Journal of Education and Health Promotion

Abstract

Abstract Chondromyxoid fibroma (CMF) is a benign tumor which usually occurs in skeletal long bones. Its
presence in zygoma is extremely rare. The patient was a 47‑year‑old female, with chief complaint of
painful swelling in the left side of zygoma since 1 month ago after a long‑lasting painless swelling for
about 15 years. Computed tomography scan showed an osteolytic lesion, in the body of left zygomatic
bone with lobulated and well‑demarcated margins. During surgery, the mass was completely excised
and the histological feature of the tumor was in favor of CMF. CMF is benign tumor and complete
resection is the treatment of choice.

Abstract CONTEXT: Disaster patient tracking consists of identifying and registering patients, recording data
on their medical conditions, settings priorities for evacuation of scene, locating the patients from
scene to health care centers and then till completion of treatment and discharge.
AIM: The aim of this study was to design a model of patient tracking system for natural disaster in Iran.
MATERIALS AND METHODS: This applied study was conducted in two steps in 2016. First, data
on disaster patient tracking systems used in selected countries were collected from library-printed
and electronic references and then compared. Next, a preliminary model of disaster patient tracking
system was provided using these systems and validated by Delphi technique and focus group. The
data of the fi rst step were analyzed by content analysis and those of the second step by descriptive
statistics.
RESULTS: Analysis of the comments of key information persons in three Delphi rounds, consisting
of national experts, yielded three themes, i.e., content, function, and technology, ten subthemes,
and 127 components, with consensus rate of over 75%, to provide a disaster patient tracking system
for Iran.
CONCLUSION: In Iran, there is no comprehensive process to manage the data on disaster patients.
Offering a patient tracking system can be considered a humanitarian and effective measure to promote
the process of identifying, caring for, evacuating, and transferring patients as well as documenting
and following up their medical and location conditions from scene till completion of the treatment.

Abstract OBJECTIVE: The present study intends to see the effect of yoga practices on lipid profile,
interleukin (IL)‑6, tumor necrosis factor (TNF)‑α, and high‑sensitivity‑C‑reactive protein (hs‑CRP)
among apparently healthy adults exposed to occupational hazards.
MATERIALS AND METHODS: In the present study, 48 participants aged 30–58 years (41.5 ± 5.2)
who were exposed to occupational hazards were randomized into two groups, that is, experimental
and wait‑list control. All the participants were assessed for lipid profile, IL‑6, TNF‑α, and hs‑CRP at
the baseline and after completion of 3 months of yoga training intervention. The experimental group
underwent yoga training intervention for 1 h for 6 days a week for 3 months, whereas control group
continued with their daily activities except yoga training. Data analysis was done using statistical
software SPSS Version 20.0. Data were analyzed using paired t‑tests and independent t‑test.
RESULTS: The results of within group comparison revealed highly significant changes in
cholesterol (P < 0.001), high‑density lipoprotein (P < 0.001), low‑density lipoprotein (LDL)(P < 0.01),
hs‑CRP (P < 0.01), IL‑6 (P < 0.001), and TNF‑α (P < 0.001) in experimental group. Comparison
between experimental and control group revealed significant changes in cholesterol (P < 0.01),
LDL (P < 0.05), IL‑6 (P < 0.01), TNF‑α (P < 0.01), and hs‑CRP (P < 0.01).
CONCLUSION: A yoga‑based lifestyle intervention seems to be a highly promising alternative therapy
which favorably alters inflammatory markers and metabolic risk factors.

Abstract BACKGROUND: The curriculum of pathology is conventionally “taught” in a series of didactic lectures,
which promotes learning by rote. In this study, case-based learning (CBL) was introduced to assess
its effect on higher order cognition and problem-solving skills in undergraduate medical students.
SUBJECTS AND METHODS: The prescribed syllabus of hepatobiliary system was delivered to the
undergraduate medical students of the fourth semester by conventional didactic lectures. A pretest,
which contained questions designed to test both analysis and recall, was administered, followed
by CBL sessions, in the presence of a facilitator, encouraging active discussion among students.
Students were then assessed using a similar posttest. The perceptions of the students and the faculty
were gathered by means of feedback questionnaires. The scores obtained by the students in the
pre- and post-test were compared by paired t-test.
RESULTS: Eighty-one students participated in CBL sessions, with 95.06% expressing a desire for
more such sessions, preferably in all the topics. The faculty members also felt that CBL would be
benefi cial for the students but opined that it should be restricted to some topics. CBL was found
to cause a highly signifi cant (P < 0.0001) improvement in the students’ higher levels of cognition,
whereas the lower orders of cognition remained unaffected (P = 0.2048).
CONCLUSIONS: CBL promotes active learning and helps in the development of critical thinking and
analysis in undergraduate medical students. Although it is resource-intensive, an attempt should be
made to incorporate it along with lectures in clinically important topics.

