mahdi sepidarkish

Labor pain management is a critical aspect of midwifery care and an essential purpose of childbirth‑related care. There is a need for comprehensive results on relevant non‑therapeutic methods of reducing labor pain. This systematic review and meta‑analysis study was conducted to investigate the effect of yoga practice on labor pain.

We performed a systematic literature search from SCOPUS, PubMed, Web of Science, and Science Direct for relevant studies from January 1, 1990 to June 2, 2022. We selected published quasi‑randomized and randomized controlled trial studies that evaluated the effect of yoga practice on labor pain. Quality research was applied. We pooled the Standardized Mean Dfference (SMD) of labor pain in pregnant women with and without yoga practice during pregnancy using a random‑effects model at 95% Confidence Intervals (CIs).

Nine studies including 660 women were included in the meta‑analysis. Pregnant women in the yoga practice group experienced statistically significantly low labor pain at the beginning of the active phase compared to the control group (SMD: ‑1.10, 95% CI: ‑1.61, ‑0.58, p </em>< 0.001; I2 = 89%). Yoga interventions also reduced the intensity of labor pain in active (SMD: ‑1.32, 95% CI: ‑2.03, ‑0.60, p </em>< 0.001; I2 = 92%) and transition (SMD: ‑1.93, 95% CI: ‑2.87, ‑0.99, p </em>< 0.001; I2 = 92%) phases compared to the control group, respectively.

The results of the study showed that yoga practice during pregnancy reduces the intensity of labor pain in different labor phases. However, these findings should be considered cautiously due to the substantial heterogeneity between studies.

Application and interpretation of statistical significance of association are the basic and necessary principle in medical research. Traditionally, hypothesis testing and reporting p-values are widely used to quantify the statistical significance of observed results. In the last two decades, the calculation of a p-value in research and especially the use of a threshold to declare the statistical significance of the p-value have been challenged. The limitations of p-value, such as the dependence of its value on the sample size and not reflecting the clinical significance, have been repeatedly mentioned. The statisticians and methodologists recommend do not report p-value alone, and reporting of effect size index with corresponding confidence interval is mandatory. However, many researchers do not pay attention to this and do not even interpret the p-value correctly. The present study intended, to provide an integrated instruction for reporting the statistical and clinical significance in medical sciences with the approach of hypothesis testing (reporting p-value).

Application and interpretation of statistical significance of association are the basic and necessary principle in medical research. Traditionally, hypothesis testing and reporting p-values are widely used to quantify the statistical significance of observed results. The majority of published research that involves statistical inference seems to make exclusive use of hypothesis testing, and summarize their findings only to statistical significance. Most importantly, p-value does not provide us with two crucial pieces of information: (1) the magnitude of an effect of interest, and (2) the precision of the estimate of the magnitude of that effect. Currently, most of the reputable journals did not accept statistical significance alone; and there has been increasing attention focused on the Effect size index, confidence limits along with clinical significant. However, there is no single guideline for reporting statistical and clinical significance, and there are inconsistencies between journals. The aim of this paper is to provide a correct and integrated instruction for reporting the statistical and clinical significance in medical sciences with the approach of estimation (reporting confidence interval).

Denture stomatitis is the most prevalent oral mucosal lesion among denture wearers. Because there have been multiple reports of resistance of Candida species to antifungal drugs in the last two decades, if the antifungal properties of Achillea millefolium and Trachyspermum ammi are validated, these compounds may be a suitable adjuvant drug along with the use of common antifungal drugs. Therefore, the current study aimed to assess the antifungal activity of alcoholic extracts of Achillea millefolium and Trachyspermum ammi against Candida albicans isolated from denture stomatitis.

Antifungal sensitivity of 50 isolates of C. albicans with the origin of denture stomatitis to the alcoholic extracts of Achillea millefolium and Trachyspermum ammi plants as well as the antifungal drugs miconazole and nystatin was determined by broth microdilution method and according to CLSI-M27S4 guidelines. The range of dilution for all compounds was 0.016-16 μg/ml. A concentration of compounds that showed at least 50% growth inhibition as compared to the positive control group was considered MIC (minimum growth inhibitory concentration). Statistical analysis was done using SPSS software and the significance level was considered as P<0.05.

