Relationship between delivery modes and genitourinary syndrome among postmenopausal women

OBJECTIVES

Many postmenopausal women suffer from genitourinary syndrome of menopause (GSM) due to the lack of estrogen. This study aimed to evaluate the relationship between mode of delivery and GSM among postmenopausal women.

METHODS

We performed a case-control study of women who had had either vaginal delivery or Cesarean section. Data were collected through a sociodemographic questionnaire and a check list for assessing signs and symptoms of GSM. Subjective symptoms of vaginal atrophy (dryness, dyspareunia, itching, burning and paleness), pH of the vagina and maturation index were assessed and recorded. Data were analyzed using the χ² test and independent t-test.

RESULTS

A total of 125 postmenopausal women were recruited (65 with a history of normal vaginal delivery (NVD) and 60 with a history of Cesarean section). Vaginal pH was more commonly lower (pH 5-5.49) in the NVD group (50.8% vs. 40%) (p < 0.001). The maturation index was also better in the NVD group (42.7 ± 6.34 vs. 24.08 ± 8.2) (p < 0.001). All symptoms of vaginal atrophy including paleness, dryness, itching, dyspareunia and burning were significantly less in the NVD group compared to the Cesarean section group (p < 0.05).

CONCLUSION

Postmenopausal women with a history of normal vaginal delivery were less likely to have GSM compared to the women with a history of Cesarean section. Other prospective studies can explore this relationship better.

Effect of different levels of dietary vitamin E on reproductive and productive performances in Japanese quails (Coturnix coturnix japonica)

The aim of this study was to evaluate the effects of dietary vitamin E on reproductive and productive parameters in Japanese quails. A total number of 240 female and 80 male Japanese quail were divided into five treatments with four replications in a completely randomized design. Experimental diets were zero control, 30, 60, 120 and 240 mg kg^-1 of vitamin E. Fertility and total hatchability were not affected by treatments. But, the lowest hatch of fertile eggs and the highest embryonic death were observed in control group (p < 0.05). Left testes weight in T2 and T4 was higher than control (p < 0.05). Right testes weight and sera FSH concentration in males were not affected by treatments. The highest testosterone concentration of males was observed in T5 (p < 0.05). Weight and length of oviduct as well as weight of ovary and FSH concentration in females did not affected by treatments. Estrogen concentration in T4 treatment was greater than control (p < 0.05). Most of the egg characteristics were not affected by treatments. However, higher egg mass and production rates were observed in T2 and T3groups than control group (p < 0.05). Feed intake and conversion ratio did not differ among treatments. In conclusion, dietary vitamin E improved hatch of fertile egg, embryonic viability, egg mass and production rates in Japanese quail. The effect of dietary vitamin E combined with selenium on these characteristics are recommended for future study in Japanese quail.

The effect of the SNAPPS (summarize, narrow, analyze, probe, plan, and select) method versus teacher-centered education on the clinical gynecology skills of midwifery students in Iran

This study aimed to determine the effect of the SNAPPS (summarize, narrow, analyze, probe, plan, and select) method versus teacher-centered education on the clinical skills of midwifery students in Iran. In this clinical trial, 36 midwifery students in their 4th year of education in 2015 were enrolled and divided into 6 groups, 3 groups for teacher-centered education and 3 groups for the SNAPPS method, with each group spending 10 days in the outpatient gynecology clinic. A questionnaire and a checklist were used to gather data. An independent t-test and chi-square test were used to analyze the data. Ability to gain the trust of the patient, verbal and nonverbal communication skills, history taking, preparation of the patient for gynecological examination, and diagnosis and treatment of common diseases were significantly better in the SNAPPS group compared to the teacher-centered education group (P<0.05). The SNAPPS education method can significantly improve the clinical skills of midwifery students in gynecology, in particular history taking, differential diagnosis, and treatment of common diseases.

