Mental Health and Social Function Among Women Subjected to Intimate Partner Violence: A Cross-Sectional Study

Intimate partner violence is a serious public health problem in all societies that affects all aspects of the victim’s health, especially mental health. The present study aimed to determine the relationship between intimate partner violence and mental health among Iranian women who referred to the Forensic Medicine Center in Tehran. This cross-sectional study was done on 196 married women who referred to the south center of Forensic Medicine in Tehran. Data were collected in 2013 by using three questionnaires: a demographic questionnaire, CTS-2, and GHQ-28. Data analyzed by using SPSS-14 software. The age of participants was 29.9±6.3 years (range 18-57 years). Most women were housekeepers (73%) with moderate economic status (48.5%). Physical violence had the highest mean score (37.29±16.80); and after that, highest mean scores are related to Psychological violence 29.37±7.01, verbal violence 14.83±8.15, Physical violence leading to injury 14.47±6.85, and sexual violence 8.38±7.36, respectively. Verbal violence didn’t show any relation with all subscales of mental health. The somatic and anxiety symptoms were significantly correlated to total, and all violence subscales score (P<0.001). Also, social function was correlated to total violence score (P=0.032), Sexual (P=0.002), and psychological violence (P=0.025). Depression symptoms were correlated to total violence score (P<0.001), physical leading to damage violence (P<0.001), Sexual violence (P<0.001), Psychological violence (P=0.002), and physical violence (P<0.001). Our results showed IPV is related to the mental health of battered women, but verbal violence didn’t show any statistical relationship with somatic, anxiety, and depression symptoms and social function.

Effects of Feedback on Midwifery Students' Self-Assessed Performance and Their Self-Assessment Ability: A Quasi-Experimental Study

This study aimed to evaluate the effects of verbal and written feedback in clinical midwifery placement on students' self-assessed performance and their self-assessment ability. This three-group quasi-experimental study was conducted on 120 students. Participants in the control group received clinical education through the routine method, while in the feedback groups received either verbal or written feedback methods on the basis of the sandwich feedback model. In the last day of clinical education, a checklist was simultaneously filled out by participants and a second instructor. There was significant direct correlation between the scores of performance assessment by both the second instructor and students in the control group (r = .38, p = .01), the verbal feedback group (r = .63, p < .001), and the written feedback group (r = .74, p < .001). The rates of student-instructor agreement in the control, verbal feedback, and written feedback groups were 32.5%, 70%, and 77.5%, respectively. Feedback is effective in significantly improving students' self-assessment ability.

Spiritual intelligence of adolescents with diabetes based on demographic components

INTRODUCTION

Spiritual intelligence is better defined as a capacity to discover and develop true meaning, deep purpose, and vision in life. The purpose of the present study was to determine the predictive role of demographic variables affecting the overall spiritual intelligence in diabetic adolescents.

METHODS

In 2016, a cross-sectional study was conducted involving 200 adolescents with type 1 diabetes referring to the Iranian Diabetes Association consenting to participate. The inclusion criteria were: age ranging from 15 to 21 years, more than a year since last diagnosed with diabetes, patients' full awareness of their disease, not having other physical-psychological illnesses, and not taking any psychiatric or narcotic drugs. Spiritual intelligence was measured using the Spiritual Intelligence Self Report Inventory questionnaire consisting of 24-questions. The alpha Cronbach's method was applied to validate the questionnaire in terms of content, form, and data with the reliability calculated as 0.903. Demographic data were analyzed using SPSS software version 18.

RESULTS

On total, 56% of the participants were female, 17.10 ± 1.85, and the mean duration of diabetes was 5.98% ± 3.79%, 62.5% reported diabetes history among immediate relatives. Forty-two percent of the participants were the oldest child in the family first children of the family and 29.5% were studying at the university. The mean score of spiritual intelligence was 60.42 60.42 ing from 15 to 21 years regression test using the enter method (ANOVA: 0.703, F: 0.739) showed that none of the demographic components explored did not significantly alter the scores that assessed spiritual intelligence.

CONCLUSION

The outcome of the current study portrayed that demographic features do not necessarily alter the overall spiritual intelligence scores, thereby not necessarily affecting an individual's overall spirituality.

