bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementing a decade of strengthening the health workforce in the WHO South-East Asia Region
Authors: Zapata Tomas , Zakoji Masahiro , Kanda Mikiko , Travis Phyllida , Tangcharoensathien Viroj , Buchan James , Jhalani Manoj 
Published: February 2021

Background
Health workers are the cornerstone of primary health care (PHC) services, the delivery of an effective coronavirus disease 2019 (COVID-19) response and progress towards universal health coverage (UHC). In 2014, the World Health Organization (WHO) South-East Asia Region committed to the Decade for Health Workforce Strengthening 2015–2024, and UHC became a regional flagship with a focus on strengthening the health workforce. Since its inception, three rounds of monitoring with standardized indicators have been completed.

Methods
In 2019, data on human resources for health were collected through the National Health Workforce Accounts online platform by the country focal points; this was complemented by a regional online consultation in June 2020. A mid-term review report on the Decade for Health Workforce Strengthening was launched during the 73rd session of the Regional Committee in September 2020.

Results
The availability of doctors, nurses and midwives in the South-East Asia Region has increased by 21% since the decade began in 2014. Nine countries of the region are now above the 2006 WHO threshold of 22.8 doctors, nurses and midwives per 10 000 population, compared with only six countries in 2014. However, only two countries are above the 2016 revised WHO threshold of 44.5 doctors, nurses and midwives per 10 000 population, the density estimated to be needed to achieve the Sustainable Development Goals. Countries of the WHO South-East Asia Region have made progress to different extents during the past 5 years on strengthening governance of human resources for health, data, rural retention and health professional education.

Discussion
Addressing broader health workforce challenges and particularly PHC workforce challenges will require extra commitment and prioritization by governments for the second half of the decade. COVID-19 presents the necessity and an opportunity to increase long-term investment in the health workforce and in strengthening PHC in the South-East Asia Region.
Quantitative and Qualitative Assessment of Waste Produced in Sari Hospitals
Authors: Ebrahimi Mohammad Taha , Jafarpour Ali , Kamgoo Somayeh , Aghamiri Shahin , Kazemi Amir Bahador , Vahidi-Kolur Robabeh , Danaei Nima 
Published: February 2021

Aims:
The Iranian city of Sari with a green nature has great environmental importance, especially in ecotourism. Thus, the proper management of medical wastes is necessary to maintain a sustainable environment. This study is aimed to determine the quantitative and qualitative wastes in the hospitals of Sari.

Materials and Methods:
This was a cross-sectional study using a descriptive-analytical approach to analyze the infectious and noninfectious wastes of four hospitals in Sari. The data collection instrument was a checklist that was completed on visits to hospitals and observation of cases. Data analysis was performed using Excel and R software programs.

Results:
The average quantity of the total waste produced in hospitals was 218, 482, 19.5, and 17 kg/day for infectious, household, sharp-cutter, and pharmaceutical wastes, respectively. The rate of hospital waste production for various types of infectious, household, sharp-cutter, and pharmaceutical wastes equaled 1.15, 2.13, 0.09, and 0.28 kg/bed, respectively.

Conclusion:
Due to the high percentage of infectious wastes, despite considerable efforts to separate wastes, there are still problems in the hospitals that require more attention from the authorities, as well as the incorporation of new methods to render waste safe before it leaves the hospital.
E-professionalism in medical sciences
Authors: Mosalanejad Leili , Tafvisi Mansoor , Zarifsanaiey Nahid 
Published: February 2021

BACKGROUND:
Professionalism is one of the most important and vital concepts in the medical sciences. With the rapid growth of e-learning in the medical sciences in the past few years, the concept of virtual professionalism has emerged. This study was conducted as a hybrid concept analysis on describing e-professionalism in medical sciences.

