The association between sexual health literacy and sexual function of women in Iran.

BACKGROUND: Considering the importance of sexual health literacy in promoting individual sexual health and ultimately improving family and social health as well as the effect of health literacy on sexual function, this study was designed and conducted to determine the association between sexual health literacy and sexual function among women. MATERIALS AND METHODS: This was a cross-sectional study. A total of 420 women referring to health centers were entered into the study using one-stage cluster sampling method. Data collection tools included a demographic questionnaire, Iranian Adult Sexual Health Literacy Assessment Questionnaire, and the Persian version of the Female Sexual Function Assessment Questionnaire (FSFI). Data were collected and entered into SPSS 22 and logistic regression. RESULTS: The results of the logistic regression test showed that the variable of sexual health literacy was effective on women's sexual function (P = 0.021) so that the chances of having a desirable sexual function in women with excellent were 4.222 times more than women with inadequate health literacy; the variables of employment status, level of education, duration of marital life, and the number of sexual intercourses per recent week were the factors affecting women's sexual function (P < 0.05). CONCLUSION: The results of this study pointed out the existence of an undesirable level of sexual function and a desirable level of sexual health literacy among participating women. Hence, designing and implementing the training plans to promote sexual function among these women is necessary.

Effect of acupuncture-like transcutaneous electrical nerve stimulation on labor pain in nulliparous women: a randomized controlled trial / 针灸推拿医学（英文版）

Objective: To examine the effect of acupuncture-like transcutaneous electrical nerve stimulation (ACUTENS) on labor pain in nulliparous women. Methods: This randomized clinical trial was conducted at Razi Hospital in Qazvin, Iran between January and July 2018. After the screening process, 144 out of 184 pregnant women were selected by convenience sampling and assigned to an intervention group or a control group by the block randomization method. The intervention group received ACUTENS at Hegu (LI4), Shenmen (HT7), Sanyinjiao (SP6), and Neimadian (Extra) during various stages of delivery in addition to routine labor care at the delivery room. For the control group, the same routine labor care was performed alone. The severity of pain was assessed in the two groups using the visual analog scale (VAS). The data were analyzed using R software (ver. 4.0.2) and repeated measurement analysis of variance. Results: ACUTENS reduced the mean score of pain intensity in the first stage of labor in the intervention group more than that in the control group (P<0.001). Also, the mean scores of pain intensity in the second stage of labor, episiotomy, and one hour after delivery in the intervention group were significantly lower than those in the control group (P<0.001). Conclusion: ACUTENS at Hegu (LI4), Shenmen (HT7), Sanyinjiao (SP6), and Neimadian (Extra) can decrease the intensity of labor pain in nulliparous women. It can be used as a non-pharmacological method for reducing pain in and after labor.

Daytime Napping and Nighttime Sleep During Pregnancy and Preterm Birth in Iran.

OBJECTIVES: This study investigated the relationship between sleep quality during pregnancy and preterm birth. METHODS: This longitudinal study was conducted between August 2018 and May 2019. The participants were 150 pregnant women who had been referred to 7 healthcare centers in the city of Qazvin, Iran and met the inclusion criteria. The Petersburg Sleep Quality Index, the Epworth Sleepiness Scale, and 2 questions about daytime sleep status and a demographic questionnaire were administered at 14-18 weeks and 28-32 weeks of gestation. Data were analyzed using the Mann-Whitney test, the Fisher exact test, and univariate and multivariable logistic regression. RESULTS: In the present study, poor sleep quality affected 84.7% of the participants at 14-18 weeks and 93.3% at 28-32 weeks of gestation. The final model for preterm birth prediction incorporated age and the Petersburg Sleep Quality Index score in the second and third trimesters. Preterm birth increased by 14% with each unit increase in age. With each unit increase in the Petersburg Sleep Quality Index score in the second and third trimesters, preterm birth increased by 42% and 28%, respectively, but the p-values of these factors were not significant. CONCLUSIONS: Although a significant percentage of pregnant women had poor sleep quality, no significant relationship was found between sleep quality during pregnancy and preterm birth.

Spiritual Intelligence and Post-abortion Depression: A Coping Strategy.

