The Global, Regional, and National Burden of Adult Lip, Oral, and Pharyngeal Cancer in 204 Countries and Territories: A Systematic Analysis for the Global Burden of Disease Study 2019.

Importance: Lip, oral, and pharyngeal cancers are important contributors to cancer burden worldwide, and a comprehensive evaluation of their burden globally, regionally, and nationally is crucial for effective policy planning. Objective: To analyze the total and risk-attributable burden of lip and oral cavity cancer (LOC) and other pharyngeal cancer (OPC) for 204 countries and territories and by Socio-demographic Index (SDI) using 2019 Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study estimates. Evidence Review: The incidence, mortality, and disability-adjusted life years (DALYs) due to LOC and OPC from 1990 to 2019 were estimated using GBD 2019 methods. The GBD 2019 comparative risk assessment framework was used to estimate the proportion of deaths and DALYs for LOC and OPC attributable to smoking, tobacco, and alcohol consumption in 2019. Findings: In 2019, 370 000 (95% uncertainty interval [UI], 338 000-401 000) cases and 199 000 (95% UI, 181 000-217 000) deaths for LOC and 167 000 (95% UI, 153 000-180 000) cases and 114 000 (95% UI, 103 000-126 000) deaths for OPC were estimated to occur globally, contributing 5.5 million (95% UI, 5.0-6.0 million) and 3.2 million (95% UI, 2.9-3.6 million) DALYs, respectively. From 1990 to 2019, low-middle and low SDI regions consistently showed the highest age-standardized mortality rates due to LOC and OPC, while the high SDI strata exhibited age-standardized incidence rates decreasing for LOC and increasing for OPC. Globally in 2019, smoking had the greatest contribution to risk-attributable OPC deaths for both sexes (55.8% [95% UI, 49.2%-62.0%] of all OPC deaths in male individuals and 17.4% [95% UI, 13.8%-21.2%] of all OPC deaths in female individuals). Smoking and alcohol both contributed to substantial LOC deaths globally among male individuals (42.3% [95% UI, 35.2%-48.6%] and 40.2% [95% UI, 33.3%-46.8%] of all risk-attributable cancer deaths, respectively), while chewing tobacco contributed to the greatest attributable LOC deaths among female individuals (27.6% [95% UI, 21.5%-33.8%]), driven by high risk-attributable burden in South and Southeast Asia. Conclusions and Relevance: In this systematic analysis, disparities in LOC and OPC burden existed across the SDI spectrum, and a considerable percentage of burden was attributable to tobacco and alcohol use. These estimates can contribute to an understanding of the distribution and disparities in LOC and OPC burden globally and support cancer control planning efforts.

Elucidating experiences of faculty members in applying effective teaching strategies in the online class during the COVID-19: A qualitative study.

BACKGROUND: Despite the restrictions on providing medical courses online in medical universities, all instructors were required to provide training on virtual platforms. This study aimed to explain faculty members' experiences applying effective strategies in online class teaching. MATERIALS AND METHODS: This study has been done with a qualitative approach and using the method of conventional content analysis. Participants included 14 faculty members working at the Shiraz University of Medical Sciences. Semistructured interviews were used to collect data. Faculty members who had experience in conducting online classes were purposefully selected. Graneheim and Lundman's (2004) approach was used to analyze interview data. RESULTS: Two main categories were obtained from the data analysis: interpersonal communication and supportive behavior. The category of interpersonal communications comprises the subcategories of emotional expression and flexibility. The category of supportive behavior includes the subcategories of educational design, learner encouragement, diversity in evaluation, collaborative learning, and prompt feedback. CONCLUSION: Our findings confirmed that an appropriate teaching strategy leads to better attention to class and deep learning in learners. The cause is that in online classes, the student's attention is more minor than in daily classes due to its virtual nature. Appropriate educational strategies will motivate learners, interest them, and improve teacher interaction. These strategies increase students' participation in educational activities.

Perceived Challenges Caused by Covid-19 Outbreak in Students of Medical Sciences.

