Risk factors for postpartum readmission: a prediction model in Iranian pregnant women.

BACKGROUND: Postpartum readmissions (PPRs) are an important indicator of maternal postpartum complications and the quality of medical services and are important for reducing medical costs. The present study aimed to investigate the risk factors affecting readmission after delivery in Imam Ali Hospital in Amol, Iran. METHODS: This retrospective cohort study was conducted on the mothers who were readmitted after delivery within 30 days, at Imam Ali Hospital (2019-2023). The demographic and obstetrics characteristics were identified through the registry system. Univariate and multivariate logistic regressions with odds ratios (ORs) and 95% CIs were carried out. To identify the most important variables by machine learning methods, a random forest model was used. The data were analyzed using SPSS 22 software and R (4.1.3) at a significant level of 0.05. RESULTS: Among 13,983 deliveries 164 (1.2%) had readmission after delivery. The most prevalent cause of readmission after delivery was infection (59.7%). The chance of readmission for women who underwent elective cesarean section and women who experienced labor pain onset by induction of labor was twice and 1.5 times greater than that among women who experienced spontaneous labor pain, respectively. Women with pregnancy complications had more than 2 times the chance of readmission. Cesarean section increased the chance of readmission by 2.69 times compared to normal vaginal delivery. CONCLUSION: The method of labor pain onset, mode of delivery, and complications during pregnancy were the most important factors related to readmission after childbirth.

Nurses' experiences of the social stigma caused by the COVID-19 pandemic: a qualitative study.

Background: One of the psychological issues that health personnel face when treating COVID-19 patients is the societal stigma. This issue has not been addressed due to the disease's devastating impact on numerous sectors of society. This study aimed to evaluate nurses' experiences of social stigma caused by the COVID-19 pandemic with a qualitative approach. Methods: Inductive qualitative content analysis was used to conduct this qualitative research. COVID ward nurses who had been subjected to social stigma were chosen as the study sample. Data were collected through semi-structured and individual interviews and were concurrently analysed using the conventional content analysis approach recommended by Graneheim and Lundman. Results: There are three categories and six sub-categories of social stigma experienced by nurses: (1) paradoxical emotions (psychological stress and positive attitude), (2) abandonment (all-round rejection and isolation) and (3) coping strategies (self-awareness over time and the influential role of the media). Conclusions: The findings of this study can help healthcare managers to improve the quality of care by enhancing understanding of the psychological needs arising from social stigma. Based on these findings, designing psychosocial interventions related to stigma can promote the mental health of this group and their families.

Anxiety, Depression, and Predictors amongst Iranian Students Aged 8 to 18 Years during the COVID-19 Outbreak First Peak.

Objective: This study aimed to assess anxiety and depression during the COVID-19 outbreak among students aged 8 to 18 years and to determine related demographic and other related factors. Method : A descriptive and analytical cross sectional study was conducted through web-based data collection which included 348 students aged 8 to 18 years in the state of Mazandaran, Iran during the first peak of COVID-19. Demographic and Revised Children's Anxiety and Depression Scale (RCADS-P) questionnaires were used to collect the data. The statistical tests including independent sample t test, ANOVA as well as linear regression were employed. Results: The average age of the subjects was reported to be 12.2 ± 3.59 years. Age, father's occupation, following COVID-19 related news, and also nervousness related to infection were predictors of anxiety (11%). Moreover, age, mother's occupation, family communication and also the safety protocols practiced by the family were found to be predictors of depression in students (17%). A significant relationship was also found between the effect of quarantine on family communication and the anxiety and depression in students (P < 0.001). Conclusion: Demographic characteristics affect student mental health during the COVID-19 outbreak. Moreover, family preventive protocols can predict depression in students aged 8 to 18 years. Better preventive precautions encourage less anxiety and depression.

Hesitancy about COVID-19 vaccination among pregnant women: a cross-sectional study based on the health belief model.

