The relationship between sonic nuisance and self-efficacy among nurses in Behbahan

Masoome Alidosti1, Gholam Reza Sharifirad2, Maedeh Majlesi3, Somaye Alibabaei4
1 Department of Public Health, Behbahan Faculty of Medical Sciences, Behbahan, Iran
2 Department of Health Education, Faculty of Health, Qom University of Medical Sciences, Qom, Iran
3 Department of Midwifery, Faculty of Nursing and Midwifery, University of Medical Sciences, Tehran, Iran
4 Department of Clinical Research Development, Kashani Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran

Background: Sound integral component of human life, but it seems the development of technology, sound in the hospital environment increased beyond the level of international standards. Voice Above Limit, the negative effects on the health of employee will have and it can affect the quality of service and efficiency. This study aimed to ‘determine the relationship between Sonic Nuisance and self-efficacy among nurses in Behbaha’ was performed in 2014.
Methods: In this cross-sectional study, the population of nurses in PA and on the basis of a sample of 151 nurses were randomly classified using the proportional allocation of the 3 hospitals were enrolled. Data collection tools of self-efficacy questionnaire Sherer and questionnaires Sonic Nuisance that level of personal sensitivity to noise was the sound measures. Data Software SPSS (IBM.com/software/analytics/spss) 16 using analysis of variance, correlation coefficient Pearson analysis and P< 0/05 was considered significant.
Results: 25/8% male nurses and 74/2% were female. The mean score of self-efficacy was 60/89 ± 6/58, and the mean sensitivity to sound and Sonic Nuisance of the 63/7 ± 22/98 and 56/52 ± 22/68, respectively. Between self-efficacy and sensitivity to sound (P = 0/005, r = −0/22), and Sonic Nuisance (P = 0/001, r = 2212–0/22) had a significant negative relationship.
Conclusions: This study showed that with increased sensitivity and Sonic Nuisance, reduced self-efficacy nurses. Therefore, strategies to reduce noise pollution in hospitals seem to be a step towards creating a healthier work environment and increase the self-efficacy of our nurses.

Keywords: Nurses, self-efficacy, Sonic Nuisance

How to cite this article:
Alidosti M, Sharifirad GR, Majlesi M, Alibabaei S. The relationship between sonic nuisance and self-efficacy among nurses in Behbahan. J Hum Health 2015;1:77-80

How to cite this URL:
Alidosti M, Sharifirad GR, Majlesi M, Alibabaei S. The relationship between sonic nuisance and self-efficacy among nurses in Behbahan. J Hum Health [serial online] 2015 [cited 2017 Feb 17];1:77-80. Available from: http://www.jhhjournal.org/text.asp?2015/1/3/77/190973

Introduction
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Noise pollution is psychologically sound undesirable, unpleasant or unwanted. In terms of noise quantity, a mixture of different sound with different wavelengths and intensities of the specific compound is unpleasant to listen.[1] The psychological effects of noise in terms of personality, the type of work and time of the day that can be heard is different, but in general it can be said noisy environment disrupt a conversation and understand the contents, loss of brain activity and disharmony of physical activities, on the other hand, the power of learning reduce and number of errors increases.[2] Hospital is one of the most important institutions for provider of healthcare with facilities. The facilities in restoring physical and mental health patients and quiet environment plays an important role, is one of the main problems in hospitals.[3] However, in the hospital, there are sound sources, including medical devices and equipment, heating and cooling systems, pager, voice of people, pulling the Trolleys, the sound of vehicles in the streets adjacent to the hospital etc., Hence, could sound with low-frequency that sound is an important factor causing Sonic Nuisance, produce. Recent studies have shown that this type of sounds uncomfortable, and in occupations such as nursing that requires mental focus and resulting in a negative impact on the performance of employees.[2] Some of the adverse effects of noise and noise pollution in long-term health of employees influences that include: (a) The emotional and psychological responses such as: Fatigue, irritability, mood disorders, anxiety, sleep disorders and feelings of hopelessness (b) communication changes, including difficulty in understanding conversations (c) changes in the performance of the staff, including: Decentralization, reduce action speed, inattention to detail, reducing the skills to perform delicate tasks, reduce speed of decision-making, discomfort and reduced job satisfaction.[4],[5]

Christensen in their study showed that sound can have a negative impact on the performance of the duties of nurses interfere creation and efficiency.[6] People with higher efficiency in the face of challenges, the most influential people in the nursing profession are considered to be which is always the possibility of unforeseen situations and challenges; there is better performance is required.[7]

One of the factors associated with each individual job believe in your strengths and weaknesses and the effective functioning; to believe in the skill and ability to perform the skills required.[8] Self efficacy is assurance that the person feels about certain activities, this concept, the effort and level of performance has overshadowed.[9],[10] Persons with low self-efficacy may believe that the situation be resolved and the belief that stress, depression, poor vision to provide relief.[11] Because nurses in restoring the patient’s physical and mental health, play an important role relative efficiency of particular importance and recognition of the effects of noise pollution on self-efficacy direction, self-efficacy promotion plan for the future of those it seems. This study was aimed to ‘determine the relationship Sonic Nuisance and self-efficacy among Nurses in Behbahan city of Iran’.

Methods
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In this cross-sectional study was conducted in 2014 by community nurses in the Behbahan on the basis of a sample size of 150 nurses have been recruited and since it was in a hospital Behbahan 3 classification method with proportional allocation was used. Shahid-Zadeh hospital 189, Farideh Behbehani Hospital 102, the Social Security Organization hospital 74 were nurses, from these hospital respectively 78, 42 and 30 nurses, randomly after the explanation of the objectives of the study were collected through a questionnaire the standard measure of the sensitivity and Sonic Nuisance and general self-efficacy questionnaire was Sherer.

