Spiritual Needs of Iranian Patients with COVID-19: A Qualitative Study.

Facing crises, life problems, and illnesses, many people turn to religion, spirituality, and faith as a psychosocial adjustment approach. This qualitative study assessed the spiritual needs of fourteen Iranian patients who recovered from COVID-19. Qualitative content analysis resulted in three themes, including "composure" with three categories of "prayer", "hope", and "connection"; "meaning in the life" comprising two categories of "a new prospect of life" and "the power of nature"; and "global responsibility" involving one category of "the relationships between individuals, communities, and the world". This study highlighted that patients relied on spirituality to cope with COVID-19 disease.

Determinants of women's agency in accessing and utilising reproductive healthcare services; a systematic review.

Women's agency is vital to access and use reproductive healthcare services, particularly in contexts where patriarchal beliefs and cultural norms limit women's desire to act on their goals or affect their access to essential resources. However, less is known about what resources enable women to exercise agency to access these services. A comprehensive systematic review was conducted to summarise existing evidence on the determinants of women's agency in accessing and using reproductive healthcare services. Various determinants were identified, including individual characteristics; household structure; reproductive health-related determinants; social relations; and economic factors. These determinants of women's agency in accessing reproductive healthcare services were strongly associated with social norms and cultural beliefs. Several gaps in the literature included inconsistent definitions and measurement of women's agency; lack of considering cultural sensitivities and socially acceptable practices in the conceptualisation and measurement of women's agency; a narrow focus on services related predominantly to pregnancy and birth, with other aspects of services including sexual health and safe abortion being largely unreported. The literature focused on developing countries in Africa and Asia, leaving a significant gap in knowledge about women's agency to access services in other geographical areas or among immigrant or refugee populations living in developed countries.

Maternal and Neonatal Outcomes of COVID-19 Infection in Pregnancy.

BACKGROUND: Limited data is available on the full spectrum of maternal COVID-19 infection in terms of pregnancy outcomes. The present study aimed to compare the maternal and neonatal outcomes of COVID-19 in infected and non-infected pregnant women. METHODS: A dual-site retrospective cohort study was conducted in two tertiary hospitals in Isfahan, Iran. The sample included 104 infected and 210 non-infected hospitalized pregnant women. Odds ratios (OR) were estimated using multivariate logistic regression. RESULTS: There were significant differences between COVID-19-infected and non-infected pregnant women regarding preterm labor (PTL) (odds ratio [OR]: 11.34, 95% confidence interval [CI]: 1.19-48.54, P=0.035); hospitalization days (OR: 7.21, 95% CI: 4.05-12.85, P≤0.001); cesarean section (CS) (OR: 4.76, 95% CI: 1.78-12.45, P=0.002); neonatal admission to neonatal intensive care unit (NICU) (OR: 1.28, 95% CI: 1.12-1.67, P=0.004); and neonatal respiratory distress (OR: 2.37, 95% CI: 1.02- 5.47, P=0.044). No significant association was found between COVID-19 infection and abortion (OR: 0.06, 95% CI: 0.01-1.45, P=0.084); stillbirth (OR: 1.84, 95% CI: 0.05-39.68, P=0.743); Apgar score (1 minute) (OR: 0.91, 95% CI: 0.74-1.13, P=0.382); Apgar score (5 minutes) (OR: 0.97, 95% CI: 0.81-1.18, P=0.765); and low birth weight (LBW) (OR: 4.76, 95% CI: 1.78-12.45, P=0.002). CONCLUSION: PTL, CS, neonatal admission in NICU, neonatal respiratory distress, and hospitalization days were significantly higher in pregnant women with COVID-19 compared to those without infection.

The impact of migration and settlement context on Iranian Women's agency in accessing and using reproductive healthcare services in Australia: A qualitative study.

