Obstetric triage systems: a systematic review of measurement properties (Clinimetric).

BACKGROUND: Since labor and delivery units often serve as emergency units for pregnant women, the use of obstetric triage systems with poor or inadequate quality can lead to unintended consequences such as over and under-triage and so a waste of humans and financial resources. Therefore, this systematic review was conducted to evaluate the measurement properties of obstetric triage tools. METHODS: PubMed, EMBASE, and Medline were searched to identify studies in October 2018 and were updated in May 2019. The risk of bias COSMIN checklist was used to evaluate the quality of the studies. The quality of every measurement property was appraised by the update criteria of COSMIN. Evidence quality was judged using the modified GRADE approach. RESULTS: A total of 444 studies were retrieved in initial search. Six studies evaluating 4 tools were included in this study. All the included studies reported only content validity and reliability. The quality of evidence varied from very low to moderate. The quality of content validity and reliability of the included tools was sufficient except for the reliability of the maternal-fetal triage index. The obstetric triage acuity scale (OTAS) was found to have higher reliability than other tools. CONCLUSIONS: Due to insufficient evidence, the conclusions about the quality of measurement properties of each obstetric triage tool may be uncertain. This review emphasizes the necessity for further studies with robust methodological quality on the measurement properties of obstetric triage tools.

Exploring the concept and structure of obstetric triage: a qualitative content analysis.

BACKGROUND: Obstetric triage is a new idea, so the design and implementation of it requires identification of its concept and structure. The aim of this qualitative study was to explore the concept and structure of the obstetric triage in Iran. METHODS: The purposive sampling was done and it continued until reaching the theoretical saturation. Thirty-seven semi-structured interviews were conducted individually and face-to-face. Interviews were audio recorded, transcribed, and analyzed using conventional content analysis. RESULTS: Two themes, 8 main categories, and 16 subcategories emerged from the content analysis of the interviews and observations. The themes were the concept and structure of obstetric triage. The concept of obstetric triage consisted of three categories of nature, process, and philosophy of obstetric triage. The structure of obstetric triage included five categories of assessment criteria, emergency grading, determining the appropriate location for patient guidance, initiation of diagnostic and therapeutic measures, and timeframe for initial assessment and reassessment. CONCLUSION: Findings highlighted that obstetric triage is a process with a dual and dynamic nature. This process involves clinical decision making to prioritize the pregnant mother and her fetus based on the severity and acuity of the disease in order to allocate medical resources and care for providing appropriate treatment at the right time and place to the right patient. The results of this study could be used for the design and implementation of the obstetric triage system.

Factors affecting childbearing intention in women employees in Birjand: Application of the theory of planned behavior.

BACKGROUND: Childbearing is one of the most important determinants of population fluctuations. Identifying factors affecting childbearing is necessary for the proper implementation of population programs. This study aimed to determine the factors affecting childbearing intention among women employees in Birjand based on the theory of planned behavior. MATERIALS AND METHODS: In this descriptive-correlational study, 405 women employees in the offices of Birjand city in 2022 were selected by stratified random sampling and completed a two-part questionnaire including demographic information and questions related to the theory of planned behavior. The data were analyzed using SPSS v19 and Pearson's correlation, logistic regression, independent t-test, and ANOVA. RESULTS: The mean age of the participants in the study was 37.82 ± 6.39 years and the mean number of current children was 1.77 ± 0.92. The mean score of childbearing intention was 8.80 ± 3.06, the attitude was 66.04 ± 11.50, the subjective norm was 27.03 ± 6.95, and perceived behavioral control was 32.90 ± 7.80. Also, there was a significant negative and direct relationship between all the constructs of the theory of planned behavior and childbearing intention (P < 0.01). The variables of age, the number of current children, and the ideal number of children were predictors of childbearing intention. According to the standardized beta coefficients, the strongest predictor of intention was the number of current children (ß = -0.464). CONCLUSION: The findings showed that various demographic factors are efficient in childbearing intention. The findings of this study can provide a picture of the current situation of factors affecting childbearing intention in society and be used as a guide for policymakers in fertility planning.

The development and validation of an obstetric triage acuity index: a mixed-method study.

