Journal of Education and Health Promotion

Abstract CONTEXT: Wearing helmet during road traffic accidents among motorcycle riders decreases the
likelihood of death by 39%. The theory of planned behavior (TPB), a psychological model helps to
explain the failure in helmet usage, by assuming a causal chain. The current study was taken up
as no studies have elicited the determinants of helmet usage in terms of TPB among health‑care
providers, the role models for healthful behavior by virtue of their profession in the current urban
Indian context.
AIMS: The aims of the study were (1) to determine the proportion of proper use of helmets
and (2) to identify TPB‑related factors and other factors influencing the use of helmets.
MATERIALS AND METHODS: A cross‑sectional study was conducted among 147 students and
staff of a tertiary health‑care center, Bengaluru, using a pretested, validated, semi‑structured,
self‑administered questionnaire. Convenience sampling was used. Hierarchical regression model
was used to explain variation in the scores of helmet‑use behavior on the basis of TPB variables.
P < 0.05 was considered as statistically significant.
RESULTS: About 65% of respondents practiced “proper use” of helmets. Intention, perceived
behavioral control (direct), and attitude (indirect) were significant predictors of helmet use (P < 0.05).
Mean scores of knowledge on helmet use and behavior showed positive correlation (P > 0.05).
CONCLUSIONS: Application of TPB in urban Indian context was successful in identifying precursors
of helmet use. This study throws a light on the strong influencers of helmet use which can assist policy
developers in developing effective programs to successfully promote the “proper use” of helmets.

Abstract BACKGROUND: Trivandrum is a place with better educational status for women. The aim of this
study is to describe young women’s attitude toward gender‑equitable norms.
METHODS: A cross‑sectional survey was conducted in Trivandrum, using multistage cluster
sampling method. Participants were 18–28‑year‑old married (n = 203) and unmarried (n = 104)
women. The scales of domestic chores and daily life domain items and violence domain items from
the compendium of gender scales were used to assess the attitude toward gender‑equitable norms.
Pearson Chi‑square test was used to check the significance of the associations.
RESULTS: The high support to gender‑equitable norms on domestic chores and daily life domain
was 29% and 18% and violence domain was 25% and 14% among unmarried and married
women, respectively. Education was interrupted among 55% of married women due to marriage,
pregnancy, childcare, and lack of resources. The ability to take final decision to work outside the
home (32% vs. 45%) and in obtaining health care (65% vs. 73%) was low among married women
compared to unmarried women. Higher education did not affect the attitude of young women toward
gender‑equitable norms on “violence domain,” but the highly educated married women showed a
slightly better support for “domestic chores and daily life domain” and had a major say in taking
decisions on health‑care seeking and work outside home.
CONCLUSIONS: In general, the support for gender‑equitable norms and the freedom in
decision‑making are not satisfactory among young women. Education alone cannot make rapid
changes in the attitude of young women toward gender‑equitable norms since it is strongly connected
with social norms and practices.

Abstract The purpose of this scoping review was to survey the most recent (10 years) estimating of needed
human resource in health‑care organization by Workload Indicators of Staffing Need (WISN)
method literature to understand themes and research avenues that may be helpful and beneficial
to estimating of needed staff in health‑care organizations. Our search strategy was based on
using search engines such as Medline, Google Scholar, Scopus, and PubMed as well publications
such as Elsevier, Emerald, ProQuest, and Springer. Finally, 31 articles extract for scoping review.
Scoping review findings emerge in four key points that mentioned as follow: Service delivery time,
Geographical features, Workload, and Supply and Demand. Furthermore, the strengths and weakness
of WISN extracted from literature. As conclusion, the WISN method is applicable to any health‑care
organization, and of course, in smaller institutions, it can be done more quickly and efficiently.
Where shortages of staff were identified using WISN, and if increasing the number of employees
was impossible, we could use the task shifting. WISN can be used to calculate the required human
resources for future models based on some assumptions such as the results of staff training,
demographic changes, and disease profiles and staff turnover.

