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Background & Aim: Pain is the most common compliant of the patients and its reduction or elimination had been always demand of most patients and health care providers. Various methods have been proposed to pain, which we can mention to attention deviation strategies. The study aims to compare these strategies and choose the most effective one method for control the pain.

Methods & Materials: The research is a quasi-experimental one by which 230 students of one of the universities of Tehran were called out and participated in the test of tolerance to cold pressure induced pain. 120 participants that their tolerance were a point of standard deviation lower than the whole group were selected and were randomly set in 4 groups (3 experimental groups and 1 control group). These groups composed of 30 people were instructed a method of attention deviation (like desirable imagery, application of concentration point, counting down). The participation’s in control and experimental groups were tested by cold pressure and data were analyzed by SPSS through descriptive indices and One-Way Analysis of Variance (ANOVA).

Results: Results show that the average score of pain toleration in experimental groups were significantly higher than control group (p<.001). Meanwhile the average point of pain toleration in desirable imagery group were significantly higher than the average point of application of concentration point, counting down groups (p<.001).

Conclusion: The attention deviation strategies were effective in increasing of the experimental pain toleration.

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Background & Objective: Preterm labor is a major risk factor of mortality and morbidity in newborns and fetuses. Low birth weight is also a risk factor for mortality and various neonatal diseases. This study aimed to determine the association between the CRP levels in first trimester of pregnancy with low birth weight and preterm labor.

Methods & Materials: In this prospective cohort study, we measured serum CRP levels in 400 pregnant women up to 20 weeks of gestation. All participants were followed up to delivery. Preterm labor was defined as delivery before 37 weeks of gestation. Low birth weight was defined as weight less than 2500 g at birth. Statistical analysis was done using Chi-square, Logistic regression, and ROC curve. P-values less than 0.05 were considered to be significant.

Results: After controlling for the effects of age above 35 years, mothers&apos occupations, history of preterm labor, socio-economic status, history of abortion, primiparity, and passive smoking, logistic regression analysis showed statistically significant relationship between the CRP and preterm labor (P-value=0.000, OR=1.24, %95 CI=1.11-1.38). However, there were no significant relationships between the CRP levels with other factors. Using Roc curve, we determined CRP cut-off point level for preterm labor. With 81% sensitivity, and 64% specificity, CRP cut-off point was 3.45 mg/l. After controlling for the effects of low socio-economic status, history of LBW, history of abortion, gravidity, primiparity, and passive smoking, logistic regression analysis showed statistically significant association between the CRP levels and LBW (OR=1.31, CI %95=1.08-1.59, P=0.005). However, there were no significant relationships between CRP levels with other factors. CRP cut-off point level for LBW was determined using Roc curve. With 87.5% sensitivity, and 74% specificity, CRP cut-off point was 4.75 mg/l.

Conclusion: It seems that the inflammatory marker, CRP, can be used to identify women who are at high risk for preterm labor and LBW. However, larger studies are needed to establish this relationship definitively

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Background & Aim: Several factors have been reported to be influential in development of the premenstrual syndrome. There are no studies available on relationship between premenstrual syndrome with body mass index in Iran. This study aimed to determine this relationship among university students.

Methods & Materials: This was a cross-sectional study conducted on a random sample of 500 students living in the dorms of Arak University of Medical Sciences. The participants had not stress, anxiety and severe depression on the basis of the DASS21. Data were gathered using Social Status Questionnaire, including demographic, menstrual status, reproductive and eating habits and body mass index measurement items. The participants completed the abbreviated form of premenstrual syndrome evaluation within seven days of bleeding up to two days after onset of bleeding for one cycle. Using logistic regression analysis, the association was assessed by adjusting for confounding variables.

Results: A majority of the students had normal BMI (<25) (90.8%). The results showed that the risk of premenstrual syndrome in the participants with high BMI was 2.43 times more than the participants with normal BMI (OR=2.43 CI=8.33-1.66).

Conclusion: High BMI increased the risk of premenstrual syndrome. Interventions to decrease the BMI should be designed and implemented in overweight and obese patients with premenstrual syndrome.

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Background & Aim: Recognizing and modifying organizational commitment and its related factors is important. It seems that nurses&apos attitudes towards learning organizations influence their organizational commitment. This study aimed to determine the relationship between nurses&apos attitudes towards learning organizations and organizational commitment.

