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.

INTRODUCTION: Nurse educators need to develop the level of scientific and practical of the students with the goal of becoming expert nurses. However, the use of modern educational methods to raise the motivation and satisfaction of learners can help individuals achieve this goal. Therefore, the aim of this study was to investigate the effect of health education in emergency nurses about triage. METHODS: A two-group pool-blind experimental study was performed on seventy emergency nurses. Samples were randomly assigned into two groups: e-learning group (35 individuals = electronic education) and traditional group (35 = workshop education). The demographic questionnaire and the satisfaction questionnaire before and 2 weeks after the intervention in both groups were completed. RESULTS: Independent t-test showed that the satisfaction scores before intervention in both e-learning and traditional groups were not statistically significant, whereas there was a significant difference between two groups after 2 weeks after the intervention (P = 0/015). CONCLUSION: Using nursing professors' electronic education programs can increase the level of satisfaction and motivation in the nursing mothers. Therefore, the use of this new educational method is recommended by managers and educational planners as an effective teaching.

INTRODUCTION: In spite of our general knowledge about psychological roots and defects of developmental processes in the formation of somatic symptoms, the effect of the interaction of developmental components with cognitive-emotional variables is unclear. Previous researches suggest that individuals with insecure attachment may have a higher risk to experience of somatic symptoms. The main aim of this study is “Modeling the Relationship between Attachment Styles and Somatic Symptoms with the Mediating Role of Emotional Processing.” MATERIALS AND METHODS: This study was a descriptive-correlational study. Two hundred and twenty individuals aged 18–59 years living in Tehran were selected by available sampling from the general population. Collins and Reed's Adult Attachment Scale, Baker's Emotional Processing Scale, and Patient Health Questionnaire were used to collecting data. Data analysis was performed by Pearson correlation and independent t-test. The conceptual model presented in this study was tested with a path analysis approach. RESULTS: Given the Chi-squared size (χ² = 1.214; P > 0.05), it can be said that the proposed conceptual model fits well with the observed model. Besides, checking the other absolute and relative indices also shows a very good fit of the model. CONCLUSION: Our results showed that when the reciprocal effects of attachment styles were controlled, secure attachment could be considered as a protective factor against deficits in emotional processing and somatization of negative emotions. On the other hand, we found that when the dominant attachment style in individuals was anxiety based, it could be possible that they experience deficiency in the processing of emotion and more severe somatic symptoms.

BACKGROUND AND OBJECTIVE: Osteoarthritis (OA) is a chronic degenerative disorder which primarily affects the articular cartilage of synovial joints followed by bony remodeling and overgrowth at the margins of these joints. The consequences of OA are pain, joint stiffness, decreased muscle performance, and decreased aerobic capacity, which eventually affect the quality of life (QOL) and increased risk for disability. The objective of the present study was to investigate the effectiveness of two nonpharmacological treatment regimens, that is, yoga and conventional physiotherapy, on QOL in patients suffering from OA of knee joint. MATERIALS AND METHODS: A total of 83 patients with bilateral OA of knee joint, between the age group of 40 and 80 years, both males and females, were assigned into two groups using computer-generated scheme: 43 in the experimental group (yoga with conventional physiotherapy program) and 40 in control group (conventional physiotherapy program). Western Ontario and McMaster Universities OA index (WOMAC) and Short-Form 36 (SF-36) health survey were measured before, after 15 days, and after 30 days of treatment sessions, and the data were analyzed using paired and unpaired t-test. RESULTS: The results of the study show significant improvement in both groups with regard to WOMAC and SF-36 at the end of 15 and 30 days of treatment regimen; however, when compared to the control group, experimental group had more significant improvement (P < 0.05) in WOMAC and SF-36 at the end of 15 and 30 days of treatment. CONCLUSION: Yoga is more beneficial when added to conventional physiotherapy treatment regimen in promoting health and improving QOL in patients with OA of knee joint.

BACKGROUND: Mental health is one of the major determinants of a person's health which has a significant impact on the quality of life. Implementing of mental health training programs for promotion of health affected teenage girls to premenstrual syndrome (PMS) in Shiraz, southern Iran: a community-based study. MATERIALS AND METHODS: This study is randomized controlled trial done on 100 teenage girls affected to PMS in Shiraz-Iran (selected from400 girls). Multistage cluster sampling method was used f or sampling. In the intervention group, six training sessions were held twice a week for 2 h. For data collection, Standard Goldberg Mental Health Questionnaire-28 and Premenstrual Symptoms Screening Tool were used. For data analysis, independent t-test and Chi-square statistics were used at significant level of 0.05. RESULTS: The average age was (16.56 ± 0.92) and (16.24 ± 1.45) in the intervention and control groups, respectively. The average intensity of physical complaints, level of anxiety and sleep disorder, level of social functions disorders and depression were significantly lower in the group of training classes than control group (P < 0.001). CONCLUSION: Appropriate training-care programs are effective in reducing stress and improving mental health, prevention and treatment of mental disorders, emotional growth, and development of communication skills among female students with premenstrual syndrome.

BACKGROUND: Many kidney transplant recipients lack the knowledge, abilities, and support they need for self-care. On the other hand, most kidney transplant centers do not have a well-planned and specific training program for them, and educational interventions for kidney transplant recipients have not been adequately effective. This study aimed to describe strategies for improving patient education in kidney transplantation. MATERIALS AND METHODS: Data were collected through semi-structured individual and group interviews with 24 patients, family members, and health-care staff in one of the main kidney transplant centers in Tehran. Participants were selected purposefully, and qualitative content analysis was used to analyze the data. RESULTS: The main finding emerged from the data was the shift from current patient education program to patient- and family-centered education (PFCE). The strategies to achieve this goal were categorized into four main categories including “continuous patient and family education” (pre- and posttransplant patient education), “facilitating the process” (using new technologies, teamwork education, and patient and family accessibility), “strengthening human resources” (empowerment health-care team, allocation of human resources, promoting staffs' motivation, and updating educational content and materials), and “monitoring and evaluation” (correcting patient education recording, supervising the patient education, and appropriate educational evaluation). CONCLUSIONS: Transforming from the current patient education program to PFCE seems to be essential to increase the effectiveness of patient education in kidney transplant process. To this end, providing continuous patient and family education, facilitating the processes, strengthening human resources, and monitoring and evaluation in health-care organizations conducting the kidney transplantation is necessary.

INTRODUCTION: Psychological factors affect the tendency of individuals toward cosmetic surgeries although their contribution has not been clearly understood. Therefore, the current study aimed at comparing the emotional intelligence, body image, and quality of life between rhinoplasty candidates and the control group. METHODS: The current case–control study was conducted on 160 individuals referring to Rhinoplasty Clinic of Imam Reza Hospital in Tabriz, Iran, from 2018 to 2019. The tools used in this study including demographic information, Schering's emotional intelligence questionnaire (α = 0.75–0.85), the 36-item Short Form Health Survey Questionnaire (α = 0.75), and body image (α = 0.77–0.91) were used to collect data. Data were analyzed by the Kolmogorov–Smirnov and t-tests for the two independent groups. P < 0.05 was considered as the level of significance. RESULTS: There was no significant difference between the groups in terms of the overall mean of emotional intelligence and its subcomponents (P > 0.05), except social skills, such as self-awareness (P = 0.019). Appearance evaluation and appearance orientation variables were statistically significant between the two groups (P < 0.05), while the quality of life was not statistically significant (P = 0.051). CONCLUSION: In the psychological parameters studied, we found that the appearance evaluation and social skills of the rhinoplasty applicants are low, and it is better to have interventions before the rhinoplasty in people who have difficulty with these variables.

CONTEXT: Universities of medical sciences are responsible for educating and training human resources (HRs) that provide services to all members of the community. Clinical educators play a significant role in the promotion of health and education in medical sciences universities. AIMS: The aim of this study was to prioritize and develop a model to illustrate the relationship between faculty recruitment challenges in medical sciences universities. SETTINGS AND DESIGN: Interpretive structural modeling (ISM) is a system design method initially introduced by Warfield (1974). This method helps create order in the complex interconnections between components of a system by interpreting the opinions of a group of experts. It both determines the priority of elements influencing one another and uncovers the association between the elements of a multipart set in a hierarchical structure. SUBJECTS AND METHODS: In this method, the identified challenges were built into a paired comparison questionnaire to be completed by policymakers and experts. By the same token, the obtained results were analyzed with the ISM technique. STATISTICAL ANALYSIS: The four steps include identified variables related to the issue, structural self-interaction matrix, initial reachability matrix, and final reachability matrix was used for analysis. According to these steps, the ISM model was portrayed. RESULTS: The ISM model was developed in ten levels that divided into three parts including key challenges, strategic challenges, and dependent challenges. CONCLUSION: Health promotion and quality of education in medical sciences universities is dependent on quality of faculty recruitment system. According to the results, it is imperative that HR managers and policymakers improve existing rules and develop policies to solve the challenges in this area.

INTRODUCTION: Midwifery screening is one of the duties of midwives according to national guidelines. It is possible to increase midwives' knowledge and practice through effective education. The aim of this study was to compare the effect of standardized patient-based education and feedback lecture on midwives' knowledge and practice in screening counseling for fetal malformations. METHODS: This quasi-experimental, two-group study (standardized patient-based training and feedback lecture) was performed on 67 midwives (licensed by the office) in Mashhad in 2018. Midwives' knowledge and practice before and 2 weeks after training (a 4-h training program) were assessed by the Objective Structured Clinical Examination and a questionnaire. The data were analyzed by the SPSS software version 16 using Mann–Whitney, Chi-square, Wilcoxon and independent t-test while P < 0.05 considered as a significant level. RESULTS: Before intervention, the total score of knowledge and practice showed no statistically significant difference between the two groups (P > 0.05). After intervention, knowledge score in feedback lecture group was statistically significantly higher than that of standard patient group (P < 0.001). In addition, there was no statistically significant difference in performance scores between the two groups after intervention (P = 0.761). CONCLUSION: Both educational methods can increase midwives' knowledge and practice in fetal screening counseling. However, in raising midwives' awareness, feedback lecture group was more effective than standard patient group.

INTRODUCTION: Sexual problems in elder people are considered as a public health concern and can affect their overall health and quality of life. This study aimed to investigate the sexual quality of life and its relationship with general health in older men in the west of Iran. METHODS: This was a cross-sectional study among 362 older men aged 60 years or older attending Comprehensive Health Care Centers in Ilam, Iran. Samples selected through Quota sampling method and simple random sampling. Data were collected using the Sexual Quality of Life Questionnaire-Male and General Health Questionnaire-28. RESULTS: The mean ± standard deviation (SD) of age was 69.9 ± 8.1 years. The mean ± SD score of sexual quality of life and general health of older men was 46.6 ± 14.6 and 19.2 ± 9.7, respectively. A positive and significant association was found between sexual quality of life and general health (P < 0.001, r = −0.41). Moreover, general health, age, sleep problems, and the level of education were the important predictors for sexual quality of life in elder men (P < 0.05). CONCLUSION: According to the results, the sexual quality of life of participants was at a moderate level. Since only some factors influencing the sexual quality of life were ascertained, further studies are required to investigate all factors influencing older men's sexual quality of life.

CONTEXT: Emotional communications play an important role in having a satisfying relationship and a more successful marriage. If marriage does not provide suitable conditions to satisfy couple's needs, not only it does not help to mental health but also results in negative and irreversible effects. AIMS: This research was performed with the aim of determining the impact of emotional intelligence training on marital satisfaction, sexual quality of life, and psychological well-being of women. SETTINGS AND DESIGN: The present research is an experimental study conducted on 70 women referring to community health centers of Shahid Beheshti University of Medical Sciences in 2019. SUBJECTS AND METHODS: The sampling was performed using multistage cluster sampling. Before implementing the training intervention, the research instruments (general questionnaire, Kansas Marital Satisfaction Scale, Iranian version of Sexual Quality of Life-Female questionnaire, and World Health Organization Five Well-Being Index) were provided to the participants in order to complete them. All participants recompleted the instruments immediately and 1 month after the training intervention. STATISTICAL ANALYSIS USED: The significance level was considered as P < 0.05. RESULTS: The mean scores of marital satisfaction in the control group had no significant difference before, immediately after, and 1 month after the intervention (P = 0.895). However, in the intervention group, over time, the mean scores of marital satisfaction increased (P = 0.001), and the difference between the two groups was significant (P < 0.001). The mean scores of sexual quality of life and psychological well-being had no significant differences before, immediately after, and 1 month after the intervention in the control group. However, in the intervention group, over time, the mean scores of sexual quality of life and psychological well-being firstly increased and then decreased (P < 0.001), and the difference between the two groups was significant (P < 0.001). CONCLUSIONS: Training the components of emotional intelligence can be effective on enhancing marital satisfaction, sexual quality of life, and psychological well-being of women.

BACKGROUND: Latinos in the U.S., one of the fastest growing minority population, have low health-related knowledge and higher rates of diabetes and obesity. AIM: The study aims (1) to assess health-related knowledge levels and change in knowledge levels after brief educational intervention and (2) to assess undiagnosed diabetes, hypertension, and hypercholesterolemia in adult Latinos residing in Immokalee, Florida. A total of 164 participants completed pre–posttests while 161 participants took part in health screenings comprising blood pressure (BP), total cholesterol (TC), blood glucose (BG), and body mass index (BMI). METHODS: Health-related knowledge levels were assessed using 10 questions before and after the educational intervention via face-to face interviews. BP was measured using automated sphygmomanometer, BG and TC were measured using lipid and glucose analyzer, waist circumference using inch tape and BMI using digital scale. T test and Chi square were used to examine the differences in knowledge levels and distribution of screening results across demographic characteristics and self-reports respectively. RESULTS: Mean age was 40.1 ± 13.3 years; there were 77 males and 87 females. The knowledge levels based on 10 questions increased by 1.43 (0.42) after educational sessions (P < 0.001). Participants with college degree had statistically significantly higher pre–posttest scores than those with no formal or less than high school education (P = 0.041). More males than females had high BP in the age groups of 18–44 and ≥45 years (P < 0.001). More males in the age group of 18–44 years had high TC (P = 0.024). Differences between screening results and self-reports for diabetes and BP were statistically significant (P < 0.001 and P = 0.01, respectively). Mean BMI was 28.5 ± 5.1 and waist circumference was 38.6 ± 4.8 inch. Mean random and fasting BG levels and TC were higher in females than in males (P = 0.003, P = 0.022, and P = 0.004, respectively). CONCLUSIONS: The study highlights undiagnosed diabetes and hypertension in Latinos and more Latino males than females to have hypertension and hypercholesterolemia. Latinos' vulnerability to chronic diseases and associated complications is further confounded by limited health knowledge. However, the results of the brief educational program were encouraging and have implications in setting up structured educational interventions in health clinics and migrant education programs.

BACKGROUND: Medical students face a variety of challenges during their years of medical education that can affect their quality of life (QOL). This study aimed to investigate the association of QOL with physical activity (PA), depression, and demographic characteristics, as well as to determine its predictors among medical students in different stages of education. METHODS: A cross-sectional descriptive-correlational study was conducted on 186 medical students of Tabriz University of Medical Sciences in different educational stages including basic sciences, physiopathology, externship, and internship using stratified random sampling method. Data were collected using demographic questionnaire, International PA Questionnaire, World Health Organization QOL Questionnaire, and Beck depression inventory-2. Data analysis was performed using SPSS/Ver 23 through descriptive and analytic statistics including one-way analysis of variance, independent t-test, Pearson and Spearman correlation coefficient, and multivariate linear regression model. RESULTS: There were significant differences in total score of QOL among students in different stages (P < 0.05). There were indirect significant correlations between total score of QOL (β [confidence interval 95%]:−0.85 [−1.11–−0.59]) and its all subdomains with Beck depression score but direct significant correlations with total PA (P < 0.05) except for social relationship. Educational stage, employment status, family income, inhabitant, moderate PA, and depression were the predictors of QOL and altogether explained 63% of its variance. CONCLUSIONS: To pay attention to the predictors of QOL, life among medical students seems necessary for increasing their QOL to provide high-quality care for people with disabilities as well as for the whole community.

