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Abstract Background Workforce health is one of the primary and challenging issues, especially in industrialized countries. The purpose of the present study was to evaluate the ability to predict accident-proneness among Saveh Industry workers in Iran, based on an extended Health Belief Model, that included the construct of spiritual health. Method This descriptive-analytical study was conducted in 2022 on 384 workers in Saveh, Iran. The study aimed to explore relationships between accident proneness behavior, spiritual health, and health beliefs. The accident-proneness questionnaire consisted of two parts: the first part included demographic questions, and the second part comprised 9 sections covering personality traits, workplace harmful factors, miscellaneous factors, musculoskeletal disorders, safety culture, safety attitudes, job stress, organization interest, and degree of risk-taking. The Health Belief Model included 31 questions, while spiritual health was measured with the 20-question Paloutzian and Ellison questionnaire. The collected data were analyzed using SPSS version 26 software. Results In terms of accident proneness, 229 (59.6%), exhibited high levels, 148 (38.5%) had medium levels, and 7 (1.8%) showed low levels of accident-proneness. Hierarchical multiple regression analysis showed that in the first model, variables of perceived self-efficacy, vulnerability, and severity independently predicted workers accident proneness, explaining a total of 43% of variance in accident proneness behavior. In the second step, perceived self-efficacy (β = 34%), perceived sensitivity (β = 27%), spiritual health (β = 16%), and perceived severity (β = 12%) were included, respectively, which explained a total of 46% of the variance of accident-prone behavior of workers. Conclusion Given the high rate of accident proneness observed in this study, there is a critical need for policymakers and health planners to design policies aimed at mitigating the risks associated with occupational accidents. Furthermore, the findings highlight the potential of integrating spiritual health into the Health Belief Model, as a conceptual framework for planning effective intervention programs to enhance workplace safety.

Background and purpose: Pregnancy, childbirth, and acceptance of parental roles are associated with anxiety and stress in parents, and mothers of premature infants have special needs. Peer education has been introduced as an effective way of educating patients and their caregivers. This study aimed to determine the effect of a peer education program on parental stress and situational anxiety in mothers of premature infants hospitalized in the neonatal intensive care unit Materials and methods: This was a quasi-experimental study conducted in Karaj. The study population consisted of 154 mothers of premature infants hospitalized in the neonatal intensive care unit of Alborz Hospital in Karaj. A sequential sampling method was used according to the inclusion criteria. First, 77 mothers in the control group were included in the study, and after collecting data, the mothers of the intervention group were selected. Five 30-minute training sessions were performed on consecutive days and at specific times by five trained counterparts for the mothers of the intervention group in small groups of 3-5 people. Training sessions consisted of discussions and exchanges of opinions between researchers and peers. The sessions were held at the hospital in the training room next to the neonatal intensive care unit at a certain time of the day and for 5 consecutive days. At the end of each session, peer educators summarized the issues raised in the group and answered the questions. Parental stress was assessed using the Parental Stress and Scale, and situational anxiety was assessed using the Spielberg Situational Anxiety Inventory. The mothers of the intervention group answered the questions of the above-mentioned questionnaire before the implementation of the peer education program immediately after the intervention and one month later. Mothers in the control group completed the questionnaire simultaneously. Data were analyzed using SPSS version 22 with analysis variances T t-test, and repeated measure test. Results: The mean age of mothers in the control and intervention groups was 29.49±4.76 and 30.5±4.5 respectively. The education level of most mothers in both the intervention and control groups was middle and high school to diploma, and most mothers of premature infants in both the intervention and control groups were housewives. None of the demographic characteristics was significantly different between the intervention and control groups. The mean stress scores in the intervention and control groups before the intervention were 120.94±16.04 and 116.26±33.82, respectively(P=0.462). Mothers in the intervention group experienced significantly less parental stress (intervention: 98.71±11.21, control: 114.83±32.56) after the peer education program compared with the control group, and this difference was statistically significant(P=0.007). There was a significant difference in parental stress one month after the implementation of the peer education program (intervention: 98.71±11.21, control: 114.83±32.56 (P

Background and Objectives: Adapting to COVID-19, as a stressful experience, is a challenging process that poses significant problems for affected individuals. One of the crucial issues in diseases, especially during epidemics, is the need to focus on the mental dimension and mental health of society and patients in the face of illness. A key component of mental health is resilience. The present study was designed and implemented to investigate the relationship between spiritual health and resilience of patients with COVID-19 in hospitals accepting COVID-19 patients in Qom Province, Iran. Methods: In this correlational and cross-sectional study, 215 patients with COVID-19 were selected to participate using convenience sampling. The participants were asked to complete a demographic information checklist, as well as Paloutzian and Ellison’s spiritual health questionnaire and Connor-Davidson’s resilience questionnaire. Spearman’s correlation coefficient was used to analyze the data using SPSS software, version 26. Results: The results showed a significant and positive relationship between the score of spiritual health and the level of resilience of patients with COVID-19. The results showed no significant relationship between any of the variables—age, gender, employment status, underlying disease, marital status, economic status, inpatient department and level of education—and the patients’ spiritual health scores or their resilience. Conclusion: There is a significant relationship between spiritual health and resilience of patients with COVID-19. Considering the essential role of mental health in enhancing resilience and facilitating the return of these patients to normal life, the healthcare team must pay special attention to this issue.

