Occurrence of microplastics in edible tissues of livestock (cow and sheep).

Plastic contamination is widely recognized as a major environmental concern due to the entry of small plastic particles into the food chain, thereby posing potential hazards to human health. However, the current understanding of microplastic (MP; < 5 mm) particles in livestock, which serve as an important food source, is limited. This study aims to investigate the concentration and characteristics of MPs in edible tissues of cow and sheep, namely liver, meat, and tripe, obtained from butcher shops in five areas of Bushehr port, Iran. The mean concentration of MPs in different tissues of cow and sheep were 0.14 and 0.13 items/g, respectively. Among the examined tissues, cow meat exhibited the highest concentration of MPs, with a concentration of 0.19 items/g. Nylon and fiber were identified as the predominant polymer types and shapes of MPs found in cow and sheep tissues, respectively. Furthermore, no statistically significant difference was observed in MP concentration across different tissues of cow and sheep. Significantly, this study highlights the elevated hazards associated with exposure to MPs through the consumption of edible cow and sheep tissues, particularly for children who consume meat. The results underscore the potential transfer of MPs from the environment to livestock bodies through their food, contamination during meat processing, and subsequent health hazards for consumers.

Analysis of microplastics in ships ballast water and its ecological risk assessment studies from the Persian Gulf.

Transport of ballast water is considered a significant vector for dispersion of different pollutants, including microplastics (MPs), throughout the world's oceans. However, there is limited information on MPs in ballast water. Size distribution, polymer type, and ecological risks of MPs in ballast water were investigated for the first time in this study. The mean levels of MPs in ballast water and seawater samples were 12.53 and 11.80 items/L, respectively. MPs with a size category of 50-300 µm was the most abundant. Fiber, black, and polycarbonate (PC) were the predominant shape, color, and polymer type of identified MPs in ballast water and seawater, respectively. The pollution load index (PLI), hazard index (HI), and risk quotient (RQ) indicated high levels of MP pollution, potentially indicating an ecological risk. These findings increase our understanding of the major sources (such as ballast water), transportation routes, and related ecological risks of MPs to marine ecosystems.

Childbirth self-efficacy and fear of childbirth and their predictors in adolescent and adult pregnant women referring to health centres of Urmia-Iran: a cross-sectional study.

OBJECTIVE: Adolescent pregnancy as a growing phenomenon in the world has been investigated from different aspects. However, the examination of childbirth fear and self-efficacy has received less attention. Therefore, this study was conducted to compare the self-efficacy and fear of childbirth and to determine their predictors in adolescent and adult pregnant women. DESIGN: In this comparative cross-sectional study, participants were selected through two-stage cluster sampling method. Data were collected using the Childbirth Self-Efficacy Inventory and Wijma Delivery Expectancy/Experience Questionnaire. The Pearson correlation test, independent t-test, and general linear model were used for data analysis. SETTING: Urmia health centres, Iran in 2020. PARTICIPANTS: Three hundred and sixty adults and adolescent pregnant women. RESULTS: The mean (SD) of fear of childbirth was 114.7 (14.1) and 108.1 (23.1) in adolescent and adult pregnant women, respectively. The mean (SD) of childbirth self-efficacy in the active phase and the second stage of labour respectively were also obtained 208.8 (28.6) and 203.5 (32.1) for adolescent pregnant women and 213.8 (25.7) and 212.0 (26.5) for adult ones. There was a significant difference between adolescent and adult pregnant women in fear of childbirth (p=0.001), self-efficacy expectancy (p=0.003) and total childbirth self-efficacy (p=0.008) in the second stage of labour. After adjusting the sociodemographic characteristics, the mean score of fear of childbirth was significantly higher in adolescent pregnant women than in adult ones whereas the mean total self-efficacy score in the second stage of labour was significantly lower in adolescent pregnant women than in adult ones. CONCLUSION: This study showed that adolescent pregnant women had more fear of childbirth and low self-efficacy than adult mothers, and there was also a relationship between fear of childbirth and self-efficacy. Paying more attention to fear and self-efficacy in childbirth and their predictors by health providers can improve pregnancy and childbirth outcomes.

Microplastics and phthalate esters release from teabags into tea drink: occurrence, human exposure, and health risks.

