Journal of Education and Health Promotion

Abstract BACKGROUND: To ascertain the effectiveness of a collaborative model between the Department
of Community Medicine and state health department to improve MCH outcomes among the urban
poor in Chandigarh.
MATERIALS AND METHODS: A quasi‑experimental study was conducted from 2011–12 to 2015–16
in the intervention and control areas. A collaboration was established between the state health
department and the Department of Community Medicine of an autonomous institute. The intervention
and control areas were mainly inhabited by the poor migrant population. Critical elements of an efficient
collaboration such as the early engagement of partners, clearly stated purpose with common goals,
effective communication, and no financial conflict were implemented in the intervention area. MCH
program’s implementation was strengthened through supportive supervision, enhanced community
engagement, male partner involvement, tracking of high‑risk pregnant women, and identification of
problem families. Trend analysis of MCH indicators was done. The difference‑in‑difference (DID)
analysis was done to measure the net effect of the intervention.
RESULTS: All the MCH indicators improved significantly in the intervention area compared to the
control area (P < 0.05). DID analysis depicted a net increase in the early registration of pregnancies
by 18%, tetanus toxoid immunization by 9.2%, and fully immunized children by 8.6%. There was also
an improvement in the maternal mortality ratio by 121.1 points, infant mortality rate by 2.2 points,
and neonatal mortality rate by 2.6 points in the intervention area.
CONCLUSION: An innovative, collaborative model between the state health department and the
Department of Community Medicine effectively improved the MCH outcomes in Chandigarh.

Abstract BACKGROUND AND AIM: Given the growing trend of aging and the limited resources of the health
system, the lack of long‑term prior government planning, and reduced growth of the productive force
of society, identifying strategies for planning and action to deal with future aging is very important.
In this regard, the study was conducted to identify strategies for dealing with the aging population
from the perspective of health system experts.
METHODS: The qualitative content analysis study was performed on 29 Iranian male and female
experts in the aging and health scope from Isfahan, Tehran, Tabriz, and Babol who purposefully
participated in the semi‑structured interview. Data were classified by qualitative content analysis.
RESULTS: Two concepts emerged according to the participated experts’ opinions, regarding the
strategies of the Iranian health system in dealing with future aging: “executive policy” strategies,
including “design, planning and implementation,” “evaluation and standardization,” “strengthening
demand‑driven” and “modeling national and international experiences,” “preventive policies”
strategy, which includes “Focus on prevention,” “Focus on values and competencies,” “Educational
empowerment,” “Knowledge‑based empowerment,” “Empowerment of age‑related groups,”
“Economic empowerment,” and “Social support.”
CONCLUSION: The diversity and breadth of the mentioned strategies indicate the necessity
of comprehensive readiness and adaptation of health services to the elderly conditions and
characteristics. Purposeful planning and timely implementation of programs and policies to better
address the health system with future aging will be possible by using practical strategies.

Abstract BACKGROUND: The loss of a pregnancy can result in grief, guilt, self‑doubt, anxiety, and
post‑traumatic stress disorder (PTSD). Considering the side effects mentioned for mental health
and the fact that the symptoms will linger if left untreated and even adversely affect the subsequent
pregnancies. The current study was designed to assess the impact of individual counseling on stress,
anxiety, and depression in mothers with pregnancy loss.
MATERIALS AND METHODS: The study commenced 100 women who experienced pregnancy loss
(in Urmia/2018-2019); they were enrolled using convenience sampling and block randomization. The
intervention group received four individual counseling sessions (weekly sessions with a duration of
1 h) based on Warden’s principles. The control group received routine care. The Depression Anxiety
Stress Scale (DASS‑42) was filled out at baseline, the pre‑ and post‑intervention. Analyses were
performed using the Chi‑square, paired, or individual t‑tests, when necessary. P value < 0.05 was
considered significant.
RESULTS: There were no significant differences regarding socio‑demographic characteristics and
clinical features between groups at baseline. Intra‑group analysis showed that all outcome measures
in the intervention group were significantly improved. According to inter‑groups analysis, a significant
association was found between pre‑test and post‑test in the intervention group (P < 0.05).
CONCLUSION: Results of this study can clarify the psychological effects of pregnancy loss in these
mothers and help the officials and responsible parties to plan the treatment and rehabilitation of these
women and include them in the healthcare system.

Abstract BACKGROUND: Male reproductive health is a necessary pillar of childbearing. If a reproductive health
assessment is conducted in the preconception period, the chance of a healthy pregnancy can increase.
This qualitative study aimed to explore men’s reproductive health needs before conception in Iran.
MATERIALS AND METHODS: This research was a qualitative study conducted in Bushehr city, Iran
to explore men’s reproductive health needs from April 2021 to November 2021. 30 semistructured
interviews were conducted with married men, women, healthcare providers, and specialists individually
in the health centers. The sampling method used in this study was purpose‑based with maximum
variety. All interviews were digitally recorded and transcribed verbatim in Persian and analyzed
using directional content analysis. MAXQDA software version 12 was used to facilitate data analysis.
RESULTS: From the data analysis, 2 themes, 15 categories, and 38 subcategories emerged. The
themes included evaluation and health promotion recommendations. It consisted of 10 categories:
reproductive life plan evaluation, medical history evaluation, family and genetic history evaluation,
social history evaluation, sexual health evaluation, medication evaluation, laboratory evaluation,
physical examination, lifestyle evaluation, and mental health evaluation. Health promotion
recommendations included five categories: nutritional recommendations, stress management,
avoiding harmful behaviors, protective measures against harmful exposure, and need for education.
CONCLUSIONS: Our results showed that men need a comprehensive evaluation of reproductive
health and recommendations to improve their health in the preconception period. Our study findings
can inform healthcare providers to increase men’s participation in reproductive health.

Abstract BACKGROUND: Over the past few years, a rapidly growing number of science and technology
parks (STPs) in health sector have emerged across the world. There has been little discussion in
the literature to show how STPs could make an attractive environment to absorb and retain potential
firms. This is even more challenging for specialized STPs in health sector. The aim of this study is
to identify the attractive factors for firms in a STP in health sector.
MATERIALS AND METHODS: A scoping review method was undertaken to review the literature
on seven databases (ScienceDirect, Scopus, ProQuest, Google Scholar, EconPapers, PubMed,
and ISI Web of Science) for peer‑reviewed articles published until 2019. The search results were
screened against the inclusion of criteria to ensure they met the objectives. The eligible papers were
then assessed on the basis of the full text, and finally the results were extracted.
RESULTS: The attractive factors for firms and talents in multidimensional STPs and those in health
sector are extracted and summarized. The attractive factors of multidimensional STPs, which
includes health sector firms, and those specialized in health sector are summarized in three main
categories; factors created by government and universities, and factors related to STP policies and
those expected by the firms.
CONCLUSION: To make STPs attractive for firms in health sector, there is a list of factors that
are required to be done not only by STP itself, but also by the national and local government and
industries. It is important to consider the factors that are expected by the firms to be implemented.
The results of this study suggest that making STPs attractive for health sector firms needs close
collaboration between government, universities, related industries, and STPs all together.

Abstract BACKGROUND: In India, competency‑based medical education (CBME) is gaining foothold to
transform the medical student into a doctor fulfilling community and societal needs. With that end
in view the teaching faculty are getting sensitized and trained by the National Faculty Development
Program (FDP). We aimed to assess the awareness about FDP among teaching faculty in medical
colleges and study the attitude and perceived barriers to implementation of CBME.
METHODOLOGY: A cross‑sectional, electronically distributed, questionnaire‑based study was
conducted among medical faculty in India. The questionnaire identified participants’ awareness,
attitude, and perceived barriers to CBME. Descriptive analysis was employed for continuous variables
and internal comparison employing Chi‑square test with α <0.05 for statistical significance.
RESULTS: Among 251 participants 90.2% faculties from private institutes had undergone FDP as
against 71% from Government sector (P = 0.008). We observed that 92.4% were aware, 80.2%
had undergone Curriculum Implementation Support Program and 95.2% did agree that CBME will
improve the medical education system. Major challenges perceived were high student to faculty
ratio (67.7%), ill developed infrastructure (41.4%) and difficulties in assessment (41.1%). The popular
solutions suggested were to increase faculty strength (73.7%), improve infrastructure (69.3%), extra
remuneration (35.9%) and increase administrative support (30.7%). There was significant difference
of opinions between teaching faculty of government and private sector (P = 0.017).
CONCLUSION: Most of the medical faculty are aware of the need and have acquired a positive
attitude towards enforcement of CBME. However, significant barriers do exist in the form of manpower
and resources which need to be addressed.

Abstract BACKGROUND: Performing appropriate and regular screening can effectively reduce cervical cancer
and mortality rate, however, the available evidence suggests that women’s participation in cervical
cancer screening remains low in middle‑ and low‑income countries, and that it is necessary to identify
appropriate intervention methods to change behavior. The present study was designed to determine
the effect of decision‑aid‑based counseling on cervical cancer screening behavior among women.
MATERIALS AND METHODS: This trial study was conducted on 154 women with no history of Pap
smear during the past 3 years and refers to Tabriz health care centers. The participants were assigned
to the intervention (decision aid based counseling) and control (routine health education) groups
through randomized block design with block sizes of 4 and 6 and a 1:1 allocation ratio. The data
were collected using the sociodemographic and fertility characteristics, stages of change checklist,
and shared decision‑making (SDM) and decisional conflict (DC) questionnaire before and 6 months
after the intervention by interview and then, analyzed by SPSS24 software. The independent t‑test,
ANCOVA tests were used.
RESULTS: A significant difference was observed between the two groups in terms of changing the
stages of cervical cancer screening behavior 6 months after the intervention. As after the intervention,
the frequency of individuals entered the preparation or action stage was more than the control
group (P = 0.001). The mean score of SDM in the intervention group was significantly higher than the
control group after intervention ([45.49 ± 1.18] vs. [27.56 ± 1.18] [Mean Difference (MD): 17.92; 95%
confidence interval [CI]: 14.59–21.25; P < 0.001]). The mean score of DC in the intervention group
was significantly lower than the control group after intervention ([29.16 ± 1.09] vs. [34.14 ± 1.09] [MD:
−4.97; 95% CI: 1.09–8.04; P < 0.002]).
CONCLUSIONS: This study revealed that evidence‑based information communicated between clients
and clinicians has very important role in clients’ health‑related behavior. It is recommended, health
care providers apply decision‑aid‑based counseling for promoting the cervical cancer screening
behavior among women.