Background and Objective: Spirituality has an undeniable impact on healing power, the ability to cope with and adapt to change, and health-related conditions. Spirituality is an essential component of health care; it is critical, vital, and distinct from other types of care. Therefore, the current study aimed to explain the perception of spiritual care from the perspective of hospitalized patients. Materials and Methods: The present study was carried out in the educational and medical centers of Qom University of Medical Sciences in 2020 using a qualitative approach and content analysis. Data were collected and analyzed concurrently through semi-structured, in-depth interviews with 12 participants using purposive sampling. Results: The participants included seven women and five men. The mean age score of participants was 44.16±10.1 years. From the analysis of interviews, 366 primary codes, 10 subcategories, and 3 main categories were extracted, indicating participants' understanding of spiritual care. The categories included religious (belief in the presence of God, observance of Sharia rules, respect for religious beliefs), moral (respect for privacy, responsibility, honesty, secrecy), and emotional (protection, support, follow-up, and continuity of care). Conclusion: In light of the findings of this study, spiritual care has a religious and ethical foundation, and its supportive aspects should receive more emphasis. According to patients, spiritual care entails responsibility, honesty, and confidentiality, as well as considering moral values and religious beliefs as a valuable resource that maximizes patient's self-care control and recovery.

With the institutionalization of tolerance in the health system, the level of intimacy increases, and the possibility of benefiting more than the company of patients and their companions are provided. Tolerance reduces the number of damages by improving the level of security and improves the health level by facilitating the achievement of goals. To achieve the above positive points, it seems necessary to have a written program in this field, especially considering the cultural and religious characteristics of Iran.

Background and Objectives: Patients have certain rights that are expected to be observed and respected by healthcare providers. These rights include universal as well as local rights determined by the social and cultural context of any society. Patient’s rights consist of statements issued to declare the duties of the health providers pertaining to patients. There are charters of patient rights in different countries including Iran. However, it seems necessary to investigate more exactly the patient rights in accordance with the Islamic perspective as the fundamental value system of the country. This study was conducted to explore and explain the patient’s rights from the clerics’ point of view. Methods: This was a conventional qualitative content analysis study. The participants were 20 clerics living in Qom selected through purposeful sampling, who met the inclusion criteria and could provide their understanding of the patient’s rights in the context of Islam. Deep semi-structured interviews were conducted. The interviews were coded and categorized through qualitative content analysis. Results: This study led to the identification of four themes as the main features of patient’s rights from the clerics’ point of view including respect for patient autonomy, considering non-physical needs of patients, high-quality healthcare, and moral conduct. Conclusion: According to the findings of this study, patient rights from the viewpoint of the clerics includes besides attending other needs of patients, their spiritual needs that should be addressed by healthcare providers.

Abstract Background Considering the importance of spiritual aspects of human beings, spiritual care provision is increasingly recognized as a major duty of healthcare providers, particularly nursing staff. Spiritual care competence is necessary for the nurses to be able to provide spiritual care, but the competence itself is associated with other variables. This study aimed to investigate if the spiritual care competence of nurses is related to their spiritual health. Methods A cross-sectional study was conducted with the participation of 172 practicing nurses in hospitals affiliated with Qom University of Medical Sciences, selected through stratified random sampling. Participants completed the Persian versions of the Spiritual Health Questionnaire (Amiri) and the Spiritual Care Competence Scale (Van Leeuwen). To examine the correlation between nurses’ spiritual health and spiritual care competence, a Spearman coefficient was used and a linear regression analysis was done to determine the predictability of the spiritual care competence of the nurses. The data were analyzed using SPSS v.23 and the significance level was set at 0.05. Results The participants showed a mean (SD) score of 108.93 (19.04) on spiritual care competence and 213.38 (16.49) on spiritual health. Spiritual care competence of nurses showed no significant relationship with demographic characteristics and their spiritual health had a significant relationship with gender only. Correlation analysis revealed a significant relationship between spiritual health and spiritual care competence and their subscales. Moreover, the linear regression analysis indicated that the nurses’ performance regarding spiritual health can predict their spiritual care competence. Conclusion The study revealed that the spiritual care competence of nurses is correlated with their spiritual health and performance as a subscale of spiritual health can predict their spiritual care competence. Thus, it can be concluded that the spiritual health of nurses is an important factor in providing spiritual care for patients and meeting their spiritual needs.

