Journal of Education and Health Promotion

Abstract BACKGROUND: Morbid obesity is rising around the world. Surgery is a selective treatment
intervention for it. Since most of the surgeons use weight loss for evaluating of the morbid obesity
surgical outcomes and paying attention to the the quality of life (QOL) and body image evaluation
are rare, this study aimed to assess the QOL and body image in pre‑ and postsurgery with other
interventions.
MATERIALS AND METHODS: This case–control study was done on 200 morbidly obese
patients (n = 100 in each group) who referred to the obesity clinic in Shiraz. The data were collected
by Body Image Concern Inventory and 12‑item Short Form Survey. The data were analyzed by
t‑test, Pearson correlation coefficient test, analysis of variance, and regression analysis. P = 0.05
was considered as significant.
RESULTS: The paired t‑test showed a significant difference in mean scores of body image (P < 0.001)
and all dimensions of the QOL (P < 0.001) in the case and control groups. In the case group, there
was a significant difference between the mean scores of the QOL and the different categories of
body mass index (BMI) in postsurgery (P < 0.05) and the different mean scores of body image and
the different categories of BMI in pre- and postsurgery wasn’t significant (P > 0.05). Age was a
predictor variable for the QOL of morbidly obese persons after surgery (P < 0.001). After surgery,
men showed better QOL than women (P < 0.001).
CONCLUSION: Final results indicated that body image and QOL defects caused by obesity could be
more improvement after surgery. This study can promote health‑care team’s knowledge about holistic
supporting of all dimensions’ QOL of obese individuals. It is suggested that supporting interventions
should be done as effective methods of maintenance for effects of weight loss methods such as surgery.

Abstract CONTEXT: Reflection is a learnable process that enhances long‑life learning, clinical decision‑making,
and can foster empathy and professionalism. One of the methods for teaching reflection is “reflective
writing” that is conducted in “reflective practice.” Some tools have been developed to assess “reflective
capacity,” and The Reflection Evaluation for Learners’ Enhanced Competencies Tool (REFLECT)
is one of them.
AIMS: This study aimed to adapt the REFLECT rubric in Persian.
SETTINGS AND DESIGN: This quantitative study was conducted in a medical school with the
participation of medical interns through census sampling, and in three stages, including translation,
pilot study, and main study.
SUBJECTS AND METHODS: Persian translation was obtained by the “forward/backward translation”
method. We made some changes in the tool and used it in the pilot and main study to confirm validity
and reliability.
STATISTICAL ANALYSIS USED: Cronbach’s alpha coefficient, Pearson correlation, and Cohen’s
kappa were applied for statistical analysis. Data analysis was performed using SPSS23.
RESULTS: We inserted a numerical value of 1–4 at the reflection levels, and also removed Axis 2 and
an optional writing component. In the pilot study, face and content validity was confirmed involving
10 interns and five medical education specialists. Then, 67 interns participated in the main study,
and we measured the reliability of the tool by internal consistency through Cronbach’s alpha (0.83)
and test‑retest through correlation coefficient (0.89). The size of the agreement was measured to
determine the inter‑rater reliability by Cohen’s kappa (0.84).
CONCLUSIONS: The modified REFLECT version is a valid and reliable tool that can help us to
assess reflective capacity. The use of this tool is recommended for reflective practice in medicine.

Abstract BACKGROUND AND AIM: Some people exposed to disasters will suffer from acute stress
disorder (ASD) due to the negative consequences of these disasters. Evaluating this disorder at a
large scale requires a credible and standardized tool. Therefore, the current study aims to investigate
the psychometric properties of the ASD questionnaire for people exposed to Kerman earthquake.
METHODS: This is a descriptive‑tooling study, conducted on 435 men and women older than 18 years
living in earthquake‑affected areas of Kerman Province (Kouh‑e‑Banan). The study was carried out
using the Persian translating of the English version of the Diagnostic and Statistical Manual of Mental
Disorders, Fifth Edition ASD questionnaire on accessible individuals living in temporary residence
tents in two initial and final stages and different stages of validity and reliability evaluation was carried
out. The findings were analyzed using descriptive statistics and Pearson’s correlation coefficient.
RESULTS: During the evaluation of content validity, no questions were eliminated. To carry out
factor analysis, sampling competence, and suitability of sample size were confirmed through
Kaiser–Meyer–Olkin and Bartlett’s tests. In the factor analysis stage, 14 items in three factors were
defined. The factors were included reexperiencing and analysis, arousal (continuous irritability), and
avoidance factors which together explained 59.43% of percentage distribution. In the next stage
of evaluating divergent validity, the results indicated a significant and inverse correlation between
ASD score and quality of life score (r = −0.43, P = 0.002) of the participants, while there was also
a positive and significant correlation between ASD score and general health disorder score of
the participants (r = 0.47, P < 0.0001). The reliability of the questionnaire was investigated using
Cronbach’s alpha, and inner class correlation coefficient was calculated to be 0.9.
CONCLUSIONS: The tool investigated in this study has suitable validity and reliability and is effective
for use by psychologists and relief workers for necessary interventions and prevention of ASD in
disasters.

