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Background: Quality of life in post-menopausal women and menopausal symptoms are closely related concepts. Influence health education policy in order to promote health and adopt a menopause lifestyle requires alternative strategies, including health training programs with community – based interventions. The current study aims to survey the effects of support groups on quality of life of post-menopausal women.Methods: A blind field trial (2010) was conducted at Saadatmandii Clinical Center (Robat Karim, Iran). 110 women were selected randomly divided into test and control groups (consisting of 55 ones). Menopause specific quality of life questionnaire (MENQOL) was used for evaluation of life quality before and three months after intervention; there was no intervention in the control group. Data were analyzed by using SPSS/16. Qualitative variables were analyzed using chi-square tests and quantitative variables were analyzed using Mann-Whitney and Wilcoxon test, paired T-test and independent t-test.Results: There was significant difference between vasomotor, psychosocial, physical, sexual aspects and life quality of this group pf women (P

Background: Quality of life in post-menopausal women and menopausal symptoms are closely related concepts. Influence health education policy in order to promote health and adopt a menopause lifestyle requires alternative strategies, including health training programs with community - based interventions. The current study aims to survey the effects of support groups on quality of life of post-menopausal women. Methods: A blind field trial (2010) was conducted at Saadatmandii Clinical Center (Robat Karim, Iran). 110 women were selected randomly divided into test and control groups (consisting of 55 ones). Menopause specific quality of life questionnaire (MENQOL) was used for evaluation of life quality before and three months after intervention; there was no intervention in the control group. Data were analyzed by using SPSS/16. Qualitative variables were analyzed using chi-square tests and quantitative variables were analyzed using Mann-Whitney and Wilcoxon test, paired T-test and independent t-test. Results: There was significant difference between vasomotor, psychosocial, physical, sexual aspects and life quality of this group pf women (P

Background: Type-2 diabetes mellitus (T2DM) is considered one of the chronic diseases that can have a relationship with age of menopause onset. Several studies have revealed that early menopause or late menopause can have a correlation with type-2 diabetes. This systematic review and meta-analysis aimed to investigate the association between the age of menopause onset and type-2 diabetes., Methods and Materials: PubMed, Web of Science, Scopus, Science Direct, Google Scholar, and Cochrane were searched for studies that have evaluated the relationship between T2DM and age of menopause onset. We pooled the effect sizes of the included studies using both adjusted odds ratios (OR) and hazard ratios (HR) of interest outcomes with their 95% confidence interval (CI)., Results: Nineteen papers were included in this study, 8 studies were cohorts, and 11 were cross sectional. Studies revealed a statistically significant association between early menopause age and increased odds of T2DM (OR = 1.24, 95% CI: 1.09-1.40; I2 = 67%; p = 0.001). Late menopause age was also associated with an increased odds of T2DM (OR = 1.14, 95% CI: 1.03-1.26; I2 = 56%; p = 0.01) compared to the reference group with normal menopausal age. As our secondary outcome, the hazard of developing T2DM in individuals with early or late menopausal age was assessed. Pooled analysis demonstrated a significantly higher hazard of T2DM among women with early menopause age (HR = 1.31, 95% CI: 1.05-1.64; I2 = 72%; p = 0.02). Late menopause age did not show a significant association (HR = 0.96, 95% CI: 0.84-1.10; I2 = 68%; p = 0.56)., Conclusion: Early and late menopause can both increase the risk of T2DM. Future research is needed to warrant the certainty of our findings., (© 2024. The Author(s).)

Aim: Sleep disorders during pregnancy can impact maternal and neonatal outcomes. The objective of this study is to examine the relationship between sleep quality and maternal and neonatal outcomes during the COVID-19 pandemic., Method: This prospective cohort study was conducted at the Educational-Therapeutic Center of Shohadaye Yaftabad Referral Hospital in Tehran, Iran, from December 2020 to September 2022. A total of 198 eligible participants were randomly assigned to either the sleep disorders group or the no sleep disorders group. Data were collected through demographic questionnaires, the Corona Disease Anxiety Scale (CDAS) questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the checklist for maternal and neonatal outcomes., Results: At baseline, the sleep disorders and no sleep disorders groups were similar in terms of age, body mass index (before pregnancy), education level, employment status, gravida, parity, abortion, and history of COVID-19. Within the sleep disorders group, there was a statistically significant, direct linear correlation between sleep disorders and FBS 34-36 weeks (r = 0.33, P < 0.001) as well as Corona Disease Anxiety (CDA) (r = 0.35, P < 0.001). The linear regression results indicated that for every unit increase in sleep disorders, the risk of FBS 34-36 weeks increased by 1.09 times (β = 1.09, P < 0.001). Additionally, sleep disorders increased the risk of CDA by 1.36 times (β = 1.36, P < 0.001). The results showed no statistically significant differences in terms of birth weight, type of delivery (vaginal or cesarean section), gestational age (preterm or full term), length of labor stages (first and second stage), Apgar score at minutes 1 and 5, and NICU admission between the two groups., Conclusion: Based on the results, a certain degree of correlation exists between sleep quality and FBS at 34-36 weeks and CDA. These findings underscore the need for future public health guidelines to formulate detailed strategies to improve sleep quality during the COVID-19 pandemic., (© 2024. The Author(s).)