Methods & Materials: In this descriptive-correlative study, 719 nurses working in Rasht educational hospitals were recruited to the study. We gathered data using the Porter organizational commitment questionnaire and the Jeong learning organization questionnaire. Data were analyzed using descriptive statistics and the Spearman and t-tests in the SPSS-18.

Results: Most of the nurses were female (94.7%) and registered (35.3%). The mean (SD) age of the nurses was 32.13 (6.98). The mean (SD) of the organizational commitment was 27.10 (42.50). The mean (SD) of the learning organization was 92.72 (10.04). The relationship between the organizational commitment and nurses&apos attitudes towards learning organizations was statistically significant (r=0.482 P<0.0001).

Conclusion: It seems improving nurses&apos attitudes towards learning organizations may result in better organizational commitments.

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  Background & Aim: Premature infants are the most admitted group to NICUs. Stabilization of cardio pulmonary parameters is a main goal in NICUs. Mechanical ventilation and endothracheal suctioning are the most common and effective procedures to stabilize cardio pulmonary parameters. The aim of present study was to compare the effects of two endothracheal suctioning methods (open and closed) on physiological stability in premature infants under mechanical ventilation .

  Methods & Materials: In this clinical trial, 90 preterm infants (GA: 27-34 weeks) hospitalized in the NICUs of Alzahra and Taleghani hospitals were selected and randomly assigned to two groups. In one group, infants were suctioned using open suctioning method and in the other group, infants were suctioned using closed suctioning method. The physiologic parameters (O2 sat, HR, mean BP variation) and stability (recovery time of HR, BP) were compared between the groups. Data were analyzed using descriptive and inferential statistical methods such as x², independent t-test and mixed model in the SPSS-21 . 

  Results: There was significant statistical difference between the two groups on mean BP (P=0.016). Recovery time of the BP and HR was shorter in the closed suctioning group. Physiologic stability was better in the closed suctioning group (P<0.05) .

  Conclusion: Variation of the mean BP and recovery time was more in the open suctioning group compared with the closed suctioning group. Considering better physiologic effects of closed suctioning, it is recommended to assess the combined effect of closed suctioning with weight on physiologic parameters of premature infants .

  

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Background & Aim: Studies have shown that family caregivers’ attitude toward mental illness affects their caring to mental patients and may reduce the quality of caring to them. This study aimed to determine the effect of group psychoeducation on attitude toward mental illness in the family caregivers of patients with bipolar disorder.

Methods & Materials: In this randomized clinical trial study conducted in 2015, 74 family caregivers of the patients with bipolar disorder who had been hospitalized in the psychiatric wards of Razi hospital in Tabriz were selected by random sampling method. Then, they were randomly assigned into the experimental and control groups. The families of experimental group participated in 8 continuous 90-minute 2 times a week psychoeducational sessions. Family caregivers’ attitude toward mental illness was measured using the questionnaire of Opinion about Mental Illnesses (OMI) before and after intervention. Data analysis was conducted using descriptive statistics, Chi-square test, independent t-test, paired t-test and ANCOVA on SPSS software version 13.

Results: The results revealed that there was no significant difference in mean score of attitude toward mental illness between the experimental group and the control group before intervention (92.54±8.51 vs. 90.52±9.43, P>0.05). But the mean score of family caregivers' posttest in the experimental group significantly increased compared to the control group (105.43±14.72 vs. 90.52±7.50, P<0.05).

Conclusion: The study results demonstrate that psychoeducational program improves family caregivers’ attitude toward mental illness. Training methods such as group psychoeducation can be effective in promoting positive attitude in the families of patients with psychiatric disorder.

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Background & Aim: In recent years, health care workers' mobile phones have been considered important as a source of infection because they could have a significant role in nosocomial infections. The aim of this study is to determine the type of microbial contamination of health care workers' mobile phones in Sina hospital in Tabriz.

Methods & Materials: In this descriptive-analytical study, 140 samples were taken from health care workers' mobile phones by convenience sampling, in 2015. The samples were taken by a sterile swab and immediately transferred to the hospital laboratory. They were cultured after incubation for 48 hrs in two plates at 37° C. Finally, the grown microorganisms were identified by biochemical tests. The data were analyzed using descriptive statistics and Chi-square test on SPSS software version 13. A level of P<0.05 was considered significant.

