فهرست مطالب

Journal of Education and Health Promotion
Volume:11 Issue: 6, Jul 2021

  • تاریخ انتشار: 1400/06/17
  • تعداد عناوین: 40
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  • Himel Mondal*, Manas Ranjan Sahoo, Ritushri Samantaray, Shaikat Mondal Page 243
    BACKGROUND

    Distance digital learning is newly implemented in the Indian medical institutions. Formative assessment is also conducted online. In this context, this study aimed at finding the perception on the usefulness of online formative assessment along with online classes among 1st‑year medical students.

    MATERIALS AND METHODS

    This cross‑sectional, observational study was conducted in August 2020. The students were exposed to online classes and online formative assessments with five multiple choice questions for a period of 4 months before the conduct of the survey. An online survey was conducted (both quantitative and qualitative data collection) to ascertain the perception on the online formative assessment quiz.

    RESULTS

    A total of 36 (14 female, 21 male, 1 did not disclose sex) 1st‑year medical students with a mean age of 19.97 ± 1.16 years participated in the survey. The majority of the students agreed that the online quiz was a valuable learning activity and has potential to replace the face‑to‑face assessment. The online quizzes provided them feedback of classroom learning and helped in identifying the weak area and motivated students to the study. The qualitative data showed that students like to get a greater number of questions and also like to participate in chapter wise multiple quizzes in spare time.

    CONCLUSION

    First‑year medical students considered the online formative assessments quiz coupled with the online classes as a valuable learning activity. It provided them feedback of learning and a motivation for further study on the topic. They like to participate in anonymous quiz with a greater number of questions with online classes. The finding of this pilot study should be further evaluated with multicenter study with more participants.

    Keywords: Distance education, learning, medical students, quiz, self‑assessment
  • Fatemeh Khademian, Azam Aslani, Ramin Ravangard, Mohammad Nami, Samaneh Abbasi, Peivand Bastani* Page 244
    BACKGROUND

    Although a certain amount of stress is essential, excessive stress can adversely influence the physiological and mental health. Hence, this study aims to assess common stressors and coping strategies among university students.

    MATERIALS AND METHODS

    This qualitative study was conducted from October to November 2019 in Iran. Twelve students were recruited based on purposeful sampling to participate focus group discussions (FGD). Transcripts of three sessions of FGD were analyzed applying Graneheim and Lundman (2004) approach, and a thematic network was applied to illustrate the findings.

    RESULTS

    The finding emerged 78 codes, 14 subthemes, and 4 main themes. Stressors were classified in two main themes, including individual stressors and the social ones. Behavioral strategies and the cognitive ones were among two categories of coping strategies. According to the thematic network, a full stress student affecting the precious stressors and the social, cultural, and the economic context may manage his/her stress applying the coping strategies.

    CONCLUSION

    The findings revealed that university students experienced different kinds of stress, and usually, they do not apply right coping strategies. It is important to establish stress counseling programs for university students. Besides, it is proposing to provide 1st year university students with workshops about the cause of stress and effective coping strategies.

    Keywords: Coping strategy, focus group discussion, qualitative research, stress, university students
  • Mohammad Ghasemi, Tahereh Kamalikhah, Mahmood Salesi, Fatemeh Rahmati* Page 245
    BACKGROUND

    Measurement of the essential risk factors for work‑related musculoskeletal disorders is a fundamental step in predicting the problem and identifying high‑risk individuals. In this regard, Maastricht upper extremity questionnaire (MUEQ) has not been validated in Iran. This study aimed to develop a valid and reliable Persian version of MUEQ.

    MATERIALS AND METHODS

    In this descriptive study, the computer users employed in a governmental informatics administration in Tehran, Iran, were included during the end of 2018 and early 2019. Face and content validity of the MUEQ was conducted, and a six‑part questionnaire was provided. The reliability of the questionnaire was obtained using Cronbach’s α and test–retest. Concurrent validity was assessed with Nordic Musculoskeletal Questionnaire (NMQ). Exploratory and confirmatory factor analysis, comparison test of independent mean, internal consistency coefficient, test–retest, and Pearson correlation were carried out using the AMOS and SPSS 22 software.

    RESULTS

    Participants consisted of 282 computer users (110 males) with a mean age of 35.17 ± 7.65 years. The mean duration of computer use in a working day was 6.68 ± 2.10 h with a range of 1–12 h. The most prevalent symptoms were existed in the neck (39.1%), back (31.0%), and lower back (30.3%) areas. KMO test and Bartlett’s test of sphericity showed that a significant correlation existed among questions. Cronbach’s alpha coefficient of the questionnaire varied from 0.61 to 0.83 and test–retest coefficient was higher than 0.7.   Correlation coefficient was between NMQ and body posture (r = 0.23, P = 0.004) and between NMQ and work environment (r = 0.28, P = 0.000). Evaluations related to the construct validity and concurrent validity demonstrated that the questionnaire has acceptable construct validity. Six factors of the MUEQ in Root Mean Squared Error Approximation (RMSEA) index (0.062) were acceptable and satisfactory in Parsimony Comparative Fit Index (PCFI), Comparative Fit Index (CFI), Normed Fit Index (NFI), and Parsimony Goodness of Fit Index (PGFI) (0.732, 0.8000, 0.680, and 0.680, respectively).

    CONCLUSIONS

    The Persian version of the MUEQ represented a satisfactory validity and reliability and was suitable for computer users in the assessment of their risk factors of musculoskeletal complaints.

    Keywords: Maastricht upper extremity questionnaire, Musculoskeletal disorders, Psychometrics
  • Mohammad Salimi Amroud, Pouran Raeissi*, Seyed‑Masoud Hashemi, Nahid Reisi, Seyed‑Ahmad Ahmadi Page 246

    Palliative care and terminal patients care centers have an important role in improving the physical and psychological state of the patient and their families and increasing their satisfaction and care providers. A literature search of online databases (PubMed, Scopus, Web of science, Cochrane library, and Google Scholar) was searched from January 1, 2000, to the end of April 2019, by using the appropriate English keywords. Furthermore, IranMedex, Barkat, and Magiran databases were searched for the Persian articles. We used Standards for Reporting Qualitative Research checklist to evaluate the articles quality. From 1328 articles, 166 were reviewed in depth with 13 satisfying our inclusion criteria. The findings of this study revealed a wide range of barriers and challenges to palliative care delivery. The identified barriers were: Cultural, social and organizational barriers, lack of resources, equipment and financing, attitudes and cultures, barriers related to the patient and the patient’s family, related barriers providers, time and money, education, communication challenges, policies, insurance problems, safety, and crisis management. The results of the studies showed that there are various barriers and challenges such as economic, cultural, social, organizational, and communication related to palliative care. Given the identified barriers and challenges, it is suggested that to improve the delivery of palliative care, the health system policy‑makers and planners consider a resource‑appropriate and culturally appropriate framework for palliative care delivery.

    Keywords: End‑of‑life care, palliative care, supportive care, systematic review
  • Zahra Ebadinejad, Maryam Rassouli, Ali Fakhr‑Movahedi* Page 247
    BACKGROUND

    Management of cancer complications requires the provision of palliative care as a comprehensive care by the main and trained members of this method of care. The aim of the present study was to assess the compliance of educational curricula of selected disciplines with the content standards of cancer‑related palliative care.

    MATERIALS AND METHODS

    In this descriptive–comparative study, the content standards of palliative care for nurses, physicians, and social workers were identified based on the World Health Organization guideline and Oxford Textbook of Palliative Nursing. For this purpose, a separate checklist was prepared for the disciplines with different dimensions. Then the face and content validity of the checklists were checked. Finally, we examined the coordination between selected curricula available on the website of Education Deputy of the Ministry of Health, Treatment and Medical Education with the dimensions of the checklists.

    RESULTS

    All three curricula in most domains were relevant with the content standards, but there was the biggest education need in the areas related to the dimensions of “planning and educational,” “educating physician in palliative care,” and “considering patient preferences” in these disciplines.

    CONCLUSIONS

    To meet the educational needs, it is suggested to change some course topics, hold training courses, or joint workshops.

    Keywords: Content standards, curriculum, medical, neoplasms, nursing, palliative care, social work
  • Maryam Karami Salaheddin Kola, Hedayat Jafari, Jamshid Yazdani Charati, Vida Shafipour* Page 248
    BACKGROUND

    The knowledge level of caregivers and their support for patients can affect the self‑care of patients with heart failure (HF). The present study was conducted to compare the effects of teach‑back, multimedia, and blended training methods on self‑care and social support in patients with HF and on knowledge in their caregivers.

