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Introduction: Workload is one of the most important occupational factors of anxiety. The present study aimed to investigate workload and its associated factors among nurses working in teaching hospitals of Shiraz University of Medical Sciences in Iran.
Methods: This cross-sectional descriptive-analytic study was conducted in 2017. A total of 340 nurses from the hospitals were selected using the stratified random sampling method, and finally 312 individuals were recruited in this study. The data collection instrument included the National Aeronautics and Space Administration Task Load Index. The data were also analyzed through descriptive indices as well as t-test, analysis of variance, Pearson’s correlation coefficient, and multiple linear regression. SPSS Software, Version 16, was used to analyze the data at a significance level of 0.05 (α=0.05).
Results: The mean score of workload was 73.47±21.81. The mean scores of the effort rate (79.09±21.81) and frustration and failure level (59.51±30.76) also received the highest and the lowest values, respectively. Moreover, statistically significant relationships were observed between level of education (p=0.03), employment relationships (p=0.001), number of patients under the nurses’ monitoring per work shift, and the mean score assigned to workload among nurses (p=0.04, r=0.117).
Conclusion: The workload among nurses examined in this study was reported at a high level. Therefore, managers should implement programs such as motivational incentives and welfare services to moderate the workload in nursing.

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Background: The management of Psychological symptom in patients and nurses, effective communication with patients are important issues that should be taken into consideration in nursing care. This study aimed to examine the effects of nursing welcome program on the level of stress and satisfaction in patients in the Coronary Care Units (CCU).
Methods: The interventional study was done on 72 patients, who were admitted to CCU at Emdadi hospital in Abhar in 2017. The patients were selected by convenience sampling and were allocated into intervention (n= 36) and control (n= 36) groups. Data was collected using a questionnaire including demographic; Depression, Anxiety and Stress Scale (DASS-21), and the La Monica–Oberst Patient Satisfaction Scale (LOPSS). The DASS-21 was fulfilled by a welcome nurse through interview in both groups. Then the welcome nurse began to implement the Nursing Welcome Program in the intervention group. The level of patients' stress and satisfaction were measured an hour and 24 hours after the intervention respectively. Patients in the control group received routine care without any intervention. Data was analyzed using independent t-test, chi-square test, and Fisher's exact test in SPSS-16.
Results: The Mean±SD of stress in intervention and control groups after intervention were 8.23±3.24 and 11.9±4.20 respectively (p= 0.001). The Mean±SD of satisfaction in intervention and control groups after intervention were 249.26±26.7 and 236.10±23.71 respectively (p=0.031).
Conclusions: According to the importance of nurses' position in communicating with patients, employing welcome nurses as an effective care method to reduce psychological symptoms and increase patients' satisfaction is suggested.

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Background: Infants are regarded as the most vulnerable group with special needs in natural disasters. Since midwives are responsible for providing reproductive health services for infants in natural disasters, this study was performed to assess their professional competencies. Methods: This cross-sectional study was conducted in Tehran, Iran. A total of 361 midwives were selected by cluster sampling method. After giving them informed consents, they participated in the study and completed the researcher-made questionnaire on providing health services for infants in natural disasters. Their professional competence was investigated through self-assessment in terms of their perceived importance, knowledge, and skill. Midwives inclusion criteria were as follows: having a degree in midwifery, having at least 6 months of experience in one of the public hospitals in the city, and a desire to participate in the study. Those who did not complete about 15% of the questionnaire items were decided to be excluded from the study.The Questionnaire included 10 items about infant care designed based on literature review of the resources and associated with the goals of MISP (Minimum package of the reproductive health services in natural disasters). To evaluate the instruments` validity, the questionnaire was given to 15 faculty members of the Nursing and Midwifery School of Tehran University of Medical Sciences. Five midwives were members of Tehran Red Crescent. After receiving comments from midwives and faculty members, the questionnaire items were reviewed. For analyzing the questionnaire reliability, the Cronbach coefficient α was calculated with 0.8. The data were analyzed by using SPSS, version 17. The analyses included descriptive and analytical statistics such as ANOVA, t-test at a significance level P<0.05. Results: Mean (SD) total score of professional competency of midwives in providing services for infants in natural disasters was 91.95(20.2) obtained from 3 subcategories: perceived importance, 39.83(9.55); knowledge, 22.5(5.06); and skill 30.16(6.86). There were significant relationships between the scores of professional competency of midwives with age (P=0.053), degree of education (P=0.028), workplace (P=0.053), and experience in natural disaster (P=0.047). About 49.86% of midwives demonstrated middle level of professional competency. The lowest knowledge and skill score were reported in managing common neonatal problems e.g. asphyxia, sepsis, physical trauma, which require referral and stability. Conclusions: The average scores of professional competencies of midwives to deliver Reproductive health service to infants in natural disasters show the necessity of related and integrated education. It is recommended that by holding emergency maneuvers and natural disaster simulations, midwives be educated with regard to natural disasters in order to know how to respond in these challenging situations. 

