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2. Global fertility in 204 countries and territories, 1950-2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021
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V Bhattacharjee, N, E Schumacher, A, Aali, A, Habtegiorgis Abate, Y, Abbasgholizadeh, R, Abbasian, M, Abbasi-Kangevari, M, Abbastabar, H, Abd ElHafeez, S, Abd-Elsalam, S, Abdollahi, M, Abdollahifar, M, Abdoun, M, Abdullahi, A, Abebe, M, Shawel Abebe, S, Abiodun, O, Abolhassani, H, Abolmaali, M, Abouzid, M, Beressa Aboye, G, Guimarães Abreu, L, Aberhe Abrha, W, M Abrigo, M, Abtahi, D, Abualruz, H, Abubakar, B, Abu-Gharbieh, E, Me Abu-Rmeileh, N, Girum Girum Adal, T, Molla Adane, M, Atanda Adeagbo Adeagbo, O, Adesoji Adedoyin, R, Adekanmbi, V, Aden, B, Victor Adepoju, A, O Adetokunboh, O, Bunmi Adetunji, J, Adedayo Adeyinka, D, Israel Adeyomoye, O, Estiningtyas Sakilah Adnani, Q, Adra, S, Felix Afolabi, R, Afyouni, S, Sohail Afzal, M, Afzal, S, Aghamiri, S, Agodi, A, Agyemang-Duah, W, Opoku Ahinkorah, B, J Ahlstrom, A, Ahmad, A, Ahmad, D, Ahmad, F, M Ahmad, M, Ahmad, S, Ahmad, T, Ahmed, A, Ahmed, H, A Ahmed, L, Saleh Ahmed, M, Anees Ahmed, S, Ajami, M, Aji, B, Taddesse Akalu, G, Akbarialiabad, H, Olusola Akinyemi, R, Ahmed Akkaif, M, Akkala, S, Al Hamad, H, Mahfuz Al Hasan, S, Al Qadire, M, Mohammed Ali Al-Ahdal, T, O Alalalmeh, S, A Alalwan, T, Al-Aly, Z, Alam, K, Mustafa Al-Amer, R, Mashhour Alanezi, F, M Alanzi, T, Albakri, A, Albashtawy, M, T AlBataineh, M, Alemi, H, Alemi, S, Mulugeta Alemu, Y, Al-Eyadhy, A, Ali Saeed Al-Gheethi, A, F Alhabib, K, Alhajri, N, Alhalaiqa Naji Alhalaiqa, F, Kaba Alhassan, R, Ali, A, Abdulqadir Ali, B, Ali, L, Usman Ali, M, Ali, R, Shujait Shujait Ali, S, Mohammad Alif, S, Aligol, M, Alijanzadeh, M, M Aljasir, M, Mohamed Aljunid, S, Al-Marwani, S, Uy Almazan, J, M Al-Mekhlafi, H, Almidani, O, A Alomari, M, Al-Omari, B, S Alqahtani, J, Yaseen Alqutaibi, A, M Al-Raddadi, R, Khalifah Al-Sabah, S, Altaf, A, A Al-Tawfiq, J, A Altirkawi, K, Oyine Aluh, D, Jawad Alvi, F, Alvis-Guzman, N, Alwafi, H, Mohammed Al-Worafi, Y, Aly, H, Aly, S, H Alzoubi, K, Kwabena Ameyaw, E, Tawfik Amin, T, Amindarolzarbi, A, Amini-Rarani, M, Amiri, S, Gyamfuah Ampomah, I, A Amugsi, D, Adeniyi Amusa, G, Ancuceanu, R, Anderlini, D, Prata Andrade, P, Liliana Andrei, C, Andrei, T, Anil, A, Anil, S, Ansar, A, Ansari-Moghaddam, A, M Antony, C, Antriyandarti, E, Anvari, S, Anwar, S, Anwer, R, Edward Anyasodor, A, Arabloo, J, Arabzadeh Bahri, R, A Arafa, E, Arafat, M, Margarida Araújo, A, Y Aravkin, A, Aremu, A, Aripov, T, Arkew, M, Armocida, B, Ärnlöv, J, Arooj, M, A Artamonov, A, Arulappan, J, Taiwo Aruleba, R, Arumugam, A, Asadi-Lari, M, Asemi, Z, Asgary, S, Asghariahmadabad, M, Asghari-Jafarabadi, M, Yesse Ashemo, M, Ashraf, M, Ashraf, T, O Asika, M, Shamsadin Athari, S, Moh'd Wahbi Atout, M, Atreya, A, Aujayeb, A, Ausloos, M, Avan, A, Mulat Aweke, A, Melaku Ayele, G, Mohammad Ayyoubzadeh, S, Azadnajafabad, S, S Azevedo, R, Y Azzam, A, Badar, M, D Badiye, A, Baghdadi, S, Bagheri, N, Bagherieh, S, Bahmanziari, N, Bai, R, Amin Baig, A, L Baker, J, T Bako, A, Kaur Bakshi, R, Balasubramanian, M, Constantin Baltatu, O, Bam, K, Banach, M, Bandyopadhyay, S, Banik, B, Chandra Banik, P, Bansal, H, Firat Baran, M, Barchitta, M, Bardhan, M, Bardideh, E, Lyn Barker-Collo, S, Winfried Bärnighausen, T, Barone-Adesi, F, Jawdat Barqawi, H, Barrow, A, Barteit, S, Basharat, Z, J Bashir, A, Akande Bashiru, H, Basiru, A, Diogo Basso, J, Basu, S, Mohammad Batiha, A, Batra, K, T Baune, B, Bayati, M, Begum, T, Behboudi, E, Hossein Behnoush, A, Beiranvand, M, Fernanda Bejarano Ramirez, D, Bekele, A, Assefa Belay, S, Iqbal Belgaumi, U, L Bell, M, Omolaja Bello, O, Beloukas, A, M Bensenor, I, Berezvai, Z, Yirga Berhie, A, C Bermudez, A, G Bettencourt, P, Srikanth Bhagavathula, A, Bhardwaj, N, Bhardwaj, P, V Bhardwaj, P, Bhaskar, S, Bhat, V, Kaur Bhatti, G, Singh Bhatti, J, S Bhatti, M, Bhatti, R, Biondi, A, Bisignano, C, Biswas, A, Kishore Biswas, R, R Bitra, V, Bjørge, T, Bliss, E, Kofi Boachie, M, Vasilica Bobirca, A, Bodolica, V, Olalekan Bodunrin, A, Ketema Bogale, E, Angaw Bogale, K, Bonakdar Hashemi, M, Bora Basara, B, Bouaoud, S, Braithwaite, D, Brauer, M, K Breitborde, N, Bryazka, D, B Bulamu, N, Buonsenso, D, Burkart, K, A Burns, R, Bustanji, Y, Shafique Butt, N, A Butt, Z, Luciano Caetano Dos Santos, F, Calina, D, R Campos-Nonato, I, Cao, F, Cao, S, Capodici, A, Carreras, G, Carugno, A, A Castañeda-Orjuela, C, Castelpietra, G, Sofia Cattaruzza, M, Caye, A, Cegolon, L, Cembranel, F, Cerin, E, Chadwick, J, Chahine, Y, Chakraborty, C, Chalek, J, Shi Kai Chan, J, Charalampous, P, Kumar Chattu, V, Chaturvedi, S, Paul Chavula, M, Chen, A, Chen, H, Chen, S, Chi, G, Chichagi, F, Chien, J, R Ching, P, S Cho, W, Choi, S, Chong, B, Chopra, H, Gajanan Choudhari, S, J Christopher, D, Chu, D, Sunday Chukwu, I, Chung, E, Chung, S, Cindi, Z, Cioffi, I, Ciuffreda, R, M Claro, R, Coberly, K, Columbus, A, Comfort, H, Conde, J, H Criqui, M, Cruz-Martins, N, Magali Cuadra-Hernández, S, Dadana, S, Dadras, O, Dahiru, T, Dai, Z, Dalton, B, Damiani, G, Mohammad Darwesh, A, K Das, J, Das, S, Dashti, M, Dastiridou, A, Alberto Dávila-Cervantes, C, Davletov, K, Tamire Debele, A, Debopadhaya, S, Delavari, S, Delgado-Enciso, I, Demeke, D, Hundessa Demessa, B, Deng, X, Denova-Gutiérrez, E, Deribe, K, Dervenis, N, Dineshbhai Desai, H, Desai, R, Gnana Chellaiyan Devanbu, V, Dhali, A, Dhama, K, Dhimal, M, R Dhulipala, V, Dias da Silva, D, Diaz, D, J Diaz, M, Dima, A, D Ding, D, Ashworth Dirac, M, Chi Do, T, Huynh Phuong Do, T, Bruneli do Prado, C, Dohare, S, Dong, W, D'Oria, M, Mombaque Dos Santos, W, Doshmangir, L, Kokou Dowou, R, Chelsea Dsouza, A, Larson Dsouza, H, Dsouza, V, Dube, J, Duprey, J, Rodrigues Duraes, A, Duraisamy, S, Christopher Durojaiye, O, Dutta, S, Dwyer-Lindgren, L, Agnieszka Dzianach, P, Marian Dziedzic, A, Ebrahimi, A, Atan Edinur, H, Edvardsson, K, Efendi, F, Andreas Eikemo, T, Ekholuenetale, M, El Tantawi, M, Mousaad Elemam, N, Metwally Tawfik ElGohary, G, Elhadi, M, Tesfaye Elilo, L, Abdelsadek Abdou Elmeligy, O, A Elmonem, M, Elshaer, M, Elsohaby, I, Emami Zeydi, A, Engelbert Bain, L, Eskandarieh, S, Esposito, F, Estep, K, Etaee, F, Fabin, N, Francis Fagbamigbe, A, Fahimi, S, Fakhri-Demeshghieh, A, Falzone, L, Faramarzi, A, Ezzat Mahmoud Faris, M, Farmer, S, Faro, A, Omolara Fasanmi, A, Fatehizadeh, A, Klau Fauk, N, Fazeli, P, L Feigin, V, Fereshtehnejad, S, Hamid Feroze, A, Ferrara, P, Ferreira, N, Fetensa, G, Filip, I, Fischer, F, Flavel, J, A Foigt, N, Oluwatoyin Folayan, M, Alekseevich Fomenkov, A, Foroutan, B, Foschi, M, Raphael Fowobaje, K, Louise Francis, K, Freitas, A, Fukumoto, T, E Fuller, J, Fux, B, Andras Gaal, P, A Gadanya, M, Motiramji Gaidhane, A, Galali, Y, Gallus, S, P Gandhi, A, Ganesan, B, Arfat Ganiyani, M, A Garcia-Gordillo, M, Garg, N, K Gautam, R, Gazzelloni, F, Olatunde Gbadamosi, S, W Gebregergis, M, Gebrehiwot, M, Brhane Gebremariam, T, B Gebremariam, T, Gebru Gebremeskel, T, Fikadu Geda, Y, Roxana Georgescu, S, Gerema, U, Geremew, H, Erena Getachew, M, W Gething, P, Ghasemi, M, Ghasempour Dabaghi, G, Ghasemzadeh, A, Ghassemi, F, Mohamed Ghazy, R, Ghimire, S, Gholamian, A, Gholamrezanezhad, A, Ghorbani, M, Gopal Ghoshal, A, Digambarrao Ghuge, A, Urievich Gil, A, K Gill, T, Giorgi, M, Girmay, A, C Glasbey, J, Göbölös, L, Goel, A, Golchin, A, Golechha, M, Goleij, P, Vali Gopalani, S, Goudarzi, H, C Goulart, A, Goyal, A, Matthew Graham, S, Grivna, M, Guan, S, Guarducci, G, Ibrahim Mohialdeen Gubari, M, Dechasa Gudeta, M, Guicciardi, S, Gulati, S, Gulisashvili, D, Asanga Gunawardane, D, Guo, C, Kumar Gupta, A, Gupta, B, Kumar Gupta, M, Gupta, M, Gupta, S, Bala Gupta, V, Kumar Gupta, V, Haakenstad, A, Habibzadeh, F, R Hadi, N, Haep, N, Hajibeygi, R, Haller, S, Halwani, R, R Hamadeh, R, M Hamdy, N, Hameed, S, Hamidi, S, Han, Q, J Handal, A, J Hankey, G, Nuruzzaman Haque, M, Maria Haro, J, I Hasaballah, A, Hasan, I, Jahid Hasan, M, M Mahmudul Hasan, S, Hasani, H, Saquib Hasnain, M, Hassan, A, Hassan, I, Hassanipour, S, Hassankhani, H, I Hay, S, J Hebert, J, E Hegazi, O, Heidari, M, Helfer, B, Hemmati, M, Yuliana Herrera-Serna, B, Herteliu, C, Hessami, K, Hezam, K, Hiraike, Y, Quoc Hoan, N, Holla, R, Horita, N, Mahbub Hossain, M, Bellal Hossain Hossain, M, Hosseinzadeh, H, Hosseinzadeh, M, Hostiuc, M, Hostiuc, S, Hsairi, M, Chia-Rong Hsieh, V, Hu, C, Huang, J, Mamun Huda, M, Humayun, A, Hussain, J, R Hussein, N, Huynh, H, Hwang, B, Emmanuel Ibitoye, S, Maria Iftikhar, P, Stephen Ilesanmi, O, M Ilic, I, D Ilic, M, Immurana, M, Raja Inbaraj, L, Iqbal, A, Rabiul Islam, M, Elkudssiah Ismail, N, Iso, H, Isola, G, Iwagami, M, Iyer, M, J, L, Jaafari, J, Jacob, L, Jadidi-Niaragh, F, Jaggi, K, Jahankhani, K, Jahanmehr, N, Jahrami, H, Jain, A, Jain, N, Abdulrahman Jairoun, A, Jakovljevic, M, Jamshidi, E, Javadov, S, Javaheri, T, Kumar Jayapal, S, Jayaram, S, Ha Jee, S, Jeganathan, J, K Jha, A, Prakash Jha, R, Jiang, H, Jokar, M, B Jonas, J, Joo, T, Joseph, N, Ehimwenma Joshua, C, Joukar, F, Jerzy Jozwiak, J, Jürisson, M, K, V, Kaambwa, B, Kabir, A, Kabir, H, Kabir, Z, Kalani, R, R Kalankesh, L, Kaliyadan, F, Kalra, S, Kamath, R, Kamath, S, Kanchan, T, Wedam Kanmiki, E, Kazeem Kanmodi, K, S, S, Kumar Kansal, S, S Kantar, R, Kapoor, N, Karajizadeh, M, Karami, M, M Karaye, I, Zaffar Kashoo, F, Kasraei, H, J Kassebaum, N, B Kassel, M, H Kauppila, J, Kazemi, F, Kazeminia, S, H Kempen, J, Shoshannah Kendal, E, Keshtkar, K, Keykhaei, M, Khajuria, H, Khalaji, A, Khalid, N, Ahmed Khalil, A, Khalilian, A, Khamesipour, F, Khan, A, Khan, I, Nuruzzaman Khan, M, Khan, M, Jobair Khan, M, Ab Khan, M, Khang, Y, Khanmohammadi, S, Khatab, K, Khavandegar, A, Reza Khayat Kashani, H, Fatima Khidri, F, Khormali, M, Ali Khosravi, M, Khosrowjerdi, M, Teklesilasie Kidane, W, Demelash Kifle, Z, Sojin Kim, J, Seo Kim, M, W Kimokoti, R, E Kinzel, K, Tsegay Kiross, G, Kisa, A, Kisa, S, Kolahi, A, Kompani, F, Koren, G, Korzh, O, Kosen, S, Lakshmi Koulmane Laxminarayana, S, Krishan, K, Krishna, V, Krishnamoorthy, V, Kuate Defo, B, M Kubeisy, C, Kucuk Bicer, B, Abdul