Journal of Education and Health Promotion

A nurturing environment for teaching molecular biology to medical students

. Mahsan Samadi; . Yousof Gheisari

Volume 11, Issue 8 , September 2021, Pages 1-2

Abstract

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Health literacy and its dimensions in elderly people in Farsan city, Iran

. Reza Mahmoodi; . Akbar Hassanzadeh; . Majid Rahimi

Volume 11, Issue 8 , September 2021, Pages 1-5

Abstract

  BACKGROUND: Health literacy is an important variable in the promotion and improvement of thehealth of all social groups, especially the elderly people. It indicates cognitive and social ...  Read More BACKGROUND: Health literacy is an important variable in the promotion and improvement of thehealth of all social groups, especially the elderly people. It indicates cognitive and social skills thatspecify the individuals’ motivation and ability to access and perceive information using methodsfor health retention and improvement. The present research aimed to study health literacy and itsrelevant dimensions in a population over 60 years of age in Farsan city.MATERIALS AND METHODS: A cross‑sectional study on 384 older people in Farsan city wasconducted, using a standard health literacy questionnaire including 33 items and 5 dimensions ona 5‑point Likert scale for collecting data. Data analysis was done using descriptive and analyticalstatistics, using the multiple linear regression analysis.RESULTS: Among the dimensions, the highest and lowest scores belonged to decision‑making andreading skill dimensions, respectively. The multiple linear regression analysis revealed that amongthe demographical variables, education level, age, sex, and job were the best predictors of totalscores of health literacy (P < 0.001).CONCLUSIONS: The health‑related institutions should make effort to improve the elderly people’shealth literacy based on general literacy, using suitable methods with less need to read and payingattention to personal characteristics.

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Effect of sense of coherence on oral health behavior and status: A systematic review and meta‑analysis

. Roksana Poursalehi; . Arash Najimi; . Bahareh Tahani

Volume 11, Issue 8 , September 2021, Pages 1-17

Abstract

  The sense of coherence (SOC) is defined as a personal orientation to life. People with higher SOCare better at dealing with stressful situations, psychological stress, and problems ...  Read More The sense of coherence (SOC) is defined as a personal orientation to life. People with higher SOCare better at dealing with stressful situations, psychological stress, and problems and are more ableto manage them, leading to better general health. The purpose of this study was to evaluate the effectof SOC on the oral health status of people in different age groups. A systematic search up to May2019 was carried out in PubMed,Scopus, Psycho info, and Persian sources. Studies were includedif they evaluated the relationship between SOC and oral health behaviors (OHBs) or oral healthstatus including dental caries. The Newcastle‑Ottawa checklist was used to appraise the selectedarticles and meta‑analysis of included studies were performed using Comprehensive Meta‑Analysissoftware. Value of P < 0.05 was considered to be statistically significant. Odds ratio (OR) was usedto measure effect size with 95% confidence interval (CI). The random‑effects model was chosenin the presence of heterogenicity. I2 index and Q index were used to measure the heterogeneitypresent between the studies. Fifteen articles received the minimum score of criticism. In general,SOC could significantly affect the oral health and OHBs of adults independently of the underlyingfactors. There was a significant relationship between SOC and tooth decay in adolescents, but thisassociation was poor after adjusting for the underlying factors. In children, only one article revealedan association with OHBs. Meta‑analysis revealed that SOC was significantly associated with thecaries rate (OR = 0.78, CI 95% = 0.9–0.67, P = 0.001) and tooth brushing frequency (OR = 1.22,CI 95% = 1.1–1.31 and P < 0.001). Sense of coherence appears to be one of the effective factorsin predicting oral health behaviors and ultimately oral health, especially in adults. The number ofarticles available for children and adolescents was not sufficient in this regard.

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Virtual learning during the COVID‑19 pandemic: What are the barriers and how to overcome them?

. Sujata Yadneshwar Khobragade; . Htoo Htoo Kyaw Soe; . Yadneshwar Sudam Khobragade; . Adinegara Lutfi bin Abas

Volume 11, Issue 8 , September 2021, Pages 1-10

Abstract

  CONTEXT: Virtual learning is not without challenges. It can cause stress, lack of motivation, and socialisolation. Due to COVID‑19 pandemic, our college shifted from face‑to‑face ...  Read More CONTEXT: Virtual learning is not without challenges. It can cause stress, lack of motivation, and socialisolation. Due to COVID‑19 pandemic, our college shifted from face‑to‑face to virtual teaching–learningstyle. the aim was to find out the barriers in virtual learning among medical students and providesolutions to overcome them.MATERIALS AND METHODS: This cross‑sectional study was conducted among 3rd‑ and 4th‑yearBachelor of Medicine and Bachelor of Surgery students in 2020. Prevalidated electronic survey formson institutional barrier, technical barrier, and individual barrier were sent to students, 160 studentsresponded. SPSS version 12 was used to calculate descriptive statistics and independent t‑test.RESULTS: The students had the highest mean score in individual barrier(mean: 2.82 [standard deviation (SD): 0.72]) followed by institutional barrier (mean: 2.79 [SD: 0.74])and technological barrier (mean: 2.72 [SD: 0.75]). Regarding technological barriers, 38.6% of thestudents agreed difficulty in procurement of the laptop and 66.4% faced slow Internet connection.Regarding institutional barriers, 75.9% were stressed to join one lecture to another lecture as thelectures were continuous, 69.6% had limited opportunity to interact with lecturers, and 62.7% hadpoor communication between lecturers and students. Regarding individual barriers, 74.1% of thestudents were not motivated for online learning, 71.5% of the students could not learn as well asthey were in the classroom, and 58.2% disagreed taking online courses in future.CONCLUSION: Low motivation, communication, Internet connectivity, and technical problems werethe main barriers. Smaller size class, highly motivated and well‑trained lecturers, and interactivelectures may help in breaking the barriers of virtual learning.

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Prevalence of water pipe smoking and associated risk factors among female adolescents

. Saeed Bashirian; . Majid Barati; . Manoochehr Karami; . Behrooz Hamzeh; . Elahe Ezati

Volume 11, Issue 8 , September 2021, Pages 1-7

Abstract

  BACKGROUND: The prevalence of water pipe smoking is increasing among young people, butthere are limited data on its use among adolescents in Iran. The aim of this study is to investigate ...  Read More BACKGROUND: The prevalence of water pipe smoking is increasing among young people, butthere are limited data on its use among adolescents in Iran. The aim of this study is to investigate theprevalence of WP smoking and associated risk factors among female adolescents in Western Iran.MATERIALS AND METHODS: This cross‑sectional study was conducted in schools. It included 1302middle school (48.1%) and high school (51.9%) female students (grades 7–12) recruited throughstage random sampling and conducted in 2019 in the western city of Kermanshah, Iran. The datacollection tool was a researcher‑made questionnaire. Logistic regression analyses and descriptivestatistics were executed using SPSS version 22.RESULTS: The mean (standard deviation) ages of the students and the ages when the participantsstarted WP smoking were 15.22 ± 1.85 and 13.64 (1.64), respectively. Nearly 32.2% had a singleexperience of WP smoking during their lifetime and 20.4% were current consumers of WP. Mostof the subjects smoked WPs at their friends’ home (45.8%) and with their friends (47.4%). Thesignificantly important factors that affect WP smoking in these age groups are the father’s andmother’s occupation, family size, living with others, father’s education, having a friend who smokesWPs, friends’ encouragement to smoke WP, and being in a family that smoke WPs.CONCLUSIONS: Considering the increasing popularity of WP among adolescent females and itsincreasing prevalence, the results showed that Water pipe smoking with friends played a key role inWP smoking among female adolescents. There is a need to design interventional studies to increasepeople’s skills and to design and implement programs to prevent water pipe.

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Knowledge, Attitudes, and Practices toward COVID‑19 among Persian Birth Cohort Participants

. Majid Mirmohammadkhani; . Maryam Bemanalizadeh; . Maryam Yazdi; . Parvin Goli; . Fatemeh Mohebpour; . Elham Saffarieh; . Navid Danaei; . Fatemeh Paknazar; . Seyede Shahrbanoo Daniali; . Roya Kelishadi

Volume 11, Issue 8 , September 2021, Pages 1-9

Abstract

  BACKGROUND: Knowledge, attitudes, and practices (KAP) toward COVID‑19 play an importantrole in controlling the outbreak. The present study aimed to investigate the KAP of a group ...  Read More BACKGROUND: Knowledge, attitudes, and practices (KAP) toward COVID‑19 play an importantrole in controlling the outbreak. The present study aimed to investigate the KAP of a group of womentoward COVID‑19 during the second wave of the outbreak in Iran.METHOD AND MATERIAL: A cross‑sectional survey of 2862 women was conducted in May and June2020 in two centers of Persian birth cohort . The survey instrument was a self‑reported questionnaireMultivariable linear regression analysis to identify factors associated with knowledge and practice.toward COVID‑19 and multinomial logistic regression analyses to identify factors associated withattitudes. Unstandardized regression coefficients (β) and odds ratios and their 95% confidenceintervals were used to quantify the associations between variables and KAP.RESULT: Good knowledge and optimistic attitudes toward the successful control of COVID‑19 wasseen among participants. Overall, about 57.3% (1640), 41.1% (1176), and 1.6% (46) of respondentswere categorized as low (score <50%), moderate (score: 50%–80%), and high (score > 80%) properpractice, respectively. Eighty‑five individuals with COVID‑19 experience (3.0%) had lower knowledgescore (79.91 ± 17.93 vs. 83.81 ± 13.88, P < 0.001) and lower proper practice score (40.22 ± 16.57 vs.47.96 ± 16.15, respectively, P < 0.001) compared to those who were not infected. A higher level ofknowledge was associated with appropriate practice in both groups of positive attitudes (χ2 = 32.23,P < 0.001) and negative attitudes (χ2 = 31.49, P < 0.001).CONCLUSION: This survey recorded good knowledge and relatively good attitudes among women.Special health policies plan should be taken for target populations among women during the COVID‑19pandemic.