Results: 84.28% of phones were positive for bacterial contamination. Coagulase-negative staphylococci (45%) had the most frequency and Bacillus species (19.28%) were in second rank. Acinetobacter found in only 1 case (0.71%) had the least frequency. More than one microorganism had grown on 5 contaminated phones (3.57%). The contamination rate was significantly higher in the intensive care units than in general wards (P<0.001).

Conclusion: According to the findings, health care workers' mobile phones is significantly contaminated. Therefore, it is necessary that the staff to be informed of the role of cell phone in the nosocomial infection, as the role of other hospital equipment. It is also important to be trained about periodic cleaning of mobile phones with suitable material such as 70% alcohol and frequent washing of hands after using the phone.

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Background & Aim: Violence against women is a serious social problem affecting public health. Given the relatively high prevalence of domestic violence and the need for screening, a simple tool for its correct diagnosis in a short time seems to be necessary. This study aimed to compare the diagnostic values of the HITS (Hurts, Insults, Threaten, and Screams) tool and CTS2 (Revised Conflict Tactics Scales) in domestic violence screening.

Methods & Materials: This cross-sectional study was conducted on 279 married women referred to health centers in Tabriz in 2014. Data were collected using the socio-demographic questionnaire, HITS and CTS2. Kappa index was used to assess agreement between instruments.

Results: Results showed that HITS tool had relatively good sensitivity (75.7%) and high specificity (93.5%). Positive predictive value and negative predictive value were 96.8% and 59.5% respectively. There was a moderate agreement between instruments (Kappa=0.6).

Conclusion: Given the simplicity of HITS and the possibility to complete it in a short time, this questionnaire can be recommended to identify people experiencing domestic violence at the broad level. In addition, the development of this tool is recommended in future studies.

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Background & Aim: Improving and modifying lifestyle is necessary for health maintenance and promotion. Modification of lifestyle can have an important role in the long-term health of women with Poly Cystic Ovarian Syndrome (PCOS). Therefore, this study aimed to determine the status of health promoting lifestyle and its socio-demographic predictors in women with PCOS.

Methods & Materials: This analytical descriptive cross-sectional study was conducted on 174 women with PCOS referred to gynecology and infertility clinics in Urmia-Iran, in 2015. The data were collected through the socio-demographic and Health Promoting Lifestyle Profile questionnaires. Descriptive statistics, independent t-test, one-way analysis of variance and multivariate linear regression were used to analyze the data through SPSS software version 21.

Results: The mean (standard deviation) of total score of the health promoting lifestyle was 2.2 (0.3) out of 4. The highest mean score was in nutrition subscale [2.9 (0.5)] and the lowest mean score was in the subscale of stress control [1.2 (0.5)]. Based on the multivariate linear regression model, the variables of BMI, spouse’s education level, the first supporter and menstrual bleeding amount were predictors of the health promoting lifestyle in women with PCOS.

Conclusion: Considering that the mean of total score of the health promoting lifestyle and some of its subscales were in the middle of the range of possible scores, it is necessary that besides other therapies, the improvement of health promoting lifestyle in women with PCOS, according to the influencing socio-demographic determinants, be on the agenda of health providers.

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Background & Aim: Moral sensitivity has various dimensions including personal sentiments, scientific competency, and reasoning and decision making capabilities. To achieve this, some personal traits and educational preparedness are needed. The aim of this study was to determine nurses’ moral sensitivity and its relationship with demographic and professional characteristics in hospitals affiliated to Tabriz University of Medical Sciences.
Methods & Materials: This descriptive, correlational study was conducted on 198 nurses working in the medical wards of hospitals affiliated to Tabriz University of Medical Sciences in 2016. Census sampling method was implemented. Data were collected through a demographic and professional characteristics form and the Moral Sensitivity Questionnaire (MSQ). The data were analyzed by the SPSS software version 13 using descriptive statistics, T test, Pearson correlation coefficient and ANOVA.
Results: The mean score for nurses’ moral sensitivity was 4.84±0.48 (out of 7). The highest scores were related to the domains of “Interpersonal orientation” and “following the rules”. The lowest scores were related to the domains of “experiencing moral conflict” and “modifying autonomy”. There was a significant and inverse correlation between age and “modifying autonomy” (P=0.008, r=-0.193) and also between age and “following the rules” (P=0.034, r=-0.156). Moreover, there was a significant and inverse correlation between work experience and “following the rules” (P=0.009, r=-0.187).
Conclusion: Given that the nurses gained a low score in the domain of “modifying autonomy”, it is suggested that client centered care and patient’s autonomy be emphasized in developing nursing curriculum and in service training programs.
 

