The Effectiveness of Information-Motivation-Behavioral Skills Model on Self-Care Practices in Early Pregnancy to Prevent Gestational Diabetes Mellitus in Iranian Overweight and Obese Women: A Randomized Controlled Trial.

BACKGROUND: Gestational diabetes mellitus (GDM) is one of the most common metabolic dysfunction in pregnancy and as overweight and obesity are of the major risk factors. The aim of this study was to determine the effect of Information-Motivation and Behavioral skills (IMB) model-based counseling on preventing GDM in overweight and obese pregnant women. METHODS: This randomized controlled trial study was conducted on 137 pregnant women in two groups; education and counseling IMB model-based for four sessions (n = 70), and antenatal usual care (AUC) (n = 67). This study was conducted on overweight and obese pregnant women, at the 12 to 16 weeks' gestation and recruited from the Prenatal Clinic of Rohani Hospital in north of Iran. Blood glucose was measured before and 8 weeks after the intervention. Descriptive and inferential statistics including mean, frequency, t-test, chi-square and ANCOVA were used. RESULTS: The prevalence of GDM was lower in the intervention group than the control group (10% and 29.9%, respectively, RR = 0.33, CI 95% (0.15- 0.74) p = .004) as well as mean fasting blood glucose (Cohen's d = 0.28, p = .07), and glucose tolerance test at the first and second hour (d = 0.41 and Cohen's d = 0.73, respectively, p < .01). CONCLUSIONS: A lifestyle intervention in early pregnancy by IMB counseling in overweight and obese pregnant women can be effective in decrease GDM.

Design, implementation and evaluation of a virtual clinical training protocol for midwifery internship in a gynecology course during COVID-19 pandemic: A semi-experimental study.

BACKGROUND: Over the past year, the occurrence of COVID-19 pandemic has challenged clinical education for health care students, due to the possibility of exposure to the virus and increased spread of the disease. Clinical training of midwifery students in gynecologic problems, based on the Iran midwifery education curriculum, was also disrupted during this pandemic. OBJECTIVES: This study was aimed at designing, implementing and evaluating a virtual clinical training protocol for midwifery internship in a Gynecology course. DESIGN: A semi-experimental study. SETTINGS: Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran. PARTICIPANTS: Forty-seven midwifery interns in Gynecology course were recruited during two semesters in 2020. METHODS: Five steps based on the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model were taken, which included 1) educational and skills needs assessment, 2) design, 3) development via focused group interviews and brainstorming with the presence of the midwifery department members in three sessions, 4) implementation including pretest and posttest, webinar, uploading the information of virtual patients, questions and correct answers, and 5) evaluation including knowledge assessment by a designed questionnaire and skills evaluation by the modified-Mini-CEX checklist. Data were analyzed using mean, standard deviation and paired t-test. RESULTS: After training, a significant increase (p < 0.001) was observed in scores of knowledge and interview skills, clinical judgment, consultation, efficiency, professionalism, clinical competence and total score of clinical skills. CONCLUSIONS: Training for gynecological diseases through virtual clinic promoted knowledge and clinical skills of midwifery interns. To enhance education, a virtual clinic may be used in crisis situations and in combination with teaching under normal circumstances by strengthening the infrastructure and removing barriers.

The effect of exercise on the prevention of gestational diabetes in obese and overweight pregnant women: a systematic review and meta-analysis.

BACKGROUND: Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy and its prevalence worldwide is increasing along with enhancing type two of diabetes. Contrary results have been found in some review articles that examine the effect of exercise activities on preventing GDM, regardless of obesity. Therefore, the aim of this study was to systematically review the articles on the effect of exercise activities on the prevention of GDM in obese and overweight pregnant women. MAIN TEXT: Literature was retrieved by formally searching PubMed, Embase, Cochrane library, Web of Science, Scopus, Proquest and by hand searching of reference lists of related articles. Finally, a total of eight literatures included, and Review manager 5.3 and STATA 14.0 statistical software were utilized for processing. In order to investigate the effect of sports activities on the incidence of GDM, the risk ratio (RR), and for quantitative indices, the standardized mean difference (SMD) with 95% confidence interval (CI) for each study was calculated. Out of 5107 papers identified, eight papers with 1441 participants included in meta-analysis (intervention group 727, control group 714). In the intervention group, 143 (19.66%, 95% CI 76.83 to 22.74) and in the control group, 196 (27.45%, 95% CI 20.24 to 30.88%), pregnant women had diabetes. The RR of gestational diabetes was 0.76 (95% CI 0.56 to 1.03, I2 = 50%, P = 0.05). In studies that the time for the intervention was three times a week or less, effect of intervention was significant in reducing the incidence of diabetes (RR: 0.59, 95% CI 0.46 to 0.76, I2 = 0%, P = 0.47). However, in studies with repeat of intervention was more than three times a week, the effect of intervention between two intervention and control groups was not different (RR: 1.03, 95% CI 0.78 to 1.35, I2 = 0%, P = 0.46). CONCLUSIONS: The exercise activities, alone, in obese or overweight pregnant women did not have a significant effect on the overall incidence of GDM, but considering the effect measure, the incidence of GDM was 24% lower in the intervention group than control group. This difference is considerable in the two groups. As the systematic review literatures both represent the information gap on the research subject and pave the way for further studies so it seems that there is a need for more randomized controlled trials so that we can make a complete conclusion on the type, intensity and duration of exercise in preventing GDM.

