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Total fertility rate relates to the number of children that a woman bears in the fertility period of her life. Fertility function is one of the most important health and population indicators. This indicator affects social, health, economic and cultural factors. This study is an ecological or correlative one. Factors affecting total fertility rate in Iran in the year 2000 are studied in this paper. The factors include coverage of women with focus on higher education, infant mortality rate (under 1 year), women’s occupation rate, urbanity ratio, mean age in the first marriage of women in the age group 15 to 49 years as per the last census in Iran in 2000 in 26 provinces. The direct and indirect effects of these factors on total fertility rate, with emphasis on path analysis have been determined. Data analysis shows that women's occupation rate is the most important factor in decreasing total fertility rate. Higher education of women is also an important element in this regard. Therefore increase in the number of women with university education not only decreases the total fertility but also increases the occupation of women.

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Background & Aim: Working conditions in some professions particularly among health care providers result in exposure to various stressors in daily work life that can affect mental health status. Regarding specific conditions that midwives encountered in their workplace, this study investigates mental health status among midwives working in Tehran&aposs public hospitals and its related factors.

Methods & Materials: In this cross-sectional study all midwives working in Tehran&aposs public hospitals who had inclusion criteria (n=370) were studied. Data were gathered using GHQ-12 questionnaire and then were analyzed using chi-square statistical test.

Results: The results showed that 35.1% of subjects had not good mental health. Midwives&apos mental health was significantly related to their educational level (P<0.001), economic statue (P=0.04), marriage status (P<0.001) and shift work (P=0.02).

Conclusion: Regarding high prevalence of poor mental health status among midwives, it is recommended to investigate related occupational factors in order to improve working conditions of midwives working in hospitals.

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Background & Aim: Drug addiction, especially addiction to Ecstasy has ruinous effect on lives. Lack of knowledge is the most important cause of Ecstasy use among young adults. Research studies showed that students use these pills in order to get comfort and to overcome grieves. Addiction to ecstasy has been increased in Iran in recent years. This study was carried out to assess the factors associated to Ecstasy use in students of Qazvin University of Medical Sciences.

Methods & Materials: In this cross-sectional study, we recruited 200 students using clustered, random sampling. Data collection tool was a structured valid and reliable questionnaire containing 28 questions in two sections. Data were analyzed using Student t-test, ANOVA and chi-square tests.

Results: Results indicated that the prevalence of Ecstasy use was 1.5%. Prevalence of alcohol and cigarette use was 1.5% too. Mean score of knowledge on Ecstasy was 9.8% (SD=3.8). Knowledge of the female students was higher than the knowledge of male ones. About 86.7% of the students took Ecstasy in order to end grieve due to family problems. Most important associated factors to Ecstasy use were: positive attitude toward Ecstasy use, lack of knowledge (96.5%), peer pressure (96%), and lck of parents&apos attention to their young children (94.5%).

Conclusion: Lack of knowledge about complications of addiction to Ecstasy is the most important factor leading to addiction among students. Living in places such as dormitories and rented houses, and lack of parents&apos control over their children can be important factors related to addiction of students to Ecstasy, as well.

 

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Background & Aim: Anxiety is a common experience which is felt as uneasiness, non-specific threat, and activation of autonomic nervous system. The aim of this study was to assess the effect of muscular relaxation on anxiety level of patients underwent cardiac catheterization.

Methods & Materials: In this clinical trial, 118 patients who were expected to have a cardiac catheterization were recruited from an educational hospital at Tehran University of Medical Science. The participants were allocated to two groups, including muscular relaxation group (50 patients), and control group (68 patients). Data were collected using a questionnaire, and a self-report paper for recording anxiety level. Anxiety level was recorded one hour before cardiac catheterization in two groups. Then, the intervention group was asked to listen to the Benson muscle relaxation guide direction tape for 20 minutes through headphone. After using muscle relaxation in the intervention group and immediately before cardiac catheterization, the anxiety level of the respondents was recorded once more. Control group received standard nursing cares. Data were analyzed using χ², Fisher&aposs exact test, Kruscalwallis, Man-Whitney and Wilcoxon statistical tests in the SPSS.

Results: There were no significant difference between two groups in demographic characteristics and anxiety level before the intervention and one hour before cardiac catheterization. After the intervention, the anxiety level was significantly reduced in the intervention group (P<0.001) while it increased in the control group.

Conclusion: Based on the results of this study, Benson muscle relaxation significantly decreased anxiety level in patients who were expected to go for cardiac catheterization.

 

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Background & Aim: Diet rich in fruits and vegetables is shown to be an important factor in prevention of chronic diseases. Adolescence is a critical period in adopting eating behaviors. Schools are important social environments in adolescents' lives and are important settings for interventions that aim to improve eating behaviors, including fruit and vegetable intake. This study aimed to assess effectiveness of a school-based intervention based on social cognitive theory on fruit and vegetable (F&V) intake of female adolescents in Tehran.

