Women’s needs in their journey toward motherhood via oocyte donation: A mixed methods systematic review

Background: Given the significant changes in family formation through donation procedures, providing an optimal level of care that is responsive to the needs of mothers who get pregnant via oocyte donation is pivotal to improve their maternal role. Therefore, it is necessary to recognize the needs of oocyte donation mothers to address their specific needs. Objective: This study aimed to review the needs of women in their journey toward motherhood via oocyte donation. Materials and Methods: In this systematic review, which followed the updated Joanna Briggs Institute’s methodological guidance for conducting a mixed methods systematic review, the quantitative observational and qualitative studies were searched through databases including PubMed, Web of Science, PsycINFO, the Cochran Library, and Google Scholar search engine. Letters to the editor, commentaries, magazine articles, articles without full text and abstracts presented in congresses were excluded. All English-language articles related to the needs of oocyte donation mothers, without time limitations, were reviewed. The eligible studies were critically appraised independently by 2 researchers. Results: 4649 records were identified from those 18 articles that were finally included in the review. The needs of oocyte donation mothers comprised 8 categories: The need for special services in fertility clinics, the need to improve the quality of care, the need for emotional support and psychological consultation, information needs, the need for financial support, the need for disclosure counseling, educational needs, and the need for sociocultural and religious support. Conclusion: This review suggests various needs of oocyte donation mothers. The results can be used in carefully planning supportive programs for this vulnerable population. Key words: Need, Women, Oocyte donation, Motherhood

The Economic Burden of depression in psychiatric disorders

Background: Psychiatric disorders are very common, but their economic costs are not calculated transparently, while they are associated with significant economic consequences. The aim of this study was to investigate the direct and indirect costs of psychiatric disorders in 2017. Method: The present cross-sectional study was performed on all psychiatric patients admitted to hospitals in Ibn-e-Sina and Hejazi hospitals of Mashhad. According to the International book of ICD10, the medical records of psychiatric patients admitted with Code of Mental and Behavioral Disorders (F32-F33.9) were first identified and their costs of hospitalized was extracted and investigated from the Hospital Information system. The Top-Down Approach was used to estimate the costs. Descriptive statistics were used to analyze the data. Result: During the study period, 6896 patients were discharged, of which 1915 (28%) had mood disorders and among the mood patients, 300 (16%) had depression. The highest treatment cost for psychiatric patients is paid by insurance (93%). The average length of stay in the hospital was 23.6 days, and the average cost of each patient was $ 1020. The greatest cost of depression patients is related to hoteling (62%) and doctor's visit (24%). Conclusion: Depression is a common and costly disease and should be prevented by designing effective intervention

The Unmet Needs of Women with Maternal Near Miss Experience: A Qualitative Study

Introduction: A maternal near-miss (MNM) case is defined as "a woman who nearly died but survived from life-threatening pregnancy or childbirth complication". This study was conducted on health care providers and near-miss mothers (NMMs) with the aim of discovering the unmet needs of Iranian NMM. Methods: In this qualitative study 37 participants of key informants, health providers, NMMs and their husbands were selected using purposive sampling. Semi-structured in-depth interviews were conducted for data collection until data saturation was achieved. Data were analyzed using Graneheim and Lundman conventional content analysis. Results: The analysis revealed the core category of "the need for comprehensive support". Eight categories included "psychological", "fertility", "information", "improvement the quality of care", "sociocultural", "financial", "breastfeeding" and "nutritional" needs emerging from 18 sub-categories, were formed from 2112 codes. Conclusion: Many of the real needs of NMM have been ignored. Maternal health policymakers should provide standard guidelines based on the needs discovered in this study to support the NMMs’ unmet needs

Emotional and Cognitive Experiences of Pregnant Women Following Prenatal Diagnosis of Fetal Anomalies: A Qualitative Study in Iran

Background: Pregnant women are often ill-prepared for the health of their unborn child in the case of abnormal findings, and experience several difficulties following the detection of fetal anomalies. Therefore, this study was conducted to explore the emotional and cognitive experiences of pregnant women following prenatal diagnosis of fetal anomalies in Mashhad, Iran. Methods: This qualitative conventional content analysis study was designed through two referral centers for fetal anomaly. The data were collected from April 2017 to January 2018 in Mashhad (Iran) through individual semi-structured in-depth interviews, from 25 pregnant women with a prenatal diagnosis of fetal anomalies. Results: Four categories and 10 subcategories emerged. Category one, grief reactions during the time of diagnosis, contained two subcategories: shocked and panicked, and distressed and disbelieved.Category two, perinatal loss through a pregnancy termination, contained four subcategories: guilt and shame during pregnancy termination, loss of their expected child, suffering and emotional distress process, and unmet needs by health professionals. Category three, fears of recurrence in future pregnancies, had two subcategories: worried about inadequate prenatal care in the future pregnancies and worried about abnormal fetus in next pregnancies. Finally, Category four, a dilemma between hope and worries contained two subcategories: hope for normality and worried about future. Conclusion: It is important to monitor emotional reactions of women following prenatal anomaly diagnosis. So, training clinicians and health-care professionals for proper response to grief reaction in post therapeutic abortion is essential

