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Fatemeh Najafi-Sharjabad, Mohammad Rayani,
Volume 16, Issue 2 (11-2019)
Volume 16, Issue 2 (11-2019)
Abstract
Background: Human Papilloma Virus (HPV) is the causative agent of cervical cancer. Vaccination against HPV is an effective strategy against cervical cancer. This study aimed to assess the acceptance of HPV vaccination for cervical cancer prevention and its relationship with knowledge and attitude about HPV vaccination among students.
Methods: This cross-sectional study was carried out on 360 female students at Bushehr University of Medical Sciences in 2018. Students were recruited using proportional stratified random sampling method. Data was gathered using a questionnaire about knowledge, attitude and effective factors of HPV vaccine acceptance. Descriptive analysis, chi-square, independent sample t-test, and logistic regression were used to analyze the data in SPSS-16.0 (SPSS Inc., Chicago, IL, USA). The significance level was set at P < 0.05.
Results: 56.4% of students had poor knowledge while 54.1% were willing to accept HPV vaccination as well as 43% who had positive attitude towards HPV vaccination. Paramedical students were 96% more likely to accept the HPV vaccination compared to health sciences faculty students (OR= 1.96; 95% CI= 1.04-3.68; p=0.036). Also, for each unit increase in the HPV knowledge score, students were 15% more likely to accept the vaccine (OR= 1.15; 95% CI= 1.07-1.24; p <0.001). Moreover, for each unit increase in attitude score, students were 16% more likely willing to accept HPV vaccine (OR= 1.16; 95% CI=1.08 -1.28; p =0.002).
Conclusions: It is necessary to implement on HPV vaccination for students. Inclusion of HPV vaccine in the National Program on Immunization would also be an effective strategy for improving HPV vaccination.
Tayebeh Ebadi, Borghei Narjes Sadat , Roghieh Bayrami , Zahra Mehrbakhsh ,
Volume 16, Issue 2 (11-2019)
Volume 16, Issue 2 (11-2019)
Abstract
Background: Preconception care is an opportunity to change unhealthy behaviors which in turn reduces unplanned pregnancy and plays an important role in reducing maternal and infant mortality. The aim of this study was to determine the level of preconception care and its related factors in pregnant women.
Methods: This cross-sectional study was conducted on 394 pregnant women referred to Gorgan health centers in 2017. Samples were selected by multi-stage stratified sampling method from Gorgan health centers in Golestan province. Data was gathered using self-report questionnaire. Data analysis was performed using chi-square test, Fisher's exact, and Kruskal-Wallis tests in SPSS-16. The P-value less than 0.05 were considered significant.
Results: 32.7% of women were received complete preconception care and 17.8% had no pre-pregnancy care. Only 44.2% of women used folic acid daily since the first trimester of pregnancy. Most of pregnant women (63.7%) performed triple screening laboratory test (FBS, CBC, TSH). Preconception care was more successful in mothers with higher level of education (p<0.001), having health insurance (p<0.001), history of disease (p=0.027), higher family income (p=0.044), and nulliparity (p= 0.049).
Conclusions: Preconception care coverage and acid folic consumption is not optimal. It seems necessary to plan more precisely on how such services need to be provided. The identification of factors associated with this care showed that far less attention was paid among low-income, without assurance coverage and low-educated people. Since these people do not have enough money to take care of mother and infant during pregnancy, health policymakers should provide the related services for free.
Fatemeh Alijani, Ahmad Khosravi , Mahdieh Sadat Mousavi , Vanessa Delarosa ,
Volume 16, Issue 2 (11-2019)
Volume 16, Issue 2 (11-2019)
Abstract
Background: Domestic violence (DV) against women is a global public health concern. The study was conducted to determine the associated factors of domestic violence against infertile women.
Methods: This cross-sectional study was done on 379 infertile women referred to the infertility clinic in Sari, between October 2015 and March 2016. The convenience sampling was used considering inclusion criteria. Data was collected using Revised Conflict Tactics Scale (CTS2). Data was presented with descriptive statistics and Logistic regression to determine associated factors with DV in SPSS-16 software. The significant level was considered P<0.05.
Results: Finding showed that majority of infertile women (88.9%) experienced domestic violence. The age (OR=0.91 95% CI: 0.85-0.99) and smoking (OR=8.12 95% CI: 1.87-35.21) with domestic violence.
Conclusions: Regarding the high prevalence of domestic violence and its consequence on society, screening violence in health centers and support at-risk family via counseling are recommended.
Ali Zafarzadeh, Abotaleb Bay, Seyed Kamal Mirkarimi, Ahmad Heidari,
Volume 16, Issue 2 (11-2019)
Volume 16, Issue 2 (11-2019)
Abstract
Background: Pesticides are chemical compounds which are used to fight against and to control plant and animal pests as vectors of diseases. In view of being exposed to pesticides, farmers are at high risk of occupational diseases. In this regard, the predictability of Health Belief Model (HBM) has been confirmed for the studies in promoting health behaviors. The aim of the study was to investigate the determinants of health behaviors of farmers on poisoning with pesticides in Golestan province based on HBM.
Methods: A cross-sectional study was conducted on 294 farmers covered under Health centers in Azadshahr, Golestan province in 2015. A multi-stage sampling method was used. Data was collected through HBM questionnaire and analyzed using Pearson and Spearman rank correlation coefficient, one-way ANOVA, and linear regression model in SPSS-16. The P-value was considered significant as <0.05.
Results: The mean age of participants was 46.12±11.45 years (ranged from 17 to 75). The majority of participants was under diploma (60.1%) and used television educational programs (76.9%) as main source of information and chemical dealers (68.4%) as main cues to action. There was a significant correlation between educational status and the amount of pesticide (p=0.024). In final, perceived barriers was the variable for predicting the healthy behavior of farmers (β= 0.208, p=0.004).
Conclusions: The results presented in this study recommend that since the majority of farmers were awarded high school diploma, designing and developing effective interventions in order to promote knowledge and perceived self-efficacy should be considered.
Hamide Jometondoki, Fereshteh Ghorat, Mohammad Hassan Rakhshani, Hasan Khalili,
Volume 16, Issue 2 (11-2019)
Volume 16, Issue 2 (11-2019)
Abstract
Background: Intravenous catheterization is one of the most common invasive interventions in the nursing profession which is associated with pain and patient dissatisfaction. The aim of the present study was to investigate the effect of topical lavender essential oil on the severity of pain caused by intravenous catheterization.
