Journal of Education and Health Promotion

Abstract INTRODUCTION: The identification of health education needs through the community results
in targeted services and health promotion. Prioritizing these needs, in addition to identifying the
desired health system based on the needs of the community, is required for the optimal allocation
of resources. Therefore, this study was conducted with the aim prioritizing the health educational
needs of Sabzevar‑Iran community.
MATERIALS AND METHODS: This study was a two‑step mix study. In the first stage, the qualitative
method of the main themes of health educational needs of Sabzevar society was determined. Then,
the questionnaire was prepared by a paired scale (36 questions) and quantitative method was used
to prioritize the main themes with Analytic Hierarchy Process (AHP) software. The random sampling
method was used in this study and data analysis was performed using Expert Choice software using
AHP method.
RESULTS: Social problems with 0.206, contagious diseases with 0.205, nutrition with 0.161, and
public health with 0.132 were in the first to fourth grades of health educational needs in Sabzevar city
and environmental health, health management, noncontagion diseases, elderly, and occupational
health were in the fifth to ninth grades. The consistency index in this study was 0.08, although the
adjustment index is <0.1 good and acceptable.
CONCLUSION: Social problems are the first priority of Sabzevar society, which require appropriate
training.

Abstract BACKGROUND: Given that the need to pay attention to measuring efficiency is considered as
one of the main pillars of improving the level of efficiency in hospitals, so this study was carried
out aimed to determine the mean technical efficiency (The technical efficiency is bound by zero
and one and a score of less than one means that the theatre is inefficient as it could) score in
terms of type and activity of the hospital, input‑oriented and output‑oriented attitude, returns to
scale (In economics, returns to scale and economies of scale are related but different concepts
that describe what happens as the scale of production increases in the long run, when all input
levels including physical capital usage are variable (chosen by the firm). The concept of returns
to scale arises in the context of a firm’s production function. It explains the behavior of the rate
of increase) in hospitals of Iran using data envelopment analysis (DEA) (DEA is a nonparametric
method in operations’ research and economics for the estimation of production frontiers. It is
used to empirically measure productive efficiency of decision‑making units) and stochastic frontier
analysis (SFA) (SFA is a method of economic modeling. It has its starting point in the stochastic
production frontier models simultaneously introduced by Aigner, Lovell and Schmidt[1977] and
Meeusen and Van den Broeck[1977]
MATERIALS AND METHODS: The present study was carried out with a systematic review
of all studies conducted on measuring efficiency of hospitals in Iran from March 21, 2001 to
December 21, 2017 using DEA and SFA. Eleven databases were searched using appropriate
keywords and 470 articles were found and evaluated using a checklist, and finally, 24 articles
were entered into the meta‑analysis process. Meta‑analysis was performed using random effect
model and fixed‑effect model, and study heterogeneity was investigated using Q‑Cochran
test and I
2 index. Furthermore, the main reasons of study heterogeneity were identified due
to meta‑regression.
RESULTS: The average technical efficiency score of hospitals using DEA and SFA method
was obtained equal to 0.885 and 0.809, respectively. Furthermore, with regard to the DEA
method, 0.885, 0.891.0.952 and 0.913 was obtained for input‑oriented and output‑oriented,
general and specialized care hospitals and constant returns respectively. With regard to SFA
method, 0.733, 0.664, 0.641, 0.802, was obtained, and the inputs and outputs affect measuring
the efficiency.
DISCUSSION: In contrast, the DEA method can investigate several input and output simultaneously
and is used as an effective and flexible tool in order to measure the efficiency of the hospital. DEA
can be easily used for calculating efficiency scores based on the proper selection of input and
output indicators. The data envelopment analysis method and different input and output variables
have been used in most studies conducted in Iran, and Stochastic Frontier Analysis has been less
considered. In the present study, the DEA method in governmental educational hospitals showed a
higher efficiency than SFA method in the hospitals under study. But in general, due to lack of optimal
efficiency level in the hospital, it is suggested that policymakers determine the hospital efficiency
indices in order to evaluate their efficiency from different dimensions.  CONCLUSION: The average technical efficiency score of hospitals using DEA and SFA method was obtained equal to 0.885
and 0.809, respectively. Also, the mean technical efficiency score in terms of input-oriented and output-oriented, general and
specialized care hospitals and constant returns to scale using the DEA method was obtained equal to 0.885, 0.891.0.952 and
0.913 and using the SFA method, respectively, it was equal to 0.733, 0.664, 0.641, 0.802, and the inputs and outputs affecting
measuring the efficiency. There is no significant difference between the mean efficiency score between the two methods, but
the data envelopment analysis method is used more. It is suggested that the hospitals efficiency indicators to be determined in
order to more accurately evaluate the hospitals efficiency.

