Journal of Education and Health Promotion

Abstract BACKGROUND: Evaluation has become an inseparable part of education process which gives
feedback to students and professors to improve education quality. This study aimed to elicit
preferences of professors and students about attributes of evaluation methods in theoretical courses
in Kermanshah University of Medical Sciences, Iran, in 2018.
MATERIALS AND METHODS: Discrete choice experiment (DCE) method used for eliciting preferences
of participants of the study. A narrative literature review and interview with eight professors and ten
students conducted to determine attributes and levels of evaluation methods in the university. Furthermore,
experimental design used for making final choice sets of the evaluation methods. We included 213
students and 30 professors in the study. Conditional logistic regression model performed to data analysis.
RESULTS: Most of the professors (36.67%) preferred to allocate up to 30% of evolution scores to
midterm examination. However, the most percentage of students (30.45%) were agree to include
midterm examination up to 15% of total scores. The majority of students prefer to examination
questions compromise just presented materials, while 70% of professors prefer to include additional
texts for evaluation examinations. In case of quiz examination, professors in comparison with students
prefer that quiz should have higher proportion of total scores. DCE analysis indicated that professors
and students preferred a mix of questions in examinations. In addition, additional resources beyond
what is taught in class made utility for professors and disutility for students. Quiz, also, increased
the utility of an evaluation package in professors.
CONCLUSION: The findings showed that there is a gap between preferences of professors and
students regarding some attributes of evaluation methods such as student’s discipline, examination
materials, and quiz. Further studies are needed to examining other attributes of evaluation methods
in theatrical and practical courses in Iran and other contexts.

Abstract BACKGROUND: Pruritus is a common skin manifestation in patients undergoing hemodialysis.
Pruritus has a negative impact on the quality of life of patients receiving hemodialysis. This study
was aimed to investigate the effect of foot reflexology massage on pruritus in hemodialysis patients.
MATERIALS AND METHODS: A quasi‑experimental study was conducted on 90 hemodialysis
patients referred to Khatam‑al‑Anbiya and Ali‑Ebne Abi‑Taleb hospitals affiliated to Zahedan
University of Medical Sciences in 2019. Patients with moderate‑to‑severe pruritus scores obtained
from the Pruritus Severity Scale (PSS) were included in the study. They were randomly divided into
intervention and control groups using shuffling cards or envelopes. The intervention group received
nine sessions of foot reflexology massage 3 days a week for 20 min (10 min on each foot) with an
emphasis on the solar plexus point. The participants in both groups again completed the PSS 48 h
after the intervention. Data were analyzed using the SPSS version 24, independent t‑test, Chi‑square
test, and paired t‑test.
RESULTS: The results of this study demonstrated that foot reflexology massage significantly reduced
itching or pruritus in hemodialysis patients (P < 0.001). Pruritus scores in the control group were
statistically significant (P < 0.001). There was no significant statistically difference between the two
groups in terms of the pruritus scores before the intervention (P = 0.59).
CONCLUSION: Our findings showed that the foot reflexology massage could relieve itching or
pruritus in hemodialysis patients. It is, therefore, recommended that it can be used as an effective
intervention technique to alleviate itching in hemodialysis patients.

Abstract Population aging is a phenomenon expanding around the world and will be increase the incidence
of chronic diseases and health costs. This study was conducted according to the preferred reporting
items for systematic reviews and meta‑analyses (PRISMA). A comprehensive literature search was
performed on 4 databases (Web of Science, PubMed, Science Direct, and ProQuest) for English
language studies from January 1, 2000, to December 31, 2019. The keywords used to extract relevant
contents were “e‑health,” “Elderly care,” “Self‑care,” “challenge,” “Opportunity” etc., The search
strategy led to a total of 638 potentially relevant papers, of which 19 papers met the inclusion criteria.
The results showed that the challenges of using mobile health in elderly self‑care can be divided into
technical, human and managerial challenges. The resulting opportunities include reducing health care
costs; no need to visit verbal and remote access to elderly information. The use of mobile health in
the elderly has advantages and disadvantages. One of the advantages of that is improving physical
activity and reducing care costs, but it may break the privacy. The disadvantages of that can be
resolved by educating the elder men.

Abstract BACKGROUND: Oral health-care providers are always at a risk of transmitting or acquiring airborne,
saliva-borne, or blood-borne infections due to their proximity to the patient’s mouth, contact with
saliva, and handling of sharp instruments. the aim this study was to evaluate the knowledge of the
dentists regarding COVID-19, methods to prevent its transmission, and implications of COVID-19
in dental treatment.
MATERIALS AND METHODS: It was a cross-sectional online survey. There were 35 questions
in total, divided into sections of knowledge of COVID-19, practices of personal protective
equipment (PPE), and knowledge of implications of COVID-19 in dental treatment. Both convenience
sampling and snowball sampling were used, so that maximal participation could be ensured. The
results were analyzed using descriptive statistics and making comparisons among various groups.
The data were summarized as proportions and percentages (%). All the associations were tested
using the Chi‑square test, ANOVA, and Pearson’s correlation coefficient. Statistical analyses were
performed using SPSS version 19.0.
RESULTS: 26.8% of respondents had a high knowledge, 61.5% had good knowledge, 10.1%
had low knowledge, and 6 (1.5%) had nil knowledge about COVID‑19. No significant association
was found between qualification and knowledge level among the respondents (P = 0.053). Both
graduates and postgraduates had low knowledge regarding effective PPE components (P = 0.053),
donning (P = 0.888), and doffing (P = 0.745). Only 52.9% of postgraduates and 43.7% graduates
answered correctly about the sequence of donning, and 47.9% of postgraduates and 46.1% of
graduates had knowledge regarding correct doffing sequence of PPE. Furthermore, knowledge was
low regarding the implications of COVID-19 in dental treatment.
CONCLUSION: Although the dentists were found to have high/good knowledge scores regarding
COVID-19, there was a lack of knowledge regarding hand hygiene, proper use of PPE, and implications
of COVID-19 in dental treatment. Thus, they need to be trained and sensitized regarding the same.

Abstract BACKGROUND: Conditions and needs of autistic children have impacts on both the children and the
family members who have crucial roles in raising the child. The prevalence of autism is increasing,
and this fact makes it necessary to focus more on experiences of parents who have children with
autism spectrum disorder (ASD). Hence, this study aimed to reflect the experiences of parents who
have autistic children.
MATERIALS AND METHODS: The present study was a qualitative research with phenomenology
approach which was conducted using content analysis approach. Participants were 14 parents with
ASD children in Ahvaz, and they were included based on purposive sampling method. To gather the
required data, semi‑structured interviews were formed. Data analysis was performed by Colaizzi’s
seven‑step method.
RESULTS: Fifty‑four conceptual codes were extracted from interviews of ASD children parents.
Parents of these children had two main experiences: first family related and second education and
treatment problems. Family problems included three categories (financial, psychological, and family
relationships). Education and treatment was categorized into three (schooling, transporting, and
quality in facilities).
CONCLUSIONS: Problems mentioned by parents of autistic children highlight the need for providing
training and counseling services as well as emotional supports from both society and government.
Planning and implementing supportive plans empower parents to strategically face problems and
eventually improve their life quality and mutual understanding.

