Background: Labor pain is a major reason behind preferring cesarean section over normal vaginal delivery. Aromatherapy is among the most common nonpharmacological therapies for pain. Objectives: The objective of this study aimed to evaluate the effects of inhalation aromatherapy with Boswellia carterii (BC) essential oil on the intensity of labor pain among nulliparous women. Methods: This randomized controlled trial was carried out on 126 nulliparous women. Women were randomly allocated to an aromatherapy (n = 63) and a placebo (n = 63) group. For each woman in the aromatherapy group, a piece of gauze was soaked with 0.2 ml of 0.2% BC essential oil diluted in 2 ml of normal saline, and then, it was attached to the collar of each woman. The intervention was repeated for each woman every 30 min up to a cervical dilation of 10 cm. The intervention in the placebo group was the same as the aromatherapy group except that the gauze was soaked only with 2 ml of normal saline. A numeric pain rating scale was used to assess the labor pain intensity before the intervention and at cervical dilations of 3–4, 5–7, and 8–10 cm. Statistical analyses were performed using descriptive and inferential statistics such as the Chi-square, the independent sample t- test, and paired t-test. Results: Between-group comparisons revealed that labor pain intensity in the aromatherapy group was significantly lower than the control group at cervical dilations of 3–4 (4.98 ± 0.93 vs. 6.68 ± 1.28, P < 0.001), 5–7 (5.79 ± 1.13 vs. 7.23 ± 1.54, <0.001), and 8–10 cm (6.35 ± 1.63 vs. 7.71 ± 1.38, P < 0.05). However, there were no significant between-group differences regarding 1 and 5 min Apgar scores (P > 0.05). Conclusion: Inhalation aromatherapy with BC essential oil has positive effects on labor pain. Therefore, it can be used for relieving labor pain in the first stage of labor.

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Background: Medication adherence is a complex behavioral pattern affecting treatment success. A stepping stone to improve medication adherence is to determine its contributing factors. Objectives: This study intended to evaluate medication adherence and its predictors among patients with heart failure in Mazandaran Heart Center, Sari, Iran. Methods: This cross-sectional study was conducted on 300 patients with heart failure who were hospitalized from January to March 2015. Sampling was done through the census method. Data were collected using the Morisky Medication Adherence Scale and were analyzed using the Chi-square test and logistic regression analysis. Results: The mean score of treatment adherence was 5.82 ± 2.54. Medication adherence had a significant correlation with education level (P = 0.012), number of children (P = 0.013), comorbidity (P = 0.002), ejection fraction (P = 0.046), and the number of tablets used per day (P = 0.001). However, it was not significantly correlated with age, gender, employment status, place of residence, income level, and the number of hospitalizations for heart failure (P > 0.05). Logistic regression analysis showed that none of the demographic and clinical characteristics was a significant predictor of medication adherence. Conclusion: Medication adherence is affected by different factors such as education level, number of children, comorbidity, disease severity, and the number of tablets used per day. Nurses need to take these factors into account when developing care plans and patient education programs.

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Background: Vaginal discharge is a common gynecological complaint among women in the reproductive age group. Objective: The aim of this study was to explore cultural practices and health-seeking behaviors related to vaginal discharge among women living in a socially marginalized community in Colombo district, Sri Lanka. Methods: A descriptive qualitative design was used in this study. Three focus group discussions (FGDs) were conducted in an urban slum community among women who had a previous history with vaginal discharge. A total of 23 women of different ethnicities and religions were included. FGDs were audio recorded and field notes were taken. Verbatim transcripts were analyzed on the basis of qualitative content analysis. Results: Six themes emerged from the data, namely, confusion in differentiating normal from abnormal vaginal discharge, effects on day-to-day life, confusion toward the causative factors, difficulties in disclosing, neglecting behaviors, and socio-cultural influences toward health-seeking behaviors. Majority of women expressed that they use home remedies before consulting a doctor for abnormal vaginal discharge. Conclusions: Women are unable to differentiate normal from abnormal vaginal discharge. Thus, it is important for nurses and primary healthcare workers to plan health education activities for women to empower them with adequate knowledge and improve their health-seeking behaviors.

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Background: There is limited information about the use of medicinal plants (MPs) by older adults in Middle East countries, including Iran. Objective: This study aimed to assess the MP use by older adults in Kashan, Iran. Methods: A cross-sectional study was conducted on 770 older adults who were randomly selected from different areas of Kashan, Iran. A questionnaire was used to gather the data. The data were described using the measures of descriptive statistics and analyzed via the Chi-square and the Fisher's exact tests. Results: Totally, 67.8% of participants used MPs. MPs were used, respectively, for abdominal pain, temperament modification, tranquilization, constipation, and common cold. Significant statistical relationships were found between MP use and variables such as gender, having hyperlipidemia, employment status, belief in the effectiveness of the MPs, and the level of knowledge about them. Conclusion: Older adults widely use MPs. Public education programs should be implemented to inform people, particularly elderly people, about the risks associated with the over-the-counter use of MPs and their interactions with conventional medications.

