Effect of Tele-Medicine on Health Anxiety and Pregnancy-Related Anxiety in Pregnant Women during the COVID-19 Epidemic in Iran

Background

The global spread of the new coronavirus has increased the necessity of innovations to increase the quality of health care. This study was intended to examine the impact of tele-medicine on health anxiety and pregnancy-related anxiety in pregnant women during the COVID-19 epidemic in Iran.

Materials and Methods

This quasi-experimental study was performed between March and May 2020. Sampling was done using multi-stage random sampling method. A total of 104 pregnant women were in two groups (intervention: n = 52, control: n = 52). Data were collected using a demographic and obstetric information questionnaire, the Health Anxiety Questionnaire, and Van den Bergh's Pregnancy-Related Anxiety Questionnaire. The intervention group received counseling services for 2 months by researchers through telephone conversations, text messages, and applications such as WhatsApp, Telegram, and Instagram. In addition to routine pregnancy care, they could contact the researchers by phone and receive the necessary advice in case of any questions, ambiguities, or problems. The control group included pregnant women who received only routine pregnancy care.

Results

After the intervention, health anxiety scores of pregnant women in the control group were significantly higher than those of the experimental group (t98 = 13.54, p < 0.001). Also, the mean (SD) scores of pregnancy-related anxiety in the control group were significantly higher compared with the intervention group (t98 = 3.80, p < 0.001).

Conclusions

Using tele-medicine, especially during the COVID-19 pandemic can reduce unnecessary referrals of pregnant women to medical centers and their risk of developing the disease, on the one hand, and by reducing women's anxiety, however, it can improve psychological consequences.

Estimating the prevalence of dyspareunia according to mode of delivery: a systematic review and meta-analysis

The present study aimed to examine the prevalence of dyspareunia in the post-partum period in relation to the mode of delivery. In this systematic review and meta-analysis, published articles until February 2020 were searched through the related key term based on mesh term in national and international databases. In the initial search, 1391 articles were found that after removing duplicate, unrelated or non-English and non-Persian articles, finally 20 studies with a sample size of 11354 of women who had given birth were introduced in this study. The prevalence of dyspareunia following vaginal delivery, C-section, and instrumental delivery with 95%CI was 42%(31-56%), 26%(19-34%), and 37%(28-46%) respectively. In addition, the prevalence of dyspareunia in primiparous was higher than multiparous (34%vs.24%), in breastfeeding women was higher than non-breastfeeding women (48%vs.33%), in women who non-used hormonal contraceptive methods were higher than who used hormonal contraceptive methods (43%vs.35%) and its prevalence was similar in women with and without episiotomy. The results indicated that vaginal delivery, breastfeeding, used hormonal contraceptive and primiparity have an impact on dyspareunia. Thus, considering the high prevalence of dyspareunia, and its impact on the quality of life of couples in the postpartum period, attention to, planning, and designing effective interventions in this regard are essential.IMPACT STATEMENTWhat is already known on this subject? Dyspareunia is one of the common experiences of women in the post-partum period. One of the most important factors affecting dyspareunia in the post-partum period is the mode of delivery.What do the results of this study add? The present study adds to examine the prevalence of dyspareunia in the postpartum period in terms of the mode of delivery. So far, no study has been found which comprehensively and systematically estimating the prevalence of dyspareunia in relation to the type of delivery mode in women who have given birth recently. In addition to the type of delivery the prevalence of dyspareunia was estimated based on parity, breastfeeding, episiotomy and consumption of hormonal contraceptive status.What are the implications of these findings for clinical practice and/or further research? This finding will be a small step to familiarise physicians and midwives as well as people with the relationship between delivery mode and dyspareunia. In addition, in the absence of medical indications and the possibility of choosing the mode of delivery selectively, help them decide and choose the appropriate method of termination of labour and ultimately improve the mental and physical health of the birthing person, family and community.

The level of satisfaction and quality of E-learning in medical universities of Iran during the epidemic of COVID-19

BACKGROUND

E-learning is web-based learning for education and training. The current global pandemic crisis created due to COVID-19 has made worldwide online learning. This study aimed to investigate the level of satisfaction and quality of E-learning in medical universities from the students' point of view during the epidemic of COVID-19 and assessing the obstacles and solutions proposed to improve the quality of E-learning.

