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During several years of cooperation with scientific journals in Iran as referee, member of
editorial boards and editor in chief, I have faced with multiple non-ethical behaviors in
publication. These days, I am witnessed to submitting articles to two or more journal
simultaneously. Due to the growing pattern of this illegal action, this editorial will assess its
dimensions and consequences.
The Article 1, Chapter VI of the National guidelines on Ethics of Publishing Medical
Research has clearly stated: "If a manuscript is published or is being considered for publication
in print or electronically, re-publishing in or submitting to other journals is not allowed. This
statement is so important that the editors of the scientific journals have mentioned it in the
author guidelines of the journals. However, what make authors, especially beginners, to submit
their articles to more than one journal are perhaps requirements of the Institutes for defending a
thesis, annual and/or academic ranks promotions.
Republishing articles in scientific journals, especially in the same language, result in
spending cost and taking time of the scientific and executive teams of the Journals and has no
added value. The negative effects of this action are more highlighted when the role of scientific
journals in promoting health care quality through publishing new and valid scientific evidences
and limited spaces of the journals are noticed.

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The essence of nursing is protecting the public and nursing profession believes that receiving high quality and safe services, is the community’s right. During the past decades nursing has been considered as a significant profession with characteristics such as autonomy, professional commitment, expertise and responsiveness (1). The body of contemporary nursing is consisted of knowledge and skills, value system, academic education and professional socialization. Autonomy has been defined as nurse’s capacity for determining their action through independent choosing in all the fields of nursing practice and self-regulatory in nursing practice is necessary for achieving professional freedom of action (2).

Professional self-regulatory is the decision-making power for determining the inclusion criteria for the members to enter the profession and start their activity in that profession. It will determine who, with what specialties and how much knowledge and skills have the inclusion criteria for the profession (3). During the mid-19^th century, combination of knowledge and skills, emphasis on commitment to duty against seeking personal interests and also independence from external interferences in professional matters (autonomy) were mentioned as the most important features of self-regulated professions. From the early 20^th century, the motivations for professionalization got in line with professional self-regulatory (2). According to the Donabedian Model, a “social contract” exists between the society and the profession and under this contract the society will accept profession’s independence in exchange for their services and will give independence to that profession so that they could manage their own matters. In return for this privilege, the profession would act responsively to maintain the public interests (4).

Professional self-regulation would be granted to a profession as a privilege when the public would be able to receive the best possible services after that professions’ self-regulation (4). In fact, professional self-regulatory would guarantee the quality of services (2,5,6). During the past two decades, World Health Organization (WHO), to educate and employ competent and skilled nursing workforce, has recommended the governments to strengthen their professional self-regulatory frameworks. International Council of Nurses (ICN) in cooperation with the WHO has published a statement of their perspective of professional self-regulatory. This statement has mentioned that safe and high quality care, creating a monitoring system for licensing, professional policy making and applying the professional laws and rules could be reached by creating and improving the infrastructures of professional self-regulatory systems. ICN stated that professional self-regulatory is a method for applying discipline, stability and control over the profession and its performance (7, 8). National and international studies have shown that would improve educational and clinical standards which in turn would increase the power of the profession in managing its own matters.

Since professional self-regulatory would lead to the activity of qualified and competent individuals in a profession, it would increase people’s trust in professional services providers as capable and honest individuals and would provide the public interests (1). In professional self-regulatory, by firing professionally unqualified and uncommitted to the ethical codes individuals from the profession, the interests of the profession would be provided (4).

In the main, there are two ways a profession can be regulated: by the profession itself (professional self-regulatory) or directly by government. If the government would take the responsibility of managing the profession, the members of the profession would be forced to accept the laws and rules of the profession; while the approved laws by the self-regulated profession are flexible and would be accepted voluntarily (9).

Self-regulatory professions have two separate bodies for their activities: 1- the monitoring body and 2- the supporting body. The monitoring body maintains the interests of the profession through creating the inclusion criteria for the profession, licensing, certifying and disciplinary actions; while the supporting body would perform toward promoting the economic and professional benefits of the profession’s members. The goal of the supporting body is to develop the profession to assist the members and advance the profession; but the monitoring body will develop the profession to support the public interests. Most of the times, the public interests are not in conflict with the profession’s interest, but in case of such conflicts, professional self-regulatory should act toward achieving the public interest (10).

