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Background Enhancing the quality of obstetric triage services requires a clear perception of the current situations and problems, this issue gained more importance during the COVID-19 pandemic. The purpose of this study was to explore the obstetric and gynecological service providers’ and recipients’ perception and experience of the quality of obstetric triage services during the COVID-19 pandemic. Methods This research was a qualitative study carried out using conventional content analysis. Participants were selected through purposive sampling, and data collection was conducted using in-depth semi-structured interviews. Data were analyzed using MAXQDA software and conventional content analysis. Validity of the data was approved based on four criteria: credibility, dependability, conformability and transferability. Results Five themes emerged through analysis: “unpreparedness to deal with the COVID-19 resulting in disorganized triage”, “threat to the physical and mental health of personnel during the COVID-19 pandemic”, “degradation of the quality of services due to improper triage structure during the COVID-19 pandemic”, “communicating with patients which is neglected during the COVID-19 pandemic” and finally “accountability required to improve the provision of services during the COVID-19 pandemic. Conclusion Obstetrics and gynecology service providers and recipients faced formidable challenges in the triage department during this pandemic caused by the complex and ambiguous nature of the Coronavirus. Identifying the problems, barriers and challenges in providing services to patients in this situation especially in triage, can lead to an improvement in the outcome of services.

Background: Maternal-infant attachment is the first social relationship between mother and baby that keeps the baby close to the mother. The conflicting results of the studies regarding the effect of kangaroo mother care (KMC) on maternal-infant attachment show the necessity of conducting a meta-analysis study. Objective: The study aimed to investigate the effects of KMC on mother-infant attachment through a systematic review and meta-analysis of randomized controlled trials. Methods: Web of Science, PubMed, Scopus, Cochrane Library, EMBASE, ProQuest, SID, and Iranmedex databases were searched to find clinical trial studies in English and Persian without a time limit. The Cochrane checklist was used to check the bias of the articles. Data analysis was performed using STATA. I2 index was used in order to assess the heterogeneity, and the funnel plot and the Egger test were used in order to examine the publication bias. Standardized mean difference (SMD) and random effects models were used to combine the studies and perform a meta-analysis. Results: In this study, 10 articles were selected for the systematic review and meta-analysis. The results of the present meta-analysis based on the random model showed SMD as -1.33 (95% CI: (-2.12, -0.54), P=0.001), and there was observed a statistically significant relationship between the control and intervention groups. So, the mother-infant attachment in the intervention group was higher than in the control group. Conclusion: This study showed that KMC improves mother-infant attachment. The results of this study can be applied to evidence-based decision-making by healthcare providers, and can also be suggested as a method to develop mother-infant attachment.

Introduction:Child abuse is a global problem that is deeply rooted in the cultural, social, and economic performance of society. It is a behavior that occurs in various forms of physical, mental, emotional, or sexual, which can cause harm to the health, welfare, and education of the child. The present study was conducted to estimate the prevalence of child abuse and its related factors in Iran.Methods:In the present systematic review study, to find articles related to the prevalence of child abuse in Iran, valid databases such as Scopus, PubMed, Cochrane, SID, Magiran, IranDoc, and Google Scholar was were searched using the keywords of “child abuse”, “physical abuse” “emotional abuse”,” neglect”, “prevalence” and “Iran”.Results: In this study, 22 articles were analyzed. Based on this review about 4.5%-58.2% of children reported physical abuse, 7.3%-91.6% emotional abuse, and 5.5%-85.3% neglect. Factors associated with child abuse were hyperactivity anxiety and mental status disorder. All studies showed a significant relationship of abuses with education, occupation, addiction, and divorce of parents. Moreover, depression and anxiety of parents and poor parental relationships were related to abuse of children. Conclusion: Child abuse has many negative effects on childish and adolescent health. It seems that child abuse in Iran is in critical condition; therefore, policymakers must take action to solve this problem and prevent it by designing special programs and effective policies in Iran.

Background: Postpartum hemorrhage is one of the most common causes of maternal mortality worldwide.Aim: The present systematic review and meta-analysis aimed to evaluate the effectiveness of herbal medicines on a postpartum hemorrhage.Method: The largest proportion of articles with funding information was found from 2000 to 2020 were included using PubMed, Scopus, ISI Web of Science, Cochrane, Magiran, SID, and Google Scholar databases. The relevant English keywords, "postpartum hemorrhage، PPH control, PPHprevention, phytotherapy, herbal medicine, complementary medicine, traditional medicine” were usedto search for the eligible studies. Data were analyzed using STATA software (version 11).Results: The results indicate heterogeneity in the studies (I2=0.87). Standardized mean difference was (SMD= -1.08, 95% CI: (-1.31, -0.85), P

