RESUMO
BACKGROUND: Urinary incontinence is widely accepted to be among the most important issues in the global health system. However, only a limited number of women are referred for treatment because different factors complicate help-seeking behaviors. The aim of this study was to explain the factors affecting help-seeking behaviors in women suffering from urinary incontinence. METHODS: This study was a qualitative study using the conventional content analysis approach. The study was conducted from December 2018 and August 2019 in Tehran, Iran. The participants were 34 women with urinary incontinence selected using a purposive sampling method. The content analysis approach was based on the Graneheim and Lundman method, and qualitative data management software was used for analysis. RESULTS: Data analysis illustrates two themes; " facilitator " and " inhibitor "; the categories "not perceiving disease", "shame", " negative support of important others", and "non-optimal health care system" were among the inhibitors and the categories " reduced quality of life " and " positive support of important others" were found to be facilitators of help-seeking behaviors. CONCLUSIONS: The findings of the present study highlight the need for understanding the underlying facilitators and inhibitors of help-seeking behaviors in women with urinary incontinence. We suggest that healthcare providers consider an open dialogue with patients and consider their subjective beliefs and life context during routine visits to facilitate early diagnosis of the disease and ultimately lead to an improvement in the woman's quality of life.
Assuntos
Comportamento de Busca de Ajuda , Incontinência Urinária , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Qualidade de Vida , Incontinência Urinária/epidemiologia , Incontinência Urinária/terapiaRESUMO
Background: Neonatal problems and adverse outcomes may be minimized by up to 90-75% when preterm delivery is diagnosed early and managed properly. This study aimed to determine the association of maternal plasma lipid indices with the occurrence of spontaneous preterm labor. Material and Methods: This matched pair case-control study was performed on 80 pregnant women referred to a teaching hospital in Tehran for childbirth in 2019. The lipid profile was assessed in women with spontaneous preterm labor and term birth. According to age, Body Mass Index (BMI), pregnancy number, employment status, and educational level, the women in each group were paired. Data were analyzed using an independent-samples t-test, Mann-Whitney U-test, Chi-square, linear regression, and conditional logistic regression. Results: Mean serum levels of total cholesterol, triglycerides, and low-density lipoprotein were all significantly higher in the case group compared with the control group (p < 0.05). The conditional logistic regression test confirmed that this association remained significant even after adjusting the effect of potentially confounding factors such as maternal age and body mass index. In addition, in linear regression the increased levels of triglyceride, total cholesterol, and low-density lipoprotein were found to be associated with 3.33-fold (1.32.-5.32 95% CI, p < 0.001), 2.94-fold (1.60-3.14 95% CI, p = 0.002), and 2.46-fold (1.31.-2.91 95% CI, p = 0.006) increased risk of preterm labor, respectively. Conclusions: High triglyceride, total cholesterol, and low-density lipoprotein serum levels may be linked to an increased chance of spontaneous preterm labor, which might be considered a risk factor for this pregnancy problem.
RESUMO
Urinary incontinence has an undeniable impact on the quality of life of affected women; however, talking about incontinence is not comfortable for many women, and they often hide it and do not seek treatment. Predictors affecting women's decisions to seek treatment in communities can be different. This study was designed to identify predictors of help-seeking behaviors among Iranian women with urinary incontinence. METHODS: This cross-sectional, analytical study was conducted on 199 women with urinary incontinence who met the inclusion criteria by convenience sampling from the beginning of 2020 to the middle of 2021. The Incontinence Severity Index, Bradley's Questionnaire for Urinary Incontinence Diagnosis, Medical Embarrassment Questionnaires, Brief-Illness Perception Questionnaire, Incontinence Quality of Life Questionnaire, Barrier to Incontinence Care Seeking Questionnaire, Medical Help Seeking Scale, and Medical Outcomes Study Social Support Survey were all self-administered data collection tools used in this study. Multiple linear regression was used to investigate the relationship and prediction of help-seeking behaviors by other variables. To analyze the data, SPSS software version 20 was used. RESULTS: The variables of shame, barriers to care, social support, quality of life, and age were found to be predictors of help-seeking behavior in the research population of women with urinary incontinence. Help-seeking had a direct relationship with quality of life and an inverse relationship with other factors. Among these factors, shame has the greatest impact (P = 0/001, ß = - 0/37). CONCLUSIONS: The extracted predictors, especially the variable of "shame" as the most important negative factor related to the treatment decisions of women with urinary incontinence, will help to health service providers to take into account these factors in the regular service provision programs that promote women's health, which are effective in facilitating the help-seeking of sufferers and correct guidance towards treatment or rehabilitation.
