Designing a Midwife-Led Birth Center Program Based on the MAP-IT Model: A Sequential Explanatory Mixed-Methods Study.

BACKGROUND: In recent decades, medical supervision of the labor and delivery process has expanded beyond its boundaries to the extent that in many settings, childbirth has become a medical event. This situation has influenced midwifery care. One of the significant barriers to midwives providing care to pregnant women is the medicalization of childbirth. So far, the policies and programs of the Ministry of Health to reduce medical interventions and cesarean section rates have not been successful. Therefore, the current study aims to be conducted with the purpose of "Designing a Midwife-Led Birth Center Program Based on the MAP-IT Model". METHODS/DESIGN: The current study is a mixed-methods sequential explanatory design by using the MAP-IT model includes 5 steps: Mobilize, Assess, Plan, Implement, and Track, providing a framework for planning and evaluating public health interventions in a community. It will be implemented in three stages: The first phase of the research will be a cross-sectional descriptive study to determine the attitudes and preferences towards establishing a midwifery-led birthing center focusing on midwives and women of childbearing age by using two researcher-made questionnaires to assess the participants' attitudes and preferences toward establishing a midwifery-led birthing center. Subsequently, extreme cases will be selected based on the participants' average attitude scores toward establishing a midwifery-led birthing center in the quantitative section. In the second stage of the study, qualitative in-depth interviews will be conducted with the identified extreme cases from the first quantitative phase and other stakeholders (the first and second steps of the MAP-IT model, namely identifying and forming a stakeholder coalition, and assessing community resources and real needs). In this stage, the conventional qualitative content analysis approach will be used. Subsequently, based on the quantitative and qualitative data obtained up to this stage, a midwifery-led birthing center program based on the third step of the MAP-IT model, namely Plan, will be developed and validated using the Delphi method. DISCUSSION: This is the first study that uses a mixed-method approach for designing a midwife-led maternity care program based on the MAP-IT model. This study will fill the research gap in the field of improving midwife-led maternity care and designing a program based on the needs of a large group of pregnant mothers. We hope this program facilitates improved eligibility of midwifery to continue care to manage and improve their health easily and affordably. ETHICAL CODE: IR.MUMS.NURSE.REC. 1403. 014.

In recent decades, medical management of the labor and delivery process has extended beyond its limitations to the extent that in many settings, childbirth has become a medical event. This situation has influenced midwifery care. The global midwifery situation indicates that one in every five women worldwide gives birth without the support of a skilled attendant. One of the significant barriers to midwives providing care to pregnant women is the medicalization of childbirth. In industrialized countries, maternal and infant mortality rates have decreased over the past 60 years due to medical or social reasons. So far, the policies and programs of the Ministry of Health to diminish medical interventions and cesarean section rates have not been successful. Midwifery models in hospital care contain midwives who support women's choices and diverse ideas about childbirth on the one hand, and on the other hand, they must adhere to organizational guidelines as employees, primarily based on a medical and pathological approach rather than a health-oriented and midwifery perspective. Therefore, the current study aims to be conducted with the purpose of "Designing a midwifery-led birth centered maternity program based on the MAP-IT model". It is a Model for Implementing Healthy People 2030, (Mobilize, Assess, Plan, Implement, Track), a step-by-step method for creating healthy communities. Using MAP-IT can help public health professionals and community changemakers implement a plan that is tailored to a community's needs and assets.

Modifying the false discovery rate procedure based on the information theory under arbitrary correlation structure and its performance in high-dimensional genomic data.