Background & aim: The postpartum period is a time of extreme vulnerability to various psychiatric disorders, such as anxiety, which exert profound negative impacts on the health of neonates, mothers, and families. Therefore, it is necessary to perform some interventions to prevent and mitigate postpartum anxiety. The current study investigated the effect of counseling based on Gamble's approach on postpartum anxiety in primiparous women. Methods: This randomized clinical trial was carried out on 60 primiparous women referred to Mashhad health centers in 2018. Participants in the intervention group received midwife-led individual counseling based on Gamble's approach during three prenatal and one postpartum session, apart from routine prenatal care. The control group only received routine prenatal care. A questionnaire to measure demographic and obstetric data as well as Depression, Anxiety and Stress Scale-21 (DASS-21) were used to collect data. The obtained data were analyzed in SPSS software (version 16) using Mann-Whitney, chi-square and independent t-test. Results: There was no significant statistical difference between the two groups before intervention (p

Background: Breast cancer is the most common cancer among women. Considering its long process of the treatment and significant influence on the health of patients, we aimed to investigate the functional and symptom scales of quality of life and the factors affecting patients with breast cancer during chemotherapy. Method: In this cross-sectional study, 94 women with breast cancer visiting Imam Reza Healthcare Center in Mashhad, who were in the course of chemotherapy, selected through convenience sampling. To investigate the functional and symptom scales of the quality of life, EORTC QLQ-BR23 was used. Data was analyzed via multiple linear regression model and significance level was considered as 0.05. Results: In functional scales, the highest and lowest score were obtained for sexual functioning (38.12±18.55) and future perspective (17.73±19.98), respectively. In the symptom scales, the highest and lowest score belonged to upset by hair loss (28.39±25.66) and breast symptoms (6.74±10.39), respectively. The results of multiple regression analysis showed that education had a negative effect on body image, menopause had a positive effect on sexual function, and tumor size had a negative effect on breast symptoms. Conclusion: Breast cancer deserves serious consideration as it affects different aspects of quality of life. Therefore, it is absolutely essential to take some measures for early diagnosis, achieve better therapeutic methods, use supportive therapy to decline the symptoms of the disease, and promote the functional level of women with breast cancer.

Background: Infertility affects women more profoundly than men, even when the male partner is the cause of infertility. Therefore, identifying the coping strategies of women in confrontation with their husbands' infertility is very important. Aim: This study aimed to explore women’s coping strategies following the diagnosis of infertility in their husbands. Method: This qualitative study was performed on 18 women whose husbands were diagnosed with infertility. The subjects were selected from those who referred to Milad Fertility Clinic and public health centers in Mashhad, Iran, through purposive sampling within 2014-2016. The data were collected by conducting semi-structured interviews. Data analysis was manually carried out using conventional content analysis. Results: The main theme emerged from the content analysis was the attempts to overcome the threat, including two categories, namely emotional coping and active coping. Emotional coping included strategies like attributing infertility to herself and others, selective disclosure, religious coping, seeking emotional support, as well as being considerate and offering verbal support to the spouse. active coping consisted of strategies namely attempting to verify the diagnosis, accepting infertility, searching for information, adhering to medical and surgical treatments, trying fertility superstitions, using alternative medicine, and changing lifestyle. Implications for Practice: Women may use a diverse set of coping strategies to adapt to their husbands’ infertility. A deep perception of these strategies is critical for controlling and managing the consequences of this diagnosis, designing interventions to strengthen preferred actions and strategies, as well as facilitating women’s coping with the infertility crisis of their spouses.

In the new millennium, exclusive breastfeeding plays an important role in national and international policies. The effects of mother-infant skin-to-skin contact (SSC) after birth has been investigated in several studies. Given that there has been no overall estimate of this effects, the present study was conducted with the aim of investigating the effects of mother-infant SSC on the rate of exclusive breastfeeding through a systematic review and meta-analysis of randomized controlled trials. In the present study, the databases of Scopus, PubMed, Cochrane, SID, Magiran, IranDoc, and Google Scholar were searched to identify randomized controlled trials that evaluated the effects of mother-infant SSC immediately after birth on the rate of exclusive breastfeeding. The risk of bias and strength of evidence were examined according to the Cochrane Collaboration’s tool and the Grading of Recommendation, Assessment, Development, and Evaluation approach, respectively. The data analysis was performed using Stata software. To assess the publication bias and heterogeneity, Egger’s and Begg’s tests and I2 were used, respectively. In addition, the fixed effects model was employed to perform the meta-analysis. The heterogeneity of the factor of effects in the studies was determined as 16.2% (p

Background: Infertility, as a life crisis, affects women more than men, even when women are not infertile. Objective: This study was conducted aimed at exploring Iranian women’s perceptions and experiences of their husbands’ behavior towards male factor infertility. Methods: This qualitative study was performed using content analysis. A purposeful sampling method was employed and continued until data saturation for women who had referred to Milad Fertility Clinic and Health Care Centers within the time period of 2014-2015 in Mashhad, Iran, with their husbands being infertile. Thirty semi-structured in-depth interviews were conducted with 18 women. Conventional content analysis was employed to analyze the data. Besides, Lincoln and Guba's evaluative criteria were utilized to check the trustworthiness of the study. Results: Perceived spousal emotional distress was the main topic of the study, which consisted of two subgroups, i.e., 1- husbands’ chaotic emotions with the sub-categories, including the “feelings of inferiority and incompetence”, “isolationism in life”, “irritability and arrogance”, “pessimism and cynicism”, as well as “anxiety and aggression”, and 2- husbands’ reluctance to seek treatment, including “inattention to medical prescriptions”, “resistance to the sperm analysis test”, and “opposition to the assisted reproductive technology and adoption”. Conclusion: Male infertility can lead to marital problems and mistreatment of women. Hence, supportive and preventive measures are required to improve the conditions of such women.

