Journal of Education and Health Promotion

Abstract BACKGROUND: Many academicians suggested the supplementary use of 3D‑printed models
reconstructed from radiological images for optimal anatomy education. 3D‑printed model is newer
technology available to us. The purpose of this systematic review was to capture the usefulness or
effectiveness of this newer technology in anatomy education.
MATERIALS AND METHODS: Twenty‑two studies met the inclusion and exclusion criteria for
quantitative synthesis. The included studies were sub‑grouped according to the interventions and
participants. No restrictions were applied based on geographical location, language and publication
years. Randomized, controlled trial, cross‑sectional and cross‑over designs were included. The effect
size of each intervention in both participants was computed as a standardized mean difference (SMD).
RESULTS: Twenty‑two randomized, controlled trials were included for quantitative estimation of effect
size of knowledge acquisition as standardized mean difference in 1435 participants. The pooled effect
size for 3D‑printed model was 0.77 (0.45–1.09, 95% CI, P < 0.0001) with 86% heterogeneity. The
accuracy score was measured in only three studies and estimated effect size was 2.81 (1.08–4.54,
95% CI, P = 0.001) with 92% heterogeneity. The satisfaction score was examined by questionnaire in 6
studies. The estimated effect size was 2.00 (0.69–3.32, 95% CI, P= 0.003) with significant heterogeneity.
CONCLUSION: The participants exposed to the 3D‑printed model performed better than participants
who used traditional methodologies. Thus, the 3D‑printed model is a potential tool for anatomy
education.

Abstract

Abstract BACKGROUND: Play therapy is an intelligent tool in cognitive–behavioral therapies. In today’s world,
the Internet and technology play a key role in all aspects of people’s life including mental health.
The present study explores the feasibility of using Internet‑assisted play therapy to solve children’s
psychological issues in primary healthcare systems.
MATERIALS AND METHODS: The present qualitative research was conducted by the content
analysis approach on 20 experts working in the healthcare centers, who were selected purposefully.
The sample was saturated with these 20 participants. Data were collected through semi‑structured
interviews and were coded manually. Then, they were analyzed in the Atlas.ti software package.
RESULTS: The results revealed 15 themes and 10 sub‑themes. The themes included (1) safety, (2)
efficiency, (3) client‑orientedness, (4) organizational growth, (5) time, (6) effectiveness, (7)
justice‑orientedness, (8) access, (9) feedback, (10) analysis, (11) children’s computer game room, (12)
reward, (13) group game, and (14) capability to be integrated into other electronic programs.
CONCLUSION: It seems that Internet‑based play therapy is plausible to be used as a service in
primary healthcare to tackle the psychological problems of children in the target population if the
challenges related to the exploratory themes are taken care of.

Abstract BACKGROUND: There are no studies pertaining to resilience related to novel coronavirus focusing
primarily on doctors and undergraduate medical students in India. The objectives of this survey
were to assess the resilience and its various domains that are needed for dealing with novel
coronavirus among doctors, interns, and undergraduate students and to see its correlation with
various sociodemographic factors.
MATERIALS AND METHOD: An online cross-sectional survey was done among doctors and
undergraduate medical students during the first COVID-19 wave from May 19, 2020 to June 8, 2020.
A total of 434 responses were recorded during the study period. All the recorded full responses were
considered for data analysis. Snowball sampling was used for this study. Resilience was assessed
using three items, which were taken from the Brief Resilience Scale (BRS).
RESULT: Out of 434 responses, 51.7% (224/433) of the respondents were non‑resilient. The presence
of the elderly at home was significantly associated with poor resilience (P = 0.02). Resilience was
not significantly associated with other socio‑demographic factors. Younger respondents (P = 0.019)
and females (P =0.0004) were of the opinion that they recovered late from stressful events. Elderly
respondents (P = 0.003) and those with chronic illness (P = 0.008) reported that it is hard for them
to snap back if something bad happens (P = 0.003).
CONCLUSIONS: More than half of the doctors and undergraduate medical students were found to
be non-resilient, underscoring the urgent need to take steps to improve the resilience of this group
of frontline workers.

Abstract BACKGROUND: Coronavirus disease 2019 (COVID‑19) constrained the regular teaching in
educational institutions and hampered the teaching–learning process across the globe. E‑learning
method is widely used in higher education in the current situation. the objective is to assess the beliefs
and expectations of the students on e‑learning among adult learners of a tertiary level health‑care
institution.
MATERIALS AND METHODS: A single group pre‑post design was adopted. Microsoft Go two‑in‑one
devices were used to find the effectiveness of e‑learning, including digital exam solution. Depending
on the availability of device, 25 participants were selected for the study from three different steams.
A 5‑point Likert scale was used for assessing the quality, adoptability, and acceptance of digital
education developed by the researchers. Chi‑square/Fisher’s exact or McNemar’s test was used to
test the association between independent or related categorical variables. Comparison of the average
score between different courses was performed using the Kruskal–Wallis test.
RESULTS: Twenty‑two participants who completed the final assessment were retained for the
analysis. Majority of the participants believed that e‑learning helps to achieve personal learning
goals or objectives and bridge skill or knowledge gaps and caters to learning preferences.
However, the overall quality score across the study groups was found to be statistically insignificant
(Kruskal–Wallis statistic: 1.26; P value: 0.533).
CONCLUSION: The findings show that the adult learners in higher education, irrespective of their
age differences, believe that intense e‑learning support with Microsoft Go two‑in‑one device has a
complementary effect on their learning outcome.

Abstract Abstract:
The coronavirus disease 2019 (COVID‑19) pandemic has negatively affected the medical services,
particularly cancer diagnosis and treatment, for vulnerable cancer patients. Although lung cancer
has a high mortality rate, monitoring and following up of these patients can help to improve disease
management during the pandemic. Telemedicine has proven to be an effective method of providing
health care to these patients. As a result, the purpose of this study was to identify telemedicine
applications in the management of lung cancer patients during the COVID‑19 pandemic. In this scoping
review, studies published in online scientific databases such as Web of Science, Scopus, and PubMed
between January 1, 2020 and September 1, 2021 were systematically searched and screened. The
studies were chosen using predetermined inclusion and exclusion criteria. The bibliometric information
and technological aspects of included studies were collected using a data extraction form and the
data was analyzed using the content analysis approach. A total of 68 articles were found, from which
four articles were finally selected based on specific inclusion/exclusion criteria. Real‑time consultation
was one of the most common applications of telemedicine to deliver health‑care services to cancer
patients. Health‑care providers used applications such as Zoom, Facetime, WeChat, and e‑mail,
as well as devices including PCs, phones, and smartphones to provide real‑time consultation to
patients via videoconferencing, phone calls, and messaging, as well as store and forward consultation
via e‑mail. Telemedicine in the COVID‑19 pandemic provides health‑care services to lung cancer
patients at their homes by enabling physicians and patients to communicate in real time. Several
telemedicine services are still unavailable for patients with lung cancer. As a result, health experts,
politicians, and entrepreneurs must pay special attention to this issue.

