Advances in Nursing & Midwifery

Introduction:This study aims to determine teachers’ food allergy and anaphylaxis management self-efficacy and knowledge levels.

Methods: This descriptive study was conducted with 399 teachers who worked in kindergarten and primary schools in a city center between March and June 2022. Data were collected through the Descriptive Characteristics Form and the Food Allergy and Anaphylaxis Management Self-efficacy Scale for School Personnel.

Results: The average age of participating teachers was 31.18± 6.79 years, and 67.2% were females, 61.9% were married, 63.7% were classroom teachers, and 56.6% did not have children. Teachers’ Food Allergy and Anaphylaxis Management Self-Efficacy Scale mean score was 21.21±6.22. Self-efficacy was higher in kindergarten teachers, teachers who had a student with food allergy, those who received first aid education after starting to work, those who think that food allergy and anaphylaxis management in school is the teachers’ duty, and those who wanted to know about food allergy and anaphylaxis management. Teachers with low self-efficacy felt/would feel most frequently panic while managing a child with food allergy (p<0.05).

Conclusions: This study found that food allergy and anaphylaxis management self-efficacy was affected by teachers’ area of specialization, presence of a student with food allergy, receiving first aid education, and thinking that teachers are responsible for the management of the process.

Keywords: Food allergy, Anaphylaxis, Child, School Health, Teacher, Public health nursing

Abstract
Introduction: Most couples with marital conflicts lack secure attachment styles that are necessary to improve the quality of their relationships and consolidate their family foundations. The present study aimed to investigate the role of an educational package based on an integrative self-analytical framework to the attachment styles of couples with marital conflicts.
Methods: The study was a randomized controlled trial with a pre-test/post-test/control group/follow-up design. The statistical population consisted of all couples with marital conflicts visiting the counseling centers in Isfahan, Iran in 2021, of whom 30 couples were selected as the sample through convenience sampling and randomly assigned to an experimental group and a control group. The participants in the experimental group attended a 12-session educational package based on an integrative self-analytical framework while those in the control group received no intervention. All participants were assessed again two months later. The research instruments included the Adult Attachment Scale. The data were statistically analyzed using Repeated Measures ANCOVA in SPSS-24. The significance level of the research was considered to be α=0.05.
Results: The mean ± SD of close subscale in the post-test and follow-up stages were 23.06±3.99 and 23.76±4.51 in the experimental group and 21.63±4.67 and 21.53±4.59 in the control group. The mean ± SD of anxiety subscale in the post-test and follow-up stages were 16.06±5.11 and 15.10±4.99 in the experimental group and 16.33±4.61 and 16.66±5.04 in the control group. Moreover, the mean ± SD of depend subscale in the post-test and follow-up stages were 15.06±3.26 and 14.80±3.01 in the experimental group and 15.40±3.77and 15.60±3.86 in the control group. The results showed that the educational package based on an integrative self-analytical framework improved the attachment styles (i.e., close, depend, and anxiety) of the participants (P<0.001) and the effects persisted during the follow-up period.
Conclusions: Consequently, Therefore, consultants and psychologists can use this intervention to improve attachment styles in couples with marital conflicts.

Abstract
Introduction: Health literacy is related to better adherence to the recommendations of health care providers, health care appointments and acceptance of preventive care such as cancer screening. Considering the importance and role of health literacy in breast cancer screening, this study was conducted to investigate health literacy about breast cancer and its related factors among women.
Methods: An analytic cross-sectional study was conducted on 186 women who were referring to health care centers in Kashan city in Iran in 2020 with basic literacy. All the participants filled out a questionnaire developed based on Health literacy of breast cancer and its related factors using the questionnaires of AHL-C (Assessment of Health Literacy in Cancer Screening) and Breast-CLAT. The random cluster sampling method was applied to select participants. The statistical analysis was performed with chi-square in SPSS 18.
Results: The majority of the participants were 40-49 and marital. The total of health literacy in half of the participants was medium. The most undesirable and desirable dimensions of health literacy were related to numerical literacy and reading literacy, respectively. Determinants related to health literacy were identified as the following: education, visit a doctor due to having a problem in the breast and cancer family history. Moreover results showed that a significant correlation between comprehensive literacy and prior knowledge dimension with performing BSE.
Conclusions: Of all the health literacy dimensions examined, Prior knowledge and comprehensive literacy were the strongest predictors with do breast self-examination. It can be concluded that, promoting health literacy could be effective for the primary prevention of non-communicable diseases and early diagnosis. We recommend educating all women for the prevention and early diagnosis of breast cancer.

