Factors in the Provision of High Quality Midwifery Care: A Qualitative Content Analysis.

Introduction: In recent years, health care has faced many changes. Thereupon, it would be beneficial to investigate the quality of midwifery care and its related factors. Many factors contribute to the provision of quality care, and recognizing factors to ensure the quality of midwifery care. This qualitative study was conducted to explain the factors that affect the provision and quality of midwifery care. Methods: This qualitative study with content analysis approach was conducted between June 2017 and February 2018 on 15 midwives working in private and public maternity hospitals in the city of Qom. The participants were selected by purposeful sampling. Semi-structured and in-depth interviews were performed with open ended questions to find out how midwives describe high quality midwifery care. Data were analyzed by conventional content analysis method through MAXQDA-11 software. Results: The findings of this study revealed two main themes, including individual factors (personal efficiency, staffs' psychological status, value-centeredness, cultural-educational issues, and professional attachment), and professional-organizational factors (professional characteristics, patient characteristics, personal-professional welfare, professional empowerment system, value-centered culture of organization, and organizational monitoring and evaluation). Conclusion: The results of this study showed that individual and professional factors are associated with the quality of midwifery care. Midwives who participated in this study believed that providing high quality midwifery care requires a broad range of prerequisites. Since high quality midwifery care decreases maternal and infant mortality and morbidity, it is imperative for policymakers to pay attention to all the factors that contribute to the quality of midwifery care.

Effect of WebQuest-based education on critical thinking and academic self-efficacy of midwifery students: Study protocol of a randomized, controlled crossover trial.

BACKGROUND AND AIM: Critical thinking fills the gap between theoretical and clinical teaching and increases the power of clinical decision-making. WebQuest is an innovative, learner-centered, and effort-driven learning approach that uses computer technology to engage and motivate learners. In WebQuest, learners are compelled to use the latest information available on the web as a tool to promote higher levels of thinking. However, we did not find a study that used WebQuest to improve students' critical thinking and academic self-efficacy. The aim of this study will be to investigate the effect of WebQuest-based education on the critical thinking of midwifery students. MATERIALS AND METHODS: This superiority randomized, controlled crossover trial will be carried out among fifth-semester undergraduate midwifery students. Participants will be allocated to one of two event groups (A and B) using block randomization. In the first sequence (FS) (four weeks) of study, both groups will simultaneously attend two different education groups (WebQuest and traditional). During the FS, WebQuest will be used to teach group A participants, while group B participants will be treated as the control group (CG) and be taught using a traditional presentation. In the second sequence (SS), the interventions will be crossed over. Participants in both groups will complete the sociodemographic questionnaire, the California Critical Thinking Skills Test (CCTST), the California Critical Thinking Disposition Inventory (CCTDI), and the Academic Self-Efficacy Beliefs Questionnaire (ASEBQ) once before the first sequence of the study, during the washout period, and at the end of the second sequence of the study. The teaching satisfaction questionnaire will be completed at the end of the study. DISCUSSION: The results of this study can be used as a basis for teaching midwifery students using WebQuest as a new teaching method.

Domains of competence in midwifery students: a basis for developing a competence assessment tool for iranian undergraduate midwifery students.

BACKGROUND: Current study was conducted with the aim of explaining domains of clinical competence in undergraduate midwifery students so that it addresses the challenges in midwifery curriculum and improving clinical assessment methods in Iranian undergraduate midwifery students. METHODS: Qualitative approach and conventional content analysis were used in the design of the present study. The research setting included midwifery and nursing schools and hospitals and health centers affiliated to Tehran and Guilan universities of medical sciences in Iran. The target population consisted of undergraduate midwifery students in the fourth to eighth semesters of school, midwives working in hospitals and health centers, midwifery faculty members, and obstetricians. The participants were selected through purposive maximum variation sampling, which continued until data saturation. After in-depth semi-structured interviews, the content of the interviews was analyzed according to the steps proposed by Zhang & Wildemuth. RESULTS: Twenty-four people participated in this study, including seven midwifery students, seven midwives, nine midwifery and reproductive and sexual health faculty members, and one obstetrician. The participants were aged 20-56 years and their mean age was 39.75 years. Their level of education varied from midwifery student to PhD. The mean work experience of the participants was 13.62 years and the mean duration of the interviews was 48 min. The analysis of the data obtained from the experiences of the participants led to the formation of the four categories of ethical and professional function in midwifery, holistic midwifery care, effective interaction, and personal and professional development, along with ten subcategories. CONCLUSION: The findings of the present study showed that clinical competence in midwifery students involves different domains that correspond well overall to the general definitions of clinical competence in different sources. These findings can be used as a basis for the design and psychometric assessment of a clinical competence assessment tool for undergraduate midwifery students.

