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Background: The families of diabetics are more likely to have diabetes. Therefore, paying attention to those households and seeking to change the way of life of those households can save diabetes to a high extent. The present study aimed to investigate the impact of cognitive-behavioral applications primarily based on interactive software on serum glucose levels and HbA1C of a family member of sufferers with kind 2 diabetes., Methods: In the present randomized clinical trial, families of diabetic patients meeting the inclusion criteria will be divided into intervention and control groups by simple random sampling. In the laboratory, 10 cc of blood samples will be taken from the participants for the tests of total cholesterol, triglyceride, fasting blood sugar, GTT, HDL-c, LDL-c, and HbA1c. Then, both groups complete the International Physical Activity Questionnaire, Adolescence Food Habit Checklist, and Glover Nilsson Smoking Behavioral Questionnaire (GN-SBQ). The intervention group will provided with a training package of lifestyle change based on a cognitive-behavioral program in the form of an application during eight sessions of 45 min in 8 weeks. Then, the laboratory tests and questionnaires will be completed again 6 and 12 months after the intervention. Data will be analyzed using statistical tests., Discussion: If an application-based cognitive-behavioral program changes the lifestyle, serum glucose levels, and HbA1C, it can be recommended to families of diabetics., Competing Interests: Conflict of interestThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s), under exclusive licence to Tehran University of Medical Sciences 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background and Aim: Assessing health promotion among adolescents is vital to identify healthy and unhealthy behaviors and to evaluate health promotion interventions. This study aimed to determine the validity and reliability of the Persian version of the Short-Form Adolescent Health Promotion scale., Methods: Three hundred and twenty-seven adolescents were recruited through a multistage sampling method in this methodological study. The original version of the Adolescent Health Promotion scale was translated from English to Persian using the Backward-Forward translation protocol. Then, the scale's validity and reliability, including the face, content, construct validity, and reliability indices, were evaluated. The statistical analysis was performed using SPSS software version 24., Results: The mean CVI and CVR were 0.99. The exploratory factor analysis revealed four factors covering 42.57% of the total variance. The factor loading order of the items did not exactly correspond to the order obtained in the English version of the scale's validity and reliability analysis. The obtained factors called included: life appreciation, stress management, nutrition, and health responsibility. In the current study, both Cronbach's ɑ and the intraclass correlation coefficient were calculated at 0.84 and 0.99., Conclusion: The Persian version of the Adolescent Health Promotion scale developed in the present study is acceptable for the validity of the content, face, and reliability. However, the construct validity of this scale should be checked in other samples., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

HIV-related stigma has been identified as a major barrier to the diagnosis, prevention, and treatment of HIV among immigrants. The intersection of HIV with other forms of stigma can lead to greater inequality in health outcomes and access to health services. This study aimed to improve the understanding of HIV stigma towards Afghan immigrants in Iran through an intersectional perspective. The data were collected using 25 semi-structured interviews with the following three groups: Afghan immigrants who were diagnosed with or at risk of HIV infection due to injection drug addiction or having multiple sexual partners (n = 8), HIV service providers (n = 8), and policymakers/managers/experts (n = 9). Thematic analysis was used for data analysis. The participants described different manifestations of stigma (internalized, anticipated, perceived, experienced stigma, and discrimination) associated with HIV and interlocked with other aspects of stigma, including migration, gender, and drug addiction. According to the results, the intersection of different layers of stigma should be taken into account while designing and implementing HIV prevention and treatment programmes. It was also recommended to conduct the necessary interventions such as comprehensive HIV education, social support, as well as peer and outreach services to reduce stigma and discrimination based on the immigrants' needs as well as cultural and social values., (© 2021 John Wiley & Sons Ltd.)

Background: Providing information to patients is an essential aspect of care. The way in which such information is transmitted is also important and is affected by different variables. The perceptions of dishonest nursing staff have not been sufficiently discussed to date., Aim: The purpose is to explore the reasons for dishonesty in transmitting information to patients., Design and Method: In this qualitative content analysis study, data were collected using semi-structured interviews with Twelve Iranian Critical Care Nurses from January 2020 till August 2020. Data were analyzed according to Graneheim and Lundman approach., Ethical Consideration: The research protocol was authorized by the Ethics Committee of the Medical Sciences University of Tehran (Register number: 95-04-99-33485)., Results: The findings indicated that dishonesty in giving information to the patients has many reasons. Although lying is not compatible with ethical care, working conditions sometimes forced nurses to hide the truth., Discussion and Conclusion: Nurses believed honesty was an integral aspect of professional practice, but situational specifics have an effect on whether the truth is told or withheld. Finally, the nurses noticed a big gap between what they want to tell and what they were doing in practice.

Background: A successful response to the risk of human immunodefficiency virus (HIV) infection among immigrants requires improved access to HIV prevention, diagnosis, and treatment services. However, most immigrants face significant challenges in accessing HIV/AIDS services. The aim of this study was to explore the aspects influencing access to HIV/AIDS services among Afghan immigrants in Iran., Methods: This was a qualitative study using conventional content analysis that was conducted from June 2018 to April 2020 in Tehran, Iran. Purposeful sampling method was performed. We conducted 25 semi-structured interviews with three groups of stakeholders including Afghan immigrants infected with or at risk of HIV (n=8), service providers (n=8), and policymakers/managers/experts (n=9). Inductive qualitative content analysis was applied according to the Granheim and Lundman method. Data were analyzed using Open Code software version 4.03., Results: Aspects influencing access to HIV/AIDS health services were categorized into 3 themes (that were extracted from 9 categories): 1. Cultural aspects (cultural similarities and differences, values and beliefs); 2. Psychosocial aspects (social support, stigma and discrimination); and 3. Service delivery related aspects (awareness, health services coverage and integrity, health services financing, accessibility, and continuity of care)., Conclusion: The findings suggest that efforts to improve Afghan immigrants' access to HIV/AIDS health services in Iran need to consider the cultural aspects, increasing HIV awareness, providing support, reducing stigma and discrimination, and improving health services coverage, integrity, financing, and continuity of accessible services., (Copyright: © International Journal of Community Based Nursing and Midwifery.)

The aim of this study was to investigate the expected roles of the Doctor of Philosophy graduated nurses and their challenges. This study was conducted as a scoping review based on Arksey and O'Malley's approach. After a search in valid databases such as Google Scholar, Information Sciences Institute, Science Direct, Ovid, PubMed, and Scientific Information Database between 2000 and 2019 and review the websites of some well-known universities and the contents of some of the global nursing websites such as the American Association of Colleges of Nursing, National League for Nursing (NLN), International Network for Doctoral Education in Nursing (IDEN), as well as reports such as Institute of Medicine. All data were collected, summarized, and then described narratively. There was much evidence that the Doctor of Philosophy programs had failed to prepare graduated nurses for the related roles and responsibilities. The expected roles of the Doctor of Philosophy graduated nurses in this study summarized in five domains of education, clinical practice, research, leadership and management, and policy-making along with worldwide challenges, especially those highlighted in Iran. It seems that besides clarifications of the expected roles of the Doctor of Philosophy graduated nurses, there should be more thought about the contents of the programs along with roles responsibilities, as well as the establishment of better communications between universities and workplaces.