Abstract BACKGROUND: Rheumatoid arthritis (RA) is a common multisystemic autoimmune disease with
peripheral joint involvement. Many autoantibodies have been introduced in the course of RA; some of
them have diagnostic and prognostic value. In this study, our aim is to determine the value of serum
glucose‑6‑phosphate isomerase (G6PI) antigen (Ag) as a diagnostic and prognostic marker in RA.
MATERIALS AND METHODS: Eighty‑seven known cases of RA who referred to an outpatient
clinic of Shiraz University of Medical Sciences and 76 healthy controls were selected. Serum G6PI
Ag was measured using sandwich enzyme‑linked immunosorbent assay method, and the enzyme
level was compared in the patient and control group, we also compared the enzyme level of patient
group with disease activity, disease duration, erythrocyte sedimentation rate (ESR), C‑reactive
protein (CRP), rheumatoid factor (RF), and anti‑cyclic citrullinated peptide (anti‑CCP) antibody (Ab).
The data were analyzed using SPSS V 16 software.
RESULTS: Positivity for G6PI was detected in 34.5% (30/87) of RA patients and 9.2% (7/76) of
control group (P < 0.001). There was no significant correlation between enzyme level and disease
activity, disease duration, ESR, CRP, RF, and anti‑CCP Ab.
CONCLUSIONS: Overall, in our study, although there was a significant difference in serum G6PI
Ag between patient and control group, no significant correlation was detected between serum G6PI
level and disease activity score, ESR, CRP, and anti‑CCP Ab, but relative correlation with ESR and
disease duration could be challenging. G6PI Ag could be introduced as a diagnostic marker in RA,
but its role as a prognostic marker is controversial.

Abstract INTRODUCTION: The Balint group’s seminars were developed by Michael and Enid Balint for the
purpose of a better understanding of doctor–patient relationships. This study aimed to introduce
the Balint group and its application to the medical science educational program and to provide an
up‑to‑date perspective on Balint group research.
MATERIALS AND METHODS: The study was carried out as a systematic literature search published
from January 2008 to September 2018 in the databases of PubMed, Scopus, Science Direct, and
Proquest, which were searched with keywords such as the Balint group and medical education
along with numerous related terms. Duplicates, non‑English language articles were discarded from
the review.
RESULTS: A total of nine papers entered the study. Among included articles, four used a qualitative
methodology, four used a quantitative methodology, and one applied a mixed methodology. Four main
aims emerged from the content of papers: (1) to evaluate resident and medical student experiences
in Balint groups, (2) to improve communication skills and reduce burnout level, (3) to assess the
Balint group’s effects on empathy, and (4) to explore the contexts and triggers of cases presented
in Balint groups.
CONCLUSION: Our results help us to the achievement of a better planning and design of an efficient
Balint group in medical education. The findings enable the policymakers to make better decisions
on the topic. Balint groups may guide medical students (residents) to become more patient centered
by improving their communication skills and empathic abilities and reducing the level of burnout.