    MATERIALS AND METHODS

    In a randomized clinical trial, a total of 150 HF patient‑caregiver dyads were randomly allocated into three equally sized training groups, using a simple number table (n = 50). The study was conducted between May to October 2018 in Sari, northern Iran. In the teach‑back, multimedia and blended training groups, patient‑caregiver dyads participated in 20–30‑min training sessions held face‑to‑face, using digital video disc (DVD) and combination of teach‑back and DVD on 4 consecutive days at the bedside of hospitalized patients in coronary care unit, respectively. Data were collected using the European Heart Failure Self‑Care Behaviour Scale and the multidimensional scale of perceived social support for patients. Caregivers’ level of knowledge was measured using the HF Knowledge Scale. Data were measured on the first day of hospitalization, 1 day before discharge and 4 and 8 weeks after patients’ discharge. Data were analyzed using SPSS version 18 (SPSS Inc., Chicago, IL, USA).

    RESULTS

    All three educational methods improved self‑care behaviors in patients. The comparison of self‑care behavior scores in patients with HF among the three groups at different time points showed no statistically significant differences (P > 0.05), except 1 day before discharge (P = 0.04). There were no statistically‑significant differences between the teach‑back, multimedia and the blended training group in terms of perceived social support at any of the four‑time points (P > 0.05). All three training methods improved the level of knowledge of caregivers. However, the score in the blended training groups was higher than the other groups (P < 0.001).

    CONCLUSION

    According to the results of the present study, it seems that all three educational interventions can improve self‑care behaviors in HF patients and increase knowledge in their caregivers. However, using the blended training method was associated with better outcomes.

    Keywords: Health education, heart failure, patient education, self‑care, teach‑back communication
  • Esmaeil Mousavi Asl*, Leila Abdi, Amirali Moghaddam Sadegh, Forouzan Behrouzian Page 249
    BACKGROUND

    Individuals with disordered eating are at an increased of having one or more additional risks for comorbid disorders, such as anxiety disorder, depressive disorder, and insomnia. Therefore, the present study aimed to investigate the mediating role of self‑compassion in the relationship between positive reactivity, negative reactivity, and perfectionism with disordered eating.

    MATERIALS AND METHODS

    The study method was descriptive‑correlational through structural equation modeling (SEM). The present study population included all students of the University of Tehran in the city of Tehran in 2018–2019. A total of 302 students were selected by convenience sampling method and completed questionnaires on eating attitudes test‑8, self‑compassion scale (short form), eating disorder inventory‑perfectionism scale, and Perth emotional reactivity scale. The SEM path analysis and Pearson correlation coefficient were conducted to analyze the obtained data in SPSS‑23 and Lisrel‑8.80.

    RESULTS

    The finding of the path analysis showed that self‑compassion acts as a mediating  role in the relationship of disordered eating with positive and negative emotional reactivity and perfectionism. Only the direct effect coefficient of general positive reactivity on disordered eating was not significant.

    CONCLUSION

    Based on the results of this study, self‑compassion can serve as a protective factor against negative emotional reactivity and perfectionism. Therefore, self‑compassion can be considered in the development of prevention and treatment programs for disordered eating.

    Keywords: Disordered eating, emotional reactivity, perfectionism, self‑compassion
  • Amy J. Sheer*, Irene M. Estores, Rachel Nickels, Nila Radhakrishnan, Dianne L. Goede, Lazarus K. Mramba, Margaret C. Lo Page 250
    BACKGROUND

    With growing resident burnout, Accreditation Council for Graduate Medical Education issued new requirements for program interventions to optimize resident well‑being. Little evidence exists on how to best teach resiliency to residents. This study assesses the impact of both a grassroots intervention and formal resiliency curriculum on resident burnout and well‑being.

    MATERIALS AND METHODS

    From November 2016 to August 2017, residents in a large Internal Medicine Residency Program participated in grassroots wellness interventions from the resident‑led Gator Council in Gainesville, FL USA. From August 2017 to June 2018, residents participated in a formal program‑driven resiliency curriculum. Wellness interventions included monthly morning reports, bimonthly workshops, and biannual noon conferences. Pre‑ and postintervention Maslach Burnout Inventory (MBI) and Physician Well‑Being Index (PWBI) assessed the effect of both interventions on resident burnout and well‑being. Statistical analyses used Student’s t‑test, Fisher’s exact tests, and linear regression model.

    RESULTS

    One hundred and twenty‑two residents participated in grassroots interventions. One hundred and seventeen (87 residents, 35 students) participated in formal curriculum. Mean MBI scores for all three sections did not differ between pre ‑and postgrassroots intervention (emotional exhaustion [EE] P = 0.46; depersonalization [DP] P = 0.43; personal accomplishment [PA] P = 0.73]) or between pre‑ and postcurriculum (EE P = 0.20; DP P = 0.40; PA P = 0.51). Students scored higher burnout levels compared to residents in EE (P = 0.001) and PA (P = 0.02). Pre‑ versus postcurriculum PWBI scores did not differ among residents (P = 0.20), while PWBI scores improved among students (P = 0.01).

    CONCLUSIONS

    This study found no improvement in resident burnout or well‑being from a bottom‑up and top‑down approach. Our results imply the need for an early wellness curriculum to improve student well‑being given their higher level of burnout. System‑wide efforts are vital to combat physician burnout.

    Keywords: Burnout, curriculum, medical residency, resident burnout, resilience
  • Esmaeil Fattahi, Mahnaz Solhi*, Zahra Sadat Manzari, Abolhasan Afkar, Javad Yoosefi Lebni, Ayoob Rastegar Page 251
    BACKGROUND

    Smokeless tobacco use is a public health problem. This study explored students’ beliefs about smokeless tobacco use in Chabahar, Iran.

    MATERIALS AND METHODS

    The qualitative study was conducted using three Focused Group Discussions among 24 students aged 12–14 years in Chabahar City. Focus Group Guide Morgan was used. Qualitative Content Analysis was used to explore and extract codes and themes. The data analysis process was carried out in accordance with the stages of proposed by Graneheim and Lundman. Guba and Lincoln criteria were used for evaluating research transferability.

    RESULTS

    Two main themes emerged from the analysis including; beliefs of being useful and harmful. Each of these themes is divided into subthemes with useful or harmful physical and psychological beliefs. Four subthemes included: beliefs of being useful physically, beliefs of being useful psychologically, harmful beliefs physically, and harmful beliefs psychologically.

    CONCLUSIONS

    One of the more significant findings to emerge from this study is that many students mentioned the benefits of using smokeless tobacco to reduce toothache, relieve headaches, and bad breath. This information can be used to develop targeted interventions aimed at reducing smokeless tobacco consumption. However, more research on this topic needs to be undertaken before the association between kinds of beliefs and smokeless tobacco consumption is more clearly understood.

    Keywords: Focus group, qualitative content analysis, smokeless tobacco, students’ beliefs
  • Mahdokht Taheri, Mehran Falahchai, Mandana Javanak, Yasamin Babaee Hemmati*, Mehdi Dasht Bozorgi Page 252
    BACKGROUND

    One of the influential factors in students’ learning is their learning styles which have the capacity to change. Furthermore, creativity is considered one of the essential cognitive features of humans. Thus, this study aimed to analyze the relationship between learning styles (Kolb and VARK) and emotional creativity with the academic achievement of dental students.

    MATERIALS AND METHODS

    In this descriptive‑analytical study, the statistical population included dental students of the third semester and above (250 persons). The data collection tools included Kolb and VARK learning style questionnaires, Averill emotional creativity questionnaire, the total Grade Point Average (GPA), and the GPA over the past two semesters of students to measure academic achievement. The data were analyzed using the measures of the descriptive (mean and standard deviation) and the inferential statistics tests including one‑sample t‑test, independent t‑test, correlation coefficients of Pearson, and Eta squared.

    RESULTS

    Based on Kolb and VARK learning styles, the majority of the students had accommodating learning style (64%) and read‑write style (31.6%) and also were single‑styled (80.4%). No significant relationship was found between the learning styles (Kolb and VARK) and creativity with academic achievement. The students scored higher than average in emotional creativity and all of its three elements. Moreover, there was a significant relationship between emotional creativity and the gender of the students (P = 0.01). Female students showed higher emotional creativity (97.26 ± 10.34) compared to the male students (94.24 ± 8.96).

    CONCLUSION

    There was no significant relationship between learning styles and emotional creativity of the students with their academic achievement. The accommodating and read‑write learning styles were more prevalent among students and they showed high emotional creativity.

