The relationship between social determinants of health and girls' age at menarche based on the world health organization model: path analysis.

Objectives: Given the descending trend of menarche age and the effect of social determinants of health on menarche, the present study was conducted to examine the relationship model of social determinants of health with menarche age of girls. Materials and methods: The present cross-sectional study enrolled 840 mothers and their 6-17 year-old daughters in the city of Kashan, Iran (2020). Questionnaires used included: demographic-family questionnaire for mothers and daughters, question about age at menarche, Perceived Social Support, Physical Activity, Socioeconomic Status, Spiritual Health, General Health Questionnaire, the quality of couple's relationship and the family communication pattern. The statistical analysis was performed in SPSS-16, and the relationship model was examined using path analysis method in LISREL-8.8. Results: The girls' menarche age was directly affected by sister's (b = 0.83) and mother's menarche age (b = 0.05), BMI (b = 0.01), physical activity (b = -0.06), conversation orientation (b = -0.002), socioeconomic status (b = -0.01) and maternal general health (b = 0.009). It was also indirectly affected by mother's menarche age, social support, socioeconomic status, and maternal spiritual health and parents relationships. Conclusions: The results showed that the numerous factors affect the girls' age at menarche directly and indirectly. Considering mutual interaction of factors revealed in the proposed model, it is recommended this model be used as an appropriate framework in research, design and implementation of programs relating to adolescent girls.

Investigating the effects of volar wrist cock-up splint and dorsal lock wrist hand orthosis in reducing signs of carpal tunnel syndrome.

Background: Carpal tunnel syndrome (CTS) is the most common compressive neuropathy presenting with sharp pain, parenthesis, dysfunction of the hand in coordination and gripping. Splinting is the most common conservative intervention to improve pain and enological symptom of this Syndrome (CTS). With regard to the importance of these interventions and controversies about different designs of splints, the aim of this study was to compare the therapeutic effects of volar wrist cock-up orthosis and dorsal lock wrist hand orthosis on pain, sensory and motor latency in carpal tunnel syndrome. Methods: In this Randomized controlled trial study, 30 patients diagnosed with mild to moderate CTS were recruited. The subjects were randomly divided into two equal groups. Both groups received one form of splints for three weeks. Before receiving the splints, Electromyography (EMG) and Visual analog scale (VAS) were performed. Then, two different designs of splints were used for a period of three weeks. After that, EMG and Numerical Rating Scale (NRS-11) were repeated to reveal the effects of splints on reducing pain, sensory and motor latency in CTS. Independent t and paired t-tests were done uding SPSS software version 19.0. P-value was set at 0.05. Results: All the variables in both groups showed significant improvement. The NRS-11 test was significantly improved in the dorsal lock wrist hand orthosis group (p<0.05). Conclusion: This study showed that the use of the dorsal lock wrist hand orthosis for about three weeks was significantly improved pain and neurological symptoms of patients with CTS because of maintaining the wrist in the neutral position. Knowing this fact helps us to design and make a less cumbersome and restrictive splint with an accurate position for the wrist and distal joints.

Efficacy of different techniques of AFO construction for hemiplegia patients: A systematic review.

Background: Ankle foot orthoses (AFOs) are frequently prescribed to improve gait deviation and normalize walking pattern in patients with drop foot hemiplegia disorder. This study was to review the efficacy of different techniques of AFO construction and biomechanics parameters of AFOs. Furthermore, this study aimed to provide a guideline for researchers in detail and help them choose a sufficient measurement instrument. Methods: Information sources included MEDLINE, CINAHL, Scopus, PubMed, and the Full Cochrane Library up to December 25, 2015. The inclusion criteria include: (1) type and method of controlled clinical trial studies; (2) age of hemiplegia groups (3); AFOs as an intervention; and (4) kinetic and kinematic parameters, and energy expenditure as an intervention of gait performance. Results: Considering eligibility criteria such as study design, setting, time frame and Language 9 papers with Pedro scores of 5 to 8 for methodological quality were included in the review. Conclusion: The findings of this review can help to develop guidelines for the best AFO reporting as an intervention and to prevent vagueness of results in the different types of AFOs.

Health need assessment in female adolescents, in Qom: A cross sectional study.

