What factors influence couples' decisions to have children? Evidence from a systematic scoping review.

BACKGROUND: One of the most significant demographic challenges over the past three decades has been the substantial reduction in fertility rates, worldwidely. As a developing country, Iran has also experienced a rapid decline in fertility over the past decades. Understanding factors influencing fertility is essential for development programs. Moreover, it's crucial to study the parameters that affect the intention for childbearing in any society. Therefore, through a systematic scoping review, the present study investigates the factors influencing couples' decisions toward childbearing. METHODS: This study was a systematic scoping review conducted in 2023. To design and conduct this scoping review, Joanna Briggs Institute's Protocol (Institute TJB, The Joanna Briggs Institute Reviewers ' manual 2015; methodology for JBI scoping reviews, 2015) was used and the framework presented by Levac et al. (2010) was also used as a guide for conducting this review. Studies were searched in three main databases including ISI Web of Sciences, PubMed, and Scopus, using a predefined search strategy. Google Scholar was also used for complementary search. The search period was from 2002 to 2022. RESULTS: A total of 18,454 studies were identified across three primary databases. After evaluating articles in three distinct phases based on title, abstract, and full-text, 46 articles were deemed eligible for inclusion in the scoping review. The qualitative analysis of the collected data from the selected studies through the scoping review led to classifying factors influencing households' desire for childbearing into eight main themes and 101 sub-themes. The main themes associated with factors impacting households' intention for childbearing encompass individual determinants, demographic and familial influencing factors, cultural elements, social factors, health-related aspects, economic considerations, insurance-related variables, and government support/incentive policies. CONCLUSIONS: Comprehensive and holistic attention from governments and officials toward the various factors affecting households' intention and behavior regarding childbearing appears beneficial and effective. Furthermore, given the relative ineffectiveness of some of the current government's supportive/incentive policies to increase couples' desire for childbearing, it seems necessary to review and amend these policies. This review should address the most significant challenges and factors contributing to couples' reluctance to childbearing or strengthen factors that can play a substantial role in fostering fertility and childbearing desires.

Tutorial on statistical data reduction methods for exploring dietary patterns.

Diet is one of the most important factors affecting human health and it is different for each person. Examining individual foods in the diet does not provide sufficient information to the researcher, so we need food patterns to obtain more complete information. Food pattern analysis is also a complementary approach that is carried out by statistical methods and provides additional evidence in this regard. In this tutorial article, we have tried to briefly explain all statistical analyses which can used for dietary pattern analysis.

COVID-19 pandemic has disrupted the continuity of care for chronic patients: evidence from a cross-sectional retrospective study in a developing country.

BACKGROUND: Any disruption in continuity of care for patients with chronic conditions can lead to poor outcomes for the patients as well as great damage for the community and the health system. This study aims to determine the continuity of care for patients with chronic conditions such as hypertension and diabetes during COVID-19 pandemic. METHODS: Through a cross-sectional retrospective study, data registered in six health centers in Yazd, Iran were analyzed. Data included the number of patients with chronic conditions (hypertension and diabetes) and average daily admission during a year before COVID-19 pandemic and the similar period after COVID-19 outbreak. The experience of continuity of care was assessed applying a validated questionnaire from a sample of 198 patients. Data analysis was done using SPSS version 25. Descriptive statistics, independent T-Test and Multivariable regression were used for analysis. FINDINGS: Results indicate that both visit load of the patients with chronic conditions (hypertension and diabetes) and their average daily admission were decreased significantly during a year after COVID-19 pandemic compared to the similar period before COVID-19 outbreak. The moderate average score of the patients` experience towards continuity of care during the pandemic was also reported. Regression analysis showed that age for the diabetes patients and insurance status for the hypertension patients affect the COC mean scores. CONCLUSION: COVID-19 pandemic causes serious decline in the continuity of care for patients with chronic conditions. Such a deterioration not only can lead to make these patients` condition worse in a long-term period but also it can make irreparable damages to the whole community and the health system. To make the health systems resilient particularly in disasters, serious attention should be taken into consideration among them, developing the tele-health technologies, improving the primary health care capacity, designing the applied responsive models of continuity of care, making multilateral participations and inter-sectoral collaborations, allocating sustainable resources, and enabling the patients with selfcare skills are more highlighted.

A national survey of Iranian general population to estimate a value set for the EQ-5D-5L.

OBJECTIVES: The main aim of this study is to estimate a national value set of the EQ-5D-5L questionnaire for Iran. METHODS: The composite time trade-off (cTTO) and discrete choice experiment (DCE) methods; and the protocol for EuroQol Portable Valuation Technology (EQ-PVT) were used to estimate the Iran national value set. 1179 face-to-face computer-assisted interviews were conducted with adults that were recruited from five Iran major cities in 2021. Generalized least squares, Tobit, heteroskedastic, logit, and hybrid models were used to analyze the data and to identify the best fitting model. RESULTS: According to the logical consistency of the parameters, significance levels and prediction accuracy indices of the MAE; a heteroscedastic censored Tobit hybrid model combining cTTO and DCE responses was considered as the best fitting model to estimate the final value set. The predicted values ranged from - 1.19 for the worst health state (55555) to 1 for full health (11111), with 53.6% of the predicted values being negative. Mobility was the most influential dimension on health state preference values. CONCLUSIONS: The present study estimated a national EQ-5D-5L value set for Iranian policy makers and researchers. The value set enables the EQ-5D-5L questionnaire to use to calculate QALYs to assist the priority setting and efficient allocation of limited healthcare resources.

A study of factors affecting the length of hospital stay (LOS) of COVID-19 patients: A qualitative evidence in Iranian hospital.

