The effect of social determinants of health on quality of life among Afghan refugees in Iran during the COVID-19 pandemic: a path analysis.

BACKGROUND: The COVID-19 pandemic has created significant challenges in 2020 in the world and Iran. To help vulnerable groups such as refugees during the response and recovery phases of the COVID-19 pandemic, identifying the quality of life (QOL) and its associated factors is helpful. Considering that research in this field is limited, this study evaluated the effect of social determinants of health on the quality of life among Afghan refugees in Iran during the COVID-19 pandemic. METHODS: We conducted a cross-sectional study on 300 Afghan refugees and migrants in Alborz province, Iran, from February to May 2022 using Convenience sampling. Data were completed using the socioeconomic status scale (SES), World Health Organization's quality of life -BREF (WHOQOL), Depression, Anxiety and Stress Scale-21 Items (DASS-21), and COVID-19 Post-Traumatic Stress Disorder Checklist (COVID-PTSD). In addition, path analysis was applied to evaluate the relationships among the research variables with quality of life. RESULTS: 64.3% of the study participants were male, with a mean of 29.29 ± 9.64 years. The path analysis showed that SES had the most positive relationship (B = .266), and the number of COVID-19 cases had the most negative relationship (B = -.169) with the quality of life from both paths. The self-rated health had the most positive relationship (B = .25), and the DASS score had the most negative relationship (B = -.2) with the quality of life through only one path. Access to medical services was the only variable that indirectly had a positive causal relationship with QOL (B = .044). CONCLUSION: We provided an empirical model that illustrates the relationships between quality of life and social determinants of health among Afghan refugees and migrants during the Covid19 pandemic. The negative emotional states of Depression, Anxiety, and Stress (DAS) as a mediator play an essential role in the quality of life and other variables.

Predictor factors affecting emotional and behavioral problems in school-aged (6-12 years) children during the COVID-19 pandemic: a cross-sectional study.

OBJECTIVES: The prolonged outbreak of COVID-19 has caused psychological problems in the community, especially in children. Given that limited studies have been conducted on this vulnerable group in Iran, we conducted this study to determine the predictor factors affecting emotional and behavioral problems in school-aged (6-12 years) children during the COVID-19 pandemic. METHODS: We conducted a cross-sectional study on 322 mothers of elementary school-aged children (6-12 years) from April 21 to June 21, 2021, in Karaj, Alborz, Iran. Sociodemographic checklist, socioeconomic status scale (SES), Depression, Anxiety, and Stress Scale (DASS-21), Corona Disease Anxiety Scale (CDAS), and the Rutter Children's Behavior Questionnaire (RCBQ) were used to evaluate the children's behavioral symptoms, the mental health of their mothers, and sociodemographic factors. RESULTS: In total, 17.7% of children (male = 27.0%, female = 11.7%) had behavioral problems. Results showed income (p-value = 0.007, 95%CI (-3.85- -0.607)), and physical activity of the child (p-value = 0.026, 95%CI (-1.03- -0.067)), were indirectly associated with children's behavioral symptoms. Having underlying disease (p-value = 0.00, 95%CI (1.712-5.949)), breastfeeding (p-value = 0.027, 95%CI (0.335-5.61)), corona-related anxiety (p-value = 0.00, 95%CI (0.158-0.318)), and DASS score (p-value = 0.00, 95%CI (0.149-0.334)) in the mothers, as well as male gender (p-value = 0.003, 95%CI (0.724-3.471)) were directly associated with children's behavioral symptoms. The most factors involved in the behavioral symptom score of children were corona-related anxiety (ß = .298), DASS (ß = 0.273), underlying disease of mothers (ß = 0.163), income (ß = -0.154), child's gender (ß = 0.142) and physical activity (ß = -0.101), and breastfeeding (ß = 0.099) respectively. CONCLUSION: Study findings showed that some factors affect the emotional and behavioral problems of school-aged (6-12 years) children during the COVID-19 pandemic. These data may help future researchers and policymakers with early intervention.

