Development and Psychometric Evaluation of the Motivation for Healing Scale in Patients with Cancer.

Introduction: This study was conducted to develop and validate a Motivation for Healing Scale (MHS) in Cancer. Methods: in this methodological study, the MHS draft was developed based on the approach of Waltz and colleagues using existing scales and concept analysis. The psychometric features, including face validity (qualitative and quantitative), content validity (qualitative and quantitative), structural validity (exploratory and confirmatory factors), and construct validity (convergent and discriminant validity) were assessed. Finally, the reliability was evaluated using internal consistency, and stability. Results: Based on the results of the qualitative phase, an initial item pool was generated with 55 items, Exploratory and confirmatory factor analyses were performed on the data collected from 404 patients. 25 Items were excluded during the psychometric evaluation phases. Reliability assessment and internal consistency assessment revealed that Cronbach's alpha value of the 25-item MHS was 0.912. The results of intraclass correlation coefficient (0.93, 95% CI: 0.86- 0.96) showed the stability was strong. Conclution: The 25-item MHS is a valid and reliable scale for the assessment of motivation for healing in patients with cancer.

Does a 30-minute introductory visit to the operating room reduce patients' anxiety before elective surgery? a prospective controlled observational study.

BACKGROUND: Patients scheduled for elective surgery typically suffer from preoperative anxiety related to the unknown environment and unclear expectations. We hypothesized that a virtual or in-person introductory visit to the operating room one day before surgery may decrease the extent of preoperative anxiety by familiarizing patients and their families with the operating room environment. So, this study aimed to evaluate the impact of operating room visits, conducted both in-person and virtual reality, on patients' preoperative anxiety. METHODS: This prospеctivе controllеd obsеrvational study еxaminеd patiеnts who wеrе candidatеs for gеnеral surgеry in a tеaching hospital in Iran. All patiеnts agеd bеtwееn 18-60 yеars, who wеrе undеrgoing gеnеral surgеry bеtwееn April and Sеptеmbеr 2022 and had prеopеrativе anxiеty basеd on thе Spiеlbеrgеr quеstionnairе, wеrе sеlеctеd. Patients who had emergency surgery or were taking anti-anxiety drugs were excluded from the study. Patiеnts wеrе thеn randomly assignеd to thе in-pеrson visit, virtual rеality visit, and control groups. In thе in-pеrson group, individuals visitеd thе opеrating room for 30 minutеs on thе day bеforе surgеry. In contrast, in thе virtual rеality group, visits wеrе conductеd via a 'livе' virtual vidеo tour of thе opеrating room for thе samе duration on thе day bеforе surgеry. The control group received routine care such as prе-surgеry hospitalization and mеdication. All participants completed the Spielberger questionnaire before the intervention (the day before surgery) and again two hours before surgery. Data were analyzed using variance analysis, t-tests, and Chi-square tests in SPSS 22 software. RESULTS: Wе idеntifiеd 105 patiеnts undеrgoing gеnеral surgеry who wеrе dividеd into thrее groups of 35 pеoplе еach. Thе rеsults showеd that, bеforе thе intеrvеntion, thеrе wеrе no statistically significant diffеrеncеs among thе thrее groups in tеrms of dеmographic data and prеopеrativе anxiеty (p > 0.05). Aftеr thе intеrvеntion, thе mеan scorеs of prеopеrativе anxiеty in thе in-pеrson visit, virtual rеality visit, and control groups wеrе 52.82 ± 4.51, 54.48 ± 5.04, and 53.42 ± 4.62, rеspеctivеly, with no significant statistical diffеrеncе (p = 0.33). Furthermore, there was no significant difference in preoperative anxiety scores before and after the intervention in the in-person visit (p = 0.13), virtual reality visit (p = 0.10), and control (p = 0.33) groups. CONCLUSION: A 30-minute visit to familiarize patients with the operating room environment, equipment, and staff, whether conducted in-person or virtually, does not significantly affect patients' preoperative anxiety or reduce their anxiety levels.

