Journal of Education and Health Promotion

Abstract

Abstract BACKGROUND: Mortality and disability rates were reported to be respectively 2‑3 and 5‑10 times
higher in C‑sections compared to Vaginal delivery.
OBJECTIVES: This study was aimed to explore the factors involved in selecting the birth type among
primiparous women.
METHODS: The present cross‑sectional research was conducted on 220 primiparous women,
who visited the health‑care centers of Bandar Abbas. They were recruited in their first trimester of
pregnancy with a simple randomized clustering method. Data were collected in a researcher‑designed
questionnaire. Its validity was confirmed by a panel of experts and reliability was tested and approved
through the test–retest method. Mean, standard deviation, independent sample t‑test, and Chi‑squared
tests for data analysis were done by SPSS 16. P < 0.05 was considered statistically significant.
RESULTS: The mean age of the participants was 27.40 ± 6.07 years. The main barriers to the choice
of vaginal delivery were the fear of pain and fear of vaginal area tears and ruptures, fear of injury to
fetus, and doctor’s recommendation. A statistically significant correlation was observed between the
age, education, employment, income, awareness, and the reasons for preferring surgical childbirth.
CONCLUSIONS: To reduce the rate of unnecessary cesarean sections (C‑section), the following
recommendations are suggested: Reducing fear of pain in expectant mothers, modifying wrong
beliefs about the culture of natural childbirth, increasing awareness of fewer adverse effects of
vaginal delivery including the vaginal tears if the mother abides by all midwife(s) instructions during
the delivery procedure, providing educational courses for the necessary movements during the
delivery, decreasing surgeons’ payment for C‑section, and increasing payment for natural childbirth
and implementing barriers for optional delivery to reduce the C‑section.

Abstract BACKGROUND: Prehypertension is one of the cardiovascular disease predicators. Management of
prehypertension is an appropriate objective for clinicians in a wide range of medical centers. Massage
therapy is primarily nonpharmacological treatment that is used to control blood pressure (BP). This
study intends to investigate the long‑term effect of massage therapy on BP in prehypertensive women.
METHODS: This was a single‑blind clinical trial study conducted on 50 prehypertensive women
who referred to Sedigheh Tahereh Cardiovascular Center, during 6 months in 2009. Participants
were selected by simple random sampling and were divided into control and intervention groups.
The test group (25 patients) received massage for 10–15 min, three times a week for 10 sessions,
and the control group (25 patients) was relaxed in the same environment but with no massage.
Their BP was measured before and after each session and 72 h and 2 weeks after finishing the
massage therapy. Analyzing the data was done using descriptive and inferential statistical methods
(Chi‑square, Mann–Whitney, paired t‑test, and Student’s t‑test) through SPSS software version 18
and a significant level was considered as P < 0.05.
RESULTS: The results indicated that the mean systolic BP (SBP) and diastolic BP (DBP) in the
massage group were significantly lower in comparison with the control group (P < 0.001). Evaluation
of durability of the massage effects on BP also indicated that 72 h after finishing the study, still there
was a significant difference between the test and control groups in SBP and DBP (P < 0.001), but after
2 weeks, there was not a significant difference in SBP and DBP (P > 0.05) between the two groups.
CONCLUSIONS: Although massage therapy seems to be a safe, effective, applicable, and cost‑effective
intervention to control BP of prehypertensive women, its effects do not persist for a long time.

Abstract Abstract:
CONTEXT: Congenital heart disease (CHD) is an important cause of death during the 1st year of life
and includes a special group of cardiac diseases that exist from birth. These conditions arise due to
the abnormal development of an embryo’s normal structures.
AIMS: A case–control study was conducted to investigate the determinant factors leading to CHD.
MATERIALS AND METHODS: All newborns who have been diagnosed with CHD upon
echocardiography in 2013 were considered as cases. The number of samples required was randomly
selected from the newborns who lacked CHD on cardiography. The mothers of both groups were
handed the questionnaires.
STATISTICAL ANALYSIS USED: SPSS 23 was employed to analyze the data.
RESULTS: A statistically significant association was seen between CHD and a positive family
history (FH) (P < 0.001), consanguinity (P < 0.001), maternal diabetes (P = 0.004), the use
of antiepileptics during the first 45 days of gestation (P = 0.002), and the mother’s education
status (P > 0.001). No significant association was observed between CHD in the newborn and the age
below 20 and above 35 years and (P = 0.11), maternal body mass index (BMI) (P = 0.44), smoking
during the first 45 days of gestation (P = 0.017), and maternal rheumatologic diseases (P = 0.4).
CONCLUSIONS: Newborns are at a greater risk of having CHD born from mothers with a FH of
CHD, from consanguineous marriages, history of diabetes, antiepileptic use, and lack of folic acid
use. However, no significant associations were found between newborn CHD and maternal age,
BMI, or cigarette smoking.

