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Background & Objective: The COVID-19 pandemic has impacted medical education worldwide with several opportunities and challenges. This study aims to provide an overview of medical education's opportunities and challenges according to the experience of the COVID-19 pandemic in order to guide future endeavors in conducting the teaching-learning process in post-COVID era support. Material & Methods: In this systematized review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, databases of PubMed, Cochrane, Scopus, Web of Science, and Eric, in addition to Google Scholar as a search engine, were searched to retrieve relevant original peer-reviewed, review, editorial, and commentary articles published from Dec 2019 to the end of Sep 2022. Results: As per the qualitative synthesis, a total of 29 articles were included from the 1534 records that were identified. Reviewing the included articles showed that most of the relevant studies were considered Medical and healthcare students (51.8%) at undergraduate level (72.5%) in University settings (62.1%). As per the qualitative synthesis, a total of 29 articles were included from the 1534 records that were identified. Reviewing the included articles showed that most of the relevant studies were considered Medical and healthcare students (51.8%) at undergraduate level (72.5%) in University settings (62.1%). On the other hand, post-COVID medical education opportunities have been grouped into four main categories, which are teaching and learning processes, psychological impact, accessibility and education equity, and management and administrative affairs. Post-COVID medical education opportunities also consist of four main categories: teaching-learning process, psychological impact, accessibility and education equity, and management and administrative affairs. Conclusion: Changes in teaching and learning processes in medical education caused by the COVID-19 pandemic created opportunities and caused important challenges that should be considered in the post-COVID era. In this regard, blended learning with the integration of technology using a flexible approach could be an effective recommendation. [ABSTRACT FROM AUTHOR]

Since its establishment, the Islamic Republic of Iran has faced various political challenges. In some instances, certain crises appeared sufficient to topple the regime, yet through crisis management by Iran's leaders, conditions eventually led to the stabilization of the revolution. The present study aims to explore the methods of the Supreme Leader and the model for addressing the political challenges of the Islamic Republic. The main research question is: ‘Does the Supreme Leader have a comprehensive model for managing political crises?’ To this aim was used qualitative descriptive method, employing document analysis and targeted sampling through interviews with experts. Content analysis of these interviews has also been conducted to identify the components of the research. Results: The study of methods and actions within the framework of crisis leadership was conducted based on indicators of control, mobilization, spiritual influence, and informed management of events. After interviews with experts, the findings were categorized into four levels: Preventive measures and challenge identification, decision-making, confrontation and management of challenges and crises, shaping awareness and conceptualization, learning, and delineating crisis lessons. Key components include: Macro-level policymaking, information assessment and awareness, management of destabilizing events, decisive confrontation with crisis inducing factors and conditions, leadership of public opinion, clarification of citizens’ and institutions’ responsibilities, utilization of the spiritual influence of the Supreme Leader, discourse formation, conceptualization, education, foresight, and further elaboration. [ABSTRACT FROM AUTHOR]

Breast milk is the perfect food during infancy. Adequate support from family and health systems can be helpful to continue breastfeeding. This study aimed to determine the status of breastfeeding challenges and its relationship with social support and socio-demographic factors. In this correlational-descriptive study, 348 breastfeeding mothers were recruited using cluster random sampling from health care centers in Tabriz, Iran in 2022. Socio-demographic, breastfeeding challenges and social support questionnaires were used for data collection. Data were analyzed for descriptive and inferential statistics (Pearson correlation tests, independent t-test, one-way ANOVA and general linear model) using SPSS version 16. Difficulty in completing household tasks and breastfeeding at the same time (32.5 percent) was the most common challenge reported by mothers. There was an inverse and significant correlation between perceived social support and experiencing challenges (r = −0.199؛ p =.001). Based on the adjusted general linear model, with increasing social support, the score of breastfeeding challenges decreased (B = −0.165; 95 percent CI: −0.07–0.25, p <.001). Considering the relationship between perceived social support and the challenges experienced during breastfeeding, it can be concluded that adequate support from family along with training and guidance from health care providers can lead women to have better breastfeeding experiences and overcome breastfeeding problems. [ABSTRACT FROM AUTHOR]

Background: The presence of accompanying midwives (doulas) in the delivery room always entails many challenges. This study was carried out to determine the challenges of attendance with training from the point of view of midwives and expectant mothers in selected hospitals of Chaharmahal and Bakhtiari province, Iran. Methods: The present study was a descriptive study on 70 midwives working in the delivery block, 120 pregnant mothers, and 20 trained attendants. The sampling of midwives and doulas was performed using the census method, and the sampling of pregnant mothers was conducted using the convenience method. The study tool included questionnaires made by the researcher about demographics and socioeconomics, therapeutics, and psychological challenges for the group of mothers and midwives. The face validity and content validity of the questionnaires were confirmed by midwifery professors and reproductive health specialists, and their reliability was confirmed by internal consistency. The data were analyzed using descriptive statistics with SPSS software (version 21). Results: In this study, 70 midwives working in selected hospitals of Chaharmahal and Bakhtiari province, 120 pregnant mothers, and 20 trained attendants were examined. Most of the pregnant women (n = 39, 32.5%) mentioned that the most important motivation for requesting a doula during pregnancy and labor was to overcome the fear of childbirth. Most of them (n = 101, 84.9%) also stated that they used doula services at the right time. Meanwhile, 54 women (45%) were familiar with doula services during pregnancy, and most of them (n = 67, 56.3%) stated that doula services can be useful and effective in all three stages of pregnancy, labor, and delivery. Conclusions: There are dissatisfactions and challenges regarding the support of doulas during pregnancy and childbirth. Therefore, it is recommended to provide the necessary training to healthcare providers, especially obstetricians, midwives, and mothers, regarding the importance and place of doula's supportive care in this era. Additionally, doula activities should be integrated and promoted in the care of the health team. [ABSTRACT FROM AUTHOR]

