Burden of fungal infections in Iran

INTRODUCTION

The number of fungal infections occurring each year in Iran is not known. As the burden of fungal disease is a measure used to assess and compare the relative impact of different type of fungal diseases on populations, we have estimated the burden of fungal diseases in Iran.

METHODOLOGY

We estimated the burden of human fungal diseases based on the specific populations at risk, existing epidemiological data in both local and international databases, and modelling previously described by the LIFE program (http://www.LIFE-worldwide.org).

RESULTS

Among the population of Iran (79,926,270 in 2016), 6,670,813 (8.3%) individuals are estimated to suffer from a fungal infection each year. A total of 2,791,568 women aged between 15 and 50 years are estimated to suffer from recurrent vulvovaginal candidiasis, annually. In addition, considering the 13.3% prevalence rate of tinea capitis in children, a total of 2,552,624 cases per year are estimated. The estimated burden of invasive aspergillosis in the 3 groups of patients with hematologic malignancy, lung cancer and chronic pulmonary obstructive disease was 6394 (8.0 per 100,000). The estimate for the burden of allergic disease related to fungi including allergic bronchopulmonary aspergillosis, severe asthma with fungal sensitization and allergic fungal rhinosinusitis was 272,095 (340 per 100,000). Based on the 28,663 cases of HIV infection reported, an estimated 900 and 113 cases with pneumocystosis and cryptococcal meningitis are annually anticipated, respectively.

CONCLUSION

Our estimates indicate that the importance of fungal infections is high but overlooked in Iran, which warrants further actions by health care authorities.

A comparison of microleakage in self-etch fissure sealants and conventional fissure sealants with total-etch or self-etch adhesive systems

Objective

The present study was conducted to compare microleakage in self-etching fissure sealants and conventional fissure sealants with total-etch or self-etch adhesive systems.

Settings and Design

This experimental in vitro study was conducted on 60 healthy third molars extracted from humans. The first group received Acid etch + Clinpro sealant, the second group received Acid etch + Single bond 2 + Clinpro sealant, the third group received Single bond universal (self-etching bonding) + Clinpro sealant, and the fourth group received prevent seal self-etching sealant.

Materials and Methods

An incision was made on the teeth after they were immersed in methylene blue 5%. The samples were then examined under a stereomicroscope and the dye penetration rate was measured based on the Williams and Winter criteria.

Statistical Analysis Used

The Kruskal-Wallis and Mann-Whitney tests were used for data analysis in SPSS-18 (P < 0.05).

Results

Group 1 which was treated with the conventional technique (acid + fissure sealant) had the highest rate of microleakage compared to Groups 2 and 3 (P < 0.001).

Conclusion

The results showed that the use of bonding results in a significant reduction in the microleakage of fissure sealants. The microleakage caused when using self-etch fissure sealant was not different from that caused by the use of the conventional method.

Survival prediction of gastric cancer patients by Artificial Neural Network model

AIM

This study aims to predict survival rate of gastric cancer patients and identify the effective factors related to it, using artificial neural network model.

BACKGROUND

Gastric cancer is the most deadly disease in north and northeast provinces of Iran. A total of 430 patients with gastric cancer who referred to Baghban clinic in Sari, from early November 2006 to late October 2013 were followed.

METHODS

A historical cohort of patients who referred to Baghban Clinic, the cancer research center of Mazandaran University of Medical Sciences in Sari, from early November 2006 to late October 2013 was studied. Three groups of variables (demographic, biological and socio-economic) were studied. Survival rate and effective factors on survival time were calculated using Kaplan-Meier methods and artificial neural networks and the best network structure were chosen using the mean square error and ROC curve. All analyses were performed using SPSS v.18.0 and the level of significance was selected α=0.05.

