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Background: Low back pain (LBP) is the leading cause of disability in the world. This study aimed to evaluate the effect of acupressure on LBP intensity and depression among chronic nonspecific LBP patients. Methods: This sham-controlled randomized clinical trial was performed on 84 patients with chronic nonspecific LBP. The data were collected using a demographic information questionnaire, the Visual Analogue Scale (VAS), and the Beck Depression Inventory-II (BDI-II). The participants were randomly assigned to acupressure (n = 42) and sham (n = 42) groups. The acupressure group was trained on how to apply pressure on Yin tang, Feng Chi, and Shu Fu acupoints; nevertheless, the sham group was trained on how to apply pressure on Chen Jiang, Huang Shu, and Ji ache acupoints. The participants in both groups applied acupressure once a day for 4 weeks. Both groups completed the VAS and the BDI-II again one day after the intervention. Results: No significant differences in LBP intensity (P = 0.45) and depression (P = 0.26) were observed between the two groups before the intervention. By controlling the baseline scores of LBP and depression, analysis of covariance revealed that the LBP and depression of the acupressure group significantly improved after the intervention, compared to the sham group (P < 0.05). Conclusions: Applying pressure on Shu Fu, Yin Tang, and Feng Chi points is effective in reducing LBP and depression among chronic nonspecific LBP patients. The findings of this study can be used in designing and evaluating more robust protocols.

Background: Visual thinking strategy (VTS) is an interdisciplinary education that focuses on art. In this method, all students think about complex artistic elements. VTS uses visual literacy to teach communication skills and thinking. Objectives: This study aims to compare the educational effectiveness of Persian pictures with classical painting, which leads to teaching the concepts of medical humanities using medical students’ perspective. Methods: In this cross-sectional descriptive-analytical study, medical students of clinical course (trainees and interns, 4th - 7th year of medicine) in the second semester of the 2021 academic year attended a VTS discussion session, which contained thinking about three paintings, including a classical western painting, a Safavid era miniature, and a contemporary painting. At the end of the session, an opinion poll on the effectiveness criteria was completed by the students separately for each painting, and the results were analyzed. Results: According to the findings, our intervention improved visual and auditory sensitivity, accuracy and attention, interaction and cooperation with others, teamwork, and an understanding of their share in the group. In addition, from the perspective of contemporary miniature students, this field played a prominent role in reducing job exhaustion, anxiety, and stress, and created a sense of calm and aesthetics in students by applying topics and issues of the day and paying attention to socio-cultural issues. Classical western painting conveyed a sense of calm and discomfort to the students. Based on the results of interpretive content analysis, this kind of painting had a profound effect on the meaning transmission so that it exposed the comprehensive views on the subject to the viewer’s sight. Given that the Safavid miniature contains various symbols that express the details of the social context and cultural traditions related to human beings, it conveys a variety of senses. On the other hand, the use of classical painting and contemporary Persian painting in VTS discussions in medical education was more prominent than the Safavid era miniature. Conclusions: Miniature can have helpful effects on improving medical professional skills similar to classical painting in VTS topics.

Background: Rationality is a complex concept that plays a vital role in human choices and decisions. However, this issue has been less addressed in studies on marital life. Objectives: This study was performed to explain the experiences of Iranian women on the verge of divorce regarding rationality. Methods: According to the five-stage Granheim and Landman’s approach, an inductive conventional qualitative content analysis was used to collect and analyze women’s experiences on the verge of divorce. Seventeen women selected through purposive sampling entered the study, and qualitative information was collected using unstructured and semi-structured interviews. Information collection and analysis proceeded simultaneously. The information was saturated with 17 participants, and no new information was extracted. In this study, Lincoln and Guba’s criteria were used to ensure the robustness of the study. Results: After information analysis, two main themes were derived. Limited rationality in marriage was the first one with three main categories: Lack of intellectual preparedness for marital life, irrational marriage decision-making, and unrealistic positive thinking. Lack of marital issues understanding was the second one, categorized into reality shock and negative cognitive-emotional experiences. Conclusions: This qualitative study showed that limited rationality plays a vital role in the lives of women on the verge of divorce. However, learning skills, such as deep thinking and realistic thinking, can help women overcome limitations toward rationality and lack of marital issues understanding.

Background: Despite advances in the treatment of substance abuse disorders, some clients experience lapse and relapse after treatment. As a stage before relapse, the lapse is a major challenge in the treatment of addiction. Objectives: This study attempted to develop and psychometrically assess a lapse management program and its educational content after quitting in patients with substance use disorders. Methods: This study was performed in two parts. In the first part, the program and its educational content were designed, and in the second part, it was validated using the opinions of 10 experts in two phases. For program validation, face validity and content validity were used both qualitatively and quantitatively. Results: The lapse management program and its educational content were designed based on self-awareness skills in eight sessions. The validation results showed that the minimum and maximum CVR values for each component of the program were calculated as 0.8 and 1, respectively. Also, the minimum and maximum CVI values were 0.86 and 1, respectively. Moreover, the average content validity index for the entire program was 0.94. Conclusions: The results showed that the lapse management program and its educational content had a good face and content validity for recovering clients and enjoyed the necessary validity for educational, clinical, and research applications.