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Validation of newly developed culturally specific diabetes self‑management education and support program for Iraqi type 2 diabetes mellitus patients

. Ehab Mudher Mikhael; . Mohamed Azmi Hassali; . Saad Abdulrahman Hussain

Volume 11, Issue 8 , September 2021, Pages 1-9

Abstract

  BACKGROUND: Diabetes self‑management (DSM) is the cornerstone in diabetes mellitus (DM)management. Unfortunately, the practice of DSM by Iraqi type 2 DM (T2DM) patients is poor thatmainly ...  Read More BACKGROUND: Diabetes self‑management (DSM) is the cornerstone in diabetes mellitus (DM)management. Unfortunately, the practice of DSM by Iraqi type 2 DM (T2DM) patients is poor thatmainly resulted from their poor knowledge about the required DSM behaviors. This lack of knowledgemay be attributed to the lack of DSM education and support (DSMES) program in Iraq. Thus, thisstudy was conducted with aim of developing and validating a culturally specific DSMES programfor Iraqi T2DM patients.MATERIALS AND METHODS: The development and validation of the DSMES program wasdone according to the Hilda Taba model. Content validity of the program was done by a panel of 6health‑care experts in management of Iraqi DM patients. Face validity was confirmed by conductinga pilot study for six adults with uncontrolled T2DM at the National Diabetes Center, Baghdad, Iraq.Both the experts and patients were asked to evaluate the developed program in regard to its contents,design, and supporting material (booklet). The evaluation was done by filling in a questionnaire thatbased on a 5‑point scale. Items with a score ≥4 by <70% of the experts and patients were subjectedto revision and further assessment.RESULTS: No total disagreement for any item was expressed by all participants (experts andpatients). Content and face validity was ensured through obtaining a positive feedback from allparticipants at which all items about the program had scores of ≥4 by at least 75% of participants.CONCLUSION: The developed culturally based DSMES program is highly suitable for educatingIraqi T2DM patients.

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New financial management system for Iran public health sector: A qualitative study

. Masoud Abolhallaj; . Mehdi Jafari; . Hesam Seyedin; . Masoud Salehi; . Arefeh Pourtaleb; . Keyvan Rahmani; . Seyede-Elahe Hosseini

Volume 11, Issue 8 , September 2021, Pages 1-7

Abstract

  BACKGROUND: Financial management system acts as a driving force and the first important principleof health sector reform. This study aimed to prepare a framework for new financial managementsystem ...  Read More BACKGROUND: Financial management system acts as a driving force and the first important principleof health sector reform. This study aimed to prepare a framework for new financial managementsystem in Iran health sector.MATERIALS AND METHODS: This qualitative study was conducted by content analysis approachand 15 key informant participants selected through purposive sampling consisted of three minsters ofMinistry of Health and Medical Education (MOHME), three vice‑chancellors in the Center of ResourceDevelopment and Management, Two members of the Health Assembly of the Islamic Consultative,four Medical Sciences university’s presidents, and three managers in Budgeting and performanceMonitoring Center of MOHME in 2017. Data were collected through semi‑structured interviews andthey were analyzed using Atlas T6 software.RESULTS: Six main themes were emerged as follow: “legal reform,” “removing barriers to set upaccrual accounting,” “cost price calculation,” “operational planning and budgeting,” “human resources’organization, recruitment, and moderation,” and “financial system output utilization (managementaccounting techniques) as the base for evidence‑based policymaking and decision‑making practices.”CONCLUSION: Any efforts for improving the current situation and reducing of mentioned limitationscould be useful in providing required space for future phases of reforms and calculation of unit cost,operational budgeting, and management of cost and productivity. This can be achieved through anintegrated system of recording and producing standard and accrual financial information. Furthermore,changing the accounting process and the financial system that complies with one single encodingin the country is a key issue.

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Prevalence and correlates of anemia among women in the reproductive age (15–49 years) in a rural area of Tamil Nadu: An exploratory study

. A. Jenit Osborn; . G. M. Muhammad; . S. L. Ravishankar; . Anil C. Mathew

Volume 11, Issue 8 , September 2021, Pages 1-7

Abstract

  BACKGROUND: Anemia is a major public health problem among reproductive‑aged women in India.Despite many programs implemented for decades to fight anemia, still the prevalence of anemia ...  Read More BACKGROUND: Anemia is a major public health problem among reproductive‑aged women in India.Despite many programs implemented for decades to fight anemia, still the prevalence of anemia ishigh because its associated factors vary among different regions. This exploratory study was carriedout to find the prevalence of anemia and factors influencing it among nonpregnant reproductive‑agedwomen (15–49 years) in a rural area of Coimbatore.MATERIALS AND METHODS: The study was conducted in the field practice area of Rural HealthTraining Centre, PSG IMSR, Coimbatore, during March 2016 to August 2016. Participants wererecruited by two‑staged random sampling method and 426 participants were enrolled. A predesignedsemi‑structured questionnaire was used to collect the data pertaining to the factors influencing theprevalence of anemia, and their hemoglobin level was measured using a hemoglobin photometer.The data were analyzed using SPSS‑24. (IBM Corporation, SPSS Inc., Chicago, IL, USA) Univariateanalysis was done using Chi‑square test and the strength of association was estimated by oddsratio. Those factors which were found to be significant by univariate analysis were further subjectedto multivariate logistic regression analysis. P < 0.05 was considered statistically significant.RESULTS: The prevalence of anemia was estimated as 64.8% (95% confidence interval: 60%–69%).Significant predictors for anemia among the study participants were less frequent intake of greenleafy vegetables (adjusted odds ratio [AOR] = 3.65, confidence interval [CI]: 2.17–6.12), lowsocioeconomic status (AOR = 3.36, CI: 1.93–5.84), illiteracy (AOR = 3.09, CI: 1.09–5.24), birthspacing <2 years (AOR = 2.49, CI: 1.19–5.25), excessive menstrual bleeding (AOR = 2.27, CI:1.09–4.76), and inadequate knowledge regarding anemia (AOR = 2.03, CI: 1.19–3.44).CONCLUSION: Anemia is still prevalent in high magnitude in reproductive‑aged women, andmeasures to prevent and control it are not optimum. Hence, its multifactorial determinants have tobe addressed to alleviate its burden.

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Utilizing “Positive deviance inquiry” to explore factors influencing child health: A qualitative study

. Rupali Sabale; . Barsha Gadapani Pathak; . Rukman M. Manapurath

Volume 11, Issue 8 , September 2021, Pages 1-7

Abstract

  BACKGROUND: India is a lower middle‑income country with one of the fastest growing economiesin the world. Despite improvements in its economy, it has a high child mortality rate, ...  Read More BACKGROUND: India is a lower middle‑income country with one of the fastest growing economiesin the world. Despite improvements in its economy, it has a high child mortality rate, with significantdifferences in child mortality both between and within different states. In this research, we tend toexplore factors as to how a particular child’s growth is optimal. With this aim, we utilized positivedeviance inquiry to study the factors influencing under five child’s health.MATERIALS AND METHODS: This qualitative study was carried out in Naigoan, an urban healthsetting of metropolitan city with 37 sample size between July 2020 and September 2020. It consistedof total 16 in‑depth interviews (IDIs), 3 focus group Discussion (FGDs), and 7 key informantinterviews (KIIs) which were performed by predesigned guides.RESULTS: Various themes evolved with the interviews; however, triangulation of the concept (fromFGDs, IDIs, and KIIs) occurred with the following themes: satisfaction among mothers for health‑careservices, community participation, family support, and new interventions.CONCLUSION: Mothers’ satisfaction to health‑care services, community participation, family support,and innovations by the health‑care providers are the influencing factors in promoting child’s health.Further research can be conducted to understand the in‑depth understanding of each factor.