RESULTS

In this research, the median survival time was 19±2.04 months. The 1 to 5-year survival rates for patients were 0.64, 0.44, 0.34, 0.24 and 0.19, respectively. The percentage of right predictions of the selected network and the area under the ROC curve were 92% and 94%, respectively. According to the results, the type of treatment, metastasis, stage of disease, histology grade, histology type and the age of diagnosis were effective factors on survival period.

CONCLUSION

the 5 years survival rate of gastric cancer patients in Mazandaran is lower than other provinces which could be due to the delay in diagnosis or patient's referral. Therefore, the use of screening methods and early diagnosis could be influential for improving survival rate of these patients.

Single-dose intravenous sodium valproate (Depakine) versus dexamethasone for the treatment of acute migraine headache: a double-blind randomized clinical trial

Objective

Migraine headache is a chronic and disabling condition in adults. Some studies have investigated the efficacy of sodium valproate in the treatment of acute migraine, but the effectiveness and tolerability of intravenous valproate as abortive therapy remains unclear. This study aimed to evaluate the effects of sodium valproate and dexamethasone in the treatment of acute migraine.

Methods

We conducted a double-blind randomized clinical trial including 90 patients aged 18 to 65 years with acute migraine headache but no aura. Patients were randomized to receive intravenous dexamethasone (8 mg) or sodium valproate (400 mg) diluted into 4 mL of normal saline. The primary outcome measure was pain relief after 0.5, 1, 3, or 6 hours after administration. The secondary outcome criteria were the associated symptom recovery, rate of headache recurrence after 24 hours, and medication side effects. Pearson’s chi square and the t-test were employed in the data analysis.

Results

Of the 90 patients, 80 were investigated. The percentage of headache improvement at 0.5 hours after treatment was 55% and 67.5% in the sodium valproate and dexamethasone groups, respectively. Before-treatment and 0.5 hour after treatment pain severity visual analog scale scores were 9.05±0.90 and 3.8±3.09 in the sodium valproate group and 8.92±0.79 and 3.10±2.73 in the dexamethasone group, respectively. There were no significant intergroup differences.

Conclusion

This randomized clinical trial showed that the intravenous injection of sodium valproate 400 mg has similar effects to those of dexamethasone for improving acute migraine headache.

BTEX exposure assessment and quantitative risk assessment among petroleum product distributors

The aim of this study was to evaluate benzene, toluene, ethylbenzene, and xylene (BTEX) exposure among workers at four stations of a major oil distribution company. Personal BTEX exposure samples were collected over working shift (8h) for 50 workers at four stations of a major oil distribution company in Iran. Measured mean values for workers across four sites were benzene (2437, 992, 584, and 2788μg/m³ respectively), toluene (4415, 2830, 1289, and 9407μg/m³), ethylbenzene (781, 522, 187, and 533μg/m³), and xylene (1134, 678, 322, and 525μg/m³). The maximum mean concentration measured across sites for benzene was 2788μg/m³ (Station 4), toluene was 9407μg/m³ (Station 4), ethylbenzene was 781μg/m³ (Station 1) and xylene was 1134μg/m³ (Station 1). The 8h averaged personal exposure benzene concentration exceeded the recommended value of 1600μg/m³ established by the Iranian Committee for Review and Collection of Occupational Exposure Limit and American Conference of Governmental Industrial Hygienists. Mean values for excess lifetime cancer risk for exposure to benzene were then calculated across workers at each site. Estimates of excess risk ranged from 1.74 ± 4.05 (Station 4) to 8.31 ± 25.81 (Station 3). Risk was assessed by calculation of hazard quotients and hazard indexes, which indicated that xylene and particularly benzene were the strongest contributors. Tanker loading was the highest risk occupation at these facilties. Risk management approaches to reducing exposures to BTEX compounds, especially benzene, will be important to the health of workers in Iran.

Determinant factors for mortality during treatment among tuberculosis patients: Cox proportional hazards model

BACKGROUND

Investigating the survival of tuberculosis (TB) patients is one of the main parts of the TB control program. It can be related to many factors. This study aimed to estimate the survival experience and its associated factors among these patients.