Methods: This randomized clinical trial performed on 66 elective surgery candidates in Shahid Beheshti Hospital of Sabzevar in 2017. The eligible patients was recruited through convenient sampling method considering inclusion criteria they were then randomly allocated into intervention (n=33) and placebo (n=33) groups using permutation blocks. 3 puffs of lavender essential oil were used onto the insertion sites of patients in the intervention group, while in the placebo group there were applied 3 puffs of distilled water. Severity of pain was measured using Visual Analogue Scale (VAS) at immediate, 5 and 10 minutes after intravenous catheterization. Data was presented descriptive statistics and analyzed using Chi-square and Mann-Whitney in SPSS-16. The P-value less than 0.05 considered significant.
Results: The mean score of pain severity in the intervention group immediately, 5 minutes and 10 minutes after the intravenous catheterization was 3.00±2.23, 1.36±1.08 and 0.51±1.14, while in patient of placebo group was 5.72±2.46, 3.12±2.23 and 1.8±1.50 respectively, there was a statistically significant difference between groups.
Conclusions: The present study showed that the use of topical lavender essential oil is effective in decreasing pain severity caused by the intravenous catheter insertion. Therefore, the topical lavender essential oil can be used to prevent pain in patients before catheter insertion.
Seyed Ali Majidi, Shiva Alizadeh, Sobhaneh Kouchakzadeh Talami, Hamideh Safarmohammadi, Ehsan Kazemnezhad Leily, Monika Motagi, Mehdi Barzegar,
Volume 16, Issue 2 (11-2019)
Volume 16, Issue 2 (11-2019)
Abstract
Background: Patient safety is one of the main components of the health care services quality that implies avoidance of any harm or damage to the patient during the delivery of health care. The purpose of this study was to determine the patient safety culture from the view point of nurses in the hospitals of Guilan province in 2016.
Methods: This cross-sectional study was done on 400 nurses from the nurse community in Guilan province, Iran in 2016. The sampling was performed as the two-stage cluster sampling method. Data were collected using a modified questionnaire based on the Hospital Survey on Patient Safety Culture (HSOPSC). Data were presented with descriptive statistics analysis using in SPSS-14. The significant level was considered less than 0.05.
Results: Most of the nurses were female (89%), with a mean age of 34.28±6.86 years. The most response to the items was related to “Please give your work area/unit in this hospital an overall grade on patient safety” that was the acceptable option (47.5%). The mean score of the patient safety was 3.28 ±0.86.
Conclusions: The results showed two dimensions including staffing and teamwork within units. Feedback and communication about errors were the most important dimensions of the patient safety culture. Accordingly, it should be noted that paying more attention to the patient safety culture can lead to improve hospital condition levels.
Volume 17, Issue 0 (4-2020)
Abstract
Soghra Khani , Souri Soleimani , Hamid Sharif Nia, Fatemeh Abdollahy,
Volume 17, Issue 0 (4-2020)
Volume 17, Issue 0 (4-2020)
Abstract
Background: Today, one of the key ways to promote Sexual and Reproductive Health of women is to attract men's participation in this field. Since there are challenges in our information about men's knowledge of their role in this field, the present study was designed to determine men's knowledge of their participation in women's sexual and reproductive health and its predictive factors in Iranian men.
Methods: The present study was designed and psychometrically analyzed the men's knowledge about their participation in sexual and reproductive health and then their knowledge was evaluated and described. In order to design the tool, the basics were prepared by interviewing and reviewing the texts.
Then, face (qualitative and quantitative), content (qualitative and quantitative), structure (convergent and discriminant) validity, and reliability of the scale were assessed. Then, in a descriptive-analytic study, 449 men were selected by convenience method from health centers, Nowshahr and Chalus cities in Mazandaran province.
Inclusion criteria included married men over 15 years of age with at least a fifth grade literacy in Farsi who came to health centers and who volunteered to participate in the study. Data were collected using a questionnaire (designed by the research team). The minimum knowledge score was 39 and the maximum was 195.
Results: Face (qualitative and quantitative (impact score>1.5)), content (qualitative and quantitative (CVR>0.62 and CVI>0.70)), structure (convergent and discriminant) validity, and reliability of the scale (Cronbach’s alpha > 0.7) were acceptable for all factors as well as internal consistency and structural reliability based on standard indices.
Confirmatory and exploratory factor analysis extracted six items of 28 items: "emotional and gender attention", "support for girls", "attention and supply of sexual and reproductive health needs", "violence avoidance", "responsibility" and "reproductive rights" with 28 items. The six-factor fitting of men's knowledge tool was confirmed by standard indices.
14.5% of the participants had a under school diploma. Most of them (76.4%) reported average household income. The maximum age of 72 was at least 23 and their mean age was 42.6. The results showed that the mean score of men's knowledge was 127.45 ± 8.33 and the maximum was 140, at least 86. Significant predictors in the regression analysis were forced marriage (B = -10.676), economic violence (B = -1.381), and having a history of abortion (B = -2.022).
Conclusions: The findings of the study showed that men's knowledge is inversely correlated with men's economic violence against women and forcing young people to choose a partner against their own inner desires and also with unwanted pregnancy and abortion. Therefore, policymakers and managers are recommended to pay close attention to increasing men's knowledge and it’s predictive to prevent these three inappropriate social phenomena.
Zohreh Shahhosseini , Zeinab Hamzehgardeshi , Souri Soleimani ,
Volume 17, Issue 0 (4-2020)
Volume 17, Issue 0 (4-2020)
Abstract
Background: Endometriosis refers to the presence of endometrial tissue (endocrine glands and stroma) outside of the uterine cavity. The prevalence of this disease is approximately 10% of women in the general population. Since there is no definitive treatment for endometriosis, medical and surgical treatment often reduces more symptoms and it prevents the progression of the disease while each of them encompasses a special side effect. CAM treatments (Complementary and Alternative Medicine) are non-pharmacologic interventions that reduce pain and mood disorder and also help to improve women's quality of life through mind and body interventions. The aim of this study was to address non-pharmacological interventions in endometriosis pain management.
Methods: This study was a review that for compile this article, at first search was done in Google Scholar database and more specifically in Persian databases such as Scientific Information Database (SID), Magiran, Iranmedex and English databases like PubMed, Springer, Scopus, Web of Science, Science Direct with key words such as endometriosis, chronic pelvic pain, hypnotisis, cognitive behavioral therapy and massage and articles related with the topic of this article were searched from 2000 to 2017. A total of 400 articles were searched that in abstract screening stage 122 articles were deleted due to being duplicate and 256 articles were deleted due to the lack of relevance with the objectives of the study and finally after reviewing the full text of articles, 22 articles were used for writing this study.
