Journal of Education and Health Promotion

Abstract INTRODUCTION: Stress in pregnancy can have a negative effect on mother and fetus and at last
on childhood. The use of stress reduction techniques in pregnant women has an effective role in
the reduction of the mother and child’s mental problems. This study aimed at determining the effect
of static immersion and relaxing the pregnant women in water on stress, participating in preparation
classes for childbirth in Isfahan, Iran, 2017.
METHODS: The present study was a semi‑experimental and had pre‑ and post‑test
one on 55 pregnant women aged 20–30 weeks (20 test group and 35 control group)
participating in the preparation classes for delivery by available sampling method selected in
2017 and their stress level was assessed by depression, anxiety, and stress scale questionnaire.
Then, they were divided into test and control groups. In the control group, no intervention was
performed, and in the test group, static immersion and calming in water was done in Isfahan
University’s 9‑Dey Pool. To analyze the data, paired t‑test, Chi‑square t‑test, and independent
t‑test were used.
RESULTS: In this study, stress in the test group decreased after the intervention, so that the mean
stress score decreased from 20.20 to 16.67 (P < 0.05). Of course, the stress level declined in the
control group, but in the control group, it decreased significantly.
CONCLUSION: Based on the findings of the present study, static immersion and calming in water
are considered as reducing women’s stress intervention in improving pregnancy period and are
therefore recommended to be included in the sanitary system.

Abstract INTRODUCTION: Women make up half of the world’s population and play a critical role in the health
and well‑being of the family and society. The purpose of this study is to determine the effectiveness
of existential psychotherapy on attitude to life and self‑flourishing of educated women homemakers.
METHODS: A quasiexperimental study with the pretest–posttest design is used in this work. The
research population included 68 homemakers with university education who live in Neyshabur, Iran.
Sampling method was available. The women were randomly assigned into two groups: intervention
and control groups. The women in the intervention group participated in 10 sessions of existential
therapy group. The data collection tool was a questionnaire of Life Regard Index (LRI) and Human
Flourishing Questionnaire (HFQ). The data were analyzed by the SPSS software version 21 using
Chi‑square, independent t‑test, and paired t‑test while P < 0.05 considered as a significant level.
RESULTS: Scores of attitude to life and self‑flourishing in educated homemakers before intervention
were not significantly different in the two groups. Independent t‑test showed that self‑flourishing
was significantly increased in the intervention group (90.88 ± 15.27) compared to the control
group (79.64 ± 15.87) (P = 0.004). The attitude to life was significantly increased in the intervention
group (35.79 ± 14.21) compared to the control group (27.50 ± 8.77) (P = 0.005).
CONCLUSIONS: The results of this study emphasize that existential group therapy is effective
in attitude to life, and self‑flourishing of educated homemakers. This therapy can also be used to
enhance individual and social abilities the importance and impact of existential psychotherapy on
enhancing capabilities such as a positive attitude to life and self‑flourishing.

Abstract BACKGROUND: Personality types of learners have determining role in their achievements. Many
researchers concentrate on noncognitive moderators such as personality traits to trace the barriers
in learning. This study attempts to find out what kinds of personality types enable learners to be
more competent in intercultural context.
METHODS: To conduct the study 236 students were randomly selected from Ardestan and Khorasgan
Universities. Two questionnaires were used to collect the data. The first one was a researcher’s
made questionnaire to assess learners’ intercultural competence; based on Bennett’s Intercultural
communicative Model of intercultural communicative competence (ICC); and intercultural competence
assessment Model of ICC, consisting four behavioral dimensions, tolerance for ambiguity, flexibility,
respect for otherness, and interaction. The second questionnaire wasMyers‑Briggs Type Indicator to
identify learner’s personality type. The means, standard deviations, t‑scores, and significance levels
of behavioral dimensions were calculated to interpret the data.
RESULTS: The analysis of the results revealed that greater general competence in cultural adjustment
is associated with greater extroversion personality. Students with thinking and judging personalities
were more tolerant for ambiguities of foreign cultures than those with feeling and perceiving personality
types. The data of respect for otherness were very similar to tolerance for ambiguity, and students
with sensing personality preference were more competent in interacting with foreign cultures than
intuitive ones.
CONCLUSION: The findings indicated the personality types play opportunity or threat roles for FL
learners in intercultural understanding. Therefore, to promote efficiency in education, it is vital to
explore the learners’ cognitive and noncognitive health conditions.

