گیتی ازگلی

Considering the prevalence of high-risk pregnancies in developing countries, the increase in maternal and fetal morbidity and mortality, as well as the adverse effects of these pregnancies on the mental health of couples، it is necessary to understand the experience of high-risk pregnancy in couples. Since one of the most realistic ways to achieve the challenges ahead is to use people's own experiences, this study was conducted with aim to explain the experience of couples with high-risk pregnancies.

 This qualitative study was conducted in 2018 on couples with high-risk pregnancies in the health centers and Sayad Hospital in Gorgan. The participants were selected in a purposeful way and with maximum diversity for structured in-depth interviews. Guba and Lincoln criteria were used for data accuracy. The data collection and analysis was done simultaneously based on the contract qualitative content analysis process based on Granheim's method and by MAXQDA software (version 10).

 Totally, 23 couples with high-risk pregnancies participated. The age range of women was 20-45 years and men were 22-52 years. The contents included the concern and fear of couples for maternal and fetal health, the way to deal with the problem, and need to comprehensive services and support of the relatives.

 Considering the worry about maternal and fetal health and the lack of comprehensive services, paying attention to increasing information and acquiring skills to cope with problems and a healthy lifestyle in couples, as well as providing comprehensive supportive services and support of the relatives is required in order to couples have a good experience of high-risk pregnancy by reducing high-risk pregnancy complications.

Cervical cancer has been recognized as an important health problem in women. Infection with some genotypes of human papillomavirus (HPV) is the most important risk factor associated with cervical cancer. The present study was conducted with aim to estimate the prevalence of genital HPV in suburban women.

In this systematic and meta-analysis study from February 20 to March 20, 2023, databases of Web of Science, Scopus, PubMed and Embase and Google scholar search engine were searched without time restrictions using the keywords such as "papillomavirus", "genital wart" and "suburban population" and relevant synonyms. In the selection criteria, observational studies on the prevalence of genital papillomavirus in suburban women were included. Heterogeneity of the studies was evaluated with I2 and Cochran's Q test. Funnel plot and Egger & Begg tests were used to assess the publication bias of the studies.

Finally, 10 studies with a sample size of 65,813 remained in accordance with the purpose of our study. The results of the meta-analysis showed that the overall prevalence of HPV in suburban women was 17% (95% CI: 13-21%) and HPV/16 genotype with a prevalence of 18% (95% CI: 13-23%) was the most common genotype in the affected people.

In general, the prevalence of genital papilloma virus infection was relatively high in suburban women. This result can be useful for policy makers in planning preventive strategies for cervical cancer in poor and low-income environments.

Although pregnancy is a pleasant period for most women, it is often a stressful period with physiological and psychological changes. Physical health and mental health are two general dimensions of quality of life. It seems that the quality of life has an effect on the sexual function of pregnant women. Therefore, this study was conducted with aim to compare the relationship between sexual function and the quality of life of pregnant women in different trimesters of pregnancy.

This cross-sectional study was conducted in 2019 on 360 pregnant women (120 pregnant women in each trimester) referring to the pregnancy care clinic of Rasht public Hospitals. The tools were questionnaires of demographic characteristics, FSFI sexual function, and quality of life SF-36. Data analysis was done using SPSS statistical software (version 23) and t-test, Chi-square, ANOVA and Pearson's correlation coefficient. P<0.05 was considered statistically significant.

The mean score of the total sexual function of the studied subjects was 18.64 ± 10.05. Sexual dysfunction was seen in 86.4% of the samples. The scores of sexual functions in the first to third trimester of pregnancy were 23.92 ± 7.79, 18.84 ± 8.84, and 13.17 ± 10.37, respectively. It showed a statistically significant difference between the total score and the scores of the dimensions of sexual function with trimesters of pregnancy (p<0.001). The quality of life of the groups with and without sexual dysfunction had statistically significant differences in the two main dimensions of physical health and mental health (p<0.001). The mean scores of physical health and mental health were 54.82 ± 18.73 and 60.18 ± 17.59, respectively. Also, satisfaction (r=0.162, p=0.002) and pain (r=0.108, p=0.041) had a positive correlation with physical health. The total score of sexual function (r=0.158 and p=0.003) had a positive correlation with mental health. Lubrication (r=0.126, p=0.017), orgasm (r=0.146, p=0.006), satisfaction (r=0.247, p=0.0001), pain (r=0.165, p=0.002) and the total score of sexual function (r=0.158, p=0.003) were positively correlated with mental health.

