Journal of Education and Health Promotion

Abstract BACKGROUND: Given the expanding range of health influencing factors, increasing expectations from
the health systems, and general challenges such as insufficient resources, the health services needed
by people cannot be provided completely by the governments alone. Therefore, nongovernmental
organizations (NGOs)‑government collaboration is considered a common approach in health‑care
provision for different communities. Since the NGO‑government collaboration is complicated and
usually influenced by many challenges and issues, the present study was conducted to identify
collaboration challenges between the government and NGOs in providing health‑care services.
MATERIALS AND METHODS: Using a systematic review method and searching in ISI Web of
Science, Scopus, PubMed, and Embase databases, using related keyword/terms, between March
2020 and June 2020, studies on NGO‑government collaboration in the health area were collected
without time limitation. After completing the article selection process, those articles that consistent
with the research purpose were chosen for the final analysis.
RESULTS: From 4236 initially collected studies, 16 studies were chosen for the final analysis. Based
on the content analysis of the selected articles, 70 challenges were identified in the NGO‑government
collaboration to provide health‑care services. These challenges were divided into five main themes:
structural issues, process issues, issues related to roles and responsibilities, trust and communications
issues, and control and power relation issues and 11 subthemes.
CONCLUSION: The present study provides significant challenges by NGO‑government collaboration
in providing health‑care services. Awareness of these challenges plays an important role in promoting
such collaborations and enables these organizations to highly exploit the strengths of each other,
resulting in a collaboration with win–win situation.

Abstract BACKGROUND: Among the COVID crisis, medical education is forced to shift to the virtual mode, for
which neither the students nor the teachers are prepared. Currently, we replaced traditional classroom
teaching (CT) by live online classes (LOC), power‑point presentations with voiceovers (UPV), or only
power point presentations (UP). Uncertainty of this situation necessitates analysis of the experiences
of its stakeholders to improve the implemented online teaching methodologies in coming time. The
present study aims to analyze and compare the effectiveness of online teaching methodologies
among themselves and against traditional CT.
MATERIALS AND METHODS: A cross‑sectional, survey based, observational study was conducted
on 250 MBBS first year students after 1 month of implementation of online teaching program.
Responses were collected on Likert scaling from 1 to 5, and data were analyzed using the Kruskal–
Wallis H‑test, ANOVA with multiple comparisons post hoc Turkey test, and an independent t‑test.
RESULTS: The students perceived that the understanding, convenience for attending class,
notes‑taking, visibility, audibility, raising queries and overall experience was best in traditional setup.
The understanding of the topic and overall experience of the students was not affected by gender.
Internet connectivity problem popped up as the major issue that adversely affected the online
teaching experience.
CONCLUSIONS: Majority of students perceived that the traditional CT is best, but at the same time,
they felt that a combination of live online classes and power point presentations with voice over can
replace the traditional online classes.

Abstract BACKGROUND: Informal settlements are considered as one of the social problems in societies. As
the residents do not have adequate access to basic services, including health services, their health
is at risk. This study was conducted to evaluate the access to health services and determine the
health needs of informal settlements in Bam city.
MATERIALS AND METHODS: This cross‑sectional study was carried out in the spring of 2020 in
Bam. The sample size was 400 residents of informal settlements in Bam, and the multi‑stage random
cluster sampling was used. A researcher‑made questionnaire was used to collect the required
data. The validity of the questionnaire was confirmed using the content validity, and its reliability
was 85% by Cronbach’s alpha. The data were analyzed using the SPSS version 23 software and
descriptive statistics (frequency, mean, standard deviation, and percentage) as well as analytical
statistics (Mann–Whitney and Kruskal–Wallis tests).
RESULTS: More than 50% of the individuals had good access to general practitioners and health
centers. However, over 50% had poor access to dental, para‑clinical, specialist, and hospital services.
Furthermore, 49.3% of the people assessed their health status as poor in the previous year. A total
of 46 items in the areas of communicable and non‑communicable diseases, women’s health, mental
and social health and addiction, environmental health, etc., were identified as the most important
health needs of the informal settlement residents.
CONCLUSION: Informal settlements are facing various health problems including environmental
health, mental and social health, and addiction, meeting which requires collaboration of all
stakeholders as well as provision of a comprehensive program and appropriate service packages.

Abstract BACKGROUND: The phenomenon of Internet addiction has increased due to the delay between
Internet technology and the culture of using it. According to the high prevalence of Internet addiction
among students and its associated complications, the present study was conducted to determine
the effect of education based on the health belief model on Internet addiction status among students
in Tehran, Iran.
MATERIALS AND METHODS: In this interventional study, two dormitories were divided into two
groups of control and intervention in a completely random manner using the random cluster sampling
method from a total of eight dormitories. Then 134 girls in each group answer two questionnaires of
Young (about Internet addiction) and health belief model‑based scale. After the need assessments
of the primary results, intervention was performed in the experimental group in a way that a textbook
based on the health belief model and ten educational text messages were sent to the students’ E‑mail.
Two months later, questionnaires were again given to both groups. The results were analyzed with
the help of independent t‑test, Chi‑square test, Fisher’s exact test, Mann–Whitney test, analysis of
covariance, and logistic regression with repetitive measures with GEE approach.
RESULTS: The average scores of knowledge (P < 0.001), perceived susceptibility (P < 0.001),
perceived severity (P = 0.006), perceived barriers (P  <  0.001), and self‑efficacy  (P = 0.002)
between the two groups, had a significant difference after the intervention. The average scores of
perceived benefits (P = 0.6), Internet addiction behavior (P = 0.11), and the frequency of Internet
addiction (P = 0.63) after intervention did not have a significant difference in the two groups.
CONCLUSIONS: The results of this study show the effectiveness of educational intervention design
based on the structures of health belief model on reducing the frequency of Internet addiction and
adopting preventive behaviors.

Abstract BACKGROUND: This research is one of the very few studies, which seeks a focalized examination
to observe the effects of the backpack on the teenager students. Adolescents prefer rucksacks as
one of their favorite school bags during their school studies. This study inspects how knapsacks
gradually bring changes as injuries in the bodies of school‑going adolescents. There are ample
studies in the past literature, which evidence the injuries of backpack among adolescents, such as
backache, neck pain, and shoulder pain. The principal objective of this study is to determine the
effects of backpacks on musculoskeletal injuries among school‑going adolescents based on previous
studies support in this research field.
MATERIALS AND METHODS: This review study selected observational studies from the past
literature indexed in the databases of Scopus, PubMed, ScienceDirect, and CINAHL during 1999–
2020. This review focused on the keywords of “Backpack,” “Musculoskeletal Injuries,” and “Adolescent”
from MESH and selected 14 out of 210 articles based on the research objective. According to the
Crombie Checklist, inclusion and exclusion criteria, and investigating the quality of the report, this
review focused on literature evidence to the field under investigation.
RESULTS: Based on the chosen 14 articles, the findings of the present review indicated two
outcomes by considering the impact of the backpack on musculoskeletal injuries and pains among
adolescents. The results of the review studies specified that there was a statistically significant
positive relationship between the prevalence of musculoskeletal injuries and pain using a backpack
among most of the male and female adolescents. The findings also stipulate that injuries and pain
intensity among female adolescents were higher than the male students.
CONCLUSION: The results of this review study specified that improper use of the backpack,
which exceeded the standard weight, caused chorionic pain and injuries between both genders of
adolescents. The generalizability of the results is suitable for this review study.