With the increase in the number of patients and activity of hospitals, the issue of hospital waste management (HWM) is becoming more and more challenging and worrying. In addition to financial losses, there will be irreparable damage to the ecosystem and environment which will create many problems for people (because the job of some people in the area is livestock and agriculture and they have a lot to do with their surroundings). It also doubles the need to pay attention to the issue of sustainable development (simultaneous attention to social, economic and environmental dimensions) in waste management. Moreover, the climatic and geographical conditions and lack of proper waste management in this area lead to major problems. Therefore, in this research, by developing a novel multi-objective mixed integer linear programming model, HWM is addressed in the hospitals of Sari, Iran. The aim is to design an HWM network considering sustainability, resiliency and uncertainty. In order to deal with uncertainty, a robust fuzzy programming approach is employed, and then an improved goal programming technique and Lp-metric method is proposed to solve the model. It was revealed that goal programming outperforms the Lp-metric method in terms of all objectives. Furthermore, the obtained results demonstrate the applicability and efficiency of the proposed methodology to design an efficient sustainable HWM network.

Background: It is believed that seniors with multiple chronic diseases are in dire need of support from their family caregivers; however, it can impose a significant burden on these caregivers. Therefore, it is imperative to take into account caregivers' needs, as covert patients, along with the needs of patients; besides, it is necessary to develop supportive and health promotion programs for them. There is a critical gap in the knowledge about health problems related to family caregivers of the growing population of these senior citizens. The present study aimed to explain the challenges imposed on family caregivers of seniors with several chronic diseases in Iran., Methods: This study was conducted based on the conventional qualitative content analysis method. For this purpose, 13 family caregivers of seniors with several chronic diseases were selected using the purposive sampling method. The study population included those referred to two health centers and outpatient clinics of two public hospitals in Khorramabad, Iran. Data were collected through semi-structured interviews. Data analysis was performed along with data collection using inductive thematic analysis proposed by Elo and Kyngäs. Besides, Guba and Lincoln's criteria were used to ensure the trustworthiness of the data., Results: The analysis of the obtained data led to the identification of challenges of family caregivers of the older patients with multiple chronic diseases; these challenges were classified into six main categories, including the impact of caregiving on family relationships, disruption of social relationships, disruption of personal and occupational plans, physical health-related issues, negative emotions, and dealing with the high costs of care., Conclusions: Given that family caregivers may face several challenges while taking care of seniors with multiple chronic diseases, healthcare providers should design and plan various interventions based on such challenges using a caregiver-centered approach., (© 2022. The Author(s).)

Aim: Cultural competence is a crucial component of nursing competency, and a valid and reliable scale is needed to measure it. This study was conducted to investigate the psychometric properties of the Persian version of the Cultural Competence Scale among Iranian clinical nurses., Design: A methodological design was used., Methods: The scale was translated into Persian, and its content, face and construct validity, and reliability were examined., Results: Two items with a content validity ratio of 0.6 were removed. In the case of the content validity index, one item with a content validity index lower than 0.70 was removed. The mean content validity index for the scale was reported as 0.99. All 31 items with an impact score index higher than 1.5 were approved. The exploratory factor analysis revealed four factors explaining 59.92% of the total variance. Cronbach's alpha and the intraclass correlation coefficient were calculated at 0.95 and 0.94, respectively., (© 2021 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Background and Aim: The nature of pediatric settings may encounter nurses with more complicated ethical issues. A code of ethics guides nurses to act and decide ethically as a profession. Also, there is always a need to evaluate amount nurses adhere to this code of ethics, using valid and reliable instruments. This study aimed to develop a questionnaire and assess its psychometric properties to measure pediatric nurses' adherence to the code of ethics., Methods: In this methodological research study, firstly, the questionnaire was developed based on an extensive review of the related literature and the theoretical framework of nursing ethics. A panel of experts (n = 12) reviewed the preliminary questionnaire qualitatively and quantitatively (using CVI and CVR). A conveniently selected sample of 156 nurses working in pediatric wards in three hospitals filled out the questionnaire. The psychometric process included determining sample size and data adequacy using KMO and Bartlette's test of sphericity; exploratory factor analysis (principal component method with Promax rotation); item analysis; and Cronbach's alpha coefficient. Also, the Interclass Correlation Index (ICC) value was determined using a two-week interval test-retest method on 30 eligible nurses., Results: The CVI and CVR for the entire questionnaire were 0.85 and 0.78, respectively. The CVI and CVR of all items were reported higher than 0.59 and 0.8, respectively. Cronbach's alpha of the 28-items instrument was 0.92. Extracted six factors explained 65.31% of the total variance, and the values of the item correlations with the total questionnaire showed good internal consistency (0.52 to 0.90). The items of each factor were evaluated to determine the values they represent. Accordingly, the factors were named beneficence, nonmaleficence, human dignity, autonomy, informed consent, and honesty. The ICC value was 0.99., Conclusions: The developed instrument is acceptable and has good reliability and validity. It can be used to assess the amount of pediatric nurses' adherence to the code of ethics by managers, teachers, and researchers., (© 2022. The Author(s).)

Objective and Background: Mental health is a widespread field that entails variables such as the presence of positive feelings like satisfaction with life and lack of negative emotions like depression, anxiety, and stress. This research aimed to study the prevalence of depression, anxiety, stress, and satisfaction with life as dimensions of adolescent girls' mental health in Tehran., Methodology: The population considered in this cross-sectional study consisted of adolescent girls in the last grade of high school in Tehran. Research samples were selected using multi-stage sampling. The sample size in this study was 491 and the research tools used were standardized questionnaires. Descriptive and inferential statistics included Spearman, ANOVA, and regression tests were used., Findings: More than half of the adolescents experienced common symptoms of depression, anxiety, and stress. About 30% of adolescents were dissatisfied with life to some extent. Satisfaction with life was negatively correlated with age, depression, anxiety, and stress. Age and depression were predictor variables of life satisfaction based on the regression model., Conclusion: A considerable percentage of adolescents suffered some form of depression, anxiety, and stress symptoms and were notably dissatisfied with life. Regarding the importance of satisfaction with life in having a joyful life and its role in initiating depression, anxiety, and stress, our findings highlight the need for interventions to prevent depression, anxiety, and stress and enhance life satisfaction among adolescents., (© 2022. The Author(s).)

Background: Patient education is a critical aspect of patient care and is considered a vital part of self-care (especially in patients with cardiovascular disease (CVD)) and health promotion. The literature supports incorporating the principles of the andragogy model (adult learning) into patient education. This study aimed to determine the concordance of the CVD patient education with the principles of the andragogy model., Methods: This cross-sectional survey was conducted on 384 adult CVD patients from 2 selected hospitals of Tehran. The sampling method was convenient, and the data collection tool was a researcher-made questionnaire based on the principles of the andragogy model. Data were analyzed using SPSS16 statistical software., Results: The mean age of the patients was 55.69 ± 13.01 years old. Frequency of distribution of the patients who, in total, selected the items of 4 or 5 for respecting the principles of andragogy model was as follows: 68.16% for the motivation, 66.29% for the need, 66.03% for the orientation, 54.16% for the experiences, 51.55% for the self-concept, and 44.65% for the readiness principle. Also, three principles of motivation (77.37) need (74.97), and orientation (74.78) had the highest mean, respectively, in terms of adhering to this model. But the most common problems in patient education were related to the principles of readiness (64.35), self-concept (68.19), and experiences (77.71) with the lowest mean., Conclusions: The findings of this study provided valuable information on the flaws in patient education, including ignoring and disrespecting the principles of adult education. Correcting these detected defects and providing feedback to health professionals can improve the quality of patient education programs and patient satisfaction. Also, it empowers healthcare providers, patients, and families through effective education strategies., (© 2021. The Author(s).)