OBJECTIVE AND AIM: Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases. The patient's fear and anxiety of shortness of breath and coughing during exercise may lead to a decrease in patients' daily activities. Therefore, the present study aimed to determine the effect of empowerment program based on the social cognitive theory (SCT) on the daily activity of patients with COPD. METHODS: This quasi-experimental study was performed on 70 patients with COPD referred to Kashani and Hajar centers in 2019. Samples were randomly divided into two groups of experimental and control. Data collection tools included demographic information questionnaire and activity of daily living questionnaire, specific for COPD, and a researcher-made questionnaire for measuring SCT constructs. For the experimental group, the training program consisted of four theoretical and practical sessions of 40 min/week. The data were collected at three time points, before, immediately and 3 months after the training are 3 time. The data were analyzed by SPSS software using descriptive and inferential statistics. RESULTS: The difference between the mean scores of behavioral ability, self-efficacy, and empowerment in the three stages was significant only in the experimental group (P < 0.001). The mean daily activity score of patients before, immediately, and 3 months after intervention showed a statistically significant difference between the two groups (52.46 ± 21.98, 63.36 ± 21.95, and 71.34 ± 19.02), respectively, in the intervention group, and (51.79 ± 19.29, 53.70 ± 19.28, and 53.82 ± 19.26), respectively, in the control group (P < 0.001). CONCLUSION: The results of this study showed that empowerment of patients through interventions based on SCT can increase the daily activity of patients with COPD. Because nurses play an important role in patient education and improvement, it is hoped that the findings of this study will be used as a strategy to increase the daily activity and ultimately improve the quality of life in these patients.

INTRODUCTION: Investigating severe maternal morbidity and near-miss cases are applied internationally as a new indicator to examine the quality of maternal care and as an effective strategy to reduce maternal mortality. This study aimed to determine the root causes of severe maternal morbidity in order to improve maternal health. MATERIALS AND METHODS: The present research is a descriptive case series study. The data was obtained from the hospital and health records of mothers admitted to hospitals affiliated to Isfahan University of Medical Sciences due to severe morbidity in the first 6 months of 2018, which were selected randomly. The data collection was completed by interviews with the mentioned mothers and 14 related health-care staffs and that led to the development of the morbidity story. The compiled story of each case was evaluated by the root analysis team's opinion. Causes of morbidity were determined according to a root cause analysis checklist composing of factors such as health-care services (human and structural factors), family-social status, and disease status of maternal morbidity. RESULTS: The findings indicated that human factors related to the health system led to severe maternal morbidity more than any cause. Inadequate knowledge and skills of service providers, disregard for guidelines and protocols, lack of teamworking, and lack of considering competency were the most important human factors. Disease condition, family, and social status were the other related factors, respectively. CONCLUSION: Human factors are the most important cause of maternal morbidity based on the results of this study. Therefore, modifying the health structure can be one of the most important reducing factors for maternal mortality in order to improve the services for these individuals.

INTRODUCTION: Social media is becoming a new tool for developing health knowledge management. However, despite the rapid growth of research in this area, few attempts have been made to review previous research. This study tried to summarize the opportunities and challenges of using social media to managing health knowledge. METHODOLOGY: This article used a narrative approach to collect and review studies. In this review, published documents during 2010–2019 were retrieved by search in the following three electronic scientific databases: Web of Knowledge, PubMed, and Google Scholar search engine using keywords including social media, public health, health knowledge, knowledge management, and health promotion. RESULTS: Social media by overcoming geographical barriers, developing health promotion, facilitating decision-making, and providing public health education has been able to enhancing health awareness and improving health behavior. Doctors' unwillingness to interact with the public, lack of compliance with the principles of medical ethics, users' privacy concerns, and difficulty of managing negative comments are the four challenges to health knowledge management in social media. CONCLUSION: Social media can be a suitable tool for developing health knowledge management processes if medical professional ethics and users' privacy managed properly.

AIM: This study aimed to investigate the effect of school-based interventions on mental health among adolescents in the southeast of Iran. METHODS: This interventional quasi-experimental study included a total of 420 adolescent girls studying 10^th grade in the public schools of Zahedan, Iran. Data were collected using general health questionnaire-28 questionnaire. After pretest, multidimensional interventions (individual education, group education, individual consultations, modern education, and parents' educational packages) were given to the intervention group from October 2015 to June 2016. After a 3-month interval, the posttest was conducted in October 2016. Data were analyzed by covariance analysis. RESULTS: There was a significant statistical difference between the changes in the mental health scores after the intervention among the two study groups (P < 0.05). Furthermore, after the intervention, moderate-to-severe mental health problems decreased considerably among the students in the intervention group compared to controls. The greatest impact was on individual psychological counseling. CONCLUSIONS: The results of the study showed that by applying group training and individual counseling in the schools improves mental health. Therefore, identifying student problems and parent–teacher cooperation as well as consulting with specialist counselors can be effective in providing practical and effective solutions in this regard. Therefore, findings suggest that prioritizing mental health and taking action on the field are of utmost importance.

BACKGROUND AND AIM: Given the absence of a scale specially designed to measure willingness to mobile learning (m-learning) in medical sciences students, the present study was conducted to design and evaluate the psychometric properties of “willingness to m-learning” scale for medical sciences students. METHODOLOGY: The study was carried out as a mixed-method study in two phases at Saveh University of Medical Sciences in 2019. Phase one was a qualitative study to elaborate on the students' perception of m-learning. Then, the statements were extracted, and statement pool was completed through reviewing the text. In the second phase, the psychometric properties including face, content, and construct validities (using explorative factor analysis), internal consistency (Cronbach's alpha), and test–retest reliability (intercluster correlation test) were measured. A total of 482 students who were selected randomly participated in the second phase. Data analysis was done with MAXQDA software (VERBI Software 2019, Berlin, Germany) for qualitative data and SPSS 19 software (SPSS Inc., Chicago, IL, USA) for quantitative data. RESULTS: Based on qualitative content analysis and literature review, 92 statements were extracted. After checking face and content validity, 55 statements remained in the study. Construct validity of the questionnaire based on explorative factor analysis removed 10 more statements and the remaining 45 statements were categorized into nine factors, namely technophilia, perceived attraction, perceived ease, perceived conflict, self-management, attitude, behavioral intention to use, educational use, and efficacy of m-learning. Reliability of the scale was obtained as 0.95 based on Cronbach's alpha and stability was checked using test–retest method (intercluster correlation coefficient; r = 0.92). CONCLUSION: Willingness to m-learning scale had an acceptable reliability and validity in medical sciences students. Therefore, it can be used for medical sciences students for improve learning and education.

BACKGROUND AND AIM: Measuring child abuse and adverse experiences is a critical task with regard to its long-term impact on the health of individuals and communities. The purpose of this study was to validate the Persian version of the International Adverse Childhood Experiences Abuse Short Form (ACE-ASF) in Iranian society. MATERIALS AND METHODS: This cross-sectional study was conducted in Kerman, southeast of Iran, in 2019, on 494 students from Kerman University of Medical Sciences, selected by convenience sampling method. Psychometric properties of the questionnaire were examined after the forward and backward translation processes. The factor structure of the questionnaire was evaluated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The concurrent validity of the questionnaire was assessed using the childhood trauma questionnaire (CTQ). Cronbach's alpha and corrected item-total correlation were used to measure reliability. RESULTS: The mean age of participants was 24.3 ± 5.3 years. Based on EFA, two physical–emotional abuse and sexual abuse factors were obtained. The CFA fit indices well supported two extracted factors. The CFA showed acceptable factor loadings. The internal consistency coefficient of Cronbach's alpha was 0.75 for the physical–emotional abuse factor and 0.77 for the sexual abuse factor. The correlation coefficient of ACE-ASF and CTQ was r = 0.56. The reliability index of intraclass correlation coefficient was 0.73 (95% confidence interval: 0.60–0.84). CONCLUSION: The Persian version of the ACE-ASF questionnaire has acceptable psychometric properties.

BACKGROUND: University health coverage gives everyone accesses to health services focused on the most important causes of illness and death and ensures that the quality of services is high enough to improve the health of those receiving services. Nurses as the largest group of staff in the health system play an important role in achieving UHC. This study aimed to determine the training needs of nursing managers in universities of medical sciences of Iran in achieving UHC. MATERIALS AND METHODS: This study was a qualitative study conducted in 2019 using the framework method. There were 15 experts in nursing management, health management, and nursing authorities at the national level using the purposive random sampling. Data were collected from the expert panel. We used the Atlas.ti software version 7.2 and using the framework method for the analysis of qualitative data. A set of codes organized into categories that were jointly developed by the researchers involved in the analysis. The UHC framework used to summarize data in a way that could support answering research questions. RESULTS: This study showed that three educational modules leadership and strategic thinking, management, and decision-making, achieving excellence in nursing management to capacity building of nursing managers in the country. CONCLUSION: Training leadership skills and strategic thinking in the nursing empowerment modules illuminate global and national health roadmaps and policies and change attitudes to the model of nursing service delivery. Since nurses are the largest group of professionals in the health system, it facilitated by changes in the role and functions of the hospital and nurses to reach UHC.

BACKGROUND: Ethnic minorities are underrepresented in health sciences programs in various nations. Furthermore, there is no known research studying the occurrence of physical inactivity (PI) and insufficient sleep (IS), and their effects on academic achievement (AA) in ethnic minority students (EMS) in higher education. OBJECTIVE: The objective of this study is to explore the occurrence of PI and IS, and their independent and mixed effects on AA in EMS of a dental school. MATERIALS AND METHODS: Thirty EMS and sixty non-EMSs were matched (1:2) in this case–control study. It was utilized as an administrative dataset that stores register related to the students. Moreover, the grade point average was considered an indicator of AA. Logistic regressions models were run, expressed in odds ratios, complemented by confidence intervals (CIs) of 95%. RESULTS: A total of 73% and 60% EMS were PI and slept insufficiently, respectively. The groups presented statistically significant differences (P < 0.0001) in physical activity, sleep, and AA, with inferior values for EMS. All unadjusted models showed that PS, IS, and low AA were strongly associated with EMS, demonstrating their independent effect. After controlling for PI and IS, the multivariate model for AA and EMS increased odds by 6.5 times (95%CI: 1.8–23;), indicating that EMS is strongly associated with low AA. Besides, PI and IS were also statistically significant higher (<0.0001) in the model, demonstrating their mixed effect. CONCLUSIONS: This study found a higher occurrence of PI and IS in EMS. Besides, independent and mixed effects of these variables on low AA in EMS were very significant.

INTRODUCTION: Gifted students are superior to their peers in terms of cognitive, educational, scientific, creativity, and artistic abilities. There are also gifted students who struggle with cognitive, educational, social, emotional, and behavioral development, especially academic performance. They are called underachieving students. One of the main problems of these students is the low level of academic engagement in educational settings. Thus, this study investigated the effectiveness of Martin's educational program on academic engagement (behavioral, emotional, cognitive, and agency) of underachieving gifted students. MATERIALS AND METHODS: Thirty underachieving gifted students were selected by purposeful sampling from a high school in Isfahan, Iran, and were divided randomly into the experimental (n = 15) and the control (n = 15) groups. All participants completed the students' academic engagement questionnaire (behavioral engagement, emotional engagement, cognitive engagement, and agency engagement) at pre/post-test. RESULTS: The findings showed that Martin's cognitive-behavioral program had a significant effect on academic engagement and its subscales, including behavioral engagement, emotional engagement, cognitive engagement, and agency engagement. CONCLUSION: School counselors could benefit Martin's cognitive-behavioral program to promote the academic engagement of underachieving gifted students.

BACKGROUND: Improving the learning process in education will empower medical students, and also formative assessment helps improve the teaching–learning process by providing ongoing reflective information about learning gaps. OBJECTIVE: The aim of this study was to explore the effect of student-centered formative assessment by weekly reflective self-correction quizzes on medical laboratory students' performance on the final examination of hematology course in 2018. MATERIALS AND METHODS: A semi-experimental study was conducted on fifty students divided randomly into intervention (n = 25) and control groups (n = 25) using convenience sampling in 2018 from Torbat Heydariyeh University of Medical Sciences, Iran. Data analysis was performed using SPSS software version 16, two-sample t- test, Chi-square test, and analysis of covariance. RESULTS: The intervention had positive effects on students' mean test scores in hematology II so that the intervention and control groups managed to obtain 18.45 ± 1.46 and 14.57 ± 2.64, respectively (P < 0.01). CONCLUSIONS: The results suggested that weekly formative assessments along with reflective self-correction activity and active participation of students in the learning process by designing questions could improve student learning.

BACKGROUND: Hypertension (HTN) has become a major public health problem which can cause serious complications when it is not well-controlled. Prevention and effective care of HTN require a population-based registry. Thus, establishing this registry can be used to collect comprehensive, timely, and reliable data on epidemiology cases. The aim is to create a registry for the collection of highly required prospective data that will present an in-depth analysis of the characteristics of all individuals with HTN and track them over a particular chronological interval. MATERIALS AND METHODS: The study was divided into three phases: At first, a comprehensive literature review was conducted to determine the proposed data classes and data fields. Then, the final minimum data set was designed by a two-round Delphi consensus approach of 20 experts of cardiologists, nephrologists, nutritionist, and health information management. Finally, a web-based registry system was developed by a Structured Query Language environment. RESULTS: A total of two clinical and nonclinical data categories with nine data classes and 68 data fields were selected for their inclusion in the registry following the consensus phase. A web-based registry was designed with a modular and layered architecture. CONCLUSIONS: This study provides an appropriate information infrastructure for active tracing and monitoring of individuals with HTN. It has provided a practical information system allowing quality improvement, aggregate reporting for planning, and research purposes.

CONTEXT: Medical ethics is a practical subject as well as a branch of ethical philosophy and an integral part of the proper practice in medicine. However, the ethics changes in places and over time and is variable. Furthermore, many issues that have occurred as a result of advances in technology add to the complexity of the ethical issues. Therefore, the objective of this research was to explore medical teachers' and interns' experiences regarding professional ethics. METHODS: This study was a qualitative content analysis conducted on 10 professionals and 10 interns of the surgery and internal departments of medical and educational centers in Qom University of Medical Sciences to discover their experiences of the medical professional ethics. The sampling method was purposive, and data were collected through semi-structured interviews. Data analysis was performed using a qualitative content analysis method with a conventional approach. RESULTS: Three main categories were obtained from the data analysis, including adherence to professional values, organizational conditions, and individual characteristics. CONCLUSIONS: Adherence to professional values, paying attention to individual characteristics, and organizational conditions are among the factors affecting the promotion of medical professional ethics; therefore, it seems that appropriate interventions on these important components can help promote the professional ethics training in the clinical practice.

CONTEXT: One of the most important issues in patients with coronary artery disease is their mental health indices such as perceived stress and perception of disease. AIMS: The aim of this study was to evaluate the effectiveness of mindfulness-based intervention on the perceived stress and disease perception of patients with acute coronary syndrome. MATERIALS AND METHODS: This is a clinical trial, two-group, and three-stage study on 76 patients with acute coronary syndrome who were randomly divided into intervention and control groups. Nine weekly sessions of mindfulness-based training program were administered to the intervention group. The control group received routine services during this period. Data collection was done before, immediately, and 1 month after the intervention, using the Perceived Stress Scale and the Illness Perception Questionnaire. Data were analyzed using descriptive and inferential statistics. RESULTS: There was no significant difference between the mean scores of perceived stress and illness perception before intervention. After the intervention and 1 month after it, the mean score of perceived stress in the intervention group was statistically significantly lower than the control group (P < 0.001), and the perception of disease in the intervention group was statistically significantly higher than that of the control group (P < 0.001). CONCLUSIONS: It is worthwhile to suggest the mindfulness-based training program to reduce the perceived stress and correct the perception of disease for patients with acute coronary syndrome.

INTRODUCTION: School teachers play an important role in instilling positive behavior changes among school children. School children at an early age group of 2–7 years face challenges and need extra support. Utilization of psychological interventions via school teachers for oral health promotion is minimal. The present study was done to determine the impact of counseling and reinforcement by school teachers on children for a follow-up period of 1 year. MATERIALS AND METHODS: A quantitative research on 58 randomly selected children for a follow-up of one year was conducted to determine the prevalence of preoperational characteristics in school children. The tools to determine characters in preoperational children consisted of classical cognitive experiments followed by behavior counseling intervention. The interventional group received reinforcement with school teachers for a follow-up of one year. RESULTS: The assessment of the three characteristics revealed a prevalence of ego centralism, centration, and lack of conservation and reversibility in 84.4%, 89.6%, and 89.6% children, respectively. A significant difference in behavior change was seen in children who received behavior counseling and reinforcement. CONCLUSION: The present study concluded that Piaget's characteristics were consistent for a follow-up period of one year.