BACKGROUND: The present study aimed to identify the administrators' and physicians' experiences and viewpoints about the factors affecting the length of stay (LOS) of COVID-19 patients and provide valid operational evidence. MATERIALS AND METHODS: The current study was carried out qualitatively and phenomenologically on experts, officials, and administrators of hospitals in 2021. Purposeful sampling was performed with the maximum diversity. To achieve a comprehensive view, snowball sampling was conducted. Twenty-one experts in the field of healthcare and emerging diseases participated in this study. Semi-structured interviews were used to collect the data. The study sites were universities of medical sciences and hospitals of the Ministry of Health of Iran. The interview questions included questions about the factors affecting the LOS and strategies for controlling the LOS of COVID-19 patients in infectious units. Text analysis was performed through the content analysis method in MAXQDA-10 software. RESULTS: Based on the experts' viewpoints, several factors affected the LOS in COVID-19 patients. These factors were divided into five clinical, preclinical, economic, social, and management subcategories. The proposed solutions included policy solutions (supportive policies, development of home care services, training and culture building, and establishment of clinical guidelines) and operational solutions (drug management, promotion of equipment and facilities, telehealth or telemedicine services, and promotion of clinical and support processes). CONCLUSION: One of the main tasks of hospital administrators is identifying the factors affecting the reduction of LOS. Among these factors, clinical and management factors in the hospital are more important and need more planning and attention by hospital officials.

Frequency of the Statistical Methods and Relation with Acceptance Period in Archives of Iranian Medicine Articles: A Review from 2015-2019.

BACKGROUND: Statistical methods (SM) are a ubiquitous tool in research. This study aimed to review SM used in original article published in the Archives of Iranian Medicine (AIM) and assess their effect on article acceptance period. METHODS: The original articles published in the period 2015-2019 from volumes 18 to 22 and issues 1 to 12 of the AIM were reviewed and six items such as SM, study design, statistical population, sample size, software and acceptance period were extracted. Mean (SD), frequency (percentage) and multiple response analysis (MRA) were used for description. The Kruskal-Wallis test and Spearman correlation coefficient were used for data analysis in SPSS 26 with significance level at 5%. RESULTS: During the study period, 423 original articles were reviewed. The statistical population in most of them was patients (38.8% and 164 articles), and most studies (51.5% and 218 articles) had a sample size of less than 500 people. The study design in most of the articles was analytical-observational (55.1% and 233 articles), and 79.7% (337 articles) used SPSS for data analysis. The median (IQR) acceptance period was 194 (134.25). MRA results showed that the highest rate of use of SM was related to descriptive statistics (277 articles, 30.3%) and Chi square test (130 articles, 14.2%). In the last two years, the acceptance period had a declining trend. There was no significant relation between mentioned variables and acceptance period (P>0.05). CONCLUSION: Contrary to the researchers' misconceptions, the acceptance period was not affected by SM, study design, statistical population, sample size, or type of software.

Investigating medical tourism development indicators in Yazd Reproductive Sciences Institute: A cross-sectional study.

Background: Payingspecial attention to the development indicators of medical tourism (MT) can lead to the further development of this industry and tourists' satisfaction. Objective: This study aimed to investigate MT development indicators in Yazd Reproductive Sciences Research Institute, Yazd, Iran in 2021. Materials and Methods: In this cross-sectional study, 430 medical tourists referred to the Yazd Reproductive Sciences Institute, Yazd, Iran in 2021 were studied. A researcher-made questionnaire with 46 questions and 10 dimensions was used in both internal and external environments to collect data. The Spearman correlation coefficient was also used to assess the correlation between the quantitative factors. Results: The reliability and validity of the scale were confirmed. The mean ± SD of the advertising and marketing index scored was lower than the other internal environmental indices (15.05 ± 2.16). Also, the economic factors and tourism infrastructure were lower than the other external environmental factors (9.8 ± 1.99, 8.53 ± 2.11, respectively). Conclusion: Given the importance of MT, top managers and relevant authorities should pay close attention to the criteria of advertising, marketing, and tourism infrastructure. MT demand can be improved by increasing the importance of advertising, implementing realistic advertising strategies, and developing adequate urban infrastructure and services.

Review of the Statistical Methods Used in Original Articles Published in Iranian Journal of Public Health from 2015-2019: A Review Article.

BACKGROUND: Nowadays, statistical methods are used frequently in research articles. This review study aimed to determine the statistical methods used in original articles published in Iranian journal of public health (IJPH). METHODS: Original articles in the period 2015 to 2019 from volumes 44 to 48 and numbers 1 to 12 were reviewed by a 3-member committee consisting of a statistician and two health researchers. The statistical methods, sample size, study design and population, type of used software were investigated. Multiple response analysis (MRA), Kruskal-Wallis test and Spearman correlation coefficient were used to data analysis. All analyzes were performed in SPSS21 software. Significant level was set at 0.05. RESULTS: Statistical population in most of the articles were related to human samples at the field level (36% and 297 articles). 66.6% (549 articles) had the sample size less than 500 cases. Study design in most of them were analytical observational 56.2% (464 cases). Acceptance period was 115.5 ± 52.27 days. All the mentioned variables had no significant relationship with the acceptance period (P>0.05). Both among the total tests and the articles, the highest rate of use of statistical methods was related to descriptive statistical method (34.4%, 75.8% and 532 articles), also, the highest use of tests was related to chi square test and t-test( (29%(450 articles)). CONCLUSION: Study design in most of the articles were analytical, to increase thematic diversity, accepting different articles seems necessary. The statistical tests, which used in most articles, were simple, so accepting articles with advanced statistical methods is recommended.