Journal of Education and Health Promotion

Abstract INTRODUCTION: White spot lesions (WSLs) are common adverse effect of orthodontic treatment,
which can be prevented and treated by orthodontists. This study was conducted to assess Iranian
orthodontists’ practice regarding the prevention and treatment of WSLs in their patients.
METHODS: In this cross‑sectional study, 109 Iranian orthodontists were selected from the Iranian
Association of Orthodontists’ directory by cluster sampling. For data collection, a questionnaire was
designed and its validity and reliability was confirmed (Cronbach’s α =0.85). The questionnaire
included eight general questions and eight questions about practice with regard to the prevention
and treatment of WSL. Data were analyzed by descriptive tests, ANOVA test, and t‑test in SPSS 20
software. P < 0.05 was considered statistically significant.
RESULTS: The mean score of orthodontists’ practice was 7.62 (range: 0–8), and 94.4% of the
participants were rated as good, while 3.7% and 1.9% were rated as moderate and weak, respectively.
Women’s score was significantly higher than that of men (P = 0.001). With increasing participants’
age, their practice has been improved (P = 0.001), but there was no significant relation between years
of experience and their practice (P = 0.230). Nearly 94.4% of the orthodontists prescribed fluoride
products. Toothpastes and fluoride mouth rinses were the most common prescribed products (34%).
CONCLUSIONS: With regard to Iranian orthodontists’ practice, it was fortunate to note that majority
of the respondents were taking care of their patients with regarding to the prevention and treatment
of WSLs. For enhancing their competencies, it is recommended to plan educational courses which
are useful for promoting their knowledge and practice about new products and procedures used for
the prevention and treatment of WSLs.

Abstract BACKGROUND: Nowadays, a large number of students experience spinal pain quite early in life due
to heavy school bag loads. Moreover, external forces in the form of school bags may influence the
normal growth, development of children and adolescents, and also maintenance of alignment of their
bodies, which can pose a huge threat to postural integrity under external load. Awareness about the
appropriate load and placement of backpack is thought to be important in reducing musculoskeletal
complications among children’s.
METHODS: A systematic review of randomized controlled trials (RCTs) was conducted to determine
the influence of postural deviations due to backpack load among school children’s. Electronic databases
were searched, and a reference list of retrieved articles were relevant to postural changes among school
children with the backpack were screened. Reviewers graded the papers according to Lloyd‑Smith’s
hierarchy of evidence scale. Papers were quality appraised using a modified Crombie tool.
RESULTS: Twelve papers were identified for inclusion in this review. Methodological difference
limited our ability to collate evidence.
CONCLUSION: Most of the articles recommended that backpack load limit for school children should
be 10–15% of body weight. However, the appropriate load limit for school children is limited due to
lack of articles, the low hierarchy of evidence, and small sample size. This review constrains the use
of published literature to inform good load limit of school pack among the school children.

Abstract BACKGROUND: The positive effects of physical activities during pregnancy are totally recognized
but due to lack of knowledge and negative aspect toward it, physical activities decrease throughout
the pregnancy period. To find the appropriate model to enhance physical activity during pregnancy,
the education that are focused on health belief constructs about physical activity during pregnancy,
were assessed.
MATERIALS AND METHODS: This was a semi‑experimental study conducted on 90 pregnant
women in their first trimester that were divided into two groups of control and intervention.
After assessing health belief model (HBM) constructs and measuring the duration of severe/
moderate‑intensity) physical activity through a questionnaire, participants were divided into
two groups of 45. The intervention group received education about physical activity based on
HBM and the control group received dental health education. In the second trimester again, the
constructs of HBM and the duration of physical activities were evaluated. Significant level was
set at P < 0.05.
RESULTS: Data analysis showed that level of perceived susceptibility/severity and perceived
benefits and also the level of appealing physical activity (P < 0.05), had a significant increase in
the intervention group after the education, but the mean of the severe/moderate‑intensity physical
activity with did not rise to 150 min/week.
CONCLUSION: Study results showed that education based on HBM could lead to an increase in
physical activity during pregnancy by increasing the level of health beliefs in pregnant women, but
this increase does not reach the adequate level.