Abstract INTRODUCTION: A sharp increase in expenditure is one of the challenges of the health system
in Iran. Every macroeconomic variable affects health, and if it is disregarded, it will lead to higher
macrobudgets. Physical and mental health as well as the use of health services change according
to the macroeconomic conditions and business cycles (boom and recession). The present study
aimed to determine the effect of macroeconomic indicators on health expenditure.
METHODS: This study was descriptive analytical. The required data related to macroeconomic
indicators and health expenditure in public and private sectors were collected during 1995–2014.
The data were analyzed using the time series models in econometrics, Vector Auto Regression,
and Granger causality technique.
RESULTS: The results of this study indicated that health expenditure has a positive bilateral
relationship with gross domestic production (GDP), gross national production, national income,
and national consumption. On the contrary, expenditure has a negative bilateral relationship with
liquidity rate and inflation rate. In addition, budget deficit has a negative unilateral relationship with
health expenditure while population rate has a positive unilateral relationship with health expenditure.
CONCLUSION: The results of this study indicated the increase of health expenditure in Iran that
GDP is the most critical determining factor of health expenditure. In general, the total expenditure in
the health sector in the world increases when the countries become richer. In line with the increase
of resources, innovative financing methods and efficiency improvement are required for providing
basic health services in low‑income countries.

Abstract BACKGROUND: The condition of epilepsy has a considerable effect on a person’s social and
personal life. Currently, a knowledge gap exists regarding the knowledge, attitude, and perception
towards epilepsy among graduate students. The objectives of the study were to initially explore the
knowledge, attitude, practices and to examine their inter‑relationship among graduate students.
MATERIALS AND METHODS: A total of 300 3rd year Bachelor of Science graduate students from
colleges near Hombegowda nagar, Bangalore, Karnataka were included from three colleges. To
achieve the objective mentioned, an instrument was framed and approved by specialists in the field.
RESULTS: About 26% believed that epilepsy is a mental illness, 64% reported that it is not a disease of
the brain, 96% believed it to be a hereditary disease. Attitude shows that 29%, 33%, and 49% believed
that Epilepsy can disturb anybody’s normal life, education, and occupation, respectively. About
31% reported that if they see a person with epileptic attack they ran away. Knowledge score have
significantly (P < 0.001) positive correlation of r = 0.810 and r = 0.794 with both attitude and practice,
respectively. Attitude and practice also have significantly (P < 0.001) positive correlation (0.856) with
practice. This clearly shows that if knowledge increases, persons will have positive attitude and good
practices whereas less knowledge leads to faulty attitude and practices.
CONCLUSIONS: There is a need to include health education programs for school children and
college students irrespective of streams, as it is crucial to bring an alteration in the presently observed
perspective, behavior, and practice.

Abstract INTRODUCTION: Routine episiotomy is a common procedure to shorten the second stage of labor.
The attitude of individuals is an important factor in episiotomy, which is often carried out without
an indication. Therefore, this study aimed to determine the effect of education and support of labor
practitioners on their attitude and performance in conducting routine episiotomy.
MATERIALS AND METHODS: This was a quasi‑experimental study. A sample of 66 midwives,
physicians, and midwifery faculty members were selected through the convenience sampling method.
The data collection instrument was the questionnaire of personnel’s attitude toward episiotomy. This
questionnaire was completed by the participants before and 3 months after the intervention. A 16‑h
workshop about the education of natural childbirth for 2 days was performed on the experimental
group. Data analysis was performed using paired t‑test and Pearson’s correlation test.
RESULTS: The findings showed that mean attitude of the participants toward episiotomy was
50.5 ± 1.58 before the intervention, which changed to 61.18 ± 2.5 after the intervention, demonstrating
a significant difference between the attitude of the participants before and after the intervention using
paired t‑test (P < 0.001). In terms of the performance of the midwives, participating in the research,
there was a significant decrease in the number of deliveries without episiotomy.
CONCLUSIONS: According to the results of the study, education and support of midwifery personnel
can change the attitude and performance of these individuals in conducting a routine episiotomy,
thereby reducing the number of child deliveries without episiotomy.