Many healthcare providers have come to an understanding of the need for addressing the spiritual dimension of human beings. From aholistic view, human beings are first and foremost spirits and should be regarded as a whole, not merely their bodies (1). Contrary to the notion of looking at patients as cases of a disease occupying hospital beds and subject to different drugs or medical interventions, patients are more and more being recognized as humans who should be considered as a whole, including physical and spiritual dimensions that correlate with and influence each other. In view of the spiritual dimension overarching other dimensions of human beings (2) and the spiritual distress faced by many patients, the healthcare system should take care not to disturb the spirituality of patients but rather try to enhance and improve it (3). Spiritual care, in this way, can improve the effectiveness and quality of care services through reform in professional care by addressing spiritual needs as a part of holistic care (4).

Background: An overview of spiritual care studies can help reveal the dimensions of spiritual care and summarize the findings of available studies. Thus, we designed the present study based on existing studies to explain the dimensions of spiritual care. Materials and Methods: In this thematic analysis, we gathered the related articles published in Persian and English in the last 8 years (2013–2021) with the help of the keywords of Care, Support, Spirituality, Religion, Treatment, Hospice, and Palliative, and searching in electronic databases, including PubMed, Scopus, Web Of Sciences, Magiran, Islamic Science Citation (ISC), and Scientific Information Database (SID). We accurately studied 79 articles that met the inclusion criteria, and then the spiritual care components were extracted and coded, and finally, the codes were categorized as themes and sub-theme. Results: Thematic analysis of available studies revealed that the dimensions (theme) of spiritual care include: spiritual and religious assessment, developing a structure for providing spiritual care, establishing effective and supportive communication with the patient, training the patient, answering his questions, encouraging, maintaining, and improving social communications, encouraging the patient to live happily, helping the patient to achieve peace and calmness, supporting for spiritual rituals and activities, supporting and training the patient's family, and supporting the dying patient. Conclusions: Spiritual care includes various and numerous dimensions. Considering the widespread dimensions of spiritual care, it seems necessary to design and plan appropriate studies to reveal other spiritual care dimensions from the perspective of patients and care providers in different cultures.

Background and Objectives: Nurses are professionally and ethically obliged to provide spiritual care as part of comprehensive care for patients. The present study was conducted to determine the educational needs of nurses to provide spiritual care. Methods: This study was performed descriptively using the Delphi technique from September 2020 to April 2021 at Qom University of Medical Sciences. In the first stage, 10 specialists were selected by purposive sampling method and answered an open-ended question to determine the educational needs of spiritual care. After collecting opinions in three rounds, the needs with an agreement coefficient of more than 51% were prepared in the form of a 15-item questionnaire and the importance of the items was determined by 144 nurses. Needs with scores of 3 or higher were finalized and general and behavioral goals were set for them. Results: In the first, second, and third rounds, 47, 25, and 15 educational needs were determined, respectively, and five general objectives, including familiarity with the holistic approach to human beings and dimensions of health, familiarity with the concepts of spiritual care, familiarity with how obtaining a spiritual history, familiarity with the types of diagnoses and spiritual interventions, and familiarity with the principles of communication in spiritual care were determined. Conclusion: The results of the study can be used for developing a spiritual curriculum and a practical guide to providing spiritual care for nurses and other groups of the health team.

Background and Objectives: Intrauterine insemination (IUI) is one of the methods of infertility treatment. When is the best time to do this assisted reproduction procedure? There are many Islamic narrations about the appropriate time for fertilization in order to give birth to a physically, mentally, and spiritually healthy child. Therefore, this study examined the relationship between the time of IUI performance and its consequences according to Islamic narrations. Methods: The present historical cohort study was conducted at an Infertility Center affiliated with the Academic Center for Education, Culture, and Research of Qom, Iran using the medical records of patients who underwent sex selection IUI procedure from 2011 to 2015. The data were collected using a researcher-made checklist consisting of demographic characteristics, factors affecting the pregnancy outcome in terms of medicine and narrations, as well as the pregnancy outcome. The collected data were analyzed in SPSS software (version 20). Results: The findings indicated that the time of IUI performance based on Islamic recommendations and the pregnancy test result had a significant relationship (P=0.003). Moreover, the time of IUI based on Islamic recommendations had a significant relationship with pregnancy outcomes (P=0.023). The highest number of abortions and neonatal disorders were observed in pregnancies that had happened at the disapproved times according to the narrations (e.g., the end of the lunar month and when the moon is in Scorpio). Besides, the highest number of births of healthy infants happened when the insemination had happened at the recommended times (e.g., Thursday noon). Conclusion: Due to the relationship between the time of IUI based on Islamic recommendations and the pregnancy outcome, it is recommended that IUI be performed based on Islamic recommendations and at times other than the disapproved times so that better results will be achieved in pregnancy. However, further studies are needed in this regard.

