Journal of Education and Health Promotion

Abstract BACKGROUND: Online teaching has been practiced after lockdown due to Coronavirus Disease 
2019 (COVID‑19) pandemic which has replaced conventional classroom teaching. The aim of the 
present study was to know the perceptions regarding online learning as perceived by both teachers 
and students during COVID‑19 pandemic.
MATERIALS AND METHODS: The present study was cross‑sectional and questionnaire‑based. 
Web‑based respondent‑driven sampling technique was used to recruit participants for the present 
study. Three hundred and thirty‑two students and 130 teachers of varying ages and gender participated 
in the study. The link of web‑based questionnaire was sent to respondents through WhatsApp/
Facebook. Responses from all the participants were tabulated and analyzed using univariate 
analysis (Chi‑square test).
RESULTS: Prerecorded lectures (38.9%) and Webinar apps (35/8%) were the most common 
modules of online teaching by students. One‑third (34.3%) had the convenience to attend lectures 
from home whereas 44.3% had difficulty in concentration. Commonly cited disadvantage by students 
was inability to do practical work (37.9%). Regarding teaching faculty, 43.8% had no prior knowledge 
of online teaching. Sixty percent of teachers had 4 h/week of online teaching. No face‑to‑face 
interaction (67.7%) and internet issues (26.9%) were commonly stated barriers by faculty.
CONCLUSION: The pandemic has pushed the teachers and students toward newer teaching avenues. 
However, more needs to be done to supplement the existent teaching pattern and preparedness of 
teaching faculty by incorporating online assignments and assessment methods, strengthening digital 
infrastructure in medical schools, and training support for teachers.

Abstract Coronavirus disease 2019 (COVID‑19) has caused different kinds of psychological consequences.
Identifying and providing psychological plans and protocols can be effective in promoting patients’
mental health. The study was conducted to investigate the effect of psychological interventions in
response to stress, anxiety, and depression in COVID‑19 patients. The present study was performed
based on a systematic review. The studies were done by using different combinations of keywords
in databases such as Science Direct, ProQuest, PubMed, and Google scholar search engines and
in Persian databases such as Magiran, SID, Iranmedex from July 25 to September 7, 2020. Out
of 4533 articles that were found after extensive search, 9 articles were evaluated and qualitatively
analyzed for data extraction with the 2010 consort checklist. The final articles were from different
countries of China, the USA, France, Italy, and Iran and were about COVID‑19 patients and their
health‑care providers. Interventions ranged from relaxation, music therapy to mental health and
extensive psychological skills including adaptation methods, mindfulness and self‑care, and crisis
management. Anxiety was the highest and then stress and depression were the next indicators. The
results showed a positive effect of these interventions on stress, anxiety, depression, and even the
quality of life, sleep and family and child function. The number of studies in this field is increasing. We
see a variety of psychological and educational interventions every day. It is hoped that by designing
standard protocols for psychological intervention, effective steps can be taken to improve the mental
health of patients and health‑care providers.

Abstract BACKGROUND: In the coronavirus disease 2019 pandemic era, clinical programs and mandatory 
hands‑on activities have been supplanted by remote teaching to maintain the fundamental capabilities 
of medical training and to furnish medical students with quality education. Nonetheless, the satisfaction 
of faculty members with this training method in the current pandemic has yet to be assessed. The 
aim of this study was to design a Persian questionnaire with appropriate validity and reliability on 
cardiology professors’ satisfaction level with virtual education.
MATERIALS AND METHODS: In this cross‑sectional study, a questionnaire was devised drawing 
upon scientific sources and Iranian medical educators’ expertise. Seventeen faculty members 
in various specialties evaluated the questionnaire concerning face and content validity. Content 
validity was assessed through the calculation of the content validity ratio (CVR) (values >0.62 
were considered acceptable) and the content validity index (CVI) (values >0.79 were considered 
acceptable), construct validity was evaluated through principal component factor analysis by the 
Kaiser–Meyer–Olkin (KMO) statistic and Bartlett’s sphericity test, internal reliability was measured 
through the calculation of Cronbach’s alpha coefficient, and consistency was appraised through the 
use of test‑retest reliability at two different time points.
RESULTS: The questionnaire had a reliability rate of 95%, indicating high internal validity. Concerning 
test‑retest reliability, the intraclass correlation coefficient was 0.96 (P < 0.001), demonstrating relatively 
good stability. The CVI was 0.81, and the CVR was 0.85. The KMO measure of sampling adequacy 
was 0.954, indicating the acceptability of the degree of common variance among the all items.
CONCLUSIONS: This Persian questionnaire on virtual education aimed at cardiology faculty members 
in the current pandemic with its low question count and appropriate domains had high reliability 
and validity. By knowing the level of professors’ satisfaction with the new method of education, it 
is possible to take steps to better provide specialized medical education to cardiology residents.