Abstract INTRODUCTION: Iodine is an essential element for thyroid function; it is necessary in minute amounts
for normal growth, development, and well‑being of all humans. There is gap in the utilization of
adequately iodized salt in the rural areas due to nonavailability, poverty, poor knowledge of iodine
deficiency diseases, and faulty storage practices.
OBJECTIVE: The objective was to find out knowledge, attitude, and practices (KAP) regarding iodized
salt consumption and association of sociodemographic factors, if any, among rural women of Tripura.
MATERIALS AND METHODS: This community‑based study was conducted among 270 rural women
residing at Madhupur village, Tripura. A self‑made pretested schedule (Cronbach’s alpha = 0.7) was
used as the study tool to collect information on KAP regarding iodized salt consumption.
RESULTS: Majority of the participants belonged to 31–40 years (30.4%), with a mean age of
38.6 (±13.8) years; all were predominantly Hindus (90.4%). Knowledge and attitude regarding
iodized salt consumption were significantly associated with age groups ≤36 years, literacy, and
general caste (P < 0.05), but practice was not significant (P > 0.05). Good knowledge and attitude
regarding use of iodized packed salt were less than half (46.7% and 41.1%, respectively), but higher
level (83.3%) of correct practice was found (P > 0.05).
CONCLUSION: The existing knowledge and attitude of participants toward iodized salt usage were
less, but majority were consuming iodized salt without knowing its benefits. Hence, there is a need to
educate rural people through nutrition education or knowledge, with active participation of grassroot
level workers in generating awareness about the health benefits of consuming adequately iodized salt.

Abstract INTRODUCTION: Breast cancer is the most common cancer in women. It can be diagnosed in
the first stage by screening. One of the methods for screening breast cancer is mammography.
Mammography as a health behavior needs education. The theory of planned behavior examines
the factors associated with the behavior.
AIM: This research was conducted to compare the individual and peer education on the constructs
of the theory of planned behavior in mammography.
METHODS: This study was a clinical trial. A total of 100 women who attending the selected health
centers of Isfahan city were classified randomly into two groups: peer and individual education.
Education was based on the constructs of the theory of planned behavior (attitude relative to the
mammography behavior, subjective norms, perceived behavioral control, and behavioral intention).
The data were collected using a researcher‑made questionnaire. Data were analyzed using
descriptive‑analytical statistics.
RESULTS: The mean score of attitude toward behavior in the individual education group was
significantly higher than peer education (P < 0.05). In addition, the average score of subjective norms
in peer education group was significantly higher than individual education (P < 0.05). The mean
scores of perceived behavioral control constructs and behavioral intention were not significantly
different (P > 0.05).
DISCUSSION: The results of this study showed the effectiveness of education (individual and peer)
based on the theory of planned behavior on attitude toward behavior, subjective norms, perceived
behavioral control, and behavioral intention related to performing mammography in women. It seems
that using educational intervention can be useful to promote the screening behaviors of breast cancer.
In general, there were no significant differences between the two methods in changing theoretical
constructs.

Abstract INTRODUCTION: Cardiovascular disease is one of the most important causes of mortality in the
world; identifying and correcting the modifiable risk factors reduce the prevalence of coronary artery
disorders. Nurses, with regard to their employment conditions, can be prone to cardiovascular
disease. The aim of this study was to compare the risk factors of cardiovascular diseases in male
and female nurses.
MATERIALS AND METHODS: In this descriptive cross‑sectional study, 263 nurses from Jahrom
University of Medical Sciences hospitals were enrolled in the study by convenience sampling. The
data collection tool was self‑report Framingham Risk Score and has two parts: first part: personal data,
history of disease, history, cigarette, stress and fat disorder, alcohol consumption, diet, exercise, and
average hours and second part: height, weight, body mass index (BMI), waist‑to‑stature ratio (WSR),
waist‑to‑hip ratio (WHR), blood pressure, triglyceride (TG), cholesterol, and fasting blood sugar. The
benchmark for blood pressure was the JNC‑7 guide. The Adult Treatment Panel III was the guideline.
Independent t‑test, Chi‑square, and Mann–Whitney tests were used for data analysis.
RESULTS: None of the staff reported smoking or alcohol history. Data were analyzed using descriptive
and inferential statistics. There was no statistically significant difference between the mean of fasting
blood glucose, systolic and diastolic blood pressure, TG and cholesterol, Framingham percentage,
religious practices, green tea and black tea, fish, vegetables, and fast food. The data were analyzed
with independent t‑test, Chi‑square, and Mann–Whitney tests. There was no statistically significant
difference between the mean of fasting blood glucose, systolic and diastolic blood pressure, TG and
cholesterol, Framingham Percentage, religious practices, green tea and black tea, fish, vegetables,
and fast food and sports and walking of men and women were not observed. However, there was
a statistically significant difference between women and men in indicators such as eating breakfast,
family history, fruit consumption, high‑density lipoprotein, BMI, WSR, and WHR.
CONCLUSION: The results of the study showed that men are at higher risk for cardiovascular
diseases and complications than women.

