فصلنامه حیات
سال شانزدهم شماره 3 (پیاپی 47، پاییز و زمستان 1389)

Preterm labor is a major risk factor of mortality and morbidity in newborns and fetuses. Low birth weight is also a risk factor for mortality and various neonatal diseases. This study aimed to determine the association between the CRP levels in first trimester of pregnancy with low birth weight and preterm labor.Methods & Materials: In this prospective cohort study, we measured serum CRP levels in 400 pregnant women up to 20 weeks of gestation. All participants were followed up to delivery. Preterm labor was defined as delivery before 37 weeks of gestation. Low birth weight was defined as weight less than 2500 g at birth. Statistical analysis was done using Chi-square, Logistic regression, and ROC curve. P-values less than 0.05 were considered to be significant. After controlling for the effects of age above 35 years, mother's occupations, history of preterm labor, socio-economic status, history of abortion, primiparity, and passive smoking, logistic regression analysis showed statistically significant relationship between the CRP and preterm labor (P-value=0.000, OR=1.24, %95 CI=1.11-1.38). However, there were no significant relationships between the CRP levels with other factors. Using Roc curve, we determined CRP cut-off point level for preterm labor. With 81% sensitivity, and 64% specificity, CRP cut-off point was 3.45 mg/l. After controlling for the effects of low socio-economic status, history of LBW, history of abortion, gravidity, primiparity, and passive smoking, logistic regression analysis showed statistically significant association between the CRP levels and LBW (OR=1.31, CI %95=1.08-1.59, P=0.005). However, there were no significant relationships between CRP levels with other factors. CRP cut-off point level for LBW was determined using Roc curve. With 87.5% sensitivity, and 74% specificity, CRP cut-off point was 4.75 mg/l. It seems that the inflammatory marker, CRP, can be used to identify women who are at high risk for preterm labor and LBW. However, larger studies are needed to establish this relationship definitively

Micronutrients deficiency is one of the most common health problems among adolescents. Theory based educational interventions which address learner's preferences are among the solutions for the matter in hand. The aim of this study was to determine the effectiveness of the Transtheoretical model (TTM) based educational package on vitamin intake in female adolescents in Tehran.Methods & Materials: A randomized community trial was applied. Study samples were consisted of 80 female students from two middle schools of Tehran, district 17th. They were selected using a cluster-random sampling method and were randomly assigned to the intervention (n=40) and control groups (n=40). The intervention group received a TTM-based educational package. Changes in vitamin intake were assessed using standard food frequency & 24-recall questionnaires.

Based on pre-test results, intake of vitamin B2, B6, B9, B12, and C were lower than Dietary Reference Intake (DRI) in both groups. Based on the post-test data, a significant increase occurred in the mean score of vitamin intake in the intervention group comparing with the control group; and also with the intervention group at pretest (P<0.05).

TTM-based educational package could be effective in improving vitamin intake in urban female adolescents.

Invasive procedures are severe stressors for in-patient children. The stress result in sleep disorder, reduced concentration, and increased pain. Nowadays, pharmacologic and nonpharmacologic interventions are used to control stress. We aimed to assess the effect of massage on children's anxiety level before intensive procedures.Methods & Materials: In this clinical trial, 70 children aged 7-11 were recruited from a children hospital. The participants were randomly allocated to the intervention and control groups. The intervention group received massage therapy in the Yeen tang point and palms for five minutes. The control group received the usual care. Anxiety was measured using OSBD-R. Data were analyzed using Mann-Wittny and Willcoxon statistical tests. The anxiety level was not significantly different between two groups before the intervention (Control group: 3.24±0.48; Intervention group: 3.24±0.56) (P=0.472). Following the massage, the anxiety level decreased significantly in the intervention group (Intervention group: 1.57±0.54; Control group: 3.37±0.46) (P<0.001). Massage in the Yeen tang point and palms can reduce the anxiety level in hospitalized children prior to invasive procedures. It is recommended to use this massage technique in pediatric wards to reduce anxiety level.

