Assessing the impact of stigma reduction interventions in Iran: A qualitative study from the perspective of mental health stakeholders.

Introduction: The fear and embarrassment associated with stigmas discourage patients from help seeking behavior, which may explain why even the patients' loved ones advise them to discontinue treatment to avoid being labeled. In addition, stigmas can lead to personal and family issues, causing patients to disregard their illness. As such, their disease may develop into a chronic condition. This being said, the present study aims to investigate the challenges, solutions, and successes associated with stigmatization in Iran from the perspective of mental health stakeholders. Method: A qualitative study was conducted in the summer of 2022. Purposive sampling was utilized to recruit participants. The primary data collection method involved a focus group interview that lasted 110 min. The project manager monitored the interviews, and all research team members attended the meetings, took notes, and made the necessary preparations. After explaining the study's purpose and ensuring the data's confidentiality, the interviewer led a focus group discussion. The interviews were recorded with the participants' consent. A focus group was used to conduct interviews with 13 individuals until data saturation was reached. Findings: Ten psychologists, psychiatrists, and managers responsible for mental health, two patients, and one patient's family member participated in the current study as eligible participants. Repeated readings led to the emergence of three main classes under the headings of challenges, solutions, and successes of stigma management in Iran, each containing subclasses. Conclusion: The majority of the proposed solutions in this study centered on raising awareness and training diverse individuals and groups to lessen stigmas. The most crucial de-stigmatization measure is to offer training that will cause the current stereotypes to change. This must be taken by patients and their families as well as therapists, leaders, policymakers, the general public, and the media. Ideally, younger members of the target groups should be considered for these pieces of training, which must be based on research and derived from cultural and localized needs.

Mental health among Iranian combat veterans with ankle-foot neuromusculoskeletal injuries.

BACKGROUND: Veterans with purely physical disorders, such as ankle-foot neuromusculoskeletal disorders, are often neglected in psychological assessments because mental health evaluations are usually focused on those with a psychological disturbance or with a high percentage of injury. The purpose of this study was to evaluate the psychological condition of veterans with ankle-foot neuromusculoskeletal disorders. METHODS: A cross-sectional study was performed between 2014 and 2016 on veterans with war-related ankle-foot injuries living in two provinces of Iran. An information form for demographic data and injury-related factors was used. Additionally, the previously validated Persian version of the Symptom Checklist-90-Revision (SCL-90-R) questionnaire was used for data collection. RESULTS: The respondents were 215 male veterans with a mean age of 51.7 ± 7.5 years. The most common mental health problems were observed for the somatization (24.7%), obsessions-compulsions (14.4%), and anxiety (12.6%). Based on the Global Severity Index (GSI), 48.6% of individuals had a possible psychiatric/psychological illness. According to the multivariate regression analysis, GSI scores were significantly higher among veterans who were older than 27 years at the time of injury (P = 0.005), had an associated injury (P = 0.002), and had a history of hospitalization within the past 12 months for reasons other than their injury (P = 0.035). CONCLUSIONS: Approximately half of the combat veterans with ankle-foot neuromusculoskeletal disorders likely had psychological problems. The evaluation of the patterns and predicting factors of psychological conditions may inform strategic planning efforts and decision-making, which, in turn, may provide a better quality of life for veterans. Further studies that utilize longitudinal designs are needed to evaluate and compare the psychological status of different groups of veterans and other groups in the general population.

Ovarian Hemangioma: a Rare Case Report and Review of the Literature.

Ovarian hemangiomas are benign and rare tumors of female genital tract with less than 60 reported cases in the literature. A 38- yr- old woman was admitted to Be'sat Hospital, Tehran, Iran in 2012, due to severe abdominal pain. Ultrasound evaluation revealed a 6 cm left ovarian cystic mass and serum tumor markers were normal. Then, left salpingo-oophorectomy was performed for the patient. Microscopic examination revealed a follicular cyst and an incidental cavernous hemangioma consisting thin-walled vascular channels filled with blood that lined with flatten endothelial cells. In IHC staining strong immunoreactivity for CD31 and CD34 were seen, finally, the diagnosis of primary ovarian hemangioma, cavernous-type was made. The clinicopathologic presentation of this unusual benign tumor is discussed.

