Melatonin effects on sleep quality and outcomes of COVID-19 patients: An open-label, randomized, controlled trial.

This trial aims to evaluate the effectiveness of adding melatonin to the treatment protocol of hospitalized coronavirus disease 2019 (COVID-19) patients. This was an open-label, randomized controlled clinical trial in hospitalized COVID-19 patients. Patients were randomized into a treatment arm receiving melatonin plus standard care or a control arm receiving standard care alone. The trial's primary endpoint was sleep quality examined by the Leeds Sleep Evaluation Questionnaire (LSEQ). The trial's secondary endpoints were symptoms alleviation by Day 7, intensive care unit admission, 10-day mortality, white blood cell count, lymphocyte count, C-reactive protein status, and peripheral capillary oxygen saturation. Ninety-six patients were recruited and allocated to either the melatonin arm (n = 48) or control arm (n = 48). Baseline characteristics were similar across treatment arms. There was no significant difference in symptoms on Day 7. The mean of the LSEQ scores was significantly higher in the melatonin group (p < 0.001). There was no significant difference in laboratory data, except for blood oxygen saturation, which has improved significantly in the melatonin group compared with the control group (95.81% vs. 93.65% respectively, p = 0.003). This clinical trial study showed that the combination of oral melatonin tablets and standard treatment could substantially improve sleep quality and blood oxygen saturation in hospitalized COVID-19 patients.

The Effect of Hajj Trip on Mental Health: A Longitudinal Study.

Hajj is a spiritual journey and religious ritual which is performed every year. Here, we evaluate the psychological effect of the Hajj. Using General Health Questionnaire (GHQ) questionnaire with 28 questions, the mental health of the pilgrims was assessed before and after the journey. A total of 154 people were questioned, 72 pilgrims (47%) were male. The mean GHQ score of participants before the journey was 50.1 and after the journey was 49.5 (P = 0.248). The results of analysis of variance and generalized estimating equation indicated that the GHQ scores had no significant difference before and after the journey.

Effect of Brief Cognitive Behavioral Counseling and Debriefing on the Prevention of Post-traumatic Stress Disorder in Traumatic Birth: A Randomized Clinical Trial.

OBJECTIVE: Planning to promote the health of mothers in postpartum is important in all countries. This study aimed to determine the effectiveness of two counseling method on prevention of post-traumatic stress after childbirth. METHODS: In this clinical trial, 193 of mothers who had experienced a traumatic birth were randomly assigned to three groups. Participants were assessed using IES_R questionnaire at 4-6 weeks and 3 months after delivery. RESULTS: Debriefing and brief cognitive behavioral counseling (CBC) significantly improved the symptoms of postpartum traumatic stress disorder. After 3 months, CBC had a significant effect on the symptoms. CONCLUSION: Screening of traumatic childbirth, implementation of supportive care, and early counseling prior to the initiation of post-traumatic stress are recommended. TRIAL REGISTRATION NUMBER: IRCT2015072522396N2. http://en.search.irct.ir/view/24735 .

The effect of cognitive-behavioural and solution-focused counselling on prevention of postpartum depression in nulliparous pregnant women.

