Journal of Education and Health Promotion

Abstract Background: Lean management is a process improvement technique to identify waste
actions and processes to eliminate them. The benefits of Lean for healthcare organizations
are that first, the quality of the outcomes in terms of mistakes and errors improves. The
second is that the amount of time taken through the whole process significantly improves.
Aims: The purpose of this paper is to improve the Medical Records Department (MRD)
processes at Ayatolah‑Kashani Hospital in Isfahan, Iran by utilizing Lean management.
Materials and Methods: This research was applied and an interventional study. The data
have been collected by brainstorming, observation, interview, and workflow review. The study
population included MRD staff and other expert staff within the hospital who were stakeholders
and users of the MRD. Statistical Analysis Used: The MRD were initially taught the concepts
of Lean management and then formed into the MRD Lean team. The team then identified and
reviewed the current processes subsequently; they identified wastes and values, and proposed
solutions. Results: The findings showed that the MRD units (Archive, Coding, Statistics, and
Admission) had 17 current processes, 28 wastes, and 11 values were identified. In addition,
they offered 27 comments for eliminating the wastes. Conclusion: The MRD is the critical
department for the hospital information system and, therefore, the continuous improvement
of its services and processes, through scientific methods such as Lean management, are
essential. Originality/Value: The study represents one of the few attempts trying to eliminate
wastes in the MRD.

Abstract Background: An active teaching method has been used widely in medical education. The aim
of this study was to determine the effectiveness of the four‑phase teaching method on midwifery
students’ emotional intelligence (EQ) in managing the childbirth. Materials and Methods: This
was an experimental study that performed in 2013 in Isfahan University of Medical Sciences.
Thirty midwifery students were involved in this study and selected through a random sampling
method. The EQ questionnaire (43Q) was completed by both the groups, before and after the
education. The collected data were analyzed using SPSS 14, the independent t‑test, and the
paired t‑test. The statistically significant level was considered to be <0.05. Results: The findings
of the independent t‑test did not show any significant difference between EQ scores of the
experimental and the control group before the intervention, whereas a statistically significant
difference was observed after the intervention between the scores of two groups (P = 0.009).
The paired t‑test showed a statistically significant difference in EQ scores in the two groups
after the intervention in the four‑phase and the control group, respectively, as P = 0.005 and
P = 0.018. Furthermore, the rate of self‑efficiency has increased in the experimental group
and control group as 66% and 13% (P = 0.024), respectively. Conclusion: The four‑phase
teaching method can increase the EQ levels of midwifery students. Therefore, the conduction
of this educational model is recommended as an effective learning method.

Abstract Background: Peer learning is an educational process wherein someone of the same age or
level of experience level interacts with other students interested in the same topic. There is
limited evidence specifically focusing on the practical use of peer learning in Iran. The aim of
this study was to explore nursing students’ experiences of peer learning in clinical practice.
Materials and Methods: A qualitative content analysis was conducted. Focus groups were
used to find the students’ experiences about peer learning. Twenty‑eight baccalaureate nursing
students at Bushehr University of Medical Sciences were selected purposively, and were arranged
in four groups of seven students each. The focus group interviews were conducted using a
semi‑structured interview schedule. All interviews were tape‑recorded, transcribed verbatim,
and analyzed using conventional content analysis method. Results: The analysis identified
four themes: Paradoxical dualism, peer exploitation, first learning efficacy, and socialization
practice. Gained advantages and perceived disadvantages created paradoxical dualism, and
peer exploitation resulted from peer selection and peer training. Conclusion: Nursing students
reported general satisfaction concerning peer learning due to much more in‑depth learning
with little stress than conventional learning methods. Peer learning is a useful method for
nursing students for practicing educational leadership and learning the clinical skills before
they get a job.

