There were no significant differences in blood glucose levels, insulin sensitivity or lipid profile among the three groups. However, the use of cinnamon and whortleberry in addition to conventional medical treatment is recommended to adjust weight and blood glucose levels in patients with T2DM, respectively.

Objective:The aim of the study was to assess the effect of mindfulness-based stress reduction (MBSR) on anxiety and self-efficacy in coping with childbirth. Material and Methods:This randomized controlled trial was conducted on 70 pregnant women in Abyek city of Qazvin province in Iran. The convenient sampling method was recruited. Samples were assigned to control and intervention groups using random blocks. In addition to routine care, individuals in the intervention group received 6 MBSR training sessions. The data gathering questionnaire in this study included mindfulness, Pregnancy-Related Anxiety Questionnaire, and self-efficacy in coping with childbirth questionnaire. Results:There was no statistically significant difference between the demographic characteristics in the control and intervention groups. The results of the analysis of variance (ANOVA) with repeated measures indicated the effect of time on the change in the total score of anxiety in the intervention group (p = .001). There was a significant difference between the two groups (p = .001). Also, the results of ANOVA with repeated measures showed that time had no impact on the score of self-efficacy in delivery coping (p = 0/1) and that there was no significant difference between the two groups in this respect (p = .6). Conclusion:The result of this study showed that mindfulness reduces anxiety of pregnant mothers, and it is suggested that mindfulness programs be educated for healthcare providers and pregnant mothers to reduce maternal anxiety and improve pregnancy outcomes and delivery. K E Y W O R D Sanxiety, mindfulness, self-efficacy, stress 2 of 7 | ZARENEJAD Et Al.

Background: Pain is a common and unavoidable phenomenon in childbirth, and in terms of severity, childbirth pain is among the most severe pains in human. Objectives: The current study aimed at investigating the effect of localized heat and cold therapy on pain intensity, duration of phases of labor, and birth outcomes among primiparous females. Satisfaction was also compared in the two intervention groups. Methods: The current randomized, controlled trial was conducted on 120 primiparous females in three groups (heat/ cold therapy, and control) from September 2015 to January 2016. Intensity of pain, duration of phases of labor, and birth outcomes were measured before and after intervention in the three groups. Satisfaction with localized heat and cold therapy was compared in the two intervention groups. No intervention was conducted in the control group. Data were analyzed using the Fisher exact, Chi-square, the Kruskal-Wallis, and ANOVA tests with SPSS version 19. Results: After intervention, statistically significant difference was found in the average pain severity respectively among the heat therapy, cold therapy, and control groups in dilations of 5 -6 cm (3.25 ± 0.91, 3.57 ± 1.14, 4.00 ± 1.37) 7 -8 cm (4.08 ± 0.91, 4.88 ± 1.05, 4.97 ± 1.17), and 9 -10 cm (6.00 ± 1.35, 6.40 ± 1.09, 7.80 ± 1.18) in the first and second phase of the labor (6.22 ± 1.13, 7.37 ± 1.08, 7.94 ± 1.08). There was a statistically significant differences in the average duration of first phase of labor, respectively among heat therapy, cold therapy, and control groups (293.70 ± 68.97, 368.57 ± 79.82, 400.86 ± 77.43) and second phases of labor respectively among heat therapy, cold therapy, and control groups (42.85 ± 13.60, 51.71 ± 12.24, 46.85 ± 13.67), but there was no statistically significant difference among the three groups in terms of the average duration of labor in the third phase. No significant difference was observed between heat and cold therapy groups in terms of satisfaction. No significant difference was observed among the three groups in birth outcomes, including the mean first and fifth Apgar scores, time of cuddling newborn, and the first breastfeeding of newborn. Conclusions: Localized heat and cold therapy are non-pharmacological, non-invasive, satisfactory for the primiparous females, and effective methods to control and relieve pain during labor without adverse effects on maternal and fetal outcomes.

Highlights Lethal forms of the disease are associated with cytokine storm. The severity of COVID-19 was associated with abdominal adipose tissue distribution. Exhaustion markers upregulated in T cells and NK cells from COVID-19 patients. There might be a connection between SARS-CoV-2 related mortality and gut microbiota.

