Journal of Education and Health Promotion

Abstract

Abstract BACKGROUND: Community health officers (CHOs) are a newly introduced cadre of mid‑level
health‑care providers who will man the health and wellness centers under Ayushman Bharat Mission
in India. Need‑based training will help them fulfil their role in early diagnosis, treatment, and referral
of tuberculosis (TB) patients. The present study identified the gaps in the awareness about TB in a
heterogeneous group of trainees and addressed them through need‑based training.
MATERIALS AND METHODS: A before and after the study was carried out in 110 trainee CHOs at
Rural Medical College, Loni. In‑depth interviews were conducted with public health experts and focus
group discussion was conducted with trainees to gain the quality inputs. Structured questionnaires
based on training objectives specifically pertaining to TB were designed. Training was provided with
an emphasis on addressing the gaps identified in the pretest. Posttest evaluation was done at the
end of the training to assess its effectiveness. Data were analyzed using the SPSS software version.
17.0 (Inc., Chicago, IL, USA).
RESULTS: The mean pretest score was 15.15 (standard deviation [SD] = 3.55) which improved
after 6 months training to 24.01 (SD = 1.223), i.e., from 60% to 96%. There was highly significant
improvement in overall knowledge score of trainees (t = 28.124, df = 109, P < 0.001). There was
a statistically significant improvement in scores of all topics at the end of 6 months training in both
Nursing and Ayurved graduates. Except for knowledge regarding the treatment of multidrug‑resistant
TB (P = 0.004), knowledge about all other topics was comparable in nursing and Ayurved graduates
at the end.
CONCLUSIONS: Needs assessment proved effective in identifying the gaps in knowledge and skills
of interdisciplinary trainee CHOs. Medical colleges with expertise in teaching, training, and health
service provision can work with the public health system to provide a model for rapid upgrading and
capacity building to meet health‑care challenges such as TB.

Abstract BACKGROUND: The present study was aimed to investigate the effects of managers’ good
character traits and perceived organizational support (POS) of employees in one of the therapeutic
and educational centers of Kermanshah, Iran.
MATERIALS AND METHODS: In this applied, descriptive, correlational, and cross‑sectional study,
the statistical population included the employees of one of the therapeutic and educational centers of
Kermanshah. Besides, Cochran’s formula was employed to determine the sample volume (n = 166),
and the samples were selected using simple random sampling. As for data collection, the standard
questionnaires of managers’ good character traits and POS of employees were utilized. To analyze
the collected data, the Kolmogorov–Smirnov test and Pearson’s correlation coefficient test were used
using the SPSS Statistical Software Version 18.0. Moreover, the structural equation approach was
employed using SPSS 22 (version 22.0, SPSS Inc., Chicago, IL, USA).
RESULTS: The results of the present study demonstrated that managers’ good character traits and
POS of employees positively and significantly correlated (P = 0.81). In addition, there were positive
and significant relationships between each of the components of managers’ good character traits
and POS of employees, and all hypotheses were supported.
CONCLUSION: Overall, the results of the present study showed that managers’ good character traits
significantly contributed to increasing the POS of employees, thereby increasing the satisfaction with
the performance of the therapeutic and educational center.

Abstract Nowadays, air ambulances have been developed as part of advanced emergency medicine services
with many countries employing these services for transferring patients in usual and emergency
conditions. However, there are challenges concerning the optimal development of air ambulance
base. The present research aimed to identify factors affecting the development of air ambulance
bases to provide the opportunity of planning to improve the quality of emergency medical services.
In this systematic literature review, the peer-reviewed papers in fiv electronic databases, including
Medline through PubMed, Scopus, Web of Science, ScienceDirect, and ProQuest, as well as
available gray literature, were searched and selected. Two combinations of groups were used as
keywords: the Health Planning and development factor, air ambulance base. The focus was on
the PRISMA checklist, with no time limitations until from 1990 to January 2020. Finally, through
5156 related citations, 20 articles were included. Descriptive and thematic content analyses were
evaluated. The factors affecting the development of the air ambulance base were classified in fiv
categories and 14 subcategories as follows: navigation criteria, process indications and standards,
sociopolitical factors, and current situation of the area. There are few studies on factors affecting the
development of air ambulance bases. It is necessary to apply multidimensional models to consider
various factors for development. The development of high populated cities, events and ceremonies
with a crowd of participants, and increase of human-made disasters are making these services
increasingly indispensable.

Abstract BACKGROUND: The development of any society depends on proper planning in various fields such
as population and birth control. Fertility control is designed to create a level of population growth
appropriate to the resources available and to ensure a good life. Receiving information and education
is one of the basic strategies to change the attitude toward fertility and awareness in most people in
society. Therefore, this study was conducted to determine the effect of education on knowledge of
fertility counseling and attitudes toward fertility control in health workers.
MATERIALS AND METHODS: The present study was a randomized clinical trial with a control
group that was conducted in the presence of 107 health workers of health centers and community
health centers working in Mashhad in 2017. The research units were randomly divided into three
groups (webinar training, group discussion training, and control). Research tools were researcher‑made
questionnaires on attitudes toward fertility and measuring healthy reproductive awareness that all
study participants completed at the beginning of the study and 2 weeks after the intervention. Data
analysis was performed by the Chi‑square, one‑way analysis of variance, and independent t‑test
using the SPSS software version 16.
RESULTS: The results of this study showed that at the beginning of the study, all three groups
were homogeneous in terms of quantitative and qualitative demographic variables including age,
education, work experience, type of employment, and number of family members. The results of
Kruskal–Wallis test showed that before the intervention, the three groups did not have a statistically
significant difference in terms of mean scores of awareness about fertility counseling (P = 0.77) and
attitude toward fertility control (P = 0.523), but this relationship was significant after the interventions.
Furthermore, the results of Mann–Whitney intragroup test showed that the scores before and after
the intervention were significant in both educational groups (P = 0.001).
CONCLUSION: Considering the importance of healthy fertility counseling and the important place
of education in promoting awareness and attitude toward healthy fertility, it is recommended to use
active educational methods to promote the awareness and attitude of health workers to provide
healthy fertility services to couples.

Abstract BACKGROUND: Stress is a subjective experience which creates an obstacle in a person’s path of
achieving his or her goals. It creates negative outcomes among the population. Medical curriculum
is very vast and stressful. As doctors are the very important part of society, medical students must
be allowed to learn their trade in a stress‑free environment. The present study aimed to assess the
perceived stress, various sources of stress among medical undergraduate students, and the coping
strategies adopted.
MATERIALS AND METHODS: This was a cross‑sectional study conducted among medical
under‑graduate students studying at a tertiary care hospital situated in Mumbai city of Maharashtra
between January and June 2018. Using purposive sampling technique, a total of 450 medical students
from 1st year to final year were invited to participate in the study. A self‑administered questionnaire
consisting of sociodemographic details and perceived stress scale questions was used. Logistic
regression analysis was carried out to assess the determinants of stress. Odds ratio, 95% confidence
interval was calculated. P < 0.05 was considered statistically significant.
RESULTS: The overall response rate was 79.11%, with 356 out of 450 students returning the
questionnaire. Among 356 participants, 324 participants (91%) were suffering from high levels
of stress. Factors such as curriculum vastness, frequency of examination, competition with peer,
performance in examinations, worry about future, loneliness, relation with opposite sex, and quality
of food played a major role in creating additional stress.
CONCLUSIONS: The perceived stress was higher among female medical students. Academic factors
are greater perceived cause of stress in medical students in this study. A substantial proportion of
medical undergraduate students were found to be stressed which necessitates appropriate and timely
interventions. Reframing the academic curriculum along with examination and evaluation patterns,
incorporating extracurricular activities, and establishment of counselling cells in the institution is the
need of the hour.