Abstract BACKGROUND: Adopting healthy behaviors can lead to better outcomes which can deeply impact
cardiovascular diseases (CVDs) development; consequently, tailoring appropriate theory‑based
interventions may improve various outcomes among patients at CV risks. This study aimed to assess
published researches on the application of health education and promotion of intrapersonal and
interpersonal theories/models’ interventions on patients with CVD.
MATERIALS AND METHODS: In this systematic review, PubMed, Web of Science, Google Scholar,
Scopus, Science Direct, and SID, Magiran databases for English and Persian studies were searched
using relevant keywords, respectively. We searched for interventional studies published with no time
limits until the end of 2020 assessing the application of health education and promotion theories/models
interventions on adult patients with CVDs. Two reviewers individually reviewed abstracts/full‑text
articles to assess inclusion according to predefined criteria. In case of discrepancy between the two
researchers, a third expert was requested to assess papers, and final selection decision was made
based on the agreement among the three evaluators. This systematic review was conducted using
the following data extraction steps and assessing the quality of the studies and results.
RESULTS: From 60 articles, 35 studies met inclusion criteria. Most interventions improved at least
some educational including models constructs (20%), clinical (14.2%), and practical (88.5%) outcome
related to CVDs. It is noted that attention to educational, practical, and clinical outcomes was focused
in published papers, respectively. Furthermore, based on the study categorization using models,
some CVDs and theories/models were more concerned compared to others.
CONCLUSIONS: Health education and promotion theory‑based interventions on patients with CVD
appeared beneficial in the most published paper.

Abstract BACKGROUND: Increasing community awareness about the transmission and treatment of
COVID‑19 will stop the spread of the virus. Pharmacy students are the potential facilitator to give
community education about COVID‑19 treatment. The objective of this study is to evaluate the
pharmacy students’ knowledge of COVID‑19 treatment, behavior, and attitude of providing the
information about COVID‑19 treatment.
MATERIALS AND METHODS: We conducted cross‑sectional study, recruiting 429 pharmacy
students from three schools of pharmacy in Indonesia. The questionnaire about the knowledge of
COVID‑19 treatment, behavior, and attitude of providing the information on COVID‑19 treatment met
the validity and reliability criteria. We defined the proportion of knowledge, behavior, and attitude of
the students using SPSS® version 22.
RESULTS: Most of the students are in the earlier years (46.63%), female (84.15%), find the information
about COVID‑19 from many sources of media (85.08%) including scientific articles and know
information about COVID‑19 transmission around their life area (76.46%). The students’ knowledge
about antiviral and plasma convalescent is good (>70%), the positive behaviors are related to the
COVID‑19 treatment information regarding to the antiviral and the provision of Vitamin C (>50%), and
the positive attitude are related to giving information about the use of avigan®, plasma convalescent,
chloroquine, hydroxychloroquine, and immunomodulator (>50%).
CONCLUSIONS: As a future pharmacist, the knowledge of pharmacy students about COVID‑19
treatment needs to be improved since earlier years. Furthermore, using the good knowledge about
COVID‑19 treatment, the positive behavior and attitude of providing information of the students, the
community behavior and attitude will be improved. The high year students have a tendency for the
good knowledge and positive behavior and attitude of providing the information.

Abstract Pharmacies are a major component of health systems and a major part of health service
provision. This study aimed at identifying and introducing the potentials of pharmacies
in health promotion. This was a systematic review that searched PubMed, Web of Science,
Science Direct, SID, Magiran, and IranMedex from February 1990 to September 2018 for
related materials. The main search keywords were (pharmacy services), (community
pharmacy services), (retail pharmacy services), (pharmacy practice intervention). Inclusion
was limited to those papers that discussed the health‑promoting services provided in
the pharmacies. The quality of included papers was assessed by the Critical Appraisal
Skills Program checklists. The Preferred Reporting Items for Systematic Reviews and
Meta‑Analyses chart was followed in all stages of the study. Of the 4156 papers retrieved,
18 met the inclusion criteria and included in the analysis. Study findings were categorized
into three main categories: Health and prevention services, services related to treatments,
and the awareness about the pharmacies’ functions. The health and prevention category
consisted of education, vaccination, screening and prevention of diseases, family planning,
blood pressure monitoring, quitting smoking, limiting alcohol, and weight management. The
treatment‑related services consisted of adherence to medication, medication consultation,
minor pains, and emergency medical services. Pharmacies can provide a wide variety of
services besides the medications. Purposeful development of the services provided in the
pharmacies and involving them in an extended array of services may accelerate the health
promotion activities of the health system and result in improved quality of life and decreased
costs. To do so, the legal, educational‑skill, and pricing challenges should be resolved.

Abstract BACKGROUND: Urinary tract infection is a common infection in women during pregnancy, leading to
many complications for both mother and fetus if untreated. The present study aimed to investigate the
predictability of constructs of the theory of planned behavior (TPB) in adopting urinary tract infection
prevention behaviors in pregnant women.
MATERIALS AND METHODS: In the present cross‑sectional study, we selected 100 pregnant
women who visited the comprehensive health service centers of Zarrinshahr using convenience
sampling from July to September 2019. We collected data by a questionnaire designed based on
the constructs of the TPB and analyzed data using SPSS 20 and linear regression test and Pearson
correlation coefficient. A significant level was considered as α < 0.05.
RESULTS: In the study, the Pearson correlation coefficient showed direct relationships between the
score of behavior and the scores of knowledge (P = 0.005), attitude (P = 0.02), perceived behavioral
control (P < 0.001), and behavioral intention (P = 0.001). Linear regression analysis indicated that
among the above variables, the perceived behavioral control, knowledge, and behavioral intention
were significant predictors of scores of urinary tract infection prevention behaviors, respectively, in
terms of their importance.
CONCLUSION: In this study, perceived behavioral control is detected as the main predictor of
doing urinary tract infection prevention behaviors in pregnant women and should be considered in
designing educational interventions.

Abstract BACKGROUND: In the wake of the novel coronavirus pandemic, the closure of educational institutions
has imposed a situation of potential gap in learning. Since training of medical and paramedical
students is vital in creation of our army of these frontline health‑care workers, this study was aimed
at comparing the asynchronous and synchronous methods of online teaching for imparting training
to students of medical laboratory technology (MLT).
MATERIALS AND METHODS: This cross‑sectional study included 33 students of the 1st‑year batch
of MLT course at a tertiary level hospital. Ten lectures each from the subject of biomedical statistics
were delivered through asynchronous (lecture shared on WhatsApp group) and synchronous (online
live lecture) methods followed by a brief examination for each topic. A short survey was designed to
assess the students’ perception of clarity of concepts, confidence of solving the examination, and
their preference for one of these methods. Appropriate statistical tests were applied to the data.
RESULTS: Synchronous method of online teaching was preferred by majority of the
students (P < 0.001). Students’ clarity in understanding of the concepts (P < 0.001) and confidence
of the ability to solve examination questions (P < 0.05) was higher after synchronous teaching. The
examination scores after synchronous online teaching were significantly higher (P = 0.0156) than
those for topics covered through asynchronous method.
CONCLUSION: Online teaching, especially the synchronous method, offers an opportunity of
continuum of training during crisis situations such as the ongoing novel coronavirus pandemic. The
wide availability of internet services and the ever‑changing global situation mandates readiness for
this modality of teaching, both for the teachers and the students.