Middle Ear Salivary Gland Choristoma: A Case Report.

Salivary gland choristoma of the middle ear cavity is a very rare condition. These lesions are a result of a defective embryonic development and their adjacent structures may be associated with abnormalities. Here we report a case of salivary gland choristoma of the middle ear who presented to Be'sat Hospital, Tehran, Iran in 2015 with unilateral conductive hearing loss. There are 41 case reports in English and non-English literature from 1961. Taylor and Martin reported the first case of middle ear salivary choristoma.

Survival analysis and prognosis for patients with serous and mucinous borderline ovarian tumors: 14-year experience from a tertiary center in Iran.

The aim of this study was to determine the prognosis and survival for patients with borderlineovarian tumor (BOT). A retrospective review of 30 patients with serous andmucinous BOT treated at or referred to our institution was performed. Fifteenpatients (50%) had serous, and the others had mucinous BOT. About 86% of allpatients in both groups were in stage I of the disease. The recurrent disease occurredin 7% and 21% of serous and mucinous tumors, respectively. All recurrences,except one in mucinous tumors, were found in advance stage disease. After amean of 37 and 52 months follow-up, the overall survival was 100% and 93%, anddisease-free survival was 93% and 79% for serous and mucinous tumors,respectively. In this series, advanced stage was associated with poorprognosis. However, to obtain more accurate information further studies withnumber of patients and longer follow-up is recommended.

Association between iron deficiency anemia and Helicobacter pylori infection among children under six years in Iran.

This study was conducted to evaluate the association between H. pylori infection and Iron deficiency anemia (IDA) among preschool children (age range: 40-75 months) at a tertiary referral hospital in Tehran.In a case-control study, the prevalence of H. pylori seropositivity was compared between 64 children with IDA diagnosis and 70 healthy non-anemic sex- and age-matched controls. Totally, 52 (81.3%) children with IDA and 10 (14.3%) non-anemic controls had a positive antibody level for H. pylori specific IgG and the difference between two groups was statistically significant (P<0.0001). H. pylori infection had a significant high prevalence among preschool patients with IDA. Eradication of H. pylori infection is recommended for patients with refractory IDA.

Application of tumor markers SCC-Ag, CEA, and TPA in patients with cervical precancerous lesions.

BACKGROUND: To determine the potential clinical utility of tumor markers CEA, TPA, and SCC-Ag for early detection of cervical precancerous lesions. MATERIALS AND METHODS: A case-control study was carried out on 120 women (46 patients with histologically confirmed cervical precancerous lesions and 74 healthy controls). The significance of serum selected tumor markers in early detection of cervical intraepithelial neoplasia (CIN) were assessed. RESULTS: Of the case group, the rates of CIN I, II, III, was 69.6%, 23.9%, and 6.5%, respectively. According to the manufacturer's cut-off values of 2 ng/ml, 5 ng/ml, and 70 U/ml for SCC-Ag, CEA and TPA tests, in that order, SCC-Ag test had a sensitivity of 13%, but CEA and TPA tests could not distinguish between case and control groups. The diagnostic sensitivities were highest at cut-off values of 0.55 ng/ml for SCC-Ag, 2.6 ng/ ml for CEA, and 25.5 U/ml for TPA which were 93%, 61%, and 50%, respectively. However, the area under the receiver operating characteristic curve was the largest for SCC-Ag (0.95 vs. 0.61 and 0.60 for CEA and TPA, respectively). Moreover, there was a highly significant direct correlation between SCC-Ag concentration and the degree of cervical precancerous lesions (r=0.847, p<0.001). CONCLUSIONS: The new cutoff of 0.5 for SCC-Ag test might be useful as a tumor marker in Iranian patients with CIN and it needs to be more evaluated by studies with larger populationa.

