Context: Depression is one of the most common psychiatric disorders, and poor sleep quality is a risk factor for it. Aims: This study aimed at determining the effect of aromatherapy with lavender essential oil on sleep quality of patients with major depression. Settings and Design: This single-blinded randomized clinical trial in Psychiatric Clinic in Yahya Nejad Hospital, Babol, Iran, during 2019. Materials and Methods: Eighty major depressive patients with sleep disorder were recruited from those referred to Psychiatric Clinic in Babol City, Iran. They were assigned into intervention and control groups (forty participants in each group). The intervention group inhaled lavender essential oil and the control group received almond oil as placebo. Sleep quality of the participants was measured before and after the intervention. Statistical Analysis Used: Data analysis was performed employing statistical tests including Chi-square, Kolmogorov–Smirnov, ANCOVA, independent t-test, and paired t-test. Results: The intervention and control groups were homogeneous in terms of demographic characteristics and the mean score of sleep quality before the intervention (P > 0.05). The patients in the intervention group had a better quality of sleep comparing to that in the control group, and the difference was statistically meaningful (P = 0.001). Conclusion: Aromatherapy with lavender essential oil has positive effects on sleep quality in depressed patients. It can be used as a noninvasive complementary method to improve sleep quality in patients with major depression.

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Context: Anxiety is an unpleasant emotion and inhaling Jasmine Essential Oil (JEO) may decrease anxiety before laparotomy. Aims: Determining effects of inhaling JEO on anxiety and blood cortisol levels in patients undergoing laparotomy. Setting and Design: The setting was 5th Azar Hospital in Gorgan (Iran) and the study was a single blind parallel, randomized, controlled clinical trial that was conducted in 2016. Materials and Methods: The subjects (84 patients) were randomly allocated in two intervention and control groups. The intervention and control group inhaled two drops of JEO and two drops of distilled water respectively for 60 min. Blood cortisol and anxiety levels were measured immediately after intervention by ELISA kit, and the Spielberger's State Anxiety Inventory, respectively. Statistical Analysis: The data were described with mean, Median, Interquartile Range (IQR) and analyzed using t-test, Chi-square, Wilcoxon signed-rank, Mann–Whitney U and correlation coefficient tests. Results: The mean score of anxiety in JEO group before and after intervention was 50.90 ± 7.71 and 36.42 ± 6.62 (P = 0.001), respectively and median (IQR) of the cortisol was 160.7 (60.88) and 93.15 (52.38), respectively (P = 0.001). In the control group, cortisol (IQR) level increased (124.1 (67.42) to 127.9 (62.42), P = 0.02) and the mean anxiety score decreased slightly (P = 0.43). Median and IQR of difference cortisol level before and after in the intervention and control group were significant (P = 0.001). Conclusion: Our findings suggest that aromatherapy with JEO may have beneficial effects on preoperative anxiety in patients undergoing laparotomy.

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Context: One of the main factors related to health literacy in chronic kidney disease (CKD) is medication adherence. Aims: The present study aimed to investigate the factors associated with health literacy and medication adherence in older adults with CKD referring to Imam Khomeini Amol Nephrology Clinic in 2018. Setting and Design: This descriptive-analytical study was performed in 2018 in Imam Khomeini Amol Nephrology Clinic. Materials and Methods: This study was performed on 150 elderly CKD patients aged above 60 years. Sampling was done using available sampling method and with the anticipation of confounders. Demographic information, elderly health literacy, and medication adherence were assessed using a questionnaire and interview. Statistical Analysis Used: Data were described with mean, standard deviation, and frequency and analyzed using Chi-square tests. Results: The results showed that the age of the participants was 64.3 ± 3.89 years, and 40% of the elderly had an inadequate health literacy, 39.3% had insufficient health literacy, 20.7% had insufficient health literacy, and excellent health literacy was observed in none of the patients. The results showed that there was a statistically significant relationship between health literacy and medication adherence (P < 0.05). Chi-square test showed that the higher the health literacy, the more the medication adherence. Conclusion: According to the results of the study on the low level of health literacy and its direct relationship with medication adherence, it can be said that more attention of nurses is needed to promote and follow drug adherence by educating patients with low levels of health literacy to prevent the progression of the disease and convert drug therapy to dialysis.

