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.     

Relationship of physical distress to dizziness in patients with fibromyalgia

Conclusions: The feelings of dizziness and unsteadiness of the patients with fibromyalgia supposed specifically amplified by the hypersensitivity mechanism of CSS (central sensitivity syndrome) of them. The severity of subjective pain and physical distress according to the questionnaires were not correlated with the objective body sway on the stabilometer. Objectives: Fibromyalgia manifests primarily as chronic pain of the entire body, but is also often associated with a variety of physical symptoms including dizziness and unsteadiness. This study assessed whether objective measures of body sway and unsteadiness of them are associated with their subjective dizziness findings. Method: Subjects were 24 patients diagnosed with fibromyalgia, but one patient who had the past history of sudden deafness was excluded. The 23 patients were assessed by a stabilometer as the objective measures of body sway, and JFIQ (Japanese version of the fibromyalgia impact questionnaire), DHI (dizziness handicap inventory) and ABC (activities-specific balance confidence) as the subjective questionnaires. Results: The significant correlations were shown between the scores of JFIQ and DHI, JFIQ and ABC, and DHI and ABC. Then, the body sway index of stabilometer environmental area was significantly correlated with DHI score. However, the stabilometer index was not correlated neither with JFIQ or ABC.     

Do parents prefer inactivated or live attenuated influenza vaccine for their children?

ObjectivesTo determine the proportion of children whose parents prefer them to receive live, attenuated influenza vaccine (LAIV) or inactivated influenza vaccine (IIV), examine reasons for preferences, and determine what percentage of vaccinated children receive other than the preferred type of vaccine and why.MethodsParental-reported data for the 2014–15 and 2015–16 influenza seasons from the National Immunization Survey-Flu (NIS-Flu), a random-digit-dialed, dual frame (landline and cellular telephone) survey of households with children, were analyzed. We calculated the proportions of vaccinated children aged 2–17 years whose parents preferred LAIV, IIV, or had no preference, and the proportions that were vaccinated with other than the preferred type of vaccine.ResultsFor the 2014–15 and 2015–16 seasons, 55.2% and 53.7%, respectively, of vaccinated children had parents who reported no preference for either IIV or LAIV. The percentage who preferred LAIV was 22.7% and 21.7%, and IIV was 22.1% and 24.7%. The most common reason given by parents for preferring LAIV was the child’s fear of needles (70.9%) and for preferring IIV was belief that the shot is more effective (29.0%). Approximately one-third of vaccinated children whose parents preferred LAIV received IIV only.ConclusionsThe main finding of this study was that most parents do not have a vaccine type preference for their children. The lack of overwhelming preference is advantageous for the maintenance of vaccination coverage levels during times when one vaccine type is not available or not recommended such as in the 2016–17 and 2017–18 seasons when there was a temporary recommendation not to administer LAIV.     

Perceptions and acceptability of piloted Taenia solium control and elimination interventions in two endemic communities in eastern Zambia

Infections with Taenia solium cause significant public health and economic losses worldwide. Despite effective control tools, long‐term sustained control/elimination of the parasite has not been demonstrated to date. Success of intervention programs is dependent on their acceptability to local communities. Focus group discussions (FGDs) and questionnaires (QS) were conducted in two study communities in eastern Zambia to assess local perceptions and acceptance of two piloted intervention strategies: one targeting pigs only (‘control’ study arm), and one integrated human‐ and pig‐based (‘elimination’) strategy. QS (n = 227) captured data regarding participation in project activities, knowledge and perceptions of T. solium and of the interventional drugs used in the study. FGDs (n = 18) discussed perceived advantages and disadvantages of the interventions and of the project's delivery and value. QS data revealed 67% of respondents participated in at least one educational activity, and 80% correctly identified at least one disease targeted by the education. All elimination study arm respondents (n = 113) had taken the human treatment, and 98% intended to do so next time. Most (70%) indicated willingness to pay for future treatments (median 0.20 USD per dose). Of pig‐owning respondents, 11/12 (92%) had allowed their pigs to be treated/vaccinated and all intended to do so again next time. Four pig owners indicated willingness to pay 0.10–0.50 USD per dose of treatment or vaccine. FGD feedback revealed positive perceptions of interventions; people reported improved health in themselves and their pigs, and fewer cysticerci in pork. Latrine use, hand washing, meat inspection and proper cooking of pork had reportedly increased since the program's inception. Preliminary assessment indicates that the piloted intervention methods are generally acceptable to the communities. The reported willingness of many respondents to pay for the medications would contribute to the feasibility of long‐term, government‐led T. solium intervention programs in future.     