Illness, hospitalization and pain are often first crisis children faced with in their early life. Performing painful procedures such as IV injections for medical purposes are inevitable and stressful events in pediatric wards. Distraction is an inexpensive, practical, and nonpharmacological nursing intervention for pain relief. This study aimed to determine the effects of distraction on some physiological indices (heart rate and O2 saturation (and intensity of pain in the hospitalized children aged 3-6 years undergoing IV injection.Methods & Materials: In this clinical trial, 72 children aged 3-6 years who were undergoing IV insertion were recruited for the study. The participants were randomly allocated into two groups of intervention and control. Distraction technique was applied using bubble-maker in the intervention group. After 10 minutes, pain intensity was measured using OUCHER scale. Moreover, heart rate and blood oxygen saturation were measured for three minutes in both groups using Pulse Oxymeter pre- and post-intervention. The findings showed statistically significant differences in the average heart rate (P<0.01) and the amount of saturated oxygen (P<0.009) and the pain intensity (P<0.001) between two groups after the intervention. The pain decreased significantly in the intervention group in comparison with the control group. According to the research findings, distraction with bubble-maker resulted in decreasing the physiological responses and intensity of pain in children aged 3- 6 years. This method can be useful in reliving the pain in preschool children undergoing IV insertion.

Regular and adequate physical activity is a major factor in maintaining good health throughout entire life course. Levels of inactivity are high in all countries. Effective educational interventions are needed to promote physical activity in all populations. The aim of this study was to determine the effect of a heath education intervention on physical activity knowledge, attitude, and behavior in health volunteers of Tehran in 2008.Methods & Materials: All active female health volunteers of Tehran, district 14 (n=100) were recruited for this experimental study. Data were gathered using a questionnaire of knowledge, attitude, and behavior regarding physical activity. The questionnaire was completed by all participants in two phases of pre- and post-intervention (four weeks after the intervention). Health education intervention strategies were presented to the intervention group during three educational sessions with one week interval between the sessions. Data were analyzed using related statistical tests. Findings showed significant statistical differences in knowledge, total physical activity rate per week, and the mean sitting time per day between the control and intervention groups after the intervention (P<0.05). While, these variables were not significantly different before the educational intervention among both groups. The health education intervention presented in this study was effective in promoting knowledge, total physical activity rate per week, and mean sitting time per day among the female health volunteers.

Gestational diabetes is a major concern during pregnancy. Psychological factors such as self-efficacy play important role in adherence of the treatment, control of blood glucose, and the outcomes of the pregnancy. The main purpose of this study was to determine correlations of self-efficacy in women with gestational diabetes attending to educational medical centers of Iran University of Medical Sciences in Tehran.Methods & Materials: In this descriptive correlational study, we recruited 100 women aged 15-49 years old with gestational diabetes and singleton pregnancies using consecutive sampling method. Data were collected using Diabetic Self-Efficacy scale. The mean age of the women was 31 years. The majority of the women (66%) had moderate economic status; and more than half (60%) had no higher education. Sixty eight percent of the study participants were obese or overweight. About 33% of the participants were nullipara; and 69% had wanted pregnancies. The results showed that 43% of the women had low self-efficacy. The self-efficacy scores were significantly correlated with education (P=0.005) and occupation (P=0.016). Self-efficacy is an important determinant of self-management and self-control in gestational diabetes. Regarding low self-efficacy among the women, it seems that implementing educational-counseling strategies to enhance self-efficacy can be helpful to promote optimum self-care among women with gestational diabetes.

Childbearing is a potentially traumatic event in the lives of women; and can lead to post traumatic stress disorder in some women. This study aimed to determine the prevalence and predisposing factors of post traumatic stress disorder after childbearing in women in Bushehr.Methods & Materials: In this cross-sectional study, 400 women who attended the medical centers 6-8 weeks after delivery were recruited to the study. Participants with traumatic delivery were included in the study. They completed the posttraumatic symptoms scale-I (PSS-I), and predisposing factors questionnaire. Data were analyzed in two groups of women with the PTSD and without PTSD using Chi-square and Fisher's exact test with P=0.05. The results of this study showed that 54.4% of women had experienced a traumatic delivery; and one-third of the women were affected to PTSD after childbearing. There were significant differences between obstetrical factors including complications of pregnancy, wanted pregnancy, post-partum complications, interval of the last two pregnancies less than two years; neonatal factors including type of feeding, issues of child care, birth weight; and psychological factors including stressful life events, and maternity social support with the PTSD (P<0.05). Income had statistically significant association with the PTSD (P<0.05). Some of obstetrical, neonatal and psychological factors are associated with occurrence of the PTSD after delivery

