Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 16 1 2022 02 08 1 8 Farideh Zafari Zangeneh Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran 2021 02 13 2021 07 04 Objective: The purpose of this review was to investigate current knowledge of COVID-19 by highlighting its effect on female reproductive tract. Materials and methods: In this study, all articles related to the effect of SARS, MERS, and CoV-19 viruses on the female reproductive system from 2003 to 2021 were reviewed. Results: The coronavirus enters the host cell by binding to the enzyme that is most abundant in the host lung. The corona or spike (S) protein of this virus is the main tool for binding to the receptor in the host cell membrane and facility the entrance of CoV into the target cells. This receptor is the Angiotensin-Converting Enzyme-2 (ACE2), but the high expression of this receptor can be a mystery to increase infection in host cells. The overexpression of ACE2 in different tissues has a close connection to the severity of this viral infection. Infection in the female reproductive system requires more attention because it may affect the generation and future progeny by damaged gametes. Conclusion: The existing evidence proposes that ACE2 is widely expressed in the reproductive tract includes: ovary, uterus, vagina, and placenta. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/1697

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 16 1 2022 02 08 43 51 Patience Doe School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana Thomas Hormenu Faculty of Science and Technology Education, University of Cape Coast, Cape Coast, Ghana Nancy Innocentia Enyan School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana 2021 04 16 2021 10 17 Objective: The preconception health (PCH) strategy provides a unique opportunity to reduce risk factors for adverse reproductive outcomes before pregnancy. However, many reproductive-aged individuals continue to miss opportunities to improve their health before pregnancy occurs. This study, qualitatively explored strategies required for integrating PCH promotion interventions into routine reproductive health services from university students’ perspectives. Materials and methods: We conducted eight mixed-gender focus group discussions (FGDs) with students in eight schools and faculties in the University from March 2019 to June 2019. Audio-taped data were transcribed verbatim and analyzed manually using inductive content analysis. Results: Three major themes emerged from the analysis of transcripts: interpersonal behavior change strategies, institutional policy directives, public policy interventions, and three main categories with eight sub-categories. The study showed that PCH promotion awareness campaigns, context-relevant service delivery initiatives, institutional and public policy directives are critical approaches for the delivery and uptake of PCH interventions. Participants also recommended prepayment schemes, walk-in services, mobile PCH clinics, and PCH incorporation into university curricula as context-specific strategies for PCH promotion among university students. Conclusion: PCH promotion could be feasible as an integral component of routine reproductive health services for university students. However, multi-level interventions at the student, health service, and institutional levels are necessary to increase awareness and facilitate the request and delivery of PCH services. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/1757

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 16 1 2022 02 08 9 15 Prakriti Singh Shrestha Division of Research and Academic Affairs, Larkin Community Hospital, South Miami, Florida, USA Angela Ishak Division of Research and Academic Affairs, Larkin Community Hospital, South Miami, Florida, USA Upasana Maskey Division of Research and Academic Affairs, Larkin Community Hospital, South Miami, Florida, USA Purushottam Neupane Division of Research and Academic Affairs, Larkin Community Hospital, South Miami, Florida, USA AND University of Health Science, Punjab Medical College, Lahore, Pakistan Sarosh Sarwar Division of Research and Academic Affairs, Larkin Community Hospital, South Miami, Florida, USA Shreeya Desai Division of Research and Academic Affairs, Larkin Community Hospital, South Miami, Florida, USA AND Pramukhswami Medical College, Anand, India Faris Naffa' Division of Research and Academic Affairs, Larkin Community Hospital, South Miami, Florida, USA Claudia Cuevas Lou Division of Family and Community Medicine, Larkin Community Hospital, South Miami, Florida, USA Miguel Diaz-Miret Division of Family and Community Medicine, Larkin Community Hospital, South Miami, Florida, USA 2021 10 08 2021 12 05 Objective: Our review aims to focus on identifying challenges faced by intellectually disabled women (IDW) in receiving gynecological and reproductive care and also highlights evidence based strategies to overcome those challenges. Materials and methods: We conducted a literature review discussing challenges faced by IDW in obtaining healthcare services by thorough search on various electronic databases (PubMed, Google Scholar, and Scopus) starting from 2000 to 28 August 2021 excluding all non-english articles, reviews, editorials and letters to editor. The keywords used for search were “reproductive care”, “gynecologic care”, “intellectual disability”, “mental handicap”, and "mental retardation". Results: The existing literature review showed that IDW have difficulty maintaining menstrual hygiene and lack knowledge regarding contraception use and sexual health resulting in violations of their reproductive rights. Sexually transmitted diseases and cervical cancer are common among IDW due to their vulnerability to sexual abuse. Nulliparity in IDW increases their suspectibility to even breast cancer. Moreover, they face problems with sexually transmitted infection (STI) and cancer screening due to physical barriers for assessment, low socio-economic status, physician-patient communication issues and deficit in skilled providers. Short acting sedatives such as ketamine or midazolam can be used to overcome challenges faced with gynecological and obstetric examination. Finally forced sterilization and institutionalization has been a habitual practice as menstrual hygiene and pregnancy in IDW raise concerns on psychosocial challenges along with associated obstetric complications. Conclusion: Reproductive and sexual health education including contraception use can be provided by using evidence based strategies involving use of pictures, animations and models by adequately trained healthcare providers including midwives. Further research involving IDW is needed to allow state-wise laws and policies to be created to mitigate the challenges and improve health outcomes in this population. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/1937