The relationship between social determinants of health and fear of contracting infectious diseases in pregnant women presenting to health centers in Kashan, Iran: a path analysis study.

INTRODUCTION: Pregnancy is one of the most critical times in a woman's life that is accompanied by a lot of worry, fear, and stress for the mother, and fear of contracting diseases and losing the children are among the most important of them. The present study investigated the relationship between the social determinants of health and fear of contracting infectious diseases in pregnant women using path analysis. METHODS: This cross-sectional study was conducted on 330 pregnant Iranian women in Kashan from September 21th, 2021, to May 25th, 2022, using a multi-stage method. Data were collected through demographic and obstetric details, fear of COVID-19, perceived social support, socioeconomic status, and pregnancy-related anxiety questionnaires. The collected data were then analyzed using SPSS-21 and Lisrel-8 software. RESULTS: According to the path analysis results, among the variables that have a causal relationship with fear of contracting infectious diseases through only one path, pregnancy anxiety (B = 0.21) had the highest positive relationship and social support had the highest negative relationship (B=-0.18) in the direct path. Among the variables that have a causal relationship with fear of contracting infectious diseases in both paths, socioeconomic status (B=-0.42) had the highest negative causal relationship with fear of contracting infectious diseases. CONCLUSION: According to the path analysis results, the fear of contracting infectious diseases in pregnant women in Kashan is moderate and prevalent, which indicates the necessity of screening pregnant women for such problems during epidemics. Moreover, to prevent this fear and its adverse consequences, the following strategies are recommended: helping promote mothers' and women's awareness, offering social support through healthcare providers, and taking measures to mitigate pregnancy-related anxiety in high-risk individuals and groups.

The relationship between social determinants of health and postpartum weight retention based on the World Health Organization model: path analysis.

BACKGROUND: Postpartum weight retention (PPWR) causes obesity, chronic diseases, and occurring adverse maternal-fetal and neonatal outcomes. Given the social factors' effect on health and disease and considering the lack of information on social determinants of health (SDH) effects on PPWR, this study was conducted to survey the relationship between SDH and PPWR based on the World Health Organization (WHO) model. METHODS: A cross-sectional study was performed on 400 women six months after delivery in 2020. Twelve health centers were randomly selected from the three universities of Medical Sciences in the city of Tehran, Iran. Participants were selected by convenience method and based on eligibility. Questionnaires used included: Lifestyle Profile Health Promoting II, Short Form Postpartum Quality of Life Questionnaire, Multidimensional Scale of Perceived Social Support, Postpartum Social Support, Depression Anxiety Stress Scales, and questionnaires designed by reviewing the literature about breastfeeding, sleep, contraceptive, child health, unhealthy behaviors, postpartum nutritional awareness/beliefs, body satisfaction, access to postpartum care, socioeconomic status, demographic, and obstetric questionnaire. Data analysis was performed in SPSS-23, and the relationship model was examined using the path analysis method in LISREL-8.8. RESULTS: Path analysis indicated the direct effect of six intermediate factors on PPWR including: gestational weight gain (ß = 0.42), access to postpartum care (ß = 0.11), postpartum nutritional awareness/beliefs (ß=-0.17), anxiety (ß = 0.09), sleep duration (ß=-0.09), pre-pregnancy body mass index (ß = 0.09). Among the structural factors, woman's education and socioeconomic status had an indirect negative effect on PPWR. The model fit indices showed good fit (RMSE = 0/05, GFI = 0.92, CFI = 0.92, χ2/df = 2.17). CONCLUSION: The results indicate the effect of structural and intermediate determinants of health on PPWR. It is recommended to use the proposed model as an appropriate framework in the research, design, and implementation of programs to prevent and control PPWR.

Predictors of the relationship between the duration of cancer and care time with the supportive care needs of patients and the quality of life of their caregivers: a path analysis.