Background: Students of medical sciences are a highly vulnerable group during COVID-19 pandemic who may experience a wide range of challenges and stresses. The aim of this study was to investigate the perceived challenges caused by COVID-19 outbreak in students of medical sciences. Materials and Methods: A qualitative study was carried out based on conventional qualitative content analysis following Graneheim and Lundman from December 2020 to February 2021. The participants were 17 students of medical sciences and data gathering was done through semistructured interviews. Results: Data analyses revealed 5 categories and 12 subcategories. The extracted categories were perceived fear of contracting coronavirus, social limitation, changes in education, neglecting health protocols, and worrying news and information overload. Conclusions: The findings indicated that students of medical sciences had been facing challenges and the COVID-19 had affected the psychological, social, and academic functioning of the health-care students. It is important to take measures to improve their mental health. These measures can prevent medical complications in these students, especially during clinical internship.

The predictive role of tendency toward mobile learning and emotional intelligence in Internet addiction in healthcare professional students.

Introduction: Internet addiction is a psychological disorder that can lead to serious damages to university students as a group at risk. This study aimed to determine the predictive role of tendency toward mobile learning (purposeful use of mobile technologies for educational purposes) and emotional intelligence in Internet addiction in healthcare professional students. Methods: A cross-sectional descriptive study was carried out on 403 healthcare professional students at Saveh University of Medical Sciences-Iran in 2021 using convenience sampling method. For data gathering, three questionnaires were used: willingness to use mobile learning, Young's Internet Addiction Test, and the Emotional Intelligence Appraisal. Data analyses were done using Pearson Correlation Coefficient and Hierarchical Regression in SPSS 16 (Inc SPSS USA, IL, Chicago). Results: The mean age of the participants was 21.09±1.47 years; 125 subjects (31.01%) were boys and 278 (68.99%) girls. As the findings showed, 16.87% of the students had Internet addiction and 33% were on the edge of developing Internet addiction. Internet addiction was significantly negatively correlated with willingness to m-learning (r=-0.45, P=0.001) and emotional intelligence (r=-0.32, P=0.01). In addition, regression analysis results showed that the variables willingness to use learning and emotional intelligence explained 23% of the Internet addiction variance (P<0.001). Conclusion: In the present study, a considerable number of the healthcare professional students had excessive and unnecessary use of the Internet. Emotional intelligence and willingness to use mobile learning had an inverse relationship with Internet addiction. There is a need to screen Internet-addicted students using proper screening tools and take primary preventive measures in this regard. In addition, proper measures are needed to be taken to improve emotional intelligence and mobile learning skills and control Internet addiction to some extent.

Development and psychometric properties of COVID-19 related Healthcare Student stress scale (CHSSS).

BACKGROUND: There is no valid and reliable tool to measure COVID-19 healthcare stress felt by healthcare students. A scale was developed to assess COVID-19 stress in healthcare students and its psychometrics was examined. METHODS: This is a two phases mixed-method study including a qualitative stage consisting of student interview and literature review to develop content of the tool. In the quantitative stage, the psychometrics of the scale was examined in 2020-2021. RESULTS: The COVID-19 related healthcare student stress scale (CHSSS) featured five factors including fear of catching coronavirus, social constraints, changes in education, non-compliance of health protocols and worrying news and overload information, which totally explained 51.75% of the total variance. CONCLUSION: Validity and reliability of CHSSS with 17 items were supported to measure COVID-19 stress in healthcare students as a self-assessment tool. Researchers can utilize this tool to assess COVID-19 stress in healthcare students and introduce policies and intervention especially designed for healthcare students.

The relationship between the willingness to mobile learning and educational achievements in health-care professional students.