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Background: Anxiety is the most common emotional reaction of women during childbirth. Anti-anxiety effects of Chamomile are documented thanks to flavonoids compounds, Apigenin, and phyto-estrogen which influence central nervous system by bounding to benzodiazepine receptors and lead to reducing anxiety. According to the importance of reducing anxiety, this study aims to evaluate the effect of chamomile essential oil on reducing anxiety in nulliparous women during the first stage of childbirth.
Methods: This randomized clinical trial was performed on 130 nulliparous women (65in intervention group and 65 in control group) who were qualified and referred to Abhar Emdadi Hospital (Zanjan, Iran) in 2013. The researcher referred to labor ward of Abhar Emdadi Hospital after determining the validity and reliability of the study, receiving ethics committee approval at No.400/4013, and registering it in Iranian Registry Clinical Trial Center at No.IRCT201308066807N7. Sampling was conducted in Abhar Emdadi Hospital from September to March 2013. The samples were assigned to case or control group according to the days divided by pockets A and B; qualified nulliparous women were placed in one of the groups in random days. In aromatherapy group, 2 drops of chamomile essential oil, and in control group, 2 drops of distilled water were spilled on sterile gauze. They were inhaled by the patients at a distance of 7-10 cm from their noses and prescription of aroma and distilled water was repeated every half an hour. At first, the anxiety level was measured with researcher by using Spielberger questionnaire at dilatations of 3-4 and 8-10 cm and effacement of 40-50 and 70-100. In all processes the samples were positioned on the bed in the left lateral position.The tools for data collection included midwifery and demographic information checklist, and Spielberg’s questionnaire. Independent t-test, for normal quantitative data and Mann-Whitney and Chi-square tests for not normal quantitative data, were used to analyze the collected data. They were analyzed using SPSS 22. The significance level was considered 0.05.
Results: At baseline, both intervention and control groups showed moderate anxiety. But after intervention, the anxiety level in intervention group at dilatations of 3-4 and 8-10 cm was (46.12 ± 3.70) and (39 ± 3.70) respectively which in turn portrayed a significant decrease (P <0.005) in comparison with control group at dilatations of 3-4 and 8-10 cm which was (60.00 ± 4.3) and (61.24 ± 4.61) respectively.
Conclusions: The findings of this study showed that aromatherapy by chamomile essential oil reduces the anxiety level during childbirth; therefore, it is recommended in order to reduce anxiety.

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Background: Lip and palate clefts are the most common birth defects that cause many medical, psychological, social and financial problems for person and his or her family. Since many factors are involved in causing these defects, this study aimed is review the effective factors causing cleft lip and palate.                                                                                              
Methods: The present study was conducted using a narrative review. For this purpose, the following keywords were searched in the PubMed, SID, Science Direct, Google Scholar, WHO, databases: Cleft Lip, Cleft Palate, neonates, Risk Factor, Effect Factors from 1990 until 2019.
Results: This study showed valuable results regarding the risk factors for neonatal cleft lip and palate, that including family and genetic history of cleft lip and palate, family marriage, using drug and antibiotics in the first 3 months of pregnancy, Maternal stressors especially in the first 3 months of pregnancy, high BMI before maternal pregnancy, maternal age over 35, maternal smoking during pregnancy, folic acid deficiency and environmental factors.
Conclusions: Lip and clefts palate can be associated with many complications such as speech and hearing problems, breast feeding problems, ear infections and psychosocial problems for the newborn. Therefore, identifying the factors that contribute to their creation can help to have healthy people in the community and prevent economic and social damage.