MATERIALS AND METHODS

A cross-sectional, web-based study was conducted among 400 medical university students of Iran during the epidemic of COVID-19. After getting written consent, three parts questionnaire contains demographic, user satisfaction, quality questionnaire, and three open-ended questions were distributed randomly using social media. Descriptive analysis, t-test, Chi-square, and Pearson correlation coefficient were used to achieve the objective of this study, with significance set to P < 0.05. Furthermore, three open-ended questions were reviewed qualitatively and the problems and solutions suggested by the students were reported.

RESULTS

Based on the findings of the descriptive section, 277 of the respondents were girls (69%) with a mean age of 21 ± 2 years. Sixty-nine percent of students were studying in medical sciences universities and 31% were studying in Islamic Azad University. The level of satisfaction was in the upper range of low (34.0 ± 10.0); P < 0.001, and intention to reuse was moderate (23.06 ± 6.0); P = 0.064. Student's perception of quality in most domains was in the upper range of low to medium. User satisfaction, intention to reuse, the quality of knowledge, and participatory quality for evaluating online courses were significantly higher in the Azad University group than in medical universities.

CONCLUSION

Given that this is the first experience in the use of E-learning in Iran, both universities have not yet fully succeeded in satisfying students and it is necessary to increase the quality of E-learning based on student suggestions.

Investigating the association of the dimensions of genital hiatus and levator hiatus with pelvic organ prolapse: a systematic review

BACKGROUND AND HYPOTHESIS

Pelvic organ prolapse (POP) is a very common and distressing problem that affects women's quality of life. This systematic review aimed to investigate the association of the dimensions of the genital hiatus and levator hiatus at rest and Valsalva with POP.

METHODS

The Cochrane Library, PubMed, Scopus, Embase and Web of Science were searched on 25 April 2020. All data were analyzed using Review Manager 5.3.

RESULTS

Of the 1288 papers reviewed, 21 (n = 5145: 2909 women with POP and 2236 controls) were considered for meta-analysis. Compared with the normal pelvic floor group, the urogenital hiatus size in the POP group was significantly higher at rest (mean difference: 0.49; 95% CI: [0.43, 0.55], P < 0.00001) and at Valsalva (mean difference: 0.79; 95% CI: [0.70, 0.89], P < 0.00001). Also, the levator ani hiatus size in the POP group was significantly higher at rest (mean difference: 0.52, 95% CI: [0.25, 0.78], P < 0.0001) and at Valsalva (mean difference: 1.01; 95% CI: [0.73,1.28], P < 0.00001) compared with that in the normal pelvic floor group.

CONCLUSION

This systematic review showed that the sizes of the urogenital hiatus and levator ani hiatus and area of the levator hiatus in the POP group were significantly higher than those in the normal pelvic floor groups in both positions (rest or Valsalva maneuver). Also, in the POP group, the levator hiatus length at rest was significantly lower than that in the Valsalva maneuver.

A Review of Pharmacological Treatments for Vaginal Atrophy in Postmenopausal Women in Iran

Vaginal atrophy is one of the most common menopausal complications and is often overlooked. There are various pharmacological and non-pharmacological treatment approaches to reduce vaginal atrophy; however, no comprehensive study on a convenient, affordable, inexpensive, and noninvasive treatment with fewer complications has been conducted so far. Thus, the current study aimed to provide a systematic review of pharmacological treatment for vaginal atrophy in postmenopausal women in Iran. In this systematic review, all Iranian articles published in Persian or English during 2009 to 2019 were collected and analyzed by searching the Scopus, PubMed, Web of Science, Magiran, Iranian Registry of Clinical Trials (IRCT), and Cochrane Library databases. The inclusion criteria were clinical trials for vaginal atrophy and menopause. Based on the selection criteria, articles with a Jadad scale score of 3 and above were included in the study and qualitatively analyzed. Overall, 15 clinical trials met the inclusion criteria. In total, 12 articles examined the efficacy of pharmacological treatments (including three herbal medicines, three vitamins and dietary supplements, and two chemical drugs) in treating vaginal atrophy in postmenopausal women. Various types of medication have been used to improve vaginal atrophy, and effective treatments include licorice, chamomile, royal jelly, vitamin E, vitamin D, hyaluronic acid, and Vagifem; however, the results of studies on fennel have been inconsistent. However, considering the small number of studies reviewed, further studies with a stronger methodology are needed to confirm the efficacy of these medications.