Journal of Education and Health Promotion

Abstract BACKGROUND: Spiritual health in the field of health has a great importance in mental disorders and
posttraumatic stress disorders, in treatment process. The present study was done aiming “determine
the effect of spiritual care education on the spiritual health of preeclamptic women with postpartum
stress disorder.”
MATERIALS AND METHODS: This randomized clinical trial was done in 2017 on 260 women with
preeclampsia in Mashhad. Data collection was done with questionnaires Perinatal Posttraumatic
Stress Questionnaire (PPQ), the posttraumatic disorder checklist, Duke University Religion Index,
and the Spiritual Well‑Being Scale (SWBS). In the intervention group, first, women were educated
on spiritual care each day based on Richards and Bergin’s pattern, in three sessions, which lasted
45–60 min. The control group also received routine cares. All units completed the questionnaire
SWBS at the 8th postpartum period. P < 0.05 was meaningful.
RESULTS: After the intervention, this score of spiritual health in the intervention and control groups
had a significant difference with independent test (P = 0.004). Spiritual health significantly increased
in the interventional group.
CONCLUSIONS: Providing spiritual care to pregnant mothers with preeclampsia, increase their
spiritual health.

Abstract INTRODUCTION: Emergency prehospital providers (EPHP) who are constantly providing medical
care in threatening conditions are more at risk of displaying psychological distress presentations in
disaster situations. Problem‑solving strategies are essential for effective and efficient management
of event position. Therefore, the present study aimed to explore psychological distress promotion
in Iranian EPHP.
MATERIALS AND METHODS: A qualitative content analysis study was conducted based on 24
semi‑structured interviews. A purposeful sampling method was applied until reaching data saturation.
Interviews were transcribed verbatim, and then, data condensing, labeling, coding, and defining
categories were performed by the qualitative content analysis recommended by the Landman and
Graneheim approach.
RESULTS: Based on the experience of study participants, two main themes with six categories
developed. The main themes included emotion‑based management and problem‑based management
when confronting with incidence scene.
CONCLUSION: The main problems of EPHP in confronting with incidence and disasters scenes
are psychological distress which some rescuers have emotional reactions while some others who
are more resilience and experience manage this problem in the form of problem‑based approach.
It is recommended these practical strategies to be taught to less experienced rescuers for avoiding
emotional‑based reactions and better management of disaster scene.

Abstract Using simulation in high‑stakes assessments has been evolving as a method to improve the
assessment process. There is a concurrent need to address challenges and establish best practices
to ensure the best quality when implementing high‑stakes evaluations. The aim of this study is to
provide an insight for stakeholders about using multiple modalities of simulation in high‑stakes
evaluations by presenting challenges, best practices, and future directions described in the relevant
literature.A scoping review of original studies (from the year 1994–2021) including the use of common
modalities (standardized patients, high‑fidelity mannequins, part‑task trainers, virtual simulation, and
hybrid simulation) was conducted. The search covered the common databases: PubMed, Education
Resource Information Center, Cumulative Index to Nursing and Allied Health Literature, and the
Cochrane library.Initial screening in the databases resulted in 111,253 articles. After the application
of a refining search strategy, 47 articles were included for comprehensive evaluation. Most articles
were about credentialing/licensure purposes of assessment. Many articles were specialty‑specific,
especially focusing on anesthesia. Most challenges described were related to the validity of the
assessment that should be considered in the planning phase. Best practices were mostly related
to planning for measures to assure the validity of the assessment tools and process.The use of
multimodality simulation for high‑stakes assessment is growing despite challenges; this growth is
associated with the accumulation of experience shared in literature. This growth will help to improve
planning, practices, and goals achievement from such an application.

Abstract BACKGROUND: The COVID‑19 pandemic with its plenitude of hardships has been a challenge for
residents in training. Besides the fear of contracting the disease, the complete reconfiguration of
hospital services has severely affected the surgical residency programs across India. The current
study highlights the lacunae that have arisen in the residency programs and design appropriate
solutions to reframe the remaining part of the surgical training.
MATERIALS AND METHODS: The present study is an observational study based on a questionnaire
survey done in November 2020 aimed at gauging the mood and perspective of residents across
India pursuing surgical residency programs on how the pandemic has impacted various domains of
their residency namely surgical training, clinical skills, research, academic curriculum, and mental
health. The analysis was performed using an Internet‑based program.
RESULTS: Seventy‑eight percent of residents felt that they have lost crucial months of surgical training.
Impact on clinical skills was reported by 73.9% of residents. Almost half of the residents (49.1%)
believed that there has been a definite increase in research activities and 81.7% believed that the
academic curriculum was affected during the past 6 months. Furthermore, 86% of respondents
admitted to have had a profound impact on their mental health as a result of the pandemic.
CONCLUSION: Formulating reform policies in the current residency programs is paramount to train
the current and future generation of surgeons. Whereas personal safety and wellness of the residents
is paramount during these times, residency training via digital medical education and various other
innovative ways needs to continue.

Abstract BACKGROUND: Happiness is one of the main components of mental health that plays an important
role in promoting people’s health. This study aimed to investigate the status of happiness in students
of Iran University of Medical Sciences and its relationship with students’ attitudes toward the field of
education and the future of career in 2017.
MATERIALS AND METHODS: This cross‑sectional study was performed on 500 students of Iran
University of Medical Sciences The data collection tool was a questionnaire consisting of three
parts: demographic information, Oxford Happiness Inventory; A questionnaire was used to measure
students’ attitudes about their career future, which was completed by students of Iran University
of Medical Sciences. In order to analyze the data, SPSS software version 24 and descriptive and
analytical statistics were used.
RESULTS: Findings showed that 72% of students had a good level of happiness. There is also a
significant relationship between happiness and attitude toward the field of study. According to the
results, there is a significant relationship between the career future and the amount of happiness.
There was a significant relationship between gender and happiness
CONCLUSION: The study findings show that, by planning correctly in determining the fields of
education and ensuring the future of the job, happiness can be improved among students. Therefore,
it is recommended that the authorities take the students with the correct needs assessment in the
field of business education in the field of study.

Abstract Antibiotics once regarded as magic bullets are no more considered so. Overuse of antibiotics in
humans, agriculture, and animal husbandry has resulted in the emergence of a wide range of
multidrug‑resistant  (MDR) pathogens which are difficult to treat. Antimicrobial resistance  (AMR)
is a serious global health problem associated with high mortality in the era of modern medicine.
Moreover, in the absence of an effective antibiotic, medical and surgical interventions can highly
become a risk. In recent times, the decreased incline of pharmaceutical industries toward research
and development of newer effective antibiotics to fight this MDR pathogens have further fuelled
the scarcity of antibiotics, thus the number of antibiotics in the pipeline is extremely limited. Hence
it is high time for the development of new strategies to fight against dangerous MDR pathogens.
Currently, several novel approaches explored by scientists have shown promising results pertaining
to their antimicrobial activity against pathogens. In this article, the authors have summarized various
novel therapeutic options explored to contain AMR with special attention to the mechanism of action,
advantages, and disadvantages of different approaches.

