ORIGINAL_ARTICLE
Different Time Schedules of Mifepristone and Misoprostol in Second Trimester Medical Abortion: A Comparative Study
Background & aim: Recently, the use of mifepristone followed by misoprostol after 36-48 h has been demonstrated to be an effective and safe method for the second trimester medical abortion. However, this regimen entails long total abortion time, and consequently increases the financial burden and anxiety in the patients. We hypothesize that one day interval would be also effective and can be used to provide the abortion care. Regarding this, the present study aimed to compare the effectiveness and safety of 24- and 36-hour intervals between the administration of mifepristone and misoprstol for second trimester abortion. Methods: This prospective comparative study was conducted on 70 females who opted for second trimester medical abortion between 12-20 weeks. Mifepristone (200 mg) was followed by sublingual misoprostol (800 mcg) after one and two days in the first and second groups, respectively. Four hours after the administration of 800 mcg misoprostol, all patients received 400 mcg sublingual misoprostol every 4 h (maximum of four doses in 24 h). For the purpose of the study, such parameters as the rate of successful abortion 24 h after the first dose of misoprostol, abortion duration, and the associated side effect profile were examined. Results: According to the results of the present study, the two-day interval (100%) was more effective than the one-day interval (91.4%) (P=0.021). Furthermore, the mean induction abortion duration was significantly less in the two-day regimen. However, the side effect profiles were comparable in both groups. Conclusion: As the findings of the present study indicated, both schedules of mifepristone and misoprostol were safe and effective in second trimester abortion. The 36-hour interval between mifepristone and misoprostol was more effective than the 24-hour interval. Furthermore, it had shorter abortion duration. We can individualize the patient care by offering a one-day interval regimen since it is more effective and has less duration for total abortion.
https://jmrh.mums.ac.ir/article_8539_ff63cef66d8df40ecee7a661af2c1e4b.pdf
2017-07-01
930
934
10.22038/jmrh.2017.8539
Abortion
Mifepristone
Misoprostol
Second Trimester
Nalini
Sharma
nalinisharma100@rediffmail.com
1
Assistant Professor, Department of Obstetrics and Gynecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
LEAD_AUTHOR
Ahanthem Santa
Singh
2
Professor and Head, Department of Obstetrics and Gynecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
AUTHOR
Thong KJ, Baird DT. Induction of second trimester abortion with mifepristone and gemeprost. BJOG: An International Journal of Obstetrics & Gynaecology. 1993; 100:758–761.
1
Ashok PW, Templeton A, Wagaarachchi PT, Flett GM. Midtrimester medical termination of pregnancy: a review of 1002 consecutive cases. Contraception. 2004; 69(1):51-58.
2
Royal College of Obstetricians and Gynaecologists. The care of women requesting induced abortion. London: Royal College of Obstetricians and Gynaecologists; 2004.
3
World Health Organization. Unsafe Abortion: global estimates of the incidence of unsafe abortion and associated mortality in 2000. 4th ed. Geneva: World Health Organization; 2004.
4
Chaudhari P, Mandal A, Das C, Mazumdar A. Dosing interval of 24 hours versus 48hours between mifepristone and misoprostol administration for mid-trimester termination of pregnancy. Inter-national Journal of Gynecology and Obstetrics. 2014; 124(2):134-138.
5
Mahajan DK, London SN. Mifepristone (RU486): a review. Fertility and Sterility. 1997; 86(6):967-976.
6
Goh SE, Thong KJ. Induction of second trimester abortion (12–20 weeks) with mifepristone and misoprostol: a review of 386 consecutive cases. Contraception. 2006; 73(5):516–519.
7
Dickinson JE, Jenning BG, Doherty DA. Mifepristone and oral, vaginal, or sublingual misoprostol for second trimester abortion: a randomized Controlled trial. Obstetrics & Gynecology. 2014; 123(6):1162-1168.
8
Hou S, Zhang L, Chen Q, Cheng L. One-and two-day mifepristone-misoprostol intervals for second trimester termination of pregnancy between 13 and 16 weeks of gestation. International Journal of Gynecology and Obstetrics. 2010; 111(2):126-130.
9
Heikinheimo O, Suhonen S, Haukkamaa M. One- and 2-day mifepristone-misoprostol intervals are both effective in medical termination of second-trimester pregnancy. Reproductive Biomedicine Online. 2004; 8(2):236–239.
10
Nilas L, Glavind-Kristensen M, Vejborg T, Knudsen UB. One or two day mifepristone-misoprostol interval for second trimester abortion. Acta Obstetricia et Gynecologica Scandinavica. 2007; 86(9):1117–1121.
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Mentula M, Suhonen S, Heikinheimo O. One-and two-day dosing intervals between mifepristone and misoprsotol in second trimester medical termination of pregnancy-a randomized trial. Human Reproduction. 2011; 26(10):2690-2697.
12
Marinoni E, Santoro M, Vitagliano MP, Patella A, Cosmi EV, Di Iorio R. Intravaginal gemeprost and second-trimester pregnancy termination in the scarred uterus. International Journal of Gynecology & Obstetrics. 2007; 97(1):35-39.
13
Tang OS, Thong KJ, Baird DT. Second trimester medical abortion with mifepristone and gemeprost: a review of 956 cases. Contraception. 2001; 64(1):29–32.
14
ORIGINAL_ARTICLE
The Relationship between Maternal Biosocial Determinants and Infant Birth Weight
Background & aim: Low birth weight (LBW) is the center of focus as a cause of many social, emotional, and mental deficiencies. The identification of the probable causes of LBW is considered as an important measure in reducing the prevalence of this health problem. Regarding this, the present study was carried out to compare some of the mental and social traits in the mothers of normal weight newborns and those with LBW neonates. Methods: This cross-sectional study was conducted on the parents of 400 neonates selected by the proportional sampling technique in Isfahan, Iran. The participants were assigned into two groups of mothers including 200 subjects with LBW neonate and 200 cases with normal birth weight newborns. The data were collected using the Depression, Anxiety, and Stress Scale (DASS-42) developed by Lavibond and Lavibond in 1995 and the couple satisfaction index. Results: According to the results of the study, there was a significant difference between the two groups of mothers in terms of depression, stress, anxiety, age, medicine consumption, level of education, and marital satisfaction (p <0.001). However, the history of urinary tract infection was not significantly different between the two groups. Conclusion: As the findings of this study revealed, different aspects of maternal mental health can affect the pregnancy outcome through many pathways. Regarding this, the implementation of the interventions improving the maternal mental health might be useful in the reduction of the neonatal and pediatric mortality and morbidity.
https://jmrh.mums.ac.ir/article_8879_e8c6db0df83d59c7c56ce2a758cacb05.pdf
2017-07-01
935
941
10.22038/jmrh.2017.8879
Anxiety
Birth weight
Depression
Level of couple satisfaction
stress
Mohammad
Zare Neyestanak
1
PhD Student, Department of Psychology and Exceptional Children Training, Islamic Azad University, Science and Research Branch, Tehran, Iran
AUTHOR
Masoud
Gholamali Lavasani
lavasani@ut.ac.ir
2
Associate Professor, Department of Psychology and Training Sciences, Tehran University, Tehran, Iran
LEAD_AUTHOR
Gholamali
Afrooz
afrooz@ut.ac.ir
3
Professor, Department of Psychology and Training Sciences, Tehran University, Tehran, Iran
AUTHOR
World Health Organization. International statistical classification of diseases and related health problems. 10th ed. Geneva: World Health Organization; 2010.
1
Smith GC, Lees CC. Disorders of fetal growth and assessment of fetal well-being. 8th ed. New York: Dewhurst's Textbook of Obstetrics & Gynaecology; 2008. P. 200-207.
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Lucas AO, Stoll BJ, Bale JR. Improving birth outcomes: meeting the challenge in the developing world. Washington, DC: National Academies Press; 2003.
3
Vahdaninia M, Tavafian SS, Montazeri A. Correlates of low birth weight in term pregnancies: a retrospective study from Iran. BMC Pregnancy and Childbirth. 2008; 8(1):12.
4
Lawn JE, Cousens S, Zupan J, Lancet Neonatal Survival Steering Team. 4 millionneonatal deaths: when? Where? Why? The Lancet. 2005; 365(9462):891-900.
5
Talebian MH, Afrooz GA, Hooman HA, Aghaei A. The relationship between biological cognitive and psychosocial characteristics of parents and the weight of infant at the time of birthin Isfahan. Journal of Education and Health Promotion. 2013; 2:43.
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Wardlaw TM. Low birth weight: country, regional and global estimates. Geneva: UNICEF; 2004.
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Movahedi M, Haghdoost AA, Pournik O, Hajarizadeh B, Fallah MS. Temporal variations of health indicators in Iran comparing with other Eastern Mediterranean Region countries in the last two decades. Journal of Public Health. 2008; 30(4):499-504.
8
Jafari F, Eftekhar H, Pourreza A, Mousavi J. Socio-economic and medical determinants of low birthweight in Iran: 20 years after establishment of a primary healthcare network. Public Health. 2010; 124(3):153-158.
9
Bryce J, el Arifeen S, Pariyo G, Lanata CF, Gwatkin D, Habicht JP. Reducing child mortality: can public health deliver? The Lancet. 2003; 362(9378): 159-164.
