Effectiveness of eHealth Interventions Targeting Employee Health Behaviors: Systematic Review.

BACKGROUND: The number of people with noncommunicable diseases is increasing. Noncommunicable diseases are the major cause of disability and premature mortality worldwide, associated with negative workplace outcomes such as sickness absence and reduced work productivity. There is a need to identify scalable interventions and their active components to relieve disease and treatment burden and facilitate work participation. eHealth interventions have shown potential in clinical and general populations to increase well-being and physical activity and could be well suited for workplace settings. OBJECTIVE: We aimed to provide an overview of the effectiveness of eHealth interventions at the workplace targeting employee health behaviors and map behavior change techniques (BCTs) used in these interventions. METHODS: A systematic literature search was performed in PubMed, Embase, PsycINFO, Cochrane CENTRAL, and CINAHL in September 2020 and updated in September 2021. Extracted data included participant characteristics, setting, eHealth intervention type, mode of delivery, reported outcomes, effect sizes, and attrition rates. Quality and risk of bias of the included studies were assessed using the Cochrane Collaboration risk-of-bias 2 tool. BCTs were mapped in accordance with the BCT Taxonomy v1. The review was reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. RESULTS: In total, 17 randomized controlled trials met the inclusion criteria. The measured outcomes, treatment and follow-up periods, content of eHealth interventions, and workplace contexts had high heterogeneity. Of the 17 studies, 4 (24%) reported unequivocally significant findings for all primary outcomes, with effect sizes ranging from small to large. Furthermore, 53% (9/17) of the studies reported mixed results, and 24% (4/17) reported nonsignificant results. The most frequently targeted behavior was physical activity (15/17, 88% of the studies); the least frequently targeted behavior was smoking (2/17, 12% of the studies). Attrition varied greatly across the studies (0%-37%). Risk of bias was high in 65% (11/17) of the studies, with some concerns in the remaining 35% (6/17). Interventions used various BCTs, and the most frequently used were feedback and monitoring (14/17, 82%), goals and planning (10/17, 59%), antecedents (10/17, 59%), and social support (7/17, 41%). CONCLUSIONS: This review suggests that, although eHealth interventions may have potential, there are still unanswered questions regarding their effectiveness and what drives the mechanism behind these effects. Low methodological quality, high heterogeneity and complexity, the characteristics of the included samples, and often high attrition rates challenge the investigation of the effectiveness and the making of sound inferences about the effect sizes and significance of the results. To address this, new studies and methods are needed. A megastudy design in which different interventions are evaluated in the same population over the same period on the same outcomes may solve some of the challenges. TRIAL REGISTRATION: PROSPERO CRD42020202777; https://www-crd-york-ac-uk/prospero/display_record.php?RecordID=202777.

The effectiveness of digital sexual health interventions for young adults: a systematic literature review (2010-2020).

There has been a proliferation of digital sexual health interventions targeting adolescents; however, limited evaluative reviews have compared the effectiveness of multiple digital tools for sexual health literacy and behaviour change. This study conducted a systematic literature review, screened 9881 records and analysed 61 studies. Findings suggest that websites and mobile phones dominate digital sexual health interventions, with a majority effectively delivering cognitive (e.g. awareness and attitudes about sexual and reproductive health) and behavioural outcomes (e.g. abstinence and use of contraception). The most popular sexual health promotion mechanisms were interactive websites, text messaging and phone calls, and online education programmes, followed by mobile applications-fewer studies in this review utilized social media, games and multimedia. Previous reviews focused on single outcome measures (e.g. sexually transmitted infection testing) to assess interventions' effectiveness. The current review moves beyond single outcome measures to cover a wider range of behavioural and non-behavioural sexual health issues and contexts covered in the literature. Four main categories were analysed as outcomes: cognitive perceptions, promoting sexual health-related behaviours, promoting sexual health-related products and services, and impact (viral load). Seventy-nine per cent of interventions focused on preventive sexual health behaviours and products (e.g. condoms) and services (e.g. HIV testing). Overall, 75% of studies effectively changed sexual health behaviour and cognitive perceptions. However, the digital-only tools did not vary from the blended formats, in influence outcomes, even after categorizing them into behavioural or non-behavioural outcomes. Compared to previous systematic reviews, more studies from the last decade used rigorous research design in the form of randomized controlled trials, non-randomized control trials, and quasi-experiments and lasted longer.