BACKGROUND: The relationship between willingness to mobile learning (m-learning) and educational achievement was examined in health-care professional students. MATERIALS AND METHODS: This is a descriptive correlative study that was conducted from January 2020 to February 2020. A total of 295 students in Saveh University of Medical Sciences in Iran were selected through census method. The data were collected using the standard willingness to m-learning questionnaire. The data collected were analyzed statistically using Pearson's correlation coefficient and concurrent regression analysis. RESULTS: The mean score of willingness to m-learning was 165.55 ± 13.4, which is an indicative of a higher willingness level in the health-care professional students for m-learning. There was a positive and significant relationship between willingness for m-learning and educational achievement (r = 0.77, P < 0.01). The predictive variable, i.e., willingness to m-learning, predicted 53.8% of the variance of educational achievement (F = 58.801, P = 0.00). Among the variables of willingness to m-learning, the regression coefficients of perceived ease, attitude, self-management in learning, educational use, and efficiency of m-learning were significant (P < 0.05). This means that these variables are direct predictors of educational achievement. CONCLUSIONS: Willingness to m-learning had a positive and significant relationship with educational achievement. Although this study was performed just before the corona outbreak, paying attention to the results of this study can be helpful for students, faculty members, and policymakers in filling the educational gap during the coronavirus disease 2019 outbreak.

The effects of combination of Zingiber officinale and Echinacea on alleviation of clinical symptoms and hospitalization rate of suspected COVID-19 outpatients: a randomized controlled trial.

OBJECTIVES: Herbal medicines, as a treatment method, have received a great deal of attention. The effects of two herbal medicines namely Zingiber officinale and Echinacea on alleviation of clinical symptoms and hospitalization rate of suspected COVID-19 outpatients were examined. METHODS: A clinical trial with 100 suspected COVID-19 outpatients as participants was conducted. The participants were allocated randomly to two groups of 50 members. The intervention group received concurrent Zingiber officinale (Tablet Vomigone 500 mg II tds) and Echinacea (Tablet Rucoldup I tds) for seven days in addition to the standard treatment. The control group only received the standard treatment (Hydroxychloroquine). After seven days, alleviation of clinical symptoms and hospitalization rate were examined. In addition, 14 days after treatment, the hospitalization was assessed again by telephone follow up. RESULTS: The two groups were identical in terms of basic characteristics. Improvement level as to coughing, dyspnea, and muscle pain was higher in the intervention group (p value <0.05). There was no significant difference between the two groups in terms of the other symptoms. In addition, the hospitalization rate in the intervention and control groups were 2 and 6% respectively, which are not significantly different (p value >0.05). CONCLUSIONS: Taking into account the efficiency and trivial side-effects of Zingiber officinale and Echinacea, using them for alleviation and control of the clinical symptoms in COVID-19 outpatients is recommended.

A comparison of learning styles of undergraduate health-care professional students at the beginning, middle, and end of the educational course over a 4-year study period (2015-2018).

BACKGROUND AND AIM: There is a growing interest in learning styles of undergraduate health-care professional students; however, the evidences about learning styles over time during undergraduate programs are rare. In this study, the learning styles of undergraduate health-care professional students from the beginning to the completion of the program were examined to determine changes in learning style over time. METHODOLOGY: This is a longitudinal descriptive study from 2015 to 2018. A total of 101 health-care professional students were selected by census method. Learning styles were evaluated using the Perceptual Learning-Style Preference Questionnaire three times in the study at the beginning (T1), the middle (T2), and the end of the educational course (T3). The data were analyzed using repeated measures ANOVA. RESULTS: In T1, auditory (mean = 13.99) and visual (mean = 13.54) styles were preferred as major learning styles, whereas at T2, visual style (mean = 13.6) was the only preferred major learning style. At T3, the major learning styles were kinesthetic (mean = 14.32), tactile (mean = 13.98), and visual (mean = 13.58). There were statistically significant differences in auditory, kinesthetic, tactile and group scale scores between the three time points (P < 0.05). Group learning style was in the negative type at all three time points. CONCLUSIONS: Learning styles can change depending on the context, environment, teaching method, and the subject of learning material and are probably a flexible changing feature rather than a fixed inherent feature a student possesses.

