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Abstract Background The aim of the present study was to determine the effect of oral health education programs on the oral health of primary school students. Methods In this randomized controlled trial study, 190 elementary fifth-grade female students were chosen using the multistage cluster sampling method. In this study, the Plaque Index (PI), Simplified Oral Hygiene Index (OHI-S), Community Periodontal Index (CPI), tooth brushing using fluoride toothpaste, dental flossing frequency and factors affecting them were determined according to social cognitive theory (SCT). Interventions were implemented using the play method and with the help of three pamphlets, five posters, a celebration of oral health, and the creation of a Telegram group. Data were analyzed using descriptive statistics indexes, t tests, paired sample t tests, chi-square tests, and Pearson correlation tests. Results The results showed that 3 months after the intervention, compared to before the intervention, the percentage of participants in the intervention group who brushed their teeth twice or more per day increased by 48.5%, and the percentage of participants who used dental floss at least once per day increased by 64.2%. The rate of gum bleeding decreased by 6.3%. The good OHI-S rate increased by 44.4%. Dental plaque decreased by 38.1%. Conclusion The results demonstrated that a gamification design can be effective and useful in promoting the oral health of students. Trial registration registration timing: retrospective, registration date: 18/10/2022, registration number: IRCT20141128020129N2.

Abstract Background One of the most common pathologic changes in older people is oral and dental problems. The oral health of older people is a public health concern. Promotion of good oral health for this cohort will have beneficial impacts on the longer-term quality of life. This study aimed to identify the types of health education interventions for the oral health of older people and to determine their effects on the oral and dental health of older people. Methods Potential articles were retrieved from four electronic databases (PubMed/Medline, Scopus, Web of Sciences, and Embase) up to 31 September 2022 in English without limit of time. Experimental and quasi-experimental interventional studies investigating the impact of educational interventions on oral and dental health among older people over 60 years old in both sexes were considered. The quality assessment tool was the Effective Public Health Practice Project (EPHPP). Results In the initial search, 1104 articles were retrieved. Finally, according to the inclusion criteria, 23 studies (seventeen randomized controlled trials (RCT) and six quasi-experimental studies) were reviewed. In this review, educational interventions for older people and their caregivers are classified. Theoretical frameworks were used in only three interventions related to older people. Outcome measures were both self-reported and objective measures. Fifteen of the included studies were of moderate quality. Conclusion This review provides evidence that the use of oral and dental health educational interventions was effective in improving the oral health of older people. Educational interventions were carried out both among older people and among their caregivers. Although a variety of interventions were used in the reviewed studies, more lectures were used in the interventions related to older people. In the interventions related to caregivers, in addition to lectures, practical education was also used. It is recommended to perform higher quality studies for assessing the effectiveness of interventions in this field.

Abstract Background Children with Phenylketonuria (PKU) need a special diet to avoid a variety of physical and psychological complications. The aim of this study was to compare and assess the effects of two interventions on and levels of phenylalanine and micronutrients in children with PKU. Methods Forty-six children with PKU (ages 1–12 years) and their caregivers were randomly assigned to one of two 10-week interventions: a caregiver educational intervention based on the Integrative Model of Behvioral Prediction (IMBP) and supplementary low-protein-modified foods. Outcomes consisted of Children's plasma phenylalanine and micronutrients (i.e., vitamin B12, vitamin D3, and zinc) and hemoglobin levels. To assess the sustainability of outcomes, we also compared the children’s phenylalanine level at five-time points including baseline and 10-week, 6 months, 12 months, and 24 months follow-ups. In addition, caregivers of both groups were asked to complete a questionnaire to assess how well the interventions were implemented as well as satisfaction with interventions. Results While a large percentage of children had phenylalanine levels out of range indicating non-adherence (69.6% and 81% in the educational and food items group, respectively), micronutrient deficiencies were not prevalent in the patient cohort. The levels of phenylalanine in both groups decreased significantly over time. However, conducting a repeated-measures ANOVA to evaluating the change in groups across five-time points, revealed a significant difference between groups (F = 4.68, p = 0.03). That is, the educational intervention was more effective in lowering the children's phenylalanine level. At 24-month follow-up, the percentage of children with a normal range of phenylalanine level in the educational and food items groups increased to 73.9 and 57.1 percent, respectively, from 26 and 38 percent at baseline. There were no significant changes in children's micronutrients level following the interventions, except in the hemoglobin. In this way, at 10-week follow-up, the mean hemoglobin of children in the educational group reduced significantly (P = 0.041). However, there was no significant difference between the two groups. In general, all caregivers completed the process evaluation checklist, the feedback was largely positive. Conclusions The results of this study demonstrated that both educational and providing food item interventions resulted in a significant reduction in phenylalanine levels. Empowering caregivers of patients, creating and fortifying social networks, providing favorable social supports, and providing access to special food items may be effective in controlling PKU. Clinical trial registration: Iranian Registry of Clinical Trials (IRCT20180506039548N1). Registered 6th Jun 2018, https://www.irct.ir/trial/30977 .