Abstract BACKGROUND: Patients’ satisfaction is a fundamental factor in the quality of nursing care. The
emergence of the novel Coronavirus Disease 2019 (COVID‑19) and the highly contagious virus
can affect nursing care by increasing the number of care‑seekers.This study aimed to determine
the patients’ satisfaction and related factors in patients with COVID‑19 hospitalized in Taleghani
Hospital, Urmia‑Iran, in 2020.
MATERIALS AND METHODS: This descriptive, correlational study was conducted on 196 patients
with COVID‑19 hospitalized in Taleghani Hospital, Urmia. Purposive convenient sampling was used
to recruit participants. Study participants completed Patient Satisfaction Instrument and demographics
questionnaires. Data were analyzed with the SPSS software version 25.0.
RESULTS: The majority of patients (68.9%) were moderately satisfied with nursing care. Based
on Pearson Correlation Analysis, only residential status had a significant inverse relationship with
satisfaction level in patients with COVID‑19 (r = −0.0238, P = 0.001).
CONCLUSIONS: The patients’ satisfaction with nursing care was mostly at a moderate level. Thus,
there is a need to educate health personnel and nurses in particular and motivate them to have
active participation in achieving patients’ satisfaction with COVID‑19. Notably, only the institutes that
take patients’ satisfaction as a top priority can succeed in a competitive market of health services.

Abstract BACKGROUND: India is all set to begin vaccination against COVID‑19. A good number of people
are falling prey to anti‑vaccination campaigns, and therefore, some amount of vaccine hesitancy
must have developed. The primary objective of the study was to find the level of potential COVID‑19
vaccine hesitancy in Kashmiri population.
MATERIALS AND METHODS: This was a cross‑sectional study conducted in the valley of Kashmir.
A predesigned questionnaire was shared online. The participation of respondents was voluntary.
Exclusions were made on account of residence outside Kashmir valley, duplicate forms, and wrong
information. The data were entered into Microsoft Excel 2010 and analyzed using SPSS version 23.
RESULTS: A total of 487 respondents were included. About 67% of the participants were in the age
group of ≤30 years, 55% female, 54% rural, and 16% had ever been COVID‑19 positive. About
14% of the participants were completely hesitant about receiving the COVID‑19 vaccine, whereas
40% were unsure if they will accept the vaccination. The main reason for the total nonacceptance of
the vaccine was the doubts about the safety of COVID‑19 vaccines (67%). Urban people were more
likely to be hesitant to the vaccine than rural people (odds ratio [OR] 1.845, confidence interval CI
1.022 to 3.333). Those who were ever COVID‑19 positive were 3.3 times more likely to say “no” to
COVID‑19 vaccination than those who were never positive.
CONCLUSION: Strategic steps must be taken to minimize the vaccine hesitancy associated with
COVID‑19 vaccination. Authorities should direct efforts toward vaccine education, creating awareness
among people about the importance of COVID‑19 vaccination.

Abstract BACKGROUND: Parents act as a role model for children in showing health behaviors. This study
investigated factors affecting the preventive behavior in elementary school students’ parents based
on protection motivation theory (PMT).
MATERIALS AND METHODS: This cross‑sectional study was conducted in Tehran (Iran) in 2020.
Multistage sampling was used to choose 660 elementary school students’ parents. The data collection
instrument was a multi‑sectional questionnaire, including sections on demographic characteristics,
PMT constructs, self‑reported health, and information sources related to COVID‑19. In this study,
descriptive statistics (mean and standard deviation) and analytical statistical methods (Pearson
correlation and path analysis) were used to analyze the data. The range of Cronbach’s alpha of the
study instrument varied from 0.71 to 0.97.
RESULTS: The results of the current study revealed significant association between all PMT
constructs and preventive behaviors. Knowledge from both direct and indirect paths was related
to preventive behaviors (B = 0.76). Preventive behaviors had the strongest, direct relationship with
age (B = 0.76). Based on the final fitted model, knowledge had the greatest impact on preventive
behaviors through indirect and direct routes.
CONCLUSION: Knowledge was the most important variable which influenced preventive behavior,
and it should be noticed in prevention programs.

Abstract BACKGROUND: Lifestyle can play an important role in controlling type II diabetes (T2D), and a
high‑risk lifestyle can exacerbate its effects. The aim of this study was to compare the effectiveness
of motivational interviewing with self‑development education on T2D patients’ lifestyle.
MATERIALS AND METHODS: This was a quasi‑experimental study in 2017–2018. The design was
pretest–posttest with an active comparison group. The population of this study was T2D patients of
Firouzgar and Imam Reza Hospitals in Tehran. Using targeted sampling, 80 patients were selected and
randomly assigned into experimental and comparison groups. The instrument was a tool for assessing
lifestyle determinants in T2D patients (determinants of lifestyle behavior questionnaire) based on the
theory of planned behavior. Intervention program was initially performed, and motivational interviewing
was conducted on Firouzgar Hospital’s patients for 10 sessions while self‑development education
was conducted on Imam Reza Hospital’s patients for 10 sessions (active comparison group). To
analyze the data, independent t‑test and Chi‑square test were used.
RESULTS: The results showed that the patients who received motivational interviewing had significant
improvement in their lifestyles with a 95% confidence level at P = 0.042, compared to the patients
who had been trained with self‑development education.
CONCLUSION: Motivational interviewing improves the lifestyle of T2D patients compared to
self‑development education. It is recommended that motivational interviewing be used to help the
rehabilitation of these patients. This method helps patients control their blood sugar while improving
their lifestyle.

Abstract BACKGROUND: Maternal attachment to the fetus is a term used to describe the emotional relationship
between mother and fetus. This emotional connection increases during pregnancy and is reflected
in her feelings, perceptions, and behaviors. Mindfulness is important as one of the factors affecting
the mental health of people during pregnancy. Therefore, the present study was conducted to
determine the relationship between the dimensions of mindfulness and maternal attachment to the
fetus during pregnancy.
MATERIALS AND METHODS: The present study was performed on 500 pregnant mothers referred
to health centers affiliated to Isfahan University of Medical Sciences. The samples were entered into
the study by available sampling method and if they had inclusion criteria and no exclusion criteria.
The research instruments were the Fetal Attachment Questionnaire and the Bauer Mindfulness
Questionnaire. The collected data were analyzed by SPSS software version 22.
RESULTS: The results of the data showed that there was no significant relationship between the
overall score of mindfulness and the overall score of maternal attachment to the fetus (P = 0.62).
While from the dimensions of mindfulness such as “action with awareness” there was a significant
negative relationship (P = 0.03) with maternal attachment to the fetus and a significant positive
relationship “observation” with maternal attachment to the fetus (P = 0.03).
CONCLUSION: According to the results of this study, there is a relationship between maternal
attachment to the fetus during pregnancy and a number of dimensions of mindfulness. For this
purpose, since mindfulness can increase the mother’s interactions with the fetus, and this interaction
begins during pregnancy and with the mother’s attachment to the fetus, it is important to pay attention
to this.

