Cyclic Progesterone Therapy in Androgenic Polycystic Ovary Syndrome (PCOS)-A 6-Month Pilot Study of a Single Woman's Experience Changes.

Background and Objectives: Women with androgenic Polycystic Ovary Syndrome (PCOS) have increased endometrial cancer risk that cyclic progesterone will prevent; it may also reverse PCOS's neuroendocrine origins. This pilot study's purpose was to document 6-month experience changes in a woman with PCOS taking cyclic progesterone therapy because she was intolerant of combined hormonal contraceptive therapy, the current PCOS standard of care. A 31-year-old normal-weight woman with PCOS had heavy flow, irregular cycles, and was combined hormonal contraceptives-intolerant. She was prescribed cyclic oral micronized progesterone (OMP) (300 mg/h.s. cycle days 14-27). She kept Menstrual Cycle Diary© (Diary) records, starting with the 1st treatment cycle for six cycles; she was on no other therapy. Statistical analysis a priori hypothesized progesterone decreases high estradiol (E2) experiences (flow, cervical mucus, fluid retention, front-of-the-breast tenderness and anxiety); analysis focused on these. Our objectives: (1) changes from cycles 1 to 6 in E2-related experiences; and (2) follicular phase E2-related changes from cycle 1 (no therapy) to cycles 3 and 6. Materials and Methods: Data from consecutive Diaries were entered into an SPSS database and analyzed by Wilcoxon Signed Rank Test (Objective #1) within-person whole cycle ordinal data, and (Objective #2 follicular phase) repeated measures ANOVA. Results: Cyclic OMP was associated with regular, shorter cycles (±SD) (28.2 ± 0.8 days). Comparison of cycles 1-6 showed decreased fluid retention (p = 0.001), breast tenderness (p = 0.002), and cervical mucus (p = 0.048); there were no changes in flow or anxiety. Fluid retention in the follicular phase also significantly decreased over time (F (1.2, 14.7) = 6.7, p = 0.017). Conclusions: Pilot daily Diary data suggest women with PCOS have improved everyday experiences on cyclic progesterone therapy. Larger prospective studies with more objective outcomes and randomized controlled trials of this innovative PCOS therapy are needed.

Adolescent use of combined hormonal contraception and peak bone mineral density accrual: A meta-analysis of international prospective controlled studies.

OBJECTIVE: Many women use combined hormonal contraceptives (CHC) during adolescence during which they are accruing peak areal bone mineral density (BMD) that relates to lifetime fracture risk. To build BMD requires formation with which CHC-related exogenous oestrogen may interfere. We compared peak BMD accrual in adolescents using and not using CHC. DESIGN/PARTICIPANTS: We performed literature searches for prospective published peer-reviewed articles providing 12- to 24-month BMD change in adolescent (12- to 19-year-old) women using CHC vs CHC-unexposed control women. METHODS: Meta-analyses used random-effects models to assess BMD change rate at lumbar spine (LS) and other sites in adolescent CHC users vs CHC nonusers. RESULTS: Literature searches yielded 84 publications of which nine were eligible. Adolescent-only data were sought from cohorts with wider age inclusions. The 12-month LS meta-analysis with eight paired comparisons in 1535 adolescents showed a weighted mean BMD difference of -0.02 (95% confidence interval [CI]: -0.05 to 0.00) g/cm2 in CHC-exposed adolescents (P = 0.04). The 24-month LS meta-analysis with five paired comparisons in 885 adolescents showed a highly significant weighted mean BMD difference of -0.02 (95% CI: -0.03 to -0.01) g/cm2 in CHC-exposed adolescents (P = 0.0006). Heterogeneities by I2 were 96% and 85%, respectively. Insufficient data for other bone sites precluded quantitative analysis. CONCLUSION: Given that adolescent exposure to CHC appears to be increasing, this evidence for potential impairment of peak spinal BMD accrual is of concern and suggests a potential public health problem. Randomized controlled trial data are needed to determine CHC effects on adolescent bone health.

Inverse relation between fruit and vegetable intake and the risk of gestational diabetes mellitus.