Abstract PURPOSE: Communication skills are essential for medical practice throughout the life of a doctor.
Traditional undergraduate medical teaching in pediatrics focuses on teaching students with theoretical
and practical knowledge of diseases, their diagnosis, and treatment modalities. This study was
done to use role play as a tool to teach basic communication skills to the final‑year undergraduate
students in pediatrics and to assess perceptions of students and faculty for using role play to teach
counseling and communication skills in pediatrics.
METHODS: It was an observational, questionnaire‑based study conducted in the Department of
Pediatrics on the final‑year medical undergraduates. Two modules for role play on common pediatric
topics were designed and role play was conducted. At the end of the session, student and faculty
feedback were taken by a prevalidated questionnaire with both close (using the 5‑point Likert scale)
and open‑ended questions. In pre‑ and post‑role play sessions, communication skills assessment
scoring was done. Statistical evaluation of the collected data was then carried out using SPSS 22.
RESULTS: A total of 98 final‑year students participated in this study. Role play was found to be
the most preferred tool (33%) for teaching communication skills to the students. Majority of the
students (88.78%) and faculty (91.67%) felt that role play helped in teaching communicating skills.
Comparison of pre‑ and post‑role play scores on communication skills showed statistically significant
improvement (P < 0.001).
CONCLUSION: Role play can be used as an effective tool to teach communication skills to
undergraduate medical students in pediatrics.

Abstract INTRODUCTION: Physical and mental health is one of the major factors during work life among
nurses that can be affected by differential aspects of work such as work resources. Therefore, the
present study was conducted to determine the relationship between work resources and physical
and mental health among nurses.
MATERIALS AND METHODS: This study was a cross‑sectional correlation study performed on
320 nurses employed in hospitals affiliated to Isfahan University of Medical Sciences in 2018. The
data gathering tools was Work Resources, Physical and Mental Health questionnaires. data were
analyzed using descriptive and analytical statistics (Pearson’s correlation coefficient, analysis of
variance, linear regression, and confirmatory factor analysis).
RESULTS: Data analysis revealed that 46% and 34% of the participants had moderate and well
work resources, respectively. Furthermore, 48% and 54% of nurses had physical and mental health
in high level, respectively. Pearson’s correlation coefficient showed that work resources score had
significant positive relationship with a score of physical and mental health score (P < 0.001, r = 0.23,
and P < 0.001, r = 0.17, respectively).
CONCLUSION: Work resources are likely to be associated with an increased physical and mental
health level among nurses in Iran. The parameters illustrated in the work resources can act as
acceptable predictors for physical and mental health as general health.

Abstract BACKGROUND: Innovation is a competitive advantage, with its preservation and continuity dependent
on the organizational innovation capability. This study was conducted with the aim of determining the
innovation capability dimensions and components in medical sciences universities of Iran.
METHODS: The present study is a qualitative study with content analysis approach, undertaken
in 2016–2017. The data processing included 10 deep interviews with the experts of the health
innovation domain in top management of the three types of the medicine sciences universities of
Iran with >5 years of experience. Targeted data sampling was performed using snowball method and
continued until the saturation of the data. Data analysis was performed using conventional content
analysis method using Maxqda 12 software.
RESULTS: Data analysis resulted in the extraction of 28 categories and 8 main themes including
communications and interactions, innovation climate, university setting, policy factors (policy‑making,
rules and regulations), organizational culture, organizational resources, management and leadership,
and organizational learning in two university internal and external dimensions.
CONCLUSION: To accelerate innovation in medical sciences universities, recognizing the potential
of innovation capability is essential.

