Critical aspects of educating clinical management and clinical reasoning in primary teeth pulpotomy: A qualitative study based on the perspectives of experts and novices.

INTRODUCTION: In dental education, students must learn to integrate and coordinate complex knowledge, skills and attitudes and to transfer this learning to clinical practice. One major issue of concern in education in general and dental education, in particular, is to fill the gap between knowledge and practice. METHODS: The purpose of this study was to explore the problems that dental students have in transferring knowledge from the classroom to the real clinical setting. More specifically, we investigated the factors that complicate clinical management and clinical reasoning for these novices, including their common errors, in order to design an educational simulation programme in primary teeth pulpotomy. To this end, we conducted 16 semi-structured interviews with experts and novices, performing a thematic analysis of the data obtained. All interviews were audio recorded and transcribed verbatim. RESULTS: For each major skill-clinical management and clinical reasoning-we identified complicating factors and common errors that related to the child (the patient), parents and dental student (the three main themes). For each theme, we identified further sub-themes. CONCLUSION: The data obtained provided valuable insights into the factors that affect dental students' performance on clinical management and clinical reasoning in primary teeth pulpotomy.

Mental Health Problems and the Associated Family and School Factors in Adolescents: A Multilevel Analysis.

Objective: Mental health is one of the most important issues in adolescents' life. Adolescents' health is highly important, because of their role in the future. This study was conducted using multilevel analysis to investigate the risk factors at student and school levels. Method : This was a cross sectional study for which 1740 students and 53 schools were selected between February and March 2018 in Qazvin, Iran. Multistage stratified cluster sampling was used for data collection. Mental health problems were measured by the Strengths and Difficulties Questionnaire (SDQ). Emotional symptom, conduct problem, hyperactivity, peer relationship problem, and prosocial behavior were the subscales. This study used multilevel analysis to determine the association between each of the questionnaire scales and students and schools variables. Results: The prevalence of the mental health problems was 16.2%. Conduct problem was more prevalent than others (21.1%). Overall, the score of mental health problems was significantly lower in boys' schools, in adolescents with physical activity, and in families with high socioeconomic status. Hyperactivity and emotional symptoms were significantly higher in girls' schools. While prosocial behavior and peer relationship problems were significantly higher in boys' schools. The association between variables and the scales of mental health problems was different.Conclusion: Results indicated desirable physical activity and socioeconomic status are effective components in the adolescents' mental health, and, mostly girls' schools were more vulnerable than boys' schools. Therefore, the educational authorities and health policymakers should consider this diversity to design interventional programs and pay more attention to the high-risk adolescents in different schools.

The role of mental health, academic stress, academic achievement, and physical activity on self-rated health among adolescents in Iran: A multilevel analysis.

BACKGROUND: Health promotion of adolescents requires appropriate evidences of its determinants. The aim of this study was to investigate predictors of self-rated health (SRH) among adolescents in Qazvin, Iran. MATERIALS AND METHODS: In this descriptive cross-sectional study, with a multistage sampling method, we recruited 1740 adolescents aged 12-19 years from 53 schools in Qazvin, Iran (2018). We used the Strengths and Difficulties Questionnaire and Adolescents' Academic Stress Questionnaire for data collection. The analysis was conducted using a multilevel logistic regression model. Gender, educational period, and socioeconomic status were considered as confounders. RESULTS: Almost 21% of the adolescents reported their SRH suboptimal. Suboptimal SRH was higher in girls and older adolescents. Mental health disorders and academic stress had a positive association with SRH. However, this association was negative for academic achievement and physical activity. The interaction between mental health disorders and academic stress with SRH had a significant association in a crud regression model. CONCLUSION: Mental health, academic stress, academic achievement, and physical activity were important predictors for SRH. Interventions that focus on promoting mental health, academic stress, academic achievement, and physical activity such as physical activity for 1 h and each day for 3 days per week can improve SRH in adolescents. Hence, policymakers should pay more attention to this issue in health promotion programs of adolescents.