Background: The aim of this study was to investigate the association of intakes of fruit, vegetable and dairy with gestational diabetes mellitus (GDM). Methods: This prospective study was conducted over a 17 month period, on a random sample of pregnant women (n = 1026), aged 18-45 y, in their first half of pregnancy, attending prenatal clinics in five hospitals' affiliated to universities of medical sciences in different districts of Tehran, Iran. Dietary intakes were assessed during gestational age ≤ 6 weeks using a 168-item validated semi-quantitative food frequency questionnaire. Between 24 and 28 weeks of gestation, all pregnant women underwent a scheduled 100 g 3-h oral glucose tolerance test. Diagnosis of GDM was based on criteria set by the American Diabetes Association. Results: Of 1026 study participants, 71 had GDM, with a mean age and pre-pregnancy BMI of 26.7 ± 4.3 y and 25.4 ± 4.5 Kg/m2, respectively. High fruit and vegetable intakes were negatively associated with GDM risk. Compared with women who consumed < 2.1 servings/day, odds ratio (ORs) for those who consumed ≥ 4.9 servings/day was 0.44 (95% CI: 0.20-0.93), after adjustment for confounding factors. Fruit and vegetable intakes were significantly and inversely associated with the GDM; ORs (95% CIs) for GDM among participants with the highest, compared to the lowest quartiles were 0.48 (0.18-0.89) for fruit and 0.46 (0.22-0.99) for vegetables intake. No association was found between dairy products and GDM. Conclusions: Fruit and vegetable consumption in women of reproductive age have beneficial effects in the prevention of GDM.

Anti-hemorrhagic activity of Punica granatum L. flower (Persian Golnar) against heavy menstrual bleeding of endometrial origin: a double-blind, randomized controlled trial.

BACKGROUND: Heavy menstrual bleeding of endometrial origin (HMB) is a major healthcare problem in premenopausal women and affects several aspects of women's health and quality of life (QoL). The aim of this study was to compare the efficacy of Persian Golnar (PG) and tranexamic acid (TA) on heavy menstrual bleeding of endometrial origin (HMB) and patients' QoL. METHODS: A double-blind randomized controlled trial with parallel design and block randomization technique was conducted. A total of 94 women with HMB were randomly assigned to take either PG or TA for 5 days from day 1 of menses for three consecutive menstrual cycles. Blood loss was measured by the pictorial blood loss assessment chart (PBAC). Hematological assessments were made before the intervention and after treatment. QoL as a secondary outcome was evaluated using SF-36 and the menorrhagia questionnaire (MQ). Statistical analysis was performed using t-test, paired ttest, χ2 test, Mann-Whitney test, and Wilcoxon signed-rank test. RESULTS: In each group, 38 women (80.8%) completed the 3-month follow-up. Both PG and TA reduced blood loss. PBAC mean (SD) score was reduced from 304.92 (176.17) and 304.44 (192.72) to 164.60 (100.24) and 143.13 (96.07) after the third treatment cycle, respectively (p< 0.001). Furthermore, mean hemoglobin, Hb (SD) concentrations in the PG and TA groups increased significantly from 12.06 (0.86) and 11.53 (0.86)mg/dl to 13.02 (0.82) and 12.72 (0.88) mg/dl (p< 0.001). QoL was significantly improved in both groups (p< 0.001). However, there were no significant differences between the groups after the intervention. CONCLUSION: The results of the present study demonstrate the efficacy of PG in treating HMB in terms of clinical and QoL indicators.

Association between maternal anaemia and postpartum depression in an urban sample of pregnant women in Iran.

The aim of this prospective study was to determine the relationship between anaemia during pregnancy and postpartum depression. Two hundred eighty-one non-anaemic mothers with singleton and low-risk pregnancy and no history of antidepressant-use were studied. Demographic and reproductive data at week 20 were obtained. Mothers were followed up and haemoglobin (Hb) was checked at delivery. Iranian version of Edinburgh Postpartum Depression Scale (EPDS) was completed 4-6 weeks after delivery. Mean age of the mothers was 26.6+/-4 years. The prevalence of postpartum depression according to EPDS was 5.5%. Binary logistic regression analysis showed that Hb <11 g/dL at delivery would increase the chance of postpartum depression (OR 4.64; 95% CI 1.33-16.08). The results show that diagnosis and treatment of physiologic factors, especially anaemia, would reduce the risk of postpartum depression.