Abstract BACKGROUND: Coronavirus disease 2019 (COVID‑19) pandemic has created unprecedented
challenges for the Indian health‑care system. Nurses, being vital partners of health care, experience
tremendous challenges and job stress to deliver quality health care with limited resources. Drastic
surge in health‑care demands during COVID‑19 pandemic amplified the challenges for nurses, yet it
remains a neglected area of concern. Job resources like working conditions, team support, and job
demands like workload, stress, and ethical dilemmas greatly affect the job satisfaction and health
outcomes in nurses. The study aims to identify the job demands and resources among nurses in
connection to COVID 19.
MATERIALS AND METHODS: A quantitative cross‑sectional design was adopted to assess the
impact of job demands and resources among registered nurses (N = 102).Those in the age group
of 21–58 years and working in regular and COVID‑19 patient care were included. Semi‑structured
interview schedule was used, and psychological impact was assessed through DASS‑21 scale. Data
analysis was done by descriptive and analytical statistical applications using Statistical Package for
the Social Sciences (SPSS) 20. The level of significance was P ≤ 0.05.
RESULTS: The study findings revealed that 66.67% of the nurses frequently experienced work
pressure, 72.55%experienced frequent moral distress, and 80.4%were dissatisfied due to being
non‑participatory inpatient care decision making. Of all, 67.3% agreed that they hadjob dissatisfaction
and 79.4% felt conflicting work climate.
CONCLUSION: Nurses, being key players in the health care, experience constant challenges in
the delivery of safe and quality patient care. Addressing the challenges of job stress and promoting
job resources can positively impact their job satisfaction, perceived autonomy, job morale, and
commitment, which directly influence positive health outcomes.

Abstract BACKGROUND: Patients with a vegetative state (VS) are completely dependent on caregivers in
all physical aspects of their lives. Caring for such patients comes with a great deal of difficulty for
family caregivers. As a result, family caregivers must be fully trained and prepared for this role. The
present qualitative study was conducted to investigate the educational challenges faced by family
caregivers of VS patients for home care preparedness.
MATERIALS AND METHODS: The present qualitative study was conducted through the conventional
content analysis method from August 2020 to September 2021 in two provinces of Iran (Sistan and
Baluchestan Province; and Razavi Khorasan Province). Fourteen family caregivers of patients in a VS
were included in the study. Semi‑structured and in‑depth interviews were employed to collect data.
The Graneheim and Lundman method was utilized to conduct the data analysis using MAXQDA2020
software. Data collection continued until data saturation and the identification of main categories.
RESULTS: As indicated by the data analysis, three categories of “unmet educational needs,”
“confused caregiver,” and “searching for practical knowledge” which included 19 sub‑categories
described the experiences of family caregivers of patients in a VS concerning challenges they went
through in preparation for patient care at home. Participants’ experiences revealed that despite the
inadequacy of educations provided by health‑care providers on knowledge and skills required by
family caregivers, they were committed to caring for the patient and trying to acquire the required
knowledge.
CONCLUSION: Results indicated that inadequate education and the lack of family caregivers’
contribution to caring for the patient in the VS during their stay in the hospital impedes their acquisition
of adequate knowledge and skill to care for patients at home. Therefore, healthcare system
policymakers should be planning to eliminate the educational barriers faced by family caregivers
and expand the educational activities of hospitals’ homecare centers to provide educational support
of family caregivers after the patient’s discharge.

Abstract
BACKGROUND: Working conditions play a significant role in the process that causes cardiovascular 
disease. In this regard, it is required to monitor the health conditions of workers to design proper 
interventions to encourage healthy behaviors. This investigation was performed to determine 
preventive behaviors against cardiovascular disease based on the health belief model (HBM).
MATERIALS AND METHODS: This research was a cross‑sectional and descriptive study with 228 
subjects of oil industry workers under shift work schedules in the oil regions of Khuzestan, Iran. The 
HBM questionnaire provided the theoretical framework for this study. Participants completed the 
questionnaires in person at work. Data were analyzed using SPSS 24.0. Descriptive statistics including 
frequencies, percentages, and means, and linear regression analysis were calculated for variables.
RESULTS: Findings of the study showed that most workers were of a weak level of knowledge (55.3%), 
self‑efficacy (82.5%), perceived severity (83.8%), perceived susceptibility (75.4%), perceived 
benefit (57.5%), and behavior (82.5%). Furthermore, results showed that most of the workers 
considered smoking (3.51 out of 5) and proper diet for good heart function (2.54 out of 5). In this study, 
the item of exercise was the lowest among all the preventive behaviors (1.39 out of 5). Self‑efficacy 
was the strongest predictor of health belief about cardiovascular disease.
CONCLUSION: To decrease the increasing burden of cardiovascular disease in our population, and 
fight against this rank‑one killer, multiple useful prevention strategies must be adopted. Educational 
theory‑based interventions and applying designed programs to improve the adoption of preventive 
behaviors are a necessity.

Abstract BACKGROUND: Linking anatomy with the clinical approach for creating an inquisitive mind for
a millennium via the digital platform is the need of the hour. Traditional lecturing makes students
have rote memorization of the human anatomy. The inquiry‑based project will allow undergraduate
medical students to have a deeper understanding of human anatomy along with team building and
interpersonal skill development. This approach of teaching would allow students to link the content
taught for human anatomy with its clinical applicability and probably generate inquisitiveness for
further exploring the course content. The study aimed to appraise and assess the perception of
medical students and faculty about the inquiry‑based digitalized project presentation.
MATERIALS AND METHODS: A descriptive cross‑sectional study was conducted for inquiry‑based
project presentation where students were divided into 15 groups with 15 inquiries, which were
presented as projects on a digital platform under the guidance of the facilitator. The perception
of students and faculty for the inquiry‑based approach was collected using a validated survey
questionnaire. The quantitative data were analyzed by SPSS‑version 15, using descriptive statistics,
Friedman’s rank, and thematic analysis for qualitative data.
RESULT: In total, 117 students participated in the pre‑test and 129 in the post‑test part of the study.
Also, 79.1% of students appreciated that the inquiry‑based project presentation approach allowed
them to link anatomy with different courses; 73.6% agreed that this approach has a positive impact
on their attitude toward learning anatomy. Then, 75.2% students appreciated of learning new skills
using the digital platform. They agreed to have developed leadership (65.1%) and team‑building
skills (83.7%) and self‑directed learning (SDL) improvement (71.3%). However, some students (9.3%)
and faculty (16.7%) had been ostracized for presenting their inquiry‑based projects on a digital
platform, whereas 65.1% of students appreciated this approach.
CONCLUSION: Inquiry‑based learning approach would allow students to have a deeper
understanding of the subject knowledge and skills for the SDL and learn strategies for the usage of
virtual technology for literature search.

