Journal of Education and Health Promotion

Abstract BACKGROUND: The emergency department is one of the most important parts of all hospitals. For
this reason, many simulation programs are performed in this department to increase the knowledge,
skills, and productivity of health‑care workers. The purpose of this study was to identify the benefits
of simulation in hospital emergency departments.
MATERIALS AND METHODS: In the present systematic study, using “AND” and “OR” operators, we
searched for the keywords “benefits,” “simulation,” and “hospital emergency department” in PubMed,
Web of Science, Scopus, Google Scholar as well as Persian language databases such SID, Magiran,
Irandoc, and Iran Medex. Then, a three‑step screening process was used to select studies relevant
to simulation and hospital emergency from 2005 to 2021 using the PRISMA checklist, and finally,
the obtained data were analyzed.
RESULTS: A total of three main groups, each with several subgroups, were extracted and identified
as the benefits of using simulation in hospital emergency departments. They included improving
the diagnosis of the disease (rapid prediction of the disease, rapid diagnosis, and patient triage),
improving the treatment process (improvement of treatment results, anticipation of admission and
discharge of patients, acceleration of interventions, and reduction of medical errors), and improving
knowledge and skills (improvement of the speed of decision‑making, staff’s acquisition of knowledge
and skills, simple, convenient, and low‑cost training, improvement of staff’s preparedness in crisis).
CONCLUSION: Based on the results of the present study, it is suggested to develop some training
programs in order to help staff upgrade their knowledge and performance as well as acquire practical
skills and also to improve the diagnosis and treatment process in hospital emergency departments.
Virtual methods are also proposed to be applied as potential and cost‑effective platforms for learning,
teaching, and evaluating the staff of hospital emergency departments.

Abstract BACKGROUND: Myocardial infarction (MI) is one of the most common cardiovascular diseases
affecting quality of life and adherence to treatment. This study aimed at assessing the impacts of an
educational program based on the Belief, Attitude, Subjective Norm, and Enabling Factors (BASNEF)
Model on quality of life and adherence to treatment in patients with MI.
MATERIALS AND METHODS: The present quasi‑experimental study was conducted on eighty
patients with MI admitted to hospitals affiliated to Shahrekord University of Medical Sciences in 2019,
which were selected by the convenience sampling and then randomly divided into intervention and
control groups. The intervention group received a BASNEF model‑based educational‑supportive
intervention including three 45‑min training sessions and three months’ follow‑up individually for
each participant. Data were collected by Ferrans and Powers Quality of Life Index (QLI)‑Cardiac
Version, Modanloo Adherence to Treatment Questionnaire (MATQ) and questionnaire modified based
on BASNEF model constructs. The collected data were analyzed using SPSS version. 22 software
using the descriptive and analytical statistical test.
RESULTS: The total score of the MATQ and its subscales had significantly improved in the intervention
group after the intervention (P < 0.001). The total score of the QLI and its subscales had significantly
improved in the intervention group after the intervention (P < 0.001) In addition, the mean scores of the
model constructs had significantly improved after the intervention in the intervention group (P < 0.001).
CONCLUSION: The results of this study showed that applying BASNEF model‑based educational
interventions can lead to improved quality of life and adherence to treatment in the patients with MI.
Therefore, this model can be used to reduce the complications of MI.

Abstract BACKGROUND: Promoting the well‑being of students and teachers should be the goal of school
mental health programs. A large body of evidence has highlighted that there is an emerging concern
regarding the increasing stresses that teachers are dealing with. Burnout is a psychophysical state
that is characterized by emotional exhaustion (EE), depersonalization (DP), and low sense of personal
accomplishment (PA). We aimed to assess burnout level in teachers’ population and its correlation
with demographic characteristics because it not only can be affected teachers’ health promotion but
also student well‑being promotion.
MATERIALS AND METHODS: In the present cross‑sectional study, 322 high‑schoolteachers from the
second district of Tehran were randomly selected and were asked to complete the standard Maslach
Burnout Inventory questionnaire to evaluate the three areas of burnout. In addition, participants were
interviewed for their demographic status (IR.TUMS.MEDICINE.REC.1397.473).
RESULTS: The results of this study showed that male teachers exhibit significantly lower score
compared with female ones in all three indicators of burnout including EE, DP, and PA (P < 0.05).
The number of children teachers and income level in men also influenced all three indices (P < 0.05).
Regarding the impact of spouse’s job status on burnout in men and women, PA was the only unaffected
area (P > 0.05). Nevertheless, none of the demographic characteristics effected burnout domains
in female teacher population.
CONCLUSION: Considering the results of this study that shows the higher burnout level in male
teachers and its association with several demographic characteristics such as income level and
number of children, special attention should be paid to this gender to reduce possible stress and
mental illness.

Abstract BACKGROUND: Caring for the children suffering from thalassemia is a stressful experience with
various aspects making the mothers face various challenges. Thus, the present study aimed to explain
the psychosocial challenges of mothers with thalassemia children based on their lived experience.
MATERIALS AND METHODS: In this qualitative study, which was conducted using the
phenomenological method, 14 mothers with thalassemia children were selected from two thalassemia
treatment centers in Hamadan and Babol (Iran) in 2020 using the purposive sampling method. Data
were collected using in‑depth and semi‑structured interviews and were analyzed by van Manen’s
phenomenological methodology.
RESULTS: In the first stage of data analysis, 534 initial codes were extracted, which were reduced
to 290 by comparison and integration. The primary themes turned into 24 secondary themes
after clustering. By comparing the secondary themes, three main themes (i.e., “psychological
distress,” “bodily burnout,” and “mothers’ need to empathy and support”) with 7 secondary
themes (i.e., “emotional exhaustion,” “mental strain,” “social stigma,” “acute psychosomatic reactions,”
“long‑term psychosomatic consequences,” “expectation of family support,” and support needs outside
the family) were extracted.
CONCLUSION: The results indicated that mothers with thalassemia children experience several
challenges in various aspects. Therefore, they require care interventions and psychosocial support.

Abstract BACKGROUND: Sexual function is affected by many psychological factors and emotions. The
impact of emotion management varies in different fertility situationsThis can affect women’s sexual
function. Therefore, the aim of this study was to investigate the relationship between sexual function
and emotional intelligence and its components based on fertility status in women referring to health
centers in Yazd.
MATERIALS AND METHODS: The present study is a correlational study that was performed on
165 women with inclusion criteria and referred to 4 selected health centers in Yazd in 2017. The
study tools include demographic questionnaire, Female Sexual Function Index sexual function, and
Bar‑On emotional intelligence. The fertility status of women in the present study included a history of
infertility, number of children, and history of abortion. The analysis was performed using descriptive
statistical methods and analytical tests with SPSS software version 18.
RESULTS: The mean score of all components of emotional intelligence except the components of
self‑expression, independence, and emotional self‑awareness and also the total score of emotional
intelligence infertile people was significantly higher than infertile people (P < 0.05). Regarding
the relationship between emotional intelligence and sexual function in terms of fertility variables,
a significant correlation was observed between the mean scores of all components of emotional
intelligence except interpersonal relationships, flexibility, responsibility, empathy, and self‑expression
with sexual performance score in fertile individuals.(P = 0.000).
CONCLUSION: As a result, it is suggested that the institutions in charge of women’s affairs try to
increase emotional intelligence and improve women’s sexual function by holding workshops and
classes for women, especially in women with infertility, childlessness, and history of abortion.

