Background: In Jordan, practices in maternity wards are not based on the best evidence. Women are still largely confined to bed during the first stage of labor. Objective: This study examined the effect of ambulation during the first stage of labor on maternal and neonatal outcomes. Methods: A blinded randomized controlled trial was conducted in a labor ward of one large hospital in Southern Jordan. Primiparous women (n = 290) were randomly assigned to an intervention group (n = 140) and a control group (n = 150). The intervention group was encouraged to ambulate, and the control group received the usual care. Descriptive statistics, independent t-tests, and analysis of variance were used for data analysis. Results: Compared to the control group, women in the intervention group experienced a shorter duration of the first stage of labor (P < 0.001), reported less intensity of labor pain (P < 0.001), and used less analgesics (P < 0.001). They experienced less augmentation of labor (P = 0.030), were more likely to give birth by normal vaginal birth (P = 0.015) and were more satisfied with the birth experience (P = 0.001). No statistically significant differences were found between groups concerning perineal status, postpartum complications, and neonatal outcomes. Conclusion: Although the intervention has had a positive impact on maternal outcomes, no negative effects on neonatal outcomes were found. Encouraging women to ambulate and assume the upright position during the first stage of labor, is likely to produce better physical, social and economic outcomes in maternity services.

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Background: Herbal products with potential antioxidant effects can be used in the management of chronic disorders such as osteoporosis. Objectives: The aim of this study was to evaluate the effects of Nigella sativa (NS) and curcumin (CUR) supplementation on oxidative stress biomarkers in postmenopausal women with primary osteoporosis or osteopenia. Methods: In this randomized controlled trial, conducted from August 2018 to April 2019 using a triple-blind factorial design, 120 postmenopausal women with primary osteoporosis (n = 74) or osteopenia (n = 46) were randomly allocated to 430 person groups, namely the NS, CUR, NS + CUR, and placebo groups. Participants in these groups daily received one 1000 mg NS oil capsule and one CUR placebo capsule, one 80 mg nanomicelle CUR and one NS placebo capsule, one 1000 mg NS oil capsule and one 80 mg nanomicelle CUR capsule, and two placebo capsules, respectively. The intervention lasted 6 months. The serum levels of the superoxide dismutase (SOD), total antioxidant capacity (TAC), and malondialdehyde (MDA) oxidative stress biomarkers were assessed before and after the intervention. Results: SOD serum level significantly increased in the NS and the NS + CUR groups and its posttest value in the NS + CUR group was significantly more than the placebo group (mean differences = 100.4, 95% confidence interval = 21.9–178.9; P = 0.013). TAC serum level significantly increased in the NS + CUR group and its posttest value in this group was significantly more than the placebo group (mean difference = 0.23; 95% confidence interval = 0.05–0.41; P = 0.011). No significant change was observed in MDA serum level in any of the study groups (P > 0.05). Conclusion: CUR is probably ineffective in significantly reducing oxidative stress, while NS can relatively alleviate oxidative stress and NS + CUR can considerably alleviate oxidative stress in postmenopausal women with primary osteoporosis or osteopenia.

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Background: Older adults face changing social roles and reduced social participation, which negatively affects their quality of life and social health. Despite reports of the benefits of intergenerational programs on the social health of older adults, studies are inconsistent in this regard. Objectives: This study aimed to examine the effect of an intergenerational program on the social health of Iranian older adults. Methods: A randomized controlled trial was conducted in 2019 with 40 grandparents over 60 years of age of girl students aged 8–12 years studying in a girl elementary school in Qom, Iran. Eligible subjects were conveniently enrolled and then randomly assigned to an intervention group and a control group of 20 participants each. An intergenerational game program was implemented in 6 sessions of 90 min each over 6 consecutive weeks. During the sessions, each older adult interacted and played with his/her grandchild in the form of a two-player game. The Keyes Social Health Questionnaire was used to assess the social health of older adults at baseline, at the end of the study, and 4 weeks after the end of the program. Data were analyzed using descriptive statistics, Chi-square test, Fisher's exact test, independent samples t-test, paired t-test, and repeated-measures analysis of variance. Results: The mean social health score of the intervention group was 106.05 ± 18.88 at baseline and changed to 129.5 ± 9.32 and 120.75 ± 10.61 at the end of the intervention and 4 weeks afterward, respectively. The mean social health score of the control group was 103.0 ± 10.61 at baseline and did not change significantly during the study. Repeated-measures analysis showed that over time, the intergenerational game program significantly increased the mean social health score in the intervention group (F [1.58] =17.602, P < 0.001), whereas it did not change significantly in the control group. Conclusions: The intergenerational game program was effective in improving the social health of older adults. Similar programs can be used to improve the social health and vitality of older adults.