This qualitative study aimed to understand how immigration and settlement context shape Iranian immigrants' agency in accessing and using reproductive healthcare services (RHCS). Twenty-one Iranian women of reproductive age (18-49 years) living in Australia were recruited in 2022 through social media platforms. The findings highlighted that although Iranian women's utilisation of RHCS in Australia is highly constrained by established sociocultural beliefs and values of their origin country, they become agents of making changes over their reproductive choices, reformulating beliefs and values, and taking control of reproductive health because of Australian sociocultural norms and context. This suggests a tension between the impacts of sociocultural contexts in their origin country and becoming agents of change after migrating to Australia. These findings need to be included in healthcare policy and practice to support greater consideration of cultural sensitivities and specific needs of immigrant women when accessing Australian RHCS.

The Impact of Women's Agency on Accessing and Using Maternal Healthcare Services: A Systematic Review and Meta-Analysis.

Agency, defined as the ability to identify one's goals and act upon them, has been recognized as a prominent strategy to access maternal healthcare services (MHS). The purpose of this study was to synthesize evidence of the association between women's agency and MHS utilization. A systematic review was performed on five academic databases, comprising Scopus, PubMed, Web of Science, Embase, and ProQuest. Meta-analysis was performed with a random-effects method using the STATA™ Version 17 software. A total of 82 studies were selected following the PRISMA guidelines. The meta-analysis demonstrated that an increase in women's agency was associated with a 34% increase in the odds of receiving skilled antenatal care (ANC) (OR = 1.34, 95% CI = 1.18-1.52); 7% increase in the odds of initiating the first ANC visit during the first trimester of pregnancy (OR = 1.07, 95% CI = 1.01-1.12); 20% increase in the odds of receiving at least one ANC visit (OR = 1.20, 95% CI = 1.04-1.4); 16% increase in the odds of receiving more than four ANC visits during pregnancy (OR = 1.16, 95% CI = 1.12-1.21); 17% increase in the odds of receiving more than eight ANC visits (OR = 1.17, 95% CI = 1.04-1.32); 13% increase in the odds of facility-based delivery (OR = 1.13, 95% CI = 1.09-1.17); 16% increase in the odds of using skilled birth attendants (OR = 1.16, 95% CI = 1.13-1.19); and 13% increase in the odds of receiving postnatal care (OR = 1.13, 95% CI = 1.08-1.19) compared to low level of agency. Any efforts to improve MHS utilization and reduce maternal morbidity and mortality should include the promotion of women's agency.

Paternal Postnatal Depression During COVID-19 Pandemic: The Role of Health Care Providers.

BACKGROUND: The fast spread of COVID-19 can cause some psychological disorders for men. One of the psychological disorders is paternal postpartum depression (PPD). The aim of the present research was to review studies that have investigated paternal postpartum depression during the COVID-19 pandemic. MATERIALS AND METHODS: For this narrative review, databases such as Google Scholar, Scientific Information Databases (SID), Magiran, PubMed, Web of Science, and Scopus were searched for the full texts of published studies in the Persian and English languages in the period of 2019 to 2021. Finally, 3 articles were selected and reviewed in this study. RESULTS: The results of this review study were classified into 3 main categories such as (1) The psychological status of men during the COVID-19 pandemic, (2) The effect of paternal PPD on children's development and family psychological status during the COVID-19 pandemic, and (3) The role of healthcare providers in the management of paternal PPD. The findings of the studies showed that paternal PPD increases the rate of child maltreatment, maternal depression, and domestic violence. The promotion of the interpersonal skills of healthcare providers with fathers suffering from depression or psychological problems is the determinant factor of successful results. CONCLUSIONS: The results showed that paternal PPD has a wide range of consequences in this pandemic. Therefore, it would be recommended that healthcare staff have close contact with families and screen fathers for paternal PPD during the COVID-19 pandemic.

Development and Psychometric Properties of a Spiritual Needs Assessment Scale for Patients With COVID-19.