Background: Given maternal health is a major health indicator, the present research aimed at determining the causal relationships of spiritual health, worries, stress and perceived social support with the fear and experience of childbirth in pregnant women., Methods: The present longitudinal prospective research recruited 352 pregnant women presenting to selected health centers in Qazvin, Iran in 2021. The data were collected using the Childbirth Experience Questionnaire-2 (CEQ-2), the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ), the Multidimensional Scale of Perceived Social Support (MSPSS), the Persian version of the Pregnancy Worries and Stress Questionnaire (PWSQ), the Spiritual Health Questionnaire, the Socioeconomic Status (SES) questionnaire and a sociodemographic checklist, and were analyzed in SPSS-25 and Lisrel-8.8., Results: The mean age of the participants was 28.1±6.8 years. According to the results of the path analysis, among the variables related to fear of childbirth, childbirth experience (B = -0.37, CI:-0.44;-0.22) in the direct path and perceived social support (B = -0.51, CI:-0.58;-0.43) in both direct and indirect paths demonstrated the most significant negative relationship. Among the variables related to childbirth experience, pregnancy worries and stress had a negative causal relationship (B = -0.06, CI:-0.079;-0.043) in the direct path, spiritual health showed the highest significant positive relationship (B = 0.01, CI: 0.008; 0.012) in the indirect path, and perceived social support (B = 0.112, CI: 0.092; 0.131) and the number of children (B = 0.32,CI: 0.30; 0.34) demonstrated the highest significant positive relationship in both direct and indirect paths. In other words, childbirth experience becomes more desirable as spiritual health, social support, and the number of children increases, and it becomes less desirable as pregnancy worries and stress rise., Conclusion: According to the present findings, various psychological, social, and spiritual factors are associated with childbirth fear and experience. It is thus necessary to utilize appropriate methods and promote training and support to reduce the adverse outcomes of childbirth., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Hosaini et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Due to the negative effects of sexual identity disorder and the lack of attention from family and society, this study aimed to investigate the relationship between Young's Early Maladaptive Schemas (YEMS) and sexual self-confidence and sexual self-efficacy in individuals with gender dysphoria (GD) after surgery., Materials and Methods: This cross-sectional study was performed on 45 individuals with GD undergoing sex reassignment surgery (SRS). Three of YEMS questionnaire (YEMSQ), sexual self-confidence, and sexual self-efficacy were completed., Results: The YEMSQ score had a significant inverse relationship with sexual self-efficacy (correlation = -0.333, P -value = 0.025). In addition, dimensions of emotional deprivation, failure to achieve, dependence/incompetence, vulnerability to harm and Illness, insufficient self-control/self-discipline, and subjugation had an adverse effect on the self-confidence and sexual self-efficacy in these individuals ( P -value <0.05)., Conclusion: According to the results of this study, YEMSQ score, sexual self-confidence, and self-efficacy were not significantly different between the two groups of male-to-female (MF) and female-to-male (FM). Also, the formation or development of these schemas in childhood in these individuals can be influential in reducing their sexual self-efficacy., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Advanced Biomedical Research.)

Heavy metals are among the most important environmental pollutants which accumulate in various organs and are associated with several toxic effects. This study was performed to determine the status of heavy metals in river buffaloes in Khuzestan province, Iran, and its relationship with hematologic and serum biochemical parameters. A total of 103 apparently healthy buffaloes were sampled from the region. The concentration of heavy metals, including lead (Pb), mercury (Hg), and cadmium (Cd), was determined in serum samples by atomic spectroscopy. In addition, complete blood counts and serum biochemical profiles were assessed. The serum concentration of Cd, Pb, and Hg in the sampled buffaloes, as mean±standard error, were 0.55±0.01, 6.51±0.10, and 6.28±0.09 µg/l, respectively, which are within the permissible serum levels in the livestock. Serum Cd and Hg levels showed no significant relationship with hematologic or biochemical analytes. However, there were significant negative correlations between Pb levels and phosphorus, magnesium, sodium, as well as potassium concentrations, while serum iron was positively correlated with lead ( P <0.05). In addition, there was a significant positive correlation between Hg level and serum aspartate aminotransferase activity ( P <0.05). Despite the fact that river buffaloes in Khuzestan spend a long time daily in the Karun River with high industrial pollution, no serum evidence of heavy metal toxicity was found in these animals. It can be suggested that river buffaloes in Khuzestan seem to be resistant to the environmental pollution caused by heavy metals. However, further studies are required to confirm this issue and identify its possible explanations., Competing Interests: The authors declare that they have no conflict of interest.

Aim: Adolescents face many challenges when entering university. The aim of this study was determined predictor role of coping with identity threat and health literacy on the quality of life and mental health of students., Methods: This is a descriptive-analytical study of the structural equation study. Random sampling was performed on 300 students of Alborz University of medical science who were eligible to enter the study. The link of the questionnaires was provided to the students through social networks. The questionnaires were used to study identity threat, mental health, health literacy, and quality of life., Results: The results of structural equations showed that health literacy has a negative and significant effect (β = -0.22) and identity threat strategy has a negative and significant effect on students' mental health disorder (β = -0.53). Mental health disorders have a negative and significant effect on the quality of life in students (β = -0.49), and health literacy has a positive and significant effect on the quality of life (β = 0.35). Based on Sobel criterion, mental health disorder was a partial mediator for the indirect effect of coping threat strategy on quality of life., Conclusions: Considering the effect of mental health and health literacy on the quality of life and the effectiveness of coping strategies, it is recommended to evaluate the mental health and health literacy of students in universities and provide educational programs for identity coping in the early years after entering the university., (© 2023 The Authors. Neuropsychopharmacology Reports published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Neuropsychopharmacology.)