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Context: Increase mindfulness can help the students in dealing and successfully finishing their studies. Therefore, it is warranted to know if autonomous sensory meridian response (ASMR) has an effect in the mindfulness of the nursing students. Aims: This study aimed to assess the immediate effects of ASMR stimulation on the mindful attention awareness of nursing students. Settings and Design: This is a quasi-experimental pre- and post-test design with two experimental groups (whispering and auditory triggers) and a comparison group (personal attention role play trigger). Materials and Methods: Fifty-four nursing students from the college of applied medical sciences were assigned into three groups: (a) the whispering group (n = 18), (b) the auditory group (n = 18), and (c) the personal attention group (n = 18). An adapted Mindful Attention Awareness Scale (MAAS) was used to assess the mindful attention awareness of nursing students. Statistical Analysis Used: Paired t-tests and ANOVA were employed to identify significant differences between pre- and post-test scores for each group. Results: Both MAAS posttest scores of the whispering sound (d = 0.49) and auditory sound (d = 0.48) acquired a significant Cohen's effect size value when compared to the personal attention triggers, suggesting a high practical significance. However, when the two experimental groups were compared, the effect size value was not significant (d = −0.02), established an equal effect on the mindful attention awareness of nursing students. Conclusion: ASMR is considered a promising intervention in the nursing education to improve students' mindful attention awareness. Specifically, the whispering and auditory sounds are better than the personal attention trigger sounds in increasing the mindfulness attention awareness scores of the nursing students.

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Context: One of the potential risk factors for marital problems in infertile couples is the difference in couple's attachment and coping style to the infertility problems. Aim: We amide to investigate the relation between couple's infertility distress with their partner's attachment and coping styles. Setting and Design: This observational-cross-sectional study was done on infertile couples that referred to the infertility center of Imam Khomeini hospital in Sari, Iran, 2016–2017. Materials and Methods: Data were collected using convenient sampling method from 120 infertile couples through sociodemographic questionnaire, Lazarus-Folkman coping strategy questionnaire, Collins and Read attachment strategy questionnaire (RAAS), and infertility-specific distress questionnaire (ISD). Statistical Analysis: Descriptive statistics that were used include frequency, means, and standard division and analytical statistics include one-way ANOVA, Independent sample T test, Chi-Square Test and Pearson Correlation Coefficient test were used. Results: The mean ISD score was obtained by husbands 42.50 ± 9.5, wives 42.55 ± 9.7 and couples 42.53±9.63. One-Way ANOVA test showed that the wives' infertility distress was correlated with their partners attachment style (p=0.004) while husbands' infertility distress wasn't correlated with their partners attachment style (p=0.485). Also, based on Pearson Correlation Coefficient test there is no correlation between the couple's infertility distress and their partner's coping strategy. Conclusions: The relationship of couples and their adjustment to infertility is influenced by their partner's attachment style and coping style. Therefore, identification of these patterns may help in identifying need and tailoring psychological interventions to infertile couples.

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Context: Elevated levels of insulin and leptin can be associated with poor prognosis in breast cancer patients. A safe and effective exercise protocol seems necessary as an adjuvant therapy in breast cancer patients. Aims: This study aimed to assess the effect of concurrent yoga and Pilates training on insulin and leptin in breast cancer survivors. Setting and Design: This study was a randomized clinical trial research with control group in a selected oncology and radiotherapy center in Rasht, Iran, in 2019. Materials and Methods: This clinical trial was performed on thirty breast cancer survivors. The participants were allocated in exercise group (n = 15) and control group (n = 15) by simple randomly. Exercise group underwent 12 weeks of concurrent yoga and Pilates training, 3 sessions/week and 75 min of workout in each session. Every participant completed the demographic questionnaire. Weight, insulin, leptin, carcinoembryonic antigen (CEA), and cancer antigen 15-3 (CA 15-3) levels were measured before and after 12 weeks of exercise in both groups. Statistical Analysis Used: Data were analyzed using descriptive statistics, one-way ANCOVA, and paired t-test and Wilcoxon. Results: Mean score of weight in the exercise group decreased from 73.03 ± 16.75 to 69.92 ± 15.46 (P = 0.01), but in control group, there was no significant improvement (from 85.54 ± 11.7 to 85.27 ± 9.71). There was a significant decrease in leptin levels (from 33.70 ± 15.93 to 21.21 ± 15.37) in exercise group (P = 0.02). However, there was no significant effect on insulin (from 7.66 ± 2.96 to 10.67 ± 4.51), CEA, and CA 15-3 (P > 0.05). Conclusion: Twelve weeks of concurrent yoga and Pilates training have positive effects on leptin levels in breast cancer survivors.

