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Abstract Background This study aimed to adapt mental health first aid guidelines to support individuals with or at risk of developing eating disorders in Iran. This adaptation seeks to enhance the support available for the Iranian population dealing with these disorders. Methods We employed the Delphi expert consensus method, utilizing two panels: health professionals (n = 37 in the first round; n = 29 in the second) and individuals with lived experience (n = 20 in the first round; n = 18 in the second). The health professionals panel was selected from the graduates of various eating disorders associated scientific fields who had a history of providing services to or conducting research on people with eating disorders, and the lived experience panel had a history of eating disorders themselves or in their family. The panel of individuals with lived experience included those who had personal or familial histories of eating disorders. Efforts were made to ensure cultural, gender, and age diversity in the selection of panel members. Panellists rated the importance of each item for inclusion in the guidelines for Iran based on the English-language Mental Health First Aid guidelines for eating disorders. Items deemed essential by at least 80% of both panels were included in the final guideline. Additionally, panel members were invited to suggest any missing items. Results A total of 57 participants took part in the first round of the survey, and 47 participated in the second round. In the first round, 204 items across 11 categories were assessed, with 174 items endorsed by the panels. Thirteen items were re-scored in the second round, and 17 items were rejected. Participants suggested 11 new items in the first round. In the second round, 18 out of 24 items were endorsed, while six were rejected. Ultimately, 192 items were incorporated into the Iranian guidelines. Conclusions The adaptation process considered Iran's social and cultural characteristics, including the stigma associated with mental health disorders, religious beliefs and rituals such as fasting, linguistic differences between English and Farsi, distrust of strangers, the influence of friends and family, differences in food access, and low mental health literacy. We recommend piloting the adapted guidelines in high schools, universities, and non-governmental organizations to evaluate their feasibility and effectiveness in real-world settings. Furthermore, it is essential to establish mechanisms for feedback, update content based on the latest evidence, and collaborate with the media to promote educational programs and public participation.

Abstract Background The spread and severity of the COVID-19 pandemic have been to such an extent that to shape an effective, collective response, governments need the participation of society and the cooperation of a wide range of civil society organizations and institutions. The objective of this study was to identify the activities of non-governmental organizations (NGOs) in response to the covid-19 pandemic in Iran and the challenges they confronted. Methods We conducted a qualitative analysis based on twenty-two individual, virtual, and semi-structured interviews. Interviewees were selected through purposeful and snowball sampling. All interviews were performed with active health-related NGO representatives willing to participate in the study and continued until data saturation. Data analysis was performed using qualitative content analysis. Results The activities and challenges raised by NGO representatives were identified in 6 main categories, including the need for the participation of NGOs in the fight against pandemics, response to the COVID-19 crisis in the society, challenges in providing services to the target group in the COVID-19 crisis, NGOs challenges in interacting with governmental and non-governmental institutions, information sources used by NGOs in the COVID-19 crisis and strategies to support NGOs in their efforts. Conclusion Considering the crucial challenges for their participation, such as the NGO access to the target groups, lack of communication network, and constructive interaction between government institutions and the NGOs, it is recommended to increase the capacity of these institutions and intervene to establish a constructive and long-term relationship with the government.

Abstract Background The beliefs and attitudes of caregivers of working children about mental health issues and first aid and their attitudes about the stigma of mental health problems can affect their motivation to seek professional help for affected children. This study aimed to assess the mental health literacy among caregivers of child labor about first aid for mental health and their attitudes about the stigma of mental disorders. Methods The Depression Health Literacy Questionnaire has been used in this cross-sectional study. All caregivers of working children who were willing to participate were included in the study. This group is covered by a Non-Governmental Organization (NGO) located in the 17th district of Tehran. Results Questionnaires completed by 131 caregivers were analyzed. The average age of the participants was 32.6 (± 7.9) years. Of which 130 (99.2%) were mothers. Amongst, only 37 individuals (28.2%) were confident in their ability to help their children in case of depression symptoms. A majority of participants, 109 (83.2%), believed that asking a depressed child about suicidal ideation was harmful. Conclusion According to the findings of this study, the literacy among caregivers of child labor about mental health first aid in our study needs to be improved. There is also a need for educational and community-based programs to reduce the stigma about mental health disorders, including depression.

