The Effect of Maternal-Foetal Attachment-Based Training Programme on Maternal Mental Health Following an Unintended Pregnancy.

INTRODUCTION: Unintended pregnancy is a risk factor for less maternal-fetal attachment (MFA) and low levels of psychological well-being. This study was conducted to determine the effect of an MFA-based training programme on maternal anxiety, depression and worries following an unintended pregnancy. METHODS: This randomised clinical trial was conducted on 68 women with an unintended pregnancy in north of  Iran during 2018-2019. Participants were allocated to the trained and control groups through simple randomisation. The trained group received the MFA-based training for three 90-min sessions. Demographic questionnaire, London measure of unplanned pregnancy, Cranley's MFA scale, Edinburgh postnatal depression, Spielberger anxiety and prenatal distress questionnaires were used. Data were analysed by descriptive statistics, chi square, Fisher's exact test, independent and paired-samples t-tests, Mann-Whitney U, analysis of covariance, and multivariate analysis of variance. RESULTS: After the intervention, the mean MFA, anxiety and depression scores were not significantly different between the trained and control groups Worry was significantly decreased in the trained group (p = 0.001) and increased in the control group (p = 0.03). DISCUSSION: Although the MFA-based training could not significantly improve MFA, maternal anxiety and depression, it has been effective on worry in women with the unintended pregnancies.

Assessment of the efficacy of group counselling using cognitive approach on knowledge, attitude, and decision making of pregnant women about modes of delivery.

The choice of casarean deliveries by mothers is highly influenced by inadequate knowldge and negative attitudes towards vaginal birth. In this semi-experimental study, we compared knowledge, attitude, and decision making about modes of delivery between nulliparous pregnant women who received eight sessions of group consultation and those who took routine prenatal education. Contrary to the control group, the improvement of knowledge and attitudes were significant in the consultation group (p < 0.001), as well as mothers' decisions for vaginal birth (p = 0.03). Group consultation is an appropriate approach to improving knowledge, attitudes, and tendencies of mothers toward natural birth.

Relationship between Revised Graduated Index (R-GINDEX) of prenatal care utilization & preterm labor and low birth weight.

Prenatal care refers to accurate and consistent performance of the principles important to maintain healthy pregnancy outcomes and also for mother and child health. One of the new indices to assess the adequacy of care is Revised Graduated Index of Prenatal Care Utilization (R-GINDEX).The study aims to assess the relationship between quantitative prenatal care factors and preterm labor and low birth weight using R-GINDEX. This historical cohort study has been conducted on 420 mothers during the first two years after delivery in 2010. The adequacy of care was calculated by R-GINDEX. Based on this index, participants have been divided into three care groups including inadequate, adequate and intensive care groups. A significant relationship has been found between R-GINDEX and preterm birth and low birth weight (P<0.05). Thus the probability of premature labor in inadequate care group (RR=3.93) and low birth weight (RR= 2.53) was higher than that of the adequate and intensive care group. The results showed that the quantity of prenatal care is effective in reducing preterm birth and low birth weight.

The effect of 8 weeks aerobic exercise on insulin resistance in type 2 diabetes: a randomized clinical trial.

Diabetes complications are the main reasons behind morbidity and mortality preventable by healthy diet and physical activity. There are few studies about the effect of aerobic exercises on insulin resistance in human. Also various training protocols are associated with different results. Since approaches to decrease insulin resistance may be followed by more effectiveness treatment, this study assessed the effect of aerobic exercise on insulin resistance in type 2 diabetes mellitus. In this randomized clinical trial, 53 type 2 diabetic women were randomly divided into two groups as exercise (n=27) and control (n=26).The exercise protocol included warm-up by stretching and flexibility exercises for 10 m, followed by walking for 30 m with maximum intensity 60% increase in heart rate and then stretching in the seated position for 10 m, 3 times a week for 8 weeks. Resistance to insulin was assessed using Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). Significant differences have been observed in insulin resistance, fasting glucose and plasma insulin between the groups after 8 weeks. There were significant differences in waist and hip circumference, BMI, plasma insulin and insulin resistance within the groups over time. In addition, the changes in waist and hip circumference, FBS, plasma insulin and insulin resistance had significant interaction with the time between the groups. The current exercise protocol has been effective in lowering plasma glucose (p = 0.05), insulin levels (p = 0.000) and insulin resistance (p = 0.02). It seems that aerobic exercises training promote the effectiveness of medical treatment in type 2 diabetes mellitus.

Prevalence and risk factors associated with low back pain in Iranian surgeons.

