Journal of Education and Health Promotion

Abstract BACKGROUND: The outbreak of new pathogens or the resurgence of pathogens that have already
spread is a serious challenge to public health. Coronavirus is a pathogen that seems to invade the
human respiratory system in the first place. Coronaviruses form a large family and are so called
because of the presence of crown like cristae on their surface.
MATERIALS AND METHODS: This is a cross‑sectional, descriptive study conducted to assess the
status of patients with COVID‑19 who were hospitalized in an educational hospital. For this purpose,
142 patients hospitalized in this hospital were followed up 2 weeks after discharge and were inquired about
the symptoms they had upon admission to the hospital, the number of hospitalization days, the history of
underlying disease, and so on. Descriptive data analysis was done with the SPSS software version 22.
RESULTS: The findings of this research showed that overweight or obese people (about 66%)
is more likely to contract the disease. It also seems that older people (37.3% older than 60 years
old) and those with a history of diseases (69.6%) such as diabetes, high blood pressure, or heart
disease are more prone to COVID‑19. The most common symptoms of COVID‑19 patients included
fever (64.5%), shortness of breath (67.4%), and dry cough (50.4%).
CONCLUSION: it seems that high risk group (obese people, old people, and people with a history of
disease) is more likely to be infect with coronavirus so they should more careful than others. Another
important issue is that policy‑makers must play an active role in public awareness of dangers of
COVID‑19 and ways to prevent it.

Abstract BACKGROUND: Physical education is undergoing a major transformation period that leads that
school discipline to influence the lifestyles of young people to help them adopt behaviors conducive to
their well health and well‑being. Health education (HE) integrates with various intervention strategies
in the field of health such as disease prevention and health promotion. In schools, the HE comes
in many forms and in relation to several disciplines. Our study focuses on the current situation of
HE in physical and sports education (PSE) in middle school. Specifically, the research question we
developed is: “What is the contribution of the PSE to the HE of middle school students?”
MATERIALS AND METHODS: This qualitative research was carried in Marrakech. Semi‑structured
interviews were conducted with ten PSE teachers after receiving their informed consent. Deductive
content analysis was used in this study.
RESULTS: Among the main results, there is a certain diversity of teachers’ representations on HE
and PSE. These teachers say mobilize PSE to contribute to the HE of students. However, it was noted
that their teaching practices are at odds with the perspective of the inclusion of HE in the field of PSE.
CONCLUSIONS: In the absence of a clear vision concerning physical activity and sport in relation to
“healthy” and “active” schools, it seems very unlikely to influence the thoughts and practices of HE
teachers; strongly attached, as they often are, to their representations of their discipline.

Abstract BACKGROUND: Several preventive measures were used by governments around the world to
suppress the transmission of SARS‑CoV‑2, including quarantine. During quarantine more people
are at risk of developing mental health problems as social media exposure was increasing.
OBJECTIVES: The objective is to investigate the impact of social media exposure during coronavirus
disease 2019 (COVID‑19) pandemic on depression, anxiety, and stress.
MATERIALS AND METHODS: A cross‑sectional study was conducted between April and May 2020
during the large scale social restriction in Indonesia using online questionnaire Indonesian citizens
over 18 years of age were invited to take part by answering online questionnaire through Google
forms (http://bit.ly/duniamayaCOVID). Data gathered were demographic data, depression, anxiety,
and stress that were assessed using Depression Anxiety Stress Scale‑21, duration of social media
usage, and social media platforms used during COVID‑19 pandemic. Data was analysed using
Pearson Chi‑square and ANOVA. Statistically significant variables and additional risk factors was
analyzed using multinomial logistic regression.
RESULTS: The median age was 24 years (range 17–56 years), 121 (55,0%) samples were female.
The three most frequent social media platforms used by participants were Instagram, WhatsApp, and
YouTube. Female were more likely to suffer from mild‑moderate depression compared to male (odds
ratio [OR]: 2.344; 95% confidence interval [CI]: 1.105–4.972; P = 0.026) and more likely to suffer
from severe‑extremely severe anxiety (OR: 2.066; 95% CI: 1.019–4.187; P = 0.044). Social media
exposure was associated with less likelihood to suffer from severe‑extremely severe depression,
mild‑moderate, and severe‑extremely severe anxiety, mild‑moderate stress.
CONCLUSION: Social media exposure was associated with less depression, anxiety, and stress in
the COVID‑19 pandemic era. Medical professionals and government officials could use social media
to disseminate knowledge about COIVD‑19 to bring positive psychological effect.

Abstract BACKGROUND: Evaluation is one of the most important tools for determining the quality of any
educational program, which can lead to reformation, revision, or termination of programs. Quality
in higher education requires assessment and judgment of goals and strategies, executive policies,
operational processes, products, and outcomes. The Context, Input, Process, and Product (CIPP)
model is a comprehensive perspective that attempts to provide information in order to make the
best decisions related to CIPP. Due to the importance of this topic, the present study examined the
application of the CIPP model in the evaluation of medical education programs through a systematic
review.
MATERIALS AND METHODS: In this systematic review, Persian databases including ISC, SID, Mag
Iran, CivilicaL, and Noormags and English databases including PubMed, Web of Science, Scopus,
ProQuest Dissertations, Embase, CINAHL, ERIC, and Google Scholar were searched using relevant
keywords, such as evaluation, program evaluations, outcome and process assessment, educational
assessment, and educational measurements. The search was done with no time limits and 41
papers were obtained until May 22, 2020. This systematic review was performed by following the
data extraction steps and assessing the quality of the studies and findings. Critical Appraisal Skills
Programs and Mixed‑Methods Appraisal Tool checklists were used to check the quality of the papers.
RESULTS: This systematic review was conducted on 41 studies, 40 of which were research papers
and one was a review paper. From the perspective of the CIPP model of evaluation, most papers
showed quite a good level of evaluation of educational programs although some studies reported
poor levels of evaluation. Moreover, factors such as modern teaching methods, faculty members,
financial credits, educational content, facilities and equipment, managerial and supervisory process,
graduates’ skills, produced knowledge, and teaching and learning activities were reported as the
factors that could influence the evaluation of educational programs.
CONCLUSION: Due to the important role of evaluation in improvement of the quality of educational
programs, policymakers in education should pay special attention to the evaluation of educational
programs and removal of their barriers and problems. To promote the quality of educational
programs, policymakers and officials are recommended to make use of the CIPP model of evaluation
as a systemic approach that can be used to evaluate all stages of an educational program from
development to implementation.

Abstract BACKGROUND: Traditional methods are not able to differentiate which feature customers regard
as attractive, mandatory, performance, and which feature customers are indifferent about. These
categories can only be differentiated based on a specific technique called Kano survey. Specific
aim of this study was to categorize the Hospital Consumer Assessment of Healthcare Providers and
Systems (HCAHPS) patient satisfaction survey questions into Kano categories.
MATERIALS AND METHODS: Design of the study was survey research. It was conducted from
6/2019 to 8/2019 at OSF Saint Francis Medical Centre in Peoria, Illinois, USA. A 34 question Kano
survey (17 positive and 17 negative questions) based on HCAHPS patient questionnaire was
designed. Surveys were analyzed using Kano analysis template. Comparative analysis of Kano
categories based on demographics was also performed.
RESULTS: 39 current patients and 25 caregivers completed the survey. All of the 17 HCAHPS
questions except “noise level at night” were classified as mandatory requirement with highest number
for information on “indications of medicines.” There was a minimum variability in the satisfaction
coefficients but large variation in the dissatisfaction coefficients. More patients above 50 years consider
“help going to bathroom” as mandatory (70.2% vs. 40.7%, P = 0.01). Sixty‑four percent of caregivers
considered “explain things (nurse)” as mandatory as opposed to 51.2% of patients (P = 0.03).
CONCLUSION: Current U. S healthcare consumers have high expectations from healthcare delivery
and consider most HCAHPS questions as mandatory requirements. Kano analysis needs to be done
on a larger, more diverse hospital setting and potentially the HCAHPS survey needs to be modified
to reflect prevailing healthcare customer requirements.

Abstract BACKGROUND: Diabetes is one of the most expensive and chronic diseases of elderly age.
Knowledge and self‑care behaviors play an important role in treating diabetes and preventing its side
effects. This study aimed to investigate the effect of peer group on self‑care behaviors and glycemic
index in the elderly with type II diabetes mellitus in Fasa city, Fars province.
MATERIALS AND METHODS: This quasi‑experimental study was conducted on 100 elderly
patients with type II diabetes (50 patients in the intervention group and 50 in control group) referred
to the diabetes center. Among the elderly, the intervention group was selected as a trainer based on
the checklist of the peer group and was trained by the researcher. In addition to the usual care of the
diabetes clinic, the patients in the intervention group received training from their peers for 8 weeks
during 8–45 min of training sessions. Data were collected using a valid self‑reported questionnaire
including demographic variables, awareness, and diabetes self‑care behaviors (Summary of Diabetes
Self‑care Activities), as well as free practice (fasting blood sugar [FBS] and hemoglobin A1c [HbA1c]),
which was completed by both groups before and 2 months after the intervention. Then, the data
were entered into the SPSS statistical software, version 22 and were analyzed using Chi‑square test,
independent t‑test, and descriptive statistical methods. P < 0.05 was considered statistically significant.
RESULTS: The results showed that the two groups of intervention and test were identical in terms
of demographic information. In the intervention group, before and after 2 months of educational
intervention, there was a significant difference in increasing awareness and self‑care behavior in
diet, physical activity, blood sugar testing, foot care, and medication (P < 0.001). However, this
difference was not significant in the control group (P < 0.05). In the intervention group, the mean
FBS and quarterly (HbA1c) index decreased significantly (P < 0.05).
CONCLUSION: This study showed that teaching self‑care program, in the same way, has been
effective in improving self‑care behavior and blood sugar index in the elderly with diabetes and
suggested that this educational method be used in other chronic diseases.

Abstract BACKGROUND: Breast cancer is the most common type of cancer among women and it is the
second leading cause of mortality among cancers in women and a major health issue in developed
countries. Although there are simple and effective screening methods, just minority of women use
them. Given the high prevalence of breast cancer in Isfahan women and the low prevalence of
screening behavior, the present study aimed to determine the impact of theory‑based educational
intervention on breast self‑examination (BSE) behavior and mammography.
MATERIALS AND METHODS: The present experimental study was conducted on 93 women referred
to comprehensive health centers in Isfahan through convenience sampling, and by this way 46 women
were included in the control group and 47 in the intervention group. Data collection was done by
a valid and reliable questionnaire. Furthermore, educational interventions were performed for the
intervention group in three sessions. Furthermore, the data were completed in the intervention group
before, immediately after, and 3 months after intervention and before and 3 months after intervention
in the control group. The data were analyzed by SPSS (16); and paired t‑test and repeated measure
test were used for analysis in the intervention group and also independent t‑test and paired t‑test
were employed to analyze data of the control group.
RESULTS: The results showed significant changes in perceived benefit constructs (P = 0.023),
knowledge (P < 0.001), self‑efficacy (P < 0.001), and behavioral intention regarding BSE (P = 0.035)
in the intervention group over time, but changes were not significant in both perceived susceptibility
and severity in the intervention group. As far as mammography behavior is concerned, only the
perceived benefit construct in the intervention group had significant changes. In terms of the screening
behavior, only BSE behavior significantly changed before and after intervention.
CONCLUSION: The study showed that theory‑based education by applying of constructs such
as perceived benefits and self‑efficacy and intention for BSE model could promote breast cancer
screening behavior such as BSE. Therefore, it is suggested that health educators utilize educational
texts based on these constructs to increase their influence on individuals via screening behavior
for breast cancer.

Abstract BACKGROUND: Critically ill patients on mechanical‑ventilation are always at a higher risk of
acquiring ventilator‑associated respiratory infections. The current study was intended to determine
the antibiotic‑resistance pattern of bacteria recovered from the endotracheal (ET) specimens of
ventilated patients.
MATERIALS AND METHODS: This was a single‑centered, retrospective study carried out in a 400‑bed
tertiary care hospital in Oman. The data of profile and antibiotic resistance pattern of bacterial isolates
recovered from ET aspirates of ventilated patients during the period from January 2017 to August
2019 were retrieved from hospital database. The data were analyzed using the Statistical Package
for the Social Sciences (SPSS) software version 22 (IBM, Armonk, New York, USA). Descriptive
statistics were applied to find the frequencies and percentages. Charts and tables were constructed.
RESULTS: In total, 201 bacterial isolates recovered from ET secretions of 154 ventilated patients were
studied. The rate of isolation was predominant among males (65.6%) and in elderly people (50%).
Gram‑negative bacilli (GNB) were predominantly (88.6%) isolated. Acinetobacter baumannii (31.3%)
was the most common isolate and 86% of them were multidrug‑resistant strains. Klebsiella
pneumoniae (23.9%) and Pseudomonas aeruginosa (22.9%) were the other common GNB, whereas
Staphylococcus aureus was the most frequently isolated Gram‑positive bacteria. Gentamicin showed
good in vitro activity against S. aureus and all the GNB except A. baumannii reflecting good choice
for empirical therapy.
CONCLUSION: Gram‑negative bacteria were the predominant isolates in ET secretions of ventilated
patients. There was an alarmingly high rate of antimicrobial resistance among GNB. A rational use
of antibiotics, regular monitoring of antibiotic resistance and use of right combination of drugs, in
addition to refining of existing infection control practices are critical to control the emergence of
drug‑resistant strains.

