مهین کمالی فرد

Introduction Pre-menstruation syndrome (PMS) includes a set of physical and psychological symptoms before menstruation which causes disorder in the life process and activity of each woman. This survey was performed with aim to evaluate the effect of foot medical zone-therapy reflex on the intensity of PMS symptoms in the students of girls’ dormitories of Tehran University of Medical Science. This one blind randomized clinical trial was performed in 2010 on 120 students who were resident in the dormitories of Tehran university of medical sciences. The samples were randomly divided in 2 groups of cases and control (n=60 each group). Zone-Therapy Reflex was done in the case group.Data collection toolwasDickerson questionnaire which was completed in two menstruation cycles before treatment and two cycles during the treatment. Data was analyzed by SPSS software (version 15) and x2,exact Fisher and covariance analysis tests. P˂0.05 was considered significant.
Results In this research, the intensity of mood signs was decreased 25.2% after true Z-T reflex and 3.8% after no true Z-T reflex, physical signs 25.26% after true Z-T reflex and 3.4% after no true Z-T reflex, and behavioral signs 20% after true Z-T reflex and 18.30% after no true-T reflex , that mood (p=0.03) and physical (p=0.040) signs were considered statistically significant and improvement was observed in the signs, but no change was observed in behavioral signs.
Conclusion Zone therapy reflex improves physical and mood signs in PMS and due to very low side effects, good effectiveness and proper treatment can be one of the first therapy steps in women with PMS.

Breast Crawl is initiating breastfeeding and evidence based method. Followed by numerous studies on breast-feeding, and mother and child heath, BC was discussed for which a protocol was presented. There are few studies on BC method. For the first time in Iran, we performed this method in Alzahra hospital of Tabriz where we came across an interesting case. The report is about a term infant who was put on the mother's abdomen to find the mother’s breast. The infant was stuck to the mother’s skin due to abundant Vernix and could not move despite her attempts. This lengthens the expected time for BC method, but in the end, the infant managed to reach the mother’s breast and started sucking on her breast without any help. There are various causes that might prolong BC implementation time or even prevent you from doing it. This case mentions to a problem that never listed in breast crawl guideline and may be selected as a hindering factor for breast crawl in future.

Background and Mothers are highly vulnerable during pregnancy and after childbirth. Some problems could even lead to mortality and morbidity after childbirth. Therefore, this study was carried out to evaluate the effect of lifestyle educational package on prevention of postpartum’s health problems in nulliparous mothers. This randomized clinical trial was conducted on 220 nulliparous women in postpartum ward. The subjects were allocated into two groups using block randomization method. Intervention group received face to face training, telephone counseling, booklets and informative text messages (both fathers and mothers), while the control group had no education or training. Any health problem on the day of discharge and two and six weeks after delivery were compared between the two groups using logistic regression test. By lowering the frequency of health problems during pregnancy, the chances of developing some complications including constipation, hemorrhoids, anal fissure, abdominal pain, headache, painful or infected suture, sleep problems during the second and sixth weeks postpartum as well as the chances of having cold and fever, backache, leg cramp, breast pain, nipple fissure, fatigue or weakness, sadness and discomfort and vaginal infection during the sixth weeks of postpartum decreased by more than 50% in educational group compared with the control group. In this study, postpartum lifestyle intervention reduced the chance of developing many health problems. Therefore, more comprehensive interventions should be carried out by healthcare providers during pureperium period in postpartum ward and the health centers for mothers and fathers.

Lack of awareness and the False beliefs about postpartum care may lead to maternal and child health problems. Thus, changing them through effective training methods should be considered as a priority. This survey was conducted to evaluate the effect of educational package on nulliparous mother’s Knowledge and belief about postpartum lifestyle. This randomized clinical trial was carried out on 220 nulliparous women in the postpartum ward in Tabriz, in 2013. The subjects were allocated into two groups using block randomization method. Intervention group received face to face education, telephone counseling, booklets and educational SMS and control group received postpartum Ward’s routine educations. Questionnaires of Knowledge and belief about postpartum lifestyle were completed by mothers at the first (or second) day after delivery and then 42 days later. Data was analyzed by SPSS-18, Independent t-test, Fisher's exact test, chi-square, chi-square for trends and ANCOVA. P<0.05 was considered significant. There were no significant statistic differences in terms of demographic characteristics and also pre-intervention lifestyle knowledge and belief scores between two groups (P>0.05). With adjusting pre-intervention knowledge and belief score, the mean scores of knowledge [adjusted mean difference 17.2, (CI: 95%: 20.2 to 14.3)] (p<0.001) and beliefs [28.7 (32.2 to 25.2)] (p<0.001) among the intervention group was significantly higher than those in control group. This study demonstrated the positive effectiveness of simultaneous use of simple and practical training techniques without financial burdens to promote nulliparous mother’s knowledge and belief about postpartum lifestyle. Yet, we cannot draw conclusions about which method is most effective, therefore more research is needed in this field.