Sexual health literacy among adolescents is essential to avert unwanted pregnancies or abortions and sexually transmitted diseases. Culturally sensitive and age-appropriate interventions are required to educate youth about safe-sex practices and increase their self-efficacy and accessibility to health products and services. Meta-analytical and systematic literature reviews have identified limitations in traditional interventions that rely heavily on classroom-based activities and lectures to educate adolescents about safe sex. In recent years, digital tools have proved productive; however, limited evaluative reviews have compared the effectiveness of multiple digital technologies (such as smartphones, web-based programs, social media, games and multimedia) used within sexual health interventions. This systematic review assessed 9881 articles and synthesized 61 experimental studies on adolescent sexual behaviour conducted in the last decade to identify tools that positively influence cognitive and safe-sex behaviour among youth. Interactive websites, mobile technology and online education programmes were popular promotional tools, but very few studies utilized multimedia alongside games and social media. Findings from this review could facilitate future research and practice in adolescent sexual health.

Do health professionals' attitudes towards alcohol use matter for alcohol prevention efforts? Results from the WIRUS-OHS study.

BACKGROUND: Use of alcohol is a major public health issue, representing the 7th largest burden of disease in the world. Workplaces offer a unique arena for health initiatives addressing alcohol use, where occupational health services (OHS) personnel play an important role. However, we do not know if the extent of such initiatives may be influenced by personal drinking attitudes among OHS personnel. Thus, the aim of the study was to explore how drinking attitudes among OHS personnel were associated with their frequency of working with alcohol-related cases and with their views on alcohol prevention activities in the OHS. METHODS: The WIRUS project included a cross-sectional survey of attitudes and practices among OHS personnel (n = 325) employed by Norwegian OHS services (n = 69), who informed about sociodemographic and professional characteristics, drinking attitudes, frequency of cases with alcohol-related issues, and perceptions toward the role of the OHS in primary, secondary, and tertiary alcohol prevention activities. Measures of associations were examined with linear and logistic regression models. RESULTS: Drinking attitudes were unrelated to the frequency of working with alcohol-related cases. Physicians, psychologists, and nurses had higher frequency of working with alcohol-related cases, compared to those with other professional backgrounds (ß = 0.46, p = 0.01). Drinking attitudes were also unrelated to attitudes towards primary/secondary/tertiary alcohol prevention activities in the OHS, while female OHS personnel were more positive towards increased primary alcohol prevention activities in the OHS (OR: 1.82, p < 0.05). Only marginal portions (1%-3%) of the variance in attitudes towards alcohol prevention activities in the OHS were accounted for by the models. CONCLUSION: This study did not find evidence of associations between OHS personnel's drinking attitudes and their practices and attitudes towards alcohol prevention activities. The lack of association between OHS personnel's attitudes towards alcohol use and their attitudes and practices relating to alcohol prevention in the workplace might point towards professionalism, as personal attitudes appear not to interfere with their priorities and professional mission. Given the small amount of outcome variance explained by the tested models, other variables should be used in future studies.

Babu and Magon uterine closure technique during cesarean section: A randomized double-blind trial.

