دکتر محمود طاووسی

The "pre-marriage education program" is one of the strategies to strengthen the family foundation in Iran. The present study was carried out with the support of the Iran Ministry of Health and Medical Education to evaluate this program. This paper presents the results obtained on knowledge and satisfaction of couples.

This was an interventional study on a sample of couples participating in a pre-marriage education program. The intervention was offered via in-person and virtual (online and offline) aproaches. Ninety-six centers of pre-marriage education through country were selected by simple random sampling. A convince sample of 15 couples (15 men and 15 women) was thought for each center. Data was collected by two questionnaires and analyzed using the SPSS-18 software.

A total of 2868 people were entered into the study. Pre-marriage education led to an increase in knowledge. The mean score of knowledge changed from 8.78 (SD = 1.693) to 9.34 (SD = 1.639) (P<0.001). The results showed that education has led to a statistically significant increase in the knowledge score of people who participated in in-person and online classes, while offline classes had no effect on increasing the knowledge of couples. Education increased knowledge of employed and unemployed people at all educational levels. Education also increased knowledge in most age groups, but it had no effect on the age group of 46-55 years. Most participants (87.1%) had "high and very high satisfaction" with timing, and overall satisfaction by 90.3% reported as high and very high. About 60% of people reported that the duration of the classes was appropriate. Overall satisfaction of women were more than men. Younger age groups had higher overall satisfaction than other age groups. The satisfaction of the unemployed was more than employed couples. People with higher education had the highest overall satisfaction with the program.

The results showed that the "pre-marriage education program" in achieving short-term goals was successful. Evaluating the effect of the program on long-term goals (such as the effect on marriage outcomes) requires a different study design.

Objective (s):

 COVID-19 vaccination is considering to be the ideal solution for the COVID-19 control. This study aimed to investigate the factors affected the COVID-19 vaccination in Iran.

This cross-sectional study included a sample of Iranian men and women over 18 years of age who agreed to participate in the study. A cluster sampling method was used, and the data was collected in 2021 through a self-designed questionnaire via telephone survey. Logistic regression was performed to investigate the influencing factors on vaccination.

Among 2649 participants from 31 provinces of Iran, about 88% had a history of injecting at least one dose of vaccine. The odds ratio of corona vaccine injection was similar among women and men. Age and marital status showed no significant effect on this ratio. The odds ratio of corona vaccine injection in people living in cities was about 40% less than people living in rural areas. Furthermore, the odds ratio of COVID-19 vaccination increased by about 11 times for each unit increase in positive attitude toward vaccination.

The findings indicated that overall those who were employed, students, and people with lower income and living in rural areas were more likely to be vaccinated. It seems that distribution and availability of vaccines by government was acceptable for quick and adequate coverage of vaccination in Iran.

With progress in medical care, the rate of premature birth has increased and the mortality rate of very low birth weight (VLBW) babies has decreased. However, there is an increased incidence of disabilities in survivors, including neurodevelopmental delay, particularly in infants born very prematurely. This study aimed to assess the neurodevelopment in such children.

This was a cross-sectional study on non-randomized sample of children aged 3 to 5 years with weight less than 1500 grams or the mother's pregnancy lasted in less than 32 weeks in 2018 and born in one of the hospitals in Tehran, Iran. and alive at the study commence. They were evaluated by the Ages and Stages Questionnaires (ASQ) in 5 developmental fields. Data was collected by completing a general questionnaire, the ASQ, and using the hospital records.  The data were analyzed by SPSS-22 software, and statistical tests included descriptive and analytical tests such as chi-square and t-test.

Out of the total number of births, the data for 220 VLBW children were eligible for analysis. Of these, 12 children (5.7%) had at least one developmental disorder in the five investigated fields including:  4.2% of the children had neurological developmental delayed in communication, 2.4% in gross motor, 2.4% in fine motor, 2.8% in problem solving, and 2.8% in the personal-social aspects. There was no significant relationship between gender, length of pregnancy, and parents' education level with children's developmental disorders. There was a significant difference between the rehabilitation status of VLBW children and developmental delay (P<0.001).

