Developing a charter of spiritual care for patients.

BACKGROUND: Spirituality is recognized as an important issue in health care, and every individual has spiritual needs. Despite increased knowledge about spiritual care and its necessity, there is no unique agreed-upon framework for spiritual care among the practitioners. This study aimed to explore the concept from the viewpoint of both health-care providers and patients within the Iranian social, cultural and overall contexts and present a charter for providing spiritual care. METHODS: The first phase of the study was a systematic literature review. The next phase consisted of two qualitative studies on the components of spiritual care from the perspective of healthcare providers and its dimensions as perceived by patients. The findings were then integrated to make up a charter draft that was accredited through expert opinion. RESULTS: The review of literatures led to the identification of two main themes and 10 themes. Perspectives of health-care providers were categorized into four main themes and 10 themes, and patients' opinions were classified into three main themes and 11 themes. The themes and their subthemes were integrated to build the concepts and form the proposed charter with 30 statements. CONCLUSION: The charter of spiritual care for patients is intended to present an agreed-upon framework for spiritual care delivery and resolve some of the problems in this path. This can improve health-care delivery system.

Design and psychometric properties of a questionnaire to assess gender sensitivity of perinatal care services: a sequential exploratory study.

BACKGROUND: Providing gender sensitive reproductive health service is recently emphasized by health organizations. This study aims to develop and assess psychometric properties of a questionnaire to assess gender sensitivity of perinatal care services (GS-PNCS) to be used by managers of perinatal services. METHODS: This study is a mixed sequential (Qualitative-Quantitative) exploratory study. In the qualitative phase, 34 participants were interviewed and the items were generated. To evaluate the validity; face, content and construct validity were assessed. The reliability was assessed by internal consistency and stability calculation. RESULTS: The content validity and reliability were demonstrated by S-CVR = 0.92 and S-CVI = 0.98, Cronbach's α = 0.880 and the ICC = 0.980 to 0.947. Exploratory factor analysis showed 8 factors which explained more than 52.53% of the variance. CONCLUSION: GS-PNCS is a valid and reliable questionnaire, with 49 items to assess gender sensitivity of perinatal care services and helps health care managers and planners to improve the quality of the services.

Paternal adaptation in first-time fathers: a phenomenological study.

OBJECTIVE: This study aimed to explore men's experiences of paternal adaptation during their first year of transition to parenthood. BACKGROUND: Stepping into fatherhood is one of the most important events that may occur in a man's life and can lead to fundamental changes in their identity and lifestyle. However, to our knowledge, no studies have been conducted on men's experiences of paternal adaptation in an Iranian context. METHODS: In this phenomenological study, 15 Iranian men who had the experience of parenting for the first time were recruited using the purposeful sampling method. In-depth semi-structured interviews guided by a questionnaire were used to collect data. The data were analysed using interpretative phenomenological analysis. RESULTS: The data analysis resulted in the development of 26 themes, 8 subordinate themes and 3 superordinate themes. The superordinate themes included 'steps toward adaptation', 'obstacles to the path of adaptation' and 'stabilisation in the paternal position'. CONCLUSION: Perceived self-efficacy and satisfaction in fatherhood means an adaptation to the paternal role. Factors influencing paternal adaptation can be classified into the domains of 'facilitating factors' and 'inhibiting factors'.

Incivility in Nursing Education: A Concept Analysis.