Introduction: Little is known about the impact of the coronavirus on sexual behavior, function, and satisfaction., Aim: The aim of the present study was to systematically review people's sexual function and behaviors and their changes in sexual activities during the COVID-19 pandemic., Methods: Comprehensive searches in PubMed, Web of Science, and Scopus were conducted with keywords in accordance with MeSH terms: COVID-19, SARS-CoV-2, coronavirus, sexual health, sexual function, sexual dysfunctions, sexuality, sexual orientation, sexual activities, and premarital sex. Two reviewers independently assessed full-text articles according to predefined criteria: original design, English studies, and investigating either the general population or sexual minorities., Results: Risk of bias in the studies was assessed by the Newcastle-Ottawa Scale, and data were pooled via random effects meta-analyses. We utilized the standardized mean difference to evaluate the effects of the COVID-19 pandemic on sexual activity, functioning, and satisfaction. We included 19 studies in the analysis and 11 studies in the meta-analysis, with a sample size of 12 350. To investigate sexual activity changes, a sample size of 8838 was entered into the subgroup analysis, which showed a significant decrease in both genders (5821 women, P < .033; 3017 men, P < .008). A subgroup meta-analysis showed that the sexual function of men and women during the COVID-19 pandemic significantly declined (3974 women, P < .001; 1427 men, P < .001). Sexual desire and arousal decreased in both genders, though mainly in women. In investigating sexual satisfaction changes during the COVID-19 pandemic, a meta-analysis with a sample size of 2711 showed a significant decrease ( P < .001). The most indicative changes in sexual behaviors during the pandemic were the increase in masturbating and usage of sex toys. Greater COVID-19 knowledge was associated with lower masturbation, oral sex, and vaginal sex. The more protective behaviors were associated with less hugging, kissing, cuddling, genital touching, watching porn with a partner, and vaginal sex., Conclusion: The COVID-19 pandemic led to increased challenges and changes for individuals' sexual behaviors. Efforts for preventive strategies should therefore be concentrated between pandemics, while ensuring that there is information available to the population during a pandemic for help in times of psychological distress or crisis., (© The Author(s) 2023. Published by Oxford University Press on behalf of The International Society of Sexual Medicine.)

Objective: Majority of breastfeeding women experience changes in sexual function. The present study was designed to assess effectiveness of auriculotherapy on improving sexual function in breastfeeding women. Method : In this randomized sham controlled trial, accomplished from January 2018 to May 2019 in a referral sexual health clinic in city of Qom, Iran, 60 eligible participants were assigned to either intervention and control groups via block randomization. In the intervention group, electrical stimulation was applied for 15 seconds on Shen Men, Zero, Thalamic, Master Cerebral, Libido, Relax, Excitement, Ovary, and Uterus points in 10 auriculotherapy sessions. Then, Vaccaria seeds were stuck on these points. The control group received the same procedure with the device off as a sham method. Data were gathered using the Female Sexual Function Index (FSFI) at three different time points. Results: At baseline, mean scores of sexual function dimensions were not significantly different between the intervention and control groups except for orgasm. Post-intervention, the results showed significant differences in sexual desire (P = 0.002), sexual arousal (P = 0.008), lubrication (P = 0.001), sexual satisfaction (P = 0.001), and orgasm (P = 0.009). One month after the intervention, the results showed significant differences in sexual desire, sexual arousal, lubrication, sexual satisfaction (P = 0.001), orgasm (P = 0.006), and dyspareunia (P = 0.015). Differences in mean score of sexual function in post-intervention and one-month follow-up were only significant in the intervention group (P = 0.001). Conclusion: Based on evidence from this study, auriculotherapy is an effective technique for improving sexual function in breastfeeding women., (Copyright © 2022 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences.)

Purpose: There are few studies on the gender differences in mental health, happiness, and their related factors among the older population through the structural equation model (SEM) in Iran. We conducted this study to evaluate the factors affecting mental health and happiness in the elderly using an SEM by gender differences., Methods: A cross-sectional study was conducted on 739 elderly people in 2019 in Karaj, Iran. Sociodemographic, Symptom Checklist-90-Revised (SCL90-R), and the Oxford Happiness Inventory were applied to evaluate the relationships between happiness, mental health, and sociodemographic factors by using statistical path analysis with Lisrel 8.8 and SPSS-17., Results: Overall, 55.5% of the participants in the study were female. The SCL90 (p value = .000) and happiness (p value = .000) scores showed significant differences between men and women. Fit indices confirmed the high model fitness, desirability, and logical relationships between the variables according to the conceptual model in both men (X2 = 3.2, df = 1) and women (X2 = 5.4, df = 2) groups. According to the path analysis, among the variables that affected happiness just through the direct path, education had the most positive causal relationship in men (B = .13) and women (B = .16), but mental health problems in men (B = -.33) and women (B = -.26), as well as the distance from home to the healthcare center in men (B = -.13) and women (B = -.11), had the most negative causal relationship with happiness respectively. Age was the only variable that was negatively related to happiness through direct and indirect paths in the women (B = -.188)., Conclusion: We provided an empirical model that illustrates the relationships between happiness, mental health, and related factors in the older population. Gender differences in path analysis showed that age negatively affects the happiness of older women but not men., (© 2022 The Authors. Brain and Behavior published by Wiley Periodicals LLC.)