Treatment of heavy menstrual bleeding of endometrial origin: randomized controlled trial of medroxyprogesterone acetate and tranexamic acid.

PURPOSE: This study aimed at comparing the efficacy of medroxyprogesterone acetate (MPA) and tranexamic acid (TA) for treating heavy menstrual bleeding of endometrial origin (HMB). METHODS: A randomized controlled trial was carried out in three gynecology clinics in Tehran, Iran. Ninety women with the HMB of endometrial origin were randomized into the study: 44 patients took MPA for 21 days from day 5 and 46 patients took tranexamic acid for 5 days from day 1 of menses for three consecutive menstrual cycles. Blood loss was measured using the pictorial blood loss assessment chart (PBAC); hematological assessments were made before intervention and after treatment. SF-36 and HMB Questionnaire (MQ) were given to assess quality of life. Statistical analysis was performed using t test, Paired t test, χ(2), Mann-Whitney, Wilcoxon signed-rank test, and repeated measure analysis. RESULTS: PBLC mean score, duration of bleeding and Hb values as well as quality of life were significantly improved in both groups (P < 0.05). But there was no significant deference between groups. More drug complication and less satisfaction were reported by MPA group (P = 0.003 and P = 0.002, respectively). CONCLUSIONS: Long-term use of MPA is as effective as Tranexamic acid in treating HMB and increasing quality of life. However, bleeding irregularity side effects of MPA might limit its use.

Bone health and prevalent fractures in women with polycystic ovary syndrome: a meta-analysis and endocrine-context pathophysiology review.

INTRODUCTION: Bone health in those with Polycystic Ovary Syndrome (PCOS) is complex, but the general consensus is that cortical areal bone mineral density (aBMD) sites will be higher in PCOS than in age- and BMI-similar controls. However, spine aBMD sites may be lower, especially in non-obese PCOS. Whether or not incident fracture risk is increased in PCOS is currently controversial; no meta-analysis has yet assessed prevalent fractures. AREAS COVERED: We assessed the bone effects of PCOS-related ovarian hormone alterations, e.g. androgen excess, tonically normal/higher estradiol, and lower-than-normal progesterone levels. We also highlighted evidence that common PCOS medications (e.g. combined hormonal contraceptives [CHC], metformin, and spironolactone) have important bone effects. In adolescents, meta-analysis of CHC showed significant negative aBMD changes. Inflammation has negative PCOS bone effects and is linked with CHC use. EXPERT OPINION: Is fracture risk altered by PCOS? Our meta-analysis showed a 25% increased risk of prevalent fracture in PCOS versus controls; this did not reach statistical significance. Future prospective research needs to collect and evaluate ovulation characteristics, progesterone exposure, and adolescent CHC use, in addition to the complex variables that may influence risks for prevalent or incident fragility fractures and/or for cortical and cancellous aBMD values in PCOS.

Developing International Classification of Disease code definitions for the study of enteric infection sequelae in Canada.

Background: Enteric infections and their chronic sequelae are a major cause of disability and death. Despite the increasing use of administrative health data in measuring the burden of chronic diseases in the population, there is a lack of validated International Classification of Disease (ICD) code-based case definitions, particularly in the Canadian context. Our objective was to validate ICD code definitions for sequelae of enteric infections in Canada: acute kidney injury (AKI); hemolytic uremic syndrome (HUS); thrombotic thrombocytopenic purpura (TTP); Guillain-Barré syndrome/Miller-Fisher syndrome (GBS/MFS); chronic inflammatory demyelinating polyneuropathy (CIDP); ankylosing spondylitis (AS); reactive arthritis; anterior uveitis; Crohn's disease, ulcerative colitis, celiac disease, erythema nodosum (EN); neonatal listeriosis (NL); and Graves' disease (GD). Methods: We used a multi-step approach by conducting a literature review to identify existing validated definitions, a clinician assessment of the validated definitions, a chart review to verify proposed definitions and a final clinician review. We measured the sensitivity and positive predictive value (PPV) of proposed definitions. Results: Forty studies met inclusion criteria. We identified validated definitions for 12 sequelae; clinicians developed three (EN, NL, GD). We reviewed 181 charts for 6 sequelae (AKI, HUS, TTP, GBS/MFS, CIDP, AS). Sensitivity (42.8%-100%) and PPV (63.6%-100%) of ICD code definitions varied. Six definitions were modified by clinicians following the chart review (AKI, TTP, GBS/MFS, CIDP, AS, reactive arthritis) to reflect coding practices, increase specificity or sensitivity, and address logistical constraints. Conclusion: The multi-step design to derive ICD code definitions provided flexibility to identify existing definitions, to improve their sensitivity and PPV and adapt them to the Canadian context.