Abstract BACKGROUND: Iranian universities optimistically can be regarded as second‑generation
research‑centered universities which train people who can only fill the predefined occupational
gaps. These universities are doing very little to become third‑generation universities. It seems that
medical science universities have a huge capacity to create and expand entrepreneurship in health
care because of their diverse activities in health services. The present study aimed to investigate the
effective factors affecting the Iranian medical universities transition to third‑generation universities.
METHODS: The present study is a qualitative study which was carried out in Kerman University of
Medical Sciences. The study population was the faculty members of Kerman University of Medical
Sciences who had been selected by purposeful sampling method. For this purpose, 13 faculty
members of Kerman University of Medical Sciences who were interested in the topic were interviewed.
To collect data, a number of general questions were asked from the participants to clarify specific
topics. The interviews lasted between 20 and 45 min. The descriptive phenomenology method was
used for data analysis based on the Colaizzi’s seven steps.
RESULTS: In the present study, five main themes include; reforming the bureaucracy, paying attention
to the empowerment of university personnel, improving the status of graduates, reviewing the status
of education and research, and connecting with the industry and making a profit were identified.
CONCLUSION: We can use strategies such as reduction of bureaucracy, privatization, reduction
of management pyramid, culture building, creation of appropriate reward system, and taking a role
model from successful people.

Abstract INTRODUCTION: The objective of the present study was to systematically review the current research
knowledge on hospital preparedness tools used in biological events and factors affecting hospital
preparedness in such incidents in using a scoping review methodology.
MATERIALS AND METHODS: The review process was conducted in accordance with the Preferred
Reporting Items for Systematic reviews and Meta‑Analyses extension for Scoping Reviews
guideline. Online databases (PubMed, Scopus, Web of Science, and Google Scholar) were used to
identify papers published that evaluated instruments or tools for hospital preparedness in biological
disasters (such as influenza, Ebola, and bioterrorism events). The search, article selection, and data
extraction were carried out by two researchers independently.
RESULTS: A total of 3440 articles were screened, with 20 articles identified for final analysis. The
majority of research studies identified were conducted in the United States (45%) and were focused
on CBRN incident (20%), Ebola, infectious disease and bioterrorism events (15%), mass casualty
incidents and influenza pandemic (10%), public health emergency, SARS, and biological events (5%).
Factors that were identified in the study to hospitals preparedness in biological events classified in
seven areas including planning, surge capacity, communication, training and education, medical
management, surveillance and standard operation process.
CONCLUSIONS: Published evidences of hospital preparedness on biological events as well as the
overall quality of the psychometric properties of most studies were limited. The results of the current
scoping review could be used as a basis for designing and developing a standard assessment
tool for hospital preparedness in biological events, and it can also be used as a clear vision for the
healthcare managers and policymakers in their future plans to confront the challenges identified by
healthcare institutes in biologic events.

Abstract BACKGROUND: Preterm low birth weight (PLBW) is a leading perinatal problem in developing
countries. PLBW is considered as a leading cause of neonatal death in the 1st year of life, with problems
in childhood and adulthood. Several studies have suggested a possible relationship between PLBW
and periodontal status of the expectant mothers. The present study was conducted to determine the
association between the maternal periodontitis and the low birth weight (BW) of the babies.
MATERIALS AND METHODS: This study consisted of 200 primipara mothers ranging between
18 and 35 years old, with a mean age of 23.96 years. The mothers were categorized based on the
weight of the infants as cases (BW <2500 g) and as controls (BW ≥2500 g). Age, mean weight,
height, body mass index, and periodontal status of the mothers as well as weight of the babies were
recorded. Periodontal parameters were assessed using the community periodontal index (CPI). The
data were recorded, analyzed, and statistically compared using the Chi‑square test (χ2
).
RESULTS: BW of the babies was regressed against CPI. Periodontitis was significantly associated
with decrease in BW of the babies (P < 0.0001).
CONCLUSION: Our findings showed an association of maternal periodontal disease with PLBW that
emphasizes to promote good oral hygiene of the expectant mothers during routine prenatal visits.

Abstract BACKGROUND AND AIM: Full health is one of the basic human rights and requires a healthy lifestyle.
Public continuous education, especially among the students who are a great target group and the
future of the country, is the best way to modify lifestyle. Therefore, the present study was conducted
with the aim of analyzing the factors affecting the prevention of non communicable diseases from
studentsʼ viewpoints in Isfahan in the academicyear of 2016–2017.
METHODS: This study was carried out through the qualitative approach and conventional content
analysis method. Participants included 27 students who were selected by convenient and purposeful
sampling method with maximum variation. Method of data collection was semi structured interviews
with sound recordings with note–taking, and data analysis method was inductive content analysis.
RESULTS: After removing repetitive codes and merging the similar ones, 1237 codes were obtained
from interviews that were placed in 7 main categories and 18 subcategories. The main categories
included “grand health policy‑makings,ˮ “the role of the educational system in promoting health,ˮ
“schools and healthy nutrition models,ˮ “schools and sports and physical activity development,ˮ
“informal learning,ˮ “preventive strategies in health promotion,ˮand “lifestyle modification.ˮ
CONCLUSION: It seems that controlling and improving the factors affecting lifestyle and making
school education more effective are the main factors that influence the efficacy of preventive
educational programs of non communicable diseases.

