Journal of Education and Health Promotion

Abstract Atypical teratoid rhabdoid tumor (ATRT) is a rare malignant tumor with gloom destiny. Our case was
a 4‑year‑old boy with a temporal lobe tumor that was then became evident of ATRT with recurrent
happening. In a retrospective review of all cytologic slides, we found unique rhabdoid cells that are
morphologically evident cells for ATRT in both times. Unfortunately, the cells were overlooked at the
first time. We conclude if the pathologist is experienced to see rhabdoid cells noticing these cells is
highly helpful for diagnosis ATRT, especially in frozen sectioning.

Abstract BACKGROUND: Medical radiation workers are potentially at a risk of unwanted ionizing radiation
exposures. This study assessed the radiation protection knowledge, attitude, and practice (RP‑KAP)
of health‑care workers who are occupationally exposed to radiation regarding protecting themselves
from radiation.
MATERIALS AND METHODS: This study was cross‑sectional in design and was carried out in 16
hospitals affiliated to the Tehran University of Medical Sciences between May and September 2014.
Total health‑care workers who were occupationally exposed to radiation comprising 670 individuals
were included in the study based on census sampling method. In total, 413 individuals consented
to complete an anonymous 32‑item questionnaire comprising single best choice questions with a
numerical value assigned to each correct answer. Each set of RP‑KAP questions was scored and
categorized as poor, medium, and good. The effect of independent variables for prediction of RP‑KAP
was explored using linear regression analyses.
RESULTS: A significant number of participants had poor RP‑knowledge (78.9%), RP‑attitude (70.7%),
and RP‑practice (32.4%). Based on linear regression analyses, it was found that field of study (β = 0.1,
P = 0.001), marital status (β = −0.14, P = 0.01), and level of education (β = 0.2, P < 0.001) were the
predictors of higher RP‑knowledge. In‑service RP‑training (β = 0.1, P = 0.04) was associated with
an increased RP‑attitude. Being a woman (β = 0.2, P < 0.001) and longer years of experience with
radiation (β = 0.2, P < 0.001) were significantly related to better practice.
CONCLUSION: In‑service training with appropriate qualified and up‑to‑date materials based on
radiation workers’ educational needs and approved protocols and guidelines is recommended.

Abstract BACKGROUND AND AIMS: Attention to the development of children as the future generation that
leads to the upbringing of productive human resources is an important subject. Development has
dimensions that a child should acquire the skills related to them in proper age. Otherwise, he may be
affected by developmental delays. There are different factors influencing children’s developmental
delays and this study is carried out to evaluate the developmental conditions of 1‑year‑old children
in the Isfahan and its effective factors.
MATERIALS AND METHODS: In a historical cohort, 725 children born in 2013 were selected using
multi‑stage random sampling from health centers licensed by Isfahan Medical University and followed
up to 1‑year and their related specifications were extracted from ages and stages questionnaire
and their families’ files. SPSS 20 software and Pearson and Spearman correlation coefficients,
independent t‑tests, ANOVA, multiple linear regression and analysis of covariance were used for
analyzing the data.
RESULTS: The minimum and maximum scores of development were observed in the personal‑social
domain (52.38 ± 9.1) and fine motor (56.06 ± 5.9), respectively. The results showed that the child
spacing has direct relation with development in fine motor domain (r = 0.2, P < 0.001), personal‑social
development (r = 0.197, P = 0.001), and problem solving domain (r = 0.18, P = 0.002). The score
for the development in gross motor skills had a direct correlation with the weight at birth (r = 0.129,
P < 0.001). Breastfeeding also improved personal‑social development (P = 0.024). Sex (P = 0.024)
and living place with communication skills also showed significant relations (P < 0.001).
CONCLUSION: The factors such as the child’s sex, feeding in the first 6 months of age, living in
urban or rural areas are effective in delayed development. Considering these factors to prevent
adverse effects of the elements and rapid identification of children with delayed development as well
as timely therapeutic interventions are essential in the health care system.