Background. Given the high prevalence of depressive disorders in the present world and the lack of adequate awareness about prevention and appropriate interventions, increasing mental health literacy is vital for promoting mental health to reduce depression and its consequences. Methods. In this descriptive cross-sectional study, participants were recruited among the second high school students in the 2018-2019 academic year. The sample size was 2038, and samples were selected by multistage cluster sampling from different areas of Tehran. Demographic variables like age, gender, level of education, and parents’ characteristics and mental health literacy questions in treatment and prevention areas were evaluated. Results. Analyses showed that of high school students, 83% considered getting help from psychiatrists and 80% considered learning stress management as the best preventive measures, while as the best treatment measures, 79.5% considered counseling the best place to refer for visiting a professional and 45% selected general counseling centers. Conclusion. The study results showed that high school students have a positive attitude toward preventing and treating depressive disorders, getting help from specialists, and useful measures for depressed people. But they did not know enough about preventive measures, including learning effective coping skills, reading self-help books, and continuing to take psychiatric medications. Planning and providing the necessary training are important, especially for high school students.

Background: Divorce has become a global issue that is increasing in many industrial and developing countries, including Iran. One of the significant reasons for divorce is sexual dysfunction. This study aimed to explore the perceptions and experiences of Forensic Medicine Department service recipients and providers in evaluating male sexual dysfunction following filing for divorce.Methods: This study was a qualitative study that was analyzed through a content analysis approach. Purposive sampling was done with maximum variation until data saturation was reached. Individual interviews were used to collect data. The data were collected through in-depth quasi-structured interviews with 20 service recipients and 9 service providers of the Forensic Medicine Department in Tehran from January 2022 to March 2022. Results: The data analysis led to the extraction of two main categories, including existing challenges of the forensic medical system in the process of sexual assessment with 3 sub-categories (absence of the plaintiff in the assessment process, sharing a common room with other clients, the psychosocial pressure associated with a Rigi scan test) and features of desirable evaluation services with 5 sub-categories (service delivery to couples, service delivery by observing ethical principles, confidentiality and human dignity, comprehensive physical-psychological-communicative assessment, service delivery that emphasizes informing couples of the path ahead, provision of services if the authenticity of the sexual problem is proven).Conclusion: Our research results indicate that the national Forensic Medical Department faces certain challenges regarding the assessment and diagnosis of sexual dysfunctions among divorce applicants. Based on these results, certain modifications should be made to the evaluation procedures of these applicants. Forensic medicine policymakers and decision-makers can utilize the results of this study to address the existent shortcomings and even prevent the increase in divorce rates due to sexual dysfunctions by developing appropriate guidelines

Abstract Background and Aims Nongovernmental organizations (NGOs) have enormous potential to effectively prevent and manage diseases; however, little research is available on interventions used to improve NGOs' participation in this area. A scoping review was conducted to identify options proposed or implemented to improve the participation of the NGOs in preventive care. Methods Pubmed, Web of Science, and ProQuest were extensively searched. Google Scholar was also searched to find potential studies related to the subject. Relevant keywords were used in the English language. The reference list of relevant studies was also scanned. Studies were screened with defined inclusion and exclusion criteria. Relevant data were then extracted. Two individuals independently screened and extracted studies. The interventions implemented or proposed to promote the participation of the NGOs in the implementation of preventive interventions were deductively identified and classified. Results Eighteen articles were included in our review. We identified 31 interventions and categorized them into 11 strategies, including (1) building strong collaboration among NGOs and with governments; (2) expanding networks and sustained relations among NGOs; (3) evaluating the NGOs' performance; (4) increasing intersectoral collaboration; (5) advocating for the role of NGOs; (6) supporting NGOs from the side of government; (7) empowering the abilities and capabilities of NGOs; (8) defining the precise roles and responsibilities of the parties; (9) strengthening the health system governance; (10) increasing the health literacy of the community; and (11) developing required regulations, rules, and policies. None of the interventions identified had evidence of its effectiveness. Conclusion The current evidence on effective interventions to strengthen NGOs' participation in implementing health care is scanty. It means there is an information gap in the effect of interventions to improve NGOs' participation in health.