Abstract BACKGROUND: Cancer cervix is caused by human papillomavirus (HPV), oncogenic virus and has
vaccines and screening as its preventive measures. This study analyzes the change in awareness
and attitudes of nonmedical students toward the condition following the use of an educational module.
METHODOLOGY: The study design was quasi‑experimental. The interprofessional (IP) team
implemented an educational module and analyzed the difference in awareness of young individuals
toward the cancer cervix. A pretest and posttest written questionnaire, customized for both genders,
was administered with the intervention of the educational module in between. The module consisted
of a short educational presentation along with a group activity. A follow‑up survey was also done after
2 months to check the attrition of awareness. The statistical analysis was done using MacNemar test
using SPSS 12 IBM software and significance of differences were determined.
RESULTS: There was a significant improvement of knowledge and awareness on linkage between
HPV and cervical cancer (P < 0.001). There was also significant change with regard to attitudes
toward cervical cancer vaccination (P = 0.004). The knowledge of HPV linkage to the malignancy
was maintained after 2 months of gap. The subjects also wished for more future awareness program.
CONCLUSIONS: There is improved awareness in the dental and foundation in science students,
and this improved awareness will ensure favorable attitudes toward cervical cancer vaccines or
will attend regular screening programs. Awareness program must be held at regular intervals at
different locations to enhance the knowledge dissemination of this common yet preventable genital
malignancy of females. The IP collaboration and practices will help in reducing the disease burden
of the society in future.

Abstract BACKGROUND AND AIM: Several factors are involved in obtaining the competence of providing
spiritual care in nursing students. The purpose of this study was to explain the relationship between
moral intelligence and the professional self‑concept with the competency of the nursing students in
providing spiritual care to promote nursing education.
MATERIALS AND METHODS: The present study was descriptive‑analytics and the participants
were the 7th and 8th semester nursing students of the processing district 6 of the medical sciences
universities. The data were collected using questionnaires “Nursing student competencies for
providing spiritual care,” “Nursing professional self‑concept” and “Moral intelligence” questionnaire
and analysed using correlation and regression tests.
RESULTS: The results showed that there is a significant relationship between the moral intelligence
and the students competency in providing spiritual care (r = 0.24, P < 0.001), while this relationship
was not significant for the professional self‑concept (r = 0.045). Furthermore, based on the results
of multiple regression analysis, the moral intelligence (B = 0.28, P = 0.001), gender (B = −4.23,
P = 0.048), place of living (B = 10.59, P = 0.046), and adherence to religion (B = −11.82, P = 0.002)
were the predictors of students’ competency in providing the spiritual care.
CONCLUSION: According to the results of this study, it is suggested that by applying strategies
to strengthen the moral intelligence of the students, such as holding‑related workshops as well
as reinforcing religiosity, the student’s competency in providing the spiritual care to the patients is
reinforced.

Abstract BACKGROUND: The decrease in coverage of exclusive breastfeeding for mothers who work
in Pontianak has an impact on the decline of the baby’s immune system. Prevention efforts can
be done by increasing knowledge about exclusive breastfeeding tips for mothers who work by
providing health education. This study aims to examine the effectiveness of the use of health
education media in increasing maternal knowledge about exclusive breastfeeding tips for working
mothers.
MATERIALS AND METHODS: This is a quasi‑experiment study with a nonrandomized design
pretest and posttest control group design. The population of nursing mothers who have children
aged 0–6 months. The number of samples is 140, which is divided into four groups. Data collection
use direct interviews. Respondents filled out the pretest questionnaire to measure knowledge before
being given health education. Then, the first group was given treatment in the form of lectures, the
second group using leaflets, and the third group was given lectures first then given leaflets. After
that, his knowledge was measured again through a posttest. Data analysis were used to determine
the increase in the score of knowledge about exclusive breastfeeding tips for mothers who worked
on each media used repeated ANOVA and Kruskal–Wallis test, while one‑way ANOVA continued
with post hoc Bonferroni and Friedman followed by Mann–Whitney test used to compare score
differences knowledge on all three media.
RESULTS: there were significant differences in knowledge, before and after being given good health
education without media, with leaflets, electronic media, and electronic leaflets before. statistical
tests before and after used leaflets and electronic media without media 19.85 (P ≤ 0.001), leaflets
without media 8.42 (P ≤ 0.001). Electronic without media at 8.14 (P ≤ 0.001). In the pre‑ and
post‑test study, the experimental study was pseudo, 140 individuals with each group 35 individuals.
CONCLUSION: The most effective method in providing health education to increase the knowledge
of breastfeeding mothers about tips on exclusive breastfeeding for working mothers is electronic
leaflet media.

