مجله دانشکده بهداشت و انستیتو تحقیقات بهداشتی
سال هجدهم شماره 3 (پیاپی 71، پاییز 1399)

The “Package for mental and social health promotion and drug abuse prevention” was developed in response to the importance of, and concerns relate to, the mental and social health in the population. Since any policy and plan needs to be assessed to find its weaknesses, strengths and challenges to ensure its successful implementation, this study aimed to find and explain the executive leadership challenges of this service package from the service providerchr('39')s perspective.

This study was a qualitative research, the data being collected through interviews and reviewing the relevant documents. The research population included experts from Kerman University of Medical Sciences, Kerman, Iran, those in charge of the package implementation, urban community health center officials and health care providers. The interviewees were selected using a targeted sampling method.

Based on the interviews, the findings were categorized into four main themes: low public cooperation, difficulty in communication, missing links in design and implementation of packages, and methods of payment to service providers. In addition, the findings based on reviewing the documents were grouped as objectives, plans, activities, target groups, and interventions related to this service package.

Based on the findings of this study, it can be concluded that the implementation challenges of the mental health care package fall into three categories, namely, policy-making, facilities, and personal challenges. Proper changes and reforms at the public policy-making level, creating individual awareness and providing proper facilities for the implementation of the package can help overcome these challenges.

Patient education is an essential component of diabetes control, and increasing the health knowledge of diabetic patients based on suitable educational theories is crucial. This study aimed to determine the effect of educational intervention using the Transtheoretical Model (TTM) on improving the nutritional habits among patients with type-2 diabetes mellitus in Maragheh city, Iran during 2017-2018.

This study was a randomized controlled trial conducted on 136 diabetic patients under coverage of Maragheh health centers, Maragheh city, Iran, randomly divided into two groups of intervention and control (68 participants in each group). The data collection tool was a three-part questionnaire with questions/items related to demographic characteristics and nutritional habits, as well as constructs of TTM and HbA1c based on the TTM. The educational program included four weekly sessions of 45-60 minutes each. The data were analyzed using the SPSS16 software, the statistical tests being descriptive and inferential tests such as ANCOVA; the significance level was set as a p-value < 0.05.

Before the intervention, the comparison and control groups did not differ significantly as regards demographic variables, HbA1c, TTM constructs and nutritional habits (p<0.05). After the educational intervention, the mean scores of nutritional habits, constructs of TTM and HbA1c were statistically significant in patients with type 2 diabetes (p <0.01).

The study results reveal that the application of transtheorical model can improve the nutritional habits of diabetic patients.

Childhood and adolescent externalizing behavior is a serious public health issue, and the family, as an underlying factor, may play an important role in preventing or reducing behavioral problems in childhood and adolescence. The aim of this study was to investigate the effective of parental autonomy support training on school studentschr('39') externalizing behavior.

Thirty school students who had got high scores in the Child Behavior Checklist (CBCL) were selected and randomly assigned to an experimental (N=15) or control (N=15) group. Mothers of the pupils in the experimental group participated in seven 90-minute sessions receiving parental autonomy intervention training; the control group did not received any training. The CBCLs were completed before and after the intervention and compared. The data were analyzed using the multivariate covariance analysis (MANCOVA).

Multivariate covariance analysis showed a statistically significant difference between the scores of the experimental and control groups (p <0.01, F = 21.123, Wilkchr('39')s Lambda = 0.266). However, no significant difference was found between the two groups as regards aggression, breaking the law and externalized behavior. Further analysis of the data revealed that parental autonomy support skills training favorably influenced the school studentschr('39') aggression, law-breaking and externalized behavior.

Based on the findings it can be concluded that parental autonomy support training can be effective in decreasing externalized behavior in school students.  Hence, it is recommended to develop and implement training programs for parents and school teachers in areas of meaningful rationales, use of non-controlling language and offering meaningful choices aiming to reduce and prevent externalized behavior in school students.

Heavy metals in atmospheric dust can enter the human body through ingestion, respiration and skin contact and cause various diseases. The aim of this study was to determine the concentration of lead, a heavy metal, in atmospheric dust and assess its health risk during the period between winter of 1397 and the fall of 1398 in regions 9, 10, 11 and 12 of Tehran Municipality, Tehran, Iran.

Atmospheric dusts were collected monthly during one year in the following locations in Tehran: west and east of region 9; east of regions 10, 11 and 12 (the locations in the west of these regions had common borders with the eastern part of the adjacent region). A factorial experiment was performed in a completely randomized design with three replications; the experimental factors included sampling locations and sampling times (seasons). The concentration of lead in the samples was then determined after extraction with hydrochloric acid and concentrated nitric acid (ration 3:1).

The lowest (177.1 mg/kg) and highest (98.476 mg/kg) concentration of lead were found to be in location 9W (Tehransar) in winter and in location 11E (Vahdet-E-eslami Avenue) in autumn, respectively. Further analysis of the data showed that ingestion of the atmospheric dust was the main risk of exposure to lead and that more than 90% of the risk index for non-cancerous diseases caused by lead was related to ingestion hazard quotient (HQ, risk equation).

Based on the findings it can be concluded that in winter the hazard quotient (HQ) and hazard index (HI, non-cancer Risk Index) for lead were lower than the maximum permitted levels for adults and children and, so, did not pose any health risk for these age groups. However, in spring, summer and autumn the risk index for lead was higher than the maximum permitted level for children and, thus, the risk of children developing non-cancerous diseases was high in all the sampling locations.