The Validity and Reliability of Persian Version of Wijma Delivery Expectancy/Experience Questionnaire (Version A) among Iranian Nulliparous Women

<p>Extreme fear of childbirth may interfere with normal process of labor and increase the rate of cesarean section.<strong> </strong>The aim of this study was to evaluate validity and reliability of a Persian version of Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) among nulliparous women. In this cross-sectional study, 200 nulliparous women of reproductive age were recruited. The original form of the W-DEQ was received from corresponding author (Garthus-Niegel). This questionnaire was translated into Persian language and back-translated to English by three experts in reproductive health and psychiatry who were fluent in Persian and English. Two questionnaires namely the Beck Anxiety Inventory (BAI) and the Depression Anxiety Stress Scale (DASS) were used to check the convergent and divergent validity. Confirmatory factor analysis was used to assess the construct validity, while the Pearson correlation coefficient was used to assess the convergent and divergent validity of the W-DEQ. Reliability was measured using Cronbach’s coefficient alpha. Factor analysis yielded nine factors that explained 70.06% of the total variation. Cronbach’s alpha was 0.64 and the convergent validity with the BAI questionnaire was (r=0.402) and the divergent validity of W-DEQ with the DASS questionnaire was (r=0.349). The Persian W-DEQ has a good validity and reliability for measuring the fear of delivery in Iranian women of reproductive age. Using this questionnaire for nulliparous women is recommended.</p>

The effect of mobile phone short messaging system on healthy food choices among Iranian postmenopausal women

Introduction:

Central adiposity and metabolic syndrome are quite common among postmenopausal women. Dietary diversity and healthy food choices have essential role in health and also in prevention of obesity. The main objective of this study was to evaluate the impact of mobile phone short messaging system on healthy food choices among Iranian postmenopausal women.

Materials and Methods:

This was a randomized controlled trial in which 100 postmenopausal women aged 40-60 years were recruited and assigned to two groups (50 each in the intervention and control groups). Food frequency consumption was measured using a questionnaire. A total of 16 text messages including information about modification of food selection (healthy choices, benefits, methods, etc.,) were sent to participants in the intervention group during 4 months follow-up (1/week). The Chi-square and independent t-test used for data analysis. Ninety-two women completed the study.

Results:

The consumption of Vitamin A rich fruits and vegetables significantly increased in the intervention group compared to the control group (P < 0.001). More women in the intervention group consumed fish after intervention (P = 0.02). The consumption of green leafy vegetables showed a nonsignificant increase in the intervention group.

Conclusion:

Using mobile phone short messaging system can improve the healthy food choices regarding Vitamin A rich fruits and vegetables and fish among postmenopausal women.

Breastfeeding or nipple stimulation for reducing postpartum haemorrhage in the third stage of labour

BACKGROUND

Oxytocin and prostaglandin are hormones responsible for uterine contraction during the third stage of labour. Receptors in the uterine muscles are stimulated by exogenous or endogenous oxytocin leading to uterine contractions. Nipple stimulation or breastfeeding are stimuli that can lead to the secretion of oxytocin and consequent uterine contractions. Consequently, uterine contractions can reduce bleeding during the third stage of labour.

OBJECTIVES

To investigate the effects of breastfeeding or nipple stimulation on postpartum haemorrhage (PPH) during the third stage of labour.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (15 July 2015) and reference lists of retrieved studies.

SELECTION CRITERIA

Randomised and quasi-randomised controlled trials comparing breast stimulation, breastfeeding or suckling for PPH in the third stage of labour were selected for this review.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed studies for inclusion in terms of risk of bias and independently extracted data. Disagreements were resolved by a third review author.