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The of effect of partnership‑based education on adherence to the treatment plans in open heart surgery

. Fatemeh Bahramnezhad; . Neda Sanaie; . Alun C. Jackson; . Esmail Shariati; . Foroozan Atashzadeh‑Shoorideh

Volume 11, Issue 8 , September 2021, Pages 1-9

Abstract

  BACKGROUND: Adherence to the treatment plans is one of the most effective conducts to preventand reduce postoperative side effects. Partnership‑based education is one of the most ...  Read More BACKGROUND: Adherence to the treatment plans is one of the most effective conducts to preventand reduce postoperative side effects. Partnership‑based education is one of the most efficient ways toshape health behaviors. The aim of the present study was to determine the effect of partnership‑basededucation on adherence to the treatment plans in open heart surgery.MATERIALS AND METHODS: This quasi‑experimental study was conducted in 2019–2020 onthe patients undergoing open heart surgery in Tehran (Capital of Iran). Sampling was done in oneeducational hospital. A total of 86 patients and their caregivers participated in the study. Samplingwas done nonrandomly by tossing a coin, and patients were allocated into the odd week in theintervention group and the even week in the control group (n = 43 in each group), and data werecollected before and after intervention using the Treatment Adherence Questionnaire concerningdietary, physical activity, and medication aspects. The educational intervention was carried out afterthe pretest analysis in five 20–45 min sessions (two individual and three group educations). Datawere analyzed with Chi‑square, independent t‑test, and paired t‑test using SPSS 19 at a significancelevel of P < 0.05.RESULTS: Patients and caregivers in both groups did not have a significant difference in terms ofdemographic variables (P > 0. 05). In addition, there was no significant difference in the mean ofdietary, physical activity, and medication plans before the intervention in both groups; however, afterthe intervention, the mean of the three aspects in the intervention group was significantly higher thanthat of control (P < 0.001).CONCLUSION: Implementing partnership‑based education with participation of patients andcaregivers is influential in improving patients’ adherence to the treatment plans and it is recommendedas a clinical dynamic educational strategy.

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Prevalence and predictors of depression in type 2 diabetes mellitus

. Ravi Kant; . Poonam Yadav; . Shruti Barnwal; . Vishal Dhiman; . Bruzily Abraham; . Kanchan Gawande

Volume 11, Issue 8 , September 2021, Pages 1-6

Abstract

  BACKGROUND: Type 2 diabetes mellitus (DM) is a multifactorial disease and can be described as anoncommunicable disease of epidemic magnitude. Little is known about the predictors of ...  Read More BACKGROUND: Type 2 diabetes mellitus (DM) is a multifactorial disease and can be described as anoncommunicable disease of epidemic magnitude. Little is known about the predictors of depressionin this population, especially among the Indian population. This study explores the predictors fordepression in patients with type 2 DM.MATERIALS AND METHODS: A cross‑sectional study was performed for a period of 7 monthsduring 2018–2019. The data were collected from 250 subjects at the diabetic clinic and psychiatryoutpatient department of a tertiary care teaching hospital. T2DM with an age group of 18–60 yearswere included. Exclusion criteria were clinical evidence of any significant Axis I psychiatric disorderaccording to the International Classification of Diseases‑10 Diagnostic Criteria for Research otherthan depression and substance use disorders. Data were analyzed with multiple linear regressionanalysis using SPSS‑23 version.RESULTS: Male and female patients were 127 (50.80%) and 123 (49.20%), respectively. Theprevalence of depression was 49.20% among 250 patients with T2DM. Female patients had higherdepression than male patients. We found age (P = 0.013), female gender (P = 0.041), locality of thepatient (P = 0.021), body mass index (BMI) (P = 0.018), and fasting blood sugar (FBS) (P = 0.045)as significant predictors of depression among T2DM patients.CONCLUSIONS: The study concludes that females and elderly patients were more affected bydepression. The predictors of depression were age, gender, locality, BMI, and FBS among diabeticpatients. The findings indicate to screen the patients of T2DM for depression, predominantly femaleand elderly patients, at regular intervals as per clinical demand.

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The effectiveness of lifestyle training program promoting adolescent health with polycystic ovarian syndrome: A study protocol for a randomized controlled study

. Fatemeh Nahidi; . Fahimeh Ramezani Tehrani; . Delaram Ghodsi; . Mahdi Jafari; . Hamid Alavi Majd; . Somayeh Abdolahian

Volume 11, Issue 8 , September 2021, Pages 1-7

Abstract

  BACKGROUND: Lifestyle training is of a key important in adolescent age for better life in the future.Healthy lifestyle in adolescents can management of any disease such as diabetes ...  Read More BACKGROUND: Lifestyle training is of a key important in adolescent age for better life in the future.Healthy lifestyle in adolescents can management of any disease such as diabetes and polycysticovarian syndrome (PCOS). Schools can provide an important environment to identify and changethe lifestyle of students. The aim of this protocol is designing and evaluating the effectiveness ofschool‑based lifestyle training program improving the PCOS of adolescents.MATERIALS AND METHODS: A cluster‑randomized controlled trial will be conducted to examinethe effectiveness of school‑based lifestyle training program in 16 to 18 years old adolescent girls.The healthy lifestyle program will be designed by modification of behavioral habit, dietary intake,and physical activity and educated in eight sessions for adolescents and one session for parents inthe intervention groups with sixty participants.RESULTS: Changes in primary and secondary outcomes in PCOS and healthy adolescentsbefore and after intervention in the intervention and control groups will be analyzed for evaluationeffectiveness by one‑way ANOVA or other nonparametric equivalents.CONCLUSION: The current study will provide information on the effectiveness of school‑basedlifestyle training programs for adolescents. With increasing numbers of PCOS at risk for long‑termand/or late effects of treatment and other chronic diseases, efforts for promoting the healthy lifestyleof this important group are urgently needed. This lifestyle program may provide valuable informationrelating to the development of other healthy lifestyle interventions for PCOS and result in appropriatebehavior change and self‑management strategies.

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Achievements and challenges of India’s sanitation campaign under clean India mission: A commentary

. Manas Ranjan Behera; . Himanshu Sekhar Pradhan; . Deepanjali Behera; . Damodar Jena; . Sudhir Kumar Satpathy

Volume 11, Issue 8 , September 2021, Pages 1-7

Abstract

  Universal access to safe sanitation is yet to be accomplished in India. Although Clean IndiaMission (named as “Swachh Bharat Mission (Gramin)” for rural India) claims that ...  Read More Universal access to safe sanitation is yet to be accomplished in India. Although Clean IndiaMission (named as “Swachh Bharat Mission (Gramin)” for rural India) claims that the sanitationcoverage in rural India has increased from 39% to 100% of households from 2014 and 2019, yetopen defaecation continues in India in large numbers. This article discusses the achievements onSwachh Bharat Mission (Gramin) and identifies the existing challenges that need to be acted on toachieve the success of India’s Swachh Bharat Mission. We searched international database mainlyGoogle scholar, Pubmed, Medline, Scopus, and Science direct using “Clean India,” “Swachh Bharat,”“Sanitation,” “Open defecation,” “Environmental heath,” and “India” as search keywords in differentcombinations. In addition, websites of relevant United Nations (UN) agencies, Government of Indiaand leading newspaper and national agencies were also searched manually for related publicationsand reports. In the last 5 years (2014‑2019), significant efforts have been made for the Swachh BharatMission by creating various social movements and awareness program to improve toilet coveragethroughout India. Over 100 million, latrines have been built as of the end of the first phase of SwachhBharat Mission (Gramin) as on October 2, 2019 and all villages across the districts of India havebeen declared Open Defaecation Free. Still, nearly half of the rural population (52.1%) defecate inthe open. Lack of piped water supply, poor construction of toilet substructures and misconceptionamong people about toilet use remain as key challenges in the achievement of India’s sanitationmission. Sanitation‑related behavioral change and improvement in toilet facilities must be prioritizedto ensure usage of built toilets and eventually can accelerate the universal access to sanitation andmeet Sustainable Development Goals.

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Effects of blended aromatherapy using lavender and damask rose oils on the test anxiety of nursing students

. Narges Hashemi; . Fatemeh Nazari; . Aref Faghih; . Mostafa Forughi

Volume 11, Issue 8 , September 2021, Pages 1-6

Abstract

  BACKGROUND: People experience extreme anxiety in testing situations, so it considers as apsychological condition and can actually impair learning and hurt test performance. People experiencesome ...  Read More BACKGROUND: People experience extreme anxiety in testing situations, so it considers as apsychological condition and can actually impair learning and hurt test performance. People experiencesome degree of stress and anxiety before and during examinations. This study aimed to investigatethe effect of blended aromatherapy using lavender and damask rose oils on the test anxiety ofnursing students.MATERIALS AND METHODS: The present study was a single‑blinded clinical trial study. Seventynursing students were selected and randomly assigned to two experimental and sham groups. Forthe experimental group, seven droplets of lavender, 10%, and three droplets of damask rose oil,10%, and for the sham group, ten droplets of sesame oil were poured on a nonabsorbent pad whichwas placed within a 20‑cm distance from the students’ noses on their chairs’ handles. The data werecollected by using a two‑part questionnaire including demographic information and State‑Trait AnxietyInventory 1, before, 15 min after the intervention, and immediately at the end of the test. Data wereanalyzed using descriptive (frequency, mean, and standard deviation) and inferential (independentt‑test, ANOVA with repeated measure, Fisher’s exact test, and least significant difference post hoctest) statistics.RESULTS: It was found that no significant difference between the two groups in terms of age, thenumber of credits, Semester Grade Point Average and, gender, place of residence and maritalstatus and the two groups were almost identical in regard of the above variables (P > 0.05). Stateanxiety mean scores of the experimental group were lower than the mean scores of the sham group,15 min after the intervention and at the end of the test, and the difference between the groups wasstatistically significant (P < 0.05).CONCLUSIONS: Blended aromatherapy is effective in improving the test anxiety of nursing students.Therefore, it can be used as a therapeutic approach to reduce test anxiety.