A one-year observational cohort study of menstrual cramps and ovulation in healthy, normally ovulating women.

This is a prospective, observational community cohort study with the objective of investigating menstrual cramp occurrence related to ovulatory characteristics. Women reported cramp intensity on daily Menstrual Cycle Diary© records over one year. Ovulation and luteal phase lengths were assessed by validated Quantitative Basal Temperature© (QBT) analysis. Healthy, normal-weight, non-smoking community dwelling premenopausal women ages 21-41 years with two consecutive, normally ovulatory, normal-length menstrual cycles were enrolled. All 53 women, with 13.6 ± 2.8 cycles per woman, reported at least one cramp episode of median intensity 1.5 [0-4 scale; range 1.0-3.5], and 2.2 days' [range 1.0-10.2] duration. Within the 49 women who experienced all ovulatory cycle types (normal, short luteal length [SLL < 10 days] and anovulatory), median cramp intensity was greater in normal-length cycles having subclinical ovulatory disturbances (SLL and anovulatory; median 1.4 [range 0.0-2.8]) than in normally ovulatory cycles (median 1.2 [range 0.0-2.3]) (P = 0.023). Cramp Scores did not differ by ovulatory status within the 19 women having both normally ovulatory and anovulatory cycles (P = 0.222). Within-woman 1-year Cramp Scores were not different in anovulatory and normally ovulatory menstrual cycles but were more intense with ovulatory disturbances.

Prospective analyses of sex/gender-related publication decisions in general medical journals: editorial rejection of population-based women's reproductive physiology.

OBJECTIVE: To assess whether editorial desk rejection at general medical journals (without peer review) of two clinical research manuscripts may relate to author gender or women's physiology topics. Given evidence for bias related to women in science and medicine, and editorial board attitudes, our hypothesis was that submissions by women authors, on women's reproductive, non-disease topics received differential editorial assessment. DESIGN: A prospective investigation of publications, author gender and topics in general medical journals in two issues following the editorial rejections of two clinical research manuscripts by five major English-language general medical journals. The rejected manuscripts (subsequently published in lower impact journals) described research funded by national granting bodies, in population-based samples, authored by well-published women scientists at accredited institutions and describing innovative women's reproductive physiology results. SETTING: Tertiary academic medical centre. MAIN OUTCOME MEASURES: All clinical research published in the two issues following rejection date by each of the five major general medical journals were examined for first/senior author gender. The publication topic was assessed for its gendered population relevance, whether disease or physiology focused, and its funding. Rejection letters assessed editor gender and status. RESULTS: Women were underrepresented as original research authors; men were 84% of senior and 69% of first authors. There were no, non-disease focused publications relating to women's health, although most topics were relevant to both genders. The majority (80%) of rejection letters appeared to be written by junior-ranked women editors. CONCLUSION: Sex/gender accountability is necessary for clinical research-based editorial decisions by major general medical journals. Suggestions to improve gender equity in general medical journal publication: (1) an editorial board sex/gender champion with power to advocate for manuscripts that are well-performed research of relevance to women's health/physiology; (2) an editorial rejection adjudication committee to review author challenges; and (3) gender parity in double-blind peer review.