Abstract BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a group of progressive lung
diseases; the most common are emphysema and chronic bronchitis. It is considered to be the major
cause of morbidity and mortality worldwide and is considered to be one of the leading causes of deaths
in India, the main reason being misconception/misinterpretation of the disease and unawareness
about the risk factors which hinder early diagnosis and its treatment effectively. Therefore, the
present study aimed to assess the knowledge, attitude and behavior about the disease process and
physiotherapy management in patients diagnosed with COPD.
MATERIALS AND METHODS: Ethical clearance was obtained before initiating the study. It was
a cross‑sectional, qualitative study. In total, 14 patients of COPD were recruited for the study by
convenience sampling. The total study duration was 6 months. Two focused groups (n = 14) were
conducted with seven COPD patients (diagnosed by chest physician on the basis of pulmonary
function testing) in each after obtaining the written informed consent. Focus group contents were
video graphed after obtaining the consent and a focus group discussion (FGD) guide comprising
of 15 questions was used for the study. Transcripts were prepared from the audio/video recordings
and were analyzed qualitatively by narrative analysis.
RESULTS:  The narration transcripted during both the sessions of FGD showed significant
negligence about the disease process, its precipitating factors, preventive measures, and
physiotherapy management among the patients suffering from COPD in the community. None
of the patients were aware even about the term “chronic obstructive pulmonary disease” and
only 35.71% of patients were aware of physiotherapy management as a mean of treatment for
COPD.
CONCLUSIONS: The present study concludes that there is a lack of knowledge, incorrect attitudes,
and flawed behavioral changes which needs to be corrected among the patients with COPD. These
patients require correct, detailed, and broad‑based information about their condition and availability
of treatment options.

Abstract INTRODUCTION: The occurrence of natural disasters such as floods, earthquakes, and storms often
has devastating effects on human societies and causes heavy casualties on their inhabitants. By
destroying the buildings and infrastructure of society, these events impose a wide range of economic
and social burdens on societies and countries. Research in the management of incidental accidents
improves the ability to respond correctly in the event of accidents. Therefore, this study was conducted
to evaluate the readiness of hospitals in unexpected events in 2017.
METHODS: This cross‑sectional study was conducted in 2017 on 10 selected hospitals affiliated to
Isfahan University of Medical Sciences. Data collection with the standard checklist included 137 yes/
no questions in 10 areas of emergency, admission, transmission, traffic, communication, security,
human resources, management, education, and support. At the end of the study, the data were
encoded and entered into the SPSS 22 software and were examined.
RESULTS: The results of this study showed that the readiness of hospitals in each of the areas studied
was as follows: emergency (79% = good), admission (72.5% = good), transmission (70.4% = good),
traffic (58% = moderate), communication (79.6% = Good), security (59.7% = average), human
resources (83.6% = very good), management (58% = moderate), education (81% = very good),
support (73% = good), and command and management (81.8% = very good).
CONCLUSION: Since hospital conditions are completely changed during a crisis, hospital adaptation
to new conditions should be based on the projected plans. As a result, everyone should be prepared
to take responsibility according to their responsibilities.

Abstract BACKGROUND: Academic stress is one of the major affecting factors on adolescent health.
This study investigates adolescents’ view about the sources of academic stress, with which their
identification could be used for the reduction of adolescent academic stress.
MATERIALS AND METHODS: This qualitative study was conducted with Directional Content Analysis
methodology. Semi‑structured interview methods were used for data collection. Participants were
students aged 12–18 years old. Purposeful sampling with Opportunistic Maximum Variation Method
was performed in terms of type of schools, socioeconomic classes, and gender of students. A total
of 43 interviews and were conducted by two interviewers.
RESULTS: A total of 173 codes, 11 subcategories, and 5 categories were extracted as academic
stressors. The categories included family factors (32 codes); peers (18 codes); teachers, school
supervisors, and educational system (72 codes); homework and test scores (32 codes); and
educational assistance classes (19 codes).
CONCLUSION: This study showed that students have different sources of academic stress. Awareness
of their source of stress can help parents and teachers to revise their treat about students’ function
and policymaker to provide better planning and management for students.