BACKGROUND: There is uncertainty about the applicability of developed country triage scales in the developing population. OBJECTIVE: To develop and validate an obstetric triage scale in Iran. METHODS: This exploratory sequential mixed-method study was conducted on experienced gynecologists, emergency medicine, midwives, and nurses as evaluators, and pregnant or parturient women as sample. Development of obstetric triage acuity index was done using qualitative study and literature review. Thirty-two evaluators in two rounds evaluated the clinical impact score, content validity ratio, and content validity index. The tool performance was compared with a standard reference in 415 women. The association of urgency levels with hospitalization, resource utilization, and emergency department length of stay were assessed in 599 women. Five midwives independently double-triaged 234 convenience women to estimate inter-rater reliability. RESULTS: Out of 191 items in the initial draft, 9 (4.7%) items in the face validity, 33 (18.1%) in the first, and 5 (3.2%) in the second content validity round were removed because not meeting the expected thresholds. Nine items added based on evaluators' suggestions. Finally, total items had a kappa above 0.74, and S-CVI/Ave, S-CVI/UA were 0.99 and 0.86, respectively. There was a significant correlation between the two tools (r = 0.661, p < 0). Level 1 mothers had a higher chance of using ≥ 2 resources (OR = 16.4, 95% CI = 2.06-129.98) and hospitalization (OR = 18.0, 95% CI = 3.96-81.51) compared to the level 5, after adjusting for gestational age/postpartum, and referral method. Sensitivity, specificity, and accuracy of the scale in predicting hospitalization were 74.8% (95% CI = 69.73-79.49), 80.8% (95% CI = 73.60-86.74), and 76.7% (72.67-80.48), respectively. The over and under-triage rates were 6.1% and 17.1%, respectively. The absolute agreement inter-raters was 86.8%, and the linear weighted kappa was 0.86 (95% CI = 0.81-0.91). CONCLUSION: The designed OB triage scale showed good validity and reliability in the tertiary teaching hospital. Studying this tool at lower levels, non-educational, and public hospitals are recommended for external validity testing.

Factors influencing the implementation of obstetric triage: a qualitative study.

OBJECTIVE: To identify factors influencing the OB triage implementation in Iran DESIGN: Qualitative study of conventional content analysis SETTING: A teaching tertiary referral hospital in Ahvaz, Khuzestan, Iran PARTICIPANTS: 37 professional midwives, nurses, gynecologists, and specialists of emergency medicine, and 6 patients MEASUREMENTS AND FINDINGS: Semi-structured interviews were conducted individually and face-to-face. Interviews were audio recorded, transcribed, and analyzed using conventional content analysis. Four overarching categories and nine themes emerged from the content analysis of the interviews and observations. Overarching categories were the guideline, individual, cultural and social context, and organization. The development and structure were themes of the guideline. Knowledge, attitudes, and behaviors were related to the category of individuals. The cultural and social context included cultural and social changes. Implementation and monitoring strategies and executive infrastructure were organizational themes. Participants had differences and similarities in understanding influencing factors. CONCLUSION: The guideline, individual, cultural and social context, and organization were key factors influencing the OB triage implementation in Iran. Some variety was detected between the different occupational groups' perceptions of influencing factors. Providing human resources and training and empowerment of them was the most significant factor influencing, which was acknowledged by almost all participants in all occupational groups. IMPLICATION FOR PRACTICE: Identifying the influencing factors from the perspective of all stakeholders can improve the process of OB triage implementation by eliminating barriers and enhancing facilitators.

Is the quality of life different in single and remarried elderly?

BACKGROUND: Due to increasing number of the world population, elderly individual's quality of life (QOL) is a matter of concern and marital status as one of the objective measures of QOL is of paramount importance. This study was done to compare the QOL between single and remarried elderly. MATERIALS AND METHODS: This case-control study was conducted on 200 elderly people in Qaen (Southern Khorasan province), Iran. The research sample consisted of two groups of single and remarried elderly, 100 in each group. A demographic and LEIPAD (an acronym deriving from the name of Leiden and Padua universities) QOL questionnaires were completed by the participants via interview. RESULTS: There was a significant difference between single and remarried elderly groups in the QOL (P < 0.001). Linear regression showed that marital status (P < 0.000), economic situation (P < 001), primary education (P < 0.0002), and diploma (P < 0.030) opposed to the illiterate were significantly related to the QOL. In other words, being married and higher economic situation and education increase the QOL. There was a significant negative correlation between the age (P < 0.000) and QOL. The strongest factor was age. CONCLUSIONS: Marital status, income, and education play an important role in all aspects of QOL in older adults. Thus, being married can be a protective factor against physical, psychological, and social problems in old age. Realizing this issue in consultation process of elderly peoples is recommended.

The relationship between health-promoting lifestyle and sleep quality in postmenopausal women.

BACKGROUND: Menopausal women are widely reported to have poor sleep quality and sleep problems. It is not clear whether increases in sleep disturbance are brought about by hormone changes associated with menopause or due to psychosocial and physical problems. METHOD: This cross-sectional study was conducted on 600 menopausal women aged between 40 and 60 without any known severe illnesses in the city of Qaen, Iran, from April 2015 to May 2016. Data were collected by Health-Promoting Lifestyle Profile II and Pittsburgh Sleep Quality Index. MAIN OUTCOME MEASURES: This study was conducted to investigate the relationship between health-promoting lifestyle and sleep quality in Iranian postmenopausal women. Data were analyzed using an independent t-test, Mann-Whitney, Chi-square, Spearman and univariate logistic regression. RESULT: The univariate logistic regression suggested that the physical activity dimension of lifestyle (OR = 1.095, 95% CI: 1.035-1.158, P < 0.006), non-smoking status (OR = 0.549, 95% CI: 0.331-0.912, P < 0.021) and occupation (women who were farmer compared with housewives) (OR = 0.239, 95% CI (0.074-0.775), P < 0.017) were associated with sleep quality. CONCLUSION: Postmenopausal women in this study were at high risk for poor sleep quality. Poor sleep quality was associated with low levels of physical activity, smoking and being a housewife compared to being a farmer. Therefore, there is an essential need to educate women about health-promoting behaviors including daily physical activity and avoiding smoking which are associated with quality of sleep.