Abstract BACKGROUND: Since the advent of coronavirus disease 2019 (COVID‑19) infection, there is
debate whether pregnancy outcome in COVID‑19 is more severe as compared to general population.
Pregnant population is particularly susceptible to viral infections due to altered immune response.
H1N1 infection and Zika virus infection led to unfavorable maternal and fetal outcomes.SARS during
pregnancy has been linked previously with high risk of spontaneous abortions, preterm births and
intrauterine growth restriction. The effects of this novel virus need to be studied.
MATERIALS AND METHODS: This is a single‑center descriptive prospective observational study
of 65 pregnant women with reverse transcriptase–polymerase chain reaction confirmed COVID‑19
infection, regardless of gestational age at diagnosis, admitted from April 15 to June 30, 2020, at the
COVID hospital in SN Medical college a tertiary center of Agra in North India. Maternal and perinatal
outcomes were studied. Data were analyzed using the SPSS software for windows. Continuous
variables were expressed as mean ± standard deviation. Categorical variables were expressed as
numbers and percentages.
RESULTS: Majority 88.4% of the women were asymptomatic. Rest had mild illness only. Majority
94.23% were third‑trimester pregnancies; preterm birth was not reported in any singleton pregnancy.
Majority 85% were delivered by cesarean section done for obstetric indications.Maternal outcome of
all patients was favourable, and only two women who had moderate pneumonia recovered. Maternal
mortality was reported in only 1 case. All neonates were negative for COVID‑19. Neonatal outcome
was favorable.
CONCLUSION: COVID‑19 in pregnancy led to mild symptoms only.Infection in the third trimester
did not led to adverse obstetric outcome including preterm labor and premature membrane rupture.
SARSCoV2 infection in pregnancy did not increase the risk of maternal mortality. Vertical transmission
of COVID‑19 was not found in neonates .The maternal, neonatal, and perinatal outcomes of
COVID‑19 patients infected in late pregnancy were favorable.

Abstract BACKGROUND: The ethical guidelines and ethical atmosphere of the hospital affect the quality
of nursing care. Improving the health of patients in most cases depends on the observance of
ethical points and ethical behaviors by nurses. The aim of this study was to determine the effect of
hospital ethics and ethical training guidelines on improving the quality of nursing care and nurses’
professional ethics.
MATERIALS AND METHODS: This is a descriptive‑analytical study. This study was performed by
multi‑stage relative cluster sampling on 260 qualified nurses in 2014. Data were collected using the
Hospital Ethical Climate Questionnaire and the Judgments about Nursing Decisions Questionnaire
and analyzed using SPSS software version 19.
RESULTS: The results showed that nurses’ perceptions of the ethical climate of hospitals were
relatively positive. The ethical behavior of nurses was moderate and good. Nurses’ perception of the
ethical climate scores was not related to the ideal ethical behavior of nurses (r = 0.11, P = 0.86).The
ethical climate perceptions of nurses were related to real workplace ethical behavior score (r = 0.188,
P = 0.002). The results also showed that ethical guidelines can improve the quality of nursing care.
CONCLUSION: Considering the results of this study, it seems that holding nursing ethics training
programs can be a big step toward promoting the professional behavior of nurses and the observance
of professional ethics by nurses.

Abstract BACKGROUND: Some nursing schools in Iran with the aim of training qualified nurses have set up
master’s degrees in emergency nursing. In any case, there are challenges in the implementation
of this discipline in academic nursing centers which prevent the fulfillment of goals and missions in
the curriculum.
MATERIALS AND METHODS: In this qualitative study, four graduates of the master of emergency
nursing and 13 undergraduate students were purposively recruited from the Nursing and Midwifery
Faculty in Qom, Iran. Data were collected through semi‑structured interviews and analyzed through
conventional content analysis.
RESULTS: Emergency nursing master’s program challenges consist of two categories: nonproductive
course design and unresolved infrastructure. The extracted subcategories were unfit curriculum,
inappropriate content, nonspecialized program, unclear roles, improper course planning, unskilled
human resources, and poor educational facilities.
CONCLUSION: Based on the experiences of nursing graduates, the curriculum of master of
emergency nursing in Iran needs to be substantially revised in terms of content and structure.

Abstract New epidemiological studies acknowledge the detrimental effects of dust storms on health.
The aim of this study was to systematically review the effects of dust storms on the morbidity
and mortality rates of cardiovascular and respiratory diseases. The results of this study were
obtained based on articles published in English-language journals. For the purpose of this
study, all articles published until the end of 2020 based on the search in the “Scopus,” “Web
of Science,” and “PubMed” databases were selected. Articles were searched independently
by two trained researchers. Dust storms are the cause of many diseases and health-related
complications, of which cardiovascular and respiratory diseases are common. It is necessary
to recognize and investigate the harmful effects of dust storms to prevent serious harms
to human societies. In the reviewed articles, the impact of dust storms on several diseases,
including cardiovascular and respiratory diseases,has been analyzed. Most of these articles
acknowledge the effect of dust storms on increasing the incidence and mortality rate of these
diseases, although in some articles this effect is not statistically significant. Many studies
conducted around the world confirm the harmful effects of dust storms on cardiovascular
and respiratory diseases, including increase in the number and duration of hospitalizations, as
well as increase in mortality and exacerbation of these diseases. However, some studies do not
consider the harmful effects of dust storms on the above diseases to be statistically significant.

Abstract BACKGROUND: Sex ratio is an important social indicator measuring the status and equality of
female in society. The falling sex ratio of our country is a demographic disaster that is waiting to
happen and is a matter of grave concern. Perception of gender by mothers or families has long‑term
implications on how children are nurtured during their lives. This study was done to understand
mother’s preference for the gender of the child and their concerns about the same.
MATERIALS AND METHODS: An observational cross‑sectional study was carried out using a
semi‑structured questionnaire. Two hundred and thirty‑four mothers were interviewed. Frequencies
and percentages were calculated. Pearson’s Chi‑square test was used to check the significance of
the association.
RESULTS: Study results depict that 26.47% of the mothers who were already having a male
child still preferred son. Preference for son was 24.52% and 48.61% among earning mothers
and nonearning mothers, respectively. Out of 206 mothers said that they would prefer male child.
Reasons cited were as follows: sons carry family name forward (30.6%), having daughters leads to
increased expenditure (20.9%), daughters are subjected to different problem in their lifetime mainly
violence (11.7%), and sons supported their parents in old age (10.7%).
CONCLUSION: Preference for male child was found to be equally prevalent in both urban and rural
areas. Mothers should be educated about the effect of declining sex ratio along with financial capacity
building of women and providing social security to senior citizens which was the main reason for
son preference .The impact of gender imbalance on individuals, families, and on society has to be
emphasized at every possible point of contact with health‑care delivery system.

Abstract BACKGROUND: The rate of reporting medication errors is lower than the actual rate. The role of
education, encouragement, and promotion of reporting culture can contribute to the increase of errors
reporting. This study was to investigate the effect of motivational program on reporting of medication
errors in the pediatric units.
MATERIALS AND METHODS: A quasi‑experimental study with pre‑ and post‑test design was done
through 60 nurses working in the pediatric wards of the selected hospital in Isfahan, Iran in 2018–2019.
Nurses participated in the study through the census sampling method. Data were collected using
a questionnaire based on eight medication principles completed by the nurses before and after the
intervention. The intervention was conducted through a motivational program in two parts of training
and positive reinforcement. Data were analyzed through the descriptive statistics (frequency, mean,
and standard deviation [SD]) as well as inferential statistics (Wilcoxon test and paired t‑test).
RESULTS: After the intervention, the most medication error reports (60%) were in the principle
of right medication (similar name). Furthermore, the total score (SD) of medication error reporting
was significantly increased from 7.35 (2.43) before the intervention to 17.04 (5.59) after the
intervention (t = 8.03, P < 0.001).
CONCLUSIONS: Motivational program increased medication error reports. Therefore, the
managers can improve medication care and the safety of children through continuous education
and encouragement in the hospitals.

Abstract BACKGROUND: Nurses have a challenging job and encounter more stressful situations. In
response to these situations, they demonstrate adaptive or maladaptive cognitive emotion regulation
strategies (CERS). As there is a lack of literature regarding the factors predicting the selection of
CERS , the present study aimed to investigate the role of age, sex, marital status, working experience,
type of ward, and education level in predicting these strategies in Iranian nurses.
MATERIALS AND METHODS: A descriptive correlational study was conducted to examine predictive
factors’ emotion regulation strategies used by 193 nurses who worked at six hospitals under the
supervision of Qazvin University of Medical Sciences in 2018. The study population were selected
by stratified random sampling method. Data were collected by two questionnaires, one demographic
questionnaire and the other was Cognitive Emotion Regulation Questionnaire conducted by
Garnefski (α = 0.8). Data analysis was performed using correlation and multiple linear regression.
RESULTS: The results showed that there is a significant relationship between the “type of ward”
and “age” with adaptive and maladaptive strategies. In the multiple linear regression model, two
variables of age (P = 0.03) and type of ward (P = 0.04) were able to predict 23% of variance CERS.
CONCLUSIONS: Based on the results of this study, health‑care providers and hospital managers
should pay attention to factors related to adaptive and maladaptive CERS.

Abstract BACKGROUND: The flipped classroom pedagogy allows students to introduce a topic and gather
their own meanings outside of the classroom, then explore the topic and create their meanings
or exclude their misconceptions during class. Our aim was to enhance the ability of self‑directed
learning (SDL) among medical undergraduates. Pedagogical benefits of the model are highlighted
along with potential challenges to its use.
MATERIAL AND METHODS: Kemp’s Instructional model was used to design flipped classroom.
Need analysis was done to assess the perceptions of the students on the current teaching practices
and their expectations for adoption of innovative methods. Validation of content was done by Delphi
method by subject experts across the institutions. Content included objectives; case scenarios and
extended multiple choice questions. Students were divided into two groups. Group A and Group B,
50 in each. A topic was given 1 week prior and both groups were subjected to a pretest to identify
their self‑study performance. Group A was exposed to 4 sessions of flipped classroom. They were
provided with PowerPoint slides with voice recordings. In the classroom, first 30 min was meant for
quiz and next 30 min was meant to clarify the doubts. Group B were exposed to the 4 regular lecture
sessions. Both the groups were subjected to the posttest and test after 4 weeks. Later with another
topic, flipped classroom was conducted for all the 100 students and the feedback was taken from
all the students and faculty using a validated questionnaire.
RESULTS: Posttest scores of students who were flipped were statistically significant (p < 0.001).
Most (98%) students opined that these interactive sessions evoked interest in the topic. Flipped
classroom sessions were found to be effective in improving students’ learning behavior toward SDL,
collaborative learning skills and critically analyzing the basic concepts.
CONCLUSIONS: By following a systematic process (Kemp’s instructional Model, it is possible
to design need‑based flipped classroom sessions. They are found to be effective in improving
students’ learning behavior toward deep learning, self‑efficacy, SDL, collaborative learning skills,
critically analyzing the basic concepts. In a flipped classroom, “the learning environment transforms
into a dynamic and more social space where students can participate in critiques or work through
problems in teams.

Abstract BACKGROUND: Health care‑associated infections (HAIs) are associated with high morbidity,
mortality, and costs in the health‑care sector. Large proportions of HAIs are preventable by following
infection prevention activities such as hand hygiene (HH) and biomedical waste management (BMWM).
AIM: The aim was to evaluate the effectiveness of a structured teaching session on the cognitive
and psychomotor domains of BMWM and HH practices in a tertiary health‑care institute.
MATERIALS AND METHODS: Every participant was evaluated for pretest knowledge assessment
using a prestructured format along with skill demonstration. The training included interactive sessions,
open discussion, and demonstration of various skills with the active participation of various participants
by trained faculty and infection control nursing officers. On completion, every participant underwent
posttest evaluation.
RESULTS: During 11‑month study period, 450 health‑care professionals (HCPs) participated in
the training program. Cognitive domain score increased from 16.3 ± 2.4 to 21.3 ± 2.0 from pre‑ to
post‑test, respectively. In psychomotor domain, pre‑ and post‑test scores for HH were 8.3 ± 3.5
and 14.3 ± 1.4, for BMWM, the corresponding values were 8.6 ± 2.1 and 9.8 ± 0.7, respectively.
Overall change in the mean (± standard deviation) score between pre‑ and post‑test for various
domains of assessment was 5.0 (±2.7), 6.0 (±3.5), 1.1 (±1.8), and 12.2 (±5.3) for knowledge, HH
skill demonstration, BMW segregation skill, and cumulative assessment, respectively.
CONCLUSION: The initiation of a structured training program can result in a significant increase in
participants’ cognitive and psychomotor domains of learning, which may have an indirect impact on
the prevention of HAIs.

Abstract BACKGROUND: Polycystic ovary syndrome (PCOS) has a profound effect on patients’ quality of
lives; and it is important to identify the affecting factors. The aim of this study was to assess the status
of and relationship between coping strategies and quality of life in women with PCOS.
MATERIALS AND METHODS: In this cross‑sectional study, we recruited 200 married women (20–
50 years old) with PCOS from Arash and Bu Ali hospitals in Tehran in 2019–2020. Data were collected
using the two following questionnaires: Coping strategies and quality of life. Data were analyzed
using the regression analysis test in the SPSS‑21.
RESULTS: The results showed that 119 (59.5%) participants were identified with increased hirsutism,
166 (83%) women were obese, 140 (70%) had irregular menstruation and 136 participants (68%) had
painful menstruation as the side effects of PCOS. Sixty nine (34.5%) individuals reported unknown
side effects. There was a relationship between emotional coping strategy and problem solving coping
strategy with quality of life (beta = 0.270 and 0.219, respectively).
CONCLUSION: Patients with PCOS were more likely to use emotional coping strategies. Low quality
of life exacerbated symptoms of the disease.

Abstract BACKGROUND: Existential anxiety (EA) revolves around the question of ultimate concern related
to life and death. It gets more prominent when there is an exposure to stressful experiences where
the stress is profound and resources seem insufficient. The objective was to measure the prevalence
and magnitude of EA in the study population from the Kashmir valley during the COVID‑19 pandemic.
MATERIALS AND METHODS: In this cross‑sectional study, data were collected through social media.
All the participants belonging to the Kashmir valley were included. EA questionnaire developed by
Weems et al. was used.
RESULTS: A total of 132 subjects were included. The prevalence of EA concerns was death 55%,
fate 62%, emptiness 73%, meaninglessness 32%, guilt 55%, and condemnation 64%. The mean EA
score was 5.0. EA was higher in those who had been diagnosed with mental illness ever in their life
by a psychiatrist than those who had no such history. EA score was much higher in those who had
ever felt a need to visit a psychiatrist than those who had not. There was no statistically significant
difference in the mean scores of EA for those who never felt this need and those who felt this need
since the start of the COVID‑19 pandemic.
CONCLUSION: There was a high prevalence of EA in the study population from the Kashmir valley.
Relative concerns were more prevalent than absolute concerns. EA score was higher among those
who had mental health issues compared to others.