Abstract BACKGROUND: The challenges of dental education place students at high risk of stress. Because
dental education is a highly demanding and challenging course, placing heavy demands on the
mental resources of the students, making them vulnerable to high levels of stress, this study aimed to
determine the prevalence of depression, suicidal ideation, and suicidal behaviors in dental students.
MATERIALS AND METHODS: A descriptive cross‑sectional study was done on a convenience
sample of 388 dental students in a teaching dental institution. Data were collected using standard,
prevalidated, self‑administered questionnaires (Patient Health Questionnaire‑9 and Suicidal
Behaviours Questionnaire‑Revised [SBQ‑R]). Analysis was done using SPSS version 20. Descriptive
statistics, Chi‑square test, and logistic regression were performed.
RESULTS: At least half of the students were in major depression with different levels of severity.
When students from different years were analyzed, majority from each year fell under II and III
categories (P < 0.001). Most of the students reported that they do not have any suicidal ideation
or behavior (SBQ‑R). Nearly 16% of the students either presented the threat of suicidal attempt
or likelihood of suicidal behavior in future. Almost 13% of the dental students thought of killing
themselves in the past year for at least two times. Around 16% of them expressed to someone about
their thought of committing suicide.
CONCLUSION: Even though depression and suicidal tendencies were not prominent in dental
students, there is a need to shed light on those who responded positively and take necessary reforms
to relieve academic stress.

Abstract BACKGROUND: Obesity and overweight in children and adolescents have become a global problem
in recent years. Adolescence increases the likelihood of obesity in adulthood and associated illnesses.
Nowadays, health literacy is one of the greatest determinants of the health. This study was conducted
to evaluate the correlation between body mass index (BMI) and health literacy in high school students.
MATERIALS AND METHODS: In this descriptive‑analytical study, 430 high school students were
enrolled in a multi‑stage random method in Yazd city in the center of Iran. The data were collected
through The Health Literacy Measure for Adolescents and calculate BMI with measurement of
height and weight of adolescents. The data were then analyzed using SPSS 25 and descriptive and
inferential statistics (Chi‑square and multivariate regression).
RESULTS: The results showed that the mean score of BMI (21.76 ± 3.76) was in a normal range.
The score of health literacy was at the borderline level (58.44 ± 13.79). BMI was not significantly
correlated with health literacy (P = 0.09). BMI was significantly different in terms of age, high school
grade, school type, and health status. School type and health status predict 37% of the variance of
BMI (R2 = 37%) and the best predictor was health status (P < 0.05).
CONCLUSIONS: The results of the present study showed that BMI was not correlated with health
literacy and student health literacy was at the borderline level. It is necessary to carry out further
studies on the causes and facilitators and the barriers to increasing health literacy. Furthermore,
educational interventions are needed to prevent the increase of BMI in adolescents and identify
determining factors.

Abstract BACKGROUND: Faculty development programs as useful approaches for organizational development
improved competencies in faculty members which assist them to cope with workload and environment
changes. Evaluating organizational development for faculty development programs provides insight
into the impact of these programs on system development. The aim of present study was conducted
to study the organizational development for faculty development programs at Kerman University of
Medical Sciences.
MATERIALS AND METHODS: This analytical and cross‑sectional study was conducted between
October and December 2020. The organizational development for faculty development questionnaire
was sent to a simple random sampling of 100 faculty members who had been participated in the
“Medical Education Fellowship” program. The data were analyzed using descriptive statistics including
independent sample t‑test, one‑way ANOVA, and post hoc, using version 24.0 of SPSS.
RESULTS: The response rate was 82%. Most of the faculty highly agreed that the “Medical Education
Fellowship” program had produced organizational development. The score of the “Development and
sustaining faculty development programs” domain (mean = 3.35, standard deviation [SD] =0.96) was
higher than “Development and innovation in teaching and learning process” (mean = 3.31, SD = 0.74).
CONCLUSIONS: Specific characteristics of the organizational development process for faculty
development programs in health profession education were recognized. The findings emphasized on
the importance of these interventions on creating developments in the broader community system.

Abstract BACKGROUND: In India, most of the deaths due to road traffic accidents (RTAs) occur within
24 h of the accident. Hence, this study aimed to assess the proportion of RTA victims reaching the
health‑care facilities within the golden hour.
MATERIALS AND METHODS: This cross‑sectional study was conducted in a tertiary care center in
South India between August and September 2017. All RTA victims who were admitted for treatment
in the emergency department during the study period were included. Data were collected using
structured, pretested, and validated pro forma. Hospital exit outcomes between those who reached
within 1 h and those who did not were expressed as proportion with a 95% confidence interval (CI).
The factors associated with hospital exit outcomes were analyzed using a Chi‑square test.
RESULTS: Among 626 RTA victims, the mean (standard deviation) age was 37.4 (2.6) years,
and about 83% (n = 521) were male. More than one‑third (37%) of the RTAs occurred on urban
roads (n = 235, 37.5%). A total of 424 (67.7%) were referred from other hospitals. The mean
time taken for RTA victims to reach any health‑care facility was 3 h. More than half (n = 346,
55% [95% CI: 51.3–59.2]) of the RTA victims had reached a health‑care facility within the
golden hour. Among those who reached beyond the golden hour, one‑fourth (n = 77, 27.5%)
were delayed due to the unavailability of transporting vehicles. Delay in communication (n = 59,
21.1%), prolonged travel (n = 41, 14.6%), lack of knowledge about nearby facilities (n = 39,
13.9%), nonavailability of attenders (n = 35, 12.5%) and financial issues (n = 29, 10.4%) were
the other reasons for the delay.
CONCLUSION: Almost half of the RTA victims reached the health‑care facilities after the golden
hour. Unavailability of ambulances or vehicles for transport and delay in communication were the
important factors that played a role in the delay.

Abstract BACKGROUND: Smokeless tobacco (SLT) products are highly addictive and contain at least 28
carcinogenic chemicals. The purpose of this study was to determine the effect of theory‑based on
the Transtheoretical Model of Behavior Change on consumption of SLT products by Merchants’
Guilds in 2018.
MATERIALS AND METHODS: The present quasi‑experimental research was conducted over one
intervention group. The research population consisted of all consumers of the SLT products among
the merchants’ guilds in Chabahar City, Iran in 2018. Data were gathered from 320 individuals by
simple random sampling using a valid and reliable researcher‑made questionnaire. The intervention
program was designed based on the Transtheoretical Model of Behavior Change cognitive processes
and lasted 6 months. After the intervention, the same questionnaires were administered among the
participants. The data were analyzed by SPSS version 20 using the descriptive and analytical tests.
RESULTS: In the preintervention phase, the participants’ mean scores of the cognitive processes
at the precontemplation, contemplation, and preparation stages were 29.16 ± 4.63, 25.07 ± 3.84,
and 12.12 ± 1.63, respectively. At the postintervention phase, mean scores of the precontemplation,
contemplation, and preparation stages reached to 40.5 ± 5.96, 38.8 ± 5.03, and 35.5 ± 4.23,
respectively. Furthermore, the participants’ mean sores at the action and maintenance stages were
36.4 ± 4.57 and 43.3 ± 3.29, respectively. According to the ANOVA, a significant relationship was
found between cognitive processes at the preintervention phase and stages of change (P < 0.001).
CONCLUSIONS: Individuals can improve from the precontemplation, contemplation, and preparation
phases to the action and maintenance stages by attending based on Transtheoretical Model of
Behavior Change educational interventions. It is suggested that the structure of this model be used
to reduce high‑risk behaviors in other occupations.

