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Abstract Introduction The World Health Organization (WHO) places great importance on oral health promotion programs in schools, given that approximately one billion people worldwide are students. This demographic not only includes the students themselves, but also extends to school staff, their families, and the broader community, all of whom are interconnected. The objectives of this study were firstly to assess the knowledge of health personnel conducting fluoride varnish treatment (FVT) in schools, and secondly to solicit their views on the effectiveness of their training methods. Methods Data was collected from health personnel involved in FVT in schools, supervised by medical universities in Tehran province, using a questionnaire. The questionnaire was divided into four sections: demographic information, methods of receiving FVT training, respondents’ knowledge regarding FVT, and opinions about the effectiveness of FVT training methods. The questionnaire was distributed via social media, phone conversations, and email. The collected data was analyzed using Mann-Whitney in SPSS Version 26. A regression model was also fitted to the data. Results The present study included 403 participants. Among various educational methods, it was found that participation in previous workshops (P = 0.001) and FVT workshops (P = 0.013) was significantly correlated with a higher FVT knowledge score. Additionally, participation in previous oral health promotion programs was significantly associated with a higher knowledge score (P

Abstract Background This systematic review aims to comprehensively assess the diagnostic accuracy of cognitive screening tools validated for older adults in Iran, providing evidence-based recommendations for clinicians and researchers. Methods A comprehensive search in March 2023 across Web of Science, PubMed, Scopus, ScienceDirect, SID, IranMedex, and IranDoc, enhanced by hand-searching references and Google Scholar, identified cross-sectional studies on cognitive screening in Iranian seniors. We assessed diagnostic accuracy, cognitive domains, and test strengths and weaknesses. A bivariate random-effects meta-analysis provided summary estimates and 95% confidence intervals, illustrated in forest plots. Results Our review, derived from an initial screening of 38 articles, focused on 17 studies involving 14 cognitive screening tools and participant counts from 60 to 350, mostly from specialized clinics. The MMSE was the only tool examined in at least three studies, prompting a meta-analysis revealing its sensitivity at 0.89 and specificity at 0.77 for dementia detection, albeit amidst significant heterogeneity (I^2 > 80%). ACE-III demonstrated the highest diagnostic accuracy for MCI and dementia, while MoCA’s performance was deemed adequate for MCI and excellent for dementia. High bias risk in studies limits interpretation. Conclusion This review identifies key cognitive tools for dementia and MCI in Iranian older adults, tailored to educational levels for use in primary and specialized care. It emphasizes the need for further validation to enhance diagnostic precision across diverse settings, within a concise framework prioritizing brevity and accuracy for clinical applicability.

Objectives Due to increase in life expectancy, the number of aged population in the world is increasing. Focusing on various aspects of their health is important for improving their quality of life. One aspect is spiritual health, which is dependent on culture. This study aims to survey the spiritual health status of Iranian older adults. Methods & Materials In this cross-sectional study, participants were recruited from among elderly people registered in the national electronic health record system using a stratified random sampling method. The Ajamzibad’s elder spiritual health scale was used to measure spiritual health and its dimensions including spiritual belief, centricity of God, altruism, spiritual conduct, and purposefulness of life. Trained healthcare workers completed questionnaires based on a telephone-based survey method in selected health centers. The non-parametric Mann-Whitney U and Kruskal-Wallis tests were used to analyze the data. Results Participants were 548 older adults from 28 provinces of Iran, with a mean age of 67.8±6.6 years. The mean total score of spiritual health was 91.2±10.0, with the highest score related to the spiritual belief (95.8%) and the lowest score related to the purposefulness of life (87%). Age had a statistically significant relationship with spiritual health in overall and all its dimensions (P

Background and Aim: A comprehensive understanding of the current state of geriatric care in Iran is necessary in order to strengthen and align it for responding to the current and future needs of the elderly in the country. The purpose of this study was to identify the challenges and barriers in the elderly care system in Iran. Materials and Methods: This was a qualitative study. Forty semi-structured interviews were carried out with various participants involved in providing care to the elderly across the country in 2019. Participants were selected using maximum variation sampling. Using MAXQDA10 software, data were analyzed by the qualitative content analysis method based on six building blocks of health systems developed by the world health organization. Results: Challenges and barriers in the elderly care system were categorized into six groups: service delivery, health workforce, health information system, access to essential medicine, financing, and governance/leadership. Also, some of the most important challenges of the elderly care system included: absence of a single organization with sufficient power as the steward for providing the elderly services, lack of integration of services for the elderly from primary care to specialized care; shortage or inadequate distribution of skilled manpower; lack of insurance coverage for home care services for the elderly; lack of registry system or database for the elderly; lack of or weakness in elderly-friendly activities in the service centers. Conclusion: The current elderly care system in Iran faces many challenges in all six building blocks of the World Health Organization. Reforming and redesigning the elderly care system based on the findings of this study is necessary and urgent in order to meet the needs of the elderly in the country.