Use of ginger versus stretching exercises for the treatment of primary dysmenorrhea: a randomized controlled trial.

BACKGROUND: Dysmenorrhea is a common gynecologic problem. In some cases, non-medical treatments are considered to be more effective, with fewer side effects. Ginger and exercise are alternative treatments for dysmenorrhea, but in the present study they were not combined. OBJECTIVE: In this study, the effects of ginger and exercise on primary dysmenorrhea were compared. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: This randomized controlled trial was performed in Mazandaran University of Medical Sciences, Iran. Two groups of female students were recruited by simple random allocation. In each group, 61 students with moderate to severe primary dysmenorrhea with regular menstrual cycles and without a history of regular exercise were assessed. The ginger group received 250 mg ginger capsules from the onset of menstruation. In the exercise group, belly and pelvic stretching exercises were performed for 10 min, 3 times per week. MAIN OUTCOME MEASURES: Intensity of pain was assessed according to a visual analogue scale after the first and the second month. RESULTS: Exercise was significantly more effective than ginger for pain relief (31.57 ± 16.03 vs 38.19 ± 20.47, P = 0.02), severity of dysmenorrhea (63.9% vs 44.3% mild dysmenorrhea, P = 0.02) and decrease in menstrual duration (6.08 ± 1.22 vs 6.67 ± 1.24, P = 0.006), in the second cycle. CONCLUSION: Stretching exercises, as a safe and low-cost treatment, are more effective than ginger for pain relief in primary dysmenorrhea. TRIAL REGISTRATION: The trial was registered in www.IRCT.ir with No. 201203118822N2.

Comparison of the Effect of Stretching Exercises and Mefenamic Acid on the Reduction of Pain and Menstruation Characteristics in Primary Dysmenorrhea: A Randomized Clinical Trial.

OBJECTIVES: Dysmenorrhea is a common gynecologic disorder. Although non-steroidal anti-inflammatory drugs are commonly used, due to their side effects and lack of response in some individuals, other approaches such as exercise have been considered. This study compared the effect of stretching exercises and mefenamic acid on the reduction of pain and menstruation characteristics in primary dysmenorrhea. METHODS: In this randomized clinical trial, 122 female students with moderate to severe dysmenorrhea were assessed and were placed in either the exercise or mefenamic acid group. The exercise program was performed for 15 minutes, three times a week and included a five-minute warm up and six belly and pelvic stretching exercises for 10 minutes. The mefenamic acid group received 250 mg capsules every eight hours from the onset of menstruation until pain relief. Both interventions were performed during two consecutive menstrual cycles. Pain intensity was measured using a 10 cm visual analog scale. RESULTS: The mean pain intensity was significantly higher in the exercise group only in the first cycle (p = 0.058). In the second cycle, the mean difference in pain reduction in the exercise group was higher than the mefenamic group compared to the start of the study (p = 0.056) and the first cycle (p = 0.007). There was no significant difference in the severity and duration of pain between the groups (p > 0.050). CONCLUSIONS: Stretching exercises were as effective as mefenamic acid in the treatment of primary dysmenorrhea. Our results suggest that the effect of exercise on relieving menstruation pain increases over time.

The effect of mefenamic acid and ginger on pain relief in primary dysmenorrhea: a randomized clinical trial.

