Journal of Education and Health Promotion

Abstract INTRODUCTION: The present study aimed to investigate the effectiveness of cognitive behavioral
therapies (CBTs) for anxiety, hardiness, and self‑efficacy in female students of Birjand University
of Medical Sciences.
MATERIALS AND METHODS: This was an interventional study. A sample of 30 participants were
selected through the available sampling method and randomly assigned into experimental (CBT)
and control groups (each group, 15 female student). The data collection instrument was the Beck
Depression Inventory questionnaire. The questionnaires of Beck Anxiety Inventory, Ahvaz Hardiness
Inventory, and Schwartz’s General Self‑Efficacy Scale were completed by all participants in two
stages (pretest and posttest). A 6‑session protocol of cognitive behavioral group therapy was
performed only on the experimental group. The data were analyzed using Kolmogorov–Smirnov,
Levene’s F, Mbox, analysis of variance, and multivariate analysis of variance tests.
RESULTS: The intervention group showed that the mean of anxiety decreased, whereas (P< 0.001) the
means of hardiness and self‑efficacy increased in the posttest for the experimental group (P < 0.001).
CONCLUSION: Based on the obtained results, it can be concluded that CBT is an effective treatment
for anxiety, hardiness, and self‑efficacy. Therefore, through managing anxiety, the levels of hardiness
and self‑efficacy can be increased in students of university to be able to cope with the different
challenges in their life.

Abstract BACKGROUND: Blood transfusion service is an important part of our healthcare system whose
aim is to provide safe, effective blood components for the patient’s requirement. The laboratory
technicians and nurses working in the blood bank form the core for the effective functioning of blood
bank. The study was to analyze the knowledge, attitude, and practice of nurses and paramedics such
as laboratory technicians working in blood banks and whether intervention of a training program had
any benefit to the participants.
MATERIALS AND METHODS: This study was conducted in our department which is a regional
training center approved by the National AIDS Control Organization for training medical officers,
laboratory technicians, and staff nurses working in blood banks. There were a total number of 48
government run hospital blood banks who participated in the study and we conducted six training
programs for 43 nurses and 64 laboratory technicians working in blood banks from the southern
states of Tamil Nadu and Pondicherry in India. The training program was for 5 days for technicians
and 3 days for nurses with theory sessions followed by hands on practical classes regarding the
daily activities in blood bank. They were given a pre‑evaluation questionnaire to test their knowledge,
attitude, and practice followed by a post evaluation questionnaire after conducting the training
program.
RESULTS: The mean percentage score in the pre evaluation test before the training program
for nurses and technicians was 47% and 53% while after the training program; the mean
percentage was 66.8% and 77% which was statistically significant in both the groups. The
correct blood bank practices followed by nurses and laboratory technicians overall were 67% and
75%, respectively. The technicians and nurses scored poorly in blood bank practices related to
hemovigilance.
DISCUSSIONS: Regular and standardized training can lead to improvements in the knowledge,
skills, and practice of nurses and paramedics who provide blood transfusion services. The constraints
faced by the nurses and paramedical personnel needs to be addressed for the overall betterment
of blood transfusion services.
CONCLUSIONS: The increase in the knowledge subsequently contributed to a better practice in the
technicians. The concept of haemovigilance and error reporting has to be stressed on the nurses
and paramedics to improve their good practices.

Abstract BACKGROUND: The objective of rehabilitation therapists is to increase the functional abilities and
quality of life in people with disability. Hence, cooperation becomes a basis for enhanced quality
of care. The current study aims to investigate the experience of faculty members at the School of
Rehabilitation Sciences, regarding teamwork education for rehabilitation students.
MATERIALS AND METHODS: This was a descriptive‑exploratory qualitative study. Maximum
variation purposive sampling was used, where in‑depth, semi‑structured interviews were conducted
with 13 faculty members working at four departments of the School of Rehabilitation Sciences, Shiraz
University of Medical Sciences, in the year 2015–2016. Each interview was transcribed word‑by‑word
and went under analysis through MAXQDA 10. Finally, after reviewing the transcripts several times,
the primary codes, subthemes, and themes were formed.
RESULTS: Data analysis resulted in the formation of 469 open codes. Three themes emerged,
including the experienced challenges to interprofessional education (IPE), experienced facilitators
of team collaboration, and optimization of IPE. The subthemes of the first theme included
personal challenges, academic context, and sociocultural atmosphere. The subthemes of second
theme‑included experience with various forms of interprofessional (IP) collaboration, IPE in certain
clinical areas, and scarcity of role models for IPE. The subthemes related to the third theme involved
the development of macro policies to facilitate IPE increased interpersonal collaboration and reduced
expectation of competition, and management and development of educational capability in professors.
CONCLUSIONS: It seems that faculty staffs do not provide the same definition of teamwork education
and often do not prioritize it in their clinical teaching. Furthermore, barriers, facilitators and some
solutions were discussed by them.