Tea, the most common infusion worldwide, is usually sold in teabags due to the ease of usage. The increase in the use of plastic materials in the food packaging industry has led to an increase in released contaminants, such as microplastics (MPs) and phthalates (PAEs), in various food products including teabags. In this research, the abundance and features of MPs as well as PAEs concentration were investigated in 45 teabag samples of different Persian and German brands. The abundance of MPs in the Persian and German teabag samples was averagely 412.32 and 147.28 items/single teabag, respectively. Also, average PAEs levels in the Persian and German teabag samples were 2.87 and 2.37 mg/g, respectively. The predominant size category of MPs was related to 100-250 µm. Fibers and transparent were the dominant shape and color of detected MPs in teabags, respectively. Polyethylene (PE) and nylon were the most common MP polymer types. The most prominent PAEs congeners in teabag samples were diethylhexyl phthalate (DEHP) and diisobutyl phthalate (DiBP). Furthermore, MP exposure hazard through tea ingestion was analyzed for children and adults. DEHP showed the cancer risk (CR) for children and adults. The findings of this research indicated that high MPs and PAEs levels are released from teabags into tea drinks. Considering a daily drinking of a volume of 150 and 250 mL tea by children and adults, 486 and 810 MPs may enter their bodies, respectively. Thus, tea prepared with teabag-packed herbs may pose a significant health risk for consumers.

Lactational Exposure of Human Infants to Metal (loid)s: A Comparison of Industrial and Urban Inhabitants in North of the Persian Gulf.

In this study, postnatal metal (loid)s (MLs) exposure was compared between the petrochemical and gas area of Asaluyeh (PGA) and urban area of Kaki (UA) in Bushehr province, Iran. Two hundred human breast milk (BM) samples from the industrial and urban areas were analyzed for MLs using Inductivity Coupled Plasma-Optical Emission Spectrometry (ICP-OES). Boron (B), copper (Cu), iron (Fe), and nickel (Ni) were found at the highest levels in both study areas. Adjusted multiple linear regression models revealed that the mean concentration of total MLs in BM samples collected from the PGA was statistically significantly greater than that of the UA (655.85 vs. 338.17 µg/L). Also, the mean concentrations of all detected MLs in BM samples collected from the PGA were statistically significantly higher than those collected from the UA. The hazard index (HI) of combined MLs in the PGA and UA illustrated non-cancer risk for infants. Lead (Pb) and chromium (Cr) in the PGA and Cr in the UA showed the risk of cancer. So it can be concluded that nursing infants from an industrial area are most at risk for MLs exposure during entire lactation course than those from an urban area.

Occurrence and ecological risks of microplastics and phthalate esters in organic solid wastes: In a landfill located nearby the Persian Gulf.

Landfill sites are the main source of plastic waste. Thus, municipal solid waste (MSW) in landfills may act as a reservior of microplastics (MPs) and related pollutants such as phthalate esters (PAEs) into surrounding environment. However, there is limited information on MPs and PAEs in landfill sites. Levels of MPs and PAEs in organic solid waste disposed in a landfill of Bushehr port were investigated for the first time in this study. The mean MPs and PAEs levels in organic MSW samples were 12.3 items/g and 7.99 µg/g, respectively, and the mean PAEs concentration in MPs was 87.5 µg/g. The highest number of MPs was related to the size classes of >1000 µm and <25 µm. The highest dominant type, color, and shape of MPs in organic MSW were nylon, white/transparent, and fragments, respectively. Di (2-ethylhexyl) phthalate (DEHP) and diisobutyl phthalate (DiBP) were the dominant compounds of PAEs in organic MSW. Based on the finding of present study, MPs showed a high hazard index (HI). DEHP, dioctyl phthalate (DOP), and DiBP demonstrated high-level hazards for sensitive organisms in water. This work illustrated considerable MPs and PAEs levels from an uncontrolled landfill without adequate protection, possibly contributing to their release into the environment. The sites of landfill located near marine environments, such as Bushehr port landfill adjacent to the Persian Gulf, may indicate critical threats to marine organisms and the food chain. Continuous landfills control and monitoring, especially the ones near the coastal area, is highly recommended to prevent further environmental pollution.

Effect of WebQuest-based education on critical thinking and academic self-efficacy of midwifery students: Study protocol of a randomized, controlled crossover trial.