Abstract INTRODUCTION: An individual’s lifestyle is closely related to the health so that a healthy lifestyle
improves the purpose of this study was prioritizing health promotion lifestyle domains in students of
Qazvin University of Medical Sciences from the students and professors’ perspective.
MATERIALS AND METHODS: This study was done in cross‑sectional method. The statistical
population of this study consisted of students in Qazvin University of Medical Sciences in the academic
year 2018. In addition, 10 faculty members in this university and five students were questioned in
Delphi method from different educational groups. The questionnaire was used consisted of two
parts. The first part included demographic characteristics, and the second part included the standard
questions for Pender’s health promotion model. The Delphi needs assessment method was also
used to collect the information.
RESULTS: The mean score of students’ health‑promoting behaviors was average (135.22 ± 19.35).
The greatest score of health promotion behaviors was related to the spiritual growth scale (25.3 ± 5.4),
and the lowest score was for physical activity (19.7 ± 05.1). The results of the Delphi method also
suggested that both groups of faculty members and students believe that the dimensions of health
accountability, physical activity, and prevention of high‑risk behaviors in the students’ lifestyle, need
to be intervened.
CONCLUSION: The results of the present study indicated that the students’ lifestyle at Qazvin
University of Medical Sciences was in average condition and low scores in the dimension of physical
activity. Planned interventions should be made to promote health‑promoting lifestyle among these
students.

Abstract INTRODUCTION: This study aimed to predict health information‑seeking behavior (HISB) components
based on health anxiety among users of public libraries.
MATERIALS AND METHODS: This research was a descriptive‑correlational study. The statistical
population consisted of users of public libraries. Data collection tools included the HISB questionnaire
and the Short Form of Health Anxiety Inventory (SHAI).
RESULTS: The results indicated that health anxiety was a significant predictor of the components
of HISB. The illness likelihood had a direct relationship with the components of the need for health
information and the purposefulness of health information seeking, and it was inversely related to
barriers to obtaining health information. In addition, the preoccupation with illness was directly related
to the components of the need for health information, the diversity of health information sources, the
time of referring to health information sources, the purposefulness of health information seeking, and
evaluation of reasons for referring to the library.
CONCLUSION: Among the components of health anxiety, preoccupation to the disease has the
highest role in the emergence of users’ information‑seeking behavior.

Abstract INTRODUCTION: HIV/AIDS is a serious challenge globally. A plethora of morbidities due to crippling
immune system reduces quality of life (QOL). The advent of highly active antiretroviral treatment
has changed this deadly disease to a chronic manageable illness with focus shifting from fighting
virus to ensuring a good QOL.
OBJECTIVE: To assess the QOL among people living with HIV/AIDS (PLHA) and factors influencing,
if any in Indian setting.
MATERIALS AND METHODS: An institutional‑based cross‑sectional study was carried out among
220 PLHA (male >15 years) attending Anti‑Retroviral Therapy Centre of the center of excellence
in HIV care in India (Calcutta School of Tropical Medicine, Kolkata) from May 2012 to April 2013.
QOL was assessed using WHO‑QOL‑BREF questionnaire from January 2013 to December 2013.
Statistical analysis was done using SPSS version 16; multivariate logistic regression was computed
with adjusted odds ratio in 95% confidence interval; P < 0.05 was considered statistically significant.
RESULTS: In this study, all 220 PLHA men participated (response rate 96.5%) where more than
half (55.5%) participants rated their QOL as neither poor nor good; only 28.2% replied good.
One‑third (38.6%) were dissatisfied while only one‑fifth (19.1%) satisfied and 41.4% mentioned neither
satisfied nor dissatisfied with their health. Mean score ± standard deviation on various domains and
facets of WHOQOL‑BREF were physical health score 56.2 ± 9.8, psychological health 63.1 ± 8.7,
social relationship 48.9 ± 14.8, and environmental health 51.3 ± 13.7.
CONCLUSION: PLHA had good QOL on psychological, physical, and environmental domain that
reflects better services provided at Calcutta School of Tropical Medicine (CSTM), Kolkata, but they
scored poorly in social relationship domain, which may be suggestive of ineffective social services
network. This study concludes that increase existing social and emotional support with innovation
should be implemented to improve their QOL.