Abstract INTRODUCTION: Exposure to noise and heat causes individuals to experience some changes in
the function of cardiovascular system in workplaces. This study aimed to find the combined effect
of heat and noise on systolic and diastolic types of blood pressure in experimentally controlled
conditions.
METHODS: This quasi‑experimental study was performed with 12 male students in a climatic chamber
in 2014. Blood pressure including systolic and diastolic was measured in the following conditions:
15 min after rest in exposure to heat (40°C, relative humidity [RH]: 30%), exposure to noise with
75, 85, and 95 dB rates in thermal comfort condition (22.1 ± 0.9 wet‑bulb globe temperature), and
combined exposure to heat (40°C, RH: 30%) and noise with 75, 85, and 95 dB. Friedman test was
used to analyze the data.
RESULTS: The mean change of systolic blood pressure was different significantly before and after
exposure to heat and noise levels including 75, 85, and 95 dB (P = 0.015, P = 0.001, P > 0.001,
P = 0.027, respectively). Although systolic and diastolic blood pressures changed drastically, it was
not significantly different in simultaneous exposure to heat and noise.
CONCLUSION: Both systolic and diastolic blood pressures decreased in exposure to heat,
while exposure to different levels of noise elevates systolic and diastolic blood pressures.
However, when exposed to a combination of heat and noise, subtle changes of blood pressure
were traced, which can be characterized as average, considering heat‑only and noise‑only
tension situations.

Abstract BACKGROUND: Awareness regarding cancer signs and symptoms and their screening and treatment
method was low in India.
OBJECTIVES: To assess the awareness level of common cancers, perception regarding prevention
and treatment of common cancers, association between sociodemographic variables with the
awareness level of common cancers in the adult population.
MATERIALS AND METHODS: A cross‑sectional study was conducted among 299 adults from the
field practice areas of Our Rural Health Centre, Puducherry, during April–May 2014. Using systematic
random sampling, 299 adults were interviewed through a pretested semi‑structured questionnaire.
Data were entered into EpiData version 3.1 and were analyzed by Statistical Package for Social
Sciences version 20. Chi‑square test was used.
RESULTS: Nearly, 64% were in the age group of ≥40 years, the majorities were
females (56.2%) and 64% were in lower socioeconomic class. Symptoms reported majorities
were unusual bleeding (41.6%), followed by nagging cough (34.1%). Risk factors reported
majorities were smoking (65%), chewing tobacco (59%) followed by alcohol use (46.5%).
Only 10% reported cancer could be diagnosed early and 27% perceived cancer could be
preventable. Only 6% perceived cancer could be cured fully. The adequate awareness level
regarding lung and oral cancer were 14%, but breast and cervical cancer were <5%. The
younger age group (<40 years) had more adequate awareness level compared to age group
≥40 years (P < 0.05).
CONCLUSION: The awareness level of common cancers was very poor. Vigorous health education
program should improve the status of early diagnosis and proper treatment for common cancers
such as oral, breast, and cervical cancer.

Abstract INTRODUCTION: Electronic medical record system (EMRS) is a valuable system for safe access
to the patient’s data and increases health care quality. Manpower is one of the requirements for
EMRS, among which manager is the most important person in any hospital. Taking into account
manager’s positive attitude and good commitments, EMRS will be implemented successfully. As
such, we decided to assess manager’s attitude and commitment toward EMRS in Isfahan hospitals
in the year of 2014.
AIM: This article aimed to determine the hospital managers’ attitude and commitment toward the
implementation of EMRS.
MATERIALS AND METHODS: The present article is an applied analytic study. Research society
consisted of the managers of all the hospitals in Isfahan that include hospitals affiliated to Isfahan
University of Medical Sciences, private, and social security hospitals. This study was done in 2014.
Data collection tools included a questionnaire for which reliability and validity were determined. Data
were analyzed by means of SPSS 20.
RESULTS: Average score for the managers’ attitude toward EMRS in the city of Isfahan was 77.5
out of 100 and their average score for commitment was 74.7. Manager’s attitude in social security
hospitals was more positive than the private and governmental ones (83.3%). In addition, the amount
of commitment by the managers in social security hospitals was higher than the same in private and
governmental hospitals (86.6%).
CONCLUSION: At present, managers’ attitude and commitment in Isfahan hospitals toward EMRS
are very high and social security hospitals show more readiness in this respect.