Abstract BACKGROUND: The trainee teacher seems to be more and more faced with frustration and
stress during the training phase, caused by accumulation of requirements and duties, making them
susceptible to the risk of burnout. The purpose of this work is to study the academic burnout of trainee
teachers at the Rabat‑Sale‑Kenitra region’s Regional Center for Education and Training Professions
during the COVID‑19 pandemic.
MATERIALS AND METHODS: Seven hundred thirty‑nine trainee teachers responded to a
self‑questionnaire comprising the Maslach Burnout Inventory–Student Survey scale in its French
validated version, as well as stress factors during the academic year 2020–2021. Both inferential
and descriptive methods of data analysis were used to represent the effect of sociodemographic
variables on burnout levels during the COVID‑19 pandemic.
RESULTS: In agreement with the literature, most of trainee teachers show moderate and high levels
of academic exhaustion; the main stressors presented are financial instability and training overload,
and the level of study influences the scale of burnout among trainee teachers.
CONCLUSION: The result of this study can serve as a predictor of academic burnout among
Moroccan trainee 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: Some pharmaceutical company sales representatives are using bribes to encourage
increasing medication prescriptions. In 2012, GlaxoSmithKline paid $3 billion on a felony charge
related to bribing doctors to prescribe the company’s medications. Using Hunt and Vitell’s general
theory of marketing ethics, the purpose of this qualitative multiple case study was to explore strategies
some sales managers in the pharmaceutical industry used to improve marketing training to reduce
unethical sales representative behavior.
MATERIALS AND METHODS: Data were collected from company reports and documents provided
by sales managers and semistructured interviews with five sales managers of different pharmaceutical
companies in the northeast region of the United States. Data were analyzed using thematic analysis
and Yin’s 5‑step process of compiling, disassembling, reassembling, interpreting, and concluding
thematic data analysis.
RESULTS: Three themes emerged from data analysis: developing ethical standards, developing
organizational policy, and implementing training and development programs. A key recommendation is
that pharmaceutical sales managers identify ethical standards to inculcate in their business practices
to achieve ethical marketing training that can result in sales representatives’ ethical behavior. The
implications for positive social change include the potential for sales managers to develop strategies
to reduce unethical behavior in the pharmaceutical industry.
CONCLUSION: Reducing unethical behavior may lead to more trust between patients and physicians,
improving patient satisfaction and promoting prosperity for the community through enhancing the
quality of health care.

Abstract BACKGROUND: Women undergoing breast cancer treatment, especially those of reproductive age,
experience sexual health challenges. The aim of this study is to design an interventional program
for promoting the sexual health of women undergoing breast cancer treatment.
MATERIALS AND METHODS: This is a mixed qualitative‑quantitative exploratory study consisting
of four phases. In the first phase, the needs and strategies for promoting sexual health of Iranian
women with breast cancer in Isfahan city will be identified through a qualitative study. The patients will
be selected using purposive sampling method and the data will be collected through semi‑structured
interviews. In the second phase of the study, the relevant literature will be reviewed. In the third phase,
the initial version of the program will be designed based on the results of qualitative study and review
of literature, the appropriate strategies are prioritized by the members of the panel of experts, and
then, the final interventional program is prepared. In the fourth phase, the designed interventional
program will be conducted as a quasi‑experimental study in two groups of intervention and control
and the effectiveness of the program on sexual quality of life, sexual satisfaction, and sexual function
of women undergoing breast cancer treatment will be evaluated. The type of the intervention will be
selected based on the results of the previous phases and the opinion of the expert panel.
CONCLUSIONS: The results of this study are expected to contribute to the design of an interventional
program based on the needs of women undergoing breast cancer treatment and promote health and
meet the sexual health needs of breast cancer patients.

Abstract BACKGROUND: Recordings of live streaming e‑lessons of pathology at medical school of National
and Kapodistrian University of Athens, Greece are uploaded to the e‑class portfolio of each student
enrolled in the course. We measured the number of views each video received and noticed that this
number exceeded the number of enrolled students. Our main aim was to investigate the correlation
between the upload of an educational video and the views it got so as to determine when the proper
time is for professors to e‑share or upload an educational video for the students.
MATERIALS AND METHODS: We measured the number of views of the recorded e‑lessons when
all videos were uploaded, with a frequency of 15 days. We used analysis of variances statistical
analysis to find the significance of the amount of time each video had been uploaded on the virtual
platform of the course. We also applied t‑tests to assess the significance of alteration of the number
of views related to the amount of time until the examinations.
RESULTS: Time was a statistically significant factor in the impact of an educational video. The
two‑factor analysis without interaction measured P ≃ 0.001, proving the strong correlation between
time and the increase of views. As the examination date was approaching, there was a statistically
significant increase in the number of views of the videotaped e‑lessons. Almost 50% of the views of
each of the videos took place in the two‑week examination period of the course.
CONCLUSIONS: The educational videos that contained the core learning concepts of the pathology
course should be uploaded first. The complex learning points of the pathology course must be
available at the beginning of the semester. Additionally, recordings of videos covering the complex
learning points of the course should be uploaded as an additional tool of asynchronous e‑learning
for the students who choose to watch their former e‑lessons to prepare for the examinations.

Abstract BACKGROUND: Investigating the status of intergenerational relationships of elderly parents with
their adult childen is very important in examining issues related to the status of the elderly such
as well being and quality of life and other aspects of elderly life. Giveeen the significance of the
topic, the current study aimed to examine the psychometric properties of the Persian version of
“Intergenerational Relationship Quality Scale for Aging Parents and Their Children” (IRQS‑AP).
MATERIALS AND METHODS: A total of 463 community‑dwelling elders (aged 60 years or older)
in Tehran participated in this study through multistage cluster sampling method. To investigate
reliability, the construct and convergent validity of the IRQS‑AP, confirmatory factor analysis (CFA),
and interclass correlation coefficient were done.
RESULTS: The content validity index was 0.84 for the entire tool. In the CFA, we found the instrument
had a four-factor structure and adequate internal consistency. The scale had a significant and positive
correlation with the two measures of loneliness and depression. Furthermore, Cronbach’s alpha was
estimated at 0.77, and the high value of the interclass correlation was 0.82.
CONCLUSION: The IRQS‑AP is a valid and reliable scale that can be used to examine the status
of intergenerational relationship quality in Iranian elder population.

Abstract BACKGROUND: Health‑care workers have to use the N95 mask as a part of the protection kit during
the COVID‑19 pandemic. The adverse effects of such practice are not fully elucidated. The study aims
to evaluate negative impacts of N95 face masks on health‑care personnel at COVID‑19 care units.
MATERIALS AND METHODS: One hundred and twenty‑two health‑care workers (aged 20–58 years)
from various health‑care settings in Sulaimani, Iraq, from January to August 2020, were enrolled in
this prospective, cross‑sectional study. The physiological variables (blood pressure, heart rate, and
oxygen saturation) were recorded before putting on the N95 mask and postremoval of the mask. The
incidence of adverse effects such as headache, difficulty breathing, redness, irritation, and dizziness
were also reported as a number and percent at the end of the work shift.
RESULTS: There was a statistically significant difference in the physiological parameters after
removal of the mask compared with baseline. Only diastolic pressure was significantly lower in those
working >6 h when compared to those working 1–6 h. The changes in physiological markers were
poorly and nonsignificantly associated with the duration of wearing the mask. Moreover, 67.2%–70.5%
of the participants complain of headaches and breathing difficulties, while 45.9%–51.6% reported
signs of itching, redness, and irritation. However, health‑care workers who put on the face mask >6 h
showed signs of headache, breathing difficulties, and itching at the exposed areas higher than those
working for 1–6 h.
CONCLUSION: N95 mask negatively impacts the physiological variables of health‑care providers.
The adverse effects may lead to excessive exhaustion after long shifts in the intensive care unit
during treatment of COVID‑19 patients.
 

Abstract BACKGROUND: Coronavirus disease‑2019 (COVID‑19) pandemic can aggravate the health
problems in slum areas. The present study intends to examine the challenges of health protection of
slum’s residences during the COVID‑19 pandemic with the Social Determinants of Health perspective,
in Kerman city in Iran.
MATERIALS AND METHODS: The present study was a qualitative content analysis. Data were
collected by purposeful sampling in‑depth and semi‑structured interviews with 16 people. The
interviews were conducted (from October to December 2020) with the local representatives of the
slum’s residents, health‑care workers, managers of facilitation offices, and welfare social service
centers that are located in slum areas (Interview’s guide is attached). The textual material from
the interviews was entered into the MAXQDA software and directed content analysis was used to
analyze the data.
RESULTS: Data analysis led to the identification of 4 categories (Sociocultural, Situational,
Economical, and Physical environment) and 12 subcategories: Sociocultural: lack of awareness,
begging culture, low trust in disease control programs, low bottom‑up planning, and increasing
violence; Situational: decreasing donors’ activities and canceling important meetings; Economical:
unemployment, decreasing in income, and increasing limitations of many institutions in providing
resources; and Physical environment: inadequate space and inappropriate conditions in some houses
and alleys for people protection against Corona viruses.
CONCLUSIONS: Slum residents have faced many challenges during the COVID‑19 pandemic.
These challenges can affect the health of slum and other urban dwellers. Multidisciplinary thinking
and actions are needed. Increase awareness and engagement slum residents in control disease
programs should be considered.

Abstract BACKGROUND: In a world where education directly influences the quality of life of an individual,
educational handicaps are a grave issue that plagues the lives of those affected. The current study
aims to find out whether there is a difference in the cognitive style and working memory capacity
among adolescents with specific learning disability (SLD) in comparison to their age‑matched
equivalent group without SLD. The study also targets to find out if there exists any relationship
between cognitive style and working memory.
MATERIALS AND METHODS: A total of sixty participants were selected (thirty adolescents with
learning disability and thirty age‑matched adolescents without learning disability) from Bangalore
district of Karnataka and Thrissur district of Kerala using purposive sampling method. The tools used
were the Indian adaptation of Embedded Figures Test by Nigam (1997) and the Wechsler Intelligence
Scale for Children‑Fourth Edition by Wechsler (2003).
RESULTS: The results showed that there exists a significant difference in cognitive style dimensions of
field dependence and independence between adolescents with learning disability (M = 11.6, standard
deviation [SD] = 6.52) and adolescents without learning disability (M = 25.2, SD = 7.33) as well as in
the working memory capacity between adolescents with learning disability (M = 66.7, SD = 19.26)
and adolescents without learning disability (M = 102, SD = 14.93) groups under study (p < 0.01).
The results also indicate that there exists no significant relationship between cognitive style and
working memory.
CONCLUSION: Adolescents with SLD was found to be field dependent and has low working
memory capacity than adolescents without learning disability. The results reflect the need for
developing cognitive interventions to enhance working memory capacity and cognitive style for
helping adolescents with learning disability in all areas of their functioning, such that the society
benefits as a whole.

Abstract The use of complementary and alternative medicine (CAM) is common in infertile women in different
countries. The purpose of the current study was to review the infertile women’s needs in relation
to CAM use. This narrative review was conducted through searching English databases including
Scopus, PubMed, Embase, Web of Science, Cochrane library as well as Persian databases consisted
of SID, and Magiran. The used keywords included “CAM/therapy, needs, and Infertility.” All studies
published in English peer‑reviewed journals from conception to October 2020, which examined the
infertile women’s needs in the field of CAM use were included in the review. In the process of data
extraction, two researchers screened the title, abstract, and full text of the articles. Out of the 2166
articles reviewed, 29 articles including six qualitative and mixed methods studies, four review, and 19
quantitative studies met the inclusion criteria. The results showed that infertile women have different
needs in six domains consisted of educational and informational needs, the need for psychological
counseling, supportive needs, the need for CAM use counseling, the need to treatment consistent with
women’s culture and demands, and the need to the integration of CAM with conventional medicine.
Awareness of infertile women’s needs toward CAM use can help health policymakers and planners
in designing and implementing counseling services in accordance with the demands and culture
of infertile couples. It also helps to develop a coherent program to integrate the use of CAM in the
classical infertility treatment.

