Context: Low sleep quality as a common problem in patients undergoing hemodialysis can lead to negative impacts such as poor quality of life. Many studies were performed in order to improving sleep quality in these patients; however, few comparative studies have been conducted to compare the effects of nonpharmacological interventions on sleep disturbances of patients undergoing hemodialysis. Aims: This study was carried out to examine the effect of warm water footbath versus Swedish massage on sleep quality and insomnia severity in patients undergoing hemodialysis. Materials and Methods: Seventy patients undergoing hemodialysis referring to two dialysis wards affiliated to Yasuj University of Medical Sciences, Yasuj Iran have included in this randomized clinical trial from November 2015 to April 2016. The eligible patients undergoing hemodialysis were selected as convenience sampling method but randomly assigned to one of the three groups of warm water footbath (n = 24), effleurage (n = 23) and petrissage (n = 23). The interventions have been performed for 15 min over 2 months. Pittsburgh Sleep Quality Index and Insomnia Severity Index was used to collect data. Statistical Analysis Used: Collected data were analyzed using SPSS, version 21, which involved running statistical tests including repeated measures ANOVA. P < 0.05 was considered to be a statistical significant difference. Results: Twenty six men (41.9%) and 36 women (58.1%) completed this study (mean age: 51.01+/-13.91). Mean global sleep quality was reported for patients in the group of warm-water footbath (14.1 ± 1.8; 7.15 ± 2.1and 5.37 ± 2.4), effleurage (13.2 ± 1.7; 8.1 ± 2.8 and 5.82 ± 2.7), and petrissage (14.1 ± 1.9; 9.18 ± 2.4 and 6.4 ± 2.8) on the baseline, the end of the 1^st and the 2^nd month of interventions, respectively. Mean scores of insomnia severity for patients in the group of warm-water footbath (21.38 ± 3.6; 11.95 ± 3.2 and 9.48 ± 3.4), effleurage (19.65 ± 3.1; 12.5 ± 3.67 and 9.1 ± 4.7), and petrissage (21.05 ± 3.68; 13.81 ± 3.1 and 10.6 ± 3.6) was observed. No statistical significant (P > 0.05) differences were observed by sleep quality and insomnia severity among three groups. Conclusion: Warm-water foot bath is as effective as Swedish massages for improving sleep quality and insomnia severity in patients undergoing hemodialysis. Further investigations are suggested to determine whether the same findings are replicated.

Context: Postpartum depression (PPD) is one of the most common psychological conditions in the postpartum stage. PPD negatively affects the baby, family, and mother's life. Aims: This study aimed to survey the effectiveness of group counseling based on emotional intelligence (EI) in the prevention of PPD. Setting and Design: In this semi-experimental study, one hundred cases were selected among pregnant mothers who were referred to health centers of Tehran, Iran, during June–September 2019. Materials and Methods: Four health centers were allocated to the intervention and control group by simple randomization and participants were recruited by convenience sampling. Participants in the intervention group attended an educational program based on EI during five weekly sessions (each 90 min). The control group did not receive any intervention. All participants completed demographic questionnaires, Beck Depression Inventory, Bar-On EI Inventory, and Edinburgh PPD Inventory. Follow-up was done 8 weeks after delivery. Statistical Analysis Used: Data were analyzed through descriptive (mean, standard deviation, and frequency) Chi-square and independent t-test. Results: The intervention group reported significantly lower PPD than the control group eight weeks after delivery (11.71 ± 3.16 and 14.47 ± 3.65, respectively, P < 0.001). The scores of EI were significantly (P < 0.001) higher 8 weeks after delivery in the intervention group (234.60 ± 8.94) compared with the control group (211.41 ± 9.62). Conclusion: According to the findings of the current study, EI program is effective in preventing PPD, so it is recommended that counseling services along with medical services be provided to improve the mental health of mothers to prevent PPD.

