Development and psychometric evaluation of the sexual and reproductive health needs of incarcerated women scale: a methodological study.

BACKGROUND: This study aimed to develop and validate a comprehensive tool designed to assess the sexual and reproductive health (SRH) needs of incarcerated women. METHODS: A methodological study was conducted from January to March 2023 in two female prisons in Tehran and Hamedan, Iran. The participant pool consisted of women who had been incarcerated for a minimum of 6 months and were aged between 15 and 49 years. The instrument development involved two phases. Phase I involved a literature review and interviews with incarcerated women to understand their SRH needs. Phase II assessed psychometric properties to establish the scale's validity and reliability. RESULTS: The SRH Needs of Incarcerated Women (SRH-NIW) scale was refined, comprising 37 items across six domains: pregnancy and childbirth services, parenting services, family planning and sexual health services, personal and medical care services, screening services and infection control services. Exploratory factor analysis explained 66.15% of variance. The Content Validity Ratio and Content Validity Index were 0.8 and 0.94, respectively, indicating high content validity. Average Variance Extracted values ranged from 0.592 to 0.698. The whole scale showed a Cronbach's alpha of 0.823, and the Intra-class Correlation Coefficient was 0.879. CONCLUSION: The SRH-NIW scale is a valid and reliable tool for assessing the SRH needs of incarcerated women. It can enhance healthcare services and interventions for incarcerated women, potentially leading to policy improvements within the prison system.

A comprehensive interventional program based on the needs and concerns related to female genital cosmetic surgeries: protocol for a multistage mixed methods study.

BACKGROUND: Dissatisfaction with one's body and the subsequent rise in the cosmetic surgery trend pose significant public health concerns today. One unusual cosmetic surgical procedure involves enhancing the genital area. Numerous healthy women and girls have recently sought Genital Cosmetic Surgery (GCS) for beauty or improved sexual performance. There is a concern that this phenomenon may be linked to developing a new standard for vulvovaginal appearance. This stringent standard could potentially adversely affect women's mental health in the future, growing feelings of insecurity and possibly leading teenagers to consider plastic surgery. Implementing empowering and awareness-raising programs for women and girls is crucial, especially in light of the constantly evolving gender norms and the medicalization of sexuality and beauty as social constructs. It is essential that such training is integrated into comprehensive sexual education programs for adolescents. These efforts align perfectly with the SDG, recognizing that education in sexual and reproductive health, ensuring access to health, and empowering women are fundamental rights for women and girls. To accomplish these objectives, we will conduct this study to elucidate the needs and concerns related to the increasing trend of GCS. By doing so, we can concentrate on the factors motivating women to undergo GCS. This approach will enable us to develop effective interventions to empower women and girls considering GCS, thus enhancing their sexual and reproductive health. METHODS AND OBJECTIVES: The objectives of this multistage exploratory sequential mixed-method study will be structured into three phases: First phase: qualitative study. 1. In-depth interviews will be conducted to elucidate the needs and concerns associated with GCS with women with a history of GCS, spouses of willing participants, and women actively seeking these procedures. 2. A literature review in parallel with the qualitative phase will be conducted to gain insights into the needs and concerns of women worldwide considering GCS. Second phase: program design. 1. To formulate an intervention grounded in the primary priorities identified during the qualitative stage and informed by the literature review. 2. To prioritize the needs and concerns of women seeking GCS and to validate and endorse the intervention through input from an expert panel. Third phase: quantitative study. To assess and determine the effectiveness of the intervention designed to address the needs and concerns of women applying for GCS procedures. DISCUSSION: This study marks the first attempt to design and assess an intervention addressing the needs and concerns of cosmetic surgeries performed on the female genital and reproductive system. The hope is that this study's compilation and implementation will yield substantial evidence and documentation regarding the impact of educational interventions on women's and girls' sexual and reproductive empowerment. Given the rising prevalence of GCS among unmarried teenagers, this approach is of utmost significance. It underscores the necessity for gynecological and midwifery service providers to have comprehensive guidance on GCS. Such guidance can be an essential resource for healthcare providers in this field.