The rate of sexual dysfunction increases with increasing gestational age. Also, quality of life with the highest mean score of mental health was related to the first trimester and the highest mean score of physical health was in the third trimester of pregnancy. Sexual function had a positive correlation with the mental health dimension of quality of life.

There is a possibility of more accumulation of environmental pollutants due to lower levels of iron in the body of women. Different results have been reported on the association of lead with breast cancer, therefore, this systematic review study was performed with aim to determine the relationship between lead and breast cancer.

In this review study, to find the related articles, international databases (Web of Science, Embase, Scopus, Google Scholar and PubMed) and national (Irandoc, Magiran, SID and IranMedex) were searched with different keyword combinations related to "Lead" And "Breast Cancer" obtained from MESH in 2000 to 2022. Selection of articles was based on inclusion and exclusion criteria and articles' quality was assessed using the Newcastle Ottawa scale.

Out of 4057 articles reviewed, 13 articles had good quality. All studies were in English and were observational. According to most studies, serum lead levels were not associated with breast cancer, but lead levels in bone and breast tissue were also associated with exposure to lead as an environmental contaminant with breast cancer.

Different ways of exposure to lead have led to different results and it cannot be certainty said that exposure to lead causes breast cancer, while this relationship also depends on the method of measuring lead. In this regard, long-term studies with accurate measurement of environmental lead and body tissues, especially for women at higher risk are recommended.

Sexual activity changes during pregnancy due to hormonal and physical changes in pregnant women. This leads to a higher prevalence of sexual dysfunction in pregnancy. Evaluation of sexual function with special tools is necessary to determine sexual dysfunction during pregnancy. Pregnancy Sexual Response Inventory is one of these tools. The present study was performed aimed to translate and determine the psychometric properties, and validate the Pregnancy Sexual Response Inventory (PSRI).

This correlation type descriptive-analytical study was translated from English to Persian "Forward / Backward" to translate, psychometrics, and validate the Pregnancy Sexual Response Inventory (PSRI) in 2021. After consulting the experts and pregnant mothers, the content and face validity of the scale were determined qualitatively. The final version of the questionnaire was completed by 260 pregnant women in Rasht, chosen via convenience sampling. The reliability of the questionnaire was assessed by Cronbach's alpha coefficient and Inter class correlation coefficient (ICC). The reliability and validity of the questionnaire structure was done by confirmatory factor analysis using AMOS software and other statistical analyzes using SPSS statistical software. P< 0.05 was considered statistically significant.

Intra-class correlation was shown for each scale between 0.602 and 0.902. There was also a moderate to high correlation between each subscale and the total score of the PSRI questionnaire. All indices of goodness indicated that all subscales of this questionnaire are suitable to measure pregnancy sexual response and activity.

The psychometric properties of the PSRI Scale showed the high reliability and validity of this scale and the possibility of using this tool in Iran.

Evidence has shown that the COVID-19 pandemic can have unpleasant side effects for pregnant women and fetuses. Therefore, vaccination of pregnant women was performed to make this group safe. In order to consolidate the existing knowledge about the effectiveness and consequences of pregnancy in women who underwent this vaccination, this study was designed and implemented.

In this systematic review study, all published studies up to 24.2.2022 were included in the study. The studies were searched in the databases of Embase, PubMed, Web of Science, Scopus using the keywords Pregnancy, COVID-19 Virus Vaccines, Pregnancy Complications and fetal outcome. The two researchers independently reviewed the articles for quality assessment (using the Newcastle-Ottawa tool) and extracted their main findings.

In this review study, 10 studies were included in accordance with the inclusion criteria with 40522 pregnant women who received the COVID-19 vaccine. The incidence of maternal complications after vaccination was extremely low. Among pregnant women, there was no significant difference in maternal complications based on whether the vaccine was given in the first, second or third trimester of pregnancy. Covid-19 vaccination during pregnancy was not associated with an increase in pregnancy complications or delivery.

Considering that the safety and efficacy of COVID-19 vaccine are important factors in achieving population immunity, more acceptance of vaccines is essential to achieve adequate immunization coverage. Health care providers can use the available data to educate and empower pregnant women to make informed decisions.

