Prevalence and Risk Factors of Urinary/Anal Incontinence and Pelvic Organ Prolapse in Healthy Middle-Aged Iranian Women

Objectives@#Urinary incontinence (UI) and anal incontinence (AI) cause concern, social exclusion, and ultimately reduced quality of life in women. The aim of present study was to assess the prevalence and related risk factors of UI, AI, and pelvic organ prolapse (POP). @*Methods@#The present study recruited 340 menopausal women living in Tabriz in northwest Iran. The data collection tools included the Pelvic Floor Distress Inventory-20 and a personal and social information questionnaire. POP was diagnosed via clinical examination using the simplified pelvic organ prolapse quantification system. @*Results@#The prevalence of UI and POP was approximately 50%, and approximately 16% of participants reported AI. Based on the odds ratios, the most remarkable risk factor of urinary stress incontinence was the number of vaginal deliveries, whereas that of urinary urge incontinence was obesity. Episiotomy and age were the most major risk factors of AI and POP, respectively. @*Conclusions@#The results of the present study showed that the prevalence of POP, UI, and AI is remarkably high among postmenopausal women, warranting the need to prioritize the assessment of POP and various incontinences in middle-aged women in the primary health care system. Furthermore, increased emphasis should be put on modifiable risk factors.

Practice of Iranian adolescent girls regarding puberty and menstrual hygiene and its predictors, 2013

Adolescence is a unique period in life cycle. During this period, adolescents face with many behavioural challenges. This study aimed to determine adolescent girls' practice regarding puberty and menstrual hygiene, as well as its relationship with socio-demographic characteristics. This cross-sectional study was conducted on 1017 female students who were studying at second and third grade of secondary schools in Tabriz, 2013. Samples were selected randomly. Questionnaires used in the study were the practice and socio-demographic questionnaires. General linear model was used to determine predictors of practice. Mean [SD] of practice score in adolescent girls was 64.2 [12.1] from attainable score of 0-100. More than half of students [56.7%] had moderate practice. According to adjusted general liner model, variables of being in second class, having a father with elementary education or illiterate, living in undesirable economic status, having peer groups and friends as main source of information, having insufficient information about puberty had negative relationships with practice score. While, there was a positive relationship between age at menarche and practice score [P<0.05]. The findings show that the practice of adolescents about puberty and menstrual hygiene is moderate. Thus, it is necessary to educate the girls about puberty and menstrual hygiene to enable them to have a healthy reproductive life in future

Effect of Hypericum perforatum L. compared with metronidazole in bacterial vaginosis: A double-blind randomized trial

Objective: To compare effect of Hypericum perforatum (H. perforatum) vaginal gel with metronidazole on bacterial vaginosis (BV) in terms of initial response to treatment and preventing recurrence (primary outcomes) and also patient complaints (secondary outcomes). Methods: In this double-blind, double dummy trial, married women aged 18-49 with BV were randomized into two groups and administered 5 g of 3% H. perforatum and placebo of metronidazole (n=82), or 5 g of 0.75% metronidazole and placebo of H. perforatum (n=80) vaginally for 5 d. Amsel criteria were used for diagnosis and assessing cure and recurrence of BV. The comparisons was done using Chi-square, Fisher's exact and logistic regression. Results: At 10-12 d, cure rate was 82% in the H. perforatum and 85% in metronidazole group (risk ratio 0.9, 95% confidence interval 0.6 to 1.3). Among the cured women, recurrence rate was 9% in the H. perforatum and 13% in the metronidazole group at the 30-35 d visit (risk ratio 0.8, 95% confidence interval 0.4 to 1.3). There was no statistically significant difference between the groups regarding any patient complaints, except itching which was less in H. perforatum group (5% vs. 16%, P=0.018 at the first and 13% vs. 43%, P < 0.001 at the second follow-up). No significant adverse event was reported at any groups. Conclusions: H. perforatum could be a good option for treatment of BV. However, further studies are needed for its public use.

Effects of cinnamon on perineal pain and healing of episiotomy: a randomized placebo-controlled trial / 中西医结合学报

