Chemotherapy-induced cognitive impairment in breast cancer survivors: A systematic review of studies from 2000 to 2021.

BACKGROUND: Studies have indicated that apart from enhancing patient survival, chemotherapy has adverse side effects on the psychological, social, and cognitive functions of breast cancer survivors. AIMS: This study was conducted to understand chemotherapy's impact on breast cancer survivors' cognitive functions. METHODS AND RESULTS: Our study is a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We searched English databases, including PubMed/MEDLINE, PsycINFO, and Web of Science, and Persian databases, such as Irandoc and Elmnet, using Persian keywords of cancer, breast cancer, chemotherapy, cognitive functions, executive functions, and neuropsychological functions. Two reviewers independently evaluated the full text of the articles according to predefined criteria. Among the 937 available studies, 26 were selected based on the inclusion and exclusion criteria, of which 17 (65%) were longitudinal and 9 (35%) were cross-sectional. The findings indicated a significant relationship between the use of chemotherapy and cognitive impairments, most notably attention, working and short-term memory, and executive functions. However, the studies differed in their findings regarding the long-term persistence of cancer-related cognitive impairment (CRCI), which could be due to the wide range of tools used, different methods to measure cognitive functions, and the difference in the sample size of the studies. CONCLUSION: Chemotherapy, affecting cortical and subcortical brain structures, causes a set of cognitive impairments that can lead to impairments in social responsibility acceptance, daily functioning, and quality of life of women. Therefore, rigorous and extensive research design is required to understand the causes and consequences of CRCI using standardized and sensitive measures of cognitive functions. Specifically, studies comparing the effects of different chemotherapy regimens on cognition and potential mechanisms and/or moderators of CRCI would be instrumental in designing more effective therapy regimens and evaluating the efficacy and cost-effectiveness of cognitive rehabilitation and supportive care programs.

Culture as an effective frame of reference in clinical decision-making: A comparison of Iranian, American, and Canadian psychotherapists.

The therapeutic communication between psychotherapist and client is highly dependent on their socio-cultural background. The purpose of this study was to examine the effects of culture on decision-making style of psychotherapists in three dimensions of decision-making: expedience vs. realism, individualism vs. collectivism, and long-term orientation vs. short-term orientation. The sample of this study consisted of 144 psychotherapists (40 Iranians educated in Iran, 33 Iranians educated in the west, 36 Americans, and 35 Canadians). Each of the participants were presented with three scenario that involved clinical challenging situations. For each area of decision-making a statement was considered and the psychotherapist was requested to rate them based on importance in his/her clinical decision-making. Findings indicated that the groups differed significantly on all dimensions with few exceptions when American and Canadian psychotherapists were compared. The decision-making style of Iranian psychotherapists was more with expediency, collectivism and long-term orientation, while the decision-making style of American and Canadian psychotherapists was more with realism, individualism, and short-term orientation. According to the results of current study, socio-cultural background of psychotherapists, as a frame of reference, significantly influenced their clinical decision-making style.

Social Determinants of Health, Maternal Involvement, and Child Development: Direct and Mediated Pathways.

OBJECTIVES: In the process of child development, a variety of factors are at play. In this regard, social determinants of health play a determining role in the development and growth of the child. This study aimed to design and test the model for social determinants of health for the development of 36-6o-month-old children in Tehran with the mediation of maternal involvement. MATERIALS & METHODS: This cross-sectional study was conducted among 1067 mothers and their 36-60-month-old children in childcare centers in Tehran, using multistage sampling. Data gathering tools consisted of a demographic questionnaire for mothers and children, a questionnaire on unhealthy behaviors, Ages and Stages Questionnaire, Economic and Social Status Questionnaire, Perceived Social Support Questionnaire, Perceived Stress Questionnaire, Spielberger Anxiety Inventory, Beck Depression Inventory, ENRICH: Marital Satisfaction Scale, and Participation Scale for Parents and Mothers. RESULTS: Model fit measures were suitable and goodness of fit (RMSEA = 0.031, GFI = 1) was satisfactory. In addition, the results of path analysis indicated that the participation of mothers in the development of children had a direct positive (ß = 0.089) and increasing effect. CONCLUSION: Findings indicated that depression, anxiety, stress, and marital satisfaction have both direct and indirect effects on the participation of mothers and child development. Moreover, the model fit measures indicated the utility and high proportionality of the model, as well as the logic of the adjusted relationships of variables based on the conceptual model.

Marital Satisfaction and Depression in Mothers of 3-4 Year Old Children with Developmental Delay in Comparison with Mothers of Normal Children.

