Psychosocial needs of inpatient women with gestational diabetes mellitus: a qualitative study

BACKGROUND

Gestational diabetes mellitus (GDM) is one of the most common medical complications associated with pregnancy. Its treatment requires multidisciplinary cooperation, and identifying the psychosocial needs of patients is important in the management of their condition.

OBJECTIVE

This study investigates the psychosocial needs of inpatient mothers with GDM from the joint perspectives of future mothers and healthcare providers.

METHODS

This qualitative study used a content analysis approach. Semi-structured individual interviews focusing on the psychosocial needs of women with GDM were conducted with twelve women suffering from GDM and eight medical staff. Sampling continued until data saturation.

RESULTS

According to the findings of this study, the psychosocial needs of these mothers were classified into the following categories: Support for worries related to the consequences of the disease, Interpersonal support, Infrastructural support, educational support.

CONCLUSION

The psychosocial needs of inpatient mothers with GDM were identified in this study. Attention to these needs can help enhance the mother's satisfaction and treatment adherence, and reduce worries and anxiety during hospitalisation.

ABBREVIATIONS

GDM: Gestational Diabetes Mellitus; hPGH: human placental growth hormone; COREQ: Consolidated criteria for reporting qualitative research; WHO: World Health Organization; HCP: healthcare provider.

Effect of Curcumin on Dysmenorrhea and Symptoms of Premenstrual Syndrome: A Systematic Review and Meta-Analysis

BACKGROUND

Dysmenorrhea and premenstrual syndrome (PMS) are common periodic and frequent complications in women of reproductive age that can negatively affect health and quality of life. The present study examined the effects of curcumin on the severity of dysmenorrhea and PMS symptoms.

METHODS

A systematic review and meta-analysis of randomized controlled trials was conducted by searching databases such as the Cochrane Library, EMBASE, Scopus, PubMed, and Web of Science from inception to January 2023. Article screening was performed using Endnote ver. X8 (Clarivate). Review Manager (RevMan ver. 5.3; Cochrane) was used for the quality assessment and meta-analysis. A total of 147 studies were screened, of which five were finally selected for quantitative and qualitative analyses. The studies were conducted between 2015 and 2021, and a total of 379 participants with a mean age of 23.33±5.54 years had been recruited in these studies.

RESULTS

The meta-analysis showed that curcumin consumption could significantly reduce the severity of dysmenorrhea (mean difference, -1.25; 95% confidence interval [CI], -1.52 to -0.98; three studies; I2=31%) and the overall score of PMS (standardized mean difference, -1.41; 95% CI, -1.81 to -1.02; two studies; I2=0%).

CONCLUSION

The reduction in the severity of PMS and dysmenorrhea has been attributed to curcumin's anti-inflammatory and antidepressant activities. Although the findings suggest that curcumin may be an effective treatment for reducing the severity of PMS and dysmenorrhea, further research with a larger number of participants from various socioeconomic levels and a longer duration of treatment is needed to evaluate the effective dose of curcumin.

The Effect of Yoga on Maternal Anxiety in Women with Excessive Gestational Weight Gain: A Randomized Controlled Trial

BACKGROUND

Excessive gestational weight gain (EGWG) and anxiety are comorbid conditions that increase the risk of adverse maternal and neonatal outcomes. This study was conducted to investigate the effect of yoga on the anxiety of women with EGWG.

MATERIALS AND METHODS

This randomized controlled trial was performed on EGWG pregnant women referring to comprehensive health centers in Qom city, Iran, between October 2021 and August 2022. Eighty-eight participants were assigned to the intervention (N = 44) and control (N = 44) groups. The experimental group participated in six sessions of 90-min yoga classes, and the control group only received routine care. Two questionnaires including a demographic information questionnaire and the State-Trait Anxiety Inventory (STAI) questionnaire were used for data collection. Data were analyzed using SPSS software version 22.

RESULTS

The results of this study showed a statistically significant difference between the two groups in terms of trait anxiety (25.84 ± 3.45 vs. 57.38 ± 8.07; p < 0.05) and state anxiety (27.93 ± 3.72 vs. 60.13 ± 8.13; p < 0.05) after intervention. On the other hand, the trait and state anxiety rates were stable in the experimental group before and after intervention, while they increased to the severe form of anxiety in the control group (effect size = -21.84 ± 10.66 vs. -19.43 ± 8.44).

CONCLUSION

The result of this study showed that yoga has a positive effect on the anxiety of pregnant women with EGWG and can be used as a preventive or complementary solution to control the anxiety of these mothers.

