فهرست مطالب roghieh kharaghani

Marital conflicts are a common phenomenon. Schema therapy is one effective approach to reducing these conflicts by assessing the impacts of individuals' past attitudes and experiences on their current relationships.

The current research was conducted to systematically investigate the effectiveness of schema therapy on marital conflicts.

Based on the PRISMA guidelines, a comprehensive search was performed in national and international databases, including the Scientific Information Database (SID), Magiran, Psych-info, Cochrane Central, Scopus, PubMed, Web of Science, and the Google Scholar search engine, and using advanced search strategies up to November 18th, 2021. The selected articles were precisely and comprehensively reviewed. After quality assessment using the Cochrane Collaboration tool, the required information was extracted from them and conducted a meta-analysis using Review Manager (Rev Man) version 5.2 software.

Out of 2921 articles, only 8 articles were entered into the study according to the inclusion criteria, consisting of 239 people in the intervention group and 162 people in the control group. The meta-analysis findings using the random-effects model showed that schema therapy significantly decreased marital conflicts in the participants by SMD=-46.01 (CI: -66.91, -25.11) points (P-value: 0.00001).

The use of schema therapy, whether integrated with other methods or individually, is effective in reducing marital conflicts. Thus, it is suggested that in case of a lack of efficient cognitive-behavioral therapy, schema therapy be taken into account as a complementary treatment method. 

Gestational diabetes mellitus (GDM) is the most common complication of pregnancy and an important public health concern. Several studies have investigated the prevalence of gestational diabetes in different parts of Iran with different results.

The present study aimed to review studies on gestational diabetes prevalence and estimate the prevalence of gestational diabetes in Iran.

A search on gestational diabetes mellitus and related synonyms was conducted using global and national databases, including PubMed, Science Direct, Scopus, Web of Sciences, Google Scholar, SID, IranMedex, Magiran, Irandoc, Medlib. Moreover, gray literature and reference checks and a library search were conducted. Keywords included: prevalence, Iran, gestational diabetes mellitus (GDM), and their synonyms. The inclusion criteria were observational studies (cross-sectional, prospective cohorts, and retrospective cohorts) published in Persian or English between 2000 and 2020 on the prevalence or incidence of gestational diabetes in Iran, a sample size of more than 100 people, and availably of full texts. The selected articles were thoroughly reviewed, and after quality assessment, the required information was extracted and included in the meta-analysis.

From 907 articles, 48 were included in the meta-analysis according to the inclusion criteria, which included 51,259 patients with an average age (standard deviation) of 27.05 years (1.83). The overall prevalence of GDM in Iran was 10% (11,9: 95% confidence interval). The prevalence of GDM had increased in recent years, from 4% before 2005 to 16% in 2016 to 2020 (20,12: 95% CI). There was significant heterogeneity between studies, and the I-square index was 98%.

The prevalence of gestational diabetes in Iran is slowly increasing. The increasing prevalence of gestational diabetes can seriously threaten the health of mothers, fetuses, and newborns in the near future.

Changes in the performance and sexual satisfaction of women during pregnancy can be one of the important factors involved in the emergence of sexual problems in women. This study aimed to compare the effect of Extended Permission, Limited Information, Specific Suggestion, Intensive Therapy (Ex-PLISSIT) and group counseling on sexual function and satisfaction of pregnant women.

A randomized clinical trial was conducted on 111 pregnant women from 2016 to 2018 in Zanjan, Iran. Eligible participants were selected through convenience sampling method and allocated into three groups Ex-PLISSIT model, group counseling and control group, using block randomization method. Sexual function and sexual satisfaction were evaluated via the Female Sexual Function Index (FSFI) and Hudson’s sexual satisfaction questionnaire at baseline and four weeks after the last counseling session. Data were analyzed using SPSS ver. 13 and ANCOVA, ANOVA, Wilcoxon, chi-square, Mann-Whitney U, and Kruskal Wallis tests.