Abstract BACKGROUND: Delay in the diagnosis and management of obstetric complications lead to raised
mortality rate. This can be curtailed by appropriate implementation of the educational intervention
among the health‑care providers. Hence, this review aimed to identify the literature evidence of the
efficacy of various educational interventions training in the management of obstetric complications.
MATERIALS AND METHODS: We searched PUBMED, Web of Science, SCOPUS, Google Scholar,
Cochrane, and maternity care databases with studies published from 2011 to 2021 for identifying
studies related to this educational intervention review using MeSH terms and free terms. The search
process was also done on the websites of the World Health Organization and the reproductive health
library in the English language. From the 1823 abstracts reviewed, 16 studies were included (15
quasi‑experimental, 01 randomized clinical trial, and 01 exploratory research design). We identified
studies that included skill assessment of nurses, midwives, auxilliary nurse‑midwives (ANMs), medical
students, interns, and doctors after implementing various educational interventions.
RESULTS: According to the findings of this literature, achieving enhanced nursing management of
obstetric complications has been developed. Especially, it suggests through better nursing training
and education and also by providing sufficient resources, time, and coordination with obstetric
specialists, nurses and midwives will be able to implement their care roles, which include proper
diagnosis, appropriate intervention, advanced care, client education, and psychological support. The
efficacy of each educational intervention varies and depends on the participants’ understanding,
interest, and the advancement of the teaching‑learning method used.
CONCLUSION: This systematic review reveals abroad and logical move towards the evaluation of
various educational interventions in the field of obstetric complications. Among all the educational
interventions implemented, mobile application, and simulation‑based training play a major role
in improving the knowledge and skills of health‑care providers in the management of obstetric
complications.

Abstract BACKGROUND: The unexpected increase in COVID‑19‑related waste and its inappropriate disposal
had blown up the threat of retransmission of this infection and adversely impacted the environment.
The aim of this study was to evaluate the existing knowledge about the handling of biomedical
waste (BMW) in the COVID‑19 Hospital setting among health‑care workers (HCWs).
MATERIALS AND METHODS: It was a prospective cross‑sectional study done for 3 months, i.e.,
October 2020–December 2020 among nursing professionals across all seniority posted in COVID
hospital. A pretested questionnaire comprised 20 questions was used as a study tool.
RESULTS: The response rate of our study was 94%. The mean age of respondents was 33.97 years,
and the mean length of service was 8.32 years. The study revealed that the respondents had a
mean knowledge score of 12.21 (Median 12, standard deviation 2.129 and 95% confidence interval
of 11.92–12.51).
CONCLUSIONS: There is consensus among the researchers/scholars that COVID‑BMW hazards
are much more significant than regular BMW. Therefore, its awareness among the HCWs can be a
panacea for safer handling of BMW generated in COVID Hospital.

Abstract BACKGROUND: Today, considering the importance of bioterrorism, it may be time to assess the
risk of bioterrorism as an important priority. Nurses, as the broadest group of therapy group, are
very influential in this regard.General aim: To determine the impact of bioterrorism education through
two methods of lectures and booklets on the knowledge and attitude of nursing staff. Practical Aim:
Minimizing the damage caused by bioterrorism attacks by empowering nursing staff.
MATERIALS AND METHODS: This two-group semiexperimental intervention study was performed as a
before and after education intervention with the participation of 80 nursing staff of Shams Al-Shomus Nezaja
Hospital affiliated to Health Administration of Islamic Republic of Iran Army Ground Forces. The study
population included all hospital nursing staff in 2021. The inclusion criteria included having a willingness
and informed consent to participate in the study and exclusion criteria included unwillingness to continue
cooperation and failure to complete more than 10% of the questionnaire by the subject. This study was
performed on 77 nurses in 2021. The nurses were divided into two groups: lecture and booklet. First,
the pretest was completed by the nurses. After the educational intervention, both groups completed the
posttest. Both groups then completed the questionnaire again after about 2 weeks. First, all the data were
measured for normal distribution by the Kolmogorov–Smirnoff test. Statistical description was expressed
for the variables with normal distribution as the ratio of geometric mean ± standard error and for abnormal
variables as mean ± standard error. To compare the means of the studied quantitative variables, t-test
and Wilcoxon matched-paired statistical tests were used. The significance level was considered <0.05.
SPSS.16 and Graph Pad Prism 8.0.1 softwares were used to analyze the statistical data.
RESULTS: Using both methods is effective in improving the level of knowledge and betterment attitude,
but according to the paired t-test in comparison of the two groups, at intervals immediately after training
and 2 weeks after training, a significant increase in the average knowledge score of the lecture group
Statistically shows (P < 0.001). However, the analysis of attitude scores was performed between the
two groups of lectures and booklets, which did not show statistically significant changes between them.
CONCLUSIONS: One of the most important issues in the performance of medical staff in bioterrorism
attacks is useful, effective, correct, and sufficient training. According to the results of the present
study,bioterrorism training leads to increasing the level of knowledge and betterment the attitude of
nurses in the field of bioterrorism. Therefore, the inclusion of training courses in medical centers,
especially military medical centers, is necessary and sensitive.

Abstract BACKGROUND: The severe acute respiratory syndrome coronavirus (SARS‑CoV‑2) has become
a public health concern worldwide. It is important for pregnant women to know about the mode of
transmission, symptoms, and preventive measures against COVID‑19. The aim of this study was
to evaluate the awareness and outlook of pregnant women and practical measures taken by them
against COVID‑19.
MATERIALS AND METHODS: This cross‑sectional questionnaire‑based study was conducted for
1 month (June 10, 2020– July 10, 2020) in the Department of Obstetrics and Gynecology, All India
Institute of Medical Sciences, Jodhpur, Rajasthan, India. A prevalidated questionnaire was given to
109 pregnant women to assess the knowledge, attitude, and practice acquired against COVID‑19
infection. The Chi‑square test or Fischer’s exact test was used to compare categorical data.
RESULTS: Among 109 participants, 103 (94.5%) had good knowledge, 4 (3.7%) had average
knowledge and 2 (1.8%) had poor knowledge about COVID‑19. Majority of them had a positive
attitude for the protective measures taken for the prevention of disease.
CONCLUSIONS: Since there is no valid treatment for COVID‑19, prevention is the only key to curve
this infection. In the present study, 94.5% pregnant women had overall good knowledge score about
the ode of transmission, symptoms, and preventive measures against COVID‑19.

BACKGROUND: The severe acute respiratory syndrome coronavirus (SARS‑CoV‑2) has become
a public health concern worldwide. It is important for pregnant women to know about the mode of
transmission, symptoms, and preventive measures against COVID‑19. The aim of this study was
to evaluate the awareness and outlook of pregnant women and practical measures taken by them
against COVID‑19.
MATERIALS AND METHODS: This cross‑sectional questionnaire‑based study was conducted for
1 month (June 10, 2020– July 10, 2020) in the Department of Obstetrics and Gynecology, All India
Institute of Medical Sciences, Jodhpur, Rajasthan, India. A prevalidated questionnaire was given to
109 pregnant women to assess the knowledge, attitude, and practice acquired against COVID‑19
infection. The Chi‑square test or Fischer’s exact test was used to compare categorical data.
RESULTS: Among 109 participants, 103 (94.5%) had good knowledge, 4 (3.7%) had average
knowledge and 2 (1.8%) had poor knowledge about COVID‑19. Majority of them had a positive
attitude for the protective measures taken for the prevention of disease.
CONCLUSIONS: Since there is no valid treatment for COVID‑19, prevention is the only key to curve
this infection. In the present study, 94.5% pregnant women had overall good knowledge score about
the mode of transmission, symptoms, and preventive measures against COVID‑19.

Abstract BACKGROUND: Unsafe medication administration and medication errors pose a threat to medication
safety. Safe medication is one of the most important nursing practices that plays an important role
in preventing medication errors. The aim of this study was to assess the medication administration
of nurses in cardiac wards and its relationship with some demographic characteristics.
MATERIALS AND METHODS: The present study was conducted as an observational study in 2021
with the 60 nurses who working in the medical cardiac wards of one selected hospital affiliated with
the Isfahan University of Medical Sciences. Data were collected using three‑part tools (demographic
information, medication checklist (55 items), and documentation checklist (8 items). The checklist
was completed by the observer after observing the nurses’ medication administration. Data analysis
was conducted using descriptive and inferential statistics in the SPSS software (version 16, SPSS
Inc., Chicago, IL, USA). A P < 0.05 was considered statistically significant.
RESULTS: The mean total score of the principles of injection and oral medication administration
were 82.53 ± 10.75 and 75.76 ± 9.62, respectively. The mean score of the principles of injection
and oral medication administration in the morning shift was significantly higher than the evening
and night shifts (P < 0.001). The relationship between the mean score of the principles of injection
medication (r = 0.234, P = 0.067), oral medication (r = 0.222, P = 0.083), and the nurses’ work
experience no significant. The rate of adherence to the principles of medication administration in the
premedication administration stage was higher than during and after drug administration.
CONCLUSION: Although the mean score of medication administration of nurses in the medical
cardiac wards was at the desired level, it is necessary to monitor and plan by nursing managers to
improve medication administration. Reducing the number of night shifts, adhering to accreditation
programs in the hospital, continuous monitoring of nurses in terms of compliance with the principles
of medication are among the proposed solutions to improve the safe medication in nurses.

Abstract Pandemic 2019 is observed in all sectors of the world which had caused a huge disruption in the
education system in India as well as worldwide adding challenges to student’s life. We aimed to
provide an outline on E‑Learning and the difficulties experienced by students of various colleges in
the southern parts of India and to conduct knowledge, attitude and practices (KAP) analysis based
on student’s perception regarding E‑learning by collecting an online survey, 346 valid questionnaires
were retrieved. In order to evaluate the association between the variables of KAP, structural equation
modeling was used for data analysis. The influencing factors of KAP were observed to know the
effect of the pandemic on E‑learning from the model. The result finding moderately fit the collected
data and reveals a good fit of the model in the means of satisfying the threshold values.

Abstract BACKGROUND: In recent years, among managers and designers of health‑care spaces, there
has been a growing tendency to move toward hospital design by combining patient perceptions
and expectations of the physical environment of the care area. The main idea of this study was
to present a conceptual model of hospital architecture in our country with a patient‑centered
approach based on some factors that were affecting the sense of place. This model determined
the architectural features of treatment spaces from a patient’s lived experience that could have a
positive mental effect on patients as well. The main question of the research was how to adapt the
objective perception to the patient’s mental perception to create a sense of place in the hospital
space?
MATERIALS AND METHODS: This research was qualitative with a phenomenological approach,
conducted between July and December 2020. Purposeful sampling consisted of 23 patients, 13 males
in the male surgery unit and 10 females in the gynecology unit, who were interviewed in‑depth. They
were hospitalized for at least 3 days in two hospitals (Dr. Pirooz in Lahijan and Ghaem in Rasht).
The data were analyzed by the Colaizzi method.
RESULTS: The results consisted of 530 primary codes, 57 subthemes, and 7 main themes. The main
themes were hospital location, access to hospital, hospital identity, hospital dependency, hospital
attachment, human interactions in the hospital, and hospital evaluation.
CONCLUSION: The hospital form guided the patient, and the hospital function directed and obviated
the patient’s needs. The healing environment and human interactions with it caused the patient to
be satisfied with the hospital environment.

Abstract BACKGROUND: Cancer is one of the leading causes of death globally. A considerable number of
different cancer types may be preventable, using primary intervention techniques, such as health
education, cancer awareness, behaviors and lifestyle modifications. The present study conducted a
comparative assessment of cancer awareness among undergraduate students of the United States
and India.
MATERIALS AND METHODS: Students from an Institution in India (KC) (55 females, 33 males),
and an Institution in the United States of America (SHU) (226 female, 58 male) during 2019–2020
participated in this study. Participants (n = 372) across all majors and all years (first through
fourth year) completed an online questionnaire and answered the questions on their demographic
characteristics (e.g., gender, age, and location), academic status (e.g., year of study, major),
multiple‑choice questions about cancer knowledge, and opinion questions (e.g., “where would you
find info,” “should therapies be free”). Student responses were collected using Qualtrics Survey
Software. Excel was used to analyze responses. We conducted statistical Χ2
 tests for independence
to determine whether there is a statistically significant difference between the expected frequencies
and the observed frequencies in one or more categories of a contingency table, with a significance
of ɑ = 0.01. While small sizes due to the small institutions and the response pool, we note that we
achieved the necessary “n” for all tests reported.
RESULTS: Our research shows a few important statistically significant differences, including
knowledge of cancer and breast lumps is dependent on location, ranking of global cancer deaths is
dependent on location, and that cancer knowledge is dependent on the information source. All for
Χ2
 tests with P < 0.001.
CONCLUSIONS: Further encouragement of education for young people in various aspects of
cancer and cancer prevention, as well as information facility and sources of reliable data, could be
helpful for improving the overall health and primary prevention. A thorough assessment is needed
to understand the responsible factors for the observed cancer knowledge variations among students
of two different places.

