Search

Context: Our world is characterized by a dynamic landscape of variations, complexities, uncertainties, and ambiguities (VUCA). These elements manifest in various domains, including politics, economics, communication, information, science, and research, all of which significantly impact our lives. It is crucial for policymakers and managers to adopt a forward-thinking approach to comprehend these VUCA elements and their implications for the future. The future will undoubtedly differ from the present and the past. However, humans possess an inherent desire to understand and anticipate the future, particularly in the face of uncertainty. Therefore, exploring and understanding the future is not just a curiosity, but a necessity. Futures Studies can serve as a valuable tool in this context, enabling us to efficiently leverage opportunities and resources to navigate the chaotic environment. Review studies play a pivotal role in this process by reviewing existing work and synthesizing knowledge in a specific field. This study aims to collate findings related to the key concepts of Futures Research, thereby contributing to our collective understanding and preparation for the future.

Background: The primary aim of this study is to evaluate the role of magnetic resonance imaging (MRI) in the assessment of soft tissue tumors with histopathological correlation at a tertiary care center. Methods: An observational study was conducted on 75 patients (n = 75) in the Department of Radiodiagnosis over 18 months. The targeted population comprised patients who presented to the Radiodiagnosis Department for radiological imaging of soft tissue tumors. Results: Out of 75 cases, 20% were found to have benign tumors, while 80% were found to have malignant tumors. The most frequent benign tumor was fibromatosis, with n = 10 cases (13.33%), and the most common malignant tumor was synovial sarcoma, with n = 14 cases (18.66%). The benign age group ranged from 11 to 20 years. T2-weighted heterogeneous hyperintensity was noted more frequently in malignant lesions, demonstrating a high positive predictive value; that is, 83% of malignant tumors exhibited changes on diffusion-weighted imaging/ apparent diffusion co efficient (DWI/ADC). Low-grade malignant lesions showed no restrictions. Most benign lesions displayed restrictions, with a high positive predictive value of 98.14%, specificity of 93.33%, and sensitivity of 88.33%. Conclusions: Soft tissue tumors can be detected and locally staged using MRI; thus, this technique has proven its value. Intralesional hemorrhage and calcification are two parameters that have been shown to have no substantial association with cancer. Due to its high sensitivity, MRI is a viable option for evaluating soft tissue tumors.

Context: Evaluation of health policies and identification of their challenges are vital for improving and implementing reforms in the healthcare system. The present study was conducted to identify interventions aimed at improving primary healthcare (PHC) services in Iran. Evidence Acquisition: This research utilizes a scoping review to examine reform interventions in PHC services across 10 selected countries: Qatar, Oman, Turkey, Georgia, Armenia, United Arab Emirates, Saudi Arabia, Bahrain, Kazakhstan, and Kuwait. The study covers areas such as the PHC delivery system, human resource management, financial mechanisms, and the framework of community participation and intersectoral collaboration from 2010 to 2022. Results: The main reform strategies for PHC systems in the reviewed countries included the establishment of family medical centers with nurse support as a comprehensive strategy for service provision in public health centers; providing comprehensive and quality healthcare service packages including maternal and child health, infectious disease immunization, chronic disease monitoring, and dental care services; health education; access to essential medications; improvement of electronic health services; implementation of health promotion and continuous prevention programs; capacity enhancement; and a greater focus on health screening programs and grading of healthcare centers. Conclusions: The major findings from the reviewed countries indicate that healthcare policymakers focus on providing preventive care services, reducing maternal and child mortality, and increasing life expectancy. Programs such as referral systems, service grading, and the adoption of electronic health services are part of their reform agenda.

Background: Due to the increasing costs of the health system and limited financial resources, healthcare policymakers should apply more cost-effective strategies. This study aimed to compare the cost-effectiveness of laparotomy cholecystectomy with laparoscopy. Methods: This economic evaluation was performed on patients with cholecystitis who were candidate for surgery in a private hospital in Ahvaz, in 2021. Data collection tools consisted of 4 parts: 1) demographic information checklist; 2) clinical information checklist; 3) cost checklist and 4) effectiveness assessment tool. We used SPSS22 and STATA14.2 for data analysis. One-way sensitivity analysis and Tornado diagrams were performed using Tree Age software. Results: The mean total effectiveness score in patients treated with laparoscopy 83.44 (SD = 11.34) was higher than those treated with laparotomy 68.39 (SD = 13.61). This difference was statistically significant in all effectiveness criteria except for postoperative infection dimensions and length of operation (P-value

