Background: Recognizing the barriers to clinical training and providing appropriate solutions to them significantly enhance the quality of clinical training.Objectives: The present study was conducted to evaluate the challenges of midwifery clinical training, and propose solutions from the perspective of midwifery instructors and students. Methods:The present qualitative study was conducted on 10 midwifery instructors and 10 midwifery students using semistructured interviews (n = 12) and focus groups (n = 8). Each interview or focus group lasted 45 -90 minutes. The interviews and codes extracted were stored in Max QD. Content analysis was also used to analyze the qualitative data.Results: Analyzing the data led to the extraction of two main themes, i.e. efficient clinical training and strategic planning challenges, four categories, i.e. efficient clinical instructors, quality of clinical setting, learners' perception of the situation and efficient educational planning, eight subcategories, i.e. instructors' clinical competence, instructors' motivation, professional attitude, humiliating experiences, restricted resources, inappropriate atmosphere of the clinical setting, inefficient curriculum and inefficient educational methods, and twenty semantic units. Conclusions:Clinical training can be improved by considering the job motivation of the midwifery instructors, reviewing the system of selecting and evaluating the instructors, paying attention to the psychological dimension and academic motivation of the students, enhancing the intra-organizational cooperation in line with training, optimally allocating educational resources, reviewing the educational curricula based on the community needs and developing midwifery references tailored to professional goals.
Introduction: One of the health system concerns is the use of medications for pain relief during labor and its side effects. Therefore, the aim of this study was to investigate the effect of epiduralspinal anesthesia (combined anesthesia [CA]) on labor outcome and satisfaction in pregnant women. Methods: In this randomized controlled trial study, we included 80 nulliparous women who had been admitted to Fatemieh hospital (Hamadan, Iran) during 2015-2016 due to spontaneous onset of labor. They were randomly assigned into 2 groups of 40, one group with CA versus normal vaginal delivery (NVD) group. Data were collected by using of demographic questionnaire, satisfaction questionnaire, and baby truck scales. Data were analyzed by descriptive and analytical statistics in SPSS version 16.0. Results: Average maternal age (mean ± SD) in the CA group was 26.94 ± 4.34 and in the NVD group was 25.89 ±5.18, respectively. There was a significant difference between the 2 groups in terms of length of second stage of labor (P=0.001), headache (P=0.04), and Apgar score (first minute) (P=0.001). Chi-square test showed a significant difference between the 2 groups in terms of satisfaction with childbirth (P=0.004). Conclusion: In this study, labor pain relief by using the spinal-epidural anesthesia (CA) increased the labor satisfaction. Nevertheless, this approach was associated with some maternal and neonatal complications such as: headaches, length of third stage of labor, and low Apgar score. It seems that the use of this method for painless delivery requires further studies.
confidence of postmenopausal women (1). Reduction in sexual attractiveness, desire, and sexual satisfaction are the most common complaints of postmenopausal women in terms of sexual function (2). Diminished estrogen level in postmenopausal women leads to atrophy and dryness of vaginal epithelium, which is accompanied by decreased vaginal lubrication during sexual intercourse. As a result, sexual pain, reduced sexuality, diminished sexual satisfaction, and disturbed sexual intercourse might happen for a couple (3). In addition to hormonal factors, numerous studies have noted the role of W
Introduction:The genetic expression of Retinoic acid and Estrogen Receptor alpha (Era) for breast tumor cells has a therapeutic importance. Hypermethylation has been shown to play a key role in silencing the expression of these genes. The present review article aimed to determine the relationship between folate and vitamin B12 levels of plasma and the status of ERa hypermethylation in patients with breast cancer. Materials and Methods: This review was gathered from original and review studies published in Google scholar, Medline, PubMed and Science direct with key words of Estrogen-Receptor alpha gene, hypermethylation, breast cancer, folate, vitamin B12 between the years of 2000 to 2017. Results: Folate and vitamin B12 are as cofactories in metabolism and supply of single carbon units for the synthesis of SAM (S-adenosylmethionine) and methylation of many biological compounds, in regulation of genes expression, purine and pyrimidine synthesis, in the formation of chromosome stability and other reactions biochemicals. Therefore, their deficiency promotes the development of cancer by disrupting gene expression regulation. The findings of this study showed the reverse effect of folate and vitamin B12 plasma on the status of hypermethylation of ERa gene in patients with breast cancer. Significant correlation was found between these values and the risk of progression of gene hypermetylation. Despite the evidence that there is an inverse relationship between folate and vitamin B12 and the risk of breast cancer, the results of a number of studies contradicted these findings. Conclusions: It can therefore be concluded that the decrease in plasma folate and vitamin B12 levels and inadequate intake of them may play a role in the prognosis of hypermethylation of genes in breast cancer patients. Original Article
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