Abstract Background: The thought of having a surgery can be stressful for everyone. Providing
the necessary information to the patient can help both the patient and the treatment team.
This study was conducted to compare the effectiveness of face‑to‑face verbal training and
educational pamphlets on the readiness of patients for undergoing non‑emergency surgeries.
Materials and Methods: The study was a before–after randomized clinical trial. 90 patients
scheduled to undergo non‑emergency surgery who referred to Shahrekord Ayatollah Kashani
Hospital in 2013 were distributed randomly and gradually into two experimental groups (group of
face‑to‑face verbal training and group of educational pamphlet) and one control group. Dependent
variable of the study was pre‑surgery readiness. Data analysis was carried out by using SPSS
statistical software. Statistical analysis were analysis of variance (ANOVA) and correlation test.
Results: Results showed that the mean scores of pre‑surgery readiness in both interventional
groups were significantly higher than that in the control group after the intervention (P < 0.05).
However, there was no significant difference between the two experimental groups (P > 0.05).
Conclusions: Each of the methods of face‑to‑face verbal education and using the pamphlet could
be equally effective in improving the readiness of the patients undergoing surgery. Therefore,
in environments where the health care providers are facing with the pressure of work and lack
of sufficient time for face‑to‑face verbal training, suitable educational pamphlets can be used to
provide the necessary information to patients and prepare them for surgery.

Abstract Background: The issue of students’ academic failure is one of the most important educational,
economic, and social issues. Cognizance of the factors related to academic downfall is so efficient
in its prevention and control and leads to protecting governmental assets and labor force. In
order to achieve this goal, this study intends to determine the predictive factors of the students’
academic performance in Isfahan University of Medical Sciences in terms of their personality profile,
mental health, and their demographic characteristics. Materials and Methods: This study was a
descriptive‑correlation study on 771 students who entered Isfahan University of Medical Sciences
between 2005 and 2007. The information was gathered through using the students’ educational and
clinical files (for measuring personality characteristics and mental health) and SAMA Software (To
get the mean scores). Minnesota Multiphasic Personality Inventory short form and General Health
Questionnaire were used for collecting clinical data. The data were analyzed using SPSS 15(stepwise
regression coefficient, variance analysis, Student’s t‑test, and Spearman correlation coefficient).
Result: The results showed that the aforementioned students obtained a normal average for their
personality profile and mental health indicators. Of all the reviewed variables, education, age, gender,
depression, and hypochondria were the predictive factors of the students’ educational performance.
Conclusion: It could be concluded that some of the personality features, mental health indicators,
and personality profile play such a significant role in the students’ educational life that the disorder
in any of them affects the students’ educational performance and academic failure.

Abstract Background: The Index used for osteoporosis detection was BMD measured in L2
, L3
, and L4
vertebrae. We compared the density of the vertebrae to select the one with maximum change
in the density for decreasing the cost and the time. Methods and Materials: Ninety seven
osteoporotic post-menopausal women with a mean age of 61.78 ± 8.48 (50 - 86) years and
a mean body mass index (BMI) of 24.75 ± 2.66 (kg/m2
) (18 - 30) without any known diseases
and on any medication affecting bone mineral density (BMD) were examined at osteoporosis
section of a teaching hospital. The vertebral bodies (L2 - L4
) of participants were measured
by using a dual energy X-ray absorptiometry system (DEXA). To investigate if the BMD
measurement of a single vertebra could replace the total L2 -
L4
 measurement, the mean BMDs
and the correlations of the L2 -
L4
 were compared. Results: Among the 97 studied women, the
mean BMI was 24.75 ± 2.66. The mean BMD of L2
, L3
, and L4
 vertebrae were 0.7199, 0.7258,
and 0.7402, respectively. There was no significant difference between the mean BMD of L2
 and
L3
 vertebrae (P > 0.05), suggesting a strong relationship between L2
 and L3
. The mean BMD
in the L4
 vertebra was significantly higher than the other two vertebrae (P < 0.05), Statistical
analysis showed that the BMD in all three L2
, L3
, and L4
 vertebrae were associated with BMI
(r > 0 and P < 0.05), but there was no significant relationship between BMD and age in the
three L2
, L3
, and L4
 vertebrae (r ≅ 0 and P > 0.05). Conclusion: Since the mean BMDs of L2
and L3
 were not significantly different, and due to a very high correlation between L2
 and L3
, we
recommend the measurement of L2
 rather than L2 - L4
 in order to save patient scanning time,
cost, and the patient X-ray exposure.