AIM: We compared the effectiveness of the Babu and Magon uterine closure technique and unlocked double-layer uterine closure on the integrity and thickness of the uterine scar. METHODS: A randomized double-blind trial was performed at Hazrat-e Rasoul -e-Akram Hospital, Tehran, Iran, from March 2018 to December 2019, in 72 pregnant women who were candidates for cesarean section for the first time. Women were randomly assigned to the Babu and Magon uterine closure technique (intervention group, n = 34) or double-layer closure of the uterine incision (control group, n = 38). The primary outcome of the study was the frequency of myometrial defects at the site of the scar (niche), and a large niche. Secondary outcomes, including the time taken for uterine closure and postpartum hemorrhage (early and late), were compared between groups. RESULTS: Adjacent myometrium thickness (AMT) between the two groups was not statistically significant. A niche was reported in 23.5% (8/34) and 50% (19/38) of women in the intervention and controls, respectively (p = 0.02). A large niche was reported in 2.9% (1/34) and 23.7% (9/38) of women in the intervention and controls, respectively (p < 0.01). The duration of uterine closure was not statistically significant between the two groups. Hemoglobin levels did not differ significantly between groups during the first 24 h post-surgery. CONCLUSION: The results of the study showed that the technique of uterine closure is one of the main potential determinants of myometrial healing. The Babu and Magon uterine closure technique seems to lead to tissue alignment during suturing and consequently cause better myometrial healing, although this issue calls for well-founded longer studies of appropriate design.

Comparison between maternal and neonatal outcome of PPROM in the cases of amniotic fluid index (AFI) of more and less than 5 cm.

The study was performed on pregnant women with a gestational age of 26-32 weeks of pregnancy, who had been admitted to the hospital with a confirmed diagnosis of premature rupture of membranes. In all eligible women, ultrasounds were performed for the evaluation of amniotic fluid index. Then, the women were divided into two groups according to amniotic fluid index of ≥5 cm and <5 cm. These women were followed and monitored up to delivery. The women of the two groups did not have significant difference between them according to age, gestational age at the time of ruptured membrane, body mass index, gravidity, parity, gestational age at delivery and route of delivery. Maternal morbidities including chorioamnionitis, placental abruption, uterine atony after delivery and retention of placenta did not show significant difference between the two groups. There was no significant difference between the two groups' amniotic fluid index <5 cm and amniotic fluid index ≥5 cm, regarding neonatal morbidities, except for neonatal sepsis and neonatal death, which were higher in the amniotic fluid index <5 cm group [7(14.6%) versus 1(2.3%), p = .039, RR = 7.7 (95%CI 0.04-0.06) and 11(30.9%) versus 2(4.7%), p = .013, RR = 6.095 (95%CI = 1.26-29.31)]. In the subgroups of two categories of gestational ages of 260-296 and 300-346, neonatal morbidities were higher in the amniotic fluid index <5 cm group. The results suggest that amniotic fluid index <5 cm should be considered as a warning sign for predicting poor prognosis of pregnancy complicated by preterm premature rupture of membranes. Impact statement What is already known on this subject? In a retrospective study in 1993, the relationship between oligohydramnios (which was defined as the largest single packet of fluid less than 2 × 2 cm) at the time of hospital admission, and the outcome of mother, foetus and neonates in a gestational age of less than 35 weeks of pregnancy was evaluated. In the oligohydramnios group, chorioamnionitis and funistis were more common. Also, the mean gestational age at the time of delivery and neonatal weight was less than that of the normal amniotic fluid group. According to these results, it was concluded that a low amniotic fluid volume in the women with preterm premature rupture of membranes (PPROM) can be considered as a prognostic factor in the cases of conservative management of PPROM. In contrast, the other study, which was performed on a larger sample size (290 patients), could not show more cases of amnionitis in the cases of amniotic fluid index (AFI) of less than 5 cm; however, the latency period was shorter in comparison with AFI of more than 5 cm. What do the results of this study add? Chorioamnionitis, placental abruption and uterine atony after delivery, retention of placenta and route of delivery did not show a significant difference between the two groups. Respiratory distress syndrome (RDS), need of surfactant and intubation, intra ventricular haemorrhage (IVH) and duration of neonatal intensive care unit (NICU) admission did not show a significant difference between the two groups; however, the rate of neonatal sepsis and neonatal death were higher in the AFI <5 cm group. What are the implications of these findings for clinical practice and/or further research? The results suggest that AFI <5 cm should be considered as a warning sign for predicting poor prognosis of pregnancy complicated by PPROM.

