Journal of Education and Health Promotion

Abstract

Abstract INTRODUCTION: We know that risk communication is equally important as risk identification, which
is usually not communicated properly to the patients and resulting in poor outcomes, especially in
hypertensive patients.
OBJECTIVE: Our study objective was to evolve and test a colour coded client segmentation based
public health approach to educate the community to deal with problem of hypertension.
METHODOLOGY: This cross‑sectional pilot study was done in March 2020 among purposively approached
in a primary health centre to 100 people aged above 18 years, among them 41 gave written consent for the
study and their demographic information was noted. They were given colour coded cards as per the current
blood pressure level and previous history of hypertension. On each colour coded card, specific advice
was written for that category. For all the participants, blood pressure and treatment seeking behaviour was
noted. For hypertensive patients, adherence to medication and non‑pharmacological measures was noted.
RESULTS: Mean age of the participants was 46.5 ± 13.06 years. Mean systolic blood pressure (SBP)
and diastolic blood pressure (DBP) of the participants were 135 ± 16.85 mm Hg and 86 ± 11.42
mm Hg, respectively. Among the participants, 10 (24.39%) had a known history of hypertension.
Among them, as per the blood pressure levels measured on the day of the study 50% (5) had their
blood pressure levels under control. Interestingly 16 (39%) participants were found hypertensive
incidentally.
DISCUSSION: It is evident from the studies that colour coded approach is used in multiple ways, in
multiple settings, for multiple diseases. To our knowledge, little focus has been given for hypertensive
disorders in the community level. We merely bother about making their risk profiling, even in the
digital age. Sometimes physicians in emergency become puzzled whenever patients collapsed in front
of them and we missed the “Golden Hour” for the treatment by searching patients’ medical details.
CONCLUSION AND RECOMMENDATIONS: The above problem can be solved by risk profiling of
chronic patients by colour coded OPD/Health cards.

Abstract CONTEXT: Hospital‑acquired infections (HAIs) are a global problem. One of the common causes of
HAI is through the health‑care workers, mainly because of failure to comply with the recommended
infection control guidelines.
AIMS: The aim of our study was to educate and train the nurses regarding infection control practices
and assess the impact of training and assess whether this training actually made any change in the
incidence of catheter‑associated urinary tract infection (CAUTI) and intravenous (IV) line‑related
infections.
MATERIALS AND METHODS: Baseline knowledge, attitude, and practices study of willingly
participating 105 nurses regarding infection control was done. The incidence of CAUTI and IV
line‑related infection was calculated in the areas of their postings. They were trained via an educational
module regarding infection control practices. We again assessed the incidence of CAUTI and IV
line‑related infections in the same areas 2 months after training. Data analysis was done using SPSS
version 20.0. Student’s t‑test was used to analyze the difference in the prevalence of CAUTI and IV
line‑associated HAIs pre intervention and post intervention.
RESULTS: There was reduction in the incidence of IV line‑related infection, though it was not
significant (P 0.15) and no change in the incidence of CAUTI after intervention.
CONCLUSION: Single educational module though improved nurses’ knowledge and attitude regarding
infection control but failed to result in significant improvement in practices and incidence of HAIs.

Abstract BACKGROUND: Oral health practitioners are at the frontline of infection, particularly with respiratory
viruses such as the novel coronavirus. Knowledge, awareness, and attitude of these workers are
considered important in preventing and controlling the outbreak. This study aims to review the
literature to provide a better understanding of the status of dentists and other oral health practitioners’
knowledge, attitude, and awareness about COVID‑19.
METHODS: A systematic review was conducted through Web of Science, PubMed, Scopus, and
ProQuest up to May 6, 2020. All the knowledge, attitude, and practice studies on oral health workers
about respiratory contagious outbreak the same as severe acute respiratory syndrome, Middle East
respiratory syndrome, and COVID‑19 were included in the meta‑analysis.
RESULTS: A total of eleven studies were included in the meta‑analysis. 85.5% of the dentists and oral
health practitioners had a high level of awareness about virus transmission modes (95% confidence
interval [CI]: 78.6%–92.4%; P < 0.001). 80.7% of the oral health practitioners gave right answers to the
questions related to virus transmission modes (95% CI: 69.9%–91.4%; P < 0.001), and 79.9% of the
dentists had a positive attitude about virus transmission modes (95% CI: 66.4%–93.4%; P < 0.001).
CONCLUSION: This meta‑analysis shows that the level of dentists and oral health practitioners’
knowledge, awareness, and attitude was relatively high about the respiratory contagious diseases
as well as COVID‑19. The present results can shed further light for policymakers to support the
best evidence medical education for all health‑care workers the same as oral health practitioners.
Preventing the dissemination of misinformation along with preparing comprehensive guidelines can
be considered by the oral health policymakers, particularly in the more infected regions.

Abstract Ergonomics of schools and school furniture is one of the main issues in students’ education. The
proportion of school furniture to the anthropometric dimensions of students is one of the main
ergonomic challenges in schools that affect students’ health. This systematic review study aimed
to examine the match between anthropometric measures and school furniture dimensions among
Iranian students. A systematic review was carried out using databases to Google Scholar, SID,
IRANDOC, PubMed, MEDLINE, and ScienceDirect and specific keywords to find papers published
before March 2020. The references of seminal studies were also used to extend the search scope.
Totally, 11 studies entered the review. The results showed that there was no proportion between
classroom furniture and students in schools under study. This lack of proportion was evident at
different grades in both boys’ and girls’ schools. The results showed a lack of proportion between
classroom furniture and Iranian students. There is a need to design and procure furniture based
on the anthropometric dimensions of the society that will help to health promotion of students. An
updated national anthropometric databank of Iranian students can be a step to solve the problem.

Abstract BACKGROUND: Critical nutrition literacy (CNL) plays an important role in how college students make
everyday decisions about nutrition choices. Increasing CNL is an aim of many introductory nutrition
courses, but there are limited instruments measuring this construct. This study aimed to assess the
changeability of CNL and the relationship between CNL and markers of diet quality in young adults.
DESIGN: This was a two‑phase research project consisting of a nonexperimental, pre–post study
and a cross‑sectional assessment from 2018 to 2019. Participants were U.S. college students,
18‑24 years old, recruited from introductory‑level courses from three participating universities, located
in Rhode Island, West Virginia, and New Jersey.
SUBJECTS AND METHODS: Interventions consisted of (1) a 4‑credit, 13‑week nutrition course
and (2) a cross‑sectional, online behavior, environment, and perception survey. CNL was measured
using the Revised CNL Tool (CNLT‑R) instrument across both phases. Measures for phases
include: (1) the changeability of CNL and (2) the relationship between CNL and markers of diet quality.
ANALYSIS: Paired t‑tests and multivariate analysis of variance were utilized through SPSS
version 25.0.
RESULTS: CNL score significantly increased from baseline to postintervention from 3.38 ± 0.48 to
3.61 ± 0.55 (P = 0.014). There was an overall significant effect of CNL on markers of diet quality, such
as cups of fruits and vegetables (F/V) and teaspoons of added sugar (F [2,1321] = 3.12, P < 0.05;
Wilks’ Λ = 0.99).
CONCLUSIONS: This research found that an introduction to nutrition course was associated with
an increase in CNL and that CNL is related to diet quality. The instrument could be used by nutrition
educators as an outcome assessment. Future research should investigate other components of the
CNL construct as well as predictive validity.