Background and Objectives:It is difficult to run current organizations without delegating some of the authority to management levels. Despite the importance of delegating authority to managers, this seems to have been neglected in organizations. The aim of this study was to identify effective strategies for delegation of authority in Tehran University of Medical Sciences. Material and Methods: The present study was conducted in 2019 in two stages. In the first stage, existing strategies to increase the willingness of managers to delegate authority were extracted through a review study. In the second stage, by conducting 18 semi-structured face-to-face interviews and holding a focused group meeting, effective and appropriate solutions were identified to increase the desire of managers to delegate authority at the university from the perspective of stakeholders. At this stage, data were analyzed by thematic analysis method by 2 people. Results: The review of studies showed two groups of strategies at the organizational and individual levels to increase the willingness of managers to delegate authority. The effect of implementing the solutions has not been fully investigated in previous studies. In the analysis of qualitative findings, three themes (including the importance of delegation at the university management levels, barriers to delegation at university and effective strategies for delegation to administrators at the university) and four sub-themes (including clarification of the delegation process, teaching how to delegate, establishing methods Correct monitoring and evaluation and the use of motivational methods appropriate to the performance of managers) were identified. Conclusion: with regard to the most important barrier to delegation at the managerial level is process-related, it is suggested that the training method and process of performance appraisal and organizational reward be reviewed to increase skills and motivate further delegation. So that, measure the effectiveness and implementation considerations, it is recommended to conduct further studies on the effective implementation of strategies and to monitor and evaluate the effects of the implementation of strategies.

Objective: Recognizing the status of mental health literacy among women and girls as effective and key individuals in family and society seem to be essential. Therefore, the present study was conducted to evaluate depression literacy among women and girls in Tehran on prevention and effective interventions for improving depression. Method: This study was part of a large mental health literacy project on residents of Tehran in 2017, with a sample size of 1023 girls and women aged 16-68 years. Random Digit Dialing (RDD) sampling was done using the Australian questionnaire, whose Persian version’s validity and reliability was tested in our previous study. Data were analyzed by SPSS 21 software. In order to determine the effect of demographic variables on predicting depression literacy among participants, multiple regression analysis was performed. Results: Receiving counseling, relaxation training, having physical activity, and studying self-help books were the most helpful items, respectively, from the participations’ point of view. More than 70% of participants agreed with avoiding stressful situations and close relationship with family and friends, while only 49.8% agreed with coping skills learning. Based on the regression analysis, only higher education and the history of exposure to a person with similar Vignette problem were able to predict mental health literacy in the area of intervention and prevention. Conclusion: Considering the effects of women’s and girls’ depression on individual, family, and even social life, more attention should be paid to improve depression literacy in this group.

Objective (s): Decision making about characteristics of reward system is one of the main challenges in organizations. The current study was carried out in order to design and provide a reward system for staff working in hospital affiliated to Tehran University of Medical Sciences (TUMS) hospitals. Methods This study was performed in two steps from May 2014 to January 2016 in Tehran. First, the research team identified the main axes of reward system using semi-structured interviews with experts and stakeholders. Then the list of final criteria for rewarding was prepared in addition to weight for each criterion using ‘pairwise comparison analysis’. Secondly, in order to identify the executive requirements, the model was implemented in one hospital as a pilot. Results: The main aspects of reward system were scoring method; type of reward; awareness program; evaluation; executive requirements (including structure and process). After pilot study criteria and scoring method were improved. Conclusion: Although the findings were promising, it seems for model success defining executive requirements (including process and structure) proportionate to available capacities and advocacy from head and senior managers is essential.