Context: Human papillomavirus is one of the most important and common sexually transmitted viruses. Aims: The aim of this study was to explore the lived experiences of patients with genital warts. Setting and Design: The present study was conducted by descriptive phenomenological method of Colaizzi's approach in 2020. Sampling was performed from Iranian people referring to the gynecologist's clinics in Iran. Materials and Methods: This study was carried out with 23 participants with genital warts who were chosen by purposive sampling based on the data saturation. The semistructured interview was used Guba and Lincoln proposed criteria were used for the rigor and strength of the study. Statistical Analysis Used: Data analysis was performed by the Colaizi method. OneNote software was used for the data analysis. Result: Patients with the age group of 15–45 years were included. Classification of codes leads to the extraction of 8 sub-themes and four main themes, including numerous fears (fear of rejection and fear of the outcomes of the disease), lack of awareness and misconceptions regarding disease (denial of the main way of getting genital warts, resorting to unconventional therapies), seeking support (the need for financial support and also medical support), and bitter experiences of the disease (physical and psychological problems and disruption of emotional and sexual relationship). Conclusion: Due to the various physical and psychological adverse effects of genital warts, it should be emphasized on increasing public awareness about the prevention, treatment, and predicting the risk of the disease in the community.

Context: The utilization of interactive observation scales can improve the quality of care. Aims: The aim of this study was to validation and reliability of the Persian version of the Interactive Observation Scale for Psychiatric Inpatients (IOSPI). Settings and Design: This methodological study was done in the two educational hospitals in Tehran. Materials and Methods: Translation of the IOSPI into Persian followed the stepwise, iterative procedures developed by the International Quality of Life Assessment project approach. The validity and reliability of the IOSPI were evaluated by using a total of 300 sets of ratings accomplished by psychiatric nurses on 40 adult psychiatric inpatients observed daily for 1 month by 6 nurses; they were interviewed by two psychologists who filled in separately the Brief Psychiatric Rating Scale (BPRS). Statistical Analysis Used: Data were analyzed by SPSS version 22 and using exploratory factor analysis and the internal consistency and test–retest. Results: The total scores of the IOSPI showed a significant correlation with total scores of the BPRS (r = 0.69), meeting the criteria of concurrent validity. Exploratory factor analysis of 16 IOSPI items revealed four distinct clusters of items that represented higher-order increased psychomotricity, social interest, self-reliance, and psychotic status. Four factors of eigenvalues are >1, which explains 70.13% of the total variance. There was also good reliability estimated by an (intraclass correlation coefficient = 0.86) of the IOSPI. Conclusions: The results showed a favorable validity and reliability for the Persian version of the IOSPI for the psychiatric patients. It was confirmed as an efficient tool to use for therapeutic care by the psychiatric nursing staff.

Context: Students are one of the most sensitive groups of the society and they face challenges through academic situations. Resilience has a protective role against the stressful situation. Aims: The aim of this study was the investigation of humor and stress resilience associations among students. Setting and Design: Two hundred and sixty students were selected from Qom University of medical sciences during multi-stage cluster random sampling for this cross-sectional study in 2020. Material and Methods: The study instruments were the Samuels Academic Resilience Indicator and the multidimensional humor questionnaire. Students were divided into different groups based on their field of study, then using random sampling method, the number of sample in each class was selected from all in the same category. Statistical Analysis Used: The collected data were analyzed by using multiple regression and descriptive statistical analysis by SPSS version 18. Results: The results showed the association between the stress resilience and humor was direct and significant. Multiple regression results also showed laughter (P = 0.001 and β = 0.26), humor enjoyment (P = 0.010 and β = 0.16) and social humor (P = 0.010 and β = 0.19) predicted the students' stress resilience; with a total of 22% of the variance of resilience. Conclusions: According to the findings, humor may play an important effective role in increasing resilience to stress, by creating and empowering these components, we may promote their resilience among medical students.