Abstract Background Musculoskeletal pains are among evident health problems in children and adolescents. Backpack carrying behaviors and the sitting postures are among behavioral factors associated with musculoskeletal pain in schoolchildren. Therefore, this study aims to identify the factors related to these important musculoskeletal behaviors, using Health Promotion Models. Methods In this cross-sectional study, a questionnaire was created based on PRECEDE Model and Health Belief Model and was administered to 673 Iranian students, whom were selected randomly from elementary schools of Hamadan, Iran, in 2018. Results The findings of the study revealed that proper sitting postures and backpack carrying were 42 and 33%, respectively. The findings also showed that predisposing factors including perceived susceptibility (p

Aims: Early childhood development is one of the priority areas of social determinants of health. A wide range of factors influence a childchr('39')s development. This study aimed to investigate the factors associated with developmental delay in children under 5 years. Instrument & Methods: This study was a case-control study that conducted from April to August 2019 in Hamadan city. 462 children under 5 years and their mothers participated (231 children that have a developmental delay in the case group and 231 healthy children in the control group). The risk factors assessed were demographic characteristics, mothers’ awareness, and childhood developmental care. The data analysis were performed using Logistic Regression by Stata11 software and a significant level of 5% was considered. Findings: The results showed that there were statistically significant relation between the developmental delay with mothers’ age (OR=1.04, 95%CI:1.00-1.08), history of child hospitalization (OR=2.57, 95%CI:1.63-4.05), tobacco use by parents (OR=2.09, 95%CI:1.20-3.64), and mothers’ awareness (OR=0.44, 95%CI:-0.25-0.82). Conclusion: Mothers with children under 5 years need to be educated on various aspects of development and caregiving behaviors that protect their children from developmental delays, and the Identify these factors can help planners to reduce developmental delays and their effects.

Health workers are at high risk of novel coronavirus (Covid-19) and preventive behaviors play an important role in reducing the incidence and deaths of this infection. Therefore, the aim of the present study was to investigate COVID-19 Preventive Behaviors and its Related Beliefs among Health Workers of Hamadan province using the Extended Parallel Process Model (EPPM). Instruments & Methods: This cross-sectional descriptive study was conducted on 950 health workers in Hamadan, in 2020 who were selected by multistage random sampling method. The data were collected using a questionnaire including demographic information and EPPM constructs. Data were analyzed in STATA 14 using descriptive statistics and Pearson correlation test. Findings: Behaviors of avoiding contact with others and frequent hand washing with soap and water with 97.8% and 95.3%, respectively, had the highest frequency among health personnel. The condition of EPPM constructs was evaluated at a relatively favorable level. Also, 46.0% of health personnel were involved in the risk perception process. Conclusion: It is necessary to improve the level of perceived self-efficacy of employees and also to emphasize the effectiveness of the recommended strategies in the prevention of Covid-19 disease.

Systematic reviews of qualitative research (‘qualitative evidence syntheses’) are increasingly popular and represent a potentially important source of information about people’s views, needs and experiences. Since 2013, Cochrane has published qualitative evidence syntheses, and the Cochrane Effective Practice and Organisation of Care group has been involved in the majority of these reviews. But more guidance is needed on how to prepare these reviews in an environment that is more familiar with reviews of quantitative research. In this paper, we describe and reflect on how Cochrane qualitative evidence syntheses differ from reviews of intervention effectiveness and how these differences have influenced the guidance developed by the EPOC group. In particular, we discuss how it has been important to display to end users, firstly, that qualitative evidence syntheses are carried out with rigour and transparency, and secondly, that these quality standards need to reflect qualitative research traditions. We also discuss lessons that reviews of effectiveness might learn from qualitative research.