Effect of educating health promotion strategies model on self-care self-efficacy in elderly with kidney transplantation.

BACKGROUND: After kidney transplantation, older adults encounter numerous problems which can negatively affect their self-care self-efficacy. According to studies, behavior modeling training has an effect on patient's self-care. Therefore, the present study was conducted to determine the effect of implementing health promotion strategies on self-care self-efficacy in older adults undergoing kidney transplantation. MATERIALS AND METHODS: This quasi-experimental study was conducted on 60 older adults undergoing kidney transplantation in Tehran's Shahid Doctor Labbafinejad Hospital in 2020. Patients were randomly divided into intervention and control groups by using block randomization method. For the patients of the intervention group, the educations were provided based on the model of individual health promotion strategies in eight sessions (i.e., 8 weeks, one session per week) for 40-60 minutes. The subjects of the control group received only their routine care. The two groups completed on-line the self-care self-efficacy questionnaire, before, immediately after and one month after the intervention. The results were analyzed by Chi-square, t-test and repeated measures analysis of variance in SPSS v19. RESULTS: According to the results, no significant difference was observed between the two groups in terms of demographic characteristics and the mean score of self-care self-efficacy before the intervention (P > 0.05). The mean score of self-care self-efficacy (P = 0.001) and some of its dimensions including stress reduction (P = 0.01) and adaptability (P = 0.01) was significantly different in the two groups in the three time intervals. Moreover, the two dimensions of decision making (P = 0.07) and enjoying the life (P = 0.20) were not significant. CONCLUSION: According to the results, education based on health promotion strategies can effectively improve self-care self-efficacy and some its dimensions. Therefore, teaching health promotion strategies as a low-cost and simple method can positively affect self-care self-efficacy in older adults undergoing kidney transplantation.

Muscle thickness and pennation angle in overweight persons with moderate haemophilia A after resistance and combined training: A randomized controlled trial.

INTRODUCTION: Muscular atrophy and overweightness develop arthropathy in persons with haemophilia (PWH), and exercise increases their muscle strength and decreases their body weight. Musculoskeletal ultrasonography may be a non-invasive, safe, valid, and reliable tool to investigate muscle thickness (MT) and pennation angle (PA) after exercise training. OBJECTIVES: The present study was conducted to evaluate the effects of 6 weeks of resistance training (RT) and combined resistance and aerobic training (CT) on MT and PA in overweight persons with moderate haemophilia A. MATERIALS AND METHODS: Forty-two persons with moderate haemophilia A with a mean age of 35-55 years and a BMI of 25-30 kg/m2 were randomly assigned to three groups of 14, namely RT, CT, and control. The RT group performed 40 minutes of RT, and the CT group performed 20 min of RT and 20 min of aerobic training. The PA and MT of the biceps brachii (BB), triceps brachii (TB), vastus medialis (VM), vastus lateralis (VL), and medial gastrocnemius (MG) were measured before and after the intervention using B-mode ultrasonography. RESULTS: Significant increases were observed in the MT of VM, VL, MG, BB, and TB and PA of VM, VL, and MG in the RT and CT groups compared to the control group (p < .001). No significant differences were observed between the intervention groups. CONCLUSION: Both RT and CT were effective in enhancing MT and PA in overweight persons with moderate haemophilia A.

The Effect of Self-care Education Based on Self-efficacy Theory, Individual Empowerment Model, and Their Integration on Quality of Life among Menopausal Women.