Abstract BACKGROUND: Continuous pertinent trainings for infection prevention and control (IPC) measures
are essential to ensure quality health‑care services along with the safety of the health personnel.
Amid the COVID‑19 pandemic, the current study focusses on the utilization of explicated video
modules training of all health‑care personnel of the institute and assessment of the effectiveness of
video training for IPC practices during COVID‑19 pandemic.
MATERIALS AND METHODS: A quasi‑experimental study, one group pre‑ and posttest design,
using Google Questionnaire forms was conducted at a tertiary care center. The training was assisted
by trained tutors, and three in‑house videos were demonstrated to the participants regarding specific
IPC measures; “Do’s and Don’ts;” “Hand hygiene and personal protective equipment’s (PPE)” and
“Environmental cleaning and disinfection.” SPSS software version 23 (IBM Corp., N. Y., USA) was
used for the analysis using the descriptive statistics, Chi‑square test, Fisher’s t‑test, ANOVA, and
post hoc Tukey’s test.
RESULTS: The level of knowledge increased significantly by 16% in the posttest. Statistically
significant association between the levels of knowledge in pretest as well as posttest scores and
age (P < 0.001), designation (P < 0.001), and years of experience (P < 0.001) was identified. The
participants were satisfied with the video‑assisted trainings and willing to use videos for revision.
CONCLUSIONS: Video‑assisted training modules similar to this study may be utilized to enhance
the knowledge of various cadres of health‑care staff regarding IPC practices.25. Pilieci SN, Salim SY, Heffernan DS, Itani KMF, Khadaroo RG.
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Abstract BACKGROUND: Social health is considered as an important part of good health both individually
and socially. The purpose of this study was to examine the content of the official medical sciences
curriculum in undergraduate degrees from a social health perspective.
MATERIALS AND METHODS: This qualitative content analysis study was conducted in 2019
at the Isfahan University of Medical Sciences using a deductive approach based on Hsieh and
Shannon's directed content analysis. For this purpose, official curricula in the fields of Public Health,
Occupational Health, Environmental Health, Nursing, Midwifery, Nutrition Sciences, and Health
Services Management were analyzed using MAXQDA 12.
RESULTS: The results showed that a total of 136 codes related to the components of social health
were identified in the topics of undergraduate medical sciences majors. Most to least relevant
topics belonged to the fields of Public Health (61 codes), Midwifery (22 codes), Nursing (16 codes),
Occupational Health (12 codes), Environmental Health and Nutrition Sciences (each 10 codes), and
Health Services Management (5 codes), respectively. Among the components of social health, only the
component related to access to insurance and health services was mentioned in all seven disciplines.
However, the components of poverty and inequality were only included in three disciplines (Public
Health, Nursing, Midwifery).
CONCLUSION: Regarding insufficient focus on social health in curricula, revision of educational
curricula is suggested from the perspective of social health, particularly in areas such as poverty
and inequality, unemployment, population, violence, and gender discrimination.

Abstract BACKGROUND: Academic procrastination is a complex phenomenon and a common behavior among
nursing students. Due to procrastinating behaviors, students cannot show their real performances in
learning processes. In order to stop this behavior, it is crucial to know the most common causes of
procrastination in the first place. The aim of this study was to identify a variety of different possible
factors influencing academic procrastination among nursing students.
MATERIALS AND METHOD: A qualitative study method with the content analysis approach was
conducted from October 2019 to March 2020. Participants were 67 nursing students and 8 nursing
educators from 3 nursing schools in Iran. Face‑to‑face semi‑structured interviews and focus group
discussions were used for data gathering. An inductive approach to content analysis was used for
data analysis.
RESULTS: Five categories and 24 subcategories emerged from the data analysis: “student‑related
factors,” “educator‑related factor,” “assignment characteristic‑related factors,” “institution‑related
factors,” and “nursing work‑related factors.”
CONCLUSIONS: The present study showed that nursing students’ academic procrastination can
have a wide range of causes and a comprehensive effort is needed to address the problems. The
result of our study will be useful to nursing students, educators, and nursing administrators in relation
to what constitutes nursing students’ academic procrastination, as well as how nursing education
can play an effective role in decreasing tendency to procrastination.

Abstract BACKGROUND: Nowadays, one of the most important challenges of the universities and higher
education centers is academic dishonesty among students. Academic dishonesty is done through
cheating, deception, and plagiarism, which creates serious educational, studious, and social problems
for the students and society. The purpose of this study was to compare the effect of virtual and
workshop training on the knowledge and attitude of M. S. students in terms of plagiarism.
MATERIALS AND METHODS: This research was an applied interventional study of quasi‑experimental
type having pretest and posttest and the participants of this study included 90 M. S. nursing students
of Medical Science University of Shiraz in the southwestern part of Iran.
RESULTS: The comparison of the three groups indicated that virtual and workshop training, both,
developed the knowledge and attitude of students regarding plagiarism; however, the comparison
between two methods did not indicate a statistically significant difference.
CONCLUSION: Both virtual and workshop training methods had an effect on increasing students’
knowledge and attitude. Regarding the positive effect of training academic dishonesty using two
workshop and virtual training methods, both can be used as efficient and effective methods in training
dimensions depending on the condition and facilities to prevent and reduce plagiarism in students.

Abstract BACKGROUND: Direct transmission of notifiable disease information in a real‑time and reliable way
to public health decision‑makers is imperative for early identification of epidemiological trends as well
as proper response to potential pandemic like ongoing coronavirus disease 2019 crisis. Thus, this
research aimed to develop of semantic‑sharing and collaborative‑modeling to meet the information
exchange requirements of Iran’s notifiable diseases surveillance system.
MATERIALS AND METHODS: First, the Iran’s Notifiable diseases Minimum Data Set (INMDS)
was determined according to a literature review coupled with agreements of experts. Then the
INMDS was mapped to international terminologies and classification systems, and the Health Level
seven‑Clinical Document Architecture (HL7‑CDA) standard was leveraged to define the exchangeable
and machine‑readable data formats.
RESULTS: A core dataset consisting of 15 classes and 96 data fields was defined. Data
elements and response values were mapped to Systematized Nomenclature of Medicine‑Clinical
Terms (SNOMED‑CT) reference terminology. Then HL7‑CDA standard for interoperable data
exchange were defined.
CONCLUSION: The notifiable disease surveillance requires an integrative participation of
multidisciplinary team. In this field, data interoperability is more essential due to the heterogeneous
nature of health information systems. Developing of INMDS based on HL7‑CDA along with
SNOMED‑CT codes offers an inclusive and interoperable dataset that can help make notifiable
diseases data more comparable and reportable across studies and organizations. The proposed
data model will be further modifications in the future according probable changes in Iran’s notifiable
diseases list.

Abstract BACKGROUND: Developed countries have strong health and demographic surveillance
system (HDSS), whereas there is a dearth of such system in developing countries like India. India
depends on national surveys and individual studies for public health information. At present All India
Institute of Medical Sciences – New Delhi HDSS and Vadu HDSS are well established HDSS in India.
MATERIALS AND METHODS: We developed a HDSS in a remote rural area of South India and
named as Community Health Information Management System (CHIMS) This covered 20 villages
around Rural Health Training Centre – Chunampet. We collected the family and demographic
information from March 2018 to October 2018. Pregnancy, birth, under‑five and mortality data were
collected once in every 3 months with the help of interns, Medical Social Workers. Data collection
done using CHIMS Guide and entered in EpiData software. EpiAnalysis, Quantum Geographic
Information System, Dropbox were the other freely available software used in this program.
RESULTS: CHIMS HDSS covered 14924 individuals belonging to 4486 households in the surrounding
twenty villages. Population density was 213/km2
. CHIMS consumed very limited resources in terms
of workforce, materials, and transport. CHIMS database was used as a baseline database for many
other studies. This CHIMS HDSS helped in many publications, postgraduate thesis dissertations
and mainly attracted many extramural research funds from leading government Research Institutes
from India.
CONCLUSION: CHIMS proved to be a robust surveillance system in providing vital public health
information about the community and attracted more extramural funds to the institute.

Abstract BACKGROUND: Mindfulness as an intervention approach in mental health has been increasingly
used to promote health in young people. The aim of this study was to investigate the effectiveness of
mindfulness training on coping with stress, test anxiety, and happiness to promote health in female
high school students.
MATERIALS AND METHODS: The design of this study was quasi‑experimental with control
group, with pretest and posttest. The statistical population of the study included all the female
students studying in the secondary high school in the city of Sanandaj in Iran with 2890 students,
40 of whom were selected by simple random sampling method and were randomly assigned to the
experimental (20 individuals) and control groups (20 individuals). Participants completed the Oxford
Happiness (0.79), Sarason Exam Anxiety (0.87), and Andler and Parker Stress Management (0.81)
Questionnaires. The method of intervention was training based on mindfulness. Data were analyzed
using covariance analysis.
RESULTS: The results showed that in the posttest, a significant difference was seen between
the mean scores of the participants of the experimental and control groups in the variables of
problem‑oriented, emotion‑oriented, and avoidant coping variables (P < 0.05). In addition, the
results showed that in the posttest, there was a significant difference between the mean scores of
test anxiety; happiness; and happiness components including life satisfaction, self‑esteem, active
well‑being, satisfaction, and positive mood (P < 0.05).
CONCLUSIONS: Based on the results of the present study, it can be said that mindfulness training
is an effective intervention to improve coping styles, test anxiety, and happiness in students.

Abstract BACKGROUND: Despite the development of valuable teaching methods and assessment tools in
the field of surgery education, yet unpreparedness for independence practice by surgical residents
remains a problem in most of the countries.
AIMS: This study aims to explain the surgical residents’ experience of the teaching and learning
process in the operating rooms in Iran.
MATERIAL AND METHODS: This study is a qualitative research that was done from May 2019
to June 2020 in Tehran and eight other cities in Iran. The selected methodology was constructivist
grounded theory. The study setting was 11 teaching hospitals. Data were collected through 36 in‑depth
interviews and 132 h of observation. Participants were selected initially by purposive sampling and
then by theoretical sampling for covering gaps and completing categories.
RESULTS: Findings showed that the confused educational system was the main concern of the
residents’ experience of the teaching and learning process in the operating room. This concern is
investigated by dividing into four subcategories: Education in the shadow of treatment, inefficient
education, patient safety versus trusting residents for independent practice, and unstructured
assessment.
CONCLUSION: Based on residents’ experience about challenges such as inefficient education,
the influence of patient safety versus trusting residents for independent practice, and unstructured
assessment, the surgical residents’ education in the operating rooms needs to revise.

Abstract BACKGROUND: Social media addiction (SMA) led to the formation of health‑threatening behaviors
that can have a negative impact on the quality of life and well‑being. Many factors can develop an
exaggerated tendency to use social media (SM), which can be prevented in most cases. This study
aimed to explore the reasons for SMA.
MATERIALS AND METHODS: This qualitative study was conducted using content analysis. A
total of 18 SM addicted subjects were included through purposive sampling. Data were collected
through semi‑structured interviews and analyzed using the Lundman and Graneheim qualitative
content analysis method.
RESULTS: The main category of “weakness in acquiring life skills” was extracted with three themes: “problems
in socializing” (including communicating and escaping loneliness), “problems in resiliency” (including
devastation in harsh conditions and inability to recover oneself and “lack of problem‑solving skills”(including
weaknesses in analysis and decision making and disorganization in planning).
CONCLUSIONS: Weakness in life skills plays an important role in individuals’ addiction to SM and
formation of the health‑threatening behaviors. Since SMA can affect behavioral health, policymakers
must adopt educational and preventive programs to increase the knowledge and skills of individuals
in different societies in the modern world.

Abstract BACKGROUND: Emotional intelligence and interpersonal sensitivity are known as important nursing
skills. They have significant role in the promotion of nurses working life and the health care which
they provide. The goal of this study was the determination of the relationship between emotional
intelligence and interpersonal sensitivity with quality of work life in nurses working in governmental
hospitals of Tehran city in 2019.
MATERIALS AND METHODS: This investigation was a descriptive‑analytical and correlation study
which was conducted among 256 nurses working in five governmental hospitals in Tehran. The studied
nurses were selected through in access sampling method. The instruments of research included
demographic, emotional intelligence, interpersonal sensitivity, and work life quality questionnaires.
The analysis of data was done by descriptive and deductive statistics (t‑test and Pearson correlation
coefficient) and also SPSS.
RESULTS: The conditions of emotional intelligence, interpersonal sensitivity, and work life quality
of nurses were, in turn, in average, severe, and weak levels. The correlation between emotional
intelligence and work life quality of nurses was significant (P ≤ 0.05) and they were positively correlated
with each other (r = 0.311). The relationship between interpersonal sensitivity and work life quality of
nurses was significant (P ≤ 0.05) and they were negatively correlated with each other (r = −0.43).
CONCLUSION: The development of emotional intelligence and sensitivity in reciprocally interpersonal
relations of nurses lead to fundamental changes in nurses’ attitude toward themselves, their
colleagues, patients and their profession and can promote their work life quality. Therefore, these
two skills are necessary for nurses and they should be taken into consideration by nursing schools,
faculty members, instructors, and nursing managers

Abstract BACKGROUND: The coronavirus, which is caused by acute respiratory syndrome, appeared in
Wuhan, China, in December 2019 and gradually spread around the world until almost all countries
became infected with the coronavirus. In Iran, the outbreak of coronavirus began on February 21,
2020, with the report of infection of two people in the city of Qom. The aim of this study is to evaluate
the clinical findings of neonates born to pregnant women with corona disease.
MATERIALS AND METHODS: During this case study (February 21 to November 30, 2020), out of
88 pregnant mothers who referred to the hospitals of Shahid Beheshti University of Medical Sciences,
44 live neonates were born from 42 pregnant women with COVID‑19, who were evaluated for clinical
signs by studying their files and reported as a case series, due to limited samples, No statistical
analysis of the study was performed.
RESULTS: In studies of clinical records of hospitalized mothers and infants, among the polymerase
chain reactions (PCRs) provided for all infants, one PCR was reported positive 2 days after birth,
whereas this infant 10 min after birth, immediately after routine procedures, due to positive mother’s
PCR was isolated from the operating room. However, all of the infant’s clinical symptoms were normal
during the 3‑day hospital stay for routine postpartum care. Twenty‑eight days after birth, the baby
was reevaluated for clinical, laboratory, and chest X‑ray symptoms, all of which were normal. The
PCR of other neonates was negative, and five intubated neonates, two twin, and two single died, and
the other neonates were discharged. In evaluating the clinical records of mothers of these infants,
the mean age is 30 years, and the average gestational age is 35 weeks, 32 cases of caesarean
section, and 10 cases of normal delivery.
CONCLUSION: We describe epidemiological data, demographics, signs and symptoms on
admission, laboratory results, comorbidities, infection COVID‑19 in the mothers and neonates,
chest radiography and computed tomography findings, treatment received for COVID‑19, and
clinical maternal, fetal, and neonatal outcomes. Due to the fact that the study population is
small consist of 42 mothers with COVID‑19 infection, among all PCR samples from infants
born to COVID‑19 positive mothers, the PCR result of one case was positive, and the rest of
was negative. Therefore, vertical transmission of COVID‑19 through the placenta to the fetus
cannot be confirmed or denied, nor can the COVID‑19 confirmed or denied the baby’s postnatal
complication during pregnancy.

