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Håkan Bergh,1,2 Margit Albrektson,3 Clovis Kastberg,4 Amir Baigi,1,2 Lennart Hedström3 1School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; 2Department of Research & Development Unit, Hospital Varberg, Region Halland, Sweden; 3Public Dental Services, Västra Vall, Varberg, Sweden; 4Tre Tandläkare, Varberg, SwedenCorrespondence: Håkan Bergh, School of Public Health and Community Medicine, Institute of Medicine, P.O. Box 463, Gothenburg, 405 30, Sweden, Email hakan.e.bergh@gmail.com Lennart Hedström, Public Dental Service, Västra Vallgatan 14, Varberg, S-43244, Region Halland, Sweden, Email h.lennart.hedstrom@gmail.comObjective: To study the association between sublingual varices (SV) and cardiovascular (CVD) risk factors.Methods: A total of 989 consecutive dental patients aged 55– 84 years participated in the study, which applied a survey about risk factors, diseases and medications. Digital photos of the lateral borders of the tongue, height, weight, waist, hip and blood pressure were registered, and blood samples were analyzed. Those with SV were compared with those without SV (nSV).Results: Those with SV had more hypertension 41.8% vs 27.0% (p< 0.0001), a higher systolic blood pressure (BP) 139.5 (SD 18.6) mmHg vs 134.3 (SD 18.8) mmHg (95% CI − 7.73 &boxh; − 2.72), more diabetes type 2 (DM-2) 7.4% vs 3.8% (p=0.014), a higher fasting plasma glucose 5.9 (SD 1.5) mmol/L vs 5.7 (SD 1.0) mmol/L (95% CI − 0.42 &boxh; − 0.05), more dyslipidemia 24.1% vs 17.7% (p=0.018), lower HDL 1.6 vs 1.7 (p=0.003), a greater waist circumference 97.0 cm vs 93.9 cm (95% CI − 4.66 &boxh; − 1.46), a greater waist/hip ratio 0.92 cm/cm vs 0.90 cm/cm (95% CI − 0.03 &boxh; − 0.01), and a higher BMI 26.6 kg/m2 vs 26.0 kg/m2 (95% CI − 1.11 &boxh; − 0.03). The following associations with SV were found in multivariate analysis: hypertension OR=1.6 (95% CI 1.19 &boxh;2.13), a high systolic BP OR =1.5 (95% CI 1.11 &boxh;2.13), a high fP-glucose OR= 1.8 (95% CI 1.03 &boxh;3.21), a low HDL OR= 1.8 (95% CI 1.15 &boxh;2.92), a greater waist circumference OR= 1.68 (95% CI 1.10 &boxh;2.58), a greater waist/hip ratio OR=2.21 (95% CI 1.36 &boxh;3.58), and a higher BMI OR=1.05 (95% CI 1.02 &boxh;1.09).Conclusion: This study shows an association between SV and a high BP, a high fP-glucose, hypertension, diabetes mellitus type 2, dyslipidemia, abdominal obesity, older age and smoking.Keywords: sublingual varices, cardiovascular riskfactors

Marie Bräutigam Ewe,1 Marie Lydell,2 Håkan Bergh,1,3 Cathrine Hildingh,2 Amir Baigi,1,3 Jörgen Månsson1 1Department of Public Health and Community Medicine/Primary Health Care, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; 2CVHI-Centre of Research on Welfare, Health and Sport, School of Health and Welfare, Halmstad University, Halmstad, Sweden; 3Research and Development Unit Halland, Region of Halland, Halmstad, Sweden Purpose: An important task in primary health care (PHC) is to address lifestyle-related diseases. Overweight (OW) individuals make up a large proportion of PHC patients, and they increasingly have lifestyle-related illnesses that influence their quality of life. Structured health promotion and weight reduction programs could help these patients. The objective of this study was to explore the characteristics, lifestyle habits, and health conditions of individuals seeking a health promotion and weight reduction program in PHC.Patients and methods: The study involved a comparative cross-sectional design performed in PHC in southwestern Sweden. The study population comprised 286 participants (231 women, aged 40–65 years, body mass index [BMI] 28–35 kg/m2) who were recruited between March 2011 and April 2014 to the 2-year program by adverts in local newspapers and recruitment from three PHC centers. Two reference populations were used: a general population group and an OW group. The study population data were collected using a questionnaire, with validated questions regarding health, lifestyle, illnesses, and health care utilization.Results: People seeking a health promotion and weight reduction program were mostly women. They had a higher education level and experienced worse general health than the OW population, and they visited PHC more frequently than both reference groups. They also felt more stressed, humiliated, had more body pain, and smoked less compared to the general population. However, they did not exercise less or had a lower intake of fruits and vegetables than either reference population.Conclusion: Individuals seeking a weight reduction program were mostly women with a higher education level and a worse general health than the OW population. They used more health care services compared to the reference groups. Keywords: lifestyle, overweight, primary health care, weight loss