Background: Maternal mortality resulting from pregnancy and delivery complications is a sensitive indicator of women's status in the society, access to care services, and sufficiency and quality of healthcare and is the major indicator of a country's developmental status. The present study aimed at determination of educational needs regarding safe motherhood from suburban women's perspective., Method: This qualitative study with conventional content analysis approach was conducted in suburban healthcare centers of Alborz University of medical sciences from 23 October to 22 December 2019. The participants included 15 eligible Iranian suburban women who were selected through purposive sampling. The data were collected via in-depth semi-structured interviews and focus groups. Data were analyzes with MAXQDA10 software., Results: Three main themes emerged from the analysis of the data (barriers against safe pregnancy, accountability multidimensional training, and threats and opportunities of distance learning), six categories, 11 subcategories and 547 codes., Discussion: The results indicated that suburban women were less probable to be present in healthcare centers and receive the required information compared to their peers due to their conditions; provision of accessible training services appropriated to their conditions can greatly contribute to elimination of these problems., Competing Interests: The authors declare no conflict of interest., (© 2021 Published by Elsevier Ltd.)

Background: Multiple sclerosis (MS) is the most prevalent progressive sensory/neurological disability in young adults, with important psychological consequences. The present study was designed to assess the effectiveness of group counseling with a client-centered approach based on the GATHER principles on sexual satisfaction in women with MS., Methods: In this clinical trial, conducted from January 2018 to May 2019, in the MS Referral Center of Tehran (Iran), 72 eligible participants were assigned to intervention and control groups (36 in each group) via simple randomization. The intervention group received group counseling based on the client-centered approach, while the control group received routine counseling. Data were collected using the Larson Sexual Satisfaction Questionnaire (LSSQ) at three different time points: before the intervention, after the final session, and one month after the intervention. The collected data were analyzed in SPSS software (version 19). In order to analyze the obtained data, independent t test, Mann-Whitney U test, paired t test, Wilcoxon test, Chi-square test, Fisher exact test, and Friedman test were used., Results: The mean score of sexual satisfaction before the intervention showed no statistically significant difference between the two groups. Based on the Friedman test in the intervention group, the trend of changes in the mean score of sexual satisfaction had a significant difference before the intervention, after the final session, and one month after the intervention (P=0.001); however, no significant difference was observed in the control group., Conclusion: Our results showed the effectiveness of group counseling with a client-centered approach based on the GATHER principles on sexual satisfaction and intimacy among women with MS. Trial Registration Number IRCT20180110038302N3., (Copyright: © Iranian Journal of Medical Sciences.)

Introduction: Compliance with ethical principles is regarded as one of the key components in providing services in midwifery profession. This study was to evaluate the effects of counseling professional ethics principles on midwifery professional codes of ethics compliance and applicability rate among midwives working in community health centers in the city of Karaj, Iran., Methods: This randomized controlled trial (RCT) was conducted in 2018 on a total number of 84 eligible midwives in two intervention and control groups, selected through multistage sampling method. The intervention group took part in six counseling sessions but the control group only received a training manual. Both groups then completed the Self-Reporting Questionnaire of Ethical Codes of Reproductive Health Providers (including 95 items in 14 domains) at three time points (before, immediately, and four weeks after intervention). Finally, the data were analyzed using the IBM SPSS Statistics (version 22) software via descriptive and inferential statistics., Results: The findings showed that level of compliance and applicability rate in all 14 domains of midwifery professional codes of ethics were higher in the intervention group (after intervention) than those in the control group and trend of time changes in mean level of compliance and applicability rate of codes of ethics during the three time points were significantly different between both groups (p < 0.001)., Conclusion: Given the effectiveness of counseling professional ethics principles on midwifery professional codes of ethics compliance and applicability rate among the midwives working in community health centers, designing and applying this counseling approach was recommended to improve quality of reproductive health care services., Competing Interests: The authors declare no competing interests., (© Soheila Shahabnia et al.)

Objective: The aim of the study was to assess the effect of mindfulness-based stress reduction (MBSR) on anxiety and self-efficacy in coping with childbirth., Material and Methods: This randomized controlled trial was conducted on 70 pregnant women in Abyek city of Qazvin province in Iran. The convenient sampling method was recruited. Samples were assigned to control and intervention groups using random blocks. In addition to routine care, individuals in the intervention group received 6 MBSR training sessions. The data gathering questionnaire in this study included mindfulness, Pregnancy-Related Anxiety Questionnaire, and self-efficacy in coping with childbirth questionnaire., Results: There was no statistically significant difference between the demographic characteristics in the control and intervention groups. The results of the analysis of variance (ANOVA) with repeated measures indicated the effect of time on the change in the total score of anxiety in the intervention group (p = .001). There was a significant difference between the two groups (p = .001). Also, the results of ANOVA with repeated measures showed that time had no impact on the score of self-efficacy in delivery coping (p = 0/1) and that there was no significant difference between the two groups in this respect (p = .6)., Conclusion: The result of this study showed that mindfulness reduces anxiety of pregnant mothers, and it is suggested that mindfulness programs be educated for healthcare providers and pregnant mothers to reduce maternal anxiety and improve pregnancy outcomes and delivery., (© 2020 The Authors. Brain and Behavior published by Wiley Periodicals, Inc.)