Abstract CONTEXT: Iranian National Health Scientific Map is a national plan the implementation of which
remarkably influences the progress of the country, though it is facing challenges in its implementation
phase.
AIMS: The present study has been conducted with the main aim of identifying the challenges facing
the comprehensive scientific health map of Iran.
SETTING AND DESIGN: This is an applied and qualitative study.
SUBJECTS AND METHODS: The study was done in 2017 with the content analysis approach
among experts of research and technology management. Some 18 people were selected and were
deeply interviewed, meanwhile observing the credibility of research.
STATISTICAL ANALYSIS USED: Data analysis was performed based on content analysis and
using ATLAS.ti software.
RESULTS: Data analysis resulted in the identification of 427 codes, 84 subthemes, and 12 themes.
Twelve themes were specified including policy‑making, management, university autonomy,
quantitative development, consideration of science production chain, designing and monitoring of
science map, finance, qualitative assessment, human resources, research ethics, as well as allocating
attention to the infrastructure and communication.
CONCLUSION: The scientific map of health challenges are indicative of the need for modification
of the scientific map and adhering to solutions in line with the removal of the identified challenges.
Today, paying attention to the solutions capable of meeting such challenges is a must.

Abstract INTRODUCTION: Oral health is an important component of general health. The World Health
Organization has highly recommended the integration of oral health promotion into general health
care. In majority of the cases, patients visit their physicians with simultaneous oral and systemic
complaints, and primary oral complaints are more frequently encountered. Therefore, primary care
physicians can play an expanded role within oral health care to raise the overall health of the patients.
AIM: This study aimed to assess the knowledge and awareness of family physicians regarding oral
health.
MATERIALS AND METHODS: An observational (cross‑sectional) study was conducted among
250 family physicians who are practicing in Tricity. A self‑structured questionnaire (close‑ended)
prepared by a panel of oral health experts in English language (close‑ended) was administered to
the study participants. The questionnaire which was divided into two parts, A and B, contained 15
questions on knowledge and awareness regarding oral health. Categorization of knowledge scores
was done at three levels: low, medium, and high. Statistical analysis was performed using analysis
of variance and Student’s t‑test.
RESULTS: Males comprised 72.8% (182) of the study population and 55.2% (138) of the participants
were doing combined practice (academic and private both). Low knowledge scores were reported
in 47.2% (118) of the participants whereas only 22.4% (56) of participants had a high score.
The mean knowledge score according to educational level and working profile was statistically
significant (P < 0.05).
CONCLUSION: The results of our study showed a considerable lack of knowledge among family
physicians regarding connection of oral health with general health. Therefore, there is an urgent
need to increase their knowledge by various continued medical education and training programs.

Abstract INTRODUCTION: Nongovernmental organizations (NGOs) play a significant role to provide
humanitarian services in natural hazards. However, few studies have been conducted on the
coordination models of NGOs. Using these models, NGOs are expected to act along with other
agencies to provide unified and effective humanitarian’s services. The present study aimed to identify
the published coordination models of NGOs.
MATERIALS AND METHODS: This systematic review was conducted from October to November
2017. Electronic source, including PubMed, Web of Science, ProQuest Research Library, and
Scopus were examined. All English articles published in journals or presented at conferences were
included in the study. Nonjournal and irrelevant articles were excluded from the study. Furthermore,
papers which were not available as a full text and published in languages other than English were
also excluded. Thematic analysis technique was used to analyze the articles.
RESULTS: From 871 documents which captured in initial search, only 7 studies identified as eligible
articles for extract 8 coordination models of NGOs in disasters and emergencies including: (1) Sphere
project, (2) Cluster approach, (3) Code of conduct, (4) Decentralized approach, (5) National Disaster
Response Framework, (6) Conceptual integrated NGO collaboration framework for community
postdisaster reconstruction, (7) Model of temporal coordination of disaster response activities,
and (8) Collabit application.
CONCLUSIONS: This systematic review identified eight proposed coordination models that have
been implemented internationally, nationally, and locally in natural hazards. However, these models
are not enough, and there are some gaps between what is it and what should be. More effective and
efficient models and strategies are needed to increase the effectiveness of coordination activities
at all levels of community. These results should serve policy‑makers and administrators of NGOs
delivering humanitarian services during and postnatural hazards to choose from a number of options
on how to coordinate their efforts.

