Background:Stigma and discrimination among patients with HIV/AIDS cause various problems for the patients and their health systems.Objectives:The purpose of this study was to explain the perceived experiences of the patients from stigma and discrimination and their roles on health-seeking services among patients.Patients and Methods:This was a qualitative research using content analysis approach and semi-structured interviews, conducted on patients living with HIV/ADS, during 2013 - 2014 in Iran. Sampling started purposefully and continued in a snowball.Results:The experiences of patients with HIV/AIDS from stigma and discrimination led to exploring three main themes and nine subthemes. The main themes were multidimensional stigma, rejection, and insult and discrimination in receiving health services.Conclusions:Stigma and discrimination play an important role in patients' lives and hinder them from accessing the treatment. The patients' responses to this event by secrecy strategy can be an important factor in the disease prevalence.

Aim Fatigue and dyspnea are debilitating symptoms in patients with heart failure (HF). The purpose of this study was to evaluate the effects of inspiratory muscle training (IMT) on dyspnea, fatigue and the New York Heart Association (NYHA) functional classification in patients with HF. Methods In this prospective, randomized, controlled trial, 84 patients with HF (NYHA classes II‐III/IV) with a mean age of 56.62 ± 9.56 years were randomly assigned to a 6‐week IMT (n = 42) or a sham IMT (n = 42) program. The IMT was performed at 40% of the maximal inspiratory pressure (MIP) in the IMT group and at 10% in the sham group. The main outcomes were assessed at baseline and after the intervention and included dyspnea severity scale (Modified Medical Research Council [MMRC], Fatigue Severity Scale [FSS] and the NYHA functional classification (based on the presenting symptoms). Results The between‐group analysis showed significant improvements in dyspnea, fatigue and the NYHA functional classification in the IMT group compared to the sham group (P < .05). The within‐group analysis showed significant improvements in dyspnea (from 2.63 ± 0.79 to 1.38 ± 0.66, P < .001), fatigue (from 43.36 ± 8.5 to 28.95 ± 9.11, P < .001) and the NYHA functional classification (from 2.73 ± 0.5 to 2.1 ± 0.6, P = .001) in the IMT group, while fatigue and dyspnea increased significantly in the sham group. Conclusions The 6‐week home‐based IMT was found to be an effective and safe tool for reducing dyspnea and fatigue and improving the NYHA functional classification.

Aim The aim of the present study was to clarify the relationship between perception of job empowerment and organizational commitment and trust among nurses in teaching hospitals of Khorramabad (Iran). Background Lack of power has been widespread among nurses in their workplaces due to uneven distribution of power among hospital staffs. Giving power to only a few individuals at the top of hospital hierarchy may often make nurses feel weak in their workplaces and causes reduction in the patients' quality care. Methods This is a descriptive cross‐sectional study which included 160 officially employed nurses in four teaching hospitals of Khorramabad (west Iran) selected by stratified random sampling. The instruments used were: The Conditions of Work Effectiveness Questionnaire–II (C.W.E.Q‐II), which measures nurses' empowerment, the Pressure Management Indicator, which measures organizational commitment and the Trust in Management Scale, which measures organizational trust. The data were analysed by the SPSS software using the descriptive and analytic statistical tests employing chi‐square, Fisher's test and the Spearman–Brown correlation coefficient. Results The results showed that the nurses had a below moderate score in their perception of job empowerment ( = 2.38 ± 0.70), with the highest score in their perception of access to “opportunity” subscale ( = 3.11 ± 0.95), and the lowest score in their perception of access to “formal power” ( = 2.43 ± 0.95). Additionally, moderate “organizational commitment” and “organizational trust” were reported with  = 4.5 ± 0.90 and  = 4.01 ± 1.11, respectively. The highest and the lowest perception scores were found for “continuous commitment” and “affective commitment” with  = 4.94 ± 0.97 and  = 4.26 ± 1.21, respectively. There were positive significant relationships between the three major variables of the study (p < 0.001). Conclusion The results showed that there was a positive and significant relationship between nurses' perception of job empowerment, organizational commitment and trust. Implications for nursing management Nursing managers can increase the motivating factors among their nurses through evaluating organizational variables like empowerment and organizational trust. In fact, through recognition of the relationship between empowerment and organizational trust, one can design the interventions of structural empowering for the improvement of professional nursing practice, nurses' workplace well‐being and safe quality care.

