Journal of School of Public Health and

---

Background and Aims: 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.
Materials and Methods: 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).
Results: 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).
Conclusion: 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.

---

Background and Aim: Premenstrual Syndrome (PMS) is experiencing some physical and psychological symptoms in the last days of the menstrual cycle; it interferes with educational, social and family functioning, creating problems for the adolescents. The objective of this study was to determinee the effectiveness of a transdiagnostic treatment program on anxiety, depression and stress in female adolescents with premenstrual syndrome and their mothers' quality of life.
Materials and Methods: This experimental study was conducted on 26 female adolescents with PMS referring to two health centers in Tehran, Iran in 2019. They were divided randomly in 2 groups, namely, an intervention (n=12, attending six 90-minute session per week‎) and a control (n=14) group. Data were gathered using the WHO Quality of Life, Beck depression, the DASS and PMS Screening Tool (PSST) questionnaires initially and after one month. The repeated ANOVA test was used for data analysis using SPSS software version 21; a p-value of <5% was considered to show statistical significance.

Results: As compared to the control group, at the end of the period the intervention group showed a statistically significant decrease in the means of the three variables of depression, anxiety and stress (p <0.05). The decrease significantly improved the quality of life of the mothers.

Conclusion: The findings of this study show that a transdiagnostic treatment program can be an effective method to reduce the psychological problems of adolescent girls and improve the quality of life of their mothers.

---

Background and Aim: Social health is one of the most basic criteria of social well-being and an effective factor in improving the quality of life of any society. .In Iran, the Office of Mental Health, Social Health and Addiction (OMSHA) is responsible for planning, implementing, monitoring and evaluating social health programs. The purpose of this research was to criticize and assess the contents of the social health component of the primary health care (PHC) system in an attempt to revise the contents.
Materials and Methods: The method used in this study was the deconstruction method. The research environment was all the contents of the social health component provided by OMSHA, and in order to obtain precise data the entire statistical population was taken as the study sample.
Results: In general, data analysis indicated the following: inappropriate screening, cultural adaptation, unidimensionality, role and responsibility adaptation, the preference of treatment to prevention, updating, comprehensiveness and adequacy of basic contents, and comprehensiveness and adequacy of practical suggestions.
Conclusion: It can be concluded that revision of the contents of the social health component of the Office of Mental health, Social Health and Addiction is a necessity in order to improve the delivery of mental health services..
 

---

Background and Aim: Tobacco use, narcotics, drug abuse, consumption of alcohol, having unsafe sexual relations and other such behaviours are risky behaviors that tend to cause great concerns in families. Parents try to cope with high-risk behaviors through care strategies. The purpose of this research was to determine the typology of strategies for taking care of risky behaviors based on to the family socioeconomic status (SES).
Materials and Methods: This was a quantitative descriptive-correlational research including all the urban families of Tabriz, Iran, from among whom a sample of 384 families was selected by the multi-stage cluster method. Two measurement tools (checklist for high-risk behavior care strategies and a family SES questionnaire) were used to gather data, the one-way analysis of variance (F) test and linear regression being used to determine the relationships between the variables.
Results: The means of strategies for taking care of risky behaviors were significantly different based on the SES of the family, the upper classes adopting a more appropriate (procedural) strategy to take care of children against risky behaviors than the lower classes. Conclusion: Families with a medium and low SES use ineffective care strategies (inefficient and momentary) to cope with risky behaviors. In order to improve the public's health, it is necessary to adopt prevention-based cultural-educational policies to transform ineffective care strategies to procedural strategies.                        
 

---

Background and Aim: The objective of this study was to gain a deep understanding of the importance (expected services) and performance (services provided) of mental health services to determine the priority indicators of mental health to help design higher quality and more effective community mental health interventions.
Materials and Methods: This was a mixed-method study including all the mental health executives and practitioners (n=998) in Iran. In the quantitative part, the Importance-Performance Analysis (IPA) model was used to determine the importance and performance of the current mental health programs in the primary health care (PHC) system, and in the qualitative part complementary explanations were analyzed using the thematic analysis method.
Results: The findings show that there were gaps between the expected services and the services provided in the mental health program. Thus, the following points should be taken into account to be able to improve the mental health services: 1. Strengthening the domestic violence prevention program as regards spouse misbehavior and misbehavior towards children; 2. Continuation of lifestyle skills and parenting programs, 3. Self-care in mental health and drug use programs; 4. psychiatric disorders diagnosis and care and a healthy adolescents program is desirable and necessary, but revising and modifying the suicide prevention program (as regards costs and treatment) are essential. 5. In addition, the psycho-social intervention programs in disasters, addiction harm reduction program, strengthening family foundation and the Competent Family Program are of low importance in formulating a strategy.
Conclusion: Corrective actions based on the prioritizations determined can be included in the working agenda of the managers of mental health care systems at the primary levels to improve the quality of mental health services.
 