Abstract BACKGROUND AND AIMS: Parenting self‑efficacy, which is one of the main determinants of effective
and positive parental behavior, has been commonly defined as the parents’ opinions and beliefs to
develop their ability to affect their children in a way that raises their confidence development and
adjustment. This study was performed to examine the effect of educational intervention on parenting
self‑efficacy in parents of primary school students.
MATERIALS AND METHODS: This quasi‑experimental study was conducted on 104 parents of
primary school students in Khomeini Shahr city, Isfahan province of Iran, in 2017. In this study, 104
parents (52 couples) of primary school students were selected and randomly assigned to experimental
and control groups. Then, an educational intervention was implemented in the experimental group
during 6 sessions of 2 h while the control group received only the usual family school education
program. The parenting self‑efficacy was measured before the intervention and 2 months afterward.
The data were analyzed by independent t‑test, paired t‑test.
RESULTS: There was no statistically significant difference between the demographic variables
of parents in both groups. Both the experimental and control groups were similar in terms of age,
number of children, education, and employment as well as parenting self‑efficacy. Two months after
the intervention, the mean of total parenting self‑efficacy, as well as play and entertainment with
the child, discipline and boundaries, self‑acceptance, learning and knowledge in the experimental
group, were significantly higher than the control group, but the mean scores of other areas were not
significantly different between the two groups (P > 0.05).
CONCLUSION: Educational interventions that engage parents in group task and facilitate expression
of experiences, are feasible in the primary school meetings and have a helpful effect on parenting
self‑efficacy.

Abstract BACKGROUND: Over 1 billion young people globally are at risk of hearing loss and road traffic
accidents due to unsafe listening practices while using personal audio devices  (PADs). Rapid
proliferation of mobile phones with built‑in music playback facility has rendered nearly universal PAD
access. The objective of this study was to ascertain the knowledge of risks and patterns of usage of
PADs among medical undergraduate students in Delhi, India.
MATERIALS AND METHODS: A cross‑sectional study was conducted among medical students]
aged ≥18  years. Data were collected using a pretested self‑administered questionnaire during
December 2016–May 2017. Chi‑square test was used to find an association between the categorical
variables.
RESULTS: A total of 255 male and 133 female students were enrolled (n = 388). Male students
used PADs with greater frequency and perceived lesser susceptibility to adverse health effects on
prolonged PAD usage compared to female students. However, volume preference for PAD usage
did not vary across gender. Self‑reported history of hearing loss and tinnitus which persisted for at
least 3 days in the previous 6 months was 10.6% and 6.4%, respectively. Nearly one in ten students
agreed to the possibility of crossing the road while listening to music on their PADs.
DISCUSSION: Unsafe music‑listening practices using PADs is potentially compromising the
health and safety of young people in India. Strategic approaches supporting information education
communication activities for promoting awareness of hearing and health risks related to prolonged
PAD use at loud volumes and enactment of policies restricting undesirable PAD usage threatening
road safety need consideration.

Abstract AIM AND BACKGROUND: Social anxiety can interfere with performance and academic success in
students. One of the third‑generation treatments for social anxiety is acceptance and commitment
therapy. Therefore, the current study aims to determine the effectiveness of acceptance and
commitment group therapy on social anxiety of female dormitory residents of Isfahan University of
Medical Sciences.
METHODS: This was a semiempirical study with pre‑ and posttest conducted on 71 female students
living in the dormitory of Isfahan University of Medical Sciences. The study was carried out in five
training sessions using the Liebowitz Social Anxiety Scale and second version of acceptance and
commitment scale whose validity and reliability were confirmed. Data were analyzed using Student’s
t‑test.
RESULTS: The findings showed that acceptance and commitment group therapy has affected the
social anxiety in female dormitory residents of Isfahan University of Medical Sciences (P < 0.0001).
CONCLUTIONS: The findings of this study can be used by student deputies of universities,
consultation centers, as well as counselors and psychologists to improve the conditions for students.