Background & aim: Maternal care during the different stages of labor should be targeted towards the promotion of maternal, fetal, and neonatal health status. Maternal position is very important in labour and delivery Care. Nevertheless, there is controversial results regarding the effect of maternal position in labor. The present study reviewed the effect of maternal position on maternal, fetal, and neonatal outcomes. Methods: In this systematic review, databases including PubMed, Web of Science, Scopus, Google Scholar as well as Persian databases of Magiran and SID, were searched and all related articles between 2005 to 2018 were retrieved. The quality of the studies was examined using the Joanna Briggs Institute tool. Results: 17 clinical trials performed on 4,848 subjects were reviewed. Maternal position during the labour were the upright and lying positions. The outcome measures included duration of the different stages of labor, persistent posterior position, postpartum hemorrhage, maternal pain, anxiety and fatigue. The fetal and neonatal outcomes entailed Apgar score, umbilical venous blood pH, need for neonatal resuscitation, and need for hospitalization in NICU. The results revealed that different maternal positions during the first- and second-stage of labor did not affect maternal, fetal, and neonatal outcomes. However, all studies stated that low-risk mothers should have the chance for choosing a comfortable position in the different stages of labor. Conclusion: In order to propose an evidence-based care plan concerning maternal position in labor, it is required to perform further studies with higher quality regarding the effect of maternal position on maternal, fetal, and neonatal outcomes.

Background and Aim: Vulvovaginal candidiasis (VVC) is one of the most common gynecologic problems among the women of childbearing age. Considering the adverse effects of chemical therapies, we performed this systematic review and meta-analysis to assess the effect of honey and yogurt on vaginal candidiasis. Material and Methods: In this systematic review and meta-analysis we searched databases of PubMed, ISI Web of science, Scopus, Cochrane, SID, Magiran ,Irandoc , Google Scholar, using the following sets of keywords: (Vulvovaginal candidiasis, Genital vulvovaginal Candidiasis, Candidiasis, genital vulvovaginal, Candida albicans, Monilial vaginitis, Vaginal yeast infections, Yeast infections, Vaginal, Genital candidiasis, Vulvovaginal moniliasis), (Treatment, Azole, Antifungal agents, Antifungal fungicides, Therapeutic fungicides, clotrimazole, clotrimazole),(honey, Bee-honey),yogurt,(controlled trial, clinical trial) and their Persian equivalent .Data were analyzed by Stata software. Heterogeneity was assessed by chi-square and I2 index and we used the random effects models to pool the data. Results: Heterogeneity analysis showed no heterogeneity between the results of studies in regard to complaints of itching, redness and vaginal inflammation and vaginal discharge caused by candida vulvovaginitis. After comparing honey & yogurt group with control group we found (95% CI: 0.09-0.99, p = 0.002, OR = 0.22) for clinical symptom of pruritus and (95% CI: 0.11-0.87; p = 0.026, OR=0.95) for clinical symptoms of redness and inflammation of vulva and vagina and and (95% CI: 0.13-0.82, OR = 0.32, p= 0.018) for vaginal discharge, which were statistically significant. Conclusion: The results of meta-analysis showed that the effect of honey and yogurt on vaginal candidiasis was statistically significant. Therefore, honey and yogurt can be used as an alternative treatment or in addition to the chemical antifungal drugs in the treatment of vaginal candidiasis. Keywords: Honey, Yogurt, Vaginal candidiasis, Systematic review, Meta- analysis

Introduction: Quality is defined based on the recipient's request. Students are the main members of the higher educational system. The aim of this study was to investigate the items related to the quality of services from the students’ point. Methods: This cross-sectional study was carried out in six faculties of Mashhad University of Medical Sciences in 2015-2016. Five hundred and seven undergraduate students were enrolled by multi-stage random sampling method. The standard SERVQUAL questionnaire with 27 pairs of questions which evaluate the quality of educational servies, was distributed. SPSS version 24 was used for data analysis. Results: Overall, 303 individuals (60%) were female and another 60% were in basic science period. There was a negative gap in all items in all the faculties. The item related to "the appealing appearance of the employees" had the smallest gap (from -0.6 to -0.1). The greatest gaps were related to the following items: in the medical(-1.7±0.1) and health (-1.8±0.2) faculties, "preparing students for future jobs by providing necessary theoretical and practical trainings"; in the faculty of dentistry(-2.0±0.1), "staff flexibility in specific conditions"; in the faculties of pharmacy(-1.5±0.1) and nursing(-1.2±0.1) "room and environmental facilities"; in the faculty of paramedicine(-1.5±0.1), "possibility for students to comment on educational programs" and "appropriate time for conducting classes". Conclusion: Items with highest gaps were not similar among different faculties. Focusing on the identified items with the greatest negative gaps is highly recommended. &nbsp

