Psychological distress, social media use, and academic performance of medical students: the mediating role of coping style.

BACKGROUND: Given that social media use (SMU) is an increasingly widespread activity among university students, more information is needed to evaluate its relationship with students' mental health, particularly medical students. OBJECTIVE: The present study assessed the relationships between SMU and coping style with psychological distress and academic performance of medical students. METHODS: An offline cross-sectional survey conducted with 398 undergraduate medical students. The survey collected data on demographics, psychological distress (DASS-21), coping strategies (Brief COPE Scale), academic performance (grade point average) and estimated average time spent on social media per day. Structural equation modeling was used to clarify relationships between the main study variables. The study also examined the mediating effect of maladaptive coping between SMU and psychological distress. RESULTS: Students with higher levels of psychological distress were more likely to be engaged in frequent social media use. Spending more than two hours a day on social media use had a positive association with maladaptive coping (p < 0.001), particularly with substance use and behavioral disengagement both of which could negatively affect academic performance. Maladaptive coping mediated the relationship between students' SMU and psychological distress. CONCLUSION: The findings suggest that medical students commonly use social media as a maladaptive coping tool to deal with psychological distress. Empowering students to adopt and foster appropriate coping strategies could help them to enhance resilience against life stresses and ameliorate potential long-term mental health consequences associated with maladaptive behaviors.

Validation of the Retirement Resources Inventory in Persian: Assessing Psychometric Properties among Iranian Retirees.

Introduction: Retirement resources are considered one of the key determinants of well-being and coping with the challenging situations of retirement courses. Therefore, due to the lack of a valid questionnaire for research and practice at the national level as well as international comparisons, this study was conducted to translate the original retirement resources inventory into Persian and assess the validity and reliability of the Persian version. Materials and Methods: The research employed a cross-sectional descriptive methodological approach, beginning with translating the questionnaire into Persian. Psychometric properties were evaluated through face, content, construct validity, and reliability tests. 335 participants were involved in assessing construct validity, while 30 participants contributed to the internal consistency test, and 20 took part in the test-retest reliability test. Data analysis was performed using SPSS Version 26 and AMOS 24 software. Results: The exploratory factor analysis (EFA) revealed eight components with eigenvalues greater than 1, accounting for 46.68% of the variance, with no questions being removed. Confirmatory factor analysis (CFA) indicated that all items had a factor loading above 0.3, resulting in a final model with 35 items and eight factors, supported by fit indices (χ 2/df = 1.95, TLI: 0.87, IFI = 0.88, RMSEA = 0.05, GFI: 0.85). Reliability measures showed Cronbach's alpha coefficients ranging from 0.71 to 0.83 and an intraclass correlation coefficient (ICC) of 0.93. Conclusion: The study concludes that the Persian version of the RRI, encompassing 35 items across eight dimensions, is a valid and reliable tool for the Iranian retiree population. This validated inventory can be utilized in future national and international studies, particularly experimental ones, to develop well-being and retirement adjustment programs, thereby aiding in understanding and supporting Iranian retirees.

Psychometric Validation and Setting Cutoff Point for the Persian Version of Mindful Self-Care Scale (MSCS) Among Older Adults.

Mindful self-care is a valuable activity that contributes to old people's independence and self-control and its development is in line with the duties of social workers. This study aimed to validate the mindful self-care scale (MSCS) for Iranian old people and was performed on old people living in the community of Shiraz, Iran. This cross-sectional study was conducted on old people living in the community who met the inclusion criteria in Shiraz, Iran. After linguistic validation of the Persian version of MSCS with 36 items, face, and content validity were determined. Then the first part of construct validity was conducted using a kurtosis test, and exploratory factor analysis with the first sample (n = 250). After selecting the appropriate items, confirmatory factor analysis was assessed with the second sample (n = 250). Scale reliability was also evaluated. The optimal cut-off points were obtained by calculating the area under the curve (AUC). SPSS version 23 was used for further data analysis, while confirmatory factor analysis was conducted using AMOS version 24. Exploratory factor analysis loaded only 24 items with four factors. The modified second-order confirmatory factor analysis model displayed a good fit (RMSEA = 0.04; CFI = 0.90; GFI = 0.90). Cronbach's alpha coefficient of MSCS with 24 items was .94. The cut-off points were 38, 11, 23, and 17 for factors of resilience, goal achievement, supportive relationship, and self-care respectively, and 90 for the whole instrument. The study found that the MSCS short form with 24 items is valid and reliable in the Iranian elderly population, making it an effective tool for mental self-care screening and a practical tool for social workers. However, the study recommends repeating the study in other cities of Iran to generalize the findings.