OBJECTIVE: The aim of this study was to evaluate the effect of cognitive-behavioural approach and solution-focused counselling on prevention of postpartum depression in nulliparous pregnant women. BACKGROUND: Maternity blues is a common disorder and postpartum depression is a serious disorder. Therefore, the use of preventive measures and timely intervention is of particular importance. METHODS: In this randomised clinical trial, 85 nulliparous pregnant women at 30-35 weeks were randomly divided into three groups: cognitive-behavioural counselling (n = 25), solution-focused counselling (n = 25) and control (n = 35). Counselling meetings were held on a weekly basis. The cognitive-behavioural group received four sessions of counselling and the solution-focused group received three sessions of counselling. The control group received only routine pregnancy healthcare services. Maternity blues and postpartum depression were, respectively, measured on postpartum days 5 and 15 through the Austin Inventory and Edinburgh Postnatal Depression Scale. The mean scores of the three groups were compared using one-way ANOVA. RESULTS: The results of this study showed that the maternity blues mean scores of the three groups of cognitive-behavioural counselling, solution-focused counselling and control groups were 6.1 ± 4.6, 4.2 ± 3.6 and 6.7 ± 4.9, respectively, and the difference between the scores was significant. The mean scores of postnatal depression on the 15th postpartum day in the three groups were 6.7 ± 5.3, 4.4 ± 4.4 and 10.4 ± 5.9, respectively. The results showed that cognitive-behavioural and solution-focused counselling significantly reduced the maternity blues and postpartum depression scores compared with the control group and no difference was observed between the scores of these two counselling methods. The odds ratio of being depressed in women with maternity blues was 7.6 (95% CI: 2.1-27.5). CONCLUSION: Integration of solution-focused and cognitive-behavioural counselling programmes in prenatal care can be effective for improving the mental health of pregnant women.

Inserting central venous catheter in emergency conditions in coagulopathic patients in comparison to noncoagulopathic patients.

BACKGROUND: The current study was designed to compare the complications and adverse effects of central venous catheter (CVC) insertion under ultrasound guidance in patients with and without coagulopathy. MATERIALS AND METHODS: In this clinical trial, 59 patients who needed CVC for various reasons were enrolled. Patients were divided into two groups of those with and without coagulopathy based on complete blood count, prothrombin time, partial thromboplastin time, and international normalized ratio test results, and then, CVC was inserted with ultrasound guidance in both groups. The CVC inserting site was examined for hematoma and hemorrhage in four stages at different times. RESULTS: There was no significant difference in the terms of demographic features, catheter lumen size (P = 0.43), and number of attempting for CVC placement (odds ratio [OR] =2.35, 95% confidence interval [CI] = 0.36-15.3, P = 0.39) between two groups. Seven out of 59 patients suffered from complications (11.9%) that the complications in coagulopathic patients were oozing (5.7%) and superficial hematoma (8.6%) while in noncoagulopathic patients were 4.2% for both complications (OR = 0.54, 95% CI = 0.09-3.07, P = 0.767). CONCLUSION: According to our results, it can be concluded that inserting CVC with ultrasound guidance under emergency conditions causes no serious and life-threatening complications in coagulopathic patients.

Bone marrow mesenchymal stem cells improve cognitive impairments induced by methamphetamine in rats and reduce relapse.

Introduction: Chronic exposure to methamphetamine (Meth) results in permanent central nervous system damage and learning and memory dysfunction. This study aimed at investigating the therapeutic effects of bone marrow mesenchymal stem cells (BMMSCs) on cognitive impairments in Meth addicted rats and comparing intravenous (IV) delivery with intranasal (IN) delivery of BMMSCs. Methods: Adult Wistar rats were randomly divided into 6 groups; Control; Meth-addicted; IV-BMMSC (Meth administered and received IV BMMSCs); IN-BMMSC (Meth administered and received IN BMMSCs); IV-PBS (Meth administered and received IV Phosphate-buffered saline (PBS); IN-PBS (Meth administered and received IN PBS). BMMSCs were isolated, expanded in vitro, immunophenotyped, labeled, and administered to BMMSCs-treated groups (2 × 106 cells). The therapeutic effect of BMMSCs was measured using Morris water maze and Shuttle Box. Moreover, relapse-reduction was evaluated by conditioning place preference after 2 weeks following BMMSCs administration. The expression of brain-derived neurotrophic factor (BDNF) and glial-derived neurotrophic factor (GDNF) in rat hippocampus was assessed using immunohistochemistry method. Results: Administration of BMMSCs caused a significant improvement in the learning and memory functions of Meth-addicted rats and reduced the relapse (P<0.01). In behavioral tests, comparison of IV and IN BMMSC-treated groups did not show any significant difference. Administration of BMMSCs improved the protein level of BDNF and GDNF in the hippocampus, as well as causing behavioral improvement (P<0.001). Conclusion: BMMSC administration might be a helpful and feasible method to treat Meth-induced brain injuries in rats and to reduce relapse. BMMSCs were significantly higher in IV-treated group compared to the IN route. Moreover, the expression of BDNF and GDNF was higher in IN-treated rats compared with IV treated group.