Breast-feeding initiation within the first half hour after birth is one of the World Health Organization recommendations. However, in most hospitals, mother-infant contact and breast-feeding initiation are delayed due to routine mother and infant care. This study aimed to determine the effect of mother-infant skin to skin contact (SSC) immediately after birth on the success rate and duration of the first breast-feeding.In this review, databases of PubMed, Scopus, Cochrane, Google Scholar, SID and Magiran and reference sections of relevant articles were searched for both Persian and English randomized clinical trials from 2000 to December 2017, using the keywords of “(Breast-feeding OR Lactation) AND (mother-infant SSC OR KMC) AND (breast-feeding success OR breast-feeding duration)”. A total of nine trials were ultimately included. Data analysis was performed with Comprehensive Meta-analysis (CMA) software version 2.In total 597 participants were assigned to the intervention group and 553 participants were assigned to the comparison group. Quantitative analysis Based on mean differences or odds ratio showed that Mother-Infant SSC had a significantly positive effect on success in first breast-feeding (MD:1.90, 95%; CI 0.958–2.856; p = 0.00, OR: 2.771 95%; CI 1.587–4.838; p = 0.00) and first breast-feeding duration (MD:26.627 95%; CI 1.070–52.184; p = 0.041).Mother-infant SSC after birth has beneficial effects on breast-feeding and can increase the success rate and duration of the first lactation. Therefore, the results of this study can be used by healthcare providers in evidence-based decision-making about ways to increase breast-feeding rates. Keywords: Mother-infant skin to skin contact, Breast feeding, Meta-analysis, Systematic review

Background: Obesity is a chronic disease and threatening factors of public health. Obese people have negative body image, and low self-confidence can lead to sexual dysfunction. Objectives: This study aimed to investigate the relationship between obesity and sexual function in women referred to health centers of Birjand in Iran. Methods: This cross-sectional study was conducted on 126 married women who were selected via a multi-stage sampling method from Birjand Health centers in 2014. The participants were categorized into three groups according to BMI (normal (BMI: 18.5 - 24.9), overweight (BMI: 25 - 29.9), and obese (BMI ≥ 30)). Then, demographic and female sexual function index (FSFI) questionnaires were completed in the groups by the self-administrative method. For data analysis, STATA version 14.1 software was used in this study. Data were analyzed using descriptive and inferential statistics tests, and multiple linear regression models. The significance level was considered 0.05. Results: The study showed a significant difference between the three groups in total score of sexual function (P < 0.001). In addition, a statistically significant difference was observed in desire, arousal lubrication, orgasm, and sexual satisfaction scores between the groups (P < 0.001). The results of the regression model showed that the sexual function score of obese people was lower by 15.87 units than normal people. Moreover, the sexual function score of overweight people was 4.67 units lower than normal people. Also, the variables of age, salary, duration of marriage, and the age at first pregnancy are effective factors in female sexual function (P < 0.05). Conclusions: Obesity can affect female sexual function. Therefore, efforts to promote sexual function in obese women are considered as one of the most important topics in women’s health care. This requires more attention to identifying various aspects of sexual life and finding effective ways to promote and improve these persons’ sexual function.

Psychological birth trauma has persistent adverse effects on the performance and health of women during and after childbirth. Therefore, Interventions to prevent and mitigate psychological birth trauma are of paramount importance.The present study aimed to investigate the effects of counseling based on Gamble's approach on psychological birth trauma in primiparous women.This randomized clinical trial was conducted on 60 primiparous women referring to the health centers in Mashhad, Iran in 2018. In the intervention group, counseling was provided by an obstetrician based on Gamble's strategy to each participant in three sessions before delivery and one session postpartum. The participants in the control group only received routine prenatal care. Data were collected using demographic and obstetrics characteristics questionnaire and psychological birth trauma questionnaire. The data were analyzed using SPSS, version 21 and chi-square and independent t-test.The mean age of the women in the intervention and control groups was 23.3 ± 3.9 and 24.4 ± 4.4, and the mean prenatal age upon delivery was 40.8 ± 5.7 and 39.8 ± 1.2 weeks respectively. The mean score of psychological birth trauma in the intervention (counseling) and control groups was 37.2 ± 10.4 and 47.6 ± 16.3, respectively, which was significantly lower in the intervention group (According to the results, counseling based on Gamble's approach could reduce psychological birth trauma in primiparous women. Therefore, this effective, simple, cost-effective, and harmless approach could be employed to reduce intrapartum and postpartum maternal traumas and prevent adverse events for the mother and the newborn.