Abstract BACKGROUND: The literacy level of the elderly is predictive of health behaviors, average
hospitalization in health centers, and the type of verbal interaction with health service providers;
as the level of literacy changes, the quality of life may also change. This study aimed to determine
the relationship between health literacy level and quality of life among the elderly living in nursing
homes in 2018–2019.
MATERIALS AND METHODS: This study was of a descriptive‑analytic, correlation type that was
performed on 175 elderly of selected nursing homes in Tehran. The research tools included the
Abbreviated Mental Test; Control, Autonomy, Pleasure and Self‑realization questionnaire‑19;
and Health Literacy of Iranian Adults Questionnaire (HELIA). Data were analyzed using descriptive
and inferential statistics by SPSS 22 software.
RESULTS: The total score of health literacy and the quality of life of the elderly was 51.01 and
47.75, respectively. The literacy of most of the studied samples was “inadequate” and “not much
adequate” (0–66). The relationship between health literacy and quality of life in the elderly was
significant, and there was a direct and statistically significant relationship between them (P = 0.003).
That is, by an increase in literacy rates, the scores of quality of life of elderly people were also
increased. The correlation was equal to r = −0.28. Health literacy has the ability (31.98%) to predict
the quality of life.
CONCLUSION: The results showed a lack of enough education literacy, the average quality of life,
and the existence of a significant relationship between health literacy and quality of life in the elderly.
The wide range of inadequate literacy in the elderly reveals the importance of paying more attention
to the issue of literacy in health planning and health promotion at the national and local levels.

Abstract BACKGROUND: Smokeless tobacco (SLT) usage contributes about 40% of the total tobacco used
in India. Among the 28 known carcinogens in SLT, tobacco‑specific nitrosamines are considered to
be the most potent. This has challenged the metabolic condition leading to a rise in the inflammatory
status, hepatic injury, and apoptosis of the liver and thyroid tissues. Therefore, the present study was
undertaken to evaluate the adverse effects of SLT on the liver and thyroid and establish a correlation
between them in Jharkhand population.
MATERIALS AND METHODS: A total of 100 individuals (50 SLT users and 50 healthy individuals)
were selected for the study. A complete history was obtained, and clinical examination was done to
evaluate any oral mucosal changes. Venous blood samples were taken to analyze the liver function
test and thyroid profile.
RESULTS: Significant changes were observed in the liver enzyme levels and thyroid profile in SLT
users when compared to healthy controls. All the parameters of liver function test had a positive
correlation with the form of SLT, whereas thyroid profile had a negative correlation.
CONCLUSION: This study might be helpful in creating awareness on the hazards of using SLT among
the Indian population as a despicable substitute to smoking tobacco. It also acts as a diagnostic tool
and warning alarm in chronic tobacco users.

Abstract INTRODUCTION: With the advancement of bioelectrical impedance analysis method, body fat
can be estimated with portable devices at home. These devices are popular in home body fat
monitoring (HBFM). However, improper use of the device may provide erroneous result.
AIM: This study aimed to find out the level of competency of the operator in HBFM.
MATERIALS AND METHODS: A cross‑sectional survey was conducted with 34 individuals
(males = 11, females = 23) during March–December, 2017. A pretested questionnaire was used to
collect information by expert interviewer. Data were collected about premeasurement precautions,
steps followed in body fat measurement proper, and postmeasurement action. Survey data were
expressed in mean, standard deviation, and percentage and statistically tested by unpaired t‑test and
Chi‑square test according to necessity with α =0.05. Analyses were done in GraphPad Prism 6.01.
RESULTS: Premeasurement precautions for maintaining proper hydration level were not followed
by majority of the participants. Avoidance of exercise in preceding 12 h was not followed by
94.12% (χ2 = 26.47, P < 0.0001), voiding bladder before the measurement was not followed by
88.24% ( χ2 = 19.88, P < 0.0001), and avoidance of diuretics (e.g., chocolate, caffeine) was not
practiced by 82.35% (χ2 = 14.24, P = 0.0002). Prescribed steps for measurement proper were followed
by majority of the operators. However, 61.76% (χ2 = 1.88, P = 0.17) forgot to keep log of the readings.
CONCLUSION: Clinicians, fitness instructors, and nutritionists should emphasize on premeasurement
factors for educating their clients for HBFM. This would help proper tracking of body fat level.

Abstract BACKGROUND: Relationship among periodontitis, obesity, and chronic diseases may be
multidirectional. Inflammatory diseases such as periodontitis induce the production of pro‑inflammatory
cytokines such as TNF‑α, IL‑1, and IL‑6. It has been suggested that the secretion of TNF‑α by adipose
tissue triggered by lipopolysaccharides from periodontal Gram‑negative bacteria promotes hepatic
dyslipidemia and decreases insulin sensitivity.
AIM: To study the association of obesity with the severity of periodontitis and to compare the blood
glucose levels and plasma lipid profile in obese and non‑obese subjects with chronic periodontitis.
METHODOLOGY: A total of 84 systemically healthy subjects, aged 30–60 years, were included in
the study. Periodontal status of the subjects was assessed by recording Community Periodontal
Index (CPI) and Gingival Index (Loe and Silness, 1963). Body mass index (BMI) and waist
circumference (WC) were used as measures to assess obesity. The fasting plasma lipids level and
fasting blood glucose level were measured. Data were analyzed by unpaired ‘t’test, Fisher’s Exact
test, and Chi‑square test.
RESULTS: There was a statistically significant difference in Gingival Index and Community
Periodontal Index between the obese and non‑obese group. Total cholesterol, triglycerides, and
low‑density lipoprotein (LDL) levels showed significant difference between the two groups. There
was no statistically significant difference in mean age, high‑density lipoprotein (HDL) levels, and
fasting blood glucose levels between the two groups.
CONCLUSION: The present study showed a positive association between obesity and chronic
periodontitis. Further long‑term studies involving larger sample size are required to confirm this
association.