Introduction: Communication is one of the main foundations of providing care. Nurses have encountered patients from different languages due to globalization and mobilities within and between countries. This study aimed to explore the Iranian pediatric nurses' experiences in providing care for children of different language backgrounds., Methodology: In this conventional qualitative content analysis study, 15 pediatric nurses were selected through purposive sampling from four specialty pediatric hospitals in Tehran, Iran. Data were collected via in-depth semistructured face-to-face interviews and concurrently analyzed via conventional content analysis., Results: Data analysis resulted in 132 primary codes, which were reduced to 95 during constant comparison and categorized into 34 subcategories, six main categories, and the main theme emerging from the categories was "language as a barrier in providing effective nursing care.", Discussion: This study suggests that language differences between pediatric nurses and hospitalized children may make nursing care less effective and act as a barrier to achieving patient care goals.

The lack of face-to-face interactions with families, the increase in the number of patients admitted to the ICU, nursing staff shortages, and inadequate personal protective equipment has created many challenges for nurses in advocacy of the COVID-19 patient with life-threatening conditions. This study aimed to explore the experiences of intensive care nurses in the advocacy of COVID-19 patients. This study was performed using a qualitative content analysis method with Graneheim and Lundman approach, Iran, 2020. Data were collected through semi-structured interviews with eighteen clinical nurses from the intensive care units of three hospitals. Themes extracted from the nurses' statements were promoting patient safety (informing physicians about the complications and consequences of treatment, preventing medical errors, protecting patients from threats), respecting the patients' values (providing comfort at the end of life, providing a comfortable environment, commitment to confidentiality, cultural observance, respect for individualism, fair care), and informing (clarifying clinical conditions, describing available services, and being the patients' voice). ICU nurses in health crises such as COVID-19 as patient advocates should promote patient safety, respect patients' values, and inform them. The results of this study could help enhance the active role of intensive care nurses in the advocacy of COVID-19 patients., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Aim: To systematically review the status of self-care in patients with heart failure through the Self-Care of Heart Failure Index scale., Design: A systematic review and meta-analysis., Methods: Following national and international databases were searched to retrieve eligible studies: PubMed, Web of Science, Embase, Google Scholar, Scientific Information Database and Magiran. The studies were screened and selected by two researchers. Data analysed through the random-effects model, and the I 2 index was used to assess heterogeneity. Stata software version 12.0 was used for analysis. The PRISMA statement was used to report systematic review and meta-analysis., Results: Of the 5,953 articles initially identified, 39 studies were included. The average score was estimated at 58.16 (CI: 54.39-61.94) for self-care maintenance, 53.11 (CI: 49.17-57.05) for self-care management and 58.66 (CI: 54.32-63.00) for self-care confidence. Despite the high heterogeneity of the studies, the results indicated that self-care practice is inadequate in all the three dimensions of self-care (maintenance, management and confidence)., (© 2021 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Purpose: This study aimed to determine the impact of MI on self-efficacy, beliefs about medicines and medication adherence among adolescents with asthma., Method: This randomized controlled trial conducted on 52 adolescents with asthma referring to the Pediatric Medical Center in Tehran, Iran. They were randomly assigned to the control and intervention groups. The educational intervention consisted of 3 one-hour sessions per week, which was held individually in the areas of medication adherence, beliefs about medicines and self-efficacy. Four validated questionnaires including demographic characteristics, medication adherence, self-efficacy and beliefs about medicines were completed by self-report both before the MI and 40 days after the end of the intervention., Results: In the baseline, the two groups were homogeneous in terms of demographic characteristics and outcome measures. At the post-test, the mean scores of the three outcome measures in the intervention group were reported higher compared to the scores in the control group (p < 0.05). The difference between the mean scores in medication adherence, beliefs about medicines and self-efficacy in the post-test between the two groups, even with the elimination of the effect pre-test scores, were significant (p < 0.05)., Conclusions: The results of this study showed that MI can be effective in improving medication adherence, beliefs about medicines, and self-efficacy., Practice Implications: The primary goal in the treatment of patients with asthma is asthma control by using corticosteroids. MI is one of the interventions that can simultaneously provide motivation, readiness, beliefs about medicine and self-efficacy for behavioral changes (medication adherence) in patients with asthma., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Mothers of premature newborns in the neonatal intensive care unit (NICU) have complex needs and require a significant amount of support during the NICU admission. However, little is known about mothers' support needs in the NICU. This study aimed to explore health care staff and mothers' experiences of meeting the mothers support needs in the NICU. This study aimed to explore health care staff and mothers' experiences of meeting the mothers' support needs in the NICU., Methods: A focused ethnographic approach was adopted. Observations and interviews with 21 mothers, 18 nurses, and five physicians were undertaken over a seven months period. Qualitative data analysis was conducted using the Roper and Shapira (2000) five-step framework., Result: Two main themes of "insufficient provision of the mothers' support needs" (subthemes: inadequate accompany of the mothers in care, assigning monitoring and care to the mothers, inadequate sharing of medical the information) and "supporting the mothers in certain circumstances" (subthemes: reassuring the mothers, supporting the mothers with reduced functional capacity, providing information) were obtained., Conclusion: The mothers experienced a gap between expected and actual support provided by health care staff. Although, the health care staff believed that mothers' support was a necessity, it was not their main concerns, and they considered workload as a barrier for the mothers support in the NICU., (© 2021. The Author(s).)

Background: Given the potential of intersectionality to identify the causes of inequalities, there is a growing tendency toward applying it in the field of health. Nevertheless, the extent of the application of intersectionality in designing and implementing health interventions is unclear. Therefore, this study aimed to determine the extent to which previous studies have applied intersectionality and its principles in designing and implementing health interventions., Methods: The title and abstract of the articles which were published in different databases e.g. PubMed, Web of Science, Proquest, Embase, Scopus, Cochrane, and PsychInfo were screened. Those articles that met the screening criteria were reviewed in full text. The data about the application of principles of intersectionality, according to the stages heuristic model (problem identification, design & implementation, and evaluation), were extracted through a 38-item researcher-made checklist., Results: Initially, 2677 articles were found through reviewing the target databases. After removing the duplicated ones and screening the titles and abstracts of 1601 studies, 107 articles were selected to be reviewed in detail and 4 articles could meet the criteria. The most frequently considered intersectionality principles were "intersecting categories" and "power", particularly at the stages of 'problem identification' as well as 'design & implementation'. The results showed that "multilevel analysis" principle received less attention; most of the studies conducted the interventions at the micro level and did not aim at bringing about change at structural levels. There was a lack of clarity regarding the attention to some of the main items of principles such as "reflexivity" as well as "social justice and equity". These principles might have been implemented in the selected articles; however, the authors have not explicitly discussed them in their studies., Conclusions: Given the small number of included studies, there is still insufficient evidence within empirical studies to show the implication of intersectionality in designing and conducting health interventions. To operationalize the intersectionality, there is a need to address the principles at various stages of health policies and interventions. To this end, designing and availability of user-friendly tools may help researchers and health policymakers appropriately apply the intersectionality., (© 2021. The Author(s).)

Background and Objective: Access to health care is a universal concern. Therefore, this study was conducted to develop a questionnaire to assess the Perceived Access to Health care based on Penchansky and Thomas's definition of access and the assessment of its psychometric properties., Method: The initial questionnaire contains 31 items developed based on a deductive approach with an extensive review of the related literature. Content validity, face validity, construct validity, internal consistency, and instrument reliability were further examined. Data analysis was conducted using SPSS software version 24, R software version 4, and lavaan package., Results: The initial questionnaire was examined using qualitative content validity, and the necessary modifications were applied to each item. The content validity ratio (CVR) was approved in 30 items with a value greater than 0.78, and one item with a CVR value lower than 0.78 was removed. In the case of the content validity index (CVI), 29 items were approved with a CVI value of greater than 0.79, and one item with a CVI value between 0.70 and 0.79 was revised. In qualitative face validity, all items were approved by a panel of experts and the participants. All 30 items with an impact score index higher than 1.5 were approved for the next steps. The confirmatory factor analysis results showed that the six-factor model of access to health care has an appropriate fit. Cronbach's alpha coefficient for the questionnaire was calculated 0.86. The value of Cronbach's alpha for the dimensions of availability, accessibility, affordability, accommodation, acceptability, and awareness were 0.61, 0.76, 0.66, 0.60, 0.80, and 0.76, respectively. The Intraclass Correlation Index (ICC) value for reliability (test-retest) of the whole instrument was calculated 0.94 using the two-way mixed absolute agreement method., Conclusion: The success of health programs depends on eliminating barriers to access to provided health care services. One of the most critical barriers to understanding access is a perception of limited access. This questionnaire might be used further to understand perceived health care access in different global contexts.