IL-8 correlates with reduced baseline femoral neck bone mineral density in adults with cystic fibrosis: a single center retrospective study.

Cystic fibrosis (CF) is a multi-system disease that is characterized by lung disease due to recurrent airway infection and inflammation. Endocrine complications, such as CF bone disease (CFBD), are increasingly identified as patients are living longer. The cause of CFBD is multifactorial with chronic systemic inflammation theorized to be a contributing factor. Thus, we attempted to identify inflammatory biomarkers that are associated with CFBD. We conducted a retrospective observational study of 56 adult patients with CF with an average percentage predictive forced expiratory volume in one second (ppFEV1) of 73.7% (standard deviation: 30.0) who underwent baseline serum analysis for osteoprotegerin (OPG) and pro-inflammatory biomarkers (IL-1ß, IL-6, IL-8 and TNF-α), and had repeated dual-energy x-ray absorptiometry (DXA) scans separated by at least 2 years to examine correlations between serum biomarkers and bone mineral density (BMD) measurements. Univariate linear regression model analysis demonstrated that serum IL-1ß and IL-8, but not other pro-inflammatory markers, were negatively correlated with baseline BMD results. However, after accounting for confounding variables, only the relationship between IL-8 and left femoral neck BMD remained statistically significant. Additionally, IL-8 level was associated with BMD decline over time. These results suggest that IL-8 might play a unique role in the pathophysiology of CFBD relative to other pro-inflammatory cytokines but further study is warranted before firm conclusions can be made.

Prevalence and potential risk factors of female sexual difficulties: an urban Iranian population-based study.

INTRODUCTION: Female sexual dysfunction is common, a multifactorial phenomenon with a potential to cause marital strain, impaired fertility, and poor quality of life. Epidemiologic data are scarce and little is known about the prevalence of sexual difficulties and the exact role of putative risk factors in Iran. AIM: To determine the prevalence of female sexual difficulties and the potential risk factors in an urban Iranian population. METHODS: A cross-sectional study was performed in the province of Kohgilooyeh-Boyerahmad (KB) in the southwest of Iran and involved sexually active urban women aged 15 years and over, selected via a quota-based cluster sampling method. The study used an ad hoc questionnaire covering the demographic and reproductive variables as well as the data related to sexual difficulties. Data were analyzed using multiple logistic regression models. The main outcome measures were the prevalence rates and the predictors of sexual difficulties. MAIN OUTCOME MEASURES: The prevalence of female sexual difficulties and the associated risk factors. RESULTS: One thousand four hundred fifty-six sexually active women living in the urban areas of KB province in 2005 were selected. The mean age of the sample was 34.04 +/- 9.2 (16-71) years and the mean number of completed grades was 7.18 (+/-4.8). More than 52% of the participants had experienced at least one type of sexual difficulty. The greatest and smallest frequencies were observed for orgasm difficulty (21.3%, confidence interval[CI](0.95) = 19.2-23.4%) and lubrication difficulty (11.9%, CI(0.95) = 10.2-13.6%). Age, education, contraceptive modality, and obstetric/gynecologic procedures were all associated with at least one type of sexual dysfunction. CONCLUSION: Similar to previous studies, we found a relatively high prevalence of sexual difficulties in this urban population of low socioeconomic status. However, our results concerning the role of some demographic and reproductive variables in producing sexual difficulties were different from those reported by other researchers.

Help-seeking behaviors for female sexual dysfunction: a cross sectional study from Iran.