Abstract Front‑line clinicians and health‑care workers need to be educated to provide care in critical situations
such as large‑scale catastrophes and pandemics. This narrative review is focused on investigating
educational strategies in confrontation with coronavirus disease 2019 (COVID‑19) pandemic. We
conducted a literature search in December 2020 through LitCovid, PubMed, ERIC, and Cochrane
Library in order to retrieve relevant studies regarding the role of education in prevention, diagnosis,
and treatment of COVID‑19. There were 12 reviewed studies related to this specific subject. The
articles selected for this study demonstrated that education and training had a positive impact on the
knowledge and attitude of the participants and also the educational interventions, whether they were
simulation‑based or other formats of training, would be deemed crucial for enhancing participants’ level
of perceptions and confidence. Therefore, it is highly recommended that public health policymakers
consider this important issue.

Abstract The coronavirus disease 2019 (COVID‑19) is a serious global pandemic that has extremely affected
health‑care systems. This article aimed to review the perspectives of general surgical practice during
the COVID‑19 pandemic. A systematic review of the literature addressing modification to general
surgical practice during the COVID‑19 pandemic indexed in PubMed, Scopus, Google, and Google
scholar was carried out on June 19–20, 2020. The literature review yielded 577 articles. The exclusion
of duplication, articles not in English, and specialized ones in various surgical disciplines precluded
398 articles. Finally, following checking for relevance and publication status, 114 papers were included.
Recommendations for surgical practice during the COVID‑19 pandemic revolved around mitigation
of the risk of virus transmission to patients and health‑care workers. The emerging themes of safety
precautions were related to patient prioritization and testing, mindful consideration of the operative
strategy, optimum use of personal protective equipment, operative room setup, and departmental
organization. However, those recommendations were often diverging and bore on a dearth of
evidence and personal opinions. Multidisciplinary work and cooperation among surgical specialties
are required to establish and validate the protocols for safe surgical practice during the pandemic
and perhaps similar crises in future. The COVID‑19 pandemic has brought several challenges to
the field of medicine, including the surgical specialty. The centrality of safety precautions emerging
in this crisis requires surgeons to adopt the new roles and work standards and translate them into
practice during the pandemic and perhaps longer.

Abstract BACKGROUND: Coronavirus disease 2019 is a new viral outbreak in the world. Dentists and
their assistants are at greatest risk of exposure to the virus, due to close contact with patients and
dealing with aerosols. Hence, the aim of this study was to compare the use of personal protective
equipment (PPE) and supplementary protective equipment (SPE) and observance of the principles
of infection control (PIC) in dentists and their assistants before and after the corona crisis.
MATERIALS AND METHODS: This cross‑sectional study was conducted using an online survey
from May 6 to 20, 2020. Convenience sampling was used to select individuals. The questionnaire,
consisting of four general categories about the use of PPE and SPE and the observance of PIC
by dentists and their assistants before and after corona crisis, was registered at Porsline website
(https://survey.porsline.ir/s/KUt7VQB). Frequencies in each subcategory were calculated and
comparisons were done using Chi‑square test, Fisher’s exact test, and paired sample t‑test. A P < 0.05
was considered statistically significant.
RESULTS: There were significant differences in the frequency of use of PPE by dentists before and
after corona crisis for oral and dental examination and also dental procedures (P < 0.001). There
were significant differences in the frequency of use of SPE and observance of PIC before and after
corona crisis, except for different types of suction types (P = 0.22), dental handpiece (P = 0.66),
and dental unit (P = 1). There were significant differences in the frequency of use of PPE by dental
assistants before and after corona crisis (P < 0.001).
CONCLUSIONS: Although the frequency of use of PPE and observance of PIC increased among
dentists and their assistants, this increase is not sufficient, especially for dental assistants, and a
higher level of use of PPE and PIC observance in face of highly contagious and life‑threatening
viruses such as corona is required.