BACKGROUND: Pregnant women are at high risk for affliction by coronavirus disease 2019 (COVID-19). Vaccination is a main strategy to prevent and manage the COVID-19 pandemic. However, hesitancy about COVID-19 vaccination (HACV) is a major public health threat and a major barrier to herd immunity. The aim of the study was to evaluate pregnant women's HACV based on the Health Belief Model (HBM). METHODS: This cross-sectional study was conducted in 2021-2022. Participants were 352 pregnant women selected from several healthcare centers in the north of Iran. Instruments for data collection were a demographic questionnaire, a COVID-19 Knowledge Questionnaire, a COVID-19 Health Belief Questionnaire, and a question about HACV. Logistic regression analysis was used to assess the effects of the study variables on HACV. RESULTS: The rate of HACV was 42.61%. In the regression model, the three factors of perceived benefits (aOR: 0.700; 95% CI: 0.594 to 0.825), cues to action (aOR: 0.621; 95% CI: 0.516 to 0.574), and history of reproductive problems (aOR: 2.327; 95% CI: 0.1.262 to 4.292) had significant effects on HACV (P <  0.001). CONCLUSION: HACV is highly prevalent among pregnant women. The perceived benefits and cues to action components of HBM have significant effects on pregnant women's HACV, while the perceived threat component has no significant effect on it. HBM is a good model to explain HACV among pregnant women. Educational interventions are necessary to improve pregnant women's awareness of the risks of COVID-19 for them and their fetus.

Acceptance of COVID-19 vaccine and determinant factors in the Iranian population: a web-based study.

BACKGROUND: Iran had a high rate of death in several COVID 19 waves. Vaccination is a method for prevention and control of the COVID-19 pandemic. Success in controlling the pandemic is not solely dependent on the effectiveness of the vaccines. It is also dependent on the global acceptance and vaccine coverage rate. This study aimed to determine the acceptance rate of COVID-19 vaccination in the Iranian population and the factors affecting it. METHODS AND MATERIALS: This study was a cross-sectional research on 1564 Iranian people above 18. Study data were collected using a web-based questionnaire and analyzed using linear regression analysis and logistics at a significance level of 0.05 using SPSS. RESULTS: Approximately 70% of the participants reported acceptance of the vaccines. Ten percent of the people were against and 20% were hesitant to get vaccinated. The results showed that risk perception (P = .003), Knowledge of the disease (P < .001), trust in the health system (P < .001), attitude towards vaccination (P < .001), and vaccination literacy (P < .001) were predictors of vaccine acceptance. People with higher levels of education and mistrust towards the health system had a reduced vaccine acceptance rate. CONCLUSIONS: The acceptance rate of the COVID-19 vaccine in Iran was higher than in the other countries in the Middle East. Extensive interventions are important to increase the trust in the health system and improve the knowledge of vaccine efficacy and literacy.

Coping strategies and depression during the COVID-19 pandemic in pregnant women: a cross sectional study.

BACKGROUND: Pregnant women are vulnerable to psychological problems depending on the adaptive capacities of their personality and coping strategies. This study aimed to investigate the association between coping strategies of pregnant women during the COVID-19 pandemic and depression. METHODS: This web-based cross-sectional study was conducted in 2021 on 318 pregnant women in Amol, Iran. Data collection was performed via questionnaires (Brief cope, Edinburgh Postnatal Depression Scale, CDA, and Demographic questionnaire). The questionnaires were completed through the WhatsApp and Telegram applications. Data were analyzed using the hierarchical regression analysis and SPSS software (v. 21) at the significance level of 0.05. RESULTS: About 40% of participants had depression. The most prevalent coping strategy used by pregnant women was the avoidance strategy. Hierarchical regression revealed that the coping strategy of avoidance was a significant predictor of depression (ß = 0.226, p = 0.046) after controlling background characteristics. CONCLUSIONS: The findings of this study suggest that avoidance style associated with depression in pregnant women. Therefore, obtaining further knowledge about impacts of coping strategies on pregnant women seems to be essential.

Global prevalence of acceptance of COVID-19 vaccines and associated factors in pregnant women: a systematic review and meta-analysis.

