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Abstract Background and aim Alexithymia is defined as emotional response inhibition. As well, empathy refers to the ability to put oneself in someone’s position and resilience is the capacity to recover from a series of negative emotional experiences. Considering the psychological distress induced by the coronavirus disease 2019 (COVID-19) pandemic together with academic stress and the role of empathy in physician–patient relationships, the present study was to investigate alexithymia, empathy, and resilience in Iranian medical interns and residents. Materials and methods This cross-sectional study was fulfilled in northern Iran in 2021–2022. In total, 394 medical interns and residents were initially recruited for this purpose. Then, an online sociodemographic survey form (SDSF), the Jefferson Scale of Empathy (JSE), the Toronto Alexithymia Scale (TAS-20), and the Connor–Davidson Resilience Scale (CD-RISC) were completed. The data analysis was performed using the IBM SPSS Statistics (ver.26) software in regard to the p

Abstract Polycystic ovary syndrome is one of the commonest and complex endocrine disorders in females of reproductive age. Attention to self-care behaviors such as health-promoting behaviors can improve physiological and psychological conditions in women with PCOS. This study aimed to determine the efficacy of Social Network-Based Motivational Interviewing on health-promoting behaviors and quality of life of infertile women with polycystic ovary syndrome. In this randomized controlled trial, 60 infertile women with polycystic ovary syndrome were randomly selected and assigned to the interventio (n = 30) or a control group (n = 30). Participants in the control group received routine care. Those in the intervention group received five motivational group sessions in WhatsApp, which were conducted in five groups of six participants each. The data related to health-promoting behaviors and quality of life were collected through an online questionnaire. Both groups were followed up immediately and 2 months after the intervention. Data collected in the two stages were analyzed using the paired-samples t-test, Chi-square, and repeated measures analysis. No significant difference was observed between the two groups before the intervention means health-promoting behaviors and quality of life scores (p>0.05). Immediately and two months after the intervention, the mean scores of health-promoting behaviors and their domains increased in the intervention group. This increase is statistically compared to the first test, and the scores obtained by the control group in the second (p< 0.001, ES = 1.5) and the third test (p< 0.001, ES= 1.3) were significant. The score of the quality of life variable increase was not statistically significant compared to the first test and also to the scores obtained by the control group. However According to the Generalized estimating equations (GEE) test, the changes in quality of life score between the two groups in the three stages of measurement are statistically significant. WhatsApp support increases the health-promoting self-care behaviors rate and has favorable effects on follow-up. Trial registration: Iranian Registry for Clinical Trial (the link to trial: https://www.irct.ir/trial/48089 ). Registered August 11 2020.

Abstract Background and Aim The relationship between psychological factors and treatment outcomes with assisted reproductive technology has sparked considerable debate. This study aims to investigate the emotional risk factors in couples seeking infertility treatment using assisted reproductive technology in Sari, Iran, from 2020 to 2022. Materials and methods This research is a cross-sectional study and emotional risk factors and other related factors were examined using the Persian version of the SCREENIVF demographic, social, and clinical status questionnaire, social, and clinical status questionnaire before using Assisted reproductive technology in 460 infertile couples selected from infertility treatment centers in Sari City, Iran. The samples were randomly selected using a table of random numbers. Data analysis was performed using SPSS version 22 software. Results The mean age of the male and female participants were 31.70 ± 5.71 and 35.22 ± 5.48, respectively. The results regarding emotional risk factors and other related factors revealed that the variables of remarriage (P = 0.048) and exposure of spouse to emotional risk factors (P = 0.001), history of depression disorder (P = 0.007), and history of anxiety disorder (P = 0.009) were significantly correlated with the exposure of women to emotional risk factors. Furthermore, men’s exposure to emotional risk factors was significantly correlated with primary education (P = 0.026) and diploma (P = 0.043) levels, age (P = 0.006), and wife’s exposure to emotional risk factors (P = 0.001). Conclusion By identifying infertile couples who are at risk of emotional risk factors, healthcare professionals can provide appropriate support and interventions to mitigate the emotional challenges associated with infertility. This proactive approach can significantly enhance couples undergoing infertility treatment’s well-being and mental health.

Background and Objectives: This study assesses the vaginal button battery insertion in a child with attention deficit hyperactivity disorder (ADHD). Methods: For the literature review, online databases, such as Google Scholar and PubMed were searched with the following keywords: “Vaginal battery” OR “vaginal button battery” OR “vaginal battery insertion” AND “girl.” The search process considered articles in English with no publication year limitation. The included studies were published from 2005 until 2023. Case Presentation: We presented an eight-year-old, second-grade elementary school girl with ADHD and a history of methylphenidate consumption, referred to the general educational hospital in north Iran with the chief complaint of inserting a vaginal foreign body (VFB). On the night of the event. The child removed a small disc battery of her toys and inserted it into her vagina. Then, she told this to her parents and was referred to the hospital. The psychiatrist’s assessment showed no psychiatric disorder, except for ADHD. The patient’s abdomen was soft in physical examination and had a rebound tenderness complaint. Also, the entrance of the vagina was erythematosus, and vaginal discharge was seen. The primary assessment by pelvic radiography indicated a round button buttery in the upper segment of the rectum. In the surgery room, a gynecologist gently removed the button battery from the wall by rectal examination and milking from the upper under general anesthesia. The patient was febrile in the follow-up for 48 h and discharged with good general health without fever and severe psychiatric symptoms. In the review section of this study, case reports conducted regarding the insertion of battery in the vagina as a VFB in girls were searched and reported. Overall, 15 case reports were included in the literature review. Conclusions: Interdisciplinary cooperation among pediatric clinicians and gynecology specialists in dealing with cases of VFB associated with a wide range of emotional and behavioral disorders, such as ADHD should be considered.

Background: Women have less interaction with the fetus in unplanned pregnancies. This study aimed to determine the effect of an antenatal training program on maternal-fetal attachment in unplanned pregnancies. Methods: This single-blind clinical trial was performed in the north of Iran in 2019. By simple randomization, 76 mothers with unplanned pregnancies were allocated to the intervention and control groups. Mothers in the intervention group attended three sessions (90 minutes per session) of training based on interaction with the fetus in small groups. The control group only received routine care. Data collection instruments included a demographics checklist, London Measure of Unplanned Pregnancy, and Cranley’s Maternal-Fetal Attachment scale. Descriptive statistics, Chi-square, Fisher’s Exact test, t-test, analysis of covariance, and multivariate analysis of variance were used for data analysis. Results: The mean difference of maternal-fetal attachment before and after training was 3.41±2.08 (P=0.112) in the intervention group and 3.96±2.17 (P=0.078) in the control group. However, the differences between and within groups were not significant. The differences in the subscales of attachment with the fetus were not also significant between the groups after the intervention. Although the post-intervention attachment score for unwanted pregnancy was lower than mistimed pregnancy in the intervention (mean difference: 14±3.61) and control groups (mean difference: 3.70±1.87), it was not significantly different based on the type of pregnancy between the groups. Conclusion: Maternal-fetal attachment training did not boost interaction with the fetus in mothers with unplanned pregnancies; thus, deeper psychological interventions are needed.