Abstract BACKGROUND: Corona virus disease 2019 (COVID‑19) is a highly infectious disease primarily
spreading through droplet infection which require significant restriction and modification in dental
treatment. This study aims to assess the knowledge and attitude of adult population toward COVID‑19
and dental treatment and to assess the availability of dental treatment and patient satisfaction during
the time of pandemic.
MATERIALS AND METHODS: An online survey was conducted using self‑designed electronic
questionnaire consisting knowledge and attitude about COVID‑19 and dental scenario and questions
regarding availability of dental treatment received during the time of pandemic. Knowledge scores
were assessed on a maximum total score ranged from 0 to 8, and descriptive statistics were done
for questions related to attitudes and dental treatment availability.
RESULTS: A total of 495 participants with mean age of 36.6 years participated in the study. The
mean knowledge score was 7.12 ± 0.99 and the participants were found to have good awareness
and positive attitude regarding COVID‑19 were as considerable number of participants were unaware
about the risk associated with dental treatment as well as restrictions imposed on dental procedures.
About 18% of participants experienced one or other form of dental complaints during the lockdown
period. 4% of participants had no accessibility to any form of treatment.
CONCLUSIONS: Public awareness is to be improved regarding risk of cross infection that can
be associated with dental treatment and public should be motivated to use virtual facilities like
tele‑dentistry so that no dental emergencies is left untreated, at the same time avoiding any sort of
unnecessary hospital visit during the pandemic time.

Abstract BACKGROUND: Medical records constitute a legal and professional document regarding the activities
of medical staff in hospitals. This study was conducted with the aim of identifying the factors that
affect the quality of medical records by implementing the accreditation models in hospitals.
MATERIALS AND METHODS: This was a qualitative study. The data were collected via
28 semi‑structured interviews. The research population included administrators and supervisors
of nursing, medical records and accreditation in educational hospitals in Ahvaz, southwest Iran.
Content analysis method was used to analyze the data. Descriptive statistics were used to present
demographic characteristics of interviewees.
RESULTS: Facilitators and barriers to improve the quality of documentation were categorized into
three levels: organizational, environmental, and personal, all achieved after the implementation
of accreditation model in hospitals. Six facilitating factors were identified including organizational
structure, organizational culture, management support, individual characteristics, and perceived
benefits science and technology. The barriers included five factors including program structure,
organizational structure, beliefs, justice, and individual characteristics.
CONCLUSIONS: The identification of factors affects the quality of medical record documentation
and it seems that health managers and policymakers should take measures to improve the quality of
medical recording documentation through strengthening the facilitators and overcoming the barriers
in the program since the purpose of accreditation is to improve the quality in hospitals.

Abstract BACKGROUND: Musculoskeletal pain is highly prevalent among office workers and causes high
costs to the public health system. Strategies including education and exercise are recommended,
with major benefits when conducted by physical therapists in the occupational environment. However,
the required investment is uncommon among companies. This study aimed to evaluate the efficacy
of a multimodal physiotherapy intervention to relieve musculoskeletal pain in office workers.
MATERIALS AND METHODS: The study employed a single group study with a pre‑post
study design and was conducted at Universidad San Jorge in 2018. Outcome variables were:
workplace ergonomics (INSHT Guide), existence and severity of musculoskeletal disorders
(Nordic Musculoskeletal Questionnaire), musculoskeletal pain intensity (Numeric Rating Scale), and
Clinical Global Impression Scale. Office workers in a university setting (n = 24, 19 females) were
assessed at baseline, after 4 weeks of in‑person sessions and following 3 weeks of autonomous
performance. The physiotherapy program included education, ergonomic supervision, self‑treatment,
strengthening, and stretching exercises. A repeated‑measures ANOVA or Friedman test (with post
hoc comparisons) and Chi‑squared test were used to compare the study variables.
RESULTS: At baseline, cervical spine (54%), shoulder (42%), and lumbar regions (37.5%) were
the most symptomatic regions according to the Nordic Musculoskeletal Questionnaire. Even if the
proportion of symptomatic areas did not decrease significantly after the intervention, a great reduction
of musculoskeletal pain intensity was observed after the program in the cervical (P < 0.001), lower
back (P = 0.005), shoulder (P = 0.006) regions, and in the overall pain level (P < 0.001).
CONCLUSIONS: These results support that a multimodal physiotherapy program can relieve
work‑related musculoskeletal pain in office workers and serve as a basis for future controlled trials.

Abstract BACKGROUND: Since the purpose of medicine science is health promotion, education of this group
is very important. The use of new evaluation methods is one of the first educational needs. Given
that many conventional clinical evaluation methods are not able to fully evaluation students in the
clinical settings and only evaluate limited information, This study is designed to evaluate the impact
of direct observation of procedural skills (DOPS) and mini‑clinical evaluation exercise (mini‑CEX)
on nursing students and their clinical satisfaction skills.
MATERIALS AND METHODS: This quasi‑experimental study was conducted in 2018 to evaluate
the dialysis unit of the 6th semester nursing students of Babol University of Medical Sciences in Iran.
Samples were selected by the census method and then random allocation. Data collection was
performed using two questionnaires and two checklists to evaluate the clinical skills and satisfaction
of the two groups of testing and control. Moreover, the data were analysed with using the SPSS
software (version 18, IBM SPSS Inc., Chicago, IL, USA) through the descriptive and analytical
statistics (Chi‑square test and t‑test).
RESULTS: The results showed that the intervention group compared with the control evaluation score
of 13/73 ± 2/44, 11/74 ± 2/43, P < 0.002, respectively. Furthermore, the mean score of satisfaction of
the intervention group with the DOPS method compared to the traditional method of the control group
was 72/50 ± 7/31, 63/48 ± 9/31, P < 0.001, respectively. As well as, the mean score of satisfaction
with the mini‑CEX method of the intervention group compared to the traditional method of the control
group was 73/28 ± 7/78, 63/48 ± 9/31, P < 0.002, respectively.
CONCLUSIONS: The results of this study showed that students who were evaluated by DOPS
and mini‑CEX methods had a higher score of clinical performance evaluation and higher level of
satisfaction. Nursing professors can improve the learning process and the satisfaction of nursing
students by using direct feedback on such evaluation methods.

Abstract BACKGROUND: Amidst corona virus disease‑2019 (COVID‑19) pandemic, disruption to the
usual ways of life can lead to anxiety and feeling of being unsafe, which may be associated with
self‑medication. The study was planned to investigate the prevalence of anxiety and self‑medication
during COVID‑19 pandemic.
MATERIALS AND METHODS: In this cross‑sectional study, data were collected through an
anonymous online survey with questionnaire consisting of four sections: demographic data of
the participants, validated COVID‑19 Anxiety Inventory Items, Self‑rating Anxiety Scale, and
self‑medication practices during COVID‑19 pandemic. The data were organized and analyzed using
Windows Microsoft excel and SPSS software (Version 21). Descriptive statistics were calculated for
all patient characteristics and survey responses. Analytical analysis included relationship between
various parameters using Chi‑square test.
RESULTS: A total of 1100 responses were received. Approximately half of the participants were
worried about getting severely ill. Majority reported reduced social contact (71.3%, n = 784) and also
communicated that the pandemic has influenced their use of safety measures (86.5%, n = 951). The
prevalence of mild‑to‑moderate, moderate‑to severe, and extremely severe anxiety cases were 23.1%,
4.7%, and 0.54%, respectively. One‑fourth of the responders reported self‑medication, out of which
60% were found to be anxious. Nonsteroidal anti‑inflammatory drugs were most commonly used.
CONCLUSIONS: Rising to the present challenge will require integration across different sectors with
the immediate aim of getting people safely through the pandemic. As the world focuses on containing
and delaying the spread of the COVID‑19, with burdened health‑care systems, we should not miss out
on people with anxiety disorders and self‑medication problem, which may worsen with the pandemic.