Abstract BACKGROUND: Several preventive measures were used by governments around the world to
suppress the transmission of SARS‑CoV‑2, including quarantine. During quarantine more people
are at risk of developing mental health problems as social media exposure was increasing.
OBJECTIVES: The objective is to investigate the impact of social media exposure during coronavirus
disease 2019 (COVID‑19) pandemic on depression, anxiety, and stress.
MATERIALS AND METHODS: A cross‑sectional study was conducted between April and May 2020
during the large scale social restriction in Indonesia using online questionnaire Indonesian citizens
over 18 years of age were invited to take part by answering online questionnaire through Google
forms (http://bit.ly/duniamayaCOVID). Data gathered were demographic data, depression, anxiety,
and stress that were assessed using Depression Anxiety Stress Scale‑21, duration of social media
usage, and social media platforms used during COVID‑19 pandemic. Data was analysed using
Pearson Chi‑square and ANOVA. Statistically significant variables and additional risk factors was
analyzed using multinomial logistic regression.
RESULTS: The median age was 24 years (range 17–56 years), 121 (55,0%) samples were female.
The three most frequent social media platforms used by participants were Instagram, WhatsApp, and
YouTube. Female were more likely to suffer from mild‑moderate depression compared to male (odds
ratio [OR]: 2.344; 95% confidence interval [CI]: 1.105–4.972; P = 0.026) and more likely to suffer
from severe‑extremely severe anxiety (OR: 2.066; 95% CI: 1.019–4.187; P = 0.044). Social media
exposure was associated with less likelihood to suffer from severe‑extremely severe depression,
mild‑moderate, and severe‑extremely severe anxiety, mild‑moderate stress.
CONCLUSION: Social media exposure was associated with less depression, anxiety, and stress in
the COVID‑19 pandemic era. Medical professionals and government officials could use social media
to disseminate knowledge about COIVD‑19 to bring positive psychological effect.

Abstract Coronavirus disease 2019 (COVID‑19) is an infectious disease caused by a newly discovered
coronavirus and the WHO declared it a pandemic, and due to the high risk, the most government
throughout the world have temporarily closed schools, colleges, and universities. The impact of this
COVID‑19 has been hit the education system worldwide, and according to the UNESCO, as of March
23, 2020, around some 1.3 billion learners worldwide were not able to attend educational institutions
so to continue the education, most of the universities are providing teaching through online mode,
but there are challenges of technological issue, time management, and adaptability.