MAIN RESULTS

We included four trials (4608 women), but only two studies contributed data to the review's analyses (n = 4472). The studies contributing data were assessed as of high risk of bias overall. One of these studies was cluster-randomised and conducted in a low-income country and the other study was carried out in a high-income country. All four included studies assessed blood loss in the third stage of labour. Birth attendants estimated blood loss in two trials. The third trial assessed the hematocrit level on the second day postpartum to determine the effect of the bleeding. The fourth study measured PPH ≥ 500 mL. Nipple stimulation versus no treatmentOne study (4385 women) compared the effect of suckling versus no treatment. Blood loss was not measured in 114 women (59 in control group and 55 in suckling group). After excluding twin pregnancies, stillbirths and neonatal deaths, the main analyses for this trial were performed on 4227 vaginal deliveries. In terms of maternal death or severe morbidity, one maternal death occurred in the suckling group due to retained placenta (risk ratio (RR) 3.03, 95% confidence interval (CI) 0.12 to 74.26; one study, participants = 4227; very low quality evidence); severe morbidity was not mentioned. Severe PPH (≥ 1000 mL) was not reported in this study.The incidence of PPH (≥ 500 mL) was similar in the suckling and no treatment groups (RR 0.95, 95% CI 0.77 to 1.16; one study, participants = 4227; moderate quality). There were no group differences between nipple stimulation and no treatment regarding blood loss in the third stage of labour (mean difference (MD) 2.00, 95% CI -7.39 to 11.39; one study, participants = 4227; low quality). The rates of retained placenta were similar (RR 1.01, 95% CI 0.14 to 7.16; one study, participants = 4227; very low quality evidence), as were perinatal deaths (RR 1.06, 95% CI 0.57 to 1.98; one study, participants = 4271; low quality), and maternal readmission to hospital (RR 1.01, 95% CI 0.14 to 7.16; one study, participants = 4227; very low quality). We downgraded the evidence for this comparison for risk of bias concerns in the one included trial (inappropriate analyses for cluster design) and for imprecision (wide CIs crossing the line of no difference and, for some outcomes, few events).Many maternal secondary outcomes (including side effects) were not reported. Similarly, most neonatal secondary outcomes were not reported. Nipple stimulation versus oxytocinAnother study compared the effect of nipple stimulation (via a breast pump) with oxytocin. Eighty-seven women were recruited but only 85 women were analysed. Severe PPH ≥ 1000 mL and maternal death or severe morbidity were not reported.There was no clear effect of nipple stimulation on blood loss (MD 15.00, 95% CI -24.50 to 54.50; one study, participants = 85; low quality evidence), or on postnatal anaemia compared to the oxytocin group (MD -0.40, 95% CI -2.22 to 1.42; one study, participants = 85; low quality evidence). We downgraded evidence for this comparison due to risk of bias concerns in the one included trial (alternate allocation) and for imprecision (wide CIs crossing the line of no difference and small sample size).Many maternal secondary outcomes (including side effects) were not reported, and none of this review's neonatal secondary outcomes were reported.

AUTHORS' CONCLUSIONS

None of the included studies reported one of this review's primary outcomes: severe PPH ≥ 1000 mL. Only one study reported on maternal death or severe morbidity. There were limited secondary outcome data for maternal outcomes and very few secondary outcome data for neonatal outcomes.There was no clear differences between nipple stimulation (suckling) versus no treatment in relation to maternal death, the incidence of PPH (≥ 500 mL), blood loss in the third stage of labour, retained placenta, perinatal deaths or maternal readmission to hospital. Whilst these data are based on a single study with a reasonable sample size, the quality of these data are mostly low or very low.There is insufficient evidence to evaluate the effect of nipple stimulation for reducing postpartum haemorrhage during the third stage of labour and more evidence from high-quality studies is needed. Further high-quality studies should recruit adequate sample sizes, assess the impact of nipple stimulation compared to uterotonic agents such as syntometrine and oxytocin, and report on important outcomes such as those listed in this review.

Comparison of Two Different Protocols of Methotrexate Therapy in Medical Management of Ectopic Pregnancy

Background:

Ectopic pregnancy (EP) is one of the most dangerous complications of pregnancy and without prompt diagnosis and treatment, it could become a major cause of maternal morbidity and mortality.

Objectives:

In this randomized controlled study, we compared single and double dose of methotrexate (MTX) therapy in the treatment of ectopic pregnancy.

Patients and Methods:

This study was performed on 76 patients who were admitted to Obstetrics Ward with primary diagnosis of ectopic pregnancy based on their medical history, physical examination, beta subunit (β-HCG) level, and transvaginal ultrasonography. Using random block allocation, the patients were classified in two groups of single dose and double dose administration of MTX. In single dose group, 50 mg/m² of MTX was given at day 0 and in double dose group, the patients received two doses of MTX at day 0 and 4. The level of β-HCG was measured at day 0, 4, 7 in both groups. The successful treatment was defined as 15% reduction in β-HCG level between day 4 and 7. The two groups were compared with each other with regard to their need for operation, or extra dose of MTX; duration of hospitalization; and MTX complications.

Results:

Results showed that the rate of success in double dose method was more than single dose one (79% versus 69%) but the difference was not significant (P = 0.29). Although the need for operation and extra dose of MTX were lower in the double dose group (15.8% vs. 18.8% and 5.26% vs. 13.2%, respectively), these differences were not significant too. Duration of hospitalization was significantly lower in double dose compared to the single dose (11.55 d vs. 14.76 d, P < 0.001).