Abstract
Introduction: Changes of physical activity before and during three trimesters of pregnancy known as pattern of physical activity and anxiety during pregnancy can be two concerns of pregnant women about preterm birth which require clarification. So, this retrospective study aimed to assess the effect of pattern of physical activity, and anxiety on preterm birth in Iranian pregnant women.
Methods: This study was a kind of descriptive correlation which was performed retrospectively. Participants of this study (2019-2020) included 118 pregnant women with preterm (n=62) and term (n=56) birth who participated in the study voluntarily and were selected according to the study inclusion criteria. The energy cost of physical activity before and during three trimesters of pregnancy, and anxiety level were recorded through interview using pregnancy physical activity (PPAQ) and Hospital Anxiety and Depression Rating Scale Anxiety (HADS) questionnaires respectively.
Results: There was no significant difference between preterm and term birth groups regarding total physical activity, and sedentary behavior energy expenditure before and during pregnancy as well as anxiety during pregnancy(P>0.05). Physical activity pattern was not significantly different between the two groups (P>0.05). However, physical activity before pregnancy was significantly higher than all trimesters of pregnancy in both groups of the study (P<0.001). In two groups of preterm and term deliver, physical activity reduced in the third compared to the second trimester of pregnancy similarly.
Conclusions: Physical activity reduced during pregnancy in preterm and term birth women similarly. In this study, physical activity, sedentary behavior and anxiety during pregnancy and before it were not effective on the pre-term birth.

Abstract
Introduction: Considering the many problems of a child with Down syndrome, early diagnosis allows parents to prepare for the birth and care of these children or to suggest termination of pregnancy. This study aimed to investigate associations between serum levels of folic acid and Superoxide dismutase (SOD1) with the results of the first trimester Down syndrome screening and fetal karyotype in high-risk pregnant women.
Methods: In this cross-sectional study, 232 women with high-risk pregnancies who had positive Down syndrome screening and undergone amniocentesis were selected through purposive sampling at the gestational age of 14-20 weeks. After obtaining an informed written consent form, the questionnaires related to the research were filled and the information on NT ultrasound and biochemical screening tests was extracted from the patients’ files. We measured serum levels of folic acid and SOD1 in all participants using the ELISA method. Statistical analysis was done by applying a multivariate logistic regression model by backward strategy. The Hosmer-Lemeshow test was utilized for better goodness of fit for the logistic regression model. In this study, p-value of <0.05 was considered statistically significant.
Results: In our study, 97% of participants consumed folic acid, serum level measurements revealed, 6.9% of participants had low folic acid levels, and 5.6% of Down syndrome positive screenings had a positive karyotype. The mean (SD) serum levels of superoxide dismutase enzyme (SOD-1) measured in the present study in the participants was 297.40 (75.55) U/ml. There were no significant relationship between serum levels of folic acid [odds ratio (OR) (95% CI): 0.125 (0.001 to 31.42); P=0.461] and SOD1 levels [OR (95% CI): 0.99 (0.976 to 1.01); P=0.799] with fetal karyotype results (P>0.05).
Conclusions: These findings demonstrate that serum folic acid and SOD1 concentration is not the predictive markers of Down syndrome karyotype in high-risk pregnant women who have positive Down syndrome screening through a double marker test.

Abstract
Introduction: Workplace bullying is a persistent amount of negative conduct which one individual is subjected to by another, and it is emotionally and psychologically aggravating. Nurses are exposed to a greater risk of bullying, due to their direct contact with patients and their associates. The present study aims to investigate the factor structure of Iranian version of Negative Acts Questionnaire-Revised.
Methods: The present methodological study was conducted amongst 400 nurses working in various hospitals affiliated to the Gorgan University of Medical Sciences, over a three month period in 2017. Construct validity of the questionnaire was assessed, and its reliability was also verified for internal consistency, and construct reliability.
Results: Exploratory factor analysis led to the extraction of the following three factors: Physically intimidating bullying, person-related bullying, and work-related bullying. The model's good fit indices confirmed the workplace bullying in nursing tool as follows: PCFI= 0.767, PNFI= 0.721, CMIN/DF= 2.325, RMSEA= 0.081, AGFI= 0.815, IFI= 0.912, and CFI= 0.918. The convergent validity and discriminant validity of the construct of workplace bullying in nursing as well as its internal consistency and construct reliability (>0.7) were confirmed.
Conclusions: The present study results showed that the three-factor construct of workplace bullying in nursing has good validity and reliability. Given its favorable psychometric properties, this questionnaire can be effective in assessing the incidence rate of workplace bullying in the nursing profession.