BACKGROUND AND AIM: Critical thinking fills the gap between theoretical and clinical teaching and increases the power of clinical decision-making. WebQuest is an innovative, learner-centered, and effort-driven learning approach that uses computer technology to engage and motivate learners. In WebQuest, learners are compelled to use the latest information available on the web as a tool to promote higher levels of thinking. However, we did not find a study that used WebQuest to improve students' critical thinking and academic self-efficacy. The aim of this study will be to investigate the effect of WebQuest-based education on the critical thinking of midwifery students. MATERIALS AND METHODS: This superiority randomized, controlled crossover trial will be carried out among fifth-semester undergraduate midwifery students. Participants will be allocated to one of two event groups (A and B) using block randomization. In the first sequence (FS) (four weeks) of study, both groups will simultaneously attend two different education groups (WebQuest and traditional). During the FS, WebQuest will be used to teach group A participants, while group B participants will be treated as the control group (CG) and be taught using a traditional presentation. In the second sequence (SS), the interventions will be crossed over. Participants in both groups will complete the sociodemographic questionnaire, the California Critical Thinking Skills Test (CCTST), the California Critical Thinking Disposition Inventory (CCTDI), and the Academic Self-Efficacy Beliefs Questionnaire (ASEBQ) once before the first sequence of the study, during the washout period, and at the end of the second sequence of the study. The teaching satisfaction questionnaire will be completed at the end of the study. DISCUSSION: The results of this study can be used as a basis for teaching midwifery students using WebQuest as a new teaching method.

Prevention of osteoporosis in menopausal women: A systematic review of nonpharmacological clinical trials.

Osteoporosis is a systemic skeletal disease that is associated with negative physical and psychosocial consequences, so understanding the effective strategies that can be used in the prevention of osteoporosis is especially important. The aim of this study was to integrative review the published interventional of nonpharmacological studies regarding the prevention and treatment of osteoporosis among menopausal women. In this systematic review, databases such as PubMed, PsycInfo, Web of Science (ISI), Scopus, ScienceDirect, EmBase, Cochrane library, Google scholar, and Iranian databases, such as Scientific Information Database and Magiran, were searched. The latest search was performed between "November 2020 and December 2020" separately by two researchers and then double-checked by them. The quality of the included studies was assessed using the Jadad score calculation tool. Twenty eight randomized controlled trials and quasi-experimental studies were included in this current study. The quality assessment indicated that 19 studies had acceptable (good) methodological quality and also 9 studies had weak methodological quality. The main results of this study were classified in three main categories such as exercise or physical activity training (n = 15), educational sessions (n = 11), and other interventions (n = 2). The results of most included studies showed that nonpharmacological strategies such as physical activity and educational interventions are considered as the appropriate actions to prevention of osteoporosis among menopausal women so implementing these strategies can be a good alternative for women with contraindication of hormone therapy or therapeutic treatment.

Emerging contaminants migration from pipes used in drinking water distribution systems: a review of the scientific literature.

Migration of emerging contaminants (ECs) from pipes into water is a global concern due to potential human health effects. Nevertheless, a review of migration ECs from pipes into water distribution systems is presently lacking. This paper reviews, the reported occurrence migration of ECs from pipes into water distribution systems in the world. Furthermore, the results related to ECs migration from pipes into water distribution systems, their probable sources, and their hazards are discussed. The present manuscript considered the existing reports on migration of five main categories of ECs including microplastics (MPs), bisphenol A (BPA), phthalates, nonylphenol (NP), perfluoroalkyl, and polyfluoroalkyl substances (PFAS) from distribution network into tap water. A focus on tap water in published literature suggests that pipes type used had an important role on levels of ECs migration in water during transport and storage of water. For comparison, tap drinking water in contact with polymer pipes had the highest mean concentrations of reviewed contaminants. Polyvinyl chloride (PVC), polyamide (PA), polypropylene (PP), polyethylene (PE), and polyethylene terephthalate (PET) were the most frequently detected types of microplastics (MPs) in tap water. Based on the risk assessment analysis of ECs, levels of perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), perfluorohexane sulfonate (PFHxS), and perfluorooctane sulfonate (PFOS) were above 1, indicating a potential non-carcinogenic health risk to consumers. Finally, there are still scientific gaps on occurrence and migration of ECs from pipes used in distribution systems, and this needs more in-depth studies to evaluate their exposure hazards on human health.

Evaluation of occurrence of organic, inorganic, and microbial contaminants in bottled drinking water and comparison with international guidelines: a worldwide review.