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An altmetric analysis of online news on India’s first indigenous COVID‑19 vaccine

. Abhishek Royal; . Sameena Ahmad; . Athar Qureshi; . Vishal Chaudhary; . Tamanna Jindal; . Vaibhav Kumar; . Kedar Mehta

Volume 11, Issue 8 , September 2021, Pages 1-8

Abstract

  BACKGROUND: Covaxin is the first indigenous vaccine developed in India against COVID‑19. Thepurpose of this study was to analyze the news stories on Covaxin published in the online ...  Read More BACKGROUND: Covaxin is the first indigenous vaccine developed in India against COVID‑19. Thepurpose of this study was to analyze the news stories on Covaxin published in the online mediabetween two statements issued by Indian Council for Medical Research on 2nd and 4th July for theircontent, quality of information, and reporting standards.MATERIALS AND METHODS: A systematic search was performed on Google to identify the newsstories related to Covaxin in the English language published between these two statements. Theselected news stories were subjected to content analysis and reviewed using the screening pointsdeveloped through a consultation by two independent experts using ten prevalidated criteria forhealth news review. The data were analyzed in MS Excel and StataMP14.RESULTS: The final analysis included 24 news stories. The mean and median score of the newsstories is 10.71 and 12 (out of 20), respectively, with a score ranging from 2 to 17. The stories didnot promote disease or vaccine mongering (100%), adequately mentioned the true novelty of thevaccine (95.8%), and source of the information (83.3%). However, they mostly failed to mentionthe information on costs, research data related to benefits, and harms and quality of the availableevidence.CONCLUSION: There is a lack of reporting of detailed analysis about the methodology of developmentof the vaccine and limitations in its research design by health journalists. It is important to trainjournalists on proper reporting of health news to improve its quality in Indian media.

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Workplace interpersonal conflict in prehospital emergency: Concept analysis

. Mohammad Parvaresh‑Masoud; . Mohammad Ali Cheraghi; . Masoomeh Imanipour

Volume 11, Issue 8 , September 2021, Pages 1-8

Abstract

  BACKGROUND: In the turbulent and stressful work environment of prehospital emergencies, the conflictamong emergency medical technicians (EMT) and other health‑care providers is inevitable. ...  Read More BACKGROUND: In the turbulent and stressful work environment of prehospital emergencies, the conflictamong emergency medical technicians (EMT) and other health‑care providers is inevitable. This studyaims to examine the concept of workplace interpersonal conflict (WIC) in prehospital emergencies.MATERIALS AND METHODS: The eight‐step Walker and Avant’s concept analysis approach wasadopted to define the concept. Iranmedex, SID, Magiran, ISC, PubMed, Scopus, Embase, and Webof Science searched with keywords such as WIC and hospital emergencies. After an extensive reviewof online national and international databases, one dictionary, nine books, and 25 articles in Englishand Persian were retrieved for the purposes of the study.RESULTS: The antecedents, attributes, and consequences of the concept identified. EMT mustlearn how to eliminate their destructive effects while enhancing constructive effects.CONCLUSION: Conflict is an inevitable part of life, and EMT must learn how to reduce their destructiveeffects while increasing constructive results.

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A reproductive and sexual health promotion program for women with heart diseases: A protocol for mixed methods study

. Shahnaz Kohan; . Nafisehsadat Nekuei; . Masoumeh Sadeghi; . Minoo Movahedi

Volume 11, Issue 8 , September 2021, Pages 1-8

Abstract

  BACKGROUND: Nowadays, for various reasons, the prevalence of heart diseases has increased inwomen during reproductive age. These diseases can lead to serious reproductive and sexual‑relatedcomplications ...  Read More BACKGROUND: Nowadays, for various reasons, the prevalence of heart diseases has increased inwomen during reproductive age. These diseases can lead to serious reproductive and sexual‑relatedcomplications in the affected women. This study will conduct to develop a reproductive healthpromotion program for women with heart diseases.MATERIALS AND METHODS: This is an exploratory sequential mixed methods study that willbe conducted in four phases. The first phase is a qualitative research that is done using contentanalysis method and semi‑structured individual interviews. The experiences of women with heartdisease and health providers’ team in educational hospitals, health centers, and private offices ofphysicians about reproductive health need will be explored. Purposive sampling will be continueduntil data saturation is reached and the conventional content analysis method will be used. In thesecond phase, the studies published from 2000 to 2020 will be reviewed by the matrix method andthen will be analyzed by using thematic analysis. Integrating the results of these two stages, the draftof the program will be designed. In the third phase, the validation of the program will be checked byusing the two‑round modified Delphi method. In the fourth phase, the program will be implementedby the health system and its process will be monitored.CONCLUSION: A life cycle reproductive health program for women with heart disease can helpimprove their preconception health, fertility planning, and sexual health and promote the well‑beingof these women in the long run.

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The effect of peer support on quality of life among type 2 diabetic patients in deprived areas in Iran: A randomized clinical trial

. Arezoo Shahsavari; . Fatemeh Estebsari; . Foroozan Atashzadeh‑Shoorideh; . Mahnaz Ilkhani

Volume 11, Issue 8 , September 2021, Pages 1-7

Abstract

  BACKGROUND: Quality of life (QOL) is one of the effective factors in promoting the health of diabeticpatients. In recent years, the role of peer support in the optimal management of ...  Read More BACKGROUND: Quality of life (QOL) is one of the effective factors in promoting the health of diabeticpatients. In recent years, the role of peer support in the optimal management of diabetes has gainedincreasing attention. However, contradictory results have been reported from the effectiveness ofthis method. This study aimed to investigate the effect of peer support on the QOL among type 2diabetic patients in deprived areas.MATERIALS AND METHODS: This study was a randomized clinical trial conducted on 80 patientswith T2D referring to the diabetes Clinic in Aligoudarz in Iran. Participants were randomly assignedinto two groups of 40 patients. Intervention group received a peer Supportive‑educational programfor 3 months and the control group received routine clinic care. Diabetes QOL brief clinical inventorywas used to collect the data. This questionnaire was completed three times at the beginning of thestudy, immediately after the 3‑day training, and after 3 months of peer supportive intervention. TheSPSS software (v. 18.0) was used to analyze the data through the Generalized Estimating Equations.RESULTS: There was no significant difference in mean QOL between the two groups before theintervention (P = 0.891) and immediately after the education (P = 0.076). However, after 3 monthsof intervention, the intervention group showed a significant improvement in mean QOL compared tothose in the control group (P < 0.001).CONCLUSION: Peer support program can improve the QOL in type 2 diabetic patients in deprivedareas. Therefore, this method can be recommended to improve care and educational programs inthese patients.

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Emotional well‑being of dentists and the effect of lockdown during the COVID‑19 pandemic: A nationwide study

. Ashish Sharma; . Kumar Gaurav Chhabra; . Sweta Surana Bhandari; . Garima Poddar; . Subha Soumya Dany; . Chaya Chhabra; . Akanksha Goyal

Volume 11, Issue 8 , September 2021, Pages 1-9

Abstract

  BACKGROUND: Lockdown in India might have adverse effects on the emotional health of the dentalprofessionals; hence, the aim of the present study was to determine the impact of various ...  Read More BACKGROUND: Lockdown in India might have adverse effects on the emotional health of the dentalprofessionals; hence, the aim of the present study was to determine the impact of various factorson emotional well‑being of dental professionals due to the effect of lockdown during COVID‑19.MATERIALS AND METHODS: It was a cross‑sectional, descriptive, questionnaire study conducted ondentists in India during April 2020. Sampling technique was convenient sampling, and sampling framewas all the dental professionals in India. The questionnaire was prepared online using Google Forms,and the link was generated which was shared among as many dentists accessible as possible, withthe help of message, mails, and WhatsApp. The questionnaire consists of questions on Demographicdetails, practice, and emotional well‑being. A total of 1844 dental professionals in 14 states in Indiaresponded. The statistical analysis was done using SPSS version no. 20. IBM SPSS version 20.0(IBM; Armonk, New York USA) Descriptive statistics and multinomial regression test was applied.RESULTS: Majority of study participants (1096[59.4%]) belonged to age group of 26–35years. Emotionalwell‑being score of 1206 (65.4%) dental professionals in the times of COVID‑19 outbreak was poorwith score between 26 and 78. It was assessed that males have significantly (P = 0.00**) (P < 0.001**)(**highly significant) poorer emotional well‑being 0.085 (0.829–1.429) compared to females. Marrieddental professionals − 0.023 (0.011–1.221) had significantly better (P = 0.05*) emotional well‑beingthan others.CONCLUSION: Emotional well‑being score of majority of dental professionals in the times ofCOVID‑19 outbreak was poor. Gender, marital status, socioeconomic status, years of experience,practicing in clinic, and average number of patients seen per month before lockdown have significantimpact on emotional wellbeing of dental professionals.