Abstract BACKGROUND: Change is a multidimensional and pervasive issue in the modern world, and
organizations are constantly changing in social, cultural, political, economic, and technological fields.
Change leadership is a model that employs a combination of leadership styles to keep the employees
and the organization prepared for learning and continuous growth. This study aims to identify the
dimensions and components of change leadership in medical sciences education to move toward
third‑generation universities through a qualitative approach.
MATERIALS AND METHODS: The present study was an applied explorative qualitative study.
Participants included the experts in the field of management and key informants in the field of change
leadership and third‑generation universities who were selected through purposive sampling. The
research tool was semi‑structured interviews aimed at the identification of dimensions and components
of the change leadership. Interview‑guided questions were about change leadership to move toward
the third‑generation universities followed by probing questions. Colaizzi content analysis technique
was used to analyze the data.
RESULTS: Data from interview transcript analysis resulted in the identification of 335 initial codes,
13 subcategories, and 3 categories or dimensions. The main categories included “change leadership
roles and specifications,” “providing a context and preparing for change,” and “change leadership
process and path.” Each of the main dimensions included several components.
CONCLUSION: The importance of leadership in the process of change is since change entails the
establishment and institutionalization of new systems and structures which is impossible without
an effective leadership style. Leaders have high expectations of their followers and inspire them
to strive toward organizational goals and facilitate the realization of the shared vision through
encouraging them. As a leadership paradigm for organization performance improvement capable
of encouraging employees and building an organizational culture in which ethical procedures are
considered behavioral norms, change leadership seeks to predict the environment changes so that
it can move in accordance with them.

Abstract BACKGROUND: Few women in history were respected by society because of their contributions
to the field of science, arts, politics, and so on, but in general, women are deprived of their rights
and being refrained from decision‑making in major areas of individual and family life. This research
tried to investigate the degree of empowerment and quality of life (QOL) of the women to find out
the relationship between empowerment and QOL of women.
MATERIALS AND METHODS: An exploratory survey was carried out among 210 purposively selected
married women aged between 20 and 49 years in a selected municipality area of West Bengal.
Data were obtained by one‑to‑one interviews using Women Empowerment Interview Schedule and
WHOQOL Scale BREF.
RESULTS: The mean total QOL score of the women was found as 98.59 ± 13.61. The transformed
scores in the physical, psychological, social relation, and environmental domains were 74.92 ± 14.97,
66.58 ± 15.78, 81.00 ± 18.07, and 65.28 ± 17.99, respectively. The degree of empowerment was
calculated as 64.71 ± 6.79. Among the women, 5% had poor, 62% had medium, and 33% had a
high degree of empowerment. A weak positive correlation (r = 0.325, P = 0.001) was found between
QOL and empowerment. Significant associations were established between empowerment and
education (Fisher’s exact = 13.975 [0.007]) and education gap with husband (Fisher’s Exact = 8.68,
P 0.069). Multiple regression analysis between empowerment dimensions and QOL shows that
personal or family dimensions, including health, are a significant predictor for the QOL (P < 0.01).
CONCLUSION: Most of the women had medium degree of empowerment. Increased degree of
empowerment improves their QOL of women. Women should be aware of their rights that can
enhance the empowerment in different dimensions of life.

Abstract Pregnancy termination and abortion‑related complications are well‑established problems among
women at reproductive age and resulted in significant morbidity and mortality. Accordingly, a
systematic study was performed to investigate the economic evaluation studies results on costs
and benefits of medical and surgical abortion methods. PubMed, Web of Science, Scopus, Embase,
Cochrane library, ProQuest, and ScienceDirect databases as well as Google scholar were searched
through June 2021. Original full‑text English language studies that performed an economic evaluation
analysis comparing medical and surgical methods of pregnancy termination were included in this
review. A critical quality assessment was conducted utilizing the Consolidated Health Economic
Evaluation Standards checklist. The latest web‑based tool adjusted the estimates of costs expressed
in one specific currency and price year into a specific target currency (the year 2020 $US). Overall,
538 records were retrieved, and 20 studies were deemed eligible for qualitative synthesis. Among
the reviewed studies, three studies investigated cost‑minimization analysis, three studies investigated
cost‑utility analysis, and 14 studies investigated cost‑effectiveness analysis. The directly comparison
of medical with surgical abortion was most frequently studied. Medical abortion saved US$ 6 to US$
2373 per patient’s costs. Medical abortion was cost‑effective and cost‑saving option in compare to
the surgical abortion across all perspectives (the incremental cost effectiveness ratio ranged from
US$ 419 to US$ 4,044). Quality scores of included studies ranged from 54% to 100%, and 70% of
studies received a score of above 85% and had “excellent” quality. According to the results, based on
various economic and clinical effectiveness decision‑making criteria used in different studies of health
economic evaluation, the majority of research provided evidence on the advantage of pharmaceutical
methods compared to surgical methods, as well as the advantages of using combinations therapy
compared to single therapeutic interventions.

Abstract BACKGROUND: Educators and health assistants can act as key players in controlling the pandemic.
In general, they are respected by the community, especially in rural areas, and can help guide and
raise the population’s awareness of preventive measures. The objective of this paper is to evaluate
the results in knowledge progress of an e‑learning course offered to educators and health assistants
by a public university and to analyze the profile and satisfaction of the participants.
MATERIALS AND METHODS: A single group pre‑ and post‑test design based on a questionnaire,
interventional, study was conducted in the period from April 20th to June 20th. All participants of the
course answered sociodemographic and satisfaction questionnaire and a pre‑ and post‑test. Data
were descriptively arranged and regarding the distribution and comparison of means and frequency,
paired t‑test for group comparisons. P < 0.05 was statistically significant. Data were collected from
the Moodle® teaching platform, without identifying the participants.
RESULTS: A total of 674 participants were enrolled in the five groups, and 583 concluded the
course (86.5%). The reasons for those who did not access the entire course (n = 47) were: Lack of
time, difficulty in accessing the internet, and lack of experience with distance learning courses. On the
evaluation of the course platform, from the tutors in general and the degree of satisfaction in several
questions, participants marked maximum grades. The comparison between pre‑ and post‑proficiency
scores showed increased proficiency of the enrolled groups (P < 0.0001).
CONCLUSIONS: The course contributed to the training of health assistants and educators, preparing
them to act in a participatory way in the prevention and control of the pandemic. The course was
well evaluated and there was a progression of knowledge by the participants.

Abstract BACKGROUND: Hospital Statistics and Information System is one of the most important health
information systems in Iran used in all hospitals in this country. Usability problems can reduce the
speed and precision of users when interacting with this system. This study aimed to identify the
usability problems of a national health system called “AVAB”.
MATERIALS AND METHODS: This descriptive cross‑sectional study was conducted in 2020, and
three experts evaluated the usability of this system independently by the heuristic evaluation method.
Nielsen’s usability principles were used to identify usability problems and to classify their severity.
RESULTS: A total of 86 unique problems were identified. The highest number of problems were
related to the two principles of “help and documentation” and “match between system and the real
world” with 23 and 11 usability problems, respectively. The lowest number of problems were related
to the two principles of “visibility of system status” and “help users recognize, diagnose, and recover
from errors,” each with three problems. 58.1% of the identified problems were in the group of major
and catastrophic problems.
CONCLUSIONS: With the help of heuristic evaluation method, a significant number of usability
problems of Hospital Statistics and Information System were identified. Most of the identified problems
were major and catastrophic, and it is necessary to solve these problems by the designers and
developers of this system.

Abstract BACKGROUND: Contribution to antibiotic resistance can happen at two interfaces – doctor
prescribing antibiotics inadvertently or patient’s usage of antibiotics inadvertently. This study was
conducted among diabetic inpatients in a rural tertiary health center in Kolar, South India, to assess
the various practices related to antibiotic use and to explore the possible reasons for these practices
with regard to antibiotic use.
MATERIALS AND METHODS: An exploratory sequential mixed‑methods study was conducted
with an initial cross‑sectional quantitative study followed by qualitative in‑depth interviews during
August–September 2019. A pretested semi‑structured questionnaire was used to capture the
sociodemographic, disease‑, and treatment‑related characteristics and practices related to antibiotic
use. An open‑ended interview guide was used to conduct in‑depth interviews. The practices to
antibiotic use were reported using frequency (percentage). Manual descriptive content analyses were
done by two investigators separately to identify codes under the broad topic “reasons for adopted
practices with regard to antibiotic use.”
RESULTS: Of the 152 diabetic inpatients interviewed, 20 (13.2%) felt that antibiotics are safe drugs
and can be used commonly. Among these inpatients, seven (4.6%) knew that antibiotics can kill
bacteria and four (2.6%) perceived ‘antibiotic resistance’ as a big problem in India. The practice
of checking the expiry date before using antibiotics was seen in 21 (13.8%) and 44 (29%) of them
finished the full course of antibiotics. A total of six codes were identified under the broad theme of
“reasons for adopted practices with regard to antibiotic use” among diabetic inpatients.
CONCLUSIONS: Less than one‑third of them completed the antibiotic course given by the doctor, and
almost everyone was ready for over‑the‑counter purchase of antibiotics offered by the pharmacist.
The reasons for such practices were mostly attributed to the “partial drug purchases” and “incomplete
advice by the doctor.” There is an urgent need to plan and deliver an interventional package to enhance
the knowledge and inculcate good antibiotic usage practices among these high‑risk populations.

Abstract BACKGROUND: Satisfaction of patients is among the top priorities of health‑care providers. Meeting
with families is essential for patients who are admitted to various wards, although it has been restricted
for many reasons such as its impact on physiologic indicators. This present research study aimed
to exploring the influence of scheduled meetings on physiological indicators of hospitalized patients
satisfaction facing acute myocardial infarction in the intensive care unit.
MATERIALS AND METHODS: This study was a nonrandomized clinical trial with a control group
conducted in the cardiac care unit ward of Hamadan’s Ekbatan Hospital. Sixty patients with acute
myocardial infarction were chosen through convenient sampling and assigned to intervention (planned
meeting) and control (routine meeting) groups in a nonrandomized manner. Data were collected by
a researcher‑made questionnaire of patient satisfaction and the observatory checklist of physiologic
indicators and then analyzed in IBM SPSS Statistics v23.
RESULTS: The total mean score of satisfaction did not significantly differ between the two
groups (P = 0.921). The satisfaction of patients for “the conduct of visitors” was significantly higher
in the intervention group (P = 0.005). During the study, no meaningful difference was found between
the two groups for physiologic indicators (P > 0.05), while these indicators, except for blood O2
saturation, were meaningfully increased in the control group during routine meetings (P < 0.05).
CONCLUSION: Planned meetings did not promote total satisfaction of patients with meetings, but
improved some aspects of satisfaction, such as the conduct of visitors. The planned meeting is
recommended as an alternative for a routine meeting, as it did not affect the physiologic indicators
of patients in the intervention group.