Conclusions:

Single dose therapy of MTX has sufficient power and efficacy in the treatment of ectopic pregnancy, however in patients with higher serum level of β-HCG, the successful treatment increases by using double dose method. Using double dose also could decrease the necessity of operation, re-administration of MTX, and duration of hospitalization.

The relation of preeclampsia and serum level of 25-hydroxyvitamin D in mothers and their neonates: a case control study in Iran

The predisposing factors of preeclampsia may endanger the mother's heath as well as her neonate. One hypothesis related to preeclampsia is vitamin D deficiency or insufficiency. This study was conducted to evaluate the relationship between preeclampsia and the serum level of 25-hydroxyvitamin D (25-OH-D) in mothers and their neonates. In this case-control study, we recruited 41 preeclamptic and 50 healthy women from the Imam Khomeini Hospital in Ahvaz, Iran. Venous blood (2 ml) from mothers (in time of labor) and 2 ml of blood from the umbilical cord were taken, centrifuged, stored at -30°C and sent to a laboratory for analysis of 25-OH-D by ELISA. Vitamin D levels<20 ng/ml were regarded as deficiency, levels between 21-29 ng/ml were regarded as insufficiency, and if levels were higher than 30 ng/ml, these were considered normal. Independent t-test, chi-square, Spearman correlation coefficient and logistic regression were used to analyze data. Mean levels of 25-OH-D were significantly lower in preeclamptic women (15.2±13.6 vs. 23.3±15.3 ng/ml, p=0.001) and in their neonates (15.2±13.1 vs. 21.6±12.6 ng/ml, p=0.01) compared to normal pregnant women and their neonates. There was a significant relationship between the levels of vitamin D in preeclamptic women with levels of this vitamin in their neonates (r=0.901, p=0.0001). 25-OH-D deficiency that exist in preeclamptic mothers, may be a health risk for their infants, therefore, early use of vitamin D supplement with higher dose than 400 IU in Iranian women is recommended.

Iranian women and care providers' perceptions of equitable prenatal care: A qualitative study

BACKGROUND

Equity as a basic human right builds the foundation of all areas of primary healthcare, especially prenatal care. However, it is unclear how pregnant women and their care providers perceive the equitable prenatal care.

OBJECTIVE

This study aimed to explore Iranian women's and care providers' perceptions of equitable prenatal care.

RESEARCH DESIGN

In this study, a qualitative approach was used. Individual in-depth unstructured interviews were conducted with a purposeful sample of pregnant women and their care providers. Data were analyzed using inductive content analysis method.

PARTICIPANTS AND RESEARCH CONTEXT

A total of 10 pregnant women and 10 prenatal care providers recruited from six urban health centers across Ahvaz, a south western city in Iran, were participated in the study.

ETHICAL CONSIDERATIONS

The study was approved by the Ethics Committee affiliated to Ahvaz Jundishapur University of Medical Sciences. The ethical principles of voluntary participation, confidentiality, and anonymity were considered.

FINDINGS

Analysis of participants' interviews resulted in seven themes: guideline-based care, time-saving care, nondiscriminatory care, privacy-respecting care, affordable comprehensive care, effective client-provider relationships, and caregivers' competency.

CONCLUSION

The findings explain the broader and less discussed dimensions of equitable care that are valuable information for the realization of equity in care. Understanding and focusing on these dimensions will help health policy-makers in designing more equitable healthcare services for pregnant women.

Glial cell line-derived neurotrophic factor in combination with insulin-like growth factor 1 and basic fibroblast growth factor promote in vitro culture of goat spermatogonial stem cells