<p><b>BACKGROUND</b>Analgesic and wound-healing effects of cinnamon, a widely used spice, have been shown in laboratory rats. However, we found no human studies in this area.</p><p><b>OBJECTIVE</b>The aim of this study was to assess the effect of cinnamon on perineal pain and healing of episiotomy incision.</p><p><b>DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS</b>In this double-blind, randomized, placebo-controlled trial, 144 postpartum women were allocated into two groups, using stratified block randomization, 1 h after completion of episiotomy repair. They received cinnamon or placebo ointment, 2 mL every 12 h for 10 d.</p><p><b>MAIN OUTCOME MEASURES</b>Perineal pain and wound healing were assessed using visual analogue scale (0-10) and Redness, Edema, Ecchymosis, Discharge, Approximation scale (0-15), respectively. General linear model was used to compare the groups on the outcomes adjusted for baseline values and stratified factors.</p><p><b>RESULTS</b>Follow-up rate was 100% up to the 8 h time point in both groups, and 86% (62 of 72) in the cinnamon group and 85% (61 of 72) in the placebo group at day 10-11 after delivery. Pain score in the cinnamon group was significantly lower than that in the placebo group at (4±1) h (adjusted difference: -0.6, 95% confidence interval: -1.0 to -0.2) and (8±1) h (-0.9, -1.4 to -0.3) after intervention, and on the 10-11th day after delivery (-1.4, -2.0 to -0.7). Also the cinnamon group showed significantly more improvement than the control group in healing score at (8±1) h (-0.2, -0.4 to -0.04) and the 10-11th day after delivery (-1.6, -2.0 to -1.1).</p><p><b>CONCLUSION</b>Cinnamon can be used for reducing perineal pain and improving healing of episiotomy incision.</p>

Effect of cervical wiping with sterile cotton on the quality of pap-smear

There are conflicting reports about the effect of wiping cervix with cotton on Pap-smear results. Therefore, we aimed to do a research about this subject. 234 eligible women attended to have Pap-smear at an educational hospital in Rasht, Iran, from July to September 2011, were allocated by block randomization into two groups. In the intervention group, we cleaned cervix with a sterile cotton rotating 360 degrees and obtained samples using spatula for exocervix and cytobrush for endocervix. This method was performed without cleaning the cervix on the control group. Data collection, vulvovaginal examination, laboratory assay were done by investigators masked to the group allocation. Participants were also blind. The data were analyzed using logistic regression in SPSS-13. Rate of sufficient endocervical cell of the slides in the intervention group was significantly higher than in the control group [70.3% vs. 57.8%, p=0.03]. In the intervention group 42.4% of the slides were satisfactory and 57.6% had limited quality for interpretation. These figures in the control group were 37.1% and 62.9%, respectively. This difference was not statistically significant. Also, there was no significant difference between the groups on rate of slides with inadequacy of squamous cells and obscuring 75% or more of the slides with inflammatory exudate or blood [p>0.05]. There were no significant differences between the groups on some quality indicators of the smears. However, frequency of smears with sufficient endocervical cells was higher in the group with cervical wipping. Therefore, it is recommended to clean cervix before obtaining the smears

Facilitators and inhibitors of health promoting behaviors: the experience of Iranian women of reproductive age

There is scant information on the facilitators and inhibitors of health promoting behaviors among reproductive aged Iranian women. This study aims to explore the experience of factors influencing health promoting behaviors among Iranian women of reproductive age from a qualitative perspective. This study was performed in Tehran in 2011, over about 8 months. Qualitative methods, specifically in depth interviews, were used to gather data on 15 women of reproductive age. Data continued to be collected until introduction of new information ceased. The interviews were recorded, transcribed verbatim, and analyzed by conventional content analysis. The reported factors were categorized into four main groups and 12 subgroups: [1] personal barriers [lack of time, school or work duties, lack of preparation or motivation, physical disability]; [2] socio environmental barriers [family responsibilities, environmental pressures, high costs and financial pressures]; [3] personal facilitators [personal interest and motivation, experience of disease]; and [4] socio environmental facilitators [family and social support networks, encouraging and motivating environment, media, and public education]. In these women's experience, factors influencing health promoting behaviors were either facilitators or inhibitors; most were inhibitors. The findings of this study show that, in addition to personal factors, the pursuit of health promoting behaviors is affected by socio environmental factors. These results will be useful in designing interventions and plans for women's health promotion that focus on the improvement of their environment and the modification of social factors

Knowledge, attitudes and practice about Pap smear among women reffering to a public hospital

The Pap smear is a reliable, inexpensive and effective screening test for cervical cancer; the second most common cancer among women worldwide. We aimed to determine women's knowledge, attitudes and practice towards Pap smear and barriers for the screening in a public hospital. This study, was carried out on 350 outpatient married women reffering for a visit at the clinics of the Alzahra educational hospital, Rasht- Iran, 2011. A questionnaire including demographic characteristics [24 questions], knowledge [14 questions], attitudes [11 statments] and practice [10 questions] towards Pap smear was completed by interview with the women. The data were analyzed using SPSS ver.13. Mean age of participants was 32 [SD 12] years. Of the respondents, only 44.3% were aware of the Pap smear and 27.1% had had it at least once in their life. The most common reason for having the test was physicians' or other health workers' advise and for not having the test was no recommendation by health providers and lack of knowledge about Pap smear. Embarrassing, fear of the test result or economic problems mentioned by only 12 [4.2%] as the main barrier. Mean [+/- SD] knowledge score of the women who had heard about the Pap smear was 59.4 [24.3] and attitudes score of all participants was 48.5 [11.6] from possible range score of 0-100. Women with a history of Pap smear had had higher awareness and attitudes score. The knowledge and practice of the women was inadequate and need to be promoted. Considering the main reason mentioned by the participants for not having the test, all health providers should educate and encourage women to do regular Pap smear