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Factor structure and psychometric properties of the Persian versions of the Pediatric Daytime Sleepiness Scale and Morningness–Eveningness Scale for Children

. Ali Nouri; . Fattaneh Esmaeili; . Heliya Seyedi; . Sahba Rezaeian; . Sareh Panjeh; . Hugo Cogo‑Moreira; . Sabine Pompeia

Volume 11, Issue 8 , September 2021, Pages 1-9

Abstract

  BACKGROUND: The Pediatric Daytime Sleepiness Scale (PDSS) and the Morningness–EveningnessScale for Children (MESC) are widely used to measure two important facets of sleep patterns, ...  Read More BACKGROUND: The Pediatric Daytime Sleepiness Scale (PDSS) and the Morningness–EveningnessScale for Children (MESC) are widely used to measure two important facets of sleep patterns, butneither have been adapted and validated for use in Iran. The purpose of this study was to examinethe psychometric properties and factor structure of the Persian versions of the PDSS and the MESCin a sample of Iranian adolescents.MATERIALS AND METHODS: The Persian versions of PDSS and MESC were translated andadministered to a representative sample (n = 407) of Iranian early adolescents, aged 9–15 years,who attended school in morning shifts. The factor structure of both scales, found in prior studies,was tested using Confirmatory Factor Analyses to assess their validity and reliability.RESULTS: The results revealed that the model fit indices of the one factor solution of the PDSSand the two factor solution of the MESC were acceptable to good. A high Pearson correlation wasfound between raw and latent factor scores for the PDSS and the two factors derived from theMESC (i.e., Morningness and Planning). Furthermore, the higher the PDSS score (more daytimesleepiness), the lower the MESC scores (more eveningness), indicating criterion validity of the scalesshowing the expected increase in daytime sleepiness in evening oriented adolescents who wakeup early for attending school.CONCLUSION: The Persian versions of the PDSS and the MESC can be considered reliable andvalid tools for evaluating, respectively, daytime sleepiness and morningness‑eveningness in theadolescent population of Iran.

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Development and validation of education materials to reduce childhood blindness due to retinopathy of prematurity

. Sonika Raj; . Praveen Kumar

Volume 11, Issue 8 , September 2021, Pages 1-5

Abstract

  BACKGROUND: Timely and appropriate follow‑up appointments for infants at risk for retinopathy ofprematurity (ROP) are very important to prevent blindness. Caregivers are important ...  Read More BACKGROUND: Timely and appropriate follow‑up appointments for infants at risk for retinopathy ofprematurity (ROP) are very important to prevent blindness. Caregivers are important members of theROP team, and their involvement is essential in ensuring optimal visual outcomes. This paper aimedto develop health information materials on ROP by a systematic process for better comprehensibilityby the target audience of low literacy.MATERIALS AND METHODS: It was a methodological study conducted at the neonatal intensive careunit of a tertiary care hospital, North India. The development and validation of educational materialswas conducted in six steps. The study focused on both the knowledge of the target audience andon the validation of the educational materials by experts and caregivers of ROP eligible infants.RESULTS: Most of the items (content, language, layout, motivation, and cultural appropriateness)were in either a suitable or adequate category. Only one item illustration was in the nonsuitablecategory. The mean final score of the leaflet after revision by experts was 9 (maximum score = 10).Regarding readability, The Flesch Reading Ease Score, Flesch‑Kincaid Grade Level, and gunningfog index were found to be 72.5, 7.4, and 6.2, respectively. The leaflet was found to be suitable forthe seventh grader. The mean knowledge score of the parents was 4 (maximum score‑5).CONCLUSION: The study showed satisfactory acceptance of the developed ROP informationmaterials by caregivers and experts. A similar approach could be adopted for the development ofother health information materials.

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The prevalence of attention‑deficit hyperactivity disorder and its related risk factors among children at elementary school in Shahroud

. Azam Hamidzadeh; . Mehrnaz Kharatha; . Milad Bazghaleh; . Hassan Basirinejad; . Nasrin Fadae Aghdam; . Hossein Ebrahimi

Volume 11, Issue 8 , September 2021, Pages 1-9

Abstract

  BACKGROUND: Attention‑deficit hyperactivity disorder (ADHD) is one of the most common reasonsfor visiting psychiatrists and psychologists. This study aimed to investigate the prevalence ...  Read More BACKGROUND: Attention‑deficit hyperactivity disorder (ADHD) is one of the most common reasonsfor visiting psychiatrists and psychologists. This study aimed to investigate the prevalence of ADHDand its related risk factors among children at elementary schools.MATERIALS AND METHODS: This cross‑sectional study focused on teachers and parents of 779elementary students who were selected through stratified cluster random sampling; Conners Parentand Teacher Questionnaires were used to collecting data. The data were analyzed by the use ofdescriptive statistics (frequency and percentage), independent samples t‑test, Chi‑square, one‑wayANOVA, and linear regression. The significant level was set at 0.05.Results: According to teachers’ responses, the prevalence of ADHD among students in elementaryschools was 4.4%, whereas parents reported a prevalence of 0.5%. There was a significantrelationship between childhood ADHD and marital status of parents, fathers’ smoking habits, previousexperience of living in rural areas, children’s previous history of having diseases and using themedicine, previous history of ADHD, and psychological problems in the family.Conclusions: According to the study, teachers and parents suffer from a lack of knowledge aboutADHD. Thus, the educational workshops and programs should be held for teachers, parents, andcounselors to inform them about the procedures for timely diagnosis and treatment of ADHD.

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Fear of COVID‑19 among the Indian youth: A cross‑sectional study

. Gaurav Gaur; . Meenakshi Sharma; . Meenu Kundu; . Harmehr Sekhon; . Nidhi Chauhan

Volume 11, Issue 8 , September 2021, Pages 1-7

Abstract

  BACKGROUND: Coronavirus disease is a highly infectious and fatal disease. It has caused distressin the form of fear, and anxiety among masses including youth. The psychosocial health ...  Read More BACKGROUND: Coronavirus disease is a highly infectious and fatal disease. It has caused distressin the form of fear, and anxiety among masses including youth. The psychosocial health of youthis important to build resilient nations after the pandemic is over.This study aimed to capture thelevel of COVID‑19 fear among youth studying in a northern Indian university and to compare it withdemographic variables.MATERIALS AND METHODS: This was a cross‑sectional study (April–May 2020) conductedamong university students in North India. Fear of COVID‑19 Scale (FCV‑19S) was used for onlinesurvey using Google Forms. FCV‑19S is a reliable tool for assessing the fear of COVID‑19 amongthe general population. Descriptive statistics and principal component analysis (PCA) with varimaxrotation were used for statistical analysis.RESULTS: A total of 521 responses were recorded. The majority (78%) of the participants were inthe age group of 18–23 years and more than half (57%) were pursuing graduation. The respondentsbelonged to 16 states and union territories in the country. A total of 17% reported severe fear, while afew reported moderate (17%) or mild (11%) fear on the FCV‑19S. No respondent could be categorizedwith “no fear” based on the overall FCV‑19S score. Approximately, 42% of respondents were nervousafter watching news/social media posts about COVID‑19. Based on PCA, factor 1 labeled as anxietytoward COVID‑19, factor 2 media effect on shaping of fear, and factor 3 thanatophobia as contributingfactors for fear among youth.CONCLUSIONS: Reflection of fear among youth suggests that adequate knowledge about COVID‑19,preventive steps, treatment options, etc., may be planned to allay fears among youth.

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The role of glass ceiling in women’s promotion to managerial positions from the perspective of faculty members at Iran University of Medical Sciences

. Ghobad Ramezani; . Ghadir Pourbairamian; . Salime Goharinezhad; . Azam Norouzi; . Mohammad Hasan Keshavarzi; . Zohreh Sohrabi

Volume 11, Issue 8 , September 2021, Pages 1-7

Abstract

  BACKGROUND: In recent years, many changes have been observed in women’s roles inorganizations. In Iran, women face challenges to be promoted to high‑level organizational positions.The ...  Read More BACKGROUND: In recent years, many changes have been observed in women’s roles inorganizations. In Iran, women face challenges to be promoted to high‑level organizational positions.The present study aimed to examine the role of glass ceiling in promoting women to managerialpositions from the perspective of the faculty members at Iran University of Medical Sciences.MATERIALS AND METHODS: This research was an applied study in terms of objectives anda descriptive‑survey study in terms of data collection, variable monitoring and control, andgeneralizability. The statistical population of the study encompassed all clinical and basic sciencesfaculty members at Iran University of Medical Sciences in 2019–2020. The simple random samplingmethod was adopted, and the study instrument was the standard questionnaire of women’s beliefsabout glass ceiling developed by Smith (2012). To analyze the data, descriptive and inferential (namelypaired‑sample t‑test and one‑sample t‑test) statistics were run in the SPSS software.RESULTS: The results revealed that glass ceiling dimensions could predict 48% of the varianceof women’s promotion to managerial positions. Furthermore, a significant difference was noticedbetween men and women’s perspectives toward glass ceiling (P < 0.001); however, there was nosignificant difference between the two groups of clinical and basic sciences (P > 0.001).CONCLUSIONS: Failure to provide appropriate opportunities for qualified women to be promoted tomanagerial positions would result in nonexploitation of about half of the available capacities and talents.Women have unique abilities and soft skills in the human resource management. At the macro‑level,policy‑makers and planners to review the plans and delegation of organizational‑managerial positionsand also to further consider the role of women in managerial positions by observing gender justiceand meeting criteria such as capability and expertise.