INTRODUCTION: We performed a systematic review and meta-analysis to evaluate the acceptance of a COVID-19 vaccine among pregnant women and its determinants. METHOD: We searched the bibliographic databases (Scopus, Medline, and Web of Science) for the relevant studies from 1 January 2020 to 11 July 2021. We pooled the prevalence of vaccine acceptance among pregnant women using a random-effects model and conducted subgroup analyses to explore its determinants. The result was expressed as a pooled prevalence percentage and adjusted odds ratio (aOR) with 95% CIs. RESULTS: We found ten studies that were suitable, with 16, 696 participants from 32 countries. COVID-19 vaccination acceptability in pregnant women was 54 percent globally (95% CI: 45, 62; I2= 99.05). There was no association between sociodemographic factors including age >35 years (aOR: 1.17, 95%CI: 0.95, 1.43), high education (aOR: 1.03, 95%CI: 0.79, 1.35), income levels (aOR: 1.18, 95%CI: 0.80, 1.75), knowledge scores (aOR: 2.55, 95% CI: 0.78, 8.34) and COVID-19 vaccine acceptance. CONCLUSION: About half of pregnant women accepted the COVID-19 vaccine. We did not find any association between sociodemographic factors and COVID-19 vaccine acceptance. However, these findings should be considered with caution due to small number of studies and the substantial heterogeneity between them.

Association of social support, spirituality with psychological factors in Iranian breast cancer survivors: An evidence from a cross-sectional study.

AIMS: The aim of this study was to explore the protective role of social support and spirituality in the prevention of depression, anxiety and fatigue severity. DESIGN: In a cross-sectional study, 305 women of breast cancer survivors were recruited in the study. METHODS: The participants answered a self-reported the hospital anxiety and depression scale, fatigue severity scale (FSS), social support and spiritual health questionnaires. The data were analysed using a multiple linear regression model to estimate the adjusted regression coefficients. RESULTS: A greater proportion of patients had moderate depression (62.9%) and moderate anxiety (67.3%). The higher level of social support was significantly associated with a lesser degree of depression (ß=-0.05, p = .001) and anxiety (ß=-0.04, p = .001), but there had been no association with the severity of fatigue score, while the association of spiritual health with depression and anxiety was not independently significant. This study highlights the importance of perceived social support in the prevention of depression and anxiety.

Pregnancy-related anxiety and its associated factors during COVID-19 pandemic in Iranian pregnant women: a web-based cross-sectional study.

BACKGROUND: Pregnancy is a risk factor for coronavirus disease 2019 (COVID-19). Pregnant women suffer from varying levels of pregnancy-related anxiety (PRA) which can negatively affect pregnancy outcomes. The aim of this study was to assess PRA and its associated factors during the COVID-19 pandemic. METHODS: This web-based cross-sectional study was conducted in 2020 on 318 pregnant women purposively recruited from primary healthcare centers in Sari and Amol, Iran. Data were collected using questionnaires (PRAQ, Edinburg, KAP of COVID-19, CDA-Q and Demographic questionnaire), which were provided to participants through the social media or were completed for them over telephone. Data were analyzed with the linear regression and the logistic regression analysis, at the significance level of 0.05 using the SPSS software (v. 21). RESULTS: Around 21% of participants had PRA, 42.1% had depression, and 4.4% had COVID-19 anxiety. The significant predictors of PRA were number of pregnancies (P = 0.008), practice regarding COVID-19 (P < 0.001), COVID-19 anxiety (P < 0.001), depression (P < 0.001), and social support (P = 0.025) which explained 19% of the total variance. Depression and COVID-19 anxiety increased the odds of PRA by respectively four times and 13%, while good practice regarding COVID-19 decreased the odds by 62%. CONCLUSION: Around 21% of pregnant women suffer from PRA during the COVID-19 pandemic and the significant predictors of PRA during the pandemic include number of pregnancies, practice regarding COVID-19, COVID-19 anxiety, depression, and social support. These findings can be used to develop appropriate strategies for the management of mental health problems during pregnancy in the COVID-19 pandemic.

COVID-19 preventive behaviors and influencing factors in the Iranian population; a web-based survey.