BACKGROUND: Financial information system is one of the subsystems in management information system that is very important in health institutions. The use of financial information system creating effective and efficient information flow will greatly assist the management in decision-making, so that it can achieve institutional goals easier. This study is endeavored to assess the success of financial information system in Isfahan University of Medical Sciences. MATERIALS AND METHODS: This descriptive-correlational study was performed on the research population consisting of financial information system users in educational, health, and medical centers affiliated to Isfahan University of Medical Sciences during 2018 that were studied by the census method (n = 108) because of a small number of these users. The data were collected using a questionnaire. The content validity of questionnaire was confirmed by pooling the ideas of five academic members of the health information management and two financial information system users. The reliability of questionnaire was also estimated by Cronbach's alpha. Then, the AMOS software was used to analyze the gathered data. RESULTS: The result shows that system quality was positively correlated to the use and user satisfaction whereas use and user satisfaction was positively correlated to net benefit (P < 0.05). Furthermore, the information quality was positively correlated to the user satisfaction (P < 0.05). CONCLUSIONS: As per the finding of this study, to improve user's intention to use the financial information system and their satisfaction toward the system, managers need to develop useful, easy-to-understand, easy-to-learn, and easy-to-use information systems.

BACKGROUND: Training of health-care providers about the various aspects of biomedical waste (BMW) management and handling (M and H) rules can improve the safe disposal of BMW and protect the patients and public from related hazards. OBJECTIVES: Our study objective was to evaluate the existing knowledge regarding BMW management rules among selected health-care professionals and to evaluate the impact of training program on BMW management on the knowledge and practices of health-care professionals. METHODOLOGY: The training program on BMW management rules was conducted in April 2018. A total of 250 participants were trained. A structured validated questionnaire was used. The data were analyzed, and the mean score of pre- and post-test was compared by the paired-t test. RESULTS: Majority of the participants were female (83%) aged 20–30 years (56%). The majority of the participants were married (74%) and were from urban areas (74%). The mean pretest and posttest score were 14.00 and 19.94 respectively (P < 0.000). CONCLUSION: The structured training on all aspects of BMW management led to statistically significant improvement in the knowledge among health-care professionals. RECOMMENDATIONS: Such training programs need to be regularly conducted.

INTRODUCTION: The ability of physicians to perform endotracheal intubation by laryngoscope is one of the essential skills. The purpose of this study was to evaluate the effectiveness of the four-step python training method with the Halsted's “See one, Do one, and Teach one” training method in endotracheal intubation competency in simulated environment. MATERIALS AND METHODS: This quasi-experimental study was performed on two independent groups with posttest. The statistical society consisted of eighth-semester medical students referred to the emergency medicine unit. The experimental group received a modified four-step python's training method that modified for small groups, and the control group received the Halsted's “See one, Do one, and Teach one” training method. Researcher-made checklist used to rate participant competency as posttest. Data were analyzed using SPSS 19 software. RESULTS: Sixty-seven students volunteered for the experimental group and 57 students for the control group. In posttest, the experimental group more competent than the control group significantly (P < 0.001). Furthermore, the training course satisfaction of the experimental group was significantly higher than the control group (P < 0.001). DISCUSSION AND CONCLUSION: Modified python training method for small groups has shown a better effect on student performance. This finding is consistent with previous researches. Modified four-step python's training for small group with an emphasis on peer to peer teaching and receiving feedback from peer can be related to the effectiveness of this training. Further research is recommended in other clinical education settings.

BACKGROUND AND AIM: Considering lack of data on clinical acumen and clinical practice readiness of graduating nurses in India; this cross-sectional survey was undertaken to assess the self-reported clinical practice readiness of graduating nurses from a selected state in India. MATERIALS AND METHODS: The survey was conducted at randomly selected public and private nursing institutes in Uttarakahnd, India, during June–July 2017. Total 173 final-year nursing undergraduates were selected through cluster sampling technique and they were asked to report their clinical competencies using a prevalidated and reliable tool, i.e. Comprehensive Nursing Competencies Questionnaire. RESULTS: The mean competencies score for basic nursing skills was reasonably high (236.5 ± 25.0). However, it was significantly low for the advanced nursing skills (148.7 ± 25.6) and selected basic nursing tasks such as perioperative care, elimination related interventions, and handling of medical equipment (recoding electrocardiogram and using defibrillator). Graduating nurses with younger age and longer duration of clinical placement had higher mean competency score in basic as well as advanced nursing skills (P < 0.05). Whereas, nurses studying at private nursing institutes had lower mean competency score for advanced nursing skills (P = 0.001). CONCLUSION: Clinical practice readiness of graduating nurses for basic nursing skills is good. However, it is seriously poor for the advanced nursing skills. This could be because of lack of sufficient clinical learning material, experienced clinical nursing faculty, and poorly equipped nursing skill labs. Nursing regulatory bodies must regularly monitor and ensure that deficiencies are rectified and nursing faculty remain clinically updated and active to produce clinically competent nurses.

BACKGROUND: Social media platforms are progressively developing as a rich source of mass communication. Increasing mental health awareness with the help of social media can be a good initiative to reach out to a large number of people in a short time frame. This study was conducted to understand the usefulness of social media platforms for health promotion. MATERIALS AND METHODS: It was a qualitative study to evaluate the effectiveness of social media platforms in hosting health promotion campaigns in the field of mental health, which was observed over 5 months from May to September 2019 to reach more people for effective information dissemination. The campaigns were as follows (1) The Buddies for Suicide Prevention: an online campaign to create awareness about suicide prevention. The campaign included script writing, slogan writing, poster making, and short films making, organized for the general public who were interested to take part; (2) The #Iquitobacco was a 21-day campaign with an idea of tobacco cessation in the community, conducted among social media viewers who were willing to participate; and (3) #Migrainethepainfultruth was yet another campaign conducted among the social media viewers who were interested to participate. All the campaigns were conducted using two famous social media platforms commonly used by young adults. Descriptive statistics such as frequency and proportions were computed for the number of likes and shares. RESULTS: The Facebook and Instagram posts concerning all the campaigns brought about a considerable amount of reach to the targeted population. After the campaigns, the page reached to around 10.3 k people (both fans and nonfans). CONCLUSIONS: Use of social media to conduct mental health campaigns is an effective initiative as one can reach out to several people over a short time period. There is an increasing trend in the awareness of mental health with the effective use of digital media as a platform for disseminating information.

INTRODUCTION: The present study aims at designing and evaluating the effect of new educational media-based educational intervention on students' stages of behavior change of physical activity. SUBJECTS AND METHODS: In the present interventional study, 225 students of medical sciences university were assigned into two experimental and one control groups using proportional stratified random sampling, where web-based and software-based educational interventions were used. Data were collected using International Physical Activity Questionnaire, Marcus's stages of change scales, and a self-made questionnaire including constructs of barriers, benefits, and self-efficacy. Evaluation was conducted through pretest and posttest and immediate and 2 and 6 months of follow-ups after the intervention. Data were analyzed by SPSS software using descriptive statistics and Chi-square, Friedman, one-way ANOVA, and ANOVA with repeated measure. RESULTS: Based on the results, there was no significant difference between the experimental and control groups before the intervention (P = 0.37); however, immediately and 2 and 6 months after the intervention, there was a significant difference between the experimental and control groups in terms of stages of change (P < 0.001). Furthermore, in the experimental group, the educational intervention led to improvement of individuals in the stages of change of physical activity. At 6-month follow-up, 75.4% of the software group and 60.6% of the web group achieved the maintenance stage. CONCLUSION: The results suggest that designing intervention based on people's level of preparation for changing behavior and using new educational methods such as web and software were effective on individuals' progress in different stages of change of physical activity behavior and physical activity rate.

INTRODUCTION: Health-care workers, especially medical intern, are at risk of exposed to blood and other body fluids in the course of their work. To reduce the risk, standard precaution (SP) is introduced. Among all communicable diseases that could be transmitted, human immunodeficiency virus (HIV) is the most stigmatized disease. However, there are some government hospitals that separated adult HIV patients with other patients to prevent additional infection. This study aims to evaluate the impact of ward separation on SP adherence. MATERIALS AND METHODS: This was an observational study conducted in March 2017 in a tertiary referral hospital for the eastern part of Indonesia. The participants were 150 medical students who underwent the past year of their clinical rotation. They were given a three-part questionnaire, consisting of their background, their SP practice in the HIV ward and non-HIV wards, and their perception and attitude regarding SP. McNemar's test and Fisher's exact test were used for the statistical analysis, using SPSS version 23.0 for Windows. RESULTS: Participants were more adhered to SP (hand hygiene, wear mask as indicated, and wear glove as indicated) in the HIV ward compare to non-HIV wards (P = 0.002, P = 0.001, and P = 0.001, respectively). Almost all participants were more careful in implementing SP in the HIV ward than in non-HIV wards and were more concerned of getting needlestick injury in the HIV ward than in non-HIV ward. CONCLUSION: HIV and non-HIV ward separation negatively impact medical students' SP adherence.

Fire buildings is considered as one of the most common and the most devastating disasters and emergencies. Saving school buildings against incidents such as fire is very important since students are so vulnerable to incidents especially fire. The most school classes were devoid of safety conditions and oil-burning heaters were used. Such a condition has increased the risk of disaster and is considered as a serious menace for students' lives. The present study conducted with aim of review the Health, Safety and Education Measures for Fire in Schools. To this purpose, we selected suitable keywords some articles published in Scientific Information Database of PubMed, Web of Science, Scopus, and ProQuest were searched. The search was limited to reviewed articles in English and Persian language published between 1970 and 2019, based on inclusion and exclusion criteria. Furthermore, the selected articles were reviewed for relevant citations. The reviewing of articles was conducted by two member of research team independently. The primary search found 194 relevant studies. After eliminating the duplicates and articles which were not related to the review of the abstract, 51 references were identified for inclusion. Finally, 13 articles were selected after screening and evaluated by two authors to final review main factors and dimensions of schools' health, safety and education include the rules and laws, allocating sufficient budgets, education the teachers, students and their families, exercise, risk analysis, intersectional relations, fire extinguishing equipment, early warning system, and also optimization and reformation of heating system. Applying these new approaches prevents disasters and increases the level of preparedness in case of fire occurrence.

INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) is a common disorder in child psychiatry, which has a greater impact on the future life of the children affected in case of being untreated and undiagnosed. Given the undeniable role of teachers in improving this disorder and preventing its destructive consequences on children, the present research has examined the knowledge, attitude, and practice of elementary school teachers regarding ADHD. MATERIALS AND METHODS: This was a descriptive, cross-sectional study carried out in 2019. One hundred and twenty teachers were randomly selected as samples among public and private schools in three districts of Isfahan. Data were collected by a self-administrated questionnaire including demographic variables, knowledge, attitude, and practice of teachers regarding ADHD and were analyzed by descriptive and analytical statistics. The Spearman's and Kendall' correlation coefficient, t-test, and Kolmogorov–Smirnov test were employed, and P < 0.50 was considered statistically significant. RESULTS: The findings indicated that 65% of teachers had favorable knowledge toward ADHD, 50% of them had a favorable attitude, and 56% of their practice was desirable. The questionnaire showed that only their knowledge about ADHD symptoms was desirable, but their knowledge about cause of the disorder and its treatment was not sufficient. There was an inverse relationship between the knowledge, attitude, and practice of teachers with age, and between education and having a child, a significant direct relationship was discovered. Teachers of public schools compared to private school teachers had significantly better knowledge, attitude, and practice. CONCLUSION: Teachers' knowledge, attitude, and practice regarding ADHD was relatively high. However, it is necessary to educate teachers about etiology and methods of treatment of this disorder and behavior management of these students, especially private school teachers who need more education.

INTRODUCTION: Professionalism is an essential theme in both undergraduate and postgraduate medical education. The current study aimed to assess the preclerkship medical students' perception on medical professionalism. METHODS: A cross-sectional qualitative study using the critical incident technique was conducted at the University of Sharjah in the United Arab Emirates (UAE). An online survey was sent to 300 medical students (years 1–3). Participants were asked to describe an official doctor–patient encounter that they have experienced in a health-care setting and to highlight the professional behaviors in that encounter. They were then requested to list the top five characteristics of a professional doctor. Thirty (10%) medical students responded to the study; only 13 reported real incidents. The responses were independently reviewed by the authors. The descriptions of the professional attitudes were grouped according to the six domains of professionalism defined by the American Board of Internal Medicine (ABIM) Physicians Charter and then plotted against the nine domains of medical professionalism published in the UAE Consensus Statement. RESULTS: The most common professional behaviors reported were patience, honesty, respect, and patient care. The participants addressed all six domains of professionalism described by the ABIM physicians charter (altruism, accountability, duty , excellence, honor and integrity, and respect for others) and all the domains of medical professionalism published in the UAE Consensus Statement, except for “commitment to advocacy” and “commitment to education” domains. CONCLUSION: Preclerkship medical students had an insight about the professional behaviors needed from doctors before formal teaching about professionalism in the curriculum.

BACKGROUND: Sedentary habits may increase the noncommunicable disease risk factors, and few teens get enough physical activity. Therefore, the current study aimed to examine the effects of a web-based intervention on the promotion of physical activity among adolescents using the transtheoretical model (TTM). METHODS AND MATERIALS: A quasi-experimental study was conducted on 278 high school students who were randomly allocated into one of the three groups: two web-based intervention groups. The intervention groups 1 and 2 received education through web (www.salamat.family), but the second group received educational strategies based on TTM. Five questionnaires were applied two times before the intervention and 6 months after the intervention. And, in the control group, the data were collected using stage of exercise behavior change questionnaire and the International Physical Activity Questionnaire. Student's t-test and two-way analysis of variance, and McNemar's test were applied to compare before and after the intervention. P < 0.05 was considered statistically significant. RESULTS: The mean differences for TTM constructs related to exercise behaviors (processes of change, self-efficacy, and decisional balance) in intervention groups 1 and 2 were very higher than the control group. Participants in intervention groups 1 and 2 who had low or moderate physical activity before the intervention were placed in high physical activity after it. CONCLUSION: According to the obtained results, education on PA based on website effective, but if we use education based on TTM, it will be more useful on the behavior.

INTRODUCTION: Chronic diseases leave a huge impact on the life of children and their family caregivers (FCGs). Therefore, the present study was conducted to determine the effect of the combination of Benson's relaxation technique (BRT) and brief psycho-educational intervention (BPI) on religious coping (RCOPE), sense of coherence (SOC), and quality of life (QoL) of FCGs in children with chronic disease. MATERIALS AND METHODS: The study population, consisted of 100 FCGs whose children were afflicted by chronic diseases, and participated in the current quasi-experimental pretest posttest design. The children were recruited from two state pediatric hospitals in Tehran, Iran. The RCOPE, SOC, and QoL of FCGs were assessed twice, through pretest (T1) and posttest (T2), four weeks after the intervention, by means of RCOPE, SOC and SF-36 questionnaires. The FCGs participated in four training sessions lasting up to 70 min over one week, followed by four more weeks of training. The Chi-square, Fisher's exact tests, independent t-test, and paired t-test were performed. RESULTS: Positive RCOPE had a significant rise at T2 (P = 0.020) compared with negative RCOPE that did not show significant changes in T2. SOC scores for the intervention group remarkably rose at T2 (P = 0.022); but, for the control group, the drop was marginal. The QoL scores of both physical and mental components were statistically significant in the intervention group at T2 (P < 0.05). CONCLUSION: Findings of the present study suggest that BRT and BPI can help significantly improve the RCOPE, SOC, and QoL of families with children suffering from chronic diseases. Measures that could enhance the RCOPE, SOC, and QoL include low-cost interventions, good safety, and decent outcome.