Assuntos
Comportamento de Busca de Ajuda , Incontinência Urinária , Feminino , Humanos , Qualidade de Vida , Irã (Geográfico)/epidemiologia , Estudos Transversais , Incontinência Urinária/epidemiologia , Incontinência Urinária/terapia , Aceitação pelo Paciente de Cuidados de Saúde , Inquéritos e QuestionáriosRESUMO
AIM: To determine the effects of protocol of admitting women in active labour on childbirth method and interventions during labour and childbirth. METHODS: This single-blind randomised clinical trial was conducted in a public hospital in Mazandaran province (Iran) in 2017. Two hundred nulliparous low-risk women were randomly assigned into intervention and control groups. The participant women were admitted in the intervention group using the admission protocol and to the group control by staff midwives and doctors. The admission criteria of the protocol were: the presence of regular, painful contractions, the cervix at least four cm dilated and at least one of the following cues: cervix effaced, and spontaneous rupture of membranes, or "show". The primary outcome measure was childbirth method. Data were analyzed in SPSS-22 using Mann-Whitney and Chi-square tests. The level of statistical significance was set as p<0.05. FINDING: There were significant differences between the intervention and control groups in the number of caesarian section (CS) (p<0.001). Two groups had a statistically significant difference in amniotomy (p=0.003), augmentation by oxytocin (p<0.001), number of vaginal examinations (p<0.001) and fundal pressure (p<0.001). CONCLUSIONS: Using a protocol for admission of low risk nulliparous women in active labour contributed to reduction of the primary caesarean section rate and interventions during childbirth. A risk assessment and using evidence informed guidelines in admission can contribute to reduce unsafe and harmful practices and support normalisation of birth. This is essential for demedicalisation and a useful strategy for reducing primary CS.
Assuntos
Parto Obstétrico/estatística & dados numéricos , Tocologia/métodos , Admissão do Paciente/estatística & dados numéricos , Administração dos Cuidados ao Paciente/métodos , Adulto , Cesárea , Parto Obstétrico/métodos , Feminino , Hospitalização , Humanos , Irã (Geográfico)/epidemiologia , Trabalho de Parto , Ocitocina , Parto , Gravidez , Resultado da Gravidez/epidemiologia , Método Simples-CegoRESUMO
Objective: The aim of this study was to evaluate the safety and efficacy of fractional CO2 laser for treatment of vulvovaginal atrophy. Materials and methods: In this clinical trial study, we evaluated the laser effect on vulvovaginal atrophy in 47 women aged 43-80 years. Each woman was treated with fractional CO2 laser, SmartXide2V2LR, DEKA, Monalisa Touch, vaginal 360o probe and cosmetic probe. The severity of vulvovaginal atrophy symptoms was evaluated before first session of laser and every 4 weeks after laser treatment until 12 weeks. Adverse effects including pain and itching were assessed at all visits. The statistical analysis was performed using SPSS version 23. Results: The response to laser therapy for vaginal dryness was significantly (p <0.001) improved. Also, the response to laser therapy for each symptom include dyspareunia, vaginal discharge, itching and urge urinary incontinence was statistically significant (p <0.001) based on visual analogue scale (VAS). Conclusion: It seems vaginal fractional CO2 laser can be applied as an effective and safe treatment method in genitourinary syndrome of menopause (GSM). It is necessary to conduct studies with long-term follow-up.