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Background: Infantile colic (IC) imposes multifactorial problems on the parents, and appropriate interventions are needed to alleviate the care burden. Objectives: This study aimed to assess the effects of an educational, supportive, and follow-up IC program on the parents' caregiver burden (CB). Methods: This randomized controlled trial was conducted with 64 parents whose infants suffered from IC. Participants were randomly assigned to an intervention group (n = 32) and a control group (n = 32). The intervention group received a blended educational, supportive, and follow-up intervention for 2 weeks. The control group received routine care. Caregiver burden was assessed on three occasions, before, immediately after, and 1 month after the intervention, using the Zarit Burden Scale. Data were analyzed through repeated-measures analysis of variance, independent-samples t-test, Chi-square, Fisher's exact, and Mann–Whitney U tests. Results: There was a significant difference between the mean scores of CB in the two groups measured immediately and 1 month after the interventions (P < 0.001). The mean score of CB was significantly lower in the intervention group than in the control group after the intervention (P < 0.05). Conclusion: The blended educational, supportive, and follow-up program could help alleviate parental care burden. Implementing such a program is recommended to reduce CB and associated problems among parents.

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Background: Many biological and cultural factors are involved in the physical resilience of older adults, but these factors are not fully known and the results of studies are contradictory in this field. Objectives: The present study was conducted to determine the level of physical resilience and its associated factors in Iranian older adults with ischemic heart disease (IHD). Methods: A cross-sectional study was conducted on 350 older adults with IHD admitted to Shahid Beheshti Hospital in Kashan, Iran, in 2018. Sampling was done consecutively. Eligible older adults completed a demographic form and the Resnick physical resilience questionnaire in the presence of the researcher. Data were analyzed using Pearson's correlation coefficient, t-test, analysis of variance, and multivariate regression. Results: A majority of the participants were female (50.6%) and mostly resided in urban areas (67.4%). The overall mean score of physical resilience was 9.57 ± 3.00 out of 15. Women, those with an unmarried child at home, those who were literate and lived in urban areas, those without comorbidities, and those who did not receive financial support from family members had significantly higher resilience scores (P < 0.05). Multiple linear regression analysis showed that younger age (P < 0.001), better cognitive function (P = 0.006), and employment (P = 0.01) significantly predicted physical resilience. Conclusion: The average score of the participants was above 50% of the score of the physical resilience questionnaire. Our findings encourage authorities to develop comprehensive care plans including community education and more diverse care for patients with noncommunicable diseases, to increase resilience in older adults with IHD.

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Background: Emergency medical technicians (EMTs) or paramedics may not be able to do according to their moral standards during the COVID-19 pandemic, which can cause burnout and job dissatisfaction. Objectives: This study aimed to evaluate moral distress (MD), job satisfaction, and burnout among EMTs during the COVID-19 pandemic. Methods: This cross-sectional study was conducted in Bam, Iran in 2020. In total, 134 EMTs completed the online survey that included demographic information, a MD scale, the Maslach Burnout Inventory, and an item for assessing job satisfaction. Descriptive statistics along with independent samples t-test, one-way analysis of variance, Mann–Whitney U, and Kruskal–Wallis tests, as well as multiple linear regression analysis were used to analyze data. Results: The mean scores of MD and job satisfaction were 25.44 ± 12.78 and 3.63 ± 1.07, respectively. Concerning severity, the mean scores of emotional exhaustion, depersonalization, and personal accomplishment (PA) were 35.45 ± 5.04, 20.61 ± 3.40, and 33.04 ± 4.07, respectively. All three burnout subscales were significantly correlated with job satisfaction (P < 0.05) and MD (P < 0.05). Access to personal protective equipment and education level significantly predicted MD (P < 0.05). Conclusion: Despite high burnout and moderate MD, EMTs reported high job satisfaction, possibly because of increased social respect and salary. EMTs can avoid MD and burnout by learning how to handle ethical challenges during the COVID-19 pandemic.

