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Background & Aim: Maternal request for caesarean section due to fear of normal vaginal delivery (NVD) is one of the main reasons for the high rate of caesarean section. This study aimed to compare the fear of NVD and type of delivery between two groups of pregnant women attended childbirth preparation classes (CPC) and women received routine prenatal care (RPC).

Methods & Materials: In this prospective cohort study, 202 Primigravid women attended healthcare centers for prenatal care services in the East of Guilan were selected using convenient sampling in 2013-2014. Fear of NVD was assessed using a childbirth attitude questionnaire at two stages (before attending CPC or receiving RPC, then at the third trimester of pregnancy). Both groups were followed up to the delivery time. Data were analyzed using inferential and descriptive statistics (Chi square, paired t-test, ANOVA, t-test) through SPSS v.16. P<0.05 was considered as significant.

Results: There was no significant difference (P=0.23) in the mean score of fear of NVD between two groups before attending CPC (35.59±8.78) and receiving RPC (37.08±9.08). The comparison of the mean score of fear of NVD between two groups at the third trimester of pregnancy showed a significant reduction (P<0.001) in the first group (32.30±8.31) than in the second group (37.29±9.55). A significant difference was also observed between two groups in the rate of NVD (P=0.002).

Conclusion: Results confirm the importance of CPC in decreasing fear of NVD and increasing the rate of NVD in primigravid women attended these classes. Therefore, women’s attendance at CPC is recommended to be encouraged.

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Background & Aim: Mother-Child bonding is an emotional aspect of relationship between mother and baby that affects children's psychological development. This study was performed to determine the predictors of mother-child bonding.

Methods & Materials: This cross-sectional study was performed on 270 mothers 8 to 10 weeks postpartum referred to eighteen health centers of Tabriz, 2014-2015. Data were collected using the obstetric and socio-demographic characteristics questionnaire, the Postpartum Bonding Questionnaire, the Edinburgh Postnatal Depression Scale and the Spielberger State-Trait Anxiety Inventory. The statistical tests including Pearson correlation, Independent t, one-way ANOVA and multivariate linear regression were used for data analysis through SPSS v.21. The significance level was considered as P<0.05.

Results: The mean (SD) of mother-child bonding score was 46.2±8.4, with achievable scores range from 0 to 125. 85.2% of mothers had a mother-child bonding disorder. The most frequent disorder pertained to the dimension of impaired mother-child bonding and the least frequent disorder was anxiety about child care. Variables of depression, state anxiety and unwanted pregnancy were among the predictors of mother-child bonding.

Conclusion: The study shows that anxiety, depression, and unwanted pregnancy are the determinants affecting mother-child bonding. Thus, the screening of mothers for the early identification and treatment of anxiety and depression, and also the reduction of unwanted pregnancy rate using purposeful family planning counseling can improve the mother-child bonding, resulting in improved children's growth and development.

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Background & Aim: Cesarean rate has had a rising trend in Iran during the last two decades. Natural childbirth promotion plan has been implemented in the form of health sector evolution plan (HSEP) in order to increase natural childbirth. Present study aimed to evaluate the effect of health sector evolution plan on cesarean rate and the average costs paid by mothers hospitalized in Kurdistan province.

Methods & Materials: This descriptive study was conducted as longitudinal and retrospective study. Cesarean rate in all hospitals of Kurdistan province was assessed in 2013 and one year after the implementation of HSEP. Furthermore, data related to the percentage of out of pocket expenditures by pregnant mothers in one of the hospitals of Kurdistan University of Medical Sciences, which was randomly selected, was also studied. Data were analyzed using SPSS v.20.

Results: There was a 14.02% reduction in the rate of cesarean in Kurdistan province one year after the implementation of HSEP compared to its basal rate in 2013 (P<0.001). The average out of pocket expenditures was 16.05% before the implementation of HSEP. This rate was reduced to 4.30% and 2.5% respectively after the implementation of first and third phases of HSEP.

