Psychosocial challenges of social reintegration for people with spinal cord injury: a qualitative study.

STUDY DESIGN: Qualitative study, using in-depth, and semi-structured interviews. OBJECTIVE: To identify the psychosocial challenges of social reintegration for people with spinal cord injury (SCI) in Iran. SETTING: People with SCI living in the community in Iran. METHOD: Eleven individuals with SCI with a median time since injury of 12 years (between 9 and 20 years), two family members, and three specialists (two social workers and one physiotherapist) were selected by purposive sampling with maximum variation. In-depth and semi-structured interviews were conducted and finally the data analyzed through qualitative content methodology. RESULTS: The psychosocial challenges were categorized into four main categories and twelve subcategories: early crises (denial and disbelief; feelings of isolation and depression; dependency crisis; and a sudden change in the normal course of life), disabling society (stigma; discrimination; employment challenges; and educational restriction), environmental barriers to access (lack of barrier-free environments and transportation challenges), and inappropriate services delivery (incomprehensive rules and lack of specialized training). CONCLUSIONS: Providing various psychosocial services is essential for the social reintegration of people with SCI. This goal could be achieved by the provision of medical and physical rehabilitation services. The ultimate purpose of rehabilitation is to reintegrate individuals into society after injury or illness; thus, psychosocial issues must also be considered to ensure effective rehabilitation.

Well-Being and Coping Capacities of Adolescent Students with Hearing Loss in Mainstream Schools.

OBJECTIVES: Coping strategies used by adolescents has an important role in preventing or decreasing their stresses and also increasing their well-beings. This study aimed at evaluating the coping capacity and well-being of adolescent students with hearing loss in mainstream schools and also the correlations between their coping strategies and positive characteristics of well-being (engagement, perseverance, optimism, connectedness and happiness (EPOCH). MATERIALS & METHODS: In this correlational study, 122 adolescent students with hearing loss were randomly selected from mainstream schools. Data collection was done by EPOCH Measure of Adolescent Well-Being and the Ways of Coping Questionnaire (WAYS). The Spearman correlation coefficient was used for determining the correlations between variables. RESULTS: The mean scores of using different coping strategies varied from 1.36 in problem solving to 1.44 in seeking support. Among the positive characteristics of well-being, happiness had the lowest (11.04) and connectedness showed the highest score (12.33). The findings also showed a significant correlation between all coping strategies and EPOCH, however there was a strong positive correlation between total coping strategy score and perseverance (0.648) and happiness (0.629). CONCLUSION: Based on the results, the score of happiness in students with hearing loss was the lowest among positive characteristics of well-being and also happiness showed a strong association with total scores in coping strategies. Accordingly, interventional studies are needed to examine whether training students with hearing loss to use coping strategies is effective in increasing their happiness and overall well-being.

Randomized trial of a resilience intervention on resilience, behavioral strengths and difficulties of mainstreamed adolescent students with hearing loss.

OBJECTIVES: Adolescents with hearing loss have shown emotional and behavioral difficulties. This study evaluated the effectiveness of a resilience-focused intervention on resilience, behavioral strengths, and difficulties of mainstreamed adolescent students with hearing loss. METHODS: In this experimental study with a pre-test, post-test, follow up, and control group design, a total number of 122 students with hearing loss, were randomly assigned to two equal groups. The intervention group received training in small groups of 3-5 self-contained classes for six weeks (two times per week for 75 min). The "Connor-Davidson Resilience Scale" and the "self-report version of Strengths and Difficulties Questionnaire (SDQ)" were used to measure the resilience and the positive and negative behavioral attributes of participants prior to intervention, then repeat of 6 and 14 weeks later. The scores were compared between intervention and control groups using the Mann-Whitney Test. RESULTS: After the intervention, the resilience scores in the intervention group was significantly higher than the control group (U = 831, p < .001). Also, the SDQ score in the intervention group was significantly higher than the control group (U = 634, (p < .001). Negative behavioral attributes (total SDQ scores, and sub-scales scores of hyperactivity, emotional, conduct, and peer problems) were decreased, and prosocial behavior was increased significantly in the intervention group (p < .001). All of the differences remained through follow-up measurement except for the subscale of conduct problems. CONCLUSION: The twelve sessions of resilience-focused intervention led to a marked increase in resilience. It also is effective in decreasing the behavioral difficulties of adolescents with hearing loss and is suggested to apply for students with hearing impairment integrated into middle schools.