Abstract Background Cancer is most commonly associated with aging. It is necessary to gain a better understanding of cancer's trend and distribution among elderlies and provide comprehensive cancer care for this population. Aims The aim of the current study was to show the trends in cancer incidence focusing on the population aged 60+ from 1990 to 2016 in Iran. Material and Results We used the dataset of the Iran Cancer Registry to estimate cancer incidences by sex, age, province, and year. In order to account for incomplete data we used a two‐stage spatiotemporal model along with random intercept mixed effect models. We calculated annual age‐standardized incidence rates (ASIRs) for age groups 60+ and 5‐interval age groups. There was an increasing trend of 25.3% to 936.9% (95% uncertainty interval: 769.6–1141.8) in ASIR in the elderly in 2016. ASIR of all cancers were 889.7 (731.3–1083.6) in women and 988.1 (811.1–1205) in men in 2016, per 100 000 respectively, which had an increasing trend comparing 1990. Skin, breast, and stomach cancers in women and prostate, skin, and stomach cancers in men were the most common types in 2016. All the most incident cancer subtypes underwent an increasing trend in both sexes, except for the bladder, esophageal, and skin cancers which almost had a similar level in 1990 and 2016. Most provinces had an increasing trend in ASIR in all cancers combined from 1990 to 2016 except Zanjan with a decreasing trend. Conclusion Regarding the persistent increasing trend of most elderly cancers' incidence, this is crucial for policymakers to establish preventive plans, determine proper resource allocation, and develop specific treatments for elderly cancer patients.

Objectives Primary care is the first main interface of health services for the elderly to maintain and improve their health. Therefore, it is essential to evaluate the appropriateness of the way to provide services for this population group, which is one of the most vulnerable classes of society. This study was conducted to explain the structural and functional challenges of comprehensive health centers in Babol City, based on the guidelines of the World Health Organization’s elderly-friendly centers to plan aging-friendly. Methods & Materials The current research was a descriptive qualitative study using the content analysis method with a conventional approach. This research was conducted on elderly people who were referred to comprehensive health centers and their families as well as service providers in the form of in-depth semi-structured interviews until reaching the level of data saturation. Each interview was implemented immediately after implementation, and the content analysis of the interviews was conducted by determining conceptual units, accurate coding, and continuous comparison method until the formation of subgroups and main classes. Results In this study, 23 elderly people with an average age of 71.47±7.88, 5 family members, and 14 service providers participated. A total of 72 codes were extracted from all the interviews, which were divided into five main categories of structural factors, behavioral issues, educational characteristics, social support, and functional challenges during the analysis process. A total of twelve subgroups emerged for the five main classes. Conclusion Several underlying factors exist in the path of making comprehensive health centers elderly-friendly, and which will be impossible to achieve this issue without providing the conditions and eliminating the existing challenges. Therefore, the obtained components may help in identifying, and prioritizing needs, and choosing the type of interventions to adapt comprehensive health centers to the needs of the elderly.

Background and Purpose: We measured the psychometric properties i.e., validity, reliability, and stability of the Persian 10-item Kessler psychological distress scale (K10) among older adults in Iran. Materials and Methods: We recruited elderly (60+ years) subjects (20 per item of the questionnaire) from various sampling units in the general population of Gorgan district, Golestan, Iran. After the translation/back-translation process, the questionnaire underwent various forms of validity and reliability, including Cronbach alpha (overall, by items, and by group of yes to an item and no to an item). The intra-class correlation coefficient was measured at a two-week interval, and inter-rater agreement was also determined. Both exploratory and confirmatory factor analyses were also conducted, along with receiver-operator characteristics vis-à-vis hospital anxiety and depression scale. Results: In total, 190 subjects (47.3% males, mean age: 70.3, 95% CI: 69.2-71.4) participated in the study. A total of 35.8% had psychological distress (PD) (i.e., score >20). The alpha coefficient was 0.88 with no item below 0.86. The alpha coefficients to report a yes to an item (α=0.85) or no to an item (α=0.90) were similar to each other. The intra-class coefficient for test-retest at a two-week interval was 0.90. Exploratory factor analysis showed a one-factor structure of the underlying construct, with a cumulative variance of 97.1%. Confirmatory factor analysis showed high fit indices for the questionnaire (0.91) and a low standardized residual of 0.05. Conclusion: We measured psychometric parameters of the Persian version of the K10 scale for detecting PD among older adults, which was found to be adequately valid, reliable, and stable. Our questionnaire fills the prior gaps regarding the lack of validated tools for the timely detection and management of PD among older adults in the Persian-language cultural contexts. Our study emphasizes that the Kessler questionnaire is a unidimensional scale, and detects non-specific PD with all items indicating a single underlying construct of “distress”.

