BackgroundAlthough most of maternal deaths are preventable, maternal mortality reduction programs have not been completely successful. As targeting individuals alone does not seem to be an effective strategy to reduce maternal mortality (Millennium Development Goal 5), the present study sought to reveal the role of many distant macrostructural factors affecting maternal mortality at the global level.MethodsAfter preparing a global dataset, 439 indicators were selected from nearly 1800 indicators based on their relevance and the application of proper inclusion and exclusion criteria. Then Pearson correlation coefficients were computed to assess the relationship between these indicators and maternal mortality. Only indicators with statistically significant correlation more than 0.2, and missing values less than 20% were maintained. Due to the high multicollinearity among the remaining indicators, after missing values analysis and imputation, factor analysis was performed with principal component analysis as the method of extraction. Ten factors were finally extracted and entered into a multiple regression analysis.ResultsThe findings of this study not only consolidated the results of earlier studies about maternal mortality, but also added new evidence. Education (std. B = −0.442), private sector and trade (std. B = −0.316), and governance (std. B = −0.280) were found to be the most important macrostructural factors associated with maternal mortality. Employment and labor structure, economic policy and debt, agriculture and food production, private sector infrastructure investment, and health finance were also some other critical factors. These distal factors explained about 65% of the variability in maternal mortality between different countries.ConclusionDecreasing maternal mortality requires dealing with various factors other than individual determinants including political will, reallocation of national resources (especially health resources) in the governmental sector, education, attention to the expansion of the private sector trade and improving spectrums of governance. In other words, sustainable reduction in maternal mortality (as a development indicator) will depend on long-term planning for multi-faceted development. Moreover, trade, debt, political stability, and strength of legal rights can be affected by elements outside the borders of countries and global determinants. These findings are believed to be beneficial for sustainable development in Post-2015 Development Agenda.Electronic supplementary materialThe online version of this article (doi:10.1186/s12992-015-0087-y) contains supplementary material, which is available to authorized users.
Objectives This study aims to determine the effectiveness of the Reitman Centre CARERS program on key outcomes in family caregivers (CGs) of people with dementia (PWD). The Reitman Centre CARERS program is an innovative, group psychotherapeutic skills‐training intervention based on integrated problem solving techniques (PST), simulation learning and group psychotherapy designed to address each CGs' unique situation. Method Family CGs of PWD (n = 264) that were referred to Reitman Center and the partner sites were evaluated before and after completion of the 8‐week CARERS program in comparison with a wait‐list control group (n = 83) who received regular care in a quasi‐experimental, non‐randomized, multiple group, multisite trial. General linear model was used to compare the results after adjusting for baseline measures and changes in the care recipients' daily activities (Katz Index of Independence in Activities of Daily Living). Results The results indicated the effectiveness and superiority of the CARERS program over usual care on measures of CG's perceived stress, depression, burden, competence, role overload, emotion and avoidance‐focused coping. Conclusion The CARERS program as a multi‐component intervention is an effective intervention that significantly improves functioning, coping skills and well‐being of dementia CGs.
Background:In different studies, the prevalence of tobacco consumption has been growing in high schools boys.Objectives:This study was conducted to determine the prevalence of smoking and its related factors among Iranian high school students in 2011.Materials and Methods:In this cross-sectional study, 450 male students from 15 high schools of Shahroud (northeast of Iran) were selected for evaluation of the knowledge, attitude and practices (KAP) of students regarding tobacco consumption. Results:Overall, 51% (95% CI: 46.5 - 55.7) of the students had positive history of smoking for at least one time and 7.1% (95% CI: 5 - 10) of them were current smokers. The most prevalent source of information about smoking was TV and radio programs (48%) and friends were the second source (22%). Based on the students’ opinions, entertainment and smoker friends were the most important reasons for smoking tendency. There was significant statistical association between students smoking and positive family history of smoking (P value < 0.05).Conclusions:The prevalence of smoking experince was very high among high school students. The most prevalent source of information about smoking was Iranian broadcasting companies. Positive family history of smoking and smoker friends were the important motivating factors toward smoking.
Objectives: While family caregivers (CGs) of persons with dementia are cost-effective for the health system, this form of caregiving leads to disproportionate vulnerability to physical, mental, and social adverse health consequences among CGs. The study goal was to determine the effect of the Reitman Centre CARERS program on key outcomes in family CGs of people with dementia. The Reitman Centre CARERS program is an innovative, group psychotherapeutic skills training intervention based on integrated problem-solving techniques (PST), simulation learning, and group psychotherapy designed to address each CGs’ unique situation. Design: A quasi-experimental, non-randomized, pre–post evaluation, multiple groups, multisite trial. Setting: Multisite group intervention provided in community agencies and hospital-based locations. Participants: Spousal or adult child family CGs (n = 264) living in the community and providing care to community-dwelling family members with dementia. Measurement: CGs were assessed for depression (CES-D); stress (PSS); burden (12-item SZBI); role overload, mastery, caregiving competence, and role captivity (Perlin scales), coping (CISS – Coping Inventory for Stressful Situations), CG reactions to CR’s memory and behavioral symptoms (RMBPC). Care recipients (CRs) were assessed on basic and complex activities of daily living (Katz and Lawton). Paired t-tests and Wilcoxon signed-rank test were used for statistical analysis of both the whole group and a more compromised subgroup of CGs. Results: For the group as a whole, CGs showed significant positive change on post-intervention outcome measures of stress, depression, burden, competence, role captivity, overload, mastery, coping, and reaction to memory issues. The intervention showed especially robust effect sizes (ES) in more compromised CGs. These positive outcomes emerged despite a significant measured deterioration in CRs’ function. Conclusion: The CARERS program may be an effective multicomponent intervention to improve the well-being, functioning, and coping skills of dementia CGs.
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