BACKGROUND: Breast cancer (BC) patients face various physical and psychological challenges. The mutual impacts of patients and caregivers on each other show the need for further supportive care from the community and family. This study aimed to identify the predictors of the direct and indirect relationships of the duration of cancer (CANCERT) and care time (CARET) with the supportive care needs (SCN) of the patients and the quality of life (QOL) of their family caregivers. METHODS: This descriptive study included 150 patients and their caregivers in Iran. Data were collected using the Supportive Care Needs Survey-Short Form (SCNS-SF34), the Caregiver Quality of Life Index-Cancer (CQOLC) scale, and a socio-demographic checklist. The data were then analyzed in SPSS-24 and Lisrel-8.8 software using descriptive statistics and path analysis. RESULTS: The mean age of the patients and caregivers was 45.76 ± 10.44 and 43.46 ± 9.5, respectively. The majority of patients (96%) were in stages II and III of the disease. There was no statistically significant relationship between cancer stages with SCN of the patients and also caregivers' QOL (P > 0.05). Based on the test results, the CANCERT was positively correlated with the patients' care and support needs (SN) in total effect (ß = 0.24). The patients' sexuality needs had the highest negative correlation with their CANCERT in the direct path (ß = - 0.27) and had the highest negative correlation with psychological needs in the indirect path (ß = - 0.174). The CARET (hours per day) had positive correlation with health systems and information needs in both the direct (ß = 0.26) and indirect paths (ß = 0.15). The highest positive correlation with physical needs was in the direct path (ß = 0.34). The caregivers' QOL had a negative and direct relationship with the CANCERT (ß = - 0.19), and there was a positive and direct relationship between CARET and the caregivers' QOL (ß = 0.18). CONCLUSIONS: The correlations obtained from this study are not necessarily strong, yet they are important and should be noticed and tested in the future studies. The present findings reveal the need to provide comprehensive care, planning to provide supportive care, and counseling to both BC patients and their family caregivers, especially when the duration of the disease is prolonged.

The relationship model among parent-child relationship, coping responses and behavioral problems in children with attention deficit hyperactivity disorder.

BACKGROUND: Attention Deficit Hyperactivity Disorder (ADHD) constitutes a prevalent behavioral problem. The present study examined the parent-child relationship model and investigated strategies to cope with behavioral problems in children with ADHD. METHODS: This descriptive study selected 300 children with ADHD using convenience sampling. The data collected using the child behavior checklist, the parent-child relationship scale (PCRS), the Billings and Moos Coping Checklist, the socioeconomic status questionnaire, the general health questionnaire-28 (GHQ-28) and a demographic checklist were analyzed in SPSS-25 and LISREL 8.8. RESULTS: According to the results of the path analysis on the relationship model among parent-child relationship domains, coping responses and children's behavioral problems, parent-child dependency domain (B = 0.22) in the direct path, disease duration (B = 0.085) in the indirect path, and conflicts in the domain of parent-child relationship (B = 0.366) in both direct and indirect paths had the most positive causal effect on behavioral problems. Furthermore, intimacy in the said domain (B = -0.42) had the most negative causal effect in both direct and indirect paths. The extent to which parents used coping responses via the direct path had a positive causal effect on behavioral problems (B = 0.12). Based on the path analysis test findings in the relationship model among positive parent-child relationship, coping responses and children's behavioral problems, the positive parent-child relationship score had the most negative causal effect via the direct path (B = -0.56). Conversely, the child's age had the highest positive causal effect via the indirect path (B = 0.1) on behavioral problems in children. CONCLUSION: Based on findings, there is a causal and significant relationship between the parent-child relationship and the extent to which coping responses are used. It is recommended that training programs be developed to strengthen communication skills, coping responses and problem-solving techniques in parents.

Social networks and internet emotional relationships on mental health and quality of life in students: structural equation modelling.

