy in a 16-year period was conducted in Urmia, Iran. Comparative statistics described differences between vasectomy users and nonusers. The data were analyzed separately in two 8-year periods, 1996-2003 and 2004-2011. The time period did not involve 2012, the year which vasectomy became outlawed in the whole country. RESULTS: During the study period, the contraceptive prevalence rate of vasectomy increased from 0.1% to 3.35%. Vasectomy users were predominantly older, better educated, had more children and more urban residents than the general male population (p<0.001). Over time, men who underwent vasectomy tended to be younger, have well-educated wife and rural resident (p<0.05). CONCLUSIONS: This study highlighted a dramatic rise in the use of vasectomy between 1996 and 2011 in Iran. While the characteristics of vasectomy users versus general population were different, especially in age, education, resident area, number and sex of their children, there were significant changes from two 8-year study time periods.

Premenstrual syndrome and quality of life in Iranian medical students.

PURPOSE OF STUDY: The purpose of this research was to investigate the prevalence of premenstrual syndrome (PMS) in medical students and to evaluate the hypothesis that PMS may result in a decrease in quality of life. METHODS: In a cross-sectional study, 142 female medical students who study at Urmia University of Medical Sciences were included. The data were compiled using a PMS questionnaire based on the fourth version (DSM-IV) criteria, the questionnaire of "Premenstrual Syndrome Scale" as well as the "World Health Organization's Quality of Life (WHOQOL-BREF)" questionnaire. FINDINGS: In total, 56 out of 142 (39.4%) female medical students met the DSM-IV criteria for PMS. In the PMS group, more than half of the girls, i.e. 60.6% had mild, 25.1% had moderate and 14.2% had severe PMS. PMS was found to be significantly high in students who have positive history of PMS in their first degree relatives and who have used drugs to relieve PMS symptoms (P<0.05). Life quality score was low in more than half of the medical students, especially in psychological and social components (P>0.05). However, the quality of life score means in mental health (P=0.02) and environmental health (P=0.002) decreases as the PMS score average increases. CONCLUSION: The results of premenstrual syndrome prevalence and their severity suggest that PMS is common in medical students and this adversely affects some domains of the quality of life. Improving the life quality of female medical students needs some interventions related to the PMS and also other interventions not related to PMS.

Intimate partner violence during pregnancy in Urmia, Iran in 2012.

BACKGROUND: In spite of enough prevalence data on Intimate Partner Violence (IPV) during pregnancy from many countries, there are still some regions such as the Middle East with relatively limited data. The purpose of research was to investigate the magnitude of IPV during pregnancy in an Iranian community. METHODS: Thirty hundred fifty women during their postpartum period were invited to participate in a cross-sectional population-based study, but 10.6% of them refused participation. The data was compiled using the Abuse Assessment Screen questionnaire. RESULTS: Of the 313 women, 55.9% reported violence during pregnancy. All types of violence were detected in victims during pregnancy, including psychological violence (43.5%), physical violence (10.2%), and sexual violence (17.2%). Intimate partner violence during pregnancy was significantly associated with lower education of the husbands (PR 1.64; 95% CI 1.15-2.36), un-employment of the husbands (PR 1.36; 95% CI 1.12-1.64), marriage duration of 5-9 years (PR 0.95; 95% CI 0.74-1.20) and gravidity of two (PR 0.80; 95% CI 0.59-1.08). CONCLUSION: The reported prevalence of IPV before and during pregnancy in this sample is substantially higher than estimates of exposure to violence in other parts of the globe, even the East Mediterranean region which has the highest prevalence estimation in the globe.

Impact of the World Health Organization's Decision-Making Tool for Family Planning Clients and Providers on the quality of family planning services in Iran.

OBJECTIVE: We investigated whether use of the World Health Organization's (WHO's) Decision-Making Tool (DMT) for Family Planning Clients and Providers would improve the process and outcome quality indicators of family planning (FP) services in Iran. METHODS: The DMT was adapted for the Iranian setting. The study evaluated 24 FP quality key indicators grouped into two main areas, namely process and outcome. The tool was implemented in 52 urban and rural public health facilities in four selected and representative provinces of Iran. A pre-post methodology was undertaken to examine whether use of the tool improved the quality of FP services and client satisfaction with the services. Quantitative data were collected through observations of counselling and exit interviews with clients using structured questionnaires. RESULTS: Different numbers of FP clients were recruited during the baseline and the post-intervention rounds (n=448 vs 547, respectively). The DMT improved many client-provider interaction indicators, including verbal and non-verbal communication (p<0.05). The tool also impacted positively on the client's choice of contraceptive method, providers' technical competence, and quality of information provided to clients (p<0.05). Use of the tool improved the clients' satisfaction with FP services (from 72% to 99%; p<0.05). CONCLUSIONS: The adapted WHO's DMT has the potential to improve the quality of FP services.

Persistence of Hemorrhage and Hypertensive Disorders of Pregnancy (HDP) as the Main Causes of Maternal Mortality: Emergence of Medical Errors in Iranian Healthcare System.

BACKGROUND: This study aimed to assess factors affecting substandard care and probable medical errors associated with obstetric hemorrhage and HDP at a Northwestern Iranian health care system. METHODS: In a community-based descriptive cross-sectional study, data on all maternal deaths occurred at West Azerbaijan Province, Iran during a period of 10 years from March 21, 2002 to March 20, 2011 was analyzed. The principal cause of death, main contributory factors, nature of care, main responsible staff for sub-standard care and medical error were determined. The data on maternal deaths was obtained from the national Maternal Mortality Surveillance System (MMSS) which were covered all maternal deaths. The "Three delays model" was used to recognize contributing factors of maternal deaths due to obstetric hemorrhage and HDP. RESULTS: There were 183 maternal deaths, therefore the Mean Maternal Mortality Ratio (MMR) in the province was 32.8 per 100 000 live births (95% CI, 32.64-32.88). The most common causes of maternal deaths were obstetric hemorrhage in 36.6% of cases and HDP in 25.7%. The factors that most contributed to the deaths were all types of medical errors and substandard care with different proportions in management of obstetric hemorrhage and HDP. CONCLUSION: A substandard care and medical error was the major contributing factor in both obstetric hemorrhage and HDP leading to maternal mortality, therefore, it is necessary to improve the quality of health care at all levels especially hospitals.