BackgroundWhat constitutes respectful maternity care (RMC) operationally in research and programme implementation is often variable.ObjectivesTo develop a conceptualisation of RMC.Search strategyKey databases, including PubMed, CINAHL, EMBASE, Global Health Library, grey literature, and reference lists of relevant studies.Selection criteriaPrimary qualitative studies focusing on care occurring during labour, childbirth, and/or immediately postpartum in health facilities, without any restrictions on locations or publication date.Data collection and analysisA combined inductive and deductive approach was used to synthesise the data; the GRADE CERQual approach was used to assess the level of confidence in review findings.Main resultsSixty‐seven studies from 32 countries met our inclusion criteria. Twelve domains of RMC were synthesised: being free from harm and mistreatment; maintaining privacy and confidentiality; preserving women's dignity; prospective provision of information and seeking of informed consent; ensuring continuous access to family and community support; enhancing quality of physical environment and resources; providing equitable maternity care; engaging with effective communication; respecting women's choices that strengthen their capabilities to give birth; availability of competent and motivated human resources; provision of efficient and effective care; and continuity of care. Globally, women's perspectives of what constitutes RMC are quite consistent.ConclusionsThis review presents an evidence‐based typology of RMC in health facilities globally, and demonstrates that the concept is broader than a reduction of disrespectful care or mistreatment of women during childbirth. Innovative approaches should be developed and tested to integrate RMC as a routine component of quality maternal and newborn care programmes.Tweetable abstractUnderstanding respectful maternity care – synthesis of evidence from 67 qualitative studies.

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Introduction:Providing for patients' comfort and reducing their pain is one of the important tasks of health care professionals in the Intensive Care Unit (ICU). The current study was conducted to determine the effect of a protocol using a Richmond Agitation-Sedation Scale (RASS) on some clinical outcomes of patients under mechanical ventilation (MV) in 2017. Methods:This single-blind clinical trial was conducted on 79 traumatic patients in the ICU who were randomly allocated into the intervention (N=40) and the control groups (N=39). The sedation was achieved, using a sedation protocol in the intervention group and the routine care in the control group. The clinical outcomes of the patients (duration of MV, length of staying in ICU, final outcome) were measured. As the participants had different lengths of MV and staying in ICU, the data were restructured, and were analyzed, using proper statistical methods. Results:The patients' level of sedation in the intervention group was significantly closer to the ideal score of RASS (-1 to +1). The duration of MV was significantly reduced in the intervention group, and the length of stay in the ICU was also significantly shorter. There was no difference in terms of final outcome. The ICU cost in the control group was twice as high as the cost in of the intervention group. Conclusion:The applied sedation protocol in this study would provide better sedation and could consequently lead to significantly better clinical outcomes, and the cost of caring as a result.Citation: Taran Z, Namadian M, Faghihzadeh S, Naghibi T. The effect of sedation protocol using Richmond agitation-sedation scale (RASS) on some clinical outcomes of mechanically ventilated patients in intensive care units.

Introduction Little is known about the impact of the coronavirus on sexual behavior, function, and satisfaction. Aim The aim of the present study was to systematically review people’s sexual function and behaviors and their changes in sexual activities during the COVID-19 pandemic. Methods Comprehensive searches in PubMed, Web of Science, and Scopus were conducted with keywords in accordance with MeSH terms: COVID-19, SARS-CoV-2, coronavirus, sexual health, sexual function, sexual dysfunctions, sexuality, sexual orientation, sexual activities, and premarital sex. Two reviewers independently assessed full-text articles according to predefined criteria: original design, English studies, and investigating either the general population or sexual minorities. Results Risk of bias in the studies was assessed by the Newcastle-Ottawa Scale, and data were pooled via random effects meta-analyses. We utilized the standardized mean difference to evaluate the effects of the COVID-19 pandemic on sexual activity, functioning, and satisfaction. We included 19 studies in the analysis and 11 studies in the meta-analysis, with a sample size of 12 350. To investigate sexual activity changes, a sample size of 8838 was entered into the subgroup analysis, which showed a significant decrease in both genders (5821 women, P < .033; 3017 men, P < .008). A subgroup meta-analysis showed that the sexual function of men and women during the COVID-19 pandemic significantly declined (3974 women, P < .001; 1427 men, P < .001). Sexual desire and arousal decreased in both genders, though mainly in women. In investigating sexual satisfaction changes during the COVID-19 pandemic, a meta-analysis with a sample size of 2711 showed a significant decrease (P < .001). The most indicative changes in sexual behaviors during the pandemic were the increase in masturbating and usage of sex toys. Greater COVID-19 knowledge was associated with lower masturbation, oral sex, and vaginal sex. The more protective behaviors were associated with less hugging, kissing, cuddling, genital touching, watching porn with a partner, and vaginal sex. Conclusion The COVID-19 pandemic led to increased challenges and changes for individuals’ sexual behaviors. Efforts for preventive strategies should therefore be concentrated between pandemics, while ensuring that there is information available to the population during a pandemic for help in times of psychological distress or crisis.