Abstract Now, lifestyle diseases are quite common globally. The risk factors of lifestyle diseases such
as sedentary habits, lack of physical exercise, and lack of fiber result in the development of
noncommunicable diseases. However, when the point of discussion slightly shifted toward toilet
habits, it is always seems to be a secret affair. In fact, the discussion of defecation‑related matter
openly is considered a taboo. This is not uncommon even in medical fraternity. In fact, during the early
1980s, some researches on the association between the diarrhea prevalence, open‑air defecation,
and latrine use rate were documented. However, nobody acknowledges it socially desirable, now,
to discuss defecation‑related issues. The public health experts completely ignored the discussion
of ill‑effects of the use of pedestal latrine on human health. It is evident from scientific studies over
a period, that many of the abdominal disorders of the human due change in his toilet habits from a
squatting‑to‑sitting posture using a pedestal latrine. That disease correlation was ignored at that time.
The increase in disease burden is due to nonmaintaining the ergonomic design during the construction
of this kind of toilets. Squatting posture for the defecation is the most appropriate way, as in this case,
abdominal muscles work actively and complete evacuation takes place. To conclude, the time has
come to reacquaint people with their natural habits and put this unfortunate experiment to an end.

Abstract BACKGROUND AND OBJECTIVE: Due to the young population of Iran, a significant number of
teenagers in our country and the importance of the health of adolescents, especially teenage girls
who are the mothers and the future‑makers of the society, we designed this study to determine the
health needs of adolescent girls living in the city of Qom.
METHODOLOGY: In this descriptive cross‑sectional study, the research population included 853
student girls in the middle and high secondary grades in the city of Qom selected and participated in
the study through a randomized multistage cluster sampling method. Data were collected by completing
the demographic information questionnaire, and the adolescent girls’ health needs questionnaire. Data
gathered were analyzed using SPSS software version 19 using the descriptive and inferential statistics.
RESULTS: The study results showed that the scores of the adolescent girls’ needs in health‑related
areas are as follows: health: 65.33 ± 22.08, nutrition: 52.81 ± 25.40, exercise and physical activity:
50.10 ± 30.55, social justice: 53.95 ± 23.82, counseling: 49.55 ± 34.97, school status: 52.69 ± 28.01,
relationship with parents: 55.10 ± 27.44, social support: 50.64 ± 30.52, education: 51.88 ± 29.61,
religious beliefs, and spirituality: 66.88 ± 20.87.
CONCLUSION: Based on the results of this study, the adolescent girls have a lot of perceived needs
in various areas of health, including psychological‑emotional, social, physical, educational, and beliefs
areas, which have not been met. Therefore, it is recommended to plan and carry out the necessary
measures to meet the needs of adolescents with their participation and relevant authorities.

Abstract BACKGROUND: Prehospital emergency care system is one of the important parts of the health
system. Heavy traffic, increasing urban population, and growing demands for prehospital emergency
services are challenges faced by this section of the health system. One of the approaches to deal
with this issue is using motor ambulances.
AIMS: This study aims to investigate the missions of motor ambulances, ambulances, and the effects
of motor ambulance services on response time and ambulance missions.
MATERIALS AND METHODS: This applied research has been designed as a descriptive and
cross‑sectional study. Overall, 267,836 missions carried out by ambulances and motor ambulances
of Tehran emergency medical service (EMS) Center in the years 2014 and 2015 were investigated.
The data were gathered personally by visiting Tehran EMS Center. The data were analyzed by
Excel (2013) software.
RESULTS: The average response time for ambulances and motor ambulances were 16 min and
14 min and 13 s, respectively. Most of the ambulance and motor ambulance missions were reportedly
due to weakness (20%) and heart problems (16%). In 57% of ambulance missions and 71.5% of
motor ambulance missions, the patients refused to being transferred to the hospital. Most of the
transport missions to hospital (24%) were caused by traffic accidents.
CONCLUSIONS: According to the results, the response time was higher than the national standards.
Locating motor ambulances on the streets and outside emergency stations during peak traffic times
decreased the response time by 2 min and by providing the necessary services in the scene and
transferring fewer patients to the hospital, it is possible to provide further services by assigning
ambulances to more urgent missions. Thus, it is recommended to employ more seasoned staff,
multiply motor ambulances, and locate motor ambulances precisely to decrease response time and
also at a lower cost more citizens are provided with prehospital care.

