Background: The principal aim of health service providers in the field of breast cancer is to detect and treat lesions at an appropriate time. Therefore, identification of barriers to screening can be very helpful. The present study aimed to systematically review the qualitative studies for extracting and reporting the barriers of screening for breast cancer from the womans perspective. Materials and Methods: In this systematic review; Pubmed, Google Scholar, Ovid Scopus, Cochrane Library, Iranmedex, and SID were searched using the keywords: screening barriers, cancer, qualitative studies, breast and their Persian equivalents, and the needed data were extracted and analyzed using an extraction table. To assess the quality of the studies, the Critical Appraisal Skills Programme (CASP) tool was used. Results: From 2,134 related articles that were found, 21 articles were eventually included in the study. The most important barriers from the point of view of 1,084 women were lack of knowledge, access barriers (financial, geographical, cultural), fear (of results and pain), performance of service providers, women's beliefs, procrastination of screening, embarrassment, long wait for getting an appointment, language problems, and previous negative experiences. Articles' assessment score was 68.9. Conclusions: Increasing women's knowledge, reducing the costs of screening services, cultural promotion for screening, presenting less painful methods, changing beliefs of health service providers, provision of privacy for giving service, decreasing the waiting time, and providing high quality services in a respectful manner can be effective ways to increase breast cancer screening.

A -Study Design, B -Data Collection, C -Statistical Analysis, D -Data Interpretation, E -Manuscript Preparation, F -Literature Search, G -Funds Collection Quality measurement is the first step in improving overall quality. Servqual has been identified as one of the most important methods frequently used in assessing the quality of healthcare services. This study aims to systematically review and conduct meta-analysis of conducted studies in this regard in which Servqual tools were used to assess and measure the quality of services. In this systematic review and meta-analysis, the required data were collected using several keywords (and their Persian equivalents): services quality, Servqual, quality, gap, primary health cares, health services, Iran. The databases searched were as follows: PubMed, Scopus, Google Scholar, SID, Magiran, and Iranmedex. The comprehensive meta-analysis (CMA) software, Version 2 was used for data analysis. Based on the random effect model, the total mean score of Service Consumers' perception, Service Consumers' expectation and the gap between them were estimated as being 3.81 (95% CI: 3.56-4.06), 4.49 (95% CI: 4.31-4.67) and -0.83 (95% CI: -065 --1.01), respectively. The lowest score of consumers' perception of services quality, was related to the empathy dimension (3.57) and the highest score of consumers' expectation of services quality was related to the reliability dimension (4.60). Furthermore, there was a quality gap in all dimensions. In order to achieve desired quality and meet service receivers' needs, attention should be always given to their views, so that proper planning can be done to address existing problems through assessing views. Should such be undertaken, we would be able to witness services quality improvement.

Background and aimEntonox was one of the important methods for pain management in the delivery process. In previous years some studies have assessed the effect of this method in Iran. In this regard, the aim of this study was to systematically review studies addressing the effect of Entonox for pain management in labor.MethodsThis systematic review and meta-analysis study was conducted in 2016. The required data was collected using keywords such as ”Entonox”, “nitrous oxide”, ”vaginal delivery”, ”pain relief”, “obstetric”, “labor pain”, and “labor analgesia”, from databases including Google scholar, PubMed, Science Direct, Magiran, SID, and Scopus, and hand-searching of related and valid journals and references of articles. Articles published from 2000 to 2016 were searched. To conduct meta-analysis, CMA:2 (Comprehensive Meta-analysis) was used.ResultsFinally, 14 articles were included in the study. Pain relief standard difference in mean between-groups was −1.01 (95% CI: −1.59 to −0.43, Q=148.5, df=8, p=0.02, I2=76) this difference was significant (p<0.05). The overall Apgar score standard difference in mean between-groups (Entonox vs. comparison) was 0.12 (95% CI: 0.01 to 0.23, Q=109.4, df=16, p=0.00, I2=85.3) this difference was significant (p<0.05). The results of mothers’ satisfaction rate show that mothers in Entonox group has a high level of satisfaction rate.ConclusionAccording to results of studies published in Iran, it seems that Entonox is an effective method for pain relief in vaginal delivery, as well as for improving infant Apgar score and mothers’ satisfaction rate. Pain relief through Entonox can be used as a strategy for cesarean section reduction plan in Iran.

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Context: Metformin has been used for diabetic patients. This medicine might decrease the risk of breast cancer. The main objective of this article was to determine the breast cancer risk in diabetic patients and its association with metformin and sulfonylurea.Evidence Acquisition: In order to gather evidences, main databases [MEDLINE, PubMed, Cochrane library, Science Direct, Trip, Google Scholar, Institute of Scientific Information (ISI), SCOPUS and EMBASE] as well as relevant websites have searched without time limitation up to June 2015. We have searched with appropriate keywords and strategies. After quality assessment of studies, consequences of risk and mortality for breast cancer have extracted. RevMan and comprehensive meta-analysis software has used, if needed, for meta-analysis.Results: A total of 423 studies, 352 studies have entered firstly and 11 studies have selected after final review. According to the significance of heterogeneity (I 2 = 94%) in these studies, meta-analysis have scrutinized by step by step removing the studies to investigate the reason of heterogeneity. So the relative risk of breast cancer was significant in favor of metformin (RR: 0.63, 95% CI (0.56 -0.70), Pv < 0.001). Conclusions:In this study, we have concluded that the incidence of breast cancer in patients with type 2 diabetes who have used metformin might be less than who have used sulfonylurea. However, this finding should consider carefully and needed to be confirmed with further studies.Keywords: Breast Cancer, Diabetes, Metformin, Sulfonylurea, Systematic Review, Meta-Analysis ContextAccording to global statistics, breast cancer has known as the most common cancer in women around the world (1). It has reported as the most common cancer and the second leading cause of cancer deaths among Iranians women (2). Breast cancer was also the most frequent cancer among Iranian women with incidence rate of 25 per 100,000 (3). Diabetes, metabolic syndrome and breast cancer were the main problems in developed and developing countries based on people lifestyle (4). The results of a study aimed at investigating the diabetes impact on breast cancer risk, reported that, 40% of deaths in the first 5 years after breast cancer have occurred in women with diabetes (5).Studies have shown there would be a strong association between diabetes and cancer (6). The use of metformin might lead to reduction of liver cancer, pancreas cancer, colon cancer, and breast cancer incidence. It could also reduce the deaths from liver and breast cancer (7). Metformin, as a drug for treatment of diabetes, has approved in Britain at 1958, 1972 in Canada and 1995. It has also considered as the only biguanide for type 2 diabetic patients with the lowest risk of side effects (9). Metformin was one of the most common anti-diabetic medicines which plenty evidences have suggested its potential impacts as an anti-cancer drug (10).In this regard, results have shown that women with diabetes with long-term use of metformin were less prone to breast cancer. Of c...