Journal of Education and Health Promotion

Abstract College students are vulnerable to a critical period in developmental maturation, facing rigorous
academic work, and learning how to function independently. Physical activities such as running and
bicycling have been shown to improve mood and relieve stress. However, college students often have
low levels of physical activity. Yoga is an ancient physical and mental activity that affects mood and
stress. However, studies examining the psychophysiological effects of yoga are rare in peer‑reviewed
journals. The aim of this study is to establish preliminary evidence for the psychophysiological effects
of yoga on stress in young‑adult college students. The present study suggests that yoga has positive
effects on a psychophysiological level that leads to decreased levels of stress in college student.
Further research is needed to examine the extent to which different types of yogic practices address
the needs of different college subpopulations (e.g., overweight, sedentary, and smokers).

Abstract BACKGROUND: Early skin‑to‑skin maternal–neonate contact during the 1st h following birth prepares
both mother and baby to establish a two‑way, interactive pattern of interaction. There are few studies
on the use of kangaroo care method in term infants and maternal postpartum behavior.
OBJECTIVE: The present study aimed to compare abdominal and kangaroo skin contact on maternal
attachment behaviors.
SETTINGS AND DESIGN: This single‑blind randomized clinical trial was performed on 68 eligible
pregnant women in Torbat Heydariyeh in 2015.
MATERIALS AND METHODS: Individuals were randomly divided into experimental groups
(kangaroo skin contact) and control group (abdominal skin contact). Maternal attachment behaviors
were observed for 15 min during 1 h postpartum. Each minute was divided into two 30 s, during
the first and second 30 s of which the maternal behavior was observed and recorded using a
checklist of behavior. Attachment behaviors were assessed using an attachment behavior checklist
(including three types of emotional, proximity‑seeking, and caring behaviors).
STATISTICAL ANALYSIS USED: After data coding, the analysis was performed using Kruskal–Wallis
test, Chi‑square test, t‑test, and Mann–Whitney test in SPSS ver. 14. P < 0.05 was considered the
significant level.
RESULTS: Among emotional, proximity‑seeking, and caring behaviors 1 h and 2 months’
postpartum in the two groups, only proximity‑seeking behaviors were significantly different 2 months’
postpartum (P = 0.033). The attachment behavior of 1 h (0.134) and 2 months’ postpartum (0.051)
did not differ significantly between the two groups.
CONCLUSIONS: Kangaroo skin contact has an effect, similar to the abdominal skin contact, on the
maternal attachment behaviors and has a positive effect on proximity‑seeking behaviors and some
components of emotional behaviors compared to abdominal skin contact.

Abstract BACKGROUND: If anxiety and depression do not detect in pregnant women, they may cause
complications for the mother, child, and family, including postpartum depression. With regard to the
administrative capability of relaxation in health centers, this study was conducted to determine the
effect of progressive muscle relaxation and guided imagery on stress, anxiety, and depression in
pregnant women.
MATERIALS AND METHODS: This randomized clinical trial was conducted on pregnant women in
the city of Kashan at 28–36 weeks. At the onset of the study, demographic questionnaire, Edinburgh
Depression Scale, and Depression, Anxiety, and Stress Scale‑21 (DASS‑21) were completed.
Providing obtaining score of mild‑to‑moderate in the stress, anxiety, and depression scale and score
of 10 or higher in Edinburgh Depression Scale, individuals were divided randomized to the intervention
group (n = 33) and control group (n = 33). DASS‑21 was again completed in the 4th–7th weeks of
beginning of the study by all women.
RESULTS: Analysis of variance with repeated measures indicated significant differences in mean
of scores of stress, anxiety, and depression at three different times in relaxation group (P < 0.05)
whereas found no significant differences in the mean of scores of stress, anxiety, and depression
in the control group.
CONCLUSIONS: In this study, relaxation could reduce stress, anxiety, and depression in pregnant
women during six sessions. Due to the simplicity and low cost of this technique, it can be used to
reduce stress and anxiety in pregnant women and improve pregnancy outcomes.