Abstract Aims: In the field of family research, previous studies have made great strides toward
understanding the relationship between marital conflict and quality. However, they have
only studied couples in short‑term marriages. Therefore, much remains to be unraveled with
regard to long‑term marriages. We aimed investigate the comparative contribution of aspects
of marital conflict to marital quality in short‑and long‑term marriages in Iranian families.
Materials and Methods: Using random clustered sampling, 400 dyads in intact first marriages
were surveyed across eight provinces of Iran. Complete surveys for both husbands and wives
were returned for 162 households (couple’s response rate: 40.5%). Survey measures included
demographics questionnaire, Barati and Sanai’s Marital Conflict Questionnaire and Blum
and Mehrabian’s Comprehensive Marital Satisfaction Scale. Structural equation modeling
was used to test the actor‑partner interdependence model of marital conflict‑marital quality.
Results: Generalized additive models were incorporated to define what constitutes short‑and
long‑term marriages. Based on the models regressed, duration ≤ 10 years was defined as
short‑term, whereas duration ≥ 25 years was labeled long‑term. In short‑term marriages (n = 44),
decreased sexual relations, increased daily hassles and sidedness in relations with parents were
negatively associated with marital quality in both actor and actor‑to‑partner paths. In long‑term
married couples (n = 46), only increased daily hassles (P < 0.001) and disagreement over
financial affairs (P = 0.005) contributed to actor paths and only sidedness in relationships with
parents showed significant negative association to marital quality in actor‑to‑partner paths.
Conclusions: Different themes of conflict contribute to the diminished level of marital quality
in early and late stages of the marriage. Conflicts over sex, relationship with extended family
and daily hassles are emphasized in the early
years of marriage, while in later years; dispute
over money and daily hassles dominate.

Abstract Background: Today, the dental practitioners are finding many more medically compromised
patients in their practice. Aims: The aim of this study was standardization of the European
Medical Risk Related History (EMRRH) questionnaire for use among Persian population.
Materials and Methods: The English original version of the EMRRH questionnaire was translated
into Persian language by a forward–backward translation method. Then reliability was tested
on 50 subjects. Also, the sensitivity, specificity, and validity of the questionnaire were assessed.
Statistical Analysis Used: Cohen’s kappa, a measure of agreement between observers that
includes an adjustment for chance agreement, was likewise calculated. Results: The reliability
coefficient (Cronbach’s alpha) of the EMRRH was above the recommended 0.7 threshold
and considered excellent (alpha 0.87). Specificity of the questions was 94% and of per
EMRRH item was 93%. Sensitivity per question was 86.1% and of per EMRRH item was
94%. Cohen’s kappa for the questionnaire was 0.89 and for subsequent questions was 0.82.
Conclusions: The EMRRH (Persian version) has been shown to be valid in comparison with
the gold standard (a medical history taken by a physician experienced) and this instrument
would be an effectual method of history taking for the dentist.

Abstract Introduction: Children are more risk‑prone group of the population and low birth
weight (LBW) is the leading cause of newborns’ mortality and morbidity. LBW is defined
as child’s birth weight lower than 2500 g. Many maternal and fetal factors are determined
as risk factors of LBW. This study tries to detect related factors to LBW and effect of them
on children’s growth pattern up to sixth month of life in Health centers of Urmia city, Iran.
Materials and Methods: A cross‑sectional study was carried out in Urmia city using
registered data from mothers` documents. All related data such age and weight of infants,
mothers’ age, gestational age (GA) at the time of delivery, time gap between two pregnancies,
past history of abortion, prenatal care history, systemic and underlying diseases, hemoglobin
of mothers during pregnancy, and pattern of infant’s growth up to sixth month of age were
registered in a questionnaire. All registered data were transferred to SPSS 15 software and
analyzed. Results: Mean ± SD of birth weight was 3071 ± 625.66 g. There was a significant
relationship between birth weight and mother’s age (P < 0.001) and weight (P < 0.001).
Children of mothers younger than 18 years had much birth weights. There was a
significant relationship between birth weight and GA during delivery (P < 0.001). Children
of preterm labor had lower birth weights. In twins, LBW was more prevalent (P < 0.001).
Conclusion: Our results show that LBW is related to multiple causes and that most of
them are preventable with educational programs and also strict and regular prenatal care.
Decreasing incidence of LBW children can be achieved by cooperation between different
parts of health and clinical systems.