BACKGROUND: Controlling the False Discovery Rate (FDR) in Multiple Comparison Procedures (MCPs) has widespread applications in many scientific fields. Previous studies show that the correlation structure between test statistics increases the variance and bias of FDR. The objective of this study is to modify the effect of correlation in MCPs based on the information theory. We proposed three modified procedures (M1, M2, and M3) under strong, moderate, and mild assumptions based on the conditional Fisher Information of the consecutive sorted test statistics for controlling the false discovery rate under arbitrary correlation structure. The performance of the proposed procedures was compared with the Benjamini-Hochberg (BH) and Benjamini-Yekutieli (BY) procedures in simulation study and real high-dimensional data of colorectal cancer gene expressions. In the simulation study, we generated 1000 differential multivariate Gaussian features with different levels of the correlation structure and screened the significance features by the FDR controlling procedures, with strong control on the Family Wise Error Rates. RESULTS: When there was no correlation between 1000 simulated features, the performance of the BH procedure was similar to the three proposed procedures. In low to medium correlation structures the BY procedure is too conservative. The BH procedure is too liberal, and the mean number of screened features was constant at the different levels of the correlation between features. The mean number of screened features by proposed procedures was between BY and BH procedures and reduced when the correlations increased. Where the features are highly correlated the number of screened features by proposed procedures reached the Bonferroni (BF) procedure, as expected. In real data analysis the BY, BH, M1, M2, and M3 procedures were done to screen gene expressions of colorectal cancer. To fit a predictive model based on the screened features the Efficient Bayesian Logistic Regression (EBLR) model was used. The fitted EBLR models based on the screened features by M1 and M2 procedures have minimum entropies and are more efficient than BY and BH procedures. CONCLUSION: The modified proposed procedures based on information theory, are much more flexible than BH and BY procedures for the amount of correlation between test statistics. The modified procedures avoided screening the non-informative features and so the number of screened features reduced with the increase in the level of correlation.

Application of distributed lag models and spatial analysis for comparing the performance of the COVID-19 control decisions in European countries.

Over the past three years, the COVID-19 outbreak has become a major worldwide problem, affecting the health systems and economies of countries. The mean delays, the expected time to observe the average effect of the number of new cases on the number of deaths, are gold times for decision-making regarding disease control and treatment facilities to reduce the fatality rate. The interest of the present study is estimating the mean delays and adjusted fatality rates of COVID-19 with the new application of Distributed Lag Models (DLM) and their spatial distributions. The daily cases and deaths data of COVID-19 for 39 European countries was obtained from two sources; the "European Centre for Disease Prevention and Control" and the "Our World in Data" database. The mean delay and the Adjusted Fatality Rate (AFR) for each country at three-time intervals; the first and subsequent peaks before and after vaccination were estimated by the Distributed Lag Models. The spatial analysis was applied to find the spatial correlation of the mean delays and adjusted fatality rates among European countries. In the three-time intervals, the first and the subsequent peaks before vaccination, and after vaccination, the median and interquartile range of the mean delays; and AFRs were: 1.1 (0.4, 3.2); 0.024 (0.016, 0.044), 9.2 (6.2, 12.40); 0.013 (0.005, 0.020) and 7.3 (4.4, 11.0); 0.001 (0.001, 0.005), respectively. In the subsequent peaks before vaccination, the mean delays considerably increased, and the AFRs decreased for most European countries. After vaccination, the AFRs decreased considerably. Except for the first peak, the spatial correlations of AFRs were not significant among neighboring countries. Consecutive outcomes will occur with delays in outbreaks of infectious disease. Also, the fatality rates for these outcomes should be adjusted on delays. Estimating the mean delays and adjusted fatality rates by Distributed lag Models and the spatial distributions of theme in outbreaks showed that prevention and medical policies after the first peak as well as vaccination were effective to reduce the fatality rate of COVID-19, but these effects were different between countries. These results recommended policymakers and governments assign prevention and medical resources more effectively.

Breastfeeding pattern and its relationship with weight gain in children older than 6 months.

Introduction: According to the World Health Organization (WHO), breastfeeding is the best way to feed infants. Adoption of some inappropriate nutritional patterns along with breast milk, especially in infants older than 6 months, may lead to a delay in the child's growth. Therefore, the present study was conducted to investigate the relationship between breastfeeding and weight gain in children aged 6-24 months. Materials and Methods: This case-control study was conducted on 120 infants aged 6-24 months and their mothers recruited from health centers of Ahvaz, southwest of Iran. The data collection tool in the present study included a questionnaire to record demographic information and information in the child's medical records in health centers. Statistical analysis of the data was done by SPSS 23 using the Chi-square test and t-test. Results: No significant difference was observed between the control and case groups in terms of the infant's age (P = 0.741) and gender (P = 0.564) and the mothers' age (P = 0.614), her educational attainment (P = 0.389), and socioeconomic status of the infant's family (P = 0.563). The type of delivery (P = 0.650), mothers' opinion (P = 0.133), and the interval between breastfeeding and complementary feeding (P = 0.144) had no significant relationship with the infant's growth disorder. On the other hand, duration of breastfeeding per meal (P = 0.007) and frequent breastfeeding (dependency on the mother's breast) (P = 0.049) had a significant relationship with children's developmental disorders. Conclusion: According to the results of the present study, growth disorders in infants in the case group could be attributed to their mothers' inappropriate breastfeeding patterns.