Conclusion: Natural childbirth promotion plan has reached its predetermined goal, which was a 10% decrease in cesarean rate one year after the implementation of HSEP compared to its rate in 2013. In addition, there was a significant reduction in the percentage of out of pocket expenditures.

Background & Aim: Cesarean rate has had a rising trend in Iran during the last two decades. Natural childbirth promotion plan has been implemented in the form of health sector evolution plan (HSEP) in order to increase natural childbirth. Present study aimed to evaluate the effect of health sector evolution plan on cesarean rate and the average costs paid by mothers hospitalized in Kurdistan province.

Methods & Materials: This descriptive study was conducted as longitudinal and retrospective study. Cesarean rate in all hospitals of Kurdistan province was assessed in 2013 and one year after the implementation of HSEP. Furthermore, data related to the percentage of out of pocket expenditures by pregnant mothers in one of the hospitals of Kurdistan University of Medical Sciences, which was randomly selected, was also studied. Data were analyzed using SPSS v.20.

Results: There was a 14.02% reduction in the rate of cesarean in Kurdistan province one year after the implementation of HSEP compared to its basal rate in 2013 (P<0.001). The average out of pocket expenditures was 16.05% before the implementation of HSEP. This rate was reduced to 4.30% and 2.5% respectively after the implementation of first and third phases of HSEP.

Conclusion: Natural childbirth promotion plan has reached its predetermined goal, which was a 10% decrease in cesarean rate one year after the implementation of HSEP compared to its rate in 2013. In addition, there was a significant reduction in the percentage of out of pocket expenditures by mothers.

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Background & Aim: Unhealthy snacks consumption has an important role in childhood obesity. The aim of this study was to evaluate the effect of an educational intervention for mothers on the consumption of healthy snacks in children aged 1-5 years using social cognitive theory.

Methods & Materials: This quasi-experimental study was (IRCT2013062912456N2) conducted on 126 mothers who had children 1-5 years old in 2013. The mothers were selected from Hamadan health centers and divided into two groups of intervention and control. The intervention consisted of four sessions, a booklet, a short video, and 6 written messages. The constructs of SCT and food consumption frequency were assessed at baseline, 10 days after the last session and 2-months after the intervention. The data were analyzed by Chi-square test, independent t-test, repeated measures and covariance analysis using SPSS software version 16.

Results: At baseline, the two groups were similar in the demographic characteristics, the constructs of SCT, and unhealthy snacks consumption frequency (P>0.05). Considering that the interaction effects of group and time in the repeated measurement analysis of variance were significant, the means of two groups were compared at each stage using independent t test and significant differences between the two groups were observed at two stages after the intervention.

Conclusion: This intervention had a positive effect on the consumption of healthy snacks. Therefore, SCT and the implemented procedure could be used to develop interventions to modify snack consumption patterns in children.

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Background & Aim: Culturally sensitive care is an essential component of professional development process and one of the predictive factors of nurses’ cultural competency. This care is the most important approach to improve the quality of nursing care in culturally diverse groups. The current study aimed to explore the consequences of culturally sensitive care in pediatric nursing.

Methods & Materials: This study is a qualitative study using conventional content analysis. 25 nurses and 9 parents were purposefully selected with maximum variation sampling from the pediatric wards of three referral teaching hospitals in Tabriz and Tehran in 2015-2016. Data were collected through in-depth interviews and field notes and simultaneously analyzed using MAXQDA software version 10.

Results: The consequences of culturally sensitive care in pediatric nursing emerged in two categories: justice-based care (with three subcategories: the lack of cultural bias, culture-based communication and effective participation) and cultural satisfaction (with two subcategories: reduced cultural stress and safe care). Culturally sensitive care prevents misunderstandings and improves nurse-child/parents communication and leads to parents’ honesty to share information and express cultural needs. The expression of cultural needs decreases stress levels in parents and children and results in safe care by reducing intractable traditional treatment.

Conclusion: According to the findings of this study, it is suggested that effective culturally sensitive interventions in pediatric wards should be included in in-service courses and nursing curriculum.

