The role of sexual partner in women's seeking for labiaplasty: a systematic review and meta-analysis.

BACKGROUND: The primary reasons for labiaplasty usually revolve around aesthetic, sexual, and functional concerns. Upon delving deeper into these issues, it becomes apparent that sexual partners play a controversial role in influencing women's decisions to undergo surgery. AIM: This study aimed to investigate the impact of sexual partners on women's choices to pursue labiaplasty. METHODS: A comprehensive search was conducted across electronic databases covering the period from January 2000 to February 2024. After removing duplicates, a total of 931 articles were retrieved by searching keywords in titles and abstracts. OUTCOMES: The meta-analysis revealed that 36.7% of women who sought labiaplasty cited their partners' negative comments as a factor influencing their decision. RESULTS: After applying the eligibility criteria and excluding irrelevant articles, a total of 12 articles involving 962 participants were included in the analysis. With the exception of 2 articles, the majority of the studies suggested a discernible influence of male partners on women's decisions to seek labiaplasty. Frequently, sexual partners are not the primary decision makers, nor do they exert significant pressure when it comes to seeking labiaplasty. In certain instances, women seeking labiaplasty acknowledged that their sexual partners did influence their decisions, either by making disparaging comments about their genitalia or by directly pressuring or requesting them to undergo labiaplasty. Additionally, women might opt for labiaplasty out of fear of their partner's negative remarks or to enhance sexual pleasure for their partners. For a more accurate result, a meta-analysis was conducted noting a considerable heterogeneity. CLINICAL IMPLICATIONS: The findings of this study can be applied in prelabiaplasty counseling sessions to acknowledge and explore the role of the sexual partner in women's decision making. STRENGTHS AND LIMITATIONS: This study stands as the inaugural systematic review examining the impact of sexual partners on women seeking labiaplasty, encompassing all original studies exploring the role of the sexual partner. However, a notable limitation lies in the varied interpretations of the sexual partner's role, that the heterogeneous nature of these interpretations poses a challenge to providing a more precise answer through meta-analysis. CONCLUSION: Based on the findings of this systematic review, it is evident that sexual partners exert multifaceted influences on women's decisions to seek labiaplasty. While not serving as the primary decision makers, women opt for labiaplasty with the aim of enhancing attractiveness in sexual relationships and mitigating potential negative comments from their partners.

Exploring sexual life enrichment: a journey into strengthening well-being for women post- menopause through qualitative study.

BACKGROUND: women post-menopause, are faced with various physical, emotional, and relational challenges. One such aspect that tends to be overlooked is the impact of menopause on sexual well-being. This study aimed to elucidate the concept of enriching the sexual life of women post-menopause. METHODS: A qualitative research strategy was adopted using a conventional content analysis approach. Data collection was conducted through semi-structured interviews with 24 participants (17 women post-menopause and 7 experts), using purposive sampling. RESULTS: The data analysis resulted in the extraction of 341 codes, 24 subcategories, and 8 categories. Ultimately, the following three themes emerged: "maintaining and enhancing the position of sexual relationships," "deepening sexual relationships and expanding intimacy," and "improving communication skills with the spouse ". CONCLUSION: Enriching the sexual life of women post-menopause, as suggested by the themes, involves nurturing their relationships, keeping these connections strong and valued, deepening intimacy, and promoting effective communication to ensure a fulfilling and enjoyable experience during this phase of life. This leads to a sense of security, health, and tranquility, ultimately manifesting positive repercussions on the couple's and family's health.

Effect of folic acid on the sexual function of postmenopausal women: a triple-blind randomized controlled trial.

