Effectiveness of Sexual Skills Training Program on Promoting Sexual Intimacy and Satisfaction in Women in Tehran (Iran): A randomized clinical Trial Study.

PURPOSE: The purpose of this study was to evaluate the effectiveness of sexual skills training on intimacy and sexual satisfaction in women. MATERIALS AND METHODS: This is a randomized clinical trial study with parallel design. 70 participants (n=35 each) were divided into 2 groups as control and intervention groups. Women were selected in multiple steps. Some requirements for inclusion criteria were: obtaining a standard score of marital satisfaction, women with a record of 6-24 months of marital life, not having a record of abortion, stillborn birth and not being in pregnancy period, not having a child, not suffering from an acute or chronic and serious disease, not having a surgery on pelvic organs, minimum elementary education of the couples and being Iranian. Some factors for exclusion criteria were: women's absence in more than 2 training classes, pregnancy during the study. Data collection was conducted through four questionnaires: demographic characteristics, marital satisfaction, sexual satisfaction and sexual intimacy. Validity and reliability of the questionnaires were measured through content validity and Chronbach Alpha, respectively. The data extracted from the questionnaires were analyzed using SPSS software, version 18.0. For data analysis, descriptive statistics, independent t-test, paired t-test, or non-parametric tests were applied. Significance level of the test was considered p<0.05. RESULTS: The results showed that sexual skills training leads to promotion of sexual satisfaction (p<0.001) and sexual intimacy (p<0.001) among the women in intervention group and the impact of training was stable two months after completion of intervention. CONCLUSION: In total, the training lessons gave positive views to participants towards their sexual issues so that they formed realistic and positive sexual expectations, healthier sexual behaviors and self-expressions and consequently, gained more sexual knowledge that made them able to experience more intimacy and satisfaction in sexual relationships with their spouses.

Effects of acupressure on the childbirth satisfaction and experience of birth: A randomized controlled trial.

BACKGROUND: Complementary and alternative medicines have been used to increase comfort and relaxation in mothers during labor. Comforting and preparing the mother in labor can create a positive birth experience. The aim of this study was to evaluate the effect of acupressure on childbirth satisfaction and the experience of giving birth in women with full-term pregnancy, before the onset of labor. METHODS: In 2016, a randomized clinical trial study was conducted in Shahid Akbar Abadi Hospital, Tehran, Iran, enrolling 120 pregnant women at 39-40 gestational weeks with no signs of the onset of labor. They were divided randomly into acupressure, sham acupressure, and control groups. Acupressure points including SP6, BL 60, and BL 32 were pressured bilaterally. Interventions were performed by the researcher, the mother and her relative (husband). Childbirth satisfaction was measured 24 h after delivery. The collected data were analyzed by SPSS software and comparing tests were Chi-squared, Kruskal-Wallis, ANOVA tests (P ≤ 0.05). RESULTS: The total childbirth satisfaction did not differ significantly among the three groups (P = 0.460), but the acupressure group had a higher level of satisfaction than the other two groups. Moreover, statistical tests regarding the expectations of the childbirth experience showed a significant difference among the groups (P = 0.033). The actual birth was closest to the expectations of subjects in the acupressure group. CONCLUSION: This study demonstrated that acupressure may be used as a method in order to attempt to provide a good birth experience and satisfaction of childbirth.

Addressing the Sexual Function of Women During First Six Month After Delivery: Aquasi-Experimental Study.

INTRODUCTION: Pregnancy and childbirth are important periods of women's life that cause hormonal and bodily changes, and these changes could have significant effects on sexual function. AIM: The aim of this study was to assess the effectiveness of PLISSIT-based counselling model on the sexual function of women during the first six months after childbirth. MATERIAL AND METHODS: This was a randomized controlled clinical trial study from June to November, 2015. Ninety lactating women,with at least one sexual problem, were included in this study. Samples were recruited and randomized into two groups (intervention group and control group). Demographic and obstetric information, Edinberg postpartum depression, Larson's sexual satisfaction and female sexual function index questionnaire were used. Data were collected from participants at two points: before consultation and 4weeks after consultation. The statistical analyses were performed using SPSS software and Data were analyzed using the Paired t-test,dependent t-test with parametric data and Chi-square tests. RESULTS: Ninety women who were the nulliparous and lactating criteria subjects were randomly divided into two groups and all recruited women completed the questionnaires. Mean score of sexual function was 19.35 before consultation and 27.90 after consultation in experimental group. In the control group, mean score of sexual function was 20.55 before consultation and 22.41 after consultation. These differences were statistically significant in pre-counseling stage and 4 weeks after counseling in the two groups (P<0.001 and P=0.002). Four weeks after consultation, there was significant difference in the mean score of sexual function between the control and experimental groups (P<0.001). CONCLUSION: Based on the result of this study, sexual problems in lactating women decreased by using the PLISSIT model. The use of the PLISSIT model is recommended in health care setting.