Clients' Viewpoints about the Quality of Services in the Premarital Counseling Classes in Tabriz Health Centers.

BACKGROUND: Premarital counseling equips couples with information about all aspects of sexuality and the related health issues. This study was aimed to assess the quality of premarital counseling services in health care centers in Tabriz. METHODS: A cross-sectional study was conducted on 236 randomly selected women from premarital counseling centers in Tabriz was carried out and a self-structured instrument including items on demographic characteristics, the quality of counseling condition and providers, family planning, genetic and thalassemia counseling and sexual health was used for data gathering. RESULTS: The results showed that the viewpoint of clients about relationship with health care provider and condition of consultation was suitable in 75.8% and 85.2% of women, respectively. It was found that in 72.5%, 38.1% and 49.6% of clients the counseling areas were in moderate level respectively for counseling about importance of family planning, genetic counseling and thalassemia. It was indicated that 58.5% of participants expressed the sexual health aspect of the premarital classes as poor or completely poor. CONCLUSIONS: Our study results can provide suitable information for health policy providers to improve the quality of premarital counseling classes. In order to develop a relatively stable behavior in young couples, it is recommended that the quality of the classes would be overemphasized.

Histopathological findings of endometrial specimens in abnormal uterine bleeding.

PURPOSE: The aim of this study was to assess the frequency of different histopathological findings obtained from dilatation and curettage (D&C) specimens in patients with abnormal uterine bleeding (AUB). METHODS: In a retrospective review of 591 specimens, the included subjects were all women with AUB who underwent D&C between 2002 and 2006 in Be'sat Hospital, Tehran, Iran. The pathological diagnoses were analyzed in four groups from normal to malignant endometrium. The pathological groups were evaluated for patients' characteristics including demographic data and medical history. RESULTS: The majority of patients (61.6%) were in the 41-50 year age group. Totally, 81.4% of patients had normal pathology. The disordered proliferative endometrium/polyps, hyperplasia, and malignant pathology were found in 15.4, 2.5, and 0.7% of specimens, respectively. The abnormal pathologies were seen more among patients with postmenopausal status, nulli-/primigravid women, and those with hypertension, diabetes, hypothyroidism, and polycystic ovary syndrome. CONCLUSIONS: The proliferative endometrium and secretory endometrium were the most common histopathological observations in AUB patients in our region, and except normal endometrium, disordered proliferative endometrium was the most common cause of AUB.

Quality of life and its related factors among Iranian cervical cancer survivors.

BACKGROUND: Cervical cancer is the main cause of malignancy-related death among women living in developing countries. OBJECTIVE: The aim of this study is to evaluate the quality of life (QOL) among Iranian cervical cancer survivors and its relationships with demographic and disease related factors. PATIENTS AND METHODS: A descriptive correlational study was carried out on 65 consecutive cervical cancer survivors in three different oncology centers related to Shahid Beheshti University of Medical Sciences, Tehran. The QOL was evaluated using three different standard questionnaires: 1) EORTC QLQ-C30 for patients with malignant tumors; 2) EORTC QLQ-CX24 for cervical cancer patients; and 3) SSQ for assessing the social support. The data was obtained by telephone interviews. The test-retest reliability and internal consistency of the scales were examined. Cronbach's alpha was calculated to assess internal consistency among items. Content validity was assessed to review the scales. RESULTS: Cervical cancer survivors stated a good QOL. However, its score was negatively associated with symptoms including short breathing, lack of appetite, nausea and vomiting, sleep disorders, peripheral neuropathy, and menopausal symptoms. Also, there was a positive association between QOL and economic conditions as well as QOL and social functioning. CONCLUSIONS: Although, the QOL in cervical cancer survivors was good, treatment of related symptoms can influence the QOL and improve the care of these patients.

The effect of oral evening primrose oil on menopausal hot flashes: a randomized clinical trial.

