Barriers to the participation of men in reproductive health care: a systematic review and meta-synthesis.

BACKGROUND: Despite emphasizing the importance and benefits of men's active engagement in reproductive health programs, their engagement in reproductive health care is low. Researchers have identified different barriers to men's avoidance of participation in various aspects of reproductive health in different parts of the world. This study provided an in-depth review of the hindrances to men's non-participation in reproductive health. METHODS: This meta-synthesis was conducted using keyword searches in databases including PubMed, Scopus, Web of Science, Cochrane, and ProQuest until January 2023. Qualitative English-language studies that investigated barriers to men's participation in reproductive health were included in the study. The critical appraisal skills program (CASP) checklist was used to assess the articles' quality. Data synthesis and thematic analysis were done using the standard method. RESULT: This synthesis led to the emergence of four main themes such as failure to access all inclusive and integrated quality services, economic issues, couples' personal preferences and attitudes, and sociocultural considerations to seek reproductive healthcare services. CONCLUSION: Healthcare system programs and policies, economic and sociocultural issues, and men's attitudes, knowledge, and preferences, influence men's participation in reproductive healthcare. Reproductive health initiatives should focus on eliminating challenges to men's supportive activities to increase practical men's involvement in reproductive healthcare.

Responding to the Essential Sexual and Reproductive Health Needs for Women During the COVID-19 Pandemic: A Literature Review.

The pandemic and its consequences have been shown to have a negative impact on the availability and accessibility of the basic services, including sexual and reproductive health (SRH) needs. The aim of this study was to investigate the responses to the essential SRH needs for women during the COVID-19 pandemic. This narrative review was conducted based on the Scale for Assessing Narrative Review Articles (SANRA), in order to present key activities for responding to the important SRH needs of women in the current COVID-19 pandemic. The literature search was performed through English databases of Cochrane Library, PubMed, Scopus and ScienceDirect, as well as Persian databases including Magiran and Scientific Information Database (SID). In addition, the World Health Organization (WHO), the Joint United Nations Programme on HIV and AIDS (UNAIDS) and the reports of Center for Disease Control and Prevention (CDC) were searched. The search was carried out from December 2019 up to 10 January 2021. Essential reproductive healthcare services for women during the COVID-19 pandemic were divided into six categories including access to contraception, safe abortion and post-abortion care, sexual health and sexually transmitted disease (STD) prevention, cervical cancer screening and prevention, maternity services and also addressing violence against women and girls. These essential needs should be considered as a priority by governments as well as public and private stakeholders. It seems that the implementation of the shifted strategies, active participation of public and private stakeholders, consideration of human rights and ethical issues, ensuring access to vulnerable populations, regular contact with individuals and the increased cooperation of individuals for responding to the SRH needs during the COVID-19 outbreak, are necessary.

The Establishment Of Shelters as A New Paradigm Towards Struggling With Violence Against Women: A Literature Review.

Objective: Shelters are an important part of a full response to survivors, as stated in many international conventions, such as the 1995 Beijing Declaration and Platform for Action (BDPfA). This study aims to provide a comprehensive perspective on the establishment of shelters for women survivors of violence. Materials and methods: This narrative review was conducted based on the Scale for the Assessment of Narrative Review Articles (SANRA). The MEDLINE, SCOPUS, Web of Science, Embase, Ovid, and EBSCO databases in English and Magiran and Scientific Information Database (SID) in Persian were searched for related documents. Also, WHO, the Joint United Nations Programme on HIV and AIDS (UNAIDS), the Centers for Disease Control and Prevention (CDC), and the United Nations Population Fund's (UNFPA) guidelines and instructions for shelter services for women and girls who have been subjected were searched up to July 31, 2023. A qualitative synthesis was carried out on the 28 eligible articles and instructions out of the 420 retrieved documents. Results: "A "shelter" describes emergency and temporary "safe accommodation for women and children who have been subjected to or are at risk of (typically male) domestic abuse. Types of shelters include emergency shelters or safe homes, second-stage or transitional housing facilities, third-stage housing, and alternative accommodation during (and occasionally after) the period of residence. The shelter delivers a wide range of services, including health services, socio-economic services, and legal services. These principles consisted of a comprehensive perspective, quality of service, organization, funding, and the right issues. Conclusion: Women who are survivors need holistic, interdisciplinary, and specialist care that focuses on safety and needs. The adoption of regulations with robust enforcement guarantees and the facilitation of approvals for the construction of non-governmental shelters and safe houses should be on the agenda setting.

Complementary and alternative medicine use in infertility: A review of infertile women's needs.