Objectives: This systematic and meta-analysis review was conducted to determine the status of Iranian children and adolescents' physical activity., Content: All the related articles which were published in the major databases, including Pubmed, Scopus, Web of Science, Embase, Magiran, SID from the beginning of 2010 to the end of 2019, were reviewed by researchers. The Newcastle-Ottawa scale was also used to evaluate the quality of articles. Moreover, I 2 index and chi-square were used to assess the heterogeneity between the results., Summary: 490 articles were found as a result of the search in the selected international and local databases, where finally, 10 articles were included into the meta-analysis after the elimination of the duplicated articles and applying inclusion and exclusion criteria. The results indicated that 29.5% of the girls were considered active according to WHO criteria (16.1-42.8: 95% CI) and also 20.5% of the boys (7.3-33.7: 95% CI)., Outlook: Overall, this study's findings showed that a large percentage of Iranian children and adolescents do not achieve the level of physical activity recommended by the World Health Organization. This can lead to undesirable consequences for this group of population that is considered as the human capital of any country; consequently, it seems necessary to take basic measures at the micro and macro levels in order to reduce such problems in the society., (© 2021 Walter de Gruyter GmbH, Berlin/Boston.)

Purpose: This study aimed to investigate the relationship between parents' unmet needs with hospitalized children and the level of parental anxiety., Design and Methods: This correlational study was conducted on 194 parents with hospitalized children. The data were collected using the questionnaires of "revised needs of parents with hospitalized children" and "Zung's anxiety scale". The data were then analyzed through descriptive and inferential statistics using SPSS software version 19., Results: There was a very weak positive relationship between the number of unmet needs of the sick child and the physical symptoms of anxiety (P = 0.038, r = 0.149) and overall anxiety score (P = 0.018, r = 0.17). However, there was no significant relationship between the number of unmet needs in other groups. Also, there was no significant relationship between the total number of unmet needs and parental anxiety. The most frequent unmet needs of parents, respectively, belonged to 1) support and guidance, 2) needs of other family members, and 3) comfort., Conclusions: It might not be possible to obviate all the parental needs during the child's hospitalization. It is noteworthy that failure to meet those parental needs directly related to the child may cause anxiety for the parents., Practice Implications: Meeting the needs of parents regarding support and guidance, comfort, other family members, and needs directly related to the child is recommended to prioritize in pediatric nursing care., Competing Interests: Declaration of Competing Interest There is no conflict of interest., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Competing Interests: Conflict of Interest: None declared.

The viral infection due to the new coronavirus or coronavirus disease 2019 (COVID-19), which was reported for the first time in December 2019, was named by the World Health Organization (WHO) as Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV2), because of the very similar genome and also its related symptoms to SARS-CoV1. The ongoing COVID-19 pandemic with significant mortality, morbidity, and socioeconomic impact is considered by the WHO as a global public health emergency. Since there is no specific treatment available for SARS-CoV2 infection, and or COVID-19, several clinical and sub-clinical studies are currently undertaken to find a gold-standard therapeutic regimen with high efficacy and low side effect. Based on the published scientific evidence published to date, we summarized herein the effects of different potential therapies and up-to-date clinical trials. The review is intended to help readers aware of potentially effective COVID-19 treatment and provide useful references for future studies.

Introduction: Heart failure is the most prevalent cardiovascular disease. It is the end stage of most cardiovascular diseases and is characterized by the reduced ability of the heart to pump enough blood to fulfill the metabolic needs of the body. Self-care is the basis of the management of chronic diseases such as heart failure. The aim of this study was to explore the barriers to self-care among patients with heart failure. Methods: This was a qualitative content analysis. Participants were fourteen patients with heart failure and three healthcare providers who were purposively recruited from cardiac care centers in Zanjan, Iran. Data were collected through in-depth semi-structured interviews and were analyzed through the conventional qualitative content analysis approach proposed by Elo and Kyngäs. Results: Self-care barriers -care among patients with HF were categorized into three main categories, namely personal factors, disease burden, and inefficient support system. Each category had three subcategories which were respectively lack of self-care knowledge, heart failure-related negative emotions, the difficulty of changing habits, progressive physical decline, comorbid conditions, financial strain, inadequate social support, healthcare providers' inattention to self-care, and limited access to healthcare providers. Conclusion: Patients with heart failure face different personal, disease-related, and support-related barriers to self-care. Based on these barriers, healthcare providers can develop interventions for promoting self-care among patients with heart failure., (© 2021 The Author(s).)

Aim: While the care of dying elderly patients at home is very complex and ambiguous, it has not been studied in Iran so far. Hence, this study aimed to explore the experience of a representative sample of the Iranian family caregivers from the end-of-life (EOL) care for their elderly relatives., Methods: The present study was conducted using a qualitative content analysis method. Twelve family caregivers caring for the chronically ill dying elderly were selected using purposeful sampling. The purposive sampling method was applied with an extreme variation in sampling, and data gathering was pursued until data saturation was achieved. Semi-structured interviews were utilized for data collection. Interviews were recorded and instantly transcribed verbatim. Inductive content analysis was used to analyze the data., Results: Four core themes and 13 subthemes emerged from the experiences of family's caregiver as fallow: (1) Committed to care: This is related to encounter with the end of stage disease of the relative, accepting the care role and priority of care, (2) challenges of Care: Caregivers, despite their efforts, provided ineffective care, so they sought to empower themselves and at the same time provide compassionate care, (3) the crisis of care including the complexity of care, fear, and wandering, helplessness, devastating tension, and vacuum of supporting, and (4) conditions after death that family members involved with a sense of loss and Tension control., Conclusion: When families had to take care of their elderly patients at home, although their wish to give the best care, they are completely powerless to provide care, and in an atmosphere of the vacuum of supporting, they encounter severe challenges and crisis. It is vital that palliative care centers in the society are arranged to care for EOL elderly with comprehensive insurance services., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Indian Journal of Palliative Care.)

Violence has a heavy impact on the physical and mental health of women in developed and developing countries; however, most of the violence victims would suffer in silence and never leave their relationship. The aim of the present study was to identify the barriers to leaving a relationship from the perspective of married abused Iranian women. The present study was a secondary analysis of the interviews conducted in a primary study. The primary study that was conducted using the grounded theory approach has assessed the coping process with domestic violence in 24 married abused Iranian women. These women were selected from local parks, health centers, and universities of Tehran city using a purposive sampling method. Qualitative secondary analysis of the interviews was conducted, in accordance with the goal of this study, using content analysis. Four categories emerged through the analysis of the data including "fear," "lack of resources," "beliefs and attitudes," and "dependence" and the common theme between these categories was " deterrents to leaving an abusive relationship." Results indicated that contextual factors such as fear, lack of resources, attitudes and beliefs, and dependence were the reason for not leaving a relationship. Interventions for enriching women's resources (improving the condition of education and employment, and improvement of the formal and informal support systems), education about domestic violence and its management methods, and modification of the existing attitudes and beliefs in this regard could keep abused women from experiencing more violence.