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Background & Aim: The delay in childbearing is associated with a reduction in the total fertility rate and increase in the risk of pregnancy at an older age. Social learning theory has mostly been used to clarify the interaction between personal and environmental factors and behavior. In order to understand the factors underlying delayed childbearing, the present study aimed to predict the factors affecting the delay in first childbearing among young married women using the Bandura’s social learning theory.
Methods & Materials: This cross-sectional correlational study was conducted on 284 married women referred to the health centers and OB/GYN clinics of teaching hospitals in Mashhad in 2015-2016. The data collecting tool was comprised of five questionnaires regarding to personal and social factors. Data were analyzed by descriptive statistics, Pearson and Spearman correlation co-efficient, linear regression and multivariate regression using the SPSS software version 16.
Results: The mean age of participants was 27.99±4.2, and the mean interval between marriage and the first child was 3.22±1.96, which was 1.25 years more than that of ideal spacing between marriage and childbirth. Multiple linear regressions showed negative and positive fertility motivations, perceived maternal self-efficacy, martial relationship, the number of sisters and childbearing-related religious beliefs had a significant effect on the interval between marriage and first childbirth (P<0.01).
Conclusion: The individual and environmental factors predicting delay in the first reproductive behavior were identified using the Bandura's social learning theory. The both factors should be considered in designing intervention programs for increasing fertility rate.
 

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Background & Aim: Family-centered care is a concept for describing the approach to caring for children and their families in health services and its main element is the involvement of parents in child care. This study aimed to compare the perception of family-centered care from the perspectives of nursing staff and mothers of hospitalized children in children’s wards.
Methods & Materials: This study was a cross-sectional study conducted on 82 mothers of hospitalized children and 60 nurses working in children’s wards of Afzalipour hospital in Kerman in 2017. In this study, a questionnaire on the family-centered care perception from the perspectives of nurses and mothers was used for data collection. Data were analyzed through SPSS software version 20 using t test, analysis of variance and Pearson correlation coefficient.
Results: Average scores for the perception of family-centered care from the perspective of nurses (3.17±0.79) and of the mothers (2.47±0.85) had significant differences between the two groups (P<0.001). In two groups, the highest average was related to the area of cooperation and the lowest average was related to the support area.
Conclusion: Findings showed nurses’ and mothers’ perceptions of family-centered care were positive but nurses have significantly more positive perception than mothers. This can be promising and nursing staff are required to be diligent about mothers’ participation in care so that the child receives better care.
 

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Background & Aim: The physiologic childbirth program in Iran is an emerging program that needs to be evaluated like any other program to improve its quality and process. Evidence suggests that the implementation of the physiologic childbirth program faces some challenges. The present research aimed to explore the challenges of the physiologic childbirth program from the perspective of service providers.
Methods & Materials: This qualitative research was carried out through a content analysis method in two mother-friendly hospitals of Ahwaz and Mashhad in 2016-2017. Data were collected through semi-structured interviews with 17 physiologic childbirth service providers. The content analysis method of Elo and Kyngas was used for qualitative data analysis.
Results: Data analysis led to five main categories: low motivation of midwives in performing physiologic childbirth; barriers related to manpower; medical interventions in physiologic childbirth; challenges from the environment and facilities; and educational barriers.
Conclusion: Different challenges in interaction with each other create a complex environment in which the implementation of physiologic childbirth program becomes more difficult. Therefore, policymakers, authorities, doctors, midwives and mothers need to work in a coordinated way to resolve the mentioned challenge.
 