Knowledge and performance of the Iranian general population in the use of masks during the 2019 coronavirus.

BACKGROUND: The use of personal protective equipment (especially face masks) has increased in different communities amid the COVID-19 pandemic. Therefore, the present study aimed to assess knowledge and performance of Iranian general population in wearing face masks. MATERIALS AND METHODS: The present study is a cross-sectional study conducted using a valid and reliable questionnaire on 1843 eligible individuals. The questionnaires were shared by Link (www.porsall.com) in groups and social networks. Data were analyzed using SPSS (Version 24.0, SPSS Inc., Chicago, IL). RESULTS: The mean age of the participants was 42.84 years (standard deviation: 16.84). The majority had inadequate and low knowledge of masks (69.2%), nearly 30% had moderate (30.1%), and few had adequate and high knowledge of masks. The individuals' knowledge on when to wear a mask was also assessed and the results showed poor and low in 42.2%, 46.9% moderate and high performance in 10.7%. The participants' performance on how to properly wear a mask was also assessed and 12% showed poor, 69.3% showed moderate, and 18.7% showed high performance. Safe removal of masks was also assessed, and the results showed 52% low and poor, 27.6% moderate, and 20.3% high performance. A significant and direct correlation was found between the overall score knowledge and performance regarding use of masks (P < 0.001). CONCLUSION: The results showed poor to moderate knowledge and performance of majority of Iranian general population regarding the masks. Therefore, further effective training courses and action plans are needed in Iran given the importance of masks for the prevention of COVID-19, especially in public places. Educational package about how to use the mask and its benefits, through the media and health centers is recommended.

Clinical placements as a challenging opportunity in midwifery education: A qualitative study.

AIM: The aim of this qualitative study was to explore some of the existing statuses of clinical education and examine the strengths and weaknesses of the clinical faculty programme. DESIGN: A qualitative study. METHODS: This qualitative study was designed through the directed content analysis approach, which was completed according to the Context, Input, Process, and Product evaluation model. The purposeful sampling method of maximum variation was employed to select 33 participants, and the data were collected through in-depth individual interviews and focus group discussion. RESULTS: After the interview transcripts were analysed, the participants' opinions of the clinical faculty programme and the relevant challenges, dimensions and factors were classified into four categories and sixteen subcategories. The categories were compiled in the CIPP evaluation model, including context, input, process and product. Based on the content analysis results, appropriate planning was recommended for teaching effective clinical skills to students.

Context, Input, Process, and Product Evaluation Model in medical education: A systematic review.

BACKGROUND: Evaluation is one of the most important tools for determining the quality of any educational program, which can lead to reformation, revision, or termination of programs. Quality in higher education requires assessment and judgment of goals and strategies, executive policies, operational processes, products, and outcomes. The Context, Input, Process, and Product (CIPP) model is a comprehensive perspective that attempts to provide information in order to make the best decisions related to CIPP. Due to the importance of this topic, the present study examined the application of the CIPP model in the evaluation of medical education programs through a systematic review. MATERIALS AND METHODS: In this systematic review, Persian databases including ISC, SID, Mag Iran, CivilicaL, and Noormags and English databases including PubMed, Web of Science, Scopus, ProQuest Dissertations, Embase, CINAHL, ERIC, and Google Scholar were searched using relevant keywords, such as evaluation, program evaluations, outcome and process assessment, educational assessment, and educational measurements. The search was done with no time limits and 41 papers were obtained until May 22, 2020. This systematic review was performed by following the data extraction steps and assessing the quality of the studies and findings. Critical Appraisal Skills Programs and Mixed-Methods Appraisal Tool checklists were used to check the quality of the papers. RESULTS: This systematic review was conducted on 41 studies, 40 of which were research papers and one was a review paper. From the perspective of the CIPP model of evaluation, most papers showed quite a good level of evaluation of educational programs although some studies reported poor levels of evaluation. Moreover, factors such as modern teaching methods, faculty members, financial credits, educational content, facilities and equipment, managerial and supervisory process, graduates' skills, produced knowledge, and teaching and learning activities were reported as the factors that could influence the evaluation of educational programs. CONCLUSION: Due to the important role of evaluation in improvement of the quality of educational programs, policymakers in education should pay special attention to the evaluation of educational programs and removal of their barriers and problems. To promote the quality of educational programs, policymakers and officials are recommended to make use of the CIPP model of evaluation as a systemic approach that can be used to evaluate all stages of an educational program from development to implementation.