Educational challenges of family caregivers of vegetative state patients for home care preparedness: A qualitative content analysis.

BACKGROUND: Patients with a vegetative state (VS) are completely dependent on caregivers in all physical aspects of their lives. Caring for such patients comes with a great deal of difficulty for family caregivers. As a result, family caregivers must be fully trained and prepared for this role. The present qualitative study was conducted to investigate the educational challenges faced by family caregivers of VS patients for home care preparedness. MATERIALS AND METHODS: The present qualitative study was conducted through the conventional content analysis method from August 2020 to September 2021 in two provinces of Iran (Sistan and Baluchestan Province; and Razavi Khorasan Province). Fourteen family caregivers of patients in a VS were included in the study. Semi-structured and in-depth interviews were employed to collect data. The Graneheim and Lundman method was utilized to conduct the data analysis using MAXQDA2020 software. Data collection continued until data saturation and the identification of main categories. RESULTS: As indicated by the data analysis, three categories of "unmet educational needs," "confused caregiver," and "searching for practical knowledge" which included 19 sub-categories described the experiences of family caregivers of patients in a VS concerning challenges they went through in preparation for patient care at home. Participants' experiences revealed that despite the inadequacy of educations provided by health-care providers on knowledge and skills required by family caregivers, they were committed to caring for the patient and trying to acquire the required knowledge. CONCLUSION: Results indicated that inadequate education and the lack of family caregivers' contribution to caring for the patient in the VS during their stay in the hospital impedes their acquisition of adequate knowledge and skill to care for patients at home. Therefore, healthcare system policymakers should be planning to eliminate the educational barriers faced by family caregivers and expand the educational activities of hospitals' homecare centers to provide educational support of family caregivers after the patient's discharge.

Interactive Effects of Nutrition Modification and Wet Cupping on Male Patients with Refractory Stable Angina.

Objectives: Routine therapies cannot control refractory stable angina, leading to a high economic burden and an impaired quality of life. Persian medicine incorporates exceptional attention to lifestyle and nutrition to prevent and treat various diseases. Previous studies have reported the analgesic and anti-inflammatory effects of wet cupping. The present study aims to determine the effects of nutrition and cupping on refractory stable angina patients. Methods: Forty male patients with refractory stable angina were randomly allocated to four groups, including nutrition modification based on Persian medicine, wet cupping, nutrition modification along with wet cupping, and control. The primary outcomes were the changes in pain score using a visual analog scale and quality of life using the Seattle angina questionnaire. The secondary outcomes were changes in the exercise test and blood pressure. Results: The results of the present study revealed that 30 days of treatment with nutrition modification based on Persian medicine, cupping, and modified nutrition and cupping along with standard treatment for stable angina significantly increased the patient's quality of life and exercise test results while reducing pain, and systolic and diastolic blood pressure. Conclusion: Applying complementary Persian medicine methods such as nutrition modification and cupping along with the classical medical treatments may improve outcomes for refractory stable angina patients.

The effect of head positioning on brain tissue oxygenation in preterm infants: a randomized clinical trial study.

BACKGROUND: CNS injury in preterm infants is still one of the leading causes of mortality and morbidity. Routine care events might affect the perfusion and cerebral oxygenation of preterm infants. Although positioning the infant's head in a particular condition to improve brain oxygenation is included in many institutions, there is no robust clinical evidence to support this intervention's effectiveness. OBJECTIVE: The present study aimed to determine the effect of head positioning on brain tissue oxygenation in preterm infants. METHODS: This study is a randomized clinical trial. In the first 48 h after birth, 39 infants who met the study inclusion criteria underwent head positioning intervention. In this case, the infants were placed in the supine position, and every 2 h, the head position was changed continuously to one of six randomized modes [using random modes generated by SPSS]. During each head positioning, brain tissue oxygenation was recorded by NIRS. RESULTS: The findings showed a significant difference in brain tissue oxygen saturation among these positions (P < 0.001). Dunn's test showed that the brain tissue oxygen saturation in the third position (head rotates 45-60 degrees from the midline to the right and the head of the bed is zero degrees) was significantly lower than the baseline (P = 0.029; Mean difference = 2.3). Also, in the third position, compared to the first position (P = 0.002; Mean difference = 1.9) and compared to the fourth position (P = 0.003; Mean difference = -2.1), and in the second position compared to the first position (P = 0.046; Mean difference = 1.3), the brain tissue oxygen saturation of the infants was lower. CONCLUSION: Based on the results of the present study, head positioning was effective on brain tissue oxygenation in preterm infants in the first 48 h after birth; Therefore, it is recommended when possible, not to rotate the infant's head during the first 48 h after birth while the head of the bed is at 0°.

