Impact of primary care posttraumatic stress disorder (PC-PTSD) on fertility problem of Iranian women with infertility during the COVID-19 pandemic.

BACKGROUND: Infertility continued to be a major stressor among women with infertility during COVID-19pandemic. This study aimed to evaluate the impact of primary care posttraumatic stress disorder (PC-PTSD) on fertility problem of Iranian women with infertility during COVID-19 pandemic. METHOD: In this cross-sectional study, 386 women with infertility completed the questionnaires of PC-PTSD-5 and Fertility Problem Inventory (FPI) at an infertility center between 2020 and 2022. RESULTS: The mean of fertility problems was 145.20 (± 32.31). In terms of FPI subscales, the means were as follows: Sexual concern 21.80 (± 7.58), social concern 26.53 (± 8.94), relationship concern 26.02 (± 9.18), need for parenthood concern 40.88 (± 8.98), and rejection of childfree lifestyle 29.96 (± 7.69). The highest mean of FPI subscales was related to the need for parenthood concern in women with infertility. The strongest correlation was found between the subscales of sexual concern and social concern followed by sexual concern and relationship concern. The variables of PC-PTSD were a predictor of fertility problems (ß = 0.203, P < .0001). Additionally, the variables of PC-PTSDwere a predictor of sexual concern (ß = 0.248, P < .0001), social concern (ß = 0.237, P < .0001), relationship concern (ß = 0.143, P < .020), and need for parenthood concern (ß = 0.101, P < .010). After adjusting for demographic characteristics, there was a significant relationship between FPI with job (ß=-0.118, P < .031), education (ß=-0.130, P < .023), living place (ß = 0.115, P < .035), smoking (ß = 0.113, P < .036), relationship with husband (ß = 0.118, P < .027), and PC-PTSD symptom (ß = 0.158, P < .0001). In addition, the multivariate linear regression showed a significant association between sexual concern and education (ß=-0.152, P < .008), smoking (ß = 0.129, P < .018), PC-PTSD symptom (ß = 0.207, P < .0001); social concern and job (ß=-0.119, P < .033), PC-PTSD symptom (ß = 0.205, P < .0001); relationship concern and education (ß=-0.121, P < .033), living place (ß = 0.183, P < .001), relationship with husband (ß = 0.219, P < .0001); and rejection of childfree lifestyle and job (ß=-0.154, P < .007). CONCLUSION: Systematic PTSD screening during COVID-19 pandemic by healthcare providers can be uniquely used to identify, evaluate, and treat trauma-related health conditions in infertility settings, which can link women with infertility to mental health services. This can be novel and useful for future policymakers and practitioners in the infertility field.

Effectiveness of distance education program on mothers' empowerment in exclusive breastfeeding: A randomized clinical trial.

BACKGROUND: Mothers need the necessary skills to be empowered in successful breastfeeding. This study aimed to investigate effectiveness of the distance education program on the mothers' empowerment in exclusive breastfeeding. MATERIALS AND METHODS: A randomized clinical trial study was done on 72 nulliparous pregnant women 28-32 weeks with normal pregnancy. The qualified women were randomly assigned to the intervention and control groups based on the random-number table. The breastfeeding training packages were sent to women in the intervention group via Telegram every week from 32 until 37 weeks of gestation. The mothers' empowerment in breastfeeding (primary outcome) and the exclusive breastfeeding rate (secondary outcome) were assessed by questionnaires. RESULTS: Based on the repeated measured tests, although scores for all domains and also the total score of the mothers' empowerment in breastfeeding between two groups had increased during the study period, there was a significant difference between the increasing trends of the maternal empowerment domains in two groups (interaction P value <0.001). Also, the prevalence of exclusive breastfeeding (secondary outcome) at 6 months was significantly higher in the intervention group (81.8% and 57.1% in the intervention and control groups, respectively) (P = 0.028). CONCLUSION: Distance education could increase all domains of the mothers' empowerment in breastfeeding after delivery. Also, exclusive breastfeeding at 6 months after delivery was significantly higher in mothers who were receiving the distance education packages.

Risk Factors for Gestational Diabetes Mellitus: A Case-Control Study.