Abstract BACKGROUND: Disease knowledge, appropriate attitude, and proper practices play an important
role in disease control and reduction of diabetes‑related complications and deaths. This study aims
to investigate the impact of knowledge, attitude, and practices (KAPs) of Type 2 diabetic patients’
outcomes.
MATERIALS AND METHODS: A cross‑sectional research was conducted on a group of 102 Type 2
diabetic participants in 17 communities in Tam Binh District, Vinh Long Province, Vietnam. The
research tool employed the KAP questionnaire using IBM SPSS 22 to analyze the data.
RESULTS: The participants’ average age was 57.02 ± 6.323 years. The proportion of women
was 76.5% (three times higher than men). The knowledge score of the participants was
low (30.04 ± 12.823), the attitude toward score of diabetics was moderate (61.544 ± 29.99), and the
practice of self‑care score was low (50.59 ± 14.881). There were also some significant relationships
between KAPs with ethnicity, marital status, diabetic duration, location, employment status, and
treatment method. In addition, there were only significant differences between the self‑care practice
groups and patients’ attitude toward Type 2 diabetes.
CONCLUSION: There is a significant relationship between KAP with some participants’ characteristics.
The KAPs of the diabetic patients in Tam Binh district are still low. This result showed that although the
patient’s attitude towards disease was good, it was not enough for them to practice good self‑control
due to poor knowledge.

Abstract BACKGROUND: Heart attack and stroke account for >80% of deaths due to cardio‑vascular
diseases (CVDs) in India. Adolescents are the most susceptible group to adopt risky behaviors
causing CVDs such as use of tobacco and alcohol, sedentary lifestyle, and unhealthy diet. This
study was conducted to assess the health literacy of CVDs such as heart attack and stroke among
school‑going adolescents and change in health literacy after different information, education, and
communication (IEC) activities.
MATERIALS AND METHODS: It was a school‑based interventional study conducted in two schools
among students of classes 6, 7, and 8. The educational interventions were done in the form of
pamphlets, posters, and lectures on heart attack and stroke. The postintervention data were collected
2 weeks after the first intervention and 3 months after the last intervention.
RESULTS: There were a higher proportion of students with satisfactory level of knowledge of heart
attack and stroke both at 2 weeks and 3 months after the interventions in both the schools, and the
results were statistically significant (P < 0.05).
CONCLUSION: The health literacy regarding CVDs has improved when compared to baseline after
IEC activities among school‑going adolescents.

Abstract BACKGROUND: This study aimed to identify the quality of life (QoL) and its predictive factors based
on the Andersen’s behavioral model among the elderly in Iran.
MATERIALS AND METHODS: A quantitative cross‑sectional study was conducted on 400 people
aged 60+ resident in Zanjan, Iran, in 2019. Data were collected based on the Andersen’s behavioral
model constructs by the questionnaires. Path analysis was used to determine both direct and indirect
effects of variables and also for estimating the values of coefficients in the underpinning linear model.
RESULTS: In this study, 50% of the participants were female, and 83% were married. The participant’s
QoL was 37.4 (9.8). The results confirmed that financial level and physical activity were the most
significant predictor of the elder’s QoL. Chronic diseases and activities of daily living as need factors
affect the QoL of participant indirectly.
CONCLUSION: The results showed that the participant’s QoL was at a moderate level. Utilizing of
primary health‑care services was the weakest predictors of QoL. Sex, marital status, and education
level were not reliable predictors of QoL in elders. Other predisposing, enabling, and need factors
should be investigated to find the main determinants to improve elder’s QoL.

Abstract BACKGROUND: The novel coronavirus (COVID‑19) has infected nearly 9.5 million people in 216
countries, areas, or territories in the world. The fight against the COVID‑19 has become a very serious
international challenge. The aim of this study was to determine the predictors of COVID‑19‑preventive
behaviors using the health belief model (HBM).
MATERIALS AND METHODS: This cross‑sectional study was conducted with the participation of
558 samples from the adult population of Iran. The online convenience sampling was conducted
in this research. The online 68‑item questionnaire link was published all over Iran through social
networks including Telegram and WhatsApp, which are common in Iran. The data were analyzed
using SPSS software version 19. Descriptive statistics, bivariate Pearson’s correlation test, and
multiple linear regression were used to analyze the data.
RESULTS: The mean age of the subjects was 33.3 ± 10.01 years. The participants were often
female (61.3%), married (57.9%), and resident of the city (81.0%) with university educational
level (78.8%). The results showed that the HBM structures predicted 29.3% of the preventive
behaviors of COVID‑19 in the subjects. The perceived benefits, perceived barriers, and self‑efficacy
significantly predicted the preventive behaviors, but the perceived susceptibility and perceived
severity were not significant in the regression model. The internet and virtual social networks (49.8%),
broadcast (33.5%), and healthcare providers (15.8%) were the most important sources of information
related with COVID‑19. In response to COVID‑19‑related internal cues to action, 36.6% did not
pay attention and 34.7% tried to self‑medicate. Only 28.5% of the subjects referred to the hospital,
healthcare center, or physician.
CONCLUSION: Self‑efficacy, perceived barriers, and perceived benefits were the key determinants
of COVID‑19‑preventive behaviors in the subjects. It can be concluded that the HBM is a good tool
to predict COVID‑19‑preventive behaviors in Iranian population.

Abstract BACKGROUND: Loss of physical function during the process of aging might affect the quality of life.
Physical function assessment tests predicts outcomes such as falls, institutionalization, and death.
Studies assessing the association of physical function with quality of life and physical activity level of
elderly population in India is scarce. Hence we aimed to assess the physical function of community
dwelling older adults and to determine its association with physical activity levels and quality of life.
MATERIALS AND METHODS: This was a cross‑sectional analytical study. 89 community dwelling
older adults between 60 and 80 years of age were recruited. Physical function was assessed by
standing balance, walking speed, and grip strength. Quality of life was assessed by WHO QOL BREF
questionnaire and physical activity level was assessed by International Physical activity Questionnaire.
RESULTS: Standing balance was reduced in 24% and walking speed was decreased in 33% of the
participants. Males had higher walking speed, and grip strength. Quality of life was better among
males. Standing balance, walking speed and grip strength was significantly higher in moderate – heavy
activity levels. There was positive correlation between physical function and quality of life. There was
also positive correlation between physical activity level and quality of life.
CONCLUSION: Physical function, quality of life and physical activity level were decreased. Males had
better physical function and quality of life. Physically active individuals had better physical function
and quality of life. Early detection of decreased physical function and increase in physical activity
level could result in better quality of life among elderly.