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 16 1 2022 02 08 52 60 Samira Barjasteh School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran Farnaz Farnam School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran Aymen Elsous Faculty of Medical Sciences, Israa University - Gaza, Gaza strip, Palestine Saharnaz Nedjat Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Saeid Razavi Dizaji Hematology, Immune Cell Therapy, and Stem Cells Transplantation Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran AND Department of Internal Medicine, School of Medicine, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran Zohreh Khakbazan School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran 2021 06 25 2021 10 19 Objective: After developing breast cancer, women experience changes in their sexuality, femininity, and fertility. These changes lead to poor mental health and increased psychological stress. Therefore, this study aimed to investigate the effects of Good Enough Sex (GES)-based, couple-centered group counseling on reproductive and sexual concerns of breast cancer survivors. Materials and methods: This was a quantitative randomized controlled clinical trial (RCT) conducted at Omid Hospital, West Azerbaijan, Urmia, Iran from March 2018 to October 2020. After completing the informed consent forms, 100 women were assigned to the intervention and control groups (50 individuals per group) using a randomized block design. The intervention included four 90-120-minute sexual counseling sessions with 2 and 3 month follow-ups. The data were collected using the socio-demographic and clinical characteristics, the Persian version of Depression, Anxiety and Stress Scale (DASS-21), Reproductive Concerns after Cancer (RCAC) scale, and Female Sexual Function Index adaptation for Breast Cancer patients (FSFI-BC). Data were collected, from control and intervention groups, at three intervals; before, besides two months and three months post intervention, then were analyzed in SPSS 20 using descriptive and repeated measures analysis of variance (ANOVA) test. Results: Significant reduction in the mean score of DASS-21, RCAC and improvement of FSFI-BC is reported between the intervention and control groups in favor of intervention group (P<0.001). However, no significant differences are observed within intervention group over two- and three-months post intervention (P > 0.05). Conclusion: The designed Good Enough Sex (GES)-based, couple-centered group counseling effectively reduced reproductive and sexual concerns of females’ breast cancer survivors. Therefore, these training and counseling programs can be organized by relevant service centers to promote the reproductive health of women with breast cancer.   https://jfrh.tums.ac.ir/index.php/jfrh/article/view/1818

