Acceptance and willingness to receive the vaccine are among the main factors in the success or failure of a health system in implementing the vaccination program. The present study was conducted in Tehran, the political and economic capital of Iran, to determine the acceptance of the COVID-19 vaccine and identify its associated factors, and explain the most important barriers and acceptance strategies for vaccination. This research was a concurrent quantitative and qualitative mixed-method study. In the quantitative part, 1200 individuals aged more than 18 years were selected from the households in 22 districts of Tehran City, with a multistage stratified cluster sampling method. Two questionnaires were used to evaluate the acceptance of the COVID-19 vaccine and vaccine acceptance determinants. The qualitative content analysis method addressed the influencing factors, as well as challenges and strategies related to the acceptance of the COVID-19 vaccine in four groups of Tehran inhabitants: the elderly, people with underlying diseases, healthcare workers, and the general population. The related data were simultaneously collected by applying in-depth semi-structural interviews and a data analysis process. Furthermore, we used the Graneheim and Lundman method for data analysis. We analyzed the data of 1200 people with a mean (SD) age of 46.4 (11.1) years, and approximately 58% of them were men. The vaccine acceptance was 83.6% (95% CI: 81.3–85.9). Among those who welcomed vaccination, 58% preferred the imported vaccines, 25% the Iranian ones, and 17% both. There was a significant association between the variables of age (adjusted odds ratio [AOR] = 1.72, 95% CI: 1.01–2.93), being single (AOR = 0.54, 95% CI: 0.41–0.91), moderate pharmacotherapy adherence (AOR = 0.58, 95% CI: 0.4–0.85), and the willingness to receive COVID-19 vaccine. Qualitative study after interviewing 45 people from four study groups showed an insufficient social trust in healthcare system officials, pharmaceutical and vaccine production companies; distrust in the effectiveness of the vaccines, concerns about the vaccine adverse effects, being tracked by microchips after vaccination, traditional anti-vaccination movements, the feeling the inessentiality of vaccination, and uncertainty about the fair distribution of the vaccine. These concerns were the main challenges addressed by the study groups. A good proportion of Tehran residents reported their willingness to receive the COVID-19 vaccine. Additionally, they expressed their critical concerns, such as insufficient trust in the healthcare system, vaccine safeties, and adverse effects that were the significant barriers to vaccine acceptance. It seems that conflicts raised by the shortage of vaccines and their import due to the sanctions have led to intense desire and demand in the general population, and especially the elderly, for vaccination. Besides, vaccination phobia in some individuals requires further investigations.

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Objective: The purpose of this review study was to investigate the association between alcohol consumption and common cancers. Methods: This study was conducted in English by February 2019 to include studies reporting alcohol consumption related cancer risks through a search in data bases of the PubMed, Scopus and Web of Science. The search strategy included the keywords: "cancer", " alcohol consumption or Alcohol Drinking or Underage Drinking ". Articles that looked at the relationship between each type of cancer and consumption of alcoholic beverages were entered in to the study and summarized in review.  Results: alcohol consumption is associated with a decreased risk of some types of cancers including: Renal cell carcinoma and Non-Hodgkin lymphoma. Also, alcohol is independent risk factor for oral and pharyngeal, laryngeal, Esophagus, Stomach, Colorectal, Breast and Liver cancer. However, further studies are required to confirm the association between alcohol consumption and Pancreas, Lung, Prostate, Endometrium, Brain tumour and Bladder cancer risks. Conclusions: Given the role of excessive alcohol consumption in the occurrence of various types of cancers, there is a need for a comprehensive plan for alcohol abuse in the community Keywords: cancer, alcohol consumption, Underage Drinking, Alcohol Drinking

Introduction: Clinical self-efficacy is an individual's belief for doing clinical skills. As much as individuals have higher efficacy in clinical practice, their clinical practice will be better. The aim of the present study was to determine the clinical self-efficacy, its dimensions and related factors in nursing students at Qazvin University of Medical Sciences in 2016. Methods: In this descriptive-analytical study, 150 nursing students were selected by the census method. Data were collected using the demographic characteristic form and clinical self-efficacy questionnaire. Also, the data were analyzed by descriptive and analytical tests using the SPSS 16 software. Results: The total mean score of clinical self-efficacy was 106.54 ± 21.14. Assessment of the patients had the highest scores among the dimensions of clinical efficacy (34.42 ± 7). There was a significant correlation between the average scores of the students (r = 0.17, P = 0.02) and studying at higher semesters (P < 0.001) with clinical self-efficacy. Conclusions: Self-efficacy is one of the important concepts to promote the clinical performance in nursing students. Therefore, it is recommended that to strengthen all aspects of clinical self-efficacy, organized educational programs with a supportive approach be developed.