Background: Incivility in nursing education is a complex concept that is not exactly defined in nursing. The purpose of this study was to clarify the concept of incivility in nursing education in the Iranian cultural context. Materials and Methods: Concept analysis was performed based on hybrid model in three steps. In the theoretical phase, a review of studies was conducted from 2000 to 2020. During the fieldwork, 7 nursing faculty members and 9 nursing students were interviewed. The third phase included the comparison of the themes that were extracted from the two previous phases. Results: From the 1250 titles, 45 articles were analyzed. Review of literature showed that incivility has several attributes: unconventional communication, irresponsible and disrespectful behavior. The fieldwork phase added unmanaged behavior and being contrary to academic goal. Conclusions: Defining the concept of incivility in nursing education refers to an unconventional, disrespectful, unmanaged behavior that is contrary to the academic goal of nursing education and results from individual differences, stress, improper application of technology, and inappropriate role models which, by creating an unsafe learning condition leads to harming the individual, organization and profession. Here, this study provides a comprehensive understanding of the incivility in nursing education that can be used in instrumentation, model building, and development of theory.

Discharge of Confirmed COVID-19 Patients Based on WHO or Regional Criteria? A Cohort Study.

BACKGROUND: Increasing the number of COVID-19 patients raises concerns about the capacity of the health care system. This issue emphasizes reducing the admission rate and expediting patient discharge. OBJECTIVE: This study aimed to develop a discharge protocol for COVID-19 patients based on the existing capacity of the healthcare system and to assess its post-discharge outcomes. METHODS: This is a multicenter cohort study. All COVID-19 patients referred to selected medical centers in Qom, Iran, from Feb. 19 to Apr. 19, 2020, were target populations. Eligible patients were classified into a) the criterion group and b) the non-criterion group. Patients were followed up daily for 14 days after discharge by phone, and the required data was gathered and recorded in follow-up form. Univariate (chi-square and t-tests) and multivariate multiple (multivariate probit regression) analysis were used. RESULTS: A total of 2775 patients were included in the study (1440 people in the criterion group and 1335 in the non-criterion group). Based on multivariate probit regression, death was statistically associated with discharge outside our criteria (p<0.001), rising age (p<0.001), and being male (p=0.019), and readmission were associated with discharge outside our criteria (p<0.001), rising age (p=0.009), and having the history of underlying diseases (p=0.003). Furthermore, remission had statistically significant associations with discharge based on our criteria (p<0.001), decreasing age (p=0.001), and lack of a history of underlying diseases (p<0.001). CONCLUSION: Mortality and readmission were significantly lower according to our discharge criteria. Our designed criteria apply to less developed and developing countries due to the limited capacity and resources available in the health care system.

Study of outcomes of delay in referral of patients with acute myocardial infarction.

BACKGROUND: Delay in seeking medical help in patients with acute myocardial infarction (AMI) challenges the patients in terms of diagnosis and treatment. This study aimed to evaluate the outcomes of delay referral (≥12 h) in patients with AMI. MATERIALS AND METHODS: In this retrospective cohort study, the medical records of 252 patients with AMI (2017-2019) admitted to Shahid Beheshti Hospital, Qom, Iran, was reviewed. Data collection tool was a researcher-made data sheet that included demographic characteristics, times, hospitalization costs, risk factors, history of heart disease, results of paraclinical tests, clinical information at the time of admission, and outcomes of delayed referral. Data were analyzed using t-test, Chi-square, Kaplan-Meier estimator, log-rank test, Cox regression by STATA, and SPSS (version 25). RESULTS: The levels of troponin, creatine phosphokinase, lactate dehydrogenase were significantly higher in the delayed referral group (P < 0.05). After treatment, the cardiac ejection fraction was significantly different in the nondelayed referral (41.56 ± 9.16) and the delayed referral group (38.39 ± 11.01) (P < 0.001). There was no significant difference in the percentage of hospital deaths in the groups (P = 0.078). CONCLUSION: Delayed referral of patients with AMI is associated with decreased physiological cardiac function, which complicates recovery for these patients.

A Thematic Analysis of Dimensions of Spiritual Care.