Abstract BACKGROUND AND OBJECTIVE: Polycystic ovarian syndrome (PCOS) is the common cause of
Oligo‑ovulation. This syndrome causes long‑term metabolic issues as well as increase the risk of
diabetes type 2, hypertension, dyslipidemia, and cardiovascular disease. The current research aimed
to study the effect of green tea on weight and hormonal changes of women suffering from PCOS.
METHODS: This two group, double‑blind, randomized clinical trial was conducted in Isfahan city.
Overweight women suffering from PCOS (n = 60) were randomly divided into two groups. Green
tea was prescribed to the experimental group, and placebo was prescribed to the control group.
Free testosterone hormones and fasting insulin were compared in both groups at the beginning and
12 weeks after the study commencement. The weight of participants of both groups was also measured
before and after the study. The statistical data were analyzed by SPSS software and paired t‑test.
RESULTS: The paired t‑test showed that there was no significant difference in the mean weight
of both groups before the intervention (P = 0.812), but the difference was significant after the
intervention (P = 0.031). There was no significant difference in the mean fasting insulin of both groups
before the intervention (P = 0.352), but the difference was significant after the intervention (P < 0.0001).
Moreover, there was no significant difference in the mean free testosterone level of both groups before
the intervention (P = 0.638), but the difference was significant after the intervention (P < 0.0001).
CONCLUSION: The consumption of green tea by overweight and obese women suffering from PCOS
leads to weight loss, a decrease in fasting insulin, and a decrease in the level of free testosterone.

Abstract CONTEXT: Type 2 diabetes is the modern epidemic wherein patient care needs multiple approaches,
education, and self‑awareness being one of them. There are some knowledge, attitude, and
practice (KAP) studies from India but very few relating it with disease control.
AIMS: We tried to study KAP of treated type 2 diabetics and its correlation with glycemic control.
SETTINGS AND DESIGN: Cross‑sectional KAP study.
SUBJECTS AND METHODS: We formulated KAP questionnaires in the form of KAP ‑ 10 points
for each and total 30. We recruited 200 type 2 diabetics (96 males, 104 females) treated by MD
physicians with known current glycemic status. They were asked KAP questionnaires one to
one by a direct interview in local language and results were associated with various factors and
glycemic control.
RESULTS: KAP score on was average 19 out of 30 in type 2 diabetics having mean age 58 years,
mean duration 9 years. KAP score was unaffected by gender, occupation, duration of disease but
significantly affected by current age, and education level. Only 40% patients had good glycemic
control who scored better KAP than poor glycemic. There was positive correlation between KAP
score and glycemic control, with significance for only glycosylated hemoglobin and not fasting blood
sugar, postprandial blood sugar.
CONCLUSIONS: Physician treated type 2 diabetics of our region had moderate KAP score, affected
by age, education which suggested to affect glycemic control. Lacunae in knowledge regarding
incurability of disease, attitudes toward complication, self‑care, and good practices like walking,
enriching knowledge need improvement so as an optimum glycemic control.