Abstract BACKGROUND: The ability to interact and communicate effectively is one of the factors affecting the
performance of faculty members, which is considered one of their basic competencies. The purpose
of this study was to identify the factors affecting on interaction of faculty member with student and
colleague, through the synthesis of literature.
MATERIALS AND METHODS: The research method was qualitative with a meta‑synthesis approach.
Meta‑synthesis was performed with Sandelowski and Barroso method. After the research of databases
in the period 1995–2021, 259 studies were collected and finally 48 sources were selected and were
included in the analysis phase. Coding method was used to analyze the data.
RESULTS: Analyzing the findings of previous researchers and synthesizing the results, 155 codes,
18 subcategories, and 6 categories were identified and validated through kappa coefficient. The
categories included “emotional‑cognitive factor,” “sociocultural factor,” “communication factor,”
“professional factor,” “educational factors,” and “management factor.”
CONCLUSION: Based on the findings of this study and the importance of faculty members’
interactions in medical universities, it is recommended that university officials and administrators
use the results of this study to provide a suitable platform for creating and strengthening these
interactions through holding workshops.

Abstract BACKGROUND: The capacity of self‑authoring one’s own beliefs, identity, and relationships is core
to many expected outcomes of future health‑care professionals. Students’ personal and professional
development for self‑authorship can be promoted by the variety of developmentally effective
“crossroads” experiences that they encounter. Identifying the characteristics of the crossroads
experiences in clinical rotations can provide a foundation for medical educators to provide an
environment that can foster self‑authorship.
MATERIALS AND METHODS: A cross‑sectional qualitative survey was conducted using a researcher
developed semi‑structured questionnaire which had three open questions and asked medical interns
to describe their internship experiences that stimulated their thinking along the self‑authorship
dimensions of identity, relationships, and ways of knowledge acquisition. Data were analyzed using
Braun and Clarkes’ thematic analysis method.
RESULTS: The survey was completed by 167 medical interns (response rate: 83%). The key features
of significant crossroads experiences and their effects were created into six themes: Experiences by
being respected and validated; experiences by involvement in patient management; experiences by
participation in interactive learning environments; experiences by participation in authentic clinical
work environments; experiences by the observation of professional behaviors; experiences through
the uniqueness of different specialties.
CONCLUSION: Authentic experiences of patient management in the real world of clinical settings with
a high interactive environment have the potential to promote interns’ self‑authorship development.
Educators can support learners by respecting and validating their capacities and by role modeling
of professional behaviors.

Abstract BACKGROUND: Learning helps acquire knowledge or skills. COVID‑19 outbreak severely affected
the progress of education all across the globe. Pandemic‑induced alternative methods of teaching
promoted the progress of online education. Hence, this study is undertaken to assess an overview
of teaching learning strategies in the COVID‑19 pandemic so as to explore the direction of medical
education and help perk up the teaching learning methods in medical education.
MATERIAL AND METHODS: The cross‑sectional study involves first year medical undergraduate
students of 2020–2021 batch studying at Dr.VMGMC, Solapur. It involves complete enumeration of
students of 2020-2021 batch. Due to the second wave of COVID‑19 pandemic hematology, classes
were continued and completed by the same faculty by online live teaching using Microsoft teams.
As this being an online survey, it was ethically exempted. A comparison of questionnaires between
offline and online classes was done by using χ2
 test and a P value less than 0.05 was considered
as significant. Quantitative data generated by the dichotomous question and five‑point Likert scale
questions were analyzed using descriptive statistics and frequency analysis. Out of 189 respondents,
majority of students preferred traditional offline classes over online classes. Self‑directed learning
was feasible in both methods of teaching.
DISCUSSION: Traditional offline classes were more interactive and enthusiastic than online classes.
Offline classes helped students to revise, recollect, and reproduce necessary information as their
attention span was better in offline teaching than online teaching.
CONCLUSION: Holistic understanding and better learning were experienced through traditional
offline classes. Although teachers take double efforts for online teaching, the overall learning effect
and impact of traditional offline classes were much better than online classes. It definitely motivates
andrgaogy and helps understand the concept on their own.

Abstract BACKGROUND: Today, the increasing process with the using internet is a kind of disease among
adolescents, especially in the COVID‑19 pandemic. The activities such as learning–educational
process and online games will become one of the problems for families. This study aimed to
determine the relationship between internet addiction and parent–child relationships in high school
girls in Isfahan.
MATERIALS AND METHODS: This descriptive‑correlational study was conducted in girls’ high school
in Isfahan, Iran. One hundred and sixty students and one of their parents had participated through
cluster sampling method. They filled out the Young Internet Addiction Questionnaire and the Fine
et al.’s Child‑Parent Questionnaire (PCRS). Data were analyzed using descriptive statistical tests
and Pearson correlation test. The significance level of the data was considered 0.05.
RESULTS: The mean score (standard deviation) of internet addiction was 52.15 (5.67). 62.5% of the
participants were not addicted to the use of the nternet. The mean score of the parent–child relationship
was 118.24 (85.35). The results of the Pearson correlation test show that there is a significant negative
correlation between parent–child relationships and Internet addiction in adolescent girls (P < 0.01).
CONCLUSIONS: Therefore, in the girl high school students who have a stronger parent–child
relationship, the rate of Internet dependence is lower. Due to the current situation of the COVID‑19
pandemic in terms of Internet addiction and the parent–child relationship, the present study can
help nurses, teachers, and educational planners to provide a suitable information for appropriate
intervention.