The MIC ranges in microbroth dilution method for the antifungal drugs miconazole, nystatin, as well as the alcoholic extracts of Achillea millefolium and Trachyspermum ammi plants on C. albicans, were close to each other, indicating that their effectiveness against C. albicans species does not differ significantly (P<0.05). The Achillea millefolium methanolic extract had the highest and lowest MIC values, with an average of 2.67±2.55 μg/ml and 0.067±0.057 μg/ml, respectively. A significant difference (P<0.001) was observed when the MICs outcomes the herbal alcoholic extracts and antifungal drugs were compared.

Based on the obtained MICs, Achillea millefolium and Trachyspermum ammi alcoholic plant extracts have a lesser efficacy than the antifungal drugs, but even though they may have a lower MIC and more effectiveness than other chemical drugs.

Threatened miscarriage is a common disorder in early pregnancy and is seen in 20% of pregnant women. Currently, there is no effective therapeutic solution for this condition. This study aimed to determine the effects of a special food (fried egg with grape molasses) on threatened miscarriage in combination with conventional therapies.

This randomized controlled clinical trial was conducted on 93 pregnant women with mild or moderate vaginal bleeding up to 16 weeks of gestation in two groups. The control group (n = 47) used progesterone 400 mg suppository daily with abstinence from sexual intercourse and physical activity. The intervention group (n = 46) consumed fried eggs with grape molasses and the routine treatment like the control group. The treatment was considered successful if the pregnancy continued up to 20 weeks. Finally, the risk of abortion (miscarriage rate) and the duration of vaginal bleeding were compared between two groups.

The risk of abortion in the control group was about 26% (12 of 45 pregnancies), while in the intervention group, it was 15% (7 of 45 pregnancies). This result was not statistically significant between the two groups (Risk ratio: 0.69, 95% CI: 0.37-1.30, P= 0.197). Additionally, no significant difference was detected regarding the duration of vaginal bleeding between the intervention and control groups (P= 0.699).

There is no significant statistical relationship between the consumption of “fried eggs with grape molasses” and reduction of abortion risk.

Our objective was to determine the overall prevalence of nonalcoholic fatty liver disease (NAFLD) in women with polycystic ovarian syndrome (PCOS) in our sample population. The second aim was to evaluate the predictive value of body mass index (BMI), waist circumference (WC), and visceral fat for the onset of NAFLD in these patients.

This cross?sectional study was performed on 71 women with PCOS who were referred to Arash Women’s Hospital in Tehran. Demographic and clinical information and anthropometric and biomedical indices were collected by a trained nurse. Liver  ltrasonography was performed for all participants by a radiologist.

NAFLD was identified in 53.5% (n = 38) of subjects and the frequency of mild, moderate, and severe grades were 65.8%, 31.6%, and 2.6%, respectively. BMI and visceral fat of patients with NAFLD were significantly higher than non?NAFLD (P < 0.001). Receiving operating characteristic (ROC) curve analysis revealed that BMI wasthe best indicator of predicting NAFLD (cutoff = 25.5 kg/m2, sensitivity 75%, and specificity 75%), whereas visceral fat (cutoff = 5.5%, sensitivity 79%, and specificity 67%) and WC (cutoff = 89.5 cm, sensitivity 73%, and specificity 64%) were inferior for predicting NAFLD in PCOS patients.

The prevalence of NAFLD in the study population is high. Our findings supported the use of BMI as a simple and practical  redictive factor for the NAFLD onset, with a cutoff level of 25.5. The use of this cutoff level will enable physicians to identify PCOS patients at risk for NAFLD.

Early diagnosis and appropriate treatment of endometriosis are vital and may prevent subsequent complications.

To investigate the diagnostic accuracy of transvaginal ultrasound sonography (TVUS) and transrectal ultrasound sonography for detecting endometriosis considering the age and body mass index (BMI).

This was a retrospective cohort study of 119 women scheduled for surgery in a tertiary health care center for clinically suspected endometriosis. Married and virgin women underwent TVUS and transrectal ultrasound sonography, respectively, before laparoscopic excision of endometriotic lesions.

