doi 10.15296/ijwhr.2017.54 doi 10.15296/ijwhr.2015.27
http://www.ijwhr.net http://www.ijwhr.net
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Original Review Article International Journal of Women’s Health and Reproduction Sciences International Journal of Women’s Health and Reproduction Sciences Vol.Vol. 3, No. 3, July 2015, 126–131 5, No. 4, October 2017, 318–323 ISSN 2330- 4456 ISSN 2330- 4456
Women on theBetween Other Side of War and Poverty: Its Effect Relationship Health-Promoting Lifestyle and on the Health of Reproduction Quality of Life in Women With Polycystic Ovarian Ayse Cevirme , Yasemin Hamlaci , Kevser Ozdemir Syndrome 1
2*
2
Abstract Mojgan Mirghafourvand1, Sakineh Mohammad-Alizadeh Charandabi2, Tahereh Behroozi Lak3, War and poverty are ‘extraordinary conditions created by human intervention’ and ‘preventable public health problems.’ War and Fatemeh Aliasghari4*
poverty have many negative effects on human health, especially women’s health. Health problems arising due to war and poverty are being observed as sexual abuse and rape, all kinds of violence and subsequent gynecologic and obstetrics problems with physiological and psychological courses, and pregnancies as the result of undesired but forced or obliged marriages and even rapes. Certainly, Abstract unjust treatment such asthe being unable footing with on thepolycystic land it is ovarian lived (asylum seeker,(PCOS) refugee,isetc.) being deprived of goals of Objectives: Promoting quality of to lifegain in women syndrome oneand of the most important social security, citizenshipand rights human rights brings isabout deprivation of area. accessThis to health and of provision the medical community theand importance of lifestyle morethe apparent in this studyservices aimed to determine the of relationship service intended for gynecology and obstetrics. Theofpurpose of this article is to address effects of war and poverty on the health of between health-promoting lifestyle and quality life in women with PCOS. reproduction women andThis to offer scientific contribution and solutions. Materials andofMethods: study was conducted on 174 women with PCOS who attended public and private fertility clinics in Keywords: Poverty, Reproductive health, War Urmia (west Azerbaijan, Iran). The participants were selected by convenience sampling method. The data were collected through
socio-demographic, health-promoting lifestyle (HPLP-II) and quality of life (PCOSQ) questionnaires. Multivariate linear regression was used to determine the relationship between the independent variables (health-promoting lifestyle and socio-demographic characteristics) and the dependent variable (quality of life). thought that severe military conflicts in Africa shorten Introduction Results: Thethe mean (standard deviation) of total the quality life was obtained (11.3)than in the2range 0 to 100. The theofexpected lifetime 45.8 for more years.between In general, Throughout history of the world, the onesscore whoofhad highest andthe lowest meanface scores in the sub-domains and had hirsutism. The mean (SD) of total score of health-promoting WHO calculated that 269 thousand people had died confronted bitterest of were poverty and war had al-of weight lifestyle (0.3) out of 4. Based on multivariate linear regression, theto variables of of health stress in 1999 due the effect wars responsibility, and that loss of 8.44 management, milways beenwas the2.2 women. As known poverty and war affects spiritual growth, body mass index (BMI), woman’s job and menstrual cycle intervals were predictors of the quality of life in women lion healthy years of life had occurred (2,3). human health either directly or indirectly, the effects of withcondition PCOS. on health and status of women in the soWars negatively affect the provision of health services. this Conclusion: Given importance of lifestyle in women to institutions maintain andsuch improve their quality of life, it is and necessary to Health as hospitals, laboratories ciety should not be the ignored. This study intends to castwith PCOS take serious strategies for changing and improving their lifestyle. health centers are direct targets of war. Moreover, the wars light on the effects of war and poverty on the reproductive Keywords: Health-promotion, Lifestyle, Polycystic Quality of life, of Women cause the migration qualified health employees, and health of women. For this purpose, the face of war Ovarian affect- syndrome,