Self-efficacy questionnaire consisted of 17 questions in areas such as non-submission problems, the ability to deal with problems, the ability to achieve the goals of stability and is activities for each question based on the Likert scale ranging from strongly disagree to strongly agree, set is. If the grading scale of 1 to 5 points each awarded the maximum score that a person can obtain a scale score of 85 and a minimum score of 17. Higher scores indicate self-efficacy stronger, and lower scores indicate self-efficacy weaker is the study of Heydari et al.[12] Internal consistency with Cronbach’s alpha test tool 81/0 and the study of Bayrami 0/79 was obtained.[13] Moreover, reliability, this tool has been reported in several studies 0/74 and 0/84.[14]

To measure the amount of Sonic Nuisance, the standard questionnaire used in the study used Golmohammadi and Aliabadi and reliability with 0/99,[15] as well as in the study of peasant culture and co-workers have confirmed its validity and reliability.[16] The questionnaire has 14 questions in the context of an individual’s susceptibility to noise environment is concerned that the level of received voice and the subjects were asked to rate sensitivity to the sound environment of 0 to 10. The devoted and the 14 questions, in terms of the level of noise is an annoyance. Grading to the annoyance of the noise was from 0 to 10. Finally, scores of sensitivity to sound and Sonic Nuisance turned to the percentage of the total score between 0 and 100, respectively. Data analysis software and Pearson correlation coefficient and significant SPSS(IBM.com/software/analytics/spss) 16 P > 0.05 was considered significant.

Results
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A total of 151 nurses enrolled 39 person (25/8%) were male and 112 were female (74/2%) had a mean score of self-efficacy 60/89 ± 6/58, respectively. In [Table 1], the mean age and work experience, sensitivity to sound and noise annoyance and their relationship with self-efficacy expression, and the results show a significant relationship between self-efficacy with age and experience, there is direct effect between self-efficacy and sensitivity to sound (P = 0/005, r = −0/22), and Sonic Nuisance (P = 0/001, r = −0/27) had a significant negative relationship [Table 1].
Table 1: Average score variables studied and to determine their relationship with self-efficacy

Click here to view

Distribution of demographic characteristics and comparison of self-efficacy in the level of education, gender, marital status and type of employment can be seen in [Table 2]. The mean score of self-efficacy at various levels of education, employment status and marital status were not significantly different but mean of self-efficacy is a significant difference between males and females and in men more than women [Table 2].
Table 2: Distribution of demographic characteristics, comparison of the self-efficacy

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Discussion
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The purpose of this study was to ‘determine the relationship between Sonic Nuisance and self-efficacy among Nurses in Behbahan’. By searching reputable sites, online resources did not found related article review the relationship Sonic Nuisance with self-efficacy nurses it in this part of the study; we will refer to the studies. The studies have been told that self-efficacy important indicator in determining the behaviour of nurses in the position and the real situation.[17] In the present study, the mean score was moderate to high self-efficacy and suggest that the self-efficacy of nurses is above average in this regard the study of Rezayat and Dehgannayeri nursing students self-efficacy were higher than average were reported.[18] In Masoudnia study, self-efficacy has been the majority of medium to high.[19]

In this study, self-efficacy with age and work experience had a direct relation and with increasing age and work experience had increased self-efficacy. In the field of study of Borhani et al.,[17] Lim et al.[20] were the same. In this study self-efficacy was significantly higher in the men than women had such a justification may be based on culture of Iran, because Women are more subjective concerns about of focus on home and bringing up children at work, therefore, reduced self-efficacy, although the results of Masoudnia [19] and McConville and Lane.[21]

In this study, between self-efficacy and sensitivity to sound and Sonic Nuisance inverse relationship has existed, which means that with increased sensitivity to environment noise and increasing Sonic Nuisance the self-efficacy declined.

Although the main concern about exposure to Sonic Nuisance hearing is, should not be aware about or other physical and psychological effects, in the workplace. Whatever complicated task then increased individual sensitivity and Sonic Nuisance towards sound disorder and this will be leads to the increasing number of errors and reduce the speed of a job.[16]

However, some studies, the amount of noise using sound level meter devices have been tested in some hospitals [2],[3],[5],[22],[23] and noise pollution have reported higher than standard but is the sensitivity to sound and Sonic Nuisance in nurses has not been investigated. In this study was the measurement and the mean score of sensitivity to sound and Sonic Nuisance was both above average and this data confirms studies in manufacturing jobs, such studies culture is a Dehghan et al.[16]

The Sonic Nuisance is often proportional to the degree of interference which can cause by noise in daily activities.[16] Studies have shown that hospitals are centres, which sound, as they have a detrimental factor and excessive noise in hospital environments in addition to physiological and psychological effects, will be lead to errors in the medical staff including the nurses.[2]

Considering the harmful effects of sound on favourable results in patients and its negative effects on efficiency nurses felt the necessity of reducing noise pollution and researchers believe that most sources of noise in the hospital is controllable and prevention.[24]

Moreover, in this fields to apply the principles of technical, engineering and management would be useful, for example, can has used for air intake and outlet valves and standard channels facilities, so that their voices are at the limit and the use of materials such as stone walls and floors that echo in the room or in the hallway of the hospital patients, should be avoided, as well as the regulations governing the sector can be prevented of significant amount of undesirable noise and the sound.[2]

Limitations of the present because this study has been done among nurses Behbahan Hospitals generalize to other groups, do research with larger sample sizes and in multiple centres in a wider geographic area are recommended.

Conclusion
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The present study showed that with increased sensitivity and the Sonic Nuisance, nurses’ self-efficacy is reduced. Therefore, use strategies to reduce of noise pollution in hospitals and take a step towards creating a healthier work environment and increase self-efficacy of nurses.