Abstract BACKGROUND: Test anxiety is a major educational problem among students all around the world.
The purpose of this study was to investigate the relationship between academic procrastination and
test anxiety among the dental students of Qazvin University of Medical Sciences.
MATERIALS AND METHODS: The present study was a descriptive–analytical study. The study
sample consisted of 152 dental students; Solomon and Rothblum’s procrastination scale and
Friedman’s test anxiety questionnaire were used to collect data. To analyze the data, descriptive
and analytical statistics (analysis of variance, independent t‑test, and Pearson’s correlation) were
used at a significance level of P < 0.05.
RESULTS: The results of the present study showed that there is a significant relationship
between procrastination and test anxiety and its components. The relationship between academic
procrastination and gender was not significant, but a significant relationship was found between test
anxiety and its dimensions with gender in terms of cognitive error and total test anxiety. No significant
relationship was found between academic procrastination and test anxiety and their components
with marital status, age, and grade point average.
CONCLUSION: According to the findings of the present study, people with academic procrastination
have more test anxiety and fear of humiliation, irrational and negative thoughts, and more stress.

Abstract BACKGROUND: Adherence to medical ethics principles by medical professionals is required to
improve health‑care system’s quality. Recognizing medical ethics’ challenges and attempting to
resolve them are important in the implementation of medical ethics in practice. This study aimed to
explore such challenges at Iran’s medical sciences universities in 2018.
MATERIALS AND METHODS: This descriptive, qualitative study utilized a conventional content
analysis approach for data analysis. This study was conducted using purposeful sampling from
participants with experience in teaching or practicing of medical ethics field, and by considering
maximum variety of disciplines (e.g., gynecology, internal medicine, surgery, and medical ethics). The
data were gathered using semi‑structured interviews. The interview guide was designed based on
previous research findings by two members of the research team and contained the main interview
questions and participants had the opportunity to express their perspectives in detail. Participants
were chosen from clinical and ethical faculty members as well as managers. The data collection
process continued until the data saturation stage, beyond which no new information or concept
achieved by continuing interviews.
RESULTS: After interviewing 14 faculty members and managers, findings were classified into 4
themes, 9 categories, and 42 sub‑categories; four main categories of medical ethics challenges are
affected by cognitive, educational, practical, and structural factors, respectively.
CONCLUSION: This study suggested that medical ethics’ cognitive and educational challenges can
alleviate using educational programs intended for improving qualitative and quantitative aspects of
medical ethics teaching for medical professionals ranging from students to faculty members. Medical
ethics’ structural and practical challenges are within policymaking and scheduling activities dealt with
through future researches by health‑care system’s managers and planners.

Abstract BACKGROUND: Cancer, as a life‑threatening disease in children, poses several challenges for
parents. It is necessary to have a tool that can comprehensively examine the stressful events for
parents of children with cancer. The aim this present study was done with the aim of study the
Persian version of pediatric inventory for parents (PIP).
MATERIALS AND METHODS: The study was a conducted based on methodological research
design. Four hundred and fifteen parents of children with cancer referring to Alia Asghar Children’s
Hospital and Children’s Medical Centre in Tehran answered the Persian version of PIP questionnaire
in 2019. a confirmatory factor analysis was carried out using LISREL (software version 8.8) to test
the construct validity of PIP. The two tools of parental stress scale and state‑trait anxiety inventory
(STAI‑Y) were used for concurrent validity purposes.
RESULTS: The results showed that, the overall score of the questionnaire was higher than the average
and related to emotional distress. The internal correlation coefficient (Cronbach’s alpha) in both parts
of the PIP was between 0.808 and 0.957 and acceptable. Concurrent validity analysis indicated
positive and significant correlation of this tool in the difficulty section of the scale with both Parental
Stress Scale and STAI‑Y. The results of confirmatory factor analysis indicated that the factor loads
of all items except three items in the frequency section were more than 0.3 and were appropriate.
CONCLUSION: The Persian version of PIP can be available to health and family experts as a valid
and reliable tool to assess stressful events of parents of children with cancer.

Abstract Fibromyalgia has been increasing worldwide and is considered a public health problem.
Nonpharmacological treatment through exercise and education is recommended for
fibromyalgia management. In this sense, there is a need for interdisciplinary programs to
promote health and improve symptoms in fibromyalgia. The purpose of this study was
to verify the effectiveness of interdisciplinary health education programs for individuals
with fibromyalgia. This is a systematic review that followed the Preferred Reporting
Items for Systematic Reviews and Meta‑Analyses recommendations and was registered
at Prospective Register of Systematic Reviews (CRD4201913228). A search was conducted
in the following databases: Scientific Electronic Library Online, Lilacs, Medical Literature
Analysis and Retrieval System Online, Scopus, Web of Knowledge ISI, Physiotherapy
Evidence Database, Excerpta Medica Database, Cumulative Index to Nursing and Allied
Health Literature, Cochrane Library, and SPORTDiscus. The descriptors used were
“Fibromyalgia” and “Health Education.” Clinical trials published between 1990 and 2019
were selected. The Jadad Quality Scale and the Cochrane Risk‑of‑Bias Tool were used to
evaluate the risk of bias and the methodological quality of the clinical trials. The search
found 2887 articles, and only two studies were included in the analysis. Both studies
conducted the interventions through lectures and group activities. In particular, the
topics most frequently approached at the interdisciplinary health education programs
were general information about fibromyalgia, body practices, physical activities, and
pharmacological approaches. An interdisciplinary health education program can improve
pain and quality of life in people with fibromyalgia; however, evidence shows low
methodological quality. This systematic review indicates that studies are of low quality,
interfering with the effectiveness of interdisciplinary health education programs.

Abstract BACKGROUND: Clinical trials concerning the effect of supplements or multivitamin on improving
the quality of life have proven different results. The present study was conducted to examine the
effect of multivitamin supplement on quality of life of the elderly.
MATERIALS AND METHODS: Sixty‑four old people over 65 years of age in Kermanshah Elderly Care
Center participated in this randomized trial. The samples were first selected using the convenience
sampling and then were randomly assigned into intervention and control groups. The intervention
group received one multivitamin mineral (MVM) supplement capsule every day for 3 months with
no intervention for the control group. Standard quality of life questionnaire was used to collect the
data. Data were analyzed using the SPSS software version 22.
RESULTS: The mean age of the participants was 70.77 ± 8.29 years. The results of intra‑group
evaluation of the aspects of quality of life of the elderly show the lack of significant changes in the mean
scores of physical health and environmental health of the elderly in the intervention group (P > 0.05)
and the significant reduction of these aspects in the control group (P < 0.05) after intervention. The
mean score of mental health scores in the intervention group significantly increased (P = 0.01),
but there are no significant changes in the control group (P = 0.273). The mean scores of social
relationships as well as the overall score of quality of life in the intervention and control groups
showed no significant changes (P > 0.05).
CONCLUSION: The present study showed that the consumption of MVM supplements can have
a positive effect on increasing the quality of life of the elderly, but it is recommended to be done in
the long term along diet. Moreover, considering the fact that no change was observed in the other
aspects of the quality of life, attentions should be paid to the environmental and social factors such
as social supports and empowerment of the old people in the future studies.