Background and Purpose: Pre-hospital emergency healthcare workers face various problems because of the complexities of providing care during emergencies. These challenges can affect their successful performance in achieving their professional goals. To identify these challenges, the present study was conducted to explain the challenges of pre-hospital emergency workers in providing care at the scene. Materials and Methods: The present qualitative study was conducted at Shahrekord University of Medical Sciences in 2022 using the contractual content analysis method. Twenty pre-hospital emergency workers were selected purposefully, and data were collected using individual in-depth semistructured interviews and analyzed using Granheim and Lundman's approach. Results: The findings include three categories (systemic obstacles, society's cultural ignorance, and religious obstacles) and seven subcategories (manpower-related obstacles, inappropriate and insufficient equipment, lack of attention and support, inconsistency between organizations, disruptive measures of care, wrong attitude and wrong belief, and gender-related barriers) of obstacles that cause emergency healthcare workers to face challenges in providing care at the scene. Conclusion: The factors that need consideration in strengthening pre-hospital emergency healthcare include improving the training process of students, planning for in-service training of employees, increasing their motivation levels, noticing their psychological issues, developing inter-organizational protocols and policies, and educating, training, and employing women in pre-hospital emergency care. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) is a debilitating, non-traumatic, neurological disorder in young adults and can reduce quality of life (QoL) by interfering with the ability to work, leisure activities, and routine living tasks. Various studies have shown the dissatisfaction of people with MS in different areas of care services. Regarding the patients' weakness with care and services, we sought to identify the challenges for patients with MS in receiving care and services in Iran. Methods: This cross-sectional study was conducted in 2016-2018 using a researcher-made questionnaire (designed by MS Specialists in an MS research center). The questionnaire examined the care challenges in four areas: 1) costs of medication, hospitalization, and rehabilitation services, 2) family support, insurance system, and job protection, 3) access to transportation system and treatment team, 4) quality of the provided care and services. Results: Completed questionnaires were received from 945 respondents. The mean age of responders was 35.92 years. In total, 731 (77.8) participants were women and 208 (22.2) were men. Academic education was reported among 615 (65.3) participants and 367 (40.2) were employed during the study, while 99 (10.5) of the subjects were not able to walk a minimum of 20 meters. The prioritization of care services challenges was as follows: the cost of pharmaceutical services (49.1), lack of telephone counseling (47.4), uninsured home rehabilitation (44.7), lack of qualified care centers (41.2), and rehabilitation costs (40.2). Conclusion: We found that patients who could not walk at least 20 meters and unemployed individuals had more problems and lower QoL. The patients who had non-academic education had more challenges with the cost of medication, transportation, and lack of familial support. This study shows the challenges of MS patients in receiving health care in Iran that vary in age, education, employment, and ability to walk. As the abovementioned challenges are of great importance in determining the QoL of people with MS, an appropriate solution is provided in this study to overcome these challenges. [ABSTRACT FROM AUTHOR]

Background: Challenges of online education among students of the University of Medical Sciences during the COVID-19 disease pandemic have often gone unrecognized. This study aimed to identify online education's challenges from the perspective of students of the University of Medical Sciences during the COVID-19 pandemic in Iran. Method: The six-step Q method was used to systematically predict the different perspectives of 31 students at the Kurdistan University of Medical Sciences, Iran. Results: Four distinct patterns of Challenges of Online Education from the Perspective of participants in the COVID-19 Pandemic were identified. Four factors, which explained 69% of the total variance, included: 1) inadequacy for practical learning (26%) 2) inadequacy of Internet and website services (17%), 3) barriers related to educational content and interaction between teacher and student (8%), and 4) lack of motivation (18%). Conclusion: The identified challenges reflect the spheres that need to be focused on in interventions to facilitate the successful implementation of the challenges of online education from the perspective of the University of Medical Sciences Students in Iran and other developing countries. [ABSTRACT FROM AUTHOR]

Objectives: One of the prominent vital needs for implementing a community-based rehabilitation (CBR) program is correct perception and we know that CBR is linked to several challenges. The current study was performed to identify the challenges of implementing a CBR program in Iran based on the perceptions of the stakeholders. Methods: This study was qualitative conventional content analysis. In total, 25 participants who were staff of the Welfare Organization at different levels, managers, and experts working in the CBR project and non-governmental organizations (NGOs) were selected according to purposive sampling. Data gathering was performed by semi-structured and in-depth interviews and continued until saturation. The interviews were performed in 2020. To test the trustworthiness of data, the Guba and Lincoln criteria (credibility, dependability, confirmability, and transferability) and MAXQDA were used for data analysis. Results: The challenges of implementing a CBR program were identified. Eight novel categories and 39 subcategories were generated as follows: neglecting the local conditions and role of provinces, poor policymaking, and planning, deviation from the main goals, lack of a comprehensive evaluation system, inefficient resource management, weakness in facilitation, ineffective communication, and the inefficiency of NGOs). Discussion: Policymakers, service providers, and managers must understand the challenges of implementing a CBR program. Also, they are expected to address to this issue. This paper showed evidence for all stakeholders. Paying attention to these challenges can lead to the program's tremendous success and ultimately, improved service provision and quality of life for people with disabilities and their families. The results support the need for policymakers and managers in the rehabilitation sector to change their vision and address the CBR as an essential part of the rehabilitation system. Also, the collected data could help to reinforce the CBR services. [ABSTRACT FROM AUTHOR]