Background: Trauma is the sixth cause of death worldwide and the fifth main cause of significant disability and carries a great economic and social burden.Objective: This study was carried out to investigate the epidemiological and clinical characteristics of trauma and to assess the correlation between the cause of trauma and its severity in different body areas.Methods: Patients with all kinds of injuries referred to the Emergency Department (ED) of Al-Zahra University Hospital in Isfahan, Iran, who met the inclusion criteria, were recruited to this study from September 2019 to January 2023.Results: Among the 869 trauma patients admitted to the hospital during this period, 444 (51.1%) were married. There was a statistically significant difference in the pattern of trauma between males and females (P = 0.003). There was also a significant relationship between the average age of people and different causes of injury (P 3, according to our findings. These research endeavors will aid in devising improved methods to prevent occurrences and enhance healthcare approaches. To prevent and manage traumatic injuries, a multi-sectoral approach and collaboration between different stakeholders is needed.

Introduction: Head injuries (HI) pose a significant public health concern globally, impacting morbidity, mortality, and economic burden. This study aimed to evaluate the epidemiology and trends associated with head injuries in Iran from 1990 to 2019. Methods: Our study, based on data from the Global Burden of Diseases (GBD) Study 2019, undertook a comprehensive comparison of the burden of HI in Iran with the Middle East and North Africa (MENA) and global benchmarks. We assessed the incidence, prevalence, and years lived with disability (YLD) through various metrics, including absolute numbers, age-standardized rates (ASR), percentage changes, and estimated annual percentage changes (EAPC) from 1990 to 2019. Results: The incidence of HI in Iran decreased significantly from 1990 to 2019, with a notable reduction compared to MENA and global trends (EAPC: -1.44, 0.71, and -0.11, respectively). Prevalence showed a declining trend (EAPC: -1.00), with a slight increase in YLDs (EAPC: 0.12). Notable peaks in HI incidence coincided with natural disasters, notably the 1990 Manjil-Rudbar earthquake and the 2003 Bam earthquake. Conclusion: Our study reveals a decline in the overall burden of HI in Iran over the study period. To sustain this positive trend and minimize the impact of HI on public health and socioeconomic well-being, policy efforts should be directed toward ongoing prevention, early detection, and preparedness for natural disasters.

The current study investigated the impact of perceived instructional strategies in online design studios on student engagement as a multidimensional construct. Given the rapid shift to online learning during the COVID-19 pandemic, understanding effective teaching strategies and their impacts on student engagement is crucial for enhancing overall student outcomes. The study also examined the role of learning motivation as a mediator in these relationships. A mixed-methods approach was employed, measuring a second-order construct of student engagement based on three reflective dimensions: cognitive, affective, and behavioral. Qualitative interviews with instructors revealed three main instructional strategies utilized in online design studios: learning by doing, learning with interaction, and learning from feedback. The present study analyzed self-report survey responses from 230 undergraduate architecture students across four major universities in Iran, utilizing partial least squares structural equation modeling (PLS-SEM). Based on the results, the perceived learning by doing (PLD) and learning with interaction (PLI) significantly improve student engagement. In contrast, the perceived learning from feedback (PLF) fails to influence student engagement directly. Additionally, intrinsic and extrinsic motivation mediated the impact of PLI and PLF on student engagement. These findings highlight the importance of effective instructional strategies in online design studios. Additionally, the results provide valuable insights for future pedagogical practices in online education, offering guidance for instructors aiming to enhance student outcomes in this dynamic learning environment.