The accuracy of TVUS in the diagnosis of right endometrioma in women with a normal BMI was superior to that in women with a BMI ≥ 30 (95.6% vs. 75.3%; p < 0.001). For the detection of left endometrioma in women with a normal BMI, TVUS demonstrated a sensitivity of 96.9% and a negative predictive value of 92.9%, which was significantly superior to TVUS in women with obesity (sensitivity: 77.4%, negative predictive value: 58.6%). The accuracy of TVUS in the diagnosis of left endometrioma in women under 35 yr was superior to that in women older than 35 yr (93.2% vs. 77.9%; p = 0.04). Similarly, the accuracy of TVUS in the diagnosis of right endometrioma in women under 35 yr was superior to TVUS in women older than 35 yr (86.5% vs. 73.3%; p = 0.04).

Ultrasound can be a useful technique for detecting endometriosis when used adjunctively with the patient’s history and physical findings, especially age and BMI.

Inflammatory bowel disease (IBD) is a broad term that refers to a group of chronic inflammatory disorders that have an unknown origin and might be associated with other diseases. The aim of this study was to determine the frequency of chronic diseases in patients with IBD.

In this case-control study, 280 patients with IBD were compared with 280 healthy individuals, frequency-matched by age, sex, place of residence and marital status. Random sampling was performed in patients that referred to the internal medicine and gastroenterology wards of hospitals affiliated to Babol University of Medical Sciences. Data collection tools included a demographic questionnaire and a checklist for chronic diseases, which were completed through interviews with the case and control groups.

Two hundred and twenty-nine (81.78%) patients with IBD had at least one chronic disease. Patients with IBD were at increased risks of rheumatoid arthritis (OR= 4.48, 95%CI: 1.48, 13.54, P= 0.008), eye diseases (OR= 3.49, 95%CI: 1.68, 7.28, P= 0.001), liver diseases (OR= 2.74, 95%CI: 1.40, 5.34, P= 0.003 ), anemia (OR = 2.53, 95%CI: 1.56, 4.13, P= 0.000), depression (OR= 2.43, 95%CI: 1.58, 3.74, P= 0.000), skin diseases (OR= 2.36, 95%CI: 1.18, 4.74, P= 0.015) and hypertension (OR= 1.77, 95%CI: 1.06, 2.95, P= 0.028).

  The frequency of chronic diseases associated with IBD has been high, therefore, physicians and health care professionals should consider the possibility of other chronic diseases when dealing with IBD patients.

The most common mental disorders in infertile patients are depression and anxiety. The four-itemPatient Health Questionnaire-4 (PHQ-4) is a widely used tool that consists of the PHQ-2 depression and GeneralizedAnxiety Disorder-2 (GAD-2) scales. Given that PHQ-4 has not been validated in infertile patients, this study aimed toexamine its reliability and validity in this population. Participants in this cross-sectional study consisted of 539 infertile patients from a referralfertility centre in Tehran, Iran. The PHQ-4, Hospital Anxiety and Depression Scale (HADS), World Health Organisation-Five Well-Being Index (WHO-5), Penn State Worry Questionnaire (PSWQ) and demographic/infertility questionnaireswere administered to all participants. Factor structure and internal consistency of PHQ-4 were evaluatedvia confirmatory factor analysis (CFA) and Cronbach’s alpha, respectively. The convergent validity of this scale wasexamined by its relationship with HADS, WHO-5 and PSWQ. CFA results provided support for a two-factor model of PHQ-4. Internal consistency of the PHQ-4 and its subscalesboth were elevated with Cronbach’s alpha coefficients of 0.767 (PHQ-4), 0.780 (PHQ-2) and 0.814 (GAD-2). Inter-itemcorrelations were between 0.386 and 0.639, and corrected item-total correlations were between 0.576 and 0.687. PHQ-4,PHQ-2 and GAD-2 showed positive correlations with measures of HADS-anxiety, HADS-depression, and PSWQ and negativecorrelations with WHO-5, which confirmed convergent validity. Among demographic/fertility variables, we observedthat gender, infertility duration, and failure in previous treatment were correlated with PHQ-4 and its subscales scores. The PHQ-4 is a reliable and valid ultra-brief screening instrument for measuring both anxiety and depressivesymptoms in infertile patients.