Postponed childbearing is a social phenomenon in Iranian families. There is a controversy about its effect on mental health. Therefore, this study was conducted aimed to determine the role of childbearing in the rate of depression, stress, and anxiety in Iranian women of childbearing age.

This cross-sectional study was performed in 2021 on 581 eligible non-pregnant married women from 31 provinces of Iran. Non-random available sampling was performed as electronic form in virtual space. Data were analyzed by Demographic and Medical History Questionnaire, Sleep Quality (adapted from LSQ), Marital Satisfaction (EMS), Perceived Social Support (MSMPSS), Socioeconomic Status (Ghodratnama Questionnaire), and Stress-Anxiety-Depression (DASS-21). Data were analyzed by SPSS software (version 22) and Independent t-test, Chi-square, and binary logistic regression. P<0.05 was considered statistically significant.

Female and spouse education (P <0.001), female employment (P = 0.004), and higher socioeconomic status (P = 0.04) were significantly higher in women without children. The marital satisfaction (P = 0.061), social support (P = 0.13), sleep quality (P = 0.58), history of chronic disease (P = 0.64), and place of residence (P = 0.058) were not significantly different between the two groups. After adjusting the data, the rate of depression in childless women is twice that of women with children (AOR=2.06 95% CI: 1.11-3.82). Stress (P = 0.38) and anxiety (P = 0.9) were not significantly different between the two groups.

Having children not only does not increase the rate of stress and anxiety, but also protects women against depression. Therefore, encouraging childbearing seems to promote the mental health of women in Iranian society.

Adipokines play essential roles in the human body, including regulating the inflammatory process, the immune system's activity, the vascular system, and reproductive function, and performing glucose homeostasis. Adipokine levels change during pregnancy and postpartum, and these hormones play an important role in fetal growth and development. This study aimed to compare maternal leptin and omentin-1 serum levels in vaginal and cesarean deliveries and their relationship with anthropometric indices.

This descriptive-analytical study was performed in 2020 on 90 women (45 patients with vaginal delivery and 45 patients with elective cesarean delivery) admitted to the Mahdieh Hospital in Tehran, who were selected conveniently. Intravenous blood samples were taken in the first 24 hours after delivery to measure maternal leptin and omentin-1 serum levels.

The mean age was 25.8±4.6 and 29.5±4.5 in women with vaginal delivery and elective cesarean delivery, respectively. The results showed that maternal leptin and omentin-1 serum levels were higher in vaginal delivery than in cesarean delivery, although the difference was significant only in leptin serum levels (p<0.001). Also, no significant relationship was observed between fetal sex and anthropometric indices with maternal leptin and omentin-1 serum levels (p>0.5).

Leptin serum levels were significantly higher in the first 24 hours after vaginal delivery than after cesarean delivery Vaginal delivery can be recommended as the preferred method due to its critical role in metabolic and anti-inflammatory activities and reproductive function regulation.

One of the goals of the third millennium development is maternal and neonatal health. One of the harmful factors of health is natural disasters. This study was performed aimed to determine maternal complications in Kermanshah earthquake in 2017.

This cross-sectional study was conducted on 850 women who had delivery in Imam Khomeini hospital of Eslam Abad Gharb. The earthquake group included the women who had delivered in the earthquake of 2017 and the non-earthquake group included the women who were delivered in the same hospital in 2016. All data obtained from patients' records. Data were analyzed by SPSS software (version 21) and Independent t-test, and Mann-Whitney test, Chi-square and Fisher exact test. P<0.05 was considered statistically significant.

In women who had delivered in an earthquake, prevalence of maternal complications included preterm labour in 99 (22.3%), premature rupture of membrane in 30 (7.05%), caesarean section in 179 (42.1%), postpartum hemorrhage in 42 (9.9%), gestational hypertension in 24 (5.6%) and abortion in 11 (2.58%). In women who had delivered in 2016, there were preterm labor in 51 (11%), premature rupture of membrane in 12 (2.8 %), caesarean section in 153 (36%), postpartum hemorrhage in 20 (5%), gestational hypertension in 9 (2.1%) and abortion in 2 (0.5%). There were significant differences between the two groups in all cases (P<0.05).

Natural disasters such as earthquakes can increase maternal complications. Therefore, necessary precautions and health care should be increased in the event of a natural disaster.