Abstract Background Injury is one of the leading causes of death worldwide, and the abdomen is the most common area of trauma after the head and extremities. Abdominal injury is often divided into two categories: blunt and penetrating injuries. This study aims to determine the epidemiological and clinical characteristics of these two types of abdominal injuries in patients registered with the National Trauma Registry of Iran (NTRI). Methods This multicenter cross-sectional study was conducted with data from the NTRI from July 24, 2016, to May 21, 2023. All abdominal trauma patients defined by the International Classification of Diseases; 10th Revision (ICD-10) codes were enrolled in this study. The inclusion criteria were one of the following: hospital length of stay (LOS) of more than 24 h, fatal injuries, and trauma patients transferred from the ICU of other hospitals. Results Among 532 patients with abdominal injuries, 420 (78.9%) had a blunt injury, and 435 (81.7%) of the victims were men. The most injured organs in blunt trauma were the spleen, with 200 (47.6%) and the liver, with 171 (40.7%) cases, respectively. Also, the colon and small intestine, with 42 (37.5%) cases, had the highest number of injuries in penetrating injuries. Blood was transfused in 103 (23.5%) of blunt injured victims and 17 (15.2%) of penetrating traumas (p = 0.03). ICU admission was significantly varied between the two groups, with 266 (63.6%) patients in the blunt group and 47 (42%) in penetrating (p

Purpose: The purpose of the National Spinal Cord Injury Registry of Iran (NSCIR-IR) is to create an infrastructure to assess the quality of care for spine trauma and in this study, we aim to investigate whether the NSCIR-IR successfully provides necessary post-discharge follow-up data for these patients. Methods: An observational prospective study was conducted from April 11, 2021 to April 22, 2022 in 8 centers enrolled in NSCIR-IR, respectively Arak, Rasht, Urmia, Shahroud, Yazd, Kashan, Tabriz, and Tehran. Patients were classified into 3 groups based on their need for care resources, respectively: (1) non-spinal cord injury (SCI) patients without surgery (group 1), (2) non-SCI patients with surgery (group 2), and (3) SCI patients (group 3). The assessment tool was a self-designed questionnaire to evaluate the care quality in 3 phases: pre-hospital, in-hospital, and post-hospital. The data from the first 2 phases were collected through the registry. The post-hospital data were collected by conducting follow-up assessments. Telephone follow-ups were conducted for groups 1 and 2 (non-SCI patients), while group 3 (SCI patients) had a face-to-face visit. This study took place during the COVID-19 pandemic. Data on age and time interval from injury to follow-up were expressed as mean ± standard deviation (SD) and response rate and follow-up loss as a percentage. Results: Altogether 1538 telephone follow-up records related to 1292 patients were registered in the NSCIR-IR. Of the total calls, 918 (71.05%) were related to successful follow-ups, but 38 cases died and thus were excluded from data analysis. In the end, post-hospital data from 880 patients alive were gathered. The success rate of follow-ups by telephone for groups 1 and 2 was 73.38% and 67.05% respectively, compared to 66.67% by face-to-face visits for group 3, which was very hard during the COVID-19 pandemic. The data completion rate after discharge ranged from 48% – 100%, 22% – 100% and 29% – 100% for groups 1 – 3. Conclusions: To improve patient accessibility, NSCIR-IR should take measures during data gathering to increase the accuracy of registered contact information. Regarding the loss to follow-ups of SCI patients, NSCIR-IR should find strategies for remote assessment or motivate them to participate in follow-ups through, for example, providing transportation facilities or financial support.

Abstract Hereby, we aimed to comprehensively compare different scoring systems for pediatric trauma and their ability to predict in-hospital mortality and intensive care unit (ICU) admission. The current registry-based multicenter study encompassed a comprehensive dataset of 6709 pediatric trauma patients aged ≤ 18 years from July 2016 to September 2023. To ascertain the predictive efficacy of the scoring systems, the area under the receiver operating characteristic curve (AUC) was calculated. A total of 720 individuals (10.7%) required admission to the ICU. The mortality rate was 1.1% (n = 72). The most predictive scoring system for in-hospital mortality was the adjusted trauma and injury severity score (aTRISS) (AUC = 0.982), followed by trauma and injury severity score (TRISS) (AUC = 0.980), new trauma and injury severity score (NTRISS) (AUC = 0.972), Glasgow coma scale (GCS) (AUC = 0.9546), revised trauma score (RTS) (AUC = 0.944), pre-hospital index (PHI) (AUC = 0.936), injury severity score (ISS) (AUC = 0.901), new injury severity score (NISS) (AUC = 0.900), and abbreviated injury scale (AIS) (AUC = 0.734). Given the predictive performance of the scoring systems for ICU admission, NTRISS had the highest predictive performance (AUC = 0.837), followed by aTRISS (AUC = 0.836), TRISS (AUC = 0.823), ISS (AUC = 0.807), NISS (AUC = 0.805), GCS (AUC = 0.735), RTS (AUC = 0.698), PHI (AUC = 0.662), and AIS (AUC = 0.651). In the present study, we concluded the superiority of the TRISS and its two derived counterparts, aTRISS and NTRISS, compared to other scoring systems, to efficiently discerning individuals who possess a heightened susceptibility to unfavorable consequences. The significance of these findings underscores the necessity of incorporating these metrics into the realm of clinical practice.