Kuddus, M, Kuddus, M, Kuitunen, I, Kulimbet, M, Kumar, H, Kundu, S, Rotimi Kunle, K, P Kurmi, O, Kusnali, A, Kusuma, D, F Kyei, E, Kyriopoulos, I, La Vecchia, C, Lacey, B, Awwal Ladan, M, Laflamme, L, Lahariya, C, Teck Ching Lai, D, Kumar Lal, D, Lalloo, R, Lám, J, Lamnisos, D, Landires, I, Lanfranchi, F, Langguth, B, Laplante-Lévesque, A, Jane Larson, H, O Larsson, A, Lasrado, S, Latief, K, Latifinaibin, K, Khanh Dao Le, L, Huu Hanh Le, N, Diep Thanh Le, T, Ledda, C, Lee, M, H Lee, P, Won Lee, S, Han Lee, Y, Kiros Lema, G, Leong, E, L Lerango, T, Li, A, Li, M, Li, S, Li, W, Li, X, S Ligade, V, S Lim, S, Lin, R, A Lindstedt, P, Listl, S, Liu, G, Liu, J, Liu, X, Liu, Y, Llanaj, E, López-Bueno, R, D Lopukhov, P, Lorenzovici, L, A Lotufo, P, Lubinda, J, Lucchetti, G, Lugo, A, Lunevicius, R, Lv, H, Feei Ma, Z, Lynn Maass, K, Machoy, M, M Madureira-Carvalho, Á, Magdy Abd El Razek, M, A Maghazachi, A, Mahjoub, S, Adam Mahmoud, M, Majeed, A, N Malagón-Rojas, J, Malakan Rad, E, Malhotra, K, Azam Malik, A, Malik, I, Carvalho Malta, D, A Mamun, A, Manla, Y, Mansoori, Y, Mansour, A, Mansouri, B, Mansouri, Z, Ali Mansournia, M, C Maravilla, J, Marino, M, Marjani, A, Martinez, G, Martinez-Piedra, R, Rogerlândio Martins-Melo, F, Martorell, M, Maryam, S, Rillera Marzo, R, Masoudi, A, Mattumpuram, J, James Maude, R, Maugeri, A, A May, E, Mayeli, M, Mazaheri, M, J McGrath, J, Mckee, M, Laura Wensel McKowen, A, A McLaughlin, S, M McPhail, S, Mehra, R, Mehrabani-Zeinabad, K, Mehrabi Nasab, E, Mekene Meto, T, Alberto Mendez Mendez-Lopez, M, Mendoza, W, G Menezes, R, A Mensah, G, A Mentis, A, Ayoub Meo, S, Merati, M, Meretoja, A, J Meretoja, T, M Mersha, A, Mestrovic, T, Metanat, P, Chamila Dinushi Mettananda, K, Mettananda, S, Mhlanga, A, Mhlanga, L, Mi, T, Miazgowski, T, Micha, G, Maria Michalek, I, R Miller, T, Huu Nhat Minh, L, Mirghafourvand, M, M Mirrakhimov, E, Kiros Mirutse, M, Mirza, M, Mirzaei, R, Mishra, A, Misra, S, B Mitchell, P, Mittal, C, Moazen, B, Z Mohamed, A, Ismail Mohamed, A, Mohamed, J, H Mohamed, M, Saad Mohamed, N, Mohammad-Alizadeh-Charandabi, S, Mohammadi, S, Mohammadian-Hafshejani, A, Mohammed, M, Mohammed, S, H Mokdad, A, Mokhtarzadehazar, P, Molavi Vardanjani, H, Molinaro, S, Monasta, L, Ali Moni, M, Moradi, M, Moradi, Y, Moraga, P, Silveira Moreira, R, Morovatdar, N, Douglas Morrison, S, Morze, J, Mosapour, A, Mossialos, E, Motappa, R, Mousavi, P, Mousavi Khaneghah, A, Mpundu-Kaambwa, C, Mubarik, S, Muccioli, L, Mulita, F, Munjal, K, Murillo-Zamora, E, Musa, J, Musaigwa, F, Musina, A, Muthu, S, Muthupandian, S, Muzaffar, M, Myung, W, Jayaraman Nagarajan, A, Nagel, G, Naghavi, P, R Naik, G, Naik, G, David Naimzada, M, Nainu, F, Nangia, V, Narasimha Swamy, S, Ramos Nascimento, B, G Nascimento, G, Y Naser, A, Javad Nasiri, M, S Natto, Z, Nauman, J, Naveed, M, Prakash Nayak, B, C Nayak, V, Ndejjo, R, Onyinye Nduaguba, S, Negash, H, Tafere Negesse, C, Negoi, I, Irina Negoi, R, Aria Nejadghaderi, S, Nejjari, C, Nepal, S, Biresaw Netsere, H, Nguefack-Tsague, G, W Ngunjiri, J, H Nguyen, D, Thi Hien Nguyen, H, The Nguyen, P, P Nguyen, Q, Thanh Nguyen, V, Khan Niazi, R, T Nigatu, Y, Konstantinos Nikolouzakis, T, Nikoobar, A, Reza Nikpoor, A, A Nnaji, C, Achilles Nnyanzi, L, Ali Noman, E, Nomura, S, Noreen, M, Noroozi, N, Adaobi Nri-Ezedi, C, H Nunemo, M, Nuñez-Samudio, V, Nurrika, D, John Nutor, J, Oancea, B, O Obamiro, K, A Odetokun, I, Martina Odogwu, N, James O'Donnell, M, Ololade Odukoya, O, Sikiru Oguntade, A, Odhiambo Oguta, J, Oh, I, Reuben Okeke, S, Paul Okekunle, A, Christabel Okonji, O, Godwin Okwute, P, T Olagunju, A, O Olasupo, O, Idowu Olatubi, M, Maria Moraes Oliveira, G, Olubukunola Olusanya, B, Olusegun Olusanya, J, Olamilekan Oluwatunase, G, A Omar, H, Latif Omer, G, E Onwujekwe, O, Ordak, M, Ebere Orisakwe, O, N Orish, V, V Ortega-Altamirano, D, Ortiz, A, Ortiz-Prado, E, S Osman, W, Levi Osuagwu, U, Osuolale, O, Otoiu, A, S Otstavnov, S, Ouyahia, A, Ouyang, G, O Owolabi, M, Ozten, Y, P A, M, Taha Pahlevan Fallahy, M, Pan, F, Pan, H, Pana, A, Panda, P, Panda-Jonas, S, Ullyartha Pangaribuan, H, D Panos, G, D Panos, L, Pantazopoulos, I, Mihaela Pantea Stoian, A, R Parikh, R, Park, S, Parthasarathi, A, Pashaei, A, Passera, R, M Patel, H, Patel, J, Patil, S, Patoulias, D, Suresh Patthipati, V, Paudel, U, Paun, M, Pazoki Toroudi, H, A Pease, S, E Peden, A, Pedersini, P, Peng, M, Pensato, U, Christian Filipino Pepito, V, Peprah, P, Pereira, G, P Peres, M, Perianayagam, A, Perico, N, Perna, S, G Pestell, R, Emily Petermann-Rocha, F, Tran Pham, H, K Philip, A, Pierannunzio, D, Pigeolet, M, M Pigott, D, Plotnikov, E, Poddighe, D, Pollner, P, Poluru, R, J Postma, M, Pourali, G, Pourshams, A, Pourtaheri, N, Prabhu, D, I Prada, S, Man Singh Pradhan, P, Prasad, M, Prashant, A, M Purohit, B, Puvvula, J, Hashim Qasim, N, Qattea, I, R, D, Rabiee Rad, M, Radfar, A, Radhakrishnan, V, Raee, P, Raeisi Shahraki, H, Rafiei, A, Niloufar Rafiei Alavi, S, Raggi, C, Raghav Raghav, P, Rahim, F, Jillur Rahim, M, Mosfequr Rahman, M, Hifz Ur 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Pantea Stoian, Romil R Parikh, Seoyeon Park, Ashwaghosha Parthasarathi, Ava Pashaei, Roberto Passera, Hemal M Patel, Jay Patel, Shankargouda Patil, Dimitrios Patoulias, Venkata Suresh Patthipati, Uttam Paudel, Mihaela Paun, Hamidreza Pazoki Toroudi, Spencer A Pease, Amy E Peden, Paolo Pedersini, Minjin Peng, Umberto Pensato, Veincent Christian Filipino Pepito, Prince Peprah, Gavin Pereira, Mario F P Peres, Arokiasamy Perianayagam, Norberto Perico, Simone Perna, Richard G Pestell, Fanny Emily Petermann-Rocha, Hoang Tran Pham, Anil K Philip, Daniela Pierannunzio, Manon Pigeolet, David M Pigott, Evgenii Plotnikov, Dimitri Poddighe, Peter Pollner, Ramesh Poluru, Maarten J Postma, Ghazaleh Pourali, Akram Pourshams, Naeimeh Pourtaheri, Disha Prabhu, Sergio I Prada, Pranil Man Singh Pradhan, Manya Prasad, Akila Prashant, Bharathi M Purohit, Jagadeesh Puvvula, Nameer Hashim Qasim, Ibrahim Qattea, Deepthi R, Mehrdad Rabiee Rad, Amir Radfar, Venkatraman Radhakrishnan, Pourya Raee, Hadi Raeisi Shahraki, Alireza Rafiei, Seyedeh Niloufar Rafiei Alavi, Cat Raggi, Pankaja Raghav Raghav, Fakher Rahim, Md Jillur Rahim, Md Mosfequr Rahman, Mohammad Hifz Ur Rahman, Mosiur Rahman, Muhammad Aziz Rahman, Vahid Rahmanian, Masoud Rahmati, Niloufar Rahnavard, Pramila Rai, Diego Raimondo, Ali Rajabpour-Sanati, Prashant Rajput, Prasanna Ram, Shakthi Kumaran Ramasamy, Juwel Rana, Kritika Rana, Shailendra Singh Rana, Chhabi Lal Ranabhat, Nemanja Rancic, Amey Rane, Shubham Ranjan, Chythra R Rao, Indu Ramachandra Rao, Deepthi Rapaka, Davide Rasella, Sina Rashedi, Vahid Rashedi, Mohammad-Mahdi Rashidi, Azad Rasul, Zubair Ahmed Ratan, Giridhara Rathnaiah Babu, Santosh Kumar Rauniyar, Nakul Ravikumar, David Laith Rawaf, Salman Rawaf, Reza Rawassizadeh, Bharat Rawlley, Murali Mohan Rama Krishna Reddy, Elrashdy Moustafa Mohamed Redwan, Giuseppe Remuzzi, Bhageerathy Reshmi, Nazila Rezaei, Aida Rezaei Nejad, Mohsen Rezaeian, Abanoub Riad, Mavra A Riaz, Jennifer Rickard, Reza Rikhtegar, Hannah Elizabeth Robinson-Oden, Célia Fortuna Rodrigues, Jefferson Antonio Buendia Rodriguez, Ravi Rohilla, Debby Syahru Romadlon, Luca Ronfani, Himanshu Sekhar Rout, Bedanta Roy, Nitai Roy, Priyanka Roy, Enrico Rubagotti, Guilherme de Andrade Ruela, Susan Fred Rumisha, Tilleye Runghien, Manjula S, Chandan S N, Aly M A Saad, Zahra Saadatian, Maha Mohamed Saber-Ayad, Morteza SaberiKamarposhti, Siamak Sabour, Fatos Sada, Basema Saddik, Bashdar Abuzed Sadee, Ehsan Sadeghi, Erfan Sadeghi, Mohammad Reza Saeb, Umar Saeed, Sher Zaman Safi, Dominic Sagoe, Manika Saha, Amirhossein Sahebkar, Soumya Swaroop Sahoo, Monalisha Sahu, Zahra Saif, Joseph W Sakshaug, Payman Salamati, Afeez Abolarinwa Salami, Mohamed A Saleh, Marwa Rashad Salem, Mohammed Z Y Salem, Sohrab Salimi, Sara Samadzadeh, Yoseph Leonardo Samodra, Vijaya Paul Samuel, Abdallah M Samy, Juan Sanabria, Nima Sanadgol, Francesca Sanna, Milena M Santric-Milicevic, Haaris Saqib, Sivan Yegnanarayana Iyer Saraswathy, Aswini Saravanan, Babak Saravi, Yaser Sarikhani, Tanmay Sarkar, Rodrigo Sarmiento-Suárez, Gargi Sachin Sarode, Sachin C Sarode, Arash Sarveazad, Brijesh Sathian, Thirunavukkarasu Sathish, Anudeep Sathyanarayan, Abu Sayeed, Md Abu Sayeed, Nikolaos Scarmeas, Winfried Schlee, Art Schuermans, David C Schwebel, Falk Schwendicke, Siddharthan Selvaraj, Pallav Sengupta, Subramanian Senthilkumaran, Sadaf G Sepanlou, Dragos Serban, Edson Serván-Mori, Yashendra Sethi, SeyedAhmad SeyedAlinaghi, Seyed Arsalan Seyedi, Allen Seylani, Mahan Shafie, Jaffer Shah, Pritik A Shah, Ataollah Shahbandi, Samiah Shahid, Moyad Jamal Shahwan, Ahmed Shaikh, Masood Ali Shaikh, Muhammad Aaqib Shamim, Mehran Shams-Beyranvand, Mohammad Anas Shamsi, Mohd Shanawaz, Abhishek Shankar, Mohammed Shannawaz, Medha Sharath, Sadaf Sharfaei, Amin Sharifan, Javad Sharifi-Rad, Manoj Sharma, Rajesh Sharma, Ujjawal Sharma, Vishal Sharma, Rajesh P Shastry, Amin Shavandi, David H Shaw, Amir Mehdi Shayan, Maryam Shayan, Amr Mohamed Elsayed Shehabeldine, Aziz Sheikh, Rahim Ali Sheikhi, Manjunath Mala Shenoy, Pavanchand H Shetty, Peilin Shi, Desalegn Shiferaw, Mika Shigematsu, Rahman Shiri, Reza Shirkoohi, Aminu Shittu, Velizar Shivarov, Farhad Shokraneh, Sina Shool, Seyed Afshin Shorofi, Kanwar Hamza Shuja, Kerem Shuval, Emmanuel Edwar Siddig, João Pedro Silva, Luís Manuel Lopes Rodrigues Silva, Soraia Silva, Biagio Simonetti, Anjali Singal, Abhinav Singh, Balbir Bagicha Singh, Jasvinder A Singh, Md Shahjahan Siraj, Georgia Smith, Bogdan Socea, Anton Sokhan, Ranjan Solanki, Shipra Solanki, Hamidreza Soleimani, Sameh S M Soliman, Yonatan Solomon, Yimeng Song, Reed J D Sorensen, Michael Spartalis, Chandrashekhar T Sreeramareddy, Vijay Kumar Srivastava, Muhammad Haroon Stanikzai, Vladimir I Starodubov, Antonina V Starodubova, Simona Cătălina Stefan, Paschalis Steiropoulos, Mark A Stokes, Vetriselvan Subramaniyan, Muhammad Suleman, Rizwan Suliankatchi Abdulkader, Abida Sultana, Jing Sun, Chandan Kumar Swain, Bryan L Sykes, Lukasz Szarpak, Mindy D Szeto, Miklós Szócska, Payam Tabaee Damavandi, Rafael Tabarés-Seisdedos, Ozra