Menopause is a physiological period in a woman's life that is accompanied by symptoms or complications which may need treatment. This study was conducted with aim to consolidate the existing knowledge to evaluate the effect of fennel on sexual health of postmenopausal women.

In this review study, to find the clinical trial studies which evaluated the effect of fennel (oral, inhaled or vaginal) on sexual health of postmenopausal women, the databases of PubMed/Medline(NLM), SCOPUS, Web of Sciences, ProQuest, The Cochrane library, and Google scholar were searched from 2000 to 2021 with no language restrictions with the keywords of "Sexual Satisfaction", "Sexual function", "Sexual life", "fennel", "Menopause" and related terms. The primary outcome was evaluation of sexual health in postmenopausal women. Studies which their full text was in Persian or English entered the study. The Cochran checklist was used to assess the quality of studies.

Seven studies with 570 postmenopausal women included in this review according to inclusion criteria. Based on the results, the positive effect of fennel in various forms of inhaled, oral and vaginal alone or in combination with other herbal medicines on the sexual health of postmenopausal women has been reported in six studies. Only one study comparing it with citalopram found no effect of fennel.

It seems that fennel is a drug which affects sexual health in postmenopausal women. In future studies on fennel, it is suggested that the evaluation of side effects and cost-effectiveness be considered.

Female sexual dysfunction is one of the major health problems of women after childbirth. So, the present study was conducted with the aim of localizing the postpartum sexual function and dyspareunia (The Carol Scale).

This methodological study conducted in 2019-2020 on 200 woman during three months after vaginal delivery. The original version of the Carol scale is in Spanish, which after obtaining permission from the tool developer, was translated into Persian using protocol of forward-backward translation. First, the face and content validity and then the construct validity were determined by confirmatory factor analysis. The reliability was determined by the test-retest method as well as the Intra class correlation coefficient (ICC).

Structural factor analysis was performed using confirmatory factor analysis and four factors of original tool were confirmed. The fit of the four-factor model was confirmed ideal fit based on goodness of fit indices. All reliability indices reported good internal consistency and the overall ICC was 0.793 which indicates the stability or repeatability of the scale over time.

The Persian version of the Carol scale has evidence supporting reliability, validity, and responsiveness and can be used for assessment of postpartum sexual function and dyspareunia among Iranian women after vaginal delivery.

Episiotomy is one of the causes that can affect mothers' postpartum quality of life. Aloe Vera plant has been suggested as one of the ways to heal wounds and reduce pain. Regarding to these properties, several clinical trial studies have been conducted to determine the effect of aloe vera on episiotomy pain relief and wound healing, and different findings have been reported. This study was performed with aim to determine the effect of Aloe Vera on episiotomy pain relief and wound healing.

In this systematic review study, the databases of Scopus, PubMed (MEDLINE), Embase, Proquest, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Library and Web of Science were searched using the keywords of "pain", "Wound", "Healing", "Episiotomy", " Perineum" and "Aleo Vera" by OR and AND without time, language and geographical limitation until 23 April 2021. The quality of the articles was evaluated using the Cochran Group tool and data were analyzed by Stata software (version 14). Cochran test and I2 index were used to assess the heterogeneity of the articles.

Finally, 9 articles with sample size of 611 people were included in this systematic review study. Preliminary studies showed the effectiveness of Aloe Vera in wound healing and pain relief. Four studies with sample size of 258 patients had the potential to perform the meta-analysis for pain outcome. Results of the meta-analysis showed that Aloe vera can reduce pain intensity compared to the control group (P<0.05).

Aloe Vera seems to be effective in repairing episiotomy wounds and reducing pain; however, high quality studies with sufficient sample size are recommended for definitive results.

Given the importance of sexual issues in women's lives and being affected by various factors such as pregnancy and diabetes, and the existence of limited research on sexual function in women with gestational diabetes, this study was performed with aim to compare sexual function of women with gestational diabetes and low risk pregnant women in third trimester of pregnancy.

This descriptive-analytical study was performed on 300 women with gestational diabetes  low-risk pregnant women in the clinics affiliated to Mazandaran University of Medical Sciences in 2019. Demographic data were collected using researcher-made Demographic-Midwifery Questionnaire, and data related to sexual function using Female Sexual Function Index questionnaire  Data were analyzed by SPSS software (version 23) and Independent t-test, Mann Whitney, Chi-square and Multiple linear regression. P<0.05 was considered statistically significant.