BACKGROUND: Social networks and relationships create a sense of belonging and social identity; hence, can affect mental health and the quality of life, especially in young people. The present study was conducted to determine the predicting role of social networks and internet emotional relationships on students' mental health and quality of life. METHODS: The present cross-sectional study was conducted in 2021 on 350 students at Alborz University of Medical Sciences selected by convenience sampling. Data were collected using five questionnaires: socioeconomic status, social networks, internet emotional relationships, stress, anxiety, depression scale (DASS-21), quality of life, and a checklist of demographic details. Data were analyzed in SPSS-25, PLS-3, and Lisrel-8.8. RESULTS: According to the path analysis, the DASS-21 score had the most significant positive causal association with internet emotional relationships in the direct path (B = 0.22) and the most negative association with socioeconomic status (B = - 0.09). Quality of life had the highest negative causal association with the DASS-21 score in the direct path (B = - 0.26) and the highest positive association with socioeconomic status in the indirect path (B = 0.02). The mean duration of using social networks (B ≈ - 0.07) and internet emotional relationships (B ≈ - 0.09) had the highest negative association with quality of life. CONCLUSION: The use of the internet and virtual networks, internet emotional relationships, and unfavorable socioeconomic status were associated with higher DASS-21 scores and reduced quality of life in the students. Since students are the future of countries, it is necessary for policymakers to further address this group and their concerns.

Socioeconomic inequality in different phenotypes of childhood obesity and its determinants in Iran: a Blinder-Oaxaca decomposition method.

BACKGROUND: Childhood obesity has become a significant public health issue worldwide. Socioeconomic status is among its key determinants. This study examined the socioeconomic inequality in different phenotypes of childhood obesity at the national level in Iran. METHODS: This national, multistage school cross-sectional study was undertaken in 2015 on 14,400 students aged 7-18 years from urban and rural areas of 30 provinces of Iran. Using principal component analysis, socioeconomic status (SES) was categorized into tertiles. SES inequality in different phenotypes of obesity (i.e., generalized obesity", "abdominal obesity", and combined obesity) was estimated using the concentration index. The determinants of this inequality were assessed by the Blinder-Oaxaca decomposition method. RESULTS: Overall, 14,274 students completed the study (response rate: 99%). The mean age was 12.28 years, 50.6% were boys, and 71.42% lived in urban areas. The prevalence of generalized obesity and abdominal obesity was 20.8% and 11.3%, respectively. The concentration index for different phenotypes of obesity was positive, indicating that inequality is more common amongst the low SES groups. High SES, being male, living in a rural, and having a positive family history of obesity were associated with general obesity. Moderate physical activity and living in a rural area were associated with abdominal obesity. In addition, living in a rural area, having a high SES, being male, and having a positive family history of obesity were associated with combined obesity. CONCLUSION: According to the present study findings, all childhood obesity phenotypes were more prevalent in Iranian children with high SES. Therefore, due to obesity and other diseases, it is essential to implement environmental changes in addition to designing macro-educational programs and prevention strategies.

Determinants of life satisfaction and self-rated health in Iranian children and adolescents: a structure equation model.

BACKGROUND: Life satisfaction (LS) and self-rated health (SRH) are related with health outcomes. It is expected that these items are also related to healthy behaviors. Therefore, this study was conducted in order to find out the main determinants of LS and SRH in nationwide representative sample of Iranian children and adolescents. METHODS: This study was performed on 13,834 students aged 7-18 years who were selected by multistage, stratified cluster sampling method from 30 provinces of Iran. Life satisfaction and SRH were assessed through a questionnaire based on World Health Organization-Global School-based Student Health Survey protocols. Path analysis was applied to evaluate the relationships among the study variables using the structural modeling. RESULTS: Life satisfaction was directly affected by age (- 0.037 in boys & -0.028 in girls); sedentary time (0.055 in boys & 0.048 in girls); school satisfaction (0.249 in boys & 0.250 in girls); and well-being (0.186 in boys & 0.176 in girls). Self-rated health was directly affected by LS (0.28 in boys & girls) and school satisfaction (0.21 in boys & 0.22 in girls); and indirectly affected by age (- 0.046 in boys & -0.017 in girls); sedentary time (- 1.99 in boys & -0.145 in girls); family size (- 0.005 in boys & -0.014 in girls); and socio-economic status (0.015 in boys & 0.058 in girls). CONCLUSIONS: This study indicated that school satisfaction had the greatest positive direct effect on both LS and SRH.