BACKGROUND: Menopause has adverse physical and emotional effects on the quality of life. The aim of this study was to determine the effect of self-care education based on self-efficacy theory, individual empowerment model, and their integration on the quality of life among menopausal women. METHODS: In this quasi-experimental study, 186 menopausal women, aged 45-60 years at Kashan health centers entered the study using cluster sampling for health centers and simple random sampling inside each center from the list of the population from December 2019 to March 2020. The intervention was performed in 3 groups, using empowerment training, self-efficacy training, and their integration for 4 sessions each lasting 1-1.5 hours of weekly training. Three study groups were selected from different centers to minimize information exchange. Menopausal women's quality-of-life questionnaire was used to assess the quality of life. Questionnaires were completed pre-intervention and one and three months after completing the intervention. SPSS16 software and ANOVA, Chi-square, and repeated measure tests were used. RESULTS: The mean±SD score of quality of life in pre-intervention measurement was 32.96±10.62 in empowerment, 31.93±12.54 in self-efficacy, and 34.07±11.7 in integrated groups. The intervention was effective in improving the quality of life of all three groups (P values were<0.001 for time, 0.92 for group, and 0.38 for time*group interaction). CONCLUSION: This study showed that empowerment and enhancing self-efficacy could improve menopausal women's quality of life. This can help health professionals to better educate postmenopausal women about self-care in menopausal complications.

The effect of Swedish massage on pain in rheumatoid arthritis patients: A randomized controlled trial.

BACKGROUND AND PURPOSE: Joint pain is one of the most common symptoms in rheumatoid arthritis patients and require medical attention. The purpose of this study was to assess the effects of Swedish massage on pain and painkiller consumption in rheumatoid arthritis patients. MATERIALS AND METHODS: A total of 60 patients participated in the experiment, with half assigned to the control group (n = 30) and half to the experimental (n = 30) group using the block randomization method. On patients in the experimental group, a 30-min Swedish massage was performed regularly for eight weeks: twice a week for the first four weeks, and three times a week for the last four weeks. The control group received routine care. The visual analogue scale-pain was used to measure pain in the two groups at three points of time: before the beginning of the experiment, immediately after the last session, and one month after the last session of the intervention. RESULTS: The analysis of covariance showed that there were significant differences between the two groups' mean scores of pain and painkiller consumption immediately after and one month after the last session of the intervention (p = 0.01). Furthermore, in the experimental group, the mean scores of pain and painkiller consumption decreased over the three points of time (p < 0.05). CONCLUSION: Swedish massage can be effective in reducing pain and the need to use painkillers in rheumatoid arthritis patients.

Motivation for Healing in Cancer Patients: A Qualitative Study.

BACKGROUND: Studies have revealed that motivation plays a vital role in a person's ability to heal. The nature of motivation for healing in cancer patients is unknown. The aim of this study was to explore the meaning of motivation for healing in cancer patients. MATERIALS AND METHODS: A qualitative research approach was used as the study design. Data were collected using individual semi-structured interviews and the themes were derived from the data using the inductive content analysis method. The patients consisted of 34 cancer patients, 4 family members, 1 psychologist, 1 oncologist, and 3 nurses. The participants were interviewed in the cancer clinics or chemotherapy wards. RESULTS: Based on the results of the interviews, three main themes and seven categories were determined. The themes were identified as (i) the desire to survive, (ii) a spirit of optimism, and (iii) belongingness and responsibility. CONCLUSIONS: The results of this study could be used by researchers to develop tools to measure motivation in cancer patients, and to design intervention mechanisms to enhance the patients' motivation in cancer care. Moreover, a better understanding of motivation can improve psychosocial support in oncology nursing.

Prevalence of Depression, Anxiety and Stress Among Patients Discharged from Critical Care Units.

INTRODUCTION: The widespread use of advanced technology and invasive intervention creates many psychological problems for hospitalized patients; it is especially common in critical care units. METHODS: This cross-sectional study was conducted on 310 patients hospitalized in critical care units, using a non-probability sampling method. Data were collected using depression, anxiety, and stress scale (DASS-21) one month after discharge from the hospital. Data analysis was performed using descriptive and inferential statistics. RESULTS: 181 males and 129 females with a mean age (SD) of 55.11(1.62) years were enrolled in the study. The prevalence of depression, anxiety and stress were 46.5, 53.6 and 57.8% respectively, and the depression, anxiety and stress mean (SD) scores were 16.15(1.40), 18.57(1.46), 19.69(1.48), respectively. A statistically significant association was reported between depression, anxiety and stress with an increase in age, the number of children, occupation, education, length of hospital stay, use of mechanical ventilation, type of the critical care unit, and drug abuse. CONCLUSION: The prevalence of depression, anxiety and stress in patients discharged from critical care units was high. Therefore, crucial decisions should be made to reduce depression, anxiety and stress in patients discharged from critical care units by educational strategies, identifying vulnerable patients and their preparation before invasive diagnostic-treatment procedures.