Abstract BACKGROUND: Management pain in hospitalized children is challenging for the health-care
professionals. Nurses have the most interactions with children who need to assess and manage for
their pain. Therefore, the aim was to describe nurses’ experiences from pain management among
hospitalized children from Iranian culture in this study.
METHODS: A phenomenological study was conducted in which 23 nurses working in an educational
hospital in Isfahan–Iran. The nurses participated in interviews based on a purposeful sampling method.
RESULTS: Participants’ experiences were categorized into three major themes and twelve subthemes
including the nurses’ ability of detection of the pain nature, reaction to pain management and belief
in pain relief.
CONCLUSIONS: The research showed that the nurses have valuable experiences in pain
management in their workplaces. Their descriptions were based on the use of three domains that
consist of knowledge, belief, and practice. Therefore, it is vital to focus on the subject of pain in
nursing curriculum and guidelines in hospitals. A more extensive research is needed to demonstrate
perceived barriers to pain management.

Abstract INTRODUCTION: Gestational diabetes is the most common metabolic disorder in pregnancy, and
lack of self‑care is the most important reason for mortality in diabetic patients. Since the glycemic
control is associated with physiological and psychological mechanisms, variables such as health
locus of control can play a role in health behaviors of diabetic patients. Therefore, this study was
aimed to predict self‑care behaviors among women with gestational diabetes based on maternal
health locus of control (MHLC) and fetal health locus of control (FHLC).
METHODS: This study is a descriptive, predictive correlational study that it is conducted on
over 400 women with gestational diabetes attending the health centers and clinic of hospitals
affiliated to Mashhad University of Medical Sciences in 2015. Data were collected using individual
questionnaire, self‑care derived from the summary of diabetes self‑care activities, MHLC, and FHLC
scale. The data were analyzed using Spearman’s correlation coefficient test, linear regressions
model, and multiple regression in SPSS software version 16. P < 0.05 was considered statistically
significant.
RESULTS: Results of Spearman’s correlation coefficient test showed a significant direct linear
relationship between self‑care and internal MHLC (P = 0.027) and internal dimensions (P < 0.0001)
and powerful others (P = 0.012) of FHLC. According to linear regressions model, internal
MHLC (P = 0.027), internal dimensions (P < 0.0001), and powerful others (P = 0.012) of FHLC are
considered as predictor variables of self‑care.
CONCLUSION: Midwives should perform interventions to increase internal locus of control and
encourage more responsibility among women with gestational diabetes to achieve better self‑care.

Abstract INTRODUCTION: Clinical evaluation is very important in the educational system of nursing. One
of the most common methods of clinical evaluation is evaluation by the teacher, but the challenges
that students would face in this evaluation method, have not been mentioned. Thus, this study aimed
to explore the experiences and views of nursing students about the challenges of teacher‑based
clinical evaluation.
METHODS: This study was a descriptive qualitative study with a qualitative content analysis approach.
Data were gathered through semi‑structured focused group sessions with undergraduate nursing
students who were passing their 8th semester at Rafsanjan University of Medical Sciences. Date
were analyzed using Graneheim and Lundman’s proposed method. Data collection and analysis
were concurrent.
RESULTS: According to the findings, “factitious evaluation” was the main theme of study that
consisted of three categories: “Personal preferences,” “unfairness” and “shirking responsibility.”
These categories are explained using quotes derived from the data.
CONCLUSION: According to the results of this study, teacher‑based clinical evaluation would lead
to factitious evaluation. Thus, changing this approach of evaluation toward modern methods of
evaluation is suggested. The finding can help nursing instructors to get a better understanding of
the nursing students’ point of view toward this evaluation approach and as a result could be planning
for changing of this approach.