Abstract INTRODUCTION: Diabetes is one of the most common metabolic disorders in the world and because
of high prevalence and incidence rate, it is a serious challenge posed to the health system in Iran.
Despite extensive knowledge of the desirable care for these patients, evidence suggests that the
quality of care provided to these patients is not desirable.
OBJECTIVE: The aim is to develop a training program to enhance the preparation of health
professionals for evidence utilization in providing comprehensive health cares to patients with diabetes.
MATERIALS AND METHODS: This is an exploratory mixed‑method study using consecutive
qualitative–quantitative methods that will be conducted in three phases using the approach proposed
by Werner and DeSimone to design the program. In the first phase, a qualitative study will be
conducted for context assessment and identification of the requirements to enhance evidence
utilization taking into account the overall knowledge translation process using semi‑structured
interviews with policymakers and health professionals. In the second phase, a training program will
be designed based on the data extracted from the first phase, experts’ opinions, and review of the
literature. In the third phase, the training program will be implemented, and its effectiveness on the
readiness of multidisciplinary health professionals for evidence utilization will be evaluated.
CONCLUSION: The results of this study will provide a better understanding of how to identify and
incorporate contextual factors and the real needs of health‑care professionals and develop a program
tailored to improving their readiness to use evidence. It can subsequently lead to providing quality
care to patients with diabetes.

Abstract Abstract:
BACKGROUND AND AIM: Concept maps hold great potential for the students as it helps in
the formulation of new concepts as well to evaluate the learning ability of the students. However, the
use of concept maps as a teaching tool in medical students in India has not been explored, to the
best of our knowledge. This study was conducted to assess the use of concept maps in improving
learning among medical students.
MATERIALS AND METHODS: This study was conducted among III MBBS students belonging to
two batches. This study was carried out in two stages. In first stage, pretest was taken to test the
knowledge of students. Later, introductory class was taken on tuberculosis and concept map was
used to explain the given concept and later posttest was taken. In second stage, feedback was
taken from the students regarding the concept map. Pre‑ and post‑test results were compared using
Wilcoxon test.
RESULTS: Significant difference between pretest (4 ± 1.593) and posttest (10 ± 0.762) score was
seen (P < 0.0001). More than 50% of students scored full marks in posttest, whereas no one got full
marks in the pretest. Positive response (82.09%) was received from the students when feedback
was taken regarding the use of concept map.
CONCLUSION: Concept maps are found to be an effective teaching and learning tool for medical
students. They can be used to enhance meaningful learning in students and can be practiced more
in the students for better understandings of the concepts.

Abstract INTRODUCTION: The study aimed to design, implement, and evaluate the process of advisor and
teaching assistant (TA) to increase the quality of cascade training in principal educational groups,
presenting the obstacles and problems of this educational intervention and introducing them to
educational planners.
METHODOLOGY: This applied developmental research was conducted in Isfahan University of
Medical Sciences in 2017–2018 in principal educational groups (internal medicine, surgery, pediatrics,
gynecology, and cardiology). For this purpose, a working party called TAs was composed of managers,
faculty members, and active and interested assistants, including 24 people. The action plan, bylaws,
job description, and logbooks were completed by the method of the focus group. Getting the report,
monitoring the activity, exchanging the ideas, and drawing up the various plans were continuously
done through bi‑monthly in‑person meetings, and the virtual group was organized for monitoring,
starting a training logbook, and doing semi‑organized interviews to evaluate.
RESULTS: In a total of 1131 h, various educational activities were conducted such as cooperating
with the advisor, teaching some part of a class, holding a workshop, contributing to question design,
preparing the educational resources, and organizing an educational round.
CONCLUSION: Improving the knowledge, attitude, and practice of assistants in cascade training,
regulating their activities, learning the teaching skills, and exercising them with the teacher were
some of the most significant opportunities of this study.

Abstract INTRODUCTION: Today, the quality of health services is considered to be providing “error‑free”
services, at the right time, by the right person and with the least resources. In recent years, education
through evidence‑based care has been emphasized by health system policymakers as a way to
improve care standards. Therefore, the purpose of this study is to teach clinical error management
to midwifery students in Shahid Sadoughi University of Medical Sciences in Yazd.
METHODS: The present study was performed using consensus‑based methods based on Delphi
technique to identify the most common errors and the best educational solution for its management
with the participation of 21 midwives by purposive sampling method in Shahid Sadoughi University
of Medical Sciences in Yazd in 2018. The rate of agreement was 75% or more. Descriptive statistical
methods and SPSS‑18 software were used for analysis.
RESULTS: The most important errors mentioned were as follows: In the field of hospital care,
it was the scope of care during labor and in clinical care, it was the scope of prenatal care. The
most important error reduction strategies that were considered in the clinical guide in general were
emphasizing the following: active supervision of instructors during the provision of students’ clinical
services, paying attention to the evaluation of service provision with the least incidence of errors in
end‑of‑course evaluation, make changes in clinical teaching methods, attention to the use of active
teaching methods and the use of educational software. The cases were considered separately in
each of the mentioned errors.
DISCUSSION AND CONCLUSION: Incidence of errors in pregnancy and childbirth as the most errors
of midwifery students in the field of hospital and clinical care was agreed on. Therefore, considering
this issue and the importance of preventing errors to provide quality services to mothers and infants,
it seems that it is time to make changes in clinical education in this field by emphasizing the use of
active educational methods.

Abstract Identifying the learners’ problems is important. Besides, many factors are associated with academic
failure, among which time management and stress are more important than any others based
on evidence. By using a systematic review and meta‑analysis, this study aims to synthesize the
findings of studies about the correlation of time management and stress with academic failure
to suggest a more in‑depth insight into the effect of these two factors on academic failure. Four
databases were searched from the inception of January 2018. Publication bias was evaluated visually
using funnel plots and sized up by Egger’s test. Ninety‑four articles were found to be qualified for
inclusion after full‑text review and additional manual reference made. Of these, 8 were studies of
educational interventions that were reviewed in this paper. Regarding the relation of stress and
academic performance, the Funnel plot (results not shown) and Egger’s test showed no publication
bias in the studies (P = 0.719). Based on this result, the estimated pooled correlation (reverted by
hyperbolic tangent transformation) between stress and academic performance was found to be −0.32
(95% confidence interval: −0.38–−0.25). In conclusion, the review recognized a series of potentially
mutable medium‑to‑large correlates of academic achievement, time management, and stress. It
would be essential to have experimental data on how easily such self‑regulatory capacities can be
altered, and these interventions could help students enhance their potential, providing empirical tests
for offered process models of academic achievement.