The Effects of Meaning-centered Play on Spiritual Sensitivity of Children: A Randomized Controlled Trial.

BACKGROUND: Spiritual sensitivity is the child's ability to be spiritually aware of what is happening both outside and within him or herself, and the further ability to respond accordingly. On the other hand, play is one of the strategies to develop children's capabilities. Yet, there is limited information about the relationship of play and spiritual sensitivity. The present study aimed to evaluate the effects of meaning-centered play on children's spiritual sensitivity. METHODS: This two-group randomized controlled trial was conducted on 120 children aged 10-11 who were recruited from two centers affiliated to the institute for intellectual development in Mashhad, Iran, by convenience sampling between May 2016 to January 2018. Samples were allocated to intervention (60) and control (60) groups through random allocation. In the intervention group, a meaning-centered play intervention was implemented in twelve 45-minute sessions, twice a week and for six weeks. The control group had the usual trend of the center's plays and programs. Spiritual sensitivity was measured via the Spiritual Sensitivity Scale for Children (SSSC) before and after the end of the intervention. The data were analyzed via the SPSS software (v. 20.0) using Chi-square, independent-sample t test, Mann-Whitney U and Wilcoxon signed-rank tests. The significance level was less than 0.05. RESULTS: Although the groups did not significantly differ from each other concerning the pretest mean scores of spiritual sensitivity and its subscales (P>0.05), the posttest values of these scores in the intervention group were significantly greater than the control group (P<0.05). After the intervention, the mean scores of spiritual sensitivity significantly increased in the intervention group (Before: 65.0±13.6, after: 79.4±12.3, P<0.001), but no significant increase was observed in the control group (Before: 66.7±14.6, after: 67.4±12.3, P=0.604). CONCLUSION: According to the results, it can be suggested that meaning-centered play program can be used in play room in schools, child care centers and hospitals to improve the spiritual sensitivity among children. TRIAL REGISTRATION NUMBER: IRCT2017022232733N.

The therapeutic effects of 1540-nm nonablative fractional erbium laser on macular amyloidosis: a randomized clinical trial.

OBJECTIVE: This aim of this study was to determine the effect of 1540-nm nonablative fractional erbium on macular amyloidosis. METHODS: This phase-II clinical trial study has been performed with parallel group with blinding of the evaluator. The skin lesions of the patients (15 patients and 30 lesions) with cutaneous macular amyloidosis were randomly assigned into laser and no-treatment groups. In the laser group, treatment was performed by 1540-nm nonablative fractional erbium laser. Thereafter, the patients' lesions were compared in terms of pigmentation, rippling, thickness, and subjective response. RESULTS: The lesions of the intervention group significantly improved in the three-month follow-up compared to the control group (in the control and intervention group, improved pigmentation was observed in 20 and 53.3% with p = .02, improved rippling in 6.7 and 60% with p = .007, diminished lichenification in 0 and 53.1% with p = .007, and overall lesion improvement in 20 and 60% with p = .03, respectively). In investigating the subjective response through patient global assessment, the patients in the intervention group had a greater satisfaction (p = .01). There was a considerable improvement of pruritus in the intervention group (p = .001). CONCLUSIONS: Use of 1540-nm nonablative fractional erbium laser offered a suitable efficacy to treat macular amyloidosis without significant complications.

Home quarantine is a useful strategy to prevent the coronavirus outbreak: Identifying the reasons for non-compliance in some Iranians.