The effect of training problem-solving skills for pregnant women experiencing intimate partner violence: a randomized control trial

Introduction

Intimate partner violence (IPV) in pregnancy is considered as an additional threat to the maternal/fetal health. The present study was aimed to investigate the effectiveness of training problem-solving skills on IPV against pregnant women.

Methods

The present randomized clinical trial was conducted on 125 and 132 women visiting the health centers of Tehran as the intervention and the control groups, respectively; samples were selected using random stratified cluster sampling. The intervention group underwent four problem-solving training sessions. Three months later, both groups completed the revised Conflict Tactics Scale questionnaire. Data were analyzed using SPSS v.16.

Results

The mean (SD) ages of the participants were 27.51 (4.26) and 27.02 (4.26) years, respectively, in the control and the intervention groups. The rates of the physical and psychological violence were significantly reduced after the intervention in the intervention group. Risk differences of the physical, psychological and sexual violence before and after the intervention were 3% (95% CI: -8.23 to14.13, P = 0.6), 1.5% (95% CI: -4.93 to 8.03, P = 0.6) and 4.8% (95% CI: -7.11 to 16.52, P = 0.4) in the control group and 8.8% (95% CI: -3.47 to 20.71, P = 0.1), 25.4% (95% CI: 15.77 to 34.66, P < 0.001) and 4.9% (95% CI: -7.38 to16.97, P = 0.4) in the intervention group, respectively.

Conclusion

It seems that training this skill as a part of the routine prenatal care could be effective in reducing intimate partner violence.

The predictive role of spiritual intelligence in self-management in adolescents with type 1 diabetes

INTRODUCTION

Self-management leads to blood glucose control and reduced morbidity and mortality in adolescents with type 1 diabetes. Different factors affect the self-management whose role and effect are still unknown. Among the influential factors whose effect is vague are spiritual intelligence, and this study aims to investigate the predictive role of spiritual intelligence in diabetes management.

MATERIALS AND METHODS

In this descriptive-correlation study, 200 adolescents with type 1 diabetes were enrolled. To measure spiritual intelligence, the 24-question SISRI questionnaire and to measure self-management of diabetes, the SMOD-A questionnaire (48 questions) were used. Data were analyzed using SPSS software version 18 using linear regression analysis tests. Data collection was conducted by simple sampling.

RESULTS

Mean score of self-management of diabetes and spirituality was 86.1 ± 15.1 and 60.42 ± 12.9, respectively. Linear regression test (ANOVA: 0.002, F = 9.839) showed effect on diabetes self-management (β: 0.218).

CONCLUSION

This study showed that spiritual intelligence can predict diabetes self-management, though poorly predicted, and by strengthening it, has a decisive role in improving the health of adolescents with diabetes. Considering the findings of this study, a new window of nurses' performance in managing diabetes based on the promotion of spiritual intelligence in the educational, care, counseling, and support roles of nursing science can be opened.

Effectiveness of an internet-based education on maternal satisfaction in NICUs

OBJECTIVE

This study was conducted to evaluate the effect of internet-based education on the satisfaction of the mothers of the preterm neonates in the NICUs.

METHODS

This quasi-experimental study was conducted on 80 mothers of preterm neonates hospitalized in the NICUs of two hospitals in Iran during 9 months. The mothers were assigned in two groups as cases and controls. The satisfaction level of the mothers was evaluated by using WBPL-Revised¹ in both groups on the first and tenth day of the study. Mothers in the case group received the educational program available at www.iranlms.ir/myinfant for 10days. After 10days, the satisfaction level of the mothers in both groups was measured by questionnaire again.

RESULT

the satisfaction of the mothers increased in both groups after this intervention. However, comparison of the mean scores revealed that the satisfaction of the mothers in the case group increased significantly following the intervention (P<0.001).

CONCLUSION

Considering the benefits of internet-based education, its utilization in mothers education programs in NICUs is recommended.

PRACTICE IMPLICATIONS

The results of this study show nurses in the NICU is a way to improve communication and education to parents of infants hospitalized in NICU.