Background: Health care-Associated Infections (HCAIs) are among the most common adverse events (AEs) that can negatively affect both patients and health systems. The elderly is among patients at high risk for infections. Some controllable risk factors have received less attention in research. Therefore, this study aims to investigate the relationship between prevalence of HCAIs among elderly inpatients, job satisfaction of nurses, and working condition. Materials and Methods: This cross-sectional study was conducted on 211 nurses working in hospitals affiliated with Iran University of Medical Sciences, Tehran, in 2021. The data were collected from HCAIs reports by the Nosocomial Infection Control Committee, a demographic questionnaire, the Practice Environment Scale of the Nursing Work Index (PES-NWI), and the Minnesota Satisfaction Questionnaire (MSQ). The data were statistically analyzed using Pearson correlation coefficient, ANOVA, t-test, and multiple linear regression (MLR) in SPSS 26. Results: The results showed that there was a significant relationship between the PES-NWI and MSQ (r = 0.68, p < 0.00). The MLR results indicated that staffing and resource adequacy, nurse participation in hospital affairs, job satisfaction, nursing manager's leadership, and nursing foundations for quality of care are predictive factors that these could explain 78% of the changes in the prevalence of HCAIs and the goodness of fit of the regression model was acceptable [F6.210 = 129.47, p < 0.001]. Conclusions: Since job satisfaction and the work condition could predict HCAIs among the elderly patients, healthcare administers are recommended to consider these two variables in the development of HCAIs prevention and control programs.

Abstract Background The conditions related to the Covid-19 pandemic and quarantine have endangered the mental health of people in the community, especially psychiatric patients. This study aims to determine the mental health services usage of outpatient psychiatric patients who attended a public mental health clinic in Tehran, during the quarantine. The study sample consisted of 387 patients with an active record in the mental health clinic. They were selected using systematic random sampling. Data was gathered with the telephone interviews using the researcher-made checklist. The data were then collected and analyzed. Results Participants in this study included 141 male and 264 female patients. One-hundred forty-two patients (36.7%) felt better during this period, and the rest got worse or did not make a difference. Among the patients who felt the need to visit, 144 (47.2%) referred for services, of which 81.7% had visited in person. Among the applicants, 84 (56%) succeeded in receiving the service. A total of 53.5% of patients had used at least one face to face, telephone, or online visit. Among them, women are compared to men (p = 0.002), educated people to low education (p < 0.001), and adults to children and the elderly (p = 0.02), and Tehran residents to foreigners (p = 0.01) used significantly more services. Conclusions Experience with pandemic quarantine conditions has shown that face-to-face use of these services faces significant barriers. In this situation, the expansion of online services can help improve the condition of patients and should be on the agenda of mental health policymakers.

Abstract Background Medications currently recommended for the treatment of Obsessive-Compulsive Disorder (OCD) usually relieve the severity of symptoms by as much as 20–30%, and satisfactory treatment is obtained in 40–60% of patients with OCD. Nevertheless, the remaining symptoms continue to impair the patients’ function. Therefore, it is necessary to investigate possible strategies to improve the mitigation of symptoms. In this study, the main objective was to examine and investigate the effectiveness of granisetron, which is a serotonin 5-hydroxytryptamine receptor type 3 (5-HT3) antagonist, as an adjunct therapy to selective serotonin reuptake inhibitors, for the purpose of ameliorating OCD symptoms. Methods fifty-eight patients diagnosed with OCD, based on Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, who had a Yale-Brown obsessive-compulsive scale (Y-BOCS) score of more than 21 were recruited in a double-blinded, parallel-group, placebo-controlled, clinical trial of 10 weeks to receive either granisetron (1 mg twice daily) and sertraline (100 mg daily initially followed by 200 mg daily after week 4) or placebo and sertraline. The primary outcome was OCD symptoms measured by the Y-BOCS. Results Y-BOCS total score significantly dropped in both groups (28.9 to 17.7 for granisetron plus sertraline and 27.5 to 19.3 for placebo plus sertraline group with a slightly greater drop for granisetron plus sertraline group), while the granisetron plus sertraline group experienced a significantly greater reduction in obsession scores (Greenhouse-Geisser F(2.32,97.57) = 4.52,p-value = 0.01). Moreover, in comparison with the placebo plus sertraline group, the proportion of the patients showing complete response was considerably higher among the granisetron plus sertraline group (P-value

Objective: In order to achieve development goals, in addition to providing students with physical health, their mental and social health should be considered as a necessity and priority in development programs. This program, called the Nemad Project in Iran was formally established in 2015. This study aims to explore the challenges of the Nemad project in Iranian schools based on stakeholders' views. Method: The present qualitative study, with a contractual content analysis approach, was conducted on 21 experts in the field of social harm prevention and mental health promotion at the senior, intermediate, and operational levels in educational institutions and schools, Ministry of Health, the Judiciary and the Planning and Budget Organization. These experts also included project technical officers. Participants were selected using snowball and purposeful sampling methods. Data were collected through semi-structured interviews and analyzed by coding, classification, and extraction of the main themes. Results: Six main themes were derived that included inefficiency in resource management (with subcategories of inadequate facilities and equipment, inadequate human resource management, and information management system deficiencies), weakness in program organization (with subcategories of poor cross-sectoral and weak inter-sectoral subgroups), challenges of laws/regulations/policies (with sub-categories of defective protocols and guidelines and lack of specific task descriptions), barriers and challenges to implementation of policies (with macro and school policy implementation subcategories), structural factors (with subcategories of financial resources allocation problems, inconsistency in managerial levels, and deficiencies in decision-making principles), weaknesses in educational processes (with subcategories of inadequate teacher education, weaknesses in parenting courses, and weaknesses in student education), and ultimately, weaknesses in monitoring and evaluation (with the subcategory of lack of a monitoring and evaluation system). Conclusion: According to experts, implementation of mental and social programs in schools is not in a desirable situation and is faced with certain challenges. To enhance the management of the Nemad project in Iranian schools, it is necessary to compile flowcharts of service delivery and inter-device communication, allocate resources to meet the expectations of each organization, do performance-based budgeting, take a comprehensive look at parental issues, and design a system of monitoring and evaluating the requirements.