BACKGROUND AND AIM: Considering the important role of universities in advancing educational, social, cultural, economic, and political affairs and given the significant and effective role of social determinants of health (SDH) in personal and social life, this study aimed to design a preliminary questionnaire to assess the awareness and attitude of students and professors of relevant medical sciences departments toward the SDH. METHODS: This is a descriptive survey study of the instrumentation type and is done on the students and professors of Isfahan and Kashan medical sciences universities in 2019. The content and face validity of the questionnaire were assessed. Cronbach's alpha coefficient and the correlation coefficient for each question as well as the total score of the questionnaire were reported for this attitude measurement questionnaire. The difficulty coefficient, optimum difficulty level, discrimination coefficient, and the relevant variance were calculated for every question in the awareness measurement questionnaire. RESULTS: The internal consistency of the questionnaire for the awareness toward the SDH for 15 questions was 0.742. This consistency was acceptable for 18 questions in the attitude measurement questionnaire after omitting two questions with not appropriate distinguishing ability. The difficulty level of the questions was relatively high. CONCLUSION: Given that no tool was observed in the search strategy to measure the SDH, therefore, the design and psychometrics of such a tool can be used to measure the awareness and attitude of the target audiences; since this tool had an acceptable validity and reliability at its initial stages, researchers are suggested to apply it for standardization in different academic societies.

BACKGROUND: Total knee arthroplasty (TKA) can cause operational anxiety in patients. The purpose of this study was to determine the effects of a hospital rehabilitation program on operational anxiety in patients following TKA. MATERIALS AND METHODS: A nonrandomized clinical trial was conducted on 96 patients who were total knee replacement (TKR) candidates in Milad Hospital, Tehran, Iran. The participants were allocated to two groups of control and experiment each with 48 participants. A rehabilitation training program was implemented in the experimental group and the routine care program was administered to the control group. The data collected through demographic form and Spielberger anxiety questionnaire. The collected data were analyzed using Fisher's exact test, covariance, independent t-test, and paired t-test (P = 0.5). RESULTS: The results of the paired t-test indicated that the mean score of anxiety in both groups was decreased. Independent t-test showed that there was a significant difference between the two groups in terms of the mean scores of anxiety so that it was significantly higher in the control group compared to the experimental group (P < 0.001). CONCLUSIONS: The implementation of the rehabilitation education by a rehab nurse can improve the surgical outcomes in patients under TKR. Despite the positive results in this study, the results should be interpreted and clinically used with caution given the small number of participants and the specific circumstances of this study.

BACKGROUND: Hospitalization in intensive care units (ICUs) can cause physiological and psychological challenges for patients and their family members. Using a family-centered approach in provision of visiting hours promotes the health of patients. The purpose of this study is to review the perception of nurses and family members of patients in ICUs about visiting their patients. METHODOLOGY: The published articles in the last 10 years from 2008 to 2018 on the perception of nurses and family members of patients in critical care units about visiting their patients searched for in databases including ScienceDirect, PubMed, Cochrane, Google Scholar, SID, Scopus, CINAHL, OVID, IRANDOC, and Magiran using keywords “family members perception,” “nurses' perception,” “intensive care units,” and “visiting” in English and Farsi, and finally, 15 articles were selected. RESULTS: Results showed that nurses do not have appropriate viewpoint about visiting patients in ICUs, and they discussed and outlined the barriers of visiting patients given the benefits of family members' presence. CONCLUSION: There are several limitations on the process of family members visiting their patients in the ICUs. It is essential to modify the nurses' attitudes and remove the organizational limitations in this area.

INTRODUCTION: Educating a mother of a premature baby and providing a structured written educational information can enhance better understanding and practice. This article describes the development and implementation of a health educational package for preemie moms in the care of their premature baby after neonatal intensive care unit discharge. SUBJECTS AND METHODS: The package known as “Preemie Mom: A Guide for You” was designed based on Stufflebeam's model and has four phases: (1) content evaluation from available sources of information, (2) input evaluation based on mothers' need related to premature baby care, (3) process evaluation for package designing and content drafting, and (4) product evaluation to determine its feasibility. The contents were extracted and collated for validation by consulting various specialists in related fields. A final draft was drawn based on comments given by experts. Comments from the mothers were taken for formatting, visual appearance, and content flow for easy understanding and usage. RESULTS: All ten existing articles and eight relevant documents were gathered and critically appraised. The package was designed based on 11 main components related to the care of premature baby after discharge. The content validation was accepted at a minimum score of 0.85 for the item-level content validity index analysis. Both experts and mothers were agreed that the package is easy to use and well accepted as a guide after discharge. The agreement rate by the mothers was at 93.33% and greater for the front page, writing style, structure, presentation, and motives of the package. CONCLUSIONS: ”Preemie Mom: A Guide for You” is a validated health educational package and ready to be used to meet the needs of the mother for premature baby care at home.

INTRODUCTION: Majority of critical care nurses do not have desirable skills in performing endotracheal tube suctioning (ETS) despite related training taught in the curricula. This study aimed to investigate and compare the effect of education through video and performance feedback (PF) on nurses' skills in performing ETS. METHODS: This was a quasi-experimental study. The sample size comprised of all nurses (n = 49) working in the intensive care unit of one of the educational hospital located in one of the western cities of Iran. Nurses were assigned to either one of educational video (EV) and PF groups. Data were collected using a 25-item structured best practices information sheet. Data were analyzed using SPSS software version 20 (SPSS Inc., Chicago, IL, USA). RESULTS: After the interventions, no significant difference was found in the total mean score of nurses' practice in ETS between those who received education through EV and those who received through PF (16.3 vs. 15.1) (P > 0.05). Before and after the intervention, a significant improvement was observed in the total mean score and other dimensions of nurses' practice in endotracheal suctioning (P < 0.0001). CONCLUSIONS: The results showed that both of methods through feedback and EV are useful in improving nurses' ETS practice. However, further studies are required to examine the effects of such interventions in the long term.

INTRODUCTION: The aim of this study was to evaluate the cognitive, psychomotor, and attitudinal readiness of faculty members and students of Shiraz University of Medical Sciences for using e-learning in 2019 in order to move toward the desired future of e-learning in medical education, promote the benefits of e-learning in the country, and provide training to each of the research groups if needed. METHODS: This is a cross-sectional study conducted in Shiraz University of Medical Sciences, Iran, in 2019. The study population consisted of 379 students and 281 professors selected through the systematic random sampling in Shiraz University of Medical Sciences. The e-learning readiness questionnaire developed by Zarif Sanaei et al. was used to evaluate the students' and teachers' viewpoints. RESULTS: The results showed that the average level of skill, knowledge, and attitude among students and teachers was positive and higher than the mean (P < 0.05). It had only a significant relationship in the level of education of the teachers and the marital status of the participants. There was also a significant interaction between skill, knowledge, and attitude. CONCLUSION: There is a need for successful implementation of e-learning by creating appropriate infrastructure, applying the required standards, as well as taking measures to reduce the existing resistance in this regard, which can be achieved through training workshops. The experience of successful universities in the country and abroad can also be used to implement e-learning.

INTRODUCTION: Hypertension is one of the major health threats in the world today. The purpose of this study was to find the relationship between hypertension with irrational health belief and health locus of controls. MATERIALS AND METHODS: The current work is a descriptive (case–control) study. One hundred patients with hypertension and 100 healthy individuals were included in the study through available sampling method. The Irrational Health Belief Scale and Multidimensional Health Locus of Control questionnaire were used. Data were analyzed using independent t-test and logistic regression. RESULTS: The findings showed a significant relationship between the variables of irrational health beliefs and the external health locus of control in hypertension. For a unit increase in an irrational health belief score, the chance of having high blood pressure increases by 6%, and for a unit increase in the score of external health locus of control, there is a 17% higher chance of having hypertension. The independent t-test of irrational health belief also showed a statistically significant difference between the two groups (P < 0.01). There was also a statistically significant difference regarding the health locus of control in the two groups of hypertension and healthy individuals in the subscale of chance control (P < 0.01) and external locus of control (P < 0.01). CONCLUSION: The results of this study make it necessary to identify irrational health beliefs as well as the health locus of control in individuals. Modification of these structures can be useful in the prevention and management of this chronic disease.

INTRODUCTION: Problem-solving skills and learner-centered approaches provide students with the ability to solve health challenges by placing them in simulated situations. The aim of this study was to determine the effect of inter-professional learning based on problem-solving on critical thinking (CT) and satisfaction with learning experience in nursing and midwifery students. METHODS: This quazi-experimental study of a single group used pretest–posttest design. 20 undergraduate nursing and 28 midwifery students at the final academic year participated in the study. The research intervention was interprofessional learning based on problem-solving conducted in five 2-h training sessions. California's CT Scale and 10-point visual analog scale were used to measure CT skills and satisfaction with learning before and after the intervention. Finally, data were analyzed by SPSS software version 23 using descriptive statistics and paired t-test. RESULTS: The findings of this study indicated that the mean score of students' CT before the intervention was poor, while it statistically significant increased after the intervention (P < 0.05). It was also found that students' satisfaction with learning, in the scale of 0–10, was reported from 5 to 9 indicating students had a high level of satisfaction with their learning experience. DISCUSSION: Based on the findings, it can be concluded that the interprofessional education based on problem-solving has been able to significantly enhance the overall critical skills of students, especially in the dimensions of analysis, inference, and deductive reasoning, and also, students' satisfaction with learning experience was also increased.

BACKGROUND AND AIM: Little information is available on the use of text messages through mobile phones to address overweight/obesity in children. This study aims to evaluate the impact of a text message-based intervention for weight control and health-promoting lifestyle behaviors of overweight/obese children. MATERIALS AND METHODS: This quasi-experimental study was conducted among overweight/obese school students. Data on sociodemographic, dietary intake, sleep, sedentary behavior, physical activity (PA), and anthropometry were collected before and after the intervention. Weight and height were examined according to the standard protocols. The intervention was consisted of tailored messages for weight control and healthy lifestyle, including diet, PA, sedentary behavior, and sleep. Child attitude and his practice were asked before and after the intervention. The paired t-test was performed to compare means of continuous variables before and after the intervention for normal distribution data. The Wilcoxon test was also used for nonnormal data. RESULTS: A total of 71 boy students were included in the study (62% obese). The mean age was 10.07 years. The means of attitude score for PA, nutrition, and sleep after intervention were greater than before it, but it was significant only for PA. The mean of nighttime sleep duration of students after the intervention was significantly less. Furthermore, unhealthy score decreases after the intervention. CONCLUSION: Three-month lifestyle intervention as text messages had positive effects on the nutritional intake of obese children and their attitudes toward PA, but no effect on child body mass index.

BACKGROUND: Inadequate lifestyle practices among individuals with diabetes may influence the progression of diabetes and its complications. The aim of this study was to assess the lifestyle practices among individuals with diabetes in Sudan. METHODOLOGY: This was a descriptive, cross-sectional, health facility-based study conducted in 3 diabetes centers treating individuals with diabetes. The data were collected using a standardized pretested metabolic questionnaire about lifestyle and were analyzed by performing descriptive and inferential statistics through SPSS program version 23. RESULTS: A total of 528 patients with diabetes answered the questionnaire. There were 52.1% of female participants and 72.9% of urban residents. 23.9% were obese, regular exercise was reported by 27.7%, and no exercise by 17%. There was a statistically significant association between lifestyle practices and gender (P < 0.001), age (P < 0.001), educational level (P = 0.002), marital status (P < 0.001), duration of diabetes (P < 0.001), hypertension (P < 0.001), high-density lipoprotein (P < 0.001), low-density lipoprotein (P < 0.001), and HbA1c level (P < 0.001). Logistic regression analysis showed male gender and education were significantly associated with lifestyle changes. Men were more likely to engage in favorable lifestyle practices than women (P < 0.001), while those with no formal education were less likely to engage in healthy lifestyle (P < 0.001). CONCLUSIONS: Health authorities in Sudan will need to put more efforts into education for promoting self-awareness and good lifestyle practices in the population with diabetes.

BACKGROUND: According to the importance of health education (HE) in disease control and prevention and inadequacy of HE in the Iran's health-care system, clarifying the HE barriers is necessary. OBJECTIVES: This study aimed to clarifying the comprehensive model of HE barriers of health-care system in Iran. METHODS: This qualitative study was conducted in 2019. Twenty-one health experts and physicians at different levels of the health system, a former health deputy of the Ministry of Health, and 26 community health workers (CHWs) were selected through purposive sampling. Data were collected through semi-structured individual interviews and group discussions and analyzed simultaneously by conventional content analysis. RESULTS: Five themes were extracted including individual barriers (most important categories: inadequate ability of CHWs in HE, poor motivational factors at individual level, and educator's wrong beliefs), interpersonal (most important categories: weakness of other health-care providers in the education of CHWs, lack of proper understanding by health authorities of scientific and correct HE, inappropriate communication, unrealistic expectations from CHWs, problems with monitoring and supervision, poor work commitment, and client-related problems), organizational (most important categories: high workload of CHWs, problems related to educational resources, inappropriate attitude of managers and officials, and inappropriate evaluation and monitoring), community (most important categories: not believing CHWs by people, people's disinterest and lack of motivation in education, cultural problems, problems with the Internet and virtual social networks, and weak cross-sectoral cooperation), and contextual barriers (most important categories: barriers related to universities, broadcasting, the nature of HE science, as well as gap between practical education and theory). CONCLUSION: Considering the multidimensional barriers such as individual, interpersonal, organizational, community, and contextual barriers, compiling and executing a comprehensive document with the participation of authorities, specialists, and service providers is recommended to remove barriers. This is in line with the Ottawa Charters' “reorienting health services.”

INTRODUCTION: Emotional intelligence (EI) and self-efficacy are important factors that lead to success in work, life, and education. Various studies assessed the relationship between EI and well-being, performance, and self-efficacy in educational levels, but this topic has been rarely assessed in the occupational and administrative environments. The present study aimed to examine the relationship between EI and self-efficacy among administrative staffs of Kerman University of Medical Sciences. METHODS: The study employed a descriptive-correlational design and was conducted in six deputies supervised by the Kerman University of Medical Sciences in 2019, and 275 participants were selected using a census method. The research data were collected using the Goleman's EI framework with a reliability coefficient of α= 0.87 and Sherer General Self-Efficacy Scale with a reliability coefficient of α = 0.78. Data analysis was performed through Kolmogorov–Smirnov, analysis of variance, Tukey, and Pearson's correlation coefficient techniques at P < 0.05 significance level. RESULTS: The mean score of EI was 98.8 ± 11.1 and the mean score of self-efficacy was 60 ± 7.17. There was a significant positive relationship between the scores of EI and self-efficacy. In addition, the findings indicated a positive significant correlation between self-efficacy with self-awareness, self-regulation, and social skills. CONCLUSION: The findings of the current study confirm that EI has positive relationships with administrative personnel's self-efficacy. Therefore, implications of the findings can help in the selection, training, counseling, and retention of administrative personnel to the improvement of medical sciences universities' occupational performance.

INTRODUCTION: The most important goal of a proper health-care system is to provide good health. Today, patients do not consider hospitals as simply a place of rehabilitation; rather, they compare the hospital with a hotel in terms of environment, facilities, services, and quality of accommodation. This study aims to use DEMATEL approach to extract factors affecting the hoteling quality. METHODS: This was a descriptive, cross-sectional study conducted in 2018. The study was carried out in two steps. In the first step, the factors affecting the hoteling quality were extracted, and in the second step, the DEMATEL technique was used to analyze and rank the cause and effect. The study population consists of all experts in the fields of medicine and health care (hospital managers, deputies, and faculty members familiar with accreditation and hoteling), among which twenty experts were selected using purposeful sampling and a questionnaire designed by the researcher consisting of 11 dimensions was distributed among them. The reliability of the questionnaire was calculated using Cronbach's alpha coefficient which was equal to 0.85 while its validity was confirmed using Delphi technique. DEMATEL approach was used for data analysis. RESULTS: The results show that among factors, human factors and economical–financial factors and, among subfactors, maintaining human dignity and quick action in providing emergency services are among the most important factors affecting the hoteling quality. Maintaining human dignity and speed of action in providing emergency services to patients was identified as the most important factor in improving hoteling quality. CONCLUSION: The results of this study can be used to evaluate the quality of accommodations and health facilities, medical equipment, and building quality of hospitals, which can lead to effective actions and improvement of patient satisfaction and the eventual success of health transformation plan.