Design and psychometric properties of willingness to mobile learning scale for medical sciences students: A mixed-methods study.

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

Lived experiences of nursing students about ethical concerns regarding mobile learning in educational and clinical contexts.

The field of education has experienced a profound change following the introduction of mobile technology over the last decades, and nursing education is not an exception. This study explored the experiences of nursing students about the ethical concerns regarding the use of mobile devices for learning purposes, that is, mobile learning, in educational and clinical contexts. A qualitative phenomenological study was carried out on nursing students (n = 19) in Saveh University of Medical Sciences of Iran between December 2017 and April 2018. Data were collected through semi-structured interviews with open-ended questions. Data analysis was done using Colaizzi's 7-step method, revealing four themes and nine sub-themes including: 1) preserving professional dignity (in front of the patient, and the teacher, and preserving academic virtual identity); 2) securing informed consent and respecting personal (the patient's and teachers) autonomy; 3) proper and efficient use (observing the regulations and codes, and making educational use); and 4) avoiding harm (responsible use of class and patient data). It was revealed that using mobile technology in education could raise ethical concerns for nursing students, and this should be emphasized in nursing educational programs.

Psychometric parameters of the Persian version of the BriefCOPE among wives of patients under hemodialysis.

Background: The Brief COPE is widely validated and popularly used in assessing coping strategies in major life stressors on various populations. This study carried out to determine the validity and reliability of the Persian version of the Brief COPE among wives of patients under hemodialysis. Methods: The Brief COPE was translated into Persian language according to the standard method and the psychometric properties of the instrument were assessed among 212 wives of patients under hemodialysis in Tehran, Iran, in 2016. Content validity was established, by 15 expert opinions. Face validity was determined by respondents and expert opinion. Construct validity was analyzed through confirmatory factor analysis. The Cronbach's alpha coefficient and intraclass correlation coefficient were used to determine the internal consistency and test-retest reliability, respectively. Results: All 28 Items of Brief COPE scale had content validity index greater than 0.7, suggesting a good validity value of the items in terms of relevancy (range 0.8 - 0.94). The wording of some items was modified to make them more readily understood by the participants, although the core meaning of each item was kept intact and to observe Iranian cultural adaptation; two items were adjusted. Result of confirmatory factor support 14 factor structure of the scale has good fit. Cronbach's alpha coefficient was acceptable for the total scale (α= 0.77) and for subscales (range 0.7 - 0.91). The intraclass correlation coefficient was acceptable for scale (r=0.76, P value= 0.001). Conclusion: The Persian translation of the Brief COPE is a valid and reliable instrument to determine coping strategies in women living with the husband on hemodialysis.

The effects of group blogging on the attitude towards virtual education in nursing students.

Background: Virtual education refers to a variety of teaching-learning methods that are implemented and supported electronically. The present study was conducted to determine the effects of group blogging on the attitude of nursing students towards virtual education. Methods: This was a quasi-experimental pretest-posttest study in which all fifth-semester nursing students (n=25) were selected and asked to design educational blogs on nursing of respiratory diseases. Attitudes of the participants towards virtual education were measured before and after the intervention. Results: Pretest and posttest mean±SD were 2.98±1.03 and 3.46±0.68, respectively, showing a significant difference (p<0.05). There were significant differences before and after the intervention in the 2 subscales of importance of virtual education and interest in using virtual environment (p<0.05). On the other hand, there was no significant difference in the anxiety of using virtual environment before and after the intervention. Conclusion: In general, the results revealed that blogging by nursing students could improve students' attitudes towards virtual education.

The effects of team-based learning techniques on nursing students' perception of the psycho-social climate of the classroom.