The quality assessment of family physician service in rural regions, Northeast of Iran in 2012

Background: Following the implementation of family physician plan in rural areas, the quantity of provided services has been increased, but what leads on the next topic is the improvement in expected quality of service, as well. The present study aims at determining the gap between patients’ expectation and perception from the quality of services provided by family physicians during the spring and summer of 2012. Methods: This was a cross-sectional study in which 480 patients who referred to family physician centers were selected with clustering and simple randomized method. Data were collected through SERVQUAL standard questionnaire and were analyzed with descriptive statistics, using statistical T-test, Kruskal-Wallis, and Wilcoxon signed-rank tests by SPSS 16 at a significance level of 0.05. Results: The difference between the mean scores of expectation and perception was about -0.93, which is considered as statistically significant difference ( P ≤ 0.05). Also, the differences in five dimensions of quality were as follows: tangible -1.10, reliability -0.87, responsiveness -1.06, assurance -0.83, and empathy -0.82. Findings showed that there was a significant difference between expectation and perception in five concepts of the provided services ( P ≤ 0.05 ). Conclusion: There was a gap between the ideal situation and the current situation of family physician quality of services. Our suggestion is maintaining a strong focus on patients, creating a medical practice that would exceed patients’ expectations, providing high-quality healthcare services, and realizing the continuous improvement of all processes. In both tangible and responsive, the gap was greater than the other dimensions. It is recommended that more attention should be paid to the physical appearance of the health center environment and the availability of staff and employee

Psychometrics of Assessment Tools to Examine the Challenges of Physicians\' Participation in Accreditation Programs

Background: Many organizations believe that physician involvement is important in quality and safety of health services, but they did not properly define, measure, and improve it, so because of the importance of the quality of health care and increasing the involvement of physician this study was conducted to evaluate the validity and reliability of a questionnaire on the challenges of physicianschr('39') participation in quality improvement programs. Methods: In this cross-sectional study conducted in the hospitals of Mashhad University of Medical Sciences, a researcher-made questionnaire about challenges of physicianschr('39') participation in accreditation activities used for data gathering. The content validity ratio index and content validity index were also calculated. To measure the internal consistency of the instrument, the questionnaire was distributed among 14 physicians, Cronbachchr('39')s alpha coefficient was determined. For stability or reproducibility of the instrument, test - retest and correlation coefficient were calculated. By distributing questionnaires among 14 people those meeting inclusion criteria, the correlation coefficient was measured twice and at intervals of 2 weeks. SPSS 21 software was used for data analysis Results: The initial questionnaire was consisted of 61 items, which were reduced to 38 items after face and content psychometrics. The questionnaire has 12 sub-concepts. Cronbachchr('39')s alpha coefficient of the questionnaire was 0.83 and the intragroup correlation coefficient in 2 measurements 2 weeks apart was 0.94. Conclusion: This questionnaire is the first and only valid and reliable dedicated tool in the field of challenges of physicianschr('39') participation in accreditation activities in Iran, which can measure and prioritize the challenges in each health center and it can be used to improve health care quality services that are performed by doctors

The Relationship between Motivation and Academic Burnout among Students of Health School, Mashhad University of Medical Sciences

Introduction: Due to increasing number of universities in recent years and lack of adequate attention to quality and standards of education, academic burnout has become a problem which is predicted to be intensified in future. Thus this study was done to determine the relationship between motivation and academic burnout among students of Health School of Mashhad University of medical sciences, 2015. Methods: This cross-sectional study was conducted on 262 students of health school. Two standard questionnaires of including Harter Motivation scale (1981) and Berso academic burnout questionnaire (1997) were used. The data was analyzed using SPSS 16. Results: The findings showed a significant inverse correlation between motivation and burnout (r=- 0/503), Also a significant relationship between motivation and exhaustion (r=-0/425), cynicism(r=-0/445), reduced efficiency(r=-0/397) was found (P Value < 0/01). Conclusion: based on the findings, enhancing academic motivation can help reduce burnout, so educational deputies and others who are officially responsible should plan and create proper frameworks for betterment