OBJECTIVES: Low back pain (LBP) is a common and costly occupational injury among health care professionals. The purpose of this study was to investigate the prevalence and risk factors of LBP in surgeons and to analyze how individual and occupational characteristics contribute to the risk of LBP. METHODS: A cross sectional study was conducted on 250 randomly selected surgeons including 112 general surgeons, 95 gynecologists and 43 orthopedists from 21 hospitals at northern Iran. A structured questionnaire including demographic, lifestyle, occupational characteristics as well as prevalence and risk factors of LBP was used. Visual analogue scale and Oswestry low back disability questionnaires were also used to assess the pain intensity and functional disability, respectively. RESULTS: Point, last month, last six months, last year and lifetime prevalence of LBP was 39.9%, 50.2%, 62.3%, 71.7% and 84.8%, respectively. The highest point prevalence was related to the gynecologists with 44.9%, and the lowest for general surgeons (31.7%). Age, body mass index, smoking, general health, having an assistant, job satisfaction, using preventive strategies and years of practice were found to be correlated with the prevalence of LBP (P < .05 in all instances except for age and job satisfaction). Prolonged standing, repeated movements and awkward postures were the most prevalent aggravating factors (85.2%, 50.2% and 48.4%, respectively). Rest was found to be the most relieving factor (89.5%). CONCLUSIONS: The results of this study demonstrate that the prevalence of LBP amongst surgeons appears to be high and highlights a major health concern. Further large scale studies, including other specialties and health professions such as physical therapy, chiropractic, and general medicine, should be performed.

Comparison of abdominal palpation, Johnson's technique and ultrasound in the estimation of fetal weight in Northern Iran.

OBJECTIVES: to assess the accuracy of abdominal palpation, Johnson's technique and ultrasound in the estimation of fetal weight (EFW). DESIGN, SETTING AND PARTICIPANTS: 174 pregnant women were recruited at random in a large teaching hospital in Iran. Fetal weight was estimated by palpation and Johnson's technique at the time of admission by one qualified midwife, and then estimated by ultrasound by one radiologist. After birth, all newborns were weighed using the same scale. FINDINGS: a significant correlation was found between EFW by ultrasound, palpation and Johnson's technique and actual birth weight. The differences between EFW by palpation, ultrasound and Johnson's technique and actual birth weight were significant for small-for-gestational-age fetuses (p<0.05, p<0.01 and p<0.001, respectively), but not for appropriate-for-gestational-age fetuses. These differences were significant for ultrasound (p<0.001) and palpation (p<0.05) in large-for-gestational-age fetuses. The sensitivity of ultrasound for EFW of low-birthweight fetuses (72.2%) and the sensitivity of Johnson's technique for EFW of normal-weight and macrosomic fetuses (97.3% and 75%, respectively) appeared to be higher than the sensitivities of the other methods. CONCLUSION: palpation and Johnson's technique can be used as alternatives to ultrasound for EFW, particularly if the measurements are taken by experienced, skilled personnel.

Low back pain in 1,100 Iranian pregnant women: prevalence and risk factors.

BACKGROUND: Low back pain (LBP) is a common and costly problem in pregnancy. It is one of the main reasons for disability, absence from work, and responsible for huge direct and indirect economical impact. PURPOSE: The purpose of this study was to determine the prevalence and risk factors of LBP during pregnancy. STUDY DESIGN: A cross-sectional study was carried out on Iranian pregnant women. PATIENT SAMPLE: Eleven hundred randomly selected pregnant women. OUTCOME MEASURES: A structured questionnaire including demographic, lifestyle, as well as prevalence and characteristics of LBP was used. Visual Analog Scale and Oswestry low back disability questionnaires were also used to assess the pain intensity and functional disability, respectively. METHODS: After ethical approval from Medical Ethics Board at the Mazandaran University of Medical Sciences and Health Services, a cross-sectional study was conducted on 1,100 pregnant women from 18 health centers in Sari district, at northern Iran. RESULTS: Point, last-month, last 6-month, last-year, and lifetime prevalence of LBP were 40.2%, 55.9%, 59.4%, 76.2%, and 84.1%, respectively. Prolonged standing and rest were found to be the most significant aggravating and relieving factors (76.3% and 87.7%, respectively). LBP was significantly correlated with history of previous LBP and LBP in previous pregnancy (p=.000 in both cases). CONCLUSION: The prevalence of LBP in pregnant women appears to be high and future research should focus on different preventive strategies during pregnancy.