Background: According to the reports, the road traffic injuries (RTI) mortality rate in Iran as a middle-income country in the Eastern Mediterranean Region (EMR) decreased in past decades but is higher than the global level and remained a health problem.Objectives: This study aimed to report the characteristics of registered patients injured by different trauma mechanisms in Yazd City, Iran.Methods: In this study, the patients were registered from September 28, 2016, to December 31, 2022, at Shahid Rahnamoon Hospital, affiliated with the National Trauma Registry of Iran (NTRI) for its first phase. Inclusion criteria were hospital length of stay (LOS) of more than 24 hours, death due to injury in the hospital, or transfer from other hospitals' intensive care units (ICU). Age, gender, Glasgow Coma Scale (GCS), systolic blood pressure (SBP), cause of injury, LOS, injury severity score (ISS), and in-hospital mortality were assessed.Results: Among 3960 participants, 2307 (58.2%) patients were injured due to RTI as the most common cause of injury. Also, 949 (23.9%) and 359 (9.1%) of the participants experienced fall and stab/cut injuries, respectively. Men were affected more than women in all injury causes (p

Summary: Background: Globally, fall-related injuries are a substantial problem, and 80% of fatal falls occur in low-income and middle-income countries. We aimed to measure time from injury to hip-fracture surgery in people aged 50 years or older living in low-income and middle-income regions, as well as to measure the proportion of patients with surgical stabilisation of their hip fracture within 72 h of admission to hospital and to identify risk factors associated with surgical delay. Methods: For this secondary analysis, we analysed data collected from Africa, Latin America, China, India, and Asia (excluding China and India) for the International Orthopaedic Multicentre Study in Fracture Care (INORMUS) between March 29, 2014, and June 15, 2022. Patients from INORMUS were included in this analysis if they were aged 50 years or older and had an isolated, primary hip fracture sustained from a ground-level fall. Staff at participating hospitals identified patients with musculoskeletal injury and referred them for assessment of eligibility. We report time from injury to surgery as three distinct time periods: time from injury to hospital admission, time from admission to surgery, and a total time from injury to surgery. Date and time of injury were self-reported by patients at the time of study recruitment. If time to hospital admission after injury exceeded 24 h, patients reported the primary reason for delayed admission. Reasons for surgery, no surgery, and surgical delay were reported by the treating team. For patients undergoing surgery, multivariable regression analyses were used to identify risk factors for surgical delay. Findings: 4486 adults aged 50 years or older with an isolated, primary hip fracture were enrolled in INORMUS from 55 hospitals in 24 countries. Countries were grouped into five regions: Africa (418 [9·3%] of 4486), Latin America (558 [12·4%]), China (1680 [37·4%]), India (1059 [23·6%]) and Asia (excluding China and India; 771 [17·2%]). Of 4486 patients, 3805 (84·8%) received surgery. The rate of surgery was similar in all regions except in Africa, where only 193 (46·3%) of 418 patients had surgery. Overall, 2791 (62·2%) of 4486 patients were admitted to hospital within 24 h of injury. However, 1019 (22·7%) of 4486 patients had delayed hospital admission of 72 h or more from injury. The two most common reasons for delayed admission of more than 24 h were transfer from another hospital (522 [36·2%] of 1441) and delayed care-seeking because patients thought the injury would heal on its own (480 [33·3%]). Once admitted to hospital, 1451 (38·1%) of 3805 patients who received surgery did so within 72 h (median 4·0 days [IQR 1·7–6·0]). Regional variation was seen in the proportion of patients receiving surgery within 72 h of hospital admission (92 [17·9%] of 514 in Latin America, 53 [27·5%] of 193 in Africa, 454 [30·9%] of 1471 in China, 318 [44·4%] of 716 in Asia [excluding China and India], and 534 [58·6%] of 911 in India). Of all 3805 patients who received operative treatment, 2353 (61·8%) waited 72 h or more from hospital admission. From time of injury, the proportion of patients who were surgically stabilised within 72 h was 889 (23·4%) of 3805 (50 [9·7%] of 517 in Latin America, 31 [16·1%] of 193 in Africa, 277 [18·8%] of 1471 in China, 189 [26·4%] of 716 in Asia [excluding China and India], and 342 [37·5%] of 911 in India). Interpretation: Access to surgery within 72 h of hospital admission was poor, with factors that affected time to surgery varying by region. Data are necessary to understand existing pathways of hip-fracture care to inform the local development of quality-improvement initiatives. Funding: The National Health and Medical Research Council of Australia, the Canadian Institutes of Health Research, McMaster Surgical Associates, Hamilton Health Sciences, and the US National Institutes of Health.