Background: Reward system program is an investment tools in order to improve quality of services. Accordingly, this study was conducted aimed to identify the challenges of the reward system and the solutions for improving that based on the views of stakeholders in Tehran University of Medical Sciences hospitals. Materials and Methods: This directional content analysis qualitative study was performed in Tehran University of Medical Sciences during 2014and 2015 using content analysis method. Targeted sampling was done and in-depth semi structured and face to face interviews were performed with a wide variety of experts and professionals including managers, faculties and hospital staffs. After word by word transcripting and extracting codes (meaningful phrases), these codes was reviewed again in order to achieve subcategories. Based on subcategories, information was classified to assossiated categories. For validity and reliability checking, stakeholders and faculties member check and peer debriefing were used.Results: Eventually, a total of 29 interviews were held. The comments were classified within 6 main categories, 19 subcategories and 1100 codes. The main categories included existing arrangements in hospitals in order to improve staff motivation; reward system challenges; derived opportunities from rewarding experiences; rewarding systematic actions; types of appropriate rewards and making infrastructure for better rewarding system implementation. Conclusion: Regarding multiple aspects of a reward system which could have an effective role in increasing staff motivation or a contradictory effect when it is inefficient, implementation of an effective reward system in hospitals by designing an appropriate model based on identified key factors in this study, is recommended.

Background: Health literacy (HL) has been recognized as an important concept in patient education and disease prevention. The rising burden of noncommunicable diseases (NCDs) in Iran is significant. Hence, we designed and validated an HL questionnaire on the most important domains of NCDs, including cardiovascular diseases, diabetes, and cancer. Methods: Literature review was conducted to examine the definition and dimensions of HL. After reaching consensus about the HL dimensions and conceptual models in focus group discussions with experts, they designed questions in each domain. Then, face, content, and construct validity as well as reliability were determined by a pilot study on 72 participants. At the end, a cross-sectional study was implemented on 206 Hamedan university employees, to finalize the questionnaire. Results: After doing the pilot study and analyzing the collected data and according to the Bartlett's test of sphericity and Kaiser–Meyer–Olkin = 0.421 with P < 0.001, factor analysis was used. Considering the eigenvalue >1.4, a 27-item questionnaire in seven domains was obtained which included attitude toward health, understanding information, social support, socioeconomic conditions, access to health services, and application of health information. Cronbach's alpha was more than 0.70 in all domains except the last one (0.47). The second phase showed that overall 75.2% of the individuals had inadequate HL with lowest scores in the application of health information. Conclusions: The designed tool seems appropriate for measuring the HL level among the Iranian population in the field of prevention of cardiovascular disease, cancer, and diabetes. The results can help policy makers to improve health promotion interventions.

Introduction & Objective: Health literacy is the degree to which individuals obtain, interpret and understand basic health information and services to make appropriate health decisions. The aim of this study was to describe health literacy of Bu Ali Sina university staff to help health care policy makers for proper interventions. Materials & Methods: In this descriptive-analytical study, health literacy of 206 employees was measured using a researcher-made questionnaire. Health literacy about risk factors of cardio-vascular diseases, cancers and diabetes was measured in 7 areas including: “attitude to health”, “understanding the information”, “social support”, “socio-economic conditions”, “ac-cess to health services", "communication with health professionals" and “application of health information”. Results: Median of overall health literacy level in identification of risk factors for all three dis-eases was 3.7, and median of health literacy level in “identification of risk factors” for heart diseases, diabetes and cancers were reported 3.53, 3.44, and 3.58, respectively. Except for cancer, health literacy levels about identification of cardiovascular disease and diabetes risk factors were significantly higher in women (P= 0.02). Educational level increase showed a significant rise in health literacy score (P= 0.008). Conclusion: As a whole, 75.2% of cases had inadequate health literacy about risk factors of all three diseases. The lowest level of health literacy was related to the” application of health in-formation”. So, regarding the importance of health literacy and its link to health outcomes, it seems that policy makers need to pay more attention to health literacy improvement, particu-larly in the “application of health information”.