Hintergrund

Exzessive Gewichtszunahme in der Schwangerschaft (EGWG) und Angst sind Komorbiditäten, die das Risiko für einen ungünstigen Verlauf für Mutter und Kind erhöhen. Diese Studie wurde durchgeführt, um die Auswirkung von Yoga auf Angst bei Frauen mit exzessiver Gewichtszunahme in der Schwangerschaft zu untersuchen.

Material und Methoden

Diese randomisierte, kontrollierte Studie wurde bei Schwangeren mit EGWG durchgeführt, die sich zwischen Oktober 2021 und August 2022 an Zentren für ganzheitliche Gesundheit in der Stadt Ghom im Iran vorstellten. 88 Teilnehmerinnen wurden einer Interventions- (N = 44) und einer Kontrollgruppe (N = 44) zugeteilt. Die experimentelle Gruppe nahm an einem Yogakurs von sechsmal 90 minuten Dauer teil, die Kontrollgruppe erhielt lediglich die Standardversorgung. Die Datenerhebung erfolgte mit zwei Fragebögen: einem Fragebogen zu demografischen Angaben und dem State-Trait-Angstinventar (STAI). Die Auswertung der Daten erfolgte mit SPSS-Software, Version 22.

Ergebnisse

Die Ergebnisse dieser Studie zeigten einen statistisch signifikanten Unterschied zwischen beiden Gruppen im Hinblick auf Eigenschaftsangst (25.84 ± 3.45 vs. 57.38 ± 8.07; p < 0.05) und Zustandsangst (27.93 ± 3.72 vs. 60.13 ± 8.13; p < 0.05) nach der Intervention. Auf der anderen Seite waren die Raten von Eigenschafts- und Zustandsangst in der experimentellen Gruppe vor und nach der Intervention stabil, während sie in der Kontrollgruppe zur schweren Form von Angst anstiegen (Effektstärke = −21.84 ± 10.66 vs. −19.43 ± 8.44).

Schlussfolgerung

Die Ergebnisse dieser Studie zeigen, dass Yoga sich bei Schwangeren mit EGWG positive auf Angst auswirkt und als präventive oder komplementäre Lösung zur Beherrschung von Angst bei diesen Müttern eingesetzt werden kann.

The Effect of Auriculotherapy on an Overweight Pregnant Women's Weight-Gaining Pattern: A Randomized Controlled Clinical Trial

Background

A concomitant increase in pregnancy complications has accompanied the growing global trend of excessive weight gain during pregnancy. This study evaluates the effect of ear acupressure (auriculotherapy) on the weight-gaining pattern of overweight women during pregnancy.

Materials and Methods

This study was a single-blinded randomized clinical trial conducted between January and September 2022. This study took place in health centers of Qom University of Medical Sciences in Iran. One-hundred thirty overweight pregnant women were selected by a purposeful sampling method and then divided into two groups by block randomization method. In the intervention group, two seeds were placed in the left ear on the metabolism and stomach points, while two seeds were placed in the right ear on the mouth and appetite points. Participants in the intervention group must press the seeds six times a day, 20 minutes before a meal for five weeks. For the placebo group, the Vaccaria seedless label was placed at the same points as the intervention group. A digital scale with an accuracy of 0.1 kg was used to weigh the pregnant women during each visit. Descriptive statistics, independent T-test, chi-square, and repeated measure ANOVA (analysis of variance) test were used to check the research objectives.

Results

There was a statistically significant difference between the auriculotherapy and placebo groups immediately after completing the study (1120.68 ± 425.83 vs. 2704.09 ± 344.96 (g); P = 0.018), respectively. Also, there was a substantial difference in the weight gain of women two weeks (793.10 ± 278.38 vs. 1090.32 ± 330.31 (g); P < 0.001) and four weeks after the intervention (729.31 ± 241.52 vs. 964.51 ± 348.35 (g); P < 0.001) between the auriculotherapy and placebo groups. Discussion. The results of the present study indicated the effectiveness of auriculotherapy in controlling the weight gain of overweight pregnant women. This treatment could be used as a safe method, with easy access, and low cost in low-risk pregnancies. Trial Registration. This trial is registered with IRCT20200104046002N1.

Prioritizing the Psychosocial Support Needs of Mothers with Gestational Diabetes: A Delphi Study

Background

Gestational diabetes is the most common medical complication in pregnancy, and the psychosocial health of women suffering from this condition affects their adherence to treatment and self-efficacy. However, since it is not possible to design interventions dealing with all of these needs, the aim of this study was to prioritize the psychosocial supportive needs of women with gestational diabetes.