BACKGROUND: COVID19 is a respiratory disease caused by a novel coronavirus. As there has been no definitive treatment for the disease so far, the only way to control the spread is to break the chain of infection. Our study aimed to analyze the preventive behaviors and influencing factors in the Iranian population. METHODS: This cross-sectional study was a web-based survey in the Iranian population. We performed the study during the first peak of COVID-19 outbreak (from March 25th, 2020 to April 5th). We used demographic and Preventive behaviors questionnaires to collect the data. This web-based survey was publicized on the internet through the common platforms used by the Iranian population. This survey was released on the website " Porsline.com ". A total of 2097 acceptable questionnaires were filled. All data were analyzed, using Statistical Package for Social Sciences (SPSS) version 19. RESULTS: 61.9% of the participants checked the hand-washing question as "Always". 55.7 and 58.2% checked the wearing masks and gloves as "Always", respectively. We found a significant relationship between gender and hand washing behavior (P = 0.006) and the use of masks and gloves (P < 0.001). Results showed that wearing gloves had a significant relation with the education status (P = 0.029) and economic status (P = 0.011). Wearing masks had a significant relation with economic status (P = 0.032). Overall women had better preventive behaviors. CONCLUSIONS: Preventive behaviors have a significant relation with some socio-demographic characteristics. According to the 3 main preventive behaviors of hand-washing, wearing masks and gloves 50% of the population has not taken these behaviors seriously.

Comparison of competitive cognitive models in explanation of women breast cancer screening behaviours using structural equation modelling: Health belief model and theory of reasoned action.

INTRODUCTION: The efficacy of the theory of reasoned action (TRA), compared with the health belief model (HBM), has not been fully elucidated in screening practices. METHODS: This population-based cross-sectional study was conducted with samples of 500 women aged 35-85 years, in the north of Iran. The data of demographic characteristics, awareness, health belief, subjective norms and screening behaviours were collected using standard instruments. Structural equation modelling (SEM) was applied to estimate the pathways of regression coefficients. RESULTS: The model that incorporated the health belief and the standardised coefficient of the knowledge scores influenced significantly on the health belief perception (beta = 0.375), and consequently, the health belief directly affected screening behaviours (beta = 0.73). In contrast, In TRA model, while the direct effect of knowledge on intention was negligible it has a greater indirect effect by mediating health belief and subjective norms (indirect beta = 0.35) on behaviour intention. A high coefficient of intention was observed by subjective norms (beta = 0.626), and the intention has a great positive effect on screening behaviour (beta = 0.601). All fitting indexes were quietly improved in the TRA model as compared with HBM. CONCLUSION: Thus, the unifying structure of knowledge, health belief, subjective norms and intention improves the predictor power in breast cancer screening behaviours.

Breast cancer screening beliefs questionnaire: psychometric properties of the Persian version.

BACKGROUND: Valid and reliable instruments are needed to assess such beliefs, attitudes, and knowledge. This study aimed to translate Breast Cancer Screening Beliefs Questionnaire into Persian and evaluate its psychometric properties among Iranian women. METHODS: In this methodological study, the twelve-item Breast Cancer Screening Beliefs Questionnaire was translated into Persian and filled out by 1256 Iranian women. Face, content, convergent, and discriminant validity were evaluated and exploratory and confirmatory factor analyses were performed for construct validity evaluation. Reliability was also evaluated through calculating Cronbach's alpha, McDonald's omega, Average inter-item correlation, and test-retest intraclass correlation coefficient and finally, composite reliability was estimated. RESULTS: Three factors were extracted in factor analysis which included screening attitude, screening knowledge and perception, and screening practice. These factors explained 55.71% of the total variance of breast cancer screening beliefs. This three-factor model was confirmed in confirmatory factor analysis based on model fit indices (PCFI = 0.703, PNFI = 0.697, CMIN/DF = 2.127, RMSEA = 0.30, GFI = 0.980, AGFI = 0.998, and CFI = 0.991). Convergent and discriminant validity were also confirmed. Composite reliability and test-retest intraclass correlation coefficient were more than 0.7. CONCLUSION: With a three-factor structure, the Persian Breast Cancer Screening Beliefs Questionnaire has acceptable validity and reliability and hence, can be used to evaluate Iranian women's breast cancer screening beliefs.

Social capital and fertility behaviors: a cross-sectional study in Iranian women health care workers.