Tabatabaei Malazy, Seyed-Amir Tabatabaeizadeh, Shima Tabatabai, Karen M Tabb, Mohammad Tabish, Moslem Taheri Soodejani, Jabeen Taiba, Ardeshir Tajbakhsh, Iman M Talaat, Ashis Talukder, Mircea Tampa, Jacques Lukenze Tamuzi, Ker-Kan Tan, Haosu Tang, Derbie Alemu DA Tareke, Mengistie Kassahun Tariku, Vivian Y Tat, Seyed Mohammad Tavangar, Mojtaba Teimoori, Mohamad-Hani Temsah, Reem Mohamad Hani Temsah, Masayuki Teramoto, Dufera Rikitu Terefa, Riki Tesler, Enoch Teye-Kwadjo, Ramna Thakur, Pugazhenthan Thangaraju, Kavumpurathu Raman Thankappan, Rekha Thapar, Samar Tharwat, Rasiah Thayakaran, Nihal Thomas, Ales Tichopad, Jansje Henny Vera Ticoalu, Tenaw Yimer Tiruye, Mariya Vladimirovna Titova, Marcello Tonelli, Marcos Roberto Tovani-Palone, Eugenio Traini, Jasmine T Tran, Nghia Minh Tran, Indang Trihandini, Samuel Joseph Tromans, Thien Tan Tri Tai Truyen, Aristidis Tsatsakis, Evangelia Eirini Tsermpini, Munkhtuya Tumurkhuu, Stefanos Tyrovolas, Sayed Mohammad Nazim Uddin, Aniefiok John Udoakang, Arit Udoh, Atta Ullah, Saeed Ullah, Sana Ullah, Srikanth Umakanthan, Chukwuma David Umeokonkwo, Brigid Unim, Bhaskaran Unnikrishnan, Era Upadhyay, Jibrin Sammani Usman, Marco Vacante, Seyed Mohammad Vahabi, Asokan Govindaraj Vaithinathan, Rohollah Valizadeh, Jef Van den Eynde, Elena Varavikova, Orsolya Varga, Priya Vart, Shoban Babu Varthya, Tommi Juhani Vasankari, Balachandar Vellingiri, Deneshkumar Venugopal, Nicholas Alexander Verghese, Madhur Verma, Massimiliano Veroux, Georgios-Ioannis Verras, Dominique Vervoort, Jorge Hugo Villafañe, Manish Vinayak, Francesco S Violante, Mukesh Vishwakarma, Sergey Konstantinovitch Vladimirov, Vasily Vlassov, Bay Vo, Simona Ruxandra Volovat, Theo Vos, Isidora S Vujcic, Hatem A Wafa, Yasir Waheed, Elias Bekele Wakwoya, Cong Wang, Denny Wang, Fang Wang, Shu Wang, Yanzhong Wang, Yuan-Pang Wang, Paul Ward, Emebet Gashaw Wassie, Stefanie Watson, Marcia R Weaver, Kosala Gayan Weerakoon, Daniel J Weiss, Katherine M Wells, Yi Feng Wen, Ronny Westerman, Taweewat Wiangkham, Dakshitha Praneeth Wickramasinghe, Nuwan Darshana Wickramasinghe, Peter Willeit, Yohannes Addisu Wondimagegene, Felicia Wu, Juan Xia, Hong Xiao, Gelin Xu, Suowen Xu, Xiaoyue Xu, Ali Yadollahpour, Shirin Yaghoobpoor, Tina Yaghoobpour, Sajad Yaghoubi, Zwanden Sule Yahaya, Danting Yang, Lin Yang, Yuichiro Yano, Habib Yaribeygi, Pengpeng Ye, Renjulal Yesodharan, Subah Abderehim Yesuf, Saber Yezli, Amanuel Yigezu, Paul Yip, Dong Keon Yon, Naohiro Yonemoto, Yuyi You, Mustafa Z Younis, Zabihollah Yousefi, Chuanhua Yu, Yong Yu, Chun-Wei Yuan, Nima Zafari, Fathiah Zakham, Nazar Zaki, Giulia Zamagni, Milad Zandi, Ghazal G Z Zandieh, Moein Zangiabadian, Mikhail Sergeevich Zastrozhin, Haijun Zhang, Meixin Zhang, Yunquan Zhang, Chenwen Zhong, Juexiao Zhou, Bin Zhu, Lei Zhu, Magdalena Zielińska, Zhiyong Zou, Samer H Zyoud, Christopher J L Murray, Amanda E Smith, and Stein Emil Vollset
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Background: Accurate assessments of current and future fertility-including overall trends and changing population age structures across countries and regions-are essential to help plan for the profound social, economic, environmental, and geopolitical challenges that these changes will bring. Estimates and projections of fertility are necessary to inform policies involving resource and health-care needs, labour supply, education, gender equality, and family planning and support. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 produced up-to-date and comprehensive demographic assessments of key fertility indicators at global, regional, and national levels from 1950 to 2021 and forecast fertility metrics to 2100 based on a reference scenario and key policy-dependent alternative scenarios. Methods: To estimate fertility indicators from 1950 to 2021, mixed-effects regression models and spatiotemporal Gaussian process regression were used to synthesise data from 8709 country-years of vital and sample registrations, 1455 surveys and censuses, and 150 other sources, and to generate age-specific fertility rates (ASFRs) for 5-year age groups from age 10 years to 54 years. ASFRs were summed across age groups to produce estimates of total fertility rate (TFR). Livebirths were calculated by multiplying ASFR and age-specific female population, then summing across ages 10-54 years. To forecast future fertility up to 2100, our Institute for Health Metrics and Evaluation (IHME) forecasting model was based on projections of completed cohort fertility at age 50 years (CCF50; the average number of children born over time to females from a specified birth cohort), which yields more stable and accurate measures of fertility than directly modelling TFR. CCF50 was modelled using an ensemble approach in which three sub-models (with two, three, and four covariates variously consisting of female educational attainment, contraceptive met need, population density in
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- 2024
3. Evaluation of patients with primary immunodeficiency associated with Bacille Calmette-Guerin (BCG)-vaccine-derived complications
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Sohani, M., Habibi, S., Delavari, S., Shahkarami, S., Yazdani, Reza, Shirmast, P., Nazari, F., Moeini Shad, T., Mamishi, S., Azizi, G., Anka, A.U., Hassanpour, G., Kalantari, A., Shariat, M., Shafiei, A., Abolhassani, H., and Aghamohammadi, A.
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- 2020
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4. Mendelian susceptibility to mycobacterial disease: Clinical and immunological findings of patients suspected for IL12Rβ1 deficiency
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Moradi, L., Cheraghi, T., Yazdani, R., Azizi, G., Rasouli, S., Zavareh, F.T., Parvaneh, L., Parvaneh, N., Sohani, M., Delavari, S., Abolhassani, H., Rezaei, Nima, and Aghamohammadi, A.
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- 2019
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5. Non-Infectious Complications in B-Lymphopenic Common Variable Immunodeficiency
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Pashangzadeh, S, primary, Delavari, S, additional, Shad, TM, additional, Salami, F, additional, Rasouli, SE, additional, Yazdani, R, additional, Mahdaviani, SA, additional, Nabavi, M, additional, Aleyasin, S, additional, Ahanchian, H, additional, Azad, FJ, additional, Chavoshzadeh, Z, additional, Nazari, F, additional, Momen, T, additional, Sherkat, R, additional, Abolnezhadian, F, additional, Esmaeilzadeh, H, additional, Fallahpour, M, additional, Arshi, S, additional, Bemanian, MH, additional, Shokri, S, additional, Ebrahimi, SS, additional, Abolmolouki, M, additional, Farid, AS, additional, Rezaei, A, additional, Esmaeili, M, additional, Kalantari, A, additional, Sadeghi-Shabestari, M, additional, Shirkani, A, additional, Behniafard, N, additional, Khalili, A, additional, Eslamian, MH, additional, Cheraghi, T, additional, Shafie, A, additional, Tavakol, M, additional, Khoshkhui, M, additional, Iranparast, S, additional, Shamshiri, M, additional, Shahri, MA, additional, Khazaei, R, additional, Asadi, M, additional, Babaha, F, additional, Aghamohammadi, A, additional, Rezaei, N, additional, and Abolhassani, H, additional
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- 2023
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6. The spectrum of inborn errors of immunity: a single tertiary center retrospective study in Alborz, Iran
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Rasouli, S.E., primary, Tavakol, M., additional, Sadri, H., additional, Chavoshzadeh, Z., additional, Alireza Mahdaviani, S., additional, Delavari, S., additional, Jamee, M., additional, Kalantari, A., additional, Seifi Alan, M., additional, Aghamahdi, F., additional, Abolhassani, H., additional, Yazdani, R., additional, Rezaei, N., additional, and Azizi, G., additional
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- 2023
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7. Ecological Factors Affecting Student Concentration in Classroom: Students' Viewpoint at Hormozgan University of Medical Sciences
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Marzban, A, primary, Rahmanian, V, additional, Ayasi, M, additional, Delavari, S, additional, and Barzegaran, M, additional
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- 2019
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8. Infectious etiology of chronic diarrhea in patients with primary immunodeficiency diseases
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Parvaneh, L., primary, Sharifi, N., additional, Azizi, G., additional, Abolhassani, H., additional, Sharifi, L., additional, Mohebbi, A., additional, Bahraminia, E., additional, Delavari, S., additional, Alebouyeh, M., additional, Tajeddin, E., additional, Mohebbi, S.R., additional, Yazdani, R., additional, Behniafard, N., additional, and Aghamohammadi, A., additional
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- 2019
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9. Management of gastrointestinal complaints in differentiated thyroid cancer patients treated with 131I
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Mirzababaee, M., primary, Shafiei, B., primary, Seifollahi, S., primary, Motazdian, M., primary, Fatholahi, L., primary, Delavari, S., primary, Naghshine, R., primary, Baharfar, N., primary, Tabeie, F., primary, Javadi, H., primary, Asli, I. N., primary, and Assadi, M., additional
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- 2014
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10. The comparison of the key feature of clinical reasoning and multiple choice examinations in clinical decision makings ability
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Zamani, S., Amini, M., Masoumi, S. Z., Delavari, S., Namaki, M. J., and Javad Kojuri
11. Can Health be Related to Interpersonal Violence in Middle Eastern Countries?
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Bayati, M., Lotfi, F., khosro keshavarz, and Delavari, S.
