A systematic review of social determinants of healthy lifestyle among Iranian women.

AIM: This review aimed to determine the social determinants of healthy lifestyle among Iranian women. DESIGN: A systematic review and meta-analysis. METHOD: A comprehensive electronic search was carried out with no time limit until 6 September 2019. Newcastle-Ottawa Quality Assessment Scale (adapted for evaluating cross-sectional survey/studies) was used to evaluate the quality of the articles. The metap code was used in SATATA16 to combine the p-values using Edgington's additive method. RESULTS: Twelve studies entered the systematic review. The meta-analysis results showed that social determinants of healthy lifestyle among Iranian women included income, job, education, spouse's education and occupation, housing and social support. CONCLUSIONS: Given the relationship between modifiable factors and women's lifestyles, it seems that it is necessary to set policies to improve the status of factors related to women's lifestyle including reducing poverty, promoting education and providing social support to eliminate.

Nonpharmacological approaches to improve women's childbirth experiences: a systematic review and meta-analysis.

Background: Childbirth is considered a significant experience in women's life. Different models of care and interventions without pharmacological approaches have been used to enhance women's positive childbirth experiences, but the most effective interventions have not been clearly identified.Objective: To assess the effectiveness of nonpharmacological approaches in improving women's childbirth experiences.Methods: We searched Cochrane Library, Medline, Web of Science, Embase, Scopus, ProQuest, Google Scholar, and Persian databases (Magiran, Scientific Information Database, and Barakat) from inception until December 2017. Randomized controlled trials and quasi-randomized controlled trials comparing interventions designed to improve women's childbirth experiences with standard cares were included in this review. Pharmacological interventions were excluded from the study. The outcome measure was women's childbirth experience. Heterogeneity was determined using the Cochrane's test and I2 index. The standardized mean differences were pooled based on random effect models.Results: We included 19 studies (10,141 women) in the review. Results of the meta-analysis of 18 studies (8487 women) demonstrated that all the interventions with nonpharmacological approaches improved childbirth experiences (standardized mean difference: 0.49; 95% confidence interval: 0.33-0.66). But, subgroup meta-analysis showed that different models of midwifery care, support during labor and natural therapies were the most effective interventions in improving women's childbirth experience.Conclusions: Nonpharmacological interventions that enable women to feel supported, safe and respected can lead to improved childbirth experiences. However, there is a need for further studies with larger sample sizes and standardized tool to better assess the effectiveness of specific interventions on women's childbirth experiences.

Adaptation of short version of questionnaire for assessing the childbirth experience (QACE) to the Iranian culture.

BACKGROUND: Given the importance of the childbirth experience, its effects on women's life and society, and the need for its assessment by accurate instruments, this study aimed to determine the psychometric properties of the Questionnaire for Assessing the Childbirth Experience (QACE) in an Iranian women population. METHODS: The validity of the Farsi edition of the questionnaire was assessed using the opinions of eight experts. Its construct validity was assessed by studying 530 mothers, at 1-4-month postpartum, who delivered in health centers of Tabriz, Iran. The exploratory factor analysis (EFA) was performed to identify its factors. Then, the confirmatory factor analysis (CFA) was performed for the structural assessment of the extracted factors. Spearman's correlation coefficient was used to investigate the correlation between factors. Cronbach's alpha and intraclass correlation coefficient (ICC) were used to obtain the internal consistency and test-retest reliability. RESULTS: In total, four factors were extracted from the EFA: "relationship with staff" (4 questions), "first moments with the newborn" (3 questions), "feelings at one-month postpartum" (3 questions), and "emotional status" (3 questions). According to the CFA, the model achieved desired fit level (RMSEA < 0.08, GFI, CFI, IFI > 0.90, and x2/df < 5.0). Cronbach's alpha (0.77-0.82) and intraclass correlation coefficient index (0.83-0.98) were desirable for all factors. CONCLUSION: The short edition of the QACE, as a standard tool, can be used by future studies to measure the experience of Iranian women.

The Relationship between Maternal Functioning and Mental Health after Childbirth in Iranian Women.