Validation of the German version of the ‘Hypogonadism Related Symptom Scale’ (HRS) in andrological patients with infertility,HIV infection and metabolic syndrome

As commonly used self‐reported screening instruments for male hypogonadism demonstrated lack of specificity, a Hypogonadism Related Symptom Scale (HRS) was developed in 2009 as a novel self‐rating screening tool. As the questionnaire has not been validated, the purpose of our study was to perform a validation in patients presenting with different disorders (e.g. infertility, HIV infection or metabolic syndrome) and disease‐related risk to develop hypogonadism. Two hundred and eighteen patients aged 19–71 years (40.1 ± 9.5) who completed the HRS and other common questionnaires [International Index Of Erectile Function (IIEF), National Institutes of Health Chronic Prostatitis Symptom Index (NIH‐CPSI), Hospital Anxiety and Depression Scale (HADS), short form (SF)‐12] were included. In all patients, blood levels of total testosterone, luteinizing hormone, follicle‐stimulating hormone, oestradiol and sex hormone‐binding globulin were determined and free testosterone was calculated. Cronbach's α for the scale was 0.896, split‐half 0.871 for the 1st half and 0.807 for the 2nd half. Spearman–Brown coefficient was 0.767, and Guttman split‐half coefficient was 0.759. Consistent correlations were found between HRS and IIEF5 (ρ = 0.57, P < 0.001), and HADS (ρ = ?0.6, P < 0.001). In addition, HRS was significantly correlated with total testosterone (ρ = 0.135, P < 0.05), free testosterone (ρ = 0.148, P < 0.05) and oestradiol (ρ = ?0.134, P < 0.05). Our validation study confirms the data from the initial development of the HRS questionnaire. Clinicians might have an additional advantage from the HRS when investigating males with suspected hypogonadism.     

Predictive validity of the Short Functional Geriatric Evaluation for mortality,hospitalization and institutionalization in older adults: A retrospective cohort survey

ObjectivesBio-psycho-social frailty is related to increased risk of death and utilization of health services. This paper reports the predictive validity of a 10-min multidimensional questionnaire on the risk of death, hospitalization and institutionalization.MethodsA retrospective cohort study was performed based on data from the “Long Live the Elderly!” program, involving 8,561 community-dwelling Italian people >75, followed for an average of 516.6 days (Median = 448, P₂₅–P₇₅: 309–692). Mortality, hospitalization, and institutionalization rates according to frailty levels assessed by the Short Functional Geriatric Evaluation (SFGE) have been calculated.ResultsCompared with the robust, the pre-frail, frail, and very frail faced a statistically significant increase in the risk of mortality (RR = 1.40, 2.78 and 5.41), hospitalization (OR = 1.31, 1.67, and 2.08) and institutionalization (OR = 3.63, 9.52, and 10.62). Similar results were obtained in the sub-sample of those with only socio-economic issues. Frailty predicted mortality with an area under the ROC curve of 0.70 (95% CI 0.68–0.72) with sensitivity and specificity of 83.2% and 40.4%. Analyses of single determinants of these negative outcomes showed a multivariable pattern of determinants for all the events.ConclusionsThe SFGE predicts death, hospitalization and institutionalization by stratifying older people according to the levels of frailty. The short administration time, the socio-economic variables and the characteristics of personnel administering the questionnaire make it suitable for being used in public health as a screening tool for a large population, to put frailty at the core of the care for community-dwelling older adults. The difficulty in capturing the complexity of the frailty is witnessed by the moderate sensitivity and specificity of the questionnaire.     

Evaluation of Web-Based,Self-Administered,Graphical Food Frequency Questionnaire

Computer-administered food frequency questionnaires (FFQs) can address limitations inherent in paper questionnaires by allowing very complex skip patterns, portion size estimation based on food pictures, and real-time error checking. We evaluated a web-based FFQ, the Graphical Food Frequency System (GraFFS). Participants completed the GraFFS, six telephone-administered 24-hour dietary recalls over the next 12 weeks, followed by a second GraFFS. Participants were 40 men and 34 women, aged 18 to 69 years, living in the Columbus, OH, area. Intakes of energy, macronutrients, and 17 micronutrients/food components were estimated from the GraFFS and the mean of all recalls. Bias (second GraFFS minus recalls) was −9%, −5%, +4%, and −4% for energy and percentages of energy from fat, carbohydrate, and protein, respectively. De-attenuated, energy-adjusted correlations (intermethod reliability) between the recalls and the second GraFFS for fat, carbohydrate, protein, and alcohol were 0.82, 0.79, 0.67, and 0.90, respectively; for micronutrients/food components the median was 0.61 and ranged from 0.40 for zinc to 0.92 for beta carotene. The correlations between the two administrations of the GraFFS (test–retest reliability) for fat, carbohydrate, protein, and alcohol were 0.60, 0.63, 0.73, and 0.87, respectively; among micronutrients/food components the median was 0.67 and ranged from 0.49 for vitamin B-12 to 0.82 for fiber. The measurement characteristics of the GraFFS were at least as good as those reported for most paper FFQs, and its high intermethod reliability suggests that further development of computer-administered FFQs is warranted.