Background and purpose: The quality of sexual life is one of the important branches of the quality of life and it is a means to examine the relationship between sexual problems and the quality of life. The meaning of life is also one of the indicators affecting the quality of life. Among the country's population, students are exposed to questions about the meaning of life due to being in a period of youth transformation. The purpose of the present study was to investigate the relationship between the meaning in life and the quality of sexual life of married students of Mazandaran University of Medical Sciences and their spouses in 2023. Materials and methods: In this cross-sectional descriptive-analytical study, after being approved by the ethics committee with code IR.MAZUMS.REC.1401.17162, 185 couples of married students of Mazandaran University of Medical Sciences and their spouses were included in the study in May and June 2023 with two stages stratified sampling method with proportional allocation. First, married students of each faculty was determined then participants were included with convenience method. Inclusion criteria were willingness to participate, being Iranian, being married, having a surviving spouse, and Monogamy, while exclusion criteria was unwillingness of the spouse to complete the questionnaire. They completed questionnaires on the Quality of sexual life, the Meaning in life, DASS-21, socio-economic status, and demographic-medical-psychological information form made by the researcher. SPSS 25 software and Pearson correlation coefficient, independent two-sample t-test, one-way ANOVA, and mixed model linear regression with Backward model were used. The drop rate was 20% and the significance level was P

Abstract Aims As a chronic inflammatory disease, endometriosis (EMS) is often associated with pain affecting different aspects of women's lives. Up to now, a wide variety of interventions have been implemented to alleviate pain in patients with this condition, including pharmacological, surgical, and rarely non‐pharmacological ones. Against this background, this review aimed to investigate pain‐focused psychological interventions among EMS women. Methods A systematic review of the articles published in this field was conducted through a comprehensive search on the databases of Scopus, PubMed, MEDLINE, Web of Science, ScienceDirect, the Cochrane Library, PsycINFO, Google Scholar, and Scientific Information Database (SID). The quality of studies was then assessed by the Jadad Scale. Results In total, 10 articles were entered into this systematic review. The findings further revealed that the pain‐focused psychological interventions in patients with EMS were cognitive‐behavioral therapy (CBT) (n = 2), mindfulness therapy (n = 4), yoga (n = 2), psychoeducation (n = 1), and progressive muscle relaxation (PMR) training (n = 1). Besides, the findings established that all the given interventions had improved and reduced pain in women living with this condition. Moreover, five articles were of good quality based on the Jadad Scale. Conclusion The study results demonstrated that all the listed psychological interventions had affected pain relief and improvement in women suffering from EMS. Considering the limited number of studies in this field and the fact that there were only five articles endowed with good quality, more high‐quality studies could provide stronger evidence to support the implementation of the mentioned interventions influencing pain in patients.

Abstract Infertility has been recognized as a distressing experience among couples worldwide, cutting across various cultures. This present study was conducted to assess the impact of a supportive stress management program led by an infertility coach for women undergoing fertility treatment. This randomized controlled clinical trial study was performed on 60 infertile women undergoing assisted reproductive techniques at Maryam Infertility Center located in Sari in 2018. After random allocation in two groups, 30 individuals were in the intervention group and 30 in the control group. The intervention program was implemented according to the infertility coach's counseling protocol in six stages. The control group received only routine ward counseling. In order to measure stress, the Newton Infertility Stress Questionnaire was used firstly before intervention and then after oocyte puncture, embryo transfer, and pregnancy testing. Data analysis was performed using SPSS statistical software version 18 and Shapiro–Wilk, Chi-square, Mann–Whitney, independent t-test, Friedman test, Wilcoxon test, GEE test, and Cohen's effect size. Our analysis approach has also been based on the analysis of (ITT). The significance level was 0.05. The mean ± SD scores of infertility perceived stress before the intervention in the control was 146.16 ± 16.90 and the intervention group was 156.53 ± 9.31, after intervention at the time of oocyte puncture in the controls was 165.36 ± 8.98 and the intervention group was 155.83 ± 10.70, at the day of embryo transfer in the control group was 156.35 ± 14.45 and in the intervention group was 123.58 ± 22.9 and in the pregnancy test day in the control group was 185.76 ± 26.56 and in the intervention group was 127.61 ± 21.57 (P

Abstract Aim This study aimed to investigate psychiatric disorders in Iranian female patients with fibromyalgia (FM). Design Female patients, newly diagnosed with FM, were interviewed by a psychiatrist for psychiatric assessments during a 2‐year period. Methods The diagnosis of the psychiatric disorders was based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5), and sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Results In total, 159 patients with the mean age of 42.15 ± 9.89 were recruited in this study. Over 92% of the cases were also diagnosed with at least one type of psychiatric disorder. Sleep disorders (SDs, 90.57%), mood disorders (MDs, 52.83%), personality disorders (PDs, 40.25%) and anxiety disorders (ADs, 16.98%) were the most prevalent diagnoses among these patients. The logistic regression results correspondingly showed that suffering from Cluster‐B PDs was associated with a higher prevalence rate of somatic symptom disorders (SSDs), with a p‐value of 0.019 and an odds ratio (OR) of 2.7.

Abstract Objective Premenstrual syndrome (PMS) is a clinical condition with physical and psychological symptoms affecting female students' quality of life, social activity, and school performance. Since most studies have focused on adult women, this study aimed to evaluate the prevalence of moderate–severe PMS, premenstrual dysphoric disorder (PMDD), and their related factors in high school students. Methods The participants of this cross‐sectional study, conducted in 2019, were 900 high school students in Sari, north of Iran. They were selected by census method from six high schools. Data were collected using Premenstrual Syndrome Screening Tool and General Health Questionnaire. Results The prevalence of moderate–severe PMS and PMDD were 33.9% and 12.3%, respectively. According to the logistic regression model, dysmenorrhea was significantly associated with a higher prevalence of moderate–severe PMS [adjusted odds ratio (AOR) 2.356, confidence interval (CI): 1.706–3.254, p

Abstract Introduction Selective serotonin reuptake inhibitors are considered the drugs, whose effectiveness in viral pandemics has been studied. The aim of this study was to evaluate of adding fluoxetine to the treatment regimen of patients with COVID‐19 pneumonia. Methods This study was a double‐blind randomized placebo controlled clinical trial .36 patients in the fluoxetine and 36 patients in the placebo group were enrolled. Patients in the intervention group were first treated with fluoxetine 10 mg for 4 days and then the dose of 20 mg was continued for 4 weeks. Data analysis was conducted using SPSS V. 22.0. Results There was no statistically significant difference between the two groups in terms of clinical symptoms at the beginning of the study and also the score of anxiety and depression, oxygen saturation at the time of hospitalization, mid‐hospitalization and discharge periods. The need for mechanical ventilator support (p = 1.00), the need for admission in the intensive care unit (ICU) (p = 1.00), rate for mortality (p = 1.00), and discharge with relative recovery (p = 1.00) were not significantly different between the two groups. The distribution of CRP within the study groups showed a significant decrease during different time periods (p = 0.001), and although there was no statistically significant difference between the two groups on the first day (p = 1.00) and at discharge (p = 0.585), mid‐hospital CRP showed a significant decrease in the fluoxetine group (p = 0.032). Conclusion Fluoxetine resulted in a faster reduction of patients' inflammation without association with depression and anxiety.