Abstract BACKGROUND: Social distancing policy during the COVID‑19 pandemic may affect physical activity
levels. This study aimed to compare physical activity levels before and during the pandemic and to
explore physical activity correlates among Indonesian young adults.
MATERIALS AND METHODS: This longitudinal study was conducted before the pandemic (n = 141)
in September 2019 and was followed by an online follow‑up survey during the pandemic
(79% response rate) in September 2020. Physical activity was measured using the global physical
activity questionnaire and was classified into “sufficient” and “insufficient.” The potential correlates
of physical activity were constructs from social‑cognitive theory and health belief model. Those were
measured using a validated questionnaire in the follow‑up survey. Physical activity levels before and
during pandemics were compared using the Wilcoxon signed‑rank test. Simple logistic regressions
were used to assess the relationships between each potential correlate and physical activity status
during the pandemic.
RESULTS: Physical activity levels decreased significantly during the pandemic, mostly in the
work‑related domain. Participants with favorable physical activity‑related constructs were more likely
to be physically active. The odds ratio ranged from 3.41 (95% confidence interval [CI] = 1.15–10.11)
in participants with higher self‑efficacy to 4.50 (95% CI = 1.44–14.06) in those with higher outcome
expectations of physical activity.
CONCLUSION: A significant decline in physical activity during the COVID‑19 pandemic among
Indonesian young adults was confirmed. The application of behavioral change theories for explaining
physical activity status during the pandemic in this population is also supported. It is recommended
to incorporate these constructs to develop physical activity interventions in this target population.

Abstract INTRODUCTION: Targeting the huge burden of adolescent anemia, the Weekly Iron and Folic acid
Supplementation (WIFS) was launched by the Government of India. Few studies have been done
to assess the effective functioning of the program since its inception. The present study was done
to assess the knowledge WIFS among adolescents of Madhya Pradesh and the associated factors.
MATERIALS AND METHODS: A cross‑sectional study was done in a total of six districts
(3 districts where the national adolescent program was implemented and 3 districts where it was not)
of Madhya Pradesh. Multistage stratified random sampling technique was used for the enrollment of
3213 adolescent boys and girls, and a prestructured and validated tool was used to collect paperless
data. Ethical approval and consent from the participants were obtained. Statistical analysis was
performed using SPSS v21.
RESULTS: It was observed that the knowledge of WIFS was more among adolescent girls (29.3%)
as compared to adolescent boys (14.1%). More of the adolescent girls received Iron and folic acid
tablets as compared to adolescent boys (60.8% girls vs. 24.1% boys). Mostly, the adolescents got
Iron tablets from school followed by Anganwadi and PHC/CHC. Girls, rural location, literacy, below
poverty line status, knowledge of anemia, adolescents who got iron and albendazole tablets, and
adequate consumption of iron tablets (>4) were associated with higher knowledge of WIFS.
CONCLUSION: The knowledge of WIFS was found to be less in adolescent boys. There is a hint of
the fact that effective execution of the program among its beneficiaries leads to an automatic increased
knowledge of the program, at least among the beneficiaries. Thus, an indirect but significant indirect
finding is that the nationwide WIFS program needs to be put to greater focus among the adolescent
boys, apart from its major focus on the female gender among most age groups.

Abstract BACKGROUND: “Three‑way summaries” (TWS) are a teaching–learning tool in which students
respond to a question or topic inquiry by three different summaries (10–15 words, 30–50 words,
and 75–100 words). The aim of this study was to introduce TWS, to establish its impact on learning
retention, and to identify students’ perception for TWS.
MATERIALS AND METHODS: It was an educational interventional study. It was carried out in two
randomly allocated groups, Group A having TWS as intervention and Group B without TWS, followed
by crossover of the groups. Participants were assessed using two multiple choice question (MCQ)
tests, ten marks each (one immediately and second after 1 week) during both phases. Students’
perception regarding TWS was assessed by questionnaire using Likert scale. Statistical analysis
was done by two‑tailed independent t‑test.
RESULTS: Both groups’ performance deteriorate after 1 week, but it was affected more in Group B
without TWS (4.85 ± 1.89–4.70 ± 2.05, P = 0.05) as compared to Group A with TWS (5.30 ± 1.81–4.63
± 1.90, P = 0.69). While in second phase, performance of the Group B with TWS improved more
significantly (5.92 ± 2.24–6.83 ± 2.21, P = 0.04) in comparison with Group A without TWS (4.96 ±
1.89–5.66 ± 2.35, P = 0.09). Most of the students liked TWS as an educational tool using Likert scale
(72%–86% agreeing and strongly agreeing).
CONCLUSIONS: TWS is highly acceptable teaching–learning tool which improves learning retention.

Abstract

Abstract BACKGROUND: In terms of public health, vaccination is considered as the most effective approach
against the infectious diseases. Accepting and receiving the first vaccine produced as an innovation
may not be easy. Therefore, the present study was conducted to investigate the predictors of intention
to receive COVID‑19 vaccine by Iranians aged 18–70 years based on the health belief model in 2021.
MATERIALS AND METHODS: This descriptive study was performed on 2365 people aged
18–70‑year old in Iran by random cluster sampling. Receipt of data was done electronically
questionnaire through the Porcelain system. Data were analyzed using SPSS software version 20
using Chi‑square, one‑way analysis of variance, independent t‑test, and multiple regression analysis
at a significance level of 0.05.
RESULTS: The mean score of receiving the Iranian corona vaccine was 3.06 ± 1.30 out of 5 points.
About 16.7% reported that they will definitely choose the Iranian vaccine. The highest correlation
was between the intention to receive the vaccine with self‑efficacy (r = 0.239, P < 0.001) and barriers
to receiving the vaccine (r = −0.237, P < 0.001). Self‑efficacy (β = 0.114, P < 0.001), perceived
barriers (β = −0.126, P < 0.001), and benefits of vaccine (β = 0.061, P = 0.022) were most important
predictors the intention to receive the vaccine.
CONCLUSION: Approximately 38% reported that they would definitely and probably not choose the
Iranian corona vaccine. Therefore, it is suggested that more information should be provided about
the features and benefits of domestically produced vaccines compared to foreign products.

Abstract BACKGROUND: Students’ perception of their academic environment has a substantial influence
on their actions, academic accomplishments, satisfaction, goal attainment, and behavior. The study
was carried out to evaluate the perception of academic environment in physiotherapy students, and
to identify the specific domains which could act as predictors of academic performance.
MATERIALS AND METHODS: This descriptive, cross-sectional research was conducted
over 12 months using total population sampling. Three hundred and forty-three (139 postgraduate
and 204 final year) final year and postgraduate physiotherapy students from five colleges of
Mumbai and Navi Mumbai, who conformed to the inclusion benchmarks, participated in the study.
Perception of educational environment was evaluated using Dundee Ready Education Environment
Measure (DREEM). Academic performance was evaluated using the percentage obtained in the
last university examination. Data were entered in MS Excel (©Microsoft, USA) and converted to
Stata Version 15.1© StataCorp, College Station, for further analysis. The mean values and standard
deviations for perception of educational environment were calculated and linear regression models
were used to conduct multivariate analysis for each item in the questionnaire.
RESULTS: The mean total DREEM score of physiotherapy students was 129.97 ± 22.72. Students
whose Students’ Academic Self‑perception scores were in the “Feeling more on the positive side”
category showed a 4.17 point increase in percentage scores as compared with those who reported
feeling like a total failure/had many negative aspects to their academic self‑perception (95% confidence
interval [CI]: 2.46, 5.89; P < 0.001). Students whose Students’ Perception of Learning (SPoL) scores
were in the “Teaching highly thought of” category showed a 2.75 point increase in percentage scores
as compared with those who viewed teaching poorly/negatively (95% CI: 0.44, 5.06; P = 0.02).
CONCLUSION: Physiotherapy students had a “more positive than negative” view of the academic
environment; however, a few “problematic areas” need to be remediated. Efforts to improve students’
academic self-perception may improve their academic performance since this was the strongest
predictor of their academic performance, followed by total DREEM scores and SPoL.

Abstract BACKGROUND: Taking exercise in health sector is one of the important steps to implement the
disaster risk management programs, especially preparedness phase. The present study aimed to
identify indexes and factors affecting successful evaluation of disasters preparedness exercises in
hot wash stage.
MATERIALS AND METHODS: This study was a qualitative content analysis. Data were collected
by purposeful sampling through in‑depth and semi‑structured individual interviews with 25 health
professionals in the field of disasters. The data were analyzed using directed content analysis method
by which the initial codes were extracted after transcribing the recorded interviews and immersing
them in the data analysis. The initial codes were reviewed, classified, and subdivided into several
stages to determine the main classes.
RESULTS: The data analysis resulted in the production of 24 initial codes, 5 subcategories, 2 main
categories of “evaluation and exercise debriefing” and “modification of programs and promotion of
exercise operational functions” under the original theme of “exercise immediate feedback.”
CONCLUSION: This study can be considered a suitable standard guide for health care organizations
to evaluate successfully disasters exercises in hot wash stage, maintain and promote their
preparedness, and properly respond to disasters.

Abstract BACKGROUND: Our study aimed to compare pectoral nerve (PEC) block with local anesthetic (LA)
infiltration for providing analgesia in superficial breast surgeries.
MATERIALS AND METHODS: This prospective comparative randomized study included seventy
American Society of Anesthesiologists I and II female patients undergoing excision of fibroadenoma.
In Group 1, the LA mixture was infiltrated in the desired planes. In Group 2, PEC I and PEC II blocks
were performed under ultrasound guidance. Patients were observed at regular time intervals for pain
scores, time to first analgesic request, and the number of patients requiring rescue analgesia with
the cumulative analgesic requirement, hemodynamic changes, and any adverse events.
RESULTS: The patients were comparable in demographic profile, duration of anesthesia, and
hemodynamic parameters. NRS scores at all times after extubation were significantly lower in Group 2
as compared to Group 1 (P < 0.0001). All patients in Group 1 required additional analgesia, while
only two in Group 2 received rescue analgesia (P < 0.0001). The time to first analgesic request was
significantly longer in Group 1 as compared to group 2 (9.5 + 0.70 h vs. 1.35 + 0.83 h) (P < 0.0001).
The cumulative requirement of tramadol in Group 1 (96.88 ± 16.45 mg) was significantly higher than
in Group 2 (6.47 ± 26.38 mg) (P < 0.0001). No adverse event was reported in either group.
CONCLUSION: PEC block is a useful method for achieving effective and long‑lasting analgesia. It
is an efficient and safe alternative to LA infiltration in patients undergoing fibroadenoma excision.

Abstract The present study aims to systematically review the women’s knowledge, attitude, and practice (KAP)
of breast cancer (BC) screening methods to get enough information for policymakers to orient the
screening strategies. All English KAP studies on BC screening methods in five databases up to January
2021 were included. The quality of the final articles was assessed using the STROBE checklist.
The qualitative synthesis was performed. Out of 5574 retrieved articles, 28 were included. About
64% of the articles were of high quality. Overall, there were poor knowledge, negative attitude, and
low practice between women. The educational programs and cultural plans can encourage regular
screening. Women’s excessive optimism to their BC risk should be eliminated by focusing on the
risk of the disease, more.