Predictors of Perceived Stress and Quality of Life among Women during the COVID-19 Outbreak: A Cross-sectional Study from Karaj, Iran.

Background: The emergence of the coronavirus disease of the 2019 (COVID-19) pandemic in Iran has markedly affected lives and taken a toll on Iranians' mental health, especially in women. The current study investigated factors that contributed to both perceived stress and quality of life (Qol) among women during the COVID-19 pandemic in Karaj, Iran. Methods: A cross-sectional online survey study was conducted between November 30, 2020, and January 30, 2021. A researcher-made questionnaire with 4 subscales, including information seeking, social support, primary appraisal, and secondary appraisal, was used. Perceived Stress Scale (PSS-10), and 36-Item Short Form Survey (SF-36) questionnaires were also applied. A total of 581 participants completed the study. The convenience sampling method was used in this study. Multiple mediation analyses were applied using pathway analysis. Results: The mean age ± SD of the participants was 38.57±7.68 years, and 40.8% had a higher education than a high school diploma. Based on the final fitted model, higher perceived stress had a direct impact on mental QoL (ß = 0.47). The Comparative Fit Index (CFI), Incremental fit index (IFI), and Goodness of Fit Index (GFI) were calculated as 1, and χ2/df was 4.87. Educational level and social support from both the direct and indirect pathway affected QoL. Social support affected both information-seeking behavior and secondary appraisal (ß = 0.50: 95% CI, 0.38-0.59). Furthermore, information-seeking behavior and secondary appraisal affected perceived stress. Perceived stress followed by educational level had the strongest and primary appraisal had the poorest indirect association with mental QoL. Conclusion: In conclusion, primary appraisal, secondary appraisal, social support, educational level, perceived stress, and information-seeking behavior were correlated with higher levels of mental QoL among women. Social support and improving the situation appraisal can provide appreciated support to manage stress induced by the COVID-19 pandemic. Further assessment is needed to determine the vulnerable groups such as illiterate people.

The relationship of supportive roles with mental health and satisfaction with life in female household heads in Karaj, Iran: a structural equations model.

BACKGROUND: Female household heads are faced with more problems than men due to their multiple concurrent roles. The present study was conducted to determine the relationship of supportive roles with mental health and satisfaction with life in female household heads in Karaj, Iran using a structural equations model. METHODS: The present descriptive-analytical study was conducted on 286 eligible female household heads in Karaj, Iran, in 2020, who were selected by convenience sampling. Data were collected using Vaux's Social Support, the perceived social support scale, the general health questionnaire (GHQ), and the satisfaction with life questionnaire plus a socio-demographic checklist, and were analyzed in SPSS-16 and Lisrel-8.8. RESULTS: The participants' mean age was 43.1 ± 1.7 years. According to the path analysis results, satisfaction with life had the highest direct positive relationship with perceived social support (B = 0.33) and the highest indirect positive relationship with age (B = 0.13) and the highest direct and indirect positive relationship with education and social support (B = 0.13). Also, mental health had a direct negative relationship with satisfaction with life (B = -0.29), an indirect negative relationship with social support, and both a direct and indirect negative relationship with perceived support (B = -0.26). CONCLUSION: Based on the results, supportive roles had a negative relationship with mental health; in other words, mental health problems increase as supportive roles decrease. They also had a positive relationship with satisfaction with life in female household heads. Accordingly, given the status and role of women in the health of family members and the community and their greater vulnerability, further attention and support should be directed toward these women by the government and relevant organizations like establishment of counseling-support centers.

A comparison between body mass index and waist circumference for identifying continuous metabolic syndrome risk score components in Iranian school-aged children using a structural equation modeling approach: the CASPIAN-V study.