Abstract Background and aim Delirium has been presented as the leading cause of sudden change in the mental state of patients with coronavirus disease 2019 (COVID‐19). Given that the delayed diagnosis of such a dysfunction is often associated with excess mortality, it seems essential to devote vastly more attention to this significant clinical characteristic. Materials and methods This cross‐sectional study was performed on 309 patients [viz. 259 cases hospitalized in general wards and 50 individuals admitted to the intensive care unit (ICU)]. For this purpose, a Demographic‐Clinical Information Questionnaire, the Confusion Assessment Method (CAM), the Confusion Assessment Method for the ICU (CAM‐ICU), the Richmond Agitation‐Sedation Scale (RASS) and face‐to‐face interviews were completed by a trained senior psychiatry resident. The data analysis was further done with the SPSS Statistics V22.0 software package. Results Out of 259 patients admitted to the general wards and 50 cases in the ICU due to COVID‐19, 41 (15.8%) and 11 (22%) individuals were diagnosed with delirium, respectively. As well, a significant relationship was observed between the incidence rate of delirium and age (p

Abstract Aim This study aimed to compare the effect of peer education and education provided by healthcare providers on PMS in high school students. Materials and Methods This quasi‐experimental non‐randomized controlled trial with a three‐armed parallel design was performed on 90 students allocated in three groups, namely, education by peer (intervention group 1 = 30), education by a healthcare provider (intervention group 2 = 30), and a control group (n = 30). The primary outcome was a change in the score of PMS, and the secondary outcomes were changes in the general health score and the frequency of premenstrual dysphoric disorder (PMDD). Education about PMS management was held in WhatsApp messenger in six sessions (two sessions per week) for both intervention groups. All three groups received routine school counseling. The researchers applied repeated‐measures ANCOVA, McNemar, and post‐hoc Bonferroni tests. Results Education in intervention group 1 (Partial Eta Squared = 0.67, p 0.05). Conclusion This study suggests education by peers and healthcare providers effects on PMS and general health in adolescents. It suggested that the effectiveness of these approaches be investigated in other adolescents' health conditions.

Abstract Background Neuroleptic malignant syndrome (NMS) is a rare and life‐threatening reaction. The incidence rate of NMS has dropped because of the higher use of atypical antipsychotics, compared with the typical ones. The mortality rate in patients taking injectable antipsychotics has been also by 38%. Aim Here, a case developing the NMS symptoms following Flupentixol (FPX) use was reported. Case presentation The patient was a 46‐year‐old man with the history of schizoaffective disorder (SAD) and recently on six‐weekly doses of long‐acting (LA) typical antipsychotic drugs. He was referred with a fever, sweating, a food intolerance, mutism, and disorientation in 2019. He was presented with generalized rigidity, negativism, and neck stiffness. The patient's initial creatine phosphokinase (CPK) level was 1476 IU/L, which gradually elevated to 3997 IU/L on Day 26. NMS was further diagnosed, in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5) criteria, and the score 9+ in the Naranjo Algorithm as the adverse drug reaction probability scale. Afterward, the patient was treated with bromocriptine at a dose of 5 mg 3 times a day, which progressively reached a maximum of 50 mg. He experienced sepsis and resistant respiratory infection several times. The case was finally discharged after 66 days of hospitalization, with a high level of consciousness, but limited verbal communication, in a fever‐free condition with the oral administration of bromocriptine and lorazepam. Conclusion In conclusion, there were suggestions for the management challenges of NMS in patients receiving LA injectable antipsychotic agents.

Abstract Background and Aim The coronavirus disease 2019 (COVID‐19) pandemic has to date overwhelmed the survivors and the general population. The present study aimed to compare the mental health status and the COVID‐19 event impact between the survivors and the general population in Mazandaran Province, Northern Iran. Design A web‐based cross‐sectional survey was used. Methods This study was performed using convenience sampling. Results In total, 1,766 participants were included in this study. The findings revealed that the posttraumatic stress disorder (PTSD) severity in both outpatient and hospitalized groups was significantly higher than that in the general population. Besides, the levels of anxiety and depression in the group receiving inpatient care and treatment had significantly elevated than those in the general population. Conclusion Given the high prevalence rate of mental disorders, healthcare professionals are recommended to plan for various interventions and support services to boost community mental health status.

Objective To determine the effect of a social network-based cognitive-behavioral intervention on postpartum body image and sexual life of primiparous women. Methods In this single-blind randomized controlled trial, 82 postpartum women were allocated into two intervention and control groups (allocation ratio, 1:1) using permuted block randomization. Primary outcome was change in body image scores between the groups over time. Secondary outcomes were genital self-image, sexual quality of life, and sexual satisfaction. The intervention group participated in eight (2 weeks) 60-minute sessions through WhatsApp (WhatsApp Inc., Mountain View, CA, USA). Data were collected at recruitment, post-intervention, and 1-month of follow-up. Results Cognitive-behavioral intervention had a medium effect on improving body image in postpartum women (partial eta squared, 0.33; P

Background and purpose: Stress and socio-economic and psychological consequences of COVID-19 pandemic have affected family and marital relationships. The present study investigated the frequency of marital conflicts and related factors in Mazandaran province, north of Iran during this pandemic. Materials and methods: In this cross-sectional study, 357 married people were selected by convenience sampling via social networks in 2020. Data were electronically collected using demoghraphic and medical checklist and the Marital Conflict Questionnaire- revised form (MCQ-R). Data were analyzed in SPSS V25. Results: The average age of participants was 38.2±9.9 years. The average duration of marriage was 14.9±10.7 years. The total mean score for marital conflicts was 103.8±28.3 indicating a moderate level of conflict. The respondents reported mild (n=188, 57.7), moderate (n=132, 40.5), and severe (n=6, 1.8) levels of marital conflicts. Significant direct relationships were found between marital conflicts and age, gender, educational level, remarriage, nuclear family or extended family, history of marital conflict before the pandemic, individual or family history of COVID-19, and number of children (P

Abstract Sinus tachycardia and orthostatic hypotension have been so far reported among the negative cardiovascular complications of antipsychotic agents. This study aimed to report a case with bradycardia induced by fluphenazine decanoate administration. The patient was a 29‐year‐old man, admitted to the general teaching hospital in Sari, Iran, with a complaint of abdominal and gastric pain as well as weight loss following 7 months of fasting based on religious delusions. The patient developed bradycardia, 36 hours after fluphenazine decanoate administration. His pulse rate was also 46 beats per min (bpm). The antipsychotic medication was thus held and the patient did not take any drugs. On the 21st day after discontinuing this agent, the pulse rate reached 70 bpm. This case report notifies that much more attention should be paid to all patients before starting fluphenazine decanoate administration, and close cardiac monitoring must be done.

