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Background: Widespread use of screening in high-income countries has led to a significant reduction in cervical cancer mortality. Most low- and middle-income countries still have poorly organized screening programs. This study aimed at policy analysis of prevention and early detection of cervical cancer in Iran, a middle-income country., Materials and Method: This qualitative retrospective study, extended by the health policy triangle model, was conducted from July 2020 to September 2021. A sample of this study consisted of 43 participants, including 16 key policy experts; nine 11 senior health system managers, 13 executives, and 3 clients selected purposefully. Data were collected through semi-structured interviews using the interview guide and analyzed using a framework analysis method based on the policy triangle model in MAXQDA 2020 ., Results: Nine themes, 15 subthemes, and 36 codes were extracted based on the 4 dimensions of the model; stakeholder analysis challenges, including conflict of interest and decision-making challenges. Moreover, the most important policy process challenges indicated the weakness of monitoring and evaluation systems and weakness of using scientific principles in policy making. Weakness of organizational and intersectoral structure and weakness of executive management were obtained among the challenges in the context analysis. Finally, the most important challenges related to content analysis are weaknesses in applying scientific principles in policy making, including weaknesses in standard operating procedures, and low use of HTA capacity in developed guidelines., Conclusion: A wide range of economic, social, and cultural problems can affect cervical cancer prevention policies. Several strategies are suggested to overcome these challenges, including allocating separate funds to cancer prevention programs, using structures to sustain prevention programs, designing, and using them to improve public awareness., Competing Interests: A conflict of interest defines an individual or organization as involved in multiple interests, financial, or other interests, in such a way that serving one interest could involve working against another. Types of screening tests can affect the quality and frequency of services provided. In addition, the poor dissociation between policy making and resource generation and the different interests between policymakers and managers in decision-making can exacerbate this conflict of interest. The new screening approach has a low price which would negatively affect the cooperation of gynecologists or midwives. Government managers said, “You should consider the profit. Previously performed several tests on the woman. That is why they non-cooperate” (MP16). The poor dissociation between stewardship and resource generation and provider financial incentives had the highest score in terms of conflict of interest. The following are the statements of the faculty in this regard: “The service provider and the service policymakers are the same; that is, the Ministry of Health is both purchasing services and making policy” (FP14). In addition, according to the gynecologist: “No doubt, this creates a conflict of interest. Let me give a simple example; it seems logical for me as a gynecologist or a private laboratory to resist a new test about which I do not have enough information or adequate test equipment” (FP15).There are no conflicts of interest., (Copyright: © 2023 Journal of Education and Health Promotion.)

Background: Widespread use of screening in high-income countries has led to significant reductions in mortality from cervical cancer. However, in Iran, the main reason for the late diagnosis of cervical cancer was the failure to perform a Pap smear (Papanicolaou). We aimed to investigate the status of cervical cancer prevention and its challenges and solutions in Iran., Method: We conducted a systematic review of literature published from 1974 to 2021 in the electronic databases, including PubMed, Web of Science, Embase, Scopus, and Google Scholar, and retrieved all English-language articles. Following the application of the inclusion and exclusion criteria, full-text articles were identified and evaluated for eligibility. Finally, these publications were analyzed as part of the synthesis., Results: Lower social-economic level, inadequate knowledge of screening tests and health centers for Pap test performance leading to worse outcomes such as lower screening participation or coverage., Conclusion: By addressing these challenges through increasing education, increasing service accessibility, expanding screening programs, improving public awareness, improving insurance coverage, and establishing a control protocol for follow-up, it is possible to reduce cervical cancer incidence and mortality., (Copyright© 2023 Pirani et al. Published by Tehran University of Medical Sciences.)

Background: Different healthcare reforms could affect the productivity of hospitals. The aim of this study was to track hospital productivity before and after the recent Iranian healthcare reform in Khuzestan province, South West of Iran., Methods: Hospital productivity was evaluated through data envelopment analysis (DEA) and Malmquist productivity index (MPI) from 2011 to 2015 for 17 Iranian public hospitals before and after the health sector transformation plan. We assumed an output-oriented model with variable returns to scale (VRS) to estimate the productivity and efficiency of each hospital. The DEAP V.2.1 software was used for data analysis., Results: After the transformation plan, the averages of technical efficiency, managerial efficiency and scale efficiency in the studied hospitals had negative changes, but technology efficiency had positive changes.44.4% of general hospitals, 25% of multi-specialized hospitals, and 100% of specialized hospitals had positive productivity changes after implementing the health sector evolution plan. The Malmquist productivity index (MPI) had low positive changes from 2013 to 2016 (MPI = 0.13 out of 1) but the mean productivity score had no change after the health sector evolution plan., Conclusions: The total productivity before and after the health sector evolution plan had no change in Khuzestan province. This and the increase in the utilization of impatient services seemed to be a sign of good performance. But apart from technology efficiency, other efficiency indices had negative changes. It is suggested that in health reforms in Iran, more attention should be paid to the allocation of resources in the hospital., (© 2023. The Author(s).)