Abstract INTRODUCTION: The concept of sexual dysfunction is dysfunction in desire and emotional – social
that it is Impact on the sexual response cycle and can cause stress and interpersonal difficulties.
Quality of marital relationship is one of the important factors predicting sexual function disorders,
which varies among different cancers. The purpose of this study is to determine the relationship
between sexual dysfunction and quality of marital relationship in genital and breast cancers in women.
METHODS: This correlational study was conducted on 150 breast and genital cancers in women
referred to Sayedoshohada and Milad hospitals in Isfahan city through a two‑stage sampling
method. Participants completed questionnaires about demographic/disease and sexual function
questionnaire (44 questions) and quality of marital relationship (11 questions). Collected data were
analyzed using SPSS version 14 software, statistical test such as, Pearson correlation coefficient
tests independent t‑ student, one way ANOVA.
RESULTS: The results showed that 70.7% of women had breast cancer and 29.3% had gynaecological
cancer. 60% of patient had good quality of marital relationship and 19.3% sexual dysfunction. There
was a significant correlation between sexual function and quality of marital relationship (P = <0.001).
CONCLUSION: There was a significant correlation between sexual function disorder and quality of
marital relationship. The inclusion of patients educational programs and couple therapy in cancer
disease rehabilitation program is important in order to improve the quality of marital relationship and
subsequent sexual dysfunction in cancer patients.

Abstract INTRODUCTION: To be more successful in medical education and identify the strengths and
weaknesses of the curriculum in this field, assessment of the students’ views, graduates, professors,
and experts is essential. The aim of this qualitative assessment was to identify the strengths and
weaknesses of the medical education curriculum.
SUBJECTS AND METHODS: This research is a qualitative study using the Eisner’s educational
connoisseurship and criticism model that was conducted in Shiraz Medical Sciences University in
2014. In this research, graduate medical education curriculum was criticized by a team of educational
experts. Fifteen professors in the first stage of the focus group meeting addressed the three
stages of educational criticism. In the second stage, several interviews were conducted with the
above‑mentioned people. In the third phase, the implementation of video recordings from the focus
group meeting was performed in written form. In the fourth stage, conventional content analysis was
used to analyze the qualitative data.
RESULTS: This curriculum has advantages and disadvantages in the constituent elements of the
program. Its weaknesses include lack of written a guide for practical courses, lack of consideration
of joint practical exercise to make integrate between lessons, lack of sufficient attention to aspects
of practical and functional knowledge in this field, lack of attention to performance evaluation and
development, and lack of routine review of the curriculum. On the other hand, the strengths of this
study include the suitability of this field for professors and its positive impact on professors and
students performance in the classroom.
CONCLUSION: As medical education is partly an emerging field in Iran and considering the
weaknesses, reviewing the curriculum based on the main part of program, the outcomes, curriculum
content, teaching strategies, student assessment, and course management are recommended.

Abstract BACKGROUND: Knowledge about cystic fibrosis (CF) in Iran is very limited. The objective of this
study was to determine the prevalence of CF among a group of high‑risk children with suggestive
clinical features in the main referral hospital in Iran.
MATERIALS AND METHODS: This study children consisted of 505 patients who had presented with
one or more of the following symptoms: chronic or recurrent respiratory symptoms, gastrointestinal
symptoms as rectal prolapse, steatorrhea, hepatobiliary disease as prolonged jaundice, failure to
thrive, hyperglycemia and glycosuria, hypochloremic metabolic alkalosis, hypoprothrombinemia,
anemia or edema, and positive family history of CF. Patients were screened using pilocarpine
iontophoresis to collect sweat and chemical analysis of its chloride content with classic Gibson and
Cooke technique.
RESULTS: Of 505 patients, 89 (17.6%) had positive sweat chloride screening test. Five (1%)
patients had required cystic fibrosis transmembrane conductive regulator protein mutation analysis
to confirm CF.
CONCLUSION: Our findings suggest that in Iran, CF is more common than what previously
anticipated. Larger studies are warranted to identify the incidence, molecular basis, and clinical
pattern of CF in the Iranian population.