12. Comparing sexual dysfunctions in men before and during their wives' pregnancy
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Abbasali Ebrahimian, Heydari, M., Saberi Zafar Ghandi, M. B., and Delavari, S.
13. A qualitative study about attrition in medical and other health sciences schools
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Kamali, F., Mitra Amini, Foroush, S. P., Yazdani, M. R., Alolaee, S. H. M., Dehghan, H., and Delavari, S.
14. Brain tissue microstructure in a prospective, longitudinal, population-based cohort of preterm and term-born young adults.
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Peterson BS, Delavari S, Sadik J, Ersland L, Elgen IB, Sawardekar S, Bansal R, and Aukland SM
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Background: Fifteen million infants annually are born prematurely, placing them at high risk for life-long adverse neurodevelopmental outcomes. Whether brain tissue abnormalities that accompany preterm birth persist into young adulthood and are associated with long-term cognitive or psychiatric outcomes is not known., Methods: From infancy into young adulthood, we followed a population-based sample of consecutively identified preterm infants and their matched term controls. The preterm group was born at an average gestational age of 31.5 ± 2.6 weeks. We obtained Diffusion Tensor Imaging scans and assessed cognitive and psychiatric outcomes in young adulthood, at a mean age of 19 (range 17.6-20.8) years. Usable data were acquired from 180 participants (89 preterm, 91 term)., Results: Preterm birth was associated with lower fractional anisotropy (FA) and higher average diffusion coefficient (ADC) values in deep white matter tracts of the internal capsule, cerebral peduncles, inferior frontal-occipital fasciculus, sagittal stratum and splenium of the corpus callosum, as well as in grey matter of the caudate, putamen and thalamus. A younger gestational age at birth accentuated these tissue abnormalities. Perinatal characteristics, including lower 5-min APGAR score, history of bronchopulmonary dysplasia, more days of oxygen supplementation and multiple births all increased ADC values in deep white matter tracts and grey matter throughout the brain. Preterm individuals had significantly lower full-scale IQ and more frequent lifetime psychiatric disorders. Those with psychiatric illnesses had significantly higher ADC and lower FA values throughout the deep posterior white matter., Conclusions: Abnormalities in brain tissue microstructure associated with preterm birth persist into young adulthood and likely represent disordered myelination and accompanying axonal pathology. These disturbances are associated with a higher likelihood of developing a psychiatric disorder by young adulthood. Brain tissue disturbances were accentuated in those born at younger gestational ages and in those with a history of perinatal complications associated with infection and inflammation., (© 2024 The Author(s). Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.)
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- 2024
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15. Teaching and learning clinical reasoning skill in undergraduate medical students: A scoping review.
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Delavari S, Barzkar F, M J P Rikers R, Pourahmadi M, Soltani Arabshahi SK, Keshtkar A, Dargahi H, Yaghmaei M, and Monajemi A
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- Humans, Learning, Teaching, Education, Medical, Undergraduate methods, Clinical Competence, Students, Medical, Clinical Reasoning
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Background: Clinical reasoning involves the application of knowledge and skills to collect and integrate information, typically to arrive at a diagnosis, implement appropriate interventions, solve clinical problems, and improve the quality of health care and patient outcomes. It is a vital competency that medical students must acquire, as it is considered the heart of medicine., Purpose: This scoping review aimed to identify and summarize the existing literature on learning and teaching strategies for improving clinical reasoning skill in undergraduate medical education., Methods: We conducted electronic searches in Scopus, PubMed/Medline (NLM), Web of Science (WOS), and ERIC to retrieve articles published between January 1, 2010, and March 23, 2024. We also performed hand searches by scanning the reference lists of included studies and similar reviews and searching three key journals. After removing duplicates, two reviewers independently extracted data from primary articles using a standard data extraction form. The authors used Arksey and O'Malley's framework., Results: Among the 46581 retrieved records, 54 full-text articles were included in the present review. We categorized the educational strategies based on their aspects, focus, and purpose. Included studies used various educational strategies for improving clinical reasoning skill in undergraduate medical education by serial cue or whole clinical cases that presented as process-oriented or knowledge-oriented., Conclusion: This scoping review investigated various dimensions of educational intervention for improving clinical reasoning skill in undergraduate medical education. There is a need for more precision studies with larger sample sizes, designing studies according to randomized controlled trials standards, determining MCID, or performing meta-analyses to acquire robust and conclusive results., Competing Interests: The authors declare no competing interests. Somayeh Delavari and Mohammadreza Pourahmadi are the Academic Editor of the PLOS ONE Journal, but there is no Competing Interests to declare., (Copyright: © 2024 Delavari et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2024
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16. Effect of spaceflight experience on human brain structure, microstructure, and function: systematic review of neuroimaging studies.
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Rezaei S, Seyedmirzaei H, Gharepapagh E, Mohagheghfard F, Hasankhani Z, Karbasi M, Delavari S, and Aarabi MH
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- Humans, Astronauts, Space Flight, Brain diagnostic imaging, Brain physiology, Neuroimaging methods, Magnetic Resonance Imaging methods, Weightlessness
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Spaceflight-induced brain changes have been commonly reported in astronauts. The role of microgravity in the alteration of the brain structure, microstructure, and function can be tested with magnetic resonance imaging (MRI) techniques. Here, we aim to provide a comprehensive overview of Spaceflight studies exploring the potential role of brain alterations identified by MRI in astronauts. We conducted a search on PubMed, Web of Science, and Scopus to find neuroimaging correlates of spaceflight experience using MRI. A total of 20 studies (structural MRI n = 8, diffusion-based MRI n = 2, functional MRI n = 1, structural MRI and diffusion-weighted MRI n = 6, structural MRI and functional MRI n = 3) met our inclusion criteria. Overall, the studies showed that regardless of the MRI techniques, mission duration significantly impacts the human brain, prompting the inclusion of various brain regions as features in the analyses. After spaceflight, notable alterations were also observed in the superior occipital gyrus and the precentral gyrus which show alterations in connectivity and activation during spaceflight. The results provided highlight the alterations in brain structure after spaceflight, the unique patterns of brain remodeling, the challenges in drawing unified conclusions, and the impact of microgravity on intracranial cerebrospinal fluid volume., Competing Interests: Declarations. Ethical approval: Not applicable. Consent for publication: This manuscript has been approved for publication by all authors. Conflict of interest: The authors declare no conflict of interest regarding the publication of this paper., (© 2024. The Author(s).)
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- 2024
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17. Strategies to promote patient-centeredness within the healthcare industry: A grey-based multicriteria decision making methods.
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Khosravi M, Izadi R, Shojaei P, and Delavari S
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- Humans, Telemedicine, Decision Making, Health Services Accessibility, Electronic Health Records standards, Benchmarking methods, Health Care Sector, Delivery of Health Care organization & administration, Patient-Centered Care organization & administration
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Rationale: The international policy agenda has recently advocated for the development of patient-centeredness in healthcare service delivery. Consequently, various stakeholders in the healthcare systems have expressed a vital need for identifying strategies and tools that can enhance patient-centeredness., Aims and Objectives: The objective of this paper was to prioritise and benchmark the strategies that can improve patient-centeredness in healthcare service delivery., Method: We employed a multi-stage research scenario that consisted of two phases: a phase including of a scoping review to identify the current strategies to improve patient-centeredness (PC); And, a phase including of a multicriteria best-worst method to assign weights to PC principles, and a questionnaire administered to a sample of experts for benchmarking the strategies derived from the literature using the Grey Multi-Attributive Border Approximation Area Comparison (MABAC-G) method., Results: The most important principle of patient-centeredness was deemed to be access to care, while telehealth tools and Electronic Health Information Systems were respectively suggested as the most efficacious platforms for promoting patient-centeredness., Conclusion: We recommend that administrators and policy makers in the healthcare industry prioritise the implementation and research of strategies such as telehealth tools and electronic health information systems to enhance access and patient-centeredness in the healthcare systems., (© 2024 John Wiley & Sons Ltd.)
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- 2024
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18. Indolent systemic mastocytosis (ISM) without skin lesions as a recurrent anaphylaxis: a case report study.
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Ghelichi-Ghojogh M, Ebrahimi M, Ghezeljeh E, Delavari S, and Aghapour SA
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Introduction and Importance: Mastocytosis encompasses a diverse range of disorders characterized by the clonal accumulation of mast cells in various tissues, including the skin, bone marrow, and gastrointestinal tract., Case Presentation: This case report describes a 32-year-old male patient who presented with a history of recurrent anaphylactic attacks and elevated serum tryptase levels without apparent skin involvement. The diagnostic process and clinical implications of non-cutaneous mastocytosis are discussed in the context of existing WHO criteria., Clinical Discussion: Mastocytosis, although a rare disease, carries the potential for severe complications and can present with atypical symptoms, thereby complicating its diagnosis and management. Consequently, the development of a reliable diagnostic and therapeutic strategy is of paramount importance., Conclusion: There is a pressing need to delve deeper into the investigation of the potential impacts and manifestations of mastocytosis to further our understanding and enhance patient care., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2024
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19. Necrotizing Fasciitis of the Hand: Management with Literature Review.
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Delavari S, Megas IF, Billner M, Reichert B, and Breidung D
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This report presents a case of necrotizing fasciitis following a seemingly minor injury sustained from handling a spiny plant. Despite initial primary care by a physician, the patient presented with severe septic shock and necrotizing fasciitis of the hand, necessitating emergency surgical intervention. The use of scoring systems aided in the prompt recognition of the condition. Subsequent surgery was required due to infection progression, leading to significant soft tissue defects and functional impairment. The patient underwent multiple reconstructive procedures, including placement of dermis-replacement material and, ultimately, free flap reconstruction, to restore the hand function. This case report highlights the importance of rapid identification of potential cases of necrotizing fasciitis in cases of hand infections, demonstrates that scoring systems can assist in smaller affected body sites such as the hand, and illustrates the difficulties of defect reconstruction following necrotizing fasciitis., Competing Interests: The authors have no financial interests to declare in relation to the content of this article. The corresponding author, David Breidung, acknowledges financial support by Deutsche Forschungsgemeinschaft and Friedrich-Alexander-Universität Erlangen-Nürnberg within the funding program “Open Access Publication Funding.”, (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)
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- 2024
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20. Noninfectious Complications in B-Lymphopenic Common Variable Immunodeficiency.
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Pashangzadeh S, Delavari S, Moeini Shad T, Salami F, Rasouli SE, Yazdani R, Mahdaviani SA, Nabavi M, Aleyasin S, Ahanchian H, Jabbari-Azad F, Chavoshzadeh Z, Nazari F, Momen T, Sherkat R, Abolnezhadian F, Esmaeilzadeh H, Fallahpour M, Arshi S, Bemanian MH, Shokri S, Ebrahimi SS, Abolmolouki M, Farid AS, Rezaei A, Esmaeili M, Kalantari A, Sadeghi-Shabestari M, Shirkani A, Behniafard N, Khalili A, Eslamian MH, Cheraghi T, Shafie A, Tavakol M, Khoshkhui M, Iranparast S, Shamshiri M, Shahri MA, Khazaei R, Asadi M, Babaha F, Aghamohammadi A, Rezaei N, and Abolhassani H
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- Humans, Female, Male, Adult, Retrospective Studies, Middle Aged, Young Adult, Autoimmunity, Adolescent, Aged, Child, Common Variable Immunodeficiency complications, Common Variable Immunodeficiency immunology, B-Lymphocytes immunology, Lymphopenia immunology
- Abstract
Background: Common variable immunodeficiency (CVID) is considered the most symptomatic type of inborn errors of immunity in humans. Along with infectious complications, which have numerous consequences, noninfectious complications are a major challenge among CVID patients., Methods: All CVID patients registered in the national database were included in this retrospective cohort study. Patients were divided into 2 groups based on the presence of B-cell lymphopenia. Demographic characteristics, laboratory findings, noninfectious organ involvement, autoimmunity, and lymphoproliferative diseases were evaluated., Results: Among 387 enrolled patients, 66.4% were diagnosed with noninfectious complications and 33.6% with isolated infectious presentations. Enteropathy, autoimmunity, and lymphoproliferative disorders were reported in 35.1%, 24.3%, and 21.4% of patients, respectively. Some complications, including autoimmunity and hepatosplenomegaly, were reported to be significantly more frequent among patients with B-cell lymphopenia. As for organ involvement, the dermatologic, endocrine, and musculoskeletal systems were predominantly affected in CVID patients with B-cell lymphopenia. Among autoimmune manifestations, the frequency of rheumatologic, hematologic, and gastrointestinal autoimmunity was reported to be higher than that of other types of autoimmunity not associated with B cell-lymphopenia. Furthermore, hematological cancers, particularly lymphoma, were the most common type of malignancy. The mortality rate was 24.5%, and respiratory failure and malignancies were the most common causes of death, with no significant differences between the 2 groups., Conclusions: Considering that some of the noninfectious complications might be associated with B-cell lymphopenia, regular patient monitoring and follow-up with proper medication (in addition to immunoglobulin replacement therapy) are highly recommended to prevent sequelae and increase patient quality of life.
