Menarche age and the risk of diabetes: A cross-sectional study in South-Eastern Iran.

Background and Aims: Diabetes is a major public health problem worldwide. This study aimed to determine the relationship between menarche age and overt diabetes in southeast Iran. Methods: This cross-sectional study was conducted on 6094 eligible women between the ages of 35 and 70 participating in the Zahedan Adult Cohort Study. Demographic and background data, fertility, anthropometry, and disease history were collected based on a questionnaire. Menarche age was classified into five categories (under 12 years, 12, 13, 14, 15 years and more). Diabetes is defined as a blood sugar of 126 or more according to the definition by the American Diabetes Association. Data analysis was done using SPSS 26 software. Descriptive analysis was performed with frequency, percentage, mean, and standard deviation; and analytical analysis using chi-square and logistic regression tests. The significance level in this study was p < 0.05. Results: The participants' mean age was 49.41 ± 8.88, and the mean age at menarche was 13 ± 1.49. 22.8% (1389 women) of participants with diabetes and 77.2% (4705 women) did not have diabetes. The findings showed that the chance of developing diabetes in women with a menarche age <12 years was significantly higher than in women with a menarche age of 13 years (reference) (OR = 1.23, 95% CI: 0.96, 1.51). This relationship was significant after adjusting variables such as body mass index, education level, fertility factors, history of diabetes, and reproductive diabetes (OR = 1.21, 95% CI: 0.90, 1.44, p = 0.04). Conclusion: Our findings suggest that young age at menarche may be a risk factor for diabetes in adulthood. Further prospective studies are needed to confirm our findings. However, it is suggested to pay attention to it in diabetes screening so that, if possible, by identifying people at risk and implementing prevention programs, the adverse consequences of diabetes can be reduced.

Effect of mindfulness on sexual self-efficacy and sexual satisfaction among Iranian postmenopausal women: a quasi-experimental study.

Background: Menopause with anatomical, physiological, and psychological changes can affect sexual satisfaction and consequently the quality of life. Aims: The study sought to evaluate the effects of mindfulness-based counseling on sexual self-efficacy and sexual satisfaction among Iranian postmenopausal women. Methods: This quasi-experimental study was conducted on 110 women who were assigned to an intervention group (n = 55) and a control group (n = 55). The intervention group received 8 sessions of mindfulness-based training and daily mindfulness exercises. Data collection tools included questionnaires of demographics and midwifery, sexual self-efficacy, and sexual satisfaction. They were completed before and 8 weeks after the intervention. The collected data were analyzed through a t test, a chi-square test, and repeated-measures analysis of variance. Outcomes: Changes in sexual self-efficacy and sexual satisfaction scores were evaluated. Results: The mindfulness-based intervention significantly improved sexual self-efficacy (F = 146.98, P = .000, ƞ2 = 0.576) and sexual satisfaction (F = 129.47, P = .000, ƞ2 = 0.545) over time. The mean scores of sexual self-efficacy (17.03 ± 2.08) and sexual satisfaction (87.94 ± 8.26) in the intervention group increased after the intervention as opposed to the mean scores of sexual self-efficacy (12.65 ± 1.70) and sexual satisfaction (76.61 ± 6.45) in the control group. Clinical Implications: Mindfulness training can improve sexual self-efficacy and sexual satisfaction in postmenopausal women. Strengths and Limitations: The intervention was implemented on a population of menopausal women in a culture in which the expression of sexual issues is taboo and has not been noticed in the past. The main limitation of this study was self-reporting, which may have affected the responses. The next limitation was the nonrandomized controlled design. Finally, the research sample included menopausal women who were heterosexual and married. Hence, the findings may not be generalizable to more diverse samples. In this study, psychological maladjustment or psychological distress was not analyzed. They should also be considered in future research. Conclusion: According to the results, it is advisable to employ mindfulness-based intervention in routine care, because it can improve different aspects of menopausal women's life.

Effect of mindfulness on sexual self-esteem and marital intimacy in postmenopausal women: a quasi-experimental study.