10
Shin YH, Choi SJ, Kim KW, Yu J, Ahn KM, Kim HY, et al. Association between maternal characteristics and neonatal birth weight in a Korean population living in the Seoul metropolitan area, Korea: a birth cohort study (COCOA). Journal of Korean Medical Science. 2013; 28(4):580-585.
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12
Field T, Diego M, Hernandez‐Reif M, Schanberg S, Kuhn C, Yando R, et al. Pregnancy anxiety and comorbid depression and anger: effects on the fetus and neonate. Depression and Anxiety. 2003; 17(3):140-151.
13
Gracka-Tomaszewska M. Psychological factors during pregnancy correlated with infant low birth weigh. Pediatric Endocrinology, Diabetes, and Metabolism. 2009; 16(3):216-219.
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Faisal-Cury A, Araya R, Zugaib M, Menezes PR. Common mental disorders during pregnancy and adverse obstetric outcomes. Journal of Psychosomatic Obstetrics & Gynecology. 2010; 31(4):229-235.
15
Farahani M. The association of personality traits and marital satisfaction and determinants of dissatisfaction in married students of Tehran University Islamic Azad University. [Master Thesis]. Tehran, Iran: Tehran University Islamic Azad University; 2008.
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Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy. 1995; 33(3):335-343.
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Beck AT, Steer RA, Carbin MG. Psychometric properties of the beck depression inventory: twenty-five years of evaluation. Clinical Psychology Review. 1988; 8(1):77-100.
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Afzali A, Delavar A, Borjali A, Mirzamani M. Psychometric properties of DASS-42 as assessed in a sample of Kermanshah High School students. Journal of Research in Behavioral Sciences. 2007; 5(2):81-92. (Persian)
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Ghodrati-Ali A, Ghodrati M. Developing and normalization of Afrooz Marital Satisfaction Scale (AMSS) (short–form). Psychology & Educational Science. 2011; 41:1-9. (Persian)
21
Patel V, Prince M. Maternal psychological morbidity and low birth weight in India. The British Journal of Psychiatry. 2006; 188(3):284-285.
22
Chen CH, Lin HC. Prenatal care and adverse pregnancy outcomes among women with depression: a nationwide population-based study. The Canadian Journal of Psychiatry. 2011; 56(5):273-280.
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Huybrechts KF, Sanghani RS, Avorn J, Urato AC. Preterm birth and antidepressant medication use during pregnancy: a systematic review and meta-analysis. PLoS One. 2014; 9(3):e92778.
24
Larsson C, Sydsjö G, Josefsson A. Health, sociodemographic data, and pregnancy outcome in women with antepartum depressive symptoms. Obstetrics & Gynecology. 2004; 104(3):459-466.
25
Kinsella MT, Monk C. Impact of maternal stress, depression & anxiety on fetal neurobehavioral development. Clinical Obstetrics and Gynecology. 2009; 52(3):425.
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Miller RL, Pallant JF, Negri LM. Anxiety and stress in the postpartum: is there more to postnatal distress than depression? BMC Psychiatry. 2006; 6(1):12.
27
Patel V, Rahman A, Jacob K, Hughes M. Effect of maternal mental health on infant growth in low income countries: new evidence from South Asia. BMJ. 2004; 328(7443):820-823.
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Murray L, Cooper PJ. Effects of postnatal depression on infant development. Archives of Disease in Childhood. 1997; 77(2):99-101.
29
Rondo PH, Ferreira RF, Nogueira F, Ribeiro MC, Lobert H, Artes R. Maternal psychological stress and distress as predictors of low birth weight, prematurity and intrauterine growth retardation. European Journal of Clinical Nutrition. 2003; 57(2):266-272.
30
Kay R. Maternal Stress and Infant Outcomes: the impact of perinatal anxiety on pregnancy and delivery outcomes. [Master Thesis]. Michigan: University of Michigan; 2009.
31
Borders AE, Grobman WA, Amsden LB, Holl JL. Chronic stress and low birth weight neonates in a low-income population of women. Obstetrics & Gynecology. 2007; 109(2):331-338.
32
Andersson L, Sundström-Poromaa I, Wulff M, Åström M, Bixo M. Neonatal outcome following maternal antenatal depression and anxiety: a population-based study. American Journal of Epidemiology. 2004; 159(9):872-881.
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Berle JQ, Mykletun A, Daltveit AK, Rasmussen S, Holsten F, Dahl AA. Neonatal outcomes in offspring of women with anxiety and depression during pregnancy. Archives of Women’s Mental Health. 2005; 8(3):181-189.
34
Fallah MH, Afrouz GA, Heidari GA. Examining the factors effective on birth weight among babies of Yazd Province in 2007. Toloo-E-Behdasht. 2008; 7(3-4):57-64. (Persian)
35
Røsand GM, Slinning K, Eberhard-Gran M, Røysamb E, Tambs K. Partner relationship satisfaction and maternal emotional distress in early pregnancy. BMC Public Health. 2011; 11(1):161.
36
Witt WP, DeLeire T, Hagen EW, Wichmann MA, Wisk LE, Spear HA, et al. The prevalence and determinants of antepartum mental health problems among women in the USA: a nationally representative population-based study. Archives of Women's Mental Health. 2010; 13(5):425-437.
37
Tough SC, Newburn-Cook C, Johnston DW, Svenson LW, Rose S, Belik J. Delayed childbearing and its impact on population rate changes in lower birth weight, multiple birth, and preterm delivery. Pediatrics. 2002; 109(3):399-403.
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Tabcharoen C, Pinjaroen S, Suwanrath C, Krisanapan O. Pregnancy outcome after age 40 and risk of low birth weight. Journal of Obstetrics and Gynaecology. 2009; 29(5):378-383.
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de Souza Buriol VC, Hirakata V, Goldani MZ, da Silva CH. Temporal evolution of the risk factors associated with low birth weight rates in Brazilian capitals (1996-2011). Population Health Metrics. 2016; 14(1):15.
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Silva AA, Silva LM, Barbieri MA, Bettiol H, Carvalho LM, Ribeiro VS, et al. The epidemiologic paradox of low birth weight in Brazil. Revista de Saúde Pública. 2010; 44(5):767-775.
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Chevalier A, O'Sullivan V. Mother's education and birth weight. London: University College London; 2007.
42
Matin A, Azimul S, Matiur AK, Shamianaz S, Shabnam JH, Islam T. Maternal socioeconomic and nutritional determinants of low birth weight in urban area of Bangladesh. Journal of Dhaka Medical College. 2008; 17(2):83-87.
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Eghbalian F. Low birth weight causes survey in neonates. Iranian Journal of Pediatrics. 2007;17(Suppl 1):27-33.
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Dimetry SR, El-Tokhy HM, Abdo NM, Ebrahim MA, Eissa M. Urinary tract infection and adverse outcome of pregnancy. The Journal Of The Egyptian Public Health Association. 2007; 82(3-4):203-218.
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Rafati S, Borna H, Akhavirad MB, Fallah N. Maternal determinants of giving birth to low-birth-weight neonates. Archives of Iranian Medicine. 2005; 8(4):277-281.
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Chen YK, Chen SF, Li HC, Lin HC. No increased risk of adverse pregnancy outcomes in women with urinary tract infections: a nationwide population-based study. Acta Obstetricia et Gynecologica Scandinavica. 2010; 89(7):882-888.
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Buist A, Morse CA, Durkin S. Men's adjustment to fatherhood: implications for obstetric health care. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2003; 32(2):172-180.
48
Rwakarema M, Premji SS, Nyanza EC, Riziki P, Palacios-Derflingher L. Antenatal depression is associated with pregnancy-related anxiety, partner relations, and wealth in women in Northern Tanzania: a cross-sectional study. BMC Women's Health. 2015; 15(1):68.
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Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR. Prevalence of depression during pregnancy: systematic review. Obstetrics & Gynecology. 2004; 103(4):698-709.
50
Ding XX, Wu YL, Xu SJ, Zhu RP, Jia XM, Zhang SF, et al. Maternal anxiety during pregnancy and adverse birth outcomes: a systematic review and meta-analysis of prospective cohort studies. Journal of Affective Disorders. 2014; 159:103-110.