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- 2024
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21. Postoperative Complications of Flap Procedures in Chest Wall Defect Reconstruction: A Two-Center Experience.
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Breidung D, Delavari S, Grimme S, Habild G, Billner M, Kraus D, Reichert B, and Megas IF
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- Humans, Male, Female, Retrospective Studies, Middle Aged, Adult, Aged, Thoracic Wall surgery, Thoracic Wall abnormalities, Postoperative Complications, Plastic Surgery Procedures methods, Plastic Surgery Procedures adverse effects, Plastic Surgery Procedures statistics & numerical data, Surgical Flaps adverse effects
- Abstract
Background and Objectives : Chest wall defect reconstruction is a complex procedure aimed at restoring thoracic structural integrity after trauma, tumor removal, or congenital issues. In this study, postoperative complications were investigated to improve the care of patients with these critical conditions. Materials and Methods : A retrospective study of chest wall reconstructions from 2004 to 2023 was conducted at Klinikum Nürnberg and Evangelisches Waldkrankenhaus Spandau-Berlin. Data included patient demographics, comorbidities, defect etiology, surgery details, and complications using the Clavien-Dindo classification. Results : Among the 30 patients included in the study, a total of 35 complications occurred in 35 thoracic wall defect reconstructions. These complications were classified into 22 major and 13 minor cases. Major complications were more common in patients with cancer-related defects, and considerable variations were observed between free flap and pedicled flap surgeries. Notably, the use of the anterolateral thigh (ALT) flap with vastus lateralis muscle demonstrated promise, exhibiting fewer complications in select cases. The reconstruction of chest wall defects is associated with substantial complications regardless of the etiology of the defect and the particular surgical procedure used. Interestingly, there was a lower complication rate with free flap surgery than with pedicled flaps. Conclusions : The ALT flap with vastus lateralis muscle deserves further research in this field of reconstruction. Multidisciplinary approaches and informed patient discussions are crucial in this complex surgical field, emphasizing the need for ongoing research and technique refinement.
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- 2024
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22. Prognostic Factors in Necrotizing Fasciitis: Insights from a Two-Decade, Two-Center Study Involving 209 Cases.
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Megas IF, Delavari S, Marti Edo A, Habild G, Billner M, Reichert B, and Breidung D
- Abstract
Introduction: Necrotizing fasciitis (NF) is a critical disease with high morbidity and mortality rates that poses significant challenges in diagnosis and treatment. Prognostic factors for the clinical course of NF remain unclear and are currently under research. This study aims to identify such factors in a large cohort of patients which represents a major comprehensive investigation of prognostic factors for NF., Methods: Retrospective analysis was conducted on necrotizing fasciitis cases from 2003 to 2023 at two German hospitals. Data included demographics, comorbidities, laboratory findings, infection site, causative microorganisms and outcomes. Statistical analysis involved t -tests, chi-square tests, and ROC analysis., Results: A total of 209 patients were included, with a mortality rate of 18%. Patients were categorized into survivors ( n = 171) and non-survivors (n = 38). Non-survivors were significantly older (68.9 ± 13.9 years vs. 55.9 ± 14.3 years; p < 0.01) and exhibited a higher prevalence of peripheral vascular diseases, cancer, and heart, liver, or renal insufficiency. Laboratory findings and scoring results also varied significantly between the two groups. The ROC curve analysis identified age as a predictor of mortality, with an optimal cut-off value of 68.5 years (sensitivity: 60.5%, specificity: 81.9%). Higher age was associated with increased mortality risk., Conclusions: The patient's age stands out as the primary predictive element for mortality in necrotizing fasciitis. Additionally, we advocate for employing the Laboratory and Anamnestic Risk Indicator for Necrotizing Fasciitis (LARINF-score), which holds substantial prognostic significance and is straightforward to calculate. Considering our findings, crafting a clinical algorithm or scoring mechanism to forecast mortality in NF would be a promising target for future research.
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- 2024
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23. Herpes simplex (HSV-1) encephalitis in an infant: a case report study.
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Hosseini PS, Golfiroozi S, Hosseini PS, Ghelichi-Ghojogh M, Delavari S, and Hosseini SA
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Introduction and Importance: The herpes simplex virus (HSV) is the most common cause of acute sporadic encephalitis, a severe and often fatal disease in humans. It is associated with high mortality and morbidity rates in untreated patients., Case Presentation: An 11-month-old child was admitted to the hospital presenting with acute fever and seizures characterized by staring episodes and spastic movements affecting the left side of the body. Diagnostic workup revealed abnormal T2 flair hyperintense foci in bi-temporoparietal lobes and right thalamus, and bilateral otomastoiditis were detected. A positive result for HSV-1 was obtained through HSV type 1/2 polymerase chain reaction (PCR) testing, leading to a diagnosis of herpes encephalitis., Clinical Discussion: While acyclovir has proven to be an effective therapeutic option, mortality and neurological sequelae continue to be reported in a notable fraction of patients. HSV encephalitis is mainly caused by two strains of the herpes simplex virus: HSV-1, more frequently observed in children and adults, and HSV-2, commonly seen in neonates and those with compromised immune systems. MRI scans often reveal that the brain lesions are localized to certain areas, although temporal involvement may not always be evident. The symptoms of herpetic encephalitis can greatly vary, making early diagnosis and treatment vital for improving patient outcomes., Conclusion: This case report highlights the clinical presentation, diagnostic challenges, and treatment strategies for HSV-1 encephalitis and underscores the importance of early recognition and prompt initiation of antiviral therapy in suspected cases of HSV-1 encephalitis., Competing Interests: The authors declare that they have no conflicts of interests.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2024
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24. Alpha-Gal syndrome as a novel food allergy: a case report study.
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Ghelichi-Ghojogh M, Ghezeljeh E, Delavari S, and Aghapour SA
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Introduction and Importance: Alpha-Gal syndrome (AGS), a distinct form of mammalian meat allergy, presents unique characteristics that set it apart from typical IgE-mediated food hypersensitivities. AGS induces an allergic response typically 3-6 h post-ingestion of mammalian meat, such as beef, pork, or lamb. This prolonged reaction time differentiates AGS from other food allergies, which usually provoke a more immediate response., Case Presentation: The authors present a case of a 35-year-old male patient who, unbeknownst to him, had been experiencing symptoms consistent with Alpha-Gal allergy for several years. His symptoms only subsided upon the complete elimination of mammalian meat from his diet. It was only then that the possibility of AGS was considered. Complete abstinence from mammalian meat, meat by-products, and other α-Gal containing foods is the most effective preventative strategy for AGS. No definitive cure for AGS has been established as of now. Treatment protocols for hypersensitivity reactions are contingent upon the severity of the reaction, with therapies ranging from antihistamine medications to the administration of epinephrine., Conclusion: There is considerable variability among AGS patients concerning the consumption of dairy products. Some individuals with AGS can safely consume dairy products without any adverse reactions, while others are advised to abstain due to potential allergenic responses. This variability in dairy tolerance among AGS patients warrants further investigation., Competing Interests: The authors have no conflicts of interest to declare.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2024
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25. Epidermoid Cysts after Percutaneous Needle Fasciotomy for Dupuytren Contracture: Literature Review.
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Breidung D, Delavari S, Megas IF, Billner M, and Reichert B
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This case report presents a rare complication after percutaneous needle fasciotomy for Dupuytren contracture: the development of epidermoid cysts. A 60-year-old man who had previously undergone a needle fasciotomy required a subsequent limited fasciectomy due to disease progression. Unexpectedly, epidermoid cysts were discovered during the procedure. The successful removal of the cysts, together with the removal of the contracture cord, resulted in a good functional outcome. The conducted literature review identified four case reports of epidermoid or dermoid cysts after treatment for Dupuytren contracture. The reported cases in the literature and our case emphasize the need for adaptability in the management of Dupuytren contracture and the potential for unexpected complications. Further investigation is essential to understand the relationship between Dupuytren disease and cyst formation., Competing Interests: The authors have no financial interests to declare in relation to the content of this article. The corresponding author, David Breidung, acknowledges financial support by Deutsche Forschungsgemeinschaft and Friedrich-Alexander-Universität Erlangen-Nürnberg within the funding programme “Open Access Publication Funding.”, (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)
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- 2024
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26. Necrotizing Fasciitis after Panniculectomy Caused by Finegoldia magna .
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Breidung D, Delavari S, Megas IF, Reichert B, and Billner M
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Necrotizing fasciitis is a rare yet severe complication after body contouring surgery. We present a case of a 54-year-old woman with a complex medical history who developed necrotizing fasciitis 9 days after panniculectomy and epigastric hernia repair. Microbiological examination revealed Finegoldia magna as the causative agent, a rare pathogen in necrotizing fasciitis. Patients undergoing body contouring may be at increased risk of developing necrotizing fasciitis; therefore, increased attention should be paid to this differential diagnosis in case of postoperative signs of infection. This case report highlights the pivotal importance of early recognition, prompt surgical intervention, and comprehensive medical treatment to improve patient outcomes in necrotizing fasciitis., Competing Interests: All authors have no financial interests to declare in relation to the content of this article. The corresponding author, David Breidung, acknowledges financial support by Deutsche Forschungsgemeinschaft and Friedrich-Alexander-Universität Erlangen-Nürnberg within the funding programme “Open Access Publication Funding.”, (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)
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- 2024
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27. Nursing labor supply in Iran: a survey in Shiraz public hospitals in 2022.
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Keshavarzi A, Delavari S, Lotfi F, Goudarzi Z, Bashiri F, and Bayati M
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Background: The labor supply of nurses, as one of the main healthcare workers, is an important issue in health human resources planning in all health systems. Finding the factors affecting it, could help policymakers to solve the shortage of nursing work supply. The present study aimed to investigating the quantity and factors affecting the nurses' labor supply in Iran., Method: In this cross-sectional study, a sample of 598 nurses working in public hospitals of Shiraz (Iran) were selected via proportionate stratified random sampling method. The required data was collected using a structured questionnaire which asked working hours and other related factors. To analyze the data, descriptive statistics, univariate analysis and multivariate linear regression were performed using STATA 15. The multivariate labor supply model was estimated separately for married and single nurses. RESULTS: The average weekly working hours of nurses was 54.65 h in all medical centers and 50.28 h in the main hospital. The regression results showed that the labor supply of nurses with work experience (β = - 0.368, P = 0.014), satisfaction with work shift arrangement (β = - 2.473, P = 0.001), income between 60-89 million rial (β = - 14.046, P = 0.002), income between 90-119 million rial(β = - 12.073, P = 0.012), and working in the emergency department (β = - 5.043, P = 0.017) had negative and significant relationship; But there was a positive and significant relationship with satisfaction of the work environment (β = 1.86, P = 0.011), workload at work (β = 1.951, P = 0.023) and employment status (contractual employees) (β = 4.704, P = 0.004)., Conclusion: The labor supply function of nurses is affected by demographic, economic and non-economic factors. The most contributing factors were related to non-economic variables. It seems that the non-financial cost and benefits related to the job as well as internal factors have more important role on the nurses' labor supply., (© 2024. The Author(s).)
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- 2024
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28. Investigating the mortality trend of gastrointestinal cancers in Babol, North Iran (2013-2021).
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Ebrahimi P, Karami M, Delavari S, Shojaie L, Hosseini-Berneti SH, Bayani F, Moghaddasi M, Babazade O, and Nikbakht HA
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- Male, Female, Humans, Middle Aged, Aged, Aged, 80 and over, Cross-Sectional Studies, Iran epidemiology, Cluster Analysis, Gastrointestinal Neoplasms epidemiology, Stomach Neoplasms
- Abstract
Background and Aim: This study aims to examine the mortality rate and trend of gastrointestinal cancers, particularly gastric cancer, as the leading cause of death among cancers in northern Iran over a 9-year period. In light of the changing incidence and mortality rates of cancer in Iran and around the world, the importance of these diseases in people's lives, and the necessity of updating and monitoring the trend of cancer mortality, we have decided to report on the mortality trend of gastrointestinal cancers, based on crude and age-standardized rates., Method: This study is a cross-sectional examination of deaths caused by gastrointestinal cancers in Babol city, Iran, between 2013 and 2021. Data was collected from the cause of death registration and classification system of Babol University of Medical Sciences. Population estimation was obtained from the latest census reports. The crude and age-standardized mortality rates and trends of the cancers were calculated., Results: Overall, there were 1345 deaths from gastrointestinal cancers with an average age of 69.11 ± 14.25 years. The crude and age-standardized rates of these cancers rose from 24.1 to 20.1 per hundred thousand people in 2012 to 29.5 and 25.5 per hundred thousand people, respectively. This trend became more prevalent significantly with the increase of each decade of age for both men (P-value Trend = 0.002) and women (P-value Trend = 0.012). An analysis of gastrointestinal cancers revealed a decreasing trend for cancers of the small intestine, an increasing trend for cancers of the colon, pancreas, and gallbladder, and a stable trend for the remaining cancers over the study period., Conclusion: The age-standardized rate and the number of gastrointestinal cancers is rising, highlighting the importance of preventative measures such as screening, increasing public awareness, and appropriate diagnostic methods., (© 2024. The Author(s).)
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- 2024
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29. Burden of upper gastrointestinal cancers in the east of Golestan province (Golestan cohort study).