Safety signs are an important tool as converting information for recognizing the event, type, severity, and control of actual hazards in the environment.  The main importance of displaying safety signs is to prevent injury and aware people of the potential hazards in particular situations in different environments. The aim of this study was conducted to determine the level of perception of Tehran city train passengers about the existing safety and warning signs and to provide an appropriate solution to improve the perception level at the metro stations.

Because the lack of access to the standard questionnaire in the present research, a researcher-created questionnaire was used based on design and manufacturing criteria, test and installation methods accordance to ISO 9186 and ISO 3864 international standards. For this purpose, by forming an expert panel, the research questions were identified and evaluated in relation to the topic, the degree of clarity, and the ease of comprehension. Stratified random sampling was conducted against 390 persons. And the Chi-square tests for datum analysis were performed using SPSS software.

According to the results, the highest perceived symbols belong to smoking symbol with 98 percent and 97 percent perceive the symbol prohibited entry of domestic animals. Symbol “no entry” with 5 percent of Understanding with the lowest level was understandable. The analytical results of this study can be a direct impact on understanding due to education level (Pvalue <0.001) and negative impact on the understanding of symbols mentioned age and income (Pvalue <0.003).

Considering the increasing development of metro lines and the results of the different understanding of each symbol in order to remove or eliminate the hazards, further studies are a necessity. The use of training for ergonomic redesign symbols is undeniable, and decision makers need to devote appropriate resources to teaching symptoms. The visual components of the environment affect the clarity and readability of the symptoms. The shape and size of a sign and board, as well as the size of the letters and position, are effective in understanding. Therefore, in addition to designing based on the psychological and physiological principles, other important factors such as continuous adjustment of symbols distance and height are necessary. When designing text for signs and signs, the space of letters, the space between the lines, the position of symbols and decorative patterns, the margins and the use of upper or lower case letters (in Latin) are important.

Nowadays, according to the large number of cesarean sections under spinal anesthesia, finding a simple and safe pre-delivery sedation technique which provides satisfaction for mothers with no over sedation and amnesia seems to be necessary. However, there is not enough evidence about the best choice of drug for this purpose. In the present study we aimed in evaluating the clinical effects of different concentrations (0.25, 0.5, 0.75mg/kg) of thiopental Na bolus for the mother’s satisfaction in cesarean section under spinal anesthesia.

Two hundred and forty term singleton pregnant women with normal ASA physical status were scheduled for an elective term cesarean delivery under spinal anesthesia and allocated into four groups. Groups I, II, III received 0.25, 0.5, 0.75mg/kg/IV of Thiopental Na respectively and group IV as the control group received 1.5cc of sterile water,1 min after spinal anesthesia. The level of consciousness with observer assessment of alertness/sedation score (OAA/S) and mother’s satisfaction was considered as primary outcomes.

The level of mothers’ satisfaction in group II was significantly higher than other groups without any over sedation (P<0.001) and no adverse effect on their verbal contact was observed and they could easily communicate. All women could remember their infants. All babies were healthy with no complications and the Apgar scores were the same in all studied groups.

Based on the results of the present study and with comparison of different concenfrations and side effects indicates pre-delivery conscious sedation with 0. 5 mg/kg/IV of Thiopental Na could be a safe and appropriate technique for sedation in cesarean sections surgery under spinal anesthesia.

Infertility is a public health problem and can lead to depressive symptoms. In recent years, the WHO-five Well-being Index (WHO-5) has been used as a screening measure for depression, but study on psychometric properties in people with infertility is scarce. The objective of this study was to examine the reliability and validity of the Persian version of the WHO-5 in people with infertility.

Overall, 539 infertile patients from a referral infertility center in Tehran, Iran in the period between May and Aug 2017, completed the WHO-5, along with other psychological measures: the Patient Health Questionnaire-9 (PHQ-9) and the Hospital Anxiety and Depression Scale (HADS). Construct validity and internal consistency of WHO-5 were evaluated using confirmatory factor analysis (CFA) and Cronbach’s alpha, respectively. Convergent validity was examined by relationship with PHQ-9 and HADS.