Abstract Abstract:
BACKGROUND: Almost 15% of all pregnant women can develop potentially life‑threatening
complications. As a result, identification of high‑risk pregnancy at earliest stage will be useful in
directing appropriate intervention. Hence, the current study was done to determine the prevalence
and outcome of high‑risk pregnancy among antenatal women in rural Puducherry.
MATERIALS AND METHODS: A record‑based longitudinal study was done during March 2018
among 569 antenatal women who have attended rural health center of tertiary care institute. High‑risk
pregnancy was classified based on the guidelines from Pradhan Mantri Surakshit Matritva Abhiyan
and outcome assessment based on the obstetric and neonatal outcomes.
RESULTS: Among 569 antenatal case record reviewed, 315 (55.3%) were in the age group of
20–25 years and majority (463, 81.4%) belonged to below poverty line families; 410 (74.3%) registered
their current pregnancy within the first trimester. The prevalence of high‑risk pregnancy among study
participants was 18.3% (95% confidence interval: 15.3%–21.7%). Majority (81.9%) had term delivery.
Regarding obstetric and neonatal outcomes, majority had spontaneous vaginal delivery (73.9%);
about 10.4% gave birth to low‑birth weight baby, and only 1.7% had stillbirth. Parity, socioeconomic
status, and unfavorable outcomes such as low‑birth weight, preterm, and postterm delivery were
associated with high‑risk pregnancy.
CONCLUSION: The current study found that almost one‑fifth of the pregnant women in rural area have
high‑risk pregnancy. Unfavorable obstetric and neonatal outcomes were common among high‑risk
cases. Hence, early detection of high‑risk pregnancy needs to be done at primary health‑care level
to improve the maternal, obstetric, and neonatal outcomes.

Abstract Abstract:
BACKGROUND/AIM: Parents have an important role to play in supporting adolescents with type 1
diabetes mellitus (T1DM). Their education and occupation are important factors for the management
of this disease. This study aimed to investigate the parental support that Iranian adolescents with
T1DM experience and to examine the effect of parents’ education and occupation on adolescents’
perceived the parental support and metabolic control.
METHODS: This is a cross‑sectional survey. The participants were 98 adolescents (aged 11–18 years)
with T1DM referred to Endocrinology Clinics of Shahid Rahimi and Shahid Madani hospitals in
Khorramabad, Iran, in 2016. For evaluating the adolescents’ perceptions of parental support, the
family version of Diabetes Social Support Questionnaire was employed. It measures in five diabetic
care areas (insulin administration, blood testing, meal planning, exercise, and emotional support).
Data were analyzed in SPSS version 22 software using descriptive statistics and inferential tests
including Pearson correlation test, ANOVA, and independent t‑test.
RESULTS: The parents’ educational level had a significant relationship with adolescents’ perceived
parental support and hemoglobin A1c (HbA1c) level (P < 0.05). Occupation of father had no significant
influence on his supportive behavior and HbA1c level in adolescents, but mother’s occupation
significantly influenced them (P < 0.05). In adolescents with higher perceived parental support, the
mean HbA1c was lower.
CONCLUSIONS: Parents with higher educational level can improve the metabolic control and provide
better meal planning in adolescents with T1DM.

Abstract INTRODUCTION: The aim of this study is assessing predictors to oral health behavior in Iranian
students based on the health belief model.
MATERIALS AND METHODS: This cross‑sectional study was conducted on 416 (applying the
statistical estimation) of fifth‑grade female students of Tehran in 2016. Random cluster sampling
method was used to recruit students. The inclusion criteria were being grade five female student
(aged 10–12 years), and studying in governmental schools, and having a signed consent from the
child’s parent or legal guardian. Logistic regression analysis was used to identify the variables that
predict oral health behaviors.
RESULTS: Overall, 416 female students were entered into the study. Of these, only
55.3% of the students reported that they were brushing at least twice a day, 22.4%
were using dental floss at least once a day, and 23.1% reported checking their teeth
every 6 months. The results obtained from the logistic regression analysis indicated that
perceived self‑efficacy, was the significant predicting factor for brushing at least twice a day
(odds ratio [OR] = 1.34, 95% confidence interval [CI] =1.06–1.69, P = 0.012) and use of dental
floss at least once a day (OR = 1.61, 95% CI = 1.14–2.27, P = 0.007). Furthermore, mother’s job
predicted use of dental floss at least once a day by (OR = 1.83, 95% CI 1.07–3.10). Perceived
benefits were the significant predicting factor for 6 months check (OR = 1.78, 95% CI = 1.14–2.77).
CONCLUSION: The current study provides evidence oral health can be promoted by increasing
perceived self‑efficacy and enhancing perceived benefits in female students.