Ultrastructural Investigation of Pelvic Peritoneum in Patients With Chronic Pelvic Pain and Subtle Endometriosis in Association With Chromoendoscopy.

STUDY OBJECTIVE: To evaluate the pelvic peritoneum under chromoendoscopy by scanning electron microscopy (SEM) as well as light microscopy with hematoxylin and eosin staining and immunohistochemistry (IHC) assays in patients with chronic pelvic pain (CPP) associated with subtle endometriosis. DESIGN: Case series study (Canadian Task Force classification II). SETTING: A referral academic community tertiary medical center. PATIENTS: Three women aged 29 to 37 years were referred to the obstetrics and gynecology clinic of the tertiary university hospital with CPP. They were suspicious for endometriosis, were not responding to medical treatments, and had undergone previous pelvic laparoscopy to determine the stage of endometriosis and preparation of peritoneal samples under the guidance of staining with methylene blue in 0.25% dilution. INTERVENTIONS: Comparison of stained and unstained pelvic peritoneal samples after the instillation of 0.25% methylene blue into the pelvic cavity. MEASUREMENTS AND MAIN RESULTS: In 3 patients, laparoscopic examination showed minimal endometriosis. A total of 18 samples (9 stained and 9 unstained) from the 3 patients were prepared for SEM. Ten of the samples (55.6%) showed microstructural peritoneal destruction (7 of 9 stained [77.7%] and 3 of 9 [33.4%] unstained). Eighteen samples (9 stained and 9 unstained) from the 3 patients were also prepared for IHC. Six of these samples (33.3%) were S-100-positive, including 4 of 9 (44.4%) stained samples and 2 of 9 (22.2%) unstained samples. CONCLUSIONS: In general, in the context of CPP and endometriosis, there is no established relationship between the severity of pain and stage of endometriosis. In the pathophysiology of CPP associated with endometriosis, ultrastructural changes can play a significant role. Under methylene blue staining, some destroyed areas were detected, but the stained areas do not necessarily correlate with increased microstructural peritoneal destruction.

Bilateral Hyperplasia of Bartholin's Gland: A Case Report.

A 37-year-old woman underwent surgery to remove bilateral vulvar masses. The masses were firm, non-tender, and immobile. Pathologic finding was a well-delineated creamy grayish mass with a homogenous grayish solid surface and mild edema, chronic inflammatory infiltration, and focal dilation of the ducts with squamous metaplasia. The diagnosis was hyperplastic and hypertrophied Bartholin's gland. Hyperplasia is a rare etiology for an enlarged Bartholin's gland. Clinical presentation of Bartholin's gland nodular hyperplasia is rather specific, although inflammatory lesion is the most common cause of swelling of the Bartholin's gland in all age groups. Bartholin's hyperplasia should be considered in cases with a solid mass. Total surgical excision is required for diagnosis. Only a few cases of Bartholin's gland hyperplasia have been reported in the literature. Our patient has been receiving regular follow-up examination and there is no evidence of dyspareunia, perineal pain, and recurrent disease 12 months after surgery.

Comparison of intramuscular progesterone with oral nifedipine for treating threatened preterm labor: A randomized controlled trial.