    Keywords: Academic achievement, creativity, dental students, learning
  • Zahra Amouzeshi, Tahereh Changiz, Arash Najimi, Mehdi Saberifiroozi, Amir Sadeghi, Mohammad Reza Farzanehfar, Manouchehr Khoshbaten, Kourosh Mojtahedi, Alireza Sima, Tarang Taghvaei, Peyman Adibi* Page 253
    BACKGROUND

    Any prediction of a person’s ability to succeed in a motor skill depends on the detection and accurate measurement of the basic abilities for the performance of that skill. Task analysis is needed to determine the psychomotor skills and abilities required to perform an action. This study aimed to determine the components of psychomotor abilities for diagnostic upper gastrointestinal (GI) endoscopy through procedural task analysis (PTA) and expert review.

    MATERIAL AND METHODS

    A multisource, multimethod task analysis was conducted in six metropolitan teaching hospitals affiliated with the adult gastroenterology and hepatology training centers in the Islamic Republic of Iran in 2019. Observation, video-recording, and think-aloud protocols were used while diagnostic upper GI endoscopy was performed. To confirm the accuracy of the PTA, the incorporated the views of the adult gastroenterology and hepatology subspecialty experts through the checklist of PTA assessment criteria. Finally, to determine the psychomotor abilities for each stage of the procedure, the study incorporated a panel of experts from occupational therapy, physical education, physical medicine, and adult gastroenterology and hepatology subspecialty.

    RESULTS

    Of the 15 psychomotor abilities examined, 11 were determined for upper GI endoscopy procedure, of which six cases (including visuospatial and perceptual abilities, hand–eye coordination, multilimb coordination, finger dexterity, arm–hand steadiness, and manual dexterity) were the most frequent.

    CONCLUSIONS

    PTA techniques and subsequent expert review were used to identify the components of psychomotor abilities for diagnostic upper GI endoscopy. It is suggested that PTA is performed for other procedures, and after psychomotor abilities are specified, proportional tests are developed.

    Keywords: Analysis task, endoscopy, gastrointestinal, performance, psychomotor performance
  • Mohan Bilikallahalli Sannathimmappa*, Vinod Nambiar, Rajeev Aravindakshan, Mohammad Saleem Jawad Al Khabori, Asma Hamed Sulaiman Al-Flaiti, Kadhiya Nasser Mohamed Al-Azri, Ali Khamis Saif Al-Reesi, Alya Rashid Mohammad Al Kiyumi Page 254
    BACKGROUND

    In diabetic foot infections (DFIs), the diversity of microbial profile and ever‑changing antibiotic‑resistance patterns emphasize accurate characterization of microbial profile and antibiotic susceptibility pattern. The aim of the study was to investigate the pathogens associated with DFI and their antibiotic susceptibility patterns.

    MATERIALS AND METHODS

    A cross‑sectional retrospective study was conducted at a tertiary‑care hospital, Oman. The socio‑demographic and microbiological profile and antibiotic susceptibility patterns of pathogens isolated from patients with DFIs from January 2013 to December 2018 were reviewed. Quantitative and qualitative variables were expressed as mean ± standard deviation and percentages, respectively. A Chi‑square test was used for testing the association between multidrug‑resistant (MDR) organisms and variables.

    RESULTS

    In total, 233 isolates recovered from 133 clinical specimens with an average of 1.8 organisms per specimen were included in the study. Fifty‑six and forty-four percent of specimens showed monomicrobial and polymicrobial growth of two or more organisms, respectively. The frequency of isolation was predominant among males (65%). Aerobic Gram‑negative rods were predominantly (75%) isolated compared to Gram‑positive organisms (25%). Staphylococcus aureus and Pseudomonas aeruginosa were the most frequently isolated Gram‑positive and Gram‑negative bacteria, respectively. Thirty‑eight percent of them were MDR strains. Gram‑negative organisms showed fairly good susceptibility ranging from 75% to 100% to carbapenems, aminoglycosides, and piperacillin‑tazobactam. While doxycycline and trimethoprim‑sulfamethoxazole showed good susceptibility toward Gram‑positive organisms.

    CONCLUSION

    DFIs are often polymicrobial with a predominance of Gram‑negative pathogens. This study recommends the use of carbapenems and doxycycline for empirical therapy of Gram‑negative and Gram‑positive bacterial DFIs, respectively.

    Keywords: Antibiogram, beta‑lactamases, carbapenems, diabetic foot, polymicrobial infection
  • Ghobad Ramezani, Yadolah Zarezadeh, Zohreh Sohrabi* Page 255
    BACKGROUND

    Universities are changing from government organizations into third generation. The aims of this study were to identify the dimensions and components of a third‑generation university and assessment of the status quo of Iran University of Medical Sciences.

    MATERIALS AND METHODS

    This study was mixed method. In the qualitative phase, participants consisted of experts of academic management and scholars in third‑generation universities. The dimensions and components of a third‑generation university were identified by content analysis. A questionnaire was prepared according to dimensions and components with Cronbach’s alpha of 0.86. In the quantitative phase, participants consisted of managers and experts of Iran University of Medical Sciences; they completed the questionnaire to assess the status quo of Iran University. Data analysis was performed by Colaizzi’s and SPSS software.

    RESULTS

    Third generation of universities of medical sciences has 2 dimensions and 17 components. Software dimension consists of course content, attitude, vision and mission of the university, organizational culture, instructors, students, employees, academic management and leadership, international approach, and social accountability components. Hardware dimension consists of organizational structure, academic infrastructures, knowledge commercialization, and communication with the government, education system, university environment, and university independence components. Status in Iran University of Medical Sciences in hardware dimension was 2.53, and in software dimension, it was 2.96.

    CONCLUSION

    Universities are required to respond to the changes in community. Therefore, universities need to change their structures, goals, approaches, perspectives, and intra‑organizational and extra‑organizational communications to be able to move toward a university which is entrepreneur, skill teaching, wealth generating.

    Keywords: Iran University of Medical Sciences, organizational structure, third‑ Generation University
  • Saeid Barzegar, Mohammad Reza Rezvani, Majid Safa, Amir Amani, Alireza Abbaspour, Aliakbar Pourfathollah, Javad Hashemi, Farhad Zaker* Page 256
    BACKGROUND

    Transfusion of healthy red blood cells (RBCs) after storage is important. One of the storage lesions on blood bags is oxidative stress. One way to prevent increased oxidative stress is to use antioxidant nanoparticles (NPs). Superoxide dismutase (SOD) and catalase (CAT) play an important role in antioxidant defense on RBC. poly lactic-co-glycolic acid (PLGA) is a nontoxic biodegradable polymer that is approved by the Food and Drug Administration for drug delivery. This study aimed to assess dose-dependent efficacy of SOD-CAT-polyethylene glycol -PLGA on RBCs storage.

    MATERIALS AND METHODS

    Using a descriptive study, during 1 month, twenty donors from Bojnourd Blood Donation Center were selected. NPs with different concentrations were injected into the satellite bags after directing blood to them. On target days, experiments were performed on the samples taken. Electrospray was employed to prepare SOD-CAT-PLGA NPs. Twenty packed RBCs were isolated from the whole blood bags by the mechanical method, and certain amount of product was transferred to the satellite bags. On days 1, 7, 14, 21, 28, and 35, bags were sampled. Malondialdehyde (MDA), prooxidant-antioxidant balance (PAB), and Annexin V were performed on the samples taken. The repeated measures analysis with the help of SPSS software version 20 was performed on samples.

    RESULTS

    MDA increased in both groups. The maximum increase in test group was seen in concentration 12 mg (MDA Day 14, test [1.93 ± 0.3], [P MDA < 0.001]). Maximum increase in PAB was seen in concentration 12 mg (from 444 ± 1.7 to 563 ± 2.5) (P PAB = 0.000). Furthermore, PS expression increased in the concentration of 12 mg greater than other concentration in consecutive (from 5.00 ± 0.8 to 22.26 ± 1.7, [P < 0.001]).

    CONCLUSION

    Evaluation of dose dependency showed that different concentrations of antioxidant NPs affect RBC. This effect can be changed oxidative stress and apoptosis. Using both changes to evaluate functional and toxicity can be helpful.

    Keywords: Antioxidant effect, blood bank, eryptosis, nanoparticles, oxidative stress
  • Alieh Sheikhalishahi, Fereshteh Jahdi*, Hamid Haghani Page 257
    BACKGROUND

    Sexual health in the development of the human personality, personal, and social health and in achieving to comfort plays an important role. Women with epilepsy are at high risk of sexual dysfunction, which has a multifactorial etiology. This study is aimed to investigate the correlation between the sexual function of women with epilepsy and personality factors.