Designing and Psychometric Evaluation of Iranian Students' Academic Stress Questionnaire (IAASQ).

BACKGROUND: Academic stress is one of the factors affecting the health of adolescents. The aim of present study was to design an academic stress questionnaire for Iranian adolescents with regard to the cultural and educational system of the country. METHODS: After reviewing the literature and identifying available tools in 2018, Iranian adolescents' views on academic stress were extracted. Similar questions have been used in other tools. According to expert opinion, the results were overviewed and the initial version was designed. The steps of content validity and instrument reliability were carried out. Internal consistency was investigated with Cronbach's alpha (α) and repeatability with Intra Class Correlation (ICC). After dividing the data into two randomized samples, exploratory factor analysis (EFA) with 899 subjects and confirmatory factor analysis (CFA) with 717 subjects were performed. The association between this tool and the Morgan and Jink's Self Efficacy Scale and the Strengths and Difficulties Questionnaire questionnaires was investigated. Data were analyzed using SPSS and Mplus softwares. RESULTS: The Iranian Adolescent Academic Stress Questionnaire (IAASQ) was designed with 57 questions. Relevancy and clarity of the whole tool were obtained as 0.81 and 0.83, respectively. In different domains, Cronbach's alpha was in the range (0.58-0.85) and ICC (0.80 (95% CI:0.66-0.90)). In the EFA, 9 factors were extracted. CFA confirmed the suitability of the model in another sample. Discriminant and convergent validity tool was approved. CONCLUSION: The IAASQ questionnaire has acceptable reliability and validity. This tool is recommended for use in related studies in the Iranian community.

Epidemiologic assessment of self-concept and academic self-efficacy in Iranian high school students: Multilevel analysis.

INTRODUCTION: In social cognitive theory, self-efficacy and self-concept (SC) have been introduced as important constructs that associate with adolescents' achievements. The aim of this study was to investigate the determinant factors of academic self-efficacy (ASE) and SC in Iranian high school students based on the multilevel analysis. MATERIALS AND METHODS: In this descriptive-analytical cross-sectional study, 1740 students from 53 high schools selected with stratified random sampling method in 2018 in Qazvin, Iran. Data collection tools were the Morgan and Jinks Self-Efficacy Scale and the Piers-Harris Children's SC Scale-Second Edition. The association between some of the students and school variables with ASE and SC was analyzed by hierarchical linear regression models. RESULTS: The score of the students' standardized ASE was lower than SC. ASE and SC had a strong positive significant association with economic status, grade point average, and the educational period of high school. Sex had no association with any of them. Physical activity had a positive significant association with SC but was no found association by ASE. CONCLUSION: These findings revealed that for improving the adolescents' ASE and SC should be attention to the adolescents' family condition and school-related factors. Proper educational, sports, and supportive programs can be effective on the adolescents' self-efficacy and SC.

Academic Stress and Adolescents Mental Health: A Multilevel Structural Equation Modeling (MSEM) Study in Northwest of Iran.

BACKGROUND: We aimed to determine the relation of different sources of academic stress and adolescents´ mental health through mediator variables on the student and school levels. STUDY DESIGN: A cross-sectional study. METHODS: Overall, 1724 students aged 12-19 yr were selected from 53 high schools in Qazvin City, central Iran through stratified cluster sampling. The sources of academic stress include family conditions, education system, future concerns, academic competitions, interaction with teachers, school disciplines, peer pressure, parental involvement, and financial problems. Academic self-efficacy and self-concept were the mediator constructs. The students and schools´ information were considered on levels 1 and 2, respectively. A Multilevel Structural Equation Modeling (MSEM) analysis was done. RESULTS: High value of academic stress was associated with reduction of mental health. On the student level, the academic stress caused by the families 0.31 (95% CI: 0.28, 0.34), peers 0.29 (95% CI: 0.27, 0.32), and the education system 0.21 (95% CI: 0.18, 0.24) had the highest impact on the adolescents' mental health, respectively. There was a direct and indirect relation between academic stress and mental health through the self-concept. On the school level, only family conditions stress had a relation with mental health (P=0.015, b=1.08). Academic self-efficacy showed no significant relation in the model. CONCLUSION: The stress from the family is the most important source of stress associated with adolescent mental health. Self-concept unlike academic self-efficacy had an important mediating role in the relation between different sources of academic stress and adolescents' mental health.