Background: An overview of spiritual care studies can help reveal the dimensions of spiritual care and summarize the findings of available studies. Thus, we designed the present study based on existing studies to explain the dimensions of spiritual care. Materials and Methods: In this thematic analysis, we gathered the related articles published in Persian and English in the last 8 years (2013-2021) with the help of the keywords of Care, Support, Spirituality, Religion, Treatment, Hospice, and Palliative, and searching in electronic databases, including PubMed, Scopus, Web Of Sciences, Magiran, Islamic Science Citation (ISC), and Scientific Information Database (SID). We accurately studied 79 articles that met the inclusion criteria, and then the spiritual care components were extracted and coded, and finally, the codes were categorized as themes and sub-theme. Results: Thematic analysis of available studies revealed that the dimensions (theme) of spiritual care include: spiritual and religious assessment, developing a structure for providing spiritual care, establishing effective and supportive communication with the patient, training the patient, answering his questions, encouraging, maintaining, and improving social communications, encouraging the patient to live happily, helping the patient to achieve peace and calmness, supporting for spiritual rituals and activities, supporting and training the patient's family, and supporting the dying patient. Conclusions: Spiritual care includes various and numerous dimensions. Considering the widespread dimensions of spiritual care, it seems necessary to design and plan appropriate studies to reveal other spiritual care dimensions from the perspective of patients and care providers in different cultures.

Relationship between coronavirus disease 2019 in pregnancy and maternal and fetal outcomes: Retrospective analytical cohort study.

OBJECTIVE: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has caused many deaths and complications worldwide. However, limited data are available about COVID-19 during pregnancy. This study aimed to assess the epidemiological and clinical features of COVID-19, and the adverse maternal and fetal outcomes. DESIGN: This retrospective analytical cohort study was conducted on all pregnant women with confirmed COVID-19 at Nekouei-Hedayati-Forghani Hospital in Qom, Iran from 15 March 2020 to 15 November 2020. For the same period, 165 pregnant women who did not have COVID-19 were selected at random and included in this study. All epidemiological and clinical features were collected from the medical records of the participants. A logistic regression model was used to determine associations between COVID-19 in pregnancy and maternal and fetal outcomes. FINDINGS: The most common symptoms reported by pregnant women with COVID-19 were shortness of breath (60.9%), dry cough (59%) and fever (42.9%). After adjustment for potential confounding factors, COVID-19 in pregnancy was associated with a significantly higher risk of admission to the intensive care unit (ICU) [odds ratio (OR) 6.16, 95% confidence interval (CI) 1.23-31], caesarean section (OR 0.45, 95 CI 0.25-1.03), preterm birth (OR 3.01, 95% CI 1.4-6.54), fetal distress (OR 5.7, 95% CI 2.13-15.59) and admission to the neonatal intensive care unit (NICU) (OR 3.04, 95% CI 1.21-7.70). KEY CONCLUSIONS: COVID-19 is associated with adverse maternal and fetal outcomes, including ICU admission, caesarean section, fetal distress, preterm birth and NICU admission.

Spirituality and effective factors in education: A qualitative study.

BACKGROUND AND AIM: Spirituality in education, as a necessity in improving the quality of teaching and learning, is affected by various personal, social, religious, and cultural factors. Since the identification of these factors can empower the faculties and facilitate the transfer of spiritual concepts through teaching, the aim of this study is explanation of the factors affecting the spirituality transfer in education process. MATERIALS AND METHODS: This qualitative content analysis approach study included 22 faculty members of medical universities, 25 faculty members of seminary, and 19 medical students interested in participating in the study. They were studied according to purposive sampling method. Data collection was done by interviewing a semi-structured questionnaire. Data were analyzed using conventional content analysis method. RESULTS: The factors influencing the spiritual transfer in teaching process were classified into two main forms of teacher-related factors and peripheral-related factors. Teacher-related factors include the teacher's insight and worldview, adherence to religious principles, belief in ethical virtues, the positive and constructive interaction of the teacher with the student, and the mastery of teaching skills. The peripheral-related factors include the highly skilled classrooms and the talented learners. CONCLUSION: The intensification of the insight, religious worldview and the basic of beliefs, consolidating ethics and empowering faculty members in teaching skills along with building a positive and constructive relationship with the students, as well as institutionalizing spirituality as the inseparable teaching element can facilitate the transfer of spirituality concepts. More studies are needed in this regard.