Abstract BACKGROUND: Clinical education provides a chance to combine theoretical knowledge and clinical
skills. Students are the key elements in the evaluation of clinical education efficacy. The present
study was aimed to define nursing students’ viewpoints concerning conformity to the characteristics
of clinical conference and clinical round.
METHODS: This descriptive analytical study was conducted on the bachelor’s students of the 4th–6th
semester of nursing. Sampling was conducted using census sampling method during the 2nd semester
of 2014–2015 school year. Data collection tool was a three‑section researcher‑made questionnaire
containing demographic, nursing round, and clinical conference characteristics. Descriptive and
inferential statistical tests (independent t‑test, ANOVA, and Spearman and Pearson correlation
coefficients) were used for data analysis.
RESULTS: Participants were 134 bachelor’s students of the 4th–6th semester of nursing. According
to half of the participants, conformity to the characteristics of clinical conference (45.5%, 53%) and
clinical round (44%, 51.5%) were poor and medium, respectively. Paired t‑test showed a significant
difference between students’ viewpoints toward the planning of clinical conference and clinical
nursing round (P = 0.006, t = 2.77).
CONCLUSIONS: According to the results of the present study on students’ viewpoints, clinical
education faces a serious challenge with regard to clinical education methods. Considering the
necessity and importance of clinical education, more investigation should be conducted to detect its
relevant factors and plan for its improvement.

Abstract BACKGROUND: Training the health personnel about domestic violence would cause them to
investigate and evaluate this issue more than before. Considering the new educational approaches
for transferring knowledge, the goal of this research was to compare the effect of group‑based and
compact disk (CD)‑based training on midwives’ knowledge and attitude toward domestic violence.
METHODS: In this clinical experiment, seventy midwives working at health centers and hospitals
of Isfahan were randomly allocated into two classes of group‑based and CD‑based trainings and
were trained in the fields of recognition, prevention, and management of domestic violence. Data
were collected by questionnaires which were completed by the midwives for evaluation of their
knowledge and attitude.
RESULTS: The mean score of midwives’ knowledge and attitude toward domestic violence had
a meaningful increase after the training (16.1, 46.9) compared to the score of before the training
(12.1, 39.1) in both of the classes (group‑based training: 17.7, 45.4) (CD‑based training: 11.7, 38.6).
No meaningful difference was observed between the two groups regarding midwives’ attitude toward
domestic violence after the intervention; however, regarding their knowledge level, the difference
was statistically meaningful (P = 0.001), and this knowledge increase was more in the CD‑based
training group.
CONCLUSIONS: In spite of the effectiveness of both of the training methods in promoting midwives’
knowledge and attitude about domestic violence, training with CD was more effective in increasing
their knowledge; as a result, considering the benefits of CD‑based training such as cost‑effectiveness
and possibility of use at any time, it is advised to be used in training programs for the health personnel.

Abstract INTRODUCTION: Understanding the development and distribution of disruptive behaviour among
members of a health‑care team is critical to the safety and quality of patient care in high‑risk
environments such as operating rooms. The present study identified disruptive behaviour and its
effect on the treatment of patients in the operating room environment.
SUBJECTS AND METHODS: This cross‑sectional study used the convenience sampling method to
select 144 operating room physicians and nurses (91 women and 53 men). The study was conducted
in the operating rooms of four academic hospitals with different specialties in North Khorasan province
in Iran from December 2013 to September 2014. The data were collected using a translated, modified,
and validated questionnaire to investigate the prevalence and consequences of disruptive behaviour,
the response of the health care system to the behaviour, factors affecting the creation of conflict and
the spread of disruptive behaviour. Statistical analysis of the data was performed using SPSS 18.
RESULTS: Disruptive behaviour was reported by 82.95% physicians and nurses. On average, 39%
of physicians and 21% of operating room nurses exhibited disruptive behaviour. Disruptive behaviour
is associated with psychological and clinical consequences. Factors such as fear of retaliation (8%),
lack of change (43.8%), lack of security (18.1%) and attitude of the organization (14.6%) are significant
reasons for the failure to report these behaviours.
CONCLUSIONS: The findings suggest that disruptive behaviour occurs and affects treatment and
workflow of treatment teams in the operating room. Interpersonal conflict contributes to the growth
of such behaviour; thus, more research should focus on this subject in the future.