Evaluation of Couple's Sexual Function after Childbirth with the Biopsychosocial Model: A Systematic Review of Systematic Reviews and Meta-Analysis.

BACKGROUND: After childbirth, sexual dysfunction refers to a chain of psychiatric, physiological, social changes and a couple's experiences. The purpose of our Systematic Review (Syst.Rev.) is to evaluate available high-quality evidence and construct a Bio Psycho Social (BPS) model of couple's sexual function after childbirth. MATERIALS AND METHODS: A systematic search was done with MeSH terms in databases, including PubMed, Web of Science, Scopus, and Science direct. A total number of 9 Syst.Rev. were evaluated from 2009 to 2019 years. The quality of extracted articles was evaluated based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist of contents using two qualified reviewers. Data synthesis was performed using the thematic analysis. RESULTS: Biopsychosocial Model of Postpartum Couple's Sexual Function (BMPCSF) is proposed as a developmental process similar to Bronfenbrenner's Bioecological Systems Model. Studies showed a significant relationship among the type of childbirth, trauma of perineum, breastfeeding, mood swings, fears, changes in the self-body image, spousal support, and Postpartum Sexual Dysfunction (PSD). Hence, the evidence about male sexuality in the postpartum period doesn't seem sufficient. CONCLUSIONS: The information from this study will help health policymakers develop the appropriate guidelines to inform couples and healthcare professionals about the BPS changes after childbirth and PSD. Besides, BMPCSF can be used in postpartum sexual counseling to improve sexual health and marital relationships. We propose comprehensive original study on couples' postpartum sexuality, especially men's conduct, emphasizing socio-cultural factors.

Predicting the Relation between Biopsychosocial Factors and Type of Childbirth using the Decision Tree Method: A Cohort Study.

Background: With the growing rate of cesarean sections, rising morbidity and mortality thereafter is an important health issue. Predictive models can identify individuals with a higher probability of cesarean section, and help them make better decisions. This study aimed to investigate the biopsychosocial factors associated with the method of childbirth and designed a predictive model using the decision tree C4.5 algorithm. Methods: In this cohort study, the sample included 170 pregnant women in the third trimester of pregnancy referring to Shahroud Health Care Centers (Semnan, Iran), from 2018 to 2019. Blood samples were taken from mothers to measure the estrogen hormone at baseline. Birth information was recorded at the follow-up time per 30-42 days postpartum. Chi square, independent samples t test, and Mann-Whitney were used for comparisons between the two groups. Modeling was performed with the help of MATLAB software and C4.5 decision tree algorithm using input variables and target variable (childbirth method). The data were divided into training and testing datasets using the 70-30% method. In both stages, sensitivity, specificity, and accuracy were evaluated by the decision tree algorithm. Results: Previous method of childbirth, maternal body mass index at childbirth, maternal age, and estrogen were the most significant factors predicting the childbirth method. The decision tree model's sensitivity, specificity, and accuracy were 85.48%, 94.34%, and 89.57% in the training stage, and 82.35%, 83.87%, and 83.33% in the testing stage, respectively. Conclusion: The decision tree model was designed with high accuracy successfully predicted the method of childbirth. By recognizing the contributing factors, policymakers can take preventive action.It should be noted that this article was published in preprint form on the website of research square (https://www.researchsquare.com/article/rs-34770/v1).

