BACKGROUND: Evidence-based medicine (EBM) plays an important and dominant role in promoting effective decision-making in the health system. This study was aimed to evaluate the EBM performance among health-care workers (HCWs) in hospitals in Iran. METHODS: In this study (a cross-sectional study), participants were 2800 HCWs in hospitals. A researcher-made questionnaire was designed, and judgments of 10 experts were used for the improvement of content validity. The reliability of the questionnaire was assessed by the test-retest method (α = 0.85). Data were analyzed using the descriptive statistics, t-test, and one-way ANOVA, in SPSS.16 software. RESULTS: Eventually, 1524 questionnaires were completed (response rate: 54.4%). The results of the study show that 62%of participants have not accessed scientific journals, 52% of them have difficulties using the Internet at work, guidelines were not reachable for 76% of them, and about 80% have not access to databases. About 39% of participants were not well informed about databases of EBM, and 15.8% of them were immensely knowledgeable about EBM terminology. The most important problems to increase HCWs information about EBM include research methodology- related problems, lack of resources and motivation, and coordination problems. The most prominent facilitators include: providing training courses in EBM and increased facilities. Only work experience showed a significant correlation with barriers and facilitators, and gender revealed a significant correlation with barriers (P < 0.05). CONCLUSION: It seems that prioritizing the increased access to information resources and databases, considering the research skills of the HCWs, extending the opportunities and increasing the facilities such as workforce, equipment, physical environment, and accessibility can have a great impact on the improvement of the activities associated with EBM.

INTRODUCTION: Iran's Health System Reform Plan (HSRP) were initiated in public and hospitals affiliated to Medical Sciences Universities in June 2015. The purpose of the present paper is to provide a critical analyse of the HSRP and its outcomes. METHODS: The study was carried out as a review critical analyse in 2019. The pertinent articles were searched for in Science Direct, PubMed, Ovid, and Google Scholar using keywords “health sector,” “reform plan,” “health system reform,” “health services,” “health care system,” and “Iran.” Published articles in scientific national and international journals in Persian and English language, of which the full-texts were available, were entered into the study. Finally, from a total of 75 articles obtained, 45 studies were carefully reviewed. RESULTS: Several factors, which impact in the success of Iran's HSRP such as social-economic and political outlooks, lack of official information and a comprehensive management system, in addition to failure to extend continuous performance control, economic sanctions against Iran. Other factors are limitations on financial transactions between Iran and the rest of the world due to the sanctions, relying merely on a few instructions, and negligence of the required infrastructures. In terms of advantages of the plan, relative decrease in patient's share in medical expenses, improvement of emergency wards, and relative decrease in the rate of C-section operations are notable. CONCLUSION: Better implementation of Iran's HSRP entails the provision of resources and facilities such as stable and adequate resources, proper management of available resources, payment mechanisms reform, attracting, and facilitating private sector's participation.

Negative psychological outcomes have been consistently associated with quarantine measure and lockdown. This article tries to look at the psychological implications of quarantine and lockdown and then touches upon how social aspects lead to psychological effects unaddressed for various communities of the people surviving in vulnerable conditions. The objective of this study was to review the psychosocial implication of quarantine and lockdown among Indian community who are facing a double burden of mental and economic crisis. Databases for relevant studies were searched in PubMed and Google Scholar with key term “quarantine,” “mental health,” “lockdown,” and “psychosocial.” Few newspaper reports related to quarantine and psychosocial implication have also incorporated. Home and facility quarantine were imposed on people in order to control and check the spread of this infectious disease. This strict imposition not just led to various other counter effects that were negative in nature, but it is predicted to have long-lasting social, economic, and psychological effects too. As social diversities lead to varied mental health adversities, a broader umbrella needs to be created in order to protect every community dealing with mental health issues due to the pandemic. In order to address the mental issues of the vulnerable classes, the issue still remains untouched, and this leaves us with a question of are we doing enough for each individual. A team of clinical psychologist, psychiatrist, and sociologist come forward to combat this mental health impact of COVID-19 outbreaks and make this quarantine tolerable for the public with appropriate solutions.

BACKGROUND: Microteaching is a teacher training technique where a teachers get a constructive feedback from peer or faculty in order to improve their teaching skills. Microteaching is conducted at the departmental level. By evaluating the components of microteaching, better teaching skills can be developed in postgraduate (PG) students. OBJECTIVES: The objectives of this study were to determine the pattern of teaching skills and to evaluate the components of teaching skills of microteaching in PG students. MATERIALS AND METHODS: It was a retrospective record-based study done over a period of 1 month. Microteaching assessment records of 34 PG students of the department of community medicine were analyzed. RESULTS: Teaching skills including setting induction during the class, lesson planning, presentation, and use of audio-visual aids were found to be satisfactory. Students lacked the skills of interaction and summarization of the topic. CONCLUSION: PG students' performance with many components was satisfactory, but still, there is a scope for improvement. Internalization of microteaching skills can make doctors a better teacher, a better learner, and a better health educator.

BACKGROUND: Although using time management skills is a major component of nursing professional practice, they have not received much attention. Time management training can improve the psychological and communication aspects of nursing care quality. Therefore, this study aimed to evaluate the effect of time management skills training on the psychosocial and communication aspects of nursing care quality. MATERIALS AND METHODS: This semi-experimental study was conducted at Valiasr Hospital of Shahr Babak City, Kerman Province, in the Southeast of Iran, during 2018. The study population consisted of 100 nurses who were randomly assigned to one of the two groups: an intervention group or a control group. To identify and measure the outcomes, nurses' perceptions of the psychosocial and communication aspects of care quality were first assessed by the Quality Patient Care Scale (Qualpacs) at pretest. Then, the intervention group received the 2 days of training on time management skills for 12 h. The posttest outcome data were collected from both the groups 1 month after the intervention. RESULTS: No statistically significant differences were observed between the two groups with respect to the total mean scores of nursing care quality and its psychosocial and communication aspects before the intervention (t = 1.96, P = 0.09). However, there was a statistically significant difference between the two groups in this regard after the intervention, and the mean nursing care quality scores and its related aspects were improved in the intervention group (t = 5.76, P < 0.0001). CONCLUSIONS: The time management skills training could significantly improve psychosocial and communication aspects of nursing care quality. Health-care managers should allocate facilities to clinical training programs so that health-care professionals can acquire the time management skills. The higher effectiveness of time management training can be determined by its application in diverse domains of health care.

BACKGROUND: The current novel coronavirus pandemic started as a simple outbreak in December 2019 from Wuhan, China, and it has now become a global threat. The governments from most of the countries including India have already taken strict precautionary measures to reduce the coronavirus spread such as social distancing, closure of schools, colleges, airports, restaurants, shopping malls, and other places where the people might gather. An increase in the levels of anxiety, aggression, depression, forgetfulness, and hallucinations are possible psychological effects of isolation. Too little is understood of the social impact of the pandemic. AIM: To study the social impact of post-COVID-19 lockdown in Kerala from a community perspective. MATERIALS AND METHODS: This cross-sectional survey was conducted among 700 families (50 families from each district) from all the 14 districts of Kerala from during April-May 2020 using respondent-driven sampling. The data were analyzed and the categorical variables have been presented as percentages and proportions. RESULTS: Anxiety (44%) and fear (44.3%) were reported by many of the study participants. The survey also picked up an increase in the prevalence of domestic violence (13.7%) during the period. The most common social change brought about by the lockdown was an improvement in the hygiene practices among the study population. CONCLUSION: The present study highlights the positive social changes brought about as a result of the COVID-19 lockdown. Further studies need to be conducted on a larger scale to assess the psycho-behavioural impact of COVID-19 on the wider population.

BACKGROUND AND OBJECTIVES: The ongoing coronavirus disease pandemic caused by a novel genetically-mutated strain of coronavirus has posed a tremendous challenge to healthcare professionals, worldwide. This study aimed to explore the healthcare professionals' knowledge, attitudes, and practices (KAP) related to coronavirus disease in Western Uttar Pradesh and provide data to improve awareness about this disease and remove the knowledge gap, if any, by disseminating the updated information to the corona warriors. MATERIALS AND METHODS: A cross-sectional survey was conducted in the form of a structured 28-item online questionnaire using SurveyMonkey software. The qualitative data were coded numerically, and the KAP score was calculated. Pearson Chi-square test was used to study the association, among variables. RESULTS: Of 509 respondents, 296 (58.19%) were males and 213 (41.81%) were females. The median age bracket of the sample was 20–40 years. By profession, 255 (50.10%) were doctors, 167 (32.74%) were medical students, 80 (15.78%) were other healthcare workers, and a minority 7 (1.38%) were the nursing staff. Educational status covered a range from secondary (2.01%) to senior secondary (17.51%) to bachelors and equivalent (29.18%) to masters and equivalent (51.31%). The average KAP scores were 54%, and the score was highest among doctors as compared to other healthcare professionals (P < 0.001). CONCLUSIONS: In light of these study findings, we conclude that healthcare professionals are aware of coronavirus disease. However, the overall KAP score regarding its clinical course, preventive strategies, and judicious use of personal protective equipment was less than expected. There is a need to address all misconceptions and empower the corona warriors with the right information through effective mass media communication and reinforcement through seminars and workshops in the medical institutes and hospitals. The healthcare professionals are a cornerstone to prevent the nosocomial and community spread of this pandemic.

BACKGROUND: The goal of treating cancer patients is to cure the patients and improve their quality of life (QoL) during their illness. The aim of this research was to assess the QoL in Iranian patients with head-and-neck cancer by European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck 35 (EORTC QLQ-H&N35) and University of Washington Quality of Life Questionnaire (UW-QoL). MATERIALS AND METHODS: In this cross-sectional study, Iranian variation of EORTC QLQ-H&N35 and UW-QoL questionnaires was administered to 210 patients with head-and-neck cancer. Patients who visited the Department of Oncology at Omid Hospital in Isfahan, Shafa Hospital in Kerman, and Emam Khomeini Hospital in Tehran were selected. Kruskal–Wallis test, general linear model multivariate of variance, multiple regression models, and SPSS version 21 were used for statistical analysis. RESULTS: In the present research work, 210 patients with cancer in head and neck were under investigation, such that 128 patients (61%) were male and 82 patients (39%) were female. Only the patients with laryngeal cancer scored worse for dyspnea according to the scores from UW-QoL questionnaires. There were statistically significant differences for pain, swallowing, social eating, social contact, speech, taste/smell, and trismus based on the QLQ-H&N35. Lower QoL was observed in patients with advanced (Stage III + IV) tumors and treated with radiotherapy plus surgical method. CONCLUSION: The study showed that quality of life differs due to location of tumor, stage of cancer, and treatment type.

BACKGROUND: The novel coronavirus (CoV) has resulted in a global pandemic despite drastic measures to avoid contagious spread. On April 3, 2020, there were around 1 million reported cases and 51,515 deaths due to CoV disease 2019. The disease presents with flu-like symptoms such as fever, dry cough, and fatigue. India being a resource-limited country, it is very important to differentiate the suspected cases clinically. AIM: The aim was to know the correlation of various clinical features of severe acute respiratory syndrome CoV 2 (SARS-CoV-2)-infected cases in selected districts of UP. SETTING AND DESIGN: This was a retrospective cross-sectional hospital-based study. MATERIALS AND METHODS: This was a retrospective cross-sectional study performed on 1243 suspected cases of SARS-CoV-2 infection from March 25, 2020 to April 17, 2020 in the department of microbiology of our institute to know the incidence of SARS-CoV-2 infection in selected districts of Uttar Pradesh. These cases were analyzed to see the association of various clinical symptoms with SARS-CoV-2 infection. For statistical analysis, Pearson's Chi-square test was performed using SPSS version 23. RESULTS: Out of total suspected cases, 4.5% were positive. Travel history was present in 80.4% of positive cases. About 83.9% had fever, 28.6% had shortness of breath, 35.7% had dry cough, 17.9% had either Type I or II diabetes mellitus, 12.5% had chronic kidney disease, and 7.1% had obstructive pulmonary diseases. CONCLUSION: Negative clinical history is very important in ruling out the suspected cases who came out to be free from the infection.

OBJECTIVE: It is common among medical students to falsely attribute bodily sensations/symptoms and holds a belief of having a medical illness with varying level of conviction. We studied and compared this condition known as “medical student syndrome”, a type of hypochondriasis, between preclinical and clinical years students. METHODOLOGY: This research was a descriptive study where a total of 100 students were approached and were asked to complete a short form of health anxiety inventory (SHAI) which has Cronbach's alpha 0.855. No personal identifiers were included in the study questionnaires. All statistical analyses were performed using the SPSS statistical software package (IBM SPSS Statistics Version 23, SPSS Inc., Chicago, IL, USA). RESULTS: The response rate among participants was 88% (42 from preclinical and 48 from clinical years of training). Health-related anxiety (SHAI main section score = 18) was found in 14.77% of students with a higher proportion in preclinical than clinical, 16.66% and 13.04%, respectively. The difference was not significant between the two groups (χ² = 0.429 [1], P = 0.766). Students having medical professional in family had lower rate of health-related anxiety, χ² (1, n = 88) = 0.228, P = 0.633. The association between family or personal history of psychiatry or medical illness was not significant with SHAI scores. No relation was noted between current health anxiety (SHAI score) and the number of visits to the doctor per year before entering the medical course (χ = 0.174, P = 0.112). CONCLUSION: Every seventh medical student was found to have health-related anxiety. It was not affected by personal and family history of either psychiatric or medical illness.

CONTEXT: At time of epidemics, fear and rumors in the community are the main obstacles to the success of prevention programs. AIMS: The aim of the study was to investigate the fear and rumors of coronavirus disease 2019 (COVID-19) among the Iranian population. SETTINGS AND DESIGN: This nationwide cross-sectional study was conducted on residents of six cities of Iran via street-based multistage sampling in March 2020. SUBJECTS AND METHODS: The eligible participants completed a self-administered questionnaire about rumor and fear related to COVID-19 epidemy. STATISTICAL ANALYSIS USED: Data were analyzed through linear regression and survey analysis using Stata (version 11). RESULTS: A total of 2249 (49.3% women) were included. The main source of information was Iranian broadcasting (68.5%). The overall mean (standard deviation) score of fear and rumor among the Iranian population was 15.68 (0.46) and 39.24 (1.27), respectively. Educational level was associated with fear of COVID-19 (P = 0.001). Trusting to the rumors was affected by age (<0.0001), education level (P < 0.0001), underlying disease (P = 0.017), and workplace situation (P < 0.001). CONCLUSIONS: The fear and rumor surrounding the epidemic of COVID-19 were common in society that could make an epidemic of COVID-19 difficult to control. Increasing public awareness via reliable mass media is recommended.

INTRODUCTION: Emotional intelligence (EI) is the ability to understand and manage our own feelings and of others. It has emerged as one of the vital elements of success and interpersonal relations in everyday life. There are individual differences of EI depending on characteristics and behaviors of an individual, which determines their personality. AIMS AND OBJECTIVES: The present study assesses the EI and personality traits of medical students and determines the relationship of EI with personality traits of the medical students. MATERIALS AND METHODS: This was a cross-sectional study and was conducted among students of a government medical college, located in New Delhi. A total of 210 participants were included in the study. After obtaining written informed consent from all participants, a questionnaire consisting of demographic information, Ten-Item Personality Inventory and Schutte EI Scale, was administered. The means and proportions were calculated. Chi-square test and Pearson's correlation test were used to test significance. P < 0.05 was considered statistically significant. RESULTS: The mean (standard deviation) age of the study participants was 21.54 (±1.98) years. The majority (65.7%) of the students were male. 51% of the students had moderate EI, and high EI was seen in 49% of the students. A positive and significant relationship between personality traits and EI was found in the study. CONCLUSION: Personality traits and EI are related to one another and could influence student academic achievement. Since EI influences academic performance so personality trait assessment and empathic perceptions exploration can facilitate to aid the academic performance of the students.

INTRODUCTION: The pandemic caused by novel coronavirus (severe acute respiratory syndrome coronavirus 2) in Wuhan, China, in December 2019 is a highly contagious disease. The World Health Organization has declared the outbreak of coronavirus diseases (COVID-19) as a global public health emergency. Currently, the research on novel coronavirus is still in the primary stage. The aim of this study is to assess the knowledge and awareness on COVID-19 disease and related infection control measures among the dental fraternity in Visakhapatnam – the smart city. METHODS: A total of 808 dentists from the Visakhapatnam region completed a questionnaire-based survey on the knowledge, awareness, and infection control measures related to COVID-19 infection. The questionnaire was tailored from the guidance and information for health-care workers issued by the US Centers for Disease Control and Prevention. Suitable sampling method was used for the collection of data and the distribution of responses was presented as percentages. Explanatory statistics were performed for all groups and subgroups based on the percentage of correct responses. Individual pair-wise comparisons were done using the Chi-square test for the percentage of correct responses. RESULTS: A total of 825 participated in the survey, of which 808 dentists completely answered the survey, and the response rate was 98%. Among the respondents, males and females are 46.8% and 53.2%, respectively. There was a statistically significant difference for all the questions solicited, among age groups (P = 0.001, 0.001) and occupation (P = 0.001, 0.001, 0.004). Private practitioners seem to more awareness compared to teaching faculty, undergraduates, and postgraduates, as they have answered correctly (>70%) for almost all the questions. CONCLUSION: The inputs from the survey help us throw some light and fill up lacunae where required. There is a strong need to implement periodic educational interventions and training programs on infection control practices for COVID-19 among dentists in particular. The information from this survey helps us to make necessary changes in implementing periodic educational webinars and stress on areas where necessary, which is important for the dental fraternity for protecting themselves and shielding our society from COVID-19.

INTRODUCTION: Spiritual health is considered one of the important dimensions of health and has been given serious attention by the scientific community, World Health Organization, health discourse, and medical education. However, despite these considerations, there is a controversy in defining the nature of this category and its dimensions and indicators. The purpose of this study is to identify the indicators and dimensions of spiritual health for medical students. MATERIALS AND METHODS: This qualitative study with exploratory approach utilized conventional content analysis and individual in-depth interviews with experts in the area of spiritual health and spirituality in medical sciences selected through purposeful sampling. The study was conducted at Aja University of Medical Sciences in Tehran in 2018. The semi-structured interview was a tool used to achieve data saturation, that interviewed with 19 experts. Member check, credibility, and reliability were measured to increase the validity and reliability of the results. Inductive content analysis was used for the analysis of data in three main phases: preparation, organization, and categories and creating categories. RESULTS: Based on the findings of the interviews, 52 indicators were identified.Then, the indicators of spiritual health were identified in the following four categories) relationship with God, relationship with himself, relationship with others, relation with the environment (and these categories were divided inthree dimentions (cognitive, attitudes and emotions, behavioral) CONCLUSION: The findings of the present study showed that in order to have spiritual health, it is important to pay attention to one's relationship with God and one's relationship with oneself, one's relationship with others, and one's relationship with the environment, and it is necessary to pay attention to it in medical science curricula.

INTRODUCTION: Disasters occur almost everywhere in the world, and preparation is essential. Preparedness is an effective approach for disaster management, and it is crucial for the health systems, especially the Emergency Medical Service (EMS) agencies. This systematic review will be conducted to assess the preparedness levels of EMS agencies in the world for the response to disasters and explore the key dimensions and strategies to enhance it. METHODOLOGY: This systematic literature review will be conducted to search comprehensively the articles published between 2000 and 2019 to explore the disaster preparedness of EMS Agencies. To this end, PubMed, Scopus, Web of Science, and Google Scholar will be thoroughly assessed. The following terms and expression will be used for searching the databases: “EMS” and other keywords “Disaster Preparedness,” “Mass Casualty Incident,” “Mass Gathering,” “Terrorist incident,” “Weapons of Mass Destruction,” and CBRNE, Disaster, included: 'Emergency Preparedness, Preparedness, Readiness. DISCUSSION: To the best of our knowledge, no systematic review study has been conducted on disaster preparedness of EMS agencies in the world. This is the first study to address this gape. It will also explore the key dimensions of disaster preparedness in EMS services and the strategies to enhance their preparedness. CONCLUSION: Identifying the key dimensions of disaster preparedness is the first step in designing valid assessment tools to evaluate disaster preparedness of EMS service. This study will provide valuable guides for EMS administrators and researchers in an attempt to enhance of preparedness of EMS systems in disasters.

BACKGROUND: Communication apprehension (CA) is the fear or anxiety about communicating. This study was designed to investigate the CA and its related factors in the medical students at Rafsanjan University of Medical Sciences (RUMS). MATERIALS AND METHODS: In this cross-sectional study, personal report of CA (PRCA-24) was administered to 340 medical and paramedical students to measure anxiety in four domains of large groups, small groups, public speaking, and dyadic interaction. Pearson's correlation and linear regression analysis were used to investigate the relationship between CA and the variables of birth order, number of siblings, and university entrance score. Data were analyzed using descriptive and inferential statistics (Chi-square and Kruskal–Wallis Test). RESULTS: CA in the dimension of public speaking was higher than the other dimensions. Evaluation of the economic stability and its relationship to CA indicated a significant difference among all the domains of the PRCA-24. There was a significant relationship between the scores of CA and the number of siblings (P = 0.001). Linear regression and Pearson's correlation tests indicated a significant correlation between the variables of birth order, number of siblings, and university entrance score. The correlation between the CA with dimensions of group discussion, interpersonal, speaking, and meeting was weak but significant (P < 0.01). CONCLUSION: Without communication, the materialization and development of the human community are not possible. This aspect is more evident and crucial in the healthcare industry. Based on the results of this study, the medical and paramedical students at RUMS have a medium-to-high level of CA. Therefore, it is of utmost importance to detect students with high CA to prevent further communication problems after graduation.

INTRODUCTION: It is vital importance to observe standard precautions (SPs) in dentistry to prevent the transfer and spread of blood-borne diseases in the community. The aim of the present study was to evaluate the effect of educational intervention using health belief model (HBM) on the observation of SPs by dental students in 2019. MATERIALS AND METHODS: Eighty-seven dental preclinical students were included in the present quasi-experimental study. The students were randomly assigned to two groups, and data were collected using a questionnaire designed based on HBM. Educational intervention was carried out after the pretest analysis in four 60-min sessions. Data were analyzed with independent t-test and paired t-test using SPSS 16 at a significance level of P < 0.05. RESULTS: After the educational intervention, the mean score of awareness (P = 0.001), perceived susceptibility (P = 0.01), perceived severity (P = 0.02), perceived benefits (P < 0.001), cues to action (P = 0.006), self-efficacy (P = 0.002), and behavior (0.03) in the intervention group was significantly increased. CONCLUSION: Despite the effect of education on increasing the students' scores in HBM constructs and observation of SPs, the most important barriers to the adoption of precautionary behaviors were deficiencies in protective tools and aids.

BACKGROUND:Saudi Arabia aims to achieve Universal Health Coverage (UHC) by a combination of free public healthcare and mandatory cooperative health insurance. To ensure the effectiveness of UHC policies, every individual should have a strong knowledge of their health-care rights and the system that guarantees it. OBJECTIVES: The aim of this study is to measure the knowledge of Alfaisal students and record their perceptions and attitudes about Saudi Arabia's basic health-care coverage structure and UHC policies. MATERIALS AND METHODS: A cross-sectional survey was developed with 22 items measuring knowledge and 7 items evaluating perception and attitudes and distributed through E-mail with a consecutive sampling method at Alfaisal University to achieve the required calculated sample size for March–April of 2020. The accumulated data were organized, tabulated, and statistically analyzed using SPSS software. Comparison between two groups and more was made using the Chi-square test. RESULTS: Students' self-reported knowledge on the three main knowledge questions ranged from 30.6% to 57.7%, with medical students admitting to similar or worse knowledge compared to their colleagues from other colleges. About 57.3% of our respondents believe the Saudi system provides effective and sufficient healthcare to all, but only 42.7% believe that the system provides financial protection to all. CONCLUSION: The study showed a low level of knowledge about Saudi Arabia's UHC policies among Alfaisal students, especially among medical students, with a generally positive perception and attitudes toward them, although with some serious misconceptions that should be addressed.

INTRODUCTION: Abortion is one of the most common complications of early pregnancy, which emerges as a physically and mentally devastating experience. Due to the prevalence and importance of postabortion mental health problems and their adverse effects on subsequent pregnancies, some interventions should be made to reduce the resultant anxiety and depression. The present study aimed to determine the effect of self-care education on anxiety and depression among pregnant women with a history of spontaneous abortion. METHODS: This randomized quasi-experimental study was performed on ninety pregnant women with a history of spontaneous abortion who referred to health centers in Zahedan in 2019. The samples were selected by convenience sampling method and randomly assigned to two intervention and control groups. Between 6 and 16 weeks of gestation, the participants in the intervention group received four sessions of 60-min self-care training over 2 weeks. On the other hand, the control group received routine pregnancy care. Data collection tools included a demographic and fertility evaluation questionnaire, a 6-item short-form of the state scale of the Spielberger State-Trait Anxiety Inventory, and a short form of Beck Depression Inventory. Posttest was performed 4 weeks after the end of the intervention. The data were analyzed in SPSS software (version 21) using statistical tests of independent t-pair, paired t-pair, Chi-square, and Fisher's exact test. RESULTS: Based on the obtained results, there was no significant difference between the two groups in terms of anxiety and depression scores before the intervention. Nonetheless, after the intervention, the mean scores of anxiety and depression in the intervention group were calculated at 7.31 ± 1.31 and 4.71 ± 1.90, respectively. However, these scores were reported as 1.87 ± 13.46 and 9.31 ± 1.59 in the control group, respectively (P = 0.0001). CONCLUSION: As evidenced by the obtained results, self-care education is effective in the reduction of anxiety and depression in pregnant women with a history of spontaneous abortion. Therefore, health professionals and health-care providers should enrich prenatal care programs with these training sessions and provide women with peace of mind and comfort during pregnancy.

BACKGROUND: Risk perception is an important predictor to mitigate climate change effects which can produce mental health consequences such as anxiety and depression. For developing policies of climate risk adaptation, awareness of public attitudes, beliefs, and perception is essential. At this study, researchers tried to focus on the often “unseen” psychological aspects of climate change. MATERIALS AND METHODS: A qualitative approach was done with a consistent content analysis method. The study consisted of 33 participants including ordinary people and experts in disasters and climate change. Purposeful sampling was adopted until data saturation. The data collection was performed through in-depth and semi-structured interviews. All interviews were transcribed after listening again and again and reading several times to catch an overall understanding of the interviews. RESULTS: The main theme of the study was “Complexity nature of climate change risk perception” and related categories including “the Mental health dimension,” “the Cognitive dimension” and “Interaction of imposed components.” The structure of the research community strongly reflected effects of cultural and religious factors in all aspects of community life. Participants' life experiences of extreme events were associated to their perception of climate change. CONCLUSIONS: Risk perception is multifactorial and complicate and should clearly be understood to improve community participation to manage climate change-related risks. We propose that authorities and related managers should pay attention to it as a priority. This may assist in developing research on public mental health practices.

BACKGROUND: Today, marked by advanced scientific approach, urbanism, and changing life style, there is an ever-growing rate of fast-food consumption, which has significantly affected public health. Hence, the present research aimed to predict factors involved in fast-food consumption in light of the prototype/willingness model among the students of Rafsanjan University of Medical Sciences. MATERIALS AND METHODS: In the present descriptive/analytical research conducted in 2018–2019, 350 students in Rafsanjan University of Medical Sciences were selected through proportionate stratified random sampling. The required data were collected using a self-administrated questionnaire in light of the constructs within the prototype/willingness model and fast-food consumption behavior. The data were analyzed in SPSS version 16.0 using descriptive and inferential statistics including mean scores, standard deviation, correlation coefficient, and linear regression. RESULTS: Behavioral intention of fast-food consumption showed to be positively correlated with positive willingness, positive prototype, positive subjective norms, and positive attitude toward fast-food consumption. Furthermore, the correlation between positive behavioral intention of consuming fast food and positive subjective norms and positive attitude toward fast-food consumption was statistically significant (P < 0.05). The underlying constructs of prototype/willingness model altogether managed to explain 13% of the total variance of fast-food consumption behavior. Behavioral intention showed to be the strongest predictor of the behavior (β = 1.613). CONCLUSION: It is suggested that the preventive measures aimed to reduce fast-food consumption among the youth focus more on strengthening negative attitudes and subjective norms concerning fast-food consumption.

Background: In health care, the rapid proliferation of health information on the internet has resulted in more patients turning to the digital media as their first source of health information and acquiring knowledge. The present study was conducted to assess use of the digital medium as a medical information resource in health-related states and to determine their experience and perceptions about the quality and reliability of the information available among the participants. Methodology: The study was done in an urban settlement of Delhi among adults who use any digital media. A sample of 321 were selected though convenient sampling. The information was collected through a semi-structured, self-administered, pre-tested questionnaire which contained questions on socio-demographic profile, internet usage and awareness about Digital India. Bivariate analysis was done to determine the association between various socio-demographic variables associated with internet usage for health information. Results: In the present study, 88.2% (283/321) were using the internet for health information through digital media. This study found out that younger age group (18-30 years), literate and higher socioeconomic group (upper middle and above) population were more likely to access health information via digital media which was found out to be statistically significant. Conclusion: Access to health information through digitization can improve health literacy among the population and help in promoting a preventive aspect to health problems and disease. They can be the building blocks to build “Swasth Bharat (Healthy India)”.

BACKGROUND: Approximately one third of the food produced in the world for human consumption was wasted. OBJECTIVES: This study aimed to determine the effect of intervention on behavior of food consumption and waste production in the restaurants of Shahid Beheshti University of Medical Sciences. MATERIALS AND METHODS: In this quasi-experimental study, 233 students of public health school were selected as intervention group, and 233 students of medical school were selected as control group. The food wastage was weighed in both “Sabz” and “Medical” restaurants for a week. Based on training needs of the samples, teaching methods and programs were implemented in the intervention group for a month. The clients of both restaurants were followed 4 weeks after the intervention. The food waste was weighed after 4 weeks. Data were analyzed using SPSS software version 16 and statistical tests (Wilcoxon, Chi-squared, McNemar, and Mann–Whitney tests). RESULTS: The results obtained from Wilcoxon test showed that, the means of awareness, attitude, and behavior were significantly improved after the intervention in the intervention and control groups (P < 0.001). After the intervention, according to the number of served foods, it was expected that the weight of food wastage to be 341.37 kg/week, but this figure was reduced to 224.98 kg/week after the intervention. CONCLUSIONS: This study has confirmed the effectiveness of implementation of interventions on enhancement of knowledge, attitude, and behavior of people about consumption of food and amount of wastage. The authors suggest that to investigate sustainability of effect of intervention on behavior of food consumption and wastage production, this study could be implemented in different and longer time intervals after the end of project.

INTRODUCTION: The recent pandemic of COVID-19 is very challenging for each and every sector like health, economic, technology, agriculture, industries, and education. In the field of education, a teaching institute or a university is suffering in regard to syllabus completion, clinical postings, and examinations which eventually ends up in huge academic loss. Thus, to minimize the academic loss and facilitate the students in distance education, online learning was the solution; in spite of various challenges, Datta Meghe Institute of Medical Sciences (Deemed to be University) have implemented the online learning program for the undergraduate students within a week of lockdown. METHODOLOGY: The survey was conducted at MGACH&RC, total of 189 students have participated in the survey. Data collected by survey with help of feedback on a 5-point Likert scale questionnaire with close- and open-ended questions and focus group discussion (FGD) with students. DISCUSSION: Although the program was implemented to verify the utility, accomplishment, and lacunas of e-learning, the survey was planned to assess the perception of students toward online learning during the COVID-19 pandemic. The e-learning model has been successfully introduced; there are more requirements from the students regarding the resource material and minimal lacunas regarding the skill of faculty members and technical issues. Students appreciate the online learning module for the pandemic situation and necessitated for the combination of both learning modalities in future. Seamlessly, the running program recommended online assessment and evaluation of the students in future.

INTRODUCTION:Professional responsibility-acquiring process among bachelor degree nursing students is important for their current and future performance and educational and health-care system, but this process has not been explored in the literature. The aim of the current study is to explore the process of acquiring professional responsibility among bachelor degree nursing students. METHODOLOGY:The study design was based on grounded theory (Corbin and Strauss 2015). Purposive and theoretical sampling led to the inclusion of 18 individual interviews and a focus group interview with bachelor degree nursing students, their instructors, and key informants in a nursing school and university, an educational hospital, and a health comprehensive service center in Tehran in 2019–2020. RESULTS:After data analysis, 6 categories, 17 primary categories, 64 subcategories, and 1747 initial codes were extracted. Trying to optimal use of the educational period was the main category of this study and its primary categories were responsible learning and performance management strategies, there were facilitators and inhibitors categories for applying these strategies. Personal, educational, and professional context factors were primary categories that may lead to the main concern (uncertain productivity of the educational period) with regard to acquiring professional responsibility. Protection of the students and others versus irresponsibility was consequence category of this process. CONCLUSION:Knowing the process of acquiring professional responsibility among bachelor degree nursing students can be used to facilitate the formation, promotion, and evaluation of professional responsible behaviors. Further researches in these areas are recommended.