51
ORIGINAL_ARTICLE
The Frequency of Risk Factors Associated with Pregnancy among Women Seeking Planned Pregnancy
Background & aim: Pre-pregnancy period is like a window of hope during which the doctors and midwives can help the mothers to solve or adjust the problems needing special care before pregnancy. Therefore, this study was carried out to determine the risk factors for pregnancy health among the females seeking planned pregnancy. Methods: This descriptive study was conducted on 350 females of childbearing age who referred to health centers of Mashhad, Iran to receive preconception care in 2013. The sampling was performed using the multistage sampling technique. The data were collected by a researcher-made questionnaire enquiring the patients’ demographic and obstetric data. Data analysis was performed through the SPSS version 16 using mean and standard deviation (for quantitative variables), frequency (for qualitative variables), and Chi-square test (to assess the relationship between the variables). P-value less than 0.05 was considered statistically significant. Results: According to the results, the age of 2% and 4.9% of the participants were < 18 and > 35 years, respectively. The most frequent risk factors for pregnancy health were related to gestational diabetes (32%), preeclampsia (22%), abortion (19.1%), history of vaginal bleeding in the second half of pregnancy, and preterm delivery (13%). In addition, the most frequent underlying diseases were diabetes mellitus (22%), thyroid disorders (22%), heart disease, as well as asthma and allergies (13%). Conclusion: As the findings of the present study indicated, most of the risk factors in the pre-pregnancy period were related to diabetes mellitus and gestational diabetes.
https://jmrh.mums.ac.ir/article_8736_859cf962646362efc206dc3dd8917b3c.pdf
2017-07-01
942
949
10.22038/jmrh.2017.8736
Planned pregnancy
Preconception care
Risk factors
Women
Fatemeh
Ghaffari Sardasht
ghaffarif891@gmail.com
1
PhD Student of Reproductive Health, Department of Midwifery, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
LEAD_AUTHOR
Nahid
Jahani Shourab
jahaninsh@mums.ac.ir
2
PhD student of Reproductive Health, Department of Midwifery, School of Nursing & Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Farzaneh
Jafarnejad
3
Lecturer, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Hibibollah
Esmaily
4
Associate Professor, Department of Biostatistics and Epidemiology, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Hafez S, Dorgham LS, Sayed SA.Profile of high risk pregnancy among Saudi women in Taif–Kingdom of Saudi Araba. World Journal of Medical Sciences. 2014; 11(1):90-97.
1
Azizi A. The prevalence of the causes of high-risk pregnancies in pregnant women of Sonqor city, 2011. The Iranian Journal of Obstetrics Gynecology and Infertility. 2015; 18(153):10-19 (Persian).
2
Hekari D, Mohammadzadeh R, Velayati A, Boloorian M. Barriers of receipt of prenatal care and its relationship to pregnancy outcome among women visited to Tabriz hospitals in 2009. Medical Sciences. 2011; 21(3):206-213 (Persian).
3
Safari M, Yazdanpanah B, Yazdanpanah S. High risk pregnancy and some of related factors in women who referred to Vasouj Health and Medical Centers. Scientific Journal of Hamadan Nursing & Midwifery Faculty. 2008; 16(2):18-28 (Persian).
4
Dean SV, Lassi ZS, Imam AM, Bhutta ZA. Preconception care: promoting reproductive planning. Reproductive Health. 2014; 11(3):S2.
5
Nasehi MM, Moosazadeh M, Amiresmaeili M, Zakizadeh R, Mirzajani M. Prevalence of five main risk factors of non-communicable diseases in Mazandaran province: a population based study. Journal of Mazandaran University of Medical Science. 2012; 22(86):193-202 (Persian).
6
Asgari F, Aghajani H, Haghazali M, Heidarian H. Non-communicable diseases risk factors surveillance in Iran. Iranian Journal of Public Health. 2009; 38(1):119-122.
7
World Health Organization. Preconception care to reduce maternal and childhood mortality and morbidity. Geneva: World Health orga-nization; 2012.
8
Mumford S, Michels K, Salaria N, Valanzasca P, Belizan JM. Preconception care: it’s never too early. Reproductive Health. 2014; 11(1):73-76.
9
Atrash H, Jack BW, Johnson K. Preconception care: a 2008 update. Current Opinion in Obstetrics and Gynecology. 2008; 20(6):581-589.
10
Bialystok L, Poole N, Greaves L. Preconception care, call for national guidelines. Canadian Family Physician. 2013; 59(10):1037-1039.
11
Merghati Khuiee E, Adab Z, Vahedi F, Farajvand N, Afzalinia T, Rahmanpour L. Compare the checklist and guideline of preconception care between Iran and some developed countries. Iranian Journal of Behdad. 2011; 3(10):33-35.
12
Dean S, Rudan I, Althabe F, Girard AW, Howson C, Langer A, et al. Setting research priorities for preconception care in low-and middle-income countries: aiming to reduce maternal and child mortality and morbidity. PLOS Medicine. 2013; 10(9):e1001508.
13
Anderson JE, Ebrahim S, Floyd L, Atrash H. Prevalence of risk factors for adverse pregnancy outcomes during pregnancy and the preconception period-United States, 2002–2004. Maternal and Child Health Journal. 2006; 10(1):101-106.
14
Ghaffari Sardasht F. The assessment of quality of preconception care provided to reproductive age’s women in health centers of Mashhad in 2012. [Master Thesis]. Mashhad, Iran: School of Nursing and Midwifery, University of Medical Sciences; 2012 (Persian).
15
Keshavarzi F, Rezaie M, Iranfar S, Fakheri T, Nankeli A, Imani A. The relationship between increases of maternal age with pregnancy outcome. Journal of Kermanshah University of Medical Sciences. 2011; 15(3):193-199 (Persian).
16
Rezavand N, Zangane M, Malek Khosravi SH, Rezaee M. A comparative study of pregnancy results in adolescents and young mothers referred to the Motazedi Hospital in Kermanshah. Journal of Urmia Nursing and Midwifery Faculty. 2009; 7(3):136-141 (Persian).
17
Aghamohammadi A, Nooritajer M, Kheyrkhah M, Hoseyni AF. Comparative Study of the pregnancy outcomes in nulliparous women over and under age 35. Iranian Journal of Nursing. 2010; 23(63):69-77.
18
Dunlop AL, Logue KM, Thorne C, Badal HJ. Change in women’s knowledge of general and personal preconception health risks following targeted brief counseling in publicly funded primary care settings. American Journal of Health Promotion. 2013; 27(3 Suppl):S50-S57.
19
Aghasiyazdi Z, Ghazavi H, Ahadi M, Behzadmehr A. Assessment of preconception care and screening high risk women in order to get pregnant in healthcare centers of medical sciences university of Mashhad in 2009 and 2010. In: 2nd Iranian Congress of Health Promotion of Newborn, Mashhad, Iran; 2013.
20
ORIGINAL_ARTICLE
The Relationship between Contraceptive Use and Unintended Pregnancies among Married Women in Thatta District, Pakistan
Background & aim: The rate of unintended pregnancy has decreased from 24% to 16% in the last four to five years in Pakistan. However, this rate stills varies among the women living in the rural and urban areas of Pakistan. The females residing in the rural areas are less likely to have many contraceptive choices and receive no/low-quality family planning services; as a result, they end up with birth control failure and unintended pregnancy. Regarding this, more studies are needed to investigate the association between the unintended pregnancy and contraceptive use, particularly in the rural areas of Pakistan.Therefore, the aim of the present study was to determine the relationship between contraceptive use and unintended pregnancy among the women at reproductive age living in Thatta district, Sindh, Pakistan. Methods:This nested case-control study was conducted on the women living in Thatta district during June 2011-July 2012. The pregnant women who did not want more children were considered as cases, and those who intended to have more children were considered as controls. The categorical and continuous variables were analyzed using the Chi-square test and independent t-tests, respectively. Results: According o the results of the present study, the use of contraceptive methods was significantly associated with increased risk of unintended pregnancy among the women living in Thatta district [OR: 2.77 (1.46-5.25)]. Moreover, there was 14% increased risk of unintended pregnancy with one year increase in the age of the women [OR: 1.14 (1.10-1.19)]. The age at marriage showed negative association with unintended pregnancy [OR: 0.92 (0.87-0.97)]. The women having at least one son (alive) were almost three times more likely to report their recent pregnancies as unintended, compared to those with no living son [OR: 2.97 (1.82-4.84)]. In addition, the husband’s education and their opposition with the use of family planning methods [OR 2.16 (1.06-4.39)] were found to be associated with unintended pregnancy. Conclusion: As the findings of the present study indicted, the unintended pregnancy is likely to occur when the women have achieved their desired family size as evidenced by the higher mean age and presence of at least one living son. We recommend to improve the quality of care and family planning services to deal with issues of birth control failure by taking such measures as the provision of emergency contraception and support.
https://jmrh.mums.ac.ir/article_8400_ada65665d3df665f3f667f5cb4372092.pdf
2017-07-01
950
957
10.22038/jmrh.2017.8400
Contraceptive usage
Pakistan
Unintended pregnancy
Sumera
Ali
sumera.ali@aku.edu
1
Aga Khan University Department of Community Health Sciences, Karachi, Pakistan
LEAD_AUTHOR
Farina
Abrejo
farina.abrejo@aku.edu
2
Aga Khan University Department of Community Health Sciences, Karachi, Pakistan
AUTHOR
Haub C. World population trends. World population data sheet 2012. Population refernce Bureau. Available at: URL: http://www.prb.org/Publica tions/Datasheets/2012/world-population-data-sheet/fact-sheets.aspx; 2012.
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Ahmed T, Ali SM, Aliaga A, Arnold F, Ayub M, Bhatti MH, et al. Pakistan demographic and health survey. Islamabad, Pakistan: National Institute of Population Studies; 2012. P. 9-13.
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Family planning/contraception. World Health Organization. Available at: URL: http://www.who. int/mediacentre/factsheets/fs351/en/index.html; 2016.
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UNICEF_SOWC--Special Edition on Children's Rights. The State of the World’s Children. Available at: URL: http://data.un.org/Data.aspx?d=SOW C&f=inID%3A34; 2011.