Studies that examined the impacts of inflammatory factors on gestational diabetes mellitus (GDM) are very sparse. The purpose of this study was to investigate the relationship between C-reactive protein (CRP) and the risk of GDM. Pregnant women who fulfilled the inclusion criteria and their gestational ages were below 10 weeks were recruited to this cohort study and were followed up until the 24-28 weeks of gestation. At the first pre-natal care visit blood samples were taken from all the pregnant women to investigate the serum concentration of CRP and fasting blood sugar. At 24-28 weeks of gestation, an oral glucose tolerance test was done to diagnose GDM as routine. About 5% of the women participating in the study were diagnosed as having GDM. There was a significant association between the increased serum concentration of CRP in the first trimester and the risk of GDM. The risk of GDM in women with the highest serum concentration of CRP is three times higher than that of women with the lowest serum concentration of CRP. Systemic inflammation can be associated with increased risk of gestational diabetes.Impact statement What is already known on this subject? Multiple studies have shown that chronic inflammation can increase the risk of developing type2 diabetes. There is incertitude as to the best attitude for screening and diagnosis of GDM. The studies were examined the impacts of inflammatory factors on GDM is very restricted. What do the results of this study add? CRP level measurement in the first trimester can be considered as a screening test. This is an easy and cost-effective test to make decision for performing oral glucose tolerance test at 24-28 weeks of pregnancy. What are the implications of these findings for clinical practice and/or further research ? The results of this study could give physicians and other health care providers the hint that increasing serum CRP levels in early pregnancy can be a risk factor for gestational diabetes.

Objectives: Surgical menopause can influence women's quality of life in many aspects. This study was designed to assess the effectiveness of a multi-dimensional group counseling program based on the great clients, ask clients, tell clients, help clients, explain how to use, return for follow up (GATHER) approach, on quality of life in the surgically menopausal women., Methods: This randomized clinical trial was conducted using two groups. The study comprised 78 women meeting inclusion criteria who had visited 4 healthcare centers in Tehran from December 2017 to September 2018. The participants were selected through simple random sampling (39 in each group). The intervention group underwent 6 consecutive weekly group counseling sessions based on GATHER approach, whereas the control group received no interventions. Data were collected using the Menopause-specific Quality of Life questionnaire at 4 time-points (i.e., baseline, immediately after the intervention, 1 month after the intervention, and 3 months after the intervention)., Results: The trend of changes at four time-points obtained on the basis of repeated measures test results showed significant betweengroup differences in vasomotor ( P = 0.001), psychosocial ( P = 0.025), and physical ( P = 0.001) domains. Friedman test showed significant between-group differences in the mean score trend of changes at 4 time-points in sexual ( P = 0.002) and overall quality of life ( P = 0.004) domains., Conclusions: On the basis of the study results, implementation of this approach with less expenditure in healthcare centers aimed at improving quality of life in surgically menopausal women is highly recommended., Competing Interests: No potential conflict of interest relevant to this article was reported., (Copyright © 2019 by The Korean Society of Menopause.)

Background and Objectives : There is still no clear portrayal of women's empowerment in managing menopause. The present study was conducted to design a model for the empowerment of Iranian women in managing menopause. Materials and Methods : This qualitative study was conducted using the grounded theory on  40-60-year-old women who were first selected through purposive sampling and then by theoretical sampling from November 2013 to July 2016. Data were collected using 33 in-depth, semi-structured, individual interviews with 30 participants. Data were analyzed using the Strauss and Corbin(2008) approach and organized in MAXQDA-10. Results : The analysis of the data led to the emergence of "active coping with menopause" as the core variable with four themes. The two themes "threat to feminine identity" and "latent opportunity" explained the context of the study, and "redefining the feminine identity" and "self-retrieval" explained its process. Conclusion : In our social context, the phenomenon of menopause is a coin with two sides and its experience leans more on the threat to feminine identity and less on latent opportunity. The model of postmenopausal women's empowerment for managing menopause might offer health policy-makers a realistic and divergent understanding of the challenges of empowering women by explaining key concepts.

Objective: Climacteric syndrome, which is related to many symptoms, often causes discomfort in women. Non-pharmacologic treatment is one of the treatment options for affected individuals, and this syndrome can be cured with psychological treatments such as cognitive behavioral therapy (CBT). The present study aimed to compare the efficacy of various CBT methods on the improvement of climacteric symptoms., Material and Methods: PubMed, Scopus, Cochrane, Medline, PsycINFO, and Google Scholar were searched for relevant articles published between January 1990 and August 2018. Data extraction and quality assessment were conducted by two authors., Results: A total of 15 articles including 910 women were entered. We divided the CBT methods into two categories, face-to-face (individual and group CBT) and indirect (self-help CBT) methods. Among the three CBT approaches, three articles covered individual CBT, nine articles carried out group CBT, and in five articles, the self-help approach was used. The climacteric symptoms that improved with CBT were categorized into three groups as vasomotor symptoms, psychological symptoms, and organic disorders. Generally, the face-to-face method played a key positive effect on symptom improvement, and the group CBT approach was more effective on psychological symptoms., Conclusion: Although the indirect method is more cost-effective, it has less impact than the face-to-face method; it is better to use face-to-face approaches to achieve better results, if possible. Further studies are required in this regard, particularly in the individual and self-help CBT approaches, to measure the impact of these approaches on more varied symptoms of menopause.