INTRODUCTION: Getting pregnant care is different due to the psychological problems of pregnant mothers. Self-compassion and social support are the important components of mental health. Women with higher self-compassion and social support can take full care of their pregnancies. The aim of this study was to determine the relationship between social support and self-compassion with adequate prenatal care. METHODS: The present study is a cross-sectional descriptive study that was performed in 2018? using the available sampling method on 500 pregnant mothers referred to Isfahan health centers. Individuals entered the study if they had entry criteria and no exit criteria, and completed social support, self-compassion, and adequacy of pregnancy care questionnaires. The data were coded and analyzed by SPSS software version 22 and Pearson's correlation statistical test. RESULTS: The results of data analysis with Pearson's correlation test showed a positive and statistically significant relationship with pregnancy care between the overall score of social support (P < 0.001) and the dimensions of social support such as family support (P < 0.002), support of friends (P < 0.004), and the support of other people (P < 0.001). The results also showed a positive and statistically significant relationship between self-compassion and prenatal care (P < 0.001). There was a significant positive relationship between the subscales of the self-empathy questionnaire, including kindness to oneself, human commonalities, mindfulness and increasing replication, and pregnancy care, but there was a significant negative relationship between subscales of isolation and self-judgment with pregnancy care. CONCLUSION: According to the results of the present study, social support and self-compassion as two components of mental health can affect the quality of services during pregnancy. For this reason, it is recommended that health-care providers pay attention to these two issues in order to increase the level of care during pregnancy and thus ensure maternal health during pregnancy and childbirth and the health of the fetus and baby.

INTRODUCTION: Understanding adaptation is strongly influenced by the culture and beliefs of every society. By increasing knowledge about the different dimensions which require the adaptation in different aspects requiring the nurse adaptation in oncology, a clear definition of the problem can be stated. Because of the lack of a standard and appropriate tool for the culture of the Iranian society, this aimed at developing and validating the nurse adaptation tool in the oncology departments. METHODS: This research is a methodological study and an exploratory mixed method being conducted in three main steps of conceptualization, production of items, and field test. Inductive conceptualization was performed through qualitative methodology and conventional content analysis approach; in the second step, developed instrument was evaluated in terms of face validity, content validity, and construct validity. In the third step, sampling of oncology nurses was done and exploratory factor analysis was performed for evaluating the construct validity, adequacy of sampling, and dimensioning. Cronbach's alpha was calculated for checking the reliability of the instrument. RESULTS: The oncology nurse adaptation questionnaire was formed with twenty items in four main dimensions, including “emotional factors,” “supportive factors,” “work-related factors in the ward,” and “factors related to job conditions.” The reliability of the tool was confirmed by evaluating the internal consistency with Cronbach's alpha, which was above 0.7 for each dimension and 0.82 for the whole instrument. CONCLUSION: This instrument can be used as a practical tool for determining the adaptation of oncology nurses for providing evidence to improve the work conditions of nurses by improving the working conditions in the workplace and providing facilities with individual intervention, and the outcome will be care of patients with high quality.

OBJECTIVES: Involving the patients in health-related decisions requires high health literacy. Health literacy is related to the concept of information literacy through its emphasis on information skills. Hence, the aim of this study was to investigate the relationship between information literacy and health literacy. STUDY DESIGN: We carried out an original research. MATERIALS AND METHODS: This is an applied research that is carried out in a survey method. The statistical population of this study is MSc and PhD students at School of Health Management and Information Science in Iran University of Medical Sciences who were selected by stratified random sampling. A standard health literacy questionnaire including access dimensions, reading skills, comprehension, evaluation, decision-making, and application of health information was used to assess the health literacy status of the students. To measure information literacy, the questionnaire includes identifying information needs, locating information, organizing information, and evaluating information were used. The data were analyzed by tests of one-sample t-test, Pearson correlation, and simple linear regression with spss software version 18 produced by IBM located at New York. RESULTS: The results showed that the level of information literacy among students was higher than the average level. The average of information literacy rate in the sample is 49.09. In this regard, the most frequent information is gained from the internet, interacting with friends, and asking practitioners and health workers. In addition, there is a positive and significant relationship between all dimensions of information literacy with health literacy and information literacy affects 35.4% of health literacy changes. CONCLUSIONS: It can be said that information literacy is a predictor of health literacy. Furthermore, the pattern of people's health information has moved to new information environments and to improve health having sufficient information seeking and information literacy skills are essential.

INTRODUCTION: Many infertile people have heard about adoption, but little is known about the true meaning of adoption and how it is accepted. Giving the right information about adoption is effective in making the right decision for couples. As a result, there is a need to intervene and provide training to improve community attitudes and increase adoption among infertile people. Therefore, the present study aimed to determine the effect of two counseling methods (face-to-face and telephone) on awareness and attitude toward adoption in infertile couples. MATERIALS AND METHODS: The present study is a randomized quasi-experimental study of two groups in the Milad Infertility Center of Mashhad on 34 (each group of 17 couples) infertile couples with the criteria to enter the study. Couples were randomly assigned to two telephone and face-to-face counseling groups, and each individual's awareness and attitudes toward adoption were completed separately before and after counseling. The average number of face-to-face sessions for face-to-face counseling was three 60-min sessions and six 30-min sessions for telephone counseling. RESULTS: Based on the results of t-test, there was a statistically significant difference between the average score of awareness of adoption before and after the intervention (2 weeks after the last counseling session), in infertile couples in face-to-face training group and in telephone training group (P< 0.0001). The score of the attitude toward adoption before counseling in the face-to-face counseling group was 60.55 ± 5.5, which reached 66.76 ± 4.7 after counseling. Based on the results of the T-pair test, this difference was significant (P < 0.0001). In addition, in the telephone counseling group, the score of attitude toward adoption increased from 59.53. 7.4 to 67.73 ± 7.5, which was a significant difference in terms of t-pair test. The mean score of attitudes toward adoption was not statistically significant in the two groups (P = 0.653). CONCLUSION: The results of this study showed that both counseling methods (face to face and telephone) increase the level of awareness and attitude of couples about adoption, but neither method was superior to the other.

BACKGROUND: Adolescence is a vital stage of growth and development; however, many adolescents do die prematurely due to accidents, suicide, violence, poor mental stability, depression, and other illnesses that are either preventable or treatable. Life skills are important for the promotion of well-being of adolescents and to develop positive attitude and values to lead a healthy life. OBJECTIVES: The study was conducted to assess the change in life skills postintervention and study the association between different variables and the postintervention life skills score. MATERIALS AND METHODS: A quasi-experimental study was conducted among 137 adolescents each in urban and rural schools. Life skills training module based on ten domains of life skills given by the World Health Organization was implemented using interactive teaching–learning methods. After 6 months of implementation of life skills training sessions, a postintervention assessment was done using the life skills assessment scale, and the differences in the scores were measured. RESULTS: Higher life skills score was observed postintervention, and this difference was statistically significant (P < 0.001). Higher postintervention mean score (above 15) was seen in critical thinking (19.58), self-awareness (18.03), creative thinking (15.78), and interpersonal thinking (15.15). CONCLUSION: Increase in the postintervention scores using an educational intervention module and interactive teaching–learning methods suggests effectiveness of the life skills education program. Implementing this health promotion module on life skills in the school curriculum will address the overall development of the personality of the school students.

INTRODUCTION: Considering the trend of reducing fertility in recent decades, the level of awareness and attitude of health workers to fertility has an important role in achieving the country's demographic goals. Improving attitudes and improving the scientific level and skills of health workers are the basic pillars to improve the quality and quantity of health-care services. Therefore, this study was conducted with the aim of improving the level of awareness and attitude toward fertility and fertility counseling skills of health workers with both face-to-face and virtual training methods. MATERIALS AND METHODS: This study was a randomized controlled trial of three groups and pre-test-posttest experiments performed on 108 midwives and health-care workers working in Mashhad Health Center and Community Health Centers and Health Centers in 2015. The tools used in this study were four researcher-made questionnaires that were validated and reliable. Data analysis was performed by Chi-square test, one-way, and independent t-analysis of variance using SPSS software version 16. RESULTS: The results showed a significant increase in awareness level, attitude toward fertility, and counseling skills in the studied groups after the implementation of interventions (P < 0.001). Furthermore, there was a significant inverse relationship between the attitude score of the research units at the beginning of the study and the demographic variables with only the average work experience. CONCLUSION: Training is effective in raising the level of awareness and changing the attitude of health workers. The use of group discussion methods in person as well as through a webinar in which learners think, interact, and gain experience in promoting healthy fertility counseling promotes awareness, attitudes toward fertility, and their counseling skills in providing healthy reproductive counseling.

BACKGROUND: Despite the multitude of studies comparing teacher burnout with an ample of variables, a need for seeking what English language teachers think about their job and the interfering variables regarding the context seems essential. The aim of this study was primarily to investigate the relationship between teacher burnout and job satisfaction of English language teachers and, then, to find out the impact of teaching experience and gender on teacher burnout and job satisfaction. MATERIALS AND METHODS: It was a mixed-methods study conducted on 103 teachers who were conveniently sampled and were investigated through questionnaires and interviews among high school English language teachers in Sistan and Baluchestan province. The sampling method was purposive, and data were collected through questionnaires and semi-structured interviews. Data analyses were performed using mixed–methods approach. RESULTS: The results revealed a moderate negative correlation between the first two elements of teacher burnout (emotional exhaustion and depersonalization) and job satisfaction (P < 0.01), whereas a positive correlation was found between the next element, i.e., personal accomplishments and job satisfaction (P < 0.05). Afterward, no statistically significant difference was detected between demographic characteristics (i.e., gender and teaching experience) (P < 0.01). Then, 15 teachers voluntarily participated in the interview sessions and expressed their opinions about the way teachers see the environment they work in. CONCLUSIONS: There are factors that influence on the quality of teaching and learning processes and lead to burnout and job dissatisfaction; therefore, it seems advisable to remove them to reduce their negative effects.

INTRODUCTION: Over the past decades, the pattern of diseases in human societies had changed from infectious diseases to noncommunicable diseases (NCDs), and according to the report by the World Health Organization, the highest burden of disease is attributed to NCDs. The study was conducted to determine the status of hypertension, type-2 diabetes, lipid disorders, and body mass index (BMI) among the patients aged over 30 years admitted to health centers of Karaj, Iran. MATERIALS AND METHODS: In this cross-sectional study, the population included 2947 men and women aged 30 years and above admitted to six health-care centers in Karaj. The questionnaire includes demographic characteristics and had the questions on hypertension, diabetes and their risk factors, like lipid disorders and BMI was administered. The data were analyzed in SPSS, version 23, software using descriptive (frequency, percentage, mean, and standard deviation) and analytical (Chi-square and analysis of variance) tests (P < 0.01). RESULTS: About 10% of the participants had diabetes and 15% of the participants had hypertension. About 32% of the participants had dyslipidemia and 87% of the participants were overweight or obese and over 35% were obese. Furthermore, with the increase in BMI, the prevalence of lipid disorder, hypertension, and type-2 diabetes increased in the studied population (P < 0.01). CONCLUSION: According to the results, a high percentage of people had hypertension, type-2 diabetes, hyperlipidemia, and BMI in the population. Gender segregation showed that lipid disorders, overweight, and obesity in women were more than in men and percentage of people with hypertension among male were significantly higher than in females. In the case of type-2 diabetes, the results showed no statistically significant differences between men and women. The results may be helpful in developing educational strategies and prevention and control of these diseases.

BACKGROUND: Dried Urmia Lake in the northwest of Iran is a major regional source of sodium and toxic metal aerosols which may cause numerous health problems. The aim of this study was to evaluate iron-deficiency anemia (IDA) and some related risk factors among women of reproductive age in the suburb of dried Urmia Lake to provide the information about the problem to the health-care providers. METHODS: This cross-sectional study was conducted on 278 healthy nonpregnant, nonlactating women aged 18–45 years, living in the rural area of the Salmas city, closest to the Urmia Lake between February and June 2017. The study participants were selected using a stratified random sampling method with proportional allocation from seven villages. A general questionnaire was completed for each participant to collect sociodemographic information and a 3-day dietary recall questionnaire to obtain daily dietary intakes. IDA was defined as a hemoglobin (Hb) level of <12 g/dl and ferritin concentration of <15 μg/l. Spearman's correlation coefficient and Fisher's exact test were applied to determine sociodemographic factors associated with the serum Hb and ferritin levels. RESULTS: The prevalence of overall anemia (Hb <12 g/dl) was 7.9%. IDA was determined in 4.3% and iron deficiency (ID) in 19.1% (serum ferritin <15 μg/l) of the participants. There was a significant positive correlation between serum Hb concentrations and the mean daily intakes of protein and iron (P < 0.001). Similarly, a significant positive correlation was observed between serum ferritin levels and body mass index (P < 0.001). Significant inverse associations were found between Hb concentrations and the number of pregnancies and children (P < 0.001), as well as the number of family members (P < 0.05). CONCLUSIONS: Results indicated a mild prevalence of IDA and a relatively high rate of ID among studied participants. Educational programs are needed to improve nutritional habits as well as the use of contraceptives to promote women's health.

OBJECTIVE: The purpose of family-centered care interventions is to enhance the abilities of family members in certain areas that overcome the barriers to health and well-being, The purpose of the present research was to determine the effect of education based on family-centered empowerment model on health-promoting behaviors and some serum metabolic indicators in elderly women. MATERIALS AND METHODS: In this stratified randomized controlled trial, 60 elderly women aged 60 years and older referring to elderly-friendly health centers in Tabriz-East Azerbaijan were divided randomly into intervention and control groups in 2019. Intervention group received a family-centered healthy lifestyle intervention once a week for 10 sessions and the control group received the routine care. The mean score of health-promoting behaviors using the Health Promoting Lifestyle Profile-II questionnaire, glycemia and serum lipid profile, liver and renal function, 25-hydroxy Vitamin D, and calcium serum levels were assessed before the intervention, 2 and 6 months after the intervention through SPSS/version 23 using independent t-test, ANCOVA, and repeated measure analysis. RESULTS: The ANCOVA test showed a significant increase in total lifestyle score in the intervention compared to the control group, 2 (adjusted mean difference [aMD]: 13.7; 95% confidence interval [CI]: 5.6–21.8) and 6 months (aMD: 17.2; 95% CI: 7.7–26.7) after education. The score of the nutrition and health responsibility domains significantly increased two (P < 0.05) and 6 months (P < 0.001) after the intervention in the intervention group compared to control. In both groups, serum levels of total cholesterol, low-density lipoprotein cholesterol, urea, and creatinine showed a significant decrease, and high-density lipoprotein cholesterol and calcium levels showed a significant increase (P < 0.05). CONCLUSION: A healthy lifestyle education based on family-centered empowerment model increased the total lifestyle score. So, it is recommended as an effective educational approach to improve the health of elderly.

INTRODUCTION:“Gender” denotes the differences in the social roles of different sexes. This interaction results in variable health outcomes and care-seeking behavior. The present study was conducted to find out the attitude of school-going adolescents regarding gender equity and also to explore teachers' perceptions in this context in a school of tribal belt of West Bengal. MATERIALS AND METHODS:A cross-sectional, mixed-method study was conducted among the students of classes eight to twelve, chosen by complete enumeration technique, with a predesigned, pretested validated questionnaire. The questionnaire was based on Gender Equitable Men scale and International Men and Gender Equality Survey questionnaire, comprising the following domains: 'Gender restrictions', 'Gender attributes', and 'Gender domination'. The respondents were categorized into 'high', 'moderate', and 'low' groups as per their domain-wise attitude scores. In-depth interviews (IDIs) were conducted among seven teachers chosen purposively. Thematic analysis was done with the qualitative data. RESULTS:Out of 191 students, 112 were girls (58.6%) and 47 belonged to scheduled tribe category (24.6%). Overall, 170 (89.0%), 80 (41.9%), and 96 (50.3%) students had a high gender-equitable attitude regarding the domains of 'gender restrictions', 'gender attributes', and 'gender domination' respectively. Girls had higher percentage of high gender-equitable attitude in all the three domains (92.0%, 57.1%, and 50.9%, respectively). Regarding 'gender restrictions', 91.2% had high gender-equitable attitude in lower age group, compared to 81.4% in higher age group. Among the lower and higher age groups, 52.7% and 41.9% respectively, had high gender-equitable attitude on 'gender domination'. Gender inequality amidst poverty, women deprived of health care, and gender violence were the major themes derived from the IDIs. CONCLUSION:Girls had a better attitude toward gender equity. Laws regarding gender dominance and violence should be focused. Conducting intensified awareness campaigns on gender equity and addressing women's right to health is a much-needed timely intervention for the health of womenfolk.

INTRODUCTION: A person with colostomy or ileostomy undergoes a comprehensive treatment with a wide range of adjustments which affect the individual's social and psychological functioning. Quality of life (QOL) is a subjective feeling which includes physical, social, psychological, and spiritual domains of an individual that can be affected by a stoma. AIM: This study is aimed at identifying the QOL and impact of stoma on their lifestyle pattern among ostomates attending stoma outpatient department of gastroenterology department of a government tertiary care center in South India during 2018. METHODS: A descriptive study using a cross-sectional survey design was conducted among 55 ostomates, following consecutive sampling technique. The data were collected using a City of Hope QOL Questionnaire for Ostomy patients which had QOL Assessment Questions from four subdomains including physical, psychological, social, and spiritual aspects. This tool also had open-ended questions on lifestyle assessment components. RESULTS: 63.6% of the participants had colostomy; 72.7% of the stomas were due to cancer. The mean QOL score of the participants was 4.13 ± 1.07. The ostomates scored relatively well in both physical (5.68 ± 1.76) and spiritual (4.32 ± 1.36) domains, but the sociological (2.85 ± 1.3) domain score was very low. Permanent ostomates scored significantly higher than the temporary ostomates (P = 0.04). CONCLUSION: The QOL score of ostomates was less than the scores reported in the Western population and living with stoma significantly alters their lifestyle. Therefore, follow-up services and counseling services to the ostomates by the health-care professionals are needed.

BACKGROUND AND AIM: Arthritis is the most common type of arthritis in people over 40 years. This study aimed to determine the effect of an educational intervention on the prevention of arthritis among middle-aged women using the health belief model. MATERIALS AND METHODS: This was a randomized controlled field trial. The study population was women aged 29–59 years who referred to health centers in Birjand. Seventy-three women were selected by a systematic random sampling method and were randomly divided into intervention (n = 36) and control (n = 37) groups. The data collection tool was a researcher-made questionnaire. Data were analyzed using the Chi-square test, Fisher's exact test, t-test, repeated-measures ANOVA, and Bonferroni post hoc test. As for the cases where the data were not normally distributed, the Friedman nonparametric test, Mann–Whitney U-test, and Wilcoxon post hoc tests were used. RESULTS: In the intervention group, the mean score of knowledge, perceived susceptibility, severity, benefits, self–efficacy, and behavior significantly increased, and the mean score of perceived barriers significantly decreased after the intervention (≤0.001). In the control group, there were significant differences in the mean scores of perceived susceptibility, perceived severity, perceived self-efficacy, and performance after an intervention (P ≤ 0.001). However, this increase was significantly higher in the intervention group than in the control group. CONCLUSION: Based on the present study and according to the positive impact of the educational intervention based on the health belief model on the prevention of arthritis, it is recommended to use this theory in educational programs to prevent arthritis.

BACKGROUND: Undergraduate dental students have to do multiple tasks as part of their extensive curriculum in order to achieve the proficiencies expected of them. During the course of their study, a tendency to procrastinate and question their self-efficacy is detrimental for the students. The aim of this study was to evaluate the level of procrastination and self-efficacy and its related factors among dental undergraduate students. SUBJECTS AND METHODS: This cross-sectional study was conducted among all (n = 361) consented dental undergraduate students of our dental school. A twenty-item Lay's Procrastination Scale for student population and a ten-item General Self-Efficacy Scale were used for the study after getting institutional ethical approval. The quantitative data were explained using descriptive statistics. Independent sample t-test and ANOVA were used to determine the association between self-efficacy, academic procrastination, and genders and academic years. Pearson correlation coefficient was used to determine the association between self-efficacy and procrastination. Multiple linear regression analysis was performed to determine the related factors to academic procrastination. RESULTS: High procrastination (score ≥62) was seen among 28.5% of students. The mean self-efficacy score was 29.5. There was no significant difference between genders for procrastination scores (P = 0.835) and between academic years (P = 0.226). Males showed significantly more self-efficacy (P < 0.001), and self-efficacy did not show any significant difference (P = 0.204) between academic years though a tendency for year 5 students to have lower self-efficacy scores was observed. Academic procrastination was negatively correlated with self-efficacy (r = −0.238 and P < 0.001). CONCLUSIONS: For dental undergraduates who have cognitive load as well as work associated with patients, procrastination and self-efficacy are negatively correlated.

INTRODUCTION: Evaluation of students' clinical performance is an essential part of nursing education. Mobile technology is one of the new methods of evaluation that has opened a new horizon for nursing professors. Therefore, this study aimed to design, implement, and evaluate mobile health technology in critical care nursing department in four-phase intervention. METHODS: This study was a four-stage educational intervention in which all postgraduate students of intensive care nursing in Isfahan University of Medical Sciences participated in the study. The four steps were designing and developing a logbook, needs assessment, designing and implementing an Android app, and evaluating users (students) of the Android app. Subjects' satisfaction scores were collected using a researcher-made questionnaire with 14 questions. Data were analyzed using SPSS 14 software. RESULTS: In this study, a clinical practice evaluation app was designed at four levels of access (student, professor, department manager, and faculty dean). The results showed that more than half of app users reported this technology in terms of an overall response to the tool (87.5%), tool specificity (100%), the amount of information displayed (75%), page layout (62.5%), information rate (75%), recall information (87.5%), and ease of doing instructions (100%) were positive. CONCLUSION: Evaluation of clinical practice using technology was associated with increasing students' satisfaction with evaluation method. In addition, this application enabled the simultaneous interaction between the professor with the higher and lower ranks, including the department manager and student and vice versa and the simultaneous recording of this interaction.

INTRODUCTION: Children are among the most vulnerable groups in society, whose health is of prominent significance. Moreover, as a group of clients with special needs in the health care system, they require special attention. Therefore, the present study aimed to investigate the 0–14-year-old children's access to health centers in rural areas of Kermanshah Province, Iran. MATERIALS AND METHODS: In the present cross-sectional study, both the latest published demographic statistics related to the Population and Housing Census, announced by the Statistical Center of Iran in 2011, and the information about the public and private hospitals in the province, collected by Kermanshah University of Medical Sciences, were used as the basis for the analyses. In addition, given the importance of the spatial nature of the research, geographic information system was used for data analysis, and a buffer model was also applied. RESULTS: The results revealed that out of the total population of 0–14-year-old children residing in rural areas within 15,000 and 30,000-km radii of Kermanshah Province, 87.94% and 75.11% of girls versus 88.15% and 75.38% of boys lacked access to health centers, respectively. CONCLUSION: It was found out that the 0–14-year-old children's access to health centers was in poor condition in rural areas of Kermanshah Province, which would endanger the health of this age group.

CONTEXT: Immersing students studying health promotion and disease prevention into community settings facing health disparities is an essential supplement to their academic experience. As part of many public health professions, these students will likely need to understand the values and beliefs of different cultures so that decisions of appropriate health promotion and treatment can be made equitably. This paper evaluates an education immersion program that was part of a National Cancer Institute funded collaboration supporting the recruitment and training of university students in cancer research. The primary aim of the Health Disparities Field Experience (HDFE) was to facilitate an experience for students pursuing a health-related degree to understand the conceptual issues in border/rural health and the cultural contexts related to health disparities among medically and financially indigent populations in the region. SUBJECTS AND METHODS: This study was conducted using qualitative research methods using a variation of the content analysis approach using open codes to categorize the data. Six students were selected to participate in the HDFE (five graduate students and one undergraduate) and all six of the participants completed pre- and post-test surveys. RESULTS: From the analysis of the data, posttest qualitative responses indicated that three participants saw racism as a primary cause of cancer-related disparities, a change from their pretest responses. When asked about the personal impact of the HDFE, respondents mentioned the importance of the experiential component. CONCLUSIONS: Participants learned about health disparities from the HDFE and expressed high satisfaction with this approach to education.

The present study aimed at identifying the prerequisites, facilitators, and barriers to adolescent mental health literacy interventions. To that end, databases PsycINFO, Science Direct, Scopus, Emerald, PubMed, Web of Science, and Google Scholar were systematically searched, out of which 39 articles that had the inclusion criteria were analyzed by the content analysis. Databases searched from September 30, 2018, to October 10, 2018, with the keywords “health literacy,” “mental health literacy,” “mental disorders,” adolescents, students, and more. Seven themes were identified as the prerequisites for interventions to improve adolescents' mental health literacy including education at the school level, parents' education, training of trainers and providers, cooperation and participation among providers, intervention assessment and monitoring, provision of educational content, consideration of the cultural and linguistic issues. Five themes were identified as facilitators: using interactive learning and teaching methods, supplying diverse and stimulating educational content, employing trainers with different backgrounds, having direct contact with people with mental illness, and utilizing technological advancements in education. Finally, short-time intervention, the collaboration between school administrators and researchers, lack of valid information sources were identified as barriers.

BACKGROUND: There is growing recognition of the role of mobile learning (M-learning) for undergraduate (UG) academic education and teaching purposes, but teacher attitudes toward it can be variable. OBJECTIVE: To determine the attitudes toward the incorporation of M-learning methods for UG medical education among resident doctors at a government medical college in Delhi, India. METHODS: A cross-sectional study was conducted for 3-months duration (2019) among 60 final year junior and senior resident doctors. The participants were selected from all the preclinical and paraclinical department, and one clinical department selected randomly based on the probability proportion to size method. The data was collected using self-administered instruments including the modified 20-item M-learning Perception Scale (MLPS). RESULTS: Social media (36.7%) and instant messaging platforms (85%) were routinely used by the participants for exchanging academic (medical) and health-related information. The mean score for all the MLPS item responses was >3, indicating positive attitudes toward M-Learning. The participants expressed maximum agreement with the views stating M-Learning can “supplement traditional teaching,” was “reliable for personal use,” and “improves the quality of lessons.” The responses of those participants having preexisting familiarity with health information and education portals, and those aware of massive open online courses correlated significantly with higher MLPS scores. CONCLUSION: M-learning is visualized as an increasingly relevant teaching and learning medium by early-career resident doctors involved in UG medical education in India.

INTRODUCTION: The ultimate goal of education at all levels is the ability to generate and foster students' creativity. This study aimed at determining and comparing creativity and its influencing factors among medical students. SUBJECTS AND METHODS: In this cross-sectional study conducted in 2019, 720 medical students in Shahroud public and private universities were selected and studied through stratified cluster random sampling. Data were collected using the Guilford Creativity Questionnaire. The data were analyzed using Chi-square, Pearson correlation coefficient, t-test, and multiple logistic regression with a significance level of 0.05. RESULTS: The mean creativity score of the students was 131.4 ± 13.8. The mean creativity scores on the fluency, elaboration, originality, and flexibility dimensions were 49.2 ± 5.3, 22.1 ± 3.4, 34.8 ± 4.7, and 25.4 ± 3.5, respectively. In terms of creativity levels, 75.2% of the students (n = 542) had moderate creativity and 23.8% (n = 171) had high creativity. A significant relationship was observed between creativity and educational level (P = 0.006). Multiple logistic regression results showed that educational level with an odds ratio of 0.59 was associated with a decreased chance of creativity. CONCLUSION: Most of the students had moderate creativity. Moreover, among the factors examined in this study, variables other than the field of the study and educational level had no significant effect on students' creativity. Therefore, using collaborative and cooperative learning and problem-based learning strategies, teachers' critical thinking styles, establishing teamwork groups, concept mapping, and using innovative and creative teaching methods can help to enhance students' creativity.

BACKGROUND: Changing human behavior for the purposes of improving the way people work is an integral part of most educational interventions. This study aimed to evaluate the effect of a model based on the theory of planned behavior (TPB) on correct principles of manual material handling (MMH) among male soldiers. SUBJECTS AND METHODS: This study was a quasi-experimental, pretest-posttest research with a control group. Furthermore, 140 soldiers, from an area located in the city of Bandar Abbas, Iran, were selected through a simple random sampling and they were divided into two groups: intervention and control (70 subjects in each group). The data were collected using a three-part questionnaire including demographic information, the theory constructs, and MMH behavior. The intervention group was given the relevant education, and after 2 months, the both groups were evaluated. RESULTS: Based on regression analysis, attitude toward behavior and perceived behavioral control were predictors for correct principles of MMH. There were significant differences between the mean scores of the theory constructs before and after the education in intervention group (P < 0.001); however, no significant differences were observed in the theory constructs in the control group after the intervention. Before the education, the mean score of MMH of the intervention group was 38.30 ± 6.45; but after, the education, this changed into 44.20 ± 6.01, and significantly increased (P < 0.001). CONCLUSIONS: Educational intervention based on the TPB was effective in improving behavior for correct MMH in soldiers. Thus, the use of such educational programs according to the constructs of the planned behavior theory is recommended.

INTRODUCTION: One of the most critical stages of women's lives is menopause. Meanwhile, group training can have a significant effect on reducing menopausal symptoms. The aim of this study was to investigate the effectiveness of group training on reducing menopausal symptoms in postmenopausal women. METHODS: This study was a randomized controlled trial. The study population was 96 postmenopausal women visiting health centers in the city of Shazand (Markazi Province, Iran). Data collection tools in this study were the Menopausal Rating Scale Questionnaire and the Beck Depression Inventory. Group training intervention consisted of four training sessions. The duration of each session was 2 h. The questionnaires were completed in two stages of pre- and post-test (8 weeks later) for the intervention and control groups. Data were analyzed using descriptive statistics (absolute and relative frequency, mean and standard deviation) and analytical statistics (independent t-test, paired t-test, and analysis of covariance). RESULTS: The mean age in the intervention group and the control group was 49.93 ± 3.44 and 51.66 ± 2.93 years, respectively. In the intervention group, the mean menstrual time was 2.37 ± 167 years and in the control group, the mean time elapsed from the last menstrual period was 3.91 ± 2.68 years. The mean scores of menopausal physical symptoms (F = 58.69), menopausal symptoms (F = 43.45), menopausal urinary and genital symptoms (F = 33.50), and depression (F = 58.25) had a significant decrease in intervention group, while in the control group, these changes were not significant (P < 0.001). CONCLUSION: Regarding the findings of this study, which indicates the effect of group training program on the improvement of physical, psychological, urinary and genital symptoms, and menopausal depression, it seems that group training in menopause can be an effective method.

BACKGROUND: Adherence to treatment is one of the major challenges in patients with HIV/ADIS. If the patients do not adhere, they will face recurrent consequences, such as disease progression. The aim of this study was to investigate the effect of information, motivation, and behavioral Skills (IMB) model on medication adherence, diet adherence, and physical activity in HIV/ADIS patients. MATERIALS AND METHODS: This interventional study was conducted on 122 patients with 20 years of age and over with HIV/AIDS in Kerman City, Iran, in 2018. A total of patients were selected by census method and categorized into the intervention and control groups. Later, a researcher-made questionnaire on IMB was used before and 3 months after the intervention to assess medication adherence, diet adherence, and physical activity .The intervention study consisted of at least 8 training sessions (90 min) over a 12-week period. RESULTS: In adherence to medication, information (P = 0.034) and personal motivation (P = 0.003) constructs and in adherence to diet, information (P = 0.025), personal motivation (P = 0.001), self-efficacy (P = 0.010), and skills (P = 0.011) were significantly different between the two groups after the intervention (P = 0.011). However, regarding the adherence to physical activity, no significant difference was found between the two groups after the intervention. CONCLUSIONS: The IMB model can be effective in promoting the diet adherence in HIV/AIDS patients. In this regard, more qualitative and quantitative studies are recommended on the adherence to medication and physical activity.

INTRODUCTION: Physical therapists provide important services to improve physical health for the general population; however, physical therapy interventions are less utilized with underserved populations such as those with severe mental illness (SMI). The quality of services for these populations is impacted in part by negative provider attitudes and lack of preparation to work with the SMI population. This study examined the impact of structured educational field experience on the physical therapist's attitudes and knowledge about working with the SMI population. This will inform future educational practices to best prepare students to provide quality of healthcare to the population. MATERIALS AND METHODS: Seven graduates of a doctor of physical therapy (DPT) program from a Mid-Atlantic University in the United States who participated in an SMI service-learning (SL) experience completed a semi-structured qualitative interview in 2016. Questions about how the experience impacted their current work were asked. Interviews were digitally recorded, transcribed, and examined using interpretive phenomenological analysis. Coding and investigator triangulation were conducted. All interviews reached thematic saturation. RESULTS: The graduated DPT students reported attitudinal changes toward people with SMI through qualitative interviews. They reported an improvement in their skills, greater competence to work with the SMI population, and an increased focus in the use of person-centered services. CONCLUSIONS: The results of this study suggest that DPT students gain an understanding of both the SMI population and themselves during SL. Using SL as part of the DPT educational curriculum can offer students and the opportunity to build confidence in working with the SMI population. SL can also improve their skills and attitudes toward the population, key areas that are identified as barriers to receiving quality physical healthcare among the SMI population.