In this study, 131 (87.3%) of women with gestational diabetes and 52 (34.67%) of low-risk pregnant women had sexual dysfunction. Gestational diabetes causes a significant decrease in sexual desire score (P< 0.001), lubrication score (p=0.006), satisfaction score (P< 0.001) and a significant increase in pain score (p=0.01).

Most women with gestational diabetes had sexual dysfunction; gestational diabetes predicts sexual function in pregnant women. Therefore, evaluation of sexual function should be a part of the usual assessment of women with gestational diabetes.

Female sexual dysfunction is one of the major health problems of women after childbirth. So, the present study was conducted with the aim of localizing the postpartum sexual function and dyspareunia assessment tool (The Carol Scale).

This methodological study was conducted in 2019-2020 on 200 woman during three months after vaginal delivery. The original version of the Carol scale is in Spanish, which after obtaining permission from the tool developer, was translated into Persian using the protocol of forward-backward translation. First, the face and content validity, and then the construct validity, were determined by confirmatory factor analysis. The reliability was determined by the test-retest method as well as the Intraclass Correlation Coefficient (ICC). Data analysis was performed using SPSS and LISREL software.

Structural factor analysis was performed using confirmatory factor analysis, and four factors of original tool were confirmed. The fit of the four-factor model was confirmed ideal fit based on goodness of fit indices. All reliability indices reported good internal consistency and the overall ICC was 0.793, which indicated the stability or repeatability of the scale over time.

The Persian version of the Carol scale has evidence-supporting reliability, validity, and responsiveness; it can be used to assess postpartum sexual function and dyspareunia among Iranian women after vaginal delivery.

Postpartum weight retention has a significant effect on obesity, chronic disease, and adverse maternal, fetal, and neonatal outcomes. Nowadays, social factors are of the basic causes of health and disease. The present systematic review was conducted with aim to investigate the relationship between social determinants of health and postpartum weight retention in Iranian studies.

In this systematic review, Persian and English observational articles (cohort, case-control, cross-sectional) were searched in databases of PubMed, Google Scholar, Scopus, Embase, Web of Science, SID, Magiran, Irandoc using the different combination of keywords related to “Social determinants of health” And “postpartum weight retention” obtained from Medical Subject Headings (MeSH) from 2000 to 2019. The articles were selected based on the inclusion and exclusion criteria. The quality of selected studies was evaluated using the Newcastle–Ottawa Scale.

From 485 reviewed articles, eight studies were selected. Social determinants of health were classified into structural and intermediate groups based on the WHO model. The structural determinants included education, occupation, income, and residence area. Intermediate determinants were classified into three domains of behavioral factors, biological factors, and psychosocial factors based on this model. According to the results of the reviewed studies, a statistically significant relationship was observed between postpartum weight retention with mother's education, exercise, postpartum functional status, exclusive breastfeeding, formula feeding, pre-pregnancy weight, gestational weight gain, parity, mode of delivery, age, depression, and anxiety.

The results of the current systematic review illustrated the impact of structural and intermediate social determinants of health- including women's education and factors in behavioral, biological, and psychosocial domains- on postpartum weight retention. This result confirms the need for health authorities and staff to pay more attention to these influencing factors along with other medical factors to help prevent or reduce the extent of this problem and its complications.

Length of delivery is among the factors affecting maternal and neonatal delivery outcomes. The effect of acupressure on decreasing the length of delivery stages has been recently evaluated. The aim of this study was to assess the effect of acupressure on gallbladder (GB21)  acupoints on the duration of delivery.

This clinical trial included 174 nulliparous women hospitalized in Mofateh Maternity Hospital in Varamin City who were eligible to enter the study. The women were randomly placed into three groups: pressure on GB21, pressure on inappropriate point (sham) and control groups. Intervention was applied during 3stages: at 3-5cm, 6-7cm, and 8-10cm dilatations at the first stage of labor and the lengths of delivery stages were measured. Data were analyzed using one-way ANOVA, Kruskal Wallis, Tukey, Bonfferoni and chi-square.