---

Background and purpose: The purpose of this research was to  write a critical review of the available service packages in the Mental and Social Health and Addiction Office (MSHAO) of the Ministry of Health and Medical Education in the areas of drugs, alcohol and tobacco, which are currently used in the primary health care system. The content analysis method was used to extract the specialists’ critiques.
Materials and Methods: Initially the MSHAO sent 1362 pages of information in the form of 47 files to researchers to be reviewed. The files were classified, eliminating/removing additional, unrelated and duplicated items; finally 840 pages in 29 files were studied and carefully examined. Then, seven experts in the field of addiction were asked to criticize the packages, using the content analysis method to extract the experts' critiques.
Results: The findings showed that comprehensive information about drugs, alcohol and tobacco addiction is provided to the clients. However, based on a critical review of the existing packages four main critiques were extracted, namely, sources/references, epidemiology, incompatibility of Iranian-Islamic culture, and technical-specialist issues. In addition, criticisms were also extracted in the following areas/services: the number of files and the variety of interventions, editing and writing problems, interventions and discussions with inappropriate in-text sources/citations, some old sources/references (published in 2013 and 2014), old interventions, lack of appropriate compatibility with the culture of the Islamic society of Iran, and direct translation of some parts of the original texts and documents of international meetings/gatherings.
Conclusion: Despite the efforts of the Mental and Social Health and Addiction Office to cover the needs of the majority of people referring to the primary care system, it seems that the high number of interventions and additional information can cause confusion of/for the physician, mental health care provider, family health care provider, general health care provider and other relevant individuals. It is, therefore, suggested that some packages be merged with each other, duplicate items be removed and specific sections be added, some packages be fundamentally revised based on the suggested items, and updated packages be developed with due consideration of  to the culture of the Iranian society.
 

---

 Background and Aim: Available evidence shows the effectiveness of psychotherapy. However, the number of patients who deteriorate or do not improve is still problematic. On the other hand, while some therapists are generally more successful than others, most therapists have experienced both success and failure of therapy in different cases. The purpose of this study was to determine the factors effective in psychotherapy from the perspective of therapists and clients.
Materials and Methods: Based on the purpose of this research, it can be considered as an applied research and qualitative in nature. Data were collected through interviews and analyzed using the content analysis method based on the analogical approach. The samples of therapists and clients were selected purposefully from the statistical population including 1. Therapists (psychiatrists, psychologists and counselors) licensed by the Psychology and Counseling Organization with 5 years or more of therapy experience, and 2. Clients who had participated in at least one psychotherapy course. The sample size was based on theoretical saturation and, therefore, the interview process continued until ensuring sufficiency of the collected data; thus the interviews ended with the 21st person in the therapists group and the 15th person in the clients group.
Results: The factors in effective treatment were found to be in three areas, namely, the therapist (attitude, competence, personality, maturity, ability and appearance), the client (demographic characteristics, reason and method of referral, insight), and environmental factors (economic, socio-political issues, location of the psychological center, supporting problems, and daily living events of clients and therapists).
Conclusion: The findings of this research show the components and importance of the model of effective factors in effective psychotherapy to policy makers, trustees, professors and therapists in the field of mental health. The achievement of these components can increase the efficiency of the therapists in achieving their goals and also help a clients to choose a therapist.
 

