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Screening is a key component of breast cancer early detection programs that can considerably reduce relevant mortality rates. The purpose of this study was to determine the breast cancer screening behavioral patterns and associated factors in women over 40 years of age. In this descriptive‑analytical cross‑sectional study, 372 over 40 years of age women visiting health centers in Tabriz, Iran, in 2023 were enrolled using cluster sampling. The data were collected using the sociodemographic characteristics questionnaire, breast cancer perception scale, health literacy for Iranian adults scale, and the Breast Cancer Screening Behavior Checklist. The obtained data were analyzed in SPSS version 16 using descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistics (univariate and multivariate logistic regression analyses). In total, 68.3% of all participants performed breast self‑examination (BSE) (9.9% regularly, once per month), 60.2% underwent clinical breast examination (CBE) (8.9% regularly, twice per year), 51.3% underwent mammography (12.3% regularly, once per year), and 36.2% underwent sonography (3.8% regularly, twice per year). The findings also showed that women with benign breast diseases were more likely to undergo CBE (OR = 8.49; 95% CI 2.55 to 28.21; P < 0.001), mammography (OR = 8.84; 95% CI 2.98 to 10; P < 0.001), and sonography (OR = 18.84; 95% CI 6.40 to 53.33; P < 0.001) than others. Participants with low and moderate breast cancer perception scores were more likely to perform BSE than women with high breast cancer perception scores (OR = 2.20; 95% CI 1.21 to 4.00; P = 0.009) and women who had a history of benign breast disease were more likely to perform screening behaviors than others (OR = 2.47; 95% CI 1.27 to 4.80; P = 0.008). Women between the ages of 50 and 59 were more likely to undergo mammography (OR = 2.33; 95% CI 1.29 to 4.77; P = 0.008) and CBE (OR = 2.40; 95% CI 1.347 to 4.20; P = 0.003) than those ≥ 60 years. Given the low participation of women in regular breast cancer screening, it is suggested that health care providers highlight the need for screening at the specified intervals in their training programs. In addition, health authorities are recommended to use reminder systems to remind women, especially those over 40 years of age, of the best time for breast screening. Moreover, health care providers must seek to improve breast cancer knowledge, attitudes, and perceptions of women who visit health centers, which are the first level of contact with the healthcare system for the general population.

Background The challenging working conditions during the Covid-19 pandemic created a perfect storm that can seriously impact nurses' physical and psychological well-being. Our study aimed to investigate complicated grief and its related factors among nursing staff during the Covid-19 pandemic. Methods This is a cross-sectional study. The participants comprised 375 nurses selected by the convenience sampling method from designated wards for patients with Covid-19 in 3 hospitals in Tabriz, Iran. Participants completed a survey containing demographic and clinical questions, the Inventory of Complicated Grief, and the Multidimensional Scale of Perceived Social Support. Multiple regression analysis was used to identify the associates of nurses' grief. The STROBE guidelines were followed in reporting the study's findings. Results A significant proportion of participants (57.6%) were found to be suffering from complicated grief. Gender, educational background, type of ward, type of nursing role, type of working shift, years of nursing work experience, and experience working in the Covid-19 settings remained the significant associates of nurses' grief in the regression analysis. Conclusion Due to frequent exposure to patients' deaths, healthcare providers are at increased risk of suffering from complicated grief during the Covid-19 and post-pandemic. If it remains unresolved, complicated grief can result in significant health problems and the experience of burnout among nurses. Governments, health authorities, and nursing managers should support nurses who work in Covid-19 settings to reduce the adverse impact of the pandemic on nurses' health and well-being.

