The Effect of Self-care Education Based on Self-efficacy Theory, Individual Empowerment Model, and Their Integration on Quality of Life among Menopausal Women.

BACKGROUND: Menopause has adverse physical and emotional effects on the quality of life. The aim of this study was to determine the effect of self-care education based on self-efficacy theory, individual empowerment model, and their integration on the quality of life among menopausal women. METHODS: In this quasi-experimental study, 186 menopausal women, aged 45-60 years at Kashan health centers entered the study using cluster sampling for health centers and simple random sampling inside each center from the list of the population from December 2019 to March 2020. The intervention was performed in 3 groups, using empowerment training, self-efficacy training, and their integration for 4 sessions each lasting 1-1.5 hours of weekly training. Three study groups were selected from different centers to minimize information exchange. Menopausal women's quality-of-life questionnaire was used to assess the quality of life. Questionnaires were completed pre-intervention and one and three months after completing the intervention. SPSS16 software and ANOVA, Chi-square, and repeated measure tests were used. RESULTS: The mean±SD score of quality of life in pre-intervention measurement was 32.96±10.62 in empowerment, 31.93±12.54 in self-efficacy, and 34.07±11.7 in integrated groups. The intervention was effective in improving the quality of life of all three groups (P values were<0.001 for time, 0.92 for group, and 0.38 for time*group interaction). CONCLUSION: This study showed that empowerment and enhancing self-efficacy could improve menopausal women's quality of life. This can help health professionals to better educate postmenopausal women about self-care in menopausal complications.

The relationship between the duration of menstrual bleeding and obesity-related anthropometric indices in students.

BACKGROUND: Many women of childbearing age suffer from problems such as dysmenorrhea and irregular menstruation. OBJECTIVES: The objective of the study is to determine the relationship between the duration of menstrual bleeding and obesity-related anthropometric indices in students. METHODS: This cross-sectional study was carried out on 250 students in 2016. Data were collected by a questionnaire composed of: 1) demographic information, 2) information concerning menstrual cycle and 3) obesity-related anthropometric parameters. Anthropometric parameters include height, weight, waist circumference, hip circumference, and arm circumference. Independent t-test, Pearson correlation coefficient, and multiple linear regressions with backward strategy were used. RESULTS: The average age of students was 21/295 (±1/585) years. For most participants, the duration of menstrual bleeding was 3-7 days (87/2%, 218 people). None of the participants had menstrual bleeding <3 days, and the duration of bleeding was >7 days for 32 participants (12/800%). A significant relationship was observed between the intervals of menstruation and the waist-to-hip ratio (r = 0/136, P < 0/041). Based on multiple linear regression, hip circumference and waist-to-weight, hip-to-waist, arm-to-weight, hip-to-thigh, and arm-to-height ratios are predictors for menstrual duration. CONCLUSIONS: In this study, a significant association was found between the anthropometric indices and menstrual characteristics. These findings suggest the need for modifying anthropometric indicators to control menstrual cycle problems.

The effect of tactile-kinesthetic stimulation on growth indices of healthy neonates.

Therapeutic touch is emphasized by healthcare professionals for improvement of neonates' growth and development. However, inconsistencies exist regarding effects and methods of massage in neonates. The purpose of this clinical trial is to assess and comprise intervention and control groups regarding the effects of tactile-kinesthetic stimulation (TKS) by mothers on growth indices of healthy term neonates. Sixty healthy term neonates were randomly assigned into intervention and control groups. Mothers of neonates in the experimental group were trained to perform TKS for their newborns at home before feeding for at least 28 consecutive days, two times a day, and 15 min each time. Neonates in the control group were not required to receive this intervention. The neonates' growth indices were measured within 24 h after birth, and then at days 14 and 28. During the study and the three consecutive measurements, no significant difference was found between the mean weights, heights, and head circumferences of the neonates in the two groups (p > 0.05).

The effect of acupressure at third liver point on the anxiety level in patients with primary dysmenorrhea.