Prevalence of water pipe use and its correlates in Iranian women of reproductive age in Tehran: a population-based study

The objective of this study was to determine the prevalence of water pipe smoking and its associated sociodemographic factors among Iranian women of reproductive age in Tehran. This was a population-based cross-sectional study of 1,359 Iranian women aged 15-49 years. The multistage random cluster technique was used to obtain the sample. Questionnaire-based interviews with questions relating to water pipe smoking and sociodemographic variables were used to collect the data. The multivariate logistic regression model was used to analyze the relationships between the dependent variable [water pipe smoking] and the independent variables [sociodemographic characteristics]. The prevalence of water pipe smoking was 6.3% among Iranian women. Water pipe smoking was more likely in the age range of 15-24 years [odds ratio [OR] = 4.8, 95% confidence interval [95% CI] = 2.7-8.6] compared to the age range of 35 years or older, in women with a university education [OR = 1.9, 95% CI = 1.3-3.0] compared to women with a high-school diploma or lower, and in women with an average crowding index score [OR = 4.7, 95% CI = 2.1-10.6] compared to women living in small families. The findings of this study show that Iranian women with a university education and the younger age group [15-24 years] were at most risk of water pipe smoking. The findings of this study about associated factors may contribute to the development of efficient health promotion programmes for the prevention and cessation of water pipe smoking

Comparison of continuation rates and reasons of discontinuation for cyclofem and depot -medroxyprogesterone acetate in rural areas of east Azerbaijan province, Iran

In this study continuation rate and reasons for discontinuation of Depot-medroxyprogestrone acetate [DMPA]and Cyclofem have been compared. A retrospective cohort study was conducted with 422 women [202 Cyclofemand 220 DMPA users]who had started using the methods 12-24 months before the study in East Azerbaijan health houses. Data were collected by reviewing the records and interview with the clients and analysed using Kaplan-Meier and Cox Regression. The 3, 6, 9, 12 months continuation rate were 56%, 37%, 30%, 27% respectively for Cyclofem versus 75%, 59.5%, 48%, 42.5% for DMPA. Menstrual changes were reported significantly more by the DMPA users than the Cyclofem users [85% vs. 73%, P=0.008] as the main reason for the discontinuation, the difference mainly reflected of amenorrhea [50% vs. 23%, P=0.003]. None of DMPA users and 11% of Cyclofem users claimed frequency of visits and lack of method supplies as their main discontinuation reason. Discontinuation rate was high for the both methods but it was higher for Cyclofem. The common side effects mentioned as the main reasons for discontinuation of the both methods are not health threatening. Therefore, health care providers may help to improve their continuation rate by appropriate consultation

Effectiveness of Transcutaneous Electrical Nerve Stimulation [TENS] on the post cesarean section pain

Transcutaneous electrical nerve stimulation [TENS] has been a non-chemical effective method in reducing pain. The mechanism of TENS is not clear but gate control theory may explain it. The purpose of this study was to evaluate the analgesic effect of TENS on the post cesarean section pain. In a randomized clinical trial, in the year 2006, at Oncology Ward of Kerman Afzalipur Hospital 72 women with cesarean delivery, participated in this study and were assigned randomly to two groups. For the TENS group [36 patients] TENS was applied and for the control group [36 patients], placebo TENS. Intensity of pain before and after interventions was assessed by visual analogue scale [VAS]. Also the first request of analgesic by the patient was compared between the two groups. The individual, and VAS results were collected in a questionnaire, analyzed by SPSS, and statistical tests The mean scores of pain for TENS group and control group were 3.78 +/- 1.72 and 6.61 +/- 2.11 respectively [p=0.0001]. There was a significant statistical difference [p=0.0001], between the different mean scores for TENS group [2.25] and control group [0.22]. Reducing pain in the TENS group and control group were 91% and16.6% respectively]p=0.0001].This study demonstrated that, using the postoperative TENS can reduce the intensity of pain and it can also, be an effective and safe method in controlling the pain of patients with cesarean section

[ attitudes of Kerman university of medical sciences interns toward the adequacy of received trainings in achieving the approved educational goals in obstetricsand gynecology ward]