Mean values for duration of the first stage of delivery in GB21, sham and control groups were 257.67±72.86, 289.31±118.72, and 245.09±80.82 min (P>0.05) and for the lengths of the second stage of labor were 71.98±39.89, 64.31±22.91 and 71.50±32.02 min respectively (P>0.05). Mean values for the lengths of the third stage in the GB21, sham and control groups were 5.17±0.9, 5.43±1.4, and 6.29±2.2 min respectively (P>0.05). There was no significant differences among the 3 groups in regard to Apgar Scores (p<0.05). But the required dose of oxytocin and the mean value for the duration of oxytocin administration were higher in the sham and control groups than that in the GB21 acupressure group (P<0.003).

No statistically significant difference was found in the duration of labor in the three groups, but the required dose and duration of oxytocin administration in the acupressure group were much less in the GB21 acupressure group than in the other two groups.

Episiotomy is the most common surgery in obstetrics that like any other wound can cause infection or delay in wound healing. Hypericum perforatum has antimicrobial and anti-inflammatory and wound healing properties. Therefore, this study was performed with aim to determine the effects of Hypericum perforatum on episiotomy wound healing in primiparous women.
This double blind randomized clinical trial was performed on 100 eligible women referred to Shahid Noorani hospital of Talesh in 2014. The subjects were randomly allocated into two groups of Hypericum cream (group A) and placebo (group B). After delivery, two groups used 2 cm Hypericum or placebo cream at scar site twice a day for 10 days. Wound healing was measured before the intervention, first 12 hours and 5 and 10 days after delivery by RIDDA scale. Data were analyzed by SPSS software (version 19) and Mann-Whitney and independent t test. P<0.05 was considered statistically significant
The mean of wound healing score before the intervention was not significant in two groups (p>0.05). The mean of RIDDA score significantly decreased at 12 hours and 5 days and 10 days after delivery in hypericum perforatum cream group (p<0.05).
Hypericum perforatum cream is effective on perineal wound healing.

It is important to pay attention to the sexual function of women of childbearing age due to long-term conflict with it and its impact on personal health, marital relations and childbearing. The phytoestrogenic effect of the Vitex agnus-castus plant on sexual function of postmenopausal women as well as in limited animal studies has been shown to improve, enhance sexual behavior and hormones, but it has not been studied in women of childbearing age. Therefore, this study was performed with aim to determine the effect of Vitex agnus-castus plant consumption on sexual dysfunction in women of childbearing age.

This double-blind clinical trial study was performed on 102 women referred to Alzahra Women's Clinic of Rasht for doing Pap smears in 2019. Eligible candidates completed the Female Sexual Function Index (FSFI) questionnaire; if they were placed in the group of sexual dysfunction and then randomly assigned to two groups of Vitex agnus-castus tablet or placebo. FSFI questionnaire was again completed after 4 weeks. Data were analyzed by SPSS software (version 21) and Chi-square, Fisher, Mann-Whitney, Independent-t and paired t-test. P<0.05 was considered statistically significant.

Two groups were homogeneous in terms of demographic, social and midwifery characteristics, and mean scores of total sexual function and domains were similar between the two groups before the (p≥0.05). After one month of the intervention, mean score of total sexual function and domains was not statistically significant between two groups (p≥0.05). In comparison of the scores within-group, only the score of orgasm domain was improved (p=0.02).

There was no change in sexual function of women before and after the intervention; so it is recommended that given the mechanism of the effects of phytoestrogens and similar studies in postmenopausal women, this study be conducted over a long period of time.

Several controversial evidences have been recently reported on the use of prostate-specific antigens in the diagnosis of polycystic ovary syndrome (PCOS). This systematic review and meta-analysis study was performed with aim to determine the levels of prostate-specific antigens (PSA) in patients with PCOS.

In this systematic and meta-analytical review, an electronic search was conducted in the databases of PubMed, Web of Science, Scopus, and Cochran Library. EndNote X6, Stata 14, and Review Manager 5.3 were used to manage the searched articles, data analysis, and quality evaluation. Begg's test and Egger's test were used to evaluate the publication bias.

In this study, 17 studies with 1,467 participants were included. Meta-analysis results showed that the amount of Prostate specific antigen in PCOS patients was significantly higher than the control group (Standardized mean difference: 1.83, 95% CI: 1.26-2.39; P<0.001), and the mean of fPSA was significantly higher in the PCOS group than the control group (Standardized mean difference: 1.25, 95% CI: 0.38-2.12, P=0.005).