    MATERIALS AND METHODS

    this cross‑sectional study was conducted on 100 women with epilepsy referred to selected centers in Tehran university of medical sciences by using continuous and availability sampling method between January and March 2014 (Iran) and evaluated with women’s sexual function index questionnaire female sexual function index and NEO‑five‑factor of personality inventory. Data were analyzed using SPSS software version 16 and Pearson correlation test.

    RESULTS

    The mean sexual function overall score in participations was 23.33 ± 2.82 there was a significant negative correlation between neuroticism and sexual function (P = 0.00, r = −0.03) and was significant positive correlation between personality traits as extraversion (P = 0.00, r = 0.63), agreeableness (P = 0.008, r = 0.26) and conscientiousness (P = 0.04, r = 0.20) and openness to new experiences (P = 0.03, r = 0.21) and sexual function in women with epilepsy.

    CONCLUSIONS

    Results indicate that the personality traits can affect on sexual health and sexual function of women with epilepsy. Therefore, it is recommended that health‑care providers with assess personality factors in women with epilepsy as a prognostic factor, take steps to prevent sexual dysfunction.

    Keywords: epilepsy, personality factor, sexual function, women
  • Mehdi Beyramijam, Mehrdad Farrokhi, Abbas Ebadi, Gholamreza Masoumi, Hamid Reza Khankeh* Page 258

    The Emergency Medical Services (EMSs) are in the frontline between the health-care systems and people in emergencies and disasters. With the increase in the frequency of natural or man-made disasters around the world, the need for prepared EMS services is increasing. This study aimed to evaluate the current disaster preparedness status of the EMS agencies in the literature and exploring the key preparedness elements and the strategies to improve the EMS disaster preparedness. The electronic database such as PubMed, Web of Science, Scopus, and Google Scholar was searched from 2000 to 2019. The searching keywords included: “EMS,” “Disaster,” “Preparedness,” “Emergency” “Preparedness,” “Disaster Preparedness,” “Readiness,” and the terms related to “disaster types” were used in combination with Boolean operators OR and AND. Out of 1412 articles, 7 articles were included in the review. The most important elements of the EMS disaster preparedness include the size and scope of the incident, surge capacity, planning, communication, training and education, policymaking, financial support, coordination, safety and security, early warning system, disaster response experience, and legal considerations. This systematic review showed that the EMS agencies in the world generally are inadequately prepared for an effective response to major emergencies and disasters. This study provides valuable information to EMS educators, EMS administrators to adopt and perform appropriate activities to improve the EMS disaster preparedness.

    Keywords: Disaster, emergency medical services, preparedness
  • Arpit Bakulash Patel, Sachi Vinodkumar Shah* Page 259
    BACKGROUND

    The concept of reflective practice is at the center of professional practice, allowing a bridge between theory and practice and learning from our own experiences in an ongoing process. Understanding what learners need such as regular observation of work, more responsibility, and technical and problem‑solving with answers allows the teacher to help learners to progress to independence in pursing their own learning needs. Therefore, it is important that medical educators continually reflect and evaluate teaching ability to meet learners’ needs and provide evidence to support it.

    MATERIALS AND METHODS

    A prospective, qualitative study was carried out using a combination of questionnaires and observed assessments. The study participants consisted of twenty final‑year medical students from King’s College London and took place at a hospital education center in the UK, April 2019. Two educational sessions were delivered by a doctor to the study group and a video recording was conducted. The educator completed a reflective portfolio using feedback questionnaires, peer observation forms, and observation of the video recording, and the results were analyzed using a video critique tool.

    RESULTS

    Twenty learner feedback forms were completed, and a peer observation form was completed. This allowed a critical analysis of educator performance, reflection, and improvement. This was further solidified by in‑depth analysis and critique of teaching session playback video.

    DISCUSSION

    This study evaluates a medical student teaching program using a reflective portfolio. This study confirms the effectiveness of using a reflective portfolio to enhance the teaching experience. Video analysis can be self‑critical, however this study shows how it is useful to review human experience first‑hand, and identifying any specific techniques that create a positive or negative change can enable educators to improve as time progresses.

    Keywords: Assessment, health care, medical education, quality improvement, reflection
  • Moslem Soofi, Behzad Karami Matin, Ali Kazemi Karyani, Satar Rezaei, Shahin Soltani* Page 260
    BACKGROUND

    The COVID‑19 pandemic has spread rapidly across the world and has currently impacted most countries and territories globally. This study aimed to identify health‑care determinants of mortality and recovery rates of COVID‑19 and compare the efficiency of health systems in response to this pandemic.

    MATERIALS AND METHODS

    A cross‑sectional study was conducted using data obtained from the World Bank database, that provides free and open access to a comprehensive set of health‑ and socioeconomic‑related data, by September 12, 2020. An adjusted linear regression model was applied to determine predictors of mortality (per 1 million population [MP]) and recovery rates (per 1 MP) in the included countries. One‑way analysis of variance was applied to assess health systems’ efficiency in response to COVID‑19 pandemic using mortality and recovery rate (output variables) and current health expenditure (CHE) per capita (input variable).

    RESULTS

    Globally, San Marino and Qatar had the highest mortality rate (1237/1 MP) and confirmed case rate (43,280/1 MP) until September 12, 2020, respectively. Iran had a higher mortality rate (273/1 MP vs. 214.5/1 MP) and lower recovery rate (4091.5/1 MP vs. 6477.2/1 MP) compared to countries with high CHE per capita. CHE per capita (standardized coefficient [SC] = 0.605, P < 0.001) and population aged 65 years and over as a percentage of total population (SC = −0.79, P < 0.001) significantly predicted recovered cases from COVID‑19 in the included countries.

    CONCLUSION

    This study revealed that countries with higher CHE per capita and higher proportion of older adults were more likely to have a higher recovery rate than those with lower ones. Furthermore, our study indicated that health systems with higher CHE per capita statistically had a greater efficiency in response to COVID‑19 compared to those with lower CHE per capita. More attention to preventive strategies, early detection, and early intervention is suggested to improve the health system efficiency in controlling COVID‑19 and its related mortalities worldwide.

    Keywords: COVID‑19, efficiency, health expenditure, health services research, mortality
  • Sakineh Nazari, Sepideh Hajian*, Zohreh Abbasi, Hamid Alavi Majd Page 261
    BACKGROUND

    The postpartum period can be considered as one of the most sensitive stages of life in different countries; however, it is inadequate in many developed and developing countries. We aimed to determine the educational needs of mothers in the postpartum period in Bojnourd.

    MATERIALS AND METHODS

    This study was conducted in Bojnourd 2019 with two parts: a qualitative part using the content analysis method and a quantitative part using the descriptive cross‑sectional method. Data were collected 45 interviews with women, spouses, and key informants. All content was recorded and fully transcribed on paper. MaxQda10software was used for the data management. A simultaneous descriptive cross‑sectional study was done including 250 pregnant in the third trimester (25.6%), in the first 48 h after delivery (24.4%), in the first 6 months after delivery (24.4%), and in the second 6 months after childbirth (25.6%) who referred to five health centers in Bojnourd to receive midwifery care. Quota sampling was performed for each center according to the population covered, and convenient sampling was done in each center.

    RESULTS

    In the qualitative study, educational needs were classified into four main categories, including “maintaining and restoring physical health,” “sexual health needs,” “mental health needs,” and “educational barriers.” In the quantitative study, according to the findings, the most educational needs among mothers were self‑care and breastfeeding and the best time for teaching was during the pregnancy, and the best method was face‑to‑face training and the best source of information was midwives and gynecologists.

    CONCLUSION

    Attention to the educational needs of each region can be done through various training courses and continuous retraining to promote health provider and should be considered in the planning officials.

    Keywords: Education need, mixed study, postpartum period
  • Atefe Zeinali, Mahrokh Dolatian*, Padideh Janatiataie, Jamal Shams, Malihe Nasiri Page 262
    BACKGROUND

    Gestational diabetes mellitus (GDM) is a common complication of pregnancy. The goal of this study was to compare health‑promoting lifestyles and irrational health beliefs in pregnant women with GDM and healthy pregnant women.

    MATERIALS AND METHODS

    The present study was a descriptive causal‑comparative study in which 100 eligible GDM women and 100 eligible healthy women were selected through available sampling in three referral hospitals in Tehran In 2020. In this study, the Health Promoting Lifestyle Profile (HPLP) and the Irrational Health Beliefs Scale (IHBS) were used. Data were analyzed using independent t‑test and logistic regression by SPSS 16 software.