Acknowledgement

We appreciate the hospital officials in Behbahan and all the nurses who have participated in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References
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  1. Golmohammadi R, Monazzam MR, Hashemi Z, Momen Bellah Fard S. Pattern evaluation of noise propagation at various units of a textile industry. CJSR 2014;3:1-8. Back to cited text no. 1
  2. Heydari HR, Mohebi S, Paidari N, Ramouz P, Nayebi T, Omrani D, et al. Noise exposure assessment among nurses in Qom Educational Hospitals in 2012, Iran. Qom Univ Med Sci J 2013;7:46-53. Back to cited text no. 2
  3. Jafari N, Bina B, Mortezaei S, Ebrahimi A, Abdollahnejad A. Noise pollution in Feyz hospital and its surrounding area. J HSR 2012;8:377-4. Back to cited text no. 3
  4. Johnson AN. Adapting the neonatal intensive care environment to decrease noise. J Perinat Neonatal Nurs 2003;17:280-8. Back to cited text no. 4
  5. Zonouzi F, Ranjbarian M, Afjeie S. Evaluation of noises in neonatal intensive care unit in Mofid Children’s Hospital. J Med Sci Islamic Azad Univ 2006;16:129-34. Back to cited text no. 5
  6. Christensen M. What knowledge do ICU nurses have with regard to the effects of noise exposure in the Intensive Care Unit? Intensive Crit Care Nurs 2005;21:199-207. Back to cited text no. 6
  7. Khodabakhsh MR, Mansuri P. Analysis and comparison between frequency and depth of job-burnout aspects among male and female nurses. Zahedan J Res Med Sci 2011;13:40-2. Back to cited text no. 7
  8. Azadi MM, Balootbangan AA, Vaezfar SS, Rahimi M. The role of coping styles and self-efficacy in nurses job stress in hospital. Iran J Psychiatr Nurs 2014;2:23-32. Back to cited text no. 8
  9. Turner EA, Chandler M, Heffer WR. The influence of parenting styles, achievement motivation, and self-efficacy on academic performance in college students. J Coll Stud Dev 2009;50:337-46. Back to cited text no. 9
  10. Alidosti M, Sharifirad GR, Golshiri P, Azadbakht L, Hasanzadeh A, Hemati Z. An investigation on the effect of gastric cancer education based on health belief model on knowledge, attitude and nutritional practice of housewives. Iran J Nurs Midwifery Res 2012;17:256-62. Back to cited text no. 10
  11. Rostami R, Shah Mohammadi KH, Ghaedi GhH, Besharat MA, Akbari S, Nosrat Abadi M. The relation among self-efficacy, emotional intelligence and perceived social support in university students. J Ofoghe Danesh 2010;16:46-54. Back to cited text no. 11
  12. Heydari M, Ali MM, Khakbazan Z, Mahmoodi M. The study of comparison of two educational methods of lecture and training package on self-efficacy 9-12 years old girls students in relation with adolescent health. Iran J Nurs Res 2015;10:1-12. Back to cited text no. 12
  13. Beyrami M. The emotional intelligence training effectiveness on assertive, efficacy and mental health in students. Tabriz Univ J Psychol 2008;3:25-41. Back to cited text no. 13
  14. Ebrahimi Moghadam H, Poorahmad F. The relationship between emotional expressiveness and self efficacy with burnout in workers of municipality. Occupational Medicine Quarterly J 2013;4:62-72. Back to cited text no. 14
  15. Golmohammadi R, Aliabadi M. Noise pollution and its irritating effects in hospitals of Hamadan, Iran. J Health Syst Res 2011;7:958-64. Back to cited text no. 15
  16. Dehghan SF, Monazzam MR, Nassiri P, Kafash ZH, Jahangiri M. The assessment of noise exposure and noise annoyance at a petrochemical company. J Health Saf Work 2013;3:11-24. Back to cited text no. 16
  17. Borhani F, Abbaszadeh A, Kohan S. Correlation of self-efficacy of nurses to deal with unexpected events with the demographic characteristics of the nurses. J Health Promot Manage 2012;1:17-26. Back to cited text no. 17
  18. Rezayat F, Dehgannayeri N. Relationship between depression and self- efficacy in nursing students. Iran J Nurs 2013;26:54-63. Back to cited text no. 18
  19. Masoudnia E. Perceived self-efficacy and coping mechanisms in stress situations. J Iran Psychiatr Clin Psychol 2008;13:405-15. Back to cited text no. 19
  20. Lim J, Downie J, Nathan P. Nursing students’ self-efficacy in providing transcultural care. Nurse Educ Today 2004;24:428-34. Back to cited text no. 20
  21. McConville SA, Lane AM. Using on-line video clips to enhance self-efficacy toward dealing with difficult situations among nursing students. Nurse Educ Today 2006;26:200-8. Back to cited text no. 21
  22. Abbasi S, Reyhanak T, Soltani F, Yousefi H. Evaluating the noise level and sources in Isfahan University Hospital’s intensive care units. J Isfahan Med Sch 2011;28:1267-74. Back to cited text no. 22
  23. Asgharnia HA, Tirgar A, Amouei AI, Fallah H, Khafri S, Mohammadi AA, et al. Noise pollution in the teaching hospitals of Babol (Iran) in 2012. J Babol Univ Med Sci 2014;16:64-9. Back to cited text no. 23
  24. Allaouchiche B, Duflo F, Debon R, Bergeret A, Chassard D. Noise in the postanaesthesia care unit. Br J Anaesth 2002;88:369-73.

How to write and publish a scientific manuscript in english: Introducing some practical guidelines for non-english speaking scholars

Correspondence Address:
Mohsen Rezaeian
Department of Epidemiology and Biostatistics, Occupational Environmental Research Center, Rafsanjan Medical School, Rafsanjan University of Medical Sciences, Rafsanjan
Iran

Nowadays, the skill of writing scholarly articles in English has become a necessary skill for the researches. If you are a non-English speaking scholar who would like to write and publish a paper in English, you should read this article very carefully. The aim of this narrative review article is to provide non-English speaking scholars with the details of some practical guidelines on how to write and publish a scientific article in English.

Keywords: Non-English speaking scholars, practical guidelines, writing scientific English paper

How to cite this article:
Rezaeian M. How to write and publish a scientific manuscript in english: Introducing some practical guidelines for non-english speaking scholars. J Hum Health 2015;1:61-2

How to cite this URL:
Rezaeian M. How to write and publish a scientific manuscript in english: Introducing some practical guidelines for non-english speaking scholars. J Hum Health [serial online] 2015 [cited 2017 Feb 17];1:61-2. Available from: http://www.jhhjournal.org/text.asp?2015/1/3/61/190971

Introduction
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Nowadays, the skill of writing scholarly articles in English has become a necessary skill for the researches.[1],[2] If you are a non-English speaking scholar who would like to write and publish a paper in English, you should follow some practical guidelines.[3],[4] Otherwise, you might end up with a rejected manuscript or even worse a published paper in an open access predatory journal full of errors.[5] In what follows, I will try based on my personal experiences to provide you with the details of some practical guidelines.

