Changes in screening, diagnosis, management, and outcomes of gestational diabetes during the COVID-19 pandemic: A systematic review.

Background: Gestational diabetes mellitus (GDM) is the most common medical complication of pregnancy, and it can lead to complications for the mother and the infant/fetus. This was especially evident during the COVID-19 pandemic. Therefore, the present systematic review aimed to describe the changes in screening, diagnosis, management, and outcomes of gestational diabetes during the COVID-19 pandemic. Methods: The systematic review was conducted from December 2019 until January 1, 2022. To find articles related to the purpose of the study, PubMed, Scopus, Web of Science, and WHO were searched using relevant and validated keywords using MeSH/Emtree. Results: In total, 675 entries were ascertained from the database inquiry, and 17 scholarly works were deemed suitable for inclusion in the final review. The salient conclusions derived from this review were as follows: (a) During the COVID-19 pandemic, there was a significant decrease in the use of OGTTs and a rise in the use of HbA1c assays for both GDM screening and diagnosing. (b) A predominant number of physicians incorporated some variation of telemedicine to remotely supervise and conduct follow-up evaluations of patients with GDM. Various strategies are presented for the provision of prenatal care to women afflicted with GDM, such as concentrating on high-risk demographics, the initiation of lifestyle modifications at early stages, and the implementation of remote patient monitoring techniques. The 'single test procedure' is identified as the most suitable for the preliminary screening of GDM. The OGTT should be assigned clinical precedence in patients at high risk during the ongoing COVID-19 pandemic. Additionally, Medical Nutrition Therapy (MNT) was established as the primary management strategy, and the most influential determinant of the transition from dietary adjustments to pharmacotherapy was the Fasting Blood Glucose (FBG) levels during the second trimester. Conclusion: Suggested strategies for GDM screening and management during the pandemic integrated into routine antenatal care, emphasized the importance of remote diabetes education and technology utilization during health emergencies.

Mental Health in Self-Quarantined Pregnant Women for 14 Days During the Coronavirus Outbreak in Iran.

Background: Quarantine during COVID-19 disease may be associated with psychological distress and other behavioral problems. This study aimed to investigate depression, anxiety, and stress in self-quarantined pregnant women at home for 14 days during the coronavirus disease outbreak in Iran. Materials and Methods: A cross-sectional web survey was carried out on 874 pregnant women in all governmental health centers of two cities in Iran using the census method in 2020-21. Survey data were collected with the Depression, Anxiety, and Stress Scale-21. Data were analyzed using descriptive statistics and analytical tests (Chi-square, Pearson's correlation coefficient, and logistic regression) at significance level less than 0.05. Results: Approximately 40.04% (N = 350) of the participants were classified as a self-quarantine group. The mean (SD) of the stress score was higher for the quarantine group compared to nonquarantine (8.12 (4.95) vs. 5.96 (4.51)) (F2,874 = 25.180, p < 0.001). But there was no significant difference in the depression and anxiety scores between the quarantine group compared to nonquarantine, respectively. Additionally, the adjusted odds ratio for stress score was associated with an unwanted pregnancy (1.993, 95% CI: 1.108-3.587; p = 0.021), younger age (1.707, 95% CI: 1.082-2.692; p = 0.022) and uninsured coverage (2.240, 95% CI: 1.320-3.801; p = 0.003), and complete quarantine (2.027, 95% CI: 1.548-2.654; p < 0.001). Conclusions: Self-quarantine during the COVID-19 pandemic has been related to high-stress levels, specifically, among women of younger age, uninsured, and unwanted pregnancies. Thus, quarantined pregnant women will need more mental health support and medical supplies.

The interplay of attachment styles and marital infidelity: A systematic review and meta-analysis.

Objectives: Marital infidelity is a highly distressing experience for those involved. Understanding the psychological factors related to infidelity can help develop targeted interventions. The primary aim of this study was to assess the association between attachment styles and marital infidelity. Methods: Seventeen studies were included, sourced from electronic databases including PubMed, Scopus, Web of Science, and PsycInfo, with no time limitations, up to April 2023. The search employed terms like "attachment AND marital infidelity." Study quality was evaluated using the Risk of Bias Assessment Tool from RevMan version 5.3. Results: The meta-analysis involved a total of 13,666 participants, ranging from 208 to 4047 individuals. Findings showed that higher levels of anxiety and avoidance in attachment were significantly associated with increased marital infidelity (r = 0.18, 95 % CI = 0.14-0.22, p < 0.0001). Conversely, weaker attachment insecurity was linked to reduced rates of marital infidelity. Additionally, both dismissive and fearful attachment styles correlated with marital infidelity, with respective weighted effect sizes of r = 0.07, p < 0.001 (95 % CI = 0.04-0.10) and r = 0.19, p < 0.001 (95 % CI = 0.10-0.29). No association was found between preoccupied attachment and infidelity. Conclusion: Individuals with insecure attachment styles, specifically those with high levels of anxiety or avoidance, are more likely to engage in marital infidelity. Attachment styles should be a focus in couples therapy, especially for treatment related to infidelity. Assessing and addressing these underlying attachment issues can better guide therapists in their work with couples facing infidelity.