Students as the major part of education are one of the best sources of information in each educationalsystem. One of the uses of this source of information is studying the achievement of educational goals.To determine the adequacy rate of presented trainings in achieving educational goals of Obstetrics and Gynecology ward from the point of view of interns.All interns of Kerman University of Medical Sciences in 2005- 2006 including 93 ones were enrolled into thestudy. Data gathering was done by using a questionnaire including the subjects of training materials in Obstetrics and Gynecology ward. Participants were asked to determine the adequacy of presented trainings for each subject.From 93 interns, 63.7% were female, 71.1% were single and 52.2% have started their medical educationprogram before 2000. Mean age of participants was 25.7 +/- 2 years. From all, 46.6% have seen the approved program ofObstetrics and Gynecology ward and 52.9% asserted that they had been informed of the educational goals at the beginningof the course. The highest adequacy rates were obtained for determining gestational age and estimated delivery datebased on LMP [90.7%], fetal heart rate controlling [87.3%] and prenatal cares [81.6%], while the lowest adequacy rateswere related to inserting and removing Norplant [respectively 16.8% and 16.2%] and inserting IUD [19.8%]. Mean totalpercentage of training adequacy in two domains of diagnosis and therapeutic activities and emergency activities showed nosignificant difference based on age, year of enrolling, marital statue and sex. Mean total score of training adequacy indiagnostic and therapeutic domain including 31 cases was 55.8 +/- 14.3 and in emergency activities including 8 cases, it was 51.23 +/- 2.1 that shows a significant difference [P= 0.002].From the point of view of studied interns, based on the approved educational goals, presented trainings in Obstetrics and Gynecology ward had not been adequate. Therefore improving the quality of clinical training and its continuous evaluation in order to make it compatible with educational goals and changing needs of community is necessary

[Motivational factors affecting educational performance from the point of view of faculty members]

Human beings behavior and activities are the result of their needs and motives. Managers byrecognizing and predicting these items and on time satisfaction of them can benefit from the work force in achieving organizational goals more efficiently.To determine motivational factors affecting educational performance from the point of view offaculty members in Kerman University of Medical Sciences.All faculty members of Kerman University of Medical Sciences [308 ones] were participated in thisdescriptive study. Data collection was done by a researcher-made questionnaire confirmed in regard to validityand reliability.According to the obtained results, male faculty members [85.6%] and those over 40 years old[54.5%] had the highest percents. In regard to the academic rank, the highest percent was related to instructors[43.7%] and assistant professors [43.7%]. Those with 11-20 years job experience had the highest percent[42.4%]. In external motives, the highest mean scores were related to "availability of conditions for improvingthe level of knowledge and information [X= 4.40, SD= 0.62]" and "job security [X=4.55, SD= 0.69]" and ininternal motives "inherent interest in teaching [X- 4.55, SD= 0.69]" and "being orderly [X= 4.40, SD= 0.79]"had the highest percents.External and internal motives both affect the performance of faculty members and consequentlythe quality of academic activities in universities

[Impact of health education on the knowledge and practice of 3rd grade guidance school girls of shahrbaback in relation to mensturation health in 2003]

Background: Adolescence is accompanied with deep psychological, physiological and social changes. Girl's lack of awareness about this period, could form the basis of many physical and behavioral problems. Planned health education programs, carried out to develop required skills and abilities leave clear impression on the manner the youth handles these changes

Objective: The aim of this study was determining the impact of health education on the knowledge and practice of 3rd grade guidance school girls of Shahrbabak city [Kerman/Iran] in relation to the health of menstruation

Methods: The present study is a quasi experimental [before-after] in which 200 Subjects were chosen by multi-stage random sampling method. Data collection was carried out through a questionnaire containing 23 questions divided into two parts of knowledge and practice. After determining the validity and reliability, questionnaires were distributed among subjects [pre-test]. Final testing [post-test] was administered after training courses

Results: : Findings of the pre test stage represented weak knowledge and practice of the students concerning health of menstruation and there was significant increase in mean scores of knowledge [from 5.8 [41.4%] to 12.7 [90.7%]] and practice [from 23.7 [65.8%] to 28.3 [78.6%]] after training program [P<0.0001]. Mean scores of practice before and after training course showed significant difference based on family size and source of information [P<0.05]. The least difference of mean score [2.17] was related to students with the greatest family size [>8]. In regard to the source of information the highest difference between mean scores of before and after training [6] was related to the students who reported their friends and teachers as their source of information

Conclusion: According to the findings showing significant increase in knowledge and practice mean scores in post-test stage, designing regular and continuous educational programs concerning the problems of girls maturity period, specially health of menstruation is recommended. It is obvious that girls' knowledge in this respect is not only their natural right but also one of the health program priorities