Practical Guidelines
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The first practical guideline is to carry out a comprehensive literature review. This not only helps you to design and conduct a sound research but also avoids you to commit research misconduct due to not comprehensively carry out your literature review.[6] Furthermore, it helps you to become familiar with the English rhetoric of scientific writing related to your topic. Read each retrieved paper carefully. Learn how other scientists in your filed write their papers. At the same time, meticulously examine their obtained materials and methods. Remember that if you are going to publish an English paper in a prestigious journal it should add something new to the existing knowledge. Therefore, you should design and conduct a better study in comparison with the previously published studies
Based on what has mentioned in the previous step, write your research proposal. At this stage and based on your type of study, try to prepare your research proposal according to its appropriate publication guidelines.[7] Furthermore, you should also try to get your research proposal funded by an appropriate funding agency.[8] If it would be possible, you should allocate some of your requested budget for translating and editing your final manuscript into English
It is very wise if from the first place you would be able to design and carry out a collaborative research with an English native speaking team and/or person.[9],[10] It would help you to not only raise the standard and quality of your research but to prepare its final manuscript in English
Carry out your designed research with the highest possible standard. Avoid any types of research misconduct either serious ones such as data fabrication or data falsification and less serious ones such as ignoring outliers or ignoring missing data [6]
As soon as finishing your actual research within the laboratory, bedside or field and carrying out your data analyses, write the first draft of your manuscript. If you have already had a native English scholar in your team, it is straightforward to prepare your first draft in English. Otherwise, you should write your first draft in your mother-tongue language
In the next step and if you have written your first draft in your mother-tongue language, you should find someone to translate it for you in English. At this stage, you should be very cautious to select someone whose first language is English and fully familiar with academic writing.[11] Beware of predatory persons or organisations who simply would like to take your money away. Besides, if you select a professional person/organisation for translation, you could be sure that they protect you from other types of research misconduct, especially plagiarism.[6] Otherwise, selecting an inappropriate person/organisation might also put you endanger of innocently committing such awful research misconduct
When receiving the first translated draft read it for a number of times. If you are uncertain about anything, ask it from your translator to make everything clear. Ask other authors of the manuscript to read it very carefully and inform you immediately of any comments that they might have. It is also wise if someone not in the authorial team who is familiar with English academic writing read your manuscript.[12] At this stage, you should make sure to resolve any problems within the manuscript before submission
Submit your manuscript to the most appropriate prestigious journal [13] and beware of some open access predatory journals.[14] Remember that a prestigious journal applies peer review process the outcome of which almost helps authors to raise the quality and standard of their manuscript.[15] While an open access predatory journal only tries to accept as much as article that it can without applying a proper peer review process. As a result such journals put you endanger of publishing an article full of errors [5]
In due course, if the outcome of the last step is positive, that is, the editor asking you to resubmit your manuscript either with minor or major corrections, you should carefully revise and resubmit your paper based on the comments of reviewers and wait for the final outcome to be announced. If the outcome of the last step is negative, you do not get disappointed. Based on the comments of the reviewers/editor, carefully revise your article and send it to the second most appropriate prestigious journal.[13]

Conclusion
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Publishing a scientific article in English has become a necessity but painstaking skill for non-English scholars. Therefore, non-English speaking scholars should follow some practical guidelines to avoid ending up with a rejected manuscript or even worse a published paper in a predatory open access journal full of errors. In the present narrative review article, the details of nine relevant practical guidelines are provided.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References
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  1. Waheed AA. Scientists turn to journals in English. ScientificWorldJournal 2001;1:239-40. Back to cited text no. 1
  2. Meneghini R, Packer AL. Is there science beyond English? Initiatives to increase the quality and visibility of non-English publications might help to break down language barriers in scientific communication. EMBO Rep 2007;8:112-6. Back to cited text no. 2
  3. Tompson A. How to write an English medical manuscript that will be published and have impact. Surg Today 2006;36:407-9. Back to cited text no. 3
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  5. Rezaeian M. Disadvantages of publishing biomedical research articles in English for non-native speakers of English. Epidemiol Health 2015;37:e2015021. Back to cited text no. 5
  6. Rezaeian M. A review on the diverse types of research misconduct. Middle East J Fam Med 2014;12:43-4. Back to cited text no. 6
  7. Rezaeian M. The application of publication guidelines should extend to cover their designing stage and protocol writing. Ann Epidemiol 2013;23:815. Back to cited text no. 7
  8. Rezaeian M. How to write a successful grant proposal. Middle East J Fam Med 2015;13:27-8. Back to cited text no. 8
  9. Chandiwana S, Ornbjerg N. Review of north-south and south-south cooperation and conditions necessary to sustain research capability in developing countries. J Health Popul Nutr 2003;21:288-97. Back to cited text no. 9
  10. Lansang MA, Dennis R. Building capacity in health research in the developing world. Bull World Health Organ 2004;82:764-70. Back to cited text no. 10
  11. Ludbrook J. Writing intelligible English prose for biomedical journals. Clin Exp Pharmacol Physiol 2007;34:508-14. Back to cited text no. 11
  12. Rezaeian M.How to avoid the rejection of your manuscript. Middle East J Bus 2015;10:46-7. Back to cited text no. 12
  13. Rezaeian M.How to select a relevant journal to submit your article. Middle East J Bus 2015;10:45-6. Back to cited text no. 13
  14. Butler D. Investigating journals: The dark side of publishing. Nature 2013;495:433-5. Back to cited text no. 14
  15. Spier R. The history of the peer-review process. Trends Biotechnol 2002;20:357-8. Back to cited text no. 15

A Survey of the Effect of Brief Solution-focused Approach on Reduction of Marital Conflicts PART2

The results were analysed via covariance analysis. [Table 1] shows the descriptive results about the scores of marital conflict in experiment and control group.

The results of [Table 1] showed that there is a significant difference between various levels of test variable (pre-test and post-test).

First hypothesis

Brief solution-focused family therapy approach is effective on reduction of the marital conflicts of the male and female susceptible to divorce [Table 2].

The results of the first hypothesis about the effect of brief solution-focused couple therapy on the reduction of marital conflict of the couples are shown in [Table 3].

Table 3: The results of covariance analysis to compare the mean of the residual scores of marital conflict in team membership

Second hypothesis

Brief solution-focused family therapy approach is effective on marital conflicts dimensions of the male and female susceptible to divorce.

After the control of the scores of pre-test of the result of covariance analysis showed that there is significant difference between two groups in the mean of marital conflict (F = 24.089, P = 0.001) and the effect of 0.45 showed the difference between the mean of the scores of two groups of independent variable (solution-focused treatment) and it is concluded that brief solution-focused couple therapy was effective on reduction of total score of marital conflict of the couples. The results of the subscales of marital conflict are shown in [Table 4].