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Curtis S, Evens E, Sambisa W. Contraceptive discontinuation and unintended pregnancy: an imperfect relationship. International Perspectives on Sexual and Reproductive Health. 2011; 37(2):58.
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10
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12
Ali SA, Saleem S, Sami N, Shabbar M, Ahmed M, Rozi S, et al. Geographic access to working family planning centers and unintended pregnancies among married women: a community based nested case control study. Open Journal of Epidemiology. 2016; 6(1):95.
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Population welfare department. Government of Sindh, Pakistan. Available at: URL: http://www.pw dsindh.gov.pk/pwd/Districts/Thatta/DistrictProfile/tabid/150/Default.aspxdsindh.gov.pk/pwd/Districts/Thatta/DistrictProfile/tabid/150/Default.aspx; 2012.
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Stephenson R, Hennink M. Barriers to family planning use amongst the urban poor in Pakistan. Southampton, UK: University of Southampton, School of Social Sciences; 2004.
16
Lemeshow S, Sturdivant RX, Hosmer DW. Applied logistic regression (Wiley Series in probability and statistics). New York: Wiley; 2013.
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Islam MM, Rashid M. Determinants of unintended pregnancy among ever-married women in Bangladesh. Journal of Family Welfare. 2005; 50(2):40.
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Winner B, Peipert JF, Zhao Q, Buckel C, Madden T, Allsworth JE, et al. Effectiveness of long-acting reversible contraception. New England Journal of Medicine. 2012; 366(21):1998-2007.
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24
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25
ORIGINAL_ARTICLE
Integration of Gender-sensitive Approach to Safe Motherhood Program for the Prevention of STD/ HIV in Iran: A Qualitative Study
Background & aim: Sexually transmitted infections (STIs) present a serious public health burden, which are considered as the factors contributing to acute illnesses, infertility, long-term disability, and mortality. The aim of the present study was to provide an in-depth understanding of the participants' perceptions about the integration of gender-sensitive approach to safe motherhood program for the prevention of STIs/human immunodeficiency virus (HIV) in Iran. Methods: This qualitative exploratory study was conducted on 32 male and female key informants, including health managers, health policy makers, and reproductive health providers. The participants were selected through the purposive sampling method, followed by the snowball sampling technique. The data collection was performed using the semi-structured interviews. The data were analyzed through the content analysis. Results: Based on the results, the participants’ perceptions were categorized into two categories, namely the STIs/HIV prevention among males in safe motherhood and gender-sensitivity in primary maternal STIs/HIV prevention. Each of the patients was further divided into codes. The first category includes accountability to men's own sexual health needs’ and prevention of ill-health effects of men on women’s STIs/HIV status and the second category includes (1) condom negotiation skills in women (2) mandatory pre-marital HIV test policy, (3) partner notification guidelines, (4) STI/HIV risk assessment in safe motherhood services, and (5) women’s right-based instruction for prenatal HIV screening in private services. Conclusion: As the findings of the present study indicated, the health policy makers were not adequately sensitive to gender sensitivity, which is particularly crucial for STIs/HIV prevention in the safe motherhood programs.
https://jmrh.mums.ac.ir/article_8929_85d5fa59bb342cefb29404b4349a0c7e.pdf
2017-07-01
958
968
10.22038/jmrh.2017.8929
Gender-sensitivity
Reproductive health
Women's rights
Fatemeh
Rahmanian
azarabad0074@gmail.com
1
Assistant professor, Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Science, Shiraz, Iran
AUTHOR
Masoomeh
Simbar
msimbar@gmail.com
2
Professor, Midwifery and Reproductive Health Research Center (MRHRC), Shahid Beheshti University of Medical Science, Tehran, Iran
LEAD_AUTHOR
Ali
Ramezankhan
3
Associate Professor, Department of Public Health, Faculty of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
AUTHOR
Farid
Zayeri
fzayeri@yahoo.com
4
Associate Professor, Department of Biostatistics, Faculty of Paramedicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
AUTHOR
Miners A, Llewellyn C, Pollard A, Lagarde M, Richardson D, Cairns J, et al. Assessing user preferences for sexually transmitted infection testing services: a discrete choice experiment. Sexually Transmitted Infections. 2012; 88(7):510-516.
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Health Protection Surveillance Centre. Surveillance of STIs: a report by the sexually transmitted infections subcommittee for the scientific advisory committee of the health protection surveillance centre. Available at: URL: http://www.hpsc.ie/ hpsc/AboutHPSC/ScientificCommittees/Publications/File,1437,en.pdf; 2016.
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World Health Organization. Strategies and laboratory methods for strengthening sur-veillance of sexually transmitted infections. Geneva: World Health organization; 2012.
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World Health Organization. HIV in pregnancy: a review. Geneva: World Health Organization; 1999. P. 66.
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Farhoudi B, Kamali K, Rajabpoor Z. Situation analysis of sexually transmitted infections in the Islamic Republic of Iran. Tehran: Ministry of Health and Medical Education; 2008. P. 54-57.
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Safari R, Shahesmaeili R, Nasirian M, Khajeh Kazemi R, Sharifi H, Hoseini Hoshyar S. Systematic review of Iraninan studies on sexually transmitted disease. Kerman: Kerman University of Medical Sciences; 2014.
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Nasirian M, Haghjou L, Mounesan L, Kamal K, Haghdoost AA. Sexually transmitted disease surveillance status in iran from the viewpoint of involved experts and practitioners. Journal of Health and Development. 2015; 4(3):259-276.
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Ministry of Health and Medical Education (MOHME). National AIDS Committee Secretariat. Islamic Republic of Iran AَIDS progress report. Tehran: MOHME; 2011.
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Ministry of Health and Medical Education Center for disease Control HIV/STI Office. Situation analysis of sexually transmitted infections in the Islamic Republic of Iran. Tehran: MOHME; 2008.
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Cook R. Advancing safe motherhood through human rights. Journal SOGC. 1999; 21(4):363-368.
11
Davis J, Luchters S, Holmes W. Men and maternal and newborn health: benefits, harms, challenges and potential strategies for engaging men. Melbourne, Australia: Compass: Women’s and Children’s Health Knowledge Hub; 2012.
12
Moderators DG, Nandraj S, Khot A. Solution Exchange for the Maternal and Child Health Community E-Discussion Summary. India: Solution Exchange; 2007.
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Pealer LN, Peterman TA, Newman DR, Kamb ML, Dillon B, Malotte CK, et al. Are counselor demographics associated with successful human immunodeficiency virus/sexually transmitted disease prevention counseling? Sexually Transmitted Diseases. 2004; 31(1):52-56.
14
Toole MJ, Coghlan B, Xeuatvongsa A, Holmes WR, Pheualavong S, Chanlivong N. Understanding male sexual behaviour in planning HIV prevention programmes: lessons from Laos, a low prevalence country. Sexually Transmitted Infections. 2006; 82(2):135-138.
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Holmes W, Otto B. Towards greater involvement of men in pregnancy, childbirth, postpartum care and infant care: knowledge, attitudes, beliefs and practices in Bali, Indonesia. Melbourne: Burnet Institute; 2009.
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Spensley A, Sripipatana T, Turner AN, Hoblitzelle C, Robinson J, Wilfert C. Preventing mother-to-child transmission of HIV in resource-limited settings: the Elizabeth Glaser Pediatric AIDS Foundation experience. American Journal of Public Health. 2009; 99(4):631-637.
17
Ehrhardt AA, Exner TM, Hoffman S, Silberman I, Leu CS, Miller S, et al. A gender-specific HIV/STD risk reduction intervention for women in a health care setting: short- and long-term results of a randomized clinical trial. AIDS Care. 2002; 14(2):147-161.
18
Ehrhardt AA, Exner TM, Hoffman S, Silberman I, Yingling S, Adams-Skinner J, et al. HIV/STD risk and sexual strategies among women family planning clients in New York: Project FIO. AIDS and Behavior. 2002; 6(1):1-13.
19
Ortiz-Torres B, Williams SP, Ehrhardt AA. Urban women's gender scripts: Implications for HIV prevention. Culture, Health & Sexuality. 2003; 5(1):1-17.
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Newmann S, Sarin P, Kumarasamy N, Amalraj E, Rogers M, Madhivanan P, et al. Marriage, monogamy and HIV: a profile of HIV-infected women in south India. International Journal of STD & AIDS. 2000; 11(4):250-253.
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Abraham L, Kumar KA. Sexual experiences and their correlates among college students in Mumbai City, India. International Family Planning Perspectives. 1999; 25(3):139-152.
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Shepard BL. Addressing gender issues with men and couples: Involving men in sexual and reproductive health services in APROFE, Ecuador. International Journal of Men's Health. 2004; 3(3):155.
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Burnet Institute. East New Britain study of male involvement in reproductive, maternal and child health. Available at:URL: www.teampata.org; 2017.
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Mullick S, Kunene B, Wanjiru M. Involving men in maternity care: health service delivery issues. Agenda Special Focus. 2005; 6:124-135.
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Story WT, Burgard SA, Lori JR, Taleb F, Ali NA, Hoque DM. Husbands' involvement in delivery care utilization in rural Bangladesh: a qualitative study. BMC Pregnancy and Childbirth. 2012; 12(1):28.
