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The treatment of infertile people is generally time-consuming and requires frequent and long-term visits and providing dignity-based services. Due to the different perceptions and experiences of people and the lack of a specific study to explain the concept of dignity-based care, this study aimed to explain the concept and dimensions of dignity-based care in infertility treatment services. This was a qualitative study with a conventional content analysis approach. Fifty participants (20 infertile women, 16 infertile men, and 14 key informants) were recruited using a purposive sampling method from an educational center of Mazandaran University of Medical Sciences and a private infertility center in Mazandaran -Iran in 2023. Sampling was continued until data saturation. Data were collected using in-depth and semi-structured individual interviews. The data were also analyzed using the conventional content analysis method and the steps suggested by Grandheim and Lundman. Also, Lincoln and Guba's criteria were used to check the trustworthiness of the data. The content analysis demonstrated 43 codes in 11 sub-categories and 4 categories. These categories are \"conserving dignity in providing care\", \"making the information accessible and obtaining informed consent for care procedure\", \"providing professional care and standard services\", and considering cultural and social aspects of infertility. The categories were used to explain the concept and dimensions of dignity-based care in infertility treatment services which are showing the multidimensional aspects of this concept. Dignity-based care in infertility treatment services means \"conserving dignity in providing care services; making the information accessible and obtaining informed consent for care procedure; providing professional care and standard services; and considering cultural and social aspects of infertility.\" This concept can be used in future policy-making and planning, and appropriate support should be taken into account to improve the quality of infertility treatment services.

Background Generally, infertile men hide their depression, which can threaten their health and lower their quality of life. Given the role of depression and its impact on people's health, this systematic review and meta-analysis aimed to investigate the prevalence of depression in infertile men. Methods This research is a systematic review and meta-analysis based on preferred reporting items for systematic reviews and meta-analyses (PRISMA). Using the keywords of \"Depression\", \"Emotional Depression\", \"Infertility\", \"Prevalence\", and \"Epidemiology\", all English language articles were searched in international databases (PubMed, Cochran library, Web of sciences, Scopus, Embase, PsyINFO, and Google scholar) by two reviewers independently and without considering the time limit until September 2022. Title, abstract, full text and quality of each study were evaluated by two reviewers independently using the Newcastle–Ottawa Scale checklist. The results were analyzed using programming language and R software, and I 2 test and Egger's Test were used to check heterogeneity and publication bias, respectively. Results Twenty-two studies were included in the systematic part of this study; and 8 different measurement tools were used to identify depression. Then, based on the possibility of meta-analysis, 18 studies were included in 4 subgroups. Given the heterogeneity of the articles, random effect model was used. The overall prevalence of depression in infertile men was 18.30%. The lowest and highest overall prevalence of depression in men was reported to be 14.04% and 23.63% in the Zung Self-Rating Depression Scale (ZDS) and the Depression Anxiety Stress Scales (DASS) tools, respectively. The overall prevalence of depression among infertile men was reported to be 18.55% and 16.75% using the Beck Depression Inventory (BDI) and the Hospital Anxiety and Depression Scale (HADS) tools, respectively. Conclusion Based on the findings of this study, the significant prevalence of depression in infertile men requires a specific attention and planning. The study revealed varying degrees of depression among infertile men, emphasizing the importance of assessing their mental health, specifically in terms of depression, during infertility treatments as a hidden variable. It is strongly recommended to develop training programs for health service providers to effectively utilize diagnostic tools in this particular field.

Background Men experiencing infertility encounter numerous problems at the individual, family, and social levels as well as quality of life (QOL). This study was designed to investigate the QOL of men experiencing infertility through a systematic review. Materials and methods This systematic review was conducted without any time limitation (Retrieval date: July 1, 2023) in international databases such as Scopus, Web of Science, PubMed, and Google Scholar. The search was performed by two reviewers separately using keywords such as QOL, infertility, and men. Studies were selected based on inclusion and exclusion criteria. The quality of the articles were evaluated based on the Newcastle-Ottawa Scale. In the initial search, 308 studies were reviewed, and after removing duplicates and checking the title and abstract, the full text of 87 studies were evaluated. Results Finally, 24 studies were included in the final review based on the research objectives. Based on the results, men’s QOL scores in different studies varied from 55.15 ± 13.52 to 91.45 ± 13.66%. Of the total reviewed articles, the lowest and highest scores were related to mental health problems and physical dimensions, respectively. Conclusion The reported findings vary across various studies conducted in different countries. Analysis of the factors affecting these differences is necessary, and it is recommended to design a standard tool for assessing the quality of life of infertile men. Given the importance of the QOL in men experiencing infertility, it is crucial to consider it in the health system. Moreover, a plan should be designed, implemented and evaluated according to each country’s contex to improve the quality of life of infertile men.