BACKGROUND AND OBJECTIVE: Due to the young population of Iran, a significant number of teenagers in our country and the importance of the health of adolescents, especially teenage girls who are the mothers and the future-makers of the society, we designed this study to determine the health needs of adolescent girls living in the city of Qom. METHODOLOGY: In this descriptive cross-sectional study, the research population included 853 student girls in the middle and high secondary grades in the city of Qom selected and participated in the study through a randomized multistage cluster sampling method. Data were collected by completing the demographic information questionnaire, and the adolescent girls' health needs questionnaire. Data gathered were analyzed using SPSS software version 19 using the descriptive and inferential statistics. RESULTS: The study results showed that the scores of the adolescent girls' needs in health-related areas are as follows: health: 65.33 ± 22.08, nutrition: 52.81 ± 25.40, exercise and physical activity: 50.10 ± 30.55, social justice: 53.95 ± 23.82, counseling: 49.55 ± 34.97, school status: 52.69 ± 28.01, relationship with parents: 55.10 ± 27.44, social support: 50.64 ± 30.52, education: 51.88 ± 29.61, religious beliefs, and spirituality: 66.88 ± 20.87. CONCLUSION: Based on the results of this study, the adolescent girls have a lot of perceived needs in various areas of health, including psychological-emotional, social, physical, educational, and beliefs areas, which have not been met. Therefore, it is recommended to plan and carry out the necessary measures to meet the needs of adolescents with their participation and relevant authorities.

Development and psychometric evaluation of the sexual knowledge and attitudes scale for premarital couples (SKAS-PC): An exploratory mixed method study.

BACKGROUND: Designing a valid and reliable questionnaire that allows a fair evaluation of sexual knowledge and attitudes and develop a proper sexual educational program is necessary. OBJECTIVE: The present study was designed to develop and psychometric evaluation of the sexual knowledge and attitudes scale for premarital couples. MATERIALS AND METHODS: An exploratory mixed method study was conducted in two phases; in the first, in order to develop a questionnaire an item pool was generated on sexual knowledge and attitudes through focus group discussions and individual interviews. In the second phase, the psychometric properties of the questionnaire were examined. For this purpose, face validity, content validity as well as construct validity were conducted. Reliability was assessed by the Cronbach's alpha coefficient to assess internal consistency and test-retest reliability. RESULTS: In the first phase an item pool with 88 questions was generated (sexual knowledge 45 items and sexual attitudes 43 items). In the second phase, the number of final items reduced to 33 and 34 items of sexual knowledge and sexual attitudes respectively, through exploratory factor analysis (EFA). Five factors for sexual knowledge and six factors for sexual attitudes identified by EFA. The Cronbach's alpha coefficient for two sections was 0.84 and 0.81 respectively. The test- retest correlations for sexual knowledge and sexual attitude was 0.74 and 0.82 respectively. CONCLUSION: The findings suggest that the Sexual Knowledge and Attitudes Scale for Premarital Couples is a valid and reliable instrument. Further studies are needed to establish stronger psychometric properties for the questionnaire.

Intratumoral and Peritumoral Mast Cells in Malignant Melanoma: An Immunohistochemical Study.

BACKGROUND: The aim of the current study was to determine mast cell infiltration in malignant melanoma by immunohistochemistry method and its relationship with some of the cancer prognostic factors, including age, sex, and depth of the tumor. MATERIALS AND METHODS: In this retrospective analytic cross-sectional study, paraffin-embedded tissue blocks of patients with cutaneous malignant melanoma who had undergone excisional biopsy were studied. Mast cells count in studied cases in different stages of the tumor depth was evaluated by mast cell tryptase immunohistochemistry method. Mast cells infiltration was evaluated both inside the tumor and peritumoral area. Tumor infiltrating lymphocytes (TILs) was also determined. Distribution of intratumoral and peritumoral mast cells and TILs was compared in different stages tof tumor depth. RESULTS: In this study, 51 cases with melanoma were studied. Mean ± standard deviation (SD) of intratumoral mast cells in stages 1, 2, and 3 was 9.4 ± 4.2, 10.8 ± 5.1, and 2.1 ± 2.3, respectively (P = 0.000). Mean ± SD of peritumoral mast cells in stages 1, 2 and 3 was 13.4 ± 2.4, 16.6 ± 2.4 and 8.2 ± 4.6, respectively (P = 0.000). There was a significant direct relationship between depth of the tumor and TIL (P = 0.000) and distribution of intratumoral (P = 0.000) and peritumoral mast cells (P = 0.000). CONCLUSION: Lower distribution of intratumoral and peritumoral mast cells and TILs in higher stages of tumor depth in malignant melanoma suggests a possible inhibitory effect of infiltrating mast cells and lymphocytes on the progression of this tumor.

Exploring the concept of continuous midwifery-led care and its dimensions in the prenatal, perinatal, and postnatal periods in Iran (Kashan).

AIM: to explore the concept of continuous care and its dimensions in the prenatal, perinatal, and postnatal periods based on the experiences of midwives, gynaecologists, obstetricians, pregnant women and their husbands. DESIGN: a qualitative study that was part of a large scale action research which aimed to develop, use and test a continuous midwifery-led care model. Data collection and analysis were performed concurrently through undertaking semi-structured interviews and using the conventional content analysis approach. SETTING: healthcare centres and hospitals affiliated to Kashan University of Medical Sciences, Kashan, Iran. PARTICIPANTS: 21 women following a recent pregnancy, five husbands, 18 midwives, and five physicians who had different official positions. FINDINGS: the participants' experiences revealed five concepts for continuous midwifery-led care which included continuity, the process of care, education and informing, management, and professionalism. Each of these five concepts consisted of several categories. CONCLUSION AND IMPLICATION FOR PRACTICE: according to the study participants, continuous midwifery-led prenatal, perinatal, and postnatal care is a multidimensional and important concept. Given the differences in the health infrastructures of different countries as well as the unique characteristics of pregnancy, higher priorities are recommended to be given to continuous midwifery-led care and its dimensions.