Introduction Child-to-parent violence (CPV) is an increasing issue globally, leading to serious adverse effects on families. This research aimed to conduct a systematic review and meta-analysis to assess the prevalence of CPV and identify its associated risk factors, thereby enhancing understanding of this escalating global issue. Methods In this systematic review and meta-analysis, a thorough search was carried out across various databases in English. The inclusion criteria were developed based on the SPIDER framework, targeting quantitative studies that focused on the prevalence and risk factors associated with CPV. Data were extracted systematically using a validated collection form, and the risk of bias was assessed using the Newcastle-Ottawa Scale. Statistical analyses included meta-regression and sensitivity analyses to determine the prevalence of CPV using Comprehensive Meta-Analysis version 3 software. Among the 25 included studies, 12 studies were included in the meta-analysis for prevalence, both overall and separately for violence against mothers and fathers. Additionally, 8 studies were analyzed through systematic and narrative data synthesis to examine determinants of CPV. Results The meta-analysis involving 25,000 participants revealed that the overall prevalence of CPV against both parents was 34.8%. Subgroup analyses indicated that physical violence prevalence was 10.0%, while psychological violence was significantly higher at 82.6%. Additionally, the descriptive analysis identified key determinants of CPV, including family conflict, parental stress, and adolescent behavioral issues, highlighting the complex interplay of factors contributing to this phenomenon and emphasizing the need for targeted interventions. Conclusion The findings underscore the urgent need for targeted interventions that address these multifaceted issues to effectively reduce CPV and its impact on families. Future research should continue to explore these dynamics to inform effective prevention strategies.

In recent years, the approach to caring for patients with breast cancer has evolved significantly, moving towards more outpatient and family-centered models. Despite this positive shift, family caregivers often find it challenging to embrace their new roles. Many are actively seeking ways to prepare themselves for the responsibilities that come with caregiving. Therefore, the present study was conducted to explore and describe the experiences of family caregivers of patients with breast cancer regarding their readiness for caregiving and the facilitating factors associated with it. This qualitative study was conducted with 11 participants who were purposefully selected from among the family caregivers of breast cancer patients visiting selected oncology centers in Tabriz, Iran. Data were collected through in-depth semi-structured individual interviews using an interview guide. Content analysis with a conventional approach was employed for data analysis. From the content analysis of the interviews with family caregivers, 216 codes, 20 sub-themes, and 5 main themes were extracted: \"self-enhancement of knowledge\", \"self-soothing\", \"gradual enhancement of competence\", \"the role of healthcare personnel in empowering family caregivers\" and \"support and empathy as the pillars of care for patients with cancer\". The results of the present study indicate the efforts of family caregivers to enhance their capabilities and readiness in caring for patients with breast cancer. The findings suggest that caregivers have employed strategies to accept this new responsibility and improve their competence in patient care, while the role of healthcare personnel in their preparation is not particularly prominent. The results of this study can serve as a basis for designing strategic programs in the country’s healthcare systems and can help enhance the capabilities of family caregivers in providing quality care to patients.

ObjectiveChild-to-parent violence (CPV) has received limited attention in scientific literature, but due to a recent increase in reported cases, it has become a subject of investigation. The reliability and validity of the Child-to-Parent Violence Questionnaire (CPV-Q), in separate mother and father versions, have not yet been studied in Iran. This study aimed to assess the psychometric properties of the Persian CPV-Q.DesignThis research employed a cross-sectional design to evaluate the Persian CPV-Q’s psychometric properties. The process included translation (using backward-forward method), face validity (via impact score calculation), content validity (using content validity ratio (CVR) and content validity index (CVI)), construct validity (through exploratory and confirmatory factor analyses (CFA)) and reliability assessment (via test–retest, coefficient α, coefficient ω and intraclass correlation coefficient (ICC)).SettingThe study was conducted at the Faculties of Tabriz University of Medical Sciences.ParticipantsA total of 500 qualified students from Tabriz University of Medical Sciences were recruited using cluster random sampling. These participants completed the Persian CPV-Q.ResultsFace validity was confirmed, with impact scores exceeding 1.5 for all items. Content validity was strong, with CVR=0.92 and CVI=0.89. Exploratory factor analysis revealed four factors related to violence frequency and two factors regarding reasons for violence, consistent with the original questionnaire, covering 19 and 8 items, respectively. Total variance explained was 0.30 and 0.39 for the mother’s version and 0.33 and 0.43 for the father’s version in frequency and reason sections. The Kaiser-Meyer-Olkin test confirmed sample adequacy (<0.001). Items were removed from both versions due to statistical insignificance, zero variance or collinearity. CFA supported the model fit. Reliability metrics showed coefficient α of 0.81 (mother) and 0.80 (father), coefficient ω of 0.77 (mother) and 0.74 (father), and ICC (95% CI) values of 0.72 (0.42 to 0.87) (mother) and 0.79 (0.56 to 0.90) (father), indicating good reliability.ConclusionsThe Persian CPV-Q demonstrates adequate validity and reliability for assessing the prevalence and causes of CPV in Iranian society.