The examination of quality of pregnancy care based on the World Health Organization's "Responsiveness" model of selected pregnant women in Tehran.

INTRODUCTION: The World Health Organization (WHO) Responsiveness model showing the ability of health systems in fulfilling people's expectations in connection with nonclinical aspects is an appropriate pattern to assess healthcare. The purpose of this study was to determine the status of pregnancy care provisions based on the responsiveness model. METHODS: This was a cross-sectional study conducted by randomly sampling 130 women visiting selected hospitals in Tehran in 2015. A researcher-made questionnaire based on the responsiveness model of WHO was used to collect data. We determined the face validity and content validity of the questionnaire, and its reliability was confirmed by Cronbach's alpha coefficient (0.94) and test-retest analysis (0.96). The obtained data were analyzed by SPSS version 20 descriptive statistics, t-test, one-way ANOVA, Pearson product-moment correlation coefficient, and Spearman correlation. RESULTS: Total responsiveness from the perspective of service recipients was 69.46±14.65 from 100. The obtained scores showed that, in the range of 0 to 100, 73.02 were about basic amenities (the most score), 72.93 about dignity, 70.91 about communication, 70.76 about confidentiality, 66.30 about provision social needs, 65.96 about choice of provider, 65.92 about autonomy, and 52.65 about prompt attention (the lowest score), which are representing the average level of service quality. There were significant relationships between participating in preparation class of labor and dignity (p<0.001), autonomy (p=0.01), provision social needs (p=0.01), and overall responsiveness (p=0.03). It was obtained that there is a significant linear relationship between scores given to hospitals and dimensions of responsiveness (p=0.05). Findings indicated a significant relationship between insurance type and dimensions of choice of provider (p=0.03) and communication (p=0.03). CONCLUSION: The mean score of service quality in the present investigation illustrated that nonclinical dimensions have been disregarded and it has potential to be better. So some grand plans are needed.

Effect of Breathing Technique of Blowing on the Extent of Damage to the Perineum at the Moment of Delivery: A Randomized Clinical Trial.

INTRODUCTION: One of the important tasks in managing labor is the protection of perineum. An important variable affecting this outcome is maternal pushing during the second stage of labor. This study was done to investigate the effect of breathing technique on perineal damage extention in laboring Iranian women. MATERIALS AND METHODS: This randomized clinical trial was performed on 166 nulliparous pregnant women who had reached full-term pregnancy, had low risk pregnancy, and were candidates for vaginal delivery in two following groups: using breathing techniques (case group) and valsalva maneuver (control group). In the control group, pushing was done with holding the breath. In the case group, the women were asked to take 2 deep abdominal breaths at the onset of pain, then take another deep breath, and push 4-5 seconds with the open mouth while controlling exhalation. From the crowning stage onward, the women were directed to control their pushing, and do the blowing technique. RESULTS: According to the results, intact perineum was more observed in the case group (P = 0.002). Posterior tears (Grade 1, 2, and 3) was considerably higher in the control group (P = 0.003). Anterior tears (labias) and episiotomy were not significantly different in the two groups. CONCLUSIONS: It was concluded that breathing technique of blowing can be a good alternative to Valsalva maneuver in order to reduce perineal damage in laboring women.

The effect of acupressure on the initiation of labor: A randomized controlled trial.

BACKGROUND: Induction of labor is a common obstetric procedure. Acupressure is a natural method that is used for inducing uterine contractions. Nevertheless, few studies have examined the impact of acupressure on the induction of labor. AIM: The aim of this study was to evaluate the effect of acupressure on the initiation of labor. MATERIAL AND METHODS: In this randomized clinical trial, 162 nulliparous pregnant women were admitted to the hospital. They were categorized into 3 groups; acupressure, sham acupressure and control. Acupressure points SP6, BL 60 and BL 32 were pressured bilaterally. The intervention was done by the researcher every other day between 9 am and 11 am. The intervention was carried out on women in the afternoon and the following day. Subjects were examined to determine the initiation of labor symptoms48 and 96h after the start of intervention and at the time of hospitalization. Data were analyzed using the ANOVA, Kruskal-Wallis and Chi-square tests (p<0.05). RESULTS: There was no significant difference among the groups for spontaneous initiation of labor within 48h (P=0.464), and 49-96h after beginning the intervention (P=0.111) and 97h after beginning the intervention to the time of hospitalization for the spontaneous initiation of labor (P=0.897). There were no significant differences in the secondary outcomes between the groups. CONCLUSION: According to the finding of this study, it seems that acupressure treatment was not effective in initiating labor as compared with the sham acupressure and the routine care groups.

Scale Development and Psychometrics for Parents' Satisfaction with Developmental Care in Neonatal Intensive Care Unit.