The findings suggest that the VLBW children are at higher risk for neurodevelopmental and behavioral disorders. It is recommended that such children undergo physical, neurological, and developmental evaluations at different ages.

 The World Health Organization has recognized public reluctance to vaccinate against Covid-19 as one of the ten biggest threats to global health in 2019. Vaccination hesitancy is likely to be a key obstacle to global production of a Covid-19 vaccine. In order to develop universal access to the corona vaccination program, this study was conducted with the aim of measuring the attitude of Iranian adults regarding the corona vaccine and the factors affecting it in the autumn  of 1400.

This was a cross-sectional study and was conducted among Iranian men and women over 18 years of age who consented to participate in the study using cluster sampling method and through telephone calls. The data was collected by a 13-item valid and reliable questionnaire and were analyzed using the SPSS-22 software.

In all 2649 Iranians were studied (50.2% men and 49.8% women). The mean attitude score towards the corona vaccine injection was 64.1 out of 100 (SD = 11.0). The results of the multivariate logistic regression analysis showed that the positive attitude of adults regarding the corona vaccine was significantly associated with male gender (OR= 1.31, 95% CI: 1.009-1.71), and marital status (OR for married = 1.35, 95% CI: 1.054-1.75). The results showed no significant association between positive attitude and other variables such as, history of corona vaccine injection, history of corona disease, and also the death history of participants' family members due to corona.

The findings suggest to increase positive attitudes towards corona virus females and those who are single, divorced and widowed should be targeted.

Since usually health literacy should be assessed in complex health care settings, this study aimed to develop a short version of the Health Literacy Instrument for Adults (HELIA-SF).

In this methodological study, the research team selected a number of items from the main instrument covering the main constructs of the HELIA. The selection was based on the most relevant items to each construct. A group of 12 experts and ten adults assessed content and face validity respectively. Exploratory and confirmatory factor analysis was performed to assess structural validity. The reliability of the instruments was evaluated by internal correlation (Cronbach's alpha coefficient) and intraclass correlation (ICC).

A nine-item questionnaire was developed. Experts identified the content validity of the short version as desirable (the CVR was more than 0.56 the CVI was more than 0.79). Also, the face validity as assessed by ten adults was satisfactory. The results obtained from exploratory factor analysis showed a two-factor structure for the questionnaire namely basic skills and decision-making skills that jointly accounted for about 61% of variance observed. Furthermore, the confirmatory factor analysis indicated acceptable fit indexes for the data: X2/df =20/2, GFI=95/0, CFI=97/0, NFI=95/0, NNFI=96/0, SRMR=068/0, and RMSEA=074/0. The Cronbach's alpha coefficient and ICC for each of the two dimensions were satisfactory (alpha = 0.84 and 0.81 and ICC = 0.85 and 0.82). The values for the whole items were 0.91 and 0.81, respectively.

The HELIA-SF, including nine items and two subscales (basic skills and decision-making skills) was found to be reliable and valid instrument to measure health literacy in adults. This version is suitable for measuring health literacy in different urban and rural population groups due to its short and concise nature.

The aim of this study was to translate and psychometrics the Cervical Cancer Screening Self-Efficacy Scale.

A standard forward-backward translation method was used to develop the Persian version of the cervical cancer screening self-efficacy scale. The validity of the questionnaire was assessed through face validity (qualitative and quantitative), content validity (qualitative and quantitative) and construct validity (exploratory and confirmatory factor analysis) in 400 women. The reliability of the questionnaire was determined by test-retest method (calculation of intra-class correlation coefficient) and also internal correlation (calculation of Cronbach-alpha coefficient). Statistical analyzes were performed by SPSS24 and lisrel 8.8 software.

The range of calculated CVR and CVI of scale items was (0.92-1.00) and (0.92-1.00) impact score of all items was more than 1.5. The range of Cronbach's alpha and ICC were calculated for the reliability of scale items respectively (0.66 – 0.85) and (0.846- 0.977). The three factors of "Confidence in controlling tangible barriers of Pap Smear test ", "Confidence in following Pap Smear test Instructions" and "Confidence in controlling intangible barriers of PAPS". In confirmatory factor analysis the fitted model based on these factors explained 58.29%of the self-efficacy in performing Pap Smear test. These factors confirmed by CFA (X2/df =3.3, CFI=0.91, GFI= 0.96, RMESA=0.081).