Median (interquartile range) of the participants’ sexual function in the Ex-PLISSIT group was 25.9 (4) in the counseling group, 26 (5.5), in the control group, and 25.8 (4.8) at the baseline. These scores changed to 28.9 (5.4), 27.9 (5.1), and 25.2 (4.3) at the 4-week follow-up, respectively. These differences were statistically significant. Moreover, there was a statistically significant difference in the mean sexual satisfaction scores between the three groups, at the follow up period.

Providing sexual counseling by any approach during routine prenatal care by community midwives may improve couples’ sexual health.

 Sildenafil citrate is a potential new strategy for the management of intrauterine growth restriction (IUGR) and preeclampsia, although its efficacy still needs to be approved. Accordingly, the aim of this study was to systematically assess the effectiveness of sildenafil on improving fetal Doppler indices, as well as the most common adverse effects of sildenafil. 

 Online databases, i.e., PubMed, Web of Science, Scopus, Embase, and Cochrane Reviews, were searched from their date of creation up to 26 Jan 2019. We conducted two meta-analyses, one for fetal Doppler indices and the other for adverse events of sildenafil. Eligible studies were randomized controlled trials (RCTs), in which the effects of sildenafil on fetal Doppler indices have been evaluated. The quality of studies was appraised through the five components of the Cochrane checklist (for quality appraisal of RCT studies) by two of the authors.

 Out of 1,087 reviewed sources, seven studies were included for meta-analysis. The following results were observed for the effect of sildenafil on the umbilical artery (UA): A significant effect on the umbilical artery pulsatility index (UA PI) (P=0.03) was observed in dosages more than 60 mg/d (P=0.008). Sildenafil was effective in UA PI of the individuals suffering from eclampsia (P=0.008); however, no significant effect was observed on IUGR disorder. Furthermore, sildenafil had no effect on the umbilical artery systolic/diastolic (UA S/D) ratio. Sildenafil was not effective on the middle cerebral artery pulsatility index (MCA PI) or on the middle cerebral artery systolic/diastolic (MCA S/D) ratio. Regarding adverse events, headaches occurred significantly more in mothers consuming sildenafil (P=0.03). 

 Obviously, we need more accurate RCTs in this issue before any decision can be made.

Despite expand using psychological interventions, there is no obvious evidence about the effects of them on sexual function. The study aimed to determine the effect of psychological interventions based on different approaches to the sexual function of women.

Pubmed, ISI, SCOPUS, EMBASE, Cochrane reviews, Science direct, SID, and Magiran were searched up to May 2019. Eligible studies were randomized controlled trials in which the effect of psychological interventions on the sexual function of women was assessed using the Female Sexual Function Index without any limitations based on age, ethnicity, language, and nationality. Two of the authors screened the titles/abstracts and obtained all full text of the candidate studies, independently. The quality of studies was assessed using the Cochrane checklist risk of bias. Meta-analysis performed via standardized mean differences with a random-effects model using Review Manager Software (RevMan) version 5.3.

Twenty-one studies with 1460 participants were included. The most effective psychological intervention was individual and group type (SMD=3.82; 95% CI, 2.56, 5.08; P<0.001) with cognitive approach (SMD=2.50; 95% CI, 1.06, 3.95; P<0.001), especially in women with no specific condition (SMD=2.17; 95% CI, 1.20-3.15; P<0.001). The effect of psychological interventions on sexual function increased from 1.48 in one month to 2.30 and 3.78 in two and three months after the intervention; however, it decreased to 1.43 in six months or more follows ups (all Ps<0.001). There was a significant change in all FSFI domains (all Ps<0.01).

Based on the results, individual and group psychological interventions using the cognitive approach and multidimensional therapies with long term follow-ups are suggested for the treatment of sexual dysfunction.

Women with unplanned pregnancy experienced a number of psychological problems. Thus, the present study aimed to examine the effectiveness of midwifery counseling based on cognitive approach in improvement of adaptation to pregnancy, mother-fetal attachment and quality of life among unplanned pregnant women.

This pre-test posttest control group single blind study was done on pregnant women who were chosen from the healthcare centers of Zanjan city, Iran.Of 187 women screened for eligibility to participate in the study, 54 unplanned pregnant women met inclusion criteria and were randomly assigned into intervention group or control group. The intervention group received eight weekly group cognitive therapy sessions. The control group received prenatal routine care. The participants answered WHO Quality of Life Questionnaire, Maternal–Fetal Attachment Scale, and Lederman Prenatal Self-evaluation Questionnaire at pretest, posttest, and one-month follow- up periods. 