Background: Threatened preterm labor (TPL) is the leading cause of hospitalization during pregnancy. Tocolytic agents are the primary therapeutic options for TPL. The aim of this study is to compare intramuscular progesterone with oral nifedipine as a tocolytic agent. Methods: This randomized controlled trial was carried out in a teaching hospital (Shahid Akbarabadi) in Tehran, Iran, from December 2011 to November 2012. Three hundred and fifteen singleton pregnant women aged >18 yrs at 26-34 weeks' gestation with the diagnosis of threatened preterm labor (TPL) were randomly received either intramuscular progesterone or oral nifedipine for tocolysis. Maternal and neonatal outcomes were then compared between the two interventions. P value less than 0.05 was considered statistically significant. IRCT registration number of this study is IRCT201112198469N1 Results: The success rate of progesterone and nifedipine in treating TPL were 83% and 82.7%, respectively. There was no significant difference between the two interventions with regard to gestational age at delivery, type of delivery, the time interval until the delivery, birth weight, NICU admission rate and hospital stays. Progesterone administration was associated with lower duration of NICU stay as compared with nifedipine (0.33±0.77 days vs.1.5±3.2 days, p<0.05). None of the two drugs caused any major side effects. Conclusion: Single dose intramuscular progesterone is as effective as oral nifedipine in treating TPL. It also significantly reduces the NICU stay.

Fabrication of textured functional ingredient based on apple: Sesame by-product.

The search for new sources of fortified components from low-cost and sustainable sources has become a trend in the last decade. Food byproducts containing valuable bioactive compounds such as dietary fiber, protein, and phytochemicals are being used as substrates for obtaining beneficial components that can promote health. Extrusion is an efficient technology for converting food by-products into nutrient-rich food ingredients. The objective of this work was to optimize the extrusion process to obtain the best combination of moisture content (14, 18 and 22%) and screw speed (SS) (120,150 and180 rpm), apple pomace (AP): semi-defatted sesame cake (SDSC) blends (25:75, 50:50 and 75:25 w/w) to fabricate textured functional ingredients (TFI) with high values of expansion ratio (ER), water absorption index (WAI), brightness level, total phenolic compounds (TPC) and antioxidant activity (AA) and lower hardness based on a central composite design. The optimal treatment was determined at 176 rpm SS, 18% moisture content and a ratio of (75:25) AP: SDSC. The desirability value has indicated an appropriate match between the predicted and the observed response. TFI exhibited higher soluble dietary fiber fraction (WAI) values and lower plate count values during 30 days of storage compared to the unprocessed by-product, suggesting that TFI could be successfully used for the manufacture of innovative, high quality products such as porridge, beverages, cookies, soups and others that could provide health benefits based on the values obtained.

A systematic review and meta-analysis uncovering the relationship between alcohol consumption and sickness absence. When type of design, data, and sickness absence make a difference.

AIM: Earlier research has revealed a strong relationship between alcohol use and sickness absence. The aim of this review was to explore and uncover this relationship by looking at differences in type of design (cross-sectional vs. longitudinal), type of data (self-reported vs. registered data), and type of sickness absence (long-term vs. short term). METHOD: Six databases were searched through June 2020. Observational and experimental studies from 1980 to 2020, in English or Scandinavian languages reporting the results of the association between alcohol consumption and sickness absence among working population were included. Quality assessment, and statistical analysis focusing on differences in the likelihood of sickness absence on subgroup levels were performed on each association, not on each study. Differences in the likelihood of sickness absence were analyzed by means of meta-analysis. PROSPERO registration number: CRD42018112078. RESULTS: Fifty-nine studies (58% longitudinal) including 439,209 employees (min. 43, max. 77,746) from 15 countries were included. Most associations indicating positive and statistically significant results were based on longitudinal data (70%) and confirmed the strong/causal relationship between alcohol use and sickness absence. The meta-analysis included eight studies (ten samples). The increased risk for sickness absence was likely to be found in cross-sectional studies (OR: 8.28, 95% CI: 6.33-10.81), studies using self-reported absence data (OR: 5.16, 95% CI: 3.16-8.45), and those reporting short-term sickness absence (OR: 4.84, 95% CI: 2.73-8.60). CONCLUSION: This review supports, but also challenges earlier evidence on the association between alcohol use and sickness absence. Certain types of design, data, and types of sickness absence may produce large effects. Hence, to investigate the actual association between alcohol and sickness absence, research should produce and review longitudinal designed studies using registry data and do subgroup analyses that cover and explain variability of this association.

Do Differences in Drinking Attitudes and Alcohol-Related Problems Explain Differences in Sick Leave? A Multilevel Analysis of 95 Work Units Within 14 Companies From the WIRUS Study.