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 16 1 2022 02 08 16 32 Hanie Kheiridoost-Langaroodi Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran Seyed Kazem Shakouri Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran Mahdi Amirpour Nutrition Research Center, Department of Clinical Nutrition, Faculty of Nutrition and Food Science, Tabriz University of Medical Sciences, Tabriz, Iran Amir Mehdi Iranshahi Nutrition Research Center, Department of Clinical Nutrition, Faculty of Nutrition and Food Science, Tabriz University of Medical Sciences, Tabriz, Iran Azizeh Farshbaf-Khalili Nutrition Research Center, Department of Clinical Nutrition, Faculty of Nutrition and Food Science, Tabriz University of Medical Sciences, Tabriz, Iran 2021 09 16 2021 12 05 Objective: To evaluate systematically the therapeutic effects of five herbal medicines (curcumin, black seed, ginger, cinnamon, and flaxseed oil) on bone turnover markers as a primary outcome. Materials and methods: A comprehensive systematic search of the literature was conducted in the electronic databases consisting of the Cochrane Library, MEDLINE, Web of Science, Scopus, Embase, ProQuest, and Google scholar, as well as SID, Magiran, and Irandoc for Persian literature up to December 2020. All Randomized controlled trials and quasi-experiments evaluated the impact of studied herbal medicines on bone turnovers of Bone Specific Alkaline Phosphatase (BSAP), osteocalcin, C-terminal Telopeptide type 1 Collagen (CTX-I), Deoxypyridinoline (DPD) were analyzed. Results: Sixteen interventional studies comprised 968 participants included in systematic review. Ten of eligible studies with 603 participants included in meta-analysis. Curcumin, black seed and flaxseed did not have a significant effect on BSAP (SMD=-1.76, 95%CI: -6.85 to 3.33, p=0.50, I2=0.99, 6 trials, 241 participants), CTx (SMD=-0.17ng/mL, 95%CI:-0.43 to 0.09, p=0.21, I2=1.000, 5 trials, 216 participants), DPD (MD=0.82nmol/mmol, 95%CI:-0.05 to 1.68, p=0.06, I2=0.000, 2 trials, 67 participants), osteocalcin (SMD=-2.02ng/mL, 95%CI:-4.49 to 0.45, p=0.11, I2=0.79, Six trials, 229 participants). As secondary outcomes, femoral neck Bone Mineral Density (BMD) increased significantly (p=0.03, I2=0.12) but lumbar spine BMD didn’t differ (p=0.28, I2=0.97). Curcumin significantly increased total hip BMD (p<0.001, I2=0.12). QiangGuYin containing cinnamon as a combined Chinese medicine had significant effect on P1NP, β-CTx, and BMD. Conclusion: Studied herbs except for QiangGuYin had no significant effects on bone turnover markers. Due to high heterogeneity between trials, further high-quality trials are suggested. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/1915

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 16 1 2022 02 08 61 66 Reena Rani Department of Obstetrics & Gynecology, Maulana Azad Medical College & Lok Nayak Hospital, New Delhi, India Mrinalini Dhakate Department of Obstetrics & Gynecology, Maulana Azad Medical College & Lok Nayak Hospital, New Delhi, India Deepti Goswami Department of Obstetrics & Gynecology, Maulana Azad Medical College & Lok Nayak Hospital, New Delhi, India Sangeeta Gupta Department of Obstetrics & Gynecology, Maulana Azad Medical College & Lok Nayak Hospital, New Delhi, India Sangeeta Bhasin Department of Obstetrics & Gynecology, Maulana Azad Medical College & Lok Nayak Hospital, New Delhi, India Asmita Rathore Department of Obstetrics & Gynecology, Maulana Azad Medical College & Lok Nayak Hospital, New Delhi, India Anjali Tempe Department of Obstetrics & Gynecology, Maulana Azad Medical College & Lok Nayak Hospital, New Delhi, India 2021 07 13 2021 12 05 Objective: This study aimed to assess the exclusive breastfeeding and contraceptive methods among women delivering within 1-week of a positive test for severe acute respiratory syndrome coronavirus- 2 (SARS-CoV-2) infection. Materials and methods: In this study, 106 women with SARS-CoV-2 infection who were either asymptomatic or had mild disease were included. They were admitted for maternity care at a tertiary center between May to September 2020. The data was collected during their hospital stay and subsequently by telephonic or in-person interviews at 4-6 weeks and 8-10 weeks postpartum for contraceptive use, breastfeeding and use of facemask and hand-hygiene. Results: Sixty-three (59.4%) womenons, support from healthcare professionals, and family backing emerging as predominant themes. Conclusion: This study revealed profound physical and mental health challenges compounded by societal stigma and limited resources. Strengthening social support networks, reducing stigma, and promoting patient-centered care are imperative. Targeted interventions are also essential to enhance health outcomes for these young mothers and their children. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/2905 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/2905/703