Background: The mortality due to Coronary Artery Bypass Graft (CABG) in patients with chronic renal failure is more common than normal population. This study evalu-ates the impacts of prophylactic dialysis on decreasing mortality and morbidity of non- dialysis-dependent patients with renal failure after CABG surgery. Methods: In this study, fifty non-dialysis-dependent patients who were suffering from renal failure and needed to CABG, were selected by convenience sampling method. Se-quentially, they were allocated to prophylactic dialysis (n=20) and no prophylactic dialysis (n=30) groups, using a randomized block design. Exclusion criteria were under 18 year old patients and doing CABG for second time. Mortality rate and some complications such as acute renal failure, brain accident and atrial arrhythmias were compared between two groups after CABG. All cardiac surgeries were performed in a single centre and through a median sternotomy. P value less than 0.05 was considered as significant. Results: The mean age of patients was (65.3±9.9). The patients included %16 (n.8) of women and %84 (n.42) of men. There were 20 patients in intervention and 30 patients in control groups. Baseline characteristics were similar in two groups. Comparison be-tween intervention and control groups after surgery did not show any difference in mortality (P=0.14), acute renal failure (P=0.4), cerebrovascular accidents (P=1) and atrial arrhythmias (P=0.3), need to second surgery due to bleeding (P=1), need to dialysis (P=0.14), need to rehospitalization (P=1), duration of ventilator use (P=0.4), duration of need to hospitalization (P=0.11), duration of a patients stay in the Intensive Care Unit (P=0.4) and deep sternal infection (P=0.7) rates. Conclusion: According the results of this study, prophylactic dialysis, before conduct-ing CABG, does not have any significant effect on mortality and other complications. The only exception is lung complications in non-dialysis-dependent patients with renal failure.

Background: Recognizing the mental health literacy condition among the people is an important step towards promotion of mental health of a society. This study has been conducted to evaluate the depression literacy among Tehran city and its suburban residents. Methods: This is a cross-sectional study of 18- to 68-year-old residents in Tehran city and suburb in 2017. Sampling in Tehran city was conducted using Random Digit Dialing (RDD) and 1340 people were recruited. In suburb Shamsabad and Salehabad from south of Tehran were considered as clusters and data gathering conducted by face to face interview. Depression literacy was assessed by a structured questionnaire. After introducing a vignette with a psychiatric disorder, participants were questioned in the domains of recognition of the disorder, intention to seek help and attitudes toward social stigma. Results: Correct recognition was 52.2% and 30% and intention to seek help was 54% and 33.3% in Tehran city and suburb, respectively. Female gender (P < 0.001), age increasing (P = 0.002) and higher education (P < 0.001) significantly scaled up the chance of correct recognition of depression, when female gender (P = 0.001), increasing age (P < 0.001), and being married (P = 0.01) could significantly improve the probability of seeking help. Results also showed that being married (P = 0.005) and higher education (P < 0.001) predicted lower stigma. Conclusions: Overall depression literacy in Tehran city and suburb was low, so intervention among target population in order to increase the depression literacy seems to be necessary.