BACKGROUND: Fertility, in addition to the biomedical aspect, is phenomena of social, economic and demographic changes. Social network were considered for understanding fertility behaviors and changes in the levels of fertility. This study was conducted to investigate the relationship between social capital and childbirth behaviors in Iranian women employees. METHODS: This cross-sectional study was conducted in 2017 on 536 women health care workers who randomly selected from health care setting Babol/Iran. Data were collected using demographic, childbearing behavior and social capital questionnaires. The SPSS-21 software was employed to analysis the data at a significant level of 0.05. RESULTS: The results of the study showed that, there was significant relationship between number of pregnancy and social capital (P = 0.039). Furthermore, social capital has a significant relationship with the time of pregnancy (P = 0.043), the time of pregnancy in women with high social capital was observed to be relatively 30% shorter compare the women with low social capital. CONCLUSION: Social capital, as one of the important factors influencing childbirth behaviors, should be considered in population planning and policy making.

Analysis of quality of life in breast cancer survivors using structural equation modelling: the role of spirituality, social support and psychological well-being.

BACKGROUND: To explore and characterize the inter-relationship between psychological well-being, spirituality, social support, comorbidity, demographic and lifestyle factors and quality of life (QoL). METHODS: This cross-sectional study was conducted with 305 breast cancer survivors in northern Iran in 2017. The demographic and socio-economic data and physical activity were measured with a standard questionnaire. The standard European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 QoL scale, a system-of-belief inventory questionnaire, the social support scale, the short form of the Hospital Anxiety and Depression Scale and the fatigue severity scale (FSS) were used in data collection. In structural equation modelling analysis, we used the maximum likelihood procedure to estimate the direct and indirect effects of relevant factors on QoL. RESULTS: The median age (quartile 1 [Q1], quartile 3 [Q3]) of patients was 50 y (43, 55). The psychological factors designated by anxiety, depression and FSS had a negative significant direct effect on QoL (ß=-0.62). Spirituality has a positive direct effect (ß=0.089) but a negligible indirect effect (ß=0.020) on QoL, while the direct association of social support was almost negligible. CONCLUSIONS: The findings emphasized the unifying structure of the determinants of QoL and the mediating negative association of psychological factors with QoL. Thus the supportive education efforts should focus on improving psychological well-being along with standard treatment in breast cancer survivors.

Reproductive health problems among female shift workers: A qualitative study in Iran.

BACKGROUND: Shift work (i.e. working between 18:00 and 07:00) is associated with sleeplessness and fatigue and hence, can cause female shift workers different health problems. This study aimed to explore reproductive health problems among female shift workers. MATERIALS AND METHODS: This qualitative study was conducted in Amol and Babol cities, Iran, on 19 female shift workers with previous history of pregnancy and breastfeeding. Participants were selected purposively and with maximum variation respecting their age, work experience, educational level, and financial and employment status. Face-to-face semi-structured interviews were held for data collection and conventional qualitative content analysis was employed for data analysis. RESULTS: Female shift workers' reproductive health problems were categorized into fourteen subcategories and the five main categories of conflict between pregnancy and shift work, breastfeeding-related challenges, impaired sexual relationships, childbearing limitations, and gynecological problems. CONCLUSION: Impaired sexual problems are the most significant reproductive health problem among female shift workers. Their reproductive health can be promoted through periodical reproductive health assessments by midwives, reproductive health specialists, psychologists, and gynecologists.

Relationship of social capital with overweight and obesity among female health care workers.