Abstract Attitude to humankind will have different effects on providing health services. Although, more attention is being paid to physical dimension of health, many researchers and health service providers consider the concept of health beyond physical health. Accordingly, the biopsychosocial model of health, which has been accepted by scientific communities for many years, has a missing link called spiritual health. In recent years, different models have been proposed to investigate the relationship between spiritual health and other dimensions of health in the form of a holistic approach to humankind. In spite of the variety of these models, the fundamental challenge is the actual place of spiritual health in comparison with other dimensions. In this study, it was attempted to address the status and weight of spiritual health and its relation to other aspects of health from the Islamic point of view.

Background and Objectives: Competency-based medical education focuses on empowering the medical students with capabilities required to act effectively in their field work, in accordance with the needs and demands of the service sector. The remarkable rise in the interconnection between medicine and religious issues in recent years has intensified the need to addressing religious competencies in medical education. However, there is little evidence of such a tendency in the Iranian medical universities. We investigated the barriers and challenges faced by medical education system for the development of religious competencies. Methods: This qualitative study was carried out by conventional content analysis method. The participants were 18 faculty members and instructors from 7 Iranian medical universities, selected through purposeful sampling. The experts' opinions were obtained through deep semi-structured interviews and analyzed by MaxQDA (version 10). Results: The results revealed the challenges of developing religious competencies in five main categories including conceptual challenges (lack of clarified concept of religious competencies, and the predominance of secular approach), motivational challenges (lack of intrinsic/ extrinsic motivation), methodological challenges (lack of appropriate teaching/ learning methodology and inadequacy of assessment mechanisms), institutional challenges (the absence of supportive and facilitating organizational culture, lack of necessary infrastructures, discordant content and resources, and improper policies), and finally contextual challenges (sociocultural conflicts and macro social structures). Conclusion: Religious competencies development in Iranian medical education is in need of close attention to multiple factors affecting it, some of which are outlined in this article. It seems that a multifaceted look is needed for a comprehensive plan in this regard.

Background and Objectives: Quality of life is a key component of health, associated with the individual and social living conditions of a person. Religious or spiritual parameters are among the most important determinants of quality of life (QOL) and its outcomes, and they are more significant and effective when the university students are involved. Therefore, the present study was conducted to evaluate religious attitude and self-control among the students of University of Qom and Qom University of Medical Sciences in Qom, Iran. This study was also targeted toward evaluating the relationship between these variables and QOL in the same population. Methods: This cross-sectional study was conducted on 298 students selected through multistage stratified random sampling technique. The participants’ religious attitude, self-control, and QOL were assessed based on the questionnaires of 40-point, 24-point, and 26-point scales, respectively. The data were analyzed through path analysis using the SPSS (version 20) and Mplus software. Results: Out of 298 participants, 160 (54%) respondents were the students of Qom University of Medical Sciences, and 178 (60.3%) students were female. According to the results, religious attitude showed a positive correlations with QOL and self-control. The results of path analysis revealed that religious attitude had an indirect effect on QOL through affecting self-control, in addition to a direct effect on QOL. The overall effect of religious attitude on QOL was estimated at 0.372, while the effect of self-control on QOL was reported as 0.449. Conclusion: As the fidnigns indicated, the promotion of religious attitudes can improve self-control, thereby leading to the improvement of QOL.

Background and Objectives: Philosophy of medicine as a field of study mainly concentrates on issues, such as ontology, epistemology, axiology, and logic. Although axiology has attracted more attention due to its position in medical ethics, especially in relation to modern medical ethical challenges, other topics of philosophy of medicine should be also considered important and necessary. Developing training courses at prestigious universities, publication of journals and books, holding conference meetings, are indicative of special attention to this relatively new field of knowledge. Some stipulated goals of Iran medical education system, such as critical thinking and problem solving skills, have also made these issues important and necessary to be paid attention to. Addressing philosophy of medicine in medical education program, can lead to contemplation on critical thinking, nature of rational thinking, its governing rules, and its role in health care system, and this is while, medical education system has taken distance from combination of wisdom and medicine, which is the main feature of former and influential Iranian physicians. Graduates of medical education system and provider of health services need to know the principles of health anthropology and the nature of health and disease in order to consider humans to be more than a body and to possess special dignity, and apply their professional practices and behaviors according to this approach. It seems that presenting the mentioned issues as a course entitled "Introduction to Medical Philosophy" to the medical students, may changes the attitude of health care providers.