Contemporary concerns about body dissatisfaction and the growing trend of cosmetic surgery, including unusual trends of genital cosmetic surgery (GCS), are raising public health issues. This study addresses the needs and concerns related to the increasing trend of GCS among women.A multistage exploratory sequential mixed-method study will be structured into three phases, incorporating both quantitative and qualitative components: 1. A qualitative phase involving in-depth interviews and a literature review 2. A program design phase to formulate an intervention through input from an expert panel. 3. A quantitative phase to assess the intervention's effectiveness. The objectives include understanding the motivations behind GCS, developing an intervention grounded in these insights, and evaluating its impact on women's sexual and Reproductive empowerment. Given the rising prevalence of GCS among unmarried teenagers, this research holds significant importance. It emphasizes the need for comprehensive guidance on GCS for healthcare providers, aligning with empowering women and ensuring access to sexual and reproductive health education.

Pregnancy rate, maternal and neonatal outcomes among breast cancer survivors: A systematic review.

AIM: This study investigated the pregnancy rate, maternal and neonatal outcomes, and breast cancer (BC) recurrence status after pregnancy among BC survivors. DESIGN: A systematic review. METHODS: Electronic databases such as PubMed, Web of Science [WOS], Scopus, ScienceDirect, Google Scholar, and Scientific Information Database were systematically searched. The quality of included studies was evaluated using the Newcastle-Ottawa Scale (NOS). Observational studies reported the pregnancy rate, maternal and neonatal outcomes among reproductive-aged BC survivors, and the recurrence status of BC after pregnancy were eligible to include in this study. RESULTS: Of the 29 included studies, 13 studies were prospective cohorts or prospective multicenter or population-based cohorts, 14 studies were retrospective cohort or retrospective population-based cohort studies, and two studies were cross-sectional retrospective surveys or population-based descriptive studies. This systematic review showed that the pregnancy rate was estimated at 3.1%-48.5% among BC survivors who attempted to conceive. The most prevalent maternal outcomes of pregnancy were miscarriage (1.8%-33.3%) and induced abortion (5.0%-44%) as well as preterm birth (PTB) or very PTB (1.2%-21.1%), and twin birth (1.1%-38.8%) were the most prevalent neonatal outcomes occurring among BC survivors, respectively. In addition, most of the included studies indicated that pregnancy had no adverse effect on the status of BC recurrence among survivors. Surviving women can be encouraged and receive a carefully multidisciplinary approach regarding healthy pregnancy. No Patient or Public Contribution.

Pregnancy Health Among Breast Cancer Survivors: Development and Validation of an Educational Package in Iran.

Reproductive-aged breast cancer (BC) survivors are concerned about their fertility potential after BC treatment. No specific and comprehensive educational and clinical package examines pregnancy health in BC survivors. This study aimed to develop and validate a pregnancy health educational package for BC survivors who intend to experience pregnancy after completing cancer treatment. The present study is a mixed methods study conducted in three phases. The researchers, in phase 1, performed a qualitative content analysis study to explore the perceived needs and experiences of pregnancy among Iranian BC survivors. Then in the second phase, the authors conducted a systematic literature review to search all available packages, guidelines, documents, and published papers on pregnancy or fertility status among BC survivors worldwide. In the third phase, the intervention type was selected according to the opinions of the expert's team during two sessions of online meetings using the Delphi technique. The package quality was assessed by an expert team using the Appraisal of Guidelines for Research and Evaluation Instrument II (AGREE II) tool. The pregnancy health package for BC survivors was developed in seven separate chapters based on the qualitative study and literature review findings. The results of the validity or quality assessment of the package according to the six domains of the AGREE II tool were reported as follows: the score for the scope and purpose domain was 95.55%, the stakeholder involvement domain was 89.16%, the score for the rigor of development domain was 92.97%, clarity of presentation domain was 94.44%, the score of applicability domain was 87.06%, and the score of editorial independence domain was calculated 93.75%. The pregnancy health package was designed with high quality and validity and, as an excellent cost-effective resource, is proposed to BC survivors to increase their awareness regarding their fertility issues before attempting to conceive.

