Abstract
. Background: Sexual Health and Relationships Education (SHRE) provides individuals with the knowledge and skills set which helps them to manage risky behaviors and take informed decisions and to protect themselves against STIs, risky behavior and unintended pregnancy. Such education is minimally provided in Iranian schools and universities and previous research has indicated demand and need for SHRE among different social groups. This study explored Iranian young adults’ sexual health education, training and service needs and ways to improve or augment the existing provision.Design and methods: a qualitative design was employed. Semi-structured interviews were conducted with a sample of 25 young adults who lived in Tehran, Iran and have volunteered to participate in our study. Transcripts were analyzed using thematic analysis.Results: Participants explained their need and demand for sexual health education and healthcare. They highlighted existing barriers such as lack of reliable resources, taboo and cultural barriers and lack of trust and protected confidentiality to gaining sexual health information and seeking related advice and healthcare. This has resulted in ambiguities and misconceptions, including those regarding the cause and transmission of STIs and correct use of contraceptions.They unanimously expressed their dissatisfaction with the limitedly available sexual health education and provided recommendations for an improved provision, including holding mixed gender extracurricular workshops with a comprehensive approach to sexual health and relationships education.Conclusions: There is a clear need and demand for provision of relevant and reliable sexual health and relationships education to young adults, which needs to be addressed in order for young adults to make informed choices and limit their risky sexual behavior.

Abstract
. Background: Sexual Health and Relationships Education (SHRE) provides individuals with the knowledge and skills set which helps them to manage risky behaviors and take informed decisions and to protect themselves against STIs, risky behavior and unintended pregnancy. Such education is minimally provided in Iranian schools and universities and previous research has indicated demand and need for SHRE among different social groups. This study explored Iranian young adults’ sexual health education, training and service needs and ways to improve or augment the existing provision.Design and methods: a qualitative design was employed. Semi-structured interviews were conducted with a sample of 25 young adults who lived in Tehran, Iran and have volunteered to participate in our study. Transcripts were analyzed using thematic analysis. Results: Participants explained their need and demand for sexual health education and healthcare. They highlighted existing barriers such as lack of reliable resources, taboo and cultural barriers and lack of trust and protected confidentiality to gaining sexual health information and seeking related advice and healthcare. This has resulted in ambiguities and misconceptions, including those regarding the cause and transmission of STIs and correct use of contraceptions.They unanimously expressed their dissatisfaction with the limitedly available sexual health education and provided recommendations for an improved provision, including holding mixed gender extracurricular workshops with a comprehensive approach to sexual health and relationships education.Conclusions: There is a clear need and demand for provision of relevant and reliable sexual health and relationships education to young adults, which needs to be addressed in order for young adults to make informed choices and limit their risky sexual behavior.

Objective: to evaluate the risk factors for severe maternal outcome (SMO) in Afghan immigrant women. Methods: Women with potentially life-threatening conditions (PLTC) were selected. Then risk factors for those PLTC which led to SMO (maternal near-miss or maternal death) were evaluated. In addition, risk factors for those SMOs occurring on hospital admission or during the first 12 hours after admission to the hospital (SMO12) were evaluated. Results: Parity ≥3 (adjusted odds ratio [aOR] 3.24, 95% confidence interval [CI] 1.62–6.50, P = 0.03), low literacy level in mother (aOR 2.99, 95% CI 1.16–5.01, P = 0.03), inadequate prenatal care (aOR 2.74, 95% CI 1.2–3.87, P = 0.01), multigravidity (gravidity ≥5: aOR 2.62, 95% CI 1.31–4.53, P = 0.03), lack of health insurance (aOR 2.52, 95% CI 1.25–4.02, P = 0.01), and low literacy level in husband (aOR = 1.49, 95% CI 1.15–2.9, P = 0.02) were the risk factors for SMO in women with PLTC. Inadequate prenatal care (aOR 4.2, 95% CI 2.05–8.25, P = 0.04), low literacy level in mother (aOR 3.38, 95% CI 1.32–6.65, P = 0.04), parity ≥3 (aOR 2.69, 95% CI 1.16–4.7, P = 0.04), and lack of health insurance (aOR 2.13, 95% CI 1.25–3.67, P = 0.03) were risk factors for SMO12. Conclusion: There was a higher rate of SMO and SMO12 cases among Afghan immigrant women.

Abstract
Background: Sexual Health and Relationship Education ( provides individuals with the knowledge and skills set which helps them to manage risky behaviours and make informed decisions and to protect themselves against STIs, risky behaviour, and unintended pregnancy. Such education is minimally provided in Iranian schools and universities; and previous research has indicated a demand and the need for SHRE among young people across the social spectrum (Chapter 1).

Aim:
The overall aims of this project were to ( conduct a needs assessment of the SHRE and sexual health service needs of young adults living in Tehran, ( investigate how such provision could be improved or augmented, taking the account of the views of health professionals and policymakers, and ( design a tailor-made SHRE programme for the future development of improved provision to be delivered in Tehran.

Methods:
This PhD project explored Iranian young adults’ sexual health education, training, and service needs and ways to improve or augment the existing provision (Chapter 3). This was followed by an investigation of Iranian healthcare professionals’ assessments of, and recommendations for, sexual health education and service provision for young people in Tehran (Chapter 4).
Both of these studies employed detailed thematic analyses of interview transcripts. Finally, a tailor-made programme outline for an improved SHRE
provision for young adults in Tehran was developed based on the findings of the first two studies, recommendations made in international guidance on the optimal content of SHRE programmes, and further stakeholder consultations using a public involvement methodology (Chapter 5).