Background: The present study aimed to evaluate the effect of Echium amoenum (EA) on the severity of premenstrual syndrome (PMS) in comparison with placebo., Methods: The present study was a randomized double-blind controlled clinical trial. A checklist questionnaire was completed by 120, 18 to 35-year-old, college students. And then, 84 eligible women (20 to 35 years old) were enrolled in the trial; they were randomly assigned to two groups of intervention (EA) and control (placebo), with 42 participants in each group. Participants in the intervention group received 450 mg capsules of EA per day (three times a day) from the 21st day of their menstrual cycle until the 3rd day of their next cycle for two consecutive cycles. The severity of PMS was measured and ranked using the premenstrual symptoms screening tool (PSST). The generalized estimating equation was used to compare the total score of the severity of PMS between the two groups., Results: Sixty-nine women with regular menstrual cycles suffering from PMS completed the study. The mean scores of the symptoms in the EA group were 35.3 and 16.1 (P ≤ 0.001) at baseline and after 2 months, respectively, while the mean scores of the symptoms in the placebo group were 31.0 and 28.3 (P = 0.09) at baseline and after 2 months, respectively. The evaluation of the first and the second follow-ups in the intervention group showed that, after being adjusted for age and body mass index (P ≤ 0.001), the mean scores of the premenstrual syndrome, using GEE analysis, have decreased to 6.2 and 11.6, respectively., Conclusion: Based on the results, in comparison with the placebo group, EA was found to be more effective in improving the symptoms of PMS, and is highly recommended for treatment of this syndrome., Trial Registration: IRCT2015110822779N3 ; Registration date: 2015-11-27.

Objectives: Weight control behavior is a strategy for weight loss or weight gains that range from healthy to unhealthy. This study is aimed to determine the prevalence of weight control behaviors and their related factors in adolescent girls in Tehran., Methods: Adolescent girls in the last grade of high school (n=491) that were selected by a multi-stage sampling method completed a cross-sectional survey (2018) in Tehran city in Iran. Data were collected using questionnaires (standard and researcher-made) by the self-report method and analyzed using descriptive and inferential statistics, including Chi-square, independent t-test, and logistic regression., Results: 17.5% of adolescents had healthy, 60.6% had unhealthy, 15.8% had extreme unhealthy weight control behaviors, and 6.1% had no weight control behaviors. 74.8% of adolescents were in the normal body mass index (BMI) percentile. Unhealthy weight control behaviors were observed more than healthy behaviors at all BMI levels. Weight control behaviors had significant relationships with weight control intention (p=0.005), family (p=0.016) and peers (p=0.011) encouragement to weight control, engagement of relatives in weight control behaviors (p=0.016), anxiety (p<0.001), and age (p=0.030). BMI has a positive correlation with body weight satisfaction (p<0.001) and body weight perception (p<0.001). The results of logistic regression showed that increasing anxiety score can increase the possibility of engaging in unhealthy weight control behaviors (odd ratio=1.086, p=0.006)., Conclusions: Considering that a significant percentage of adolescents have unhealthy and extreme unhealthy weight control behaviors, and some of these behaviors leave irreversible effects on the health of this age group, design, and implementation of educational programs to prevent such behaviors seem imperative., (© 2020 Walter de Gruyter GmbH, Berlin/Boston.)

Background and Aims: Prostate cancer screening applied for early diagnosis of prostate cancer. But it is not usually pursued by men. This study was conducted to determine the effect of educational program based on the Theory of Planned Behavior (TPB) on prostate cancer screening., Methods: A randomized clinical trial was carried out on 68 middle-aged men referring to community houses in Iran. Samples were selected consecutively considering the inclusion criteria. Then block randomization was used to assign the participants into two groups. Data collection included demographic characteristics, knowledge and construct of TPB (Attitude towards the behavior, Subjective norms, Perceived behavioral control, behavioral intention) and behavior. The participants in the intervention group attended a theory based program 4 session twice per week. The participants were evaluated before and two month after the intervention. P <0.05 was considered statistically significant., Results: After the 2 months intervention, the pretest-posttest changes in the intervention group compared to the control group were in the Knowledge 9.26 ± 3.5 vs. 0.03 ± 1.68, Attitude 11.46 ± 3.5 vs. -0.16 ± 1.39, Subjective norms 3.16 ± 2.6 vs. 0.29 ± 1.3, Behavioral control 6.76 ± 4 vs. 0.12 ± 1.60 and Behavioral intention 1.4 ± 1.54 vs. 0.00 ± 1.00 ( P < 0.05). While none of the subjects in control group performed the prostate screening, 10 people (33.2%) performed it in the intervention group. ( P < 0.001)., Conclusions: Educational program based on TPB has a positive effect on prostate cancer screening. It is recommended to set up regular training programs based on TPB to encourage middle-aged men for prostate cancer screening., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 International Journal of Preventive Medicine.)

The relationship between healthcare providers and parents of infants in neonatal intensive care unit is based on trust and constitutes a core measure of family-centred care and health. The aim of the present qualitative study was to explore mothers and nurses experiences of trust in one another around the caregiving of the hospitalised infant in intensive neonatal care unit. Focused ethnographic research study conducted through observations and in-depth interviews with 20 mothers and 16 nurses in NICU of Tabriz (Iran) in 2017. Two main themes of 'gradual and fragile trust of mother-to-nurse' (subthemes: Primary trust-mistrust, mother's trust to responsible nurse, mother trust Increase with skilful nurse performance, and vulnerability to trust) and 'gradual and fragile trust of nurse-to-mother' (subthemes: Nurse's initial assessment of trust to mother's readiness to participate, Development of trust to mother, and vulnerability of nurse's trust to mother) were obtained. The present study revealed that mutual trust between the nurse and the mother in the care of the infant was a gradual and progressive process that was achieved over time. Complexities around the care of a hospitalised infant influenced how fragile or vulnerable the trust became between nurse and mother. Findings from this research can be used in supporting increased maternal participation in infant care and improvement of family-centred care in the neonatal intensive care unit., (© 2019 Nordic College of Caring Science.)

Introduction and Objective: Managing chemotherapy-induced nausea and vomiting (CINV) in patients with cancer is still a challenge for the patients and also the clinicians. The Multinational Association of Supportive Care in Cancer (MASCC) has developed a scale for better measurement and management of CINV. Thus, this paper aims at translating the scale into Persian and assessing the psychometric properties of the proposed translated version of MASCC Antiemesis Tool (MAT)., Methods: Having received the necessary permissions and complying with the Forward-Backward translation protocol, we conducted a qualitative assessment of the face validity through cognitive interviewing and content validity assess with 5 experts in Persian Literature. Internal consistency using Cronbach's Alpha Coefficient was applied to determine the scale reliability. In order to determine the construct validity, the three methods of exploratory factor analysis, known group analysis, and convergent validity (assessment of the correlation between Rhodes Index of Nausea, Vomiting and Retching (INVR) scale and the Persian version of MAT scale) were conducted on 300 participants., Results: About 300 patients with a mean age of 50.73 ± 0.81 participated in the study. The results showed a significant difference in the index of nausea and vomiting between the patients who are below 50 years old and those who are above 50 (P = 0.0001). The Cronbach's Alpha Coefficient was reported 0.88 for the whole MAT questionnaire. Due to the low factor load (fewer than 0.5) for question 1, it was removed in the factor analysis. Besides, exploratory factor analysis (EFA) led to the exploration of the two factors of nausea and vomiting., Conclusion: According to the results of the study, the Persian version of the MAT questionnaire is considered as a highly reliable and valid tool, in order to efficiently and accurately measure chemotherapy-induced nausea and vomiting and to better manage this side effect.

