Health Education and Health Promotion
Volume:10 Issue: 1, Winter 2022

Social media has increasingly been used as a tool to deliver health education. This study examined the effect of a Telegram delivered oral health education program on self-efficacy, perceived benefits and barriers, gingival index, motivational beliefs, and dental cleaning behavior among students with gingivitis.

This randomized controlled trial was conducted in Sanandaj city, Iran, from January to December 2019. A total of 160 students were recruited from 8 schools and randomized into intervention and control groups. An oral health education program aimed at increasing dental cleaning behavior was developed based on the trans-theoretical model. The program consisted of 9 sessions delivered via a social media app called Telegram for 24 weeks. Outcomes included dental cleaning behavior, perceived self-efficacy, benefits, barriers, motivational beliefs, and gingival index, measured at baseline and 24 weeks after the intervention.

There were significant differences between the intervention and the control groups in the mean scores of perceived self-efficacy (p=0.01), perceived benefits (p=0.01), motivational beliefs (p=0.01), and gingival index (p=0.01) after the intervention. Further, 71.3% (n=57) of students in the intervention group (versus 10.1% (n=10) in the control group) performed the dental cleaning behavior after intervention (p<0.01).

The findings showed that an oral health education program delivered via social media apps could improve students' oral health. Social media apps could reach a broad range of users, thus could improve access to oral health education programs.

Pregnancy is associated with changes in the woman's nutritional needs. The mother's nutritional status affects her own health, that of the fetus, and the outcome of the pregnancy. This study aimed to determine the knowledge, attitude, and practice of pregnant women towards proper nutrition.

This cross-sectional study was carried out on 445 pregnant women who were referred to urban health centers in Jiroft, Kiar, Fasa, Borkhar, and Ilam cities in 2020. Participants were selected by multi-stage random sampling. The instrument to collect data was multi-section research made questionnaire including demographic information, knowledge, attitude, and practice towards proper nutrition. Data was analyzed using SPSS 18 by Chi-square, t-test, ANOVA, and correlation coefficient.

The mean age of participants was 29.58±9.81 years and the mean month of pregnancy was 5.58±2.30 in all cities. Of them 59.10% had a good level of knowledge. In general, 81.10% had a positive attitude, but in Kiar city, 86.70% of pregnant women had a moderately desirable level of attitude and 63.8% were in a good level of behavior. There was a significant relationship between the history of receiving education and knowledge level in Jiroft and Kiar cities (p<0.05).

Due to the low levels of knowledge, attitude and practice of pregnant women towards proper nutrition, it is recommended to provide nutrition counseling for pregnant women in health centers. As a result of women's awareness of the principles of proper nutrition during pregnancy, the consequences of pregnancy will improve.

The current study aimed to determine the relationship between nutritional status and cognitive functioning of the elderly.

This Descriptive-analytical study was performed in 2019 in health centers in Amol. This study was performed on 260 elderly people, covered by health centers in Amol, Iran in 2019. Participants were selected by cluster sampling method. Data were collected using the Mini Nutritional Assessment questionnaire, Psychometric Evaluation of the Cognitive State Test, Geriatric Depression Scale, Instrumental Activities of Daily Living Scale, and Geriatric Oral Health Assessment Index. Statistical analysis was conducted using descriptive and inferential tests in SPSS version 20.

The mean age of the elderly was 67.3±6.65 years. Overall, 87.7% of the participants had a cognitive score above 25.5. The results of Spearman’s correlation test showed a significant positive relationship between the nutritional status and cognitive functioning of the elderly; this relationship was also significant in the regression model.

There is a relationship between nutritional status and cognitive functioning of the elderly covered by health centers in Amol, Iran.

Being diagnosed with cancer is a stressful event that may have negative effects on the quality of life of the patient. The purpose of this study was to determine the quality of life of cancer patients in Iran.

This systematic review is a meta-analysis study that was conducted in 2020. Five electronic databases and Google Scholar were used to search for original research papers published up to December 20, 2020, on the quality of life of cancer patients in Iran. Overall, 30 articles were selected and analyzed using the Comprehensive Meta-Analysis 2.2.064. Heterogeneity of the studies was assessed using Cochran’s Q-test statistics and I2 test, and publication bias was assessed using Egger’s test. Meta-regression was performed to assess the variables suspected to affect the heterogeneity. The outcomes of the studies were combined using the random‑effects model.