Introduction: Neutrophil-to-lymphocyte ratio (NLR) is considered as an independent predictor of long-term prognosis in the individual patients with coronary artery disease (CAD). This study sought to assess the relationship between NLR and CAD severity in Iranian patients undergoing cardiac catheterization.Material and Methods: This prospective study was conducted on 500 patients with acute coronary syndrome (ACS) presented to Shahid Beheshti Hospital, Qom, Iran, for admission and underwent cardiac catheterization between March 2015 and May 2017. The patients were assigned into three groups of high NLR (more than 3), intermediate NLR (between 2 and 3), and low NLR (less than 2). Then the CAD severity and its relationship with NLR were assessed.Results: According to the results, there was a significant difference between the groups in terms of CAD severity (P

Human health includes physical, social, mental and spiritual dimensions and medicine is perfect when all aspects of health are considered. There are several reasons for the need for health personnel familiarity with issues related to spiritual health that some of them are: Finding best responds to the spiritual needs of patients, the use of spiritual care to improve health in four levels of prevention, the correct decision when creating a conflict between the spiritual beliefs of the patient and the diagnostic and therapeutic processes as well as spiritual beliefs of physician with the aforementioned processes. Members of the health team can affect the spiritual health in various forms including the impact on presentation of services environments, attention to client's spiritual health, presentation of spiritual health services and self-care education to patients. The spiritual health issue should be entered into the educational curriculum of medical sciences and its theoretical and practical aspects to be taught properly. Also, spiritual health topics should be included in the continuing education programs of medical practitioners.

Background and Objectives: Patient’s rights are one of the pivots to define the standard clinical care programs. Patient’s Rights Charter has been compiled and applied for defending human rights, protecting honor and dignity of patient, and ensuring that patients receive treatment without discrimination especially in case of medical emergencies. The aim of this study was to compare the contents of Patient’s Rights Charter with those of the Holy Quran and Ahadith. Methods: To conduct this library, descriptive study, first, the principles of the Charter were drawn and then the Quran and relevant literature indexed in different databases were reviewed. Then, the points in question were written down, classified, and compared to those of the Charter. Results: In general, the principles of the Charter represented in nine terms which were consistent with several verses of the Quran and Ahadith. These terms consisted of human dignity, justice and avoidance of injustice, beneficence, knowledge value, moral virtue, privacy and confidentiality, ownership, authority, and life-saving and life-sustaining. Conclusion: All of the concepts of Patient’s Rights Charter can generally conform to the verses of Holy Quran and Ahadith. Since religious beliefs can play effective role in performance of health care professionals regarding patient's rights, it is recommended to apply the Quranic proofs of the Patient’s Rights Charter, which are in line with the Charter, for better performance.

Attitudes to humankind will have different effects on health service delivery. Health might used to be intended to provide physical health in the past; today, however, many researchers and clinicians consider the concept health to be beyond physical health. In support of this claim, it is enough to indicate that the bio-psycho-social model has for years been held by scientific communities to be a fully admitted model. However, the missing ring in this model, as suggested by many, is the spiritual health. In recent years, the relationship between spirituality and clinical interventions with a comprehensive focus on health has been under increasing scrutiny. Although different models have been presented for investigation of the relationship between spiritual health and other dimensions, the fundamental challenge in this regard is the actual place of spiritual health compared with other dimensions. In this article, attempts are made to address the position and weight of spiritual health from the Islam’s point of view.

Background and Objectives: Lack of a constructive and appropriate communication between medical universities authorities and students’parents can lead to problems for students and universities. In this study, attitudes and challenges of communication between parents and medical universities were investigated from the point of view of medical and nursing students. Methods: The study was persormed as a cross-sectional study on nursing and medical students of Qom University of Medical Sciences in 2014. Data collection tool was a researcher-made questionnaire containing 18 questions about attitude and challenges of students about communication between parents and medical University. Data were analyzed using t- and Pearson correlation tests. Results: A total of 102 students responded to the questionnaire (85%). The general attitude of students towards the communication between parents and university was positive, and there was no significant relationship between students' attitude score and sex, course of study, and marital status. Thirty percent of the students mentioned that University Counseling Center plays the greatest role in this communication. Conclusion: The results of this study showed that the attitude of the students towards the relationship between their parents and university is positive, thus creating communication centers could be effective in improving the quality of students’ education and areas of cooperation between their parents and the university.

BACKGROUND: Spiritual care is one of the important and essential aspects of healthcare. The impact of spirituality on healing, health-related states, and the ability to cope and adapt to the disease is undeniable. Thus, this study is aimed to explain the perception of the spiritual care of patients by health-care providers. MATERIALS AND METHODS: The present study was performed with a qualitative approach using content analysis by the conventional method in hospitals of Qom University of Medical Sciences. The data were collected through in-depth semi-structured interviews with 11 participants through a purposeful sampling method and analyzed simultaneously. The consistency of the data was confirmed by the participants. RESULTS: Data analysis provided four main categories as follows: “Observing the patient's rights” with subcategories of respect, right to choose, preserving the patient's privacy, proper communication with the patient, “professionalism” with subcategories of responsibility, acceptance of mistakes, development of technical skills and knowledge, “supportive behaviors” with subcategories of paying attention to emotional and psychological needs and “Strengthening the patient's religious dimension” with subcategories of honoring religious beliefs and providing healthcare along with trust in God. CONCLUSIONS: According to the study findings, spiritual care from the perspective of health-care providers was explained as attention to emotional and psychological needs, reverence for patients' religious beliefs, respect for human dignity, and sense of responsibility.