Abstract BACKGROUND: Facing a devastating infectious outbreak like COVID‑19, the command of “stay at
home” was recommended by some officials as a self‑voluntary quarantine strategy for controlling
the outbreak, but the people perceived and act differently. In this study, we aimed at ethnographic
evaluation of public response to this command.
MATERIALS AND METHODS: This research used ethnography for observing the public response to
the recommendation of “stay at home” in the COVID‑19 outbreak. Data were collected via observing
public behavior and documentation; then, the data were qualitatively analyzed.
RESULTS: Our findings showed 10 different ignored dimensions in this moral statement including
lack of legal and administrative support, diverse perception and contradictory reactions of the people
to the epidemiological forecasting and recommendations, different response to moral statements,
various perceptions of the people about health and wellbeing, feeling exhausted of staying at home,
not including justice and fairness in the moral statement, not clarifying the meaning of necessary
matters, not considering the COVID‑19 infected patients and their requirements, assigning the
responsibility of government to the public, and halting other scientific activities and investigations in
charge of COVID‑19.
CONCLUSIONS: Taken together, the officials should take an active role in implementing this moral
statement by strict regulations, public education about the disease, its control, and the importance
of quarantine, considering justice and fairness in implementation.

Abstract BACKGROUND: Pregnancy alone is associated with many anxieties and worries for many women.
Prenatal diagnosis of fetal malformations is one of the most important anxious events for women.
Increasing knowledge empowers the person to identify the important issues and by increasing
understanding, creates a positive attitude in people. Therefore, the aim of this study was to investigate
the effect of education on the level of anxiety of pregnant mothers before invasive screening for fetal
abnormalities (amniocentesis).
MATERIALS AND METHODS : This is a quasi‑experimental study with two parallel designs in three
stages: Pretest (before intervention), posttest (after intervention), and after amniocentesis. This study
was performed on 80 pregnant women candidates for amniocentesis (40 pregnant women in the
control group and 40 pregnant women in the intervention group) referred to the perinatology clinic in
Yazd in 2020. Data collection tools were demographic and midwifery questionnaires and Spiel Berger
anxiety questionnaires. In the experimental group, the intervention was performed as group training
for 90 min immediately before amniocentesis. In the control group, only routine procedures (brief
description by a perinatologist during amniocentesis) were performed. SPSS software version 16
was used to analyze the data.
RESULTS: The mean age of the research units was 67/5 ± 5/33 years. The results of Mann–Whitney
intergroup test showed that the mean scores of overt anxiety before the intervention between the
control and intervention groups were not significant (P < 0.014) but were significant after training and
after amniocenter (P < 0.001). Furthermore, the results of Mann–Whitney group test showed that
the mean scores of overt anxiety in the intervention group before and after training were significant
(P < 0.001). Furthermore, the results of the control group showed significant results (P < 0.001). The
results of the independent t‑test showed that the mean scores of latent anxiety before the intervention
between the control and intervention groups were not significant (P < 0.194) but were significant
after the training (P < 0.57) but The results were not significant after amniocentesis (P < 0.216).
Furthermore, the results of paired t‑test within the group showed that the mean scores of overt
anxiety in the intervention group before and after training was significant (P < 0.001). Furthermore,
the results of the control group showed significant results (P < 0.001).
CONCLUSION: The findings of the present study indicate the positive effect of education on anxiety of
pregnant women candidates for amniocentesis. The results also show the important role of education
on the psychological dimension of high‑risk pregnant women in relation to the consequences of
pregnancy and childbirth. According to the research results, it seems that education affects the
cognitive system and information processing by increasing people’s awareness of the amniocentesis
process and its consequences.

Abstract BACKGROUND: Courses’ resources is an important ingredient for building awareness, despite the
availability of health and environmental knowledge in some subjects, students’ practices still need
more improvement. The study aims to investigate the level of health and environmental practices
among university female students of both scientific and humanities subject majors, and its relationship
to the academic major.
MATERIALS AND METHODS: A descriptive research design is applied to a sample of 410 female
students enrolled in scientific and humanities majors during 2017/2018 academic year. A “Health and
Environmental Practices Scale” is prepared for data collection. It includes 58 items with Cronbach’s
alpha = 0.71 and 0.69 for the two domains. The means percentage and independent t‑test for the
two majors applied, as P ≤ 0.05 was statistically significant.
RESULTS: Results showed that (i) the level of health and environmental practices is “moderate”
with a mean of 2.89, 3.17 for both domains, respectively; (ii) there is no statistically significant
difference between health practices level and environmental practices level; (iii) there is no statistically
significant difference between humanities and scientific majors and health and environmental
practices level among students of humanities and scientific majors, which means that the impact of
the interdisciplinary courses on the level of health and environmental practices is not clear.
CONCLUSIONS: Health and environmental awareness among students are found to be moderate.
However, actual health and environmental practices are still a huge challenge because of the gap
between theory and practice.

Abstract BACKGROUND: The COVID‑19 pandemic led to the closure of crowded places such as universities
and replaced face‑to‑face learning with virtual education. The purpose of this qualitative study was
to investigate the challenges of virtual learning from the students’ perspectives.
MATERIALS AND METHODS: This qualitative descriptive study was conducted on students of
Sabzevar University of Medical Sciences. Purposeful sampling was performed by semi‑structured
group interviews on the Internet in the WhatsApp social network. Fifty‑two nursing, midwifery,
hygiene, and paramedical students were interviewed. Every interview was started by asking the
question “what is your experience about virtual teaching?” The data were analyzed using MAXQDA
software version 2020. According to the steps of qualitative content analysis, content analysis was
performed and the themes were extracted.
RESULTS: Fifty‑two students were interviewed in eight group sessions. Qualitative data analysis
leads to the extraction of 23 codes, 7 categories, and the 2 main themes; dissatisfaction with virtual
education with 4 categories (lack of feedback, communication channel problems, the unpreparedness
of the message receiver, and weakness in educational content) and solutions to the modification of
virtual teaching with three categories (possibility of receiving feedback, channel improvement, and
strengthening educational content) were extracted. The highest frequency of code was related to
the dissatisfaction with the uploaded contents.
CONCLUSIONS: Virtual education has created a negative experience among students for various
reasons, including the lack of distance learning infrastructure and the lack of a standard for preparing
quality content. Therefore, it is necessary for the officials of the Education Development Center to
supervise the prepared contents and improve distance learning infrastructure.