Abstract BACKGROUND: The current corona virus disease 2019 (COVID‑19) pandemic has led to the
disruption of academic activities including medical education which has made online learning only
available options for continuing education worldwide. Online learning has its own limitations, which
are further amplified if not implemented properly. Hence, there is a need to assess various barriers
faced in the implementation of effective online learning.
OBJECTIVES: The objective of the study was to identify the barriers and motivators in online learning
among medical undergraduates.
SUBJECTS AND METHODS: This internet‑based cross‑sectional study was conducted among
medical undergraduates of Punjab. The data collection tool was a semi‑structured self‑made
questionnaire prepared using “Google Forms,” which was then circulated in the WhatsApp groups
of the students. Received responses were imported to the Microsoft Excel sheet and statistical
analysis was done.
RESULTS: Out of the 592 participants, 533 (90%) faced some kind of problem in online learning.
Major among them were lack of personal interaction with teachers (52%), distractions at home (43.6%),
technology failure (43.2%), limited access to the Internet (39.2%), visual fatigue (38.5%), and
increased workload (25%). Benefits perceived were the comfortable environment of home (41%), easy
accessibility of recorded lectures (36.8%), and the opportunity to keep in touch with studies (35%).
CONCLUSIONS: The online learning process is not a replacement for routine classroom teaching
and clinical postings in medical education. However, it can supplement routine teaching, especially
during current COVID‑19 pandemic‑like situations. Most of the students (90%) were facing some
kind of difficulty in the online learning process due to unplanned and sudden shifts. Therefore, it is
necessary to identify and eliminate the various barriers to make online learning effective.

Abstract BACKGROUND: During the 2nd week of July 2020, the coronavirus disease 2019 (COVID 19)
infection spreading in the community. Now more than 15 lakhs peoples have been infected in India,
out of the 26816 patients were deceased. COVID 19 outbreaks become an additional hazard to the
health‑care workers (HCWs), leading to fatigue, anxiety, depression and fear of death. The objective
of this questionnaire‑based study is to know about the knowledge of HCWs about COVID 19, their
experiences while dealing with the disease, and the protective measures taken to prevent the infection.
MATERIALS AND METHODS: A cross‑sectional, questionnaire‑based study was conducted for
1 month starting from the 2nd week of June 2020 after getting institutional ethical clearance. This
study included 240 HCWs posted in the medical and surgical Departments of All India Institute of
Medical Sciences, Jodhpur, Rajasthan. This questionnaire was prepared in online Google forms and
required 2 min to complete. Mean, median, range, and standard deviation were used to describe the
continuous variables, and percentages were used to describe the categorical data.
RESULTS: Among 240 HCWs, 79.16% (n = 190) participants have good knowledge and adapted
good precautions (score 15–23) for COVID 19 infection. Rest 20% (n = 48) and 0.8% (n = 2)
participants has average (score 8–14) or poor knowledge (score <8) with adaptation of average or
poor precautionary measures against COVID 19, respectively.
CONCLUSION: This study concluded that we have the requirement of more educational training
programs for awareness of HCWs and precautionary measures against COVID 19. Thereby, HCWs
can improve their knowledge and participate in this fight against COVID 19 with more efficiency and
confidence.

Abstract BACKGROUND: Corona virus disease 2019 (COVID‑19) is a highly infectious disease primarily
spreading through droplet infection which require significant restriction and modification in dental
treatment. This study aims to assess the knowledge and attitude of adult population toward COVID‑19
and dental treatment and to assess the availability of dental treatment and patient satisfaction during
the time of pandemic.
MATERIALS AND METHODS: An online survey was conducted using self‑designed electronic
questionnaire consisting knowledge and attitude about COVID‑19 and dental scenario and questions
regarding availability of dental treatment received during the time of pandemic. Knowledge scores
were assessed on a maximum total score ranged from 0 to 8, and descriptive statistics were done
for questions related to attitudes and dental treatment availability.
RESULTS: A total of 495 participants with mean age of 36.6 years participated in the study. The
mean knowledge score was 7.12 ± 0.99 and the participants were found to have good awareness
and positive attitude regarding COVID‑19 were as considerable number of participants were unaware
about the risk associated with dental treatment as well as restrictions imposed on dental procedures.
About 18% of participants experienced one or other form of dental complaints during the lockdown
period. 4% of participants had no accessibility to any form of treatment.
CONCLUSIONS: Public awareness is to be improved regarding risk of cross infection that can
be associated with dental treatment and public should be motivated to use virtual facilities like
tele‑dentistry so that no dental emergencies is left untreated, at the same time avoiding any sort of
unnecessary hospital visit during the pandemic time.