Abstract In December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2)
became evident in Wuhan, China, and then spread rapidly worldwide. Numerous drugs
and vaccines are under clinical trial pipeline for investigation against coronavirus disease
2019 (COVID‑19) infection. The aim of this systematic review was to discuss about
investigational new as well as repurposed drugs currently under trial for COVID‑19
infection. An exhaustive search was carried out for this review article including scientific
databases of PubMed, Embase, ClinicalTrials.gov, WHO International Clinical Trials
Registry Platform, Web of Science, ScienceDirect, ProQuest, Google Scholar, and Scopus
search engines using keywords of “Coronavirus,” “COVID‑19,” “MERS‑CoV,” “MERS,”
“SARS‑CoV‑2,” and “SARS‑CoV‑1” and “Solidarity trial” and their Persian‑equivalent
keywords from inception until May 2020. After screening the 296 articles searched from
different databases (PubMed = 97 and other search engines = 199), 52 articles were included
in the final systematic review. It was found that the World Health Organization introduced
a Solidarity international clinical trial to discover an effectual treatment of COVID‑19. Based
on established in vitro and in vivo activity against different strains of coronaviruses, four
repurposed drugs – remdesivir, lopinavir/ ritonavir combination, lopinavir/ritonavir
with beta‑1a, chloroquine, and hydroxychloroquine – were considered for clinical trial
against COVID‑19. A number of other drugs and vaccines are under clinical trial pipeline
for investigation against COVID‑19 infection. Despite multitude of treatment options
available, treatment of choice is still not well established. Moreover, optimum supportive
care and monitoring of seriously ill patients is the need of the hour.

Abstract BACKGROUND: Commitment to implementing cardiac rehabilitation (CR) plays an important role in
managing the problems caused by heart diseases. Commitment to the treatment plan implementation
is accompanied by numerous positive consequences. This study was carried out to explain the
consequences of commitment to CR.
MATERIALS AND METHODS: Data were collected through semi‑structured individual interviews with
26 participants (13 CR specialists and 13 patients), using purposeful sampling. Interview questions
focused on the factors influencing the formation of commitment to the CR and its consequences.
Conventional content analysis with Graneheim and Lundman’s approach was used to analyze the
data. To obtain data trustworthiness, Lincoln and Guba’s criteria were used.
RESULTS: The findings were classified in three categories: purposeful of a purposeful behavior
structure (sense of controlling and managing the condition, sense of responsibility, sense of security),
formation of active performance structure (interaction between the patient‑family‑treatment team,
stabilization of behavior and prevention of intermittent behavior, no cessation of the treatment plan
and adherence to it, directing behaviors and adaptation to conditions) and achieving dynamic and
effective care (active follow‑up of the treatment plan, sense of satisfaction, reduced readmission,
reduced costs, improved quality of life, reduced anxiety and concerns about treatment failure,
increased self‑care ability).
CONCLUSION: The results show that the patient’s commitment to CR is accompanied by optimal
consequences. The results of this study can help design the training plan for the CR staff and develop
the clinical practice guidelines to provide educational‑care approaches to patients to reinforce their
commitment.

Abstract INTRODUCTION: Cardiopulmonary resuscitation (CPR) is regarded as the most important skill of
the medical staff who is required to be aware of the latest changes to the CPR guidelines so that
they can take the most effective actions in the critical conditions of CPR. Therefore, the present
study aimed to determine the levels of CPR literacy among the personnel of universities of medical
sciences based in Kermanshah and Khuzestan provinces based on the latest 2015 CPR guidelines
in 2019.
MATERIALS AND METHODS: In this descriptive, analytical, cross‑sectional study, 525 subjects
were selected as the sample population using the two‑stage cluster sampling. For data
collection, a researcher‑made questionnaire was used, whose content validity and reliability were
confirmed (r = 0.71). The study screened the data received and analyzed valid data set through the
ttest and Spearman’s correlation coefficient by incorporating SPSS Statistics software version 23.0.
In addition, P < 0.05 was considered statistically significant.
RESULTS: The 2015 CPR literacy levels of the samples were as follows: excellent (85 subjects or
16.2%), good (404 subjects or 77%), and average (36 subjects or 6.9%). The results of Pearson’s
correlation coefficient revealed a weak and inverse relationship between the levels of CPR literacy
and the age of samples (r = −0.092) and work experience (−0.029), which were statistically significant.
In addition, the results of Mann–Whitney U‑test demonstrated that the level of CPR literacy among
the personnel of Ahwaz University of Medical Sciences exceeded that among the personnel of
Kermanshah University of Medical Sciences (P < 0.001).
CONCLUSION: It is suggested that in retraining the nursing and paramedical personnel, CPR be
carried out with more emphasis on the changes introduced in this guideline compared to that in 2010,
including esophageal tracheal airway, reasons for the cessation of CPR, intraosseous infusion, and
induced hypothermia.

Abstract BACKGROUND: Many countries are implementing measures for social distancing to contain the
spread of the coronavirus disease 2019 (COVID‑19) pandemic. The Indian government also issued
an order for complete lockdown of the country, with all the nonessential services, including most of
the services for nonemergency health issues, being temporarily suspended.
OBJECTIVES: This study aimed to understand the effect of pandemic lockdown on medical
advice‑seeking behavior and the medication practices of the non‑COVID Indian patients
confined to homes, who would have normally visited the outpatient departments (OPDs) for medical
advice.
MATERIALS AND METHODS: It was a questionnaire‑based, cross‑sectional study conducted online
during the lockdown period. The questions dealt with medical advice‑related practices, self‑medication,
the sources of medical advice, and the need to visit emergency department. Evaluation of data was
done as for descriptive studies.
RESULTS: A total of 106 people (34%) out of the 312 participants had either old or new health
problems. Ninety‑six of such people (90.5%) tried to manage their sufferings by either continuing
the drugs prescribed earlier or by making phone calls to doctors along with taking the help of home
remedies, if needed. Ten (9.5%) of the symptomatic participants did not consult any doctor waiting
for natural course of relief. None of the participants practiced self‑medication of modern medicine
therapy. Only one participant (of the total 312) took hydroxychloroquine as self‑medication for assumed
prophylactic therapy against the COVID‑19 infection.
CONCLUSION: Most of the people with medical conditions, confined at home due to national
lockdown, are coping with their problems without any irrational self‑medication with modern medicines
or any misuse of prophylactic therapy against the COVID infection. This seemingly positive trend may
also have been due to the strict enforcement of the lockdown rules by the law enforcement agencies.

