Iranian Women's Experiences of Breastfeeding Support during the COVID-19 Pandemic: A Qualitative Study.

Background: The impact of the coronavirus disease 2019 (COVID-19) pandemic on health systems worldwide has been associated with less attention to maternal support in breastfeeding. The objective of this study was to explore the experiences of breastfeeding mothers, during the COVID-19 pandemic, and the impact of the pandemic on breastfeeding initiation and maintenance. Materials and Methods: A qualitative, descriptive study was conducted by means of in-depth semi-structured interviews. The study participants included 28 mothers who had children aged 0 to 12 months, lived in Guilan Province, Iran, and had breastfed their children at least once after March 2021. Conventional content analysis was performed simultaneously with data collection. Results: Data analysis led to the extraction of three main categories and nine subcategories: in the shadow of peace (receiving correct information from reliable sources, observing health and quarantine principles, and enjoying the awareness of not having COVID-19 [both the mother and the infant]), under the stress (information poverty, invalid and stressful information, and stressful association of underlying diseases), and in the delusion of exposure (refusal to breastfeed, and non-compliance with recommendations). Conclusions: Mothers' breastfeeding experiences during the COVID-19 pandemic indicate factors such as receiving or not receiving breastfeeding support, quarantine and the resulting stress, and exposure to conflicting information. Mothers felt that their experience with breastfeeding during the pandemic encouraged them to continue breastfeeding, but it is important to support breastfeeding mothers. Monitoring and supporting vulnerable groups such as breastfeeding mothers, for mental health problems during the COVID-19 pandemic, should be considered during the planning phase.

"Interprofessional Collaboration" among Pharmacists, Physicians, and Nurses: A Hybrid Concept Analysis.

Background: "Interprofessional Collaboration" is associated with improving the quality of care. The objective of this study was the analysis of the concept of "Interprofessional Collaboration" using a hybrid model. Materials and Methods: A hybrid model was used in order to analyze the concept of "Interprofessional Collaboration." The first phase was the scientific search of texts in all valid electronic databases. The second phase includes fieldwork in which medical, pharmaceutical, and nursing staff were interviewed. Data were collected, reviewed, and analyzed in the third phase. Results: The four main themes extracted in the theoretical phase included: "attributes of individual, team, organizational, and system." In the fieldwork phase, three themes and seven sub-themes were identified: "Dynamism/effectiveness of collaboration, uncertain boundaries of collaboration, advanced organizational culture." In the final phase, with the combination of the results of two previous phases, the final definition of the concept was presented: "A process that brings together systems, organizations and individuals from various professions to achieve common interests and goals. Achieving common goals and interests is influenced by individual, team, organizational, and system attributes." Conclusions: Defining the concept of interprofessional collaboration and identifying its various aspects can be a practical guide for creating and evaluating it in educational and clinical settings.

Role of handgrip strength in predicting the quality of life in older adults: A cross-sectional study.

BACKGROUND: Quality of life (QOL) is a vital component in assessing the standard of living for seniors. Hand grip strength (HGS) is a widely used measure to diagnose muscle strength decline that often occurs due to age-related loss of skeletal muscle mass and function. This study focuses on the HGS in predicting the QOL of older adults who are referred to retirement centers in Guilan Province. MATERIALS AND METHODS: In 2021, a cross-sectional analytical study was conducted among 115 older adults who were residing in retirement centers located in Guilan Province, Northern Iran. The participants were selected using a two-stage sampling method, where three retirement centers were randomly chosen followed by convenience sampling from each center. The selected retirement centers were situated in Langrod, Sowme'eh Sara, and Rasht cities in the east, west, and center of the province, respectively. The data were collected through a demographic information questionnaire, QOL scale (CASP-19), and HGS measurement using a dynamometer. RESULTS: Of the participants, 57.4% were male, 51.3% had middle income, and 96.5% were categorized as young elderly. The mean overall QOL score was found to be 37.026 ± 6.123, while the mean HGS level was 31.74 ± 7.45 and 18.48 ± 5.13 among males and females, respectively. There was a significant association between the level of education and QOL (P = 0.002). Moreover, there was a positive and significant correlation between HGS and QOL (r = 0.54, P = 0.001). The results of the multiple linear regression identified HGS as a predictor of QOL (Adj R2 = 0.44, ßHGS = 0.79). CONCLUSION: Given that HGS has been identified as a predictor of QOL in older adults, improving this factor through exercise can lead to enhancement in their QOL. Therefore, regular sports exercises can be recommended as a means of improving HGS and subsequently enhancing the QOL of older adults.