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Reece M, Hollub A, Nangami M, Lane K. Assessing male spousal engagement with prevention of mother-to-child transmission (pMTCT) programs in western Kenya. AIDS Care. 2010; 22(6):743-750.
28
Mullany BC. Barriers to and attitudes towards promoting husbands' involvement in maternal health in Katmandu, Nepal. Social Science & Medicine. 2006; 62(11):2798-2809.
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Mize SJ, Robinson BE, Bockting WO, Scheltema KE. Meta-analysis of the effectiveness of HIV prevention interventions for women. AIDS Care. 2002; 14(2):163-180.
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Chimbiri AM. The condom is an 'intruder' in marriage: evidence from rural Malawi. Social Science & Medicine. 2007; 64(5):1102-1115.
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Bauni EK, Jarabi BO. The low acceptability and use of condoms within marriage: evidence from Nakuru district, Kenya. African Population Studies. 2003; 18(1):51-65.
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Alrajhi AA. Premarital HIV screening in Saudi Arabia, is antenatal next? Journal of Infection and Public Health. 2009; 2(1):4-6.
33
Alrajhi AA, Halim MA, Al-Abdely HM. Mode of transmission of HIV-1 in Saudi Arabia. AIDS. 2004; 18(10):1478-1480.
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Clark JL, Long CM, Giron JM, Cuadros JA, Caceres CF, Coates TJ, et al. Partner notification for sexually transmitted diseases in Peru: knowledge, attitudes, and practices in a high-risk community. Sexually Transmitted Diseases. 2007; 34(5):309-313.
35
Wakasiaka SN, Bwayo JJ, Weston K, Mbithi J, Ogol C. Partner notification in the management of sexually transmitted infections in Nairobi, Kenya. East African Medical Journal. 2003; 80(12):646-651.
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Klisch SA, Mamary E, Diaz Olavarrieta C, Garcia SG. Patient-led partner notification for syphilis: Strategies used by women accessing antenatal care in urban Bolivia. Social Science & Medicine. 2007; 65(6):1124-1135.
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Woodstock Striley C, Margavio C, Cottler LB. Gender and race matching preferences for HIV post-test counselling in an African-American sample. AIDS Care. 2006; 18(1):49-53.
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Adeoye-Agboola DI, Evans H, Hewson D, Pappas Y. Factors influencing HIV disclosure among people living with HIV/AIDS in Nigeria: a systematic review using narrative synthesis and meta-analysis. Public Health. 2016; 136:13-28.
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Greig A, Peacock D, Jewkes R, Msimang S. Gender and AIDS: time to act. AIDS (London, England). 2008; 22(Suppl 2):S35-S43.
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Were E, Curran K, Delany-Moretlwe S, Nakku-Joloba E, Mugo NR, Kiarie J, et al. A prospective study of frequency and correlates of intimate partner violence among African heterosexual HIV serodiscordant couples. AIDS (London, England). 2011; 25(16):2009-2018.
42
ORIGINAL_ARTICLE
The Relationship between Sexual Self-concept and Sexual Function in Women of Reproductive Age Referred to Health Centers in Gorgan, North East of Iran
Background & aim: The preservation and enhancement of the sexual function are the key elements of sexual health. One of the most important predictive factors of sexual behavior and function is sexual self-concept. This construct is defined as the individuals’ understanding and evaluation of their own sexual desires and orientations. The aim of the present study was to determine the correlation between the dimensions of sexual self-concept and sexual function in the women of reproductive age. Methods: This correlational descriptive study was conducted on 79 married women of reproductive age referred to the health centers in Gorgan, Iran. The sample size was determined using the sample size formula with a power of 90% and a confidence interval of 95%. The data collection tools included the Persian multidimensional sexual self-concept questionnaire included 23 items covering five dimensions (i.e., sexual anxiety, sexual fear, sexual self-efficacy, sexual self-esteem, and sexual satisfaction) and the Persian Female Sexual Function Index consisted of 19 items in six dimensions. Data analysis was performed using the Mann-Whitney U test and Spearman's rank correlation coefficient through the SPSS software (version 16). Results: The Spearman correlation test revealed a significant direct correlation between the sexual self-esteem and the positive dimensions of sexual function, including desire (P=0.002, r=0.3), arousal (p <0.0001, r=0.4), lubrication (p <0.0001, r=0.4), orgasm (p <0.0001, r=0.4), and satisfaction (P=0.002, r=0.3). Likewise, the sexual self-concept had a significant direct correlation with the positive dimensions of sexual function (p <0.0001, r=0.4). Furthermore, this variable had a significant indirect correlation with the negative dimension of sexual function (i.e., pain) (p <0.0001, r=-0.4). There was a significant indirect correlation between the sexual anxiety and the positive dimensions of sexual function (p <0.0001, r=-0.4). Additionally, a direct correlation was observed between the sexual anxiety and sexual pain (p <0.0001, r=0.4). Conclusion: The enhancement of the positive dimensions of the sexual self-concept (i.e., self-esteem and sexual satisfaction) and reduction of its negative dimensions (i.e., sexual anxiety) could strengthen the positive sexual function in the women of reproductive age. The findings of the present study can be useful in designing the sexual counseling methods, preserving or enhancing the sexual health and function, and consequently improving the stability of the family system.
https://jmrh.mums.ac.ir/article_8744_7cda1f4464ae5ac19432ce7ef66cdb7c.pdf
2017-07-01
969
977
10.22038/jmrh.2017.8744
Gorgan
Reproductive-aged women
Sexual function
Sexual self-concept
Tayebe
Ziaei
tayebe.ziaee@yahoo.com
1
Assistant Professor, Counseling and Reproductive Health Research Centre, Golestan University of Medical Sciences, Gorgan, Iran
AUTHOR
Halimeh
Farahmand Rad
farahmand.rad@gmail.com
2
MSc in Counseling in Midwifery, Counseling and Reproductive Health Research Centre, Golestan University of Medical Sciences, Gorgan, Iran
LEAD_AUTHOR
Masoumeh
Rezaei Aval
3
MSc in Clinical Psychology, Counseling and Reproductive Health Research Centre, Golestan University of Medical Sciences, Gorgan, Iran
AUTHOR
Gholamreza
Roshandel
roshandel_md@yahoo.com
4
Assistant Professor, Gastroenterology and Hepatology Research Center, Golestan University of Medical Sciences, Gorgan, Iran
AUTHOR
Aggleton P, de Wit J, Myers T, Du Mont J. New outcomes for sexual health promotion. Health Education Research. 2014; 29(4):547-553.
1
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3
World Health Organization. Developing sexual health programmes: a framework for action. Geneva: World Health Organization; 2010.
4
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Crisp C, Vaccaro C, Fellner A, Kleeman S, Pauls R. The influence of personality and coping on female sexual function: a population survey. The Journal of Sexual Medicine. 2015; 12(1):109-115.
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Mueller K, Rehman US, Fallis EE, Goodnight JA. An interpersonal investigation of sexual self-schemas. Archives of Sexual Behavior. 2016; 45(2):281-290.
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Stanton AM, Boyd RL, Pulverman CS, Meston CM. Determining women's sexual self-schemas through advanced computerized text analysis. Child Abuse & Neglect. 2015; 46:78-88.
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Hsu HY, Yu HY, Lou JH, Eng CJ. Relationships among sexual self‐concept and sexual risk cognition toward sexual self‐efficacy in adolescents: Cause‐and‐effect model testing. Japan Journal of Nursing Science. 2015; 12(2):124-134.
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Rellini AH, Meston CM. Sexual self-schemas, sexual dysfunction, and the sexual responses of women with a history of childhood sexual abuse. Archives of Sexual Behavior. 2011; 40(2): 351-362.
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Stephenson KR, Meston CM. Why is impaired sexual function distressing to women? The primacy of pleasure in female sexual dysfunction. The Journal of Sexual Medicine. 2015; 12(3):728-737.
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Winter L. The role of sexual self-concept in the use of contraceptives. Family Planning Perspectives. 1988; 20(3):123-127.
22
Rostamkhani F, Ozgoli G, Khoei EM, Jafari F, Majd HA. Effectiveness of the PLISSIT-based Counseling on sexual function of women. Journal of Shahid Beheshti School of Nursing & Midwifery. 2012; 22(76):9-1 (Persian).
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Ziaei T, Khoei EM, Salehi M, Farajzadegan Z. Psychometric properties of the Farsi version of modified Multidimensional Sexual Self-concept Questionnaire. Iranian Journal of Nursing and Midwifery Research. 2013; 18(6):439.
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Mohammadi KH, Heydari M, Faghihzadeh S. The female sexual function index (FSFI): validation of the Iranian version. Payesh. 2008; 7(3):269-278 (Persian).
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Rosen C, Brown J, Heiman S, Leiblum C, Meston R, Shabsigh D, et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. Journal of Sex & Marital Therapy. 2000; 26(2):191-208.
26
Rowland DL, Adamski BA, Neal CJ, Myers AL, Burnett AL. Self-efficacy as a relevant construct in understanding sexual response and dysfunction. Journal of Sex & Marital Therapy. 2015; 41(1): 60-71.