Abstract BACKGROUND: Health‑care providers, including physicians and nurses, are vital resources of the
health‑care system, and their health is essential to ensure safe care and to control outbreaks in the
community. The aim of this study was to explore the experiences of physicians and nurses infected
with COVID‑19.
MATERIALS AND METHODS: This descriptive exploratory qualitative study was conducted in 2020.
To conduct this study, 19 participants (5 physicians and 14 nurses) were selected using purposive
sampling. Data were collected using semi‑structured interviews. Data analysis was performed using
conventional content analysis.
RESULTS: Eight main categories of “Fear and anxiety,” “Fighting against COVID‑19,” “Feeling
abandoned during home quarantine period,” “Denial of disease despite testing positive,” “Recovery:
the second opportunity,” “Imposition of psychological burden after returning to work,” “Promotion of the
health professional perception,” and “Promising supportive resources,” as well as 21 subcategories,
were extracted from the participants’ experiences.
CONCLUSION: The experiences of physicians and nurses with COVID‑19 revealed that their
perception of the profession and providing care had changed. This experience has highlighted the
focus and effort to promote patient‑centered care and interprofessional collaboration among them.

Abstract BACKGROUND: The mental health of health‑care workers with their unique role in responding
to the COVID‑19 pandemic is strictly essential. Hence, to react effectively to the pandemic, it is
essential to collect further data on the stressors and adaptation strategies. The aim of this study is
to explain the health‑care workers’ experiences of stressors and adaptation strategies used during
the COVID‑19 pandemic outbreak.
MATERIALS AND METHODS: A qualitative content analysis approach was employed in this
study, with semi‑structured in‑depth interviews. Nineteen health‑care workers participated in the
study by purposeful sampling method. The study setting included selective educational hospitals
that admitting patients infected with COVID‑19. The data were analyzed using content analysis
method.
RESULTS: Stressors were classified under four major categories: idiopathic, i.e., arising from
unknown causes, individual and familial, stressful work environment, and socially imposed stressors.
The adaptation strategies were classified under inactive and active adaptation strategies.
CONCLUSIONS: The stressors include the stresses arising from the unknown nature of the disease,
stressful work environment, individual and familial stresses, and the socially imposed stresses. The
adaptation strategies include inactive and active adaptation strategies. Identification of these factors
can help workers and management to effectively react to the pandemic.

Abstract BACKGROUND: The use of personal protective equipment (especially face masks) has increased in
different communities amid the COVID‑19 pandemic. Therefore, the present study aimed to assess
knowledge and performance of Iranian general population in wearing face masks.
MATERIALS AND METHODS: The present study is a cross‑sectional study conducted using a valid
and reliable questionnaire on 1843 eligible individuals. The questionnaires were shared by Link (www.
porsall.com) in groups and social networks. Data were analyzed using SPSS (Version 24.0, SPSS
Inc., Chicago, IL).
RESULTS: The mean age of the participants was 42.84 years (standard deviation: 16.84). The
majority had inadequate and low knowledge of masks (69.2%), nearly 30% had moderate (30.1%),
and few had adequate and high knowledge of masks. The individuals’ knowledge on when to wear
a mask was also assessed and the results showed poor and low in 42.2%, 46.9% moderate and
high performance in 10.7%. The participants’ performance on how to properly wear a mask was also
assessed and 12% showed poor, 69.3% showed moderate, and 18.7% showed high performance.
Safe removal of masks was also assessed, and the results showed 52% low and poor, 27.6%
moderate, and 20.3% high performance. A significant and direct correlation was found between the
overall score knowledge and performance regarding use of masks (P < 0.001).
CONCLUSION: The results showed poor to moderate knowledge and performance of majority of
Iranian general population regarding the masks. Therefore, further effective training courses and
action plans are needed in Iran given the importance of masks for the prevention of COVID‑19,
especially in public places. Educational package about how to use the mask and its benefits, through
the media and health centers is recommended.

Abstract BACKGROUND: In terms of missions, hospitals are divided into teaching and nonteaching. In addition,
differences in health‑care systems in countries will lead to differences in hospitals’ operation. Iran, as
a specific health‑care system, is different from other countries. Hence, the present study investigated
differences between teaching and nonteaching hospitals and their differences in Iran and the world.
MATERIALS AND METHODS: A concurrent mixed‑methods study was conducted in two stages.
The first stage was a narrative review of studies (2000–2020). Using narrative inquiry and reflective
analysis, the content was analyzed and the categories were extracted. The second stage was a
qualitative study conducted using semi‑structured interviews with forty Iranian hospital managers and
policymakers through a purposive sampling in 2020. Content analysis was made using deductive
approach, and MAXQDA 12 was used for data analysis.
RESULTS: According to the first stage, categories were extracted as follows: service quality, type
of cases, patient satisfaction, efficiency, performance indicators, patient safety, personnel, use of
drugs, access to services, technologies, justice in the type of services received, using guidelines,
processes, and number of services. In the second stage, 8 main categories, 17 categories, and 45
subcategories were extracted. The extracted main categories were as follows: mission and target,
management and behavioral organizations, supply chain and chain of results, human resources,
costs and budget, policy demands, clients’ satisfaction and patients’ right, and integration of medical
education.
CONCLUSION: Unlike other countries, in Iran, the combination of missions and the complete
dependence of teaching hospitals on the government has caused differences. Reducing the treatment
mission of teaching hospitals; differences in the budget and development of its indicators; lower tariffs
for teaching hospitals; developing a cost–income management model and supply chain; preventing
uncertainty other than medical students except medicine; considering the clients’ right to choose
hospital; and organizing research missions in hospitals were the solutions for decrease differences.

Abstract BACKGROUND: The World Health Organization recommendation requires the development and use
of effective, brief, clear, and evidence‑based education packages to improve health‑care outcomes.
No comprehensive sexual health improvement package exists for the pregnancy period in the Iranian
health system. This study aimed to develop a package to promote sexual health in pregnancy.
MATERIALS AND METHODS: The present study is a qualitative study, which was conducted
in 2019 in Tehran, Iran. Sexual health package during pregnancy was developed based on the
National Institute for Health and Clinical Excellence (NICE) steps. The first step included reviewing of
international guidelines, strategies, handbooks, education packages, and articles in this regard. The
package was developed in the second step. In the third step, quality assessment was performed using
expert opinion with the Appraisal of Guidelines for Research and Evaluation Instrument II (AGREE
II) tool, and validation was performed using Delphi method.
RESULTS: Package content was designed in two sections: for midwives and health‑care providers
and for pregnant mothers in three sessions (in each trimester of pregnancy). The quality assessment
using the AGREE II guidelines revealed excellent quality (>89%). The package was validated based
on expert opinion (>95%).
CONCLUSION: The sexual health promotion package during pregnancy was designed with high
quality and validity based on NICE steps. It is recommended, midwives be performed this designed
and validated package in routine pregnancy care to promote the couple’s sexual health.

Abstract BACKGROUND: Breastfeeding is beneficial for the health of infants and mothers. It is a complex
social behavior that may be influenced by social support. The study aimed to determine the relationship
between perceived social support of breastfeeding women and their breastfeeding patterns.
MATERIALS AND METHODS: The research was a cross‑sectional study on 300 mothers with
6‑month infants or younger who were selected randomly. The data collection tool consisted standard
social support and breastfeeding patterns questionnaires. We analyzed data using descriptive and
analytical tests and SPSS 18 at a significance level of < 0.05.
RESULTS: The results indicated that 85%, 82.2%, and 38% of the infants were exclusively
breastfed at 1 week, 4, and 6 months after delivery, respectively. The result of post hoc LSD test
indicated that the mean number of supporters for mothers, who were in the 6th month of delivery,
was significantly lower than other times (P = 0.001). The one‑way analysis of variance indicated
no significant difference between perceived satisfaction of social support at different periods after
delivery (P = 0.92). Despite the present results, which indicated that the number of supporters and
scores of satisfaction with support in exclusive breastfeeding were higher than other groups, the
differences were not statistically significant.
CONCLUSIONS: The mean number of supporters was less in women, who had 6‑month‑old infants,
than mothers who had just given birth. It seems mothers with supplements and formula feeding
patterns, such as breastfeeding mothers, may be supported to use these methods. Therefore, more
studies are suggested on this field.