Average quality of life among cancer patients was 50.83±3.07 (44.80-56.86: 95% CI). The highest quality of life was observed in the city of Qazvin in 2012 at 103.07±1.61 (100.11-106.03: 95% CI) and the lowest quality of life was observed in the city of Tehran in 2010 at 4.05±0.36 (3.35-4.75: 95% CI). A statistically significant correlation was observed between the quality of life, publication year, average age, and sample size (p<0.05).

The results of this study indicated that the average quality of life of cancer patients in Iran was moderate.

Dental academics should know COVID-19 to save themselves, the students, and the community during a pandemic. We assessed the knowledge of dental academics regarding the COVID-19 pandemic and the factors associated with it.

This cross-sectional study was conducted online in April 2020 in the dental school of Tehran University of Medical Sciences. Two hundred seventy-four participants were selected by a convenient and snowball sampling. This study was part of a multinational study and used a valid and reliable questionnaire. Multiple linear regression models served for statistical analysis in SPSS 21.

Of the 274 respondents, 66.4% were female. COVID-19 total knowledge score was 74.30 (of 100), with dental precautions having the highest domain score of 86.28 and warning signs having the lowest (56.93). Multiple regression models controlling for backgrounds revealed moderate and less academic experience associated with higher transmission and protection knowledge. More patient visits and dealing with fewer students (p=0.021) were associated with lower treatment knowledge, having administrative roles was associated with higher protection knowledge (p=0.043), and men had less knowledge of dental precautions (p=0.049).

Dental academics have an overall rather desirable knowledge, while their knowledge on COVID-19 warning signs is insufficient.

Meaning of life is of great importance to promoting various dimensions of the quality of life in women with breast cancer. The current study aimed to find out and describe the experience of the meaning of life in women with breast cancer.

22 women with breast cancer were selected using the purposive sampling method in this qualitative study. The data were collected via semi-structured interviews and then analyzed by conventional qualitative content analysis and Graneheim & Lundman’s approach in MAXQDA software (ver. 10).

Two themes and ten categories have appeared. Seven categories in the “development in the process of life” theme include: feeling the change in the life routine, achieving a better recognition of the life value, having life satisfaction despite the illness, hoping for and accepting that the illness will end, trying to cope with the illness, tolerating the pain and suffering from illness, worrying about future of the children, in the “the attempt to promote spiritual well-being” themes three categories: personal belief, spiritual contentment, and religious acts.

The meaning of life in women with breast cancer is multidimensional. Due to the important roles of women in the family and even in society, the health system should take necessary measures and supporting actions to improve the meaning of life in these patients.

In the past few years, cosmetic surgeries as aesthetic procedures have been highly welcomed in Iran. Therefore, identifying factors affecting people’s tendency towards undergoing such surgeries can give rise to the effectiveness of educational interventions to boost health-promoting behaviors. The present study aimed to reflect on the factors influencing cosmetic surgeries concerning the theory of planned behavior in candidates and non-candidates referred to the hospitals affiliated to Shahid Beheshti University of Medical Sciences, Tehran, Iran.

This descriptive-analytical cross-sectional study was conducted on a total number of 400 patients (including 200 candidates and 200 non-candidates for cosmetic surgeries) in 2019. The data collection tool was a researcher-made questionnaire developed based on the TPB, comprised 47 items about demographic variables and the TPB constructs. The data analysis was performed using the SPSS 23 software by multiple logistic regression analysis.

The study results also revealed that a one-unit increase in behavioral beliefs, normative beliefs, and perceived capability could augment the chances of undergoing cosmetic surgeries by 11%, 3%, and 2%, respectively. Moreover, among the model constructs, attitudes were highly correlated with the likelihood of performing cosmetic surgeries. A one-unit growth in attitudes would add to the chances of having cosmetic surgeries by 13%.

People’s attitudes are the most relevant variable affecting the practices of cosmetic surgeries in girls and women. Therefore, much more attention needs to be paid to attitudes in designing interventions targeting health-promoting behaviors.

Learning health systems are healthcare systems in which awareness formation processes are inserted into daily practice to provide constant development in care. Many students have difficulty completing the health systems courses due to a lack of Higher-Order Thinking Skills (HOTS). Therefore, this study aims to improve students' HOTS using a mobile-based instructional approach.

