Context: Turnover intention, the nursing profession, is one of the major challenges for the nursing staff around the world that leads to reduce work motivation and poor quality of care. Aim: The aim of this study is to determine relationship among role conflict, role ambiguity, and the turnover intention the nursing at hospitals of the Qom University of Medical Sciences in 2018, Iran. Setting and Design: A cross-sectional survey was conducted at five hospitals of Qom Medical Science University. Materials and Methods: Two hundred and sixteen nurses included to the study using the simple random sampling a three part questionnaire asking for information on demographic characteristics, role conflict and role ambiguity, and nurses' turnover intention was used as a data gathering tool. Statistical Analysis Used: Date were analyzed using the univariate and multivariate logistic regression. Results: 48.8% of nurses intended to leave their profession. In a univariate logistic regression model, it was found that role conflict, role ambiguity, being single, and working overtime increased nursing staff turnover intention. Furthermore, increase in age, work experiences, official recruitment, and a fixed morning shift decreased nurses' turnover intention. In multivariate logistic regression model, only role conflict and role ambiguity were significantly associated with turnover intention the nursing profession. Conclusion: Based on the findings, role conflict and role ambiguity can predict nursing staff turnover intention. Therefore further attention to occupational variables seems to be necessary to reduce high nursing staff turnover intention.

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Context: Aromatherapy is a complementary therapy to improve the sleep quality. Aims: The aim of the current study was to compare the effect of aromatherapy with essential of Damask Rose and Citrus aurantium on the sleep quality of the elders. Setting and Design: This quasi-experimental study conducted in the day-care centers. Materials and Methods: Sixty elderly people were randomly selected and inhaled essential of Damask Rose 10% on the pillows concurrently, for three nights, before sleeping. After 1 month wash out, they were under aromatherapy with C. aurantium 10%, as the same method. At both periods, sleep quality were assessed by Pittsburgh Sleep Quality Index. Statistical Analysis Used: Data were analyzed by SPSS version 25 and using independent t-test, paired t-test, and Wilcoxon signed-ranks test. Results: Although the total sleep quality score was improved at two periods of aromatherapy, it was significantly better at Damask Rose period, compared to C. aurantium (P < 0.001). Regarding to sleep domains, at both periods, aromatherapy had no effects on sleep disturbance. The score changes of subjective sleep quality (P = 0.001), sleep efficacy (P = 0.013), and daytime dysfunction (P = 0.033) were significantly better at the Damask Rose period, compared to C. aurantium. Conclusion: Both essential of Damask Rose and C. aurantium could improve the sleep quality, although the effect of Damask Rose on the total sleep quality score of elders was more than C. aurantium. Therefore, regarding to elders' preferences, one of these mentioned essentials could be used for improving sleep quality.

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Context: One method for improving marital satisfaction is to educate relationship enrichment programs to couples. Aim: This study aimed to determine the effects of relationship enrichment counseling on the marital satisfaction among infertile couples with a history of domestic violence. Setting and Design: This study was conducted in Imam Khomeini Hospital of Sari city in 2015. Materials and Methods: This was a semiexperimental study with pre and postintervention measurements. The study was conducted in two intervention and control groups consisting of 44 infertile couples referred to Imam Khomeini Hospital of Sari city in 2015. Statistical Analysis Used: SPSS 20 software was used for data analysis applying descriptive and inferential statistics (repeatedmeasures oneway ANOVA and twoway ANOVA). Results: The means of marital satisfaction scores were obtained as 3.4 ± 0.36, 3.71 ± 0.4, and 3.87 ± 0.28 in intervention and 3.44 ± 0.47, 2.56 ± 0.3, and 2.52 ± 0.33 in control groups at pretest, immediate posttest, and 2 months after the intervention, respectively. There was no statistically significant difference in the mean score of quality of life between the two intervention and control groups at pre and postintervention (P = 0.75). As evidenced by the repeatedmeasures ANOVA test, the relationship enrichment program was effective in boosting marital satisfaction score among infertile couples (P = 0.001). Conclusions: The enrichment program was effective in improving marital satisfaction and its all domains among infertile couples with a history of domestic violence.