A survey of midwifery graduates' opinions about midwifery education in Iran: a cross-sectional study.

BACKGROUND: Attaining high-quality education requires continuous evaluation and revision of the curriculum. The view of the graduate students can provide valuable insight into the necessary evaluations and revisions. Therefore, this study aimed to evaluate the opinions of midwifery graduates about midwifery education in Iran METHODS: This was a descriptive cross-sectional study and the research data were collected through a census sampling procedure from all (82) midwifery graduates of the Nursing and Midwifery School of Shiraz University of Medical Sciences between 2018 and 2020. The data collection instrument was a validated researcher-made questionnaire derived from the Graduation Questionnaire (GQ) developed by the Association of American Medical Colleges (AAMC). The data were then analyzed using SPSS 22. RESULTS: In this study, about 62% of the graduates were satisfied with the quality of the midwifery education they had received during the four-year program. Moreover, 61% of the graduates maintained that theoretical courses were well-integrated with the clinical experience they needed. The quality of the internships in different wards and departments was also evaluated from the viewpoints of the graduates, and the results indicated that they were relatively satisfied with their internship experiences. However, only 40% of the graduates were satisfied with the quality of their clinical evaluation, since they faced the most significant challenges in the clinical and maternity wards (47%) with the midwifery staff and gynecology residents and found the quality of facilities in the clinical program to be lacking. According to the participants, the quality of teaching was not good for some courses such as biochemistry and microbiology. CONCLUSION: It seems that the midwifery curriculum needs to be constantly revised, aiming to improve student satisfaction with their midwifery education. Some effective measures in this regard are employing experienced professors, developing cooperation between midwifery instructors and clinical departments, and trying to improve the educational environment. Attention to the improvement of facilities and equipment and agreement between the content of the theoretical education and practical topics are also recommended to improve the quality of midwifery education.

'Does HPV affect my fertility?' Reproductive concerns of HPV-positive women: a qualitative study.

BACKGROUND: Reproductive health changes can occur following infection with Human papillomavirus. HPV is the most prevalent sexually transmitted infection causing a variety of clinical manifestations ranging from warts to cancer. This study aimed to explore the reproductive concerns of women infected with HPV. METHODS: In this qualitative study, we used the conventional content analysis approach, with the aid of MAXQDA.10 software, to analyze data extracted from the face-to-face semi-structured interviews with 20 Iranian HPV-positive women (sampled by maximum variation purposive sampling). The accuracy of this research was ensured according to the four criteria proposed by Guba and Lincoln. RESULTS: Exploring participants' reproductive concerns, three main categories were identified from the interviews including concerns about fertility potential, pregnancy and non-pregnancy reproductive issues. HPV-positive women concerned about reduced female/ male fertility due to HPV, the impact of the HPV on the fetal health, adverse pregnancy outcomes such as miscarriage and preterm delivery, and mother-to-child transmission of HPV during breastfeeding. HPV-positive women with abnormal cytology results were anxious that becoming pregnant or taking hormonal contraception might worsen their abnormalities. Most married women were reluctant to use a condom. Participants requested further information about the potential reproductive risks of the HPV vaccine. They also wanted to know about the safety of HPV vaccine during pregnancy and breastfeeding. CONCLUSIONS: HPV-positive women had some reproductive concerns that should be considered in the designing of educational-consulting interventions. Women need to be better understood and informed about the impact of HPV on their reproductive health. Health care providers may lack knowledge about these specific areas, and they could benefit from additional up-to-date information to address women's reproductive concerns.