The prevalence of poor well-being was 44.3% and that of depression was 18.6%. CFA confirmed the unidimensional factor structure of the WHO-5. Internal consistency of the WHO-5 was good (Cronbach’s alpha=0.858). The WHO-5 significantly correlated with the PHQ-9 (r=-0.522), HADS-anxiety (r=-0.524) and HADS-depression (r=-0.630), confirming convergent validity.

The WHO-5 is a short and easy to use questionnaire with satisfactory reliability and validity that appears suitable for use as a screening test for depressive symptom in infertile people. In addition, the prevalence of depression and poor well-being was very high in this population.

Unintended pregnancy, as one of the main issues in reproductive health, is defined as a mistimed or unwanted pregnancy all over the worlds. This study aimed to determine the prevalence and risk factors of unintended pregnancy among Iranian women. As part of a survey on twin or multiple pregnancies in Tehran, Iran, this cross-sectional study considered a total of 5152 deliveries in 103 hospitals during 2015. The required data were gathered at the time of delivery or within the next 2-3 days from physically unstable women. The sampling was carried out within two weeks. All women, regardless of method of delivery, being primiparous or multiparous, and pregnancy outcome were included in the study. According to the results, the prevalence of unintended pregnancy in Iran was estimated 19.81%. Based on univariate analysis, the mean age of mothers, the mean age of fathers, number of pregnancies, and number of deliveries in unintended pregnancies were significantly higher than those in intended pregnancies. In addition, the prevalence of unintended pregnancy among housewives, as well as women with low levels of education and income was high. According to multiple logistic regression analysis, economic status and number of deliveries were the main predicting factors of unintended pregnancy. In general, the prevalence of unintended pregnancy in Iran is lower than that in other countries. However, preventive actions and health education programs still should be undertaken for mothers in order to minimize the prevalence of unintended pregnancies, thereby reducing the consequences for mother and baby

Neurologic dysfunctions, specifically hearing impairments due to hyperbilirubinemia are ranked among the main concerns in medicine. This study evaluates the prevalence of acute auditory neuropathy (AN) disorders in term neonates with mild to moderate hyperbilirubinemia and low bilirubin-induced neurological dysfunction (BIND) score and the roll of early treatment on reducing their incidence. Fifty one term jaundice neonates with normal newborn exam and total serum bilirubin (TSB) ≥ 15 mg/dL after the third day of birth with normal otoacoustic emission (OAE) test were enrolled. The BIND score assessment for severity of neurologic dysfunction was done. Neonates with low BIND score were divided into two groups based on their TSB levels at the time of admission (15 - 18 mg/dL: Mild-moderate hyperbilirubinemia and ≥ 19 mg/dL: Severe hyperbilirubinemia). ABR was performed within the first 12 hours of their admission and the second ABR was performed before discharge. The 30.60% of neonates with TSB < 19 mg/dl had abnormal ABR. Latency of V, III waves and interpeak interval latency of I-III, I-V waves were detected. Mean latency of wave V and I-V interpeak latency after phototherapy were significantly decreased compared to pre-treatment (P < 0.001). With the prevalence of auditory neuropathy (AN) at lower TSB concentrations (that have traditionally been considered safe) it can be concluded that more attention should be given to this group despite the absence of neurologic signs, and it also shows the sensitivity of early phototherapy to lower bilirubin level.

Infertile women are at a higher risk of sexual dysfunction compared to fertile women. Infertility is a major source of stress, anxiety, and depression, which strongly affects sexual health. The aim of this study is to estimate the prevalence of female sexual dysfunction (FSD) among infertile Iranian women. We searched the main international databases (Web of Science, PubMed, Medline, and Scopus) and national databases (Scientific Information Database, Magiran, and IranMedex) from their inception until April, 2017. Due to heterogeneity between the studies, the extracted data were pooled using a random-effects model by Stata software. Out of 313 retrieved studies, we included 18 studies of 3419 infertile women in the meta-analysis. The pooled prevalence of FSD was 64.3% [95% confidence interval (CI): 53.3-75.3]. Our findings revealed that sexual desire (59.9%, 95% CI: 38.7-81.2) was the most prevalent disorder and vaginismus (19.2%, 95% CI: 11.3-27.2) was the least prevalent among infertile women. The results of our meta- analysis suggested that more than 64% of infertile Iranian women reported sexual dysfunction, which was meaning- fully high. This study also showed that sexual desire was significantly more common than other sexual dysfunction dimensions and the prevalence of vaginismus was the least common.