A growing number of researchers are preparing systematic reviews of qualitative evidence, often referred to as ‘qualitative evidence syntheses’. Cochrane published its first qualitative evidence synthesis in 2013 and published 27 such syntheses and protocols by August 2020. Most of these syntheses have explored how people experience or value different health conditions, treatments and outcomes. Several have been used by guideline producers and others to identify the topics that matter to people, consider the acceptability and feasibility of different healthcare options and identify implementation considerations, thereby complementing systematic reviews of intervention effectiveness.Guidance on how to conduct and report qualitative evidence syntheses exists. However, methods are evolving, and we still have more to learn about how to translate and integrate existing methodological guidance into practice. Cochrane’s Effective Practice and Organisation of Care (EPOC) ( www.epoc.org ) has been involved in many of Cochrane’s qualitative evidence syntheses through the provision of editorial guidance and support and through co-authorship. In this article, we describe the development of a template and guidance for EPOC’s qualitative evidence syntheses and reflect on this process.

Aims: Incomplete adherence to iron supplementation consumption program is one of the main causes of iron deficiency anemia during pregnancy. The purpose of this study was to investigate the effect of educational intervention on promoting adherence to different aspects of iron supplementation consumption program in pregnant women. Materials & Methods: This semi-experimental study with pretest-posttest design with control group was conducted among 100 pregnant women during 16-20 weeks of pregnancy who referred to two health centers in Asadabad, Hamadan in 2017. The subjects were selected using random sampling method and randomly divided into intervention and control groups (50 people in each group). The training program was presented to the intervention group in the form of text messages along with pictures, self-monitoring and a phone call. Blood parameters were measured by blood tests and other variables were evaluated using a questionnaire. Data were analyzed by SPSS 21 software using Chi-square test, independent t-test and paired t-tests. Findings: Intervention could make a significant difference in the behavior of mothers in both groups regarding iron supplementation consumption with vitamin C sources (p

Abstract Background Neck and shoulder pain is relatively common among children and teenagers and has a negative impact on their physical and psychological health. This study was carried out to assess the prevalence of neck and shoulder pain among elementary school students, and to investigate the relationship between this pain and its risk factors. Methods In this cross-sectional study, 693 elementary school students aged 7 to 12 years from Hamadan city, located in western Iran, were selected through the multistage cluster random sampling method. Data were collected through interviews and questionnaires. For the social and psychological variables, the parent version of the Strengths and Difficulties Questionnaire (SDQ) was used. For assessing each student’s posture, an observational checklist, the Rapid Upper Limbs Assessment (RULA), was used. The data was analyzed using the unadjusted (univariate) and adjusted (multivariate) logistic regression. Results The prevalence of the neck pain was slightly higher than that of shoulder pain. The prevalence reported over a month was 35.8 and 30.9% for neck and shoulder pain, respectively. The logistic regression analyses showed that, very high desk height (odds ratio (OR) =1.96, 95% confidence interval CI: 1.02–3.74), backward seat pan inclination (OR = 2.10, 95% CI: 1.37–3.24), forward seat pan inclination (OR = 3.12, 95% CI:1.46–6.68), difficulty in viewing the board (OR = 2.54, 95% CI: 1.10–5.84), too much homework (OR = 2.59, 95% CI: 1.49–4.51), RULA score at level III (OR = 2.88, 95% CI:1.64–5.05), and RULA score at level IV (OR = 3.12, 95% CI: 1.72–5.63) increased the risk of neck pain independently. On the other hand, sitting on desk and seat (OR = 0.59, 95% CI: 0.39–0.91) and laying position for doing homework (OR = 0.53, 95% CI: 0.34–0.81) reduced the related risk. Very short desk height (OR = 2.41, 95% CI: 1.26–4.61) and too much homework (OR = 1.94, 95% CI: 1.10–3.42) increased the risk of shoulder pain. Conclusion The elementary school students reported a high prevalence of shoulder and neck pain. This study found that improper sitting positions, as well as physical factors such as the school furniture, too much homework, and difficulty in viewing the classroom board, were associated with pain. Proper interventions considering the risk factors assessed in this study, are suggested.

ObjectiveThere is a relationship between pesticide exposure and farmworkers' health. Well-conducted evaluations can provide an insight into how to develop and implement more effective interventions to prevent farmers and farmworkers' exposure to pesticides. This review aimed to summarize the literature on the effectiveness of interventions to promote pesticide safety and reduce pesticide exposure among farmers and farmworkers.MethodsA comprehensive search on PubMed, Embase, ISI Web of Science, Scopus, Science Direct, Agricola, NIOSHTIC, and Agris databases was performed to identify relevant studies published from 2000 to 2019. Randomized controlled trials (RCTs) and quasi-experimental studies assessing the effectiveness of interventions on a variety of outcomes related to pesticide exposure were considered. The searches were restricted to articles written in English. The methodological quality of included reviews was appraised using the Effective Public Health Practice Project quality assessment tool (EPHPP).ResultsThe initial search led to 47912 records, 31 studies of which including nine RCTs and twenty-two quasi-experimental studies met the criteria. The majority of the included studies focused on the educational/ behavioral approach. The studies that applied this approach were effective in improving the participants' knowledge and attitude; however, these interventions were less effective in terms of making changes in participants' behaviors and their risk of exposure to toxic pesticides. Multifaceted interventions were moderately effective in terms of improving farmers' and farmworkers' behaviors and reduction in exposure to toxic pesticides. We did not find any studies that had evaluated the effectiveness of engineering/technological, and legislation/enforcement interventions.ConclusionsAlthough the majority of studies were based on an educational/behavioral approach and did not assess the effect of interventions on objective measures, the results of this review highlight the significant effectiveness of educational programs and some potential key elements of these interventions. These findings may inform policymakers to develop interventions to reduce pesticide exposure among farmers and farmworkers.