Midwifery students' experiences: Violations of dignity during childbirth.

BACKGROUND: The principle of human dignity is woven into the ethical principles of the midwifery profession, noted as both an obligation and a human right. RESEARCH OBJECTIVES: The aim of this study is to explore the experiences of midwifery students regarding threats to women's dignity during childbirth. RESEARCH DESIGN: This is a qualitative study with explorative design. Participants and Research Context: The research was carried out in 2022 at Kermanshah University of Medical Sciences, involving 32 midwifery students in individual interviews that lasted between 30 and 90 minutes. These participants aged 21 to 28 years, with an average age of 23.5 years, provided their perspectives on the matter. RESULTS: Four key themes described the threats to women's dignity during childbirth: 1) professional incompetence, 2) abuse of power imbalance, 3) caring only for physical and not mental health, and 4) structural issues within the healthcare system. Professional incompetence was characterized by outdated practices and lack of adherence to evidence-based medicine. Abuse of power imbalance was demonstrated in instances where the authoritative position of healthcare providers was misused, thereby disrupting the respectful care that women are entitled to receive. The disproportionate emphasis on physical health over mental health was evidenced by the disregard for mothers' psychological well-being during childbirth. Lastly, systemic structural issues emerged as significant impediments, revealing the need for system-wide changes. Ethical considerations: This study was approved by the Ethics Committee of the Research Deputy at Kermanshah University. Participation was voluntary and the confidentiality were maintained. CONCLUSION: The findings underscore the role that unprofessional behavior, ethical lapses in medical practices, and systemic challenges play in undermining maternal dignity during childbirth. These threats necessitate urgent attention and must be adequately addressed in policy development and program implementation to safeguard the dignity of mothers during childbirth.

Nurses and midwives' sleep quality and its associated factors during the early COVID-19 pandemic in Iran.

Objectives: Good sleep quality is crucial for medical staff especially nurses and midwives to prevent possible errors and injuries during the providing care. The aim here is to investigate the sleep quality of nurses and midwives during the early corona pandemic and its related factors. Methods: An online observational and cross-sectional study included 340 medical staff who engaged in the treatment of patients with COVID-19 infection in 2020. Participants completed questionnaires about working characteristics, Pittsburgh Sleep Quality Index (PSQI), and Social Support Indexes (SSI). Pearson's correlation analysis and Multivariate logistic regression identified the interactions between these factors. Results: The mean PSQI and SSI were 8.4 ± 4.46 and 28.6 ± 13.29, respectively, indicating poor sleep quality and moderate social support. The condition of the participants was serious in terms of sleep efficiency, and sleep disturbance. More than half of the participants reported severe and very serious daytime dysfunction. Poor sleep quality was more common, in nurses than in midwives (OR:0.074, CI; 0.032-0.098, P < 0.001), nurses working in intensive care units than in other wards (OR:1.082, CI; 1.003-4.023, P = 0.005), in people who had long shifts (OR:1.757, CI; 1.123-4.323, P = 0.003), and in people working more than 5 years (OR:4.949, CI; 1.673-6.023, P = 0.028). Social support has a statistically significant relationship with the quality of sleep (OR:0.013, CI; 0.001-0.244, P = 0.004). Conclusion: The sleep quality of the medical staff has been impaired during the epidemic period, especially among nurses. Targeting staff who are more prone to sleep disturbance, such as nurses with longer work experience, helps us design an optimal strategy to support them through sleep hygiene education.

Comparing the Effect of Extended PLISSIT Model and Group Counseling on Sexual Function and Satisfaction of Pregnant Women: A Randomized Clinical Trial.