Abstract INTRODUCTION: Perception the risk of disasters, is mainly of universal and theoretical nature
and is a means of achieving risk understanding/knowledge. In Sendai Framework, the focus is on
increasing risk understanding plans in order to achieve community resilience. Therefore, to achieve
greater public participation in planning for disaster risk reduction (DRR), this study was conducted
primarily to clarify people’s expectations from disaster risk management authorities in order to
approach managers’ and experts’ views to people’s views.
MATERIALS AND METHODS: This qualitative study was conducted through semi‑structured
interviews with 22 participants, who were selected using a purposive sampling technique, in three
provinces of Iran. Data analysis was performed by qualitative content analysis using open coding,
classifying, and abstracting.
RESULTS: By constant, comparison of data, classes, and subcategories were defined. Knowledge,
beliefs, practical obligation, respect for human beings, endeavoring for systemic actions in terms
of planning, implementation, and evaluation classes. In three more abstract categories, personal,
interpersonal, and social commitments were defined.
CONCLUSION: At the preparatory stage, disaster managers need the maximum participation of
people in DRR programs. They, in addition to understanding the importance of their managerial
positions at individual levels and social interactions, are committed to reducing risk.

Abstract INTRODUCTION: Given the importance of feedback to improve teachers’ educational performance,
the current study aimed to identify the challenges and problems involved in providing feedback to
clinical teachers on their educational performance.
MATERIALS AND METHODS: In the first phase of this mixed‑methods study, the clinical teachers,
students, and university officials were interviewed on feedback problems and challenges. After
an inductive content analysis, and based on the problems enlisted, a ten‑item questionnaire was
developed. Subsequently, 25 clinical teachers completed the questionnaire by scoring the importance
and urgency of each problem.
RESULTS: Overall, 18 individual and group interviews were conducted with 24 people. A total
of ten themes and five categories emerged, including “lack of transparency of feedback system,”
“absence of criticizability culture,” “lack of motivation to improve performance,” “failure to consider
factors affecting teacher’s performance,” “lack of formative evaluation,” “inappropriate data obtained
on teacher’s performance,” “inappropriate feedback providers,” “inappropriate feedback recipients,”
“inappropriate feedback provision,” and “no feedback follow‑up.” Three items of priority involved
“inappropriate feedback providers,” “inappropriate data,” and “failure to consider factors affecting
the teacher’s performance.”
CONCLUSIONS: All the raised problems obtained high scores; nevertheless, the interviewees had
more problems with the feedback provider, the data collected on the performance, and inattention
of university officials to the factors influencing performance than feedback presentation methods.
Hence, gaining the trust of teachers on the collected data, providing feedback by their trustworthy
individuals, and paying attention to the factors influencing teachers' performance are associated with
an increased possibility of feedback acceptance.

Abstract INTRODUCTION: Hospital websites are one of the most important communication and information
distribution tools in hospitals. Evaluation of hospital websites based on different aspects including
design, content, accessibility, and other related criteria can determine hospitals’ situation in the use
of novel information technologies. Therefore, this study aims to evaluate public hospital websites of
Isfahan using WebMedQual approach.
MATERIALS AND METHODS: This study is an applied study carried out using a survey method which
evaluated the public hospital websites of Isfahan using WebMedQual scale in the year 2015. Validity
and reliability of the scale was confirmed. This scale includes 8 main components, 8 subcomponents,
95 items, and 3 supplementary questions. The study population included 17 public hospital websites
in the city of Isfahan. Data were analyzed using SPSS version 22 software.
RESULTS: Based on the general score of WebMedQual scale, the websites of Noor and Ali Asghar
hospitals with 42.21% had the highest and the website of Ibn Sina hospital with 22.81% had the
lowest score. Findings also showed that among eight factors used in this scale, design with 59.96%
and accessibility with 44.70% had the highest average scores. On the other hand, source credibility,
user support, and privacy have the lowest average scores with averages of 22.87%, 21.56%, and
1.63%, respectively. The total average score of all factors was 31.94%.
CONCLUSION: Scores showed that based on WebMedQual, public hospital websites in Isfahan
have low quality. Therefore, it is necessary to review and make corrections regarding privacy and
confidentiality guidelines, update website information, website content (clinical content and other
contents) and website writers, and provide forums and other design‑related factors for these websites.