Results: The results of reviewing studies regarding the non-pharmacological treatments methods for endometriosis were organized in 6 main categories. 1. Moxibustion, a traditional Chinese medicine that involves of moxa at specific points of the body, 2. Medicinal herbs such as Astragalus, Ginkgo and Ginseng, 3. Massage therapy, 4. Psychological interventions such as cognitive-behavioral therapy, 5. Acupuncture, such as ear and body acupuncture, 6. Chinese Enema.
Conclusions: It seems that non-pharmacological treatments reduce the pain score in patients with endometriosis. These treatments can be proposed as common methods to treat patients with painful conditions of reproductive system including endometriosis. However, further studies on this issue should be conducted with larger samples with specified pain conditions.
Soghra Khani , Souri Soleimani , Hamid Sharif Nia, Fatemeh Abdollahy,
Volume 17, Issue 0 (4-2020)
Volume 17, Issue 0 (4-2020)
Abstract
Background: Men's participation is an important strategy in achieving the goals of the Third Millennium Development such as empowering women and promoting maternal health. Men's participation includes responsibilities and their participation in the vital aspects that promote the promotion of sexual and reproductive rights and health for men and women in society. The purpose of this study was to determine men's attitude towards their participation in women's sexual and reproductive health and its predictive factors in Iranian men.
Methods: This is a descriptive-analytic study. The men were selected by convenience method from health centers, laboratories and dental clinics of Nowshahr and Chalus cities in Mazandaran province. A total of 449 men (≥15 years) were married at least once. Demographic information was collected using a demographic questionnaire and attitudes toward participation in sexual and reproductive health with an attitude questionnaire (designed and researched by the research team).
Results: Among the participants (n = 449), all men were married, their mean age was 42.6, and 14.5% of them had a under school diploma. Most of them also reported moderate (76.4%) household income. Minimum attitude score was 38 and maximum was 190. The results showed that the mean score of men's attitude was 98.97 ±6.92 and the maximum was 105, its minimum was 65. Significant predictors were in the regression analysis of temporary marriage (B = - 0.210) and physical violence (B = - 0.170). Both variables (physical violence and temporary marriage) were inversely correlated with men's participation in sexual and reproductive health.
Conclusions: According to the results of this study, there is a need for serious training and efforts and prevention of violence, including physical violence of men against women, in order to promote men's attitude to participation in women's sexual and reproductive health. Promoting permanent marriage rather than temporary marriage is also offered to those in the cultural sphere.
Methods: This is a descriptive-analytic study. The men were selected by convenience method from health centers, laboratories and dental clinics of Nowshahr and Chalus cities in Mazandaran province. A total of 449 men (≥15 years) were married at least once. Demographic information was collected using a demographic questionnaire and attitudes toward participation in sexual and reproductive health with an attitude questionnaire (designed and researched by the research team).
Results: Among the participants (n = 449), all men were married, their mean age was 42.6, and 14.5% of them had a under school diploma. Most of them also reported moderate (76.4%) household income. Minimum attitude score was 38 and maximum was 190. The results showed that the mean score of men's attitude was 98.97 ±6.92 and the maximum was 105, its minimum was 65. Significant predictors were in the regression analysis of temporary marriage (B = - 0.210) and physical violence (B = - 0.170). Both variables (physical violence and temporary marriage) were inversely correlated with men's participation in sexual and reproductive health.
Conclusions: According to the results of this study, there is a need for serious training and efforts and prevention of violence, including physical violence of men against women, in order to promote men's attitude to participation in women's sexual and reproductive health. Promoting permanent marriage rather than temporary marriage is also offered to those in the cultural sphere.
Tayebeh Ebadi, Narjes Sadat Borghei , Roghieh Bayrami, Zahra Mehrbakhsh,
Volume 17, Issue 0 (4-2020)
Volume 17, Issue 0 (4-2020)
Abstract
Background: Preconception care is an opportunity to change unhealthy behaviors, and reduces unplanned pregnancies and plays important role in reducing maternal and infant mortality. Considering the importance of these care services, this study was conducted to determine preconception care and its related factors in Groan's pregnant women.
Methods: This cross-sectional descriptive study was conducted on 394 pregnant women referring to Gorgan health centers. Samples were selected by multi-stage Stratified sampling. Bayrami's researcher-made questionnaire, that validity and reliability Steps has been accomplished in Mashhad urban community, was used to collect information. Data analysis was performed by using SPSS16 software and chi-square test and KruskalWallis. P value less than 0.05 was considered significant.
Results: 32.7% (129) of women was received complete preconception care and 17.8% (70) had no pre-pregnancy care, only, 44.2% (174) of women used folic acid daily from the previous three months of pregnancy. Also, 251 (63.7%) of pregnant women performed triple screening laboratory test (FBS, CBC, TSH). Preconception care was done better in mother's with high education (P <0.001), health insurance (P <0.001), illness history (P <0.005), high family income (P <0.001) and nulliparity (P = 0.001).
Conclusions: Preconception care coverage and acid folic consumption is not optimal. It seems to be necessary to plan more precisely how such services are provided. The identification of factors associated with this care, showed that less attention was paid for low-income, without assurance coverage and low-educated people. Although these people will not have enough money to take care of their during pregnancy, health policymakers should take care of these services for free.
Seyede Mahshid Seyed Hoshiyar, Elham Khoori , Mahin Tatari , Tayebe Ziaei,
Volume 17, Issue 0 (4-2020)
Volume 17, Issue 0 (4-2020)
Abstract
Background: Menopause is a physiologic and natural period in women’s lives. Available solutions to improve quality of life include counseling interventions. Thus, present study has been performed with the purpose of evaluating the effects of self -awareness-based counseling on quality of life of postmenopausal women in Gorgan during 2018.
Methods: The present study is a clinical trial including two groups of pretest and posttest. Stratified sampling was performed by appropriate allocation of the selection and straw poll and 52 postmenopausal women placed in two groups of control and intervention. In order to prevent probable exchange of information between the two groups, at first the control group filled in the demographic specification form and menopausal quality of life questionnaire at the beginning of the study, and after 6 and 10 weeks. The intervention group, also, filled in the demographic specification form and menopausal quality of life questionnaire at the beginning of the study, after 6 sessions of self-awareness counseling and one month after termination of the sessions. Finally, the data were analyzed by SPSS16 software and Anova analysis testing method with repeated measures.