Abstract BACKGROUND: Elderly people often suffer from sleep disorders. Chamomile due to the many health
benefits such as sedation may be effective in improving sleep quality in elderly people. This study
aimed to determine the effect of Matricaria chamomilla extract on sleep quality in elderly people
admitted to nursing homes of Isfahan in 2014.
MATERIALS AND METHODS: The present study is a quasi‑experimental clinical trial. The study
population was 77 cases of elderly hospitalized in nursing homes. Participants were selected through
random continuous sampling and divided into intervention and control groups. The intervention group
received 400 mg oral capsules of chamomile twice daily, after lunch and after dinner for 4 weeks. The
control group did not receive the intervention. Sleep quality in older adults before and after intervention
were compared using the Pittsburgh Sleep Quality Index questionnaire. Data were analyzed using
descriptive statistics and paired t‑ and independent t‑tests, one‑way analysis of variance and liner
regression analysis, using SPSS software version 17.
RESULTS: Before intervention, the mean score of sleep quality both experimental and control groups
showed no significant difference (P > 0.05). After intervention, the mean score of sleep quality was
a significant difference between experimental and control groups (P < 0.001).
CONCLUSIONS: Oral administration of chamomile extract has sedative properties in sleep quality of
hospitalized elderly patients in nursing homes. Therefore, it can be used in similar cases and nursing care.

Abstract CONTEXT: During different planning periods, human resources factor has been considerably
increased in the health‑care sector.
AIMS: The main goal is to determine economic planning conditions and equilibrium growth for
services level and specialized workforce resources in health‑care sector and also to determine the gap
between levels of health‑care services and specialized workforce resources in the equilibrium growth
conditions and their available levels during the periods of the first to fourth development plansin Iran.
MATERIALS AND METHODS: In the study after data collection, econometric methods and EViews
version 8.0 were used for data processing. The used model was based on neoclassical economic
growth model.
RESULTS: The results indicated that during the former planning periods, although specialized
workforce has been increased significantly in health‑care sector, lack of attention to equilibrium
growth conditions caused imbalance conditions for product level and specialized workforce in
health‑care sector.
CONCLUSIONS: In the past development plans for health services, equilibrium conditions based on
the full employment in the capital stock, and specialized labor are not considered. The government
could act by choosing policies determined by the growth model to achieve equilibrium level in the
field of human resources and services during the next planning periods.

Abstract BACKGROUND: As one of the indicators of actual growth and scientific development capacity of
countries, the importance of the research is steadily increasing. Knowing that success depends on
the work done by researchers so identified identify these barriers and pave the way for one of the
concerned authorities of their research.
METHODS: This qualitative study using analysis of the theme. Semi‑structured interviews were
used to collect the data. Participants include people who are experienced and knowledgeable in
the field. Sampling was purposeful and continued until data saturation. The criteria of “reliability”,
“trustworthiness”, “reliability” and “significant consolidation” of data were considered.
RESULTS: Data analysis led to the extraction of code 600, 5, and 35 issues were Zyrmvzv. Five topics
including motivation, success factors, barriers and problems, reflections and strategies, respectively.
Conclusion: Discussion interest, innovation, the ability to apply research methods, specializes in
the research literature and English language skills of researchers successfully in printing paper.
Creating strong incentives to improve the material and spiritual encouragement and removal of
obstacles, increase the amount of scientific publications and its opposite, although the force can cause
increased production of scientific publications, but the negative consequences of such unhealthy
competition and robbery also will follow. As a result, universities have to go through proper planning
and management in the areas of research and teaching more responsible to pay it.