Psychometric Properties under EFA, CFA, Measurement Invariance, and IRT Models for Older Adults' First Aids Knowledge Scale among Iranian Grandparents: The Modified Scale.

This research aims to create and evaluate an assessment tool termed Older Adults' First Aid Knowledge Scale, which measures the knowledge and attitude of Iranian grandparents about first aid. In accordance with COSIM guidelines, 485 individuals in southern Iran completed the instrument as part of a psychometric investigation. Rasch partial credit model (PCM), exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and receiver operating characteristic (ROC) analysis were used to analyze the results. The final version of OFAKS consisted of 18 items that were validated through EFA, CFA, and item response theory (IRT) analysis. All items showed measurement invariance and consecutive response groupings in the predictable order, and the instrument had strong internal consistency. Although Rasch's analysis demonstrated the significance of OFAKS, further investigations and testing in different settings are required to confirm the validity of the tool.

Development and validation of the Women's Self-care Knowledge and Attitude Questionnaire (WSKAQ).

BACKGROUND: Menopausal women should learn self-care practices to enjoy a healthy lifestyle, positive health behaviors, and health status. In addition, the lack of self-care knowledge can lead to unhealthy attitudes and lifestyles, resulting in many complications. Improved self-care knowledge can foster positive attitudes, leading to healthier lifestyles as a beneficial cycle. However, menopausal women have limited knowledge about self-care and evaluation tools. Therefore, this study aimed to develop and investigate the validity and reliability of the Women's Self-care Knowledge and Attitude Questionnaire (WSKAQ) in Iranian menopausal women. METHODS: This cross-sectional study was conducted on 249 menopausal women, aged between 45 and 65 years and at least one year post-menopause, with a minimum literacy level of elementary education. Validation properties included construct validity, exploratory (EFA), and discriminant validity. Reliability was further established through Cronbach's α and McDonald's Omega. PASS 15 and SPSS 27 software were used to select centers, calculate sample size and analyze the data, respectively. RESULTS: The initial stage of construct validity involved the Kolmogorov-Smirnov test and EFA, resulting in a 6-item self-care knowledge subscale, 47.29% of the total data variance, and 7-item self-care attitude subscale, 55.50% of the total data variance. Independent t-test indicated that menopausal women with education level equal to or higher than diploma have significantly higher self-care attitude scores than those with lower than diploma (p = 0.007). Additionally, significant correlations were observed between self-care knowledge and attitude (r:0.30). Cronbach's α and McDonald's Omega coefficients of the 13-item WSKAQ were 0.77 and 0.78, respectively. CONCLUSIONS: Based on the results, the WSKAQ, consisting of 13 items, was validated and reliable for assessing the self-care knowledge and attitude of Iranian menopausal women.

Predictors of hospital nursing staff's adherence to safe injection guidelines: application of the protection motivation theory in Fars province, Iran.

BACKGROUND: Needle stick injuries (NSI) can lead to dangerous infectious diseases for health care workers. This study aimed to determine the predictors of observance of safe injection guidelines in hospital nursing staff, based on protection motivation theory. METHODS: This cross-sectional study was conducted on the nursing staff of five randomly selected teaching and general hospitals of Shiraz University of Medical Sciences, Fars province, Iran, in 2021. Data were collected using a researcher-made questionnaire which was developed based on protection motivation theory. Data were processed and analyzed using SPSS 22 and Amos 24 at a significance level of < 0.05. Pearson's correlation coefficient, Multiple linear regression, and Structural Equation Modeling were used. RESULTS: The mean age of the participants (No = 280) was 32.5 ± 8.09 years. Most of the participants [80%] had encountered NSI, patients' blood, or body fluids at least once. Protection motivation was the only predictor of protective behaviors (ß = 0.573), while perceived efficacy (ß = 0.142) and perceived rewards (ß = -0.229) were the strongest predictors of motivation. The structural equation modeling analysis showed that standardized total effects of protection motivation, perceived response costs, rewards, and efficacy on the protective behaviors were 0.573, -0.159, -.104, and 0.81, respectively. While standardized total effects of perceived rewards, efficacy, and response cost on protection motivation were -0.229, 0.142, and -0.033, respectively. The model fit indices indicated the acceptable final model fit. CONCLUSION: The results suggest that perceived efficacy, perceived effectiveness, and perceived rewards were the most important predictors of adherence to Safe Injection Guidelines in nursing staff.