Despite many decades of intensive research by universities and other research centers in the public and private sectors that could improve finance and monetary applications in agriculture activities, there has as yet not been any brilliant transforming commercialization. As the objective. Commercialization barriers causing slow market growth and poor acceptance of agriculture research in Iran are discussed here. The study's population consists of Qom Keshavarzi Bank employees. The sampling method is proportional classification, and a questionnaire is a research tool. The validity of the questionnaire was confirmed by the ideas of the specialists' panel while its reliability was supported by using Cronbach's alpha ratio with an internal correlation coefficient of 0.79. Descriptive and deductive methods were used to analyze information. SPSS and LISREL software packages were used for statistical analyses. Findings indicate that the research theoretical model on the direct and negative impact of such challenges as lack of knowledge on commercialization, policy making, lack of organs that support commercialization, commercialization negligence, and research structure on latent variable of agricultural research findings is confirmed by high fitness which indicates right identification of affecting challenges on research commercialization and needs to find solution for facilitating the modification of such challenges. [ABSTRACT FROM AUTHOR]

Background: Natural disasters, such as floods provide the basis for spreading vector-borne diseases by creating environmental changes. This study aims to investigate the common vector-borne diseases during floods in Khuzestan Province, Iran, in 2019 and the strategies and challenges to control them. Materials and Methods: This research is applied objectively and it is a descriptive survey in terms of collecting data using a qualitative method. The statistical population in the qualitative section included 15 experts from health centers in Khuzestan Province with a history of presence in flooded areas who were purposively selected using the snowball technique. The data collection tool was a semi-structured interview. Results: Qualitative data were categorized into 5 categories of common arthropods, common vector-borne diseases, vector control strategies and challenges, and organs involved in vector control programs during floods. The most common arthropods were lice, mites, mosquitoes, flies, and scorpions. The most prevalent vector-borne diseases during the flood were scabies, pediculosis, mosquito bites, and scorpions. The critical challenge was the lack of national vector control guideline in disaster condition. Conclusion: Considering the history of floods and health problems caused by these natural disasters, it is necessary to recognize the common vector-borne diseases, develop national guidelines, and provide solutions to deal with them. [ABSTRACT FROM AUTHOR]

Objective: The present study was investigate parents' experiences of children with Epidermolysis bullosa. So, this descriptive phenomenological qualitative study was conducted on 17 parents of children with EB from five hospitals affiliated with the University of Medical Sciences, west of Iran. Data was collected through semi-structured interviews. COLAIZZI's method was also used to analyze the data., Results: Three main themes were extracted in this study: invasion of psychological crisis, alive but no living, and comprehensive support, including 10 categories. The parents of these children are the target of psychological crises that severely reduce their quality of life. In this regard, they need extensive support to improve their living conditions. Therefore, it is suggested to provide cultural and institutional contexts in which all components of the children's dignity are emphasized., (© 2024. The Author(s).)

Introduction: Identifying and exploiting stewardship and financing challenges in Iran's health insurance system as an ecosystem is essential to achieving predetermined goals. This study aimed to determine the challenges and strategies in the Iranian health insurance ecosystem to provide relevant evidence to healthcare managers and policymakers to improve its functions and perform necessary reforms., Method: This qualitative study was conducted at the national level in Iran. Data were collected using semi-structured interviews and analyzed using the directed content analysis method. The study participants included managers and experts in health insurance and faculty of universities of medical sciences, who were selected by purposive sampling., Results: The challenges and strategies expressed by participants were categorized into two functions: stewardship and financing. Four main themes, ten subthemes, 22 challenges, and 24 strategies were identified in the stewardship function, along with three main themes, 12 subthemes, 17 challenges, and 16 strategies in the financing function. The major challenge in the Iranian health insurance ecosystem was the complexity and conflict of interests between multiple actors with different roles, which led to fragmentation, diverse structures, and a gap between other functions and objectives, hindering the effective functioning of the ecosystem., Conclusion: In order to deal with the challenges of the health insurance ecosystem, it is suggested to create a coherent insurance system through a single utility system, and by paying more attention to health-oriented services, the health insurance ecosystem becomes a health-oriented system instead of being treatment-oriented. In addition, in order to strengthen the governance of the country's health insurance ecosystem, the number of actors with multiple roles should be reduced and the roles of the actors should be clarified and separated in order to prevent conflicts of interest and structural corruption in this ecosystem., (© 2024. The Author(s).)