Abstract INTRODUCTION: The family members’ presence during teaching rounds is introduced as a
challenging issue. The outcomes of family presence during teaching rounds in adult care settings is
an under investigate issue. The propose of this study was to determining the effect of family presence
at teaching rounds on patient’s anxiety and satisfaction in cardiac intensive care unit (CICU).
MATERIALS AND METHODS: In this double‑blind randomized controlled trial, 60 patients who
were hospitalized in CICU were selected based on inclusion criteria and then assigned into 2
groups (with and without family members presence during teaching round), equally by the random
minimization method. The patient’s anxiety score was measured before and after rounds on the
Spielberger State‑Trait Anxiety Inventory (STAI). Furthermore, the patient’s satisfaction about various
clinical aspects of round was measured by a self‑reported questionnaire. The data were analyzed by
SPSS software using Kolmogorov–Smirnov test, Chi‑square test, independent sample and paired
sample t‑test, at the significance level of 0.05.
RESULTS: The study groups were similar in terms of demographic variables. In the family members
presence group, the STAI score significantly decreased after intervention (P = 0.001). Furthermore,
in this group, the after‑intervention STAI score was significantly lower than family absence
group (P = 0.011). The mean changes of patient’s satisfaction about quality of round score in family
member presence group were significantly higher than family absence group (P = 0.001).
CONCLUSIONS: Family presence during teaching rounds led to patient’s lower anxiety and higher
satisfaction score.

Abstract BACKGROUND: The impact of infertility and assisted reproductive treatment on the mental health of
infertile couples is documented, and the identification of its predictor factors can be helpful in identifying
susceptible individuals. Therefore, the aim of this study was to identify the factors associated with
psychological symptoms of infertile couples undergoing assisted reproductive treatment.
MATERIALS AND METHODS: Using convenience sampling method, this cross‑sectional study
was conducted on 212 couples undergoing assisted reproductive treatments. The levels of mental
disorders (depression, anxiety, and stress) of the couples undergoing assisted reproductive treatments
were assessed via self‑report questionnaire of Depression, Anxiety, and Stress Scales. Data analysis
was performed using paired t‑test, independent t‑test, Wilcoxon signed‑rank test, Pearson correlation
coefficient, Spearman correlation, and multivariate linear regression.
RESULTS: The mean scores of stress, anxiety, and depression in women (14, 9.93, and 10.7) were
significantly higher than that in men (9, 5.51, and 6.6). Correlation coefficient of stress, anxiety, and
depression scores in women was inversely correlated with their age. Moreover, stress, anxiety, and
depression scores in men were significantly correlated with the duration of infertility. In both men and
women, stress, anxiety, and depression scores were inversely correlated with the level of education
and economic situation.
CONCLUSION: The results showed that during assisted reproductive treatment, women are more
likely to experience psychological problems than their spouses. In addition,   underlying factors such
as age, duration of infertility, and educational level do not similarly cause of lower mental health in
men and women.

Abstract BACKGROUND: India is at the nascent stage of competency‑based medical education. Faculties
trained in medical education are the main driving force for change. The present study explores
the perception of faculties about the current practices and problems in medical/dental/nursing
undergraduate assessment, barriers to adoption of best practices, and solutions for addressing them.
METHODOLOGY: A qualitative study was designed and data collected through an asynchronous
online discussion forum. A group of 31 health professionals (FAIMER fellows selected on the basis
of active participation in department of medical education of respective colleges) participated in the
forum. An open‑ended topic guide with prompts was designed. The forum was initiated by release
of discussion topics (threads) at the start of the month and remained in forum throughout the month.
Researchers moderated and recorded day‑to‑day events. All online forum data were coded line by
line and analyzed using conventional content analysis.
RESULTS: Four categories generated were: (1) Low utility of current skill assessment system due
to low validity and reliability; (2) Barrier in adopting newer assessment tool due to the absence of
felt need of faculties and students, mistaken beliefs, and limited resources; (3) Poor implementation
of newer assessment tools such as formatives and objective structured clinical examination with
no blueprinting; and (4) Solutions proposed were regular formative assessment, criterion‑based
examination, quality‑assured faculty development programs, and administrative support.
CONCLUSIONS: Barriers in adopting newer assessment tools are related to the faculty’s perception
and resource constraint. This can be addressed by quality‑assured faculty development programs
and effective implementation of competency‑based education.