    RESULTS

    Findings showed that there is a significant relationship between the variables of IHBS and HPLP. For every one unit increase in an IHBS score, the chance of having diabetes increases by 2.8%. In the case of HPLP, women who exercised well were 7.5% less likely to develop diabetes, and those who took good responsibility were 7.8% less likely to develop diabetes. Furthermore, in independent t‑test, the HPLP variable showed a significant difference between the two groups with diabetes and healthy individuals (P < 0.001). Furthermore, in comparing the subscales of this variable, physical activity (P < 0.0001), self‑fulfillment (P < 0.004), responsibility (P < 0.003), and stress control (P < 0.001), a significant difference was observed. The results of IHBS research showed a significant difference between the two groups of gestational diabetes and healthy individuals (P < 0.004).

    CONCLUSION

    The results of the present study show the need to identify and focus on irrational health beliefs and health‑promoting lifestyles. Modification of these psychological structures can be useful in the prevention and management of this chronic disease.

    Keywords: Gestational diabetes mellitus, health‑promoting lifestyle, irrational health beliefs
  • Mohammad Hosein Mehrolhasani, Vahid Yazdi‑Feyzabadi, Sara Ghasemi* Page 263

    Community empowerment has been proposed since the 1980s as a way to increase people’s power to influence social determinants of health. However, community empowerment for health promotion in urban slums still faces challenges. The present study examined interventions, challenges, actors, scopes, and the consequences mentioned in various studies and with emphasizing interventions and executive challenges tried to create a clear understanding of empowerment programs in slums and improving their health. Narrative review method was used to conduct the study. Databases including PubMed, Scopus, Embase, Web of Science, and Cochrane were searched. The selection of studies was done according to the “community empowerment” defined by the World Health Organization, the concept of bottom–up approach for health promotion of Laverack and Labonte’s study and definition of slums by UN-HABITAT. Finally, Hare and Noblit’s meta-synthesis was used to analyze the studies. From 15 selected studies, the most intervention proposed for empowerment was identified to be “residents’ participation in expressing problems and solutions.” The challenge of “creating a sense of trust and changing some attitudes among residents” was the greatest challenge in the studies. Moreover, “improving living conditions and health services” were the most important outcomes, “slum residents” and “governments” were the most important actors, and “sanitation” was the most important scope among the studies. Having a comprehensive view to the health and its determinants and attention to the factors beyond neighborhood and health sector would lead to fewer implementation challenges and better intervention choices to health promotion of slum dwellers.

    Keywords: Community empowerment, health promotion, poverty areas, slum, urban slums, Ghetto, wellnessprogram
  • Anand Bihari, Sonali G. Choudhari*, Ankit Srivastava Page 264
    BACKGROUND

    Lecturing (didactic) has been the key teaching-learning method for a long time. As per competency-based medical education, an Indian medical graduate should be competent in recommended skills. In the subject of Community Medicine of medical undergraduation, “Biostatistics” is one of the components of the curriculum. Often the students find the statistics challenging to understand and thus neglect it or prefer rote learning. In the recent era, many newer teachinglearning modalities have come up, namely problem-based learning (PBL), small group teaching, community-based learning, etc. The objective was to compare the utility and effectiveness of PBL versus traditional teaching techniques (didactic) for Biostatistics.

    MATERIALS AND METHODS

    The study was conducted in the department of Community Medicine, Government Medical College, Azamgarh (Uttar Pradesh) from March to November 2019. A total of 96 medical students of the final year were randomly divided into two groups. ‘Group A’ underwent didactic lecturing whereas “Group B” had problem‑based learning for identified topics in Biostatistics. The teaching material and instructors were the same for both groups. Two weeks after completion of sessions, students’ assessment was carried out for both groups.

    RESULTS

    The study demonstrated that the PBL method was a more effective way of teaching-learning statistics compared to didactic lecturing. A significant difference (P < 0.05) was observed between the mean examination score of Group A (traditional teaching technique) and Group B (PBL). Group B had higher scores than group A in all assessment heads (Objective, Descriptive, and Viva-voce). PBL was perceived to be a student-centric Teaching-learning method promoting analytical skills, critical thinking & overall self-directed learning.

    CONCLUSION

    PBL teaching method was found to be effective in improving the students’ performance in Statistics in comparison to didactic lecturing.

    Keywords: Performance, problem-based learning, statistics
  • Ali Barkhori, Hamid Pakmanesh, Amirreza Sadeghifar, Ali Hojati, Morteza Hashemian* Page 265
    BACKGROUND

    Although surgical techniques have been improving, preoperative anxiety is still a challenge in preoperative care and is known as an expected response experienced by patients waiting to undergo surgery. The present study aimed to compare preoperative anxiety levels in three educational hospitals in Kerman.

    MATERIALS AND METHODS

    This cross‑sectional study was conducted in three educational hospitals in Kerman, Iran, from December 2017 to May 2018. The participants were 100 patients from each hospital (300 patients in sum) who were selected through the convenience sampling method. Sampling was not restricted to sex and type of surgery. The 40‑item Spielberger State‑Trait Anxiety Inventory was administered to the patients to assess the level of preoperative anxiety experienced by them. Bivariate linear regression models were used to compare the preoperative state anxiety levels based on the patients’ demographic information. A multivariate linear regression model was used to determine the predictors of preoperative state anxiety.

    RESULTS

    The participants were 149 males and 151 females with a mean age of 36.38 (12.75) years (age range: 12–79 years). Almost two‑third of the patients showed upper‑middle symptoms of state anxiety (n = 197, 65.7%) followed by upper‑middle symptoms of trait anxiety (40% and 49.3%, respectively). There was a significant relationship between the patient’s sex and state anxiety (P = 0.05) and also between trait anxiety and state anxiety (P ≤ 0.001). It was shown that train anxiety could predict state anxiety before surgery (B: 0.53, 95% confidence interval: 0.44, 0.62; P ≤ 0.001).

    CONCLUSION

    The results of the present study confirmed the presence of preoperative anxiety in a sample of Iranian patients. Although the anxiety scores were not very high, organizing intervention and training programs to control and reduce preoperative anxiety among patients seems essential.

    Keywords: Educational hospitals, Iran, predictors, preoperative anxiety, surgery
  • Abdul Ahad, Puneet Chahar, Ekramul Haque*, Afshan Bey, Meena Jain, Waseem Raja Page 266
    BACKGROUND

    The objective was to assess the prevalence and the associated demographic factors of stress, anxiety, and depression among undergraduate (UG) Indian dental students and determine whether the pattern is different in government‑run institutions and those managed by private authorities.

    MATERIALS AND METHODS

    A cross‑sectional study was conducted among dental UG students from five dental colleges. Snowball sampling was used to approach 776 potential participants, resulting in a complete response from 507 students. The questionnaire consisted of demographic data; year of study; type of college; accommodation; and Depression, Anxiety, and Stress Scale (DASS)‑42. Descriptive data and inferential statistics were obtained. Chi‑square test was applied for categorical data to test for significance, and higher analysis was done using multiple linear regression.

    RESULTS

    Females and males comprised 71.8% (n = 364) and 28.2% (n = 143) of the study population, respectively. The prevalence of anxiety was highest (66.86%, n = 339), followed by depression (57.39%, n = 291) and stress (43.99%, n = 223). In terms of severity also, anxiety was the most prevalent condition as more than one‑fourth of the students presented with severe and very severe scores in this aspect (25.43%, n = 129) compared to depression (14.39%, n = 73) and stress (10.09%, n = 51). Regression analysis revealed age as a strong positive predictor for all the three conditions, while staying in the hostel was a positive predictor for anxiety and stress. Being female was also an independent predictor for the high prevalence of stress.

    CONCLUSION

    Stress, anxiety, and depression are highly prevalent among Indian dental students. Clinical students and interns have a higher prevalence of stress than preclinical students. Age, being female, and staying in the hostel are positive predictors for the severity of stress. There is no significant difference between government and private colleges, regarding the prevalence of any psychological condition.

    Keywords: Anxiety, dental education, depression, stress
  • Shahnaz Mojahed, Fariba Reyhanizadeh*, Razieh Sadat Tabatabaei, Ali Dehghani Page 267
    BACKGROUND

    Amniocentesis is one of the methods for diagnosing prenatal abnormalities. Pregnant women with high‑risk fetal screening results are the candidates for amniocentesis. Most of these women are afraid of this procedure because they predict that the test will be painful and worried about its adverse effects on pregnancy, fetal injury, or the risk of maternal death. Therefore, the aim of this study was to determine the effect of education on the perceived stress of mothers who are the candidates for amniocentesis.