Abstract BACKGROUND: Dynamic and static activities in dentistry cause musculoskeletal disorders, but
dental students do not have sufficient awareness about the effects of ergonomic factors on their
health. The aim of this study was to investigate ergonomic factors that cause pain muscle in dental
students in Kerman Medical University, Iran.
METHODS: This cross‑sectional analysis study was carried out on dental students of the 3rd, 4th, 5th,
and 6th year, in clinical practice in the School of Dentistry, Kerman University of Medical Sciences.
A convenient sample of 199 students who met the inclusion criteria was selected and those willing
to participate signed an informed consent form. Data were collected by means of a structured
questionnaire for ergonomic factors and the presence of pain. The variables evaluated were pain,
affected zones, gender, postures, and work environment.
RESULTS: The present research work reveals that over 69% of the dental students complained
of pain in at least one part of their body. Most individuals suffered from hand and elbow (23%) and
head (19%) pain. The clinical areas where more pain was found were endodontics and pedodontics.
Furthermore, it was found that a high percentage of students usually worked with their legs slightly
separated, with the sole of the feet resting on the stool when working. The presence of muscular
pain was higher in males in this study. Furthermore, there was a statistically significant relationship
with the final Rapid Entire Body Assessment score in different body parts and the participants’
demographic data (sex, age, weight, height, sports, and smoking).
CONCLUSIONS: The results of this study showed that the students’ sitting positions and working
environments need to be improved and it seems more training is necessary in this field.

Abstract BACKGROUND: Given new reforms in Iran’s health‑care system and due to the need for gathering
evidence regarding the implementation of this plan, this study aimed to investigate opportunities and
challenges created by resident specialist attendance plan guidelines in university hospitals.
MATERIALS AND METHODS: This study used the qualitative method. Semi‑structured interviews
were used for data gathering. The study population included all experts of Isfahan University of
Medical Science. Sampling was carried out using purposeful sampling method and continued until
data saturation was reached. In total, 16 experts were interviewed. Criteria such as “reliability of
information,” “trustworthiness,” and “verifiability of the information” were considered. Interviewees
were assured that their names would keep hidden and that all information is confidential. Subject
analysis method was used for data analysis.
RESULTS: The findings of this study based on subject analysis led to extracting three themes in
regards of challenges in the implementation of resident (specialist or fellowship) plan in hospitals
including structural, management, and resource challenges and one theme in the area of opportunities
which were improved quality and timely provision of services.
CONCLUSION: The findings showed that despite the strengths of this guideline, there are some
fundamental challenges in various areas and need better attention by national level policymakers.
These results help health‑care policymakers to evaluate the problem with a better attitude and
improve the necessary plans for implementation of these guidelines.

Abstract INTRODUCTION: In recent decades, the focuses of health studies were mostly in middle‑aged
women, and few studies have investigated the lifestyle of women after delivery. The aim of this
study was to determine the effects of both self‑efficacy and perceived barriers on Iranian women
health‑promoting lifestyle (HPL) in the first 1 year after childbirth.
MATERIALS AND METHODS: Using a cross‑sectional design, 310 women at first‑year postpartum
were surveyed in Zanjan (Iran) in 2016. The proportionate stratified random sampling method was
carried out to select a participant. HPL has assessed with HPL profile II questionnaire. Self‑efficacy
was assessed using self‑rated abilities for health practices scale. Perceived barriers were assessed
by Barriers to Health‑promoting Activities for Disabled Person scale. A meditational model was used
to examine whether perceived barriers mediates between perceived self‑efficacy and HPL.
RESULTS: The participants mean age was 29.82 (5.1) years, 53.9% were primiparous, and most
of them were homemakers (82.9%). The mean total score of HPL was 2.50 (0.29). The relationship
between HPL and self‑efficacy was mediated by perceived barriers partially.
DISCUSSION: Self‑efficacy, not only promotes women’s HPL but also indirectly affect the women’s
lifestyle by reducing perceived barriers.