MATERIALS AND METHODS:
This is a qualitative study with a hybrid concept analysis approach, consisting of theoretical stage, field research, and analysis. In the theoretical stage, the concepts of e-professionalism in medical sciences were identified through a review of the literature. During the fieldwork stage, in-depth interviews were conducted with five medical students who were intentionally selected. Finally, after analyzing the literature and the qualitative interviews, a theoretical description of e-professionalism concept in the field of medical sciences was extracted.

RESULTS:
the themes (3 numbers) and the subthemes (4 numbers) were extracted from 62 codes. These themes include information and communion technology and educational strategies professionalism in medical education.

CONCLUSIONS:
For describing professionalism, it is necessary to consider education and culture, role models, by emphasizing on the acceptance of professional responsibility, developing and improving social media policies, determining the scope of communication and interaction between individuals, and identifying the boundary between local laws and customs.
The relationship between physical performance and quality of life and the level of physical activity among the elderly
Authors: Prasad Lekshmi , Fredrick Jean , Aruna R 
Published: February 2021

BACKGROUND:
Loss of physical function during the process of aging might affect the quality of life. Physical function assessment tests predicts outcomes such as falls, institutionalization, and death. Studies assessing the association of physical function with quality of life and physical activity level of elderly population in India is scarce. Hence we aimed to assess the physical function of community dwelling older adults and to determine its association with physical activity levels and quality of life.

MATERIALS AND METHODS:
This was a cross-sectional analytical study. 89 community dwelling older adults between 60 and 80 years of age were recruited. Physical function was assessed by standing balance, walking speed, and grip strength. Quality of life was assessed by WHO QOL BREF questionnaire and physical activity level was assessed by International Physical activity Questionnaire.

RESULTS:
Standing balance was reduced in 24% and walking speed was decreased in 33% of the participants. Males had higher walking speed, and grip strength. Quality of life was better among males. Standing balance, walking speed and grip strength was significantly higher in moderate – heavy activity levels. There was positive correlation between physical function and quality of life. There was also positive correlation between physical activity level and quality of life.

CONCLUSION:
Physical function, quality of life and physical activity level were decreased. Males had better physical function and quality of life. Physically active individuals had better physical function and quality of life. Early detection of decreased physical function and increase in physical activity level could result in better quality of life among elderly.
Health and environmental practices levels among female students of scientific and humanities academic majors
Authors: El Senousy Hala , ALsharoa Ayat 
Published: February 2021

BACKGROUND:
Courses’ resources is an important ingredient for building awareness, despite the availability of health and environmental knowledge in some subjects, students’ practices still need more improvement. The study aims to investigate the level of health and environmental practices among university female students of both scientific and humanities subject majors, and its relationship to the academic major.

MATERIALS AND METHODS:
A descriptive research design is applied to a sample of 410 female students enrolled in scientific and humanities majors during 2017/2018 academic year. A “Health and Environmental Practices Scale” is prepared for data collection. It includes 58 items with Cronbach's alpha = 0.71 and 0.69 for the two domains. The means percentage and independent t-test for the two majors applied, as P ≤ 0.05 was statistically significant.

RESULTS:
Results showed that (i) the level of health and environmental practices is “moderate” with a mean of 2.89, 3.17 for both domains, respectively; (ii) there is no statistically significant difference between health practices level and environmental practices level; (iii) there is no statistically significant difference between humanities and scientific majors and health and environmental practices level among students of humanities and scientific majors, which means that the impact of the interdisciplinary courses on the level of health and environmental practices is not clear.

CONCLUSIONS:
Health and environmental awareness among students are found to be moderate. However, actual health and environmental practices are still a huge challenge because of the gap between theory and practice.
Development and validation of a questionnaire for professionalism in cyber users in medical sciences in Iran
Authors: Mosalanejad Leili , Abdollahifard Saeed 
Published: February 2021

BACKGROUND:
Considering the importance of virtual professionalism and professional ethics in medical sciences, and the necessity to pay attention to this issue and its impact on medical professionalism, this study aimed to build a professional culture questionnaire in a virtual environment for students of medical sciences in Iran.