METHODOLOGY

All TB patients detected during March 2005 to 31 September 2014 were entered into this prospective cohort. Each patient was investigated from the diagnosis date and followed until the last available information during treatment. Data analysis was performed using Kaplan Meier and multivariate Cox regression models.

RESULTS

The survival experience of 2493 TB patients was investigated 73.7% of which were pulmonary type. Mean and median survival time were 6.5 and 6.2 months respectively. The incidence rate of death among patients during the treatment courses was 0.99 (95% confidence interval: 0.84-1.1) per 100 person-months. Controlling the confounders, the incidence (95% confidence interval) of death was significantly higher among men (HR=1.8; 1.2-2.6), diabetic patients (HR=1.7; 1.2-2.6), cancerous patients (HR=4.8; 2.6-8.8) and HIV positive patients (HR=22.1; 7.3-66.4).

CONCLUSION

This study showed that male gender, TB/HIV co-infection and concurrent development of TB and cancer were determinant factors of death during the treatment period of TB.

Evaluation of E-cadherin Expression in Gastric Cancer and Its Correlation with Clinicopathologic Parameters

Background: Gastric cancer is one of the most common cancers in the world. There are many genomic and molecular factors that cause gastric cancer to occur. Also, many markers that associate with tumor invasiveness have been known. E-cadherin is a calcium- mediated cell adhesion molecule. In some studies, abnormal expression of E-cadherin has been seen in gastric carcinoma. However, in the studies done there has been some conflicting information about abnormal expression of this marker in a variety of gastric carcinoma and also about the expression of this marker and its correlation with various clinicopathologic factors of tumor. Subjects andMethods: A case control study was performed on total or partial gastrectomy tissue samples obtained from 70 patients with gastric cancer and adjacent non-neoplastic tissues. The immunohistochemistry was used to assess E-cadherin expression. The correlation between abnormal E-cadherin expression and tumor histopathology was evaluated in all patients. Results: Among 70 patients who were analyzed, 48.6% showed abnormal E-cadherin expression. A significant correlation was seen between abnormal E-cadherin expression and tumor stage, grade, lymph node metastasis, tumor phenotype, tumor type, depth of invasion and age. Conclusion: Abnormal E-cadherin expression is a common phenomenon in gastric cancer. Because there was a strong correlation between abnormal E-cadherin expression and tumor stage, tumor grade, depth of invasion and regional lymph node involvement, this marker may be used as a predictive factor for tumor invasiveness in gastric cancer.

Dietary Patterns Are Associated with Risk of Diabetes Type 2: A Population-Based Case-Control Study

OBJECTIVE

We aimed to assess the relationship between major dietary patterns and risk of diabetes type 2 among Iranian adults.

METHODS

In this population-based case-control study in Mazandaran province, we enrolled 332 subjects (110 newly diagnosed cases and 222 controls) aged 43 - 77 years. Dietary intakes were collected using a validated semi-quantitative food frequency questionnaire (FFQ). Data on demographic, anthropometric, socioeconomic characteristics and other covariates were collected using structured lifestyle questionnaires. Factor analysis was used to identify major dietary patterns. Odds ratios (OR) were calculated for risk of type 2 diabetes across quartiles of dietary pattern scores.

RESULTS

Three major dietary patterns were identified, including: "healthy", "transitional" and "traditional". A significant direct association was found between the transitional dietary pattern and risk of diabetes type 2 after adjustment of potential confounders (OR = 2.17; 95% CI: 1.0, 4.50; Ptrend = 0.02). The traditional dietary pattern was significantly associated with the increased risk of diabetes type 2 after controlling for confounders (OR = 2.13; 95% CI: 1.03, 4.41; Ptrend = 0.01). There was no significant relationship between healthy dietary pattern and risk of diabetes type 2.