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 18 4 2024 12 22 253 260 EN Maria Nascimento Department of General and Specialized Surgery, Professional Master's Program in Maternal and Child Health, Faculty of Medicine, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil Lara Marchesi Faculty of Medicine, Department of Clinical Medicine, Universidade Federal Fluminense – UFF, Niterói, RJ, Brazil Wender Soares Faculty of Medicine, Department of Clinical Medicine, Universidade Federal Fluminense – UFF, Niterói, RJ, Brazil Jenaine Rosa Emiliano Faculty of Medicine, Department of Clinical Medicine, Universidade Federal Fluminense – UFF, Niterói, RJ, Brazil Maria Auxiliadora Saad Faculty of Medicine, Department of Clinical Medicine, Universidade Federal Fluminense – UFF, Niterói, RJ, Brazil Glaucimara Hacar Maternity Ward, Rede D’Or São Luiz, Oeste D’Or Hospital, Rio de Janeiro (RJ)- Brazil Gabriel Chiracava Faculty of Medicine, Department of Clinical Medicine, Universidade Federal Fluminense – UFF, Niterói, RJ, Brazil 2024 09 14 2024 11 27 Objective: Stillbirth is a neglected problem that needs to be given a greater visibility, especially in developing countries. This study aimed to describe temporal trends of stillbirth rates disaggregated by maternal and gestational age. Materials and methods: This is an ecological study conducted in Brazil. Stillbirth rates and temporal trends were calculated using data from 2011-2021, considering variables such as gestational age (≥ 22 weeks) and maternal age (10-19, 20-34, and ≥ 35 years old). Stillbirth rates were presented per 1,000 births, and trends were assessed via autoregressive models. Results: There were 228,386 stillbirths in Brazil, corresponding to 1 event per 133 live births at ≥ 22 gestational weeks in singleton pregnancies. At ≥28 weeks, the average stillbirth rates were 139.46 per 1,000 births (28-31 weeks), 36.59 per 1,000 births (28-36 weeks), 6.07 per 1,000 births (28-41 weeks), and 5.94 per 1,000 births (28-42 weeks and more). Data disaggregation by maternal age showed that average stillbirth rates were 7.69 per 1,000 births (mothers aged 10-19 years), 6.90 per 1,000 births (mothers aged 20-34 years), and 10.34 per 1,000 births (mothers aged ≥ 35 years). The temporal trends showed statistically significant increase in stillbirth rates in almost all gestational age strata among adolescent mothers, but not among older women. Conclusion: Older women experienced the highest stillbirth rates in Brazil but with a clear declining trend. The upward stillbirth trends revealed among adolescent mothers suggest that the fetal death prevention must be prioritized in the Brazilian adolescent health policy agenda. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/2914 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/2914/704

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 18 4 2024 12 22 261 268 Hery Bemanana Regional Directorate of Public Health Atsinanana, Toamasina, Madagascar AND University of Toamasina, Madagascar AND Sylababa Association Madagascar 2024 09 25 2024 11 27 Objective: This study aims to analyze the association between the likelihood of giving birth in a healthcare facility and various sociodemographic characteristics in Madagascar. Materials and methods: This study utilized data from the 2021 Madagascar Demographic and Health Survey which included a representative sample of women of reproductive age (15-49 years). The sociodemographic variables analyzed included age, birth order, education level, region residence and economic status with the place of delivery being the primary dependent variable. Data analysis was conducted using R software. A chi-square test was applied to assess associations between variables, with a significance threshold set at 5%. Results: The prevalence of institutional childbirth services usage in Madagascar was 37.4% (35.1-39.7). The results showed that women under 20 years had an assistance rate of 36.7% (33.9-39.4), while the rate for primiparas reached 49.9% (48.5-51.3). Prenatal visits, mother’s age, birth order, region, residence, education level, and economic quintile significantly influenced access to care, with p-values < 0.0001. Only 17.5% (15.6-19.4) of women in the lowest quintile received qualified assistance at childbirth. Conclusion: The results highlight the impact of age, birth order, residence, education level, region and socioeconomic status on access to childbirth services, necessitating a multisectoral approach to improve equity. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/2928 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/2928/705

