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.

Background and Aim: Regarding the controversial results on the effects of anesthetics, especially thiopental sodium, on the duration and severity of seizure and the lack of adequate information on the use of doses of anesthetic and paralysing drugs during ECT, this study was designed to determine the effect of repetitive doses of succinylcholine and Thiopental sodium was administered on the duration and severity of seizure during ECT. Materials and Methods: The present study was a one-blind randomized clinical trial on patients admitted to the psychiatric ward of Dezful Ganjavian Hospital. The research samples were selected after informed consent and entry criteria. Then, the samples were randomly assigned to two groups. In one group, succinylcholine dose was repeated (one third of the initial dose), and in the other group, the dose of thiopental sodium was repeated (one third of the initial dose). In all patients, seizure duration based on EEG monitoring and severity of seizure was determined by the psychiatrist based on the symptoms of the patient during seizure. Results: There was a significant difference between the quality of seizure in the two treatment groups after the intervention. There was a strong and good seizure in the thiopental sodium group (p <0.0001). There was a significant difference between the variables of seizure status in comparison with the previous shock in the two treatment groups after the intervention (p <0.0001). The duration of seizure was higher in thiopental sodium treatment group, but no significant difference was observed (p = 0.82). Conclusion: The results of this study showed that the duration and quality of seizure was better in patients requiring repetitive doses of hypnotic drugs (Thiopental Sodium), which was used to repeat the dose of muscle relaxant (succinylcholine).

Objectives: Consciousness during anesthesia is a non-reversible complication that may expose the patient to severe, long-term, emotional injuries and post-traumatic stress. Therefore, this study aimed to compare the effect of two methods of induction maintenance of anesthesia with thiopental sodium-remifentanil and propofol-alfentanil on consciousness during orthopedic surgery using a bispectral index (BIS) device. Methods:In this triple-blind clinical trial, 111 patients who underwent orthopedic surgery in Dezful Hospital (southwestern Iran) were investigated. Patients were randomly assigned into two groups: The intervention Group "A" received thiopental for the induction of and fentanyl for maintenance and intervention Group "B" received propofol and alfentanil. The patients underwent BIS monitoring before the end of surgery, and the BIS value was recorded. The Brice questionnaire was used to measure the consciousness. The data were analyzed using repeated Measure ANOVA test. Results:In the intervention Groups A and B, the mean BIS score was 63.71 and 60.62 in the first 5 min after surgery, reaching 65.25 and 67.73 60 min after surgery, respectively. The results of repeated measures ANOVA test showed that the mean BIS score was significantly different from the preoperative value (baseline) group during repeated measurements after surgery (5, 10, 15, 30, 40, and 60 min) (p<0.001). According to the Brice questionnaire, the prevalence of hearing loss during surgery showed a statistically significant difference between the two intervention Groups (A and B), and the incidence of hearing during surgery in intervention Group "B" was approximately 3 times higher than intervention Group "A" (odds ratio=3.22, 95% confidence interval: 1.32-7.79). Conclusion:The results indicate that none of the induction and maintenance pharmacologic methods have any superiority in terms of optimal depth of anesthesia in patients undergoing orthopedic surgery.

Background: This study was aimed to determine the children's' blood sugar level in fluid therapy with DSS, RSand NS 0.9% serums and its relationship with the depth of anesthesia in elective surgery.Method: This double-blind experimental study was performed with 90 children referred to the surgical ward, including: group A (receiving DSS), group B (receiving NS 0.9%) and group C (receiving RS) that the blood sugar of each group in 5 steps was measured: half an hour before induction of anesthesia, during induction of anesthesia, half and one hour after induction of anesthesia and after complete awakening in recovery. In addition, the monitoring the vital signs, measuring depth of anesthesia, pulse oximetry and electrocardiogram were performed for all groups.Results: The results showed that the mean blood sugar in the 5 steps measured had a significant difference in three groups under study (P <0.05). The mean blood sugar in the group receiving DSS was significantly higher than the two groups receiving RS and NS 0.9%. Also the mean depth of anesthesia in three groups did not show a significant difference.Conclusion: Finally, according to this study, the use of DSS from the beginning of anesthesia, RS half an hour after the start of anesthesia and NS 0.9% one hour after the start of anesthesia can increase blood sugar in children. Therefore, the use of DSS is not recommended due to the stressful nature of anesthesia and operating room and the possibility of hyperglycemia.

Background: This study was aimed to determine the children's' blood sugar level in fluid therapy with DSS (dextrose saline serum), RS (ringer serum) and NS 0.9% serums (normal saline 0.9%) and its relationship with the depth of anesthesia in elective surgery. Method: This double-blind experimental study was performed with 90 children referred to the surgical ward, including: group A (receiving DSS), group B (receiving NS 0.9%) and group C (receiving RS) that the blood sugar of each group in 5 steps was measured: half an hour before induction of anesthesia, during induction of anesthesia, half and one hour after induction of anesthesia and after complete awakening in recovery. In addition, the monitoring the vital signs, measuring depth of anesthesia, pulse oximetry and electrocardiogram were performed for all groups. Results: The results showed that the mean blood sugar in the 5 steps measured had a significant difference in three groups under study (P <0.05). The mean blood sugar in the group receiving DSS was significantly higher than the two groups receiving RS and NS 0.9%. Also the mean depth of anesthesia in three groups did not show a significant difference. Conclusion: Finally, according to this study, the use of DSS from the beginning of anesthesia, RS half an hour after the start of anesthesia and NS 0.9% one hour after the start of anesthesia can increase blood sugar in children. Therefore, the use of DSS is not recommended due to the stressful nature of anesthesia and operating room and the possibility of hyperglycemia.