Objective This study aimed to determine the effect of a support program on burden of spouses caring for their partners with breast cancer. Methods This randomized controlled trial was conducted among spouses of women with breast cancer undergoing chemotherapy at a referral chemotherapy center in Iran. They were assigned to intervention (n=40) and control (n=40) groups using permuted block randomization. Three small group sessions lasted 45–60 minutes, followed by three telephone-based sessions, lasting 15–20 minutes (twice a week). The intervention sessions included defining stress management strategies in different situations: strengthening creativity, optimism, and management in planning, and defining the role of the caregiver. Primary outcome was care burden, and secondary outcomes were spouses’ stress, satisfaction with intervention, and partners’ quality of life (QOL). The caregiver burden inventory, depression anxiety stress questionnaire, World Health Organization QOL brief version, and client satisfaction questionnaire were completed before and after the intervention and at a 6-week follow-up. Results Thirty-eight participants in each group with a mean age of 44.24±9.01 years completed the study. Repeated measures analysis of variance showed a significant difference in the care burden (P

Key Clinical Message In some patients, neuroleptic malignant syndrome is accompanied significant high levels of erythrocyte sedimentation rate (ESR), C‐reactive protein (CRP). Abstract Neuroleptic malignant syndrome (NMS) is an idiosyncratic life‐threatening adverse reaction and usually triggered in response to antipsychotic drugs. In addition, leukocytosis and increased muscle enzymes levels (especially creatine phosphokinase) are observed in NMS. In addition, a transient increase in different types of acute phase reactants in NMS has been mentioned. This article describes a woman treated with haloperidol, perphenazine, escitalopram, and alprazolam because she developed catatonic symptoms after psychological stress. She suffered from NMS symptoms and had elevated CRP and ESR levels, among other signs and symptoms. Given the COVID‐19 pandemic and reports of co‐occurrence of catatonia and NMS and COVID‐19 and elevated erythrocyte sedimentation rate (ESR) and C‐reactive protein (CRP), this patient was a diagnostic dilemma. After consultation with the consultation‐liaison psychiatry units, she was managed adequately with electroconvulsive therapy and lorazepam.

Key Clinical Message Quetiapine can lead to the face, extremity and particularly chest wall edema in hospitalized patients in the supine position. Abstract Quetiapine (QTP) is known as an atypical antipsychotic agent with some adverse effects, such as edema. However, along this line, peripheral edema is not a life‐threatening episode, but it is an important side effect affecting medical compliance. Therefore, QTP‐induced chest wall edema with the swellings of the face and the extremities is very rare. This report is about a young man who was admitted in the intensive care unit with multiple trauma (MT). On account of his delirious state, QTP was started at 25 mg and then increased to 75 mg, three times a day. The patient developed swelling of the face, the upper and lower limbs, and the chest wall. After stopping the QTP use, his edema went down. Although there is still speculation about the possible mechanisms of antipsychotic‐induced edema, some studies have pointed to the relationship between dopaminergic antagonism and peripheral edema. Therefore, it is very important to pay close attention to this side effect.

Abstract Aim A widespread outbreak of COVID‐19 is followed by adverse effects on the mental health of the general population. Therefore, this study is an audit to investigate the activities of various organizations during the COVID‐19 pandemic in Mazandaran Province, Iran. Methods The aim of the study was to collect the data, the relevant officials in various organizations and units were contacted to collect the statistics of actions taken in psychology and psychiatry wards. Moreover, databases such as Google Scholar and Iranian resources were searched. Results According to the results, different healthcare systems worked in parallel during the peak of the COVID‐19 pandemic. For example, Mazandaran University of Medical Science [MAZUMS] Health Vice‐Chancellor performed the following activities during this crisis: establishing a virtual crisis management working group, holding a provincial educational committee to train the crisis management teams, organizing virtual psychological intervention teams in the healthcare systems, and so forth. In addition, the mental health activities by Mazandaran Welfare Organization during the COVID‐19 outbreak included providing hostelry free psychological counseling, quarantine boarding and rehabilitation centers, and providing harm prevention protocols of COVID‐19, especially for marginalized regions. In the third level of medical centers, including hospitals, consultation‐liaison psychiatry or psychiatrists and clinical psychologists, therapeutic interventions for comorbid psychiatric disorders with COVID‐19 disease, and online workshops for mental health were conducted to reduce burnout of medical staff and nurses. Conclusion This study can provide a good guideline for different service providers by using the experiences of other centers to achieve better results.

Abstract Aim To determine the effectiveness of the progressive muscle relaxation (PMR) technique on anxiety caused by Covid‐19 in pregnant women under the auspices of comprehensive health service centers in the nineteenth district of Tehran University of Medical Sciences. Method This study is a randomized clinical trial. A total of 126 pregnant women were randomly allocated to the intervention group (N = 63) and control group (N = 63). All participants completed demographic questionnaires and the Corona Disease Anxiety Scale electronically. The intervention was held in six sessions through Sky Room (three times a week). It consisted of training and practicing the PMR. The intervention group was re‐evaluated with the related questionnaires immediately after the intervention and 2 weeks later, and the control group 2 and 4 weeks after the baseline. Results There was a significant difference between the control and intervention groups at the baseline (P = .05). Nevertheless, analysis of variance test results showed that the difference between the intervention and control groups was found to be significantly different statistically; (22.92 ± 6.07) for intervention versus (28.13 ± 6.93) for control, with the second follow up (P = .01). Conclusions Progressive muscle relaxation is used as a useful intervention to reduce anxiety in pregnant women during coronavirus pandemics educated and recommended with more emphasis and sensitivity in pregnancy care by healthcare providers.

Objectives: This study assesses complex factors related to marital and sexual satisfaction among couples undergoing infertility treatment. Methods: This cross-sectional study was conducted with 140 couples who visited fertility centers in Iran, between September 2015 and July 2016. Data collection was done by Marital and Sexual Satisfaction Questionnaires and were analyzed by the IBM SPSS 26 software. Results: There was a significant difference between wives and husbands in the MSQ total scores (p = 0.027). However, there was no significant difference between wives and husbands in the SSQ total scores (p = 0.398). Sexual satisfaction and decision-maker in life among wives and husbands were significant predictors of MSQ. The kind of treatment, cause of infertility and BMI among wives and kinds of treatment, cause of infertility, and decision-maker among husbands were also significant predictors of SSQ. Conclusion: The findings of this study showed that there is a difference between the understanding of marital and sexual satisfaction in wives and their husbands. Healthcare providers need to pay more attention to these differences.

Abstract Background and aim Health care workers (HCWs), mostly frontliners, are encountering numerous physical and psychosocial stressors, and even managing some conflicts over the course of the novel coronavirus disease 2019 (COVID-19). In this respect, the present study was to investigate the prevalence rate of occupational burnout (OB) in such workers during this pandemic. Materials and methods This cross-sectional study was conducted between April 6 and May 30, 2020, via an online survey in 31 provinces of Iran, on HCWs selected based on convenience sampling method. For data collection, a socio-demographic information form and the Maslach Burnout Inventory (MBI) was utilized. Descriptive statistics, Chi-square test, and multivariate regression analysis were also applied to test the research hypotheses. Results In total, 7626 HCWs participated in the present study. Accordingly, 73.2 and 26.8% of the workers were female and male, respectively. As well, 57.8% of the respondents were nurses and 14.4% of the cases were clinicians. Moreover, 44.8% of the participants had thus far worked in isolation wards and 40.3% of these individuals reported working for 4–8 hours with COVID-19 patients. The prevalence rate of OB was 18.3%. Besides, 34.2, 48.7, and 56.1% of the respondents had severe levels of emotional exhaustion (EE), higher depersonalization (DP), and decreased sense of personal accomplishment (PA), respectively. Besides, the HCWs at the age range of 20 to 30, having female gender, no children, and a bachelor’s degree, and working in isolation wards showed the higher levels of OB with reference to the Chi-square test results (p