Related Factors to Paternal Adaptation: A Cross-sectional Study for First-time Fathers.

BACKGROUND: Becoming a father challenges men's ability and many men describe fathering as a negative and frustrating experience. This study was designed to determine related factors to paternal adaptation in first-time fathers. MATERIALS AND METHODS: This cross-sectional study was conducted in healthcare centers in Qom and environs, Iran, from July to September 2015. Participants were 572 first-time fathers. Healthcare centers were selected by lottery and sampling was carried out continuously. Data were collected by demographic form and Paternal Adaptation Questionnaire; Spearman's correlation coefficient, Mann-Whitney and Kruskal-Wallis test, and multiple linear regression model were used. p < 0.05 was considered as significant level. RESULTS: Participants were first-time fathers with a mean (SD) age of 29.89 (4.45) years. The results indicated that planning for parenting is the most predictive factor in the ability to perform the paternal roles and responsibilities (ß = 2.67, p < 0.001); marital satisfaction is the most predictive factor with regard to perceiving parental development (ß = 3.09, p = 0.001) and stabilization in paternal position (ß = 4.66, p < 0.001). Father's self-employment was the only predictive factor relating to challenges and worries (ß = -1.19, p < 0.001) and marital satisfaction was the most predictive factor for paternal adaptation (ß = 14.68, p < 0.01). CONCLUSIONS: It appears that the father's occupation, planning for becoming a parent, and marital satisfaction are the most predictive factors for paternal adaptation and its domains, thus by planning appropriate interventions aimed at developing the ability of fathers in these aspects, especially marital satisfaction, it is possible to facilitate men's adaptation to paternal role.

Structural challenges in the health domain of the health system reform: A qualitative study.

BACKGROUND AND AIM: Considering that the Qom University of Medical Sciences was a pioneer to implement the health system reform (HSR) in the domain of health services and the lack of a study that has addressed the challenges and strategies to promote the HSR in the health domain, this study was designed to explain the structural challenges and its solutions in the health domain of the HSR in the city of Qom, Iran, 2017. MATERIALS AND METHODS: This study was a qualitative research. The health managers, the health-care providers, and the recipients of health services referring to the health centers in Qom were the participants in this study who were selected using the convenience sampling method. The data were collected using individual interviews and with the guidance of a semi-structured questionnaire. Collected data were analyzed by the qualitative content analysis method with an inductive approach. After extracting the challenges of the HSR in the health domain through a qualitative approach, these challenges were prioritized through Delphi's technique in terms of relevance and resolving strategies. RESULTS: From the perspective of the study participants, the structural challenges of HSR in the health domain in order of importance and priority included problems due to the SIB system, defects in the instructions, the disruptions caused by multitasking, poor service coverage, incomplete health-care packages, and the shortage of resources. CONCLUSION: According to the findings of this study, we hoped that the HSR in the health area can be improved to increase its success by modifying the guidelines and the coverage of services, modifying the SIB system, providing requires resources, completing the service packages, and solving the multitasking problem.

Customers' satisfaction with the Iranian health system reform plan.