Loss of pregnancy is a major stressor which can cause mental disorders. In stressful conditions, spiritual intelligence can be used as a coping strategy to manage and cope with the stressor. It may also produce positive outcomes in spontaneous abortion. This study aimed to assess the relationship of spiritual intelligence with depression after spontaneous abortion. This cross-sectional descriptive-correlational study was done in 2015-2016 on 185 women with spontaneous abortion who were hospitalized in the postnatal care ward of Kowsar teaching hospital, Qazvin, Iran. Data collection was performed in two steps. In the first step, a demographic and obstetric characteristics questionnaire and the Spiritual Intelligence Self-Report Inventory were completed by participants during their hospital stay. In the second step, i.e., 7 days after spontaneous abortion, the Edinburgh Postnatal Depression Scale was completed for each participant over the phone. Variables which were found in univariate analysis to have a significant correlation with depression were entered into multiple logistic regression analysis to assess their roles in predicting depression. Most women were depressed (54%). Multiple logistic regression analysis revealed that the significant predictors of depression were women's educational status (OR 0.419; CI 0.18-0.93), gestational age at the time of abortion (OR 1.121; CI 1.02-1.22), and the personal meaning production dimension of spiritual intelligence (OR 0.82; CI 0.73-0.91). Spiritual intelligence is significantly correlated with post-abortion depression. Developing and following strategies for promoting spiritual intelligence can alleviate depression, stress, and anxiety after spontaneous abortion and also help manage complicated pregnancies.

Nutrition as a Potential Factor of Primary Dysmenorrhea: A Systematic Review of Observational Studies.

BACKGROUND: The incidence and severity of primary dysmenorrhea are influenced by various factors. The aim of the present study was to review nutritional factors influencing primary dysmenorrhea. METHODS: Academic databases including Web of Science, EMBASE, Scopus, and PubMed (including Medline) were searched using keywords of nutrition, diet, and primary dysmenorrhea. In this study, observational studies that were published in English from 1990 to April 2018, which focused on nutritional factors affecting primary dysmenorrhea, were selected. The evaluation of studies was performed using a modified STROBE checklist with 10 items. RESULTS: Out of 5,814 retrieved studies, 38 articles met inclusion criteria and were included for final data synthesis. The increased consumption of fruits and vegetables as the sources of vitamins and minerals, as well as fish and milk and dairy products have positive associations with less menstrual pain. Inconsistent results were reported on the consumption of other nutritional groups. Studies showed negative associations of meal skipping and following diet to lose weight with severity of dysmenorrhea. CONCLUSION: A few studies showed inconclusive findings due to methodological heterogeneities for assessing nutritional habits and different methods of measuring dysmenorrhea pain. Therefore, further analysis and future interventional studies with stronger methodologies are required.

Mental health and primary dysmenorrhea: a systematic review.

Several factors including demographic, reproductive, lifestyle, psychological and social factors can affect incidence and severity of primary dysmenorrhea. This study aimed to systematically review the psychological risk factors associated with primary dysmenorrhea. Embase, ISI web of knowledge, ProQuest, Science Direct, Scopus and PubMed central were searched using keywords related to risk factors and primary dysmenorrhea. Observational studies, published in English after 2000, focusing solely on psychological factors affecting primary dysmenorrhea were included. The search process retrieved 11,928 potential related articles. Thirty three articles met inclusion criteria and were assessed for final synthesis. The STROBE checklist was used to quality assessment of studies. Results of study showed that few studies had investigated relationship between dysmenorrhea and most psychological disorders. Most studies have investigated the relationship between dysmenorrhea and depression, anxiety, stress, alcohol abuse and somatic disorders. So, further studies are needed to investigate relation between most psychological disorders with primary dysmenorrhea. Significant relationship between some mental health components such as depression, anxiety and stress with primary dysmenorrhea shows the importance of psychological assessment before the choice of therapeutic methods. Also, the feasibility of designing and evaluating the effectiveness of the use of psychotherapy interventions for the treatment of primary dysmenorrhea as alternative therapies can be considered.

Prevalence and predictors of food insecurity among pregnant women: A cross sectional study in Qazvin Province, Iran.

INTRODUCTION: Food insecurity is associated with adverse health consequences in women, especially pregnant ones. Present study is aimed to investigate prevalence and predictors of food insecurity among pregnant women. METHOD: A cross-sectional study was conducted on 394 pregnant women in Qazvin during November 2016-May 2017. The Household Food Insecurity Access Scale (HFIAS) was used to assess food insecurity among pregnant women. Besides, the relationship of demographic, midwifery and socioeconomic factors was investigated using Chi-squared and logistic regression tests. Then, the obtained data were analyzed in Stata-12 software at the significance level of 0.05. FINDINGS: Nearly 44% of the participants had food insecurity. In multivariate analysis, only husbands' unemployment and unwanted pregnancy were associated with food insecurity; thus, the chance of food insecurity among women with unemployed husband was higher than the women with employed husband by 4.7 times [OR (95% CI) = 4.69(1.64, 13.42)]. Furthermore, the probability of food insecurity among the participants with unwanted pregnancy was twice more than those with wanted pregnancy [OR (95% CI) = 2.07(1.14, 3.74)]. CONCLUSION: Unemployed husband and unwanted pregnancy are related to food insecurity among pregnant women. Nevertheless, due to the nature of this study, it was not possible to clearly specify the path of such a relationship. To reduce food insecurity among pregnant women, it is essential to take all the necessary measures for providing financial supports for pregnant women through different ways in order to reduce the stress and worries caused by financial burden of pregnancy, and to improve nutrition quality and eating behaviours among pregnant women.