Background: The underlying causes of gestational diabetes mellitus (GDM) are important because they are effective for the diagnosis and prevention of this condition. The aim of this study was to identify the risk factors for GDM and the possible etiological agents. Materials and Methods: This case-control study was conducted with 100 women with GDM and 100 healthy pregnant women at a tertiary care hospital, affiliated to Babol University. GDM was identified by impaired oral glucose tolerance test based on the Carpenter and Coustan criteria. Healthy women were randomly selected from the prenatal health care clinic of the same center and were matched to gestational age of 24 to 28 weeks. Descriptive and inferential statistics were used for data analysis via the SPSS software. Results: After adjusting variables, multivariate analysis identified 4 significant risk factors of GDM, including prepregnancy low physical activity (odds ratio [OR] = 2.85, 95% confidence interval [CI]= 0.97-8.34), advanced maternal age (OR = 1.24, 95% CI = 1.13-1.35), body mass index ⩾ 30 kg/m2 (OR = 1.10, 95% CI = 1.02-1.20), and family history of diabetes mellitus (OR = 5.62, 95% CI = 2.26-13.96). Conclusion: We observed significant associations between low prepregnancy physical activity and obesity with GDM risk. Thus the finding of this study can help devise strategies for the prevention of GDM.

Student Attitudes About Reproductive Health in Public Universities: A Cross-Sectional Study.

BACKGROUND: Determine attitude of young people to reproductive health issues can somewhat predict their behavior in this area. This helps us in planning future on reproductive health. The aim of this study was to determine the attitude of reproductive health and related factors among Iranian students in public universities in Iran. METHOD: A cross-sectional study was carried out. The tool was developed based on a literature review to find out about reproductive health attitudes and sociodemographic factors associated. The face and content validity of the questionnaire was performed using expert judgment. Cronbach's coefficient and test-retest were used to determine the reliability. Data were analyzed using the Statistical Package for Social Sciences software by independent t test, ANOVA, and multiple linear regression. RESULTS: Out of 461 respondents, the majority of students were nonmedical sciences (81.1%). The main sources of information for reproductive health awareness were the media (40%); 54.9% disagreed with having premarital sex in both sexes, while only 36% agreed to postpone sexual activity until marriage in order to prevent sexually transmitted diseases. Moreover, 64% believed that contraception would cause infertility in the future. The majority found the need for reproductive health services and education essential for single youth. Multiple regression showed a poor reproductive health attitude in nonmedical students, families who did not talk about boy-girl relationships, as well as in satellite users and hookah consumers. CONCLUSION: The students' level of attitude on reproductive health was not satisfactory. Intervention programs related to reproductive health taking into account the cultural aspects of Iranian society can protect young people from risky behaviors and unwanted pregnancies by creating a positive attitude.

Reproductive health problems among female shift workers: A qualitative study in Iran.

BACKGROUND: Shift work (i.e. working between 18:00 and 07:00) is associated with sleeplessness and fatigue and hence, can cause female shift workers different health problems. This study aimed to explore reproductive health problems among female shift workers. MATERIALS AND METHODS: This qualitative study was conducted in Amol and Babol cities, Iran, on 19 female shift workers with previous history of pregnancy and breastfeeding. Participants were selected purposively and with maximum variation respecting their age, work experience, educational level, and financial and employment status. Face-to-face semi-structured interviews were held for data collection and conventional qualitative content analysis was employed for data analysis. RESULTS: Female shift workers' reproductive health problems were categorized into fourteen subcategories and the five main categories of conflict between pregnancy and shift work, breastfeeding-related challenges, impaired sexual relationships, childbearing limitations, and gynecological problems. CONCLUSION: Impaired sexual problems are the most significant reproductive health problem among female shift workers. Their reproductive health can be promoted through periodical reproductive health assessments by midwives, reproductive health specialists, psychologists, and gynecologists.

A study on menstruation of Indian adolescent girls in an urban area of South India.

BACKGROUND: Menstrual cycle is an important indicator of women's reproductive health. However, menstruation has a different pattern within a few years after menarche, which might not be well understood by many adolescent girls. MATERIALS AND METHODS: A cross-sectional study was conducted on 536 healthy menstruating females aged 10-19 years. Standardized self-reporting questionnaires were used to obtain relevant data. The categorical data were analyzed using Chi-square or Fisher's exact test. RESULTS: Mean age of menarche was 13 ± 1.1 years with wide variations, i.e., 10-17 years. 73.1% had cycle duration of 21-35 days. More than half of them reported 5-6 days' duration of menstrual blood flow and 12% of the participants had >7 days of flow. Long blood flow duration was more prevalent in early than in late adolescence. 30.1% reported abundant blood loss. 66.8% had dysmenorrhea and no difference was observed between early and late adolescents. Menstrual cycles tend to be shorter in early adolescence period. CONCLUSION: A comprehensive school education program on menarche and menstrual problems may help girls to cope better and seek proper medical assistance.