BACKGROUND: Female sexual dysfunctions (FSD) are prevalent multifactor problems that in general remain misdiagnosed in primary health care. This population-based study investigated help-seeking behaviors among women with FSD in Iran. METHODS: This was a cross sectional study carried out in Kohgilouyeh-Boyer-Ahmad province in Iran. Using quota sampling all sexually active women aged 15 and over registered in primary health care delivery centers were studied. Experience of sexual problems was assessed using an ad-hoc questionnaire (Female sexual dysfunction: help-seeking behaviors survey) containing 14 items. Trained female nurses interviewed all participants after a verbal informed consent. Data were analyzed in a descriptive manner. RESULTS: In all 1540 women were studied. Of these, 786 (51%) cases had experienced at least one of the FSD problems. Results showed that 35.8% of women with FSD had sought no professional help and the most reasons for not seeking help were identified as: 'time constraints' and believing that it 'did not occur to me' (39.1 and 28.5% respectively). Sixty one percent of women who sought help for FSD reported that 'doctor gave me a definite diagnosis' and 'a definite treatment plan was given' in 57% of cases. CONCLUSION: The study findings indicated that FSD problems were prevalent and many women did not seek help for their problem. Finding 'time constraints' and believing that the problem 'did not occur to me' as the most cited reasons for not seeking help might facilitate to understand potential barriers that exist in recognition and treatment of the female sexual dysfunctions. Since FSD might have a negative impact on interpersonal relationships and women's quality of life, it seems that there is need to address the problem both at local and national primary health care services.

Pre-pregnancy consumption of starchy vegetables and legumes and risk of gestational diabetes mellitus among Tehranian women.

AIMS: The aim of this study was to investigate the association between legumes and starchy vegetables, including 1. potatoes and 2. other starchy vegetables (corn, squash, green pea, and green lima beans), and GDM among Tehranian women. METHODS: Our study included 1026 pregnant women, aged 18-45 years, who consecutively attended prenatal clinics in five hospitals affiliated to universities of medical sciences in Tehran. The diagnosis of GDM was based on the criteria set by the American Diabetes Association. Dietary intakes were assessed during gestational age ≤6 weeks with a validated food frequency questionnaire. RESULTS: Of the 1026 pregnant women, 6.9% developed GDM. With respect to potato, higher consumption was negatively associated with GDM risk; OR for those who consumed ≥2.1 servings/week was 0.53 (95% CI 0.29-0.97), an association which disappeared after adjustment for confounding factors. For legumes, higher consumption was negatively associated with GDM; OR for those who consumed ≥3.3 servings/week was 0.38 (95% CI 0.19-0.74), also an association that did not change appreciably after adjustment for confounding factors. There was no significant association with the consumption of total starchy or other starchy vegetables with GDM. CONCLUSIONS: Higher consumption of legumes during reproductive age decrease the risk of GDM during pregnancy.

Does Molimina Indicate Ovulation? Prospective Data in a Hormonally Documented Single-Cycle in Spontaneously Menstruating Women.

Approximately 33% of normal-length (21⁻35 days) cycles have subclinical ovulatory disturbances and lack sufficient progesterone, although their normal length ensures enough estrogen. Subclinical ovulatory disturbances are related to significant premenopausal spine bone loss (-0.86%/year). Molimina, non-distressing premenstrual experiences, may detect ovulation within normal-length cycles. This prospective study assessed the relationship between molimina and ovulation. After 1-cycle of daily diary and first morning urine collections, women answered the Molimina Question (MQ): "Can you tell by the way you feel that your period is coming?" and were invited to share (a) predictive premenstrual experience(s). A 3-fold increase in follicular-luteal pregnanediol levels confirmed ovulation. In 610 spontaneously menstruating women (not on hormonal contraception, mean age 31.5 ± 5.3, menarche age 12.7 ± 1.5, cycle length [CL] 29 days, MQ positive in 89%), reported premenstrual experiences which included negative moods (62%), cramps (48%), bloating (39%), and front (26%) or axillary (25%) breast tenderness. Of 432 women with pregnanediol-documented cycles, 398 (92%) were ovulatory (CL: 29 ± 5) and 34 (8%) had ovulatory disturbances (CL: 32 ± 14). Women with/without ovulatory cycles were similar in parity, body mass index, smoking, dietary restraint and the MQ; ovulatory-disturbed cycles were longer. Molimina did not confirm ovulation. A non-invasive, inexpensive ovulation indicator is needed to prevent osteoporosis.

Adult Premenopausal Bone Health Related to Reproductive Characteristics-Population-Based Data from the Canadian Multicentre Osteoporosis Study (CaMos).