Abstract Background: Eating breakfast is crucial for adolescents to be healthy. It also improves
students’ capacity of learning and doing school homework. Although healthy habits such as
eating breakfast, weight control, and regular sleep increase the lifespan in adults, the effects of
healthy habits on school‑age children have not been studied much. The present study aimed at
investigating the impact of an educational program based on Theory of Planned Behavior (TPB)
on eating breakfast among middle school students. Materials and Methods: This interventional
study was conducted on sixth‑grade students in Qom City during the academic year 2012–2013.
First, 97 students were randomly assigned to the experimental group and 97 other students
were assigned to the control group. Then, a questionnaire was developed on eating breakfast
by the researchers according to the TPB. A pilot study was conducted to assess the reliability
of the questionnaire. To assess the validity of the questionnaire, advice by a panel of experts
was sought. To carry out a pre‑test, both groups answered the questions. After analyzing the
pre‑test results, the required content was developed for the experimental group. Educational
methods included delivering speech, discussion groups, pamphlets, and posters. The required
educational content was provided for students during five sessions and for parents in one session.
To determine the effect of educational intervention, a post‑test study was carried out 2 months
after the intervention. Collected data were analyzed using independent t‑test, χ,
[2] and repeated
measures. Results: In the experimental group, 36.7% of students were eating breakfast at least in
a day of a week, before educational intervention. After implementation of the educational program,
only 32.7% of them were continuing their past habit. There was a significant difference between the
mean scores of attitudes, perceived behavioral control, intention, and practice of eating breakfast in
the experimental and control groups (P < 0.05), while there was no significant difference between
the mean scores of subjective norms after
implementing the educational program in both
groups (P < 0.26). Conclusion: Using the TPB
improved students’ intentions and behavior
of eating breakfast. Thus, it seems necessary
to consider all effective environmental factors
on the subjective norms in the education
of healthy eating behaviors or improving
breakfast‑eating practice among students.

Abstract Background: The rate of hospital deductions is a commonly cited concern among teaching
hospitals in Iran. The objective of the present study is to access the effect of the quantitative
and qualitative analysis of inpatient medical records on deductions and identifying the major
resources of deductions. There are currently no published interventional studies that have
investigated this issue quantitatively. Materials and Methods: In an interventional study,
we reviewed all the 192 patient’s medical records (PMRs) for any documentation errors, to
determine the rate of deductions. We conducted a pilot of 30 cases prior to the actual survey.
Nonprobability‑based consecutive sampling was used. The main study was conducted in three
phases: 1. Primary evaluation; 2. Training, performance of intervention and corrective actions;
and 3. Final assessment. Comprehensive assessments of medical records and follow‑up of
error correction were carried out systematically and according to the pre‑set schedule. Pre‑ and
post‑intervention assessments were compared in order to evaluate the effect of the intervention.
Data were analyzed using the SPSS‑20 statistical software. Paired‑sample t‑test was used to
compare changes in deduction scores before and after the intervention. Differences at a P value
less than 0.05 were considered statistically significant. Results: In the initial survey of 800 PMRs,
nearly one quarter (24%) (Or 192 cases) had at least one type of deduction. The three top types
of deductions were Laboratory (47.9%), Medical radiation (45.3%), and Physician visit (35.9%).
The results showed a 2.7‑ to about 36‑fold lower rate of hospital deductions (average: 6.4‑fold;
reduction from 21131 to 3285 US dollars). Conclusion: All in all, the results of the present study
indicated that educational interventions and quantitative and qualitative analysis of inpatient
medical records are very beneficial and effective in the reduction of medical record deductions.