Abstract While battling the life‑threatening complications of COVID‑19, its effect on the menstrual
cycle and infertility has been somewhat ignored. This brief review aims on highlighting the
importance of menstrual abnormalities being experienced during the post‑COVID period
and to make the clinicians aware about what to expect in regard of menstrual abnormalities
by learning from various studies that have been conducted worldwide. This review article
was written with systematic literature review with the help of data search machine such
as PubMed, Scopus, Web of Sciences, and Google Scholar.A search strategy leads to the
extraction of 160 related articles that after the removal of inappropriate and duplicate
articles, 33 articles were selected for the review. To find other potentially relevant articles,
the references of the extracted articles were thoroughly examined. The search was carried
out using keywords including “COVID‑19,” “Menstrual abnormalities,” and “Infertility.”
Using OR and AND, the keywords mentioned above were combined and then utilized in
the search box of the databases. Articles published from January 2020 to September 2021
were included in this study. It includes worldwide data ranging from studies done in China,
India, Ireland, Turkey, Jordan, and Germany. During the post‑COVID period, there is a
significant alteration in the sex hormones of females infected by COVID‑19 which may
manifest as menstrual cycle abnormalities such as decreased cycle length or prolonged
menstrual cycle bleeding. It may also manifest as infertility due to ovarian failure due
to suppression of ovarian function COVID‑19 a novel coronavirus which is presently a
pandemic has affected the world in manner reminding the world of 1918 Spanish flu.
However, while battling the deadly pandemic, the clinicians should also be aware of the
repercussions of the effect this infection has on multiple organs such as ovarian suppression
leading to infertility, oligomenorrhea, or menorrhagia.

Abstract BACKGROUND: Living with children with autism spectrum disorder (ASD) can affect different
aspects of parents’ physical and mental health and quality of life. This study aimed to identify parents’
perceptions of their quality of life and factors influencing such perceptions and investigate how they
cope with difficulties in their daily lives.
MATERIALS AND METHODS: This study was conducted using a qualitative research design to gain
insight into how children with ASD may influence their parents’ quality of life. A total of 31 parents
and school counselors were selected by the snowball sampling method in autism schools in Tehran
in the academic year 2018–2019. Semi‑structured interviews were used to collect the data. Each
interview was held based on a preprepared guideline by the researchers. In‑depth questions were
also asked as needed. Finally, the data were analyzed using the content analysis approach.
RESULTS: The participants reported a variety of difficulties and crises to cope with in their daily
lives. The factors reported to decrease the quality of life were categorized into six main themes and
20 subthemes. The main themes included “family interactions,” “parenting,” “daily living,” “health,”
“financial issues,” and “community‑related.”
CONCLUSIONS: Due to the diversity and multilevel factors affecting the quality of life of parents
having children with ASD, it is essential to adopt a comprehensive approach with the participation
of all stakeholders in the development, design, and implementation of future interventions.

Abstract BACKGROUND: Early childhood caries is like an epidemic, especially in the developing world,
hence exploring its appropriate factors in causing the disease the need of the hour. Hence, the aim
of the present study was to evaluate social and behavioral determinants of early childhood caries
within the region of Ambala, Haryana.
MATERIALS AND METHODS: The present survey elaborated oral examination among 398 study
participants within the age group of 4–5 years. Carious tooth was recorded using Gruebbel’s deft DEFT
index using clean mouth mirror and probe. A questionnaire comprising 21 questions in English as
well as Hindi was prepared. There was an interviewer who took the interview of parents or caregivers.
The questionnaire consisted of questions which were aimed at gaining information regarding infants
feeding practice, social factors, and dental health behavior. The results of the study were tabulated,
and inferential statistics were applied using ANOVA test along with regression (multiple logistic)
procedure.
RESULTS: The occurrence of caries was affected by the behavioral factors such as breastfeeding
habits, bottle feeding habits, age of beginning of solid foods in children. There was no influence of
age of beginning of taking fluid from cup. Besides social factors like annual family income, education
of mothers, age of mother at the time of birth of children, age of children, order of children in the
family had a significant effect over the occurrence and severity and extent of caries. Factors such
as gender of children and profession of mother did not have had a significant role in early childhood
caries. Dental health habits such as tooth brushing frequency, brushing under supervision, frequency
of toothbrushing, quantity of toothpaste used had a significant effect over the frequency, and acerbity
of caries in early infanthood.
CONCLUSION: It can be concluded from this study that there is a significant correlation between
several social and behavioral determinants and early childhood caries.

Abstract BACKGROUND: Disaster can pose significant challenges to the health infrastructure in the
community. Hospitals are the central unit for providing health services in the disaster response
plan. With regard to the vital role of military hospitals in health response to disaster, this study was
carried out with the aim of investigating the disaster risk management (DRM) challenges in military
hospitals in Iran.
MATERIALS AND METHODS: The current study was qualitative research performed in 2020 in
military hospitals in Iran. Participants consisted of 12 managers and staff of the military hospitals in
Tehran and professionals in health in emergencies and disasters who were included in the study by
the purposive sampling technique. Semistructured individual interviews based on the interview guide
were exploited for the data collection, and a content analysis method was used to analyze them.
RESULTS: DRM challenges in military hospitals were explained in the form of six categories:
“management and leadership, planning, prevention and mitigation, preparedness, response, and
recovery” and 22 subcategories.
CONCLUSION: Managers’ awareness of DRM challenges in hospitals, particularly military hospitals,
and the design and implementation of solutions can lead to the promotion of hospital DRM and
hospital preparedness to deal with disasters.

Abstract In COVID pandemic, attending the continuing medical education, workshops, and conferences with
physical attendance is not possible. We designed, developed, and hosted the first of its kind academic
virtual/online conference at par with an in‑person academic conference to disseminate the expertise
of the renowned subject experts along with researchers to present their research work due to the
ongoing pandemic. We, in this article, had summarized the most critical steps in order to make the
process easier for first‑timers while providing our more comprehensive walkthroughs on each step.
We choose a live session of the speakers on the Zoom meeting mode to retain the atmosphere of
a live conference. WhatsApp, Google (Google Meet and E‑mail), and Kahoot were other platforms
to communicate with speakers, researchers, and participants to seamlessly participate. A number
of advantages in terms of protection for delegates/speakers and their families came from the Virtual
Conference on Nutrition and Health, restricting the spread of COVID‑19, low budget for organizers,
economically much cheaper alternatives both for speakers and participants, dissemination of
knowledge, time productive, and meeting research paper presentation eligibility for a professional
course. When one is new to technology, try adding an innovative aspect as a starting point to future
virtual and in‑person events, and seeing how it works is imperative. Ensuring Internet bandwidth,
updated hardware, or webcam and/or microphone functionality at the participant end is critical.

Abstract BACKGROUND: Although basic life support (BLS) has been taught in school by a variety
of professionals, it is still unclear that, whether the instructor’s previous cardiopulmonary
resuscitation (CPR) experience is an important factor. This study aimed to compare the effect of
BLS training, based on trainer experience in actual situations, on knowledge and skills of secondary
high school students.
MATERIALS AND METHODS: In this randomized controlled trial, 150 high school students were
selected based on the inclusion criteria and then assigned into two groups, (76 in Group A), and (74
in Group B) randomly. Both groups were trained according to adult BLS: 2020 American Heart
Association guidelines on mannequins in three 60 min in‑person training sessions. The knowledge
and skill scores were measured for both groups before, immediately, and 1 month after intervention
by a questionnaire. Data were analyzed by the SPSS software version 22, using Chi‑square,
Mann–Whitney U, repeated‑measure ANOVA tests, and statistically modeling at a significance
level of 0.05.
RESULTS: There were no significant differences between groups regarding demographic
characteristics. The knowledge and skill scores in both groups increased significantly compared
to baseline immediately and 1 month after the intervention (P = 0.001). However, there was no
significant difference in knowledge scores between groups (P = 0.076(. However, at the immediacy
and 1 month after the intervention, the skill score in “Group A” was significantly higher than the
“Group B” (P = 0.001).
CONCLUSIONS: The trainer’s experience of CPR in the actual setting in the transfer of BLS
knowledge is not important, but it improved Student’s BSL skill acquisition score.

Abstract BACKGROUND: Online learning environments are becoming more frequent in teaching and learning
than ever before. Asynchronous learning provides “high degree of interactivity” between participants
and helps them to reflect upon their ideas/thoughts, before sharing them with others leading to more
insightful responses and in‑depth learning. Moderating an online discussion is an art and challenging
task, which needs meticulous planning and effective execution approaches. One of the major
challenges in online discussion is to ensure active participation and interest among participants,
and therefore, it reiterates the need for inclusion of interactive strategies to enable it meaningful
and effective. The present article is to share our experiences in moderating session on “Dramatics
in Medical Education” (DIME) as a part of ML web discussion of Foundation for Advancement in
International Medical Education and Research (FAIMER) at one of the regional FAIMER institutes
in India.
MATERIALS AND METHODS: Thirty‑two FAIMER fellows participated in online discussion on DIME,
supplemented with various engagement triggers including, sharing of real‑life situation case scenarios,
motivational quotes, competitions and rewards, script writing, script editing exercises by using Forum
Theatre method, discussion on uploaded academic videos on “YouTube,” use of mnemonics, etc.
RESULTS: Online discussion yielded improved knowledge and positive attitudes of participants
toward DIME. Task‑based exercises within authentic or realistic situations, teamwork, and interactions
facilitated active learning of participants.
CONCLUSIONS: Appropriate planning, well coordination, and interactive strategies can foster
learning and reflective abilities as well as develop favorable perceptions of learners toward virtual
mode of teaching‑learning.

Abstract BACKGROUND: Applying new methods of clinical education seems to provide nursing students
with educational opportunities. The present study aimed to compare the effectiveness of training
through demonstration, video display, and virtual social space on the learning of clinical skills among
nursing students.
MATERIALS AND METHODS: In this semi‑experimental research with posttest that was performed
in 2019, thirty nursing students of the seventh semester were randomly assigned to three groups of
demonstration, video display, and the social virtual space education with ten people in each group.
The research was conducted in the hemodialysis ward of university hospitals. Each group was trained
and evaluated during 10 days with 5‑h sessions continuously. Participants’ skills were evaluated
using eight self‑made, valid and reliable checklists, and the three groups were compared. For data
analysis such as the means and standard deviations and inferential statistics, Mann–Whitney test,
Kruskal–Wallis likelihood‑ratio, and Chi‑squared test in SPSS version 16 were used.
RESULTS: The results indicated that practical skill levels in the group of virtual social network were
significantly higher than the two groups of video display (P = 0.045) and demonstration (P = 0.03).
In addition, the group of virtual space had significantly higher scores than those of the other two
groups only in two skills of “prime” and “disconnecting the patients from the machine” (P < 0.05).
CONCLUSION: Proper use of networks and social virtual space for clinical training, along with
conventional methods of learning, provides good learning opportunities and is affordable in terms
of time, cost, and process.

Abstract BACKGROUND: In the past, textbook or printed material was the only source of information for
medical students or post-graduate students. After the introduction of internet, knowledge can be
accessed easily which is updated with various aids such as animation, videos which improve the
learning efficiency. This study was conducted to compare the learning efficiency between textbookbased seminar to that of internet-based seminar in postgraduate students of the department of
dermatology.
MATERIALS AND METHODS: It was a non-randamized controlled study. The postgraduate students
in the department of dermatology, Jawaharlal Nehru Medical college, DMIMS(DU),Sawangi (Meghe),
Wardha, Maharashtra, India were divided into two equal groups by simple randomization method
by flipping the coin. Totally 20 seminar topics were divided into two groups (A and B) consisting
of 10 seminars in each group. Postgraduate students assigned in group A were asked to prepare
seminar solely from textbooks while in group B, students were asked to prepare seminar by referring
internet. Feedback form which consists of 7 points, i.e. appearance, completeness of preparation,
clarity of presentation, appropriate use of audio visual aids, understanding of subject, ability to
answer questions, and overall performance were filled up from faculties and postgraduate students
after completion of each seminar. Pretest and post-test were filled up from postgraduate students
before and after each seminar respectively. Learning gain was calculated by comparing the scores
of pretest and posttest. Paired t-test was used to compare results in the group and unpaired t-test
was used to compare results between the two groups.
RESULTS: Faculties’ feedback on overall performance was higher (4.59 ± 0.15) in web-based
seminars as compared to in textbook-based seminars (3.85 ± 0.1) with significant P = 0.008.
Furthermore, postgraduate students’ feedback showed statistical significant value of 0.02 in webbased seminars (4.65 ± 0.06) compared to textbook-based seminars (3.2 ± 0.06). Learning gain
was significantly higher in web-based seminar compared to textbook-based seminar with P = 0.02.
CONCLUSION: It can be concluded that web-based learning can improve the learning efficiency in
postgraduate medical students.