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Woodard TL, Diamond MP. Physiologic measures of sexual function in women: a review. Fertility and Sterility. 2009; 92(1):19-34.
28
Woertman L, van den Brink F. Body image and female sexual functioning and behavior: a review. Journal of Sex Research. 2012; 49(2-3):184-211.
29
Hucker A, Mussap AJ, McCabe MM. Self-concept clarity and women's sexual well-being. Canadian Journal of Human Sexuality. 2010; 19(3):67-77.
30
Zhang H, Yip PS. Female sexual dysfunction among young and middle‐aged women in Hong Kong: prevalence and risk factors. The Journal of Sexual Medicine. 2012; 9(11):2911-2918.
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Impett EA, Tolman DL. Late adolescent girls’ sexual experiences and sexual satisfaction. Journal of Adolescent Research. 2006; 21(6):628-646.
32
Sweeney KK, Horne SG, Ketz K. Sexual orientation, body image, and age as predictors of sexual self-schema for women with physical disabilities. Sexuality and Disability. 2015; 33(3):313-326.
33
ORIGINAL_ARTICLE
Knowledge and Attitude of Midwifery Students towards Observing the Ethical and Legal Standards of Patients' Rights
Background & aim: In the midwifery profession, observing legal and ethical issues in professional practices should be emphasized. Legal and ethical advancements in the realm of midwifery have raised the need for midwives’ awareness as to patient rights. This study was performed to evaluate midwifery students’ knowledge and attitude towards observing the ethical and legal standards of patient rights in 2015. Methods: This descriptive study was conducted on 85 midwifery students in the 5th and 7th semesters of Bachelor of Midwifery program, the 1st and 3rd semesters of Master of Midwifery program, and 1st and 3rd semesters of Counselling in Midwifery master’s program at Mashhad University of Medical Sciences. Data collection tool was a researcher-made questionnaire consisting of three domains of demographics, knowledge (30 questions), and attitude (35 items) towards observing the legal and ethical standards of patient rights. To analyze the data, descriptive statistics, analysis of variance, Student’s t-test, and correlation coefficient tests were used in SPSS, version 16. Results: The means of overall knowledge and attitude towards ethical and legal standards were 17.55±3.15 (moderate knowledge) and 145.40±12.33 (good attitude), respectively. No significant association was found between knowledge score of the subjects and observing the patient rights and midwifery ethical codes (p <0.05). Conclusion: Most students had good attitude, but moderate knowledge about ethical and legal standards of patient rights. Given the importance of observing these principles in providing obstetric care, we recommend holding workshops on this issue.
https://jmrh.mums.ac.ir/article_8888_6357f79549160bb6109964774923e9f5.pdf
2017-07-01
978
987
10.22038/jmrh.2017.8888
Attitude
Ethical and legal standards
Knowledge
Midwifery students
Patient rights
Sedigheh
Yousefzadeh
yousefzadeh@mums.ac.ir
1
Lecturer, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Momeneh
Zohani
zohanim921@mums.ac.ir
2
MSc in Midwifery ,Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
Seyyed Reza
Mazloom
3
a) Lecturer, Evidence-Based Caring research center, Mashhad University of Medical Sciences, Mashhad, Iran b) Department of Medical Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Mohammad Gafar
Feyzabadi
4
Lecturer, Department of Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Hatami H. The principles of patients’ rights in traditional medicine resources. Medical Law. 2011; 5(16):11-38 (Persian).
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Yousefzadeh S, Kordi M, Mazlom SR, Tara F. The survey of midwives’ knowledge, attitude and practice about professional ethics codes in the maternity of Mashhad educational hospitals in 2014. The Iranian Journal of Obstetrics Gynecology and Infertility. 2016; 18(173):23-31 (Persian).
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Madhivanan P, Krupp K, Kulkarni V, Kulkarni S, Vaidya N, Shaheen R, et al. HIV testing among pregnant women living with HIV in India: are private healthcare providers routinely violating women’s human rights? BMC International Health and Human Rights. 2014; 14(1):7.
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Azimi N, Tadayon Najafabadi M, Ziagham S, Kiani M. Knowledge of students of medical science schools about retributive legal midwifery in field of medicine, Ahvaz Jundishapur University in 2013. The International Journal of Frontier Missiology. 2014; 19(2):313-319.
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21
Jahanpour F, Sedighi Z, Azodi P. Assessing nurses› knowledge, attitude and practice about professional legal. Quarterly Journal of Nersing Management. 2013; 1(4):54-60.
22
Ghadipasha M, Bashardoost N, Ghodoosi A, Samadirad B, Nikian Y, Roohparvar R. Knowledge level of gynecologists and midwives of Yazd concerning rules and regulations of therapeutic abortion (legal) and criminal abortion. Journal of Shahid Sadoughi University of Medical Sciences. 2011; 19(2):141-147.
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Shah Hosseini Z, Rashidi S, Abedi K. Knowledge of legal rules and drug midwives in midwifery. Journal of Legal Medicine. 2006; 11(3):154-157.
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Banaeian SH, Sereshti M. Knowledge of midwives, from Chaharmahal and Bakhtiary province to ward midwifery legal and religious commandments and some of the relevant factors in 2006. Shahrekord Uuniversity of Medical Sciences Journal. 2007; 9(3):37-44.
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Ranjbar M, Dehghani A. Students’ awareness of patients’ right in teaching hospitals of Yazd. Iranian Journal of Medical Ethics and History of Medicine. 2010; 3:51-60.
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Vahedian Azimi M, Ghasem Kashani A, Avazeh S, Sepehri Nia A, Rohani M. Awareness of nurses about patients’ rights and the extent they respect it. Preventive Care In Nursing & Midwifery Journal. 2011; 1(1):55-63.
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Bahrani F, Farzin M, Nozari L. Shiraz dentists’ knowledge of professional ethics. Iranian Journal of Medical Ethics and History of Medicine. 2012; 5(6):69-80.
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Negarandeh R, Ghobadi S. The knowledge and attitudes of nurses and midwives in hospitals in city of Zanjan on ethical issues 2001. Journal of Zanjan University of Medical Science & Health Services. 2001; 9(36):55-59.
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Hafiei F, Farhadie F, Taheri SA, Samoee R, Piraste A. Nurses' awareness about the regulations considering guild and vocational violations of staff affiliated to medical sciences careers. Health Information Management. 2013; 9(7):1152-1157.
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Amiri M, Afkar A. As providers of health services of patients' rights in hospitals anymore University of Medical Sciences. Health Management. 2009; 1(2):47-54 (Persian).
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Parsapoor A, Mohammad K, Malekafzali H, Alaeddini F, Larijani B. The necessity of observing patients' right: surveying patients', physicians' and nurses' attitudes around it. Iranian Journal of Medical Ethics and History of Medicine. 2009; 2(4):79-90.
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Motamed JM, Dehghani SL. Students' Attitudes toward principles of medical ethics and matching them with Islamic ethics in Kerman university of medical sciences. Journal of Babol University Of Medical Sciences. 2014; 16(7):29-35.
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Mokhtari Lakeh N, Nafar M, Ghanbari Khanghah A, Kazemnezhad Leili E. Nursing students’ views on code of ethics, commitment to the ethic of, academic dishonesty and neutralization behaviors. Holistic Nursing and Midwifery Journal. 2014; 24(3):64-71.
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39
ORIGINAL_ARTICLE
Investigating the Determinants of Maternal Empowerment During Pregnancy: A Strategy for Prenatal Healthcare Promotion
Background & aim: Empowerment of pregnant mothers promotes their health and pregnancy outcomes. Given the importance of empowerment of women during pregnancy, this study was conducted to determine the level of empowerment during pregnancy and its determinants.
Methods: This cross-sectional study was carried out on 161 pregnant mothers who were selected using random cluster sampling in Gorgan, North East of Iran in 2015. To measure the level and determinants of empowerment, Kameda’s prenatal empowerment scale was used. Data analysis was carried out using descriptive and inferential statistical tests including linear regression analysis. P< 0.05 was considered significant.
Results: The regression analysis showed that age at first pregnancy (βeta standardized coefficient (β) =0.474), marital satisfaction (β=0.239) and spiritual support (β=0.227) had the highest coefficient in the regression. However, the age of marriage, the size of family as well as experience of violence had negative impact on prenatal empowerment.
Conclusion: Awareness of determinants of maternal empowerments could help policy makers to develop programs for promotion of mothers' empowerment during pregnancy. It seems that through developing counseling and educational programs with special focus on reducing domestic violence and enhancing marital satisfaction as well as offering spiritual support could promote prenatal empowerment and as a consequence facilitate moving towards safe motherhood.
https://jmrh.mums.ac.ir/article_7980_2f829f34c724916ac19c0bbb7dbedd9a.pdf
2017-07-01
988
997
10.22038/jmrh.2016.7980
Empowerment
Power (Psychology)
pregnancy
prenatal care
Narjes Sadat
Borghei
borghei2006@yahoo.com
1
a) Assistant Professor, Counseling and Reproductive Health Research Center, Golestan University of Medical Sciences, Gorgan, Iran b) Department of Midwifery, School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran
AUTHOR
Ali
Taghipour
taghipoura@mums.ac.ir
2
a) Associate Professor, Management and Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran b) Department of Biostatistics and Epidemiology, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
Robab
Latifnejad Roudsari
rlatifnejad@yahoo.com
3
a) Associate Professor, Evidence-Based Care Research Centre, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran b) Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Hadi
Jabbari Nooghabi
jabbarinh@yahoo.com
4
Associate Professor, Department of Statistics, Faculty of Mathematical Sciences, Ferdowsi University of Mashhad, Mashhad, Iran
AUTHOR
Jahdi F, Montazeri A, Balouchi M, Behboodi MZ. The impact of group prenatal care on pregnant women empowerment. Payesh. 2014; 13(2):229-234 (Persian).