Results: There was a significant statistical difference in mean score of quality of life in menopause and its various dimensions in the intervention group during three times studied. However, there was no statistical difference in the control group. In the intergroup comparisons of the two groups, a significant statistical difference was observed in mean score of quality of life and its various dimensions except for psychosocial dimension.
Conclusions: Self-awareness-based counseling will cause in improvement of life quality. Therefore, self-awareness-counseling should be used in healthcare centers to promote postmenopausal women’s quality of life.
Methods: The present study is a clinical trial including two groups of pretest and posttest. Stratified sampling was performed by appropriate allocation of the selection and straw poll and 52 postmenopausal women placed in two groups of control and intervention. In order to prevent probable exchange of information between the two groups, at first the control group filled in the demographic specification form and menopausal quality of life questionnaire at the beginning of the study, and after 6 and 10 weeks. The intervention group, also, filled in the demographic specification form and menopausal quality of life questionnaire at the beginning of the study, after 6 sessions of self-awareness counseling and one month after termination of the sessions. Finally, the data were analyzed by SPSS16 software and Anova analysis testing method with repeated measures.
Results: There was a significant statistical difference in mean score of quality of life in menopause and its various dimensions in the intervention group during three times studied. However, there was no statistical difference in the control group. In the intergroup comparisons of the two groups, a significant statistical difference was observed in mean score of quality of life and its various dimensions except for psychosocial dimension.
Conclusions: Self-awareness-based counseling will cause in improvement of life quality. Therefore, self-awareness-counseling should be used in healthcare centers to promote postmenopausal women’s quality of life.
Razieh Karrabi , Maryam Farjamfar, Foroughossadat Mortazavi, Ali Mohammad Nazari, Shahrbanoo Goli,
Volume 17, Issue 0 (4-2020)
Volume 17, Issue 0 (4-2020)
Abstract
Background: Pregnancy is one of the enjoyable and evolutionary aspects of women’s lives. In addition to being enjoyable, pregnancy is usually stressful. Counseling is one of the most appropriate interventions for decreasing worries and anxiety. Solution-focused counseling is a short-term treatment which focuses on positive and healthy aspects of liferather than problems and illnesses. In this regard, instead of focusing on shortcomings and disabilities, the therapist focuses on resources and abilities of the clients. This study was conducted to determine the effect of solution-focused counseling group therapy on pregnant women’s worries.
Methods: This clinical trial was performed on 108 pregnant women who met the inclusion criteria: mothers aged 15-45, first pregnancy, gestational age of 6 to 19 weeks, reading literacy and worry score ≥ 55, from May to September 1397. The study was conducted at Sabzevar University of Medical Sciences and Reyhaneh Beheshti Obstetrics Consultation Center.
The subjects were randomly assigned to 4 blocks in two groups namely intervention group (5 sessions of solution- focused consultation) and control group regarding prenatal care (individual and psychological health education, sex, nutrition, breastfeeding, etc ...). Demographic and obstetric information were completed before the intervention. Concerns of pregnant women were evaluated before, after, and two months after the intervention with the Farsi Cambridge Worry Scale. This scale measures pregnant women's concerns about social medical status, socioeconomic status, maternal and neonatal health, childbirth, and relationship with spouse and others. There were graded scales on a 6-point Likert scale including: “not worried” (0) to “I am deeply concerned about” (6). The data were analyzed using t-test, chisquare, and repeated measure analysis of variance through SPSS software version 22. A P value less than 0.05 was considered as statistically significant.
Results: The mean score of women’s worries before the beginning of the study in the intervention and control group were (58.9 ± 5.9) and (58.8 ± 4.37) respectively. After intervention, these values were 34/6 ± 3.13 and 57.7 ± 8.78. Two months after the study, these values were 31.1 ± 10.1 and 54.6 ± 10.9 respectively. The analysis of variance with repeated measurements showed that pregnant women’s concerns about childbirth, fetal health, maternal health, and family relationships significantly reduced after the intervention and two months later. Women’s worries regarding socioeconomic issues did not significantly reduce after the intervention and two month later in comparison with the control group )p = 0/563).
Conclusions: A solution- focused consultation is an effective way to reduce pregnant women's concerns about maternal, maternal health, delivery, and family relationships and can be used in conjunction with pregnancy care.
Methods: This clinical trial was performed on 108 pregnant women who met the inclusion criteria: mothers aged 15-45, first pregnancy, gestational age of 6 to 19 weeks, reading literacy and worry score ≥ 55, from May to September 1397. The study was conducted at Sabzevar University of Medical Sciences and Reyhaneh Beheshti Obstetrics Consultation Center.
The subjects were randomly assigned to 4 blocks in two groups namely intervention group (5 sessions of solution- focused consultation) and control group regarding prenatal care (individual and psychological health education, sex, nutrition, breastfeeding, etc ...). Demographic and obstetric information were completed before the intervention. Concerns of pregnant women were evaluated before, after, and two months after the intervention with the Farsi Cambridge Worry Scale. This scale measures pregnant women's concerns about social medical status, socioeconomic status, maternal and neonatal health, childbirth, and relationship with spouse and others. There were graded scales on a 6-point Likert scale including: “not worried” (0) to “I am deeply concerned about” (6). The data were analyzed using t-test, chisquare, and repeated measure analysis of variance through SPSS software version 22. A P value less than 0.05 was considered as statistically significant.
Results: The mean score of women’s worries before the beginning of the study in the intervention and control group were (58.9 ± 5.9) and (58.8 ± 4.37) respectively. After intervention, these values were 34/6 ± 3.13 and 57.7 ± 8.78. Two months after the study, these values were 31.1 ± 10.1 and 54.6 ± 10.9 respectively. The analysis of variance with repeated measurements showed that pregnant women’s concerns about childbirth, fetal health, maternal health, and family relationships significantly reduced after the intervention and two months later. Women’s worries regarding socioeconomic issues did not significantly reduce after the intervention and two month later in comparison with the control group )p = 0/563).
Conclusions: A solution- focused consultation is an effective way to reduce pregnant women's concerns about maternal, maternal health, delivery, and family relationships and can be used in conjunction with pregnancy care.