Abstract BACKGROUND: Critical thinking is one of the goals of education. It is a criterion for academic
accreditation in medical education by concentration on students’ soft skills. Due to lack of basic
information on critical thinking tendency in undergraduate medical program, this study aimed to
determine the trend of tendency toward critical thinking of medical students in two phases: basic
science (year 1) and preinternship (year 5) at Tehran University of Medical Sciences.
MATERIALS AND METHODS: This longitudinal descriptive–analytic study has been conducted
in two phases (2010 and 2015); all 105 medical students were selected by accessible sampling
method. Years of entrance to college was the inclusion criterion. The psychometric properties of The
California Critical Thinking Dispositions Inventory (CCTDI) were confirmed, and then, the instrument
was completed twice by participants. Data were analyzed by SPSS: 16 using student t-test, and
paired t-tests.
RESULTS: There was a significant difference between genders of students (P < 0.05). Males were
more disposed toward critical thinking than females. The significant increase was found between mean
of truth‑seeking in the second test compared to the first test; instead, the mean of inquisitiveness,
analyticity and self‑confidence and inquisitiveness was significantly decreased (P < 0.05).
However, in other subscales, there were no significant differences between the 1st and the 5th year
students (P > 0.05). The total score of the test in the second phase was lower than the first phase,
which was not significant.
CONCLUSION: According to the findings, there is necessary to consider the critical thinking
dispositions in medical students training programs and break down the barriers. Tendency toward
critical thinking seems to be as prerequisite of critical thinking skills in undergraduate medical program.

Abstract BACKGROUND: Pain and nausea and vomiting are of serious complications following the use of
opiates after surgery, especially cesarean section. Control of postoperative complications is one of
the necessities of quality promotion of health‑care system. Medications with few side effects such
as corticosteroids including dexamethasone can be an appropriate option. In addition, the route of
administration can have a significant effect on the effectiveness of the drug. The aim of the present
study was to compare the effects of intrathecal with intravenous dexamethasone in reducing the
complications associated with intrathecal morphine after cesarean section.
MATERIALS AND METHODS: The study was a double‑blind randomized controlled clinical trial and
determined the effect of intrathecal and intravenous dexamethasone on the incidence and severity
of complications of intrathecal morphine after cesarean section on 120 patients and its relationship
with serious complications after surgery. Descriptive and analytical statistics were used to examine
the characteristics of the case and control groups, and STATA SPSS software was used to compare
the two groups.
RESULTS: There was no significant association between the two groups in terms of baseline
characteristics. Pain score in the intrathecal injection group was lower than the intravenous injection
group, with a statistically significant difference (P = 0.02). In addition, there was a significant
association regarding to the incidence of nausea, vomiting, and itching between intrathecal and
intravenous injection groups (P = 0.008).
CONCLUSION: Dexamethasone was effective to reduce opiate complications after cesarean section.
Establishing a suitable association between dexamethasone half‑life, efficacy, type of use, and time
of use can result the best outcomes and promote patients’ satisfaction in cesarean section.

Abstract BACGROUND: Low back pain (LBP) has been regarded as one of the musculoskeletal problems
which is affecting more than three‑quarters of individuals in their lifetime. Nowadays, various
pharmacological and nonpharmacological therapies are employed for relieving and treating LBP. This
study was conducted to compare the effects of topical hot salt and hot sand on patients’ perception
of LBP.
MATERIALS AND METHODS: In this, quasi‑experimental study patients with LBP referring to the
orthopedic clinic of Shahrekord educational hospital were divided randomly into two interventions and
one control group in 2020. All three groups were received naproxen cream and daily physiotherapy
in the same manner, the interventional groups in addition either topical hot salt or topical hot sand.
Data gathering tool for measuring patients’ perception of LBP was the McGill Pain Short Form
Questionnaire to be completed at the beginning, immediately at the end, and 2 months after the
intervention. The data were analyzed using SPSS statistical software (version 21.0).
RESULTS: Totally, 90 patients were randomized based on the table of random numbers (mean age
51.1 + 11.1), and finally, 87 patients completed the study. Patients’ perception of LBP before the
intervention was homogenous in hot salt, hot sand, and the control group The mean score of total
pain experience before the intervention was 14.1 ± 11.3 for hot sand, 13.9 ± 10.7 for hot salt and
13.7 ± 10.1 for control group The mean scores of these three groups were not significant before the
intervention (P > 0.05). The mean score of total pain experience immediately after the intervention
was 6.7 ± 4.2 for hot sand, 5.2 ± 3.1 for hot salt and 13.9 ± 9.8 for control group. The mean scores
of the hot sand group and the hot salt group were significantly decreased compared with control
group (P > 0.05). The mean score of total pain experience two months after the intervention was
5.6 ± 3.27 for hot sand, 4.21 ± 2.14 for hot salt and 13.8 ± 10.4 for control group. Mean score of total
pain experience in both intervention groups had significantly reduced two months after the intervention
compared to control group (P ≤ 0.001); so that the effect of hot salt treatment on reducing total
pain experience was larger than hot sand (P ≤ 0.001). The same trend was observed for VAS and
Present pain intensity variables.
CONCLUSIONS: The findings have revealed that the topical treatments with hot salt and hot sand
could have a significant effect on the perception of LBP compared to those in the control group;
whereas hot salt might be stronger effects than hot sand on reducing LBP.

Abstract INTRODUCTION: The study aims to measure and compare pulmonary function tests (PFTs) in oral
submucous fibrosis (OSMF) patients (smokers/nonsmokers) and normal individuals.
MATERIALS AND METHODS: The study population included 150 participants that comprised 50
nonsmoker OSMF patients, 50 OSMF patients who smoke as well, and 50 patients with no deleterious
habits. Spirometer was used to assess PFT.
RESULTS: Results showed that a significant P value was obtained for forced vital capacity (FVC),
forced expiratory volume in 1 s (FEV1), FEV1/FVC, peak expiratory flow rate (PEFR), and maximum
voluntary ventilation (MVV) and also for the predicted values of FEV, FEV1, FEV1/FVC, PEFR, and
MVV in OSMF (smokers/nonsmokers) study groups.
CONCLUSION: Thus, the decrease in pulmonary function can be an alarming sign for restrictive
type of pulmonary disease.

Abstract BACKGROUND: Self‑care activities are associated with prognosis of type‑II diabetes mellitus
patients and include medication adherence, dietary adherence, physical activity, self‑monitoring of
blood glucose (SMBG), and appropriate foot care. The behaviors of a patient’s family members can
influence the patient’s self‑care activities, but little data exist on this association. The objective of this
study was to assess the extent of the association between behaviors of family members of Type‑II
diabetes patients and the patients’ self‑care activities.
MATERIALS AND METHODS: We conducted a cross‑sectional study at a teaching hospital
in Kathmandu, Nepal, and interviewed 411 outpatients with Type‑2 diabetes mellitus. We used
exploratory factor analysis to group family members’ behaviors into 3 domains (“authoritarian,”
“supportive,” and “planning” behaviors) and graded the level of the behavior into 3 categories (“high”
vs. “medium” vs. “low”) according to its ranking distribution in each domain. We assessed the
association between domains of family behavior and self‑care activities using multivariate logistic
regression with Bonferroni correction.
RESULTS: High (vs. low) level of supportive behavior was associated with compliance to SMBG (58%
vs. 11%; adjusted odds ratio [OR] =7.44; 95% confidence interval [CI] =2.41, 23.01). High (vs. low)
level of planning behavior was associated with high level of foot care adherence (64% vs. 21%;
adjusted OR = 6.03; 95% CI = 3.01, 12.11).
CONCLUSIONS: We found associations between behaviors of diabetes patients’ family members
and the patients’ own self‑care behaviors. However, the incongruence between the family behavior
measurement questions and the self‑care of interest limited the implications of the findings.