Background: Hot flashes (HF) are a common symptom during the menopausal transition. It is therefore important to identify effective drugs that can alleviate HF. This study aimed to systematically review published clinical trials on the efficacy and safety of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) in the treatment of HF in healthy menopausal women.Methods: In this systematic review, articles published during 2003-2019 in PubMed, MEDLINE, Web of Science, Scopus, Science Direct, PsycINFO, CINAHL, the Cochrane Central Register of Controlled Trials, and Google Scholar as well as Iranian databases such as SID, and Magiran were searched. The quality of the selected articles was assessed using the Jadad score calculation. Results: Thirty-six articles on randomized controlled trials were included in this study, out of which 27 articles had acceptable, and nine had weak methodological quality. Findings on SSRIs class of drugs indicated that escitalopram, paroxetine, and fluoxetine have higher efficacy and safety in the treatment of menopausal HF than other drugs. Studies on the effectiveness of sertraline, citalopram, and fluvoxamine are limited in number or show inconsistent results. Therefore, further high-quality studies are required to confirm their effectiveness in alleviating HF. Within the SNRIs class, venlafaxine and desvenlafaxine showed significant efficacy in the treatment of menopausal HF. However, studies on the effectiveness of duloxetine are also limited, which requires further research. Conclusion: Most studies have indicated the efficacy and safety of some antidepressants, such as SSRIs and SNRIs, in decreasing the frequency and severity of HF. These drugs are therefore recommended for the treatment of menopausal HF.

Abstract Background: Menopause is a normal physiological phenomenon, closely identified with a great deal of physical-psychological symptoms, including hot flashes (HFs) with a prevalence rate of 20-80%. Various pharmacological and non-pharmacological interventions have been thus far practiced to reduce this common symptom of the menopausal transition. Objective: This systematic review was conducted to evaluate the effects of psychological interventions on menopausal HFs. Materials and Methods: In this review, the databases of Google Scholar, Scopus, PubMed, Web of Science, Science Direct, the Cochrane Library, and Scientific Information Database were searched applying the Boolean searching operators as well as the keywords of `hot flashes', `menopause', `psychological intervention', and `vasomotor symptoms'. Accordingly, a total number of 20,847 articles published from January 2000 to June 2019 were retrieved. After excluding the duplicate and irrelevant ones, the risk of bias of 19 clinical or quasi-experimental clinical trials was assessed using the Cochrane collaboration tool. Results: The interventions implemented in the studies on menopausal HFs included cognitive behavioral therapy, mindfulness-based stress reduction, hypnotherapy, and relaxation techniques. All of the articles reported improvements in HFs in postmenopausal women, except for 4 studies. Conclusion: Based on the findings of this systematic review, psychological interventions, especially cognitive behavioral therapy and relaxation techniques, are potentially effective for vasomotor symptoms and HFs in healthy postmenopausal women, although the quality of published research on this topic is sometimes questionable.

Abstract Background Expectant fathers experience a range of different emotions during their wife’s pregnancy; one of these feelings is fear. It has adverse consequences on both the father and his family. The aim of this study was to investigate the effect of midwifery-led counseling on the fear of childbirth among expectant fathers. Methods A two-armed parallel design randomized controlled trial was conducted from July to August 2020. Fifty expectant fathers with severe fear of childbirth at the 24th–27th weeks of gestation, in the Iranian setting, were assigned to intervention and control groups (allocation ratio1:1) using permuted block randomization. Participants assigned to the intervention group were engaged in six 60–90-min midwifery-led counseling sessions (twice a week) in the Skyroom platform. Measures were administered at recruitment, post-intervention, and one-month follow-up. The primary outcome was the change in fear of childbirth score between groups over time. Secondary outcomes were changes in the General Self-Efficacy score as well as changes in the frequency of the preferred type of delivery between groups over time. Results The mean age of the participants was 31.64 (3.33) years. In the intention-to-treat analysis, the fear of childbirth score in the intervention group significantly decreased (β = − 11.84; 95% Confidence Interval: − 21.90 to − 1.78; P = 0.021) compared to that of the control group. In terms of secondary outcomes, the intervention group showed a significant increase in General Self-Efficacy compared to the intervention group at one-month follow-up measurement (β = 1.43; 95% Confidence Interval: 0.28 to 2.58; P = 0.014). However, the frequency of preferred delivery type was not significantly different between the intervention and control groups (P = 0.139). Conclusions Midwifery-led counseling can be an effective approach in reducing expectant fathers’ childbirth fear with potential clinical significance. Although the inconclusive results imply more research on this issue. Trial registration Registration number: IRCT20150608022609N6 . Registered 12/04/2019.

Background: Nausea and vomiting are considered the most common side effects of chemotherapy, and they can affect different dimensions of the lives of women with breast cancer. Thus, the management of these complications is of great significance. Various interventions are drawn upon to alleviate nausea and vomiting. This review aimed to investigate the effects of psychological interventions on chemotherapy-induced nausea and vomiting among women with breast cancer.Methods: A systematic review of clinical or quasi-experimental clinical trials published from 2000 to 2020 on the effects of psychological interventions on nausea and vomiting induced by chemotherapy in women with breast cancer was conducted via a comprehensive search in web search engines including Google Scholar and PubMed and databases such as Web of Science, Scopus, ScienceDirect, Cochrane Library, Springer, Elsevier, Magiran, and Scientific Information Database (SID). Medical Subject Heading (MeSH) was employed with the following keywords: nausea, vomiting, breast cancer, chemotherapy, and psychological intervention. The quality of the included studies was assessed via the Jadad scale. Results: Nine studies were included in this systematic review. Psychological interventions in chemotherapy-induced nausea and vomiting in women with breast cancer consisted of cognitive-behavioral therapy, progressive muscle relaxation training, yoga, and guided imagery. The results indicated that in all the studies, except one, the interventions improved conditions and reduced chemotherapy-induced nausea and vomiting. Conclusion: The results of this study indicated that psychological interventions such as cognitive-behavioral therapy, progressive muscle relaxation training, guided imagery, and yoga alleviated nausea and vomiting induced by chemotherapy in women with breast cancer. Therefore, it is recommended that these interventions be applied by healthcare providers to ameliorate nausea and vomiting in these patients. The abstract was presented in the 15th International Congress on Obstetrics and Gynecology, Tehran, Iran, 8–11 October 2019, as a poster and published in the congress book.

Abstract Aim The main purpose of this study was to assess the levels of anxiety, depression, and stress among healthcare providers in Iran. Methods This descriptive cross‐sectional survey was performed on healthcare providers selected through the convenience sampling method from April 6 to May 19, 2020, during the COVID‐19 pandemic. To this end, a self‐report web‐based questionnaire made up of a sociodemographic characteristics information form, Depression, Anxiety, and Stress Scale (DASS), and Corona Disease Anxiety Scale (CDAS) was distributed. Descriptive statistics, chi‐square test (χ2), and univariate and multivariate logistic regression models were accordingly practiced to analyze the data using the Statistical Package for Social Sciences (SPSS) software. Results Of 1343 healthcare providers, 45.8% and 73.0% had moderate physical and psychological anxiety symptoms, respectively. The logistic regression model similarly demonstrated that anxiety caused by COVID‐19 was significantly correlated with the age ranges of 41‐50 (P = .007) and 51‐60 (P = .014) years as well as male participants (P