Training of Pelvic Floor Muscle Training Improves the Severity and Quality of Urine Incontinence and Increases Social Participation of Older Women in Southern Iran.

BACKGROUND: Aging and gender are risk factors for urine incontinence, which can lead to psychological, physical, and social complications. OBJECTIVE: This community-based study investigates the effectiveness of pelvic floor muscle training on the severity and quality of urine incontinence and social participation of older women. METHODS: This quasi-experimental community-based study was performed with the participation of 60 older women referring to the Public Health Center in Kerman City, southern Iran. The experiment group was trained with pelvic floor muscle training in 7 training sessions with distance health education in the second half of 2021. Before and after the intervention, data were collected based on: demographic, severity and quality of urine incontinence, and social participation inventories. Data were analyzed using a t-test and ANOVA (P ≤ 0.05). RESULTS: The mean scores of severity and quality of urine incontinence and social participation in the experiment and control groups before receiving the intervention were not statistically significant (P ≥ 0.05). But after that, a statistically significant difference was observed between the groups (P <0.05), which showed an improvement in the severity and quality of urine incontinence scores as well as SP in the experiment group. CONCLUSIONS: Tele-training of the Kegel exercise, even during the pandemic, can play an important role in improving incontinence and social participation in older women. Therefore, this training can be used to prevent and improve urine incontinence in public health centers in the community.

Environment Intensifies Imbalance and Fear of Falling: Comparing Urban and Rural Aging Communities.

BACKGROUND: The relationship between environmental diversity and the health status of older adults has been less considered in studies. This study seeks to investigate the causal relationship among the environment, falling, fear of falling, and the imbalance of older adults in southern Iran in 2021. OBJECTIVE: The investigation into the relationship between environmental pollution to the imbalance and fear of falling, especially in comparing urban and rural aging societies is the aim of current study. METHODS: In a cross-sectional study, 489 older samples from rural and urban areas were chosen randomly and their experience of falling, fear of falling, imbalance, and IADL were examined. The ordinal and nominal logistic regression and ANOVA were performed using IBM-SPSS. RESULTS: With a mean age of 71.8 (SD = 8.3), older participants have long time chronic disease (69.6%) and falling experience twice a year (42.7%). The values of effect size indicated the high effectiveness of settlement in explaining IADL, health situation, experience and fear of falling, and imbalance (Eta squared > 30). The odds ratio for being in the urban settlement was 5.51, indicating the imbalance score increased by approximately 5.52 times. CONCLUSION: Imbalance in older people leads to the fear and experience of falling. This imbalance is strongly influenced by the environment. Urban pollution can contribute to this problem. Future studies on aging need to focus on environmental pollution and diversity in the experience of falling and imbalance.

Validation of the Persian version of the 9-item Berg Balance Scale Among Older Iranians.