Diet adherence is a major issue in cardiovascular diseases control. Patient education could be a valuable strategy for promoting diet adherence. The aim of this study was to compare the effects of computer-assisted vs. face to face education on dietary adherence among patients with myocardial infarction.Methods & Materials: In this experimental study, 117 patients with the first acute myocardial infarction were selected via a convenience sampling. The participants were randomly allocated into three groups. Patients in the face to face group (n=43) received an education about diet in two two-day sessions. The computer-assisted education group (n=33) received the same educational plan provided by computer software containing audio, text, images and animations at home. The control group (n=41) received their usual care. Adherence to dietary regimen was assessed three months after the educations. There were not significant association between the three groups in terms of demographic characteristics and disease history. There were no significant different in unhealthy diet adherence between the three groups. There were not significant differences in healthy diet between the computer-assisted and face to face education groups. The computer-assisted education group had significantly better adherence with the consumed amount of fats (P=0.01), useful meat substitutes (P=0.01), and other foods (P=0.012) than the control group. In addition, the face to face education group had significantly greater adherence scores with consuming meat substitutes (P=0.04), and fats (P=0.04) than the control group. Both computer-assisted and face to face educational strategies had positive effects on improving adherence following myocardial infarction.

Osteoporosis is a serious metabolic bone disorder and a major health concern in women. Osteoporosis affects the quality of life of women. Studying the osteoporosis related food habits and behaviors can promote health promotion program planning. It seems that female teachers are the best models and educational sources for female students. This study was carried out to determine the osteoporosis related food habits and behaviors among female teachers.Methods & Materials: This study was a cross-sectional study in which 308 female teachers were randomly selected using stratified sampling method from the schools of the 6th district of Tehran. Data were collected using a questionnaire and analyzed using student t-test, one-way analysis of variance and Tukey test. Mean score of osteoporosis related food habits and behaviors was 14.9±4.2 (out of a possible 24 maximum attainable score). Osteoporosis related food habits and behaviors score was significantly higher in the teachers who had higher knowledge score, aged more than 50 years old, had worked for more than 25 years, had used educational books and booklets as the first informational source, and among the post- menopausal teachers (P<0.03). According to the findings, the teachers demonstrated average level of osteoporosis related food habits and behaviors, whereas their mean calcium intake was relatively adequate, but their other food habits and behaviors were relatively inappropriate. It seems developing and implementation of educational programs and offering educational booklets to teacher can help to promote their food habits and behavior which may be helpful in enhancing student's food habits.

Labor pain management is one of the most important procedures of midwifery cares. Acupressure, a non-pharmacological method of labor pain relief, is an available, easy to use, inexpensive, and without side effect method of pain relief. The purpose of this study was to compare the effects of LI-4 acupressure on labor pain in women during first stage of labor.Methods & Materials: A single blind randomized clinical trial study was carried out on 83 primipara women. The inclusion criteria were singleton pregnancy in 38-42 weeks of gestation, cephalic presentation, and spontaneous uterine contractions. Participants were divided into three groups including acupressure group, touch group, and the usual care (control group). The intensity of labor pain was measured using visual analog scale with the rating from 0-100 mm immediately, 30 minutes, and one hour after the intervention during the first stage of labor. Data were analyzed using statistical tests of ANOVA, Chi-square, and Exact chi-square. Findings indicated that acupressure group had lower labor pain in the active phase of the first stage of labor immediately after intervention than the other groups (P=0.026). The results of this study suggested that LI4 acupressure reduced the intensity of labor pain in the first stage of labor without any side effects to mother and infant. This procedure can be used as a simple, safe and inexpensive method to relief labor pain.