Abstract INTRODUCTION: Undiagnosed and uncorrected refractive errors in childhood can negatively affect
the development of vision and cause students to have low academic success and even quit school
before graduation. This study aims to determine the effects of an eye health promotion program on
the health protective behaviors of primary school students.
MATERIALS AND METHODS: This experimental study using a pretest‑posttest design with a control
group was conducted in three public primary schools in Aydın, a city in the Western Anatolia Region
of Turkey, between April and November 2014. The eye health promotion program was provided by the
researchers to the experimental Group 2 days in 4 weeks. The data were analyzed using the t‑test,
Chi‑square analysis, the Mann–Whitney U‑test, the Wilcoxon signed‑rank test, and the McNemar test.
RESULTS: The average age of the students was identified as 9.0 ± 3.64 years. The students
wearing glasses all in the experimental group and 53.3% in the control group were found to always
wear their glasses after the education program was completed (P < 0.05). These students, 97.9%
in the experimental group and 58.1% in the control group underwent eye examinations from an
ophthalmologist (P < 0.05). The eye health protective behaviors of the experimental group were
found to have positively changed in the final follow‑up, compared to the control group (P < 0.05).
CONCLUSION: The eye health promotion program was found to be effective in improving eye health
protective behaviors within the experimental group.

Abstract INTRODUCTION: Hot flashes are considered to be a common experience for menopausal women
and they can compromise the quality of life. The objective of this study is to assess the efficacy of
Cimicifuga racemosa in comparison with evening primrose oil (EPO) in postmenopausal women
with menopause‑related symptoms.
MATERIALS AND METHODS: This study was performed on 80 postmenopausal women with hot
flashes. The participants were randomly divided into two groups by blocked randomization. The
participants of one group received black cohosh and the other group received EPO for 8 weeks.
The severity and number of hot flashes and quality of life were measured by four‑point scale, and the
Menopause‑Specific Quality of Life (MENQOL) questionnaire at pre‑intervention, 1st, 4th, and 8th weeks
after treatment. Data were analyzed in SPSS Version 16 using independent t‑test, Chi‑square, and
Fisher’s exact test.
RESULTS: Average severity of hot flashes in both groups and number of hot flashes in black cohosh
group in 8th week were significantly lower than 1st week (P < 0.001), but number of hot flashes in
primrose oil group in 8th week showed no significant differences (P = 0.32). The number of hot flashes
and quality of life score in black cohosh arm compared to EPO showed a significant decrease in
the 8th week (P < 0.05). All MENQOL scores were significantly improved in two groups (P < 0.05),
but the percentage of improvement in black cohosh arm was significantly superior to EPO group.
CONCLUSION: Both herbs were effective in reduction of severity of hot flashes and improvement of
the quality of life, but it seems that black cohosh is more effective than primrose oil because it was
able to reduce the number of hot flashes too.

Abstract INTRODUCTION: Teaching and learning process is increasingly metamorphosing from the traditional
chalk and talk to the modern dynamism in the information and communication technology. Medical
education is no exception to this dynamism more especially in the teaching of gross anatomy, which
serves as one of the bases of understanding the human structure.
OBJECTIVE: This study was conducted to determine the gender preference of preclinical medical
students on the use of traditional (chalk and talk) and PowerPoint presentation in the teaching of
gross anatomy.
SUBJECTS AND METHODS: This was cross‑sectional and prospective study, which was conducted
among preclinical medical students in the University of Maiduguri, Nigeria. Using simple random
techniques, a questionnaire was circulated among 280 medical students, where 247 students filled
the questionnaire appropriately. The data obtained was analyzed using SPSS version 20 (IBM
Corporation, Armonk, NY, USA) to find the method preferred by the students among other things.
RESULTS: Majority of the preclinical medical students in the University of Maiduguri preferred
PowerPoint method in the teaching of gross anatomy over the conventional methods. The Cronbach
alpha value of 0.76 was obtained which is an acceptable level of internal consistency. A statistically
significant association was found between gender and preferred method of lecture delivery on the
clarity of lecture content where females prefer the conventional method of lecture delivery whereas
males prefer the PowerPoint method, On the reproducibility of text and diagram, females prefer
PowerPoint method of teaching gross anatomy while males prefer the conventional method of
teaching gross anatomy.
CONCLUSION: There are gender preferences with regard to clarity of lecture contents and
reproducibility of text and diagram. It was also revealed from this study that majority of the preclinical
medical students in the University of Maiduguri prefer PowerPoint presentation over the traditional
chalk and talk method in most of the questions ask.