Materials and Methods

This was a modified Delphi design study involving 22 experts who were selected using purposive and snowball sampling methods. The study was conducted between April 2021 and June 2021. First, the psychosocial needs of diabetic pregnant women were extracted through a qualitative study involving interviews with multidisciplinary specialists and diabetic pregnant mothers (22 participants) and a systematic review of reputable scientific databases. Throughout the two Delphi stages, the questionnaire was classified, quantified, and analyzed.

Results

Based on the results of this study, the following are the top priorities when addressing the psychosocial needs of mothers with gestational diabetes: paying attention to and identifying the mother's worries and anxiety, husband and family support for diabetic pregnant women, the inclusion of specialized nutrition counseling services in mothers' treatment plan, timely education of mothers about diabetes and its complications, and proper nutrition for diabetic mothers.

Conclusions

The priorities of the supportive needs obtained in this study can be used to design interventions aimed at promoting psychosocial health, reducing stress and anxiety, and improving medication adherence in women with gestational diabetes.

Effect of Selenium Supplementation on Biochemical Markers of Women with Polycystic Ovarian Syndrome: A Systematic Review

Polycystic ovary syndrome (PCOS) is a widespread endocrine disorder among fertile women and may be induced by nutritional deficiencies. In this study, we assess the impact of selenium supplementation (SS) on biochemical markers in women with PCOS. To gather relevant literature, we searched the Web of Science, Cochrane Library, Scopus, Embase, and MEDLINE databases from inception up to July 24, 2022. Subsequently, we included all published full-text randomized clinical trials examining the effects of SS versus placebo on biochemical changes in women with PCOS. Review Manager 5.3 was used to collect and analyze data and assess the risk of bias. Seven articles, comprising 413 women, were ultimately involved in the study. According to the results, SS could increase the level of quantitative insulin sensitivity check index [standardized mean difference (SMD)=0.34, 95% confidence interval (CI)=0.04∼0.65], total antioxidant capacity (SMD=0.89 mmol/L, 95% CI=0.52∼1.26), and glutathione (SMD=1.00 μmol/L, 95% CI=0.22∼1.78). Conversely, SS could decrease triglyceride, cholesterol, fasting plasma glucose, insulin, and the homeostasis model of assessment-insulin resistance levels compared with the placebo. Furthermore, there were no significant differences regarding sex hormone-binding globulin level, testosterone level, malondialdehyde, and body mass index between the two groups. In addition, the results suggest that SS improves biochemical markers in women with PCOS and thus is recommended for treating biochemical disorders among these women in addition to standard treatment.

Continuous non-locking vs. interrupted suturing techniques for the repair of episiotomy or second-degree perineal tears: A single-blind randomized controlled trial

Objective

Perineal trauma is a serious and frequent problem after childbirth which is experienced by millions of women worldwide. The technique used for perineal repair may have an impact on pain and wound healing. The aim of the present study was to compare the continuous non-locking technique with interrupted suturing for the repair of episiotomy or second-degree perineal tears.

Methods

A single-blind randomized-controlled trial was conducted from October 2021 to August 2022 in Sina Hospital, Ahvaz, Iran. Three hundred women were selected and randomly assigned into control and intervention groups using block randomization technique. The main outcomes included pain and wound healing that were assessed using visual analog scale (VAS), as well as redness, edema, ecchymosis/bruising, discharge, and approximation scale (REEDA). The secondary outcomes were the use of analgesics, duration of perineal repair, material used for suturing, pain during urination and defecation, and resumption of sexual intercourse. The participants were followed up on the first and seventh days and in the 6th week postpartum. Mann-Whitney, Chi-square, and Generalized Estimating Equations (GEE) model were used for data analysis.

Results

Wound healing was significantly better in the continuous non-locking suture technique compared to the interrupted technique (β = -1.98; P > 0.0001). Women also experienced less pain in the continuous non-locking suture technique (β = -2.46; P > 0.0001). There was a reduction in the use of analgesics, the duration of perineal repair, and the material used for suturing in the continuous non-locking suturing technique as opposed to the interrupted method (P < 0.0001).The odds of pain during urination and defecation significantly reduced in women who underwent the continuous non-locking method (P < 0.001). Also, women in the continuous non-locking group resumed their sexual intercourse earlier (P < 0.0001).

Conclusion

The findings of this study revealed that use of continuous non-locking technique for suturing was associated with reduced perineal pain and improved wound healing. Furthermore, it was associated with a shorter duration of perineal repair, less suture material used, and less need for analgesics compared with the interrupted method. There is, however, need for more studies to confirm the results of the present study.Iranian registry for randomized controlled trials (Ref. ID: IRCT20190415043283N1).