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Background: Lack of information in marital relationships can be an important factor in sexual dysfunction and dissatisfaction. Many marital problems are caused by dissatisfaction with sex. The lack of awareness in this area is due to marriage in adolescence age and regarding sex as a taboo in religious, cultural and social matters. In such cases, it may be appropriate to take advantage of modern teaching methods. Due to the increase in technology, the present study was designed and conducted to determine the role of multimedia education on sexual satisfaction in Afghan refugees’ adolescent women.
Methods: The present study is a quasi-experimental educational intervention in which Afghan adolescent women referred to selected charity centers in Mashhad were selected as the intervention (n = 34) and control (n = 34) using sortation method. Sampling was convenience and women with inclusion criteria brought in the study. Inclusion criteria were Afghan adolescents aged 10-24 years, having ability to communicate in Persian (reading and writing), formal marriage, first marriage and single marriage, residing in Mashhad, Marriage duration of at least one year, no formal and comprehensive sex education, no underlying medical conditions (diabetes, thyroid dysfunction, liver and kidney disease), non-addicted and non-psychiatric couples, lack of stress experiences in the last 3 months, no pregnancy, abortion, or delivery in the last 3 months, living with spouse in a shared home at the time of research, having sex with spouse, accessing a computer or CD player, and knowing how to use these devices or having access to the person helping the participant to use them. First, the participants completed the demographic characteristics Questionnaire and Sexual Satisfaction Questionnaire. The second questionnaire had 25 questions (13 negative and 12 positive answers) which were answered by likert scale of 1 to 7. The overall scores` range was from 25 to 175 and it categorized sexual satisfaction in three level: low level (score between 25 and 67), moderate level (score between 67 and 100) and high level (score above 100). To assess the validity of the questionnaire, face validity was approved by a survey of 6 midwifery experts and then the content validity was evaluated by 14 experts to assess the simplicity, clarity, necessity, relevance and importance. The results of the data analysis indicated that all the questions were simple and clear. The index for the whole instrument was 0.91, indicating that the instrument was content valid. By calculating the CVR index for each item, the lowest value was 0.57, and according to the Lauvche table, the allowable value for this index was 0.51, and all the questions were sufficiently valid. Test-retest method was used to evaluate the reliability of the tool. The questionnaires were given to 20 members of the study population who were not present in the study sample and after two weeks the questionnaires were again completed by the subjects; correlation coefficients were 0.79. The intervention program consisted of 4 sessions (every session was 60-minute) and 4 CDs provided to the intervention group every week to be observed during the week. Delivering subsequent educational content to participants was based on the researcher's assurance of viewing previous educational content and it was proved by asking a few questions about those contents. All educational contents were first collected by the researcher from various books about sexual subject and finally approved by a qualified professor in this field from the viewpoint of psychology. Control group participants received routine charity programs. The sexual satisfaction questionnaire was completed again at the end of training (4 weeks) and 8 weeks after the beginning of the study. After checking the data normality for data analysis and descriptive statistics such as adjusting frequency distribution tables, calculating numerical indices and inferential statistics of chi-square, independent t-test, paired t-test, One-way analysis of variance was used.
Results: The mean ± SD of the intervention group age was 22.88 ±1.200 and for the control group was 22.44 ± 1.637. 15 and 12 participants in the intervention and control group, respectively, had undergraduate education. 20 and 22 participants had high school diploma or higher. Before the intervention, sexual satisfaction was not significantly different between two groups (P = 0.729), while it increased significantly at week 4 (P = 0.013) namely 8 weeks after the intervention (P <0.001). In the intervention group, the mean of sexual satisfaction was 130.11 ± 24.54 which subsequently increased to 140.50 ±20.51 after intervention and 148.35 ± 18.88     8 weeks after intervention which in turn indicates the persistence of information. There was also an increase in scores of participants. In the control group, the mean sexual satisfaction was 128.82 ± 19.88 in the first week, 128.26 ± 19.57 in the fourth week and 128.41 ±19.65 in the 8^th week which showed no significant difference.
Conclusions: Due to the nature of sex education which is associated with shame, using multimedia method was more effective and cost-effective. This method also does not need face-to-face visits and improved the sexual satisfaction of adolescent Afghan refugee women therefore it can be used in sex education for Afghan couples.

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Background: Unplanned pregnancy challenges maternal adaptation process, which can disrupt Maternal Fetal Attachment and increase maternal and infant physical and mental symptoms determining the effectiveness of Cognitive Counseling on Maternal Fetal Attachment of women with unplanned pregnancy.
Methods: The study was a randomized controlled trial in health care centers in Zanjan, Iran in 2018. Among the mothers with inclusion criteria, 54 mothers were selected with convenience sampling and were divided into intervention (27 person) and control (27 person) groups with blocked randomization (combine two and four person block). The inclusion criteria comprised having unplanned pregnancy, satisfaction to participate in the study, lack of obstetric complications, psychological disease and  medication use, gestational age less than 14 weeks, lack of known psychological disease, being married and living with their husbands, having an alive mother, lack of narcotic substance abuse in women or their husbands, and at least attaining  secondary education. Exclusion criteria included the unwillingness to continue the cooperation in the study, non-participation in two or more than two sessions, occurrence of any pregnancy complications or disease, occurrence of any stressor event or accident during the study and incompleteness of the questionnaires. The intervention group received eight sessions 90-60 minute (one session per week) under cognitive group counseling based on pregnancy adaptation stages. The control group received usual care. Furthermore, this group received intervention, pamphlets, and training packages at the end of the study. Data collection tool included demographic checklists, Cranley’s Maternal Fetal Attachment questionnaire, completed at baseline, immediately after intervention, and one month after the last session by self-report method. The data of this study were analyzed by appropriate statistical tests by SPSS v.16 software.
Results: At baseline, Maternal Fetal Attachment scores did not show significant differences between the two groups (intervention group 56±6.28 and control group 57.70±3.39). Regarding post-test (intervention group 84(2) and control group 55(4.50)) and regarding the one-month follow-up period (intervention group 84(3.50) and control group 57(4.75)), median (inter quartile range) of Maternal Fetal Attachment scores were significantly higher in the intervention group than the control group (P<0.001).
Conclusions: Cognitive counseling in mothers with unplanned pregnancy improves maternal fetal attachment. Therefore, it is recommended that the maternal fetal attachment should enhance in unplanned pregnancies, followed by the child's psychological health, and educational and counseling measures. This intervention can be recommended as a striking solution that can be applied by trained midwives in developing countries.