Abstract BACKGROUND: Innovation in the development and review of curriculums is one of the requirements
of medical education in the present era. SPICES model has been taken into consideration by nursing
faculties to promote quality of nursing education and to eliminate conventional curriculums. In Iran,
for competency‑based nursing education, review and development of curriculums are necessary.
OBJECTIVE: The objectives of the present study were to determine the implementation of SPICES
model in nursing curriculums of Tehran (Iran), Western (Canada), and Hacettepe (Turkey) nursing
faculties and also to present recommendations to operationalize it in the nursing curriculum of Iran.
MATERIALS AND METHODS: This study using comparative method with Brady’s model was
conducted in 2018. In this study, curriculums of nursing faculties of Tehran, Western Canada, and
Hacettepe were compared. Data were extracted through texts and documents available at electronic
pages of universities. Curriculums of these nursing faculties were compared from the perspective of
SPICES model strategies (student‑based, problem‑based, integration, community‑based, elective,
and systematic) at four steps of description, interpretation, juxtaposition, and comparison.
RESULTS: The results showed that curriculums in Western Canada reside at the end of the innovative
spectrum of SPICES model. Curriculums in Tehran and Hacettepe in most of the strategies of this
model reside at the beginning of the spectrum, and in most cases, conventional methods were used.
CONCLUSIONS: According to successful experiences of Western Canada in the implementation
of SPICES model’s strategies and also considering this fact that still conventional approaches are
prevalent in Iran, it is recommended to focus on experiences and, according to social conditions
and facilities of the nursing community, to implement necessary changes in the curriculums based
on this model.

Abstract The practice style variation (PSV) incurs undesirable clinical and economic consequences for patients
and the healthcare system. This review aims to analyze the economic consequences of PSV in
medical interventions. A comprehensive electronic search was conducted through PubMed, Web of
Sciences, EBSCO, EMBASE, and Cochrane databases to retrieve studies on economic consequences
of PSV within 1975–2018. The studies were independently assessed by two reviewers. The quality
of studies was assessed by Strengthening the Reporting of Observational Studies in Epidemiology
checklist. No language restriction was applied. Only four studies met the eligibility criteria. These
studies have been conducted retrospectively in developed countries. Most of the included studies
used consumer demand theory to measure the economic consequences of PSV. Findings showed
12%–74% of all variations in healthcare services are related to PSV, thereby incurring up to 23 million
dollars for the healthcare system. The PSV is related to the total expenditure, price elasticity, and
coefficient of variation of healthcare services. PSV associated with huge inefficiency and inequity in
access to healthcare services. To mitigate the consequences of PSV, policymakers should consider
PSV in both developing the medical education plans as well as cost management. Using multilevel
analysis to investigate the determinants of PSV would be beneficial.

Abstract BACKGROUND: Given the substantial role of information systems in planning and simplifying the
decision‑making process for the government, organizations, health centers, and facilitators, in order
to attract medical tourists from less developed and neighboring countries, the comprehensive Iranian
Medical Tourism Information System can be used. The objective of this study was to designing a
conceptual model for Iranian medical tourism information system.
METHODOLOGY: This study was carried out in a three‑step applied and combined method. In the
first step, a systematic review was done on the studies and then the reliability of the results was
checked during a semi‑structured in‑depth interview with 11 experts in medical tourism through open
questions. In the third step, the Delphi method was conducted quantitatively to get the ideas of 26
experts. SPSS software version 22 was used for factor analysis.
RESULTS: The proposed conceptual model for Iranian Medical Tourism Information System includes
a variety of services from the first moment of decision to travel until the moment of returning from a
medical journey, following up the treatment, and sharing the patients’ experiences.
CONCLUSION: It could be concluded that considering the commercial importance and financial
benefits of medical tourism, it should provide the necessary facilities to expedite the provision of
services to these foreign patients; consequently, an appropriate basis for attracting more medical
tourists from neighboring countries, developing countries, and even developed countries will be
provided.

Abstract BACKGROUND: Regarding lack of resources in the health‑care sector, prioritization of these
resources is inevitable. The objective of the current study was to elicit public preference in prioritizing
and allocating health resources using a discrete choice experiment technique, which is currently the
most commonly applied method in this field of researches.
METHODS: In this discrete choice study, five attributes were selected through interview with 25 health
experts to elicit people preferences in Tehran (Iran) in 2017. Eighteen choice tasks were arranged
within 3 blocks, and this would be achieved with a sample size of 579. Choice data were modeled
using generalized estimating equation method and STATA 14 software.
RESULTS: Five attributes including level of emergency, severity of disease, communicable, benefit
from treatment, and age are the most important attributes in the prioritizing health resources from
the expert’s point of view. As well as among these attributes, communicable (odds ratio = 2.81) is
the most important attributes from the public’s point of view.
CONCLUSION: The results of this study could be very useful for prioritizing resources which is one
of the most challenging measurements of the health system. By identifying the importance of each
patient’s characteristic, patients can be categorized in groups with different priorities, as well as the
diagnosis‑related group system, based on which resources are allocated.