BACKGROUND: Government of India recognizes the use of “information, communication, and technology” in the provision of comprehensive primary healthcare. In 2014–2015, Karuna Trust, a nongovernmental organization, Bengaluru, India, introduced an electronic health record (EHR) innovation, namely “Comprehensive Public Health Management” application (CPHM App). Data could be entered in an offline mode followed by syncing with cloud. The CPHM App was piloted in primary health center (PHC) Gumballi, in Karnataka, with focus on household survey and maternal and child health (MCH) services. OBJECTIVES: To compare the consistency of selected MCH process indicators for Health Management Information System [HMIS] available from paper-based records and those generated through the CPHM App (2016–2017). We also explored the implementation enablers, barriers, and suggested solutions from the user perspective. METHODS: A sequential mixed-method study design was followed. Quantitative phase involved aggregate data analysis looking into the consistency of selected MCH process indicators available from paper-based records and those generated through the CPHM App (2016–2017) followed by thematic analysis of in-depth interviews of healthcare providers. Consistency was defined as a percentage where the numerator was the HMIS-related process indicator data from CPHM App and denominator was the data from paper-based records. RESULTS: Three out of 12 selected MCH indicators had consistency of >80%. The quarterly consistency reduced over the 2 years. Dual burden of entry and regular monitoring of paper-based records by district health and family welfare department were the reasons why more importance was given to entry in paper-based records. Ability to generate aggregate indicators with CPHM App, easy to use and retrieve data in the field, and reminder facility for planned health activities were some of the factors facilitating CPHM implementation. The key barriers were limited technical expertise and support from the technical team and no internet connectivity in the field and traveling to PHC to sync the data. Provision of real-time technical support and availability of data connectivity in the field were some of the solutions suggested. CONCLUSION: There should be a minimum of 1–2 years of simultaneous use of EHR and paper-based records after which one must shift to EHR.

INTRODUCTION: One of the psychiatric disorders related to childhood is attention deficit hyperactivity disorder that can negatively affect the family interactions of these children. Parents of these children, especially the mother as the main caregiver, need comprehensive training to make a positive difference in their attitudes and behaviors with these children. The purpose of this study was to investigate the effect of emotion regulation training on family relationships in hyperactive children. METHODS: This was a randomized clinical trial study with a control group performed on eighty mothers of hyperactive children who were selected randomly. The intervention group members attended emotion regulation skills training sessions for one session of 90 min each week for 8 weeks. During the training course in the intervention group, the control group did not receive any training. Data collection tools included demographic information questionnaires, Mother–Child Relationship Evaluation, and Rahim Organizational Conflict Inventory-II. Data analysis was performed by descriptive statistics and the analysis of covariance. RESULTS: The mean scores of the mother–child relationship in the intervention group showed a significant improvement in the subscales of acceptance, overprotection, facilitation, and rejection (P < 0.0001). The results of this research also showed improvements in all the five communication styles of integrating, avoiding, compromising, obliging (P < 0.0001), and dominating (P < 0.012) between spouses. CONCLUSION: It seems that the emotion regulation training approach in mothers with hyperactive children improved both the mother–child relationship and the interactive spousal styles and can be considered by the managers of treatment and rehabilitation field as an adjunctive therapy for the families of these children.

BACKGROUND: An unhealthy lifestyle can threaten the health of nursing staff, especially in the context of cardiovascular diseases (CVDs). Considering the importance of health education in promoting preventive behaviors against these diseases, this study aimed to evaluate the effect of an educational program based on the health belief model (HBM) on improving preventive behaviors of nurses against CVDs. MATERIALS AND METHODS: This is a randomized controlled trial with a pretest–posttest design conducted on 104 nursing staff of Imam Khomeini Hospital in Kuhdasht, Lorestan, Iran, in 2017. They were randomly assigned into two groups of HBM (n = 52) and control (n = 52). The HBM group received the educational intervention for 6 weeks, one session per week each for 30–40 min. They were measured before and after the intervention using a demographic form, a researcher-made HBM questionnaire, Baecke Habitual Physical Activity Questionnaire, and the 3-day food intake record all in Persian. The collected data were analyzed in the Statistical Package for the Social Sciences (SPSS) v. 24 software using the Chi-squared test and paired t-test. RESULTS: The educational program could only increase the perceived severity (22.64 ± 2.22), perceived benefits (50.83 ± 5.22), and perceived self-efficacy (42.37 ± 5.93) of nurses in the HBM group compared to the controls (P < 0.05). The nurses' perceived sensitivity was also increased, but it was not significant (P > 0.05). In the HBM group, a significant change was found in the food intake level for energy (t = 4.79, P = 0.000), protein (t = −2.99, P = 0.004), and unsaturated fat (t = −2.94, P = 0.005) after intervention. No significant difference was observed in the total physical activity score after the intervention (P > 0.05). CONCLUSION: An educational program based on the HBM model can be used to increase the severity, benefits, and self-efficacy of the nurses' preventive behaviors against CVDs and modify their dietary regime.

INTRODUCTION: Marital quality is an important predictor of marital continuity, which can lead to mental health, well-being, and happiness for couples, and marital quality is equivalent to marital satisfaction and adjustment. This study was carried out to purpose the effectiveness of metacognition therapy on marital quality of women in the city of Isfahan. MATERIALS AND METHODS: The research method was quasi-experimental with a pretest–posttest and control group design. The study population included all married women visiting consultation centers in the city of Isfahan during March 2018–March 2019. The sampling method was nonrandom voluntary sampling used to select 30 participants who were then randomly divided into experiment and control groups (15 individuals each). The research tool was the Revised Dyadic Adjustment Scale(RDAS). The experiment group participated in eight sessions of metacognition therapy, each lasting 90 min. Covariance analysis method was used to analyze the data via SPSS21. RESULTS: The result of covariance analysis showed that metacognition therapy has been effective in improving the marital quality of the women in the city of Isfahan (P < 0.01). CONCLUSION: The results of this study emphasize that metacognition therapy is effective on the marital quality of the women in the city of Isfahan. Using this treatment plan can result in improved marital quality and marital satisfaction and therefore improve the relationship of couples. Therefore, the results of the current study can provide empirical support for the use of metacognition therapy to improve marital quality.

INTRODUCTION: Schools are a valuable platform for promoting oral health through oral health education as the children spend most of their active time in schools. Training school teachers on oral health promotion will help to inculcate healthy oral habits in children during their formative years of life. OBJECTIVES: The objective of this study was to assess the knowledge, attitude, approach, and action change of school teachers toward oral health and the impact of this training intervention in improving their knowledge. MATERIALS AND METHODS: An interventional study was conducted among 50 primary school teachers across the country selected by the Ministry of Human Resource Development. A self-administered, 28-item questionnaire in Google document format was developed to evaluate the knowledge and practice of teachers toward oral hygiene before and after the teachers' training program. The training was done using a validated training manual on oral health promotion for school teachers developed by the Ministry of Health and Family Welfare. Needs assessment for training was conducted 1 week before this training program. STATISTICAL ANALYSIS: Wilcoxon signed-rank test and Mc Nemar tests were used to assess the difference between the scores before and after oral health education. RESULTS: The needs assessment revealed that majority of the teachers felt the need to participate in oral health promotion training. A significant increase (P < 0.001) in mean knowledge scores of school teachers was seen after a 1-day training program. CONCLUSION: The training improved the knowledge of school teachers on oral health which indicates that the adopted method of oral health education was well received by the participants from all over the country.

BACKGROUND: The empirical assessment of the health outcomes associated with migration caused by climate change is still unclear. However, health outcomes in the early stages are expected to be similar to the health outcomes associated with refugees. The objective of the present study was a systematic review of the health effects of migration caused by climate change. METHODOLOGY: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Online databases (PubMed, Scopus, Web of Science, and Google Scholar) were used to identify papers published that evaluated the health effects of migration caused by climate change. The search, article selection, and data extraction were carried out by two researchers independently. All English-language articles on the health effects of migration caused by climate change were included in this study. RESULTS: An analysis of the complex ways in which climate change influences populations can be facilitated using a three-class classification: compulsory displacement, resettlement planning, and migration. Subsequent to climate changes, other changes, and environmental deficiencies, compulsory displacement may occur in case of inadequacy of compatibility responses. A part of migration-related health outcomes caused by climate change is from displacement from rural to urban areas, especially in developing countries. There is significant documentation on health and livelihood inequalities between migrant groups and host populations in developed countries. CONCLUSION: If climate change continues in its current direction, it is likely that the number of refugees and crises will increase in the coming decades. Although the domain and the extent of health hazards caused by the displacement of the population associated with climate change cannot be clearly predicted, by reducing global greenhouse gas emissions, along with social and environmental adaptation strategies, migration caused by climate change, health risks and its relevant crises can be greatly reduced.

BACKGROUND: Childbearing is an important biological and social event in the life of most women. It is a voluntary behavior that can be affected by many factors. Behavioral theories are a potential path way to study and influence childbearing behavior. The present study was conducted to determine the effect of an educational intervention based on the theory of planned behavior (TPB) on childbearing intentions in women presenting to premarital counseling centers in Tehran. MATERIALS AND METHODS: This randomized controlled quasi-experimental study was conducted on 150 women aged 20–35 years presenting to premarital counseling centers. The participating women were randomly divided into an intervention (n = 75) and a control (n = 75) group using randomized sampling in Excel. The intervention group received two 90-min sessions of training. The effect of training was assessed 6 weeks after the intervention using the researcher-made questionnaire based on the components of the TPB. The questionnaires included subjects' demographic details, knowledge (11 items), attitude (13 items), subjective norms (10 items), perceived behavioral control (8 items), and behavioral intention (4 items). Data were analyzed by SPSS software (version 22) and independent t-test, Chi-square, Mann–Whitney U-test, and Wilcoxon test.P<0.05 was considered statistically significant. RESULTS: There were significant differences between the intervention and control group after the intervention in the Mean ± SD scores of knowledge (6.73 ± 2.63 vs. 4.73 ± 2.85, P = 0.001), attitude (48.23 ± 7.19 vs. 40.13 ± 5.80, P = 0.001), perceived behavioral control (33.19 ± 5.28 vs. 23.59 ± 3.47, P = 0.001), and behavioral intention (13.84 ± 2.95 vs. 11.77 ± 2.12, P = 0.027). CONCLUSION: The findings showed that an education based on the TPB increased women's childbearing intentions by affecting their knowledge, attitude, perceived behavioral control, and intention. It is therefore essential to implement better public policies, create a more conducive educational setting for women of different age groups, and build a social support system.

INTRODUCTION: It is less than a decade in Iran that integrated health kiosks have been limitedly provided to public by private sector. Considering the significant benefits of them, this study aimed to identify the barriers and facilitators for deploying kiosks in Iran's formal health system in three phases, “design and construct, implement, and use.” MATERIALS AND METHODS: This was a qualitative study in Iran, and the data were collected through 20 semi-structured interviews with experts in 2019. Participants were selected by purposeful method with the most diversity in terms of background and work experience; the interview texts were coded in MAXQDA10 software and analyzed through framework analysis. Participants' viewpoint was used to verify the data and observers' review to confirm them. RESULTS: The barriers for designing and constructing kiosks were identified in the form of two main themes: the overall structure of the country and the structure of the health system; the obstacles for implementing were categorized in one main theme, lack of sources; and the barriers to use were also fall into four themes related to people, policymakers, service providers, and designers of kiosks. The facilitators at construction and implementation phases included the overall structure of the country and the structure of health system. At the use stage, the facilitators related to people, health and insurance policymakers, and owners and constructers were identified. CONCLUSION: It is possible to deploy health kiosks in the Iranian formal health system, although there are some time-consuming and costly barriers which can be overcome by the strengths and opportunities of the system.

BACKGROUND: This study has been carried out to study the usefulness of the clinical posting at the National Referral Hospital in Bhutan. It is important to know whether the clinical experience leads to gaining nursing skills, and nursing being a skill-oriented profession, clinical placement provides an opportunity, and education that carry a heavy weight in their wholesome nursing education. OBJECTIVE: The objective was to explore how nursing students commonly perceive their clinical experience. METHODS: A focus group discussion was conducted with eight to ten students/group from three levels of nursing education. The groups were 1^st-, 2^nd-, and 3^rd-year students who expressed their clinical experiences during the focus group discussions. The data were analyzed by content analysis using a thematic analysis. RESULTS: Four themes emerged from the focus group discussion. The themes were “good exposure,” “connect theory to practice,” “anxiety and fear,” and “learning by task participation and helping.“ CONCLUSION: The clinical environment is different to classroom. In clinical areas, the students experience stress and anxiety, and learning is through working together, moreover, it finds out that real situation is not what is taught in the classroom.

BACKGROUND: Desirable sexual function is one of the symptoms of mental and physical health. Many causes can cause sexual dysfunction. Emotional problems in marriage are one of the main causes of sexual dysfunction. The purpose of this study was to investigate the relationship between emotional intelligence and its components with sexual function of women of reproductive age. MATERIALS AND METHODS: The present study was a co-relational–analytic study that was performed on 165 women of childbearing age in the second half of 2018 in selected health centers. Data were collected using a three-part questionnaire including demographic questionnaire, FFI standardized sexual function questionnaire, and Bar-On Emotional Intelligence Questionnaire. Data were analyzed using descriptive statistics, Spearman, and Pearson correlation. RESULTS: Most of the study participants were in the age group of 26–30 years (30.4%). The results showed a positive correlation and a statistically significant relationship between the mean score of all the components of emotional intelligence except the interpersonal relationships, responsibility, empathy, and self-esteem with sexual performance score (P < 0.05). CONCLUSIONS: Based on the positive correlation between some components of emotional intelligence and sexual function, emotional intelligence can be considered as an important and effective variable in improving women's sexual function, so focus on emotional intelligence in counseling and education Individuals and emphasis on promotion are recommended.

INTRODUCTION: Internationalization of higher education involves mutual exchanges as well as a consensus based. Political, economic, sociocultural, and scientific reasons recommend the need to move toward the internationalization of higher education. The current study highlights the strengths of the internationalization of Iran's medical sciences education. MATERIALS AND METHODS: This descriptive exploratory study was carried out in 2016–2017 in Iran. The techniques used for data collection included review of articles, interview with subject experts, and the focus group and the nominal technique group to explore the views of various stakeholders. The data were analyzed with the qualitative content analysis method. RESULTS: The inductive qualitative content analysis of all data generated 13 categories and 88 subcategories. The categories were geographical and geostrategic position of Iran; the historical, cultural, religious, and tourist attractions of Iran; the security of Iran; priority to internationalization policies and programs in Iran's macro plans; the existence of regulations, laws, and approvals for international activities; same language with neighboring and regional countries; the low cost of studying and living in Iran; the ability of Iranian faculty members and experts for internationalization; the background, reputation, and the progress of medical education, health, and care in Iran; the cheaper forces of Iran and their welcome to foreigners; the existence of motivation, zeal, and belief for internationalization; the existence of proper infrastructure; and the existence of a suitable capacity for internationalization. CONCLUSIONS: Iran has some positive points that can be used to promote international activities, provided it does some good advertising in this regard. It is suggested that the challenges, opportunities, and threats to Iran's internationalization should be collated from the perspective of the various stakeholders.

INTRODUCTION: Clinical education is one of the most important parts of medical students' education, and it is a major part of the education of qualified and professional people. Therefore, this study was conducted to determine the effect of applying Direct Observation of Procedural Skills (DOPS) on midwifery students' clinical skills. MATERIALS AND METHODS: This is a quasi-experimental, two-group study conducted as a pre- and post-study on midwifery students in 2017–2018. Cluster and randomized sampling method was used. The processors involved in this study were three main skills of vaginal examination, pelvic examination, and vaginal delivery. The DOPS method was used to assess the practical skills in the interventional group during three times the process at day, 1 day, and at least 1 week later; the usual logbook method was used in the control group. Two groups were evaluated at the end of the midwifery course by Comprehensive Final Midwifery checklist. The tools were checked for validity and reliability, and data were analyzed using descriptive and analytical statistics. RESULTS: There was no statistically significant difference between the two groups in terms of important demographic variables such as age, grade, marital status, and initial assessment score (P > 0.05). The mean of final scores in the normal delivery, vaginal examination, and pelvimetry was statistically significantly higher in the interventional group (P < 0.001). On the other hand, the functional field of the students in the interventional group was statistically significantly improved in normal delivery and pelvimetry (P < 0.05), and this difference was not significant in the vaginal examination. In addition, the mean scores of students before and after the DOPS method were statistically significantly different in every skill in Comprehensive Final Midwifery checklist (P < 0/05). CONCLUSIONS: The DOPS assessment methodology is not only a useful tool of clinical evaluation, but also an effective tool for clinical learning of students. For this purpose, it is suggested that educational members of midwifery take enough time to design DOPS method in the same process.