Abstract BACKGROUND: The background is to determine the influence of speed and strength training of
schoolchildren aged 13–14 on the indicators of the ability of children with different nervous system
strength to switch attention.
MATERIALS AND METHODS: This was a cross‑sectional study conducted on sixty schoolchildren
in a class 7, located in the city of Kirov, in Russia. The data were collected using an independent
pedagogical experiment. Physical education at the school was held two times a week for 40 min
each lesson. Children from class 7a (20 people) were engaged in the usual program and formed a
control group. Children from class 7b (20 people) formed an experimental group, they performed an
additional set of physical exercises at each lesson, aimed at developing speed and strength abilities.
The strength of the nervous system was determined by tapping test, and the indicators of switching the
attention of schoolchildren were determined by the test «Method of Numbers». T‑student was used.
RESULTS: After the pedagogical experiment, the indicators of attention switching in the control
group improved. In children with a strong nervous system, the indicator was higher by 7%, and in
children with a weak nervous system, the indicators increased from 33.7 ± 3.1 s to 32.0 ± 2.9 s. At
the same time, in the experimental group, in both subgroups, the indicators increased significantly.
Children with a strong nervous system improved performance by 14%, and children with a weak
nervous system improved performance from 34.4 ± 3.9 s to 29.2 ± 3.3 s.
CONCLUSION: The indicators of switching the attention of children aged 13–14 years will improve
if they perform physical exercises at each physical culture lesson at school, which are aimed at
developing speed and strength abilities. The components of the load for the development of abilities
should be differentiated taking into account the strength of the schoolchildren nervous system.

Abstract BACKGROUND: Dental education is considered a challenging and taxing program as on successful
completion one is required to attain unique and diverse competencies. There is an established
perception that students do not enjoy their experiences in the dental institution and they always
demand for certain amendments. Therefore, a dental education perceptions and metacognition
assessment tool (DEPMAT) was developed for Indian undergraduate and postgraduate dental
students for assessing their learning in Deemed University versus Maharashtra University of Health
Sciences in Pune, Maharashtra.
MATERIALS AND METHODS: This cross‑sectional study was conducted among students of four
dental colleges of two types of universities in Pune, India, using a 31‑item DEPMAT based on
Dundee Ready Education Environment Measure and metacognition awareness inventory using five
subscales. Psychometric properties were also tested for this new tool. Data were analyzed using
the SPSS software.
RESULTS: Of 512 participants, 498 (96.88%) students had duly returned the questionnaire.
Cronbach’s alpha coefficient value for reliability was found to be 0.87 which indicated good internal
consistency and test‑retest reliability was found to be kw = 0.76, which indicated substantial agreement.
Significant difference was found among undergraduates in domains regarding their perception toward
academics, infrastructure and learning environment, and health and stress.
CONCLUSION: This study suggested that the general perception toward learning among final year
postgraduate students was positive in both the universities. However, the perception of final year
undergraduates toward learning was negative and students have suggested certain amendments in
both the universities. This study also suggested the new tool was effective in assessing the attitude
of practice of both undergraduate and postgraduate students.

Abstract BACKGROUND: Noncommunicable diseases (NCDs) may be influenced by lifestyle behavior,
acquired during transition in student life at university. Health is a major concern globally. The
developing counties are facing a double burden of disease, both communicable and NCD. This
study is aimed to assess the lifestyle and its associated factors that can affect the health status of
medical and nursing students.
MATERIALS AND METHODS: A community‑based cross‑sectional study was conducted among
medical and nursing students of Sasaram, Bihar, by universal sampling. The study population
consisted of 303 medical and 233 nursing students. The 536 students in the study, included 195
from rural areas and 341 from urban areas. Simple Lifestyle Indicator Questionnaire was used and
Chi‑square statistics was computed to determine the association of demographic variables with
lifestyle behavior using Epi InfoTM 7 analysis software.
RESULTS: Mean age and body mass index were 21 ± 2.59 years and 22.12 ± 3.77, respectively.
After statistical analysis utilizing the Chi‑square test, it was shown that the difference was found to
be nonsignificant (P > 0.05) in all the following variables, such as gender, age, marital status except
in designation, and alcohol and tobacco intake which showed the difference to be highly significant.
CONCLUSIONS: The maximum number of students in the study population showed intermediate
healthy lifestyle (57.1%), despite being the upcoming health‑care providers of future. Fruits were
rarely present in diet in 82%, no physical activity in 21.2%, and tobacco and alcohol were consumed
by 11.7% and 13%, respectively. Targeted intervention for healthy diet, physical activity, stress,
tobacco, and alcohol reduction can lead to healthy lifestyle. Independence and autonomy gained in
the transition phase in student life needs guided supervision to raise responsible adults. It may help
to assist or to plan accordingly in future to improve lifestyle of the students.

Abstract BACKGROUND: The objective of the study was to analyze and determine statistically significant
impact of the COVID‑19 on clinical load of plastic and reconstructive surgery practices.
MATERIALS AND METHODS: The retrospective analysis and comparison of the number of patients
visiting to outpatient clinic, number of patients admitted, number of patients operated in the plastic
and reconstructive surgery department during the COVID‑19 pandemic months of January 2020–
June 2020 with the same months of preceding non‑COVID‑19 year was done. The data obtained
were tabulated in Microsoft Excel spread sheet and the statistical analysis done using MedCalc
statistical software.
RESULTS: The mean ± standard deviation of patients attended in outpatient department (OPD),
admitted in inpatient department (IPD), emergency surgeries performed, and elective surgeries
performed during ‑COVID‑19 versus COVID‑19 pandemic period is (651.167 ± 310.42 vs.
212.5 ± 307.591), (83.5 ± 16.263 vs. 34.333 ± 53.74), (5.167 ± 4.243 vs. 3.333 ± 4.95),
and (74.333 ± 28.284 vs. 40.833 ± 60.811), respectively. The difference in means is highly significant
statistically in the number of patients attended in OPD, admitted in IPD, and elective surgeries
performed during pre‑COVID versus COVID period; however, the difference in the means is not
statistically significant in the number of emergency surgeries performed during pre‑COVID versus
COVID period.
CONCLUSION: The COVID‑19 pandemic has significantly reduced the number of patients attended in
OPD, admitted in IPD, and elective surgeries performed in the department of plastic surgery. However,
there is a reduction in number of emergency surgeries but statistically insignificant. The strategy is
to use telemedicine portal e‑Sanjeevani services for OPD, encourage admission of patients with
reverse transcription polymerase chain reaction negative for COVID‑19, and perform reconstructive
and esthetic plastic surgery operative procedures using COVID‑19 appropriate precautions.