Introduction: This study was aimed to assess the effectiveness of auriculotherapy on managing nausea and vomiting during pregnancy., Methods: In this randomized clinical trial, 128 pregnant women suffering from nausea and vomiting were selected and assigned to study groups. The data were collected using demographic information and Rhodes' questionnaires and analyzed in SPSS v.22., Results: After intervention, the average nausea score of the Rhodes index declined significantly in patients in the intervention group (p < 0.001).However, there was no significant (p = 0.305) difference between the two groups regarding vomiting. The results of the repeated measures showed that interventions had a significant effect on the total score of the questionnaire and also the scores regarding nausea (p < 0.04)., Conclusion: The appropriate use of effective points on ears to control nausea and vomiting as a non-medicine and complementary treatment can alleviate nausea among pregnant women., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background Premenstrual syndrome (PMS) has a high prevalence among women of reproductive ages but despite its high prevalence, it has no determined and absolute treatment, so far. So, the aim of the present study was to compare the effect Pimpinella Anisum (Anise) with placebo on the intensity of the symptoms of PMS. Methods The present study was a randomized double-blind controlled clinical trial. College students who were suffering from PMS and had the inclusion criteria were selected and randomly assigned into two groups of intervention (Anise) and control (placebo). Participants in the intervention group, received 110 mg capsules of Anise three times day (a total dose of 330 mg per day); the control group received similar capsules with the same dosing that contained starch. Consumption of the capsules was started 7 days before the start of the menstruation and continued until 3 days after, which was a total of 10 days during two consecutive menstruation cycles. The intensity of the symptoms of premenstrual syndrome was measured using Premenstrual Symptoms Screening Tool (PSST). To compare the intensity of the symptoms between the two study groups, generalized estimating equation statistical method was used. Results Eventually, sixty-seven 18-35 year old college students who were suffering from premenstrual syndrome were enrolled in the study. Comparing the mean score of the intensity of the syndrome between the two groups after the first and the second menstruation cycles showed a decrease in the intervention group to 13.9 (p-value<0.001; 95% CI: 16.5,-11.4) and 9.8 (p-value<0.001; 95% CI: 12.4,-7.3), respectively. Conclusion Results of the study showed that, in general, Anise was effective in decreasing the symptoms of premenstrual syndrome in comparison to placebo.

Background: Sexual harassment is complex and has occupational hazards in nursing. Nurses experienced it than other employees. Female nurses are with the highest rate in the profession. Our aim was to determine the prevalence of sexual harassment against female nurses, the types, perpetrators, and health consequences of the harassment., Method: We undertook a systematic review to synthesize quantitative research studies found in Pubmed, Scopus, ProQuest, Web of Science and Google Scholar databases. The studies included were observational, on sexual harassment against female nurse, full text, and published in peer-reviewed English journals up to August 2018. Two independent reviewers searched the articles and extracted data from the articles. The quality of the articles was evaluated using the Modified Newcastle Ottawa Scale for Cross-Sectional Studies Quality Assessment Tool. A descriptive analysis was done to determine the rate of items from the percentages or proportions of the studies., Result: The prevalence of sexual harassment against female nurses was 43.15%. It ranged 10 to 87.30%. The 35% of the female nurses were verbally, 32.6% non-verbally, 31% physically and 40.8% were being harassed psychologically. The 46.59% of them were harassed by patients, 41.10% by physicians, 27.74% by patients' family, 20% by nurses and 17.8% were by other coworker perpetrators. The 44.6% of them were developed mental problems, 30.19% physical health problems, 61.26% emotional, 51.79% had psychological disturbance and 16.02% with social health problems., Conclusion: The prevalence of sexual harassment against female nurses is high. Female nurses are being sexually harassed by patients, patient families, physicians, nurses, and other coworkers. The harassment is affecting mental, physical, emotional, social and psychological health of female nurses. It is recommended policymakers to develop guidelines on work ethics, legality and counseling programs. Nursing associations to initiate development of workplace safety policy. A safe and secure working environment is needed in the nursing practice and nursing curriculum in prevention strategy. Research is needed on factors associated with sexual harassment. Since only female nurses were the participants, it could not be representative of all nurses. There was no fund of this review., Competing Interests: Competing interestsWe do not have potential conflicts of interest with respect to the research, authorship, and publication of this article., (© The Author(s) 2020.)

Background: 5-Fluorouracil (5-FU) and capecitabine are fluoropyrimidine derivatives that mainly metabolized with dihydropyrimidine dehydrogenase enzyme (DPD). The genetic polymorphism in the genes encoding this enzyme may result in a decrease or loss of enzyme activity which may lead to the accumulation of medicines, their metabolites and potential toxicity., Method: This cross-sectional study was conducted on 88 participants with colorectal cancer (CRC). After DNA extraction, polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was used to determine the DPD gene (DPYD) polymorphisms including IVS 14 + 1 G > A, 2846 A > T and 2194 G > A. Chemotherapy-induced side effects were evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE Version 5.0)., Result: Data were collected from 227 chemotherapy cycles of 88 patients with CRC. In a comparison of FOLFOX and FOLFIRI regimens, there was no significant difference in the occurrence of chemotherapy-induced diarrhea, nausea, vomiting and oral mucositis. However, the peripheral neuropathy was more frequent in patients who were treated with FOLFOX (P <  0.001) and hair loss was more common in patients who received FOLFIRI regimen (P = 0.048). Incidence of the DPD IVS14 + 1 G > A polymorphism was observed in four patients (5.5%). There was no association between IVS14 + 1 G > A polymorphism and the occurrence of adverse reactions., Conclusion: FOLFOX and FOLFIRI were the most common regimens in CRC patients and their toxicity profile was different in some adverse reactions. Prevalence of IVS14 + 1G > A variant was relatively higher than other similar studies., Trial Registration: Approval code; IR.MAZUMS.REC.95.2480.

Introduction: Hookah smoking has grown considerably among Iranian Turkmen in the past two decades. The reasons for this increase in the consumption of hookah are unclear. Therefore, this study was conducted with the aim of determining the factors related to the start of hookah smoking in men with Turkmen ethnicity., Methods: This qualitative study was conducted between February 2018 and June 2018 in Turkmen cities of Golestan provinces in Iran. The study participants included 26 male Turkmen water pipe smokers with various ages, occupation, and education level. Study data were collected through semi-structured individual interview and the results were analyzed in August 2018 by content analysis. Data management was done by software, MAXQDA version 10., Results: In this study, 26 hookah smoker men with the age range of 20-45 years were interviewed. The age of the participants at the time of starting hookah consumption varied from 14 to 25 years. On the basis of qualitative data, the reasons for the start of hookah smoking in male Turkmen were classified into three main categories: (1) individual (curiosity and sense of adulthood, fewer perceived risks compared with other substances and hookah's sensory attractions); (2) interpersonal (hookah-smoking friends and consumption of hookah by family members); and (3) societal (blaming unemployed people in small neighborhoods, cultural influence, more social acceptance compared with other substances, and easy access to hookah)., Conclusion: Individual, interpersonal, and societal factors play important role in the start of hookah smoking among male Turkmens. Developing health policies based on the above factors can be effective in adopting hookah prevention and control strategies. Moreover, future studies could be developed with the goal of discovering ways to solve the problem of unemployment and plan for developing recreational activities in this area to prevent initiation of hookah smoking especially among youth., Competing Interests: The authors declare they have no conflicts of interest., (© 2019 Atlantis Press International B.V.)