Growth factors are increasingly considered as important regulators of spermatogonial stem cells (SSCs). This study investigated the effects of various growth factors (GDNF, IGF1, bFGF, EGF and GFRalpha-1) on purification and colonization of undifferentiated goat SSCs under in vitro and in vivo conditions. Irrespective of the culture condition used, the first signs of developing colonies were observed from day 4 of culture onwards. The number of colonies developed in GDNF + IGF1 + bFGF culture condition was significantly higher than the other groups (p < 0.05). In contrast, the size of colonies developed in GDNF + EGF + LIF culture condition was significantly higher than the other groups (p < 0.05). Immunocytochemical stationing for specific biomarkers of somatic cells (vimentin, alpha-inhibin and α-SMA) and spermatogonial cells (PLZF, THY 1, VASA, alpha-1 integrin, bet-1 integrin and DBA) revealed that both cell types existed in developing colonies, irrespective of the culture condition used. Even though, the relative abundance of VASA, FGFR3, OCT4, PLZF, BCL6B and THY1 transcription factors in GDNF + IGF1 + bFGF treatment group was significantly higher than the other groups (p < 0.05). Additionally, goat SSCs developed in the latter culture condition could colonize within the seminiferous tubules of the germ-cell depleted recipient mice following xenotransplantation. Obtained results demonstrated that combination of GDNF with IGF1 and bFGF promote in vitro culture of goat SSCs while precludes uncontrolled proliferation of somatic cells.

The Long Term Effect of Elective Colpoperineoplasty on Sexual Function in the Reproductive Aged Women in Iran

Objective. Many women are suffering from sexual dysfunction followed by vaginal laxity in their reproductive age. The aim of this study was to evaluate the long term effect of colpoperineoplasty on sexual function in Iranian reproductive aged women. Methods. This was a prospective observational study in which 79 women with vaginal laxity who were candidate for selective colpoperineoplasty in Jahrom, Iran, were recruited. Data on sexual function was collected via the Female Sexual Function (FSFI) questionnaire preoperatively, six months and 18 months after colpoperineoplasty. The paired t-test, Wilcoxon, Mann-Whitney, and Repeated Measure test were utilized for statistical purposes. Results. Seventy-six women completed the study by 18 months. The mean FSFI score changed from 24.19 ± 3.09 in baseline to 26.92 ± 3.41 after six months (P < 0.001); however dyspareunia and vaginal dryness were increased significantly. After 18 months all areas of sexual function including pain and lubrication improved significantly compared to the 6th month (P < 0.001). Sexual satisfaction was increased significantly six and 18 months after surgery (P < 0.001), and the total score of sexual function increased to 32.61 ± 1.32 after 18 months (P < 0.001). Conclusion. The long term effect of colpoperineoplasty in women who suffer from vaginal laxity is promising. It seems that patient's dissatisfaction of sexual function can be a basis for colpoperineoplasty.

The relation between stress and sexual function and satisfaction in reproductive-age women in Iran: a cross-sectional study

The present study aimed to evaluate the relation between stress and different aspects of female sexual function and satisfaction. This cross-sectional study was conducted on 228 reproductive-age women who were referred to the public Health Centers in Ahvaz, Iran. All eligible participants were asked to complete a demographic questionnaire, the Female Sexual Function Index, and the Perceived Stress Scale. The data were analyzed using independent t test, Pearson correlation, and logistic regression. The mean score of stress was 32.9 (SD = 4.7) in the normal sexual function group and 33.3 (SD = 5.5) in the unfavorable sexual function group. There was a significant correlation between stress and sexual function score, sexual desire, arousal, orgasm, lubrication, sexual pain, and satisfaction (p <.001). Spouses' education (OR = 0.15, CI [0.02, 0.97], p =.04) and frequency of sexual intercourse per week (OR = 1.8, CI [1.3, 2.5], p <.001) had a significant relation with stress. There is a significant relation between women's perceived stress and sexual function and satisfaction. Further analytical studies are needed to show the harmful effects of stress on women's sexual activity and satisfaction.

The effect of face-to-face with telephone-based counseling on sexual satisfaction among reproductive aged women in Iran

This study was designed to investigate and compare the effect of face-to-face with telephone-based counseling on sexual satisfaction in women of reproductive age in Iran. This study was a randomized controlled trial in which 46 married women who got married 1-5 years ago were randomly selected and assigned to 1 of 2 groups (face-to-face and telephone-based counseling). Two groups received counseling by a trained midwife once a week for 4 weeks. The sexual satisfaction (using the Sexual Satisfaction Index) score was calculated in the beginning of the study and after 4 weeks. An independent t test, chi-square test, likelihood ratio test, Fisher's exact test, and linear-by-linear test were used for analyzing data. The mean score of sexual satisfaction in the face-to-face group was 93.6 (SD = 7.1) and improved significantly to 108.08 (SD = 5.44) after intervention (p =.001). The mean score of sexual satisfaction in the telephone-based counseling was 93.52 (SD = 5) and increased to 113 (SD = 6.07) after 4 weeks (p =.001). Telephone-based counseling could increase the sexual satisfaction better than face-to-face counseling (mean difference: 20.34 [SD = 7.38] vs. 14.47 [SD = 5.32], p =.003). The telephone-based counseling is an effective and affordable method to solve the sexual problems and could increase the sexual satisfaction. Using this method in public health centers is recommended.