BACKGROUND: There are reports of sexual dysfunction in postmenopausal women, and several treatment recommendations are available. AIM: To investigate the effect of folic acid on postmenopausal women's sexual function. METHODS: This triple-blind randomized controlled trial was conducted in Tehran, Iran, in 2020. A sample of 100 postmenopausal women was recruited from comprehensive health centers affiliated with the Shahid Beheshti University of Medical Sciences. Eligible women were randomly assigned to receive folic acid (5 mg) or placebo on an empty stomach every day for 8 weeks. Women were assessed at 3 time points: baseline and 4 and 8 weeks after the intervention. OUTCOME: Sexual function was the main outcome, as measured by the Female Sexual Function Index. RESULTS: The mean ± SD age of participants in the folic acid and placebo groups was 53.2 ± 3.84 and 54.4 ± 4.05 years, respectively (P = .609). The results obtained from mixed effects analysis of variance revealed a statistically significant difference between baseline and posttreatment scores and the interaction between time and group for desire, orgasm, satisfaction, arousal, pain, and total sexual function score, with the folic acid group improving more than control group. Lubrication was the only domain that showed no significant difference for the interaction between time and group. CLINICAL IMPLICATIONS: Folic acid may beneficially affect sexual function in postmenopausal women. STRENGTHS AND LIMITATIONS: Strengths include the novelty of the subject, the triple-blind design, the block randomization, the administration of a standard scale for sexual function (Female Sexual Function Index), and the affordability and availability of folic acid. This study was conducted with a small sample size and short follow-up time; therefore, interpretation of the results requires great caution. CONCLUSION: The findings suggest that folic acid possibly improves sexual function in postmenopausal women. Larger studies are needed to confirm the findings. TRIAL REGISTRATION: IRCT20150128020854N8; August 2, 2020. Iranian Registry of Clinical Trials; https://en.irct.ir/user/trial/48920/view.

The self-care situation analysis of reproductive-aged women in Tehran: a survey study.

BACKGROUND: Along with a global increase in the prevalence of infectious and non-communicable diseases, self-care with an emphasis on reproductive health Self-care has received special attention. Given the importance of women's health, assessment of their self-care status using a valid and reliable tool seems to be necessary to determine the needs for future women's reproductive health promotion interventions. The present study aimed to assess the women's self-care at reproductive age in Tehran, to determine women's health needs based on global guidelines for women's health. METHODS: This was a descriptive cross-sectional study on 1051 women of reproductive age, living in Tehran. The Subjects were recruited using a multi-stage sampling method. The women completed a socio-demographic and valid and reliable questionnaire to assess their self-care status. The data were analyzed using SPSS 24 and by Pearson, Spearman, ANOVA, and regression tests. RESULTS: The mean score of self-care was 49.57 ± 23.50% in the reproductive-aged women. The lowest scores were related to psychosocial health (32.12 ± 29.93%) and reproductive-sexual health (49.74 ± 27.99%) respectively. There were significant positive correlations between the self-care and women's education level (r = 0.180; p < 0.01), and husband's education level (r = 0.272; p < 0.01), while there was a negative significant correlation between the self-care and the family size (r = - 0.135; p < 0.01). CONCLUSION: The findings showed inadequate self-care among reproductive-aged women in Tehran. The most important challenge in their self-care behaviors was related to psychosocial and reproductive-sexual health. It seems to provide a package for promoting women's self-care in four areas of physical, psychosocial, reproductive-sexual health, and screening tests, with an emphasis on the first two priorities, namely psychosocial and reproductive health necessary in Tehran.

The framework for integrated, people-centered health services was introduced in 2016 by the World Health Organization (WHO) (World Health Organization, Interim report: placing people and communities at the Centre of health services: WHO global strategy on integrated peoplecentred health services 2016-2026: executive summary, 2015). A people-centered approach supports health literacy so that people can take responsibility for their health with evidence-based self-care interventions. When people have agency and autonomy, they can make and enact decisions in all aspects of their lives, including health (World Health Organization, WHO consolidated guideline on self-care interventions for health: sexual and reproductive health and rights: executive summary, 2019). The WHO defines self-care as "the ability of individuals, families, and communities to promote health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a healthcare provider". Self-care allows people to become agents of their health, leading to improved outcomes, especially in the area of sexual and reproductive health where stigma may prevent them from seeking care. Women and girls can identify their own health needs, and effectively manage their health conditions through self-care approaches. The WHO places great emphasis on promoting self-care, especially in women's reproductive-sexual health, and encourages countries to design and implement their programs. Given the diversity of women's self-care needs, this study designed women's self-care assessment tools in two reproductive age groups in 4 dimensions including physical, psychosocial, sexual-reproductive health, and screening tests, based on a review of the valid international guidelines. The results showed that women are practicing only half of self-care and the main challenges were in psychosocial health and sexual-reproductive-health self-care in Tehran. It seems that evidence-based planning is necessary to promote self-care among reproductive-aged women.