Abstract INTRODUCTION: Evidence‑based dentistry (EBD) is an approach to oral healthcare by combining
the best scientific evidence and clinical diagnostics, clinical expertise of the dentist, and the patient’s
treatment needs and preferences. The aim of the present study is to evaluate the effectiveness of
an education program on EBD offered in a community‑dentistry course in improving knowledge and
attitudes of students in this regard.
STUDY METHODS: By a quasi‑experimental study design, 64 senior dental students of Islamic
Azad University of Khorasgan recruited in a controlled trial. All of the students were randomized as
intervention (32) and control (32) groups. A course‑based educational program on EBD was randomly
assigned to one group. Actual knowledge, self‑assessed knowledge, and attitudes, before and after
education, were measured in both groups. A questionnaire consisted of 40 items developed by the
researcher was used after confirming its validity and reliability. The difference between mean scores
at two timelines were measured and compared in three fields by paired t‑test and independent t‑test
analysis via SPSS version 20 software.
RESULTS: While the mean scores of actual and self‑assessed knowledge and attitude were not
significantly different between two groups at the beginning of the program (P > 0.05), the mean
scores of all fields in the intervention group were significantly more than those of the control group
after education (P < 0.001). The effect size of intervention was 86%, 62%, and 57% in three fields,
respectively. There was not a significant difference between mean scores of three fields in the control
group, after the intervention.
CONCLUSION: Due to the poor knowledge and attitudes of students and improved knowledge and
attitudes of the intervention group after education, the education program seems to be effective.
Durability of educational impact and evaluating evidence‑based performance can be studied in the
future.

Abstract BACKGROUND: The positive effect of breastfeeding on health is globally accepted. However,
breastfeeding has not yet practiced at a favorite level. Empowerment of mothers is an important
factor for continuing breastfeeding. This study was conducted to explore women’s perception of
empowerment in breastfeeding.
METHODS: The present qualitative study was conducted in conventional content analysis method.
Thirty‑four semi‑structured deep interviews were conducted with 18 mothers, four key family members,
and 12 other personnel involved in breastfeeding counseling services.
RESULTS: Analysis of participants’ descriptions led to the emergence of five main categories: Enough
knowledge and skill for breastfeeding, feeling adequacy in breastfeeding, overcoming breastfeeding
problems, informed belief in the value of breastfeeding, and perceiving comprehensive support for
breastfeeding.
CONCLUSION: in participants’ point of view, empowerment in breastfeeding can be formed
through an acquisition of “Enough knowledge and skill for breastfeeding” as well as assurance
about the proper quality and quantity of mother’s milk. As well as overcoming breastfeeding
problems will lead to stabilization empowerment in breastfeeding. In addition, data analysis
showed that informed belief in the value of breastfeeding strengthens the empowerment in
breastfeeding and presence of perceived comprehensive support for breastfeeding facilitates
empowerment in breastfeeding continuance. Thus, comprehensive plans should be designing
for promoting breastfeeding.

Abstract INTRODUCTION: Since 2013, in Iran’s health care, the contribution of direct payments for health‑care
services was estimated more than 50 % of all expenditures. In May 2014, Iran’s health‑care reform was
established to improve health services quality and reduce patients’ out‑of‑pocket payments <10% in
urban and 5% in rural areas. Therefore, the purpose of this study is to investigate unmet costs (those
which are not covered either by the insurance companies nor the recent reform coverage mentioned
in Sections 1.2.2 and 1.2.1, Article 6 of the Health Minister Reform Guideline) in the inpatient billings
within the first 5 months from the reform implementation.
METHODS: This study was conducted as a cross‑sectional research in the second half of 2014 on
the selected hospitals in Isfahan Province. Data were collected by investigating 97,000 inpatients’
billing records issued by 28 hospitals affiliated to Isfahan University of Medical Sciences using
census method.
RESULTS: Findings of the study showed that the average of unmet costs paid by the inpatients
constituted 21.8% of the total billing costs in 28 hospitals, and the average unmet costs paid by each
patient was 1,903,832 Rials.
CONCLUSION: Considering the definition of unmet cost in the context of health‑care reform
guideline and hospitals’ problems in providing some costly services, drugs, and medical
equipment (that were not covered by insurance organizations and the reform scheme) within
the obligations of the reform, it is necessary to review these obligations and further interact with
insurance companies about expanding the coverage to some costly services required by the
patients.