Abstract INTRODUCTION: The World Health Organization (WHO) recommends the integration of traditional
medicine into each country’s health systems by formulating and implementing national policies and
laws in accordance with the country’s own situation. This study aims to examine and analyze the
national laws and regulations in Iran concerning the integration of traditional medicine into the health
system of the country based on the WHO definition.
METHODS: Policy document analysis was performed through content analysis according to the
WHO components for the integration of traditional and complementary medicine (T&CM ) into health
systems. All government and state websites were explored to locate policy‑associated documents
and laws. Only documents were ultimately included in the study that had been approved by a senior
official of a ministry.
RESULTS: Nine policy documents related to T&CM were found. In these documents, reference
was made to the availability of education (26 cases), regulation (20 cases), availability of therapies
(17 cases), research (15 cases), and insurance coverage (7 items).
CONCLUSIONS: While policies and laws on the integration of T&CM in Iran have been formulated,
this research showed that these policies have been implemented slowly or, in cases, not implemented
at all. The government and the Ministry of Health and Medical Education need to take measures in
this regard after they have evaluated the policies and programs. Given the tendency of the Iranian
people to T&CM , the insurance of T&CM and the development of clinics and hospitals should be
prioritized.

Abstract BACKGROUND: Pediatric foreign body aspiration (FBA) is a life‑threatening condition responsible
for many deaths every year, especially among children younger than 2 years.
OBJECTIVE: This study aimed to determine the level of knowledge among students in Jeddah,
Saudi Arabia.
SUBJECTS AND METHODS: This observational, cross‑sectional study was conducted between
December and January 2018 at Jeddah, Saudi Arabia via a paper‑based questionnaire survey of
male and female high school and middle school students. The Chi‑square test was used to compare
frequencies, and the independent t‑test was used to compare means.
RESULTS: A total of 671 students participated in this survey. The second item, “It is possible for
a child to choke on a small toy” had the highest rate of correct responses among both males and
females (93.2% vs. 94%, respectively). The eighth item “Sudden cough is a sign of choking among
children” had the lowest rate of correct responses among males (40.8%) and females (33%). Most
female participants (74.2%) knew that batteries are the most dangerous items a child can swallow,
which requires immediate medical attention (item 14), while only 56.2% of male participants knew
that (P < 0.001). The only significant predictor on linear regression analysis was “Having treated
anyone with FBA” (coefficient = −0.24, P = 0.03).
CONCLUSIONS: There is inadequate knowledge regarding FBA among middle and high school
students, as is the case among mothers. Moreover, only a small percentage of participants had any
first aid training.

Abstract CONTEXT: The success of the health system research and technology management in the 21st century
can play an important role in advancing the country toward becoming a scientific power.
AIMS: The study aimed to increase knowledge and identify factors affecting the health system
research and technology, as well as to provide solutions for improving the status of health science
and technology.
MATERIALS AND METHODS: This was an applied and descriptive study conducted in 2018 using
cross‑impact analysis. The factors affecting the Iranian Health System Research and Technology
Management and their influences on each other were identified using an expert panel. The key‑driven
factors were determined using the MICMAC software.
RESULTS: The input, stake, target, resultant, excluded, and regulating factors were identified. The
degree of fill rate the matrix was 58.9%. Financial annex of the health scientific map (S = 206),
roadmap (S = 206), governmental laws and regulations (S = 198), and sufficient governmental budget
allocation (S = 194) earned the highest potential influence scores by 2025. Furthermore, scientific
authority (S = 216), international communication (187), university relationship with industries (S = 187),
and competitive infrastructure (S = 178) obtained the highest potential dependence scores by 2025.
CONCLUSIONS: The success of the Iranian Health System Research and Technology Management
by 2025 requires the development of the financial annex of the comprehensive scientific health map,
the development of the road map, and the allocation of sufficient governmental budget for health
research. Policy‑making in health system research and technology management requires more
attention to these factors and the dynamics of relationships among factors in the model.