Iranian women's psychological responses to positive HPV test result: a qualitative study.

BACKGROUND: Human papillomavirus testing as an established screenings test allow for the early detection and treatment of cervical cancer. Testing positive for HPV may have adverse consequences for women. This study aimed to explore the psychological impacts of testing positive for HPV on women in a developing country with a distinct cultural and religious background. METHODS: Qualitative face-to-face semi-structured interviews were conducted with 40 Iranian women who received a positive high-risk HPV result. Content analysis approach was used to data analysis through MAXQDA10. RESULTS: Three main categories were emerged: initial confrontation; STD-related psychological burden; and rebuilding health. Initial reactions to positive HPV results were shock, unrealistic fear, confusion, distress, and financial concerns. Stigma was manifested in form of self-blame, fear of HPV-disclosure, negative body image, being stigmatized by healthcare providers, and receiving health care anonymously. Refusal to use insurance services showed how evident and powerful the stigma was. Most women reported lifestyles and sexual behaviors modifications to help their immune system to clear HPV; indicating that the screening can work as a valuable opportunity to improve women's physical and sexual health. Regular follow-up, safe sex and a focus on spirituality enable women infected with HPV to take control of the situation. Worrying about other HPV-linked cancers (oropharynx and anal) and fears of partner infection indicated that women consider HPV to be more than just a cause of cervical cancer. CONCLUSIONS: The findings implied to the HPV-positive women's need to support and factual information. Designing and implementing interventions that mitigate the psychological effect of positive HPV test results can highlight the potential benefits of screening for women's health.

Understanding HPV-positive women's needs and experiences in relation to patient-provider communication issues: a qualitative study.

BACKGROUND: HPV testing has been integrated in cervical cancer screening program. Patient-providers relationship is extremely important to improve cervical cancer screening outcomes. This qualitative study aims to understand HPV-positive women's needs and preferences about HCPs and patient-provider communication based on their experiences of accessing primary and specialized care. METHODS: We conducted 40 semi-structured interviews with HPV-positive women. Recorded interviews transcribed and analyzed using conventional content analysis approach. RESULTS: The analysis of the data led to the extraction of three main categories, including: provider's communication and counseling skills, commitment to professional principles, and knowledgeable and competent provider. Women needed understandable discussion about HPV, emotional support and acceptance, receiving HPV-related guidance and advice, and some considerations during clinical appointments. Women needed HCPs to treat them respectfully, gently and with non-judgmental attitude. "Precancerous" and "high-risk" words and watching colposcopy monitor during procedure had made women anxious. Weak referral system and limited interactions among gynecologists and other HCPs highlighted by participants. CONCLUSION: The results of this study, based on the experiences and perceptions of HPV women receiving health care, contain messages and practical tips to healthcare providers at the primary and specialized levels of care to facilitate patient-provider communication around HPV. Providers need to approach the discussion of HPV with sensitivity and take individual needs and preferences into account to improve the HPV-positive women's healthcare experience.

A population-based study of health-promoting behaviors and their predictors in Iranian males, 2019.

BACKGROUND: Health-promoting lifestyle (HPL) is any measure taken to maintain a person's health. The most important and influential factor in maintaining and enhancing health are health-promoting behaviors (HPB). This study aimed to determine HPB and their predictors among Iranian men. METHODS: In this cross-sectional study, 783 Iranian men, living in Tehran, were selected, using multistage cluster sampling. The employed questionnaires, namely the sociodemographic questionnaire, Health-Promoting Lifestyle Profile II (HPLP-II), and the second part of the Personal Resource Questionnaire (PRQ 85-Part 2), were completed through interviews. The relationship between the dependent variables (HPLP-II and its subdomains) and independent variables (sociodemographic characteristics and social support) was investigated using the adjusted General Linear Model (GLM). RESULTS: The mean ± standard deviation of the total HPLP-II score was 2.72 ± 0.44 in the range of 1-4. Among the six dimensions of the HPB, the participants achieved the highest score (3.00 ± 0.52) and lowest score (1.96 ± 0.56) in spiritual growth and physical activity, respectively. The Pearson test showed that the perceived social support was significantly correlated with HPLP-II (r = 0.23; p < 0.001) and all of its subdomains (r = 0.09-0.24; p < 0.001). Based on the adjusted general linear model, social support, age, job, and income adequacy were the predictors of HPL in men and could explain 30.9% of the variance of the HPL score. CONCLUSIONS: The research findings confirmed the importance of social support and modifying variables (social and personal) in the incidence of HPB in men.