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Background & Aim: Stoma in children causes physiological and psychological changes and reduces self-esteem and quality of life. The aim of study is to determine the effectiveness of self-care skills training on self-esteem and quality of life in 8-12 year old children with stoma.
Methods & Materials: This study is a non-randomized clinical trial with pretest and posttest design, performed in selected hospitals (Mofid, Hazrat Ali Asghar and Medical Center) in Tehran in 2016-17. A total of 36 children aged 12-8 years with stoma, were selected using the convenience sampling method and divided into two groups of intervention (n=18) and control (n=18). Self-care skills training was performed in six sessions of 45 minutes for the intervention group. The control group received routine care. The Cooper Smith questionnaire and the Kindle quality of life questionnaire were used in this study. Data were analyzed by descriptive and inferential statistics using the SPSS software version 16.
Results: The repeated measures analysis of variance showed a significant difference in the quality of life score means over time (P<0.005) and between the two groups of intervention and control (P<0.015). Also, there was a significant difference in the self-esteem score means over time (P=0.004) and between the intervention and control groups (P=0.004).
Conclusion: Self-care skills training for 8-12 year-old children with stoma, has increased their self-esteem and quality of life. Therefore, nurses can use self-care skills training for similar patients.
Clinical trial registry: IRCT20160802029166N2
 

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Background & Aim: The goal of asthma treatment and management is its control. Yoga is one of the complementary treatments which is used to control asthma. This study aimed to determine the effect of yoga breathing exercises on asthma control in 5-11 year-old children with asthma.
Methods & Materials: In this quasi-experimental study, 84 children with asthma, aged 5-11 years, referred to Asthma and Allergy Clinic of Aliasghar hospital, were included in the study in 2018. The participants were selected through continuous sampling and non-randomly allocated to an experiment- or a control group (42 in each group). The Childhood Asthma Control Test (C_ACT) was used to collect the data, before and after the intervention. The intervention included yoga breathing exercises. The researcher trained the children and their parents at the clinic and these exercises were performed by the children for two months, with parental supervision at home. Data were analyzed by the SPSS software version 21 using independent t-test, paired t-test, chi-square and Fishers exact test.
Results: The mean of age was 8.42(1.96) for the experiment group and 8.11(1.8) for the control group. In the experiment group, 76.2% were male, and 23.8% were female. In the control group, 73.8% were male and 26.2% were female. Before the intervention, the mean of asthma control score was 17.81±4.42 for the experiment group and 18.38±4.24 for the control group but this difference was not statistically significant (P=0.54). After the intervention, the mean of asthma control score for the experiment group and control group was 21.69±1.6 and 19.83±2.4, respectively. This difference was statistically significant (P˂0.001).
Conclusion: Yoga breathing exercises improved asthma in children. According to the results, yoga breathing exercises are suggested as scientific, simple and refreshing techniques in children with asthma.
Clinical trial registry: IRCT20180501039489N1
 

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Background & Aim: Considering the importance of accidents prevention especially in children under 5 years, the study was conducted to determine the predictor factors for household accidents in children under 5 years based on protection-motivation theory (PMT) in Bushehr.
Methods & Materials: In this descriptive study, 700 mothers with a child aged 6 months to 5 years, referred to health centers in Bushehr were selected by the convenience sampling method from March to August 2018. To collect the data, a valid and reliable self-structured questionnaire including demographic characteristics, questions on constructs of PMT and questions on the household accidents prevention behaviors was used. Data were analyzed by the SPSS software version 22.
Results: In this study, 86% of mothers (602) were housekeeper and 46% (326) had academic education. The most common accident prevention behavior was preventing access to drugs, chemicals and toxins (98%). Perceived self-efficacy (P<0.001, B=0.259) and perceived cost (P<0.001, B=-0.159) were significant predictors for household accident prevention behaviors in children under 5 years, and perceived self-efficacy was the most predictors construct. Based on the linear regression model, these two constructs along with a history of prior accident, predicted 15% (R²=0.150) of behavioral changes.
Conclusion: According to the results of the study, the PMT is a poor predictor for accident prevention behavior, and in educational programs, emphasis on promoting self-efficacy and providing assistance to reduce barriers and difficulties in creating safety in the home (decreasing perceived cost) are necessary for reducing household accidents in children under 5 years.
 