Abstract BACKGROUND: Physical activity and nutrition interventions are the most important ways to prevent
gestational diabetes. The purpose of the study was to determine the effect of healthy lifestyle
intervention to promote preventive behaviors of gestational diabetes in the rural woman of Shoush city.
MATERIALS AND METHODS: In an experimental study, 60 pregnant women were selected using
simple random sampling and allocate into intervention group (n = 30) and nutrition program. The
study was conducted from September to June 2018. The data were collected in baseline and 1 month
and 3 months of follow‑up phase and were analyzed using Chi‑square test, repeated‑measure test,
and generalized linear model (GLM). The α = 0.05 was considered as significance.
RESULTS: The mean age in the intervention and control group was 25.9 ± 5.6 and 27.2 ± 5.9,
respectively. The GLM test showed a significant increase in the physical activity level and the mean
of nutrition behaviors within the intervention group over time (P = 0.013). Further, based on the results
of repeated‑measure test, the mean of weekly MET‑minute was increased in the intervention group
in comparison to the control group at 1 month and 3 months of follow‑up (P < 0.001).
DISCUSSION AND CONCLUSION: The lifestyle interventions are appropriate programs to the
reduction of the risk of development of gestational diabetes in pregnant women.

Abstract BACKGROUND: Infertility is one of the main concerns in women’s lives that may lead to psychological
imbalance and disrupt their sexual relationship. The study was conducted with the aim of evaluating
role of mental health in prediction of sexual function in infertile women.
MATERIALS AND METHODS: This analytic‑descriptive study was conducted in 2015–2016 in
424 infertile women referring to Fatemeh Zahraa Infertility and Reproductive Health Center, Babol,
Iran. The participants filled out the Female Sexual Function Index (α = 0.72–0.90), General Health
Questionnaire (GHQ‑28, α = 0.86), and demographics questionnaires. Linear regression used to
analyze the data.
RESULTS: The mean of total GHQ was 23.57 ± 12.06. The highest mean of GHQ subscales was
social dysfunction (8.68 ± 3.69). There was a negative association between GHQ with the overall
sexual function of infertile women (r = −0.397, P < 0.0001). The higher mental health disorder was
associated with lower sexual function. Furthermore, there was an inverse significant association
between all the subscales of mental health and sexual function. Based on the multiple linear regression
analysis, the variables of anxiety and sleep disorder (β = −0.143, P < 0.035), social dysfunction
(β= −0.139, P < 0.003), depression symptoms (β = −0.121, P < 0.046), sexual intercourse frequency
(β = 0.272, P < 0.0001), and educational level (β = −0.110, P < 0.016) were the significant predictors
of perceived sexual dysfunction after adjusting for other variables. The strongest predictor of the
GHQ subscale was anxiety and sleep disorder.
CONCLUSIONS: Undesirable conditions of mental health and its adverse effects on sexual function
and also other predictors emphasize the need to develop more effective screening and supportive
strategies with the help of the psychologists.

Abstract BACKGROUND: Diabetes mellitus (DM) is one of the main public health troubles diabetic foot
ulcer (DFU) is one of the most important and relatively common causes of hospitalization. This study
investigates the prevalence of peripheral artery disease (PAD) in Imam Reza Hospital of Kermanshah
during 2017–2018.
MATERIALS AND METHODS: This study is descriptive‑analytical. The study population was
196 cases with infectious DFUs admitted to Imam Reza Hospital of Kermanshah during 2019–2020.
The presence or absence of PAD was assessed in these cases. The collected data were analyzed
by SPSS software (version 18.0).
RESULTS: Among 196 patients studied, 120 (61.22%) patients had PAD. The prevalence of
PAD was higher in men than in women and it was more common in Type 2 DM patients than in
Type 1 DM patients. The majority of ulcers were located on the nonplantar surface of the foot.
Moreover, the prevalence of PAD had a significant relationship by increasing the duration of
diabetes (P = 0.041), history of amputation (P = 0.002), history of diabetic foot (P = 0.006), and
peripheral neuropathy (P = 0.005).
CONCLUSION: A considerable number of diabetic patients with DFU had PAD. This necessitates
more intense interventions to manage PAD as a strong risk factor for DFU in diabetics. Neurovascular
assessment of diabetic patients and early diagnosis of PAD may be appropriate interventions to
prevent development of DFUs. We recommend trial studies to find out the best methods to address
early detection of PAD in diabetics.

Abstract BACKGROUND: To have a thorough understanding of epidemic surveillance, it is essential to broaden
our knowledge of death tolls worldwide. This study aimed to determine the age‑standardized mortality
rate (ASMR) and predictors of mortality among coronavirus disease 2019 (COVID‑19) patients.
MATERIALS AND METHODS: In this cross‑sectional design, all COVID‑19 patients with a
positive polymerase chain reaction test in the population covered by Arak University of Medical
Sciences (AUMS) were entered to the study. Data collection was conducted by phone interview.
The study variables comprised age, sex, coronary heart diseases, diabetes, and some symptoms
at admission. The adjusted odds ratio (OR) and 95% confidence intervals (CIs) were obtained by
logistic regression. The direct method was applied to calculate ASMR (per 100,000) of COVID‑19.
The analysis was applied by STATA software 12.0.
RESULTS: A total of 208 cases of COVID‑19 (out of 3050 total infected cases) were dead and
2500 cases were recovered. The mean age of dead patients was 70 years. The COVID‑19 fatality
rate in the population equaled 6.8%; in those patients who were 70 years old or more, however, the
case fatality rate was 16.4%. The ASMR of COVID‑19 was 12.9 (CI 95%: 11.2, 14.8). The odds of
COVID‑19‑related death in the age over 60 were 10.87 (CI 95%: 6.30, 18.75) times than lower 45 years
old. Moreover, it was observed that COVID‑19 significantly increased the odds of COVID‑19‑related
death in diabetes patients (OR = 1.45, CI 95%: 1.02, 2.06, P = 0.036).
CONCLUSION: The ASMR of COVID‑19 was relatively higher in males than females. In general, the
COVID‑19 fatality rate was relatively high. We found that older age and diabetes can have impact
on the death of COVID‑19, but the headache was found to have a negative association with the
COVID‑19‑related death.

Abstract BACKGROUND: Following the COVID‑19 pandemic, the Government of India announced lockdown
from March 25, 2020, which included measures such as social distancing, canceling mass gatherings,
and closure of schools and colleges. Since the present generation of students spends a lot of time
on social media, especially WhatsApp, the utility of the same to discuss the various public health
domains of COVID‑19 through multiple‑choice questions (MCQs) was explored.
MATERIALS AND METHODS: This longitudinal study was conducted among 154
participants (undergraduates, interns, postgraduates, and teaching faculty) for 3 months. MCQs on
COVID‑19 were disseminated through WhatsApp status of the investigator, and feedback regarding
the same was taken at the end of 3 months. The activity log was maintained, and the information was
downloaded as a comma‑separated value (CSV) file and exported to MS Excel. Descriptive statistics were
applied. The location of the participants was entered into the Microsoft Excel sheet and converted into
CSV file. The Geographical data were analyzed in the Quantum Geographical information System (QGIS).
RESULTS: Among the 154 study participants, 48% were undergraduates, 10.4% were interns,
30.6% were postgraduates, and 11% were teaching faculty. Eighty‑nine percent of the participants
felt that WhatsApp can be used as a platform for discussing MCQs. 89%, 93%, and 89.6% of the
participants felt that the exercise improved their analytical skills, helped in self‑directed learning, and
improved collaborative learning, respectively.
CONCLUSIONS: Majority of the participants responded that WhatsApp can be used as a platform
to discuss MCQs and that the exercise helped in collaborative and self‑directed learning.

Abstract BACKGROUND: With the increase in the elderly population in the world and the consequent increase
in diseases and their physical and mental problems, improving self‑care behaviors by increasing
self‑efficacy in the elderly plays an important role in promoting their health and can increase their
life satisfaction. This study aimed to investigate the effect of self‑care self‑efficacy program on life
satisfaction of the elderly referred to selected health centers in Isfahan, Iran, in 2014.
MATERIALS AND METHODS: This study was a quasi‑experimental study with two experimental
and control groups and was performed on 64 elderly people referred to selected health centers in
Isfahan. The samples were randomly divided into experimental and control groups, and a self‑care
self‑efficacy program was performed on the experimental group. Data collection tools included
demographic information questionnaire and life satisfaction indexes A questionnaire. Data were
analyzed using the statistical tests such as Chi‑square, independent t‑test, Mann–Whitney, repeated
measures analysis of variance, and Least Significant Difference (LSD) post hoc test.
RESULTS: There was no significant difference between the two groups in terms of demographic
characteristics. Before the intervention, the mean score of life satisfaction was not statistically
significantly different between the two groups (P = 0.88). However, immediately and 1 month after
the intervention, the mean score of life satisfaction in the experimental group increased, and this
score was significantly different between the two groups (P < 0.001).
CONCLUSIONS: The results of this study showed that the self‑care self‑efficacy program has been
effective in increasing the life satisfaction of the elderly. Therefore, using this self‑care self‑efficacy
program is recommended to promote life satisfaction in the elderly.

Abstract BACKGROUND: Benefactors of nongovernmental organizations (NGOs) are the hidden public health
promotion systems. These benefactors are the symbol and intermediary of people participation, which
is one of the main arms of health promotion and reduction of poverty and injustice in the societies.
The present study is aimed to identify the benefactors’ experiences in NGOs in terms of providing
and promoting health‑oriented services.
MATERIALS AND METHODS: This study was conducted with a qualitative approach. The total
number of participants was 32, which consisted of 25 chief executive officers from active and inactive
organizations. Active organizations refer to organizations that submitted their 6‑month report at the
time of the investigation and whose operating license was renewed and in operation and seven
officials of the social deputy of governmental organizations related to NGOs. Data collection was
performed by using semi‑structured interviews and with purposive sampling and then continued until
data saturation. Furthermore, the content analysis method was used for data analysis. MAXQDA
software version 2007 was used to manage quality data.
RESULTS: During the data analysis, the following four subcategories were obtained: “high effort
in empathy with fellow human beings,” “role of merit in the success of donors,” “creating a platform
for social attention for the client’s spontaneity,” and “respect of the client,” which were the results of
experience and dimensions. The performance of non‑governmental organizations is in line with the
confrontation and responsibility of non‑governmental organizations with a focus on health‑oriented
services.
CONCLUSION: Having benevolent motives, benefactors attempt to provide conditions, in which help
seekers have more chance for living through establishing new, sustainable, and future‑reassuring
conditions.

Abstract BACKGROUND: Studies have shown that quality of life in women with unintended pregnancy is
significantly less than the ones with wanted gestation. Therefore, this study was aimed to determine
the effect of intervention based on the positive psychology interventions on women’s QoL with
unintended pregnancies in Kermanshah, Iran.
MATERIALS AND METHODS: In this randomized clinical trial, 40 women with unintended pregnancy
met the eligibility criteria and were randomized into experimental (n = 20) or control (n = 20) groups.
The Short‑form 36‑item Questionnaire (SF‑36) was administered at pretest, post‑test, and six weeks
after the intervention. Positive psychology interventions were performed in each session once
a week for 10 weeks, with a duration of 90 minutes. The Friedman test and Mann–Whitney U‑test
were used to analyze QoL and all eight domains for within‑group and between‑group comparisons,
respectively. The level of confidence was set at 0.05 significant.
RESULTS: Distribution of matched variables was not significantly different between the two trial
groups. Over the intervention period, the mean of total scores of QoL and seven dimensions showed
significant improvement among the experimental group, whereas in the control group, it decreased
significantly (P < 0.05). In addition, in the posttest and follow‑up stages, the mean score of six
dimensions of QoL was higher than the control group (P < 0.05).
CONCLUSION: According to the results of the present study, unintended pregnancy has side effects
on QoL in women. Positive counseling interventions can improve the quality of life in women with
unintended pregnancy.

Abstract BACKGROUND: Fertility is always one of the most important functions of the family. Having a
child equals growing up and entering the adult world. Adoption is one of the methods that can be
considered to treat infertility. One of the duties of health professionals, especially midwives, is to
advise and educate infertile people, which helps them in a way beyond medical treatment. Therefore,
this study was conducted to determine the effect of face‑to‑face and telephone counseling on the
desire for adoption in infertile couples.
MATERIALS AND METHODS: The present study was a two‑group counseling intervention study that was
performed on 34 infertile couples referred to Mashhad Infertility Center. Infertile couples were randomly
assigned to face‑to‑face and telephone counseling groups. All participants completed the Adoption
Adoption Questionnaire at the beginning and end of the study. Data were analyzed by spss16 software.
RESULTS: The mean score of propensity to adopt in the face‑to‑face counseling group 2 weeks after
the intervention was significantly higher than before the intervention. Furthermore, the mean score
of desire for adoption in the telephone counseling group increased significantly 2 weeks after the
intervention compared to before (P < 0.001). Adoption scores varied in the face‑to‑face counseling group
at 3.15 and in the telephone counseling group at 3.23. There was no statistically significant difference
between the two groups (P < 0.885). The most common reason for not wanting to adopt was hope
for self‑treatment and having children (70.6% women and 67.6% men). The most common reason for
accepting an adopted child was the strong need to have a child (23.5% in women and 23.5% in men).
CONCLUSION: According to the results of this study, counseling can increase people’s awareness
of the conditions of adoption and thus increase the desire of people to accept the adopted child. For
this reason, considering adoption counseling sessions for infertile couples who have been receiving
infertility treatment for a long time but have not become pregnant can help the couple decide.