A comparative study of the effectiveness of self-management and group management on the amount of weight loss of nurses under low-calorie diet treatment: A simultaneous mixed-methods study.

BACKGROUND: Nursing is a profession that is associated with a lot of stress and a risk of being overweight or obese. The purpose of this research was to determine the comparative effectiveness of self-management (self-M) and group management (group-M) on nurses who were following a diet with the aim of proposing a proper planning and a healthy lifestyle for them. MATERIALS AND METHODS: This study was a simultaneous mixed-methods design (interventional and qualitative). The participants were all overweight or obese nurses working in teaching hospitals at Guilan University of Medical Sciences in 2019 (n = 96). In the qualitative part, data were extracted from semi-structured interviews. For quantitative data analysis, relevant statistical methods such as Kolmogorov-Smirnov test, analysis of variance (ANOVA), and analysis of covariance (ANCOVA) were used. For qualitative data analysis, the conventional content analysis approach was used and Lincoln and Guba's criteria were applied to ensure the accuracy of the data. RESULTS: In both quantitative and qualitative sections, the results showed that following a diet treatment with group-M is more effective than self-M. CONCLUSION: The results showed that a healthy lifestyle can be achieved for nurses if they participate in training classes and group programs, which are proven to be effective based on this article and some other studies. Also, since weight gain and obesity, as one of the most important problems of health systems, continue to increase and can impose a heavy economic and social burden on human societies, various general policies should be used and these solutions can range from home to society to prevent and control them.

The effect of teach-back versus pictorial image educational methods on knowledge of renal dietary restrictions in elderly hemodialysis patients with low baseline health literacy.

INTRODUCTION: Adherence to renal dietary restrictions is an important method for minimizing complications in dialysis patients. This study aimed to investigate the effect of teach-back versus pictorial image educational methods on knowledge of renal dietary restrictions among elderly hemodialysis patients in Iran. Selected markers of diet and kidney function were also measured. METHODS: Sixty-nine elderly hemodialysis patients with a low level of health literacy were randomly divided into three groups: pictorial image education, teach-back education, and usual care (controls). The intervention groups received diet education comprising four 20-30 min sessions. Subsequently, nutrition knowledge was assessed in each of the three groups by questionnaire before and 2 months after the intervention. Blood laboratory indices were obtained from the patients' medical records and compared before and 2 months after the educational intervention. FINDINGS: There were significant differences in the mean nutritional knowledge scores between the two intervention groups and the controls (p < 0.001). Nutrition knowledge scores were higher after educational sessions incorporating images compared to those using a teach-back strategy. DISCUSSION: Nutrition educational strategies utilizing either pictorial images or teach-back techniques increased knowledge relating to renal nutrition.

Status of the utilization of preventive care services and its associated socio-demographic factors among Iranian elderly.

Introduction: The growing population of the elderly, the rising costs of medical care and the low use of preventive services are three factors that highlight the importance of using preventive health care services in the Iranian population. This study aimed to determine the status of the use of preventive care services and its associated socio-demographic factors in the elderly referred to health centers. Methods: In this analytical cross-sectional study, a number of 160 elderly people referred to health centers in East Guilan, Iran was selected by multi-stage cluster sampling. Data were obtained from May to September, 2021 using a questionnaire containing utilization of preventive care services (9 items) and socio-demographic characteristics. Results: The highest and the lowest utilization rates of preventive care services among study participants were related to the blood pressure test (96.9%) and colonoscopy (17.5%), respectively. Multivariate analysis showed that only income had a significant association with performing fasting blood sugar test (p = 0.004), blood lipid test (p = 0.004), and blood pressure test (p = 0.013). Also, the associations between having an underlying disease and performing fasting blood sugar test (p = 0.032) and blood pressure test (p = 0.002), the association between gender and performing the bone mineral density test (p < 0.001), and the association between occupation and performing Pap-smear test (p = 0.011), were statistically significant. Conclusions: The utilization rates of screening tests for most cancers, including gastrointestinal cancers, were low. Since, there were a significant association between income, disease, gender and occupation with the utilization of some preventive care services, considering them in health centers' preventive care program design might be useful.