The postpartum period is critical for new mothers, in terms of performing maternal functions, which can be affected by physical or psychological complications. The purpose of the present study is to determine the relationship between maternal functioning and mental health in the postpartum period. This cross-sectional descriptive-analytic study was conducted on 530 eligible women who referred to health centers in Tabriz, Iran in 2018. The participants were selected through randomized cluster sampling, and data were collected by using a socio-demographic characteristics questionnaire, Mental Health Inventory (MHI), and the Barkin Index of Maternal Functioning (BIMF). These assessments were collected between 1 and 4 months postpartum. The relationship between maternal functioning and mental health was determined by conducting bivariate analysis via Pearson and Spearman correlation analysis and the general linear model (GLM) in a multivariate analysis. The mean (SD) mental health score in women was 79.1 (15.0) in the obtainable score range of 18 to 108, and the mean (SD) BIMF score in women was 97.4 (12.9) in the obtainable score range of 0 to 120. Based on Pearson or Spearman correlations, mental health and its sub-domains had positive, significant correlations with infant care, mother-child interaction, mental well-being, social support, management, adjustment, self-care, and maternal functioning (p < 0.001). Based on the GLM, increased maternal functioning was associated with higher total mental health score, having a moderate income, and receiving support for infant care (p < 0.05). High levels of postpartum mental health can have a positive impact on maternal functioning. Additionally, having support with infant care tasks can also improve functioning.

Developing of a new guideline for improving birth experiences among Iranian women: a mixed method study protocol.

BACKGROUND: The childbirth experience has significant effects on the life of the mother and family. However, there are no Iranian studies which evaluate and measure women's childbirth experiences to provide accurate data on this important matter. The aim of this study is to develop a new guideline to improve women's childbirth experiences by meeting their needs and expectations. METHODS/DESIGN: The present study will use the mixed method with the explanatory sequential approach. Phase one is a cross-sectional survey with random cluster sampling of the health centers in Tabriz. Eight hundred primiparous women will be selected to measure their childbirth experiences and predictors factors. Phase two is a qualitative study to explore women's perceptions of the aspects and determinants of the childbirth experience. Phase two participants will be selected using purposive sampling from the women who participated in phase one. Phase three involves developing a new guideline to improve women's childbirth experiences. The new guideline will be developed based on the following elements: a) the results of the qualitative and quantitative data from phase one and two, b) a review of the related literature, and c) expert opinions that have been collected using the Delphi technique. DISCUSSION: By exploring women's childbirth experiences and the influencing factors, a culturally sensitive evidence-based guideline can be developed. The provision of the evidence-based guideline resulting from this study might be effective in improving the quality care of the services for pregnant women. ETHICAL CODE: IR.TBZMED.REC.1396.786.

The effect of probiotics, prebiotics, and synbiotics on hormonal and inflammatory indices in women with polycystic ovary syndrome: a systematic review and meta-analysis.

INTRODUCTION: Polycystic ovary syndrome (PCOS) is among the most prevalent endocrine disorders in women and can lead to many other disorders and chronic diseases. Thus, early diagnosis and treatment of this syndrome is important. Using probiotics, prebiotics, and synbiotics supplementations to treat PCOS seems appropriate because of their useful effects and low complications. AIMS: To assess the effects of probiotics, prebiotics, and synbiotics on hormonal indices such as testosterone, dehydroepiandrosterone sulfate (DHEA-S), sex hormone binding globulin, Free Androgen Index (FAI), and inflammatory indices, such as high sensitive C reactive protein (hsCRP), malondialdehyde (MDA), total glutathione (GSH), nitric oxide (NO), and total antioxidant capacity (TAC) as the primary outcomes and the hirsutism score as the secondary outcome. METHODS: All published articles from the beginning until 10 November 2018 in English (Cochrane Library, Web of Sciences, Google Scholar, PubMed, Scopus, and ProQuest) and Persian (SID and Magiran) databases were searched. The effect of interventions on the outcomes was reported with a standard mean difference (SMD) and confidence interval of 95%. In case of high heterogeneity, the random effect model was used instead of the fixed effect model. The statistical heterogeneity of the included clinical trials was tested using the Chi square test and I2. RESULTS: Thirteen studies with 855 participants with PCOS(438 women in the intervention group and 417 women in the control group) were included in the meta-analysis. Results of the meta-analysis showed that the SHBG (SMD: 0.56; 95% CI 0.26-0.86; P = 0.0002) and NO (SMD: 0.38; 95% CI 0.09-0.68; P = 0.01) concentration increased significantly in the probiotics and synbiotics groups compared to the placebo group. FAI (SMD: - 0.58; 95% CI - 0.95 to - 0.21; P = 0.002) and MDA (SMD: - 0.76; 95% CI - 1.46 to - 0.05; P = 0.03) concentration in the probiotics and synbiotics groups reduced significantly compared to the placebo group. The results of meta-analyses on other hormonal and inflammatory indices such as testosterone, DHEAS, GSH, hsCRP, TAC, and hirsutism score showed that there were no significant differences between the intervention and control groups. CONCLUSION: Using synbiotics and probiotics in women with polycystic ovary syndrome improve hormonal (FAI, SHBG) and inflammatory (NO, MDA) indices in these patients.