Background Women with medical problems during pregnancy, including women with Gestational Diabetes Mellitus (GDM), experience an increased prevalence of mental health disorders which can affect their quality of life. This study aimed to assess the relationship between GDM-related quality of life and depression, anxiety, and stress. Methods This analytical cross-sectional study was performed on 150 women with GDM. The participants were selected using a multi-stage sampling including quota and then randomized method from maternal care centers affiliated with Shahid Beheshti University of Medical Sciences, Tehran-Iran. The data were collected using a personal information questionnaire, the GDM-related quality of life questionnaire (GDMQoL-36), and the depression, anxiety, and stress scale (DASS). The data were analyzed using SPSS-23 software and statistical tests of coefficient Spearman’s correlation, t -test, analysis of variance, and multiple linear regression. Results The mean ± SD score for the GDM-related quality of life and the DASS scale were 55.51 ± 8.87 and 27.12 ± 19.43%, respectively. Different degrees of depression, anxiety, and stress were present in 40, 61.3, and 42% of women, respectively. The total score of GDM-related quality of life had a significant negative correlation with the total score of DASS and the scores of the subscales including depression, anxiety, and stress ( P  < 0.001). There were significant correlations between the total score of GDM-related quality of life with age, BMI, length of marriage, educational level of the woman and her spouse, the occupation of the woman and her spouse, income, and economic class of the family. Multiple linear regression revealed that depression, education, and job are predictive factors for GDM-related quality of life. Conclusion GDM-related quality of life is related to some mental disorders. Therefore, it is important to consider the mental health promotion of pregnant women with GDM in future prenatal health programs to improve their quality of life. This also shows the importance of integrating mental health promotion strategies to enhance the quality of life of pregnant women with GDM.

Background Infertility in men causes problems in various aspects of their lives, including personal, family and social life. One of the most important of these problems is anxiety. Anxiety in infertile men can affect their health, quality of life, and response to treatment, highlighting the significance of anxiety in these men. Thus, this systematic review and meta-analysis was conducted to investigate the prevalence of anxiety symptoms in infertile men. Methods To conduct this review study, two researchers independently searched international databases such as PubMed, Cochrane Library, Web of sciences, Scopus, PsyINFO, and the Google scholar search engine in English without considering any time limit until January 2, 2024. Keywords such as \"anxiety,\" \"infertility,\" \"prevalence,\" and \"epidemiology\" were used, taking into account the specific search method of each database. Using the Newcastle–Ottawa Scale (NOS), the quality of the articles was evaluated by two researchers independently. Results In the systematic part of the study, 27 studies were included, and given the variety of measurement tools (8 different tools) used to investigate anxiety symptoms in infertile men, 24 studies were analyzed in five subgroups of tools. The pooled prevalence of anxiety symptoms in infertile men was 21.37% (95% CI: 15.73–27.02). The lowest and highest prevalence of anxiety in infertile men were related to the Beck anxiety inventory (BAI) and Depression Anxiety Stress Scales (DASS), accounting for 7.08% (95% CI: 3.27–10.90) and 34.90% (95%CI: 28.90–40.90) values respectively. This prevalence was 19.80% (95%CI: 9.01–30.59) for the Hospital Anxiety and Depression Scale (HADS), 30.06% (95%CI: 18.59–41.52) for the Spielberger Trait Anxiety Inventory (STAI-T), and 18.52% (95%CI: 7.76–29.29) for the Self-Rating Anxiety Scale (SAS). Conclusion The results of this systematic review and meta-analysis indicated that the prevalence of anxiety symptoms in infertile men requires special attention to healthcare planning. The healthcare system of different countries should evaluate the symptoms of anxiety in infertile men and take appropriate measures to reduce them according to the culture of the countries. It is recommended that all infertile couples be assessed for anxiety symptoms using a standardized tool during their initial evaluation.

Background Considering ethical issues in midwifery care is essential for improving the quality of health services and the client's satisfaction. This study aimed to develop and validate the code of ethics for Midwives in Iran (ICEM). Materials and methods This was a mixed sequential study that was performed in three phases including a qualitative study, a review, and the content validity assessment. The first phase was a qualitative study with a content analysis approach. The data were collected by conducting in-depth semi-structured individual interviews with 14 midwifery and ethics experts. The purposive sampling method was used to recruit the participants and sampling continued until data saturation. The data were analyzed using the conventional content analysis described by Graneheim and Lundman. Lincoln and Guba’s criteria were used to confirm the trustworthiness of the data. Then, a narrative review of the selected national and international codes of ethics for Midwives was performed to complete the items of the ICEM. For validity assessment, the face and content validity of the items of ICEM was assessed by 15 experts to calculate the content validity ratio (CVR) and index (CVI). Results Fourteen experts were interviewed in the qualitative phase, and 207 codes were extracted from a content analysis which were categorized into 23 sub-categories and 6 main categories. The extracted codes were considered as the items for ICEM that were completed by a review of the selected national and international code of ethics for Midwives. The content validity and ratio assessment of the items demonstrated an average CVI = 0.92 and CVR = 0.85. Then, the final version of ICEM was developed with 92 items in 6 domains about; 1) \"professional Commitments\" with 30 items; 2) \"providing midwifery services to the client and her companions” with 26 items; 3) “relationship with colleagues\" with 11 items; 4) “herself” with 6 items; 5) “education and research” with 8 items; and, 6) “management” with 11 items. Conclusion ICEM was prepared with 92 items in six sections that facilitate its use for midwives who are working in the different fields of care, counseling, education, research, and management. In this new version of the ICEM, the items related to recent social-, scientific, and technical improvements were considered for providing ethical midwifery care.