    MATERIALS AND METHODS

    The present study was a quasi‑experimental, two‑group clinical trial with a parallel design. This study was in three stages: pretest (before intervention), posttest (after intervention), and after amniocentesis. This study was performed on 80 pregnant women who were the candidates for amniocentesis (15–20 weeks of pregnancy) with high‑risk fetal screening results referred to the perinatology clinic in Yazd in 2020. The intervention package included training and using breathing techniques, broadcasting educational animations on how to perform amniocentesis, expressing experiences by people who had experienced amniocentesis, and finally visiting the amniocentesis site and getting to know the relevant perinatologist. Data collection tools were demographic and midwifery profile questionnaires and Cohen perceived stress. SPSS software version 16 was used for statistical analysis of data.

    RESULTS

    The results showed that the research units had high stress at the beginning of the study. The perceived stress score at the beginning of the study in the intervention group was 30.1750 ± 6.53153 and in the control group was 28.2750 ± 8.57841. After the intervention, the participants’ stress level decreased below the cutting point. In the experimental group, the mean stresses after the intervention and after amniocentesis were significantly lower than before the intervention; however, after amniocentesis, it was somewhat higher than the postintervention stage. In the preintervention stage, the mean stress score between the two groups was not statistically significant. The difference after the intervention between the two groups was significant (P < 001.0); however, in the postamniocentesis stage, the difference in stress was not significant. After the intervention and after amniocentesis, the perceived stress of pregnant mothers in the experimental group was less than the control group.

    CONCLUSION

    Considering that the perceived stress in amniocentesis candidate mothers was high in the present study, so that after performing the method, mothers left the center with high stress, it is very important to pay attention to its psychological aspects. Therefore, it is suggested that educational interventions before and during amniocentesis be considered for them along with psychological support and follow‑up care after amniocentesis.

    Keywords: Amniocentesis, education, perceived stress
  • Nasrin Shaarbafchizadeh, Zahra Fouladi, Pejman Aqdak, Ahmad Reza Raeisi* Page 268
    BACKGROUND

    Health system reform plan in public health sector in Iran in the first phase focused on improving primary health care in suburban areas in and around big cities. The present study was conducted to assess the implementation process challenges of the reform plan in comprehensive health service centers at suburban areas of Isfahan in 2019.

    MATERIALS AND METHODS

    This qualitative study with conventional content analysis approach was conducted in 2019. Participants were purposefully selected and interviewed at provincial levels from Isfahan University of Medical Sciences health department and health‑care providers of comprehensive health services centers. The saturation point was reached after 21 face‑to‑face semi‑structured interviews. Thematic analysis was employed to analyze transcribed documents assisted by MAXQDA version 10.

    RESULTS

    The results revealed four main themes; the human resource management, the executive management, the electronic infrastructure, and the resource management.The major challenges in the implementation planning process included: the referral system, monitoring and supervision, electronic services infrastructure in the design and development of the EHR called the SIB system, lack of instructions guide, salaries and benefits, inconsistent financial and human resources and inappropriate allocation of theses resources.

    CONCLUSION

    Despite the achievements in the development of the Iran health system reform plan, there were many challenges in the implementation planning process. It is recommended that theses challenges be reviewed and amended by health system managers and policymakers.

    Keywords: Health system reform, primary health care, suburban area
  • Avinash Chakrawarty, Piyush Ranjan*, Kamal Bandhu Klanidhi, Divjyot Kaur, Siddharth Sarkar, Anamika Sahu, M. Bhavesh, Upendra Baitha, Arvind Kumar, Naveet Wig Page 269
    BACKGROUND

    COVID‑19 may seem to have an impact on middle‑aged and elderly people. However, not much is known about the lived experiences of middle‑aged and elderly people during this pandemic. The study aims to explore psychosocial and behavioral impact of COVID‑19 on the lives of these individuals.

    MATERIALS AND METHODS

    Three focus group discussions and seven in‑depth interviews were conducted. A format to guide discussions and interviews was made to bring uniformity across groups and participants. Participants were recruited through purposive and snowball sampling techniques. Discussions were recorded and transcribed verbatim. Thematic analysis method was used to extract key conceptual themes.

    RESULTS

    There were 12 male and 10 female participants included, with a mean age of 62.2 years. Five subcategories identified were: Fear and anxiety, household confinement, lifestyle modification, preventive practices, and coping strategies. These sub‑categories formed three major categories‑psychological, social, and behavioral which ultimately led to the emergence of the main theme that is, COVID‑19 effects on the life of middle‑aged and older individuals.

    CONCLUSION

    Middle‑aged and elderly people are affected in many ways due to COVID‑19. Addressing the psycho‑social and behavioral problems can help in the better adjustment to tide over the pandemic.

    Keywords: COVID 19, focus group discussions, focused group discussions, psycho‑social behavioral functioning, qualitative research
  • Faridokht Yazdani, Parvaneh Abazari*, Fariba Haghani, Bijan Iraj Page 270
    BACKGROUND

    Education in vulnerable communities can be a health affordable strategy to promote patient empowerment. Recognition and understanding the problems of diabetes education are of significance to overcome the barriers and advance the educational and care services to control diabetes and promotion of society health. The aim of this study was to explore participants’ perspectives, experiences, and preferences, regarding diabetes education problems.

    MATERIALS AND METHODS

    This descriptive, qualitative study was conducted from March 2016 to September 2017. The participants were 23 people including nine patients with diabetes and their family members and 14 members of diabetes healthcare team (physicians, nurses, and nutritionists). The data were collected through individual semi‑structured interviews and analyzed through conventional content analysis approach proposed by Graneheim and Lundman. Some main categories and subcategories emerged.

    RESULTS

    Three main categories showed the most prominent problems of diabetes education, namely, inadequate infrastructure for diabetes education, insufficient defined and de facto position for the role of diabetes nurse educator, and the failure in patient‑oriented team approach in diabetes education.

    CONCLUSION

    This article addresses the most important problems of diabetes education. The fundamental strategy to overcome these problems seems to be the planning and management of diabetes education as a high priority in the noncommunicable disease management policies of the Ministry of Health and Medical Education.

    Keywords: Diabetes mellitus, education of patients, Iran, nursing, qualitative research
  • Maryam Saeedi, Raziyeh Ghafouri*, Fereshteh Javaheri Tehrani, Zahra Abedini Page 271

    Motivation is one of the key factors in educational achievement. Like any other field of study, motivation in nursing is highly critical. The instructor’s knowledge about the teaching methods that are effective in academic motivation of students enables them to adopt proper measures to improve the teaching efficiency. The present paper is a systemic review of the efficiency of instructional interventions in improvement of academic motivation in nursing students. The published papers related to the study from 2000 to February 2020 were searched at different databases such as PubMed, Scopus, Web of Science, PsycInfo, and ERIC. To examine the quality of the articles, critical appraisal instrument for reports of educational interventions was used. Totally, 18 articles entered the study for structured review. The majority of the articles reported that educational interventions improved academic motivation in nursing students. The effective teaching methods described in the reviewed articles that led to an improvement in academic motivation were simulation, case‑based learning, cooperative learning, learning contract, peer assessment, and self‑assessment using video typing. As the findings showed, implementation of applied and participatory methods in teaching process improved the academic motivation of nursing students. Therefore, using such methods, nursing instructors can improve the academic motivation of their students.

    Keywords: Motivation, nursing, students, systematic review, training techniques
  • Seyedeh Atefeh Koohpayeh, Meimanat Hosseini*, Morteza Nasiri, Masoud Rezaei Page 272

    Recent studies have reported inconclusive results regarding the therapeutic effects of Rosa damascena on the outcomes of primary dysmenorrhea (PD) and premenstrual syndrome (PMS). Hence, this study is aimed to summarize the findings of randomized controlled trials (RCTs) regarding the effects of this treatment on menstruation‑related pain as the primary outcome and menstruation‑related headache, fatigue, anxiety, and bloating as the secondary outcomes. This study evaluated parallel‑group and cross‑over RCTs on aromatherapy, topical treatment, or oral intake of R. damascena products for the treatment groups versus placebo, nontreated, or conventional treatment groups. Seven electronic databases (Web of Science Core Collection, Scopus, Embase, CENTRAL, CINAHL, SID, and MagIran) and one search engine (PubMed) were searched from inception to January 15, 2021. Of 1468 trials found in the initial search, 983 potentially relevant articles were screened by title and abstract. After examining the full‑text of 13 studies for compliance with the inclusion criteria, seven studies were considered eligible for this review. A random‑effects model was used to pool the data; otherwise, a narrative summary was presented. The retrieved studies were conducted on females with PD or PMS, aged 18–35 years. The total sample size of the intervention and comparator arms was 276 and 272. The results showed that R. damascena had a nonsignificant alleviating effect on the menstruation‑related pain (weighted mean difference [WMD]: −0.47; 95% confidence interval [CI]: −1.25, 0.31; P = 0.234). Such findings were also found for menstruation‑related anxiety (WMD: −0.40; 95% CI: −0.91, 0.11; P = 0.125). However, the treatment significantly reduced the menstruation‑related headache (WMD: −0.42; 95% CI: −0.74, −0.11; P = 0.008), fatigue (WMD: −0.48; 95% CI: −0.87, −0.09; P = 0.015), and bloating (WMD: −0.72; 95% CI: −1.21, −0.22; P = 0.005). Since R. damascena had no significant effects on menstruation‑related pain and anxiety, further studies with improved methodological quality are suggested to evaluate the effects of the treatment on these symptoms, using different dosages and durations.