The condition of professional self-regulatory in Iranian nursing

Iranian nursing has had significant advancements during the recent years which development of academic education, formation of Iranian Nursing Organization (INO), establishment of Scientific Association of Iranian Nursing, establishment of research centers and publishing numerous research-scientific journals in different fields of nursing are some of them (11). However, the profession of nursing in Iran still has many shortcomings. Evaluating the laws of the Nursing Organization of the Islamic Republic of Iran, which is the greatest non-governmental nursing organization in Iran, although the goals of the organization are in line with the self-regulatory goals of the profession, but in most of the self-regulation requirements, no independent role has been defined for the organization, in a way that, in the definition of 6 duties out of 8 defined duties for the INO cooperation with or helping other organizations has been used and only in the third duty, “trying for improvement of the quality, skills and knowledge of nursing graduates” and the seventh duty, “determining standards for issuing, extending or cancelling membership cards”, the legislator has appointed an independent role for the organization. Maybe for this reason, and many other reasons that are not in the scope of this article, the INO has not considered professional self-regulation performances sufficiently. Other nursing associations in Iran, due to lack of regulatory mechanism and also the low number of members from the nursing profession, could not have an effective role in professional self-regulatory. In Iran, regulating the rules and managing the matters of nursing have always been a responsibility of the government (6,12). On the other hand, during the recent years, we have witnessed the establishment of the nursing deputy in the Ministry of Health and Medical Education (MOHME) which indicates the efforts for governmental management of this profession.

The authorities’ approach toward the nursing profession during the recent years for encountering various challenges is one of the examples of governmental management and lack of professional self-regulatory. For example, the nursing shortage could be mentioned which is a global problem. To resolve this problem, the MOHME has increased the capacity of training nursing students and the number of nursing schools. These measures have led to educating students at schools with no infrastructures and no competent educational board which is in conflict with the quality of services (public interests). In return, the next measure to compensate for the shortage in nursing workforce is educating practical nurses by the MOHME. Most of the experts have suggested this solution for the problem of shortage in nursing workforce, but it has been perceived as compulsory by the members of the profession and they disagree with it (13).

Considering that finding an appropriate self-regulatory mechanism for the profession requires the involvement of all the beneficiaries, especially the members of the profession, it is recommended that all of the active organizations in the field of nursing would start determining the characteristics and features of an appropriate self-regulatory organization for the nursing profession of Iran through conversations and then would make their best efforts for its establishment.

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Background & Aim: Randomized clinical trials (RCTs) are studies which are able to provide the most valid evidence to compare various interventions in health research. Biases can affect the quality of research and ultimately make the results of a study invalid. One of the most important biases is selection bias. The best way to reduce selection bias is the use of random allocation. The aim of this study is to provide comprehensive, practical and simple information regarding proper implementation of the random allocation process in randomized clinical trials.

Methods & Materials: A review study was performed using available resources and comprehensive analysis. For this purpose, we searched the relevant books & articles in databases including Medline, Scopus, Science Direct, Google Scholar and Magiran. Key words were randomization, random sequence, allocation concealment, randomized controlled trial, randomized clinical trial, and bias.

Results: From the literature review, we obtained 39 articles and one relevant book that their findings were presented in a simple language with practical examples in three parts including random sequences generation, random allocation concealment and implementation.

Conclusion: Selection bias in clinical trials has an adverse effect on the accuracy of results. In order to avoid it, researchers should employ proper methods in randomization and random allocation concealment, and report it in their articles properly. Therefore, researchers can obtain valid results through a better understanding of randomization and its proper implementation.

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Background & Aim: The physiological and psychological changes in pregnancy, can affect the lives of couples. The present study aimed to determine the effect of sex education on the marital relationship quality of pregnant women.

Methods & Materials: This study is a quasi-experimental. In this study, 100 pregnant women referred to health centers in Zahedan in 2015, were selected and assigned into two groups of intervention and control (50 in each group). Data collection tool was the perceived marital relationship quality components questionnaire. Questionnaires were completed by the both groups before and six weeks after the sex education sessions. Data were analyzed using descriptive and inferential statistics through SPSS software version 20.