Abstract Background: Anxiety is one of the most common psychological issues among all age groups
including children. The main role of parents has been known to support their children. Being far
away from a source of support has been shown to be a potential trigger for childhood anxiety.
Periodical jobs, including offshore work, are among the main reasons for absence of one of
the parents. Therefore, this study aims to assess anxiety in children of National Iranian Drilling
Company offshore staff. Materials and Methods: In this historical cohort study, 160 students
including 80 boys and 80 girls were selected through convenient random sampling from the
schools of National Iranian Drilling Company. Data were collected using Revised Children’s
Manifest Anxiety Inventory (by Reynolds and Richmond), consisting 37 items and a demographic
questionnaire. The collected data were statistically analyzed by t-test and logistic regression
tests through SPSS software. Results: The mean anxiety score was 12.80 among offshore staff’s
children and 11.67 among the children of the based staff. The ratio of manifest anxiety among
the offshore workers’ children was significantly more than the based ones’. Conclusions: Based
on the findings, offshore fathers’ job affects the anxiety of the children.

Abstract Introduction: Television (TV) viewing by children may be linked to a range of adverse health
and behavioral outcomes. This study was aimed at examining the relationship between
socioeconomic factors of families and TV watching behavior among 3–5 years old children
in Ardakan, Yazd, Iran. Materials and Methods: In the cross‑sectional study, mothers of 188
children (93 boys and 95 girls) between 3 and 5 years old completed a researcher‑designed
questionnaire. Data were analyzed by using SPSS, using bivariate correlations and t‑test for
independent samples. Results: The mean of TV viewing was 2.68 ± 1.6 h daily, ranging from
0 to 9 h. There were no statistically significant gender differences on the basis of daily TV
watching. There were positive associations between the children’s daily TV watching and age
as well as children’s daily TV watching and their mothers’ time spent on watching TV. Children
who lived in houses with the yard and could use it as a playground watched less TV than did
the children who lived in houses without the yard. Conclusion: The results suggest that health
care professionals should be aware of the association between different socioeconomic status
aspects of families, such as the children’s and mothers’ time spent on watching TV and having
a yard in the house in an attempt to develop effective strategies and interventions to prevent
excess TV watching.

Abstract Background: Violence is now regarded as a serious problem and its complication causes heavy
costs on the healthcare systems. The present study aimed to investigate the correlation between
some demographic characteristics and confrontation with violence. Since there is no study on
the prevalence of violence among the support and administration staff of hospitals in Iran, this
study was conducted to investigate violence in these departments. Materials and Methods: This
descriptive–analytical and correlation survey was carried out by census among the support and
administrative staff interacting with patients and their companions in Al‑Zahra University Hospital
of Isfahan in 2013. Research tool was a researcher‑made questionnaire including five domains:
Personal information, workplace information, verbal violence, physical violence, and other violent
acts. Its validity was evaluated by experts reviewing it and its reliability by test–retest (r = 0.9).
Finally, data were analyzed using descriptive statistical indicators and statistical tests such as
Chi‑square for sex, marital status, and work department and Mann–Whitney U test for age, level
of education, work experience, and violence types by the statistical software SPSS version 20.
Results: According to the results obtained, 81% of subjects had been abused at least once
and the most reported violence was related to verbal violence (78.4%). There was significant
correlation between sex and violence and men were the main victims of violence, but there was
no relation between marital status, age, and violence. Work experience was correlated to physical
violence and other violent acts conversely. There was also an inverse correlation between physical
violence and education; also, security staff faced more violence than others. Conclusion: As
high prevalence of violence was found especially among the security staff and personnel with
less education and work experience, it is suggested to take actions such as educating about
patient accompaniment and visiting condition, holding training workshops on confronting with
violence and appropriate communication with patients and families, using experienced and
patient staff to interact with clients.