Objectives: This study aimed at investigating the effects of speech intervention on Non-Oral Cleft Speech Characteristics (NCSCs), intelligibility, and Quality of Life (QoL), as well as the relationship between speech variables and QOL-related variables in intensive speech therapy among children with cleft palate. Methods: This single-group pre-test and post-test clinical trial study was performed on 12 Persian-speaking children with cleft palate and NCSCs aged 3-7 years. For this purpose, we used 30 sessions of speech therapy and the Persian version of the Pediatric Quality of Life Inventory (PPedsQL). The pre-test and post-test assessments included perceptual assessment using the CAPS-A and QoL assessment using the Parent Proxy of the Persian version of the PPedsQL. The Wilcoxon’s test was applied to analyze group differences in the NCSCs, the intelligibility of speech, the total score of PPedsQL, physical, emotional, social, and school functions before and after providing the speech therapy. Results: The obtained results indicated that the frequency of NCSCs, the intelligibility of speech, the total score of PPedsQL, and its subscales significantly improved after the intervention (P

Abstract Background Through the process of normal aging, cognitive decline would cause a lower level of functioning in real life. This flow might interfere with health-related quality of life (QoL). The purpose of this study is to investigate the effect of computer-based cognitive intervention on increasing QoL of elderly people. Methods A total number of 52 community-dwelling older adults participated in this study. This community scored ≥ 21 in the Mini-Mental State Examination (MMSE) and a clock drawing test score ≥ 4 from health centers in Tehran, Iran. This study is a parallel group stratified randomized clinical trial. The intervention group received a 45-min cognitive training session twice a week for 10 sessions, using Attentive Rehabilitation of Attention and Memory (ARAM) software focusing on selective attention and working memory. QoL was evaluated as a primary outcome. The control group participated in educational workshops. Results From fifty-two persons, only one participant was excluded from the study in the intervention group during follow-up. Results revealed by increasing cognitive function, improvement occurred in QoL (F = 13.417, p value

The experience of the loss of the relatives, which is naturally one of the most stressful events in a person’s life, has turned into a new concept and challenge for survivors and mental health professionals during the coronavirus era. We discussed how restrictions caused by social distancing potentially increase the likelihood of a phenomenon called complicated grief or prolonged bereavement disorder and multilayer response by case finding to increase the access to public education to manage this complicated situation.

Introduction. Action observation therapy (AOT) is a mirror neuron-based approach that has been recently used in poststroke rehabilitation. The main goal of this study was to investigate the effectiveness of AOT of occupations and tasks that are meaningful for chronic stroke patients on occupational performance, upper-extremity function, and corticospinal changes. Method. A randomized control trial was designed to compare between experimental (n=13) and control groups (n=14). In both groups, the execution of meaningful tasks was practiced, but the videos of those tasks were just shown to the experiment group. Instead, patients in the control group watched nature videos as a placebo. Clinical outcomes were evaluated using the Canadian Occupational Performance Measure (COPM), Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Box-Block Test (BBT) on 3 occasions: baseline, post (at 4 weeks), and follow-up (at 8 weeks). The assessments of central motor conduction time (CMCT) for abductor policis brevis (APB) and extensor indicis (EI) were only recorded at baseline and posttreatment. Both assessors of clinical and neurophysiological outcomes were blinded to the allocation of subjects. Result. Finally, the results of outcomes in 24 patients who completed the study were analyzed. In both groups, significant improvements after treatment were seen for most outcomes (p≤0.05). These changes were persistent until follow-up. There were significant differences in COPM performance (p=0.03) and satisfaction (p=0.001) between the experimental and control groups. In contrast, other clinical assessments such as FMA, ARAT, and BBT did not show significant differences between the two treatments (p≥0.05). The results of CMCT related to APB showed a more significant change in the experiment group compared to the control group (p=0.022). There was no difference in change detected between the two groups for CMCT related to EI after treatments. Conclusion. Observation and execution of meaningful activities can enhance the effects of simply practicing those activities on occupational performance/satisfaction and corticospinal excitability poststroke.

BACKGROUND: Advanced stages of dementia interfere with elderly self-care. Consequently, they need caregivers who take responsibility for their care in the long-term. Restrictions to the caregiver's access to information, resources, and organizational support have created problems in their caregiver role, which is why the World Health Organization (WHO) emphasizes caring for caregivers by providing evidence-based information and training programs. As there is no clinical practice guideline for home care in the Islamic Republic of Iran, this study aims to develop a home health care guideline for the elderly with dementia. MATERIALS AND METHODS: The ADAPTE process provided by the Guidelines International Network was considered as the basis. In order to identify the care needs of Iranian patients with dementia, semi-structured interviews were added to this guideline. DISCUSSION: The identification and implementation of the perspectives of patients and caregivers during the process of guidelines adaptation increase the applicability of the guidelines. Improved quality of life for the patients in their place of residence is one of the expected consequences of this guideline's implementation. The developed guidelines will be used at home health care centers, and dementia and Alzheimer's associations in Iran.