The results of this study showed that serum levels of PSA were higher in PCOS patients. It seems that racial differences and differences in assay techniques can affect the levels of PSA levels in PCOS patients. Measurement of the level of this antigen can be helpful in the diagnosis of PCOS.

Controlling postpartum pain affects maternal care of baby and mother's return to normal life. Studies have shown the effect of pressure on the 3- liver point in reducing uterine-induced pain, such as menstrual pain. Therefore, this study was performed with aim to evaluate the effect of 3-liver pressure point on postpartum severity of pain.

This controlled randomized clinical trial study was performed on 150 mothers who had normal delivery and complained of postpartum pain in the postpartum ward of Shahid Sadoughi Hospital in Yazd in 2017-2018. Mothers were randomly divided into three groups of 3-liver pressure point (n=50), Sham group (n=50) and Ibuprofen group (n=50). All three groups received oral Ibuprofen 400 mg every 6 hours up to 24 hours if they had moderate or severe pain. In the 3-liver pressure point group (intervention group), the pressure was applied to the 3-liver point for 10 minutes on each foot, and in the Sham group, the same pressure was applied to the ectopic point. The Control group received medication only (routine care). Pain was measured every 6 hours before, 30 and 120 minutes after each intervention. Data analysis was performed using SPSS software (version 16) and tests of Chi-square, Friedman, Kruskal Wallis, Wilcoxon, and GEE)Generalized Estimation Equations (. P<0.05 was considered statistically significant.

The postpartum pain severity after the intervention were statistically significantly different in each group (p <0.001). The mean of postpartum pain severity decreased as 0.34 over time. The mean pain score in the 3-liver point group was 0.8±0.23 lower than the control group (p=0.001). The mean pain score in the 3-liver point group was 0.0±64.3 lower than the sham group (p = 0.035). But there was no significant difference between the sham and control groups (p = 0.468).

Acupressure at 3-liver point is effective in relieving postpartum pain and it can be used like other pressure points affecting postpartum pain.

Puberty is the period of developmental changes from childhood to adulthood and the acquisition of fertility. The time of puberty likely affects future risks such as cancer, metabolic syndrome and cardiovascular diseases. Many evidences point to the role of environmental exposure in changing the time of puberty. This review article was performed with aim to investigate the effect of lead on pubertytime in girls and boys based on the studies performed in this field.

In this review article, English and Persian articles related to observational studies which were indexed in databases of Embase, PubMed, Scopus, ISI Web of Science, SID, and Google Scholar during 2000-2018 with different combinations of the keywords of "lead” and "Puberty" were selected from Medical Subject Headings (MESH). From 182 reviewed articles, 12 articled related to the aim were selected based on inclusion and exclusion criteria and quality of reporting articles according to STROBEchecklist. 

12 articles were classified in two domains of lead effects on the puberty of girls and boys. The results of most studies showed that there was a statistically significant association between blood lead levels in girls, especially high levels, with delayed appearance of menarche, development of breast and growth of pubic hair. In boys, there was a statistically significant association between blood lead levels, especially high levels, with a delay in the process of puberty, including increased testicular mass and growth of pubic hair.

Lead can affect the natural process of puberty, and especially is effective in delaying puberty of girls and boys.

Female sexual dysfunction in the postpartum period is one of the major health problems of women. The aim of this study was to determine the postpartum sexual dysfunction and its related factors in Iranian women.

In  this systematic review and meta-analysis study, Iranian articles published at PubMed, Scopus, Web of Science, ProQuest, Magiran, Scientific Information Database (SID), IranMedex, IranDoc were searched by keywords related to "postpartum sexual function". The inclusion criteria were as the studies, which used standard tools to measure sexual function, and included observational studies (from 1990 to 2019). Egger statistical test was used to investigate the probability of bias in the publication bias. Data were analyzed using STATA 14 software.

Finally, after quality assessment by Newcastle Ottawa instrument, 12 articles were analyzed. The overall mean score of sexual function after sensitivity analysis was 22.30 [95% confidence interval (CI): 21.8-22.8], the lowest score was in the sexual desire dimension as 3.52 (95% CI, 3.2-20-3.84), and in the sexual satisfaction dimension, it was 4.28 (5 95% CI: 4.4-4.03). Factors related to sexual function included individual and demographic factors, medical factors, and emotional and psychological factors.