The Comparison of Two Types of Relaxation Techniques on Postoperative State Anxiety in Candidates for The Mastectomy Surgery: A Randomized Controlled Clinical Trial

BACKGROUND

Anxiety among patients after surgery can affect their physiological and psychological well-being. The aim of this study was to investigate and compare the effects of Benson's relaxation and rhythmic breathing techniques on postoperative anxiety in candidates for the mastectomy surgery.

METHODS

This randomized controlled clinical trial study was conducted with ninety patients in 2013. The patients were hospitalized for the mastectomy surgery in three surgical wards in a teaching hospital, Tehran, Iran. They were randomly assigned into three groups: Benson's relaxation including the cognitive relaxation technique type, rhythmic breathing including the somatic relaxation technique type and control groups. According to the Davidson and Schwartz multi-process theory, the Benson's relaxation and the rhythmic breathing techniques have cognitive and somatic effects, respectively. One day before the surgery, the patients in the intervention groups were trained regarding relaxation and breathing techniques and were asked to perform the techniques under the supervision of the researcher in the night before the surgery. The cognitive somatic anxiety questionnaire was used to measure anxiety before the intervention and half an hour after recovery of consciousness after the surgery. Descriptive and inferential statistics were used for data analysis via the SPSS v.21 software.

RESULTS

There were no statistically significant differences between the groups in terms of demographic characteristics. The application of both techniques reduced the level of patients' anxiety after the surgery. The patients in the Benson's relaxation technique group reported only the relief of somatic anxiety. However, the breathing technique patients reported a reduction in both cognitive and somatic anxiety.

CONCLUSION

The Benson's relaxation and rhythmic breathing techniques can reduce postoperative anxiety in patients after the mastectomy surgery. Trial Registration Number: IRCT2014042017350N1.

The effect of mothers' empowerment program on premature infants' weight gain and duration of hospitalization

Background:

The readiness of mothers to take care for infants at discharge is a critical issue. Poor readiness of mothers in taking care of premature infants at the time of discharge is associated with potential adverse consequences. This study examined the effect of implementing mothers’ empowerment program on the weight gain and duration of hospitalization in premature infants.

Materials and Methods:

This study was a quasi-experimental before-after study with a control group, in which 80 mothers with premature infants who were hospitalized in NICU Level II of two hospitals were recruited in the study. Mothers’ empowerment program was implemented as a three-stage training program for the intervention group. Mothers’ readiness questionnaire was completed by the mothers before the intervention and at the discharge time. The changes in mean of mothers’ readiness scores were compared in both the groups.

Results:

The mean of daily weight gain in infants of the intervention group (3.95 g) was significantly higher than that of the infants in the control group (−0.9 g) (P = 0.003). The average duration of hospitalization for infants in the intervention and control groups was 15.45 days and 20.95 days, respectively, showing a statistically significant difference (P = 0.003).

Conclusions:

Providing training to the mothers regarding how to care for premature infants can be a useful and effective method in the process of weight gain of premature and low-birth newborns, and may shorten the duration of infants’ hospitalization.

Development and Validation of Attitude toward Gestational Surrogacy Scale in Iranian Infertile Couples

Background

Surrogacy is one of the most challenging infertility treatments engaging ethical, psychological and social issues. Attitudes survey plays an important role to disclosure variant aspects of surrogacy, to help meeting legislative gaps and ambiguities, and to convert controversial dimensions surrounding surrogacy to a normative concept that eliminates stigma. The aim of this study is to develop a comprehensive scale for gestational surrogacy attitudes.

Materials and Methods

Development process of gestational surrogacy attitudes scale (GSAS) performed based on a descriptive cross-sectional study and included a rich data pool gathered from literature reviews, a qualitative pilot study on 15 infertile couples (n=30), use of expert advisory panel (EAP) consisting of 20 members, as well as use of content validity through qualitative and quantitative study by the means of content validity ratio (CVR) and content validity index (CVI). Also internal consistence using Cronbach’s alpha and test-retest reliability using intracalss correlation coefficient (ICC) were evaluated. Application of GSAS was tested in a cross-sectional study that was conducted on 200 infertile couples (n=400) at Royan Institute, Tehran, Iran, during 2014.