Effects of health belief model in promoting self-care behaviors among hypertensive older adults.

BACKGROUND: Aging has the fastest growth rate in age groups. With age, the prevalence of a variety of chronic diseases also increases. Among chronic diseases, hypertension is one of the most important diseases among older adults and self-care is one of the effective approaches to control it. The aim of the present study was to apply the health belief model (HBM) in promoting self-care in hypertensive older adults to help improve self-care behaviors in this age group. SETTINGS AND DESIGN: This was a quasi-experimental study. This study was conducted at comprehensive health centers in the east of Guilan province, Iran. METHODS AND MATERIAL: This intervention study was conducted on 106 elderly people with hypertension who were selected with a multi-stage random sampling method from those referred to east health centers of Gilan, Iran, in 2019. The data gathering tool was a questionnaire including demographic characteristics, HBM structure, hypertension knowledge, and hypertension self-care questionnaires. The intervention group received an educational program based on the HBM model. The questionnaire was completed by the elderly before and 2 months after the intervention. The data were analyzed by descriptive statistics, Mann-Whitney, Chi-square, Wilcoxon, Fisher, and ANCOVA tests usingSPSS ver.16. RESULTS: There was a significant difference in knowledge and all HBM constructs before and after the intervention in the intervention group (P < 0.001). In the control group, knowledge (P-value = 0.023), self-efficacy (P-value = 0.001), perceived severity (P-value = 0.005), and cues to action (P-value = 0.008) were significantly different (P < 0.05) after the intervention. CONCLUSION: The present study showed that HBM-based education can be considered an effective educational framework for improving self-care of the hypertensive older adults.

The Correlation and Agreement of Montreal Cognitive Assessment, Mini-Mental State Examination and Abbreviated Mental Test in Assessing the Cognitive Status of Elderly People Undergoing Hemodialysis.

Background: Cognitive disorders are one of the most common disorders in elderly people with chronic renal failure. This study aimed to investigate the correlation and agreement of Montreal Cognitive Assessment (MoCA), Abbreviated Mental Test Score (AMTS), and Mini-Mental State Examination (MMSE) tests in assessing the cognitive status of elderly patients undergoing hemodialysis at Guilan University of Medical Sciences in north of Iran. Materials and Methods: This cross-sectional study was conducted on 84 elderly people undergoing hemodialysis. Inclusion criteria was having an age of 60 years old and older, hemodialysis treatment for at least 6 months, and having reading and writing skills. The Pearson correlation test, Intraclass Correlation Coefficient (ICC) test, and Bland-Altman plot were used for data analysis. Results: The majority of samples were in the age group of 60-65 years (28.57%) and the majority of them were male (66.66%). The results showed a significant positive correlation between MoCA and MMSE (r = 0.69, p = 0.001), between MMSE and AMTS (r = 0.64, p = 0.001), and between MoCA and AMTS tests (r = 0.62, p = 0.001). The results also showed a weak agreement between MoCA and MMSE tests (ICC = -0.11, p = 0.633), between MMSE and AMTS tests (ICC = -0.007, p = 0.369), and between MoCA and AMTS tests (ICC = -0.001, p = 0.780). Conclusions: Based on the results, these tools seem to complement each other. The inconsistency between cognitive tests indicates a serious need to develop appropriate instruments for detecting cognitive disorders in elderly.

Efficacy of Knee Arthroplasty on the Outcomes of Knee Osteoarthritis in Iranian Elderly Individuals.