Abstract BACKGROUND: The expansion of pregnancy‑related mobile applications has led to an increase
in the usage of these applications by Iranian women, which has the potential to have a long‑term
impact on women’s pregnancy health and, as a result, community health. The goal of this research
was to investigate the state of pregnancy‑related mobile applications in Iran.
MATERIALS AND METHODS: This was a descriptive‑applied research approach which was
conducted in 2020. One hundred and fifty‑seven pregnancy apps from different Iranian mobile app
markets were installed and were examined in terms of the resources used and their validity, subject
distribution, participation of obstetricians in the app development, apps volume, rank acquired by
users and distribution of apps according to the developers. The relationship between the number of
resources used and user rankings was also tested.
RESULTS: A total of 157 apps were categorized into 12 subject categories based on their content.
Only 1.3% of the apps were developed with the participation of obstetricians. Only 5% of the apps
had used reliable information resources. Furthermore, the number of resources referenced in the
studied apps did not have a significant relationship with star ratings (r = 0.03, P = 0.64), according
to the Pearson correlation test.
CONCLUSION: Iranian mobile applications in the field of pregnancy have grown significantly in
terms of quantity, subject diversity, and user acceptance; however, the credibility of the information
in these apps cannot be validated. This serves as a reminder to users to exercise caution while
using such apps.

Abstract BACKGROUND: In this novel intervention, we have tried to incorporate case‑based learning with
creative and critical thinking. Creative thinking indulges students to generate and apply new concepts
in specific situations, seeing current situations in a new light, identifying alternative theories, and
exploring new links that help generate a positive outcome. This may involve combining various
hypotheses to form something original, sifting and refining ideas to discover possibilities, constructing
new theories, and acting on intuition.
MATERIALS AND METHODS: This is a quasi‑experimental study on educational intervention.
First Bachelor of Medicine and Bachelor of Surgery (MBBS) students (N = 80) in their First MBBS
students were randomly divided into control (n = 40) and study (n = 40) groups after they had
undergone case‑based learning in their first semester. The study group was asked to prepare three
cases each on type II diabetes mellitus (DM), Fe deficiency anemia, and obstructive jaundice by
discussion. Each case was prepared with a) an introduction consisting of presenting complaints,
b) body comprising laboratory findings, and c) five questions related to the case. The cases were
reviewed by a facilitator and presented to the other groups for discussion. Pretest and posttest
questionnaires were collected and analyzed.
RESULTS: Based on the pretest scores, students were grouped as low, average, and high performers.
Wilcoxon signed rank test was performed, which revealed significant improvement in the posttest
scores of all students in the study group.
CONCLUSION: By designing new case histories themselves, students were able to understand
the biochemical concepts of common diseases and apply these concepts in causation of diseases.
Thus, case‑based learning in this setting helped to foster creative and critical thinking skills of first
MBBS students.

Abstract BACKGROUND: There have been criticisms that local authorities develop disaster planning
independently, which led to less sensitiveness and responsibility of community‑based
organizations (CBOs). Disasters planning should incorporate into CBOs’ management processes.
This study aims to set goals of a community‑based plan based on preparedness capacities that
CBOs need to have in the COVID‑19 pandemic.
MATERIALS AND METHODS: This cross‑sectional study used a prevalidated and reliable
questionnaire assessing (CBOs). The tool assesses preparedness in the field of planning, training,
and infrastructure. Forty CBOs met the inclusion criteria as assisting or cooperating agencies during
the COVID‑19 pandemic. Then, key informants, who simultaneously have been working in the health
system and CBOs, prioritized low‑scale items that have shown capacity gaps according to effects
on the vulnerable group, sustainability, and capability of the health system. Descriptive statistics
performed using SPSS18 software (SPSS Inc., Chicago, USA).
RESULTS: The results showed that the preparedness of CBOs was weak in the field of planning,
training, and infrastructure. Besides, overlaps of CBOs’ resources and covering the clients’ medical
needs in the COVID‑19 pandemic were the most priority that needs to be intervened.
CONCLUSION: Providing medical needs by CBOs require legal legitimacy assigned by health
authority, especially in epidemic‑prone diseases. In addition, assigning a coordinator to set a priority
list and mutual agreements authoried by health departments can solve the problem of overlapped
resources. Therefore, functional roles of CBOs in the pandemic should focus mostly on resource
allocation and the medical needs of clients to set goals and functional objectives.

Abstract BACKGROUND: The COVID‑19 pandemic has affected face‑to‑face teaching across the globe.
The sudden shift in learning methods has impacted learning experiences significantly. Students’
perception about online compared to blended learning might affect learning. The objective of this
study was to evaluate physiotherapy students’ perception of blended compared to online learning.
MATERIALS AND METHODS: This mixed‑method study documents physiotherapy students’ perception
about the courses delivered through blended learning (BL) mode during the COVID‑19 pandemic.
Physiotherapy graduates and postgraduate students who completed their evidence‑based physiotherapy
practice courses at Sri Ramachandra Institute of Higher Education and Research, Chennai (N = 68)
participated in this study. The participants’ perceived experience about synchronous online mode and
BL during the pandemic was assessed using a questionnaire and focus group discussion.
RESULTS: All the participants felt that the course outcomes were met and that they gained knowledge
and skills in evidence‑based practice. Most of the students (93%) recommended a blended mode of
learning compared to online learning alone. Thematic analysis of the focus group discussion (FGD)
identified enhanced learning experience, collaborative learning as enablers to BL, and availability
of gadgets and quality of online contents as barriers.
CONCLUSION: Participants showed par preference for blended learning over online learning as it
provided flexibility and facilitated active learning compared to online learning alone.

Abstract BACKGROUND: Crises are often unavoidable events that occur around the world. Hospitals play
an important role in treating patients and preventing extensive injuries in times of crisis, requiring
adequate preparedness. In order to design a proper planning system, it is essential to be aware of
the challenges of hospitals during a crisis. The purpose of this study was to explain the challenges
of hospitals admitting COVID‑19 patients in the city of Mashhad, Iran, from the perspective of their
managers.
MATERIALS AND METHODS: This study employed a qualitative approach, using the method of
conventional content analysis and was conducted from May to July 2020. A purposive sampling
method was used to recruit the senior managers of hospitals admitting COVID‑19 patients in Mashhad.
The interviews were conducted face to face, with open‑ended questions following an interview guide
based on semi‑structured questions, and continued until data saturation was reached. Data were
analyzed using Atlas Ti software.
RESULTS: After the implementation of the interviews, first 665 initial codes were extracted from
the data, and after removing the overlapping sequences, a total of 115 codes were obtained. Three
categories (organizational challenges, extra organizational challenges, and challenges related to
information domain), 13 sub‑categories, and 33 codes were extracted from the content analysis of
the interviews. The main themes propounded in the field of challenges of COVID‑19 referral hospitals
in Mashhad were organizational challenges, extra organizational challenges, and information domain
challenges.
DISCUSSION: The results of this study showed that the hospitals admitting COVID‑19 patients in
Mashhad faced many challenges. To improve the quality of services in postcrisis phase, replacing
hospitals’ equipment, revising curriculums at medical universities, staff retraining, recruiting skilled
human resources, and creating a supportive community context are necessary.
CONCLUSION: For sure, the COVID‑19 crisis will not be the last one, we have to be prepared for
the bigger health crisis.