Abstract INTRODUCTION: Selection of the managers and leaders is a major concern of leading organizations.
Recruitment of the qualified individuals in an educational organization depends on effective
selection techniques. The present study reports the experience of Tehran University of Medical
Sciences (TUMS) in designing a framework for selection of school dean.
MATERIALS AND METHODS: First, a literature review was conducted to identify the common
frameworks for the selection of deans in academic environment. Then, the perceptions of key
stakeholders were collected via focus group discussions. Thematic analysis was used to categorize
participants’ comments. Following, an institutional guideline for selection of school dean was
developed based on the derived themes and subthemes by a task force and approved by the board
of directors.
RESULTS: Three themes and nine subthemes were extracted, resulting in the selection framework
for the school dean at TUMS with three phases of preparation, selection, and appointment. The
preparation phase includes organizational needs analysis, designing the selection strategy and
determining the eligibility of nominee. In the selection phases, various methods such as personal
resume, interview, and consultation with beneficiaries were recommended, and the appointment
phase includes formal appointment of the selected nominee by the university chancellor.
CONCLUSIONS: We developed a framework for selection of school dean at TUMS. It recognizes
the process that top managers would look out when selecting school deans. The framework may
result to choose the proper individuals who have suitable plans and stronger Curriculum Vitae, while
involving key stakeholders and collecting wisdom.

Abstract INTRODUCTION: Student–supervisor conflict is inevitable in an academic setting. The purpose
of the present study aimed to argue that using intelligent interaction as an appropriate strategy to
manage the student–supervisor conflict in Iranian nursing schools.
MATERIALS AND METHODS: This qualitative study was a part of larger grounded theory research.
Data were collected by conducting a semi‑structured interview with nine nursing students and five
supervisors who were selected by purposeful sampling in the current investigation. Data analysis
was done through the recommended method of Corbin and Strauss (2015).
RESULTS: Intelligent interaction was extracted as one of the main categories for managing
student–supervisor conflict. Intelligent interaction consisted of four subcategories including use a
logic strategy, competent role play, flexible and smart selection, and getting help from other sources.
CONCLUSION: Intelligent interaction is an appropriate strategy to resolve and manage the
supervisor–student conflict in the Iranian academic setting. It is suggested that universities
must consider intelligent interaction in developing a policy‑procedure process for managing the
student–supervisor conflict in Iranian academic settings.

Abstract CONTEXT: Young people play major roles in the future of a society and face major challenges in
the field of reproductive health during this period. Therefore, it is particularly important to investigate
their educational needs for the reproductive health self‑care.
AIMS: The present study aimed to provide a needs assessment and determine the educational
needs of reproductive health self‑care in female students.
SETTINGS AND DESIGN: Isfahan University of Medical Sciences. The present research was
descriptive cross‑sectional.
SUBJECTS AND METHODS: Data were collected from 96 female students who were selected
using quota sampling and also 15 providers of reproductive health services. Data collection tool
was a researcher‑made questionnaire comprising two parts of the demographic information and
the reproductive health needs assessment. The content and face validity were determined by the
cooperation of ten reproductive health and adolescence health experts, and Cronbach’s alpha
coefficient was used to determine the reliability of the questionnaires.
STATISTICAL ANALYSIS USED: Data analysis was done by descriptive statistics (mean and
frequency distribution) and one‑sample t‑test using the SPSS 20 version.
RESULTS: The total mean of needs for reproductive health education was 3.51 out of 5 in female
students. Apart from the high‑risk behavior, mean scores of other fields were significantly greater
than the average (3). Three educational priorities included cervical cancer, violence against women,
and ovarian cysts. In addition, among the popular educational methods, most people chose the
non‑attendance method and mostly mobile applications and then educational booklets.
CONCLUSIONS: Results indicated that female students had a great need for self‑care education
in different fields of reproductive health; hence, it seems essential to implement the educational
programs in accordance with their needs by taking advantage of the available learning opportunities in
universities, particularly universities of medical sciences for their health promotion and empowerment
to acquire self‑care skills. Furthermore, the present research emphasized the need to pay attention
to education using the Internet applications.