Objectives: Old age is often associated with a progressive decline in the capacity of individuals to maintain dynamic and static balance, leading to falls and fear of falling. This study aimed to validate the 9-item Berg Balance Scale (BBS-9) for the older Iranian population. Methods: The current psychometric study involved translation of the BBS-9 to Persian language and its validation among a cohort of Persian-speaking elderly people. Confirmatory factor analysis, exploratory factor analysis, internal consistency, construct validity, test-retest reliability, receiver operating characteristic analysis, inter-rater, and convergent validity of the BBS-9 (Persian) were investigated and statistically analyzed. Results: The participants were 9117 Iranians with an average age of 64.3±2.45 years. The cohort was 54.1% female. Nearly three quarters of the subjects (72.4%) lived alone, 92.9% needed help with activities of daily living, and 93.0% sustained falls in the previous two years. Internal consistency was confirmed using intraclass correlation coefficient and McDonald's Omega (≥ 0.75). The receiver operating characteristic analysis represented the exact cut-off values for male and female and with or without fear of falling with good specificity and sensitivity. Analysis of variance revealed that fear of falling was significantly related to age, Aging in Place, loneliness, hospitalization rate, frailty, and sense of anxiety (effect size ≥ 0.130, p ≤ 0.050). Conclusions: The Persian version of BBS-9, a psychometrically sound self-reported measure of fear of falling, retained the original's satisfactory psychometric properties. It has the potential to be used among older Iranians in community-based and clinical settings.

Policy requirements in promoting older people health care in Iran: A qualitative study.

BACKGROUND: The demographic structure of Iran as a developing country has undergone various changes in recent years. Therefore, the present study sought to analyze policy and upstream documents related to the older people health in Iran in order to identify and analyze the requirements considered by health policymakers to promote the older people health in Iran. MATERIALS AND METHODS: This is a qualitative study conducted in 2021 through national qualitative document analysis. All upstream documents published and related to older people health were reviewed between February 1979 and October 2021. The Scott's four-step method was used to extract the related documents. RESULTS: Policy requirements for promoting older people healthcare in Iran were categorized into 4 main themes in the form of a conceptual framework and 15 sub-themes. Thus, in order to ensure the health of the older people in Iran, it is necessary to take into account the four categories of managerial requirements, financing, infrastructures, and providing older people services. In other words, the sustainable financing requirements and the infrastructural requirements should firstly exist together as basic requirements. Then, geriatric health management requirements are needed to provide the older people health services along with the previous requirements and finally ensure the health of the older people in Iran. CONCLUSION: The results of this study can be helpful in the review of upstream older people health policy documents by policy makers in order to better promote the health of the older people and pave the way for new policies to enter the agenda of policy makers.

Effectiveness of Otago Exercise Program on Successful Aging within Older Women with Migrant Children Referring to Public Health Centers in Shiraz City, Iran.

Background: Successful aging (SA) is considered an indicator of satisfaction of older people. This study aimed to evaluate the effectiveness of the Otago Exercise Program (OEP) on SA among older women. Materials and Methods: quasi-experimental research with a control group was conducted in 2021 on 120 older women in Shiraz city, south Iran. Eligible samples were selected by a three-stage cluster sampling method and were classified into two equal intervention and control groups. Eight training sessions (exercises) were conducted for the intervention group using the OEP. SA questionnaire was completed at the beginning and 2 months after the intervention. The data were analyzed using the IBM-SPSS version 26, and the effect sizes were extracted. Results: The mean age of samples in the intervention and control groups was 69.71 + 59.59 and 68.83 + 5.08 years, respectively. Although there was no significant difference in the mean scores of SA between the two groups at the beginning of the study, 2 months after the intervention implementation, the mean scores of SA increased significantly in the intervention group (t = 8.57, p ≤ .001). Conclusion: It seems that OEP is an effective strategy for supporting SA in older people.

Psychometric Properties of the Falls Efficacy Scale-International, Cut-off Points, and Validating its Short Version Among Iranian Older People.

Objectives: Older people have a fear of falling, which is far more difficult than falling itself. We measured the extent of this feeling using a short and valid Falls Efficacy Scale-International (FES-I) 7-item questionnaire for the aging community in Iran. Methods: The present psychometric work deals with outlining the validation and translation of FES-I (short version) among 9117 Persian-speaking elderly people with a mean age of 70.2±8.3 years (54.1% female and 45.9% male) in July 2021. Investigations were performed on confirmatory factor analysis, exploratory factor analysis, internal consistency, and construct validity along with test-retest reliability, receiver operating characteristic analysis, inter-rater, and convergent validity. Results: 72.4% of the subjects were living alone, 92.9% required support in activities of daily living, and 93.0% experienced falling in the past two years. A one-factor solution was assigned by exploratory factor analysis for FES-I. Thus, this model was proved by the confirmatory factor analysis with valid fit indices. Based on Cronbach's alpha, intra-cluster correlation coefficient, and McDonald's omega (≥ 0.80), internal consistency was confirmed. The exact cut-off value was represented by the receiver operating characteristic analysis for male/female and between with/without fear of falling among older samples with higher measures of specificity and sensitivity. Moreover, a significant effect of age, aging in place, loneliness, hospitalization rate, frailty, and sense of anxiety (effect size ≥ 0.80, p ≤ 0.05) on fear of falls was detected using analysis of variance. Conclusions: The psychometric properties of the original scale were preserved by the Persian version of FES-I seven items as a self-reported measure of fear of falling. It could be assuredly a measure in both community and clinical settings. The possible uses and limitations of the Iranian FES-I were also discussed.