Abstract BACKGROUND: Medical education has special features due to the need various areas of
learning. The present study was conducted to provide a complete picture of the evaluation system
in Iran University of Medical Sciences for improving the evaluation system and medical sciences
examinations.
MATERIALS AND METHODS: The research was cross‑sectional study that conducted through
self‑reporting of educational departments, a comprehensive review of the student evaluation system
in the affiliated faculties of Iran University of Medical Sciences from 2017 to 2018. Educational
members and heads of nine faculties and 80 departments participated in this study. The research
tool was a researcher‑made questionnaire, include two parts: (1) 10 general questions about the
activities of the educational groups regarding the student evaluation system and (2) 20 questions
about the types and quality of examinations.
RESULTS: From 80 questionnaires, 71 were completed by the managers of the departments. The
results showed that 62% of the faculty members in the educational departments in the last 2 years did
not participate in the workshop on the methods of evaluation and making tests. 56% of the faculties
have a reference for continuous monitoring of students’ assessment and evaluation, and in 87% of
the cases, the content is given in accordance with the objectives. The use of logbooks was more
common (28%) than other methods to assess practical skills.
CONCLUSION: Empower faculty members on the use of various tools, strengthening the supervision
of formative evaluation and use of medical education graduates to promote evaluation methods
seems necessary.

Abstract Postpartum weight retention (PPWR) is a factor that causes permanent obesity and subsequent
chronic and noncommunicable diseases. The relationship between depression/stress/anxiety and
PPWR has been studied in some articles, but there is no definitive conclusion in this regard. The
present systematic review was conducted to investigate the relationship between depression/stress/
anxiety and PPWR. An extensive search was performed in the PubMed, Scopus, Embase, Web
of Science, Google Scholar, SID, and Magiran, Irandoc databases using Medical Subject Headings
terms (or their Persian synonyms) from 2000 to 2020. Inclusion and exclusion criteria were used for
articles selection. The quality of the selected articles was assessed using the Newcastle–Ottawa Scale.
Out of 371 reviewed articles, 24 articles were selected. The total sample size was 51,613 (range:
49–37,127). The mean of PPWR ranged from 0.5 kg (standard deviation [SD] = 6.49) to 6.4
kg (SD = 8.5). There was a statistically significant relationship between depression/stress/anxiety
and PPWR in 12 of 23, 4 of 6, and 3 of 8 studies. This review demonstrates the relationship between
depression/stress/anxiety and PPWR. Time of depression/stress/anxiety assessment is an important
issue, as well as different measurement tools. Prevention of the mothers’ psychological problems
through educational and supportive programs may help to limit PPWR.

Abstract BACKGROUND: Incivility has been raised as a growing concern and a hot topic in nursing education.
The aim of this study was to determine the effect of a context‑based educational intervention on the
nursing students’ civility index and their perception of uncivil behaviors.
MATERIALS AND METHODS: This quasi‑experimental study was done from 2019 to 2020 in
Khorramabad, Iran. A context‑based educational intervention focusing on problem‑based scenarios
was conducted for 4 weeks. Clark Civility Index for Students and Classmates (2017) and Clark
Incivility Scale in the University Environment (2014) were used. Data were analyzed using Stata,
descriptive statistics, and paired t‑test.
RESULTS: There was a significant difference between the mean score of students’ civility index
before and after the intervention (8.31 points increase, P = 0.004). However, there was no significant
difference between the mean score of the civility index for classmates before and after the intervention.
Furthermore, the mean score of students’ perception of incivility after the intervention increased by 5.88
points, which confirmed the significant effect of the intervention in improving students’ understanding
of uncivil behaviors (P = 0.018).
CONCLUSIONS: Considering the effectiveness of the problem‑based scenario along with other
strategies such as journal club and self‑learning in increasing the awareness of civility and improving
the civility index, the use of these strategies is recommended in order to reduce incivility.

Abstract BACKGROUND: With the Philippines emerging as the hotspot in the Western Pacific Region for
the COVID‑19 cases, the study aimed to understand the COVID‑19 preventive behavior of Filipinos
using the health belief model (HBM).
MATERIALS AND METHODS: The cross‑sectional study included 304 respondents recruited for
the whole month of July 2020 through various social media platforms. Participants were requested
to answer an online questionnaire, and results were analyzed using SPSS software.
RESULTS: The majority of respondents were female (71.1%), with an average age of 29,
college graduate (57.6%), and living in an area where modified general community quarantine is
implemented (63.2%). Good preventive behavior was noted among the participants, and not shaking
of hands with others and refraining from touching of surfaces were reported as the most practiced
behavior. Spearman’s correlation and Pearson’s Chi‑square showed that age and sex are significant
predictors for the HBM constructs and preventive behavior. Furthermore, results showed that cues to
action, self‑efficacy, and perceived barrier have a significant association with COVID‑19 preventive
behavior.
CONCLUSION: Findings prove that HBM is useful in understanding preventive behaviors in times
of coronavirus pandemic. Strategies that promote a supportive environment and help overcome the
perceived barriers can guide Filipinos to adopt the desired health behavior. Interventions to promote
preventive behaviors should be focused on males and younger individuals.

Abstract Medication errors (MEs) are a critical worldwide concern and can cause genuine clinical ramifications
for patients. Studies concerning such errors have not been undertaken as much in the Middle
Eastern region. The aim of this study was to systematically review and identify studies done in the
Middle Eastern nations to recognize the principle contributory factors included and to estimate the
prevalence in the region. A review of the retrospective, prospective, cohort, and case–control studies
based on MEs in the Middle Eastern nations was directed in January 2020 utilizing the accompanying
databases: Embase, Medline, PubMed, Ebsco, Cochrane, Scopus, and Prospero. The search
methodology incorporated all ages and in English only dating back to 2010. The search methodology
included articles about MEs in the Middle East with errors in people of all ages, articles in English,
and articles dating back to 2010. The Preferred Reporting Items for Systematic Reviews and MetaAnalyses appraisal instrument was used to assess the quality of the included articles. Individual
data extraction, pooled analysis, and the accompanying databases were used for data analysis of
the MEs in eligible studies. Fifteen of the 18 articles reviewed from four Middle Eastern countries
had low risk of bias, while three out of 18 had medium risk of bias. A total of 58,221 reported people
were studied, with a total of 34,730.9 reported MEs. The pooled analysis showed that numbers of
errors were mainly prescribing errors (n = 22,715.25), general prescription errors (n = 8097.16), and
commission errors (n = 158.2). Iran had the highest rate amid the reported administration errors, at
25.07% (599.11/2388.9). Measuring a patient’s clinical laboratory values was another less common
type of prescription ME. Lebanon reported to have the highest monitoring errors, with a rate of 13.13%
(277.91/2117). A negative trend was shown in the amount of MEs in the vast majority of the nations
under the examination. The under-reporting or uncertain information recommended that significan
changes are needed in the healthcare sector. There is solid need of literature on healthcare services
in the region to completely understand and address the MEs and issues.