Abstract CONTEXT: Radiological anatomy (RA) knowledge is essential for the current‑day clinical practice
due to the rapid development in imaging technologies. As there is a long interval between learning
RA in the 1st year and applying it in their clinical disciplines impedes their functional understanding,
this study has been planned to provide the students with a right mix of anatomy and radiology in
order to promulgate deeper medical comprehension.
AIM: This study aimed to evaluate the effectiveness of integrated RA in honing the radiological
reasoning abilities in 1st year medical students and to develop critical thinking skills through
small‑group, case‑based learning experience.
METHODOLOGY: All the students of 2017–2018 batch were randomized equally into study group
and control group. The study group was exposed to the interactive RA module followed by posttest.
The control group was exposed to traditional teaching and then given posttest. The groups were
flipped for successive regions of anatomy. Feedbacks were obtained by both quantitative and
qualitative methods.
STATISTICAL ANALYSIS: Posttest scores were compared using Student’s t‑test. Feedbacks were
analyzed using descriptive statistics.
RESULTS: The posttest scores were significantly higher in the study group when compared to the
control group. Nearly 92% of the students felt that the integrated module made them learn better and
44% of the students felt that it helped them to apply the knowledge in clinical context.
CONCLUSION: For the present millennial‑generation students, integrated RA lectures help develop
their critical thinking and help in the subsequent clinical years.

Abstract BACKGROUND AND OBJECTIVES: School resilience is defined as risk‑reducing strategies used to
create a safe environment for students when faced natural disasters. Resilient schools, in addition to
their educational role, provide a suitable capacity for responding to disasters and rehabilitation after
the incidence. This study determined the level of disaster resilience of schools in Yazd, central Iran.
MATERIALS AND METHODS: This is a descriptive‑analytic study conducted among 400 schools
and 367 participants in Yazd, 2018. To collect data, we used the school resilience in disasters
questionnaire (α =0.95 and intraclass correlation coefficient = 0.97 [95% confidence interval:
0.96–0.98]) containing 48 questions. We also analyzed the gleaned data through the Pearson
correlation coefficient, one‑way ANOVA, and independent t‑test.
RESULTS: The total score of school disaster resilience was 153.30 ± 29.57. In these schools, the
function had the highest (47.76 ± 13.96), and safety had the lowest (6.74 ± 3.18) score among
all areas of school disaster resilience. There was a positive significant correlation between total
resilience and areas of function, education, structural, nonstructural, architecture, commute routes,
safety, location, and equipment (P < 0.001). Location had the smallest (r = 0.424) and function had
the greatest (r = 0.854) correlation with total resilience.
CONCLUSION: It can help the school management board in assessing the level of resilience of their
school and determining the priorities for disaster risk reduction. Awareness of the status of resilience
can help policy‑makers and experts create an effective program for increasing resilience.

Abstract BACKGROUND: Postpartum period and recurrent abortion are stressful conditions that affect
women’s mental health. Stress and depression lead to the release of stress biomarkers that may
be dangerous for the mother and fetus. The aim of this study was to determine stress in the after
recurrent pregnancy loss (RPL) and normal vaginal delivery (NVD) in the north of Iran.
MATERIALS AND METHODS: This case–control study was done on forty women with NVD and
forty women with RPL. Stress was measured through measuring serum cortisol, Perceived Stress
Scale‑14 (PSS‑14), and the revised version of the Symptom Checklist‑90 (SCL‑90‑R). Data were
analyzed using the Statistical Package for the Social Sciences (SPSS) 22.0 software. Chi‑square
test, independent‑samples t‑test, Mann–Whitney U‑test, and Pearson correlation were used to
analyze the data.
RESULTS: Findings showed that nonpregnant healthy women had significantly higher
cortisol level than RPL women (mean ± standard deviation [SD]: 155.80 ± 84.97 ng/ml and
126.02 ± 50.44 ng/ml, P < 0.011), respectively. Furthermore, they had higher PSS‑14 and
SCL‑90 scores than PRL women (mean ± SD: 25.87 ± 7.48 and 25.5 ± 9.19, P = 0.745, and
mean ± SD: 1.27±0.63 and 1.20 ± 0.53, P = 0.624), respectively.
CONCLUSION: High levels of cortisol reflect the acute stress caused by the care of the baby in
women. Therefore, social support for the pregnant woman by the health‑care team is an essential
factor for reducing postpartum depression.