Abstract Background Primary care depends upon a good information flow across professional and structural boundaries to provide the best care for patients. Previous research has mainly focused on Evidence-Based Practice (EBP) within specific professions. Mapping of pan-professional experiences of and attitudes to EBP in publicly funded clinical practice is necessary to deepen the understanding of EBP and its implementation. Thus, this study aimed to investigate healthcare professionals’ experiences of and attitudes towards working in accordance with EBP in primary care. Methods The study used a convergent mixed methods design divided into two strands: a quantitative enquiry tool (Evidence-Based Practice Attitude Scale, EBPAS) and a set of qualitative interviews analysed by means of qualitative content analysis. Both strands included all primary care employees with patient interaction in the studied county (n = 625), including doctors, nurses, physiotherapists, psychologists and assistant nurses. Out of the original 625 healthcare professionals, 191 finished the first strand and 8 volunteered for the second strand (2 nurses, 2 physiotherapists, 1 psychiatrist and 3 doctors). Results The EBPAS value of 2.8 (max 4) indicated a generally positive attitude towards EBP amongst the population, which was also evident in the interviews. However, there were additional experiences of not having the ability or resources to engage in EBP. This was illustrated by the theme that emerged from the qualitative content analysis: “The dilemma of the split between theory and reality”. Due to the organisational and managerial focus on efficiency rather than quality of care, there were few or no incentives for promoting individual educational or research development. Conclusions Although the general attitude towards EBP is positive, experiences of practising it differ. There is a need to increase knowledge of EBP concepts, requirements and implementation in the clinical setting. The absence of opportunities to do research and collegial debate about new ways of finding and implementing research-based evidence results might influence the quality of care.

Abstract Background The COVID-19 pandemic, which had recorded 769 million cases and resulted in 6.95 million deaths by August 2023, has put pressure on healthcare systems. Frontline medical professionals face stress, potentially leading to health challenges. This research aimed to examine the mental health of staff during the COVID-19 pandemic. Methods This cross-sectional descriptive-analytical study was conducted in several hospitals in Tehran, Kerman, and Golpayegan between 2021 and 2022. The study encompassed a population of 1,231 nurses and physicians. Data collection was done using the General Health Questionnaire-28 (GHQ-28). We applied the K-means clustering algorithm to unveil hidden patterns within the data and extract valuable insights from participants' responses to the GHQ-28. This method was chosen because our dataset lacked explicit labels, making grouping individuals with similar characteristics necessary. The primary aim was to delineate how the COVID-19 pandemic affected the mental health of hospital staff and identify which factors played a more significant role in this process. Results We have observed that Cluster two exhibits the highest scores in response to the GHQ-28 questions, indicating a more significant degree of mental distress. Within this cluster, 83.0% of individuals identify as female, 71.0% hold bachelor's degrees and 42.8% are nurses who have experienced the most substantial impact. Among these individuals, 90.4% did not have a history of smoking. Additionally, 59.7% are married, suggesting that these mental health issues may also affect their families. Conclusion Given that the most critical subscale is related to anxiety/insomnia within the second cluster, it is necessary to implement management plans aimed at appropriately redistributing night shifts to improve employee health.