OBJECTIVES: The present study evaluated the depression and marital satisfaction in mothers of 36-48 months old children with developmental delay in comparison with mothers of normal children. MATERIALS & METHODS: This cross-sectional study was performed on 616 mothers and their children, aged 36 - 48 months, from Apr 2015 to Feb 2016, in some kindergartens in Tehran, Iran. Participants were selected through multi-stage random sampling. The children were divided according to the developmental status into two groups of normal development and developmental delay. The following instruments were used: A demographic and children specification questionnaire, marital satisfaction scale, the Beck Depression Inventory, and the Ages and Stages Questionnaire. The data were analyzed using SPSS16 software. Independent t-test and Pearson correlation were employed at significance level of 0.05. RESULTS: The mean age of children with developmental delay and normal development was 41.94±4.48 and 42.17±5.02 months, respectively. The prevalence of developmental delay in children aged 36-48 months was 17.4% and in normal development children was 82.6%. Developmental delay in boys was 23%. The highest incidence of developmental delays was in fine motor skills. Independent t-test revealed a significant difference between mothers' depression and marital satisfaction with and without developmental delays in their children (P=0.0001). In addition, the correlation was observed between the mother's depression and marital satisfaction (P=0.0001). CONCLUSION: Mothers of children with developmental delay suffer more from depression and have less marital satisfaction compared to mothers of healthy children. Interventional studies to reduce depression and increase marital satisfaction and its impact on development status should be conducted.

Cultural differences in conceptual representation of "Privacy": A comparison between Iran and the United States.

Culture consists of shared conceptual representations in an individual's cognition. Thus, there may be cultural differences in the representation of a concept. To assess this possibility, we compared the subjective semantic structure of "privacy" in Iran and the United States. Participants were 200 adults, 100 from Iran and 100 from the United States. In the first phase of the experiment, using the associative terms task, we detected nine of the most frequent terms that were associated with the concept of "privacy" in each culture. In the second phase, using the judged-similarity task, we asked participants to rate the degree to which each of the nine terms from the previous phase was associated with every other term and with the concept of "privacy." Results from a correspondence analysis model suggest similarities in the mapping of terms related to "privacy" along the dichotomous dimension of physical vs. informational concerns. However, cultural differences emerged in a second dimension, the extent to which individualism vs. collectivism was stressed. While "personal privacy" and an individual's relationship with the government was important for American adults, the main focus for Iranian adults was "familial privacy" and family-centered living.

Socioeconomic Status Index to Interpret Inequalities in Child Development.

OBJECTIVE: There have been contradictory findings on the relationship between Socioeconomic Status (SES) and child development although SES is associated with child development outcomes. The present study intended to define the relationship between SES and child development in Tehran kindergartens, Iran. MATERIALS & METHODS: This cross-sectional survey studied 1036 children aged 36-60 month, in different kindergartens in Tehran City, Iran, in 2014-2015. The principal factor analysis (PFA) model was employed to construct SES indices. The constructed SES variable was employed as an independent variable in logistic regression model to evaluate its role in developmental delay as a dependent variable. RESULTS: The relationship between SES and developmental delay was significant at P=0.003. SES proved to have a significant (P<0.05) impact on developmental delay, both as an independent variable and after controlling risk factors. CONCLUSION: There should be more emphasis on developmental monitoring and appropriate intervention programs for children to give them higher chance of having a more productive life.

Relationship of Mothers' Psychological Status with Development of Kindergarten Children.

OBJECTIVE: Given the importance of children's development and the role of psychological status of mothers in this regard, this study investigated the relationship of mothers' psychological status (stress, anxiety and depression) with the development of children aged 36-60 months. MATERIALS & METHODS: This descriptive study was performed on 1036 mothers and their children, aged 36 to 60 months, in different kindergartens in Tehran City, Iran, in 2014-2015. Participants were selected through multi-stage random sampling. The following instruments were used in this study: A demographic and obstetric specification questionnaire, children specification questionnaire, the Beck Depression Inventory, Spiel Berger Test, Perceived stress questionnaire and the Ages and Stages Questionnaire to determine the status of the children's development. Data were analyzed using SPSS20 software, Mann-Whitney; independent t-test and logistic-Regression model were used. RESULTS: The prevalence of developmental delay in children aged 36-60 months was 16.2%. The independent t-test showed a relationship between maternal stress and developmental delay in children. The Mann-Whitney test revealed a significant relation between mothers' depression level and developmental delay in their children. There was a significant relation between trait anxiety and developmental delay in children. Moreover, a significant relation was found between maternal stress and developmental delay in fine motor skills. The logistic regression model showed a significant relationship of child gender, economic and social states with developmental delay. CONCLUSION: This study showed mothers' psychological status probably is an effective factor in developmental delay. The assessment of mothers' psychological status is suggested for early interventions.

Development of Children in Iran: A Systematic Review and Meta-Analysis.