Table 4: The results of covariance analysis of the mean of the residual scores of the dimensions of marital conflict scale

The results of the table showed that brief couple therapy is effective on all subscales of marital conflict (P = 0.01) and the effect on reduced cooperation (0.21), reduced sexual intercourse (0.63), increased emotional reactions (0.32), increased child support (0.43), increased personal relationships with relatives (0.72), reduced family relationship with the spouse’s relatives (0.57), separating finances (0.71), and reduction of effective communication (0.56). Statistical power was high in all the above dimensions and it showed that the sample size was adequate in the present study.

  Discussion and Conclusion 

The results of the present study showed that brief solution-focused couple therapy was effective on marital conflict and its dimensions (P < 0.001). Watsel, Prest and Zimerman (1997, cited in Nazari and Soleimani, 2007) applied dyadic adjustment scale to evaluate the changes in couples relation and the scores in the couples’ condition scale as pre-test and post-test showed the reduction of couple’s divorce.[13]

The results of the analysis showed that brief solution-focused treatment improved the sexual relationship of the couples as 0.63. The results of the study are consistent with the study of Saeidi. By the improvement of emotional relation of the couples, it can be expected that their sexual intercourse was improved. The brief solution-focused treatment improved the sexual issues between the couples.[14] The solution-focused treatment improved the 0.72 of the relation with the relatives and friends of the spouse. The couples should consider the border between themselves and others (the main family and friends). These borders considered the couples a separate system of other systems and they are flexible borders and the couples can use the recommendations of the main family. This is done by some techniques as glass house metaphor and improving the relation with the spouse family.

The treatment improved as (0.56) the effective communication of the couples. Mudd in a study titled ‘solution-focused treatment and training communication skills’ showed that solution-focused approach increases communicative skills. The result of the present study is consisting with the study of Mudd.[15] Solution-focused treatment was effective on reduced cooperation of the couples (0.20). It can be said that the couples who participated in solution-focused counselling reached higher level of cooperation skill compared to control group. The results were consistent with the results of the study performed by Moore, who stated that the subjects participating in solution-focused sessions solved their interpersonal problems by their capabilities.[16]

Solution-focused couple therapy had a positive effect on separating finances. One of the determining factors of power in the family is money. When there is conflict, the couples have different views about spending money, and one of them tries to spend much money (woman) and the man tries to be cautious about the expenditure. It does not seem that solution-focused treatment directly affected the increase of the participation of the couples in economic affairs of the house. It can be said that when the couples’ relation is improved, the money is spent fairly, and they try to agree on spending the money.

A solution-focused approach based on Lee results can be applied for the experts with various experience level and one member instead of the whole family. This characteristic of the solution-focused counsellor is an advantage compared to the view of family therapy that emphasize on the presence of all family members in counselling sessions.[17]

The results of the present study were consistent with the results presented by O’Hanlon and Weiner-Davis, showing that the subjects participating in solution-focused counselling revealed better methods to cope with the emotional issues compared to control group.[18]

The results of the present study were consistent with the results of Lamber et al. They found that the clients in the study could cope with the adjustment problems, drug abuse and anxiety compared to the control group.[19]

Furthermore, the results of the present study were consistent with the results of the study performed by Conoley, Graham, New, Craig, Opry, Cardin, Brossart and Parker (2003, cited in Kuri, 2009). They found that the parents and the students participating in the solution-focused counselling showed less problematic behaviours and could reduce their behavioural problems.[20]

As most of the couples who referred to counselling centre and most of the couples who have problems in their relations but they do not admit the centres are failed in solving their problems and creating problem-solving skills among the couples can prevent many conflicts. One of the most important skills being proved as life skills from the World Health Organization is ‘problem-solving skill’. Problem-solving training is of great importance as one of the life skills, and this technique is applied mostly in solution-focused approach. By various techniques of this approach, we can help the couples with their problems and their solutions and improve their marital satisfaction. This approach is effective due to the short duration of the sessions in creating the couples cooperation.

References
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  1. Gottman JM. The Marriage Clinic: A Scientifically Based Marital Therapy. New York: W. W. Norton; 1999. Back to cited text no. 1
  2. Sinha P, Mukerjec N. Marital adjustment space orientation. J Soc Psychol 1990;130:633-9. Back to cited text no. 2
  3. Rice JK. Cross-cultural parsectiveson divorce and family life cycle (invited address). Washington, DC: American Psychological Association; 2000. Back to cited text no. 3
  4. Howard J. Markman, Renick MJ, Floyd FJ, Stanley SM, Clements M. Preventing marital distress through communication and conflict management training. J Clin Psychol 1993;61:70-7. Back to cited text no. 4
  5. Kaslow FW. Divorce: An evolutionary process of change in family system. J Divorce 1984;7:21-39. Back to cited text no. 5
  6. Myers DG. Exploring Social, Psychology. Boston: McGraw Hill; 2000. p. 284. Back to cited text no. 6
  7. Kitson GC, Babri KB, Roach MJ. Who divorces and why: A review. J Fam Issues 1985;6:255-93. Back to cited text no. 7
  8. Goldenberg I, Goldenberg H. Family Therapy; Translators (Brovati S, Naghshbandi, Arjmand). Tehran: Psychology Press; 2002. p. 65. Back to cited text no. 8
  9. de Shazer S. Muddles, bewilderment, and practice theory. Fam Process 1991;30:453-8. Back to cited text no. 9
  10. Nazari AM. Couple’s Therapy, Family Therapy Principles. Tehran: Science Publications; 2007. Back to cited text no. 10
  11. Rusbult CE. A longitudinal test of the investment model: The development (and deterioration) of satisfaction and commitment in heterosexual involvements. J Pers Soc Psychol 1986;45:101-17. Back to cited text no. 11
  12. Sanaei MB. Assessment Family. Tehran: The Institute’s Beaasat; 2009. p. 100. Back to cited text no. 12
  13. Nazari AM, Soleymani A. Factor Analysais Questionnaire Marital Satisfaction Snayder. Thesis.unpub: Tehran Teacher Training University; 2003. Back to cited text no. 13
  14. Saeidi L. The effectiveness of brief solution-focused approach on couples’ conflict decrease. New Res Consult 2006;20:35. Back to cited text no. 14
  15. Mudd J. Solution-Focused Therapy and Communication Skills Training; An Intergraded Approach to Couple Therapy. Thesis Submitted to the Faculty of the Virgina Polytechnics Institute and State University in Partial Fulfillment of the Requirements of the Degree of Master of Science; 2000. Back to cited text no. 15
  16. Moore S. Sociology Alive. Cheltenham, Great Britain: Nelson Thornes Ltd; 1st edition. 1987. p. 121. Back to cited text no. 16
  17. Lee MY. A study of solution-focused brief family therapy: Outcomes and Issue. Am J Fam Ther 1997;25:1-70. Back to cited text no. 17
  18. O’Hanlon WH, Weiner-Davis M. In Search of Solution: A New Direction in Psychotherapy. New York: Norton; 1989. Back to cited text no. 18
  19. Lamber MJ, Okiisgi JC, Finch AE, Johnson LD. Outcome assessment: From conceptualization to implementation. Prof Psychol Res Pr 1998;29:63-70. Back to cited text no. 19
  20. Correy S. New N. Y law protects assessing divorce. Boston: Lawyers USA; 2009. p. 198. Back to cited text no. 20