Abstract BACKGROUND: Bibliotherapy is defined as using dynamic interaction along with reading a book in
order to help the people to increase their cognitive understanding. This study aims to investigate the
effect of bibliotherapy on the psychological capital of the employees of the Department of Management
and Medical Informatics of Isfahan University of Medical Science.
MATERIALS AND METHODS: This is an applied study using a semi‑empirical method. The
statistical population consists of all nonfaculty employees of the target department (70 people).
Twenty eight people were randomly selected and divided into experiment and control groups and
answered the psychological capital questionnaire. The data gathering tool was the psychological
capital questionnaire of Luthans. The experiment group underwent six 2‑h sessions of bibliotherapy
where the control group underwent no interference. Both groups answered the questionnaire again
1‑month after the final bibliotherapy session. The information was analyzed using descriptive
(average and frequency distribution) and analytical (independent t‑test, paired t‑test, Chi‑square
test, and Mann–Whitney U‑test) with the help of SPSS 20 software.
RESULTS: The findings showed no meaningful distinction average scores of the physiological capital
of both groups before interference. However, the average physiological capital score and an average
score of each factor in the experiment group was meaningfully higher than that of the control group
after the bibliotherapy sections.
CONCLUSION: The results showed that bibliotherapy is a suitable method for increasing the
psychological capital of the employees of different organizations which will in turn provide both the
employees themselves and the organization with material and spiritual gains.

Abstract OBJECTIVE: Cancer is one of the most preventable and common chronic diseases that have
economic, social and psychological burden for patients, families, and the society. Cancer can be
monitored by new information technology. Digital games as a uniquely powerful interaction tool
support optimal care management program operation in all dimensions. The aim of this review article
is to describe opportunities and challenges of this new modern technology on the delivery of cancer
care services in cancer management domains for cancer care improvement.
METHODS: This study was un‑systematic (narrative) review article. In this research, 50 full‑text
papers and reports had been retrieved, studied exactly, and arranged based on study aims. We
searched papers based on specific and relevant keywords in research databases including PubMed,
ScienceDirect, Scopus, and Google scholar.
CONCLUSION: In cancer management domain, digital games are as an effective medium for
health education and intervention, disease self‑management training, attention distraction to relieve
pain, enhance clinical outcomes, improvements in lifestyles, and physical and psychosocial activity
promotion when active participation and behavior rehearsal are required for cancer patient. In spite
of potential benefits of new technology, sometimes people confront various challenges such as
social isolation, unusual anxiety, and disorder in physiological times of body, low physical activities,
decrease academic performance, increase aggressive behavior, and physical pain. These problems
can be partly overcome by proper planning, good design, and usage of suitable and continuous
monitoring.

Abstract INTRODUCTION: Each mother has the legal right to decide about her delivery, but this decision
should be made based on scientific knowledge. Instructions during pregnancy help to choose the
proper type of delivery. This study conducted aimed to compare two instructional methods of role
playing and lecture on primigravida decision about type of delivery.
SUBJECTS AND METHODS: In this single‑blind clinical trial 67 primigravida, 34–36 week were
selected using multi‑stage sampling and assigned into two groups randomly. Decision‑making
(before, 2‑week after, and at admission in maternity department) was tested by a questionnaire. In
role‑playing group, advantages and disadvantages of two type delivery were presented by role‑playing
in 90‑min by three scenarios. In lecture group, it was also presented in a 90‑min lecture. Data were
analyzed by mean difference test, Fisher test, independent and paired t‑test.
RESULTS: Two groups showed a significant difference in terms of decision at admission to
maternity department (P = 0.000). 75% of lecture group and 100% of role‑playing group selected
normal delivery. Postintervention knowledge score in lecture group was 18 ± 5.3 and in role‑playing
group 17.1 ± 4.0. Percent of change in knowledge scores in two groups was significant (P = 0.001).
Participants’ attitude, before and after the intervention, in both groups was significant (P < 0.05).
Mean difference of pre‑ and post‑test in relation to two groups’ knowledge and attitude scores was
not significant (P > 0.05).
CONCLUSION: In this research, lecture was more effective in raising knowledge level, and role
playing was more effective in raising decision to vaginal delivery and reducing elective caesarean
section. It is therefore suggested to use both teaching methods altogether for pregnant women to
decrease the rate of unnecessary cesarean.