Abstract BACKGROUND: Blended learning (BL), the integration of online with face to face teaching, is
established as a teaching method in higher education. Understanding the learner’s readiness
toward online component of BL is important in designing and delivering BL. Nursing students require
proficiency in interpersonal relationship and social interaction apart from knowledge and skills. BL
may provide an opportunity to acquire the professional skills better than the traditional face to face
sessions. The objectives of this study were to identify the nursing student’s readiness toward BL
and perceptions about the online learning component of BL.
MATERIALS AND METHODS: First‑ and second‑year entry level graduate nursing students of Sri
Ramachandra Institute of Higher Education, Chennai, India, were the participants of the study. This
study used a mixed method approach. An online questionnaire, developed based on the literature
and expert consensus, was used in the first phase. A focus group discussion (FGD) with ten random
participants of the survey was conducted to understand the perceptions and readiness to adopt the online
component of BL. The present study was conducted from December 2019 to January 2020. Survey
results were analyzed through descriptively. Content analysis was carried to summarize FGD results.
RESULTS: A total 158 students of entry level nursing graduate programme participated in the survey.
53.8% of felt BL will have positive effect on their learning and 70% of the respondents were ready
to adopt BL. The FGD identified two themes: (I) Readiness to adopt online learning as a component
of BL and (II) perceived barriers and challenges in adopting online contents.
CONCLUSION: Entry level nursing graduate students had a positive perception about the online
components. Majority of them are confident in accessing the online contents. Willingness to learn
through online, previous experience with online learning, and perceived advantages of online
component might influence the learner’s readiness. Availability of internet and absence of teachers
were perceived as the barriers to online learning by the participants.

Abstract

Abstract BACKGROUND: Prenatal education provides opportunities for health promotion of healthy behaviors
and risk reduction. Quality and coherence with prenatal health promotion best practices depend on
an individual class instructor. The objective of our study was to document the experiences, practices,
and perceptions of our diverse Ottawa, Canada community of prenatal educators.
MATERIALS AND METHODS: In this quantitative, mixed methods e‑survey conducted in Ottawa,
Canada, prenatal educators were asked to describe their prenatal class settings, delivery formats,
content, perceptions of pregnant women, and recommendations. Data were analyzed by descriptive
statistics and thematic content analysis.
RESULTS: Respondents included public health nurses and a diverse group of “allied childbirth
educators” (ACE). Topics related to pregnancy, labor, and postpartum issues were well addressed;
however, established and emerging risks to pregnancy were omitted. Nurses were more likely to
discuss lifestyle risks to pregnancy and general prenatal health promotion, whereas ACE respondents
emphasized informed consent and individualized counseling. Women marginalized by social exclusion
including Indigenous women, immigrants, and women with disabilities were perceived as missing
from prenatal educational settings.
CONCLUSIONS: Heterogeneity of prenatal education provides opportunities for collaboration;
however, established and emerging risk factors to pregnancy are neglected topics. Addressing the
needs of diverse communities of pregnant women requires timely, evidence‑based, inclusive, and
culturally safe delivery of prenatal health promotion.

Abstract BACKGROUND: Patient satisfaction is a comprehensive measurement of patients’ happiness with
the level of health care delivered to them both inside and outside the physician’s office. It is commonly
used as an indicator to assess the health‑care quality and affects a wide range of components related
to the provision of health services such as ease of access, medical malpractice, and clinical outcomes.
The study aimed to analyze patients’ satisfaction with the quality of health care they received at
the outpatient department of Klinik Kesihatan Maharani Muar Healthcare Facility (KMMHF), Johor.
MATERIALS AND METHODS: This cross‑sectional study was conducted between August and
December 2019 period. Demographic information and information on patients’ feelings about their
physicians, treatment, and health facilities provided were collected from 407 consented patients in a
simple random sampling survey using a researcher‑made, an adapted Medical Interview Satisfaction,
questionnaire which was pilot tested before administration to the patients. Data were analyzed with
SPSS version 23. Descriptive statistics and correlational and group comparison analyses were utilized.
RESULTS: Of the 407 patients studied for physician–patient satisfaction, the overall mean of all the
respondents responding was 4.089 ± 0.5, which was ranked the highest among the three objectives.
The effectiveness of treatment came as the second highest with the overall mean of 4.088 ± 0.5.
Finally, the overall health‑care facilities had the lowest overall mean of 4.077 ± 0.5 among the three.
CONCLUSION: Most patients who visited KMMHF were mostly satisfied with the outcomes of
physician–patient interaction in the clinic.

Abstract BACKGROUND: Knowledge of a disease can influence paramedic’s attitudes and practices, and
incorrect attitudes and practices directly increase the risk of infection. Understanding paramedic’s
knowledge, attitudes, and practices (KAPs) and possible risk factors helps to predict the outcomes
of planned behavior. To assess KAP regarding COVID‑19 through Google form among paramedical
staff at tertiary care teaching institutes of central India.
MATERIALS AND METHODS: A cross‑sectional, multicentric, questionnaire‑based study was
conducted from May 2020 to August 2020 among 230 paramedical staff from two tertiary care
teaching institutes through Google form. Data were analyzed by Chi‑square test and parametric test
using GraphPad prism software version 5.0.
RESULTS: All participants had knowledge about symptomatology of COVID‑19. However, significantly
more participants in nursing cadre know about definition of close contact. The mean knowledge
score was 4.84 ± 0.6. The mean score for attitude was 4.48 ± 0.83. Overall, 54.78% of paramedical
staff follow correct prevention strategies. Of them, significantly more nursing staff correctly practice
infection control measures upon arrival of COVID‑19 patients (P = 0.033). There was a significant
difference among both groups regarding wearing of appropriate personal protective equipment while
transporting/accompanying patients who are confirmed with COVID 19 (P = 0.009). The overall score
for practice is 3.97 ± 1.03. The practice score was significantly better in nursing cadre as compared
to nonnursing cadre (P = 0.038).
CONCLUSION: Majority of the participants had good knowledge and positive attitude. Nursing cadre
follows better preventive practices as compared to nonnursing cadre while performing COVID‑related
duties. Considering these facts, dodges responsible for poor practices should be identified and
resolved so that India will be able to conquest the battle against the disease.

Abstract BACKGROUND: The Swiss cheese model of accident causation is a model used in risk analysis
and risk management, including aviation safety, engineering, healthcare, and emergency service
organizations, and as the principle behind layered security, as used in computer security and defense
in‑depth. This study aimed to develop and weight the occupational health leading indicators using
the Swiss cheese model.
MATERIALS AND METHODS: The present study was a descriptive, cross‑sectional study;
occupational health performance assessment indicators were classified into five main groups of
chemical, physical, ergonomic, psychosocial, and biological harmful agents. In addition, potential
hazards and their prevention methods were identified using the Swiss cheese model. The leading
performance measurement indicators (n = 64) were developed based on preventive methods and
were weighted and rated by fuzzy analytic hierarchy process.
RESULTS: Thirty‑six out of 64 indicators were related to the management measures, 25 indicators
were related to exposure to harmful occupational agents, and the remaining indicators were
occupational‑related illnesses and diseases rate. Considering the importance and frequency of
indicators, psychological agents were the most important indicators (40%) and physical agents had
the greatest frequency (59%).
CONCLUSIONS: Process of indicators’ development has demonstrated that the major occupational
health prevention measures in the oil and gas industry are concentrated on physical, psychological,
and chemical agents, respectively. Thus, to provide protection for employees against occupational
diseases and improve health performance indicators, paying special attention to mentioned agents
is essential in the oil and gas industry.

Abstract Drug abuse is one of the most important threats to human beings today, leading to disability and
even early death. In the past, opium had only therapeutic uses, but now, drug addiction is one of the
major public health problems in Iran. Opium and its derivatives are the most commonly used illicit
drugs in this country. Therefore, this study was conducted to evaluate the treatment strategies of
opium addiction from the perspective of Persian medicine. In this narrative review, the search was
conducted using appropriate keywords in the authoritative books of Persian medicine documentations
of databases of PubMed, Google Scholar, PsycINFO, American Academy of Medical Sciences, United
Nations Office on Drugs and Crimes with keywords of opioid and opium since 2000 AD. In Persian
medicine books, “Afioon” means poppy plant (Papaver somniferum), which is called opium in English
and “Theriac” in Persian. To quit, they should be gradually reduced and replaced with appropriate
spices such as henbane (Hyoscyamus niger) seeds or mandrake (Mandragora officinarum) fruit or
root or poppy (P. somniferum) seeds or poppy shell or Lettuce (Lactuca sativa) seeds, or castor
testis or nutmeg (Myristans fragrans) fruit or ajwain (Trachyspermum copticum) seeds or baked
bread. Opioid quit should be gradual and delayed in time of consumption and gradual reduction of
opium levels, and bodies that have become lean for a long time will gradually recover with adequate
nutrition over time.

Abstract BACKGROUND: COVID‑19 virus has resulted in significant psychological distress for many
individuals, particularly, those in underserved communities. Social media have the potential to be
one of the most effective tools for mental health campaigns, reaching wide audiences in the shortest
amount of time. In this paper, the potential of harnessing social media platforms to address mental
health needs in underserved populations is presented. In addition, description of the preliminary
implementation of a social media mental health campaign, the 5 × 5 campaign, is described
as an example of the feasibility and benefits of such efforts. Key implications gleaned from the
implementation process are also presented.
MATERIALS AND METHODS: Utilizing a participatory approach, the 5 × 5 campaign aimed to
improve recognition of mental health symptoms, promote help seeking, and provide immediate
strategies for self‑care for individuals experiencing psychological distress related to the COVID‑19
pandemic in low‑income, high‑risk communities in and around Guatemala City. Campaign content
was promoted on Facebook, Instagram, and WhatsApp from April 2020 to June 2020.
RESULTS: Preliminary analysis of the 5 × 5 campaign demonstrated feasibility and substantial
impact with over 84,000 individuals reached by the campaigns through initial messaging and shares.
CONCLUSION: The 5 × 5 highlights the feasibility of using social media campaigns for mental health
promotion and key factors that should be incorporated in the planning of social media mental health
campaigns aimed at promoting awareness, engaging underserved communities, and encouraging
help seeking.

Abstract Coronavirus disease 2019 (COVID‑19) is an infectious disease caused by a newly discovered
coronavirus and the WHO declared it a pandemic, and due to the high risk, the most government
throughout the world have temporarily closed schools, colleges, and universities. The impact of this
COVID‑19 has been hit the education system worldwide, and according to the UNESCO, as of March
23, 2020, around some 1.3 billion learners worldwide were not able to attend educational institutions
so to continue the education, most of the universities are providing teaching through online mode,
but there are challenges of technological issue, time management, and adaptability.

Abstract BACKGROUND: Fire is one of the most important threatening factors for hospitals and needs special
attention. The present study was conducted to explain the factors affecting hospital emergency
evacuation following fire based on hospital administrators’ experiences.
MATERIALS AND METHODS: This was a qualitative study conducted employing the content analysis
approach. Participants included 22 hospital administrators in Tehran, Lorestan, Kurdistan, and Ilam
provinces. The participants were purposefully selected and included until reaching principle of data
saturation. Data were collected through in‑depth semi‑structured interviews from November 2019
to August 2020 and analyzed by the content analysis method.
RESULTS: Factors affecting hospital emergency evacuation during fire were categorized into five
main categories and 17 subcategories including response to incident (five subcategories of fire nature,
emergency evacuation, service provision, coordination and communication; and collaboration and
companionship), human factors (two subcategories of individual characteristics and competencies),
hospital preparedness (three subcategories of planning, safety and security; and information
management system), environmental factors (two subcategories of hospital design and infrastructure;
and weather condition), and finally ethical values (five subcategories of human dignity, trust, altruism,
responsibility and accountability; and empathy).
CONCLUSION: The results of this study indicated that during fire in Iranian hospitals, several factors
in addition to available standard guidelines affect the emergency evacuation process that need to
be considered. Hospital emergency evacuation during fire is a complex process and necessitates a
full and high‑level hospital preparedness, so using the results of this study can be used to develop
and practice evacuation plans and improve the hospital preparedness.

Abstract BACKGROUND: The National Examination of Knowledge in Medicine establishes the knowledge
profile  (PdC) a physician must possess to practice public medicine in Chile. However, no study
has evaluated the perception of dermatology training regarding the acquisition of the minimum
competencies required. This study described and compared the impressions of the dermatology
training received by the University of Chile (UCh) graduates with graduates from other national and
international faculties of medicine.
MATERIALS AND METHODS: This was a cross‑sectional study, based on a single survey model,
applied via E‑mail to registered physicians in an online database, with emphasis on UCh medicine
graduates, from the generations 2012 to 2016. The data were collected anonymously, tabulated,
and analyzed in MINITAB.
RESULTS: From 908 UCh graduates, 141 surveys were answered (15.5%). Nine of 10 physicians
considered “important” to obtain knowledge in dermatology. About 68.8% found the information
they received was adequate. When comparing UCh graduates with other Chilean universities,
UCh graduates had a slightly better impression of their training. When comparing Chilean versus
foreign graduates, the latter presented a better perception of their preparation in cutaneous
pathology.
CONCLUSION: UCh graduates were satisfied with their dermatological training at the undergraduate
level and felt better prepared than colleagues from other Chilean universities when facing cutaneous
pathologies.

Abstract BACKGROUND: With recent changes in the curriculum of bachelor of medicine and bachelor of
surgery  (MBBS) course to meet the global trends and to fulfill the standards expected from an
Indian medical graduate, introduction of newer teaching methodologies becomes mandatory. The
usage of flipped classroom (FCR) in medical education has always been rewarding. This study was
to evaluate the effectiveness of FCR as a teaching method in comparison with traditional lectures
in histology sessions in Sri Ramaswamy Memorial (SRM) Medical College Hospital and Research
Centre, Chennai, Tamil Nadu, India.
MATERIALS AND METHODS: This interventional study was conducted among the 1st year MBBS
students in SRM Medical College Hospital and Research Centre for a period of 1 year (2018–2019
academic year). The histology sessions were taught using both traditional lectures and FCR
methodology. Pre‑  and posttests were conducted for each traditional and FCR session with ten
multiple‑choice questions pertaining to that topic. Students’ performance was assessed by paired
t‑test (for pre‑ and posttest comparisons) and independent t‑test (for traditional and FCR posttest
mark comparison) using SPSS software version 26. A feedback survey based on Likert scale was
also conducted on the students and was analyzed. P < 0.05 was considered statistically significant.
RESULTS: Posttest marks had statistically significantly improved when compared to pretest
marks (P  <  0.0001) in both traditional and FCR teaching methods. Comparison of posttest
marks showed statistically significantly higher marks in FCR when compared to traditional
teaching (P < 0.0001). Similarly, students’ feedback survey showed that FCR benefitted the students
in achieving the competency required.
CONCLUSION: FCR methodology of teaching histology had a very impressive outcome and the
students’ perception was very positive.