PURPOSE: The purpose of this study was to investigate the association of anthropometric indices with continuous metabolic syndrome (cMetS) risk score components in a large population-based sample of children and adolescents. METHODS: This multi-centric study was performed on 3843 students aged 7-18 years who were selected by multistage, stratified cluster sampling method from 30 provinces of Iran. Demographic, anthropometric and biochemical factors were obtained and standardized residuals (z-scores) were calculated for MetS components. A structural equation modeling approach was applied to evaluate the relationships among the study variables and to implement the subsequent structural modeling. RESULTS: The mean age of the participants (52.3% boys) was 12.4 ± 3.05 years. Standardized scores of body mass index (ZBMI) and waist circumference (ZWC) had a direct effect on standardized scores of mean arterial pressure (ZMAP) (0.23 and 0.24 in boys and 0.22 and 0.23 in girls, respectively) and triglyceride (ZTG) (0.07 and 0.04 in boys and 0.02 and 0.06 in girls, respectively), but the effect of ZWC was stronger than ZBMI on these variables. Age, socioeconomic status and sedentary behaviors showed a positive direct effect on ZWC (0.01, 0.05 and 0.07 in boys and 0.05, 0.08 and 0.002 in girls, respectively). These variables induced indirect effects on cMets risk score components through ZWC. CONCLUSION: The magnitude of association between WC and continuous metabolic syndrome risk score components was higher compared to BMI in school-aged children, emphasizing on paying more attention to central obesity in childhood. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Factors affecting self-management in Iranian tuberculosis patients: A path analysis model.

BACKGROUND: Self-management behaviors can reduce the progression of an illness. Although various factors affect self-management, no study has been conducted on the self-management of tuberculosis (TB) through path analysis. OBJECTIVES: This study evaluated the factors affecting self-management in TB patients using path analysis. METHODS: A cross-sectional study was done on 133 non-prisoner TB patients that referred to all health centers in Karaj, Iran, in 2017. A structured questionnaire was applied. Data were analyzed with SPSS-17 and Lisrel 8.8, utilizing statistical path analysis to evaluate the relationships between self-management and its related factors. RESULTS: Overall, 52.3% of the participants in the study were female and 47.7% were male. Respondents of were 46.9% smear-positive, 9.4% smear-negative, and 43.8% extra-pulmonary TB. Fit indices confirmed the model fitness and logical relationships between the variables according to the conceptual model (χ2 = 49.80, df = 25). The final path model showed that age (ß = 0.84), attitude (ß = 0.10), marital status (ß = 0.04), and house condition (ß = 0.03) impact self-management through the direct path. Knowledge (ß = 0.83) and education (ß = 0.16) affect self-management through both direct and indirect paths. Education indirectly affects self-management through both knowledge and attitude. Knowledge indirectly impacts self-management through attitude. In other words, knowledge and attitude mediate the relationship between some factors and self-management. CONCLUSIONS: This study provided an empirical model that illustrates the relationships between self-management and related factors in TB patients. The knowledge can be the target of interventions in support of self-management.

Factors affecting the quality of life in women with gestational diabetes mellitus: a path analysis model.

BACKGROUND: Quality of life (QoL) is the most important indicator for assessing the status of health care in chronic diseases. The present study aimed to determine the pathway determinants model of QoL in patients with gestational diabetes mellitus (GDM). METHODS: This cross-sectional study was conducted on 329 women with GM referred to health care centers in Qom, Iran during 2018. Convenience sampling methods was used. Inclusion criteria were: afflicted by GM and received pregnancy care services from health center. Several questionnaires (Knowledge, attitude, self-efficacy (SE), social support (SS), pregnancy distress, self-management(SM) and QoL) were used for data collection. Data were analyzed with SPSS-21 and Lisrel-8.8 software using statistical path analysis. RESULTS: The mean age of participants was 30.93 ± 5.42 years. The final path model fitted well (CFI =1, RMSEA = 0.0003) and showed that, only age variable from both direct and indirect path had an impact on QoL (B = 0.51). Among variables that directly affected the QoL, SS had the highest effect (B = 1.02) and SE (B = 0.01) had the lowest effect. In the indirect path, only the knowledge variable by affecting the SE had an impact on the QoL (B = 0.0045). CONCLUSION: SS had the greatest impact on the QoL. Obviously, providing all the requirements to support patients can help them overcome problems and improve their QoL. Distress negatively affects the QoL through SM and it should be noticed in interventional studies.