BACKGROUND: Menopause is a turning point in women's lives and a major medical challenge, leading to drastic changes in sexual self-esteem and the husband-wife relationship, which can have an undeniable impact on the quality of their life. AIM: To assess the effect of mindfulness-based education on sexual self-esteem and marital intimacy in postmenopausal women. METHODS: This quasi-experimental study was conducted with 130 women who were assigned to 2 groups, intervention (n = 65) and control (n = 65), out of whom 127 completed the study. The interventional group received 8 training sessions. The mindfulness-based intervention consisted of 8 educational sessions and daily mindfulness exercises. Sexual self-esteem was assessed by the Sexual Self-esteem Index for Woman-Short Form, and marital intimacy was measured with Thompson and Walker's Intimacy Scale. The collected data were analyzed via analysis of covariance. OUTCOMES: Outcomes included changes in sexual self-esteem and marital intimacy scores. RESULTS: Participants in the intervention group demonstrated higher levels of total self-esteem posttreatment than participants in the control group (125.15 vs 119.46) and higher levels of intimacy (74.22 vs 61.59). The difference was still significant after adjusting for self-esteem (η2 = 0.312, P < .001) and intimacy (η2 = 0.573, P < .001) at baseline. CLINICAL IMPLICATIONS: Mindfulness may be used as a strategy to improve sexual self-esteem and marital intimacy. STRENGTHS AND LIMITATIONS: Unlike other treatments, mindfulness seems to be low cost and less complex in improving sexual self-esteem and marital intimacy. Limitations of this study include use of available sampling methods, nonrandom allocation of participants, and self-reporting data collection. CONCLUSION: As evidenced by the results, 8 weeks of mindfulness training could improve sexual self-esteem and marital intimacy in menopausal women. The mindfulness-based intervention should be incorporated into routine care to help menopausal women.

Health-promoting behaviors and intermediary social determinants of health in low and high-risk pregnant women: an unmatched case-control study.

BACKGROUND: High-risk pregnancies require increased health and care resources to reduce the severe perinatal consequences. The adoption of a health-promoting lifestyle and social determinants is an important strategy for achieving the desired outcomes of pregnancy. This study aimed to compare intermediate determinants of social health in low and high-risk pregnant women. METHODS: This unmatched case-control study was performed with a ratio of 1: 2 and 300 pregnant women including 200 healthy and 100 pregnant women with gestational hypertension were included using the available sampling technique. Data were collected using socio-demographic and obstetrics, Health-promoting behaviors, Self-efficacy, Perceived stress, and Social support questionnaires by the self-report method. RESULTS: There was no significant difference in the demographic characteristics between the two groups, except for the spouse's education status. The total score of health-promoting behaviors and social support in the healthy group was significantly higher than women with gestational hypertension. However, the perceived stress in women with gestational hypertension was significantly higher than in the healthy group. In the multivariate analysis, those women with high stress [AOR 1.13, 95% CI (1.08-1.18)] and whose Spouse's Educational status was low [AOR 4.94, 95% CI (1.54-15.81)] had higher odds of gestational hypertension than women who haven't respectively. The development of gestational hypertension was decreased by increasing the score of social support [AOR 0.96, 95% CI (0.93-0.98)]. The results showed that the two variables of social support (ß=0.331) and self-efficacy (ß=0.215) have the greatest impact on the score of health-promotion behaviors, respectively. Based on regression analysis, 21.2% of the health-promotion behaviors changes could be explained by three independent variables. CONCLUSION: Women with gestational hypertension have unhealthier lifestyles. Having a high level of stress is a risk factor for gestational hypertension but Social support has a protective effect on it. Recognizing the risk factors of gestational hypertension could help the determination of high-risk cases and it is important to pay attention to women's psychosocial to create appropriate sources of social support and provide the necessary action to reduce stress.

Association between perceived stress, fear and anxiety of COVID 19 with self-care in pregnant women: a cross-sectional study.

Pandemic COVID-19 has negative effects on the mental health of all people, especially pregnant women. This study aimed to determine the psychological effects of COVID-19 on self-care in pregnant women. The Cross-sectional study using the Multistage sampling technique was conducted among 215 pregnant women selected randomly from the Iranian Integrated Health System in 2020. Data were collected using demographic and obstetrics questionnaires, Pregnancy Self-Care Scale, Fear of COVID-19, COVID-19 Anxiety Scale(CDAS), and Perceived Stress Scale (PSS) by the self-report method. Data analysis was performed using SPSS software version 21 with Pearson correlation test and multivariable linear regression.The Mean (Standard Deviation (SD)) of Fear, anxiety, perceived stress, and self-care was 20.85(6.45), 18.20(10.45), 31.16 (7.65) and 40.84(4.11), respectively. The correlational analyses showed small positive significant associations between Fear (r=0.20; P=0.004) and anxiety of COVID-19 (r=0.14; P=0.03)with self-car but the association between perceived stress and self-care was small negative significant (r= -0.14; P=0.04). Based on regression analysis, 11% of the self-care changes could be explained by three independent variables (ß= 0.130, SE= 0.043, P=0.002). Based on the findings, pregnant women may benefit from psychoeducation that focuses on the effect of mental health problems on pregnant women.