Results:
Young adults in Tehran expressed their need and demand for enhanced sexual health education and healthcare. They highlighted existing barriers such as almost non-existent official education and the lack of reliable resources, taboo and cultural barriers, and lack of trust and confidentiality when seeking sexual health information, advice, and healthcare. This has resulted in
ambiguities and misconceptions, including those regarding the cause and transmission of STIs and the correct use of contraception methods. They unanimously expressed their dissatisfaction with available sexual health education and provided recommendations for an improved provision, including holding mixed-gender extracurricular workshops with a comprehensive approach to sexual health and relationship education (Chapter 3). Validating young adults’ views, healthcare professionals emphasised the need for improved SHRE and service provision for young adults. They also confirmed the barriers highlighted by young Tehranians and collectively supported the augmentation of educational provision and healthcare services and provided recommendations on how this could be achieved (Chapter 4). A bespoke SHRE programme was then developed based on the aforementioned needs assessments, in addition to comments from the programme’s stakeholders and best practice guidelines
published by six national and international organisations. The programme provides content and delivery recommendations, along with objectives and
deliverables for each content category. The final programme outline is intended as a blueprint for improved SHRE provision in Tehran, and potentially Iran
(Chapter 5).

Conclusion:
This PhD project has generated two novel in-depth needs assessments complemented by a theory- and evidence-informed, tailor-made SHRE programme outline which has the potential to augment the currently
minimal SHRE provision in Tehran. This enhanced programme will have the capacity to provide young adults with reliable and non-judgmental sexual health
and relationship knowledge and skills, which can result in improved sexual health and confidence in managing healthy relationships. Overall, this research
demonstrates the unmet needs and desires of Tehranian young adults and healthcare professionals concerning sexual health and relationship education. It provides several recommendations for the future development and implementation of SHRE programmes in Tehran.

Abstract
. Background
. Sexual Health and Relationships Education (SHRE) provides individuals with knowledge and skills to manage risky behaviors and take informed decisions to protect themselves against STIs, and unintended pregnancy. Only minimal SHRE is provided in Iranian schools and universities and previous research has highlighted needs and demands for improved SHRE and sexual services in Iran. This study explored young, Iranian adults’ experience of, and need for sexual health education, sexual skills training and sexual healthcare services, as well their views on how to augment and improve existing provision.
.
. Design and methods
. Semi-structured interviews were conducted with a sample of 25 young adults who lived in Tehran, Iran and had volunteered to participate in the study. Transcripts were analyzed using thematic analysis.
.
. Results
. Participants explained their needs and demands for sexual health education and sexual healthcare. They unanimously expressed their dissatisfaction with available SHRE and sexual health care provision. They highlighted barriers to gaining sexual health information and seeking advice and healthcare, including a lack of reliable resources, taboo and cultural barriers, lack of trust and protected confidentiality. This has resulted in ambiguities and misconceptions, including those regarding the cause and transmission of STIs and correct use of contraceptives. Participants recommended improvements, including holding mixed-gender extracurricular workshops with a comprehensive approach to sexual health and relationships education.
.
. Conclusions
. There is a clear need and demand for provision of relevant and reliable sexual health and relationships education for young adults in Tehran. This should be addressed to empower young people to make informed choices and avoid risky sexual behavior.
.

Background & Objective: Asthma is the most common chronic respiratory disorder during pregnancy and it may affect pregnancy outcomes. This study aims to compare the pregnancy, delivery and neonatal outcomes between asthmatic and non-asthmatic pregnant women. Materials & Methods: the study was designed as a historical cohort among pregnant women with and without asthma. A total number of 583 asthmatic patients were allocated to the case group and 753 women without asthmatic history were placed in the control group. Pregnancy, labor and neonatal outcomes were compared between the two groups. Results: the baseline characteristics of the women in both groups did not show significant differences. Gestational hypertension was more in the asthmatic group [43 (7.37%) VS 26 (3.45%), P=0.001]. Also, the rate of preterm delivery was higher in asthmatic women (72 (12.34%) VS 77 (10.22%) in the control group, P=0.04). However, the rate of preeclampsia was less in the asthmatic group [29 (4.97%) VS 71 (9.42%), P=0.008]. Apgar score at minutes 1 and 5 was less in asthmatic group. Intra Uterine Fetal Demise (IUFD) (24 (4.1%) VS 13(1.7%), P value=0.009), and neonatal death (31 (5.31%) VS 10 (1.32%), P=0.001) were more in the asthmatic group. The maternal and neonatal complications did not show significant differences in various severities of asthma. Multivariate regression model showed more risks for neonatal death (adjusted odds ratio (AOR)=4.18; CI95% 2.03-8.60), IUFD (AOR=2.43; CI 95% 1.22-4.82), gestational hypertension (AOR=1.43; CI 95% 1.40-1.45), and lower risk for preeclampsia (AOR 0.37; CI 95%0.17-0.79) in asthmatic women. Conclusion: Regardless of the fact that asthmatic mothers had higher frequencies of gestational hypertension, IUFD and neonatal death, the effect of asthma on perinatal outcome is minimal, probably because of efficient medical control.