Improving family health climate, effect of role modeling and maternal support in female students.

INTRODUCTION: Girls can use their mother's emotional, informational and behavioral support to perform healthy behaviors due to their constant access to their mothers. This study aimed to evaluate the effect of role modeling and maternal support in the family to improve healthy behaviors and perceived Family Health Climate (FHC) in female students. METHODS: In this educational quasi-experimental study, 261 female students (133 in the intervention group and 128 in the control group) and 223 mothers (109 intervention and 114 control) were selected using the cluster multi-stages sampling method and entered the study. Participants (intervention and control groups) completed the FHC scale at three stages (before intervention, immediately after the intervention, and 2 months after intervention). A training program that comprised 12 sessions for students and six sessions for their mothers using collaborative learning techniques and printed materials was conducted with the experimental group. Also after completing the questionnaire in the follow-up phase, pamphlets and educational videos were given to the control group. Data were analyzed using SPSS20 via a chi-square test, independent t-test, and Repeated Measures ANOVA at a significance level of 0.05. RESULTS: Before the intervention, there was no significant difference between demographic variables and the score of the FHC scale in both groups (p < 0.05). Immediately and 2 months after the intervention, the experimental group (female students and their mothers) showed a significant increase in dimensions of FHC, including FHC-NU (Family Health Climate-Nutrition) and FHC-PA (Family Health Climate-Physical Activity), compared to the control group (p < 0.05). CONCLUSIONS: Educating and informing mothers about the impact of their role modeling on their children, especially girls, can make them more aware of health-oriented behaviors towards their children. Such findings reinforced the importance of focusing on actions to encourage a healthy lifestyle (healthy diet and physical activity) in students with a focus on role modeling and parental support, especially mothers.

Sense of loneliness of veterans in Southern Iran: a cross-sectional study.

AIMS: More than three decades have passed since the end of the Iraq-Iran war, and this period has been concurrent with a rapid growth of the older community in Iran which includes the community of veterans who often suffer from serious psychological and behavioral problems. The study aimed to investigate the prevalence and determinants of loneliness in middle and older veterans in southern Iran. MATERIALS & METHODS: A cross-sectional study conducted among 583 middle and older male veterans (50 years <) who were selected by the census method in 2021. Data collection was done using UCLA Loneliness Scales. The collected data were entered into SPSS version-26 and Amos-24 and analyzed by multivariate ANOVA, multivariate regression, and structural equation at a threshold significance level of 0.05. FINDINGS: The mean score of feeling lonely in the veterans was 51.08 ± 4.74. The study found a significant relationship between the participants' education and their feeling of loneliness (P-value = 0.01, effect size = -0.31). Multivariate regression demonstrated that demographic variables (i.e., age, employment status, level of education, type of living) and the severity and type of injury predict 31% of the variance in the middle and older veterans' feeling of loneliness. CONCLUSION: The mental, psychological and physical effects of war disability were associated with the social functions of veterans in the family and community. Strategies such as increasing social support and psychological counseling for veterans along with improving their pension and income can be effective in promoting public health, especially the mental health of this group.

Predictors of health behavior compliance for the prevention of Covid-19 based on the extended parallel process model in pregnant women in Iran.