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Jahani MA, Esmaeili R, Abbasi M, Nikbakht HA, Azarbakhsh H, Roshandel G, Delavari S, Shojaie L, and Mahmoudi G
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- Humans, Female, Male, Cohort Studies, Cost of Illness, Iran epidemiology, Gastrointestinal Neoplasms epidemiology
- Abstract
Background: Cancers, especially Upper Gastrointestinal Cancers (UGCs), pose a substantial burden on society, particularly in developing nations. Golestan province, Iran, is known for its high UGC rates globally., Aims: This study delves into the disease burden of UGCs in the eastern part of Golestan province., Methods and Results: This study was conducted using the results of the Golestan cohort study. 2711 patients participating in this cohort, who visited Atrak Clinic during 2001-2020, participated in this study. After excluding patients with incomplete records, 2481 patients were included in the study. To compute the metrics of years of life lost (YLL), years of life lived with disability (YLD), and disability-adjusted life years (DALY), we utilized the World Health Organization's standard life table, stratified by age and gender. The majority of UGC patients in our study were married (81.8%), had limited formal education (82.6%), and were predominantly male (61.1%). A substantial proportion resided in suburban areas (85.8%), and over half of the patients (52%) reported a history of drug addiction. The mean age at diagnosis for men was 65.76 years with a standard deviation of 11.34, while for women, it was 64.38 years with a standard deviation of 11.66. Regarding disease impact, YLL, YLD, and DALY for men were 21 240, 1956, and 23 196 (307.8 per 100 000), respectively. For women, these figures were 15 609 for YLL, 1367 for YLD, and 16 976 (223.1 per 100 000) for DALY., Conclusion: After the increasing trend of the burden of UGCs in Golestan province in the early years of the study, this rate has been decreasing in recent years. Effective strategies necessitate collaborative efforts across various sectors to alleviate this burden, focusing on preventive measures, timely diagnosis, and well-coordinated therapeutic interventions., (© 2024 The Authors. Cancer Reports published by Wiley Periodicals LLC.)
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- 2024
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30. Clinical heterogeneity in families with multiple cases of inborn errors of immunity.
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Delavari S, Rasouli SE, Fekrvand S, Chavoshzade Z, Mahdaviani SA, Shirmast P, Sharafian S, Sherkat R, Momen T, Aleyasin S, Ahanchian H, Sadeghi-Shabestari M, Esmaeilzadeh H, Barzamini S, Tarighatmonfared F, Salehi H, Esmaeili M, Marzani Z, Fathi N, Abolnezhadian F, Rad MK, Saeedi-Boroujeni A, Shirkani A, Bagheri Z, Salami F, Shad TM, Marzbali MY, Mojtahedi H, Razavi A, Tavakolinia N, Cheraghi T, Tavakol M, Shafiei A, Behniafard N, Ebrahimi SS, Sepahi N, Ghaneimoghadam A, Rezaei A, Kalantari A, Abolhassani H, and Rezaei N
- Subjects
- Child, Humans, Adaptor Proteins, Signal Transducing, Antigens, CD19, Autoimmunity, Protein Serine-Threonine Kinases, Intracellular Signaling Peptides and Proteins, Delayed Diagnosis, Quality of Life
- Abstract
Background: Inborn errors of immunity (IEI) are a diverse range of genetic immune system illnesses affecting the innate and/or adaptive immune systems. Variable expressivity and incomplete penetrance have been reported in IEI patients with similar clinical diagnoses or even the same genetic mutation., Methods: Among all recorded patients in the national IEI registry, 193 families with multiple cases have been recognized. Clinical, laboratory and genetic variability were compared between 451 patients with different IEI entities., Results: The diagnosis of the first children led to the earlier diagnosis, lower diagnostic delay, timely treatment and improved survival in the second children in the majority of IEI. The highest discordance in familial lymphoproliferation, autoimmunity and malignancy were respectively observed in STK4 deficiency, DNMT3B deficiency and ATM deficiency. Regarding immunological heterogeneity within a unique family with multiple cases of IEI, the highest discordance in CD3
+ , CD4+ , CD19+ , IgM and IgA levels was observed in syndromic combined immunodeficiencies (CID), while non-syndromic CID particularly severe combined immunodeficiency (SCID) manifested the highest discordance in IgG levels. Identification of the first ATM-deficient patient can lead to improved care and better survival in the next IEI children from the same family., Conclusion: Intrafamilial heterogeneity in immunological and/or clinical features could be observed in families with multiple cases of IEI indicating the indisputable role of appropriate treatment and preventive environmental factors besides specific gene mutations in the variable observed penetrance or expressivity of the disease. This also emphasizes the importance of implementing genetic evaluation in all members of a family with a history of IEI even if there is no suspicion of an underlying IEI as other factors besides the underlying genetic defects might cause a milder phenotype or delay in presentation of clinical features. Thus, affected patients could be timely diagnosed and treated, and their quality of life and survival would improve., Competing Interests: Declaration of competing interest The authors declare that they have no relevant conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)- Published
- 2024
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31. The Reconstitution of T-cells after Allogeneic Hematopoietic Stem Cell Transplant in a Pediatric Patient with Congenital Amegakaryocytic Thrombocytopenia (CAMT).
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Bayegi SN, Hamidieh AA, Behfar M, Saghazadeh A, Bozorgmehr M, Tajik N, Delbandi AA, Delavari S, Shekarabi M, and Rezaei N
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- Female, Humans, Child, T-Lymphocytes, Thrombocytopenia diagnosis, Thrombocytopenia therapy, Thrombocytopenia genetics, Hematopoietic Stem Cell Transplantation adverse effects, Graft vs Host Disease diagnosis, Graft vs Host Disease etiology, Congenital Bone Marrow Failure Syndromes
- Abstract
Background: Congenital amegakaryocytic thrombocytopenia (CAMT) is a bone marrow failure syndrome with autosomal recessive inheritance characterized by the lack of megakaryocytes and thrombocytopenia. The cause of the disease is a mutation in the c-Mpl gene, which encodes the thrombopoietin (TPO) receptor. The main treatment for this genetic disorder is an allogeneic hematopoietic stem cell transplant (allo-HSCT). However, transplant-related mortality, development of acute and chronic graft-versushost disease (GvHD), and susceptibility to opportunistic infections are major barriers to transplantation. Delay in the reconstitution of T cells and imbalance in the regeneration of distinct functional CD4 and CD8 T-cell subsets mainly affect post-transplant complications. We report a case of CAMT, who developed acute GvHD but had no signs and symptoms of chronic GvHD following allo-HSCT., Case Presentation: At the age of four, she presented with petechiae and purpura. In laboratory investigations, pancytopenia without organomegaly, and cellularity less than 5% in bone marrow biopsy, were observed. A primary diagnosis of idiopathic aplastic anemia was made, and she was treated with prednisolone, cyclosporine, and anti-thymocyte globulin (ATG), which did not respond. Genetic analysis revealed the mutation c.1481T>G (p. L494W) in exon 10 of the c-Mpl gene, and the diagnosis of CAMT was confirmed. The patient underwent allo-HSCT from a healthy sibling donor. Alloimmunization reactions and immune disorders were present due to long-term treatment with immunosuppressive medications and repeated blood and platelet transfusions. Hence, the regeneration of T-lymphocytes after allo-HSCT was evaluated., Conclusion: Successful treatment of acute GvHD prevented advancing the condition to chronic GvHD, and this was accompanied by delayed T-cell reconstitution through an increase in Treg:Tcons ratio., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)
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- 2024
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32. PERCHING syndrome caused by variant gene KLHL7 in the first Iranian patient: a case report study.
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Ghelichi-Ghojogh M, Golfiroozi S, Delavari S, and Hosseini SA
- Abstract
Introduction and Importance: PERCHING syndrome is a condition that affects many parts of the body and is caused by genes passed down from both parents. People with this syndrome have delays in their development, unusual facial features, trouble eating and breathing, slow overall growth, weak muscles, and stiff joints., Case Presentation: The child at the age of 6 months suffered from developmental delay, delayed walking, speech delay, and hypotonia and was referred to the Neurologist. Also, he has an abnormal phenotype. Whole-exome sequencing (WES) revealed a missense variant in the KLHL7 gene at a highly conserved genomic Chr7: 23124718T>G; NM_018846:exon3:c.110T>G:p.Val37Gly., Clinical Discussion: One way to explain the difference in physical characteristics caused by recessive KLHL7 mutations might be related to the person's genetic makeup. However, the genes someone has do not always accurately determine their physical traits., Conclusion: This report will help us learn more about the different traits and characteristics of Perching syndrome. The authors need to do more research on how proteins work and study more about patients with different characteristics to fully understand this., Competing Interests: Not applicable.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2023
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33. A methodological quality review of citations of randomized controlled trials of diabetes type2 in leading clinical practice guidelines and systematic reviews.
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Aletaha A, Malekpour MR, Keshtkar AA, Baradaran HR, Sedghi S, Mansoori Y, Hajiani M, Delavari S, Habibi F, Razmgir M, Saeedi S, Soltani A, and Nemati-Anaraki L
- Abstract
Objective: Evaluate methodological quality of type 2 diabetes RCTs conducted in Iran and cited in clinical practice guidelines and systematic reviews and meta-analyses., Methods: We conducted a descriptive methodological quality review, analyzing 286 Randomized Controlled Trials (RCTs) on diabetes mellitus published in Iran from July 2004 to 2021. We searched six databases systematically and evaluated eligible articles using the CONSORT 2010 checklist for abstracts. Two investigators assessed the data using a 17-item checklist derived from CONSORT. Additionally, we examined the citations of each RCT in 260 clinical practice guidelines, with a specific focus on the adequate reporting of outcomes., Results: Out of 6667 articles, 286 analyzed. Poor reporting and failure to meet criteria observed. Only 3.8% cited in guidelines. Reporting rates: primary outcomes (41.9%), randomization (61.8%), trial recruitment (12.6%), blinding (50.8%). 27.9% cited in systematic reviews, 50.34% in systematic reviews and meta-analyses, 26.57% in meta-analyses. 67.8% of papers cited in systematic reviews. Adherence highest for participants, objective, randomization, intervention, outcome; lowest for recruitment, trial design, funding source, harms, and reporting primary outcomes., Conclusions: Poor methodological reporting and adherence to CONSORT checklist in evaluated RCTs, especially in methodological sections. Improvements needed for reliable and applicable results in guidelines, reviews, and meta-analyses. Inadequate outcome reporting challenges researchers, clinicians, and policymakers, impacting evidence-based decision-making. Urgent improvements in RCT registration necessary., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interests that are relevant to the content of this article., (© The Author(s), under exclusive licence to Tehran University of Medical Sciences 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)
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- 2023
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34. Strengthening E-learning strategies for active learning in crisis situations: a mixed-method study in the COVID-19 pandemic.
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Jahani MA, Ghanavatizadeh A, Delavari S, Abbasi M, Nikbakht HA, Farhadi Z, Darzi A, and Mahmoudi G
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- Humans, Pandemics, Problem-Based Learning, Faculty, Medical, Students, Medical, Interprofessional Relations, Computer-Assisted Instruction, COVID-19 epidemiology, Education, Medical methods
- Abstract
Background: Medical universities are responsible for educating and training healthcare workers. One of the fields significantly impacted by the pandemic is medical education. The aim of this study is to identify strategies for enhancing e-learning for active learning and finding solutions for improving its quality., Methods: This mixed-method (quantitative-qualitative) research was conducted in 2023 at three selected universities in Mazandaran Province. In the quantitative phase, 507 students participated via stratified random sampling using a standard questionnaire. In the qualitative phase, data were collected through semi-structured interviews with 16 experts until data saturation was achieved. SPSS 21 and MAXQDA 10 software were used for data analysis., Results: In the multivariate regression analysis, an increase of one point in the dimensions of student-teacher interaction, active time, immediate feedback, and active learning corresponded to an average increase in learning scores of 0.11, 0.17, 0.16, and 1.42 respectively (p≤0.001). After the final analysis in the qualitative phase, four main domains (infrastructure, resources, quantity of education, and quality of education) and 16 sub-domains with 84 items were identified., Conclusions: The greatest challenge in e-learning is the interaction and cooperation between students and teachers. The implementation of the identified strategies in this research could provide useful evidence for policymakers and educational administrators to implement interventions aimed at addressing deficiencies and enhancing e-learning., (© 2023. BioMed Central Ltd., part of Springer Nature.)
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- 2023
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35. microRNA-382 as a tumor suppressor? Roles in tumorigenesis and clinical significance.
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Fattahi M, Shahrabi S, Saadatpour F, Rezaee D, Beyglu Z, Delavari S, Amrolahi A, Ahmadi S, Bagheri-Mohammadi S, Noori E, Majidpoor J, Nouri S, Aghaei-Zarch SM, Falahi S, Najafi S, and Le BN
- Abstract
MicroRNAs (miRNAs) are small single-stranded RNAs belonging to a class of non-coding RNAs with an average length of 18-22 nucleotides. Although not able to encode any protein, miRNAs are vastly studied and found to play role in various human physiologic as well as pathological conditions. A huge number of miRNAs have been identified in human cells whose expression is straightly regulated with crucial biological functions, while this number is constantly increasing. miRNAs are particularly studied in cancers, where they either can act with oncogenic function (oncomiRs) or tumor-suppressors role (referred as tumor-suppressor/oncorepressor miRNAs). miR-382 is a well-studied miRNA, which is revealed to play regulatory roles in physiological processes like osteogenic differentiation, hematopoietic stem cell differentiation and normal hematopoiesis, and liver progenitor cell differentiation. Notably, miR-382 deregulation is reported in pathologic conditions, such as renal fibrosis, muscular dystrophies, Rett syndrome, epidural fibrosis, atrial fibrillation, amelogenesis imperfecta, oxidative stress, human immunodeficiency virus (HIV) replication, and various types of cancers. The majority of oncogenesis studies have claimed miR-382 downregulation in cancers and suppressor impact on malignant phenotype of cancer cells in vitro and in vivo, while a few studies suggest opposite findings. Given the putative role of this miRNA in regulation of oncogenesis, assessment of miR-382 expression is suggested in a several clinical investigations as a prognostic/diagnostic biomarker for cancer patients. In this review, we have an overview to recent studies evaluated the role of miR-382 in oncogenesis as well as its clinical potential., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)
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- 2023
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36. Research impact in randomized controlled trials of diabetes: an altmetric approach.