Background Stress is gender-specific and differs between in infertile women and men Therefore, according to the importance of this issue, this systematic review and meta-analysis was conducted to investigate the difference in stress in infertile women and men. Methods This a systematic review and meta-analysis in accordance with PRISMA guidelines was conducted without time limit until August 20, 2024 through searching in the international database (PubMed, Web of sciences, Scopus), and the Google Scholar search engine using the keywords of infertility and stress. The words were combined using AND and OR, and the specific search strategy for each database was used. All articles retrieved from the databases were imported into EndNote 7 software. Duplicate records were removed, and studies were then screened according to the predefined inclusion and exclusion criteria. The quality of the articles was assessed by two reviewers independently using the Joanna Briggs Institute (JBI). The analysis was performed using STATA 18.0. Cohen’s d index was used to examine the effect size. Results The systematic part of the study included 53 studies with a total sample size of 21,355 infertile people, 12,913 men and 8,442 women. Nine questionnaires including the Fertility Problem Inventory (FPI), the Perceived Stress Scale (PPS), the Perceived Stress Questionnaire (PSQ), Booklet contains several questions related to reproductive health, stress, social relations, coping, and well-being (The COMPI questionnaire), Depression Anxiety and Stress Scale (DASS), the Psychological State of Stress, Specific stress symptom scale, Treatment related Stress Scale (TTS), and the Infertility-Related Stress Scale (IRSS) were used in this study. Given the fact that at least 3 studies are needed to perform a meta-analysis, it was only possible to compare the stress of infertile men and women on the FPI questionnaire and its dimensions. The difference in the total stress score of infertile men and women was 0.33 (95%CI: 0.23–0.44, P ˂0.001), and in the dimensions of the FPI questionnaire, it was 0.35 (95%CI: 0.12–0.59, P  < 0.001) for social concern, 0.35 (95%CI: 0.08–0.61, P  = 0.005) for sexual concern, and 0.31 (95%CI: 0.19–0.43, P  < 0.001) for need for parenthood. The difference between women and men was significant, and women’s stress score was higher than men’s. Conclusion The stress in infertile women and men is an important issue that requires attention and planning and affects both sexes. It is suggested that couples’ stress be assessed in infertility evaluations using standard tools, and that appropriate planning for screening and counseling in this area be designed, implemented, and evaluated in accordance with the culture of each country.

Introduction Ethics is an important aspect of midwifery care. A code of ethics in midwifery can provide a general framework for ethical behavior among midwives and enhance the quality of midwifery services. However, there is no tool to assess adherence to codes of ethics in midwifery. This study aims to design and evaluate the psychometric properties of a tool to measure Adherence to the Code of Ethics in Midwifery (ACEM). Methodology This was a methodologic study based on the steps described by Waltz for tool development. The concept of ethics and the codes of ethics were used to design the preliminary tool. Then qualitative and quantitative face and validity assessments were performed. The construct validity was assessed using Exploratory Factor Analysis (EFA) on 200 samples through a cross-sectional study. The reliability was evaluated by stability and internal consistency assessment using the test re-test method and by intra-cluster correlation coefficient (ICC) calculation. Absolute reliability was also measured by calculating the standard error of measurement (SEm) and minimum detectable change (MDC) indexes. Finally, Confirmatory Factor Analysis (CFA) was implemented by another cross-sectional study on 200 samples using Structural Equation Modelling (SEM) and calculating the fit indexes of the model. Sampling was conducted using a convenience sampling method among midwives working in various departments (public hospitals, private hospitals, health centers, university faculty members, university staff, research centers, headquarters, and private offices) across four regions of Iran: North, South, East, and West. The sampling was carried out electronically via Google Forms, and the questionnaire link was distributed to eligible individuals through the university of medical sciences, the deputy of health and medical services, and medical council of the Islamic republic of Iran. Results The preliminary tool was developed with 92 items. After the face and content validity assessment, the items were reduced to 55. The validity assessment showed S-CVI = 0.94, I-CVR ranges > 0.88, Kappa *>0.6. These values ​​indicate that the tool has appropriate content validity. The EFA resulted in the design of the ACEM with 42 items in 4 factors including; “Professional commitment (17 items)”, “client-centered service (11 items)”, “Professional management (7 items)”, and “Standard services (7 items)”. These four factors explained 65.912% of the variance of ACEM. Intra-class correlation coefficient (ICC) of the entire tool was 0.98 (CI 95%: 0.97–0.99) and Internal consistency with α-Cronbach calculation for the entire questionnaire was 0.98 Considering that it is above 0.8, it is very good reliability. The standard error of measurement) SEM (for the entire instrument is 0.74. This means that an individual’s score on the instrument may vary by ± 0.74 upon repeated testing. The minimum detectable change (MDC (for the entire instrument is 2.05, indicating that a change of at least 2.05 points is needed to be considered a true change beyond measurement error. Since the percentage of minimum detectable changes for each dimension and the entire instrument is less than 30%, this level of sensitivity is acceptable. The findings of the CFA were completely consistent with EFA and Structural Equation Modelling (SEM) showed all fit indexes in the acceptable levels. Conclusion The ACEM-42 is a valid and reliable tool to assess adherence to codes of ethics in midwifery practice. ACEM-42 can show the ethics-related gaps in midwifery services and so it can be used for improving ethics and quality of midwifery services. It could be integrated into routine practice or training programs and used to evaluate midwifery personnel.