INTRODUCTION: In social cognitive theory, self-efficacy and self-concept (SC) have been introduced as important constructs that associate with adolescents' achievements. The aim of this study was to investigate the determinant factors of academic self-efficacy (ASE) and SC in Iranian high school students based on the multilevel analysis. MATERIALS AND METHODS: In this descriptive-analytical cross-sectional study, 1740 students from 53 high schools selected with stratified random sampling method in 2018 in Qazvin, Iran. Data collection tools were the Morgan and Jinks Self-Efficacy Scale and the Piers-Harris Children's SC Scale-Second Edition. The association between some of the students and school variables with ASE and SC was analyzed by hierarchical linear regression models. RESULTS: The score of the students' standardized ASE was lower than SC. ASE and SC had a strong positive significant association with economic status, grade point average, and the educational period of high school. Sex had no association with any of them. Physical activity had a positive significant association with SC but was no found association by ASE. CONCLUSION: These findings revealed that for improving the adolescents' ASE and SC should be attention to the adolescents' family condition and school-related factors. Proper educational, sports, and supportive programs can be effective on the adolescents' self-efficacy and SC.

INTRODUCTION: After graduation, public health students should be able to work as health care givers providing first-level health care services. Therefore, the educational objectives of public health bachelor's programs should ensure that they acquire the capabilities necessary for this purpose. This study identified the educational objectives that are essential for these students and compared them with the current curriculum in Isfahan, Iran. METHODS: This needs assessment study was conducted in two phases. In the first phase, the essential educational objectives were identified using a qualitative approach, which involved eight focus group discussions held by a group consisting of experts of the public health headquarters and public health network administration offices of Isfahan province and the public health graduates working in the province's comprehensive health service centers, who were chosen using the purposive sampling method (n = 59). In the second phase, a comparative study was performed by turning the list of essential educational objectives into a checklist and using it to compare these objectives with the objectives in the current course plan in the examined curriculum. In the end, a list of educational objectives not included in the current curriculum of the public health bachelor's program was created. RESULTS: The focus group discussions produced 433 educational objectives in the cognitive domain, 79 objectives in the affective domain, and 179 objectives in the psychomotor domain, which were arranged in eight competency categories. Comparison of the essential educational objectives with the current curriculum showed that the current curriculum does not cover any of the essential objectives regarding care for the age groups of 18–29 and 30–59 and the first aid and only partially covers essential objectives in other competency categories. CONCLUSION: This study found that considering the requirements of first-level health services and the tasks expected from public health graduates to be providing these services, the current curriculum does not cover all essential learning objectives and should be revised to meet additional essential educational objectives.

BACKGROUND: Menstruation is a normal physiological process among reproductive age group females. Although some of them show the abnormal menstrual pattern, which is influenced by several factors, including sociodemographic status, psychosocial stress, improper sleep level, etc. The identification of these risk factors associated with abnormal menstrual patterns may permit risk stratification among adolescent girls. This study was planned to determine various factors which depict menstrual cycle pattern among adolescent girls in urban India. MATERIALS AND METHODS: A school-based case–control study was carried out in urban India from May to December 2019. Urban locality and schools were randomly selected, and data were collected in two phases. Adolescent girls in the age group of 10–19 years studying in government and private (both Hindi medium and English medium) schools of urban India were screened for the abnormal menstrual pattern. Equal numbers of age-matched controls were also enrolled. Data were collected with the help of self-administered predesigned pretested semi-structured questionnaire. Chi-square test, Fisher's exact test, unpaired t-test, and McNemar tests were used to analyze data using SPSS version 23.0. RESULTS: A total of 100 cases and 100 age-matched controls (mean age 14.8 ± 1.5 years) were included in the study, almost half of the cases and controls have normative menarche. Improper sleep patterns increased stress levels, and low education status of mothers show statistically significant (P = 0.047) association with abnormal menstrual patterns. CONCLUSION: More stress, improper sleep levels, and low education status of mothers among school-going adolescent girls were strongly associated with abnormal menstrual patterns with more symptoms during menstruation.

BACKGROUND: Mobile app education is one of the new educational models. Hence, the purpose of this study was to determine the effectiveness of mobile app intervention on knowledge, attitude, and practice of youth for a healthy marriage. MATERIALS AND METHODS: This quasi-experimental study was conducted in 2019 on 88 young people who were selected by simple random sampling in premarital counseling center of Falavarjan city (Isfahan). Then, participants were randomly allocated to an intervention and a control group. Mobile application intervention was installed on the intervention group's mobiles. Data were collected by questionnaire in two times. Data were analyzed using paired t-test and independent t-test. RESULTS: The mean (Standard deviation) of couples' age was 21.11 (5.06) years. The results showed that after the installation of educational consulting app in the intervention group, the mean score of knowledge (P = 0.001), attitude (P = 0.001), and practice (P = 0.001) after intervention were significantly higher than before the intervention. CONCLUSION: Mobile-based educational and counseling app increases couples' knowledge, attitude, and practice in premarital education. Therefore, it is recommended that this type of education (mobile app) be used to promote premarriage education classes.

INTRODUCTION: The clinical environment is an essential and irreplaceable resource in preparing nursing students for their professional role. Despite many changes that occur in the clinical learning environment (CLE), these environments remain important to nurse training. With regard to the importance of students' viewpoints in the evaluation of CLE, this study was performed to the determination of nursing students' viewpoint of the actual and preferred CLE at Bushehr University of Medical Sciences in Iran 2013. MATERIALS AND METHODS: In this cross-sectional analytic study, due to the small size of the research population, all nursing students (86 students) of Bushehr University of Medical Sciences in Iran who had passed at least one clinical course were selected through the census. Participants were invited to complete anonymously the actual and preferred Farsi versions of the CLE Inventory consisting of 42 items originally developed by Professor Chan (2001). Data were analyzed using frequency distribution, mean, standard deviation, and paired t-test. RESULTS: The results indicated that there were significant differences between students' perceptions of the actual and the preferred CLE (P < 0.001). The highest and lowest mean scores of actual CLE belonged to student involvement and individualization, respectively, and the highest and lowest mean scores of preferred CLE belonged to task orientation and individualization, respectively. CONCLUSION: In general, students prefer a more positive CLE than what they actually have experience and would prefer an environment with higher levels of clarification of personalization, student Involvement, satisfaction, task orientation, innovation, and individualization.

A valid tool is of paramount importance in determining women's sexual and reproductive health status, meeting their health needs, and recognizing the effectiveness of some interventions. This review study aimed to assess sexual and reproductive health dimensions tools in women with type 1 diabetes mellitus with regard to Consensus-based Standards for the selection of health status Measurement Instruments (COSMIN) checklist. In this review study, in addition to Iranian databases (MagIran, Sid, Irandoc), non-Iranian databases (PubMed, Scopus, Embase, and Web of Science) and Google Scholar search engine were considered. The mentioned databases were searched for articles in English and Persian published within 2000–2019, using the search strategy for each database and Boolean operators along with appropriate keywords according to the MESH term. Articles with nonresearcher-made tools measuring the sexual and reproductive health concepts and dimensions were included in the present study. Afterward, the psychometric properties of the tools were assessed according to the COSMIN checklist. In the selected articles, there were 14 psychometrically valid tools to be assessed from 151 articles containing the sexual and reproductive health dimensions; among which, seven tools were evaluated with regard to COSMIN. None of the tools also had all the features noted in COSMIN. Moreover, all the concerned scales were not interpretable and accountable; however, a majority of them had internal consistency and construct validity. In this study, there was no valid and specific tool for measuring sexual-reproductive health status in this population group. Therefore, it is necessary to develop a valid tool according to the dimensions and needs of specific reproductive health in type 1 diabetes.

CONTEXT: Inappropriate self-medication can increase chances of adverse drug reactions, disease aggravation, or drug interactions. Analgesics are most commonly used as self-medication. AIMS: The aim of this study was to evaluate and compare analgesic self-medication practices among medical and paramedical undergraduate students of a tertiary care teaching institute in Central India. MATERIALS AND METHODS: A cross-sectional, observational study was conducted in 216 undergraduate medical (MBBS and BDS) and paramedical (occupational therapy/physiotherapy and BSc nursing) students. A predesigned, self-developed, semi-structured questionnaire was used. STATISTICAL ANALYSIS: The Chi-square test was used for testing statistical significance. RESULTS: The overall prevalence of self-medication with analgesics was 83.33%. Self-medication was significantly high among medical students as compared to paramedical students (P = 0.003). Significantly more medical students were aware about adverse drug reactions of analgesics as compared to paramedical students (P = 0.019). The most common source of information about drugs was previous prescription (58.33%), followed by media including the Internet (53.70%). The most dominant symptom compelling self-medication was found to be muscular pain (42.12%), followed by headache (36.57%). 54.16% of the students revealed that self-medication provides quick relief from pain. The most commonly used analgesic was paracetamol (82.40%), followed by diclofenac (22.68%). A significant number of paramedical students do not know exactly what precautions should be taken while taking analgesics (P = 0.002). CONCLUSIONS: Medical students are more indulged in self-medication practices with analgesics. Paramedical students need to be educated regarding safe use of analgesics.

INTRODUCTION: Providing information based on truth is very important in patients' treatment-related decisions and reduces emotional and physical sufferings as well as patient costs. The aim of this study was to design a model that is based on the culture and health-care context of Iran in order to establish a truth-based communication and provide accurate information to patient. MATERIALS AND METHODS: This qualitative study was conducted in 2019. Data were collected through semi-structured interviews with 18 nurses who had been selected by purposeful sampling method. Data analysis was performed in two steps. In the first step, the participants' experiences were determined using the grounded theory approach. In the next step, using Walker and Evant's (2011) method, the concepts and statements were combined and presented in a central concept. RESULTS: The central concept in this study was “an attempt to establish a truth-based communication with patient,” and then, a truth-based communication model was presented. The components of the model were presented in three parts: improving patient communication skills, managing the situation in which the truth is presented, and the patient's participation in decision-making. CONCLUSION: To present the truth of the treatment, which can sometimes be unpleasant and bitter, it is very important to improve communication skills and choose an effective communication strategy. To establish a truth-based communication, it is necessary to create a suitable ground for communication, which should be provided in clinical setting and community.

BACKGROUND: Disordered eating attitude may lead to full-blown eating disorders. Recent longitudinal studies show that disordered eating attitudes either remain stable or even increase from childhood to adulthood. The current study was done to determine the psychometric properties of the Eating Attitudes Test-8 (EAT-8) and introduce the suitable measure for researchers and therapist in the field of clinical psychology and psychiatrist. MATERIALS AND METHODS: The Persian version of the EAT-8 was produced through forward translation, reconciliation, and back translation. A sample of 302 students were selected through convenience sampling method and completed a set of questionnaires, including the EAT-8, Eating Attitudes Test-16 (EAT-16), Eating Beliefs Questionnaire-18 (EBQ-18), self-esteem scale, and self-compassion scale short-form. The construct validity of the EAT-8 was assessed using confirmatory factor analysis and divergent and convergent validity. Internal consistency and test–retest reliability (2 weeks' interval) were conducted to evaluate the reliability. Data analysis was conducted using SPSS (version 22) software and LISREL (version 8.8). RESULTS: EAT-8 was found to be valid and reliable measures, with good internal consistency and good test–retest reliability among students. In terms of convergent validity, EAT-8 showed a significant positive correlation with self-report measures of EAT-16 and EBQ-18. EAT-8 showed a negative correlation with self-compassion and self-esteem, thus demonstrated a good divergent validity. The results of this study also provide support for the one-factor model of the EAT-8. CONCLUSION: The EAT-8 showed good validity and reliability and could be useful in assessing disordered eating in Iranian population. The EAT-8 shows notable promise as a measure for use in disordered eating research and clinical settings.

BACKGROUND: Experiential learning sessions as a teaching aid have been applied early in the medical undergraduate curriculum to improve the knowledge and inculcate research interest. We compared the ability of 1^st-year medical undergraduates to answer the molecular biology questions among those who had attended the experiential learning sessions of molecular biology techniques versus those who did not attend. SUBJECTS AND METHODS: A randomized controlled trial was carried out with 200 1^st-year medical undergraduates, among whom 69 students were selected by simple random sampling for the demonstration of the molecular biology techniques, such as isolation of genomic DNA, polymerase chain reaction, cell culture techniques, western blotting, and high-performance liquid chromatography for 1-week duration. Student's feedback was collected on a five-point Likert sc ale at the end of the session to understand how they agree or disagree with a particular statement. The content validity rate (CVR) and content validity index (CVI) of the questionnaire were determined, and its internal consistency was examined by Cronbach's alpha. The internal assessment marks of these students, valued by faculty who were blinded to their training sessions, were compared with the rest of the 131 students by independent t-test to know the outcome of these experiential learning sessions. RESULTS: On CVR and CVI assessment, all the questions scored more than 0.70 and 0.85, respectively. Cronbach's alpha for the whole questionnaire was 0.85. Student's feedback indicated that these sessions did complement the cognitive skills acquired for these techniques. We also found a statistically significant improvement (P = 0.006) in the examination performance between the students who attended versus those who did not attend the experiential learning sessions. CONCLUSION: Experiential learning, through demonstration and hands-on experience, enhance d the learning of molecular biology techniques among 1^st-year medical undergraduates.

INTRODUCTION: Considering the importance of the academic level of university graduates in the advancement of communities, it is necessary to evaluate factors affecting the academic achievements of university students. Therefore, this study investigated the relationship between religious beliefs and academic achievements of students in the Dental School in Qazvin University of Medical Sciences. MATERIALS AND METHODS: In this correlational study, all the dentistry students in the last 4 years of education were selected as the study samples. Of 109 students who had the inclusion criteria, 81 (31 males and 50 females) completed the questionnaires. The data collection tools were three questionnaires, including Gluck–Stark's questionnaire, two researcher-made questionnaires on “sympathy with and responsibility for patients,” and the “self-satisfaction” questionnaire. Data were analyzed with descriptive and deductive statistics (t-test, Friedman test, and Pearson's correlation coefficient). RESULTS: According to the analyses, a significant and positive correlation was found between religiosity and students' overall mean grades (r = 0.27, P = 0.016) or “sympathy with and responsibility for patients” (r = 0.21, P = 0.05). No significant correlation was found between self-satisfaction and religious beliefs. CONCLUSION: Based on the results of the present study, the religious beliefs of the students were at a moderate level. On the other hand, this variable had a direct relationship with academic achievement and responsibility. Therefore, attention has to be paid to the promotion of these beliefs among students in colleges. Reinforcement of religious beliefs will improve the students' academic achievement. Based on the findings of this study, it should be considered by university professors and educational planners that the average score of students with higher religiosity was higher, and with the increase of religious beliefs, academic achievement is increased.

INTRODUCTION: Reporting medical errors is one of the common methods for identifying and preventing mistakes in-hospital care. This study was conducted to identify the status of reporting and related factors in two groups of midwives and midwifery students. METHODOLOGY: This research was analytic correlational; it was conducted among all the midwives working in the midwifery and labor departments and midwifery students in Isfahan University of Medical Sciences. The data collection tool included a checklist of errors and the researcher-construed questionnaires of awareness and attitude toward reporting errors. The results were examined using descriptive and inferential statistics (ANOVA, Pearson and Spearman correlation coefficient, and independent t-test) by SPSS software version 20. RESULTS: In this research, the error reporting in midwifery staff was 79.1% and the most frequent error was related to the patient's process of testing; the error reporting among the students was 90% and the most frequent error occurred in the labor processes. The present study also showed that there was a direct relationship between awareness and attitude toward reporting medical errors (P < 0.001), while there was not a significant relationship between the midwifery students' awareness and attitude toward reporting the medical errors (P = 0.31). CONCLUSION: According to the study, hospital midwives reporting is less than midwifery students. Accordingly, it is recommended to focus on the error and risk management committee to strengthen the reporting system.

BACKGROUND: Internet addiction (IA) currently is the major public health concern, especially in adolescents, although the results of previous reports are not generally uniform. This study was conducted to determine IA in adolescents and to examine the correlation of IA with mental health in adolescents. METHODS: This cross-sectional study was conducted in 2019 in Ilam city. In this study, 362 persons were included using stratified cluster sampling; clusters were geographical area and schools. The valid questionnaires including Internet Addiction Test and 28-item General Health Questionnaire (GHQ-28) were used to interview. The correlation statistical technique was used to determine the association between the two variables. The significance level was considered <0.05. RESULTS: The mean ± standard deviation age of the responders was 16.40 ± 2.47 years; the total score of IA and mental health was 43.02 ± 16.50 and 19.27 ± 9.72, respectively. We found that 5.5% of the adolescents had a severe level of IA. The lack of control with anxiety, neglect work and social dysfunction, and neglect social life and severe depression in internet users were found to be statistically significant: r (365) = 0.151, P < 0.033; r (365) = 0.126, P < 0.021; and r (365) = 0.125, P < 0.033, two-tailed, respectively. CONCLUSION: According to the results, the excessive use of internet, lack of control, and neglect social life are significantly correlated with mental health in adolescents; these results could be contribute to improve the theoretical models for IA in adolescents.

INTRODUCTION: Acquired immune deficiency syndrome (AIDS) is a pervasive disease, and its epidemic is spreading around the world. The only way to effectively fight against human immunodeficiency virus (HIV)/AIDS is good-quality health. The present study aimed to investigate the effect of an educational intervention program on HIV/AIDS preventive behaviors based on the Health Belief Model (HBM) in vulnerable women residing in peripheral neighborhoods. MATERIALS AND METHODS: This study was a quasi-experimental research conducted among 200 vulnerable women, randomly selected from four community health centers in peripheral neighborhoods in 2019 in Zahedan, Iran. The data were collected using a researcher-made questionnaire, containing demographic information, HIV knowledge, and the HBM constructs. Besides, the data were collected before, immediately after, and 1 month after the intervention in both groups. Data analysis was performed in SPSS (version 24) using descriptive statistics, Chi-square test, independent t-test, repeated-measures analysis of variance, and multivariate linear regression. RESULTS: The findings revealed no significant difference in the mean scores of knowledge and the HBM constructs before the educational intervention (P > 0.05). However, after the intervention, this difference was significant in three time intervals (P < 0.05). Despite the effectiveness of the educational intervention in the mean scores of knowledge and the HBM constructs in the intervention group compared with the controls, the largest effect size was observed, respectively, in knowledge (d = 0.762) and perceived barriers (d = 0.612), and the smallest effect size was reported in cues to action (d = 0.421). As well, the F-statistic ratio (0.847) demonstrated that the selected demographic variables had failed to explain variations in knowledge mean scores (P = 0.497). CONCLUSION: HBM-based training interventions were positive for HIV/AIDS prevention behaviors. However, training alone does not seem to have enough effect on behavior persistence. Therefore, further research is recommended to investigate the role of predictive factors, especially social determinants of health and their relationship to different parts of the model, to take more effective measures for behavioral stability at the same time as training.

INTRODUCTION: Medical education is tricky to imbibe and difficult to apply. Various teaching–learning (TL) methods have been tried from time to time to enhance the proficiency of students. The aim was to assess the students' perception toward three different TL methods (pedagogy, andragogy, and heutagogy) in medical education. MATERIALS AND METHODS: A comparative experimentalquestionnaire-based study was done on population of second-year MBBS students of SMS Medical College, Jaipur, in October 2019. They were taught topic of anticancer drugs using pedagogy, andragogy, and heutagogy methods. Then, their opinion regarding these methods was collected and evaluated. The reliability of the questionnaire was ascertained by Cronbach's alpha value which turned out to be 0.89. The data collected were analyzed statistically using one-way Analysis of Variance (ANOVA) and Principal Component Analysis (PCA). RESULTS: The results showed that all these methods differ significantly from each other as the P < 0.05 considering 5% as level of significance. PCA revealed that andragogy and heutagogy were found to be most effective in this study. CONCLUSION: Competency-based andragogy and capability-based heutagogy are more effective TL methods than didactic lecture-based pedagogy for MBBS undergraduate students.

INTRODUCTION: The world's population is aging and this trend continues. Older adults are living healthier and longer than in the last decades and their sexual function should also be considered along with their general health. This study aimed to examine the correlation between general health and sexual function in elderly women. MATERIALS AND METHODS: In this cross-sectional correlation study, 1245 women over 60 years old were selected in Ardabil health-care centers by a convenient sampling method. Demographic data of all participants were noted and general health and sexual function were evaluated by the Goldberg General Health Questionnaire and Female Sexual Function Index (FSFI) Questionnaire. RESULTS: The participants' mean ± standard deviation age was 75.1 ± 7.2 years, most of the women (40.08%) were illiterate, and the majority of them were living with their married (44.81%) or single children (27.14%). The general health score for 380 older women (30.52%) was under 22 (healthy). About 60% of the women had engaged in sexual activity during the past 4 weeks, and the total mean score of FSFI was 17.36 ± 1.44. In addition, 84.33% of the women had sexual dysfunction (FSFI < 26.55). The age (P < 0.05), educational level (P < 0.001), living with children (P < 0.01), and general health status (P < 0.01) were found to be significantly related to sexual function. The total scores for FSFI and the scores for all domains except for satisfaction were in positive correlation with the score for the total and all domains of general health (P < 0.001). CONCLUSION: Sexual function in elderly women is affected by several factors, such as general health. Therefore, to promote successful aging in women, sexual function and general health require more attention when implementing women's health initiatives.

CONTEXT: Quality of life is significant in all stages of life, including within pregnancy. The hormonal, emotional, psychological, and physical factors specific to pregnancy can affect and threaten the quality of life of pregnant mothers. AIMS: This study sought to investigate the health-related quality of life (HRQoL) and related factors among pregnant women SETTINGS AND DESIGN: This cross-sectional study was performed on 300 pregnant women who were in the second and third trimesters of pregnancy without any risk of high-risk pregnancy covered by a community health center in Yazd, Iran, between 2018 and 2019. SUBJECTS AND METHODS: The required data were collected using demographic questionnaire and HRQoL (SF-12v2) questionnaire STATISTICAL ANALYSIS USED: Data were analyzed using SPSS 18 software and ANOVA statistical tests (P < 0.05). RESULTS: Physical dimension of quality of life of pregnant women had the mean and standard deviation of 43.7 ± 7.3 and that psychological dimension had the mean and standard deviation of 31.5 ± 11.8. Physical dimension of quality of life was significantly correlated with maternal age, gestational age, body mass index before 12 weeks of pregnancy, mother's education and job as well as spouse's level of education (P < 0.05). Furthermore, the psychological dimension of quality of life was significantly correlated with gestational age, mother's education and occupation as well as spouse's level of education (P < 0.05). CONCLUSIONS: According to the findings, attention to physical and psychological aspects of quality of life of pregnant women and demographic factors affecting it is essential for improving maternal and child health during and after pregnancy.

BACKGROUND: There is a growing global movement toward quality and safety in healthcare and quality improvement (QI) in general surgery. The first step in any QI initiative is identifying the challenges and barriers to achieve such goals and then to define appropriate actions. This study aims to provide an overview of the QI challenges in Iranian hospitals' surgery-related processes and suggest applied solutions accordingly. METHODS: This is a sequential (qual-quant) mixed-method study from November 2019 to January 2020, involving 21 face-to-face interviews with hospital managers, quality officers, and surgery-related clinicians and staff, followed by a Delphi consensus-seeking stage to finalize solutions. MAXQDA software was applied for organizing the concepts, and thematic content analysis was used for analyzing the data as an inductive approach to extract the emerging themes and sub-themes. RESULTS: The managerial problems were classified into four groups of (I) defects and delays in completing patient medical records, (II) irregularity and the lack of transparency in the direction of processes in the hospital, (III) inappropriate and unrealistic operating scheduling, and (IV) poor safety considerations. The proposed solutions included imposing stricter regulations for competing for medical records, such as reduction of payments, development of guiding brochures or protocols for patients on their arrival, assigning a certain number of experienced nurses and surgeons for schedule management, rewarding the report of medical and surgical error cases, and developing a regular monitoring program for the proper implementation of surgical safety guidelines. CONCLUSION: There are various managerial barriers that hamper QI in hospitals' surgery-related processes. Implementing simple but agreed solutions can lead to saving patients' lives, reduction of the unnecessary use of resources, and enhance of patient and staff satisfaction.

Schools are considered as a first community, which plays an essential role in developing the child's life skills; thus, it is important to provide safety and health in these places. Accordingly, health, safety, and environmental (HSE) issues in schools are among the important issues that should be considered. Therefore, the purpose of this study was to review the studies conducted on the HSE status of Iranian schools. A systematic search of databases, including Google Scholar, SID, PubMed, IRANDOC, MEDLIB, and Science Direct, was performed using keywords by March 2020. The reference lists of key studies were also scanned to find additional articles that are suitable to include in this study. Twenty-five studies met the inclusion criteria. The results of the studies showed that the surveyed schools had favorable status in terms of HSE indicators, and only 12% of the studies reported poor status. About 88% of schools had favorable or average condition. Some cases, such as lack of safe emergency exit and inadequate ergonomic seats, have been reported, and some differences have been observed in schools in rural and urban areas. The results showed that the health and safety situation in most of the urban schools in Iran is good and relatively favorable. However, there have also been some problems; hence, the implementation of integrated HSE management is imperative to improve the status of schools. Personal health education and safety education are also recommended.

BACKGROUND: There are various instructional methods worldwide and virtual instruction is one of them. This widely used method involves online instruction and e-learning. The present study compares the effects of lecture-based and virtual instruction on student learning, satisfaction, and content retention among surgical technology students at Isfahan University of Medical Sciences. MATERIALS AND METHODS: The population of this two-stage, quasi-experimental study consisted of 40 surgical technology students at the School of Nursing and Midwifery. After fulfilling inclusion criteria, they were randomly assigned to the virtual instruction group (VG, n = 20) and the traditional, lecture-based instruction group (TG, n = 20). Data were collected via a researcher-made student satisfaction questionnaire and two learning examinations. Their validity and reliability had been confirmed. The data were analyzed using SPSS 13 and analytical and descriptive tests (P < 0.05). RESULTS: There was no statistically significant difference between the TG and the VG with respect to the mean score in the first examination (P = 0.89). However, the two groups were significantly different in terms of the mean score in the second examination (P = 0.03). Regarding content retention and recall performance, the VG outperformed the TG. Furthermore, the mean satisfaction score of the VG (132.24 ± 17.92) was higher than that of the TG (115.56 ± 17.57) (P < 0.05). CONCLUSION: Virtual instruction and lecture-based instruction had comparable short-term learning outcomes. Nevertheless, with the passage of time, it was revealed that virtual instruction could result in better learning performance and higher content retention and satisfaction.

BACKGROUND: Child abuse (CA) is prevalent in every segment of society and is witnessed in all social, ethnic, religious, and professional strata. In this situation, dentists are in an ideal position to help detect signs of CA and should be able to recognize those signs. AIM: To assess the perspectives toward CA and neglect among dental practitioners of Belagavi city. MATERIALS AND METHODS: A cross-sectional survey was conducted among 102 dental practitioners. The data were collected by self-administered structured questionnaire. Data were analyzed using descriptive analyses for responses to each question, and Chi-square test was applied to test the association. RESULTS: 59.8% had learned the topic of CA and neglect as a student. Overall, 16 participants have recognized suspicious case of CA and neglect in their dental office. Only 34.3% had knowledge regarding the findings pointing to CA and neglect, and 96% had reported that there are barriers regarding reporting the same. 93% are of opinion that the topic is of utmost importance and more training is required in this aspect. CONCLUSION: Training and continuing dental education programs should be tailored to the specific needs of all professionals to diagnose, report, and prevent CA.

INTRODUCTION: Outsourcing, as one of the important managerial strategies to improve performance, has become one of the main areas of research in hospital management studies. The aim of this study was to identify the challenges of outsourcing hospital services in Iran. METHODS: This research was conducted in a qualitative manner with the aim of determining the challenges of outsourcing hospital services in Iran. The research community consisted of managers and experts in the field of outsourcing. 21 managers and staff experts of the Ministry of Health, universities, and hospitals affiliated to Iran University of Medical Sciences, Tehran, and Shahid Beheshti, were selected as the target for the interview. Finally, the data were analyzed using content analysis method. RESULTS: Outsourcing challenges were extracted and reported in the form of 6 theme topics and 40 subthemes. The main issues included legal and political challenges, finance, human resources, organizational, managerial, and private sector. CONCLUSION: Outsourcing hospital services in all six areas faced serious challenges. To this end, partnership between the private and government sectors through outsourcing requires the continuous development of effective political, organizational, and managerial capacity in order to guide and manage this process properly and efficiently to ensure that the goals and policies in the field of health. It is clearly understood and not forgotten or neglected.

BACKGROUND: Empowerment is an essential issue in women's lives. Powerful women can act successfully in health-related issues more than others. This study aimed to determine the effectiveness of an educational intervention designed based on theory of planned behavior (TPB) on health care empowerment among married women in reproductive age. METHODS: This randomized controlled trial was carried out among 488 reproductive-age women between 2018 and 2019 in Tehran, Iran. Participants were recruited using randomized cluster sampling and divided into intervention (n = 243) and control (n = 245) groups by random allocation. Data were collected using a self-administered researcher-made questionnaire based on TPB and Health Care Empowerment Questionnaire. Validity (content validity index = 0.87; content validity ratio = 0.89) and reliability of the questionnaires were confirmed (α = 0.96). Intervention was implemented within four sessions (lasting 60 min) using eight health related scenarios based on TPB constructs. Baseline and post intervention data (6 months after the intervention) were analyzed by SPSS₂₅(Inc., Chicago, IL, USA) using independent t-test, Chi-squared test, Fisher's Exact test, Mann–Whitney, path analysis, and regression of generalized estimating equation model. P < 0.05 was considered statistically significant. RESULTS: Results showed the mean ± standard deviation age of the participants was 33.6 ± 7.1. Six months after the intervention, a significant difference was highlighted in health care empowerment domains as well as behavioral intention, attitude toward behavior, subjective norms, and perceived behavioral control (P < 0.001) between intervention and control groups. CONCLUSION: TPB-based educational intervention can significantly improve women's perception about health care empowerment. Tailoring and implementation of TPB-based intervention by health policy makers and health care providers is suggested to achieve better perception of empowerment toward receiving health care among women.

BACKGROUND: Student nurses' experience of stress while enrolled in educational programs is well-documented; however, complementary and alternative therapies to alleviate or prevent nursing program-related stressors are not. The purpose of this study was to explore the effect of a yoga intervention on stress, self-compassion, and quality of life in undergraduate nursing students. METHODS: Seventy-three undergraduate nursing students participated in this two-group, quasi-experimental, repeated-measures, study. Students self-selected participation in a one-hour yoga class, offered each week for 12 weeks, and completed Stress, Self-Compassion, and QOL scales at baseline, week 6, and week 12. Information on intervention participation and yoga practice outside the intervention was also solicited. Descriptive statistics and mixed-model analysis of variance were used to analyze the data. RESULTS: There were no statistically significant differences between groups over time on perceived stress or QOL. There were statistically significant differences between groups on self-kindness (F3, 69 = 3.86, P = 0.013). CONCLUSIONS: Further research on the effects of yoga for stress reduction in nursing students using randomized controlled trials is recommended.

BACKGROUND AND AIM: To answer the society's health-care needs related to social determinants of health (SDH), higher education system must be responsive in training knowledgeable students and faculty members. Therefore, this study was carried out to determine the responsiveness of higher education system in relation to the SDH. METHODS: This is a content analysis study carried out using qualitative approach. Semi-structured interviews were used to gain access to the knowledge of experts in the fields of health care, education, and SDH. Sampling was carried out until data saturation was achieved during which 15 experts were selected using purposeful sampling method with highest possible variety. Data were categorized using qualitative content analysis approach. RESULTS: In total, 11 themes and 43 categories of codes were identified in semi-structured interviews with experts. A total of two approaches were identified for the training of responsive students including educational–research approach and cultural–social approach; five approaches were identified for the development of faculty members including cognitive development, executive development, evaluation, promotion and incentives, and revisions; two approaches were identified for provision of theoretical and practical education including education in a real and active environment and structural education; and finally, two approaches were identified for evaluation of students and faculty members in regard to their responsiveness to society's health needs and SDH including content and operational approaches. CONCLUSION: In general, the results of the current study indicate the need for the higher education system to use educational, research, and society-based approaches in real and social environments along with an incentive system and use of evaluation for responsiveness to society's health needs and SDH. These results can be useful for the health-care system and the higher education system.

There is growing evidence that the problematic use of mobile phone is an evolving problem. Although some studies have noted a greater prevalence in the Middle East, intercultural differences have not been sufficiently studied to date. The present study, therefore, aims at reviewing Iranian published studies on the problematic use of mobile phone in Iran. This study was conducted as a review study. For this purpose, we searched all published studies in this field that were conducted in Iran and reviewed all of the articles by studying the prevalence of the problematic use of cell phone in Iran, the adopted measuring instruments, the employed terms, predictors of the problematic use of cell phone, and the consequences of the problematic use of cell phone. After applying the inclusion and exclusion criteria, 47 articles were selected for evaluation. Among the problematic consequences, sleep disturbance was the most studied factor. Additionally, gender, feeling of loneliness, attachment stiles and age were mostly referred to as predictors. In addition, the reported prevalence varied from 0.9% to 64.5%, depending on the studied population and the measuring instruments. The diversity of reported prevalence rate of problematic use of mobile phone in Iran can be related to the ambiguity of the concept of “problematic use” and the diversity of the employed measuring tools. Thus, care should be taken in generalizing and interpreting the results.