Abstract INTRODUCTION: The inappropriate use of drugs is a global health problem, especially in developing
country like India. Irrational prescriptions have an ill effect on health as well as health‑care expenditure.
Prescription auditing is an important tool to improve the quality of prescriptions, which in turn improves
the quality of health care provided. The present study was conducted to investigate the rational use of
drugs for completeness, legibility, and against the World Health Organization (WHO)‑recommended
core drug use indicators.
MATERIALS AND METHODS: A cross‑sectional, outpatient department‑based study was carried
out in a rural hospital of Delhi wherein 120 prescriptions were randomly sampled, irrespective of
patient characteristics and diagnosis over a period of 1 month. All the prescriptions were analyzed
for general details, medical components, and WHO core drug use indicators. The data obtained were
summed up and presented as descriptive statistics using the Microsoft Excel and were analyzed
using SPSS version 16.
RESULTS: All the prescriptions had general details mentioned in it. The diagnosis was mentioned
in 64.2% of prescriptions, and 85.8% of drugs were prescribed by generic name. An average of 3.02
drugs per encounter was prescribed. The average consultation time and dispensing time were 2.8 min
and 1.2 min, respectively. Only half of the patients had correct knowledge of dose.
CONCLUSIONS: Our study highlights the need to train our prescribing doctors on writing rational
prescriptions for quality improvement.

Abstract BACKGROUND: Family physician (FP) is one of the best strategies to reform health system and
promote population health. Due to the different context, culture, and population, implementing this
reform within cities would be more challenging than in rural areas. This study aimed to assess the
challenges and strengths of Urban FP Program in Fars Province of Iran.
MATERIALS AND METHODS: It was a qualitative study using framework analysis for collecting and
interpreting data. The participants included health policy‑makers, top managers, and involved health
staff selected through purposive and snowball sampling. Participating in the program or working
as a physician in urban areas were among inclusion criteria. Three focus groups with experts as
well as the content analysis of national documents were also performed. The research tool was a
semi‑structured interview guide. Interviews and focus groups were recorded and transcribed word
by word. The framework of triangle for data analysis and the content was analyzed using MAXQDA
2010 software.
RESULTS: The participants’ mean age was 44.9 ± 6.4 years, with a mean work experience of
13.2 ± 7.4 years. The transcripts revealed six themes and 17 subthemes. The emerging themes
included three challenges and three solutions as following: social problems, financial problems, and
structural problems as well as resistance reduction, executive meetings, and surveillance.
CONCLUSION: Resolving staff shortage, decreasing the public resistance, and eliminating
unnecessary referrals were among the strategies used by Fars, during FP implementation. To
be successful in implementing this program, the required perquisites such as infrastructures
and culture growth must be undertaken. The current study suggests the establishment of the
electronic health record to improve the pace and quality of service provision as well as reducing
violations.

Abstract INTRODUCTION: Medical sciences effects on people’s health; therefore, it is necessary to identify all
threats, opportunities, and challenges in its policy and planning particularly in the education field. The
orthotics and prosthetics (O and P) field of study has great importance alongside other rehabilitation
sciences due to its preventive status, therefore, the purpose of this study is to investigate the role
of key factors and, subsequently, identifying uncertainties to compile and plot a bright and planned
future for O and P education system.
MATERIALS AND METHODS: At first, the key factors seemed to be influential improving the
education and training quality of O and P students, were identified, weighted and ranked. All these
steps were based on documentations and opinions of elites and deans of O and P through a
semi‑structured interview. Then, the final list of key factors and extracted drivers was placed and
analyzed in cross‑impact matrix by MicMac software.
RESULTS: Among the initial list of key factors and drivers which identified 45 elements; 19 key
factors and drivers scored the highest. Among 238 evaluable relationships in the cross‑impact
matrix, 123 relationships (51.6% of total matrix volume) are 0, which means that factors do not
affect each other and are not affected either. Two key factors were identified as critical uncertainties
out of 19 key factors.
CONCLUSION: Achieving education development without a dynamic and active planning system is
not possible. “Community‑based education” and “government financial support” were identified as
critical uncertainties of O and P future education system.