Results

Final version of GSAS had 30 items within five subscales including "acceptance of surrogacy", "Surrogacy and public attitudes", "Child born through surrogacy", "Surrogate mother", and "Intentional attitude and surrogacy future attempt". Content validity was represented with values of CVR=0.73 and CVI =0.98. Cronbach’s alpha value was 0.91 for the overall scale, while ICC value due to test-retest responses was 0.89.

Conclusion

Acceptable level of competency and capability of GSAS is significantly indicated; therefore, it seems to be an appropriate tool for the evaluation of gestational surrogacy attitudes in Iranian infertile couples.

The effect of educational program on stress, anxiety and depression of the mothers of neonates having colostomy

OBJECTIVE

One of the problems that mothers of neonates having colostomy face is their disability in caring colostomy at home. This article is going to demonstrate the impact of educational program for these mothers on their sense of empowerment in caring their neonates.

METHODS

This clinical trial was performed in the Neonatal Intensive Care Units (NICUs) to evaluate the level of stress, anxiety and depression of mothers of neonates having colostomy before and after the educational program. In this program, 42 mothers were divided into two groups: experimental group (21 mothers who went under educational plan) and control group (21 mothers who only received the routine care). The levels of stress, anxiety and depression in all mothers were evaluated before and after the educational program with DASS 21 questionnaire.

RESULTS

The results showed that educational program in the NICU for experimental groups made them independent and also empowered to care better for their babies. In addition, their depression, anxiety and stress levels were decreased.

CONCLUSION

Since the educational program led to a decrease in the levels of stress, anxiety and depression in mothers, this program is recommended to mothers of neonates having colostomy.

Effects of telephone follow-up on blood glucose levels and postpartum screening in mothers with Gestational Diabetes Mellitus

BACKGROUND

Gestational diabetes mellitus (GDM) is a form of diabetes that occurs in pregnancy. GDM, defined as glucose intolerance, first diagnosed or initiated during pregnancy affects 1-14% of pregnancies based on various studies. Screening and early diagnosis and appropriate glycemic control can improve prenatal outcomes. Telephone follow-up seems to be a reasonable way for pregnant women follow-up. The present study evaluated the effects of telephone follow-up on blood glucose level during pregnancy and postpartum screening.

METHODS

Eighty mothers with GDM were enrolled in this clinical trial and randomly divided into intervention and control groups. All mothers were asked to check their blood sugar levels fivetimes daily. In intervention group, telephone intervention was performed for 10 weeks. In each follow-up, individuals were followed for insulin injections, diet, clinical tests and reminding the next visit. In control group, three times of telephone call was established to record blood sugar levels. Another telephone call was established at 6 weeks of postpartum in both study groups to evaluate the performance of the screening test for blood sugar.

RESULTS

The mean age of mothers was 30.9±5 years in the control and 30.7±5.1 years in the intervention groups In intervention group, mean level of blood glucose, 2 hours after lunch at 28 weeks of pregnancy was significantly lower than the control group (P<0.05). Mean differences in levels of fasting blood glucose between 28 weeks and 32 and between 28 and 36 weeks of pregnancy were significantly higher in the intervention than the control group (P<0.05). Rate of postpartum glucose screening test was significantly higher in the intervention group (P<0.001).

CONCLUSION

The findings of this study demonstrated that telephone follow-up could significantly reduce fasting blood glucose levels in mothers with gestational diabetes and also increased the rate of postpartum screening test.

Nurses Use of Critical Care Pain Observational Tool in Patients with Low Consciousness

OBJECTIVES

The diagnosis of pain in patients with low consciousness is a major challenge in the intensive care unit (ICU). Therefore, the use of behavioral tools for pain assessment could be an effective tool to manage pain in this group of patients. The aim of this study was to determine the effects on pain management by nurses using a critical care pain observational tool in patients with a decreased level of consciousness. .

METHODS

Our research used a before and after design to evaluate the ability of nurses to manage pain in patients with low consciousness. A total of 106 ICU nurses were included in the study. The study was divided into three phases: pre-implementation, implementation, and post-implementation. The researchers first observed the nurses management of pain in their patients; this was done three times using a checklist following tracheal suctioning and position change procedures. The nurses were then taught how to apply the critical-care pain observational tool (CPOT). Post-implementation of the tool, the researchers re-evaluated trained the nurses' pain management. .