Background: Road traffic accidents (RTAs) are the leading cause of death for children and young adults aged 5 to 39 and the third-leading cause of death in Iran.Objectives: The aim of this study was to assess in-hospital costs of patients following RTAs and identify associated factors among the patients admitted to Sina Hospital, a collaborating hospital with the National Trauma Registry of Iran (NTRI).Methods: A hospital-based registry study was conducted between September 17, 2016, and April 30, 2022, involving 3245 patients affected by RTAs. Data collection utilized the NTRI minimum dataset. To assess the factors influencing in-hospital costs of RTAs, various statistical analyses were performed, including independent sample t-tests, one-way ANOVA, and multiple linear regression analysis.Results: The distribution of studied subjects based on sex, age, and road user group revealed that the majority were male (91%), within the working age range of 21-60 years (78.2%), and motorcyclists (55.2%). The mean in-hospital cost per patient following RTAs was 152.3 million Iranian Rial (IRR) ($609.35). In the multiple linear regression analysis, several factors were significantly associated with higher in-hospital costs (ps

Background: The registry systems are a tool to provide information which can be used for improvement of medical care and preventive policies over time. The efficacy of trauma registries in improving the quality of care depends on the quality of their data. Objectives: This study aimed to determine the completeness, reliability, validity, and patient coverage of the Sina Hospital Trauma Registry (SHTR). Methods: The data collected in the SHTR by May 28, 2021, were used to assess the data completeness. A random sample of 250 patients was re-registered to evaluate the reliability and validity. The intraclass correlation coefficient (ICC) and the kappa and weighted kappa statistics were used to assess the reliability of data and agreement. The coverage was determined by comparing the list of trauma patients obtained from the trauma registry and the one from the hospital information system. Results: The overall average completeness for all variables was 97.9%. The inter-rater agreement on important variables including Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), and final outcomes was, respectively, perfect (kappa= 0.90) optimal (ICC = 0.72), and substantial (kappa= 0.71). The patient coverage was 79.6%. Conclusion: The results confirm that the data quality and patient coverage were high. In addition, although the reliability of most variables was acceptable, the agreement between NTRI’s data and the medical record for AIS codes and ISS was moderate.

Abstract Background and Aims This systematic review aimed to evaluating the effectiveness of machine learning (ML) algorithms for the prediction and diagnosis of meningitis. Methods On November 12, 2022, a systematic review was carried out using a keyword search in the reliable scientific databases PubMed, EMBASE, Scopus, and Web of Science. The recommendations of Preferred Reporting for Systematic Reviews and Meta‐Analyses (PRISMA) were adhered to. Studies conducted in English that employed ML to predict and identify meningitis were deemed to match the inclusion criteria. The eligibility requirements were used to independently review the titles and abstracts. The whole text was then obtained and independently reviewed in accordance with the eligibility requirements. Results After all the research matched the inclusion criteria, a total of 16 studies were added to the systematic review. Studies on the application of ML algorithms in the three categories of disease diagnosis ability (8.16) and disease prediction ability (8.16) (including cases related to identifying patients (50%), risk of death in patients (25%), the consequences of the disease in childhood (12.5%), and its etiology [12.5%]) were placed. Among the ML algorithms used in this study, logistic regression (LR) (4.16, 25%) and multiple logistic regression (MLR) (4.16, 25%) were the most used. All the included studies indicated improvements in the processes of diagnosis, prediction, and disease outbreak with the help of ML algorithms. Conclusion The results of the study showed that in all included studies, ML algorithms were an effective approach to facilitate diagnosis, predict consequences for risk classification, and improve resource utilization by predicting the volume of patients or services as well as discovering risk factors. The role of ML algorithms in improving disease diagnosis was more significant than disease prediction and prevalence. Meanwhile, the use of combined methods can optimize differential diagnoses and facilitate the decision‐making process for healthcare providers.