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Background: Health concerns are common issues during adolescence due to the wide range of changes and challenges in this period. As a major population of many countries, including Iran, adolescents need some opportunities to express their thoughts and concerns. Identifying the worrisome subjects among this population group can help us in providing appropriate health education and consultations. Considering that in the majority of studies, adolescent girls express higher concerns compared to boys and since they are more mentally vulnerable than boys, the study aimed to determine health concerns of adolescent’s high school girls from their personal perspectives in Gorgan."
Methods: This study was a quantitative content analysis based on responses of high school female students in private and public schools in Gorgan. The sample size of this study) at least 500 people (was based on the population ratio of high school girls in the public and private schools. As a result, three public and two private schools were randomly chosen. From each grade in the schools, one class was randomly selected. Assenting to take part in the study, adolescents high school girls were asked to fill an anonymous sheet containing demographic information with an open question at the bottom of the sheet in the form of: “Dear adolescent please write down all the concerns you have in your daily lives in the assigned space below”; Finally, 548 sheets were collected and analyzed.
Results: The findings showed that 3 categories including “Self” (%93.8) with 11 subcategories including “education”, “Occupation”, ”Future life”, “Health”, “Marriage”, ”Nutrition”, “Religions”, “Exercise and Recreational activities”, “Appearance“, “Puberty“, and “Risky behavior, “Significant Others“(%44.8) with 3 subcategories including “Family”, “Peers”, and “School staff”, and finally “Peripheral system”(%21.2) with 4 subcategories including “Society“, “School”, “Environment”, and “Cyberspace” as the main adolescents were found as health concern sources.
Conclusions: Based on the findings of the present study, it can be stated that Iranian adolescents experience an atmosphere full of educational, career, family, social, and the future concerns. Thus, modifying the educational system and job creation should be seriously considered by the policy makers to reduce adolescents' health concerns. In this regard, periodical evaluation of health concerns in high schools are recommended. In fact, our findings can give adolescents a stronger voice to increase policy maker’s awareness regarding the adolescents` concerns.

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Background: Sexuality is a complex aspect of the human being’s life and is more than of only the sexual act. Normal sexual functioning consists of sexual activity with transition through the phases from arousal to relaxation with no problems, and with a feeling of pleasure, fulfillment and satisfaction. Rheumatic diseases may affect all aspects of life including sexual functioning. The reasons for disturbing sexual functioning are multifactorial and comprise disease-related factors as well as therapy.
Methods: Searching performed in some databases like PubMed, google scholar, Scopus, Springer and Science Direct. 22 full text articles in English from 2000 until 2019 were found
Which their topic was similar to our topicThe presence of sexual dysfunction was assessed with the questionnaire ‘Female Sexual Function Index (FSFI)’. The FSFI was self-administered and consisted of 19 questions covering six domains; desire, subjective arousal, lubrication, satisfaction, orgasm and pain. The patients’ answers were based on the 4 weeks prior to completing the questionnaire. A total score of ≤ 26 indicated sexual dysfunction.
Results: In rheumatoid arthritis and ankylosing spondylitis patients, pain and depression could be the principal factors contributing to sexual dysfunction. On the other hand, in women with Sjögren’s syndrome, systemic lupus erythematosus and systemic sclerosis sexual dysfunction is apparently most associated to vaginal discomfort or pain during intercourse. Finally, sexual dysfunction in patients with fibromyalgia could be principally associated with depression, but the characteristic symptoms of fibromyalgia (generalized pain, stiffness, fatigue and poor sleep) may contribute to the occurrence of sexual dysfunction.
Rheumatic diseases affects sexual health as a result of pain, reduced joint mobility, fatigue, depression and body image alterations. Sexual function is closely related to satisfactory quality of life. The treatment of sexual dysfunction will depend on the specific patient’s symptoms, however, there are some general recommendations including: exploring different positions, using analgesics drug, heat and muscle relaxants before sexual activity and exploring alternative methods of sexual expression.
 Conclusions: Sexual dysfunction in females with rheumatic diseases is multifactorial due to chronic disease aspects, disease activity and drugs. A multidisciplinary approach is essential in order to offer preventive measures for these patients.
The investigated material provides few solutions to sexual health problems of female patients. The most commonly mentioned solution is increased information and communication between health professionals and patients. Further research is needed to understand which types of intervention can help women with rheumatic disease to improve their sexual health
The results of this studies indicated that more attention should be paid to the sexual health of women suffering from rheumatic diseases as a neglected aspect of their treatment, which requires an interdisciplinary approach to shift the care of these patients from a biomedical model to a biopsychosocial model.