Inflammatory bowel disease (IBD), including Crohn's and ulcerative colitis diseases, is characterized by clinical periods of remission and relapse. Excessive care stress can have long-term negative physical and psychological consequences not only for caregivers but also for the recipients of care. This integrative review aims to identify, describe, and synthesize the results of current available research focused on the burdens of IBDs on family caregiver. An integrative review was performed using Whittemore and Knafl methodology. A systematic search of electronic databases including Web of Science, PubMed, Embase, and Scopus from January 2000 to October 2019 was conducted. Articles were included if published in English and focus on IBD burden on family caregivers. Of 730 records, 16 articles with quantitative, qualitative, and Q methodology study designs were eventually included in the review. The synthesis of these articles led to the identification of four key types of effects: biopsychosocial, daily life activities, physical health, and financial. The chronic and relapsing nature of IBD exposes family caregivers to considerable risk. Thus, the care burden of IBD patients' caregivers needs to be evaluated continuously and relieved through family-centered interventions.

BACKGROUND: An infant admitted to the neonatal intensive care unit (NICU) is a potentially stressful event for parents. Severe stress is experienced by parents, affecting their mental health and relationship, and infants' development. The current study aims to assess the stress levels among parents of neonates admitted to NICU and to identify the factors influencing their stress levels. MATERIALS AND METHODS: A cross-sectional study was conducted in a tertiary care hospital of Eastern India over 2 months. Stress levels were assessed using Parental Stressor Scale: NICU questionnaire among 100 NICU parents (mother or father) with more than 24 h of admission. Stress was quantified using the Likert scale. The statistical analysis was performed using the SPSS software. RESULTS: In this study, 60.8% parents experienced severe and extreme stress level for overall stress. The mean for overall stress experienced was 3.71 ± 0.70. There was no significant difference in overall stress between father and mother (P = 0.65). The highest levels of stress experienced were in sight and sound subscale (3.23 ± 0.41) followed by relationship with the baby and parental role,” i.e., 2.46 30. There was no significant association in overall stress score with maternal age, parity, education level, previous baby being admitted to the NICU (P > 0.05). Stress in sight and sound domain was statistically significantly higher (P = 0.009) among parents of babies with stay of ≤7 days. CONCLUSION: These results support wider use in research and clinical practice to identify parental stress. Interventions can be developed to ameliorate its negative effects on individual, interpersonal, and societal levels. The stress score was not significantly different between fathers and mothers of neonates admitted to NICU and the length of stay was significantly associated with sight and sound domain. Appropriate counseling should be targeted toward both parents. Future intervention studies should be planned to decrease the stress level among parents.

INTRODUCTION: Recently, the night shift is included in the curriculum of nursing internship students. However, this shift is associated with some problems and benefits for students, which have been assessed in limited studies. This study aimed to discover and describe the problems and benefits of the night shift for nursing internship students. METHODOLOGY: This qualitative method was carried out with the conventional content–analysis method. In total, 15 seventh-semester and eighth-semester nursing students at Sabzevar University of Medical Sciences, Iran, were selected by purposeful sampling. Data were collected using in-depth semi-structured interviews about students' perceptions of night shift problems and benefits. In addition, data analysis was performed applying the conventional content–analysis technique. RESULTS: In this study, seven main categories were extracted, five of which included problems such as exploitations, being an outsider, moral distress, learning deficits, and annoyance. The other two categories were benefits including gaining new experiences and independence. CONCLUSION: The problems related to the students were the nursing personnel and the educational system of hospitals, which can be dealt with through the interaction of the educational system with hospitals managers in order to clarifying the role of students, fair division of work, and making educational resources available. Moreover, gaining new experiences and independence are among the benefits of the night shift for students, the continuation of which is in favor of nursing education.

BACKGROUND: Health literacy is the capacity to acquire, process, and understand basic information and services necessary for appropriate health decisions. Given the importance of health literacy in women, the aim of the present study was to determine the effect of health literacy level on improving the quality of care during pregnancy in pregnant women. MATERIALS AND METHODS: The present study was a cross-sectional analytical study. In this study, 130 women referred to Yazd health centers were examined. Health literacy questionnaires and a researcher-made checklist of the quality of pregnancy care were used to gather information. The researcher-made checklist of the quality of pregnancy care was in accordance with the standard protocol of the Ministry of Health and Medical Education, entitled Integrated Health Care for Pregnant Mothers, which was validated and reliable. SPSS statistical software version 19 and t-test and ANOVA statistical tests were used to analyze the data. RESULTS: According to the findings, the average score of health literacy in pregnant women was 74.09, which showed that the level of health literacy was in the marginal or border range. People with higher health literacy received significantly more prenatal counseling than other women and had a planned pregnancy (P = 0.04). CONCLUSION: The level of health literacy in pregnant women is unfavorable. Given that the high level of health literacy in women in society can lead to an increase in the quality of pregnancy care, so to increase health literacy in women, it is recommended that regular training in society by health-care providers be given more attention.

INTRODUCTION: Feedback is an important part of the assessment process. However, one-to-one structured and constructive feedback to the students is not practiced mostly due to lack of practice and feasibility issues. The present study was conducted to understand the perception of students and faculty toward one-to-one structured feedback. METHODOLOGY: All the 3^rd MBBS professional students were included in the study. An orientation was given to the faculty regarding the importance of feedback and how to give structured feedback. A standardized format was provided to the faculty for providing the feedback to the students. After completion of the assessments, a one-to-one structured verbal feedback was given to all the students. Thereafter, faculty and student's perception on the feedback process was obtained through questionnaires. A focused group discussion was also conducted among the students. RESULTS: A total of 42 students participated in the study out of 50. A positive response was received from all the students regarding the feedback. Nearly84.34% of the students acknowledged that feedback is important for understanding their mistakes, 92.84% of the students responded positively that feedback helps to build a good rapport with the teacher, and 92.85% of the students reported that they were satisfied with the overall experience of receiving feedback. Most of the faculty (80%) perceived that giving feedback after the assessment was a good idea. The faculty felt motivated to give feedback to the students after the hands-on experience. However, only 20% of the faculty agreed that the process of feedback was easy to carry out (mean score: 2.2 ± 1.09). CONCLUSION: The positive responses received from both the students and the faculty highlight that the students are receptive toward feedback provided it is structured, constructive, and helps them to achieve their learning goals.

INTRODUCTION: Since routine counseling does not suffice to resolve the sexual problems at postpartum period, the present study aimed to investigate the effect of counseling based on the Ex-PLISSIT model on sexual function and marital satisfaction of postpartum women. METHODS: This was a randomized controlled clinical trial that was conducted on 68 postpartum women (within 3–6 months after childbirth) who obtained a score <28 on the Female Sexual Function Index (FSFI). The participants were randomly assigned to the intervention and control groups. Participants in the intervention group received counseling based on the Ex-PLISSIT model and those in the control group received the routine postpartum care. The required data were collected using a demographics form, the FSFI, and the ENRICH Marital Satisfaction Scale. The primary outcomes were the mean function and martial satisfaction score of participants 4 and 8 weeks after the intervention. RESULTS: There was no statistically significant difference between the two groups in terms of sexual function at baseline (P = 0.381), but it was significantly higher in the intervention group than control group after intervention (the adjusted MD: 4.24, 95% confidence interval [CI]: 3.18–5.29, P < 0.001). There was no statistically significant difference between the two groups in marital satisfaction before the intervention (P = 0.433), but it increased significantly in the intervention group in comparison to control after intervention (adjusted MD: 23.17, 95% CI: 15.10–31.24, P < 0.001). CONCLUSIONS: The study findings suggested that sexual counseling based on the Ex-PLISSIT model can improve the sexual function and increase marital satisfaction of postpartum women.

INTRODUCTION: The use of ionizing radiation in various sciences, especially in medical science, has played an important role in human health. As the use of radiology tests in medical centers, including the operating room ward, is increasing, increasing the level of awareness of the operating room staff can improve their performance in this area as well as reduce the risk of exposure to radiation. The aim of this study was to determine the knowledge and performance of surgical technologists about radiation protection in Zahedan educational hospitals. MATERIALS AND METHODS: The present study is a descriptive-analytical study that was performed on 80 surgical technologists of Zahedan teaching hospitals from January 2019 to December 2019. The Knowledge Questionnaire was used in this study, which was a researcher-made questionnaire. After filling out questionnaires and checklists, the data were analyzed by SPSS software using descriptive statistics and analytical, statistical tests, including independent t-test and Pearson correlation coefficient. RESULTS: The results showed that the mean age of participants was 31 ± 7.03 years . 27% were men, and 53% were women. The mean of work experience was 7 ± 7.56. The mean score of knowledge was 6 ± 3.02 and the performance score was 12 ± 7.38. There was a correlation between age, awareness and performance of the participants (P < 0.001), and there was a correlation between participants' radiation protection training and awareness and performance (P = 0.000). There is a direct relationship between staff knowledge and performance. No significant relationship was found between the other variables (P = 0.029). CONCLUSION: The results of the study showed that there is a relationship between radiation protection training courses so that the personnel who passed these courses are more aware and functioning. Given that action is needed to raise awareness through workshops.

AIM: To assess the knowledge, attitude, practices (KAP), and barriers regarding pharmacovigilance and adverse drug reaction (ADR) reporting among medical and dental faculties of the teaching hospitals. METHODOLOGY: This study was conducted for a period of 3 months among medical and dental faculties. A self-structured, 42-item closed-ended questionnaire based on pharmacovigilance and ADR reporting was used in this study. Data were analyzed using Statistical Package for the Social Sciences Version 21. All the items of the domains along with demographic variables were summarized as absolute and relative frequencies. Intergroup comparison was done using Kruskal–Wallis test and Mann–Whitney U-test. The correlation between the domains was assessed by Spearman correlation coefficient. RESULTS: Among the study subjects, 272 (60.4%) were females and 178 (39.6%) were males. The number of medical and dental faculties was 360 (80%) and 90 (20%), respectively. The mean KAP scores for medical and dental faculties were 7.58 and 5.37, 8.78 and 6.01, and 6.91 and 6.32, respectively. The Spearman correlation coefficient (ρ) was found to be significant for knowledge–attitude and knowledge–practice domains. The values obtained between attitude with practice and barrier also were significantly correlated. CONCLUSION: Our study findings advocate that although medical faculties have better knowledge about pharmacovigilance and ADR reporting, dentists have a positive attitude, thereby suggesting a huge scope of progress if more emphasis is given on the need for continuous educational initiatives and including the topic in their academic curriculum.

CONTEXT: The 30-item nurses' observation scale for inpatient evaluation (NOSIE-30) developed for the behavioral and observational rating of psychiatric inpatients. AIMS: The purpose of this study was to evaluate the validation of the NOSIE-30 and mental health-care promotion. MATERIALS AND METHODS: The participants with psychiatric disorders were selected from 310 inpatients referred to the military educational hospital in Iran. This study was carried out in two phases: First, translation of the NOSIE-30 into Persian followed the stepwise, iterative procedures developed by the International Quality of Life Assessment project approach. Second, face validity, criterion-related validity and construct validity, and reliability of the Persian version were determined. The concurrent validity was assessed by using the global assessment of functioning (GAF) instrument. Data were analyzed with the SPSS software of version 22. Exploratory factor analysis, the Cronbach's alpha coefficient, and interrater agreement with intraclass correlation coefficient and Pearson's correlation coefficient were used to data analysis. RESULTS: Pearson's correlation coefficient between the NOSIE and GAF was 0.75. The interrater reliability for subscale scores and structure of the NOSIE were ranging from 0.70 to 0.94 and Cohen's kappa = 0.74. Furthermore, the internal consistency of the scale's total scores was estimated by Cronbach's alpha = 0.85. CONCLUSIONS: The finding indicated that NOSIE-30 Persian version scale has the desirable validity and reliability for evaluating the nursing care of inpatients. Thus, nurses can promote mental health care by applying this scale in the psychiatric setting.

INTRODUCTION: Due to the significant decrease in fertility in recent decades and the important role of health workers and health-care providers in providing healthy reproductive counseling, their training is necessary using effective educational methods. Webinar and group discussion (GD) are effective in this regard. This study was conducted to determine the most effective method and with the aim of comparing the effect of two training methods (webinar and GD) on the attitude and performance of health workers in providing counseling with fertility promotion approach in comprehensive health centers in Mashhad. METHODS: In this randomized trial study with a control group, 108 health workers working in health centers no. 2–3 and 5 of Mashhad entered the study and were randomly divided into three groups of training by webinar, GD, and control. Intervention groups received healthy fertility counseling skills in three training sessions. Research tools were demographic information questionnaires, fertility attitudes, and performance measurement checklists for fertility counseling. The questionnaires were completed in three groups at the beginning and after the completion of the interventions. Data analysis was performed by Chi-square test and one-way analysis of variance using SPSS software version 16. RESULTS: The analysis of variance test showed that before the intervention, there was no statistically significant difference between the three groups in terms of average scores of fertility attitude and performance scores of fertility counseling. After the interventions, the difference between the fertility attitude scores (P < 0.001) and the performance scores of fertility counseling (P < 0.001) was significant in the three groups. There was no significant relationship between demographic characteristics and attitude and performance. CONCLUSION: Teaching by webinar and GD promotes the attitude and performance of health workers in providing counseling with a fertility promotion approach. Therefore, it is recommended to use new educational methods such as webinar and GD to promote childbearing counseling, which has been emphasized in the country's population policies. Since the mean score difference for the webinar training method was the highest due to the mean scores, this method could be more effective than the GD method.

INTRODUCTION: Adequate knowledge about the presence of postexposure prophylaxis (PEP) against human immuno-deficiency virus (HIV) is imperative for health-care workers. This study focuses on the evaluation of the present knowledge and practice of nurses and paramedical workers on the post exposure prophylaxis against HIV. AIM: The aim of this study is to assess and compare the knowledge and practice of PEP against HIV among Staff Nurses and Paramedical workers. SUBJECTS AND METHODS: A descriptive cross-sectional questionnaire study about the knowledge and practice of PEP against HIV among Staff nurses and Paramedical workers done at a tertiary care hospital in South India. The analysis of the data was performed using SPSS software version 24. The statistical tests used to compare the knowledge between nurses and paramedical workers was Chi-square test. P < 0.05 was considered statistically significant. RESULTS: About 339 nurses and 66 paramedical workers participated in the study. An overall of 65.4% of the study participants had a good level of knowledge, higher (P = 0.000) among nurses (71.1%) compared to paramedical workers (36.3%). However, only 23% of nurses and 14.3% of paramedical workers received PEP after a needle prick injury. CONCLUSION: This study revealed a low-level practice of HIV PEP among staff nurses and paramedical workers despite their good knowledge. This can be improved by providing formal training sessions to the health care workers.

BACKGROUND: Implementing a cervical cancer prevention program requires an exploration of certain behaviors concerning this disease. This study is aimed to evaluate the psychometrics of a questionnaire that enquired about the factors involved in Precaution Adoption Process Model (PAPM) for cervical cancer among suburban women in Bandar Abbas, south of Iran. MATERIALS AND METHODS: The primary draft of the questionnaire was developed with a review of the related literature on cervical cancer and the constructs affecting PAPM, with 68 items. The face validity, content validity ratio (CVR), and content validity index (CVI) of the questionnaire were approved by a panel of 10 experts. The internal consistency and test-retest reliability of the questionnaire were estimated too. Field testing sample included 300 women recruited from a women's healthcare center in suburban areas of Bandar Abbas in the south of Iran. Exploratory factor analysis was used to evaluate validity, and Cronbach's alpha coefficient was estimated for reliability. RESULTS: After the face validation, 11 items were eliminated. Once CVR was estimated, two items were discarded. The remaining items had a CVR >0.79. All had a CVI >0.79. Six items were eliminated in the factor analysis. The final questionnaire included 49 items organized in 8 factors including awareness, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, social norms, fear, and self-efficacy. Principal component analysis with varimax rotation indicated eight main components that explained 56.25% of the variance. Reliability assessment showed a good internal consistency for all subscales and the Cronbach's alpha score ranged between 0.82 and 0.90. The test-retest reliability showed that the correlation coefficients (between 0.81 and 0.89) were significant at the 0.01 level for all sub-scales. CONCLUSIONS: The final questionnaire was a new instrument comprised the effective constructs of PAPM and had a high reliability and validity. Thus, this questionnaire is recommended to be used to explore and enhance preventive behaviors of cervical cancer.

BACKGROUND: Students must be made aware about the essentiality of optimum level of physical activity and the fact that it is the key to good health and an important technique to prevent and control a lot of noncommunicable diseases including depression and other related mental ill-health. MATERIALS AND METHODS: It was an institution-based intervention study among 187 Madrasah students of classes VII and VIII, conducted in five-phase assessment of the training needs of Madrasah students on different aspects of healthy lifestyle, development of a need-based module to be used by teachers to impart training of students through classroom setting, training of teachers to use the module to train students, training of students by the trained teachers in classroom setting, and evaluation of effectiveness of the training module. RESULTS: The mean pretest knowledge score in study Madrasah was 2.64 ± 1.35 (Mean ± SD) and post test score was 4.13 ± 0.88 (Mean ± SD). In paired t- test, t- value was 13.54 and P < 0.05 with effect size of 1.370 (Cohen's d). Practice related to the mean score in pretest was 2.38 ± 1.08 and posttest score was 2.73 ± 1.03. In paired test, t- value was 6.25 and P < 0.05 with effect size of 0.458 (Cohen's d). CONCLUSIONS: The study revealed the effectiveness of training by teachers using the module developed by the researcher to address significant changes in lifestyle-related issues.

Palliative care has been proposed as a multidisciplinary method for providing patients with care. The present study proposes to discuss the necessary principles required for any country to successfully implement a palliative medicine program. The present study was a systematic review conducted in January 2019, and the articles related to palliative care requirements on the databases of Web of Science, PubMed, Scopus, Science Direct, Ovid, ProQuest, Wiley, and Google Scholar from January 1, 2009, to January 20, 2019, were searched. Strategy for searching and selecting the articles was Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines. The findings showed that the World Health Organization has introduced for main phases for increasing these types of services including: defining and developing a national policy, training and educating healthcare employees and general public, as well as pain relief. In general, two scenarios are described in the development of palliative medicine: bottom-up and top-down approaches. In conclusion, although there seem to be progressing activities regarding the issue of making palliative medicine accessible, there are still many obstacles including lack of adequate knowledge and political support, social and cultural problems, inadequate training and education of physicians and nurses, fixed and biased attitude in medical professions, and low priority of palliative medicine among policymakers. Therefore, it could be said that implementing palliative medicine programs requires an overall change in culture, public and individual education, political support, and appropriate policies.

BACKGROUND: In medical education, the learning–teaching method is an active process in which both students and teachers have to work mutually to enlighten the knowledge. Currently, in India, there is an increase in the enrollment of students in medical fields and thus medical educators face the challenge of teaching larger classes in a short period. Furthermore, it is observed that there is a lack of consensus about the best teaching and learning methods for medical students. This study aims to assess the preference of teaching methods and identify the reason for absenteeism among medical undergraduate students in a tertiary care teaching hospital. MATERIALS AND METHODS: A cross-sectional study was conducted among 246 medical undergraduate students in a tertiary care teaching hospital from August 2019 to October 2019. A pretested, validated self-administered questionnaire was used to assess the preference of teaching methods. The data were analyzed using SPSS-IBM software 23. RESULTS: The majority of the students belonged to 20–21 years of age group. Most of the students preferred practical demonstration (81.3%) as the preferred method of teaching and computer with a liquid crystal display projector as ideal media for teaching (63.8%). Boring/monotonous teaching class was found (73.5%) to be an important cause for absenteeism among medical undergraduate students. CONCLUSION: The results indicate that the medical student's preference is changing from passive learning to active learning. We conclude by linking these emerging perceptions with suggestions to help drive excellence in medical education.

BACKGROUND: In Iran, community health workers (CHWs) are native and are only employed in the health-care system. Therefore, the training and empowerment of these staff are essential. The present study was aimed to develop cooperative learning techniques in CHWs to improve both cognitive and noncognitive aspects such as accountability and other social skills in learners. METHODOLOGY: This study employed a quasi-experimental pre- and post-test design with a control group that was conducted in Kangavar City, Iran, in 2019. Forty-four CHWs were selected using a two-stage cluster sampling, of whom 22 were randomly assigned to the experimental group where the jigsaw technique was applied and the rest to the control group where the lecture method was applied. The aim was to identify job performance and motivation among the CHWs after instruction and compare the two groups. Pre- and posttests were applied to the groups before and after an in-service training course using valid questionnaires. Data analysis was performed on both descriptive and inferential statistics such as mean and standard deviation, paired t-test, and covariance analysis with the confidence level of 95%. RESULTS: The findings showed that the intervention significantly increased the mean score of motivation and performance in the experimental group. Covariance analysis with the removal of the pretest effect was also statistically significant (P = 0.01). Moreover, the MANCOVA test showed the jigsaw technique effect considering motivation and performance with a confidence level of 95%. CONCLUSION: Given the well-known effect of cooperative learning techniques and since CHWs have multi roles and tasks, it is necessary to use such techniques so that they can be accountable for developing health indicators in local areas.

INTRODUCTION: The state of health-care disaster preparedness in Iran prior to the possible earthquakes is not well documented. This study identified the challenges of the Iranian health system before possible earthquakes in Tehran based on the World Health Organization (WHO) framework. MATERIALS AND METHODS: In this qualitative study, in-depth and semi-structured interviews were conducted for 17 health experts and authorities, who were selected based on purposive sampling method. The questions were designed based on the proposed framework of the WHO in six areas including policies and planning, communication, collaboration and coordination, training, volunteers and the public, and surge capability. The data were analyzed by using framework analysis. RESULTS: The main themes included weak communication infrastructures, inappropriate assessment of specialized training courses and lack of a clear scenario, integrated urban commanding, extra-sectorial coordination, and data banks for public volunteers. CONCLUSION: Iran health-care disaster preparedness was tested by many earthquakes. This research showed that disaster preparedness in Iran faces several challenges.

INTRODUCTION: Reporting medical errors is a major challenge in patient safety and improving service quality. The purpose of the present study is to investigate the status of error reporting and the challenges of developing an error-reporting system in Iran. METHODS: This study was designed with qualitative approach and grounded theory method in teaching hospitals affiliated to Iran University of Medical Sciences. The views of safety authorities at various levels of management, including those responsible for safety at the Ministry of Health, Vice Chancellor and Hospitals affiliated to Iran University of Medical Sciences, were investigated in 2019 regarding adverse events. RESULTS: Four major themes were identified included iceberg reporting and disclosure, weak reporting, underreporting, and non-error disclosure. The most common problems in reporting medical error were non-involvement of physicians in the error-reporting process, structural (human and information) bugs in root cause analysis sessions, and defective error prevention approaches designed based on the failure mode and effects analysis. DISCUSSION: Despite a large number of medical errors occurred in health-care settings, error reporting is still very low, with only a limited number of errors being reported routinely in hospitals and the rest are minor and occasional reports. CONCLUSION: Creating a mandatory error-reporting system and requiring physicians to report and participate in error analysis sessions can create a safety culture and increase the error-reporting rate.

CONTEXT: Well-being in schools is often considered in relation to the educational and academic success of students. However, it is difficult, at present, not to consider the well-being of a student without an ecological and holistic perspective, in view of the interaction principles implemented in schools. This research aimed to identify the representations hold by Moroccan teenagers about well-being. It aimed, also, to do a comparison between two groups of teenagers: one belonging to urban and the other to rural areas. METHODS: This quantitative study concerns a sample of 1444 pupils (755 girls and 689 boys) enrolled in middle school. Research instrument for this study was questionnaire that includes 15 questions relating to well-being at school, relationships with the teacher, relationships between students, violence experienced, and coeducation. RESULTS: From the analysis of data, pupils in the rural areas seem to be most sensitive to the “emotional” aspects of the teacher–pupil relationship. The girls are more satisfied in middle school than boys. This fact seems to be a very important factor in their retention and in reducing their dropout rate. As expected, academic success is highlighted in the two groups of students as an indicator of well-being. However, the fact of not knowing which orientation to choose constitutes a factor of ill-being for pupils, especially for girls. The results show also that well-being is not taken care of in the two environments (urban and rural). This will explain the results of Moroccan students assessed by the Program for the Monitoring of Student Achievement. CONCLUSIONS: Training programs should focus on the development of teachers communication skills, ability to manage behavioral problems of their students and use teaching approaches to develop positive relationships between students.

CONTEXT: Along with the evolutions of medical sciences education, the importance of medical education discipline has gained more attention for keeping up with these evolutions. Therefore, paying attention to policymaking regarding the development of this discipline and its position in universities is very necessary. AIMS: This study has been done with the aim of investigating key educational and research factors affecting the future of medical education discipline in Iran. SETTINGS AND DESIGN: This is a qualitative study with directed content analysis approach, which has been conducted in eight medical sciences universities having medical education department (Tehran, Iran, Shahid Beheshti, Isfahan, Mashhad, Shiraz, Tabriz, and Kerman) in 2018–2019. SUBJECTS AND METHODS: A total of 25 participants (professors, students, and graduates) of medical education discipline were selected by purposeful sampling and with maximum diversity. Data were collected through semi-structured interviews. Interviews were analyzed using MAXQDA software. RESULTS: After analyzing the data, a number of 1561 initial codes were obtained, of which 914 codes were extracted after removing repetitious codes and merging similar codes. Finally, the obtained results from content analysis were classified into two main categories including key educational and research factors and ten subcategories. CONCLUSIONS: Among the most important key educational and research factors affecting the future of medical education discipline, it can be mention to the role of the discipline curriculum and need to revise it, the need to monitor the graduates and their status , globalization, the role of medical education centers and departments, and the role of theses. It is recommended that future studies investigate other key factors affecting the future of the discipline.

Globalization has been attracted by great literature and papers of many disciplines in recent years. Although globalization has considerable social, political, and economic effects, it has turned to an important challenge in health-care systems. Nursing, as the largest part of the health system in the world, has also been affected by globalization. The purpose of the present paper is to critique globalization and its impacts on the nursing profession. This review article was conducted by searching for reliable internet resources in the English language on the impact of globalization on nursing. Published articles were searched until 2018, and related articles were extracted in three stages: 1-selection of articles by reading abstract, 2-selection with an overview of the text, and 3-selection with a full review of the article's text. According to the literature of globalization, we categorize and discuss the nursing areas that are affected by globalization in nine areas: global nursing development, nurses emigration,information interchange and interactions in nursing, higher education in nursing, professional territory, nursing specialization, professional ethics, management and supervision, and professional independence. The intensity of globalization effects on the nursing profession has not been the same in all societies, and factors such as compliance of society, culture, and technology are among the most important factors that affect it. Globalization is an inevitable process and brings with itself many prominent promotions such as global nursing development and important challenges such as nursing emigration and ethical issues.

BACKGROUND: Nurses in their workplace, for a variety of reasons, always face moral distress that is an underlying issue in the nursing profession, which can lead to problems such as reduced quality and quantity of care and sleep disorder. Besides, given the increased privatization of hospitals, this study aimed to explore the association between nurses' moral distress and sleep quality and its comparison among nurses in private and public hospitals. MATERIALS AND METHODS: This was a descriptive-analytical study involving 150 nurses working in Ilam Province hospitals. Sampling conducted using a multistage random sampling method. Data were collected through the questionnaire of sociodemographic characteristics, the Corley's Moral Distress Scale, and the Pittsburgh Sleep Quality Index. Data were analyzed using SPSS software version 22. Descriptive statistics such as frequency, mean, ANOVA, independent t-test, multiple linear regression, and Pearson correlation coefficient at the significant level of P < 0.05 were calculated. RESULTS: The analysis revealed that moral distress was positively associated with sleep quality. Furthermore, the scores of nurses' moral distress and sleep quality were different in private and public hospitals, so that the level of moral distress in the public hospital and sleep quality in the private hospital was higher and lower, respectively, but the difference was not statistically significant. Moreover, sleep quality, and the type of employment was the most important predicting variables of moral stress (B = 1.86) and sleep quality (B = 2.39), respectively. CONCLUSION: According to the study results, a positive and significant association was found between moral distress and nurses' sleep quality. It is recommended that appropriate strategies and training program be formulated by the health-care system to increase nurses' ability to combat moral distress adverse effects.

BACKGROUND: International research collaboration (IRC) is known as one of the important indicators of productivity, efficiency, and validity of universities in the world. In other words, IRC is necessary for the scientific trade-off between researchers in international scientific societies. The study aimed to address the experiences of an academic researcher about factors related to IRC. MATERIALS AND METHODS: The present study was conducted using a qualitative approach and conventional content analysis method. The participants consisted of 19 experienced faculty members and researchers from Isfahan University of Medical Sciences, who were selected based on the purposive and snowball sampling techniques. Data were collected through semi-structured interviews and were analyzed using the content analysis technique. Guba and Lincoln's evaluative criteria, including credibility, confirmability, dependability, and transferability, were applied to evaluate the trustworthiness of the study. RESULTS: According to the research findings, factors of “personal skills,” “personality,” “professional position,” and “scientific activities” under the category of personal factors; “rules and regulations” and “equipment and facilities” under the organizational factors; and “domestic policies” and “foreign policies” were identified under the government factors category. CONCLUSION: Research collaborations are influenced by individual, intra-academic, and extra-academic factors; thus, research policymakers can help further to enhance the quantity and quality of scientific output and promote the university's placing in international rankings through providing conditions that enable international interactions.

BACKGROUND AND OBJECTIVE: Dental students and practitioners are frequently prone to work-related musculoskeletal disorders (WMSDs) due to the unawareness of ergonomic principles when practicing dentistry. The aim of this study was to assess the dental student knowledge, attitude, and practice toward ergonomics in three different dental schools. METHODOLOGY: A cross-sectional study was conducted among 1166 dental students from three different dental schools of Andhra Pradesh, India, to assess knowledge, attitude, and practice regarding ergonomics. All the participants were provided with prestructured questionnaire form comprising 13 questions to know their knowledge, attitude, and practice related to ergonomics before and after providing guidelines on ergonomic principles. RESULTS: The majority of the dental students appreciate that the most affected regions due to work-related disorders were back (475 before and 559 after instructions), neck (354 and 420), hand and wrist (205 and 117), and shoulder and elbow (132 and 70), respectively. Knowledge and practice scores of dental students (mean and standard deviation) regarding WMSDs before and after applying ergonomic principles were 3.92 ± 2.44, 1.29 ± 1.67 and 5.81 ± 0.87, 3.03 ± 0.60, respectively. CONCLUSION: The present study provides an insight into ergonomics for dental students during routine dental procedures. The knowledge, attitude, and practice related to ergonomics were satisfactorily increased among the participants. Thus, ergonomic education of the dental health-care personnel must be focused in all the educational institutions and at continuing dental health programs by delivering ergonomic principles both theoretically and practically and should be a part of the curriculum.

BACKGROUND: Breast cancer is the most common cancer in Iranian women. The number of people with this disease is increasing across the world. Positive family history is one of the risk factors for developing breast cancer. However, early detection is the main method to fight this disease. This study was conducted to examine the effect of education based on the health belief model (HBM) on self-care behaviors among first-degree relatives of patients with breast cancer. METHODS: This clinical trial was conducted in 2016 on 80 women in Tehran city, Iran. Data were collected using a three-part questionnaire regarding demographic data, the HBM, and self-care behaviors. The educational program based on the HBM was held in 4 ninety-minute training sessions through lectures, group discussions, question and answer, image presentations, and PowerPoint presentations. The questionnaires were completed before and 2 months following the intervention by intervention and control groups. Data were analyzed using descriptive and inferential statistics through the SPSS16 software. RESULTS: The mean score of the HBM constructs before the intervention in the groups had no statistically significant differences (P > 0.05). Eight weeks after the intervention, the mean score of the constructs of the HBM in the intervention group significantly increased and a statistically significant increase in the mean score of self-care in the intervention group compared to the preintervention was found, so that the self-care behavior score in the intervention group was 0.69 ± 0.09 before the intervention and was changed to 0.74 ± 0.09 after the intervention (P < 0.0001). CONCLUSION: Our results suggest that education based on the HBM was effective in promoting self-care behaviors among first-degree relatives of breast cancer patients. Therefore, education based on HBM may have an important implication for breast cancer prevention in Iran.

INTRODUCTION: Given the close relationship between life style and mental health and the importance of students as valuable human resources, the present study aimed at determining the relationship between life style and mental health among medical students in Kermanshah. METHODS: This is a descriptive-correlational study that was conducted in 2018. The study involved 200 medical students. The sampling method was convenience sampling. Demographic questionnaire, general health questionnaire, and life style questionnaire were used for data collection. The data were analyzed Pearson's correlation test and regression analysis. The significance level was considered 0.05. RESULTS: The mean mental health score of the students was 25.43 ± 13.02 (2 points higher than the cutoff point of this test). The life style of 59.5 students was moderate. The results showed that all life style subscales had a negative significant relationship with the total mental health score and all its subscales (P < 0.05). Among the life style subscales, the highest relationship and predictive power to mental health were obtained for psychological health, social health, sport and fitness, and environmental health (R² = 0.48, P < 0.001). CONCLUSION: According to the results, the life style of most medical students in the final year of Kermanshah University of Medical Sciences was moderate. Further, the students had a better life style, and they had higher mental health. Therefore, considering the vital role of medical students in providing and promoting community health, the need for more detailed planning and interventions to improve their life style and mental health is essential.