Objectives: The theory of planned behavior (TPB) has been used in pregnant women’s choice of delivery method and other health-related behaviors. This study extended TPB to predict the role of social support in pregnant women’s choice of delivery method. Materials and Methods: This prospective cohort study was conducted on pregnant women referred to Fatimah hospital in Hamadan, Iran, from 2015 to 2016. A total of 206 nulliparous pregnant women, who referred to Fatimah hospital, completed a self-report questionnaire including measures of intentions, attitudes, subjective norms, perceived behavioral control and social support. These women were followed up until the end of their pregnancy. Results: On the basis of structural equation modeling, adding social support variable improved the indices of the model slightly, but this variable cannot be regarded as a predictor of behavior. A gap between intention and behavior and other factors together with social factor may be the reason. The perceived behavioral control of the individuals was a signifcantly effective predictor for selecting the type of delivery. Conclusions: Attitude, subjective norms, perceived behavior control, and social support were distinguished as signifcant predictors of the choice of delivery type. Therefore, it seems that designing an intervention with emphasis and focus on making changes in these variables and considering different dimensions of social support can increase people’s intention towards natural delivery by providing facilities in the childbirth environment.

Abstract Background Dental caries among Iranian elementary school children aged 6–12 years continue to rise. To estimate treatment needs and guide health initiatives, current epidemiologic data are required. Such data are currently unavailable for dental health. The purpose of this study was to assess caries experience, dental plaque, and associated factors in elementary school-aged children from Iran. Methods In this cross-sectional study, 988 elementary school children aged 7–12 years were selected by multistage cluster sampling. Dental caries was studied using the WHO criteria, dental plaque was examined according to O’Leary index. Data on parental education and occupation, living district, dental pain within the past year, and tooth brushing habits under parental supervision were collected through interviews based on questionnaire. The data were analyzed with descriptive statistics and logistic and linear regression. Results The mean (SD) age of the elementary school children was 9.64 (1.73) years. The highest dmft was seen in elementary school children aged 7–8 years 6.53 (4.37) and the highest DMFT and dental plaque was in 12 year olds recorded as 1.17 (1.77) and 51.97 (25.86), respectively. The proportion of decayed teeth in 7 years old elementary school based on dmft index was 80.36%, moreover, the proportion in 12 years old elementary school was 40.17% based on the DMFT index. Age, gender, and dental pain within the past year were significantly associated with DMFT and dmft. The odds of developing dental caries (DMFT) was 1.70 times higher in girls than in boys (p

Background Well-informed interventions are needed if school-based health promotion is to be effective. Amongother aims, the Iranian Health Promoting School (IHPS) program that was launched in 2011, has an important aimof promoting dietary behaviors of adolescents. The present study, therefore, aimed to investigate the factors affectingunhealthy snacking of adolescents and provide evidence for a more effective IHPS program. Methods In a cross-sectional study design, 1320 students from 40 schools in Kerman city were selected using aproportional stratified random sampling method. A modified qualitative Food Frequency Questionnaire (FFQ) wasused to gather data about unhealthy snacking behavior. Data about intrapersonal and environmental factors wereobtained using a validated and reliable questionnaire. A mixed-effects negative-binomial regression model was usedto analyze the data. Results Taste and sensory perception (prevalence rate ratio [PRR] = 1.18; 95% CI: 1.09-1.27), being a male (PRR = 1.20;95% CI: 1.05-1.38) and lower nutritional knowledge (PRR = 0.96; 95% CI: 0.91-0.99) were associated with higher weeklyunhealthy snaking. Perceived self-efficacy (PRR = 0.95; 95% CI: 0.91-1.00) negatively influenced the frequency ofunhealthy snaking, with this approaching significance (P< .06). In case of environmental factors, high socio-economicstatus (SES) level (PRR = 1.45; 95% CI: 1.26-1.67), single-parent family (PRR = 1.14; 95% CI: 1.01-1.30), more socialnorms pressure (PRR = 1.08; 95% CI: 1.01-1.17), pocket money allowance (PRR = 1.21; 95% CI: 1.09-1.34), easyaccessibility (PRR = 1.06; 95% CI:1.01-1.11), and less perceived parental control (PRR= 0.96; 95% CI: 0.92-0.99) all hada role in higher consumption of unhealthy snacks. Interestingly, larger school size was associated with less unhealthysnacking (PRR = 0.79; 95% CI: 0.68-0.92). Conclusion Unhealthy snacking behavior is influenced by individual, socio-cultural and physical-environmentalinfluences, namely by factors relating to poor parenting practices, high SES level, family characteristics, improper socialnorms pressure, and less knowledge and self-efficacy of students. This evidence can be used to inform a more evidencebased IHPS program through focusing on supportive strategies at the home, school, and local community levels.