Introduction: The need for dental data in healthcare services and the inadequacy of paper records due to their inherent limitations have led to a shift towards electronic dental record systems (EDR). Implementing EDR comes with numerous barriers and challenges. Therefore, this research was conducted to identify the implementation barriers and facilitators for EDRs., Methods: This descriptive-analytical cross-sectional study was conducted on dentists working in public and private clinics in Tehran, Iran. A questionnaire consisting of three sections was designed to collect data on the demographic information of dentists, the barriers in five categories including financial barriers (6 questions), organizational barriers (11 questions), technical barriers (5 questions), personal barriers (3 questions), and ethical and legal barriers (6 questions), as well as facilitators for the implementation of EDR (15 questions) based on the literature, using a five-point Likert scale. 130 dentists from 60 dental clinics participated in the study. The data were analyzed using descriptive statistics (calculating frequency distribution, mean, and standard deviation). The mean scores were classified into four categories based on quartiles from very low importance to very high importance including very low importance (mean ≤ 1.25), low importance (1.25 ≥ mean < 2.5), important (2.5 ≥ mean < 3.75), and very high importance (mean ≥ 3.75). Finally, each of the barriers and facilitators among user dentists and non-user dentists was compared using the Mann-Whitney U test. The data were analyzed using SPSS software., Results: The findings indicate that dentists consider all barriers and challenges in implementing EDR to be important, and all the proposed facilitators for addressing these challenges to be very important. Among these important barriers are the rapid turnover of managers and policymakers at higher levels (3.69 out of 5) as a personal barrier, legal issues related to electronic records (3.65 out of 5) as an ethical-legal barrier, the lack of necessary standards for data exchange between different systems (3.64 out of 5) as a technical barrier, dentists' limited awareness of the benefits of this system (3.63 out of 5) as a personal barrier, and the lack of suitable legal infrastructure for EDR implementation (3.62 out of 5) as an ethical-legal barrier. Additionally, among the very important facilitators, training dentists and staff on EDR (4.31 out of 5) is noteworthy., Conclusion: To address the important barriers to EDR implementation, including legal-ethical barriers, legal institutions, and regulators must establish relevant laws and regulations to overcome these obstacles. Furthermore, if system users learn about the features, goals, benefits, and positive impact of EDR on their work and gain the necessary awareness, their resistance to changes will decrease, and their interest and readiness to accept EDR will increase., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: The operating room nurses have encountered several challenges during the current COVID-19 Pandemic, which subsequently impact their clinical performance. The present study aimed to investigate the experiences of operating room health care professionals' regarding the COVID-19 pandemic challenges in southern Iran.Methods: This is a descriptive qualitative study. The required data were collected using in-depth and semi-structured interviews. Accordingly, 19 operating room health care professions were included in this study through purposive sampling. The data were collected from February 2020 to August 2021 and then analyzed using the Granheim and Lundman's method.Results: Three main themes and 9 sub-themes were presented in this study. They included: 1- Challenges of applying protocols and standards of care in the COVID-19 pandemic in the operating room (lack of specific guidelines regarding care protocols and standards for crisis management of Covid-19 in the operating room and impossibility of keeping social distance in the operating room). 2- Professional challenges (tedious and hard work, professional burnout, lack of adequate support by the managers and lack of personal protective equipment). 3-Psychological crises (indescribable anxiety and worry, parenting stress, and weakened resilience).Conclusion: Based on the findings of the present study, it was indicated that lack of a specific guideline in the COVID-19 pandemic led to a sense of indecision and confusion among operating room staff. In this regard, performing tedious tasks, feelings of tiredness and exhaustion, lack of support by the authorities, and lack of access to adequate facilities and equipment were reported as the professional challenges of the healthcare staff in the current COVID-19 pandemic, which consequently affected the quality of care and patient's safety. It seems that hospital officials can use the results reported in this study for efficient planning and effective management during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: With the unprecedented expansion of COVID-19 in the world since December 2019, Iran's health system, like other countries, faced various challenges in managing the disease, which led to numerous experiences and lessons learned. This study was conducted to identify these challenges regarding unique political, economic, and cultural issues, which could help other countries with similar situations.Methods: The present study was performed using a qualitative multi-method approach with a content analysis method. The data were collected through in-depth and semi-structured interviews and focused group discussions with 60 key persons who were selected purposefully, including policymakers, health care workers, and affected people by the disease, and the review of all available national reports between February 21, 2020, and March 22, 2021. The data collection and analysis were done simultaneously.Results: Identified critical challenges for the management of COVID-19 in the health system were limited evidence and scientific controversies, poor social prevention and social inequalities, burnout and sustained workload among healthcare workers, improper management of resources and equipment, the lack of a guideline for contact tracing, and patient flow management, and mental health problems in the community.Conclusions: According to our results, measures should be taken to conduct a continuous comprehensive risk assessment and develop a national response plan with an emphasis on precise contact tracing, active screening, patient flow, paying attention to the psychological and social dimensions of the disease, and also transparency of social inequalities in the face of risk factors of the COVID-19. Also, the social protection programs should become a vital tool for policymakers and supporting the vulnerable groups using the capacity of the community and international cooperation to develop a vaccine, which is difficult to procure due to the sanctions. [ABSTRACT FROM AUTHOR]

Aims: Inherited bleeding diseases greatly affect education, working, job, social activities and quality of life. We aimed to discover the sources of identity challenges among patients with Haemophilia. Design: The present study has been designed and performed as a qualitative content analysis research. Methods: Participants were purposively selected from haemophilia patients referred to our clinic during one year, from March 2018 to April 2019. Data collection was done through semi‐structured, in‐depth interviews using purposeful sampling. Data were analysed based on Granheme and Landman method. The main categories were fear of rejection, losing social roles, discrimination and stigma and marriage breakdown. Results: Patients with haemophilia encounter several challenges due to physical and social constraints caused by the disease. Such challenges result in disturbances in the self‐identity of the patients. Conclusion: According to the results of this study, the nurses should plan to have attention to the patients with haemophilia, based on more protection and better supports. [ABSTRACT FROM AUTHOR]

BACKGROUND: Traditional medicine is a complete system, including diagnostic methods, etiology and treatment based on interpersonal differences. Owing to a lack of investigations in the field of Iranian traditional medicine as well as its many present challenges, certain studies in this area can prove quite practical in identifying and solving ongoing challenges. This study investigates the challenges of the health system in Iranian traditional medicine in the context of control levers. METHODS: The study was qualitative content analysis. A framework analysis, "Control Knob Approach", was considered appropriate to promote apprehension of challenges of health systems in Iranian traditional medicine. Data were collected by purposeful sampling through in-depth and semi-structured individual interviews with 35 experts of Iranian traditional medicine. Directed content analysis was used to analyze the data, which extracted the initial codes after performing the recorded interviews on paper and immersing them in the data analysis. RESULTS: Upon analysis of data by Iranian medicine experts, five main categories including financing, payment system, regulations, behavior and organization were defined alongside 13 subcategories. CONCLUSION: According to current challenges and the tendency of society to receive traditional medicine services, as well as the long history of traditional medicine in Iran, fair access to traditional medicine services should be provided. This access must be through the production of indigenous knowledge and the formulation of regulatory and educational policies and guidelines and the empowerment of relevant, healthy, effective, evidencebased and cost-effective forces. [ABSTRACT FROM AUTHOR]