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Context: The spouse has a very important role to play in increasing the emotional and supportive resources of the family as well as in increasing patient adjustment. Therefore, understanding their experiences can lead the health-care system to the improvement of effective care and support. Aims: This study was conducted to the explanation of the lived experiences of women with spouses with mental illness. Settings and Design: This qualitative study was carried out using the van Manen phenomenology method. Materials and Methods: Ten women were participated by purposeful sampling. Data were gathered through semi-structured interviews, observation, and Memo. Statistical Analysis Used: To analyze data, six-step method of “Van Manen” was used. Results: The results of life with a mentally impaired spouse include the main theme of “frustration” that includes four subthemes of “gradual extinction”, “disappointment”, “forgotten”, and “financial disconnection”. The gradual extinction consists of three subcategories: “role relocation”, “self-neglect”, and “early aging”. Disappointment consisting of four subcategories “misery”, “obligate life”, disturbance and distress” and “loneliness”. Forgotten consists of three subcategories: “not being comprehensive of treatment system”, “isolation and seclusion”, and “lack of a support”. Financial disconnection includes three sub-categories: “lack of governmental support”, “economic disturbance of the family”, and “working of woman and the children”. Conclusions: Participants in this research showed a lack of knowledge about dealing with the patient as well as the lack of attention to individual problems. Families expressed the need for effective support due to the status of women.

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Context: Type 2 diabetes mellitus (T2DM) is a common metabolic disorder. In traditional medicine, camel milk has been used in the treatment of some of diseases such as diabetes. The studies on effect of camel milk on glycemic control are limited and contradictory. Aims: The effect of camel milk on blood glucose and lipids in T2DM patients and compare it with the control group. Setting and Design: This case-controlled clinical trial study was performed in the endocrinology clinic in Iran. Materials and Methods: 50 patients with T2DM were allocated into two groups. 25 participants in the intervention group consumed 500 ml camel milk and 25 participants in the control group consumed 500 ml cow milk daily for 8 weeks. Weight, fasting blood sugar (FBS), total cholesterol (TC), and triglyceride (TG) were measured at the baseline and end of intervention. Statistical Analysis Used: Data were analyzed using SPSS v.16, independent t-test and analysis of covariance. Results: Mean of glycosylated hemoglobin (HbA1c) and TG concentration was significantly decreased in the camel milk group at the end of the study (P < 0.05). There was an increase in HbA1c in the cow's milk group, while the TG was not changed in this group. No significant differences were shown in weight, FBS, and TC at the end of the study in comparison with baseline values in any of the two groups. Conclusion: Camel milk can improve glycemic control according to HbA1c index. It might contribute to decreasing TG level in patients with T2DM.

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Context: Hospitals usually are at risk of potential hazards, which may necessitate emergency hospital evacuation (EHE). Deciding about hospital evacuation is of the critical task and is affected by numerous factors. Aims: The aim of this study then was to explore the factors behind the decision for EHE in disasters. Setting and Design: This is a qualitative study that was conducted from May 2014 to February 2015, employing conventional content analysis. Materials and Methods: This is a qualitative study (conventional content analysis). Data were collected through in-depth semi-structured interviews with 25 key participants, who were selected using purposeful sampling. Data were analyzed using conventional content analysis according to the technique described by Graneheim and Lundman. Statistical Analysis Used: No statistical methods were used in this study. Results: Factors behind the decision for EHE in disasters merged into three main categories, including risk assessment and estimation, the possibility of continuing service provision, and the necessary prerequisites for evacuation. The seven subcategories of these three main categories were hospital population density, hospital characteristics, accident characteristics, vulnerability of the hospital, potential capabilities of the hospital, administrative adjustments, and the possibility of safe patient transfer. Conclusion: Many different factors can contribute to the decision for EHE. The findings of this study can help hospital administrators to develop plans for making better evacuation-related decisions.