  Psychometric of Persian version of the cervical cancer screening self-efficacy scale with 8 items and 3 domains has proper validity and reliability to evaluate the cervical cancer screening self-efficacy in females.

Acceptance of COVID-19 vaccination could be influenced by attitude towards the vaccine. The aim of this study was to develop and evaluate the validity and reliability of adult attitudes towards COVID-19 vaccination.

First, an item pool was generated by reviewing existing resources. Then content and face validity was examined. In the next stage, the structural validity (exploratory and confirmatory factor analysis) of the questionnaire was examined in two distinct samples among 505 Iranian adults. Finally, the attitude was assessed among two samples. The internal consistency of the instrument was estimated by calculating Cronbach's alpha.

The initial questionnaire consisted of 38 items that after examining the content and face validity, a number of items was removed and corrections were applied to the remaining items. The results of exploratory factor analysis showed a three factor solution (emphasis on the need for corona vaccine, no need for corona vaccine and emphasis on the side effects of corona vaccine) including 13 items that jointly explained about 52% of variance observed. Similarly, the results obtained from confirmatory factor analysis indicate a good fit for the data. The fit indexes were as follows: (X2/df =2.15, GFI=0.91, CFI=0.95, NFI=0.91, NNFI=0.94, SRMR=0.068, RMSEA=0.076). The reliability of the questionnaire as assessed by the Cronbach’s alpha was 0.853 for the scale and ranged from 0.68-0.74 for its dimensions. Finally, the mean attitude score of the participants was 64.1 out of 100 points.

Considering the validity and reliability of the attitude assessment questionnaire regarding the COVID-19 vaccination in adults, this questionnaire could be used for measuring attitude towards COVID-19 vaccination.

This study aimed to review Persian biomedical literature on psychometric properties of health literacy measures in Iran.

The Scientific Information Database (SID) and Google Scholar were searched using the keyword ‘health literacy’ in the titles of the articles. First, duplicate articles were removed from the search list. Then, articles that met the inclusion criteria were included in the study. Finally, information about the health literacy measures including development or psychometric evaluation in Persian literature were extracted and presented in relevant tables.

In all, 600 articles were identified. After excluding duplicates and papers that did not meet inclusion criteria, 26 articles were included in the review. Of these, 17 articles reported on the development of a health literacy measure. These measures assessed health literacy among general populations, specific populations, or specific topics. The remaining nine articles reported translation and psychometric properties of a number of known measures, including the TOFHLA, the STOHFLA, the NVS, the FCCHL, the OHLI, the MHLAP, the RELAM, and the Health Literacy Scale for Women of Reproductive Age.

The results indicated that the development of a new health literacy measure was more prevalent among Iranian investigators instead of using existing measures. In addition, improper reporting on the development and psychometric evaluation of measures was evident.

Birth of an infant with very low birth weight (VLBW) (weight less than 1500 grams) is a major cause of deaths and complications in infancy and childhood. Despite recent progressions in medical care and treatment for VLBW children, the mortality rate is high in this group of children. The present study was performed to better identify the survival rate of these children and the problems that affect the survival of this group of infants in the short and long term.

The study population was all infants weighing less than 1500 grams or infants who borne at less than 32 weeks of pregnancy. Infants whom birth occurred from the beginning to the end of 2018 in hospitals in Tehran were included. Information about these children was provided by the Family and Population Health Office of the Ministry of Health and Medical Education. Sampling was non-random and all information about the infants under study was recorded in a questionnaire. All data from the study were entered into SPSS-22 software and the results were presented using descriptive and analytical statistics. Survival analysis was performed by Kaplan-Meier test and the effect of variables on survival was evaluated using multivariate Cox model.

A total of 338 children were studied. Based on the results of cox regression models, the probability of one-month survival of children was about 68% and the probability of one-year survival was about 60%. Of the 10 variables affecting the survival of VLBW infants and children under study, 6 variables of maternal education, number of pregnancies, parent and infant insurance, gestational age, birth weight and maternal vaccination before pregnancy were significantly related with the death of infant (P ≤0.05).

