Journal of Holistic Nursing and Midwifery
Volume:35 Issue: 2, Spring 2025

To date, few studies have evaluated the effects of probiotics in women at high risk of spontaneous preterm birth (PTB), which have presented contradictory results.

This study aims to investigate the efficacy of administrating probiotics together with 17α-hydroxyprogesterone (17α-OHP) on spontaneous PTB and related pregnancy outcomes in pregnant women at high risk for PTB.

This randomized clinical trial was conducted on 118 pregnant women at high risk for PTB (with a history of PTB or pregnancy termination in the second trimester) receiving 17α-OHP injection (250 mg, IM). They were assigned to probiotic group (n=58) and placebo group (n=60). The probiotic group received a 500 mg Lactofem bio-capsules orally and daily, containing Lactobacillus acidophilus 2×109 cfu/g, Bifidobacterium bifidus 2×109 cfu/g, Lactobacillus rutri 2×109 cfu/g, Lactobacillus fermentum 2×109 cfu/g, from the 16th to the 37th week of pregnancy. The placebo capsules contained starch powder. The obstetric outcomes included Preterm Premature Rupture of Membranes (PPROM), PTB and mode of delivery. The neonatal outcomes included anthropometric characteristics and Apgar score (at 1 and 5 minutes after birth). The obtained data were analyzed using t-test and chi-square test. The significance level was set at 0.05.

The mean age of the participants was 30.27±7.56 and 28.93±7.32 years in the probiotic and control groups, respectively. Their mean body mass index (BMI) was 26.80±2.12 and 26.74±2.98 kg/m2, respectively. Also, 8.62% and 15% of women in the probiotic and placebo groups had PTB before the 34th week of pregnancy, while 12.06% and 16.7% had PTB from the 34th to the 37th week of pregnancy, respectively. There were no significant differences between the two groups in these obstetric outcomes. After delivery, the newborn’s weight was 2928.07±454.83 and 2879.16±348.27; head circumstance was 33.39±1.15 and 33.46±1.46; height was 49.58±1.30 and 49.93±1.45; Apgar score at 1 minute after birth was 8.7±0.6 and 8.6±0.5, and Apgar score at 5 minutes after birth was 9.8±0.6 and 8.9±0.8, respectively. There were no significant differences between the two groups in these neonatal outcomes.  

The use of probiotic adjuvant in combination with 17α-OHP injection from the 16th to the 37th week of pregnancy cannot reduce the risk of spontaneous PTB or improve neonatal and obstetric outcomes in women at high risk for PTB.

One of the most important factors related to the quality of care is the proper communication between nurses and patients. One of the factors that affects patient safety is the working environment. 

This study aimed to determine the use of augmentative and alternative communication (AAC) methods by nurses in intensive care units (ICUs) of hospitals in Ahvaz, southwest of Iran, and assess its relationship with work environment and patient safety culture.

This is a correlational and cross-sectional study. Using a census sampling method, 378 nurses working in the ICUs of hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences were selected, of whom 249 were eligible to participate in the study. Data were collected from May to June 2022 using the hospital survey on patient safety culture (HSOPSC), nursing work index (NWI) and an AAC method use questionnaire. The association between the study variables was assessed using Spearman’s correlation test. P<0.05 were considered statistically significant.  

Among participants, 87.1% were female, and 85.1% had a bachelor’s degree. The most common method of communication was verbal communication, as 61 nurses (24.5%) reported they “always” used this method, while it was “often” used by 79(31.7%) nurses. Moreover, 93 nurses (37.3%) reported that the nurse call bell was the most commonly used tool for communication. Spearman’s test results showed a significant relationship between some NWI variables and the use of AAC methods, including a significant relationship between speaking valve use for communication and adequacy of resources and staffing (r=0.380, p=0.001) and between communication with sign language and overall perception of patient safety (r=-0.330, P=0.001). There was also a significant relationship between many HSOPSC variables and the use of AAC methods (P<0.05).

Promoting a patient safety culture and improving the working environment can improve nurses’ use of AAC methods in ICUs.