M edical education, beyond the acquisition of a set of knowledge and skills, is a quite complicated process of cultivation, formation, and development of health professionals (1) in the educational context which in turn, is deeply associated and intertwined with health delivery system. This is an output of close relationship and long-term interaction of the learner with the educational environment. The optimum output of this system, will be a graduate, possessing the required competencies and capable of performance with a holistic approach, a part of which are spiritual competencies (2). Regarding the significance of spirituality in holistic approach to health, medical education institutes and their accrediting agencies all over the world have seriously addressed the issue as an inseparable part of instructional goals and programs (3). Although this, by nature, is based on an old and original need, it is a relatively new phenomenon in formal medical education and thus undergoing a process of trial and error. Considering the multiple teaching and learning strategies and methods in medical education (4), the question arises about the best way for spirituality to be taught in medical schools. Determining the appropriate educational strategies in this field depends on a clear explanation of the aims and purposes of addressing spirituality in medical education. These aims could be classified in different levels, the minimum level being an overall perception of non-physical dimensions of human being. Nevertheless, the ultimate goal of incorporating spirituality in medical education according to the authors can be stated as a shift from the narrow biomedical paradigm to a deepened and strengthened holistic view among the health care potential workers, with special attention to Spirit as a truth composing a main part of his existence. It is believed that this recognition, followed by a comprehensive understanding of man and his diverse needs, leads to improvement in healthcare system and transcendence of health in human communities. In this way, addressing spirituality in medical education should be regarded paradigmatically, influencing many fundamentals of knowledge, attitude, and behavior. In other words, spirituality should be covered in medical curricula to convey a thorough knowledge of human being (5). It should be noted that during medical education, apart from technical knowledge and skills, a set of character traits and a kind of professional identity are formed, not only as a result of textbooks and educational materials, but through implicit and indirect messages conveyed within the atmosphere of education. These messages mainly focus on cultural customs, values, norms, social and behavioral expectations and tendencies, encompassing the concept of hidden curriculum in which, in addition to the content of the message, the sender, the environment and the way the message is exchanged are of particular importance (6). Hidden curriculum provides a capacity for transmission of messages beyond curriculum, which can be means of better training and finally better performance. Hidden curriculum, influenced by the organizational culture and especially role models, may be contrary to formal curriculum and the explicit educational goals. This is especially significant in clinical stages of medical education in which the actions of professors and others whose behavior is accepted as reference, accompanied by the overall atmosphere of the educational settings play a major role. It seems that to teach spirituality with the above-mentioned goals, it is necessary to take advantage from the capacity of hidden curriculum (7). Firstly, because it can be helpful in preventing against the negative consequences of what is implicitly taught in educational contexts, and secondly, to prepare the ground for utilizing it to develop and strengthen these competencies and meet existing challenges in areas such as medical ethics, professionalism, social accountability, and integrity. So, despite acknowledging spirituality and especially spiritual care as a part of formal curriculum, it seems that the effect of hidden curriculum is clearly greater on this dimension of health compared with other aspects of health. Although hidden curriculum exerts its effects in an implicit and at times unintended manner, targeted and planned interventions can lead to desirable effect on the learners. So it is recommended to consider spirituality in different levels from policy-making to planning, implementation and evaluation.

Awareness of the occurrence of medical errors is the right of patients and duty of the health service providers. This study was conducted to evaluate to what extent people want to know the occurrence of an error in their medical care, what they expect to be disclosed about medical error, and what are the influential factors in filing a lawsuit against physicians in disclosed medical errors from their point of view. In this cross-sectional survey, 1062 people residing in the city of Qom, Iran, were telephone interviewed using the random digit dialing method. The questionnaire used consisted of 4 demographic questions and 2 scenarios of major and minor medical error; the participants were asked if the physician should disclose the error in each scenario. The questionnaire also consisted of 16 questions about other issues related to error disclosure. Data were analyzed through descriptive and inferential statistics in SPSS software. About 99.1% of the study population believed that errors had to be disclosed to patients. They all wished to know that measures would be taken to prevent further errors. Moreover, 93.1% of the participants expected an explanation on the incident. As for the factors that decreased the likelihood of taking legal action against the physician from the viewpoint of the study population, treatment of the complications (96.1%) and honesty of the physician (95.8%) had the highest frequency. Based on the considerable preference of patients for error disclosure, it is recommended that physicians disclose all minor and major errors sympathetically and with transparency, honesty, and efforts to prevent future errors.

Toriyeh means concealing real intention of speech using its parallel and common words so that the listener constructs from speaker's speech a meaning what he/she meant. The purpose of this research is studying jurisprudential dimensions of toriyeh in order to clarify its distinction from lying and related jurisprudential commandments by explanation of the most important discussions about toriyeh. This research was conducted via library method using verses, narratives, jurisprudence sources and decrees by religious authorities. two types of Second type: the speaker`s intention is the outward meaning but the listener misunderstands due to his mental moods. Some of the contemporaries regard the first type as forbidden and they regard the second type to allowable Toriyeh is not equivalent in the meaning with lying and jurists have mentioned narrative-based reasons to prove it. Therefore, in cases of emergency in which man is allowable to tell lie for removing inevitable loss he should use toriyeh as much as possible, and not tell a lie. Of course, toriyeh in the first sense is permissible and if a forbidden thing is conformed to it as a subordinate, it will lose its legality.