Abstract INTRODUCTION: India being a disaster-prone country necessitates us to be able to act proactively
for any sort of preparedness and prevention. This necessitates a curriculum which can bring all the
aspects related to disaster under one umbrella and thus impart training.
AIM: The aim of the study was to assess the responses of students about the importance of disaster
management (DM) in their MBBS course, take up suggestions about the important inclusions to be
made in their curriculum, and get an insight of the higher education and research of DM domain in
the Indian context.
METHODOLOGY: A cross-sectional study with a batch of 100 MBBS students purposively sampled
were part of the questionnaire. Besides, a thorough Internet search for institutes providing training
on DM was done, and relevant details were noted down. Later on, the students were given guest
lectures and demonstrations by certified trainers and experts along with a know-how of where to go
for getting a hands-on training and whom to respond to.
RESULTS: Seventy-two percent of the students felt the portion of DM being taught to them to be
insufficient, and 95% never got any training or demonstration for DM although 22% felt that it is
not so important for them as a doctor. Only 23% of them knew about any sort of DM courses or
certifications in India, and almost 16% of the students were confident enough to tackle any incidence
of public health emergency.
CONCLUSION: Making an earlier start will impart seriousness and accountability in the mindset of
budding physicians.

Abstract INTRODUCTION: After the psychiatric revolution and implementation of deinstitutionalization policies,
caring for people with a mental health condition shifted from psychiatric hospitals to their families. In
this way, family caregivers were forced to take full responsibility for taking care of the patients that
lead to the occurrence of challenges for them. Only a few studies have investigated the caregiving
challenges of family caregivers in patients with schizophrenia.
AIM: This study aimed to gain a better understanding of caregiving burden in family caregivers of
patients with schizophrenia and its related factors.
MATERIALS AND METHODS: This qualitative study was performed based on 12 family caregivers
of schizophrenia patients visiting a psychiatric hospital in Tehran in 2018. Sampling was carried out
based on the purposive sampling method and was continued until data saturation. All interviews were
recorded, transcript, and imported into the MAXQDA software. Then, qualitative content analysis
was conducted based on Graneheim and Lundman’s five‑step method.
RESULTS: One theme, two main categories, and five subcategories were identified from the
continuous analysis and data comparison. The “Perceived objective burden” as theme included
two main categories: “Heavy involvement of caregivers” and “Challenges of the healthcare system”.
CONCLUSION: The results of this study indicate that the family caregivers of the patients with
schizophrenia encounter many problems related to multiple responsibilities in the caring process and
challenges in the provision of mental health‑care services. This finding could improve psychiatric and
mental health nurses’ knowledge and awareness about caregiving challenges in family caregiver of
patients with schizophrenia and related factors.

Abstract BACKGROUND: A proper measurement instrument is selected based on the suggested use of
the instrument, the target concept of measurement, and features of measurement (e.g. internal
consistency, reproducibility, content and construct validity, responsiveness, and interpretability).
Concerning the design and features of measurement, there are not any adequately specific standards
for instrumentation to measure oral health literacy (OHL). The present study proposes a protocol
that attempts to fill this gap by introducing the psychometrics of a standard questionnaire which
measures OHL.
MATERIALS AND METHODS: The present research employs a methodological design and is carried
out in Tehran, with data collected through interviews that are held face to face. The data collection
procedure involves a review of the related literature, cognitive interviews, fuzzy Delphi Method, and
focal groups with participants with OHL work experience for item generation. The target participants
of this research are the Iranian adult population and experts working professionally in different
health domains. For qualitative data analysis, the content analysis strategy and in the instrument
Psychometrics COSMIN checklist will use.
CONCLUSIONS: Achievement of the present research  will be used to evaluate the capability of
the Iranian adult population in searching, processing, and deciding on healthcare services. This
instrument will focus on evaluating both clinical and nonclinical settings. The present research can
vastly improve our knowledge of the state of OHL in the Iranian adult population.