Abstract BACKGROUND: The 2019 coronavirus disease (COVID‑19) lockdown has caused significant
changes in everyday life. This study evaluated the effect of the COVID‑19 quarantine on dietary and
alcohol consumption habits and body weight of Italian university students.
MATERIALS AND METHODS: An online cross‑sectional survey was carried out among university
students than 18 years in July 2020. The online self‑administered questionnaire included demographic
and anthropometric data (reported weight and height), weight, and dietary habits changes during of
the COVID‑19 lockdown.
RESULTS: A total of 520 respondents have been included in the study. A total of 393 (~76%) were
female, 3.8% was obese, and the mean age was 23 ± 4 years. Numerous students reported a change
in their eating habits during the lockdown with an increase in consumption of chocolate (40%),
ice cream, and desserts (34%), but most of all an increase of homemade bread and pasta (60%),
pizza (47%), and homemade sweets (55%). The students also reported an increase of vegetables,
fresh fruit, legumes, eggs, and coffee, but also of processed meat, fried foods, cheeses, butter,
and sweet beverage, and a reduction in alcohol intake. The weight gain was observed in 43.8%,
and males have greater weight gain than females (57% vs. 46%, respectively; P = 0.04). A greater
increase in body weight was observed in obese as compared to those with normal weight (77% vs.
44%, respectively; P < 0.001).
CONCLUSIONS: Our data highlighted the need for dietary guidelines to prevent weight gain during
the period of self‑isolation, especially targeting those with overweight and obesity.

Abstract BACKGROUND: The first case of COVID‑19 was reported in Iran on February 19, 2020, in Qom. Since
Mazandaran is one of the high‑risk provinces with many patients and deaths, this study was conducted
to investigate the epidemiological characteristics of COVID‑19‑related deaths in Mazandaran.
MATERIALS AND METHODS: In this descriptive study, demographic information and clinical
findings in patients who died following COVID‑19 in the medical centers of Mazandaran University of
Medical Sciences from February 8, 2020, to October 10, 2020, were extracted. Data were analyzed
by using SPSS 21. Logistic regression was used to compare the data. P < 0.05 was considered as
the significance level.
RESULTS: Out of a total of 34,039 patients admitted during the 8 months, 2907 patients died. Of
these, 1529 (52%) were male, and the rest were female. In terms of age, 10 cases in the age group
of fewer than 15 years, 229 cases in the age group of 15–44 years, 864 patients in the age group of
45–64 years, and 1793 people in the age group of 65 years and over died. 2206 people (more than
75%) by personal visit referred to medical centers. The mortality rate was more than 8 cases per 100
hospitalized patients. Men were 16% more likely to die from COVID‑19 than women.
DISCUSSION AND CONCLUSION: Older adults over 65 have the highest incidence and death rate
due to this disease. The incidence rate was higher in women, and the death rate was higher in men,
which differs from the national pattern.

Abstract Private hospital services (PHS) with the undeniable effects on the Universal Health Coverage (UHC)
goals have a considerable contribution to the health system of developing countries. The purpose of
this systematic scoping review (ScR) was to identify and map the available evidence regarding the
developing countries to scrutinize the nature of the PHS toward UHC through providing graphical/
tabular information of the records trends and types, sources of the records, frequent settings, drivers
of the PHS growth, range of the PHS, behaviors of the PHS, and opportunities for policy actions.
This study was performed following the 2017 published methodological guidance of the Joanna
Briggs Institute for the conduct of ScR. Furthermore, a narrative‑thematic synthesis integrated with
the systematic analysis applying approach to health system strengthening (HSS) through systems
thinking was employed. Thirty‑two included records in English that met the inclusion criteria were
found between 2011 and July 2020. There has been a sharp increase in the generation of the records
with a 90.6% growth rate between 2015 and 2020. The most frequent records types were review
article, and the lancet was the most specialized journal. India was the most frequent country. Near
half of the growth drivers of PHS have been originated from the governance. Besides, the range of
PHS was identified only about Mongolia, and the significant frequency of codes of the PHS behaviors
(32.6%) was related to integrated people‑centered health service delivery. 47.8% of the identified HSS
interventions were recommended about governance. Governance plays a decisive role in the nature
of the PHS in UHC. Concerning the dynamic architectures of interactions between health system
functions, probably the countries themselves have realized the importance of the governance role in
the HSS than other functions. Given the all of the recommended interventions were a combination of
foundational and institutional, sustainable participation of PHS in the health system seems far and
requires a solid will of the governments. Future research is needed about the range of PHS and its
behaviors in terms of consumables, revenue‑raising, and pooling of funds.

Abstract BACKGROUND: Improvement of the learning in undergraduate bedside teaching needs to be
promoted through innovative interventions. Changes in the structured format (SF) for bedside case
discussion may help students improve their learning experience and gain insights into collaborative
self‑directed learning. The aim of the present study was to encourage collaborative and self‑directed
learning strategies by MBBS undergraduate students through a new case presentation format
structured for this purpose.
MATERIALS AND METHODS: This was an interventional study carried out in the year 2010–2011.
A new SF for bedside cases presentation was developed. A comparison with the traditional format
was done by holding one session in each format. Uniformity of topic and teaching style was ensured
by having the sessions on pulmonary medicine cases with the same teacher. The student perspective
of the educational process was analyzed using evaluation pro forma, Likert scale, and narratives.
RESULTS: Ninety final year and prefinal year MBBS students participated in this study. There was
significantly higher participation in history taking (50.7%) and clinical examination (60%) in the SF.
A higher statistically significant number of clinical possibilities were considered in the SF (85.3%
vs. 66.6%). Similarly, significantly higher number of students indulged in self‑directed learning and
referred to learning resources in the SF. The SF provided students an active role (96.9%), encouraged
access to resources (93.9%), and control of learning (75.7%). The additional interactive session was
productive (90.9%), discussions were streamlined (66.6%), and the role of a teacher was considered
important (75.7%).
CONCLUSION: The SF generated higher participation in the aspects of history taking, clinical
examination, and consideration of differential diagnoses. It led to a perceived improvement in
self‑directed and collaborative learning among students.

Abstract INTRODUCTION: In the COVID‑19 crisis, nurses are directly involved in patient care, so they face
many challenges. This study was performed to determine the challenges faced by nurses while
caring for COVID‑19 patients in Iran in 2020.
MATERIALS AND METHODS: This qualitative, content analysis was conducted in Iran on ten nurses
directly involved in the fight against the corona epidemic, selected through a purposeful sampling
strategy. Data were collected through deep interviews consisting of open questions. All the interviews
were recorded, and immediately after each interview, it was transcribed into written form. The data
were analyzed using MAXQDA software.
RESULTS: All the challenges could be classified into three main categories and 17 subcategories.
The main categories were miss‑management in controlling corona conditions, mental and physical
complications and challenges in corona work conditions, and lack of sufficient workforce.
CONCLUSION: Hospital managers and authorities play a significant role in meeting the financial
needs and requirements of nurses, and can minimize the job discrimination prevalent at medical
centers through providing financial and nonfinancial incentives for nurses. Moreover, the findings
of the present study can help hospital managers and authorities to gain a better understanding of
the experiences of nurses, and to take the necessary measures to obviate the challenges faced by
nurses in public health emergencies.