thus the health services hitches. Assessments made indicate that the effect of destruction in the infrastructure of health continues for 5-10 years even after the finalization Health-promoting lifestyle includes behaviors that of conflicts (3). Due to resource requirements the reenable people to increase their controlinover their health structuring investments after war, the share allocated to most common endocrine disorders (1) with multiple and ultimately to improve their own and the society’s health has decreased (1). War and Women’s Health reproductive, hormonal and complexities health (9,10). Health-promoting lifestyle is the foundation Famine, synonymous with war andmetabolic poverty, is clearer for determined as ovarian dysfunction and clinical or of long-lasting health (11). Since promoting the quality of women; war means deep disadvantages such as full deMortalities and Morbidities biochemical of hyperandrogenism life in women with PCOS is wars one are of the most struction, loss ofsymptoms future and uncertainty for women. Wars and The ones who are most affected from women andimportant are conflicts that destroy families, societies and (2). cultures deaths depending on direct violence afsonographic appearance of polycystic ovaries Women children. goalsWhile of the medical community, the importance of male population, the indirect kill children, that negatively the risk health community and cause with PCOS areaffect at high ofoffertility problems, such as fect the lifestyle is more apparent in deaths this area (12). A study by andet elders In Iraq in- on the violation ofendometrial human rights. According to the data of World infertility, cancer, late menopause (3), and also women Clark alonmore. women withbetween PCOS 1990-1994, was conducted fant deaths had shown this reality in its more bare form Health Organization (WHO) and World Bank, in 2002 metabolic disorders, such as dyslipidemia, type 2 diabetes effect of lifestyle modification. The results showed that with an increase of 600% (4). The war taking five years wars had been among the first ten reasons which killed mellitus and cardiovascular diseases (4). The main cause interventions improved the quality of life (13). Thomson increases the child deaths under age of 5 by 13%. Also 47% the most and caused disabilities. Civil losses are at the rate of this disorder is still unknown and researchers believe studiedinlifestyle of life seekers in women with of allet thealrefugees the worldand andquality 50% of asylum of 90% within all losses (1). that is no cure effects for this andOne available PCOS and reported that and limiting energy and displaced people are women girls and 44% to ref-moderate War there has many negative on syndrome human health. of treatments aim improve the its symptoms (5). life. improves the quality of life, while doing ugeeslevel and asylum seekers are children under the age of exercise these is its just effect of to shortening average human According to the of WHO, human Quality of lifedata is based on the theaverage perception oflife lifeis and 18 (5). without proper diet has no greater benefits (14). Lifestyle As the result of wars and armed conflicts, women aretreatment years for males (6) andas 72.7 years It is being is68.1 quite subjective well as for it isfemales. a multidimensional modification is suggested as the first-line PCOS ing the women, the problem of immigration, inequalities in distribution of income based on gender and the effects of all these on the reproductive health of women will be Introduction addressed. ovarian syndrome (PCOS) is one of the Polycystic
concept including physical, psychological and social (15). It has been reported that using appropriate lifestyle aspects of health (7). According to the World Health in women with PCOS has improved 75% of problems (16). Received 12 December 2014, Accepted 25 April 2015, Available online 1 July 2015 Organization (WHO), 60% of individual’s quality of life Given that most patients are young women and that 1 Department of Nursing, Sakarya University, Sakarya, Turkey. 2Department of Midwifery, Sakarya University, Sakarya, Turkey. *Corresponding author: Yasemin Hamlaci, Department of Midwifery, Sakarya University, Sakarya, Turkey. Tel: depends on their attitude and lifestyle (8). many factors can+905556080628, affect various aspects of their lives, Email:
[email protected]
Received 8 December 2016, Accepted 8 March 2017, Available online 25 March 2017 Department of Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran. 2Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. 3Reproductive Health Research Center, Urmia University of Medical Sciences, Urmia, Iran. 4Students’ Research Committee, Nursing and Midwifery Faculty, Aras International Branch, Tabriz University of Medical Sciences, Tabriz, Iran. *Corresponding Author: Fatemeh Aliasghari, Tel: +989906124003, Email:
[email protected] 1
Mirghafourvand et al
it is necessary to modify lifestyle, maintain health and improve the quality of life in these women. Furthermore, no study has been conducted on the relationship between health-promoting lifestyle and quality of life in Iranian women with PCOS; therefore, we decided to evaluate the relationship between quality of life and health-promoting lifestyle in these women to take effective steps in improving their lifestyle and quality of life. Materials and Methods Study Population This cross-sectional study was conducted on 174 women with PCOS who attended public and private fertility clinics in Urmia (capital of west Azerbaijan province, Iran) in 2015. The participants were selected according to the physician’s final diagnosis of PCOS. Inclusion criteria included diagnosis of PCOS based on medical records, willingness to participate in the study, being in reproductive age and having secondary school education and higher. Exclusion criteria included suffering from physical or mental diseases leading to limitations in health-promoting lifestyle, such as experiencing grief or other life events during the last three months, having special diets and having a history of depression. Sampling Sampling was performed in 2 private and 2 public centers in Urmia. Since convenience sampling was used, the researcher attended the mentioned centers and evaluated all the women who referred to the centers for various reasons such as amenorrhea, oligomenorrhea, hirsutism, ultrasound results indicating ovarian cysts, acne, infertility and so on. The participants were enrolled according to their medical record and the physician’s final diagnosis of PCOS. Women who were willing to participate in the study were assessed in terms of eligibility criteria and if they were eligible, they signed the informed consent and were assured of confidentiality of all the information. Finally, they completed the questionnaires. Measures The data collection tools included socio-demographic and obstetrics, Health-Promoting Lifestyle Profile-II (HPLPII), and Polycystic Ovarian Syndrome Quality of Life (PCOSQ) questionnaires (see Supplementary file). HPLP-II consists of 52 items containing 6 dimensions of health-promoting behaviors related to nutrition, physical activity, spiritual growth, health responsibility, stress management and interpersonal relationships. All items were scored based on Likert scale ranging from 1 to 4 (1 = never, 2 = sometimes, 3 = frequently, 4 = always) (17). Higher scores indicate higher health-promoting behaviors. Persian version of this tool was used in a study on women of reproductive age and Cronbach α and the intra-class correlation coefficient (ICC) have been reported 0.9 and 0.89, respectively (18).
PCOSQ includes 26 items containing dimensions of emotions, hirsutism, weight, infertility and menstrual disorders. All items were scored based on Likert scale ranging from 1 (strongly/all of the time) to 7 (no problems/never) (19). Higher scores indicate better quality of life. Validity and reliability of the Persian version of questionnaire was confirmed by Amini et al (20). The reliability of the HPLP-II and PCOSQ was determined by repeating the test-retest with a 2-week interval on 20 women with PCOS through using the ICC assessment. The ICC was 0.96 for HPLP-II and 0.99 for PCOSQ. Sample Size and Statistical Methods Based on the parameter of quality of life and according to the results of the study by Amini et al (21), the sample size was calculated as 146 individuals (mean = 48.13, standard deviation [SD] = 29.69, precision around the mean = 0.1, α = 95%, and power = 90%). Considering the 20% sample loss, the final sample size was calculated as 174 individuals. Statistical analysis was performed in SPSS version 21.0 software. Normality of the quantitative data was confirmed by Skewness and Kurtosis. Descriptive statistics including frequency and mean (SD) were used to describe socio-demographic characteristics, quality of life and health-promoting lifestyle. Pearson correlation coefficient was used to determine the relationship between healthpromoting lifestyle and quality of life, and independent t test and one-way analysis of variance (ANOVA) were used to determine the relationship between socio-demographic characteristics and quality of life, then all variables with P