Female sexual outcomes in primiparous women after vaginal delivery and cesarean section.

BACKGROUND: Sexual function is an essential component of life and yet very little is known about the relationships between the female sexuality and the mode of delivery. OBJECTIVE: To compare sexual outcomes after vaginal delivery and cesarean section. METHODS: A cross-sectional study was conducted on women in two stages; early pregnancy and 3 to 6 months after delivery in health centers. Female sexual outcomes evaluated were female Sexual Function Index scores and the time required to resume sexual activities after delivery. RESULTS: Sexual function did not differ significantly among two groups vaginal delivery n=90 and cesarean section n = 113 with regard to duration of marriage, educational level, contraception methods, and occupational status p = 0.8.The mean timing of the resumption of sexual activity was 8.9 ± 1.3, and there was no substantial conflict between the two groups. Mean frequency of intercourse in the post-partum period was 1.8±1.2 times per week with significant difference compared to pre pregnancy P<0.05. The individual domain scores after the delivery was significantly lower in comparison with pre-pregnancy p<0.004. CONCLUSION: No differences in sexual outcomes between vaginal delivery and cesarean section. Consequently cesarean section cannot be recommended in the view of maintenance of normal sexuality after child birth.

Perceived health discomfort among adolescent girls and related factors in an urban area, South India.

INTRODUCTION: Adolescence is a period of life that is a bridge between childhood and adulthood. India has the world's largest adolescent girl's population, and adolescent girls are an important vulnerable group of population. Perceived health is a predictor of morbidity and mortality in adults and has been an important marker of the health status in population health studies for decades. The aim of the study was to describe adolescent's perception of health and association between some factors such as nutrition status, socioeconomic status (SES), and health status. As their perception of health discomfort affects their health behavior and self-care, therefore, their health status is an important matter to discuss. MATERIALS AND METHODS: A cross-sectional study was conducted in urban areas from a major city in South India. Six hundred and fifty adolescent female students aged 10-19 years formed the study population. Standardized self-reporting questionnaires were used to obtain relevant data regarding demographic features, SES, and health status. BMI calculated for each individual. The data were analyzed using SPSS version 16. RESULTS: About 83.3% of participants ranked their health status as good to excellent. A majority of the girls had one or more problems related to their menstrual cycles. The most common occurring problem was headache (45.3%). 47.8% of participants exhibited symptoms of mild insomnia. Strong significant association between nutritional status and SES was found. Higher percentage of undernourished adolescents belonged to low SES. CONCLUSION: Adolescents are expected to enjoy good health, but this does not seem to be the case in the developing countries like India, where poverty, malnutrition, and repeated infection are rampant. Majority of the problems such as healthy nutrition and self-care can be solved by community-based programs, health education, and food fortification.

Weight-related concerns and diet behaviors among urban young females: A cross-sectional study.

BACKGROUND: Females are more likely than males to perceive themselves as too heavy, this has been explained in terms of the equation of "female beauty with extreme thinness." Therefore, females are in general prone to develop unhealthy behaviors for weight management. Wrong weight control behaviors have significant health consequences. OBJECTIVES: To investigate the body weight concerns, body satisfaction, and weight control behaviors among young females and their association with age and socioeconomic status (SES). MATERIALS AND METHODS: A cross-sectional study conducted in urban areas from a major city in South India. About 650 healthy unmarried females aged 15-25 years formed the study population. Self-reporting questionnaires were used to obtain relevant data. The categorical data were analyzed using Chi-square, correlation, and regression analyses by SPSS version 16. RESULTS: Most overweight and obese subjects perceived themselves as overweight. Adolescents were more likely to report themselves as overweight. The perceived weight, body satisfaction, and weight control behaviors are influenced by weight status and age of the subjects. However, SES of the participants did not exhibit effect of others' opinion about their weight and body satisfaction as well as weight management behaviors. CONCLUSION: The high prevalence of weight-related concerns suggests that all females should be reached with appropriate information and interventions. Healthy weight control practices need to be explicitly promoted and unhealthy practices discouraged. Young females need special attention toward weight management.