MATERIALS AND METHODS:
This is an exploratory, sequential, mixed-methods research which was conducted in three sections. In the first section, the concept of e-professionalism in medical sciences was analyzed using the hybrid concept analysis in the theoretical work, field work, and final analysis stages in order to extract information related to the concept. In the second section, an item of the questionnaire was designed based on the concept, reviewed texts, and related questionnaires, in the third section, psychometric properties of a questionnaires were evaluated.

RESULTS:
Totally, 39 items were included in the initial pool, which reduced to 33 items in the final questionnaire after reviewing the psychometric properties. Factor analyses led to extraction of five factors including appraisal of e-professionalism compliance with the laws and regulations governing cyberspace, individual professionalism, knowledge management, respect for professionalism in interpersonal and group rules, and complying with ethics in the use of cyberspace. The internal consistency of questionnaire was also confirmed by Cronbach's alpha coefficient of 0.78, also all factor correlations absed stability were significant (P < 0.05).

CONCLUSION:
An exploratory sequential study in this study led to the extraction of five factors and development of a 33-item questionnaire in e-professionalism. As results and analysis of the psychometric properties and validation of each item, this questionnaire is valid and reliable for the assessment of levels of e-professionalism in medical sciences in Iran.
The effect of educational intervention based on theory of planned behavior on the improvement of colorectal cancer screening intention among average-risk individuals referring to Asadabad city clinics
Authors: Maheri Mina , Darabi Fatemeh , Khalili Saeede , Hesari Marziyeh 
Published: February 2021

BACKGROUND:
Colorectal cancer (CRC) is the third most common cancer in men and the fourth most common cancer in women in Iran. Therefore, the aim of this study was to determine the effect of educational intervention based on the theory of planned behavior (TPB) on the improvement of CRC screening intention among average-risk individuals.

MATERIALS AND METHODS:
This quasi-experimental study was performed on the 50–69-year-old individuals referred to Asadabad city clinics in 2020. The individuals were randomly assigned to multistage cluster sampling in each intervention and control group. The instrument used in this research was a researcher-made questionnaire based on TPB. Educational intervention was conducted for the intervention group, one of their family members, and staff of clinic under intervention. Finally, the data were entered into SPSS and analyzed utilizing descriptive and analytical statistics. Results were considered significantly <0.05.

RESULTS:
There were no significant differences between two intervention and control groups in the preintervention phase in terms of the mean scores of attitude (P = 0.58), subjective norms (P = 0.59), and behavioral intention (P = 0.66). However, in the postintervention phase, these differences were significant. Furthermore, regarding the mean score of perceived behavioral control, there was a significant difference between the two groups in the preintervention phase (P < 0.02), while in the postintervention phase, this difference was not significant (P = 0.29).

CONCLUSION:
Educational intervention based on the TPB has been effective in improving the CRC screening intention among average-risk individuals. Therefore, using the results of this research and developing appropriate educational programs at the community level can be increased the participation of community members in CRC screening programs.
Application of health belief model to predict COVID-19-preventive behaviors among a sample of Iranian adult population
Authors: Mirzaei Amin , Kazembeigi Farogh , Kakaei Hojatollah , Jalilian Mohsen , Mazloomi Sajad , Nourmoradi Heshmatollah 
Published: February 2021

BACKGROUND:
The novel coronavirus (COVID-19) has infected nearly 9.5 million people in 216 countries, areas, or territories in the world. The fight against the COVID-19 has become a very serious international challenge. The aim of this study was to determine the predictors of COVID-19-preventive behaviors using the health belief model (HBM).

MATERIALS AND METHODS:
This cross-sectional study was conducted with the participation of 558 samples from the adult population of Iran. The online convenience sampling was conducted in this research. The online 68-item questionnaire link was published all over Iran through social networks including Telegram and WhatsApp, which are common in Iran. The data were analyzed using SPSS software version 19. Descriptive statistics, bivariate Pearson's correlation test, and multiple linear regression were used to analyze the data.