Abstract BACKGROUND: Diagnostic dilemma arises when patients with clinical suspicion of COVID‑19
disease having moderate‑to‑severe respiratory symptoms yield negative result for COVID‑19 in
reverse transcription polymerase chain reaction (RT‑PCR). This study evaluated the clinical, laboratory
and HRCT thorax findings among RT‑PCR‑negative COVID‑19 suspects with moderate‑to‑severe
disease.
MATERIALS AND METHODS: A hospital‑based retrospective observational study was conducted
between July 2021 to December 2021, among 60 moderate and severe symptomatic COVID‑19
suspects admitted in the severe acute respiratory illness (SARI) ward and intensive care unit (ICU),
who were negative for COVID‑19 in RT‑PCR. Data were abstracted from the medical records section
of the hospital using a predesigned data abstraction form and presented by descriptive statistics.
RESULTS: Mean age of study participants was 55.5 years (SD 14.1 years), and majority were
males (n = 43, 71.7%). Common presenting symptoms were fever (n = 60, 100%), dyspnea
(n = 57, 95%), and cough (n = 54, 90%). The common laboratory findings were rise of C‑reactive
protein (n = 60, 100%), NLR (n = 49, 81.7%), d‑dimer (n = 47, 78.3%), ferritin (n = 46, 76.7%), and
LDH (n = 40, 66.7%). HRCT scan of thorax revealed ground glass opacities with or without consolidations
located bilaterally with diffuse or peripheral distribution, interlobar septal thickening (n = 43, 74.1%),
vascular thickening (n = 35, ≥58.3%), and sub‑pleural lines (n = 32, 53.3%). Median CT‑SS value
was 15 (IQR 11–19), and majority (n = 56, 93.3%) belonged to CO‑RADS ≥4.
CONCLUSION: Diagnosis of COVID‑19 can be presumed in RT‑PCR‑negative suspected
COVID‑19 patients with moderate‑to‑severe disease, with marked rise of inflammatory markers and
HRCT revealing typical findings of COVID‑19 pneumonia.

Abstract BACKGROUND: Congenital heart disease (CHD) is one of the underlying medical conditions that
put children at increased risk for coronavirus. This study aimed to predict preventive behaviors of
COVID‑19 among children with CHD based on the protection motivation theory (PMT).
MATERIALS AND METHODS: This cross‑sectional study was conducted from March 2021 to April
2021, on 240 children 3–7 years with CHD whose data had been registered in Persian Registry of
Cardiovascular Disease/CHD (PROVE/CHD) System in Isfahan, Iran. The research variables were
measured using an online researcher‑made questionnaire that was based on PMT constructs. The
collected data were analyzed using statistical tests (e.g., Pearson correlation coefficient and linear
regression analysis).
RESULTS: From a total of 240 participants (mean age of 4.81 ± 1.50) in the present study, 122 (50.8%)
were girls. The most common types of CHD among children participating in this study were related
to atrial septal defect (ASD) (29.2%, n = 70) and ventricular septal defect (VSD) (26.7%, n = 64),
respectively. Protective behaviors showed a significant correlation with all constructs of PMT. The
PMT constructs explained 41.0% of the variances in protective behavior, in which the perceived
reward (β = 0.325) and perceived self‑efficacy (β = 0.192) was the most important, respectively.
CONCLUSION: The results of this study showed well the effectiveness of PMT on the preventive
behaviors of COVID‑19 in children with CHD. This theory can be used to teach preventive behaviors
of COVID‑19 to children with CHD in education programs.

Abstract BACKGROUND: Coronavirus disease (COVID‑19) causes significant psychological distress among
nursing students. College‑bound nursing students might have preferred different types of coping
strategies to deal with psychological distress. This study aims to measure the psychological distress
and role of coping styles to mediate the stress level among the baccalaureate nursing students amid
the COVID‑19 pandemic.
MATERIAL AND METHODS: A cross‑sectional online survey was conducted in December 2020 at
a nursing college attached to a tertiary care teaching hospital, North India. Nearly 251 baccalaureate
nursing students completed the Impact of Event Scale‑Revised (IES‑R) and Coping Orientation to
Problems Experienced Inventory (Brief‑COPE) scale to report their psychological distress and coping
styles, respectively. Chi‑square test, independent sample t‑test followed by binary and multivariable
regression were used to identify the factors associated with distress in students during the pandemic.
RESULTS: Students’ mean age was 22.22 ± 1.24 years. The mean IES‑R was 19.59 ± 12.45 in
nursing students. Psychological distress found a significant association with age (P = 0.022), academic
class (P = 0.016), travel history (P = 0.034), and being positive reverse transcription–polymerase
chain reaction (RT‑PCR) for COVID‑19 status of self (P = 0.018) and family members in the medical
profession (P = 0.013). In binary logistic regression, stress level found a significant association with
first‑year academic level (OR: 3.250, 95% CI: 1.429–7.390, P = 0.005) and family members in the
medical profession (OR: 4.44, 95% CI: 1.019–19.382, P = 0.047). Adaptive coping styles were more
frequently preferred than maladaptive coping styles (54% vs 41%). Adaptive (r = 0.295, P < 0.001)
and maladaptive coping (r = 0.403, P < 0.001) shows a significant positive relationship with stress
in students, respectively.
CONCLUSIONS: Coronavirus pandemic causes significant distress among nursing students. Students
were able to manage stress using acceptance and religious/spiritual coping strategies. During the
pandemic, stress management to support mental health is highly recommended.

Abstract BACKGROUND: During the course of their education, medical students must attain moral
competence. The current study aims at designing a formative structured examination that would create
the opportunity for learners to practice and interact with simulated patients under expert supervision.
MATERIALS AND METHODS: This article reports an experience in developing and implementation
of a formative assessment of moral competence and the point of view of medical students. In this
study, the formative structured examination of medical ethics for 80 medical students in 2 rounds
with eight stations was designed. In each station, a scenario was proposed, and the opportunity was
provided to the learners to interact with a simulated patient under the supervision of a medical ethics
expert. Then, the learners would receive structured feedback in accordance with their performance.
All learners expressed their experience in reflective writing, and their opinions were put under content
analysis.
RESULTS: The content analysis of this reflective writing revealed three main categories, namely
“Deeper understanding of ethical subjects,” “Collaborative thinking and synergy with peers,” and
“Effective feedback of supervisors.”
CONCLUSION: Within the framework of a formative structured examination of medical ethics, a safe
space was created for interacting with simulated patients and practicing ethical reasoning, as well
as dimensions of moral competence.