Background: Infertility stress can have a devastating impact on the lives of couples and influence their physical and psychological health. The purpose of this study was to investigate the effects of group counseling on female stress and gender-role attitudes in infertile women., Methods: The present study is a randomized clinical trial conducted on 90 infertile women referred to Rooyesh Infertility Treatment Center in the city of Karaj, Iran. The convenience sampling method was used. Samples were divided into intervention and control groups through four-block random allocations. Accordingly, the intervention group received five-session group counselling and the control group only received routine care. Newton's fertility problem inventory (FPI) and gender role questionnaire (GRQ) were used for collecting data before, after, and one month after the intervention. The significance level was set at 0.05., Results: The result showed a significant relationship between gender role attitude and stress in infertile women (p=0.03) and indirect association between of them (r=0.13). And also repeated measures test indicated that length of time had affected the total scores of infertility stress (p<0.001) and gender role attitude scores (p= 0.001) and there was a significant difference between the two groups in infertility stress scores (p<0.001) and gender role attitude scores (p=0.001)., Conclusion: Group counseling can be used in stress reduction and also improved gender role attitude of infertile women., Competing Interests: Conflict of Interest The authors of this study declared no conflict of interest.

Background: Training needs are multidimensional requirements affected by social and cultural background, level of knowledge and personal and health conditions. This study was conducted to explain the needs for a training software among Iranian infertile couples., Materials and Methods: In this qualitative study, we used content analysis to examine the need among ten infertile participants (four men and six women) and six health care professionals (including two gynecologists, two reproductive health specialists and two midwives). The present research was carried out from January 2017 to July 2018 at Rouyesh and Ibn Sina infertility treatment centers in Karaj, Iran. The participants were selected through purposive sampling with maximum variation. Four focus group discussions with the health care professionals and twelve semistructured, in-depth interviews with the infertile participants were held for data collection. Data were analyzed using conventional content analysis in MAXQDA-10., Results: Data analysis led to the extraction of a central theme of "a multidimensional training application" and its four main categories, including "pre-treatment training", "diagnostic training", "mid- and post-treatment training" and "continuous psychological training". These main categories also had 20 subcategories., Conclusion: Based on the results of this study, infertile women and men have multidimensional training needs before and after treatment and during the process of diagnosis; psychological aspects should also be considered.The interviewed health care professionals helped to explain these training needs. A training software thus needs to be designed based on the real needs of the infertile community., Competing Interests: The authors declare no conflicts of interest., (Copyright© by Royan Institute. All rights reserved.)

Background: Age at the onset of menopause is the most important determinant of women's future health outcomes. While the basic mechanisms contributing to the onset of menopause are still not fully understood, age at menopause depends on a complex set of various factors. In this regard, the effects of diabetes (DM I/II) on the age at the onset of menopause have received little attention., Methods and Analysis: Electronic databases including PubMed/MEDLINE, Web of Science, Scopus, EMBASE, and Google Scholar will be searched for articles published during January 2000 to August 2018 and containing combinations of related MeSH terms, i.e., "age at menopause" and "diabetes." Additional studies will also be extracted from the reference lists of the selected papers, gray literature, and key journals in the field. A set of inclusion criteria will be defined, and all eligible observational studies will be included. Two reviewers will independently conduct the study selection, data extraction, and quality assessment of the selected studies. All cases of disagreement will be resolved through consensus. The methodological assessment of the primary studies will be performed based on the Newcastle-Ottawa Scale (NOS). In case of the availability of sufficient data, fixed or random effects models will be used to combine all data. Heterogeneity will be assessed by I 2 statistic and chi-square test. Stata V.11.1 will be used for data analysis (CRD42017080789)., Ethics and Dissemination: This systematic review will not raise any ethical issues. Journal publication and conference presentations will facilitate the wide dissemination of the findings to relevant clinicians and researchers.

Background: Adherence to regular screening programs for cervical cancer in Iranian women is not common. The aim of this study was to explore contextual factors influencing behavior and compliance with guidelines. Methods: This qualitative content analysis study was conducted in 2016-2017 in Hamadan city, Iran. Semi-structured in-depth interviews were conducted with 31 participants who were selected purposefully on referring to health centers. Twenty-three were women with various experiences of cervical cancer screening and 8 were health care providers (4 midwives, 1 gynecologist, 1 general practitioner and 1 family health expert). Guba and Lincoln criteria were used for tustworthiness. MAXQDA10 software was employed for data analysis. Results: Four themes were extracted from the data: an opportunity maker system, opportunities to become acquainted, concerns for healthy living, and perception of cancer. Conclusion: The results showed sensitivity of health care providers and their appropriate performance in relation to regular screening behavior of women is very important. Women’s perception of cancer and its curability is another factor with a major effect on screening behavior. Opportunities for people to become acquainted with the Pap smear in a variety of ways and concern for healthy living and the need to have a healthy life to ensure quality of life were also found to be important., (Creative Commons Attribution License)

We conducted a double-blind randomized placebo controlled trial to evaluate the impact of Lemon balm ( Melissa officinalis L.) on the bleeding and systemic manifestations of menstruation. A total of 90 students were randomly assigned to treatment or placebo group. Bleeding and systemic manifestations were evaluated with a menstrual pictogram and multidimensional verbal scale before and during 2 consecutive menstrual cycles, respectively. Statistical tests indicated that in both groups, the severity of the systemic symptoms associated with dysmenorrhea significantly decreased ( P = 0.001). Among the systemic symptoms, the mean severity of fatigue, the lethargy, and nervous changes in the two groups decreased after the treatment, which was statistically significant. There was no significant difference between the two groups regarding fatigue in the three cycles, but there was a significant difference between the two groups regarding lethargy in the first cycle ( P = 0.05) and the second cycle ( P = 0.001) after the treatment. The present study demonstrated that Melissa officinalis decreases the severity of the systemic signs associated with menstruation. It showed that the herb does not increase the severity of bleeding and the duration of menstruation. However, it reduces the mean total score of the severity of all the systemic symptoms associated with dysmenorrhea.