A Survey of the Effect of Brief Solution-focused Approach on Reduction of Marital Conflicts

Research Center for Psychiatry and Health Psychology, Qom University of Medical Sciences, Qom, Iran

Introduction: The adverse conflicts are the set of the events imposed on one or more family members or all of them or the family and affect all the family members. The present study is aimed to evaluate the effect of solution-focused approach on the reduction of the marital conflicts of the couples in Qom city.
Methods: The method was semi-experimental with pre-test, post-test and experiment and control group. The study population was the couples referring family consulting centre and they were volunteers. The sample size was 50 couples being a volunteer in the study, and they were selected as convenient and random sampling method in experiment and control group. The study instrument was including a demographic questionnaire and marital conflict questionnaire of Sanayi. For data analysis, in addition to descriptive statistics methods, covariance analysis method was applied.
Results: The data analysis showed that solution-focused approach was effective on whole marital conflict scale (F = 24.089, P< 0.001) and all the subscales of low collaboration (F = 7.4, P< 0.001), low sexual intercourse (F = 50.4, P< 0.001), increase of emotional reactions (F = 10.89, P< 0.001), increase of child support (F = 22.3, P< 0.001), increase of the relation with the relatives (F = 77.4, P< 0.001), reduction of the relation with the relatives and friends of the spouse (F = 31.02, P< 0.001), separating finances (F = 71.1, P< 0.001), and reduction of effective relation (F = 1.73, P< 0.001).
Conclusion: The problem-solving skills among the couples can prevent many conflicts. Problem-solving training is of great importance as one of the life skills, and it is used more in solution-focused approach. By various techniques of this approach, we can help the couples with the problems that know the solution and improve their marital satisfaction.

Keywords: Brief solution-focused couple therapy approach, couples, marital conflict

How to cite this article:
Shahsiah M. A Survey of the Effect of Brief Solution-focused Approach on Reduction of Marital Conflicts. J Hum Health 2015;1:67-71

How to cite this URL:
Shahsiah M. A Survey of the Effect of Brief Solution-focused Approach on Reduction of Marital Conflicts. J Hum Health [serial online] 2015 [cited 2017 Sep 21];1:67-71. Available from: http://www.jhhjournal.org/

Introduction
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Mostly, marital life failure is because seen each other in a useless circle of the endless talking, or they feel alone in their marital life.[1] Unfortunately, divorce statistic is increased recently. Our country is not an exception and divorce is increasing in Tehran, and it is increased by 12%. There is one divorce for every 5 marriages, and it is increased gradually.[2]

An intimate couple relationship is including the challenge that they learn how to communicate with each other and how they are different. In keeping the communication and the differences, the conflict is created. When various degrees of independence and dependence are required for the common decision making of the couples, the contradictory situation is occurred. Wal and Nolan (1987) stated that the conflicts can be defined in a range of responses ranging from mild disagreement to violent conflict.[3] In various studies, anxious couples reported a high level of conflict, negative feeling and complaint compared to the peers without any problems.[4] As the inability in solving the conflicts leads into losing the intimacy, better understanding of the conflict, and helping the spouses to learn constructive management is of great importance.[5]

Today, the family therapists proposed some solutions to reduce the conflict between the couples and one of the approaches is the solution-focused approach. This approach is a form of brief treatment relying on the clients’ resources. The treatment model aimed to help the clients to reach their goals via creating the solutions for their problems. This approach is in contradiction with the problem-focused traditional treatments in most of other approaches and some of the other treatment methods. Myers besides referring to the competition quality between the opposite philosophies believes that individuals respond the conflict via various ways.[6]

According to a solution-focused therapist, continuous change is unavoidable. This, it is emphasized on changing issue in treatment process not on impossible issues. This model emphasizes on taking small steps for the start and change, and the process is changed. The capabilities and solutions are emphasized in this model rather than the problems.[7]

Like the magnetic resonance imaging (MRI) model, solution-focused model aim is to solve the complaints being raised. They do it by helping the clients to think about the different activity making them happy in their life. Solution-focused therapists rely on the clients to achieve their goals more than MRI therapists. They believe that the human beings have the required skill to solve their problems but by exaggerating about their problems, they cannot see their strengths and abilities. It is assumed in this approach that the client knows what to do to solve his problems, and the therapist should help them to make new application cases for the pre-learned knowledge. The general aim of this approach is helping the client to start problem-solving process.[8]

de Shazer uses the metaphor of a lock and a key to explain his therapeutic approach – clients’ complaints are like locks on doors that can be opened to a happy life on condition that the can find the key. When it is tried to find about the reason of locked door, the time is lost, and failure is increased. Especially when the family tries to find the key, the general role of the therapist is to find the ‘main key’ for the family, some of the interventions being applied for a range of the locks.[8] He considered common treatment collaboration between the client and the counsellor and both discover the solutions.[9] Despite the problem-focused view, solution-focused family therapy emphasizes on finding the solutions. This view focuses on the definition of the presented problem and is based on systematic view and social structuralism.[10]

Divorce process starts with the tension between the couples, and this leads into emotional indifference and conflict. This incompatibility breaks the social relations of the people and the members and endangers the organizational unity and leads into family dissolution. Based on high divorce rate and the importance of the family in our country, the present study aimed to evaluate the effect of solution-focused family therapy on reduction of marital conflicts in couples susceptible to divorce.