PURPOSE: The aim of the study was to compare the effect of mefenamic acid and ginger on pain management in primary dysmenorrhea. METHODS: One hundred and twenty-two female students with moderate to severe primary dysmenorrhea were randomly allocated to the ginger and mefenamic groups in a randomized clinical trial. The mefenamic group received 250 mg capsules every 8 h, and the ginger group received 250 mg capsules (zintoma) every 6 h from the onset of menstruation until pain relief lasted 2 cycles. The intensity of pain was assessed by the visual analog scale. Data were analyzed by descriptive statistics, t test, Chi-square, Fisher exact test and repeated measurement. RESULTS: The pain intensity in the mefenamic and ginger group was 39.01 ± 17.77 and 43.49 ± 19.99, respectively, in the first month, and 33.75 ± 17.71 and 38.19 ± 20.47, respectively, in the second month (p > 0.05). The severity of dysmenorrhea, pain duration, cycle duration and bleeding volume was not significantly different between groups during the study. The menstrual days were more in the ginger group in the first (p = 0.01) and second cycle (p = 0.04). Repeated measurement showed a significant difference in pain intensity within the groups by time, but not between groups. CONCLUSION: Ginger is as effective as mefenamic acid on pain relief in primary dysmenorrhea. Ginger does not have adverse effects and is an alternative treatment for primary dysmenorrhea.

The effect of honey gel on abdominal wound healing in cesarean section: a triple blind randomized clinical trial.

OBJECTIVE: To assess whether honey can accelerate the wound healing in women undergoing cesarean section. METHODS: This was a triple blinded randomized prospective clinical trial. Women with cesarean section were randomly designated as drug (37 cases) and placebo (38 cases) groups. The drug group received local honey gel 25% while the placebo group received similar free-honey gel on abdominal cesarean incision twice a day for 14 days. REEDA scale (Redness, Edema, Ecchymosis, Discharge and Approximation of wound edges) was used to assess wound healing. RESULTS: The mean REEDA was 2.27 ± 2.46 and 3.91 ± 2.74 (p=0.008) on the 7(th) day and 0.47 ± 0.84 and 1.59± 1.95 (p=0.002) on the 14(th) day for the drug and placebo groups, respectively. Redness, edema and hematoma in the drug group were significantly lower on the 7(th) and 14(th) days. CONCLUSION: Honey was effective in healing the cesarean section incision. Using topical honey is suggested as a natural product with rare side effects in order to reduce the complications of cesarean wounds.

Association between quality of life and religious coping in older people.

AIM: To examine the association between quality of life (QoL) and religious coping in older people living in their own homes. METHOD: A descriptive analytical study was undertaken in Iran with 200 older people aged over 60 living in their own homes who were selected for inclusion by systematic random sampling. Data were collected by use of the Short Form 36 (SF-36) QoL questionnaire and a religious coping questionnaire developed previously by the authors. RESULTS: There was no significant association between QoL and religious coping. However, mental health (r=0.20, P=0.003) and social function (r=0.20, P=0.004) had a significant association with the total score for religious coping. An association between a high level of religious coping and QoL was significant only for the mental health domain of the SF-36 (P=0.04). CONCLUSION: In light of these results, it can be suggested that older people's mental health and social function may be improved by strengthening their religious beliefs. Mental health and social function are associated with other QoL domains and so their promotion may also improve overall QoL.

The influence of cold pack on labour pain relief and birth outcomes: a randomised controlled trial.

AIMS AND OBJECTIVES: (1) To evaluate the influence of local cold on severity of labour pain and (2) to identify the effect of local cold on maternal and neonatal outcomes. BACKGROUND: Fear of labour pain results in an increase in pain and duration of labour, maternal discontent and demand for caesarean section. Regarding maternal and foetal complications of analgesic medications, the attention to application of nonpharmacological methods including cold therapy is increased. DESIGN: Randomised controlled trial. METHODS: Sixty-four pregnant women, at initiation of active phase of labour, were allocated randomly to cold therapy and control groups (n = 64). Null parity, term pregnancy, presence of single foetus, cephalic presentation and completing informed consent were considered as inclusion criteria. Administration of analgesic and anaesthesia, foetal distress, skin lesions in regions of cold therapy and high-risk pregnancy provided exclusion criteria. Cold pack was applied over abdomen and back, for 10 minutes every 30 minutes during first phase of labour. Additionally, cold pack was placed over perineum, for 5 minutes every 15 minutes during second phase. Pain severity was assessed based on the visual analogue scale. RESULTS: The two groups were not significantly different considering demographic data, gestational age, foetal weight, rupture of membranes and primary severity of pain. Degree of pain was lower in cold therapy group during all parts of active phase and second stage. Duration of all phases was shorter in cold therapy group in all phases. Foetal heart rate, perineal laceration, type of birth, application of oxytocin and APGAR score were not significantly different between two groups. CONCLUSION: Labour pain is probably reduced based on gate theory using cold. Pain control by cold maybe improves labour progression without affecting mother and foetus adversely. RELEVANCE TO CLINICAL PRACTICE: Local cold therapy could be included in labour pain management.