The Effect of Spiritual Counseling on Hope in Patients with Multiple Sclerosis: A Randomized Clinical Trial.

BACKGROUND: Spiritual practices have recently emerged as beneficial to both mental and physical health. The present study was conducted to determine the effect of spiritual counseling on hope among patients with Multiple Sclerosis (MS). METHODS: This single blind randomized controlled clinical trial was conducted on the patients with MS in April-June 2020, Kashan, Iran. 50 patients were randomly assigned to two 25-member groups. The patients in the intervention group participated in eight 60-minute spiritual counseling program. They were asked to fill out the demographic information questionnaire before the intervention and Herth Hope Index (HHI) before, immediately (in the 4th week of the study) and a month after the intervention (in the 8th week of the study). Data were analyzed using Chi-square, independent samples t-test and repeated measures ANOVA in SPSS version 16. The significance level was considered P<0.05. RESULTS: The results showed that the differences between the two groups before the intervention were not statistically significant in terms of demographic variables (P>0.05) and the mean score of hope (P=0.61). However, the total mean score of HHI in the intervention group was significantly different from the control group immediately and a month after the intervention (44.95±1.42 VS. 31.66±2.45 and 43.25±1.84 VS. 30.58±2.24), respectively (P<0.001). According to the results of the repeated measures ANOVA, the level of hope and its dimensions significantly changed in the intervention group over time (P<0.001). CONCLUSION: The results of the present study showed that spiritual counseling promoted the hope score in patients with MS. It is recommended that spiritual counseling should be use as a complementary therapy along with other counseling treatments to increase hope in patients with MS. TRIAL REGISTRATION NUMBER: IRCT20190819044567N.

Predictors of self-medication with herbal remedies during pregnancy based on the theory of planned behavior in Kashan, Iran.

BACKGROUND: The incidence of application of medicinal herbs during pregnancy has increased significantly among women over the past years; however, the safety and efficacy of medicinal herbs during pregnancy are still unclear. The aim of the present study was to categorize the predictors of self-medication with herbal remedies during pregnancy based on the theory of planned behavior (TPB). METHODS: The present descriptive-analytical study was conducted on 300 pregnant women referred to Kashan health center to receive prenatal care services in 2020. The study participants were randomly selected using stratified random sampling with proportional allocation. The data collection tool was a two-part researcher made questionnaire. The first part of the questionnaire included demographic information, midwifery information, and questions related to women's awareness about herbal medicine. The second part of the questionnaire was designed based on the theory of planned behavior including attitudes, perceived behavioral control, subjective norms, intention, and behavior performance. Data were analyzed using descriptive statistics, regression analysis, and SPSS version 18.0. RESULTS: The mean age of participants was 28. 7±5.4 years (range, 15-45 years), the majority were housewives (88.3%) and had secondary education (39.3%). A total of 164 women (57. 1%) used medicinal herbs during pregnancy. The individual's attitude towards herbal medicines consumption, subjective norm, and perceived behavioral control was correlated with behavioral intention (P < 0.05). Similarly, subjective norms were the most predictor of using herbal medicine among pregnant women (P < 0.05). CONCLUSION: The findings revealed that more than 50 % of pregnant women used medicinal herbs during pregnancy. The present study showed that the individual's attitude towards herbal medicines consumption, subjective norm, and perceived behavioral control was correlated with intention of herbal medicine use among pregnant women. Likewise, subjective norms were the most predictor of herbal medicine use among pregnant women. The TPB should be addressed in planning health education programs and modifying health behaviors, including self-medication, especially during pregnancy.