The aim of this study was to evaluate the levels of inorganic and organic substances as well as microbial contaminants in bottled drinking water on a global scale. The findings were compared to WHO guidelines, EPA standards, European Union (EU) directive, and standards drafted by International Bottled Water Association (IBWA). Our review showed that 46% of studies focused on the organic contaminants, 25% on physicochemical parameters, 12% on trace elements, 7% on the microbial quality, and 10% on microplastics (MPs) and radionuclides elements. Overall, from the 54 studies focusing on organic contaminants (OCs) compounds, 11% of studies had higher OCs concentrations than the standard permissible limit. According to the obtained results from this review, several OCs, inorganic contaminants (IOCs), including CHCl3, CHBrCl2, DEHP, benzene, styrene, Ba, As, Hg, pb, Ag, F, NO3, and SO4 in bottled drinking water of some countries were higher than the international guidelines values that may cause risks for human health in a long period of time. Furthermore, some problematic contaminants with known or unknown health effects such as EDCs, DBP, AA, MPs, and some radionuclides (40K and 222Rn) lack maximum permissible values in bottled drinking water as stipulated by international guidelines. The risk index (HI) for OCs and IOCs (CHBrCl2, Ba, As, and Hg) was higher than 1 in adults and children, and the value of HI for CHCl3 in children was more than 1. Thus, further studies are required to have a better understanding of all contaminants levels in bottled drinking water.

Occurrence, seasonal distribution, and ecological risk assessment of microplastics and phthalate esters in leachates of a landfill site located near the marine environment: Bushehr port, Iran as a case.

Plastic wastes are produced in a large amount everywhere, and are commonly disposed in landfills. So landfill leachate seems an obvious source of microplastics (MPs) and phthalate esters (PAEs) due to a huge usage as plastic additives and plasticizers. But this issue still lacks attention and the present study provides the first information on the levels of MPs and PAEs in the fresh landfill leachate of Bushehr port during different seasons. The mean levels of MPs and PAEs in the fresh leachate in all seasons were 79.16 items/L and 3.27 mg/L, respectively. Also, the mean levels of PAEs in MPs were 48.33 µg/g. A statistically significant difference was detected in the levels of MPs and PAEs among different seasons with the highest values in summer and fall. MPs with a size of >1000 µm had the highest abundance in all seasons. The most prominent shape, color, and type of MPs in the leachate were fibers black, and nylon, respectively. Dibutyl phthalate (DBP) and Di(2-ethylhexyl) phthalate (DEHP) were the most dominant PAEs present in the leachate samples. The results of this study revealed high hazard index (HI) and pollution load index (PLI) of MPs in all seasons. Dioctyl phthalate (DOP), DEHP, DBP, diisobutyl phthalate (DiBP), butyl benzyl phthalate (BBP), and diethyl phthalate (DEP) represented a high risk to the sensitive organisms. The results of this study showed that significant levels of MPs and PAEs may release into the surrounding environment from the landfill sites without sufficient protection. This issue is more critical when the landfill sites in particular are located near the marine environments like the Bushehr landfill that is located near the Persian Gulf, which can lead to serious environmental problems. Thus permanent control and monitor of landfills, especially in the coastal areas are highly needed to prevent further pollution.

Occurrence and exposure assessment of microplastics in indoor dusts of buildings with different applications in Bushehr and Shiraz cities, Iran.

The increase in annual usage of plastics for different purposes has led to an increase in microplastics (MPs) particles in various environments including inside of buildings. In the present study, levels and characteristics of MPs in the indoor dust of buildings with different uses including residential house, mosque, hospital, kindergarten, and university in two cities, Bushehr port and Shiraz in Iran, were determined. Thirty dust samples from various buildings were collected. The average numbers of MPs in the indoor dust of buildings of Shiraz and Bushehr were 90.8 and 80.8 items/mg, respectively. Fiber and polyethylene (PE) were the most common shape and polymer types of identified MPs, respectively. The highest number of MPs was observed in the indoor dust of kindergartens with a mean number of 121 items/mg in Bushehr and 104 items/mg in Shiraz. Except for mosques, a significant difference (p-value <0.05) were not observed between the MPs levels of buildings with similar applications in Bushehr and Shiraz cities. In addition, the high daily intake to MPs via indoor dust ingestion and inhalation were found for infants in kindergartens and mosques. The results of this study showed that MPs are present in high concentrations in indoor environments and may pose a high exposure risk for different age groups.