Postpartum period can influence on the women''s hygiene and lifestyle. Postpartum lifestyle includes physical activity، nutrition and health-related behaviors. Women''s knowledge about puerperium care and health concerns enables them to prevent the complications. This study was performed with aim to assess knowledge and belief regarding postpartum lifestyle and its predictors among nulliparous mothers in Tabriz. This cross-sectional study was conducted on 220 nulliparous mothers admitted in postpartum wards in two medical and training hospitals and one private hospital in Tabriz in 2013. Convenience method was used for sampling. Data was collected using questionnaires of socio- demographic، knowledge and belief related to lifestyle. The data analysis was performed by SPSS software (version 18) and independent t-test، one way ANOVA، univariate and multivariate general linear model. The Mean±SD score of knowledge and belief were 72. 6±16. 9 and 50. 4±12. 5، respectively، of the attainable range score of 0-100. According to general linear model and with adjusting on other variables، having university education and receiving care from both physician and health center had statistically significant positive association with knowledge score، and there was significant positive relationship between education level and belief (P=0. 015). In the present study، the rate of knowledge of lifestyle was good and belief score was at moderate level. Education level and place of receiving prenatal care were the most important variables affecting knowledge and belief about postpartum lifestyle.

Proper nutrition is essential in the prevention and improvement of maternal problems and fetal health during pregnancy. The aim of this study was to determine the effect of nutrition education package on knowledge and nutritional behavior of pregnant women coping with problems and taking supplements during pregnancy. In the present clinical trial، a number of 88 pregnant women referred to health centers in Karaj، Iran، were selected and randomly divided into two groups (Intervention and control group). Two sessions of approximately 60 minutes including classes on nutrition during pregnancy was held for the intervention group using presentation، booklets، and educational film; sex education with similar method was held for the control group. Data were collected through a questionnaire. The collected data was analyzed by analysis of variance with repeated measures analysis of covariance and logistic regression analyzes. In the intervention group، in the field of knowledge dealing with problems during pregnancy and after the intervention supplements in two stages were significantly higher than the control group (p˂001). Scores in the intervention group in the field of nutritional problems during pregnancy included constipation، heartburn، swollen hands and feet، anemia and urinary tract infections during both stages of the intervention were better than the control group (p˂005). Iron and multivitamin supplementation in the intervention group during two phases after the intervention phase was better than the control group (p˂005). The content of educational package was evaluated as an appropriate policy in promoting nutritional knowledge and behavior among pregnant women

Premenstrual syndrome (PMS) is a common disease in women. Because of unknown etiology of PMS, various medical treatments and clinical trials have been conducted to treat and prevent this syndrome. This research was performed to determine the effect of foot reflexology (reflex zone therapy) on the physical symptoms of premenstrual in students of girls hostels of Tehran University of Medical Sciences. This single blind randomized controlled clinical trial was carried out on 120 students with PMS history. After confirming the PMS, through registry of daily status (Dickerson questionnaires) in two menstruation cycles, the subjects were randomly divided into two groups of actual and false zone therapy. Actual group received 30 minutes of the treatment once per week for 8 subsequent weeks. Data were analyzed by Chi-square, exact fisher test and repeated measurement of ANOVA using SPSS-ver15. Decreased menstrual symptoms were observed in 25.26 percent of cases in actual reflex zone therapy and 3.8 percent of cases in false zone therapy. Based on the results and attended to this symptom's spread, the necessity of attention to reflex zone therapy, as a substitute and complement treatment, is clear.

