Maternal mid- and late-pregnancy distress and birth outcome: A causal model of the mediatory role of pregnancy-specific distress

Background: There is lack of information about the effect of general distress and pregnancy-specific distress in mid- and late-pregnancy separately on neonatal outcome. Objective: The aim of this study was to assess the effects of mid-maternal distress on late-maternal distress and birth outcomes with a causal model of relationships among general distress and pregnancy-specific distress. Materials and Methods: In this longitudinal descriptive study, 100 low-risk pregnant women participated. Participants completed three questionnaires at mid-pregnancy (13–26 wk) and at late pregnancy (27–40 wk). Pregnancy-general distress was assessed by the Perceived Stress Scale and the Hospital Anxiety Depression Scale. Pregnancy specific distress was evaluated by the Prenatal Distress Questionnaire. The pregnant women were followed to after birth and neonatal outcome were assessed. Results: All total effect pathways were significant as predictors of birth outcomes (height, weight, and head circumference). Mid-pregnancy-specific distress had a significant relationship with late pregnancy-specific distress. However, mid-maternal distress was not related directly to birth outcomes. The effect of mid-maternal distress on birth outcomes was related indirectly to late-maternal distress. Both late general distress and late pregnancy-specific distress had direct negative effects on three indexes of birth outcome. The negative effect of late general-pregnancy distress and mid-pregnancy-specific distress on birth outcome was mediated through late pregnancy-specific distress. Conclusion: Both late pregnancy-general distress and pregnancy-specific distress have negative effects on birth outcomes. These findings support a role for negative effect as mediating the relationship between late pregnancy-specific distress and birth outcomes

The Spatial Distribution of Cancer Incidence in Fars Province: A GIS-Based Analysis of Cancer Registry Data

Background: Cancer is a major health problem in the developing countries. Variations of its incidence rate among geographical areas are due to various contributing factors. This study was performed to assess the spatial patterns of cancer incidence in the Fars Province, based on cancer registry data and to determine geographical clusters. Methods: In this cross sectional study, the new cases of cancer were recorded from 2001 to 2009. Crude incidence rate was estimated based on age groups and sex in the counties of the Fars Province. Age standardized incidence rates (ASR) per 100,000 was calculated in each year. Spatial autocorrelation analysis was performed in measuring the geographic patterns and clusters using geographic information system (GIS). Also, comparisons were made between ASRs in each county. Results: A total of 28,411 new cases were diagnosed with cancer during 2001 2009 in the Fars Province, 55.5% of which were men. The average age was 61.6 ± 0.5 years. The highest ASR was observed in Shiraz, which is the largest county in Fars. The Moran\u27s Index of cancer was significantly clustered in 2004, 2005, and 2006 in total, men, and women. The type of spatial clustering was high high cluster, that to indicate from north west to south east of Fars Province. Conclusions: Analysis of the spatial distribution of cancer shows significant differences from year to year and between different areas. However, a clear spatial autocorrelation is observed, which can be of great interest and importance to researchers for future epidemiological studies, and to policymakers for applying preventive measures

Quality of Mother–Infant Attachment after Physiological Birth

Background Childbirth affects the quality of mother–neonate attachment after delivery. The aim of this study was to compare the quality of mother–infant attachment in physiological delivery with non-physiological delivery after birth. Materials and Methods A case-control study was conducted on 60 women (n = 30 non- physiological delivery, 30 physiological delivery) referred to Shahid YahyaNejad Hospital (Babol city, Iran) durring 2015 to 2016. Subjects in the physiological delivery group received special care from the midwife or significant other, labor mobility, spontaneous progress of labor, and non-pharmacological methods. Subjects in the non-physiological delivery group received medical interventions including birth aids, use of analgesics, and local anesthesia. Quality of mother-infant attachment after delivery was assessed with a valid Persian version of Avant’s mother-infant attachment. Multivariate analysis of variance (MANCOVA) was also used to assess the differences in two groups. Results The mean of mother–infant attachment scores in the physiological delivery compared with non-physiological delivery group were as follows: emotional behavior (2.29 ± 38.7 vs. 1.56 ± 27.23), proximity behavior (1.82 ± 27.30 vs. 1.49 ± 20.70), caring behavior (1.17 ± 15.77 vs. 1.13 ± 10.80), and total score (4.58 ± 81.72 vs. 3.66 ± 58.73). Results showed that in all three dimensions of attachment (emotional, caring, and proximity behavior), physiological delivery showed higher scores than did non-physiological delivery (P < 0.05). Conclusion Thequality of mother–infant attachment (emotional, proximity, and caring behaviors) was higher in women with physiological birth than non-physiological birth

Pharmacological and Non-pharmacological Therapeutic Strategies for Improvement of State-Trait Anxiety: A Randomized Controlled Trial Among Iranian Infertile Women With Sexual Dysfunctions

Objective: To compare the effects of pharmacological and non-pharmacological therapeutic strategies for improvement of state-trait anxiety among Iranian infertile women with sexual dysfunctions (SDs). Material and Methods: In a randomized controlled clinical trial, 105 women with infertility suffering from SDs were randomly assigned to participate in a 2-hour group weekly session of psychosexual therapy (PST) (n = 35), took a tablet of bupropion ER 150 mg/d (BUP ER) (n = 35), or control (n = 35) for 8 weeks during 2014–2015. The Female Sexual Function Index (FSFI) and Spielberger State-Trait Anxiety Inventory (STAI) were completed before and after of the study. Results: State and trait anxiety levels had mean values of 47.80 ± 10.93 and 48.78 ± 11.34, respectively. Mean values of state and trait anxiety levels observed at baseline significantly decreased toward the end of the study in each of the treatment groups (PST, P < 0.0001 and P < 0.0001; BUP, P < 0.005 and P < 0.001, respectively), and the decrease was more significant in the PST group than in the BUP ER group (P < 0.001 and P < 0.007, respectively) and the control group (P < 0.0001) and P < 0.0001, respectively). Significantly high improvement in state and trait anxiety levels was observed in the PST group than the BUP and control groups. However, the decrease in the BUP group was not significant than the control group (P < 0.076 and P < 0.186, respecttively). Conclusion: PST compared to bupropion ER treatment was found to be a more favorable strategy for improvement of state and trait anxiety symptoms