Abstract BACKGROUND: Cervical cancer is the leading cause of death worldwide, especially in developing
countries. More than one‑fifth of newly diagnosed cervical cancer cases are occurring in India. Cervical
cancer is a highly preventable and curable cancer compared with other types of cancer, if detected
at an early stage. The present study has been carried out to assess whether a community‑based,
multicomponent, nurse‑led intervention program improves cervical cancer screening behavior of
women.
MATERIALS AND METHODS: An experimental randomized controlled trial was carried out by
recruiting 419 women in the age group of 30–60 years (246 in the experimental group and 173 in the
control group) residing in a selected rural community (selected tribal settlements) of Idukki district of
Kerala, India, using multistage cluster sampling. The intervention comprising small group education
followed by reinforcement session, telephonic reminders, navigation and guidance for Pap smear,
and follow‑up visit by the investigator was administered to the experimental group, and the control
group did not receive any intervention. Knowledge, attitude, and screening behavior of women related
to prevention of cervical cancer were assessed before and twice after the intervention.
RESULTS: The experimental and control groups were homogenous in all baseline sociodemographic
variables. The community‑based intervention program was effective in improving knowledge(P< 0.001),
attitude (P < 0.001), and screening behavior (P < 0.001) of women regarding the prevention of cervical
cancer. A significant moderate positive correlation was found between knowledge and screening
behavior (r = 0.408). Significant association was found between knowledge, attitude, and practice
regarding prevention of cervical cancer with education, age at the time of marriage, and number of
pregnancies.
CONCLUSION: The community‑based, multicomponent, nurse‑led intervention program was
effective in improving cervical cancer screening behavior among women. Repeated motivation and
reinforcement are needed to bring behavioral change and to increase uptake of screening services
among rural women.

Abstract BACKGROUND: Adopting a healthy lifestyle is necessary to maintain and promote health. The aim
of this study was to determine the effect of teach‑back method on improving the lifestyle of health
ambassadors in Urmia.
MATERIALS AND METHODS: In this quasi‑experimental study, 200 health ambassadors were
participated. The research sample was obtained using simple random sampling method. Data
collection tool was a questionnaire including demographic characteristics and lifestyle standard. The
educational intervention was performed in 4 sessions of 45 min based on the teach‑back method.
Data were collected through a lifestyle questionnaire before and 3 months after the educational
intervention. Then, the data were analyzed by mean and standard deviation, independent t‑test,
paired t‑test, and Chi‑square test through SPSS 19.
RESULTS: The results showed that 24% of the control group and 21% of the intervention group
had a good lifestyle before the educational intervention. After the educational intervention 27% of
the control group and 54% of the intervention group were in good lifestyle. The results also showed
that the mean score of total lifestyle and all its dimensions in the intervention group increased
compared to the control group after the educational intervention and the difference between the
mean score of total lifestyle and all its dimensions in the intervention group after the intervention
was significant (P < 0.05).
CONCLUSIONS: Among health ambassadors, teach‑back communication is more effective in
improving the lifestyle. Therefore, it is suggested that this method must be used in designing training
programs for health ambassadors.

Abstract BACKGROUND: During clinical practicum, nursing students are subjected to stressors that can
affect their well‑being, academic performance, and technical skills. The purpose of this study was to
evaluate the psychometric properties of the Arabic version of the Perceived Stress Scale of Clinical
Practicum (PSS‑CP) in a sample of Moroccan nursing students.
MATERIALS AND METHODS: In this study, a translation and back‑translation method and
comparisons were made with the original version. The study population consisted of 215 nursing
students. The construct validity of PSS‑CP was measured using exploratory (EFA) and confirmatory
factor analysis (CFA). Convergent validity was demonstrated by correlation with the Arabic version
of the Depression, Anxiety, and Stress Scale (DASS‑21). For reliability, Cronbach’s alpha and test–
re‑test reliability (with a 10‑day interval) were used. Data were analyzed using IBM SPSS Statistics
V. 23.0 (SPSS) and AMOS V.21.0 (SPSS) software.
RESULTS: The results showed that the PSS‑CP is a reliable and valid scale with good internal
consistency and test–re‑test reliability. In terms of convergent validity, the PSS‑CP showed a positive
and significant correlation with the DASS‑21 scale items. The results of this study led to a two‑factor
model consisting of 29 items.
CONCLUSION: The PSS‑CP is a valid and reliable instrument for assessing clinical stressors among
nursing students in Morocco.

Abstract BACKGROUND: Improving self‑care in adolescent pregnancy leads to improved maternal and
neonatal outcomes of pregnancy. However, self‑care in adolescent pregnancy is less than other
women. The aim of this study was to compare the effect of face‑to‑face training and telemedicine
on self‑care in adolescent pregnant women.
MATERIALS AND METHODS: The present study is a quasi‑experimental study that was conducted
in Zahedan in 2021 and 120 adolescent pregnant women with a gestational age of 15–20 weeks
participated in it. The sampling was done in multistage, and the samples were divided into three groups:
Face‑to‑face training, telemedicine, and control. Face‑to‑face training was presented in five sessions
and the telemedicine group received the similar educational content through the mobile applications.
The samples completed a researcher‑made self‑care questionnaire before the intervention and at
28 weeks of gestation. SPSS software version 21 was used for the analysis, and data were analyzed
by ANOVA, Tukey post hoc, Kruskal–Wallis, and Mann–Whitney tests.
RESULTS: There was no significant difference in face‑to‑face and telemedicine training in improving
the scores of nutritional performance, smoking and narcotics use, personal hygiene, and routine
pregnancy care (P > 0.05), but face‑to‑face training caused more improvement in the scores of
sports and physical activity as compared to telemedicine group (P = 0.04). Face‑to‑face training
and telemedicine training in all domains led to a significant improvement in scores as compared to
the control group (P < 0.05).
CONCLUSION: The results of this study showed that the face‑to‑face training and telemedicine
methods were proper methods for self‑care education in pregnant adolescent women. It is
recommended to use these methods in promoting self‑care in pregnant adolescent women.