BackgroundExclusive breastfeeding (EBF) in the first 6 months of life is the best and most complete option for an infant, in that supplies the vitamins and minerals the baby needs. Several studies in Iran have been conducted concerning the prevalence of EBF. The aim of this study was to determine the prevalence of EBF in the first 6 months of life and associated factors in Iran synthesizing published studies.MethodsWe searched PubMed/MEDLINE, Embase, Scopus, ISI/Web of Science, the Cochrane Library, Directory of Open Access Journals Directory (DOAJ) and Google Scholar as well as Iranian databases (Barakathns, MagIran and the Scientific Information Database or SID) up to November 2018. The Newcastle-Ottawa Scale was used to assess the quality of studies. Analyses were performed by pooling together studies using DerSimonian-Laird random-effects model with 95% confidence interval. To test for heterogeneity, I2 test was used. The Egger’s regression test and funnel plot were used to evaluate the publication bias. The strength of EBF determinants was assessed computing the Odds-ratios (OR) using the Mantel–Haenszel method.ResultsIn the initial search 725 records were found. Finally, 32 studies were selected based on inclusion/exclusion criteria. The sample size of studies varied between 50 and 63,071 subjects. The overall prevalence of EBF in Iran was 53% (CI 95%; 44–62). The OR for breastfeeding education received before pregnancy was 1.13 (0.94–1.36), for mother’s job 1.01 (0.81–1.27), for education level 1.12 (0.89–1.42), for type of delivery 1.16 (0.98–1.37), and for gender of child 1.03 (0.83–1.28).ConclusionIn Iran health policy- and decision-makers should try to take interventions that encourage mothers to use their milk to breastfeed the infants.

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ObjectiveCesarean section (CS) is one of the most common surgical procedures in the world. In developed and developing countries, CS has grown significantly over the past decades. The Iranian Ministry of Health and Medical Education has developed a health transformation plan (HTP) in order to reduce CS rate and promote vaginal delivery. This study was conducted with the aim of reviewing the results of published studies on the impact of the HTP on CS in Iran.ResultsWe searched Embase, PubMed/MEDLINE, ISI/Web of Sciences, Scopus, as well as Iranian databases (MagIran, SID and Barakatkns), from May 2014 to October 2018. To assess the quality of studies, the checklist “A Cochrane Risk of Bias Assessment Tool: for Non-Randomized Studies of Interventions” was utilized. Twelve studies were selected. Seven studies reported statistically significant results, showing a positive impact of the implementation of the HTP on CS reduction. Despite the decreased CS rate in Iran after about 4 years of the implementation of this policy, the goal of a yearly reduction by 10% has not been achieved yet. Increasing access to maternity services and community-based education through mass media could help changing the attitudes of Iranian mothers towards CS.

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Introduction: Burnout syndrome is one of the consequences and the results of occupational or job stress emerged in the form of emotional exhaustion feeling, depersonalization and decrement personal accomplishment. The aim of this study was to determine the occupational stress and its relationship with burnout syndrome in the academic members of Lorestan University of Medical Sciences. Methods: This descriptive cross-sectional survey was conducted on 111 of the faculty members via multistage sampling. Data were collected by the questionnaire of Maslach Burnout Inventory (MBI), and Osipow Occupational Stress Inventory (OSI- R). Data were analyzed by using descriptive statistics as well as analytical statistics such as chi square, Kruskal-Wallis, Mann Whitney tests and Pearson correlation coefficient. Results: The results showed that the most of the participants had a low level of burnout three dimensions including emotional burnout (72.1%), depersonalization (81.1%), and the decrement of personal accomplishment (56.8%). Moreover 79.3% of samples had a low occupational stress, but there was a meaningful relationship between occupational stress and dimensions of burnout syndrome with an exception for the intensity of decrement of personal accomplishment. Conclusion: Academic members were in an appropriate condition concerning burnout syndrome and occupational stress. However by applying some strategies to decrease stress and determining stress resources, we can improve their psychological health of academic members.