Abstract BACKGROUND: The best mechanisms for medical librarians to be more involved in health, especially
during crisis condition, and to expand their roles are using experiences of other individuals and
performing new activities. This study aimed to identify the roles of medical librarians in the COVID‑19
crisis in Iran.
MATERIALS AND METHODS: This research was done by a qualitative content analysis method.
Research participants in the first phase included whole scientific papers (19 documents) which had
been published by medical librarians related to the COVID‑19 issue and in the second phase 10
medical librarians involved in the COVID‑19 who were interviewed and continued until data saturation.
Data were collected through each interview, and data analysis was performed using content analysis
method. Then, obtained information of the first and second phases was merged together, and codes,
subcategories as well as main categories were formed.
RESULTS: According to the results, 7 main categories and 24 subcategories regarding the roles
of librarians in COVID‑19 crisis were identified. The main categories include hygiene  services
promotion, development of health information‑seeking skills, health research services, interaction‑level
development, evidence‑based policy development, information dissemination services promotion, and
management services development. Furthermore, regarding barriers to the role of medical librarians
in the COVID‑19 crisis in Iran, four subcategories were identified that are medical librarian‑related
barriers, organization‑related barriers, profession‑related barriers, and context of society (country
conditions)‑related barriers.
CONCLUSION: Medical librarians relatively have been able to provide effective health information
services to managers, health‑care specialists, and the general public in a variety of health fields.

Abstract BACKGROUND: Given the relationship between positivity interventions and psychological problems,
this study aimed to investigate the effect of positive thinking training on stress, anxiety, depression,
and quality of life of hemodialysis patients.
MATERIALS AND METHODS: This is a quasi-experimental and interventional study conducted
on 70 hemodialysis patients referred to Fasa hemodialysis centers, Iran, between April 2019 and
October 2019. Patients were selected using a simple sampling method and randomly divided into
control (n = 35) and intervention (n = 35) groups. The intervention group was trained on positive
thinking skills in eight sessions of a workshop. Before and after the intervention, stress, anxiety,
depression, and quality of life in both the groups were measured using the Depression, Anxiety,
and Stress Scale-21 and Short Form-36 Questionnaire. Data were analyzed using paired t-test,
independent t-test, Kolmogorov–Smirnov, and Chi-square tests.
RESULTS: There was no significant difference in the mean scores of stress, anxiety, depression,
and quality of life in the two groups before the intervention.(P > 0.05), and in the control group, there
was no statistically significant difference before and after the intervention (P = 0.092, P = 0.228,
0.280, respectively). In the intervention group, the mean score of stress and anxiety decreased from
23.65 ± 4.12 to 16.68 ± 4.41 (P < 0.001) and from 17.77 ± 5.15 to 14.57 ± 4.18 (P = 0.002), respectively,
and that of the patients’ quality of life also increased from 35.19 ± 10.07 to 55.98 ± 11.71 (P < 0.001).
However, the mean score of depression did not change significantly after the intervention (P = 0.689).
CONCLUSION: According to the results of this study, the use of positive thinking intervention
programs with other methods for hemodialysis patients’ care and treatment is recommended as a
nonpharmacological, cost-effective, and uncomplicated method.

Abstract BACKGROUND: Although the work environment of oncology nurses is highly complex and
challenging, their occupational health needs are scarcely studied. This study aimed to explore the
occupational health needs of oncology nurses.
MATERIALS AND METHODS: This qualitative descriptive study was conducted in 2018–2019. The
participants consisted of 52 oncology nurses and 11 other key informants. They were chosen from
eight cancer treatment centers in different cities of Iran. Data were collected through semi‑structured
individual interviews and analyzed using conventional content analysis.
RESULTS: The occupational health needs of oncology nurses were grouped into three main
categories included needs for self‑care, development of professional competency, and a safe and
healthy work environment.
CONCLUSION: The work environment of oncology nurses needs to be optimized in terms of physical,
psychological, organizational, and sociocultural conditions. Furthermore, the necessary measures
should be taken to encourage oncology nurses to implement self‑care, thus creating the preparedness
to face the challenges of the workplace by developing their professional competencies.

Abstract BACKGROUND: Lecture is a common teaching method, which is not considered efficient for the
development of critical and intellectual acquisition in the students of clinical courses. Although in
theory combined methods are known acceptable, in practice, they are not commonly applicable.
The present study aimed to compare the combination of problem‑based learning (PBL), weblogs,
and lectures with lecture alone to achieve an advantageous teaching method for clinical courses.
MATERIALS AND METHODS: This quasi‑experimental study was conducted on 63 medical
students (5th year) taking obstetrics and gynecology clinical courses at Sabzevar University of
medical sciences, Iran. The participants were selected via census sampling. Based on the Student’s
number and using the random number table, the students were randomly assigned to two groups
of interventions. The exclusion criteria were unwillingness to participate and absence for more than
two sessions. Initially, the similarity of obstetrics and gynecology knowledge in both groups was
confirmed based on a pretest (P > 0.05). A conventional lecture was performed for both groups. In
the intervention group (B), the researcher asked each student (32 persons) to provide a case/problem
from mentioned subjects outside the class concerning the given lecture and upload it to the lecturer’s
weblog to show commonalty. In the next session, the presented cases were initially discussed, and
another lecture was carried out. Finally, two methods were compared through identical theoretical
and practical exams and scored based on a Likert scale using a questionnaire. Data analysis was
performed in SPSS 19 using t‑test and Chi‑square at the significance level of P < 0.05.
Results: Group B achieved higher grades in the scientific exams (P < 0.001), especially in the
domains of perception, learning and memorizing of subjects, motivation, and communication with
the classmates and tutor (P = 010). Therefore, satisfaction was higher in the intervention group
compared to the control group (P = 0.001).
Conclusion: The training of pensive, creative, and active experts for the future of medicine requires
the combination of new collaborative methods with lectures, which are undoubtedly effective learning
techniques. According to the results, PBL and weblogs could be invaluable for the improvement of
students’ knowledge, as well as the relations between tutors and students.

Abstract BACKGROUND: Over the past few decades, significant demographic and epidemiological changes
have been occurred and led to serious changes in the health-care needs of the elderly. Integrated
care has been emerged as a strategy to provide better care for the elderly in the community. The aim
of this study was conducted to evaluate components of integrated health-care program of the elderly.
MATERIALS AND METHODS: This quantitative cross-sectional study was conducted in Tehran
(Iran) in 2019. For the purpose of the study, a two-stage cluster sampling method was employed.
In the firs stage, primary health-care centers were selected, then in the second stage, a systematic
random sampling was conducted based on the number of the elderly covered by each center. level
of frailty, medication use awareness, and self-care ability were evaluated by the elderly self-report
questionnaire. The questionnaire was piloted with thirty respondents. The test–retest reliability score
for the questionnaire was r = 0.795, P < 0.001. Data analysis of the questionnaire was conducted
using generalized estimating equation model by SPSS software Version 22. Statistical significance
for all analyses was set at P < 0.05.
RESULTS: Findings of the components showed that the mean ± standard deviation of frailty (80 ± 17)
and self‑care ability (87 ± 17) were higher than the mean of medication use awareness (49 ± 19).
Frailty and self‑care ability (β = frailty, self‑care) of the elderly had a positive statistical significance
with the ones with good financial status (β = 5, 10) and without chronic disease (β = 4, 5). Medication
use awareness had a negative statistical significance with illiteracy (β = −9.5).
CONCLUSIONS: It is suggested that the medication use awareness of the elderly should be prioritized
by improving integrated health‑care program.