Abstract INTRODUCTION: Shoulder dystocia is one of the obstetric emergencies that are accompanied to
serious risks for mother and fetus. It necessitates making the method of training of shoulder dystocia
management more efficient, i.e., better management and giving services with higher quality. Thus,
this study was carried out to compare the impact of training by simulation and oral technique on
the skill of the employed midwives in obstetric clinics at Mashhad city (Iran) in shoulder dystocia
management during 2012.
METHODS: The current research is a double‑group clinical trial that was conducted on 51 members of
the employed midwives in the obstetric clinic at Mashhad city in 2012. The questionnaire of personal
specification and awareness about shoulder dystocia and practical examination (objective‑structured
clinical examination) were employed as tools for data collection. The learners were divided into two
groups by randomized allocation. Training was done by the presentation of lecture in the oral content
group and a short movie was displayed at the end of it. The shoulder dystocia management technique
was simulated in another group and through role‑playing of instructor application of moulage (station)
training was conducted. The period of the training course (4 h) and content of the educational
workshop was identical for both groups. The practical examination was held for the learners
before and immediately after training course. The given data were analyzed by means of statistical
descriptive tests including Mann–Whitney U‑test and Wilcoxon test via SPSS software (version 16).
The significance level was considered as (P < 0.05) in all cases.
RESULTS: The total mean score was significantly increased for the variable of shoulder
dystocia management skill after intervention in both groups (P < 0.0001). Similarly, the results of
Mann–Whitney U‑test statistical tests indicated that total mean score for the variable of shoulder
dystocia management skill after the intervention was significantly greater in simulation group than
in an oral group (P = 0.040).
CONCLUSION: Training in simulated delivery room by means of role‑playing is an efficient method
for training shoulder dystocia management skill, so it is recommended to use this program in the
training of this skill.

Abstract INTRODUCTION: The birth of an infant requiring hospitalization in the neonatal Intensive Care
Unit (NICU) uniformly is reported to be stressful for parents and family members. This study aimed
to determine parent–staff communication in the NICU and its relationship to parent stress.
MATERIALS AND METHODS: Two hundred and three Iranian parents with preterm infants
hospitalized in the NICU participated in this descriptive‑correlational study. The participants were
selected by the quota sampling method. Data collected included a three‑part: questionnaire, the
first part covered demographic parent and infant information, the second was the Parent–Staff
Communication Scale (the score of which ranged from 0 to 180), and the third was the Parental
Stress Scale (the score of which ranged from 0 to 102). Descriptive and inferential statistics including
the Pearson’s correlation coefficient test were applied to the data, using SPSS software Version 16.
RESULTS: This study revealed that fathers and mothers’ stress and communication scores were
almost comparable and both higher than expected. The total mean score of the two main variables,
i.e., parent–staff communication and parental stress were, respectively, 100.72 ± 18.89 and
75.26 ± 17.6. A significant inverse correlation was found between parental stress and parent–staff
communication scores (r = −0.144, P = 0.041).
CONCLUSIONS: Based on this study finding showed that better parent–staff communication is related
to lower parent stress scores, it is recommended that nurses and physicians receive specific skill training
for the establishment of effective parent–staff communication. It is anticipated that such improved staff
skills will help decrease parent stress and therewith likely promote parent and infant health in the NICU.

Abstract INTRODUCTION: Nowadays websites are among the most important information sources used by
most people. With the spread of websites, especially those related to health issues, the number of
their visitors also increases, more than half of which are about nutritional information. Therefore,
quality analysis of nutrition and diet therapy websites is of outmost importance. This study aims to
evaluate the quality of Persian nutrition and diet therapy websites.
METHODS: The current work is a survey study and uses an applied study method. The statistical
population consists of 51 Persian websites about nutrition and diet therapy and census method was
used in order to study them. Data gathering was done using a checklist and with direct visit to each
website. Descriptive and analytical statistics were used to analyse the gathered data with the help
of SPSS 21 software.
RESULTS: Findings showed that content (66.7%), organization (82.4%), user friendly
interfaces (52.9%) and total quality (70.6%) of most websites had a mediocre score while the design
score for most of the websites (70.6%) was acceptable also organizational websites had better design,
organization and quality compared to private websites. The three websites with the highest general
quality score were the websites of “Novel Diet Therapy,” “Behsite” and “Dr. BehdadiPour” (jointly)
and “Dr. Kermani” respectively. Also in the dimension of content the factors of goal, relevance and
credibility, in the dimension of design the factors of color, text and sound, pictures and videos, in the
dimension of organization the factors of stability and indexing and in the dimension of user friendliness
the factors of confidentiality, credibility and personalization had the highest scores.
CONCLUSION: The results showed that the design score was higher than other scores. Also the
general quality score of the websites was mediocre and was not desirable. Also websites didn’t have
suitable scores in every factor. Since most people search the internet for nutritional and diet therapy
information, the creators of these websites should endeavor to fix the shortcomings of their websites
and increase the quality of their websites in several different areas.