Scoping Review on the Concept of Patient Motivation and Practical Tools to Assess it.

BACKGROUND: In this scoping review, the concept of patients' motivation and the tools that have been designed to measure this concept in clinical settings are presented. MATERIALS AND METHODS: Arksey and O'Malley's framework was used in conducting the current scoping review. Google Scholar, PubMed, Scopus, and Web of Science databases were searched for relevant English articles published between January 1995 and January 2020 using the keywords motivation and tool, and their synonyms. Out of 2820 articles, 34 articles were chosen and were entered into the final analysis. Definitions of patients' motivation were determined using Kyngäs et al., content analysis method. RESULTS: The findings showed that new tools had been developed in 38% of the studies and other studies had revised or translated existing questionnaires. Moreover, 62% of the tools were used to measure patient motivation in mental disorders. Most of the studies did not clearly define the concept of patient motivation in the clinical environment. The findings of content analysis outlined the 3 categories of motivation determinant factors, decisions, and behaviors that determine overall levels of motivations and its consequences. CONCLUSIONS: Motivation is a dynamic concept and is a result of internal and external motives that lead to decisions and behaviors. There are limited tools for measuring motivation in clinical settings. This addresses the need to design specific tools in various diseases, especially chronic diseases. By the concept defined in this study, it is possible to design a short tool with general application that can be used in all diseases.

The effects of foot reflexology on depression during menopause: A randomized controlled clinical trial.

OBJECTIVE: The purpose of this study was to determine the effects of foot reflexology on depression during menopause. DESIGN: Randomized controlled clinical trial. SETTING: Gynecology outpatient clinic. INTERVENTIONS: We enrolled 90 menopausal women with depression. Participants were assigned to the intervention (n = 45) and control (n = 45) groups by block randomization. Participants in the intervention group received 15 min of foot reflexology on each foot for a total of 30 min in evenings, twice a week for six weeks. Participants in the control group received only the routine care for menopause patients. MAIN OUTCOME MEASURES: The Beck Depression questionnaire was completed by all participants at the beginning of the trial and the end of the intervention and two months after completion of the intervention. RESULTS: A total of 121 patients were assessed for eligibility to participate in the study. One-hundred patients met the criteria to participate, and 90 participants-45 participants in each group-completed the study. In the intervention group, the mean scores of depression before, immediately after, and two months after the study were 26.97 ± 4.47 (95% CI = 25.3-28.3), 22.55 ± 5.18 (95% CI = 20.9-24.1), and 21.20 ± 5.74 (95% CI = 19.4-22.9), respectively. In the control group, these scores were 26.15 ± 5.01 (95% CI = 24.6-27.6), 26.22 ± 5.14 (95% CI = 24.7-27.7), and 26.66 ± 3.87 (95%CI = 25.5-27.8), respectively. Using Repeated Measures ANOVA, the comparison of the mean scores of depression in the two groups indicated that the scores were decreased over time. CONCLUSION: The findings indicated that the foot reflexology technique can be effective for reducing women's depression during menopause. However, considering the study's limitations, including a small sample size and no intervention in the control group, more studies are needed to verify the findings.

Perineal trauma: incidence and its risk factors.