Background: Breastfeeding is one of the most effective behaviors in health promotion and one of factor affecting its success, is breastfeeding self-efficacy. Low breastfeeding self-efficacy entails consequences such as early cessation of breastfeeding, reduction of exclusive breastfeeding, negative effect on sensation and performance. Regarding this study aimed to investigate the breastfeeding self-efficacy and its related factors in pramiparous breastfeeding mothers. Materials and Methods: This descriptive cross-sectional study was conducted on 300 primiparous breastfeeding mothers with less than 6 months infants referring to healthcare centers of Mashhad, Iran. The study population was selected through multi-stage random sampling technique. Data collection was performed by demographic form and Breastfeeding Self-efficacy Scale developed by fax and Dennis (1999). Data were analyzed using descriptive and inferential statistics, through SPSS version 16. Results: In present study,majority of participants were housewife within the age range of 15-25 years with diploma education and had normal delivery. Majority (79.33%) of mothers had high level of breastfeeding self-efficacy with a mean of 130.89±13.60. According to the multiple regression model, employed mothers (B =5.88, p=0.040) with an appropriate income (B=3.7, p=0.42) had significantly higher breastfeeding self-efficacy, compared to those with low family income. On the other hand, mothers with rental houses had significantly lower breastfeeding self-efficacy than their peers with owned properties (B = -3.48, p=0.023). Conclusion: As findings indicated, breastfeeding self-efficacy of participants was at high level. This factor can help health care providers to predict length of breastfeeding, and success rate of exclusive nutrition in mothers, and thereby identify mothers, who are at risk of early breastfeeding stop.

Background:Systemic lupus erythematosus (SLE) is an autoimmune disease with multiple organ involvement and periods of relapse and remission that mainly affects young women of childbearing age. In this regard the reproductive health is an important issue. Although diagnosis, treatment and management of pregnancy in SLE women have been improved recently, but the main concern is effects of SLE on maternal, fetal and neonatal outcomes. This study aimed to investigate the maternal, fetal and neonatal outcomes in pregnant women with SLE. Materials and Methods: The databases of PubMed, Medline, Scopus and Web of Science as well as domestic database (Persian) such as SID, Magiran, Irandoc, and Google Scholar were searched with using keywords such as" Systemic lupus erythematosus"; "Pregnancy"; "Neonatal lupus"; "maternal, fetus or neonatal outcome"; and equivalent Persian words. Included were all Persian and English articles, published between 2000 and May 2017. Finally, a total of 77 studies were included. Results: Adverse perinatal outcomes increase in pregnancies with lupus. Outcomes include respiratory, cardiovascular, blood and skin disorders in mothers; stillbirth, spontaneous, and recurrent abortion in fetuses and neonatal lupus, prematurity, intrauterine growth restriction (IUGR), and small for gestational age (SGA) in neonates, respectively. Conclusion: Pregnant women with SLE are at high risk due to increased complications for both mother and fetus. It seems broad control of the women before fertilization, so that they be at full remission in the beginning of pregnancy and the disease activity be in complete control, it can help to improve outcomes of pregnancy and so better results can be expected.

Background: In medical sciences, commitment to lifelong learning has been expressed as an important element. Today, due to the rapid development of medical information and technology, lifelong learning is critical for safe medical care and development in medical research. JeffSPLL is one of the scales for measuring lifelong learning among the staff of medical sciences that has never been used in Iran. Objectives: The aim of the present study was to determine the factor structure and reliability of the Persian version of JeffSPLL among Persian-speaking staff of universities of medical sciences in Iran. Methods: This study was a cross-sectional study, methodologically, that was conducted in 2012-2013. In this study, 210 staff members of Birjand University of Medical Sciences were selected. Data collection tool was the Persian version of JeffSPLL. To investigate the factor structure of this tool, confirmatory factor analysis was used and to evaluate the model fit, goodness-of-fit indices, root mean square error of approximation (RMSEA), the ratio of chi-square to the degree of freedom associated with it, comparative fit index (CFI), and root mean square residual (RMR) were used. To investigate the reliability of tool, Cronbach's alpha was employed. Data analysis was conducted using LISREL8.8 and SPSS 20 software. Results: Confirmatory factor analysis showed that RMSEA was close to 0.1, and CFI and GFI were close to one. Therefore, four-factor model was appropriate. Cronbach's alpha was 0.92 for the whole tool and it was between 0.82 and 0.89 for subscales. Conclusion: The present study verified the four-factor structure of the 19-item Persian version of JeffSPLL that included professional learning beliefs and motivation, scholarly activities, attention to learning opportunities, and technical skills in information seeking among the staff. In addition, this tool has acceptable reliability. Therefore, it was appropriate to assess lifelong learning in the Persian-speaking staff population.