Abstract INTRODUCTION: Health‑care workers in community service professions are the formerly candidate
for occupation burnout. This study aimed to investigate the relationship between empowerment and
job burnout among auxiliary health workers (behvarzan) at Fasa University of Medical Sciences.
MATERIALS AND METHODS: In this descriptive‑analytical study, 120 auxiliary health workers were
enrolled using the census. Spritzer’s psychological empowerment and Maslach burnout inventory
questionnaires were used to collect the data. Then, they were analyzed through the SPSS software,
using descriptive analytical tests.
RESULTS: The findings of this study revealed that the auxiliary health workers’ empowerment was
in the range of 22–75 with a mean ± standard deviation [SD] of 48.5 ± 9.71, which is in a fairly high
level considering the highest score (75) in this scale. Moreover, with respect to burnout (mean ± SD
of 58.03 ± 18.64), 36 participants (30%) had low level of burnout, 69 subjects (57.5%) were at the
intermediate level, and 15 (12.5%) suffered high levels of job burnout. According to the results of
this study, there were a high correlation and negative relationship (r = 0.406, P > 0.001) between
psychological empowerment and job burnout among the auxiliary health workers. On the other hand,
all empowerment components (competence, autonomy or independence, effectiveness, and trust)
had a reverse and significant association with burnout.
CONCLUSION: Based on the results of this study, the auxiliary health workers (behvarzan) were in a
good range of empowerment; also, the dimensions of empowerment were correlated with job burnout
in Fasa university‑affiliated hospitals’ health workers. On the other hand, demographic features had
no association with these two factors. It is suggested that health authorities should take measures to
empower the workers and identify and remove the effects of the various dimensions of job burnout
among the health workers in these hospitals.

Abstract BACKGROUND: During the immediate post delivery period, women are particularly susceptible
to distension of the bladder. Complementary and alternative medicine is becoming an established
intervention modality within the contemporary health care system. However, very little is known
about the impact of foot reflexology on the urinary system. The aim of this study was to evaluate the
effect of the most popular type of complementary therapy (the foot reflexology) on first voiding time
following elective cesarean section without urinary catheter.
METHODS: This experimental study was performed on 61 pregnant women in Pastor Hospital,
Mashhad, Iran, who met the inclusion criteria. Accordingly, participants were randomly allotted to
either treatment or control groups. The intervention group received a single 20‑min foot reflexology
session at 2–3 h after the surgery. The time taken for first void was recorded by research assistant
that blinded to the allocation of groups. The findings were recorded and analyzed with the SPSS
software by using of Chi‑square, independent t‑test, Mann–Whitney, and Fisher exact methods
P < 0.05 was considered as statistically significant.
RESULTS: Using General Linear Model (GLM) for controlling of confounding variables, the results
of t‑test showed significant differences between two groups in terms of first voiding time (P = 0.001)
following surgery.
CONCLUSION: It seems that the use of foot reflexology as a nursing care plan to prevent urinary
retention after cesarean section without urinary catheter does shorten first voiding time and increase
maternal satisfaction.

Abstract BACKGROUND: Road traffic continues to be a major developmental issue and a public health
concern. Road accidents in India kill almost 1.5 lakh people annually, and India accounts for almost
11% of the accident‑related deaths in the world. Prevention of road traffic accidents is very crucial
by creating awareness and taking proper measures toward road safety.
AIMS: The aims of this study were to assess the knowledge about road safety regulations and to
assess the attitude and practices regarding road safety regulations.
SETTINGS AND DESIGN: This cross‑sectional study was conducted in a pharmacy college.
SUBJECTS AND METHODS: Study participants were all 4 academic years’ pharmacy students
who know driving two‑ or four‑wheeler motor vehicle. Data were collected from a sample of 132 by
predesigned pretested semi‑structured questionnaire.
STATISTICAL ANALYSIS USED: Data were presented in proportions with confidence interval
using SPSS ver. 22.
RESULTS: 81.1% of the participants knew the minimum age to obtain driving license. Only 16%
follow the road signs strictly and 76% wear helmet for long‑distance ride. Poor attitude was observed
for wearing helmet for short‑distance ride, pillion rider wearing helmet, and drink and drive.
CONCLUSIONS: Majority of the participants were aware of road safety regulations. In spite of having
positive attitude toward road safety measures by participants, they could not translate attitude into
practice.

Abstract INTRODUCTION: Education is one of the most important approaches to preventing infectious
diseases at the time of the pandemic. The purpose of the study was to develop an intervention‑training
program using an intervention mapping approach (IMA) to prevent COVID‑19 infection in adults at
the time of the pandemic by health workers.
MATERIALS AND METHODS: The present study was a study protocol where IMA was used as a
planning framework for developing an intervention‑training program to prevent COVID‑19 infection
in adults at the time of the pandemic by health workers in Ardabil city. Six intervention mapping (IM)
steps have been described in this protocol. As the first step, needs assessment was performed by
reviewing the studies, qualitative evaluation, and interviews. In the second step, the matrix of change
objectives was designed from the intersection of performance goals and determinants. Later on,
after designing the program and planning the program implementation, the program evaluation plan
was developed.
RESULTS: IMA guided us in designing and implementing a control‑oriented training program with
the participation of the participants along with the definition of outcomes, performance goals and
determinants, theoretical methods and practical applications, intervention program, implementation,
and step by step assessment.
CONCLUSION: IM is a control‑oriented, systematic, participation‑based approach to design and
implement targeted and on‑going health promotion programs based on the needs of the target group
at the time of the pandemic by health workers.

Abstract BACKGROUND: The study aims to record the perceptions of medical faculties regarding the
effectiveness of theory‑based examination to assess the newly introduced competencies of attitude
ethics and communication (AETCOM) in the competency‑based medical curriculum for Indian
medical graduates.
MATERIALS AND METHODS: This is an analytical cross‑sectional study performed on the month
of February 2020 where a prevalidated questionnaire consisting of components of AETCOM was
e‑mailed to the teaching faculties of IQ City Medical College via Google Forms. Consenting faculties
responded. Their results were analyzed by inbuilt Google statistics and were cross‑verified with
SPSS 20.0.
RESULTS: Sixty percent faculties strongly agree regarding the beneficial role of mandatory inclusion of
AETCOM competencies in competency‑based medical education. About 61.66% of faculties strongly
agree that both formative assessment and summative assessment of AETCOM are essential. Although
48.33% of faculties believed that theoretical questions can be used to assess AETCOM, 51.66% of
faculties do not agree that theory examination serves as an effective tool to assess AETCOM. They
believe that AETCOM cannot be written on paper and attitude can change in reality when facing
a real‑world clinical scenario in contrast to what is written in answer script during creative writing.
CONCLUSIONS: Assessment of AETCOM is essential and it should be preferably done via a practical
approach in a real‑world simulated scenario and not by written theoretical examination.