Abstract STATEMENT OF THE PROBLEM: Examinations have an important role in evaluating students’
learning outcomes and their mastery of a subject. Passing or failing an examination can have
far‑reaching consequences for the students. Therefore, it is not surprising that international studies
consistently show that dental students report examinations and grades among the highest ranking
stressors in dental schools.
PURPOSE: The aim of this research was to measure the levels of anxiety, self‑perception of
preparation and expectations for success using an objective structured clinical examination (OSCE),
a written examination and a preclinical preparation test, and to examine the effects of the three
predictive variables on the outcomes of assessments.
MATERIALS AND METHODS: The present research is a cross‑sectional study. The population under
consideration was students of Kerman Dental School in 2013. Examination anxiety was measured
with Spielberger’s state anxiety inventory. Preparation for the assessment (I am fully prepared = 4,
I am prepared = 3, I’m not prepared = 2, I’m not fully prepared = 1) and expectation to succeed (I am
quite successful = 4, I am successful = 3, I’m not successful = 2, I’m not quite successful = 1) were
quantified with Likert scale. The questionnaire was completed during an OSCE, a written examination,
a preclinical crown and bridge preparation test and a nonexamination situation.
RESULTS: The study population consisted of 138 4th, 5th, and 6th year Kerman dental students (65 males
and 73 females). The results showed that all the assessment methods induced a significant increase
in state anxiety compared to baseline levels with the highest anxiety levels reported during an
OSCE (62.4 ± 8.1, P = 0.04) and a written examination (48.8 ± 9.2, P = 0.04). The preparation levels
in females were significantly higher than those in males in OSCE (P = 0.03) and written (P = 0.04).
CONCLUSION: State anxiety was high in all the three assessment methods. OSCE induced more
anxiety than other assessment formats. However, anxiety was not predictive of performance outcomes
in contrast to preparation and expectation to succeed, which were good predictors of the outcome
scores. Also, this study showed that despite a better answer to the assessment of (I prepared myself
well for the test), the students showed high levels of state anxiety.

Abstract CONTEXT: Oral cancer is preceded by visible changes in the oral mucosa. These lesions can be
detected by oral self‑examination, but awareness about oral cancer is still low in developing countries.
AIM: To evaluate the effect of health education on awareness about oral cancer and oral
self‑examination.
SETTINGS AND DESIGN: Quasi‑experimental trial was conducted in an urban resettlement colony
of Chandigarh, India.
MATERIALS AND METHODS: A brochure having information and pictorials on oral lesions was
used for conducting health education sessions on a one‑to‑one basis in the household setting
among 85 males in age group 15–59 years during 2013, and each participant was encouraged
to perform an oral self‑examination. Study participants were interviewed about their awareness
on oral cancer and oral self‑examination before‑ and after‑health education using a pretested
interview schedule.
STATISTICAL ANALYSIS: Awareness items were scored, and mean change in awareness score
was computed. Paired t‑test was used for testing statistical significance.
RESULTS: Thirty‑three percent of the study participants were current smokers, 25% consumed
alcohol, and 9.4% chewed tobacco. The awareness scores after health education increased
significantly from 5.3 to 6.7 (P < 0.05), and 34% of the tobacco or alcohol users expressed their
intention to quit these habits, and two persons actually quit tobacco chewing. Out of the 77 study
participants who performed oral self‑examination, nine were able to detect lesions, and one was
found to have submucous fibrosis.
CONCLUSIONS: Health education intervention was able to initiate a favorable behavior change in
the community. Hence, oral self‑examination programs should be promoted.