Abstract BACKGROUND: Student evaluation of teaching (SET) is considered to be one of the most important
as well as inexpensive resources for sustaining professional development in medical teaching. The aim
of this project was to improve the quality of education in our medical college by using student feedback
as a tool for faculty development. However, it is also important to obtain teachers’ perceptions on SET.
MATERIALS AND METHODS: This was an educational research study conducted on a single
practical/tutorial batch of fourth‑semester students in pathology chosen by random selection.
Feedback regarding teaching was collected for all the teachers in the department of pathology
where the students had to rate the teachers on a scale of 1–5. Teachers’ perceptions on students’
feedback were gathered with the help of another structured prevalidated questionnaire containing
15 questions/items. The feedback data were obtained using a 5‑point Likert scale. The scores
obtained from the students’ evaluation data and the teachers’ perception data on the different items
were analyzed using SPSS software version 20.0.
RESULTS: Significant findings from students’ feedback were that 80% of teachers had a median
score of >4 in explicit curriculum, indicating that most of the students agreed that the teachers teach
their core subject well. However, only 20% of teachers had a median score >4 in implicit curriculum.
Teachers, in their feedback, fully agreed that students should be involved in the evaluation of teachers
and that student feedback ensures the overall faculty development in the institute and can be used
as a tool for quality assurance in medical education.
CONCLUSION: Students’ feedback is one of the best methods of evaluation of teachers to ensure
the overall faculty development and quality assurance in medical education. Thus, a regular feedback
mechanism should be in place for the entire institution.

Abstract INTRODUCTION: Sexual dysfunctions are considered as the most prevalent problems in the general
population and their prevalence is so dispersed depending on different cultures and living conditions.
This research investigates the prevalence of sexual dysfunctions and their relevant factors in Tehran.
MATERIALS AND METHODS: In this cross-sectional questionnaire-based study, 1129 women and
men referring to health centers in 22 Districts of Tehran were selected using quota, stratified and
cluster sampling. Demographic questionnaire, female sexual function index (FSFI), and Brief Sexual
Function Inventory (BSFI) were used to collecting data.
DATA ANALYSIS: The data were analyzed using descriptive methods, and the findings were
compared using the Chi-square, analysis of variance, and independent t-tests.
RESULTS: Totally 561 women and 568 men with the average ages of 33/06 and 34/98 participated
in this study. In general, 77/6% of women and 35/6% of men complained about sexual problems.
The most prevalent problems in women were sexual desire dysfunction (45/3%) and arousal
dysfunction (38/85%), and the most prevalent problems in men were erection dysfunction (40/4%)
and then ejaculation dysfunction (32/5%). Prevalence rates of dysfunctions of orgasm, dyspareunia,
and vaginal dryness were, respectively, 9/2%, 9/0%, and 7/0%, and prevalence of sexual drive
dysfunction in men was 10/6%.
CONCLUSION: The prevalence of sexual problems in Iranian women is so much higher than the
global findings, and in men, this rate is somewhat higher than global prevalence. This difference can
be due to the culture and the chosen silence about sexuality and specially women’s sexuality in the
Iranian culture that requires extra attention to this area.

Abstract BACKGROUND: Although there is a reduction in cervical cancer incidence over the years, it keeps
the second position of the most common cancers among females in India. The aim of this review
is to understand the challenges of health promotion and education strategies to prevent cervical
cancer in India.
MATERIALS AND METHODS: This review is based on 78 studies published during 1993–2017 on
the topics of awareness, attitude, and acceptance toward cervical cancer, screening, and human
papilloma virus vaccination among Indians. The extracted information was summarized according to
different populations such as people from different social and community groups, women and men
attended clinics, students (nursing/medical/nonmedical), health‑care providers (doctors, nurses, and
other health workers), migrated Indians, and cervical cancer patients.
RESULTS: The awareness about cervical cancer and its prevention was very poor among women
from different communities and the majority had a negative attitude toward screening and vaccination
in general. The health professionals and medical students were more aware of cervical cancer and
its prevention compared to the general population. Majority of students irrespective of medical or
nonmedical background had a positive attitude toward vaccination. Only a small proportion of women
in the general population were ever screened.
CONCLUSIONS: Observations from this review indicate immediate attention of the public health
authority to take appropriate actions to educate and motivate general population toward cervical
cancer prevention and to improve the facilities to incorporate the much needed preventive and early
detection interventions in India.

Abstract INTRODUCTION: Hospitals as the first place for injuries have to keep up and increase activities in
emergency and disasters. Therefore, any hospital necessarily requires disasters plan to improve its
preparedness. The aim of this study is to investigate the effect of education and implementation of
“National Hospital Disaster Preparedness Plan (NHDPP)” on  Vali Asr Hospital preparedness in Iran.
METHODOLOGY: In a pre‑ and post‑intervention study, NHDPP educated in five sessions, and it
was used as a guide in the promotion of Vali Asr Hospital preparedness in Iran. The Iranian version
of “Hospital Disaster Preparedness (HDP) assessment tool” was used to measure the hospital
preparedness score. Finally, the quantitative data analyzed by using IBM SPSS Statistics for Windows,
Version 22.0. Armonk, NY: IBM Corp.
RESULTS: Before intervention, the HDP score was measured in total and in the nine dimensions
of preparedness. But after the intervention, it increased, 33% in command and control dimension,
33% in communication, 21% in safety and security, 26% in triage, 36% in surge capacity, 24% in the
continuity of vital services, 27% in human resources, 13% in support and supplies management, and
7% in post disaster recovery dimension. Furthermore, the total HDP score increased about 24.5%
after the intervention.
CONCLUSION: This study demonstrates that the “Iranian HDP plan” leads to improve the Vali
Asr HDP score. Therefore, by planning and implementation of effective educational programs, it is
possible to improve the hospitals’ preparedness in Iran.