Introduction: Marriage is a social capital in society, so that makes the behavioral and social stability of parents and children in a generation, productive. Various factors can affect the intention of marriage, including individual, economic, social and cultural factors. The present study aimed to determine predictors of university students' intention to marriage based on the theory of planned behavior (TPB). Methods: This cross-sectional study was performed among 192 single students (Master and PhD students with five to seven years of dentistry and medicine) in Hamadan, in 2014. The samples in this study were selected through convenient sampling. The data collection tools were demographic and TPB questionnaires. A questionnaire based on the TPB model was used in order to assess attitude toward behavior, subjective norms, perceived behavioral control, and intention. Data were analyzed by using SPSS16 and descriptive indexes, independent-samples t-test, One-way ANOVA and multivariate linear regression at 95% significant level. Results: The results showed that attitudes toward marriage (β=0.217; p=0.001), subjective norms (β=0.366; p

Background: Childbirth preparation training courses on maternal and neonatal health increase awareness, and capability of pregnant women in overcoming fear and anxiety and managing labor pains. Objective: To identify the affecting factors and barriers of these courses from the perspective of their instructors. Methods: This qualitative study of the content analysis type, has been conducted on 16 certified teachers of the training courses of the Hamadan city in 2015. Data were collected by semi-structured in-depth interviews and were then analyzed by using MAXQDA10 application. Results: Participants' experiences are indicated on three main themes including the objectives of the course, facilitators and barriers. The main objectives of the course were reported as to improve maternal and newborn health, promote natural childbirth and preparedness for parenting and breastfeeding. The main facilitators of the successful implementation include observing educational standards, strengthening the communication and relationship between mothers and staff, mobilization, and the role of instructor. The major barriers are reported as inadequate support from management system, insufficient intra-sector collaboration, poor attitude of obstetricians and physicians, inadequate access, theory-practice gap and not intended to labor naturally. Conclusion: The results of our study show that multiple factors are involved in the participation of pregnant women in antenatal classes. Promoting natural childbirth requires intra-sector and inter-sectoral collaboration, as well as the community participation.

Background & Aim: Unhealthy snacks consumption has an important role in childhood obesity. The aim of this study was to evaluate the effect of an educational intervention for mothers on the consumption of healthy snacks in children aged 1-5 years using social cognitive theory. Methods & Materials: This quasi-experimental study was (IRCT2013062912456N2) conducted on 126 mothers who had children 1-5 years old in 2013. The mothers were selected from Hamadan health centers and divided into two groups of intervention and control. The intervention consisted of four sessions, a booklet, a short video, and 6 written messages. The constructs of SCT and food consumption frequency were assessed at baseline, 10 days after the last session and 2-months after the intervention. The data were analyzed by Chi-square test, independent t-test, repeated measures and covariance analysis using SPSS software version 16. Results: At baseline, the two groups were similar in the demographic characteristics, the constructs of SCT, and unhealthy snacks consumption frequency (P>0.05). Considering that the interaction effects of group and time in the repeated measurement analysis of variance were significant, the means of two groups were compared at each stage using independent t test and significant differences between the two groups were observed at two stages after the intervention. Conclusion: This intervention had a positive effect on the consumption of healthy snacks. Therefore, SCT and the implemented procedure could be used to develop interventions to modify snack consumption patterns in children.