 The postpartum sexual function in Iranian women is influenced by several factors; so it is recommended to pay attention to the sexual dimension of women's postpartum counseling, and to plan interventional measures in this regard.

Sexual problems are prevalent in women with multiple sclerosis (MS), and sexual self-efficacy as an effective variable plays an important role in sexual health and sexual quality of life of these women. The aim of this study was to determine the predictors of sexual self-efficacy in women with multiple sclerosis. This descriptive analytical study was conducted in Tehran, Iran, with participation of 200 women with MS, who referred to the Iranian MS society, had Expanded Disability Status Scale (EDSS) ≥ 7, and met the inclusion criteria in year 2019; they were selected using convenience sampling method. For data collection and assess the predictor factors of sexual self-efficacy in women with MS, related standard questionnaires were used. Data were analyzed using Pearson correlation coefficient, t-test, one-way ANOVA, and multiple linear regression model via SPSS software. The mean age of participants was 36.33 ± 5.22 years, and the mean score of sexual self-efficacy was 16.54 ± 7.27. After entering the significant variables derived from measuring the relationship between each variable individually with the score of sexual self-efficacy in multiple linear regression model for controlling confounders, sexual dysfunction (P = 0.001), anxiety (P = 0.024), stress (P = 0.006), and the number of sexual intercourse (P < 0.013) were significantly predictor factors of sexual self-efficacy in women with MS. The sexual dysfunction, anxiety, stress, and the number of sexual intercourse significantly predicted sexual self-efficacy in women with MS. Therefore, considering these factors in the treatment process of these patients can help to promote sexual self-efficacy and empower them in sexual life.

Some studies have shown the relationship between vitamin D3 deficiency, with primary dysmenorrhea and associated systemic symptoms. However, the relationship between pain severity and serum vitamin D level is not known. Therefore, this study was performed with aim to investigate the relationship between the severity of primary dysmenorrhea and associated systemic symptoms with serum levels of vitamin D. This cross-sectional study was performed on 143 students with primary dysmenorrhea in dormitories of Shahid Beheshti University of Medical Sciences in 2018. Data related to menstruation cycle and severity of primary dysmenorrhea were collected using demographic questionnaire, menstrual status and pain index. The serum level of 25-hydroxyvitamin D3 was determined by LIASON device, by Chemiluiminescence method and was analyzed in DiaSorin kit. Data were analyzed by SPSS software (version 24) and Mann-Whitney test and independent t-test. P No significant relationship was found between the mean score of primary dysmenorrhea and serum vitamin D levels (P>0.05). There was a significant relationship between severity of headache, fatigue, nausea and vomiting with serum vitamin D levels (P <0.001), but this relationship was not found with severity of diarrhea (P>0.05). There is no significant relationship between severity of primary dysmenorrhea and serum vitamin D levels, but significant relationship was found with severity of headache, fatigue, nausea and vomiting. Performing larger studies in a non-homogeneous society is suggested for closer evaluation of this relationship.

Postpartum pain is one of the common problems in mothers، and mothers tend to use medicinal plants for soothing the pain. In recent years، the clinical performance، according to evidence، was noticed. Therefore، this clinical trial was designed and implemented to determine the effects of Zataria multiflora Boiss capsule and Ibuprofen on postpartum pain. This randomized double-blinded clinical trial was performed on 100 mothers that had natural vaginal birth in Imam Khomeini hospital in Ahwaz in 2016. The women were randomly assigned into two groups of Zataria multiflora Boiss capsule and Ibuprofen. Then, the subjects received one capsule every 6 h for 24 h. The pain intensity was studied before each intervention and 1 h after that using the numerical scale of pain. The data were analyzed by SPSS software (version 18) and statistical tests, including Mann-Whitney U test، t-test، Chi-square test, and Repeated measures. P-value less than 0.05 was considered statistically significant. In this study, both groups had no statistically significant difference in the interventions, such as the age، number of delivery, and weight of neonate (P>0/05). Comparing the mean scores of postpartum pain intensity between the two groups after the fourth intervention showed no significant difference (P=0/057), and in both groups, the intensity of postpartum pain decreased. According to the results of the present study, Zataria moltiflora Boiss capsule similar to Ibuprofen can decrease the postpartum pain intensity.