Abstract BACKGROUND AND AIM: Recognized as one of the key elements of growth and development,
education is an important strategy for successful provision of services in all social dimensions. Moreover,
it is categorized among empowerment tools to achieve goals. In the field of health, health education
encourages people to be healthy. This study aimed to evaluate the health literacy of health‑care
providers and its relationship with strategies of using health literacy in the provision of health education.
MATERIALS AND METHODS: This cross‑section correlational study was carried out on a group
of health‑care providers in Isfahan, Iran, in the second trimester of the Persian year 1397 (2018).
Participants were selected by multistage sampling, for which two questionnaires of Test of Functional
Health Literacy in Adults and inventory of strategies of using health literacy in education were applied.
The validity and reliability of the research tools were formerly approved. In addition, data analysis was
performed in SPSS version 21 using Pearson’s correlation coefficient and linear regression model.
RESULTS: In total, 230 participants with a mean age of 34.32 ± 7.71 years were entered into
the study, 92.9% of whom were female and 7.1% were male. The mean health literacy score of
the participants was 79.60 ± 12.41. In the sections of knowledge, attitude, and performance were
related to the use of health literacy education strategies, and we obtained the means 5.20 ± 1.94,
43.11 ± 4.11, and 28.96 ± 6.73, respectively. Moreover, Pearson’s results were indicative of a
significant relationship between health literacy of health‑care providers and knowledge (r = 0.245;
P < 0.05) and performance (r = 0.208. P < 0.05) regarding the use of education strategies. However,
no significant association was found between health literacy of health‑care providers and attitude
toward the use of health literacy education strategies (r = 0.081; P = 0.225).
DISCUSSION AND CONCLUSION: While the results showed that 75% of health‑care providers had
a favorable level of health literacy, and despite the proper attitude toward the use of health literacy
education strategies, the knowledge and performance of the participants were estimated at < 60% in
this regard. It is suggested that the potential of health‑care providers in terms of achieving, processing,
and perceiving health‑related information and fundamental services be improved to enhance their
knowledge and performance regarding the use of health literacy education strategies.

Abstract BACKGROUND: The pediatric hospital is an environment with a high level of stress for most parents.
Parents experience high levels of stress if their children are hospitalized due to the fear for the loss
of their child’s life.
OBJECTIVE: The objective of this study was to evaluate stress factors in parents of hospitalized
children.
MATERIALS AND METHODS: This study was conducted from January to July 2019 at the General
Pediatrics Department of Fieri Regional Hospital. The study sample was composed of 200 parents,
of which 86 (43.3%) were males and 114 (56.7%) were females. The parents chosen as our sample
had their children hospitalized for at least 5 days.
RESULTS: Our results showed that 80% of the sample was stressed out by waiting at the hospital,
whereas 42% of them felt stressed also by their child’s oral problems. Parents of hospitalized
children (83%) felt stressed about the painful techniques applied to their children. Nearly 65% of
them were stressed out by the hospital environment; child's sleep bruxism was considered another
stressor by 39% of the sample.
CONCLUSION: This study claims that parents of hospitalized children experience stress from different
stressors such as dental visits, waiting for the diagnosis, and sleep bruxism. There are other factors
which do not influence parental stress including residence, divorced parents, and  hospital conditions.

Abstract INTRODUCTION: One of the key elements in family‑centered care is educating parents with
hospitalized infant at intensive care unit. Education is a fundamental role of nursing at intensive
care units to satisfy parents and accelerate disease progression that eventually reduces hospital
re‑admission.
MATERIALS AND METHODS: This was a cross‑sectional study conducted in 2018, and the study
population was admitted infants (n = 90) in the neonatal intensive care unit (NICU) of Shahid Beheshti
University of Medical Sciences hospitals. We used a questionnaire including sociodemographic
characteristics and performance of nurses in educating parents. Nurses’ performance was assessed
in five major areas composed of family‑centered care, delivering cares according to individualized
needs, education on equipment, basic needs of infants, and finally, nutritional education. All statistical
analyses were conducted using SPSS version 22. The data were analyzed using t‑test, ANOVA,
and nonparametric tests.
RESULTS: Findings from the current study indicated that nurses performed their educational role
weakly (37% of standard level). We also found that nurses who participated in neonatal educational
courses had better performance compared to their counterparts. The results showed that year of
experiences working as a clinical nurse was significantly associated (P < 0.05) with performing
standard education.
CONCLUSION: Our findings indicated that nurses performed their educational role weakly which
might be due to staff shortage, heavy workload, and lack of time for educating parents. Therefore,
it is necessary to improve the quality of education among nurses working at the NICUs and provide
the necessary standards and indicators to evaluate this important task.