Abstract BACKGROUND: Due to the COVID‑19 pandemic, many countries have implemented nationwide
lockdowns. While this leads to a decrease in disease transmission, there is a concurrent increase in
the levels of psychological distress. To estimate the levels of psychological distress in school‑ and
college‑going adolescents currently under lockdown and to determine the factors associated with
this psychological distress.
MATERIALS AND METHODS: A cross‑sectional study conducted in Army Public School and
College (APSAC) Sibi, Balochistan province of Pakistan between March and May 2020. Students
of APSAC Sibi were enrolled in this research. Modified Kuppuswamy Socioeconomic Scale, Godin
Leisure‑Time Exercise Questionnaire, and Kessler‑10 were used for data acquisition. Chi‑square
and t‑tests and univariate analysis (nonparametric test) were performed using the Statistical Package
for the Social Sciences (SPSS) version 23.0 (IBM, Armonk, US).
RESULTS: Out of 225 participants, 57.4% were studying at school. Sixty‑four percent of the participants
were likely to be suffering from psychological distress. There is a significant effect of physical activity,
sleep duration, bedtime at night, screen‑time duration, and COVID‑19 positive family member on the
levels of distress. A moderate positive correlation was between psychological distress and bed‑time at
night (rho[223] = 0.328, P < 0.001) and screen time duration (rho[223] = 0.541, P < 0.001). A moderate
negative correlation of physical activity (rho[223] = −0.340, P < 0.001) and a weak negative correlation
of sleep duration hours (rho[225] = −0.158, P = 0.018) was found with psychological distress levels.
CONCLUSIONS: The COVID‑19 lockdown and pandemic have had a considerable psychological
impact on both school‑going and college‑going students, showing increased level of stress. A strong
public health campaign along with mental and physical and social support programs are the need
of the hour.

Abstract INTRODUCTION: It is universally acknowledged that strengthen the participation rate in breast
cancer (BC) screening can find cancer in its earlier stages. The aim of this study was to determine the
effect of regular visits to the health centers on women’s knowledge and attitude about BC screening.
MATERIALS AND METHODS: In a cross‑sectional study, data were collected from 380 women
identified with Kurdish background, who were registered in health care centers of Islamabad‑e Gharb
during January and February 2017. The subjects were divided into two regular and irregular groups
based on the quantity of presence in health centers. Data on women’s awareness and attitude about
BC screening were collected by a trained interviewer using a structured questionnaire. Bivariate
analysis, analysis of variance, and independent sample t‑test were used to see the mean differences
within the groups. The level of confidence was set at 0.05 significant.
RESULTS: Women were representative of four health‑care centers of the city, mainly ≤39 years
old  (73.9%), married  (96.3%), with high school education  (44.2%) characteristics. The total
mean  ±  standard deviation of awareness score about BC was 6.03  ±  3.90. In total, 19.2% of
participants had poor  (<2.13), 64.2% had an average  (2.13–9.93), and 16.6% had good  (˃9.93)
awareness about BC. The results showed that the level of knowledge and attitude about BC screening
was significantly different between regular and irregular groups (P < 0.05).
CONCLUSION: An important message from this study is the need for improved and coordinated
BC education for all social classes of women. It is necessary to discover ways to encourage women
with academic education to visit health centers regularly during interventional studies.

Abstract In recent years, many reforms have been made on the structure of hospital administration, most
of which are proposed by Parker–Harding models. Therefore, the purpose of this study is to
systematically review global relevant experiences in reforming the hospital governance structure
with emphasis on the Parker–Harding model. Required information was collected using keywords
autonomization, corporatization, privatization, decentralization, reform, hospital autonomy, governance
model, and structural reform in databases such as EMBASE, PubMed, Scopus, SID, MagIran, and
other resources. Information on the subjects under study was collected from 1990 to 2020. The
content extraction method was used for data extraction and data analysis. Thirty‑nine sources were
included in the study. Results of searching for relevant evidence on a variety of hospital governance
models (government, board, corporate, and private) based on the Parker–Harding model in four
categories including strengths (31), weaknesses (30), outcomes (26), and interventions (21) are
outlined. In this study, strengths, weaknesses, outcomes, and corrective interventions were presented
for different models of hospital administration that could be used by healthcare policymakers. Also,
According to the results of this study, governmental model less recommended.

Abstract BACKGROUND: The long‑term outcomes are important concepts for cost‑effectiveness analysis
in patients with premature coronary artery disease after revascularization (coronary artery bypass
grafting [CABG] and percutaneous coronary intervention [PCI]) and medical therapy (MT). The
finding of this study will be used to calculate the events probabilities for cost‑effectiveness study.
METHODS AND ANALYSIS: This systematic review will use studies in which patients age must be
18–60 years in eligible studies that obtained from PubMed, Web of Science, Scopus, and Embase.
We will assess the long‑term outcomes after CABG, PCI, and MT by random‑effects meta‑analysis
and effects will be shown by risk ratio. We will ascertain the probabilities of adverse events during
certain periods and then outcomes will compare separately based on specific characteristics.
CONCLUSION: This study will provide information related to outcomes of CABG, PCI, and MT
in patients with premature coronary artery disease. Doing this systematic review is valuable from
clinically and economically aspects such as cost‑effectiveness and cost‑utility analysis.

Abstract BACKGROUND: During the pandemic period of coronavirus disease, appropriate oral health
management and disease prevention of children are very important for children’s oral and general
health. The aim of this study was to survey to better understand in children’s dental health and dietary
habits and to learn about parents’ attitudes toward dental treatment and clinical factors associated
with their QoL using the Turkish version of KIDSCREEN‑10 during the initial stage of the COVID‑19
pandemic in the general public.
MATERIALS AND METHODS: A two‑part questionnaire , namely Part 1 addressed topics
regarding changes in general and dental health, dietary habits of children under quarantine, and
sociodemographic characteristics of the family and Part 2 impact of QoL was assessed by the
KIDSCREEN‑10 scale with 10 questions. The questionnaire was sent online using WhatsApp to a
convenience sample of mothers with children between the age group of 8 and 18 years, who lived
in Istanbul. Variables were statistically analyzed using the Student’s t‑test for independent samples
and Univariate F‑test, ANOVA according to the characteristics of variables which were analyzed.
RESULTS: This study included 328 from 557 mothers with 58% respondent rate. The consumption
of fast food, packaged food, and carbonated beverages decreased during the COVID‑19 outbreak.
Half of the mothers of children reported that they were anxious or fearful about their children
visiting dentists during the pandemic and 64.2% of the children missed routine dental visits. The
KIDSCREEN‑10 scores for 13 years old or older children were influenced more by the COVID‑19
pandemic than those for the 8–12 years old, who had a better QoL (P = 0.008).
CONCLUSIONS: The results of this study emphasize the importance of oral health and QoL of
children during the initial phase of the COVID‑19 outbreak. The general perception of QoL in this
group of Turkish children seemed to be substantially affected by COVID‑19 outbreak.