The enhanced HOTS is measured using indicators of critical and creative thinking processes known as Bloom's taxonomy concept. Furthermore, this is experimental research with a pre-test-post-test random control group pattern and ADDIE technique to develop the mobile-based instructional Approach. The study involved 120 students who were evenly divided into the experimental class and the control class. Respondents were selected from 650 SMK students in Central Java using the random cluster sampling method. 

Based on the results, this is evidenced by the ability to answer challenging questions associated with critical and creative reasons. 

Therefore, the use of a mobile-based instructional Approach supports independent learning.

This study aims to identify and describe online learning in Special Schools (SS) and implement Project-Based Learning (PjBL) and Health-promoting lifestyle (HPL) in children with mild to moderate special needs.

The method used in this research is descriptive with survey method. This study involved 80 special education teachers in Central Java Province, Indonesia. The data was collected through a questionnaire accompanied by 11 questions whose validity was tested through focus group discussions. Data were analysed qualitatively, collecting data, validating data, tabulating, conveying data, and concluding data.

The results showed that 96% of SS teachers in Central Java Province admitted to implementing online learning for children with special needs. 75% of SS teachers stated that online learning was not very effective and not meaningful. Project-based online learning needs for SS teachers are at a high level of 72% for the very needy and 28% for the needy.

Online PjBL exercises for children with mild special needs have a meaning in increasing critical thinking skills, while for children with intermediate special needs, it means increasing activity-based and Health-promoting lifestyle.

Aims:

 Global challenges affect universities in Indonesia to improve academic services and health promotion. This study aimed at how universities consider student satisfaction with academic services and health promotion.

Instrument & Methods:

 This research uses a descriptive method. This research was conducted in six state Islamic universities in Indonesia and involved 315 students. Research data collection using a questionnaire. The variables in the study include lectures, counseling, health issues, additional services, hidden services, explicit services, and social atmosphere. This study uses Rasch analysis to measure variables with the help of WINSTEPS 3.73 in determining validity and reliability. The RASH model is used in this study to verify the measurement of service quality variables. Rash’s model only focuses on student perceptions and gains satisfaction with the dimensions of academic service and health promotion.

Findings :

The results showed student satisfaction based on demographic characteristics that state Islamic universities were more dissatisfied than university-type Islamic colleges.

Conclusion:

 Academic services to students need to be considered to increase student satisfaction.

Appropriate complementary feeding is one of the main ways to prevent malnutrition in infants, which is a serious health problem in developing countries including Iran. This study aimed to investigate the effectiveness of a theory-based educational intervention on timely complementary feeding initiation in primiparous mothers.

In this randomized controlled trial, 68 primiparous mothers (34 in each intervention and control group) of infants aged 2 to 3 months participated in the study using a Multi-stage random sampling method in Kashan, Iran, 2019. The educational intervention was designed based on the theory of planned behavior. The data collection tool included a demographic information questionnaire and a researcher-made questionnaire designed based on the theory of planned behavior. SPSS 22 software was used for data analysis, using Chi-square test, independent and paired t-test. Statistical significance was set at p<0.05.

After the intervention, there were significant increases in the mean scores of knowledge (p=0.004) and attitude (p=0.02) in the intervention group compared to the control group, but the mean scores of intentions to initiate complementary feeding timely, showed no significant differences between the control group and the intervention group. A significant increase was seen in the mean score of perceived behavioral control in the intervention group (p=0.002). Only perceived behavioral control significantly increased the chances of timely initiation of complementary feeding (OR=1.36, p=0.002).

The educational programs based on the theory of planned behavior has small effects on improving timely complementary feeding.

Preventive behaviors play an important role in reducing mortality caused by this disease. This study aimed to determine the application of the extended theory of planned behavior to predicting preventive behaviors against COVID-19.

In this descriptive-analytical cross-sectional study, 416 university students were selected and examined through virtual networks through convenience and snowball sampling methods. The data collection tool was developed by the researcher-made questionnaire based on the extended theory of planned behavior. Data were analyzed using descriptive statistics and correlation test and linear regression by SPSS 18 software.