Abstract BACKGROUND: The vulnerability of the youth to acquired immune deficiency syndrome (AIDS) and
smoking is one of the most important public health issues around the world. Adequate knowledge
about AIDS and smoking is a powerful tool for promoting positive attitudes and safe behaviors.
OBJECTIVE: This study aimed to determine the effect of self‑care education on AIDS and smoking
on the level of adolescents’ knowledge and health attitude.
MATERIALS AND METHODS: This experimental study was conducted in the academic year of
2017–2018, and the participants were selected using randomized cluster sampling. These participants
included 220 female students of the third grade of middle school in Isfahan (105 in the intervention
group and 115 in the control group). Data were collected using a demographic questionnaire; a
researcher‑made questionnaire on knowledge about AIDS, knowledge about smoking, and attitudes
toward smoking; and a standard questionnaire on students’ attitude toward AIDS. After completing the
pretest, the intervention group performed two training sessions and completed the posttest 1 month
later. One month after completing the pretest, the control group completed the posttest and did not
receive an intervention. Finally, the data were analyzed using descriptive statistics, statistical tests,
and statistical software SPSS version 22.
RESULTS: The results showed that despite the similarity between the two groups at the beginning
of the study, after self‑care education, the knowledge level of AIDS (P < 0.001) and attitude
toward AIDS (P < 0.001) and the knowledge level of smoking (P < 0.001) and attitude toward
smoking (P < 0.001) in the intervention group were significantly higher than the control group. In
intragroup analysis, it was also observed that the difference between the scores before and after
was only significant in the intervention group.
CONCLUSION: It seems that education can promote the level of knowledge and attitude of
adolescents toward AIDS.

Abstract BACKGROUND: Metacognitive therapy (MCT) is a new psychotherapy for depression. This
study was conducted to compare the effectiveness of citalopram and MCT on major depressive
disorders (MDDs).
MATERIALS AND METHODS: A total of 36 patients with MDD were randomly assigned into three
groups of citalopram (n = 12), MCT (n = 16), and control (n = 8). MCT group received ten sessions
of metacognition therapy. Citalopram group received 20–40 mg citalopram, and the control group
did not receive any interventions. Outcomes were measured using the Beck Depression Inventory‑II,
Metacognition Questionnaire‑30, and Cognitive‑Emotion Regulation (CER) Questionnaire. Data were
analyzed with ANCOVA using SPSS version 18.
RESULTS: Depression score reduction was significant in both citalopram and metacognitive
groups (P < 0.05). However, there was only a statistically significant difference between MCT and
control group in CER and metacognition.
CONCLUSION: MCT and citalopram both are effective in symptom reduction in MDD. Furthermore,
MCT could lead to more improvement in metacognition, depression symptoms, and CER than
citalopram, when treating MDDs.

Abstract INTRODUCTION: Disaster can occur at any time any place. Disaster preparedness plays an important
role to reduce the loss of a community/country. The aim of this interventional study was to ascertain
the impact of a video‑based educational intervention program on improvement in knowledge and
attitude of paramedical students in a hospital.
MATERIALS AND METHODS: A pre–post study (interventional study design) was conducted on
paramedic students. Our study period was 6 months which was divided into Phases I, II, and III. For
administrative purpose, we included all paramedical students, and our sample size was 119. The
baseline assessment of knowledge and attitude of paramedic students was done by a pretested
questionnaire (Observation 1) with having a baseline scoring. After that, intervention Phase 1 was
implemented, and later, end line observation (Observation 2) was made. Changes in knowledge and
attitude were observed by the score difference (Observation 2–Observation 1). Descriptive statistics
were calculated, and the mean of cumulative score was compared using the Wilcoxon signed‑rank
test. We applied Mann–Whitney U‑test for finding associations between dependent variables with
an independent variable using SPSS version 22 (IBM, Chicago, USA) software.
RESULTS: Our baseline results showed that most of our participants had average
knowledge (54.6%), followed by poor knowledge (24.4%). Approximately one‑fifth (21.0%) of the
participants had good knowledge regarding disaster preparedness.   A significant improvement was
observed in cumulative score (P < 0.005). A significant difference was observed in knowledge and
attitude with respect to age and courses (P < 0.05). Forty percent of the students responded that
they would like to get trained by that mock drill, and 26.1% were interested in disaster preparedness
workshops in the future.
CONCLUSION: Our present study results indicate that the overall knowledge and attitude level of
the students was average and required improvement. A similar result was reported in some studies
conducted globally for the same purpose. All of our students perceived that training for disaster
preparedness is necessary for all health facilities, and it is important to have an emergency plan
and disaster management committee. Regarding training methods, most of our students liked our
interactive audiovisual method. However, their preferred methods were mock drill and workshops.
It can be arranged in the future for them.