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Background: Mothers with high risk pregnancies, in addition to medical problems, experience behavioral, and emotional problems. One of the problems mothers with high risk pregnancies encounter is the effect of high risk pregnancy conditions on their marital relationships. Therefore, caregivers' attention to mothers with high-risk pregnancies and counseling in this regard is necessary in order to lessen the care of mothers. It is recommended to focus on preventing sexual intercourse in high risk pregnancies. Therefore, the researchers conducted a qualitative study to understand and experience mothers with high risk pregnancies of marital relationships during pregnancy.
Methods: In this study, through a qualitative content analysis, data was collected via interviews. The research population including all mothers with high risk pregnancies were collected by sampling method. The research area was the public and private hospitals in Mashhad. Completing the legal and ethical steps and approving the plan, the researcher introduced himself to the ethics committee of Mashhad University of Medical Sciences and also to the participants. In addition, they presented the purpose of the research to the participants and obtained the written informed consent form. Subsequently, with a semi-structured, isolated face-to-face interview with contributors, they discovered the feelings, perceptions, and thoughts of contributors. The interviews were completely recorded by an MP3 Player device after getting permission of the participants. Data analysis was carried out simultaneously with data collection, in a conventional way of content analysis, based on the approach of Graneheim, Lundman (2004), and MAXQDA1 software used to manage the data.
Results: 12 pregnant women with high risk pregnancy were saturated. Interviews lasted between 45 and 75 minutes. 1000 codes were obtained. The resultant subcategories included: distance in marital relationships, damaged sexual relations, sexual dysfunction in high-risk pregnancies, and values priority in high risk pregnancies. The final theme extracted is "marital and sexual relations are considered as the missing ring in high risk pregnancies."
 Conclusions: Sexual and marital relationships and marital status are neglected in high risk pregnancies, which in turn causes mothers to experience negative emotions, therefore consultation with mother’s .should be considered.

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Introduction: Infertility is a growing problem in all cultures and societies, and almost all over the world. Therefore, the present study examines the quality of life of infertile couples and their relationship with the practical flexibility of infertile couples referring to Yazd's centers of infertility.
Methods: This research is a descriptive-correlational study. The research population consisted of all infertile couples who referred to Infertility Centers in Yazd in the winter of 2016. Sampling was conducted in a non-random and accessible manner. The instrument used in the research included: a) demographic information questionnaire, and "quality of life infertile couples" questionnaire. Data were analyzed by SPSS software version 17 at a significant level of p> 0.05.To describe the data, descriptive statistics methods were used and the inferential statistics (Pearson correlation coefficient, paired t-test and variance analysis) were used to test the research hypotheses.
Result: People (202 couples) participated in this research. The mean of total quality of life (184.26 ± 36.4), physical dimension (26.43 ± 6.6), psychological dimension (70.8 ± 13.1), religious dimension (18.85 ± 3.7), economic dimension (31 Sexual satisfaction (15/15 ± 4/1), emotional dimension (15/68 ± 4/9), social dimension (23/3 ± 6/6). There was a significant difference in the relationship between demographic variables with quality of life, mean of gender variables (p <0.01) and education (p <0.001). The average quality of life in men and people with university education was higher. In this study, 65.64% of the subjects had a neutral quality of life, 63.3% had a positive quality of life and 3% had a completely positive quality of life.
Conclusion: Considering the lower quality of life in women, it is essential to pay attention to the necessity of designing and implementing appropriate educational programs to improve the quality of life of this stratum from society.

