Development and psychometric properties of maternal health literacy inventory in pregnancy.

BACKGROUND: Pregnancy is one of the most sensitive and important stages of women's life. Maternal health literacy is the key to achieving a healthy pregnancy. It also affects pregnancy outcomes by improving the quality of health care in this period. The aim of this study was to develop and evaluate the psychometric properties of maternal health literacy inventory in pregnancy (MHELIP). METHODS: This sequential, exploratory and mixed study was carried out in two parts (qualitative study and psychometric evaluation of the tool) in Tehran in 2016-18. The first part involved a qualitative content analysis with a traditional approach using in-depth, semi-structured and personal interviews with 19 eligible pregnant women. Then, the pool of items extracted from the qualitative part was completed by reviewing the existing literature and tools. In the second part, the overlapping items were summarized and the tool was validated. In order to evaluate the construct validity, a cross-sectional study was conducted with the participation of 320 pregnant women. Data analysis was performed by SPSS-19 software using exploratory factor analysis and reliability tests (Cronbach's alpha and ICC). RESULTS: Findings of qualitative part produced a pool of 120 items that reached to 124 items after reviewing the literature. After confirming face and content validity by calculating CVI and CVR for each item, 53 items remained in the pool. Finally, the results of exploratory factor analysis confirmed a tool with 48 items in four factors, explaining 46.49% of the variance of total variables of the tool. Reliability of the tool was approved by Cronbach's alpha = 0.94 and test-retest with 2-weeks intervals, indicating an appropriate stability for the scale (ICC = 0.96). Finally, the tool was finalized with 48 items in 4 dimensions, including "Maternal Health Knowledge", "Maternal Health Information Search", "Maternal Health Information Assessment" and "Maternal Health Decision Making and Behavior". CONCLUSION: The designed tool is a multidimensional, reliable and validated scale for assessing maternal health literacy during pregnancy. This tool can be used to evaluate different aspects of maternal health literacy in pregnant women, which was prepared based on their experiences during a qualitative study.

Prevalence and Predictive Factors of Sexual Dysfunction in Iranian Women: Univariate and Multivariate Logistic Regression Analyses.

BACKGROUND: Female sexual dysfunction, which can occur during any stage of a normal sexual activity, is a serious condition for individuals and couples. The present study aimed to determine the prevalence and predictive factors of female sexual dysfunction in women referred to health centers in Ilam, the Western Iran, in 2014. METHODS: In the present cross-sectional study, 444 women who attended health centers in Ilam were enrolled from May to September 2014. Participants were selected according to the simple random sampling method. Univariate and multivariate logistic regression analyses were used to predict the risk factors of female sexual dysfunction. Diffe rences with an alpha error of 0.05 were regarded as statistically significant. RESULTS: Overall, 75.9% of the study population exhibited sexual dysfunction. Univariate logistic regression analysis demonstrated that there was a significant association between female sexual dysfunction and age, menarche age, gravidity, parity, and education (P<0.05). Multivariate logistic regression analysis indicated that, menarche age (odds ratio, 1.26), education level (odds ratio, 1.71), and gravida (odds ratio, 1.59) were independent predictive variables for female sexual dysfunction. CONCLUSION: The majority of Iranian women suffer from sexual dysfunction. A lack of awareness of Iranian women's sexual pleasure and formal training on sexual function and its influencing factors, such as menarche age, gravida, and level of education, may lead to a high prevalence of female sexual dysfunction.

The Effect of Oxygen Inhalation Plus Oxytocin Compared with Oxytocin Only on Postpartum Haemorrhage: A Randomized Clinical Trial.

INTRODUCTION: Post Partum Haemorrhage (PPH) is the leading cause of maternal mortality across the world, mainly in the developing countries. AIM: The present study was conducted with the aim to investigate effect of oxygen inhalation plus oxytocin compared with oxytocin only on PPH. MATERIALS AND METHODS: This study was a clinical trial which was performed in Shahid Mustafa Khomieni Teaching Hospital of Ilam (western Iran) from April 2012 to Nov 2013. One hundred and twenty pregnant women who were referred to delivery ward for normal vaginal delivery were selected with convenience sampling method and they were randomly assigned into two groups. For both groups management of the third stage of labour was done using 1000CC Ringer and 20 units of Oxytocin. In the intervention group, in addition to the routine administration, 8 liters of oxygen via face mask was used continuously until 2 hours after delivery. Blood loss was determined by regular weighing of the buttocks that were previously weighted. The difference was calculated before and after weighing (1 gram increasing of weight was considered to be equivalent to 1CC blood loss). Data were analysed by SPSS 16 version using Student- t and Chi-square tests. RESULTS: The two groups were homogenous in regard to all the base line variables. The study results indicated that the mean of blood loss were (256.16±97) ml at two hours after delivery in the control group and (149.5±46.49) ml in the intervention group. There was a significant difference between PPH of the two groups (p<0.006). CONCLUSION: Research findings showed that the use of inspired oxygen during the third stage of labour and oxytocin infusion during 2hours later resulted in a significant decreasing in the amount of bleeding after normal vaginal delivery.