INTRODUCTION: The coronavirus outbreak has become a worrying issue and some people refuse to stay at home. Therefore, this study aims to identify the reasons behind some Iranian people's refusal to stay at home to prevent further virus transmission. METHOD: This cross-sectional study was conducted on postgraduate students in Iran. A questionnaire was designed based on 50 experts' opinions by using the Delphi method and 203 students completed the designed questionnaire in telegram groups. RESULTS: 35% of participants were upper 30 years of age, 70.4% were female, 74.4% had no coronavirus infection among their relatives, and 54.7% of them were Ph.D. candidates. The relations between "unclear accountability of events by some officials" and age as well as "failure to provide dissenting viewpoints and critical comments" and age were statistically significant (p = 0.027، p = 0.014). Moreover the relation between coronavirus infected relative and "persistent beliefs" was statistically significant (p = 0.014). The Chi-square test showed that gender, degree, resident and education province did not affect questions answering. The greatest agreement with questions is as following: lack of real situation understanding; 89.7%, people's livelihoods, and lack of government planning for low-income groups support; 86.7%, lack of people's knowledge concerning the coronavirus; 80.8%, lack of communicative educations for crisis situations; 79.8%, false assurance as well as minimizes the risks; 78.3%. CONCLUSION: Identifying the non-compliance factors with health recommendations can guide health care providers and managers to implementation of beneficial intervention.

Comparison of Support Vector Machine, Naïve Bayes and Logistic Regression for Assessing the Necessity for Coronary Angiography.

(1) Background: Coronary angiography is considered to be the most reliable method for the diagnosis of cardiovascular disease. However, angiography is an invasive procedure that carries a risk of complications; hence, it would be preferable for an appropriate method to be applied to determine the necessity for angiography. The objective of this study was to compare support vector machine, naïve Bayes and logistic regressions to determine the diagnostic factors that can predict the need for coronary angiography. These models are machine learning algorithms. Machine learning is considered to be a branch of artificial intelligence. Its aims are to design and develop algorithms that allow computers to improve their performance on data analysis and decision making. The process involves the analysis of past experiences to find practical and helpful regularities and patterns, which may also be overlooked by a human. (2) Materials and Methods: This cross-sectional study was performed on 1187 candidates for angiography referred to Ghaem Hospital, Mashhad, Iran from 2011 to 2012. A logistic regression, naive Bayes and support vector machine were applied to determine whether they could predict the results of angiography. Afterwards, the sensitivity, specificity, positive and negative predictive values, AUC (area under the curve) and accuracy of all three models were computed in order to compare them. All analyses were performed using R 3.4.3 software (R Core Team; Auckland, New Zealand) with the help of other software packages including receiver operating characteristic (ROC), caret, e1071 and rminer. (3) Results: The area under the curve for logistic regression, naïve Bayes and support vector machine were similar-0.76, 0.74 and 0.75, respectively. Thus, in terms of the model parsimony and simplicity of application, the naïve Bayes model with three variables had the best performance in comparison with the logistic regression model with seven variables and support vector machine with six variables. (4) Conclusions: Gender, age and fasting blood glucose (FBG) were found to be the most important factors to predict the result of coronary angiography. The naïve Bayes model performed well using these three variables alone, and they are considered important variables for the other two models as well. According to an acceptable prediction of the models, they can be used as pragmatic, cost-effective and valuable methods that support physicians in decision making.

Modelling the number of dermal lesions in anthroponotic cutaneous leishmaniasis and its associated factors in Herat province, western Afghanistan, during 2012-2013.

Cutaneous leishmaniasis (CL), caused by Leishmania tropica, is the main causative agent of CL in the Herat province, western Afghanistan. In CL patients, one of the most important indicators for reducing the amount of body damage and the choice of treatment is the number of dermal lesions, but there is no strong evidence in this regard. Therefore, using count regression models, the main objective of this historical cohort study was to identify the distribution of the number of dermal lesions and determine the associated factors among CL patients referring to leishmaniasis reference laboratory in Herat province, from January 2012 to December 2013. In a total of 4,127 clinically suspected CL cases, 50.20% were female and 49.80% male. Based on the results of ZINB model, which is the best model suggested by goodness-of-fit criteria, age variables (IRR = 1.007), duration of lesion (6-12 weeks compared to < 6 weeks with IRR = 1.36 and >12 weeks with IRR = 1.39 compared to <6 weeks), type of lesion(both nodule and ulcer compared to papule with IRR = 2.03), location of lesion (trunk with IRR = 1.90, upper with IRR = 1.66, lower with IRR = 1.61 and mix with IRR = 10.35 compared to head/neck/ears) and type of lesion (ulcer compared to papule with IRR = 0.50, nodule and lupoid, respectively, as IRR = 0.72 and IRR = 0.51 compared to papule) had a significant effect on the mean number of dermal lesions (p < .05). Also, our results showed that among four models used, the ZINB model represented a better performance to determine the associated probable factors about the number of dermal lesions in ACL patients. Moreover, there was a direct association between age and number of dermal lesions; in addition, duration of lesion, type of lesion and location of lesion had a significant effect on the number of dermal lesions. Therefore, a comprehensive planning is necessary for controlling and reducing the number of dermal lesions.