Abstract BACKGROUND: To avoid making decisions based on the unproven opinions of emergency medical
technicians (EMTs), many emergency medical service (EMS) systems rely on emergency medical
protocols. As protocol‑based on‑scene decision‑making is influenced by many challenges, identifying
these challenges can result in providing appropriate conditions for EMTs’ decision‑making. Therefore,
this study aimed to identify the barriers and requirements in the off‑line emergency medical protocols
implementation m in the prehospital emergency medical system.
MATERIALS AND METHODS: To conduct this study, qualitative content analysis using 10 field
observations, 22 interviews, and 2 rounds of focus group discussions was applied. The duration of
interviews lasted from October 2019 to January 2020. The Graneheim and Lundman approach was
used to analyze the data.
RESULTS: Seven categories (15 subcategories) including education and awareness (professional
training and education and community‑based education); attitudes (professional attitude and
community attitude); interactions and coordination (interpersonal interactions, organizational
interferences, and community’s interactions); rules and instructions (instructions and supportive
rules); control system (monitoring and evaluation and motivational system); accessibility (recourses
and communication); and organization (structure and process) were obtained as the obstacles and
challenges in the offline emergency medical protocol implementation in the prehospital system.
CONCLUSIONS: There are many challenges in implementing offline emergency medical protocols in
the prehospital emergency system. To achieve the effectiveness and efficiency of offline prehospital
emergency protocols, it is necessary to facilitate these challenges and improve the EMTs’ knowledge,
attitude, and performance through cooperative and skill‑based education. The findings of this study
can be useful for EMS systems from national to local levels.

Abstract The outbreak of the COVID‑19 epidemic started in late 2019 in Wuhan, China, causing many
psychological and occupational effects for the medical staff, including dentists and all those who work
to promote oral health. The present systematic review study investigates the psychological causes
and effects of the COVID‑19 epidemic outbreak on dentists.Systematic search was performed on valid
databases such as Science Direct, Web of Science (WoS), Embase, Cochrane, and Scopus. The
English articles published from December 2019 to November 2020 were selected according to the
inclusion and exclusion criteria. The quality of the articles was assessed using an existing checklist.
Then, their full texts were reviewed to extract the necessary data. Finally, the data were summarized in
a table.This systematic review study showed the emergence of psychological symptoms such as fear,
anxiety, and stress are the three most common disorders in dentists and all those who work to promote
oral health as the medical staff. This pandemic has had occupational and economic consequences
for dentists.In general, the research results indicated that the outbreak of COVID‑19 had affected
the dental profession in two areas: (1) Psychological consequences: Reviewing the articles showed
that the essential psychological effects in the dental profession are the fear of infection by patients,
anxiety, and stress, respectively. (2) Occupational effects: The second significant consequence of the
COVID‑19 outbreak was that due to fear and anxiety of getting infected with the virus in the dental
environment, containing particles and aerosols from patients’ saliva and blood, dentists had to limit
doing their jobs in the emergency room and sometimes even closing their offices. This issue may
cause economic problems for their professions. There is also a need to allocate additional costs for
the provision of sanitary equipment.

Abstract BACKGROUND: A doctor–patient relationship built on the concept of empathy is so essential to
attain the best clinical outcomes in medicine. Since empathy has a positive role in interpersonal
relationships and medical outcomes, its assessment is highly crucial. The aim of this study was to
assess the empathy in last‑year medical students using the Persian version of the Jefferson Scale
of Physician Empathy (JSPE) and correlate empathy scores with demographic features.
MATERIALS AND METHODS: In this cross‑sectional study, last‑year medical students at Shiraz
Medical School, Shiraz, Iran, were recruited for this study. In this research, we used the Persian
version of JSPE. The validity and reliability of the Persian version of this tool were confirmed in the
previous research. For the analysis of data, we employed descriptive statistics and the independent
sample t‑test.
RESULTS: One hundred and eighty‑five final‑year medical students were included in this study.
The maximum score of the questionnaire was 140, and the total mean score of empathy was
98.15 ± 13.29. The females’ total mean score (102.05 ± 11.89) was higher than the males’
score (93.57 ± 13.46). The difference between the mean score of gender and empathy was
significant (P value <.001), but there was no significant difference between empathy and the two
other demographic factors (P > 0.05).
CONCLUSIONS: Although physicians would gain the essential characteristics of empathy during their
career, attending professors and other responsible policymakers in medical education should focus
more on the factors related to physicians’ empathy to train better and more professional physicians.

Abstract BACKGROUND: The coronavirus disease‑19 (COVID‑19) emerged from China and rapidly spread
to many other countries all over the world. This study aimed to assess the prevalence of anxiety,
depression, posttraumatic stress disorder, and obsessive–compulsive (OC) symptoms among
COVID‑19 survivors after their discharge from the COVID‑19 treatment center.
MATERIALS AND METHODS: This was a cross‑sectional, hospital‑based study performed among
119 COVID‑19 survivors. The Hospital Anxiety and Depression Scale (HADS) was used to measure
anxiety and depression. Posttraumatic Stress Disorder (PTSD)‑Checklist (PCL) and Brief OC Scale
were used to measure PTSD and OC symptoms. Data were analyzed by descriptive and inferential
statistics using the SPSS (IBM Corp. Released 2015 version 23.0).
RESULTS: The mean anxiety, depression, and PTSD scores were, 7.12 ± 0.68, 8.08 ± 0.22, and
19.78 ± 0.88, respectively. Based on cutoff scores, the prevalence of anxiety, depression, and
PTSD among COVID‑19 survivors was n = 53, 44.54%; n = 73, 61.34%; and n = 30, 25.21%,
respectively. Older COVID‑19 survivors (≥50 years) were more likely to show symptoms of
depression and anxiety (P < 0.001) compared to younger ones. Furthermore, COVID‑19 survivors
who were ≥50 years of age experienced a greater level of PTSD compared to younger ones; similar
trends were seen in those experiencing OC symptoms. In the present study, n = 98 (82.4%) were
obsessed with fears of contamination and an equal number had compulsive handwashing.
CONCLUSION: Anxiety, depression, PTSD, and OC symptoms are common among the COVID‑19
survivors and that underscores the need to diagnose and manage mental health morbidities among
these survivors long after their recovery from COVID‑19.

Abstract BACKGROUND: Medical images have been widely used for various aims, especially for the
educational purposes. Patient confidentiality and consent should be deemed crucial. In this study,
we sought to assess patients’ satisfaction with taking medical photos of their skin lesions and giving
their physicians consent to use them for educational purposes.
MATERIALS AND METHODS: This multi‑method study included quantitative and qualitative phases
and was performed from April to November 2018 in the Dermatology Department of Shiraz Faghihi
Hospital in South Iran. Demographic information was analyzed using the descriptive statistics. To
resolve the simultaneous effect of demographic variables on patient satisfaction, we conducted linear
regression. All the tests were analyzed at the 0.05 significance level.
RESULTS: In this study, all the patients except one (99.5%) preferred that only a physician who had a
direct role in their care can access their digital photos. Of 200 patients, 134 patients (62.33%) preferred
the utilization of hospital cameras in photographing their skin lesions (P = 0.002). On the other hand,
131 patients (49.81%) did not gave consent about using a personal phone camera for photographing
their skin lesions (P = 0.001). In the qualitative phase, two major themes (trusting attending physician
and paying attention to patient confidentiality) and five sub‑themes (considering their physicians
as professional people who always do the right thing, allowing physicians to use their images for
educational purposes, covering patient’s face, using hospital cameras, and obtaining informed consent
from patients) were derived from qualitative semi‑structured interviews.
CONCLUSION: The results showed that there is a need for developing international and national
photography guidelines in the era of technology development.