RESULTS

Performance scores after training improved with relation to the nurses diagnosis of pain, pharmacological and nonpharmacological actions, reassessment of pain, and re-relieving of any pain. However, use of the tool did not improve the recording of the patient's pain and the relief measures used. .

CONCLUSION

Use of the CPOT can increase nurse's sensitivity to pain in non-conscious patients and drive them to track and perform pain management.

The effect of empowerment program on "perceived readiness for discharge" of mothers of premature infants

OBJECTIVES

Poor readiness of mothers to take care of their premature infant at the time of hospital discharge is associated with potential adverse consequences. The aim of this study was to examine the effect of empowerment program on "perceived readiness for discharge" of mothers of premature infants at the time of discharge.

METHODS

A quasi-experimental before-after study design with consecutive inclusion of all mother-child pairs was used to conduct the study. Eighty mothers and their premature infants (40 pairs of mother-infant in the experimental group and 40 pairs of mother-infant in the control group) were recruited in the study. The program to empower the parents was implemented as a 3-stage training plan for the experimental group. "Parent discharge readiness" questionnaire was completed by mothers before intervention and at discharge time, and was evaluated by nurses at discharge time. The groups were compared in terms of readiness for discharge according to the scores given by mothers and nurses.

RESULTS

At discharge time, there was a statistically significant difference between technical readiness of control and experimental groups according to mothers' self-report (p < 0.001) and nurse evaluation (p < 0.0001). Also, there was a statistically significant difference between emotional readiness of mothers in control and experimental groups according to mothers' self-report (p < 0.0001) and nurse evaluation (p = 0.003).

CONCLUSION

The implementation of empowerment program is an effective strategy to promote the readiness of mothers of premature infants at discharge time.

The impact of instructing management skill to managers on the obstetrician's efficiency

The importance of efficiency and improvement of health service for resolving people's health requirement and meeting their expectation is increasing. In addition, it considers as a priority for making decision and manager's activity in health officials. Manager's control on the management principle and the proper use of their management skill and creating a sense of trust and commitment are the tools that were providing a good condition for working and catching the organization's goals. In this quasi-experimental study, before beginning the research, the non-teaching hospitals that are affiliated to the Kurdistan's medical science university were randomly divided into 2 groups. Three hospitals from 3 cities considered as a control group, and three hospitals from 3 cities considered as an intervention group.80 person of hospital's obstetrician staff classified in these 2 group by quota method and the hospital's nurses and obstetrician's manager of case-control involved by census method. The research's tool was Hersi and Gold Smith's standard efficiency questionnaire, which was filled out at the beginning of the study by the obstetricians of both groups and then it gave to the hospital's nurses and obstetrician's managers of the case group's instructing management skills for 16 hours. The efficiency's questionnaire was filled out, compared, and evaluated again by the obstetricians of both groups, 12 weeks after intervention. The data analyzed by the independent T-test, variance analysis, paired T-test, and SPSS 22. The findings showed that the average of the obstetrician's efficiency mainly developed in the intervention team after the instruction of management skills to the managers (P < 0.001).

CONCLUSION

The instruction of the management skill to the nurses and obstetrician's managers caused the efficiency's promotion. Therefore, the instruction of the management skills has suggested as a method of increasing efficiency in hospitals.

The effect of facilitated tucking during endotracheal suctioning on procedural pain in preterm neonates: a randomized controlled crossover study

BACKGROUND

Premature infants not only feel and understand the pain, but also respond more intensively compared with term infants. Non-pharmacological methods of pain control are suitable to relieve pain in painful procedures. The facilitated tucking position is considered as a non-pharmacological method of pain control in infants; however, its impact on frequent and repeated procedural pain such as endotracheal suctioning remains to be studied.

OBJECTIVES

This paper is the report of a study that examined the impact of facilitated tucking position on behavioral pain during suctioning in premature neonates.

DESIGN

This was a clinical trial study with a crossover design.

SETTINGS

The study was conducted in a level II Neonatal Intensive Care Unit, located in a teaching hospital, affiliated to Tehran University of Medical Sciences, Tehran, Iran.