A positive and significant correlation was observed between the mean of all the studied theoretical constructs with preventive behaviors against COVID-19 (p<0.01). Attitudes, subjective norms, perceived behavioral control, and perception of others' behavior predicted 43% of behavioral intention variance. Moreover, behavioral intention perceived behavioral control and perception of others’ behavior predicted 56% of preventive behaviors variance against COVID-19. Behavioral intention, attitude, perception of others' behavior, subjective norms, and perceived behavioral control had the greatest impact on COVID-19 preventive behaviors.

The extended theory of planned behavior can be used as an appropriate framework in designing educational interventions to promote preventive behaviors against COVID-19.

Breast cancer represents one of the most prevalent cancers and is also the main cause of cancer-related deaths in women globally. Thus, this study was aimed to construct and compare the performance of several rule-based machine learning algorithms in predicting breast cancer.

The data were collected from the Breast Cancer Registry database in the Ayatollah Taleghani Hospital, Abadan, Iran, from December 2017 to January 2021 and had information from 949 non-breast cancer and 554 breast cancer cases. Then the mean values and K-nearest neighborhood algorithm were used for replacing the lost quantitative and qualitative data fields, respectively. In the next step, the Chi-square test and binary logistic regression were used for feature selection. Finally, the best rule-based machine learning algorithm was obtained based on comparing different evaluation criteria. The Rapid Miner Studio 7.1.1 and Weka 3.9 software were utilized.

As a result of feature selection the nine variables were considered as the most important variables for data mining. Generally, the results of comparing rule-based machine learning demonstrated that the J-48 algorithm with an accuracy of 0.991, F-measure of 0.987, and also AUC of 0.9997 had a better performance than others.

It’s found that J-48 facilitates a reasonable level of accuracy for correct BC risk prediction. We believe it would be beneficial for designing intelligent decision support systems for the early detection of high-risk patients that will be used to inform proper interventions by the clinicians.

Major traumatic events such as the COVID-19 pandemic and the related lockdown can affect the family as the fundamental unit of all societies. This study aimed to explain family members’ psychological experiences of the COVID-19 lockdown.

This qualitative study was conducted from October 2020 to February 2021 on Public population living in Khorramabad, Iran. The sample size that achieved data saturation was 29 by purposive sampling. Unstructured in-depth interviews were used to collect the data. The inductive content analysis approach proposed by Graneheim & Lundman was used to analyze the data.

Both positive (movement toward the expansion of the worldview and a sense of pleasure and happiness) and negative (anxiety, a sense of isolation, intensification of loneliness, mood and energy changes, hardship and fatigue from lockdown, boredom, anger, depression, disruption of the sleep-wake patterns, being fed up with limitations, feelings of helplessness, more frequent family disputes and arguments and Internet abuse) psychological aspects were recognized, each of which had some subcategories.

The COVID-19 pandemic lockdown created negative and disruptive experiences and positive and constructive experiences for different individuals.

Occupational safety, contact care, safety policy, as well as mental-environmental conditions, are supposed among the most significant factors shaping the levels of stress in nurses. Therefore, this path analysis was fulfilled to test a theoretical model to reflect on the relationship between Safety policy, occupational safety, mental-environmental conditions, and Contact Care.

This predictive cross-sectional study was conducted in 2018-19. A total number of 530 nurses were selected from 11 hospitals in 4 provinces in Iran. The Stress of Exposure to Sharps Injury Scale was used. A path analysis was also utilized by SPSS 24 software.

The mean age of the nurses was 35.72±7.78. As well, 12.5% of the nurses had associate’s degrees and 82.2% of them were holding bachelor’s and higher degrees. The path analysis also explained 57.6% of the variance in contact care. Moreover, the findings indicated a direct effect as a significant positive relationship between occupational safety and mental-environmental conditions. Likewise, safety policy could mediate the relationship between occupational safety, mental-environmental conditions, and safety policy.

The study findings suggested that safety policy could mediate the relationship between occupational safety, mental-environmental conditions, and contact care. therefore, designing and implementing suitable safety policy statements can play a vital role in reducing the levels of stress among nurses in terms of patient care.

Fear of falling in the elderly is a significant health problem. This study was aimed to compare the two CBT and Tai Chi exercise methods to reduce the fear of falling among retirees.