BACKGROUND: Death anxiety is one of the most common problems among women with cancer, which can affect the useful treatment process. With regard to the superior role of spiritual well-being over other aspects of health, the present study is aimed to compare the relationship between spiritual well-being and death anxiety among women with breast and cervical cancers and women with gastric and colorectal cancers. METHODOLOGY: This was a descriptive–correlational study. Research statistical population included Iranian women with cancer at major hospitals in Isfahan, Iran. 160 research samples were selected through convenience sampling method based on inclusion criteria using a demographic questionnaire, spiritual well-being scale (Paloutzian et al.) and death anxiety scale (Templer). Research data were analyzed through SPSS 22 using independent t-test, Pearson's correlation, and analysis of variance at significance level 0.05. RESULTS: The study findings indicated a significant inverse relationship between death anxiety and spiritual well-being (at 0.05) in both groups. As a result, people with higher spiritual well-being would experience less anxiety about death. In addition, the relationship between death anxiety and spiritual well-being in women with gastric and colorectal cancers was stronger than those with breast and cervical cancers. CONCLUSION: Spiritual well-being is of effective factors of death anxiety among women suffering from cancer. Spirituality and meeting spiritual needs are considered as nursing care priorities for these women. Furthermore, paying attention to the spirituality by nurses may shield against individual difficulties.

INTRODUCTION: Providing information exchange and collaboration between isolated information systems (ISs) is essential in the health-care environments. In this context, we aimed to develop a communication protocol to facilitate better interoperability among electrophysiology study (EPS)-related ISs in order to allow exchange unified reporting in EPS ablation. MATERIALS AND METHODS: This study was an applied-descriptive research that was conducted in 2019. To determine the information content of agreed cardiac EPS Minimum Data Set (MDS) in Iran, the medical record of patients undergoing EPS ablation procedure in the Tehran Heart Center (THC) hospital was reviewed by a checklist. Then, an information model based on Health Level Seven, Clinical Document Architecture (HL7 CDA) standard framework for structural interoperability has been developed. In this framework, using NPEX online browser and MindMaple software, a set of terminology mapping rules was used for consistent transfer of data between various ISs. RESULTS: The information content of each data field was introduced into the heading and body sections of HL7 CDA document using Systematized Nomenclature of Medicine – Clinical Terminology names and codes. Then, the ontology alignment was designed in the form of thesaurus mapping routes. CONCLUSION: The sensitive, complex, and multidimensional nature of cardiovascular conditions requires special attention to the interoperability of ISs. Designing customized communication protocols plays an important role in improving the interoperability, and they are compatible with the needs of future Iranian health information exchange.

INTRODUCTION: Maternal–fetal attachment is a term used to describe the emotional relationship that a pregnant woman has with her developing fetus. Mental care for pregnant women (fear of childbirth and a sense of cohesion of pregnant women) is one of the most important aspects of prenatal care that affects the mother's attachment to the fetus. If fear and anxiety are relieved, psychological and physical relaxation will be replaced. Therefore, the present study was conducted with the aim of determining the relationship between fear of childbirth and the sense of cohesion with the attachment of pregnant mothers to the fetus. METHODS: The present study is a descriptive study that was performed by multi-stage sampling method on 500 pregnant mothers who referred to health centers in Isfahan in 2017. The study participants completed the following questionnaires: fear of childbirth, sense of cohesion, and mother's attachment to the fetus. The data were analyzed by descriptive and analytical statistical methods (Pearson correlation) using SPSS software version 22. RESULTS: The results showed that there was a significant negative relationship between the overall score of maternal attachment to the fetus and fear of childbirth (r = −0.153, P = 0.001). However, there is a significant positive relationship between the overall score of maternal attachment to the fetus and the sense of cohesion (r = 0.112, P = 0.01). The results also showed a significant negative relationship between the fear of childbirth and the dimensions of maternal attachment to the fetus, including interaction with the fetus (P = 0.04), self-sacrifice (P = 0.04), and attributing characteristics to the fetus (P = 0.05). There was a positive and significant relationship between the sense of coherence and the subsequent acceptance of the maternal role of maternal attachment to the fetus (P = 0.004). CONCLUSION: More attention of prenatal care provider to the psychological issues of the pregnant mother and their fears and worries can lead to appropriate interventions in this field, and as a result, mothers' attachment to their fetus has increased so that they can take proper care during and after pregnancy.

INTRODUCTION: Menstruation is a natural phenomenon among women who experience shedding of blood for 1–7 days every month which usually starts between age 11 and 14 years and continues until menopause at about 51 years of age. It is important to maintain menstrual hygiene, as poor practices increase vulnerability to reproductive and urinary tract infections. The present study was conducted with an aim to investigate the impact of focused group discussion (FGD) compared to didactic lectures (DLs) on the menstrual hygiene knowledge and practices. METHODS: The present cross-sectional study was conducted among 649 school girls during January to August 2019 using a convenience sampling technique. After collecting baseline information using a pretested, predesigned, standardized questionnaire, the participants in the control and intervention groups were exposed for the DLs and FGD, respectively, and 1 month after such intervention, the same questionnaire was again self-administered by participants. All tests were performed at a 5% level of significance using SPSS (version 22.0). RESULTS: The baseline characteristics of both the groups such as participants' mean age, mean age of menarche, mother's literacy status, religion, type of family, and socioeconomic status were comparable. There was a difference in the knowledge and practice mean score of participants in the control group for pre- and postintervention, which was highly statistically significant (P < 0.001). CONCLUSIONS: This study reveals that menstrual hygiene is far from satisfactory among most of the school girls. The DLs and FGD have improved the menstrual hygiene knowledge and practices among school girls.

INTRODUCTION: In order to improve outpatient education, it is necessary to carry out formative standard evaluation to reveal the strengths and weaknesses to improve planning the quality of clinical education. Due to numerous challenges in clinical education, the present study was conducted to determine the extent to which outpatient education standards were achieved in the major departments of Shiraz Medical School. METHODS: In this quantitative combined, cross-sectional and practical investigation in the academic year 2018–2019, 178 interns who had passed the outpatient education in the four major wards (internal medicine, pediatrics, gynecology, and surgery) in Shiraz Medical School were randomly selected. A 26-item researcher-made questionnaire, based on the Handbook of the Ministry of Clinical Education (Outpatient Education) for Health and Medical Education's Criteria and indicators, was used in three areas of preparation, timing and implementation; and the psychometric properties of the questionnaire were determined. For quantitative data analysis, SPSS version 22 was used. Furthermore, we performed a qualitative study through semi-structured interviews with 16 interns and analyzed the data using MAXQDA 10 software. RESULTS: The results of the quantitative study showed that 8.4% of interns evaluated the program as poor, 66.3% moderate, and 25.3% good. The qualitative study showed that number and diversity of patients, instructor's educational model, and number of interns had a significant role. CONCLUSION: Although the outpatient teaching in the four major departments of Shiraz Medical School was evaluated relatively acceptable, it is far from the ideal point and need to be improved.

BACKGROUND: Assessing how programs are implemented from the perspective of the learners themselves is one of the most effective ways to improve the quality of continuing education. The aim was to evaluate the implementation of in-person continuing education programs from the perspective of nurses. METHODOLOGY: Setting of the study was the selected hospital of Isfahan University of Medical Sciences (Al-zahra hospital). This study is a descriptive cross-sectional one. Using a researcher-made questionnaire, the implementation of continuing education programs in four areas of the aim, educational techniques, educational content, and educational field was evaluated. The sample consisted of 236 nurses working in these hospitals who participated in the study through convenience sampling. Data were analyzed by SPSS software version 19 using descriptive statistics. RESULTS: Based on the results, “the need for new content learning” was mentioned as the first priority in continuing education programs. The majority of participants scored each of the following domains (aim, educational techniques, educational content, and education field) as well as all items related to the continuing education program evaluation as “moderate.” CONCLUSION: Most nurses assessed the implementation of in-person continuing education programs implemented in Isfahan University of Medical Sciences in general and in each of the domains as “moderate.” Therefore, in order to improve the quality of programs, it is necessary to take steps to match the goals with the needs of learners, improve teaching techniques, improve the quality of program contents, and optimize the scope of the programs.

BACKGROUND: Medical students should have adequate knowledge on tuberculosis (TB) and national guidelines pertaining to its control, which is a major public health problem in developing countries. The present study aims to evaluate the knowledge on TB and Revised National TB Control Programme (RNTCP) among medical interns and the change in the level of knowledge following the dissemination of self-directed learning (SDL) modules using an e-learning tool (WhatsApp). MATERIALS AND METHODS: A prospective, nonrandomized, pre- and posttest study was done among 124 medical interns in a private medical college during July–August 2019. A semi-structured, self-administered questionnaire was prepared and filled by the interns in the pretest. Following the educational intervention, the same questionnaire was administered and posttest data were collected. The pre- and posttest results were expressed in frequency and percentage. Wilcoxon signed rank test was used to compare the change in the total mean score of knowledge using the e-learning tool following the dissemination of SDL modules. RESULTS: The mean age of the interns was 22.82 ± 0.82 years. Of the total 124 interns, 60 (48.3%) had heard about the recent changes in RNTCP. The Internet (25.8%) and textbooks (23.4%) were the most common source of recent information regarding TB and RNTCP. The mean pretest score was 12.9 ± 3.08, which increased to 15.3 ± 2.62 during the posttest (z = −9.75, P< 0.05) following the intervention. CONCLUSIONS: The knowledge regarding TB and RNTCP among the interns was inadequate. The usage of an e-learning tool “WhatsApp” was found to be effective in improving the knowledge in posttest as compared to pretest.

INTRODUCTION: Teaching is one of the most important needs of human societies, and selecting the best method of teaching is so important to improve the teaching as well as learning of students. The purpose of this study was to determine the effect of case-based teaching (CBT) and flipped classroom methods in comparison with lecture method on students' learning and satisfaction at internship of Department of General Surgery, Isfahan University of Medical Sciences. MATERIALS AND METHODS: This experimental study was performed on fifty medical surgery internship students in Isfahan University of Medical Sciences in 2017. Students were randomly divided into two groups of control group and intervention group. The data were collected by a posttest after holding every class and a researcher-made form for evaluating students' satisfaction after the end of the project. The results of this study were analyzed by SPSS 21 software using descriptive statistical methods (mean and standard deviation) and paired t-test. RESULTS: The comparison of the mean posttest scores in the three classes showed that the mean scores of the students in the intervention group in the first and second sessions unlike the third session were higher than that in the control group; this difference was statistically significant in the first session (P = 005) and the third session (P = 0.002). Students' satisfaction with case-based learning method (4.03 ± 0.87) was higher than that of lecture method (2.88 ± 0.78). CONCLUSION: In CBT and flipped classroom, students' learning and the quality of teaching were improved. In addition, students were more satisfied with this method in comparison with the lecture method. However, it should be noted that the success of using this teaching method depends on choosing the appropriate subject.

BACKGROUND: Oral soft tissue diseases include a broad spectrum, and the wide array of patient data elements need to be processed in their diagnosis. One of the biggest and most basic challenges is the analysis of this huge amount of complex patient data in an increasing number of complicated clinical decisions. This study seeks to identify the necessary steps for collecting and management of these data elements through establishing a consensus-based framework. METHODS: This research was conducted as a descriptive, cross-sectional study from April 2016 to January 2017, which has been performed in several steps: literature review, developing the initial draft (v. 0), submitting the draft to experts, validating by an expert panel, applying expert opinions and creating version v.i, performing Delphi rounds, and creating the final framework. RESULTS: The administrative data category with 17 and the historical data category with 23 data elements were utilized in recording data elements in the diagnosis of all of the different oral diseases. In the paraclinical indicator and clinical indicator categories, the necessary data elements were considered with respect to the 6 main axes of oral soft tissue diseases, according to Burket's Oral Medicine: ulcerative, vesicular, and bullous lesions; red and white lesions of the oral mucosa; pigmented lesions of the oral mucosa; benign lesions of the oral cavity and the jaws; oral and oropharyngeal cancer; and salivary gland diseases. CONCLUSIONS: The study achieved a consensus-based framework for the essential data element in the differential diagnosis of oral medicine using a comprehensive search with rich keywords in databases and reference texts, providing an environment for discussion and exchange of ideas among experts and the careful use of the Delphi decision technique.

INTRODUCTION: Oral health is a very important issue for different groups, especially adolescents. Social cognitive theory seeks to describe and promote people's health behaviors in a variety of ways. The aim of this study was to determine the role of self-efficacy, outcome expectation, and outcome expectancy in promoting oral health behaviors in adolescent girls in Shahrekord. METHODS: The present study was performed as an intervention in junior high schools in Shahrekord (school year: 2018–2019). Using cluster sampling method, a total of eighty adolescent girls studying in Shahrekord public schools were selected and randomly divided into two groups of intervention and control. A researcher-made questionnaire was used to collect data on demographic variables, outcome expectation, and outcome expectancy constructs. In addition, a checklist was used to assess the status of oral health among the participants. Education for the experimental group was held in four sessions, each lasting 50–60 min. The data required for the study were collected in three stages: before the intervention, immediately after, and 2 months after the intervention. Using SPSS statistical software version 18, the collected data were analyzed through paired t-test and analysis of variance via repeating the observations. RESULTS: There was no significant difference between the two groups in terms of demographic variables. Before the intervention, there was no significant difference between the two groups in terms of the mean scores of outcome expectation, outcome expectancy, and self-efficacy; however, after the intervention, there was an increase in the scores of the experimental group (P < 0.001). Two months after training, there was also a significant increase in the mean score of oral health behavior in the experimental group (P < 0.001). CONCLUSION: Training based on perceived self-efficacy, outcome expectation, and outcome expectancy played an important role in creating the desired attitude toward oral health-promoting behavior among students.

BACKGROUND: In the postpartum period, changes in sexual desire and marital satisfaction can be seen. Learning and giving enough information on changes in pregnancy and postpartum can help to increase marital satisfaction. The purpose of this study was to determine the effect of prenatal training on the level of postpartum marital satisfaction in nulliparous women. METHODS: This study is a semi-experimental two-group study in which 150 nulliparous women were divided into two groups: control and intervention groups. The samples into intervention group received routine prenatal care and eight sessions of prenatal education with a training package (educational pamphlet on sexual health and sexual issues and an educational CD on pregnancy and pelvic exercises), and the control group received only routine prenatal care along with a pregnancy education pamphlet. Marital satisfaction was measured before intervention during pregnancy and 3 months after delivery (after intervention) using the ENRICH Marital Satisfaction Scale. Data were analyzed using t-test, paired t-test, Mann–Whitney, and Chi-square test. RESULTS: There was no significant difference in demographic and obstetric variables and pregnancy status between the two intervention and control groups (P > 0.05). There was no significant difference in marital satisfaction during pregnancy between the two groups (before intervention) (P > 0.05). However, there was a significant difference in the level of postpartum marital satisfaction in the intervention group (P < 0/05). So that, the average marital satisfaction is increased from 52.2 to 64.6. CONCLUSION: The results of this study show that eight sessions of prenatal education class with a training package (educational pamphlet on sexual health and sexuality and training CD of prenatal and pelvic floor exercise) can improve postpartum marital satisfaction in women.

CONTEXT: Harmful use of alcohol has led to 1.7 million deaths from noncommunicable diseases and 1 million injury deaths including road traffic accidents, self-harm, and interpersonal violence. The opportunistic screening can be used to screen for substance abuse in outpatient department (OPD) attendees of primary health-care (PHC) settings in India. AIMS: This study was conducted to determine the prevalence of willingness to quit alcohol use among alcohol users and factors associated with it. SUBJECTS AND METHODS: A facility-based cross-sectional study was conducted in urban PHCs and willingness to quit alcohol was assessed among the alcohol users. Alcohol Use Disorder Identification Test (AUDIT) scale was used to assess the alcohol use disorder score. Data were entered using Epidata version 3.1 and analyzed using STATA version 14. RESULTS: It is found that two-third of the male OPD patients are using alcohol and 59% of the alcohol users were willing to quit alcohol. Education (adjusted prevalence rate ratio [aPR] = 1.9; 95% confidence interval [CI]: 1.2–2.9), occupation (aPR = 1.4; 95% CI: 1.1–1.8), higher AUDIT scores (aPR = 2.7; 95% CI: 2.2–3.5), frequency of alcohol use (aPR = 1.6; 95% CI: 1.2–2.0), and positive family history of alcohol-related illness times (aPR = 1.6; 95% CI: 1.3–2.0) were significantly associated with willingness to quit alcohol. CONCLUSION: Two-third of the male OPD patients are using alcohol and 59% of the alcohol users were willing to quit alcohol. Education, occupation, higher AUDIT scores, frequency of alcohol use, and positive family history of alcohol-related illness were significantly associated with willingness to quit alcohol.

INTRODUCTION: Infertility by creating a disturbing and debilitating condition is considered as an important individual, public, and social health problem. The purpose of this study was to determine the effect of counseling based on acceptance and commitment therapy (ACT) on mental health and quality of life in infertile couples. METHODS: In this randomized controlled trial, 54 infertile couples referring to the Sanandaj-Iran Infertility Clinic were assigned into two groups of counseling and control by random blocking with a 1:1 ratio. The consulting group received 8 weekly 90-min sessions of group counseling based on ACT. The General Health Questionnaire-28 (GHQ-28) and Fertility Quality of Life were completed before and 1 month after the completion of the intervention. Primary outcome measures were mean score of mental health and quality of fertility life. Independent t-test, ANCOVA, and Mann–Whitney U-test were used to analyze data. RESULTS: There was no significant intergroup difference in demographic information (P > 0.05). One month after the end of the intervention, the mean overall mental health score in the couples of the counseling group was significantly less than the control group (adjusted mean difference [aMD]: −8.4; 95% confidence interval [CI]: −10.4–−6.4; P< 0.001). Furthermore, the mean overall score of quality of life in the counseling group couples was significantly more than the control group (aMD: 14.8; 95% CI: 11.8–17.9; P< 0.001). CONCLUSION: Based on the effectiveness of counseling based on ACT on mental health and quality of life in infertile couples, it can be used in the infertility clinics. Health-care providers and counselors should train in the ACT courses to improve the mental health and quality of life of infertile couples.

INTRODUCTION: Spread of novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) has become a global and pandemic crisis. Some measures such as excessive use of disinfectants, increased production of nonbiodegradable waste, and water pollution will be the consequences of fighting against coronavirus disease 2019 (COVID-19), which harms the environment. Due to the fact that these effects will be identified in the long term, they may be neglected in the current situation. Therefore, the aim of this study was to investigate the environmental challenges caused by the SARS-CoV-2 pandemic crisis. MATERIALS AND METHODS: This was a review study conducted by search in databases, including Scopus, PubMed, and science direct until early May 2020. Keywords included “SARS-CoV-2,” “COVID-19,” and “Environment.” Studies published in English and conducted in different countries were also selected for the analysis. The guidelines published by reputable organizations such as the World Health Organization, the Centers for Disease Control prevention (CDC), and the Ministry of Health have also been used in this study. CONCLUSION: The results of this study have shown that the COVID-19 virus, in addition to human damage and mortality, also affects the environment, and the damages and losses resulting from this pandemic may be identified later. Water pollution, increasing chemical pollution in the air, and increasing the production of nonbiodegradable waste are of these issues. For this purpose, it is recommended that, in addition to trying to improve the control of this pandemic, other environmental aspects in disinfection methods and disposal of dry and wet contaminated waste should be done more accurately and based on standard protocols. Infectious waste, in addition to the problem of standard sanitation, will become a major challenge that pollutes the environment. Based on this, it can be said that if home quarantine is observed voluntarily, in addition to reducing the risk of the SARS-CoV-2 and reducing the volume of visits to medical centers, it can be associated with another positive achievement, which is the reduction in waste production and protection of the environment.

CONTEXT: Empathy is considered to be backbone of the patient–physician relationship. The consultation and relational empathy (CARE) measure is widely used internationally to measure empathy. However, no validated tool is available to gather patient feedback on dentists' empathy in India. OBJECTIVE: The objective of this study was to explore the reliability and validity of a CARE measure and to assess the factors influencing CARE score and to determine if there was an association between their CARE score and satisfaction of the patient. SETTING AND DESIGN: A cross-sectional study was done in dental colleges. SUBJECTS AND METHODS: A questionnaire study was carried out among 100 patients from 6 dental colleges in Bangalore using validated CARE measure. STATISTICAL ANALYSIS: Internal consistency of items was evaluated by the Cronbach's alpha, and construct validity was assessed by confirmatory factor analysis. Satisfaction was assessed by a question response on 5-point Likert scale. Descriptive and inferential statistics were performed with significance set at 5%. RESULTS: The mean CARE score was 43.80 ± 5.36. Internal reliability was high (Cronbach's alpha: 0.859) and was reduced by the removal of any of 10 items. High corrected item-total correlations ranged from 0.752 to 0.847. Factor analysis showed a single solution with high item loadings (>0.80). Self-perception of overall health (odds ratio [OR] = 3.78), relationship with family (OR = 4.61) and friends (OR = 3.78), and previous dental experience (OR = 16.00) were more likely, whereas dentist-provided treatment (OR = 0.20), number (OR = 0.07) and dental treatment taken (OR = 0.13), presence of anxiety (OR = 0.03), and fear (OR = 0.05) were less likely to have CARE score. The satisfaction of the patient regressed significantly with the relationship with family members (ß = 0.77) and CARE score (ß = 0.21). CONCLUSION: This study confirms the educational opportunity and implementation of CARE in dental students. CARE scores among patients varied depending on personal factors and dental treatment-related factors. The satisfaction of the patient was influenced by the relationship with family members and CARE scores.

Due to the short span available for consultation with clinicians, patients try to become well versed with their clinical conditions before the medical consultation. They search Google for their medical information; here comes the problem of authenticity of the sources. It is very difficult to obtain authentic medical information for the patients from the Internet. As a result, sometimes, patients ask questions to the overburdened doctors and irritate them. To solve this problem and wider dissemination of authentic medical knowledge, the existing website of Post Graduate Institute of Medical Education and Research (PGIMER) has been utilized. In PGIMER, Chandigarh, health education materials in text and video formats have been uploaded on the PGIMER website for empowering patients. All these have been successfully tested in the outpatient departments of PGIMER, Chandigarh. To our knowledge, this unique approach is the first of its kind in India. We hope this approach of sharing medical information through the PGIMER website may help patient empowerment to a large extent. Later, this concept can be replicated in all medical colleges in India.

BACKGROUND AND OBJECTIVE: Unless mental health care is provided to suicide attempters after discharge from the emergency department, suicide prevention opportunities may be lost. The purpose of this study was to determine the effect of motivational interviewing (MI)-based training on using mental health services and reducing the severity of suicidal thoughts. METHODS: This quasi-experimental study was performed on seventy suicide attempters who had been admitted to the emergency department of three university hospitals in Southeast Iran in 2019. Eligible patients were chosen through convenience sampling, and they were randomly divided into the experimental (n = 35) and control (n = 35) groups. The intervention group received three MI sessions on the day of discharge and the 1^st week after discharge. Twelve weeks after the intervention, the Beck Scale for Suicidal Ideation and the using mental health services were completed in both the groups. Data were analyzed using Chi-squared test, independent t-test, and paired t-test. RESULTS: While there was no significant difference between the two groups in terms of the mean score of suicidal ideation on the pretest, the experimental group experienced a significant decrease in this respect at the end of the study; thus, this group scored 8.86 ± 5.30, which is considerably lower than that obtained in the control group (15.85 ± 6.65) (P = 0.0001). Furthermore, at the end of the study, the rate of using mental health services increased much more in the experimental group than in the control group (P = 0.01). CONCLUSION: MI training had a significant positive impact on mitigating suicidal ideation and promoting mental health services use. To improve mental health and to better serve suicidal individuals, it is recommended that short-term interventions be developed in the form of post-discharge education for suicidal patients admitted to the emergency department.

BACKGROUND: The current nursing shortage is complicated because of turnover intention among nurses. Most of the inactive nurses returned to professional nursing practice. Returned to professional nursing practice program was low attrition rates and a more cost-effective strategy that prepared inactive nurses returning to practice. This study aimed to explain the process of returned to professional nursing practice. MATERIALS AND METHODS: This study was a grounded theory study, which lasted from about 2018 to 2020. Data were collected through semi-structured interviews and observations with participants after signing an informed consent form. The average interview duration was 45 min. The study participants were selected through purposeful sampling from both public and private hospitals affiliated to Iran University of Medical Sciences. Interviews were verbatim transcribed and analyzed using a constant comparative analysis method. RESULTS: In this study, 16 participants were selected, including ten nurses, two educational supervisors, two head nurses, and two matrons. The “transformed competence” as the core concept and the four main concepts of “feeling alienated with the new environment,” “getting prepared for restart,” “gradual maturity in clinical practice,” and “components of organizational culture” were extracted from the data analysis process. CONCLUSION: The process of returned to professional nursing practice in the context of the organizational culture of incentive learning leading to a high level of competence, and in the context of the organizational culture of inhibiting learning, is leading to deficiency incompetence.

BACKGROUND: Designing information systems will increase the efficiency and effectiveness of the system according to the information needs of the stakeholders. The present study examined the effective features of designing the information system of medicinal plants from the perspective of its users as a prerequisite for the design of this system. MATERIALS AND METHODS: This applied research was carried out using survey method and a researcher-made questionnaire. The study population consisted of two groups of information users (faculty members, students, and researchers of medicinal plants) and information disseminators (librarians), and 308 individuals were selected by cluster sampling from five universities. Data analysis was performed using descriptive and inferential statistics using SPSS software version 22. RESULTS: The results showed that in view of the two groups of users, there was a significant difference in the search options in the database of medicinal plants and the displaying characteristics of the search results. On an average, the rank of the two groups in these two domains was largely different. In other cases, the users considered shared features for capabilities and facilities in an information system of medicinal plants. CONCLUSION: According to the results, for obtaining the information system of medicinal herbs with better capabilities and facilities, it is essential for designers to pay attention to all elements and objections in the interaction of the human and the system, especially in the field of search.

BACKGROUND: Nurses' knowledge and Experience with Health Literacy can affect the treatment process, improving the quality of health care and effectively communicating with all clients. Evaluation of nurses' knowledge and experience requires a reliable instrument. This study aimed to translate cross-cultural adaptation and testing of Health Literacy Knowledge and Experience Survey (HL-KES). MATERIALS AND METHODS: This cross-sectional methodological study was done during 2018–2019. The study was carried out in two stages: the first phase was designed to obtain a translation and cross-cultural equivalent of the (HL-KES), based on the World Health Organization (2018) and the Sousa and Rojjanasrirat (2011) Guidelines in six steps: preparation, forward translation, reconciliation, back translation, back translation review and pretesting and cognitive debriefing of the translated questionnaires. The second phase was conducted to evaluate the psychometric properties of the questionnaire. RESULTS: The content validity index and content validity ratio values of all items were >0.62 and 0.79, respectively. Based on the Kuder–Richardson formula, the reliability of the knowledge dimension was reported as 0.7. Furthermore, split-half coefficient for inter-rather reliability and test–retest were 0.76 and 0.96, respectively. The reliability of their experiences with the HL-KES was measured using Cronbach's alpha, in which it was 0.82. CONCLUSIONS: The Persian version of the instrument for assessing nurses' knowledge and experience with health literacy had good validity and reliability. It is recommended that it should be used in educational, clinical environments, and also in future research studies.

INTRODUCTION: Educational interventions have been associated with improved performance and significant changes, especially in perinatal outcomes. Teaching is one of the main components in educational planning which is a key factor in conducting educational plans through various teaching strategies such as simulation, demonstration and video teaching. AIM: The study aimed to assess lecture cum demonstration (LCD) versus video-based teaching (VBT) regarding active management of the third stage of labor (AMTSL) in terms of knowledge and skills of General Nursing Midwifery (GNM) students. METHODS: This was a quasi-experimental study conducted on 100 GNM third-year students selected by purposive sampling and randomly assigned to LCD (n = 50) and VBT (n = 50) groups. Sample characteristics performa, Structured Knowledge Questionnaire, and observational checklist were used to collect data from GNM students through self-report and observational technique. RESULTS: The study results showed that the mean posttest knowledge scores of LCD (17.32 ± 2.14) and VBT group (16.90 ± 2.41) were nearly equal and mean rank posttest skills score of LCD group (54.40) was slightly higher than VBT group (49.51), but computed “ t ” value of mean posttest knowledge and computed “ Z ” value of skill score of both LCD and VBT group (0.47, 0.54) were found to be statistically non-significant at 0.05 level of significance. CONCLUSION: It can be concluded that both LCD and VBT were found to be effective in improving knowledge and skills of GNM students regarding AMTSL.

INTRODUCTION: One of the most thought-provoking problems in the world is child marriage that is affected by various factors. Therefore, the purpose of this study is to identify the social determinants of child marriage in Kurdish regions of Iran. MATERIALS AND METHODS: This qualitative study was conducted using conventional content analysis approach. The participants of the study were 30 Iranian-Kurdish women married under the age of 18 who were selected through purposeful and snowballing sampling. Data collection was conducted through semi-structured interviews and face-to-face interviews and continued until the saturation of concepts was achieved. Graneheim and Lundman method was used to analyze the data, and Guba and Lincoln criteria were used to strengthen the research. RESULTS: In general, findings include 5 categories and 17 subcategories: 1 – economic factors (financial problems and economic benefits); 2 – sociocultural factors (social customs, cultural beliefs, community encouragement, social learning, gaining prestige, and social support); 3 – individual factors (physical characteristics, personality traits, lack of awareness of the damaging consequences of early marriage, and fear of the future); 4 – family factors (dysfunctional family, weak awareness of parents, and harm prevention); and 5 – structural factors (high demand, limited access to educational services, and the lack of supportive social and legal structures). CONCLUSION: By raising the level of awareness and attitude of girls and their families about the consequences of early marriage, creating the culture of correcting cultural beliefs and social misconceptions, passing appropriate laws, and the use of local and national media to prevent child marriage, this social harm can be reduced.

BACKGROUND: Health literacy plays an important role in adopting preventive behaviors. Considering the relatively high prevalence of breast cancer in women, this study aimed to assess the association between health literacy and adopting the preventive behavior of breast cancer in Iran . METHODS: This was a descriptive, cross-sectional study, in which 375 female students at Imam Khomeini International University in Qazvin in the academic year of 2018–2019 were selected through a stratified random sampling method. Demographic and background questionnaire, the standard questionnaire of Health Literacy for Iranian Adults in addition to another questionnaire for measuring breast cancer preventive behaviors, were used for collecting data. Data were analyzed using SPSS 22 using descriptive statistics and logistic regression. RESULTS: The mean of the breast cancer preventive behaviors and health literacy were 8.92 ± 1.82 out of 16 and 70.80 ± 12.49 out of 100. Regression results showed that there was a statistically significant association between the adoption of breast cancer preventive behaviors and physical activity (P < 0.001) and health literacy (P < 0.018). Accordingly, the chance for adopting the preventive behaviors in good level among students with rare and without physical activity was 0.105 and 0.100 times, respectively, more than students who had been doing physical activity on a daily basis. Moreover, the same chance among students with adequate and very adequate health literacy was 1.802 and 2.169 times more than students with inadequate health literacy. CONCLUSION: The results indicated that students with lower levels of health literacy and less physical activity had shown less tendency to adopt preventive behaviors of breast cancer. Therefore, special attention should be paid to health literacy (HL), particularly physical activity, application of health information, and assessment in students when designing educational programs to prevent breast cancer.

BACKGROUND: Anxiety before and pain intensity after cesarean section is among the factors that should be taken into consideration among the candidates for cesarean section. The present study aimed to investigate the effect of familiarity with cesarean section and the operating room environment on anxiety and pain intensity among the mothers undergoing cesarean section. METHODS: This clinical trial was conducted on 80 women referred to the hospitals affiliated to Shiraz University of Medical Sciences for cesarean section in 2018. The participants were randomly divided into a control (n = 40) and an intervention group (n = 40). The intervention group took part in four educational sessions, while the control group received the hospital's routine care. The Beck Anxiety Inventory was completed by the two groups before and after the intervention. The McGill Pain Questionnaire was also filled out by the two groups in the ward after the cesarean section. After all, the data were entered into the SPSS software, version 21, and were analyzed using independent t-test and ANCOVA. RESULTS: The results showed no significant difference between the two groups regarding the mean score of anxiety prior to the intervention. After the intervention, the mean score of anxiety was 7.98 ± 3.77 in the intervention group and 19.70 ± 6.45 in the control group, and the difference was statistically significant (P < 0.0001). Indeed, the mean intensity of pain was 43.98 ± 7.63 in the intervention group and 57.75 ± 10.69 in the control group after the intervention, and the difference was statistically significant (P < 0.017). CONCLUSION: The patients' familiarity with cesarean section and the operating room environment caused a decline in the anxiety level prior to cesarean section as well as a decrease in the score of pain after the operation. Hence, midwives and nurses have to play effective roles in decreasing pregnant women's anxiety and pain through identification of strategies for empowering them and managing their worries.

Obesity is a commonly encountered health-care problem that is an independent risk factor for chronic metabolic complications. Primary care physicians are the first point of contact in the management of obesity. Weight management is a step-wise intensification of interventions that initiates with lifestyle modification. Dietary and physical activity advices are integral components of all weight loss consultations and should ideally be imparted by a dietician or a nutritionist. In case of their nonavailability, the onus for lifestyle counseling rests with the physician. The prescription for a low-calorie diet coupled with increased physical activity might seem simple, but the success lies in compliance and sustainability of this advice. Compliance can be enhanced through patient-specific diet and activity plans along with corrections in eating and activity behavior. Barriers in patient's environment must also be addressed to achieve sustainable weight loss. This review covers practical insights in standard lifestyle management techniques, which can help the physicians to set better weight loss goals, adapt to patient specific lifestyle counseling, and apply strategies to enhance compliance for sustained weight loss.