The current mixed methods, exploratory study aimed to develop and determine the psychometrics of a scale to assess the spiritual needs of patients with coronavirus disease 2019 (COVID-19). The study was performed in two stages: qualitative and quantitative. Through 14 interviews with patients with COVID-19, three themes, including Composure, Meaning in Life, and Global Responsibility, were formed. In the quantitative stage, content validity was achieved through the comments of 10 experts and patients. A total of 330 participants completed the instrument to assess construct validity. Exploratory factor analysis with 29 items and four subscales was performed, indicating a 6-point Likert scale. Cronbach's alpha coefficients ranged from 0.82 for the whole scale and 0.85, 0.81, 0.79, and 0.72 for the Composure, Communication, Meaning in Life, and Global Responsibility subscales, respectively. Intraclass correlation coefficient (test-retest analysis) was 0.79 and showed acceptable stability for the scale. The "Spiritual Needs Assessment Scale for COVID-19 Patients" is a 29-item multi-dimensional scale with robust psychometric properties, which can measure various aspects regarding the spiritual needs of patients with COVID-19. [Journal of Psychosocial Nursing and Mental Health Services, 60(4), 47-54.].

Women empowerment in reproductive health: a systematic review of measurement properties.

INTRODUCTION: There is a considerable dearth of official metrics for women empowerment, which is pivotal to observe universal progress towards Sustainable Development Goals 5, targeting "achieve gender equality and empower all women and girls." This study aimed to introduce, critically appraise, and summarize the measurement properties of women empowerment scales in sexual and reproductive health. METHODS: A comprehensive systematic literature search through several international electronic databases, including PubMed, Scopus, Embase, ProQuest, and Science Direct was performed on September 2020, without a time limit. All studies aimed to develop and validate a measurement of women empowerment in sexual and reproductive health were included. The quality assessment was performed through a rating scale addressing the six criteria, including: a priori explicit theoretical framework, evaluating content validity, internal consistency, and factor analysis to assess structural validity. RESULTS: Of 5234 identified studies, fifteen were included. The majority of the studies were conducted in the United States. All studies but one used a standardized measure. Total items of each scale ranged from 8 to 23. The most common domains investigated were decision-making, freedom of coercion, and communication with the partner. Four studies did not use any conceptual framework. The individual agency followed by immediate relational agency were the main focus of included studies. Of the included studies, seven applied either literature review, expert panels, or empirical methods to develop the item pool. Cronbach's alpha coefficient reported in nine studies ranged from α = 0.56 to 0.87. Most of the studies but three lack reporting test-retest reliability ranging r = 0.69-0.87. Nine studies proved content validity. Six criteria were applied to scoring the scales, by which nine of fifteen articles were rated as medium quality, two rated as poor quality, and four rated as high quality. CONCLUSION: Most scales assessed various types of validity and Internal consistency for the reliability. Applying a theoretical framework, more rigorous validation of scales, and assessing the various dimensions of women empowerment in diverse contexts and different levels, namely structural agency, are needed to develop effective and representing scales.

Impact of COVID-19 Infection on Neonatal Birth Outcomes.

INTRODUCTION: There is limited data on newborns born to mothers with COVID-19 infection. This multicenter cohort study aimed to investigate the clinical characteristics and outcomes of neonates born to mothers with and without COVID-19 infection to fill a gap in the literature review. METHODS: The medical records of all neonates in Isfahan, Iran, between October 2020 and March 2021, were retrospectively reviewed. RESULTS: Among the 600 neonates in this study, 255 (42.5%) were in the infected group and 345 (57.5%) were assigned to the control group as they were born to non-infected mothers. In the infected group, sepsis, fever and pneumothorax were detected in 3 (1.2%), 3 (1.2%) and 4 (1.6%) neonates, respectively, compared with no case in the control group. In the infected group, neonatal respiratory distress (NRDS) (32, 12.5%) was significantly higher than the control group (27, 10.6%). Asphyxia in the infected group was 22(6.4%), compared with 19 (5.5%), in the control group. Preterm labor (PTL) (55, 21.65%), premature rupture of membranes (PROMs) (24, 9.4%) and intra-uterine growth retardation (IUGR) (15, 5.9%) were significantly higher in women with COVID-19 (45, 13.0%, 4, 1.2% and 7, 2.0%, respectively). Low birth weight (LBW) accounted for 42 (16.5%) neonates in the infected group and 25 (7.2%) in the control group (p < 0.05). Of the 255 neonates born to infected mothers, 38 (14.9%) were admitted to the Neonatal Intensive Care Unit (NICU), compared with 31 out of 345 (9.0%) in the control group (p < 0.05). RT-PCR test results were positive in two newborns (0.8%), one of whom died of necrotizing enterocolitis. CONCLUSION: As a result of maternal COVID-19 infections, neonates experienced higher rates of sepsis, fever, pneumothorax, asphyxia and NRDS in addition to PTL, PROMs, IUGR, and LBW.