Introduction: This study systematically evaluates the effect of telerehabilitation on improving physical activity, physical function, and quality of life (QoL) in individuals with multiple sclerosis (MS). Materials and Methods: Studies were obtained by searching the title, abstract, and keywords without time limit in the Scopus, PubMed, Embase, and Web of Science databases. The quality of the included studies was assessed using the Joanna Briggs institute checklist. The same checklist was used for data extraction. Results: A total of 16 eligible articles were found. In 12 studies, the results showed significant performance improvement, reduced fatigue, improved physical activity, and general balance in the telerehabilitation approach. Furthermore, of the 16 included studies, 5(31) reported an improvement in individuals’ QoL, two of which showed a significant improvement in the individuals’ QoL in the intervention group compared to the control group. Conclusion: The findings of this review showed that telerehabilitation services for MS individuals’ precautions are comparable to or better than conventional services. Telerehabilitation is an effective educational instrument to restitute and maintain physical activity and balance in individuals with MS; however, no considerable improvement in individuals’ QoL was reported.

Introduction: A minimum data set improves the potential of data standardization and overcoming the problem of low-quality speech therapy data by providing coherent, complete, and uniform data elements. Therefore, this study was conducted to compare speech therapy minimum data set among different countries. Material and Methods: A systematic review was conducted without time limits in PubMed, Scopus, Web of Science, Embase, SID, Magiran, Elmnet databases, and in the Google search engine to retrieve articles, speech therapy forms, and speech therapy registry sites. Keywords related to speech therapy minimum data set including minimum data set, registry, and speech therapy, were used. First, studies were reviewed based on titles and abstracts. Then, the selected studies from the previous stage were examined independently by two researchers. A similar standard checklist was used to extract and compare the findings. Results: A total of 1710 related records were extracted for review, and finally, six main articles and 11 forms were included in this review. The six original articles included two related to speech therapy minimum data set in the United States, two related to Iran, and one related to Australia and Germany. A comparative review of the most important data elements obtained from the articles and input forms in this review, including identity and admission information, referral information, history, assessment of verbal skills, assessment of non-verbal skills, assessment of organs of production, assessment of cognitive skills, assessment of other aspects of speech, and linguistic and cultural considerations, were information elements related to diagnoses, recommendations, and treatment plans. Conclusion: It could be concluded that an agreed classification system is needed to facilitate communication between speech therapists. This potentially enables further testing of diagnostic and therapeutic hypotheses with more coherent and simultaneous data collection. The challenge ahead is to create a comprehensive and universally agreed-upon classification system that meets the needs of professionals and researchers.

Abstract Background In Sweden social security is a means-tested financial allowance. The Social Services Act states that an individual is entitled to financial support when his/her needs are not met in any other way. The aim of the present study was to analyse the prevalence and impact of various illness factors and symptoms in social security recipients compared to non-recipients in a welfare state, in this case Sweden. Methods A simple random sample of 20 100 individuals was selected from a national survey that covered all individuals in the 18–84 year age group in Sweden. A postal survey was thereafter conducted. Multiple logistic regression was employed as a statistical test. Odds ratio (OR) and a 95% confidence interval (CI) was used. Results Social security recipients were found to have a significantly higher risk in most of the studied variables. Reduced psychological wellbeing measured by means of the GHQ12 was significantly higher in this group compared to the rest of the population (OR 1.41 CI 1.03–1.94) and their lack of trust was greater (OR 1.96, CI 1.45–2.66). They reported more sleep disturbances (OR 2.16, CI 1.58–2.94) and suffered from anxiety (OR 1.74, CI 1.28–2.36). Their dental health was worse (OR 2.44, CI 1.82–3.28) and they had more pain in their hands and legs (OR 1.57, CI 1.16–2.12). Social security recipients were more often humiliated (OR 1.79, CI 1.31–2.44) and exposed to threat (OR 1.69, CI 1.09–2.61). They were less physically active (OR 1.56, CI 1.17–2.08), had a poorer diet (OR 1.95, CI 1.45–2.63) and were more often smokers (OR 3.20, CI 2.37–4.33). Implication The challenge for the welfare state consists of recognising the significance of both structural and lifestyle factors as a means of reducing the health gap.