Considering the importance of childrenchr('39')s dietary patterns in the general health and vitality of the population in the future and the effect of maternal depression on performing maternal tasks  and responsibilities regarding childrenchr('39')s eating habits and behaviors, this study was designed and conducted to determine the relationship between maternal depression and childrenchr('39')s dietary patterns.

This cross-sectional descriptive-analytical study included 313 primary school children in Tehran in the first semester of the academic year 2018-2019 selected through stratified cluster sampling. The following questionaires were used to collect the data: general and demographic questionnaires  related to mothers and children, the Beck standard questionnaire to assess maternal depression, and a food frequency questionnaire to assess the children’s food patterns. The SPSS-22 and Stata-13 were used to analyze the data. Using exploratory factor analysis the dominant food patterns of the children were determined. The statistical tests used for data analysis included descriptive statistics, Mann-Whitney, Kruskal-Wallis and Pearson and Spearman correlation coefficients.

Data analysis showed the prevalence of depression among the mothers and the dominant dietary pattern among the children to be 31.3% (n=98)  and vegetarian dietary patterns, respectively. The children’s body mass index, heights and waist circumference were significantly positively associated with with some of the dietary patterns (p<0.05). However, no significant association was found between maternal depression and the childrenchr('39')s dietary patterns (p>0.05).

According to the findings of this study, maternal depression has no significant association with childrenchr('39')s dietary patterns. Conducting similar studies with larger sample sizes are recommended.

This study aimed to improve the symptoms of children with obsessive-compulsive disorder (OCD), relationships between parents and children, and marital satisfaction using the family-based cognitive-behavioral therapy (CBT).

This was a quasi-experimental pretest-posttest research. The statistical population was all of the 9- to 12-year-old school students suffering from OCD who had consulted the Psychological and Consultation Services Center during academic year 2015-2016 in the city of Tehran. A sample of 28 students selected randomly were assigned to an experimental and a control group. The following questionnaires were completed initially (pre-test) and finally (post-test): 1. Questionnaires completed by the mothers of the children: the Spence Anxiety Scale-Parent Form, the Parent-Child Relationship Questionnaire and the Afrooz Marital Satisfaction Questionnaire (short form); 2. The questionnaires completed by the children: the Spence Childrenchr('39')s Anxiety Scale. The intervention program was designed based on CBT and included 22 sessions, eight group sessions for mothers, eight individual play therapy sessions for children, and two specific sessions for each family.

Data analysis using multivariate analysis of covariance showed that family-based cognitive-behavioral therapy was effective in improving marital satisfaction and parent-child interaction as well as reducing child anxiety (p <0.01).

Based on the findings, it can be concluded that family-based cognitive-behavioral therapy intervention may lead to improved relationship between parents and children with obsessive-compulsive disorder and marital satisfaction, as well as reduced anxiety of these children and their parents.

Based on the Iranian Social Security Organization statistics, in 2012 the accidents occurring in the construction industry accounted for 26% of all the occupational accidents in the country. Therefore, this study was conducted to identify the individual and occupational risk factors affecting the causes of occupational accidents in this industry using the fuzzy hierarchical analysis approach in Kurdistan province, Iran.

The individual and occupational risk factors affecting the occurrence of accidents in the construction industry were first identified. This was followed by completion of a questionnaire, designed based on the fuzzy hierarchical analysis, by 121 safety officials, safety officers, Labor Office inspectors, university occupational health professors and occupational health graduates in Kurdistan Province, Iran in 2019. Based on the minimum acceptable incompatibility rate of 0.1, 40 questionnaires were discarded and, so, only the remaining 81 questionnaires were analyzed. The data were analyzed based on the fuzzy hierarchical analysis approach.                                                   

Of the five individual factors and three occupational factors, the risk factor of unsuitable physical fitness for the assigned task and the risk factor of salary were found to have the highest weight risk factors, namely, 0.41 and 0.57, respectively.

Based on the results of the this study, it is suggested that in order to reduce the occurrence of accidents in the construction industry, the relevant project contractors should give due attention and priority to the financial concerns and physical fitness of the workforce.

Prostitution is one of the alarming social harms in any population with considerable challenges and concerns. Many prostitutes have been victims of unfavorable social conditions. The purpose of this study was to determine and explain the goals, service patterns, challenges and proposed solutions for the Program of Rehabilitation of Socially Harmed Women in the Iranian Welfare Organization (IWO).

A qualitative study was conducted in 2016. The participants included managers and experts of the general departments of the IWO in 31 provinces, 21 members of public mediators and stakeholder organizations, and 5 senior staff managers and senior experts of the IWO Deputy Director’s Office for Social Affairs. Data were collected using document analysis and in-depth individual interviews and focus group discussions and analyzed using the content analysis method.

Based on the data collected, the challenges of the program implementation were found to be as follows: non-acceptance of these women by the society, identity problems of the children borne to them (legally), poor chances of employment, sexual abuse of the women by the employers and mental disorders of the women, as well as poor intersectoral collaboration in IWO and lack of sufficient manpower. Proposed solutions for improvement of the situation included increasing financial credits, creating a national database, informing and sensitizing the people and approving some new judicial laws, as well as reforming some of the existing judicial laws.

Despite the services delivered in this national program, the program faces challenges at the government and public levels. In order to improve the current situation, it is essential to apply the proposed solutions, as well as review and modify the relevant processes.