Coping Strategies of Pregnant Women with Detected Fetal Anomalies in Iran: A Qualitative Study

Background: Progressing technology has increased the detection of fetal abnormalities in the pregnancy. Detection of fetal abnormalities during pregnancy can cause significant social, physical, psychological, and emotional stress. The aim of this study was to explore the coping strategies of Iranian pregnant women with detected fetal anomalies. Materials and Methods: This qualitative content analysis study was conducted on two referral centers for fetal anomaly. The data were collected from April 2017 to January 2018 in Mashhad (Iran) through individual, semistructured, in-depth interviews with 25 pregnant women with a prenatal diagnosis of fetal anomalies. Data were analyzed using conventional content analysis based on Graneheim and Lundman's approach. Results: As a result of data analysis, the four categories of seeking information, religiousness and spirituality, cognitive avoidance, and seeking social support, and 12 subcategories emerged. Seeking information consisted of the four subcategories of personal search, visiting different doctors, performing various diagnostic tests and sonography, and seeking peers' experiences. Religiousness and spirituality contained the three subcategories of praying, acceptance of destiny, and reliance on faith. Cognitive avoidance consisted of the two subcategories of avoiding negative information and avoiding situations that remind them of their problem. Seeking social support contained the three subcategories of getting support from family, getting support from friends, and getting support from others. Conclusions: The findings showed that pregnant women with detected fetal anomalies reported a variety of coping strategies. Therefore, it is important that healthcare providers encourage mothers to use strategies that are likely to be more effective

Mothering sweetness mixed with the bitterness of death: the lived mothering experience of near-miss mothers

Purpose Maternal near miss (MNM) refers to women who survive death as a result of life-threatening obstetric complications or organ system dysfunction during pregnancy, childbirth or postpartum. The aim of the present study was to gain an understanding of mothering experiences in survivors ‘mothers due maternal near miss event. Materials and methods Heideggerian hermeneutic phenomenology guided this qualitative study. The study was conducted 1 June and 30 December 2019. The sampling was purposeful with maximum variation of 11 near miss mother that used unstructured face-to-face interview for data collection. Data analyzed using Diekelmann, Allen, and Tanner seven stage thematic analysis approach. Findings Emergent theme was “mothering sweetness mixed with the bitterness of death.” The two themes constituting the essence was: “An Angel with Broken Wings” and “Mothering in the Shadow of Death.” The subthemes comprised five sub-sub themes which emerged from over 850 meaning units. Data were analyzed using MAXQDA10 software. Conclusion Maternal health providers need to know that it is not enough only to focus on saving the mother’s physical life. While strengthening the role of mothering is essential element to support near-miss mothers who have experienced difficult physical and psychological conditions. The “beyond numbers” concept, implies that it is not enough only to focus on saving the mother’s physical life. Removing barriers in order to achieve to early mothering, can have a significant impact on reducing the psychological burden of MNM events

Informational needs of pregnant women following the prenatal diagnosis of fetal anomalies: A qualitative study in Iran

INTRODUCTION: An appropriate exchange of information between the health-care provider and the family is an important component of coping with stress following the prenatal diagnosis of fetal anomalies. Therefore, this study was conducted to explore the informational needs of pregnant women following a prenatal diagnosis of fetal anomalies in Mashhad, Iran. SUBJECTS AND METHODS: This qualitative, conventional, content analysis study was designed through two referral centers for fetal anomaly. The data were collected from April 2017 to January 2018 in Mashhad (Iran) through individual semi-structured in-depth interviews, from 25 pregnant women with a prenatal diagnosis of fetal anomalies. RESULTS: Three categories and nine subcategories emerged. Category 1, information needed for clarifying the diagnosed anomaly and making a decision, containing four subcategories: The need to know the reasons of doing more diagnostic tests; The need to know the facts regarding the anomaly and its cause; The need for more information to gain control over the situation; and The need to know about legal permission for therapeutic abortion. Category 2, Information needed for preparing to the future, containing three subcategories: Practical and economic issues; The delivery and postnatal situation; and Future mortality and morbidity of especial anomaly. Category 3, the adequacy of the information provided, containing two subcategories: Information overload and Inadequate information. CONCLUSIONS: Pregnant women receiving a prenatal diagnosis of fetal anomaly have a variety of information needs that are not adequately met by the health-care providers. Further research is required for finding a means to meeting this information need