Abstract BACKGROUND: Birth of a child with cleft lip and palate, as a crisis, can affect family relationships and
interactions seriously and hence self‑esteem in family members. The present study was conducted
to investigate the effect of a happiness training program on self‑esteem in the mothers of children
with cleft lip and palate.
MATERIALS AND METHODS: In this quasi‑experimental study, 64 mothers of children with cleft lip
and palate referring to health‑care team in the Isfahan University Medical Sciences were enrolled
by convenience random sampling. Then, the program of happiness training was implemented within
10 sessions, and a questionnaire of demographic characteristics and Coopersmith Self‑Esteem
Inventory was filled out before and 2 months after the last session. The data were analyzed by
descriptive and analytical statistics (paired t‑test, independent t‑test, Chi‑square, and Mann–Whitney)
in SPSS 20 (SPSS Inc: Chicago),
RESULTS: The mean age of the mothers in intervention and control groups was 33.3 ± 6.3 and
33.5 ± 5.8 years, respectively. The mean age of the children in the intervention and control groups
was 6.34 ± 3.37 and 5.03 ± 3.36 years. Independent t‑test indicated a significant difference in
self‑esteem mean score after training in the intervention and control groups. Moreover, paired t‑test
indicated a significant difference in self‑esteem mean score between before and after training in the
intervention group.
CONCLUSION: In the light of the effect of happiness training on the promotion of self‑esteem
in children with cleft lip and palate, this program can be used as a care intervention to reduce
psychological and mental problems and to enhance adjustment in parents.

Abstract BACKGROUND: Newspapers play an important role in improving public health literacy. This study
analysis the content of pediatric information in widely circulated Iranian newspapers in 2014.
MATERIALS AND METHODS: This is an applied survey performed using content analysis
method. The data gathering tool was a checklist designed by the researcher. The sample size was
determined using nonprobability sampling to be 426 articles with pediatric‑related topics of five
Iranian newspapers.
RESULTS: The results showed that the most popular topics included “psychological disorders” (19.6%)
and “nutrition” (19.27%). The null areas include “physiopathology of body fluids and fluid therapy”
and “gynecological problems in childhood” (0%).
CONCLUSION: The messages identified were more in line with needs of Iranian society which
shows a need to pay more attention to international standards by both journalists and pediatricians.

Abstract INTRODUCTION: Cardiovascular diseases are the leading cause of death all over the world. Lifestyle
can have an important role not only in reducing risk factors but also in the prevention and treatment
of coronary heart diseases. The aim of this study was to examine the relationship between clinical
parameters and various aspects of patients’ lifestyles according to the severity of their coronary
artery stenosis.
MATERIALS AND METHODS: This study was a descriptive, analytic study carried out on 220 patients
undergoing coronary angiography at Mazandaran Heart Center. Based on the angiography results,
patients were divided into two groups: artery stenosis > 50% (110 cases) and < 50% (110). Patients’
lifestyles were evaluated using health‑promoting behavior questionnaire. Blood pressure and
triglyceride, low‑density lipoprotein, high‑density lipoprotein, cholesterol, and fasting blood sugar
were also measured. After collecting data, SPSS 21 software, Chi‑square test, t‑test, and multiple
linear regression were used for analysis of the data.
RESULTS: The results showed that in patients with positive angiographic data, there is a significant
correlation between clinical parameters and dimensions of health‑promoting behavior (P < 0.05).
CONCLUSION: Given the impact of clinical parameters on various aspects of lifestyle, it seems
that by teaching the different aspects of lifestyle (such as having a healthy diet consisting of fresh
fruits and vegetables, reducing intake of saturated fat, physical activity and regular exercise, stress
management, and blood pressure control) to patients with a positive angiographic result, we can
improve their lifestyles by means of improving clinical parameters.