Abstract BACKGROUND: As shown in previous persons that used the effective coping strategies are more
aware to recent stressful life events in their live, this study conducted to investigate the main stressful
life events and common coping styles in adult’s population.
MATERIALS AND METHODS: This cross‑sectional study was conducted in 2018. In overall, 345
persons aged 18 years and more by stratified cluster sampling were enrolled in the study. The valid
questionnaires including the coping inventory for stressful situations‑21, the Holmes‑Rahe Stress
Inventory, and 28‑item General Health Questionnaire (GHQ‑28) were used to interview. The analysis
of variance and t‑student (t‑test) was used to determine the association between the two variables.
The statistical significance level was considered <0.05.
RESULTS: The top three importance events among 43 stressful items in our study were change
in financial state, gain of a new family member, and death of close family member. We found that
task‑oriented coping (P < 0.001) and avoidance‑oriented coping (P = 0.021) significantly more used
in males compered to females. According to Holmes‑Rahe life stress inventory instructions only 4.7%
of participants are prone to getting ill in next 2 years.
CONCLUSION: The results of this study showed a positive relationship between coping styles and
lower risk of mental health problems and stressful life events. Hence, activities and training programs
aiming to enhance personal approach coping skills is important to reduce of side effects of stressful
life events especially those recently exposed to negative life events and stresses.

Abstract BACKGROUND: There is a lack of organized effort in the arena of school health promotion, which
has been recognized as an effective approach to combat the growing incidence of communicable
and noncommunicable diseases. With this view, a study was conducted to develop comprehensive
and replicable model for health promotion in schools.
MATERIALS AND METHODS: The Knowledge to Action (KTA) framework recognized by the World
Health Organization as an implementational framework was used in an implementation study in
a school of urban Jodhpur to assess the challenges and gaps associated with health promotion
interventions in the school. Baseline regarding knowledge application and practices was gathered
using interviews with school staff, parents, and group interaction with students. Knowledge synthesis
was done by a thorough search of available literature and the gathered baseline. Resource mapping
was carried out using checklists developed from knowledge synthesis. Tailor‑made tools were
constructed for knowledge implementation for each component of the action cycle. Knowledge of
facts related to health behaviors among students was evaluated using pre‑ and postquestionnaires
and practical application of knowledge was assessed using a checklist of 28 indicators on a 5‑point
Likert scale. Values of tests were gathered and compared with test values 3 and 6 months after the
implementation of tailored interventions using descriptive and inferential statistics.
RESULTS: Increase in correct answers by students (42% to 96%) and average response for
indicators on the Likert scale (3.23–4.86) was seen on repeated interventions over 6 months. Tobacco
consumption by school staff reduced by 20% and an increase in willingness among teachers was
observed on follow‑up interviews.
CONCLUSION: The study thus developed a model for health promotion in a school with the help of
the KTA framework using tailored interventions that could further be evolved in other setups based
on local needs and available resources.

Abstract BACKGROUND: Hemodialysis patients suffer from mental disorders such as anxiety and depression.
One of the known nonpharmacological methods to eliminate these disorders is music therapy. The
present study aimed to investigate the effect of instrumental music on state depression and anxiety
in hemodialysis patients.
MATERIALS AND METHODS: This study was a clinical trial. The population was hemodialysis
patients in Hamedan in 2017 and 50 patients were selected and randomly divided into experimental
and control groups. The duration each time of the instrumental music intervention for the experimental
group was 3 weeks, 3 times a week for 20 min. Data were measured by beck depression inventory
and SpeilBerger State–Trait Anxiety Inventory‑Y1 before the intervention and immediately after
the last intervention and analyzed using Yates correction, Chi‑square test, Mann–Whitney U‑test,
independent t‑test, and Wilcoxon test.
RESULTS: No significant difference between the intervention and control groups was observed
before the study in terms of demographic variables (P > 0.05). In the intervention group, the mean
and standard deviation of the depression score before the intervention was 8.99 ± 23.68 and after
the intervention reached 7.54 ± 14.88, which shows that the variable was significant (P = 0.001);
however, no significant difference was observed in the control group. In the intervention group, the
mean of state anxiety before the intervention was 10.05 ± 53.76 and after the intervention reached
9.76 ± 42.48, which was statistically significant (P = 0.004), while no significant difference was
observed in the control group.
CONCLUSION: The results indicate the positive effect of instrumental music on reducing anxiety
and depression in hemodialysis patients. It is recommended that this therapy be used as a nursing
method to reduce state anxiety and depression in hemodialysis patients.

Abstract BACKGROUND: nongovernmental organizations (NGOs( are the hidden system of promoting public
health and the symbol and mediator of people’s participation. The aim of the present research was
to assess the status and recognize the performance of various NGOs in providing health‑oriented
services as opportunities in promoting community health.
MATERIALS AND METHODS: The present study was a descriptive–analytical (cross‑sectional)
study, which was conducted on the position and function of all NGOs in Kerman from February 2014
to the end of January 2015. A researcher‑made checklist was used to collect the data, which was
designed based on the statutes of NGOs. The information was collected from a total of 150 NGOs.
To analyze the data, in addition to descriptive statistical tests (frequency, percentage, mean, and
standard deviation), other tests were also used (Chi‑square test and Fisher’s exact test). Moreover,
all data analysis was done using SPSS (ver. 16).
RESULTS: There was a significant relationship between the levels of prevention and field of activity
and the objectives and methods of implementation of these objectives (P < 0.001). There was a
significant relationship between health prevention levels in the target community of the NGO and
initial assets (P = 0.02), licensing organization (P < 0.001), management type in terms of the board
of trustees or membership availability (P < 0.001), relevance of members’ major with organizational
goals (P = 0.02), and activeness or inactiveness of the organization (P = 0.007).
CONCLUSION: The results showed that there was a relationship between NGO’s target population
in terms of levels of prevention and the studied factors. The relationship between the services of
these organizations and the levels of prevention is a very important and effective role in community
health promotion.

Abstract BACKGROUND: In several countries such as Iran, the use of complementary and alternative medical
products like herbal medicine is growing. There is, however, a lack of research on the prospects
of herbal medicine patrons regarding facilitators and herbal medicine use barriers. The aim of this
study was to explain the facilitators and the barriers of herbal medicine use in type 2 diabetes
mellitus (T2DM) patients.
MATERIALS AND METHODS: Qualitative one‑to‑one in‑depth interviews were conducted with
patients with T2DM from the Yazd Diabetes Research Center, using a semi‑structured guide. For
the recruitment of T2DM participants who used herbal medicine beside conventional medicine,
purposeful sampling was used. Analysis of the data was carried out using the steps proposed by
Graneheim and Landman strategies.
RESULTS: Sixteen patients were interviewed. There were 2 subjects (facilitators and barriers herbal
medicine use), 8 categories, and 89 initial codes. The facilitators included individual preferences,
preparation skills, and family support and the factors obstructing the use of herbal medicine included
insufficient skills about preparing, lack of easy access to consumption, insufficient of efficacy of herbal
medicine, and negative properties of herbal medicine and taking time in preparing herbal medicine.
CONCLUSION: Although some people use herbal medicine, the interest in use of herbal medicine
is limited because of inadequate awareness of the impact and usage them. Therefore, the use of
effective strategy in the integration of herbal remedies with conventional medicine can promote
well‑being of patients.