Contradictory results have been reported on the impact of COVID-19 infection on neonatal outcomes. We conducted a review of 600 cases of neonates, with 255 (42.5%) in the COVID-19 infected and 345 (57.5%) in the control group. The results indicated that neonates born to women with COVID-19 showed higher rates of sepsis, fever, pneumothorax, asphyxia and neonatal respiratory distress in addition to preterm labor, premature rupture of membranes, intra-uterin growth retardation and low birth weight.

Characteristics and outcomes of COVID-19 pneumonia in pregnancy compared with infected nonpregnant women.

OBJECTIVE: To compare the clinical and paraclinical features and outcomes of pregnant and nonpregnant women with COVID-19. METHODS: A multicenter retrospective cohort study of pregnant and nonpregnant women of reproductive age hospitalized between March and October 2020 in Tehran, Iran. Medical records were reviewed and women who tested positive for SARS-CoV-2 on RT-PCR were included. Extracted data were compared and logistic regression performed. RESULTS: A total of 110 pregnant and 234 nonpregnant COVID-19-positive women were included. Frequency of severe disease was higher in nonpregnant women than pregnant women (29% vs 11.8%; P < 0.001). Symptoms including cough, dyspnea, chill, fatigue, and headache were more frequent in nonpregnant women (P < 0.05). Pregnant women had higher oxygen saturation levels and lower lymphocyte count (P = 0.001). Six (5.5%) pregnant and 12 (5.1%) nonpregnant women died (P = 0.80). No significant differences between the groups were found for ICU admission and end organ failure. Significantly more nonpregnant women had acute respiratory distress syndrome (ARDS, 9.4% vs 0%; P = 0.001). Univariate regression indicated association between hypertension and death; oxygen saturation and ARDS; and body mass index and ICU admission. No association was found between pregnancy and death, ICU admission, or ARDS. CONCLUSION: Pregnant women with COVID-19 are not at higher risk of adverse outcomes compared with nonpregnant women.

The mental health of healthcare workers in the COVID-19 pandemic: A systematic review.

Purpose: The novel coronavirus 2019 (COVID-19) is widely spreading all over the world, causing mental health problems for most people. The medical staff is also under considerable psychological pressure. This study aimed to review all research carried out on the mental health status of health care workers (HCWs) to bring policymakers and managers' attention. Methods: A literature search conducted through e-databases, including PubMed, EMBASE, Scopus, and Web of Science (WoS) from December 2019 up to April 12th 2020. All cross- sectional studies published in English which assessed the health workers' psychological well-being during the SARS-CoV-2 pandemic included. Study quality was analyzed using NHLBI Study Quality assessment tools. Results: One hundred relevant articles were identified through systematic search; of which eleven studies were eligible for this review. Their quality score was acceptable. The lowest reported prevalence of anxiety, depression, and stress among HCWs was 24.1%, 12.1%, and 29.8%, respectively. In addition, the highest reported values for the aforementioned parameters were 67.55%, 55.89%, and 62.99%, respectively. Nurses, female workers, front-line health care workers, younger medical staff, and workers in areas with higher infection rates reported more severe degrees of all psychological symptoms than other health care workers. Moreover, vicarious traumatization in non-front-line nurses and the general public was higher than that of the front-line nurses. Conclusion: During SARS-CoV-2 outbreak, the health care workers face aggravated psychological pressure and even mental illness. It would be recommended to the policymakers and managers to adopt the supportive, encouragement & motivational, protective, and training & educational interventions, especially through information and communication platform.