This study investigates and fully identifies the challenges of the Iranian e-learning system. The approach was qualitative and the method was research synthesis. The statistical population consisted of studies from 2006 to 2019 in the field of challenges of the e-learning system of Iran collected with specific keywords from the country’s databases. A total of 48 studies were identified as relevant. They were screened in stages and evaluated based on their title, abstract, and content. The final 19 articles selected underwent content analysis, revealing that Iran’s e-learning system faces problems in eight dimensions: legal, human, educational, technological, sociocultural, support, economic, and managerial-organizational. The results of the analysis could serve as a model for countries with similar technology infrastructure and cultural features wishing to improve their e-learning systems. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to present challenges of implementing the accreditation model in university and military hospitals in Iran.Methods: In this qualitative study, purposive sampling was used to select hospital managers and implementers of the model working in 3 hospitals affiliated to Kerman University of Medical Sciences and in 3 military hospitals in Kerman, Iran. A total of 39 participants were interviewed, and semi-structured questionnaires and thematic analysis were used for data collection and analysis, respectively.Results: In this study, 5 major codes and 17 subcodes were identified: (1) perspectives on accreditation model with 5 subcodes: a difficult and time-consuming model, less attention to the patient, accreditation as a way of money acquisition, not being cost-effective, and accreditation means incorrect documentation; (2) absence of appropriate executive policy, with 3 subcodes: lack of financial funds and personnel, disregarding local conditions in implementation and evaluation, and absence of the principle of unity of command; (3) training problems of the accreditation model, with 2 subcodes: absence of proper training and incoordination of training and evaluation; (4) human resources problems, with 3 subcodes: no profit for nonphysician personnel, heavy workload of the personnel, and physicians' nonparticipation; (5) evaluation problems, with 4 subcodes: no precise and comprehensive evaluation, inconformity of authorities' perspectives on evaluation, considerable change in evaluation criteria, and excessive reliance on certificates.Conclusions: This study provided useful data on the challenges of implementing hospitals' accreditation, which can be used by health policymakers to revise and modify accreditation procedures in Iran and other countries with similar conditions. The accreditation model is comprehensive and has been implemented to improve the quality of services and patients' safety. The basic philosophy of hospital accreditation did not fully comply with the underlying conditions of the hospitals. The hospital staff considered accreditation as the ultimate goal rather than a means for achieving quality of service. The Ministry of Health and Medical Education performed accreditation hastily for all Iranian hospitals, while the hospitals were not prepared and equipped to implement the accreditation model. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to explore the challenges of providing primary health care (PHC) to Afghan immigrants in Tehran as an important global human right issue. Design/methodology/approach: In this exploratory study, a total of 25 purposively selected PHC providers, including physicians, psychologists and midwives, were approached for face-to-face, semi-structured interviews, lasting 30 min on average. Thematic analysis was used to analyze the data. Findings: The most common challenges of providing PHC to Afghan immigrants were categorized at individual, organizational and societal levels. Communication barriers and socioeconomic features emerged at the individual level. The organizational challenges included mainly the lack of insurance coverage for all immigrants and the lack of a screening system upon the immigrants' arrival from the borders. At the societal level, the negative attitudes toward Afghan immigrants were causing a problematic challenge. Research limitations/implications: The main limitation was the possibility that only health-care professionals with particular positive or negative perspectives about immigrants enter into the study, because of the voluntary nature of participation. Practical implications: Findings can help policymakers adopt evidence-informed strategies for facilitating PHC provision and improving the access to health care in immigrants as a global human right concern. Social implications: This study alerts about undesirable consequences of certain attitudes and behaviors of the society toward immigrant health. Originality/value: To the best of the authors' knowledge, this is one of the first studies conducted in PHC centers in Tehran Province that explores the challenges of providing PHC to Afghan immigrants. [ABSTRACT FROM AUTHOR]

Introduction: Faculty members' evaluation is an important factor for promotion, tenure, payment of rewards or incentives, accountability and continuation of developing faculty at medical university. Studies showed that having a fair and meaningful faculty evaluation system has an impact on the performances of all faculty members. The present study aimed at investigating the challenges of faculty about faculty members' evaluation systems. Methods: In this qualitative content analysis study, participants were 10 faculty members from the Tehran University of Medical Sciences. The participants were selected through purposeful sampling. The data which were collected through semi-structured interviews were used for establishing the codes, subcategories, and main categories. The collected data were analyzed by constant comparative analysis being recommended by Corbin and Strauss 2015. Results: The challenges of faculty evaluation system were explored in four main categories: "providing feedback for the faculty", "objective evaluation", "evaluation based on student perspective", and "faculty members' performance analysis". Discussion: This study founded the faculty members who preferred to receive feedback, qualitative evaluation, the need for multiple sources of information gathering, greater transparency, increased trust, and accreditation of the evaluation process. It is recommended to explore the process of faculty evaluation in Iran. [ABSTRACT FROM AUTHOR]