    Keywords: Dysmenorrhea, herbal medicine, menstruation, review, Rosa damascena
  • Fatemeh Mohammadi, Shahnaz Kohan, Sedigheh Farzi, Mojgan Khosravi, Zeinab Heidari* Page 273
    BACKGROUND

    Postpartum depression and anxiety is one of the most common complications that women face and cause many problems for mother, baby, and family. Considering the effect of self‑efficacy on women’s adaptation to pregnancy and delivery conditions and their mental health during this period, the present study was designed to investigate the effect of pregnancy training classes based on Bandura self‑efficacy theory on postpartum depression and anxiety and type of delivery.

    MATERIALS AND METHODS

    In this clinical trial study, 64 pregnant women were randomly divided into intervention and control groups. Mothers in the intervention group received pregnancy training in eight sessions (each session was 2‑hour) from the 20th week of pregnancy. The classes were run by a trained midwife and the content of the training was based on Bandura self‑efficacy components. The mothers in the control group received routine care. The demographic‑reproductive information form, Beck Depression and Spielberger Anxiety Questionnaire were completed by pregnant women of both groups at several times, before the program, 1 week and 1 month after delivery.

    RESULTS

    The results showed that the training program significantly decreased the depression score in 1 week and 1 month after delivery in the intervention group compared to the control group. In addition, this training program decreased the mean score of apparent and hidden anxiety in the intervention group 1 month after delivery, although this decrease was not statistically significant. Furthermore, 80.55% of the intervention group and 58.33% of the control group had vaginal delivery, which were significantly different between the two groups in terms of the type of delivery.

    CONCLUSION

    The findings showed that pregnancy training classes based on Bandura self‑efficacy theory decrease depression and anxiety and increases vaginal delivery rate.

    Keywords: Anxiety, depression, pregnancy, self‑efficacy
  • Priyadarshini Pattath* Page 274
    BACKGROUND

    The motivation to seek health information on the Internet for individuals has been varied. The purpose of this paper was to explore the perspectives and experiences about online health information seeking in information technology (IT) professionals.

    MATERIALS AND METHODS

    A qualitative case study research design was employed to examine the behavior of 15 IT professionals from a state organization in the East Coast of the United States of America. Convenience sampling was used to identify the setting, and purposeful sampling was used to select the participants. A survey questionnaire was used as a recruitment tool, and in‑depth individual interviews with standardized semi‑structured questions were used to collect data.

    RESULTS

    Findings illustrated that the Internet was the first source of reference for wellness and prevention information to maintain a healthy lifestyle, and to alleviate and prevent work‑related musculoskeletal disorders (WMSDs). The themes that emerged from the study were that the IT professionals searched the Internet for information to self‑educate about medical conditions, to maintain fitness, communicate with health‑care professionals, decide their treatment options, and to make lifestyle modifications such as ergonomic adjustment of their workstation, postural adjustments, and changing negative health behaviors.

    CONCLUSION

    The results of this study provide practical implications for organizations and health professionals in providing health education to prevent WMSDs as participants sought health information online to take actions and collaborate with their health‑care professionals and actively contributed to their medical health decisions. This underscores a valuable opportunity for health‑care providers and public health officials to become more proactive by providing their patients with quality health information outside their office through the Internet by referring them to credible website sources.

    Keywords: Health information‑seeking behavior, information technology, internet, work‑related musculoskeletaldisorders
  • Mukesh Bairwa, Rajesh Kumar*, Poonam Yadav, Yogesh Bahurupi, Ravi Kant Page 275
    BACKGROUND

    COVID‑19 was declared an emergency of international concern by the World Health Organization in 2020. This study assesses patients’ awareness, perception, and mitigating measures taken during the COVID‑19 outbreak visiting an apex tertiary health‑care center in North India.

    MATERIALS AND METHODS

    A cross‑sectional study was conducted between September 15, 2020, and November 15, 2020, in a tertiary care public hospital, North India, using a structured self‑administered questionnaire. The survey included 809 patients using a consecutive sampling strategy. The self‑structured and prevalidated questionnaire was used to collect information on study variables. Chi‑square test and independent samples t‑test, followed by binary and multivariate logistic regression, was used to determine the factors associated with awareness toward COVID‑19.

    RESULTS

    The mean age of participants was 32.41 (±11.24) years. Multivariate logistic regression shows that married participants (OR: 0.660, 95 % CI: 0.440-0.989, P= 0.044), reading books/ magazine or attended institutional lectures (OR: 2.241, 95% CI: 1.545–3.249, P = 0.001), and watching television and radio (OR: 1.824, 95% CI: 1.283–2.592, P = 0.001) are significantly more aware than their counterparts. Participants with higher income group (>20,000 Indian rupee) significantly had higher awareness than participants having salary <10,000 rupees (OR: 0.280, 95% CI: 0.178–0.440, P = 0.001) or 10,001–20,000 rupees (OR: 0.481, 95% CI: 0.297–0.777, P = 0.003). Patients avoiding traveling across or abroad had significantly much reasonably good awareness than their counterparts (OR: 0.357, 95% CI: 0.139–0.918, P = 0.033).

    CONCLUSIONS

    Participants demonstrated good awareness, encouraging perception, and complied with appropriate mitigating measures during the outbreak. Considering frequent waves and the pandemic’s long duration, consistent reinforcement of government measures, including masks, maintaining social distance, and frequent handwashing, is much needed.

    Keywords: Awareness, COVID‑19, education, mitigation, perception
  • Hadis Amiri, Maysam Rezapour*, Nouzar Nakhaee, Mahmoud Nekoei‑Moghadam, Yunes Jahani Page 276
    BACKGROUND

    Traumatic events and psychological damage are common. Identifying different types of traumatic events contributes to the development of psychopathology and can be very helpful in macroeducational and treatment planners. The current study extracted the patterns (overlap) of different traumatic events that Iranian college students commonly experience, with the aim of understanding their association with posttraumatic growth (PTG) and religiosity.

    MATERIALS AND METHODS

    Four hundred and sixty‑six students from Kerman universities completed a cross‑sectional survey about religion, and questions about PTG and traumatic events have experienced in the past 5 years. The latent class analysis (LCA) was used for extracting patterns of traumatic events, and the one‑way ANOVA test was used to compare PTG and religiosity across these classes in Iranian college students.

    RESULTS

    The LCA revealed that a three‑class solution had an adequate relative and absolute fit. The three classes were labeled and characterized as multiple‑traumatic events (2.9%), intermediate‑traumatic events (31.1%), and low‑traumatic events (66.0%). In ANOVA results for PTG and Duke University Religion Index (DUREL) domains across classes, individuals in the multiple‑traumatic classes had the lowest score of PTG and DUREL domains.

    CONCLUSION

    Although the current study showed the relative frequency of multiple‑traumatic events in Iranian students is low, individuals categorized in this class had the lowest PTG, and these findings reveal the necessitation of planning and interventions for PTG.

    Keywords: Latent class analysis, posttraumatic growth, religion, traumatic events
  • Behnaz Shojaei, Marzeyeh Loripoor*, Mahmoud Sheikhfathollahi, Fariba Aminzadeh Page 277
    BACKGROUND

    Exercising during pregnancy has various benefits for the mother and the fetus, but there are controversial results about its effect on labor and delivery. Therefore, the present study was conducted to evaluate the effect of walking during late pregnancy on the outcomes of labor and delivery.

    MATERIALS AND METHODS

    The present randomized clinical trial was conducted on 102 pregnant women who were referred to the comprehensive health service centers of Rafsanjan and were selected using convenient sampling method and randomly were allocated into two groups from August 2018 to February 2019. The intervention group performed walking from the 34th week of pregnancy until the time of delivery 4 times per  week, each time for 40 min. The control group just received the routine prenatal care. Information about the outcomes of delivery were gathered from the participants’ medical files in the hospital and were analyzed using SPSS software version 22 and Chi‑square and independent t‑tests.