Abstract BACKGROUND: Achievement of productivity and improvement of quality in the educational system
is the effective, influential factors for countries development. Academic achievement is the main
objective of the training program and the most important concerns of teachers, education officials,
and university Student’s families. Self‑esteem is one of the factors affecting student academic
achievement. This study is aimed to investigate the relationship between self‑esteem and academic
achievement in Medical Sciences students of in 2014–2015.
SUBJECTS AND METHODS: This is a descriptive–correlational study. In this study, 537 university
students were selected using random stratified sampling method from Guilan University of Medical
Sciences in 2014–2015. Data were collected using the standard self‑esteem questionnaire of Cooper
Smith consisting of four elements (general, social, familial, and educational) and a demographic
questionnaire. Data were analyzed using SPSS software version 21 and descriptive statistics such
as Spearman correlation and Logistic Regression.
RESULTS: The results indicated a significant relationship between grade point average and
educational self‑esteem (P = 0.002, r = 0.135) and global self‑esteem (P = 0.02, r = 0.102). There
was also a significant relationship between composite Index educational status and general
self‑esteem (P = 0.019, r = 0.102) and academic achievement (P = 0.007, r = 0.116) and global
self‑esteem (P = 0.020, r = 0.102).
CONCLUSIONS: According to the results, the highest mean score of self‑esteem was related to
the familial element, and the lowest average was in terms of social self‑esteem, therefore, given the
importance and necessity of self‑esteem in academic achievement, strengthening of all aspects of
self‑esteem is suggested.

Abstract CONTEXT: Physical medicine and rehabilitation (PMR) is a specialized clinical field of musculoskeletal
diseases and physical impairment that is unknown for most of the medical students.
AIMS: This study aimed to assess medical students’ attitude and knowledge toward PMR and its
role in the diagnosis and treatment of musculoskeletal diseases.
SETTING AND DESIGN: This cross‑sectional study was done on 175 medical students of Isfahan
University of Medical Sciences from 2015 to 2016. Sample population was selected by random
sampling among 350 students.
MATERIALS AND METHODS: Participants were evaluated by a research‑made questionnaire
with confirmed validity and reliability. This questionnaire included 36 questions divided in four parts
including demographic data, knowledge, attitude, and performance ranking.
STATISTICAL ANALYSIS USED: Data were analyzed using SPSS 20. Statistical test for quantitative
and qualitative variables was carried out by mean ± standard deviation and percentage or number,
respectively. For analyzing variables, Student’s t‑test and Chi‑square test were used.
RESULTS: In this study, 150 medical students with a mean age of 24.48 ± 1.48 years participated
of which 40% of them were male. The mean score of Student’s knowledge about PMR and its role
in diagnosis and treatment of disorders was 5.16 ± 1.90, and 91.3% had low level of knowledge.
The mean score of student’s attitude toward PMR and its role in the diagnosis and treatment of
musculoskeletal problems was 3.33 ± 0.46, and 69.3% had attitude level above the average.
Evaluation of student’s performance showed that when they manage patients with musculoskeletal
problems as general physician, they refer the patients to physiatrists at the first step if it is necessary.
CONCLUSION: Understanding the factors influencing the attitudes and knowledge of medical students
is prime to help establishing the roles, providing proper facilities, carrying out successful planning to
train expert physicians and create a motivated environment in medical schools.

Abstract BACKGROUND: Worldwide, studies show negative attitude among medical students toward psychiatry
and mental illness. The knowledge of the attitude and awareness of the undergraduate medical students
toward psychiatry, mental health, and psychiatric disorders are most important as they are going to be
involved in the care of these patients either directly or indirectly during the later years of their careers.
AIM: This study aims to assess attitude toward psychiatry and mental illness among undergraduate
medical students.
METHODOLOGY: The responses of 67 medical students from the 6th semester (third professional
year) batch who completed their 2‑week clinical posting of psychiatry in 4th semester (i.e., second
professional year) were collected using validated questionnaires, attitude towards mental illness (AMI),
and attitude towards psychiatry (ATP) that assessed their attitudes to psychiatry and mental illness.
Double data entry and validation were done using EpiData and analysis using Epi Info software.
RESULTS: Median AMI score was 54 (out of maximum 100) showing a neutral AMI. Median ATP
score was 82 (out of maximum 150) also showing a neutral ATP. The theme‑wise analysis showed
that the attitude of students toward psychiatrist and psychiatry branch was relatively better compared
to their AMI.
CONCLUSION: Undergraduate students have a neutral attitude to psychiatry and mental illness.
More efforts are needed to change the attitude to favorable side.