Azam Evin , Farnoosh Khojasteh , Hossein Ansari ,
Volume 17, Issue 0 (4-2020)
Volume 17, Issue 0 (4-2020)
Abstract
Background: Introduction: Since birth, a stressful experience, self-efficacy and self-confidence play an important role in mother's perception of delivery. Today, yoga is used to control anxiety and increase the sense of self-efficacy in different areas. The purpose of this study is to determine the effect of yoga on the self-efficacy of primiparous women.
Methods: This randomized clinical trial was conducted in 2017 on 60 primiparous women aged 18-40 and referred to Zahedan health centers. The participants were randomly assigned to two groups of intervention and control. During the weeks 26-27 of pregnancy, 30 mothers of the intervention group, received 12-15 sessions of Yoga exercises and 30 mothers of control group received normal care. Data were collected using a demographic an self-efficacy questionnaires. The pre-test was completed at week 26 and post-test at weeks 34-36 with two weeks in between; the data was analyzed using paired t-test Mann-Whitney and chi-square tests, linear regression tests and SPSS 16.
Results: The mean of self-efficacy score before intervention in the experimental and control group was (78.43 ± 24.7) and (62.69 ± 21.74) and after the intervention (124.45 ± 13.26) and (16.33±92.75) respectively, and (P=0001).
Conclusions: After the intervention, the mean of self-efficacy increased. It seems that Yoga has been used to increase self-efficacy of primiparous women in the second and third trimesters.
Mahnaz Niknejad Talemi, Fatemeh Ranjkesh, Mehdi Ranjbaran, Nasim Bahrami ,
Volume 17, Issue 0 (4-2020)
Volume 17, Issue 0 (4-2020)
Abstract
Background: Midwives experience high levels of perceived stress due to the nature of their work. Certain factors can play a significant role in occupational stress experience of this group. The aim of this study was to investigate the role of emotional intelligence in occupational stress among midwives.
Methods: In this descriptive - correlational study, 250 midwives working in health centers and public and private hospitals in Rasht from May to September 2012 were entered into the study by random sampling method. Demographic, emotional intelligence and occupational stress questionnaires were used to collect data. Data analysis was performed using descriptive and analytical statistics including independent t-test, one way ANOVA, Pearson correlation, multiple linear regression at the significant level of P <0.05 in SPSS version 23.
Results: The mean and standard deviation of emotional intelligence (114.20 ± 12.55) and midwifery occupational stress (119.66 ± 15.48). Occupational variables including workplace (Private Hospital: β=-0. 19,P=0.012) , overtime hours (β = -0.33, P = 0.001), sleeping hours (β = 0.13, P = 0.011), social activity (β = 0.11, P = 0.029) , age of the midwife (β = 0.25, P = 0.045), and the overall score of emotional intelligence (β = 0.55, P = 0.001) were predictors of occupational stress (P <0.05). These variables explained 49 % of variance of occupational stress.
Conclusions: The occupational stress of midwives is affected by certain individual and occupational factors. Therefore, by modifying or changing some of these variables such as emotional intelligence, the midwives' occupational stress may be reduced. In addition, by designing effective programs in this field, midwives can improve their performance by reducing their stress levels.
Methods: In this descriptive - correlational study, 250 midwives working in health centers and public and private hospitals in Rasht from May to September 2012 were entered into the study by random sampling method. Demographic, emotional intelligence and occupational stress questionnaires were used to collect data. Data analysis was performed using descriptive and analytical statistics including independent t-test, one way ANOVA, Pearson correlation, multiple linear regression at the significant level of P <0.05 in SPSS version 23.
Results: The mean and standard deviation of emotional intelligence (114.20 ± 12.55) and midwifery occupational stress (119.66 ± 15.48). Occupational variables including workplace (Private Hospital: β=-0. 19,P=0.012) , overtime hours (β = -0.33, P = 0.001), sleeping hours (β = 0.13, P = 0.011), social activity (β = 0.11, P = 0.029) , age of the midwife (β = 0.25, P = 0.045), and the overall score of emotional intelligence (β = 0.55, P = 0.001) were predictors of occupational stress (P <0.05). These variables explained 49 % of variance of occupational stress.
Conclusions: The occupational stress of midwives is affected by certain individual and occupational factors. Therefore, by modifying or changing some of these variables such as emotional intelligence, the midwives' occupational stress may be reduced. In addition, by designing effective programs in this field, midwives can improve their performance by reducing their stress levels.
Asieh Sadat Baniaghil, Shohreh Ghasemi, Masumeh Rezaei Aval , Nasser Behnampour,
Volume 17, Issue 0 (4-2020)
Volume 17, Issue 0 (4-2020)
Abstract
Background: Patient interview is the most common professional activity of clinicians. Effective interview can strengthen clinician-patient relationship and improve treatment outcomes. In some studies, such as saboori et al. (87-86) and Managheb et al. (2010), the Calgary-Cambridge model-based learning skill is effective in interviewing skills, while in other studies including Rezvani (2014), communication skills based on the Calgary-Cambridge model did not mention effective interviewing skills. This study aimed to evaluate the effects of communication skills training through the Calgary-Cambridge model on interviewing skills among midwifery students.
Methods: This two-group pretest-posttest randomized controlled field trial was conducted in 2017–2018. The number of participants was thirty including the students in the sixth and eighth semester of bachelor of midwifery conveniently recruited from Golestan University of Medical Sciences, Gorgan, Iran. Initially, their interviewing skill was assessed using Evan and colleague’s History-taking Rating Scale. Then, they were randomly allocated to a control (15) and to an intervention group (15) through stratified randomization based on their interviewing skill scores and their academic semester. Participants in the control group did not receive any communication skills training, while those in the intervention group received communication skills training based on Calgary-Cambridge model in four four-hour sessions held twice weekly (16 hours). Interviewing skills in the control and in the intervention groups was re-assessed respectively four weeks after pretest and four weeks after the intervention. Exclusion criteria were unilateral withdrawal from the study, two or more absences from communication skills training sessions, and failure to attend the communication skills assessment session. Therefore, one student in the control group and one student in the experimental group were excluded. Data were analyzed using SPSS software (v. 18.0).
Results: The pretest mean score of interviewing skills in the intervention and the control groups was 33.71±7. 342 and 33.64±6.021 respectively, with no significant between-group difference (P = 0.978). At posttest, the mean score of interviewing skills in the intervention and the control groups was 54.50±8.169 and 33.93±5.399 respectively and the between-group difference was statistically significant (P < 0.001).