The two groups were not different in terms of age (p = 0.89), educational status (p = 0.56), and job status (p = 0.31). In addition, they were not different regarding pre-test scores of Lederman Prenatal Self-evaluation Questionnaire (p = 0.27), Maternal–Fetal Attachment Scale (p = 0.22), and WHO Quality of Life Questionnaire (p = 0.37). At posttest and one-month follow- up, the intervention group showed significant improvement in adaptation to pregnancy (p < 0.0001), Maternal-fetal attachment (p < 0.0001), and quality of life (p < 0.0001) than the control group.

Midwifery counseling based on cognitive approach could be an effective approach to improve adaption to pregnancy, maternal-fetal attachment, and quality of life among women who became pregnant unintentionally.

One of the most important indices of health planning and policymaking in every country is the distribution and leading causes of mortality. This study was conducted to determine the prevalence of stillbirth and it’s maternal, fetal, and delivery risk factors in Zanjan province during 2014 - 2015. The study was descriptive-analytical research. The electronic birth registration form, which is used to collect delivery data in Iran, was used for data collection. Data were analyzed using descriptive, univariate, and multivariate regression tests. The incidence of stillbirth was 10 per 1000 births and consistent with the country’s rate. There was a significant correlation between stillbirth and gestational age, birth weight, anomalies, vaginal delivery, outside hospital delivery, delivery complications, episiotomy, and labor induction and augmentation. It seems that changing modifiable factors such as the place of delivery, type of delivery, and labor interventions can prevent stillbirth more effectively.

Fear is an important factor that causes pregnant women to opt for cesarean section. Women with the fear of childbirth consider labor pain to be beyond their power. Basically, these women request cesarean section only to avoid normal vaginal delivery, which indicates their low self-efficacy in normal vaginal delivery. The present study aimed to investigate the effects of couples counseling based on the problem-solving approach on the fear of delivery, self-efficacy, and choice of delivery mode in the primigravid women requesting elective cesarean section in Zanjan, Iran. This quasi-experimental study was conducted on 76 pregnant women in the second trimester of pregnancy and their spouses. The women were eligible for elective cesarean section and met the inclusion criteria. The intervention was based on the problem-solving counseling approach with the couples, which was performed in three weekly sessions at the clinic of Shahid Beheshti Hospital in Zanjan, Iran. Data were collected using the questionnaires of knowledge and attitude, Wijma delivery expectancy/experience questionnaire, and Louis’ self-efficacy scale at the baseline and after one month of the final session. Data analysis was performed using independent t-test, Chi-square, and one-way analysis of variance (ANOVA). Significant differences were observed in the mean scores of knowledge and attitude of women and men, and fear of delivery and self-efficacy of women between the intervention and control groups after counseling (P<0.001). The women in the intervention group were significantly more likely to do normal delivery compared to the control group (P<0.001). According to the results, couples counseling based on the problem-solving approach could be effective in reducing the fear of delivery and increasing the self-efficacy of primigravid women. Furthermore, it could improve the knowledge and attitude of couples, thereby decreasing the rate of cesarean section and tendency toward this mode of delivery.