Abstract BACKGROUND: Securing a healthy sexual relationship during middle‑agedness would cause new
needs and expectations in women, considering the special changes of this period. Therefore, the
present study was conducted to determine the sexual needs of middle‑aged women.
METHODS: The present study was a qualitative study with content analysis approach. Participants
were 15 middle‑aged women; their expectations and needs about sexual relationship were gathered
using in‑depth semi‑structured interviews. Data were analyzed using Graneheim and Lundman
inductive content analysis.
RESULTS: The main themes that were appeared in the present study included “the need
for information” with subcategories of “the need for information about physiologic changes”
and “information about psychological changes;” “the need for sympathy” with subcategories of “the
need for receiving appropriate feedback” and “appropriate space for expressing the emotions;”
“the need for changing social norms” with subcategories of “accepting middle‑agedness by the society”
and “the need for changing the concept of femininity;” and finally “the need for repairing the sexual
relationship” with subcategories of “solutions for solving sexual problems” and “paying attention to
the new aspects of sexual relationship.”
CONCLUSIONS: Results showed that middle‑aged women have various sexual needs and
expectations and paying attention to these needs and expectations could affect the improvement of
the sexual and mental health of middle‑aged women and their families.

Abstract BACKGROUND: Social support is one of the most effective factors on the diabetic self‑care. This
study aimed to assess social support and its relationship to self‑care in type 2 diabetic patients in
Qom, Iran.
STUDY DESIGN: A cross‑sectional study was conducted on 325 diabetics attending the Diabetes
Mellitus Association.
METHODS: Patients who meet inclusion and exclusion criteria were selected using random sampling
method. Data were collected by the Summary of Diabetes Self‑Care Activities and Multidimensional
Scale of Perceived Social Support, with hemoglobin A1
C test. Data were analyzed using descriptive
statistics and independent t‑test, analysis of variance, Pearson correlation, and linear regression
test, using 0.05 as the critical significance level, provided by SPSS software.
RESULTS: The mean and standard deviation of self‑care and social support scores were
4.31 ± 2.7 and 50.32 ± 11.09, respectively. The mean level of glycosylated hemoglobin (HbA1
C) of
patients was 7.54. There was a significant difference between mean score of self‑care behaviors
and social support according to gender and marital status (P < 0.05). The regression analysis
showed that disease duration was the only variable which had a significant effect on the level
of HbA1
C (P < 0.001). Pearson correlation coefficient indicated that self‑care and social support
significantly correlated (r = 0.489, P > 0.001) and also predictive power of social support was 0.28.
Self‑care was significantly better in diabetics with HbA1
C ≤7%. Patients who had higher HbA1
C felt
less, but not significant, social support.
CONCLUSIONS: This study indicated the relationship between social support and self‑care behaviors
in type 2 diabetic patients. Interventions that focus on improving the social support and self‑care of
diabetic control may be more effective in improving glycemic control.

Abstract OBJECTIVE: The objective of this study was to better understand veterinary medical students’
sleep hygiene and identify the extent to which sleep hygiene behaviors may result in consequences
(either positive or negative) for students.
SAMPLE: A total of 187 doctor of veterinary medicine (DVM) program students at a large College
of Veterinary Medicine in the United States.
METHODS: The Epworth Sleep Scale and Daytime Sleepiness Scale were administered to
393 students enrolled in the DVM program.
RESULTS: About 55.1% of students reported <7 h of sleep per night, 28.9% reported having trouble
sleeping, and 50.3% reported feeling sleepy all day. With respect to sleep quality, 5.3% described
it as excellent, 52.4% as good, 34.2% as fair, and 8.0% as poor.
CONCLUSIONS: A significant percentage of veterinary medical students exhibit poor sleep hygiene
habits that may be detrimental to both their health and academic endeavors.