Association Between Awareness, Perceived Severity, and Behavioral Control of COVID -19 With Self-Care and Anxiety in Pregnancy: A Cross-Sectional Study.

COVID-19 pandemic has caused a tidal wave of anxiety and stress among Iranians, especially pregnant women. This study aimed to assess the association between knowledge, perceived severity, and controllability of COVID-19 with self-care and health anxiety specially in pregnancy. This cross-sectional study was performed on 440 pregnant women. Data were collected using demographic-obstetrics characteristics, as well as the questionnaires of knowledge, perceived severity, and perceived controllability of the COVID-19, health anxiety, and self-care. Self-care was positively correlated with knowledge, perceived severity, and perceived controllability of the COVID-19. Nonetheless, health anxiety had a significant and inverse association with knowledge and perceived controllability, while there was a positive and significant correlation between perceived severity and health anxiety. Based on linear regression, three variables of knowledge, perceived severity, and perceived controllability of the COVID-19 could explain 46.3 and 17.5% of variations in self-care and health anxiety, respectively. It is suggested that due to the critical importance of prenatal care, managers, and health-care providers promote the use of such methods as telehealth and home-based caregivers, especially in areas with inadequate access to health care. So, the pregnant women can be followed up and receive medical care devoid of any stress and anxiety.

Promotion of osteoporosis-preventive behaviors in adolescents: Application of protection motivation theory.

BACKGROUND: Osteoporosis is considered a health problem that can be simply prevented by lifestyle modifications in adolescence. Therefore, this study was conducted to investigate the effects of protection motivation theory (PMT)-based training on osteoporosis-preventive behaviors in female high school students in Zahedan, Iran. MATERIALS AND METHODS: The present quasi-experimental study was performed on 240 female high school students who were selected by a multistage sampling technique in Zahedan in 2019-2020. To collect the data, a multipart questionnaire was distributed among the participants in three stages, namely at the baseline, immediately, and 2 months after the intervention. This instrument consisted of demographic information, socioeconomic status, knowledge, PMT constructs, and preventive behaviors. The intervention group was subjected to educational content. The collected data were analyzed in SPSS software (version 22) by descriptive and analytical tests (i.e., Chi-square, independent t-test, and ANOVA). RESULTS: Based on the results, the intervention and control groups showed no significant difference in terms of the mean score of knowledge, theoretical constructs, and preventive behaviors at the baseline (P > 0.05). However, the two groups were significantly different in terms of the mentioned variables immediately and 2 months after the intervention (P = 0.001). Mean score of preventive behaviors, the two groups also demonstrated a significant difference (i.e., calcium intake, physical activity, and sunlight exposure) 2 months after the intervention, compared to before the intervention. (P = 0.001). CONCLUSION: The findings of the present study were indicative of the PMT effectiveness, which can, therefore, be used as a framework for designing educational programs regarding osteoporosis prevention.

Explaining the experience of prenatal care and investigating the association between psychological factors with self-care in pregnant women during COVID-19 pandemic: a mixed method study protocol.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a novel global public health emergency. Prenatal care (PNC) providing institutes should identify the needs and demands of pregnant women by optimizing the means of PNC services during the COVID-19 pandemic. The present study aims to: a) explain prenatal care experiences; b) assess the factors affecting self-care, and c) present a prenatal care guideline and Strategies to improve the PNC. METHODS: This mixed-methods study with a sequential explanatory design consists of three phases. The first phase is a qualitative study exploring the prenatal care experiences among pregnant women. In this phase, the subjects will be selected through purposive sampling; moreover, in-depth individual interviewing will be used for data collection. Finally, the conventional content analysis approach will be employed for data analysis. The second phase is quantitative and will be used as a cross-sectional approach for assessing the association between psychological factors of self-care. In this regard, a multistage cluster sampling method will be used to select 215 subjects who will be visited in health care centers of Tabriz, Iran. The third phase will be focusing on developing a prenatal care guideline and Strategies, using the qualitative and quantitative results of the previous phases, a review of the related literature, and the nominal group technique will be performed among experts. DISCUSSION: The present research is the first study to investigate the prenatal care experiences and factors influencing self-care among pregnant women during COVID-19 pandemic. For the purposes of the study, a mixed-methods approach will be used which aims to develop strategies for improving health care services. It is hoped that the strategy proposed in the current study could lead to improvements in this regard. ETHICAL CODE: IR.TBZMED.REC.1399.003.