The Effect of Female Genital Cosmetic and Reconstructive Procedures on Body and Genital Self-Image: A Systematic Review and Meta-Analysis.

Performance of female genital cosmetic and reconstructive procedures (FGCRP) has been increasing over past decades. Appearance and functional concerns are the most common reasons for seeking FGCRP. Poor body and genital self-image may contribute to the increase in demand for surgery. The aim of this systematic review is to explore outcomes of FGCRP in the domains of body and genital self-image. A systematic literature review of PubMed, Web of Science, Scopus, PsycINFO, Embase, and the Cochrane Library was conducted to identify articles that measured body and genital self-image in females after FGCRP. The authors identified 5 articles for a systematic review of body image and 8 studies for a systematic review of genital self-image. The most common procedure performed was labia minora labiaplasty. Instruments for body image evaluation were the Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder and the Body Image Quality of Life Inventory. Genital image was assessed with the Female Genital Self-Image Scale and Genital Appearance Satisfaction (GAS) scale. Most of the studies indicated that FGCRP can improve both body image and genital self-image; meta-analysis revealed that FGCRP improved GAS scores by 17.96 (range: 0-33; P < .001). It appears that FGCRP leads to improvements in females' body and genital self-image. Inconsistencies in study design and measures, however, limit this conclusion. Future research should involve more rigorous study designs (for example randomized clinical trials with large sample sizes) for a more accurate assessment of FGCRP's consequences.

Secondary traumatic stress in iranian midwives: stimuli factors, outcomes and risk management.

BACKGROUND: The present qualitative study was conducted to explain the experiences of secondary traumatic stress (STS) and its related factors in midwives working in maternity wards. METHODS: Data were collected using semi-structured interviews with 11 midwives working in the maternity wards of hospitals in Urmia, Iran, through in-depth interviews with open-ended questions. Data were analyzed using the conventional content analysis approach. RESULTS: The results of data analysis led to the extraction of three themes, seven main categories, and 18 subcategories. The first theme was "STS stimuli," with the two categories of "Discriminatory approach to midwifery" and "The nature of the midwifery profession". The second theme was "Traumatic outcomes", which included the subcategories of "Psychological-emotional trauma", "Physical trauma" and "Social trauma". The third theme was "Risk management", which had the two subcategories of "Reactive approach" and "Proactive approach". CONCLUSIONS: The results showed that, in addition to the traumatic nature of events that midwives experience during work as the secondhand victims, factors such as governance-organizational structure, unbalanced distribution of power, and poor supportive laws undermine their professional role and provide conditions conducive to STS. Therefore, avoiding traumatic situations and scientific and skill self-empowerment were the most important strategies adopted by the midwives in this study to prevent risky situations and cope with the consequences of STS. The participation of midwifery stakeholders in policy-making and adopting supportive legislation in redefining the position and role of midwives can play a major role in reducing STS and sustaining their role and position in maternal care.

Development and psychometric assessment of the sexual-reproductive health profile of women with type-1 diabetes mellitus.