Pregnant women are at higher risk of getting severe Covid-19 disease and consequences on the health status of them and their fetuses. Despite vaccination, all preventive behaviors are emphasized. This study aimed to identify the determinants of Covid-19 preventive health behaviors in pregnant women using Extended Parallel Process Model. This cross-sectional study, was conducted on 175pregnant women. The model fit indices were acceptable. Knowledge had indirect effect on adherence to Covid-19 preventive behaviors trough mediating role of self-efficacy and response efficacy. So, it is suggested that, educational interventions should focus on increasing knowledge.

There were statistically significant correlations between all constructs of the EPPM model except knowledge, with adherence to Covid-19 preventive behaviors.Self-efficacy and response efficacy were the strongest predictors of Covid-19 prevention behaviorsPerceived susceptibility and severity were the other significant predictors of Covid-19 preventive behaviors.Knowledge indirectly through the mediating role of response efficiency and self-efficacy effected on preventive behaviors.

Psychometric Properties of the CAGE Questionnaire Amongst Middle-Aged and Older Adults in Khuzistan Province of Iran.

The CAGE questionnaire is an instrument, proved useful in helping to make a diagnosis of alcoholism. The questions focus on Cutting down, Annoyance by criticism, Guilty feeling, and Eye-openers. The questionnaire has been more pervasive simple tool than AUDIT and LAST scales to screen in busy medical settings where limited time is considered for adult patient interviews. The present study aimed to determine the reliability and validity of the CAGE questionnaire in Khuzistan province, Iran and evaluate its role in detecting alcohol-related problems. For this purpose, 382 men with mean age of 65 ± 5 were sampled by cluster-random sampling method in convenience model from the medical centers in eight counties of Khuzistan province during 2019 and they responded to the CAGE questionnaire. The coefficients of Cronbach's alpha (α = 0.82), convergent validity (0.73), divergent validity (-0.06), and criterion validity (0.87) were estimated (ρ < 0.01). The exploratory factor analysis demonstrated that the four -items related to the CAGE for the aged samples are organized into one factor, which clarifies 94% of the variance. Based on the results of the second-order confirmatory factor analysis, all factors were matched up well into a principal factor. Finally, the one -factor model was appropriate for the data by using the fit index techniques for adjusting the scale (AGFI = 0.81, TLI = 0.91, GFI = 0.93, RMSEA = 0.006, IFI = 0.94, NFI = 0.91, CFI = 0.97).The results could prove the well-adjusted reliability and validity of the CAGE and its usefulness for the relevant studies.

Effect of Sexual Knowledge, Attitude and Quality of Life on Marital Satisfaction of Aged Couples in South Iran: APIM-SEM Analysis.

Marital satisfaction is important for health and well-being among aged couples. The aim of this study is to explore the relationship between knowledge, sexual attitude, and quality of life with marital satisfaction of aged couples of over 60 years in southern Iran. This APIM analytical study was performed on 510 aged couples in southern Iran in 2020. Proportionate stratified sampling was randomly performed in three stages relative to the aging population in main cities in the south Iran. Data collection tools included demographic information (age, education, occupation, living alone, type of disability, etc.), sexual knowledge and attitude scale (SKAS-10), quality of life scale (SF-12), and marital satisfaction questionnaire. Mean score of marital satisfaction, sexual attitude, sexual knowledge, and QoL (SF-12) was 49.71 (SD = 14.8), 27.5 (SD = 7.3), 24.7 (SD = 8.5), and 31.49 (SD = 3.2), respectively. The present study showed that sexual knowledge and attitude, quality of life, are among the estimators of marital satisfaction in aged couples.

Older people's health promotion policies challenges: Making an avenue for policy responses in a developing country.

BACKGROUND: Older people's health policies suffer from many challenges in Iran. The issue is more highlighted considering the increasing rate of the older population in the country. This study aimed to explore the challenges of older people's health policies in Iran as well as make an avenue for policy responses. MATERIALS AND METHODS: This study was a qualitative study that was conducted using conventional content analysis in 2020-2021 in Iran. The purposive and snowball sampling methods were used for semi-structured interviews with 30 selected participants. Data were analyzed through the content analysis approach using Granheim and Landman's five-step thematic method. RESULTS: The results of analyzing the data were categorized into four main themes, 16 sub-themes, and 70 final codes. The main themes were executive, policymaking, intra- and inter-sectoral, and environmental challenges. CONCLUSIONS: Older people are facing challenges in receiving appropriate and timely care. In order to achieve a wide national policy dialogue for covering all older people's health needs in policy agendas and better formulation and implementation of the policies, it is necessary for Iranian health policymakers to address executive challenges and apply effective strategies.