RESULTS:
The mean age of the subjects was 33.3 ± 10.01 years. The participants were often female (61.3%), married (57.9%), and resident of the city (81.0%) with university educational level (78.8%). The results showed that the HBM structures predicted 29.3% of the preventive behaviors of COVID-19 in the subjects. The perceived benefits, perceived barriers, and self-efficacy significantly predicted the preventive behaviors, but the perceived susceptibility and perceived severity were not significant in the regression model. The internet and virtual social networks (49.8%), broadcast (33.5%), and healthcare providers (15.8%) were the most important sources of information related with COVID-19. In response to COVID-19-related internal cues to action, 36.6% did not pay attention and 34.7% tried to self-medicate. Only 28.5% of the subjects referred to the hospital, healthcare center, or physician.

CONCLUSION:
Self-efficacy, perceived barriers, and perceived benefits were the key determinants of COVID-19-preventive behaviors in the subjects. It can be concluded that the HBM is a good tool to predict COVID-19-preventive behaviors in Iranian population.
Effect of classmate as peer-led education on clinical performance
Authors: Mehdipour-Rabori Roghayeh , Nematollahi Monirsadat , Bagherian Behnaz 
Published: February 2021

BACKGROUND:
Achieving an excellent clinical education by nursing students is one of the primary goals of any nursing school. Nursing educators try to use different methods to enhance clinical skills. One of them is a peer-led method that can be used in theoretical and clinical education. It is developing as a suitable educational method to promote health. This study assessed the effect of classmates as peer-led education on the clinical performance of nursing students.

MATERIALS AND METHODS:
This study was conducted using a mixed-method approach and a sequential explanatory design. In the quantitative phase, a quasi-experimental study with a two-group pre- and post-test design was conducted. The sample of this phase consisted of 70 nursing students (35 persons in each group) who were selected through random convenience sampling. The intervention group participated in a peer-led education program. The control group received routine training. The members of both groups completed the clinical performance checklist before, and after the intervention, The collected data were analyzed using SPSS V21 software using descriptive and inferential statistics. In the qualitative phase, the researchers interviewed 18 undergraduate students using semi-structured in-depth and face-to-face approaches. These participants were selected by purposive sampling method. Data were analyzed using conventional content analysis. MAX DATA 10 was used to categorize the data. To establish the reliability and validity of findings, Graneheim, and Landman's criteria were considered

RESULTS:
In the quantitative phase of the study, the results showed that the mean score of clinical performance was not statistically significant between the control and intervention groups before the intervention (P > 0.05). At the same time, it was significantly different after the intervention (P < 0.05), implying that the peer-led education of the intervention group significantly increased compared to that of the control. The main theme was “learning based on friendship,” which included two categories, namely “deep learning” and “learn in the shadow of relaxing.”

CONCLUSION:
Classmate as peer-led education could increase the ability of nursing students in clinical performance, and was able to enhance deep learning among them.
Exploring medical ethics’ implementation challenges
Authors: Mashayekhi Jannat , Mafinejad Mahboobeh Khabaz , Changiz Tahereh , Moosapour Hamideh , Salari Pooneh , Nedjat Saharnaz , Larijani Bagher 
Published: February 2021

BACKGROUND:
Adherence to medical ethics principles by medical professionals is required to improve health-care system's quality. Recognizing medical ethics' challenges and attempting to resolve them are important in the implementation of medical ethics in practice. This study aimed to explore such challenges at Iran's medical sciences universities in 2018.