Abstract BACKGROUND: The Health System Reform Plan, especially in medical education, has undoubtedly
caused changes in the university. The continuation of this project requires recognizing the challenges
confronted by those in charge of its implementation. This study aimed to explore the challenges of
the implementers of the Transformation and Innovation Plan in Medical Education in the universities
of Macroregion 5.
MATERIALS AND METHODS: The qualitative research was conducted using the content analysis
method. Semi‑structured interviews with health and medical education managers were used to
collect information. Participants were 11 educational leaders of universities who were selected by
purposeful sampling. Data collection continued until data saturation was reached. Data analysis
was performed continuously and simultaneously with data collection. The Graneheim and Lundman
methods were used to analyze the data.
RESULTS: From 11 interviews, one theme, five categories, and 12 subclasses were obtained. Five
categories include lack of proper groundwork, weak leadership, structural problems, inability to fund,
and inadequate monitoring.
CONCLUSION: Innovation and transformation in medical education are one of the critical missions
and admirable actions of the Ministry of Health in the field of education, but a review of this plan
can, in addition to identifying shortcomings and problems, pave the way for success, and progress
in future programs.

Abstract BACKGROUND: Conducting online classes and assessment during the COVID‑19 pandemic is
not without challenges. The world of medical education is adapting online training and assessment
because of COVID‑19 pandemic restrictions. The present study was conducted to assess the
students’ perception regarding the process, difficulties encountered and perceived effectiveness of
online assessment.
MATERIALS AND METHODS: Online viva‑voce (theory and visual based) was conducted in
a government medical college in Karwar, Karnataka, India using videoconferencing application
(Google Meet) to 149 second MBBS students as a formative assessment in 2020 over 3 months.
Ten students per day joined Google Meet, 10 questions were asked to each student and assessed
using a tutor marking system (on‑spot). A feedback questionnaire (Google Form) was administered
to students who attended online Viva‑Voce. Data was analysed using descriptive and inferential
statistics (Student’s t‑test).
RESULTS: Out of 149 students, 132 participated and responded to a feedback questionnaire.
Majority of the participants (91%) agreed that questions covered all topics kept for viva, 82% of
them felt it would be helpful for performance in final examinations. Thirty percent of students faced
network issues at their places, 45% felt nervous while facing viva in the presence of other students
and 35% of participants preferred online methods over traditional viva voce. Online viva voce can
be transparent (90%) and less biased (88%) if done in structured format.
CONCLUSION: Online viva‑voce may become relevant and effective in medical education
assessment with transparent marking system for students’ performance.

Abstract BACKGROUND: Sleep quality is an important factor in adolescents’ health; physical as well as
psychological. The aim of this study was to determine sleep quality and daytime sleepiness and their
effect on the quality of school life (QSL) and achievement.
MATERIALS AND METHODS: This cross‑sectional study was conducted in high schools. The data
collection was done on a random sample of 500 students from 15 to 19 years. The questionnaires
included the Pittsburgh Sleep Quality Index (PSQI) to measure sleep quality and the Epworth
Sleepiness Scale to measure daytime sleepiness as well as QSL. Data were analyzed by SPSS
25. Linear and logistic regressions were used to obtain adjusted and unadjusted odds ratios as well
as predictors.
RESULTS: The mean PSQI score was 6.2 ± 2.4. It was realized that 377 participants (75.4%)
were poor sleepers; 6.2% had excessive daytime sleepiness. There was a significant association
between age and quality of sleep (P < 0.04). No association between gender and quality of sleep
or between the quality of sleep and school achievement was found. Linear regression exhibited a
significant relationship between the quality of sleep and daytime sleepiness (β = 0.218; t = 4.982,
P = 0.000). There was a significant, inverse correlation between sleepiness and the total score of
QSL (P = 0.000). Stepwise linear regression analysis exhibited that daytime sleepiness (P = 0.002)
and school achievement (P = 0.001) were predictors of QSL.
CONCLUSION: According to the study results, sleepiness affects school performance and QSL,
and on the other hand, daytime sleepiness is under the effect of sleep quality.

Abstract BACKGROUND: Basic infection control measures are required in India’s health‑care setting in
Neonatal Intensive Care Units (NICUs) to lower the prevalence of hospital‑associated infections.
The aim of the present study was to assess practices followed by nurses of NICUs for nosocomial
infection prevention.
MATERIALS AND METHODS: From January to February 2020, a descriptive cross‑sectional study
was conducted. Participants in the study were chosen by total enumeration sampling technique,
i.e., 60 nurses were included in this study who working in tertiary care institutions, India. The study
respondents’ knowledge and practice for nosocomial infection control strategies were assessed by
using a 30‑item and 27‑item questionnaires, respectively. SPSS (version 23.0) was used to analyze
the data collected.
RESULTS: Results showed that all nurses (100%) were females, belongs to the age group of
26–35 years (82%), hold professional qualifications (34%) in GNM as well as post basic BSc nursing,
married (72%), had 1–5 years of professional experience (66%), and working in the NICUs for
1–3 years (74%). Most of nurses (55%) had never attended any session on nosocomial infection
prevention. Nurses of NICUs (70%) had just a moderate degree of understanding on nosocomial
infection prevention. Nurses’ practice showed good practise (60%) for nosocomial infection prevention
in NICUs.
CONCLUSIONS: The necessity to adopt health‑care policy about nosocomial infections and execution
of regular training program to upgrade and refresh nurses’ knowledge and practices regarding
for nosocomial infection control measures is indicated to fill gap among knowledge and practices
concerning nosocomial infection control and prevention.

Abstract BACKGROUND: Metamotivation is a process that students use to monitor their motivational states
to reach their academic goals. To date, few studies have addressed the ways that medical students
manage their motivational states. This study aim to identify the motivational strategies of medical
students as they use the metamotivational process to monitor and control their motivational states.
MATERIALS AND METHODS: This qualitative study uses directed content analysis of the narrative
responses of 18 medical students to draft an in‑depth and semistructured interview protocol which were
conducted through WhatsApp due to social distance restrictions of COVID‑19. Data were collected,
encoded, and analyzed using deductive content analysis approach descripted by Elo and Kyngäs.
RESULTS: Seven main themes were extracted as the motivational strategies of medical students
including “regulation of value,” “regulation of situational interest,” “self‑consequating,” “environmental
structuring,” “efficacy management,” “regulation of relatedness,” and “regulation of situational
awareness.” In this study by identifying new strategies, we provide a broader framework of
metamotivational strategies in the field of the progression of learners in medical education.
CONCLUSION: Medical students use a variety of strategies to regulate their academic motivation. To
sustain and improve the motivation of medical students, identifying and strengthening metamotivational
strategies is the first step.

Abstract BACKGROUND: COVID‑19 initiated in December 2019 in Wuhan, China, and over a period of
time, the infection outspread across the world in a rapid pace. To protect the people and to further
limit the spread of infection, lockdown was declared in most parts of the world including India.
As all people were forced to stay indoors during this pandemic, internet was the only source of
entertainment whose overuse has side effects on anxiety and sleep quality. This study is aimed to
know the impact of Internet addiction during COVID‑19 on anxiety and sleep quality among college
students of Bhubaneswar city.
MATERIALS AND METHODS: This was a web‑based cross‑sectional, questionnaire study. It
administered 475 students from six colleges. The students were assessed by a proforma containing
demographic details, patterns of internet use, Youngs Internet Addiction Test, Generalised Anxiety
disorder score, and the Pittsburgh Sleep Quality Index. Statistical analysis was done using SPSS
version 21.0 using Chi‑square test and Wilcoxon signed‑rank test.
RESULTS: The mean age of the study group was 18.81 ± 1.189. Out of 475 students, 60.6% were
female and 39.4% were male. 23.6% and 13.4% of recruited students had severe internet addiction
and anxiety disorder, respectively. The mean global PSQI score in the study was 6.356 ± 1.88.
About 84.6% of the students had poor global sleep quality score. All components of sleep quality
were significantly associated (P = 0.000) with different degrees of internet addiction except sleep
duration (P = 0.589) and efficiency (P = 0.767).
CONCLUSION: Females were highly addicted than males. The study findings specified that students’
excessive internet usage leads to anxiety, and affects mental health. Monitoring and controlling
students’ internet addiction through informative sessions on how to use the Internet adequately is
useful.

Abstract BACKGROUND: The exponential increase of cases and the emergence of the new COVID‑19
variants continue to be a challenge. It remains crucial to assess whether or not minimum health
standards against COVID‑19 are consistently followed. This study determined the higher education
students’ practice of protective measures against COVID‑19 of more than a year into the pandemic.
MATERIALS AND METHODS: A questionnaire web survey, cross‑sectional study was conducted
among higher education students (n = 2309) of a public university in the Philippines. Data were
analyzed using the SPSS software.
RESULTS: Results indicated that students generally had a high practice of COVID‑19 preventive
measures. However, only 45.9% always practice physical distancing measures, and only 35.9%
always seek information related to COVID‑19 after more than a year into the pandemic. Female,
married, graduate level, with a monthly family income of PHP 10,000 and above, and personal
knowledge of someone who tested for COVID‑19 had a significantly higher practice of COVID‑19
protective measures. Older age, higher general self‑reported health status, and higher intention
to comply with recommended protective health behaviors were significantly correlated with higher
practice of preventive measures against COVID‑19.
CONCLUSION: After more than a year of being into the pandemic, students still practice preventive
health behaviors, however, this is not done consistently. As the pandemic is still not over in the country
and many parts of the world, continuous monitoring and a reminder to practice minimum protective
health protocols are needed to mitigate and prevent the spread of COVID‑19.

Abstract BACKGROUND: Assessment of the patient safety competency is necessary for the growth of nursing
and safe care profession as well as evaluation of the nurses’ educational needs. The present study
was conducted to determine psychometric properties of the Persian version of the patient safety
competency self‑evaluation (PSCSE) tool in Iranian psychiatric wards.
MATERIALS AND METHODS: All nurses (n = 209) working in two psychiatric hospitals of Kerman,
Iran, were included in the present cross‑sectional study using census method. This tool contains 41
items: six items are related to knowledge, 14 items deal with attitude, and 21 items are about skill
dimension. Psychometric properties of the questionnaire including its content and face validity were
also examined. The factor structure of the questionnaire was evaluated using exploratory factor
analysis. The internal consistency and reliability were assessed by test–retest method with an interval
of 14 days. Cronbach’s alpha and corrected item‑total correlation were used to measure reliability.
RESULTS: The content validity index was 0.65 and the content validity ratio was 0.89. Item 14 was
removed from the skill domain because it was not related to the psychiatric ward. According to the
results of factor analysis, there was a significant relationship between the questions and the relevant
factors. The correlation coefficient for test–retest with 14 days interval was intraclass correlation
coefficient = 0.92 for the whole instrument and 0.89, 0.89, and 0.92 for the domains of knowledge,
attitude, and skill, respectively. The internal consistency coefficient (Cronbach’s alpha) of the whole
tool was 0.95 and 0.95, 0.79, and 0.95 for the domains of knowledge, attitude, and skill, respectively.
Finally, PSCSE Questionnaire was obtained with 40 items in dimensions of knowledge (6 items),
attitude (14 items), and skills (20 items).
CONCLUSION: Persian version of the nurses’ competency tool in ensuring patient safety in psychiatric
wards has acceptable psychometric characteristics.