Footprint as an alternative to X-ray in hallux valgus angle measurement.

Background: X- ray images provide accurate and reliable data in different foot pathologies. However, the accompanied complications will limit its use for epidemiological studies and research purposes, especially in children. Therefore, simple, accessible, and cost- effective methods such as footprint, with a good correlation with x-ray images, are needed to help diagnose different foot pathologies. In the present study, the accuracy of footprint technique in assessing hallux valgus angle (HVA) was evaluated based on x-ray images through measuring the angle between the medial border protrusion of the foot and the hallux. Methods: In this cross-sectional study, 42 participants with symptomatic hallux valgus were recruited. HVA was measured by both x-ray imaging and footprint. The differences between the two approaches were identified by applying correlation-coefficient test and reliability, which was assessed using interclass correlation (ICC). Results: A significant correlation was found between the HVA measured by x-ray and HVA by footprints (p< 0.001), and the ICC was upper than 90%. Conclusion: Foot print is a reliable method for measuring HVA, as it was highly correlated with the HVAs obtained by x-ray imaging.

Signet ring carcinoma of ampulla of vater.

Signet ring carcinoma is a common type of adenocarcinoma of stomach but its occurrence in ampulla of Vater is extremely rare. There are only a few previous reported cases of signet ring carcinoma of ampulla of Vater. Here we reported a 61-year-old woman with obstructive jaundice. Ultrasonography and computed tomography (CT scan) examination showed intra- and extrahepatic bile duct dilatation. Endoscopic examination with biopsies revealed a small-size mass in ampulla of Vater with diagnosis of signet ring carcinoma. On consequent pancreatoduodenectomy the tumor was diagnosed as T2N0M0, stage IB. Because of the specific site of signet ring carcinoma of ampulla of Vater, the tumor seems to present itself at an early stage of disease. We review in the literature to suggest our idea.

Iranian obstetricians' views about the factors that influence pregnant women's choice of delivery method: a qualitative study.

BACKGROUND: Caesarean section is a commonly performed childbirth procedure. While caesarean section is undeniably a lifesaving procedure for some mothers and babies, it can also be an unnecessary procedure for others. Different factors may be involved in the rate of birth by caesarean section. QUESTION: This qualitative study was conducted in Kashan city, Iran, to explore obstetrician's views of what might influence pregnant women's choice of delivery method. METHODS: Obstetricians' views and experiences were collected using semi-structured interviews. Interviews were conducted in a clinic or hospital, based on the preference of the 18 physicians who agreed to participate in the study. All interviews were recorded and transcribed. Participants were asked key questions, including: "Why do some women prefer caesarean section?"; "What kind of delivery did you have and why?"; "What kind of delivery would you recommend to pregnant women and why?" Inductive qualitative content analysis was undertaken using the method described by Morreti with 120 initial codes categorized into six categories. FINDINGS: The six categories developed from the initial codes were: factors relating to women, obstetricians, delivery conditions, complications, society's beliefs and the health system. CONCLUSION: A qualitative study conducted in Iran showed that most of the factors identified by participants facilitated the choice of caesarean section. Vaginal birth was anticipated as a painful and lengthy process, with low cultural acceptance and resulting in less income for obstetricians.

Relationship between quality of life and depression in pregnant women.

BACKGROUND: Quality of life differs for different people in different situations and is related to one's self-satisfaction with life. Quality of life is affected by health status. OBJECTIVES: The current study examined the relationship between quality of life and depression in pregnant women in Kashan city. PATIENTS AND METHODS: A Case - control study was performed on 112 depressed pregnant women (Case Group) and 353 Non-depressed pregnant women (Control Group) who referred to the prenatal health care centers of Kashan University of Medical Sciences .They completed Short Form 36 Health Survey (SF-36) to assess the quality of life and the Beck Depression Inventory to assess the level of depressive symptoms. T-test, chi-square and Pearson correlation coefficient statistical tests were used for data analysis. RESULTS: The findings showed that there was an inverse relationship between quality of life and depression in pregnancy (P = 0.0001). Average scores in all eight domains of quality of life were significantly lower in depressed pregnant women compared to non- depressed women. The strongest relationship was observed between depression and vitality (r =-0.52, P = 0.0001), mental health (r = -0.50, P = 0.001) and social functioning (r =-0.38, P = 0.001). CONCLUSION: Depressed pregnant women had a lower quality of life. The proper management of depression during pregnancy can improve the quality of life in women. It is recommended that antenatal services integrate screening for depression into routine antenatal care.