Context: Drug use during pregnancy is an important issue that is frequently encountered and difficult to decide on as it is closely related to the health of both the mother and the fetus. Aim: This study was conducted to identify the relationship between the health literacy level and drug use in pregnant women. Settings and Design: This was a descriptive cross-sectional study in a state hospital's outpatient department in Turkey in 2017. Materials and Methods: In this study, 469 pregnant women were included with simple random sampling. The data collection form included sociodemographic characteristics and drug use behavior of pregnant women and the Health Literacy Scale (HLS). Statistical Analysis: Descriptive statistics, t-test, Mann–Whitney U, Kruskal–Wallis, ANOVA, Bonferroni, and multiple regression analysis were used. Results: The mean HLS subdimension scores were access 21.7 ± 3.4, understanding 28.1 ± 4.8, appraisal 34.2 ± 5.0, application 22.5 ± 2.9, and total score was 106.6 ± 14.01. We found that 49% of the variance related to the HLS score was associated with using the drugs recommended by the physician regularly (beta = −1.665, P < 0.05) and knowing the foods that should not be consumed with the drugs (beta = −4.024, P < 0.05). Conclusions: The health literacy levels of pregnant women were found to be relatively adequate. The increase in the level of health literacy of pregnant women affects their drug use behavior positively. Therefore, planning for the improvement of pregnant women's health literacy is recommended.

Context: Cancer is a common chronic disease that affects all aspects of the patients' personal, familial, and social life, especially in adolescents. Aims: The aim of this study was to identify the relationship between the perception of family and friends' support and psychosocial adaptation in adolescents with cancer. Setting and Design: Among adolescents who were referred to two hospitals of Shiraz Medical University, 95 adolescents aged 11–20 years were selected according to the inclusion criteria and by available sampling method from July to November 2020. Materials and Methods: In this descriptive-correlational study, data were collected through demographic characteristics form, perceived support by family, perceived support by friends, and psychosocial adaptation questionnaires. Statistical Analysis Used: Data were analyzed using SPSS software version 16 and statistical tests such as independent t-tests, one-way analysis of variance, Chi-square, and Pearson correlation coefficients at the significance level of P < 0.05. Results: Most patients had a moderate perception of family and friends' support. Psychosocial adaptation to the disease with a total score of 2.01 was at the level of strong adaptation. The perception score of family support was directly related to the score of psychosocial adaptation in the family environment dimension (P < 0.05), and the perception score of friends' supports was directly related to the total score of psychosocial adaptation and attitudes toward illness and social environment (P < 0.05). Conclusion: According to this study's results, it was proved that there is a correlation between the perception of family and friends' support with psychosocial adaptation to the disease in adolescents suffering from cancer.

Context: Promoting of women's sexual health literacy depended to the study of this variable. This study aimed to determine the status of women's sexual health literacy and its dimensions. Setting and Design: This cross-sectional study conducted in health centers in Amol, Iran, from July to September 2019. Materials and Methods: A total of 400 women of reproductive age who registered with Iran's integrated health record system selected via two-stage sampling technique. The Sexual Health Literacy for Adults questionnaire consists of 40 items regarding four dimensions of access, reading and understanding, analysis, and appraisal, and application was used to collect data. Statistical Analysis Used: Data were analyzed in SPSS version 16 using the descriptive and Friedman test with significance level of (P < 0.05). Results: According to the results, 23.3% of the participants had insufficient sexual health literacy. The highest mean score of sexual literacy was related to reading and understanding, whereas the lowest score was related to the application dimension. There was a significant difference in the mean scores of various dimensions of sexual health literacy (P < 0.001). The mean rank of scores was lower for the application dimension in all age groups, education (except primary and secondary levels), and participation in training courses (P < 0.001). Conclusions: Approximately one-fourth of the research sample had insufficient sexual health literacy, with their lowest score being related to the application dimension. Further studies should be designed to better perceive the application dimension of sexual health literacy and its effective factors.