Abstract BACKGROUND: Some risk factors that would lead to therapeutic abortion do even exist before
pregnancy and could be resolved or corrected through appropriate interventions. The present study
was conducted to evaluate the condition of preconception care among therapeutic abortion applicants.
MATERIALS AND METHODS: This research was a descriptive, cross‑sectional study that was
conducted on 200 applicants for therapeutic abortion at the Forensics Medicine Center of Isfahan (Iran)
who were selected convenience sampling from October 2014 to March 2015. Data were gathered
using a researcher made checklist. Data were analyzed using SPSS version 16 through descriptive
statistics and Chi‑square and independent t‑test.
RESULTS: Eighty‑five percent of the participants were applicants for therapeutic abortion due to
fetal problems, and the other 15% were due to maternal issues. About 41.7% of participants with
fetal problems and all of the participants with maternal issues had not received preconception care.
In 93.3% of the applicants with maternal issues, the disease existed before the pregnancy. About
48.2% of participants needed genetic counseling, but 28.6% had not received any.
CONCLUSIONS: Results showed that in most of the participants, the risk factor for therapeutic
abortion existed before the pregnancy. Providing preconception care along with the elimination
of risk factors before the pregnancy could prevent some of the pregnancies with the indication of
therapeutic abortion.

Abstract BACKGROUND: As an important right and a treatment priority, pain management and alleviation
can prevent harmful consequences and sever effects to the infant. The aim of this study was to
determine the nurses and physicians’ viewpoints about assessment, intervention, and evaluation of
pain in the infants in the neonatal Intensive Care Units (NICUs).
METHODS: The cross-sectional study was performed in census method in the NICUs of educational
hospitals with participation of 157 staff in 2015 in Iran. Data collection tool was a questioner that was
designed to assess the four components of pain management namely assessment, pharmacological
intervention, nonpharmacological intervention, and evaluation. The collected data were analyzed in
a descriptive and inferential statistics by means of the SPSS software, version 16.
RESULTS: The fi ndings of study indicated the total average scores of pain management from nurses
and physicians’ viewpoint 66.7 and 65.5, respectively that were at the moderate level. The average
score of nonpharmacological interventions from nurses’ viewpoint (69.4) was meaningfully higher than
that of the physicians’. A signifi cant relationship was noticed between the respondents’ viewpoint on
the nonpharmacological interventions and their NICU background (r = 0.18, P = 0.03). A meaningful
relation was found between participation in continuing education and scores of pain management.
CONCLUSIONS: The results of this study showed that the nurses and physicians’ viewpoint about
pain management was at a moderate level. The effect of work experience and continuing education
on pain management is proved in the study. Researchers suggest that both experienced staff
employment and education continuation must be incorporated in pain management in NICUs.

Abstract INTRODUCTION: Internet addiction refers to the excessive use of the internet that causes mental,
social, and physical problems. According to the high prevalence of internet addiction among university
students, this study aimed to determine the effect of an educational intervention on preventive
behaviors of internet addiction among Tehran University of Medical Sciences students.
MATERIALS AND METHODS: This study was a quasi‑experimental study conducted among female
college students who live in the dormitories of Tehran University of Medical Sciences. Two‑stage
cluster sampling was used for selection of eighty participants in each study groups; data were
collected using “Young’s Internet Addiction” and unstructured questionnaire. Validity and reliability
of unstructured questionnaire were evaluated by expert panel and were reported as Cronbach’s
alpha. Information of study groups before and 4 months after the intervention was compared using
statistical methods by SPSS 16.
RESULTS: After the intervention, the mean scores of internet addiction, perceived barriers
construct, and the prevalence of internet addiction significantly decreased in the intervention group
than that in the control group and the mean scores of knowledge and Health Belief Model (HBM)
constructs (susceptibility, severity, benefits, self‑efficacy) significantly increased.
CONCLUSIONS: Education based on the HBM was effective on the reduction and prevention of
internet addiction among female college students, and educational interventions in this field are
highly recommended.