This randomized clinical trial study was conducted from December 2018 to October 2019 on elderly retirees who were referred to the Retirees Association at Kerman University of Medical Sciences in Kerman, Iran. A number of 120 elderly people were randomly assigned to Tai Chi, CBT, and control groups (40 retirees/group). The intervention in CBT groups consisted of 16 sessions of 60 to 70 minutes for eight weeks and in Tai Chi groups consisted of 16 sessions of 45 to 60 minutes for eight weeks. The participants in the control group received training on the problems of old age. The self-report scale assessed fear of falling before, one, and two months after the intervention. Data were analyzed by SPSS software version 18 using ANOVA and Chi-square tests.

Before and in the first month after intervention, there was no significant difference between the three groups regarding the total score of fear of falling and its components (p<0.05). In the second month, the total score of fear of falling in the Tai Chi group was 8.95±1.63, the CBT group was 8.6±1.63, and the control group was 7.63±1.36, and there was no significant difference (p=0.147). Also, the most significant difference in the total fear of falling score was between the Tai Chi and the control groups.

Tai Chi and CBT interventions are effective in the fear of falling in the elderly.

The social status of nurses is one of the factors affecting the professional identity and plays an important role in how people perceive this profession and also the tendency of people to this profession. So this study was conducted to determine the Iranian population's attitude toward the social status of the nursing profession.

This descriptive-analytical cross-section study was conducted in public places in Hamadan from October to February 2019. Four hundred citizens participated in the study by available sampling method from 4 urban areas of Hamedan. The data were collected by a social status researcher-made questionnaire. Collected data were analyzed using SPSS 16 and, parametric statistical tests such as t-test and ANOVA and non-parametric tests such as Chi-square.

The mean age of participants was 34.30±9.98 years. The mean of the obtained score from the status questionnaire was 71.23±11.76, which was at a moderate level in qualitative leveling. Statistical tests showed that social status score was statistically significantly related to gender, education, and media relations (p<0.05).

Considering that individuals' attitudes on the social status of the nursing profession are moderate and people who had more contact with the media reported lower scores of social status, it is recommended that members of the media take action to reflect the true image of the nursing profession.

The internship course is an essential component of the nursing undergraduate program. This study was aimed to explore nursing students' experiences of role transition in the internship program during the COVID-19 pandemic.

This qualitative study was conducted on last semester’s nursing students practicing in an internship course during the COVID-19 pandemic at Lorestan University of Medical Sciences, Iran from February to June 2021. The internship BSc nursing students were selected by a purposive sampling that reached 12 students by achieving data saturation.

The findings included 5 categories of psychological challenges, unsuitable professional support and supervision, self-centeredness and independence, mandatory restrictions, and acquiring a professional identity.

The internship curriculum must be planned and supervised in a nursing education program by faculty authorities to prepare senior nursing students to enter the workplace, not only for their career retention but also for their actual growth/development in any workplace.

The present study was conducted to review the relationship between health literacy and self-care of diabetic patients.

This study is a systematic review based on the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and was implemented systematically through an electronic search in Iran Medex, SID, Magiran databases, Web of Science, PubMed, Scopus, Google Scholar, and Science Direct from January 2011 to April 2020. The terms were used, including health literacy, self-care, diabetes and their combinations. To maximize the comprehensiveness of the search in Persian references, general and general Persian keywords, including health literacy, self-care, diabetes self-care, health literacy, and self-care, health literacy, and diabetes and their possible combinations in the abstract, title, and keywords were used “AND” and “OR” operators were used for this purpose. For the English equivalent of Latin and MESHE, the words were searched, including “Health literacy”, “diabetes”, “self-care”, “Diabetes self-care”, and a combination of the “AND” and “OR” operators.

The results showed that in most studies there is a significant relationship between health literacy and self-care in patients with diabetes.

Health literacy plays an important and key role in promoting self-care behaviors in diabetic patients. It requires paying attention to health literacy and adopting strategies to improve the health literacy of diabetic patients.

COVID-19 outbreak in China affected all age groups. Among these groups, pregnant women are among the most important ones. This study aimed to investigate the effect of educational intervention in terms of the pattern of health beliefs to promote preventive behaviors against COVID-19 among pregnant women.