---

Background and Aim: Despite the importance of reproductive health and the utilization of contraceptive methods, their significance in public health and well-being is not yet fully understood in developing countries. It is expected that significant changes in Iran's family planning policy, coupled with the emergence of Covid-19, have influenced the contraceptive methods employed in the country.
Materials and Methods: This research was a cross-sectional study including 1200 married women of reproductive age using a quantitative survey method in Shiraz city, Iran in 2019. Sampling was done using a combination of multi-stage and systematic random classification methods. Data collection was done through a researcher-made structured questionnaire and analyzed using the SPSS software, the statistical tests being chi-square tests and multiple logistic regression.
Results: The main predictors of using contraceptive methods included women's age, actual fertility, ideal fertility, education level of the couple, and the employment status of the couple. After the Covid-19 pandemic there was an increase in the likelihood of utilizing traditional contraceptive methods.
Conclusion: Based on the findings of this study, considering the notable preference among women for traditional contraceptive methods, particularly during epidemics, it is imperative to educate them about the problems associated with these methods. As traditional contraceptive methods can result in unintended pregnancies, educating women about these methods should be integrated into population policies.
 

---

Background and Aim: Adolescence is a period of rapid biological, cognitive and neurological changes. The aim of this research was to conduct a cultural critique of the educational package of intra-family and extra-family communication for adolescents, which was implemented as part of the mental health services within the health network and based on Iranian-Islamic culture.
Materials and Methods: This qualitative study utilized the theme analysis method developed by Brown and Clark in 2006. The study population comprised all mental health contents within the health network. Targeted sampling was used to investigate the content related to communicating with adolescents. Data analysis involved the use of theme format analysis, theme network, and comparative analysis.
Results:  Data analysis resulted in the extraction of 30 primary, 4 secondary and 2 overarching themes. The secondary themes included respect for parents, social norms, moral norms and a lack of cultural norms, while the overarching themes included values and norms.
Conclusion: The findings of this study highlight the need to revise and rewrite the content of the family foundation-strengthening program for parents and adolescents.
 

---

Background and Aim: The suicide is one of the threatening topics for the health general of society, and spiritual health and ego strength strength are among the factors that can be effective in reducing it. Therefore, this study aimed to the causal modeling of suicidal psychopathology based on spiritual health and ego strength.
Materials and Methods: The present study was descriptive-correlation. The statistical population included all individuals with a history of suicide registered in the site of the Payesh Center in Shiraz University of Medical Sciences (SUMS) in the first half of year 2022. Among them, 210 people were selected by purposive sampling and they answered the Inventory of Motivations for Suicide Attempts (May & Klonsky, 2013), Spiritual Wellbeing Scale (Paloutzian & Ellison, 1982), and Psychosocial Inventory of Ego Strength (Markstrom, 1997). Data were analyzed using path analysis of structural equation in SPSS₂₃ and Amos₂₄ softwares.
Results: The findings showed that direct effect spiritual health (negatively) on suicidal psychopathology is significant (p <0.05). Also, the results of the mediating role of ego strength showed that ego strength have a significant mediating role between spiritual health and suicidal psychopathology (p <0.05).    
Conclusion: The results of this study showed that the spiritual health directly, and ego strength indirectly has been effective on the suicidal psychopathology. Therefore, it is suggested that mental health clinics pay attention to their spiritual health and ego strength in review suicidal psychopathology of individuals with a history of suicide.  
 

---

Background and Aim: Deficits in inhibitory control can lead to numerous problems, including academic, social, and occupational difficulties, and may also affect psychological and neuropsychological functions. This study aimed to examine the role of cognitive inhibition in the psychological symptoms of mothers of children with attention-deficit/hyperactivity disorder (ADHD) in 2024.
Materials and Methods: Ninety-three mothers were selected through convenience sampling. After obtaining informed consent, participants were assessed using the Stroop Color–Word Test and the SCL-90-R questionnaire. Data were analyzed using Pearson’s correlation and multivariate analysis of variance (MANOVA) with SPSS version 26.
Results: Correlation and MANOVA results indicated that inhibitory control performance had a strong and significant association with the depression, anxiety, and phobic anxiety subscales (p < 0.001). The observed effect sizes (ranging from 0.39 to 0.67) highlighted the influential role of inhibition as a key underlying mechanism in explaining the variance of these symptoms. No significant relationships were found between inhibition and the other SCL-90-R subscales.
Conclusion: Optimal performance of neuropsychological functions, particularly inhibitory control, can play a vital role in mental health. Accordingly, interventions based on cognitive inhibition training are recommended.