Abstract BACKGROUND: This study investigated the reasons for the students’ attendance in and absenteeism
from lecture classes from the perspective of professors, students, and educational planning to change
the unsatisfactory status quo.
MATERIALS AND METHODS: The present study was a narrow needs assessment survey which was
performed on students (n = 70) of the Faculty of Dentistry, Tehran University of Medical Sciences,
in four stages. In the first stage, the opinions of professors and students about the reasons for
absenteeism from the lecture classes were collected. In the second stage, the results of the first
stage were discussed by an expert panel to find solutions for the problem. The results of the survey
were tabulated, summarized, and discussed. In the third stage, online classes were held as one of
the solutions and evaluated in the fourth stage.
RESULTS: The results showed that various factors, such as professor empowerment, evaluation
system, audiovisual equipment of the classes, educational curriculum, and class schedules, are
associated with the students’ attendance in the classes. Along with these factors, one of the most
important reasons for students’ absenteeism from classes in recent years might be the generational
differences of students. The evaluation of online classes showed that the ratio of the number of
students who actively participated in the online classes to the number of students participating in
the online classes varied from 30% to 64% (P < 0.05).
CONCLUSION: In addition to improving the factors associating students’ attendance in classes,
online education is a proper solution for reducing absenteeism in lecture classes and increasing
students’ active participation from the perspective of professors and students.

Abstract BACKGROUND: Multiple sclerosis (MS) is a chronic disease of the central nervous system. Most
women with MS are diagnosed during their reproductive ages. The aim of this study was to evaluate
the interaction between fertility, pregnancy, and MS.
MATERIALS AND METHODS: A retrospective descriptive–analytic study was conducted on 110
women suffering from MS with a history of pregnancy (between 2007 and 2017 years) in Isfahan,
Iran. Samples were selected in a census model. Women completed a researcher-constructed
questionnaire by telephone. The questionnaire consisted of three parts: demographic information, MS
and its symptoms and treatment, and reproductive system and the history of pregnancy associated
with MS. The data were analyzed by SPSS software version 16 using Chi-square, ANOVA, and t-test.
RESULTS: The mean age of women was 32.4 years. In this population, the average number of
pregnancies was 1.61, the number of deliveries was 1.35, the number of abortions was 0.24, the
history of ectopic pregnancy was 0.01, the number of alive children was 1.36, and the number of dead
children was 0.01. The average time of the last MS attack before the pregnancy was 21.36 months.
Fatigue (24.5%) was the most common symptom exacerbated during pregnancy. MS symptoms
improved in 55.0% of women in the second trimester.
CONCLUSIONS: MS had no effect on the pregnancy status, such as the number of abortions,
ectopic pregnancy, alive and dead children, and the duration of pregnancy. Symptoms of the disease
improved during pregnancy. Therefore, pregnancy has a protective role against MS.

Abstract BACKGROUND: One of the most important ways to acquire knowledge in the present age is education
based on new technologies, including mobile learning. The purpose of this study was to investigate
the effect of a multi‑stage mobile training based on Gagne instructional design on learning, retention,
and satisfaction of health volunteers.
MATERIALS AND METHODS: In this interventional study, 112 health volunteers a Health Centre
in Mashhad during 2019–2020 were enrolled. The participants were randomly divided into two
groups: mobile education based on Gagne model (n = 56) and conventional lecture (n = 56).
A researcher‑made questionnaire was completed by the eligible subjects before, after, and 2 months
after the intervention to assess their learning, retention and satisfaction in educational methods.
Face validity, content validity, and reliability of the data collection tool and model fitness indices
were confirmed. Content validity of data collection tools verified by experts and its reliability was
calculated to be 0.78. The collected data were analyzed in SPSS‑25, using descriptive (mean and
standard deviation [SD]) and analytical statistical tests (independent t‑test).
RESULTS: The results showed that 2 days and 2 months after the intervention, learning, and retention
rate was significantly higher in the mobile learning based on Gagne model group in comparison to
conventional lecture group (P < 0.001). Furthermore, the intervention group was generally satisfied
with the mobile training method.
CONCLUSION: Mobile learning based on Gagne model is recommended for improving learning,
retention among health‑care workers

Abstract Malignant epidural spinal cord compression (MESCC) represents the most common indication
for emergent radiotherapy. First‑year residents must quickly gain competence in managing
this condition prior to taking call for the department. We sought to develop a hybrid
didactic/simulation exercise to assist first‑year radiation oncology residents in developing a
skillset relevant to treating a MESCC case in an emergency situation. This was a prospective,
qualitative survey study conducted at the University of California, Los Angeles, during the
years 2014–2016. Following an introductory lecture during orientation for academic years
2014–2016, residents completed a simulated consultation on a patient with suspected MESCC.
Subsequently, they worked with radiation therapists to complete the clinical treatment
procedure (including field placement and manual calculation of monitor units needed to
deliver the prescribed dose) to a phantom placed on a linear accelerator. Residents were
then surveyed about whether the exercise increased confidence in their ability to successfully
complete a consult, and urgent treatment if needed, for MESCC. All residents agreed or
strongly agreed that this exercise had improved this ability, and all agreed or strongly
agreed that the exercise was valuable and should be retained in the curriculum. Simulated
consultation and treatment of MESCC provides new residents with increased confidence and
knowledge regarding this relatively common indication for emergent radiation.

Abstract BACKGROUND: In 1985, the Iranian parliament approved the integration of Medical Education and
Health Services and the establishment of the Ministry of Health and Medical Education, which has
since been the policymaker of Health Higher Education in Iran. The policies are not based on a codified
framework and many were abolished at some point. Some critical issues are not addressed and some
activities overlap. The purpose of the present study was to identify the content themes of core policies
in the Iranian Health Higher Education system and provide a detailed policy orientation taxonomy.
MATERIALS AND METHODS: This qualitative study was conducted in 2019 using the thematic
content analysis of documents relevant to Higher Education and Health Higher Education, including
upstream documents, and documents and enactments of the Deputy Minister of Education and its
policy centers.
RESULTS: From 586 policy documents, six main themes or six core policy orientations in the
Health Higher Education System were identified, including Development of Medical Education
System Policies; Ensuring the Alignment of Operations with Policies; Policies Related to Medical
Education Development; Value‑orientation; Networking and Development of Medical Education
System Interactions; and the Development of Research, Management, and Translation of Medical
Education knowledge.
CONCLUSION: Developing a taxonomy of Health Higher Education policy orientations helps
policymakers identify the neglected and overstressed areas. It can provide education policymakers
with categorized and comprehensive information to quickly access accurate information, make
informed decisions, avoid mistakes, and increase productivity.

Abstract BACKGROUND: Given that many Iranian were interested in the consumption of foods that are high
in fats, the present study was done to determine the effect of a nutrition education intervention on
knowledge, attitude, and intake of foods high in fat among a sample of women in Tehran.
MATERIALS AND METHODS: In this quasi‑experimental study, 92 female referrals to the health
houses affiliated to Tehran municipal were selected and assigned to either intervention (n = 46) or
control (n = 46) groups. Information (data) regarding women’s knowledge, attitude, and practice in
terms of foods rich in fat intake was collected by three questionnaires. Then, a nutrition education
intervention included four 40–60 min training sessions over 4 weeks was designed and conducted
to the study participants in the intervention group. Two groups were followed up 2 months after the
intervention. Finally, all data were analyzed by using the independent‑samples t‑tests, Student’s
paired‑samples t‑test, and Pearson correlation analysis on the R software (version 6.3.2).
RESULTS: The results showed that there were significant reductions in a positive attitude  towards food
with high fat content and intake of these foods in the intervention group compared with the control
group after the intervention (P < 0.001). Furthermore, following the intervention, the intervention group
reported a significant increase in dietary fat nutrition knowledge than the control group (P < 0.001).
Conclusion: Developing nutrition education interventions is an effective strategy for reducing the
consumption of foods rich in fat in Iranian women.