Evaluation of the effectiveness of a postnatal support education program for husbands in promotion of their primiparous wives' perceived social support: a randomized controlled trial.

BACKGROUND: Primiparous women experience various challenges if not provided with social support in the early postpartum period. Support in form of postpartum education programs is needed to improve mental well-being in primiparous women. The aim of this study was to determine the effect of a postnatal supportive education program for husbands on the perceived social support (primary outcome), and stress and maternal self-efficacy (secondary outcome) of their primiparous wives. METHODS: This randomized clinical trial was performed on pregnant women referring to healthcare centers for routine care from September to November 2021 in Kermanshah, Iran. One hundred pregnant women were randomly divided in to intervention and control groups. Four 45-90 min online training sessions were held weekly for the husbands of the intervention group. The primiparous women completed the Postpartum Partner Support Scale, Perceived Stress Scale, and Postpartum Parental Expectations Survey before (third day after delivery, immediately and one month after completing the intervention. Data were analyzed using Fisher's exact test, Chi-square test, independent t-test, and repeated measures analysis of variance in SPSS version 24, and p < 0.05 was considered statistically significant. RESULTS: In the control and intervention groups before the intervention, socio-demographic characteristics (P > 0.05), the mean scores of perceived social support (P = 0.11), maternal self-efficacy (p = 0.37) and perceived stress (p = 0.19) were not statistically significant. However, in the intervention group compared to the control group the mean scores of perceived social support (79.42 ± 7.17 vs. 37.26 ± 7.99, P < 0.001), maternal self-efficacy (186.22 ± 39.53 vs. 106.3 ± 32.88, P < 0.001) and perceived stress (16.36 ± 6.65 vs. 43.3 ± 7.39, P < 0.001) immediately after the intervention and the mean scores of perceived social support (84.4 ± 5.91 vs. 37.14 ± 6.63, P < 0.001), maternal self-efficacy (191.24 ± 38.92 vs. 112.34 ± 37.12, P < 0.001) and perceived stress (13.98 ± 4.84 vs. 39.06 ± 7.25, P < 0.001) one month after the intervention changed significantly. CONCLUSION: The postpartum supportive education program for husbands was effective in promoting social support for primiparous women. Thus it can be introduced as routine care in the postpartum period. TRIAL REGISTRATION: Clinical trial registration Iranian Registry of Clinical Trials; https://en.irct.ir/user/trial/56451/view (IRCT20160427027633N8), registered (15/06/2021).

The Effect of Benson Relaxation Technique on Stress, Anxiety, and Depression in Pregnant Women.

Relaxation programs can be effective in establishing psychological tranquility for maternal and fetal health. This study was conducted to evaluate the effect of this low-cost, effective, easy method on the stress, anxiety, and depression in pregnant women. This randomized clinical trial study was conducted from July 2015 to July 2016. Seventy pregnant women in the third trimester of pregnancy were included in this study. Participants were randomly assigned to 2 groups of 35 subjects using a random number table. Participants in group 1 received relaxation training and group 2 received routine care. A demographic questionnaire and Depression, Anxiety, and Stress Scale (DASS-21) were completed before and 1 and 2 months after the intervention. The SPSS software version 18 was used for data analysis. There were significant differences in the mean difference of the total DASS score (14; 95% confidence interval [CI]: 4 to 32) as well as the scores of stress (4; 95% CI: 1 to 10), anxiety (6; 95% CI: 2 to 10), and depression (6; 95% CI: 2 to 12) 2 months after the intervention between the 2 groups. The Benson relaxation technique decreased DASS-21 scores in the intervention group.

Experiences of Iranian female patients with systemic lupus erythematosus: A qualitative study.