Abstract BACKGROUND: Type 1 diabetes mellitus (T1DM) and its related comorbidities are considered an
important health issue. This study aimed to evaluate the impact of glycemic control on lipid profile
variables in children with T1DM.
MATERIALS AND METHODS: This study included 274 children (≤19 years of age) with T1DM who
had referred to the outpatient clinics of endocrinology in Emam‑Hossein Hospital of Isfahan, Iran.
Based on American Diabetes Association criteria, patients were divided into two groups including
optimal glycemic control (OGC) and poor glycemic control (PGC). Mean lipid level and frequencies
of lipid profile abnormalities between the two studied groups were compared.
RESULTS: Mean age of the studied population was 13 ± 5.9 years and 133 (48.5%) were boys. A total
of 162 (59.1%) and 112 (40.9%) patients had PGC and OGC, respectively. Hypercholesterolemia was
the most common dyslipidemia in both groups (33 [29.1%] of OGC and 63 [39.1%] of PGC patients).
The frequency of high low‑density lipoprotein (LDL) was significantly higher in patients with PGC
than those with OCG (P = 0.007). The frequencies of hypercholesterolemia, hypertriglyceridemia,
and low levels of high‑density lipoprotein were also higher in PGC group, but did not reach the
significant threshold.
CONCLUSION: It is suggested that glycemic control is in association with lipid profile abnormality
in patients with T1DM. High LDL was significantly more frequent in patients with PGC than those
with OGC. It is recommended to investigate the role of glycemic control on other cardiometabolic
risk factors of T1DM patients. Our findings could be used for planning preventative strategies for
reducing T1DM‑related cardiovascular disease.

Abstract PURPOSE: Postpartum period is a critical interval in which the woman is under risk for psychiatric
disorders including postpartum depression (PD). This study was performed to investigate the impact
of the mode of delivery on the occurrence of PD in primiparous mothers.
MATERIALS AND METHODS: This correlational study was performed on 244 primiparous
women (aged 15–49 years) in 17 primary health‑care centers. Sociodemographic, obstetric, and
PD‑related data were gathered using questionnaires and the Edinburgh Postnatal Depression
Scale (EPDS) on the 1st and 3rd months after delivery. The questionnaires were administered to all
primiparous mothers who were registered to the relevant health-care center. Questionnaires were
administered by the researcher for 25–30 min with face-to-face interview technique.
RESULTS: Comparison of EPDS scores on the 1st and 3rd months indicated that there was a
remarkable decline over time (Z = 11.112, P = 0.001). There was an inverse association between
educational level and EPDS scores on the 3rd month (P = 0.037). On the other hand, no significant
relationship was detected between age groups, occupation, income, place of accommodation, and
EPDS scores. Evaluation of the relationship between obstetric features and EPDS scores revealed
that desired and performed modes of delivery, induction, episiotomy, and spinal anesthesia were
not linked with EPDS scores. The postpartum behavior (2=10.315; P = 0.035) and feeding method
of infants (2 = 6.109; P = 0.013) were associated with EPDS scores on the 1st month, but not with
EPDS scores on the 3rd month.
CONCLUSION: Effective measures must be established for early recognition of factors affecting the
occurrence of PD. Health planners and policymakers must spend their efforts for promotion of the
knowledge and attitudes of mothers during pregnancy. Identification of factors for PD necessitates
implementation of multicentric, controlled trials on larger series.

Abstract INTRODUCTION: Maternal confidence is an extremely important factor in playing the mother’s role
and her identity formation. Loss of self‑confidence occurs in primiparous women due to the lack of
maternal skills. Obtaining the behaviors of maternal role and self‑confidence, the mother provides
better care for her child. Hence, the aim of this study was to examine the effect of maternal role
training program based on Mercer theory on maternal self‑confidence of primiparous women with
unplanned pregnancy.
METHODOLOGY OF THE RESEARCH: This clinical trial was performed on 67 primiparous
women referring to Mashhad health centers. Individuals were randomly divided into intervention
and control groups. A maternal role training program based on Mercer theory was carried out for
intervention group (three sessions of group training in the 34th, 35th, and 36th weeks of pregnancy
and one individual training session before discharge from the hospital and then, weekly follow‑up
over the phone for 4 weeks). The control group received the normal pregnancy care. The research
tools were questionnaires of demographic characteristics, London, DASS 21, Edinburgh Postnatal
Depression Scale, Parenting Sense of Competence, General Impressions on Infant Temperament
Questionnaire, and Six Simple Questions. Maternal self‑confidence was measured before training,
4 weeks after delivery, and 4 months after delivery. Data analysis was carried out using independent
t‑test, Chi‑square test, paired t‑test, Mann–Whitney test, one‑way ANOVA, and Wilcoxon test. P < 0.05
was considered statistically significant.
RESULTS: There was a significant difference between mean maternal self‑confidence
changes (before training and 4 weeks after delivery (P = 0.003) and before training and 4 months
after delivery (P = 0.001) in both groups. After eliminating the effect of interventional variables, the
mean scores of maternal self‑confidence after training in the intervention group had a statistically
significant difference with that in the control group (P = 0.001).
CONCLUSIONS: Maternal role training program based on Mercer theory increases maternal
self‑confidence in primiparous women with unplanned pregnancy. Teaching maternal role is
recommended to all health‑care providers.