BACKGROUND AND AIM: Customer's satisfaction is one of the main goals of the health system because it is effective on the desire of external customers for using the services of the health system and also the quality and quantity of the provided care for the internal customers and eventually the health of the society. Considering the importance of the subject, the present study was designed to determine the customers' satisfaction with the health system reform plan in the field of health. MATERIALS AND METHODS: Participants in the present content analysis qualitative study were 22 technical and operational managers and 118 health-care providers, and 15 recipients of health services referring to the health centers in Qom; who individually answered the questions of the interview guide. The gathered qualitative data were analyzed using conventional qualitative content analysis. RESULTS: Customers' satisfaction with the health system reform plan was categorized into six themes of decreased trust of the caregivers, wasting caregivers' time in the health units, increased provision of services to the caregivers, decreased motivation for work, occupational burnout, and a sense of petition in the care providers. CONCLUSIONS: Although external customers were satisfied with some services of the health system reform such as providing various free services, follow-up the patients, and beautification the environment of the health centers; but there are multiple weaknesses in this plan that would cause dissatisfaction in the external and internal customers. More studies seem necessary to better determine the different aspects of the satisfaction in the caregivers and care.

Health need assessment in female adolescents, in Qom: A cross sectional study.

BACKGROUND AND OBJECTIVE: Due to the young population of Iran, a significant number of teenagers in our country and the importance of the health of adolescents, especially teenage girls who are the mothers and the future-makers of the society, we designed this study to determine the health needs of adolescent girls living in the city of Qom. METHODOLOGY: In this descriptive cross-sectional study, the research population included 853 student girls in the middle and high secondary grades in the city of Qom selected and participated in the study through a randomized multistage cluster sampling method. Data were collected by completing the demographic information questionnaire, and the adolescent girls' health needs questionnaire. Data gathered were analyzed using SPSS software version 19 using the descriptive and inferential statistics. RESULTS: The study results showed that the scores of the adolescent girls' needs in health-related areas are as follows: health: 65.33 ± 22.08, nutrition: 52.81 ± 25.40, exercise and physical activity: 50.10 ± 30.55, social justice: 53.95 ± 23.82, counseling: 49.55 ± 34.97, school status: 52.69 ± 28.01, relationship with parents: 55.10 ± 27.44, social support: 50.64 ± 30.52, education: 51.88 ± 29.61, religious beliefs, and spirituality: 66.88 ± 20.87. CONCLUSION: Based on the results of this study, the adolescent girls have a lot of perceived needs in various areas of health, including psychological-emotional, social, physical, educational, and beliefs areas, which have not been met. Therefore, it is recommended to plan and carry out the necessary measures to meet the needs of adolescents with their participation and relevant authorities.

Explaining the Relationship between Moral Intelligence and Professional Self-Concept with the Competency of Nursing students in Providing Spiritual Care to Promote Nursing Education.

BACKGROUND AND AIM: Several factors are involved in obtaining the competence of providing spiritual care in nursing students. The purpose of this study was to explain the relationship between moral intelligence and the professional self-concept with the competency of the nursing students in providing spiritual care to promote nursing education. MATERIALS AND METHODS: The present study was descriptive-analytics and the participants were the 7th and 8th semester nursing students of the processing district 6 of the medical sciences universities. The data were collected using questionnaires "Nursing student competencies for providing spiritual care," "Nursing professional self-concept" and "Moral intelligence" questionnaire and analysed using correlation and regression tests. RESULTS: The results showed that there is a significant relationship between the moral intelligence and the students competency in providing spiritual care (r = 0.24, P < 0.001), while this relationship was not significant for the professional self-concept (r = 0.045). Furthermore, based on the results of multiple regression analysis, the moral intelligence (B = 0.28, P = 0.001), gender (B = -4.23, P = 0.048), place of living (B = 10.59, P = 0.046), and adherence to religion (B = -11.82, P = 0.002) were the predictors of students' competency in providing the spiritual care. CONCLUSION: According to the results of this study, it is suggested that by applying strategies to strengthen the moral intelligence of the students, such as holding-related workshops as well as reinforcing religiosity, the student's competency in providing the spiritual care to the patients is reinforced.

Design and Evaluation of the Psychometric Properties of a Paternal Adaptation Questionnaire.