The Structural Model of Spirituality and Psychological Well-Being for Pregnancy-Specific Stress.

Women experience different types of stress in their lifetime. The present study was conducted to examine the structural model of spirituality and psychological well-being for pregnancy-specific stress. The present descriptive correlational study was conducted on 450 pregnant Iranian women (150 women from each trimester) in Dehdasht city in 2015. Data were collected using the personal-social questionnaire, the pregnancy-specific stress questionnaire, the spirituality questionnaire and the psychological well-being questionnaire and were then analyzed in SPSS-16 and Lisrel-8.8 for carrying out a path analysis. The fit indices of the model indicate the good fit and high compatibility of the model and rational relationships between the variables (GFI = 0.94, NFI = 0.85, CFI = 0.94 and RMSEA = 0.048). Of the variables that affected pregnancy-specific stress through both paths, spirituality had a positive effect (B = 0.11) and the personal-social variable a negative effect (B = -0.37). Psychological well-being affected pregnancy-specific stress negatively and directly and through one path only (B = -0.59). The results obtained through the model confirm the effect of spirituality and psychological well-being in reducing pregnancy-specific stress. Given that handling stress has a major role in the quality of daily life in pregnant women, stress management skills are recommended to be promoted among pregnant women so as to mitigate stress and its negative consequences.

Psychosocial factors in pregnancy and birthweight: Path analysis.

AIM: Birthweight is known to be affected by several factors. In the present study a relationship model of psychological and economic determinants of birthweight was designed and tested. METHODS: This prospective study involved 400 pregnant women in four districts of Tehran, Iran. The subjects were selected through a multistage sampling method. Seven questionnaires (socioeconomic status; Holmes and Rahe Stress Scale; Perceived Stress Scale; 21-item Depression, Anxiety, and Stress Scale [DASS-21]; perceived social support; pregnancy-related anxiety scale; and domestic violence questionnaire) were used to assess participant psychosocial and economic conditions. In order to collect post-partum information about the mother and the infant, the women were followed up until delivery. Data were analyzed using SPSS-16 and Lisrel-8.8. RESULTS: Based on the obtained path diagram, the greatest adverse effects on birthweight were exerted directly by DASS-21 score (B = -0.14) and indirectly by stressful life events (B = -0.037). Among variables that affected birthweight in both paths, socioeconomic status and perceived stress had the strongest overall effects on birthweight (B = 0.203 and -0.1024, respectively). CONCLUSION: According to the path analysis model, psychosocial and economic factors can directly/indirectly affect birthweight.

Social determinants of health on attitudes toward childbearing among women with multiple sclerosis: A cross-sectional study.

BACKGROUND: Pregnancy and motherhood are very valuable but challenging for women with multiple sclerosis (MS). Given that there are limited studies in this field, this study aimed to determine the social determinants of health on attitudes toward childbearing among women with MS. METHODS: We conducted a cross-sectional study on 206 women with MS in Alborz province, Iran, from February to June 2023 using convenience sampling. The data were collected using the questionnaire, and a linear regression analysis was applied. RESULTS: The mean age of the participants was 36.80 ± 6.50 years. Participants' Attitudes toward Fertility and Childbearing (PAFC) had a positive significant association with social support (B = .10, SE = .04, p = .023) and a significant negative association with the total score of depression, anxiety, and stress scale (B = -.13, SE = .06, p = .047) and depression (B = -.40, SE = .18, p = .023). However, the association between anxiety (B = -.25, SE = .20, p = .211), stress (B = -.36, SE = .18, p = .050), MS severity (B = .04, SE = .30, p = .890), and socioeconomic status scale (SES) (B = -.08, SE = .32, p = .806) was nonsignificant with PAFC. CONCLUSION: Our results showed that factors, including social support and mental health especially depression, can affect PAFC in women with MS. Therefore, it is necessary to determine specific strategies for policymakers to help MS patients manage pregnancy and motherhood.