Assessing the Functions of Non-Suicidal Self-Injury: Factor Analysis of Functional Assessment of Self-Mutilation among Adolescents.

Objective: The aim of this cross sectional study was to assess the factor analysis of Functional Assessment of Self-Mutilation (FASM) among Iranian adolescents with non-suicidal self-injury. Method: In this study, 646 high school students, with the mean age of 16.55 ± 0.7, were selected using a multistage cluster sampling method; they completed FASM and the demographic form. Data were analyzed using the descriptive statistics, chi-square (χ2), independent sample t test, MANOVA, and confirmatory factor analyses (CFA). Results: Of the participants, 178 reported at least 1 episode of NSSI during the previous year. The mean age of the participants when they first harmed themselves was 14.64 (±1.71). Most of them reported to engage in NSSI impulsively (39.32%) and experienced little (31.5%) or moderate physical pain (31.5%) There were no significant differences between males and females in severity of NSSI, frequency of NSSI, thinking about NSSI prior to engaging in the act, and age of onset. The results of the confirmatory factor analysis supported the 4-factor model of NSSI functions suggested by Nock and Prinstine [Χ2/df = 1.84; RMSEA = 0.07; GFI = 0.82; AGFI = 0.77]. The most frequent function for engaging in NSSI was Automatic Negative Reinforcement. Conclusion: Findings of this study supported the structural validity of the FASM; thus, this tool can be useful in treatment and research contexts as a measure of NSSI functions. Moreover, this study found that adolescents engage in non-suicidal self-injury because of 4 distinct reinforcement processes. The study findings have important implications for the assessment and treatment of NSSI.

Design and assessment of psychometric features of life skills inventory.

INTRODUCTION: The importance of life skills and their application in promoting personal, family, and occupational health in military personnel is well recognized. It is, therefore, important to identify and assess life skills in military personnel with a valid and reliable tool. The present study aims to develop such a tool and evaluate its psychometric features in military personnel. MATERIALS AND METHODS: As part of a mixed study, a qualitative concept analysis study was conducted using hybrid approach to redefine life skills in military personnel, and results obtained were used to form a pool of items. Next, in a methodological study, psychometric evaluation, qualitative and quantitative face validity, qualitative and quantitative content validity, and construct validity (exploratory factor analysis), and reliability (using test-retest and internal consistency) were performed on the inventory. RESULTS: Initial pool of items was designed with 156 items, which were reduced to 93, following qualitative face validity, and further reduced to 80 after quantitative face validity (item impact score). No further reduction was implemented after qualitative and quantitative content validity (content validity ratio and content validity index ratio). Following construct validity (factor analysis), the remaining 80 items were summarized in 5 factors. Cronbach's alpha for the 5 factors was found 0.7, and correlation coefficient of test-retest results exceeded 0.9 and was significant at 0.01. CONCLUSION: Given the acceptable results of psychometric features, this tool can be used as a valid and reliable tool for assessing life skills in military personnel.

Effects of Combining Medication and Pivotal Response Treatment on Aberrant Behavior in Children with Autism Spectrum Disorder.