Background: Systematic reviews have shown a strong relationship between alcohol consumption and sick leave. The effect of alcohol consumption on sick leave may, however, vary according to the work environment. While attitudes toward drinking may impact sick leave, there is little research on the contribution of drinking attitudes to sick leave. Moreover, alcohol-related problems and drinking attitudes may be influenced by the broader sociocultural contexts of the organizational units where people work. Objectives: This study aimed to explore the relationship of alcohol-related problems and drinking attitudes with sick leave while considering the nesting of employees within working units within companies. Method: Data from the WIRUS (Workplace Interventions preventing Risky alcohol Use and Sick leave) study were linked to company-registered sick leave data for 2,560 employees from 95 different work units in public (n = 9) and private companies (n = 5) in Norway. Three-level (employee, work unit, and company) negative binomial regression models were estimated to explore the 12-month prospective association of alcohol-related problems and drinking attitudes with four measures of sick leave (one-day, short-term, long-term, and overall sick leave days). Models were adjusted for gender, age, cohabitation status, educational attainment, work position, and employment sector. Results: We observed higher variation of one-day, short-term, and overall sick leave days between companies than between work units within companies (15, 12, and 30% vs. 0, 5, and 8%, respectively). However, neither alcohol-related problems nor drinking attitudes were associated with sick leave and, thus, those variations in sick leave were not explained by alcohol-related problems or drinking attitudes. Conclusion: Our findings suggest company-level differences are more important than within company differences when explaining differences in sick leave. While alcohol-related problems or drinking attitudes were not associated with sick leave, future studies may need to explore the role of company policies, practices, or social norms in variations in sick leave rates.

The correlation between the cerebroplacental ratio and fetal arterial blood gas in appropriate-for-gestational-age fetuses: A cross-sectional study.

BACKGROUND: The cerebroplacental ratio (CPR) is an important index for predicting adverse pregnancy outcomes in small-for-gestational-age and appropriate-for-gestational-age fetuses. OBJECTIVE: To find out whether there is an association between the CPR level and the blood cord gases analysis in appropriate for gestational age fetuses. MATERIALS AND METHODS: This cross-sectional study included 347 pregnant women at the gestational age of 37-40 wk. Patients had an appropriate-for-gestational-age fetus confirmed from their first ultrasonography results. Participants were divided into two groups based on their CPR, measured before delivery. Finally, after delivery, arterial blood gas level and the incidence of emergency cesarean section, intrapartum fetal distress and neonatal intensive care unit admissions were compared between the two groups. RESULTS: Fifty-four (15.6%) cases had a CPR below the detection limit of the assay. The incidence of fetal distress, emergency cesarean section, neonatal hospitalization in the neonatal intensive care unit, and pH < 7.2 were significantly lower in women with CPR ≥ 0.67 multiples than in women with a CPR < 0.67 multiples of the median. CONCLUSION: The third-trimester CPR is an independent predictor of stillbirth and perinatal mortality and morbidity. The role of UA/MCA Doppler and the CPR in assessing the risk of adverse pregnancy outcomes should be evaluated prospectively.

Perceived discrimination and subjective well-being among Middle Eastern migrants in Australia: The moderating role of perceived social support.