Introduction: Changes in the performance and sexual satisfaction of women during pregnancy can be one of the important factors involved in the emergence of sexual problems in women. This study aimed to compare the effect of Extended Permission, Limited Information, Specific Suggestion, Intensive Therapy (Ex-PLISSIT) and group counseling on sexual function and satisfaction of pregnant women. Methods: A randomized clinical trial was conducted on 111 pregnant women from 2016 to 2018 in Zanjan, Iran. Eligible participants were selected through convenience sampling method and allocated into three groups Ex-PLISSIT model, group counseling and control group, using block randomization method. Sexual function and sexual satisfaction were evaluated via the Female Sexual Function Index (FSFI) and Hudson's sexual satisfaction questionnaire at baseline and four weeks after the last counseling session. Data were analyzed using SPSS ver. 13 and ANCOVA, ANOVA, Wilcoxon, Chi-squared, Mann-Whitney U, and Kruskal Wallis test. Results: Median (Interquartile range) of the participants' sexual function in the Ex-PLISSIT group was 25.9(4) in the counseling group, 26(5.5), in the control group, and 25.8(4.8) at the baseline. These scores changed to 28.9(5.4), 27.9(5.1), and 25.2(4.3) at the 4-week follow-up, respectively. These differences were statistically significant. Moreover, there was a statistically significant difference in the mean sexual satisfaction scores between the three groups, at the follow up period. Conclusion: Providing sexual counseling by any approach during routine prenatal care by community midwives may improve couples' sexual health.

Evaluation of Couple's Sexual Function after Childbirth with the Biopsychosocial Model: A Systematic Review of Systematic Reviews and Meta-Analysis.

BACKGROUND: After childbirth, sexual dysfunction refers to a chain of psychiatric, physiological, social changes and a couple's experiences. The purpose of our Systematic Review (Syst.Rev.) is to evaluate available high-quality evidence and construct a Bio Psycho Social (BPS) model of couple's sexual function after childbirth. MATERIALS AND METHODS: A systematic search was done with MeSH terms in databases, including PubMed, Web of Science, Scopus, and Science direct. A total number of 9 Syst.Rev. were evaluated from 2009 to 2019 years. The quality of extracted articles was evaluated based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist of contents using two qualified reviewers. Data synthesis was performed using the thematic analysis. RESULTS: Biopsychosocial Model of Postpartum Couple's Sexual Function (BMPCSF) is proposed as a developmental process similar to Bronfenbrenner's Bioecological Systems Model. Studies showed a significant relationship among the type of childbirth, trauma of perineum, breastfeeding, mood swings, fears, changes in the self-body image, spousal support, and Postpartum Sexual Dysfunction (PSD). Hence, the evidence about male sexuality in the postpartum period doesn't seem sufficient. CONCLUSIONS: The information from this study will help health policymakers develop the appropriate guidelines to inform couples and healthcare professionals about the BPS changes after childbirth and PSD. Besides, BMPCSF can be used in postpartum sexual counseling to improve sexual health and marital relationships. We propose comprehensive original study on couples' postpartum sexuality, especially men's conduct, emphasizing socio-cultural factors.

Infidelity and Its Associated Factors: A Systematic Review.

BACKGROUND: Infidelity can be facilitated and/or inhibited as a result of interrelations among multilevel contexts. Despite the existence of numerous studies about infidelity, there is no developmental model that considers multilevel contexts of factors associated with infidelity. AIM: To review published articles addressing factors associated with infidelity and to apply the ecological model to these factors. METHODS: A systematic review of the literature was conducted using the PubMed, Scopus, Web of Science, and PsychoInfo. Literature search was restricted to articles published in English up to June 2018. All quantitative and full-text studies that addressed associated factors with infidelity were included. This study was conducted following PRISMA guidelines. MAIN OUTCOME MEASURES: This article reports a review of the literature on the factors associated with infidelity based on the ecological model. RESULTS: We retrieved 5,159 titles, of which 82 were qualified after the qualitative synthesis. The Ecological Couples Systems Diagram (ECSD) is proposed as a developmental model similar to Bronfenbrenner's Bioecological Systems Model. There was an inconsistency between variables of microsystem and infidelity engagement. However, the results of some studies indicated the impact of demographic factors, personality traits, and sexual information on infidelity, considering partner characteristics. Variables belonging to a mesosystem had a more stable association with infidelity than those from other systems. In addition, the review reveals the complexity of infidelity, associated with following factors: 68.3% (n = 56) of the studies were based on microsystem variables, 48.8% (n = 40) used mesosystem variables, 19.5% (n = 16) used exosystem variables, 26.8% (n = 22) used macrosystem variables, 6.1% (n = 5) used chronosystem variables, and 50% (n = 41) included variables from 2 or more levels. CLINICAL IMPLICATIONS: The ECSD can be used not only for assessing couple compatibility in premarital counseling, but also for consulting couples who want to have a long-term romantic relationship. As a potential clinical application, therapists can use the ECSD to assess unfaithful clients and their partners, improving the quality of counseling. STRENGTHS & LIMITATIONS: This study reveals different environmental layers of various variables related to infidelity. Determining the effect size of variables associated with infidelity was not possible due to the heterogeneity of infidelity assessment tools and test analysis. CONCLUSION: Apparently, incompatibility of interpersonal characteristics is more likely associated with infidelity than incompatibility of intrapersonal characteristics. It is important to consider couple compatibility before starting an exclusive relationship, such as marriage, for individuals who intend to maintain a long-term exclusive romantic relationship. Haseli A, Shariati M, Nazari AM, et al. Infidelity and Its Associated Factors: A Systematic Review. J Sex Med 2019;16:1155-1169.

