Investigation of the effectiveness of psychiatric interventions on the mental health of pregnant women in Kashan City - Iran: A clinical trial study.

AIM: Pregnancy is one of the most sensitive periods in a person's life; therefore maternal mental illness during pregnancy increases the risk for adverse developmental outcomes in children (Jha et al., 2018). The aim of this study was to determine the effectiveness of psychiatric interventions in the mental health of pregnant women in Kashan, Iran. METHODS: The purpose of this clinical trial was to evaluate an integrated model of mental health during pregnancy over the period of 2015-2018 in Kashan. Subjects consisted in 202 pregnant women (101 in the intervention group and 101 in the control group) who were referred to Kashan Health Centers in the 6th to 10th weeks of pregnancy. The General Health Questionnaire-28, Golombok Rust Inventory of Marital State, an interview on psychiatric symptoms, and a review of the history of the mental health of the mother and first-degree relatives were utilized for data collection. In the intervention group, psychiatric measures and predictive drug treatments were presented. RESULTS: Overall, from among 102 pregnant mothers, 39 women (37.14%) were identified as at-risk and high-risk. The highest number of mothers identified as at-risk and high-risk were in the first trimester of pregnancy and in the 6th to 10th weeks of care (64%). With the start of psychiatric interventions in the intervention group, the subscale of physical complaints and anxiety showed a significant decrease compared to the control group (P < 0.01). Mental health improvement was achieved in 95% of expectant mothers through Level I predictive measures, and only 5% of participants required the specialist level of intervention. CONCLUSION: By identifying psychiatric disorders in pregnant mothers during the first level of pregnancy care services and taking suitable measures, an integrated model for mental health services in primary health care for pregnant women can help managers, policymakers, and decision-makers to improve health and reduce the costs in the health system in order to achieve the Sustainable Development Goals.

A Qualitative Study of Community-based Health Programs in Iran: An Experience of Participation in I.R. Iran.

BACKGROUND: Community-based health programs (CBHPs) with participatory approaches has been recognized as an important tool in health promotion. The goal of this study was to understand the nature of participation practice in CBHP and to use the data to advocate for more participation-friendly policies in the community, academy and funding organizations. METHODS: In this qualitative study, 13 CBHPs, which were active for last 5 years have been assessed using semi-structural in-depth interviews with programs principal and managers and focus group discussions with volunteers and service users. Data analysis was based on the deductive-inductive content analysis considering the participatory approaches in these programs. RESULTS: The results show that, the main category of participation was divided to community participation and intersectional collaboration. The community participation level was very different from "main," "advisory" or "supporting" level. The process of recruitment of volunteers by the governmental organization was centralized and in non-governmental organizations was quite different. According to respondents opinion, financial and spiritual incentives especially tangible rewards, e.g., learning skills or capacity building were useful for engaging and maintaining volunteers' participation. For intersectional collaboration, strong and dedicated partners, supportive policy environment are critical. CONCLUSIONS: It seems that maintaining partnership in CBHP takes considerable time, financial support, knowledge development and capacity building.

The main advantages of community based participatory health programs: an experience from the islamic republic of iran.

INTRODUCTION: Community based participatory program is an approach that emphasize on community empowerment as an important tool in health promotion especially in low and middle income countries. This article presents findings from a study of assessing performed participatory community based health programs in the Islamic Republic of Iran. METHODS: This study was a qualitative study using focus group discussions. Thirteen community based programs related to health that were active for last five years were selected and assessed. Data analysis was based on deductive-inductive content analysis approach considering the predetermined structure according to study questions. RESULTS: In this study, strengths points of community participatory health programs based on the locality of the implementation of the programs; governmental organization and nongovernmental organizations (NGO's) were evaluated. The main strengths of these programs were the presence of the spirit of empathy and high motivation in working for community, absorbing the community assistance, community empowerment, presence of female volunteers, using local volunteers, creation of social prestige and evidence based decision making for community problem solving. CONCLUSION: Capacity building of the community, NGOs and policymakers plays key role in participation mechanisms, partnership, team working and mobilizing of necessary resources in the promotion of participatory community based health programs.

Parents or School Health Trainers, which of them is Appropriate for Menstrual Health Education?

OBJECTIVES: The purpose of this community-based participatory research was to compare different training sources for adolescents' menstrual health education. METHODS: From 15 middle schools in Tehran, through quota random sampling, 1823 female students were selected proportionally and allocated randomly to three groups (parent trained, schools' health trainers trained, and control). Following a two-year training program, the adolescents' menstrual health was compared. RESULTS: In the present study, the school health trainers trained group showed a better feeling for menarche, compared to the two other groups (P < 0.001). The need for adolescent health training was emphasized by 82% of the participants; they also believed that the appropriate age for such empowerment courses was about 12 years. In the school health trainers trained group, the offered age was significantly lower than in other groups (P < 0.001). The adolescents trained by the school health trainers had a better practice of habits related to menstrual and hygiene practices, like having a bath during menstruation and the use of sanitary pads or cotton, compared to their counterpart groups (P > 0.05). CONCLUSION: It is suggested that school-based health training leads to better menstrual health promotion and healthy puberty transition, and school health trainers play a key role in this regard.