BACKGROUND: Middle Eastern (ME) migrants are vulnerable to developing mental health problems due to pre-migration and post-migration traumas and stresses. The evidence on the subjective well-being of ME migrants and its contributing factors is limited and inconclusive. OBJECTIVES: The aim of this study is to examine the moderating role of perceived social support in the association between perceived discrimination and subjective well-being, after controlling for socio-demographic factors. METHOD(S): This cross-sectional survey study was conducted in Queensland, Australia. A total of 382 first-generation young adult ME migrants, aged between 20 to 39 years, completed a self-administered questionnaire. To analyse data, a series of three hierarchical multiple regression (HMR) analyses were conducted, one for each of the subjective well-being components (i.e., positive affect, negative affect, and satisfaction with life). The interaction between perceived social support and perceived discrimination for the prediction of subjective well-being components was further explored using simple slope analysis. RESULTS: Gender was found to be a significant predictor of positive and negative affect. Education was found to predict satisfaction with life, but not positive and negative affect. Married migrants were found to have significantly higher life satisfaction, positive affect and lower negative affect. Perceived social support had a moderating role in the association between perceived discrimination and subjective well-being. CONCLUSION: Considering the buffering role of perceived social support against the adverse effects of perceived discrimination on subjective well-being, organizations and individuals working with ME migrants should acknowledge the significance of social support and improve their capacity to deliver effective and appropriate social support services to migrants experiencing discrimination.

The effect of vaginal progesterone on Doppler findings in increased uterine artery resistance.

OBJECTIVE: The present study aimed to evaluate the effect of vaginal progesterone on Doppler finding in increased uterine artery resistance compared with aspirin. MATERIALS AND METHODS: This study is a double-blind randomized clinical trial that was conducted on 140 pregnant women with increased uterine artery resistance who were referred to the Shariati hospital (Tehran, Iran) in 2017-2018. Patients were randomized to 1 of the 3 treatment groups - group A: tablet aspirin 80 mg; group B: vaginal suppository progesterone; and group C: control group without any intervention. Low-risk pregnant women at the gestational age of 16-20 weeks, were assessed by the uterine artery Doppler. In the presence of increased resistance of the uterine artery, patients were randomly assigned to one of the three above mentioned groups. RESULTS: The results of paired t-tests for right uterine artery pulsatility index (RUA.PI), right uterine artery resistance index (RUA.RI), left uterine artery PI (LUA.PI), and left uterine artery RI (LUA.RI) before and after of intervention in the three groups were statistically significant. Also, the one-way analysis of variance (ANOVA) results for comparison between three groups showed that before the intervention only means of RUA.PI has a significant difference between three groups (p = .025), but means of all variables after intervention shows a significant difference (p < .001). CONCLUSION: The findings showed that the use of vaginal progesterone suppressed the resistance of uterine artery compared to aspirin.

Maternal and Fetal Outcomes of Pregnant Women Infected with Coronavirus Based on Tracking the Results of 90-Days Data in Hazrat -E- Rasoul Akram Hospital, Iran University of Medical Sciences.

OBJECTIVE: To evaluate the maternal and fetal outcomes of COVID-19 up to three months after the delivery in pregnant women. METHODS: This case series study was conducted on all pregnant women with COVID-19 hospitalized in Hazrat -E- Rasoul Akram Hospital, Tehran, Iran from March 8, 2020 to December 28, 2020. Data were included maternal age and gestational age (GA) which presenting signs and symptoms were collected at hospital admission. To confirm COVID-19 diagnosis, high-resolution computed tomography (HRCT) or reverse transcription-polymerase chain reaction (RT-PCR) tests were conducted. Both the mothers and the newborns were followed up to three months after delivery. RESULTS: Fourteen pregnant women with the median age of 31.5 were enrolled. HRCT was done in twelve mothers (85.7%), and eleven mothers (78.6%) were evaluated via RT-PCR; four of them (36.36%) were positive. Two mothers (14.28%) were admitted to ICU. The cesarean section (C/S) was done following fetal distress in only three mothers due to their concerns of vertical transmission. Two mothers were admitted to the intensive care unit (ICU), and one of them died of pneumomediastinum. Fortunately, no neonatal death was reported three months after the delivery. CONCLUSION: COVID-19 affects mothers more in the last trimester of the pregnancy. Although no fetal death was reported in the recent study, physicians should closely monitor pregnant women to reduce the adverse event .

The Impact of COVID-19 Pandemic on Stress and Anxiety of Non-infected Pregnant Mothers.