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Background & Aim: Creating and maintaining a safe environment is an important part of care in psychiatric wards. The results of previous studies indicated that some features of the physical environment facilitate the ward’s safety. The experiences of people who are most likely to be present in these environments can be the best source for identifying these features. Therefore, this study was conducted to explain patients’ and employees’ perceptions toward the features of a safe physical environment in psychiatric wards.
Methods & Materials: In this exploratory qualitative descriptive study, seven patients at discharge time and nineteen employees working in psychiatric wards were interviewed about their experiences in psychiatric wards and 84 hours of field observation was done. The data were analyzed using a qualitative content analysis approach according to the method proposed by Graneheim and Lundman.
Results: The results showed a safe physical environment in psychiatric wards meant “having an accident-free environment”. This theme was abstracted from two main categories included “Accidents prevention through design” and “having a natural life environment”, which, according to the experience of the staff, is required to balance the two. The subcategories of “having the design of accidents prevention” were “eliminating or modifying accident-causing objects”, “wards based on the characteristics of the patients” and “conditions for facilitating staff performance” and the subcategories of “having a natural life environment were “meaningful activities", “healthy and pleasant conditions” and “preserved privacy”.
Conclusion: According to the results of the study, it is necessary to create a physical environment free of accidents and at the same time to meet the daily needs of patients in order to prevent physical and psychological damage to patients and staff in psychiatric wards.
 

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Background & Aim: Gestational diabetes mellitus is the most common medical disorder during pregnancy that has many negative psychosomatic effects on the pregnant women and their fetus. According to existing studies, the role of counseling and husband’s support in gestational diabetes has been less studied, so the present study aimed to determine the effect of couples' supportive counseling on self-care behavior in women with insulin-treated gestational diabetes.
Methods & Materials: In this randomized clinical trial, 64 pregnant women (26-30 weeks of gestation) with gestational diabetes referred to the diabetes clinic of Umm al-Banin Hospital in Mashhad in 2018-2019 were divided into the intervention or control groups using the 4-way blocking method. For the women and their husbands in the intervention group, couples' supportive counseling was conducted by the researcher in the form of three one-hour sessions with one week interval. A diabetes self-care questionnaire was completed in two stages, before and four weeks after the intervention for both groups, and data were analyzed by independent t-test and paired t test using the SPSS software version 16.
Results: There were no statistically significant differences between the two groups in pre-intervention self-care scores (P>0.05). After the intervention, the difference between the mean of self-care scores before and after the intervention in the intervention group was 12.09±7.56 and in the control group was 0.00±3.60, which a significant increase was observed in the self-care score for the intervention group compared to the control group (P<0.001).
Conclusion: Couples' supportive counseling helps to promote self-care behavior in patients with gestational diabetes and can be used as an effective method to reduce the adverse consequences of gestational diabetes.
Clinical trial registry: IRCT20181002041202N1
 

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Background & Aim: Clinical competence is the ability to perform professional tasks and coordinate cognitive, communication and psycho-motion skills in patient care, and empathy is one of the factors influencing clinical competence. Given the role of clinical competence in the quality of midwifery care, this study aimed to determine the effect of empathy skill training on clinical competence in midwifery students.
Methods & Materials: This randomized clinical trial study was conducted on 73 midwifery students and 438 pregnant women in 2015. A clinical competence questionnaire was used to assess the clinical competence of the students, which was completed in two ways by self-assessment and researcher assessment (after reviewing the student's performance for 3 times). Data were analyzed by chi-square test, independent t-test and paired t-test using the SPSS software version 16.
Results: There was no significant difference between the two groups in the mean score of clinical competence in the ways of self-assessment and assessment by the researcher before the intervention (P>0.05). Results from the post-intervention showed that there was significant difference between the two groups. However, the clinical competence score by the researcher assessment in the intervention group was significantly higher than in the control group (P<0.05). Also, the difference in the mean scores of the self-assessment of clinical competence before and after the intervention between the two groups was not significant (P>0.05), but the difference in the mean scores of the researcher assessment of clinical competence before and after the intervention between the two groups was significant (P<0.05).
Conclusion: Empathy skill training is an effective way to increase the clinical competence of students.
Clinical trial registry: IRCT 2016051127855N1
 