Abstract INTRODUCTION: The current study aims to study people’s access to oral and dental health‑care
services and their satisfaction with the services provided to them.
MATERIALS AND METHODS: A descriptive study with multi‑stage sampling was conducted on
1360 people aged 16–64 years residing in Isfahan city, Iran. The required data were collected by a
questionnaire which comprised of three main parts: demographic characteristics, patients’ access
to oral and dental health‑care services and its barriers and participants’ satisfaction with access to
services. Data were analyzed by SPSS statistical software.
RESULTS: The results showed 40% of participants reported an average level for oral health, and
82% of them did not have any problems regarding access to dental care facilities. The main causes of
their dissatisfaction were high cost of services (60%) and insufficient health insurance coverage (40%).
About 73% reported that they had to spend 30 min or less to access to a dental health‑care facility.
In addition, 50% of participants were satisfied with the provided services. The main reported reasons
for referring to dentists were oral and dental problems (69%) and regular check‑ups (15%). There
was no significant relationship between participants’ gender, education level, insurance coverage,
and access to dental health‑care centers (P > 0.05).
CONCLUSION: Most participants were satisfied with access to dental healthcare, but they were
dissatisfied with the costs and inadequate insurance coverage. About half of the participants were
satisfied with the services provided to them, and the highest level of satisfaction was reported for
easy access to health‑care centers.

Abstract BACKGROUND AND OBJECTIVE: There is remarkable alteration in hypertension prevalence
and awareness, and their correlates among various geographic locations and ethnic groups. The
aim of this study was to report hypertension prevalence, awareness, and its correlates as well as
hypertension treatment, and control among Azari people aged 35 years and older.
MATERIALS AND METHODS: The pilot phase of the Azar Cohort Study; a state level of a nationwide
PERSIAN cohort study was conducted in Khameneh city between October 2014 and January 2015.
All people 35 years of age and above were invited to take part in this study. A comprehensive range of
different biomarkers, lifestyle, socioeconomic factors, and health‑related factors was collected. Blood
pressure was measured by a trained nurse/midwife. Descriptive statistical methods were used to present
general characteristics of the study population as frequency tables. Separate multiple logistic regression
models were built to assess the predictors of hypertension prevalence.
RESULTS: A total of 1038 people were included in this study. The overall prevalence of hypertension
was 22.9%. Awareness of hypertension was 60.5% and in those with known hypertension, 84% were
using the antihypertensive medications, of those 68.5% had controlled hypertension. After adjustment;
age (odds ratios [OR] adj = 1.12 95% confidence interval [CI]: 1.09–1.15), gender (ORadj = 1.65 95% CI:
1.08–2.51), obesity ORadj = 2.51 (1.40–4.88), waist‑to‑hip ratio (WHR) (ORadj = 1.70 (1.05–2.75), and
comorbidities (ORadj = 2.51 (1.72–3.66) were independent predictors of hypertension.
CONCLUSION: Age, sex, body mass index, WHR, and comorbidities were known as predictors
of hypertension in this study, health promotion strategies including lifestyle modification to reduce
overweight/obesity and secondary prevention programs for early detection of hypertension in high‑risk
groups according to age, gender, and disease profile are recommended.

Abstract CONTEXT: The ergonomic posture protocol is extremely important for the maintenance of
occupational health in dentistry. The lack of compliance with this protocol results in a high risk of
developing musculoskeletal disorders.
AIMS: This study developed a direct observation method for the evaluation of dental student
compliance with ergonomic posture protocol.
SUBJECTS AND METHODS: The method is named compliance assessment of dental ergonomic
posture requirements (CADEP). During the development of the method, 14 items were elaborated
considering the theory of dental ergonomics. Each item should be classified as appropriate, partially
appropriate, or inappropriate. After evaluation, all item values should be added, and the final score
expressed as the percent of compliance with correct postures, with a score range of 0%–100%.
STATISTICAL ANALYSIS USED: The reliability of CADEP was assessed through intra‑ and
interobserver reproducibility. For the CADEP application, 73 senior year students from the
undergraduate course in dentistry were evaluated. The intra‑ and interexaminer concordance
was estimated using the intraclass correlation coefficient (ρ). A descriptive statistical analysis was
performed.
RESULTS: The reproducibility of evaluator 1 (ρ =0.90; confidence interval [CI] 95%: 0.83–0.94),
evaluator 2 (ρ = 0.83; CI 95%: 0.70–0.90), the interexaminer in the first evaluation (ρ = 0.81; CI
95%:0.67–0.89), and in the second one (ρ = 0.76; CI 95%: 0.59–0.87) was classified as good. In the
analysis of the compliance, it was verified that moderate compliance was the most prevalent among
the evaluated students (65.6%, CI 95%: 60.3%–70.7%).
CONCLUSIONS: CADEP was valid and reliable for the assessment of dentistry students’ compliance
regarding ergonomic posture requirements.