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1- Introduction In recent decades, countries around the world have thought about using clean energy carriers as a solution for problems caused by excessive air and environmental pollution. Meanwhile, natural gas consumption has been increased due to less diffusion of carbon dioxide (compared to other fossil fuels) and more environmental sustainability it can cause thus, demand for it has risen to the utmost degree. Iran owns 18% of world total gas reserves which makes it the second-biggest gas owner in the world. Thus, this country can play a prominent role in answering the increased demand for gas in the new atmosphere mentioned above and this can add to its geopolitical prominence. However, in spite of various potential benefits of natural gas for Iran, due to existing challenges, this country has not been able to use its opportunities. In the current research, we study Iran's challenges and opportunities with respect to natural gas, from a geopolitical perspective. 2- Research Method This study has been conducted through using analytical descriptive method. Considering the nature of the studied subject, the needed data has been gathered by using library resources. 3- Discussion With regard to gas reserves, Iran is a very rich country, and by having 29.61 trillion cubic meters of exploitable gas reserves- which consists of 15.8% of proven gas reserves of the world- it has the second-largest gas reserves in the world after Russia. More than half of Iran's gas reserves are located in common gas fields and more than two-thirds of them are placed in non-associated gas fields. Iran's the most important non-associated gas fields are: South Pars, North Pars, Nar, Khangiran. Most of Iran's gas reserves are in southern areas of the country, near Persian Gulf, and many of them are jointly owned by Iran and its neighboring countries. The largest of them is South Pars field that holds half of Iran's gas reserves. Compared to its huge gas reserves and its rank in the world in that respect, Iran's gas production is far less than expected. However, in recent years, an increase in gas production can be witnessed, the amount of which has been 131.2 billion cubic meters in 2009. This amount has been 4.4% of total amount of worldwide gas production and makes Iran the fourth-biggest producer of gas in the world. Concerning gas consumption, in 1993, Iran has consumed 26.6 billion cubic meters of natural gas which has risen to 131.7 billion cubic meters in 2009. These figures show that in 16 years, the amount of gas production in Iran has increased five times. So, we can see that Iran's huge gas reserves pose their own challenges for the country, the most important of which is excessive consumption of natural gas. 4- Conclusion Iran has the second-largest gas reserves in the world. However, this country is facing significant challenges in this respect, the most important of which are excessive consumption of natural gas, common gas fields, amount of burnt gases, and sanctions encouraged by the US and the opposition of that country to the development of Iran's gas sector. These sanctions have caused foreign companies not to invest in Iranian gas market, and thus, Iran's natural gas sector has a lower development rate compared to other gas owners in the world. However, this sector can offer great opportunities for Iran and it can be a base for the development of the country. By exporting gas and changing it into materials with higher added value, Iran's financial development can be accelerated. We should consider that gas is the main fuel used by Iranian petrochemical industries. Furthermore, transferring gas through pipelines to other countries and the resulting long-term contracts can improve Iran's financial and political relationship with other countries. Through this, Iran can reach out to Asian and European regions and by providing gas for them, Iran can increase its national security. This can be achieved through objection of these countries to any kind of sanction or threat imposed against Iran. In other words, Iran's geopolitical and strategic position, combined with its huge gas reserves, can help Iran reach out to international gas markets, which can increase Iran's economic and political power. In addition to that, gas injection to Iran's oil reservoirs can improve recycling and production of oil, the economic benefits of which are more than gas exportation at the moment. Furthermore, by adding to the number of gas-burning vehicles, Iran can reduce the amount of its imported petrol, which is considered as Iran's Achilles' heel in west's view. Iran is facing de facto challenges in natural gas sector which have brought about considerable harms for the country. But its opportunities in this sector are still untapped and for realizing them, Iran should first face the challenges and then solve them. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to determine the challenges and opportunities of the Communicable Diseases Surveillance System (CDSS) in Iran. Methods: This qualitative study was conducted using semi-structured interviews and focus group discussions (FGD) with 64 participants from October 2016 to April 2017. Purposeful sampling was used to recruit participants. The collected data were analyzed via the content analysis method. Data analysis was performed using MAXQDA10 software. Results: The results of this qualitative study were categorized in two parts: Challenges and opportunities. The CDSS is facing challenges in the fields of stewardship, reporting, information analysis, information, interventions, and education. Good infrastructures and structure, the technical support provided by the Centre for Communicable Disease Control (CCDC), the achievements of the CDSS, and the suitable electronic systems are among the opportunities of CDSS. Conclusion: The results of this study showed that CDSS has several major challenges. Authorities and policymakers must not ignore communicable diseases and their management tools, including CDSS because of their focus on non-communicable diseases. Some important strategies to overcome the challenges of CDSS can be the following: motivating policy makers to put emphasis on communicable diseases as a national security issue, the ratification and modification of laws and regulations on reporting, the involvement of the CDSS in the accreditation of hospitals and the renewal of the license for healthcare professionals, and motivating organizations outside the health sector to participate in the programs through inter-institutional agreements. [ABSTRACT FROM AUTHOR]

Cancer is a growing problem in the world, meanwhile, the issue of providing care for cancer patients has been associated with multiple ethical challenges (ECs). This study aimed to investigate and explain the nurses' perceptions of ECs in caring for cancer patients in Iran. In this qualitative study, the participants consisted of 25 nurses working in cancer wards. The typical EC that the nurses are faced with while caring for cancer patients included categories such as "creating moral distresses" and "threat to patient's autonomy." The category of creating moral distress consisted of two subcategories, including "faulty communication process" and "provision of futile care." Also, the category of "threat to patient's autonomy" included subcategories of "individual factors" and "organizational factors." Since disregarding ethical principles in caring for patients with cancer will result in greater ECs in this respect, the healthcare administrators should make more effort to help establish transparent rules, and develop protocols needed to identify and eliminate these ECs. [ABSTRACT FROM AUTHOR]