Abstract BACKGROUND: Patient safety culture is an integral part of patient care standards and a prerequisite
for safe care. SBAR is an acronym for Situation, Background, Assessment, Recommendation; this
communication model has gained popularity in health‑care settings, especially among professions
such as nursing. However, there is little evidence that nursing professional education can enhance
patient safety culture. The aim of this study was to investigate the effect of a SBAR‑based training
program on patient safety culture in intensive care unit (ICU) nurses.
MATERIALS AND METHODS: The quasi‑experimental study was carried out in 2018–2019 at areas
covered by Shahrekord University of Medical Sciences, Iran. This study was performed on 60 nurses
working in ICU. The participants were randomly assigned to two experimental and control groups of
30 each. For the experimental group, five workshop sessions of SBAR‑based program were held.
For the control group, the patient delivery process was performed according to the ward routine. Data
were collected using patient safety culture questionnaires before and 1 month after the intervention,
and were analyzed using descriptive and analytical tests such as paired t‑test, independent t‑test,
and Chi‑square test by SPSS 22.
RESULTS: The mean score of safety culture was 31 ± 23.5 and 55.2 ± 28.6 in frequency of reporting
events, 32.8 ± 17.8 and 54.3 ± 19 in overall perception of patient safety, 23 ± 20.1 and 52.9 ± 26 in
communication channel openness, and 35.2 ± 19.8 and 52.4 ± 18.8 in information exchange and
conveyance before and after training intervention, respectively, so that they improved from poor
level to neutral‑moderate level. There was no strength in any dimensions of safety culture; however,
the implementation of the SBAR‑based program was significantly associated with patient safety
culture (P < 0.001).
CONCLUSIONS: Improving patient safety culture requires attention to patient safety models such
as SBAR approach that provides an appropriate and reliable structure for quality improvement.
SBAR‑based program training is effective in promoting patient safety culture; therefore, it is
recommended that managers use this technique to promote patient safety culture.

Abstract The current outbreak of coronavirus disease 2019 (COVID‑19) across the world forced universities
to suspend learning to limit the spread of the virus. Many medical schools have shifted to online
education as an information delivery mechanism where the educator and learner are separated in
space and potentially also in time. This systematic review aims to explore and understand the variety
of distance learning strategies in medical students in the contexts of COVID‑19. A systematic review
was conducted in Web of Sciences, PubMed, Educational Resources and Information Center, and
Scopus from December 2019 to July 2020. Eight sets of terminology were used, combining “Distance
learning” AND “Medical education” AND “Pandemic.” Studies were reviewed independently by two
reviewers. Data were extracted and quality appraised using QualSyst tools, and synthesized by
performing thematic analysis. A total of 473 articles were identified after removing duplicates and
314 records were screened, of which 125 were included in this study. The primary articles were 52
primarily qualitative articles. Five learning strategies consisted of technology‑enhanced learning (TEL),
simulation‑based learning, technology‑based clinical education, mobile learning, and blended learning.
Tools, methods, and learning resources associated with these five learning strategies were extracted
from the articles. Our review highlights that TEL and simulation‑based learning were more commonly
used than others in distance learning in medical education during the COVID‑19 pandemic. These
strategies have the potential to improve learners’ level of knowledge and performance through
making online learning resources such as Massive Open Online Courses, virtual clinical cases, and
blended sources accessible.

Abstract BACKGROUND: The 2019-novel coronavirus (2019-nCoV) started as an epidemic later
transformed into a pandemic causing a threat to public health globally.  Any community to fight
the COVID-19 pandemic requires adequate knowledge, attitude of the people, and practice of the
government-imposed laws and regulations. Based on these factors, we framed the objectives to
find the sociodemographic profile of the study group and to assess their knowledge, attitude, and
practice (KAP) toward COVID-19. These results will help the health planners and administrators in
each state to find out the gap in health education efforts.
MATERIALS AND METHODS: A descriptive, cross-sectional study was conducted on South
Indian population to know KAP toward COVID-19. A convenient sampling technique was used to
collect the data using Google forms, and analysis was done using the SPSS software version 21.
The questionnaire includes sociodemographic information, KAP questions toward COVID-19, and
perception toward national and community responses.
RESULTS: A total of 1644 were participated; the average knowledge score was 17.5 (+1.9).
Most of them (92.9%) respondent’s perceived that early detection will have a better outcome from
COVID-19, whereas the knowledge compared with practice, there is a significant difference Pearson
correlation (0.404) P is < 0.001.
CONCLUSIONS: Although a high level of knowledge on COVID-19 in the public gradually decreasing
the practice of preventive measures, the government should continue the consistent efforts to change
the behavioral communication and motivate the public social responsibility to adhere to the health
protocols, masking, hand hygiene, social distancing, and vaccination to prevent expected COVID-19
subsequent episodes.

Abstract BACKGROUND: All policies and decisions need evidence examined by scientific methods. Moving
toward evidence‑based decision‑making (EBDM) as a change in organizations, especially health
systems (HSs), is inevitable. This study was conducted to identify the factors affecting EBDM in HSs
from two approaches and to score them.
MATERIALS AND METHODS: A mixed‑method study was carried out using the force field analysis
regarding the change toward EBDM in HS in 2020. This study included six steps to identify and
score the key driving forces (DFs) and restraining forces (RFs) to change toward the EBDM in
HS: first, finding forces from literature; second, selecting key DFs and RFs through focus group
discussion; third, scoring the first group of DFs and RFs by the experts through electronic forms;
fourth, determining key DFs and RFs from the managers’ perspective using qualitative interviews;
fifth, scoring the second group of DFs and RFs by the experts; and sixth, comparison between forces
resulted from two approaches.
RESULTS: According to the literature and experts’ opinions, “relevant, reliable, interpretable, and
understandable evidence” and “interaction between researchers and decision‑makers” were the
strongest forces to change, and “lack of organizational commitment and support” and “lack of relevant/
high‑quality evidence” were the strongest forces against the change toward EBDM in HS. Further,
based on managers’ perspective and scores by the experts, “suitable supervision and control” and
“reforming the planning and decision‑making system” were the strongest forces to change, and
“inadequate knowledge of the managers and staff about the principles and contents of EBDM” and
“issues beyond the authorities of managers” were the strongest forces against the change toward
EBDM in HS.
CONCLUSIONS: Based on the findings, HSs’ managers can focus to reduce RFs and promote DFs
for implementing EBDM strategies, so they can provide better services by making more efficient
decisions.

Abstract BACKGROUND: More than one‑half of people with diabetes need at least one surgery in their
lifespan. Few studies have addressed how to manage the needs of these patients after discharge
from the hospital. The present study is designed to determine the effect of home care on readmission
of Type 2 diabetic patients who underwent surgical procedures.
MATERIALS AND METHODS: The present study was a randomized clinical trial. Sixty‑nine
patients with Type 2 diabetes undergoing surgery were assigned to the intervention and control
groups via blocking order in the selected educational hospitals of Isfahan 2019. Home care
was performed for 3 months with interprofessional team approach. Data collection tools were
re‑admission checklist. Data were entered in SPSS software version 23 and were analyzed by
nonparametric tests.
RESULTS: The background characteristics in the intervention and control groups were not different.
The frequency of readmission in the control and intervention groups from the time of discharge until
3 months later was 25.7% and 18.9%, respectively. Frequency of readmission in the intervention
and control groups was not significant in 3 months from discharge, P > 0.05. The mortality rate was
11.4% and 0% in control and intervention groups, respectively, P < 0.05.
CONCLUSION: It can be argued that continued home care can decrease the rate of readmission
and mortality rate in patients with Type 2 diabetes who will discharge from surgical wards.