Abstract BACKGROUND: The first step to properly designing image retrieval systems with the aim of meeting
the needs of students and researchers is to be fully aware of their behavior in the face of these
systems and image resources. The purpose of this study is to identify image retrieval behavior of
medical students.
MATERIALS AND METHODS: This study is an applied research that has been done by descriptive‑survey
method. The statistical population of this study is 816 general(clinical) medical students who are studying
in the fourth and fifth years. Using Morgan and Krejcie table, the number of statistical sample members
was 265 who were selected using random sampling method. Research data have been gathered using
a questionnaire (researcher made) and then analyzed using SPSS22 software.
RESULTS: The findings showed that 78.1% of students consider the use of images in class
presentations or scientific reporting as the most important reason. According to 73.6% of respondents,
the highest rate of image search is in the form of videos. About 76.2% of them consider general
search engines to be the most common source for receiving images. For this purpose, only 3.8% of
students refer to the librarians. Among the databases from which medical images can be obtained,
the most well‑known source was the Springer website, which 30.6% of respondents were familiar.
CONCLUSION: The process of meeting the image‑seeking needs is influenced by various individual,
social, and other factors. This study can improve this process by providing the necessary suggestions
to medical students, for eliminating barriers and problems in accessing reliable resources and visual
information they require, to clarify the necessity of promoting technical knowledge to search accurately
and to help for finding solutions to medical and treatment educational centers to have access to
reliable and up‑to‑date information.

Abstract BACKGROUND: The importance of dental implant quality register has been well‑documented.
However, no systematic review conducted on dental implant quality register can be found in the
literature. Therefore, the purpose of this study was to study the existed dental implant quality registries
to explain the goals, data elements, and reports of dental implant quality registries.
MATERIALS AND METHODS: This systematic study was conducted in PubMed, Scopus, Web
of Science, and Embase databases. For evaluating dental implant quality registers, all studies in
the English language were examined with no time limitation. Case reports, conference abstracts,
and letters to the editor were excluded. The analysis of the quality of the studies was done by the
STrengthening the Reporting of OBservational studies in Epidemiology checklist.
RESULTS: The primary search identified 5565 articles. After eliminating duplicate articles and articles
that did not meet the inclusion criteria and reviewing 40 full texts, 11 studies were included in this
study. In this review, seven countries as Sweden, the USA, Canada, Germany, Finland, Australia,
and South Korea had dental implant quality registers. Furthermore, the goals of dental implant quality
registers were classified into the categories of research, epidemiology, administrative, clinical, and
surveillance.
CONCLUSION: The results of this study provide dentists and other stakeholders useful information
on the existed dental implant quality registers and databases worldwide. It also provides a framework
of the goals, data elements, and reports of dental implant quality registry. The establishment of
dental implant quality register will be beneficial for societies and also allows them to control the
complications of dental implants in future.

Abstract BACKGROUND: Rational pharmacology use and appropriate prescribing are among the key learning
outcomes in medical education. Some medical faculties include rational pharmacotherapy course
in their education programs at different years of education in Turkey. The aims of this study were to
investigate the differences in effect of rational pharmacotherapy course on short- and long-terms by
comparing two cohorts who attended the course in different clinical years of medical education by
identifying which parameters of prescription items are different among groups.
MATERIALS AND METHODS: This quasi-experimental study was conducted in School of Medicine.
Participants consisted of 157 students who attended the course in Grade 4 (n = 110, Group A) and
Grade 5 (n = 47, Group B). Students were asked to complete a prescribing task both upon completion
of the course and 1 year after. The performance in prescribing was determined by prescription
scoring form. Repeated measures ANOVA was employed to test the intervention effect between
two periods. McNemar test was employed to measure the change in each item on the prescription.
Point-biserial correlations between each item on the prescription and their scores on the test as a
whole were calculated.
RESULTS: The mean score of Group A dropped to 59.41 (standard deviation [SD] = 14.06)
from 90.43 (SD = 8.90), and the mean score of Group B dropped to 73.37 (SD = 12.56) from
83.91 (SD = 10.03). All the prescription components in the scripts of the Group A students worsened
significantly, except the “name of drug,” whereas Group B students maintained most of them after
1 year.
CONCLUSIONS: This study shows that the long-term retention effect of rational pharmacotherapy
course conducted in later years of education is better than the course conducted in earlier years of
education, which may be related to the fact that students in later years are more likely to take on
responsibility for patient therapy process in clinical education.

Abstract BACKGROUND: Healthy dietary adherence might be one of the effective and modifiable factors
for hypertension (HTN) control; therefor, empowering patients for self‑care management including
healthy food patterns play a key role in guiding their care, in partnership with health care providers.
This study aimed to identify the factors predicting nutritional knowledge, illness perceptions, and
adherence to a diet based on transtheoretical model (TTM) among hypertensive middle‑aged women.
MATERIALS AND METHODS: A cross‑sectional survey was conducted on 164 patients with
HTN attending west health centers of Tehran, Iran, in 2020. Simple random sampling was used.
Sociodemographic characteristics of the respondents were collected, a valid and reliable measure
on nutritional knowledge, illness perceptions, and adherence to diet, and a researcher‑made
measure based on TTM constructs through in‑person interview was applied. Descriptive statistics
and general linear model were utilized for data analysis using SPSS version 25. The significance
level was considered less than 0.05.
RESULTS: Mean and standard deviation of participants was 50.82 ± 8.77 years. Multivariate
regression analysis indicated that family income (P < 0.001) and body mass index (P < 0.001) predicted
nutritional knowledge and adherence to diet, respectively. Decisional balance and self‑efficacy
constructs predicted nutrition knowledge and illness perceptions (P < 0.001). In adherence to diet,
overcoming the temptation construct was indicated as the only predictor (P < 0.001).
CONCLUSION: Study findings highlighted the necessity of tailoring and implementing interventions
based on TTM using appropriate strategies to promote quality of HTN management approach in
nutritional knowledge, illness perceptions, and dietary adherence.

Abstract With the onset of the coronavirus disease 2019 (COVID‑19) outbreak, the transformation of the care
delivery model from conventional in-person (face to face) to largely virtual or remote care has been
accelerated to appropriately allocate resources and constrain the spread of the virus. In this regard,
telemedicine is a breakthrough technology to battle against the COVID‑19 emergency. Therefore, we
sought to identify the telemedicine applications in the COVID‑19 pandemic (tele‑COVID) according
to interaction modes, transmission modalities, and disease categories. This systematic review
was conducted through searching five databases including PubMed, Scopus, ProQuest, Web of
Science, and Science Direct. Inclusion criteria were studies clearly outlining any use of telemedicine
interactive mode during the COVID‑19 pandemic, written in English language and published in
peer-reviewed journals in 2020. Finally, 43 articles met the inclusion out of the 1118 search results.
Telemedicine provides a diversity of interaction modes and modalities affordable by patients and
physicians including short message service, E-mail and web portals, secure telephone calls or VOIP,
video calls, interactive mobile health applications (m-Health), remote patient monitoring, and video
conferencing. Transmission of video data using synchronized video calls via common social media
had the highest and exchange of data using store-forward service via secure messaging technology
and prerecorded multimedia had the lowest popularity for virtual disease management during the
COVID‑19 outbreak. Selection of telemedicine communication services and interaction modes with
regard to its use‑case, disease category, and application plays a significant role in the success of
remote disease management infrastructures in this scenario and their implication for a better future
healthcare system.