The use of complementary and alternative medicine (CAM) is common in infertile women in different countries. The purpose of the current study was to review the infertile women's needs in relation to CAM use. This narrative review was conducted through searching English databases including Scopus, PubMed, Embase, Web of Science, Cochrane library as well as Persian databases consisted of SID, and Magiran. The used keywords included "CAM/therapy, needs, and Infertility." All studies published in English peer-reviewed journals from conception to October 2020, which examined the infertile women's needs in the field of CAM use were included in the review. In the process of data extraction, two researchers screened the title, abstract, and full text of the articles. Out of the 2166 articles reviewed, 29 articles including six qualitative and mixed methods studies, four review, and 19 quantitative studies met the inclusion criteria. The results showed that infertile women have different needs in six domains consisted of educational and informational needs, the need for psychological counseling, supportive needs, the need for CAM use counseling, the need to treatment consistent with women's culture and demands, and the need to the integration of CAM with conventional medicine. Awareness of infertile women's needs toward CAM use can help health policymakers and planners in designing and implementing counseling services in accordance with the demands and culture of infertile couples. It also helps to develop a coherent program to integrate the use of CAM in the classical infertility treatment.

Domestic Violence against Infertile Women: A systematic review and meta-analysis.

Domestic violence (DV) against infertile women is an important health concern affecting their well-being. This systematic review and meta-analysis investigated the prevalence of DV against infertile women. The study was done based on the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guideline. Various international electronic databases were utilised in order to retrieve the necessary data. Articles were included if they were cross-sectional studies published in English and in Persian journals and investigated the prevalence of DV against infertile women up to May 2020. Out of 630 studies, 26 cross-sectional studies were systematically reviewed, from which 15 studies were included in the meta-analysis. The experiences of DV varied widely among the infertile women (14.987-88.918%). The results of meta-analysis showed that the prevalence of DV stood at 47.163% (95% Confidence Interval: 34.660-59.850). Psychological and emotional violence were among the most common types of violence. Considering the high rate of DV, it is recommended that policymakers address the issue by providing supportive care to such vulnerable populations, including educational and counselling services.

Metallated phthalocyanines and their hydrophilic derivatives for multi-targeted oncological photodynamic therapy.

BACKGROUND AND AIM: A photosensitizer (PS) delivery and comprehensive tumor targeting platform was developed that is centered on the photosensitization of key pharmacological targets in solid tumors (cancer cells, tumor vascular endothelium, and cellular and non-cellular components of the tumor microenvironment) before photodynamic therapy (PDT). Interstitially targeted liposomes (ITLs) encapsulating zinc phthalocyanine (ZnPC) and aluminum phthalocyanine (AlPC) were formulated for passive targeting of the tumor microenvironment. In previous work it was established that the PEGylated ITLs were taken up by cultured cholangiocarcinoma cells. The aim of this study was to verify previous results in cancer cells and to determine whether the ITLs can also be used to photosensitize cells in the tumor microenvironment and vasculature. Following positive results, rudimentary in vitro and in vivo experiments were performed with ZnPC-ITLs and AlPC-ITLs as well as their water-soluble tetrasulfonated derivatives (ZnPCS4 and AlPCS4) to assemble a research dossier and bring this platform closer to clinical transition. METHODS: Flow cytometry and confocal microscopy were employed to determine ITL uptake and PS distribution in cholangiocarcinoma (SK-ChA-1) cells, endothelial cells (HUVECs), fibroblasts (NIH-3T3), and macrophages (RAW 264.7). Uptake of ITLs by endothelial cells was verified under flow conditions in a flow chamber. Dark toxicity and PDT efficacy were determined by cell viability assays, while the mode of cell death and cell cycle arrest were assayed by flow cytometry. In vivo systemic toxicity was assessed in zebrafish and chicken embryos, whereas skin phototoxicity was determined in BALB/c nude mice. A PDT efficacy pilot was conducted in BALB/c nude mice bearing human triple-negative breast cancer (MDA-MB-231) xenografts. RESULTS: The key findings were that (1) photodynamically active PSs (i.e., all except ZnPCS4) were able to effectively photosensitize cancer cells and non-cancerous cells; (2) following PDT, photodynamically active PSs were highly toxic-to-potent as per anti-cancer compound classification; (3) the photodynamically active PSs did not elicit notable systemic toxicity in zebrafish and chicken embryos; (4) ITL-delivered ZnPC and ZnPCS4 were associated with skin phototoxicity, while the aluminum-containing PSs did not exert detectable skin phototoxicity; and (5) ITL-delivered ZnPC and AlPC were equally effective in their tumor-killing capacity in human tumor breast cancer xenografts and superior to other non-phthalocyanine PSs when appraised on a per mole administered dose basis. CONCLUSIONS: AlPC(S4) are the safest and most effective PSs to integrate into the comprehensive tumor targeting and PS delivery platform. Pending further in vivo validation, these third-generation PSs may be used for multi-compartmental tumor photosensitization.

Attritional evaluation of lipophilic and hydrophilic metallated phthalocyanines for oncological photodynamic therapy.