A comparative study on the efficacy of glucose and sucrose on the vaccination pain: a randomized controlled clinical trial.

OBJECTIVES: This study was performed to compare the effectiveness of two analgesics for the management of vaccination pain. MATERIALS AND METHODS: A total of 90 neonates to be vaccinated against Hepatitis B were assigned to Glucose, Sucrose and control groups at Shahid Mostafa Khomini hospital. 2cc oral Glucose 25% and 2cc oral Sucrose 25% with Syringe were given for 30 sec then 2 min later Hepatitis-B vaccine injected by vaccinator and pain intensity measured by Neonatal Infant Pain Scale (NIPS) during 1-2 min. The third group (control) no intervention was performed. The collected data were analysed by SPSS18 Software and ANOVA and LSD tests were used. RESULTS: Research results showed that there were no significant differences between groups in term of Apgar score, delivery type, sex, head circumstance, weight and height. By comparison of pain severity in two groups, mean and Standard deviation of pain, group that received Glucose solution had more intensity than Sucrose group (3 ± 1.66 vs. 2.90 ± 1.44), but this difference was not significant statistically (p=0.78). Comparison of pain intensity in control and intervention groups showed that the pain intensity in control group is higher than intervention groups (p<0.001). CONCLUSION: Patients who received Glucose or Sucrose had lower pain intensity in comparison with the other. The pain intensity in patients who received sucrose was less than the glucose group, but this difference was not significant statistically.

Occupational Mental Health: A Study of Work-Related Mental Health among Clinical Nurses.

OBJECTIVE: This paper reports a study performed to investigate and assess the mental health as well as the demographic characteristics of nurses to examine their mental health status based on four physical, anxiety, social-function and depression items. MATERIALS AND METHODS: This descriptive cross-sectional study was accomplished on 86 nurses working at three hospitals, affiliated to Iranian health ministry, in Ilam city(western Iran) all the cases were selected by purposeful sampling method. Data was collected by a two-part questionnaire containing individual data and GHQ -28 Standardized Questionnaire. The GHO-28 was developed by Goldberg, in 1978, as a screening tool to detect those likely to have or be at risk of developing psychiatric disorders. The GHQ-28 is a 28-item measure of emotional distress in medical settings. Analysis was done by SPSS 18 software. RESULTS: The majority of participants were females(50.6 vs.49.4) of 35-40 years old(27.2% ), 84 percent were married(vs.16%), 35.8 percent with 10-15 years of record(vs.33.3% less than 5), 22.2% with 5-10, and 8.6% with more than 15-years of work record. The majority of participants have worked in surgical wards of hospitals. The analysis of GHQ results showed that 43.2%(n=35) of participants were suspected to suffer from mental disorders(vs.56.8% n=46 healthy participants); of all the suspected cases, 12.3% were supposed to have physical symptoms, 16% anxiety symptoms, 42% social dysfunction, and 6.2% symptoms of depression. In general, the participants demonstrated a Mean±SD of mental health score equal to 23.65±9.43. CONCLUSION: Research results showed that the high prevalence of depression, anxiety and stress symptoms among nurses is alarming. It was concluded that providing efficient adequate and appropriate support services for this group can result in more healthy nurses as well as promotion of public health.

Effect of acupressure (UB32) on pain intensity in intramuscular injections.

BACKGROUND: Pain originating from intramuscular (IM) injection should not be underestimated, because it can damage the nurse-patient relationship. This research aimed at answering two main questions, whether acupressure is effective on pain severity due to IM injection or not and whether pain severity in two groups is different or not. MATERIALS AND METHODS: This research was performed in government-affiliated hospitals of Ilam. The patients were 15-55 years old. Subjects were individually asked to participate in the research, and an informed consent was obtained from them. Before injection, the patients were asked to lie in prone position and the acupressure point UB32 was found. It was pressed for 1 min circularly. Then, the acupressure point was pressed directly (pressure equal to 4.5 kg/cm(2)) by thumb three times sequentially. After acupressure, 3 ml penicillin 6.3.3 was injected to buttock muscle. In the control group was injected only penicillin 6.3.3 by the conventional method. Collected data were analyzed by SPSS 16 version. RESULTS: Means of pain intensity in the acupressure group according to body mass index values (BMIs) were 1.50 ± 0.75 in thin, 1.64 ± 0.72 in normal, 1.38 ± 0.60 in overweight, 1.40 ± 0.54 in obese, and 1 ± 0.0 in severely obese subjects, with a total score of 1.53 ± 0.68. Analysis of variance (ANOVA) showed no significant difference between mean pain intensities based on BMI. There was no significant difference in the two groups concerning BMI and age (age: 30.24 ± 10.98 vs. 29.26 ± 10.07; BMI: 23.74 ± 4.45 vs. 23.88 ± 5.74), but the difference between them in terms of pain intensity mean was statistically significant. CONCLUSION: It is concluded that acupressure in UB32 is effective on reducing the pain severity. Pain severity mean in the acupressure group was lesser than in the other group, and t-test showed a significant difference between the two groups.