Background: The rate of exclusive breast feeding is low in many societies and has diminished in recent years in Iran. This study was conducted to determine the effects of postpartum mother–infant skin-to-skin contact on exclusive breastfeeding in neonatal period. Materials and Methods: This was a randomized control trial. 114 healthy primiparous mothers and their neonates were recruited in Om-ol-banin hospital in Mashhad, Iran. Upon hospital admission, mothers in active labor were allocated randomly to either SSC or routine care. In the intervention group, SSC was continuously performed during the first 2 hours post-birth. In controls as is routine Om-ol-banin hospital, the first contact and breastfeeding were initiated after repairing the routine episiotomy and delivering neonates routine care. Mothers in both groups were interviewed on the 28th days postpartum to determine the exclusive breastfeeding in neonatal period. Results: There was significant difference between two groups in the rate of breastfeeding initiation in the first 30 minutes post birth (P

Context In medicine and health care, empathy is a very important component of relationship between a physician or healthcare provider and patients. Aims This study was designed to investigate the factors affecting empathy with patient among healthcare provider students using structural equation model. Settings and design Cross-sectional study. Materials and methods It was a cross-sectional study to examine the conceptual model based on JSE-HPS. Three hundred ninety-eight students of School of Nursing and Midwifery, Mashhad University of Medical Sciences, Iran participated in the study. They were selected by quota-stratified sampling. The data were collected by JSE-HPS. Statistical analysis used To examine the conceptual model, and SEM was used for ordinal data using WLSMV in Mplus 6. Results Findings indicated proper model fit so that "perspective-taking" had a positive effect on "compassionate care". "Compassionate care" had a positive effect on "standing in patient's shoes". Conclusion The results of this study can improve students' empathic relationships with patients. The "perspective-taking", "compassionate care" and "standing in patient's shoes" must be emphasized in training programs for medical students providing healthcare in order to familiarize them with the importance of empathy and its role in care. Key messages Empathy is truly the heart of the relationship, Perspective-Taking, Compassionate Care, and Standing in Patient's Shoes can be taken into account to improve the empathy and establish empathic relationships with patients. Proper environment is expected for improving the disease consequences by establishing empathic relationships. How to cite this article Karimi FZ, Abdollahi M. Factors Affecting Empathy with Patient among Healthcare Provider Students: A Structural Equation Modeling Study. Indian J Crit Care Med 2019;23(9):396-399.

Background: One of the causes of postpartum hemorrhage is prolongation of third stage of labor. Mother-infant skin to skin contact (SSC) immediately after delivery is one of the non-pharmacological interventions to reduce this stage. Studies which assessed the effect of mother-infant SSC after delivery on duration of the third stage of labor reported controversial results on this issue. Therefore, this study investigated the effect of mother-infant SSC immediately after birth on the duration of third stage of labor Methods: In this systematic review and meta-analysis, the databases of PubMed, Scopus, Cochrane, SID, Magiran IranDoc and Google Scholar were searched from 2000 to 2018, using the keywords related to the objectives of this review to access randomized control trials published in Persian or English. The quality of papers was examined using Cochran's Risk of bias tool. Data was analyzed using Stata software. We used I2 index and Chi-square test to investigate heterogeneity and Egger’s and Begg’s tests to assess publications bias. Random effects model was used to combine the data. Results: Six studies were entered into the meta-analysis. The third stage of labor in SSC group was shorter than that of control group with a mean difference of -1.33 and 95% CI (-2.31 to -0.36) and this difference was statistically significant (P=0.007). Conclusion: Mother-infant SSC decreases the duration of third stage of labor. Therefore, the current study provides some evidences to use this non-pharmacological method in order to accelerate the third stage of labor and ultimately prevent postpartum hemorrhage.

Introduction: Gender inequality and gender-based discrimination and violence undermine the opportunities and facilities of women and have negative effect on sexual and reproductive health behaviours. Given the importance of men’s role in establishing gender equality, awareness of men’s attitude towards gender equality is very important. However, there are no valid tools for measuring the attitude of men towards gender equality in Persian. Aim: This study was conducted with the aim of investigating the validity and reliability of Persian version of Gender Equitable Men-Scale (GEM-Scale) in Male Students of Nursing and Midwifery school, Mashhad University of Medical Sciences in 2015. Materials and Methods: This study was a methodological and validation study. A total of 232 male students of Nursing and Midwifery School of Mashhad University of Medical Sciences were selected through census method. The data collection tool was Persian version of GEM-scale. Factor analysis was used to examine the factor structure of the tool and Cronbach’s alpha coefficient was used to investigate the reliability of the tool. The analyses were conducted using LISREL software version 8.8 and SPSS version 20. Results: The fitting indices of the confirmatory factor analysis model showed that the fitting of the two-factor model was appropriate (CFI, GFI, AGFI near 1, RMSEA index less than 0.1, and c2 /df ratio less than 3). Cronbach’s alpha coefficient for the whole tool was obtained 0.79, showing that the internal reliability of the tool is also acceptable. Conclusion: The present study confirmed two-factor structure of the Persian version of GEM-scale, which includes inequitable gender norms subscale and equitable gender norms subscale. Therefore, this tool is suitable for assessing the attitude of men towards gender equality in Farsi-speaking men’s society.