The present study aimed to design and evaluate the psychometric properties of the Paternal Adaptation Questionnaire (PAQ). The study was a mixed (qualitative and quantitative) sequential exploratory study. In the qualitative phase, a preliminary questionnaire with 210 items emerged from in-depth interviews with 17 fathers and 15 key informants. In the quantitative phase, psychometric properties of the PAQ were assessed. Considering cutoff points as 1.5 for item impact, 0.49 for content validity ratio (CVR), and 0.7 for content validity index (CVI), items of the questionnaire were reduced from 210 to 132. Assessment of the content validity of the questionnaire demonstrated S-CVR = 0.68 and S-CVI = 0.92. Exploratory factor analysis resulted in the development of a PAQ with 38 items classified under five factors (ability in performing the roles and responsibilities; perceiving the parental development; stabilization in paternal position; spiritual stability and internal satisfaction; and challenges and concerns), which explained 52.19% of cumulative variance. Measurement of internal consistency reported a Cronbach's α of .89 for PAQ (.61-.86 for subscales), and stability assessment of the PAQ through the test-retest demonstrated Spearman's correlation coefficients and intraclass correlation coefficient of .96 (.81-.97 for subscales). It was identified that the PAQ is a valid and reliable instrument that could be used to assess fatherhood adaptation with the paternal roles and fathers' needs, as well as to design appropriate interventions and to evaluate their effectiveness.

Experiences of Fathers with Inpatient Premature Neonates: Phenomenological Interpretative Analysis.

BACKGROUND: Birth and hospitalization of premature neonates create enormous challenges for the family with serious impacts on parents' mental and emotional health. The present study was designed to explore the experiences of fathers with premature neonates hospitalized in a neonatal intensive care unit (NICU). MATERIALS AND METHODS: In this interpretative phenomenological study, data were collected using in-depth interviews guided with a semi-structured questionnaire and analyzed by interpretative phenomenological analysis. Totally seven interviews were conducted with six participants. RESULTS: The mean age of the fathers was 32 (23-42) years, and all of the fathers lived with their wives. Experiences of the fathers were categorized into 13 subordinate and three superordinate themes: "abandonment and helplessness" (lack of financial support, lack of informational support, and indignation and distrust toward the hospital staffs); "anxiety and confusion" (family disruption, shock due to the premature birth of the neonate, uncertainty, the loss of wishes, feeling of guilt and blame, and occupational disruption); and "development and self-actualization" (emotional development, spiritual development, independence and self-efficacy, and responsibility). CONCLUSIONS: The present study showed that the fathers with premature neonates hospitalized in NICU encounter both positive (development and self-actualization) and negative experiences (lack of financial and informational supports, distrusting toward the hospital staffs, family disruption, and occupational disruption). Planning to manage adverse experiences can help fathers to cope with this situation.

Exploring the Lived Experience, Meaning and Imperatives of Fatherhood: An Interpretative Phenomenological Analysis.

INTRODUCTION: There have been considerable changes in the concept and meaning of fatherhood in the past few decades and a lot of studies has down in this area, but there is no information about fathering and fatherhood from Iranian perspective, thus present study designed to explore the men's understanding of fathering and paternal role during their first year of transition to parenthood. METHOD: This phenomenological study included accounts of 17 Iranian fathers, who had experienced fathering for the first time. Data was analyzed using the Interpretative Phenomenological Analysis (IPA) approach. RESULTS: The results reveal that a father is a man who reproduces a child and accepts the responsibility for supporting his family as the fulcrum. A father is a good-tempered, faithful, patient and hardworking man with essential knowledge and proficiency. A father should accept his role as the father. He is also expected to participate actively in dealing with family daily issues, value and promote the health and well-being of his children, and have skills of self-management and self-care. CONCLUSION: Iranian fathers not only committed to play their traditional roles and responsibilities, but also welcome new roles such as constantly being with their children and providing emotional support to them.

Social Capital as a Determinant of Self-Rated Health in Women of Reproductive Age: A Population-Based Study.