BACKGROUND: Knee osteoarthritis is a common musculoskeletal condition in elderly individuals. This survey was conducted with the aim to identify the problems of this group of patients for compilation of healthcare programs targeted at determining the outcome of osteoarthritis before and 3 months after knee arthroplasty. MATERIALS AND METHODS: In the present cross-sectional study, 150 elderly individuals who had volunteered for knee arthroplasty were selected through nonrandomized sampling and were evaluated using the Knee Osteoarthritis Outcome Score (KOOS) questionnaire and a demographic characteristics form before and 3 months after the surgery via nonparametric statistical tests (Wilcoxon, Mann-Whitney U, and Kruskal-Wallis tests). RESULTS: The mean (SD) age of the study subjects was 64.40 (7.20) years. A significant difference was observed between the mean scores of all subscales (pain with Z=10.62, knee pain/knee stiffness with Z=10.54, daily activity with Z=10.62, sport with Z=2.95, and quality of life with Z=10.48) before and after knee arthroplasty based on Wilcoxon test (˂0.05). The results of the Mann-Whitney U test showed a significant statistical relationship between the difference in the mean score of daily activities and history of opium consumption (Z=1.90, p ˂ 0.05) as well as that between knee pain/knee stiffness and gender (Z=2.57, p ˂ 0.05) and educational level (Z=2.11, p ˂ 0.05). CONCLUSIONS: Knee arthroplasty and history of opium consumption were correlated with improvement of patients' performance in their daily activities, and gender (women) and educational level (unread) were correlated with improvement of the score of the knee pain/knee stiffness subscale.

The relationship between frailty syndrome and self-care ability in the elderly with heart failure.

BACKGROUND: Identification of frailty syndrome in patients with heart failure can affect the process of the disease and their ability to self-care. Considering the lack of a study on the relationship between frailty syndrome and self-care ability in the elderly with heart failure in the Guilan province, the North of Iran, this study was conducted to determine the relationship between fertility syndrome and self-care ability in these patients. MATERIALS AND METHODS: The present cross-sectional correlational study was conducted in 2020. Research settings were the CCU and post CCU wards in the East Guilan public hospitals. The sample size was 125 people who were selected by the convenience sampling method. The research tools include; Self-Care Heart Failure Index and Tilburg Frailty Index Questionnaires. Data were analyzed using SPSS software version 20 using descriptive and inferential statistics with a significance level of 0.05. RESULTS: The results showed that the mean score of frailty syndrome in the elderly with heart failure was 5.44 ± 2.47. In addition, the mean score of self-care in the elderly with heart failure was 67.16 ± 10.96. There was a significant and negative correlation between frailty syndrome and the ability to care in the elderly with heart failure (P < 0.001, r = -0.358). CONCLUSIONS: According to the results, the elderly with fragility syndrome cannot take good care of themselves. This indicates that in the management of heart failure, the assessment of frailty syndrome as a care/treatment goal in the care programs of these patients should be considered.

Psychometric properties of the Persian language person-centered climate questionnaire - Patient version (PCQ-P).

BACKGROUND: Person-centered care is a valuable approach to improve the quality of care of the elderly and is a starting point for maintaining the dignity of people needing care. OBJECTIVES: This study aimed at translation, cultural adaptation, and validation of the Persian version of the Person-centered Climate Questionnaire-Patient questionnaire in elderly patients admitted to the Eastern Guilan hospitals from 2017-2018. DESIGN: This research was a cross-sectional study. The Persian version of Person-centered Climate Questionnaire -Patient version was completed by 200 older adults admitted to different wards of the hospitals. They were selected through convenient sampling. Data were collected in 5 hospitals affiliated to Guilan University of Medical Sciences, East of Guilan located in the north of Iran, from November 2017 to February 2018. METHODS: This study was carried out in two phases. In the first phase, the original questionnaire with 17 items was translated from English into Persian using Forward-Backward translation method. In the second phase, the psychometric properties of the questionnaire were evaluated using face, content, and construct validity, as well as reliability (internal consistency and stability). Data were analyzed via SPSS software v.16. RESULTS: The results of exploratory factor analysis (EFA) led to retaining 17 items with three factors of "Safety", "Hospitality", and "Everydayness" which explained 47.69% of the total variance. Cronbach's alpha coefficient was calculated for each factor (0.85, 0.70, and 0.64, respectively) as well as the whole instrument (0.85), to ensure internal consistency. Stability was confirmed by calculating the intra-class correlation coefficient as 0.99. CONCLUSIONS: The current study found support for assessing the person-centered climate from the perspective of the elderly patients by using the Persian version of the Person-centered Climate Questionnaire-Patient that has an appropriate cultural adaptation, validity, and reliability.