Abstract BACKGROUND: Chronic liver disease (CLD) is one of the most common chronic diseases in the
world that threatens the health of children due to its many complications such as malnutrition and
problems related to growth and development. Paying attention to nutrition and lifestyle modification
in these children is of special importance. Therefore, the aim of this study was to determine the effect
of nutritional education program on micronutrient intake in children with CLD.
MATERIALS AND METHODS: The present study is a two‑group randomized clinical trial that was
performed by available sampling and referred to Ghaem Children’s Hospital in Mashhad in 2016. In
this study, 77 children with CLD who met the inclusion criteria (45 children in the intervention group and
32 children in the control group) were studied. The intervention included six workshops and training on
proper diet, post‑workshop phone calls, and regular face‑to‑face counseling sessions (first 4 weeks
once a week and second 4 weeks once every 2 weeks) on adherence to the above diet. Patients
in the control group received routine care. The collection tools in the study included demographic
information questionnaires, body composition device, and diet plan form in the form of 24‑h recall
forms. Data analysis was performed using descriptive statistical tests and Mann–Whitney and
Wilcoxon statistical tests using SPSS software version 16.
RESULTS: Based on the results of the study, the mean age of the research units was 7.8 ± 3.6 years.
The mean duration of CLD was 4.6 ± 1.8 years in the intervention group and 5.1 ± 1.9 years in the
control group. The mean crude intake of most minerals after the intervention was significantly higher
than before the intervention, except for the crude intake of retinol, thiamine, riboflavin, folate, Vitamin
C, iodine, and Vitamin B12. Furthermore, in relation to the modified intake of micronutrients, the
mean modified intake of most micronutrients after the intervention showed a significant increase
compared to before, except for retinol, Vitamin D, niacin, B12, and iodine.
CONCLUSION: Considering the effect of providing a nutritional education program to improve
micronutrient intake in children with CLD and emphasizing the importance of adequate micronutrient
intake in improving the health of children, special nutrition programs should be provided to these
children with special attention. In this regard, nurses can play an important role in improving the
quality of nutrition of children by providing nutrition programs with appropriate follow‑up.

Abstract BACKGROUND: Choosing the right career can be one of the most crucial decisions in one’s life.
Nevertheless, career decisions are filled with uncertainty and daunting challenges. Therefore, finding
ways to assist students to better understand and cope with these difficult career decisions is a worthy
topic of research. This research was aimed to examine the career decision‑making self‑efficacy of
medical students’ using a version of the Career Decision Self–Efficacy Scale–Short Form (CDSES‑SF)
that was translated and adapted with permission to the Vietnamese context.
MATERIALS AND METHODS: A descriptive study was carried out at Can Tho University of Medicine
and Pharmacy with a total number of 326 questionnaires distributed to freshmen students and 314
questionnaires collected back. Exploratory factor analysis (EFA) was used to finalize the structure
of the Vietnamese Career Decision Self‑Efficacy Scale– Short Form (VCDSES‑SF).
RESULTS: EFA resulted in the five named factors or subscales of the VCDSES‑SF with 23 items:
Occupational Information and Planning (7 items), Self‑Assessment and Career Readiness (6
items), Confidence to Change Careers (3 items), Fit My Lifestyle and Interests (4 items), and Goal
Selection (3 items).
CONCLUSIONS: A number of empirical studies undertaken in various cultural contexts have found
different models of career decision‑making self‑efficacy measurement. The present study found that
although the VCDSES‑SF is somewhat different than the original CDSES‑SF, the resultant measure
is a reliable and effective tool that can be used within the Vietnamese context.

Abstract BACKGROUND: Planning for the issuance of professional competency examination has been put on
the agenda of professional policymakers, but the ways of evaluating and conducting examinations and
its dimensions are the main challenges. The present study aimed to explain the essential dimensions
of professional competency examination in Iran from academic and clinical nurses’ perspective.
MATERIALS AND METHODS: The present mixed‑method study was performed at three stages,
systematic review, qualitative, and quantitative stages. At the first stage, 56 articles and texts were
collected from PubMed, CINHAL, Ovid, and ProQuest databases, by using the keywords, namely
professional competency examination and assessment. Base on the inclusion criteria and eligibility
assessment of article, six articles and one text on regulation were selected. At the second stage,
the results of the literature review were approved by 20 nursing experts. Direct content analysis was
used for data analysis. The results were prepared in the form of a questionnaire. At the last stage,
the questionnaire was given to 2209 clinical, academic, nurse managers, and nurses.
RESULTS: Based on findings of the review literature, essential dimensions of the professional
competency examination included a central theme of the client’s needs with four categories. At the
second stage, the Professional Competency Examination dimensions were approved by experts.
At the third stage, a comparison of findings indicated that clinical nurses emphasized more on
cardiopulmonary resuscitation, client safety, and implementation of procedures, while academic
nurses emphasized on the client’s needs, client education, and clients’ physiological integrity.
CONCLUSION: The client’s need is the most important dimension in the professional competency
examination. The nurses will be successful in providing care if they can identify the clients’ needs
and provide care plans based on client needs and priorities.

Abstract BACKGROUND: The coronavirus has caused fundamental changes in our way of life, leading to a
wave of psychological distress associated with the COVID‑19 epidemic, including stress, anxiety,
perceived threats, and fear.Considering the psychological consequences of COVID‑19, the present
study was conducted with the aim of mediating the role of compassion in the relationship between
COVID‑19 anxiety syndrome and COVID‑19 burnout.
MATERIALS AND METHODS: The design of the present study was descriptive correlation. The
present study population included all students of Ahvaz Jundishapur University of Medical Sciences
in the academic year 2020. Two hundred and fifty‑one students were selected and completed the
COVID‑19 Anxiety Syndrome Questionnaire, Compassion Scale, and COVID‑19 Burnout Scale.
Pearson correlation coefficient test and structural equation model were performed using SPSS
version 18 and LISREL 8.8.
RESULTS: The results showed that COVID‑19 burnout had a positive and significant relationship
with the overall score of anxiety syndrome (r = 0.42, P = 0.01), while it has a negative and significant
relationship with compassion (r = −0.37, P = 0.01). Compassion also has a significant negative
relationship with anxiety syndrome (r = −0.35, P = 0.01). In addition, the results of path analysis
showed that compassion plays a mediating role in the relationship between COVID‑19 anxiety
syndrome and COVID‑19 burnout.
CONCLUSION: Based on the findings of the present study, it can be said that compassion acts
as a protective factor against the negative effects of anxiety syndrome. Therefore, this factor can
be considered in the development of prevention and treatment programs for burnout caused by
COVID‑19.