The effect of cognitive-behavioral therapy on psychological distress in the mothers of preterm infants: a systematic review and meta-analysis.

Introduction: The birth of a preterm infant has the potential to cause stress, anxiety, depression and Post-Traumatic Stress Disorder (PTSD) in mothers. Numerous interventions have been developed for the parents of preterm infants to deal with these problems. Cognitive-Behavioral Therapy (CBT) is a client-centered intervention for improving mental health and alleviating psychological distress by transforming unconstructive thoughts and behaviors. The present systematic review was conducted to evaluate the effect of CBT on anxiety, depression and PTSD (the primary outcomes) and stress (the secondary outcome) in the mothers of preterm infants.Methods: A search was carried out of all the articles published by 30 Sep. 2018 in English and Persian databases including Medline (via PubMed), Scopus, Embase (via Ovid), Web of Science, Psycinfo, Google Scholar, SID, Magiran and Iran Medex. The risk of bias was assessed for the studies based on the Cochrane Handbook. The meta-analysis results were reported as Standardized Mean Difference (SMD). The heterogeneity of the studies was examined using I2, T2 and Chi2.Results: Four clinical trials on 455 mothers with preterm infants were systematically reviewed. The meta-analysis results revealed a lower mean depression score in the CBT group compared to the controls (SMD = -0.45; 95% CI: -0.98 to 0.08), but this difference was not statistically significant (p = .09). The mean scores of PTSD (MD = -11.69; 95% CI: -19.45 to -3.94; p = .003) and anxiety (SMD = -0.38; 95% CI: -0.61 to -0.15; p = .001) were significantly lower in the CBT group too.Conclusion: CBT was effective in decreasing the level of PTSD and anxiety in the mothers of preterm infants. Due to the small number of included studies and the small sample size, clinical trials with large sample sizes and a low risk of bias are recommended to provide evidence for the implementation of interventions affecting psychological distress in the mothers of preterm infants in clinical settings.

The psychometric properties of the Barkin index of maternal functioning (BIMF) for the Iranian population.

BACKGROUND: Mothers' capability for childcare and compatibility with the maternal role represent important challenges in postpartum care. Given the significance of evaluating maternal functioning, and the lack of adequate standard instruments in Iran for this purpose, the present study was aimed at translating and conducting a psychometric assessment of the Barkin Index of Maternal Functioning (BIMF) for Iranian women. METHODS: The instrument was translated into Persian using the Backward Forward method. The study included 530 women in the postpartum period admitted to healthcare centers in Tabriz, Iran; they were selected through the cluster sampling method. Face, content, and construct (through exploratory and confirmatory analyses) validity were presently examined. Reliability of the questionnaire was determined using the internal consistency and test-retest reliability methods. RESULTS: Two factors (mom's needs and competency), emerged based on exploratory factor analysis. The x2/df ratio was less than 5, and the values of the Root Mean Square Error of Approximation (RMSEA) and the Root Mean Square Residual (RMR) were less than 0.08 and 0.1, respectively, verifying the model validity. Cronbach's alpha coefficient and Intra-class Correlation Coefficient (ICC) were calculated as 0.88 and 0.85, respectively, indicating reliability. CONCLUSION: The Persian version of the BIMF is a valid and reliable instrument for measuring the postpartum functioning of Iranian mothers.