Correction to: Efficacy of Stretching Exercises on Fibromyalgia Impact and Quality of Life in Patients under Medical Treatment: A Randomized Clinical Trial, 2021 Zahra Madani1,2, Sahar Bagheri1, Forozan Elyasi3,4, Maryam Mobini5, Jamshid Yazdani Charati6, Faeze MalekLou7, Hanieh Ahmadi8 1 Assistant Professor, Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, Iran 2 Assistant Professor, Department of Sports Medicine, Traditional and Complementary Medicine Research Center, Mazandaran University of Medical Sciences, Sari, Iran 3 Associate Professor, Psychiatry and Behavioral SciencesResearch Center, Sexual and ReproductiveHealth Research Center, AddictionInstitute, Mazandaran University ofMedical Sciences, Sari, Iran 4 Department of Psychiatry, Faculty ofMedicine, Mazandaran University of Medical Sciences, Sari, Iran 5 Associate Professor, Diabetes Research Center, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran 6 Professor, Department of Biostatistics, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran 7 MD, Sport Medicine Specialist, Tehran , Iran 8 Assistant Professor, Department of Sports Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran In the article published in volume 33, issue 219, 2023, the affiliations of Forozan Elyasi and Faeze MalekLou were published incorrectly, which are now corrected.

Abstract Aim To compare the effect of school‐based education programs, by peer group versus health practitioner on Premenstrual Syndrome (PMS) in adolescent girls. Design Non‐masked three‐armed clinical trial. Methods Ninety 11th‐grade students with moderate to severe PMS will be allocated to Intervention Group 1 (IG1), Intervention Group 2 (IG2) and Comparison Group (CG). Three weeks (six online sessions) of parallel education will be implemented in IG1 by trained peer educators and in IG2 by a health practitioner. The primary outcome will be changes in PMS severity score between three groups over time (measured by Daily Record of Severity of Problems). Secondary outcomes include changes in Premenstrual Dysphoric Disorder and General Health. Data collection will be conducted in two‐time points, at baseline, and at the end of the intervention. Results Our study will explore the effect of school‐based education programs, by peer group versus health practitioner on PMS. This will add to the evidence‐based interventions to PMS management and the effectiveness of peer education in health promotion of adolescents girls.

Abstract Aim To investigate clinical trials affecting anxiety, stress and fear of childbirth in fathers. Design A systematic literature search was conducted based on Cochrane Collaboration statement recommendation and Preferred Reporting Items for Systematic reviews and Meta‐Analyses checklist. Methods With assistance of Medical Subject Headings, keywords were employed to search for relevant trials. Articles published between November 2000–November 2019 were searched in five electronic databases including PubMed, Web of Science, Google Scholar, Scopus and Cochrane as well as Iranian databases. The risk of bias was assessed by Cochrane Risk of Bias Scale. Results A total of eight studies met the inclusion criteria. Interventions were classified into four categories including pre‐natal education, music therapy, massage therapy and relaxation training. The results showed that there is no evidence of a best intervention, but it showed that non‐pharmacological interventions can decrease anxiety, stress and fear of childbirth and increase the positive experience of childbirth in the expectant fathers.

Introduction and purpose: Infertility and its related factors are among the conditions affecting and reducing the quality of life in both physical and psychological dimensions. Given the critical importance of the role played by the quality of life in the success of treatment, the present study aimed to assess the non-pharmacological interventions made to improve the quality of life among infertile women. Methods: A systematic search was conducted on Scientific Information Database, including MagIran, Google Scholar, PubMed, ScienceDirect, Embase, Scopus, and IranMedex from 2010- 2021. Data were extracted from all the studies that met the eligibility criteria based on the aims of the study. A total of 23 related articles were extracted and used. The quality of the articles was assessed based on the Risk of bias Cochrane. Results: A total of 23 articles met the eligibility criteria for a scoping review, 11 studies were published within the last five years, and 13 articles were performed In Iran. Psychological interventions were the most studied, and 15 (65.2%) evaluated studies included multilateral interventions (6;26%) and complementary interventions (2; 8.6%). The majority of interventions improved the quality of life among the studied participants. In this study, the highest risk of bias was related to performance and detection, and the lowest number of articles were related to detection bias. Conclusion: The majority of non-pharmaceutical interventions, especially in the field of psychology, are effective in the enhancement of infertile women’s quality of life. Therefore, it is suggested that special attention be devoted to effective counseling services and planning, along with common infertility treatments, to improve their quality of life. Nevertheless, more culture-based research is required to make more effective interventions and change the policies.

Objective: Attachment is a socio-emotional relationship between the mother and infant that increases the probability of a preterm infant's survival. This study aimed to evaluate the effectiveness of Kangaroo Mother Care (KMC) on maternal attachments of mothers with premature infants. Study design: This quasi-experimental study was performed on 100 mothers of premature infants who were admitted to neonatal intensive care units. A questionnaire comprising demographic information and the Maternal Attachment Scale were used as data collection tools. All data analysis was performed using SPSS software version 25. Significant level is considered P

Abstract Aim To investigate the effect of a supportive program on coping strategies and stress in women with breast cancer. Design A randomized, two‐armed, controlled trial. Methods Sixty women were randomly allocated to intervention group (N = 30) and control group (N = 30). The interventions were held in six sessions, weekly from August 2018–March 2019 It was consisting of education regarding breast cancer; progressive muscle relaxation; stress management; emotional coping; and problem‐solving strategies. Results At baseline, there was no difference between the two groups regarding the mean score of coping strategies and stress. Supportive program group participants experienced a significantly higher increase on their problem‐oriented coping strategies score in comparison with the control group. At the same time, scores in emotion‐oriented coping strategies and stress decreased significantly in the intervention group compared with the control group. Result of this study can be used to develop relevant interventions targeting coping strategies to reduce stress among women with breast cancer.

Background: Due to the fear of childbirth (FOC) and failure to provide painless delivery in Iran, the prevalence rate of elective cesarean section (C-section) performed on request by pregnant women is on the rise. However, no systematic review assessing the results of studies in this respect has been thus far developed. Objective: To systematically review published psychological intervention research reflecting on FOC in Iran. Materials and Methods: In this systematic review, the databases of PubMed, MEDLINE, PsycINFO, Wiley, ISI Web of Science, Scopus, Science Direct, Cochrane Library, Google Scholar, and Scientific Information Database were searched to retrieve the relevant studies. Manual searches were performed to find the relevant articles and finally 21 intervention studies were reviewed. Results: Based on the modified Jadad Scale, a methodological quality (risk of bias) assessment tool, 14 and 7 studies had acceptable or good and low quality, respectively. The included articles covered fear, fear of childbirth, pregnancy, and psychological intervention in Iran. Cognitive behavioral therapy, relaxation techniques, psychological counseling, childbirth preparation classes (CPCs), mindfulness programs, and psychoeducation had been also practiced as the main types of psychological interventions for reducing FOC in pregnant women. Conclusion: There was no clear evidence to establish the most effective method for minimizing levels of FOC in pregnant women. Based on the assessment tool and since most of the studies had moderate or low quality, conducting standard and high-quality randomized controlled trials focusing on FOC in pregnant women is of most importance in Iranian population.