BACKGROUND: The newly emerging COVID-19 has caused severe anxiety around the world and it is infecting more people each day since there is no preventive measure or definite therapy for the diseases. The present study aimed to evaluate its effect on anxiety and stress of pregnant mothers during perinatal care. METHODS: Three-hundred pregnant mothers without COVID-19 infection who were referred to the hospitals affiliated to Iran University of Medical Sciences for delivery during April 2020, based on negative clinical symptoms and the results of polymerase chain reaction (rt-PCR) for COVID-19, were recruited by census method and asked to complete the Persian version of the perceived stress scale (PSS); participants views about their anxiety level and the role of COVID-19 as the source of their stress and worries were recorded. Women who refused to continue the study were excluded. The frequency of variables and mean scores were calculated using SPSS v. 21. RESULTS: Mean age of mothers was 30.20±16.19 years; 31.3% were primigravida and mean gestational age was 38.00±4.14 weeks. Moreover, 16.3% asked for earlier pregnancy termination and 39% requested Cesarean section (C/S). Assessing the mothers' anxiety revealed a high/very high level of anxiety in 51.3%. The majority felt worried and frustrated because of COVID-19 (86.4%). Social media had a great impact on the level of stress among these mothers (60.3%). CONCLUSION: COVID-19 pandemic is an important source for the increased anxiety and stress among healthy pregnant mothers.

Woman with Pregnancy and Lactation-Associated Osteoporosis (PLO).

Osteoporosis is a disease known to reduce bone density and to damage bone microarchitecture leading to increased fracture risk. Osteoporosis is one of the most common diseases among the middle aged and elderly people that impose high costs on the community. So far, despite rare cases of pregnancy and lactation-associated osteoporosis (PLO) reported in Iran, it can be treated with accurate diagnosis. Patient Introduction. A 24-year-old woman was referred to the outpatient rheumatologic clinic after the cesarean section during the first pregnancy with severe back pain. In the thoracolumbar radiographs, a loss of vertebral height in the T11 to L5 vertebra was recognized. Other complaints were abdominal pain and anemia. In order to evaluate the gastrointestinal disease and celiac, the patient underwent gastrointestinal and hematologic workup. Ultimately, secondary causes of the osteoporosis were excluded. Based on the patient's clinical course, imaging finding, and exclusion of other causes of osteoporosis, the patient was diagnosed with PLO. Conclusion. Clinicians should be aware of PLO as rare complication of pregnancy. The situation should be particularly considered in females offering from new onset back pain in the third trimester of pregnancy or breastfeeding period.

Development of a scoring system for prediction of placenta accreta and determine the accuracy of its results.

Background: Optimal management of women with placenta accreta requires accurate preoperative diagnosis. Therefore, this study was conducted with the aim to evaluate a new prediction scoring items for risk assessment on placenta accreta and determine its accuracy ratio.Methods: This prospective cohort study was carried out on 159 suspected pregnant women morbidly adherent placenta (MAP) in Shariati, Imam Khomeini, and Yas Hospitals in Tehran from October 2016 to May 2018. The number of previous cesarean deliveries; lacunae stage, location of placenta; Doppler assessment; and loss of clear zone were used for review and scoring of ultrasound images. Ultimately after collecting scores, subjects fall into one of the following three categories: low (≤5 points), moderate (6-7 points), or high (8-10 points) probability for placenta accreta. Ultimately, diagnosis of accreta was based on hysterectomy during surgery or reports of pathology. A logistic regression model was used to calculate the probability of placenta accreta on univariable analysis, to assess the discriminant power of all explanatory variables assessed by the receiver operating characteristic (ROC) curve.Results: The area-under-the-ROC curve of the composite scores was 98% and the overall sensitivity, specificity, and positive and negative predictive values of our developed scoring system were 91.84%, 87.27%, 86.54%, and 92.31%, respectively.Conclusion: Combination of several simple ultrasound and clinical characteristics in a scoring system may be highly effective for prenatal risk assessment and prediction of placenta accreta. Output of scoring system helps medical staff to prepare appropriately before surgery and avoid perinatal mortality and morbidity.