Background: Subjective well-being (SWB) can be a buffer against mental health problems. Patients with multiple sclerosis (MS) tend to experience low levels of subjective well-being. Objectives: The two objectives were (1) to examine whether peer-led and nurse-led self-management training can improve SWB of patients with MS and (2) to compare the effect of these two interventions on SWB of patients with MS. Methods: In this trial, 81 patients were randomly assigned to either nurse-led (n = 41) or peer-led (n = 40) groups. Both groups participated in six weekly-based 1.5‐hr self-management sessions. The cognitive and affective components of SWB were evaluated using the Satisfaction with Life Scale and the Scale for Positive and Negative Experience, respectively. Results: Life satisfaction increased in both groups over time (P < 0.001), although it was not significantly different between the two groups (P > 0.05). Positive and negative experiences increased in both groups over time (P < 0.05), but the increase in positive experience in the peer-led group was significantly larger than those in the nurse-led group (P < 0.05). Conclusions: Peer-led and nurse-led self-management training, are feasible tools to enhance the cognitive component of SWB, i.e., life satisfaction. Considering the affective component of SWB, positive experience in the peer-led group improved better than in the nurse-led group over time. Therefore, if healthcare providers improve the SWB of patients with relapsing-remitting MS, the self-management intervention led by peers is preferred than nurse-led self-management training.

Background: Sexual dysfunction is one of the most common complications of spinal cord injury with potentially negative impacts on sexual satisfaction. Objectives: This study aimed to compare the effects of app-based and lecture-based sexual education on the sexual satisfaction of disabled men with spinal cord injury. Methods: A randomized clinical trial was conducted on disabled men with spinal cord injury in 2019. The participants were selected using a convenience sampling method from the Welfare Organization of Birjand city. A demographic form and Larson’s Sexual Satisfaction Questionnaire were completed before the intervention. Then, the participants were randomly assigned to two groups (app-based and lecture-based groups). In the app-based group, the sexual education content was prepared as an Android app that was accessible for the group participants for two months. Similar content was communicated to the lecture-based group in the form of lectures during ten 60- to 90-min sessions over two months. Six weeks after the end of the intervention, Larson’s Questionnaire was completed again for both groups. Data were analyzed using the Fisher’s exact test, Kolmogorov-Smirnov test, paired t-test, and independent t-test. The significance level was set at P < 0.05. Results: In both groups, the mean scores of sexual satisfaction significantly increased after the intervention (P < 0.05). Nevertheless, the mean change in the sexual satisfaction score was significantly more in the app-based group (18.16 ± 3.31) than in the lecture-based group (7.52 ± 4.59) (P < 0.05). Conclusions: App-based sexual education can be more effective than lecture-based sexual education in improving the sexual satisfaction of disabled men with spinal cord injury.

Background: The prevalence of stress and anxiety in pre-hospital emergency personnel is high. Objectives: The present study was conducted to investigate the effect of inhaling the Aroma of Rosemary essential oil on stress and anxiety of emergency medical personnel. Methods: In this quasi-experimental study, 8 pre-hospital emergency stations affiliated to Birjand University of Medical Sciences in Birjand city were randomly selected. Then, 4 stations were randomly allocated to the intervention group and 4 stations were assigned to the control group. In the next step, among personnel of each station about 8-10 participants were selected according to the inclusion criteria (39 participants in each group). Afterwards, these participants completed demographic and DASS-42 questionnaires (stress and anxiety subscales). Badges with 25% rosemary essential oil in the intervention group and badges impregnated with refined sweet almond oil were used in the control group for two hours in 3 shifts per week for one month. The anxiety and stress subscales of the DASS-42 questionnaire were completed by the participants one hour as well as 30 days after the last intervention in each group. In this study, chi-square, Mann-Whitney and Friedman tests were used. Results: The statistical analysis showed that the mean stress and anxiety scores in the two groups did not have significant differences before intervention (P > 0.05). One hour after the last intervention, statistical analysis showed that the mean of stress scores in the intervention group was significantly reduced compared to the control group (P 0.05). In the case of anxiety, one hour after the intervention the mean scores in the intervention group were significantly decreased compared to the control group (P 0.05). Conclusions: Aromatherapy with rosemary essential oil can have positive effects in reducing stress and anxiety in pre-hospital emergency personnel.