Fetal movement counting is a method that used by the mother to quantify her baby''s movements. Since 1970s a variety of counting techniques with different alarm limits have been developed few of which have been evaluated for predictive values and hence the clinical value of the absolute number of fetal movements has not been established. This cross-sectional study was carried out in 2011 in Educational and Medical Center of Alzahra in Tabriz. Three hundred singleton pregnant women at 32-40 weeks’ gestation having inclusion criteria were selected randomly from among women with complaint of decreased fetal movement. To perform the counting of three fetal movements in one hour and their recording in related chart was instructed by the researcher in a face to face manner. After the counting، pregnant woman was referred to ultrasound unit in order to perform the test of biophysical profile، then the two test results were compared with each other. According to the test of fetal movement counting، 99. 7% of fetuses were active and 0. 3% of them were inactive. On the basis of the test of biophysical profile، 96. 3% of fetuses had score of 10 and 3. 7% had score less than 10. In this study، a significant relationship was found to exist between the result of maternal fetal movement counting and biophysical profile (p< 0. 001). The sensitivity، specificity، positive and negative predictive value of the test of fetal movement counting were 100%، 96%، 9% and 100% respectively. The result of this study suggests the usefulness of maternal fetal movement counting as an early simple screening and noninvasive method in assessment of fetal well-being.

Pre-marriage counseling enables couples to be aware of all aspects of sexuality and make them enjoy sexual activity. This study aimed to assess quality of sexual health counseling services in pre-marriage counseling centers in Tabriz. In this study, 236 individuals referred to the pre-marital counseling centers in Tabriz were randomly selected. Data were gathered using a self-structured instrument including items on demographic characteristics and sexual health. The validity and reliability of the instrument was confirmed. The results showed that 5.1% of the clients did not receive any sexual health services. More than half of the participants (53.4%) received low information and 41.5% received moderate information on the sexual health. There was a significant relationship between age and sexual health (p<0.05). It seems that focusing on the quality of sexual health services could help couples to have a healthy marriage.

Adequate nutrition is an important part of a healthy pregnancy and nutrition education can play an important role in improving the health of the mother and her child. The aim of this study was to determine the effect of an educational package on nutritional knowledge, attitude, and behavior of pregnant women. : In this quasi-experimental study, 88 women of 8-14 weeks of pregnancy referring to health centers in Karaj were selected through convenience sampling method and were randomly allocated to the experiment (n=44) and control (n=44) groups. The experiment group received nutrition education program including two 60-90 minute lecture sessions and an educational booklet and film. The control group received sexual education with similar method. Data were gathered using a self-made questionnaire including demographic characteristics, nutritional knowledge, attitude, and behavior (with 16,21,14,and 21 items, respectively); before and four weeks after the intervention. Data were analyzed using chi-square test, paired-T-test, T-test, McNemar test and analysis of covariance and logistic regression. At baseline, there was no significant differences between the two groups in terms of demographic and clinical characteristics, and mean of nutritional knowledge, attitude and behavior scores (P<0.05). After the intervention, the mean scores were significantly higher in the experiment group than those in the control group in terms of the knowledge (63.5±13.5 vs. 35.7±12.8), attitude (74.8±7.8 vs. 65.2±8.3) and behavior (61.5±14.5 vs. 36.7±13.9) (p<0.001). Also, optimal food intake was significantly more frequent in the experiment group compared with the control group on meat (OR= 4.51, CI95% 1.56-13.00), bread and cereal (OR= 3.68, CI95% 1.32-10.25), and milk and dairy products (OR=3.38, CI95% 1.12-10.21). Findings of the study indicate that the educational package was effective in promoting nutritional knowledge, attitude, and behavior of pregnant women. This intervention program is easy to implement. Therefore, it is recommended to implement it at health centers.

A woman’s perception of labor pain is affected by different issues such as cultural، social، psychosocial and environmental factors. Due to limited studies performed on labor pain in our country، we aimed at studying more on this topic. In this descriptive-comparative study، women’s hospitals were selected by using multistep random-sampling method considering each category’s segment. One hundred and fifty cases were randomly selected for each category. Data collection was done using questionnaire and labor pain was measured with visual analogue scale of pain (VAS) and interviewing. In this study، in the state hospitals the mean score of pain in primiparas was 8. 21±2. 65، while it was 8. 90 ±2. 48 in the multiparas. In the private hospitals، the mean score of pain in primiparas was 8. 90±1. 09، while it was 9. 07 ±1. 13 in multiparas. The mean score of pain in private hospitals was higher than the state hospitals (P<0. 001). The result of regression model showed that factors such as type of hospital، environmental، therapeutical and caring factors، and labor phobia are considered as items for predicting the rate of pain intensity. The relationship between fear، anxiety and social، treatment factors and the pain was not significant in primiparas. Also relationship between the level of supporting and the pain in primiparas was significant but it was not the same in multiparas. The results showed that the type of hospital، physical and environmental factors، treatment and care، labor fear and anxiety increased the pain intensity.