Background: Infertility has been recognized as a stressful clinical condition, significantly affecting couples' emotional functioning. Objective: To investigate the relationship between coping/attachment styles and infertility-specific distress (ISD) in infertile participants. Materials and Methods: Atotal number of 240 infertile participants (120 women and 120 men) who attend the Outpatient Infertility Clinic in Sari, Iran between February and October 2017 were selected using the convenience sampling method. Data were collected using a questionnaire addressing sociodemographic variables. In addition, coping and attachment styles were evaluated via the Coping Strategies Questionnaire and the Revised Adult Attachment Scale by Collins and Read (1990); respectively. Ultimately, the Infertility Distress Scale was used to assess ISD. Results: The mean ISD score was 42.53 ± 9.63. Secure and insecure attachment styles were observed in 37.9% and 62.1% of the cases, respectively. There was a significant difference among ISD and different groups of attachment styles (p = 0.001) and emotion-focused coping style (p = 0.021). However, no significant relationship was found between problem-focused coping style and ISD (p = 0.985). Conclusion: Considering the relationship between coping/attachment styles and ISD, it was recommended to implement stress prevention and coping education within the framework of coping/attachment theories for infertile individuals.

Background: Women with breast cancer undergo painful and distressing treatment procedures. Hypnotherapy and cognitive-behavioral therapy (CBT) could be considered as an effective therapy. Method: In this clinical trial, 50 women aged 25 to 65 were assigned to three groups (CBT, hypnosis, and control groups). Eight one-hour treatment sessions were run for each of the hypnosis and CBT groups. We utilized The European Organization for Research and Treatment of Breast Cancer-specific Quality of Life (QoL), The European Organization for Research and Treatment of Cancer QoL questionnaires, and The Hospital Anxiety and Depression Scale for the evaluation of the QoL, anxiety, and depression at the beginning and end of the treatment, as well as six months post-treatment. Results: The improvements in the stress, depression, and qoL amongst the three groups were significant, although these improvements in CBT group were more than those in hypnosis group, and in hypnosis and CBT groups were not significant. Physical functioning, body image, sexual functioning, arm symptoms, breast symptoms, future perspective, pain, digestive problems, and functional scale significantly changed in CBT and hypnosis groups (p

Abstract Background Fear of childbirth is reported in 13% of fathers, and it may have adverse consequences for the fathers’ health as well as their families. To reduce the fear of childbirth in the expectant fathers, an appropriate screening tool is needed. Due to the lack of a valid and reliable questionnaire to measure fathers’ fear of childbirth, this study was conducted to develop the Fathers’ Fear of Childbirth Scale and evaluate its psychometric properties. Methods This mixed method study was conducted in two phases. In the qualitative phase (or item generation), semi-structured interviews were conducted with 20 expectant fathers, and a literature review was performed to generate the Fathers’ Fear of Childbirth Scale items pool. In the quantitative phase (or psychometric evaluation), reliability as well as face, content, and construct validity of this scale were evaluated. To establish construct validity, exploratory and confirmatory factor analyses were performed. Reliability was evaluated through internal consistency and composite reliability measures. Results The primary version of Fathers’ Fear of Childbirth Scale contained 32 items, which were reduced to 17 items while establishing construct validity. Exploratory factor analysis extracted two factors, namely fear of childbirth process (12 items) and fear of hospital (5 items). These factors explained 50.82% of the total variance. Goodness of fit indices within the confirmatory factor analysis was acceptable. Internal consistency and composite reliability indices of all the factors were greater than 0.70. Conclusion The Fathers’ Fear of Childbirth Scale has a suitable validity and reliability for assessing fear of childbirth in fathers. It is a simple report instrument that can be easily implemented by health care professionals.

Abstract Aim The aim of this study was to investigate the predictive role of marital satisfaction on similarities in parenting styles. Design The present cross‐sectional study was conducted on 617 Iranian father–mother dyads in 2018. Methods During a systematic sampling method, Afrooz Marital Satisfaction Scale and Parenting Styles and Dimensions Questionnaire were administered. The data were analysed using a t test, a chi‐square test, one‐way ANOVA and logistic regression. Results Results showed that 71.47% of the couples exhibited agreement in parenting styles and that 82.50% reared their children in an authoritative manner. The logistic regression indicated that increased marital satisfaction among fathers (AOR: 3.19; CI: 2.06, 4.92) and mothers (AOR: 2.74; CI: 1.76, 4.25) could elevate the odds of correspondence in parenting styles. The findings suggest that agreement on parenting styles should be considered when evaluating marital satisfaction in couples. Intervention targeting marital satisfaction to improve parental agreement is recommended.

Introduction: A person's sexual satisfaction reflects their judgment and analysis of their own sexual behavior. Factors that affect sexual satisfaction vary in different societies and cultures. Aim: This study investigated the determinants of sexual satisfaction in women referred to health centers in Sari, north of Iran, in 2016. Methods: This cross-sectional study investigated 490 women who had been referred to health centers in 2016 and who were qualified for the study; the population was selected using convenient sampling method. Main Outcome Measure: The main outcome of this study was sexual satisfaction that assessed by the Larson's sexual satisfaction questionnaire. Other Data were 2 questionnaires: the general health questionnaire–28 and a researcher-made questionnaire developed on factors related to sexual satisfaction. Data were analyzed with IBM SPSS software using the one-way analysis of variance, Pearson correlation coefficient, and t-test. To determine the predictors of sexual satisfaction, all the significant independent variables were incorporated into a linear regression model. Results: The average age of the women in this study was 33.6 years, and average sexual satisfaction score was 99.26. The results of the linear regression model showed that the spouse's job as a laborer (P = .003), a low income (P

Background: Diabetes mellitus (DM) is a chronic disease inducing short-term and longterm complications including sexual dysfunction (SD) which can consequently reduce patients’ quality of life. Given the limited literature on frequency of SD in men experiencing diabetes in northern Iran, the present study was conducted in the city of Sari in Mazandaran Province, with the aim of investigating SD in men with type II diabetes. Methods: Using a descriptive cross-sectional research design, a total number of 350 male patients suffering from type II diabetes referring to endocrinology clinics in the city of Sari in. The patients were requested to fill out the demographic questionnaire, depression, anxiety and stress scale-21 items (DASS-21) and the 15-question International Index of Erectile Function (IIEF). The data were analyzed using the IBM SPSS statistics software Results: The average period of time in which the patients were facing diabetes was 3.65±5.75 years. The IIEF mean score was equal to 16.98±43.79. Erectile dysfunction (ED) was also evident in 152 patients (62.2%). Moreover, increase in age had significantly decreased the IIEF scores (p

Background and purpose: Patients with systemic lupus erythematosus (SLE) suffer from a variety of psychological problems, including depression, anxiety, and stress. This study aimed to examine the effect of mindfulness-based metacognitive skills training on depression, anxiety, stress, and sense of well-being in patients with SLE. Materials and methods: This randomized clinical trial with pre-test/post-test design was carried out in 60 patients with SLE attending Babol Shahid Beheshti Nephrology Clinic, 2018. They were randomly divided into two groups (n=30 per group). The experimental group received weekly sessions of mindfulness-based metacognitive skills training (1 hr/ 8 weeks), while the control group did not receive any intervention. The patients’ socio-demographic information was recorded and Depression Anxiety and Stress Scale (DASS-21) and Psychological Well-Being Scale (PWB) were administered. Descriptive and inferential statistical methods including generalized estimator equations with autoregressive correlation structure were applied in SPSS V24. Results: In experimental group, the mean scores for depression, anxiety, and stress significantly changed after the intervention (P=0.001). In this group, the post-intervention mean score for well-being also significantly improved (P=0.006). Compared with the experimental group, the control group was not found with any significant changes in depression, anxiety, stress, and well-being. Conclusion: Mindfulness-based metacognitive skills may improve depression, anxiety, stress, and sense of well-being in patients with systemic lupus erythematosus. (Clinical Trials Registry Number: IRCT20171203037723N2)