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Background & Aim: Caring for children with chronic illness is associated with the care burden of families and affects their self-efficacy. In addition, family-centered care can have positive outcomes. The aim of this study was to determine the relationship of the perception of family-centered care, burden of care and self-efficacy in the mothers of children with chronic illness.
Methods & Materials: This descriptive-analytical study was conducted in 2019 on 220 mothers of children with chronic illness, admitted to pediatric hospitals in Tehran and were selected using the convenience sampling method. Data were collected using the Perception of Family-Centered Care-Parent, Perceived Maternal Parenting Self-Efficacy, and the Impact-on-Family Scale. Data were analyzed by SPSS software version18 using descriptive and inferential statistics such as Pearson correlation and regression tests at the significance level of 0.05.
Results: Results showed that perception of family-centered care is directly associated with self-efficacy and inversely associated with the burden of care (respectively P<0.001 and P=0.022), so that for each 1-unit increase in the score of perception of family-centered care, self-efficacy of mothers increased by 0.25 and the burden of care decreased by 0.23. No significant association was found between self-efficacy and the burden of care (P=0.962).
Conclusion: Given that family-centered care can lead to an increase in self-efficacy and a reduction in the burden of care, nurses can improve mothers’ self-efficacy and reduce their burden of care by improving family-centered care.
 

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Background & Aim: Tokophobia was introduced as a psychiatric disorder for the first time in 2000. The purpose of this study is to answer four questions: What is tokophobia and how does it occur? What is the global prevalence of tokophobia? What are the symptoms of tokophobia? and what are the strategies for the control and treatment of tokophobia?
Methods & Materials: This systematic review was conducted by searching articles in English and Persian published between January 2000 and January 2018 on international databases; PubMed, Scopus, Web of Science, Google Scholar, Science Direct, and domestic databases; Magiran and SID, along with a manual search in resources.
Results: After reviewing 151 articles, finally 16 were included in the study. The results indicate that tokophobia is a severe and pathological fear of childbirth. In the categorization of psychiatric disorders, it is classified as a specific phobia based on the Diagnostic and Statistical Manual of Mental Disorders, 4^th edition (DSM-IV). The etiology of tokophobia is multifactorial, and its prevalence in pregnant women was reported around 14 percent among 18 countries. The signs and symptoms of the disorder are insomnia, crying, restlessness, depression, anxiety and severe worry about childbirth. Psychological strategies, cognitive behavior therapy and medication have been proposed to reduce the fear of childbirth in women in different studies.
Conclusion: As a guide, these results can assist the healthcare team members to recognize and screen at-risk women as well as to perform nursing interventions and psychotherapy in the prenatal and delivery stages.
 

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Background & Aim: The healthy nutrition education is one of the most important priorities in all life periods, especially in childhood. The teaching method is also considered one of the important factors for the effectiveness of education. Therefore, the aim of this study was to compare the effect of lecture and role-playing methods on awareness of healthy nutrition in school-age children.
Methods & Materials: This quasi-experimental study was conducted on 60 primary school students in Gonabad city in 2017. Participants were selected by multistage random sampling and allocated into two groups of role-playing and lecture. Students' awareness was measured by a self-structured questionnaire before, immediately and one month after education. Data were analyzed using the SPSS software version 16 by descriptive and inferential statistics. A P-value less than 0.05 was considered significant.
Results: The mean score of awareness for the role-playing group before, immediately and one month after the intervention respectively was 10.77±2.55, 14.1±55.15 and 14.50±1.10 and for the lecture group respectively was 11.07±1.85, 13.72±1.43 and 11.47±2.84 (the score range: 0-16). There was a significant difference in the mean score of awareness before, immediately and one month after the intervention between the two groups (P<0.001), and in the role-playing group, the increase in awareness score was more than in the lecture group.
Conclusion: Considering the greater effect of role-playing method than lecture on healthy nutrition education in school-age children, it is suggested that more attractive, dynamic and effective methods such as role-playing, in accordance with educational behavioral goals, be used in school nutrition education programs. In addition to enhancing educational efficiency, this will make the effects of education and learning more sustainable for students.
 