CONCLUSIONS

In conclusion, transitional dietary pattern characterized by high consumption of salt, organ meats, dried fruits, poultry, tea, low- fat dairy and other vegetables. Traditional dietary pattern characterized by high intakes of garlic, dough, high- fat dairy, dried fruits, red meats, grains, as well as animal and hydrogenated fats were associated with an increased risk of type 2 diabetes. No significant associations were found between the healthy dietary pattern and risk of diabetes type 2.

Application of Parametric Models to a Survival Analysis of Hemodialysis Patients

Background

Hemodialysis is the most common renal replacement therapy in patients with end stage renal disease (ESRD).

Objectives

The present study compared the performance of various parametric models in a survival analysis of hemodialysis patients.

Methods

This study consisted of 270 hemodialysis patients who were referred to Imam Khomeini and Fatima Zahra hospitals between November 2007 and November 2012. The Akaike information criterion (AIC) and residuals review were used to compare the performance of the parametric models. The computations were done using STATA Software, with significance accepted at a level of 0.05.

Results

The results of a multivariate analysis of the variables in the parametric models showed that the mean serum albumin and the clinic attended were the most important predictors in the survival of the hemodialysis patients (P < 0.05). Among the parametric models tested, the results indicated that the performance of the Weibull model was the highest.

Conclusions

Parametric models may provide complementary data for clinicians and researchers about how risks vary over time. The Weibull model seemed to show the best fit among the parametric models of the survival of hemodialysis patients.

Photocatalytic degradation of furfural in aqueous solution by N-doped titanium dioxide nanoparticles

The photocatalytic degradation of furfural in aqueous solution was investigated using N-doped titanium dioxide nanoparticles under sunlight and ultraviolet radiation (N-TiO₂/Sun and N-TiO₂/UV) in a lab-scale batch photoreactor. The N-TiO₂ nanoparticles prepared using a sol-gel method were characterized using XRD, X-ray photoelectron spectroscopy (XPS), and SEM analyses. Using HPLC to monitor the furfural concentration, the effect of catalyst dosage, contact time, initial solution pH, initial furfural concentration, and sunlight or ultraviolet radiation on the degradation efficiency was studied. The efficiency of furfural removal was found to increase with increased reaction time, nanoparticle loading, and pH for both processes, whereas the efficiency decreased with increased furfural concentration. The maximum removal efficiencies for the N-TiO₂/UV and N-TiO₂/Sun processes were 97 and 78 %, respectively, whereas the mean removal efficiencies were 80.71 ± 2.08 % and 62.85 ± 2.41 %, respectively. In general, the degradation and elimination rate of furfural using the N-TiO₂/UV process was higher than that using the N-TiO₂/Sun process.

Efficacy of 10% sucralfate ointment after anal fistulotomy: A prospective, double-blind, randomized, placebo-controlled trial

INTRODUCTION

The most frequent problems after anal fistulotomy are pain, bleeding, and delayed or impaired wound healing. Topical Sucralfate preparation has been used to treat a wide variety of wounds. In this study, we investigate effects of 10% sucralfate ointment on wound healing and postoperative pain after fistulotomy.

METHODS AND MATERIALS

A total of 41 patients undergoing anorectal fistulotomy were included in this randomized, blinded, controlled trial and were randomly allocated to either sucralfate ointment (every 12 h) or placebo. The patients were visited weekly for up to 5 weeks. The intensity of pain and the wound healing were assessed.

RESULTS

The sucralfate group had significantly less pain at rest (1.92 ± 0.88 vs 2.96 ± 0.98; P = 0.002) and on defecation (1.68 ± 0.92 vs 3.08 ± 1.12; p < 0.001) than the placebo group from 1st to 5th post-operative visits. Complete wound healing was achieved after 8.15 ± 1 weeks in placebo group versus 5.9 ± 0.8 weeks in sucralfate group (p < 0.001). There were no significant differences in the frequencies of postoperative complications between the two groups.