Validation of the Iranian version of the childbirth experience questionnaire 2.0.

BACKGROUND: Assessing women's childbirth experiences is a crucial indicator in maternity services because negative childbirth experiences are associated with maternal mortalities and morbidities. Due to the high caesarean birth rate in Iran, measuring childbirth experience is a top priority, however, there is no standard tool to measure this key indicator in Iran. The aim of present study is to adapt the "Childbirth Experience Questionnaire 2.0" to the Iranian context and determine its psychometric characteristics. METHODS: Childbirth Experience Questionnaire 2.0 was translated into Farsi. A total of 500 primiparous women, at 4 to 16 weeks postpartum, were randomly selected from 54 healthcare centres in Tabriz. Internal consistency and reliability was calculated using the Cronbach's Coefficient alpha and Intraclass Correlation Coefficient, respectively. Construct validity was assessed using exploratory and confirmatory factor analysis and discriminant validity using the known-group method and the Mann-Whitney U-test. RESULTS: The internal consistency and reliability for the total tool were high (Cronbach's alpha = 0.93; Intraclass Correlation Coefficient = 0.97). Explanatory factor analysis demonstrated the adequacy of the sampling (Kaiser-Meyer-Olkin = 0.923) and significant factorable sphericity (p < 0.001). Confirmation factor analysis demonstrated acceptable values of fitness (RMSEA = 0.07, SRMSEA = 0.06, TLI = 0.97, CFI > 0.91, x 2/ df = 4.23). Discriminatory validity of the tool was confirmed where the CEQ score and its subdomains were significantly higher in women who reported having control over their childbirth than women who did not. CONCLUSION: The Farsi version of the Childbirth Experience Questionnaire 2.0 tool is a valid and reliable tool and can be used to measure the childbirth experience in Iranian women.

Predictors of traumatic birth experience among a group of Iranian primipara women: a cross sectional study.

BACKGROUND: Traumatic birth experience has undesirable effects on the life of the mother, child, family, and society. The identification of predictive factors can be useful in improving birth experiences among women. This study aimed to assess the prevalence of a traumatic birth experience and identify its predictors among a group primiparous women. METHODS: A cross-sectional study was conducted among 64 health centres in Tabriz, the second largest city in Iran. Cluster sampling was used to recruit 800 eligible women at one to 4 months postpartum. The Persian version of the Childbirth Experience Questionnaire was used to measure the womens' birth experiences. Data were collected through face to face interviews and analysed mainly by multivariable logistic regression. RESULTS: The prevalence of traumatic birth experience was 37% in the study group. The independent predictors of the traumatic birth experience were related to antenatal and intrapartum factors. The antenatal predictor was the lack of exercise during pregnancy (OR = 2.81, CI 1.40-5.63, P = .003) and the intrapartum predictors were the absence of pain relief during labour and birth (OR = 4.24, CI 2.12-8.50, P < .001), and the fear of childbirth (OR = 3.47, CI 1.68-7.19, P < .001). CONCLUSIONS: The findings revealed the high rate of traumatic birth experience among the primimarous women and identified the importance of a woman-centered care where a woman can actively make decision about the care she receives receive during labour and birth.

Effect of birth plans on childbirth experience: A systematic review.

AIM: The birth plans were developed as an approach for pregnant women to present their expectations for labour and childbirth. The aim of this study was to assess whether birth plans (a written document in which pregnant women describe preferences about their care during labour and childbearing) compared with standard or routine approach (supine position, continuous fetal monitoring, enema, episiotomy) affect the birth experience (woman's perception of labour and childbirth as positive or negative experience) or satisfaction with birth. METHODS: This systematic review was performed by searching several databases, including Cochrane Library, Web of Science, MEDLINE, Embase, CINAHL, Scopus, PsycINFO, ACP Journal Club, Google Scholar, and Persian databases (SID, Magiran, and Barakat) up to February 10, 2018. RESULTS: By searching the databases, 1006 published articles were found, of which 480 and 114 articles were excluded by review of the titles and the abstracts, respectively. Finally, we included three clinical trials (1132 women) in the review. The results of two study showed that the mean score of birth experience in the birth plan group was significantly higher than the control group (P ≤ 0.01). However, the results of a study showed that there were no statistically significant differences between birth plan and control groups (P > 0.05). Quality of included studies was very low. CONCLUSIONS: There is not enough evidence to support or refute that birth plan can improve the birth experience or satisfaction with birth.