Side effects and Immunogenicity following administration of the Sputnik V COVID-19 vaccine in health care workers in Iran.

The Sputnik V is a COVID- 19 vaccine developed by the Gamalia institute of epidemiology and microbiology and released on August 11, 2020. We provided independent evidence on side effects and immunogenicity following the administration of the Sputnik V COVID-19 in Iran. In this observational study, the healthcare workers who were vaccinated with the Sputnik V COVID-19 vaccine within February and April 2021 were evaluated. Among a total of 13,435 vaccinated healthcare workers, we received 3236 self-declaration reports of Sputnik V associated adverse events with the mean age 39.32 ± 10.19 years old which 38.8% were men and 61.2% were women. Totally 68.8% of females versus 66.2% of males reported side effects after receiving the first dose and 31.2% of females versus 33.8% of males reported side effects after the second dose of vaccine. The most common side effect was a pain in the injection site (56.9%), fatigue (50.9%), body pain (43.9%), headache (35.7%), fever (32.9%), joint pain (30.3%), chilling (29.8%) and drowsiness (20.3%). Side effects of the vaccine were significantly more frequent in females and younger individuals. Among a total of 238 participants, more than 90% after the first and second dose of vaccine had a detectable level of SARS-CoV-2 RBD antibody and SARS-CoV-2 neutralizing antibody. Although the overall rate of adverse effects was higher than the interim results from randomized controlled trials, our findings support the manufacturer's reports about the high humoral immunogenicity of vaccine against COVID-19.

Perceived Psychological Traumatic Childbirth in Iranian Mothers: Diagnostic Value of Coping Strategies.

OBJECTIVES: The aim of this study was to investigate the diagnostic value of a stress coping scale for predicting perceived psychological traumatic childbirth in mothers. METHODS: This cross-sectional study was performed on 400 new mothers (within 48 hours of childbirth). Psychological traumatic childbirth was evaluated using the 4 diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders. Coping was measured using Moss and Billings' Stress Coping Strategies Scale. RESULTS: The overall mean score of stress coping was 29 ± 14.2. There were 193 (43.8%) mothers that had experienced a psychological traumatic childbirth. A stress coping score ≤ 30, with a sensitivity of 90.16 (95% CI = 85.1-94.0), and a specificity of 87.44 (95% CI = 82.1-91.6), was determined as a predictor of psychological traumatic childbirth. So that among mothers with stress coping scores ≤ 30, 87% had experienced a psychological traumatic childbirth. CONCLUSION: Investigating the degree of coping with stress can be used as an accurate diagnostic tool for psychological traumatic childbirth. It is recommended that during pregnancy, problem-solving and stress management training programs be used as psychological interventions for mothers with low levels of stress control. This will ensure that they can better cope with traumatic childbirth and post-traumatic stress in the postpartum stage.

The effects of transcranial direct current stimulation compared to standard bupropion for the treatment of tobacco dependence: A randomized sham-controlled trial.

BACKGROUND: Current treatments for smoking cessation are not effective for most smokers. This study aims to examine the effectiveness of transcranial Direct Current Stimulation (tDCS) on smoking cessation. METHODS: In this randomized, sham-controlled trial study, tobacco-dependent (by DSM-5) male participants were recruited from the general public invitation. Participants were randomly allocated to 5 groups; (A), treatment with 300 mg bupropion for 8 weeks; (B), active tDCS (20 sessions for 4 weeks); (C), sham for group B ; (D), active tDCS (20 sessions for 12 weeks), and (E), sham for group D. The electrode montage was anode F3 and cathode F4. Study outcomes include salivary cotinine, Fagerstrom test for nicotine dependence, and smoked cigarette per day, were examined on three time points. Repeated-measures analysis of variances and the generalized estimation equation (GEE) model were employed for data analysis. RESULTS: Among 210 volunteers, 170 participants completed the study. Mean age of participants was 42.9 years, ranging from 21 to 64 years. The 6-month point abstinence rates in groups A, B and D were 20%, 7% and 25.7%, and in C, D sham groups were 3.1% and 3% respectively. Results of the GEE model showed that although group D was not different from group A in abstinence rate, i.e., salivary cotinine >4 (p = 0.266), nicotine dependency by Fagerstrom test was lower in this group compared to group A (p = 0.019). CONCLUSIONS: The 12-week tDCS had a clinically good therapeutic effect on smoking cessation and its dependency. It may be a substitute for bupropion treatment.