BACKGROUND: Primary dysmenorrhea may lead to severe anxiety and pain relief during menstruation may reduce the anxiety levels. This study was aimed to determine the effect of acupressure at third liver and placebo points on the anxiety level in patients with primary dysmenorrhea. MATERIALS AND METHODS: This clinical trial was conducted in parallel in the control and treatment groups for three menstrual periods at the dormitory of Kashan University of Medical Sciences between March and June 2012. Students with pain score equal to or greater than 4 were selected and divided into groups based on severity of pain using a randomized block design with the allocation ratio of 1:1. Acupressure was applied in two acupoints including third Liver point (Liv3) and placebo points. Spielberg (STAI) anxiety questionnaire was completed before and after intervention. Randomization, subjects, and data analyzer were blinded to the analysis. Chi-square tests, t-test, Mann-Whitney, paired sample t-test, and univariate analysis of variance were used for statistical analysis. P values <0.05 were considered statistically significant. RESULTS: Mean [standard deviation (SD)] values of apparent anxiety levels before and after intervention for liv3 were 45.100 (9.769) and 38.100 (10.608), respectively. For the control group, they were 41.200 (9.795) and 38.900(10.140), respectively. Difference was significant only in the intervention group (P < 0.001). Hidden anxiety did not show a significant change before and after intervention. There was no difference between groups in apparent or hidden anxiety after intervention. CONCLUSIONS: Pressure on liv3 point reduces anxiety. As there are no previous studies on this topic, further studies with more samples are recommended.

The association of sexual intercourse during pregnancy with labor onset.

BACKGROUND: Pregnancy is one of the most critical periods in women's lives. Sexual relationships change in this period. Monitoring of uterine contractions has been shown increase in uterine activity after sexual intercourse in pregnant women. OBJECTIVES: This study aimed to determine the association of sexual intercourse during pregnancy with labor onset. PATIENTS AND METHODS: This cross-sectional study included 120 pregnant women with signs of labor onset at referral hospitals of Kashan University of Medical Sciences between November and March 2012. Signs of labor onset included labor pain, bloody show, or rupture of membrane. Subjects were investigated in two groups regarding history of coitus in the last week of pregnancy. A questionnaire containing demographic questions, obstetrical history, and sexual activity was completed by trained midwife through face-to-face interview. Chi-square test, Fisher's exact test, and t-test were used to check the homogeneity of the two groups for basic and confounding variables. Independent-samples t-test was used to compare differences between groups in terms of mean gestational age. RESULTS: There was no significant difference between groups in age (P = 0.434), body mass index (P = 0.705), neonatal weight (P = 0.421), maternal education (P = 0.963), occupation (P = 0.381), and parity (P = 0.925). Gestational age at the time of delivery was significantly lower in intercourse group in comparison with control group based on last menstrual period (P = 0.012) and ultrasonography (P = 0.002). There was no correlation between intercourse and cause of admission (P = 0.720). Type of delivery (cesarean section or vaginal delivery) was not affected by intercourse (P = 0.820) or contact with semen (P = 0.841). Results showed no significant difference in neonatal weight based on presence of sexual intercourse (P = 0.422) or contact with semen (P = 0.583) at the last week of pregnancy. CONCLUSIONS: Sexual activity in last week of pregnancy might be associated with the onset of labor. Therefore, in the absence of complications in term pregnancy, sexual activity can be considered as a natural way to prevent post term pregnancy.

The Impact of Postpartum Depression on Quality of Life in Women After Child's Birth.