Evaluation of Tuberculosis Situation in Economic Cooperation Countries in 2009; Achievement and Gaps toward Millennium Development Goals.

BACKGROUND: Evaluating the tuberculosis (TB) status of the Economic Cooperation Organization (ECO) member countries relation to goal 6-c of the third millennium, which includes that TB incidence, prevalence, and death rates should be halved by 2015, compared with their level in 1990. METHODS: In 2009, we have critically reviewed the countries' Millennium Development Goals (MDGs) reports and extracted the data from the surveillance system and published and unpublished data. The main stakeholders, from both governmental and international organizations in the country have been visited and interviewed by the research team as part of the data validation process. RESULTS: The TB incidence is very heterogeneous among ECO countries, which differ from 21.7 in Iran to 230.7 per 100,000 in Tajikistan. TB incidence (per 100,000) is more than 100 in six countries and is from 50 to 100 in two countries and is less than 30 in two countries. Only in two countries the crude death rate (CDR) is higher than 70%. In seven countries the death rate is higher than 10 per 100,000. Two countries are among the 20 top world countries with the highest tuberculosis burden. CONCLUSION: THERE ARE SOME SIGNS AND SIGNALS INDICATING THE BAD CONDITION OF AN ECO MEMBER INCLUDING: incidence of more than 50 per 100000, CDR of less than 70%, death rate more than 10 per 100,000, and rating two member countries among 20 top countries with the highest burden in the world. Iran and Turkey could achieve MDGs by 2015, but if other countries do not prepare urgent intervention programs, they will not be able to fulfill the goals.

The key stakeholders' opinions regarding university counseling centers: An experience from Iran.

BACKGROUND: Student counseling centers are responsible for physical, mental and social health of university students. Therefore, this study was conducted to assess the key stakeholders' opinions on different aspects of the activities performed in these centers. METHODS: This qualitative study used focus group discussion. Key stakeholders including university students and key informants from nine randomly selected medical universities participated in the study. After data saturation, thematic analysis was conducted. Themes were drawn out through constant comparative method. RESULTS: Based on 243 extracted codes and through comparative analysis, four categories were determined, namely students' need for students counseling centers, successes and limitations of student counseling centers, student counseling services priorities, and suggestions for service promotion. CONCLUSIONS: According to stakeholders' opinions, youth participation in needs assessment and priority setting processes in real-based situations leads to better performance of counseling services. Empowering the counselors is another point required for better outcomes. In addition, strategic planning and monitoring, along with evaluation of programs, could promote the provided services.

Prevalence of obsessive-compulsive disorder in Iran.

BACKGROUND: Estimates of the annual prevalence for Obsessive Compulsive Disorder (OCD) were consistent across the international sites range, 1.9%-2.5%. The nine population surveys, which used Diagnostic Interview Schedule, estimated a six-month prevalence of OCD ranging from 0.7% to 2.1%. This study performed in order to determine the prevalence of OCD in a population-based study among Iranian adults aged 18 and older and to study the association of them with factors such as sex, marital status, education, type of occupation and residential area. METHODS: A cross-sectional nationwide epidemiological study of the Iranian population aged 18 and older was designed to estimate the prevalence of psychiatric disorders and their association with the above mentioned factors. 25180 individuals were selected and interviewed through a randomized systematic and cluster sampling method from all Iranian households. Schedule for Affective Disorders and Schizophrenia (SADS) and Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria were used in diagnosis of OCD. 250 clinical psychologists interviewed the selected subjects face to face at their homes. RESULTS: The prevalence of OCD in Iran is 1.8% (0.7% and 2.8% in males and females; respectively). 50.3% of the survey sample were men, 49.9% women, 29.1% single, 67.45% married, 0.4% separated or divorced, 2.5% widow/widower and 4% undetermined. All of the above-mentioned factors were examined in the univariate and multivariate logistic regression models. Although the data did not fit the models well, but in univariate models, sex, the category "single" of marital status, age, the categories "business" and "housewife" and residential areas showed significant effect adjusting for the factors, but the models didn't fit the data properly. CONCLUSION: The study suggests that the prevalence of OCD is not rare in the community of Iran and is within the range of other countries. Similar to prior studies in other communities, OCD is more common in females than males.