Effective factors on nutrition behaviors of pregnant women based on the beliefs, attitudes, subjective norms, and enabling factors model: A cross-sectional study.

BACKGROUND: One of the useful models in health education is the Beliefs, Attitudes, Subjective Norms, and Enabling Factors (BASNEF) model. The model is used to study behavior and to plan for change it and to determine the factors that influence people's decision-making. The aim of this study was to investigate the factors affecting the nutritional behavior of pregnant women based on BASNEF model. MATERIALS AND METHODS: This cross-sectional study was performed on 360 pregnant women referring to health centers of Tabriz-Iran by two-stage cluster sampling method from April to December 2016. Data were collected using sociodemographic, nutrition subdomain of Health Promoting Lifestyle-II (HPLP-II), and researcher-made questionnaire based on constructs of BASNEF model. Data were analyzed using the SPSS software version 21 and Pearson correlation test and General Linear Model (GLM). RESULTS: Mean ± standard deviation (SD) of nutrition subdomain of HPLP-II was 24.65 ± 4.75 within the range 9-36. Mean ± SD of BASNEF model constructs (score range) was also obtained as 45.30 ± 10.80 (0-100), 17.98 ± 2.40 (8-24), 9.30 ± 2.82 (0-20) and 2.47 ± 1.74 (0-6) for belief, attitude, subjective norms, and enabling factors, respectively. Based on the GLM, there was significant relationships between nutritional behavior and BASNEF model constructs (belief [P < 0.001], attitude [P = 0.043], enabling factors [P < 0.001], and subjective norms [P = 0.038]) as well as the variables of job, husband's education, and job and sufficiency of income for expenses. CONCLUSION: The results of the present study showed the impact of BASNEF model constructs and some sociodemographic variables on nutrition behaviors in pregnant women. Therefore, in order to improve nutrition behaviors of pregnant women, designing and implementation of interventions based on the BASNEF model are recommended.

Knowledge and performance of the Iranian general population in the use of masks during the 2019 coronavirus.

BACKGROUND: The use of personal protective equipment (especially face masks) has increased in different communities amid the COVID-19 pandemic. Therefore, the present study aimed to assess knowledge and performance of Iranian general population in wearing face masks. MATERIALS AND METHODS: The present study is a cross-sectional study conducted using a valid and reliable questionnaire on 1843 eligible individuals. The questionnaires were shared by Link (www.porsall.com) in groups and social networks. Data were analyzed using SPSS (Version 24.0, SPSS Inc., Chicago, IL). RESULTS: The mean age of the participants was 42.84 years (standard deviation: 16.84). The majority had inadequate and low knowledge of masks (69.2%), nearly 30% had moderate (30.1%), and few had adequate and high knowledge of masks. The individuals' knowledge on when to wear a mask was also assessed and the results showed poor and low in 42.2%, 46.9% moderate and high performance in 10.7%. The participants' performance on how to properly wear a mask was also assessed and 12% showed poor, 69.3% showed moderate, and 18.7% showed high performance. Safe removal of masks was also assessed, and the results showed 52% low and poor, 27.6% moderate, and 20.3% high performance. A significant and direct correlation was found between the overall score knowledge and performance regarding use of masks (P < 0.001). CONCLUSION: The results showed poor to moderate knowledge and performance of majority of Iranian general population regarding the masks. Therefore, further effective training courses and action plans are needed in Iran given the importance of masks for the prevention of COVID-19, especially in public places. Educational package about how to use the mask and its benefits, through the media and health centers is recommended.

Occurrence of microplastics and phthalate esters in urban runoff: A focus on the Persian Gulf coastline.

Urban runoff seems an obvious pathway for the transfer of microplastics (MPs) and phthalate acid esters (PAEs) from land-based sources to the marine environment; an issue that still lacks attention. This study presents the first results on MP and PAE levels in the urban runoff into the northern part of the Persian Gulf during the dry season. Average concentrations of MPs and PAEs in the urban runoff of eight selected sampling sites (N = 72) along the Bushehr coast were 1.86 items/L and 53.57 µg/L, respectively. MPs with a size range of 500-1000 µm had the highest abundance, and the mean levels of PAEs in MPs were 99.77 µg/g. The results of this study show that urban runoff is a main source of MP and PAE contaminants that are discharged into the Persian Gulf. Therefore, to decrease these pollutants from entering the aquatic environment, decision-makers in the area should consider this problem and stop the direct discharging of urban runoff into water bodies.