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 18 4 2024 12 22 269 273 EN Fatemeh Golshahi Department of Perinatology, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Fatemeh Rahimi-Sharbaf Department of Perinatology, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Mahbobeh Shirazi Maternal, Fetal and Neonatal Research Center, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Sara Saeedi Department of Perinatology, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Athar Abdolrazagh Nejad Department of Perinatology, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Sahar Garfami Department of Perinatology, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Nafise Saedi Department of Perinatology, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Jafar Golshahi Department of Cardiology, Isfahan University of Medical Sciences, Isfahan, Iran Zeynab Amiriarya Department of Perinatology, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Narjes Tavakolikia Vice-Chancellor for Health, Tehran University of Medical Sciences, Tehran, Iran Behrokh Sahebdel Department of Perinatology, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran 2024 06 09 2024 09 22 Objective: Amniocentesis and chorionic villus sampling (CVS) are the most widely used prenatal diagnostic methods. Despite their benefits, they can be associated with adverse pregnancy effects, but the exact prevalence of these complications especially in twin pregnancies is not exactly known. Therefore, the present study was conducted to determine post-amniocentesis or CVS complications in twin pregnancies. Materials and methods: This retrospective observational study was conducted on 187 pregnant women who underwent amniocentesis or CVS in the perinatology department of Yas Hospital affiliated with Tehran University of Medical Sciences from January 2011 to March 2020. All participants were evaluated with amniocentesis or CVS by an expert perinatologist. The study outcomes were considered as the occurrence of vaginal bleeding, rupture of the membranes, chorioamnionitis, and abortion. Results: The mean age of women was 33.5 ± 6.5 years. About 90 % of pregnant women underwent amniocentesis and the others underwent CVS. In 132 (70.6%) pregnant women, the most common indication for diagnostic prenatal tests was having high-risk first/second-trimester screening followed by abnormal ultrasound anomaly scan in 31 (16.6%) cases. It was also found that in 80 (42.8%) patients, the placenta site was in the anterior part and 65 (34.8%) in the posterior part. The diagnostic test results were normal in 170 (90.4%) cases, while trisomy 21 was detected in 13 (7%) cases and trisomy 13 in 4 (2.1%) cases. The rate of abortion following CVS or amniocentesis in twin pregnancies was 3.7%, which was not associated with the study variables. Conclusion: The results of the present study showed that the rate of miscarriage following amniocentesis and CVS in twin pregnancies is 3.7%. Therefore, reassuring the parents about the benefits of amniocentesis or CVS rather than their rare complications is necessary. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/2716 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/2716/706

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 18 4 2024 12 22 274 280 Roya Sahebi Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran Jafar Hassanzadeh Department of Epidemiology, Research Center for Health Sciences, Institute of Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran Rezvan Haghighi Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Mehrzad Lotfi Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Alireza Mirahmadizadeh Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran 2024 07 27 2024 09 22 Objective: The widespread utilization of high-resolution computed tomography (HRCT) for diagnosing and management of COVID-19 during the pandemic has prompted worries regarding a potential rise in future breast cancer cases. We aimed to estimate the Life Attributable Risk (LAR) of breast cancer in Shiraz, Iran, linked to HRCT use during the COVID-19 pandemic. Materials and methods: A cross-sectional study was conducted at Namazi Hospital in Shiraz from February 2, 2020, to December 31, 2022.The Imaging Performance Assessment of CT Scanners (ImPACT) patient dosimetry calculator was used to determine organ doses. LAR was computed utilizing the Biological Effects of Ionizing Radiation (BEIR) Committee models. Results: The sample size was 666, with ages spanning from 15 to 95 years. 25% (168) had HRCT more than once (2 to 8 times). The mean and 95% uncertainty limits (UL) for Total LAR of breast cancer, considering both single and multiple doses of radiation exposure, was 217 (95% UL, 194-244) per 100,000 persons. Conclusion: According to our research, the risk of potential breast cancer should not be overlooked. It is advised to use the ultra-low-dose protocol over the low-dose in HRCT. Physicians, pulmonologists, and infectious disease specialists are advised to avoid unnecessary and repeated requests for chest HRCT in a short period. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/2838 https://jfrh.tums.ac.ir/index.php/jfrh/arti