The impact of motivational interviewing on behavior stages of nulliparous pregnant women preparing for childbirth: a randomized clinical trial.

OBJECTIVE: To examine the effectiveness of motivational interviewing (MI) on the stages of behavior change among nulliparous pregnant women who were preparing for childbirth. METHODS: In this randomized clinical trial, 234 pregnant women were studied in two intervention groups (MI and lecture), and one control group at three stages. In weeks 16-19 of pregnancy, two counseling sessions were held for the MI group, and one lecturing session was held for the lecture group. In weeks 21 and 37 of pregnancy, the three groups were reevaluated. RESULTS: At baseline, more than 70% of women were at pre-contemplation and contemplation stages. In week 21 of pregnancy, in MI 71% were at preparation stage, whereas in the lecture and control groups, 51.9% and 49.4% were at the contemplation stage, respectively. In week 37 of pregnancy, in MI, lecture and control groups, 90%, 59.7% and 27.3% were at the action stage, respectively (p < .001). The result of generalized estimating equation (GEE) analysis using a Poisson model indicated that the incident rate for lecture group was 1.7 (95% CI: 1.2-2.5) times the incident rate for the MI group. Also, the incident rate for control group was 3.4 (95% CI: 2.2-5.0) times the incident rate for the MI group. CONCLUSIONS: Motivational interviewing was effective in guiding nulliparous mothers toward positive behavior stages.

Perceptions of Iranian Female Drug Users Toward HIV Testing: A Qualitative Content Analysis.

BACKGROUND: Drug-dependent women are the vulnerable population deprived of access to health services and also have particular relevance to public health perspective because they are important bridge population for driving HIV/AIDS epidemic. This qualitative study aimed to explore the perception of drug-dependent women regarding HIV testing. METHODS: In this qualitative study, we approached 23 women with substance use disorders in 2 of the selected drop-in centers in the south Tehran. Focus group discussion, face-to-face semistructured interviews, and field notes were used to collect the data. Qualitative content analysis was used to extract the explanatory model of women's perceptions about HIV testing. RESULTS: Four main themes emerged from the data: forgotten health during use, having misconception, and sharing of sexual partner in secrecy and concerns. Seven subthemes were extracted, including not being sex worker, point of ruin, voluntary selection and concerns about fear of abandonment and fear of loss and death, double concern, and future of children. CONCLUSION: Beliefs and values of drug-dependent women can be positive points leading them to do an HIV test, and misconceptions of these women would be corrected by using safe behavioral skills training.

Sexual Risk Behaviors Constructed in Iranian Women's Life with Substance Use Disorders: A New Implication of Human Ecological Theory.

BACKGROUND: Drug abuse is one of the important variables influencing protective sexual behavior. The objective of this study was to explore how risky sexual behaviors develop in drug abusing women using human ecological theory. METHODS: In this study, we used a descriptive exploratory approach. The participants were 32 drug abusing women from two of the selected drop-in centers (DICs) in south Tehran, Iran, where we could have access to a vast number of female drug users. Data was collected using semi-structured face-to-face interviews. Qualitative content analysis was used to analyze the data using Graneheim and Lundman procedure. FINDINGS: Risky sexual behavior in drug use disorders in women was found in four themes with thirteen emerged; sexual untaught at micro-system with two subthemes "unsafe home" and "drop out of school", Perception of differences at meso-system with three subthemes "lack of link between family and school", "doing manly behavior" and "low awareness of health puberty than peers", inappropriate marriages at exo-system with three subthemes "stigma", "fear of losing love relationship" and "self-devotion", marginalization at macro-system with four subthemes "barrier access to rights", "selling sex as a tool of security", "lack of belief as a sex worker" and "mistrust and doubt partner" using implication of human ecological theory. CONCLUSION: Findings suggest that strategies supporting the discovery of risky sexual behaviors in drug use disorders in women are important in order to provide counseling and education to form their decisions toward safety sex.