Abstract INTRODUCTION: Pathology is basic science, and steps are being taken to integrate the clinical
sciences in undergraduate pathology curriculum. The present study was undertaken with the aim to
assess the need for revision of the undergraduate pathology curriculum with a focus on assessment
methods.
MATERIALS AND METHODS: This study included a questionnaire‑based, anonymous, survey in a
5‑point Likert‑type scale for undergraduate students who have completed pathology subject including
the interns and a qualitative approach through interviews and focus group discussions from the
pathology senior residents and faculties using the essentialist thematic analysis.
RESULTS: There were a total of 109 feedbacks from undergraduate students and also the interns.
A total of 10 feedbacks from the senior residents and faculties were analyzed. About 70%–90% of
the students were satisfied with the pathology curriculum and teaching and clinical integration in
pathology. However, only 52.3% of students felt morphology being extremely important as compared
to 80% of faculties, showing a discrepancy between the students’ perception of the importance of
morphology and that of the faculties.
CONCLUSION: Although both students and faculties find the curriculum adequate, it is suggested
that teaching could be made more clinical oriented. The assessment based on morphology should
be given less emphasis during the assessment.

Abstract BACKGROUND: Obesity and iron deficiency (ID) are two forms of the most usual nutritional disorders
worldwide. Some studies have discovered a correlation between ID and obesity although more
investigation is required. This study was aimed to determine the association between obesity and
ID anemia (IDA) in Iranian childbearing age women.
MATERIALS AND METHODS: This cross‑sectional study was done on 256 women of reproductive
age in northern Iran. The anthropometric measurements including height and weight were measured,
and body mass index (BMI) was calculated. Low blood index of the hemoglobin (Hb), mean cell
volume (MCV), and mean corpuscular hemoglobin (MCH) were evaluated with ferritin, serum iron,
and total iron‑binding capacity. Baseline data were expressed as means ± standard deviations.
Chi‑square test was applied to compare the categorical variable. Differences between the two groups
were evaluated with independent samples t‑test. A value of P < 0.05 was considered as statistically
significant.
RESULTS: Obesity was in urban women higher than rural women (55.1% vs. 44.9%), and this
difference was significant (P < 0.021). There was found no association between hematological
characteristics and BMI. The data showed that only 13.4% of obese women and 17.1% of the women
with normal weight had IDA (odds ratio = 0.75; 95% confidence interval: 0.39–1.49, P > 0.05).
CONCLUSIONS: According to the results of this study, it seems that the relationship between obesity
and IDA is controversial. Hence, further studies are needed to be done.

Abstract BACKGROUND: The dust and sand storms (DSS) in Iran increased in recent years, which have
caused adverse health effects. Regarding the effects of DSS on the health indicators, the health
system plays a key role based on the mission and the services which it provides. The present study
was conducted, in Iran, to fill the existing knowledge gap and to understand the preparedness
challenges of the health system in response to the DSS.
MATERIALS AND METHODS: Twenty‑one semi‑structured interviews, in 2016–2017, were
undertaken. This study carried out using purposeful sampling with key informants in the Khuzestan
Province, national policymakers in Tehran, as well as people affected by this phenomenon.
A qualitative approach, using the conventional content analysis, was employed to analyze the
collected data.
RESULTS: Four main categories that appear to explain the preparedness challenges of the health
system for DSS include the risk assessment, knowledge management, organizational elements, as
well as monitoring and evaluation.
CONCLUSIONS: It is imperative that policymakers of the country pay special attention to the hazard
risk understanding and managing the various aspects of the beliefs and attitudes associated with
DSS. The development of early warning system, regular drills and exercises, as well as public and
specialized health promotion training related to this phenomenon are suggested.