Abstract BACKGROUND AND OBJECTIVE: This study aimed to examine the effect of educational intervention
using the health belief model on knowledge, attitude, and function of women about Pap test at health
centers.
METHODOLOGY: This randomized controlled clinical trial was conducted on 120 women who
were allocated into two groups (intervention = 60 and control = 60). The sampling method was a
multistage cluster. The training was provided in two sessions for 90 min. Data gathering tool was
a 4‑part researcher‑made questionnaire including demographic characteristics, knowledge, health
belief model structures, and function. Women were evaluated and completed the questionnaire in two
stages (before and 2 months after training). Data were analyzed by Kolmogorov–Smirnov, Wilcoxon,
linear regression, Mann–Whitney U‑test, Fisher, Chi‑square, and marginal homogeneity tests.
RESULTS: At baseline, there was no significant difference between the groups regarding the mean of
knowledge and the structures of health belief model scores. The average scores of participants in terms
of health belief model structures were increased significantly after the training sessions. Furthermore,
the comparison of the performance of Pap smear before training showed that in the intervention
group (23.3%) and in the control group (31.7%), there was no significant difference in terms of the
history of performing the Pap smear test (P = 0.414). However, a significant difference (P = 0.001)
was observed after training in the intervention group (31.7%) and in the control group (3.3%).
CONCLUSION: Educational intervention using the health belief model is effective in increasing
knowledge, attitude, and function of women in terms of providing useful and required education.

Abstract Behavioral and emotional problems are the most common form of child psychiatric pathology.
Parenting styles are one of the factors affecting the formation of children’s personality and the use of
inefficient styles can lead to several negative consequences such as behavioral problems. The aim
of the present article is to describe a variety of parenting styles and their relationship with children
behavioral problems. The present study reviews a variety of parenting styles including Kazdin’s Parent
Management Education Model, Barclay’s Parent Training Program, Adler and Dreikurs Approach,
and Positive Parenting Program. Finally, based on reality theory, parenting is neglected to be one
of those styles. Therefore, it is imperative to do a research based on reality theory with existential
psychotherapy and with the view that everyone chooses to behave, external pressure is always an
imposition, the children learn from their mistakes, and everyone is responsible for his own happiness.

Abstract AIM: The aim of this interventional study was to introduce classroom quality circles (QCs) among
first‑year MBBS students, to assess the effectiveness of QCs on learning experience of the students,
and to evaluate the students’ satisfaction level during the process of learning.
MATERIALS AND METHODS: A problem pool was created through a questionnaire. The study was
carried out in the department of biochemistry, for a period of 6 months. Student’s quality circle (SQC)
group of five students was created. Then, feedbacks were collected from students by SQC after every
class/topic delivered, and fortnightly meeting was held between the SQC group and faculty members
of the department, and issues were brought to focus depending on these feedbacks collected by
them. Possible initiatives and improvements were done on teaching–learning strategies depending
on the outcome of these discussions.
RESULTS: The effectiveness of SQC group was assessed by a pre‑post questionnaire (Questionnaire‑3)
feedback from the students and scoring was done based on 5‑point Likert scale. There was a
statistically significant difference (P = 0.009) between the mean of pre‑post questionnaire. To analyze
the students’ satisfaction level, a set of questionnaires were given to them and scoring was done.
Thirty‑four students agreed, 11 students were neutral, and 6 students were disagreed, that introduction
of SQC was effective in solving their problems related to teaching and learning of biochemistry.
CONCLUSION: SQC creates an environment of student centric, fairness, student empowerment,
improving solving skills. Implementation of student‑generated feedback through introduction of SQC
has improved the quality of the course as well as its delivery. It complements and supplements in
achieving students intended learning outcome and hence may contribute to overall learning quality
in the long run.

Abstract BACKGROUND: Cardiovascular diseases are among progressive diseases that begin in childhood
and are manifested mainly in adulthood. This study was assessed the validity and reliability testing
of the Persian version of the Perceived Health Competence Scale (PHCS) among patients with
cardiovascular diseases referred to Shahid Rajaie Heart center in Tehran, Iran.
METHODS: In this cross‑sectional study, a convenience sample of 700 patients with cardiovascular
diseases referring to Shahid Rajaie Heart center in Tehran were recruited (response rate = 100%;
n = 700). Content validity was established using translation and back‑translation procedure and getting
views of the expert panel. The content validity of the questionnaire was measured using content
validity ratio (CVR) and content validity index (CVI). Reliability was ascertained using Cronbach’s
alpha. The stability was confirmed using intra‑class correlation coefficients.
RESULTS: In this study, CVI = 0.81 and CVR = 0.72 were calculated. Scale reliability was sufficient
(α = 0.78; range = 0.73–0.77). Furthermore, reliability based on the stability of the whole scale was
0.75.
CONCLUSIONS: The PHCS‑Persian confirmed as a valid and reliable instrument to measure
perceived health competence. The PHCS‑Persian scale could be a useful, comprehensive, and
culturally sensitive scale for assessing perceived health competence.

Abstract BACKGROUND: A key step for improving the effectiveness of diabetes self‑management
education (DSME) is to identify its restrictors.
OBJECTIVES: The aim of this study was to explore the restrictors of the effectiveness of DSME.
METHODS: This descriptive qualitative study was conducted in March 2016–2017. Participants
were 16 DSME providers (viz., physicians, nurses, nutritionists, and psychologists) and nine DSME
receivers (viz., patients and their family members) – 25 in total. Semi‑structured interviews were held
for data collection. Interviews were transcribed word by word and analyzed through conventional
content analysis approach proposed by Graneheim and Lundman.
RESULTS: The restrictors of the effectiveness of DSME were categorized into three main categories
and 11 subcategories, namely patients’ limited welcoming of DSME classes (allocating limited time
for participation in DSME classes, inadequate knowledge about diabetes mellitus [DM] importance,
inappropriate educational environment, and financial problems), unfavorable adherence to
treatments: serious challenge (inattention to educations, poor motivation for adherence to medical
recommendations, and inattention to the psychological aspects of DM), and the difficulty of adult
education (the difficulty of changing health‑related attitudes and behaviors, mere information
delivery during education, adults’ physical and perceptual limitations, and diabetes educators’ limited
competence in adult education).
CONCLUSION: The findings of the present study provide an in‑depth understanding about the
restrictors of the effectiveness of DSME. DM management authorities and policymakers can use
these findings to develop strategies for improving the effectiveness of DSME.