Abstract BACKGROUND: Prevalence of hypertension in patients with type 2 diabetes is two to three times
more than nondiabetic patients. This study aimed at assessing the impacts of an educational program
based on BASNEF Model on blood pressure modification among diabetic patients with hypertension.
MATERIALS AND METHODS: Two hundred patients with type 2 diabetes were recruited in an
educational intervention study among two groups. The intervention group attended a 3‑month
self‑care educational program regarding hypertension control in addition to the regular care presented
for both the groups. Another group received no extra program except regular treatment. To collect
information about demographic characteristics, type 2 diabetes‑related variables, and BASNEF Model
construct items, a self‑designed questionnaire was utilized. Data analyzed by SPSS version 16 using
Chi‑square, independent t‑test, and paired t‑test.
RESULTS: Knowledge, behavioral beliefs, attitude to action, enabling factors, subjective norms, and
practice were significantly higher in intervention group as compared to the controls (P< 0.001). In addition,
blood pressure revealed significant differences in intervention group before and after program using paired
t‑test (P= 0.001) while in the control group, there was no significant difference in blood pressure (P= 0.54).
DISCUSSION: The study results revealed a significant change in blood pressure and model constructs
in intervention group compared to control. This research suggested intervention program based on
BASNEF Model has essentially effectiveness in blood pressure modification among diabetic patients.
CONCLUSION: BASNEF Model has effectiveness to high blood modification among diabetic patients
with hypertension.

Abstract BACKGROUND: The study aimed to assess interdisciplinary communication among various
Educational and Research Departments of Isfahan University of Medical Sciences (IUMS) in clinical
medical sciences using social network analysis.
MATERIALS AND METHODS: The study was carried out using scientometrics method and
interdisciplinary communication network analysis. Interdisciplinary network of 1298 articles in medical
sciences published in Journal of Isfahan Medical School was evaluated using macro‑ and micro‑level
criteria of network analysis. Ravar Matrix, UCINET, and VOSviewer software were used to analyze
the interdisciplinary network of medical sciences articles.
RESULTS: Findings showed that “Students Research Committee” and “School of Medicine,” the
affiliations of the medical students in general practice with scores of 272 and 197, “Epidemiology and
Biostatistics,” “Community Medicine,” and “Internal Medicine” with 170, 101, and 99, respectively,
possessed the first ranking of productivity index in scientific communication. Furthermore, in
betweenness centrality index, “Epidemiology and Biostatistics” (3427.807), “Students Research
Committee” (2967.180), and “Community Medicine” (1770.300) have an appropriate position in
the network. Based on the centrality index, “Epidemiology and Biostatistics” (22.412), “Students
Research Committee” (22.185) as well as “Community Medicine” and “School of Medicine” (both
21.554) acquired the least amount of distance with other nodes in network.
CONCLUSION: Given the increased specialization in medical fields in recent years, communication
between researchers with various specializations and creation of interdisciplinary or multidisciplinary
departments had turned into an undeniable necessity. Therefore, communication between educational
or research departments can facilitate the flow of information between researchers; and consequently,
the top ranking departments in this study had more participation in scientific production of IUMS
and getting more scores in annual evaluation by scientometrics department. This network analysis
showed that researchers in various medical fields closely collaborate with each other and are able
to connect with <2 intermediates.