This descriptive study was performed as an intervention on pregnant women in Qom in 2021. One hundred-six women were chosen by multi-stage sampling. The pre-test questionnaire was electronically given to the target group, and the educational protocol was provided to the group for a 2-month duration during several virtual sessions through videos, posters, and pamphlets. Thereafter, the questionnaire was completed again by all the individuals. The required data were collected in SPSS 20 software and then analyzed by t-test.

Before conducting the educational intervention in terms of some variables, including age, education, occupation, spouse occupation, number of abortions, number of deliveries, weeks of pregnancy, illness during pregnancy, family illness, relatives, and death in family members due to diseases, no statistically significant difference was found between the intervention and control groups (p>0.05). After conducting the educational intervention, a significant difference was observed in the intervention group in terms of all constructs of the health belief model compared to the control group (p<0.05).

The results of this study support the effectiveness of the intervention based on the health belief model in promoting preventive behaviors against COVID-19.

Aims. Experience in many wars and armed conflicts has shown that in order to achieve the desired result, the team in the security forces should be monolithic. Gender dissonance is a factor that negatively affects the ability of the officer team to fulfil its assigned tasks. The purpose of the study lies in highlighting important gender issues in the education of cadets, namely female cadets of Ukrainian security forces universities, which were identified during their expert survey. Methods. In the course of the study, the research was carried out in the form of a survey among third- and fourth-year female cadets. A total of 100 future officers were surveyed. The age range of the survey participants is between 19 and 22. Findings. The study identified the following problems in the gender education of female cadets: relatively high levels of material motivation when enrolling in a security forces university, insufficient level of psychological readiness for service in combat units, low aspirations for career advancement, and unsuitable living environment. Conclusion. The gender policy pursued by the state through the relevant governing bodies significantly lags behind the realities that spontaneously materialise, especially within the officer teams. At a time when the need for certain changes has already become formalised among officials in the security forces, the reality is at a different level of development. The authors consider it appropriate to carry out further comprehensive scientific research work, which should reflect the social, psychological, legal, economic and cultural aspects of the gender equality problem.

Aims Covid-19 infected patients are necessarily treated under isolation procedure in health facilities. However, those who have clinically mild symptomps are recommended to self-isolate. This study aims to explore the experiences of Covid-19 survivors who underwent self-isolation from the beginning of infection until declared cured. Participant and Method Phenomenological design study was used in this qualitative research to describe the experiences of Covid-19 survivors who were under self-isolation in Semarang, from the beginning of infection until declared cured. Data was collected using semi-structured in-depth interviews through offline and online methods. Findings   Positive thinking and the support of family and companion motivated them to survive in self-isolation condition. Environmental stigma was the most undesirable obstacle felt by the Covid-19 survivors during self-isolation at home. Covid-19 survivors experiencing clinically mild symptoms tended to distrust the media because the media provides frightening information about Covid-19. Conclusion Positive thinking and family support are the successful key of self-isolation. Media can be used responsibly to reduce stigma and to support Covid-19 sufferers who are undergoing self-isolation.

Aim. The aim of this paper is to analyse current environmental risk management systems, identify their shortcomings and implement solutions that will help avoid them, as well as to study the environmental component when creating documents concerning the environmental modernisation of enterprises. Methods. The present study investigates the environmental and civil safety and is performed using the method of logical analysis, the method of comparative analysis, the formal legal method, the method of synthesis, the method of deduction, as well as the method of analysis of scientific literature. Findings. The result of this paper is the identification of theoretical and practical foundations of environmental risk management systems, their effectiveness in preventing anthropogenic and environmental disasters, as well as the analysis of the regulatory framework for creating and implementing documentation to be used in the environmental modernisation of enterprises. Conclusion. The authors developed environmental risk management systems, eliminating shortcomings in their performance, introducing methods that will improve and make such systems more effective, as well as increasing the level of environmental component during operations with documents that are cornerstones for environmental improvement of institutions and enterprises.

This study aimed to assess the impact of Benson's Relaxation Technique (PRT) on psychological distress and sleep quality among older people's during COVID 19 pandemic.

A quasi‐experimental research design was used to achieve the aim of this study. 95 elders, recruited randomly as follows; 50 from Geriatric social club in Zagazig City, 20 from El‐Resala geriatric house in Zagazig City, and 25 from geriatric home in Met Ghamr City. Three tools were utilized for data collection, namely, Interview questionnaire sheet, Depression Anxiety Stress Scales (DASS) for measuring depression, anxiety as well as stress, and Pittsburgh Sleep Quality Index (PSQI) for measuring sleep quality.