Designing and psychometric of reproductive health related behaviors assessment tool in Iranian males: an exploratory mixed method study protocol.

BACKGROUND: Male reproductive health is a relatively new concept, and most men are neglected in reproductive health discussions. Therefore, it appears that there is insufficient information about the male reproductive health. This study aims to design a psychometric instrument for assessing the male reproductive health-related behavior. METHODS/DESIGN: This is a sequential exploratory mixed-method study with a classical instrument development design. It will be conducted in two qualitative and quantitative phases on the studied units including the men living in Tehran. In the first phase, a qualitative study of a contractual content analysis approach will be conducted in order to perceive the concept of male reproductive health-related behavior, determine the dimensions of the questionnaire, and explore the items. In the second phase, a quantitative study will be carried out to evaluate the psychometric properties as well as (form, content, and construct) validity and reliability of the instrument designed in the first phase. Finally, the instrument will be scored and interpreted. DISCUSSION: Discovering men's perception of concept of reproductive health-related behavior can help design a valid and reliable questionnaire which can be used in studies evaluating the male reproductive health-related behavior. ETHICAL CODE: IR.TUMS.FNM.REC.1397.157.

Effects of Feedback on Midwifery Students' Self-Assessed Performance and Their Self-Assessment Ability: A Quasi-Experimental Study.

This study aimed to evaluate the effects of verbal and written feedback in clinical midwifery placement on students' self-assessed performance and their self-assessment ability. This three-group quasi-experimental study was conducted on 120 students. Participants in the control group received clinical education through the routine method, while in the feedback groups received either verbal or written feedback methods on the basis of the sandwich feedback model. In the last day of clinical education, a checklist was simultaneously filled out by participants and a second instructor. There was significant direct correlation between the scores of performance assessment by both the second instructor and students in the control group (r = .38, p = .01), the verbal feedback group (r = .63, p < .001), and the written feedback group (r = .74, p < .001). The rates of student-instructor agreement in the control, verbal feedback, and written feedback groups were 32.5%, 70%, and 77.5%, respectively. Feedback is effective in significantly improving students' self-assessment ability.

Comparison of Transcutaneous Electrical Nerve Stimulation and Lidocaine on Episiotomy Complication in Primiparous Women: A Randomized Clinical Trial.

INTRODUCTION: Transcutaneous electrical nerve stimulation (TENS) through the skin is a nonpharmacological method of pain relief. The present study aimed to compare TENS and lidocaine on episiotomy complication in primiparous women. MATERIAL AND METHODS: In a randomized, controlled clinical trial, 80 participants were included from March to July 2011 at the antenatal clinic and postdelivery ward in the Social Security Organization Hospital, Khorramabad, Lorestan, Iran. Data were collected using a demographic questionnaire, visual analog scale and redness, edema, ecchymosis, discharge, and approximation scales. The participants were randomized into two groups with equal number of participants. All participants received 5 cc of local infiltration of 1% lidocaine before episiotomy, and TENS electrodes were placed on He Gu and Shenmen points during the crowning of fetal head. The TENS group received TENS with 100; 250 µs, the output range of 15-20 mm amplifier from crowning of first stage of labor to the end of the episiotomy repairing. The lidocaine group received 10 cc of local infiltration of 1% lidocaine before episiotomy repair while did not receive TENS electrodes. The pain intensity during and after episiotomy repair was recorded. RESULTS: TENS and lidocaine have similar effects on pain relief at the episiotomy cutting, the start of the episiotomy repair, and at end of the episiotomy repair; however, the pain relief of both the interventions was different during the episiotomy repair. The effect of TENS in reducing edema was statistically significant (P = 0.001). CONCLUSIONS: TENS and lidocaine are effective for the episiotomy complications during and after episiotomy repair.