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Background: Delayed umbilical cord separation (UCS) can increase the risk of infection. Therefore, cord care is of great importance. Objectives: This study aimed to compare the impacts of topical chlorhexidine and dry cord care on UCS time. Methods: In this quasi-experimental study, 174 neonates were recruited from two teaching hospitals affiliated to Kashan University of Medical Sciences, Kashan, Iran. They were assigned to chlorhexidine and dry cord care groups. In the first group, 4% chlorhexidine solution was applied to the cord stump 3 h after birth and then every 12 h until 2 days after cord separation. The mothers of neonates in the dry cord care group were recommended to avoid using any material on the cord stump. The signs of cord stump infection were assessed by mothers on a daily basis and also by the second author at four-time points, namely, 3 h after birth (in hospital), 3 and 7 days after birth (through home visits), and 2 days after cord separation (through home visits). UCS time was documented by mothers. The Chi-square and the independent-samples t-tests were used to analyze the data. Results: UCS time in the chlorhexidine group was significantly longer than the dry cord care group (13.28 ± 6.79 vs. 7.85 ± 2.51 days; P < 0.001). The longest separation time in these groups was 53 and 17 days, respectively. There were no significant differences between the groups with regard to infection signs, namely, discharge, redness, foul odor, inflammation, and swelling (P > 0.05). Conclusion: Dry cord care not only is as effective as topical use of chlorhexidine in preventing cord stump infection but also is associated with shorter cord separation time.

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Background: Effective diabetes mellitus (DM) prevention and management necessitate blood glucose monitoring, health education, and professional nursing care. Objectives: The aim of this study was to compare the effects of Tai Chi and walking on fasting blood glucose (FBG) among patients with type II DM. Methods: In this randomized controlled trial study, 100 patients with type II DM were randomly allocated to a Tai Chi, a walking, and a control group. Patients in the control group performed no regular physical exercise. However, patients in the Tai Chi and the walking groups, respectively, did Tai Chi and walking in three 30-min sessions a week for eight successive weeks. FBG was assessed before and after the interventions. The data were analyzed through the one-way analysis of variance paired-sample t, and Scheffe's tests. Results: Posttest values of FBG in the Tai Chi and the walking groups were significantly lower than the corresponding pretest values (P = 0.013 and 0.004, respectively). Moreover, after the intervention, FBG level in the control group was significantly higher than the Tai Chi (P < 0.001) and the walking (P < 0.0001) groups while the difference between the Tai Chi and the walking groups was not statistically significant (P = 0.571). Conclusion: Eight-week Tia Chi and walking are effective in lowering blood glucose among patients with type II DM. These exercises are recommended for patients with type II DM.

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Background: Nausea and vomiting are among the most important and the most common intraoperative and postoperative complications. Objective: This study aimed to determine the effects of capsaicin ointment application to the K-K9 acupressure point on intraoperative and postoperative nausea and vomiting associated with cesarean section (CS) under spinal anesthesia. Methods: This double-blind three-group randomized controlled trial was conducted on 120 women who referred to Ommolbanin Hospital, Mashhad, Iran, to undergo nonemergency CS under spinal anesthesia. Women were randomly allocated to three groups to receive capsaicin ointment on the K-K9 point (intervention group), capsaicin ointment on the K-D2 point (control group), and Vaseline ointment on the K-K9 point (placebo group). Nausea, vomiting, and retching were assessed at five time points, namely during and 30, 60, 90, and 120 min after CS. Moreover, the need for antiemetic medications was also assessed in all three groups. The data were analyzed through running the one-way analysis of variance, the Kruskal–Wallis, the Friedman, and the Chi-square tests. Results: There were no significant differences among the groups, respecting the scores of nausea, vomiting, and retching at different measurement time points (P > 0.05). However, the number of women who needed antiemetic medication in the intervention group (11) was significantly less than the control (22) and the placebo (15) groups (P = 0.04). Conclusion: Capsaicin ointment application to the K-K9 acupressure point is an easy-to-use noninvasive method for significantly reducing the need for antiemetic medications during and after CS under spinal anesthesia.

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Background: Autism spectrum disorder (ASD) is a severe developmental disorder which leads to physical disability. Positive normative feedback can promote motor learning. Objectives: The aim of this study was to evaluate the effects of positive normative feedback on learning a throwing task among children with ASD. Methods: This quasi-experimental study was carried out on twenty children with ASD who aged 6–10 years. Children were assigned to a positive normative feedback and a control group. In the positive normative feedback group, children were trained to throw beanbags to a target point on the ground with their nondominant arms. The acquisition phase included six ten-trial sets. Children in both groups received veridical feedback after each trial. However, children in the positive normative feedback group also received bogus feedback (scores, which were 20% greater than their actual scores) about their performance in each set. A retention test was performed 24 h after the acquisition phase. The independent sample t-test and the repeated measures analysis of variance were used to analyze the data. Results: There was no significant difference between the groups regarding the performance mean score at baseline. Moreover, despite increases in the performance mean scores over time in both groups, between-group differences in the acquisition and the retention phases were not statistically significant (P > 0.05). Conclusion: Positive normative feedback does not have significant motivational effects on motor learning among children with ASD.

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