A Systematic Review on the Anxiolytic Effect of Aromatherapy during the First Stage of Labor.

Introduction: Anxiety is the most common psychological response of women to labor. The aim of the present systematic review was to evaluate and summarize the available clinical evidence on the anxiolytic effects of aromatherapy during the first stage of labor. Methods: Electronic databases including: Cochrane Library, MEDLINE/ PubMed, Scopus, CINAHL, SID, Iran Doc, ProQuest, and Google Scholar were searched up to Sep10, 2017 with the keywords of 'aroma*', 'aromatherapy', 'essential oil', 'anxiety', and ' labor '. The risk of bias in the included studies was assessed using the Cochrane Collaboration's 'Risk of bias' tool. The results were reported qualitatively. Results: A total of 14 published papers and 2 unpublished papers were retrieved which met the inclusion criteria. The studies were conducted in Iran, Egypt, Korea, and Italy. Essential oils had been used were lavender in 5 articles, rose, clary sage, geranium and frankincense in 3 articles, chamomile, bitter orange, sweet orange and peppermint in 2 articles, mandarin orange, jasmine and clove in 1 article. A majority of the studies suggested a positive effect of aromatherapy in reducing women's anxiety during the first stage of labor. Conclusion: It is recommended that aromatherapy could be applied as a complementary therapy for reducing anxiety during the first stage of labor, but methodologically rigorous studies should be conducted in this area.

The Role of Lifestyle in Developing and Maintaining Vasomotor Symptoms: A Cross-Sectional Study among Iranian Postmenopausal Women.

OBJECTIVE: Lifestyle patterns are not only related to healthy life but also could be related to modifying menopausal symptoms. Considering the lack of data, the present study aimed to evaluate the relationship between lifestyle and vasomotor symptoms among Iranian postmenopausal women. MATERIALS AND METHODS: The present cross-sectional questionnaire-based study was conducted among 302 eligible postmenopausal women referring to Shahroud health centers (Shahroud, Iran) during June 2017 and October 2018. The Iranian standard questionnaire on women health project (Saba questionnaire) was used for data collection. Our data were analyzed using the SPSS software (version 18). Descriptive statistics, Chi-square test, Fisher's exact test, and multiple logistic regression were used to address sociodemographic characteristics among our participants and the relations between lifestyle and vasomotor symptoms. RESULTS: We found a significant relation between daily dairy units (P = 0.05), daily vegetable units (P = 0.01), weekly use of solid oils (0.01), and hot flush. The relation between daily vegetable units and urinary incontinence was also statistically significant (P = 0.02). When we use multiple logistic regression, we found significant predictive relations between daily vegetable unit status (P = 0.01), weekly use of solid oils (P = 0.04), body mass index (P = 0.03), and hot flush. CONCLUSION: The study provided findings to support the probable relation between some of lifestyle-related variables and vasomotor symptoms in postmenopausal women.

Do Breathing Techniques Enhance the Effect of Massage Therapy in Reducing the Length of Labor or not? a Randomized Clinical Trial.

Introduction: Prolonged labor is a common birth complication that is associated with some negative maternal and fetal effects. The aims of this study were 1) to evaluate the effect of effleurage abdominal massage and 2) to assess the effects size of breathing techniques with massage on the length of labor. Methods: This study was a randomized trial with concealed allocation, assessor blinding for some outcomes and intent-to-treat analysis. Primiparous women (n=117) age 18-35 years who were randomly assigned to three groups; abdominal massage (n=37), abdominal massage with breathing technique (n=38) and control (n=42). Although it was randomized block design with the allocation ratio 1:1:1 but soon after the sample was withdrawn in labor, another was replaced. Experimental groups' participants received a 30-min effleurage abdominal massage during the active and transitional phases of labor. Particular breathing techniques in each stage of labor were done. Data were analyzed using SPSS ver.13. Results: Duration of the active phase was 244.89(83.30) min in the massage, 254(68.55) min in massage with breathing and 312.07(67.17) min in control group, which was significantly different between the massage and control groups (P<0.001, Min Diff; -67.18), as well as massage with breathing and control groups (P=0.003, Min Diff; -9.63). The Scheffe test showed no significant difference between the two experimental groups. Conclusion: Effleurage abdominal massages decrease length of active phase on labor, but the learning of breathing techniques in labor couldn't enhance this effect of massage, so it is likely that breathing exercises may be considered during pregnancy.