Results: There was no statistically significant difference between the two groups (P<0.05) in terms of age, the duration of marriage, gestational age and gravidity. In post-test measurement, the mean of the total score of marital relationship quality and components such as satisfaction, sexual excitement, love, commitment, intimacy, and trust, were significantly higher in the intervention group than in the control group. Analysis of covariance also showed that the total score mean for the marital relationship and its components had significant difference in the pregnant women in two groups, after sex education (P<0.001).

Conclusion: Given the effectiveness of sex education in the improvement of marital relationship quality in pregnant women, this educational intervention is recommended to be integrated into the education program and prenatal care of pregnant women in order to improve the couple’s relationship quality in pregnancy.

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Background & Aim: Mastalgia is one of the most common complaints of women and its cyclic type constitutes two-thirds of the cases. This study aimed to determine the effect of Nigella Sativa syrup on cyclic mastalgia.

Methods & Materials: This study is a triple-blind randomized clinical trial (IRCT201104304785N3). The study samples included 65 women with cyclic mastalgia referred to the Breast Cancer Research Center (BCRC), Academic Center for Education, Culture and Research (ACECR) in Tehran in 2014-2015. The samples were randomly divided into two groups: intervention group (Nigella Sativa=36) and placebo group (oral paraffin=36). The pain was measured by the VAS and McGill Short Form questionnaire two months before and three months after the intervention. Data were analyzed using statistical tests on the SPSS software version 18.

Results: The results of the VAS and McGill pain score changes showed a significant difference between the two groups. Considering that the interaction between time and group was significant, the two groups were compared at each stage using independent t-test and the Bonferroni correction test. Thus, there was no significant difference between the two groups of Nigella Sativa and placebo on the basis of the McGill instrument but a significant difference was observed between the two groups on the basis of the VAS (P=0.002).

Conclusion: According to the results, Nigella Sativa reduces pain more than placebo. Therefore, it can be used along with other medications for the treatment of mastalgia.

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Background & Aim: Infertile women experience greater stress in their life and have lower quality of life compared to fertile women. The present study aimed to evaluate the effect of mindfulness-based cognitive psychotherapy (MBCT) on quality of life in infertile women.
Methods & Materials: In a randomized clinical trial (IRCT2017021132321N2) with the Solomon four-group design, 60 infertile women referred to Fatemeh Zahra Infertility Research Center in Babol in 2015, were randomly assigned into four groups (15 in the group of experiment with pretest, 15 in the group of experiment without pretest, 15 in the group of control with pretest, 15 in the group of control without pretest). A total of thirty participants in the experimental group received MBCT in eight group sessions (120 minutes, once a week). The control group received no intervention. Thirty participants at the beginning and sixty participants at the end of study completed the Quality of Life Questionnaire (WHOQOL-26). Data were analyzed by the SPSS software version 20 using univariate ANCOVA.
Results: The mindfulness-based cognitive psychotherapy improved the quality of life in both experimental groups. The mean scores for all the four domains of quality of life including, physical health, psychological health, social relationships, and environment significantly increased in both experimental groups compared to control groups (P<0.05).
Conclusion: The use of MBCT as a reliable method for promoting the quality of life of infertile women is recommended in infertility clinics.
 

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Background & Aim: The physiologic childbirth program in Iran is an emerging program that needs to be evaluated like any other program to improve its quality and process. Evidence suggests that the implementation of the physiologic childbirth program faces some challenges. The present research aimed to explore the challenges of the physiologic childbirth program from the perspective of service providers.
Methods & Materials: This qualitative research was carried out through a content analysis method in two mother-friendly hospitals of Ahwaz and Mashhad in 2016-2017. Data were collected through semi-structured interviews with 17 physiologic childbirth service providers. The content analysis method of Elo and Kyngas was used for qualitative data analysis.
Results: Data analysis led to five main categories: low motivation of midwives in performing physiologic childbirth; barriers related to manpower; medical interventions in physiologic childbirth; challenges from the environment and facilities; and educational barriers.
Conclusion: Different challenges in interaction with each other create a complex environment in which the implementation of physiologic childbirth program becomes more difficult. Therefore, policymakers, authorities, doctors, midwives and mothers need to work in a coordinated way to resolve the mentioned challenge.
 