Abstract CONTEXT: Measures related to birth preparedness and complication readiness (BPCR) during
pregnancy play an important role in producing better pregnancy outcome. If the pregnant females are
properly counseled during antenatal visits, it could help in bringing out desirable behavior changes.
AIMS: This study aims to study BPCR‑related awareness and practices among the pregnant females
and the effect of focused and structured birth preparedness counseling on complication readiness
among pregnant females.
SUBJECT AND METHODS: A facility‑based follow‑up study was conducted from July to December
2016, and a total of 130 pregnant females were enrolled. All study participants were initially assessed
for various domains of BPCR index consisting of seven key indicators. The index reassessment
was done again, after 1 month, during follow‑up visit. Information regarding any pregnancy‑related
complication in due course and behavior was also recorded during successive follow‑up.
STATISTICAL ANALYSIS USED: The difference in pre‑ and postcounseling mean BPCR index was
assessed using paired t‑test, and McNemar’s test was used for paired categorical data analysis.
P < 0.05 was considered to be statistically significant.
RESULTS: The postcounseling BPCR index  (70.65 ± 19.18) was found to be significantly much
higher as compared to pre‑counseling baseline BPCR index (41.12 ± 11.34). Knowledge about
danger signs of pregnancy, transportation services provided by government, financial assistance
provided in Government schemes, identification of skilled birth attendant, mode of transportation,
and arrangement of emergency blood donor was found to increase significantly after counseling.
Abortion was found to occur significantly higher (about thrice) among those who had postcounseling
BPCR index below average, i.e., <50% (P < 0.05).
CONCLUSIONS: The results of the present study revealed that focused birth preparedness
counseling on complication readiness could play an important role in increasing the baseline
knowledge of pregnant females regarding pregnancy‑related complications and bring out desirable
ideal health‑seeking behavior changes during pregnancy.

Abstract BACKGROUND: Initial formative years in every children’s life are critical for their optimal development,
as these frame the foundation of future well‑being. With a varied prevalence of developmental
delays (DDs) in the world and most of the studies representing the hospital‑based data. The present
study was aimed to find the prevalence and risk factors for DDs (domain wise) in children aged
2 months to 6 years in the rural area of North India.
METHODS: This was a cross‑sectional study in which a multistage random sampling technique was
used. From 30 Anganwadi centers, 450 children aged 2 months–6 years were taken in the study.
Rashtriya Bal Swasthya Karyakram screening tool developed by the Ministry of Health and Family
Welfare, India, was used for developmental screening. Binary logistic regression analysis was done
to identify the predictors for DDs (domain wise).
RESULTS: Seventy‑three (16.2%) children were found to have DDs and 60 (13.3%) children had
the global DDs. About 84/421 (20.0%) children had cognitive delay, followed by 43/450 (9.6%)
children who had delay in speech and language area. About 17/190 (8.9%) children had social
delay while 26/407 (6.4%) children had hearing and vision impairment. Gross motor delay was
seen in 24/450 (5.3%) children and 16/300 (5.3%) children had fine motor delay. Gestational
age (adjusted odds ratio [AOR] – 13.30), complications during delivery (AOR – 25.79), meconium
aspiration (AOR – 12.81), and child never breastfed (AOR – 8.34) were strong predictors for the
delay in different domains of developmental milestones.
CONCLUSION: Socio-economic, ante-natal, natal and post-natal factors should be considered for
prompt identification and initiation of intervention for DDs.
RECOMMENDATION: There is a need for increasing awareness and knowledge of parents regarding
the achievement of developmental milestones according to the age. A multipronged approach to the
holistic treatment of developmentally delayed children for early intervention is required.