Objectives-The accurate, rapid diagnosis of stress urinary incontinence (SUI) in women can profoundly improve their sexual and psychosocial life. In this study, the diagnostic power of SUI was assessed by transperineal ultrasound.Methods-In this hospital-based case-control study, married women who were referred to the gynecologic and ultrasound wards with negative urinalysis and culture results were enrolled by random sampling. Patients with positive cough signs based on the urodynamic testing data were considered cases, whereas control women showed no cough symptoms and were recruited from the same ward.Results-There was a significant difference (P < .001) in bladder neck descent (mean AE SD, 10.89 AE 5.51 versus 7.08 AE 2.60 mm, respectively; P = .0001) and the retrovesical (β) angle with the Valsalva maneuver (144.22 AE 19.63 versus 111.81 AE 24.47 ; P < .001) between the case and control groups. Also, the β angle without the Valsalva maneuver was higher in the case group (112.35 AE 23.10 ) than the control group (120.17 AE 25.16 ; P = .001). There was no case of a urinary leak, urethral diverticulitis, a bladder stone or mass, and cystourethrocele in the patients of each group. The results of multivariate logistic regression with a backward method showed that bladder neck descent (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.09-1.40), the β angles with and without the Valsalva maneuver (OR, 1.1; 95% CI, 1.06-1.13; and OR, 1.04; 95% CI, 1.01-1.06) were the predictors of SUI. A β angle higher than 127 with the Valsalva maneuver, with an area under the curve of 0.89 (95% CI, 0.75-0.96), could very well predict the SUI response. This finding shows that it can be very well used to distinguish between normal and non-normal responses, with 89% sensitivity and 79% specificity.Conclusions-The β angle with the Valsalva maneuver could very well predict the SUI response. Key Words-diagnosis; female urogenital diseases; retrovesical angle; stress urinary incontinence; transperineal ultrasound S tress urinary incontinence (SUI) is one of the crucial pelvic floor disorders, affecting many women around the world. 1 This disease occurs with an incidence rate ranging from 10% to 30% in different ethnicities/races. 2 Stress urinary incontinence is defined as unintended urine leakage by coughing, sneezing, lifting, or laughing, which can rigorously impair the patient's quality of life 3 and negatively affect her social and sexual life. Women with this problem will avoid social gatherings and lose

The Internet has dramatically influenced the introduction of Background virtual education. Virtual education is a term that involves online education and e-learning. This study was conducted to evaluate a virtual education system based on the DeLone and McLean model. : This descriptive analytical study was conducted using the census Methods method on all the students of the Nursing and Midwifery Department of Alborz University of Medical Sciences who had taken at least one online course in 2016-2017. Data were collected using a researcher-made questionnaire based on the DeLone and McLean model in six domains and then analyzed in SPSS-16 and LISREL-8.8 using the path analysis.: The goodness of fit indices (GFI) of the model represent the Results desirability and good fit of the model, and the rational nature of the adjusted relationships between the variables based on a conceptual model (GFI = 0.98; RMSEA = 0.014).The results showed that system quality has the greatest impact on the net benefits of the system through both direct and indirect paths (β=0.52), service quality through the indirect path (β=0.03) and user satisfaction through the direct path (β=0.73).: According to the results, system quality has the greatest overall Conclusions impact on the net benefits of the system, both directly and indirectly by affecting user satisfaction and the intention to use. System quality should therefore be further emphasized, to use these systems more efficiently.

Background Age at the onset of menopause is the most important determinant of women’s future health outcomes. While the basic mechanisms contributing to the onset of menopause are still not fully understood, age at menopause depends on a complex set of various factors. In this regard, the effects of diabetes (DM I/II) on the age at the onset of menopause have received little attention. Methods and analysis Electronic databases including PubMed/MEDLINE, Web of Science, Scopus, EMBASE, and Google Scholar will be searched for articles published during January 2000 to August 2018 and containing combinations of related MeSH terms, i.e., “age at menopause” and “diabetes.” Additional studies will also be extracted from the reference lists of the selected papers, gray literature, and key journals in the field. A set of inclusion criteria will be defined, and all eligible observational studies will be included. Two reviewers will independently conduct the study selection, data extraction, and quality assessment of the selected studies. All cases of disagreement will be resolved through consensus. The methodological assessment of the primary studies will be performed based on the Newcastle-Ottawa Scale (NOS). In case of the availability of sufficient data, fixed or random effects models will be used to combine all data. Heterogeneity will be assessed by I 2 statistic and chi-square test. Stata V.11.1 will be used for data analysis (CRD42017080789). Ethics and dissemination This systematic review will not raise any ethical issues. Journal publication and conference presentations will facilitate the wide dissemination of the findings to relevant clinicians and researchers.

Background: The Internet has dramatically influenced the introduction of virtual education. Virtual education is a term that involves online education and e-learning. This study was conducted to evaluate a virtual education system based on the DeLone and McLean model. Methods: This descriptive analytical study was conducted using the census method on all the students of the Nursing and Midwifery Department of Alborz University of Medical Sciences who had taken at least one online course in 2016-2017. Data were collected using a researcher-made questionnaire based on the DeLone and McLean model in six domains and then analyzed in SPSS-16 and LISREL-8.8 using the path analysis. Results: The goodness of fit indices (GFI) of the model represent the desirability and good fit of the model, and the rational nature of the adjusted relationships between the variables based on a conceptual model (GFI = 0.98; RMSEA = 0.014).The results showed that system quality has the greatest impact on the net benefits of the system through both direct and indirect paths (β=0.52), service quality through the indirect path (β=0.03) and user satisfaction through the direct path (β=0.73). Conclusions: According to the results, system quality has the greatest overall impact on the net benefits of the system, both directly and indirectly by affecting user satisfaction and the intention to use. System quality should therefore be further emphasized, to use these systems more efficiently.