Abstract BACKGROUND: COVID-19 lockdown has mandated the medical colleges to start academics using
electronic mode. Synchronous e-learning was started by our institute to replicate traditional classes in
line with the routine academic schedule. the objective of this study attempted to assess the e-learning
readiness of the students of our institute.
MATERIALS AND METHODS: A cross-sectional descriptive study was planned using the model
proposed by Oketch et al. with local modifications. The questionnaire was designed in Google
Forms and mailed to respond using Likert scale. The nonparametric data collected from the total 84
respondents were analyzed for validity and reliability of the questionnaire, mean values to know the
readiness (mean = 3.4), and one‑step multiple regression to know the predictors.
RESULTS: The mean eLR (e-learning readiness) as evaluated from attitudinal readiness (MeanAR = 3.6),
culture readiness (MeanCR = 2.3), material and technological readiness (MeanMTR = 3.7), and mental
health readiness (MeanMHR = 2.4) is 3.03 (60.6% with n = 84). Multiple regression analysis revealed
that all the variables except MHR can significantly predict e‑learning readiness linearly (P < 0.05).
CONCLUSION: The institute is ready for e‑learning in terms of AR and MTR (mean values >3.4).
CR and MHR still need a lot of improvisation to make it acceptable for e‑learning. The model could
explain 54.9% readiness level with CR as the most important predictor. More than 73% (n = 84) of the
respondents have acknowledged the present form of online classes to be the best available option
in COVID-19 lockdown and most of them are adapted to e-classes in the institute.

Abstract BACKGROUND: Social media platforms such as Facebook, WhatsApp, and Instagram etc., are
becoming very popular now not only for youth but for all walks of life. People are more often seen in
busy in tweeting, chatting, or putting selfies. No one actually knows the mental state of a person in
the online platform. In this article, we will be focusing on how social media is affecting issues such
as road accident, murder, and suicide. The research is done by three parts.
MATERIALS AND METHODS: Google Form analysis, machine learning used for prediction, and by
sentimental analysis of what people think in twitter. All the datasets are based in India. From these
datasets, the different machine learning algorithm is used to do the analysis. The project strives to
bring the real‑world solution in the matter of advancement.
RESULTS: The static data analysis and dynamic data analysis shows the various sentimental analysis
and predictions and the technique to predict different mental states. Thus we get clearly about the
current world is getting into social issues. This research findings helps to bring social awareness
among the current generation by understanding the sensitivity of the youths.
CONCLUSION: Thus through this paper we get known clearly how the current world is getting
into social issues like victim of murders or road accidents or committing suicide. The paper clearly
helps us to understand the sensitivity of the youths. Therefore brings a social awareness among
the current generation.

Abstract BACKGROUND: Nowadays, providing access to the required information by clinical informationist (CI)
is vital for clinical teams to make the best decision. This study was carried out to identifying how CIs
should participate in grand round (GR).
MATERIALS AND METHODS: The current study is an action research study. It was conducted in the
GR sessions of the Gastroenterology department of Al‑Zahra Hospital affiliated with Isfahan University
of Medical Sciences in 2017. Participants included attending physicians, fellowship students of the
Gastroenterology departments, a CI, and two supervising medical librarians. Data were collected
through observation and discussion. Qualitative content analysis and concept mapping were used
for data analysis.
RESULTS: The findings indicated that existing problems were related to the CI, medical team, and
infrastructural ones. The participation of the CI in medical team was arranged based on the following
steps: planning, action, evaluation, and suggestions. It started from an initial diagnosis of patients
and ended in GR meetings. During evaluation step, suggestions were made to remove the existing
problems and in the fifth step, results were summarized and a framework for the participation of the
CI in GR sessions was suggested.
CONCLUSIONS: Medical team members were satisfied with the participation of the CI, but it is
necessary to remove the existing structural and personal barriers (related to the CI and medical
team members), in order to improve the efficiency of this participation.

Abstract BACKGROUND: The role of citizens’ participation in the process of social, economic, and cultural
development is necessary. Institutionalizing this role is inevitable to identify priorities and also planning,
implementing, and evaluating health services. This study aimed to identify challenges ahead of
volunteers’ participation toward primary health‑care (PHC) system and providing managerial solutions.
MATERIALS AND METHOD: The study employed a qualitative research design. The data were
collected via semi‑structured interviews with key experts in the Ministry of Health, university education
and health promotion officials, education experts, health center staff, and health volunteers. Then,
a focused group discussion method was employed to provide solutions. The participants were
selected via the purposive sampling method. The qualitative data were analyzed using a thematic
analysis method.
RESULTS: The analyzed data were categorized into 6 main themes and 24 subthemes. The most
important challenges were categorized into six temporal, management, education, quality of services,
motivation, and infrastructural themes. Allocating special funds for the health volunteer program,
paying attention to the problems of the health workers, providing motivational programs, holding
regular retraining courses and providing educational software for health volunteers, holding regular
training courses for health trainers and volunteers, and supporting the health volunteer program are
among the solutions.
CONCLUSION: The present study showed that the health volunteer program in the PHC system
faces several challenges, most of which are organizational and managerial ones. Therefore, a
multifaceted approach should be used to improve the participation of health volunteers. In addition to
motivational factors, factors such as allocating proper resources, empowering trainers, and mobilizing
the community should be also considered. It seems that interaction among health system, people,
and health volunteers should be improved.

Abstract BACKGROUND: An interprofessional community‑based education provides proper situations
that learners can be prepared to play their professional responsibilities and team duties in the
community. This study aims to assess the effect of interprofessional community‑based education
on attitudes and performances of learners toward interprofessional collaboration and their readiness
for interprofessional learning.
MATERIALS AND METHODS: The study is a quasi‑experimental design. The learners in six different
disciplines, including medicine, pharmacy, nursing, midwifery, public health, and nutrition (n=122) at
Shahid Sadoughi University of Medical Sciences were participated in the present study. in the present
study, interprofessional education intervention was conducted in two steps. First, the interprofessional
learning situation brought learners the familiarity with the concepts of interprofessional collaboration,
teamwork, and educational medical content, such as backache, fatty liver, diabetes, and HIV. Second,
learners from different disciplines participated in interprofessional teams in community settings. These
learners taught people about health‑related topics, such as backache, fatty liver, and HIV. Participants
filled out the questionnaires before and after interventions. Data were analyzed by Student’s t‑test
and one‑way ANOVA in SPSS 16.0 software (SPSS, Inc., Chicago, IL, USA).
RESULTS: The present results showed that the scores of learners in readiness for interprofessional
learning 3.82 (0.35) versus 4.60 (0.29) (P = 0.001) (P = 0.0001), attitudes to interprofessional teamwork
3.83 (0.40) versus 4.18 (0.30) (P = 0.0001) (P = 0.0001), interprofessional collaboration 7.46 (0.70)
versus 8.35 (0.43) (P = 0.001) improved significantly before and after the educational interventions.
CONCLUSION: The present results showed that interprofessional community‑based education
has improved the readiness of the learners for interprofessional learning. Besides, attitude toward
teamwork and interprofessional collaboration performance have also been improved from participants’
viewpoints.