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Background: Because of the importance of adolescence, the priority of reproductive health in the world is adolescent reproductive health. What distinguishes this age from other phases of life is the emergence of fertility. Sexual ability, especially among this age group, is a matter of great significance. In fact, today's adolescents, like their peers at all times, are sexually active, with the difference that they are exposed to more sexual stimuli comparing to the past. Moreover, through promoting views about pro-individuality, freedom, opposite-sex friendship, and even establishing advanced relationships are encouraged more than ever. Hence, adolescents face unique reproductive health challenges. The purpose of this study was to discover the views of mothers of adolescent girls about sexual education for adolescent girls.
Methods: In this qualitative study, data were collected through 4 focus group discussions with 26 mothers who had at least one adolescent girl between the ages of 14 -19, not married, living with parents, and attending public schools of Mashhad in 2016. The sampling method, given that the interviews were conducted at the adolescent girls' school, was designed to purposely select schools in a way that encompassed all three high, low, and medium economic and social situations of city dwellers. The number of participants in the focus group sessions ranged from 6 to 8 and the duration of each session was between 60 to 90 minutes. All focus groups were recorded using two digital recorders and field notes with the consent of the interviewees. Having been transcribed, the data were coded and categorized using the conventional content analysis method with the Grunheim and Lundman approach and using MAXQDA10 software.
Results: Data were collected in four main categories: Self-study over time- Sexual education is a moral deviation factor- The need to increase mothers' sexual literacy- and School and family participation
 Conclusions: Most participants` mothers emphasized the need for adolescent girls' sexual education and believed that this should be done with the participation of schools and families. However, they disagreed with the exact time of initiation into teaching. Some of the mothers believed that the best time for initiation to teaching is the time of marriage, and others, considering the prevailing conditions in the community, especially easy access to Internet, surmise that the sexual education should begin during adolescence and before marriage, however, they though that pre-marriage sexual education should initiate according to certain criteria, in this regard, they emphasized the school's involvement which, in turn, needs the government appropriate policies.

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Background: reproductive health is having physical, mental and social health not being sick or disable, in all related systems of reproduction, function and its process. This study aims to investigate the effective factors on using reproductive health services and their outcomes.
Methods: this was a narrative review and the keywords, including reproductive health, family health, services, health promotion, barriers and effective factors outcome, were determined basing on Mesh and searching the papers in Google, PubMed, Science Direct, SID and Scholar, published since 1990 to 2019. The criteria to participate in this study included the papers examined the effective barriers on using  reproductive health services and their outcomes; the criteria of putting unrelated papers aside were basing on the subject. Finally 39 papers were chosen from 85 ones (26 English and 13 Persian papers) to write the review.
Results: our findings in this paper were related to the effective barriers on using reproductive health services and their outcomes and divided into four groups. the effective barriers on using reproductive health services included poverty, violence, migration, injustice , inequality and their outcomes as the outcomes of poverty (access to modern family planning services, difference between fertility in urban and rural population due to in equality in access to contraception methods , differences in level of women’s knowledge about reproduction issues in poor and rich communities , increasing infertility, unsafe abortion and increasing  sexually transmitted diseases ), violence including some scopes like mental health (depression, sleep disorder, Posttraumatic Stress Disorder and suicide), reproductive health (unintended pregnancy, unsafe abortion, Complications of pregnancy, sexual disorders and   sexually transmitted diseases like HIV), risky behaviors (unprotected sex, multiple sex partners and sexual violence ), tragic outcomes (death caused by pregnancy complications, rape, unsafe apportion, killing newborn infant and suicide) and social outcomes (unintended pregnancy, leaving school, losing relationships and rejection by family and friends ), migration (increasing undesirable outcomes of pregnancy like low birth weight, sexually transmitted diseases, induced abortion and decreasing access to health services ) , injustice and inequality (reduced access to family planning services by poor communities comparing to rich ones and increasing fertility, increasing unintended pregnancy, short intervals between pregnancies and increasing family members ).
 Conclusions: according to the important role of reproductive health in human and communities, training people is necessary, not only for medical reasons but also as a basis in strength of marital life. Lack of information or incorrect data can increase family and marital problems so the effective factors and barriers should be determined and met.

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Background: Sexual self-concept is a cognitive evaluation which refers to a person's perception of tendencies and self-sexuality and may be affected by factors such as chronic illnesses. Therefore, this study was conducted to compare sexual self-concept in married diabetic women with married non-diabetic women.
Methods: This Analytical cross-sectional study was performed on 200 married diabetic women and 200 non-diabetic women referred to healthcare centers of Gorgan. Inclusion criteria were: high school education or more, Iranian nationality, living with their spouses for the past 4 weeks, and getting married once. Exclusion criteria were: history of adverse events in the past three months, identified physical, psychological and sexual problems, having psychiatric disorders diagnosis by a psychiatrist, current couple's drug and alcohol addiction, pregnancy, menopause, infertility, and lactation. Samples were selected by systematic random sampling. Data were collected using Farsi Multidimensional Sexual Self-Concept Questionnaire and were analyzed by SPSS16 software using Mann-Whitney nonparametric test.
Results: The results showed that the mean of positive sexual self-concept (103/2 ± 25/59) and the mean score of situational sexual self-concept (33/6± 11/3) in diabetic women were significantly lower than the mean scores of similar areas in non-diabetic women who showed positive sexual self-concept as 111.41 ±24/59 and situational sexual self-concept as 38/2 ± 11/04. Furthermore, the mean score of negative sexual self-concept (27/9 ± 8/5) in diabetic women was significantly higher than the mean scores of similar areas in non-diabetic women (24/9 ± 7/09).
 Conclusions: Diabetes is known as an effective factor on women's sexual issues such as sexual self-concept. According to the results of this study, it seems that some interventions must be designed to improve the positive and situational sexual self-concept and to reduce negative sexual self-concept.