PARTICIPANTS

Thirty four infants were enrolled in this study based on the following inclusion criteria: age between 29 to 37 weeks of gestational age, birth weight 1200 grams or more, having an endotracheal tube, no congenital anomalies, no seizures diagnosis, no chest tubes, no intracranial hemorrhage higher than degree II, not receiving opiates and sedatives four hours before intervention and not receiving any painful procedure at least half an hour before the intervention.

METHODS

The samples were randomly received a sequence of suctioning with/without or suctioning without/with facilitated tucking. Preterm Infant Pain Profile (PIPP) was used to collect the data. SPSS version 16.0 for Windows (SPSS Inc., Chicago, IL, USA) was used for statistical analysis.

RESULTS

While 38.2% of infants experienced severe pain during suctioning without intervention, only 8.8% of them experienced severe pain during suctioning with intervention. The results of the paired t-test show that there is a statistically significant difference in the mean scores of pain between non-intervention and intervention cases (p < 0.001), and the mean pain score substantially reduced in cases with intervention.

CONCLUSIONS

Given the multiplicity of endotracheal suctioning frequency and the impossibility of frequent use of pharmacological methods of pain relief, the facilitated tucking position can be used as a safe non-pharmacological method for procedural pain management. 

The effect of facilitated tucking position during endotracheal suctioning on physiological responses and coping with stress in premature infants: a randomized controlled crossover study

OBJECTIVE

Premature infants respond more intensively to pain compared with term infants. Facilitated tucking position as a non-pharmacological method of pain in infants has been suggested; however, its effect on acute procedural pain such as endotracheal suctioning remains to be studied. This study examined the effect of facilitated tucking position during suctioning on physiological responses and coping with stress in premature infants.

METHODS

This was a randomized controlled crossover study. Thirty-four premature infants received an order of either suctioning with intervention - suctioning without intervention, or suctioning without intervention - suctioning with intervention. Neonatal Infant Pain Scale (NIPS) was used to collect the data.

RESULTS

No statistical significant difference was seen between intervention and non-intervention cases in terms of the average time duration to reach the pain score to one or zero, and also, in the average of changes in oxygen saturation. However, changes in heart rate were less in intervention cases.

CONCLUSION

The effect of facilitated tucking position on coping with stress was not found in this study. This non-pharmacological strategy can be suggested because of its effect on reducing changes in heart rate during painful procedure. It is suggested to replicate the study with larger number of samples.

Comparison of halogen light and vibroacoustic stimulation on nonreactive fetal heart rate pattern

BACKGROUND

One of the first-line assessment tools for fetal surveillance is nonstress test (NST), although it is limited by a high rate of false-nonreactive results. This study was performed to investigate if external stimulation from vibroacoustic and halogen light could help in provoking fetal responsiveness and altering NST results.

MATERIALS AND METHODS

This is a clinical trial. Sampling was done from April to July 2010. One hundred pregnant women with nonreactive NST for 20 min were allocated in two groups: Vibroacoustic stimulated NST (VNST, n = 50) who received vibration from a standard fetal vibratory stimulator and halogen light stimulated NST (LNST, n = 50) who received a halogen light source for 3 and 10 sec, respectively. Results were compared together and then compared to biophysical profile (BPP) scores as a backup test. We used Mann-Whitney U test, Chi-square test, and Fisher's exact test to compare the variables in the two groups through SPSS version 14. P < 0.05 was considered as statistically significant.

RESULTS

Following stimulations, 68% nonreactive subjects in halogen light stimulation group and 62% in vibroacoustic stimulation group changed to reactive patterns. Time to onset of the first acceleration (VNST: 2.17 min; LNST: 2.27 min) and the test duration (VNST: 4.91 min; LNST: 5.26 min) were the same in the two groups. In VNST 89.5% and in LNST 87.5% of nonreactivity followed by score 8 in BPP. There was no significant relation between stimulus NSTs and BPPs.

CONCLUSION

Vibroacoustic and light stimulation offer benefits by decreasing the incidence of nonreactive results and reducing the test time. Both halogen light stimulation and vibroacoustic stimulation are safe and efficient in fetal well-being assessment services.

Reducing perineal trauma through perineal massage with vaseline in second stage of labor

PURPOSE

Maintaining an intact perineum is a highly regarded aim in delivery procedures today. Since perineal massage is a common practice during delivery, the present study aims to investigate the effect of perineal massage with Vaseline on perineal trauma (rate of episiotomy procedures and perineal tears).