Background: Developing maternal competence in first time mothers has a significant impact on neonate's growth psychosocial development and neonates growth and psychological development. Social support can be an important element for becoming a new mother. We aimed to investigate how social support and maternal competence change during pregnancy and 4 months after it and examine the relationships among social support and maternal competence., Methods: This longitudinal study was conducted on 100 first time mothers attending health centers in Alborz city, Alborz Province, between February 2015 and January 2016. Data were collected through perceived social support questionnaire that consisted of 12 questions and Parenting Sense of Competence Scale consisting of 17 items scored based on Likert's scale. The collected data were analyzed by SPSS software, version 16. Repeated-measure test and Pearson's correlation coefficient were used. P<0.05 was considered significant., Results: Maternal competence significantly reduced during the study (P=0.008), while perceived social support did not show any significant reduction (P=0.286). A direct relationship was found between social support and maternal competent six weeks after childbirth (r=0.19, P=0.049), and also social support and maternal competence sixteen weeks after childbirth (r=0.23, P=0.01)., Conclusion: Considering the reduction of maternal competency during the study, social support by healthcare providers may be helpful for the mothers' transition to motherhood, and midwives must design specific interventions to promote the sense of maternal competence and perceived social support in first time mothers.

Background The phenomenon of street children is a bio-psychological and social issue that not only harms children, but also endangers the health of a society. In line with the national programs for the development and promotion of street children's health in Iran, health policy making and essential strategies for this group of children will be presented in this paper. This paper will discuss the main issues and challenges of street children's health and, also, health policy and guidelines for this population. Methods In this review study, the keywords; street children, health, challenges, policy, and health policy making were searched through PubMed, SID, Iranmedex, World Health Organization (WHO), Emro, the Cochran Library, Medline and Google scholar to collect data. The search resulted in 84 related resources from which 48 cases that were more relevant to this research and covered the issue more comprehensively, were used. All data published during 2002-2015 have been included in this paper. Results Key concepts including street children and their health, health policy, strategies to improve the health of street children, health policy approaches for street children, the WHO's strategies, and social support program for street children must be considered in the health policy making processes for street children, as precise identification of the relevant information makes planning more effective in health policy making for this group of children. Conclusion The phenomenon of street children is a growing problem in the world and it has turned into a serious concern in many countries including Iran. The findings of this study can be used for identifying necessary measures in order to use research outcomes more effectively in policy making processes and reforming street children's health policies in Iran.

Background: Increased life expectancy and the growing phenomenon of aging can lead to increased burden of chronic diseases (CDs) which adversely affects the overall health of elderly, their sexuality in particular. Sexual life of an aged population is overlooked in many of the societies. In the present narrative review, we aim to assess the impact of CDs on sexual function of elderly people., Materials and Methods: We used internet databases including PubMed, EMBASE, ISI Web of Science, Google Scholar, SID, Iran Medex, Magiran, IPPF, and UNFPA without time limit. Ninety-eight out of 174 relevant articles were selected which met the inclusion criteria: those articles were research-based in English or Persian (original or review articles) and textbooks; specified one or more CDs and sexual function of the cases; elderly people over the age of sixty, men and women; and coordination between articles and research goals. We excluded qualitative and case studies. We reported the most related CDs with sexual function in literature review and used the biological and psychological impact of the CDs on sexual function of elderly population based on the conceptual model of Verschuren et al . (2010)., Results: The results of the studies were classified into the themes including physical, psychological, and cultural and social. Diabetes, cardiovascular, cancerous, and chronic respiratory diseases and also some medications can reduce sexual capacity and desire in particular resulting in negative impact on the quality of elderly sexual life. CDs may influence sexual expressions and responses which adversely affect one's mood and energy so that can cause depression and grief, as well as loss of self-confidence, self-esteem, and self-concept in elderly adults. The factors affecting sexuality of an elderly with CDs include cultural and mythical beliefs about age and illnesses, fear, and embarrass of changed physical appearance. The research conducted among elderly population examining the adverse influence of CDs on aged people's sexual life in general, sexual function and performance, and intimate interaction., Conclusion: It is considered that programs on sexual health needs of aged population for the health-care workers can prove beneficial in improving sexual health., Competing Interests: There are no conflicts of interest.

Objective: The aim of this study was to investigate the effect of Lavender essence inhalation on severity of labor pain and duration of labor., Methods and Materials: This single-blind, randomized clinical trial was conducted on 120 pregnant women in two groups. The experimental group received 2 drops of Lavender essence inhaled at three stages (4-5, 6-7, 8-9 cm cervical dilation) and severity of the labor pain and duration of labor was measured before and after intervention. The control group was treated with distilled water as a placebo in the similar ways, too., Results: The results showed that difference in the labor pain before and after intervention in two groups was significant (P = 0/001). But there was no difference in mean duration of the active phase and the second stage of labor between the two groups., Conclusion: Lavender essence aromatherapy may be an effective therapeutic option for pain management for women in labor., (Published by Elsevier Ltd.)