Fatigue and sleep quality in different trimesters of pregnancy.

OBJECTIVES: Fatigue is one of the most common and persistent complaints of pregnant women. Increased severity of fatigue during pregnancy can increase the risk of preterm labor, prolonged labor, cesarean section, and postpartum depression. Therefore, this study aimed to determine the fatigue status in different trimesters of pregnancy and its relationship with sleep quality in pregnant women. MATERIAL AND METHODS: This cross-sectional study was performed by two-stage cluster sampling on pregnant women referred to Tabriz health centers. Data were collected using socio-demographic questionnaire, multidimensional assessment of fatigue and Pittsburgh sleep quality index. RESULTS: Among the 605 pregnant women studied, 94.2% of women suffered from fatigue during pregnancy. The mean (standard deviation) of fatigue score in the first, second and third trimesters of pregnancy was 23.53 (8.05), 25.78 (6.56) and 26.46 (6.72), respectively. There was also significant reverse correlation between total fatigue score with total sleep quality score (p=0.031) and with an increase in fatigue, sleep quality was reduced. DISCUSSION: The findings of this study may be used to design interventional measures for fatigue and medical care to improve quality of sleep in pregnancy.

Knowledge and viewpoint of adolescent girls regarding child marriage, its causes and consequences.

BACKGROUND: Child marriage is a violation of children's rights and it exposes them to social isolation and psychological damages. These negative effects are not limited to them and expands to the family and society as well. The present research aimed at determining the knowledge and viewpoint of adolescent girls regarding child marriage, its causes and consequences in the city of Tabriz-Iran, in 2020-2021. METHODS: This cross-sectional study was carried out on 300 adolescent girls who had records in the health centers in the city of Tabriz. The data were collected using the sociodemographic characteristics questionnaire, questionnaire of knowledge, and view of adolescent girls regarding child marriage, and its causes and consequences. The multivariate logistic regression model with adjusting the sociodemographic characteristics was used to determine the relationship between the viewpoint of adolescent girls about child marriage and their knowledge in this regard. RESULTS: The mean (SD) knowledge about child marriage was 6.70 (3.09) (score range: 0-11). The majority of the girls (85.4%) were against marriage before the age of 18 and only 16 girls (5.1%) of them agreed with marriage before the age of 18. Investigating the viewpoint of adolescent girls regarding the causes of child marriage revealed that the important issue leading to reduction of child marriage can be "intellectual, emotional, social, and economic maturity of girls plus their physical puberty (92.4% agree), increase in the girls' education (79% agree) and increasing girls' awareness regarding the consequences of early marriage in schools and media (69.6% agree). Illiteracy or lack of education of parents (64% agree), meeting the emotional needs (59.3% agree), family problems and conflicts (59.6% agree), and lack of exhilaration in daily life, especially in the rural regions and suburbs (58.3% agree) were among the reasons of increase of child marriage. The most important consequence of child marriage from the viewpoint of the girls is deprivation from the chance of education. The results of multivariate logistic regression model by adjusting the possible confounding variables, showed that girls who believed the appropriate age for marriage is under 20 were almost 13 times more likely to agree with child marriage than girls who believed the appropriate age for marriage is over 20 years (aOR = 13.82; 95% Cl 2.61-71.16 p = 0.002) and girls who opposed their parents' decision to marry under the age of 18 were less likely to agree with the child marriage than girls who did not oppose their decision (aOR = 0.09; 95% Cl 0.01-0.63 p = 0.016). CONCLUSIONS: The results revealed a good level of knowledge and negative attitude to child marriage among the girls. The girls who disagreed with child marriage were more knowledgeable than the girls who agreed with child marriage. Thus, the increase of the level of knowledge of girls and their families regarding the consequences of early marriage and developing the culture for correcting the cultural beliefs and wrong social beliefs to prevent child marriage can decrease this damage to a great extent.

The relationship between sexual function and mental health in Iranian pregnant women during the COVID-19 pandemic.