Abstract BACKGROUND: Sexual assertiveness plays a crucial role in the quality of sex, as well as in
investigating and treating sexual problems. The purpose of this study was to determine the impact of
assertiveness‑based sexual training on the quality of marital relationships of married female students.
METHODS: This quasi‑experimental study was done in southeastern Iran in the academic year
of 2017. A total of 80 married women were chosen from university students through convenience
sampling, and they were assigned to the intervention (n = 40) and control (n = 40) groups. Data were
collected using the Perceived Relationship Quality Components Inventory. For the intervention group,
assertiveness‑based sexual counseling was provided in four sessions (90–120 min each session).
The posttest was performed 12 weeks after the last counseling session. Independent t‑test and
covariance analysis were employed to analyze data using SPSS version 21 software.
RESULTS: After the intervention, the two groups revealed a significant difference in their respective
mean total score of the quality of various dimensions of marital relationships (P = 0.0001). This
indicates that assertiveness‑based sexual counseling has improved this mean total score in the
intervention group compared to the control group.
CONCLUSION: Given the positive impact of assertiveness‑based sexual training on the quality of
students’ marital relationships, the integration of sexual training with focus on assertiveness in usual sexual
counseling will help therapists to improve the quality of marital relationship from the perspective of women.

Abstract INTRODUCTION: An important indicator increasing the survival chances of patients and injured
people immediately after emergency and disaster is the rapid access to medical services. The
establishment of Emergency and Disaster Medical Response Teams (EDMRTs) is one of the main
strategies to improve response capacity and capability in the field of EDMRT. This study aimed to
probe the structural factors influencing of EDMRTs.
METHODOLOGY: In this study, a comparative review method was used. The current study was
conducted between March 2017 and September 2018. For this, articles, books, formal reports, and
information concerning the available websites regarding the structure of EDMRTs were analyzed. To
access relevant scientific articles, an extensive search was carried out in several steps using divergent
keywords in the Scopus, ProQuest, PubMed, ScienceDirect, and Google Scholar databases. After
accessing the resources and documents, the process of analyzing and comparing different team
structures was carried out using content analysis.
RESULTS: Following the search of relevant databases and websites, the structure of EDMRTs in the
United States, Australia, Japan, Turkey, New Zealand, Canada, and the World Health Organization
were taken into consideration and compared. Two areas of “Organization and Management” as well
as “Capacity and Capability Development” were explored along with multiple subsets.
CONCLUSION: The results of this study revealed that the model and structure of EDMRTs have
direct relationship with such elements as the structure of the disaster risk management system, risk
assessment, impact of the hazards and medical needs of the affected area, population distribution,
level of team activity, and timing of the teams’ presence after disasters. The research team
recommends designing and conducting studies for determine the roles and responsibilities of the
teams.

Abstract BACKGROUND: One of the important challenges at the Universities of Medical Sciences is the
mentorship of postgraduate students’ academic theses. Since 2015, the Research Mentorship
Program (RMP) has been implemented with the aim of improving research knowledge and skill,
thesis quality, and quantity and quality of papers of emerging from postgraduate students’ theses.
METHODS: This was a prospective cohort study with census sampling method (nonprobability
sampling), completed between 2015 and 2018. Twenty‑eight postgraduate students participated in
the program. Each trainee student is done during the research period through the supervisor and
another student in a higher level of education as mentor. Questionnaire with open‑ended questions
and checklist was used for data gathering. For statistical analysis, Chi‑square test was used.
RESULTS: 100% of the mentors and 93% of the mentee participated at the Research Mentorship
Program were satisfied. In addition, the duration of the research course for the master’s students
participated in the RMP was reduced. Participants in this program had higher quantity and quality of
papers resulting from postgraduate student’s academic theses. RMP can enhance the postgraduate
students’ knowledge and skills in their research projects and research methods, develop personal
and professional relationships, and promote interpersonal communication as a student or mentor.
CONCLUSION: This program and its similar programs can improve the quality of postgraduate
students’ academic theses and reduce their research period.