The prevalence of low birth weight (LBW) has been estimated at 15.5%, and approximately 15 million preterm births (PTB) occur across the world. These rates have been reported to be 9% and 9.2% in Iran, respectively. The present study aimed to assess the prevalence of LBW and PTB and compare their influential factors in Zanjan province, Iran during 2014-2016. This descriptive-analytical study was conducted on 41,265 neonates (stillbirth and alive) in Zanjan province and suburbs. Data were collected using the registries of the midwives in charge of the maternal and neonatal registry system. Data analysis was performed in Excel and SPSS version 16 using descriptive and analytical tests, including the univariate and multivariate logistic regression models. The prevalence of LBW and PTB was 7.2% and 8.2%, respectively. Odds ratio of LBW was lower with increased parity (OR=0.736; P<0.001) and gestational age (OR=2.570; P<0.001), while it was higher in female neonates (OR=1.324; P<0.001) and infants with congenital malformations (OR=2.570; P=0.001). Odds ratio of PTB was higher with increased abortions (OR=1.206; P<0.001) and in male neonates (OR=1.440; P<0.001), while it was lower with increased birth weight (OR=0.996; P<0.001). Maternal underlying diseases and diabetes reduced the odds ratio of LBW (OR=0.633; P=0.019) and increased the odds ratio of PTB (OR=3.650; P<0.001). Moreover, preeclampsia and eclampsia increased the odds ratio of LBW (OR=3.140; P<0.001) and PTB (OR=1.489; P=0.005). In terms of social factors, maternal education level decreased the odds ratio of LBW (P<0.05). The prevalence of PTB increased by 22.8% in 2015 compared to the previous year (P=0.012). According to the results, congenital malformations, gender, gestational age, birth weight, maternal education level, and maternal underlying diseases were significantly correlated with LBW and PTB. Therefore, improving maternal and neonatal health requires proper planning to control the influential factors in LBW and PTB.

Urinary incontinence is a common disorder in women. Pelvic floor muscle exercise is one of the effective treatment methods. Self-efficacy is considered an effective and strong predictor of willingness to perform and continue these exercises. In Iran, there is no appropriate tool for assessing self-efficacy. So this study was performed to determine the psychometric properties of the Broome scale in women with urinary incontinence.
Methods & Materials: A psychometric study of the Broome scale was conducted on women with urinary incontinence who referred to health centers affiliated to Tehran University of medical sciences in 2015.In this study, following processes were implemented: translation, back translation, face validity, content validity using CVR and CVI, reliability using Cronbach’s α coefficient, and construct validity using explanatory factor analysis.

The face validity was confirmed through the modification of ambiguous items based on the patients’ views. Content validity (CVR= 0.8 and CVI= 0.8 to 0.9) and reliability (Cronbach’s α= 0.96) were also confirmed. Explanatory factor analysis showed two factors with eigen value more than 1 including pelvic floor exercise self-efficacy in usual and special situations. These factors explained 82.08 percent of the total variance.

The reliability and validity of the Broome scale were confirmed for using by Iranian women with urinary incontinence, and this scale can be used to measure these women's self-efficacy in performing pelvic floor exercises.

The prevalence of suicide in Iran is higher than other West Asian countries.
The aims of the present study were to determine the prevalence of suicide attempt in psychiatric patients, and determine its associations with clinical and sociodemographic factors, and gender differences.
Participants in this descriptive-analytic study were 941 patients who were hospitalized for at least 2 days in Razi center in Tehran in 2010. Univariate and multivariate logistic regressions were used to analyze the factors related to suicide by SPSS software Version 17.
Almost 23.4% of the participants had a history of suicide attempt. Of the 250 females, 42 and of the 691 males, 178 attempted suicide. Suicide attempt in divorced, separated, and widowed females was much higher than in single females (P = 0.032). Also, those females who were drug abusers attempted suicide more often compared to non-users (P = 0.047). Suicide attempt was more prevalent in young males (P There were significant differences in suicide attempt risk factors between males and females with psychiatric disorders; these differences could not be related to different exposures to the known risk factors in the 2 genders.

Reproductive variables may play an important role on the correlation between irrational parenthood cognition (IPC) and destructive behaviors of infertile couple.
The aim of this study was to determine the correlation between IPC and destructive behaviors by reproductive variables in primary infertile women.
The study was descriptive-analytic. 183 cases of primary infertile women living in Zanjan-Iran and attended to the Infertility Clinic in Ayatollah Mousavi Hospital were investigated from 2015 to the end of 2016. The instrument included a three-part questionnaire of individual and reproductive information, IPC, and the destructive behaviors of marital relationship based on Glaser's choice theory. Data were analyzed by SPSS software using descriptive and Pearson correlation test (P There was a significant direct correlation between IPC and destructive behaviors of marital relationship in infertile women (r=0.47, p Identifying infertile women with high IPC and destructive behaviors is important to educate regarding life skills and provide counseling services.