Diabetes mellitus (DM) is the most prevalent metabolic disease worldwide and is associated with coronary artery disease (CAD). Therefore it is very important to find a clue to diagnose the presence of CAD as early as possible in DM patients. The aim of this study was to find any correlation between microalbuminuria (MAU) and the severity of CAD in patients with DM type 2. This was a cross sectional study that included 77 DM type 2 patients with suspected CAD that all of whom were performed coronary angiography in our hospital (from 2010 to 2011). Patients were divided into two groups, the case group (group 1) that includes patients with MAU and the control group (group 2) that include patients without MAU. Severity of CAD was estimated by using Gensini score and MAU was defined as the ratio of urine albumin to urine creatinine. Of 77 patients forty three (55.8%) were female, mean ± SD of their ages was 55.8 ± 10.3 and sixteen (21%) of them had MAU. Gensini score of case group was significantly higher than control group (94.94 ± 12 versus 33.25 ± 25.4, P

Background: Women play a central role in the health of the whole family, but they are faced with more barriers while taking part in physical activities. Methods: This study was composed of two main phases. In the first phase, the status of physical activity among young and adolescent in Iran and global evidence of effective interventions were searched. In the second phase, Focused Group Discussion (FGD) sessions were held with the key stakeholders in Tehran to investigate the results obtained from the first phase. Results: Physical activity among young and adolescent in Iran is inadequate. Based on the results obtained from the evidence and analysis of the FGDs, solutions defined as supporting policies, supporting environment, and supporting programs for physical activities. Conclusions: Multilevel cooperation among schools, families, and society is necessary to develop and implement policies and supporting programs, with an emphasis on combined interventions.

Evaluation of magnesium levels in serum and cerebrospinal fluid of patients with febrile convulsion (FC) hospitalized in Bahrami hospital in Tehran in 2010-2011. In the past, decreased levels of magnesium in serum and CSF of patients with FC were reported. The purpose of this study was to identify the possible role of magnesium in febrile seizures in children. Identifying this condition, we may control seizures and also prevent subsequent convulsion. In this cross-sectional study, inclusion criteria were the existence of convulsion due to fever and exclusion criteria were having a known neurological disease which could induce a seizure, and children younger than one month. In each group (cases include children with febrile convulsion and controls include febrile children without convulsion), Mg was measured in blood, and cerebrospinal fluid of 90 children and then they were compared. The data were analyzed by SPSS (α=0.05). The mean serum and CSF levels of Mg in case and control groups were equal (P

Background: Development of a manual or well-defined criterion for prioritizing the topics of clinical practice guidelines (CPGs) will help validate and organize this process evermore. This study was conducted to design an applicable manual that would prioritize the CPG topics for family physicians. Methods: This study was a multi-stage method using a qualitative approach that was conducted for the manual developing. The manual development process took place in four steps, as follows: Literature review, interviews with ten experts, preparing a list of criteria and determining its appropriateness by applying the RAND/UCLA Appropriateness method, and development of the final draft of the manual and pilot study. Results: Interview transcripts went under content analysis and were classified into eight main groups, 12 subgroups, and 85 themes. A comprehensive list consisting of fifty preliminary criteria were extracted. After summarizing and classifying the criteria, 12 appropriate criteria were evaluated using the RAND appropriateness method. Eventually, based on the literature review and our own results of the interview analysis, a manual consisting of five main sections and one clause on ethics was developed. Later, a pilot study was conducted on ten family physician topics, and prioritized by nine experts. Conclusions: The manual can be eyed as a tool ensuring the quality of the process of prioritizing CPG topics for family physicians, as it takes into account the issues involved in priority-setting. Selecting informed stakeholders for rating the criteria and ranking the topics was an issue that was greatly emphasized by the experts. Eventually, the application of this manual can be the first step toward systematizing the process of prioritizing CPG topics in the country.

Objective: In this study efficacy of sub lingual Misoprostol was examined in comparison to Oxytocin (I.V.) for inducing of labor in term pregnancy. Materials and methods: Seventy patients were allocated by blocked randomization to Groups A (n=35, sub lingual Misoprostol 25 μg four hourly to maximum of 5 doses) and B (n=35, continuous Oxytocin infusion). Results: Delivery active phase and total labor phase were shorter with sublingual Misoprostol in comparison to intravenous Oxytocin (p< 0.001) and the rate of cesarean section was lower in Misoprostol group (p