Abstract BACKGROUND: A Medical Certificate of Cause of Death (MCCD) is a vital document issued by a
doctor and has a prescribed format published by the World Health Organization. It is an essential
tool to obtain scientific and reliable information in terms of the cause of mortality. The aim of this
study is to assess the knowledge about MCCD and to evaluate the impact of sensitization training
on the MCCD among the physicians working in the trauma and emergency department in a Tertiary
Care Centre.
MATERIALS AND METHODS: A quasi‑experimental quality improvement hospital‑based study
executed in Trauma and Emergency Department of Tertiary Care Hospital in Chhattisgarh State,
India. The physicians posted in the Trauma and Emergency Department were participated in the
study and attended the sensitization training session on MCCD. Statistical analysis used; the data
were entered in Microsoft Excel and analyzed with SPSS version 20 statistical software. Mean scores
and standard deviation (SD) were used for pre and posttest data while statistical significance was
tested using the paired t‑test. P < 0.05 was considered as significant. The technical and medical
errors in MCCD forms were depicted in percentages.
RESULTS: A total of 54 physicians completed the study, including 42 junior resident doctors, 6 senior
resident doctors, and 6 faculties. There was a significant difference in the scores before (M = 4.39,
SD = 1.571) and after (M = 7.5, SD = 0.885) the training (t = 17.6, P < 0.0001). The participants
showed substantial improvement by reduction in technical errors from 28% to 14% while the medical
error also slashed down from 42% to 16%.
CONCLUSIONS: Sensitization and educational training should be carried out consistently on regular
intervals to improve the knowledge of physicians regarding the appropriate filling of MCCD and
minimize the errors in MCCD, ultimately this will enhance usability and comparability of mortality
statistics generated from International Classification of Diseases data.
Keywords:
Death certificate, effectiveness of training, errors, medical certification of cause of deathBACKGROUND: A Medical Certificate of Cause of Death (MCCD) is a vital document issued by a
doctor and has a prescribed format published by the World Health Organization. It is an essential
tool to obtain scientific and reliable information in terms of the cause of mortality. The aim of this
study is to assess the knowledge about MCCD and to evaluate the impact of sensitization training
on the MCCD among the physicians working in the trauma and emergency department in a Tertiary
Care Centre.
MATERIALS AND METHODS: A quasi‑experimental quality improvement hospital‑based study
executed in Trauma and Emergency Department of Tertiary Care Hospital in Chhattisgarh State,
India. The physicians posted in the Trauma and Emergency Department were participated in the
study and attended the sensitization training session on MCCD. Statistical analysis used; the data
were entered in Microsoft Excel and analyzed with SPSS version 20 statistical software. Mean scores
and standard deviation (SD) were used for pre and posttest data while statistical significance was
tested using the paired t‑test. P < 0.05 was considered as significant. The technical and medical
errors in MCCD forms were depicted in percentages.
RESULTS: A total of 54 physicians completed the study, including 42 junior resident doctors, 6 senior
resident doctors, and 6 faculties. There was a significant difference in the scores before (M = 4.39,
SD = 1.571) and after (M = 7.5, SD = 0.885) the training (t = 17.6, P < 0.0001). The participants
showed substantial improvement by reduction in technical errors from 28% to 14% while the medical
error also slashed down from 42% to 16%.
CONCLUSIONS: Sensitization and educational training should be carried out consistently on regular
intervals to improve the knowledge of physicians regarding the appropriate filling of MCCD and
minimize the errors in MCCD, ultimately this will enhance usability and comparability of mortality
statistics generated from International Classification of Diseases data.

Abstract BACKGROUND: Early intervention programs are supremacy in health, psychological, social,
and sports care policies in many developed countries, considering the necessity to identify the
circumstances and any support required as soon as possible. Consequently, understanding the critical
role of mothers of children with Down syndrome in meeting the needs of their children is crucial, as
well as developing their capacity to make positive contributions to the psychosocial harmony of their
children. Hence, this study aims at determining the real role of early intervention programs in the
rehabilitation of mothers of children with Down syndrome and identifying the obstacles that prevent
early intervention services and programs from achieving their objective and how to treat it.
MATERIALS AND METHODS: The descriptive‑analytical approach was used. In order to achieve
these objectives, an online questionnaire consisting of (88) phrases, divided into three areas, was
applied to (20) mothers of children with Down syndrome.
RESULTS: The assessment study concluded several results from the mothers’ perspective,
indicating that cognitive qualifications were highest at an average of 52.66%, followed by educational
qualifications at an average of 50.73%, social qualification at an average of 48.78%, and religious
qualification at an average of 48.33%. Finally, psychological qualifications were lowest at an average
of 45.22%. The approval rate of all these proposals exceeded 90%.
CONCLUSION: Based on these results, a proposal for activating early intervention programs for the
rehabilitation of mothers of children with Down syndrome, in light of the Saudi Vision 2030, was set.
It was also recommended to give continuous and intensive courses to mothers, in order to improve
their children’s skills and self‑sufficiency.

Abstract BACKGROUND: COVID‑19 pandemic has changed the life of people in many facets, economic,
social, and psychological. Frontline health‑care workers (HCWs) fighting against this pandemic faced
some psychological as well as social issues which are of major concern. The objective of the study is
to evaluate the magnitude of mental health problems, namely depression, anxiety, and stress among
frontline HCWs as well as their perception on ongoing events and surroundings.
MATERIALS AND METHODS: It was a prospective, observational study on n = 85 HCWs over
a 4‑month period. Study participants were sampled purposively in accordance with inclusion and
exclusion criteria; data were collected by online survey method. A semi‑structured scale was used:
Part A of which assessed the demography and perception of HCWs on surrounding along with ongoing
social events and Part B consisted of the Depression, Anxiety, and Stress Scale‑21 that was used
to assess mental health issues. All the associations were tested in percentages and proportions.
Statistics was calculated by using SPSS 24th version.
RESULTS: Majority of the participants were female doctors and belonged to 21–30 years’ age
group. Most of them were marginally worried of contacting infection (73%) but were substantially
apprehensive of transmitting infection to their family (56.5%) and hoped positive outcome ultimately
in the form of recovery from infection. Majority (96.4%) gathered information from authentic sources
and were confident of adequacy of their knowledge. Majority (88.3%) were satisfied about their
occupational safety and responded on scientific solution of pandemic. However, we got a mixed
result about their professional appreciation. Depression symptom score was higher than anxiety and
stress symptom score in our participants.
CONCLUSIONS: Doctors and nurses both were suffering from mental health issues, and provision
of adequate information and occupational safety may lessen these burdens.

Abstract BACKGROUND: Substance use disorders (SUDs) are one of the most stigmatized health conditions
that impact drug user’s treatment engagement. However, to date, little is known about perceived
stigma and its correlates with psychological factors among high‑risk groups such as people with
SUDs in the criminal justice system. This study aimed to determine the association of psychological
factors and perceived stigma of addiction among women with SUDs.
MATERIALS AND METHODS: This cross‑sectional design was conducted on 652 women with SUDs
who were treated in all 7 compulsory drug detention centers in Thailand with consecutive sampling
technique. The data were collected by standardized interviewers with interviewing questionnaire.
Multiple logistic regression was applied to examine the effect of psychological factors and perceived
stigma.
RESULTS: More than half of SUD patients (57.2%) were methamphetamine abuse or dependence,
approximately 69.9% reported high level of perceived stigma, 56.7% had mild depression, 34.8% had
low level of perceived social support, and the average perceived stress score was 19.2 (standard
deviation, 7.5). The perceived stigma was positively related to depressive symptom and perceived
stress while was inversely related to perceived social support.
CONCLUSION: The psychological factors were strongly associated with perceived stigma of addiction.
Thus, the detection of psychological problems among SUD patients may be benefit clinicians for
identifying which patients are most at risk of perceived stigma and are the potential targets of
intervention to reduce stigma in clinical practice.

Abstract BACKGROUND: Osteoporosis is mainly characterized by a low bone mineral density and a sharp
architectural and biomechanical deterioration in bone tissue required to maintain bone homeostasis.
The theory of planned behavior (TPB) can be considered as one of the leading theories when designing
an evidence‑based intervention. This study was carried out based on the TPB to determine the effect
of an educational intervention aimed at mothers on the prevention of osteoporosis in female students.
MATERIALS AND METHODS: A total of seventy mothers of lower secondary school students
in Tehran, Iran, participated in this experimental study which was conducted in 2019–2020. The
participants were randomly assigned to two groups, namely experimental and control groups. Based
on the TPB, a demographic and a researcher‑made questionnaire consisting of five sections were
used in order to collect data. The validity and reliability of the questionnaires were confirmed before
data collection. Four 45–60 min training programs were delivered to the subjects using the TPB.
Data were collected before, immediately after, and 1 month following the training program. Finally,
IBM SPSS Statistics 21 was used for statistical analysis.
RESULTS: No significant difference was observed in terms of attitude, subjective norms, perceived
behavioral control, behavioral intention, and osteoporosis prevention‑related behavior between the
experimental and control groups before proceeding with the intervention (P > 0.05). However, the
mean scores of attitude, subjective norms, perceived behavioral control, behavioral intention, and
behavior were significantly higher in the experimental group compared to those of the control group
following the educational intervention (P < 0.05).
CONCLUSION: It can be concluded that such interventions based on the TPB can, in fact, produce a
significant effect on osteoporosis prevention‑related behaviors. Thus, it can serve as a useful model
for planning educational interventions.