Introduction: Job satisfaction is one of the factors that can affect the health of staff in hospitals. Organisations often cause job dissatisfaction among employees in three mechanisms which include formal structure of organisation, command-andcontrol leadership. Aim: To investigate organisational culture and job satisfaction of specialty hospitals in Hamadan. Materials and Methods: This descriptive analytical study was conducted in two Hamadan specialised hospitals in the west of Iran. The organisational culture and job satisfaction were evaluated using Robins’ Organisational Culture and Minnesota Job Satisfaction Questionnaires. Based on inclusion criteria (lack of significant physical and psychological disorders, at least one year of work experience), 600 staff were entered in this study. Results: The results showed that the organisational culture score was average in both hospitals (131-206) and the mean score of organisational culture in the hospital 1 (175.89±12.35) was higher than that of the hospital 2 (171.86±11.35), but this difference was not statistically significant (p=0.216). In term of job satisfaction, the average score of internal (30.69±7.22), external (29.60±6.80) and overall job satisfaction (60.29±13.61), in hospital 1 was better than the hospital 2 (29.29±7.45, 29.07±7.15, 58.27±14.17 respectively), but for external and overall satisfaction the difference was not statistically significant (p>0.05). Also, job satisfaction was average in two hospitals (48-76). The results showed that, organisational culture has a significant relationship with internal, external and overall job satisfaction (p

Background and Objectives: Marital relationship has been regarded as one of the deepest types of communication. This study was performed to determine the effect of communication skills training on increasing marital satisfaction among couples by applying the social support theory on females referred to health centers in Bahar. Materials and Methods: This experimental study was performed on 100 females, referred to Bahar health centers in Hamadan province, during year 2016. For the sampling purposes, 100 females were randomly selected from health centers of Bahar city. The participants were randomly divided to 2 experimental and control groups (each group included 50 females). Data collection tools consisted of 3 questionnaires, including Enrich marital satisfaction questionnaires, social support questionnaire, and Burton communication skills questionnaire, which were completed through self-reporting by couples. An educational program in 3 sessions and 2 consulting classes were performed only for the intervention group and post-test questionnaires were completed after one month. Data were analyzed by SPSS-16 software using independent t test, paired t test, Fisher Exact test and Analysis of Covariance (ANCOVA). Results: Results showed that the mean scores of communication skills, marital satisfaction, and social support after the intervention were significantly increased in the experimental group compared to the control group (P

Background and Objectives: Oral health behaviors of pregnant women are important due to their effects on mother and child’s health. The objective of this study was to investigate dental care and its related barriers among pregnant women in Hamadan city, Iran. Materials and Methods: This cross-sectional study was carried out on 280 pregnant women in Hamadan city in 2012. We used stratified cluster sampling to select the subjects and a researcher-made questionnaire was used. The questionnaire included demographic information, common dental problems, visit of a dentist during pregnancy and tooth brushing, as well as the perceived barriers of these two behaviors. The reliability and validity of the tool were evaluated using estimates of internal consistency and the opinions of a panel of experts, respectively. Data were analyzed in SPSS-16 using logistic regression test. Results: The mean age of pregnant women was 27.2 ± 4.88 years. Tooth brushing after each meal and use of mouthwash rates were 12% and 20%, respectively. Half of the participants had not seen a dentist during their current pregnancy. The most important barriers to brush twice a day were impatience and lack of energy. Dental visit barriers were cost, low priority, and stress related to dentistry. Factors associated with no dental visit included poor economic status (P= 0.011) and working outside of home (P= 0.045). Conclusions: Given the important adverse outcomes associated with poor oral health on mothers and babies, interventions to reduce the barriers of dental cares are crucial.

Background and Objectives: Low levels of medication adherence in patients with type 2 diabetes is one of the greatest challenges in the treatment and control of diabetes. This study was designed to determine medication adherence and its related factors in patients with type II diabetes. Materials and Methods: In this cross-sectional study, a total of 300patients with type 2diabetes records in the health centers of Tuyserkan city were randomly selected in 2015. Data collection instrument was a self-made questionnaire, which consisted of factors related to the medication adherence. Questionnaires were completed after confirmation of validity and reliability, by interviews. To analyze the data, descriptive and inferential statistics (T-test, AnOVA, Simple and multiple linear regression) were applied, using SPSS software, version 19. Results: Overall, %26.3 of patients were male and %73.7 were female. Also, %65 of patients were illiterate, %24 had some degree of symptoms, and %59.4 had poor medication adherence. There was a significant relationship between age, education, patient care and treatment expenditure, health care team and health system, therapy-related factors and condition-related factors, beliefs about illness, efficacy, and concerns about drugs and medication adherence (P < 0.05). Conclusions: This study showed that medication adherence in patients with diabetes was not suitable and individual, economical and social factors were influential.Therefore, the role of these factors must be considered when designing intervention programs.