CONCLUSION

Compared with placebo, sucralfate ointment reduced postoperative pain at rest and on defecation and improves wound healing in patients undergoing fistulotomy.

The Effect of Green Tea Gargle Solution on Sore Throat After Coronary Artery Bypass Grafting: A Randomized Clinical Trial

Background

Tracheal intubation is an essential method of keeping the airway open in patients under general anesthesia. Sore throat is a prevalent complication after endotracheal intubation.

Objectives

The aim of this study was to investigate the effect of green tea gargling on sore throat after coronary artery bypass grafting (CABG).

Patients and Methods

This was a single-blind, randomized clinical trial, in which 121 patients who had undergone CABG were divided into two groups: those who gargled distilled water and those who gargled a green tea solution. An hour after extubation, the patients of the intervention group were asked to gargle 30 cc of green tea, and the patients of the control group were asked to gargle 30 cc of distilled water, every 6 hours for up to 24 hours (four times per patient). A sore throat questionnaire was filled out 6, 12, and 24 hours after endotracheal extubation.

Results

The results showed that there were no significant differences between the two groups with regard to patient age, sex, body mass index, smoking background, and duration of anesthesia. There was no significant difference between the two groups in terms of sore throat before the intervention (P = 0.461) and 6 hours after the intervention (P = 0.901). However, a significant difference was observed between the two groups in terms of sore throat 12 hours (P = 0.047) and 24 hours (P < 0.001) after removing the endotracheal tube.

Conclusions

Gargling a green tea solution, an anti-inflammatory, natural, and harmless substance, can reduce the pain of sore throat in patients after endotracheal extubation.

The impact of oral care on oral health status and prevention of ventilator-associated pneumonia in critically ill patients

BACKGROUND

Ventilator-associated pneumonia is one of the most common nosocomial infections which increase mortality rate and length stay of hospitalisation. Oral care would not only improve patient's oral health and well-being, but it can also reduce the incidence rate of ventilator-associated pneumonia.

OBJECTIVES

The objective of this study was to identify the impact of oral care practices on oral health status of patients in intensive care unit and the incidence rate of ventilator-associated pneumonia.

METHODS

This clinical trial recruited 100 participants who were randomly assigned to a control group (receiving oral care by nurses) and an intervention group (receiving systematic care by the researcher) during 2015-2016. Beck Oral Assessment Scale was used to determine the required number of times for receiving oral care with regard to patient's oral health in the intervention group. Each care included adjusting endotracheal tube cuff pressure, brushing with toothpaste, using antiseptics and moistening the lips. The oral cavity was examined using BOAS and Mucosal-Plaque Score, and Clinical Pulmonary Infection Score was used for detecting pneumonia.

RESULTS

The BOAS scoring showed significant differences between the two groups from the first to fifth day (P<0.001). The mucosal-plaque index was significantly different between the two groups from the third day to fifth day (P<0.001). The incidence rate of pneumonia on the third and fifth day was 10% (5) and 14% (7) in the control group, and 4% (2) and 10% (5) in the intervention group, respectively. The Fisher test did not show significant difference (P=0.538), however, the incidence rate in the intervention group reduced compared with the control group.

CONCLUSION

Although following a systematic oral care program could not significantly decrease the incidence of ventilator-associated pneumonia in critically ill patients compared to the conventional oral care practices, it significantly improved the oral health and mucosal-plaque index.

Sleep Quality and Depression and Their Association with Other Factors in Hemodialysis Patients

BACKGROUND

Sleep disorders and depression, accompanied by reduced quality of life and increased mortality are the most common psychological problems in dialysis patients. This study was conducted with the aim to investigate depression and sleep quality and their association with some demographic and clinical factors in hemodialysis patients.

METHOD

This descriptive-correlative study was conducted on 310 patients undergoing hemodialysis in 8 centers in educational hospitals in Mazandaran University of Medical Sciences. Data collection tools included a demographic questionnaire, Beck Depression Inventory, and Pittsburg Sleep Quality Index (PSQI). Statistical analysis was conducted using Chi-Square test and regression model.