OBJECTIVE: Developmental care comprises a wide range of medical and nursing interventions used in the neonatal intensive care unit (NICU) to mitigate and reduce stressors affecting preterm or ill neonates. Because patient satisfaction survey is a valuable quality improvement tool, we aimed to develop and test the psychometric properties of a tool for measuring parent satisfaction of developmental care in the NICU. MATERIALS &METHODS: In this psychometric methodological study, the item pool and initial questionnaire were designed based on a comprehensive literature review and exploring NICU parent satisfaction questionnaires. The validity of the designed questionnaire was determined using face, content (qualitative and quantitative), and construct validity. Exploratory factor analysis was performed using responses from 400 parents of infants hospitalized in the NICUs of 34 hospitals in 2015 in Tehran, Iran. The reliability of the questionnaire was identified using Cronbach's alpha and stability measures. RESULTS: The initial questionnaire was designed with 72 items in five domains. After testing the face validity, 3 items were omitted. The results of validity testing were acceptable. The exploratory factor analysis was performed on 69 items, and 5 factors (care and treatment with 20 items, information with 15 items, hospital facilities with 9 items, parental education with 7 items, and parental participation with 8 items) were extracted. The reliability was supported by high internal consistency (α = 0.92). CONCLUSION: This questionnaire could be valid and reliable tool for measuring parents' satisfaction.

Development and psychometric testing of a scale for the assessment of the quality of developmental care in neonatal intensive care units in Iran.

INTRODUCTION: Developmental care provided to infants hospitalized at neonatal intensive care units (NICU) help weaken environmental stressors and reduce infant morbidity rates. Assessments are the first step to improving the quality of any type of care. Therefore, this study was conducted to design and assess the psychometric features of a scale designed for measuring quality of developmental care in the NICU in Iran. METHODS: This study was conducted from December 2014 through September 2015 in Tehran, Iran. The present mixed-methods sequential exploratory (quantitative-qualitative) study used the Delphi method to design an initial questionnaire through a review of the literature and by using the input of experts. The validity of the questionnaire was ensured by assessing then validity of its content (qualitative-quantitative), face (qualitative-quantitative), and construct (exploratory factor analysis with 500 NICU personnel from 34 hospitals in Tehran), and its reliability was ensured by assessing its internal consistency (using Cronbach's alpha) and by assessing its stability through the test-retest method. RESULTS: The qualitative stage of the study resulted in a 93-item questionnaire with eight domains. After performing the content and face analyses, a factor analysis was performed on 90 items of the questionnaire, yielding a 76-item questionnaire with five domains, including "sleep, pain and stress management," "routine care," "the family," "management," and "sensory care," which explained 62.5% of the variance. The reliability of the questionnaire was confirmed with a Cronbach's alpha of 0.9 and its stability was confirmed by an Intraclass Correlation Coefficient (ICC) of 0.93. CONCLUSION: The questionnaire developed for the assessment of developmental care in the NICU covered all of the dimensions of this type of care, and it is a valid and reliable tool for assessing and improving developmental care in the NICU.

Effect of Acupressure on Cervical Ripening.

BACKGROUND: Cervical ripening is one of the main stages of initiation labor. Acupressure in Chinese medicine is considered as an invasive technique, which through reliving oxytocin ripens the cervix. Acupoint Sanyinjiao (SP6) was selected in this study because it is the acupoint selected in gynecology and it is easy for women to locate and apply pressure without medical assistance. OBJECTIVES: The aim of this study was to determine the effect of acupressure on cervical ripening. PATIENTS AND METHODS: In this randomized clinical trial, 150 primigravida with term pregnancy who had referred to Deziani hospital in Gorgan were chosen and divided to three groups: in the first group acupressure was done by the researcher while in the second groups this was performed by the mother her self, and the third group served as a control and only received routine care. For both intervention groups the pressure was applied on Sp6 for about 20 minutes during one to five days. Elements were checked from cervical ripening at 48 and 96 hours after intervention and at the time of hospitalization. The tools for gathering information included demographic characteristics and midwifery history questionnaire, daily records and follow up forms. Content validity was used for validity of tools. Reliability of the observation check-list and physical examination was confirmed by inter-rater scores (inter observer), and daily records by test-re-test. Data was analyzed by analysis of variance (ANOVA), Kruskal-Wallis and Chi-squared tests (P ≤ 0.05). RESULTS: There was a significant difference between mothers' educations in the three groups. Most of the mothers (59.5%) in the researcher-performed acupressure group had secondary education. Cervical ripening was significantly different between the three groups after 48 hours (P ≤ 0.05), yet there was no significant difference after 96 hours and at the time of admission. Mean Bishop score was enhanced after 48 hours in the researcher-performed acupressure group (P ≤ 0.021) and the self-performed acupressure group (P ≤ 0.007) in comparison to the control group. CONCLUSIONS: The results showed that acupressure is a safe technique and leads to cervical ripening. Thus, regarding the desired results that were achieved when mothers applied acupressure themselves, it could be suggested that it is beneficial for mothers to be trained to apply this method at home.