Context: Menopause is described as a period of psychological difficulties that changes the lifestyle of women in multiple ways. Menopausal women require more information about their physical and psychosocial needs. Empowerment during the menopause can contribute to improving the perception of this stage and the importance of self-care. It is essential to increase women's awareness and adaptation to menopause, using empowerment programs. The aim of this study was to review the empowerment and coping strategies in menopause women., Evidence Acquisition: In this review, PubMed, EMBASE, ISI, and Iranian databases were scanned for relevant literature. A comprehensive search was performed, using the combinations of the keywords "empowerment, menopause, coping with" to review relevant literature and higher education journals., Results: Most interventions for menopause women have focused on educational intervention, physical activity/exercise, healthy diet, stress management, healthy behaviors, preventing certain diseases and osteoporosis. Health education intervention strategy is one of the alternative strategies for improving women's attitudes and coping with menopause symptoms, identified as severalof the subcategories of health promotion programs., Conclusions: Empowerment of menopausal women will guarantee their health during the last third of their life. It will also help them benefit from their final years of reproductive life. The results of the present study can pave the way for future research about women's health promotion and empowerment.

Unintended pregnancy is among the most troubling public health problems and a major reproductive health issue worldwide imposing appreciable socioeconomic burden on individuals and society. Governments generally plan to control growth of births (especially wanted births as well as orphans and illegitimate births) imposing extra burden on public funding of the governments which inevitably affects economic efficiency and leads to economic slowdown, too. The present narrative review focuses on socioeconomic impacts of unintended pregnancy from the health system perspective. Follow of Computerized searches of Academic, 53 scientific journals were found in various databases including PubMed, EMBASE, ISI, Iranian databases, IPPE, UNFPA (1985-2013). Original articles, review articles, published books about the purpose of the paper were used. During this search, 20 studies were found which met the inclusion criteria. Unintended pregnancy is one of the most critical challenges facing the public health system that imposes substantial financial and social costs on society. On the other hand, affecting fertility indicators, it causes reduced quality of life and workforce efficiency. Therefore lowering the incidence of intended pregnancies correlates with elevating economic growth, socio-economic development and promoting public health. Regarding recent policy changes in Iran on family planning programs and adopting a new approach in increasing population may place the country at a higher risk of increasing the rate of unintended pregnancy. Hence, all governmental plans and initiatives of public policy must be regulated intelligently and logically aiming to make saving in public spending and reduce healthcare cost inflation.

Background: One of the main criteria to verify the effectiveness of a health training program is to measure quality of life in menopausal women., Objectives: Hence the aim of this review was to evaluate the effects of self-directed learning (SDL) on MENQOl., Patients and Methods: The present single blind field study was conducted in Saadatmandi Health Center of Robat Karim (Iran, Southwest of Tehran Province) from August to December 2010. One handred and ten menopausal women were selected using convenience sampling method and then divided into two experimental (Self-directed Learning) and control groups of 55 each. Four manuals were developed to guide the women in the experimental group containing practical ways to treat menopausal symptoms. They were distributed among the participants for four weeks on a specific day. Menopausal Specific Quality of Life Questionnaire (MENQOL) was used to determine and compare quality of life scores of these women (before and three months after intervention sessions). The control group did not receive any intervention. Statistical analysis was performed by SPSS/16 software using Kolmogorov-Sminov, ANOVA, independent paired t test and Chi-square test., Results: There were significant statistical differences between two groups regarding the age of subjects; age of menopause; economic, educational and employment status; number of dead and living children; BMI and vasomotor, physical, sexual and psycho-social postmenopausal symptoms. The implementation of Self-directed Learning (SDL) model leads to a significant statistical difference in scores of vasomotor symptoms (16.32 ± 5.92 to 13.26 ± 5.31), psychosocial symptoms (34.8 ± 11 to 27.18 ± 10.83), physical symptoms (75.02 ± 18.07 to 61.42 ± 15.49), sexual symptoms (15.36 ± 6.10 to 12.00 ± 4.97) and the overall score for quality of life (141.5 ± 41.09 to 113.86 ± 36.6) (P < 0.001). No significant changes were found in the QOL scores of the control group., Conclusions: Implementation of self-directed learning provides a useful strategy that should be included in health intervention and national surveillance programs in order to improve health and therapeutic compliance in postmenopausal women.

Background: Quality of life in post-menopausal women and menopausal symptoms are closely related concepts. Influence health education policy in order to promote health and adopt a menopause lifestyle requires alternative strategies, including health training programs with community - based interventions. The current study aims to survey the effects of support groups on quality of life of post-menopausal women., Methods: A blind field trial (2010) was conducted at Saadatmandii Clinical Center (Robat Karim, Iran). 110 women were selected randomly divided into test and control groups (consisting of 55 ones). Menopause specific quality of life questionnaire (MENQOL) was used for evaluation of life quality before and three months after intervention; there was no intervention in the control group. Data were analyzed by using SPSS/16. Qualitative variables were analyzed using chi-square tests and quantitative variables were analyzed using Mann-Whitney and Wilcoxon test, paired T-test and independent t-test., Results: There was significant difference between vasomotor, psychosocial, physical, sexual aspects and life quality of this group pf women (P<0.001). There was no statistically significant difference in the quality of life of women in control group., Conclusion: According to the results method of support group can lead to improved quality of life for post-menopausal ones and it can be appropriate healthcare policy to promote health and improve life quality of this group of women.