Abstract In December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2)
became evident in Wuhan, China, and then spread rapidly worldwide. Numerous drugs
and vaccines are under clinical trial pipeline for investigation against coronavirus disease
2019 (COVID‑19) infection. The aim of this systematic review was to discuss about
investigational new as well as repurposed drugs currently under trial for COVID‑19
infection. An exhaustive search was carried out for this review article including scientific
databases of PubMed, Embase, ClinicalTrials.gov, WHO International Clinical Trials
Registry Platform, Web of Science, ScienceDirect, ProQuest, Google Scholar, and Scopus
search engines using keywords of “Coronavirus,” “COVID‑19,” “MERS‑CoV,” “MERS,”
“SARS‑CoV‑2,” and “SARS‑CoV‑1” and “Solidarity trial” and their Persian‑equivalent
keywords from inception until May 2020. After screening the 296 articles searched from
different databases (PubMed = 97 and other search engines = 199), 52 articles were included
in the final systematic review. It was found that the World Health Organization introduced
a Solidarity international clinical trial to discover an effectual treatment of COVID‑19. Based
on established in vitro and in vivo activity against different strains of coronaviruses, four
repurposed drugs – remdesivir, lopinavir/ ritonavir combination, lopinavir/ritonavir
with beta‑1a, chloroquine, and hydroxychloroquine – were considered for clinical trial
against COVID‑19. A number of other drugs and vaccines are under clinical trial pipeline
for investigation against COVID‑19 infection. Despite multitude of treatment options
available, treatment of choice is still not well established. Moreover, optimum supportive
care and monitoring of seriously ill patients is the need of the hour.

Abstract BACKGROUND: The novel coronavirus (CoV) has resulted in a global pandemic despite drastic
measures to avoid contagious spread. On April 3, 2020, there were around 1 million reported cases
and 51,515 deaths due to CoV disease 2019. The disease presents with flu‑like symptoms such as
fever, dry cough, and fatigue. India being a resource‑limited country, it is very important to differentiate
the suspected cases clinically.
AIM: The aim was to know the correlation of various clinical features of severe acute respiratory
syndrome CoV 2 (SARS‑CoV‑2)‑infected cases in selected districts of UP.
SETTING AND DESIGN: This was a retrospective cross‑sectional hospital‑based study.
MATERIALS AND METHODS: This was a retrospective cross‑sectional study performed on 1243
suspected cases of SARS‑CoV‑2 infection from March 25, 2020 to April 17, 2020 in the department
of microbiology of our institute to know the incidence of SARS‑CoV‑2 infection in selected districts
of Uttar Pradesh. These cases were analyzed to see the association of various clinical symptoms
with SARS‑CoV‑2 infection. For statistical analysis, Pearson’s Chi‑square test was performed using
SPSS version 23.
RESULTS: Out of total suspected cases, 4.5% were positive. Travel history was present in 80.4%
of positive cases. About 83.9% had fever, 28.6% had shortness of breath, 35.7% had dry cough,
17.9% had either Type I or II diabetes mellitus, 12.5% had chronic kidney disease, and 7.1% had
obstructive pulmonary diseases.
CONCLUSION: Negative clinical history is very important in ruling out the suspected cases who
came out to be free from the infection.