Hormonal imbalance due to menopause may cause physical, psychosocial, sexual, and vasomotor symptoms that can hinder the quality of life (QoL) of postmenopausal women. In Nepal, postmenopausal women are at potential risk of decreased QoL since it is a patriarchal society and gives low priority to women

This research aimed to evaluate the QoL of postmenopausal women residing in Lalitpur district, Nepal.

This is a community-based analytical study with a cross-sectional design conducted on 215 postmenopausal women aged 45-60 years residing in Mahalaxmi municipality of Lalitpur district, Nepal, who were selected using a systematic random sampling technique. The Menopause-specific QoL (MENQOL) questionnaire was used to collect data through face-to-face interviews. Descriptive statistics and the chi-square test were used to analyze the collected data.

The mean age of women was 54.51±3.83 years. The majority of them were married (87.4%), living in a joint family (74%) and illiterate (66%). Among women, 98.6% had experienced at least one menopausal symptom based on the MENQOL domains. Also, 62.8% had moderate QoL, 20.2% had good QoL and 17% had poor QoL. The level of QoL was significantly different based on occupation (P=0.03) and age at menarche (P=0.003).

Menopausal symptoms are dominant among postmenopausal women in Nepal, among which physical symptoms are the most common, and vasomotor symptoms are the least common symptoms. It is recommended that effective interventions be planned and implemented to improve the QoL of Nepali postmenopausal women.

Studies have shown conflicting results regarding the skin absorption of iodine from povidone-iodine solution (Betadine 7.5%) and its effects on the health of operating room personnel.

This study aimed to measure the urinary iodine concentration (UIC) among the operating room personnel of a hospital in Isfahan, Iran, after using povidone-iodine scrub (Betadine 7.5%).

This descriptive-analytical study was conducted among operating room personnel of a selected hospital in Isfahan, Iran. Using a convenience sampling method, 100 participants were selected and divided into two groups: Povidone-iodine scrub (n=50) and alcohol-based scrub (n=50). The scrubs were used for one week, three times per day, each for three minutes. One week after the study, morning urine samples were collected to measure the UIC using the Sandell-Kolthoff reaction method. The Shapiro-Wilk test assessed the normality of data distribution, and statistical comparisons between the two groups were conducted using the Mann-Whitney U test and chi-square test.

The mean age of the povidone-iodine scrub group and the alcohol-based scrub group were 31.9±6.29 and 31.7±5.59 years, respectively. Also, 94% in the povidone-iodine scrub group and 86% in the alcohol-based scrub group were female. No significant differences were observed between the two groups in age, work experience, gender, educational level, scrubbing frequency, or number of shifts per week. The results showed a significantly higher UIC in the povidone-iodine scrub group compared to the alcohol-based scrub group (290.0±0.73 vs 106.8±27.88 μg/L; P=0.001). Additionally, the prevalence of iodine poisoning (>300 μg/L) was higher in the povidone-iodine group (8% vs 0%; P=0.001). Furthermore, in the povidone-iodine scrub group, the UIC was significantly higher in individuals with hand scrubbing frequency ≥10 per week compared to those with fewer frequency (316.3±54.20 vs 196.5±54.00 μg/L, P=0.001) and in those who worked ≥6 shifts per week (299.3± 66.9 vs 206.2±81.6 μg/L; P=0.011).

This study suggests that hand scrubbing with povidone-iodine (Betadine 7.5%) can increase the UIC and the risk of iodine poisoning in operating room personnel. Therefore, it is recommended to consider alternative solutions, such as alcohol-based solutions, for hand scrubbing in operating rooms.

Treatment adherence refers to the degree to which an individual’s behavior complies with health or treatment recommendations. 

This study aims to determine treatment adherence and the related factors among patients with myocardial infarction (MI) admitted to selected hospitals in Hilla, Iraq.

In this cross-sectional study, 264 patients over 18 years of age diagnosed with MI for at least six months from three hospitals in Hilla, Iraq, were selected by a convenience sampling method. A demographic form and the coronary artery disease treatment adherence scale (CADTAS) were used to collect data. Pearson correlation test, Independent t-test, analysis of variance, multivariable general linear model (GLM) and Wilk’s lambda statistic was used for data analysis.