RESUMO
Previous studies have shown controversial results about the role of androgens in coronary artery disease (CAD). We performed this study to examine and compare the relationship between androgenic hormones and CAD using conventional linear statistical techniques as well as novel non-linear approaches. The study was conducted on 502 consecutive men who were referred for selective coronary angiography at Tehran Heart Center due to different indications. We studied the relationship between androgenic hormones and CAD by using the generalized linear models, generalized additive models, and neural networks. Free testosterone (fT), total testosterone (tT) and dehydroepiandrosterone sulfate levels in patients with significant CAD versus normal individuals were 6.69 +/- 3.20 pg/ml, 16.60 +/- 6.66 nm/l, and 113.38 +/- 72.9 microg/dl versus 7.12 +/- 3.58 pg/ml, 15.82 +/- 7.26 nm/l, and 109.03 +/- 68.19 microg/dl, respectively (P > 0.05). The Generalized linear models was unable to show any significant relationship between androgenic hormones and CAD, while generalized additive model and neural networks supported the significant effect of androgenic hormones on CAD. This finding suggests a nonlinear association of tT levels with CAD: lower levels have a preventive effect on CAD, whereas higher values increase the risk of CAD. Emphasizing the non-linearity of the variables may provide new insight into the possible explanation of the effect of androgenic hormones on CAD.
Assuntos
Doença da Artéria Coronariana/epidemiologia , Dinâmica não Linear , Testosterona/sangue , Adulto , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/sangue , Humanos , Irã (Geográfico)/epidemiologia , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Fatores de RiscoRESUMO
OBJECTIVE: Urinary tract infection (UTI) is common during pregnancy and can cause serious complications for the mother and fetus. Vitamin D, is known to have an effect on the urothelium, with immunomodulatory capacity against bacterial infection. This study explored the association between serum vitamin D levels and urinary tract infections in pregnant women. STUDY DESIGN: In this case control study, 187 participants including, 97 pregnant women diagnosed as a symptomatic UTI (case group) and 90 matched healthy pregnant women (control group) were consecutively enrolled from prenatal care clinic of Imam Reza Hospital in Urmia, North West of Iran. The two groups were matched for trimester and parity, and sexual intercourse. Blood samples were collected from both groups. Chemiluminescent immunoassay (CLIA) was used to evaluate the serum vitamin D levels. We used a binary multivariate unconditional logistic regression approach to evaluate the association between UTI and vitamin D and risk factor of the UTI. RESULTS: Vitamin D deficiency (less than 20â¯ng/mL) was diagnosed in 85.7% of case group and 52.2% of control group. The serum vitamin D levels were significantly lower in pregnant women in the case group compared to the control group (12.7⯱â¯5.9â¯ng/ml vs 26.05⯱â¯10.37; pâ¯<â¯0.001). Pregnant women in case group with acute pyelonephritis had significantly lower serum vitamin D levels than those with Cystitis (pâ¯<â¯0.05). The serum vitamin D level of less than 20â¯ng/ml was the only factor associated with UTI after adjusting for all the confounders in multiple binary logistic regression modeling (AdjORâ¯=â¯3.67; 95% of CI: 1.19-6.24; pâ¯<â¯0.001). CONCLUSIONS: Women with vitamin D deficiencies are at increased risk of urinary tract infections during pregnancy. However, further studies are essential to confirm these observed results.
