فصلنامه حیات
سال سیزدهم شماره 4 (پیاپی 35، زمستان 1386)

Socio-economical changes have increased the women's opportunity to take job in recent decades. The increased levels of women in work places, has resulted in a high interest in the potential adverse effects of work on pregnancy outcome. This study was conducted in order to surveying the association between occupational factors and preterm childbirth.Methods & Materials: It is a cross-sectional study. Samples consisted of nurses and midwives (518 person) who working in Tehran's universities of medical sciences hospitals. Also they delivered newborns in gestational age more than twenty weeks (term or preterm) in years 2001-2006. The subjects were selected using a multi stage sampling method. Data gathered using a self-administered questionnaire. Occupational factors labeled as fatigue score and working hours. The relation between Occupational factors and preterm birth was analyzed using descriptive and inferential statistics (Chi-squared, t-test and Mann-Whitney U test) by SPSS software. Based on the study findings, the prevalence of preterm labor was 17.2% (95%CI=0.14-0.20). Although the proportions of unfavorable working conditions include: working at acute clinical wards, standing up more than 3h per each working shift, physical exercise, working in cold or hot weather, working in busy environment with continuous noise, being checker of visual and aural monitoring signals, working hours equal or more than 40 hours per week, and working fatigue score equal or more than 3 were higher in preterm group; but it didnt show any significant relation with preterm birth. According to the research findings, it seems that occupational factors do not have explicit effect on preterm childbirth. Therefore more investigations are recommended.

High frequency of traumatic and non-traumatic brain injuries in one hand and improvement of the health care condition to restore patient's life in the other hand has increased the frequency of comatose patients in ICU. These patients often experience physical, cognitive, behavior or sensory defects, and the sensory input reduction in intensive care units expose them to cognition disorders. It seems that using sensory stimulation programs may be effective in preventing from sensory deprivation and facilitating recovery process.Methods & Materials: In this quasi-experimental study, 30 comatose patients who were hospitalized in ICU in Shariati and Sina hospitals were sought to be studied. The subjects were selected randomly using matching that was placed in case and control group. In the intervention group, patients received an auditory stimulation for 2 weeks, 6 days of a week, 2 times a day. The auditory stimulator was a recorded tape (5-10 minutes) of a familiar voice for 30 minutes. The Glasgow Coma Scale (GCS) was used for measuring the level of consciousness (LOC). LOC was measured before and after each intervention 4 times a day. The control group LOC was measured in a similar manner to the case group. At the same time, homodynamic symptoms (blood pressure, pulse rate, and mean arterial pressure) were measured. Non-parametric test was used for analyzing data. The data was analyzed through SPSS V.11.5 computer software. The findings indicated that there was a significant difference in LOC of the intervention group at the first day and after fourteen days of the intervention (P<0.001), but not in the control group (P=0.769). Although 2 groups were similar in LOC of the first day (P=0.605) but there were a significant difference between their LOC at the fourteenth day (P=0.001). The results showed that the auditory stimulations with familiar voice were effective in increasing LOC in the comatose patients. It is suggested that nurses expose comatose patients with auditory stimulations using a recorded tape of familiar voice in ICU.

Adverse childbirth experiences as a trauma can evoke fear and post-traumatic stress disorder in some women. This study was conducted to investigate the effect of counseling on post traumatic stress disorder after a traumatic childbirth.Methods & Materials: This research was a clinical trial which was conducted at Kamaly hospital in Karaj. Samples (300 women) who had experienced a traumatic childbirth were selected by a convenient sampling method and were randomized into an intervention (n=150) and a control (n=150) group. The intervention group received face-to-face counseling within 72 hours of birth for forty to sixty minutes in a session. The control group just received usual care after childbirth. The data collection tool was questionnaire, which was completed via interview. The measuring variables were demographic characteristic, reproductive history, maternity social support, and post-traumatic stress disorder. Data were analyzed using descriptive statistics and inferential tests (Chi-square, Fisher's exact test, and generalized Fisher's exact test) by SPSS v.13 software. After 4-6 weeks of follow-up there was no significant difference regarding post-traumatic stress disorder between two groups (P=0.295). At 3-month of follow-up, the intervention group reported less post-traumatic stress disorder comparing with the control group (P=0.001). A midwife-led counseling plan is effective in reducing post-traumatic stress disorder during a long term.