The relationship between food security and quality of life among pregnant women.

BACKGROUND: Household food insecurity through influencing the quality and sufficiency of nutrition can have considerable effects on individuals' health. Previous studies have shown the relationship between household food insecurity and quality of life among adults, infants, and people of minority ethnicity. However, no studies have been conducted on household food insecurity and quality of life among pregnant women. This study aimed to investigate the effect of food insecurity on quality of life among pregnant women in Qazvin city, Iran. METHODS: This cross-sectional study was conducted between May 2017 and November 2017 on 394 pregnant women. A random cluster sampling method was used to select eight urban health and medical centers from four geographical regions of Qazvin city, Iran. In the selected centers, pregnant women were recruited using eligibility inclusion criteria. Data was collected using the SF-36 Health-related Quality of Life, Household Food Insecurity Access Scale and a demographic questionnaire for recording the women's gestational and demographic information through interviews. Descriptive and inferential statistics including Chi-square test, one-way analysis of variance with Bonferroni post-hoc test and multiple linear regression were used for data analysis. P < 0.05 was considered statistically significant. RESULTS: Food insecurity was reported in 43.9% of the pregnant women. Overall pregnant women's quality of life had the highest score (Mean ± SD) in the domain of 'social performance' (76.4 ± 21) and the lowest one in the domain of 'role limitation due to physical reasons' (60.5 ± 43). Pregnant women with food insecurity had the lowest score in role limitation due to physical reasons domain of quality of life (68.6 ± 40.4, 61.3 ± 45.5 & 51.3 ± 47.7 respectively for mild, moderate and sever food insecurity). The results of multiple linear regression showed that one unit reduction of household food security significantly decreased the total quality of life score by 5.2 score (95% CI: -9.7, - 0.7) among the mild food insecure group, 10.8 score (95% CI: -17.1, - 4.6) among the moderate food insecure group and 14.1 score (95% CI: -19.7, - 8.5) among the sever food insecure group. CONCLUSIONS: Screening of the household food security status during the primary prenatal care can identify high-risk pregnant women to improve the quantity and quality of their diet. Moreover multi-level actions including policy-making, supplying resources, and providing appropriate services are needed to ensure that pregnant women have access to high-quality foods.

Domestic Violence Among Iranian Women: A Systematic Review and Meta-Analysis.

CONTEXT: Violence against women, or domestic violence, is both a physical and mental health issue that is rampant in many societies. It undermines the personal health of those involved by inflicting physical, sexual, and psychological damage. The purpose of the present systematic review and meta-analysis is to assess the prevalence of domestic violence in Iranian society. EVIDENCE ACQUISITION: A total of 31 articles published between 2000 and 2014 in Iranian and international databases (MagIran, IranMedex, SID, Google Scholar, Science Direct, PubMed, Pre Quest, and Scopus) were examined. The data collected from the articles were analyzed through a meta-analysis using a random effects model. The heterogeneity of the articles was examined using the I2 index, and the analyses were performed with STATA software version 11.2. RESULTS: Based on the 31 articles, which represent a sample size of 15,514 persons, we estimated the prevalence of domestic violence to be 66% (CI 95%: 55 - 77). The geographical classification showed that the prevalence of domestic violence was 70% (CI 95%: 57 - 84) in the east of the country, 70% in the south (CI 95%: 32 - 100), 75% in the west (CI 95%: 56 - 94), 62% in the north (CI 95%: 37 - 86), and 59% in the center (CI 95%: 44 - 74). CONCLUSIONS: The results of the study showed a high prevalence of domestic violence in Iran, which requires the adoption of appropriate measures and the initiation of effective interventions by the legal authorities. These measures and interventions should aim to determine the causes of domestic violence and to develop ways of controlling and reducing this destructive phenomenon.

Psychosocial factors in pregnancy and birthweight: Path analysis.

AIM: Birthweight is known to be affected by several factors. In the present study a relationship model of psychological and economic determinants of birthweight was designed and tested. METHODS: This prospective study involved 400 pregnant women in four districts of Tehran, Iran. The subjects were selected through a multistage sampling method. Seven questionnaires (socioeconomic status; Holmes and Rahe Stress Scale; Perceived Stress Scale; 21-item Depression, Anxiety, and Stress Scale [DASS-21]; perceived social support; pregnancy-related anxiety scale; and domestic violence questionnaire) were used to assess participant psychosocial and economic conditions. In order to collect post-partum information about the mother and the infant, the women were followed up until delivery. Data were analyzed using SPSS-16 and Lisrel-8.8. RESULTS: Based on the obtained path diagram, the greatest adverse effects on birthweight were exerted directly by DASS-21 score (B = -0.14) and indirectly by stressful life events (B = -0.037). Among variables that affected birthweight in both paths, socioeconomic status and perceived stress had the strongest overall effects on birthweight (B = 0.203 and -0.1024, respectively). CONCLUSION: According to the path analysis model, psychosocial and economic factors can directly/indirectly affect birthweight.