Conclusions: Communication skills training through Calgary-Cambridge model is effective in significant improving midwifery students’ interviewing skills. The Calgary-Cambridge model could be used as part of the midwifery educational curriculum to improve the skills of interviewing midwifery students.
Methods: This two-group pretest-posttest randomized controlled field trial was conducted in 2017–2018. The number of participants was thirty including the students in the sixth and eighth semester of bachelor of midwifery conveniently recruited from Golestan University of Medical Sciences, Gorgan, Iran. Initially, their interviewing skill was assessed using Evan and colleague’s History-taking Rating Scale. Then, they were randomly allocated to a control (15) and to an intervention group (15) through stratified randomization based on their interviewing skill scores and their academic semester. Participants in the control group did not receive any communication skills training, while those in the intervention group received communication skills training based on Calgary-Cambridge model in four four-hour sessions held twice weekly (16 hours). Interviewing skills in the control and in the intervention groups was re-assessed respectively four weeks after pretest and four weeks after the intervention. Exclusion criteria were unilateral withdrawal from the study, two or more absences from communication skills training sessions, and failure to attend the communication skills assessment session. Therefore, one student in the control group and one student in the experimental group were excluded. Data were analyzed using SPSS software (v. 18.0).
Results: The pretest mean score of interviewing skills in the intervention and the control groups was 33.71±7. 342 and 33.64±6.021 respectively, with no significant between-group difference (P = 0.978). At posttest, the mean score of interviewing skills in the intervention and the control groups was 54.50±8.169 and 33.93±5.399 respectively and the between-group difference was statistically significant (P < 0.001).
Conclusions: Communication skills training through Calgary-Cambridge model is effective in significant improving midwifery students’ interviewing skills. The Calgary-Cambridge model could be used as part of the midwifery educational curriculum to improve the skills of interviewing midwifery students.
Aniseh Pourrasmi Mamaghani, Mohammadhiwa Abdekhoda, Parvin Bastani Alamdari, Masoud Mohammadi,
Volume 17, Issue 0 (4-2020)
Volume 17, Issue 0 (4-2020)
Abstract
Background: The rate of cesarean delivery in Iran is four times higher than the standard defined by the World Health Organization. Information counseling is a method for providing accurate information and helping primiparous women to make evidence-based decisions. This research was conducted to determine the effect of information counseling on decision making process of delivery.
Methods: This was a before and after clinical trial in which 120 pregnant women in the 28thweek of the pregnancy with no indication of cesarean sections (CS) and a health record were included. Sample size was calculated using cluster sampling and the formula n= (〖(Z_(α⁄(2- Z_(β ) )) )^2 δ〗^2 )/d^2 . The sample size was approximately 63 individuals. To correct the effect of cluster sampling, the calculated sample volume was multiplied by a factor of 1.4. To further validate the data, the number reached 120. Data gathering tool was a questionnaire designed based on reviewing previous studies and considering the purpose of the study whose validity and reliability were measured. The questionnaires were given to the women in two stages at week 28 and week 36. The interventions were in the form of packages containing brochures and information booklet on the benefits and disadvantages of natural childbirth and cesarean section in addition to training sessions taught by a midwifery specialist. Pros and cons of vaginal and cesarean modes of delivery were presented by training sessions. Women's preferential delivery mode were measured by a pre- and post- questionnaires and follow-up. After data collection, the analysis was performed at two levels of descriptive and inferential statistics. Finally, data were analyzed by SPSS16using t-test.
Results: The findings showed that the main indicators for determining the type of delivery, including awareness about delivery, making decision for delivery mode, understanding the risks of delivery mode, and self-efficacy were significantly associated with educational intervention and counseling (P<0.01). In the pre-intervention phase, 66.7% of women had normal delivery and 33.3% had cesarean section. After intervention, with a significant increase in choosing normal delivery, 78.4% chose natural childbirth and 15.3% chose cesarean section as the best option for delivery. Follow-up results after educational intervention showed that 44.2% of participants in this study performed normal delivery and 50% cesarean section. 8.5% were excluded from the study for certain reasons. After reviewing the results, it was found that encouraging physicians’ team to cesarean section was the main and primary cause of cesarean.
Conclusions: The implementation of information counseling has a great effect on encouraging women to change their decision patterns and self-making decision for VD maternity and reducing CD. However, in practice, certain factors, especially the constant recommendation of physicians’ team to CD as a programmable and convenient delivery, undermine the role of these interventions.
Methods: This was a before and after clinical trial in which 120 pregnant women in the 28thweek of the pregnancy with no indication of cesarean sections (CS) and a health record were included. Sample size was calculated using cluster sampling and the formula n= (〖(Z_(α⁄(2- Z_(β ) )) )^2 δ〗^2 )/d^2 . The sample size was approximately 63 individuals. To correct the effect of cluster sampling, the calculated sample volume was multiplied by a factor of 1.4. To further validate the data, the number reached 120. Data gathering tool was a questionnaire designed based on reviewing previous studies and considering the purpose of the study whose validity and reliability were measured. The questionnaires were given to the women in two stages at week 28 and week 36. The interventions were in the form of packages containing brochures and information booklet on the benefits and disadvantages of natural childbirth and cesarean section in addition to training sessions taught by a midwifery specialist. Pros and cons of vaginal and cesarean modes of delivery were presented by training sessions. Women's preferential delivery mode were measured by a pre- and post- questionnaires and follow-up. After data collection, the analysis was performed at two levels of descriptive and inferential statistics. Finally, data were analyzed by SPSS16using t-test.
Results: The findings showed that the main indicators for determining the type of delivery, including awareness about delivery, making decision for delivery mode, understanding the risks of delivery mode, and self-efficacy were significantly associated with educational intervention and counseling (P<0.01). In the pre-intervention phase, 66.7% of women had normal delivery and 33.3% had cesarean section. After intervention, with a significant increase in choosing normal delivery, 78.4% chose natural childbirth and 15.3% chose cesarean section as the best option for delivery. Follow-up results after educational intervention showed that 44.2% of participants in this study performed normal delivery and 50% cesarean section. 8.5% were excluded from the study for certain reasons. After reviewing the results, it was found that encouraging physicians’ team to cesarean section was the main and primary cause of cesarean.