RESULTS

Results obtained showed 44.8% depression in patients. Significant relationships were found between depression and increased blood phosphorus (P=0.002) and urea (P=0.001). Poor sleep quality was observed in 73.5% of hemodialysis patients, which was found significantly related to aging (P=0.048), female (P=0.04), and reduced frequency of weekly hemodialysis (P=0.035).

CONCLUSION

Depression and poor sleep quality are two common factors in hemodialysis patients, but patients do not overtly show symptoms of these disorders.

Parametric Model Evaluation in Examining the Survival of Gastric Cancer Patients Andits Influencing Factors

<p><strong>BACKGROUND:</strong> Cox proportional hazard model is the most common technique to analysis the variables effect on survival time, but under certain circumstances, parametric models may offer advantages over Cox’s model. In this study we use cox regression and alternative parametric models such as Weibull, exponential, log-normal, logistics and gamma model to evaluate factors affecting survival of patients with gastric cancer. Comparisons were made to find the best model.</p><p><strong>METHOD</strong><strong>:</strong> In this study, data from 643 patients with gastric cancer who were referred to Imam Khomeini hospital with personal details during 2007 to 2013 have been reviewed in order to determine the survival rate of gastric cancer. It was observed that 74 cases were eliminated due to incomplete information and 569 persons were examined. Akaike Information model was used for comparison between models.</p><p><strong>RESULT:</strong> Of a total of 569 patients, 329 (57.8%) died during the period. The figure of Cox-Snell residuals indicates that only the exponential model does not have better fitness. Weibull, log-normal, log-logistic and gamma models show the better fitness because points are on straight line. At the time of diagnosis, stage with (p&lt;0.0008) and metastasis with (p&lt;0.0219) were subjected to higher risk of death.</p><p class="Default"><strong>CONCLUSION:</strong> Based on Akaike's criterion, the Weibull model with Akaike value of 257.165 is the most favorable for survival data.</p>

Effectiveness of Vitamin D Supplement Therapy in Chronic Stable Schizophrenic Male Patients: A Randomized Controlled Trial

In this study, the aim was to determine whether adding vitamin D to the standard therapeutic regimen of schizophrenic male patients with inadequate vitamin D status could improve some aspects of the symptom burden or not. This study was an open parallel label randomized clinical trial. Eighty patients with chronic stable schizophrenia with residual symptoms and Vitamin D deficiency were recruited randomly and then received either 600000 IU Vitamin D injection once along with their antipsychotic regimen or with their antipsychotic regimen only. Serum vitamin D was measured twice: first at the baseline and again on the fourth month. Positive and Negative Syndrome Scale (PANSS) was assessed at the baseline and on the fourth month. During the study, the vitamin D serum changes in vitamin group and control group were 22.1 ± 19.9(95%CI = 15.9-28.8) and 0.2 ± 1.7(95%CI = 0.2-0.8) (ng/mL) (p<0.001) respectively. The changes of PANSS positive subscale score (P) were -0.1±0.7 (95%CI =-0.3-0.1) and 0.00 ± 0.8 (95%CI = -0.2-0.2) in vitamin D and control group respectively (p=0.5). The changes of PANSS negative subscale score (N) were -0.1 ± 0.7 (95%CI = -0.3-0.05) and -0.1 ± 0.5 (95%CI = -0.2-0.04) in vitamin D and control group respectively (p = 0.7) and there was a negative but not significant correlation between serum vitamin D level changes and PANSS negative subscale score (r = -0.04, p = 0.7). We did not find a relationship between serum vitamin D level changes and the improvement of negative and positive symptoms in schizophrenic patients and more randomized clinical trials are required to confirm our findings.