Marital Adjustment and Its Relationship with Religious Orientations Among Iranian Infertile and Fertile Women: A Cross-Sectional Study.

This study aimed to determine the status of marital adjustment and its relationship with religious orientations in fertile and infertile women. This study was conducted on 160 infertile and 320 fertile Muslim Iranian women. There was significant difference in terms of marital adjustment in two groups. There was significant relationship between marital adjustments with intrinsic religious orientation in two groups; however, there was no significant relationship between marital adjustments with extrinsic religious orientation. The results suggest that intrinsic religious orientation is likely to increase marital adjustment in fertile and infertile women. However, further studies should be performed to assess the association of religious orientations with marital adjustment in other communities and religions.

Feasibility, Reliability, and Validity of the Iranian Version of the Quality of Life Questionnaire for Pregnancy.

BACKGROUND: Clinical studies are giving increased importance to quality of life assessments as measures of the relative effectiveness of prevention and treatment programs used during pregnancy and antenatally. OBJECTIVES: The aim of this study was to validate the Quality of life gravidarum (QOL-GRAV) questionnaire for Iranian women during the pregnant period. PATIENTS AND METHODS: In this cross-sectional methodological study, content validity following back and forward translation was assessed by a panel of experts. Using the two-stage cluster sampling method, 565 pregnant women referred to health care centers from April to June 2015 in Tabriz, Iran were enrolled in the study. Construct validity by assessing the factor structure, and convergent and discriminant validity were evaluated using scale-item correlations and known group analyses. Internal consistency and test-retest reliability were assessed in a sample of 30 pregnant women by the Cronbach's α coefficient and intra-class correlation coefficient (ICC). RESULTS: The QOL-GRAV showed good content validity (CVI value = 0.95 and CVR value = 1), internal consistency (α = 0.79), and test-retest reliability (ICC = 0.86). The results of the CFA for two-factor models indicate an acceptable fit of the proposed model (RMSEA; 90% CI = 0.083; 0.068-0.099, CFI = 0.95, GFI = 0.96, and AGFI = 0.92). CONCLUSIONS: The findings support the validity and reliability of the Iranian version of the QOL-GRAV questionnaire. Therefore, it is recommended to be used for both clinical and research purposes.

Sexual Dysfunction and Help Seeking Behaviors in Newly Married Men in Sari City: a Descriptive.

INTRODUCTION: Sexual dysfunction is a major concern for people's general health. The aim of this study was to determine the status of sexual function and help-seeking behaviors in newly married men. METHODS: This descriptive study was conducted on 363 newly married men. Simple random sampling was used according to premarital counseling offices in the health center of Sari city. Data collection instruments included personal and social characteristics, Arizona Sexual Experience Scale (ASEX), and help-seeking behaviors questionnaires. In order to determine the relationship between characteristics and sexual function, general linear model and also between socio-demographic characteristics and receiving or lack of receiving help, multivariate logistic regression test were used. RESULTS: The mean of sexual function score was 21.3 (2.7) out of possible 5-30, and 26% of men suffered sexual dysfunction. The highest prevalence (27.2%) of dysfunction was in the dimension of sexual stimulation, and the lowest (15.7%) in maintaining erection. For the treatment of sexual dysfunction, only 32% men had sought help, and 40% of them had visited specialists. The most frequent reasons for not seeking help were feeling uncomfortable with doctor, and their belief that doctor is not able to do much. 65% of men desired to be treated. CONCLUSION: The results demonstrated relatively high prevalence of sexual dysfunction among men, and unfortunately, most of them did not seek help for their sexual problem. Since Sexual dysfunction can leave damaging effects on the quality of life and marital relationship, interventions to deal with these challenges and screening to identify such problems appear necessary.