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Background & Aim: Cesarean section (CS) rate was 56% in 2012 in Iran, which was considerably higher than the WHO recommended rate (10-15%). Thus, the Normal Delivery Promotion (NDP) program as a part of Iran’s Health Transformation Plan (HTP) was implemented in 2014 to reduce unnecessary cesarean deliveries and promote maternal and neonatal health. The aim of the study was to evaluate the effect of the NDP plan on the CS rates.
Methods & Materials: This quasi-experimental and longitudinal study analyzed the immediate and long- term effects of the NDP program on the CS trend in Iran using an interrupted time series analysis. Monthly CS rates in the hospitals of the country were extracted from April 2013 to September 2018.
Results: Overall CS rate in Iran decreased by 6% immediately after the implementation of the NDP program and then remained at the same level. The NDP program reduced the CS rate in teaching (9.5%), non-teaching (11.7%), private (18.1%), and charity (27.1%) hospitals. But the CS rate increased in social security (7%) and other hospitals (15.7%). The CS rate would have reached 58.5% by September 2018 if the NDP program had not been implemented.
Conclusion: The NDP program was somewhat effective in reducing the CS rate in Iran. Promoting this program by formulating a strategic plan and comprehensive action plans addressing various underlying causes of CS at meta (ministry of health), macro (universities of medical sciences), meso (hospitals) and micro (obstetricians, midwives, and mothers) levels and considering effective solutions in the areas of governance and leadership, financing, human resources, equipment, information and service delivery is critical to achieve the determined national goals.
 

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Background & Aim: In recent years, significant changes have occurred in the dynamics of childbearing within familial context. Notably, Iranian families have witnessed a noticeable decline in the desire for childbearing and having additional children. The aim of this study was to explore the determinants of childbearing decision-making among women and men of reproductive age.
Methods & Materials: This study adopts a qualitative research design using the conventional content analysis approach in 2023. The participants comprised 19 married women and men of reproductive age living in Zanjan, who were purposively selected to ensure maximum variation. After obtaining informed consent, the participants were invited to participate in individual, semi-structured interviews. Data collection continued until data saturation was reached, with concurrent analysis conducted throughout the process. The textual data were managed using MAXQDA software, version 2020.
Results: Throughout the inductive data analysis process, seven main categories emerged as determinants of decision-making about childbearing. These categories included social role modeling, reflection within family structure, social and economic requirements, contemporary concerns in parenting, avoidance of responsibility and comfort-seeking, unpleasant past experiences and age-related challenges. Among these categories, social and economic requirements emerged as the most prevalent concept across all interviews, with a total of 505 open codes associated with this category.
Conclusion: The normalization of reduced childbearing rates within the society, accompanied by shifting values and attitudes towards the significance of children, as well as economic and social problems have contributed to an increasing preference for smaller families. Furthermore, the desire for fewer children can be viewed as a response to the individualistic tendencies of women and men, as well as a means of avoiding parenting concerns.

 

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Background & Aim: Preoperative anxiety can lead to various challenges. Aromatherapy using lemon essence may alleviate certain complications. This study aimed to determine the effect of lemon essence aromatherapy on anxiety levels and physiological indices (systolic and diastolic blood pressure, pulse rate, respiration rate, and SPO₂) in patients who are candidates for lower extremity fracture surgery.
Methods & Materials: This randomized clinical trial employed convenience sampling to recruit 90 patients referred to SUMS, who were subsequently randomized into control (n=45) and intervention (n=45) groups in 2021. The aromatherapy intervention commenced on the morning of the surgical procedure and extended through the operating and recovery rooms, continuing for 16 hours post-surgery. Almond essential oil was administered to the control group. Data collection involved the Spielberger Inventory for anxiety assessment and a checklist of physiological indices. Data were analyzed using two-way repeated measures ANOVA.
Results: The study findings showed a significantly greater reduction in state anxiety levels in the intervention group compared to the control group (P<0.001). Moreover, the physiological indices of the intervention group exhibited greater stability in comparison to the control group (P<0.05). However, the intervention did not have a significant impact on the diastolic blood pressure and respiratory rate of the patients (P>0.05).
Conclusion: The utilization of aromatherapy with lemon essential oil resulted in a decrease in the state anxiety and an improvement in some physiological indices of the patients who underwent surgery for lower extremity fractures. Therefore, this complementary approach is recommended in conjunction with routine treatments.
Clinical trial registry: IRCT20130616013690N10