The effectiveness of lavender essence on strernotomy related pain intensity after coronary artery bypass grafting

Background:

Considering the side effects of pharmacological methods, there has been a suggestion to use nonpharmacological methods such Aromatherapy following coronary artery bypass grafting (CABG). This study aims to evaluate the effectiveness of lavender 2% aromatherapy on sternotomy pain intensity after coronary artery bypass graft surgery in patients who have undergone surgery.

Materials and Methods:

During this clinical trial, 50 patients who were candidates for CABG, were randomly divided into two equal groups, that is, the control group (n = 25) and the case group (n = 25). Following CABG, the case group received two drops of 2% lavender oil every 15 minutes with supplemental oxygen and the control group received only supplemental oxygen through a face mask. The data collection tools comprised of the demographic check list and visual analog scale (VAS) for evaluating the pain intensity. The pain intensity were assessed pre- and five, 30, and 60 minutes post aromatherapy. The final data were analyzed by the t-test and chi-squared test.

Results:

The findings showed that the pain perception intensity in the case group was lower than that in the control group at the 30- and 60-minute phases after intervention (P < 0.0001).

Conclusion:

The result indicated that aromatherapy can be used as a complementary method in postoperative pain reduction, as it reduced pain. The patients require two sedative drugs, and moreover, it avoids expenses of treatment.

A clinical trial comparing the effect of peer education and orientation program on the anxiety levels of pre-CABG surgery patients

Background and Objectives: One of the main treatment methods of coronary artery disease is coronary artery bypass graft (CABG) surgery. The anxiety level in patients undergoing this surgery is relatively very high. Thus, reducing anxiety in these patients is an important step toward wellness. This study aimed to compare the effects of peer education (PE) and orientation program (OP) on the anxiety levels of patients before CABG surgery. Material and Methods:This randomized controlled trial was conducted in 2014 at the Mazandaran Heart Center on three groups of 50 persons each: PE, OP, and control (Cl). The anxiety levels of patients in each group were measured one day and one hour before the surgery. All groups received routine education. In addition, the PE group received PE and the OP group received OP. Two questionnaires were used to collect the demographics and the clinical data; and Spielberg state anxiety questionnaire was used to measure the anxiety level. Data from descriptive statistics, chi-square, ANOVA, ANCOVA, Bonferroni, and Fisher exact test were analyzed in SPSS v20 software. Findings: The mean anxiety score before surgery was not significantly different in the three groups (P=0.955). However, after the intervention at 1 h before surgery, the mean anxiety level in the PE and OP group was lower than in the Cl group (P=0.000). However, the mean anxiety score between PE and OP groups showed no significant difference (P=0.051). Conclusion: Both PE and OP group reduced the anxiety naturally developed in a patient before surgery. Although the influence of the PE group was greater in reducing anxiety, the use of this technique in clinical practices required further studies.

A Cross-sectional Study of Midwives' Perspectives Towards their Professional Educational Needs

BACKGROUND

Midwives are one of the most important health care providers and meeting their professional educational needs can be effective in maternal and child health promotion.

AIM

The aim of this study was to investigate the midwives' perspectives towards their educational needs.

METHODS

In this cross-sectional study which was conducted in 2012 in Sari, North of Iran, 223 midwives during a convenience sampling method expressed their educational needs. The instrument of the data collection was a self-administered 64-question researcher- made questionnaire about the participants' educational needs in 10 fields related to midwifery profession.

RESULTS

The mean age and employment record of the participants were 33.87±10.49 and 10.09±8.14 years respectively, and the majority (65.02%) of them was employed in the health care centers. Findings showed that the highest score of midwives' educational need was related to need to education about labor and delivery care (75.14±21.13%) which was followed by the need to education about pre marriage counseling (74.04±19.95%) and pre conception counseling (71.33±21.89%).

CONCLUSIONS

Owing to the emergence of new dimensions of tasks in midwifery practice and due to developing some changes in the educational needs of midwives, it's necessary to implement an updated educational package in order to deliver the recommended standards of care and to increase midwives' participation in continuing education programs.