INTRODUCTION: Recognition of the factors related to women's health is necessary. Evidence is available that the social structure including social capital plays an important role in the shaping people's health. The aim of the current study was to investigate the association between self-rated health and social capital in women of reproductive age. METHODS: This study is a population-based cross-sectional survey on 770 women of reproductive age, residing in any one of the 22 municipality areas across Tehran (capital of Iran) with the multi stage sampling technique. Self-rated health (Dependent variable), social capital (Independent variable) and covariates were studied. Analysis of data was done by one-way ANOVA test and multiple linear regressions. RESULTS: Depending on logistic regression analyses, the significant associations were found between self-rated health and age, educational level, crowding index, sufficiency of income for expenses and social cohesion. Data show that women with higher score in social cohesion as an outcome dimension of social capital have better self-rated health (PV = 0.001). CONCLUSION: Given the findings of this study, the dimensions of social capital manifestations (groups and networks, trust and solidarity, collective action and cooperation) can potentially lead to the dimensions of social capital outcomes (social cohesion and inclusion, and empowerment and political action). Following that, social cohesion as a dimension of social capital outcomes has positively relationship with self- rated health after controlling covariates. Therefore, it is required to focus on the social capital role on health promotion and health policies.

Emotional experiences in surrogate mothers: A qualitative study.

BACKGROUND: Surrogacy is one of the new techniques of assisted reproduction technology in which a woman carries and bears a child for another woman. In Iran, many Shia clerics and jurists considered it permissible so there is no religious prohibition for it. In addition to the risk of physical complications for complete surrogate mothers, the possibility of psychological complications resulted from emotional attachment to a living creature in the surrogate mother as another injury requires counseling and assessment prior to acceptance by infertile couples and complete surrogate mothers. OBJECTIVE: The purpose of this study was to assess the emotional experiences of surrogate mothers. MATERIALS AND METHODS: This was a qualitative, phenomenological study. We selected eight complete surrogate mothers in Isfahan. We used convenient sampling method and in-depth interview to collect the information. The data analysis was fulfilled via Colaizzi's seven-stage method. Reliability and validity study of the roots in the four-axis was done. RESULTS: The findings of these interviews were classified into two main themes and four sub themes: acquired experiences in pregnancy (feelings toward pregnancy, relationship with family, relatives and commissioning couple) and consequences of surrogacy (complications of pregnancy, religious and financial problems of surrogacy). CONCLUSION: Surrogacy pregnancy should be considered as high-risk emotional experience because many of surrogate mothers may face negative experiences. Therefore, it is recommended that surrogates should receive professional counseling prior to, during and following pregnancy.

Effects of music on physiological and behavioral responses of premature infants: a randomized controlled trial.

INTRODUCTION: Despite persuasive theories about the beneficial effects of music and singing in developmental care for premature infants, few small studies are available in this regard. We conducted this study to investigate the physiological and behavioral responses of premature infants to recorded lullaby music and silence. METHODS: In a randomized controlled trial, 90 premature infants in the neonatal care unit of a hospital in Qom (Iran) were randomly allocated to intervention (lullaby and silence) or control groups. Lullaby music was played via headphones at a volume of 50-60 dB. In the silence group, headphones were placed on the infants' ears while no music was played. The three groups were surveyed for physiological responses including oxygen saturation, respiratory and heart rates, and behavioral states every five minutes before, during, and after the intervention. RESULTS: The three groups were not significantly different in terms of mean values of respiratory and heart rates, oxygen saturation, and behavioral states of infants. Similarly, no significant within group differences in respiratory and heart rates, oxygen saturation, and behavioral states were observed at different times. CONCLUSION: Our findings did not support the beneficial effects of music for premature infants. However, music is a noninvasive, non-pharmaceutical, and relatively low-cost intervention that can be implemented at infants' bedside. Thus further research is warranted to determine whether the effects noted in previous studies can be consistently replicated in diverse settings and with diverse groups of preterm infants.