Abstract BACKGROUND: Self-care for diabetes is very important in preventing complications of diabetes
and also improving quality of life. This study aims to find the various self‑care practices of type 2
diabetes patients who are being treated at a rural health center of a medical college and the factors
influencing self‑care.
MATERIALS AND METHODS: This is a hospital‑based cross‑sectional study. Type 2 diabetes
patients registered and receiving treatment from the noncommunicable disease clinic of a rural health
center were administered a pretested questionnaire, developed based on different diabetes self-care
questionnaires making changes as appropriate and including most aspects of self-care practices. The
proportion of compliant was then cross-tabulated with background characteristics and their glycated
hemoglobin (HbA1c) levels. SPSS version 16.0 was used for the analysis.
RESULTS: Among 390 patients with a mean age 56 years, 25.5% adhered to at least four dietary
modifications, 46% were physically active, and 57% had good compliance to drugs; hypoglycemia
prevention practices ranged from 21% to 51%. Except for avoiding barefoot walking (90%), other
foot‑care practices were followed by only a quarter of them. Among ever users, 69.2%, 64.3%, and
29.4% have quit smoking, alcohol, and tobacco use, respectively. Adherence to dietary modifications
and drug compliance were associated with a lower HbA1c level of ≤7 g% (P < 0.05).
CONCLUSION: In this study, the compliance to physical activity or medications is much better
than dietary changes and foot-care practices. Focused education programs and monitoring during
follow-up visits will improve self-care in the less adhered to aspects. Those who are adherent to
dietary modifications and drugs have better glycemic control.

Abstract BACKGROUND: The demands and learning challenges in medical schools are not efficiently
overcome by all learners. Despite the gravity of the problem, there is a dearth of studies to identify,
define, and address the needs of learners. Thus, the present study was designed to do a situational
analysis to identify and define the problems of learners and to develop a model for student support
system in our institution.
MATERIALS AND METHODS: A phenomenological type of qualitative research was undertaken.
One‑to‑one in‑depth interviews (IDIs) were conducted, 10 each among undergraduate medical
students, faculties and parents (n = 30) to understand the problems of students and their suggested
solutions from each one’s perspective. The interviews were audio‑recorded, transcribed verbatim,
and manual thematic analyses were performed.
RESULTS: Manual thematic analysis of the transcripts yielded 16 subcategories and 7 categories.
The various categories that emerged are (1) curriculum related; (2) interpersonal adjustment
problems; (3) personal issues and family problems; (4) cognitive learning disabilities; (5) poor
organizational skills; (6) students’ lack of motivation; and (7) miscellaneous. Based on the problems
and their suggested solutions, a model for the essential components of a student support system for
our college was developed. It outlines the principal roles of four key stakeholders, namely students,
faculties, parents, and college administration.
CONCLUSION: It has been found that students face various academic problems, personal,
interpersonal and family level issues. We developed the support system model suitable for our
context. In future, it may be implemented and evaluated to check if it achieves the desired purpose.

Abstract BACKGROUND: Little is known about the inference that physical activity (PA) may have on academic
performance and learning styles of Latin American dental students.
MATERIALS AND METHODS: In this cross‑sectional study, an administrative dataset and a voluntary
university characterization provided information about PA and academic performance. Moreover, 218
dental students of the University of Antioquia in Colombia completed a structured questionnaire to
identify their learning styles. To analyze the information obtained a Pearson correlation, and logistic
and linear regression models were implemented.
RESULTS: A total of 131 (60%) students informed being physically active (PA group), and 87 (40%)
did not report PA (non‑PA group). The results showed a high‑grade point average (GPA) in the
PA group (P = 0.01). The PA group showed a preference for the theorist and pragmatist learning
styles with statistically significant differences between the groups (P = 0.004 and P < 0.0001,
respectively). It was also observed a statistically significant Pearson positive correlation between the
theorist style and higher GPA (r = 0.15; P = 0.04). The multivariate regression model showed that
PA protects against lower means of GPA (odds ratio = 0.3; 95% confidence interval [CI]: 0.09–0.7,
P = 0.01). Furthermore, the adjusted linear regression models also showed that PA protects against
lower means of the theorist (β= −0.15; 95% CI: −0.02 to − 0.002, P = 0.002) and pragmatist styles
(β= −0.18; 95% CI: −0.03 to − 0.006, P = 0.0006). Interestingly, men were statistically significant in
all multivariable models.
DISCUSSION: This study suggests that PA is associated with higher academic performance and
the theorist and pragmatist styles. Male students were also more physically active; therefore, it is
relevant to establish strategies to stimulate physical activities in dental students, especially in women,
including extracurricular activities.

Abstract BACKGROUND: The practice of yoga is proven to have physical, cognitive and emotional benefits
for school children. Despite this many schools do not include yoga in their daily schedule. The
reasons cited are lack of time and resources. To overcome these problems the present study aimed
to develop and validate a short duration Integrated classroom yoga module. The design guidelines
were that it should be possible to practice in the classroom environment and that it could be led by
the class teacher. In this way the module would overcome the problem of both time and resource.
MATERIALS AND METHODS: The study had two main  phases. In the first phase, selected ICYM
practices based on the literature review were validated by 21 subject matter experts using Lawhse’s
content validity ratio (CVR) formula. In the second phase, a pilot study using a paired sample prepost
measurement design was carried out on 49 high school children. The study was conducted in June
2019. The intervention period was 1 month, and the test variables were physical fitness, cognitive
performance, self‑esteem, emotional well‑being, and personality characteristic. Paired sample t‑test was
the analysis tool and the software used was the Statistical Package for the Social Science version 26.
RESULTS: In the Lawshe’s CVR analysis, 17 out of the 24 practices tested were rated by experts
as essential as was the overall module (CVR score ≥0.429). In the pilot study, there were significant
differences in the postmean scores compared to premean scores, for all the 4 EUROFIT physical
fitness testing battery tests (P < 0.02), all the three scores of the Stroop  color‑word naming
task (P < 0.001) and the Rosenberg self‑esteem scale (P < 0.008).
CONCLUSION: ICYM was validated and found feasible by the present  study. It was found to have a
statistically significant impact on physical fitness, cognitive performance, and self‑esteem variables.
However, a randomized control trial with a longer intervention period is needed to strengthen the
present study.

Abstract BACKGROUND: Employing appropriate and deserving staff is goal of human resource
management (HRM). A group of staff at medical science universities are clinical teachers. Considering
the position and importance of these peoples, this study addresses the challenges of recruiting
clinical teachers.
MATERIALS AND METHODS: This is a qualitative study of the conventional content analysis done
in Isfahan medical university in 2018. The participants were selected through intensity sampling of
purposive sampling method, and data were obtained through semi‑structured interviews conducted
to survey 23 experts and clinical faculty members concerning the challenges involved in employing
clinical teachers. Data were analyzed using conventional content analysis method and OneNote 2013.
RESULTS: Two main categories and ten subcategories were classified as follows: HRM inadequacy
in educational departments with six subscales such as indefiniteness of the workforce status for HR
managers, reluctance of educational departments to increase human resources, nonproportionality
of the teacher–student ratio, recruitment of faculty based on the needs in the treatment sector,
weakness of the infrastructure to use nonfaculty teachers, and reduced public interest in employment
as a faculty and weakness of the selection process with four subscales based on data analysis such
as undesirable manner of selection, recruitment based on the score given by the national board of
medical examiners, purpose‑based calls to recruit predefined individuals, and personal and emotional
issues, rather than managerial standards, governing cooperation with teachers.
CONCLUSION: Recruitment process is part of HRM tasks. Employment system in a medical
sciences university must be considered to improve the clinical faculty recruitment. HRM inadequacy
in educational departments and weakness of the selection process are challenges that affect the
employment system. According to these findings, it is necessary to review the regulations and tasks
of HRM in medical sciences universities.

Abstract BACKGROUND: Education is considered as one of the most important well‑known roles of nurses,
which is based on the patients’ needs and awareness level. Thus, training the skill to nursing students
is highly prioritized. The present study aimed to compare traditional and role‑play training methods
on nursing students’ performance and satisfaction in the principles of patient education course.
Materials and Methods: The present quasi‑empirical study was conducted in 2019 among 36
fourth‑semester nursing students at the School of Nursing in Borujen branch. In this regard, the
students were randomly divided into experimental (n = 18) and control (n = 18) groups and trained
through role‑play and traditional methods, respectively. The data were collected using demographic
questionnaire, training method satisfaction form, and student performance evaluation checklist (30
items), among which the two last ones were researcher made. Then, data were analyzed by SPSS
software version 19 and using descriptive and analytical statistical tests such as Chi‑square and
Mann–Whitney.
RESULTS: The results demonstrated a statistically significant difference (P < 0.05) between the mean
score of students’ satisfaction with teaching method in the control (17.15 ± 0.89) and experimental
groups (19.03 ± 1.49), as well as between that of their performance in the control and experimental
groups (115.31 ± 2.07 and 118.28 ± 3.59, respectively).
CONCLUSION: Based on the results, role‑play training method affected nursing students’
performance in the principles of patient education course higher. Thus, using the method in training
students and in‑service training for nursing personnel is recommended to education planners and
nursing education authorities for improving the skill.

Abstract BACKGROUND: Most patients with myocardial infarction (MI) suffer from one or more risk factors
such as obesity and overweight, unhealthy diet, lack of physical activity (PA), and high blood pressure.
Individual control of these risk factors by lifestyle modification raises the probability of survival in
these patients; hence, we used a self‑management intervention to assess its effect on the lifestyle
of post‑MI patients.
MATERIALS AND METHODS: This quasi‑experimental study was conducted on 92 hospitalized MI
patients in Hamadan province in 2016. Convenience sampling method was used for selecting the
participants. The patients were selected and assigned to experimental and control groups. The main
parameters (diet, blood pressure, waist circumference, and body mass index [BMI]) were measured
at the baseline and 8 weeks after discharge. Domestic PA was the only parameter measured 8 weeks
after their discharge. A self‑management intervention was adopted for the experimental group. The
data were analyzed using paired and independent‑sample t‑tests with SPSS software version 16.
RESULTS: The comparison of the scores obtained for diet, blood pressure, waist circumference,
and BMI in post‑MI patients revealed no statistically significant difference between the two groups
at the beginning of the study (P > 0.05). Following the intervention, the experimental group had a
significantly higher mean score for diet and domestic PA (walking program from 1st week to 8 weeks),
compared to the control group (P < 0.001); however, the intervention had no significant effect on
BMI, waist circumference, and systolic and diastolic pressure (P > 0.05).
CONCLUSION: The findings indicated that the program had an impact on some risk factors. Therefore,
it is recommended to use self‑management support in MI patients during the discharge process to
improve their lifestyle.

Abstract BACKGROUND: In the recent years, the accreditation of educational institutions and hospitals has
attracted a lot of attention in different countries to ensure the quality of medical education. In this
regard, examining the experiences of different countries will help to improve the world and local
standards. This study was an attempt to explore the lived experiences of senior managers about
the educational accreditation challenges and appropriate strategies to overcome these challenges.
MATERIALS AND METHODS: The authors used a phenomenological approach to explore the lived
experiences of the senior managers about educational accreditation of teaching hospitals affiliated
to Iran University of Medical Sciences. Semi‑structured interviews were conducted to reach data
saturation. For this purpose, three semi‑structured face‑to‑face interviews and six electronic interviews
were conducted. Data were analyzed using the Colaizzi method.
RESULTS: Data analysis showed that the most important challenges of educational accreditation
of teaching hospitals were related to standards and criteria, executive policies of accreditation, and
educational, attitudinal, and financial infrastructures. The strategies expressed by the participants
were categorized into four themes including reviewing and revising standards and criteria, planning
for education, providing human and financial resources, and modifying the executive structure of
accreditation.
CONCLUSIONS: In order to improve the quality of educational accreditation programs, it is necessary
to identify and find a solution for the existing challenges by experiential support of the senior
managers of teaching hospitals and the other stakeholders (e.g., faculty members and students).
It also provides an opportunity for educational policy‑makers to improve the hospital’s educational
accreditation program.

Abstract BACKGROUND: To extend our knowledge of social barriers in relation to mental health, the present
study was conducted to investigate the impact of social barriers on mental health help‑seeking among
Saudi Arabians aged 18 years and above.
MATERIALS AND METHODS: This cross‑sectional study was carried out on 1632 participants in
2018 during the months of October and November. The participants completed self‑administered
online surveys about the demographic characteristics, social barriers, and knowledge and attitudes
about mental health.
RESULTS: The majority of the participants agreed that social barriers could prevent them from
seeking mental health help. Stigma was chosen as the most common social barrier among the
participants (76.3%), followed by culture (61.5%) and negative perceptions (56.2%).
CONCLUSION: Social barriers are a challenge in seeking mental health. Increasing public awareness
of available services and resources as well as developing programs to fight stigmatization should be
initiated to create more positive attitudes toward people with mental illness and promote holistic well‑being.

Abstract BACKGROUND: Length of stay (LOS) and patients’ outcome are two important indicators in intensive
care units (ICUs). The severity of illness influences these variables and could have a predictive value
in clinical settings. The impact of severity of illness on the LOS and outcomes in patients admitted
to ICUs was investigated in a selected hospital in Iran in 2019.
MATERIALS AND METHODS: This research was a descriptive longitudinal study. Data were
prospectively collected on 150 patients. The sequential organ failure assessment (SOFA) score, LOS,
and demographic variables of the patients were recorded. Abbreviated mental test and Barthel index
measuring activities of daily living questionnaires were completed at the time of the discharge from
ICU and 1 month later to show the patient outcomes. Data analysis was performed using Chi‑square
test, t‑test, analysis of variance, Pearson’s correlation, and linear and ordinal logistic regression with
SPSS software version 16.
RESULTS: The mean of LOS was 11.21 ± 10.54 days. 24.7% of the patients were discharged from
ICUs with optimal recovery, 49.3% with poor recovery, and 26% died in ICUs. One month after
discharge, 67.6% of patients had optimal recovery, 24.3% had poor recovery, and 8.1% died. The
SOFA score had a significant relation with LOS and patient outcomes in discharge and 1 month later.
All the patients with SOFA score <5 survived, and all the patients with SOFA score more than 12 died.
CONCLUSIONS: The severity of illness had a significant relation with LOS and patient outcomes in
the time of the discharge from ICU and 1 month later. It seems that the initial SOFA score of 12 and
higher can be suggested as a cutoff point for poor prognosis in ICU patients.