Abstract Both natural and man‑made disasters are increasing in occurrence at the world. Hospitals and
health‑care centers are very complex and have a high potential for vulnerability depending on external
and internal factors. Unfortunately, past experiences show that health‑care centers and the health
system are vulnerable to disasters. Therefore, risk analysis and safety assessment studies of hospitals
and other health‑care centers are absolutely necessary. This systematic review study was conducted
on the basis of the Preferred Reporting Items for Systematic Reviews and Meta‑Analyses guidelines.
English language international databases (Pub Med, Scopus, Embase, Web of Science, and Google
Scholar) were searched through January 1, 2000 up to June 20, 2019. The quality of the studies was
assessed using the International Narrative Systematic Assessment tool. From 3630 titles identified in
this search, 24 studies were selected. The important findings of this study were grouped into five main
categories: risk analysis method, type of disaster, hospital safety methods, hospital components and
key outcomes of risk analysis, and hospital safety assessments. The nature of disasters is a threat
to the lives and property of the people, and therefore hospitals must be available at the incidents
and disasters and they must be able to respond to the needs of the disaster‑affected community.
The probability of an incident and its consequences can never be reduced to zero; because the
severity of many natural and even man‑made disasters is unpredictable and the probability of their
occurrence is different; however, it is possible to identify weaknesses and strengths through risk
analysis studies as well as hospital safety assessments and implement retrofitting programs based
on the type of risks and safety status and reduce the level of risk to an acceptable level.

Abstract BACKGROUND: The nationwide coronavirus (COVID‑19) pandemic and ensuing lockdown has
enforced institutions crosswise India to provisionally close to inhibit the spread of the virus and
started online learning for students. To measure the level of satisfaction of nursing students with
online learning and to identify the barriers which restrict to online learning.
MATERIALS AND METHODS: The current study adopted quantitative research approach with an
online survey research design and carried out during May–June 2020. Participants were selected
through a web‑based survey (Google form), in which 219 students enrolled. Self‑structured
questionnaire with the Likert scale was used to measure the level of satisfaction of nursing students
with online learning and identify the barriers which restrict online learning. The descriptive and
inferential statistics were used for the analysis in which 219 participants were enrolled in the study
of data with IBM SPSS version 20.
RESULTS: Majority of student’s participants 148 (67.57%) were extremely satisfied with online
learning. The findings suggest that the highest barriers which restrict to online learning among
nursing students is low voice and language clarity (2.16 ± 0.593), physical health barriers such as
eye strain (2.43 ± 0.613), reliability and connectivity problem (2.26 ± 0.534). Among all demographic
data, age is significantly associated with the level of satisfaction of online learning.
CONCLUSIONS: The study data indicated that maximum students were extremely satisfied the with
online learning and among barriers which effect online learning is low voice and language clarity,
reliability and connectivity problem, physical health barriers such as eye strain.

Abstract BACKGROUND: Patients with inflammatory bowel disease (IBD) experience wide range of physical
and psychological problems experience. The use of strategies to improve disease management by
patients is of has special importance in solving these problems. The aim of present study was to
discover the strategies and behaviors of patients to manage their disease.
MATERIALS AND METHODS: The present study was conducted with a qualitative research approach
and a qualitative content analysis method. The research participants included 20 patients with IBD
referred to gastrointestinal wards in 2020 in Mashhad. Data were collected through unstructured
interviews and purposeful sampling method and continued until data saturation. Data analysis was
performed continuously and simultaneously with data collection and comparatively.
RESULTS: Data analysis provided five themes of “Improving self‑efficacy and problem‑solving skills,”
“Coexistence with disease,” “Reviewing and modifying of interactions,” “Adjusting job and professional
conditions” and “Commitment to self‑care.” The combination of these concepts indicated that is the
main theme in disease management for these patients.
CONCLUSIONS: Reconstruction of individual, social, and professional life can improve self‑regulation
and problem‑solving skills in these patients and make them a sense of control on their lives and
disease.

Abstract BACKGROUND: Internet addiction (IA) is a severe problem, especially in academic communities.
The association between IA and unfavorable emotional conditions (e.g., anxiety, stress, and
depression) can harm students’ relationships and academic and career performance. The present
study evaluated (a) the prevalence of IA in a sample of medical sciences university students; (b) the
association between IA and depression, anxiety, stress, and sleep disorders; and (c) the association
between demographic characteristics and IA, depression, anxiety, and stress.
MATERIALS AND METHODS: In this descriptive cross‑sectional study, 268 students from Abadan
University of Medical Sciences were selected using Morgan Table. The participants responded to
the Young Internet Addiction Test, the Depression Anxiety Stress Scales‑42, and the Pittsburgh
Sleep Quality Index. Data were analyzed using descriptive statistics, Pearson correlation coefficient,
independent sample t‑test, one‑way ANOVA, and least significant difference.
RESULTS: The mean score of IA was 45.65 ± 35.40. IA was found to be significantly related to
depression, anxiety, stress, and sleep disorders (except for sleep disturbance) (P < 0.001). Males
were found to be more likely than females to suffer from IA, depression, anxiety, stress, and sleep
disorders. Furthermore, age was inversely related to IA, depression, and stress. Finally, medical
sciences students suffered from depression, anxiety, and stress more than students majoring in
other fields.
CONCLUSIONS: The simultaneous occurrence of IA and depression, anxiety, stress, and sleep
disorders in students indicates that IA is associated with other psychological problems. Therefore,
researchers and policymakers need to identify preventive measures to help internet‑addicted students.

Abstract BACKGROUND: The spread of novel coronavirus diseases‑2019 (COVID‑19) across the world and
its associated morbidity and mortality confronted the nations by various means. COVID19 pandemic
had significant psychological effects not only on the general population but also on health‑care
workers (HCWs). Hence, we aimed to found the level of anxiety and depression among health‑care
professionals amidst coronavirus.
MATERIALS AND METHODS: This is a cross‑sectional study conducted on 829 participants including
doctors and nurses and other medical staff who were posted in the COVID ward and COVID intensive
care unit using a well‑structured questionnaire through the Google Forms. The two scales used to
measure anxiety and depression among the HCWs were the Hamilton anxiety scale (HAM‑A) and the
Patient Health Questionnaire (PHQ‑9), Cronbach’s alpha of HAM A is 0.921 and Cronbach’s alpha
of PHQ 9 is 0.851. Data analysis was done using SPSS 26, Chi‑square test and Fisher’s exact test
were used to establish the association between categorical independent and dependent variables.
RESULTS: The results of this study demonstrate that anxiety and depression were significantly
higher in doctors and staff nurses as compared to other medical staff. According to HAM‑A, 65.1% of
respondents were in the mild category, 22.0% mild to moderate, and 12.9% moderate to severe. The
HAM‑A (P = 0.022) and PHQ‑9 (P = 0.001) for anxiety and depression respectively were significantly
higher in females. The means of the scales got increased after postings in the corona wards.
CONCLUSION: Concerning the high occurrence of anxiety and fear among health‑care professionals,
appropriate psychological/psychiatric intervention necessitates and emphasizes the need to implement
urgent measures to prevent further progress to severe mental health disorder.