Abstract BACKGROUND: Noncommunicable diseases (NCDs) are the leading causes of mortality worldwide.
Environmental factors play an important role in development of risk factors. Hence, the study was
done to assess the neighborhood environmental factors related to NCDs in urban area.
METHODOLOGY: This community‑based cross‑sectional study was carried out among three selected
wards of urban Puducherry. All shops/establishments related to the risk of NCDs within the study
area were study units. Information regarding tobacco, alcohol, diet, and physical activity‑related
establishments was assessed using pretested semi‑structured pro forma. Shops/establishments were
labeled either as “favorable” (prevents the risk of NCDs) or “unfavorable” (increases the risk of NCDs).
RESULTS: Among 655 establishments, 372 (56.8%) belonged to favorable and 283 (43.2%)
to unfavorable category, respectively. Tobacco‑related establishments amount to 15.1% (95%
confidence interval: 12.6–18.1) of the total establishments. Among these tobacco establishments,
almost one‑third were selling tobacco to minor and located within 100 m of school. Fruits and vegetable
markets contributed to 21.8% of the total establishments. About 22% of the establishments were
fast‑food outlets. Public health sports facilities were only 6.8% of the total establishments.
CONCLUSION: The current study reported almost equal distribution of favorable and unfavorable
establishments. However, among unfavorable establishments, tobacco establishments raised
concern as one‑third of those were selling tobacco to minors. Healthy diet and physical activity related
establishments were also found to be less. Hence, corrective measures are to be implemented which
will reduce the burden of behavioral risk factors.

Abstract INTRODUCTION: The lack of experienced midwifery in obstetrics and gynecology centers would
have harmful consequences. Resilience could increase midwives’ endurance while caring for women
and neonates in the maternity hospitals. Research on resilience of midwives is rare. The purpose of
this study was to explore and describe resilience strategies against working pressures in midwives
in Sabzevar, Iran.
METHODOLOGY: The qualitative study was conducted using content analysis method. Twelve
midwives, who had at least 1 year of work experience, were selected by purposeful sampling. Data
collection was conducted using semi‑structured deep interviews on midwives’ resilience strategies.
The analysis was carried out using conventional content analysis method.
RESULTS: The five main categories of data were extracted, including self‑management, supporters
in the workplace, sense of usefulness and reassuring, the nature of creation, and life dynamic in the
workplace, and accountability. Reading recitation and recourse, obtaining decision‑making power,
and problem‑solving were subcategories of the self‑management. Intimate the communication, peer
support, physician support, and family support were subcategories of supporters in the workplace.
The subcategories of sense of usefulness and reassuring were work autonomy, satisfaction of
applying the knowledge in practice, the feeling of energy evacuating with much work, and trying to
reassuring mothers.
CONCLUSION: All extraction factors were related to the midwife and did not relate to the therapeutic
system and management. However, hospital managers can provide their supporting and facilitating
role to reduce the risk of depreciation and burnout in midwives.

Abstract BACKGROUND: Structural empowerment (SE) is an effective method of advancing work
environments and has previously been widely discussed in Western countries. Due to the lack of
culturally and academically accepted scales in Iran for measuring SE, localization of a foreign scale
in this field is necessary.
OBJECTIVES: This study aimed at investigating the validity and reliability of the Persian Version of
the Conditions of Work Effectiveness Questionnaire‑II (CWEQ‑II‑PV) among Iranian nurses.
METHODS: The present cross‑sectional methodological research was conducted during 2017–2018.
Participants were 230 nurses working in four teaching hospitals affiliated to Kashan University of
Medical Sciences in Kashan, Iran, who were selected using quota sampling. A standard forward–
backward translation procedure according to Wild et al. (2005) was used to translate the English
Version of the CWEQ‑II to Persian. The psychometric evaluation processes were achieved by face,
content, and construct validity (confirmatory factor analysis [CFA]). Reliability was examined using
test–retest and Cronbach’s alpha for internal consistency reliability.
RESULTS: The CWEQ‑II‑PV showed good content validity (the mean content validity scores for
relevancy, clarity, and simplicity were 94%, 96%, and 94%, respectively). In the CFA, the original
six‑factor version with 19 items was confirmed. The original model was presented and incorporated in
the CFA, indicating an acceptable fit for the model (root mean square error of approximation = 0.06,
comparative fit index = 0.92, goodness of fit index (GFI) = 0.94, and adjusted GFI = 0.91). Cronbach’s
alpha coefficient for the total scale was 0.84 and for each component ranged from 0.71 to 0.87,
indicating good internal consistency, and the test–retest Spearman and intraclass correlation
coefficients were 0.93 and 0.87, respectively, showing good test–retest reliability.
CONCLUSIONS: Evidence was found to support the reliability and validity of the CWEQ‑II‑PV scale
that measures the quality of the work environment for nurses from a SE perspective.