BACKGROUND: To improve the sexual-reproductive health (SRH) of women with type-1 diabetes mellitus (T1DM), plans should be formulated on the basis of the existing situation. The situation can be examined by a valid tool conforming to the specific domains of SRH in the target group. The present study seeks to develop and assess the psychometric properties of the SRH Profile of Women with T1DM. METHOD: Based on the extracted concepts of SRH Profile of Women with T1DM in a previously conducted study, a tool was designed using the following steps: The selection of the conceptual model, explaining the objectives, designing the roadmap and development of the tool. In the psychometric assessment phase, the content, face and construct validity (convergent validity and principal component analysis) were assessed with the participation of 365 married women of reproductive age with T1DM. The reliability of the tool was determined by the internal consistency method (Cronbach's alpha) and its stability using the test-retest method (Intraclass Correlation Coefficients). RESULTS: The SRH Profile of Women with T1DM was formed with 53 items in two sections. Twenty-six items were about safe motherhood and reproductive system; 27 items were about the three components of concerns about the reproductive system health and function, sexual health and function, and violence related to T1DM. The three components in the second section explained 49.44% of the total variance. Cronbach's alpha was 0.872 and the total intra-cluster correlation coefficient was 0.946. CONCLUSION: SRH Profile of Women with T1DM is a valid, reliable, and specific tool for assessing sexual-reproductive health in women with type-1 diabetes mellitus.

Challenges facing clinical midwifery education in Iran.

BACKGROUND: Delivering high-quality midwifery services requires a professional, educated and competent workforce. The challenges of clinical training and education for midwives in Iran have prevented midwifery students from fully gaining the clinical competency required of midwifery graduates. METHODS: This qualitative study was conducted to identify and explain the challenges of clinical training for midwives in Iran and to determine their underlying factors within the sociocultural and educational context of this country. Data were collected from a purposive sample in a western province of Iran, which included clinical midwives working in public and private maternity units, midwifery instructors working at educational institutes, and midwifery students. After receiving an ethics approval for the project and informed consent from the participants, data were collected through focus group interviews held with midwifery students (n = 9) and semi-structured interviews held with midwifery instructors (n = 6) and clinical midwives (n = 7). Data were then analyzed using the framework proposed by Graneheim and Lundman using MAXQDA-10. FINDINGS: The analysis of the data led to two themes: "Discriminatory approach in the health system" and "Professional nature of midwifery". The noted discrimination was caused by the insecure position of midwives in the health system, inequalities related to education and training opportunities, and the demotivation of midwives. The professional nature of midwifery discussed the community in transition, functional paradoxes and high-risk labor. CONCLUSION: The findings revealed numerous challenges facing clinical midwifery education and training in the study setting, which may in part be explained by the sociocultural context of maternity services in Iran. The learning opportunities provided to midwifery students should be improved by making significant revisions to the structure of clinical settings where students are placed. Tackling discrimination against a profession and its students is essential, and it is equally important to value the contributions of midwifery students and midwives to their practice and their efforts to ensure safe maternity care for women and newborns. The quality of the clinical learning environment must therefore be improved for this group, and the active participation of competent and autonomous midwifery instructors in this environment can have a facilitatory role.

The effect of sexual health education on sexual activity, sexual quality of life, and sexual violence in pregnancy: a prospective randomized controlled trial.

BACKGROUND: Some women avoid sexual intercourse during pregnancy due to the physiological changes they undergo during this period as well as their fear of causing harm to the fetus and to themselves, which can lead to problems in sexual health. The aim of the present study was to investigate the effects of a sexual health education package on the dimensions of sexual health in pregnant women. METHODS: This randomized, longitudinal, clinical trial was carried out in 2018-2019 on 154 pregnant women in early to late pregnancy who presented to comprehensive health centers in Rasht, Iran, and were divided into three groups: Group A or the training group (50 participants), Group B or the self-training group (53 participants), and Group C or the control group (51 participants). The study tools included the Pregnancy Sexual Response Inventory (PSRI), the Sexual Quality of Life-Female (SQOL-F) and the Sexual Violence Questionnaire. The dimensions of sexual health were examined before beginning each intervention in each trimester of pregnancy and then at the end of pregnancy using these questionnaires. The collected data were analyzed using statistical tests, namely the Chi-square test, one-way ANOVA, Cochrane's test, and the repeated measures ANOVA at a significance level of P < 0.05. RESULTS: There was no statistically significant difference in the mean total scores of SQOL-F and PSRI in the three groups at baseline. As for the intergroup results, there was a statistically significant difference in the mean score of SQOL-F and PSRI at the end of pregnancy. The mean scores of PSRI and SQOL-F in the training group (Group A) increased from the beginning to the end of pregnancy compared to the control and self-training groups. As for the intergroup comparisons, there was no statistically significant difference in the mean total scores of sexual violence among the pregnant women in the different groups in the third trimester of pregnancy and at the end of the third trimester. Although sexual violence was not statistically significant, the number of sexually-violated women in the training group decreased during the training period compared to the self-training and control groups. CONCLUSION: The results obtained in the intervention group compared to the control group revealed the effectiveness of the sexual health education package in terms of improvement in the dimensions of sexual health. According to the results, in order to maintain and promote the sexual health of pregnant women, health care providers are recommended to offer sexual health training during pregnancy along with other health care services. TRIAL REGISTRATION: IRCT20190427043398N1 ; the trial was registered on June 2, 2019. (retrospective registration).