Abstract BACKGROUND: The clinical laboratories require organizational behavior management approach
that creates a balance between directors’ expectations and staffs’ needs in this field. This study was
aimed to explain the role of organizational behavior management in clinical laboratories and suggest
mechanisms for its implementation in these organizations.
MATERIALS AND METHODS: In this research, using several Persian and English databases by
keywords consist of the clinical laboratory, organizational behavior management, and staff diversity.
Three hundred and fifty four references from 1990 to 2020 were studied, and 72 references, including
abstracts and full papers utilized for this research, and excluded papers presented at conferences,
seminars, and dissertations. Using MESH strategy and Pico’s instruction.
RESULTS: The results of studies revealed staffs’ individual differences in all aspects, including early
and secondary dimensions may influenced the style of leadership implemented in clinical laboratories,
“job‑personality compatibility theory,” job satisfaction and job commitment of staffs work in clinical
laboratories and the way the directors and managers can develop the job loyalty and improve the
organizational productivity in these organizations.
CONCLUSION: It is suggested a conceptual model for understanding and assessing the different
organizational behaviors of clinical laboratories staffs based on communication skills, staffs’
interaction, and socio‑political, economic, and cultural elements, which should be more developed
in future using the other similar studies.

Abstract BACKGROUND: Quality of relationship marital status affects all aspects of family functioning,
including sustainability of cohabit living, supporting children, and happiness of couples. This study
was conducted to examine the effect of group cognitive‑behavioral counseling on optimism and
self‑esteem of women during the 1st month of marriage that referring to marriage counseling center.
MATERIALS AND METHODS: A semi‑experimental study was designed by a test, posttest, and
follow‑up. Participants consisted of 30 women admitted to premarriage counseling center of Farsan
city in 2018 with using purposive sampling by random numbers’ table into experimental and control
groups. The experimental group participated in eight consecutive 2‑h group counseling sessions.
Data collection tools were demographic questionnaire, Rosenberg’s Self‑Esteem Scale, and optimism
designed by Mir Ahmadi (reliability and validity are calculated and was 0.96) and completed in three
rounds. Women’s self‑esteem retested was done after 1 month. Data were analyzed with independent
t‑test and repeated measures ANOVA (significance level <0.005). Quantitative variables were
analyzed using the Kolmogorov–Smirnov test.
RESULTS: There were no significant differences between optimism scores in the
experimental (M = 150.47, standard deviation [SD] = 22.07) and control groups (M = 149.2,
SD = 21.54) prior to intervention (P = 0.875). The mean optimism score was significantly different in
intervention (M = 169.33, SD = 17.01) and control (M = 147.2, SD = 22.22) groups immediately after
counseling (P = 0.005) and 1 month after counseling (P = 0.002, M = 171.08, SD = 17.98). The mean
self‑esteem scores were statistically significant in both groups immediately after counseling (P = 0.023,
I: M = 37.06, SD = 8.69, C: M = 31.4, SD = 4.83) and 1 month after counseling (P = 0.028, I: M =
34.73, SD = 4.93, C: M = 30.06, SD = 4.8).
CONCLUSION: Cognitive‑behavioral counseling enhances women’s optimism by emphasizing
the training of communication and conflict resolution skills, which leads to positive attitude and life
satisfaction. Therefore, using cognitive‑behavioral counseling in marriage counseling sessions can
improve couples’ relationships.

Abstract BACKGROUND: Before the COVID-19 pandemic, medical students had reported experiencing high
rates of distress, burnout, anxiety, and depression. The psychological impact of the COVID-19 in the
general population suggested that the mental health impact was increased anxiety, depression, and
stress. There were no exceptions if medical students also experience the same psychological impact.
The aimed to this study is analyze the mental and emotional effects of the COVID-19 pandemic
among medical students.
MATERIALS AND METHODS: An observational analytic study was used with a cross-sectional
approach. Data were obtained with questionnaires distributed through social media platforms from
July 14, 2020, to July 21, 2020. This study using the Fear of COVID-19 (FCV-19) Scale and the
Depression, Anxiety, and Stress Scale-21 to assess FCV-19, anxiety, stress, and depression.
statistical analysis used IBM SPSS Statistics 24 was used to analyze the two-tailed Chi-square test,
the Mann–Whitney test, and the Kruskal–Wallis test, which were used with statistical significance
as P < 0.05 for all tests.
RESULTS: Out of 1027 samples, 44.6% had stressed, 47.8% had anxiety, and 18.6% had depression.
The gender (P = 0.000), educational stage (P = 0.000), and the comorbidity factor (P = 0.001 for
stress and anxiety, P = 0.036 for depression, and P = 0.000 for FCV-19) had a significant association
with stress, anxiety, depression, and FCV-19 in medical students. The hometown that showed zone
risk of infection only showed significant differences in FCV-19 (P = 0.026).
CONCLUSIONS: Protection and psychological support for a medical student is extremely high
importance given that COVID-19 is now a well-established pandemic and there will be other
pandemics in the future.

Abstract BACKGROUND: To determine functional gastrointestinal disorder (FGID) aspects, there should
be a guideline to retrieve documents in this area for researchers with different levels of knowledge
about these disorders. the objective of this study was conducted in order to compile different terms
related to different categories of these disorders and to determine the sensitivity of them.
MATERIALS AND METHODS: To set a proper search, some strategies were used to enhance
the precision and sensitivity. After preparing the list of terms according to some sources such as
thesauruses, Rome classification, related review articles, and so on, they were divided into seven
categories and the queries in each of them were searched on the Scopus.
RESULTS: The sensitivity for each of the terms in categories were calculated, and the highest values
were as follow: FGIDs with 189 queries (“digestive* system* function* disorder*”), irritable bowel
syndrome with 142 queries (“irritable colon*”), functional constipation with 13 queries (“function*
disorder*” and constipation), functional diarrhea with 16 queries (“function* disorder*” and diarrhea),
functional bloating with 29 queries (“function* disorder*” and bloat*), Functional Dyspepsia with 29
queries (“functional dyspep*”), and neurogenic bowel with 7 queries (“neurogenic bowel*”).
CONCLUSION: Given the values calculated for sensitivity, and considering the type of study, in
order to retrieve documents in this area, it is necessary to apply all or part of the proposed queries
to the search strategy.