Abstract BACKGROUND: The main manifestations of coronavirus disease‑2019 (COVID‑19) are similar
to the many other respiratory diseases. In addition, the existence of numerous uncertainties in
the prognosis of this condition has multiplied the need to establish a valid and accurate prediction
model. This study aimed to develop a diagnostic model based on logistic regression to enhance the
diagnostic accuracy of COVID‑19.
MATERIALS AND METHODS: A standardized diagnostic model was developed on data of 400
patients who were referred to Ayatollah Talleghani Hospital, Abadan, Iran, for the COVID‑19
diagnosis. We used the Chi‑square correlation coefficient for feature selection, and logistic regression
in SPSS V25 software to model the relationship between each of the clinical features. Potentially
diagnostic determinants extracted from the patient’s history, physical examination, and laboratory
and imaging testing were entered in a logistic regression analysis. The discriminative ability of the
model was expressed as sensitivity, specificity, accuracy, and area under the curve, respectively.
RESULTS: After determining the correlation of each diagnostic regressor with COVID‑19 using
the Chi‑square method, the 15 important regressors were obtained at the level of P < 0.05. The
experimental results demonstrated that the binary logistic regression model yielded specificity,
sensitivity, and accuracy of 97.3%, 98.8%, and 98.2%, respectively.
CONCLUSION: The destructive effects of the COVID‑19 outbreak and the shortage of healthcare
resources in fighting against this pandemic require increasing attention to using the Clinical Decision
Support Systems equipped with supervised learning classification algorithms such as logistic
regression.

Abstract INTRODUCTION: Educators, academicians, and teachers are responsible for the development of
the nation’s human capital. Teacher coping methods are becoming more widely recognized as a key
factor in determining teacher effectiveness. The aim of this study was to identify the various coping
strategies adopted by high school teachers in Southern India.
MATERIALS AND METHODS: A cross‑sectional study was conducted in government, aided, and
unaided schools of Udupi, a coastal district in Southern India. A self‑administered questionnaire was
used to collect the data from 460 high school teachers chosen based on convenience sampling.
The coping strategies were identified using a modified version of Brief COPE(Coping Orientation to
Problems Experienced) Inventory (Carver, 1997). Data were entered using SPSS version 15 and
descriptive statistics was performed.
RESULTS: The study found that teachers had moderate level of coping skills in all domains. The most
popular coping techniques used by secondary school teachers were positive reframing, active coping,
and planning; nevertheless, substance use was recognized as the least popular coping strategy.
CONCLUSION: Positive reframing, active coping, and preparation were the most commonly used
coping strategies by the teachers in the survey. Teachers are a vital resource who have received less
attention than they deserve for their psychological well‑being. A customized intervention program
based on their perceived needs could be a good place to start.

Abstract BACKGROUND: Professional identity includes the values and beliefs of a nurse that guide her
thinking, action, and interaction with patients. The stressful conditions of the COVID‑19 pandemic
may have affected nursing students’ resilience and attitudes toward their profession. Therefore, the
aim of this study was to investigate the professional identity and resilience in nursing students during
the COVID‑19 pandemic.
MATERIALS AND METHODS: This cross‑sectional descriptive study was performed in November and
December 2020 with the participation of all nursing students of Babol University of Medical Sciences
who spent at least one semester of internship in a hospital during the COVID‑19 pandemic. Data
were collected using demographic questionnaire, Connor‑Davidson resilience scale, and nursing
students’ professional identity scale. Data analysis was performed using independent t‑test, ANOVA,
and correlation tests at a significance level of 0.05.
RESULTS: Nursing students in the 3rd, 5th, and 7th semesters have spent a minimum of 13 and a
maximum of 151 days of internship during the pandemic period. The mean score of professional
identity of nursing students was 61.86 ± 9.34 and their mean resilience score was 32.08 ± 13.54. The
resilience score of 92% of students was below 50. Professional identity was significantly stronger,
and resilience was considerably higher in students who were satisfied with their profession and lived
with their families (P < 0.05). In other words, students with higher professional identity scores had
higher resilience (r = 0.39, P = 0.000).
CONCLUSION: Despite a good professional identity score, the resilience of nursing students during
the COVID‑19 pandemic is low. Therefore, professors and the clinical education system should
provide more support for students in such stressful times as the COVID‑19 pandemic period.

Abstract BACKGROUND: Empathy is regarded as a fundamental personal attribute for in-training and inpractice doctors. Several factors may play a significant role to facilitate or prevent the ability of doctors’
empathy toward their patients. The objective of the present study is to investigate the relationship of
empathy with personality traits (extraversion, agreeableness, conscientiousness, neuroticism, and
openness to experience) among undergraduate medical students.
MATERIALS AND METHODS: This study was based on a correlational, cross-sectional design
and was conducted from January 2020 to April 2020. The sample consisted of 301 undergraduate
medical students studying in different medical colleges situated in Riyadh, Saudi Arabia. Personal
information form, the big-five personality inventory, and the interpersonal reactivity index scales were
administered. Obtained data were analyzed by applying several methods such as mean, standard
deviation, Mann–Whitney U test, Pearson’s correlation coefficient, and multivariable linear regression.
RESULTS: Regression analysis revealed that personality dimensions accounted for 10–19% of
the variance in scores of empathy sub-dimensions of perspective-taking, empathetic concern,
fantasy, and personal distress. Agreeableness was found to be associated with empathetic
concern and perspective-taking. Openness to experience was found to be significantly related to
perspective-taking and fantasy, whereas extraversion was negatively associated with perspectivetaking. Neuroticism had an association with personal distress, empathetic concern, and fantasy.
Additionally, no gender difference was observed and students with people-oriented specialty
preferences showed significantly higher scores on empathy sub-domains than technology-oriented
students.
CONCLUSION: This study confirmed that personality dimensions play a notable role to predict
empathetic behaviors among Saudi undergraduate medical students. This study would help to design
individualized strategies by incorporating personality dimensions in the training program to enhance
empathetic behavior among medical students.

Abstract BACKGROUND: Despite the great comparative advantage of Iran in terms of infrastructure,
technology, and human resources as well as the significance of medical tourism in the tourist industry,
in practice, the quality of human resources has received less attention. Consequently, this study was
conducted to design a model of competency‑based training for Iranian medical tourism.
MATERIALS AND METHODS: This study was an exploratory mix, and the Delphi method and
semi‑structured interviews were used for the qualitative part of this study. In the second part, the
analytical method was utilized for the quantitative part of this study.
RESULTS: The results indicated the main components of medical tourism to be public interactions
and private interactions and seven subcomponents. Medical Tourism’s Competency includes three
main components and seven subcomponents.
CONCLUSION: Although some training separated and scattered is present in Iran’s medical tourism.
However, Iran requires a comprehensive training model of which its design was explained in this paper.

Abstract BACKGROUND: Road traffic accidents (RTAs) are an emerging public health issue of global concern
causing 1.35 million deaths per year. They are the leading cause of death among 5–29 years who
contribute to the future and current productive population of the country. The outcome of mortality
and permanent disability are public health concerns. We determined the factors associated with RTAs
among medical undergraduates and assessed their knowledge of road traffic rules.
MATERIALS AND METHODS: This study had 500 medical undergraduates from a tertiary hospital
located in Chengalpattu district, Tamil Nadu. Data were collected using questions from “Road safety
question bank” issued by Ministry of Road Transport and Highways, Government of India, sent as
Google forms to students. Descriptive statistics were used and multivariate analysis was performed
to identify risk factors associated with RTAs.
RESULTS: The mean age of the students was 21.4 (standard deviation = 1.7) years. About 30.4%
of students suffered from RTAs in the past 2 years. Practice of drunken driving and mobile phone
usage showed significant association with RTA occurrence (P < 0.001). Multiple logistic regression
revealed that students crossing speed limits and jumping signals had 3.19 and 2.04 times more
risk of sustaining RTAs. Seventy‑five percent of students had good knowledge on road traffic rules.
CONCLUSION: Nearly half the subjects have suffered RTA in the past 2 years. Students who over
speed, jumped signals and used mobile phones while driving sustained more RTAs. Overall, road
traffic rules knowledge was satisfactory. Students need education on risky driving behaviors and
aftermath of crashes.

Abstract BACKGROUND AND AIM: Bipolar disorder (BD) is one of the most challenging psychiatric disorders
in the management area that can lead to functional, occupational, and cognitive disorders. Without
proper care, this complication can lead to profound psychological challenges and even death. The
aim of this study is to design a minimum data set (MDS) for BD.
MATERIALS AND METHODS: This descriptive cross‑sectional study was conducted in two steps.
In the first step, a survey was conducted in PubMed, Web of Science, and SCOPUS databases to
identify the demographic, managerial, and clinical data elements. Then, the required data elements
were extracted from the studies by the data extraction form and used in a questionnaire. In the
second step, to confirm the data element set, the designed questionnaire was distributed and
collected among 20 psychiatrists and subspecialists during a two‑stage Delphi technique. Descriptive
statistics (frequency and mean) were conducted to analyze the data.
RESULTS: Totally, 112 managerial and clinical data elements in 14 categories were extracted from
the studies. Based on the experts’ opinion and their consensus, 88 necessary data elements were
considered to bipolar MDS. “Medication nonadherence,” “history of suicide,” and “substance abuse
and addiction” were the most important data elements.
CONCLUSION: In this study, an MDS was designed for BD. Providing this MDS, in addition to
improving the clinical processes, it is possible to help electronic system designers and health data
managers to know what information should be included in the health systems or any kind of self‑care
or self‑management software to meet the information needs of these patients.

Abstract BACKGROUND: Intellectual property rights (IPRs) are increasingly becoming significant for
sustainable growth of today’s knowledge‑based society. An inappropriate knowledge regarding IPR
can fail to reserve rights for one’s intellectual creation. Hence this study was planned with an aim to
assess knowledge, awareness, and practices regarding intellectual property rights in India amongst
the health-care professionals in Belagavi city.
MATERIALS AND METHODS: A descriptive cross‑sectional study was conducted among the
postgraduate students and faculty of six health‑care professional institutions in Belagavi, Karnataka.
A total of 724 responses were recorded using convenient sampling. Data was collected using
self‑administered validated questionnaire which included demographic details and total 20 questions
pertaining to knowledge, awareness, and practices regarding IPR. Two‑point Likert scale was used.
Descriptive statistics, Mann–Whitney U‑test, and Chi‑square test were applied.
RESULTS: A total of 724 responses were recorded, 411 from postgraduate students and 313 from
faculty of 6 health‑care professional institutions. It was observed that 24.3% and 39.3% of postgraduate
students and faculty participants, respectively, had maximum knowledge while 35.5% of faculty and
27.5% of postgraduate students had maximum awareness regarding IPR in India. Only 17.6% and
10.2% of faculty and postgraduate students had previously attended workshops on IPR.
CONCLUSION: The present study identified that both faculty and postgraduate students of health‑care
profession have less knowledge and awareness regarding IPR. However, both knowledge and
awareness regarding IPR were better among faculty when compared to postgraduate students.
Thus, the academic community requires a higher level of sensitization and exposure to IPR in India.