The Effectiveness of a Resilience Intervention Program on Emotional Intelligence of Adolescent Students with Hearing Loss.

Adolescents with hearing loss have been shown to have some emotional difficulties. This study investigated the effectiveness of a resilience training program on the emotional intelligence of mainstreamed adolescent students with hearing loss. In this experimental study, a pre-test, post-test, follow up and control group design was implemented. After receiving informed consents, 122 students with hearing loss in mainstreaming settings were randomly assigned to intervention and control groups (61 students in interventional group and 61 in control). The interventional group received training in groups of 3 to 5, for 6 weeks (two times per week for 75 min). The intervention focused on feelings, thinking (positive, negative) and outcomes of negative thinking, coping strategies, strengths and weakness, problem solving, communication skills, social skills, negotiation, despising and ridiculing, intra- and interpersonal skills. The Connor-Davidson resilience scale (CD-RISC) and the Schutte Emotional Intelligence Scale were used to measure the resilience and the emotional intelligence (EI) of participants respectively just before intervention, as well as at the 6- and 14-week marks. The Friedman Test was used to compare changes in emotional intelligence between interventional and control groups. The intervention increased the resilience scores by 20 points. Although the EI of both groups were similar at the beginning of the research, there was a significant difference between the control and interventional groups in emotional intelligence and its aspects after intervention, at the 6-week and 14-week measurements (p < 0.001). The effect size was 1.5 for the EI total score. The 6-week resilience training program was very effective at improving emotional intelligence and could be readily used to help students with hearing loss improve their emotional abilities.

Early storybook reading and childhood development: A cross-sectional study in Iran.

Background: Development is a process that continues from childhood to death, and most developmental changes occur during childhood. UNICEF introduced early storybook-reading (ESR) and storytelling as part of child care indicators. The aim of this study was to investigate the status of book-reading to children and its relationship with early childhood development in Iran. Methods: This is a descriptive-analytic study conducted in Tehran April-May 2017. In total, 272 mothers of children aged 3-30 months, who were referred to health centers, were selected using a convenience sampling method. Exclusion criteria was scoring below the cutoff point of any developmental domains of the Ages and Stages Questionnaire (ASQ). ESR was assessed by checklist and child development was assessed by the ASQ. Data were analyzed using SPSS. Results: The mean number of children's books owned was 10.23±8.642, and 84.75% had at least 3 books. The average book reading, storytelling and singing duration for children was 10±9.65, 11.48±11.756, and 23.88 ±17.880 min per day, respectively. Average book reading, storytelling, and singing duration was significantly greater in children 18-30 months than <17 months. There was a significant relationship between the number of books and a child's age, mother's age, family income, income satisfaction, father's employment, and parents' education. The score of communication domain in the ASQ questionnaire was significantly related to the number of books, duration of reading and storytelling, while problem-solving had a significant relationship only with the number of books (p˂0.05). Based on linear regression, child's age, income, and mother's and father's educational level were models for predicting the number of children's books (p=0.0001 for all). Conclusions: ESR was associated with some developmental domains of communication and problem-solving in the present study. Therefore, creation of ESR culture in Iranian families as an integral part of the life of children is necessary from birth.

Early Childhood Development and Iranian Parents' Knowledge: A Qualitative Study.

BACKGROUND: Early childhood is the most important step throughout the lifespan and it is a critical period continuing to the end of 8-year-old. Mothers' knowledge is one of the important aspects of child development. The goals of this study were to determine the situation of knowledge in Iranian parents about the concept and the importance of early childhood development (ECD) and determining the sources of parental knowledge about ECD from the perspective of parents and grandparents. METHODS: This qualitative study was conducted based on the directional content analysis in 2016. The purposive sampling method is utilized to select 24 participants among parents and grandparents in Tehran. The inclusion criteria consisted of speaking in Persian and having a child or grandchild <3-year-old. Data were collected through four focus group discussions and four individual interviews. RESULTS: Iranian parental knowledge about integrative ECD is not enough, their knowledge about motor development and speech and language are relatively better, about cognitive development is little and socialemotional is very little. They said parents and other caregivers influence the process of children's development. Parents' knowledge resources about ECD included human resources, physical resources, virtual space, and the media. According to the majority of participants, "pediatricians are the most reliable source of parents' knowledge about ECD" even though the main focus of pediatricians is on treating diseases, physical health, and growth of children. CONCLUSIONS: According to the results, the knowledge of Iranian parent is not enough about ECD; therefore, actions must be taken to increase their knowledge in these domains. Parents look for reliable and valid sources to enhance their knowledge and they rely the most on pediatricians in this regard. Therefore, more studies on assessing parents' knowledge in community and the practical methods for knowledge promotion in this field is recommended.