OBJECTIVES: This study aims to explore the perceptions, concerns, expectations, and viewpoints of female patients with systemic lupus erythematosus (SLE) regarding reproductive health in Iran. PATIENTS AND METHODS: This qualitative research was conducted using 27 semi-structured deep interviews with 19 married female patients (mean age 37.4±7.0 years; range, 15 to 49 years) suffering from SLE selected through purposive sampling in the Rheumatology Center of Shariati Hospital, Tehran, Iran between August 2017 and March 2018. RESULTS: Patients' perceptions were classified into six categories and 14 subcategories: physical suffering (debilitating pain, gradual disability, and apparent transformation), psychological stress (family disturbance and sexual dissatisfaction), challenging fertility (bothersome pregnancy and impaired parenting), adaptation to the disease (self-care and lifestyle modification), need for a supporter (support from the spouse, support from the family and acquaintances, and lack of occupational and social support), and spirituality (forgiveness of sins and resorting to God). CONCLUSION: The findings clearly suggested the negative effects of SLE on the reproductive health of these patients. This study emphasized the importance of care and support for female patients with SLE. We hope that this research enhances the awareness of care providers about physical, sexual, psychological, social, and spiritual factors, since taking care of these patients requires strategic and multidisciplinary management.

Marriage, a way to achieve relaxing evolution: A grounded theory investigation.

BACKGROUND: Marital satisfaction is a complex of feelings, which includes pleasure, satisfaction, and pleasure experienced by the husband or wife in all aspects of marriage, and it is an important part of individual health, especially mental health. This qualitative study was conducted to understand marital satisfaction using grounded theory on couples. MATERIALS AND METHODS: This qualitative study was implemented using grounded theory based on Corbin and Strauss, 2008, to investigate the process of marital satisfaction formation among couples from 2014 to 2016. The sampling was started as purposeful and continued as theoretical. The data were obtained using semi-structured interviews. 28 interviews were taken from 25 participants; MAXQDA software was used to facilitate the organization of classes and subclasses. RESULTS: The central variable of this study was called "toward a relaxing evolution." On that account, the main classes included "supportive companionship" and "responsible love," and variables of "personality traits," "interactive relationships," "economic status," "passage of time," and "present resources in society" provided the basis for the formation of marital satisfaction. CONCLUSION: To achieve marital satisfaction, couples should set their family's ultimate goal toward achieving a relaxing evolution for the entire family, and they should accompany each other in order to achieve that goal. This sometimes requires sacrifice and forgiveness to achieve the ultimate goal of the family.

Evaluation of effectiveness of a sexuality education program for parents of male adolescents: promoting of parent-adolescent sexual communication.

OBJECTIVES: Parents play a significant role in promoting of healthy sexuality in adolescents. The purpose of the present study was to assess the effectiveness of a sexuality education intervention program to enhance parent-adolescent sexual communication. METHODS: This study was a randomized controlled field trial. Parents of male adolescent aged 13-16 years were recruited from eight public all-boys high schools in Karaj, Iran. A multi-stage stratified random sampling method was used and 102 parents were assigned into intervention and control groups. The recruitment and data collection process lasted from February to November 2019. Self-report demographic questionnaire and six general parenting and parent-adolescent sexual communication measures were used to assess the impact of intervention. Sexuality education program was presented for the parents of intervention group, in the form of four weekly 2-h sessions. Parents were assessed at the baseline, within one week post-intervention, and three-month follow-up to evaluate the outcome variables. The data were analyzed using the Chi-square test, two-sample t-test, general linear model analyses, and Bonferroni test. RESULTS: In terms of parent-adolescent general communication, parental monitoring, parent-adolescent communication about sex-related topics, parent's sexual communication skills, parent's self-efficacy, and responsiveness to sexual communication. There were no significant differences between intervention and control groups at the baseline (p>0.05). Compared to controls, intervention parents reported more improvement in general communication across the time; however, significant differences were not observed regarding general communication and parental monitoring (p=0.94, p=0.95). Parents in the intervention group significantly differed from those in the control group for the mean scores of parent-adolescent communication about sex-related topics (p=0.04), parent's sexual communication skills (p=0.04), parent's self-efficacy (p=0.002), and responsiveness (p<0.001) to sexual communication at each follow-up. CONCLUSIONS: We identified the educational program as a promising tool for improving parent-adolescent communication regarding sexuality-related issues. This program provides the evidence for implementation of parent-based sexuality education programs.

Designing and psychometric of reproductive health related behaviors assessment tool in Iranian males: an exploratory mixed method study protocol.