Objective: To evaluate the effects of self-management education tailored to health literacy on medication adherence and blood pressure control., Method: This randomized controlled trial was conducted in 2018 with 118 elderly people with uncontrolled primary hypertension and inadequate health literacy. Self-management education was developed on the basis of the health literacy index. Medication adherence and blood pressure were assessed using 8-items Morisky Medication Adherence Scale and a mercury sphygmomanometer, respectively., Results: At baseline, there were no significant between-group differences regarding participants' demographic characteristics, medical history, and medication adherence. After the intervention, between-group comparisons adjusted for pretest scores showed a significant reduction in the mean score of systolic and diastolic blood pressure and increase adherence to medication due to intervention (P < 0.05). However, the proportions of controlled systolic and diastolic blood pressure were not statistically significant different between-group (P > 0.05)., Conclusion: Self-management education tailored to health literacy significantly promotes medication adherence but has no significant effects on control of blood pressure., Practice Implication: To promote adherence to antihypertensive medications, tailored patient education to Health literacy is recommended. Limited pieces of evidence are available on the effectiveness of health literacy index-based interventions, so further studies are required., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background and Objectives : There is still no clear portrayal of women's empowerment in managing menopause. The present study was conducted to design a model for the empowerment of Iranian women in managing menopause. Materials and Methods : This qualitative study was conducted using the grounded theory on  40-60-year-old women who were first selected through purposive sampling and then by theoretical sampling from November 2013 to July 2016. Data were collected using 33 in-depth, semi-structured, individual interviews with 30 participants. Data were analyzed using the Strauss and Corbin(2008) approach and organized in MAXQDA-10. Results : The analysis of the data led to the emergence of "active coping with menopause" as the core variable with four themes. The two themes "threat to feminine identity" and "latent opportunity" explained the context of the study, and "redefining the feminine identity" and "self-retrieval" explained its process. Conclusion : In our social context, the phenomenon of menopause is a coin with two sides and its experience leans more on the threat to feminine identity and less on latent opportunity. The model of postmenopausal women's empowerment for managing menopause might offer health policy-makers a realistic and divergent understanding of the challenges of empowering women by explaining key concepts.

Objective: The purpose of this study was to explore perceptions about barriers to decision-making in Iranian patients with cancer about their care., Methods: Utilizing a qualitative approach, semi-structured interviews were conducted with 15 cancer patients., Results: Data analysis revealed four central categories reflecting patient perceptions about barriers that included medical dominance (uninformed decision-making, perceived inability to disagree secondary to despair, and patient objectification), healthcare system mistrust (physician, nurse, and medical center facility and equipment), healthcare system characteristics (services and facilities' limitations, poor communication, healthcare setting compulsion), and cultural barriers (feeling unfamiliar, insecurity in an unfamiliar environment, language barriers, limited attention to religious beliefs)., Conclusions: Barriers may impact the perceived ability of Iranian patients' with cancer ability to participate in decision-making regarding their care. Such barriers contain the potential to disrupt patient-centered care. Perceptions about barriers articulated by patients are modifiable. While some Iranian healthcare systems may have problematic challenges, targeted allocation of resources and education of healthcare providers convey strong possibilities to enhance patient-centered care., Competing Interests: There are no conflicts of interest., (Copyright: © 2019 Ann & Joshua Medical Publishing Co. Ltd.)

Background: Treatment decision making largely depends on patients' own preferences. However, the availability of different treatment approaches often results in decisional conflict, discomfort, doubtfulness, and uncertainty about the best option., Objectives: This study evaluated decision-making participation regarding surgery among women with early-stage breast cancer., Methods: This cross-sectional, descriptive-correlational study included 328 Iranian women with early-stage breast cancer. A convenience sample completed a demographic questionnaire, the Control Preferences Scale, the nine-item Shared Decision Making Questionnaire, and the Decisional Conflict Scale., Findings: Most participants preferred to maintain passive roles. High decisional conflict was associated with uncertainty about surgical treatment options, whereas lower decisional conflict was related to values clarity. Although preferred roles were not related to experienced involvement, they were related to heightened decisional conflict.

Objectives: Although effective performance in clinical settings requires the integration between theory and practice, there is a gap between theoretical knowledge as taught in the classroom and what the students experience in clinical settings. This study aimed to elicit and explore the barriers of utilizing theoretical knowledge in clinical settings., Methods: A qualitative study was adopted with a conventional content analysis approach. Fifteen nursing and paramedic's students, faculty members and experienced nursing staff participated in the study. Data were collected by semi-structured individual interviews until data saturation and concurrently analyzed via MAXQDA 10., Results: Five main categories emerged as barriers of utilizing theoretical knowledge in the clinical settings i.e. non-standard practices in clinical settings; lack of trust in clinical competence; lack of perceived professional support; insufficiencies in teaching and learning process; and differences between doing things in simulated and real clinical situations., Conclusion: Transferring theory into practice in a structured manner requires professional support in the workplace, trust and the opportunity for direct experience, using valid and up-to-date knowledge by clinical staff and bridging the simulated situations with real life scenarios., (© 2019 Chinese Nursing Association. Production and hosting by Elsevier B.V.)

BACKGROUND: The cultural and social background of the individual would seem to be important factors that can affect recovery from major depressive disorder (MDD). Currently, there is little information on the process of recovery from MDD in Middle Eastern countries, such as Iran. AIMS: This study was conducted to explore the process of recovery from MDD in Iran. METHOD: A grounded theory approach by Corbin and Strauss was used to explore recovery from MDD. Twenty patients were recruited using purposive and theoretical sampling methods. RESULTS: Several themes emerged from the data, the primary of which was "Attempting to restore integrity of the self," which included the two subthemes of "Attempting to restore health," and "Attempting to reacquire the lost abilities." Various contextual factors also affected recovery, including poverty, inefficient health care systems, perceived support, feelings of failure, and social stigma. During the recovery process, participants adopted both "effective strategies" and "ineffective strategies." Following the attempt to restore integrity, participants experienced different levels of integrity, ranging from "complete recovery" to "no recovery/relapse." CONCLUSIONS: The results from this study contribute to the body of knowledge regarding recovery from MDD in Iran. The data suggest that recovery from depressive disorder is a very personal experience that is affected by different and variable factors and conditions. However, the attempt to restore integrity of the self can result in achieving a higher level of performance and health.

Background and objectives : This study aimed to assess the level of HIV disclosure to children in sub-Saharan Africa as it relates to prevalence of disclosure, barriers, merits and demerits, timing of disclosure, and factors that promote parents and caregivers' decisions to disclose the information. Materials and Methods: A systematic literature search was performed using the following online databases: PubMed, Google Scholar, Web of Science, Scopus, and Embase, to obtain relevant articles on HIV disclosure to children in sub-Saharan Africa. The following search terms were used: "HIV" AND "Disclosure" AND "Sub-Saharan Africa" AND "Children". Results: A total of 18 articles were included in this systematic review. The studies on HIV status disclosure to children in sub-Saharan Africa included a total of 1343 HIV-positive children and 1879 caregiver/child or healthcare worker-child dyads, from the following countries: Ethiopia, South Africa, Ghana, Kenya, Cote d'Ivoire, Burundi, Cameroon, Democratic Republic of Congo, Uganda, Burkina Faso, and Zambia. The prevalence of HIV disclosure ranged from as low as 9% to 72%. Age was a major factor associated with disclosure. Conclusions: HIV status disclosure to children is quite low in sub-Saharan Africa. This is a result of multiple factors such as parents'/caregivers' fear of the child disclosing status to others, a lack of knowledge on how the disclosure should be made, and the assertion that the children are young and cannot withstand the psychological impact of diagnosis., Competing Interests: The authors declare no conflict of interests.