Abstract INTRODUCTION: Spread of novel coronavirus (severe acute respiratory syndrome coronavirus
2 [SARS‑CoV‑2]) has become a global and pandemic crisis. Some measures such as excessive
use of disinfectants, increased production of nonbiodegradable waste, and water pollution will be
the consequences of fighting against coronavirus disease 2019 (COVID‑19), which harms the
environment. Due to the fact that these effects will be identified in the long term, they may be
neglected in the current situation. Therefore, the aim of this study was to investigate the environmental
challenges caused by the SARS‑CoV‑2 pandemic crisis.
MATERIALS AND METHODS: This was a review study conducted by search in databases, including
Scopus, PubMed, and science direct until early May 2020. Keywords included “SARS‑CoV‑2,”
“COVID‑19,” and “Environment.” Studies published in English and conducted in different countries
were also selected for the analysis. The guidelines published by reputable organizations such as
the World Health Organization, the Centers for Disease Control prevention (CDC), and the Ministry
of Health have also been used in this study.
CONCLUSION: The results of this study have shown that the COVID‑19 virus, in addition to human
damage and mortality, also affects the environment, and the damages and losses resulting from
this pandemic may be identified later. Water pollution, increasing chemical pollution in the air, and
increasing the production of nonbiodegradable waste are of these issues. For this purpose, it is
recommended that, in addition to trying to improve the control of this pandemic, other environmental
aspects in disinfection methods and disposal of dry and wet contaminated waste should be done
more accurately and based on standard protocols. Infectious waste, in addition to the problem of
standard sanitation, will become a major challenge that pollutes the environment. Based on this, it
can be said that if home quarantine is observed voluntarily, in addition to reducing the risk of the
SARS‑CoV‑2 and reducing the volume of visits to medical centers, it can be associated with another
positive achievement, which is the reduction in waste production and protection of the environment.

Abstract INTRODUCTION: The 2019 coronavirus disease (COVID‑19) is a major global health concern. Joint
efforts for effective surveillance of COVID‑19 require immediate transmission of reliable data. In this
regard, a standardized and interoperable reporting framework is essential in a consistent and timely
manner. Thus, this research aimed at to determine data requirements towards interoperability.
MATERIALS AND METHODS: In this cross‑sectional and descriptive study, a combination of
literature study and expert consensus approach was used to design COVID‑19 Minimum Data
Set (MDS). A MDS checklist was extracted and validated. The definitive data elements of the MDS
were determined by applying the Delphi technique. Then, the existing messaging and data standard
templates (Health Level Seven‑Clinical Document Architecture [HL7‑CDA] and SNOMED‑CT) were
used to design the surveillance interoperable framework.
RESULTS: The proposed MDS was divided into administrative and clinical sections with three and
eight data classes and 29 and 40 data fields, respectively. Then, for each data field, structured data
values along with SNOMED‑CT codes were defined and structured according HL7‑CDA standard.
DISCUSSION AND CONCLUSION: The absence of effective and integrated system for COVID‑19
surveillance can delay critical public health measures, leading to increased disease prevalence and
mortality. The heterogeneity of reporting templates and lack of uniform data sets hamper the optimal
information exchange among multiple systems. Thus, developing a unified and interoperable reporting
framework is more effective to prompt reaction to the COVID‑19 outbreak.

Abstract BACKGROUND AND AIM: Given the prevalence of novel coronavirus disease 2019 (COVID‑19)
and the lack of information on coronavirus and pregnancy, the purpose of this study was to evaluate
the association of COVID‑19 and perinatal outcomes in pregnant women.
MATERIALS AND METHODS: In the present review article, the search process was conducted on
English and Persian scientific databases of PubMed, Scopus, Google Scholar, Magiran, Irandoc,
Iranmedx, and SID as well as the websites of international organizations of World Health Organization
and Centers for Disease Control and Prevention using the main keywords of “Pregnancy,” “Perinatal
outcomes,” “Coronavirus,” “COVID‑19,” “MERS‑CoV,” “MERS,” “SARS‑CoV‑2,” and “SARS‑CoV‑1”
and their Persian‑equivalent keywords from inception until March 16 2020.
RESULTS: The findings of studies on mothers with COVID‑19 were limited, and insufficient information
is available on the adverse pregnancy outcomes in pregnant women with COVID‑19. In cases of
infection with other coronaviruses such as Middle East respiratory syndrome and severe acute
respiratory syndrome during pregnancy, there have been reports on adverse pregnancy outcomes
such as miscarriage, stillbirth, preterm labor, low birth weight, and congenital malformations following
high fever in the first trimester.
CONCLUSION: Pregnant women may be more susceptible to viral respiratory infections, including
COVID‑19, due to immunological and physiological changes. Therefore, pregnant women should
take routine preventive measures, such as washing their hands frequently and avoiding contact with
infected people, to prevent infection.