Background: Assessing the net-results of microsurgical varicocelectomy in infertile men with non-obstructive azoosper- mic (NOA) and clinical varicocele in five years at Royan Institute. Materials and Methods: This is a descriptive retrospective cohort study. A backward-looking review of patients treated for NOA and varicocele from march 2011 to march 2016 was performed. In addition, MDTESE results of 57 patients with NOA and clinical varicocele, with 537 NOA patients without varicocele were compared. Results: Of 57 patients who underwent varicocelectomy, eight patients (14%) had sperm on sperm analysis post-opera- tively. One of the eight patients was single, and one of them had spontaneous pregnancy (1/7) 14%, and one had a child by microinjection (1/7) 14%. Out of these 8 patients, 6 had hypospermatogenesis pathology. Of 38 patients who under- went MDTESE, 14 patients (36%) had sperm on their testis tissues, but one of them had no egg fertilization. Therefore, the fertilization rate was (92%). Of the remaining 13 patients, 3 had live child birth (3/13) 23%. Sperm retrieval rate (SRR) in NOA men without clinical varicocele was lower from those who had varicocele and NOA (22 vs. 36%). Also live birth rate in NOA men with varicocelectomy was higher than NOA men without varicocele (23 vs. 11%). Conclusion: Microsurgical varicocelectomy in NOA men may have positive effects on post-operative sperm in ejacu- late and natural or assisted pregnancies, but it seems that the effect is more significant on MDTESE results and follow- ing successful microinjection. Meanwhile, SRR and live birth rate was higher in our patients compare to NOA men without clinical varicocele.

Endometriosis is a common chronic inflammatory, estrogen-dependent disease with characteristics similar to cancer. Epidemiological studies of the association between endometriosis and breast cancer have yielded inconsistent results. The present study aimed to investigate the association between endometriosis and breast cancer risk factors.
This case-control study (with 222 persons in each group) was conducted in Arash Women's Hospital from 2014 to 2017. Women with laparoscopically proven endometriosis were considered as cases. Controls were selected from women who had previous laparoscopic surgery due to any reason, and the absence of endometriosis was confirmed in them.
Multivariate logistic regression analysis by considering the risk factors (age, body mass index, gravidity, age at first pregnancy, age at menarche, history of breast-feeding, history of oral contraceptive and hormone use, history of miscarriage and induced abortion, breast cancer in first-degree relatives, and physical activity) revealed that endometriosis was positively association with age at first pregnancy (OR = 1.16, 95% CI: 1.08-1.25; P Women with endometriosis have some of the breast cancer risk factors in their history, and these risk factors (gravidity, age at first pregnancy, history of breast-feeding, and OCP or hormone use) can change the risk of endometriosis as they increase or decrease the risk of breast cancer.

Dry cupping has been used as a treatment for abnormal uterine bleeding in Iranian traditional medicine.
The present study aimed at evaluating the usefulness of dry cupping on excessive menstrual blood loss in menorrhagia with a well- validated menstrual pictogram compared to medroxyprogesterone acetate.
A total of 162 women with menorrhagia were enrolled in this prospective, randomized, controlled trial in Iran from 2015 to 2016. Written informed consent was obtained, then, patients were randomly allocated into dry cupping (3 sessions of interrupted and kinetic dry cupping during menstrual bleeding) or medroxyprogesterone acetate (10 mg/day throughout the luteal period) groups using a random number sequence. The number of bleeding days and objective estimation of menstrual blood loss using a pictorial blood loss assessment chart (PBAC) were recorded before the intervention and at specific intervals (1 and 3 months post-intervention).
At 1 and 3 months, PBAC scores were significantly lower in women treated with cupping compared with women treated with medroxyprogesterone acetate. These reductions in PBAC score were 214.9 mL with 95% CI (120.5 to 309.2) greater than medroxyprogesterone acetate at 1 month and 237.3 with 95% CI (143.0 to 331.7) at 3- month follow- up period. Reduction in the number of bleeding days in the cupping group for almost one day was better than the control groups at 1 and 3 months follow- up (Mean difference:-1.03, 95% CI (-1.78 to -0.26), P = 0.007).
Dry cupping is an effective treatment in reducing the intensity of bleeding during the menstrual period compared to medroxyprogesterone acetate.