Nutrition during pregnancy is a key factor influencing mother’s health، as well as the growth and development of her fetus. As limited studies have been conducted in this field، we aimed to determine the nutritional behaviors of women in the first trimester of pregnancy and its relationship with some socio-demographic characteristics. This cross-sectional study was carried out on 103 pregnant women in 8-14 weeks who referred to four public health centers of Karaj in 2011. Data were collected by a self-made questionnaire consisted of 21 questions about nutritional behavior. Data were analyzed by using statistical SPSS software version 13. Logistic and linear regression statistical tests were used to determine the association between some socio-demographic characteristics and nutritional behaviors. P value less than 0. 05 was considered statistically significant. About half of the women (53. 4%) were nulliparous and 71 women (69%) of them stated that they have not received any nutritional education during pregnancy. The Mean ± SD total score of nutritional behavior was 32. 0±17. 2 and behavior score in dealing with complications during pregnancy was 18. 5±8. 2 from possible range of 0-100 points. Nutritional behavior of 57 person (55%) and 84 person (88%) in dealing with complications during pregnancy were weak (score less than 33). A quarter of pregnant women had not taken folic acid in this period. There were a significant relationship between total nutritional behavior score with educational level (p=0. 020) and average monthly household income (p=0. 017). So between number of pregnancy and taking of folic acid (p=0. 023)، the average family income and the optimal reception of meat and beans، and milk and dairy (p=0. 001، 0. 014 respectively) relationship were significant. Nutritional behavior in most of pregnant women، especially those with lower income and education level، was weak. Inadequate intake of meat and cereal as well as milk and dairy products was more common among those with lower income.

Depo-provera and cyclofem are the only available injection methods used by 2.6% of internal groups of women of Iran.Cyclofem has been provided by the public health system since 2007. However there is no study on continuances of this method in Iran; all of the studies on DMPA published in Iran have been conducted in urban areas. The aim of this study is to compare continuation rate and reasons for discontinuation of Depo-provera and cyclofem in health houses of East Azarbaijan. A retrospective cohort study was conducted on 422 women who had started using cyclofem (202 women) or Depo-provera (220 women) within 12-24 months prior to data collection.Data were gathered by a questionnaire which was completed by interview with individuals and were analyzed by SPSS/ using Kaplan Mayer and chi-square tests. The mean age of participants was 33 year(SD=7). 10% of participants had secondary education or higher. 92.5% were housewives. Continuation rate for Cyclofem during first 24 months was significantly less than Depo-provera (P<0.001). continuation rate of the 3, 6, 9, 12 monthes use of cyclofem were 56%, 37%, 30%, 27% versus 75%, 59.5%, 48%, 42.5% for Depo-provera.The most common reasons for discontinuation in the both groups were menstural changes as a combined reason (85% for Depo-provera versus 72% for cyclofem,P=0.008) and amenorrehea as a individual reason (50% versus 22%, P<0.001). Continuation rate of cyclofem was significantly lower than Depo-provera (P<0.001). The main reason for discontinuationof the methods in both of these groups was menstrual changes especially amenorrhea or menstruation spotting which have no life-threating side effects. Regarding this case and low relativecontinuity of these methods (compared with studies conducted in other countries) health providers can help to improve continuation rate by appropriate consultation education of women.

Prematurity is still one of the main causes of neonatal mortality and morbidity that makes a lot of financial, psychosocial and emotional problems. Although the main cause of preterm labor is unknown but understanding of its risk factors is important for planning health policies for preventing and decreasing the rate of preterm labor. This study aimed to compare lifestyle of women with term and preterm delivery. This research is a case-control study. Subjects of this study were 132 women with preterm labor and 264 women with term labor that referred to Educational and Medical Center of Alzzahra. The subjects were selected by convenience method and matched in age and educational level. Data were collected by questionnaire containing two sections, demographic characteristics and woman's lifestyle including, nutrition, exercise, smoking and use of alcohol and substance abuse, social support, stress management and self care. Data were analyzed by SPSS with descriptive statistics and statistical tests of t Test, Man Witny U, χ 2 and Fisher's Exact Test. The results of this study showed significant differences in nutrition, smoking, use of alcohol, substance abuse, social support, stress management and self care between two groups, but the mean score of exercise in term and preterm birth was not statistically significant. The findings of our study suggest that there is a relation between lifestyle in pregnancy and preterm birth. Lifestyle is changeable and achieving this aim is possible by efforts to increase health education.