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Establishing clinical governance model in primary health care: A systematic review

. Leila Hosseini Ghavamabad; . Abbas Vosoogh‑Moghaddam; . Rouhollah Zaboli; . Mohsen Aarabi

Volume 11, Issue 8 , September 2021, Pages 1-7

Abstract

  Clinical governance is a systematic approach to enhancing the quality of primary health care andensuring high clinical standards, responsiveness to performance, and continuous improvementin ...  Read More Clinical governance is a systematic approach to enhancing the quality of primary health care andensuring high clinical standards, responsiveness to performance, and continuous improvementin service quality. The objective of the current study was to investigate the global experiencesof clinical governance in primary health care. In the present systematic review, relevant articlesfrom different countries were searched in various databases such as MD PubMed from Medlineportal, Emerald Springer link, ProQuest, Cochrane, Scopus, Web of Science, and Consult untilApril 2019. The searched articles were checked through CASP and PRISMA checklists, and theirresults were extracted. Of the 17 selected studies, 16 belonged to developed countries, includingEngland (13), Australia, Italy, and New Zealand, and one was from Turkey. The findings were dividedinto three general categories: (1) principles of effectiveness and risk management, (2) deploymentrequirements such as structural and organizational needs, resource and communication, andinformation management, and (3) barriers of clinical governance toward providing primary healthcare. it is recommended that a suitable framework or model be developed and designed adaptedto the local culture and taking into account all effective dimensions for a proper establishment andimplementation of clinical governance in primary health care.

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Relationship between mindfulness and maternal stress and mother – Infant bonding in neonatal intensive care unit

. Ashraf Khoramirad; . Zahra Abedini; . Zohre Khalajinia

Volume 11, Issue 8 , September 2021, Pages 1-6

Abstract

  BACKGROUND: Having a baby admitted to a neonatal intensive care unit (NICU) is so stressful, hasa negative impact on mother well‑being, and also disrupts mother‑infant bonding process ...  Read More BACKGROUND: Having a baby admitted to a neonatal intensive care unit (NICU) is so stressful, hasa negative impact on mother well‑being, and also disrupts mother‑infant bonding process becausethe infant spend the first several weeks or months in the NICU. Previous studies have shown thepositive association of the mindfulness and various health conditions. This study investigated therelationship between mothers’ dispositional mindfulness and level of stress and bonding in motherswith infants in the NICU.MATERIALS AND METHODS: A cross‑sectional study was performed during 2019 on 140 motherswith newborns admitted to the NICUs in two hospitals in Qom city in Iran. The self‑report measures ofdispositional mindfulness, Parental Stressor Scale: NICU, and the Postpartum Bonding Questionnairewere administered to mothers on the 2nd–5th day after birth. The data analysis was carried out byusing a stepwise multiple regression model.RESULTS: The mean scores of mindfulness, stress, and bonding were 3.32 ± 0.52, 2.32 ± 0.77,and 0.47 ± 0.37, respectively. There was a statistically significant inverse relationship between totalmindfulness score and stress (P < 0.001). Furthermore, high scores of mindfulness were associatedwith better bonding (P = 0.04).CONCLUSIONS: Improvement in mindfulness helps mothers to reduce stress and make betterbonding with infants. It is recommended that mindfulness interventions use during pregnancy alsoafter birth, especially for mothers that their infants admitted to in the NICUs.

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Psychological impact of COVID‑19 on medical interns – Findings from a nationwide survey

. Chandrashekar B. Huded; . Smitha Lamiya Rasquinha; . Pradyumna Rao

Volume 11, Issue 8 , September 2021, Pages 1-13

Abstract

  BACKGROUND: The COVID‑19 pandemic has negatively impacted the mental health of health‑careworkers worldwide. This study aimed to estimate the prevalence of psychological distress ...  Read More BACKGROUND: The COVID‑19 pandemic has negatively impacted the mental health of health‑careworkers worldwide. This study aimed to estimate the prevalence of psychological distress in medicalinterns during the pandemic and examine the factors influencing it.MATERIALS AND METHODS: A cross‑sectional online survey was conducted using snowballsampling among 764 medical interns across India, who were evaluated using the KesslerPsychological Distress Scale, Fear of COVID‑19 Scale, and semi‑structured questionnaires. Univariateanalysis was done using Chi‑square test, unpaired t‑test, and ANOVA, while multivariate analysiswas conducted using binary logistic regression.RESULTS: 57.5% of the interns reported psychological distress, with 39.8% having moderate‑to‑severedistress. Past consultation with a mental health professional (odds ratio [OR]: 2.15; 95% confidenceinterval [CI]: 1.42–3.26) and perceived lack of support from friends (OR: 2.33; 95% CI: 1.33–3.99)and faculty (OR: 2.15; 95% CI: 1.41–3.28) were the most significant predictors of distress. Fearof COVID‑19 was higher in interns who were female, were medically ill, were dissatisfied with thepandemic preparedness at the hospital, and perceived the faculty to be less approachable andsupportive. Majority of the interns felt that the pandemic had hampered their learning and wereworried about an extension to their internship and their performance in the postgraduate entranceexaminations.CONCLUSIONS: Psychological distress was highly prevalent among interns, with several workplacesand personal factors affecting the distress levels. Most interns perceived a negative impact of thepandemic on their learning and career. Addressing these issues could help alleviate the distressand bolster the mental health of interns.

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Comparing the effect of face-to-face education and using educational films on couples’ sexual dysfunction during pregnancy

. Maryam Mohammadi; . MohammadBagher Khani

Volume 11, Issue 8 , September 2021, Pages 1-9

Abstract

  BACKGROUND: Pregnancy is a special period in a woman’s life during which physical, mental,social, and cultural changes would affect sexual desires during this period. The present ...  Read More BACKGROUND: Pregnancy is a special period in a woman’s life during which physical, mental,social, and cultural changes would affect sexual desires during this period. The present study wasconducted to compare the effect of face‑to‑face education and using educational films on the sexualdysfunction in couples.MATERIALS AND METHODS: The present study was a semi‑experimental research. Studypopulation contained pregnant women and their husbands. Samples were selected randomly. Datawere gathered using demographic characteristic questionnaire and sexual dysfunction in men andwomen questionnaire. Sample size was 96 couples (32 couples in the face‑to‑face group, 32 in theeducational films group, and 32 in the control group). Data were analyzed using SPSS20 software.RESULTS: The mean total score of preintervention sexual function in face‑to‑face education groupwas 46.72 ± 9.79, in educational film group 47.82 ± 13.07, and in control group 43.84 ± 12.76. Inthe case of postintervention, it was, respectively, 60.62 ± 9.72, 57.37 ± 14.74, and 43.61 ± 14.21.Face‑to‑face education led to the treatment of sexual dysfunction during pregnancy (P < 0.001). Inthe educational film group (P = 0.40), sexual dysfunction during pregnancy was not treated, but therewas an improvement in sexual function (P = 0.001). In the control group, there was a significantdifference regarding the decrease in the score of sexual function and untreated sexual dysfunctionduring pregnancy (P = 0.001). Furthermore, no improvement was observed in the sexual dysfunctionduring pregnancy (P = 0.90).CONCLUSIONS: According to the results, face‑to‑face and film education are effective in sexualfunction during pregnancy, but face‑to‑face education in pregnancy is more effective in the treatmentof sexual dysfunction, and so this causes promoting sexual health during this period.

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The role of hackathon in education: Can hackathon improve health and medical education?

. Mohammad Hossein Yarmohammadian; . Sanaz Monsef; . Shaghayegh Haghjooy Javanmard; . Youseph Yazdi; . Mostafa Amini‑Rarani

Volume 11, Issue 8 , September 2021, Pages 1-5

Abstract

  To develop the next generation of healthcare innovators, students at all levels of education shouldbe trained and encouraged to employ innovative and entrepreneurial approaches to deal ...  Read More To develop the next generation of healthcare innovators, students at all levels of education shouldbe trained and encouraged to employ innovative and entrepreneurial approaches to deal withcomplicated challenges of today’s health system. Applying innovation and entrepreneurship trainingto solve complex problems and focus on solution design has recently become common in medicaluniversities all over the world. This paper clarifies the role of hackathons as an innovative educationalapproach in healthcare education systems. We propose a process model concerned with organizinghackathon events in the healthcare education system. This model can be used in the academic andpractical design of hackathons for innovation purposes.