Most of the participants were male (72.7%), married (72.3%), worker (44.3%) with a middle school education (28%) and a mean age of 60.87±8.25. The mean total CADTAS score was 92.28±8.01( From 35 to 175 possible scores). The CADTAS score had significant and negative relationship with age (r=-0.225, P=0.001) and age at the onset of diagnosis (r=-0.239, P=0.001). The results of the GLM showed the significant and negative association of the history of heart attack (B=-2.645; 95% CI, -5.106, -0.184, P=0.035) and the history of underlying diseases (B=-2.828, 95% CI, -5.463, -0.193, P=0.036) with the CADTAS score. Also, the medication use duration was positively and significantly associated with the CADTAS score (B=1.145; 95%CI, 0.069, 2.222, P=0.037). Also, Wilks’ Lambda values showed a significant difference in the CADTAS score in terms of gender (Wilks’ Lambda =0.933, P=0.002), occupation (Wilks’ Lambda =0.845, P=0.001), history of heart attack (Wilks’ Lambda =0.950, P=0.013), history of underlying diseases (Wilks’ Lambda =0.953, P=0.018), and medication use duration (Wilks’ Lambda =0.938, P=0.003) 

The results of this study showed that the mean score obtained by the study samples was higher than the mean score of the tool used to determine the level of adherence. Given the MI patients’ treatment adherence scores, more studies are needed to determine the reasons for non-adherence to treatment in Iraqi patients with MI. Planning education for these patients and their families can be helpful to increase their treatment adherence.

Breastfeeding is one of the most effective ways to ensure child survival and health. In Iran, over 50% of mothers face breastfeeding difficulties. The breastfeeding duration is related to the breastfeeding experience.

This study aimed to investigate the impact of mobile-based breastfeeding education on Iranian mothers’ breastfeeding experiences. 

This quasi-experimental study included 81 nursing mothers selected using a multi-stage cluster random sampling method from selected comprehensive health centers in Rasht, Iran. Using the block randomization method, they were allocated to the intervention group (n=41) and control group (n=40). Data were collected using a demographic form and the Breastfeeding Experience Scale (BES), completed 3-5 days after delivery by both groups. The intervention group received a breastfeeding app installed on their Android mobile phones and were asked to read the educational content in the app for two months. After this period, both groups completed the BES again. Independent t-test, chi-square test , Mann–Whitney U test, Kruskal-Wallis test, Wilcoxon test, Shapiro-Wilks test and ANCOVA were used to analyze the data. 

In the post-test phase, 81 women participated. The mean age of mothers and their spouses was 29.55±6.56 and 32.93±5.44, respectively. There were no significant differences in demographic, social, or reproductive characteristics between the two groups. The intervention group showed an increase in exclusive breastfeeding rate and a decrease in formula milk use for feeding. The total BES score in intervention and control groups after education was 27.93±7.43 and 32.88±9.89, respectively. The results of ANCOVA showed a significant difference in the total BES score between the two groups after intervention (P=0.001, Eta squared=0.196). Regarding the type of infant feeding (exclusive breastfeeding and mixed feeding), the results showed a significant difference between the two groups after education (P=0.023). 

Mobile-based breastfeeding education can positively affect Iranian mothers’ breastfeeding experience. Therefore, healthcare providers in north of Iran can utilize educational apps to promote exclusive breastfeeding in women.

Heart failure (HF) is a complex and common clinical syndrome whose symptoms are caused by structural or functional disorders in the heart. Although several studies have been conducted to identify the factors associated with the hospital readmission of patients with HF, statistics still show a high readmission rate in these patients. Therefore, it is necessary to conduct further studies to identify the factors that are effective in reducing the readmission rate and preventing the cost burden on the health system and patients.

This study aims to investigate the factors associated with the 30-day readmission rate of patients with HF in Iran.