Abstract BACKGROUND: Achieving an excellent clinical education by nursing students is one of the primary
goals of any nursing school. Nursing educators try to use different methods to enhance clinical
skills. One of them is a peer‑led method that can be used in theoretical and clinical education. It is
developing as a suitable educational method to promote health. This study assessed the effect of
classmates as peer‑led education on the clinical performance of nursing students.
MATERIALS AND METHODS: This study was conducted using a mixed‑method approach and
a sequential explanatory design. In the quantitative phase, a quasi‑experimental study with a
two‑group pre‑ and post‑test design was conducted. The sample of this phase consisted of 70 nursing
students (35 persons in each group) who were selected through random convenience sampling. The
intervention group participated in a peer‑led education program. The control group received routine
training. The members of both groups completed the clinical performance checklist before, and after
the intervention, The collected data were analyzed using SPSS V21 software using descriptive and
inferential statistics. In the qualitative phase, the researchers interviewed 18 undergraduate students
using semi‑structured in‑depth and face‑to‑face approaches. These participants were selected by
purposive sampling method. Data were analyzed using conventional content analysis. MAX DATA
10 was used to categorize the data. To establish the reliability and validity of findings, Graneheim,
and Landman’s criteria were considered
RESULTS: In the quantitative phase of the study, the results showed that the mean score of clinical
performance was not statistically significant between the control and intervention groups before the
intervention (P > 0.05). At the same time, it was significantly different after the intervention (P < 0.05),
implying that the peer‑led education of the intervention group significantly increased compared to that
of the control. The main theme was “learning based on friendship,” which included two categories,
namely “deep learning” and “learn in the shadow of relaxing.”
CONCLUSION: Classmate as peer‑led education could increase the ability of nursing students in
clinical performance, and was able to enhance deep learning among them.

Abstract BACKGROUND: Colorectal cancer (CRC) is the third most common cancer in men and the fourth
most common cancer in women in Iran. Therefore, the aim of this study was to determine the effect
of educational intervention based on the theory of planned behavior (TPB) on the improvement of
CRC screening intention among average‑risk individuals.
MATERIALS AND METHODS: This quasi‑experimental study was performed on the 50–69‑year‑old
individuals referred to Asadabad city clinics in 2020. The individuals were randomly assigned to
multistage cluster sampling in each intervention and control group. The instrument used in this
research was a researcher‑made questionnaire based on TPB. Educational intervention was
conducted for the intervention group, one of their family members, and staff of clinic under intervention.
Finally, the data were entered into SPSS and analyzed utilizing descriptive and analytical statistics.
Results were considered significantly <0.05.
RESULTS: There were no significant differences between two intervention and control groups in the
preintervention phase in terms of the mean scores of attitude (P = 0.58), subjective norms (P = 0.59),
and behavioral intention (P = 0.66). However, in the postintervention phase, these differences were
significant. Furthermore, regarding the mean score of perceived behavioral control, there was a
significant difference between the two groups in the preintervention phase (P < 0.02), while in the
postintervention phase, this difference was not significant (P = 0.29).
CONCLUSION: Educational intervention based on the TPB has been effective in improving the CRC
screening intention among average‑risk individuals. Therefore, using the results of this research
and developing appropriate educational programs at the community level can be increased the
participation of community members in CRC screening programs.

Abstract BACKGROUND: Considering the importance of virtual professionalism and professional ethics
in medical sciences, and the necessity to pay attention to this issue and its impact on medical
professionalism, this study aimed to build a professional culture questionnaire in a virtual environment
for students of medical sciences in Iran.
MATERIALS AND METHODS: This is an exploratory, sequential, mixed‑methods research which
was conducted in three sections. In the first section, the concept of e‑professionalism in medical
sciences was analyzed using the hybrid concept analysis in the theoretical work, field work, and final
analysis stages in order to extract information related to the concept. In the second section, an item
of the questionnaire was designed based on the concept, reviewed texts, and related questionnaires,
in the third section, psychometric properties of a questionnaires were evaluated.
RESULTS: Totally, 39 items were included in the initial pool, which reduced to 33 items in the final
questionnaire after reviewing the psychometric properties. Factor analyses led to extraction of five
factors including appraisal of e‑professionalism compliance with the laws and regulations governing
cyberspace, individual professionalism, knowledge management, respect for professionalism in
interpersonal and group rules, and complying with ethics in the use of cyberspace. The internal
consistency of questionnaire was also confirmed by Cronbach’s alpha coefficient of 0.78, also all
factor correlations absed stability were significant (P < 0.05).
CONCLUSION: An exploratory sequential study in this study led to the extraction of five factors
and development of a 33‑item questionnaire in e‑professionalism. As results and analysis of the
psychometric properties and validation of each item, this questionnaire is valid and reliable for the
assessment of levels of e‑professionalism in medical sciences in Iran.

Abstract BACKGROUND: Lockdown was imposed as a preventive measure for coronavirus disease
pandemic. Social media was the most common tool available for the masses, including the 1st
year medical students during the lockdown. The objectives of the present study were to determine
the extent of use of social media and the effects on mind‑body and social distancing.
MATERIALS AND METHODS: It was mixed research conducted on 1st‑year medical students
using convenience sampling. The quantitative aspect of E‑survey was administered through Google
forms sent via E‑mail, and structured telephonic interview was conducted as a qualitative aspect on
randomly selected 10 students based on predecided interview questions. This study was reported
as per the Checklist for Reporting Results of Internet E‑Surveys. The analysis was performed using
percentages and paired t‑test with significance at P < 0.05, Chi‑square test with Yate’s correction.
Qualitative responses were analyzed using coding and categorization.
RESULTS: The response rate was 88%. Time spent on social media for >4 h increased from 1.1% to
47.72% during lockdown. Forty three (48.86%) of the students reported increased mood fluctuations.
The relation between mood fluctuations and time spent on social media of >4 h was significant
𝜒2 = 6.41 with P < 0.05. Average hours of sleep after using social media before lockdown increased
significantly from 6.68 h to 8.10 h during lockdown using paired t‑test, where “t” was 6.84. There
was a positive impact on communication with friends and family.
CONCLUSION: Due to the increased extent of use of social media during lockdown, negative
mind‑body effects have surfaced but emerged as boon in terms of communication .

Abstract BACKGROUND: Ancient history mentions the dominance of men in nursing; however, now nursing
has a feminine image, and globally more than 90% of nursing workforce is females. Recently, more
number of males are attracted to nursing, but there is a paucity of literature on the attitude of people
about men in nursing may be because of a lack of measurement scales available for this purpose.
The aim of this study was to develop and validate a new scale measuring attitude of people toward
men in nursing.
MATERIALS AND METHODS: The present study was conducted at a tertiary care hospital and used
an exploratory sequential design with an instrument development model. A total of 400 participants
were selected using the simple random sampling technique. The reliability, content validity, face
validity, and construct validity of this newly developed scale were computed. For data analyses SPSS
AMOS version 23 was used for performing exploratory and confirmatory factor analyses.
RESULTS: The new scale “AMnQ” consists of 15 items under three factors: (I) nursing is feministic
and professionally low, (II) higher suitability of male nurses in technical and challenging situations,
and (III) synonymy of empathy and care with a female. The final model with 15 items of AMnQ scale
was validated by confirmatory factor analysis and showed a good fit to data. The Cronbach’s α for
the overall scale was 0.87, and for Factors I, II, and III, it was 0.80, 0.88, and 0.89, respectively.
CONCLUSIONS: The “AMnQ” is a valid, reliable scale to assess the attitude of patients, nurses,
physicians, and nursing students toward men in nursing. There is an assumption that nursing is a
feminine profession; therefore, a valid and reliable scale to measure the attitude of people toward
men in nursing will help to generate pieces of evidence on this subject, so that policymakers can
make unbiased decisions on liberalizing entry of men in nursing.