BACKGROUND: Male reproductive health is a relatively new concept, and most men are neglected in reproductive health discussions. Therefore, it appears that there is insufficient information about the male reproductive health. This study aims to design a psychometric instrument for assessing the male reproductive health-related behavior. METHODS/DESIGN: This is a sequential exploratory mixed-method study with a classical instrument development design. It will be conducted in two qualitative and quantitative phases on the studied units including the men living in Tehran. In the first phase, a qualitative study of a contractual content analysis approach will be conducted in order to perceive the concept of male reproductive health-related behavior, determine the dimensions of the questionnaire, and explore the items. In the second phase, a quantitative study will be carried out to evaluate the psychometric properties as well as (form, content, and construct) validity and reliability of the instrument designed in the first phase. Finally, the instrument will be scored and interpreted. DISCUSSION: Discovering men's perception of concept of reproductive health-related behavior can help design a valid and reliable questionnaire which can be used in studies evaluating the male reproductive health-related behavior. ETHICAL CODE: IR.TUMS.FNM.REC.1397.157.

The effect of educational program based on theory of planned behavior on health promotion and childbearing of minor thalassemia couples.

INTRODUCTION: It is essential to provide key information and support to every woman regarding pregnancy and childbirth to enable all women to make a fully informed decision regarding their choice of reproduction. The study aimed to find the impact of an educational program based on the Theory of Planned Behavior (TPB) on health promotion and childbearing of minor thalassemia couples. SUBJECTS AND METHODS: This study was quasi-experimental. A total of 70 women with minor thalassemia held in Minudasht health center were classified into two groups: study and control. The study group received the educational program based on TPB, and the control group only received the routine program. The data were collected using the TPB-based questionnaire at baseline and 3 months after the intervention. They were analyzed by Chi-square, Student's t-test, Wilcoxon test, and regression analysis through SPSS version 16. RESULTS: The mean (standard deviation) ages of the participants in the control and study group were 30.69 (6.20) and 31.08 (6.66), respectively. There were significant differences between the two groups (study vs. control) in terms of perceived behavioral control, intention, attitude, or childbearing behavior (P < 0.001). The change in fertility behaviors had a significant increase in the study group (62.8%) compared to the control group (2.9%) (P < 0.001). CONCLUSION: Based on the results, the TPB is an effective model to explain fertility intentions and behaviors in Iranian women with minor thalassemia; however, further researches are needed to generalize our findings to other people including healthy women.

The presence of the child, the opportunity or a threat to marital satisfaction: A qualitative study.

BACKGROUND: The aim of this qualitative study was to explore if the presence of a child in the family was an opportunity or threat to the marital life. METHODS: In this common qualitative content analysis, semi-structured interviews with 20 participants were conducted. All of the interviews were recorded and then transcribed. The data were categorized, and the main themes and sub-themes were extracted. RESULTS: Twenty transcription were analysed. The data analysis led to the development of the first theme of "feeling evolution" with the category of "flourishing the motherhood sense," and the second theme of "strengthening the marital life" with the two categories of "the marital life stabilization" and "efforts for a common goal." CONCLUSIONS: The presence of the child can lead to the feeling of development and stabilizing the marital life. Furthermore, the presence of the child can facilitate or hinder marital satisfaction. Given the challenges due to a lack of preparation of parents for childbirth, consultation and support by family members or the society can help with adaptation with this life period and increasing the positive effects of the presence of the child on parents' relationships and marital satisfaction.

Prevalence of sexual dysfunction in women with systemic lupus erythematosus and its related factors.