The findings suggest one of the effective strategies for improving VLBW infant survival rate is encouraging women to continue their education, vaccinating mother before pregnancy, insuring family members and preventing multiple pregnancies.

Considering the high mortality rate due to traffic accidents in children and the necessity of prevention of these events, the researchers decided to consider accidents caused by vehicles among Iranian children and teenagers.

This study was a systematic review study. The keywords in this study were "Traffic accidents, road accidents, road deaths, child mortality, traffic deaths" in the title and abstract of all published articles from 1991 to November of 2017 in the Google scholar search and the Scientific Information Database – SID. After removing repetitive and unidentified articles from extracted papers, the full text of the final selection papers related to vehicle accidents in schoolchildren was reviewed and the results were categorized and presented in terms of the Phrases and tables.  

Out of 841 articles, after the remove duplicates and articles with unrelated and non-consistent topics for study purposes, 12 papers were finally examined. The prevalence of accidents caused by vehicles in children and adolescents was between 6% and 53.87%. The studies were heterogeneous and were divided into two main categories: a total of 5 studies examined the prevalence of these events and the rest were related to the related cases.

Considering the significant contribution of vehicle accidents to the rate of accidents and incidents in children and adolescents, the need for education them and their parents, as well as the attention and emphasis of legislators on the adoption of laws on the creation of greater safety in Children are essential.

The aim of this study was to investigate the fertility indicators in Iran. 

This was a cross-sectional study and included Iranian women of reproductive-age. The data were collected using a questionnaire and analyzed using SPSS18.

In all 10547 women included in the study. The mean live birth was 1.96 and it was increased as age of both women and husbands were increased; and it was decreased as age at marriage, age at birth of the first child, and education were increased. Live birth was more in low-income women and in rural areas. The frequency of stillbirth was 4.8% and increased as age of both women and husbands were increased. The stillbirth decreased as age at marriage, the age at birth of the first child, and education were increased. There was no relationship between stillbirth and women’s occupation, occupation of husbands, and religion. The stillbirth was more in low-income women and in rural areas. The frequency of abortion was 18.2% and increased with age of women, age of husbands, and age at birth of the first child. Abortion decreased with increased age at marriage and education. Abortion was more common in low-income women. Abortion had no relationship with women’s occupation, religion, and urban/rural residency. The frequency of the cesarean section was 42.1%. Cesarean increased with increased age of women and husbands, age at marriage, age at birth of the first child, and education. Delivery by cesarean had no relationship with occupation of husbands. The cesarean decreased with decreased income and was higher in urban areas.

Investigating the trend of fertility indicators can play important role in identifying problems, planning for required services, and optimal allocation of resources. The findings from this study will complement the information that is needed by policy-makers.

Despite the existence of numerous tools to measure health literacy, there is no general agreement on this issue. Researchers around the world have been involved in the development of an instrument to measure health literacy. The psychometric properties of the Health Literacy for Iranian Adults (HELIA) scale have been approved in the general population; however, the validity and reliability of this indigenous questionnaire has not been explored in students. Therefore, due to demographic differences, the present study investigated this questionnaire in a sample of students for structural validity and reliability. 

This cross-sectional study was conducted on 340 dormitory students of Shahid Beheshti University of Medical Sciences in 2016, in Tehran City, Iran. A single-stage cluster sampling technique was used for sampling. Cronbach’s alpha coefficient was used to verify the reliability of the questionnaire and the confirmatory factor analysis was used to investigate the validity of the constructs by LISREL software. 

The mean±SD age of studied students was 22.93±4.05 years. The questionnaire had a desirable internal consistency (Cronbach’s alpha coefficient: 0.77-0.90) to assess health literacy in participating students. The confirmatory factor analysis result was satisfactory for its overall fitness. (RMSEA=0.095, CFI=0.94, NFI=0.92, NNFI=0.94, SRMR=0.075, X2/df=4.09). 

The study findings revealed that HELIA is a reliable and valid instrument for measuring health literacy among students.