BACKGROUND: The high incidence of dental diseases among Indian children can be attributed to low awareness regarding the oral health maintenance. The school health curriculum in India is deficient of an oral health component, and there are no organized oral health programs for schoolchildren existing at present. Therefore, the present study was conducted to assess the effectiveness of an oral health curriculum in improving the oral health behavior and dental caries experience in schoolchildren. METHODS: A nonrandomized trial with pretest/posttest design was conducted among 600 schoolchildren. Two intervention arms were designed with one group receiving health education from a dental health professional and other from a school teacher. The oral health curriculum was customized for three sections of different age groups (lower primary [LP], upper primary [UP], high school [HS]) and implemented for a period of 1 year. Oral health behaviors were recorded using a Knowledge, Attitude and Practice (KAP) questionnaire and were evaluated at baseline, 6 months, and 1 year of the educational intervention. Dental caries experience was measured Pre and Post - intervention using deft and decayed, missing, and filled teeth indices. Descriptive statistics were calculated for continuous data, and the change in KAP scores and dental caries experience was analyzed using the repeated measures of ANOVA, independent t-tests, and paired t-tests. RESULTS: There were significant improvements in KAP regarding oral health among Indian schoolchildren. Significant reductions in decayed primary teeth were observed in LP and UP schoolchildren post-intervention. However, there was no significant difference in primary outcome between the two intervention arms. CONCLUSIONS: A curriculum-based health education intervention customized for different age groups was found to be effective in improving oral health behavior and dental caries experience among Indian schoolchildren.

BACKGROUND: Poor adherence in treatment and medication is a global issue in curing the chronic diseases such as hypertension. The present study was conducted to identify the factors related with medication adherence among hypertensive patients referred to the health centers of Borujerd based on the Pender's Health Promotion Model (HPM). MATERIALS AND METHODS: This cross-sectional study was conducted on 463 patients who were referred to the comprehensive health centers of Borujerd city by cluster sampling method in 2019. The data were collected using a questionnaire including demographic variables and Pender's HPM constructs. Data were analyzed by SPSS 18 software using Pearson correlation coefficient and linear regression. RESULTS: The mean and standard deviation of the participants' age was 63.29 ± 11.2 years. The results showed that hypertensive patients had a relatively desirable level of medication adherence behavior. Perceived barriers (β = −0.169), perceived self-efficacy (β = 0.196), activity related affect (β = 0.232), and following medication regimen (β = 0.225) were the best predictors of performing the medication adherence behavior. In total, different structures of the HPM explained 42.2% of the variation of medication adherence behavior changes. CONCLUSIONS: According to the findings, the design of educational programs using HPM is recommended to increase the medication adherence among hypertensive patients.

INTRODUCTION: A large number of women experience sexual health problems during the postpartum period. This study aimed to evaluate the effect of sexual health education on sexual function and time of sexual intercourse resumption after childbirth in primiparous women in Southeast Iran. MATERIALS AND METHODS: This randomized clinical trial was conducted on 94 primiparous women randomly divided into two groups of intervention and control. The intervention group was subjected to three training sessions 3–5, 10–14, and 30–45 days after childbirth ( first session lasting 20 min and other sessions 60 min). On the other hand, the participants in the control group only received the routine postpartum training. The Female Sexual Function Index (FSFI) was completed by all participants before and 8 weeks after the intervention. Data were analyzed in SPSS software (version 22) using descriptive and inferential statistics, such as Chi-square test, independent t-test, and paired sample t-test.P< 0.05 was considered statistically significant. RESULTS: The mean score of FSFI in the intervention group was increased from 12.70 ± 6.166 before the onset of the intervention to 17.36 ± 5.407 after 8 weeks (P = 0.01). In the control group, the mean score of FSFI was decreased from 13.09 ± 4.306 to 12.29 ± 3.511 on the 8^th week postpartum (P = 0.06). The mean times of sexual intercourse resumption in the intervention and control groups were 5.82 ± 0.17 and 5.81 ± 0.22 weeks, respectively, which were not significantly different between the two groups (P = 0.879). CONCLUSION: Sexual health education for women in the postpartum period could improve their sexual function after childbirth. However, it is recommended to use sexual health education programs in women during the postpartum period to promote female sexual function.

BACKGROUND: First point-of-care (FPC) at the primary health care (PHC) level is an important public health issue at the global level. Patients directly come to tertiary health centers without a referral. AIMS AND OBJECTIVES: Hence, the current study was done to assess the proportion of individuals availing health-care services from rural health center (RHC) as FPC and reasons for not availing it. METHODS: A community-based cross-sectional study was conducted in Puducherry, coastal South India, among 367 households with 1510 individuals. Sociodemographic details, recent FPC during the past 6 months, morbidity profile, and reasons for not seeking were collected from all the individuals. RESULTS: About 44.5% (672/1510) of individuals used any health facilities, of which 70.4% (473/672) used RHC as the FPC. About 33.2% of individuals had a respiratory illness, 22.3% had general signs and symptoms. About 24.6% (32/130) mentioned the reasons for not seeking care as lack of appropriate health facilities. CONCLUSION: More than one-fourth of the study population not utilized services at PHC level. Improving the health facilities may help to increase these services.

OBJECTIVE: The aim was to explore the relationship between mental health problems (MHPs) and health-promoting lifestyle (HPL) in the medical students. METHODS: This cross-sectional study was carried out on medical students in 2017 at Semnan University of Medical Sciences applying a stratified random sampling. The Symptom Checklist-25 and the HPL profile scales were used. Logistic regression models were used to analysis. RESULTS: Of the participants, 84 were male and 148 were female. The mean age was 22.69 years (±2.42). Most students (95.3%) were single and 40.1% were in the preclinical stage. The mean MHP score was 44.14 (±13.99), and 3% were in the severe category. The mean HPL score was 104.88 (±16.84); 95.7% and 4.3% of them had average and satisfactory lifestyles, respectively. The MHP score of the female (P < 0.001), younger (P < 0.001), single (P = 0.045), preclinical (P < 0.001), and who were away from home (P = 0.009) were significantly higher. The HPL score of female (P < 0.001), older (P = 0.041), and married students (P = 0.028) were significantly higher. The female gender (odds ratio [OR] = 4.45, P < 0.001) and studying in the clinical level (OR = 0.30, P < 0.001) were the most important associated factors with MHP. Adjusting for them, there was a significant relationship between an increase in the HPL score and a decrease in the likelihood of MHP (OR = 0.96, P < 0.001). CONCLUSIONS: The mental health of medical students was shown to be in association with lifestyle independent of other important determinants, including gender and academic level. It seems that modifying the lifestyle to a healthier way can improve students' mental health.

BACKGROUND: Evidence is accumulating that the pattern and nature of marital relationships are very different in different cultures. This nationwide study aimed to determine marital satisfaction and the prevalence of emotional divorce as well as to identify the sociodemographic correlates in a Muslim population. MATERIALS AND METHODS: In this cross-sectional study, one-third of Iran's provinces were selected randomly and a representative sample of inhabitants of their central city was included in the study. The ENRICH marital satisfaction scale was used to determine marital satisfaction levels. A single-item measure with confirmed validity and reliability was used to find out about emotional divorce. The demographic variables included respondent's age, spouse's age, gender, educational level, residency, childbearing, and premarriage familiarity. RESULTS: Of the 2033 participants, 1034 were women (50.9%). Nearly one-third of both men and women had academic degrees. Almost 53% of them were satisfied with their marital life and 9.7% had emotional divorce. Men with academic degrees had a higher probability of marital satisfaction (odds ratio [OR] =1.26, 95% confidence interval [CI]: 1.04–1.53) and a lower prevalence of emotional divorce (OR = 0.37, 95% CI: 0.24–0.58). CONCLUSION: This study showed a relatively high percentage of marital dissatisfaction as well as emotional divorce. Policymakers should strengthen premarriage education programs and postmarriage counseling centers.

BACKGROUND: Thinking styles' effect on academic achievement is a challenging topic that has been raised with very different results in previous studies. Since thinking styles are influenced by the contexts, this study was conducted in the context of the occupational therapy, which is one of the disciplines in the rehabilitation sciences in Iran and its educational studies are still developing. The purpose of this research is to study thinking styles and their relationship with the educational achievement of occupational therapy students at Shiraz School of Rehabilitation Sciences. METHODS: This was a descriptive correlational study conducted at Shiraz School of Rehabilitation Science in 2015. As sampling was considered by the census of all students in the 2^nd–4^th year of Bachelor of Occupational Therapy, demographic data questionnaire and the “Short form of Wagner-Sternberg Thinking Styles Inventory (1992)” were distributed among all 78 students. Students' academic achievement was also considered by grade point average obtained from the educational office at school. The data were analyzed by descriptive and analytic statistics utilizing SPSS21 software. Pearson's correlation coefficient and linear regression tests were used for data analysis. RESULTS: Forty-two students participated in this study with their personal consents. The results revealed that hierarchic (18.47 ± 2.54) and external (18.47 ± 3.23) were the dominant thinking styles of the occupational therapy students, followed by judicial, legislative, oligarchic, executive, conservative, liberal, monarchic, anarchic, local, global, and internal thinking styles. In addition, there was no correlation between any of the thinking styles and students' achievement (P = 0.354). Thinking styles predicted only 4.9% of changes in academic achievements in this study. CONCLUSION: Thinking styles could predict only limited amount of the academic achievements of occupational therapy students. Furthermore, as the dominant thinking styles of the occupational therapy students are hierarchic and external, it seems that occupational therapy students prefer to have a hierarchy of academic goals and seek tasks that provide them with the opportunity to interact with the others.

BACKGROUND: In recent decades, the use of psychological methods has been considered to improve the barriers and challenges of abuse adolescent females. This study focuses on comparing the efficacy of trauma-focused cognitive-behavioral therapy (TF-CBT) and theory of mind (ToM) on social competence among abused children. MATERIALS AND METHODS: A clinical trial was performed with 39 abused children as the subjects of the study. Participants are residents in Ahvaz (Iran) host-family centers and were randomly divided into two groups of experimental subjects and control subjects. The data collection method utilized the Social Competence Questionnaire. Descriptive statistics, covariance analysis, and Tukey's post hoc test were used for the data analysis. RESULTS: Comparison of the groups showed that the average behavioral and cognitive competence increased in both TF-CBT and ToM groups, but the average emotional, social competence is significantly higher in the ToM group. It is also found that the average social motivational competence is significantly higher in the TF-CBT group than in the ToM group. CONCLUSION: TF-CBT and ToM can be effectively used to improve the social competence of abused adolescent females.

INTRODUCTION: Teacher empowerment is thought to improve student learning by fostering teaching quality. Therefore, the purpose of this study is investigating the relationship between empowerment and self-efficacy of Iranian English as Foreign Language teachers. MATERIALS AND METHODS: The present study is an experimental study; the population of the study includes all the English language teachers of the universities of Ilam, Iran. Among whom by random sampling, the sample which was consisted of 60 teachers were selected. Participants in this study answered the School Participant Empowerment Scale questionnaire (Short and Rinehart, 1992) as the instrument of the study. The Pearson product-moment correlation was computed to determine the relationship between teacher empowerment and teacher self-efficacy. RESULTS: The results showed that there was a positive correlation between teacher empowerment and their self-efficacy (r = 0.55,P< 0.01) and differences among teachers' self-efficacy is not significant according to age (r = −0.14, P = 0.23). CONCLUSIONS: Based on the results of the study, empowerment and self-efficacy have interactive relationships; i.e. self-efficacy in teachers leads to empowerment and empowerment in teachers leads to self-efficacy.

BACKGROUND AND AIM: Given the prevalence of novel coronavirus disease 2019 (COVID-19) and the lack of information on coronavirus and pregnancy, the purpose of this study was to evaluate the association of COVID-19 and perinatal outcomes in pregnant women. MATERIALS AND METHODS: In the present review article, the search process was conducted on English and Persian scientific databases of PubMed, Scopus, Google Scholar, Magiran, Irandoc, Iranmedx, and SID as well as the websites of international organizations of World Health Organization and Centers for Disease Control and Prevention using the main keywords of “Pregnancy,” “Perinatal outcomes,” “Coronavirus,” “COVID-19,” “MERS-CoV,” “MERS,” “SARS-CoV-2,” and “SARS-CoV-1” and their Persian-equivalent keywords from inception until March 16 2020. RESULTS: The findings of studies on mothers with COVID-19 were limited, and insufficient information is available on the adverse pregnancy outcomes in pregnant women with COVID-19. In cases of infection with other coronaviruses such as Middle East respiratory syndrome and severe acute respiratory syndrome during pregnancy, there have been reports on adverse pregnancy outcomes such as miscarriage, stillbirth, preterm labor, low birth weight, and congenital malformations following high fever in the first trimester. CONCLUSION: Pregnant women may be more susceptible to viral respiratory infections, including COVID-19, due to immunological and physiological changes. Therefore, pregnant women should take routine preventive measures, such as washing their hands frequently and avoiding contact with infected people, to prevent infection.

BACKGROUND: The use of physical restraint in health-care settings is common and complex practice as it has physical, psychological, judicial, ethical, and moral issues. Nurses are the key persons regarding physical restraint use in hospitals as they are managing the whole process beginning with decision-making, application, caring the restrained patients. Lack of understanding and negative attitude of nurses in the use of physical restraints will hamper patient safety. MATERIALS AND METHODS: A descriptive cross-sectional survey was carried out among 110 rando mly selected nurses working in various departments at a tertiary care center Uttarakhand, India, in 2019. The data were collected using self-reported questionnaires consisting of three parts: demographic information, knowledge assessment questionnaire, and attitude rating scale regarding the use of restraints. Data were analyzed using the SPSS version 23 descriptive (frequency, percentage, mean, mean percentage, and standard deviation) and inferential statistics (Mann–Whitney and independent t-test). RESULTS: The findings indicated that the mean knowledge and attitude of the nurses for physical restraints were 13.9 ± 1.9 (0–20 points), 35.2 ± 4.7 (28–55 points), respectively. The study revealed that there was no relationship found between knowledge and attitude of nurses regarding the use of physical restraints (r = 0.084). CONCLUSION : The knowledge and attitude regarding the use of restraints among nurses were found to be moderate. In-service training is highly recommended for nurses to improve the knowledge and practices related to the use of physical restraint.

BACKGROUND: The identification of parental health knowledge related to obesity and overweight status in children is an important area. Its importance relates to understanding gaps in knowledge that can be used to create targeted intervention and prevention strategies to improve the management of child's weight. AIM: There is a growing awareness of the potential health risks associated with increased childhood weight. It is currently unclear how well the public understands these risks and if understanding is linked to improvement in obesity or overweight levels in children. This review focused on determining if the current research is available to describe parental knowledge and whether it is connected to improved outcomes in the child's weight status. METHODS: The search for original research articles published between 2003 and 2018 involved six databases, including CINAHL, EBSCOhost, PubMed, PsycINFO, Psychology, and Behavioral Sciences Collection, and OneSearch. The OneSearch database is a comprehensive search engine that allows simultaneous searching of the entire library category and results that are ranked by relevance to the search terms. The terms used included for the keyword search in each database included: “knowledge” or “awareness,” “health risk” or “consequence,” “obesity” or “overweight,” and “weight” or “body mass index,” “child,” and “parent” or “parental.” A content analysis of included articles was performed to synthesize available literature into a review. RESULTS: This review included nine articles dealing specifically with parents of children and their knowledge levels. As there was limited information about if child's weight status connected to parental knowledge, an additional seven articles addressing how knowledge affects weight at any age was examined. The findings for parental knowledge and its effect have mixed results and varying methods of measurement. CONCLUSIONS: While some studies have indicated the importance of knowledge, it is difficult to establish a reliable connection due to the limited examination of this subject. This is, therefore, an underexplored area that needs further study.