OBJECTIVES: Systemic lupus erythematosus (SLE) affects all body organs. This disease has marked physiological, mental, and cognitive effects on the patient and results in sexual dysfunction, depression, and decreased self-confidence. This study was conducted to compare sexual function, depression, anxiety, stress, and the related factors in women suffering from SLE. MATERIAL AND METHODS: In this cross-sectional study, 340 women (170 with SLE and 170 healthy) aged 18-49 years were investigated. Convenience sampling was used to select the participants. In this study, a demographic questionnaire, the Depression, Anxiety, and Stress Scales - 21 Items (DASS-21), and the Female Sexual Function Index (FSFI) were applied. Data were analyzed with SPSS 16 using Spearman's correlation, χ2, Mann-Whitney, covariance, and multiple regression statistics; p-values less than 0.05 were considered significant. RESULTS: The results showed a significant difference in sexual function between the SLE and healthy groups. According to covariance analysis, the difference remained significant after controlling for confounding factors (stress, depression, anxiety). Moreover, the effect of SLE on the sexual function had a significant correlation with age, life status, number and age of children, economic status, menstruation, duration of marriage, age at diagnosis, disease duration and activity, stress, anxiety, and depression. The results of multiple regression analysis showed that age, disease activity, depression, and life status had the highest correlation with sexual dysfunction in women with SLE. CONCLUSIONS: The results of this study indicated that more attention should be paid to the sexual health of women suffering from SLE as a neglected aspect of their treatment, which requires an interdisciplinary approach to shift the care of these patients from a biomedical model to a biopsychosocial model.

Legal complaints about midwives and the impact on the profession.

INTRODUCTION:: Midwives play an important role in maintaining and increasing women's health and well-being. Training professional midwives is one of the main policies of any healthcare system. Since the number of complaints against midwives has increased recently, this study was conducted to explore the perspectives of midwives regarding patients' complaint to authorities and their impacts on the profession of midwifery. METHODS:: Being conducted in 2013, this qualitative study was the first of its type in Iran. Data were collected through in-depth semi-structured interviews with 14 midwives working in different cities across the country. The participants were selected using a purposive sampling method. Interviews were transcribed verbatim and analyzed following a qualitative content analysis approach. Written text was then coded, and themes were extracted from the data. Ethical considerations: The study was conducted with midwives' free informed consent and was approved by Ethics Committee of Tehran University of Medical Sciences. FINDINGS:: By analyzing the data, four main themes regarding the impact of complaint on midwifery profession were developed. These included the following: "dissatisfied of midwifery, professional deviation, obsession with work, and weakening of the professional status." CONCLUSION:: The experience of patients' complaint to legal authorities against midwives was described, by participants, as a painful experience. Lack of midwives' knowledge about professional rules and litigation process created many problems for them and could negatively affect their practice and the society's attitude toward midwifery. Thus, we suggest that in order to prevent such problems, midwives and midwifery students should be educated regarding factors that have the potential to create such problems and also prevention strategies.

Perceptions of teenage women about marriage in adolescence in an Iranian setting: A qualitative study.

BACKGROUND AND AIM: Early marriage threatens the health and human rights of millions of girls all around the world. The aim of this study was to explore the perceptions of Iranian teenage women about marriage in adolescence. METHODS: A qualitative study was conducted based on the conventional content analysis approach on 14 teenage married women (aged13-19 years) who attended all urban-rural healthcare centers (4 centers) in Ardabil, Iran between May 2016 and Jan 2017. Data were collected through in-depth semi-structured interviews. Purposeful sampling was continued until data saturation. The data were analyzed using the Graneheim and Landman strategies. RESULTS: The mean age at marriage was 13.2 (SD=1.25) years and the duration of marital life ranged from 45 days to 3 years. During the data analysis, three main categories were extracted that each of them consisted of three sub-categories. The main categories, included "a false sense of sexual development", "death of dreams", and "threatened independence". CONCLUSION: Results of this study revealed that teenage women could not comprehend opportunities in life. These findings could help health care providers and policy makers to provide teenage women with special care and better support to prevent negative consequences of early marriage.

The Effect of Empowerment and Educational Programs on the Quality of Life in Iranian Women with HIV.

AIDS affects physical, mental, social, and psychological health status. One of the goals of Health for All in the 21st century is to improve the quality of life. This study is a randomized clinical trial conducted on 120 HIV-positive women. Women were administered assessment questionnaires to be completed during the structured interview. After sample collection, participants were divided randomly into 3 groups by using the table of random numbers, then, respectively, received educational intervention, empowerment program, and routine procedures offered by the center and were followed by refilling the questionnaires 12 weeks after intervention. Depending on the type of data, chi-square, analysis of variance, and paired t test were used, and SPSS version 16 was used for data analysis. The finding showed that knowledge increased after intervention in educational ( P = .02) and empowerment groups ( P = .006); also empowerment group indicated significant difference in psychological ( P = .006) and spiritual ( P = .001) domains and their total quality of life ( P = .004). According to this study, exposing HIV-positive women to empowerment education is effective in improving their quality of life.