Conclusions: The implementation of information counseling has a great effect on encouraging women to change their decision patterns and self-making decision for VD maternity and reducing CD. However, in practice, certain factors, especially the constant recommendation of physicians’ team to CD as a programmable and convenient delivery, undermine the role of these interventions.
Roghayeh Haji Gholikhani, Fatemeh Seifi, Mohammad Sadegh Montazeri, Naser Behnampour,
Volume 17, Issue 0 (4-2020)
Volume 17, Issue 0 (4-2020)
Abstract
Background: Drug addiction is one of the most significant psychosocial disorders. According to studies, considering the increasing prevalence of this problem, Education, with Creating Supportive environment to reduce Sustained injuries the family members with an Addict Is felt More than ever. Thus a study was conducted to determine the effectiveness of communication skills training on marital satisfaction in Wives of Men are in Drugs Withdrawal Period in Gorgan.
Methods: This randomized controlled field trial was performed on 40 patients. The Code of Ethics is IR.GOUMS.REC.1397.068. Samples were included in the study with a set of criteria (leaving husbands addicted men, ages 45-18, can read and write, at least one year of living together, single-wives ...). The intervention group was trained in communication skills at the nearest holistic health center of their residence, for 8 sessions (5 to 10 people). The control group received no intervention. Immediately after the end of the eighth session and one month thereafter, both groups completed the Persian Enrich Marital Satisfaction Questionnaire. The data were analyzed using SPSS 16 software and parametric t-test for two independent groups and paired t-test for comparison before and after the intervention and Mann-Whitney test.
Results: The results of this study showed that the mean and standard deviation of quantitative data (age, income, and duration of marriage…) were not significantly different between intervention and control groups (P> 0.05). Also, the results of the comparison of all qualitative data (education, ethnicity, occupation, the type of drug used before Withdrawal Period…) were homogeneous in the intervention and control groups (P> 0.05). The mean and standard deviation of marital satisfaction were significantly different in the intervention group, before (100/11 ± 25/24), immediately after (125/75 ± 12/35) and one month thereafter (114/18 ± 5/63) counseling (P <0/0007). However, the difference of mean and standard deviation of marital satisfaction were not significant in the control group, before (98/65 ± 14/41), immediately after (95/35 ±15/51) and one month thereafter (93/15 ± 16/35) counseling (P> 0.05).
Conclusions: According to the results of the study, Communication Skills Training can improved the Marital Satisfaction in Wives of Men are in Drugs Withdrawal Period in most subscales.Therefore, and further studies are suggested to increase the skills of families of addicts.who are leaving.
Methods: This randomized controlled field trial was performed on 40 patients. The Code of Ethics is IR.GOUMS.REC.1397.068. Samples were included in the study with a set of criteria (leaving husbands addicted men, ages 45-18, can read and write, at least one year of living together, single-wives ...). The intervention group was trained in communication skills at the nearest holistic health center of their residence, for 8 sessions (5 to 10 people). The control group received no intervention. Immediately after the end of the eighth session and one month thereafter, both groups completed the Persian Enrich Marital Satisfaction Questionnaire. The data were analyzed using SPSS 16 software and parametric t-test for two independent groups and paired t-test for comparison before and after the intervention and Mann-Whitney test.
Results: The results of this study showed that the mean and standard deviation of quantitative data (age, income, and duration of marriage…) were not significantly different between intervention and control groups (P> 0.05). Also, the results of the comparison of all qualitative data (education, ethnicity, occupation, the type of drug used before Withdrawal Period…) were homogeneous in the intervention and control groups (P> 0.05). The mean and standard deviation of marital satisfaction were significantly different in the intervention group, before (100/11 ± 25/24), immediately after (125/75 ± 12/35) and one month thereafter (114/18 ± 5/63) counseling (P <0/0007). However, the difference of mean and standard deviation of marital satisfaction were not significant in the control group, before (98/65 ± 14/41), immediately after (95/35 ±15/51) and one month thereafter (93/15 ± 16/35) counseling (P> 0.05).
Conclusions: According to the results of the study, Communication Skills Training can improved the Marital Satisfaction in Wives of Men are in Drugs Withdrawal Period in most subscales.Therefore, and further studies are suggested to increase the skills of families of addicts.who are leaving.
Houri Alijani , Narjes Sadat Borghei, Naser Behnampour ,
Volume 17, Issue 0 (4-2020)
Volume 17, Issue 0 (4-2020)
Abstract
Background: Pregnancy is considered as a critical stage in the life of a woman due to the creation of new tasks and anxieties, If we consider the fear of childbirth as one of the main causes of pregnancy anxiety, To reduce it, we need to look for other solutions, such as psychological solutions. This study was conducted with the aim of determining the effect of group-based cognitive-behavioral Educations on the fear of delivery of Primiparous mothers.
Methods: This quasi-experimental study with pre-test and post-test design, three groups were conducted in the second half of the year in 1396 cities of Gorgan.The data collection tool was a demographic data form and Wijma Delivery/Expectency fear of childbirth Questionnaire (version A). Primiparous Pregnant mothers who were 20-28 weeks old were asked to participate in the study through the Lean system, and 211 patients were referred to relevant health centers and clinics. They completed the maternity fear questionnaire. Among these mothers, 104 nulliparous women with average score of fear of childbirth of 55 and above were divided into three groups: first and second intervention and control group. Based on ethical considerations, the allocation of mothers to intervention and control groups conducted based on their desire. The first intervention group performed eight sessions of group training based on cognitive-behavioral techniques, the second intervention group spent eight sessions of conventional pregnancy training, and the control group did not receive any training. The scores of fear of childbirth in all three groups before and immediately after intervention were analyzed by ANOVA, Kruskal-Wallis, Wilcoxon and paired t-test using SPSS software version 18, were compared and analyzed statistically. The significance level of the tests was considered to be 0.05.
Results: The results showed that before the intervention, the mean scores of fear of childbirth in the three groups were statistically significant and the first group of intervention (group training based on cognitive-behavioral techniques) had a higher mean scores 92.58 ± 12.70, compared to the second group of intervention (conventional education during pregnancy) was 66.54 ± 10.48 and the control group was 73.33 ± 13.13 (P-value <0.0001). Therefore, comparison of the difference before and after the mean scores and the rate of change in the three groups were used. Also, the mean scores of fear of childbirth after intervention in group training based on cognitive-behavioral techniques were 42.81 ± 18.45 in the conventional education group 67.19 ± 11.91 in control group 83.83 ± 18.28 and (P-value< 0/0001). The comparison of the mean scores of fear of delivery before and after intervention showed that group training based on cognitive-behavioral techniques -49.76 ± 19.86 was more than that of the conventional education groups in the period of pregnancy of 0.65 ± 10.14 And control group 11.5 ± 11.36 had a significant reduction in fear scores, which was statistically significant (P-value <0.0001).