Abstract BACKGROUND: Spiritual care is one of the important and essential aspects of healthcare. The
impact of spirituality on healing, health‑related states, and the ability to cope and adapt to the disease
is undeniable. Thus, this study is aimed to explain the perception of the spiritual care of patients by
health‑care providers.
MATERIALS AND METHODS: The present study was performed with a qualitative approach using content
analysis by the conventional method in hospitals of Qom University of Medical Sciences. The data were
collected through in‑depth semi‑structured interviews with 11 participants through a purposeful sampling
method and analyzed simultaneously. The consistency of the data was confirmed by the participants.
RESULTS: Data analysis provided four main categories as follows: “Observing the patient’s rights”
with subcategories of respect, right to choose, preserving the patient’s privacy, proper communication
with the patient, “professionalism” with subcategories of responsibility, acceptance of mistakes,
development of technical skills and knowledge, “supportive behaviors” with subcategories of paying
attention to emotional and psychological needs and “Strengthening the patient’s religious dimension”
with subcategories of honoring religious beliefs and providing healthcare along with trust in God.
CONCLUSIONS: According to the study findings, spiritual care from the perspective of health‑care
providers was explained as attention to emotional and psychological needs, reverence for patients’
religious beliefs, respect for human dignity, and sense of responsibility.

Abstract BACKGROUND: Professionalism is one of the most important and vital concepts in the medical
sciences. With the rapid growth of e‑learning in the medical sciences in the past few years, the concept
of virtual professionalism has emerged. This study was conducted as a hybrid concept analysis on
describing e‑professionalism in medical sciences.
MATERIALS AND METHODS: This is a qualitative study with a hybrid concept analysis approach,
consisting of theoretical stage, field research, and analysis. In the theoretical stage, the concepts of
e‑professionalism in medical sciences were identified through a review of the literature. During the
fieldwork stage, in‑depth interviews were conducted with five medical students who were intentionally
selected. Finally, after analyzing the literature and the qualitative interviews, a theoretical description
of e‑professionalism concept in the field of medical sciences was extracted.
RESULTS: the themes (3 numbers) and the subthemes (4 numbers) were extracted from 62
codes. These themes include information and communion technology and educational strategies
professionalism in medical education.
CONCLUSIONS: For describing professionalism, it is necessary to consider education and culture,
role models, by emphasizing on the acceptance of professional responsibility, developing and
improving social media policies, determining the scope of communication and interaction between
individuals, and identifying the boundary between local laws and customs.

Abstract BACKGROUND: Discrimination in health care is a common phenomenon whose complete
understanding has always been a major concern of health-care systems to control and reduce it.
This study aimed to explore the experiences of unintentional discrimination and related factors in
health-care providers.
MATERIALS AND METHODS: This qualitative study was conducted with a content analysis approach
in 2019. Data were collected through semi-structured interviews with 13 health-care providers including
two physicians, three nursing supervisors, two head nurses, four staff nurses, and two nurse aides
in two general hospitals in Tehran, Iran. Participants were selected through purposeful sampling.
The obtained data were analyzed by Graneheim and Lundman method.
RESULTS: Three main categories and eight subcategories were obtained from the data
analysis: (1) forced discrimination (superiors’ pressures and executive orders, occupational concerns,
and fear of the superiors); (2) guided discrimination (professional challenges, managers’ policymaking,
and lack of medical ethics knowledge); and (3) lack of resources (workforce shortage and lack of
medical equipment).
CONCLUSION: The results of this study suggest that health-care providers such as doctors and
nurses are unintentionally forced to provide discriminatory care on some occasions. Knowing and
managing these unwanted factors can partly counteract unintentional discrimination. Thus, preventing
the factors that lead to superiors’ pressures and occupational forces and improving the medical ethics
knowledge should be considered by health-care managers.

Abstract BACKGROUND: Irritable bowel syndrome (IBS) is one of the most common gastrointestinal diseases,
and obsessive–compulsive disorder (OCD) is one of the main causes of this disease. The present
study was aimed to investigate the prevalence of OCD in patients with IBS.
MATERIALS AND METHODS: The present research is a cross‑sectional survey study. The research
sample included 120 patients with IBS who referred to Imam Reza Hospital and gastrointestinal
clinics in Kermanshah (Iran) in the 3 months of April, May, July in 2019 that were selected using the
census sampling method, and demographic information, clinical and medical records were collected.
Data analysis was performed using frequency, percentage, and Chi‑square.
RESULTS: Among the patients who were studied, 58 of them (48.3%) were women and 62 (51.7%)
were men, the results showed that the prevalence of OCD in patients with IBS was 14.96 and the
symptoms of washing, checking, skepticism and slowness‑repetition had the highest prevalence,
respectively. These symptoms were more common in women than in men. There was also a significant
relation between OCD prevalence in patients with IBS and with female gender, age‑range 30–21 years,
single, and history of OCD in the patient’s immediate family and close relatives (P < 0.05), but there
was no significant relationship between OCD prevalence in patients with IBS and level of education,
occupation, income status, and place of residence
CONCLUSION: Due to the high prevalence of OCD in patients with IBS, the interaction of
gastroenterologists and psychiatrists to treat irritable bowel syndrome is very important.

Abstract BACKGROUND: Induced demand is a major challenge for financing health promotion, whereby
providers exploit patients’ information gap to manipulate their demand for health care. The purpose
of this study was to identify the factors associated with induced demand for health‑care services in
hospitals affiliated with Iran University of Medical Sciences (IUMS) in 2018.
MATERIALS AND METHODS: In this qualitative study, semi‑structured interviews were conducted
with 20 participants from IUMS hospitals, including faculty members, physicians, public hospital
managers, patients, and researchers with academic and practical experience. Inductive content
analysis was used to analyze the data.
RESULTS: Overall, 24 subthemes or factors were identified and classified into the health system,
the insurer, health‑care provider, and health‑care recipient themes. Poor monitoring and control,
the fee‑for‑service payment system, limited role of insurance companies, insufficient monitoring of
insurance companies, the educational nature of our health centers, health‑care providers’ interests,
and patients’ information gap were some important factors in induced demand for health‑care services.
CONCLUSION: Our results showed that there are many factors that contribute to induced demand for
health care. Given the four levels of factors identified in this study, health policymakers and managers
must develop strategies at each level to reduce induced demand for health care.

Abstract BACKGROUND: The objective was to evaluate an innovative physical medicine and
rehabilitation (PMR) course for undergraduate students of Tehran University of Medical Sciences
and their attitude and knowledge change following course participation.
MATERIALS AND METHODS: Ninety‑one medical students filled the knowledge, attitude, and
satisfaction forms pre‑ and postintervention. Nineteen medical students, two faculty physiatrists, two
residents, two physical therapists, and two occupational therapists participated in the focus groups.
RESULTS: We found significant attitude improvements. They declared the usefulness of PMR
course for undergraduate. Moreover, they agreed that physiatrists could be first choice for refer of
musculoskeletal patients and they preferred PMR as future career after course experience. Also,
they preferred to refer musculoskeletal patients including carpal tunnel syndrome, frozen shoulder,
nonspecific low back pain after course participation. We found a good relationship between attitude
and practice scores (r = 0.543, P = 0.000); in fact, students’ attitude would strongly predict their
practice through a model involving age, satisfaction, and exam scores (R2 = 0.356, B = 0.35 [0.06],
and P = 0.000).
CONCLUSION: We found that internship training course might be an effective method of teaching
PMR. Improving attitude toward the field of PMR and patient referral practice, career choice and
disability perceptions of undergraduates is concluded in this study. Investigation of the advantages
of such courses in larger studies with longer follow‑up time‑points is highly recommend.