Abstract BACKGROUND: “Should students keep their webcams on or off during synchronous online classes?”
is an unanswered question with educators’ opinions divided on this aspect. Along with educators’
perspectives, it is also important to unfold students’ perspectives on this question. The objectives
of this study were to determine the routine and opinion of students’ regarding webcam usage and
identification of students’ reasons for not using webcams during online learning.
MATERIALS AND METHODS: A cross‑sectional study was carried out at Margalla Institute of Health
Sciences, Rawalpindi, Pakistan. Census was done for data collection by including all dental students(n=180)
enrolled at the institute attending synchronous online preclinical and clinical operative dentistry classes.
Data collection was carried out using a self‑administrated questionnaire. Descriptive analysis was used to
describe survey item responses. Pair‑wise differences between demographic categories (female vs. male,
and preclinical vs. clinical) were analyzed using the Pearson Chi‑Square test. Correlation of routine and
opinion with students’ reasons were done using Spearman correlation. Ordinal regression analysis was
done to associate routine and opinion with reasons. The level of significance (P value) was set at 0.05.
RESULTS: Out of 180 students, 141 submitted the survey form, with a response rate of 77.47%. The
majority of the students (n = 117, 83%) used to keep their webcams off during online classes and
were (n = 69, 48.9%) of the opinion that webcams should be kept off during online classes. The most
common reasons for keeping the webcam off during online classes were “comfort” (n = 87, 61.7%)
and “distractions” (n = 84, 59.6%). A statistically significant association of gender was obtained, with
females more likely than males due to distraction, self‑consciousness, and appearance (P = 0.000,
0.003, and 0.016, respectively). The odds of gender highly influenced routine use of cameras, and
this was statistically significant (OR: 3.478, P = 0.011). Students tended to keep their webcam off
when they were inattentative during online classes (OR; 3.743, P < 0.001).
CONCLUSION: The majority of the students did not agree to keep the webcam on during online
synchronous learning. The main reasons for students’ reluctance to keep the webcam on were
self‑consciousness, surrounding consciousness, distractions, and technological issues. Students
can be encouraged to turn the webcam on by framing strategies according to students' concerns.

Abstract BACKGROUND: The minimum data set (MDS) is one of the important steps in the development of
health care information systems. According to the Ministry of Health in Iran, a central and national
registry along with Parkinson’s MDS (PMDS) has not yet existed. So, this research was conducted
to establish a PMDS in Iran.
MATERIAL AND METHODS: This study was a descriptive–comparative method, which was done
in 2019–2021 in four phases: (1) determining data elements related to Parkinson’s disease in Iran
and selected countries; (2) extracting and categorizing the data elements; (3) making a PMDS
draft; (4) evaluating a draft by Delphi technique. The research population was the MDS in Australia,
Canada, the United States of America, and Iran. After extracting the data elements of Parkinson’s
disease from various resources, the primary draft PMDS was developed. Then, the research group
divided it into two categories (administrative and clinical). After that, it was sent to 50 healthcare
professionals for validation by the Delphi method.
RESULTS: Following the results of the two rounds of Delphi technique, Finally, PMDS was established
including a total of 223 data elements in two categories: administrative and clinical with 72 and 151,
respectively. Every category included 10 and 14 subcategories.
CONCLUSION: The first and the most important step for standardization of data collection nationally
is creating MDS. Due to the necessity of the existence of PMDS, a complete list of PMDS was
established for collecting data on Parkinson’s patients.

Abstract BACKGROUND: The influence of western lifestyle such as high‑caloric dense food and sedentary
lifestyle has a great influence on Indian children, and the current prevalence of childhood overweight
in India ranges between 4% and 22%. The primary aim of the study was to determine the change
in growth parameters (waist circumference) as well as dietary behaviors at baseline and at the
end of first, third, sixth, and ninth months among overweight adolescent girls and boys following a
school‑based nutritional education program.
MATERIALS AND METHODS: The study was conducted in 2019 in four urban schools at Puducherry
which were randomly assigned to study and control groups by lottery method, and 140 overweight
children aged 11–14 years were in the study group and 140 children were in the control group.
Simple random sampling method was used to select the samples A nutrition education program
highlighting the importance of balanced nutrition and the ill effects of obesity was imparted to students
in the study group through a PowerPoint presentation. As a means of reinforcement, posters and
pamphlets were distributed. The waist circumference and the mean calorie, protein, and fat intake
were assessed at baseline and at the first, third, sixth, and ninth months and compared between
groups using independent t test.
RESULTS: There was a statistically significant reduction in waist circumference in the study group
when compared to the control group at P < 0.05. A significant decrease in the calorie intake at
P < 0.001 and fat intake at P < 0.01 was observed in the study group. The protein intake in the study
group increased at the end of 9 months, which was significant at P < 0.001.
CONCLUSION: School‑based nutritional education program has been found to be a successful
intervention in controlling unnecessary weight gain among overweight adolescents.

Abstract BACKGROUND: Role of multimedia training materials on Mini-CEX scores of internal medicine
residents. We aimed to assess the effect of multi multimedia training materials on Mini-CEX scores
of internal medicine residents of Isfahan University of Medical Sciences.
SETTINGS AND DESIGN: A quasi-experimental action research study on 1st, 2nd, and 3rd-year
internal medicine residents were implemented.
MATERIALS AND METHODS: The Mini-CEX test measures students’ performance in six core skills
necessary for medical practice. Mini-CEX scores of 135 internal medicine residents in 2017–2018
were compared before and after the training with prepared multimedia materials. We used repeated
measured ANOVA and Mann–Whitney U test to compare the distribution of Mini-CEX scores across
corresponding groups. Analysis was done using the SPSS software version 23 (IBM SPSS Statistics
for Windows. Armonk, NY, USA: IBM Corp).
RESULTS: The median Mini-CEX score (IQR) of students in preintervention and postintervention
groups were 16.14 (5.19) and 19.62 (3.13), respectively. Findings of this study showed a significant
increase in mini-CEX scores of the groups who used the multimedia learning material compared to
those who did not use it (P < 0.001).
CONCLUSIONS: Multimedia learning resources demonstrated a promising influence on internal
residents’ mini‑CEX scores in this study. They demonstrate significantly greater performance after
using multimedia learning materials compared to their same‑year residents who did not benefit from
it. This demonstrates the favorable effect of multimedia on the acquisition of practical skills such as
obtaining a history or performing a physical examination.