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Background & Aim: Structured description of pediatric medical emergencies requires the assessment and classification of underlying factors. The aim of study was to investigate frequency of predisposing factors for the entry of foreign bodies (FB) in the ear, ingestion and aspiration in children under five years in Tabriz.
Methods & Materials: This is a descriptive, cross-sectional study conducted through convenience sampling (n=245) in the ENT and emergency departments and the clinic of children's hospital in Tabriz, from March 2019 to June 2019. A researcher-made tool including the demographic characteristics form and questionnaire on predisposing factors was used to collect the data. Data was analyzed using the SPSS software version 21 through descriptive statistics.
Results: There were 137 (55.9%) cases of  FB aspiration into the airways (upper and lower), and the highest was related to nose. FB in ear was 19.6% and in stomach was 19.2%. Clinical manifestations were pain (50.2%), no clinical signs (29.4%), and the rest were bleeding with pain, cough, shortness of breath, suffocation, wheezing, nausea, and vomiting. The place of event was at home (in living room) and in the evening and night time. FB types included objects, food stuff/snacks/nuts, beans and fruit cores, and toy pieces, and it is most likely to be seed, toy pieces, nuts, shirt buttons, and rosary beads.
Conclusion: Parental, child-related, and environmental predisposing factors were reported. Therefore, future studies are suggested to evaluate the contribution of each of three factors and to implement necessary educational, notification, and interventional measures.
 

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Background & Aim: Sexual function is an important part of the health of women, and the satisfaction of basic psychological needs is among the variables related to sexual dysfunction. The self-determination theory is one of the most important motivational theories, which considers one’s internal motive the main cause of behavior, and also views three psychological needs (autonomy, relatedness, and competence) as the basis of human behavior. This study was to determine the effect of sexual consulting based on the self-determination theory on women’s sexual function.
Methods & Materials: This clinical trial was conducted on 104 married women aged 18 to 49 years referred to Mashhad health centers in two groups of intervention and control in 2019. The intervention group received five sessions of two-hour group counseling based on the constructs of self-determination theory, with intervals of one week. The data was collected using the sexual performance questionnaire and the constructs of self-determination theory (basic psychological needs) before and after the intervention. Data was analyzed using the SPSS software version 16 through independent t-test, paired t-test, Mann-Whitney and Wilcoxon tests.
Results: There was no statistically significant difference between the two groups in the average score of sexual function before the intervention. However, after the intervention, the difference in the average score of sexual function between before and after the intervention was 2.76±3.02 for the intervention group and -0.25±0.73 for the control group, which showed a significant increase in the sexual function score of the intervention group compared to the control (P<0.001). Moreover, after the intervention between the intervention and control groups, a statistically significant difference was observed in the average scores of autonomy, competence and relatedness (P<0.001).
Conclusion: Providing group sexual counseling based on the self-determination theory can satisfy the basic needs relating to sexuality and improve women's sexual performance.
Clinical trial registry: IRCT20180726040602N1
 

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Background & Aim: Stroke, as the primary and most critical cerebrovascular condition, is known as a leading cause of disability and mortality. Timely and appropriate care plays an important role in reducing death and associated complications. The purpose of this research is to assess the knowledge and adherence of emergency nurses to tissue plasminogen activator guidelines for patients with stroke.
Methods & Materials: In this descriptive study, a random quota sampling method was employed to select participants. A total of 170 emergency department nurses in Tabriz hospitals in 2023 self-administered knowledge and adherence scales. Data were analyzed using SPSS version 26, employing t-test, one-way ANOVA and Pearson’s correlation coefficient.
Results: The mean (SD) age of the nurses was 34.24±6.57 years, with a majority (101 nurses, 59.4%) having completed courses on the process and activation of Code-724. The mean scores for nurses' knowledge and adherence to tissue plasminogen activator guidelines were 52.67±10.37 (range score: 0-100) and 68.14±5.18 (range score: 15-75), respectively. A positive yet weak relationship was observed between nurses' knowledge and adherence to the guidelines (r=0.263, P=0.332). No significant association was found between nurses' socio-demographic characteristics and their knowledge and adherence scores (P>0.05).
Conclusion: The findings revealed suboptimal scores in nurses' knowledge and adherence to tissue plasminogen activator guidelines for stroke patients. Given the importance of adequate knowledge for adherence to guidelines, it is suggested to implement essential training and supervision measures for nurses.