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Background: General self-concept refers to the set of emotions and perceptions of one's self, while sexual self-concept refers to the perception of each individual as a sexual being. General and sexual self-concepts are affected by various life problems including infertility. Infertility can affect people's self-concept by affecting their personal and sexual life. Lack of negative mood management can also affect people's self-concept by creating psychological problems such as anxiety and depression. Mood regulation skill as a protective factor for people experiencing psychological problems in their relationships, will modify emotional responses which in turn leads to improve their physical and psychological health through positive and adapted behaviors. The purpose of this study is to determine the effect of mood regulation education on general and sexual self-concept in infertile women.
Methods: This clinical trial study conducted in 1397, 34 infertile women referred to the only infertility center in Gorgan who were included in the study and were selected by available sampling method, (n=17) in the intervention group and (n=17) in the control group. Education program of mood regulation was performed in four, 90- minute-long sessions of a one-time workshop for individuals in the intervention group. Inclusion criteria were: Iranian nationality, high school education, not having any stepchild, primary infertility, absence of known physical and psychological illnesses (according to their own declaration), not taking psychiatric medication, non-drug addiction of both the woman and the spouse and not having any life skills training. Exclusion criteria were: not attending in educational sessions more than once and unwillingness to continue this study. Both groups completed Rogers' Persian self-concept questionnaire and Snell's self-concept questionnaire before, immediately and one month after the intervention. Data analysis was performed using SPSS software (version 16), repeated measures analysis of variance, and adjusted Bonferroni test (P <0.05).
Results: In this study, the mean age of the samples in the intervention group was 33.18 ± 6.07 and 30.41 ± 4.54 in the control group. Results showed that before intervention, general self-concept in intervention group was 9.41, positive sexual self-concept 123.76, negative 12.17, and situational was 43.17. One month after intervention, general self-concept was 6.21, positive sexual self-concept 139.29, negative 5.70 and situational was 54.23. The results of repeated analysis of variance showed that mood regulation education had a positive effect on promotion of general self-concept and sexual self-concept of infertile women one month after intervention, therefore this effect was statistically significant.
 Conclusions: Mood regulation education improves the general and sexual self-concept of infertile women and can be used in health care, infertility and midwifery centers.

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Background: Infertility, having the conditions of a crisis incident, creates a comprehensive crisis in the lives of infertile couples. Infertility is not only influenced by physiological factors and in the field of medical sciences, but also involves many psychological and social aspects. The purpose of this study is to review the psychological and social outcome of infertility in Iranian women, and review the findings of relevant articles.
Methods: In this review study, related English and Persian articles were collected by using of keywords infertility, psychological outcome, social outcome of infertility from reliable scientific databases such as IranMedex, Irandoc, Google scholar, SID, Magiran, Pubmed, Science Direct, MedLib from 2000 to 2018. Of the 47 related articles, 32 articles (quantitative and qualitative study) were in the main objectives of the study, which were examined.
Results: The psychological and social outcome of infertility in women with infertility in Iran can be described as the consequences of cognitive, emotional (internal and family conflicts) and socio-cultural aspects of infertility (social isolation and social stigma). Fear, anxiety, depression, loneliness, sin, lack of self-esteem, regret and aggression are as internal conflicts and friendship disturbances, Sexual dysfunction and loss of life satisfaction, including family conflicts among infertile women. Infertility is also considered as a social stigma, which can lead to social isolation and loss of social status of infertile women.
 Conclusions: Considering the psychological and social outcome of infertility should be taken at individual, interpersonal and social proceedings in order to empower couples with infertility to promote mental health and their active participation in society.