Abstract BACKGROUND: Chronic and persistent alcohol use is one of the most common significant
psychiatric illnesses known to cause sexual dysfunction. The aim of the present study is to study
the prevalence and types of sexual dysfunction in the clinical sample of married male patients with
alcohol dependence syndrome (ADS).
MATERIALS AND METHODS: The present cross‑sectional study was conducted in a tertiary
healthcare center from Central Rural India over an 18‑month period (from November 1, 2017, to
April 30, 2019), with a sample size of 100 patients with diagnosis of ADS. Data were collected
using convenient sampling method from married male patients diagnosed with ADS, based on the
International Classification of Mental and Behavioral Disorders, 10th Edition–Diagnostic Criteria for
Research. Sociodemographic profile and clinical variables were recorded in a specific case report
form prepared for the study using the severity of alcohol dependence questionnaire (SADQ) to assess
the severity of ADS and using Arizona sexual experiences scale (ASEX) to assess the types and
prevalence of sexual dysfunction among patients with ADS. Data were collected and analyzed using
SPSS Software Version 15.0, Chi‑square test, and Pearson’s test of correlation.
RESULTS: Of the 100 patients of ADS assessed, 48% had sexual dysfunction. Majority of the patients
reported more than one sexual dysfunction with 87.5% of the patients reporting reduced sexual drive,
79.1% of the patients reported dysfunction in sexual arousal, while erectile dysfunction was found in
58% of the patients. 54% of the patients reported difficulty in reaching orgasm. The lowest prevalence
in our study was of orgasmic satisfaction reported by 31.2% of the patients. There was high positive
correlation between SADQ scores and ASEX scores. Thus, as the severity of ADS increased, the
risk of development of sexual dysfunctions also increased. Further, there was comparatively low but
positive correlation between duration of ADS and sexual dysfunction on ASEX scores, indicating
that as the duration of ADS increased, the risk of occurrence of sexual dysfunctions also increased.
CONCLUSION: Chronic and severe alcohol dependence increases the chances of developing sexual
dysfunctions. These findings can be utilized in the motivation enhancement therapy of patients with
ADS to quit alcohol consumption and to improve their quality of sexual life.

Abstract BACKGROUND: Education development centers (EDCs) have a vital role in improving the quality
of medical education. This study was conducted with the aim of discovering educational leadership
characteristics in EDCs.
MATERIALS AND METHODS: This study was carried out with a qualitative approach and using a
conventional content analysis method. The sampling was purposive. Twenty‑four faculty members,
managers, and experts of EDCs in the universities of medical sciences included 13 males and
11 females participated in this study. Semi‑structured interviews were utilized for data collection.
The conventional content analysis approach was utilized to analyze the data.
RESULTS: From the data analysis, two categories included “personality characteristics” and “job
characteristics” and six subcategories included reliabilism, humanness and altruism, accountability,
decisiveness, dynamism and perfectionism, and knowledge, experience, and expertise and 24 codes
were extracted.
CONCLUSION: Results obtained in the present study will help to increase the awareness of the
educational leaders of the EDCs in improving their personality and job skills and this will lead to the
qualitative development of educational leadership.

Abstract BACKGROUND: Primary osteoporosis is a common complication of aging and menopause. The
negative effects of osteoporosis in the coming years will increase by increasing life expectancy and
population aging. The purpose of this research was to compare health‑promoting lifestyle and quality
of life in postmenopausal women with and without primary osteoporosis.
MATERIALS AND METHODS: This cross‑sectional analytical research was conducted on 445
postmenopausal women aged 50–65 selected by simple random sampling in Tabriz health centers
from September 2018 to July 2019. Data collection instruments included demographic, midwifery,
anthropometric, health‑promoting lifestyle profile II and menopausal quality‑of‑life questionnaire
questionnaires, and serum test checklist (25‑hydroxy vitamin D, complete blood count/diff,
thyroid‑stimulating hormone, fasting blood sugar, Calcium, and Phosphor). Dual‑energy X‑ray
absorptiometry method was used to measure bone density. Data were analyzed using SPSS/23
through descriptive and inferential statistics such as Chi‑square, independent t‑test, Mann–Whitney,
and multiple regression.
RESULTS: The mean score of lifestyle was 141.2 ± 21.9 in normal and 127.2 ± 25.4 in osteoporosis
group, and differences were statistically significant in total score (P < 0.001) and all subdomains.
The mean score of quality of life was 3.9 ± 1.2 in the normal and 4.5 ± 1.4 in the osteoporotic group.
The differences were significant in total score (P < 0.001) and all subdomains except for sexual
function subdomain (P = 0.064). Logistic regression adjusted for confounders indicated by one unit
increase in total lifestyle score, the odds of primary osteoporosis reduced by 2.2% (adjusted odds
ratio [0.95% confidence interval]: 0.978 [0.963–0.994], P = 0.006).
CONCLUSION: To prevent of primary osteoporosis and improve the quality of life of postmenopausal
women, it seems that education and implementation of health‑promoting lifestyle are essential. The
research findings can be used to plan for health care in middle and old ages.

Abstract BACKGROUND: COVID‑19 has become a global health emergency after its first case in Wuhan city,
China. An increasing number of cases and deaths are challenging the health‑care system globally.
This study aims to assess knowledge, attitude, and practice toward COVID‑19 disease among health
personnel in rapid outbreak in India.
MATERIALS AND METHODS: A cross‑sectional survey was conducted using Google Forms through
Google platform on-line. A total of 713 health personal allied health‑care staff, working in different public
and private health‑care facilities, was conducted in the mid of April 2020. A structured knowledge, attitude,
and practice questionnaire used to assess health personnel’s knowledge, attitude, and practice toward
COVID‑19. All instruments were validated and pretested before use. Chi‑square test, followed by binary
logistic and multivariate regression, was applied to determine factors associated with knowledge scores.
RESULTS: Seven hundred and thirteen health personnel participated, and 703 (98.6%) participants
responded were analyzed for final results. 95.9% of the health personnel were aware about route
of transmission and clinical symptoms (95.3%) of COVID‑19. 63.7% believed that virus outbreak
would be controlled globally and followed standard precautions (81.8%), including wearing the mask.
Further, majority (98.3%) of the participants avoided social contact by not going to crowded places
and not calling people to their homes (82.2%) during the advisory of the government. In binary
logistic regression analyses, the adequate knowledge score found significantly associated with
MBBS/bachelor’s degree (odds ratio [OR]: 2.309, confidence interval [CI]: 1.232–4.324, P < 0.009)
and master’s degree (OR: 2.944, CI: 1.485–5.835, P < 0.002), working with government health‑care
facility (OR: 3.662, CI: 1.624–8.285, P < 0.002), and holding a post of a physician (OR: 7.735, CI:
2.210–27.091, P < 0.001) during outbreak.
CONCLUSIONS: The level of education is associated with adequate knowledge scores among the
health personnel. Type of health‑care facility and post held in a health‑care facility are significant
predictors of adequacy of knowledge.

Abstract