Primary Dysmenorrhea and Menstrual Symptoms in Indian Female Students: Prevalence, Impact and Management.

BACKGROUND: Dysmenorrhea is the most common gynecological problem among females and it is defined as cramping pain in the lower abdomen occurring just before or during menstruation. Menstrual symptoms are a broad collection of affective and somatic concerns that occur around the time of menses. The effect and importance of dysmenorrhea is very wide, therefore managing the problem is important. OBJECTIVE: To ascertain the prevalence, and impact of primary dysmenorrhea in student girls and their management behaviors. METHODS & MATERIALS: A Cross-sectional study was conducted on 1000 healthy females aged 11-28 years. Standardized Self-reporting questionnaires were used to obtain relevant data. Pain intensity was assessed by using the Numerical Pain Scale (NPS). Data was analyzed by SPSS version 16. RESULTS: Prevalence of dysmenorrhea was 70.2%. Majority of the subjects experienced pain for one or 1-2 days during menstruation. 23.2% of the dysmenorrheic girls experienced pain for 2-3 days. The most common symptom in both dysmenorrheic and non dysmenorrheic girls during the menstrual periods was tiredness and second most prevalent symptom was back pain.Females experiencing mild pain on an average absented for one and half day a month while 2.1±1.2 and 2.5±1.3 days for those who experienced moderate and severe forms of dysmenorrhea respectively. A small proportion of girls sought pharmacological management (25.5%) and 83.2% depended on non-pharmacological methods. Only 14.2% had sought medical advice. CONCLUSION: Sub optimal use of the medical advice and the barriers to seek medical attention by dysmenorrheic females need exploration. It is important that health education on puberty and menstruation is regarded as inadequate for many girls in India.

Relationship of coping ways and anxiety with Pregnancy Specific-stress.

OBJECTIVES: To explore whether coping strategies and general anxiety are associated with pregnancy-specific stress (PSS) and how much of variance of PSS is explained with these variables. METHODS: A cross sectional study was conducted at two teaching hospitals between November 2013 and December 2015. Total 190 pregnant women (60 women at 6-13-weeks of gestation, 60 at 13-26 weeks, and 70 at 27-40 weeks of gestation) completed the study. The participants completed three questionnaires including; Pregnancy experience scale (PES-41), Ways of Coping Questionnaire (WCQ), and State-Trait anxiety inventory (SATI). Pearson coefficients and analysis of regression was done to assess the correlations between variables. RESULTS: Pregnant women who experienced higher mean level of pregnancy specific-stress had significantly higher mean level of occult anxiety, overt anxiety, and total anxiety than women who did not experience PSS. Although there was a positive and significant relationship between intensity of hassles and uplifts and ways of coping, the correlation between PSS and ways of coping was not significant. The results of analysis regression showed that general anxiety during pregnancy predicted 25% of the variance of PSS (F=4.480, ß=0.159). Also, ways of coping predicted 38% of the variance in pregnancy Hassles (F=7.033, ß=0.194). CONCLUSION: The ways of coping predicted the variance of pregnancy hassles, but does not evaluate pregnancy specific-stress. To think about PSS in terms of general anxiety may help to clarify past findings and to guide future research and interventions.

Comparison of the serum iron, ferritin levels and total iron-binding capacity between pregnant women with and without gestational diabetes.

BACKGROUND: Gestational diabetes mellitus (GDM) is the most common metabolic disorder during pregnancy. GDM causes substantial morbidity and mortality and long- term complications. GDM-related risk factors have not been completely identified yet. Some studies have found relationship between increased serum ferritin and impaired oral glucose tolerance test but the relationship between serum ferritin and risk of GDM has been controversial. The aim of the study was to determine serum iron and ferritin levels and total iron binding capacity (TIBC) in women with GDM and comparison with normal pregnant women. MATERIALS AND METHODS: This case-control study was performed among 200 pregnant women (case = 100, control = 100) who were referred to Yahya-Nejad Hospital in the second trimester in Babol from 2008 to 2009. GDM was diagnosed by impaired OGTT based on Carpenter and Coustan criteria. The 2 groups were matched in age, gestational age and parity. RESULTS: High serum ferritin level increased the risk of gestational diabetes to 2.4-fold [OR = 2.4 (0.83-6.9) CI = 95% (P = 0.10)], while in those with low ferritin levels, the risk of developing gestational diabetes was reduced to 82% [OR = 0.8 with (0.08-0.37) CI = 95% (P = 0.001)]. Using the logistic regression model, after adjustment for BMI, the OR was 2.37 [(0.80-7.01) CI = 95% (P = 0.11)] for low ferritin level and OR = 0.20 [(0.09-0.44) CI = 95% (P = 0.0001)] for high ferritin level, which was statistically significant. CONCLUSION: The serum ferritin level was markedly higher in women with gestational diabetes than in normal pregnant women; therefore, high ferritin can be regarded as a significant risk factor for the development of gestational diabetes.