Abstract INTRODUCTION: In different countries around the world, the involvement of women in academic
medicine was less in comparison with men. This study aimed to assess whether there were significant
gender differences in research perception, practice, and publication in Sudan.
METHODS: This was an analytical cross‑sectional study was carried out using questionnaire among
153 teaching staff of five Sudanese medical faculties from both genders, including teaching assistants,
lecturers, assistant professors, associate professors, and full professors.
RESULTS: There were no significant differences among participants’ gender regarding their
universities, qualifications, research training received after graduation, and participation in research
currently or in the past or current position, but female participants seem to be younger as their mean
of age was 38.8 (±9.2) compared with 42.6 (±10.1) for males. Importantly, the males’ researcher has
not only published significantly more than females but also appeared to have significantly more years
of research experience. The mean score of research perception was higher among male participants
who indicated that they had a more favorable perception of research.
CONCLUSION: The study showed that in Sudanese medical colleges significantly higher percentage
of men published scientific papers more than women. In addition, the male also had a significantly
higher mean score of research perception which indicated that they had a more favorable perception
of research.

Abstract INTRODUCTION: An appropriate exchange of information between the health‑care provider and
the family is an important component of coping with stress following the prenatal diagnosis of fetal
anomalies. Therefore, this study was conducted to explore the informational needs of pregnant
women following a prenatal diagnosis of fetal anomalies in Mashhad, Iran.
SUBJECTS AND METHODS: This qualitative, conventional, content analysis study was designed
through two referral centers for fetal anomaly. The data were collected from April 2017 to January
2018 in Mashhad (Iran) through individual semi‑structured in‑depth interviews, from 25 pregnant
women with a prenatal diagnosis of fetal anomalies.
RESULTS: Three categories and nine subcategories emerged. Category 1, information needed for
clarifying the diagnosed anomaly and making a decision, containing four subcategories: The need to
know the reasons of doing more diagnostic tests; The need to know the facts regarding the anomaly
and its cause; The need for more information to gain control over the situation; and The need to know
about legal permission for therapeutic abortion. Category 2, Information needed for preparing to the
future, containing three subcategories: Practical and economic issues; The delivery and postnatal
situation; and Future mortality and morbidity of especial anomaly. Category 3, the adequacy of the
information provided, containing two subcategories: Information overload and Inadequate information.
CONCLUSIONS: Pregnant women receiving a prenatal diagnosis of fetal anomaly have a variety
of information needs that are not adequately met by the health‑care providers. Further research is
required for finding a means to meeting this information need.

Abstract INTRODUCTION: Dental and oral health is a core component of general health and well‑being. Few
aspects of health are as accessible to personal control as oral hygiene which can be improved by
simple behavioral changes. In recent years, dentists in the field of oral and dental health improvement
have been research doing for measurement of validity and efficiency of available educational
interventions. In this regard, meta‑analysis integrates the results of different studies then determines
the effect size of educational interventions. This study seeks to investigate the effective educational
interventions on improving oral and dental health improvement in Iran by following the meta‑analysis
model.
MATERIALS AND METHODS: The present research was a meta‑analysis study. This research by
using the technique of meta‑analysis to integrate the results of different studies, to determine the
effect size of an educational intervention on improving oral and dental health improvement in Iran.
Seventeen studies accepted in methodology were collected in Iran during 2001–2018, and analyzed
through meta‑analysis. The research tool was meta‑analysis checklist. Effect size for each study
was manually calculated.
RESULTS: The study findings showed that the rate of the effect size of educational intervention on
Improving Oral and Dental Health Improvement in Iran was 0.62 (P ≤ 0.008) which according to
Cohen’s table was intermediate.
CONCLUSION: Findings of this meta‑analysis support of the effectiveness of educational interventions
on improving oral and dental health improvement in Iran. It seems that the educational interventions on
improving dental and oral health can be used as a method for improving oral and dental health in Iran.

Abstract BACKGROUND: Aerobic exercise is helpful in reducing elevated blood pressure (BP). It was also
found that yoga is useful in reducing raised BP. Thus, they both can be used in prevention and
treatment of hypertension. Hence, the study aimed to observe both awareness and practice of aerobic
exercise and yoga among hypertensive patients in Anand city.
MATERIALS AND METHODS: A cross‑sectional descriptive study was conducted. A questionnaire
was prepared containing 24 questions about awareness and practice of aerobic exercise and yoga
among hypertensive patients. The questions were explained to all the patients, and 200 patients
were recruited from Anand city through convenience sampling.
RESULTS: Two‑hundred patients were included in this study, of which 100% were aware of
hypertension. 67.68% were aware of the role of aerobic exercise in hypertension, of which 58.29%
practiced them. The awareness of the role of yoga in hypertension was noted in 33.67% of patients,
of which only 13.07% practiced pranayama and 9.50% practiced asanas.
CONCLUSION: There was a complete awareness of hypertension among hypertensive patients.
A large number of patients were aware of the role of aerobic exercise in hypertension, but only few of
the patients practiced them. However, there was less awareness of the role of yoga in hypertension
and even lesser number practiced them.