BACKGROUND: Communication skills are one of the most important competencies required for community health workers (CHWs); however, there is no systematic evidence-based communication training course for them. In this study, we aim to develop a comprehensive communication skills curriculum for CHWs based on the intervention mapping (IM) approach. MATERIALS AND METHODS: We used the IM approach to develop a systematic evidence-based communication skills curriculum for CHWs. First, we will determine the required competencies (by a literature search, a qualitative study, and a Delphi study), and then, we will develop a questionnaire for need assessment, and finally, we will implement the course and evaluate its efficacy by conducting a randomized controlled trial. This study was designed according to the steps of IM. CONCLUSION: This protocol reports an example of developing a training course using IM. This course could be applied for similar health workers across the world, as well as the CHWs.

BACKGROUND: An alarming trend of sustained blood pressure elevation among children and adolescents has been found. Health education to schoolchildren in their formative age is the most effective method to be able to modify their habits, and further, they can be enrolled as an effective health educator for their parents. OBJECTIVE: To study the effectiveness of health education module on study participants about prevention and control of hypertension (HTN) and the effectiveness of child as a health educator on parents' knowledge about prevention and control of HTN. MATERIALS AND METHODS: This quasi-experimental study was conducted with a control group among high school students in two urban secondary schools. There were 110 students and 100 parents each in the intervention and control groups. Modular training with interactive teaching–learning methods was conducted for students in the intervention group. They, in turn, educated their parents. RESULTS: Postintervention, the study results showed a higher median for various domains in the intervention group as compared to the control group among both students and parents. On applying Mann–Whitney test, this difference was statistically significant with P < 0.001. CONCLUSION: The increase in the knowledge of parents belonging to the intervention group suggests the effective transfer of knowledge from the students to their parents.

INTRODUCTION: Health policymaking seems simple; in practice, but, it is very complex. However, this study aimed to provide a framework to bridge the gap between policy and action in order to present an interconnected model for developing countries. MATERIALS AND METHODS: This was a qualitative study. Using desk search, different models were searched from various scientific databases for formulation of an integrated policy-making framework. In next stage, the identified National upstream documents were analyzed to achieve existing policymaking evidence. Then to determine the validity of the initial model and to gather the views of key experts, two Delphi rounds were used. The tool used in Delphi method was a 9-point Likert questionnaire that was sent to the experts via E-mail. RESULTS: This model, by employing integrated chain of visions and strategic targeting of ultimate aims on the one hand and expected key functions and support functions for generating output (operational goal) on the other, provides an extensive operable insight being influenced by human-Islamic principles and values, social, technological, economic, environmental, and political for strategic as well as operational managers./Policy makers CONCLUSION: This framework consisted of general, strategic, and executive levels. It creates the needed institutional and structural capacity to achieve a comprehensive health approach for all laws and policies to control social factors affecting health, improve health situation, and promote the health of citizens.

BACKGROUND: Peak expiratory flow rate (PEFR) is widely used as a predictor of treatment of asthma patients. Peak expiratory flow and forced expiratory volume in first second (FEV₁) are the most useful parameters for the diagnosis of asthma. Spirometry is not often available in the primary care setting, and economic factors may limit its testing. Mild airway narrowing may be present in asymptomatic children, which can be identified by determining their PEFR. This will enable us to initiate early treatment. MATERIALS AND METHODS: We selected 200 asymptomatic children at the age of 10–15 years without a history of smoking, tuberculosis, or other respiratory illness. A family history about asthmatic symptoms was sought. PEFR values of all children were recorded, and 40 children showed PEFR values less than 80% of their predicted values. To confirm whether the low observed values were because of airway obstruction, their spirometry was performed. RESULTS: Nine out of 47 (19.14%) children from asthmatic families and 31 out of 153 (20.26%) from nonasthmatic families showed PEFR values <80% of the predicted value (P > 0.05). Considering a decrease in the FEV₁/forced vital capacity (FVC) ratio to <80% for the diagnosis of obstructive disease, only two out of 35 children were found to have it. Correlation between PEFR and FEV₁/FVC ratio was not significant (r = 0.314 and P = 0.065). CONCLUSIONS: Asymptomatic children with low PEFR values may not show abnormal lung functions on spirometry. However, these children, particularly those having the risk of family history of asthma, may be followed for the development of airway obstruction.

CONTEXT: Performance is a significant objective of any organization. To grow and develop and to improve the performance of the education development centers (EDCs) of medical sciences universities at Iran, the recognition of the performance criteria of these centers is important. This study was conducted with the aim of discovering the performance criteria of EDCs of medical science universities. SUBJECTS AND METHODS: This study was conducted using qualitative research and a semi-structured interview. Participants were selected using an expert sampling method is a sub-type of purposive sampling. Twenty-three faculty members and expert staff (11 males and 12 women) participated in the interview. Data were collected using the participant's perception. The data analysis was performed based on the interpretative analysis steps of Gillham and Rubin. RESULTS: From the analysis of data, seven categories including leadership, strategy, stakeholders, workforce, knowledge management, processes management, and results were obtained. CONCLUSIONS: The obtained criteria in this study assist managers to design and to develop self-assessment questionnaires and a performance measurement program for EDCs of medical sciences universities. This will facilitate performance evaluation of EDCs.

BACKGROUND: Metacognition and academic self-efficacy are two emerging resources in the process of learning. Basic levels of metacognition and academic self-efficacy may differ and be influenced by demographic and academic factors. This study investigated impacts of demographic and academic factors on metacognition, metacognitive skills, and academic self-efficacy in health sciences students. MATERIALS AND METHODS: A cross-sectional study was conducted among 404 participating students attending various fields of study in health sciences at Shahrekord University of Medical Sciences. Demographic and academic data were collected. Global metacognition, metacognitive skills, and academic self-efficacy scores were assessed using published or online questionnaires. Means were compared using Student's t-test, whereas intra- and intergroups' scores were compared using one-way ANOVA test. RESULTS: Global metacognition and academic self-efficacy were not impacted by demographic students' status. The gender and age impacted both knowledge and control of process- planning (favoring male gender), as well knowledge and control-of-self (disfavoring 20–30 age class) of metacognitive skills, (P < 0.05). Academic status did not influence academic self-efficacy. The school type influenced the metacognitive skill component to knowledge and control of process-regulation (disfavoring nursing school) (P < 0.05). The academic discipline impacted the global metacognition (P < 0.05) and its knowledge and control of self-component (P < 0.01). CONCLUSIONS: Demographic and academic status does impact metacognitive skills and global metacognition scores. Given the heterogeneous level to innate metacognitive skills, this study sheds lights on usefulness to screen learners' subgroups that require supplementary educational instructions to uniformly optimize metacognitive skills.

BACKGROUND AND OBJECTIVE: Patients undergoing hemodialysis due to multiple drug therapies, special diet plans, and need to acquire the ability to adapt to physical and mental disabilities require special monitoring. The PRECEDE-PROCEED model is a process for behavior change and can lead to the promotion of self-care behavior. The aim of this study was to evaluate the effect of a health promotion program based on the PRECEDE-PROCEED model on self-care behaviors in hemodialysis patients. METHODS: This was a clinical trial study that was performed on 67 patients undergoing hemodialysis in Lordegan Hospital that has been distributed in two groups randomly. Data were collected using self-care assessment form according to the PRECEDE-PROCEED model. Based on the results of this questionnaire, five educational sessions were held in the fields of knowledge, attitude, enabling factors, reinforcement, and behavioral factors for the samples. Data were analyzed using descriptive and analytical statistics with SPSS version 21 software. RESULTS: According to statistical analysis before intervention, no significant difference was observed between the mean scores of self-care among the two groups. However, instantly and 3 months after intervention, the mean score of self-care (P = 0/03), knowledge, attitude, reinforcement factors, and behavioral factors (P < 0.05) significantly increased in the experimental group. CONCLUSION: Based on the results of this study PRECEDE-PROCESS model, the health promotion program increased the mean self-care score of hemodialysis patients. This program has been able to improve their self-care behaviors by changing knowledge, attitudes, and reinforcement and behavioral factors of patients and is recommending as an application in the nursing of these patients.

BACKGROUND: New gamification technology with a detailed understanding of the goals and prospects, and with the help of game elements and techniques, leads to promotion of motivation and participation, and ultimately behavior change. Therefore, this study aimed to evaluate the implementation of a mental gamification from blended learning based on the flex model and efficacy of this program on students. METHODS: In this study, with the design of mental illness lessons for undergraduate and executive groups, using flex model, two parts of technical and educational design were used. In the technical section, three parts on dynamics, mechanisms, and elements of gaming were considered. Intervention was studied on different groups of medical students including medical, health, and laboratory sciences. Effect of this educational program and its impact on their students' learning, motivation, and satisfaction was studied using quantitative and qualitative analyses. RESULTS: The results of the students' prospective about the efficacy of the method showed that the mean scores of most of the items were higher than the average. This implies that students' attitude toward using gamification was positive. In the other part, the qualitative results of the study were analyzed and the students' analysis of their advantages and disadvantages and their perceptions on the impact of the intervention was examined. CONCLUSION: Based on the flex model, mental gamification based on blended learning is effective in shaping the students' satisfaction.

INTRODUCTION: Smoking is a significant health problem among Indonesian adolescents and adults. The Indonesian government had issued several policies to alleviate this problem, including placement of pictorial health warning (PHW) on cigarette package. There had been several evaluation studies regarding the effectivity of PHW in urban areas but none in rural areas. This study aims to evaluate the effectivity of PHW in motivating smoking cessation in a rural area in Indonesia. MATERIALS AND METHODS: This was a descriptive cross-sectional study conducted in August 2017 in Losari village, Indonesia. Respondents of this study were villagers aged 18–60 years who were active smokers and purchased cigarette with PHW on the package. The research instruments for this study were questionnaire and printout pictures of each PHW approved by the Indonesian government. RESULTS: There were 94 respondents recruited in this study. Among them, only 26 (27.7%) stated that PHW motivated them to stop smoking. From the five figures of PHW, a picture of lung cancer was the most effective PHW to motivate smoking cessation. Eighty-one of 94 respondents affirm that there are other factors besides PHW that might motivate them to stop smoking. Most of them agreed that an increase in cigarette price will force them to stop smoking. CONCLUSIONS: Current PHW used on cigarette package might be ineffective in motivating smoking cessation at Losari village. Further study with larger samples needs to be done to confirm this finding.

INTRODUCTION: Emotional intelligence and learning strategies are among the major requirements for success and academic achievement. The present research was designed and carried out to explore the relationship of emotional intelligence with learning strategies in postgraduate students. METHODS: The study employed a cross-sectional design and was conducted at Kerman University of Medical Sciences in 2018. Using the emotional intelligence questionnaire by Bradberry and Greaves and a researcher-made questionnaire of learning strategic, we assessed the relationship of emotional intelligence with learning strategies in postgraduate students using a census method (n = 338). Data were analyzed using descriptive statistics including mean and standard deviation and analytic statistics such as Kolmogorov–Smirnov test, ANOVA, t-test, and Pearson's correlation coefficient at P < 0.05 significance level. RESULTS: This study showed that the mean emotional intelligence score of postgraduate students was 91.12 ± 13.92 and also no significant relationship between the learning strategies and the emotional intelligence in the participants, but the emotional intelligence components showed a positive significant relationship with the learning strategy components, namely self-efficacy, rehearsal, critical thinking, cognitive self-regulation, time and study environment management, peer learning, and help-seeking. CONCLUSION: It could be stated that emotional intelligence components can be taught and fostered to improve the emotional intelligence of the learners, optimal learning, and the quality of educational outcomes. However, a learning strategy is a natural, habitual, unique, and fixed preferential method that serves to absorb, process, and maintain new information and skills. In other words, reinforcement of emotional intelligence facilitates learning.

BACKGROUND: Caregiver stress is harmful to the health of both caregivers and people living with Alzheimer's disease or other dementias. The present study was conducted to assess stress and its predictors of people living with Alzheimer's disease or other dementias' caregivers. METHODS: The present descriptive, analytical, cross-sectional study was conducted in December 2017–June 2018 in Isfahan, Iran. Data were collected by interviewing 99 caregivers had at least 6 months of experience caring for a patient diagnosed with Alzheimer's disease, through questionnaires developed by the researcher. A convenience sample (easy access) of caregivers was recruited from calling the home of formally diagnosed with Alzheimer's patient, that have registered in educational hospitals affiliated to Isfahan University of Medical Sciences and psychiatrists' office both paid caregivers (formal) and unpaid caregivers (family). All caregivers provided informed consent. The type and severity of the relationship between the dependent (stress) and independent variable were assessed using Pearson's and Spearman's correlation coefficients, the independent t-test, and the multivariate regression analysis. RESULTS: The caregivers' mean stress score was 25.4 ± 10.9 (range: 4–54). About 80% of the caregivers were female. Age and stress score was correlated (P = 0.004), the mean stress score was significantly higher in female caregivers (P = 0.04), informal caregivers (P < 0.001), and significantly lower in the caregivers with previous experience of caring for Alzheimer's patients (P = 0.02) or those introduced by service companies (P = 0.005). Variables including the family relationship with the patient (P = 0.01), kind of caregiving (P = 0.03), and previous experience of caring for Alzheimer's patients (P = 0.04) were stronger predictors of the stress score. CONCLUSION: Stress is a challenge in promoting mental health among dementia caregivers. Providing social support with an emphasis on physical, mental, and social health is mandatory, especially for female and family caregivers, to promote stress management, mental health in this group, and enable optimal and purposeful care.

INTRODUCTION: Spiritual health is one of the four dimensions of health in humans, and the others are physical, psychological, and social dimensions. This dimension is essential to increase the adaptation to the disease. Therefore, this study was aimed to determine spiritual health in women with multiple sclerosis (MS) and its association with self-esteem. METHODS: This is a descriptive cross-sectional study, and 210 women with MS referring to Ayatollah Kashani Hospital affiliated to Isfahan University of Medical Sciences were selected using convenience sampling method. The data were collected by questionnaires of demographic characteristic questionnaire (6 items), Rosenberg Self-esteem Scale (10 items), and Ellison and Paloutzian Spiritual Well-being Questionnaire (20 items). Data were analyzed using descriptive statistics, Pearson's correlation coefficient, and multiple regression analysis at a significance level of 0.05. RESULTS: The mean and standard deviation of spiritual health (including religious health and existential health) and self-esteem in MS patients were 48.8 ± 6.80, 44.7 ± 6.70, and 3.21 ± 2.5, respectively. The results showed that 95.2% of the research units had moderate-to-high spiritual (religious and existential) health and 57.7% had high self-esteem. Pearson's correlation coefficient also showed a significant positive correlation between religious health and existential with self-esteem (r = 0.22, P = 0.03 and r = 0.24, P = 0.01, respectively). CONCLUSIONS: In this study, most of the women with MS had high levels of spiritual health and self-esteem. This can be used as a coping strategy and has a protective effect against stress-induced illness and even against complications of the treatment. In addition, in some cases, it is effective in alleviating frustration in these patients.

BACKGROUND: Hospitals in developed countries allocate itself about 40% of health-care costs and in developing countries up to 80%. In this study, researchers reviewed the related article in the field of the hospitals' performance evaluation due to the identification of common indicators used in different models with the aim of providing simple list for evaluating hospitals' performance to the researchers who are interested to these issues. METHODS: The databases for the search included Medline, Google Scholar, and Scopus. A search strategy leads to the extraction of 403 related articles that after the removal of inappropriate and duplicate articles, 42 studies were selected for the scoping review. RESULTS: This scoping review showed that 9 of 42 selected articles use data envelopment analysis model, 6 of them Pabon Lasso model, 3 of them balanced scorecard, 3 of them organizational excellence model, and the remaining articles used key performance indicators to evaluate hospital performance. A process approach was used to categorize the common indicators because the literature review indicated that common indicators mainly evaluate data, process, output, or impact of performance. The findings included 36 input, 39 process, 27 output, and 8 impact common indicators for evaluating performance. DISCUSSION: This scoping review of related literature indicated that despite differentiation in the time and place of past studies in the field of performance evaluation models, there are some indicators that are common in most popular performance evaluation models. These simple lists can apply for evaluation of hospitals' performance instead of complicated models.