Assuntos
Complicações Infecciosas na Gravidez/epidemiologia , Infecções Urinárias/epidemiologia , Deficiência de Vitamina D/epidemiologia , Adulto , Estudos de Casos e Controles , Cistite/epidemiologia , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Modelos Logísticos , Gravidez , Pielonefrite/epidemiologia , Fatores de Risco , Índice de Gravidade de Doença , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Adulto JovemRESUMO
BACKGROUND: Being overweight, a constituent of the metabolic syndrome, is also an important contributing factor to the development of coronary artery disease in younger patients, compared with the older patient population. Owing to the above-mentioned fact, we sought to assess the association of the metabolic syndrome with premature coronary artery disease. METHODS: In an analytic cross-sectional study, 940 patients (553 womenAssuntos
Doença da Artéria Coronariana/epidemiologia
, Estrogênios/sangue
, Síndrome Metabólica/epidemiologia
, Adulto
, Estudos Transversais
, Feminino
, Humanos
, Masculino
, Pessoa de Meia-Idade
, Prevalência
, Fatores de Risco
, Fatores de Tempo
RESUMO
Ecstasy normally contains 3,4 methylenedioxymethamphetamine (MDMA) that increases the levels of serotonin, dopamine, and epinephrine in the central nervous system with consequent adverse effects on the cardiovascular system. Herein, we presented a case of ecstasy abuse which resulted in two episodes myocardial infarction during a three month period; the second episode led to death due to thrombus formation.
Assuntos
Alucinógenos/efeitos adversos , Infarto do Miocárdio/induzido quimicamente , N-Metil-3,4-Metilenodioxianfetamina/efeitos adversos , Adulto , Evolução Fatal , Humanos , Masculino , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , RecidivaRESUMO
BACKGROUND: Hyperhomocysteinemia is known as an independent risk factor of atherosclerosis, but the probable role of hyperhomocysteinemia in premature Coronary Artery Disease (CAD) is not well studied. The aim of this study was to assess the role of hyperhomocysteinemia, folate and Vitamin B12 deficiency in the development of premature CAD. METHODS: We performed an analytical case-control study on 294 individuals under 45 years (225 males and 69 females) who were admitted for selective coronary angiography to two centers in Tehran. RESULTS: After considering the exclusion criteria, a total number of 225 individuals were enrolled of which 43.1% had CAD. The mean age of participants was 39.9 +/- 4.3 years (40.1 +/- 4.2 years in males and 39.4 +/- 4.8 years in females). Compared to the control group, the level of homocysteine measured in the plasma of the male participants was significantly high (14.9 +/- 1.2 versus 20.3 +/- 1.9 micromol/lit, P = 0.01). However there was no significant difference in homocysteine level of females with and without CAD (11.8 +/- 1.3 versus 11.5 +/- 1.1 micromol/lit, P = 0.87). Mean plasma level of folic acid and vitamin B12 in the study group were 6.3 +/- 0.2 and 282.5 +/- 9.1 respectively. Based on these findings, 10.7% of the study group had folate deficiency while 26.6% had Vitamin B12 deficiency. Logistic regression analysis for evaluating independent CAD risk factors showed hyperhomocysteinemia as an independent risk factor for premature CAD in males (OR = 2.54 0.95% CI 1.23 to 5.22, P = 0.01). Study for the underlying causes of hyperhomocysteinemia showed that male gender and Vitamin B12 deficiency had significant influence on incidence of hyperhomocysteinemia. CONCLUSION: We may conclude that hyperhomocysteinemia is an independent risk factor for CAD in young patients (below 45 years old)--especially in men--and vitamin B12 deficiency is a preventable cause of hyperhomocysteinemia.