Investigating the effect of education on man immunodeficiency virus/acquired immune deficiency syndrome preventive behaviors in vulnerable women living in peripheral neighborhoods: Applications of the health belief model.

INTRODUCTION: Acquired immune deficiency syndrome (AIDS) is a pervasive disease, and its epidemic is spreading around the world. The only way to effectively fight against human immunodeficiency virus (HIV)/AIDS is good-quality health. The present study aimed to investigate the effect of an educational intervention program on HIV/AIDS preventive behaviors based on the Health Belief Model (HBM) in vulnerable women residing in peripheral neighborhoods. MATERIALS AND METHODS: This study was a quasi-experimental research conducted among 200 vulnerable women, randomly selected from four community health centers in peripheral neighborhoods in 2019 in Zahedan, Iran. The data were collected using a researcher-made questionnaire, containing demographic information, HIV knowledge, and the HBM constructs. Besides, the data were collected before, immediately after, and 1 month after the intervention in both groups. Data analysis was performed in SPSS (version 24) using descriptive statistics, Chi-square test, independent t-test, repeated-measures analysis of variance, and multivariate linear regression. RESULTS: The findings revealed no significant difference in the mean scores of knowledge and the HBM constructs before the educational intervention (P > 0.05). However, after the intervention, this difference was significant in three time intervals (P < 0.05). Despite the effectiveness of the educational intervention in the mean scores of knowledge and the HBM constructs in the intervention group compared with the controls, the largest effect size was observed, respectively, in knowledge (d = 0.762) and perceived barriers (d = 0.612), and the smallest effect size was reported in cues to action (d = 0.421). As well, the F-statistic ratio (0.847) demonstrated that the selected demographic variables had failed to explain variations in knowledge mean scores (P = 0.497). CONCLUSION: HBM-based training interventions were positive for HIV/AIDS prevention behaviors. However, training alone does not seem to have enough effect on behavior persistence. Therefore, further research is recommended to investigate the role of predictive factors, especially social determinants of health and their relationship to different parts of the model, to take more effective measures for behavioral stability at the same time as training.

Comparing the effect of sucrose gel and metronidazole gel in treatment of clinical symptoms of bacterial vaginosis: a randomized controlled trial.

BACKGROUND: Lactobacilli, as normal vaginal flora, have a central role in controlling body environment and preventing the growth of pathogens. Sucrose, by promoting the growth of Lactobacilli, accelerates the suppression of pathogenic bacteria. The aim of this research was to compare the effects of sucrose gel with those of metronidazole gel in treating women with bacterial vaginosis (BV). METHODS: This triple-blind clinical trial (IRCT2016112631105N1) was conducted with 70 sexually active, premenopausal women diagnosed with bacterial vaginosis through meeting at least three out of four Amsel criteria. The subjects were randomly divided into two groups of 35 patients, one group treated with sucrose vaginal gel, and the other with metronidazole vaginal gel. The treatment period was 14 days for each group. At the end of the treatment period, the status of each woman's improvement was determined by elimination at least three out of four Amsel criteria (homogeneous vaginal discharge, presence of clue cells > 20%, positive whiff test and vaginal pH value > 4.5), and clinical complaints and reported side effects of medication were recorded for the patients. Data were analyzed using the t test, chi-squared test and McNemar's test). RESULTS: The sucrose vaginal gel and metronidazole vaginal gel were not significantly different in reducing patients' clinical complaints or in elimination at least three out of four of the Amsel criteria that were positive before treatment. With an 85.7% improvement rate with sucrose gel and an 88.5% improvement rate with metronidazole gel, the differences in therapeutic response were not significant, and neither was statistically different in improving the disease (p = 0.389). CONCLUSION: It seems that sucrose vaginal gel might be considered a possible alternative to metronidazole vaginal gel in the treatment of bacterial vaginosis. TRIAL REGISTRATION: Iranian Registry of Clinical Trials, IRCT2016112631105N1 . Registered on 27 December 2016.