Serum levels of lead and selenium in patients with premature graying of the hair.

BACKGROUND: The exact etiology of premature hair graying (PHG) remains unknown; however, oxidative stress is shown to be involved. Selenium, as an antioxidant, is widely known for its antiaging potentials. Moreover, PGH is more prevalent among addicts and because Lead is a common impurity found in illegal drug. AIMS: We evaluated the serum levels of lead and selenium in patients with PHG and compared it with a control group. PATIENTS/METHODS: In this cross-sectional study, 60 patients referred to Dermatology Clinic of Imam-Reza Hospital of Mashhad, Iran in 2015 were evaluated in two groups with and without PHG. Demographic information and disease characteristics, skin phenotype, and family history of PHG were recorded. Furthermore, 5 mL of brachial blood was drawn for measuring selenium and lead levels. RESULTS: The mean patients' age was 28.1 ± 4.8 years. Age, sex, occupation, and skin phenotype in individuals with and without PHG were not significantly different (P > .05) but family history of PHG was significantly higher in the patients with PHG (P = .001). Similarly, the number of white hairs was significantly higher (P < .001), and the age of onset of hair graying was significantly lower in patients with PHG (P < .001). Serum levels of selenium and lead were not significantly different between two groups (P < .05). However, the serum levels of lead in the patients with PHG were slightly higher. CONCLUSIONS: The results of this study showed that there was no significant difference in lead and selenium serum levels in patients with and without PHG.

Effect of Using a Simulation Device for Ostomy Self-care Teaching in Iran: A Pilot, Randomized Clinical Trial.

The appearance of a stoma and the potential for contact with stool may negatively affect postoperative teaching effectiveness, especially for patients with cultural and religious backgrounds that consider stool untouchable. Instruction that involves the use of a physical stoma simulator for practice may help address this problem. PURPOSE: The aim of this pilot study was to determine the effects of simulation in ostomy self-care training on self-efficacy and adjustment. METHODS: A randomized clinical trial was conducted among patients at 2 public medical center surgical units in eastern Iran from April 2015 to December 2015 using consecutive sampling. Patients who spoke Persian, were 18 to 65 years of age, had a temporary or permanent intestinal stoma, and did not have comorbidities that might interfere with self-care teaching were invited to participate and randomly allocated to the simulation (SG) or the control group (CG). Both groups were provided 4 training sessions; the first and fourth session was the same for each group, but in sessions 2 and 3, the SG group used a wearable stoma simulator, whereas the CG group used the demonstration-return method. Demographic and stoma variables were collected, and the Stoma Self-Efficacy Scale (SSES) and Ostomy Adjustment Inventory-23 (OAI-23) were administered at baseline (following surgery), after 4 instructional sessions, and 45 days following the last education session. Descriptive statistics and chi-squared, Fisher's exact, Mann-Whitney U, repeated measure, and least significant difference tests were used to analyze the data. RESULTS: Of the 53 patients enrolled, 46 (23 in each group) completed the study. Mean age for SG and CG patients was 45.91 ± 10.40 and 53.78 ± 9.15, respectively (P = .009). The majority of patients were female (SG: 11 [47.8%]; CG: 14 [60.9%]), married (SG: 20 [87.0%]; CG: 19 [82.6%]), and had a diagnosis of cancer (SG: 20 [87.0%]; CG: 21 [91.3%]). The mean SSES score for stoma self-efficacy was 103.82 ± 15.81 in the SG and 89.91 ± 13.41 in the CG after the fourth session. Results indicated an improvement in self-efficacy in both groups from baseline to final follow-up visit (P <.0001). SSES in the SG was significantly different from baseline to final follow-up visit during the study (F = 3.183, P = .008). Mean OAI-23 scores were 51.04 ± 13.37 in the SG and 50.82 ± 13.84 in the CG at baseline and after the intervention (fourth session) were 60.56 ± 16.41 in the SG and 53.95 ± 13.22 in the CG group. The repeated measure test results indicated significant increases in adjustment scores from baseline to final follow-up visit in both groups (P = .000). CONCLUSION: The results of this pilot study suggest that using simulation to teach ostomy self-care improves self-efficacy after 3 and 9 weeks. Further randomized controlled trials that expand the sample size and demographic should be conducted.