Background Objectives: A nurses’ job satisfaction is a significant factor behind their motivation for quality care delivery. The aim of this study was to examine the relationship of communication skills with job satisfaction among hospital nursing staff. Methods: In this descriptive-correlation study, 162 nursing staff were recruited through stratified random sampling from teaching hospitals in Birjand, Iran. They were asked to complete a demographic questionnaire, job descriptive index, and burton’s communication skills questionnaire. The SPSS program (v. 18.0) was employed to analyze the data via the analysis of variance, the independent-sample t, the Tukey’s tests, Pearson correlation analysis, and the stepwise multiple linear regression analysis. The level of significance was set at less than 0.05. Results: The mean scores of participants’ communication skills and job satisfaction were 63.83 ± 7.56 (out of a 18 - 90 range) and 3.25 ± 0.53 (out of a 1 - 5 range). Participants’ communication skills mean score had a significant correlation with their job satisfaction mean score (r = 0.36; P < 0.001). Stepwise, multiple linear regression analysis revealed that the scores of the feedback and the verbal domains of communication skills explained 11% of the total variance of job satisfaction (R2 = 0.11, β= 0.17). Conclusions: Hospital nursing staff’s communication skills can significantly affect their job satisfaction. In-service training programs are recommended for improving nursing staff’s communication skills.

Background: Adolescence is among the most critical stages of life, during which assertiveness starts to develop. Parents and their communication patterns have significant roles in adolescents’ successful transition to adulthood. The present study aimed to examine the relationship of family communication patterns with adolescents’ assertiveness. Methods: This descriptive - analytical study was conducted on 400 high - school students in Birjand, Iran. Students were selected via multistage random sampling. A demographic questionnaire, the 26 - item Revised Family Communication Patterns, and the 30 - item Rathus Assertiveness Schedule were employed for data collection. The SPSS software (v. 16) was used to analyze the data by conducting the one - way analysis of variance, the Chi - square test, and the stepwise multivariate regression at a significance level of less than 0.05. Results: The most and the least common family communication patterns among participants were pluralistic (73 students, 28.1%) and protective (58 students, 22.3%) patterns, respectively. Students with pluralistic family communication patterns obtained significantly higher assertiveness scores than those with laissez - faire (P < 0.001) and protective (P = 0.004) patterns. The conversation orientation dimension of family communication pattern explained 9% of the total variance of students’ assertiveness. Conclusions: The conversation orientation dimension of family communication pattern is a significant predictor of adolescents’ assertiveness. Parents can increase their adolescents’ assertiveness through creating a more hospitable and open atmosphere in their families and encouraging adolescents to express and discuss their ideas and feelings.

Background: Lifestyle is a set of health-promoting behaviors, which empower individuals to maintain and promote their health and prevent illnesses. Poor lifestyle habits in adolescence endanger individuals’ health in adulthood. The present study was performed to analyze the relationship between social capital and lifestyle among a group of Iranian adolescents. Methods: This cross-sectional descriptive-analytic study was performed during year 2014. A stratified random sample of 400 tenth-, eleventh- and twelfth-year students was recruited from boys’ and girls’ high schools located in Birjand, Iran. Data were collected via a demographic questionnaire, the social capital index, and the adherence to a healthy lifestyle questionnaire. The data were entered in the SPSS software (v. 16). Descriptive statistics measures, such as frequency, mean, and standard deviation, were used to describe the data. Moreover, pearson and spearman correlation analyses, one-way analysis of variance, stepwise regression analysis, as well as independent-sample t, Mann-Whitney U, and Kruskal-Wallis tests were performed for data analysis. Results: Most participants had good social capital and a moderately healthy lifestyle. Social capital was positively correlated with lifestyle (r = 0.49; P < 0.001). Stepwise regression analysis showed that gender and social capital explained 33% of the total variance of lifestyle (R2 = 0.33; F = 100.52; and P < 0.001). Conclusions: Improvement of adolescents’ social capital could promote their lifestyle.

Background and Aim: Organizational effectiveness is the main goal of organizational development and excellence. Improvement of staff’s quality of work life may improve organizational effectiveness. The aim of this study was to analyze the relationship between quality of work life and organizational effectiveness among hospital nurses. Methods: This descriptive-analytical study was conducted on 225 hospital nurses who worked in teaching hospitals affiliated to Birjand University of Medical Sciences, Birjand, Iran. Nurses were recruited through random multi-stage cluster sampling. Data were collected using a demographic questionnaire, Brooks and Anderson quality of nursing work life questionnaire, and parsons organizational effectiveness questionnaire. SPSS software (v. 16.0) was used for data analysis via Mann-Whitney U, Kruskal-Wallis, and independent-sample t tests, one-way analysis of variance, and Pearson and Spearman correlation analyses. Results: From 225 nurses, 201 completely filled out their questionnaires. The mean of their work experience in nursing was 7.87 ± 7.62 years. Nurses’ organizational effectiveness was significantly correlated with their quality of work life (P < 0.001) and working ward (P = 0.04). The work context subscale of quality of work life was a significant predictor of nurses’ organizational effectiveness in which, each one-point increase in quality of work life was associated with a 0.66-point increase in organizational effectiveness. Conclusions: Nurses’ quality of work life is significantly correlated with their organizational effectiveness. Therefore, improving nurses’ quality of work life can improve their organizational effectiveness.