Abstract BACKGROUND: There is growing acknowledgment that medical education can be a stressful
experience for students and may have a devastating effect on their psychological well‑being. The
present article, therefore, aimed at investigating students’ academic resilience as a mediating variable
in self‑efficacy‑test anxiety relation.
MATERIALS AND METHODS: In this cross‑sectional correlational study, a convenience sample
of 243 medical students was selected and participated, three prevalidated questionnaires were
applied, that is, general self‑efficacy questionnaire, academic resilience questionnaire, and test
anxiety questionnaire. To analyze the data, Pearson’s correlation coefficient as well as structural
equation modeling (SEM) were used.
RESULTS: According to Pearson’s coefficients, self‑efficacy was found to be positively correlated
with academic resilience (r = 0.437, P ≤ 0.01) and negatively with test anxiety (r = −0.475, P ≤ 0.01).
SEM results also indicated that self‑efficacy positively impacts on academic resilience (β = 0.43,
P < 0.001) and negatively on test anxiety (β = −0.37, P < 0.001). In addition, results demonstrated the
mediating role of academic resilience in self‑efficacy‑test anxiety relationship (β = −0.108, P < 0.001).
CONCLUSION: This study showed that academic resilience could play a mediating role in students’
self‑efficacy‑test anxiety relationship.

Abstract BACKGROUND: The academic environment is a challenge for dental students due to the multiple
sources of stress they face. For this reason, the present study analyzes the psychometric properties
of the Dental Environment Stress (DES) questionnaire. The secondary objective was to identify the
specific sources of stress perceived by dental students related to gender and years of study.
MATERIALS AND METHODS: A cross‑sectional study was conducted among dental
students (n = 340; Mage = 22.45) from the Romanian University of Medicine and Pharmacy in
October– December 2019. The factorial structure of the questionnaire was performed by means
of the confirmatory factor analysis (CFA) and the multi group‑CFA. The convergent and divergent
validities were measured by associating DES with scales that measure depression, anxiety, and
tension/stress (Depression Anxiety Stress Scale‑21‑R), perceived stress (Perceived Stress Scale‑14),
and life satisfaction (Satisfaction with Life Scale).
RESULTS: New measure obtained supported a five‑factor and thirty‑item structure, which is gender
invariant. All the factors within DES have a significant positive correlation with depression, anxiety,
tension/stress, and perceived stress and a negative correlation with life satisfaction. The Cronbach’s
α coefficients are acceptable (range: 0.67–0.89). The female students perceive aspects related to
performance, the relations with the faculty, clinical responsibilities, and personal life to be more
stressful than males. Senior students perceive more stressed aspects related to personal life, while
freshmen have higher scores on stress associated with clinical responsibilities.
CONCLUSIONS: The present results show that DES has psychometric properties which are adequate
for the assessment of dental stress in the case of Romanian students; nevertheless, it is necessary
to extend the use of DES to students attending other universities and to dental practitioners.

Abstract BACKGROUND: The mental health of the mothers of the children with cancer is strongly influenced
by the child’s illness and treatment process. This study aimed to investigate the effect of a self‑help
educational program with peer group on anxiety of the mothers of the children with cancer.
MATERIALS AND METHODS: This clinical trial study was conducted on 44 mothers of the children
with cancer in an educational Hospital of Isfahan University of Medical Sciences, Iran. Convenience
sampling method was performed on the eligible mothers, and using random allocation, they were
divided into two groups of the intervention (n = 22) and the control (n = 22). Both groups completed
the Hamilton Anxiety Questionnaire before and after the intervention. The intervention of the study
was a self‑help educational program with peer group that was performed in collaboration with the
mothers of the children with cancer, a psychiatrist, and cancer nurses in the hospital within 3 months.
RESULTS: The results showed that 55% of the mothers of the intervention group had severe and
very severe anxiety before the intervention, but the intensity of their anxiety was reported to be
moderate after the intervention. The analysis of covariance with adjusted anxiety score in the two
groups showed that the mean score of anxiety in the intervention group decreased from 22.3 to 12.3
after the intervention, showing a significant difference (P < 0.05).
CONCLUSION: The program, designed to support the mothers and guide the specialists and
psychiatrists to counsel the mothers, can enhance their self‑help and reduce their anxiety level.

Abstract BACKGROUND: Sexual dysfunction in women is a common disorder. Yet, there is no consensus
on its treatment. Few studies have shown that Vitex agnus‑castus improves sexual dysfunction in
postmenopausal women; the present study was conducted to evaluate the effect of V. agnus‑castus
on the female sexual function in the reproductive age.
MATERIALS AND METHODS: This was a double‑blinded randomized control clinical trial on the
women of reproductive age referred to the gynecology clinic of Al‑Zahra Medical Center in Rasht, Iran,
from February 2018 to December 2019. The intervention group received Agnugol tablet containing
3.2–4.8 mg dried extract V. agnus‑castus (51 participants) and the control group received a placebo
tablet (51 participants). All participants received one tablet daily for 16 weeks. The participants were
asked to complete the Female Sexual Function Index questionnaire at the beginning of the study and
after 4, 8, 12, and 16 weeks. Data were analyzed in SPSS statistics (version 21) using Chi‑square
test, t‑test, Mann–Whitney U‑test, analysis of variance, and mixed model to examine the differences
between the groups.
RESULTS: The results showed that the difference between the two groups was not significant in
each domain, but there was a significant difference in the overall sexual function mean score so
that the intervention group had a higher score than the placebo group after 16 weeks (P < 0.05).
CONCLUSION: In the present study, it was observed that the consumption of V. agnus‑castus during
16 weeks was more effective than the placebo in improving sexual dysfunction. Further studies with
larger sample sizes are needed to be able to decide on the prescription of this drug in the clinics.

Abstract BACKGROUND: Administrative staff may be exposed to a great deal of the mental workload (MWL)
due to the long working hours and the responsibility of responding to large numbers of clients.
Occupational burnout (OB) is one of the issues that can be affected by MWL. The aim of the present
study was to investigate the relationship between mental MWL and OB, as well as the internal
interactions between OB dimensions.
MATERIALS AND METHODS: This cross‑sectional and descriptive (correlation) study was conducted
among faculty members and administrative staff of public health school of Yazd province. Samples
were collected through the simple random sampling. NASA task load index and Maslach questionnaire
were used for the assessment of MWL and OB, respectively. Frequency and percentage were used
for the descriptive analysis. Spearman, Mann–Whitney U, and Kruskal–Wallis H tests were used
for inferential statistics.
RESULTS: Ultimately, 29 individuals from faculty members and 82 individuals from administrative
staff participated in this study. Most of the participants (73.9%) had experienced many MWL instances
in performing their jobs duties. No significant relationship between MWL with OB and MWL with
any of the demographic characteristics was found, as well (P > 0.05). In case of OB, a significant
relationship was discovered between depersonalization with gender and personal accomplishment
with work section (P < 0.05).
CONCLUSIONS: MWL cannot be considered as a contributing factor of OB of the administrative
staff because no significant relationship has been noted between them. Reducing working hours,
selection of suitable staff, and allowing a few minutes to rest on a daily basis represent the suggested
solutions for reducing the MWL of staff.

