Journal of Education and Health Promotion

Abstract Background: A student under optimal stress does bring out his or her best; however, extreme
stress can result in mental health problems and deteriorates their academic performance.
Students who esteem themselves low are most likely to engage in destructive and self‑destructive
behaviors. Moreover, excessive stress is harmful to academic performance and may lead to
dropping out in student. Can Yoga be of benefit in students for improving their attention and
self‑esteem (SE)? Objective: To assess attention and SE in girls undergoing Integrated Yoga
Module (IYM). Materials and Methods: Sixty low‑income high school girls with 15.17 + 0.64 years
of mean age participated in this single group pre‑post study. The data was collected before and
after 5 days of IYM. Statistical Analysis: Means, standard deviations, Kolmogorov‑Smirnov
test, and Wilcoxon signed rank test were used to analyze the data with the help of SPSS 16.
Results: The data analysis showed 9.04% increase (P = 0.001) in SE scores, whereas d2 test for
attention revealed 10.12% increase (P < 0.001) in total number of symbols processed scores and
44.73% decrease (P < 0.001) in total number of errors. Conclusion: The present study suggests
that of IYM can result in improvement of attention and SE among students and thereby enhancing
their mental health and can help them in improving their academic achievement. Efforts aimed
at reducing mental health problems among students may focus more on implementing effective
and culturally acceptable interventions, such as Yoga, counseling, and social support. Additional
well‑designed studies are needed before a strong recommendation can be made.

Abstract Background: The purpose of this paper is to propose a novel intelligent model for AIDS/HIV
data based on expert system and using it for developing an intelligent medical consulting
system for AIDS/HIV. Materials and Methods: In this descriptive research, 752 frequently asked
questions (FAQs) about AIDS/HIV are gathered from numerous websites about this disease. To
perform the data mining and extracting the intelligent model, the 6 stages of Crisp method has
been completed for FAQs. The 6 stages include: Business understanding, data understanding,
data preparation, modelling, evaluation and deployment. C5.0 Tree classification algorithm is
used for modelling. Also, rational unified process (RUP) is used to develop the web‑based
medical consulting software. Stages of RUP are as follows: Inception, elaboration, construction
and transition. The intelligent developed model has been used in the infrastructure of the
software and based on client’s inquiry and keywords related FAQs are displayed to the client,
according to the rank. FAQs’ ranks are gradually determined considering clients reading it.
Based on displayed FAQs, test and entertainment links are also displayed. Result: The accuracy
of the AIDS/HIV intelligent web‑based medical consulting system is estimated to be 78.76%.
Conclusion: AIDS/HIV medical consulting systems have been developed using intelligent
infrastructure. Being equipped with an intelligent model, providing consulting services on
systematic textual data and providing side services based on client’s activities causes the
implemented system to be unique. The research has been approved by Iranian Ministry of
Health and Medical Education for being practical.

Abstract Introduction: Assessment for practical skills in medical education needs improvement from
subjective methods to objective ones. An Objective Structured Practical Examination (OSPE)
has been considered as one such method. This study is an attempt to evaluate the feasibility
of using OSPE as a tool for the formative assessment of undergraduate medical education
in pharmacology. Materials and Methods: Students of second year MBBS, at the end of the
first term, were assessed by both the conventional practical examination and the Objective
Structured Practical Examination (OSPE). A five‑station OSPE was conducted one week after
the conventional examination. The scores obtained in both were compared and a Bland Altman
plot was also used for comparison of the two methods. Perceptions of students regarding the
new method were obtained using a questionnaire. Results: There was no significant difference
in the mean scores between the two methods (P = 0.44) using the unpaired t test. The Bland
Altman plot comparing the CPE (conventional practical examination) with the OSPE showed that
96% of the differences in the scores between OSPE and CPE were within the acceptable limit
of 1.96 SD. Regarding the students’ perceptions of OSPE compared to CPE, 73% responded
that OSPE could partially or completely replace CPE. OSPE was judged as an objective and
unbiased test as compared to CPE, by 66.4% of the students. Conclusion: Use of OSPE is
feasible for formative assessment in the undergraduate pharmacology curriculum.

Abstract Backgrounds: Marriages and establishing a family is one of the most important events in the
life of each person. It has significant effects on personal and social health, if it occurs with
sufficient knowledge in the proper conditions. The aim of this study is to determine the effect
of pre‑marriage instruction on the knowledge and health attitudes of the couples attending the
pre‑marriage counseling classes. Materials and Methods: This pre and post quasi‑experimental
study was conducted on 250 couples attending the pre‑marriage counseling classes. The
required information was collected using an autonomous questionnaire designed based on
the research objectives. The questionnaire included three parts: Demographic information,
knowledge (27 questions) and attitude (18 questions. The questionnaire was filled out before
and after the pre‑marriage counseling program, which was presented as lectures. The effect
of the instructional program was analyzed using a statistical test. Results: The results showed
that 83.2% of the couples had poor knowledge, 16% average, and 0.8% had good knowledge
before the intervention. After the intervention, 60.4% of couples had poor knowledge, 31.6%
average and 8% had good knowledge. The results also revealed that that the difference in
mean scores of knowledge and attitudes regarding reproductive health, family planning, genetic
diseases and disabilities was statistically significant (P < 0.001). Conclusions: Despite the
mean scores of knowledge and attitude of the couples had increased after the instructional
intervention, the increase in knowledge level was not very high. So the knowledge score of
the couples increased just 4.3%, and only 8% of the couples had good knowledge after the
instructional intervention. Therefore, to achieve a relatively stable behavior change in individuals
and improving the health level of the young couples, it is recommended that more attention
pay to the quality of the instructional classes.