Abstract BACKGROUND: Chronic liver disease is associated with decreased quality of life. The quality of life
of children with chronic liver disease is related to their quality of life. Malnutrition is associated with
death from cirrhosis, development of complications, and health‑related quality of life in people with
liver disease. Therefore, this study was conducted to determine the effect of nutritional adjustment
program on quality of life in children with chronic liver disease.
MATERIALS AND METHODS: This clinical trial study was performed on children with chronic liver
disease referred to the nutrition clinic of Ghaem Educational‑Research Center in Mashhad in 2015.
In this study, 77 children with chronic liver disease were randomly divided into two groups. Before
and after the intervention, patients’ quality of life was assessed with the PedsQL™ 4.0 generic core
scale questionnaire. Data analysis was performed using SPSS16 software.
RESULTS: In the postintervention stage, the mean total score of quality of life in the experimental
group was 1965.0 ± 270.9 and in the control group was 1522.5 ± 321.3 (P < 0.001). The difference
in quality of life score of physical, social, and school performance in the two groups was significant.
CONCLUSION: According to the results of this study, it seems that interventions that can improve
the quality of life of children with chronic liver disease can be an important step in advancing these
people toward a healthy and quality life. As a result, it is possible to take steps to improve the quality
of life of patients by encouraging children with liver disease and providing information about diet.

Abstract BACKGROUND: Female sexual dysfunction is a common and often distressing public health problem.
This study aimed to determine the effect of the sexual health program on female sexual function and
attitude in reproductive age in the west of Iran.
MATERIALS AND METHODS: This was a field trial study. A total of 103 women attending health
centers were assigned into two groups; an experiment and a control group. Data collection tool involved
sociodemographic characteristics questionnaire, sexual female attitude questionnaire, and the Female
Sexual Function Index (FSFI), which was completed by participants before and after the implementation
of a sexual health education program. Data were analyzed using SPSS software version 22.
RESULTS: The results revealed that after the intervention, female sexual function in the experiment
group based on the FSFI tool was significantly improved (P < 0.01) in the domains of desire, arousal,
orgasm, satisfaction, pain, and the total score compared with the control group. Besides, there was
no significant difference between posttest mean score of sexual attitude in the experiment group and
control group (P > 0.05). However, a significant difference was found in the mean score of sexual
attitudes in the experimental group before and after the intervention (P = 0.004).
CONCLUSION: The findings showed that sexual health program was effective in improving women’s
sexual function and attitude in the experiment group. It is recommended that the effect of other training
methods remain to be addressed on women’s sexual function and attitude.

Abstract BACKGROUND: Employees spend most of their time at work, and hence, it is important to pay
attention to health‑promoting behaviors. The purpose of the present study was to investigate the
status of health‑promoting behaviors of employees in the Medical University of Ilam‑Iran.
MATERIALS AND METHODS: This cross‑sectional, descriptive study has been conducted by
the participation of 208 employees, whom selected through the simple random sampling method.
In the present study, participants completed Walker’s Health Promoting Life Style Profile II in the
self‑report form. The gathered data were analyzed using software at the significant level of 0.05.
Data were analyzed by the independent samples t‑test, one‑way analysis of variance, and Pearson
correlation coefficients.
RESULTS: The highest correlation of health‑promoting behaviors was related to spiritual
growth (r = 0.785), stress management (r = 0.777), interpersonal relationships (r = 0.767), health
responsibility (r = 0.730), nutrition behaviors (r = 0.641), and physical activity (r = 0.611) were in
the next places (P < 0.001), respectively. Among sub‑scales, the highest correlation was observed
between spiritual growth and stress management (r = 0.676, P < 0.001) and the lowest correlation
between physical activity and interpersonal relationships (r = 0.253, P < 0.001).
CONCLUSIONS: The score of physical activity was lower compared to other dimensions of health
promoting behaviors. Therefore, it is necessary to make more effective interventional measures for
improving physical activity status.

Abstract BACKGROUND: Online learning (OLL) methodology has been incorporated in higher education
extensively on the mount over the last few decades and with the onset of COVID‑19 situation, the
virtual method in academia became essential. After observing worldly destructions and death due
to coronavirus, the WHO declared a high alert emergency, and since Pakistan started to follow
lockdown since March 2020 to prevent high penetration and consequently, the online teaching method
was adapted to keep the learning atmosphere alive. The study is aimed to identify the influencing
factors and compliance for the implementation of the OLL system in COVID‑19 and, in the future,
nonpandemic state as well.
MATERIALS AND METHODS: The present study is designed to observe the adaptability and hurdles
among pharmacy students, and for the purpose of the study, a questionnaire on the Likert scale was
developed and asked to respond from pharmacy undergraduate and postgraduate students after
taking consensus, which further analyzed through IBM SPSS Statistics Version 26.
RESULTS: The outcomes of the study were analyzed with a high level of conformity; however, the
gender‑based reservations were observed, and moreover, merits of OLL were observed with high
jeopardy.
CONCLUSION: The adaptation of OLL, though proved as the only troubleshooter in an uncontrollable
situation and enabled universities, professors, and students for patience, resilience, and hopefully,
will serve as swift safeguard for future challenges of epidemic and pandemic disasters. According
to the evolution theory, brain adaptability and plasticity of human organisms grow the capacity to
adjust itself with an advanced characteristic.

Abstract BACKGROUND: Online self‑assessment tools have become an important asset among current
teaching, learning, and assessment methods, especially among medical students. Developments
in information technology and recent changes in methods of undergraduate learning, especially with
the current COVID‑19 pandemic situation, will provide an impetus among students to uptake this
assessment tool. The study is aimed at bringing out the perception of medical students in using an
online self‑assessment tool in Biochemistry on the topics “Liver Function Tests” and “Renal Function
Tests.”
MATERIALS AND METHODS: This study was an observational study conducted among 150 1st year medical students employing an online self‑assessment tool in Biochemistry, and the perception
response toward the questionnaire was graded.
RESULTS: The participation was 100%, with the perception questionnaire having a good internal
validity (α = 0.847). The students’ response was maximum for questions 9 and 10, which favored
for provision of instantaneous feedback and application of the same tool for other topics. A positive
correlation was observed between questionnaires for perceived learning and perceived engagement
using the online self‑assessment tool (r ± 0.554, P = 0.001).
CONCLUSION: Self‑assessment tools have an impact on the learning of students only when provided
in a suitable environment such as immediate feedback and nonranking mechanisms.

Abstract BACKGROUND: COVID‑19 has a great impact on medical sciences education. Some researches
have been conducted on the effects of the COVID‑19 pandemic on medical sciences education
in the world. The aim of this study was to identify the effects of this disease on medical sciences
education in Iran.
MATERIALS AND METHODS: This futures study research was carried out using the future wheel
method in Iran’s University of Medical Sciences in the spring of 2020. A semi‑structured interview
was also conducted on the vice chancellors of medical sciences universities, faculty presidents,
faculty vice chancellors, faculty members, medical education specialists, and university students,
who were purposefully identified. The interview continued until achieving data saturation. Analysis
of the interviews was performed by MAXQDA version 10 software.
RESULTS: The effects were presented at three levels including primary effects, secondary effects,
and third effects. In addition, 16 primary effects, 51 secondary effects, and 24 tertiary effects were
recognized. One primary effect of the coronavirus (COVID‑19) pandemic on medical sciences
education in Iran was fear, stress, and anxiety among students and faculty members as well as
staffs to get the disease. In addition, rumor was circulated concerning the infection of some people,
thus, there was a need for holding courses regarding stress management and rumor management.
One secondary effect of the coronavirus (COVID‑19) pandemic on medical sciences education in
Iran was allocation of a number of educational hospitals to the referral hospitals of COVID‑19. One
tertiary effect of the coronavirus (COVID‑19) pandemic on medical sciences education in Iran was
increasing the number of virtual courses.
CONCLUSIONS: The most important effect of this disease on medical sciences education is the
postponement of practical and apprenticeship classes, and consequently the increased length of the
academic term that leads to delay in the students’ graduation, which can reduce the workforce. On
the one hand, this disease causes death of a number of students, educational and medical staffs,
and faculty members, as well as reduces the workforce. Also, lengthening the recruitment of faculty
members will add to this challenge. In this regard, there is a need to plan to compensate for the
shortage of required human resources.

Abstract BACKGROUND: Reproductive motivation is a complex issue that has cultural, behavioral, and
ideological roots and changes in the context of population transfer and economic and social
development. Reproductive motivations include positive and negative motivations that can be
influenced by education. Training can be done in different ways. It seems that face‑to‑face training
increases learning. On the other hand, face‑to‑face training increases participants’ cooperation and
desire for educational topics. Therefore, the aim of this study was to compare and determine the
effect of two counseling methods on the fertility motivation of infertile couples.
MATERIALS AND METHODS : This intervention study was performed on 68 men and women
with infertility referring to Milad Infertility Center in Mashhad in 2016–2017. Subjects were randomly
assigned to two methods of counseling. Participants completed written consent to participate in
the study. Infertile couples were included in the study if they met the inclusion criteria. The fertility
motivation questionnaire was completed by the participants at the beginning of the study before
the consultation and 2 weeks after the consultation. The collected data were analyzed by SPSS
Software Version 16.
RESULTS: According to the independent t‑test, there was no statistically significant difference
between the mean scores of positive fertility motivation in the two groups of face‑to‑face and telephone
counseling before the intervention. Independent t‑test showed that 2 weeks after the intervention,
there was no significant difference between the two groups in terms of this variable (P = 0.283). There
was no statistically significant difference between the mean scores of positive fertility motivation in the
face‑to‑face counseling group before and after the intervention. Further, in the telephone counseling
group, there was no significant difference between the mean scores of positive fertility motivation
in the two stages before and after the intervention. According to the independent t‑test, there was a
statistically significant difference between the mean scores of negative fertility motivation in the two
groups of face‑to‑face and telephone counseling before the intervention (P = 0.025). However, this
test showed that there was no significant difference between the two groups in terms of this variable
2 weeks after the intervention.
CONCLUSION: The results of this study showed that face‑to‑face and telephone counseling did not
have a significant effect on fertility motivations of infertile couples. In other words, the mean scores
of positive and negative fertility motivations before and after counseling remained unchanged in both
groups and the two groups did not differ in this regard. In other words, the issue of fertility motivation
in infertile women can be affected by different characteristics such as social, family, cultural, and
economic conditions of individuals. If infertile people do not make having a child a necessity in their
lives and cope with it more easily, no counseling can change their motivation. On the other hand,
if infertile women consider having a child as an essential part of their married life and the health of
their married life, counseling can have the greatest effect on them.

Abstract Population aging has increased the need for long‑term care of older persons who suffer from
multi‑morbidity and chronic conditions. Today, the majority of older people are living alone in their
home in which they try to cope with highly risky conditions such as sensory impairment, diminished
mobility, and medication management. Recent developments in information technologies could
improve the access to care for older people as well as reducing the need for full‑time caregivers
both in homes and institutions such as nursery homes and hospitals. This study aimed to review
the economic evaluation of such technological advancements in the care of older people. Through
a systematic approach, electronic databases were searched and of 2732 records retrieved, three
papers were included in the final review. Three different models of economic evaluation including
cost analysis, cost–benefit analysis and cost‑effectiveness analysis were applied in these studies
in the context of telemedicine and older persons’ care. Since the methodological approaches were
quite different and the outcomes reported were not consistent between studies, no meta‑analysis
was applicable and we qualitatively reviewed the papers. All studies have reported cost savings
associated with the use of telemedicine technologies such as video visits and smart homes in the
care of older persons.

Abstract BACKGROUND: There is abundant documentation in literature that presence of maternal periodontal
infections has been attributed to serious health problem to the mother and the child. Regular evaluation
of any illness burden is required for planning preventive and treatment strategies and fills the existing
health gap. There is a lack of literature about the predictors and prevalence of periodontal diseases
in expectant women in the slum areas of Patna.
MATERIALS AND METHODS: It was a cross‑sectional study conducted on pregnant women of
slum areas of Patna, Bihar, by convenience sampling method. Using a questionnaire, data collection
was carried for demographic and oral hygiene habits information. Periodontal examination was
done using modified community periodontal index criteria (WHO, 2013) by recording bleeding on
probing (BoP),   periodontal pockets (PD) and loss of attachment (LoA). The prevalence of potential
predictors was estimated and bivariate analysis was performed with BoP, PD, and LoA and then to
explore the prevalence of odds ratio (ORs) multivariate logistic regression framework was employed.
The level of significance was kept at P < 0.05.
RESULTS: A higher level of BoP and PD was observed among women who had the habit of
cleaning their teeth once daily a day than those who cleaned their teeth with brush twice a day. Oral
cleanliness (hygiene) frequency established the maximum OR of 2.77 (2.07–3.71) for BoP. Gingival
bleeding robustly was related with PD. Among all multivariate framework of predictors of LoA, BoP,
and PD came as the firmest predictors.
CONCLUSION: Teaching correctly how to maintain oral hygiene and periodic periodontal check‑up
can improvise the general well‑being and adverse pregnancy outcomes can be lessened.