Abstract BACKGROUND: Nowadays, emergencies and disasters are considered one of the biggest problems
in human life. To reduce the risk of emergencies and disasters, governments must develop strategies
and policies using evidence‑based methods. Disaster databases are the main source and tool for
storing and managing a wide range of data in this field. This study was conducted with the aim of
exploring the necessary criteria and components of the emergency and disasters database in Iran.
MARTIALS AND METHODS: This qualitative study was performed using content analysis in which 18
managers and experts with experience in registering, documenting, or responding to emergencies and
disasters were selected through purposive sampling. Data collection was done using semi‑structured
interviews that continued until saturation. Data were analyzed by means of qualitative content analysis
recommended by Landman and Graneheim.
RESULTS: In total, three main concepts concerning the necessary criteria and components of the
database of natural and artificial emergencies and disasters in Iran were explored. The main concepts
include information resources, information evaluation, and information management. Subconcepts
include data collection, information transfer, access to information, information validation, disaster
leveling, information registering, information storage and retrieval, information analysis, and
information dissemination.
CONCLUSION: The experience of the participants showed that there are many challenges in the
field of monitoring and gathering information about injuries and damages caused by emergencies
and disasters in the country. The knowledge obtained from this study can be used to create and
develop a database of emergencies and disasters in Iran. It will also provide insights for healthcare
policymakers and managers in future planning areas to more effectively address identified challenges
in preventing and responding to disasters at both regional and national levels.

Abstract BACKGROUND: In recent years, the prevalence of dust events has increased in the region and
the world. According to the Meteorological Organization, the most frequent days with dust events
are on stations located in Khuzestan province. Objective: Assessment of the effects of dust events
and meteorological elements on stroke morbidity in health in Iran: a health promotion approach.
MATERIALS AND METHODS: The present study was a retrospective cohort study 2020 and 2013
provided between based on ecological data‑based on population. Information about patients with
stroke was obtained from the hospital. Information on the dust events and meteorological elements
was also from the data center of the Meteorological Organization of Iran. Using STATA the correlation
between the diseases and the, 14 statistical software version occurrence of dust events and changes
in meteorological elements was obtained and the statistical model (Spearman correlation coefficient)
individually estigate the equation was used inv modified by Poisson regression simultaneous effect
of variables.
RESULTS: the results of adjusted statistical models show that increasing the severity of dust
event increases the risk of stroke in males (lag 0–21 confidence interval [CI] 95% = 1.496–1.0067
relative risk [RR] = 1.03 P = 0.01). Increasing the average wind speed also increases the
risk of stroke in males (lag 0–3 CI 95% = 1.0491–0.9996 RR = 1.02 P = 0.05). Increased
rainfall and average relative humidity increase the risk of stroke in people under 60 years
(lag 0–7 CI 95% = 1.0012–0.9058 RR = 1.95 P = 0.05). Increasing the average daily temperature
reduces the risk of stroke in males (lag 0–3 CI 95% = 0.9874–0.9254 RR = 0.51 P < 0.001).
CONCLUSION: Increasing the intensity of dust storms along with meteorological elements has
increased the risk of stroke. However, increasing the average temperature has had a protective
effect on the risk of stroke.

Abstract BACKGROUND: An outbreak of atypical pneumonia termed COVID‑19 has widely spread all over
the world since the beginning of 2020. In this regard, designing a prediction system for the early
detection of COVID‑19 is a critical issue in mitigating virus spread. In this study, we have applied
selected machine learning techniques to select the best predictive models based on their performance.
MATERIALS AND METHODS: The data of 435 suspicious cases with COVID‑19 which were recorded
from the Imam Khomeini Hospital database between May 9, 2020 and December 20, 2020, have
been taken into consideration. The Chi‑square method was used to determine the most important
features in diagnosing the COVID‑19; eight selected data mining algorithms including multilayer
perceptron (MLP), J‑48, Bayesian Net (Bayes Net), logistic regression, K‑star, random forest,
Ada‑boost, and sequential minimal optimization (SMO) were applied in data mining. Finally, the most
appropriate diagnostic model for COVID‑19 was obtained based on comparing the performance of
the selected algorithms.
RESULTS: As the result of using the Chi‑square method, 21 variables were identified as the
most important diagnostic criteria in COVID‑19. The results of evaluating the eight selected data
mining algorithms showed that the J‑48 with true‑positive rate = 0.85, false‑positive rate = 0.173,
precision = 0.85, recall = 0.85, F‑score = 0.85, Matthews Correlation Coefficient = 0.68, and area
under the receiver operator characteristics = 0.68, respectively, had the higher performance than
the other algorithms.
CONCLUSION: The results of evaluating the performance criteria showed that the J‑48 can be
considered as a suitable computational prediction model for diagnosing COVID‑19 disease.

Abstract BACKGROUND: Use of face covering may help prevent COVID‑19 transmission. However, there
is a lack of data on behavioral drivers of face covering use and compliance to mandatory face
covering policy at health facilities. This study aimed to describe behavioral drivers and observed
face covering use among outpatients and visitors at a tertiary hospital in Southern Thailand during
the COVID‑19 pandemic.
MATERIALS AND METHODS: We conducted a hospital‑based, cross‑sectional study in June 2020.
We developed, pilot‑tested and finalized an interview questionnaire in Thai. We also developed a
structured observation questionnaire. Two trained enumerators recruited outpatients and visitors at
the hospital’s internal medicine outpatient department (OPD), surgery OPD, and the pharmacy using
the convenience sampling. Another enumerator conducted structured observation of face covering
use among outpatients and visitors when interviews were not taking place. We analyzed the data
using the descriptive statistics.
RESULTS: A total of 206 persons that our interview enumerators approached agreed to
participate (n = 206; response rate = 62.4%). Nearly all participants stated that the use of face
covering was beneficial in preventing COVID‑19 infection from others and preventing others from being
infected (94.0% and 98.0%, respectively). Common barriers included inconvenience in breathing and
speaking (19.7%) and pain at the ears (9.6%). Structured observation of 408 outpatients and visitors
showed that nearly everyone (>99%) had a face covering on their person, most of whom (94.6%)
covered both their nose and mouth.
CONCLUSION: We found near‑universal perceived benefits and compliance, but variations in
perceived barriers, cues, and social norms for the use of face coverings. The findings of this study
can inform future intervention programs on face covering use promotion.

Abstract BACKGROUND: Musculoskeletal disorders (MSDs) were known as one of the main occupational
problems among health‑care workers. However, we had some limitations and difficulties for
transferring ergonomic concepts to the health‑care workers, especially nurses due to heavy work
task and insufficient time for that. This study compares the impacts of two ergonomic training
methods (lecture and pamphlet) in nurses of an Iranian tertiary hospital on prevalence of their upper
and lower extremity complaints.
MATERIALS AND METHODS: In the present randomized clinical trial with parallel groups, 1140 nurses
were randomly selected and allocated to the control and two interventional groups. In the interventional
groups, nurses revived a training program and pamphlet as ergonomic training methods about
work‑related MSDs and related ergonomic concept to MSDs prevention and nurses in the control group,
did not receive any ergonomic training methods. Upper and lower extremity complaints measure among
study nurses with Nordic MSDs before 6 months and 1 year after trial intervention. Statistical analysis
including the Kolmogorov–Smirnov goodness‑of‑fit, Chi‑square test, and independent sample t‑test
was performed using SPSS version 22. A two‑tailed P ≤ 0.05 was considered statistically significant.
RESULTS: At the first and second parts of the study follow‑up, the prevalence of upper and lower
extremities significantly improved in the interventional groups in comparison with the control group.
Moreover, between the two trial groups, the frequency of MSDs in upper and lower extremities
significantly improved among nurses of the pamphlet group in comparison with the lecture group.
CONCLUSION: Findings of the study showed that we can use pamphlet as a suitable tool for
describing ergonomic concepts in comparison with lecture among nurses.