Amelioration of lipid abnormalities by vitamin therapy in women using oral contraceptives.

OBJECTIVE: Combined oral contraceptives (COCs) have some adverse effects on the serum lipid profile. Because hyperlipidemia is one of the risk factors in cardiovascular diseases, lipid abnormalities should be evaluated in women consuming COCs. Vitamins E and C are known to have beneficial effects on serum lipid profiles. Therefore, in this study, we evaluated the effects of vitamins E and C on serum lipids in women using COCs. METHODS: The study compared changes in lipid parameters with and without vitamin therapy in women consuming COCs compared to those of a control group (40 non-contraceptive users or NCU) for 4 weeks. Total cholesterol and triglyceride, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) levels along with HDL/LDL ratios were measured for all participants. RESULTS: COC users experienced significantly higher increases in the levels of triglycerides and LDL than non-users (p<0.05). However, no significant differences were noted in the total cholesterol and HDL levels. In the treated COC group receiving vitamins E and C, the HDL level and the HDL/LDL ratio increased and the LDL and triglycerides levels decreased significantly compared with those of the other groups. CONCLUSION: The results of our study indicate that supplementation with antioxidant vitamins E and C restores a normal lipid profile in COC users.

Quality of life and its related factors among Iranian cervical cancer survivors.

BACKGROUND: Cervical cancer is the main cause of malignancy-related death among women living in developing countries. OBJECTIVE: The aim of this study is to evaluate the quality of life (QOL) among Iranian cervical cancer survivors and its relationships with demographic and disease related factors. PATIENTS AND METHODS: A descriptive correlational study was carried out on 65 consecutive cervical cancer survivors in three different oncology centers related to Shahid Beheshti University of Medical Sciences, Tehran. The QOL was evaluated using three different standard questionnaires: 1) EORTC QLQ-C30 for patients with malignant tumors; 2) EORTC QLQ-CX24 for cervical cancer patients; and 3) SSQ for assessing the social support. The data was obtained by telephone interviews. The test-retest reliability and internal consistency of the scales were examined. Cronbach's alpha was calculated to assess internal consistency among items. Content validity was assessed to review the scales. RESULTS: Cervical cancer survivors stated a good QOL. However, its score was negatively associated with symptoms including short breathing, lack of appetite, nausea and vomiting, sleep disorders, peripheral neuropathy, and menopausal symptoms. Also, there was a positive association between QOL and economic conditions as well as QOL and social functioning. CONCLUSIONS: Although, the QOL in cervical cancer survivors was good, treatment of related symptoms can influence the QOL and improve the care of these patients.

The effects of acupressure on severity of primary dysmenorrhea.

BACKGROUND: Dysmenorrhea constitutes one of the most frequent disorders in women of a fertile age. The objective of this research was to determine the effects of acupressure at Sanyinjiao (SP6) point and DiJi (SP8) point on pain severity of primary dysmenorrhea and the associated systemic symptoms. MATERIALS AND METHODS: In this crossover clinical trial, 50 females aged 18-30 years old who met the study criteria and were under the care of Sarpolezahab Health Center were selected. Subjects were randomly assigned to one of two groups and evaluated during three menstrual cycles. We evaluated pain severity using the McGill pain scale and associated systemic symptoms using a verbal multidimensional scoring system. Data acquired from 42 cases were analyzed using SPSS software, with a P value of <0.05 considered significant. RESULTS: The findings of our study indicate that the severity of dysmenorrhea pain diminishes significantly for up to 2 hours following treatment with acupressure at the SP6 and SP8 points (P < 0.001). Furthermore, the severity of associated systemic symptoms reduced significantly after acupressure at the SP6 and SP8 points, except for nausea and vomiting. Comparison of the severity of systemic symptoms with acupressure at the SP6 and SP8 points revealed no significant difference except for severity of fatigue, which was reduced significantly further with SP6 point compared to SP8 point (P = 0.004). CONCLUSION: Acupressure at the SP6 and SP8 points can reduce pain severity of dysmenorrhea for up to 2 hours after application, and these points may be used to alleviate the severity of systemic symptoms accompanying dysmenorrhea.

Commentary: childbirth education in iran.

With regard to childbirth, the role of every health-care system is to improve maternity care as well as the birth experience of women and their family members. Despite many efforts to improve maternity care in the Islamic Republic of Iran, the nation's childbirth care still faces a tremendous amount of unnecessary intervention and, consequently, a high rate of cesarean births. This article describes the strengths and weaknesses of Iran's maternity-care system and childbirth education in light of evidence-based practice.