Relationship between Structural and Intermediary Determinants of Health and Preterm Delivery.

BACKGROUND: Preterm birth is a major health problem that leads to infant morbidity and mortality. The main goal of this study was to find the relationship between social determinants of health and preterm delivery. METHODS: A prospective longitudinal cohort study was carried out on 500 pregnant women in their 24th to 28th gestational weeks in 2012. The pregnant women filled out a self-report questionnaire on the structural determinant, perceived stress, and perceived social support. The participants were followed up until labor and the data about mother and the newborn were collected after labor. The data were analyzed by SPSS 21 and Lisrel 8.8 software programs using pathway analysis. RESULTS: The final path model fit well (CFI=0.96; RMSEA=0.060). Path analysis showed that among structural factors, income had a direct effect (ß=0.06) and the factors of income (ß=0.00594), number of children (family size) (ß=-0.024), as well as mother's education (ß=-0.0084) had the greatest overall effect on gestational age at birth respectively. Also, the results showed that among intermediate factors of social determinants of health, stress in the direct path (ß=-0.12) and among the overall effects, the perceived stress (ß=-0.12) and perceived social support (ß=0.0396) affected the gestational age at birth. CONCLUSION: The current study showed that some structural and intermediary determinants such as income and perceived stress had an effect on preterm labor.

Preterm delivery and psycho-social determinants of health based on World Health Organization model in Iran: a narrative review.

BACKGROUND: Preterm delivery is still the primary cause of mortality and morbidity in infants, which shows a problematic condition in the care of pregnant women all over the world. This review study describes prevalence and psycho - socio-demographic as well as obstetrical risk factors related to live preterm delivery (PTD) in the recent decade in Iran. METHODS: A narrative review was performed in Persian and international databases including PubMed, SID, Google Scholar, Iran Medex, Magiran and Irandoc from 2001 to 2010 with following keywords: preterm delivery and pregnancy outcomes with (prevalence, socioeconomic condition, structural determinant, Intermediary determinants, Psychosocial factor, Behavioral factor and Maternal circumstance, Health system). All of article was reviewed then categorized based on WHO model. RESULTS: Totally 52 article were reviewed and 35 articles were selected, of which 26 were cross-sectional or longitudinal, 9 were analytical (cohort or case-control). The prevalence rates of preterm delivery in different cities of Iran were reported between 5.6% in Quom to 39.4% in Kerman. The most common social factors in structural determinant were educational level of mother, and in intermediary determinants were Psychosocial factor (maternal anxiety and stress during pregnancy), Behavioral factor and Maternal circumstance (violation and trauma) and in Health system, lack of prenatal care. CONCLUSION: The prevalence rate of preterm delivery is a matter of concern. Since many psycho-social factors may affect on the condition and its high rate in poor communities might reveals a causal relationship among biological and psychosocial factors, performing etiological investigations is recommended.

Effect of portfolio assessment on student learning in prenatal training for midwives.

The tendency to use portfolios for evaluation has been developed with the aim of optimizing the culture of assessment. The present study was carried out to determine the effect of using portfolios as an evaluation method on midwifery students' learning and satisfaction in prenatal practical training. In this prospective cohort study, all midwifery students in semester four (n=40), were randomly allocated to portfolio and routine evaluation groups. Based on their educational goals, the portfolio groups prepared packages which consisted of a complete report of the history, physical examinations, and methods of patient management (as evaluated by a checklist) for women who visited a prenatal clinic. During the last day of their course, a posttest, clinical exam, and student satisfaction form were completed. The two groups' mean age, mean pretest scores, and their prerequisite course that they should have taken in the previous semester were similar. The mean difference in the pre and post test scores for the two groups' knowledge and comprehension levels did not differ significantly (P>0.05). The average scores on questions in Bloom's taxonomy 2 and 3 of the portfolio group were significantly greater than those of the routine evaluation group (P=0.002, P=0.03, respectively). The mean of the two groups' clinical exam scores was significantly different. The portfolio group's mean scores on generating diagnostic and therapeutic solutions and the ability to apply theory in practice were higher than those of the routine group. Overall, students' satisfaction scores in the two evaluation methods were relatively similar. Portfolio evaluation provides the opportunity for more learning by increasing the student's participation in the learning process and helping them to apply theory in practice.