BACKGROUND: Women during menopause stages experience many symptoms, for which they lack enough knowledge to manage them. This study aimed to compare the effect of self-directed and support group health education on the quality of life (QOL (and self-care of postmenopausal women. MATERIALS AND METHODS: This field trial study was carried out with three groups. One hundred and eight menopause women were selected through convenient sampling method based on the inclusion criteria from three comprehensive health centers. Health centers were randomly assigned to support (n = 36), self-directed (n = 36), and control groups (n = 36). In the self-directed group, education was provided through educational package, and the control group received routine care from the health center. The support group received education through four group sessions by trained healthy volunteers. Data were collected by menopause-specific QOL and self-care standard questionnaire. RESULTS: Immediately after the intervention, the mean scores of QOL in the self-directed group, support group, and control group were 41.82 ± 7.61, 40.31 ± 4.80, and 48.17 ± 8.45, respectively (P < 0.05). In addition, the mean scores of self-care were significantly different between the self-directed (40.67 ± 7.36) and support (36.50 ± 3.36) groups compared to the control group (47.83 ± 8.47) (P < 0.05). After 1 month from intervention, QOL scores in the self-directed group (40.67 ± 7.36), support group (36.50 ± 3.36), and control group (47.83 ± 8.47) were significantly different (P < 0.05). In addition, the mean scores of self-care were 64 ± 6.79 and 65 ± 8.32 in the self-directed and support groups, respectively, compared to the control group (49.09 ± 9.43). Post hoc test (least significant difference) revealed higher effectiveness of the support group (P < 0.001). CONCLUSIONS: Results indicated QOL and self-care in menopause women in self-directed and support groups improved. However, the support group provided higher effectiveness. Therefore, we recommended paying more attention to the capabilities of healthy volunteers for the promotion of QOL in menopause women.

CONTEXT: In the era of technology, social networking has become a platform for the teaching–learning process. Exploring international students' perspective on using Twitter would reveal the barriers and potential for its use in higher educational activities. AIMS: This study aimed to explore the postgraduate students' perspective on using Twitter as a learning resource. SUBJECTS AND METHODS: This qualitative study was conducted as part of a postgraduate program at a university in the United Kingdom. A focus group discussion and five in-depth interviews were conducted after receiving the informed consent. The qualitative data were analyzed by R package for Qualitative Data Analysis software. ANALYSIS USED: Deductive content analysis was used in this study. RESULTS: Qualitative analysis revealed four salient themes, which were (1) background knowledge about Twitter, (2) factors influencing the usage of Twitter, (3) master's students' experiences on using Twitter for education, and (4) potential of using Twitter in the postgraduate study. The students preferred to use Twitter for sharing links and appreciated the benefit on immediate dissemination of information. Meanwhile, privacy concern, unfamiliarity, and hesitation to participate in discussion discouraged the students from using Twitter as a learning platform. CONCLUSIONS: Using social media platforms in education could be challenging for both the learners and the educators. Our study revealed that Twitter was mainly used for social communication among postgraduate students however most could see a benefit of using Twitter for their learning if they received adequate guidance on how to use the platform. The multiple barriers to using Twitter were mainly related to unfamiliarity which should be addressed early in the learning process.

INTRODUCTION: Due to changes in scientific findings and assigned tasks, continuing education and other enabling programs are increasingly critical for primary healthcare providers to keep them up-to-date in delivering oral health services. Planning these educational courses based on actual PHCPs' needs is fundamental to provide effective ones. The purpose of this study was to elucidate the experiences and needs of PHCPs regarding the quality of the oral health training provided in continuing education and other enabling courses. SUBJECTS AND METHODS: A qualitative study with content analysis approach was conducted in Najaf-Abad, Isfahan, Iran, in 2017. Data were gathered through in-depth semi-structured interviews with 19 primary healthcare providers. The sampling was started with purposeful method and continued through snowball method. Qualitative data were coded and analyzed using MAXQDA (VER 12). RESULTS: Factors affecting the quality of oral health training were categorized into three themes and nine subthemes, including instructor's related factors (knowledge, skills, and relevant experiences), educational content (content relevance, content innovation, and content update), and teaching methods and educational tools (fitting educational contents, covering learners' needs, and considering available possibilities). CONCLUSION: Instructors with inadequate level of knowledge, skills, and relevant experiences as well as inappropriate selection of educational content, teaching methods, and educational tools, were recognized as affecting factors on the quality of oral health training and effectiveness of continuous education and enabling programs.

INTRODUCTION: Today, it is important to use different indices to measure the performance of hospitals. This study aimed to investigate and evaluate the performance indicators of military hospitals and measurement of performance by using the Pabon Lasso model. METHODS: This was an applied and descriptive-analytical study that was conducted among five military hospitals affiliated to the Army of the Islamic Republic of Iran by using data from 2017 to 2018. Raw data related to performance indicators such as bed occupancy ratio (BOR), average length of stay (ALoS), and bed turnover rate (BTR) were collected by referring to the hospital medical record unit. After comparing performance indicators with the standards of the Ministry of Health, the Pabon Lasso model was used to measure hospitals' performance. RESULTS: In general, the average BOR and bed turnover interval rate are higher than that of the national standard in all hospitals and are in favorable status. However, the average length of stay in all hospitals was in unfavorable status. Furthermore, one and two hospitals were located in zone 3 in Pabon Lasso graph in the years 2017 and 2018, respectively. Overall, there was no change in the performance of the hospitals in the study time periods. CONCLUSION: In general, except for the average length of stay indicator, hospitals had a favorable performance level. Therefore, planning to improve performance indicators should be at the top of the programs.

INTRODUCTION: Bachelor's program in surgical technology is a major of medical science, in Iran. Learning and adapting to different skills and roles in the operation room environment is a daunting work. The complexity of this environment needs to bring together researchers in this field to work on different aspects. The aim of this qualitative study was comprehensively understanding of clinical teaching process in surgical technology. MATERIALS AND METHODS: The present study was conducted based on the qualitative research design of the grounded theory approach (Corbin and Strauss, 2008). This study was conducted at schools of nursing and paramedical in five academic settings. Study participants in the present study include 14 students, seven educational instructors, six staff of operation room, one dean of faculty, three surgeon assistants, one instructor, and four head nurses of operation room. A semi-structured interview method and a memo were conducted using theoretical and purposive sampling. Constant comparative analysis was used for data analysis. RESULTS: Findings showed that the nonacceptance of student by surgical team was identified as the main concern of the students. The “gaining clinical competence and approval” was found the central process (strategy) in response to main concern of clinical education, and the “interactive and dynamic nature of the operation room environment” was defined as the context for this major concern. Strategies that students used to address this concern included individual efforts to overcome distrust, learning in the shadow of surgical team members, and seeking help and support of the instructor. CONCLUSION: Accepting the students of surgical technology as a member of surgical team creates opportunities for students to learn, gain experience, and enhance their professional qualifications and abilities.

INTRODUCTION: The need assessment is a fundamental part of any planning, and almost by neglecting it, the effectiveness of the programs is impossible. The purpose of this study was the prioritization of needs among students of the Iran University of Medical Sciences. MATERIALS AND METHODS: The design study was conducted in two parts; in the first part, the design of the questionnaire was done by qualitative methods. The questionnaires were extracted by interviewing and obtained acceptable validity and reliability. Moreover, the second part created a questionnaire consisting of four categories: education, welfare, economic, and psychological and social. A simple random sampling method was used to select 363 people using the Cochran formula. Finally, 336 people (including 28 people excluded) completed the questionnaire. A questionnaire designed to collect sample data was used and analyzed using version 23 of SPSS. RESULTS: A total of 336 students (26.77 ± 5.45 years) participated in the study. 123 (36.6%) were male and 213 (63.4%) were female. Psychological and social needs of students were prioritized, and educational priorities were ranked second. The findings showed that there was no significant statistical difference between the scores of welfares and psychosocial and educational needs and the gender of the research units (P > 0.05). However, in the mean of economic needs scores, there is a significant statistical difference between the marital status of the research units (P < 0.05). CONCLUSION: The results of our study in the research units showed that the priority of psychosocial needs was more than other needs and the educational priority was the next. According to the results of this study, we suggest that, in future educational and educational planning, policymakers and planners should pay attention to psychological and social issues.

BACKGROUND: Dental education can be a critical wellspring of stress among dental students, and studies have observed higher levels of stress among dental students than in the all-inclusive community. The present study aims to evaluate the perceived stress among dental undergraduate students, the sources of stress, and an association of perceived stress with sociodemographic characteristics and various stressors. MATERIALS AND METHODS: A cross-sectional study was conducted among 380 undergraduate dental students (from 1^st year to final year) in a private dental college, Kanpur. A self-administered questionnaire was used to collect data regarding sociodemographic profile, perceived stress using Perceived Stress Scale-14, and academic, psychosocial, and environmental stressors. Data were analyzed using IBM SPSS Statistics-Version 21 (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0, Armonk, NY, USA: IBM Corp.). RESULTS: The mean perceived stress score was 30.25 ± 1.914. The median perceived stress score was 30. Statistically significant (P < 0.001) values were found for higher age group and year of studying Bachelor of Dental Surgery (BDS) were important sociodemographic determinant of stress. Vastness of academic curricula, frequency of examination (P < 0.05), and fear of failure/poor performance in examinations were important academic determinants of stress. High parental expectations and family problems were important psychosocial stressors. Accommodation away from home was an important predictor of stress (P < 0.001). CONCLUSION: This study revealed that there are various sociodemographic (age and year of study in BDS), academic (curricula, frequency of examination, and performance level) determinants and predictors of stress (type of accommodation), along with psychosocial stressors (parental expectation and family problems). Dental colleges should develop stress management programs to promote gender and social equity and strategies to improve psychological support services. The stress management programs reported either helped to reduce the number of stressors or enhance stress coping skills, using relaxation techniques such as deep breathing, yoga, and stress management programs.

BACKGROUND: Sufficient physical activity (SPA) in children and adolescents has an important role in health, growth, and development of persons. This study aimed to investigate the prevalence of and inequality in physical activity (PA) in 12–15-year-old students in the West of Iran, 2018. MATERIALS AND METHODS: In this cross-sectional study, 1404 students from 14 schools of Kermanshah city were included. Data on demographic and socioeconomic status (SES) of students and their family, body mass index, moderate-to-vigorous PA of students were collected. Normalized concentration index (NC) and decomposition analysis applied to measure inequality in SPA and the contribution of affecting factors, respectively. RESULTS: About 19% of the students had SPA. The proportion of SPA in boys was higher than girls (38.98% vs. 9.84%). There was a significant deviation from equality line (NC = 0.31; 95% confidence interval [CI]: 0.23, 0.38) and NC for boys and girls were 0.15 (95% CI: 0.04, 0.25) and 0.05 (95% CI: −0.07, 0.17). Sex of students and SES of households with 59.09% and 39.77% contribution to the measured inequality in SPA were the highest positive contributors. Household size (−2.60) had a negative contribution to inequality in SPA. CONCLUSION: There was a significant pro-rich socioeconomic inequality in SPA and sex, and SES were the main contributors to the inequality in PA. Some interventions are needed to improve PA among children and adolescents with a focus on girls and low-SES groups to narrow the existing gaps.

INTRODUCTION: Maternal attachment to the fetus is an emotional bond and the unique relationship of the pregnant woman to the fetus. Attachment is an important predictor of mental health. One of the psychological factors affecting mental health is resilience and hope. The purpose of this study was to determine the relationship between hope and resilience with promoting maternal attachment to the fetus during pregnancy. METHODS: This is a descriptive correlational study performed on 386 pregnant women referred to community health centers in Isfahan-Iran. The research instruments were standard questionnaires of Hope Snyder, Conor and Davidson Resilience, and maternal attachment to the fetus of Cranley. Data were analyzed using descriptive statistics and Pearson's correlation test. RESULTS: The results showed that there is no significant relationship between the overall score of maternal attachment to the fetus and the total score of hope (P = 0.73). The overall score of maternal attachment to the fetus was positively and significantly correlated with hope subscales, including thinking (P = 0.004) and path (P = 0.047). The overall score of maternal attachment to the fetus was positively and significantly correlated with the overall score of resilience (P = 0.03). There was a correlation between the dimensions of maternal attachment to the fetus, including interaction with the fetus (P = 0.003) and self-sacrifice (P = 0.015). Maternal role acceptance (P = 0.001) was positively and significantly correlated with hope thinking subscale. Self-sacrifice (P = 0.027) and differentiation between self and fetus (P = 0.035) were positively and positively correlated with hope path subscales. Self-sacrifice (P = 0.03) and attribution to fetus (P = 0.001) had a significant positive relationship with resilience. CONCLUSION: The results of this study showed that hope and resiliency are positively and significantly associated with maternal attachment to the fetus during pregnancy. Hope and resiliency are positively and significantly associated with maternal attachment to the fetus, thus increasing the expectation of pregnant mothers to increase their attachment to their fetus. As a result, they are paying more attention to prenatal care, which can guarantee the health of their mothers and their babies.

INTRODUCTION: Marital satisfaction is a situation in which the husband and wife enjoy marrying and feeling emotional; on the other hand, the existence of religious beliefs has a significant effect on family stability. The aim of this study was to determine the relationship between religious orientation, sexual satisfaction, and marital satisfaction in women of reproductive age. METHODS: This is a correlational study performed on 150 married women aged 45–45 years who referred to Neyshabur comprehensive health services centers. The sampling method was clustered. The present study used three questionnaires: Spinner Marital Satisfaction, Larson's Sexual Satisfaction, and Allport Religious Orientation Questionnaire. The reliability of these questionnaires was confirmed by the retest method. T-test, Pearson correlation, and one-way ANOVA were used for data analysis. RESULTS: Data analysis showed that there is a significant and positive relationship between religious orientation and sexual satisfaction and marital satisfaction. Religious commitment has a predictive role in promoting sexual satisfaction and marital satisfaction, with increasing religious commitment, increasing sexual satisfaction, and marital satisfaction. CONCLUSION: Psychologists and counselors in individual and couple counseling sessions with sexual problems and marital dissatisfaction and premarital counseling can increase marital satisfaction with regard to religious factors and religious and spiritual teachings.

BACKGROUND AND AIM: Spirituality in education, as a necessity in improving the quality of teaching and learning, is affected by various personal, social, religious, and cultural factors. Since the identification of these factors can empower the faculties and facilitate the transfer of spiritual concepts through teaching, the aim of this study is explanation of the factors affecting the spirituality transfer in education process. MATERIALS AND METHODS: This qualitative content analysis approach study included 22 faculty members of medical universities, 25 faculty members of seminary, and 19 medical students interested in participating in the study. They were studied according to purposive sampling method. Data collection was done by interviewing a semi-structured questionnaire. Data were analyzed using conventional content analysis method. RESULTS: The factors influencing the spiritual transfer in teaching process were classified into two main forms of teacher-related factors and peripheral-related factors. Teacher-related factors include the teacher's insight and worldview, adherence to religious principles, belief in ethical virtues, the positive and constructive interaction of the teacher with the student, and the mastery of teaching skills. The peripheral-related factors include the highly skilled classrooms and the talented learners. CONCLUSION: The intensification of the insight, religious worldview and the basic of beliefs, consolidating ethics and empowering faculty members in teaching skills along with building a positive and constructive relationship with the students, as well as institutionalizing spirituality as the inseparable teaching element can facilitate the transfer of spirituality concepts. More studies are needed in this regard.

CONTEXT: Health promotion (HP) and clinical risk management (CRM) topics are seldom discussed during medical school lessons. Peer-assisted learning (PAL) has long occurred informally in medical education, and interest in this method has recently grown, as it is considered a valuable technique for both tutors and tutees. AIMS: The aim was to evaluate the impact of HP and CRM PAL intervention on medical students' (tutees) knowledge level. SETTINGS AND DESIGN: A PAL intervention has been implemented at Udine University medical school during 2017. It was composed of lectures and practical activities conducted by ten near-peer tutors. METHODS: The effectiveness has been evaluated by giving tutees: (1) a knowledge multiple-choice questionnaire, before and after the intervention; (2) a satisfaction questionnaire; and evaluating (3) tutees' group assignments. STATISTICAL ANALYSIS USED: We performed descriptive analysis; then McNemar, Wilcoxon signed rank, Wilcoxon Mann–Whitney, and t-tests were applied. RESULTS: The number of students addressed by PAL intervention was 62. Difference in total correct answers among pre- and post-intervention questionnaires showed a statistically significant improvement (P < 0.0001), both when analyzing it globally and by area (HP/CRM). Students' satisfaction for CRM was greater than for HP area (P = 0.0041). CONCLUSIONS: This educational intervention based on PAL showed its effectiveness producing a statistically significant improvement in students' knowledge. Our findings confirm that PAL could be a feasible method for HP and CRM topics.