Perineal trauma can lead to short- and long-term complications for the mother. The purpose of this study was to determine the incidence of perineal trauma and its related factors. In this cross-sectional study, the maternal, neonatal, obstetric and childbirth information for all women who delivered in Kashan city hospitals was studied. Data were analysed using the Chi-square test, the t-test and logistic regression. The incidence of perineal trauma was 84.3%. Ninety-five percent of the primiparous women and 43.9% of the multiparous women had an episiotomy ([p value<.001], AOR = 24.4). The chance of birth trauma in the cases of younger maternal age, increasing gestational age, induction of labour, fundal pressure, Iranian nationality and nulliparity are increased. The incidence of perineal trauma in this study was high and should be minimised with a limited use of an episiotomy. It is recommended that midwives and obstetricians pay more attention to the women at risk. Impact Statement What is already known on this subject? Perineal trauma is common in vaginal delivery. Scientific literature shows several predictors of perineal trauma such as maternal age, parity, induction of labour, gestational age and birth weight, etc.; although in other studies some of these variables were not associated with perineal trauma. Considering that the findings about the factors associated with birth injuries are controversial, we decided to assess the incidence of perineal trauma and its risk factors during childbirth. What the results of this study add? This study indicated a high incidence of perineal trauma and agrees with the existing literature that maternal age, parity, the induction of labour, gestational age, fundal pressure and nationality are associated with perineal trauma; however, other factors were not found as predictors in our study. What the implications are of these findings for clinical practice and/or further research? Our results agreed with the existing literature regarding some predictors of perineal trauma but not for birth weight, foetal distress, second stage duration, hospital type, etc. This data could be used to implement protocols for reducing the rate of a routine episiotomy, considering too the high risk women for the prevention of perineal trauma.

Development and psychometric evaluation of the sexual knowledge and attitudes scale for premarital couples (SKAS-PC): An exploratory mixed method study.

BACKGROUND: Designing a valid and reliable questionnaire that allows a fair evaluation of sexual knowledge and attitudes and develop a proper sexual educational program is necessary. OBJECTIVE: The present study was designed to develop and psychometric evaluation of the sexual knowledge and attitudes scale for premarital couples. MATERIALS AND METHODS: An exploratory mixed method study was conducted in two phases; in the first, in order to develop a questionnaire an item pool was generated on sexual knowledge and attitudes through focus group discussions and individual interviews. In the second phase, the psychometric properties of the questionnaire were examined. For this purpose, face validity, content validity as well as construct validity were conducted. Reliability was assessed by the Cronbach's alpha coefficient to assess internal consistency and test-retest reliability. RESULTS: In the first phase an item pool with 88 questions was generated (sexual knowledge 45 items and sexual attitudes 43 items). In the second phase, the number of final items reduced to 33 and 34 items of sexual knowledge and sexual attitudes respectively, through exploratory factor analysis (EFA). Five factors for sexual knowledge and six factors for sexual attitudes identified by EFA. The Cronbach's alpha coefficient for two sections was 0.84 and 0.81 respectively. The test- retest correlations for sexual knowledge and sexual attitude was 0.74 and 0.82 respectively. CONCLUSION: The findings suggest that the Sexual Knowledge and Attitudes Scale for Premarital Couples is a valid and reliable instrument. Further studies are needed to establish stronger psychometric properties for the questionnaire.

Pain management of trauma patients in the emergency department: a study in a public hospital in Iran.

BACKGROUND: Pain is a common problem which the patients in emergency departments (ED) face, especially trauma patients under treatment may suffer from physical, psychological and ethical issues. The purpose of this study was to evaluate traumatic pain management in the emergency department at a public hospital in Iran in 2014. METHODS: This observational prospective study was conducted on 450 trauma patients admitted to a trauma emergency department. The tool used in this study has three parts: demographic data, data of trauma, and VRS (Verbal Rating Scales) score at a 7-point scale-at the arrival time to 4h later. The statistical analysis was conducted by using Mann-Whitney and Kruskal-Wallis tests, repeated measures, survival analysis, and multiple regression analysis. RESULTS: The majority of the samples were male (83.3%) with the mean age of 35.2years. The patients mostly suffered from contusions and strains (42.4%). The majority of the patients [274 patients (60.8%)] received no intervention for pain relief and only 60 patients (13.3%) received analgesics. The mean time period of the first analgesic utilization was 41 (±20.4) minutes. Pain in admission, pain assessment, and receiving intervention could explain the 32% of pain reduction. No other variables such as age, sex, education, kind of trauma, and the shift of admission were involved in pain reduction. CONCLUSIONS: This research study demonstrated that comprehensive, adequate pain management remains an obscure goal within the emergency nursing setting. There is a need to undertake further research and develop educational programs on effective analgesic practice in pain management.