Methods & Materials: This experimental school based field trial was conducted on 296 female students aged 10-13 years old (157 in the intervention and 139 in the control groups). The intervention included classroom nutrition education on F&V and increasing availability of F&V through school buffet. Psychosocial characteristics of the students were assessed using a questionnaire and F&V intake were measured using 24-hr recall method, at baseline and after three months intervention. Descriptive and inferential statistics were used for data analysis.

Results: After the intervention, vegetable and fruit intake were 0.6 and 0.63 servings higher in the intervention group compared to the controls. Knowledge and self-efficacy scores were significantly higher in the intervention group compared to the control group. Home availability and observational learning scores were significantly decreased in the intervention group.

Conclusion: Through the intervention process, many valuable experiences were gained to be used in future interventions.

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  Background & Aim: There is little information regarding relationship between maternal dietary pattern and infant anthropometric parameters at birth. This study was carried out to determine relationship between dietary patterns in pregnancy with infants' anthropometric parameters .

  Methods & Materials: In this cross-sectional study, 94 pregnant women (GA: 37-40 weeks) referred to Ahvaz Razi hospital were selected. Anthropometric parameters were measured. The dietary intakes were assessed using a semi-quantitative food frequency questionnaire. Factor analysis was used to identify dietary patterns. Statistical analysis was done in the SPSS. 

  Results: In this study, three major dietary patterns including "healthy", "traditional" and "western" dietary patterns were identified. After adjusting of confounders (age, physical activity, energy intake, pregnancy weight gain and infant sex), the relationship between dietary patterns with birth weight, height and head circumference were exhibited in three models. The relationship between healthy dietary pattern and infant weight, height and head circumference at birth was significantly positive in all models (P<0.05). Western dietary pattern had significant negative relationship with head circumference in the model 1 and 2. Moreover, it had negative relationship with birth weight in the model 1 (P<0.05). Traditional dietary pattern did not show any significant relationship with anthropometric parameters at birth.

  Conclusion: The present study found significant relationship between maternal dietary patterns with anthropometric parameters at birth. Further prospective studies are suggested to confirm the findings.

  

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  Background & Aim: Cervical cancer is the fourth common cancer worldwide. Pap smear is a usual t est to screen cervical cancer. The aim of the present study was to determine factors associated with Pap smear screening among married women aged 15-49 years in Lamerd health centers based on the Protection Motivation Theory .

  Methods & Materials: In this cross-sectional study, 220 married women aged 15-49 years were selected. Data were gathered using a questionnaire designed based on the Protection Motivation Theory. The questionnaires were completed via individual interviews with the participants. Validity and reliability of the questionnaire were approved. Data were analysed using the Kruskal-Wallis, U-Man Whitney test and c ² in the SPSS-16.

  Results: Most of the participants ( 40%) had a high school diploma and 70% of them were housewives. Most of the participants (65.6%) had used the test once at least. There were statistically significant relationships between the use of Pap smear with the protection motivation against cervical cancer (P<0.001 ), perceived self-efficacy ( P =0.002 ), perceived response efficacy ( P =0.007 ) and perceived costs ( P <0.001 ) .

  Conclusion: Regarding the statistically significant relationships between the constructs of the Protection Motivation Theory and the use of Pap smear screening test among women , it is recommended to design educational programs based on the Protection Motivation Theory to encourage married women for using Pap smear screening test.

  

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  Background & Aim: The aim of present study was to assess psychometric properties of premenstrual symptoms screening tool (PSST) to provide a fast and appropriate screening tool for women who suffer from severe PMS/PMDD and their clinicians .

  Methods & Materials: It was a cross-sectional study. The study included 404 female students studying at Semnan University who were randomly selected using stratified method. In order to assess psychometric properties, we used the exploratory factor analysis, convergent validity (evaluated by symptom checklist-90-Revised), criterion-related validity (calculated by comparing psychiatrist diagnosis and PSST). Sensitivity and specificity coefficients of optimal cutoff points were calculated by the ROC Curve and construct validity was evaluated by the PSST ability to separate PMS and PMDD groups from healthy group. Reliability was evaluated using the cronbach’s alpha and test-retest method . 

  Results: The p rinciple component analysis revealed that the PSST consists of four factors: interest reduction, interference in functions, physical and neurotic symptoms, and eating and sleep patterns. As an evidence of convergent validity, PSST scores showed significant correlations with the SCL-90-R’s dimensions. Agreement coefficient between psychiatrists and the PSST diagnosis was 0.314 for the PMS and 0.80 for the PMDD. This tool separated the PMS and PMDD groups from healthy group well. Optimal Cutoff point for separating females suffering from PMDD was 2.22. The sensitivity and specificity coefficients were 0.9 and 0.77, respectively. The cronbach’s alpha was 0.91 and the test-retest reliability was 0.56 for the total tool .

  Conclusion: The translated version of the premenstrual symptoms screening tool can be used as a valid tool for Iranian females. This instrument can be useful for rapid screening and identifying women who suffer from severe PMS/PMDD, especially in clinical settings .