Background: Team-based learning is a structured type of cooperative learning that is becoming increasingly more popular in nursing education. This study compares levels of nursing students' perception of the psychosocial climate of the classroom between conventional lecture group and team-based learning group. Methods: In a quasi-experimental study with pretest-posttest design 38 nursing students of second year participated. One half of the 16 sessions of cardiovascular disease nursing course sessions was taught by lectures and the second half with team-based learning. The modified college and university classroom environment inventory (CUCEI) was used to measure the perception of classroom environment. This was completed after the final lecture and TBL sessions. Results: Results revealed a significant difference in the mean scores of psycho-social climate for the TBL method (Mean (SD): 179.8(8.27)) versus the mean score for the lecture method (Mean (SD): 154.213.44)). Also, the results showed significant differences between the two groups in the innovation (p<0.001), student cohesiveness (p=0.01), cooperation (p<0.001) and equity (p= 0.03) sub-scales scores (p<0.05). Conclusion: This study provides evidence that team-based learning does have a positive effect on nursing students' perceptions of their psycho-social climate of the classroom.

Placebo use in clinical practice by nurses in an Iranian teaching hospital.

The present study was carried out to explore Iranian nurses' use of placebos in clinical practice and their knowledge and attitude towards its use. A cross-sectional, descriptive study was conducted using self-report questionnaires. All nurses working in a university hospital in Arak (n=342) were invited to participate in the study. Among 295 respondents, 221 (75%) reported that they had used at least one placebo within the past year and 179 (81%) told patients they were receiving actual medication. The most common reason and symptom for placebo use were after unjustified demand for medication and pain, respectively. Only 60 (20.33%) of the nurses believed that placebos should never be used. Results showed that most nurses in our study had used placebos and probably will continue to use them. Placebo use is viewed as ethically permissible among nurses. Some patients benefit from the placebos, but their use raises ethical questions. The role of placebo treatment, its mechanisms, and its ethics issues should be taught to nurses.

A comparison of the cooperative learning and traditional learning methods in theory classes on nursing students' communication skill with patients at clinical settings.

The purpose of this study was to compare the effect of traditional learning and cooperative learning methods on nursing students' communication skill with patients. This was an experimental study in which 34 nursing students in their 2nd semester of program participated. They were divided randomly into two groups, a control group who were taught their medical/surgical nursing course by traditional learning method and an experimental group, who were taught the same material using cooperative learning method. Before and after the teaching intervention, the students' communication skills with patients at clinical settings were examined. The results showed that no significant difference between the two groups in students' communication skills scores before the teaching intervention, but did show a significant difference between the two groups in the interaction skills and problem follow up sub-scales scores after the teaching intervention. This study provides evidence that cooperative learning is an effective method for improving and increasing communication skills of nursing students especially in interactive skills and follow up the problems sub-scale, thereby it is recommended to increase nursing students' participation in arguments by applying active teaching methods which can provide the opportunity for increased communication skills.

Comparing the effects of two educational methods of intravenous drug rate calculations on rapid and sustained learning of nursing students: formula method and dimensional analysis method.

Accurate calculations of flow rate of intravenous medication are crucial to safe patient care. Flow rate of these medications can be calculated using either the formula or dimensional analysis method. However, few studies have assessed the effectiveness of this teaching method or any other method of calculating drug dosages. The purpose of this study was to compare the effects of formula and dimensional analysis educational methods of intravenous drug rate calculations on nursing students' rapid and sustained learning. This was an experimental study in which 42s year nursing students participated. They were divided randomly into two groups, control and experimental and the drug calculating skills were taught to them through formula method (control group) and dimensional analysis method (experimental group), respectively. Before the education, immediately, and three months after the teaching intervention, the students' skills were examined using a drug calculation test. The results showed that no significant difference between the two groups in pre-test and post-test 1 scores (P>0.05), but did show a significant difference between the two groups in post-test 2 scores (P<0.05). The mean of the scores differences of pre-test and post-test 2 were 9.8+/-3.34 and 12.85+/-3.07 in formula method group and dimensional analysis group, respectively, which showed significant difference between two groups. This study showed that immediate post education intervention learning was significantly better in both groups, but, in the dimensional analysis method group, the sustained learning rate was significantly better than in the formula method group.