Abstract Background In Sweden, as well as in Scandinavia, there is no easy way to evaluate patients' difficulties when they suffer from lateral epicondylitis/epicondylalgia. However, there is a Canadian questionnaire, in English, that could make the evaluation of a patient's pain and functional loss both quick and inexpensive. Therefore, the aim of this study was to translate and cross-culturally adapt the questionnaire "Patient-rated Tennis Elbow Evaluation" into Swedish (PRTEE-S; "Patientskattad Utvärdering av Tennisarmbåge"), and to evaluate the reliability and validity of the test. Methods The Patient-rated Tennis Elbow Evaluation was cross-culturally adapted for the Swedish language according to well-established guidelines. Fifty-four patients with unilateral epicondylitis/epicondylalgia were assessed using the PRTEE-S (Patientskattad Utvärdering av Tennisarmbåge), the Disabilities of Arm, Shoulder, and Hand questionnaire, and the Roles & Maudsley score to establish the validity and reliability of the PRTEE-S. Reliability was determined via calculation of the intra-class correlation coefficient (ICC) the internal consistency was assessed by Cronbach's alpha, and validity was calculated using Spearman's correlation coefficient. Results The test-retest reliability, using the PRTEE-S (Patientskattad Utvärdering av Tennisarmbåge) intraclass correlation coefficient, was 0.95 and the internal consistency was 0.94. The PRTEE-S correlated well with the Disabilities of the Arm, Shoulder, and Hand questionnaire (r = 0.88) and the Roles & Maudsley score (r = 0.78). Conclusion The PRTEE-S (Patientskattad Utvärdering av Tennisarmbåge) represents a reliable and valid instrument to evaluate the subjective outcome in Swedish speaking patients with lateral epicondylitis/epicondylalgia, and can be used in both research and clinical settings.

Introduction: In the digital age, since the application of artificial intelligence (AI) is increasingly penetrating the world, the cultivation of AI literacy has become increasingly important for everyone. This systematic review investigated the level of AI literacy among healthcare professionals and students. Material and Methods: We searched the databases PubMed, Embase, Scopus, and Web of Science for relevant material. The evidence gathered from the studies included in this systematic review was reported in this study using preferred reporting items for systematic reviews and meta-analyses (PRISMA). Studies that assessed the level of AI literacy among medical and healthcare professionals and students met the inclusion criteria for this study. The quality of the included study for this review was assessed using the analytical cross-sectional critical assessment checklist developed by the Joanna Briggs Institute (JBI). The same standard checklist was used for data extraction. Results: Of the 10 included studies, 4 (40%) reported a low level of preparation, knowledge, and literacy. In a study, it was also shown that radiologists had acceptable literacy about AI, and it seems that they had a better study of this field compared to other specialists. Another study showed that initially the level of AI literacy was not acceptable but improved significantly after training. Two studies also hailed AI's contribution to improving healthcare. Conclusion: Evidence from this review indicated that half of the studies on the AI literacy of professionals and students were very low, and other included studies also reported the basic literacy of AI acceptably. Finally, in all included studies, AI training courses and their application in healthcare were considered necessary for professionals and students, and they were trying to improve the educational infrastructure.

Introduction: Colorectal cancer is one of the most common gastrointestinal cancers, and it is the third and fourth most common cancer among Iranian men and women, respectively. Patients suffering from cancer have different information needs, and one of the most important and reliable sources of information for them is their physicians. Therefore, this study aimed to assess the sources and information needs of patients suffering from colorectal cancer and physicians' viewpoints regarding this issue. Material and Methods: This cross-sectional questionnaire survey-based study was conducted from May to December 2017. All patients diagnosed with colorectal cancer and physicians in oncology outpatient clinics at a specialized cancer hospital and a radiotherapy oncology center in Mashhad, Iran were invited to participate in the study using the census technique. The patient questionnaire was about patients' attitudes toward the consultant's information and disease, information leaflets, the treatments and complications and information sources for the disease. The physician questionnaire was about the information the physician would give to the patients. Results: The mean ages of the patients and physicians participating in this study were 50.72±16.15 and 40.03±11.08 years, respectively. Most of the cases (44.8%) wanted to know everything about their illness as much as possible, while 45.5% of the patients needed the information. The majority (85.9%) of the participants were willing to know about all possible therapies regarding their illness, while 63.3% of the physicians provided treatment options that were suitable for the patient in their view, and only 33.3% of the physicians told the patients all possible treatment options. Conclusion: Information regarding the illness, diagnosis, and treatment is one of the essential needs for patients suffering from colorectal cancer. It seems that it is necessary to have a good and organized plan to provide the patients suffering from colorectal cancer with the required information and increase their health information literacy as one of their undeniable rights.