INTRODUCTION: Some working and organizational conditions, such as psychological stress and shift work, are factors that threaten the health of staff working in health centers. These factors can cause fatigue in a long time. Fatigue reduces the ability to process information and decrease to respond to hazardous conditions and will affect the safety of the environment. Therefore, the purpose of this study was to determine the relationship between safety climate and occupational fatigue in nurses working in Zabol city. METHODS: This cross-sectional study was performed on 143 nurses working in educational hospitals of Zabol in 2019. The proportional sampling method was used, and the Swedish Occupational Fatigue Questionnaire and the Nurses Safety Questionnaire were used for data collection. Data were analyzed using independent t-test, analysis of variance, Mann–Whitney, Kruskal–Wallis tests, and SPSS-21 software. RESULTS: In the present study, 57.3% were women and 42.7% were men. The mean score of occupational fatigue was 85.09 ± 41.49, and the mean score of safety climate was 67.15 ± 12.73. There is a significant inverse relationship between occupational fatigue and safety climate. The comparison of safety climate and its subscales between occupational and demographic variables showed that the score of male supervisors' attitude was 01.36 ± 2.41 while the score of female supervisors' attitude was 8.88 ± 2.61, and this difference was significant. Furthermore, cumulative burnout, the attitude of supervisors, and the safety climate were significantly different between different educational levels. CONCLUSION: The results of this study showed that there is a relationship between occupational fatigue and safety climate. Issues related to safety and risk factors in hospitals due to the high risk of disease outbreak and mortality, in addition to being economical, are important in terms of the human aspect as well. In addition, the activity of nursing staff is more important compared to other groups because of providing health care and communicating with patients; thus, more education about the safety climate of the workplace environment in hospitals can reduce nurses' fatigue.

CONTEXT AND AIMS: The country development can be promoted through applying policies of the resistance economy in the health system and universities. Therefore, this paper aimed to provide a scientific analysis of resistance economy policies and providing a roadmap for their implementation in the field of health care of Isfahan University of Medical Sciences. MATERIALS AND METHODS: This is a qualitative study. The basis, general purposes, and strategies of the resistance economy were extracted from the review of the policy of the resistance economy with a political research approach. Then, effective programs and indicators to achieve the goals of the resistance economy were proposed by holding 10 sessions of a centralized group discussion. Finally, the implementation of the resistance economy in the deputies of the University of Medical Sciences was approved by these programs and indicators along with other components and Delphi questionnaire to 30 experts. Framework analysis and descriptive statistics were used to analyze the data from the group discussion and the Delphi stage, respectively. RESULTS: Implementation of general policies of resistance economy in the field of health and treatment of Isfahan University of Medical Sciences with eight thematic bases, 39 goals, 54 strategies, and 98 programs and indicators were approved by experts. The eight areas of people-centered, economic growth, economic justice, support for internal services, economic flexibility, economic stability, economic influence, and economic health were identified as the thematic bases of communicative policies of the resistance economy in the field of health. CONCLUSION: The implementation of resistance economy policies entails planning in the long run, culture-building, appreciating the resistance economy in health issues, cooperation, and synergy among different institutions, restructuring the education system at different levels of the health system, and entrepreneurship training.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is one of the most suitable methods for long-term nutritional support. In this study, the empowerment of intensive care nurses is examined by a simulation technique to control the short-term complications of PEG. METHODS: A two-group clinical trial study will be conducted on eighty intensive care nurses in a teaching hospital in Tehran. The study participants will be randomly assigned to one of the two control and intervention groups based on the inclusion criteria. A pretest will be given to both groups using a researcher-made tool. Then, the empowerment package developed by the researcher will be provided to the intervention group in two stages. Next, a posttest will be administered. After this stage, patients' complications with PEG will be observed using a researcher-made checklist. Nurses' performances in both control and intervention groups will be evaluated in terms of preventing and controlling short-term complications up to 1 week after PEG insertion. All of the data collected in this research will be analyzed with statistic tests such as independent t-test, standard deviation, T pair, ANOVA, and mean based on the SPSS 16 software. RESULTS: At present, the research team is designing an empowerment package for nurses and tools needed to evaluate the nurses' empowerment. CONCLUSION: This study will attempt to design and evaluate the empowerment package of graduate nurses with a cognitive empowerment approach and using a simulation technique to care for patients with PEG and to control their short-term complications.

BACKGROUND: The progress in the usage of technology in hardware, software, and cost-effective Internet connectivity enable the availability of science-related information and its usage in all the developing countries. Hence, in this practical world, there should be a need to implement effective and affordable dental education strategies to attain oral health for all in the coming years. OBJECTIVE: The aim of this study is to reduce the need to teach theory-based, on-site classes, e-learning came into existence. E-learning for dental education may alleviate the burden of severe health worker shortages and deliver affordable access to high-quality dental education. METHODOLOGY: Evaluation and assessment methods were done to know the effectiveness of e-learning in dental education by conducting continuing dental education on newer materials and methods, assignments/formative assessments and by open discussions of case descriptions and their treatment modalities through Edmodo app in our dental institute. Effect on knowledge, skills, attitudes, and satisfaction levels of dental students compared to other traditional methods. RESULTS: Dental e-learning has the capacity to develop into a leading-edge to strengthen clinical training skills among dental students by conducting continuing dental education, assignments, formative assessments, case descriptions, and their treatment modalities through e-learning are the best ways to improve quantity and quality in dental education. CONCLUSION: The probable prospective of e-learning could be innovative or revolutionary because this helps in both theoretical-related and clinical-related advancements, and it is possible only with e-learning in developing countries to meet the quality in education.

INTRODUCTION: The virtual reality-based (VR) game can be considered as a new approach to education and to enhance the skills of health-care students. AIMS: The purposes of this research were to design a VR game and to apply it to teach physiotherapy in neurological diseases. METHODOLOGY: In this study, at first, a VR game was designed for upper limb rehabilitation in brain-injured patients based on the literature and the opinions of physiotherapy experts and game designers. Then, the designed game was used for teaching physiotherapy in neurological diseases. Thereafter, the opinions of 31 undergraduate students about the teaching session were evaluated by two anonymous questionnaires. Data analysis was performed using descriptive statistics through SPSS (version 19). RESULTS: The VR game developed under expert supervision. The evaluation showed that the median score for students' perception of learning was 3.11. The median scores of questions related to the “facilitating level of virtual reality” and “student satisfaction” were 8.66 and 9, respectively. The analysis of students' responses to open-ended questions highlighted the therapeutic aspect of the game compared to its educational aspect. CONCLUSIONS: Application of VR games in education can enhance the students' perception of learning. Furthermore, it can provide a better understanding of physiotherapy in patients with neurological diseases as well as the satisfaction of students. However, the survey indicated that the good results of this teaching method are due to the use of VR for guiding the patient's movements.

Background: Organizational capacity development is an important outcome of faculty development programs, but there is a lack of an appropriate instrument for its evaluation. Aims and Objectives: The aim of this study was to develop a questionnaire to evaluate the organizational capacity development for faculty development programs and to test its psychometrics. Materials and Methods: The initial capacity development for faculty development questionnaire (CDQ-FD) of 26 items was developed based on a literature review and opinion of experts. Content validity ratio (CVR), content validity index (CVI), content validity index for items (I-CVI), and the content validity index for scales (S-CVI) were computed for content validity. Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were performed for construct validation. Results: The score for CVR, CVI, I-CVI, and S-CVI was 0.71, 0.83, 0.87, and 0.90, respectively. EFA resulted in a three-factor model with total variance extraction of 64%. Cronbach's alpha and Spearman Brown coefficient were investigated for reliability assessment. The Cronbach's alpha of overall scale was 0.8 and the test-retest reliability of the overall scale was 0.78. The final CDQ-FD contained 21 items and three categories. Conclusions: The CDQ-FD questionnaire appears to be a valid and reliable instrument for the evaluation of organizational capacity development for faculty development in the medical education.

INTRODUCTION: Academic burnout is one of the issues involving the educational systems at all levels, which wastes the human resources and expenditures. Academic burnout refers to the sense of exhaustion due to educational requirements, the sense of cynicism and indifference, and the sense of lack of competence. Considering the fact that burnout has already been studied in different professions and in cultures different from that of ours, there is a need to identify these factors among the Iranian medical students and accordingly propose some strategies to reduce burnout symptoms among these students. With this end, this study aimed to identify and quantify the importance of possible factors causing burnout among medical students in the 2^nd and 4^th years of their studies in Mashahd University of Medical Sciences and provide some suggestions. METHODS: The present research is a cross-sectional study conducted in 2017. The participants included medical students who had entered Mashhad University of Medical Sciences in Iran in 2013 and 2015 and were in their 4^th and 2^nd year of their studies in the university. A questionnaire prepared and validated by Maslach et al. was used to collect the data and distributed among 195 participants who were selected randomly as the sample. RESULTS: The results showed that the mean scores given by 195 selected respondents regarding emotional exhaustion, indifference, and inefficiency were respectively 3.89, 3.87 and 4.12 out of 7. CONCLUSION: Based on the results, students had the highest level of academic burnout in personal inefficiency or incompetence component and the lowest level was observed in indifference. Therefore, burnout and its components were explicitly seen among medical students; the authorities are recommended to take measures to reduce academic burnout among the students.

CONTEXT: Currently, self-directed learning (SDL) is emphasized in medical institutions all over the world. The skills of SDL enable one to be a lifelong learner, a necessity to cope up with fast-expanding medical knowledge. AIMS: This study aims to develop and implement an “SDL” module for medical undergraduates and find out their perception about the same. SETTINGS AND DESIGN: A cross-sectional study using a mixed-method design (having both qualitative and quantitative components) was conducted in the Department of Community Medicine, UCMS, Delhi, India. METHODS: A module was developed following an extensive literature review and focus group discussions with the teaching staff of the institute. First-semester undergraduate students were invited to participate in the study and asked for feedback using a semi-structured questionnaire. STATISTICAL ANALYSIS: Quantitative data were expressed in mean, range, and frequency. For qualitative data, thematic analysis was performed. RESULTS: The module was implemented with 160 students, in November for 10 hour distributed over 5 weeks. Feedback could be obtained from 130 students. Sixty-seven percent of students were satisfied and 66% reported as motivated to study the allotted topic further. Qualitative analysis showed that though the students liked the learning process based on this module, they also felt facilitators could have been more active in imparting knowledge and skills. CONCLUSIONS: To make learners equipped with the ability to learn throughout a professional learning course, SDL as a learning tool should be introduced in the medical undergraduate curriculum.

BACKGROUND: One of the serious issues in the field of children's social and mental health globally, is conduct disorder. Concerning the special problems of these children, their need for appropriate education seems vital. Thus, this study aimed to identify the educational deficiencies in the Iranian education system in terms of educating children with conduct disorder. SUBJECTS AND METHODS: This was a qualitative content analysis study of the directed type. The population was in Tehran City, Iran. This research was performed on 23 individuals using a triangulation sampling technique and in-depth interviewing. The study subjects were children with conduct disorder, their parents, teachers, and social workers, and psychology experts. The study participants were selected using a purposive sampling method, and the tool used for data collection was a checklist of questions that has been approved by 4 experts. MAXQDA (version 12) software was used for data analysis in this study. RESULTS: The obtained data suggested that the deficits of the educational system in Iran are classified into four categories, including the lack of knowledge and skills of school staff, the lack of necessary workforce, the lack of appropriate hardware facilities, and the lack of coordination and cooperation between individuals and systems. CONCLUSION: Considering the present study results, to improve the educational status of children with conduct disorder and reduce their problems, it is necessary to resolve the identified educational deficiencies as soon as possible by the government, policymakers, and educators.

INTRODUCTION: Organization survival is dependent on communications and managers spend a main portion of their time to establish communications. The identification, improvement, and development of communication skills serve as the essential components of successful organizations. The present study aimed to investigate the role of communication skills in human resource (HR) productivity in North Iran and aimed to investigate the role of communication skills in health HR (HHR) productivity in North Iran. METHODS: The study employed a cross-sectional design and was conducted in six deputies supervised by the Alborz University of Medical Sciences, in 2019. The statistical population included all 302 employees were selected as the sample population according to the Cochran's formula. Using two researcher-made questionnaires of communication skills and HHR productivity, we assessed the role of communication skills in HHR productivity. RESULTS: According to the research findings, there were significant relationships between communication skills including verbal skills, listening skills, and effectiveness skills with HHR productivity (P ≤ 0.05). There was a significant relationship between age group, gender, level of education, and travel home-university distance with communication skills and resource productivity of employees (P ≤ 0.05). CONCLUSION: This study examines the role of communication skills in the promotion of HHR productivity who work in the administrative section of the University of Medical Sciences in Iran. Findings suggest that health planners and authorities may need to examine factors that contribute to the promotion of the communication skills for increase HHR productivity of employees and improved performance of health organizations.

INTRODUCTION: The qualification of managers in terms of management skills is one of the most important factors in the continuous success of each organization, and utilizing such skills can have a positive contribution in the effectiveness of the organization while improving the performance of the employees in line with the objectives and goals of the organization. The study's primary objective was to examine the necessary skills of the hospital managers and their capabilities to manage the challenges in providing health care facilities to their patients and employees. MATERIALS AND METHODS: This study is a qualitative that deep interviews were performed with 22 managers (senior and middle managers) of educational hospitals of Kermanshah city, and the sample size was 22 individuals. The interviews were analyzed by a MAXQDA software application after transcription. RESULTS: This study includes 8 themes and 23 subthemes. The strategic skill, the perceptive skill, the human relations skill, work experience, and personal characteristics were among the skills necessary for hospital managers. Some of the challenges facing the hospital managers included rapid changes in the policies, the limitations of financial resources, and lack of proportion between the educational and occupational spheres. CONCLUSION: Because of their existential philosophy and differences with other service sectors, managing hospitals poses a particular sensitivity. In this regard, the role of the hospital manager is very important. Therefore, in order to meet the satisfaction of those receiving services, decision-makers and policy-makers must think twice when selecting and appointing hospital managers and evaluate and appraise this group in terms of abilities and skills necessary for managing such an important service section.

BACKGROUND AND OBJECTIVES: This study was conducted to evaluate the health experts and professionals' education program in order to become multiprofessionals regarding health system transformation plan by a descriptive and educational evaluation method based on the context, input, process, and product (CIPP) evaluation model in 2018. MATERIALS AND METHODS: The statistical population included managers and experts of health deputy (13 people), managers and authorities in health networks (32 people), teachers (251 people), and learners (1914 people). Data were collected by four researcher-made questionnaires based on the CIPP model and evaluation checklist of facilities and equipment. The view of experts was used to measure the face validity and content validity of the questionnaire, and Cronbach's alpha coefficient was used to determine reliability. Data were entered into SPSS 23 software, and data were provided using descriptive statistics (frequency, mean, and standard deviation). RESULTS: The evaluation indicators of the educational course in the field of context were evaluated desirable by province's managers and experts (95% questions), city managers (100% questions), teachers (95% questions), and health caregivers (80% questions). In the field of input, it was evaluated desirable by managers and experts' input of province (60% questions) and city managers (70% questions) and it was evaluated semi-desirable by teachers (78.95% questions) and health caregivers (88.24% questions). In the field of process, it was evaluated desirable by province's managers and experts (73.68% questions) and city managers (66.67% questions) and it was evaluated semi-desirable by teachers (66.67% questions) and health caregivers (94.4% questions). In the field of product, it was evaluated semi-desirable by managers and experts of province (63.63% questions), teachers (81.81% questions), and health caregivers (100% questions) and it was evaluated desirable by city managers (72.72% questions). CONCLUSION: Holding initial service education course of health caregivers has been necessary, and the public health, family, and midwifery disciplines needed to be educated in a university appropriate to the description of tasks of health caregivers.

BACKGROUND: Washing of hands and maintenance of appropriate hand hygiene plays a significant role in preventing the spread of many communicable diseases. However, literature demonstrating the efficacy of the World Health Organization (WHO) recommended handwashing procedure among schoolchildren in India is scanty. AIM: The aim of this study was to assess hand hygiene efficacy through graphical assessment technique utilizing ultraviolet (UV)-sensitive fluorescent lotion before and after handwashing demonstration among students aged 12–18 years. MATERIALS AND METHODS: This was an interventional study carried out over a period of 5 days among 21 schoolchildren aged 12–18 years in their respective school premises. Participants were requested to rub their hands with an UV-sensitive fluorescent lotion and then wash them. Hands were air-dried and examined under UV rays for blue light emission in a dark room. Emission of blue light highlighted parts of hand where lotion is still present and area not washed properly. Such areas were painted with nontoxic skin-friendly paints. Painted hands were imprinted over graph papers. Hand hygiene demonstration was provided to the participants as per the WHO guidelines by qualified public health dentists using audiovisual aids. Postintervention, the procedure followed at baseline was adopted to obtain imprints of uncovered (not covered during hand hygiene process) parts of hands. The mean percentage of uncovered parts of hand was assessed and compared between baseline and postintervention. RESULTS: The overall mean percentage score of uncovered hand area significantly reduced from 73.90 ± 19.81 mm² at baseline to 20.05 ± 17.0 mm² after demonstration of proper hand hygiene guidelines (P < 0.001). CONCLUSION: Hand hygiene demonstration by qualified public health dentists using audio-visual aids has significantly contributed to improving their hand hygiene practice.

CONTEXT: Payment mechanisms are one of the effective tools for achieving optimal results in health system. Pay for performance (P4P) is one of the best programs to enhance the quality of health services through financial incentives. Considering of implementing family physician program in Iran and the P4P system, it is essential to address the challenges of implementing P4P system in the family physician program. AIMS: This study aimed to investigate the challenges of implementation of P4P system in family physician program. SETTINGS AND DESIGN: The qualitative study was carried out at areas covered by Iran University of Medical Sciences in Tehran, Iran. MATERIALS AND METHODS: The semi-structured interview was conducted on 32 key informants in 2019. The sampling method was determined based on purposeful sampling. The topic guide of interviews was experiences in implementing of family physician program and challenges of implementing P4P system. Participants had least 5-year experience in the family physician program. STATISTICAL ANALYSIS USED: A framework analysis was used to analyze the data using the software MAXQDA 10. RESULTS: The current study identified 7 themes, 14 subthemes, and 46 items related to the challenges to successful implementation of P4P systems in the family physician program including family physicians' workload, family physician training, promoting family physician program, paying to the family physician team, assessment and monitoring systems, information management, and the level of authority of family physicians. CONCLUSION: The study results demonstrated notable challenges for successful implementation of P4P system which can helpful to managers and policymakers.

INTRODUCTION: The performance of the emergency department (ED) as one of the main parts of hospitals, have a great impact on the performance of the whole-hospital. In Iran, the official education program of this discipline was started in 2001 and has expanded in most medical universities. Given the unprecedentedness of emergency medicine (EM), there are limited studies about this specialty. Thus, this study aims to explore the status, role, and performance of Iranian EM specialists. MATERIALS AND METHODS: This qualitative study was conducted using content analysis of 19 semi-structured interviews with EM specialists and key informant. Purposive sampling was conducted, and some teaching and nonstate hospitals in different geographic regions of Tehran city were selected. Conducting interviews continued until reaching the data saturation. Thematic analysis was employed. Extracted themes were reviewed and confirmed by some of the participants. RESULTS: The study results were categorized within five main themes; included the role of ED from EM specialists' viewpoint, EM specialists' viewpoint on their discipline, performance of EM specialists (including medical, managerial, and economic performance), and role of EM specialists in patient satisfaction; and opportunities and challenges of EM specialists. CONCLUSION: Overall, the study findings highlighted the effectiveness and positive medical, managerial and economic impacts of EM in Iran, inside and beyond hospitals. However, the study addressed significant opportunities some solvable challenges in educational, professional and economic domains, and interdisciplinary relationships. Further studies are recommended for comprehensive exploring viewpoint of other disciplines and stakeholders.

BACKGROUND: Cardiovascular disease accounts for 40% of the world's fatality and after accidents and traumas, is the second leading cause of death in Iran. Given the role of psychological characteristics such as hostility and anger in the development of certain behaviors and habits affecting heart problems, this study aimed to investigate the relationship between hostility and anger with coronary artery disease. METHODOLOGY: In this cross-sectional study, 320 patients referring to the hospital with coronary artery stenosis enrolled in the study and were available for angiography. Data collection tools included demographic and disease status questionnaires and aggression questionnaire. The data were analyzed by SPSS software version 16, and Spearman's correlation coefficient, Student's t-, and one-way analysis of variance tests was used for the statistical analysis. RESULTS: In this case, we have the following. Out of 302 cases, 183 were males and 119 were females. One hundred and ninety-seven patients with coronary artery disease and 105 patients with angiography had no coronary artery disease. CONCLUSION: People with coronary artery disease and healthy controls had no significant differences in demographic characteristics, history of illness, and education. Furthermore, there was no statistically significant relationship between hostility and anger with vasoconstriction. Since there is no relationship between hostility and anger with coronary artery disease, further studies are needed to investigate the presence of mediating variables to design appropriate and preventive interventions.

INTRODUCTION: Families, especially parents, play an important role in identifying their children's talents and directing their educational journey. The role of parents in their children career applies both to collectivist and to noncollectivist culture. AIM: To examine the correlation between parental influences on medical students' self-efficacy and career exploration in collectivist culture. METHODS: This research was a quantitative study. The study involved 1017 medical students of medical faculties in four faculties of medicine in Indonesia. All data were collected online in August 2018. The study was conducted using an online survey questionnaire and analyzed to finally form a model that displays the determinants of career exploration behavior. The data were analyzed using the maximum likelihood estimation in IBM AMOS 24. RESULTS: The results found a model that has various routes toward career exploration in collectivist culture. Path analysis revealed both direct and direct effect toward the variable studied. Parents' expectations had influence on self-efficacy. CONCLUSION: The findings show the important role between the influence of parents expectations for self-efficacy and career exploration in children.

BACKGROUND: Osteoporosis is one of the major problems associated with aging and is more common among women than men. This study was designed to modify osteoporosis-related behaviors in female students based on the transtheoretical model (TTM). MATERIALS AND METHODS: This quasi-experimental study was conducted on female secondary school students. The sample size was determined 100 by using Altman's nomogram, including 50 cases and 50 controls. Participants were completed the Demographic Information and Osteoporosis-Related Behavior Questionnaire based on TTM. Evaluation of the data showed that each participant was at what stage of change in physical activity and preventive dietary behavior of osteoporosis. The content of the training package was designed, and for the intervention group, 2-h training sessions were held weekly by the instructor in accordance with the stage of change for 2 months, and the booklet was provided with the appropriate contents of the stage of change. Three months after the completion of training, the questionnaires were completed by intervention and control groups. Statistical analysis was performed using SPSS 23 software. RESULTS: Concerning the stages of change in physical activity and nutrition, a significant difference was before and after the intervention in the intervention group (P < 0.001), while no significant difference was observed in the control group. After the intervention, there was a significant difference in the self-efficacy and some subconstruct of processes of change, but there wasnot a significant difference in the decisional balance. CONCLUSION: Educational intervention based on TTM has been successful in achieving the goal of modifying osteoporosis-related behaviors in female students. The results of this study can be used by health planners to plan and implement health promotion interventions that will undoubtedly help reduce the burden of disease.

BACKGROUND: One of the most important responsibilities of today's university libraries is supporting research activities. The present research is aimed at explaining the librarians' competencies in providing research services for researchers of Isfahan University of Medical Sciences. MATERIALS AND METHODS: This study was performed in 2018 with a qualitative approach and conventional content analysis. The participants were 18 faculty members, students, and librarians selected by purposive sampling. Data collection was done by 18 semi-structured interviews. Continuous data analysis was performed by conventional content analysis. RESULTS: According to the participants' experiences, two major categories were recognized, including “general competencies” and “specialized competencies.” The general competencies category included three subcategories of communication skill, professional ethics, and basic abilities. The specialized competencies category included six subcategories of information resource retrieval and evaluation, using research software, research assistance, intellectual property literacy, scientific publication literacy, scientometrics, and altmetrics. CONCLUSION: According to the participants' experiences, university librarians need specialized competencies in addition to basic and transdisciplinary abilities. It is suggested for research managers and policymakers to plan for empowering librarians regarding the results of the present study.

BACKGROUND: Breastfeeding is not only a perfect food for the infant but also is a living fluid with many features. It provides the infant's physical growth and is responsive to its emotional needs. Since determining the knowledge and attitude of girls in this period and promoting, it is considered as the main principle in motivating them for choosing this method in future. MATERIALS AND METHODS: This descriptive-correlational study was conducted to determine the knowledge and attitude of 630 high-school students on breastfeeding at a selected public high school in Tehran, Iran in 2018. A researcher-made questionnaire was administered to collect the data, to determine the validity of the tool; content validity was used and to determine its reliability, a test re-test method was applied. Data were analyzed by the nonparametric tests of Chi-square, multiple comparisons, and Spearman correlation coefficient. RESULTS: The results showed that 80.3% had moderate knowledge. The mean score of knowledge in the human sciences group was significantly higher than others. Furthermore, the attitude of 22.5% of girls was positive, 77.5% had no idea, none of them had negative attitudes. There was a statistically significant difference between the mean score of attitude of the students in groups of knowledge (good, moderate, and weak) (P < 0.01), and multiple comparison tests showed that the positive attitude score in the moderate knowledge group was more than the attitude score in weak and good knowledge. CONCLUSION: The results indicate that there is an unbiased attitude about the moderate knowledge of different aspects of breastfeeding among pre university students, although they have a moderate knowledge on a complete and successful breast feeding.

BACKGROUND: Assessing the effectiveness of in-service training courses in order to achieve the desired goals and reduce the waste of costs and opportunities in the system is necessary. The purpose of this study was to determine the effectiveness of the “pharmacopeia home health” course considering its importance in different aspects using the Kirkpatrick model. MATERIALS AND METHODS: The present study was a quasi-experimental conducted at community health workers (CHWs) on three levels of reaction, learning, and behavior. In each phase, a valid questionnaire was used to measure the outcome according to the Ministry of Health guidelines with pretest and posttest measurements. The data were analyzed through SPSS 23, using descriptive statistics and repeated measures test and general linear model. RESULTS: The results of the study showed that at the level of reaction in terms of content and holding, conditions of implementation were favorable. Findings at the level of learning showed that the training course was only effective in enhancing the knowledge and awareness about drug maintenance and had no significant effect on other areas. In the third level, the results of the CHWs' performance showed that in some areas, the results were influenced by the demographic variables. CONCLUSION: The present study showed the effectiveness of education in different areas using on the Kirkpatrick model. Given the lack of impact of education in some areas in the present study and on the other, it is necessary to consider cooperative learning methods in order to develop the effectiveness of the courses.

BACKGROUND: Depression is a disorder of the brain, a state of low mood and aversion to activity that can affect a person's thoughts, behavior, feelings, and sense of well-being and can cause alteration in sympathetic activity of the body, thus affecting heart rate variability (HRV). AIM: The study was conducted to determine the effects of depression on HRV parameters in clinically known cases of depression. MATERIALS AND METHODS: A cross-sectional (observational) study was conducted on fifty known patients of depression, aged 18–65 years, and fifty healthy, age-matched, normal controls. HRV test was conducted, and the results were analyzed statistically using Student's “t”-test for equal variance, for various parameters. RESULTS: The study showed that the differences in mean R-R interval(s), mean HR (beats/min), very low frequency (VLF) power (milliseconds squared [ms²]), and low frequency/high frequency (LF/HF) power (%) (LF/HF ratio) among controls and cases were statistically highly significant, while the differences in LF power (ms²) in controls and cases were statistically significant. However, the differences in basic anthropometric parameters, STD (standard deviation of the normal to normal)(s), root mean square successive difference (ms), NN50 (count), pNN50 (%), VLF peak (Hz), LF peak (Hz), HF peak (Hz), HF power (ms²), VLF power (%), LF power (%), HF power (%), LF power (nu), and HF power (nu) were found to be statistically insignificant. CONCLUSION: Depression leads to changes in autonomic control of the body and changes the autonomic balance in favor of an increased sympathetic tone, which can be detected with fair accuracy with HRV analysis.

Clinical education requires creating a supportive atmosphere for learners and nursing students, who need support to be prepared for their future profession. The purpose of this study is to investigate the challenges of supporting the nursing students in clinical education. This article reviewed studies conducted between 2009 and 2019 with the keywords including support, challenge, students, education, and nursing using SID, Magiran, IranMedex, Google Scholar, Elsevier, and PubMed as databases. Among the 926 articles obtained during the two review stages, which were based on the inclusion and exclusion criteria and the first one analyzed the title and the abstract and the second one analyzed the whole article, ultimately 32 articles were selected for the study. The types of articles used in this study are as follows: qualitative (16 articles), descriptive analytical and cross-sectional (12 articles), review (3 articles), and mixed-methods (1 article). The focus of all studies was on the students' clinical education environment. The participants of the studies were undergraduate nursing students (in 22 articles), graduate students (in 2 articles), nursing instructors and students (in 4 articles), and nursing instructors and managers (in 1 article). Most of the challenges of supporting the students included violence, fear, and anxiety; socio-cultural challenges, environmental-organizational stresses; and ineffective clinical education. The findings of this study showed that nursing students face many challenges in the clinical setting. Therefore, the managers of educational and health-care centers should give a high priority to their students' support programs.

BACKGROUND: Dynamic aging depends on providing opportunities to improve the quality of life of the elderly. The objective of this study was to investigate the relationship between social support and quality of life in the elderly in Guilan. MATERIALS AND METHODS: This descriptive-correlational study was conducted in the elderly who visited urban public places in the East of Guilan (mosques, parks, weekly markets, and clubs). A total of 168 elderly who met the inclusion criteria were selected through two-stage, cluster, and convenience sampling. Data were collected using Phillips Standard 23-item social support scale and 12-item quality of life scale-short form. Data were analyzed through descriptive and inferential statistics (Pearson correlation coefficient). RESULTS: The mean score of social support in the elderly in Guilan was 73.25 ± 9.18 and the mean quality of life was obtained at 24.67 ± 7.06. Data analysis showed that there was a significant and positive correlation between social support and quality of life (r = 0.29, P < 0.0001). CONCLUSIONS: Increased social support leads to a higher quality of life in the elderly. Thus, it is necessary to timely identify the needs and promote comprehensive social support to improve the quality of life in the elderly.

BACKGROUND: It is essential to evaluate the performance of hospitals in the health system. Hospitals need a performance evaluation system to develop and compete in order to measure the efficiency and effectiveness of their programs, processes, and human resources. This study aimed to evaluate the performance of teaching hospitals using the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) method and hierarchical analysis. MATERIALS AND METHODS: This was a cross-sectional and descriptive study conducted in 2019 in all teaching hospitals affiliated to Shahid Beheshti University of Medical Sciences. The required data were collected using a standard checklist. The collected data were analyzed using the analytic hierarchy process (AHP) and TOPSIS. In the first phase, annual indicators of hospital evaluation were collected. Following the AHP, key performance indicators (KPIs) were selected and prioritized in hospitals. RESULTS: The questionnaires were provided to 15 experts to weigh KPIs, and the most important indicators were selected. The results of hierarchical analysis showed that three main indicators in evaluating the performance of hospitals were bed turnover rate, emergency clients, and length of stay. CONCLUSIONS: One of the problems in evaluating hospitals is the use of key indicators that alone measure the quantity or quality of their performance. Multicriteria decision-making can be used to determine key indicators first, and then by combining these indicators into a multicriteria decision-making model, a better assessment of the role and performance of hospitals can be provided.

INTRODUCTION: Professionalism is an important measure of the efficacy of the medical education. Some studies showed that dominant values changed during clinical education, and some negative values might replace positive ones. In this regard, this study aimed to explore barrier to professionalism in clinical medical education. METHODS: This was a qualitative study conducted with the content analysis method. A total of 34 interviews with 23 participants were done. RESULTS: Two hundred forty-eight original codes were extracted from the research data, which were classified under the theme of “Academic Exhaustion” and the four following categories: “stressful environment, “human conflict,” “Poor Inter professional collaboration,” and “emotional exhaustion.” DISCUSSION: It can be admitted that having full knowledge of the factors influencing professionalism from the viewpoint of stakeholders can improve the environmental and organizational conditions to prevent professional misconduct.

BACKGROUND: Marital satisfaction is a complex of feelings, which includes pleasure, satisfaction, and pleasure experienced by the husband or wife in all aspects of marriage, and it is an important part of individual health, especially mental health. This qualitative study was conducted to understand marital satisfaction using grounded theory on couples. MATERIALS AND METHODS: This qualitative study was implemented using grounded theory based on Corbin and Strauss, 2008, to investigate the process of marital satisfaction formation among couples from 2014 to 2016. The sampling was started as purposeful and continued as theoretical. The data were obtained using semi-structured interviews. 28 interviews were taken from 25 participants; MAXQDA software was used to facilitate the organization of classes and subclasses. RESULTS: The central variable of this study was called “toward a relaxing evolution.” On that account, the main classes included “supportive companionship” and “responsible love,” and variables of “personality traits,” “interactive relationships,” “economic status,” “passage of time,” and “present resources in society” provided the basis for the formation of marital satisfaction. CONCLUSION: To achieve marital satisfaction, couples should set their family's ultimate goal toward achieving a relaxing evolution for the entire family, and they should accompany each other in order to achieve that goal. This sometimes requires sacrifice and forgiveness to achieve the ultimate goal of the family.