Abstract BACKGROUND: Regular physical activity during preconception period has beneficial effects
on the health of women during conception and the identification of factors associated with it is
an effective factor for improving the behavior. Therefore, the aim of this study is to evaluate the
relationship between the physical activity and health belief model (HBM) constructs (perceived
susceptibility/severity, barriers, and self‑efficacy) as intrapersonal factors among women undergoing
preconception care.
METHODS: In this cross‑sectional study, 110 women who were undergoing preconception care were
carried out. Moreover, health belief constructs and attitude toward physical activity were assessed
through the use of researcher‑made questionnaire. In addition, the duration of physical activity with
moderate/vigorous intensity was evaluated utilizing a long form of the International Physical Activity
Questionnaire.
RESULTS: The results showed that although there was a relationship between the all health belief
constructs and attitude toward physical activity and the duration of leisure physical activities carried
out during (P < 0.05), but using the linear regression test showed that only perceived barriers,
independent from other variables, had a significant inverse correlation with this type of activities
(β = −0.27, P = 0.02).
CONCLUSION: The findings of this study showed that among the constructs of theHBM, perceived
barriers are the most important predictor of physical activity in women during the preconception
period and emphasize the need to design possible means to promote physical activity to remove
barriers to effective physical activity.

Abstract INTRODUCTION: Disasters are inescapable phenomena. Once they occur, reliable and objective
information becomes vital in sound decision‑making to respond. Emergency health evaluation of
affected population can be used to gather information about the patterns of access to medical care,
basic household needs, and other health needs. The objective of this review was to summarize
evidence from scientific studies on the various methods of emergency health evaluation following
disasters.
MATERIALS AND METHODS: A comprehensive list of studies was provided in May 2017 by an
extensive search using PubMed, Web of Sciences, Ovid Medline, ProQuest Research Library, and
World Health Organization Library.
RESULTS: Of the 1592 retrieved articles, 21 articles were included in this review. In a majority of the
studies (n = 18), a questionnaire was used and an interview was conducted to collect information,
but in three studies, smartphone‑based methods were used. Sampling method in most of the studies
was cluster sampling in Community Assessment for Public Health Emergency Response method. But
in eight studies, random sampling method was used. In a majority of the studies, the demographic
status of samples and in 18 studies, the condition of diseases, water, shelters, health, food, mortality
rate, and existing medical services were investigated.
CONCLUSIONS: Although new methods such as social media and smartphones were already
investigated in some articles, but these approaches require further investigation since there is a
growing need for new methods.

Abstract INTRODUCTION: Mobile phone dependence has become an emerging public health problem. This
cross‑sectional study was conducted to find out the mobile phone involvement and dependence
among undergraduate medical students in a Medical College of West Bengal, India.
MATERIALS AND METHODS: A study was conducted at IQ City Medical College, Durgapur, District
Burdwan, West Bengal, India, during July–August 2015 among 252 undergraduate medical students.
Involvement and dependence were elicited by mobile phone involvement questionnaire (MPIQ) and
mobile phone dependence questionnaire (MPDQ), respectively. Statistical Package for the Social
Sciences (SPSS) software (version 19.0) was used for analysis.
RESULTS: About 14.9% of students were being highly involved with their mobile phone. The
mean score of MPIQ was greatest in domain 5, i.e. euphoria followed by domain 2, i.e. behavioral
salience and then domain 4, i.e. conflict with other activities. About 19.4% of males and 11.1% of
females had high dependence. Mean MPDQ score was higher among males, though it was not
significant statistically. Sex, total recharge, and total hours spent on mobile phone could explain
between 2.2% and 3.8% variance of the presence of dependence in binary logistic regression. Total
recharge (adjusted odds ratio 1.144) and total hours spent on mobile (adjusted odds ratio 1.135)
were positively associated with the presence of dependence.
CONCLUSION: Many students were highly involved and dependent on mobile phone and they had
already been experiencing some health‑related problems. There is a need to identify students having
high involvement and dependence so as to generate adequate awareness and plan educational or
treatment interventions accordingly.