Abstract INTRODUCTION: Primary dysmenorrhea, painful menstruation without pelvic pathologic
complications, is one of the most common problems in women’s gynecology and is one of the main
causes for women referring to the clinic. Overweight and obesity may play a role in the etiology of
primary dysmenorrhea. As a result, this study was conducted to determine the association between
primary dysmenorrhea and anthropometric indices in female high school Students.
METHODS: This descriptive, cross‑sectional study was conducted on 200 high school female students
with primary dysmenorrhea in 2017 in Sabzevar. Anthropometric indicators were considered by the
students if they had entry criteria. Data analysis was done using SPSS software.
RESULTS: The results of data analysis showed that there was a significant difference between
the presence of dysmenorrhea and anthropometric indices at height P = 0.05, waist circumference
P = 0.03, waist circumference with height P = 0.01, height to waist circumference P = 0.01, thigh
circumference to height P = 0.04, height to thigh circumference P = 0.04, waist circumference to
hip circumference P = 0.04, hip circumference to hip circumference P = 0.05, and No significant
relationship was found between the other indicators.
CONCLUSION: Adherence to a balanced diet and proper lifestyle can prevent dysmenorrhea in
adolescent girls.

Abstract BACKGROUND: Child abuse and violence toward children has become a complex phenomenon in
nowadays societies leaving hurt children with numerous complications such as lowered self‑efficacy.
Hence, this study was conducted to assess the effect of trauma‑focused cognitive behavioral
therapy (TF‑CBT) in physically abused children self‑efficacy.
MATERIALS AND METHODS: This study was a randomized clinical trial. From this statistical
population of all abused children aged 9–12 in Kermanshah in 2016–2017, 40 were divided into
intervention and control groups randomly. Tools used in this study were Maurice self‑efficacy
questionnaire and child abuse questionnaire. Data analysis was done using Chi‑square test, paired
t‑test, and independent t‑test.
RESULTS: It was revealed that the mean difference between two groups was not meaningful before
intervention. After TF‑CBT in intervention group, self‑efficacy mean scores of social (17.95 vs. 24.20)
and emotional (15.05 vs. 19.05) domains showed meaningful differences, whereas academic
self‑efficacy mean score did not change significantly (14.10 vs. 14.65) (P < 0.086). In control
group, social (16.20 vs. 15.55), emotional (13.90 vs. 14.35), and academic (13.40 vs. 13.90) mean
self‑efficacy scores were not of significant difference (P > 0.001).
CONCLUSIONS: TF‑CBT can be used as an appropriate therapy intervention to improve social and
emotional self‑efficacy in abused children.

Abstract BACKGROUND AND AIM: Twitter® use among paramedics and other prehospital care clinicians is
on the rise and is increasingly being used as a platform for continuing education and international
collaboration. In 2014, the hashtag #FOAMems was registered. It is used for the sharing of emergency
medical services, paramedicine, and prehospital care‑related content. It is a component of the ‘free
open‑access meducation’ (FOAM) movement. The aim of this study was to characterize and evaluate
the content of #FOAMems tweets since registration.
MATERIALS AND METHODS: An analytical report for #FOAMems was generated on symplur.com
from February 4, 2014, to April 30, 2017. A transcript of all #FOAMems tweets for a randomly selected
1 month period (October 2015) was generated, and quantitative content analysis was performed by
two reviewers. Tweets were categorized according to source (original tweet/retweet) and whether
referenced. The top 92 tweeters were analyzed for professional identity.
RESULTS: During the study period, there were over 99,000 tweets containing #FOAMems, by
over 9,200 participants. These resulted in almost 144 million impressions. Of the top 92 tweeters,
50 were paramedics (54%). Tweets were mainly related to cardiac (23%), leadership (19%), and
trauma (14%). The 1‑month period resulted in 649 original tweets, with 2110 retweets; 1070 of these
were referenced.
CONCLUSION: Paramedics are engaging with both clinical and nonclinical content on Twitter® using
#FOAMems. Social media resources are widely shared, which is in line with the FOAM movement’s
philosophy. However, opportunities exist for paramedics to share further diverse resources supported
by referenced material.