The effect of massage and topical violet oil on the severity of pruritus and dry skin in hemodialysis patients: A randomized controlled trial.

BACKGROUND: Pruritus is one of the common problems in hemodialysis patients that involves more than 45% of Iranian patients. Its exact pathogenesis is unclear. Meanwhile, violet is an old plant with anti-scratching effects, which is extensively used to treat diseases in the Persian medicine. This study aimed to evaluate the effect of massaging the body with and without violet oil in the treatment of uremic pruritus. METHODS: In this study 57 hemodialysis patients who had uremic pruritus were categorized randomly into two groups. The treatment involved massage with and without topical 5 ml violet oil for 7 min during six sessions (two weeks) on the healthy hand which did not have fistula pruritus score questionnaire were completed before and after the intervention. RESULTS: There was no difference between the two groups before the intervention; however, after the intervention, a significant difference was observed within each group and between the groups in terms of skin dryness score, severity, location, and frequency of pruritus, which were recovered significantly in both groups. CONCLUSION: The results of this study indicated that massage with violet oil is more effective than massage alone and is recommended as a complementary treatment for patients with uremic pruritis.

Determination of the Effect of Sexual Assertiveness Training on Sexual Health in Married Women: A Randomized Clinical Trial.

BACKGROUND: Sexual health is a state of physical, mental, and social well-being in relation to sexuality. Sexual assertiveness is a person's ability to meet sexual needs. Considering limited sexual information of women and the taboo nature of talking about sexual needs, the purpose of this study is to evaluate the effectiveness of the sexual assertiveness training on sexual health. MATERIALS AND METHODS: This randomized clinical trial assignment parallel study with a control group was performed in September and October 2016 on 60 married women referred to Imam Reza Health Center in Mashhad. The sample size was estimated to be 30 subjects per group. Instruments included demographic characteristics, sexual assertiveness, and sexual health questionnaire. The pretest was completed in two groups at the beginning of the study and post-test was done for both groups 1 week after educating the experimental group. Descriptive statistic tests included Chi-square, t-test, and paired t-test, and one-way analysis of variance. A p value less than 0.05 was considered to be statistically significant. RESULTS: The two intervention and control groups showed no significant difference in terms of sexual health level before starting the study (t 58 = 0.854, p > 0.05). After the study, based on the independent t-test, the two groups showed significant differences (t 58 = -4.077, p < 0.001). CONCLUSIONS: Sexual assertiveness training can improve women's sexual health. Considering the lack of research in this area and due to the effect of mutual understanding of couples on emotional and sexual issues, further research is necessary for this field.

Modified Deep Sclerectomy for the Surgical Treatment of Glaucoma.

PURPOSE: To report the short-term outcomes of modified deep sclerectomy (MDS) in the management of open angle glaucoma. METHODS: This prospective, non-randomized, controlled study included 105 eyes (105 patients) with open angle glaucoma. Eyes were categorized as follows: trabeculectomy (30 eyes), MDS (27 eyes), phacotrabeculectomy (28 eyes), and phaco-MDS (20 eyes). The MDS technique involved removal of a third scleral flap to expose the suprachoroidal space and excision of a trabecular block. A two-site approach was used for combined surgeries. Main outcome measures included intraocular pressure (IOP), number of glaucoma medications, and complications. Treatment success was defined as an IOP of 6-15 mmHg and/or a 30% reduction in IOP. RESULTS: All groups showed significant decrease in IOP and number of medications (both P s < 0.001). The MDS group had a higher IOP (13.9 ± 3.8 vs. 12.4 ± 2.5 mmHg, P = 0.080) and required more medications (P = 0.001) than the trabeculectomy group at 1 year. The MDS group had a higher baseline IOP than the trabeculectomy group (P = 0.004) and both the groups showed similar IOP reductions (33.3% vs. 25.7%, P = 0.391). The phaco-MDS and phacotrabeculectomy groups had comparable IOP (13.3 ± 3.1 vs. 12.4 ± 3.1 mmHg, P = 0.354), number of medications (P = 0.594), and IOP reduction (P = 0.509) at 1-year follow-up visit. The trabeculectomy and phacotrabeculectomy groups developed more wound leaks (P = 0.043) and required more bleb needling during the early postoperative period (P < 0.001). CONCLUSION: The MDS technique seems to be slightly inferior to trabeculectomy, but when combined with phacoemulsification, is safer and results in similar IOP outcomes.