BACKGROUND AND AIM: Oncological photodynamic therapy (PDT) relies on photosensitizers (PSs) to photo-oxidatively destroy tumor cells. Currently approved PSs yield satisfactory results in superficial and easy-to-access tumors but are less suited for solid cancers in internal organs such as the biliary system and the pancreas. For these malignancies, second-generation PSs such as metallated phthalocyanines are more appropriate. Presently it is not known which of the commonly employed metallated phtahlocyanines, namely aluminum phthalocyanine (AlPC) and zinc phthalocyanine (ZnPC) as well as their tetrasulfonated derivatives AlPCS4 and ZnPCS4, is most cytotoxic to tumor cells. This study therefore employed an attritional approach to ascertain the best metallated phthalocyanine for oncological PDT in a head-to-head comparative analysis and standardized experimental design. METHODS: ZnPC and AlPC were encapsulated in PEGylated liposomes. Analyses were performed in cultured A431 cells as a template for tumor cells with a dysfunctional P53 tumor suppressor gene and EGFR overexpression. First, dark toxicity was assessed as a function of PS concentration using the WST-1 and sulforhodamine B assay. Second, time-dependent uptake and intracellular distribution were determined by flow cytometry and confocal microscopy, respectively, using the intrinsic fluorescence of the PSs. Third, the LC50 values were established for each PS at 671 nm and a radiant exposure of 15 J/cm2 following 1-h PS exposure. Finally, the mode of cell death as a function of post-PDT time and cell cycle arrest at 24 h after PDT were analyzed. RESULTS: In the absence of illumination, AlPC and ZnPC were not toxic to cells up to a 1.5-µM PS concentration and exposure for up to 72 h. Dark toxicity was noted for AlPCS4 at 5 µM and ZnPCS4 at 2.5 µM. Uptake of all PSs was observed as early as 1 min after PS addition to cells and increased in amplitude during a 2-h incubation period. After 60 min, the entire non-nuclear space of the cell was photosensitized, with PS accumulation in multiple subcellular structures, especially in case of AlPC and AlPCS4. PDT of cells photosensitized with ZnPC, AlPC, and AlPCS4 yielded LC50 values of 0.13 µM, 0.04 µM, and 0.81 µM, respectively, 24 h post-PDT (based on sulforhodamine B assay). ZnPCS4 did not induce notable phototoxicity, which was echoed in the mode of cell death and cell cycle arrest data. At 4 h post-PDT, the mode of cell death comprised mainly apoptosis for ZnPC and AlPC, the extent of which was gradually exacerbated in AlPC-photosensitized cells during 8 h. ZnPC-treated cells seemed to recover at 8 h post-PDT compared to 4 h post-PDT, which had been observed before in another cell line. AlPCS4 induced considerable necrosis in addition to apoptosis, whereby most of the cell death had already manifested at 2 h after PDT. During the course of 8 h, necrotic cell death transitioned into mainly late apoptotic cell death. Cell death signaling coincided with a reduction in cells in the G0/G1 phase (ZnPC, AlPC, AlPCS4) and cell cycle arrest in the S-phase (ZnPC, AlPC, AlPCS4) and G2 phase (ZnPC and AlPC). Cell cycle arrest was most profound in cells that had been photosensitized with AlPC and subjected to PDT. CONCLUSIONS: Liposomal AlPC is the most potent PS for oncological PDT, whereas ZnPCS4 was photodynamically inert in A431 cells. AlPC did not induce dark toxicity at PS concentrations of up to 1.5 µM, i.e., > 37 times the LC50 value, which is favorable in terms of clinical phototoxicity issues. AlPC photosensitized multiple intracellular loci, which was associated with extensive, irreversible cell death signaling that is expected to benefit treatment efficacy and possibly immunological long-term tumor control, granted that sufficient AlPC will reach the tumor in vivo. Given the differential pharmacokinetics, intracellular distribution, and cell death dynamics, liposomal AlPC may be combined with AlPCS4 in a PS cocktail to further improve PDT efficacy.

Factors affecting the choice of type of delivery with breast feeding in Iranian mothers.

OBJECTIVE: This study assessed the factors affecting the choice of type of delivery with breast feeding in Iranian mothers. METHODS: This Cross section descriptive analytic study was performed using a random sampling technique, using data from 400 pregnant women who attended the maternity centers in Borazjan and Kazerun in Iran in 2014. A questionnaire covering demographic characteristics, mode of delivery and postpartum conditions was completed for each mother. Descriptive analysis and Chi square test were used along with SPSS 23 software to statistically analyze the data and p-value less than 0.05 was considered for statistical significance. RESULTS: In this study, the rate of normal delivery and cesarean operation are considered equal. In the main factors influencing the choice of delivery, mothers' education level (p=0.028) and pregnancy status (p=0.041) showed a significant relationship. Although no significant association between child nutrition with the type of delivery was found, duration of breastfeeding with the type of delivery showed significant association (p=0.046). CONCLUSION: Although cesarean delivery in many cases is life-saving for mother and fetus; in addition to medical indications, parents with higher education and pregnancy status are also important factors in increasing the rate of cesarean section compared to vaginal delivery. Babies of mothers with normal delivery had a longer time of breastfeeding. Further studies in Iran are necessary, regarding the reasons for high cesarean section and their outcomes.