Introduction: This study provides a scientometric analysis of the health impact assessment within AirQ between 2005 and 2019, which are listed in the web science databases. Studies have been conducted in various indexed journals, researchers in World Health Organization (WHO) regional areas on product articles, international collaboration, and citation and keyword analysis. Materials and methods: Bibliographic records of research publications and articles were found and after screening process were input to study plan. The authors compared the growth of article that was published in this period time, conducted a citation and co-authorship analysis, and keywords co-occurrences relationship by publication using the scientometric visualization, VOSviewer. Results: The AirQ applying tool in research literature has seen most increase in 2017 production over the study period. Contributions by authors affiliated with WHO-Eastern Mediterranean Regional Office (EMRO) account for the most research literature. Most of studies focus on particles Particulate Matter with diameter

Objectives The current study aimed to determine the relationship between oral health and demographic characteristics of retired elderly people. Methods & Materials This cross-sectional study was conducted on 158 older adults aged ≥60 years. The subjects were selected using random sampling method and personnel codes. All the elderly participants were retired members of the Tehran Municipality Administration. The study data were collected by direct visit to the subjects’ place of residence and conducting interviews. The data collection tool was a questionnaire that included 2 sections. The first section consisted of demographic, socioeconomic, and health profiles, while the second section consisted of Geriatric Oral Health Assessment Index (GOHAI). Results We collected data from 158 participants (90 men, 68 women). The mean age of the participants was 68.78 years. The obtained data suggested that 38 (24.05%) participants had a poor state of oral health. About 50% of the participants mentioned high dental care costs as a reason for not referring to the dentist. According to the findings of this study, there is a direct relationship between educational level and oral health status in the elderly (P

Abstract Introduction Understanding local perceptions of mental health in different cultures and contexts is crucial for designing and implementing appropriate mental healthcare services. Methods This qualitative study was conducted to investigate local perceptions of mental health in two highly populated provincial districts in Iran. Data were collected using the free list technique and interviews. A two‐phase training workshop was held with the research team at a local health center, followed by a pilot study with the participation of six subjects. All the interviews were audio‐recorded, transcribed, and then analyzed by the third and fourth authors in DEDOOSE. Results A total of 30 individuals (20 in the free list and 10 as key informants in the interviews) took part in the study. Based on the study findings and the key informants' ideas, mental health problems were categorized into three categories of depression, anxiety, and obsessive–compulsive disorder (OCD). Conclusions Mental health problems appear to be expressed in different ways and with different symptoms in different cultures, and there is a distinct need for examining mental disorders in each culture and nationality separately using culturally appropriate tools for disease screening.

Background: Age associated cognitive decline or normal cognitive aging is related with lower levels of functioning in real life, and may interfere with maintaining independence and health related quality of life (HRQL). Objective: In this study, health related quality of life and cognitive function in community-dwelling older adults were evaluated with the aim of exploring the association between them by adjusting for potential confounders. Methods: This cross-sectional study, was implemented on 425 community-dwelling older adults aged 60 and over, between August 2016 and October 2016 in health centers of the municipality of Tehran, Iran, using Mini Mental State Examination (MMSE) to assess cognitive function and Short Form-36 scales (SF-36) to assess HRQL. The relation between HRQL and cognitive function was evaluated by Pearson’s correlation coefficient, and the impact of cognitive function on HRQL adjusted for potential confounders was estimated by linear regression model. All analyses were done using SPSS, version 22.0. Results: A positive significant correlation between cognitive function and quality of life (r=0.434; p

Purpose: This study aimed to investigate the electromyographic activities and balance of Vastus Medialis Obliquus (VMO) and Vastus Lateralis (VL) muscles during Straight Leg Raise (SLR) in individuals with and without Patellofemoral Pain Syndrome (PFPS). Methods: Through an analytical case-control study, 26 persons with PFPS and 26 healthy subjects were recruited by non-random and convenience sampling method. All subjects performed SLR movement. The EMG activity of VMO, VL and VMO/VL ratio were recorded and measured. The muscles activation level were compared between the 2 groups using the Independent t test. The obtained data were analyzed using SPSS. Results: The mean and maximum EMG activity of VMO, VL and VMO/VL ratio did not have any significant differences between the PFPS and healthy groups (P>0.05). In other words, during SLR, the VMO and VL muscles activation in the PFPS group were approximately the same as the healthy group. Conclusion: These data suggest that not all individuals with PFPS had weak quadriceps muscles. Many factors may contribute to PFPS that should be considered in the assessment and rehabilitation of individuals with PFPS.