The relationship between postmenopausal women's body image and the severity of menopausal symptoms.

BACKGROUND: Body image is the main element of an individual's personality that may be influenced by many factors during menopause. We aimed to assess the relationship between postmenopausal women's body image with the severity of menopausal symptoms. METHODS: This was a cross-sectional study on 300 postmenopausal women, aged 45 to 65 years old, in Tehran, Iran. We recruited the samples using the multi-stage sampling method. Tools for data collection were: 1) the Menopausal Rating Scale (MRS), 2) the Fisher's Body Image questionnaire and 3) a socio-demographic questionnaire. We analyzed data using the independent samples t-test, Pearson correlation coefficient, Spearman's correlation coefficient, and multiple linear regression tests. RESULTS: Three hundred women aged 55.11 ± 3.99 years old, participated in the study. Mean scores for body image and MRS were 163.07 ± 21.17 (Range: 46-230) and 16.45 ± 8.38 (Range: 0-44), respectively. About 50% of women had severe symptoms of menopause (MRS score ≥ 17). There was a negative correlation between the total score and the score of all dimensions of body image with the total score and all dimensions of MRS (P < 0.001). There were also significant relationships between women's body image with: their education (P < 0.001, r = 0.20) the spouse's education (P < 0.001, r = 0.26), adequacy of monthly household income (P < 0.001, r = 0.32), marital status (P = 0.36), their occupation (P = 0.007) and housing status (P = 0.012). There was also a significant negative correlation between women's lower body organs image with the number of children (P = 0.017, r = - 0.14). According to the multiple linear regressions model, severity of menopausal symptoms (Beta = - 0.45, P < 0.001) and adequacy of monthly household income (Beta = 0.15, P = 0.005) are the significant related factors with postmenopausal women's body image. CONCLUSIONS: Body image is correlated with menopausal symptoms of women during menopause. Therefore, it seems that interventions aimed at relieving the annoying symptoms of menopause can help to improve their body image. Also, body image could be influenced by some socio-demographic factors which should be considered in menopause health promotion programs.

Effect of lifestyle modifications on anthropometric, clinical, and biochemical parameters in adolescent girls with polycystic ovary syndrome: a systematic review and meta-analysis.

BACKGROUND: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of childbearing age. This study aimed to compare the effects of lifestyle interventions on anthropometric, clinical, and biochemical parameters in adolescent girls with PCOS. METHODS: PubMed, Scopus, and Web of Science was systematically searched to retrieve studies investigating the effects of lifestyle modifications in adolescent girls with PCOS, which were published up to December 2019. The primary outcome was Body Mass Index (BMI) and secondary outcomes were all manifestations of PCOS, including clinical, metabolic, and hormonal parameters. Random effect meta-analysis was applied for significant results. Publication bias was assessed using the Egger test. RESULTS: This study showed significant improvements in luteinizing hormone (LH) (Pooled SMD = - 0.1.23; 95% CI, - 2.44 to - 0.03), and Free Androgen Index (FAI) levels (Pooled SMD = - 0.78 95% CI, - 0.1.42 to - 0.13) in adolescent girls receiving lifestyle intervention compared to baseline. This study also revealed that diet modifications alone were associated with a significant decrease in Body Mass Index (BMI) (Pooled SMD = - 0.45; 95% CI, - 0.76 to - 0.13), and FG score (Pooled SMD = - 0.81; 95% CI, - 1.33 to - 0.28). Exercise interventions were associated with significant changes in the menstrual cycles (Pooled SMD = 1.16; 95% CI, 0.72 to 1.61), Ferriman-Gallwey (FG) score (Pooled SMD = - 0.57; 95% CI, - 0.99 to - 0.15), LH (Pooled SMD = - 056; 95% CI, - 0.98 to - 0.14), Anti-Müllerian Hormone (AMH) (Pooled SMD = - 0.81; 95% CI, - 0.1.24 to - 0.38), and Triglyceride (TG) levels (Pooled SMD = - 0.32; 95% CI, - 0.62 to - 0.02). CONCLUSION: This meta-analysis concluded lifestyle interventions, such as diet and exercise, can improve some clinical, metabolic, and hormonal parameters in adolescent girls with PCOS.