BACKGROUND: Sexual function, a significant contributor to quality of life, is affected by various factors, including overall mental health. COVID-19 is a current pandemic that influences the mental health of various populations, especially pregnant women. Despite the importance of sexual health, the specific nature of its relationship to overall mental health during the COVID-19 pandemic is not clearly defined. Thus, this study investigates the relationship between sexual function and mental health during the COVID-19 pandemic in Iranian pregnant women. METHODS: This descriptive-analytical, cross-sectional study was carried out among 437 pregnant women using the sociodemographic and obstetrics characteristics questionnaire, Female Sexual Function Inventory, Stress, Depression, and Anxiety Scales. Random sampling was employed to select pregnant women who had a medical record in Health Centers of Tabriz city, Iran. The questionnaires were sent to the participants' cell phones via WhatsApp or text messages, including links of questionnaires and the participants completed these questionnaires. Spearman correlation test was used to determine the relationship between sexual function and stress, anxiety, and depression. Generalized linear modeling was used to estimate each of the independent variables (sociodemographic characteristics, stress, anxiety, and depression) on the dependent variable (sexual function). RESULTS: The mean (Standard Deviation) sexual functioning (total) score was 20.0 (8.50) from the available range of 2 to 36. The mean (SD) of depression, stress, and anxiety scale was 4.81 (5.22), 5.13 (4.37), and 7.86 (4.50) (possible score ranging from 0 to 21), respectively. Based on Spearman's correlation test, there was a significant reverse correlation between the total sexual function score and stress, anxiety, and depression, indicating that all three variables negatively impacted sexual functioning. Variables such as mild stress, spouse type of job, sufficient household income, living with parents, higher marital satisfaction, and higher gestational age had a significant, positive impact on sexual function and could predict 35.8% of the variance model. CONCLUSIONS: Sexual functioning was significantly impacted by stress, anxiety, and depression - all of which are heightened during a pandemic. This topic warrants further study, and the general public should be educated on the protective influence of safe sex/intimacy on overall mental health.

Two decades of Iranian midwives' activities as a health care provider under supervision in a multidisciplinary team in reducing maternal mortality.

Iran is amongst the countries that have achieved the fifth goal of the United Nations Millennium Development Goal. The maternal mortality ratio (MMR) in Iran has declined from 48 cases per 100,000 in 2000 to 16 cases per 100,000 in 2017, showing an annual decline rate of about 6.3%. In the International Year of the Nurse and the Midwife (year 2020), this commentary highlights two decades of Iranian midwives' activities as a health care provider under supervision in a multidisciplinary team in reducing maternal mortality.

Depression, stress, anxiety and their predictors in Iranian pregnant women during the outbreak of COVID-19.

BACKGROUND: Pregnancy as a sensitive period of a woman's life can be affected by various psychological factors that can have adverse effects on the woman, her fetus and future baby. Since COVID-19 is a new phenomenon with limited information available, it may have adverse psychological effects on pregnant women. Therefore, this study was conducted to determine the status of depression, stress, anxiety and their predictors in Iranian pregnant women during the outbreak of COVID-19. METHODS: This descriptive-analytical cross-sectional study was performed on 205 pregnant women covered by Tabriz health centers in Iran. The sampling method used was cluster sampling. The data collection tool was the socio-demographic characteristics questionnaire and the DASS-21 (Depression, Anxiety and Stress Scale-21), which were completed online by pregnant women. The general linear model was used to determine the predictive factors of depression, anxiety and stress. RESULTS: The mean (SD) score of depression, stress, and anxiety were 3.91 (3.9), 6.22 (4.25), and 3.79 (3.39), respectively; the score range of 0 to 21. Depression, stress, and anxiety symptoms were observed in 32.7, 32.7, and 43.9% of the participants, respectively, with varying degrees from mild to very severe. Based on the adjusted general linear model, variables of education level, spouse's job and marital life satisfaction were the predictors of depressive symptoms. Variables of spouse's education level, spouse's support, marital life satisfaction and the number of pregnancies were the predictive factors of anxiety symptoms and the variables of spouse's education level, household income sufficiency, spouse's support and marital life satisfaction were predictors of stress symptoms. CONCLUSIONS: Considering the role of marital life satisfaction, high level of spouse's education and income in reducing symptoms of stress, anxiety, and depression in pregnant women in critical situations such as the prevalence of COVID-19, it seems that using strategies to promote marital life satisfaction and socio-economic status can play an effective role in controlling anxiety and reducing stress and depression in pregnant women.