1
Dumas L. Focus groups to reveal parents' needs for prenatal education. The Journal of Perinatal Education. 2002; 11(3):1-9.
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Rahimi T. The basic strategies for improving health and reducing maternal mortality. National Congress of strategies for improving health and reducing maternal mortality, Tehran, Iran; 2014. P. 27-28 (Persian).
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Froozanfar S, Majlessi F, Rahimi FA, Pourreza A. Assesment of the relationship between empowerment and reproductive behavior. Daneshvar Medicine. 2012; 18(99):1-9 (Persian).
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Abrejo FG, Shaikh BT, Saleem S. ICPD to MDGs: missing links and common grounds. Reproductive Health. 2008; 5(1):4.
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Kameda Y, Shimada K. Development of an empowerment scale for pregnant women. Journal of the Tsuruma Health Science Society Kanazawa University. 2008; 32(1):39-48.
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Small N, Bower P, Chew-Graham CA, Whalley D, Protheroe J. Patient empowerment in long-term conditions: development and preliminary testing of a new measure. BMC Health Services Research. 2013; 13(1):263.
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United Nations Population Fund. Working to end gender inequality. Women empowering. New York: United Nations Population Fund; 2007.
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1Shady Talab Z, Gheraee NeJad A. Poverty in female-headed households. Woman in Culture and Art. 2003; 2(1):49-70 (Persian).
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Shakouri A, Rafat Jah M, Jafari Mahtash M. Components of women's empowerment and explaining factors affecting it. Woman in Culture and Art. 2013; 5(1):1-26 (Persian).
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Hunter BA, Jason LA, Keys CB. Factors of empowerment for women in recovery from substance use. American Journal of Community Psychology. 2013; 51(1-2):91-102.
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Sipsma H, Ofori-Atta A, Canavan M, Udry C, Bradley E. Empowerment and use of antenatal care among women in Ghana: a cross-sectional study. BMC Pregnancy Childbirth. 2014; 14(1):364.
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Jennings L, Na M, Cherewick M, Hindin M, Mullany B, Ahmed S. Women's empowerment and male involvement in antenatal care: analyses of Demographic and Health Surveys (DHS) in selected African countries. BMC Pregnancy Childbirth. 2014; 14(1):297.
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45
Shahidi S, Aghdak P, Izadi M. Effect of pre-conception care protocol on women's awareness. Iranian Journal of Medical Education. 2011; 10(5):525-532.
46
ORIGINAL_ARTICLE
The Effect of Education Based on Systematic Comprehensive Health Education and Promotion Model to Health Volunteers on Their Female Clients' Knowledge Regarding Breast Cancer Screening
Background & aim: Despite the importance of screening for early diagnosis of breast cancer, few women have adequate knowledge in this regard. This study was performed to determine the effect of education based on comprehensive systematic health education and promotion model (SHEP model) on breast cancer screening knowledge of women referred to Mashhad health centers.
Methods: This quasi-experimental study with two groups of trainers and audiences was performed at Ab-o-Bargh and Shahid Najafi Health Centers that were randomly assigned to experimental and control centers. The study subjects were 12 health volunteers and 120 audiences (women referred to the health centers). In the case group, the health volunteers received training based on the SHEP model during two four-hour sessions. The control group received the routine training program. In both centers, ten women were randomly allocated to each health volunteer. The trainers of each group held a two-hour training session for the women covered by the health centers. The women's knowledge was assessed before, as well as immediately and four weeks after the intervention using a self-made questionnaire. To analyze the data, Mann Whitney, Friedman, Chi-squared, and Fisher’s exact tests were run in SPSS, version 20.
Results: Before the intervention, mean knowledge scores of the experimental and control groups were 16.52 and 16.53, respectively, which were not significantly different (P>0.05). Immediately and four weeks after the intervention, mean scores of knowledge in the experimental group were significantly higher than in the control group (43.13 and 42.38 vs 23.28 and 22.83; P<0.05). In both groups, there were significant differences in mean scores of knowledge at the three time points of before, immediately after, and four weeks post-intervention, but these disparities were greater in the experimental group compared to the control group.
Conclusion: Our outcomes confirmed the effectiveness of training based on SHEP model by matched trainers on women’s short- and long-term knowledge promotion as to breast cancer screening.
https://jmrh.mums.ac.ir/article_7979_834491e910f43ee4cff52c4221a657c3.pdf
2017-07-01
998
1007
10.22038/jmrh.2016.7979
Breast cancer screening
Knowledge
SHEP model
Khadijeh
Mirzaii
mirzaiikh@mums.ac.ir
1
Associate Professor, Department of Midwifery, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Shadan
Nesari Ashkezari
nesarish921@mums.ac.ir
2
MSc Student of Counselling Midwifery, Department of Midwifery, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
Talaat
Khadivzadeh
3
Assistant Professor, Department of Midwifery, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Mohammad taghi
Shakeri
shakerim@mums.ac.ir
4
Professor, Department of Biostatistics and Epidemiology, Faculty of Public Health, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global Cancer Statistics. CA: a Cancer Journal for Clinicians. 2011; 61(2):69–90.
1
Nejad FA, Abbasian M, Delvarianzadeh M. Evaluation of the knowledge, attitude and skills among the health volunteers regarding the breast self-examination in Shahroud. Journal of Knowledge & Health. 2007; 2(2):23-27 (Persian).
2
Harrirchi I, Ebrahimi M, Zamani N, Jarvandi S, Montazeri A. Breast Cancer in Iran: a review of 903 case records. Public Health. 2000; 114(2):143–145.
3
Homaei F, Farokh D, Nemati M, Bahar MM, Shabahang H, Tavassoli A. Breast cancer prevention, early detection,treatment and follow up. Mashhad: Mashhan University of Medical Science; 2012 (Persian).
4
Zamani M, Ghoorchi Moheb Seraj M, Jooya M. Early detection of common cancers. Mashhad: Ghaf Mashhadol Reza; 2013. P. 64 (Persian).
5
Jill P. Cancer prevention,treatment and palliation. London: Chapman Hall; 1995.
6
Davis TC, Williams MV, Marin E, Parker RM, Glass J. Health literacy and cancer communication. CA: a Cancer Journal for Clinicians. 2002; 52(3):134–149.
7
Reisi M, Mostafavi F, Hasanzadeh A, Sharifirad GR. The relationship between health literacy, health status and healthy behaviors among elderly in Isfahan. Health System Research. 2011; 7(4):1-11.
8
Narimisa P, Adnan F, Heydarianzadeh Z. Promotion health literacy in community. Behvarz. 2014; 25(1):28–30 (Persian).
9
Hearth-Holmes M, Murphy P, Davis TC, Nandy I, Elder CG, Broadwell LH, et al. Literacy in
10
patient with chronic disease: systemic lupus erythematosus and the reading level of patient education materials. The Journal of Rheumatology. 1997; 24(12):2335–2339.
11
Tehrani Banihashemi SA, Amirkhani MA, Haghdoost AA, Alavian SM, Asgharifard H, Baradaran H, et al. Health literacy and the influencing factors: a study in five provinces of Iran. Strides in Development of Medical Education. 2007; 4(1):1-9 (Persian).
12
Salehi M, Kelishadi M, Zandye M, Keshavarz J, Bagheri A. The effect of female health volunteers education on knowledge and attitude of urban population about mental health in Isfahan province. Iranian Journal of Medical Education. 2005; 5(2):111-119.
13
What is SHEP model? Systematic Comprehensive Health Education and Promotion Model. Available at: URL: http://www.shepmodel.com; 2012.
14
Soofizadeh K. Usage of SHEP model in teaching prevention and diabet control among femel students in Khoramabbad Technical Faculty. [Master Thesis]. Tehran, Iran: Tarbiat Modarres; 2013 (Persian).
15
Akbarzadeh M, ZangAbadi M, Motahhari M, Tabatabaei H. Comparing the effect of teaching breast self-examination by peers and health care personel on students knowledge and attitue. Iranian Journal of Medical Education. 2008; 8(2):195–203.
16
Banaeoam SH, Kazemian A, Kheiri S. Knowledge, attitude and practice about breast cancer screening and related factors among women referred to health care centers in Boroujen in 2005. The Journal of Shahrekord University of Medical Sciences. 2006; 1(8):28-34 (Persian).
17
Abedian K, Shah Hosseini Z, Adeli M. Survey of health beliefs of women about performing mammography in the health servic centers of Sari. Journal of Mazandaran University of Medical Sciences. 2006; 16(54):90-98 (Persian).