BACKGROUND: Postpartum depression (PPD) is a common problem after child's birth and may influence the quality of life (QOL). Investigation of postpartum QOL and depression can be useful for better care for mothers and improvement of their well-being. OBJECTIVES: The objective of this study was to assess the life quality in mothers with and without PPD. PATIENTS AND METHODS: In a prospective study, women who had experienced child's birth with and without PPD were recruited in Kashan-Iran. PPD was measured using the Edinburgh Postnatal Depression Scale (EPDS) and QOL was measured by SF-36 questionnaire. Data collection was conducted at two assessment points: second month (n = 321) and fourth month (n = 300) postpartum. Based on EPDS, a score of 13 or more was defined as PPD. Mean scores of SF-36 questionnaire were compared between women with and without PPD at two assessment points and within each group from the first to the second assessments. Moreover, correlation between scores of EPDS and scores of life quality dimensions were evaluated. Data were analyzed by using the Student's t-test, Mann-Whitney U-test, ANOVA, Kruskal-Wallis, Chi-square test, Pair t test, Wilcoxon, Pearson and Spearman Correlation Coefficient. RESULTS: Differences in seven out of eight mean scores of QOL dimensions (except role-physical) between depressed and non-depressed women at the first and the second assessments were significant. Results of changes in mean scores of QOL dimensions from the first to the second assessments in each group showed that non-depressed women scored higher in all of eight dimensions with significant differences in two dimensions (bodily pain and role-emotional as well as mental health component). In depressed women, scores of life quality decreased in some of QOL dimensions but differences were not significant. There were significant negative correlations between EPDS scores and scores of seven out of eight SF-36 sub-scales (except role-physical) in addition to physical and mental health components at two assessments. The highest correlation was found between EPDS scores and emotional well-being and total scores of SF-36 dimension at the first and the second assessments (r = -o.489, r = -0.381), respectively. CONCLUSIONS: The findings demonstrated that postpartum depression leads to a lower life quality at second and fourth months postpartum. Integration of PPD screening into routine postnatal care is recommended.

Effect of mode of delivery on postpartum depression in Iranian women.

AIM: The aim of this study was to determine the relation between mode of delivery (cesarean section [CS] or unassisted vaginal delivery) and postpartum depression (PPD). MATERIAL AND METHODS: In a prospective study, 300 women who had experienced vaginal delivery (VD) or CS were recruited in Kashan, Iran. PPD was measured using the Edinburgh Postnatal Depression Scale (EPDS). A score of 13 or more was defined as PPD. Data collection was conducted at two assessment points: 2 months and 4 months postpartum. Mean scores of EPDS and PPD were compared between the VD and CS groups. RESULTS: Differences in mean scores of EPDS between CS (n = 150) and VD (n = 150) groups at the first and the second assessments were not significant. The depression mean scores differences from the first to the second assessment were compared between the two groups; VD group showed more decrease on EPDS score (P = 0.006). Comparing the two assessments, the VD group showed a more decreased EPDS from the first to the second one. PPD prevalence rates (score ≥ 13) among the VD and CS groups were 24% and 20.7% for the first and 14.7% and 16.7% for the second assessment, respectively, which were not significantly different. The logistic regression showed that an unwanted pregnancy and PPD 2 months after delivery were determinants for PPD 4 months after delivery. CONCLUSION: There was no relation between delivery mode and PPD at 2 and 4 months after delivery; however, the VD group showed greater decrease in EPDS score from 2 to 4 months after delivery.

Investigatingthe effect of pressure on third liver point on primary dysmenorrhea: a randomized controlled clinical trial.

BACKGROUND: Primary dysmenorrhea (PD) is a term used to describe uterine muscle spasms which occurs during the days of menstruation. OBJECTIVES: To determine the effect of acupressure on third liver point on primary dysmenorrhea. PATIENTS AND METHODS: Female students living in dormitories of Kashan University of Medical Sciences in Iran who had PD were studied for three menstrual cycles between March till June 2012. Individuals with depression score higher than 19 according to the Beck-21 Depression scale were excluded. In the first cycle, pain intensity was assessed without intervention, and 67 samples with a pain score greater than 4 according to the visual analogue scale (VAS) were selected. Then they were randomized into third liver point (liv3) and control (placebo) groups using randomized block design with 1:1 allocation ratio based on pain intensity. In the second and third cycles, pressure was applied by the research unit intermittently for 16 minutes (2 minutes pressure, 2 minutes resting) with the starting of blood flow. Primary outcome of this study was the pain intensity which was compared between first and third cycles. Someone who divided groups, samples and data analyzer was blinded. RESULTS: In the treatment group 27 samples and in the control group 32 samples were analyzed. Friedman test showed significant differences in pain intensity before and after the intervention within both groups (P < 0.05). There were no significant differences between the groups according to the ordinal regression test in 3 cycles (P > 0.05). CONCLUSIONS: The pressure on the LIV3 applied in this investigation was effective in reducing primary dysmenorrheal pain. So using this method is recommended to reduce PD.