BACKGROUND/AIM: Adolescent girls' concerns about their body images can negatively affect their social and academic performance. This study aimed to determine the prevalence of body image concern (BIC) in adolescent schoolgirls in Iran and its risk factors. PATIENTS AND METHODS: This epidemiological study with cross-sectional design was conducted in 2018 on 396 middle schoolgirls aged 12–17 years (mean age = 14 years) living in Khorramabad, Iran. For screening BIC, the Persian version of BIC inventory (BICI) was used. Their birth order, school grade, school type, father's education, and household income were also recorded. Collected data were analyzed in SPSS v. 18 software using descriptive statistics and Chi-square test. RESULTS: Of 396 girls, 106 (26.8%) had BIC, 89 (84%) reported moderate BIC, and 17 (16%) severe BIC. Their mean BICI score was 40.84 ± 12.93 (out of 42). Most of them reported to spend a significant amount of time checking their appearance in the mirror (n = 81, 20.5%) and examining flaws in their appearance (n = 74, 18.7%). A few of them were embarrassed to leave the house because of the appearance and avoided from looking at the appearance in the mirror (n = 6, 1.5%). There was no significant difference in BIC severity in terms of birth order, school grade, school type, father's education, and household income factors (P > 0.05). CONCLUSION: The prevalence of BIC among schoolgirls in Iran is high. Appropriate therapeutic interventions should be carried out to improve their quality of life, mental health, and self-esteem to reduce the BIC prevalence.

Pneumonia triggered by novel corona virus (SARS-CoV-2) in Wuhan, China, in December 2019 is an extremely contagious disease. The WHO has stated the outbreak of COVID-19 (corona virus) as a pandemic issue. Corona virus cases started increasing day by day in India, also from the time the first case was diagnosed on January 30, 2020. In this regard, there are so many colleges and universities across India which cancelled or rescheduled their academic activities such as conferences, workshops, and other academic and sports activities. Because the universities and colleges should protect and take care of their students and faculty in this regard. In this brief communication, I would like to give an idea on the potential impact of the dangerous COVID-19 outbreak on the education system and mental health of students and staff.

BACKGROUND AND AIM: There is a growing interest in learning styles of undergraduate health-care professional students; however, the evidences about learning styles over time during undergraduate programs are rare. In this study, the learning styles of undergraduate health-care professional students from the beginning to the completion of the program were examined to determine changes in learning style over time. METHODOLOGY: This is a longitudinal descriptive study from 2015 to 2018. A total of 101 health-care professional students were selected by census method. Learning styles were evaluated using the Perceptual Learning-Style Preference Questionnaire three times in the study at the beginning (T1), the middle (T2), and the end of the educational course (T3). The data were analyzed using repeated measures ANOVA. RESULTS: In T1, auditory (mean = 13.99) and visual (mean = 13.54) styles were preferred as major learning styles, whereas at T2, visual style (mean = 13.6) was the only preferred major learning style. At T3, the major learning styles were kinesthetic (mean = 14.32), tactile (mean = 13.98), and visual (mean = 13.58). There were statistically significant differences in auditory, kinesthetic, tactile and group scale scores between the three time points (P < 0.05). Group learning style was in the negative type at all three time points. CONCLUSIONS: Learning styles can change depending on the context, environment, teaching method, and the subject of learning material and are probably a flexible changing feature rather than a fixed inherent feature a student possesses.

AIM: This study was intended to evaluate the knowledge and attitudes regarding infant's oral health care among graduating medical students from Kulasekaram, Tamil Nadu. MATERIALS AND METHODS: A cross-sectional survey research design was employed in this study. Self-administered questionnaire of the validated “Graduating medical students' Knowledge and Attitudes Survey Regarding Infant's oral health care” were utilized to ascertain the baseline levels of knowledge and attitudes of graduating medical students' in Kulasekaram hospital. In this regard, a preliminary study with a convenience sample of 100 medical students was conducted so as to assess the knowledge of infant oral health care among graduating medical students in Kulasekaram. This study, while limited in sample size, benefits the general practitioners as target readers to assess the abnormalities in children at early stages of life. RESULTS: The results of the study revealed that the mean percentage score overall was 65.7%. Only 3.2% of participants obtained a passing score of 80% or greater. Widespread knowledge deficits and poor attitudes among graduating medical students were noted in this study, particularly in the domain of pharmacological management of pain. Positive correlations were observed between the respondents' score and level of education. Further analysis revealed respondents had an inaccurate self-evaluation of their pain management knowledge. CONCLUSION: The results of this study reveal that there is dearth of knowledge and attitudes of graduating medical students' regarding infant oral health care. Educational and quality improvement initiatives in oral health care of infants could enhance medical student's knowledge baseline in the area of oral health care and possibly improve practices.

INTRODUCTION: Prenatal care refers to proper and principled implementation aimed at maintaining a healthy pregnancy in terms of physical health and favorable psychological outcomes for the mother, infant, and family. The adequacy of prenatal care is an important indicator in predicting infant and maternal mortality. Mental health components such as hope and happiness can influence the quality of prenatal care. The aim of this study was to determine the relationship between hope and happiness with prenatal care. METHODS: This is a cross-sectional study that was performed on 200 pregnant mothers referred to Isfahan, Iran, comprehensive health centers in 2018 using an available sampling method. The research instrument was a questionnaire of hope, happiness, and quality of prenatal care that was completed by qualified people. The data were analyzed by descriptive and analytical statistical methods (Pearson correlation). RESULTS: The results of this study showed that there is a significant relationship between the adequacy of care and overall hope score (P = 0.032). There was also a positive and significant relationship between the adequacy of care and the subscales of hope (thinking [P = 0.002] and path [P = 0.004]). There was a positive and significant relationship between the adequacy of prenatal care and overall happiness score (P = 0.03). Positive emotion subscale (P = 0.033) had a significant positive correlation and negative emotion subscale (P = 0.001) had a significant negative relationship with the adequacy of prenatal care. CONCLUSION: According to the results, mental health can affect the quality of prenatal care. As a result, health providers to pregnant mothers can improve the adequacy of prenatal care by examining pregnant women in terms of these two issues, thereby improving the health of themselves and their children, and ultimately, community health.

INTRODUCTION: The Internet has drastically affected human behavior, and it has positive and negative effects; however, its excessive usage exposes users to internet addiction. The diagnosis of students' mental dysfunction is vital to monitor their academic progress and success by preventing this technology through proper handling of the usage addiction. MATERIALS AND METHODS: This descriptive-analytical study selected 447 students (232 females and 215 males) of the first and second semesters enrolled at Kermanshah University of Medical Sciences, Iran, in 2018 by using Cochrane's sample size formula and stratified random sampling. The study applied Young's Internet Addiction Test and Goldberg General Health Questionnaire 28 for data collection. The study screened the data received and analyzed valid data set through the t-test and Pearson's correlation coefficient by incorporating SPSS Statistics software version 23.0. RESULTS: The results of the current study specified that the total mean score of the students for internet addiction and mental health was 3.81 ± 0.88 and 2.56 ± 0.33, correspondingly. The results revealed that internet addiction positively correlated with depression and mental health, which indicated a negative relationship (P > 0.001). The multiple regression analysis results showed students' five significant vulnerability predictors toward internet addiction, such as the critical reason for using the Internet, faculty, depression, the central place for using the Internet, and somatic symptoms. CONCLUSIONS: The study findings specified that students' excessive internet usage leads to anxiety, depression, and adverse mental health, which affect their academic performance. Monitoring and controlling students' internet addiction through informative sessions on how to use the Internet adequately is useful.

INTRODUCTION: Unusual impacts of disasters on normal living conditions pose challenges to the health system. Nurses who take care of disaster victims may face situations that make decision-making difficult; hereon, the use of new technologies can be a useful solution. The study aimed to identify the telenursing care during incidents and disasters. METHODS: The study was conducted at a medical science university in Iran from 2018 to 2019. This was a semi-structured interview-based qualitative study using content analysis. Eighteen nurses, nursing teachers, and emergency medical technicians were included in the study. Data analysis was performed using inductive content analysis and coding with MAXQDA (2010) software. The Lincoln and Guba (1985) trustworthiness criteria were used for the reliability and validity of the data. RESULTS: Telenursing in critical and supportive care was the main theme identified from data analysis. This theme included six main categories: (1) management of trauma, (2) technical skills, (3) care and decision-making in stressful situations, (4) management of patients with special needs, (5) life-saving intervention, and (6) psychological and emotional supports. CONCLUSIONS: Telenursing in disasters is the turning point of the care management of victims. In order to achieve this goal, nurses should acquire the relevant knowledge, skills, and abilities.

INTRODUCTION: The 2019 coronavirus disease (COVID-19) is a major global health concern. Joint efforts for effective surveillance of COVID-19 require immediate transmission of reliable data. In this regard, a standardized and interoperable reporting framework is essential in a consistent and timely manner. Thus, this research aimed at to determine data requirements towards interoperability. MATERIALS AND METHODS: In this cross-sectional and descriptive study, a combination of literature study and expert consensus approach was used to design COVID-19 Minimum Data Set (MDS). A MDS checklist was extracted and validated. The definitive data elements of the MDS were determined by applying the Delphi technique. Then, the existing messaging and data standard templates (Health Level Seven-Clinical Document Architecture [HL7-CDA] and SNOMED-CT) were used to design the surveillance interoperable framework. RESULTS: The proposed MDS was divided into administrative and clinical sections with three and eight data classes and 29 and 40 data fields, respectively. Then, for each data field, structured data values along with SNOMED-CT codes were defined and structured according HL7-CDA standard. DISCUSSION AND CONCLUSION: The absence of effective and integrated system for COVID-19 surveillance can delay critical public health measures, leading to increased disease prevalence and mortality. The heterogeneity of reporting templates and lack of uniform data sets hamper the optimal information exchange among multiple systems. Thus, developing a unified and interoperable reporting framework is more effective to prompt reaction to the COVID-19 outbreak.

BACKGROUND: Today's Bachelor in Medicine, Bachelor in Surgery (MBBS) students will become Indian Medical Graduates in future. Emotional intelligence (EI) is an essential component in the making of an Indian Medical Graduate. There is increasing stress during medical training. The study was conducted to compare the association of EI score and perceived stress scale (PSS) among average and excellent undergraduate medical students. The secondary objective was to find the predictors of excellent academic performance. MATERIALS AND METHODS: This descriptive cross-sectional study was conducted after institutional ethics committee approval. All 522 consented students studying in 2^nd, 4^th, 7^th, and 9^th semesters filled up established pre-validated questionnaires ; Schutteself report EI test and Cohen's perceived stress scale. Sociodemographic details of the respondents were collected. Average attendance and marks of previous semester examinations of all included students were collected from academic cell of the institution. All students were grouped into three groups: average, good, and excellent performers from the marks collected. Comparison of EI scores and PSS scores was done between students in excellent and average groups using unpaired t-test. RESULTS: Of the 94.9% of respondents, 78.2% of the students were included in the study. The mean EI and PSS scores were 123 ± 14.5 and 22.8 ± 13.9, respectively. There was no statistically significant difference in EI scores between average and excellent performers ([123.8 ± 18.7] vs. [127.7 ± 16]; P – 0.089). Perceived stress was lower in excellent performers ([20.9 ± 11.1] vs. [24.8 ± 15.0]; P – 0.01). EI was associated with better performance in clinical year students. EI was negatively correlated to perceived stress. CONCLUSION: Our study provides predictors of excellent academic performances among Indian medical undergraduates. This study suggests introduction of extracurricular activities in ongoing undergraduate curricular syllabus. It imparts awareness among students about the importance of attending classes. This study bestows higher EI and lower perceived stress to better academic performance.

BACKGROUND: The Internet of Things is a revolution in health care both in the field of patient treatment and health information management. This technology can improve the status of patients, providing them with healthcare, collecting, sharing, storing and analyzing their medical information. AIMS AND OBJECTIVES: Since the use of the IOT will create a wonderful future in the field of electronic health and the telecommunications industry, hospitals, health centers and policymakers in the health sector in the country should not neglect to get advantage of this technology. Therefore, this study aims to collect the necessary indicators for entering this technology and also measuring its preparation to use it. MATERIALS AND METHODS: This is a practical research and in terms of information gathering, a descriptive survey type that describes and evaluates the preparation of IOT technology implementation in hospitals affiliated to Isfahan University of Medical Sciences. In order to measure the preparation for implementation of such technology in the treatment centers, a model based on the opinion of the experts in this area should be designed. According to which the model of this assessment in 5 different sections in the treatment centers that require this technology are also significant and Effective changes will be reviewed to assess their preparation. RESULT: According to the standard coefficients obtained as a result of reviewing the opinions of the experts in this field, the most effective factor is “training of specialist staff in the university” and the least effective factor is “purchasing technical knowledge from universities and affiliated centers”. CONCLUSION: The results show that current hospitals are not prepared to move to this area and the universities should be able to enter the field quickly.

BACKGROUND: Happiness is among the factors that promote mental health in mothers with unplanned pregnancy. The present study aimed to determine the impact of attachment skills training on happiness among women with unplanned pregnancy. MATERIALS AND METHODS: This clinical trial was conducted on 84 women with unplanned pregnancy referred to three prenatal clinics in Shiraz in 2018. The participants were randomly divided into an intervention group and a control group using permutation block. At first, the participants were requested to sign written informed consent form, demographic information form, and mental health questionnaire. Then, they were asked to complete Oxford Happiness Questionnaire and Cranley's Maternal-Fetal Attachment Scale. The intervention group received attachment training through six 90-min sessions, while the control group underwent the hospital's routine care. The two groups were required to fill out the study questionnaires once more after 4 weeks after the intervention. After all, the data were analyzed using Chi-square test, Fisher's exact test, independent t-test, and ANOVA. RESULTS: There was a significant difference between the two groups' pretest and posttest mean scores of happiness (P = 0.0001). The results showed that in the experimental group, pretraining and posttraining period mean scores were 89.64 (7.2) and 93.13 (6.09), respectively; while in the control group, pretraining and posttraining period mean scores were, respectively, 91.69 (9.96) and 91 (8.82). The difference between the two groups was statistically significant. No significant relationship was observed between happiness and the couples' occupations, number of pregnancies, and number of miscarriages in the two groups (P > 0.05). CONCLUSION: The mean score of happiness increased after the training, being significantly different from that in the control group. Therefore, happiness is a changeable feature that can be promoted among pregnant women via interventional methods.

BACKGROUND: The prevalence of viral diseases is on the rise and has caused many problems for public health. COVID-19 is a new viral outbreak in the world. This study aimed to investigate the trends of incidence and case fatality rate (CFR) of COVID-19 in the world by April 30, 2020. METHODS: This was a descriptive-analytical study. We investigated the number of cases and deaths in 35 selected countries and regions of the WHO that had at least 10,000 cases by the time of the study. In addition, the incidence and CFR of COVID-19 were investigated. Finally, time trends of the number of cases, deaths, and CFR were investigated using ordinary least squares regression models. RESULTS: The total number of confirmed cases of COVID-19 was 3,090,184. The European region had the highest number of COVID-19 patients (1,434,649 [46.43%]). Ukraine with 10,406 and the USA with 1,003,974 cases have reported the lowest and highest confirmed cases, respectively. In addition, the European region and the African region with 157.13 and 2.50 patients per 100,000 population had the highest and the lowest incidence rate, respectively. India (2.44) and Spain (455.69) had the lowest and the highest incidence rate per 100,000 population, respectively. In the world, 217,759 deaths have happened, of which 135,961 (62.44%) were reported in the European region. Furthermore, the USA had the highest number of deaths (52,428) due to COVID-19. CFR was 7.05% in the world, which ranged from 3.74% in the African region and 9.48% in the European region. The number of patients and deaths due to COVID-19 had increasing trends in all countries, and the trend of CFR just for Iran and Ukraine was negative. CONCLUSION: The countries had different trends in the morbidity and mortality of COVID-19. However, regarding the increasing trend of the disease in the world, it will be more important to rely on public prevention strategies. It is necessary to apply and continue public health policies at national and global levels till the control of the disease.

INTRODUCTION: Most of the neonatal and maternal deaths occur within the first 48 hours post-delivery. Hence, this time period is very crucial for the survival of newborns and mothers both. As per maternal and child health program guidelines in India, it is clearly mentioned that all the government health facilities should discharge the mother and baby only after 48 hours of delivery in case of normal delivery and after 7 days in case of delivery conducted by cesarean sections. AIM: The aim of the study was to find the various factors responsible for early maternity discharge (<48 h) of normal vaginal deliveries (NVDs) conducted at government health facilities. MATERIAL AND METHODS: The study was conducted in a rural block of Haryana, North India, from May to June, 2015. Postnatal women with NVD within 6 months of duration from initiation of the study were included after taking proper informed consent. A questionnaire was developed by the investigators to interview the women. The questionnaire consists of 26 items which included the socio-demographic details and questions on various factors affecting postnatal stay at the health facility. RESULTS: A total of 40 postnatal women consented and participated in the study. Their mean age was 23.46 ± 5.63 years. Majority of them (24, 60.0%) were having their first child. Out of them, 12 delivered at primary health centers (PHCs), 18 at community health centers, and the rest at the district hospital. A total of 24 (60%) of them were discharged early (<48 h) as per laid guidelines. It was observed that primiparity, delivery at PHC, normal birth weight of baby, and term deliveries were significantly associated with early discharge. Among those who had NVD and stayed beyond 48 h, most of them mentioned that the round-the-clock availability of doctors/nurses was the main reason for their staying at the health facility. CONCLUSION: The proportion of postpartum women discharged early is high and alarming. There is a need for essential counseling to be imparted to the mothers by doctors/nurses at all the health facilities for staying till 48 hours and by health workers during the antenatal period of the importance of the stay at the facility post delivery .

INTRODUCTION: Health promotion through lifestyle improvement is an important topic that has received considerable attention from the scientific community worldwide. This study aimed to determine the effect of Pender's health promotion model on self-efficacy and treatment adherence behaviors of hemodialysis patients in Shahrekord, Iran, in 2018–2019. METHODS: This quasi-experimental study was performed on 70 hemodialysis patients who were attending routine hemodialysis sessions in Hajar hospital in Shahrekord. Individuals were selected by simple random sampling and randomly assigned to two groups of control and intervention. In the preintervention stage, all patients completed a questionnaire that was prepared to collect demographic information and measure health-promoting behaviors, self-efficacy, and treatment adherence. The intervention group participated in eight sessions of a health promotion model-based education program. Both groups were asked to complete the questionnaire again immediately after the intervention and also 2 months later. RESULTS: The repeated measures analysis of variance (ANOVA) showed a significant difference between the two groups in terms of the extent of change in mean scores over the three measurement stages (before the intervention, after the intervention, and 2 months after the intervention) (P < 0.001). A statistically significant difference was observed between the two groups in terms of self-efficacy scores in the postintervention and follow-up stages (P < 0.05). The repeated measures ANOVA also revealed a significant difference between the two groups in terms of the extent of change in mean treatment adherence scores over the three measurement stages (P < 0.001). CONCLUSION: Considering the positive effects of the program on patients undergoing hemodialysis, it is recommended to use the program to promote the well-being of these patients without time restrictions.

BACKGROUND: The health-promoting lifestyle by empowering individuals will increase control over their health, improve quality of life, and prevent diseases. The purpose of the present study was to determine the effect of the educational intervention based on the intervention mapping approach on health-promoting lifestyle in Iranian college students. METHODS: This study is a quasi-experimental control study that was conducted in two groups of 65 students of Iran University of Medical Sciences in 2018–2019. The data were collected using the Health-Promoting Lifestyle Standard Profile II questionnaire and a researcher-made questionnaire based on the mapping approach, whose validity and reliability were confirmed. The educational intervention was designed according to the pretest results, including five training sessions and performed for the intervention group. The two groups were evaluated with the same questionnaires 1 month and 3 months later, and the data were analyzed using independent t-test, Spearman, ANCOVA, ANOVA test, and covariance. Results: Before the intervention, no significant difference was observed between the mean scores of health-promoting behaviors in the two groups, but after the intervention, the mean scores of attitude, subjective norms, enabling factors, and perceived self-efficacy and mean scores of health-promoting lifestyle and its dimensions increased significantly in the intervention group (P < 0.001) compared to the control group. Conclusion: The educational intervention is effective in improving behaviors related to health-promoting lifestyle and its dimensions. Therefore, performing educational interventions are suggested to adopt and adhere to behaviors related to health-promoting lifestyle by utilizing and reinforcing perceived self-efficacy, subjective norms, enabling factors, and attitudinal change.

Clinical informationist (CI) is one of the current trends in the field of medical librarianship and information science. CIs are members of clinical care teams, and their main duty is to fill the gap in the information needs of health-care workers and patients using information sources. They need an official and standard education. This study aims to identify the educational goals and needs of CIs. To this end, a scoping review was conducted using the Preferred Reporting Item for Systematic Reviews and Meta-analyses guidelines. The ISI Web of Science, Scopus, Proquest (MEDLINE), Science Direct, Emerald, ERIC, Cochrane, and Library, Information Science and Technology Abstracts were searched. The Journal of the European Association for Health Information and Libraries was hand searched for relevant studies. A total of 1026 studies were extracted, and 38 studies were selected for the final review. The review resulted in identifying 18 goals in cognitive, emotional, and psychomotor areas. Furthermore, the educational needs were identified in eight educational needs including research method and statistics, education, medical knowledge, information and librarianship science, clinical environment knowledge, evidence-based knowledge, information technologies and systems, management, and leadership. Although part of these educational needs can be met through general medical librarianship and information science education, further specialized education for CIs requires specific aims and curriculum. Thus, the results of this study can be the basis for future studies regarding the competencies of CI in order to provide a more precise and detailed curriculum based on these educational needs.

INTRODUCTION: Novel coronavirus is believed to be tiny enough (0.08–0.14 μm) to penetrate through face mask, thus protection offered by cloth mask may be too low. However, the use of cloth face mask in community has been recommended by the United States Centre for Disease Control and Prevention and regulatory bodies of other countries. There is paucity of literature on efficacy of cloth face mask in preventing SARS-CoV-2 infection transmission; thus, this review aims to update the available most recent evidences on efficacy of cloth face masks in prevention of viral infection transmission. METHODS: We searched MEDLINE, EMBASE, and Clinical Trials Register for identifying studies related to this review using free-text terms and MeSH terms. Both experimental and observational studies on efficacy of cloth masks which were published in English language have been included in this review except expert opinions, commentaries, editorials, and review articles. Twelve studies were eligible to be included in review for data extraction and qualitative synthesis was carried out from extracted data but quantitative analysis (meta-analysis) could not be performed because of serious heterogeneity between the studies. RESULTS: Cloth face masks show minimum efficacy in source control than the medical grade mask. The efficacy of cloth face masks filtration varies and depends on the type of material used, number of layers, and degree of moisture in mask and fitting of mask on face. CONCLUSION: Cloth face masks have limited efficacy in combating viral infection transmission. However, it may be used in closed, crowded indoor, and outdoor public spaces involving physical proximity to prevent spread of SARS-CoV-2 infection.

BACKGROUND: In chronic diseases such as osteoporosis, understanding the factors that improve prevention, such as health literacy (HL), is essential in reducing the incidence of these diseases. This study aimed to determine the association between HL and adoption of osteoporosis-preventive behaviors among students in Qazvin. SUBJECTS AND METHODS: This is a cross-sectional study in which 375 female students (aged 15–18 years) at high schools (grades 10^th, 11^th, and 12^th) in Qazvin city were selected, in 2019. Sampling method was multistage. To collect data, the standardized questionnaire for measuring HL in adolescents (health literacy measure in adolescents), in addition to another questionnaire for assessing osteoporosis-preventive behaviors, was used. Data were analyzed using SPSS 22 by descriptive statistics and logistic regression. The association considered significant when P < 0.05. RESULTS: The mean scores of adoption of osteoporosis-preventive behaviors and HL were 22.43 ± 5.60 and 70.84 ± 12.58, respectively. Logistic regression showed that there was a significant association between the adoption of osteoporosis-preventive behaviors and HL (P = 0.001). In addition, the association between the adoption of osteoporosis-preventive behaviors and age was also significant (P = 0.048 and odds ratio = 3.35). CONCLUSIONS: Young students and those of low HL showed less adoption of osteoporosis-preventive behaviors. Therefore, it is necessary to pay more attention to design educational programs that may raise the knowledge and awareness of those students about such these diseases, mainly prevention.

Although telemedicine has been used spottily in Indian health care so far, the 2020 Covid-19 pandemic provided the nation's health systems an unprecedented opportunity to make a concerted effort to increase access and coverage. Health-care providers can incorporate telemedicine systems to reduce doctor-patient visits and help in breaking the chain of transmission of infections. Anticipating the increased need of telemedicine by health-care providers, the Medical Council of India released practice guidelines in March 2020. In this article, the literature pertinent to telemedicine and its applications with special reference to recently released practice guidelines were reviewed and summarized in a historical and current context. Telemedicine is bound to grow and be adopted by more health-care practitioners and patients in a wide variety of forms due to ease and availability. At the same time, it cannot replace in-person consultation or emergency medicine.

INTRODUCTION: Occupational accidents have many undesirable and irreparable effects on labor forces, assets, environment, and credibility of organizations. Human errors are one of the most important causes of occupational accidents. Human errors have different causes, but in all cases, human cognitive abilities and limitations play important roles; in this research, the relationship between occupational cognitive failures and work-related accidents in heavy equipment operators of Shahid Rajaee Port Complex has been investigated. METHODS: This research was done through the field method. A sample of 332 people was selected by a stratified sampling method among all heavy equipment operators. The data gathering tool contained a 30-item occupational cognitive failure questionnaire. Furthermore, regression analysis method was used to test the hypotheses. RESULTS: The results of this study showed that cognitive failures of occupational accidents on direct work-related accidents in heavy equipment operators of Shahid Rajaee Port complex have a direct effect (P < 0.00). Further more, variables that modify the research are age, work experience, working hours, educational level, type of occupation, and marital status of the operators. CONCLUSION: Regarding the direct relation between cognitive occupational failures and occupational accidents, one can predictive this result that the occupational cognitive failure questionnaire can be used as a predictive tool in accidents of Shahid Rajaee Port Complex.

BACKGROUND: Iran has experienced an increasing number of earthquake disasters in the past three decades. Due to nurses' unique role as professional and volunteer responders in times of disaster, more information is required regarding the capabilities they need to provide more effective care during the crisis. The aim of this study was to identify professional capabilities needed by nurses to provide care to the injured of earthquake. MATERIALS AND METHODS: The present study was conducted as a qualitative conventional content analysis, and data collection was carried out through 16 semi-structured and in-depth interviews with the nurses involved in providing care to the injured in the Kermanshah earthquake. The data were analyzed following Graneheim and Lundman's approach. RESULTS: Data analysis led to the emergence of 427 primary codes, 10 subcategories, and four categories. The four categories included clinical competence (professional knowledge and clinical skills), personal competences (communication skills, resiliency, and creativity and innovation in providing care), ethical competence (commitment to ethics and professional responsibility), and essential skills in caring for the injured (skills in triage, psychological care skills, and skills in observation and monitoring) CONCLUSION: The present study identified a wide range of professional capabilities required by nurses in disasters. Given that nurses do not acquire some of these specialized and technical skills during their education, it is recommended to enhance the professional capacity of nurses in disasters. In addition, special training programs in this field can be incorporated into the curriculum of nursing programs and in-service nursing education.

INTRODUCTION: Many women refuse to exercise during pregnancy due to lack of awareness and not receiving training. The aim of this study was to investigate and compare the effect of group and telemedicine education on exercise during pregnancy by using the health belief model (HBM). MATERIALS AND METHODS: This quasi-experimental study was carried out in 2019 in Zahedan, and a total of 135 pregnant women participated in it. Samples were randomly assigned to the following three groups: group training (n = 45), telemedicine (n = 45), and control (n = 45). Group training was presented in three sessions, and the telemedicine group received the educational content through mobile applications. The samples completed the HBM questionnaire before and 6 weeks after the intervention. In addition, within 6 weeks after the intervention, they completed the exercise activity schedule. SPSS software Ver. 16 (IBM Corp, Armonk, NY, USA) was used for analysis, and data were analyzed by ANOVA, Tukey's post-hoc test, Kruskal–Wallis test, and Mann–Whitney test. RESULTS: After intervention, the scores of HBM constructs and exercise levels in group training, telemedicine group, and control group, respectively, were as follows: perceived susceptibility 25.91 ± 3.24, 25.51 ± 1.97, and 22.55 ± 3.78; perceived severity 27.48 ± 2.27, 25.13 ± 2.29, and 22.51 ± 3.88; perceived benefits 27.28 ± 2.97, 25.68 ± 3, and 22.8 ± 3.05; perceived barriers 10.69 ± 2.69, 10.66 ± 3.19, and 14.17 ± 3.14; cues to action 24.71 ± 4.35, 23.9 ± 2.48, and 22.84 ± 3.02; self-efficacy 26.17 ± 3.05, 25.2 ± 2.82, and 22.51 ± 3.38; and exercise levels 70.99 ± 20.43, 56.51 ± 21.99, and 37.62 ± 29.66. Group training and telemedicine led to significant improvement in all HBM constructs and exercise levels (P < 0.05, P < 0.0001, and P = 0.003, respectively). Group training provided more improvement than telemedicine in the scores of perceived severity (P < 0.0001), perceived benefits (P = 0.001), cues to action (P = 0.02), and mean exercise time (P = 0.001). CONCLUSION: The results of this study showed that the HBM is a proper model for exercise education in pregnant women. It is recommended to use HBM as a group training and telehealth in promoting the rate of exercise in pregnant women.

BACKGROUND: Teenagers are increasingly interested in computer games, and the adverse effects of these games are dependent on the execution of these games. The theory of planned behavior (TPB) is one of the most important theories in behavior change. This study aimed to determine the effect of educational planning based on TPB on the level of dependence on computer games in high school male students in Gonabad, Iran. MATERIALS AND METHODS: This was a randomized controlled trial. The study population was students of computer games in Gonabad. Sixty-four students were selected by a multistage random sampling method and were randomly divided into intervention (n = 32) and control (n = 32) groups. Data-gathering tool was the standard questionnaire of computer game dependency and researcher-made questionnaire according to TPB constructs that were completed before, immediately, and 3 months after the intervention. The intervention consisted of eight 90-min training sessions. Data were analyzed using the Chi-square test, Fisher's, t-test, repeated measures ANOVA, and Bonferroni post hoc test. RESULTS: Before the intervention, the intervention and control groups were matched for the mean score of model constructs. However, after the intervention, the mean score of computer game addiction significantly decreased (≤0.001). However, the mean score of knowledge, attitude, perceived behavioral control, and behavioral intention increased, which was statistically significant. Furthermore, the mean changes of model structures were statistically significant (P < 0.05). CONCLUSION: The findings revealed that TPB can be used as a good theoretical framework for designing and implementing educational programs to reduce the dependency of computer games on students.

INTRODUCTION: Hypertension is one of the most critical factors for chronic diseases such as cardiovascular disease, stroke, arrhythmias, heart failure, and renal disease. The aim of this study was to evaluate the quality of life and its related factors in hypertensive patients. MATERIALS AND METHODS: This study was descriptive research. The sampling method was simple random, i.e., 137 were selected among the ten health centers of the list of the existing patients by simple random sampling. Data were collected using a questionnaire World Health Organization Quality of Life-BREF (Short Form-26). After collecting the questionnaires, the data analysis was carried out using SPSS software and using statistical methods (e.g., number, percentage, mean, standard deviation, and MANOVA tests). RESULTS: The results showed that the mean score for the physical domain (52.82), the psychological domain (50.26), the social domain (48.33), the environmental domain (46.1), and the total quality of life (49.60). Among the demographic variables, the education level variable (P =0.000), job (P = 0.013), and the duration of hypertension (P = 0.039) were significantly correlated with the quality of life of patients. The “levels of education” variables are significantly correlated with the physical domain (P = 0.000), psychological domain (P = 0.000), social domain (P = 0.000), and environmental domain (P = 0.000) of the quality of life. The “job status” variable is only significantly correlated with the social domain of the quality of life (P = 0.005). The “duration of hypertension” variable is only significantly associated with the physical domain of the quality of life (P = 0.011). CONCLUSION: The findings of the present study show that demographic variables such as educational level, occupation, and duration of hypertension have a significant relationship with the quality of life domains of hypertensive patients. It is recommended that the principled education of patients is a step toward the improvement of the quality of life of patients.

INTRODUCTION: Conduct disorder is among the most serious and complex complications in school-aged children. Considering severe problems in the families of children with conduct disorder, this article aimed to investigate such problems in this group. SUBJECTS AND METHODS: This qualitative research was conducted on 23 participants in Tehran, Iran. The study participants were selected by purposive sampling technique. Interviewees consisted of children with conduct disorder (8–12 years old), their parents, teachers, and relevant experts. This study is a qualitative research which is a content analysis. The research tools included a checklist of questions approved by experts. The content analysis method was used with the help of MAXQDA software to analyze the obtained data. RESULTS: The findings comprised the studied families' issues in five categories. These classes included the parents' marital problems, helplessness, and inability of the family to improve conditions; inappropriate discipline approaches; the family's lack of interest in the treatment; and the family members' mental harms. CONCLUSIONS: It is necessary to provide appropriate facilities and health-care centers for the families to reduce the burden of their problems. In addition, a specialist and experienced work team consisting of at least a child psychiatrist, a child psychologist, and a social worker is necessary to serving these families.