Abstract: The purpose of this study was to investigate the effects of combined risperidone (RIS) and pivotal response treatment (PRT) on children with autism spectrum disorder (ASD). A total of 34 children diagnosed with ASD according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V) (mean age of 12.36 years) were randomly assigned to either of two groups; the first group (n = 17) received combined PRT-RIS while the second group (n = 17) received RIS only. Behavioral problems were evaluated with the Aberrant Behavior Checklist (ABC), whereas global improvement (GI) was measured with the Clinical Global Impressions (CGI). Assessment of ABC was performed before intervention, after intervention (12 weeks), and following 3 months of the intervention (follow-up). Total ABC scores were seen to decrease in both groups after 3 months, as compared with the scores prior to the interventions. Also, in both groups, mean scores of behavioral problems after the intervention were not significantly different from those prior to the intervention, in all subscales but the inappropriate speech (p < 0.001). However, both groups showed significant differences in mean scores of ABC subscales in both of the post-intervention evaluation stages. It was concluded that the combination of behavioral and drug interventions can further improve behavioral problems, ultimately improving patient's communication and social skills.

A Randomized Controlled Trial of Acceptance and Commitment Therapy for Type 2 Diabetes Management: The Moderating Role of Coping Styles.

BACKGROUND AND AIM: Evidence of the efficacy of existing psychological interventions for self-management in diabetes is limited. The current study aimed at assessing the effects of group-based ACT on self-management of patients with T2DM, considering the moderating role of coping styles. METHODS: One hundred and six patients with type 2 diabetes were randomly assigned either to the education alone (n = 53) or to a combination of education and group-based acceptance and commitment therapy (n = 53) over a period of 10 sessions. In each group, 50 participants completed a 3 month follow-up assessment. RESULTS: After 3 months, compared to patients who received education alone, those in the group-based acceptance and commitment therapy condition were more likely to use effective coping strategies, reported better diabetes self-care, and optimum glycated hemoglobin (HbA1C) levels in the target range. CONCLUSIONS: Consideration of the role of coping style for a more accurate evaluation of the effects of acceptance and commitment therapy may be a useful addition to services provided for patients with type 2 diabetes.

Self-care activities and glycated haemoglobin in Iranian patients with type 2 diabetes: can coping styles and social support have a buffering role?

BACKGROUND: Diabetes self-care is a key element in the overall management of diabetes. However, the importance of psychosocial factors for successful disease management is under investigated. This study aimed at exploring the role of coping styles and social support in the relationship between self-care activities and glycated haemoglobin in patients with type 2 diabetes. METHODS: One hundred adults (60% female, aged 40-70 years) with type 2 diabetes completed questionnaires assessing self-care activities, coping styles and social support. In addition, a blood test was performed to obtain glycated haemoglobin levels. RESULTS: Result showed significant relationships of glycated haemoglobin with self-care activities, coping styles and social support. Regression analysis indicated that social support had a moderating role on the relationship between self-care activities and glycated haemoglobin, such that, at very high levels of social support the association, between Self-Care and HbA1c disappears. CONCLUSIONS: Findings indicate that health care providers, within the context of the Iranian social and cultural situation, should pay more attention to psychosocial factors when addressing self-care activities. Delineation of the role of coping styles and social support might be useful for identifying patients in need of particular counselling and support for improving self-care activities and HbA1c levels.

Protective Factors Enhancing Prosocial Behavior and Preventing Internalizing and Externalizing Symptoms among Adolescents Living in Forster Care Homes.

OBJECTIVE: Based on Problem Based Theory, this study investigated a broad array of putative protective factors associated with psychopathological symptoms and prosodical behaviour. METHODS: Participants were 140 orphan adolescent girls and boys living in foster care homes in Tehran, chosen with convenience sampling procedures. Using a cross-sectional design this study examined the individual and interactive properties of protective factors in this high-risk population. RESULTS: Findings with theoretically derived multi-item subscales indicated a high degree of association specificity based on type of psychopathology and depending on gender. RESULTS with the whole sample indicated that theoretically derived individual protective factor scales associations were obtained mainly for conduct problems and emotional symptoms, and with girls only. CONCLUSION: The present study provides introductory information on the identification of protective factors that can be utilized in educational, interventional and preventive public health programs for this high-risk population. One innovative contribution of the present research is to provide an introductory validation of a theory-based model of adolescent protection and resilience, for which there is ample empirical support, in a high-risk population of Iranian adolescents living in foster homes centers in a metropolitan urban setting.