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Designing a model for patient relationship management in the general hospitals using the combination of analytic hierarchy process and interpretive structural modeling

. Mohammad Meskarpour-Amiri; . Mohammadkarim Bahadori; . Fatemeh Rahmati; . Ramin Ravangard; . Maryam Yaghoubi

Volume 11, Issue 8 , September 2021, Pages 1-10

Abstract

  BACKGROUND: Patient relationship management (PRM), in addition to saving costs, increasespatient loyalty and creates a satisfactory environment for the patient and the service provider. ...  Read More BACKGROUND: Patient relationship management (PRM), in addition to saving costs, increasespatient loyalty and creates a satisfactory environment for the patient and the service provider. Thisstudy aimed to design a model of PRM in general hospitals using the combination of the analytichierarchy process and interpretive structural modeling (ISM).METHODS: This was an applied and cross‑sectional study conducted in 2020 at three stages. Atthe first stage, using a systematic review, factors affecting PRM were identified. In the second stage,these factors were prioritized based on the pair‑wise comparisons. In the third stage, the interactionlevels of the factors were modeled for the general hospitals using ISM through the use of the MICMACtechnique and Excel 2007 software.RESULTS: The results showed that “integrated information system,” “registration of the patient’sessential information,” and “right data at the correct time” were the first to third priority in implementingPRM in the general hospitals. In the final model of ISM, three levels of effective factors were extracted,and 10, 4, and 6 factors were identified in the first, second, and third levels, respectively.CONCLUSION: Establishing the PRM strategy in the hospital, in addition to executive and managerialrequirements, depends on the existence of an electronic customer relationship management system,and the choice of new technology, as well as the integration of information systems and technologyculture, should be given special attention by managers.

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Knowledge and attitude regarding cervical cancer and its prevention among young female adults in Kuantan, Malaysia

. Munawara Burhan; . Nor Azlina A. Rahman; . Mainul Haque

Volume 11, Issue 8 , September 2021, Pages 1-9

Abstract

  BACKGROUND: Cervical cancer is the second‑most common female cancer in Malaysia after breastcancer. This study intended to investigate the knowledge and attitude regarding cervical ...  Read More BACKGROUND: Cervical cancer is the second‑most common female cancer in Malaysia after breastcancer. This study intended to investigate the knowledge and attitude regarding cervical cancer andits prevention and its associated factors among young female adults in Kuantan, Malaysia, to gaugethe community’s understanding and idea about this issue.MATERIALS AND METHODS: The study was conducted in attractive places in Kuantan, Malaysia,such as shopping malls and Urban Transformation Centre, using a cross‑sectional study design andconvenience sampling method. Data on the respondents’ knowledge and attitude regarding cervicalcancer and its prevention were collected using a questionnaire. Kruskal–Wallis, Independent t‑,and Pearson correlation tests were used to investigate the study variables’ association using SPSSsoftware.RESULTS: From the total of 142 respondents, almost half of them aged between 20 and 24 years oldwith the majority were Malays (85.9%) and single (74.6%). The internet (78.1%) was identified as themain medium to gain information regarding cervical cancer. The results show that levels of education,races, and occupation types were statistically significantly associated with the respondents’ knowledgeand attitude scores in this study. Age was found to be associated with knowledge scores only, whilemarital status was only significantly associated with the attitude scores regarding cervical cancer andits prevention. Knowledge scores were also found to be positively associated with attitude scores.CONCLUSION: Several socio‑demographic factors were significantly associated with the knowledgeand attitude regarding cervical cancer and its prevention. In view of the positive association betweenknowledge and attitude scores, suitable health promotion activities can be designed and planned toincrease young female adults’ knowledge and attitudes toward cervical cancer and its prevention.

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Effectiveness of ethics case based on blended learning approaches on medical students’ learning: A quasi‑experimental study

. Atefeh Karamzadeh; . Leili Mosalanejad; . Leila Bazrafkan

Volume 11, Issue 8 , September 2021, Pages 1-7

Abstract

  BACKGROUND: The use of active teaching methods in ethics education, instead of being merelyteacher centred, can lead students to problem‑solving in a practical way. Therefore, this ...  Read More BACKGROUND: The use of active teaching methods in ethics education, instead of being merelyteacher centred, can lead students to problem‑solving in a practical way. Therefore, this study wasconducted with the aim of comprehensive medical ethics education based on educational approachesand the effect of this approach on students’ learning and moral reasoning skills.MATERIALS AND METHODS: This quasi‑experimental intervention study was performed on seventyphysiopathology medical students who had taken the medical ethics course. The students’ educationalprogram included teaching theoretical concept of medical ethics, discussing ethical cases and clinicalreasoning in class, and then discussing in forum environment and individual assignments in thelearning management system (LMS) system and completing the portfolio. Student evaluation wasassociated students’ knowledge, attitu de, and moral reasoning skills and learning. A comprehensiveprogram including forum participation, individual assignments in LMS, theory and objective structuredclinical examination (OSCE) tests, and portfolio completion was used to evaluation of students. Thestudents’ learning was compared to students of the previous year, which was conducted through atraditional teacher‑centered method. Data analysis was conducted using IBM® SPSS® Statistics 21at two levels of descriptive statistics and analytic statistics.RESULTS: The results showed that there was a significant difference between the mean learning ofstudents compared with traditional class (P < 0.05). Furthermore, comparison of students’ practicalscores through the OSCE test showed its impact on changing students’ knowledge, attitude, andperformance in moral reasoning.CONCLUSION: According to research findings, it seems that the mentioned model is one of theimportant and new issues as a suitable method of teaching medical ethics. Furthermore, it can besuitable model in other medical courses. The more research in multicentral may be need to assessother effects on students’ learning indicators.

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Causes of nonadherence to treatment in people with myocardial infarction: Content analysis

. Yaghoub Nadery; . Parvaneh Khorasani; . Aram Feizi; . Soroor Parvizy

Volume 11, Issue 8 , September 2021, Pages 1-6

Abstract

  BACKGROUND: Nonadherence with the medication regimen in patients with heart disease canlead to treatment failure. The purpose of this study was to identify the causes of nonadherence ...  Read More BACKGROUND: Nonadherence with the medication regimen in patients with heart disease canlead to treatment failure. The purpose of this study was to identify the causes of nonadherence inpeople with myocardial infarction.MATERIALS AND METHODS: This study is a qualitative conventional content analysis. Data werecollected through semistructured interviews. Thirteen individual interviews and a focus group wereconducted with nurses, patients, and doctors. Data were analyzed using conventional content analysis.RESULTS: Four main themes were identified, which are organizational‑managerial causes andfactors (drug‑related problems, educational system‑related problems, weak performance of hospitals,and problems related to insurance companies); sociocultural causes and factors (factors relatedto cultural problems and factors related to social problems); causes and factors related to careproviders (skill problems of care providers and functional problems of care providers); and causesand factors associated with caregivers (factors related to social characteristics of the patient, factorsrelated to patient characteristics, and factors related to the patient’s belief).CONCLUSIONS: Many individual and organizational factors affect nonadherence, which can bereduced by fundamental changes.

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Worldwide disaster loss and damage databases: A systematic review

. Sadegh Ahmadi Mazhin; . Mehrdad Farrokhi; . Mehdi Noroozi; . Juliet Roudini; . Seyed Ali Hosseini; . Mohammad Esmaeil Motlagh; . Pirhossein Kolivand; . Hamidreza Khankeh

Volume 11, Issue 8 , September 2021, Pages 1-13

Abstract

  Nowadays, disaster databases have become a valuable tool for disaster risk management andhealth promotion and serve various purposes. The purpose of this study is to provide a systematicreview ...  Read More Nowadays, disaster databases have become a valuable tool for disaster risk management andhealth promotion and serve various purposes. The purpose of this study is to provide a systematicreview of disaster databases in the world and to identify the objectives, information sources, criteria,and variables of disaster data registration in the world’s reputable databases. To conduct review,all English‑language articles published without a time limit until the end of September 2020 wereextracted from the databases of Web of Science, PubMed, Scopus, Cochrane Library, ScienceDirect, Google Scholar, and Embase. Necessary information in the papers including study time, typeof disasters, related databases, dimensions and indicators of global and regional databases wereextracted by using a researcher‑made questionnaire. A total of 22 studies have been reviewed toidentify the dimensions and indicators of disaster databases worldwide. The main focus was on globaland regional databases, mostly used at the level of scientific societies and disaster experts. Afterexplanation, researchers highlighted each of the disaster databases, along with the main differencesavailable among the existing databases. Some databases have well‑defined data collection methods.Their knowledge is high quality and they can be used to create and improve a disaster database atother levels. Disaster database limitations include risk bias, time bias, accounting bias, thresholdbias, and geographical bias. To support the right decisions to reduce disaster risk, it is necessaryto complement existing global, regional, and national databases. Countries need to take action toset up national databases.