Background: Coronavirus illness (COVID-19) has spread globally and is affecting everyone severely. The evaluation of educational needs (knowledge, attitudes, and practices) is important in controlling COVID-19 situations. The goal of this study is to find out what adults in Ardabil City know, how they feel, and what they do about the COVID-19 infection., Methods: In November 2021, a cross-sectional descriptive-correlational survey of 384 people was conducted using stratified-cluster sampling in Ardabil. The researchers created a self-reported questionnaire with 23 items as the data collection technique. The quantitative data were evaluated using descriptive statistics, the chi-square test, the correlation coefficient, and regression analysis., Results: The correct answer rate for this research found that 73.17% of participants ( n = 281) had appropriate knowledge, 61.19% ( n = 235) had favorable attitudes, and 69.53% ( n = 267) had enough practice behavior. However, knowledge was related to gender, employment, and location of residence. Age, marital status, education level, and location of residence were all connected with attitude. Age, gender, and marital status were all related to the behavior. The findings of linear regression analysis revealed that knowledge and attitude influence behavior., Conclusion: The study findings revealed a high degree of understanding of COVID-19, a positive attitude, and a strong commitment to good practices. Knowledge, attitudes, and behaviors were influenced to varying degrees by age, marital status, education level, employment, and location of residence. Furthermore, knowledge and attitudes influenced behaviors., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Background: Conditions and needs of autistic children have impacts on both the children and the family members who have crucial roles in raising the child. The prevalence of autism is increasing, and this fact makes it necessary to focus more on experiences of parents who have children with autism spectrum disorder (ASD). Hence, this study aimed to reflect the experiences of parents who have autistic children., Materials and Methods: The present study was a qualitative research with phenomenology approach which was conducted using content analysis approach. Participants were 14 parents with ASD children in Ahvaz, and they were included based on purposive sampling method. To gather the required data, semi-structured interviews were formed. Data analysis was performed by Colaizzi's seven-step method., Results: Fifty-four conceptual codes were extracted from interviews of ASD children parents. Parents of these children had two main experiences: first family related and second education and treatment problems. Family problems included three categories (financial, psychological, and family relationships). Education and treatment was categorized into three (schooling, transporting, and quality in facilities)., Conclusions: Problems mentioned by parents of autistic children highlight the need for providing training and counseling services as well as emotional supports from both society and government. Planning and implementing supportive plans empower parents to strategically face problems and eventually improve their life quality and mutual understanding., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Education and Health Promotion.)

Warfarin is the drug of choice to achieve therapeutic anticoagulation in patients with mechanical heart valves. Factors that interfere with the reliable absorption of warfarin may result in difficult to control international normalized ratio (INR) and can cause significant bleeding complications due to supra-therapeutic INR and thromboembolism from sub-therapeutic INR. The patient's non-compliance is an important factor leading to difficult to control INR but there are additional factors that should be considered in difficult cases when dietary and medication compliance are observed. Gastroparesis is one such predominant and overlooked factor. A 58-year-old African American female with a history of mechanical mitral valve who was on anticoagulation with warfarin was admitted multiple times, with frequent episodes of significant bleeding episodes and fluctuating INR between sub- and supra-therapeutic readings despite being on a relatively stable dose of Coumadin. She was eventually diagnosed with severe gastroparesis, which was the cause of her fluctuating INR. A case can be made to consider gastric motility testing in such patients, where achieving a therapeutic range for anticoagulation is difficult in the setting of medication and dietary compliance., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Efficiency is one of the most important indicators of hospital performance evaluation., Aim: The study was conducted to measure the efficiency of public hospitals., Material and Methods: This was a cross-sectional and panel data study. Data were retrospectively collected using hospital records and hospital information system. In this study, panel data of 17 public hospitals affiliated with Ahvaz University of Medical Sciences, in southwest of Iran were studied during 2012-2016. The output-based data envelopment analysis technique and variable return to scale assumption (VRS) were used. Regression model was used to assess factors affecting hospital efficiency. Data were analyzed using Deap2.1 and R software., Results: The mean of technical efficiency, managerial efficiency, and scale efficiency of the hospitals during 2012-2016 were 0.230, 0.272 and 0.732, respectively. Assessment of return to scale results over 5 years showed that 65% (11 cases) of hospitals had a decreasing return to scale, 24% (4 cases) had a constant return to scale, and 12% (2 cases) had an increasing return to scale. Also, mean of technical managerial, and scale efficiency in specialized hospitals were higher than other hospitals (0.331, 0.353, and 0.873). Beta regression analysis showed the effect of both variable length of stay and number of beds on hospital efficiency was significant (p-value <0.05).., Conclusions: The results showed that efficiency of selected public hospitals was the poor. Technical efficiency and managerial efficiency were lower than scale efficiency rate. Also, Multi- specialized hospitals were in critical status considering resource management and economies of scale.