Background and Objectives : The objective of this study was to determine and compare the general levels of awareness of patient’s rights among the patients and nurses in training hospitals in Qom province. Methods: In a descriptive analytical study, 150 nurses and 200 hospitalized patients were asked about patient’s rights in all public hospitals in Qom. Data were collected using questionnaires and analyzed by SPSS. A p -value of

Background and Objectives: Medical ethics has a long history worldwide; although it is a new scientific discipline. Also, it is not just for a specific single group or discipline in a treatment team; it is the entire medical community who benefits from it. Given the importance of this issue, this study examined the viewpoints of the specialist physicians in Qom province on the most common issues in medical ethics, with the hope to take a step forward through identifying common problems and solving them. Methods: This descriptive study used the Delphi Method in which the views of the specialist physicians on the medical ethics were analyzed through two questionnaires. The first questionnaire contained some open questions, and the second one was designed to rank and rate the titles of medical ethics problems in terms of their prevalence. Results: The most common problems in medical ethics derived from the first questionnaire based on the order of priority were: secrecy, doctor-patient relationship, justice, telling the truth, privacy, informed consent, relationship with colleagues, patient's participation in treatment methods, dealing with improper treatment and interaction between the physician and treatment authorities. Conclusion: By identifying the common and more important problems based on the viewpoints of the specialist physicians in Qom province, it seems necessary to pay more attention on training in order to solve these problems.

Background: Dysmenorrhea has negative effects on women′s life. Due to side-effects of chemical drugs, there is growing trend toward herbal medicine. The aim of this study was to assess the effect of Dill compared to mefenamic acid on primary dysmenorrhea. Materials and Methods: This double-blind, randomized, clinical trial study was conducted on 75 single female students between 18 and 28 years old educating in Nursing and Midwifery School and Paramedical Faculty of Qom University of Medical Sciences of Iran in 2011. They were allocated randomly into one of the three groups: In Dill group, they took 1000 mg of Dill powder q12h for 5 days from 2 days before the beginning of menstruation for two cycles. Other groups received 250 mg mefenamic acid or 500 mg starch capsule as placebo, respectively. Dysmenorrhea severity was determined by a verbal multidimensional scoring system and a visual analog scale (VAS). Students with mild dysmenorrhea were excluded. Data were analyzed by SPSS using the descriptive statistic, paired-samples t-test, Wilcoxon signed-rank test, Mann-Whitney test, and Kruskal-Wallis test. Results: There were no significant differences between three groups for demographic or descriptive variables. Comprising the VAS showed that the participants of Dill and mefenamic acid groups had lower significant pain in the 1 st and the 2 nd months after treatment, whereas in the placebo group this was only significant in the 2 nd month (P < 0.05). Conclusion: Dill was as effective as mefenamic acid in reducing the pain severity in primary dysmenorrhea. Further studies regarding side-effects of Dill and its interactivity are recommended.

Introduction: Success in surveillence programs is mostly dependent on physicians’ skill to report diseases. Self-learning is an appropriate method for medical education programs and has been used in many countries. The purpose of this study was to compare self-learning of reporting diseases through compact disks (CD) and booklets in physicians’ education. Methods: This study was a quasi-experimental study performed on 40 general physicians in Qom . They were divided into two groups [CD (n=20) and booklet (n=20)] by balanced block randomization. Knowledge and attitude were assessed before the intervention and a month after. The data collection tool was a self-administered questionnaire in 4 parts: demographic information, knowledge and attitude about notifiable diseases and evaluation of the educational method applied. The data were analyzed by SPSS software, through calculation of frequency, mean, standared deviation, t-test, kolmogorov -smirnov test and mann-whithney U- test. Results: Knowledge and attitude were promoted significantly in both groups(p

Background: The current treatment of IBS is often unsatisfactory and frustrating. Several controlled trials have demonstrated benefits of tricyclic antidepressants for irritable bowel syndrome, especially when pain is a prominent symptom but the efficacy of antidepressants in irritable bowel syndrome is controversial. The aim of this study was to compare the effect of doxepin and nortriptyline on diarrhea-predominant irritable bowel syndrome.Methods: Seventy-five patients with IBS according to Rome III criteria were treated for two months. The patients were randomly assigned to one of three groups treated with doxepin, nortriptyline or placebo. Subjects were assessed clinically one month and two months after treatment. The symptoms and adverse effects of the drugs were recorded in the questionnaire. The total score was considered as the number of the symptoms for each patient, which ranged between zero and six.Results: Improvements in abdominal pain and bloating in the doxepin group were significantly higher than the nortriptyline or the placebo groups (P=0.001 and P=0.012, respectively). However, improvement in diarrhea in patients on nortriptyline was significantly higher than the other groups (P=0.018). The average improvement of symptoms in the patients after two months of treatment in doxepin, nortriptyline and placebo groups, respectively were 2.56, 2 and 0.6 (P