BACKGROUND: In order to gain a better perspective of the developmental status of children in different regions of Iran, this study was carried out to determine the prevalence and the factors impacting child development in Iranian studies. MATERIALS & METHODS: Articles published in Iranian and international journals indexed in the SID, PubMed, Scopus and Magiran databases from 2001-2015 were systematically reviewed using standard and sensitive keywords. After evaluating the quality of 155 articles in the initial search, 26 articles were analyzed according to the inclusion criteria. After investigations, meta-analysis was done for six studies and the results were combined using Random Effects model, and the heterogeneity of studies was evaluated using the I2 index. Data analysis was performed using STATA version 11.2. RESULTS: Eagger & Beggs tests, respectively with 0/273 & 0/260 did not confirm the probability of publication bias in the data, but heterogeneity in studies was confirmed (p˂0/001). On such basis, the pooled prevalence of developmental disorder based on Random Effect model was calculated to be 0.146, CI (0/107-0/184). The prevalence of developmental disorders in children in the studies reviewed was reported between 7 to 22.4%. The most important risk factors were in SES )Socio Economic Status) and Prenatal, Perinatal, Neonatal &Child groups. CONCLUSION: More extensive studies and early intervention with respect to causes of developmental delay in children seems necessary.

Spiritual Care Training for Mothers of Children with Cancer: Effects on Quality of Care and Mental Health of Caregivers.

BACKGROUND: The purpose of this study was to explore the effectiveness of a spiritual care training package in maternal caregivers of children with cancer. MATERIALS AND METHODS: This study was a quasi-experimental study with pretest and posttest design consisting of a sample of 42 mothers of children diagnosed as having cancer. Participants were randomly assigned to either an experimental or a control group. The training package consisted of seven group training sessions offered in a children's hospital in Tehran. All mothers completed the Spirituality and Spiritual Care Rating Scale (SSCRS) and the Depression, Anxiety and Stress Scale (DASS-21) at pre and post test and after a three month follow up. RESULTS: There was significant difference between anxiety and spiritual, religious, Personalized care and total scores spiritual care between the intervention and control groups at follow-up (P<0.001).There was no statistically significant difference in stress and depression scores between the intervention and the control groups at follow-up. CONCLUSIONS: Findings show that spiritual care training program promotes spirituality, personalized care, religiosity and spiritual care as well as decreasing anxiety in mothers of children with cancer and decreases anxiety. It may be concluded that spiritual care training could be used effectively in reducing distressful spiritual challenges in mothers of children with cancer.

Parental self-efficacy as a determining factor in healthy mother-child interaction: a pilot study in iran.

OBJECTIVE: Parental self-efficacy is associated with increasing mental health in children. There is a paucity of research in Iran on the role of parental self-efficacy in increasing mental health status of children. In this preliminary study, we studied the effectiveness of the World Health Organization international child development program (2002) for children aged 3 years and younger in increasing positive interaction between child and mother as an important component of mental health. METHODS: Forty mothers from a central hospital child-caring center in Mashhad participated in the study and were randomly divided into an experimental group (n = 20) and a control group (n = 20). The experimental group received the World Health Organization international child development program for 6 consecutive weeks while the control group remained without manipulation. The Parenting Self-Agency Measure (PSAM) was administered at pre-test, post-test and at 1-month follow-up. RESULTS: The study findings indicated that parental efficacy in the experimental group increased after 6 consecutive weeks of training and remained unchanged after 1 month of follow-up while the control group showed no difference regarding scores obtained at three stages of the study. CONCLUSION: International programs such as the World Health Organization international child development program can increase positive child-mother interaction as an important factor which contributes to mental health in early years of life but further studies with larger samples in longer terms and with more follow-up periods in Iran are suggested. DECLARATION OF INTEREST: None. Clinical Trial Registration-URL: http://www.irct.ir. Unique identifier: IRCT2012073010445N1.

Forgiveness in relation to attachment style and consanguine marriage in Iranian married individuals.

The aim of this study was to compare forgiveness in secure and insecure Iranian married couples. Whether marriage had occurred within the family (consanguine) or not (non-consanguine) was also considered. 400 married participants completed the Family Forgiveness Scale and the Adult Attachment Questionnaire. Analysis of reported forgiveness within the marital family showed that, although there was no significant difference between secure and insecure participants in overall forgiveness, secure participants rated "reparation" and "resolution" higher, whereas insecure participants rated "realization" and "recognition" higher. Comparing the experience of forgiveness in the family of origin, securely attached couples not only reported significantly more overall forgiveness but reported more "realization" and "resolution" while forgiving. Some interesting sex differences were also found, as individuals in consanguine vs non-consanguine couples differed in mean "recognition" in the forgiveness process.