BackgroundThe current study was conducted to investigate the relationship between unwanted pregnancy based on couples’ opinions and infant nutrition type in women referred to the health centers in Mashhad city and their husbands.Materials and MethodsIn this analytical-descriptive study, unwanted or wanted progenies were studied from the viewpoints of 366 women referred to the health centers in Mashhad city, Iran and their husbands, and also their relationships with infant nutrition type at the age of 4 months. The data were collected through questionnaires. The validity and reliability of the method and instruments were confirmed by content validity and test-retest. Moreover, data analysis was done using SPSS-16.0 software.ResultsThe average age of women in wanted pregnancy was 26.43±4.57 years and 27.57±5.22 years in unwanted women. The results showed a statistically significant relationship between unwanted pregnancy from the viewpoints of couples and infant's nutritional status (P=0.03). The prevalence of unwanted pregnancy in women with lower education (middle and high school) was higher than those with higher education.ConclusionOur results showed a significant association between baby’s nutrition and unwanted pregnancy. Furthermore, an increased use of non-exclusive breastfeeding in unwanted pregnancy is necessary. Hence, proper use of contraceptive methods, preventing the adverse consequences of unwanted pregnancy such as non-exclusive breastfeeding, useful educational strategies, counseling and health services are necessary to be taken into account.

Introduction: Medication errors are among the most serious health errors threatening patient safety in all countries, with major impacts on public health. Midwives as members of healthcare systems are prone to such errors. Therefore, in this study, we aimed to determine medication errors and the contributing factors among midwives working in maternity units of Mashhad University of Medical Sciences, Mashhad, Iran in 2015. Methods: This descriptive, cross-sectional study was performed on 104 employed midwives at four hospitals (Imam Reza, Ghaem, Omolbanin, and Hashemi Nezhad hospitals), affiliated to Mashhad University of Medical Sciences. The validity and reliability of the data collection tools were confirmed through content validity and internal consistency (Cronbach's alpha), respectively. For data analysis, descriptive and analytical tests, multiple linear regression, and negative binomial regression analysis were performed, using SPSS version 20 and STATA version 11. Results: The average incidence of medication errors for each midwife was 21.24±2.89 in the past six months. Among reasons against reporting medication errors, fear of confrontation with authorities (3.79±1.5) and attributing the medication error to individual factors by officials (3.88±1.34) had the highest average scores. The most common causes of medication errors were overcrowding of the ward (4.32±1.01), excessive workload and overexertion (4.19±1.08), and presence of critically ill patients in the ward (4.03±1.18). Conclusion: Overcrowding of the ward, fear of authorities, and attributing the medication error to individual factors were the main reasons against reporting medication errors, respectively. Therefore, more attention should be paid to error reporting systems, and workshops in this area are highly recommended.

Objective. This study aimed to investigate the effectiveness and safety of Tribulus Terrestris (TT) in male fertility problems, the studied variables being semen parameters and erectile function. Methods. In this systematic review and meta-analysis, all relevant articles were searched in the relevant databases, including ISI Web of science, Scopus, PubMed, Cochrane, SID, Magiran, IranDoc and Google Scholar, using the keywords which included (Tribulus Terrestris OR Puncture Vine OR Protodioscin) AND (sperm parameters OR Sperm Counts) AND (Oligozo-ospermia OR Azoospermia OR Erectile dysfunction OR Male Sexual Impotence OR Infertility). Risk of bias was assessed using Cochrane Collaboration’s tool. The data were analyzed using STATA software version 11. To examine the heterogeneity, I2 index and Q test were used and the fixed effects model was applied to pool standardized mean differences (SMDs). Results. A total of 10 articles were included in this study, some of which revealed that TT administration improved a number of semen parameters, such as sperm concentration, motility, liquefaction time, and normal acrosome reactions. However, some other studies did not report statistically significant differences in relation to other semen parameters, such as sperm morphology and ejaculate volume. The quantitative analysis showed a statistically significant effect of TT on erectile function (SMD: 0.54; interval confidence 95% CI: 0.30 to 0.78; P < 0.001; heterogeneity: I2 = 0%, p = 0.98, the fixed effects model; 2 trials). Conclusions. The findings of the present study indicated that TT improved some sperm parameters and also had a benefi-cial effect on erectile function. However, these findings should be interpreted with caution, due to the small sample size and some methodological differences among the studies. There-fore, further trials are still required to confirm these findings. © 2020, EDRA S.p.A. All rights reserved.

Introduction Infertility, as a global phenomenon and one of the most important issues of reproductive health, affects women more often than men, even when the infertility is due to a male factor. The purpose of this study was to explore the cognitive emotional experiences of women faced with male infertility. Methods This qualitative study was conducted in 2014-2015 in Mashhad, Iran. The perceptions and experiences of healthy women whose husbands were diagnosed with primary male factor infertility were investigated using a qualitative content analysis approach. Participants were selected through purposeful sampling, and data collection was conducted using in-depth semistructured interviews. Data were analyzed using conventional content analysis with MAXqda software. Study rigor was verified via criteria proposed by Lincoln and Guba. Results One main theme emerged through analysis entitled "cognitive emotional reactions confronting infertility diagnosis" with sub-themes of cognitive emotional reactions when confronted with male infertility diagnosis with subthemes of disbelief and denial, fear and apprehension, suffering and emotional distress, disappointment, frustration, confusion, and joy. Conclusion The diagnosis of male infertility was associated with important emotional cognitive consequences for their female partners. Emotional support, providing new insights into how to treat the issue, and trying to shorten the process of diagnosis are necessary for these women. This kind of support could reduce the psychological effects of confrontation with the diagnosis of male infertility, including social insecurity for women.