The Needs of Parents of Preterm Infants in Iran and a Comparison With Those in Other Countries: A Systematic Review and Meta-Analysis.

CONTEXT: Proper accountability to needs of preterm infants' parents requires recognition of these needs and how they change in different conditions. The aim of this study was to assess the needs of parents of preterm infants in Iran, as compared to those in other regions in the world. EVIDENCE ACQUISITION: A search of Iranian databases (Iran Medex, Magiran, and SID) and international resources (PubMed, Scopus, and Google Scholar) was conducted, with no time limitations, to 5 October 2014. Using standard tools, all quantitative studies that considering the parental needs of preterm infants and parental support were extracted. The STROBE checklist was used for the evaluation of the studies. Thirty-one studies were extracted in the qualitative evaluation, of which 17 were included in the meta-analysis. The variance between the studies was analyzed using tau-squared (Tau2) and review manager 5 software. RESULTS: The results obtained using the nurse-parent support tool (NPST) showed that mothers considered that all the fields of support were of great importance. The parental needs in Iran were similar to those of parents in other regions worldwide. However, the mean score for Iranian parents' assessment of the support they received was 2.20 ± 0.06, whereas it was 3.84 ± 0.72 for other countries. The mean scores for parents' assessment of the provision of emotional, informational appraisal, and instrumental support in Iran were 1.73 ± 0.06, 2.1 ± 0.06, 1.54 ± 0.6, and 3.44 ± 0.04, respectively, compared to 3.18 ± 1.34, 4.11 ± 0.5, 4.26 ± 0.18, and 4.51 ± 0.14, respectively, in other countries. CONCLUSIONS: Parents always prefer the priorities of their babies to their individual needs. Given the lower scores for the parental assessment of received support in Iran, it is important to focus on these specific items in providing interventions to meet the needs of Iranian parents.

Randomized Control Trials on Otago Exercise Program (OEP) to Reduce Falls Among Elderly Community Dwellers in Shahroud, Iran.

BACKGROUND: Fall is a worldwide health problem among elderly people and a known leading cause of disabilities. Fall prevention programs have been implemented in various forms. The Otago exercise program (OEP) is one of the most recent home-base exercise training program. OBJECTIVES: This study was conducted to examine the effectiveness of OEP to reduce falls among elderly people in Shahroud, IR Iran. MATERIALS AND METHODS: This randomised control trial was conducted among the elderly community dwellers in Shahroud city of the Semnan province, IR Iran, with experience of falls in the last 12 months. Subjects of the study (n = 317) were recruited from elderly senior citizens at public health centers. Block systematic random sampling was applied to categorize the subjects in experimental and control groups. The experimental group (n = 160) received OEP for six months and was compared with the control group (n = 157) who received general health training. This study was registered with the following ID, IRCT2014012016285N1. RESULTS: The findings of the study showed that OEP improved physical performance (Berg-Balance-Score with P > 0.025, and Timed-Up-Go-Test with P > 0.017) and functional capacity (Arm-Curl-Test with P > 0.00 and Chair-Stand-Test with P > 0.01). In addition, OEP significantly reduced the incidence of falls (P ≤ 0.00) among senior citizens in the experimental group. DISCUSSION: The OEP as a home-based exercise is effective for the reduction of the incidence of falls among senior citizens with a history of falls. The OEP can be recommended for elderly homebound people who do not have access to facilities.