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Sedghi S, Abouhamzeh K, Dokhani F, Delavari S, Soltani A, Soleimanpour S, Nemati-Anaraki L, and Aletaha A
- Abstract
Purpose: This study aimed to assess the impact of research in randomized controlled trials (RCTs) of diabetes and explore the various subject areas related to diabetes that receive attention on social media platforms. Altmetric measures were utilized to collect and extract relevant data, providing valuable insights into the social reach and influence of clinical research beyond traditional citation-based metrics., Methods: The research focused on RCTs of diabetes involving at least one Iranian author, indexed in Scopus. Altmetric.com was employed to extract altmetric data, and the collected articles were categorized into 14 subject areas for individual analysis using STATA., Results: The analysis revealed that a majority of the diabetes studies examined nutrition, complications, treatment, genetics, basic mechanisms, and comorbidities of the disease. Conversely, subject areas such as diagnosis, education, gestational diabetes, psychology, physical activity, prevention, dentistry, and economics had fewer studies associated with them. Among social media platforms, Twitter, Facebook, Google+, and Reddit emerged as the most frequently mentioned platforms. Furthermore, Mendeley readership was identified as the preferred platform for engagement across several subject areas., Conclusions: The substantial number of social media mentions indicates a significant level of public interest and concern regarding diabetes. Social media platforms serve as effective tools for disseminating research findings from clinical trials. Altmetric data proves valuable to researchers and funding agencies seeking to comprehend the impact of their work, enabling them to allocate resources more effectively., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interests that are relevant to the content of this article., (© The Author(s), under exclusive licence to Tehran University of Medical Sciences 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)
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- 2023
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37. What is the role of institutional quality in health outcomes? A panel data analysis on 158 countries from 2001-2020.
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Hadipour A, Delavari S, and Bayati M
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Our study investigated the impact of institutional quality on health system outcomes, utilizing worldwide governance indicators and analyzing data from 158 countries between 2001 and 2020. We employed Principal Component Analysis (PCA) to create a composite index of institutional quality and conducted various tests to select the appropriate econometric model. The role of institutional quality, along with other variables, in health outcomes was estimated using fixed effects and generalized method of moments (GMM) models. High-income and low-income countries were analyzed separately. The results of our study revealed that institutional quality, as measured by Control of Corruption, Voice and Accountability, Political Stability, Rule of Law, Regulatory Quality, and Government Effectiveness, had a negative impact on infant mortality rates and a positive impact on life expectancy. Similarly, variables such as GDP, mean years of schooling, total health expenditure, and urbanization rate showed a negative association with infant mortality rates and a positive association with life expectancy. Conversely, the logarithm of CO2 emissions exhibited a positive effect on infant mortality rates and a negative effect on life expectancy. These findings highlight the crucial role of institutional quality in determining health outcomes. Improving institutional quality contributes to the development of democratic and meritocratic systems, infrastructure enhancement, efficient tax and subsidy systems, optimal budget allocation, improved public education, and enhanced access to primary healthcare services. The influence of institutional quality is particularly significant in high-income countries compared to low-income countries. In conclusion, our study emphasizes the importance of institutional quality in shaping health system outcomes. Enhancing institutional quality is essential for the overall advancement of healthcare systems, encompassing governance, infrastructure, education, and access to healthcare services. It is crucial to prioritize efforts to improve institutional quality, especially in high-income countries, to achieve better health outcomes for populations worldwide., Competing Interests: 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., (© 2023 The Authors.)
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- 2023
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38. Disturbance in the reconstitution of distinct T-cell subsets and the incidence of GvHD following allo-HSCT in pediatric patients with non-malignant hematological disorders.
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Bayegi SN, Hamidieh AA, Behfar M, Bozorgmehr M, Saghazadeh A, Tajik N, Delbandi AA, Zavareh FT, Delavari S, Shekarabi M, and Rezaei N
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- Humans, Incidence, T-Lymphocyte Subsets pathology, T-Lymphocytes, Regulatory pathology, Hematopoietic Stem Cell Transplantation adverse effects, Graft vs Host Disease pathology, Bronchiolitis Obliterans Syndrome
- Abstract
Background: The reconstitution of different T-cell subsets following allogeneic hematopoietic stem cell transplantation (allo-HSCT) is critical for efficient pathogen protection and the prevention of graft-versus-host disease (GvHD). In particular, studies have highlighted the importance of balanced ratios of regulatory T-cells (Tregs) and distinct functionally T-cells in preventing acute and chronic GvHD., Methods: We evaluated the regeneration of CD4 and CD8 T-cell subpopulations in nine pediatric patients with non-malignant disorders following allo-HSCT from a fully HLA-identical donor., Results: CD4 and CD8 T-cells were higher 12 months after the transplant but still lower than in healthy controls and pre-transplant. However, we found after allo-HSCT, central memory and effector memory cell subsets were the predominant phenotypes in the CD4 and CD8 T-cell populations, respectively. In patients who had developed acute GvHD, there was an increase in the frequency of TEMRA (effector memory T cells that re-express CD45RA) cells within the CD4 T-cell population. Meanwhile, in patients with chronic GvHD, we observed a decrease in Th1 cells in CD4 T-cells and effector memory cells within the CD8 T-cell population. In addition, we found decreased TEMRA cell subsets in CD4 and CD8 T-cell populations in chronic GvHD., Conclusion: Our findings suggest a possible relationship between the influence of acute GvHD and its prevention on delayed CD4 T-cell reconstitution and, reciprocally, unbalanced regeneration of CD4 and CD8 T-cell subsets in the development of chronic GvHD., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests., (Copyright © 2023. Published by Elsevier B.V.)
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- 2023
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39. The Effect of Iran Health Transformation Plan on Equity in Health Financing: A Systematic Review.
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Bordbar S, Gholampoor H, Jalali FS, and Delavari S
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Background: Achieving financial goals is one of the health systems goals, especially for those in low- and middle-income countries. Since financing equity, is an objective of Health Transformation Plan (HTP) implementation in Iran, this study examined this plan toward improving equity in healthcare Financing, using four payment indices: Out-of-Pocket Payment (OOP), Catastrophic Health Expenditure (CHE), Fair financial Contribution Index (FFCI) and Impoverishing Health Expenditure (IHE)., Methods: Articles published in English on equity in financing related to HTP were searched and retrieved in the Web of Science, Scopus, PubMed, and Embase databases between Jan 2014 and Dec 2020, following PRISMA guidelines. Overall, 1319 papers were retrieved initially, and 31 were selected for analysis., Results: After implementation of HTP, OOP index has decreased between patients and households. No consistent trend was evident for CHE. HTP reforms have a limited effect on the FFCI. The one study on IHE has shown an upward trend for this index. In general, in the early years of HTP, there was a higher downward trend in equity in financing indicators than in subsequent years., Conclusion: HTP has made significant accomplishments in equity, such as the financial protection of patients in healthcare centers, but fail to achieve this plan goals, significantly reduced its value. Therefore, it is necessary for managers and health policy makers around the world, with scientific and principled solutions, to prevent loss of their reform plans positive achievements., (Copyright© 2023 Bordbar et al. Published by Tehran University of Medical Sciences.)
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- 2023
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40. Clinical learning evaluation questionnaire: a reliable and valid tool for the evaluation of clinical education by educators and students.
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Ostovarfar J, Soufi SK, Moosavi M, Delavari S, Moghadami M, Ghazanfari SM, and Amini M
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- Humans, Educational Status, Language, Schools, Program Evaluation, Educational Measurement, Surveys and Questionnaires, Learning, Students, Medical
- Abstract
Background: The clinical learning evaluation questionnaire can be used in the clinical trial period of medical students to measure the effectiveness of the clinical learning environment. The purpose of this study was to collect validity evidence of an adapted questionnaire to measure the transcultural adaptation of a Persian version of CLEQ., Methods: A total of 200 questionnaires were completed by students who were at the end of their clinical rotation. The study instrument was the latest version of the CLEQ consists of 18 Items in four dimensions. The CLEQ was translated into Persian language through a four-step process of forward and backward translation. Data analysis was performed on two softwares, SPSS, version 22 and Lisrel, version 8.8., Results: The results showed that the 18-question CLEQ could be applied to the Persian translation of the tool. The response process evidence of the Persian questionnaire was established through feedback from 15 students in the sample group. The content validity index (CVI) for the items were between 0.8 and 0.9, and the content validity ratio (CVR) for the entire questionnaire was 0.9. The 4-factor feature of CLEQ was good model fit. The internal consistency analysis indicated that the Cronbach's alpha values for all items of the 18-item questionnaire were equal to 0.87 and for the subscales were 0.68 to 0.79., Conclusion: The Persian translation of the 4-factor CLEQ has sufficient validity evidence to measure the transcultural adaptability of clinical education activities by instructors and students. The validity evidence are content, response process and internal structure. We recommend that the English 6-factor and 6-factor versions of CLEQ be tested on medical students at multiple foreign academic institutions to assess their efficiency., (© 2023. BioMed Central Ltd., part of Springer Nature.)
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- 2023
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41. Factors affecting oral and dental services` utilization among Elderly: a scoping review.
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Ghanbari-Jahromi M, Bastani P, Jalali FS, and Delavari S
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- Aged, Humans, Databases, Factual, Dental Care, Educational Status, Facilities and Services Utilization, Stomatognathic Diseases
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Background: Regular use of oral and dental services by the elderly is one of the important factors in reducing oral and dental diseases. This study aimed to identify the factors affecting oral and dental services` utilization among elderly., Methods: The published articles on the factors affecting oral and dental services` utilization among elderly were found through a scoping search and using related keywords in PubMed, Scopus, Embase, and Web of Science databases within January 2000 - December 2022 according to the PRISMA guidelines. The data were analyzed using the thematic analysis method., Results: Among the 2381 articles retrieved from the databases, forty-two were extracted. The factors affecting oral and dental services` utilization among elderly were classified into five main components as follows: access, demographic factors, social factors, health level, and mental factors. The results showed that income, education level, living area, number of teeth, and importance of care were the most frequent in the main components of access, demographic factors, social factors, health level, and mental factors, respectively., Conclusion: Equitable utilization of oral and dental services is the right of all members of the society, especially the elderly. Therefore, it is necessary to provide the elderly with suitable conditions to utilize such services, which are mostly luxury items. Furthermore, increasing the elderly's awareness and encouraging them to use oral and dental services regularly can help reduce the burden of oral and dental diseases., (© 2023. BioMed Central Ltd., part of Springer Nature.)
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- 2023
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42. Strategies for maintaining and strengthening the health care workers during epidemics: a scoping review.
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Valiee S, Zarei Jelyani Z, Kia M, Jajarmizadeh A, Delavari S, Shalyari N, and Ahmadi Marzaleh M
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- Humans, Health Personnel, Disease Outbreaks, Government Programs, COVID-19 epidemiology, Epidemics prevention & control
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Introduction: During epidemics such as COVID-19, healthcare workers (HCWs) face several challenges, leading to a shortage and weakening of human resources. To address this issue, employing effective strategies is essential in maintaining and strengthening human resources during outbreaks. This study aimed to gather and classify strategies that could retain and strengthen human health resources during epidemics., Methods: In this scoping review, all studies published about strategies for maintaining and strengthening HCWs in epidemics were collected from 4 international databases, including PubMed, Embase, Scopus, and Web of Science. The English language articles published after 2000 up until June 2022 recommended specific strategies regarding the research question. Then, they were analyzed and classified according to thematic analysis based on Braun and Clarke 6 phases protocols., Results: In total, 9405 records were screened, of which 59 articles were included, and their full texts were reviewed. Fifty factors were identified and classified into five themes: Instruction, Protection, Supporting, Caring, and Communication. Most of the suggestions were conducted in high-income countries and related to the Supporting theme., Discussion: The majority of strategies discussed in the literature addressed only one or two aspects of human resources. This study provides a holistic perspective on these issues by providing a thematic map of different strategies for strengthening and maintaining HCWs during epidemics. Considering the multidimensionality of human nature, it is suggested that policymakers and managers of health systems provide facilities that simultaneously address a wide range of needs., (© 2023. The Author(s).)
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- 2023
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43. Factors affecting the acceptance of tele-psychiatry: a scoping study.