Abstract BACKGROUND: Coronavirus disease 2019 is a new viral outbreak in the world. Dentists and
their assistants are at greatest risk of exposure to the virus, due to close contact with patients and
dealing with aerosols. Hence, the aim of this study was to compare the use of personal protective
equipment (PPE) and supplementary protective equipment (SPE) and observance of the principles
of infection control (PIC) in dentists and their assistants before and after the corona crisis.
MATERIALS AND METHODS: This cross‑sectional study was conducted using an online survey
from May 6 to 20, 2020. Convenience sampling was used to select individuals. The questionnaire,
consisting of four general categories about the use of PPE and SPE and the observance of PIC
by dentists and their assistants before and after corona crisis, was registered at Porsline website
(https://survey.porsline.ir/s/KUt7VQB). Frequencies in each subcategory were calculated and
comparisons were done using Chi‑square test, Fisher’s exact test, and paired sample t‑test. A P < 0.05
was considered statistically significant.
RESULTS: There were significant differences in the frequency of use of PPE by dentists before and
after corona crisis for oral and dental examination and also dental procedures (P < 0.001). There
were significant differences in the frequency of use of SPE and observance of PIC before and after
corona crisis, except for different types of suction types (P = 0.22), dental handpiece (P = 0.66),
and dental unit (P = 1). There were significant differences in the frequency of use of PPE by dental
assistants before and after corona crisis (P < 0.001).
CONCLUSIONS: Although the frequency of use of PPE and observance of PIC increased among
dentists and their assistants, this increase is not sufficient, especially for dental assistants, and a
higher level of use of PPE and PIC observance in face of highly contagious and life‑threatening
viruses such as corona is required.

Abstract BACKGROUND: In their apprenticeship program, health information technology (HIT) students are
deprived of the ample opportunity to work with the hospital information system (HIS). This study
aimed to design an interactive simulator for the HIS training and evaluate its effects on the informatics
skills of HIT students.
MATERIALS AND METHODS: This study was conducted on 16 Bachelor of Science students of
HIT at Kashan University of Medical Sciences in 2019. After the functionalities and features of the
simulator were determined based on similar existing simulators, expert opinions were received to
simulate eight important processes of admission, discharge, and transfer module in HIS. The scores
of students’ skills and time taken to perform the processes were recorded and analyzed before and
after the educational intervention. After they were trained by the simulator, the students filled out a
usability evaluation questionnaire. The data were then analyzed in SPSS version 21.
RESULTS: The simulators of health information systems were characterized by interactivity,
multimedia applications, practice exercises, tests, and feedback. After the students were trained by
the developed simulator, their skills scores improved significantly in 75% (6/8) of the processes, and
the timespans of all processes decreased significantly (P < 0.05). The usability evaluation indicated
the usability of the simulator was at a “good” level.
CONCLUSIONS: According to the study results, using the simulator improves the informatics skills
of HIT students in working with HIS. It is recommended that this method also be used in other
apprenticeship programs to teach health information systems.

Abstract BACKGROUND: Globally, 30% of female over 50 years old have osteoporosis. This disease is one
of the major causes of disability and death in the elderly. This research was aimed to determine
the prevalence of primary osteoporosis and low bone density based on bone mineral density in
postmenopausal women and its sociodemographic, obstetric, and life style risk factors.
MATERIALS AND METHODS: This cross-sectional descriptive-analytical study was performed by
simple random sampling on 850 postmenopausal women aged 50–65 years covered by all health
centers, from August 2018 to April 2019, in Tabriz-Iran. Four hundred and forty-five eligible women
underwent densitometry using dual-energy X-ray absorptiometry in the lumbar spine and femoral
neck. Socio-individual, obstetric-medical, international physical activity questionnaires-short form,
and anthropometric questionnaires were completed. Data analyzed using descriptive and analytical
statistics including multivariate logistic regression in SPSS 21 software.
RESULTS: The prevalence of primary osteoporosis based on lumbar vertebra T-score, femoral
neck T-score, and total was 23.4%, 3.4%, and 24.5%, respectively, and the prevalence of primary
osteopenia based on lumbar vertebra T-score, femur neck T-score, and total was 42%, 35.5%, and
43.6%, respectively. The present study showed that the odds of osteoporosis increased by increment
of age (odds ratio [OR]: 1.18; 95% confidence interval [CI]: 1.07–1.30), but it decreased by increasing
menopausal age (OR: 0.92; 95% CI: 0.85–1.01), body mass index (OR: 0.87; 95% CI: 0.78–0.97),
arm circumference (OR: 0.84; 95% CI: 0.74–0.95), and education level (P = 0.028). It was higher in
unmarried women (OR: 2.65; 95% CI: 0.99–7.08) and those with nonpersonal housing (OR: 4.02;
95% CI: 1.24–13.07).
CONCLUSIONS: Given the high prevalence of primary osteoporosis and low bone mass in postmenopausal
women, health education is necessary for preventing modifiable risk factors and reducing the complications
of this disease.

Abstract BACKGROUND: Absenteeism is a situation whereby students absence themselves from clinical
posting without good reason, this incidence among student nurses contributed a significant problem
that if not addressed will adversely affect the quality of nursing care; therefore, motivation of student
during clinical posting found to be an important ingredient needed in eradicating absenteeism.
Consequently, this study aims to determine the reasons why student nurses absenting themselves
from clinical posting, its effect and how clinical instructor can motivate student nurses since they are
the first role models and have a significant impact in their skill development.
MATERIALS AND METHODS: A descriptive, quantitative design was used to elicit the information
from a sample of 80 nurses and 80 students’ nurses. Nurses: 25 medical surgical ward, 23 surgical
ward, 17 obstetrics and gynecology ward, 15 theaters, and 80 student nurses, statistically drawn
through a stratified sampling technique across the wards and school of nursing. Data collected were
analyzed using tables, percentages, means, and standard deviation at 0.05 level of significance
through the Statistical Package for the Social Sciences software.
RESULTS: The student participants reported that non conducive working environment, working
in infectious ward without adequate protection, noncooperation from clinical instructor, excessive
number of clinical hours, embarrassment faced in front of patients and other medical personnel, lack
of prompt medical treatment and care when sick, too much workload, and other number of clinical
assignments as a major reason why they absenting themselves from clinical posting. The effect of
student absenteeism and how students can be motivated is identified in this study.
CONCLUSION: Reported factors leading to absenteeism among nursing students and identified
motivating care should be handled carefully by the hospital managers to produce better health-care
delivery’ nurses in future.

Abstract BACKGROUND: The ultimate goal in educating medical students is to train skilled workforce who
by obtaining the required knowledge of the discipline, personal and professional skills, and attitudes
to enter the national health‑care system. This study was conducted with the goal of designing a
comprehensive clinical competency test of operating room technology student using the Delphi
technique, and then, the clinical skills of the operating room technology students of the paramedical
school were assessed using the CIPP evaluation model.
MATERIALS AND METHODS: The present study was conducted in the University of Medical
Sciences to evaluate clinical skills with Delphi technique and CIPP evaluation model. This was
a mixed methods study. Purposive sampling method was employed in the qualitative stage, and
a census was conducted in the quantitative part. A comprehensive clinical competency test was
designed in this research using the Delphi technique and was conducted with 18 students. Then,
clinical skills evaluation was performed by descriptive-analytical statistical tests and evaluator’s
observation using the CIPP model.
RESULTS: The comprehensive clinical competencies test of the surgical technology students was
designed in four sections: content, evaluation method, test conditions, and the criteria for passing the
comprehensive test. The results in the implementation stage showed that the operating room technology
students had a range of excellent to weak performances in exhibiting basic skills at different levels.
CONCLUSIONS: The results of the present study showed that the comprehensive test, designed
based on the Delphi technique of experts, and using the CIPP model can be a good criterion for the
evaluation of the operating room technology students before entering the clerkship.