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Background: The close engagement of family caregivers in the care of older adults with chronic obstructive pulmonary disease (COPD) may predispose them to anxiety, frustration, and social isolation, which may consequently affect their resilience and care burden. Objectives: The purpose of this study was to examine the relationship between caregiver burden and resilience in family caregivers of older adults with COPD. Methods: This cross-sectional, descriptive study was conducted on 240 family caregivers of older adults with COPD who were referred to a specialty pulmonology clinic in Iran. The participants were recruited by convenience sampling. Data were collected using the Zarit Burden Inventory and the 25-item Connor Davidson Resilience Scale. Statistical analyses included t-test, analysis of variance, Pearson's correlation coefficient, and stepwise multiple regression. Results: The mean age of the caregivers was 51.20 ± 11.84 years. The majority of participants experienced low (55.7%) or moderate (43.8%) caregiver burden. The overall mean caregiver burden score was also moderate (20.01 ± 6.46). The overall mean resilience score was high (77.85 ± 10.17). An inverse relationship was found between resilience and caregiver burden (r = −0.38; P < 0.001). Conclusion: As resilience increases, caregiver burden decreases. Implementing early counseling intervention for promoting resilience, increase tolerance to problems, and reduce caring burden among family caregivers of older adults with COPD.

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Background: The COVID-19 pandemic has affected many individuals, including midwives. Objectives: This study aimed to explore the Indonesian midwives' psychological well-being and to investigate their coping strategies during the COVID-19 pandemic. Methods: This qualitative study investigated 10 midwives, from 9 provinces in Indonesia, who provided care during the COVID-19 pandemic. Semi-structured online interviews were conducted. Prior to the interviews, an online survey was distributed to identify potential participants. The interview data were analyzed using thematic analysis. Results: This study summarized the midwives' psychological distress and coping strategies during the COVID-19 pandemic, categorizing the information into four themes and fourteen subthemes: (a) “I am worried,” (b) professional and personal responsibilities, (c) coping strategies, and (d) policy and expectations were the main themes emerged. Conclusions: Midwives experienced challenging situations that negatively affected their psychological state, due to the COVID-19 pandemic. The biopsychosocial and cultural contexts influenced the midwives' psychological well-being and coping strategies. Midwives should be empowered to prevent and manage their psychological distress, as well as their patients' concerns, during this unprecedented period.

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Background: Pregnant women experience physical and psychological changes during the gestation period. These changes cause psychopathological disorders such as stress and anxiety in mothers. Paying attention to the psychological health of pregnant women is a major global concern, especially during the COVID-19 pandemic. Objectives: This study aimed to assess the perceived stress, social support, and related factors in pregnant women during the COVID-19 pandemic. Methods: This cross-sectional study was conducted on 240 pregnant women who were referred to health centers in Zanjan, Iran, between January 2021 and April 2021. A cluster sampling method was used to recruit the participants. A demographic and midwifery information questionnaire, the 14-item Cohen's Perceived Stress Questionnaire, and Winfield and Tiggemann's Social Support Questionnaire were used to collect data. Data were analyzed using the Chi-square test and multiple linear regression analysis. Results: The mean age of mothers was 27.12 ± 7.01 years. The mean scores for social support and perceived stress were 17.95 ± 5.52 and 26.71 ± 8.84, respectively. No significant association was found between social support and the independent variables. However, perceived stress was significantly associated with social support, such that perceived stress decreased as social support increased. Conclusion: There was a significant relationship between social support and perceived stress. Midwives and gynecologists should implement strategies to reduce stress and reinforce social support during pregnancy.

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