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Mobile‑application intervention on physical activity of pregnant women in Iran during the COVID‑19 epidemic in 2020

. Neda Kiani; . Asiyeh Pirzadeh

Volume 11, Issue 8 , September 2021, Pages 1-7

Abstract

  BACKGROUND: Considering the low level of physical activity in pregnant women in the COVID‑19pandemic period, and on the other hand, the benefits of mobile application (mobile app) ...  Read More BACKGROUND: Considering the low level of physical activity in pregnant women in the COVID‑19pandemic period, and on the other hand, the benefits of mobile application (mobile app) learning,we decided to conduct a study to determine the impact of educational intervention based on mobileapp on physical activity in pregnant women.MATERIALS AND METHODS: The present study was quasi‑experimental and examined 93 pregnantwomen aged 16–20 weeks of gestation. Sampling was done on pregnant women participating inthe childbirth preparation classes in Isfahan. We used the validated and reliable questionnaireincluding perceived benefits, perceived barriers, perceived enjoyment, perceived social support,and Pregnancy Physical Activity Questionnaire. The intervention was based on mobile app, and thecontent of the application contained 12 main domains such as description of physical activity andbenefits and barriers of exercise in the pregnancy, different types of proper pregnancy exercise,planning for exercise, and different types of exercise. Finally, data were analyzed using SPSS20,and the Chi‑square test, independent t‑test Paired t‑test were employed. The significance level wasconsidered to be <0.05.RESULTS: The results showed that, after the intervention based on mobile app, the mean scoreof perceived benefits and enjoyment were significantly higher than before the intervention inthe intervention group. Finally, total mean score of physical activity significantly increased in theintervention group, while the change decreased in the control group.CONCLUSION: The results indicated that the use of mobile app can be used to promote physicalactivity in pregnant women. Therefore, it is recommended that mobile app education should applywith face‑to‑face classes in health centers for physical activity in pregnant women in the pandemicsituation.

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Impact of mobile phone dependence on behavior and academic performance of adolescents in selected schools of Uttarakhand, India

. Mahendra Singh Yadav; . Malar Kodi S; . Rupinder Deol

Volume 11, Issue 8 , September 2021, Pages 1-7

Abstract

  BACKGROUND: Mobile phones are one of the excellent gifts of technology in the 21st century, whichis most popular among adolescents. Today, mobile phones have infinite resources that ...  Read More BACKGROUND: Mobile phones are one of the excellent gifts of technology in the 21st century, whichis most popular among adolescents. Today, mobile phones have infinite resources that have multiplebenefits and applications. Its excessive use may impact adolescents in the form of behavioral changesand diminish the academic performance. This study explores the relationship between mobile phoneusage with behavioral modifications and educational achievement among adolescents.MATERIALS AND METHODS: A descriptive correlational study was conducted amongadolescents (n = 285 –male‑210, female‑75) at selected schools of Rishikesh, Uttarakhand, India.The test of mobile dependence was used to assess the mobile phone dependence, and a behavioralLikert scale to evaluate the behavioral changes through the self‑report method. The academicperformance was observed by school records; percentage of the last two examination results wasconsidered. Collected data were analyzed using descriptive and inferential statistics.RESULTS: The study shows that 156 (54.70%) participants had a low mobile dependency,191 (67%) participants had negative behavioral changes, and 125 (43.90%) participants had shownreduced academic performance due to overuse of the mobile phone. A significant relationshipwas seen between mobile phone dependency with behavioral changes (P < 0.001) and academicachievement (P < 0.035) seen among adolescents. Regression analysis predicted 49% of thedifferences among adolescents with selected variables due to the overuse of mobile phones.CONCLUSION: The study concluded that mobile dependency changes adolescent’s behavior aswell as reduces their academic performance due to the overuse of the mobile phone.

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Competencies required for medical students to confront the COVID‑19 pandemic: A needs assessment study

. Ali Ardekani; . Zahra Rahimian; . Afrooz Feili; . Mitra Amini; . Parinaz Tabari; . Mahsa Moosavi

Volume 11, Issue 8 , September 2021, Pages 1-7

Abstract

  BACKGROUND: The outbreak of coronavirus disease 2019 (COVID‑19) has turned attention to theessential competencies needed to confront pandemics for a physician. However, medical students,as ...  Read More BACKGROUND: The outbreak of coronavirus disease 2019 (COVID‑19) has turned attention to theessential competencies needed to confront pandemics for a physician. However, medical students,as future physicians, are not adequately trained for such a situation. This study aimed to determinethe essential competencies for a medical student to face the COVID‑19 pandemic.MATERIALS AND METHODS: We performed this mixed‑method needs assessment study at ShirazUniversity of Medical Sciences in May–June 2020 in three steps: the first step was a brainstormingsession followed by a nominal group technique with the experts’ participation. The second stepwas determining the validity of competencies by calculating the content validity ratio. In the thirdand last step, three rounds of the modified Delphi technique were held with the participation of22 medical faculty members and 45 undergraduate medical students to reach a consensus aboutthe competencies utilizing quantitative analysis.RESULTS: A total of 30 key competencies essential for a medical student were obtained through thecurrent study. They were categorized into four major themes: (1) developing knowledge and abilitiesfor effective diagnosis and treatment of COVID‑19, (2) demonstrating safety principles correctly,(3) demonstrating effective behavior, and (4) determining the meta‑competencies.CONCLUSIONS: Although medical students will be the frontline physicians in the future pandemics, theyare not prepared to display the diversity of requisite skills to practice effectively and safely. This studyprovides essential competencies for medical students during the COVID‑19 pandemic and underlinesthe importance of a paradigm shift from traditional time‑based to competency‑based education.

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Evaluation of the educational services quality from the viewpoint of postgraduate students at Kermanshah University of medical sciences in 2019

. Razie Toghroli; . Farideh Moradi; . Laleh Hassani; . Teamur Aghamolaei; . Nafiul Mehedi; . Fatemeh Mahmoodi; . Azam Faraji; . Ava Sadat Hoseini; . Ali Soroush; . Behdad Ziapour

Volume 11, Issue 8 , September 2021, Pages 1-5

Abstract

  BACKGROUND: At present, the SERVQUAL model is one of the most significant tools for measuringcustomers’ expectations and perceptions in organizations. Determination of expectations ...  Read More BACKGROUND: At present, the SERVQUAL model is one of the most significant tools for measuringcustomers’ expectations and perceptions in organizations. Determination of expectations andperceptions of students who are the main university customers from educational services can providevaluable information to the programmers to improve the condition of educational services. Therefore,this study aims to measure the quality of education services from the viewpoint of postgraduatestudents at Kermanshah Medical Sciences University using the SERVQUAL model in 2019.MATERIALS AND METHODS: This was a descriptive cross‑sectional study. The population under thestudy consisted of 162 students at the postgraduate education section (Master’s degree and Ph.D.)studying in the second semester of the academic year of 2019 at Kermanshah Medical SciencesUniversity. The standard SERVQUAL questionnaire was used for data collection, which includedfive dimensions of the quality of educational services, and the random‑stratified sampling methodwas employed. The data were analyzed using the  SPSS Statistics software (version 23.0, SPSSInc., Chicago, IL, USA), and descriptive and other statistical tests, including the Pearson correlationcoefficient, and paired and independent t‑tests were performed.RESULTS: Based on the students’ perspective in the provision of service there was quality gapexisted in all services, and the largest gap was in the reliability dimension (−0.37), and after that,empathy (−0.37), guaranty (0.27), and responsiveness (−0.24) dimensions, respectively, and thelowest one was in the tangible dimension (0.15). There was a statistically significant observeddifference between the quality gap in different educational dimensions (P > 0.001).CONCLUSION: Research findings showed that students were not meeting their expectations fromthe presented educational services. Hence, holding a training workshop is suggested in the field ofhow to serve and enhance communication skills for employees and teachers.

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Validation of Metacognitive Awareness Inventory from a Private Medical University in India

. Abirami Omprakash; . Archana Prabu Kumar; . Maheshkumar Kuppusamy; . Thyagarajan Ravinder; . Padmavathi Ramaswamy

Volume 11, Issue 8 , September 2021, Pages 1-6

Abstract

  BACKGROUND: Metacognition is the awareness and the capability to regulate one’s own thinkingprocess. Metacognition is critical in medical education for clinical reasoning and ...  Read More BACKGROUND: Metacognition is the awareness and the capability to regulate one’s own thinkingprocess. Metacognition is critical in medical education for clinical reasoning and management. Hence,the objective of this study is to evaluate the construct validity and reliability of the MetacognitiveAwareness Inventory (MAI) among first‑year medical and dental students, from a private medicaluniversity in India, using confirmatory analysis and internal consistency method.MATERIALS AND METHODS: This was a cross‑sectional study using convenient sampling.Fifty‑two‑item MAI was administered to 933 first‑year medical and dental students from a privatemedical university in India. Exploratory factor analysis (EFA), principal component analysis,Cronbach’s α, and confirmatory factor analysis with global fit indices were performed. Structuralequation modeling (SEM) was performed to evaluate the relationship between the structural pathand factors using AMOS version 22.RESULTS: During EFA, 12 items with <0.40 factor loadings were trimmed sequentially. The remainingitems with respective factors had a good internal consistency of ≥ 0.9. Comparative fit index (0.78),goodness‑of‑fit index (0.8), adjusted goodness of fit index (0.77), Tucker–Lewis index (0.7),standardized root mean square residual (0.06), and root mean square error of approximation (0.09)values showed that six‑factor model fits to satisfactory. Pearson’s correlation coefficient was foundto be high between factors (>0.80). SEM for each item (observed) and factor (unobserved) illustratedthe hypothesized model.CONCLUSION: The resultant 40‑item model based on MAI designed by Schraw is a valid andreliable tool for assessing the metacognitive awareness of Indian students. Employing a valid andreliable tool in assessing the metacognitive awareness will help the academicians in incorporatingappropriate curricular interventions.

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