BACKGROUND: The epidemic of obesity has turned into a major global health challenge. Environmental and social factors such as social capital, can significantly affect obesity. This study aimed to evaluate the relationship of social capital with overweight and obesity among female health-care workers. METHODS: This cross-sectional study was conducted in 2018 on 680 female health-care workers who were randomly selected from healthcare settings affiliated to Babol University of Medical Sciences, Babol, Iran. Data were collected using a demographic questionnaire and the Workplace Social Capital (WSC) questionnaire. The SPSS Version 21 was employed to analyze the data through conducting the independent-sample t and the chi-square tests as well as the linear and the logistic regression analyses at a significance level of less than 0.05. RESULTS: Linear regression analysis revealed that age, marital status, satisfaction with economic status, and structural social capital were significant predictors of body mass index (P<0.05). Moreover, logistic regression analysis indicated that weak social capital increased the odds of overweight/ obesity by 1.3 times (OR=1.345; 95% CI: 0.643-2.812) and weak structural social capital significantly increased the odds of overweight /obesity by almost four times (OR=3.757; 95% CI: 1.628-8.671; P=0.002). CONCLUSION: Social capital, particularly structural social capital, is a significant predictor of body mass index and a protective factor against obesity among female health-care workers. Further studies are needed to determine the paths through which social capital affects obesity- and overweight-related behaviors.

Erratum: Shift work and metabolic syndrome: A multi-center cross-sectional study on females of reproductive age.

[This corrects the article DOI: 10.3892/br.2019.1205.].

Shift work and metabolic syndrome: A multi-center cross-sectional study on females of reproductive age.

Shift work during reproductive age can be a risk factor for metabolic syndrome. The present study evaluated the association between shift work and metabolic syndrome during reproductive age. This multi-center cross-sectional correlational study was performed between September 2017 and May 2018. A total of 419 female shift and day workers were purposively recruited to the study from three central cities in Mazandaran, Iran. To diagnose metabolic syndrome based on the National Cholesterol Education Program Adult Treatment Panel III guidelines, the anthropometric measures, blood pressure, and levels of serum triglyceride, high-density lipoprotein and fasting blood sugar were taken. Data were analyzed using the independent-sample t, Chi-square and the Fisher's exact tests as well as the logistic regression analysis. Among the 419 participants, 28 were excluded during the study. The total prevalence of metabolic syndrome was 16.3%, and its prevalence among shift workers and day workers was 17.3 and 14.9%, respectively. The most prevalent components of metabolic syndrome were low serum level of high-density lipoprotein and abdominal obesity. Following adjustments for the effects of potential cofounders, the logistic regression analysis revealed that the odds of metabolic syndrome among shift workers was ~2 times greater than day workers (odds ratio, 1.83; 95% confidence interval, 0.088-3.79), although this association was statistically insignificant (P=0.10). The results of the current study suggest that shift work is associated with a greater risk of metabolic syndrome for women. The most important components of metabolic syndrome are low serum level of high-density lipoprotein and abdominal obesity, which are attributable to limited physical activity and high occupational stress. The risk of metabolic syndrome among female shift workers of reproductive age may be reduced through strategies, including awareness raising, dietary educations and provision of physical activity facilities in the workplace.

Psychometric Properties of Persian Version of the Short-Form Workplace Social Capital Questionnaire for Female Health Workers.

BACKGROUND: The workplace social capital is one of the important features of clinical work environment that improves the productivity and quality of services and safety through trust and social participation. Evaluation of workplace social capital requires a valid and reliable scale. The short-form workplace social capital questionnaire developed by Kouvonen has long been used to evaluate the workplace social capital. OBJECTIVE: To evaluate the psychometric properties of the Persian version of the questionnaire among a group of female Iranian health care workers. METHODS: The Persian version of the short-form questionnaire of workplace social capital was finalized after translation and back-translation. 500 female health care workers completed the questionnaire. Then, the content validity and the construct validity of the questionnaire were assessed. The reliability of the questionnaire was assessed by Cronbach's α, θ, and McDonald's Ω. The construct reliability and ICC were also evaluated. RESULTS: Based on the maximum likelihood exploratory factor analysis (n=250) and confirmatory factor analysis (n=250), two factors were identified. The factors could explain 65% of the total variance observed. The model had an acceptable fit: GFI=0.953, CFI=0.973, IFI=0.974, NFI=0.953, PNFI=0.522, RAMSEA=0.090, CMIN/DF=2.751, RMR=0.042. Convergent and divergent validity as well as internal consistency and construct reliability of the questionnaire were confirmed. CONCLUSION: The Persian version of Kouvonen workplace social capital has acceptable validity and reliability. The questionnaire can thus be used in future studies to assess the workplace social capital in Iranian health care workers.