This is a retrospective single-center study, which was conducted on 312 patients with HF admitted to a hospital affiliated to Isfahan University of Medical Sciences, Isfahan, Iran from April to September 2019. The medical records of these patients were reviewed and followed up for 6 months after the initial admission to assess the rate of 30-day readmission to the same hospital. The information was collected using a researcher-made form that surveyed sociodemographic characteristics, clinical characteristics, common drug treatments and discharge conditions. The data were analyzed using inferential statistics, including t-test, chi-square test/Fisher’s exact test and multiple logistic regression analysis.

Among patients, 181(58%) were over 65 years of age, 65.7% were male and more than 88% were married. The overall 30-day readmission rate was 7.4% (23 out of 312), and the rate of over 30-day readmission was 17% (53 out of 312). The readmission rate in men (8.8%) was higher than in women (4.7%), but this difference was not statistically significant. The readmission rate in unemployed patients (21.4%) was higher than in patients with other occupations (0.9-3.9%). The results of logistic regression showed that as body mass index increased, the likelihood of readmission decreased (OR=0.84, 95% CI, 0.74, 0.96, P=0.001), and the likelihood of readmission in patients who received diuretic therapy was 4.24 times higher than in those who did not receive diuretics (OR=4.24, 95% CI, 1.02, 1.17, P=0.047). 

The follow-up of patients with HF treated with diuretics, as well as those with high body mass index are needed due to their higher risk of hospital readmission. Developing a post-discharge care plan for these patients can be effective in reducing their 30-day readmission rate.

Measuring the health-related quality of life (HRQOL) in children with cancer is very important. The pediatric quality of life inventory™ 4.0 (PedsQL 4.0) is a well-established tool for measuring the HRQOL of children aged 2-18 years with cancer. 

The present study aimed to determine the psychometric properties of the Persian version of the PedsQL 4.0 for Iranian children with cancer.

This is a methodological study. The PedsQL™ 4.0 was first translated into Persian and then psychometrically evaluated. The participants included 200 children with cancer and 200 parents referred to a specialized hospital for children in Rasht, Iran, from October 2021 to October 2022, who were selected by a convenience sampling method. The face validity, and construct validity (by confirmatory factor analysis [CFA] were assessed. Internal consistency was assessed by calculating Cronbach’s α and the test re-test reliability was measured by calculating the intraclass correlation coefficient (ICC). 

The mean age of children and parents was 5.9±4.2 and 37.83±5.86 years, respectively. The CFA results showed that the eight-factor model had a good fit. In the child self-report version, Cronbach’s α value for the eight subscales was in the range of 0.72-0.88 and for the overall scale, it was 0.80. In the parent proxy-report version, Cronbach’s α value was in the range of 0.82-0.93 and for the overall scale, it was 0.81. In the test re-test reliability, the ICC value in the child self-report version for the age groups 5-7, 8-12 and 13-18 years old was 0.85, 0.78, and 1, respectively. The ICC value in the parent proxy-report version for the age groups 2-4, 7-5, 8-12 and 13-18 years old was 0.97, 0.87, 0.87 and 1, respectively.

The Persian version of the PedsQL 4.0 has good psychometric properties for Iranian children with cancer. Therefore, it can be used as a valid and reliable tool to measure the HRQOL of these children in Iran.

Clinical education is the first source of learning and creates the professional identity of medical students. It is the most important part of nursing education. Clinical education in therapeutic settings is provided in different forms, such as holding morning report sessions, rounds/grand rounds, journal club, and clinical training. Nursing education is provided through nursing rounds, bedside education, nursing duties, nursing care conferences, nursing team conferences, individual conferences, field visits and the registration process. Evidence-based clinical education for medical students by strengthening their problem-solving skills, active participation in the learning process and facing the real situation, and using documented and comprehensive resources leads to deeper learning. This method can also improve the decision-making skills of medical students. Among the various methods of clinical education, morning report (MR), which is a basic educational conference, is the most effective and widely used method for improving the quality of medical education in the world. The results of studies have shown that, among the teaching methods, the highest satisfaction of students was with the MR.