Methods
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The present study is an applied design. The semi-experimental method was used in this study. The present study was conducted on control and experiment group. The study population of the study was all the couples referring to family consulting centre of Qom city. A total of 50 couples registered to participate in the study and they were divided into experiment and control group randomly. For both groups, a pre-test was done 1-week before doing consulting method and post-test was done after the end of the sessions. The pre-test was performed of all the subjects in the first session. For the experiment group, the solution-focused approach was performed in 6 sessions and the second group (control) did not receive any education or treatment method. The sessions were held weekly and totally 6 sessions were taken. Finally, post-test was performed of both groups. The sessions took averagely 1-h and half. For data analysis, covariance analysis test was applied. The following instruments were applied in the present study. Marital conflict questionnaire: A marital conflict questionnaire is a 54-item tool that measures marital conflict devised by Dr. Bagher Sanai et al. (2007). This questionnaire measures eight aspects of marital conflict: Reduced cooperation, reduced sexual intercourse, increased emotional reactions, increased child support, increased personal relationships with relatives, reduced family relationship with the spouse’s relatives, separating finances, and reduction of effective communication.

Validity and reliability

The Cronbach’s alpha for the questionnaire as a whole for a population of 270 persons was calculated at 0.96 and for each of the eight subscales as follows: Decrease in cooperation 0.81, decrease in sexual relations 0.61, increase in emotional reactions 0.70, increase in trying to gain child support 0.33, increase in personal relationships with relatives 0.86, reduced family relationship with the spouse’s relatives 0.89, separating finances 0.71, and decrease in effective communication 0.69.[11],[12]

X syndrome prevalence among infertile women need reproductive technology In vitro fertilisation and intracytoplasmic sperm injection

Maryam Kianpour1, Mina Fazlollahi Mohammadi2, Ashraf Kazami1, Seyed Mehdi Ahmadi3
1 Department of Midwifery, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Health Education and Health Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
3 Isfahan Fertility and Infertility Center, Isfahan, Iran

Introduction: The different prevalence of metabolic syndrome in numerous populations justifies its determination in order to assist design strategies for screening programs to prevent long-term complications. Then, the current survey was aimed to determine the prevalence of metabolic syndrome in infertile women referring to an infertility clinic in Isfahan city.
Materials and Methods: Prevalence of metabolic syndrome was determined in a cross-sectional survey conducted on 149 women require reproductive techniques in infertility clinics in Isfahan. These samples were selected using convenient sampling through patients referring in the clinic during January 2013 to June 2014. Metabolic syndrome was diagnosed according to National Cholesterol Education Programme Adult Treatment Panel III criteria.
Results: The mean age of women was 32.2 ± 5.3 years. Prevalence of metabolic syndrome was 33.4% (49 women). With regards to the findings, the most frequent feature of metabolic syndrome was abdominal circumference by 70% (103 women) and the lowest one was about blood sugar by 18.2% (12 patients).
Conclusion: The current results revealed that the prevalence of metabolic syndrome in infertile women was 33.4%, then screening of infertile women in terms of indicators of syndrome before entering the costly process of reproductive technology recommended due to its adverse effect on fertility.

Keywords: Infertility, metabolic syndrome, prevalence

How to cite this article:
Kianpour M, Mohammadi MF, Kazami A, Ahmadi SM. X syndrome prevalence among infertile women need reproductive technology In vitro fertilisation and intracytoplasmic sperm injection. J Hum Health 2015;1:63-6
How to cite this URL:
Kianpour M, Mohammadi MF, Kazami A, Ahmadi SM. X syndrome prevalence among infertile women need reproductive technology In vitro fertilisation and intracytoplasmic sperm injection. J Hum Health [serial online] 2015 [cited 2017 Feb 16];1:63-6. Available from: https://www.jhhjournal.org

Introduction
Top

Infertility is the couple inability to achieve pregnancy after 12 months regular and unprotected sexual relationship.[1],[2] Infertility imposes a huge burden on families. It might be followed by the consequences including the conflict in the family, violence, stigma, isolation and divorce.[3],[4] Infertility is in both primary and secondary form with the prevalence of 15% in both forms.[5] Infertility occurs nearly 37% in all infertile couples [6] and primary and secondary infertility have been reported 0.6–3.4% and 8.7–32.6%, respectively.[7] Vahidi et al. study (during 2004–2005) exploring the prevalence of infertility in all provinces of Iran showed that the history of primary infertility and infertility during the survey were 24.9% and 3.4%, respectively.[8] Infertility is associated with geographic and environmental conditions. In some West African communities, infertility rate is about 50% while it is reported 12% in some communities of West Europe. In addition, there are differences in developed countries in the way that infertility rate in this countries is 5.3–16.7% while fertility rates in less developed countries are 3.9–9.6%.[9],[10] Infertility might be caused by numerous male and female related factors. The reasons for female infertility include ovulation disorders, pelvic inflammatory disease, endometriosis, polycystic ovary syndrome (PCOS), a hormonal imbalance to cause spontaneous pregnancy and environmental factors such as exposure to chemicals and radiation, age over 30 years, poor weight (high decrease or weight gain), sports (excessive exercise, more than 60 min a day), stress and other factors such as alcohol and tobacco consumption.[11] Treatment of infertility depends on its cause. One of the factors affecting the success of reproductive techniques is mother weight. Obesity is a major concern for women’s health and is one of the main symptoms of metabolic syndrome.[12],[13] Syndrome X or metabolic syndrome is defined to identify the at risk population of cardiovascular disease. This syndrome consisted of factors including visceral obesity, insulin resistance, hyperglycaemia, hypertension and dyslipidaemia.[14] Syndrome X is a complex multi-organ dysfunction that produced by several factors such as physical inactivity, eating habits and dysfunction of the hypothalamic-pituitary and adrenal.[15],[16] There are evidence of metabolic syndrome effects on fertility such as PCOS that is one of the causes of infertility.[17] The prevalence of metabolic syndrome in women with PCOS in different populations was explored. Its prevalence in America, Brazil, Hong Kong and Czech is 43, 28.4, 24.9 and only 1.6% in women.[17],[18],[19],[20] In a survey, the prevalence of this syndrome was 10–15% among men and women aged 30–39 years.[20] It seems that aforementioned age group included couples who are expecting to get pregnant. The difference in the prevalence of this syndrome in numerous populations justifies its necessity to help for designing preventing screening strategies and preventing long-term effects. So far, studies usually executed in prevalence of this syndrome in women with PCOS and then this study was aimed to estimate the prevalence of syndrome X in infertile women referring to infertility clinic in Isfahan city because of the limited number of studies on the consequences of the disorder and its prevalence in the population of infertile women.