METHOD

Ninety primiparous women (aged between 18 and 30 years with gestational age of 38-42 weeks) were selected sequentially in Tehran in 2009. Once participants' characteristics were registered, they were randomly assigned to the intervention (perineal massage with Vaseline) or control groups. In the massage group, perineal massage was performed in the second stage of delivery once the genitalia were treated with sterilized Vaseline. The perineum was examined after the delivery in terms of episiotomy or tear and its severity degree.

RESULTS

The two groups were homogeneous in terms of demographic data, weight gain during pregnancy, gestational age, abortion history and fetal weight. The second stage of delivery was significantly shorter in the massage group than the control group and the massage group had significantly more intact perineum (P = 0.004). In addition, lower episiotomy and higher first- and second-degree perineal tears were seen in the massage group in comparison with the control one (P < 0.001). Neither of the groups suffered from third- and fourth-degree tears.

CONCLUSION

The findings showed that the perineal massage with Vaseline in the second stage of labor increases perineal integrity and decreases perineal traumas (episiotomy and tears). So, it seems that the perineal massage could be an effective way to preserve an intact perineum in labor.

Is social support associated with greater weight loss after bariatric surgery?: a systematic review

Social support may be associated with increased weight loss after bariatric surgery. The objective of this article is to determine impact of post-operative support groups and other forms of social support on weight loss after bariatric surgery. MEDLINE search (1988-2009) was completed using MeSH terms including bariatric procedures and a spectrum of patient factors with potential relationship to weight loss outcomes. Of the 934 screened studies, 10 reported on social support and weight loss outcomes. Five studies reported on support groups and five studies reported on other forms of social support (such as perceived family support or number of confidants) and degree of post-operative weight loss (total n = 735 patients). All studies found a positive association between post-operative support groups and weight loss. One study found a positive association between marital status (being single) and weight loss, while three studies found a non-significant positive trend and one study was inconclusive. Support group attendance after bariatric surgery is associated with greater post-operative weight loss. Further research is necessary to determine the impact of other forms of social support. These factors should be addressed in prospective studies of weight loss following bariatric surgery, as they may represent ways to improve post-operative outcomes.

The effect of education on quality of life in patients under interferon therapy

BACKGROUND AND AIMS

The main purpose of treating and caring for patients with chronic viral hepatitis is to promote life satisfaction and a feeling of well-being in patients suffering from this disease. The aim of this study was to evaluate the effect of education on quality of life in patients with chronic hepatitis who were treated with Interferon alpha.

METHODS

This quasi-experimental study was conducted on 60 patients with viral hepatitis. The intervention included teaching them the method of self injection of Interferon alpha 2 b, giving them educational pamphlets and then following their continuing treatment with interferon. Patients were randomly assigned to two 30-patient groups. The data- gathering tool was a demographic characteristics questionnaire and the Quality of Life Questionnaire for Patients with Chronic Liver Disease (CLDQ). The educational program was done in four 45- minute sessions for the case group and their relatives. The follow-up period was 12 weeks. Quality of life in patients with chronic hepatitis was measured before initiating interferon therapy, and after the educational period. Quality of life in the two groups was compared.

RESULTS

The total quality of life score in the two groups before therapy did not show any significant difference (P = 0.351); while 12 weeks after education there was a significant difference between the two groups (P < 0.001) in three items including abdominal symptoms (P = 0.01), worry (P < 0.001) and emotional factors (P < 0.001). The other three items did not show a significant difference between the two groups. The total quality of life score in the case group was significantly different before and after education (P < 0.001), and improved after education. The total quality of life score in the control group did not differ significantly after 12 weeks (P = 0.143).

CONCLUSIONS

Planning short and simple educational programs has a significant effect on the patient's control of his/her disease and its side effects; and can improve quality of life, life satisfaction, and mechanisms of coping with treatment in patients with viral hepatitis.

Colonoscopy: why are general surgeons being excluded?