    RESULTS

    The results indicated that the Bishop score of the intervention group was significantly higher than the control group (P < 0.05). Furthermore, regarding the duration of the third phase of delivery, spontaneous labor, induced labor, cesarean section , and instrumental delivery, a statistically significant difference was observed between the intervention and the control groups (P < 0.05). There was no statistically significant difference between both the groups regarding the duration of the first and the second stages of delivery and Apgar score at 1st and 5th min (P > 0.05).

    CONCLUSIONS

      Walking during late pregnancy could improve Bishop score, increase spontaneous onset of labor, and decrease induction, cesarean, and instrumental delivery without having any adverse effect on the neonate’s Apgar score.

    Keywords: Delivery, late pregnancy, outcome labor, walking
  • Divya Verma*, Divita Sharma, Meenakshi Khapre Page 278
    BACKGROUND

    Online platforms are the most popular mode of entertainment, simultaneously imparting knowledge and education. During COVID pandemic, there was a sudden influx of educational videos on social media/websites with a purpose of spreading the information about hand hygiene (HH) practices. The aim of this study was to explore and assess the HH videos based on its content and technical quality to promote the learning experience of videos.

    MATERIALS AND METHODS

    HH videos from the official sites of five international health organizations and 42 national health institutes were assessed based on their availability of the HH videos. Verified YouTube videos on HH since January 2020 were further screened and assessed using the author’s designed validated checklist. Each video was systematically evaluated and scored against the seven categories, namely introduction, audio, visuals/background, speaker/demonstrator, content, timing, and appeal.

    RESULTS

    A total of 50 videos were assessed for analysis. Of these, 82% of videos scored >50%, i.e., 14. Among low scorer, seven videos were from YouTube channel. Majority of the videos were technically sound, 44% aroused interest, 82% had a simple, understandable message; in around 46% of the videos, the presenter was a healthcare worker; and in 24%, the information was accurate as per the World Health Organization guidelines.

    CONCLUSIONS

    This study concluded that most of the HH videos were found to be just above average in their content quality and technicality.

    Keywords: Content analysis, COVID‑19, hand hygiene, internet, video‑audio media
  • Golrokh Atighechian, Fatemeh Rezaei, Nahid Tavakoli*, Mitra Abarghoian Page 279
    BACKGROUND

    At the beginning of the COVID‑19 pandemic, the Iranian Ministry of Health and Medical Education set up a 24‑h call center, i.e., Center 4030, to mitigate people’s worries and anxieties, create composure, increase people’s trust, and answer their questions. This qualitative study aimed to identify the challenges of COVID‑19‑related‑information among people in point of experts’ views.

    MATERIALS AND METHODS

    This qualitative study was conducted to collect the opinions of experts on the identification of the Information challenges of COVID‑19 during March–June 2020. The research population included all health professionals and experts. The sampling method was initially purposive and continued to saturate the data as snowball technique. In this study, 19 participants were interviewed. The data were collected using a semi‑structured interview. After collecting the data, the audio files of the interviews were written down to extract their external and internal elements. MAXQDA version 12 software was used to organize qualitative analysis and coding data.

    RESULTS

    The results of this study involved eight themes, i.e., lack of planning, lack of social trust in government, lack of COVID‑19‑integrated scientific authority in the country, conflicts of interest, lack of integrated information sources, distracting public attention, infodemic, and poor information quality, classified into 16 categories.

    CONCLUSIONS

    The main information challenges that people in Iran faced included the lack of a scientific reference source to access accurate information, the existence of a large volume of information in virtual networks, and a huge volume of statistics from various information channels that caused confusion among people.

    Keywords: COVID‑19, information challenges, qualitative research
  • Vahid Hatami Garosi, Sepideh Tanhaie, Fakhreddin Chaboksavar, Teymour Kamari, Parvin Abdi Gheshlaghi, Razie Toghroli, Simin Soltaninezhad*, Seyyed Amar Azizi, Vahid Yazdani, Fatemeh Mahmoodi Page 280

    Coronavirus disease 2019 (COVID‑19), caused by severe acute respiratory syndrome coronavirus 2, was first reported in December 2019 in Wuhan, Hubei province, China. It is now known as a pandemic and a global crisis due to rapid human‑to‑human transmission with the vast expansion that has affected almost all countries. The primary source of the disease is still unknown, but it is possible that the virus was transmitted through bat to an intermediate host and then to humans. The main and early symptoms of COVID‑19 infection are fatigue, fever, dry cough, myalgia, and dyspnea. The incubation period of the disease is about 2–14 days, which is one of the important parameters for planning to prevent disease outbreak. PT‑polymerase chain reaction test is used to diagnose the disease; chest computed tomography scan, chest X‑ray, blood tests, and symptoms are also very helpful in diagnosing the disease. There is a strong emphasis on controlling infections and hand hygiene to prevent the transmission of the disease. There is not enough knowledge about this disease yet, and there are no specific vaccines or medications available to prevent and treat this disease. The current review study uses articles indexed on databases of Embase, Elsevier, PubMed, and World Health Organization and Centers for Disease Control and Prevention, and keywords of coronavirus, COVID‑19, acute respiratory distress syndrome and China.

    Keywords: COVID‑19, epidemic, novel coronavirus, pandemic, Infectious disease, SARS‑CoV‑2, healthemergency, review
  • Fertaj Alzwain, Mohammad Bashatwa, Burhan Hamadneh* Page 281
    BACKGROUND

    Over the last year, the world has witnessed an infectious disease (COVID‑19) outbreak that has shown a high rate of spread. Therefore, several prevention and mitigation measures have been imposed to control the spread of the virus worldwide. The aim of the current study is to identify the commitment level to social distancing and its relationship to psychological stress among members of Saudi society during COVID‑19 pandemic.

    MATERIALS AND METHODS

    The descriptive correlational design was employed in the current study, and the sample of the study consisted of 536 Saudis selected using convenient sampling method. The study was conducted in four cities in Saudi Arabia (Altayef, Mecca, and Najran, in 2020 during COVID‑19 pandemic using quantitative survey method. Several analysis methods using SPSS software were used to analyze the data such as mean and standard deviation, three‑way ANOVA, Scheffe’s test, and Pearson correlation.

    RESULTS

    The study revealed that the psychological stress and commitment level to social distancing by the study sample during COVID‑19 pandemic was moderate, and differences were observed among the study variables. Furthermore, the study revealed a statistically significant negative correlation between the commitment level to social distancing and the exposure to psychological pressures.

    CONCLUSION

    The study contributed to literature by developing a model to enhance the importance of social distancing of people during COVID‑19 pandemic. The study recommends the necessity to provide advice and counseling services that enhance community members’ awareness about the application of social distancing during COVID‑19 pandemic.,

    Keywords: COVID‑19, individual variables, indoor distancing, outdoor distancing, psychological pressure, Saudicommunity, social distancing
  • Mehdi Kargar, Seyed Aliakbar Faghihi, Mahin Nazari* Page 282
    BACKGROUND

    Taking care of patients with bipolar disorder (BD) makes critical challenges for their informal caregivers (ICGs) and forces them to tolerate considerable burden. This qualitative study explored the dimensions of ICGs’ care burden (CB) based on their own experiences and the patients’ therapists.

    MATERIALS AND METHODS

    This is a qualitative study which was conducted based on conventional content analysis through semistructured and in‑depth interviews. Purposive sampling was used to select the participants including 13 ICGs and 14 therapists (2 psychiatrists, 10 psychiatric nurses, and 2 clinical psychologists). Interviews were audiotaped, transcribed verbatim, and analyzed using Graneheim’s 2004 principles.

    RESULTS

    Qualitative analyses yielded three major themes: “challenges associated with the nature of BD,” “challenges related to the ICGs,” and “challenges related to interventions.” The categories of the first theme entailed “individual‑oriented characteristics of BD” and “social‑oriented characteristics of BD.” The categories of the second theme consisted of “social stigma,” “psychiatric problems and helplessness of ICGs,” “financial costs related to providing cares,” and “insufficient self‑efficacy of ICGs in cares provision.” The categories of the last theme included “educational interventions” and “organizational interventions.”

    CONCLUSIONS

    This study showed that the burden of ICGs have individual, social, and organizational aspects. Every one of them impacts the severity of their burden remarkably. The depth of the therapists’ experiences has a significant role in designing the interventions to reduce this burden. The present investigation emphasized the constitution of a comprehensive framework related to all factors affecting burden in a developing country.

    Keywords: Bipolar disorder, care givers, qualitative research