Abstract Introduction: How to train nurses to provide spiritual care, as one of the basic competencies
of nursing, based on patient’s perception and culture has been considered highly important.
Although nurses’ training is recommended in this area, few researches have studied the format
of such programs. This study is conducted with the aim of introducing the training course of
spiritual care and determining its effectiveness on nursing students’ self‑efficacy in providing
spiritual care. Materials and Methods: The method of this study was of a pre‑post interventional
research. Senior students (n = 30) of the Shahrekord University of Medical Sciences, passing
the training course in the field, were chosen as the studied sample. Study intervention was the
implementation of the designed curriculum based on nursing books, focusing on providing the
spiritual care for patients. The dependent variable of the study was the students’ self‑efficacy
feeling in providing spiritual care to the patients. A researcher‑made questionnaire, as well as
the pre‑post interventional tests, was used, then, to assess this variable. By means of Statistical
Package for the Social Sciences software, data were analyzed, and the level of significance was
considered at P < 0.05. Findings: The findings of the study showed that self‑efficacy mean score
of nursing students in providing spiritual care in the pretest was 13.74, showing the average level of
perceived self‑efficacy. The students’ self‑efficacy mean, after participating in the training spiritual
care programs, however, changed to 21.1, indicating the increased level of self‑efficacy. Results
of paired t‑test, also, showed that self‑efficacy mean score of the study samples has significantly
increased in the posttest, compared with the pretest. Discussion and Conclusion: According
to these findings, it can be concluded that based on this designated curriculum, students have a
chance of getting acquaintance with some concepts as: Spirituality and spiritual care, identifying the
spiritual needs of patients, and designing a care plan to meet these requirements. These factors,
therefore, have a great impact on students’ effectiveness in providing spiritual care for patients.

Abstract Today, viral hepatitis has become a silent epidemic worldwide. It is the major cause of liver
cirrhosis and liver carcinoma. In a dental office, infections can be expedited through several
routes, including direct or indirect contact with blood, oral fluids, droplet splatter, aerosols,
etc. The aim of the present review is to increase the awareness among dental practitioners,
so as to reduce the burden of hepatitis in their community. Electronic databases like PubMed,
Medline, ProQuest, etc. were searched using the keywords hepatitis, dentist, liver disease,
and infection control. Manual search of various journals and books was also carried out. Only
highly relevant articles from English literature were considered for the present review. The
results revealed that the dentists were among the high-risk groups for hepatitis, and they have
little information on the factors associated with adherence to hepatitis B vaccination. A dentist
can play a major role in the prevention of hepatitis by considering each and every patient as a
potential carrier of hepatitis. Proper infection control, sterilization, and prophylactic vaccination
protocols should be followed in order to reduce the risk of hepatitis.

Abstract Advances in modern medicine are resulted from unrestricted and unlimited research
disregarding many essentials of a research including ethical issues. Following ethical issues,
many of unwanted pregnancies and abortions can be avoided. Several factors such as medical
issues including X linked disease, has encouraged couples to select traditional or modern
techniques in selecting the gender of their children. Some of these methods are corrected
Swim-up method or washing of spermatozoa, Percoll gradient sperm separation method, grass
wool column filter method method, albumin separation method, microsort method using FISH
(Fluorescence in situ hybridization), free electrophoresis method, Ph adjustment method, pre
implantation genetic diagnosis (PGD)/fluorescence in situ hybridization. This technology is
confronted with many ethical issues. Ethical considerations PGD in the SEX SELECTION differ in
different religions and their perspectives on this issue. In this this review, electronic databases,
books and Internet sites were completely searched and full articles including required keywords
and techniques were obtained and reviewed. The rites and religions, were different and had
legal perspectives and opinions about PGD. In some non-Islamic countries there are strict rules
to control the use of technology. Some of these methods are costly and even risky. They also
involve ethical issues such as legitimacy of the conceived fetus; recommending final touches
in sex selection is still considered a taboo and a big issue in some cultures or mono-sexual
families. Islamic views and beliefs are more flexible and the use of these technologies are
allowed to preserve the health and lives permit. Islam strongly favors humanity and supports
different issues if they are not in conflict with the primary concept of legitimate reproduction
and are beneficial to human beings.