Gestational weight gain (GWG) can be associated with some adverse maternal and neonatal outcomes. Relatively, in order to investigate the relationship between GWG with cesarean delivery, low birth weight and preterm birth in women with a body mass index (BMI) less than 18.5 kg per square meter, this study was accomplished.
This was a cross-sectional study. Data were collected by 103 trained midwifes from 103 hospitals, which were equipped to obstetrics and gynecology wards, in Tehran (2015). Meaningly, 234 underweight pregnant women who had singleton births were studied. GWG was categorized by institute of medicine (IOM) recommendation.
The prevalence of LBW, cesarean section and preterm birth was 5.94, 56.16 and 7.17%, respectively. The risk of cesarean delivery in women with high GWG was 2.59 times (p=0.018) than those with normal GWG. The risk of preterm birth in women with low GWG was 5.01 times (p=0.019) than those with normal GWG. Considerably, after controlling for confounder variables, no significant association was observed between GWG and low birth weight in underweight women.
In underweight women (BMI less than 18.5 kg per square meter), the risk of preterm birth, and the risk of cesarean delivery, respectively, was increased with GWG less and more than the recommended amounts by IOM

Gestational weight gain (GWG) is an important issue for all pregnant women due to its effect on pregnancy outcomes. Regarding this, the aim of the present study was to assess the relationship of GWG with cesarean section, birth weight, and gestational age at birth in the women with a pre-pregnancy body mass index (BMI) of ≥ 25 kg/m2.
This cross-sectional study was conducted on 2,147 obese or overweight pregnant females who had singleton births as a secondary analysis. The data were collected by filling out a checklist in 103 hospitals, which were equipped with department of obstetrics and gynecology, in Tehran province, Iran, in 2015. Data analysis was performed using binomial logistic regression model in Stata software version 14.
According to the results, the prevalence of cesarean section was 74.35%. Furthermore, the mean GWG was 11.7 kg. The odds of cesarean delivery in the women with low and high GWG were 0.62 times smaller and 1.20 times larger than that for normal GWG, respectively (95% CI: 0.42-0.92, P=0.019 and 95% CI:0.90-1.59, P=0.197, respectively). After adjusting for confounding variables, GWG had no significant association with birth weight and gestational age at birth in the overweight and obese women.
The findings of this study revealed a significant relationship between GWG and cesarean section. Furthermore, the odds of cesarean section in the women with low GWG was less than that in the women with normal GWG. Regarding this, GWG should be considered as one of the determinants of cesarean delivery. Therefore, it is suggested to conduct further prospective cohort studies to clarify the impact of GWG on pregnancy complications.

Polycystic ovary syndrome (PCOS) is a frequent condition in reproductive age women with a prevalence rate of 5-10%. This study intends to determine the relationship between PCOS and the outcome of assisted reproductive treatment (ART) in Tehran, Iran.
In this historical cohort study, we included 996 infertile women who referred to Royan Institute (Tehran, Iran) between January 2012 and December 2013. PCOS, as the main variable, and other potential confounder variables were gathered. Modified Poisson Regression was used for data analysis. Stata software, version 13 was used for all statistical analyses.
Unadjusted analysis showed a significantly lower risk for failure in PCOS cases compared to cases without PCOS [risk ratio (RR): 0.79, 95% confidence intervals (CI): 0.66-0.95, P=0.014]. After adjusting for the confounder variables, there was no difference between risk of non-pregnancy in women with and without PCOS (RR: 0.87, 95% CI: 0.72-1.05, P=0.15). Significant predictors of the ART outcome included the treatment protocol type, numbers of embryos transferred (grades A and AB), numbers of injected ampules, and age.
The results obtained from this model showed no difference between patients with and without PCOS ac- cording to the risk for non-pregnancy. Therefore, other factors might affect conception in PCOS patients.