Abstract BACKGROUND: Short‑term academic procrastination may be accompanied by negative outcomes
such as anxiety, stress, and depression. The current study aims to evaluate the two parameters of
procrastination and test anxiety in physiotherapy students and explore whether a relationship exists
between them.
MATERIALS AND METHODS: A descriptive, cross‑sectional survey with a prospective study design
was carried out over a period of 6 months. The study used a two‑staged cluster sampling method:
220 undergraduate and postgraduate physiotherapy students from colleges in Mumbai and Navi
Mumbai participated in the study, ensuring participation of students from each year of the course.
The Westside Test Anxiety Scale was administered to evaluate test anxiety, and the Academic
Procrastination Scale was used to evaluate procrastination. To illustrate the basic demographics
of the participants, descriptive statistics were used. A correlation matrix was used to analyze the
correlation between the two parameters.
RESULTS: The mean procrastination score of the physiotherapy students was 74.1. Amongst
undergraduates, the highest procrastination was seen in the 3rd Bachelor of Physiotherapy
students (mean = 76.7), whereas among postgraduates, the highest procrastination was seen in
Master of Physiotherapy 1 students (mean = 75.7). The mean test anxiety score was 3, indicating
moderately high test anxiety among students. There was a statistically significant, positive correlation
between test anxiety score and procrastination score (P value = 0.000, Pearson’s correlation
co‑efficient = 0.383).
CONCLUSION: Both test anxiety and the tendency to procrastinate were present among
undergraduate and postgraduate physiotherapy students, in varying degrees. There was a positive
correlation between the two factors.

Abstract BACKGROUND: Pregnant women are classified as one of the vulnerable groups. Physiological and
psychological changes during pregnancy predispose them to serious psychiatric disorders; if not
identified and treated in time, it can have a negative and long‑term impact on mental health. The aim
of this study was to determine the effect of cognitive–behavioral counseling of pregnant women with
the presence of a spouse on the level of stress, anxiety, and postpartum depression.
MATERIALS AND METHODS: The present study is a clinical trial that was performed on 40 pregnant
women with a gestational age of 32–28 weeks (20 in the intervention group, 20 in the control group)
who were randomly assigned to the intervention group and the control group according to the inclusion
criteria. Cognitive–behavioral group counseling in the presence of spouses was performed by the
midwife and under the supervision of a psychologist, in eight sessions, each session lasting 90 min,
once a week for the intervention group. The control group received routine care and a counseling
session. Data collection tools were demographic information questionnaire and Depression–Anxiety–
Stress Scale 21, which were completed before the intervention, immediately after the intervention,
and on the 14th day after delivery in both groups. Data analysis was performed using statistical tests,
independent t‑test, repeated measures test, Bonferroni post hoc test, and Kolmogorov–Smirnov test.
RESULTS: The results of this study showed that the mean scores of stress, anxiety, and depression
in the two groups in the preintervention stage were not significantly different (P < 0.05), but in the
postintervention stage and follow‑up, the mean scores of stress (P < 0.001), depression (P = 0.010),
and anxiety (P = 0.029) in the intervention group were significantly reduced compared to the control
group.
CONCLUSION: According to the research findings, cognitive–behavioral group counseling can be
effective as an approach in improving the symptoms of stress, anxiety, and depression in pregnant
women. Therefore, it is necessary to plan properly to use this counseling approach to manage stress,
anxiety, and depression in women during pregnancy.

Abstract BACKGROUND: Support services are a very important element for all educational institutions. The
aims of this study were to explore the components of the student support system in blended learning
for universities of medical sciences in Iran.
MATERIALS AND METHODS: The present study was performed qualitative with exploratory
approach. The tool used to collect data was a semi‑structured interview, after conducting interviews
with 17 e-learning experts and specialists of universities of medical sciences, we reached information
saturation. The study was conducted at Aja University of Medical Sciences in Tehran in 2020. Data
analysis was performed as Thematic Content Analysis by Attride‑Stirling method.
RESULTS: From the content analysis of the interviews, 6 main themes and 19 sub‑themes were
obtained. Main themes included “Scientific- cognitive Support”, “Systematic Support”, “Human
Resource Support”, “Emotional Support”, “Technical Support” and “Financial- economic Support”.
CONCLUSION: Based on the results of this study, 6 basic components and its subcomponents of
the student support system were obtained. It is suggested that the educational officials of medical
universities with blended learning use the results of this study in setting up their student support
system for academic success in e‑learning and medical students.

Abstract BACKGROUND: Substance use relapse after treatment is one of the most important aspects of
addiction. The present study aimed to investigate the factors affecting the substance use relapse
among Iranian addicts.
MATERIALS AND METHODS: This cross‑sectional study was conducted in 2019 on 396 addicts
referring to the addiction treatment centers in Hamadan, who were selected using a cluster random
sampling method. The data were collected by a two‑section questionnaire (demographic variables
and risk factors for substance abuse recurrence). The collected data were analyzed using descriptive
statistics and logistic regression analysis.
RESULTS: The participants’ mean (standard deviation) age was 36.56 (8.8) years, and 84.6%
of the participants had a history of relapse. The logistic regression analysis revealed that
marital status (odds ratio [OR] = 2.594; 95% confidence interval [CI]: 1.472–4.570), personal
willingness (OR = 8.186; 95% CI: 1.875–35.738), pleasure (OR = 2.738; 95% CI: 1.122–6.679), drug
availability (OR = 3.392; 95% CI: 1.023–11.247), family disputes (OR = 4.583; 95% CI: 1.345–15.609),
an addicted friend (OR = 2.693; 95% CI: 1.014–7.157), and close addicted relatives (OR = 3.513;95%
CI: 1.193–10.348) were the main predictors of addiction relapse (P < 0.05).
CONCLUSION: The present study confirmed the effect of several factors (namely demographic,
individual, interpersonal, environmental, and behavioral) on the substance use relapse. Accordingly,
designing and implementing some interventions based on the findings of the present study may
contribute to preventing substance use relapse.

Abstract BACKGROUND: With the emerging knowledge and understanding of novel coronavirus infection,
dentists must be capable of resuming their practice with necessary precautions in near future; hence,
the aim of the present study was to evaluate the knowledge, attitude, and practices along with felt
challenges by the dentists concerning practicing dentistry during pandemic in India.
MATERIALS AND METHODS: An online cross‑sectional questionnaire study was conducted on
the dental practitioners of Uttarakhand, India. The dentists were approached by obtaining their
E‑mail address from the heads of dental institutions or dental association branches in the state. The
knowledge, attitude, and practices along with apparent challenges of practicing during pandemic
were assessed using closed‑ended questionnaire. The relationship between the mean scores and
demographic variables was determined using Student’s unpaired t‑test by keeping the significance
level below 0.05.
RESULTS: Out of 759 respondents, a total of 458 respondents were male (60%), whereas 301 (40%)
were female. The mean knowledge scores were higher in females (11.06 ± 2.12) compared to
males (9.72 ± 4.53), which was statistically significant (P < 0.05). The mean practice score was lower
in males (17.49 ± 6.47) compared to females (19.26 ± 6.69) and likewise lower scores were seen in
graduates compared to specialists and these differences were again statistically significant (P < 0.05).
Majority of the study participants felt that following various safety guidelines were not feasible (96.97%)
and too expensive (96.44%) and considered them as a challenge.
CONCLUSION: It is imperative that dentists should be fully prepared before resuming their services
and reach the right kind of awareness to limit the spread of the disease.

Abstract The biotechnology revolution and the emergence of new ways to change the genetic material of an
organism have led to an increased risk of biological wars. Coping strategies against these threats
is very important to improve the health of people. Therefore, due to the importance of this issue,
this study is aimed to review the scope of using biotechnology and genetic engineering in wars and
coping strategies in all over the world. In this review study, database includes of PubMed, Web of
Science, Google Scholar, Scopus, and Science Direct were searched. The search was limited to
reviewed articles in English published between 1990 and 2020. The primary search results generated
148 relevant references. After eliminating the duplicates and articles which were not related to
the review of the abstract, 11 references were identified for inclusion in this review. Based on the
results of these studies, the advances in genetic engineering can lead to the development of new
weapons for other types of conflict and war scenarios, secret operations, and sabotage activities.
Rapid developments in biotechnology and genetics have created environmental, ethical, political,
and social challenges for many communities. Increasing awareness and sensitivity, monitoring, and
building capacity for effective coping are essential. Biotechnology areas that will probably significantly
contribute to countering biological weapons include recognizing the human genome, strengthening
the immune system, identifying bacteria and viruses’ genome, equipment for biological identification,
new vaccines, new antibiotics, and anti‑viral drugs must be monitored.

Abstract BACKGROUND: Responsibility of individuals in adapting to life events depends on the intertwined
cooperation of intellectual and emotional capacities, and a person’s success in life depends on his
emotional responses. Given that health‑care providers are at the forefront of providing health services,
they need to improve their job performance with better control of their emotions and better social
relationships. The aim of this study was to determine the relationship between emotional intelligence,
social responsibility, and job performance in health‑care providers and caregivers.
MATERIALS AND METHODS: A cross‑sectional correlational study was performed on 270 health
workers working in the western cities of Isfahan province in the first quarter of 1998 by random
classification sampling method. To collect information, two questionnaires of Bradbury emotional
intelligence, responsibility, social responsibility, whose validity and reliability had been proven in
previous studies, and job performance scores of the samples were used. The collected data were
analyzed using descriptive tests and Pearson correlation.
RESULTS: The participants were 270 health workers and caregivers with a mean age of 34.54 ± 7.26.
87.5% of the samples were female and 21.5% were male. The mean score of social responsibility
was 124.95 ± 10.41, the mean score of emotional intelligence was 125.58 ± 15.86, and the mean
score of job performance was 86.91 ± 9.0.18. The results of Pearson correlation showed that all four
components of social responsibility and total emotional intelligence have a significant correlation at
the level of 0.01. Total emotional intelligence and each of its components did not show a significant
correlation with job performance. Between social responsibility and job performance of health workers,
only the moral component significantly predicts job performance (r = 0.133 and P = 0.026).
CONCLUSION: Although the results of the study showed that the job performance, social
responsibility, and emotional intelligence of the study group were desirable, the score of some
components of social responsibility and emotional intelligence is lower than their maximum score.
In addition, according to the results of the study that showed the relationship between emotional
intelligence and social responsibility and some of their components with job performance, improving
the knowledge and skills of health‑care providers and caregivers in the field of social responsibility
and emotional intelligence and their components seems necessary.

Abstract BACKGROUND: COVID‑19 is a serious and costly problem for communities. Observing health
issues and performing preventive behaviors is influenced by their knowledge and skills of people
toward COVID‑19. Hence, this study investigated the knowledge, skill, and practice of the public of
Shahrekord toward COVID‑19.
MATERIALS AND METHOD: The present study was performed as a cross sectional. Data were
collected using an online questionnaire from 540 Shahrekord residents who were selected via
convenience sampling in 2020. Knowledge, skill, and practice toward COVID‑19 were assessed
using a prevalidated questionnaire. Collected data were analyzed by SPSS‑21 software (one‑way
analysis of variance, Pearson test, and regression test).
RESULTS: In this study, 39.1% were male, and 60.9% were female and 46.3% were 20–25 years.
The mean score of knowledge, skill, and preventive behaviors was 75.69 ± 17.85, 53.87 ± 27.40,
and 59.97 ± 23.79, respectively. There was a significant direct relationship between knowledge
and skill (P = 0.05 and r = 081) so that public with more knowledge had a better skill as well.
There was a significant association between age (P = 0.036), education level (P = 0.019) , and
job (P = 0.014) with knowledge. In addition, a significant association between job (P = 0.027) and
marital status (P = 0.014) with skill was observed. Knowledge, skill, and demographic variables
predict 37.6% preventive behavior.
CONCLUSION: The majority of the participants had good knowledge, moderate skill, and relatively
enough practice. Government and policymakers must consider these knowledge levels, skill, and
practices to implement productive interventions for preventing the COVID‑19.

Abstract BACKGROUND: Preterm birth (PTB) is one of the most important factors that increase the risk of
chronic diseases and postpartum death in infants. The aim of this study was to determine the maternal
factors that affect the birth of preterm infants in the city of Bandar Abbas.
MATERIALS AND METHODS: This is a case–control study that was performed on 400 preterm
infants. Sampling was done by a simple method, and information was gathered by interviewing the
mothers and their medical records. Data were collected by SPSS software version 16. To compare
risk factors in the two groups, conditional logistic regression was used, and P < 0.05 was considered
statistically significant.
RESULTS: Results showed that factors such as type of delivery (odds ratio [OR] = 3.584, 95%
confidence interval [CI]: 1.981–6.485), preeclampsia (OR = 2.688, 95% CI: 1.164–6.207), history
of PTB (OR = 4.171, 95% CI: 1.483–11.728), premature rupture of membranes (OR = 3.273,
95% CI: 1.745–6.137), care during prenatal (OR = 0.334, 95% CI: 0.159–0.701), placental
abruption (OR = 3.209, 95% CI: 1.209–8.519), placenta previa (OR = 9.333, 95% CI: 2.086–41.770),
and cervical insufficiency (OR = 11, 95% CI: 1.381–87.641) were independent risk factors of preterm
infant birth.
CONCLUSIONS: The PTB risk is higher for women with cervical insufficiency, history of placenta
previa, and history of preterm. Early recognition and management of these high‑risk conditions among
pregnant women may lead to a reduction in PTB rates.

Abstract BACKGROUND: The current corona virus disease 2019 (COVID‑19) pandemic has led to the
disruption of academic activities including medical education which has made online learning only
available options for continuing education worldwide. Online learning has its own limitations, which
are further amplified if not implemented properly. Hence, there is a need to assess various barriers
faced in the implementation of effective online learning.
OBJECTIVES: The objective of the study was to identify the barriers and motivators in online learning
among medical undergraduates.
SUBJECTS AND METHODS: This internet‑based cross‑sectional study was conducted among
medical undergraduates of Punjab. The data collection tool was a semi‑structured self‑made
questionnaire prepared using “Google Forms,” which was then circulated in the WhatsApp groups
of the students. Received responses were imported to the Microsoft Excel sheet and statistical
analysis was done.
RESULTS: Out of the 592 participants, 533 (90%) faced some kind of problem in online learning.
Major among them were lack of personal interaction with teachers (52%), distractions at home (43.6%),
technology failure (43.2%), limited access to the Internet (39.2%), visual fatigue (38.5%), and
increased workload (25%). Benefits perceived were the comfortable environment of home (41%), easy
accessibility of recorded lectures (36.8%), and the opportunity to keep in touch with studies (35%).
CONCLUSIONS: The online learning process is not a replacement for routine classroom teaching
and clinical postings in medical education. However, it can supplement routine teaching, especially
during current COVID‑19 pandemic‑like situations. Most of the students (90%) were facing some
kind of difficulty in the online learning process due to unplanned and sudden shifts. Therefore, it is
necessary to identify and eliminate the various barriers to make online learning effective.