MATERIALS AND METHODS:
This descriptive, qualitative study utilized a conventional content analysis approach for data analysis. This study was conducted using purposeful sampling from participants with experience in teaching or practicing of medical ethics field, and by considering maximum variety of disciplines (e.g., gynecology, internal medicine, surgery, and medical ethics). The data were gathered using semi-structured interviews. The interview guide was designed based on previous research findings by two members of the research team and contained the main interview questions and participants had the opportunity to express their perspectives in detail. Participants were chosen from clinical and ethical faculty members as well as managers. The data collection process continued until the data saturation stage, beyond which no new information or concept achieved by continuing interviews.

RESULTS:
After interviewing 14 faculty members and managers, findings were classified into 4 themes, 9 categories, and 42 sub-categories; four main categories of medical ethics challenges are affected by cognitive, educational, practical, and structural factors, respectively.

CONCLUSION:
This study suggested that medical ethics' cognitive and educational challenges can alleviate using educational programs intended for improving qualitative and quantitative aspects of medical ethics teaching for medical professionals ranging from students to faculty members. Medical ethics' structural and practical challenges are within policymaking and scheduling activities dealt with through future researches by health-care system's managers and planners.
The prevalence of obsessive–compulsive disorder in patients with irritable bowel syndrome
Authors: Davarinejad Omran , RostamiParsa Fatemeh , Radmehr Farnaz , Farnia Vahid , Alikhani Mostafa 
Published: February 2021

BACKGROUND:
Irritable bowel syndrome (IBS) is one of the most common gastrointestinal diseases, and obsessive–compulsive disorder (OCD) is one of the main causes of this disease. The present study was aimed to investigate the prevalence of OCD in patients with IBS.

MATERIALS AND METHODS:
The present research is a cross-sectional survey study. The research sample included 120 patients with IBS who referred to Imam Reza Hospital and gastrointestinal clinics in Kermanshah (Iran) in the 3 months of April, May, July in 2019 that were selected using the census sampling method, and demographic information, clinical and medical records were collected. Data analysis was performed using frequency, percentage, and Chi-square.

RESULTS:
Among the patients who were studied, 58 of them (48.3%) were women and 62 (51.7%) were men, the results showed that the prevalence of OCD in patients with IBS was 14.96 and the symptoms of washing, checking, skepticism and slowness-repetition had the highest prevalence, respectively. These symptoms were more common in women than in men. There was also a significant relation between OCD prevalence in patients with IBS and with female gender, age-range 30–21 years, single, and history of OCD in the patient's immediate family and close relatives (P < 0.05), but there was no significant relationship between OCD prevalence in patients with IBS and level of education, occupation, income status, and place of residence

CONCLUSION:
Due to the high prevalence of OCD in patients with IBS, the interaction of gastroenterologists and psychiatrists to treat irritable bowel syndrome is very important.
The experiences of families raising autistic children
Authors: Faraji-Khiavi Farzad , Zahiri Mansour , Amiri Elham , Dindamal Behnaz , Pirani Narges 
Published: February 2021

BACKGROUND:
Conditions and needs of autistic children have impacts on both the children and the family members who have crucial roles in raising the child. The prevalence of autism is increasing, and this fact makes it necessary to focus more on experiences of parents who have children with autism spectrum disorder (ASD). Hence, this study aimed to reflect the experiences of parents who have autistic children.

MATERIALS AND METHODS:
The present study was a qualitative research with phenomenology approach which was conducted using content analysis approach. Participants were 14 parents with ASD children in Ahvaz, and they were included based on purposive sampling method. To gather the required data, semi-structured interviews were formed. Data analysis was performed by Colaizzi's seven-step method.

RESULTS:
Fifty-four conceptual codes were extracted from interviews of ASD children parents. Parents of these children had two main experiences: first family related and second education and treatment problems. Family problems included three categories (financial, psychological, and family relationships). Education and treatment was categorized into three (schooling, transporting, and quality in facilities).

CONCLUSIONS:
Problems mentioned by parents of autistic children highlight the need for providing training and counseling services as well as emotional supports from both society and government. Planning and implementing supportive plans empower parents to strategically face problems and eventually improve their life quality and mutual understanding.