Background: Despite all the efforts made to control and eliminate malaria in Iran, this disease is still considered as a priority health problem in the South East of Iran. We aimed to determine the cultural obstacles which have prevented the elimination of malaria in this region. Method: This study was carried out through qualitative content analysis. Purposeful sampling was done from people who had malaria or were involved with malaria patients in 2015, in Sarbaz City, Sistan and Baluchestan Province, Eastern Iran. Data were collected through interviews using open questions and continued until data saturation. Results: The most important barriers in malaria prevention was delay in visiting health centers, delay in diagnosis and treatment due to superstitious beliefs, lack of information about the disease, misdiagnosis and fake doctors. Other obstacles were lack of trust and cooperation with interventions offered by the health system, lack of proper use of the available facilities to prevent malaria and commuting in the high-risk neighbor countries. Conclusion: Raising awareness in people, officials and health workers about malaria and preventive health interventions as well as health risks associated with fake doctors, following up and re-examination of peripheral blood smear in suspected cases, establishing malaria control stations in border areas and specific measures to refer immigrants and people crossing the border toward malaria diagnosis stations is suggested. [ABSTRACT FROM AUTHOR]

Background: Assessment of ethical issues in sexual health research around the world shows that published studies are scattered and limited and cannot be used as reliable sources for other studies. Objectives: This qualitative study aimed to explore the challenging experiences of sexual health researchers in Iran. Methods: This study was conducted using a conventional qualitative content analysis method. Data were collected through indepth individual interviews. The interviews were written and coded through conventional content analysis to form the initial categories. Results: Based on the data analysis, three main categories, seven subcategories, and 14 second subcategories were extracted. The main categories included: 1- challenges related to biomedical research ethics committees, 2- challenges of sexual health researchers, and 3- challenges related to sexual health topics. Conclusions: This study was carried out to provide a better understanding of the challenges of sexual health researchers in their studies. The importance of detecting these challenges empowered researchers to cope with the challenges during their study. [ABSTRACT FROM AUTHOR]

Aim: Cancer patients are confronted with different challenges. The purpose of current study was to explore Iranian cancer patients’ perceptions of these challenges.Subjects and methods: The study took a qualitative approach. Semi-structured interviews were held with 26 cancer patients in four university hospitals in Iran. Transcripts of the interviews underwent conventional content analysis, and categories emerged.Results: The findings came under two major categories: psychological challenges and socio-cultural challenges. Psychological challenges had two subcategories: repressed wishes, and negative feelings. Socio-cultural challenges also had two subcategories: deteriorated relationships and work distress.Conclusion: Findings of the current study have potential to identify psychosocial challenges of cancer patients. These findings propose that psychological support is essential for them. Our results recommend that healthcare providers should work to remain sensitive to cancer patients’ challenges. There is a need for culture-based caring programs that are responsive to these patients. [ABSTRACT FROM AUTHOR]

Introduction: After more than three decades of network system design, epidemiological transition, as well as the change in needs and expectations of rural communities, have brought some challenges for Iran,s health houses. So, this study is aimed at identifying these challenges through a qualitative study. Methods: This was a qualitative and phenomenological study which was carried out in three phases in Iran in 2015. In the first phase, the required data was collected through semi-structured interviews with selected experts, health workers and referrals to Iran,s health houses, so that all were selected purposefully. In the second phase, two expert panels were conducted to provide solutions. In the third phase the strengths, weaknesses, opportunities and threats were evaluated using the Strengths, Weaknesses, Opportunities, Threats (SWOT) method. The data of the first two phases were analyzed using the Collaizi method. Results: Fourteen subthemes under five themes of ; quality of provided services, human resources, infrastructure, inter-sectorial and intra-sectorial relations, and contextual factors were identified as the challenges of Iran,s health houses, and consist of fourteen sub themes. Continuous education of health workers, equipping and renovating old buildings, improving inter and intra-sectorial relationships and the proportionating workload with a number of workers, were the most important solutions. Conclusion: The study showed that, over time, many of the functions of Iran,s health houses have been faced with problems, therefore, training the manpower, equipping Iran,s health houses and creating better public spaces and building culture are recommended to enhance the effectiveness and revisions based on the study. [ABSTRACT FROM AUTHOR]

This study integrates the motivating and challenging elements impacting on the implementation of organic farming practice in Iran. Analysis was based on the results of two surveys; one from organic farmers to determine motivating factors and the other from experts in organic farming to identify challenging factors. These surveys incorporated a gender perspective to enable gender comparison and analysis of the results presents a practical model to support program developers in Iranian organic agriculture. Gender comparison indicated that attitudes among farmers to organic agriculture were slightly variable according to gender; while experts' attitudes to organic agriculture remained constant and were not influenced by gender. The practical model ranked motivating factors as husbandry, financial, health-quality of life, general and personal; and challenging factors as financial, legal, educational, and technical. Finally, several suggestions are made according to these findings. [ABSTRACT FROM AUTHOR]

A descriptive survey research was undertaken in order to assess challenges facing agricultural mechanization development in Iran. The research population included agricultural mechanization experts, managers and specialists in private and governmental sections. Using proportional stratified sampling, a sample of 119 was constituted out of a total population of 809 based on the Cochran formula. Data were collected using questionnaire on which the statements were collected after literature review of research and interviews with mechanization specialists. The questionnaire was validated by a panel of experts and its reliability index was established by a Cronbach's coefficient. A pilot study was conducted with 30 questionnaires (not included in the sample population) to determine the reliability of the questionnaire. Computed Cronbach's alpha score was 75%, which indicated that the questionnaire was highly reliable. All survey data were analyzed using the Statistical Package for Social Sciences (SPSS 16.0). The results of factor analysis indicated that 69% of the variances of the challenges could be classified in seven groups, namely: programming, technical, infrastructural, managerial, economical, research and extension, and content area. From each group the most important challenges facing agricultural mechanization development in Iran include: inefficiency of subside payment methods for buying agricultural machinery, large number of time-worn agricultural machinery, incomplete collection of agricultural equipments for power generator machinery (tractor), slow trend of beneficiaries in accepting new technologies, financial weakness of agricultural beneficiaries, inefficiency of agricultural extension and education methods, and weakness of agricultural machinery producers and operators in protecting their guild benefits. [ABSTRACT FROM AUTHOR]