Abstract Abstract:
CONTEXT: Chlamydia trachomatis is one of the most prevalent factors of sexually transmitted
diseases worldwide, which causes abortion, premature rupture of membrane, uterine cervicitis, pelvic
inflammatory diseases, and ectopic pregnancy.
AIMS: The aim of this study was to investigate the presence of C. trachomatis genome in pregnant
women with abortion in Yasuj, Iran.
SETTINGS AND DESIGN: This is a descriptive–analytical study in Shahid Mofateh Gyneco‑obstetrics
clinic and Emam sajjad Hospital.
SUBJECTS AND METHODS: Specimens of cervix, urine, placenta, and blood of 107 pregnant
women were simultaneously collected at maternity ward and operation room and were stored for
molecular tests. The molecular tests were performed, and the results were analyzed.
STATISTICAL ANALYSIS USED: Analysis was performed using SPSS software 9.1 (IBM, Illinois,
Chicago, USA) with descriptive–analytical statistics.
RESULTS: Of 107 women, 15 had polymerase chain reaction‑positive tests for C. trachomatis. The age
of the studied individuals was 15–38 years with mean age of 26.6 years. The highest infection rates were
in the age group of 21–25 years (7.47%), and the lowest frequency was in the age group of 36–40 years.
A significant difference was noted between the number of first abortions in the case and control groups.
CONCLUSIONS: Our results showed that C. trachomatis as a sexually transmitted agent causes
severe complications such as abortion; thus, it is important to screen pregnant and sexually active
women who are craving to carry a baby.

Abstract CONTEXT: Cutaneous Leishmaniasis (CL) is a self‑healing lesion but prevention of complications
and involvement of vital organs such as palpebra requires proper treatment.
AIMS: The main objectives were to detect agents of CL in palpebral region and estimate the proportion
of palpebral lesion also possible complications among CL patients in a zoonotic CL endemic area.
SETTINGS AND DESIGN: The study was performed from April 2012 to March 2013 in a total of
1613 CL suspected patients by interview and physically exam.
SUBJECTS AND METHODS: The samples were used for direct smear using Giemsa stain method, or
cultured in Novy‑McNeal‑Nicol medium. For further checked, nested polymerase chain reaction (PCR)
was used for negative palpebral samples. Of the 1613 examined samples, 848 (81.4%) by direct
smear, 188 (18%) by culture and 6 (0.6%) by nested PCR were positive, respectively. A total of 233
of the patients showed lesions on the face of whom 15 (male = 5, female = 10, 1.43% of all and
6.43% of facial lesions) presented with palpebral CL. The results of nested PCR indicated that all
the palpebral cases were due to Leishmania major.
CONCLUSIONS: About 93% of the patients with palpebral lesion were under 5 years old and were
infected in the hyper endemic regions, but no ocular complication was seen in any of them. Based
on the results, it seems that early referring to the medical center for proper diagnosis and treatment
is the main reason for prevention of further complications.

Abstract CONTEXT: One of the main goals of antenatal testing is to identify fetuses at the risk of neurologic
injury or death so that these adverse outcomes can be prevented. We want to assess the effects of
BL67 points’ stimulation on fetal heart rate parameters and fetal movements during nonstress test
(NST). We did a quasi‑experimental design in Shahid Beheshti Hospital in Isfahan in 2011.
AIMS: This study aims to assessment of the effects of BL67 points’ stimulation on fetal heart rate
parameters and fetal movements.
SETTINGS AND DESIGN: We did a randomized controlled clinical trial in Shahid Beheshti Hospital
in Isfahan in 2011.
SUBJECTS AND METHODS: This study is a quasi‑experimental design that was conducted in one
group and the two steps (before‑after study). Participants were pregnant women (primigravida) who
were 35–18 years that refer to Shahid Beheshti Hospital in Isfahan in 2011 to receive routine prenatal
care. The 32 pregnant women were selected for acupressure during the second NST.
STATISTICAL ANALYSIS USED: The statistical processing was performed by descriptive, paired
t‑test through SPSS version 20.
RESULTS: There was no significant difference in mean number of accelerations in fetal heart
rate and mean number of fetal movement before and after intervention; however, there was a
significant difference in mean time to the second acceleration before and after the intervention
(P = 0.04).
CONCLUSIONS: No difference between parameters of the fetal heart rate before and after stimulation
and lack of uterine response by this method is a significant advantage and is probably why stimulating
this point could not create a risk to the fetuses.