Background: Smoking hookah is considered a health problem among the adolescents, which currently has a high prevalence. The present study aimed to determine the reasons for tendency toward smoking hookah., Methods: Participants of this qualitative study were 24 adolescents from Tehran selected using purposeful sampling method in 2017. Data gathered through individual semi-structured interviews and two focus groups. Using directed content analysis approach 423 primary codes were categorized into 28 subcategories and 9 categories., Results: Most of the participants were 16 to 18 yr old (64%), male (58%) and had high school degree (58%) and 75% of them were student. In Theory of Planned Behavior, attitude toward smoking hookah contained categories of replacement for cigarette, the pleasurableness of hookah, easy access and spending the leisure times. Subjective norms contained the categories of family, friends and society. The construct of behavioral control contained the categories of personal and social factors., Conclusion: Our Results could be helpful in policy-making and planning toward improving the awareness and changing the attitude and performance of the adolescents toward smoking hookah., Competing Interests: Conflict of interests The authors declare that there is no conflict of interests.

Objective: A prominent challenge in modeling choice is specification of the underlying cognitive processes. Many cognitive-based models of decision-making draw substantially on algorithmic models of artificial intelligence and thus rely on associated metaphors of this field. In contrast, the current study avoids metaphors and aims at a first-hand identification of the behavioral elements of a process of choice. Method : We designed a game in Mouselab resembling the real-world procedure of choosing a wife. 17 male subjects were exposed to cost-benefit decision criteria that closely mimic their societal respective conditions. Results: The quality of choice index was measured with respect to its sensitivity to the final outcomes as well as process tracing of decisions. The correlation between this index and individual components of process tracing are discussed in detail. The choice quality index can be configured as a function of expected value and utility. In our sample the quality of choice with an average of 75.98% (SD: ±12.67) suggests that subjects obtained close to 76% of their expected gains. Conclusion: The quality of choice index, therefore, may be used for comparison of different conditions where the variables of decision-making are altered. The analysis of results also reveals that the cost of incorrect choice is significantly correlated with expected value (0.596, sig = 0.012) but not with utility. This means that when sub-jects face higher costs prior to making a decision, there exists a corresponding higher expectation of gains, i.e., higher expected value., (Copyright © Psychiatry & Psychology Research Center, Tehran University of Medical Sciences.)

Background: Moral distress is a very common experience in the nursing profession, and it is one of the main reasons for job dissatisfaction, burnout, and quitting among nurses. For instance, morally difficult situations in taking care of child patients who are severely ill may lead to moral distress for nurses. However, most of the studies about moral distress have been conducted on nurses of special wards and adult medical centers with much focus on developed countries. Subsequently, little has been researched on this topic among nurses in other nations such as Iran, and most certainly, there has been hardly any such research involving Iranian pediatric nurses., Aim/objectives: This study was conducted to evaluate moral distress among nurses in selected pediatric hospitals in Tehran, Iran., Research Design: This cross-sectional study was conducted on eligible nurses who were selected through proportional stratified sampling and who completed demographic characteristics and the pediatric version of Moral Distress Scale-Revised questionnaires. Data were analyzed using descriptive statistics, t test, one-way analysis of variance, and Pearson correlation coefficient., Participants and Research Context: In total, 195 pediatric nurses working at three selected children's specialized university hospitals in Tehran participated in this study., Ethical Considerations: This study was evaluated and approved by the institutional review board of Tehran University of Medical Sciences., Findings: The mean and standard deviation of total score of moral distress was 106.41 ± 61.64 within a range of 10-257. Also, the difference between the mean score of moral distress of the group who had not quitted their position and those who have quit in the past was statistically significant (p = 0.043). The situation that was associated with the highest moral distress was "observing medical students performing painful procedures on patients just to gain some skill." Total score of moral distress was significantly higher among male nurses (p = 0.014), while nurses with a master's degree experienced just a higher intensity of moral distress compared to those who had a bachelor's degree (p = 0.006)., Conclusion: Since many pediatric nurses clearly face moral distress while taking care of children, it is necessary to consider measures for preventing or decreasing situations that would lead to this distress.

Aim: Hepatitis is a systemic infection that causes restrictions in the life of many patients due to its chronic nature and it necessitates the use of coping strategies to improve the quality of life. This study aims to demonstrate the experiences of hepatitis B carriers in coping with the disease., Methods: The present study was conducted by using a qualitative content analysis. The data were collected through 18 unstructured and in-depth interviews from 2014 to 2016 at medical centers, a gastrointestinal and liver diseases research center in the cities of Babol and Amol (northern Iran) and Tabriz (north-western Iran) with patients infected with hepatitis B. The study was carried out by using purposive sampling., Results: The data analysis led to the extraction of the main theme, "attempting an active expansion of interactions," and its three subthemes, including: "denial of the disease," "protecting oneself or others," and "coping with the disease.", Conclusion: Patients with hepatitis B use different strategies to cope with this disease. In order for patients to properly face the disease and to live with minimum challenges and limitations, they need to be suitably understood and supported. Therefore, consideration of education and consultation programs regarding the different aspects of this disease is urgent., (© 2018 Japan Academy of Nursing Science.)

Background: Heart failure is one of the serious cardiovascular diseases, which poses a global pandemic and places a heavy burden on health care systems worldwide. The incidence of this disease in Iran is higher than in other Asian countries. To reduce patients' complications, readmission rates, and health care expenditures, it is necessary to design interventions, which are culturally appropriate and based on community needs., Methods: In 2016, a randomized clinical trial (IRCT2017010731804N1) was initiated to compare tailored tele-monitoring intervention with usual care. In total, 80 patients completed the study after a follow-up period of 8 weeks. The primary end point was heart failure self-care, which was measured using the Iranian version of the European Heart Failure self-care questionnaire. Secondary end points were heart failure related readmission rates., Results: The mean scores for self-care behaviors of the two groups showed significant difference at the baseline ( p  = 0.045). The results of the analysis of covariance that was used to control the differences in the pretest scores of self-care behaviors showed that the difference between both groups after the intervention was still significant ( p  < 0.001). The percentage of patients' readmissions in the intervention group (20%) was less than that in the control group (42.2%); however, the results were not statistically significant ( p  = 0/066)., Conclusion: This study showed that tele-monitoring improved self-care behaviors in Iranian patients with heart failure but did not reduce their readmission rates., Competing Interests: None declared., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: Post-divorce regret is a context-based phenomenon and in every community it is affected by the personal, social and cultural factors of that community. This study was conducted to investigate the post-divorce regret among Iranian women., Methods: This qualitative content analysis study was conducted from November 2015 to December 2017 in Tehran. 15 divorced women were selected through purposeful and snowball sampling. The data were collected through in-depth individual semi-structured interviews. Interview with participant no. 13 was conducted in two sessions (not having enough time for a long interview). Data were analyzed using Graneheim and Lundman's proposed method. The MAXQDA 10 software was used for the management of data., Results: Four main categories and 12 subcategories of data were extracted. The main categories and their subcategories were identity threat (stigma, becoming a sex object, discrimination), loss of independence (economic dependence, lack of independence in choosing a place to live, being controlled), vague future (concerns about children's future, little chance of having an appropriate remarriage, fear of loneliness) and the absence of the husband and his role (emotional and sexual needs, children's need for their father, need for a supporter and security)., Conclusion: The findings of this study showed that many of the participants had got involved in multiple social, economic and support problems after divorce. Most of the participants were not able to adjust to life after their divorce and consequently regretted their decision to divorce. Therefore, it is necessary to provide the appropriate social and economic support for these women based on the culture of the society.