Mohammad K Moslemi1, Seyed M Moosavi Movahed2, Akram Heidari3, Hossein Saghafi2, Mehdi Abedinzadeh41Department of Urology, 2Department of Nephrology, 3Department of Health, Kamkar Hospital, Qom University of Medical Sciences, Qom, Iran; 4Department of Urology, Moradi Hospital, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, IranBackground: Unrestricted antibiotic use is very common in Iran. As a result, emergence of resistant organisms is commonplace. Antibiotic prophylaxis in surgery consists of a short antibiotic course given immediately before the procedure in order to prevent development of a surgical site infection. The basic principle of prophylaxis is to maintain effective concentrations of an antibiotic active against the commonest pathogens during the entire surgery.Materials and methods: We prospectively investigated 427 urologic surgery cases in our department between August 2008 and September 2009 (Group1). As reference cases, we retrospectively reviewed 966 patients who underwent urologic surgery between May 2004 and May 2008 (Group 2) who were administered antibiotics without any restriction. Prophylactic antibiotics such as cefazolin were administered intravenously according to our protocol. Postoperative body temperature, peripheral white blood cell counts, urinalysis, and urine culture were checked.Results: To judge perioperative infections, wound condition and general condition were evaluated in terms of surgical site infection, as well as remote infection and urinary tract infection, up to postoperative day 30. Surgical site infection was defined as the presence of swelling, tenderness, redness, or drainage of pus from the wound, superficially or deeply. Remote infection was defined as occurrence of pneumonia, sepsis, or urinary tract infection. Perioperative infection rates (for surgical site and remote infection) in Group 1 and Group 2 were nine of 427 (2.6%) and 24 of 966 (2.5%), respectively. Surgical site infection rates of categories A and B in Group 1 were 0 and two (0.86%), respectively, while those in Group 2 were 0 and five (0.92%), respectively. There was no significant difference in infection rates in terms of remote infection and surgical site infection between Group 1 and Group 2 (P = 0.670). The amounts, as well as the prices, for intravenously administered antibiotics decreased to approximately one quarter.Conclusion: Our protocol effectively decreased the amount of antibiotics used without increasing perioperative infection rates. Thus, our protocol of prophylactic antibiotic therapy can be recommended as an appropriate method for preventing perioperative infection in urologic surgery. Keywords: surgical site infection, antibiotic prophylaxis, single dose, urologic surgery

Background. Increased insulin resistance is an extragastrointestinal manifestation of Helicobacter pylori (HP) infection. HP changes the level of inflammatory markers and cytokines and changes the adipocyte function by altering the adiponectin level. Given the high prevalence of HP and diabetes in our society, we evaluated the association between HP and serum adiponectin level. In this cross-sectional study, 211 diabetic patients under treatment other than insulin were studied. These patients were divided into two groups of HP+ and HP− based on their HP IgG antibody serology and their blood adiponectin levels were measured. Data was analyzed using independent t-test, Chi-square test, and Fisher’s exact test. Results. Seventy-two patients with an average age of 51.56±8.34 years were HP− and 139 patients with an average age of 50.35±9.01 years were HP+. The mean serum adiponectin level in HP− and HP+ groups was 4.54±5.43 and 5.64±3.88 ng/mL, respectively. Insulin resistance degree was significantly higher in HP+ group (HP− = 3.160±3.327 versus HP+ = 4.484±3.781, P=0.013) but no significant difference was found between the mean serum adiponectin level in HP− and HP+ groups (P=0.140). Conclusions. Although the insulin resistance degree was significantly higher in HP+ diabetic patients, no significant relationship was found between HP infection and serum levels of adiponectin.

Lecture is the most common teaching method used in ethics education, while problem-based learning (PBL) and small group discussion (SGD) have been introduced as more useful methods. This study compared these methods in teaching medical ethics. Twenty students (12 female and 8 male) were randomly assigned into two groups. The PBL method was used in one group, and the other group was taught using the SGD method. Twenty-five open-ended questions were used for assessment and at the end of the course, a course evaluation sheet was used to obtain the students' views about the advantages and disadvantages of each teaching method, their level of satisfaction with the course, their interest in attending the sessions, and their opinions regarding the effect of teaching ethics on students' behaviors. The mean score in the PBL group (16.04 ± 1.84) was higher than the SGD group (15.48 ± 2.01). The satisfaction rates in the two groups were 3.00 ± 0.47 and 2.78 ± 0.83 respectively. These differences were not statistically significant. Since the mean score and satisfaction rate in the PBL group were higher than the SGD group, the PBL method is recommended for ethics education whenever possible.