PURPOSE: Hot flashes are common experience for menopausal women, and for many, are severe enough to significantly compromise their overall sense of well being and quality of life. The aim of this study was to compare the efficacy of evening primrose with placebo in improvement of menopausal hot flashes. METHODS: In a 6-week randomized clinical trial, a total of 56 menopausal women aged 45-59 years were participated in this study. The patients were asked for their hot flashes characteristics and responded to HFRDIS (hot flash related daily interference scale) questionnaire before and after the intervention. The participants were randomly assigned to take two capsules per day (totally 90 capsules for 6 weeks) of placebo or evening primrose (500 mg) for continuous 6 weeks. Then, the improvement in hot flashes was compared between two groups. RESULTS: The percent of improvement in hot flash frequency, severity and duration were 39, 42 and 19 %, in evening primrose group compared with 32, 32 and 18 % in placebo group, respectively. Although all three characters of hot flash was ameliorated in evening primrose arm, only its severity was significantly better in this arm compared with placebo group (P < 0.05). All HFRDIS score were significantly improved in two groups, but the percentage of improvement in social activities, relations with others, and sexuality was significantly superior to placebo group (P < 0.05). CONCLUSIONS: The application of oral evening primrose oil compared with placebo for controlling hot flashes may decrease more the intensity of attacks as well as ameliorating the HFRDIS score.

Latent and active tuberculosis: evaluation of injecting drug users.

BACKGROUND: There is a high risk of tuberculosis (TB) infection among injecting drug users (IDUs). OBJECTIVES: This study aimed to determine the frequency of latent and active TB infection among IDUs. MATERIALS AND METHODS: In a cross-sectional study between 2008 and 2009, IDUs referred to the methadone maintenance treatment (MMT) centers in Hamedan-Iran, undergone tuberculin skin test (PPD; purified protein derivative) were recruited. The participants with positive results for PPD test (> 5 mm and > 10 mm in HIV positive and negative cases), undergone other complementary procedures such as chest-X-ray and sputum smear test. RESULTS: Overall, 268 IDUs between 18 and 70 (mean: 34.5 [8.2]) years were included in the study. PPD test had positive findings in 49 cases (18.3%). There was no significant difference of PPD positivity between HIV positive and negative participants (17.7% vs. 18.5%). An active TB was found among IDUs. CONCLUSIONS: The high prevalence of latent and active TB among IDUs indicates the need for TB screening tests among this population.

Knowledge and attitude of women regarding the human papillomavirus (HPV) infection, its relationship to cervical cancer and prevention methods.

This study aimed to determine knowledge and attitude of women to HPV and its association with cervical cancer and prevention methods. In a cross-sectional study, 500 women, aged between 20 and 50 presenting to local health centers in Tehran, were asked about demographic factors and questioned about cervical cancer, HPV, and prevention methods. Responses were tabulated and summarized. Although knowledge of HPV, its relation to cervical cancer and prevention methods among Iranian women is not enough, their attitude towards education in this regards is extremely high. The results reflect the need of advertising and educational programs for public about HPV prevention methods, to reduce the prevalence of this infection and its severe consequences.

Comparison of Pap smear, visual inspection with acetic acid, and digital cervicography as cervical screening strategies.

PURPOSE: To compare the sensitivity, specificity, positive and negative predictive values (PPV and NPV), and accuracy of Pap smear, visual inspection with acetic acid (VIA) and digital cervicography (DC). METHODS: This is a cross-sectional study on 100 women in the age group of 20-60 years, sequentially using the Pap test, the VIA, and the DC for screening. All women underwent colposcopic biopsy as the gold standard in comparing the methods. RESULTS: Of the total of 100 women with the mean age 36.0 years, 17 cases were recognized positive for abnormal cervical cell by gold standard. The sensitivity, specificity, PPV, NPV, and accuracy of the Pap test, the VIA, and the DC were 23.5, 100, 100, 86.5, and 87%; 62.5, 98.8, 90.9, 93.2, and 92.9%; and 46.7, 97.6, 77.8, 91, and 89.8%, respectively, for cervical neoplasia. CONCLUSIONS: The Pap test had low sensitivity but high specificity, whereas VIA had a high sensitivity in addition to being easy and low-cost. Adjuvant methods of screening such as VIA can be a valuable alternative to the Pap test for cervical cancer screening in low-resource settings.