The effect of SMS messaging on the compliance with iron supplementation among pregnant women in Iran: a randomized controlled trial

We examined the effect of SMS text messages on compliance with iron supplementation among pregnant women. A randomized controlled trial was conducted on 116 pregnant women referred from public health centres in Ahvaz. Their gestational age was 14-16 weeks. The subjects were randomly assigned to a control group who received usual care, or to a 12-week intervention with SMS reminders in addition to usual care. Participants in both groups were provided with iron supplements and taught how to take iron tablets. Most women in the intervention group (94%) had high compliance with iron supplements compared to the control group (66%); this difference was significant (P = 0.003). Although haemoglobin, haematocrit and ferritin decreased significantly in each group, there was no significant difference between them. Using SMS reminders is an efficient way of improving compliance of women with iron supplementation during pregnancy. However, in the present study better compliance did not improve anaemia.

The effect of vitamin B1 on bleeding and spotting in women using an intrauterine device: a double-blind randomised controlled trial

OBJECTIVES

Excessive menstrual bleeding, the most common complication caused by intrauterine devices (IUDs), often leads to discontinuation of use. Our study investigates the effect of vitamin B1 on menstrual bleeding and spotting after insertion of the TCu380A IUD.

METHODS

This double-blind, randomised controlled trial involved 110 Iranian women. We recruited women who noted that their menstrual flow (duration, amount, and number of sanitary pads needed) or intermenstrual spotting had increased one month after the insertion of a TCu380A, and randomly assigned them to two groups. The intervention group and the control group received 100 mg of vitamin B1 or a placebo, respectively, daily, for three months. We followed all participants for four months. The Higham scale was used for estimating the volume of menstrual bleeding. The Mann-Whitney test, paired t-test, independent t-test and Repeated Measure test were used for statistical purposes.

RESULTS

In the intervention group the duration of menstrual bleeding, the number of sanitary pads and the amount of spotting decreased significantly compared to the control group (p < 0.001).

CONCLUSION

Vitamin B1 is a safe, natural and cost-effective supplement that is devoid of side effects and reduces menstrual bleeding and spotting caused by a copper bearing-IUD.

The relationship of serum vitamin D with pre-eclampsia in the Iranian women

Vitamin D deficiency may be a risk factor for negative outcome in pregnancy, such as pre-term labour, low birthweight, intrauterine growth retardation and gestational diabetes. This study aimed to evaluate the relationship between vitamin D and pre-eclampsia. This was a case-control study of 59 pre-eclamptic women and 59 healthy pregnant women selected in two hospitals in Ahvaz, Iran. Women with term singleton pregnancy, nulliparous and of reproductive age were selected. Venous blood samples (2 mL) were taken and the level of 25-dihydroxy vitamin D (25-OH-D) was measured. If the levels of 25-OH-D were less than 10 ng mL(-1), between 10 ng mL(-1) and 29 ng mL(-1) and more than 30 ng mL(-1), they were considered as indicating deficient, insufficient and normal 25-OH-D concentrations, respectively. The independent t-test, Mann-Whitney U-test, chi-square and logistic regression were used for analysing the data. Vitamin D deficiency was significantly higher in the pre-eclampsia group [odds ratio (OR) = 24.04, confidence interval (CI) = 2.10-274.8, P = 0.01]. Older women (30-35 years) were more likely to develop pre-eclampsia compared with the control group (OR = 10.36, CI = 2.18-49.09, P = 0.003). The results showed that women with body mass index (BMI) <20 were more likely to develop pre-eclampsia. The ages between 20 years and 30 years and normal BMI were not the risk factors for pre-eclampsia. Vitamin D deficiency has a statistically significant relationship with pre-eclampsia. It seems that the serum vitamin D levels are low in Iranian women because of their particular lifestyle and they may need more than 400 IU day(-1) vitamin D supplement during pregnancy.