Analysis of Maternal Coronavirus Infections and Neonates Born to Mothers with 2019-nCoV; a Systematic Review.

INTRODUCTION: The emergence and fast spread of 2019 novel coronavirus (2019-nCoV) threatens the world as a new public health crisis. This study aimed to clarify the impact of novel coronavirus disease (COVID-19) on pregnant patients and maternal and neonatal outcomes. METHODS: A comprehensive literature search was conducted in databases including PubMed, Scopus, Embase, ProQuest, and Science Direct. All studies including original data; case reports, case series, descriptive and observational studies, and randomized controlled trials were searched from December 2019 until 19 March 2020. RESULTS: The search identified 1472 results and 939 abstracts were screened. 928 articles were excluded because studies did not include pregnant women. Full texts of eleven relevant studies were reviewed and finally nine studies were included in this study. The characteristics of 89 pregnant women and their neonates were studied. Results revealed that low-grade fever and cough were the principal symptoms in all patients. The main reported laboratory findings were lymphopenia, elevated C-Reactive Protein (CRP), Amino alanine transferase (ALT), and Aspartate amino transferase (AST). In all symptomatic cases, chest Computerized Tomography (CT) scans were abnormal. Fetal distress, premature rupture of membranes and preterm labor were the main prenatal complications. Two women needed intensive care unit admission and mechanical ventilation, one of whom developed multi-organ dysfunction and was on Extracorporeal Membrane Oxygenation (ECMO). No case of maternal death was reported up to the time the studies were published. 79 mothers delivered their babies by cesarean section and five women had a vaginal delivery. No fetal infection through intrauterine vertical transmission was reported. CONCLUSIONS: Available data showed that pregnant patients in late pregnancy had clinical manifestations similar to non-pregnant adults. It appears that the risk of fetal distress, preterm delivery and prelabor rupture of membranes (PROM) rises with the onset of COVID-19 in the third trimester of pregnancy. There is also no evidence of intrauterine and transplacental transmission of COVID-19 to the fetus in the third trimester of pregnancies.

Effect of counseling on quality of marital relationship of infertile couples: a randomized, controlled trial (RCT) study.

BACKGROUND: Infertility is a major cause of marital problems and sexual dissatisfaction. This study was conducted to determine the effects of counseling on infertile couple's marital relationship and sexual satisfaction. MATERIALS AND METHODS: This study was performed as a randomized controlled trial (RCT) in which 100 infertile couples (200 participants) who visited Reproductive Health Research Center Tehran, Iran were randomly assigned into two groups: intervention (n = 50 couples, 50 wives and 50 husbands) and control (n = 50 couples, 50 wives and 50 husbands). Intervention was defined as three counseling sessions per week, each lasting 60-90 min. Counseling in the intervention group was conducted separately for each couple. Demographic characteristics and marital and sexual satisfaction were investigated using three questionnaires through interviews. The outcomes, including changes in marital satisfaction and sexual satisfaction, were compared between the two groups 3 months later. RESULTS: Based on the data collected 3 months after the intervention period, the mean scores of marital and sexual satisfaction in intervention and control groups for wives were 49.62 ± 11.09 versus 54.97 ± 12.64 (P = 0.036) and 36.00 ± 8.37 versus 40.04 ± 7.69 (P = 0.019), respectively. Respective scores for husbands were 45.48 ± 9.55 versus 50.08 ± 11.43 (P = 0.042) and 33.37 ± 7.09 versus 36.63 ± 6.52 (P = 0.025), respectively. It should be noted that higher scores in questionnaires inspecting marital and sexual satisfaction indicate lower satisfaction. CONCLUSIONS: Infertility counseling improves marital and sexual satisfaction in infertile couples.