Abstract BACKGROUND: Pregnancy anxiety is associated with a diverse birth outcomes. Mothers’ education
could have a critical role in increasing their self‑efficacy to defeat their anxiety and improve pregnancy
and child birth outcomes. The study was conducted to examine the effect of intervention based on
self‑efficacy theory on pregnancy anxiety and child birth outcomes.
MATERIALS AND METHODS: The study was conducted as a quasi‑experimental design on
60primiparous women (26–28 weeks) in Birjand (East Iranian province) from May to September 2017,
who were randomly divided into intervention and control groups. The intervention group received
8 sessions of 90‑min educational intervention based on self‑efficacy theory strategies besides the
routine prenatal care. Vanden Bergh’s pregnancy anxiety questionnaire and checklist of pregnancy
and delivery outcomes were used for data collection.
RESULTS: The level of pregnancy anxiety was similar in both groups before the intervention, but
immediately and 1 month after the intervention, the mean score of pregnancy anxiety significantly
reduced in the intervention group and significantly increased in the control group (P < 0.001). There
was a significant difference in mean neonatal weight (P < 0.001) between the two groups. Emergency
and elective cesarean section were significantly lower in the intervention group compared to the
control group (P < 0.001), but there were no significant differences in the frequency of preterm
delivery between two groups (P < 0.05).
CONCLUSION: The results provide support for the effectiveness of intervention based on self‑efficacy
theory in reducing pregnancy anxiety and enhancing positive pregnancy outcomes. Hence,
theory‑based educational interventions may serve as a cost‑effective and noninvasive approach to
reduce pregnancy anxiety in Iran.

Abstract BACKGROUND: One of the useful models in health education is the Beliefs, Attitudes, Subjective
Norms, and Enabling Factors (BASNEF) model. The model is used to study behavior and to plan
for change it and to determine the factors that influence people’s decision‑making. The aim of this
study was to investigate the factors affecting the nutritional behavior of pregnant women based on
BASNEF model.
MATERIALS AND METHODS: This cross‑sectional study was performed on 360 pregnant women
referring to health centers of Tabriz‑Iran by two‑stage cluster sampling method from April to December
2016. Data were collected using sociodemographic, nutrition subdomain of Health Promoting
Lifestyle‑II (HPLP‑II), and researcher‑made questionnaire based on constructs of BASNEF model.
Data were analyzed using the SPSS software version 21 and Pearson correlation test and General
Linear Model (GLM).
RESULTS: Mean ± standard deviation (SD) of nutrition subdomain of HPLP‑II was 24.65 ± 4.75
within the range 9–36. Mean ± SD of BASNEF model constructs (score range) was also obtained
as 45.30 ± 10.80 (0–100), 17.98 ± 2.40 (8–24), 9.30 ± 2.82 (0–20) and 2.47 ± 1.74 (0–6) for belief,
attitude, subjective norms, and enabling factors, respectively. Based on the GLM, there was significant
relationships between nutritional behavior and BASNEF model constructs (belief [P < 0.001],
attitude [P = 0.043], enabling factors [P < 0.001], and subjective norms [P = 0.038]) as well as the
variables of job, husband’s education, and job and sufficiency of income for expenses.
CONCLUSION: The results of the present study showed the impact of BASNEF model constructs
and some sociodemographic variables on nutrition behaviors in pregnant women. Therefore, in order
to improve nutrition behaviors of pregnant women, designing and implementation of interventions
based on the BASNEF model are recommended.

Abstract BACKGROUND: Considering the importance of sexual health literacy in promoting individual sexual
health and ultimately improving family and social health as well as the effect of health literacy on
sexual function, this study was designed and conducted to determine the association between sexual
health literacy and sexual function among women.
MATERIALS AND METHODS: This was a cross‑sectional study. A total of 420 women referring
to health centers were entered into the study using one‑stage cluster sampling method. Data
collection tools included a demographic questionnaire, Iranian Adult Sexual Health Literacy
Assessment Questionnaire, and the Persian version of the Female Sexual Function Assessment
Questionnaire (FSFI). Data were collected and entered into SPSS 22 and logistic regression.
RESULTS: The results of the logistic regression test showed that the variable of sexual health literacy
was effective on women’s sexual function (P = 0.021) so that the chances of having a desirable sexual
function in women with excellent were 4.222 times more than women with inadequate health literacy;
the variables of employment status, level of education, duration of marital life, and the number of
sexual intercourses per recent week were the factors affecting women’s sexual function (P < 0.05).
CONCLUSION: The results of this study pointed out the existence of an undesirable level of sexual
function and a desirable level of sexual health literacy among participating women. Hence, designing
and implementing the training plans to promote sexual function among these women is necessary.

Abstract BACKGROUND: Women’s health is supposed to be one of the indicators of development.
Reproductive health is an important part of women’s health. Vulnerable women are a group of women
whose reproductive health needs to be given special attention. The purpose of this study was to
compare the reproductive health of vulnerable and nonvulnerable women.
MATERIALS AND METHODS: This cross‑sectional study was conducted on vulnerable
women (n = 250) and nonvulnerable women (n = 250). The samples were selected from vulnerable
women’s centers and comprehensive health centers in Isfahan by quota and using simple random
sampling method in 2017. The research tool was a researcher‑made questionnaire completed by the
researcher using interview method. Internal reliability of the questionnaire was confirmed to be 0.89
using Cronbach’s alpha. A P < 0.05 was considered to be statistically significant. Data analysis was
performed using SPSS 18 software and independent t‑test, Mann–Whitney, Pearson, Spearman,
and Chi‑square tests.
RESULTS: The results showed that the mean total score of reproductive health in the nonvulnerable
group (81.41) was significantly higher than that of the vulnerable group (68.6). The mean total score
and the score of reproductive health components, except some of them, were significantly different
between the two groups (P < 0.05). Having an addicted spouse and unsafe sex were the most
prevalent features associated with high‑risk behaviors.
CONCLUSIONS: According to the results, reproductive health status of vulnerable women
is inappropriate in all dimensions. Given the importance of this issue, the development and
implementation of special health programs for this group seem to be necessary.

Abstract BACKGROUND: E‑learning is web‑based learning for education and training. The current global
pandemic crisis created due to COVID‑19 has made worldwide online learning. This study aimed to
investigate the level of satisfaction and quality of E‑learning in medical universities from the students’
point of view during the epidemic of COVID‑19 and assessing the obstacles and solutions proposed
to improve the quality of E‑learning.
MATERIALS AND METHODS: A cross‑sectional, web‑based study was conducted among 400
medical university students of Iran during the epidemic of COVID‑19. After getting written consent,
three parts questionnaire contains demographic, user satisfaction, quality questionnaire, and three
open‑ended questions were distributed randomly using social media. Descriptive analysis, t‑test,
Chi‑square, and Pearson correlation coefficient were used to achieve the objective of this study, with
significance set to P < 0.05. Furthermore, three open‑ended questions were reviewed qualitatively
and the problems and solutions suggested by the students were reported.
RESULTS: Based on the findings of the descriptive section, 277 of the respondents were girls (69%)
with a mean age of 21 ± 2 years. Sixty‑nine percent of students were studying in medical sciences
universities and 31% were studying in Islamic Azad University. The level of satisfaction was in the
upper range of low (34.0 ± 10.0); P < 0.001, and intention to reuse was moderate (23.06 ± 6.0);
P = 0.064. Student’s perception of quality in most domains was in the upper range of low to medium.
User satisfaction, intention to reuse, the quality of knowledge, and participatory quality for evaluating
online courses were significantly higher in the Azad University group than in medical universities.
CONCLUSION: Given that this is the first experience in the use of E‑learning in Iran, both universities
have not yet fully succeeded in satisfying students and it is necessary to increase the quality of
E‑learning based on student suggestions.