Caesarean section (CS) rates have risen substantially worldwide over the past decades particularly in Latin America, the Caribbean and Iran. In this way, the aim of the study was to determine the rate of CS among multiparous, and indentifying the related factors.
This cross-sectional study was performed on 2189 multiparous who gave singleton birth in Tehran province, Iran from 6-21 July 2015. Data were collected by a researcher-made questionnaire through interview with mothers and review of their medical records. Logistic regression analysis was used to evaluate factor associated with CS.
The CS rate was 71.8% in this study. In univariate analysis, higher maternal age, parents’ educational level, economic status, body mass index (BMI), parity, infant weight, baby’s head circumference, history of abortion, and use of assisted reproductive technology were associated with CS. Moreover, multivariate analysis has shown a significant relationship between CS and mother’s age, mother’s education, economic status, BMI, parity, infant weight and baby’s head circumference.
The CS rate among multiparous in Tehran is substantially high. Therefore, there are essential requirements for providing immediate strategies (such as education and psychological interventions to increase women’s knowledge about the risks of CS as well as to change women’s attitude toward CS and improving the quality of natural delivery) to reduce CS rate. Furthermore, factors such as mother’s age, economic status, BMI, parity, infant weight and baby’s head circumference were related to CS.

Lack of exercise is inconsistent with healthy lifestyle. In recent years, it has increased in different age groups, particularly in children and adolescents. To implement any health program, we should have a deep understanding of the health program. This study aimed to recognize characteristics of a school-based program for promoting physical activity in adolescents from the perspective of experts and health authorities, as well as student and parent’s overviews. Also, implementation and integration of this program was investigated by faculty members and connoisseur's perspectives.
The qualitative study was performed through in-depth interviews and Focus group discussion (FGD) on faculty members, experts of different ministries and students and parents. Overall, 24 experts, and 6 faculty members and connoisseurs participated in the study. Also, four FGD were held with students and parents. The findings were examined using content analysis.
The results were divided in two parts: A) Existing problems and characteristics of a school-based intervention program for promoting physical activity from the perspective of students, parents and experts of different Ministry B) implementation and integration of the program by faculty members and connoisseur's perspectives. Totally, we identified 3 categories and 28 themes for the section A, and 2 categories and 22 themes for the section B. The following three domains were extracted for the section A including management problems, shortage of resources, and approaches of increasing physical activity. Two domains for the section B were barriers to intersectorial coordination and characteristics of a school-based program. The results of the interviews with faculty members and health authorities led to identify a twentieth-stage framework for implementing the program.
The results indicated a severe lack of human and financial resources, and a coherent and systematic program to promote physical activity in schools. The identified framework can be used for implementing other health interventions.

The multiple pregnancy incidence is increasing worldwide. This increased incidence is concerning to the health care system. This study aims to determine the frequency of multiple pregnancy and identify factors that affect this frequency in Tehran, Iran.
This cross-sectional study included 5170 mothers in labor between July 6-21, 2015 from 103 hospitals with Obstetrics and Gynecology Wards. The questionnaire used in this study consisted of five parts: demographic characteristics; information related to pregnancy; information related to the infant; information regarding the multiple pregnancy; and information associated with infertility. We recruited 103 trained midwives to collect data related to the questionnaire from eligible participants through an interview and medical records review. Frequencies and odds ratios (OR) for the association between multiple pregnancy and the selected characteristics (maternal age, economic status, history of multiple pregnancy in first-degree relatives, and reproductive history) were computed by multiple logistic regression. Stata software, version 13 (Stata Corp, College Station, TX, USA) was used for all statistical analyses.
Multiple pregnancy had a prevalence of 1.48% [95% confidence interval (CI): 1.19-1.85]. After controlling for confounding variables, we observed a significant association between frequency of multiple pregnancy and mother’s age (OR=1.04, 95% CI: 1.001-1.09, P=0.044), assisted reproductive technique (ART, OR=6.11, 95% CI: 1.7- 21.97, P=0.006), and history of multiple pregnancy in the mother’s family (OR=5.49, 95% CI: 3.55-9.93, P=0.001).
The frequency of multiple pregnancy approximated results reported in previous studies in Iran. Based on the results, we observed significantly greater frequency of multiple pregnancy in older women, those with a history of ART, and a history of multiple pregnancy in the mother’s family compared to the other variables.