The increased prevalence of cesarean section (C–section) is a global epidemic. The aim of this study was to determine the prevalence and demographic, fertility, and childbirth-related factors of C–section in Zanjan province, Iran,-Zanjan province in the period sincefrom 21 March 2014 through theto 19 March 2016. This study was a descriptive analytic study, carried out in the 2014–2016, which gathered 41, 265 registered childbirth data in Zanjan province hospitals and, from country electronic childbirth register system. Data were analyzed using descriptive, univariate and multivariate logistic binominal regression. according to the findings, Thethe prevalence of C–section was 40.1%. The odds of having C–section went up raised enhanced with increasing maternal age (OR=1.026), gravidity (OR=0.670), and gestational age (OR=0.093), while it decreased with an increased parity, end educational level up to high school graduate. decreased the odds of having C–section, while In contrast, higher educational (OR=3.064) level increased the odds of having C–section. Living in the urban areas (OR=1.855) also increased the odds./degrees/rates/amouts of C–section. Diabetes (OR=1.990), preeclampsia or eclampsia (OR=2.350), hypertension (OR=1.983), and thyroid disorders (OR=2.289) increased the odds of having C–section. Newborns with with low birth weight (OR=1) and macrosomia (OR=2.663), and boys (OR=1.107) were delivered more by via C–section. f Among the interventions during labor, induction (OR=1.131) and stimulation of labor (OR=0.269) reduced the odds of C–section (P<0.05). C–section rate is very high in Iran and its association with different variables can be a basis for planning and policymaking in order to reduce the C–section rate, particularly in this Zanjan province.

Reproductive variables may play an important role on the correlation between irrational parenthood cognition (IPC) and destructive behaviors of infertile couple.
The aim of this study was to determine the correlation between IPC and destructive behaviors by reproductive variables in primary infertile women.
The study was descriptive-analytic. 183 cases of primary infertile women living in Zanjan-Iran and attended to the Infertility Clinic in Ayatollah Mousavi Hospital were investigated from 2015 to the end of 2016. The instrument included a three-part questionnaire of individual and reproductive information, IPC, and the destructive behaviors of marital relationship based on Glaser's choice theory. Data were analyzed by SPSS software using descriptive and Pearson correlation test (P There was a significant direct correlation between IPC and destructive behaviors of marital relationship in infertile women (r=0.47, p Identifying infertile women with high IPC and destructive behaviors is important to educate regarding life skills and provide counseling services.

Context: Dysmenorrhea is the most common gynecological complaint in Iran but the true prevalence of it is not clear yet. This study is aimed to estimate the overall prevalence of dysmenorrhea in Iran.
Evidence Acquisition: International and national electronic databases including PubMed, ISI, Ovid, Scopus, Science Direct, SID, MagIran and IranMedex were searched up to January 2016. All studies, in which the prevalence of dysmenorrhea in Iran had been reported, were included in this meta-analysis. Eligible studies were reviewed, and data was extracted onto a standard data sheet. A Meta-analysis was done by a random-effects model with a 95% confidence interval (CI).
Twenty-five studies were assessed involving an overall of 9,677 participants, of which 6,748 had primary dysmenorrhea and 280 had secondary dysmenorrhea. The overall prevalence of primary and secondary dysmenorrhea was 0.71 (95% CI: 0.65, 0.77) and 0.18 (95% CI: 0.03, 0.32), respectively.
Primary dysmenorrhea is a common problem in Iran however, there are only a few studies regarding secondary dysmenorrhea prevalence. Moreover, there is a significant variation between the results of the studies on the primary dysmenorrhea prevalence. Therefore, further evidence-based data on national studies is needed to estimate the exact estimation of dysmenorrhea prevalence in Iran.