Abstract Background Self-medication is described as the use of drugs without a physician’s prescription to treat self-recognized illness or symptoms, and an important health issue among the elderly. Despite the wide range of different definitions, recognizing all forms of self-medication among older adults, particularly, in developing countries, help healthcare professionals and providers to reduce harmful effects of self-medication. The purpose of this study is to describe the practice of self-medication and its related factors among elderly people in Iran based on the experiences of people who are involved in this phenomenon. Methods This qualitative study was conducted using content analysis. Purposive sampling was used to select the participants and continued until saturation. The participants were the elderly, their care-givers, physicians, and pharmacists. Data was collected using semi-structured interviews, and analysis was done using an inductive approach. The theory of planned behavior was used as a framework to explain the role of the emerged factors in the occurrence of self-medication behavior. Results Based on the expressed experiences of the participants, factors related to the practice of self- medication among the elderly in Iran fit in these 5 categories: “patient’s attitudes towards disease, treatment, and physicians”, “living with disease”, “unfriendly environments”, “enabling health system”, and “influential others”. Conclusions Based on the results of this study, self-medication of the elderly in Iran has commonalities with many countries in regard to over-the-counter medications and complementary and alternative medicine; however, self-medication is also seen with drugs that require a prescription but can easily be obtained from pharmacies. Contributing factors, apart from the elderly themselves, include their families, caregivers, and social circle, the physical environment where they live, and the health system from which they receive services.

Purpose: Neck pain is one of the most common health problems that its prevalence ranges from 34% to 50%. Chronic Neck Pain (CNP) is also a frequent complaint in the general population. The pathogenesis of nonspecific CNP is not clear. This study aimed to assess the effects of soft tissue release, muscle energy techniques and exercise on neck Range of Motion (ROM), Neck Disability Index (NDI), and pain in patients with nonspecific CNP. Methods: This is a randomized, single-blind, clinical study conducted on two groups of patients in Iran, during 2016-2017. Group A received intervention treatment and group B, as control, received no treatment for 21 days. Each group consisted of 12 participants who were selected considering inclusion and exclusion criteria. Each patient in group A received manual treatment protocols (soft tissue release and muscle energy techniques) plus exercise therapy, in six sessions, one session per day, two days a week over a period of 21 days. Clinical assessments were performed at the first and last session (before and after the treatment). Before starting the study, the reliabilities of measurement methods were evaluated and the results were acceptable. Clinical assessments included neck ROM, NDI and pain based on Visual Analogue Scale (VAS). Repeated measures ANOVA test was performed for data analysis using SPSS (version 20). Results: Totally, 16 women and 8 men were participated in this study. To test the hypothesis and analysis of the study variables at regular intervals from the beginning to the end of treatment, repeated measures ANOVA was used. In the intervention group, the indexes showed significant improvements (P

Objectives Because of increasing geriatric population in Iran, the present study aims to plan, prevent, and mitigate the complications among the retired elderly of the Tehran Municipality Pension Organization and then investigate its relation to gender. Methods & Materials The descriptive and analytic approach was adopted on 300 elderly subjects who were 60 years and older (Mean [SD]: 68.14[7.11] years). The subjects were selected using random sampling method. All the elderly subjects were retired members of the Tehran Municipality Administration. The data were collected by direct reference to the subjects’ home and conducting interviews. The data collection tool included questionnaires with two sections. The first section consisted of the demographic, socioeconomic, and health profiles, and the second section consisted of WHO Disability Assessment Schedule 2.0 questionnaire. The obtained data were analyzed by SPSS 18. Results Among the elderly subjects in this study, 175 (54%) had no disability, 125 (46%) were disabled, and 19.13% had mild disability. The average disability rate was 5.6% in females and 4.38% in males; these rates were high compared to the present rate in the society. However, the lowest rate of disability (0.72% in males and 1.07% in females) was related to self-caring and personal health. Conclusion In conclusion, the retired elderly of Tehran Municipality Administration showed a lower level of disability compared to those of other developed countries. However, there is an increasing need for setting up geriatric cares units as the population pattern of elderly people is rising in Iran. In addition, the rate of disability was found to be higher in females (58.14%) compared to males (53.31%), which shows a significant relation of disability status with gender and age (P

Objectives: The elderly population is increasing globally and as the age increases and the functions of some organs decrease, some problems in elderly age, including sleep problems increase. Sleep disturbances cause neurological, autonomic, and biological changes. Therefore, attention should be paid to the problems that eliciting for the elderly and their families subsequently. The aim of this study was to evaluate the effect of oil on lemon on sleep disorders in the elderly. Methods & Materials: The study is a stratified design with IRCT2016061528485N1 registration Code and IR.USWR.REC.1395.50 Code of Ethics approved by the Ethics Committee of the University of Social Welfare and Rehabilitation Sciences. A total of 93 subjects (45 men and 48 women) were enrolled in the intervention, 22 men in the intervention group, 23 in the control group, 24 in the intervention group and 24 in the control group. Of these, 85 participated in the third stage of the intervention, 43 women (51%) and 42 men (49%), 41.17% in the age group of 74-60 years and 58.82% in the age group above 75 years. The Mean±SD age of the elderly was 75.88 ± 9.19 years, with the lowest age of 61 years and the highest age of 94 years. Outbreaks were hospitalized, departures and deaths. After completing an examination, a score of more than 5 Pittsburgh questionnaires, a visit by a psychiatrist and a self-reported sleep disorder, and considering the medical records, consumables , and entry criteria they were studied according to the randomization tables and divided into intervention and control groups. Validity and reliability of Pittsburgh questionnaire have been studied in various research. The intervention group received oil from the lemon and the inactive oil control group for four weeks, once daily, twice daily in the morning and night, with a drop per nose. No specific side effects were reported. In 3 cases, mild headache was reported, which was associated with a history of sinusitis, and the intervention was either performed or excluded from the tampon. Results: At the beginning of the study, demographic questionnaires, Pittsburgh Sleep Quality Index, and then Pittsburgh Questionnaire 2 and 4 weeks after the beginning of the intervention, were again asked by interview method and the data were analyzed by SPSS v. 23. The tests were one-way variance analysis, follow-up tests, independent samples T and single-sample t-test. Conclusion: Based on the results of the study, the oil to lemon has been shown to improve the sleep disorders of the elderly in the intervention group (P 000.03) and Effect size = 0.155). Sleep disturbances The intervention group improved in the second week and the fourth week after the onset of intervention compared to the control group