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IntroductionAlong with the challenges of COVID-19 vaccine supply in low-income countries, vaccine hesitancy was another problem for the health system. The aim of this study was to deeply understand the challenges of vaccine acceptance, the vaccination process, and to compare the affecting vaccine acceptance in the high and low points of the epidemic in Iran.MethodsIn the qualitative part of this mixed-methods study, content analysis was used to investigate experiences and perceptions about COVID-19 vaccination in four groups. In the quantitative study, in March 2021 (low point), and on August 1, 2021 (high point), two population-based cross-sectional studies were performed in Tehran and its rural, with sample sizes of 1,200 and 1,872 people aged over 18 years, respectively. Multinomial (polytomous) logistic regression was used to determine the factors affecting hesitation and unwillingness to receive the vaccine.ResultsDisbelief in vaccine safety, vaccine distrust, ignorance and confusion, and inadequate facilities were the common reasons extracted in the two qualitative studies. At the low and high points of the epidemic, vaccine acceptance was 83.6% (95% CI: 81.3–85.9) and 65.8% (95% CI: 65.8–71.0), respectively. Residence in rural areas, (Odds Ratio: 0.44, p = 0.001), being a student (Odds Ratio: 0.41, p = 0.011), housewives (Odds Ratio: 0.63, p = 0.033), illiteracy (Odds Ratio: 4.44, p = 0.001), and having an underlying disease (Odds Ratio: 4.44, p = 0.001) were factors affecting on vaccine acceptance.DiscussionCounter-intuitively, acceptance did not increase at the peak of epidemic. The presence of obstacles, such as increased distrust in the effectiveness of vaccines due to the occurrence of multiple peaks in different vaccinated countries, as well as the influence of the media, anti-vaccine campaigns, and lack of proper communication about risks caused more hesitation. More investigation to understand how people accept or reject vaccine and its long term consequences is recommended.

Background and Aim: Myasthenia Gravis (MG) is a neuromuscular disorder and auto-immune disease that is associated with symptoms of fluctuating muscle fatigue and dysfunction of the neuromuscular junction system. This disease greatly affects various aspects of the patient's life and impacts the person's perception of the quality of life. The aim of this study was to explain and analyze life experiences with myasthenia gravis disease in a young girl. Methods & Materials: This report is a qualitative case with interpretive phenomenological approach that examines the life experiences of a young girl with myasthenia gravis in 2019. Data were collected through semi-structured interviews and analyzed using Van Manen's phenomenological approach. Ethical Considerations: This study was registered in the Research Ethics Committee of Khatam University (Code: 3299/100/P/98). Results: Thematic analysis indicated that myasthenia gravis disease affects all aspects of person's life world. These four aspects include living and feelings with time, body, space, and others. Eventually, three interrelated themes emerged from the patient's perception of the world around her, including physical weakness, future ambiguity, and frustration. Conclusion: The present study shows a clear image and understanding of the problems of living with MG in a young girl. The phenomenological world of mixed by physical weakness, ambiguity in the future, and frustration that indicating the suffering and distress that the patient experiences following the illness. The results of this study contribute to the awareness of health and rehabilitation specialists in the field of work and research in myasthenia gravis as a neurological disease.

Background and Purpose: Military nurses are exposed to various occupational stresses. Spirituality contributes to adaptation to critical situations and stresses. Spiritual care is an essential part of holistic care which in recent years has attracted the attention of health-related organizations. The aim of this study was to determine the attitude of military nurses, faculty members and military nursing students toward spirituality and spiritual care.Methods: In a cross-sectional descriptive study, 214 military nurses, faculty members and nursing students of Baqiyatallah University of Medical Sciences in Tehran were selected according to inclusion criteria by simple sampling method and completed the Spirituality and Spiritual Care Rating Scale [SSCR].Results: The mean score of attitude toward spirituality and spiritual care in clinical nurses was 69.4 [SD±12.6] in nursing professors 74.6 [SD±6.6] and in students 67.5] SD±4/11]. The majority of the research community was at a high and desirable level. [Between 63 and 92, which was the maximum score of the questionnaire].Conclusion: The results of this study showed that military nurses, faculty members and nursing students of Baqiyatallah University of Medical Sciences in Tehran have a positive attitude toward spirituality. They tend to provide spiritual care. Therefore, it is necessary to provide a suitable platform for providing spiritual care.