Assuntos
Doença da Artéria Coronariana/sangue , Ácido Fólico/sangue , Homocisteína/sangue , Vitamina B 12/sangue , Adulto , Estudos de Casos e Controles , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/etiologia , Feminino , Deficiência de Ácido Fólico/complicações , Deficiência de Ácido Fólico/epidemiologia , Humanos , Hiper-Homocisteinemia/complicações , Hiper-Homocisteinemia/etiologia , Masculino , Prevalência , Fatores de Risco , Caracteres Sexuais , Deficiência de Vitamina B 12/complicações , Deficiência de Vitamina B 12/epidemiologiaRESUMO
BACKGROUND AND OBJECTIVE: The frequency of chromosomal aberrations in Iran is not definitely known. This study determined the frequency of chromosomal aberrations in a series of couples with two or more spontaneous abortions and compared the findings with that reported from other countries. METHODS: This was a descriptive study conducted on 100 couples with recurrent abortions. Both partners were karyotyped as part of the primary investigation. Other probable causes of abortion were also investigated. RESULTS: Chromosomal aberrations were found in 8 (8%) of the females and 5 (5%) of the males. The prevalence of chromosomal abnormalities was as follows: 4 (30.8%) balanced reciprocal translocations, 3 (23%) Robertsonian translocations, 3 (23%) pericentric inversions, 1 (7.7%) paracentric inversion, 1 (7.7%) chromosomal marker, and 1 (7.7%) polymorphism 9qh+. CONCLUSIONS: The pattern of chromosomal aberrations was similar to that reported in other studies, but the prevalence of chromosomal aberrations was higher.
Assuntos
Aborto Habitual/genética , Inversão Cromossômica , Marcadores Genéticos , Polimorfismo Genético , Translocação Genética , Adulto , Citogenética , Pai , Feminino , Humanos , Irã (Geográfico) , Cariotipagem , Masculino , Mães , Adulto JovemRESUMO
We performed this study to compare of CAD risk factors in young male and female in Iran. In an analytic cross-sectional study, two groups of patients were evaluated with and without Coronary artery disease. The result of study suggests that there is a relationship between CAD and diabetes mellitus, increasing level of LDL and lipoprotein A in women, While CAD in men had more relation with smoking and opium use. High prevalence and uncontrolled diabetes mellitus in females and relatively high prevalence of opium consumption in males result in different premature CAD patterns.
Assuntos
Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/etiologia , Diabetes Mellitus/epidemiologia , Transtornos Relacionados ao Uso de Opioides/complicações , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Ópio/administração & dosagem , Adulto , Estudos Transversais , Complicações do Diabetes/complicações , Complicações do Diabetes/epidemiologia , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores SexuaisRESUMO
BACKGROUND: The effects of opium consumption on coronary artery disease are still unknown. METHODS: A cross-sectional study was conducted on 2405 patients admitted to the Angiographic Ward at Tehran Heart Center from 7 May 2005 to 13 August 2005. RESULTS: After adjusting for conventional cardiovascular risk factors, opium consumption was a significant risk factor for coronary artery disease (P=0.01 and odds ratio=1.8). Moreover, the amount of opium consumption was associated significantly with the severity of coronary atherosclerosis, as measured by clinical vessel score (r=0.2, P=0.002). CONCLUSIONS: To our knowledge, this is the first time that the adverse effects of opium consumption on coronary arteries was defined.
Assuntos
Doença das Coronárias/induzido quimicamente , Ópio/efeitos adversos , Idoso , Relação Dose-Resposta a Droga , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Fumar/efeitos adversos , Transtornos Relacionados ao Uso de SubstânciasRESUMO
AIMS: To answer the question whether the delay in coronary artery bypass grafting (CABG) after carotid stenting (CAS) results in adverse events, we describe our experience with planned staged CAS followed by CABG. METHODS AND RESULTS: We retrospectively surveyed our hospital carotid stenting data base, to identify all patients who were scheduled to undergo staged carotid stenting followed by CABG. A total of 39 patients who underwent CAS were candidates for staged CABG but only 28 (71.7%) of them referred. In the interval between carotid stenting and CABG, 4 deaths occurred (14.2% of cases), all of them were in the first week after CAS and due to cardiac problems. Also, 2 patients (7.1%) had a minor stroke. Increased number of predictors of type C (most important was stenosis of 95%-99%), age > 75 or significant valvular heart disease were associated with increased rate of complications after CAS. CONCLUSION: Should carotid intervention be performed in the high risk group of patients with > 4 suggested predictors of type C (most importantly is stenosis of 95%-99%), valvular heart disease or age > 75, physicians should closely observe the patients (perhaps in the hospital) during the waiting period before CABG, particularly in the first week after carotid stenting.