Spatial Analysis of Breast Cancer Incidence in Iran.

Breast cancer (BC) is the most common cancer in females (27% of the total) and the main cause of death (16%) due to cancer in women in developed and developing countries. Variations in its incidence rate among geographical areas are due to various contributing factors. Since there have been a lack of studies on this topic in our country, the present spatial analysis of breast cancer incidence in Iran in 2009 was conducted using data from the national cancer registry system. The reported incidences of the disease were standardized according to the World Health Organization population and the direct method. Then data was inserted into the GIS software and finally, using the Hot Spot Analysis (Geties-Ord Gi), high-risk areas were drawn. Provinces with incidences 1.96 SD higher or lower than the national average were considered as hot spots or cold spots, at the significance level of 0.05%. In 2009, a total of 7,582 cases of BC occurred in Iran. The annual incidence was 33.2 per hundred thousand people. Our study showed that the highest incidence of BC in women occurred in the central provinces of the country, Tehran, Isfahan, Yazd, Markazi and Fars. The results of hot spots analysis showed that the distribution of high-risk BC was focused in central parts of Iran, especially Isfahan province (p <0.01). The other provinces were not significantly different from the national average. The higher incidence in central provinces may be due to greater exposure to carcinogens in urban areas, a Western lifestyle and high prevalence of other risk factors. Further epidemiological studies about the etiology and early detection of BC are essential.

Trends in Incidence of Common Cancers in Iran.

Cancer is a major public health problem in Iran. The aim of this study was to evaluate trends in incidence of ten common cancers in Iran, based on the national cancer registry reports from 2004 to 2009. This epidemiological study was carried out based on existing age-standardized estimate cancer data from the national report on cancer registry/Ministry of Health in Iran. The obtained data were analyzed by test for linear trend and P ≥ 0.05 was taken as the significant level. Totals of 41,169 and 32,898 cases of cancer were registered in men and females, respectively, during these years. Overall age-standard incidence rates (ASRs) per 100,000 population according to primary site weres 125.6 and 113.4 in males and females, respectively. Between 2004 and 2009, the ten most common cancers (excluding skin cancer) were stomach (16.2), bladder (12.6), prostate (11), colon-rectum (10.14), hematopoeitic system (7.1), lung (6.1), esophagus (6.4), brain (3.2), lymph node (3.8) and larynx (3.4) in males; and in females were breast (27.4), colon-rectum (9.3), stomach (7.6), esophagus (6.4), hematopoeitic system (4.9), thyroid (3.9), ovary (3.6), corpus uteri (2.9), bladder (3.2) and lung (2.6). Moreover, results showed that skin cancer was estimated as the most common cancer in both sexes. The lowest and the highest incidence in females and males were reported respectively in 2004 and 2009. Over this period, the incidence of cancer in both sexes has been significantly increasing (p<0.01). Like other less developed and epidemiologically transitioning countries, the trend of age-standardized incidence rate of cancer in Iran is rising. Due to the increasing trends, the future burden of cancer in the Iran is going to be acute with the expected increases in aging populations. Determining and controlling potential risk factors of cancer should hopefully lead to decrease in its burden.

Spatial Analysis of Colorectal Cancer in Iran.

Colorectal cancer is one of the most common cancers. Due to demographic changes, it is predicted that the incidence of this cancer will increase. Variations of its incidence rate among geographical areas are due to various contributing factors. Since there have been a lack of studies on this topic in our country, the present assessment of spatial patterns of colorectal cancer incidence in Iran was performed. In this ecological study, the new cases of colon cancer were extracted from Cancer Registry Center report of the Health Deputy of Iran in 2009. The reported incidences of the disease were standardized on the basis of the World Health Organization population and the direct method. Then the data were inserted into the GIS software, and finally, using the analysis of hot spots (Getis-Ord Gi) high-risk areas were drawn. Provinces that are higher or lower than the national average (1.9 SD) were considered hot spots or cold spots, significant at the level of 0.05. A total of 6,210 cases of colorectal cancer were registered in Iran in 2009, of which 3,727 were in men and 2,783 in women (age-standardized rates of 11.3 and 10.9 per 100,000 population, respectively). The results showed that in central and northern Iran including Isfahan, Qom, Tehran, Qazvin and Mazandaran significant hot spots in men were present (p <0.05). In women also we have high incidence in northern and central states: Mazandaran province (p<0.01) and the province of Tehran (p<0.05) had higher incidences than the national average and were apparent as significant hot spots. Analysis of the spatial distribution of colorectal cancer showed significant differences between different areas pointing to the necessity for further epidemiological studies into the etiology and early detection.