Introduction: Nowadays breast cancer is the most important factor concerning the women’s health which can affect the quality of life (QOL). This study was performed with aim to investigate the QOL and the related factors in Iranian women diagnosed with breast cancer in 2014-2015. Methods: This cross-sectional study was performed on 94 women with breast cancer who were selected by convenience sampling in Mashhad, Iran from 2014-2015. The data were collected through Demographic and Clinical Questionnaire and EORTC QLQ-C30.V3 Standard Questionnaire. Data was analyzed by SPSS software (version 18) and also descriptive statistics and linear regression analysis. P

Background: Diabetes self-care helps to control the blood sugar which, in turn, results in a better state of health. However, more than 50% of diabetic patients do not have self-care capabilities. Objective: To determine type 2 diabetes self-care capabilities among patients visiting a Bandar Abbas diabetes clinic in 2016. Methods: The present descriptive-analytical research was of a cross-sectional type. The sample was comprised of 120 patients afflicted with type 2 diabetes, who had been selected through the simple randomized sampling method. The data collection instrument was a questionnaire comprised of two sections: demographic information, and a summary of patients’ diabetes self-care activities. A 7-point Likert scale was used for the rating. The final score would be interpreted as any of the three levels: good (acceptable) (75-100), moderate (50-74) and poor (below 50). The data entered SPSS version 18.0 for the required statistical analyses. Results: The mean age of the sample was 51.88±10.12 years. Of the 120 subjects, 86 were female (71.7%) and 34 were male (28.3%). The findings revealed that the self-care capability of 83 subjects (69.2%) was poor; capability of 28 subjects was moderate (23.3%) and the same score of good/acceptable in 9 subjects (7.5%). Conclusion: The results of the present research indicate that a large number of diabetic patients have a poor self- care capability. Due to the key role of such activities in a diabetic patient’s life, it is suggested to include educational programs to increase the level of self-care capabilities among these patients.

Since the breast is strongly relevant to sexual desire, and physical and sexual attractiveness, the high prevalence of breast cancer (BC) in Iran and longterm survival of patients experiencing side effects means that measures to identify associated sexual problems are necessary. Therefore, this study was conducted to assess sexual function and affecting factors in women with BC.This crosssectional study was performed on 94 women with BC, referred to Imam Reza (AS) Hospital, Mashhad, Iran, in 2014. The data were collected through demographic and clinical questionnaires and also a sexual function questionnaire and analyzed using SPSS version 16.The total score of women's sexual function was about 24.3±4.41. Of the total, 63 (71.3%) reported sexual dysfunction, for example reduced satisfaction or more pain. Age was the only significantly related factor.Breast cancer can adversely affect women's sexual function and decrease quality of life. Thus, taking measures to overcome women's sexual problems are necessary.

Background Despite the fact that both men and women are equally subject to infertility, it is usually women who bear the burden of treatment and its consequences, even in cases of male infertility. Therefore, it is more necessary to recognize their health problems in order to help them. Aim To explore women's perceptions and experiences of the challenges they face in the process of male infertility treatment. Methods This qualitative study was conducted during 2014-2015 using content analysis. Thirty semi-structured interviews were conducted with women whose husbands suffered from male infertility. Purposive sampling was conducted until data saturation was achieved. All interviews were recorded, transcribed and analyzed using conventional content analysis adopted by Graneheim and Lundman. Results From data analysis, the major category of "treatment-related stresses" and four subcategories of "high treatment expenses", "inefficiency of healthcare system", "being captive in the infertility treatment" and "treatment failure" emerged. Conclusion Experiences of women who face male infertility indicate their various concerns in the process of treatment. Therefore, it is required to develop emotional and financial support for the clients and to promote their quality of healthcare services. In addition, awareness of treatment challenges of these women can assist proper planning to promote the quality of services they need.

To assess postpartum sexual function in mothers using different infant feeding methods.The comparative cross-sectional study comprising women referred to health centres in Mashhad, Iran, was conducted from July 7 to December 11, 2011. Sexual function and infant-feeding method of the subjects were assessed four months after childbirth. Data was collected using the standard Female Sexual Function Index and baby's feeding method questionnaire. SPSS 11.5 was used for statistical analysis.There were 366 women in the study with a mean age of 26.70±4.70 years who were using four methods of infant-feeding: exclusive breastfeeding, breastfeeding plus complementary feeding, formula milk, and breastfeeding plus formula. There was a significant difference between women's sexual function score and infant-feeding method (p=0.04). The highest score 6.23±3.5 belonged to women who had exclusive breastfeeding.There was a difference in women's sexual function between different groups of infant feeding methods. The highest score of sexual function was found in breastfeeding women. Women need to be educated about exclusive breastfeeding and its positive effects on sexual function.