Abstract BACKGROUND: Low self‑esteem and inefficiency are major problems in multiple sclerosis (MS)
patients. A progressive muscle relaxation technique is one of the complementary therapies. The
objective of this study was to investigate the effect of progressive muscle relaxation techniques on
self‑esteem and self‑efficacy in MS patients.
MATERIALS AND METHODS: This clinical trial was conducted on 100 MS patients were randomly
divided into two groups of experimental (n = 50) and control (n = 50). The experimental group received
progressive muscle relaxation techniques in eight 60‑min sessions twice a week for 4weeks. Rosenberg’s
Self‑Esteem Scale and Self‑Efficacy Scales of MS patients were completed before, immediately, and
4 weeks after the intervention. Data were analyzed using the SPSS software version 16.
RESULTS: The mean score of self‑esteem was not significantly different between the
control (26.02 ± 5.83) and experimental (26.40 ± 6.06) groups before intervention (P = 0.247).
The mean score of self‑esteem in the control group (27.16 ± 7.45) and the experimental
group (29.06 ± 6.61) immediately after the intervention (P = 0.083) was not significantly different.
4 weeks after the intervention, the mean scores of self‑esteem in the control (26.96 ± 8.33)
and the experimental (29.98 ± 7.02) groups were significantly different (P = 0.012). The
mean score of self‑efficacy was significantly different between the control (41.62 ± 4.46) and
experimental (39.32 ± 4.31) groups before intervention (P = 0.010). The mean scores of self‑efficacy
in the control group (38.38 ± 5.07) and the experimental group (44 ± 4.46) immediately after the
intervention (P < 0.001) and 4 weeks after intervention showed a significant difference between the
control group (38.04 ± 5.46) and the experimental (46.40 ± 5.04) groups (P < 0.001).
CONCLUSION: Due to the effect of progressive muscle relaxation on self‑esteem and self‑efficacy
of MS patients, its safety and simplicity, this technique can be used as a complementary therapy to
enhance the level of self‑esteem and self‑efficacy of MS patients.

Abstract BACKGROUND: Professional ethics is a set of principles and standards of human behavior that
affect individual behavior and leads to improve care that provided by medical staff. The present
study examined the knowledge and attitude of medical and nursing students toward professional
ethics in Iran.
MATERIALS AND METHODS: This descriptive‑analytic study was carried out on 176 medical and
nursing students in Bam University of Medical Science, Iran in 2019. In this study, students were
selected by census sampling. Data collected using two researcher‑made questionnaires related to
knowledge and attitude toward professional ethics. Data were analyzed in SPSS software.
RESULTS: The mean scores of knowledge among nursing and medical students were 86.56 (8.76)
and 85.10 (12.19), respectively. The mean score of attitude among nursing and medical students
was 127.06 (12.45) and 129.9 (11.88), respectively. Results of the Pearson correlation test showed a
positive and significant associated between the score of knowledge and attitude nursing and medical
students’ (P < 0.001), (r = 0.76) (r = 0.66). Among the demographics characteristics, student age
was associated to their attitude and knowledge significantly (P = 0.03).
CONCLUSION: Iranian nursing and medical students have a positive attitude and a high level of
knowledge about professional ethics. A high level of knowledge was related to the most positive
attitude.

Abstract BACKGROUND: The use of social networks in the field of education has also accelerated and
has become a powerful source of learning for transformation and empowerment in various fields.
This study aimed to test the adaptation and psychometric properties of an instrument for students’
prospective on e‑professionalism in the use of social media in Iranian medical science students.
MATERIALS AND METHODS: In this questionnaire, with the aim of psychometric properties of the
perception toward social media in Iranian students, this survey instrument developed by (Ness et al.)
in five fields in 2nd‑year pharmacology students in Purdue University The fields include accountability,
hiring decisions, profile editing, professionalism, and privacy settings. In this study, first, a cultural
adaptation was done by an expert panel. Then, psychometric properties of an instrument by content
validity and construct validity using explanatory factor analysis were performed. Reliability was
assessed by test–retest and internal consistency of items. The reliability of the survey instrument
with three factors was 0.82 using the test–retest, and the internal consistency was good (r = 0.94).
RESULTS: The result of psychometric properties using the principal component method extracted
three factors (accountability, hiring decision, and professionalism) to assessment of students’ attitude
to professionalism using social media in Iranian students.
CONCLUSION: The adapted and psychometric properties of the instrument developed by Ness
et al., 2013, with three dimensions and ten items proved to be a valid, reliable instrument for use
for assessing perspectives on e‑professionalism and social media in Iranian medical students. This
questioner may be suitable for Iranian researches in medical education.

Abstract CONTEXT: Understanding how middle‑aged people perceive healthy aging and what they need to do
to stay healthy as they age can help public policy planning to enhance the lifestyles of middle‑aged
and elderly people.
AIMS: The purpose of this study was to clarify the concept of healthy aging and strategies to achieve
it from the perspective of middle‑aged people in Tehran, Iran.
SETTING AND DESIGN: This qualitative study was performed on 21 middle‑aged people aged
45–59 years of Tehran in 2019.
SUBJECTS AND METHODS: The data collection was carried out through semi‑structured and
in‑depth interviews; the interviews were audiotaped, transcribed. Sampling was carried out gradually
until data saturation through purposive sampling was achieved.
STATISTICAL ANALYSIS USED: Data collection and analysis were performed simultaneously.
Data were analyzed using conventional content analysis. To establish the reliability and validity of
findings, Graneheim and Landman criteria were considered.
RESULTS: The middle‑aged perspective on healthy aging was included in four main themes:
having good physical and mental health, having financial well‑being, having social support.
Strategies for achieving healthy aging were included in five themes: future financial planning,
promoting physical health, promoting psychological health, maintaining and improving
communication.
CONCLUSION: From the middle‑aged perspective, healthy aging and strategies to achieve it are
multidimensional. Planning for promotional interventions to have a healthy old age should be including
all dimensions and done from the years before old age.

Abstract One of the most commonly used methods for training is simulation. It is important to examine the
effects of simulation training of health information systems on the knowledge, attitude, and skill in
trainees. This review provided a summary of relevant literature on how simulation training affects
the learning of health information systems and determine the features and functional capabilities
of existing simulators. Studies and websites using simulation training to teach health information
systems were included. Studies were searched through Medline (via PubMed), Scopus, and ISI Web
of Science and websites through Google search by the end of 2019. The characteristics of studies,
features, and functional capabilities of simulators and effects on learning outcomes were extracted.
The included studies and websites were categorized according to different characteristics including
simulation types, learning outcome categories, and the effects of simulation training on learning
outcomes. The learning outcomes were categorized into four groups: knowledge, attitude, skill, and
satisfaction. The effects of interventions on outcomes were categorized into statistically significant
positive, positive without statistical argument, no effect (not statistically significant), negative without
statistical argument, or statistically significant negative. Ten studies and eight websites that used
simulation training to teach health information systems (mainly electronic health record [EHR])
were included. EHR simulation was performed in 80% of the included studies and trainees in 70%
of studies were physicians and nurses. All studies were conducted in three developed countries. In
the included studies, four learning outcomes (i.e. skill, attitude, knowledge, and satisfaction) were
assessed. Ninety percent of the included studies assessed skill‑related outcomes, with more than half
mentioning significant improvement. Thirty percent of the included studies assessed outcomes‑related
knowledge and attitude, all of which reported the positive effects of simulation training. The simulators
offered a variety of functional capabilities, while all of which simulated the clinical data entry process.
In teaching health information systems, especially EHRs, simulation training enhances skill, attitude,
knowledge, and satisfaction of health‑care providers and students.