OBJECTIVE:Gingivitis and poor oral hygiene status are the most prevalent oral diseases among primary school students. Poor oral hygiene status, gingivitis and socio-demographic determinants have been shown to be associated with periodontal diseases. There is limited information on the gingivitis and oral hygiene status among Iranian children. In the present study, the status of gingivitis, oral hygiene status, and their association with socio-demographic determinants among schoolchildren aged 7-12 years old in Hamadan were investigated. METHODS:In this cross-sectional study, 988 primary school students aged 7-12 years old were selected. The oral hygiene status was measured through Simplified Oral Hygiene Index (OHI-S) and Community Periodontal Index (CPI) was used to evaluate gingival bleeding and calculus. CPI was measured using a standardized protocol to investigate gum bleeding and calculus. The oral hygiene was classified as good, fair or poor based on calculus and debris measurements. Age, gender, educational level, occupation and residence district of parents, dental pain experience in the last year and whether parents supervised their children while brushing were assessed by the questionnaires. The collected data were analyzed using descriptive statistics and logistic regression analysis. RESULTS:The oral hygiene status was good in 644 students (65.20%), fair in 341 (34.50%) and poor in three (0.30%). Moreover, the results of CPI depicted that 639 students (64.07%) had healthy periodontium, 320 (32.40%) had periodontal bleeding and 29 (2.9%) were with calculus. Higher percentage of the boys in the age group of 12 years old had periodontal bleeding and fewer good oral hygiene. The results of CPI and OHI-S scores depicted that more than half of the primary school students had healthy gums and periodontium (64.1%) and good oral hygiene status (65.2%). There were significant statistical associations between age and residence district with calculus measured by the CPI, also between gender, age, residence district, and mother's occupation with the gingival bleeding measured by the CPI. Furthermore, age and mother's occupation were significantly associated with OHI-S index. CONCLUSIONS:In general, the periodontal health status is poorer in students attending suburban schools compared to those in urban schools in Hamadan. Since there are significant associations between gender, school districts and mother's occupation with oral hygiene index among schoolchildren in primary schools, considering them in schools' oral health program design might be useful.

Background and Objectives: While all students are vulnerable to injuries, such vulnerability may even be higher in the deaf and hard-of-hearing students. Therefore, this study evaluated a health belief model-based educational program to prevent school injuries among deaf and hard-of-hearing high school students. Materials and Methods: This quasi-experimental study was conducted on all deaf and hard-of-hearing students who attended two special schools in Hamadan (Iran) during 2014. They were randomly assigned to either the intervention group (n = 23) or the control group (n = 27). Data were collected using a self-report questionnaire containing items on demographic characteristics, constructs of the health belief model, and knowledge and preventive behaviors. In both groups, the questionnaires were filled out through interviews before and two months after the intervention. The intervention included distributing booklets and holding five educational sessions. Data were analyzed with paired t, independent t, chi square, and Fisher’s exact tests in SPSS16. Results: After the educational intervention, the mean scores of knowledge (P=0.002), preventive behaviors (P=0.001), and constructs of the health belief model, i.e. perceived severity (P=0.001), perceived benefits (P=0.001), self-efficacy (P=0.001), and cues to action (P=0.001), were significantly higher in the intervention group than in the control group. Conclusion: According to our findings, an educational intervention based on the health belief model can promote behaviors to prevent school injuries among deaf and hard-of-hearing students.

Background: To investigate the prevalence of antibiotic usage in children aged

Background and Objectives: There has been growing interest in adolescents’ emotional intelligence and strengthening their various skills including effective and efficient communication. Therefore, this study sought to investigate the relationship between emotional intelligence and communication skills of high school students in Hamadan, Iran based on the theory of social support. Materials and Methods: This descriptive-analytical study was conducted in 2014. Multistage sampling was performed to select 497 students from high schools of Hamadan. The subjects completed a questionnaire containing items on communication skills, emotional intelligence, and social support. The collected data were analyzed using Pearson’s correlation test, Spearman’s correlation test, t-test, and analysis of variance in SPSS-18. Results: There was a significant relationship between emotional intelligence and communication skills of the participants. The students had a moderate level of communication skills. In general, girls enjoyed higher levels of communication skills, emotional intelligence, and social support (except appraisal support) compared to boys. Moreover, constructs of social support were significantly related with emotional intelligence and communication skills. Conclusion: According to our findings, educational interventions and training packages for students, parents, and schoolteachers are required to improve the students’ emotional intelligence and communication skills.