Core components of clinical education: a qualitative study with attending physicians and their residents.

INTRODUCTION: In medical education, particularly in residency courses, most of the training occurs in real clinical environments. Workplace-based learning profoundly affects students' knowledge, attitudes, and practice; therefore, it should be properly planned.  Due to the extensiveness   of the clinical   environment   and   its   importance in training residents, investigating how residents learn in these environments and detecting factors that influence effectiveness will help curriculum designers to promote residents' learning by improving their learning environment.  Therefore, our qualitative content analysis study, aimed  to  examine  the experiences and perspectives of internal and surgical residents and their attending physicians about learning in clinical settings. METHODS: This qualitative content analysis study was conducted through purposeful sampling.  Semi-structured interviews were conducted with 15 internal and surgical residents and 15 of their attending physicians at educational hospitals of Tehran University of Medical Sciences. RESULTS: The main categories explored in this study were hidden curriculum, learning resources, and learning conditions. In the context of clinical environment and under its individual culture, residents learn professionalism and learn to improve their communication skills with patients and colleagues. Because of clinical obligations such as priority of treating the patients for education or workload of the attending physicians, residents acquire most of their practical knowledge from colleagues, fellows, or follow-up patients in different learning conditions (such as: educational rounds, morning reports and outpatient clinics). They see some of their attending physicians as role models. CONCLUSION: Changing cultural and contextual factors is of prime importance to promote a learning-oriented environment in a clinical setting. The present findings will help curriculum planners and attending physicians to improve residents' learning by means of appropriate workplace planning and by considering the components involved in clinical learning.

Effects of telephone follow-up on blood glucose levels and postpartum screening in mothers with Gestational Diabetes Mellitus.

BACKGROUND: Gestational diabetes mellitus (GDM) is a form of diabetes that occurs in pregnancy. GDM, defined as glucose intolerance, first diagnosed or initiated during pregnancy affects 1-14% of pregnancies based on various studies. Screening and early diagnosis and appropriate glycemic control can improve prenatal outcomes. Telephone follow-up seems to be a reasonable way for pregnant women follow-up. The present study evaluated the effects of telephone follow-up on blood glucose level during pregnancy and postpartum screening. METHODS: Eighty mothers with GDM were enrolled in this clinical trial and randomly divided into intervention and control groups. All mothers were asked to check their blood sugar levels fivetimes daily. In intervention group, telephone intervention was performed for 10 weeks. In each follow-up, individuals were followed for insulin injections, diet, clinical tests and reminding the next visit. In control group, three times of telephone call was established to record blood sugar levels. Another telephone call was established at 6 weeks of postpartum in both study groups to evaluate the performance of the screening test for blood sugar. RESULTS: The mean age of mothers was 30.9±5 years in the control and 30.7±5.1 years in the intervention groups In intervention group, mean level of blood glucose, 2 hours after lunch at 28 weeks of pregnancy was significantly lower than the control group (P<0.05). Mean differences in levels of fasting blood glucose between 28 weeks and 32 and between 28 and 36 weeks of pregnancy were significantly higher in the intervention than the control group (P<0.05). Rate of postpartum glucose screening test was significantly higher in the intervention group (P<0.001). CONCLUSION: The findings of this study demonstrated that telephone follow-up could significantly reduce fasting blood glucose levels in mothers with gestational diabetes and also increased the rate of postpartum screening test.

Effect of educational software on self-efficacy of pregnant women to cope with labor: a randomized controlled trial.