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Context: Self-care plays a vital role in the management of diabetes. Commitment to medical adherence in diabetes care is linked with lower morbidity, mortality, and treatment cost. Aim: This study aimed on investigating the mediating role of illness perception concerning the relationship between psychosocial elements and medical adherence among patients with type II diabetes. Setting and Design: This is a correlational study that is conducted based on a well-framed equation modeling path analysis method. The study's statistical population consisted of all patients diagnosed with diabetes who referred to the International Iranian Diabetes Control and Prevention Foundation located in the Milad Clinic, in Mashhad during the first half of 2018 (n = 5600). Material ans Methods: Using the convenience sampling method, 392 eligible cases were selected among 5600 patients. Participants assessed with illness perception questionnaire, Lazarus and Folkman stress coping inventory, Tangney's self-Control scale, the multidimensional scale of perceived social support, patient–doctor relationship questionnaire-9, and the medication adherence rating scale-5. Statistical Analysis Used: SPSS20 and AMOS software were used to process and analyze the gathered data using structural equation modeling path analysis and the Sobel test. Results: Findings confirmed the mediating role of illness perception concerning the relationship between psychosocial factors and medical adherence in patients diagnosed with type II diabetes (P < 0.05). Social support can positively impact patients' illness perception (β = 0.2). The emotion-focused coping style has a significant, negative, and direct effect on illness perception (β = 0.13). It was found that self-control, problem-focused style, and the doctor-patient relationship had no significant effect on illness perception (P > 0.05). Conclusion: This study's findings suggest psychosocial factors including stress coping styles, social support, the patient–doctor relationship, and self-control associated with medical adherence. Moreover, the impact of psychological factors on medical adherence increases with higher illness perception.

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Context: The Dimensions of Mastery Questionnaire has been widely used to assess children's motivation to master skills and solve problems. Aims: The present study examined Iranian parents' views on the mastery motivation of their children compared with the children's views of their own mastery motivation. Setting and Design: This analytic cross-sectional and psychometric study was done in 2017-2018 in Iranian governmental regular schools in Sari, Babol (Mazandaran) and Tehran. 11 schools (5 Tehran, 3 Sari and 3 Babol) were selected based on cooperation and acceptance of the study. Materials and Methods: A convenience sampling of 114 families with schoolage children was invited to participate in the present study. Fathers (33.7%) or mothers (69.7%) and their 1115 yearold children (67% boys) filled the questionnaires; 42 parents and 33 children were asked to refill questionnaires after 2 weeks. Statistical Analysis Used: All data were analyzed using descriptive statistics, inferential internal consistency, and testretest reliability. Results: There was no difference between parent and child views on 3 out of 4 persistence subscales, but for all the emotional subscales plus general competence, children rated themselves higher than the parents rated them. The intraclass correlation coefficient of all domains and total score were significant (P 0.01). Conclusions: Pediatric rehabilitation professionals need to be aware that children and adults may differ in their view of the children's motivation. Disagreements should be discussed with parents and students. Specific treatment goals should be developed for the dimensions on which both parents and their children agree.

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Aims: The aim of this study was the evaluation of combination training program influence on the placental growth factor (PIGF) and vascular endothelial growth factor receptor 1 (VEGFR-1) indicators among CABG patients. Setting and Design: The study method was semi-experimental; the statistical population was some patients who had heart disease, after CABG at Babol city hospitals, Iran. Materials and Methods: 16 patients were selected by convenience sampling method.The expression levels of the PIGF and VEGFR-1 genes were measured by the Real Time PCR method. Statistical Analysis Used: The covariance analysis method and the dependent t-test were used. Results: The results showed that changes in PIGF and VEGFR-1 gene expression in the experimental group had a significant decrease in the posttest stage compared to the pretest stage; While changes in PIGF and VEGFR-1 gene expression in the control group were not significantly different in the posttest stage compared to the pretest stage; also, data analysis showed that changes in gene expression of PIGF and VEGFR-1 factors had a significant decrease in the experimental group compared to the control group. Conclusion: The study results showed 8 weeks of combination exercises among the experimental group had a significant decrease in the expression levels of PIGF and VEGFR1 genes among CABG patients compared to the control group. Physical activity may decrease PIGF levels, which is an important factor in oxidative stress and inflammation.

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The current paper reports two pregnant patients with botulism were infected during a botulism outbreak. They were a 26-year-old Gravida 2 Para 1, 24 weeks and a primigravida 29-year-old, 27 weeks women. The first one suffered from ptosis, blurred vision, chewing muscles weakness, dysphagia and urinary incontinence a few days after eating local yogurt. Moreover, the second one was intubated due to dyspnea, dysphonia, muscles weakness and decreased O₂ saturation, 20 hours after ingestion of local yogurt. Both of them were treated by trivalent antitoxin every 8 h for 2 days. They were discharged at the 5^th and 25^th days in well condition, respectively. There was no problem with their pregnancy until they were followed up. In conclusion, in pregnant patients with botulism, treatment should be started as soon as possible and the earlier treatment will reduce the risk of complications.

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