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Background & Aim: Structured description of pediatric medical emergencies requires the assessment and classification of underlying factors. The aim of study was to investigate frequency of predisposing factors for the entry of foreign bodies (FB) in the ear, ingestion and aspiration in children under five years in Tabriz.
Methods & Materials: This is a descriptive, cross-sectional study conducted through convenience sampling (n=245) in the ENT and emergency departments and the clinic of children's hospital in Tabriz, from March 2019 to June 2019. A researcher-made tool including the demographic characteristics form and questionnaire on predisposing factors was used to collect the data. Data was analyzed using the SPSS software version 21 through descriptive statistics.
Results: There were 137 (55.9%) cases of  FB aspiration into the airways (upper and lower), and the highest was related to nose. FB in ear was 19.6% and in stomach was 19.2%. Clinical manifestations were pain (50.2%), no clinical signs (29.4%), and the rest were bleeding with pain, cough, shortness of breath, suffocation, wheezing, nausea, and vomiting. The place of event was at home (in living room) and in the evening and night time. FB types included objects, food stuff/snacks/nuts, beans and fruit cores, and toy pieces, and it is most likely to be seed, toy pieces, nuts, shirt buttons, and rosary beads.
Conclusion: Parental, child-related, and environmental predisposing factors were reported. Therefore, future studies are suggested to evaluate the contribution of each of three factors and to implement necessary educational, notification, and interventional measures.
 

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Background & Aim: Tonsillectomy is one of the most common pediatric surgeries. Preoperative anxiety in children is one of the concerns of caregivers, and its management is an important part of nursing care. The aim of this study was to investigate the effect of guided imagery on anxiety in children candidate for tonsillectomy.
Methods & Materials: In this clinical trial, 70 children aged 7 to 12 years, candidates for tonsillectomy in the ENT ward of Amirkabir hospital in Arak in 2021 were divided into experimental or control groups. A demographic information form and the face anxiety scale were used to collect the data. In the control group, anxiety was assessed one hour before and 15 minutes before the surgery. In the experimental group, one hour before the operation and after completing the questionnaire, the child was asked to listen to an audio file with the hands-free for 15 minutes and visualize it in his mind. Then, the anxiety scale was completed again.
Results: The mean score of anxiety before the intervention was 4.31±0.79 in the experimental group and 4.06±0.87 in the control group, which had no statistically significant difference. The mean score of anxiety after the intervention was 3.83±0.89 in the experimental group and 4.89 ± 0.90 in the control group, which showed the mean score of anxiety of children after the intervention had a statistically significant difference between the two groups (P<0.001).
Conclusion: The preoperative intervention reduced preoperative anxiety in the children candidate for tonsillectomy. This intervention is an easy and safe process and can be used as an effective method.
Clinical trial registry: IRCT20211008052701N1

 

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Background & Aim: Child marriage is a violation of human rights and children's rights. Since most of these marriages take place without the informed consent of children, and parents are the final decision makers. Therefore, the mothers’ attitude towards the marriage of girls can have an undeniable effect on the early marriage of their daughters. The aim of the present study was to determine the knowledge and attitude of mothers with teenage daughters towards early marriage, its causes and consequences.
Methods & Materials: This descriptive-analytical, cross-sectional study was conducted on 270 mothers with teenage daughters in Tabriz in 2020-2021. Data were collected using a researcher-made questionnaire, and were analyzed using descriptive statistics, one-way analysis of variance, Chi-square test and Fisher's exact test through the SPSS software version 21.
Results: More than half (55.2%) of the mothers had a good level of knowledge about early marriage. The majority of mothers (87.0%) were against marriage before the age of 18. There was a statistically significant relationship between mothers' knowledge and attitude towards early marriage (P<0.001). The emotional, social, intellectual and economic maturity of girls were the most important reasons for the decrease in early marriage, and one of the most important reasons for the increase in early marriage was not reaching intellectual-psychological maturity. The most important consequence of early marriage from the mothers' points of view was the high possibility of family involvement in married life and decision-making.
Conclusion: Despite the negative attitude of mothers towards early marriage, nearly half of them had poor and moderate levels of knowledge regarding early marriage. Therefore, raising the level of knowledge of mothers with teenage daughters about the consequences of early marriage, creating a culture to correct social misconceptions, passing appropriate laws to prevent child marriage, can reduce the severity of this harm.

