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PURPOSE: This study investigated the effectiveness of a happiness counseling program on depression, anxiety, and stress in pregnant women with a history of recurrent miscarriage. PATIENTS AND METHODS: A parallel randomized controlled trial research design was used in this study, which was conducted at the high-risk inpatient unit of the Obstetrics and Gynecology Hospital of Cairo University Hospitals in Cairo, Egypt. A total of 60 pregnant women who had previously experienced multiple miscarriages were randomly assigned to intervention and control groups (n=30 each). The tools used for data collection were demographic and obstetric data questionnaires and the 21-item Depression, Anxiety, and Stress Scale (DASS-21). Happiness counseling sessions were conducted for the intervention group. Data for qualitative variables were analyzed with the chi-squared test, and the Student's t test for paired samples was used to compare mean DASS-21 scores of the intervention and control groups. The Pearson correlation coefficient was used to analyze the association between variables. RESULTS: The happiness counseling sessions reduced depression, anxiety, and stress in women with recurrent miscarriage, resulting in lower mean DASS-21 scores for the intervention group compared to the control group. CONCLUSION: The happiness counseling program had a positive effect on reducing depression, anxiety, and stress in women with recurrent miscarriage. We recommend that this program be used as an effective, low-cost, and noninvasive intervention to improve the mental health and overall wellbeing of women with recurrent miscarriage.
RESUMEN
OBJECTIVE: To synthesize the evidence on the most effective medications for the relief of intrauterine device (IUD) insertion-related pain. DESIGN: Systematic review and network meta-analysis of randomized controlled trials (RCTs). SETTING: Not applicable. PATIENT(S): Patients undergoing IUD insertion who received different medications for pain relief versus those who received placebo. INTERVENTION(S): Electronic search in the following bibliographic databases: Medline via PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and ScienceDirect. MAIN OUTCOME MEASURE(S): Visual analog scale (VAS) pain score during tenaculum placement, IUD insertion, and 5 to 20 minutes after insertion, the score of easiness of insertion and the need for additional analgesics. RESULT(S): The present review included 38 RCTs (n = 6,314 patients). The network meta-analysis showed that lidocaine-prilocaine cream (genital mucosal application) statistically significantly reduced pain at tenaculum placement compared with placebo (mean difference -2.38; 95% confidence interval, -4.07 to -0.68). In the ranking probability order, lidocaine-prilocaine cream ranked the highest in reducing the pain at tenaculum placement, followed by lidocaine (paracervical). Similarly, lidocaine-prilocaine cream ranked as the highest treatment in pain reduction during IUD insertion, followed by lidocaine (paracervical). CONCLUSION(S): Lidocaine-prilocaine cream is the most effective medication that can be used for IUD insertion-related pain. Other medications are not effective.