Nutrition is a very important factor in toddler age growth. Getting started the first steps of the children with family in this period shows the necessity of paying attention to the correct nutritional behaviors. Therefore this research has been conducted for assessing the effect of nutritional behavior model on the quality of toddler's nutrition and performance of their mothers.Methods & Materials: This research is a semi-experimental study, in which sixty six children (12-36 months old) were selected from two health care centers in the southern part of Tehran. The subjects were selected using non probability-convenient sampling method. The data gathering tool was 3 questionnaires: 1. Mother and child demographic characteristics 2. Mother's function assessment tool about toddler's behavior during feeding 3. Reminding tool of 24 hours food. The tools were filled in using interviews. Then nutritional behavior model was instructed in a workshop during 2 days, 3 hours a day. After the intervention data were recollected again and were analyzed by descriptive and inferential statistics. The results showed a significant difference in mother's function about toddlers nutritional behavior during nutrition before and after the intervention (P<0.001). Also a significant difference was seen in the toddlers nutrition pattern before and after the intervention (P<0.05). Based on the research findings it can be concluded that nutritional behavior model is effective in improving the pattern of toddler's nutrition and in increasing mother's knowledge related to a correct function on toddler's behavior during feeding. Therefore educational plan to mothers on correct nutritional behaviors is suggested in order to improving the quality of toddler's nutrition.

Labor pain is regarded as one of the most intolerable pains which women experience during their life. Although there are many alternatives which can effect on person's response and perception to pain and suffering, the pain is felt especially more severely and longer by primogeniture. Annually thousands of selective cesarean operations are performed just because of delivery pain frightening as the main reason. The pain can produce diverse and unwanted effects on delivery procedure and mother-fetus condition. So finding a method to relieve the pain and suffering is one the policies intently considered by health care systems. The aim of present study is to determine the effect of Entonox on implication of painless labor and woman's satisfaction in a Hospital in Orumieh in 1385.Methods & Materials: This research is a single blind clinical trail. Samples were consisted of women (160 persons), in two groups (each group 80 persons), which selected randomly. The intervention group used Entonox and the control group inhaled Oxygen. All subjects were instructed to use Visual Analogue Scale (VAS) and to inhale gases correctly. Due to emergency need for caesarean operation 2 members of the intervention group and 3 ones from the control group leaved the study. Data gathering tool were consisted of data registration form, VAS scale, mother vital sign recorder, and fetus heart rate recorder. The data were analysed using descriptive (relative & absolute frequencies, mean, and standard deviation) and inferential statistics (t-test, Mann-Whitney U, Chi-squared, Kolmogrove-Smirnov test) by SPSS computer software. According to the findings pain severity rate among the intervention group significantly was lower than the control group in the different hours of delivery procedure (P<0.001). Using Entonox made no effect on mother's vital signs, labor process, fetus heart rate, first and fifth minute Apgar and bleeding rate after delivery. Also it was shown that probable side effects of Entonox inhalation such as drowsiness and mouth stiffness were more common in the intervention group (P<0.001), but no significant difference was seen in other complications. Meanwhile delivery satisfaction rate was higher in the intervention members. It seems that Entonox inhalation might come in useful as an effective and safe method to alleviate labor pain and suffering along side with fewer likely risks for fetus and mother in clinical centers.