Mental and personality disorders in infertile women with polycystic ovary: a case-control study

Background: Polycystic Ovarian Syndrome (PCOS) is one of the most common causes of infertility in women. Objective: The current study investigated mental and personality disorders in infertile women with and without PCOS. Methods: This case-control study evaluated 400 infertile women who referred to the Infertility Center in Babol city (North of Iran). Participants were categorized into the case group (201 PCOS) and the control group (199 without PCOS). All of the participants completed the Millon Clinical Multi-axial Inventory-III (MCMI-III). Results: The mean scores for clinical personality patterns were significantly higher for six personality disorders (schizoid, avoidant, antisocial, depressive, sadistic, and negativistic) and for three classes of severe personality disorder patterns (schizotypal, borderline, and paranoid) in infertile women with PCOS than in women without PCOS. The mean scores for eight clinical disorders (somatoform, manic disorder, dysthymia, alcohol-dependence, drug-dependence, post-trauma stress disorder, major depression, and delusion disorder) were also higher in infertile women with PCOS than in women without PCOS. Conclusion: The scores of many mental and personality disorders are higher in infertile women with PCOS than in women without PCOS. Thus, clinicians should prioritize recognizing and treating psychological problems of infertile women with PCOS

Psychosocial Predictors of Cognitive Impairment in the Elderly: A Cross-Sectional Study

Objective: Cognitive impairment is a major public health problem among elderly population. The aim of this study was to assess some psychosocial predictors of cognitive impairment (age, education, living alone, smoking, depression and social support) in the Iranian elderly population. Method: A total of 1612 elderly (over 60 years) were enrolled in this cross-sectional study. Cognitive function was assessed using Mini Mental State Examination (MMSE). In addition, data from psychological tests and demographic characteristics were analyzed. Results: Older age, low education level, living alone, smoking, depressive symptoms, and lower social support were associated with an increased risk of cognitive impairment. Ages 70 to 74 (OR = 3.47; 95% CI, 2.13-5.65), 75 to79 (OR = 3.05; 95% CI, 2.11-4.41) and 80 to 85 (OR = 5.81; 95% CI, 2.99-11.22) and depression symptoms (OR = 1.64; 95% CI, 1.27-2.13) were significant positive predictors, whereas social support with scores ranging from 26 to 30 (OR =0. 32; 95% CI, 0.16-0.62) and 31 to 33 (OR =0.29; 95% CI, 0.14-0.61) and more than 5 years of education (OR = 0.19; 95% CI, 0.14-0.27) were the negative predictors of cognitive impairment. Conclusion: The findings suggest older age and depression as positive predictive factors and higher education level and social support as negative predictive factors of cognitive impairment in the elderly population

Prevalence and Factors related of psychiatric symptoms in low risk pregnancy

Background: Psychiatric disorders are associated with poor pregnancy outcomes both for mother and child. This study aimed to determine the prevalence and related demographic risk factors of psychiatric symptoms among the pregnant women in Babol City. Methods: This cross-sectional study was conducted in five private and public obstetrics clinics of Babol city. During routine appointments of prenatal care, 176 pregnant women filled in three questionnaires including; sociodemographic questionnaire, Edinburg Prenatal Depression Scale (EPDS), and Symptom Checklist-25 (SCL-25). Wilcoxon test, Spearman correlation, and multivariate logistic regression tests were used to interpret the data. Results: The prevalence of depressive disorders was 15.4 for Edinburg scores &#8805;13.&#160; The overall rate of maternal psychiatric symptoms (global severity index or GSI scores &#8805; 1.75) was 48.5. The prevalence of psychiatric symptoms was high; for 25 somatization, 258 anxiety, obsession-compulsion disorders or OCD 6.4, 8.8 interpersonal sensitivity, 5.3 phobia, 7.6 paranoid ideation, and 1.2 psychoticism. Multivariate logistic regression revealed that pregnant women with history of abortion in previous pregnancy were at risk of depressive symptoms more (&#946;=3.18, CI 1.28-7.93, p=0.01) than those without history of abortion. Also, the only demographic factor related to psychiatric symptoms was the age of pregnant women; younger age was associated with higher symptom levels for GSI ((r=-0.17). Conclusion: The high prevalence of psychiatric symptoms, especially depressive symptoms, in pregnant women highlights the need for continued research on screening, identifying the risk factors, and developing effective treatments for mental disorders in pregnant women

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0–100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8–98·1) in Iceland, followed by 96·6 (94·9–97·9) in Norway and 96·1 (94·5–97·3) in the Netherlands, to values as low as 18·6 (13·1–24·4) in the Central African Republic, 19·0 (14·3–23·7) in Somalia, and 23·4 (20·2–26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1–93·6) in Beijing to 48·0 (43·4–53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6–68·8) in Goa to 34·0 (30·3–38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view—and subsequent provision—of quality health care for all populations.info:eu-repo/semantics/publishedVersio