Introduction: Dyslipidemia is one of the major risk factors for atherosclerosis and the main cause of death in the developing and developed countries. In this cohort study, the incidence of dyslipidemia and its components have been studied among individuals over 20 years old in Ahvaz, southwest of Iran., Materials and Methods: The Phase 1 of this study was conducted on the prevalence of Metabolic syndrome and its related factors by Diabetes Research Center in 2009. The target population included individuals over 20 years old who were selected using cluster sampling in Ahvaz health centers. In the second phase of the study, 5 years later in 2014, subjects were again recalled by health centers. Questionnaires, anthropometric indices and measurements were repeated similar to Phase 1. The blood sample was taken from everyone after 12h of fasting and then the factors (Chol, TG, HDL) were measured., Results: The cumulative incidence of dyslipidemia obtained 60.7% (males 56.7% and females 64.8%). lipid profile {HDL, Triglycerides and Cholesterol had changes in their means(a significant reduction in the mean about 10, 22.25 and 13 units respectively) between baseline and 5 years later. Waist circumference here associated with incidence of high LDL and high chol, also sex and High LDL 'educational level and daily consumption of vegetables were associated with incidence of low HDL and dyslipidemia respectively., Conclusion: Age, educational level and daily intake of fruits and vegetables were effective variables on incidence of dyslipidemia. According to various studies, LDL and HDL levels in different regions of Iran, seems to be influenced by factors such as climate, nutrition and activity levels., (Copyright © 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Background: Cardiovascular diseases are the most common cause of death. The prevalence of cardiovascular diseases was reported to be 3,500 per 100,000. And it is predicted that these numbers will increase in the near future. By removing the main factors responsible for non-communicable diseases, cardiovascular disease can be prevented by 80%., Aim: The aim of this study was to compare the population attributable fraction for cardiovascular diseases' risk factors in Iran, USA and Spain., Methods: This study was a comparative study and the population consisted of Iran, USA and Spain. The required information was collected from printed and electronic documentations and articles published in reliable databases, in the period 2007-2015., Results: The cardiovascular diseases' Population Attributable Risk or Fraction for blood pressure was calculated to be 11.37%, 54% and 60%, diabetes 7.32%, 13% and 18%, and high cholesterol 6.85%, 13% and 20%, for Iran, USA and Spain respectively. Among risk factors, blood pressure was the most relevant factor to cardiovascular disease., Conclusions: The risk factor for high blood pressure had a more population attributable fraction than other physiological factors in the development of cardiovascular disease. Hence, by implementing comprehensive health policies, educating healthy lifestyle, screening and finding related cases as well as conducting health promotion programs, these diseases can be prevented., Competing Interests: • Conflict of interest: none declared.

A variety of bacterial pathogenicity determinants, including the type VI secretion system and the virulence cassettes from Photorhabdus and Serratia, share an evolutionary origin with contractile-tailed myophages. The well-characterized Escherichia coli phage P2 provides an excellent system for studies related to these systems, as its protein composition appears to represent the "minimal" myophage tail. In this study, we used nuclear magnetic resonance (NMR) spectroscopy to determine the solution structure of gpX, a 68-residue tail baseplate protein. Although the sequence and structure of gpX are similar to those of LysM domains, which are a large family associated with peptidoglycan binding, we did not detect a peptidoglycan-binding activity for gpX. However, bioinformatic analysis revealed that half of all myophages, including all that possess phage T4-like baseplates, encode a tail protein with a LysM-like domain, emphasizing a widespread role for this domain in baseplate function. While phage P2 gpX comprises only a single LysM domain, many myophages display LysM domain fusions with other tail proteins, such as the DNA circulation protein found in Mu-like phages and gp53 of T4-like phages. Electron microscopy of P2 phage particles with an incorporated gpX-maltose binding protein fusion revealed that gpX is located at the top of the baseplate, near the junction of the baseplate and tail tube. gpW, the orthologue of phage T4 gp25, was also found to localize to this region. A general colocalization of LysM-like domains and gpW homologues in diverse phages is supported by our bioinformatic analysis.