Postpartum depression is a severe and pervasive sadness with labile mood that affect 8-15% women after delivery. It can negatively impress mother-infant bonding. There are a lot of factors which make women vulnerable to postpartum depression so that controlling them can prevent from the postpartum depression incidence. Several researches have shown an association between serum cholesterol reduction and depression. The aim of present study is to determine relation between postpartum depression with total serum cholesterol changes before and after child birth in Lahijanian women in years 2006-2007.Methods & Materials: This research sought a descriptive-analytical design. Samples consisted of healthy Primigravidia women (101 persons) with normal labor, normal delivery at term, married, and a medium to high socio-educational level, without history of a depressive disorder, and metabolic disorders or hyperlipidemia. The excluded were the women with maternal or fetal complication before delivery, having problem with accepting infant gender, fetal death and being depressed during pregnancy. All women were visited in two stages: 3 weeks before the expected delivery and also 6 weeks after delivery. On both visits the Beck depression inventory and serum cholesterol registration questionnaire were completed. Data were collected using a questionnaire which had three sections: demographic characteristics, the Beck depression inventory and laboratory tests. Data were analysed using descriptive and inferential statistics (Spearman correlation coefficient and t-test) by SPSS computer software. Findings indicated that serum cholesterol declined considerably in the postpartum period, also it was shown that there was a significant correlation between reduced serum cholesterol and postpartum depression (r=-0.331, P<0.001). Serum cholesterol reduction has a relation with postpartum depression.

Screening methods of gestational diabetes mellitus (GDM) diagnosis is controversy. The survey of relation between GDM and its risk factors helps to determine screening methods. This study was performed to find weather the prevalence of gestational diabetes mellitus (GDM) is influenced by higher hemoglobin (Hb) level and mean corpuscular volume (MCV) before 14 weeks gestation in GDM women and healthy women.Methods & Materials: In this case-control study, 33 pregnant women with GDM in case group (diagnosed according to the Carpenter and Costan criteria) were compared with 33 pregnant women in control group without GDM after 24-28 week's gestation. Data were gathered using a questionnaire and a data registration form by interview and biophysical methods. The data were analysed by descriptive and inferential statistics (Chi-squared, Fisher exact test, two samples Kolmogrov-Smirnov test, and Pearson correlation coefficient). There was no significant difference between two groups in demographic factors and medical history. T-test showed a significant difference between the amount of Hb in the control group (13.23±0.078 gr/dl) and the case group (12.23±0.70 gr/dl) before 14 weeks gestation (P<0.001). There was no significant difference between MCV level in two groups (P=0.294). Also MCV level before 14 week's gestation was 86.92+ 4.51 fl in the case group and 85/56+5/84 fl in the control group. The result showed that GDM women had higher Hb level than the control group before 14 week's gestation. It seems that a high maternal Hb in the first trimester is a risk factor for GDM and it can be used for screening and diagnosing of GDM. Also more investigations of the logic of routine iron supplementation in pregnant women who have a high level of Hb are suggested.

Pulse Oximeter monitoring technology has become so common in intensive health care settings over the last decade that blood oxygen level is now considered as the fifth vital sign. However, it seems that medical and nursing staffs are not specially educated to operate with the devices. The aim of the study was to investigate the knowledge of medical assistants (residents), nurses and anesthesia technicians of pediatric intensive care units regarding Pulse Oximetery.Methods & Materials: This is a cross-sectional study. The study population consisted of all nurses, first year to third year medical assistants, and anesthesia technicians who working in intensive care units in Pediatric Center. A questionnaire was used for data gathering that had three sections: the first section as demographic data (occupational condition, record of service in pediatric unit, having the experience of using Pulse Oximetery, having enough knowledge about Pulse Oximetery, and its educational program type); the second section (eighteen short answer questions) in order to determine the participants knowledge about Pulse Oximetery and the third section (four imaginary clinical scenarios) evaluating the participants interpretation on Pulse Oximetery reports and its changes in patients. The collected data were analyzed through descriptive and inferential statistics (Fisher exact test) by SPSS v.15 and EPI6 computer softwares. The analyses showed that 77.4% of the participants did not pass any educational course regarding Pulse Oximetery, also 67.9% of them correctly identified what Pulse Oximeter measures, and 47.2% of the subjects correctly identified how a Pulse Oximeter works, and 13.2% identified its normal range, but only 26.4% had a correct understanding of the Oxhemoglobin dissociation curve and explained it completely true. It was found that the majority of the participants were wrong in their answers about Pulse Oximeter monitoring. They made mistakes in interpretation of the imaginary clinical scenarios. The results of the study showed that the majority of pediatric intensive care unit staffs have little knowledge regarding Pulse Oximeter monitoring, then with attention to the vast usage of the technology the necessity of formal educational programs in colleges and retraining courses during employment about the device for health care providers is apparent.