Correction to: Is body image a predictor of women's depression and anxiety in postmenopausal women?

An amendment to this paper has been published and can be accessed via the original article.

Development and psychometric evaluation of the female infertility stigma instrument (ISI-F): protocol for a mixed method study.

BACKGROUND: Infertility stigma is one of the greatest challenges in most societies for reproduction and sexual health of infertile women. Since no specific tool exists for assessing the infertility stigma in women, this study would be conducted to develop and evaluate the psychometric properties of Female Infertility Stigma Instrument (ISI-F). METHODS: This is a mixed method study with sequential exploratory design (qualitative and quantitative phase). In the first qualitative phase, semi-structured interviews would be performed with infertile female who had experienced infertility whithout any psychological disorder. Women who are eligible for participating in the study will be selected using purposeful sampling method with maximum variation in terms of age, education, occupation and infertility duration. Data would be analyzed using conventional content analysis and in this phase the primary item pool will be developed for the Female Infertility Stigma Instrument (ISI-F). In the quantitative phase, the psychometric properties of the Instrument would be evaluated, including the content, face and construct validity as well as reliability via the internal consistency and stability. The psychometric properties described in the COSMIN checklist will be utilized for designing the instrument. DISCUSSION: Developing a valid and reliable scale for Female Infertility Stigma Instrument (ISI-F) would be helpful for future studies to assess the status of this situation. It also helps planning interventional studies for improvement of the reproductive health of infertile women.

Beneficial effects of pelvic floor muscle exercises on sexual function among postmenopausal women: a randomised clinical trial.

Background The adverse effects of menopause on sexual function could be mitigated by pelvic floor muscle (PFM) training. This study aimed to investigate the effects of PFM exercises on sexual function in postmenopausal women. METHODS: A randomised clinical trial was conducted among 97 Iranian postmenopausal women, aged 40 to 60 years. The participants' baseline sexual functions were assessed using the Female Sexual Function Index (FSFI) questionnaire. They were then randomly designated to two groups: (1) the intervention group, which received specific instructions on PFM exercises and was followed up on a weekly basis; and (2) the control group, which received general information on menopause. After 12 weeks, the sexual functions of the participants were reassessed. RESULTS: No significant difference was initially observed between the two groups in terms of demographic and socioeconomic characteristics and total scores of FSFI. After the intervention, however, the scores of arousal, orgasm and satisfaction were significantly higher in the intervention group (3.10, 4.36, and 4.84 vs 2.75, 3.89, and 4.36 respectively; P<0.05). CONCLUSION: PFM exercises have the potential to improve the sexual function of postmenopausal women and are thus suggested to be included in healthcare packages designed for postmenopausal women.

The relationship between menopausal symptoms and sexual function.