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Background:Attachment is a lasting psychological relationship between two people which is formed in the first two years of one's life. It has two types of secure and insecure attachment. The insecure type is separated into anxiety-ambivalent and avoidant, each causing problems for children and their families. Counseling families with attachment problems will lead to higher levels of secure attachment in their children, so these families need to be more aware of effective counseling approaches to correct their children's insecure attachment. Therefore, the aim of this study is to review children's attachments and the impact of counseling approaches on them.
Methods: This review study utilized Persian keywords attachment, child and counseling at SID and Magiran databases, and English equivalent verbs extracted from Mesh-PubMed, including Parent-Child Relation, Counseling Child, and Attachment, in the database. Searches from Web of Science, Science direct, Medline-PubMed, Scopous, and Google scholar search engine from 2010 to 2019 between February and March 2018. By eliminating duplicates using End Note software and then screening at title level, abstract and full text finally 7 English and 6 Persian articles were entered and evaluated using Jadad Scale.
Results: Between 13 articles, 9 were quasi-experimental and 4 were clinical trials. Four common treatment approaches for families with attachment problems have been found . The first approach is psychoeducation, which focuses on enhancing parent/caretaker knowledge and includes positive behavior management techniques, assisting the parent-child relationship, and improving child conflict. The second approach, parent and child psychotherapy, aims to overcome negative interpersonal patterns in children. The third approach is group education to parents /caretaker to encourage consistent behaviors at home, school, and community; and the fourth is group play therapy for early school-age children to change their insecure attachment to secure attachment.
Conclusion: Identifying children with attachment problems and then using counseling approaches can improve insecure attachment and increase secure attachment.

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Background: Menstrual cycles in women are sometimes accompanied by symptoms that lead to a series of physical, cognitive, behavioral and mood changes called PMS. PMS generally leads to a decline in women's quality of life. Therefore, effective, safe and inexpensive treatment to relieve or improve these symptoms seems necessary. So the aim of this study is to review the complementary medicine and psychological interventions affecting premenstrual syndrome.
Methods: The present review study using the keywords Therapy, Pharmacy, Complementary medicine, Psychological, Premenstrual syndrome that extracted from Mesh-PubMed, was used in Web of Science, Scopous, Medline-PubMed, Cochrane Library, Clinical Key, Magiran, Scientific Information Database (SID) Data base, and the Google Scholar Search Engine for the period 2010-2019 within Apr and May 2018. Out of 338 articles found, 101 repetitive articles in EndNote, 180 articles with screening in the main title, 24 articles in abstract, 15 articles in full text, 1 article were evaluated by the quality of the journal in the source system, and 3 articles were evaluated by the quality of the article according to the scale of isolation. And ultimately, 8 English and 6 Persian articles were entered.
Results: Between 14 articles, 5 were quasi-experimental and 9 were clinical trials. The pharmaceutical interventions including estrogen-progesterone hormone combinations, zinc supplements, calcium and vitamin B6, respectively, hormone therapy and vitamin B6, had the most effect in reducing the symptoms of mild to moderate PMS. Herbal remedies including royal jelly, black bean, chamomile have the most positive effects for reducing PMS intensity. In category of non-pharmacological psychological interventions; PMS education, Cognitive-behavioral therapy, Stress management, and cognitive-based therapy. The most successful interventions for anxiety and depression in women with PMS have been given.
Conclusions: Different types of pharmaceutical and non-pharmaceutical interventions will be applied depending on the density of PMS in each individual and with regard to the change in PMS (physical, cognitive, behavioral, and mood).

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Background: One of the important criteria in patients receiving artificial respiration is the time of weaning from the mechanical ventilator. As physician’s decision might be somehow subjective, several tools have been suggested for prediction of the time of weaning more objectively. This study aimed to determine the predictive value of Persian Weaning Tool (PWT) compared with Physician- directed approach as the gold standard.
Methods: This diagnostic accuracy study was done in 2016-2017 in Two Medical and Educational Centers of Gorgan, Iran.  97 admitted patients in intensive care units, under mechanical ventilation were evaluated. The patients were recruited into the study by a convenience sampling method and evaluated for readiness to wean using two approaches (physician’s decision and using PWT). Successful weaning was considered as the ability of patient to breathe spontaneously during the first 48 hours after weaning. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR), as well as the agreement (kappa coefficient) between the two approaches, were calculated. In addition, to compare the differences between variables in two groups, chi-Square, T and man-Whitney tests were used. All analyses were performed using SPSS software ver.16, and MedCalc program ver.13. P<0.05 was considered as statistically significant.
Results: Most patients (64.9%) were men. The mean age, duration of hospital admission, and duration of mechanical ventilation of the participants were 46.49±18.15 years, 67.11±7.14 days, and 31.5±2.5 days, respectively. Weaning was successful in 87.6% of the patients. PWT had a significant agreement with the physician’s choice (kappa coefficient=0.637, P<0.001) with sensitivity, specificity, PPV, NPV, PLR, and NLR of 100%, 50%, 93.4%, 100%, 2, and 0, respectively. The cut-off level of 53 was considered as the best point to improve the diagnostic accuracy to 92.94%, 75%, 96.3%, 60%, 3.72, and 0.094, respectively.
Conclusions: Findings showed that PWT is an accurate tool for predicting the readiness of patients for weaning objectively. This tool can be used as a complementary approach by physicians and other care providers in intensive care units.