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Izadi R, Bahrami MA, Khosravi M, and Delavari S
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Background: In today's digital world, providing services through telemedicine has become an essential issue in health systems, and the Covid-19 pandemic has made this necessity even more apparent. On the other hand, mental health services are needed more than ever, and their nature makes their delivery via telemedicine more feasible than other specialized services. This study aimed to determine the factors affecting the acceptance of telemedicine among users of this technology in the field of mental health., Methods: This article is a scoping review based on the PRISMA guidelines and without any time limit until June 20, 2022. The search was performed in PubMed, Scopus, Web of Science, and PsycINFO databases using keywords related to the three fields of telemedicine, acceptance, and mental disorders. Two authors independently selected the studies based on inclusion and exclusion criteria. Then the data were collected using a data extraction form, and finally, the results were determined using the content analysis method., Results: Five main factors affect the acceptance of telemedicine among users of this technology in the field of mental health: perceived effectiveness, users' understanding of the effects of telemedicine on the quality and outcomes of care delivery, technological aspects, organizational change capacity, the nature of the disease and psychological and psychosocial factors. These main factors are associated with 21 related sub-factors., Conclusions: Revealing the factors affecting the acceptance of telemedicine among recipients and providers of services, as key actors in health systems, can help managers and policymakers to successfully implement telemedicine in the less-regarded field of mental health, especially in the early stages., (© 2023. The Author(s).)
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- 2023
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44. Assessment of the first presentations of common variable immunodeficiency in a large cohort of patients.
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Esmaeilzadeh H, Jokar-Derisi A, Hassani AH, Yazdani R, Delavari S, Abolhassani H, Mortazavi N, and Askarisarvestani A
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- Humans, Female, Male, Child, Adolescent, Young Adult, Adult, Iran epidemiology, Retrospective Studies, Autoimmunity, Common Variable Immunodeficiency complications, Common Variable Immunodeficiency epidemiology
- Abstract
Background: Common Variable Immunodeficiency (CVID) is a primary immunodeficiency syndrome resulting in recurrent infections, autoimmunity, and granulomatous manifestations., Methods and Materials: This retrospective study was conducted on an Iranian national registry of immunodeficient patients from 2010 to 2021. The frequency of first presentations of CVID and its association with sex, age of onset, and family history of CVID was evaluated., Results: A total of 383 patients entered the study, 164 of whom were female, and the rest were male. The mean age of the patients was 25.3 ± 14.5 years. The most frequent first presentations of CVID were pneumonia (36.8%) and diarrhea (19.1%). Patient sex, age of onset, and family history did not make significant differences in first presentations of this disease., Conclusion: pneumonia is the most common first presentation of CVID. Family history of CVID, the age of symptom onset, and sex made no differences in the first presentations of CVID., (© 2023. The Author(s).)
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- 2023
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45. COVID-19 Reinfection Rate and Related Risk Factors in Fars Province, Iran: A Retrospective Cohort Study.
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Tavakoli A, Lotfi F, Lotfi M, Bayati M, Seif M, Salesi M, Emadi M, Keshavarz K, and Delavari S
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- Male, Adolescent, Humans, Iran epidemiology, Retrospective Studies, Risk Factors, Reinfection epidemiology, COVID-19 epidemiology
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Background: Reinfection with Coronavirus Diseases 2019 (COVID-19) has raised remarkable public health concerns globally. Therefore, the present retrospective cohort study intended to investigate COVID-19 reinfection in registered patients of Fars province in Iran from February 2020 to April 2021., Methods: The patients' data, including the COVID-19 infection, symptoms, comorbidities, and demographics, were collected using the Health Information Systems (HISs). The patients were divided into three groups in terms of the duration between the initial infection and reinfection, including 28-44, 45-89, and more than 90 days. Following the univariate analysis, logistic regression was used to investigate the factors effective on COVID-19 reinfection., Results: A total of 213768 patients had a positive Polymerase Chain Reaction (PCR) test. The reinfection rate was 0.97% (2079 patients). Of these re-infected individuals, 14.9%, 18.5%, and 66.6% had their second positive test 28-45, 45-89, and ≥90 days later, respectively. The mean duration between the initial infection and reinfection was 130.56 days (29-370 days). The chance of reinfection was significantly higher in the youths (Odds Ratio (OR)=2.055; P<0.001), men (OR=1.283; P<0.001), urban population (OR=1.313; P<0.001), and healthcare providers (OR=4.453; P<0.001). The patients with chronic pulmonary diseases, chronic kidney diseases, and malignancy were 1.421 (P=0.036), 2.239 (P<0.001), and 3.437 (P<0.001) times, respectively, more likely prone to reinfection., Conclusion: The results of this study showed that there is a higher risk of reinfection in several vulnerable groups including healthcare providers, young individuals, residents of urban areas, men, and individuals with underlying diseases., Competing Interests: None declared., (Copyright: © Iranian Journal of Medical Sciences.)
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- 2023
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46. What Quality Assessment Tool Should I Use? A Practical Guide for Systematic Reviews Authors.
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Delavari S, Pourahmadi M, and Barzkar F
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- Systematic Reviews as Topic, Research Design
- Abstract
Competing Interests: None declared.
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- 2023
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47. The Autoimmune Manifestations in Patients with Genetic Defects in the B Cell Development and Differentiation Stages.
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Azizi G, Hesari MF, Sharifinejad N, Fayyaz F, Chavoshzadeh Z, Mahdaviani SA, Alan MS, Jamee M, Tavakol M, Sadri H, Shahrestanaki E, Nabavi M, Ebrahimi SS, Shirkani A, Vosughi Motlagh A, Delavari S, Rasouli SE, Esmaeili M, Salami F, Yazdani R, Rezaei N, and Abolhassani H
- Subjects
- Male, Humans, Child, Adolescent, Young Adult, Adult, Child, Preschool, Iran, Autoimmunity genetics, B-Lymphocytes, Cell Differentiation genetics, Adaptor Proteins, Signal Transducing genetics, Guanine Nucleotide Exchange Factors, Immunologic Deficiency Syndromes
- Abstract
Purpose: Primary B cell defects manifesting as predominantly antibody deficiencies result from variable inborn errors of the B cell lineage and their development, including impairments in early bone marrow development, class switch recombination (CSR), or terminal B cell differentiation. In this study, we aimed to investigate autoimmunity in monogenic patients with B cell development and differentiation defects., Methods: Patients with known genetic defects in the B cell development and differentiation were recruited from the Iranian inborn errors of immunity registry., Results: A total of 393 patients with a known genetic defect in the B cell development and differentiation (257 males; 65.4%) with a median age of 12 (6-20) years were enrolled in this study. After categorizing patients, 109 patients had intrinsic B cell defects. More than half of the patients had defects in one of the ATM (85 patients), BTK (76 patients), LRBA (34 patients), and DOCK8 (33 patients) genes. Fifteen patients (3.8%) showed autoimmune complications as their first manifestation. During the course of the disease, autoimmunity was reported in 81 (20.6%) patients at a median age of 4 (2-7) years, among which 65 patients had mixed intrinsic and extrinsic and 16 had intrinsic B cell defects. The comparison between patients with the mentioned four main gene defects showed that the patient group with LRBA defect had a significantly higher frequency of autoimmunity compared to those with other gene defects. Based on the B cell defect stage, 13% of patients with early B cell defect, 17% of patients with CSR defect, and 40% of patients who had terminal B cell defect presented at least one type of autoimmunity., Conclusion: Our results demonstrated that gene mutations involved in human B cell terminal stage development mainly LRBA gene defect have the highest association with autoimmunity., (© 2023. The Author(s).)
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- 2023
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48. Autoimmune versus Non-autoimmune Cutaneous Features in Monogenic Patients with Inborn Errors of Immunity.
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Sharifinejad N, Azizi G, Rasouli SE, Chavoshzadeh Z, Mahdaviani SA, Tavakol M, Sadri H, Nabavi M, Ebrahimi SS, Shirkani A, Vosughi Motlagh A, Momen T, Sharafian S, Mesdaghi M, Eslami N, Delavari S, Bahrami S, Yazdani R, Rezaei N, and Abolhassani H
- Abstract
Cutaneous manifestations are one of the most common presentations among patients with inborn errors of immunity (IEI). These skin manifestations are often among the first presenting features in the majority of patients preceding the IEI diagnosis. We studied 521 available monogenic patients with IEI listed in the Iranian IEI registry up to November 2022. We extracted each patient's demographic information, detailed clinical history of cutaneous manifestations, and immunologic evaluations. The patients were then categorized and compared based on their phenotypical classifications provided by the International Union of Immunological Societies. Most patients were categorized into syndromic combined immunodeficiency (25.1%), non-syndromic combined immunodeficiency (24.4%), predominantly antibody deficiency (20.7%), and diseases of immune dysregulation (20.5%). In total, 227 patients developed skin manifestations at a median (IQR) age of 2.0 (0.5-5.2) years; a total of 66 (40.7%) of these patients initially presented with these manifestations. Patients with cutaneous involvement were generally older at the time of diagnosis [5.0 (1.6-8.0) vs. 3.0 (1.0-7.0) years; p = 0.022]. Consanguinity was more common among patients who developed skin disorders (81.4% vs. 65.2%, p < 0.001). The overall skin infection rate and the type of dominant pathogens were significantly different among the IEI patients in different phenotypical classifications ( p < 0.001). Atopic presentation, including urticaria, was highly prevalent among patients with congenital defects of phagocytes ( p = 0.020). The frequency of eczema was also significantly higher among cases with both syndromic and non-syndromic combined immunodeficiency ( p = 0.009). In contrast, autoimmune cutaneous manifestations, including alopecia and psoriasis, were most common in patients with immune dysregulation ( p = 0.001) and defects in intrinsic or innate immunity ( p = 0.031), respectively. The presence of autoimmune cutaneous complications significantly improved the survival rate of IEI patients ( p = 0.21). In conclusion, cutaneous manifestations were observed in nearly 44% of Iranian patients with monogenic IEI. A considerable number of patients with cutaneous involvements developed these disorders as their first manifestation of the disease, which was particularly noticeable in patients with non-syndromic combined immunodeficiency and phagocytic defects. The neglected skin disorders in IEI patients might delay diagnosis, which is generally established within a 3-year interval from the development of skin-related problems. Cutaneous disorders, especially autoimmune features, might indicate a mild prognosis in IEI patients.
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- 2023
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49. T helper 17 and regulatory T-cell profile and graft-versus-host disease after allogeneic hematopoietic stem cell transplantation in pediatric patients with beta-thalassemia.
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Bayegi SN, Hamidieh AA, Behfar M, Saghazadeh A, Bozorgmehr M, Karamlou Y, Shekarabi M, Tajik N, Delbandi AA, Zavareh FT, Delavari S, and Rezaei N
- Subjects
- Humans, Child, T-Lymphocytes, Regulatory, T-Lymphocyte Subsets, beta-Thalassemia therapy, Graft vs Host Disease, Bronchiolitis Obliterans Syndrome, Hematopoietic Stem Cell Transplantation adverse effects, Hematopoietic Stem Cell Transplantation methods
- Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an effective treatment option for hereditary hemoglobin disorders, such as beta-thalassemia; However, this procedure is not without constraints, mainly engendering complications such as acute graft-versus-host disease (aGvHD), chronic GvHD (cGvHD), and susceptibility to infections. The clinical outcomes of allo-HSCT are highly dependant on the quality and quantity of T-cell subsets reconstitution. Following the allo-HSCT of six pediatric patients afflicted with beta-thalassemia, their mononuclear cells were isolated, and then cultured with a combination of phorbol myristate acetate (PMA)/ionomycin and Brefeldin A. The content of CD4 T-cell subsets, including T helper 17 (Th17) cells and regulatory T cells (Tregs), were determined by specific conjugated-monoclonal antibodies three and six months post-HSCT. An increased frequency of total CD4 T-cells, Tregs and Th17 cells was observed at day 90 and 180 after allo-HSCT, albeit the numbers were still lower than that of our healthy controls. In patients who developed cGvHD, a lower Th17/Treg ratio was observed, owing it to a decreased proportion of Th17 cells. In conclusion, creating balance between Th17 and Treg subsets may prevent acute and chronic GvHD in patients after allo-HSCT., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests., (Copyright © 2023 Elsevier B.V. All rights reserved.)
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- 2023
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50. Factors facilitating and inhibiting the social participation of the elderly in health-oriented activities in Shiraz, Southern Iran.
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Jalali MT, Sarikhani Y, Askarian F, Marzaleh MA, Najibi SM, and Delavari S
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- Humans, Aged, Middle Aged, Iran epidemiology, Cross-Sectional Studies, Canada, Surveys and Questionnaires, Social Participation, Aging
- Abstract
Background: The social participation (SP) of the elderly is one of the factors that contribute to the improvement of their well-being. SP, one of the most important factors of active ageing, is mainly influenced by a number of facilitating or inhibiting factors., Aims: This study aimed to identify the factors that prevent and facilitate the SP of the elderly population in Iran., Methods: A cross-sectional study carried out in Shiraz, southern Iran in 2021. Participants were selected using a convenience sampling method. Shiraz is divided into 11 districts and the largest park in each district is selected for data gathering. The questionnaires were completed by 612 people aged over 60. Data were collected using the Canadian Elderly Survey Project scale and a health-related lifestyle questionnaire and were analyzed using t-test, ANOVA, Pearson's correlation, and ANCOVA., Results: The mean SP score of the elderly in Shiraz was 24.2 out of 60, which is below the midpoint. The results of the covariance analysis revealed that the SP had a significant relationship with the experience of physician consultation, cost barriers, age, marital status, income level, and education level (P < 0.001). Moreover, the results of Pearson correlation revealed a significant correlation between SP and different dimensions of health-oriented activities (< 0.001)., Conclusions: This study revealed that the main barriers to older people's participation in health-related activities are cost and access barriers, such as transportation issues. Moreover, higher income level and higher educational attainment have been recognized as the main facilitators of SP in the elderly. In this regard, it can be suggested to apply a combination of health promotion strategies, financial support programs, and development of optimal transportation infrastructure to increase the SP of the elderly., (© 2023. The Author(s).)
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- 2023
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