The Effect of Mindfulness-integrated Cognitive Behavior Therapy on Depression and Anxiety among Pregnant Women: a Randomized Clinical Trial.

Introduction: Pregnancy can be associated with different psychological problems such as depression and anxiety. These problems are often neglected and left untreated. This study aimed to examine the effect of mindfulness-integrated cognitive behavior therapy on depression and anxiety among pregnant women. Methods: A convenient sample of 80 pregnant women were selected. Participants were randomly allocated to either the experimental or the control groups. Participants in the experimental group received mindfulness-integrated cognitive behavior therapy while women in the control group only received routine prenatal care services. A demographic questionnaire, the Edinburgh Postnatal Depression Scale, and the Beck Anxiety Inventory were used for data collection. Descriptive statistics measures such as frequency, mean, and standard deviation as well as the repeated-measures analysis of variance test were used for data analysis. Results: After the study intervention, the mean scores of anxiety and depression in the experimental group were significantly lower than the control group. Conclusion: Mindfulness-integrated cognitive behavior therapy can significantly alleviate pregnant women's depression and anxiety. So implementation of this method alongside with other prenatal care services is recommended.

The Etiology and Clinical Evaluations of Neonatal Seizures in Kashan, IRAN.

OBJECTIVE: Detection of seizure, its etiology, and clinical types is important for guiding therapy. This study was designed to evaluate the etiology and clinical evaluations of neonatal seizures in Kashan, Iran. MATERIALS AND METHODS: The data of 100 hospitalized neonates with a complaint of seizures in Kashan City, from January 2006 to January 2011 were evaluated. The pediatric neurologist made the final diagnosis. The gestational age, neonate admission age, type of delivery, and laboratory and radiological investigations were reviewed from the medical records. The relation of seizure etiology and other variables were compared using the Chi-square test. All the statistical analyses were performed using SPSS (ver 11.5). RESULTS: A total of 100 neonates were hospitalized with a diagnosis of seizures. The overall incidence rate of seizures was 2.6 per 1,000 live births. A total of 59% of seizures happened in the first three days of life. The etiologies of seizures were hypoxicischemic encephalopathy (HIE) (36%), hyponatremia (12%), hypoglycemia (11%), intracranial hemorrhage (11%), infections (10%), hypocalcemia (8%), metabolic disorders (7%), the structural anomalies (5%), and hypomagnesaemia (4%). In 23% of neonates, no specific etiology was found and 23% had multiple etiologies. In 45% of neonates, the EEG was not recorded. The type of the seizures were focal-clonic (26%), tonic (25%), multifocal clonic (34%), subtle (11%), and myoclonic (4%). The types of the seizure were unrelated to the paraclinical findings. CONCLUSION: Neonatal seizures are common and HIE was the main cause of seizures in this study. The clinical evaluation of neonatal seizures needs improvement.

Early pregnancy waist-to-hip ratio and risk of preeclampsia: a prospective cohort study.

Preeclampsia is a major cause of maternal death and morbidity. Body mass index (BMI) predicts an increased risk of developing hypertensive disorders and preeclampsia. However, waist-to-hip ratio (WHR), as a central obesity index, has not been assessed in predicting this disorder in pregnancy. We assumed that WHR might be more sensitive in predicting the risk of preeclampsia, compared with BMI. The aim of this cohort study was to investigate the relationships of BMI and WHR with preeclampsia. This was a prospective cohort study of 1200 pregnant women with singleton pregnancies. Anthropometric indices included WHR and BMI, which were measured at the first antenatal visit (⩽ 12 weeks of gestational age). The incidence of preeclampsia was assessed after 20 weeks of gestation. Maternal demographic data and obstetric outcomes were also recorded for each subject. All of the statistical tests were performed using SPSS software, version 16. The overall incidence of preeclampsia in the study population was 4.2%. The maternal WHR and BMI at the beginning of pregnancy were significantly associated with the occurrence of preeclampsia (P = 0.006 and P = 0.001, respectively). WHR ⩾ 0.85 and BMI ⩾ 25 kg m(-2) in the first 12 weeks of pregnancy had relative risks of 2.317 (confidence interval (CI): 1.26-4.27) and 3.317 (CI: 1.6-6.86) for preeclampsia. BMI and WHR were anthropometric indicators that presented correlations with preeclampsia. Of these anthropometric indices, BMI had greater predictive value in preeclampsia.