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Context: Anxiety is the most common disorder in childhood. Several factors may play a role in anxiety, such as child's emotional and social behavior and mother employment. Aims: the present study aims to evaluate the anxiety disorders of 3–6-year-old children of nurses working in the educational hospitals in the city of Qazvin. Settings and Design: This cross-sectional study was performed in September 2018. Materials and Methods: This is a descriptive-analytical study. Spence anxiety scale for preschool children was used to collect data. In this self-report instrument, parents are asked to rate the frequency of child behavior on a 5-point Likert scale from Never (0) to Ever (4). The children with a score above 34 were rated as having anxiety disorder. One hundred and fifty-five nurses were willing to participate in the study. Inclusion criteria for children were 3–6 years of age, for nurses were being employed in educational hospitals of Qazvin University of Medical Sciences and the exclusion criteria of this study moving from Qazvin to another city. Statistical Analysis Used: Data were analyzed using SPSS version 20 ( SPSS Inc., Chicago, IL, USA), univariate and multivariate regression coefficients. P < 0.05 were considered as significant levels. Results: The results showed that 32.9% of children of the nurses had anxiety disorder and there was a significant positive relationship between child gender (P = 0.008), child care during hospital shifts (P = 0.013) and anxiety among in these children. Furthermore, the prevalence of anxiety disorder in girls and child care by other family members were associated with the anxiety. Conclusions: Nurses are exposed to work-family conflicts due to their occupational conditions, which play an important role in children's anxiety and it declares the need to pay more attention to this large segment of society. To generalize the results, it is suggested that this study be conducted on the statistical population of other regions of the country.

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Context: Notwithstanding the recognizable impact on public health, knowledge regarding this virus remains inadequate. Aims: This study aimed to determine the knowledge, attitudes, and practices of medical and allied health students regarding COVID-19 and its relationship to their demographic information. Setting and Design: This study was conducted at the University of Hail, Hail region, Kingdom of Saudi Arabia. This study used a quantitative comparative-correlational design. Materials and Methods: There were 232 students recruited as respondents resulting from convenience sampling. A Google Forms survey was used to collect the data from March 2, 2020, until April 15, 2020. Statistical Analysis Used: One-way ANOVA, t-test, and Pearson's correlation test were used to analyze the data. Results: The participants had good knowledge, positive attitudes, and good practices on COVID-19. Of all the variables tested, only gender (P < 0.002) has statistical difference to knowledge. The Pearson's results showed no significant relationship between knowledge and attitudes (P > 0.5), knowledge and practices (P > 0.5), or attitudes and practices (P > 0.5). Conclusion: With the good knowledge, positive attitudes, and good practices of the participants about COVID-19, it is inferred that they can help to do information dissemination needed by the community. As females found to be more knowledgeable than males, female involvement in prevention and information of COVID-19 in the family dynamics of the Saudi context is worth considering. Moreover, male participants' knowledge should be improved through health education.

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Context: Toxoplasmosis in females plays a prominent role in fetal health owing to serious pathological problems including abortion, hydrocephaly, mental retardation, and chorioretinitis. Aims: The purpose of the present investigation was to study the seroprevalence and genetic characterization of Toxoplasma gondii in female population using ELISA and polymerase chain reaction (PCR) techniques in Mazandaran Province, Iran. Setting and Design: This was a cross-sectional study on girls and women of childbearing age in Mazandaran Province from 2018 to 2019. Materials and Methods: A total of 500 serum samples were collected and studied employing ELISA and PCR assays. Prior to sampling, a questionnaire was filled out for each case. Statistical Analysis Used: Chi-square or Fisher's exact test was used to analyze the obtained data, and associations were considered statistically significant at P < 0.05. Results: The total seroprevalence of the studied sera was 26.6% for IgG antibody, and also, 4.2% of the samples showed anti-Toxoplasma IgM antibody. Furthermore, there was a statistically significant relationship between seroprevalence of Toxoplasma and residential area and marital status. Genetic characterization of T. gondii revealed that 20% of the positive samples were Type II and 0.2% was Types I and II. Conclusions: The seroprevalence of toxoplasmosis in girls and women of childbearing age in the north of Iran is considerable. Residential area and consumption of vegetables are identified as potentially preventable risk factors for acquiring toxoplasmosis in Mazandaran Province.

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Context: Self-efficacy is one of the important determinants of the behaviors that influence the physical and psychological health among patients with chronic medical conditions. Aims: This study was aimed to investigate the factors that influence the self-efficacy of patients with thalassemia. Setting and Design: This was a qualitative study using a directed content analysis design. The research population consisted of the patients with thalassemia major who referred to the thalassemia ward of the medical training centers in Iran for blood transfusion. The research sample included 16 patients with thalassemia major who were selected using the purposeful sampling method with maximum variation. Materials and Methods: Data were collected from 16 patients with thalassemia major, using a semi-structured interview in 2018–2019. Statistical Analysis Used: Data were analyzed using the Elo and Kyngäs method and MAXQDA10 software (Berlin, Germany). Results: The analysis of the data resulted in 70 initial codes and the emergence of five generic categories including: (1) the performance accomplishments, (2) the vicarious experience, (3) the verbal persuasion, (4) the physiological states, (5) the self-persuasion. Conclusions: Factors influential on the creation and promotion of the self-efficacy of the patients with thalassemia include the performance accomplishments, the vicarious experience, the verbal persuasion, the physiological states, and the self-persuasion. Self-efficacy affects the onset and persistence of behavior. Therefore, designing practical programs containing factors affecting the self-efficacy of the patients with thalassemia seems necessary to improve quality of life and physical and mental health of these patients.

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