Abstract BACKGROUND: Postgraduate medical curriculum is usually devoted to developing competencies
in the specialty concerned, patient care, and submitting dissertations. The need to impart teaching
skills during postgraduation has gone unnoticed, hence Ramachandra Annual Postgraduate Teaching
Skills (RAPTS), a teaching skills workshop, was conceptualized and implemented as postgraduate
students serve as tutors/residents in the department to teach undergraduate medical students. This
study is aimed to evaluate the effectiveness of the teaching skills workshop for postgraduates.
MATERIALS AND METHODS: One hundred and seventy‑eight postgraduate students of pre‑ and
paraclinical department underwent the training in medical education principles and participated in
the feedback. RAPTS Workshop was implemented as per the six‑step approach. The learning was
evaluated through a pre‑ and posttest scores. Student feedback was also obtained on the process
overall objectives and contents of the workshop. Force‑field analysis was performed.
RESULTS: There was a significant learning by the postgraduates on various medical education
principles as evidenced by significant improvement in the posttest scores (P < 0.05). Feedback
regarding the general aspects of the workshop showed that 92% of the participants felt that the
contents of the workshop suited their learning. Eighty‑four percent of the participants opined that the
presentations of the sessions were good and 91% felt that time management was good. Force‑field
analysis indicated that the factors favoring teaching skills workshop were higher.
CONCLUSION: This study has highlighted the importance of including teaching methodology training
in the postgraduate curriculum that helps in grooming the future teachers in the right direction, in
the right time. Competencies related to teaching skills based on medical education principles can
be included in the postgraduate curriculum.

Abstract BACKGROUND: The coronavirus disease 2019 (COVID‑19) pandemic has prompted the further
virtualization of medical education. The satisfaction level of specific users such as cardiology residents
with virtual education can augment its quality; hence, the significance of a valid and reliable questionnaire
to obtain feedback is needed. This study aimed to design and measure validity and reliability of a
satisfaction questionnaire for virtual education of cardiology residents during COVID‑19 pandemic.
MATERIALS AND METHODS: In this cross‑sectional study, a self‑administered questionnaire
was developed by the faculty members of Rajaie Cardiovascular Medical and Research Center.
Reliability was tested utilizing Cronbach’s alpha  and intercorrelation which was tested using Pearson’s
correlation coefficient test (ICC). Factor analysis was done by the Kaiser–Meyer–Olkin measure of
sampling adequacy and Bartlett’s sphericity test. The statistical analyses were performed with the
SPSS software version 22.
RESULTS: The face validity index was determined via an assessment of the relevance, clarity, and
simplicity of each item, and values >0.79 were accepted. The total Cronbach’s alpha coefficient was
calculated 0.93. Concerning test–retest reliability, the correlation between two rounds of evaluation
was >80 (P > 0.001) and ICC was 0.99 (P = 0.001). The content validity evaluation yielded an index of
0.95 and a ratio of 0.91. The principal component factor analysis, conducted to investigate construct
validity, generated four domains.
CONCLUSIONS: The study results confirmed the validity and reliability of the designed questionnaire
to evaluate the level of satisfaction of cardiology residents with virtual learning in COVID‑19 pandemic.

Abstract BACKGROUND: Unwanted sound is recognized as the most extensive source of contaminant
in the workplace. Exposure to intense, continuous, and higher than 85 dB level noise can lead to
noise‑induced hearing loss.The aim of the present study was to determine the level of noise exposure
and its impact on hearing health among auto body workers.
MATERIALS AND METHODS: This descriptive‑analytic study was conducted in 2020 to investigate
the hearing health status of workers in auto body workshops. Sixty‑one participants were randomly
selected for audiometric testing. The equivalent sound level (Leq) of the workers was measured using
a Casella CEL‑320 noise dosimeter. Audiometric testing was performed using an AC40 audiometer.
The mean hearing threshold levels (HTLs) of both ears were calculated for different frequencies. The
results obtained were analyzed using SPSS v21.0 at a significance level of 95%.
RESULTS: The participants had an average age of 35.5 ± 11.8 years and an average work experience
of 16.5 ± 9.8 years. The mean Leq was 92.3 ± 4.7 dB. The mean HTLs for the right ear and left ear
were 20, 15, 17.6, 19.2 dB, respectively with the right ear suffering more loss. A significant relationship
was found between hearing loss in both ears (P < 0.001). The highest prevalence of hearing loss
in both ears was observed at a frequency of 4 kHz. About 73.8% of the subjects had a normal HTL,
23.3% had mild hearing loss, and 3.3% had severe hearing loss. With increasing work experience,
HTLs also increased significantly, particularly at 2–8 kHz.
CONCLUSIONS: Chronic exposure to noise pollution threatens hearing health. Therefore, it is
necessary to raise the level of awareness among workers in order to enable better hearing health
protection and also to promote the use of hearing protection devices.

Abstract BACKGROUND: Ethical attitude of paramedic personnel is one of the most important factors in their
effective and useful performance. Therefore, according to the importance of this issue and immense
effect of religious culture on the formation of ethics, this study aimed to effect bio‑ethical principles
teaching on moral attitude of paramedic emergency personnel in Iran.
MATERIAL AND METHODS: The present study was an experimental study carried out in 2020 on
60 of paramedic emergency personnel. Samples were available, randomly selected and assigned
to two groups of control and intervention. The intervention was performed for a 2‑h workshop of
bioethical principles in 4 day based on Quran verses. Moral attitude of both groups was studied
before and after each intervention. Data were analyzed using Kolmogorov–Simonov, Chi‑square,
t‑test, one‑way, and paired t‑test with SPSS version 16 (P ≤ 0/05).
RESULTS: Ethical attitude means for both groups of control and intervention demonstrated that
ethical attitude has meaningfully increased after the workshop. Demographic variables such as age,
gender, and work experience of participants in workshops were not different between these two
groups (P < 0/05). The study of these two groups showed that there is no relationship among work
experience, gender, marital status, age, and ethical attitude.
CONCLUSION: Prehospital emergency is quite different from the other occupations in health‑care
system and the ethical issues of this field are more important. Therefore, teaching in workplace and
through ethical principles based on religious teachings will have a profound effect on improving
biological ethics of paramedic prehospital staffs.

Abstract BACKGROUND: COVID-19 was declared as pandemic by the WHO in March 2020. Social distancing
and hand hygiene is advised during the pandemic to contain the spread of the virus. Rapid sharing
of scientific information in an extraordinary way is the characteristic of the COVID-19 pandemic.
There may be gap between information provided and received. Perception and practices in the
community regarding handling materials need to be pointed out. the aim of this study was to assess
the perception about myths and facts and change in the practices before and during the COVID-19
pandemic among the faculties.
MATERIALS AND METHODS: A cross-sectional survey was conducted during May–June 2020
among the faculties of Science and Technology. By multistage sampling technique, five districts from
Maharashtra state and then one institution from each district was selected. A questionnaire was shared
by Internet to institutional faculties. Descriptive and inferential statistics (Chi-square test) is applied.
RESULTS: Out of 276 faculties, 248 had responded. Most of the faculties were aware about basic
preventive measures for COVID-19 infection. However, 25% of the faculties were unaware about
the safe physical distance. Eating garlic and pepper protect against COVID-19 as per 63 (25.3%)
and 59 (23.9%) faculties, respectively, was effective, whereas 56.8% of participants did not believe
so. 93 (37.5%) respondents believed that respiratory function ultimately indicates the presence
or absence of disease. About 95% of participants adopted new hygienic practices during the
pandemic (P < 0.0001).
CONCLUSION: COVID-19 can spread rapidly if the basic preventive measures are ignored by the
small proportion of unaware people Hence, awareness needs to be improved. People have adapted
to new hygienic practices for handling the material during the pandemic.