Frailty and Mental Health Disorders Before and During COVID-19 Occurrence in Older Population in Iran: A Longitudinal Repeated-Measures Study.

PURPOSE: Iranians' worry over the number of older patients negatively impacted by COVID-19 surged dramatically throughout the 5 waves of the COVID-19 pandemic, which lasted from January 2020 to September 2021. The goal of this research was to assess the physical and mental health of Iranian older persons throughout the COVID-19 pandemic's major waves. METHODS: The health condition of 507 older persons with a positive examination for COVID-19 illness was assessed before and throughout the 5 waves of coronavirus in south Iran in analytical and hybrid longitudinal research. RESULTS: The primary consequences of COVID-19 incidence on frailty and mental health issues were revealed in this investigation. Using a linear mixed model, we found a reduction of 0.33 in loneliness (ß = -.33, 95% CI -0.39 to -0.26) during the COVID-19 pandemic. The probabilities of becoming depressed, anxious, or frail rose 4.61 (95% CI: 3.77-5.63), 1.85 (95% CI: 1.52-2.24), as well as 1.42 (95% CI: 1.17-1.42) time, subsequently, with COVID-19 occurrence, according to the mixed logistic models. Furthermore, the influence of COVID-19 incidence on loneliness result differs by gender; for depression, it varies by education; and for anxiety, it changes by comorbidities and living independently. CONCLUSION: The COVID-19 pandemic significantly impacts the mental health and frailty of older persons with the positive COVID-19 situation, and this scenario is gender-based too.

Tendency to Breast Cancer Screening Among Rural Women in Southern Iran: A Structural Equation Modeling (SEM) Analysis of Theory of Planned Behavior.

Background: Early detection of breast cancer is a crucial factor in surviving the disease. This study aimed to investigate the mammography screening based on the theory of planned behavior (TPB) among rural women in Fasa and Shiraz cities, Iran. Methods: This study is a cross-sectional study performed on 800 female clients referring to rural health centers in Fasa and Shiraz cities in southern Iran in early 2021. The authors decided to send and distribute the electronic questionnaire form through the WhatsApp application in collaboration with the health staff of rural health centers for the people covered by these centers. Data gathering tools were a questionnaire on demographic characteristics, a questionnaire based on constructs of TPB, and behavior of mammography screening. Using the structural equation model (SEM), the TPB constructs and demographic variables were entered into the model. Data analysis was executed employing SPSS software version 26 and Amos version 24 (IBM Co., Ann Arbor, MI, USA). Analyzing the data was carried out using the 1-way analysis of variance (ANOVA), logistic regression, and structural equation analysis. During data analysis, various model indicators such as the goodness of fit, including comparative fit index (CFI), goodness-of-fit index (GFI), root mean square error of approximation (RMSEA), and chi-square index/df were evaluated. The significance level in all tests was considered 0.05. Results: The knowledge, attitude, and perceived behavioral control were the predictors of intention and behavior of mammography screening among the women. Among demographic variables, age, literacy, being menopausal, cancer in family, city, and ethnicity contribute more to the variance variation in TPB constructs. In this study, 7.2% of Persians, 8% of Qashqai Turks, and 4.5% of Arabs are contemplating going to mammography screening. In total, 6.8% (54 people) of all individuals intended to go mammography screening, and 5.4% (43 people) had a history of mammography screening. Goodness-of-fit indices (χ2 = 18.45, df = 10, n = 800, χ2/df = 1.845, RMSEA = 0.032, GFI = 0.90, non-normed fit index (NNFI) = 0.91) of conceptual model of this study indicate the suitability of the model. Conclusions: The results of the study indicated that the constructs of the TPB can predict mammography screening behaviors in rural women. It has also demonstrated that mammographic behavior can be improved in rural women using education based on the TPB model, emphasizing critical psychological factors of creating or changing behavior.