Background: Alzheimer's disease (AD) is a progressive and debilitating disorder that strongly affects people with AD and their families. The changes in signs of the disease and its treatment lead to many challenges in people with AD that affect the performance and the ability of caregivers, their social life, and physical, emotional, and psychological aspects of caregivers' health. Therefore, this study was designed to develop and validate the Care Challenge Scale (CCS) for family caregivers of people with AD in the care context of Iran., Method: This is a cross-sectional study, and the primary scale was based on 14 semi-structured interviews with family caregivers of Iranian people with AD. In the next phase, the psychometric features were assessed, including the face validity (qualitative and quantitative), content validity (qualitative and quantitative), item analysis, structural validity (exploratory and confirmatory factors), and construct validity (convergent and discriminant validity). Finally, the reliability was assessed using internal consistency (Cronbach's alpha, McDonald's omega coefficient, and the average inter-item correlation), stability (intraclass correlation coefficient), and absolute reliability., Results: Totally, 435 Iranian family caregivers filled out online questionnaires, with a mean age of 50.26(±13.24) years. Based on the results of the qualitative phase, an item pool was generated with 389 items, and after deleting overlapping and unrelated items, the CCS with 14 items was created. The results of the quantitative phase showed that the CCS consists of two factors with 10 items each, which are named effective role-play challenge and lack of social-financial support, and they explained 42.23% of the total variance. Furthermore, the results of confirmatory factor analysis showed a good fitness of the scale structure model, and it had convergent and discriminant validity. The reliability indexes showed this scale has internal consistency and stability., Conclusion: The most care challenge among Iranian family caregivers of people with AD is effective role-play challenges and lack of social-financial support. The scale as designed has good validity, internal consistency, and stability that can be used by therapists, nurses, and researchers for the assessment of the challenges of this population., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Sharif Nia, Sivarajan Froelicher, Hosseini, Ashghali Farahani and Hejazi.)

Online learning has now become an accepted and popular method of education for large numbers of universities in Iran, and now many higher education institutions are offering online courses to their students. The present study was carried out with the aim of investigating challenges to developing online learning in higher education. The study was based on survey research method and a questionnaire was developed to gather the data. The study population was postgraduate students (M.Sc. and Ph.D.) of different faculties in Tehran University who were selected by applying purposive sampling technique. The sample size for students was 152 persons. Data were analyzed by using SPSS/WIN software and descriptive and inferential methods were used for the data analysis. The results of the research indicated that three major factors explained 74.4% of variances of challenges to developing online learning. These factors were cultural/educational, technical, and financial challenges. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic was affect the entire food system including compromising food security and in a matter of months, has brought about a change in behavior. Due to the impossibility of face-to-face training, using smartphones can be a way to prevent malnutrition. Objective: Aim this study how avoid to preventing further spread of unhealthy nutrition Using smartphones. Material and Methods: This review study examines the results of papers in year 2020 and papers published in this time. The studies conducted in the field of Smartphone, COVID-19, nutrition and challenge in valid databases of Iran medex, Google scholar, PubMed, Web of Science, and Scopus were investigated, and the results were extracted. Results: In the coronavirus pandemic, nutritionists and dietitians can offer remote nutritional education and follow-up. This training method can be associated with some challenges, for example: If, Access to connectivity limited for some populations, Ensure appropriate online support. Also, maybe participants worried from how privacy. so, It is important to ensure that the privacy, confidentiality and consent of the respondents is maintained and Be clear on the limitations and representation of the data. The opportunity for nutrition education is to advocate for nutrition quality and access to healthy food for all, in the best and worst of times. In this time, proper planning with focusing on the remote recommendations of nutritionists Utilizing technologies such as mobil is needed to ensure that this pandemic does not threaten food security and health. [ABSTRACT FROM AUTHOR]

Hemiscorpius lepturus (H. lepturus) is one of the most dangerous scorpions and the most medically important scorpion in Iran. The clinical signs of H. lepturus envenomation, including dermonecrosis, hematuria, renal failure and early death, are attributed to phospholipase D activity. This study was conducted to develop a novel recombinant phospholipase D1 (rPLD1) toxoid and investigate its immunogenicity and protective effects against the lethality of H. lepturus venom. The lethal protein recombinant phospholipase D1 was expressed from PLD H. lepturus venom gland. The rPLD1 toxin was converted into toxoid (the first toxoid of H. lepturus PLD) with a 0.25% concentration of formalin and stored for ten days at room temperature. In the toxicity test, the lethal activity of recombinant phospholipase D1 was fully inhibited. When it reached up to 3 times higher than the maximal effective concentration of the purified toxin (11.1 μg), rPLD1 toxoid was used. The sphingomyelinase activity was inhibited when up to 5.4 times of the LD100 of the purified toxin (20 μg), toxoid was used. It was then used to produce an antibody in BALB/c as an antigen and the mice were then challenged with rPLD1 toxin and the whole venom. The immunogenicity of rPLD1 toxoid was evaluated and the maximum titer of the raised antibodies was determined by ELISA assay. The optimum titer for anti-rPLD1 toxoid sera was obtained at the third intraperitoneal injection of rPLD1 toxoid, and a high titer was reached at the fourth injection in the mice. This toxoid increased the amount of antibodies and produced a protective antiserum against the whole venom of H. lepturus and rPLD1 toxin. The in-vivo test results showed that the mice were completely resistant against 200 times the LD100 of recombinant phospholipase D1 and the whole venom of H. lepturus. To conclude, rPLD1 can be used in toxoid form as an immunogen in the production of a new generation of neutralizing antibodies against the lethality and toxicity of H. lepturus whole venom., (Copyright © 2018 Elsevier Ltd. All rights reserved.)