Background: Responsiveness as a non-medical, non-financial goal of the health system is of special importance to people with physical disability. The current study assessed the experiences of people with physical disabilities when they encounter rehabilitation centers in Tehran.Methods: This cross-sectional study was conducted in Tehran, the capital of Iran. The sample consisted of 610 people with physical disabilities referred to 10 comprehensive rehabilitation centers (CRCs) selected by Quota sampling. Data were collected by a standard responsiveness questionnaire proposed by the World Health Organization (WHO) and were analyzed by a standard protocol. Blinder-Oaxaca analysis was done to explain the inequality in performance of public and private sectors.Results: Study participants included 298 (48.7%) women and 312 (51.3%) men. The mean age of the respondents was 46.3 (SD = 14.3) for women and 45.6 (SD = 15.4) for men. Prompt attention (33.3%) and confidentiality (1.3%) were the most and least important reported domains, respectively. Overall poor responsiveness was reported by 20.9% of respondents. Private rehabilitation centers showed significantly better performance in communication, basic amenities and autonomy compared to public centers (P ≤ 0.05). Perceived social class explained 76% of the inequality in autonomy in the private and public sector (P ≤ 0.05).Conclusion: Improving overall responsiveness in domains that are of high importance from the respondents' viewpoint but are performing poorly—areas such as prompt attention and basic amenities—is essential. Additionally, interventions are needed to improve the performance of the public centers and providers in the areas of participation of service users in all social classes in their rehabilitation decisions and procedures, clear communication, and basic amenities.

Objective: Responsiveness refers to meeting the legitimate expectations of people who interact with the health system. This study aimed to assess the presence of any inequality in responsiveness based on the different sociodemographic groups. Methods: This cross-sectional study was carried out in Tehran. A total of 610 people with a physical disability from 10 comprehensive physical rehabilitation centers (5 public and 5 private) were included in the study through quota sampling. Data were gathered using the World Health Organization Standard Responsiveness Questionnaire and a sociodemographic checklist. Relative inequality indices were used for the analytical statistics. Results: Study respondents between 18 and 59 years and those equal to or older than 60 years formed 78.1% (475/610) and 21.9% (133/610) of the total study sample, respectively. The study sample consisted of 298 (48.7%) women and 312 (51.3%) men, and their mean age was 46.4 and 45.6 years, respectively. No significant inequality was found in responsiveness of total centers based on the socioeconomic status of the study participants. However, in the private comprehensive physical rehabilitation centers, significant inequality was found in responsiveness based on residential area per capita, with more reporting of poor responsiveness by people with physical disability in the lower residential area per capita quintiles (Wagstaff index [WI] = −0.262; P = .01). Inequality in responsiveness was also found in the public centers based on education level, with poorer experience in people with higher level of education quintiles (WI = 0.163; P = .02). Conclusion: In the private sector, economic issues are the main reason for the poorer experiences. Furthermore, residential area per capita showed to be a more sensitive index among economic indices to measure inequality. In public sector, education level was the key social factor. More attention and interventions need to be implemented by mid-level policymakers and rehabilitation service providers to meet the needs of people with physical disability.

Network scale-up is one of the most important indirect methods of estimating the size of clandestine populations and people with high-risk behaviors. The present study is an indirect estimation of the population size of students with high-risk behaviors in select universities of medical sciences.A total of 801 students from two University of Medical Sciences at Tehran and Alborz University of Medical Sciences were selected through convenience sampling. Six subgroups of high-risk behaviors were examined in the study, including Tramadol use, cannabis use, opium use, alcohol consumption, extramarital heterosexual intercourse, and heterosexual intercourse in return for money. To estimate the social network size in the study population, each participant was asked to name their close student friends from the two select universities. Data were collected using a checklist designed for this purpose.The participants' mean number of close friends from the selected medical universities was C = 8.14 (CI: 7.54-8.75). Within these social networks, friends with extramarital heterosexual intercourse (5.53%) and friends who consumed alcohol (4.92%) had the highest frequency, and friends who used opium (0.33%) had the lowest frequency. The variables of age, gender, marital status, type of residence and academic degree were significantly related to the likelihood of having close friends with certain high-risk behaviors (P