BackgroundBreast milk is crucial for the health and survival of infants, but exclusive breastfeeding often fails due to various reasons such as lack of breastfeeding empowerment.ObjectivesThis study aimed to determine the status of breastfeeding empowerment and its relationship with health literacy and perceived spousal support among breastfeeding mothers while recognising that other related factors also contribute to breastfeeding empowerment.DesignCross-sectional study.SettingPrimary health centres of Tabriz city, Iran.ParticipantsIncluded 342 breastfeeding mothers with infants aged 6 months or younger in Tabriz, Iran.ResultsThe mean (SD) scores for breastfeeding empowerment, health literacy and partner support were 141.98 (33.92) out of a possible range of 37 to 185, 126.08 (21.27) out of a possible range of 33 to 165 and 64.95 (12.62) out of a possible range of 20 to 100, respectively. Based on the adjusted general linear model, for every unit increase in perceived spousal support, women’s breastfeeding empowerment score increased significantly (B=0.546; 95% CI 0.29 to 0.79; p<0.001). Additionally, working mothers had a significantly higher breastfeeding empowerment score compared with housewives (B=13.91; 95% CI 0.88 to 27.73; p=0.04), and currently, breastfeeding mothers had a significantly higher score compared with mothers who were not currently breastfeeding (B=72.26; 95% CI 60.42 to 84.10; p<0.001).ConclusionsThe findings of this study underscore the critical role of perceived spousal support in enhancing breastfeeding empowerment among mothers. By encouraging spousal involvement, families can create a supportive environment that values and facilitates breastfeeding. Healthcare providers also can play an essential role in offering guidance and resources to both mothers and their partners. By emphasising the importance of spousal support in breastfeeding, a supportive culture can be fostered that values breastfeeding as a natural aspect of motherhood.

Family caregivers are considered the main providers of care and support for cancer patients, and need to be adequately prepared for this role. Preparedness for caregiving, a key component of family-centered care, means that family caregivers have the skills and knowledge to fulfill their responsibilities, including addressing patients’ physical and emotional needs and coordinating care plans. This study investigated preparedness for caregiving and its association with health literacy and caregiving competence among family caregivers of breast cancer patients. This descriptive correlational cross-sectional study, represented the quantitative phase of a sequential explanatory mixed-methods design. It involved 354 family caregivers of breast cancer patients attending selected oncology and radiotherapy centers in Tabriz, Iran, from March 2023 to January 2024. Data collection instruments included the Individual-Social Characteristics Questionnaire, Preparedness for Caregiving Scale (PCS), Health Literacy Caregiver Scale-Cancer (HLCS-C), and Caregiver Competence Scale (CCS). Data analysis employed descriptive statistics (frequencies, percentages, means, and standard deviations) and inferential statistics (Pearson’s correlation, independent t, one-way ANOVA, and general linear model (GLM)) using SPSS version 16. The means (SD) for preparedness for caregiving, health literacy, and caregiving competence were 21.62 ± 4.69 (range: 0–32), 142.97 ± 17.23 (range: 42–192), and 13.27 ± 1.87 (range: 4–16), respectively. GLM analysis revealed a significant positive association between preparedness and both health literacy (B = 0.10; 95% CI: 0.05 to 0.14; p  < 0.001) and caregiving competence (B = 1.01; 95% CI 0.64 to 1.37; p  < 0.001). Compared to housewives, employed or retired family caregivers exhibited significantly higher mean preparedness scores (B = 2.05; 95% CI 0.16 to 3.94; p  = 0.033). Family caregivers with illiterate patients (B = − 2.29; 95% CI − 4.37 to − 0.21; p  = 0.031) compared to having a university education, as well as whose patients were diagnosed within the past 12–18 months (B = − 4.42; 95% CI − 8.36 to − 0.49; p  = 0.028) compared to 18–24 months, demonstrated significantly lower mean preparedness scores. The positive correlation between family caregivers’ preparedness for caregiving, health literacy, and caregiving competence suggests that enhancing these aspects can potentially improve family caregivers’ readiness to provide effective care. The findings of this study can be used in planning educational interventions to improve preparedness for care among family caregivers of breast cancer patients. This can be helpful in reducing healthcare costs for symptom management, fostering better decision-making preparedness, managing family caregiver stress, and improving the quality of life for both family caregivers and patients.