Materials and Methods
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Prevalence of metabolic syndrome was determined in a cross-sectional survey conducted on 149 women require reproductive techniques in infertility clinics in Isfahan. This centre is one of the infertility treatment centres that accepts patients referred from different provinces of the country. These samples were selected using convenient sampling through patients referring in the clinic during January 2013 to June 2014. Inclusion criteria were as follow: (1) Being eligible to treat by the reproductive technique diagnosed by a physician, (2) incline to participate in the study and (3) being Iranian. After selecting subjects at last visit of the doctor, researcher ask all women to test triglyceride (TG), high-density lipoprotein (HDL) and fasting blood sugar and abdominal circumference, height, weight, blood pressure (BP) and body mass index (BMI) were also measured by attending in the clinic of fertility and infertility of Isfahan city. Metabolic syndrome was diagnosed according to National Cholesterol Education Programme Adult Treatment Panel III (NCEP-ATP III) criteria.[21] Abdominal obesity equal to or more than 89 cm, levels of serum TGs equal to or more than 150 mg/dL, low serum levels of HDL cholesterol ≤50 mg/dL, high fasting blood glucose equal to or more than 110 mg/dL and high BP more than 130/85 mm Hg were accepted. Existences of three above criteria were considered as metabolic syndrome.[22] Seca fixed scale was used to determine the weight and cloth meter was applied to measure the height. Waist and hip circumferences were measured using a cloth meter with an accuracy of 0.1 cm. To ensure the accuracy of data, the measurement was performed twice and if there were differences in size, a third measurement was performed and the close average of two measurements was considered. The pressure gauge was used for measuring the BP after 5 min of rest. All anthropometric assessment was done by a person in Isfahan fertility and infertility centre. Blood biochemical tests were conducted by a laboratory in fertility and infertility centre to obtain fasting blood glucose, TGs and HDL.

To analyse data, SPSS IBM (version 19) statistical software and descriptive methods (mean, standard deviation and frequency table) and Chi-square and independent t-test were used. P value was taken 0.05 significant.

Results
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In this survey, 149 of eligible infertile women need reproductive techniques were included in the study. Two women were excluded due to the lack of testing for metabolic and in final the data collected from 147 infertile women were analysed. The mean age of women was 32.2 with a standard deviation of 5.3 years. In total, 43.5% had a university education and 80.3% were housewives. 79.6% had primary infertility and the ovarian problem was the most common causes of infertility 49.7%. Intracytoplasmic sperm injection (ICSI) was used by 57.9% of women as reproductive method [Table 1]. The prevalence of metabolic syndrome estimated 33.4% (49 women) according to the NCEP-ATP III. With regards to the current findings, the most frequent features of metabolic syndrome was associated with abdominal circumference by 70% (103 women) and the lowest was about blood sugar by 18.2% (12 patients) [Table 2]. The results suggest that 50 women (68.5%) were overweight (BMI 25–29.9) and obese (BMI 30 and above) from 73 infertile women with ovarian causes. While, 33 (44.6%) were overweight and obese from 74 infertile women caused by other factors that were statistically significant (P = 0.002). The results recommended that the group with metabolic syndrome, 36.2% required by ICSI/in vitro fertilisation and in the group without the syndrome, 44% used this technique for fertility. ICSI was conducted by 63.8 and 56% of women in groups with and without the syndrome, respectively.

Prevalence of metabolic syndrome was 33.4% (49 patients) according to the NCEP-ATP III. The prevalence of this syndrome in women with PCOS was 43–46% in Ramezanali. study,[23] this prevalence is lower in the current study compare to Ramezanali that might be resulted by exploring women with all causes of infertility in the current study, while, in a study conducted by Ramezanali, women only with PCOS were studied. Hahn et al. reported that the prevalence of metabolic syndrome was 33.8% according to the International Diabetes Federation criteria for German women with PCOS, also revealed that this syndrome prevalence increased along with the rise in obesity and age.[24] Our study showed that the majority infertile women with ovarian causes were categorised in the overweight and obese groups. In a study in Brazilian women with PCOS, the prevalence of metabolic syndrome was 3.2, 19.2 and 52.3% according to normal, overweight and obese, respectively.[18] The current results inconsistent with the above findings showed that infertile women with ovarian factor had a significant increase in BMI compared to other causes of infertility. It seems that the increase of insulin and androgens in obese women may play an important role in developing PCOS and metabolic syndrome.[25] In our study, the frequency of abdominal circumference more than 89 cm by 70% had the most frequency compared to other indicators of this syndrome. The lowest frequency was about BP equal to or higher than 130/85 (16.3). Igosheva et al., study (2010) believed that despite the fat accumulation in the central region, often in obese women, waist-to-hip ratio increased and the chance of natural pregnancy decreased due to reducing this ratio <0.85.[26] Obesity can reduce the number and quality of oocytes, a decrease of the embryo, follicles and follicular atresia growth and an increase of abortion. To describe, The researchers suggest that central obesity is associated with a significant increase in intracellular lipid that accumulate (overtopping) fatty acids and the influence of the electrons from mitochondrial membrane and create an lipo-toxic condition in the genital tract of women and insulin resistance.[27] The prevalence of metabolic syndrome in women with PCOS had a higher prevalence in Sharpless study.[28] Other studies also reported the risk of this syndrome in women with PCOS 11 times higher compared to the control group.[29],[30] In our study, almost half of women (73 women, 49.7%) had infertility with ovarian factor which 29 women (20%), had metabolic syndrome, while from 74 infertile women with tubal causes, endometriosis and other causes, 20 women (14%) had metabolic syndrome. Although the prevalence of this syndrome among infertile women with ovarian causes was more than other causes, however, was not statistically significant. Studies also suggest that the prevalence of metabolic syndrome in women with the polycystic ovarian syndrome is more prevalent.[28] Then, it seems likely reasonable to achieve this result. In our study, infertile women were examined with all causes of infertility that can effect on the prevalence of X syndrome compared to other studies focused on women with PCOS.

References
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