Abstract BACKGROUND: Evidence‑based practice (EBP) is the integration of clinical expertise, patient
values, and best research evidence into the decision‑making process for patient care. Identification
of barriers that refutes the use of EBP in day‑to‑day practice will go a long way in designing programs
for inculcating EBP among physiotherapy students. Therefore, the aim of this study was to identify
perceived barriers to EBP among physiotherapy students.
METHODS: A convenience sample of 429 participants were recruited from physiotherapy colleges
affiliated to a State Health Science University as per the inclusion criteria. Participants were asked to
fill the self‑reported questionnaire that was developed by researchers based on possible items from
previously developed surveys. Data collected were tabulated and analyzed by descriptive statistics.
Response frequencies for the survey questions were determined and displayed in graphical formats.
RESULTS: The study comprised of 182 final year students, 112 interns, and 135 postgraduate
students having a mean age of 21.29 (0.85), 22.30 (0.77), and 24.34 (1.45) years, respectively.
Majority of participants reported insufficient time, poor understanding of statistical analysis, lack of
research skills, lack of formal training, lack of access to paid article, poor ability to critically appraise
articles, and inadequate infrastructure facilities as barriers towards practicing EBP.
CONCLUSION: Physiotherapy students perceived various organizational, training‑related, and
personal barriers toward the use of EBP. Effective education could prove to be the most powerful
tool to overcome these barriers toward the use of EBP.

Abstract INTRODUCTION: Volunteers are valuable human resources for service‑providing organizations.
Health system requires their participation and cooperation in all sectors to achieve more success.
The present study was conducted to recognize factors influencing the use of volunteer clinical
forces (VCFs) in Tehran hospitals from 2018 to 2020.
METHODS: This is a qualitative study, based on grounded theory approach, and was done through
semi‑structured interviews. The studied population included the experts, managers of hospitals, and
high‑ranking managers in the Ministry of Health, Iranian Red Crescent Organization, and health
nongovernmental organizations (NGOs). Nineteen persons were selected by purposeful sampling
method and interviewed. The achieved data were analyzed by content analysis method.
RESULTS: The results showed that using VCFs in Tehran’s hospitals was affected by eight following
factors: organizational, legal, policy‑making, economic, social, security, personal, and cultural
dimensions. These findings illustrated the necessity of making changes in the structures, the rules,
and the culture of health system to fit the bases with new approaches.
CONCLUSION: VCFs amplify the quality and structure of service providing for patients in hospitals.
The focus of policymakers and high‑ranking managers in health system is on accelerating their use
permanently and legally. Developing health‑centered NGOs facilitates the access to VCF, lessens
nonclinical loads of hospitals, and improves the organization of human forces. The experiences and
knowledge of VCFs cause to develop hospitals’ resilience, develop social participation, and improve
social capitals in medical field.

Abstract INTRODUCTION: Making decision for separation from the spouse is one of the crises which are
followed by unpleasant feelings such as self‑criticism in the people. The purpose of the present
study was to investigate the effectiveness of compassion‑focused therapy (CFT) on self‑criticism of
the women applying for divorce.
MATERIALS AND METHODS: The research design was quasi‑experimental with pretest, posttest,
and control group type. The population included all the women applying for divorce who referred to
an intervention‑in‑crisis center under the supervision of the organization of well‑being in the city of
Tehran in 2019. It had the convenient sampling method where the subjects were accommodated
into two groups of fifteen women both in the experimental and control groups. The present study had
the convenient nonrandom sampling method and the statistical population included 30 women from
whom 15 women were accommodated into experimental group and so were 15 in the control group.
Sampling method was in available, nonrandom type wherein 15 women were accommodated in the
experimental group and so were 15 women in the control group. The experimental group participated
in eight 90‑min sessions of CFT and the control group did not receive any intervention. Before and
after practical experimental administration, both the groups were assessed through self‑criticism
questionnaire by Smart et al. (2016). The statistical method used in the data analysis was ANCOVA.
RESULTS: The results showed that at the error level of 0.5, after controlling the effect of pretest scores
as a covariance factor, the mean of the experimental group was significantly lower than the mean
of the control group, which shows that CFT approach has been effective in reducing self‑criticism.
CONCLUSION: As a result, CFT approach can help the people who face the crisis of making decision
for divorce and self‑criticism to be able to confront this issue effectively and achieve mental health.

Abstract INTRODUCTION: Foot problems are most common among patients with diabetes, and they are
an important cause of morbidity in patients with diabetes mellitus (DM). They can be prevented by
following a simple foot care practice. The study objective was to stratify the level of risk for diabetic
foot ulcer (DFU) among patients with diabetes by screening.
MATERIALS AND METHODS: Adescriptive cross‑sectional study design was adopted in this study.
The sample size was 196, and a standardized INLOW’S 60‑s diabetic foot screening tool was used
to assess the risk of diabetic foot. Data collection was done by face‑to‑face interview, and diabetic
foot risk (DFR) was assessed by direct observation, inspection, and palpation methods.
RESULTS: Among the 196 patients, majority required yearly foot screen in both feet. The mean
and standard deviation of the level of DFR in the left foot (LF) and right foot (RF) was 4.31 ± 2.267
and 4.51 ± 2.391, respectively. There was a statistically significant association between the
practice of treatment and level of foot screening recommendation in the LF with Chi‑square value of
χ2 = 8.20 (df = 2) and RF with Chi‑square value of χ2 = 7.95 (df = 2) at P < 0.05 level.
CONCLUSION: Health‑care providers should be made aware of the regular practice of screening the
foot of diabetic patients along with health education awareness programs. It may be helpful to identify
the foot ulcer risk at an early stage. It will prevent further complications of DFU and recurrence of ulcer
and will reduce the economic burden to patients and their family members and the health‑care system.

Abstract INTRODUCTION: Childbearing is an important event in a couple’s life. The parents might have children
with disability that affected on their well‑being after the children’s birth. Well‑being considered as an
important aspect of a couple’s quality of life which may alter the future of their fertility. The present
study was conducted to the association of psychological well‑being and fertility intention in parents
with educable intellectually disabled children.
METHODS: The study was a cross‑sectional descriptive research conducted on parents of children
with intellectual disability (n = 386). Parents were selected randomly of schools of exceptional
education and welfare. The data were collected using Ryff’s scale of psychological well‑being,
demographic information, and fertility intention questionnaire. Data were analyzed using descriptive
and analytical tests including independent t‑test, Chi‑square test, Mann–Whitney U‑test, and Logistic
regression.
RESULTS: The majority of parents (83.9%) reported the negative infertility intention. Despite the mean
score of well‑being in parents without fertility intention (75.71 ± 11.67) was lower than parents with
fertility intention (76.90 ± 11.27), the difference was not statistically significant (P > 0.05). The logistic
regression analysis indicated that the parents’ age and number of children with intellectual disability
were predictors of fertility intention (P < 0.05), and their increase decreased the fertility intention.
CONCLUSION: It seems that the lack of difference in psychological well‑being scores between the
two groups of parents might be due to the equal severity of disability in children. The results also
indicated parents’ age and the number of children correlated with fertility intention. The findings can
be used to advance counseling programs in the field of healthy reproduction for this group of parents.