Abstract CONTEXT: Predicting residents’ academic performance is critical for medical educational institutions
to plan strategies for improving their achievement.
AIMS: This study aimed to predict the performance of residents on preboard examinations based
on the results of in‑training examinations (ITE) using various educational data mining (DM)
techniques.
SETTINGS AND DESIGN: This research was a descriptive cross‑sectional pilot study conducted at
Iran University of Medical Sciences, Iran.
PARTICIPANTS AND METHODS: A sample of 841 residents in six specialties participating in the
ITEs between 2004 and 2014 was selected through convenience sampling. Data were collected
from the residency training database using a researcher‑made checklist.
STATISTICAL ANALYSIS: The analysis of variance was performed to compare mean scores
between specialties, and multiple‑regression was conducted to examine the relationship between
the independent variables (ITEs scores in postgraduate 1st year [PGY1] to PG 3rd year [PGY3],
sex, and type of specialty training) and the dependent variable (scores of postgraduate 4th year
called preboard). Next, three DM algorithms, including multi‑layer perceptron artificial neural
network (MLP‑ANN), support vector machine, and linear regression were utilized to build the
prediction models of preboard examination scores. The performance of models was analyzed
based on the root mean square error (RMSE) and mean absolute error (MAE). In the final step,
the MLP‑ANN was employed to find the association rules. Data analysis was performed in SPSS
22 and RapidMiner 7.1.001.
RESULTS: The ITE scores on the PGY‑2 and PGY‑3 and the type of specialty training were the
predictors of scores on the preboard examination (R2 = 0.129, P < 0.01). The algorithm with the
overall best results in terms of measuring error values was MLP‑ANN with the condition of ten‑fold
cross‑validation (RMSE = 0.325, MAE = 0.212). Finally, MLP‑ANN was utilized to find the efficient
rules.
CONCLUSIONS: According to the results of the study, MLP‑ANN was recognized to be useful in the
evaluation of student performance on the ITEs. It is suggested that medical, educational databases
be enhanced to benefit from the potential of DM approach in the identification of residents at risk,
allowing instructors to offer constructive advice in a timely manner.

Abstract BACKGROUND: With an estimation of every two women newly diagnosed with breast cancer,
one dies. It is accounted that 1 in 28 women is likely to develop breast cancer during her lifetime.
Developing a risk prediction tool by assessing the prevalence of known risk factors in the community
will help public health intervention.
METHODOLOGY: A cross‑sectional study was conducted among 18–64‑year‑old women to gather
the prevalence of known breast cancer risk factors, through a community survey (sample survey). In
this multistage random number‑based cluster sampling study, the results were compiled, collated, and
analyzed in rates and proportions. Statistical conclusions were made using spreadsheets (Microsoft)
and the values were converted into ordinal values using modified Likert scale and median was used
to estimate central values. The estimated prevalence of these known risk factors was re‑assorted for
analysis and these re‑assorted data were categorized into range of values across the communities.
The internal validity of the survey questionnaire was measured using Cronbach’s alpha (α).
RESULTS: The analysis of 558 participants was performed for the known risk factors for breast cancer
including participant’s age, age at menarche, marriage, first childbirth, menopause, family history of
breast cancer and benign breast disease, history of abortion, and body mass index. Based on the
estimated prevalence of these risk factors, a community‑based risk prediction tool was developed
with Cronbach’s α score of medium internal validity.
CONCLUSIONS: The risk assessment tool has collated most of the risk factors of breast cancer
that are capable of being measured at community level. The survey findings concluded that the
community under survey was bearing moderate risk for breast cancer for women.

Abstract The political, social, economic, and security implications of health‑related issues such as emerging
infectious diseases or the epidemic of Non Communicable Diseases offer a rare opportunity for
professionals in foreign policy and international relations to engage with the health arena and at the
same time for global health experts to enter into and intersect with the domain of diplomacy. The aim
of this review is to understand and explore the concepts of global health diplomacy (GHD), health
security, and human security. For this narrative review, a literature search was done in PubMed,
Scopus, and EBSCO for the “global health diplomacy,” “health security,” and “human security,” and
full‑texts were reviewed. The recent outbreaks of Ebola in West Africa and Zika in South America
are pertinent examples of the nature of the human security crisis and the imminent and severe threat
posed to human life across the globe as a result of these epidemics. The Commission on Human
Security defines human security as the protection of the vital core of all human lives from critical
and pervasive threats. We highlight the ways in which health has now become an issue of national
security/global concern and also how GHD can aid in the development of new bilateral or multilateral
agreements to safeguard the health and security of people in our globalized world. The paper provides
a prospective about, and overview of, health and human security that essentially emphasizes the
growing interlinkages between global health, diplomacy, and foreign policy.