10.30699/jambs.28.126.1 Background & Objective: Dietary patterns and the consumption of some macronutrients could influence hypertension as a public health problem. This study was conducted to identify dietary patterns and compare the intake of some micronutrients, as well as food groups, according to the Dietary Approach to Stop Hypertension (DASH) guidelines. Materials & Methods: This cross-sectional study assessed the dietary patterns of 101 people with mild to moderate hypertension who were randomly selected among outpatients attending hospital clinics and health centres at Zanjan. Food intake data were collected using the food frequency questionnaire (FFQ) and three-day food diaries. Factor analyses and binary logistic regression were used to identify dietary styles and the associations between types of dietary patterns and hypertension, adjusted for covariates. Results: Two main dietary patterns were identified, including the DASH-style dietary pattern and the modern dietary pattern which contains high intakes of fast foods, junk foods, animal fat, organ meat, chicken, tea, and coffee. A greater odds ratio for hypertension (odds ratio: 3.95; 95% CI: 0.91-17.2) was found at the first quartile of the modern pattern compared to the last one, adjusted for confounding variables. Also, patients at the last quartile of the DASH-style pattern received significantly more sodium (P=0.02). Hypertensive patients consumed more sodium and less potassium, calcium, and magnesium than given in the DASH recommendations for both identified dietary patterns. Conclusion: Two main dietary patterns were found in hypertensive patients. Considering both dietary patterns and micronutrient intake in prevention programs for hypertensive patients is suggested. Future research is recommended.

Background Providing high quality and respectful care during pregnancy and birth is one of the ways to reduce complications in women. Respectful care is a type of care that requires a valid instrument to measure. This study was conducted to determine the validity and reliability of the Persian version of the Respectful Maternity Care (RMC) questionnaire in 2018. Methods This study was performed with 150 women (in the first 48 h after birth), who were admitted in the postpartum wards of public hospitals from 1st January until 6th April 2018 in Zanjan city in Iran. Participants were selected randomly using the Poisson distribution (Time) sampling method. After receiving permission from the questionnaire’s author, the internal consistency of the tool was measured by Cronbach’s alpha coefficient after the Forward translation of the Persian version of the tool under expert supervision. The reliability of the modified questionnaire was assessed using a test-retest method in 10 eligible postpartum women, who completed the same questionnaire again after 72 h. The validity of the tool was confirmed by exploratory and confirmatory factor analysis using LISREL and SPSS software. Results The original RMC tool achieved an overall high internal reliability (α = 0.839). Confirmatory factor analysis of original RMC scores demonstrated poor fit indices. In LISREL proposed paths for the model, one item was excluded and a re-exploratory factor analysis was performed with the remaining 14 items. Four new subscales were defined for the revised tool including Abusive Care, Effective Care, Friendly Care, and Respectful Communication, which explained 60% of the variance. Conclusions The revised tool included four subscales of Abusive Care, Effective Care, Friendly Care, and Respectful Communication in 14 items which explained 60% of the variance. Given the importance of providing high quality maternity care, and the variety of cultures and birth services across different countries, further research is needed on this RMC tool to evaluate its use in other countries and regions.

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The need to improve patient's safety is to change the patient's safety culture. This study was conducted to determine the effect of the patient safety education program on nurses' patient safety culture and patient safety indicators. This single-blind clinical trial was conducted in two cardiac medical wards that were randomly selected as research settings among the hospital teaching wards of the Zanjan city in Zanjan. Twenty-six nurses participated in this study under in the experimental and control groups. The experimental group received the educational program for two sessions, and the control group received a booklet about patient safety. The nurses' patient safety culture was assessed using the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire before and 3 months after intervention. The patient safety indicators were assessed 1400 times before and 3 months after intervention using a standard checklist by direct observation of all indicators (N = 100 for each). The results revealed that the patient safety educational program could improve some safety indicators, and overall perception of patient safety composite from safety culture, positively (P = 0.034). The patient safety indicators in pharmacological considerations (P = 0.001), personal information considerations (P = 0.001), and proper implementation of procedure considerations (P = 0.001) were significantly improved in the experimental group compared to the control group. It seems that changing the patient's safety culture using educational program requires more training courses.