The Relation of Pre and Postnatal Depression and Anxiety with Exclusive Breastfeeding.

INTRODUCTION: Studies on the relationship between prenatal psychosocial risk factors and breastfeeding are disjointed. Maternal health status has a great influence on breastfeeding, growth, and general health of the neonates. The aim of this study was to ascertain the relation between maternal mental health and breastfeeding status of mothers in Kazerun (Fars province, Iran). METHODS: This cross-sectional study was conducted on a total of 92 pregnant women recruited from clinics in Kazerun in 2015. Participants were divided into two groups subject to exclusive breastfeeding. Spielberger Anxiety Inventory, Beck Depression Inventory and Edinburgh Postnatal Depression Scale (EPDS) were used for data collection. Data analysis was performed by the SPSS version 16 using descriptive statistics, Chi-square, and Fisher's exact test. RESULTS: The average of state anxiety score according to Spielberger Anxiety Inventory was 1.97±0.51 in the exclusive breastfeeding group versus 1.77±0.66 in the non-exclusive breastfeeding group (p = 0.229). The mean trait anxiety score according to Spielberger Anxiety Inventory was 1.98±0.44 in the exclusive breastfeeding group versus 2.22±0.44 in the non-exclusive breastfeeding group (p=0.132). An average of Beck Depression Inventory score was 1.35±0.84 totally (1.33±0.81 in the exclusive breastfeeding group vs. 1.33±1.00, P=0.584). An average of EPDS score was 1.65±1.11, 1.64±1.11, and 1.44±0.88 in total, in the exclusive breastfeeding and non-exclusive breastfeeding groups, respectively (p=0.604). CONCLUSIONS: Screening anxiety and depression before and during pregnancy appeared to be necessary.

Effects of tail fat on recovery times of anesthesia with isoflurane in fat-tailed Iranian Lori-Bakhtiyari lambs.

In the present study, the effect of tail fat on recovery times in intact sheep and sheep with a ligated median sacral artery following similar anesthetic exposure with isoflurane was investigated. This study was performed using seven healthy fat-tailed Iranian Lori-Bakhtiyari ewe lambs. The lambs were anesthetized twice at two week intervals (the experiment was performed in two stages). After mask induction with isoflurane in 100% oxygen, sheep were intubated and anesthesia was maintained for 4 hr using a rebreathing system. Induction and extubation times and time to sternal recumbency and attempts to stand were recorded during anesthetic induction and recovery (Stage 1). Two weeks later, prior to the second anesthesia, the median sacral artery (MSA) was ligated under epidural anesthesia in sheep. All sheep were anesthetized as mentioned above (Stage 2). No significant differences were observed for the induction time between two stages (p > 0.05) but extubation, sternal recumbency and attempts to stand times were significantly longer in intact sheep (Stage 1) after 4 hr anesthesia with isoflurane (p < 0.05). Recovery time was decreased following MSA ligation in fat-tailed sheep, which suggested that body fat had a major role in the recovery time of isoflurane in sheep. We developed an animal model to investigate fat drug solubility of isoflurane gas. Therefore, using less-soluble in fat anesthetics is better than high-soluble anesthetics for prolonged anesthesia to decrease postoperative complication in obese patient.

Comparison of the effects of Matricaria chamomila (Chamomile) extract and mefenamic acid on the intensity of premenstrual syndrome.

The study aimed to compare the effects of Chamomile Extract and Mefenamic acid (MA) on the intensity of Premenstrual syndrome (PMS) symptoms. This study was a clinical randomized double blind trial, carried out with 90 students living in the dorms of Iran. The participants filled the daily forms about the intensity of PMS for two consecutive months. Once the definitive diagnosis of PMS was made, the participants were divided into two groups, each receiving either Chamomile capsule 100 mg or MA 250 mg three times a day. Intensity reduction of emotional symptoms was significantly higher among Chamomile Extract-users (30.1 ± 26.6 and 33.4 ± 25.3 percent) than that among MA-users (11.6 ± 25.7 and 10.7 ± 26.8 percent) after two cycles intervention (p < 0.001). Intensity reduction of physical symptoms was not significantly different (p > 0.05) among groups. Consumption of Chamomile seems to be more effective than MA in relieving the intensity of PMS associated symptomatic psychological pains.