Abstract BACKGROUND: The preeminent mental health conditions, namely social phobia and depression
among adolescents, usually remain incognito. The transition period from childhood to adulthood
makes adolescents more liable for low amour‑propre, loneliness, and even increases the suicidal
tendencies among them. To burgeon the knowledge regarding social phobia and depression among
adolescents, the present study was put forward with the objective to assess the prevalence of social
anxiety disorders (social phobia) and depression among adolescents.
MATERIALS AND METHODS: A cross‑sectional study was conducted for 2 months on 600 students
aged 10–19 years belonging to classes VIII–XII of government and private schools in the Dehradun
district recruited through multistage random sampling technique. A pre‑tested semi‑structured
questionnaire having sociodemographic details, validated self‑administered tools, Social Phobia
Inventory tool, and Kutchers Adolescent Depression Scale (Cronbach’s alpha: 0.77 and 0.79) were
used. Statistical package for social sciences, version 23 was used for data analysis. Chi‑square test,
Fisher exact test, and Pearson correlation analysis were used for analysis
RESULTS: Prevalence of social phobia was found to be 37% among school‑going adolescents.
Further, 23.7% of the study participants had mild social phobia, while moderate and severe phobia
was seen among 11.5% and 2.3%, respectively. Females had more moderate and severe social
phobia than males. Adolescents of government schools had more moderate affective distress and
somatic distress as compared to adolescents of private schools.
CONCLUSION: Social phobia and depression among school‑going adolescents are on the upsurge.
The present study shows that social phobia and depression have a strong correlation among
themselves, which needs to be addressed as expeditiously as possible. Coping strategies and social
skill therapy and programs are pressing priorities for the fulgent future of adolescents.

Abstract BACKGROUND: Technical skills result in the patient’s safety. Psychiatric nurses need to learn and
apply them to provide effective and secure cares. This study explains the technical competency
required for postgraduate psychiatric nursing students.
MATERIALS AND METHODS: This conventional qualitative content analysis study is part of a larger
study on the clinical competency of postgraduate psychiatric nursing students performed in Iran in
2020. A qualitative study was conducted at universities holding master’s degree courses in psychiatric
nursing. Participants were instructors and postgraduate psychiatric nursing students, psychiatric
nurses, psychologists, and psychiatrists selected by purposeful sampling method. Sampling continued
until data saturation was achieved. Data were collected through a semi‑structured individual interview
and were analyzed by conventional qualitative content analysis.
RESULTS: The “technical competency” has two subcategories of “specialized knowledge” (including
general nursing knowledge, psychiatric nursing knowledge, and basic knowledge of psychology)
and “application of knowledge in practice” (including clinical experience, skills of psychiatric nursing
interventions, educational skills, and research and evidence‑based practice skills).
CONCLUSION: The psychiatric nursing student learns and operates knowledge of psychiatric
nursing, psychology, education, and research, besides improving their knowledge of general nursing.

Abstract BACKGROUND: The care of infants during their first six months is a significant matter. As there
have been shifts in social and economic conditions, families are diverging into several forms. This
study aimed to explore parenting styles for infants and the relation between parenting styles for
infants and family types.
MATERIAL AND METHOD: This study was a cross‑sectional study, focusing on the main caregivers
of approximately six‑month‑old infants. The data was collected from February to July 2021. The
research tool employed was an interview form. The collected data was then analyzed.
RESULTS: Two hundred sixty‑four families of primary caregivers were included in the study.
The family type most frequently found was the skipped generation family, accounting for
119 families (45%). All family types mostly practiced the uninvolved parenting style as the parenting
style for infants. Regarding response to infants, most families practiced the permissive parenting
style. When investigating relations between parenting style for infants and family type, it was found
that skipped generation family caregivers practiced a less authoritative parenting style than the
nuclear family, including holding family activities with the infant (0.16, 95%CI: 0.05–0.47); when the
infant raises their voice to communicate (0.32, 95%CI: 0.14–0.71); training the infant to roll over
(0.21, 95%CI: 0.06–0.69); when the infant cries (0.16, 95%CI: 0.05–0.47); and when the infant does
not respond (0.19, 95%, CI: 0.05–0.74)
CONCLUSION: The most practiced parenting style for infants among all the three family types was
the uninvolved parenting style. Regarding the response to infants, the permissive parenting style
was mostly observed.

Abstract BACKGROUND: Medical students are exposed to stresses which have irreversible consequences,
such as suicidal ideation. The present study aimed to investigate the level of occupational stress in
medical students and its relationship with the prevalence of suicidal ideation and attention among
them and then provide mental health promotion approaches.
MATERIALS AND METHODS: This cross‑sectional descriptive study was performed on
325 undergraduate medical students residing at the dormitory of Shahid Beheshti University of Medical
Sciences. The sample size was determined by the census method. Osipow and Suicide Behaviors
Questionnaires were used to measure job stress and suicidal ideation, respectively. The condition
of entry into the study was living in the dormitory and spent at least one semester. Linear regression
and logistic regression were used to examine the relationship between variables.
RESULTS: The mean score of occupational stress among students with a mean age of 21 (±2.18)
years was 158.84 (±27.07) and 60% (n = 180) of students had high levels of stress. There
was a significant relationship between age and educational level with stress level and suicidal
ideation (P < 0.05). They had the highest effect on stress (P = 0.031) and suicidal ideation (P = 0.001),
respectively, among students. High level of stress was 11.829 times more likely to have suicidal
thoughts than low‑stress level (P < 0.001).
CONCLUSIONS: Stress and suicidal ideation are much higher in students of lower semesters and
lower ages than students with higher semesters. Students should learn how and with what approach
to control and manage exposure to stressors. Measures such as holding stress management training
courses as well as managing stressful situations are among the effective measures in improving
mental health and reducing stress levels and its effects.

Abstract BACKGROUND: Increase in competitive demands has led to the promotion of seminar presentation
by the students to increase active learning and for the assessment of learning. Portfolios are an
important tool for assessment for learning. The objectives of the study were to compare the gain in
knowledge among the conventional and the blended seminar groups (intervention group), analyze
the working portfolios to assess for learning, and to gather the perception of students.
MATERIALS AND METHODS: This was an interventional study (2016) with convenience sampling
that included 27 students each in the conventional and interventional groups. It was conducted in a
medical college in central India. The conventional group was teacher led and the blended seminar
group was student led with interaction with the students regarding the contents of the portfolio.
Student’s unpaired and paired t tests were used for statistical analysis. P < 0.05 was considered as
the level of significance. Class average normalized gain (g) was used as a measure of effectiveness
of the intervention. Quantitative questions were analyzed using percentages and qualitative data
using categorization.
RESULTS: Significant difference was found between the conventional and intervention
groups (P < 0.05) with gain “g” being 0.52 for the intervention group. On evaluation of the feedback,
students commented regarding its interactive nature and progress during the learning process. The
reflections were coded as text as the unit of coding and student as the unit of coding. It was also found
that the students who were critical reflectors were the ones who scored > 50% in the posttest scores.
CONCLUSION: The present study showed that seminar when blended with portfolio yielded positive
results in the process of learning, and hence was effective in assessment for learning.