Prevalence of Posttraumatic Stress Disorder and Related Factors Among Patients Discharged From Critical Care Units in Kashan, Iran.

BACKGROUND: Posttraumatic Stress Disorder (PTSD) is a severe anxiety disorder occurred due to past adverse experiences. Several researches have demonstrated that PTSD is quite common among patients discharged from critical care unit. OBJECTIVES: This study aimed to investigate the prevalence of PTSD and its related factors among patients discharged from critical care units in Kashan, Iran, during 2014. PATIENTS AND METHODS: A descriptive prospective study was performed on 332 patients admitted to critical care units of Kashan Shahid Beheshti Hospital using a convenience sampling method. Data were collected in wards during hospitalization and one month after their discharge from hospital using questionnaires on demographic, medical information and PTSD Checklist (PCL). The PCL scores of 45 or more were considered as PTSD. Data were analyzed using chi-square, t-test, Mann-Whitney U and logistic regression. RESULTS: From a total of 332 patients, 160 cases (48.2%) had PTSD and the mean total PCL score in participants was 44.24 ± 19.89. There was a significant difference between the total score of PTSD and its domains in patients with and without PTSD. the univariate analysis showed a significant association between PTSD and increasing age, increased length of hospital stay, more children, having additional comorbidities, unemployed, use of mechanical ventilation (P < 0.001), drug abuse (P = 0.003) and single patients (P = 0.028). However, there was no significant association between PTSD and gender, type of the critical care unit, level of education and admission due to trauma. However, in multivariate analysis using logistic regression, factors associated with PTSD were older age of the participants, use of mechanical ventilation having additional comorbidities, unemployed (P<0.001) and being single (P=0.04). CONCLUSIONS: Prevalence of PTSD is high among patients discharged from ICUs and some medical individual factors such as elderly, unemployed, being single, using mechanical ventilation and pre-existing diseases are risk factors. Therefore, it is recommended to perform appropriative educational plan for these patients to reduce the risk of PTSD.

Effect of ginger on relieving nausea and vomiting in pregnancy: a randomized, placebo-controlled trial.

BACKGROUND: Nausea and vomiting are common and unpleasant complications in pregnancy. Although many alternative therapists support the use of ginger for nausea and vomiting of pregnancy, there is currently insufficient clinical evidence to support its use in this condition. OBJECTIVES: The present study was performed to assess the effectiveness of ginger in the treatment of nausea and vomiting in pregnancy. PATIENTS AND METHODS: This seven-day clinical trial was performed on 120 eligible pregnant women with symptoms of mild to moderate nausea and vomiting before 16 weeks gestation. They were divided into; ginger, placebo and control groups, by block randomization. Women were asked to record their nausea and vomiting for three days, and then participants received either ginger capsules, or a placebo for four days. No intervention was done with the control group. Data measure was self-recorded symptoms according to the Rhodes Index. Data were analyzed by ANOVA, ANCOVA, Kruskal-Wallis, Chi-square, and Fisher's exact test, for the quantitative and qualitative variables. RESULTS: There were no statistical differences in the baseline demographics between the three groups apart from age of marriage and wanted or unwanted pregnancy. An ANCOVA test (covariance test) showed significant differences in mean scores after the intervention in the three groups (P < 0.001). CONCLUSIONS: Ginger was effective for the relief of mild to moderate nausea and vomiting in pregnant women at less than 16 weeks gestation.