BACKGROUND

The role of surgeons as endoscopists has been extensively debated in the literature, with conflicting studies published regarding the safety and efficacy of surgeons performing colonoscopies. A multitude of medical federations and societies have set various standards for granting endoscopy privileges, many with a bias against general surgeons [1, 3]. We reviewed the colonoscopy experience at our institution to evaluate differences between gastroenterologists (GI) and general (GS) and colorectal surgeons (CRS) in procedure times and complication and cecal intubation rates.

METHODS

Between January 2000 and July 2002, 5237 colonoscopies were performed at our institution. The data for procedure times, completion, and complication rates were collected in a prospective database. Complications were defined as perforation, bleeding, and postpolypectomy syndrome. Incomplete colonoscopies due to colitis, poor bowel preparation, or tumor obstruction were excluded. Chi-squared test was used to compare complication and cecal intubation rates between the three groups. Median procedure times were compared using the Kruskall-Wallis and Dunn's pairwise tests. A significant p-value was defined as <0.05.

RESULTS

No differences in the complication rate was noted between the three groups: GI (0.12%), CRS (0.15%), and GS (0.11%) ( p = 0.99). There was a trend toward a lower incomplete colonoscopy rate in the GS group compared to CRS and GI: 0.32% vs 0.84% and 0.36%, respectively ( p = 0.07). The median colonoscopy times for GS (29 min), however, were shorter than for GI (34 min, p < 0.001) or CRS (31 min, p < 0.001).

CONCLUSION

General surgeons perform colonoscopies expeditiously, with as low a morbidity rate and as high a completion rate as their gastroenterology or colorectal surgery colleagues. As the results of this study confirm, general surgeons should not be excluded from endoscopy suites.

Screening colonoscopy in the asymptomatic 50- to 59-year-old population

BACKGROUND

In an effort to decrease the death rate from colorectal cancer, a multitude of medical societies and task forces recommend routine screening for colorectal cancer beginning at age 50. Yet, there is no consensus as to the best and most cost-effective screening method. Medicare now pays for screening colonoscopies for its average risk beneficiaries [3]. Many insurance companies, however, will not cover this test in younger patients. We therefore reviewed our institution's colonoscopy experience with asymptomatic 50- to 59-year-olds, with negative fecal occult blood tests and negative family histories.

METHODS

Between January 1999 and January 2002, 4779 colonoscopies were performed at our institution. The charts for 619 persons 50-59 years of age were retrospectively reviewed, with 91 patients meeting the strict requirements of this study. We defined polyps with high-grade neoplasias as those with villous or tubulovillous components, and cancerous lesions included those with carcinoma in situ. The distal colon was defined as the rectum and sigmoid colon.

RESULTS

There was a 58% incidence of neoplastic polyps in this younger asymptomatic population. More than 4% of our subjects had high-grade neoplasias or cancerous lesions. In the absence of any distal findings, flexible sigmoidoscopy would have missed up to 38% of these polyps.

CONCLUSIONS

The findings generally support the recommendations by the American College of Gastroenterology for average-risk patients to preferentially undergo a screening colonoscopy at age 50 in lieu of other methods.

Impact of a medical back care program on utilization of services and primary care physician satisfaction in a large, multispecialty group practice health maintenance organization

STUDY DESIGN

Samples of patients with new back pain were compared at two medical centers, one with and one without a medical back care program.

OBJECTIVES

To measure the impact of a medical back care program on use of services and physician satisfaction in a health maintenance organization.

SUMMARY OF BACKGROUND DATA

A medical back care program is staffed with specially trained primary care physicians and provides consultative and educational services to the medical center.

METHODS

Program impact on services was measured by comparing the number of physician office visits, consultations, physical therapy referrals, and imaging procedures provided to a sample of patients with back pain at the two medical centers. Physician satisfaction with care provided to patients with back pain was measured by a survey sent to primary care physicians at both medical centers.

RESULTS

At the medical center with a back care program, 42% fewer consultations, 59% fewer physical therapy referrals, and 33% fewer imaging procedures were ordered. Less expensive consultations with back care physicians in medicine or family practice were ordered more frequently than consultations with either neurologists or orthopedists. This change in pattern of care took place without significantly altering clinical course. The effect of the program on the rate of surgery was not measured.

CONCLUSIONS

The results of this study support the benefits of an organized medical back care program.