Background. Self-efficacy is an important psychological and motivational factor in breastfeeding, and it is a valuable framework that predicts breastfeeding outcomes and demonstrates maternal confidence in breastfeeding. The meta-analysis evaluated the effectiveness of educational interventions on improving breastfeeding self-efficacy (BSE). Methods. The English and Persian databases including Medline, Embase, Cochrane Database of Systematic Reviews (CDSR), PubMed, Web of Science, Scopus, CINAHL, Sid, IRANDOC, and Marg-Iran were systematically searched for studies published from January 2005 to December 2020. The quality of studies was evaluated using the Cochrane risk of bias tool and the heterogeneity by I² statistic. The extracted data were analyzed using RevMan 5 statistical software and presented using random effects standardized mean difference (SMD). The funnel plot was used for evaluating publication bias. Results. Results from 40 RCTs showed that educational intervention had a positive effect on the BSE compared with the usual/standard care (pooled SMD = 1.20; 95% CI = 0.75–1.64, value <0.001). The subgroup analysis indicated that the educational intervention was based on theory, group class format, direct method education, during the first week of postpartum, doing during pregnancy, on primiparous women, and health center setting, and the Asian region has a more effect on BSE than the others. Conclusion. Breastfeeding education is considered an influential factor in the improvement of BSE. It is recommended that breastfeeding education should be continued for several weeks after childbirth for gaining its benefit. The Asian region has a more effect on BSE than the others. Therefore, it is important to add the values in content of education in each country.

Objective. To determine the relationship of selenium plasma level and preeclampsia, as an antioxidant, against reduction damage of free radicals. Methods. A case control study was carried out on 40 preeclamptic, and 40 healthy pregnant women in 34–39^th week of gestation who were matched on the age of pregnancy and mineral supplements intake, in Iran. The plasma level of selenium measured by atomic absorption. Data was analyzed by using the statistical tests (t-test, chi-square, regression), α = 0 .05. Results. The mean plasma level of selenium significantly decreased in preeclamptic women compared to healthy pregnant women (p = 0.001). There was a relationship between plasma levels of selenium and preeclampsia. The odds of having preeclampsia in women who were at the bottom tertile of plasma selenium was 4.96-fold (OR = 4.96, CI 95%; 1.56–15.6, P = 0.006) and in the second tertile 3.94-fold greater (OR = 3.94, CI 95%; 1.26–12.33, P = 0.019) than third tertile of plasma selenium. Selenium plasma level under 60 μg/L has a sensitivity of 87.5%, a positive predictive value of 64.8% and Youden index was 0.4. Conclusion. The result of this study shows that the reduction of selenium plasma level in preeclamptic women in comparison with healthy pregnant women may demonstrate a higher demand of Se in preeclamptic pregnancies. Selenium plasma level <60 μg/l might be a favorite cut-off point for screening of preeclampsia specially in pregnancies with low selenium plasma level; however, it may not be a favorite predictive.

Background: Self-efficacy is an important motivational factor that can be affected by physiological responses such as stress. Objective: The study aimed to determine the effect of stress management counseling on self-efficacy and continuity of exclusive breastfeeding in mothers. Materials and Methods: This randomized controlled trial was carried out on 46 pregnant women recruited at three Childbirth Preparation Centers of Zanjan (Iran) in 2018. The eligible women were allocated into two intervention and control groups according to the block design. Stress management counseling was carried out individually in four sessions, twice a week at 35 and 36 weeks of gestation. The control group only received routine cares. The self-efficacy and continuity of exclusive breastfeeding were measured monthly up to 4 months after childbirth. Results: Breastfeeding self-efficacy showed a statistically significant difference between the two study groups at 1 and 4 months after childbirth (p = 0.001). More women in the control group terminated exclusive breastfeeding compared to those in the intervention group (16 (72.7%) versus 8 (34.8%), p = 0.013). Conclusion: The results showed that integration of stress management counseling in breastfeeding education package can improve the self-efficacy and continuation of breastfeeding in mothers.

Objective. It is important to evaluate the long-term effects of the COVID-19 pandemic on the intention of midwives to leave their jobs. The study examined the relationship between burnout and the intent to leave work among midwives who worked at Ayatollah Mousavi Hospital of Zanjan, one year after the COVID-19 outbreak. Method. In a descriptive-analytical study, the intention of 88 midwives to leave their jobs was evaluated, one year after the outbreak of COVID-19 disease in 2021. The midwives were selected using convenience sampling methods. Data were collected using the Maslach burnout questionnaire and the Anticipated Turnover Scale (ATS). Data were analyzed with descriptive statistics, Chi-square test, Pearson correlation coefficient, and multiple linear regression model with the stepwise method at a 95 confidence level. Results. The mean intention to leave the job was 29.71±6.75. Most of the midwives reported a moderate level of intention to leave the job (47.7). There was a significant positive correlation between the intention to leave the job and all three components of burnout. The stepwise regression analyses indicated that emotional exhaustion (β=0.344) and working rotational shifts (β=0.276) were significant predictors of intent to leave the job. Conclusions. It can be concluded that the intention to leave the job of midwives was moderate. Given the relationship between emotional exhaustion and the intent to leave the job, interventions to increase the mental strength and resilience of midwives during the COVID-19 pandemic seem necessary.

Background: Mental disorders are the most common health problems that affect different population groups. According to the national survey in 2015 based on General Health Questionnaire-28 (GHQ-28), 23.44% of Iranians older than 15 years were suspected of having a mental disorder. The study aimed to determine the mental health status of the population over 15 years of age in the Islamic Republic of Iran, one year after the outbreak of COVID-19 in 2020. Methods: The population-based study was performed on 24584 individuals over 15 years of age in Iran between December and February, 2020. The GHQ-28 was completed through telephone interviews. Data were analyzed using descriptive statistics, chi-square test, independent t-test, and multiple logistic regression at 95% confidence level. Results: The results showed that the mean age of participants was 44.18±16.47 years. The prevalence of mental disorders was 29.7%. Mental disorder was associated with female gender (OR=1.195, 95% CI 1.10–1.29), 25–44 years (OR=1.206, 95% CI 1.06–1.36), urban life (OR=1.116, 95% CI 1.04–1.19), illiteracy (OR=1.286, 95% CI 1.11–1.48), being divorced (OR=1.924, 95% CI 1.50– 2.45), and unemployment (OR=1.657, 95% CI 1.40–1.94). Among the participants and their families, 14.7% and 32.3% were infected with the disease, respectively. The COVID-19 mortality rate in their families was 13.2%. The prevalence of mental disorders in infected people (40% vs. 27.3%) and bereaved families (39.6% vs. 35.3%) was more than the non-infected groups. Conclusion: Our results showed that in Iran, the mental health of the general population had a rising trend compared to 2015, especially in people infected with COVID-19 and bereaved families. The observed difference may be due to the prevalence of the COVID-19 epidemic and rapid demographic, social, and economic changes in Iran. Planning to improve mental health in the mentioned population should be considered for the post COVID-19 era.