Abstract INTRODUCTION AND AIM: Biopsychosocial approach suggests that the individual’s health condition
is partly influenced by the interactions of biological, psychological, and social processes. It also
concludes that the clinical method should be patient‑centered, which is based on the physician’s
involvement in the patient’s world and the physician’s ability to see the illness from the patient’s view.
In this study, we aimed to determine the extent to which medical faculty assistant doctors use the
biopsychosocial approach in their clinical practice.
MATERIALS AND METHODS: Our study is a cross‑sectional type, descriptive, and analytical
research. The sample size consisted of assistant doctors who met the inclusion criteria which were
accepted to participate in the study between December 1, 2017, and March 1, 2018, at the medical
faculty hospital of Dicle University. Two hundred and three physicians participated in our study. The
Patient–Physician Orientation Scale (PPOS), The Jefferson Scale of Physician Empathy (JSPE),
and a survey study including questions in relation with sociodemographic characteristics were
conducted in our study. The reliability of the Patient–Physician Orientation Scale (PPOS) and JSPE
used in our study was tested with Cronbach’s alpha and found to be 0.878 and 0.931, respectively.
Questionnaires were administered by a face‑to‑face interview method during interview. Information
on the purpose and method of the study was given.
RESULTS: A total of 203 physicians participated in our study. One hundred and forty‑three (70%)
participants were male and 60 (30%) were female. According to medical disciplines, eight
physicians (3, 9%) from psychiatry, 21 (10, 3%) from family medicine, 104 (51, 2%) from other
internal medical disciplines, and 70 (34, 5%) from surgical medical disciplines participated in the
study. In the first subgroup of the PPOS, which is used in our study, the average score of psychiatry
physicians was 3.67 ± 0.99, family medicine assistant doctors 3.92 ± 0.67, other internal medical
disciplines 3.98 ± 0.65, and surgical medical discipline 3.83 ± 0.61. In the second subgroup, which is
defined as the care in the same scale, the average score of psychiatry assistant doctors was found
to be 3.20 ± 0.45, family medicine assistant doctors 3.68 ± 0.54, other internal medical disciplines
3.49 ± 0.60, and surgical medical discipline 3.68 ± 0.58. The results of the Jefferson Scale used to
determine the level of empathy in our study are found as psychiatry 78.25 ± 14.78, family physician
67.71 ± 14.69, other internal medical disciplines 72.03 ± 13.46, and surgical medical discipline
70.87 ± 15.24.
CONCLUSIONS: The biopsychosocial approach is primarily an elementary approach model in
medical discipline such as family medicine and should be applied to other internal and surgical
medical disciplines as well. With conducting this study, the awareness of this area will be increased
and related issues in the literature will be enriched.

Abstract BACKGROUND: Internet is one of the most advanced modern communication technologies. Despite
the positive uses of internet, the existence of extreme behaviors and its harmful consequences has
attracted the attention of all. The aim of this study was to determine the relationship between internet
addiction with anxiety and educational performance.
MATERIALS AND METHODS: This research is a descriptive correlative study. The statistical
population of the study includes a total number of 4401 female students in the high school in the city
of Ilam‑Iran in the academic year of 2017–2018. The sample size includes353 students estimated
using Cochran’s formula. They were selected by random cluster sampling. For data collection, the
Young’s Internet Dependency Questionnaire, Academic Performance Inventory, and Marc et al.,
anxiety Scale were used. Data were analyzed at the significant level of α = 0.05.
RESULTS: The results showed a positive and significant correlation between internet dependency
and students’ anxiety (P < 0.01). There is also a negative and significant correlation between internet
dependency and academic performance of students (P < 0.01), and also a negative and significant
correlation between anxiety and educational performance of students (P < 0.01).
CONCLUSION: On the one hand, the results indicate a high prevalence of internet dependency and
its significant relationship with anxiety and academic performance in students, and on the other hand,
the negative effect of internet dependency on the students’ educational performance. Therefore, it is
necessary to design some intervention programs to prevent harm to students who are increasingly
interacting with internet. In addition, raising the level of the students’ awareness on the complications
of internet addiction and the proper use of the internet seems to be necessary.

Abstract