Background Breast cancer is a prevalent cancer characterized by its aggressive nature and potential to cause mortality among women. The rising mortality rates and women’s inadequate perception of the disease’s severity in developing countries highlight the importance of screening using conventional methods and reliable scales. Since the validity and reliability of the breast cancer perception scale (BCPS) have not been established in the Iranian context. Therefore, this study aimed to determine the measurement properties of the BCPS in women residing in Tabriz, Iran. Methods The present study comprised a cross-sectional design, encompassing a sample of 372 Iranian women. The participants were selected through a multi-stage cluster random sampling technique conducted over a period spanning from November 2022 to February 2023. The measurement properties of the Iranian version of BCPS were assessed following the guidelines outlined in the COSMIN checklist. This involved conducting various steps, including the translation process, reliability testing (internal consistency, test-retest reliability, and measurement error), and methodological tests for validity (content validity, face validity, construct validity, and hypothesis testing). The study also investigated the factors of responsiveness and interpretability. The presence of floor and ceiling effects was assessed. Results The internal consistency of the scale was assessed using Cronbach’s alpha, yielding a satisfactory value of 0.68. Additionally, McDonald’s omega (95% CI) was computed, resulting in a value of 0.70 (0.66 to 0.74). Furthermore, the test-retest reliability was evaluated, revealing a high intraclass correlation coefficient (ICC) of 0.97 (95% CI: 0.94 to 0.99). The CVI, CVR, and impact scores of the BCPS were determined to be 0.98, 0.95, and 3.70, respectively, indicating favorable levels of content and face validity. To assess construct validity, an examination of the Exploratory Factor Analysis (EFA) was conducted on a set of 24 items. This analysis revealed the presence of six distinct factors, which collectively accounted for 52% of the cumulative variance. The fit indices of the validity model (CFI = 0.91, NFI = 0.96, RFI = 0.94, TLI = 0.90, χ 2 /df = 2.03, RMSEA = 0.055 and SRMR = 0.055) were confirmed during the confirmatory factor analysis (CFA). The overall score of BCPS exhibited a ceiling effect of 0.3%. The floor effect observed in the overall score (BCPS) was found to be 0.5%. Concerning the validation of the hypothesis, Spearman’s correlation coefficient of 0.55 was obtained between the BCPS and the QLICP-BR V2.0. This correlation value signifies a statistically significant association. Furthermore, it is worth noting that the minimum important change (MIC) of 3.92 exhibited a higher value compared to the smallest detectable change (SDC) of 3.70, thus suggesting a satisfactory level of response. Conclusions The obtained findings suggest that the Iranian version of the BCPS demonstrates satisfactory psychometric properties for assessing the perception of breast cancer among Iranian women. Furthermore, it exhibits favorable responsiveness to clinical variations. Consequently, it can serve as a screening instrument for healthcare professionals to comprehend breast cancer and as a reliable tool in research endeavors.