Sexual function could be affected by several factors in postmenopausal women. This cross-sectional study aimed to investigate the relationship between the severity of menopausal symptoms and sexual function. The study was conducted among 405 postmenopausal women aged 40-65 years, in Chalous and Noshahr, Iran, from October 2013 to May 2014. The participants were selected using a multistage sampling method. The instruments used for data collection were the Female Sexual Function Index (FSFI), the Menopause Rating Scale (MRS), and a demographics questionnaire. The relationship between the severity of menopausal symptoms and sexual function was examined using Pearson's correlation coefficient and multiple linear and logistic regressions. The mean unadjusted FSFI and MRS scores were 24.11 and 12.45, respectively; and 61.0 percent of the participants had female sexual dysfunction (FSD) (FSFI ≤26.55). A significant negative correlation was observed between the MRS scores (total and all subscales) and the total scores for FSFI (p < 0.001). The results of the logistic regression analysis showed that with every unit increase in the total score of MRS, the likelihood of sexual dysfunction was 9.6 percent greater. We conclude that menopausal symptoms need to be considered in the design of health initiatives aimed at postmenopausal women's sexual function.

Spiritual needs of cancer patients: a qualitative study.

INTRODUCTION: Diagnosis of cancer can cause huge spiritual crisis in a person and affect different aspects of life. At this stage, patients have certain spiritual needs. AIM: This study was conducted to explain spiritual needs of cancer patients in Iran. MATERIALS AND METHODS: In this qualitative study, 18 cancer patients, referred to the Cancer Institute of Imam Khomeini Hospital in Tehran were selected using purposive sampling method, and their spiritual needs emerged out of conventional content analysis of interviews conducted with them. RESULTS: From 1850 initial codes, 4 themes (connection, peace, meaning and purpose, and transcendence) were identified that contained categories of social support, normal behavior, inner peace, seeking forgiveness, hope, acceptance of reality, seeking meaning, ending well, change of life meaning, strengthening spiritual belief, communication with God, and prayer. CONCLUSIONS: Spiritual needs of cancer patients should be recognized, realized, and considered in care of patients by the medical team. An all-out support of health system policy makers to meet patients' spiritual needs is particularly important.

The nature and course of illness perception following cardiac pacemaker implantation: a self-regulatory approach.

This study was designed to explore the relationship between illness perceptions and educational intervention based on the Leventhal's model in pacemaker patients. Fifty-one consecutive patients who were admitted for implantation of permanent cardiac pacemaker were recruited to receive an educational intervention, which consisted of two sessions delivered in the hospital and clinic, respectively. Participants completed a pacemaker-specific Brief Illness Perception Questionnaire (BIPQ) twice, one prior to educational intervention and the other 10 weeks following the pacemaker implantation. Data regarding the dimensions of cognitive and emotional representations based on the Leventhal's model have demonstrated the relationship between the patients' perception before and after the educational intervention. Overall, after the educational intervention, the patients have considered the illness as having a moderate impact on their life and have known their illness as a chronic condition that was responsive to treatment and influenced by personal behavior. Participants believed they had a good understanding of their illness and had less 'concern' and 'emotional representation'. Based on the results of the present study, pacemaker patients had a more benign view about their illness after educational intervention compared with before this intervention. These explanations might affect the acceptance and treatment seeking and even lead to lower complications.

Job adjustment predictive factors of healthcare midwives in health system reform in Iran.

BACKGROUND: Possessing sensitive and multiple responsibilities in the country's health system, particularly after the implementation of the health reform in Iran, midwives must be able to optimally perform their duties in their new job as healthcare providers. This study aimed to identify the factors that predict job adjustment for Iranian midwives working in healthcare. METHODS: In this cross-sectional study, 310 midwives were recruited from 209 health centers in the Iranian province of West Azerbaijan using the census method and asked to complete research questionnaires. Data were collected using job adjustment, job satisfaction, and organizational commitment scales. SPSS version 25 was used to perform ANOVA and calculate multiple linear regression coefficients for data analysis. In addition, the AMOS software was employed for path analysis and the identification of predictive variables. RESULTS: The mean age of the participants was 37.67 ± 7.1 years. Most participants (35.5%) were interested in their occupation as a midwife, and 27.1% were very interest. They had a moderate to strong tendency (76.1%) to remain in their new profession. In addition, 58.1% of participants experienced moderate job adjustment. For healthcare midwives, "desire to remain in the midwifery profession" and "organizational commitment" were significant predictors of job adjustment. "Desire to remain in the midwifery profession" directly affected midwives' job adjustment, while "interest in the new profession" had an indirect effect. Furthermore, "adequacy of income to expenses," "job satisfaction," and "organizational commitment" through the mediating role of "desire to remain in the profession" can, directly and indirectly, influence their job adjustment. CONCLUSION: To better prepare midwives for their role as healthcare providers, organizational managers should focus their efforts and plan primarily on providing incentives to increase the longevity of staying in the profession of midwifery increase job adjustment, job satisfaction, and organizational commitment, thereby improving the quality-of-service delivery.