Abstract CONTEXT AND AIMS: We aimed to evaluate the effectiveness of hydroalcoholic extract of Quercus
brantii’s nut on clinical, endoscopic, and pathological findings of patients with dyspepsia.
PATIENTS AND METHODS: In this randomized, double-blind clinical trial, patients with symptomatic
dyspepsia who had an endoscopic evaluation for dyspepsia were included and randomized into two
groups. One Group (A) received drug extract with a dose of 100 mg twice a day for 10 days. Group B,
as a control group, received placebo. Immediately and 2 months after intervention, the patients were
followed up, and the characteristics of their dyspepsia (severity and frequency), endoscopic and
pathologic fi ndings were reevaluated and compared.
RESULTS: In this trial, 13 and ten patients participated in the study in Groups A and B, respectively.
Two months after intervention, ten (76.9%) and six (60%) participants referred for follow-up
and endoscopic evaluation. There were no signifi cant changes in clinical presentations after
intervention (P > 0.05). Two months after intervention, clinical presentations including severity and
frequency of epigastric pain had signifi cant decrease in Group A and endoscopic evaluation indicated
signifi cant improvement in Group A (P < 0.05). Pathologic fi ndings were similar and not signifi cantly
different in two studied groups after intervention (P > 0.05).
CONCLUSIONS: The fi ndings of this trial indicated that hydroalcoholic extract of Q. brantii’s nut
could have delayed signifi cant proper effect on clinical and endoscopic presentations of patients
with dyspepsia. We recommend that this study should be considered as pilot one in this fi eld. The
results could be used as baseline data for more interventional studies. More surveys are needed to
investigate the mechanism of extract action at molecular basis.

Abstract INTRODUCTION: The maternal role is one of the most basic and important roles played by
women during their lifetime. The process of the maternal role starts during pregnancy and
to continue and develop after postpartum with the growth of suckling. However, unplanned
pregnancy may jeopardize achieving the maternal role and reduce maternal role satisfaction.
Therefore, the researcher conducted the present study to determine the impact of maternal
role training program on attainment of role and role satisfaction in nulliparous women with
unplanned pregnancy.
METHODOLOGY OF THE RESEARCH: In this clinical trial, the researcher divided 67 nulliparous
women with unplanned pregnancies into two groups at random by drawing lots. For the
intervention group, in addition to the usual pregnancy care, the researcher conducted 3 group
training sessions at weeks 34, 35, and 36 of pregnancy and an individual training session in the
1st day after delivery before release; then, during the next 4 weeks, the researcher made follow‑up
phone calls each week. The control group received the usual pregnancy care. The research
tools included London questionnaire to measure unplanned pregnancy, Myself‑As‑Mother
Scale (SD‑Self), My‑Baby Scale (SD‑Baby), Perceived Competence Scale to measure maternal
role attainment, and Parenting Sense of Competence Scale to measure maternal role satisfaction.
The researcher measured the maternal role attainment and maternal role satisfaction before
training and 4 weeks after delivery. The researcher analyzed the data using SPSS software
version 21 and statistical tests such as independent t‑test, Chi‑square, paired sample t‑test,
Mann–Whitney, one‑way analysis of variance, and Wilcoxon. The amount of P was supposed
to be <0.05.
RESULTS: The mean age of research units was 24.10 ± 4.3. Twenty‑one persons (60%) in the
intervention group and ten persons (31.3%) in the control group attained the maternal role (P = 0.019)
and changes to achieve the maternal role in intervention group were significantly more than the control
group (P = 0.002). Changes in the mean scores of maternal role satisfaction in the intervention group
were significantly more than the control group (P = 0.023).
CONCLUSION: Maternal role training for nulliparous women with unplanned pregnancy during
pregnancy and postpartum period can help them in maternal role attainment and maternal role
satisfaction.

Abstract Postpartum depression is a debilitating mental disorder with a high prevalence. The aim of this
study was review of the related studies. In this narrative review, we report studies that investigated
risk factors of postpartum depression by searching the database, Scopus, PubMed, ScienceDirect,
Uptodate, Proquest in the period 2000‑2015 published articles about the factors associated
with postpartum depression were assessed in Farsi and English. The search strategy included a
combination of keywords include postpartum depression and risk factors or obstetrical history, social
factors, or biological factors. Literature review showed that risk factors for postpartum depression
in the area of economic and social factors, obstetrical history, and biological factors, lifestyle and
history of mental illness detected. Data from this study can use for designing a screening tools for
high‑risk pregnant women and for designing a prevention programs.