Abstract BACKGROUND: This study aimed to investigate the psychometric properties of children’s
somatization inventory (CSI‑24) in a sample of Iranian school adolescents.
MATERIALS AND METHODS: In this study, after translating and back‑translating CSI‑24,
comparisons were made with the original version. The study population consisted of 394 school
adolescents. Cronbach’s alpha method was used to examine the reliability of the scale. Furthermore,
the correlation of the scale with the Symptom Checklist‑90‑Revised was evaluated to determine its
criterion validity, using Pearson’s correlation coefficient. Exploratory and confirmatory factor analysis
methods were applied for construct validity.
RESULTS: Investigation of the psychometric properties of the Iranian version of CSI‑24 showed its
high reliability and confirmatory factor analysis results show the model’s satisfactory fitting.
CONCLUSION: The Persian version of CSI‑24 is a useful self‑report tool for evaluating the physical
complaints of Iranian school adolescents aged between 12 and 18 years.

Abstract BACKGROUND: From December 2019, atypical pneumonia termed COVID‑19 has been increasing
exponentially across the world. It poses a great threat and challenge to world health and the economy.
Medical specialists face uncertainty in making decisions based on their judgment for COVID‑19.
Thus, this study aimed to establish an intelligent model based on artificial neural networks (ANNs)
for diagnosing COVID‑19.
MATERIALS AND METHODS: Using a single‑center registry, we studied the records of 250 confirmed
COVID‑19 and 150 negative cases from February 9, 2020, to October 20, 2020. The correlation
coefficient technique was used to determine the most significant variables of the ANN model. The
variables at P < 0.05 were used for model construction. We applied the back‑propagation technique
for training a neural network on the dataset. After comparing different neural network configurations,
the best configuration of ANN was acquired, then its strength has been evaluated.
RESULTS: After the feature selection process, a total of 18 variables were determined as the most
relevant predictors for developing the ANN models. The results indicated that two nested loops’
architecture of 9‑10‑15‑2 (10 and 15 neurons used in layer 1 and layer 2, respectively) with the area
under the curve of 0.982, the sensitivity of 96.4%, specificity of 90.6%, and accuracy of 94% was
introduced as the best configuration model for COVID‑19 diagnosis.
CONCLUSION: The proposed ANN‑based clinical decision support system could be considered as a
suitable computational technique for the frontline practitioner in early detection, effective intervention,
and possibly a reduction of mortality in patients with COVID‑19.

Abstract INTRODUCTION: Improving participation in life meaningful roles is one of the most important
predictors of quality of life (QOL) and life satisfaction (LS) in later life. The purpose of this study was
to investigate the effect of Elder Care by Elderly People (ECP) on LS and QOL among institutionalized
senior citizens.
MATERIAL AND METHOD: This was an interventional study involving a targeted sample of 36
older adults in Ghods nursing home in Tehran in 2018. WHOQOL‑OLD 24‑item and LS 40‑item
questionnaires were used to measure LS and Olathe repeated‑measures ANOVA and descriptive
was employed to obtain the objectives.
RESULTS: The participants were 36 older adults in Ghods nursing home. The mean age of older
adults was 67.27 (standard deviation [SD] = 7.6), of whom about 77.8% were male. The mean score
of QOL increased from 74.38 (SD = 13.09) pre intervention to 83.72 (SD = 11.43) 2 months post
intervention, with most significant change of 9.3 QOL points between pre intervention and 2 months
post intervention alone (P < 0.01). Similarly, LS increased from 114.19 (SD = 26.93) pre intervention
to 133.94 (SD = 20.49) 2 months post intervention, with most significant change of 19.7 LS points
between pre intervention and 2 months post intervention alone (P < 0.001).
CONCLUSIONS: The results of this study showing the evidence of the positive impact of the ECP
Programmed for the elderly, therefore, it is suggested that the programmer is evaluated in future
studies.

Abstract BACKGROUND: It is evident that the novel coronavirus disease pandemic inevitably resulted in
increased stress and anxiety in the general population. Pregnancy is a challenging period, and
COVID‑19 has added risk to women pregnant during the pandemic.
AIM: The present study was aimed to assess the emotional difficulties in pregnant females who
tested positive for COVID‑19. The current study estimated the prevalence of depression, anxiety,
and stress among 63 pregnant ladies who tested positive for COVID‑19.
MATERIALS AND METHODS: The study was conducted in Child and Maternity Hospital of GMC
Anantnag, Kashmir, India, from April to December 2020. A total of 63 pregnant females who tested
positive for COVID‑19 participated in the study. The COVID‑positive pregnant ladies were interviewed
in the outpatient department of the child and maternity clinic 2 weeks after the infection. The interview
scale used was Depression, Anxiety, and Stress Scale‑21. The data were analyzed using Chi‑square
test and Fisher’s exact test.
RESULTS: We found that the mean age of participants was 33.5 ± 7.4. We found that 38.1% of the
females had positive bad obstetric history. The prevalence of depression, anxiety, and stress was
33.32%, 50.83%, and 60.3%, respectively. In correlation analysis, notably bad obstetric history and
working females were significant independent factors for higher levels of depression, anxiety, and
stress. The depression was also found more in literate females and the third trimester.
CONCLUSION: The study indicates high levels of depression, anxiety, and stress in pregnant females
who tested positive for COVID‑19. The emotional difficulties were found to be higher in educated and
working females. The bad obstetric history was found to be an independent factor for higher levels of
emotional difficulties in COVID‑positive pregnant females. This calls for extra measures to promote
the mental health and resilience of pregnant females, especially during a crisis.

Abstract BACKGROUND: The corona virus disease‑2019 (COVID‑19) infection is a current public health
crisis, and it is challenging to the world health‑care system. As there is no treatment, prevention
is the crucial importance to break the chain of transmission of infection and prevent fatality among
the high‑risk populations. The aim of the study was to assess the Expressed COVID‑19 preventive
practices among health‑care workers (HCWs) and the public visiting tertiary care hospital, AIIMS,
Jodhpur.
METHODOLOGY: A cross‑sectional study was conducted among 406 HCWs and 238 public, recruited
by convenient sampling technique. A validated and pretested self‑structured practice questionnaire
used to collect the data regarding COVID‑19 preventive practice. The data were collected through
online Google Forms and interview techniques and analyzed by software SPSS 26 version.
RESULTS: Majority of 87.7% HCWs and 76.5% public always followed practice of hand wash with
soap and water and sanitize for 20 s. Majority of 79.6% HCWs and 49.2% public maintain social
distance in public place. Gender (χ2 = 18.806 P ≤ 0.001) and education (χ2 = 43.270 P ≤ 0.001)
among HCWs and in public demographic variable income (χ2 = 21.102 P = 0.002), religion (χ2 = 13.302
P = 0.006) and source of information (χ2 = 17.030 P = 0.026) was significantly associated with level
of COVID‑19 preventive practice.
CONCLUSION: The study showed moderate level of COVID‑19 preventive practice among HCWs
and public. Based on this result, an effective IEC intervention programs can be designed to educate
public and HCWs and follow a safe COVID‑19 preventive practice.