More than three‐quarters of the participants had chronic diseases. The majority had unsatisfactory knowledge about Benson's Relaxation Technique at the pre‐intervention phase. Two thirds of elders had severe depression level; slightly less than two thirds had severe anxiety, about three quarters had severe stress at the pre‐intervention phase with statistical significant reduction post intervention phase. The majority had poor sleep quality (97.9%) at the pre‐intervention phase, which decreased at the post‐intervention phase to 50.5%.

This study concluded that. Benson's Relaxation Technique have great effect on psychological distress and sleep quality of elderly people. Gero‐psychiatric nurses should encourage elderly people to apply BRT for enhancement of their psychological wellbeing.

Two hundred thirteen clinical specimens were collected from patients after48h admission in Al–Faehaa Educational Hospital, AL-Sader Educational Hospital and Pediatric Specialist Educational Hospital from November 2020 to April 2021, the ages of patients were ranged from 5 months to 80 years, 94 (44%) males and 119(56%) females. The highest prevalence of bacterial nosocomial infections was recorded in 5 months-10 years (27.5%), while the 21-30 years group showed a high prevalence of hospital acquired fungal infections (22.02%). Furthermore, diabetic patients (43.7%) tended to be more susceptible to fungal infections. A fifty nine yeast isolates were isolated from clinical specimens, all of which were identified morphologically, physiologically and molecularly. The most fungal isolates were returned to the genus Candida that including: Candida albicans (47.5%), C. glabrata (16.4%), C. tropicalis (11.48%), C. parapsilosis (9.84), (4.91%) for each C. krusei and C. dubliniensis, C. lusitaniea (3.28%) in addition to 1.68% of Naganishia globosa with significant difference (P≤ 0.05) among isolated species. Additionally, Naganishia globosa was firstly record as a nosocomial agent in Iraq. The phylogenetic a nalysis of neighbor joining tree revealed that 28S region is very efficient in differentiation among fungal species and can be considered as powerful marker in fungal identification.

Considering the importance of mortality management in the control of COVID-19 disease, this study was performed to investigate the risk factors of mortality of adult inpatients with Covid-19 in Tehran, Iran using a retrospective cohort study.

This retrospective cohort study was performed among a random sample of confirmed COVID-19 hospitalized patients, in a main general military hospital in Tehran city (Iran). Laboratory data, clinical sign and symptom, treatment and demographic data were collected and compared between survivors and non-survivors patients.

Among 393 patients who contributed in this study, 37 (9.4%) with 95% confidence interval (6.7% to 12.7%) died during hospitalization. The result of this study also showed that comorbidity like hypertension and  CHF, vital sign like dyspnea,  RR>24  and Oxygen saturation also laboratory variable like WBC, Lymphocyte, CRP, CR, ESR, , LDH, Sodium, troponin, Procalcitonin in addition lesion type shown the significant relationship with patients death. The findings of this study showed that the use of drug including Kaltra, Vancomycin, Ribavirin, Meropenem, Levofloxasin, and Methyiprednisolon increased the risk of death but use of drug like Azithromycin, Hydroxychloroquin and Naproxen decrease risk of death in COVID-19 hospitalized patients. More results also showed that ARDS, AKI and intubation are the most cause of death among patients.

According to the risk factors identified in this study, patients with a higher chance of death can be identified and the necessary treatment measures can be taken to reduce the risk of COVID-19 hospitalized patients.

This study aimed to investigate and analyze the internal factors affecting the development of health tourism.

The statistical population of this research is the Cultural Heritage and Tourism Organization experts, the managers of travel services offices, and doctors in the field of health tourism. By examining the literature and experts' opinions, eight variables were identified.

The most important factors affecting the development of health tourism. As can be seen in the graph, the geometric shape used as a symbol of each factor is different in size. The reason for this is the difference in the importance of each factor in the model. In other words, the factors can be prioritized in terms of importance. Based on the fuzzy cognitive mapping analysis results, the number of medical centers and marketing are the most affected factors (Susceptibility was 0.2 and 0.1, respectively).

This research can be generalized by considering other factors and their relationships and implementing more policies.