Cyclic Mastalgia (CM) is the most common breast complaint among reproductive-aged women and can affect their quality of life. The exact etiology is not completely understood, but several factors are suggested to be effective. This study aimed to assess the relationship of some possible related factors with CM. This cross-sectional study was conducted on 335 female students with severe cyclic Mastalgia. They were selected by multi-stage sampling method from dormitories of Shahid Beheshti University of Medical Sciences in Tehran-Iran. Data was collected using an online questionnaire including the Beck's Depression Inventory, the Spielberger Anxiety Inventory, the Fisher Body-Image Questionnaire, the Cardiff Breast Pain Chart (NDBP), and a socio-demographic questionnaire. The data were analyzed by SPSS 29 and using Spearman, Mann-Whitney, Kruskal-Wallis, and multiple linear regression tests. The average age of the participants was 25.61 ± 5.92 years with a Cardiff score of 31.76 ± 4.33 (mean ± SD). The mean scores for body image, anxiety, and depression were 159.33 (±37.62), 43.35 (±10.32), and 10.80 (±9.79), respectively. Beck's depression score had a significant positive correlation with the severity of CM (P = 0.035). A significant positive correlation was also found between smoking and the severity of CM (P = 0.035, r = 0.115). There were significant positive correlations between the severity of CM with the duration of the menstrual cycle (P < 0.001) and menstruation (P = 0.001). There were no significant relationships between the severity of CM with other variables. The multiple linear regression test demonstrated that depression (P = 0.014) and duration of the menstrual cycle (P = 0.001) are predictors of severity of CM. Depression and duration of menstrual cycle are potential predictors of the severity of CM. Promotion of Women's menstrual and mental health as well as prevention of high-risk habits such as smoking should be considered for the severity of CM and improving the quality of life.

Background Obesity leads to increased disease burden, decreased life expectancy, and disrupted sexual life. One of the most effective ways of obesity treatment is bariatric surgery. This study was conducted aiming to determine and compare sexual self-concept in women with obesity pre- and post-bariatric surgery. Method A longitudinal study comparing sexual self-concept pre and post- surgery was conducted on women with obesity referring to obesity clinics in the city of Tehran in 2020–2021. Data collection was performed using Snell’s Multidimensional Sexual Self-Concept Questionnaire (MSSCQ), which was completed online. Data were analyzed using SPSS version 16 statistical software and Fisher’s exact test, chi-square, Mann-Whitney, independent t, and logistic and linear regression tests. A p -value of less than 0.05 was considered significant. Results According to the findings, the mean (standard deviation) score of sexual self-concept was 240.26 (26.82) in the post-surgery group and 200.26 (32.24) in the pre-surgery group ( P  = 0.001), and the highest mean (standard deviation) score of sexual self-concept both in the pre-surgery group (13.06 [4.00]) and in the post-surgery group (15.46 [2.16]) was related to the area of sexual depression ( P  = 0.05). Also, with increasing educational level, the odds of bariatric surgery increased by 33%, and those who had no private bedroom had lower odds of bariatric surgery by 65%. In those who did not have other individuals living in their house and their spouse was not a smoker, the self-concept score was 52.35 and 23.11 units higher. Conclusion In general, bariatric surgery can improve sexual self-care. Considering the issue of sexual self-concept in bariatric surgery, it is recommended to design appropriate counseling and planning before surgery according to the culture of each country.