INTRODUCTION: Adolescence is characterized by a rapid phase of growth and development during which the requirement of nutrition and micronutrients is relatively high. Although there is a decreasing trend in the prevalence of undernutrition among adolescents, the current prevalence of undernutrition is still very high (41.9%). Adolescents with good nutrition knowledge are more likely to follow healthy eating habits. In the light of this, the current study was planned to assess the baseline nutrition-related knowledge of adolescent girls and the effectiveness of nutrition education material (flipchart) in increasing their nutrition-related knowledge. MATERIALS AND METHODS: A school-based interventional study was conducted among adolescent girls of class 9^th of a school in an urban slum of Delhi. A structured pretested Knowledge Assessment Questionnaire consisting of 10 multiple-choice questions in Hindi with a maximum score of 10 was used. The intervention was a nutrition education session conducted by doctors of Community Health department using specially designed flipcharts covering important aspects of nutrition relevant for adolescent girls. A demonstration of food items and charts and flex material was also given. The total sample size was 265 adolescent girls. RESULTS: Baseline knowledge as assessed by mean pretest score was poor (3.698 ± 1.81). The students' baseline knowledge was significantly associated with mother's educational status (P = 0.024). There was a significant increase (mean difference was 1.7890 ± 0.1434) in the nutrition-related knowledge of the participants after the intervention (P < 0.001). The proportion of students who improved, i.e., 147 (55.47%) was more than proportion who deteriorated (25 [9.43%]) after the educational session. This difference was found to be statistically significant (P ≤ 0.001). CONCLUSION: Nutrition knowledge was found poor among school-going adolescent girls, which significantly improved after the nutrition education session.

BACKGROUND: Health promotion of adolescents requires appropriate evidences of its determinants. The aim of this study was to investigate predictors of self-rated health (SRH) among adolescents in Qazvin, Iran. MATERIALS AND METHODS: In this descriptive cross-sectional study, with a multistage sampling method, we recruited 1740 adolescents aged 12–19 years from 53 schools in Qazvin, Iran (2018). We used the Strengths and Difficulties Questionnaire and Adolescents' Academic Stress Questionnaire for data collection. The analysis was conducted using a multilevel logistic regression model. Gender, educational period, and socioeconomic status were considered as confounders. RESULTS: Almost 21% of the adolescents reported their SRH suboptimal. Suboptimal SRH was higher in girls and older adolescents. Mental health disorders and academic stress had a positive association with SRH. However, this association was negative for academic achievement and physical activity. The interaction between mental health disorders and academic stress with SRH had a significant association in a crud regression model. CONCLUSION: Mental health, academic stress, academic achievement, and physical activity were important predictors for SRH. Interventions that focus on promoting mental health, academic stress, academic achievement, and physical activity such as physical activity for 1 h and each day for 3 days per week can improve SRH in adolescents. Hence, policymakers should pay more attention to this issue in health promotion programs of adolescents.

BACKGROUND AND PURPOSE: The World Health Organization has identified health literacy (HL) as one of the most important determinants of people's health. Therefore, this research aimed to investigate the status of HL and its predictors. MATERIALS AND METHODS: This research was a cross-sectional study that was performed on 600 adults in Bijar County, Iran. Cluster sampling was used to select the samples. Data were collected using the questionnaire of HL for Iranian adults. Data were analyzed using one-way analysis of variance, Student's t-test, and multiple linear regression in SPSS 21. RESULTS: The mean score of HL was 3.6 out of 5; 69% and 29% of the samples had a moderate-to-high health status, respectively. Among the dimensions of HL, the highest and the lowest means were perception (3.94) and evaluation (3.21), respectively. Based on the multiple regression results, the variables (gender – B = −0.142, confidence interval [CI]: −0.409 to −0.011, P = 0.39; education level – B = 0.391, CI: 0.149–0.287, P = 0.00; and income level – B = 0.203, CI: 0.00–0.00, P = 0.01) were significantly positively associated with HL. CONCLUSION: The results of this study can be applied to educational interventions through media and radio-television to increase public awareness. Education is also strongly recommended in terms of demographic variables and characteristics to promote HL in the society.

INTRODUCTION: Professionalism and medical ethics are a vital quality for doctors, which has been taken into account seriously in recent years. Perception of the factors affecting professionalism may help develop more efficient approaches to promote this quality in medical education. This study was aimed to explain the role of hidden curriculum in the formation of professional ethics in Iranian medical students. MATERIALS AND METHODS: This qualitative study was performed on 15 medical interns of Kermanshah University of Medical Sciences in 2019, using grounded theory. Sampling was started by purposive sampling and continued through theoretical sampling until complete data saturation. Data collection and analysis were done simultaneously. Data were interpreted by a constant comparative method according to Strauss and Corbin's approach. RESULTS: The analysis of the participants' interviews and reduction of findings using common themes yielded one class and four categories as well as a number of concepts as the role of hidden curriculum in the formation of professional ethics in medical students. The categories included the role of modeling in the formation of professional ethics, role of education in the formation of professional ethics, role of environmental factors in the formation of professional ethics, and role of personal and inherent attributes in the formation of professional ethics. CONCLUSION: Curriculum developers and medical education authorities need to proceed in line with the findings of the present study to provide a proper learning environment, in which the modeling, learning, and teaching conditions and supportive environmental atmosphere are taken into account in accordance with the inherent and individual characteristics of the learners in order to guarantee the formation of professional ethics in medical students.

CONTEXT: Pap smear test is one of the most important actions in preventing cervical cancer. This study aimed to perform a meta-analysis on all related literature about the effects of health belief model (HBM)-based training on Pap smear screening test performance of Iranian women. METHODS: The search was performed in Scopus, PubMed, and Web of Science. Eligibility criteria were limited to English and Persian language articles with experimental or semi-experimental methods until October 2019 that evaluated the effect of HBM-based training on Iranian women's performance of Pap smear test. We excluded studies that used both cervical and breast cancer screening together. RESULTS: Twelve studies were performed on totally 1605 participants. This meta-analysis showed that all of Health Belief Model (HBM) constructs improved significantly among HBM-based trained women, perceived susceptibility (standard mean division [SMD] =0.785; P = 0.002; confidence interval [CI] = 0.005 to 1.56; Heterogeneity; P = 0.013; I²⁼ 97%)., perceived severity (SMD = 1.14; P = 0.001; CI = 0.66–1.62; heterogeneity; P < 0.001; I²⁼ 92%), perceived benefits (SMD = 1.25; P = 0.001; CI = 0.545–0.135 heterogeneity; P = 0.003; I²⁼ 97%), perceived barrier (SMD = 0.20; P = 0.001; CI = 0.44–1.24; heterogeneity; P < 0.001; I²⁼ 92%) and perceived self-efficacy (SMD = 0.638; P < 0.001; CI =1.76–0.426; heterogeneity; P < 0.001; I²⁼ 97%). CONCLUSION: Cervical screening education program based on the HBM can be effective on Iranian women's performance in their perceived susceptibility, perceived severity, perceived barrier, and perceived self-efficacy about Pap smear test.

INTRODUCTION: Use of technology and ICT tools is ubiquitous among college students including medical students. However overuse or misuse may lead to many physical and psychological problems including the risk of harming professional standing in the long term. The purpose of this study was to explore techno stress among freshmen at a medical institute and to suggest measures to reduce problematic use of technology pertaining to internet. OBJECTIVES: (i) To explore the extent of technology use including internet among medical freshmen, (ii) To identify the content of usage (iii) To quantify the extent of techno stress and iv. To suggest measures to reduce problematic use of technology. MATERIALS AND METHODS: The sample comprised all the freshmen at a medical institute (n = 61). A semi structured questionnaire was used to collect socio demographic details of students and their patterns of technology usage. Perceived Stress Scale was used to measure stress. RESULTS: The mean age of the sample was 18.34 (±0.58) years comprising 68% males and 32% females. Students spent a mean time of 3.96 h/day on the technology tools (standard deviation = 4.99). Ninety-two percent of the students used technology for educational purposes followed by entertainment (89%), social networking (77.78%), watching films (70.37%), communication (66.67%) and watching pornography (46.3%). 11.47% had symptoms suggestive of problematic internet use. One percent had craving suggestive of addiction. All these had stress out of which 43% had high and 57% had moderate levels of stress. DISCUSSION: Considering the students' present usage of social media, it can serve as a potent academic tool. However, awareness is required to be raised with regard to its use as a medical professional. CONCLUSION: Use of technology is crucial in the current academic world and restrictions on usage may neither be practical nor feasible. However, understanding patterns of usage among students is a preliminary step that can enable educators and administrators to formulate guidelines to channelise their usage in more productive ways.

BACKGROUND: Recently, the Iranian Ministry of Health estimated about 750,000 deaths are attributed smoking complications. The aim of this study was to apply the transtheoretical model (TTM) on general population of Mashhad city to evaluate the stages of change and possible cultural factors regarding smoking cessation. METHODS: This descriptive, cross-sectional population-based study was conducted in Mashhad, Iran. A total number of 562 participants selected by multistage sampling. They were asked about stages of change for smoking cessation for both hookah and cigarette smoking. Stages of change refer to an orderly sequence of changes in smoking behavior that people progress through according to the TTM. Its six stages are as follows: precontemplation (PC) (no intention to quit smoking within 6 months), contemplation (planning to quit smoking in the following 6 months), preparation (planning to stop smoking within 1 month), action (quit smoking for <6 months), maintenance (stopped smoking for 6 months or more), and termination (will never smoke again). Data were analyzed using tests such as Chi-square, Kruskal–Wallis, and logistic regression by SPSS 11.5. RESULTS: About 18% and 19% of people in this study were regular hookah and cigarette smokers, respectively. There was significant difference between cigarette smoking and sex (P < 0.001) and marital status (P = 0.01). There was a statistically significant difference between stages of change in men and women from the point of cigarette smoking (P < 0.001). Male sex, hookah smoking, and alcohol abuse were predictors of PC, and age was the only predictor of termination stage for cigarette smoking. Sex did not have any role in hookah smoking. CONCLUSION: Targeted education based on gender and marital status warrant attention. Community-wide education and interventions such as increasing the price of cigarettes are desired.

INTRODUCTION: To design instructions in health sciences education, it is highly relevant to heed the working memory and the approaches for managing cognitive load. In this article, we tried to mention the implications of cognitive load theory (CLT) for optimizing teaching-learning in health sciences education and discussing cognitive load from the perspective of cognitive neurosciences as brain-aware medical education. MATERIALS AND METHODS: We searched databases of Pubmed, Proquest, SCOPUS, and ISI Web of Science for relevant literature in September 1, 2018. RESULTS: The 27 articles out of a total of 46 records, along with 23 papers from snowballing and hand searching were included in this study. Main items encompassed; “Various types of cognitive loads,” “Aim of cognitive load theory,” “Strategies to managing Cognitive Load,” “Cognitive Load Theory in novice and experienced learners and “expertise reversal effect,” Medical and Health Sciences Curriculums and Cognitive Load Theory,” “Challenges of Cognitive Load Theory.” CONCLUSIONS: We discussed six important themes for CLT in health sciences education according to the literature. Mental imagery (visualization) as one of the useful techniques to optimize germane load was suggested, as it processes further gain access to neural circuits that are engaged in sensory, motor, executive, and decision-making pathways in the brain.

BACKGROUND: The concept of electronic health literacy has become a main focus of health-care professionals along with the increasing use of the Internet. In Iran, the Internet not yet has much impact on providing health services, and the physicians' and patients' community are now more willing to use the traditional method for diagnosing disease and prescribing medicines. This study aimed to determine the correlation between electronic health literacy, quality of life (QoL), and self-efficacy among Tehran citizens. MATERIALS AND METHODS: The present study is a descriptive, cross-sectional study with a correlation approach that was conducted on 400 clients of community health centers of Shahid Beheshti University of Medical Sciences in 2019. Samples were selected by stratified random sampling method. Data were collected using E-Health Literacy Questionnaire (α = 0.88), 12-item Short-Form Health Survey (α = 0.73), and General Self-Efficacy Scale (α = 0.87). Analytic statistics were using by descriptive statistics (mean and standard deviation) and inferential statistics (Pearson correlation coefficient and regression analysis) at the significant level (P < 0.05). RESULTS: Correlation between electronic health literacy and QoL was 0.14 and with self-efficacy was 0.10, which was positive and statistically significant (P < 0.05). In addition, the correlation between QoL and self-efficacy was 0.33, which was positive, statistically significant, and moderate (P < 0.05). CONCLUSION: According to the findings of this study, it is possible to improve the QoL through the promotion of electronic health literacy and self-efficacy. The results of this study can be used as a basis for health service providers and policymakers in designing and implementing health-related interventions.

BACKGROUND: Postpartum depression is a significant common health problem that has negative effects on mental and physical health of mothers and their infants. The main purpose of this study was to investigate the relationship between spiritual well-being (SWB) and perceived social support with postpartum depression in new mothers. MATERIALS AND METHODS: Using a descriptive survey design, 200 mothers in the 4^th–8^th weeks after delivery, who referred to selected therapeutic centers in Qom Province, were selected by a convenience sampling method. They were asked to answer the question of the Edinburgh Postnatal Depression Scale, Multidimensional Scale of Perceived Social Support, SWB Scale, and Farhangestan Spiritual Health Questionnaire. Data were analyzed using Pearson correlation and Chi-square. RESULTS: The prevalence of postpartum depression in this group was 22%. Pearson correlation test showed that there was a negative correlation between high level of perceived social support and SWB with postpartum depression. CONCLUSION: The findings of this study suggest that perceived social support and SWB have an important role in low depressive symptom in mothers during postpartum. This result can help health-care professionals to pay much attention to social support and SWB as a protective factor against postpartum depression in postpartum or pregnancy care programs.

INTRODUCTION: Regular training in the blood transfusion process is crucial for transfusion safety. Hospital transfusion committees have an obligation to provide this education to hospital employees through training activities. E-learning is positioning itself as a valid alternative to physical-presence courses. MATERIALS AND METHODS: We describe a training course on blood transfusion to members of our hospital who are involved in the transfusion process, including technicians, nurses, and doctors. The course uses Moodle as the e-learning platform; it is evaluated using a satisfaction survey along with a knowledge-transfer and impact survey a year after taking the course. RESULTS: From 2015 to 2018, seven editions of the online transfusion course were developed. Six hundred and eighty students enrolled; of these, 124 did not take the final examination (18.2%); 60 never began the course (8.8%). Of the 556 students who completed the course, 546 passed (98.2%). The average score from the initial self-assessment was 7.3 while the average score from the final self-assessment was 9.2; the mean improvement was 1.9 (out of 10). The level of general course satisfaction was 9.27 (an average out of 10). More than 90% of the students stated that they were able to apply the acquired knowledge in the workplace after a year. CONCLUSIONS: E-learning has demonstrated itself as an affordable solution that could help in the training of all staff involved in the transfusion process at our hospital, with the advantage that it includes general knowledge and particular skills in local transfusion medical practice.

INTRODUCTION: Disciplinary-based information literacy (DIL) or professional-related information literacy has not been widely studied in the academic context, including medical sciences. This study aimed at investigating the status of DIL among medical students in an Iranian medical university. MATERIALS AND METHODS: This study was a cross-sectional survey. A random sample consisting of 298 students majoring in general medicine at Tehran University of Medical Science, Tehran, Iran, in the academic year of 2018–2019 completed a valid and reliable 20-item questionnaire on DIL. Data were analyzed using SPSS statistical software. RESULTS: Participants' DIL was less than expected, especially in the skills related to professional information access and evaluation. The majority of them had low DIL level. However, medical students in their last 2 years of study had significantly high scores in DIL than those in their first 2 years of study. CONCLUSION: Information literacy has not been seriously considered in health-related higher education in Iran. It is needed to consider DIL in the medical curriculum for training students to be proficient specialists in medical practice.

INTRODUCTION: Despite the progress of health care and the application of new technology in the care of patients, the need to train highly skilled and specialized nurses is inevitable. Given that a master's degree in neonatal intensive care nursing has been recently established in Iran, the aim of the study was to explain the educational challenges of neonatal intensive care postgraduate nursing students in their perspective. MATERIALS AND METHODS: This conventional content analysis was performed by conducting semi-structured interviews with 18 students of neonatal intensive care in X University of Medical Sciences from 2018 to 2019. Data were analyzed using conventional content analysis. To establish the reliability and validity of findings, Graneheim and Landman criteria were considered. RESULTS: Following the data analysis, two main categories were extracted: “theoretical education challenges” and “clinical education challenges.” The first main category was comprised of the following subcategories: “detachment of nursing department and hospital,” “defects in weekly scheduling,” “combination of care and treatment approaches in education,” “inconsistency between the content of theoretical courses,” “limited collaboration between basic science and medical departments,” “low number of lecturers,” “lecturers' unrealistic expectations,” and “the importance of the scoring system.” “Extended work shifts,” “a large number of students,” “lack of opportunity to do clinical practices,” “lack of training classes,” and “limited amenities in the hospital” were recognized as subcategories of the second category. CONCLUSION: Managers can address some of the students' challenges and provide the opportunity to enhance the quality of education through being familiar with, considering and meetings the needs and expectations of these students.

INTRODUCTION: Diet adherence may cause diabetes complications to be diminished. OBJECTIVES: This study aimed at identifying determinants of diet adherence among patients with Type 2 diabetes based on the health action process approach (HAPA). METHODS: In this cross-sectional study, 734 patients with Type 2 diabetes, attending to South Tehran health centers, were recruited during June–December 2018. The dietary regimen scale (nine items) and a researcher-designed questionnaire consisting of HAPA constructs were used to gather the data. Data were analyzed using the Mann–Whitney test, Pearson Chi-squared test, Fisher's exact test, and linear regression test. All statistical tests were assessed using SPSS (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY, USA: IBM Corp.). RESULTS: The level of nonadherence to diet was 91.1%. Diet adherence was significantly associated with family income (P = 0.005), level of education (P < 0.001), and age (P = 0.009). The linear regression showed that 55% of the variance of diet adherence was determined by HAPA variables. Diet adherence was associated with intention (P < 0.001), action planning (P = 0.005), and barriers (P = 0.003). CONCLUSION: Most of the patients did not adhere to their diet. Appropriate programs should be designed to promote diet adherence among the patients, especially those with low literacy and patients living in poor communities.

BACKGROUND AND OBJECTIVES: Because the performance assessment of the health system is used as the basis for decision-making and demonstrates progress or failure in achieving the goals of the health system, promoting the health system performance assessment can play a major role in improving and enhancing the health system. Therefore, the main aim of the study was to identify and prioritize the challenges of promoting the health system performance assessment. MATERIALS AND METHODS: There were two approaches in both qualitative and cross-sectional studies. At first, using semi-structured interviews with 52 performance appraisers, data related to the challenges of promoting the health system performance assessment were collected and thematically analyzed. Then, in cross-sectional terms, the performance appraisers were provided with researcher-made checklists which contained a list of challenges to determine the priority of challenges by scoring. The data were handled and analyzed using MAXQDA Plus version 12 and Microsoft Excel. RESULTS: Our results revealed five themes and ten subthemes on the challenges of promoting the health system performance assessment. Themes (subthemes) included infrastructures (cultural and technological), implementation (organizational support, process, and responsibilities), human resources (motivation and training), assessment (performance monitoring), and content of measures (reliability and validity). We also prioritized 31 listed challenges in three priority groups, including below average, average, and above average. CONCLUSION: Our findings suggest that promoting the health system performance assessment in Iran can be accomplished by allocating financial and nonfinancial motives to the performance assessment staffs, using performance assessment results in policymaking, clarifying tasks of assessment process executors, and reviewing and adapting the performance assessment indices according to contingencies in the health system.

BACKGROUND: Better preventive care is a prerequisite to foster community health and in reducing the unnecessary burden on the health-care system. The Unani System of Medicine has given due emphasis on preventive care. This article aims to discuss the health promotion and disease prevention approaches in Unani Medicine. MATERIALS AND METHODS: A manual literature survey of classical Unani texts such as Firdaus-al-hikmat, Al Qanoon-fit-tib, Kitab-al-mansoori, Kitab-al-kulliyat, and Kitab-al-taisir was conducted to collect the information available on the strategic approaches of health promotion and disease prevention in Unani Medicine. To obtain the appropriate English equivalent words for Unani terms and the scientific name of the drugs, “Standard Unani Medical Terminology” and “Classification of Unani Drugs” were consulted, respectively. RESULTS: The findings of the literature survey revealed that Unani physicians have advocated the personalized and predictive approaches for maintaining health and preventing diseases. Personalized approach mainly centers on the temperament of an individual. By determining an individual's temperament, Unani physician can tell what is adequate or not adequate for the individual. While in the predictive approach, correct knowledge of prodromal symptoms is a prerequisite to predict the future developments in the human body and recommending the appropriate preventive measures accordingly. CONCLUSION: These approaches present interesting perspectives in the field of promotive and preventive care and are of much relevance in the present scenario. Unfortunately, the lack of efficacy studies is a limiting factor in their application. Hence, effective protocol must be developed to provide evidence-based data and to give grounds for their widespread usage.

BACKGROUND AND AIM: Posttraumatic growth following traumas such as chronic illnesses can occur in some people. The psychological factors, such as cognitive emotion regulation (CER), can influence its formation. CER is a type of coping strategy that helps to efficiently deal with trauma. Due to the importance of the topic and the lack of sufficient studies on posttraumatic growth and CER in hemodialysis patients, this study aims to investigate the relationship between posttraumatic growth and CER in hemodialysis patients. METHODS: This is a descriptive study performed on hemodialysis patients in Bou Ali and Velayat hospitals in Qazvin. One hundred and sixty-two patients were selected by the convenience sampling method, and Garnefski Cognitive Emotion Regulation Questionnaire (α =0.92) and Tedeschi Posttraumatic Growth Questionnaire (α =0.96) were used. Data were analyzed using Pearson correlation and ANOVA tests. RESULTS: The results showed that the majority of the hemodialysis patients experienced some degree of posttraumatic growth. The participants achieved high scores in the domains of spiritual development and communication with others. Moreover, posttraumatic growth was positively and significantly correlated with CER (r = 0.67, P < 0.001). CONCLUSIONS: Hemodialysis provides the basis for the positive mental reactions known as posttraumatic growth in hemodialysis patients. Nurses and other authorities can use this phenomenon to adapt to illness and care planning.

INTRODUCTION: Brucellosis is one of the common diseases between humans and animals. The purpose of this study was to investigate behavioral determinants of brucellosis incidence among stockbreeders and their family members in a rural area based on the PRECEDE model. MATERIALS AND METHODS: This cross-sectional study was carried out among 540 stockbreeders and their family members in Northeastern Iran in 2019. Sampling was done in two stages including stratified sampling and random sampling method. Data collection was conducted by a valid and reliable questionnaire developed based on the PRECEDE model. Data were analyzed using SPSS16 through Pearson correlation coefficient, independent t-test, and ANOVA. Furthermore IBM SPSS AMOS version 20 was used for the path analysis. RESULTS: The mean age of the participants was 39.02 ± 16.41 years, of whom 53.1% and 46.9% were men and women, respectively. About 23.9% of the participants had a history of brucellosis in their families. Enabling factors were the most important determinant of self-efficacy and self-efficacy was the most important determinants of behavior. Evaluation of the chi-square indicators, chi-square ratio to degree of freedom, root mean square error of approximation, adjusted goodness of fit index, parsimony comparative fit index, comparative fit index, incremental fit index, and parsimonious normed fit index indices indicated that the model was well fitted and there was a positive and significant relationship between the predisposing, enabling, and reinforcing factors on the one hand and behavior on the other. chi-square indicators, chi-square ratio to degree of freedom, root mean square error of approximation, adjusted goodness of fit index, parsimony comparative fit index, comparative fit index, incremental fit index, and parsimonious normed fit index CONCLUSION: Designing and implementing health plans based on the PRECEDE model with more emphasis on self-efficacy as the most important behavioral determinants can bring about a positive effect on enhancing the brucellosis preventing behaviors.

INTRODUCTION: The educational service is expensive and having the right financial information is one of the most important tools for managing financial resources. Therefore, due to the importance of this issue, this study aimed to determine the cost of educational services for medical sciences students at Alborz University of Medical Sciences. METHODOLOGY: A cross-sectional study was conducted between March 20, 2018, and March 20, 2019, at Alborz University of Medical Sciences. The current and capital cost data were extracted from the university's financial database, and the cost price of services provided was calculated using the activity-based cost model. RESULTS: The mean annual cost of services per student was $4778, and the mean cost of education per hour was $113. The total cost price of services provided per student at the school was 65% for wages and salary, 26% for depreciation of building and equipment, and 9% for consumable goods and services. Furthermore, the share of different cost centers to the total cost price of services provided per student was 82% for educational services, 11.9% for student welfare services, and 6.1% for research services. CONCLUSION: Costs of personnel, especially pays to faculty members and the costs of capital expenditures, are the most important costs in higher education institutions. It seems reducing of pay to faculty members through novelty approach of education and evaluation, reducing capital expenditures through use effective of buildings and equipment that can be placed higher education institutions in the path to productivity.

INTRODUCTION: As a part of healthcare providers of the Health System Reform Program, midwives are required to master the necessary knowledge and skills to meet the related demands of society. This study was aimed to assess the knowledge and skills training needs of practicing midwives of health and medical centers of Isfahan. METHODS: This study is a descriptive cross-sectional study. The statistical target population was midwifery experts working in Isfahan health centers and the samples were selected through simple random sampling (sample size 250). Data were collected by two questionnaires to assess knowledge and skill needs. The validity of the questionnaires was confirmed by experts of the province and city health centers and medical education experts and its reliability was calculated by Cronbach's alpha (98%). Data were analyzed using SPSS 23 software and descriptive and analytical statistical methods (frequency, mean, variance). RESULTS: The first five knowledge training priorities of employed midwives in health and medical centers, which comprise most of the means values, are pregnancy complications and abnormalities (3.64 ± 1.21); mammography and its interpretation (64.3 ± 1.30); skills and principles of parenting (3.59 ± 1.24); shortness of breath and palpitations during pregnancy (3.58 ± 1.16); and common mental disorders (3.57 ± 1.16). The most important skills training needs were Excel (1.21 ± 3.59), PowerPoint (27.1 ± 54.3), internet (3.52 ± 1.25), and parameters registration and reporting in the SIB system (3.49 ± 1.28). Employed midwives of the health and medical centers displayed a significant difference in feeling the need for training in some subjects. CONCLUSION: Needs assessment is the foundation of purposeful training, and better training leads to improved performance of personnel and organizations. Therefore, it is imperative that reliable and documented data be utilized for promotion and improvement of in-service training programs of employed midwives of the health and medical centers of Isfahan province and also for revising university curriculums. Taking these measures would lead to the empowerment of personnel and general development of society.

BACKGROUND: Health communication is a field that uses social and behavioral models to improve health outcomes and raise awareness on major health risks that threaten human well-being. Low-income countries (LICs) suffer from the effects of communicable and noncommunicable diseases that are exacerbated by weak health-care systems, lack of awareness campaigns, and ineffective communication tactics. This work aims to explore health communication research in LICs to find strategies that help improve health outcomes in the future. MATERIALS AND METHODS: The PubMed database was explored systematically for publications related to health communication from LICs between January 1, 1960, and January 1, 2020. Publications were categorized according to country of origin and were analyzed with respect to population size, gross domestic product (GDP), and primary school enrollment of each state as obtained from the World Bank Open Data. RESULTS: Collectively, LICs published 796 contributions, comprising 1.08% of the total biomedical research published by LICs and 0.27% of the world's health communication research. Malawi had the highest number of publications per GDP, with 32.811 publications per billion US$. Uganda had the most contributions per population, with 9.579 publications per million persons. Ethiopia had the highest amount of contributions per primary school enrollment with a ratio of 2.461 publications per %gross. The role of health communication in promoting HIV awareness and prevention was the most common theme explored. Other infectious diseases, such as malaria, tuberculosis, and Ebola, were also highlighted. Improving communication in health education was also explored. CONCLUSION: Health communication is a rising field in LICs, with research focusing on disease prevention. Efforts to amplify research are key to effectively utilize the health communication models and improve health outcomes in LICs.

INTRODUCTION: Different types of learners based on sensory modalities are observed. Cognition or physiological alterations in the sensory pathways might play its role in different modalities of visual, auditory, read and write, and kinesthetic learners which are based on different sensory modalities of perception OBJECTIVE: The objective of this study is to ascertain an objective parameter (neurophysiological parameters) for the classification of learners based on their preferred sensory modality MATERIALS AND METHODS: An experimental cross-sectional study was conducted among 100 medical students. Learners were classified into visual, auditory, read-write, and kinesthetic learners based on the interpretation drawn on the basis of the VARK questionnaire. Sensory-evoked potentials (SEPs), including pattern shift visual (PSVEPs), brain stem auditory (BAEPs), short-latency somatosensory (SSEP), and event-related potentials (P300) were measured. SEPs measured in microvolts were recorded from the scalp with the help of active and reference electrodes. Multiple responses to sensory stimuli (using NIHON KOHDEN Corporation Neuropack X1, Tokyo, Japan) were recored and averaged using the computerized signal averging technique. RESULTS: No statistically significant difference was observed in conduction velocities (in terms of latency and amplitude) of SEP among different type of learners, except latency N145 wave form in VEP (P < 0.05). A characteristic pattern of minimal comparative latency was observed among the majority of visual learners. Similary, P300 has shown a characteristic pattern of decreased comparative latency among majority of read and write learners. CONCLUSION: Study findings suggested that among existing teaching and learning modalities, visual modalities were observed faster but to retain it in memory and for abstract thinking, students should utilize read and writing skills which are lacking in the era of digitalization and overuse of electronic devices.

BACKGROUND: Today, one of the biggest concerns of parents is protecting their children and properly educating them about sex. The aim of this study was to determine the effect of educational intervention on parental skills in sex education on their children in elementary schools in the northwest of Tehran-Iran in 2019 based on literature. MATERIALS AND METHODS: This quasi-experimental study was conducted on 125 parents of elementary schoolchildren in the northwestern of Tehran. The data were collected by valid and reliable questionnaire. Before the intervention, two intervention and control groups filled up the pretest questionnaire; the data were collected by valid and reliable questionnaire. Before the intervention, two intervention and control groups filled the pretest questionnaire, and then the parents participated in the educational program based on dramatic literature. Two months later, the same questionnaire was completed by the control and intervention groups. Finally, the data were analyzed by regression and one-way ANOVA test. RESULTS: The results showed that there was a statistically significant difference between the mean scores of knowledge in the experimental and control groups in the posttest (P < 0.01). There was also a statistically significant difference between the mean scores of attitude in the experimental and control groups at the posttest stage (P < 0.01). There was also a statistically significant difference between the mean scores of performance based on group membership (experimental group and control group) in the posttest phase (P < 0.01). CONCLUSIONS: The findings of the study showed that educational intervention on parental skills in sex education based on the dramatic literature to their children has significant effect on parental knowledge, attitude, and performance.

BACKGROUND: In the 21^st century, with the epidemiological and demographic transition and the changing nature of diseases and the increase in the burden of chronic diseases, the need to strengthen primary health care and the development of the family medical program as a strategy is felt significantly. AIM: The purpose of this study is to compare the model of implementation of family physician program (FPP) in the United States, England, Germany, Singapore, Turkey, Egypt, and Iran. MATERIALS AND METHODS: This is a comparative study that examines the model of family physician implementation in selected countries. Data for each country were gathered from the valid databases, were compared according to the comparative table, and analyzed by a framework approach. In order to assure the validity of data, the researchers referred to the websites of the selected nations' Ministry of Health and also cross-checked the findings with reports published by the World Health Organization. RESULTS: In this study, we used the Control Knobs framework to compare countries' FPPs because the framework can demonstrate all necessary features of national health system programs. This framework includes governance and organization, regulation, financing, payment, and behavior in each country. The results of this study show that although the principles of FPP in the selected countries are almost common, they use different methods in FPP implementation. CONCLUSIONS: As the success of any policy depends on the political, economic, social, and cultural context of each country, considering these factors and reinforcing each of the control knobs are critical to the success of the family physician's policy implementation.

BACKGROUND: Underweight is still prevalent in developing countries like India. Prepregnancy body mass index (BMI) is used as the standard against which the measurements are made in pregnancy. AIM: To study the association between early pregnancy BMI and feto-maternal outcome among nulliparous women METHODOLOGY: This is a prospective observational study, with a sample size of 294. The antenatal patients were categorized into four categories of BMI according to the WHO classification, and pregnancy outcomes were compared. Data were analyzed using SPSS Software Version 17.0. Statistical tools used were percentages and mean, and categorical variables were analyzed by Chi-square statistics. RESULTS: 48.94% of the patients enrolled in the study had normal early pregnancy BMI, and 44.22% and 6.8% were underweight and overweight, respectively. Obese women who gained more weight were at a higher risk of preterm delivery, cesarean section, and more time required for resumption of normal routine. Underweight women were at higher risk of postterm delivery, low birth weight, and increased hospital stay. CONCLUSION: Adverse maternal and fetal outcomes are seen more commonly with the extremes of BMI.