The Effect of Malva Sylvestris Cream on Episiotomy Pain and Healing: A Randomized Controlled Clinical Trial

Background

Episiotomy is one of the common procedures during childbirth in Iran, which causes pain, discomfort, and scar in the perineum. This study aimed to pursue the effect of Malva Sylvestris cream on episiotomy pain and healing.

Methods

This study was a double-blinded randomized-controlled clinical trial that was conducted from April to December 2021 at the Sina hospital in Ahvaz, Iran. Sixty women were selected and randomly assigned to control and intervention groups using block randomization. The main outcomes included pain assessment and episiotomy wound healing that are assessed by the Visual analog scale (VAS), and perineal healing scale included redness, edema, ecchymosis/bruising, discharge, approximation (REEDA). The cream was used twice a day for up to 14 days. The participants were followed on the first, seventh, and fourteenth days postpartum. Independent T-test, Mann-Whitney, and Chi-square, and Generalized Estimating Equations (GEE) model were used by SPSS software version 22 for data analysis. Statistically significant level was considered less than 0.05.

Results

There were no significant statistical differences between the two groups in demographic characteristics (P>0.05). No significant statistical differences were found in both groups in terms of perineal healing (B=-0.05; P=0.89) and pain scores (B=0.15; P=0.56). However, the chance of external dysuria in the intervention group decreased by 77% (P=0.01).

Conclusion

Despite showing the positive effect of Malva Sylvestris extract on wound healing in animal and in-vitro studies, this clinical study failed to show the positive effect of this extract on wound healing and pain relief of episiotomy. However, future clinical trials are needed to substantiate the above findings.Trial Registration Number: IRCT20190826044621N1.

Effects of Aromatherapy with Citrus Aurantium Lavender on Sexual Function of Postmenopausal Women: A Randomized Controlled Trial

Objective: The purpose of this study was to explore the effectiveness of aromatherapy with Citrus aurantium Lavender on the sexual function of postmenopausal women.

Materials and methods: A randomized controlled trial with single-blind design was conducted on eighty postmenopausal women in Ahvaz, Iran from January to December 2019. The women were randomly assigned to the Citrus aurantium group (n=40) and placebo group (n=40). The intervention group received two drops of Citrus aurantium essential oil twice a day, for four consecutive days a week, for four weeks as inhalation. Similarly, placebo was received by the control group.

Results: The results of this study revealed that in the intervention group, the FSFI total score and all of its dimensions were significantly improved compared to the control group.

Conclusion: Aromatherapy using Citrus aurantium can be used as an alternative or complementary method for improvement of sexual function in postmenopausal women. It is recommended that the postmenopausal women suffering from sexual dysfunction be informed on the aromatherapy by Citrus aurantium essential oil.

The Effect of Citrus Aurantium Aroma on the Sleep Quality in Postmenopausal Women: A Randomized Controlled Trial

Background

One of the most common problems in menopausal women is sleep disturbance. Citrus aurantium has sedative, hypnotic, and anti-anxiety effects. The aim of this study was to investigate the effect of Citrus aurantium aroma on the sleep quality of postmenopausal women.

Methods

This was a double-blind randomized controlled trial that was conducted from Feb to Dec 2019 on 80 postmenopausal women who suffered from sleep disturbances. The participants were assigned into two groups randomly. Women in the intervention group were requested to use 2 drops of essential oil of Citrus aurantium, twice a day, for 4 consecutive days in a week, for 4 weeks as inhalation. The control group received almond oil in the same way. The quality of sleep was evaluated using the Pittsburgh Sleep Quality Index (PSQI) before the intervention and 4 weeks after the intervention started. The data were analyzed using the SPSS statistical software, version 21, and P<0.05 was considered statistically significant.

Results

After 4-weeks of intervention, the mean score of sleep quality was significantly lower in the Citrus aurantium group compared to the control group (5.75±1.33 vs 13±1.59, P<0.001). In the intervention group, all dimensions of PSQI were improved significantly (P<0.001).

Conclusion

The results of this study showed that the aroma of Citrus aurantium essence could significantly improve the sleep quality of postmenopausal women. Therefore, it is recommended that health care providers should inform the postmenopausal women and advise them to use this intervention for reduction of sleep disorders.

Trial Registration Number

IRCT20160427027633N7.