Causal association between family health, perceived relationship quality components, and attitudes toward childbearing in Iranian women: A WHO model analysis.

BACKGROUND: Given the unprecedented global decline in fertility as a major demographic development in recent years, the present study was conducted to determine Causal association Between Family Health, Perceived Relationship Quality Components, and Attitudes toward Childbearing in Iranian Women: A WHO Model Analysis METHODS: In 2023, this descriptive study recruited 400 married women presenting to selected comprehensive health centers affiliated to Alborz University of Medical Sciences, Karaj, Iran. The data were collected through multistage stratified cluster sampling and using a socioeconomic status questionnaire (Ghodratnama), the Perceived Relationship Quality Components (PRQC) scale, the family-of-origin scale (FOS), the attitudes toward fertility and childbearing scale (AFCS) and a demographic checklist were analyzed in SPSS 25 and LISREL 8.8. RESULTS: According to the path analysis, family health exerted the most significant and positive causal effect on attitudes to childbearing directly through one path (B = 0.334) and relationship quality (B = 0.698) and duration of married life (B = 0.387) both directly and indirectly. The number of children (B = -0.057), however, exerted the most significant and negative causal effect on attitudes to childbearing through both paths. CONCLUSIONS: The present findings suggested the significant effects of family health and relationship quality on attitudes toward childbearing. It is therefore recommended that these variables be screened in comprehensive health centers, the associated limitations and problems be identified and appropriate training and counseling solutions be provided by health specialists.

Components related to ethical decision making in medical science students: A structural equation model.

BACKGROUND: Evaluating moral principles in the Society of Medical Sciences and health care workers (HCWs) is imperative due to their direct contact with the community and the significant impact of their attitudes and decisions on people's lives. This study aimed to determine the components related to ethical decisions in medical sciences students. METHODS: One thousand two hundred thirty-five eligible students in the Alborz University of Medical Sciences participated in this descriptive study. We gathered their socio-demographic information, assessed their moral reasoning, and used the ethical decisions questionnaire, Lutsen moral sensitivity questionnaire, and general health questionnaire (GHQ) for data gathering. The data were analyzed with SPSS software version 25 and LISREL version 8.8. RESULTS: According to the path analysis test findings, ethical reasoning significantly correlated with ethical decision-making (B = 0.40). The number of clinical courses passed, moral sensation (moral sensitivity), and the total number of passed academic semesters had the greatest positive and negative association with ethical decision-making, respectively. (B = 0.54), (B = 0.524) and (B = -0.11). CONCLUSION: Based on the findings of the moral reasoning test, the moral sensation was associated with ethical decision-making, which indicates the necessity of attending to ethical aspects, promoting moral reasoning, sensitivity, and students' accuracy.

Spatial, geographic, and demographic factors associated with adolescent and youth suicide: a systematic review study.

Background: Suicide is a public health issue and a main cause of mortality among adolescents and the youth worldwide, particularly in developing countries. Objectives: The present research is a systematic review aiming to investigate the spatial, geographical, and demographic factors related to suicide among adolescents and the youth. Methods: In this systematic review, two researchers examined PsycINFO, Web of Science, Scopus, and PubMed databases on December 7th, 2022 with no time limits from the beginning of publication until 2022 to identify the primary studies on spatial and geographic analysis on adolescent and youth suicides. Once duplicate studies were identified and removed, the titles and abstracts of studies were examined and irrelevant studies were also removed. Finally, 22 studies were reviewed based on the inclusion criteria. Results: Our findings show that suicide rates are generally higher among men, residents of rural and less densely populated regions, coastal and mountainous regions, natives, 15-29 age group, less privileged populations with social fragmentation, unemployed, divorced or lonely people, those who live in single parent families, people with mental health issues, and those with low levels of education. Conclusions: Stronger evidence supports the effects of geographic and demographic variables on youth and adolescent suicide rates as compared with spatial variables. These findings suggest that policy makers take spatial and demographic factors into consideration when health systems allocate resources for suicide prevention, and that national policymakers integrate demographic and geographic variables into health service programs. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023430994.