Abstract BACKGROUND: Clinical training during internship is an important part of medical education. The
maternity ward is a clinical environment in which medical students pass their obstetrics and gynecology
internship to obtain competencies in this field. The present study was conducted to explain medical
interns’ manner of learning in the maternity ward.
MATERIAL AND METHODS: The present study was conducted using a qualitative approach with
the inductive content analysis method. This study observed the maternity wards of teaching hospitals
affiliated to medical sciences universities of Isfahan and Shahrekord. Data were collected through
observation and semi‑structured individual interviews.
RESULTS: Two main categories and seven subcategories emerged from the analysis of the data.
Inadequate participation in learning opportunities included the following three subcategories: the
incongruousness of the learning opportunities with the educational goals, inadequate readiness for
participation in learning opportunities, and the overlap between learning opportunities and diminished
autonomous practice. Inadequate formal and structured education included the following four
subcategories: inadequate learning support and direction, subordinate roles and aimless presence,
the pale educational role played by the attendants and senior residents, and learning through the
support of midwifery educators.
CONCLUSION: Participation in and access to learning opportunities in the maternity ward are very
difficult for interns. Interns, therefore, need to attend the maternity ward by a structured program and
in the company of training supervisors or competent educators to obtain the required competencies
in pregnancy and childbirth.

Abstract BACKGROUND: Social resources help to adapt to stress and might positively affect the well‑being
of individuals with severe conditions like human immunodeficiency virus/acquired immunodeficiency
syndrome (HIV/AIDS). The present study investigates the effect of social support, social capital, and
coping in a positive state of mind of Iranian older people with HIV/AIDS.
MATERIALS AND METHODS: This cross‑sectional study was conducted on 160 older people with
HIV referred to AIDS clinics in Tehran in 2019. Samples were randomly selected from patients aged
50 years and older. Data were collected using a questionnaire, a positive state of mind, social capital,
coping, social support, and a checklist of demographical variables. Data analysis was performed
using SPSS software version 21.
RESULTS: A significant positive correlation was found between social support, social capital, coping,
education, and a positive state of mind. A significant negative correlation was also found between
age, several chronic diseases of the patient, and a positive state of mind. The linear regression results
showed that social support, social capital, coping, and education improved the positive state of mind.
CONCLUSIONS: Based on our findings, we believe that social and psychological interventions
effectively enhance patients’ positive state of mind with HIV and ultimately, improve their quality of life.

Abstract BACKGROUND: Given coronavirus disease (COVID‑19’s) unknown nature, diagnosis, and treatment
is very complex up to the present time. Thus, it is essential to have a framework for an early prediction
of the disease. In this regard, machines learning (ML) could be crucial to extract concealed patterns
from mining of huge raw datasets then it establishes high‑quality predictive models. At this juncture,
we aimed to apply different ML techniques to develop clinical predictive models and select the best
performance of them.
MATERIALS AND METHODS: The dataset of Ayatollah Talleghani hospital, COVID‑19 focal center
affiliated to Abadan University of Medical Sciences have been taken into consideration. The dataset
used in this study consists of 501 case records with two classes (COVID‑19 and non COVID‑19) and
32 columns for the diagnostic features. ML algorithms such as Naïve Bayesian, Bayesian Net, random
forest (RF), multilayer perceptron, K‑star, C4.5, and support vector machine were developed. Then,
the recital of selected ML models was assessed by the comparison of some performance indices such
as accuracy, sensitivity, specificity, precision, F‑score, and receiver operating characteristic (ROC).
RESULTS: The experimental results indicate that RF algorithm with the accuracy of 92.42%, specificity
of 75.70%, precision of 92.30%, sensitivity of 92.40%, F‑measure of 92.00%, and ROC of 97.15%
has the best capability for COVID‑19 diagnosis and screening.
CONCLUSION: The empirical results reveal that RF model yielded higher performance as compared
to other six classification models. It is promising to the implementation of RF model in the health‑care
settings to increase the accuracy and speed of disease diagnosis for primary prevention, screening,
surveillance, and early treatment.

Abstract BACKGROUND: Ethic education as a part of medical school curriculum is one which requires
constant re‑evaluation and re‑emphasis. The medical regulatory body of India has, in recent times,
introduced a revised module of the same, which is implemented across the country in all medical
schools. Medical students’ perception of ethics education is an important variable which will influence
the validity of this module. This study attempts to evaluate the same.
MATERIALS AND METHODS: A peer‑validated questionnaire was distributed to 150 undergraduate
and postgraduate medical students (response rate: 74.4%) with the aim to evaluate their attitude
toward knowledge of ethics, and their perceptions of contents and methods of learning ethics.
RESULTS: A significant number of students recognize the importance of medical ethics knowledge
and its positive impact on their career (P < 0.05). They accept material taught as per planned
curriculum as a source of learning and favor interactive methods of teaching (P < 0.05). Research
projects and didactic lectures were rejected as learning methods (P < 0.05).
CONCLUSION: “Deliberate teaching” has been accepted as a source of learning ethics by all students,
though undergraduate students also favored learning about ethics “during practice.” Perceptions
have been identified that need to be addressed. The study reveals a need to further explore the
purpose and contribution of role models in this context and to identify ways of strengthening their
related perceptions by students.

Abstract BACKGROUND: Various kinds of stressors and psychological problems have been reported in
the adolescent student population. This study assessed and compared depression, anxiety, and
various coping styles among high school students attending coaching classes for medical entrance
examination (MEE) and those not.
MATERIALS AND METHODS: Systemic random sampling technique was used to recruit 400 high
school students with equal number of those attending (Group 1) and those not attending any coaching
class for MEE (Group 2). They underwent screening for depression and anxiety through Patient Health
Questionnaire‑9 and Generalized Anxiety Disorder 7‑item. Coping styles were assessed through
brief COPE inventory. Screening positive subjects were assessed in detail by a psychiatrist using
ICD‑10 (International Classification of Diseases 10th Revision), Diagnostic Criteria for Research (DCR).
The severity of depression and anxiety was measured through HAM‑D and HAM‑A, respectively.
RESULTS: Depression and anxiety were reported by higher proportion of Group 1 (36%) than
Group 2 (22%), χ2 (1) = 9.52; P = 0.002. In both the groups, depressive disorder was the most
common, followed by generalised anxiety–disorder and mixed anxiety–depression. The severity
of depression (HAM‑D score) and anxiety (HAM‑A Score) was significantly more Group 1. “Active
coping” (χ2 = 4.79 P = 0.02) and “Humor”  (χ2 = 30.90, P ≤ 0.01) were more commonly used by
healthy students, while “Religious coping” (χ2 = 37.92 P ≤ 0.01) were the most common among
those diagnosed with depression/anxiety disorder.
CONCLUSION: Higher prevalence of the psychological problems in adolescent school students
preparing for MEE highlights the importance of aptitude assessment, career counseling, and school
mental health program before their exposure to the competitive academic atmosphere.