Abstract CONTEXT: Clinical supervision is a mechanism that allows medical trainees to learn their profession
through the practice of clinical activities alongside more experienced physicians who ensure safe
and timely care delivery. Therefore, recognizing of medical students experiences as people who
will provide health services to people in future can be an important source for gathering information
and planning to improve the quality of clinical education. The aim of this study was to explain the
experiences of medical students from clinical educational supervision.
METHODS: This study was a qualitative content analysis conducted on 15 interns of the surgery
and internal departments of medical and educational centers in Islamic Azad University Najafabad
Branchin Isfahan, Iran to discover. The sampling method was purposive, and data were collected
through semi‑structured interviews in 2019. Data analysis was performed using a qualitative content
analysis method with a conventional inductive approach.
RESULTS: Five main categories and ninesubcategories were developed. The main categories include
fundamental role, relaxed alertness, shadow education, toxic education, and abandoned educational.
CONCLUSION: The educational clinical supervisory has an efficient performance in clinical teaching
which needs to be more assessed and improved.

Abstract BACKGROUND: “Stress” acts as both etiological link and also as an outcome in the case of diabetes
mellitus. There is a paucity of literature regarding stress levels and also factors associated with it
among diabetic patients in India.
OBJECTIVE: To assess the perceived stress levels and their associated factors among diabetic
inpatients in a rural tertiary health care center, South India.
MATERIALS AND METHODS: Afacility‑based cross‑sectional analytical study was conducted among
inpatient diabetics seeking care at a rural tertiary care center in Kolar district of Karnataka. Apre‑tested
semi‑structured questionnaire was used to capture the sociodemographic, disease‑related,
treatment‑related and behavior‑related characteristics of the inpatients. The outcome of “perceived
stress” was captured using a standard questionnaire of Cohen Perceived Stress Scale–10. Poisson
regression was used for multivariable analysis, and the association was expressed as prevalence
ratio with 95% confidence intervals (CI).
RESULTS: Out of the 247 study participants analysed, “perceived stress” was seen among 97 (39.3%)
of the participants (95% CI: 33.3%–45.5%). Multivariable analysis showed that factors like younger
age, lesser duration of diabetes, presence of any comorbidity, being underweight, having conflicts
at work place/home in the last 1 month, and not having enough money for treatment had shown
higher levels of “perceived stress.”
CONCLUSION: About two out of five inpatient diabetics seeking care from rural tertiary health centres
had shown to have “perceived stress.” There is a need for the inclusion of stress management
techniques in the diabetes education program at all levels of health‑care systems.

Abstract Inappropriate and irrational use of numerous advanced diagnostic imaging technologies has
recently been highlighted in many countries and has gathered the attention of policymakers.
This matter has not only increased health costs in countries but also resulted in adverse health
results. Various factors are involved in the inappropriate or unnecessary use of advanced
medical imaging techniques including patient‑related, physician‑related, technological,
and ultimately radiologist‑related factors. This calls for the provision of new guidelines by
policymakers to encourage all service providers to make appropriate use of such techniques.
One of the main approaches in this regard is the application of clinical guidelines and decision
support systems. The present study was a systematized review that conducted in January
2019, and the articles related to palliative care requirements on databases of Web of Science,
PubMed, Scopus, ScienceDirect, Ovid, ProQuest, Wiley, and Google Scholar from January
1, 2009, to January 20, 2019, were searched. Strategy for searching and selecting the articles
was Preferred Reporting Items for Systematic Reviews and Meta‑Analyses Guidelines.
Overview of the studies shows that various reasons for the overuse of diagnostic imaging
technologies and effects of applying clinical guidelines on reducing diagnostic costs of
treatment are investigated in this article with respect to various aspects and viewpoints.
Clinical guidelines can be significantly effective in evaluating suitability and quality of
referrals for diagnostic imaging, if only adapted properly.

Abstract INTRODUCTION: Health promotion is one of the most important aspects in pregnancy, and
health‑promoting behaviors are one of the major determinants of health under the influence of various
factors. This study aimed to determine the association between social support and psychological
factors with health‑promoting behaviors in pregnant women.
MATERIALS AND METHODS: This cross‑sectional was performed on 375 pregnant women when
they had 24–28 weeks in Ilam, October 2018 to May 2019. Two‑stage cluster sampling was performed
after checking the inclusion criteria. Data collection tools consisted of four questionnaires that were
completed in self‑report form. The collected data were analyzed by the descriptive and inferential
tests with the SPSS software version 19.
RESULTS: The mean score of health‑promoting behaviors was 139.87 (21.26) and self‑healing and
physical activity had the highest and the lowest mean 27.67 (4.84) and 16.29 (4.84), respectively.
Linear regression analysis showed a significant difference between different level of stress, anxiety,
depression, and social support with health‑promoting behaviors (P < 0.001). The results showed
that one‑point increase in the score of stress, anxiety, and depression led to the 2.2%, 6.1%, and
24.1% reduction of health‑promoting behaviors, respectively, and one‑point score increase in social
support resulted in 40% increase in health‑promoting behaviors (P < 0.001).
CONCLUSION: A negative association was found between psychological factors and a positive
relationship with health‑promoting behaviors. Although perceived moderate health promotion
behaviors and perceived social support were moderate, they did not have a good status in terms of
psychological factors. Given awareness of the issues under study in each region is essential and
planning to improve stress, anxiety, and depression, as well as promoting and correcting inappropriate
behaviors through planned interventions are required.

Abstract BACKGROUND: Medical Council of India has suggested competency‑based curriculum for
undergraduate students to make it learner centric. One‑month “Foundation course” was introduced
at the beginning of the course to promote better adaptation to the new curriculum. A cross‑sectional
study was conducted to analyze the feedback from students who attended the foundation course.
MATERIALS AND METHODS: All first‑year Bachelor of Medicine and Bachelor of Surgery students
who underwent 1‑month foundation course were included in the study. The course was conducted
in six modules. All the sessions were handled by efficient resource people and conducted in an
interactive manner. A form in which response against each topic/talk was graded as average, good,
or excellent was used to obtain the feedback. Data were analyzed using Statistical Package for
Social Sciences 16 software. Responses among various modules were subjected to Chi‑square
two‑sided test with Yates’s correction.
RESULTS: A total of 98 students (32 males and 66 females) attended the foundation course of
21 days. Among the modules conducted, basic skill training module was scored excellent (67%)
remarks, followed by sports and extracurricular activities (64.6%) (P = 0.8806). Among the skill
training module, both basic life support training and first aid on medicine/pediatrics achieved 92%
excellent score. One of the orientation module sessions, research methodology, scored least. The
descending order of excellent remarks was skill module > sports and extracurricular activities > field
visit to the community and primary health center > orientation modules > enhancement of language.
CONCLUSION: Attention should be given to include more topics concerned to the modules of
skill training and extracurricular activities in upcoming years. Foundation courses can increase the
confidence and better adaptability of the students toward a new environment.