Amenorrhea is important for women's bone health. However, few have reported reproductive, anthropometric (body mass index [BMI], height) and bone health (areal bone mineral density [BMD], prevalent fractures) in a population-based study. The purposes of this cross-sectional study of women in the randomly-selected Canadian Multicentre Osteoporosis Study (CaMos) population were: (1) to describe reproductive, demographic, anthropometric and lifestyle variables; and (2) in menstruating women, to relate reproductive and other variables to BMD at the lumbar spine (L1-4, LS), femoral neck (FN) and total hip (TH) sites and to prevalent fragility fractures. This study describes the reproductive characteristics of 1532 women aged 30⁻60 years. BMD relationships with reproductive and other variables were described in the 499 menstruating women. Mean menarche age was 12.8 years, 96% of women were parous and 95% had used combined hormonal contraceptives (CHC). Infertility was reported by 9%, androgen excess by 13%, amenorrhea by 8% and nulliparity by 4%. LS BMD was negatively associated with amenorrhea and androgen excess and positively related to current BMI and height. A later age at menarche negatively related to FN BMD. BMI and height were strongly related to BMD at all sites. Prevalent fragility fractures were significantly associated with quartiles of both LS and TH BMD.

Development and psychometric evaluation of the sexual knowledge and attitudes scale for premarital couples (SKAS-PC): An exploratory mixed method study.

BACKGROUND: Designing a valid and reliable questionnaire that allows a fair evaluation of sexual knowledge and attitudes and develop a proper sexual educational program is necessary. OBJECTIVE: The present study was designed to develop and psychometric evaluation of the sexual knowledge and attitudes scale for premarital couples. MATERIALS AND METHODS: An exploratory mixed method study was conducted in two phases; in the first, in order to develop a questionnaire an item pool was generated on sexual knowledge and attitudes through focus group discussions and individual interviews. In the second phase, the psychometric properties of the questionnaire were examined. For this purpose, face validity, content validity as well as construct validity were conducted. Reliability was assessed by the Cronbach's alpha coefficient to assess internal consistency and test-retest reliability. RESULTS: In the first phase an item pool with 88 questions was generated (sexual knowledge 45 items and sexual attitudes 43 items). In the second phase, the number of final items reduced to 33 and 34 items of sexual knowledge and sexual attitudes respectively, through exploratory factor analysis (EFA). Five factors for sexual knowledge and six factors for sexual attitudes identified by EFA. The Cronbach's alpha coefficient for two sections was 0.84 and 0.81 respectively. The test- retest correlations for sexual knowledge and sexual attitude was 0.74 and 0.82 respectively. CONCLUSION: The findings suggest that the Sexual Knowledge and Attitudes Scale for Premarital Couples is a valid and reliable instrument. Further studies are needed to establish stronger psychometric properties for the questionnaire.

Premature Spinal Bone Loss in Women Living with HIV is Associated with Shorter Leukocyte Telomere Length.

With advances in combination antiretroviral therapy (cART), people living with HIV are now surviving to experience aging. Evidence suggests that individuals living with HIV are at greater risk for low bone mineral density (BMD), osteoporosis, and fractures. Better understanding of the pathophysiology of bone health in women living with HIV (WLWH) is important for treatment strategies. The goal of this study was to explore new biological factors linked to low BMD in WLWH. Standardized BMD measures of WLWH were compared to reference values from an unselected population of women from the same geographical region of the same age range. Linear regression analysis was used to assess relationships among health-related characteristics, cellular aging (measured by leukocyte telomere length; LTL), cART, and BMD of WLWH. WLWH (n = 73; mean age 43 ± 9 years) had lower BMD Z-scores at the lumbar spine (LS) (mean difference = -0.39, p < 0.001) and total hip (TH) (-0.29, p = 0.012) relative to controls (n = 290). WLWH between 50 and 60 years (n = 17) had lower Z-scores at the LS (p = 0.008) and TH (p = 0.027) compared to controls (n = 167). Among WLWH, LS BMD was significantly associated with LTL (R² = 0.09, p = 0.009) and BMI (R² = 0.06, p = 0.042). Spinal BMD was adversely affected in WLWH. Reduction of LTL was strongly associated with lower BMD and may relate to its pathophysiology and premature aging in WLWH.