Abstract INTRODUCTION: Nowadays with respect to the automation of the lifestyle, immobility statistics
in middle‑aged women has increased and they are at risk for complications of immobility. One of
the models used to identify factors associated with physical activity is Health Belief Model utilized
in different age and different cultural backgrounds and different results have been obtained from
those studies. The purpose of this study was to investigate the factors affecting on physical activity
in middle‑aged women using Health Belief Model.
MATERIALS AND METHODS: This descriptive‑correlation study was conducted on 224 middle‑aged
women referring to health centers in Isfahan. Health Belief Model structures including perceived
susceptibility and severity, perceived barriers and benefits, and self‑efficacy were measured
by questionnaire and physical activity was assessed using the international physical activity
questionnaire. Collected data were analyzed using descriptive statistics and Pearson correlation
coefficient test and regression analysis.
RESULTS: There wasn’t significant correlation between perceived susceptibility (P = 0.263, r = 0.075)
and perceived severity with physical activity duration (P = 0.127, r = 0.058) but there was positive
and weak correlation between physical activity duration with perceived benefits (P = 0.001 and
r = 0.26) and perceived self‑efficacy (P = 0.001, r = 0.54) and had weak and inverse correlation with
perceived barriers (P = 0.001, r = ‑0.25). Regression analysis also showed that from among all the
Health Belief Model structures just self‑efficacy structure has influenced on behavior independently
and other structures are affected by it.
CONCLUSION: The obtained results implied on a correlation between benefits, barriers and perceived
self‑efficacy with and moderate physical activity. Therefore it is necessary to develop appropriate
educational programs with emphasis on structures of Health Belief Model that has the maximum
impact on physical activity in middle‑aged women.

Abstract CONTEXT: Quality of life (QOL) is one of the important indexes of health and well‑being promotion
in the diabetic patients. Based on numerous studies, these patients have a lower QOL, compared
to nondiabetic individuals. In addition, a higher prevalence of sexual function disorder has been
reported in their population that can have a negative effect on their QOL.
AIMS: This study aimed to investigate the association between sexual function and QOL in diabetic
women referring to health care centers in Mashhad during 2013–2014.
SETTINGS AND DESIGNS: In this correlational study, the association between sexual function and
QOL in 90 diabetic women with type two diabetes referring to health care centers in Mashhad during
2013–2014 was investigated.
SUBJECTS AND METHODS: Data were collected by Rosen female sexual function index and short
form‑36 questionnaires.
STATISTICAL ANALYSIS USED: Data were analyzed by mean comparison and Spearman
correlation coefficient statistical test through SPSS 16.
RESULTS: Subjects’ mean sexual function score was 21.7 ± 6.30. Based on the finding, 25.6% of the
subjects suffered from sexual function disorder. Subjects’ mean score of QOL was 58.75 ± 1616.24.
There was a significant association between an overall score of sexual function and its subscales,
with their QOL and two dimensions of overall physical and psychological and mental health scores
(P < 0.005).
CONCLUSIONS: Sexual function is one of the important and associated aspects of QOL in diabetic
patients. Designing and evaluation of the interventions with the goal of an improvement in this variable
plays a notable role in the promotion of these patients’ QOL. However, with regard to limited research
in this field, further studies on this association are suggested.