Abstract Introduction: Medical tourism for any study area is complex. Materials and Methods: Using
full articles from other databases, Institute for Scientific Information (ISI), Science Direct,
Emerald, Oxford, Magiran, and Scientific Information Database (SID), to examine systematically
published articles about medical tourism in the interval 2000-2011 paid. Articles were obtained
using descriptive statistics and content analysis categories were analyzed. Results: Among the
28 articles reviewed, 11 cases were a kind of research articles, three cases were case studies
in Mexico, India, Hungary, Germany, and Iran, and 14 were case studies, review documents
and data were passed. The main topics of study included the definition of medical tourism,
medical tourists’ motivation and development of medical tourism, ethical issues in medical
tourism, and impact on health and medical tourism marketing. Conclusion: The findings
indicate the definition of medical tourism in various articles, and medical tourists are motivated.
However, most studies indicate the benefits of medical tourism in developing countries and
more developed countries reflect the consequences of medical tourism.

Abstract Background: Nowadays, cesarean section rate is increasing in Iran and throughout the
world. Cesarean section is one of the major surgical procedures, which carry serious and
rarely fetal risk for mother and child. This study was conducted to determine the effects of
health education on husbands of pregnant women in reducing elective cesarean section.
Materials and Methods: This study was a trial study, in which 88 pregnant women between
28‑32 weeks of pregnancy, who referred to the private clinics in Isfahan, were randomly
assigned into case and control groups. The husbands of the women within case group were
educated about cesarean and vaginal delivery. At the beginning of study and 4 weeks after
an educational intervention, the knowledge and attitude of 3 groups (cases, controls, and
husbands of case group) were determined. The type of delivery was determined by phone call.
Findings: Educational intervention on husbands caused a significant increase in the knowledge
and a positive attitude in mothers within case group towards vaginal delivery. Elective cesarean
section in case group was significantly lower than that of the control group (29.5% vs. 50%,
P < 0.05). Conclusion: The results of the present study showed that husbands’ education can
effectively increase the knowledge and improve the attitude of their wives, and reduce the rate
of elective cesarean section.

Abstract Background: The achieve uses 7 variables: ability; clarity; help; incentive; evaluation; validity;
and environment, to provide leaders and staffs with the necessary tools to improve performance,
and help managers to determine cause of performance problem. And create change strategy
for solving those problems. We try to determine factors affecting the performance of nurses,
base on this model in selected hospital of Isfahan (Iran). Materials and Methods: This was a
descriptive‑correlation survey. The population of study was 85 nurses of 9 hospitals in Esfahan.
Data gathering was done via achieve questionnaire. Reliability was calculated by Cronbach’s
alpha (r  = 0.85). Data analysis was done by using SPSS 16. Result: The ability and help
variables were the most important factors in improving performance of nurses and validity and
evaluation were less important. Conclution: Today, staff effectiveness is one of the important
problems in health care organization. In fact, performance improvement is the most important
step for organization improvement.

Abstract Background: In the hot weather, overweight and obesity are considered as significant risk
factors for the incidence of cardiac strain in workers. This study is aimed at comparing the
cardiac strain among overweight and normal‑weighted workers, in the hot, humid conditions
of the south of Iran. Materials and Methods: This cross‑sectional study was conducted
on 71 workers in the south of Iran, in the summer of 2010.The heart rate was measured at
rest and at actual work. Cardiac strain based on the working heart rate (WHR), the relative
cardiac cost (RCC), the net cardiac cost (NCC), the load relative cardiovascular (CVL), and
heart rate reduction were analyzed in 35 normal weight people (BMI <25) and 36 people who
were overweight (BMI >25), using descriptive statistics and t‑ tests. Results: In 42% of the
total workers, the body mass index was more than 25. The average temperature of the two
groups was not significantly different. The mean WHR in these two groups was 101 ± 20.3
and 112 ± 18.9, respectively (P = 0.026). Percentages that exceeded the acceptable limits
in parameters of NCC, RCC, WHR, CVL, and the Brouha index, were significantly higher in
overweight people than those in people with normal weight. Conclusions: Based on the study
results, the severity of cardiac strain was higher in overweight workers when compared with
normal weight workers. Hence, in order to decrease the cardiac strain, selecting overweight
individuals for these jobs should be avoided, as also some vital intervention for losing weight,
such as, nutrition education and encouraging them to increase their physical activity, should
be implemented.