Abstract INTRODUCTION: Self‑confidence means recognizing your abilities, self‑interest, and being aware
of your feelings. Risk‑taking is one of the personality traits that may be affected by confidence. It
can be defined as behavior that increases the probability of negative consequences. Considering
the importance of students’ self‑confidence and its relation with risk‑taking, the aim of this study is to
study the relation between self‑confidence and risk‑taking among the students of Tehran University
of Medical Sciences in 2017.
MATERIALS AND METHODS: This cross‑sectional study was done on 363 students of TUMS by
stratified sampling. The tool for collecting data is based on a self-confidence questionnaire and a
risk-taking questionnaire developed by Moradi et al. Data analysis was performed using Pearson’s
correlation coefficient.
RESULTS: The mean age of participants was 21.86 years and 54.5% of participants were girls and
the rest were boys. No significant correlation was observed between risk‑taking and self-confidence
in students according to the Pearson’s coefficient test (r = 0.05, P = 0.29).
CONCLUSION: The results indicated that there is no relation between self‑confidence and
risk‑taking among students, and students who have higher self‑confidence are not exposed
to high risks. Therefore, we need more studies in different age groups to validate this exact
relationship.

Abstract CONTEXT: Emergency Department Information System (EDIS) plays a significant role in supporting
the emergency department (ED) workflow. Hence, it is vital to assess the services provided by this
system in order to identify its strengths and weaknesses.
AIMS: The study aimed to assess the information systems in use in the ED of 11 teaching hospitals
associated with Isfahan University of Medical Sciences (IUMS) so as to identify their strengths and
weaknesses and improving the quality of these systems.
SETTINGS AND DESIGN: This study was conducted using descriptive‑applied research method.
SUBJECTS AND METHODS: Data collection tool was a checklist developed based on EDIS
functional profile. It covered two sections of the profile, namely direct care and supportive functions
and their respective subsections.
STATISTICAL ANALYSIS USED: Data were analyzed using descriptive statistics through the
estimation of the frequency and frequency percentage for each respective section and subsections
using SPSS software v. 20.
RESULTS: The content conformance rate of the information systems in use in the EDs of IUMS’
teaching hospitals was found to be 49.72% and 75.25% for the direct care section and supportive
functions section, respectively. In addition, the overall conformance rate in the hospitals surveyed
was up to 53.15%.
CONCLUSION: As per the findings of this study, it is suggested that some important clinical and
administrative functions should be incorporated into the redesigned information systems in use in
the EDs under study.

Abstract INTRODUCTION: Every individual has different learning approaches in acquisition and processing
of knowledge. Physiotherapy, an evolving allied health science profession, is developing rapidly.
Exploration of learning approaches among physiotherapy students will help the academicians to enrich
the quality of learning. This study aimed to analyze the learning approaches among physiotherapy
students.
MATERIALS AND METHODS: A cross‑sectional study was carried out among 435 physiotherapy
students. The Approaches and Study Skills Inventory for Students questionnaire was used to evaluate
learning approaches in both preclinical and clinical students. Data were analyzed using the Statistical
Package for the Social Sciences software version 21. Statistical significance was set at P < 0.05.
RESULTS: A total of 435 participants, 233 (53.56%) in preclinical phase and 202 (46.44%) in clinical
phase with a mean age of 19.01 ± 1.01 and 22.03 ± 1.43 years, respectively, participated in the
study. Among the 435 students, 411 (94.49%) adopted the deep approach, while only 21 (4.83%)
and 3 (0.69%) adopted strategic approach and surface approach, respectively. Preclinical students
had significantly higher mean scores for strategic and surface approaches than clinical (P = 0.000)
and (P = 0.000) using independent t‑test, respectively. Out of the 435 students, 50 (11.45%) were
male and 385 (88.51%) were female. Male students appeared less likely to adopt the deep learning
approach than female students (P = 0.013).
CONCLUSIONS: Assessment of learning approaches will assist the academicians to develop
teaching and learning strategies and effective curriculum depending on the perspectives of students.
Multiple methodologies focused on interactive student‑centric approach should be utilized to enhance
positive learning outcomes.