There is a little consistency among prenatal care guidelines. An evidence-based guideline can be used to improve the quality of the mother and child health care. This study was designed to compare the consistency of the Iranian integrated maternal health care guideline with evidence-based prenatal care manuals and American guidelines.
In this comparative study, the Iranian guideline recommendations were compared with the content of American prenatal care according to obstetrics and gynecology recommendations of the U.S. preventive services task force and evidence-based prenatal care. The strength of the recommendations was assessed based on evidence-based medicine.
In this study, 71 recommendations were compared in four parts. About 18.3 percent of the recommendations were consistent with all guidelines. Screening for group B streptococcus, performing chorionic villous sampling and amniocentesis for at risk women, and anomaly screening were not mentioned in the Iranian guideline. The Iranian guideline was consistent with the content of U.S. preventive services task force in 38% of the recommendations, American Obstetricians and Gynecologists expert panel guidelines in 75.6% of the recommendations, and with evidence-based care in 66.2% of the recommendations.
Although there was a little consistency among guidelines, the Iranian guideline had a good consistency with the American guidelines and evidence-based care recommendations. Updating clinical tests and the prenatal screening part of the Iranian guideline based on the results of this study may increase the effectiveness of the prenatal care and ultimately improve the mother and child’s health.

Several studies have been conducted to investigate the prevalence of preeclampsia and eclampsia in Iran. These studies have yielded different results. This meta-analysis was aimed to estimate the prevalence of preeclampsia and eclampsia in Iran. International and national electronic databases were searched up to August 2014 including PubMed, Science Direct, Scopus, Science Information Database, MagIran, and IranMedex as well as conference databases. All studies, in which the prevalence or cumulative incidence of preeclampsia in Iran was reported, were included in this meta-analysis. Thirty-six separate studies were assessed involving overall 132,737 participants, of which 4360 had preeclampsia and 49 had eclampsia. Overall prevalence of preeclampsia and eclampsia was 0.05 (95% CI: 0.05, 0.06) and 0.23% (95% CI: 0.12%, 0.33%) respectively. The prevalence of preeclampsia, increased from 0.04 (95% CI: 0.03, 0.05) during 1996 to 2005 to 0.07 (95% CI: 0.04, 0.09) during 2010 to 2013, while the prevalence of eclampsia decreased from 0.30% (95% CI: 0.15%, 0.45%) to 0.01% (95% CI: 0.01%, 0.01%), during the same period. The preeclampsia prevalence had an increasing growth and the eclampsia prevalence had declining growth in recent years. In addition, despite many studies aimed the prevalence of preeclampsia and eclampsia in Iran, there is a significant variation between the results. So, it is difficult to give an exact estimation of the preeclampsia and eclampsia prevalence in Iran.

A surveillance system helps to detect epidemics and the pattern of the incidence of the problems in the community and is important for evidence based decision making. This study was conducted to determine the feasibility of the Pregnancy Risk Assessment Monitoring System (PRAMS) in Iran. PRAMS feasibility was assessed in a cross-sectional study in the city of Shahriar, located in the west of Tehran in 2013. In this study, 811 women within 2 to 6 months postpartum who had a live or still birth were selected from thyroid screening forms and hospital records through a systematic simple random sampling method. Trained interviewers collected the data via calling mothers from health centers or through home visits. The outcome was tested on the «TELOS» model including technical, economic, legal, operational and schedule feasibility components. Thirty-seven health volunteers collected the data in this study. Many prevalence estimates were comparable with national and Tehran data (technical feasibility). A home based completed questionnaire cost 2. 45 and a phone cost 1. 89 USD (economic feasibility). The project was consistent with legal requirements (legal feasibility). The participation rate was 92. 8% (95%CI: 92. 7-95. 3) for home visits and 90. 9% (95% CI: 87. 3-93. 6) for the phonemethod. Over 80% of different sections of the questionnaire were completed (operational feasibility). All data collection processes took 35 days (schedule feasibility). The adapted PRAMS could be considered feasible in Iran. Its widespread and periodic implementation can provide valuable maternal and child health information in the country.