The Experience of Litigation From the Perspective of Midwives in Iran.

INTRODUCTION: Errors and notices to appear in court are a reality of life for many midwives and exert significant effects on both their professional and personal lives. Given the increasing population policies in place, this study was conducted to examine midwives' experiences of litigation in Iran. METHODS: A qualitative study was conducted in 2014 using an interpretive phenomenological approach. The interviews were recorded and transcribed and were then analyzed using the Diekelmann method. FINDINGS: Midwives who participated had professional experience ranging from 3 to 22 years at the time of the complaints. Five participants had received more than one complaint, and 10 participants were judged as guilty creating/leaving significant effects on various dimensions of their lives. CONCLUSION: The present research disclosed four main themes from the interviews including feeling ruined by the complaints, being conflicted between denial and belief, having shattered hopes of release, and experiencing the slowed-down rhythm of midwifery. From these, a basic pattern of "living in despair" was extracted. Litigation is a painful experience for midwives. Anxiety regarding compensation for the patients' losses, public judgment, prolonged litigations, and undermined professional dignity create physical and psychological ramifications for these midwives. Negative feelings about litigation, compounded by the lack of legal support from the authorities, cause a sense of hopelessness regarding the future of the midwifery profession.

Marital satisfaction through the lens of Iranian women: a qualitative study.

INTRODUCTION: One of the common concepts to show the happiness and stability of marriage is the concept of marital satisfaction. Marital satisfaction plays an important role in the stability of marriage. This study was conducted to explain the perception of marital satisfaction among Iranian women. METHODS: This study was conducted between March and September 2015 by common qualitative content analysis approach through semi-structured interviews and 19 participants were selected by purposive sampling. RESULTS: With the analysis of data two themes: (maturity of personality) which included a sub-theme of blossoming of feelings, and (romantic interaction) consisted of three sub-themes of; mutual support, sense of peace and joyful dependence emerged. CONCLUSION: Marital life can lead to the development of people and lovely interaction between them. Surely it needs to passing of time and self-knowing and couple-knowing of each other. Family consultants need the perception of how couple's interaction is, also they need to understand about couples who can communicate well to each other so they can overcome many life's other deficiencies.

Curcumin attenuates severity of premenstrual syndrome symptoms: A randomized, double-blind, placebo-controlled trial.

BACKGROUND: Most women experience premenstrual syndrome (PMS) at their reproductive age. PMS is a combination of psychological, physical and behavioral changes that interfere with familial communication and social activities. OBJECTIVES: Different methods have been suggested for treating PMS and one of them is herbal medicine. This study was done to evaluate the effects of curcumin on severity of PMS symptoms. METHODS: This research was a clinical trial, double-blinded study. After having identified persons suffering from PMS, participants were randomly allocated to placebo (n=35) and curcumin (n=35) groups. Then each participant received two capsules daily for seven days before menstruation and for three days after menstruation for three successive cycles and they recorded severity of the symptoms by daily record questionnaire. RESULTS: The baseline level of PMS symptoms of before intervention did not differ between groups. While after three consecutive cycles treatment with curcumin, total severity of PMS score had reduced from 102.06±39.64 to 42.47±16.37 (mean change: 59.59; 95% confidence interval [CI]: 46.19-72.99) and in Placebo, total severity of PMS score changed from 106.06±44.12 to 91.60±43.56 (mean change: 14.45; 95% CI: 2.69 to 26.22). Furthermore, difference between mean changes was significant (mean difference: 45.14; 95% CI: 6.10-14.98). CONCLUSIONS: Our results for the first time showed a potential advantageous effect of curcumin in attenuating severity of PMS symptoms, which were probably mediated by modulation of neurotransmitters and anti-inflammatory effects of curcumin.