Quality of Life and Associated Factors among Mothers with Gestational Diabetes Mellitus by using a Specific GDMQ-36 Questionnaire: A Cross-Sectional Study.

Background: Gestational Diabetes Mellitus (GDM) has physical, social, mental, and psychological consequences that can affect mothers' Quality of Life (QOL). This study was conducted with the aim to evaluate the QOL of mothers with GDM and its associated factors using a specific questionnaire. Materials and Methods: This cross-sectional study was conducted on 200 mothers with GDM who were referred to clinics affiliated with Shahid Beheshti University and Qom University of Medical Sciences, Iran, in 2019-2020. The specific QOL questionnaire for women with GDM (GDMQ-36) and the demographic questionnaire were completed for participants. Independent variables were entered into the multiple linear regression model and were analyzed. Results: The total Mean(SD) score of the QOL of mothers with GDM who participated in the study was 46.83 (11.66) based on percentage. The highest and lowest QOL Mean (SD) scores were obtained on the support 76.50 (14.50) and concerns about a high-risk pregnancy 31.40 (19.80), subscales, respectively. The total QOL score decreased by 7.14 and 5 points on average in mothers treated with medication regimens and mothers who had a pre-high school education, respectively. The support subscale score increased by 5 points in mothers who had a previous history of GDM. Conclusions: The present study showed that the QOL of women with GDM had been severely affected by concerns about a high-risk pregnancy. Some individual and social factors can be associated with the QOL of mothers with GDM and its subscales.

The trend analysis of neurological disorders as major causes of death and disability according to human development, 1990-2019.

This study aims to assess the trends in the incidence rate of neurological disorders in developed and developing countries worldwide during 1990-2019. The age-standardized incidence rate (per 100000 persons) of neurological disorders was the primary outcome, extracted from the Global Burden of Disease database for 189 countries and territories from 1990 to 2019. Using the Human Development Index (HDI), countries were classified into developed (HDI ≥ 0.7) and developing (HDI < 0.7) groups. Longitudinal analysis was performed using the Latent Growth Model (LGM) to assess the change in the incidence rate of neurological disorders over time in these groups. In developed countries, the most increasing rate is related to depressive disorders, with a rising rate of 40.15 in 100000 every five years (p = 0.001). Alzheimer's and dementia, Parkinson and multiple sclerosis are in the next rank, with increasing rates of 8.77, 1.24, and .02, respectively (all p < 0.001). Over time, the significant decreasing trend has been determined related to conducting disorder, attention-deficit and hyperactivity, meningitis, anxiety, and eating disorders, with the rates of - 13.92, - 4.96, - 2.7, - 1.6, and - 1.44, respectively (all p < 0.05). In developing countries, meningitis, conduct disorder, attention-deficit and hyperactivity, stroke, and autism spectrum showed a significant decreasing trend over time, with rates of - 15.45, - 5.84, - 2.56, - 1.86, and - 1.07, respectively (all p < 0.05). Headache disorder has the most increasing rate of 79.5, following depressive (rate 35.32), substance use (rate 14.99), anxiety (rate 7.18), and eating (rate 3.4) disorders. Also, Alzheimer's and dementia, bipolar disorder, schizophrenia, Parkinson's, brain and central nervous system cancer, and multiple sclerosis are in the next rank and had significant increasing trends (all p < 0.05). Given the high economic and social burden of neurological disorders, the rate of these diseases in most countries does not seem to have dropped remarkably. The heterogeneous incidence rate in some world countries seems to be due to underestimating and gaps in epidemiological information. It is necessary to provide exact registry systems for health policies, especially in developing countries.