The importance of neonatal jaundice is not only for its social, economic, and psychological complications resulted from hospitalization of neonates in the hospital, but also for the permanent neurological handicaps and its consequent high morbidity. Since Iranian mothers have no, in spite of the importance of matter, appropriate approach in coping with their newborn jaundice, this study aimed to explore mother’s experiences of neonatal jaundice.Methods & Materials: This qualitative study was carried out through in-depth semi-structured interviews with 14 mothers whose infants were hospitalized in one of the hospitals affiliated to Shahrood University of Medical Sciences with a diagnosis of neonatal jaundice. The participants were selected purposefully and the data were analyzed using qualitative content analysis. Two main themes and several subthemes emerged from the data. The main themes were as follows: mothers’ experiences of jaundice crises and its management, and mothers’ present ex- periences after crisis of jaundice. First theme arranged into four subthemes and second theme was grouped into three subthemes. Mothers’ and grandmothers’ cultural and dietary beliefs have an important impact on mothers’ health-seeking behavior. Educational programs about neonatal jaundice and its manage- ment through prenatal care consulting and mass media is recommended as an important priority for health system of country.

In order to achieve acceptable health indices and the general welfare، family planning is necessary in any society. The aim of this study was to identify the perspectives of health care providers about the unmet needs of family planning in health centers of Tehran and Shahroud in 2011. The present study was a qualitative research including 27 of the staff and administrators of health centers recruited with purposive sampling. Data gathering was conducted by holding several individual discussions with staff from different centers of Shahroud and Tehran with different social، cultural، and economic status. Then all of the recorded speeches were written on paper and the main themes and sub-themes were extracted. Themes extracted from the statements of the participants were organizational factors (such as integration of family health services with midwifery services، and lack of privacy)، occupational pressure، and the excessive paperwork of the midwifery unit، which had reduced the quality of family planning services. Moreover، other obstacles cited included the participation of men، time limitations، misconceptions، and health center supervisors acting according to personal preferences. Overlooking social، cultural، and organizational issues may reduce the quality of family planning services.

Recently, harm reduction programs have been used to reduce mortality and morbidity among smokers. The main objective of this study was to evaluate the effect of harm reduction programs on the smoking patterns of subjects who presented to a smoking cessation clinic in Tehran, Iran. This observational study was conducted between September 2008 – September 2009 on 132 patients who were unable to quit smoking. Patients were enrolled by the first come first service method. During the study period, subjects were assigned to either group or individual visits every 15 days in conjunction with the use of nicotine gum. The main objective of this study was to evaluate at the third and sixth months of follow-up: the number of smoked cigarettes, level of expired carbon monoxide (CO), and numbers of nicotine gum used. Data were analyzed by the Wilcoxon rank, Fisher's exact, and Pearson's chi-square tests and SPSS version 17 software. A total of 87.1% of the subjects were males. We noted decreases in the number of cigarettes smoked daily and the level of expired CO, whereas the amount of nicotine gum used significantly increased during the time interval between the first session and the third and sixth month follow-up visits (p < 0.001 for all variables). During the follow up sessions, 64.4% of subjects reduced the number of cigarettes they smoked daily by at least 50% and 12.9% of subjects quit smoking. Behavioral and pharmacological therapy in harm reduction programs result in a decrease in the number of cigarettes smoked daily and a reduction in the amount of expired CO. Therefore, these methods can be beneficial in achieving complete smoking cessation.

This was an analytical historical cohort study based on an existing data base study conducted in different areas of Tehran. The present study determined the effect of demographic factors and cigarette smoking status on success rate of addiction treatment in outpatient treatment and rehabilitation clinics for substance abusers. We accomplished our study in outpatient clinics authorized by the “welfare organization,” which included three governmental treatment centers and private centers among those located in 22 regions of Tehran. Data were collected using a checklist, which contained demographic characteristics, personal information and information about prevention, treatment and follow-up records of 1372 patients. Factors associated with addiction treatment success rate were reviewed using multiple logistic regression tests Our study showed that addiction treatment was successful in only 258 cases (18.8%). The final multiple regression model showed that single and married patients were 2.18 times (P=0.033) and 2.70 times more successful in quitting than divorced, or separated cases (P=0.005). In addition, patients who lived in rental or mortgaged houses were 1.43 times more successful than homeowners (P=0.036). More than 90% of participants in this study were daily smokers at the time of the study. Patients who did not have a history of smoking were 1.69 times more successful than ex-smokers (P=0.007). Based on our study results only a few people were successful in addiction treatment; marital status, type of housing, residential status and smoking status were the most important factors associated with the outcome of addiction treatment.