Background Breast cancer and genital cancer are known as cancers that affect people’s relationships with their partners. Women with such cancers are emotionally vulnerable and need more support from their partners. The present systematic review and meta-analysis evaluated the effectiveness of couple-based interventions on the marital outcomes of patients with these cancers and their intimate partners. Methods To perform this systematic review, Google Scholar and databases such as PubMed, Web of Science, Cochrane, Scopus, SID (Scientific Information Database), and Magiran were searched systematically. The reviewed studies included randomized controlled trials and quasiexperimental studies in which the intervention group, couple-based interventions, and the control group received routine care, general education or no intervention for cancer treatment. In this study, the included participants were patients with breast cancer or genital cancer and their intimate partners. The primary outcomes considered in this study included patients’ marital adjustment, patients’ marital satisfaction, patients’ marital intimacy, and patients’ marital relationships. The secondary outcomes were partners’ marital adjustment, partners’ marital satisfaction, partners’ marital intimacy, and partners’ marital relationships. A meta-analysis was performed with Review Manager v. 5.3 software (The Nordic Cochrane Centre, Cochrane Collaboration, 2014; Copenhagen, Denmark). The intervention impacts on continuous outcomes were measured using standardized mean differences (SMDs) with 95% confidence interval because of the use of various scales to evaluate the outcomes. The quality of evidence presented in the included studies was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. In the subgroup analysis, the studied outcomes were divided into two parts (theory-based and non-theory-based) in terms of the theoretical context of couple-based interventions. Results From a total of 138 retrieved studies, 14 trials were eligible for inclusion in the study. The results of the meta-analysis showed that the patient’s marital satisfaction increased significantly with couple-based interventions (SMD 0.46, 95% confidence interval 0.07 to 0.85; 7 trials, 341 patients, very low certainty) compared to the control group, but the evidence was uncertain. However, there were no significant differences between the groups in the partner’s marital satisfaction, the patient’s and partner’s marital adjustment, and the patient’s and partner’s marital intimacy. Additionally, the results of the subgroup analysis showed that the couple-based interventions significantly increased the patient’s marital adjustment (SMD 1.96, 95% CI 0.87 to 3.06; 4 trials, 355 patients, very low certainty), the partner’s marital adjustment (SMD 0.53, 95% CI 0.20 to 0.86; 4 trials, 347 partners, very low certainty), the patient’s marital satisfaction (SMD 0.89, 95% CI 0.35 to 1.43; 2 trials, 123 patients, very low certainty), and the partner’s marital satisfaction (SMD 0.57, 95% CI 0.20 to 0.94; 2 trials, 123 partners, very low certainty) compared to the control group in theory-based studies. In. However, in non-theory-based studies, the results of the meta-analysis revealed no significant differences between the intervention and control groups. Conclusions The results of this study demonstrated the impact of couple-based interventions on the marital outcomes of patients with breast and genital cancers. Because of the very low confidence in the evidence, high-quality randomized trials with a sufficient sample size should be conducted considering the proper theoretical context.

Background Considering the values and preferences of individuals who attempt to quit smoking is a crucial step in the development of smoking cessation technologies. This study aimed to explore preferences regarding smart smoking cessation technologies. Methods This parallel convergent mixed-methods study was conducted in two phases: quantitative and qualitative. In the quantitative phase, a cross-sectional study was conducted with 360 participants selected through stratified random sampling from technology-based smoking cessation clinics in Tabriz, Tehran, and Karaj cities in Iran. Data on demographic characteristics and preferences for smart smoking cessation technologies were collected using questionnaires and analyzed using descriptive statistics. In the qualitative phase, 25 users of these technologies were selected through purposeful and snowball sampling. The data were gathered through in-depth semistructured interviews and analyzed using qualitative content analysis with a conventional approach. Quantitative and qualitative data were integrated using the merging strategy and convergence model. Results The quantitative phase results indicated that the highest preference was related to wearing and using a smartwatch for smoking cessation and using mobile apps. In the qualitative phase, 17 subcategories were extracted and classified into 8 main categories: high effectiveness, better management of the smoking cessation process, personalized technology, safe and uncomplicated technologies, attractiveness and innovative design, scientific basis, mobile applications, and smart monitoring devices. Conclusion By combining and integrating quantitative and qualitative results, it can be concluded that users are more interested in wearable technologies and interactive mobile applications. The findings of this study can assist smoking cessation technology developers in designing and improving their tools based on user needs and preferences to enhance their effectiveness and acceptability.