A comparative study on the efficacy of Ibuprofen and celecoxib on the intensity of perineal pain following episiotomy: a randomized clinical trial.

BACKGROUND: Pain is a worldwide problem that often originates from disease process, and diagnostic and treatment procedures such as surgical operations. OBJECTIVES: This trial was performed to compare the effectiveness of two analgesics for the management of perineal pain caused by episiotomy. MATERIALS AND METHODS: A total of 170 nulliparous women who gave birth vaginally with episiotomy between March 2009 and November 2010 were randomly assigned to receive either ibuprofen or celecoxib which were given orally every 6 or 12 hours, respectively. Pain levels were measured before the intervention, and at 1, 2, 4, 8 and 12 hours after providing the first dose on a 10-cm visual analogue scale. RESULTS: The results showed that the two groups had no significant differences regarding demographic characteristics, maternal, neonatal, and post-delivery factors, and mean premedication pain severity. Means of pain severity were different between the two groups as patients in the celecoxib group had lower means than the other group at 1,2,4,8 and 12 hours (4.01 ± 1.8 vs. 4.46 ± 1.9, 3.17 ± 1.9 vs. 3.79 ± 1.7, 2.89 ± 1.3 vs. 2.96 ± 1.5, 2.19 ± 1.8 vs. 2.55 ± 1.4, and 1.98 ± 1.1 vs. 2.45 ± 1.2, respectively) after administration of analgesics. CONCLUSIONS: Patients who received celecoxib had lower VAS in comparison with others. Although these differences were not significant, as celecoxib has longer half-life, fewer upper GI symptoms, and is better tolerated based on the previous studies, and this study is in favor of using it.

What is missed in self-immolated patients' care? A grounded theory study.

AIMS AND OBJECTIVES: To explore rehabilitation care process in patients who commit self-immolation. BACKGROUND: Self-immolation is not only a type of burn injury, but it is also a suicidal method. It is placed in burn injury category that requires long-term rehabilitation and treatment measures. As a suicidal method, among all forms of suicidal attempts, it is the most dramatic, violent and often difficult one to understand. Unfortunately, there are few reported studies investigating experiences and perceptions of nurses about burn care and with qualitative study about the patients' experiences and perceptions. DESIGN: On the basis of the research question, the grounded theory method was used. METHODS: Considering ethical codes of Belmont and Helsinki statements, purposive sampling was used to select the participants. The patients were deliberately selected, based on the research needs. They were self-immolated patients being referred to Talaghani hospital of Ilam (western Iran) or discharged previously (time of interview and observation ranged from immediately later the burn till 5 years after), in Ilam, where self-immolation rate is very high. The main methods for data collection were deep, open ended, semi-structured interviews, dairies and observations. The interviews were audio taped in Persian, and verbatim transcriptions were made. By doing so, semantic meaning is preserved, and misinterpretation of data due to translation into English is minimised. Data analysis was conducted using the Strauss and Corbin method. RESULTS: Five main categories were emerged: situation of crisis unprofessional care, prolongation and formidability of the journey, self-immolation as paralyse, and attempt for self-management. Finally, by constant, comparison of collected data and emerged categories, central variable entitled unintegrated care emerged as the main problem of self-immolated patients' care. CONCLUSION: The study comes to the conclusion that we need to focus on specific considerations to provide integrated care for the burned patients as it is a decisive component of care that is missed. RELEVANCE TO CLINICAL PRACTICE: Although self-immolation requires long-term treatment and social, emotional rehabilitation, such a rehabilitation care process is not clear.

Tragedy of women's self-immolation in Iran and developing communities: a review.

Committing Suicide is an awful way to die as well as a historical psycho-social problem of human community worldwide. Suicide is an action deliberately initiated and performed by a person with complete awareness of its fatal outcome, prevalence of which is very rare in developed countries, but it is reported with more frequency in Baltic region, Africa (including Egypt), The Middle East (including Iran), The Far East, particularly India and Vietnam. Its rate has ranged from10 per 100,000 people/year in Egypt, and up to 35 per 100,000 people/year in Baltic region (including Lithuania, Finland, and Russia). Categorically Iran is the 93th country of the world in terms of suicide Rate, but self immolation in the reported suicides is very high. There are many different approaches of suicides based on culture, symbols, religion, geographical regions, genders and socioeconomic factors. Self-inflicted burn or self immolation is a common suicidal method. According to the American Burn Association, self- immolation is placed in burn injury category that required long-term treatment as well as social and emotional rehabilitations. Deliberative burn injuries are classified into self- inflicted (self-immolation) or else-inflicted burn (assault burn). In this review study, we try to focus on self- inflicted burn or self- immolation as the most dramatic and violent method of suicide. The present review article was aimed to assess the epidemiology of self immolation phenomenon and its associated factors as a worldwide problem, particularly in Iran and other developing communities. The main victims of this awful way of death are women who are considered the most vulnerable group in such societies.