 

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Background & Aim: Fear of childbirth is one of the reasons for choosing cesarean section. Given the consequences of repeated cesarean section, interventions that control the fear of childbirth are important in mother's decision for the mode of birth. The aim of the study is to assess the effect of individual counseling based on the Fogg model on the motivation and the fear of natural childbirth in women with previous cesarean section.
Methods & Materials: In this clinical trial, 62 pregnant women with a previous cesarean section, referred to Mashhad Comprehensive Health Centers in 2020, were randomly assigned into intervention or control groups. In the intervention group, individual counseling based on the Fogg model was provided in two face-to-face 45-60 minute sessions biweekly and one non-face-to-face session on the Telegram channel at 28-30 weeks of pregnancy. Data was collected by a demographic form, the motivation questionnaire, and the Wijma expectation/ experience questionnaire at the beginning and two weeks after the intervention. Data analysis was performed using statistical tests by the SPSS software version 25 at a significance level of 0.05.
Results: The mean difference of the fear of childbirth score before and after the intervention was 15.84±20.07 for the intervention group and 6.06±23.28 for the control group. Counseling with the fog approach has significantly changed the fear of childbirth score in the intervention group compared to the control group (P<0.001), but the changes in motivation were not statistically significant.
Conclusion: Counseling with the Fogg approach reduced the fear of childbirth score. It is recommended to use this counseling method to reduce the fear of childbirth, and to use strategies to increase the motivation for natural childbirth after cesarean section.
Clinical trial registry: IRCT20200105046014N1

 

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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.

 

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Background & Aim: Pressure ulcers pose a serious and anticipated challenge within the health system. The present study aimed to determine the incidence of pressure ulcer and associated factors among children and newborns.
Methods & Materials: In this cohort study a sample size of 1025 children aged 0 to 14 years hospitalized in two medical training centers affiliated with Kermanshah University of Medical Sciences, were included. The sampling method employed was convenience sampling, conducted between March and July 2022. The data collection tools utilized in this study included a demographic information questionnaire, the Glasgow Coma Scale, National Pressure Ulcer Counseling Association classification, and Braden Q Scale. The data was analyzed using both univariate and multivariate logistic regression analyses.
Results: The incidence rate of pressure ulcers was found to be 4.97% (51 people). In terms of severity, the majority of pressure ulcers were categorized as first grade, accounting for 82.14% (46 people), with the hand area being the most frequently affected site of ulceration, representing 35.71% (20 people). The factors exhibited a significantly higher relative risk of pressure ulcers in children and infants included consciousness level of less than 14 (RR=6.07, 2.90-12.73: 95%CI), hospitalization duration of more than five days (RR=1.08, 1.05-1.12: 95%CI), presence of respiratory problems (RR=2.17, 1.19-3.94: 95%CI), immobility (RR=6.46, 3.44-12.13: 95% CI), utilization of NCPAP mask (RR=1.11, 1.05-1.18: 95% CI), and pulse oximeter (RR=6.07, 1.03-1.10: 95% CI). In the multivariate analysis, hospitalization duration of more than five days (RR=4.89, 2.29-10.40: 95% CI, P<0.001) and immobility (RR=2.49, 1.29-6.29: 95% CI, P=0.01) were found to be significantly associated with an increased risk of pressure ulcers.
Conclusion: The incidence rate of pressure ulcers observed in the present study was relatively low, measuring below 5%. Notably, prolonged hospitalization duration and immobility were identified as the most important risk factors contributing to the development of pressure ulcers among children and infants. Moreover, the utilization of specific medical devices, especially angiocaths and NCPAP masks, as well as the presence of respiratory diseases emerged as additional significant factors associated with the occurrence of pressure ulcers.