Evolutionary relationships may exist among very diverse groups of proteins even though they perform different functions and display little sequence similarity. The tailed bacteriophages present a uniquely amenable system for identifying such groups because of their huge diversity yet conserved genome structures. In this work, we used structural, functional, and genomic context comparisons to conclude that the head-tail connector protein and tail tube protein of bacteriophage lambda diverged from a common ancestral protein. Further comparisons of tertiary and quaternary structures indicate that the baseplate hub and tail terminator proteins of bacteriophage may also be part of this same family. We propose that all of these proteins evolved from a single ancestral tail tube protein fold, and that gene duplication followed by differentiation led to the specialized roles of these proteins seen in bacteriophages today. Although this type of evolutionary mechanism has been proposed for other systems, our work provides an evolutionary mechanism for a group of proteins with different functions that bear no sequence similarity. Our data also indicate that the addition of a structural element at the N terminus of the lambda head-tail connector protein endows it with a distinctive protein interaction capability compared with many of its putative homologues.

Purpose: To characterize the relationship between applied power and treatment duration in their effect on extent of coagulation produced with a 2.45-GHz microwave applicator in both an ex vivo and a perfused in vivo liver model., Materials and Methods: All experimentation was approved by the Institute of Animal Care and Use Committee. Multiple tissue ablations were performed in ex vivo bovine liver (120 ablations) and in vivo porcine liver (45 ablations) with a 5.7-mm-diameter 2.45-GHz microwave applicator. The applied power was varied from 50 to 150 W (in 25-W increments ex vivo and 50-W increments in vivo), while treatment duration varied from 2 to 20 minutes (in eight time increments for ex vivo and five for in vivo liver). Three-dimensional contour maps of the resultant short- and long-axis coagulation diameters were constructed to identify the optimal parameters to achieve maximum coagulation in both ex vivo and in vivo models. Multivariate analysis was performed to characterize the relationship between applied power and treatment duration., Results: Power and treatment duration were both associated with coagulation diameter in a sigmoidal fashion (ex vivo, R(2) = 0.78; in vivo, R(2) = 0.74). For ex vivo liver, the maximum short-axis coagulation diameter (7.6 cm +/- 0.2 [standard deviation] by 12.3 cm +/- 0.8) was achieved at greatest power (150 W) and duration (20 minutes). In vivo studies revealed a sigmoidal relationship between duration and coagulation size, with a relative plateau in coagulation size achieved within 8 minutes duration at all power levels. After 8 minutes of treatment at 150 W, the mean short-axis coagulation diameter for in vivo liver was 5.7 cm +/- 0.2 by 6.5 cm +/- 1.7, which was significantly larger than the corresponding result for ex vivo liver (P < .05)., Conclusion: Large zones of ablation can be achieved with the 2.45-GHz microwave applicator used by the authors. For higher-power ablations, larger zones of coagulation were achieved for in vivo liver than for ex vivo liver with short energy applications, a finding previously not seen with other ablation devices, to the authors' knowledge., ((c) RSNA, 2006.)

Background: Transradial percutaneous coronary intervention (PCI) results in fewer vascular complications, earlier ambulation, and improved patient comfort. Limited data exist for radial access in acute myocardial infarction, where reperfusion must occur quickly., Methods: In a multicenter pilot trial, 50 patients with myocardial infarction requiring either primary or rescue PCI were randomized to radial or femoral access. All operators had previously performed at least 100 transradial cases. Procedure times were prospectively recorded., Results: Thrombolysis was used in 66% of the cases and glycoprotein IIb/IIIa inhibitors in 94%. Crossover from radial to femoral access was required in one case. Percutaneous coronary intervention was performed in 47 patients, with stenting in 45. One procedural failure occurred with radial access because of inability to cross the occlusion. The time from local anesthesia to first balloon inflation was 32 (25th percentile 26, 75th percentile 38) minutes for radial access and 26 (22, 33) minutes for femoral access (P = .04). There were no significant differences in contrast use or fluoroscopy time. No patient experienced major bleeding or required transfusion. Doppler studies demonstrated 2 asymptomatic radial occlusions and 2 pseudoaneurysms (1 from each group). One patient in the femoral group died 2 days after PCI. At 30 days, there were no strokes or reinfarctions and no patient required bypass surgery or repeat PCI., Conclusions: Primary and rescue PCI can be performed with high success rates using either radial or femoral access. Although radial access was associated with a longer time to first balloon inflation, the difference was small and likely not clinically significant. In patients without shock, major bleeding and vascular complications are infrequent with either access site despite the high use of thrombolysis and glycoprotein IIb/IIIa inhibitors.