Abstract BACKGROUND: The relationship between cigarette smoking and development of Alzheimer’s
disease (AD) is not fully determined, and previous reports disagree, with some studies suggesting
an increased relative risk and others a decreased odds ratio. Consequently, we wanted to determine
if the prevalence of past cigarette smoking observed in a community‑based clinic sample of patients
with AD would be more consistent with the expected value obtained from a model using either an
increased relative risk or a decreased odds ratio to estimate the effect of smoking on development
of AD.
MATERIALS AND METHODS: Retrospective cross‑sectional analysis of all patients treated for AD
in a community‑based Neurology Clinic during a 2‑year period. Estimates of expected past smoking
prevalence were calculated based on published values for either an increased relative risk or a
decreased odds ratio and compared to the past smoking prevalence observed in the clinic sample.
RESULTS: The observed past smoking prevalence in the clinic population was 29.17%.
The expected past smoking prevalence calculated using the increased relative risk was
30.07% (95% confidence interval [CI] = 27.67–32.32%), and using the decreased odds ratio was
12.54% (95% CI = 6.32–24.81%).
CONCLUSION: The observed past smoking prevalence among the patients being treated for AD
in a community‑based clinic falls within the expected 95% CI for the increased relative risk model
and outside of the expected 95% CI for the decreased odds ratio model. These results support
the contention that the relationship between cigarette smoking and development of AD is the best
characterized by an increased relative risk.

Abstract BACKGROUND: Limited information exists in India about the awareness and perception of the
people regarding pictorial health warnings (PHWs) and text warnings on tobacco products, more
so from rural areas. Objectives were to report the awareness of these warnings, factors predicting
awareness and perceived effectiveness of PHWs, and understanding of their content in a rural
population.
MATERIALS AND METHODS: A community‑based cross‑sectional study was conducted in
two villages (chosen randomly out of total four) in the rural field practice area of a tertiary care
teaching hospital in Puducherry. Households were selected by systematic random sampling. All
persons ≥18 years and residing in the area for at least 6 months were included. Data regarding
awareness and perception of participants was collected through a semi‑structured interview
schedule.
RESULTS: A total of 428 participants were recruited; 197 (46%) were male, and 231 (54%) were
female. The mean age of the participants was 38.9 (standard deviation 15.0) years. Awareness
of PHWs and text warnings was 39.5% (169/428) and 21% (90/428), respectively. Only 11.2%
participants perceived PHWs as effective. Most (45%) of the participants had a vague understanding
of the content of PHWs. On multivariate logistic regression, male gender, current tobacco use, and
better education emerged as predictors of greater awareness of PHWs. Extended family predicted
greater perceived effectiveness of PHWs, whereas, high socioeconomic class and middle school
completion predicted lower perceived effectiveness of PHWs.
CONCLUSION: Awareness and perceived effectiveness of adults in rural Puducherry regarding
PHWs were low. There is a need to create awareness through education and using meaningful,
larger pictures.

Abstract BACKGROUND: The purpose of this study was to evaluate diabetes control, as measured by
hemoglobin A1c (HbA1c) improvements among African American and Hispanic patients receiving
conventional clinical treatment combined with a bilingual diabetes educator using culturally and
linguistically appropriate educational materials. This study also sought to estimate the healthcare cost
savings resulting from any A1c improvements and assess the cost‑effectiveness of this approach.
MATERIALS AND METHODS: This was a multistage, face‑to‑face observational study undertaken
in Texas, United States and focused on 153 African American and Hispanic patients with poor
blood glucose control (baseline A1c >8.0%). For two years, a bilingual care coordinator motivated
patient behavior changes that could lead to improvements in glucose control. The primary
evaluation measure was change in %HbA1c, with secondary measures being change in blood
pressure (BP) and low‑density lipoprotein (LDL). We also sought to gauge the program’s potential
cost‑effectiveness.
RESULTS: Within the study group, A1c levels decreased over the study period from a mean of
10.0% to 8.4%. The same group saw no statistically significant improvement (reduction) in blood
concentrations of LDL. The African American subgroup had a small reduction in systolic BP while
changes for non‑White Hispanics were not statistically significant. The average A1c reduction
realized in this observational study provided estimated cost savings that are nearly twice pilot
expenditures.
CONCLUSIONS: Combining standard diabetes care with a bilingual educational care coordinator
results in significant reductions in mean A1c (−1.6% HbA1c) in patients with poorly controlled blood
glucose and African American/non‑White Hispanic heritage, an intervention that also was shown to
be cost‑effective. This may be an effective model for improving diabetes care in provider practices.