Context: Many couples' problems are related to failure a successful relationship. Aim: The aim of this study was to investigate the demand/withdraw communication pattern and its related factors between couples. Setting and Design: This cross-sectional study was performed on couples in Sari, Iran, 2018. Materials and Methods: This study was performed on 260 couples living in Sari who were selected through cluster sampling. Data were collected using a social-medical questionnaire, NEO Personality Inventory, General Health Questionnaire, Enrich couple scale, and couples Communication Patterns Questionnaire (CPQ). Statistical Analysis Used: For data analysis, we used descriptive (mean standard deviation [SD]) and frequency and inferential statistics (simple and multiple regression model). Results: The mean (SD) of women's age was 34.08 (7.71) years, whereas the mean (SD)and of men's age was 39.13 (9.18) years. Furthermore, 34.2% of women and 38.8% of men used the demand/withdraw communication pattern. The results of regression showed that the variables of flexibility (P = 0.036), conscientiousness (P = 0.011), and satisfaction of socioeconomic status (P = 0.038) were positively and current pregnancy (P = 0.005) and female marriage age (P = 0.019) were had negatively correlated with demand/ withdraw communication pattern in both women and men Conclusion: According to the results, there was a relationship between couples' demand/withdraw communication pattern and demographic characteristics, marital satisfaction, and personality traits. Therefore, it is recommended that the factors related to couples' communication patterns to provide a solution to promote these patterns toward constructive communication pattern and take effective steps toward preventing marital conflicts for establishing a more efficient relationship.

Context: Midwives who perform the act of child delivery, which is one of the most sensitive and private occasions for women, can face the stress of conscience when they fail to perform their duties in this process for any reason or cannot decide what to do. There is very little information about the stress of conscience levels of delivery room midwives. Aim: This study aims to determine the stress of conscience and related factors in midwives who deliver a baby actively in the delivery room. Settings and Design: This descriptive and cross-sectional study was performed in April 2021 at six public hospitals in Kocaeli, Turkey. Materials and Methods: The study was conducted with 67 midwives who worked in delivery rooms through the census method. The data were collected using a “Demographic Information Form” and the “Stress of Conscience Questionnaire.” Statistical Analysis Used: Descriptive statistics, including frequency, mean, and standard deviation, and analytic statistics, including Mann–Whitney U- and Kruskal–Wallis tests, were used. Results: Among the participants, 61.2% stated that they experienced a guilty conscience while working in the delivery room, and they stated that the biggest (28.4%) reason for a guilty conscience was problems related to mother–infant health. The ethics training of the midwives was a factor that increased their stress of conscience scale internal factors subscale scores (P = 0.01). In addition, being married was a factor that increased their internal factor subscale scores (P = 0.008), and having worked in the delivery room for more than 6 years was a factor that increased their external factor subscale scores (P = 0.02). Conclusions: The results of the present study, the married midwives, those who had worked in the delivery room for longer than 6 years, and those who had received ethics training were found to have high stress of conscience levels. Sharing the results of such studies with managers can be a guide in solving problems.

Context: Hypertension (HTN) is the leading risk factor for mortality worldwide. People tend to seek traditional therapies since chemical medicines have various side effects and high costs. Aims: Therefore, the present study investigated the effect of natural products on blood pressure in Iran by meta-analysis. Materials and Methods: In this meta-analysis, those initial studies were included that were randomized clinical trials with or without blinded and studies with quasi-experimental design. The national and international databases included Barekat Gostar, SID, Magiran, IranDoc, PubMed, Scopus, Web of Science, Cochrane, and Google Scholar by keywords: natural products, medicinal plants, herbal medicines, pharmaceutical plant, blood pressure, hypertension, Iran. Statistical Analysis Used: The gathered data were analyzed in STATA ver. 14. Results: In 76 studies with a sample size of 2886 subjects, 60 types of natural products were used to reduce blood pressure. The most to the least effective natural products for systolic blood pressure (SBP) were the mixture of garlic and lemon juice, barberry, sour tea, barberry juice, cumin powder, resveratrol, garlic, olive leaf, orange juice, artichoke, flaxseed, saffron, Berberis vulgaris + apple vinegar, and lemon, respectively. Considering the natural products reducing diastolic blood pressure (DBP), the most to the least effective natural products were the mixture of garlic and lemon juice, sour tea, olive leaf, saffron, and olive oil, respectively. Conclusion: Based on the results, the mixture of garlic and lemon juice had the greatest effect on reducing both SBP and DBP levels. It was also found out that its effect was slightly greater in decreasing the SBP than the DBP.