AIM: The aim of this study was to determine the effect of educational software on self-efficacy of Iranian pregnant women to cope with labor. METHODS: This study was a randomized controlled trial which was carried out on 150 Iranian nulliparous pregnant women randomly assigned to two groups of 75 women each. The control group routinely did not receive any kind of childbirth education and the intervention group only received the childbirth educational software for 6-8 weeks. In order to determine self-efficacy, the Childbirth Self Efficacy Questionnaire (CBSEI) was used which measures the outcome expectancy and the self-efficacy expectancy of the first and second stages of labor separately. This questionnaire was completed at 28-32-week gestation as a pre-test and at 36-38 weeks as a post-test by the participants. Data were analyzed using Chi-square, Mann-Whitney U and Wilcoxon tests. RESULTS: After the intervention, the median and mean of CBSEI scores for the intervention and the control groups were 607, 604/20 ± 16/630 and 394, 392/51 ± 16/758, respectively. There was a statistical difference between the two groups (p = 0.001). Also, statistically significant differences existed in the median of outcome expectancy and self-efficacy expectancy after intervention in both stages of labor between the two groups (p = 0.001). CONCLUSIONS: The educational software program significantly increased self-efficacy of Iranian pregnant women to cope with labor. Despite lack of educational childbirth classes in Iran, the use of this method is recommended. However, to find whether this technique can be substituted for the educational classes, further studies are needed.

Reducing perineal trauma through perineal massage with vaseline in second stage of labor.

PURPOSE: Maintaining an intact perineum is a highly regarded aim in delivery procedures today. Since perineal massage is a common practice during delivery, the present study aims to investigate the effect of perineal massage with Vaseline on perineal trauma (rate of episiotomy procedures and perineal tears). METHOD: Ninety primiparous women (aged between 18 and 30 years with gestational age of 38-42 weeks) were selected sequentially in Tehran in 2009. Once participants' characteristics were registered, they were randomly assigned to the intervention (perineal massage with Vaseline) or control groups. In the massage group, perineal massage was performed in the second stage of delivery once the genitalia were treated with sterilized Vaseline. The perineum was examined after the delivery in terms of episiotomy or tear and its severity degree. RESULTS: The two groups were homogeneous in terms of demographic data, weight gain during pregnancy, gestational age, abortion history and fetal weight. The second stage of delivery was significantly shorter in the massage group than the control group and the massage group had significantly more intact perineum (P = 0.004). In addition, lower episiotomy and higher first- and second-degree perineal tears were seen in the massage group in comparison with the control one (P < 0.001). Neither of the groups suffered from third- and fourth-degree tears. CONCLUSION: The findings showed that the perineal massage with Vaseline in the second stage of labor increases perineal integrity and decreases perineal traumas (episiotomy and tears). So, it seems that the perineal massage could be an effective way to preserve an intact perineum in labor.

Menstrual cycle and knee joint position sense in healthy female athletes.

PURPOSE: The aim of this study was to investigate the effect of menstrual cycle on knee joint position sense (JPS) in healthy female athletes. METHODS: Sixteen healthy female athletes participated in this study. Serum estrogen and progesterone levels were collected during the three phases of menstrual cycle. The knee JPS was also measured during the same phases using a system comprise of skin markers, digital photography, and AutoCAD software. Absolute angular errors were calculated as well as changes in hormone levels between the three phases. RESULTS: Serum estrogen concentration was significantly higher during the mid-luteal (179.5 Pg/ml) and mid-follicular (125.6 Pg/ml) phases as compared with the early-follicular (menses) (22.8 Pg/ml) phase (P = 0.0001). Also serum progesterone concentration was significantly higher during the mid-luteal phase (7.35 Ng/ml) as compared with the menses (0.58 Ng/ml) and mid-follicular (0.5 Ng/ml) phases (P = 0.0001). The greatest amount of mean (SD) value of absolute error was at menses (4.2°), and the least amount of it was at mid-luteal (2.5°) phase. Also, a significant difference was observed within three phases of menstrual cycle (P = 0.025). CONCLUSION: The result of this study suggests that healthy female athletes have different levels of knee JPS across a menstrual cycle. JPS accuracy decreases in menses, when circulating sex-hormones levels are low. Therefore, female athletes are at higher risk of injury at menses and improving their awareness regarding the knee injury risk factors can be a fundamental step toward preventing injuries. LEVEL OF EVIDENCE: Case series, Level IV.