Effect of Pistacia atlantica kurdica gum on diabetic gastroparesis symptoms: a randomized, triple-blind placebo-controlled clinical trial.

BACKGROUND: Gastroparesis is a recognized problem of type 1 and 2 diabetes mellitus that is defined by delayed gastric emptying. Due to insufficient satisfaction of current treatments, the use of complementary and alternative medicine in this field seems essential. According to Persian medicine, Pistacia atlantica gum has proper effect on gastrointestinal disorder specially stomach diseases. OBJECTIVE: The aim of this study was to assess the effect of Pistacia atlantica gum on diabetic gastroparesis symptoms. METHODS: A triple-blind randomized placebo-controlled trial on subjects with diabetic gastroparesis was conducted at the clinic of Imam Reza Hospital in Mashhad city in Iran, from November 2016 to May 2017. Fifty-four patients (16.7% males and 83.3% females) enrolled in the 8-week study and were randomly divided into two groups of intervention Pistacia atlantica and placebo groups. Both of the groups had received current dietary advice. Severity of gastroparesis symptoms was assessed with a Gastroparesis cardinal symptom index (GCSI) questionnaire. SPSS software version 16 was used to analyze the data and Generalized Estimating Equation (GEE) model, Independent-samples t-test, Paired-samples t-test, Mann-Whitney U test, and Wilcoxon signed-rank test were used to assess variables. RESULTS: All gastroparesis symptoms of patients (14.6% diabetes type 1 and 85.4% diabetes type 2) including nausea/vomiting, postprandial fullness/early satiety, and bloating were significantly declined in each group during study (p<0.0001). Pistacia atlantica gum significantly reduced severity of gastroparesis symptoms including Postprandial fullness/early satiety (p=0.04), Bloating (p<0.0001), and GCSI scores (p=0.001) versus placebo. Systolic blood pressure (p=0.006), BMI (p=0.018), and HbA1c (p=0.038) significantly decreased in the Pistacia atlantica group after the intervention. CONCLUSION: This study showed that daily consumption of Pistacia atlantica gum for one month improves diabetic gastroparesis symptoms. TRIAL REGISTRATION: The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the code of IRCT2016110630739N1. FUNDING: This study was supported by funding (grant no.: 950153) from the Mashhad University of Medical Sciences Research Council, Mashhad, Iran.

Effect of spiritual care education on postpartum stress disorder in women with preeclampsia.

INTRODUCTION: Posttraumatic stress disorder is an anxiety disorder that occurs after exposure to an event that causes injury or threat. The prevalence of preeclampsia was reported to be 28%. Considering the significant role of spiritual care in physical and psychological outcomes of patients, this study was conducted to determine "the effect of spiritual care education on postpartum stress disorder in women with preeclampsia". MATERIALS AND METHODS: In this randomized clinical trial, 72 pregnant women (36 in each group) were selected in a convenient way between the ages of 34 and 38 weeks who had preeclampsia and admitted to two public hospitals in Mashhad. The questionnaires such as Duke University Religion Index, DASS 21, the Posttraumatic Stress Disorder Checklist (PCL), and Prenatal Posttraumatic Stress Questionnaire (PPQ) were used at the beginning in two groups. In the intervention group, first, women were educated each day based on Richards and Bergin's pattern, in three sessions, which lasted 45-60 min. The control group also received routine cares. All units completed questionnaires such as Prenatal Posttraumatic Stress Questionnaire (PPQ) at the 4th-6th postpartum period. Results were analyzed by independent t-test, Mann-Whitney test, Chi-square test, and SPSS version 16. RESULTS: The mean change score of postpartum stress disorder in the intervention and control groups was different after intervention (P = 0.001). CONCLUSION: Providing spiritual care to pregnant mothers with preeclampsia reduces their risk of postpartum stress disorder. Therefore, this kind of care as an effective intervention is included in the routine care of this group with high-risk pregnancies.