The psychosocial challenges associated with gestational diabetes mellitus: A systematic review of qualitative studies

BACKGROUND

Gestational diabetes is a disease with complex management that requires multidisciplinary collaboration. To achieve treatment goals, in addition to using medications and paying attention to exercise and diet, it is also important to take into account the mental health and psychosocial aspects of diabetes management. This study aimed to highlight these challenges associated with gestational diabetes.

METHOD

This qualitative systematic review involved a search of the following databases: CINAHL, EMBASE, MEDLINE, and PsycINFO. Title, abstract, and full-text screening was done using Covidence software, and quality assessment of the included papers was conducted using the Critical Appraisal Skills Programme Checklist. Enhancing transparency in reporting the synthesis of the qualitative research statement (ENTREQ) was used in the design of this paper. Data synthesis was done using meta-aggregation method.

RESULTS

Out of the 2440 articles searched, 24 were qualitatively analyzed. The CASP score of the included papers was optimal. The 514 findings extracted from the 24 studies were aggregated into five broad conceptual categories: psychological challenges, socio-cultural challenges, information-communication challenges, challenges associated with a lifestyle change, and challenges related to health care.

CONCLUSION

Recognizing the psychosocial challenges associated with gestational diabetes and developing support packages tailored to psychosocial needs can help improve the management of these patients.

The level of satisfaction and quality of E-learning in medical universities of Iran during the epidemic of COVID-19

BACKGROUND

E-learning is web-based learning for education and training. The current global pandemic crisis created due to COVID-19 has made worldwide online learning. This study aimed to investigate the level of satisfaction and quality of E-learning in medical universities from the students' point of view during the epidemic of COVID-19 and assessing the obstacles and solutions proposed to improve the quality of E-learning.

MATERIALS AND METHODS

A cross-sectional, web-based study was conducted among 400 medical university students of Iran during the epidemic of COVID-19. After getting written consent, three parts questionnaire contains demographic, user satisfaction, quality questionnaire, and three open-ended questions were distributed randomly using social media. Descriptive analysis, t-test, Chi-square, and Pearson correlation coefficient were used to achieve the objective of this study, with significance set to P < 0.05. Furthermore, three open-ended questions were reviewed qualitatively and the problems and solutions suggested by the students were reported.

RESULTS

Based on the findings of the descriptive section, 277 of the respondents were girls (69%) with a mean age of 21 ± 2 years. Sixty-nine percent of students were studying in medical sciences universities and 31% were studying in Islamic Azad University. The level of satisfaction was in the upper range of low (34.0 ± 10.0); P < 0.001, and intention to reuse was moderate (23.06 ± 6.0); P = 0.064. Student's perception of quality in most domains was in the upper range of low to medium. User satisfaction, intention to reuse, the quality of knowledge, and participatory quality for evaluating online courses were significantly higher in the Azad University group than in medical universities.

CONCLUSION

Given that this is the first experience in the use of E-learning in Iran, both universities have not yet fully succeeded in satisfying students and it is necessary to increase the quality of E-learning based on student suggestions.

Investigating the association of the dimensions of genital hiatus and levator hiatus with pelvic organ prolapse: a systematic review

BACKGROUND AND HYPOTHESIS

Pelvic organ prolapse (POP) is a very common and distressing problem that affects women's quality of life. This systematic review aimed to investigate the association of the dimensions of the genital hiatus and levator hiatus at rest and Valsalva with POP.

METHODS

The Cochrane Library, PubMed, Scopus, Embase and Web of Science were searched on 25 April 2020. All data were analyzed using Review Manager 5.3.

RESULTS

Of the 1288 papers reviewed, 21 (n = 5145: 2909 women with POP and 2236 controls) were considered for meta-analysis. Compared with the normal pelvic floor group, the urogenital hiatus size in the POP group was significantly higher at rest (mean difference: 0.49; 95% CI: [0.43, 0.55], P < 0.00001) and at Valsalva (mean difference: 0.79; 95% CI: [0.70, 0.89], P < 0.00001). Also, the levator ani hiatus size in the POP group was significantly higher at rest (mean difference: 0.52, 95% CI: [0.25, 0.78], P < 0.0001) and at Valsalva (mean difference: 1.01; 95% CI: [0.73,1.28], P < 0.00001) compared with that in the normal pelvic floor group.

CONCLUSION

This systematic review showed that the sizes of the urogenital hiatus and levator ani hiatus and area of the levator hiatus in the POP group were significantly higher than those in the normal pelvic floor groups in both positions (rest or Valsalva maneuver). Also, in the POP group, the levator hiatus length at rest was significantly lower than that in the Valsalva maneuver.