Feasibility of Telerehabilitation Implementation as a Novel Experience in Rehabilitation Academic Centers and Affiliated Clinics in Tehran: Assessment of Rehabilitation Professionals' Attitudes.

Introduction. This study aimed to assess rehabilitation professionals' attitude toward implementation and application of telerehabilitation technology as a novel study in rehabilitation academic centers and affiliated clinics in Tehran. Methods. It was a descriptive cross-sectional study. To collect data, a researcher-designed questionnaire was developed. 141 rehabilitation experts participated in the study. Results. A majority of faculty members (78%) and clinicians (89.7%) either were in "definite agreement" or "somewhat agreed" with implementation and application of this technology, which demonstrates an overall positive attitude. Discussion. Based on the positive attitudes of the majority of participants toward implementation and application of this technology and their preferences in offering different telerehabilitation services, it seems that there is an appropriate and desirable acceptance and administrative culture to implement this technology among rehabilitation experts in Tehran. It is thus expected that implementation and application of this technology will be a promising experience in rehabilitation academic centers and affiliate clinics in Tehran.

The effect of social skills training on perceived competence of female adolescents with deafness.

BACKGROUND: Although there are considerable researches on effectiveness of social skills training, little information is available on the effects of such training on perceived competence of adolescents with deafness. OBJECTIVES: This study was conducted in special school settings to determine the effects of social skills training on perceived competence of female adolescents with deafness. PATIENTS AND METHODS: A prepost quasi-experimental design was used to perform the study. Sixty nine female students with deafness who were enrolled in all of the four different special secondary schools in Tehran, Iran, between 2010 and 2011 participated in this research. Two of four secondary schools were randomly allocated to the intervention group (33 students), and the other two to the control group (36 students). The participants were between 11 and 21 years (Mean = 15.43; SD = 1.89), and more than three fourth of each groups ( i.e. 28 students in each groups) were affected by profound hearing impairment . The intervention group participated in twelve bi-weekly sessions. Pretest and posttest data were collected using the 'Hearing Impaired Children Self-Image Test'. The questionnaire was filled by an interviewer. This questionnaire asks students about their feeling toward their own competence in domains of cognitive, physical, socio-emotional and communication competence and school adjustment. The data was analyzed by using SPSS software, version 16. RESULTS: The intervention led to significant improvement in total perceived competence scores of adolescents with deafness (P < 0.001) as well as in three domains of socio-emotional competence (P = 0.003), communication competence (P < 0.001), and school adjustment (P = 0.018). CONCLUSIONS: It is likely that learning social skills in adolescents with deafness would improve their sense of competence, and emotional well being.

Effects of folic acid on preschool children's appetite: randomized triple-blind clinical trial.

BACKGROUND: In recent years some Iranian pediatricians have used folic acid empirically as an appetite-enhancing drug in poor-appetite, low-weight children. Many parents have expressed their satisfaction with this treatment but until now no study has been done to confirm or exclude folic acid as an appetite enhancer. METHODS: In order to determine if complementary folic acid has any effect on preschool children's appetite, 61 3-5-year-old children (27 girls and 34 boys) whose weight/age and weight/height ratios were below the 25 centile and whose parents regarded them as having poor appetite were randomly assigned to receive either folic acid (1 mg/day) or placebo for 20 days. The primary outcome measures were any appetite changes during and 1 month after the end of the intervention, measured by means of a questionnaire completed by parents on the 20th and 60th days. Secondary measures were mean weight gain on the 30th and 60th days. RESULTS: Children who received folic supplement had a significantly better appetite on the 20th day than those who received placebo (mean difference of appetite score: 1.7; 95% confidence interval: 0.1-3.4; P = 0.04) and significantly more children receiving folic acid were reported to have increased appetite than the placebo group (P = 0.03). But 40 days after the end of the intervention there was no difference between the two groups. Weight gain did not significantly differ between groups. CONCLUSIONS: Although folic acid appears to improve preschool children's appetite, further study is necessary to determine whether it has any effect on growth as an adjunctive to management protocols of low appetite for undernourished children.