Conclusions: Group-based cognitive-behavioral techniques focusing on reducing childbirth fears have the potential to reduce the fear of childbirth in all domains, for the promotion of normal delivery, the Changing the routine content of traditional pregnancy education is a matter of community based on cognitive-behavioral techniques, Focus on reducing fear of childbirth should be considered by healthcare providers.
Methods: This quasi-experimental study with pre-test and post-test design, three groups were conducted in the second half of the year in 1396 cities of Gorgan.The data collection tool was a demographic data form and Wijma Delivery/Expectency fear of childbirth Questionnaire (version A). Primiparous Pregnant mothers who were 20-28 weeks old were asked to participate in the study through the Lean system, and 211 patients were referred to relevant health centers and clinics. They completed the maternity fear questionnaire. Among these mothers, 104 nulliparous women with average score of fear of childbirth of 55 and above were divided into three groups: first and second intervention and control group. Based on ethical considerations, the allocation of mothers to intervention and control groups conducted based on their desire. The first intervention group performed eight sessions of group training based on cognitive-behavioral techniques, the second intervention group spent eight sessions of conventional pregnancy training, and the control group did not receive any training. The scores of fear of childbirth in all three groups before and immediately after intervention were analyzed by ANOVA, Kruskal-Wallis, Wilcoxon and paired t-test using SPSS software version 18, were compared and analyzed statistically. The significance level of the tests was considered to be 0.05.
Results: The results showed that before the intervention, the mean scores of fear of childbirth in the three groups were statistically significant and the first group of intervention (group training based on cognitive-behavioral techniques) had a higher mean scores 92.58 ± 12.70, compared to the second group of intervention (conventional education during pregnancy) was 66.54 ± 10.48 and the control group was 73.33 ± 13.13 (P-value <0.0001). Therefore, comparison of the difference before and after the mean scores and the rate of change in the three groups were used. Also, the mean scores of fear of childbirth after intervention in group training based on cognitive-behavioral techniques were 42.81 ± 18.45 in the conventional education group 67.19 ± 11.91 in control group 83.83 ± 18.28 and (P-value< 0/0001). The comparison of the mean scores of fear of delivery before and after intervention showed that group training based on cognitive-behavioral techniques -49.76 ± 19.86 was more than that of the conventional education groups in the period of pregnancy of 0.65 ± 10.14 And control group 11.5 ± 11.36 had a significant reduction in fear scores, which was statistically significant (P-value <0.0001).
Conclusions: Group-based cognitive-behavioral techniques focusing on reducing childbirth fears have the potential to reduce the fear of childbirth in all domains, for the promotion of normal delivery, the Changing the routine content of traditional pregnancy education is a matter of community based on cognitive-behavioral techniques, Focus on reducing fear of childbirth should be considered by healthcare providers.
Hossein Hatami, Omid Mozafari, Somayeh Zakeri, Fatemeh Kolangi,
Volume 17, Issue 0 (4-2020)
Volume 17, Issue 0 (4-2020)
Abstract
Background: Just as breastfeeding is important, breastfeeding is one of the most important stages of mother and baby life. Disregard for this stage of a child's life can have profound effects on the physical and mental health of the child and even the mother. Anxiety, restlessness, weight loss, and disruption of the child's relationship to and trust in the mother are the most common.
Methods: This study was a descriptive review and the content of infant weaning in traditional Iranian medical literature was studied. For this purpose, 8 books were selected from the most prestigious sources of traditional Iranian written medicine and extracted and extracted from the lactation section on how to wean. Then the contents of each title from the extracted notes were put together. The texts were translated with difficult prose simplifications and Arabic texts were finally summarized by summarizing these titles.
Results: In ancient medical texts of Iran, the weaning of the baby from mother was reported. It was believed that the best time for a baby to breastfeed is about one year and nine months to two years of age. The best season is spring and then autumn and weaning are not recommended in the summer heat. Breastfeeding should be gradual and gradually replacing breast-feeding with age-appropriate foods. In the alternative food chain, they have recommended a range of suitable foods, including breadcrumbs, egg yolk with breast milk, chicken breast, and chicken salads. It should be noted when breastfeeding that the child does not become dehydrated, so it is advisable to consume sufficient fluids, including cucumber juice, buttermilk, and purslane juice, as well as preventive measures to be taken with henna on the palm of the hand and head. Breastfeeding with something bitter that does not harm the baby is another recommended procedure.
Conclusions: Studying Iranian traditional medicine texts and using the recommended wisdom (after updating them) along with the current methods used may help in better management of conditions such as in the phase of weaning breastfeeding With the least amount of physical and psychological damage Helps, with specialized recommendations for each individual, tailored to each season, appropriate foods and other harmless recommendations.
Methods: This study was a descriptive review and the content of infant weaning in traditional Iranian medical literature was studied. For this purpose, 8 books were selected from the most prestigious sources of traditional Iranian written medicine and extracted and extracted from the lactation section on how to wean. Then the contents of each title from the extracted notes were put together. The texts were translated with difficult prose simplifications and Arabic texts were finally summarized by summarizing these titles.
Results: In ancient medical texts of Iran, the weaning of the baby from mother was reported. It was believed that the best time for a baby to breastfeed is about one year and nine months to two years of age. The best season is spring and then autumn and weaning are not recommended in the summer heat. Breastfeeding should be gradual and gradually replacing breast-feeding with age-appropriate foods. In the alternative food chain, they have recommended a range of suitable foods, including breadcrumbs, egg yolk with breast milk, chicken breast, and chicken salads. It should be noted when breastfeeding that the child does not become dehydrated, so it is advisable to consume sufficient fluids, including cucumber juice, buttermilk, and purslane juice, as well as preventive measures to be taken with henna on the palm of the hand and head. Breastfeeding with something bitter that does not harm the baby is another recommended procedure.
Conclusions: Studying Iranian traditional medicine texts and using the recommended wisdom (after updating them) along with the current methods used may help in better management of conditions such as in the phase of weaning breastfeeding With the least amount of physical and psychological damage Helps, with specialized recommendations for each individual, tailored to each season, appropriate foods and other harmless recommendations.
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