  

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Background & Aim: Pedestrians are the most vulnerable road users. In many cases, pedestrian-vehicle crashes are often the result of their risky road crossing behaviors. So, this qualitative study aimed to explore the reasons for risky road crossing behaviors among young people.

Methods & Materials: The current study was designed as a qualitative content analysis. Twelve males and females who had a car-accident were purposefully selected with maximum variation sampling. Data were collected and analyzed by semi-structured individual interviews.

Results: Conformity with the masses including “conformity with peers and conformity with the public space of society”, and anomie emerged as the most important social reasons for young pedestrian’s risky road crossing behaviors.

Conclusion: According to the results of this study, young pedestrian’s risky road crossing behaviors are affected by conformity with the masses and peers and as well as anomie so that risky behaviors have been commonplace and inevitable and a part of their lifestyle.

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Background & Aim: Postpartum depression disorder is a common psychosocial disorder with negative consequences for the mother and child. On the other hand, attention training technique can be more effective than other techniques for intervention in the cognitive-attention syndrome. Therefore, the present study was conducted to determine the effectiveness of attention training technique on the symptoms of depression, anxiety and metacognitive beliefs in patients with postpartum depression.
Methods & Materials: This study was conducted in a single-case experimental design using a multiple baseline design in eight sessions during one-, three- and six-month follow-ups on two patients, referred to the psychology and psychiatry unit of Tabriz Red Crescent in 2018. The Beck Depression Inventory, the Beck Anxiety Inventory and Metacognitive Beliefs Questionnaire were used to collect the data. Data analysis was performed using the Excel software as a graphical analysis and then based on the percentage of improvement, effect size and clinical significance.
Results: At the end of treatment, a significant reduction was observed in the symptoms of depression (61% remission), anxiety (48% remission) and metacognitive beliefs (83% remission) in patients with postpartum depression.
Conclusion: The results of this study showed that attention training technique can be effective in the treatment of patients with postpartum depression. However, further studies are needed in this area.
Clinical trial registry: IRCT20171227038096N1
 

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Background & Aim: The Covid‐19 pandemic has posed numerous ethical challenges to nurses and has exacerbated moral distress in clinical settings. Hence, due to the important role of nurses in pandemics, this study was conducted to investigate the severity and frequency of moral distress among nurses working in clinical settings at Maragheh teaching hospitals during the outbreak of COVID-19.
Methods & Materials: This was a cross-sectional study conducted on 174 nurses working in surgical-medical, intensive care, pediatric and emergency wards of Maragheh hospitals in 2020-2021. Data were collected using a demographic form and the Corley’s Moral Distress Scale.
Results: The median (Interquartile Range (IQR) = Q3 − Q1) of the severity and frequency of moral distress experienced were 54 (44-59) and 52 (43-58), respectively. The median of moral distress experienced in the intensive care and emergency wards were 56 (51-59) and 46 (43-51), which was more severe than that of in other wards. The median of frequency and severity of moral distress in men were 48 (41-59) and in women 50 (43-59), respectively, which was significantly higher than that of in women (P<0.001). The severity and frequency of moral distress had a statistically significant relationship with age, and work experience (P>0.05) so that with increasing age and work experience, the severity and frequency of moral distress decreased.
Conclusion: Given the high frequency of moral distress among nurses during the COVID-19 pandemic in specific clinical settings, the use of management strategies in order to improve working conditions and create a positive setting can be helpful. It seems that holding courses on coping with moral distress in nurses in the context of the COVID-19 pandemic is an appropriate practical solution.

 

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Background & Aim: In recent years, significant changes have occurred in the dynamics of childbearing within familial context. Notably, Iranian families have witnessed a noticeable decline in the desire for childbearing and having additional children. The aim of this study was to explore the determinants of childbearing decision-making among women and men of reproductive age.
Methods & Materials: This study adopts a qualitative research design using the conventional content analysis approach in 2023. The participants comprised 19 married women and men of reproductive age living in Zanjan, who were purposively selected to ensure maximum variation. After obtaining informed consent, the participants were invited to participate in individual, semi-structured interviews. Data collection continued until data saturation was reached, with concurrent analysis conducted throughout the process. The textual data were managed using MAXQDA software, version 2020.
Results: Throughout the inductive data analysis process, seven main categories emerged as determinants of decision-making about childbearing. These categories included social role modeling, reflection within family structure, social and economic requirements, contemporary concerns in parenting, avoidance of responsibility and comfort-seeking, unpleasant past experiences and age-related challenges. Among these categories, social and economic requirements emerged as the most prevalent concept across all interviews, with a total of 505 open codes associated with this category.
Conclusion: The normalization of reduced childbearing rates within the society, accompanied by shifting values and attitudes towards the significance of children, as well as economic and social problems have contributed to an increasing preference for smaller families. Furthermore, the desire for fewer children can be viewed as a response to the individualistic tendencies of women and men, as well as a means of avoiding parenting concerns.