The relationship of fat soluble antioxidants with gestational diabetes in Iran: a case-control study

OBJECTIVE

The primary aim of this study was to evaluate the relationship of fat soluble antioxidants (retinol and α-tocopherol) with gestational diabetes (GDM).

METHODS

This was a case-control study in which 41 pregnant women with GDM and 41 healthy women were recruited. The inclusion criteria were gestational age ≥32 weeks, singleton foetus, nulliparous or parous women up to four pregnancies and normal fasting blood sugar in the early pregnancy. Two groups were matched regarding age, gestational age and body mass index. A 5 ml venous blood sample were drawn and analysed with the chromatograph for measuring retinol and α-tocopherol. Data were analysed through Chi-square and t test.

RESULTS

The mean serum retinol of the GDM group was 0.46 µg/dl and in the control group it was 0.59 mg/dl (p = 0.01).The mean α-tocopherol in the women with GDM was 6.21 mg/dl and in the control group it was 6.92 mg/dl (p > 0.05).

CONCLUSION

The level of retinol in the diabetic pregnant women was significantly lower than that in the control group. This reduction may be due to the reduced antioxidant defences in women with GDM.

Iranian family caregivers' challenges and issues in caring of multiple sclerosis patients: A descriptive explorative qualitative study

BACKGROUND

The broad spectrum of problems caused by multiple sclerosis (MS) imposes heavy responsibility to caregivers in caring of their patients. Therefore, they encounter many issues and challenges in this situation. The purpose of this study was to explore the experiences and challenges of MS family caregivers.

MATERIALS AND METHODS

A qualitative design, based on a thematic analysis approach, was used to reach the study aim. Data were collected and analyzed concurrently through in-depth unstructured interviews, field notes, and observations that were held with 23 participants (14 family caregivers and 9 MS patients) at two referral centers in Ahvaz, Iran.

FINDINGS

THREE MAJOR THEMES WERE EXTRACTED FROM THE ANALYSIS OF THE TRANSCRIPTS: "emotional exhaustion of caregivers," "uncertain atmosphere of caring," and "insularity care." The first theme consisted of three subthemes: "stressful atmosphere of caring," "conflict and animism," and "continuing distress affecting the caregiver." The second theme consisted of three subthemes: "unstable and complicacy of disease," "caring with trial and error," and "frequent hospitalization of patients," and the third theme consisted of two subthemes: "caring gap and disintegration" and "lack of sufficient support."

CONCLUSIONS

This study will be useful to healthcare system for managing the challenges of MS patients' family caregivers. Improving the conditions and performance of family caregivers is crucial in order to provide high-quality care to people with MS.

Biomedical Properties of Edible Seaweed in Cancer Therapy and Chemoprevention Trials: A Review

This review article summarizes in vitro and in vivo experiments on seaweed anticancer activity and seaweed chemical components. Seaweed use in cancer therapy, chemopreventive randomized control trials (RCTs) and quasi-experiments are discussed. The literature reviewed in this article was obtained from various scientific sources and encompasses publications from 2000–2012. Seaweed therapeutic effects were deemed scientifically plausible and may be partially explained by the in vivo and in vitro pharmacological studies described. Although the mechanisms of action remain unclear, seaweed's anticancer properties may be attributable to its major biologically active metabolites. Much of the seaweed research outlined in this paper can serve as a foundation for explaining seaweed anticancer bioactivity. This review will open doors for developing strategies to treat malignancies using seaweed natural products.

Biomedical properties of edible seaweed in cancer therapy and chemoprevention trials: a review

This review article summarizes in vitro and in vivo experiments on seaweed anticancer activity and seaweed chemical components. Seaweed use in cancer therapy, chemopreventive randomized control trials (RCTs) and quasi-experiments are discussed. The literature reviewed in this article was obtained from various scientific sources and encompasses publications from 2000-2012. Seaweed therapeutic effects were deemed scientifically plausible and may be partially explained by the in vivo and in vitro pharmacological studies described. Although the mechanisms of action remain unclear, seaweed's anticancer properties may be attributable to its major biologically active metabolites. Much of the seaweed research outlined in this paper can serve as a foundation for explaining seaweed anticancer bioactivity. This review will open doors for developing strategies to treat malignancies using seaweed natural products.