Abstract INTRODUCTION: The hospitals are a stressful environment for employees, especially nurses. Stress
and other health problems may lead to occupational burnout and reduction of nurses’ efficiency.
The aim of the current study is to investigate the effect of emotional intelligence training on health
promotion of nurses in Sabzevar Hospitals.
METHODOLOGY: The current study is a field trial with a random control group. The sample
group was 135 nurses of Sabzevar Hospitals. They were then divided randomly into experimental
and control groups. First, all of the samples answered the questionnaire of personal information,
Bar‑On Emotional Intelligence, and General Health Questionnaire. The first group (intervention)
was trained by giving the speech, and the second group (control) did not receive any intervention
about the subject of the study. The experimental group was then trained for the components
of emotional intelligence and answered the questionnaire again. The significance level was
considered as P < 0.05.
RESULTS: The results showed that the distribution of qualitative variables in the study was similar
and also the scores of emotional intelligence and the dependent variables after intervention in the
intervention group had a significant and inverse relationship, meaning that the score of emotional
intelligence decreased with the score of general health score. This could be significant in comparison
to the two groups. Findings showed that emotional intelligence at the beginning of the study in
the intervention and control groups were 35.03 ± 32 and 30.89 ± 33, respectively, and after the
intervention, it was 29.68 ± 35 and 42.89 ± 34, respectively. Total general health was 19.76 ± 84 and
18.77 ± 77 in the case group before intervention and 14.55 ± 56 in the case group and 17.68 ± 52
in the control group, respectively (P < 0.001).
CONCLUSION: Findings indicated the significant mutual effect of emotional intelligence changes
and general health variables. It means as the score of emotional intelligence gets more, health score
decreases and the rate of general health increases.

Abstract INTRODUCTION: The incidence of renal failure in children is increasing worldwide, and most renal
diseases do not show clinical symptoms for the patient. Moreover, given the importance of screening for
patient identification and prevention planning that result from screening, the present study was performed.
METHODS: This cross‑sectional study was performed on 292 children aged 7 years who referred
to Neyshabur health centers during 2017–2018. In addition, sampling was clustered. The first urine
sample was taken in the morning, and the dipstick test was performed. Data were analyzed using
SPSS software version 11.5 and Mann–Whitney, Chi‑square, and Pearson’s tests.
RESULTS: Of the 292 children, 142 (48.6%) were male and 150 (51.4%) were female. All the boys had
been circumcised. The children were 7‑year‑old. Urinary tract problems were present in 31 (10.61%)
children. Urinary problems were observed in 163 children (55.82%) considering crystalluria. Some
children had more than one type of urinary disorder. Pyuria was the most common disorder in
13 (8.7%) of the studied children, and proteinuria was the least common. Nitrite and hemoglobin
were not found in the urine of the studied children. There was a statistically significant relationship
between gender and white blood cell count (P < 0.001), crystalline oxalate (P = 0.004), and specific
gravity (P = 0.009). There was also a statistically significant relationship between urinary‑specific
gravity and pH (P < 0.001).
CONCLUSION: Asymptomatic urinary problems may be identified by screening tests in school‑aged
children. Therefore, it is necessary to determine the exact cause of the obtained abnormal results
and determine whether or not they are related to renal disease in order to reduce the number of
people with untreated renal diseases in future.

Abstract BACKGROUND: The importance of spirituality and spiritual growth in humans has been increasingly
taken to attention by psychologists and mental health professionals. In this study, we aimed to
investigate the relationship between the tendency to aggression and individual resilience also
considering the role of mediator of spirituality in academic students by path analysis.
MATERIALS AND METHODS: A cross‑sectional study was conducted using structural equation
method (SEM). The target population consisted all of undergraduate academic students in Ilam, Iran
University of Applied Sciences, in 2018. Participants included 200 people whom were selected by
stratified random sampling. Data collection tools were demographic, Buss and Perry aggression,
spirituality assessment, and resiliency of Connor and Davidson questionnaire. In this study, bivariate
analysis was used to determine the directionality correlation between the study variables.
RESULTS: The results showed that there was a significant and positive correlation between
spirituality and resilience (r = 154% r = 83%). Furthermore, there was a negative and nonsignificant
relationship between aggression with resiliency (r = −122% P = 101). In addition, there was no
significant correlation between the aggression and spirituality (r = 0.05%, P = 0.942). The results of
SEM showed that spirituality and aggression can predict about 20% of the variations in the degree
of resilience in academic students. Accordingly, the results of SEM spirituality in an indirect path
reduce the aggression and thus increase the resilience (r = 0.102).
CONCLUSION: The results of this study showed the effect of spirituality on increasing the level of
resilience and also positive mediator role of spirituality between aggression and resiliency.

Abstract