Background and purpose: Sexual dysfunction (SD) is a common symptom of multiple sclerosis (MS). This study was conducted to determine the frequency of sexual dysfunction and its types in women with MS and identifying the related factors. Materials and methods: A descriptive cross-sectional study was done in female patients (n= 114) attending an outpatient MS clinic in Sari, Iran 2018. The participants included female married patients with no history of relapse and pulse therapy during the past three months, no history of hepatic problem, no history of pschyciateric diseases and pschyciateric medications. Information was collected using the Female Sexual Functioning Index (FSFI). Data analysis was done in SPSS V16 applying correlation test. Results: All patients (100%) reported sexual dysfunction, including painful intercourse (93%), decreased lubrication (80.7%), lack of arousal (43.9%), lack of desire (38%), difficulty in reaching orgasm (36.8%), and lack of satisfaction (36.8%). In this study, 63.1% of the patients experienced mild depression. Significant associations were seen between depression (P=0.007), sphincter problems (P=0.02), and sexual dysfunction. Conclusion: Awareness on the high frequency of sexual dysfunction in MS patients helps to eliminate the underlying causes and improving the quality of life in these patients.

Abstract Objectives The present study was conducted to assess 3(HCWs) during the COVID‐19 pandemic. Methods A total number of 7626 HCWs were included in this web‐based cross‐sectional study, via the convenience sampling technique. To collect the required data, the sociodemographic characteristics information form, the Depression Anxiety Stress Scale‐21 (DASS‐21), and the Corona Disease Anxiety Scale (CDAS) were also employed. In addition, data analysis was performed using the SPSS Statistics software (ver. 24), as well as descriptive statistics, Chi‐square test (χ2), and univariate/multivariate logistic regression models. Results The CDAS results revealed that 47.9% and 70.5% of the HCWs had experienced moderate levels of physical and psychological anxiety, respectively. Based on the DASS results, 44.8%, 43%, and 34.8% of the HCWs had been subjected to depression, anxiety, and stress symptoms during the COVID‐19 pandemic, respectively. The logistic regression models correspondingly showed that depression among the HCWs was significantly correlated with risk factors, such as the age groups of 20–30 years (p = .001), 31–40 years (p = .006), female HCWs (p> .001), history of physical illnesses (p = .004), and history of psychiatric disorders (p> .001). Moreover, factors including the age groups of 20–30 years (p .001), history of physical illnesses (p .001) were assumed as significant predictors of anxiety in these individuals. Besides, factors such as the age groups of 20–30 years (p = .002), 31–40 years (p = .004), female HCWs (p>.001), occupation (p = .016), history of physical illnesses (p .001) could significantly predict the prevalence rate of stress in the HCWs in times of this crisis. Conclusion Given the importance of mental health status among HCWs during the COVID‐19 pandemic, health administrators and policymakers of the Ministry of Health and Medical Education in Iran are suggested to provide psychological screening and supportive care programs for HCWs with the aim of enhancing their mental health and successful coping with critical circumstances.

Background: Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are prescribed widely for the treatment of depression, anxiety disorders and other psychiatric disorders. Although antidepressants are considered as a safety drug category but unexpected cardiovascular events have been reported as the most serious complications. The aim of this study was to introduce a case presentation on bradycardia due to the drug interference of venlafaxine and cyclosporine. Case presentation: The patient was a 38-year old woman diagnosed with systemic lupus erythematosus 5 years ago, who was admitted to a general educational hospital in northern Iran due to intensified rheumatologic symptoms and complaining about abdominal pain. Cyclosporine tab were administered to the patient, 50 mg twice daily. Two weeks after the administration of cyclosporine, the level of blood cyclosporine was checked. The patient became bradycardic after starting a single dose of venlafaxine (heart rate 52 ppm). Cardiac assessment showed no reason for bradycardia and it subsided after a drop of venlafaxine. Conclusion: As a result of the potential adverse drug interactions between cyclosporine and antidepressants such as venlafaxine, physicians should be aware of the possibility of bradycardia in the simultaneous prescription of these drugs in cases.

Background One of the stressful and critical experiences that threat the individual, family, marital, and social stability is infertility. Objective To identify the effects of midwifery-led counselling programs on the perceived stress of the women undergoing assisted reproductive treatment. Materials and Methods In this randomized clinical trial, 50 infertile women who underwent in vitro fertilization treatment for the first time were enrolled in two groups. The intervention group received six sessions of group counselling by M.Sc. midwifery of counseling student and the control group received only the routine care. All participants filled Newton's standard questionnaire before and at the time of puncture, embryo transfer and the pregnancy test. Results The mean ± SD scores for the perceived infertility stress before the intervention in the control and the intervention groups were 167.92 ± 12.14 and 166.75 ± 13.27, respectively. The mean of perceived stress after intervention at the time of oocyte puncture in the control and case group were 177.12 ± 19.37 and 115.75 ± 13.88, at the time of embryo transfer were 179.40 ± 18.34 and 118.08 ± 15.37, and at the time of pregnancy test was 183.76 ± 14.97 and 120.50 ± 16.24, respectively. The perceived stress of infertility after intervention were statistically significant in the two group (p ≤ 0.001). Conclusion Group counselling is one of the effective methods for reducing the perceived stress in the women undergoing assisted reproductive treatment.

Background: Nomophobia is the fear of being disconnected from one’s mobile phone, prevailing in modern area. To the best of our knowledge, no Persian psychometric scales are available for investigating nomophobia among Iranians. Therefore, we here aimed to translate and validate the Nomophobia Questionnaire (NMP-Q) for being used in Iran. Methods:The NMP-Q was translated from English to Persian using a classical “backward and forward” procedure. Exploratory factor analysis (EFA) was carried out to explore the underlying factor structure of the translated questionnaire. A principal component analysis (PCA) approach with varimax rotation was further performed. Findings: 425 volunteer students were included. Among them, 80.2% were 20-30 years old. Men and women constituted 187 (44.0%) and 238 (56.0%) of the participants, respectively. 100 (23.5%) of the subjects were medicine graduates. Using mobile phones for more than 5 years was noted in 215 (50.6%) subjects. Also, 422 (99.3%) subjects connected to the Internet via their cellphones. Regarding cellphone usage, 301 (70.8%) subjects used them less than 5 hours a day, 158 (37.2%) subjects checked their cellphones less than 10 times a day, and 92 (21.6%) subjects checked their cellphones every 20 minutes. Eigenvalues and the scree-plot supported a 3-factorial nature of the translated questionnaire. NMP-Q showed an overall Cronbach's alpha coefficient of 0.93 (the coefficients of 0.90, 0.77, and 0.71 for the three factors, respectively). The first, second, and third factors explained 26.30%, 20.84%, and 17.60% of the variance, respectively. The total score of NMP-Q correlated with the hours spent with mobile phones, the years of using them, and the age. Conclusion: Our findings showed that the Persian version of the NMP-Q was a valid and reliable tool for evaluating nomophobia among Iranians.