Abstract AIM: This study aimed to identify models for the participation of the city council and municipality with
the health system in selected countries.
SUBJECTS AND METHODS: This is a descriptive comparative study conducted in 2020 qualitatively.
The countries studied were examined in terms of the following characteristics: type of political
structure, type of health system, level of cooperation between local government and health system,
municipal financing, type of financial participation of local government and health system, method
or institution for participation Created, level of participation, local government influence on health
system decisions, advantages and disadvantages of a partnership between local government and
health system. Data were collected through valid databases (PubMed, Scopus, Embase, and Google
Search engine) and website of the World Health Organization, local government, and the Ministry
of Health of countries concerned and analyzed in a framework of analysis.
RESULTS: Countries were divided into two groups in terms of a partnership between the health
system and local governments, which had a distinct partnership between the health system and local
government and without their participation. Factors that contribute to the creating and strengthening
of partnerships include beliefs of health authorities and local government, the need for participation,
transparency in participatory programs, designing a specific mechanism for participation, local
authority, and financing joint participation plans.
CONCLUSION: In countries with planned participation, citizens have better access to services.
Citizens’ participation, as well as the private sector, is greater in health issues. In these countries,
participation in health financing by the private sector and other related agencies has increased.
Planning and service delivery increases according to neighborhood needs. The variety of services
provided and the use of new methods of service are more, and in these countries, the focus of
the Ministry of Health on the preparation of strategies and monitoring the quality of services is
increasing.

Abstract INTRODUCTION: Clinical rounds provide opportunities for medical students to acquire essential
skills to practice medicine in the real world. Although this kind of training is one of the most important
components of medical education, it is replete with barriers in its effective implementation. This study
aimed to investigate medical students’ experiences concerning the barriers and strategies of clinical
rounds in Kerman University of Medical Sciences (KMU).
MATERIALS AND METHODS: This qualitative research was conducted on 12 medical students
in KMU in 2017. Purposive sampling was used and participants in three grades (stagers, interns,
and residents) were selected, and individual semi‑structured interviews were conducted until data
saturation. The average of the interview time differed among the three batches (stagers, 51 min;
interns, 38 min; and residents, 31 min). Content analysis using deductive approach was used for
data analysis. MAXQDA version 10 was used for data analysis.
RESULTS: Data analysis yielded the identification of six themes related to the system of clinical
education, fields of clinical education, clinical environment, educational program, medical teachers,
and medical students concerning the barriers and five themes related to the strategies for clinical
rounds.
CONCLUSIONS: Findings revealed a deeper understanding of medical students’ experiences. Our
investigation identified multiple challenges embedded in our context and strategies to overcome
them. As teaching in clinical rounds is invaluable, there is a need to take into account the identified
challenges and overcome them. Thus, more effective rounds with higher efficacy toward students’
professional development can be implemented.

Abstract BACKGROUND: Emergency department (ED) overcrowding is one of the leading problems of
health‑care organizations, discerned by ED medical staff, but it has never been measured objectively.
OBJECTIVE: A 2 months prospective cross‑sectional study was conducted to compare ED
overcrowding measurement tools with the perceptions of ED emergency physician and ED assistant
nursing superintendent (EDEP/EDANS).
RESULTS: The results have shown that perceptions of ED overcrowding as noted by EDEP and
EDANS, taken on a Likert scale, were 83.34% and 86.67%, respectively. Kappa values show a
significant agreement between EDEP and EDANS subjective perceptions with objective values of the
National Emergency Department Overcrowding Study (NEDOCS), Real‑time Emergency Analysis of
Demand Indicators (READI), and Emergency Department Work Index (EDWIN) scales. Furthermore,
all three scales have statistically significant correlation; NEDOCS and READI had highest level of
correlation coefficient (r = 0.662, P < 0.01) whereas READI and EDWIN shows least correlation
coefficient value (r = 0.155, P < 0.01).
CONCLUSION: Therefore, these scales may serve to quantify the subjective impressions of ED
overcrowding. Evidence is clear of overcrowding harms, measures are needed to provide urgent
medical care and future work up is need of the hour to systematically evaluate interventions and
guide evidence‑based policies.

Abstract OBJECTIVE: According to the World Health Organization, estimates about 1,800,000 people lived
with disability in Tehran. Against there is little evidence of physical access to rehabilitation facilities
in Tehran. This study is aimed to assess the physical access to physical rehabilitation facilities in
Tehran and compare it with the country.
METHODS: This is a cross‑sectional study conducted since January to April 2017. We used a master
facilities list of rehabilitation facility that developed in Iran to collect the information. The samples of
this study included all existing physical rehabilitation centers in Tehran province. Data analysis was
done using the SPSSr version 21.0 (SPSS Inc., Chicago, IL).
RESULTS: The results showed that rehabilitation facilities existed at different levels, including
inpatient (10.51), outpatient (224.28), community based (36.72), and long‑term care (4.96)/1,000,000
populations. Rehabilitation services are provided by rehabilitation professional including: Physical
medicine and rehabilitation specialists (8.7), physiotherapists (132.89), occupational therapists (57.4),
speech therapists (42.11), and audiologists (48.84) (in 1,000,000 populations).
CONCLUSION: Tehran needs to increase the physical access to rehabilitation facilities and
compared with country was disproportionate physical access to facilities in most cases. It
is necessary to establish an interdisciplinary referral system between different rehabilitation
providers.

Abstract INTRODUCTION: The aim of the present study was to show the effect of public health educational
campaign regarding antibiotic use and microbial resistance on knowledge, attitude, and practice of
people in Isfahan.
MATERIALS AND METHODS: This quasi‑experimental study was conducted in October 2019 on
the public population in Isfahan (a city in the center of Iran). Simple random sampling was done in ten
urban areas.). A total of 708 people participated in the study. For assessing the knowledge, attitude,
and practice a related researchers‑made questionnaire was used in the present study. Finally, data
were entered into SPSS (20) and analytical statistics including paired t‑test were used. The statistical
significance level was considered <0.05.
RESULTS: The majority of participants in this study were female 434 (61.9%) and the rest of them
were male. The mean ± standard deviation of age was 31.68 (11.11), range of 11–67. More than
50 present of participants had a Bachelor’s degree (37.7%) and diploma (27.7%). Most individuals
were self‑employed 277 (43.1%). About the type of marriage, 54.89% were single and others
were married. Results showed that the mean of knowledge and attitude was increased after the
intervention (P < 0.05).
CONCLUSION: Increase knowledge between people, adherence to treatment and minimizes
healthcare costs, however, “antibiotics are misused so often because of the belief that these are
benign drugs. In the absence of urgent corrective and protective actions, the world is heading towards
a postantibiotic era, in which many common infections will no longer have a cure and once again,
kill unabated.

Abstract

Abstract