18
Abedzadeh M, Sadat Z, Saberi F. Knowledge, attitude, and performance of women referring health care centers in Kashan towards breast cancer and its screening tests. KAUMS Journal (FEYZ). 2003; 7(2):85-92 (Persian).
19
Mazloumi S, Zare M, Feisal M, Maleki F, Servat F, Ahmadieh MH. Effects of health education on knowledge, attitude and practice of female teachers in Yazd intermediate schools on breast cancer. Journal of Birjand University of Medical Sciences. 2006; 13(1):12-18 (Persian).
20
Kashfi SM, Khani Jeihooni A, Yazdankhah M. The effect of education about breast self-examination on knowledge, attitude and practice of women in nourabad mamasani health clinics, 2009. Journal of Jahrom University of Medical Sciences. 2009; 10(1):36–40.
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Taghdisi MH, Abolkheirian S, Hosseini F. Effectiveness of education and its influential factors on empowerment of the health volunteers in the west of Tehran health center. Iran Occupational Health Journal. 2011; 8(2):24–30 (Persian).
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Malak AT, Dicle A. Assessing the efficacy of a peer education model in teaching breast self-examination to university students. Asian Pacific Journal of Cancer Prevention. 2007; 8(4):481-484.
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Malak A, Bektash M, Turgay A, Tuna A, Ekti R. Effects of peer education, social support and self esteem on breast self examination performance and knowledge level. Asian Pacific Journal of Cancer Prevention. 2009; 10(1):605–608.
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Karayurt O, Dicle A, TunaMalak AT. Effects of peer and group education on knowledge, beliefs and breast self-examination practice among university students in Turkey. Turkish Journal of Medical Sciences. 2009; 39(1):59–66.
26
ORIGINAL_ARTICLE
The Relationship of Attachment Styles with Childbirth Self-efficacy in Nulliparous Pregnant Women: The Mediating Role of Alexithymia
Background & aim: The enhancement of childbirth self-efficacy to manage the labor pain can help the nulliparous pregnant women to make informed choice about vaginal delivery. Regarding the relationship of the childbirth self-efficacy with psychological antecedents, the present study aimed to explore the meditating role of alexithymia in the relationship of attachment styles and childbirth self-efficacy among the nulliparous pregnant women. Methods: This descriptive correlational study was conducted on 210 nulliparous pregnant women, living in Shiraz in 2016. The samples were selected from the nulliparous women referring to the public and private health and medical centers through the purposive sampling technique. The data were collected using a researcher-made demographic form, Iranian version of Childbirth Self-Efficacy Inventory, Hazan and Shaver’s Adult Attachment Inventory, and Farsi Toronto Alexithymia Scale-20. The data analysis was performed using the descriptive statistics and structural equation modeling through the SPSS version 20 and AMOS version 21, respectively. Results: Our findings indicated that all aspects of attachment styles (i.e., secure, avoidant, and ambivalent) would be able to predict the childbirth self-efficacy in the nulliparous pregnant women. On the other hand, the secure and insecure attachment styles predicted alexithymia among this population. The results of the path analysis demonstrated that alexithymia had a mediating role in the relationship of the attachment styles and the childbirth self-efficacy. Conclusion: Based on the findings of the present study, it can be concluded that the attachment styles and childbirth self-efficacy had an indirect relationship mediating through such variables as alexithymia.
https://jmrh.mums.ac.ir/article_8944_3f7946b9392911f29c7f8479173399bb.pdf
2017-07-01
1008
1017
10.22038/jmrh.2017.8944
Alexithymia
Attachment Styles
Childbirth
Nulliparous pregnant women
Self-efficacy
Marziye
Daneshmaram
danesmaram@gmail.com
1
MSc in Clinical Psychology, Department of Psychology, Shiraz Branch, Islamic Azad University, Shiraz, Iran
AUTHOR
Sareh
Behzadi Pour
behzadi@iaushiraz.ac.ir
2
Assistant Professor, Department of Psychology, Shiraz Branch, Islamic Azad University, Shiraz, Iran
LEAD_AUTHOR
Rowe H. Biopsychosocial obstetrics and gynecology–a perspective from Australia. Journal of Psychosomatic Obstetrics & Gynecology. 2016; 37(1):1-5.
1
Ip WY, Tang CS, Goggins WB. An educational intervention to improve women’s ability to cope with childbirth. Journal of Clinical Nursing. 2009; 18(15):2125-2135.
2
Lowe NK. Self-efficacy for labor and childbirth fears in nulliparous pregnant women. Journal of Psychosomatic Obstetrics & Gynecology. 2000; 21(4):219-224.
3
Wijma K, Wijma B. A woman afraid to deliver: how to manage childbirth anxiety. In Bio-Psycho-Social Obstetrics and Gynecology. New York, USA: Springer International Publishing; 2017. P. 3-31.
4
Laursen M, Johansen C, Hedegaard M. Fear of childbirth and risk for birth complications in nulliparous women in the Danish National Birth Cohort. BJOG: An International Journal of Obstetrics & Gynaecology. 2009; 116(10):1350-1355.
5
Schwartz L, Toohill J, Creedy DK, Baird K, Gamble J, Fenwick J. Factors associated with childbirth self-efficacy in Australian childbearing women. BMC Pregnancy and Childbirth. 2015; 15(1):29.
6
Carlsson M, Ziegert K, Nissen E. The relationship between childbirth self-efficacy and aspects of well-being, birth interventions and birth outcomes. Midwifery. 2015; 31(10):1000-1007.
7
Meredith P, Strong J, Feeney JA. Adult attachment, anxiety, and pain self-efficacy as predictors of pain intensity and disability. Pain. 2006; 123(1):146-154.
8
Wilson CL, Simpson JA. Childbirth pain, attachment orientations, and romantic partner support during labor and delivery. Personal Relationships. 2016; 23(4):622-644.
9
Costa-Martins JM, Pereira M, Martins H, Moura-Ramos M, Coelho R, Tavares J. Retracted: attachment styles, pain, and the consumption of analgesics during labor: a prospective observational study. The Journal of Pain. 2014; 15(3):304-311.
10
Lewis JB, Sullivan TP, Angley M, Callands T, Divney AA, Magriples U, et al. Psychological and relational correlates of intimate partner violence profiles among pregnant adolescent couples. Aggressive Behavior. 2017; 43(1):26-36.
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Szpak M, Białecka-Pikul M. Attachment and alexithymia are related, but mind mindedness does not mediate this relationship. Polish Psychological Bulletin. 2015; 46(2):217-222.
12
Besharat MA, Khajavi Z. The relationship between attachment styles and alexithymia: mediating role of defense mechanisms. Asian Journal of Psychiatry. 2013; 6(6):571-276.
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Taylor GJ, Bagby RM, Kushner SC, Benoit D, Atkinson L. Alexithymia and adult attachment representations: associations with the five-factor model of personality and perceived relationship adjustment. Com-prehensive Psychiatry. 2014; 55(5):1258-1268.
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Taylor GJ, Bagby RM. New trends in alexithymia research. Psychotherapy and Psychosomatics. 2004; 73(2):68-77.
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Scarpazza C, Sellitto M, di Pellegrino G. Now or not-now? The influence of alexithymia on intertemporal decision-making. Brain and Cognition. 2017; 114:20-28.
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Bandura, A. On the functional properties of perceived self-efficacy revisited. Journal of Management. 2012; 38:9-44.
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Lyvers M, Kohlsdorf SM, Edwards MS, Thorberg FA. Alexithymia and mood: recognition of emotion in self and others. American Journal of Psychology. 2017; 130(1):83-92.
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ORIGINAL_ARTICLE
Acalculous Cholecystitis Presenting as Intractable Hypere-mesis during Pregnancy: A Case Report
Background & aim: Nausea and vomiting manifest in more than 50% of pregnancies; in case of severe nausea and vomiting during pregnancy, or hyperemesis gravidarum, other diagnoses should be considered.
Case report: This case report details a 34-year-old pregnant woman with diabetes whose primary symptom was nausea and vomiting; she presented with mild abdominal pain without abdominal tenderness. After hospital admission, she was treated as a case of hyperemesis. Sonography revealed acalculous cholecystitis, necessitating laparoscopic cholecystectomy that led to resolution of her condition.
Conclusion: As hyperemesis is a diagnosis always arrived at by ruling out other possibilities, a complete physical examination should be performed and other patient symptoms must be considered in pregnant women with this disorder.
https://jmrh.mums.ac.ir/article_8773_f4af5989462c0f32d330dbac52ce4b28.pdf
2017-07-01
1018
1020
10.22038/jmrh.2017.8773
Acalculous cholecystitis
Cholecystitis
Hyperemesis gravidarum
Fatemeh
Tara
1
Professor, Department of Obstetrics and Gynecology, Faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Atiyeh
Mohammadzade Vatanchi
vatanchia@mums.ac.ir
2
Assistant Professor, Department of Obstetrics and Gynecology, Faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
Leila
Pourali
pouralil@mums.ac.ir
3
Assistant Professor, Department of Obstetrics and Gynecology, Faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Atefe
Alamtian
4
Resident of Obstetrics and Gynecology, Faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
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