[Validation of the World Health Organization-5 Well-Being Index; assessment of maternal well-being and its associated factors]. / Dünya Saglik Örgütü-5 Iyilik Hali Endeksi Geçerligi:Annenin Iyilik Hali ve Bununla Iliskili Faktörlerin Degerlendirilmesi.

OBJECTIVE: The aim of this study was to validate the World Health Organization-5 Well-Being Index (WHO-5) in a sample of pregnant Iranian women, to explore the changes in maternal well-being from pregnancy to postpartum, and to determine the factors associated with maternal well-being. MATERIALS AND METHODS: This study included 341 pregnant women that presented to healthcare centers affiliated with Shahroud University of Medical Sciences, Iran, in 2011. The participants completed the General Health Questionnaire (GHQ-28) and Farsi version of WHO-5 during the third trimester of pregnancy and at 2 months postpartum. RESULTS: Cronbach's alpha coefficient for WHO-5 items was 0.85. The correlation coefficient between WHO-5 and GHQ-28 was -0.64 (P < 0.001). Exploratory factor analysis yielded 1 factor with an eigen value equal to 3.15, which explained 63.1% of the total variance. Confirmatory factor analysis confirmed the 1-factor structure. The area under ROC curve was 0.82. A WHO-5 cut-off score of <50 exhibited optimal sensitivity (0.84) and specificity (0.59) for identifying psychological symptoms (GHQ-28 score ≥24). There was a significant difference between third trimester (58.4 ± 22) and postpartum (64.1 ± 22.3) mean WHO-5 scores (P < 0.001). Maternal level of education (OR = 1.130; 95% CI: 1.307, 1.232) was the only predictor of maternal well-being during third trimester. Breastfeeding difficulty (OR = 0.923; 95% CI: 0.882, 0.965) and maternal well-being scores during third trimester (OR = 1.038; 95% CI: 1.019, 1.058) were predictors of maternal well-being during the postpartum period. CONCLUSIONS: The Farsi version of WHO-5 was observed to be a reliable and valid instrument for screening psychological symptoms in pregnant Iranian women. The present findings show that maternal well-being improved following childbirth.

Crosswise Model to Assess Sensitive Issues: A Study on Prevalence of Drug Abuse Among University Students of Iran.

BACKGROUND: Precise assessment of the prevalence of illicit drug use, face various methodological challenges. OBJECTIVES: The current study aimed to investigate the prevalence of illicit drug use among students studying at Universities in Shahroud (Northeast of Iran) through crosswise method. PATIENTS AND METHODS: Participants of this cross-sectional study were 1646 students at Universities in Shahroud. The data collection instrument was a questionnaire designed based on crosswise model (CM). RESULTS: The results of the study showed that 19% of students used at least one kind of illicit drug and 14.9% used opium residue once in their life. Moreover, 3.5% of students used drug and 3% used opium residue during the last month; 40.3% of the students admitted that they fully understood the instruction of the questionnaire; 9.6% said that did not comprehend the instruction at all, and 38.1% believed they partly understood the instruction. The result showed that 33.7% of the students fully trusted, 39.8% partly trusted, and 18.4% poorly trusted this method. There was a significant relationship between comprehension level and trust in CM (P < 0.001). CONCLUSIONS: This method can be appropriate to estimate sensitive issues; however, lack of understanding the method or doubting the confidentiality of the responses can lead to bias in the results. That is to say, if the instructions are introduced better, the level of trusting the method will increase and accordingly more reliable responses can be obtained. More studies under controlled conditions are required to interpret the findings of the current study better.

Cross cultural adaptation, validity, and reliability of the farsi breastfeeding attrition prediction tools in Iranian pregnant women.