Background and Objectives: Despite associating regular breakfast consumption habits with a range of health benefits, the rate of skipping the meal is high. The present study was conducted to determine the factors associated with breakfast consumption among female students of Hamadan University of Medical Sciences based on the Social Cognitive Theory (SCT). Materials and Methods: The present cross-sectional study was carried out on 423 female students in different faculties of Hamadan University of Medical Sciences. Participants were selected through multistage random sampling. The frequency of breakfast consumption and SCT variables, including knowledge, hope, outcome expectancies, observational learning, social support and self-efficacy, was measured using a self-administered questionnaire. Data were analyzed in SPSS-16 using the chi-square test, the correlation test and the linear regression analysis. Results: 24% of the students stated that they always ate breakfast. 10% of the students skipped breakfast. On average, the students ate breakfast 4.2 times a week. Self-efficacy (p

Introduction: Fast-food consumption among Iranian families appears to be increasing probably due to urbanization, popularization of western-style diets and increased women's labor force participation. Few theory-based investigations have assessed the determinants of fast food consumption. Therefore, the aim of this study was to determine the predictors of fast food consumption, based on the social cognitive theory (SCT) among women referred to health centers in Hamadan, West of Iran. Materials and Methods: This cross-sectional study was conducted using structured self-administered questionnaires on 384 women referred to 10 health centers in Hamadan city, Western of Iran. Health center was considered as a sampling unit and systematic random sampling method was applied to select health centers. Participants filled a questionnaire containing SCT constructs, an eight-item food frequency questionnaire, and demographic characteristics. Data was analyzed by independent T-test, one-way ANOVA, and multiple linear regression using SPSS-16. Results: The model could explain 21% of the variance in frequency of fast food consumption. Outcome expectations (p=0.04) and availability (p< 0.001) were the significant predictors. The career status of women was the only related demographic characteristic (p< 0.001). Conclusion: Interventions aimed to change outcome expectations and introducing nutritious alternatives to fast food could be promising to decrease the rate of fast-food consumption.

Background: There is an international emphasis on providing timely and high quality data to monitor progress of countries toward Millennium Development Goals. Iran′s Multiple Indicator Demographic and Health Survey (IrMIDHS) aimed to provide valid information on population and health outcomes to monitor progress in achieving national priorities and health programs and to assist policy makers to design effective strategies for improving health outcomes and equity in access to care. Methods: A cross-sectional multi-stage stratified cluster-random survey is conducted through face-to-face household interviews. The sampling frame is developed using Iran′s 2006 population and housing census. Provincial samples ranging are from a minimum of 400 households per province to 6400 households in Tehran province. Cluster size is 10 households. The target sample includes 3096 clusters: 2187 clusters in urban and 909 clusters in rural areas. IrMIDHS instruments include three questionnaires: Household questionnaire, women aged 15-54 questionnaire, children under five questionnaire, supervision and quality assessment checklists and data collection sheets and standard weight and height measurement tools for under-five children. A cascading decentralized training method is used for training data collection and supervision teams. Quality assurance procedures are defined for the five steps of conducting the survey including: Sampling, training data collection and training teams, survey implementation, data entry and analysis. A multi-layer supervision and monitoring procedure is established. All the questionnaires are double entered. Conclusions: IrMIDHS will provide valuable data for policymakers in Iran. Designing and implementation of the study involve contributions from academics as well as program managers and policy makers. The collaborative nature of the study may facilitate better usage of its results.

Background: Providing a variety of foods has been emphasized as one of the most important features of optimal complementary feeding. This study investigated key beliefs that guide mothers' intention to adherence to dietary diversity in their 1–2-year-old children's complementary feeding. Methods: This was a cross-sectional study involving 290 mothers (mean age = 27, standard deviation = 5.32) with child 1–2-year-old attending maternal and child health section of health centers in Rasht, Iran. To represent the socioeconomic status of the participants, 6 centers out of 15 were selected from three different socioeconomic areas (low-, middle-, and high-income areas). Mothers completed a questionnaire assessing intention and belief-based items of theory of planned behavior. Correlations and multiple regression analyses were performed. Results: The mean age of mothers was 27 ± 5.33 (27–43 years). Regression analyses revealed that among behavioral beliefs, the perception that adherence to dietary diversity would lead to improve children's growth was the significant predictor of intention (β = 0.13,P= 0.04). Regarding normative beliefs, perceived social pressure from health-care professionals to adherence to dietary diversity significantly predicted intention (β = 0.15,P= 0.01). Among control beliefs, the perception that daily pressures made difficult adherence to dietary diversity was the key determinant (β = 0.19,P= 0.01). Conclusions: Findings of this study represent the important beliefs that can be addressed in development planning aimed at modifying mothers' child complementary feeding practices.