Sexual dysfunction among women with diabetes mellitus in a diabetic center in Amol.

BACKGROUND: Sexual disorders among diabetic men have been proved in different studies but sexual dysfunction of diabetic women has received attention only recently. Neuropathy, vascular impairment, and psychological complaints have been implicated in the pathogenesis of decreased libido, low arousability, decreased vaginal lubrication, orgasmic dysfunction, and dyspareunia among diabetic women. AIM: The aim of this research was to study the prevalence of sexual dysfunction in different areas among diabetic women. MATERIALS AND METHODS: A cross-sectional study was conducted on 500 women who were recruited from a diabetes center, based on questionnaires completed by them. Data regarding demographic features, physical complications, and sexual disorders were obtained. Medical records of patients were used to obtain body mass index (BMI) and details of complications. RESULTS: Mean age of participants, duration of diabetes, and BMI was 48.8 ± 0.4, 8.9 ± 0.32 years, and 28.9 ± 0.23, respectively. Prevalence of sexual dysfunction was 32.3%. Low sexual desire was seen in 81.8%, disorders of arousal in 78.3%, of orgasm in 47.5%, and 35.1% had disorder in resolution area. There was no significant relationship between some factors such as age, duration of diabetes, BMI, and frequency of sexual dysfunction. Frequency of diabetic complications demonstrated a significant effect on the prevalence of sexual dysfunction. CONCLUSION: Sexual problems are frequent among diabetic women and deserve more attention in clinical practice and researches.

Effects of depression and anxiety symptoms on cardiac mortality following myocardial infarction: a 2-year follow-up.

OBJECTIVE: The purpose of this study was to determine the impact of symptoms of depression and anxiety on mortality in patients hospitalized for acute myocardial infarction (MI). METHODS: A total of 806 consecutive patients were screened within 15 days after MI and 24-month survival rate was ascertained. The Beck Depression Inventory and the State-Trait Anxiety Inventory were completed by patients hospitalized for MI. We tested the BDI × STAI interaction effect in addition to the BDI and STAI main effects. RESULTS: At 24 months' follow up cardiac mortality was assessed in 540 of 806 eligible patients (67% response rate); 531 of 806 for whom baseline data were collected (65.9%) were depressed and 556 (69.0%) were anxious after their MI. Fifty-five (10.2%) patients died during the 24-month follow-up. Neither state of anxiety nor depression scores at entry was different between patients who died from those who survived. CONCLUSIONS: Symptoms of depression and anxiety did not predict cardiac mortality after MI, but despite the negative results regarding the impact of depression on cardiac outcome, it should be stressed that this does not mean that physicians and cardiologists could ignore depression and anxiety.

Sexual function among married menopausal women in Amol (Iran).

BACKGROUND: Sexual activity is an important part of the human being's life but this instinct could be influenced by some factors such as diseases, drug using, aging, and menopause. But information about that is limited. AIM: The aim of this study is to determine the status of sexual activity among married menopausal women in Amol, Iran. MATERIALS AND METHODS: This descriptive analytical study was conducted to describe the sexual activity and sexual dysfunction of women after menopause. Data were collected from health centers in Amol from 280 married women using a questionnaire (self-completed or by interview). FINDING: Mean age of subjects were 55.9 ± 6.02 years. 23.4% of subjects reported that their sexual intercourse had been low. 70% of subjects reported a decrease in their sexual activities after menopause. Sexual dysfunctions includes sexual desire disorder 80% arousal dysfunction 80%, orgasmic dysfunction 25%, dyspareunia 55.6%, and lack of sexual satisfaction 43.2%. CONCLUSION: Findings revealed high percentage of sexual desire disorder and sexual arousal disorder in menopausal women. Therefore, we should have emphasis on counseling and education about sexual activities during the menopause period.