BACKGROUND: The rate of exclusive breastfeeding in Iran is decreasing. The breastfeeding attrition prediction tools (BAPT) have been validated and used in predicting premature weaning. OBJECTIVES: We aimed to translate the BAPT into Farsi, assess its content validity, and examine its reliability and validity to identify exclusive breastfeeding discontinuation in Iran. MATERIALS AND METHODS: The BAPT was translated into Farsi and the content validity of the Farsi version of the BAPT was assessed. It was administered to 356 pregnant women in the third trimester of pregnancy, who were residents of a city in northeast of Iran. The structural integrity of the four-factor model was assessed in confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). Reliability was assessed using Cronbach's alpha coefficient and item-subscale correlations. Validity was assessed using the known-group comparison (128 with vs. 228 without breastfeeding experience) and predictive validity (80 successes vs. 265 failures in exclusive breastfeeding). RESULTS: The internal consistency of the whole instrument (49 items) was 0.775. CFA provided an acceptable fit to the a priori four-factor model (Chi-square/df = 1.8, Root Mean Square Error of Approximation (RMSEA) = 0.049, Standardized Root Mean Square Residual (SRMR) = 0.064, Comparative Fit Index (CFI) = 0.911). The difference in means of breastfeeding control (BFC) between the participants with and without breastfeeding experience was significant (P < 0.001). In addition, the total score of BAPT and the score of Breast Feeding Control (BFC) subscale were higher in women who were on exclusive breastfeeding than women who were not, at four months postpartum (P < 0.05). CONCLUSIONS: This study validated the Farsi version of BAPT. It is useful for researchers who want to use it in Iran to identify women at higher risks of Exclusive Breast Feeding (EBF) discontinuation.

Breastfeeding practices during the first month postpartum and associated factors: impact on breastfeeding survival.

BACKGROUND: The introduction of fluids to infants during the first days postpartum, which may be harmful to infant health, is a common practice in Iran. OBJECTIVES: This study aimed to find the prevalence of breastfeeding practices using monthly dietary recall and factors associated with introduction of fluids during the first month of life and determine the effects of these supplementations on breastfeeding survival. PATIENTS AND METHODS: This longitudinal study carried out in Shahroud, Iran from May 2011 to October 2013. Using convenient sampling strategy, 358 mothers in their third trimester of pregnancy were enrolled in the study and completed the questionnaires. Then the data regarding the introduction of fluids during first month postpartum was collected. We followed women monthly up to breastfeeding cessation. Kaplan-Meier and time-to-event methods were used to assess breastfeeding survival. A multinomial logistic regression analysis was used to identify the variables that determined breastfeeding practices at the first month postpartum. The Cox regression analysis was used to estimate the effect of variables on breastfeeding survival. RESULTS: The prevalence of exclusive, predominant, and partial breastfeeding during the first month postpartum were 33.1%, 58.2%, and 8.6%, respectively. Predominant breastfeeding was associated with the lack of breastfeeding experience (OR = 1.93; 95% CI [1.02 - 3.66]). Partial breastfeeding was associated with the maternal age ≥ 30 y (OR = 5.96; CI [1.66 - 21.37]), family income higher than the mean (OR = 3.39; 95% CI [1.17 - 9.81]), and breastfeeding difficulties score higher than mean (OR = 3.09; 95% CI [1.10 - 8.71]). The Cox regression analysis revealed that breastfeeding practices at the first month was associated with an increased risk for breastfeeding discontinuation. The hazard ratio of breastfeeding discontinuation for predominant and partial breastfeeding groups were 1.11 (95% CI: 0.82, 1.51; P = 0.49) and 2.23 (95% CI: 1.39, 3.58; P = 0.001), respectively compared to the exclusive group. CONCLUSIONS: The prevalence of predominant breastfeeding during the first month postpartum is high in Shahroud. Interventions to strengthen adherence to WHO guidelines for breastfeeding should be considered. Breastfeeding education providers at the hospitals should emphasize the effects of formula on breastfeeding continuation at early postpartum.