Examining Psychometric Characteristics of a Menopausal Health Questionnaire: Translation and Psychometric Evaluation of the Persian Version.

INTRODUCTION: Menopause is a natural event in a woman's life which affects her general health and quality of life. However, currently there is no Persian instrument for measuring health status during this period. Therefore, the present study was performed to assess the validity and reliability of the Persian version of the Menopausal Health Questionnaire in Iran. METHODS: The questionnaire was translated to Persian with the approach of Jones et al and its validity was assessed by a panel of experts. The Persian version was tested among 300 patients who had referred to the gynecological clinic at the Ali ibn Abi Talib Hospital in Zahedan. Convenience method was used for sampling. Exploratory factor analysis was used to assess construct validity of collected data. Test-retest method was used to determine reliability in two-week intervals and Cronbach's alpha coefficient was used to check the internal consistency. RESULTS: According to research findings, the exploratory factor analysis showed an acceptable fitness. Varimax rotation indicated 6 factors with Eagan values more than 1, which explained 49.27% of the variance. Cronbach's alpha coefficient for the entire tool was 0.84 and it was from 0.50 to 0.82 for the subcategories. All factors had a significant case-total correlation. Results of test-retest showed the stability of the questionnaire and its subcategories, and the intraclass correlation coefficient (ICC) was assessed to be 0.93. CONCLUSIONS: The 14-item Menopausal Health Questionnaire is a valid and reliable instrument to assess postmenopausal women's health.

The impact of social capital and social support on the health of female-headed households: a systematic review.

BACKGROUND AND AIM: Social capital and social support as determinants of health play an important role in the health of female heads of households. Considering the increasing number of female-headed families in Iran and the world, this study was conducted to systematically review the impact of social capital and social support on the health of female heads of households. METHODS: This study was conducted as a systematic review in September 2016. Its data were collected from available papers in different databases including Iranmedex, Magiran, Scientific Information Database (SID), Irandoc, Scopus, Science Direct, PubMed and Google Scholar. Using advanced search, all published papers from 2000 to 2015 with full text were selected using related keywords. After reviewing by browsers and adapting to the inclusion and exclusion criteria, 15 papers were entered into the study. The Strengthening the Reporting of Observational Studies in epidemiology (STROBE) checklist was used to evaluate the quality of papers. RESULTS: Based on the findings of these studies, there was a significant relationship between social capital and its components (trust, sense of belonging and social participation) as well as all aspects of health. Additionally, social support and its dimensions (emotional, instrumental and informational) affected health; however, among these dimensions, instrumental support of a stronger predictor was concerned with health, especially mental health. CONCLUSION: Social factors such as social capital and social support are effective on human health, particularly health of female-headed households, since they affect proactive identity and increase information resources, collaboration as well as collective decisions and actions. Furthermore, they provide emotional and instrumental support to group members and prevent further health problems.

Investigating the Prevalence of Preterm Birth in Iranian Population: A Systematic Review and Meta-Analysis.

Introduction: Despite medical advances, preterm delivery remains a global problem in developed and developing countries. The present study was aimed at conducting a systematic review and meta-analysis of studies on the prevalence of preterm delivery in Iran. Methods: This study was carried out on studies conducted in Iran by searching databases of SID, Magiran, Irandoc, MEDLIB, Iranmedex, PubMed, Web of science, Google Scholar and Scopus. The search was conducted using advanced search and keywords of preterm delivery and equivalents of it in Mesh and their Farsi's Synonymous in all articles from 2000-2016.After extracting the data, the data were combined using a random model. Heterogeneity of the studies was assessed using Q test I2 index and the data were analyzed using STATA Ver.11 software. Results: The total number of samples in this study was 41773. In 19 reviewed articles, the overall prevalence of preterm delivery, based on the random effects model, was estimated to be a total of 10% (95% CI, 9-12). The lowest prevalence of preterm labor was 5.4% in Bam and the highest prevalence was 19.85% in Tehran. There was no significant difference between the prevalence of preterm delivery compared to year of study and sample size. Conclusion: This study reviewed the findings of previous studies and showed that preterm delivery is a relatively prevalent problem in Iran. Therefore, adopting appropriate interventions in many cases including life skills training, self-care and increasing pregnancy care to reduce these consequences and their following complications in high risk patients seem necessary.