Reviewing the prevalence of (cigarette) smoking and its related factors in students of tehran university, iran.

BACKGROUND: This study aimed to determine the prevalence of smoking behaviors among students in Tehran University, Iran. METHODS: This was a cross-sectional study on 400 participants of Tehran University. A self-administrated, anonymous questionnaire was used for data gathering. FINDINGS: The mean age of students was 21.70 ± 2.73 years, and 92% of them were single. The prevalence of smoking was 27.3% including 35.4% of men and 12.6% of women (P < 0.001). The mean duration of smoking was 4.22 ± 3.05 years. There was a significant association between smoking behaviors among students and their age, gender, type of accommodation, field of study, income status, duration of study, and existence of smoking habits among family members. CONCLUSION: The prevalence of cigarette smoking among university students is high. The lack of adequate information about smoking related diseases indicates the incapability and inefficiency of educational programs on this issue.

Helicobacter pylori infection and postoperative nausea and vomiting.

BACKGROUND/AIMS: The aim of this study was to identify factors most relevant to postoperative nausea and vomiting (PONV) and determine the association of Helicobacter pylori with PONV. METHODOLOGY: A cross-sectional analytic survey was conducted on 127 elective patients who underwent general and urological surgery at Sina Hospital in Tehran between March 2005 and March 2006. Related factors considered to have a possible effect on the prevalence of PONV events were evaluated by using a special questionnaire and serological laboratory test of H. pylori. Data was analyzed using t test and chi2 test and logistic regression analysis for comparing the variables. RESULTS: Prevalence of PONV was 54.7% in patients having H. pylori infection. There was no relationship between H. pylori infection and PONV (p>0.05). Prior history of PONV was a significant risk factor for increasing the prevalence of PONV (p<0.05). Also, history of PONV beside female gender, overweighting/obesity and operation type (urologic surgery) could increase the severity of PONV (p<0.05). But, administration of opioids could decrease the severity of PONV (p<0.05). CONCLUSIONS: It was found that PONV had a high prevalence among patients undergoing urologic and general surgery. H. pylori infection cannot affect the prevalence of PONV. More surveys are needed to develop effective protocols for preventing this common and unpleasant problem.

Preoperative clinical and paraclinical predictors of choledocholithiasis.

BACKGROUND: Choledocholithiasis is the most common cause of obstructive jaundice and cholangitis and occurs in about 10% of patients with symptomatic gallstone. The aim of this study was to find preoperative and non-invasive tests for predicting common bile duct stones (CBDs). METHODS: Findings of clinical examination, history, laboratory tests and ultrasound (US) in 60 patients with CBDs were compared retrospectively, with 60 patients with gallstones. The data were collected from medical charts. The sensitivity, specificity and positive predictive value (PPV) were determined. RESULTS: The comparison between the two groups showed significant differences in anorexia, itching, dark urine, subicterus (slightly elevated serum bilirubin without clinical evidence of jaundice) and jaundice appearance, increased bilirubin level, aspartate aminotransferase (AST) and alanine aminotranferase (ALT), CBD diameter >6 mm and stone observation under US (P<0.05). The highest specificity (100%) and PPV (100%) were found in dark urine and pale colored stool, history of cholangitis, and icterus. Among paraclinical tests, alkaline phosphatase (ALP) had the highest specificity (72.1%) and PPV (12.5%). Under US, stone observation in CBD was the most important factor with a sensitivity of 94.5%, a specificity of 100% and a PPV of 100%. CONCLUSIONS: The most important factors for predicting CBDs are history of cholangitis and pancreatitis, presence of icterus, dark urine, pale colored stool, elevation of ALP, and sonographic evidence of chledocholithiasis.