INTRODUCTION: Various programs are implemented internationally to promote the mental and social health of the students in schools. This study systematically reviewed and categorized all resources, indicators, and criteria for evaluating mental and social programs of schools. MATERIALS AND METHODS: This systematic review was conducted by collecting data from the PubMed, Google Scholar, Scopus, ProQuest, and Web of Science databases using the keywords of “evaluation, mental health program, social health program, behavioral and emotional program.” In the initial review, 4295 studies were found, which reduced to 75 after removing the repetitions and evaluating the studies' quality. The articles were selected using the PRISMA chart. RESULTS: The findings resulted in three main categories of structure, process, and outcome; 16 subcategories; and 166 codes. The category of structure included the subcategories of human resources, physical space, facilities, training, needed committees and teams, financing, and implementing mental and social programs. The subcategories of process category were functional indicators, guidelines and protocols, communication, documentation, planning/coordination, time management, and monitoring. The subcategories of behavioral-therapeutic, satisfaction, and educational outcomes were associated with the outcome category. CONCLUSION: Application of the structure, process, and outcome indicators, derived from the findings of this study, will greatly improve evaluation of the international mental health programs in schools.

Background: The present study focuses on comparing the effects of home-based (HB) and group-based (GB) physical activity on mental health in a sample of older adults in Shahr-e-kord. Methods: In this quasi-experimental study, a twice-weekly physical activity program for 2 months was provided either individually at home or in a group format for 181 people who were divided into two groups (HB and GB). The outcome, mental health, was measured with the 28-item General Health Questionnaire (GHQ-28). Results: Mental health status improved after participation in the physical activity program. The decrease in GHQ-28 total score in GB group, 3 months after intervention, was 3.61 ΁ 2.28 (P < 0.001). In HB group, this reduction was 1.20 ΁ 2.32 during the same period (P < 0.001). The difference of these "before-after differences" between the two groups in the GHQ-28 and all its subscales was statistically significant (P < 0.001). Also, the effects of GB physical activity on mental health compared with HB physical activity, adjusted for related baseline variables, were significant. Conclusions: These findings reveal the probable effects of GB rather than HB physical activity on mental health among the elderly.

PURPOSE: To evaluate the safety and efficacy of pediatric percutaneous nephrolithotomy (PCNL) using adult sized instruments in the management of pediatric urolithiasis. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 38 children younger than 15 years who had undergone 45 PCNLs with adult sized instruments in our center between August 2007 and February 2010. RESULTS: There were 26 boys and 12 girls, with a mean age of 8.4 ± 4.24 years (range, 12 months to 13 years). Twelve patients had complete staghorn stone. Mean stone burden was 2.93 ± 0.89 cm. The tract was dilated between 26 and 30 F. Standard PCNL was performed in 8 patients and tubeless PCNL in the next 37 subjects. Simultaneous transurethral lithotripsy was done in 9 patients. Stone clearance rate was 67%. Mean pre and postoperative hemoglobin levels were 12.67 ± 1.7 and 11.39 ± 1.6 g/dL, respectively. Mean hospitalization was 3.5 ± 1.1 days. Eight subjects had postoperative fever beyond day 1. Blood transfusion was required in only one patient. In one patient (3 years old) with a staghorn stone, hyponatremia and seizure occurred, which were treated consevatively without any adverse sequela. There was a significant difference in hospital stay between tubeless and standard PCNL groups (P < .02). CONCLUSION: We concluded that PCNL using adult sized instruments was relatively safe in children, with a clearance rate of 67%. We suggest prospective randomized studies to compare mini-perc and adult sized instruments use in pediatric PCNL.

Background: The aim of the study was to evaluate potential risk factors of children mortality between 1-59 months of age. Methods: This nested case-control study was conducted among children born from June 1999 to March 2009 in rural areas of Shahroud, located in the central region of Iran using health care visit reports and follow-up data available in household health records. Results: Mortality was significantly associated with breastfeeding duration (OR: 0.87, 95% CI: 0.81-0.93), total health care visits (OR: 0.90, 95% CI: 0.83-0.98) and low birth weight (LBW) (OR: 7.38, 95% CI: 1.37-39.67). Conclusion: In our study, a longer breastfeeding period and more frequent health care visits were two important protective factors, while LBW was an important risk factor for 1-59 month child mortality. It seems, that complex and multiple factors may be involved in mortality of under 5-year-old children, so combined efforts would be necessary to improve child health indicators.

Network scale-up is an indirect method for estimating the size of hidden, hard-to-count or high risk populations. Social network size estimation is the first step in this method. The present study was conducted with the purpose of estimating the social network size of the Tehran Province residents and its determinants.Maximum Likelihood Estimation was applied to estimate people's network sizes by using populations of known sizes and the scale-up method. Respondents were selected from Tehran province through convenience sampling in 2012. Out of thirteen selected subpopulations with known size, ten had minimum accuracy which used in our analysis.Of the 1029 respondents in this study, 46.7% were male. The social network size of Tehran Province residents was estimated to be 259.1 (CI95%: 242.2, 276) based on the ten known populations remained in this study. This size was 291.8 in men and 230.4 in women. Younger people (18-25 years old) had larger network sizes compared to the other age groups (P