Background: Multiple sclerosis (MS) is a long-term autoimmune disorder affecting the central nervous system, leading to reduced quality of life and impaired physical and psychological functions. Objectives: This study aims to examine the relative efficacy of yoga and relaxation therapy in improving sleep disturbances, fatigue, and cognitive impairment among individuals diagnosed with MS. Methods: This study employed a semi-experimental research design, including a pre-test, post-test, and follow-up over three months. The target population comprised all MS patients referred to the Iranian MS Association in Tehran between July and November 2023. Sixty participants were selected using purposive sampling and randomly assigned to research groups: Two yoga therapy groups with 17 participants each, a relaxation therapy group with 16 participants, and a control group with 18 participants. The yoga therapy group participated in twelve 90-minute sessions twice a week, while the control group received no intervention and was placed on a waiting list. Various tools, including the Multidimensional Fatigue Inventory (MFI), Cohen-Mansfield Agitation Inventory (CMAI-O), and a concentration skills questionnaire, were used to collect data. The data were analyzed using ANOVA, Bonferroni post hoc test, MANCOVA, and Kruskal-Wallis H tests with a significance level of 0.05, utilizing SPSS 27 software. Results: The study found a significant difference (P < 0.001) in the restlessness factor in both the post-test and follow-up phases. Additionally, there was a significant difference (P < 0.001) in the levels of physical fatigue, mental fatigue, decreased activity, and decreased motivation in both the post-test and follow-up phases, indicating significant changes in the fatigue factor among the research groups. However, there was no significant difference in the general fatigue component between the research groups. A significant difference (P < 0.001) was also found in the concentration factor, particularly in the components of voluntary and involuntary concentration, during both the post-test and follow-up stages. Conclusions: The results of this study indicate that both yoga and relaxation therapy techniques significantly reduce restlessness, physical tiredness, mental fatigue, decreased activity, and decreased motivation. Furthermore, the findings validate that both yoga and relaxation therapy techniques effectively enhance voluntary and involuntary concentration.

Background: There have been few investigations into the impact of high-intensity interval training on blood rheology. Objectives: This study aimed to evaluate how high-intensity interval training conducted with different duration affects fibrinogen and plasma viscosity in sedentary young college men. Methods: For this study, 36 healthy male participants were selected and grouped based on their individual characteristics. The groups included a control group (n = 9), a 45-second training group (tr-45; n = 9), a 30-second training group (tr-30; n = 9), and a 15-second training group (tr-15; n = 9). The training regimen comprised six sessions over two weeks, with varying sets (4, 5, 6, 6, 7, 4 respectively) and durations of 15, 30, and 45 seconds for different groups. There was a fixed 4-minute rest interval between each set, with a consistent load of 0.6 on the Wingate cycle ergometer. Blood samples were collected 48 hours before and after the final session to analyze fibrinogen and plasma viscosity levels. Results: There were no significant differences between groups in plasma fibrinogen levels (F3, 32 = 2.303, P = 0.96). However, post-test analysis revealed a significant decrease in plasma fibrinogen in the tr-45 group (P = 0.027) compared to pre-test levels. Plasma viscosity did not significantly change between groups (F3, 32 = 0.651, P = 0.058), but there was a significant interaction between time and group (F3, 40= 4.43, P = 0.009). Post-test analysis showed a significant decrease in plasma viscosity in the tr-45 (P = 0.010), tr-30 (P = 0.002), and tr-15 (P = 0.003) groups, while it significantly increased in the control group (P = 0.004) compared to pre-test levels. Conclusions: The findings suggest that high-intensity interval training can effectively decrease blood rheology and factors such as fibrinogen and plasma viscosity, with the 45-second HIIT being more efficient. Therefore, incorporating this training into Physical Activity Programs could be beneficial for inactive men.

Background: The adoption and successful implementation of digital health solutions heavily depend on digital health literacy, which is particularly critical in the current COVID-19 era. Low levels of digital health literacy are associated with poor preventative practices, the spread of inaccurate information, vaccine hesitancy, and reduced subjective well-being. Thus, the aim of this review was to highlight areas of current scholarly interest and identify any gaps in the literature regarding conceptual and methodological advancements in digital disruption. Methods: The authors conducted a literature search using the databases Scopus, Embase, Web of Science, PubMed, and Google Scholar, focusing on papers released between 2003 and October 2023. The following keywords were used to conduct a thorough literature search: ((digital health OR digital disruption OR digital dental health)) AND (medical health OR telemedicine)), ((online doctor OR online consultation OR online health app)) AND (COVID-19 OR pandemic)). A total of 1,244 studies were screened, including duplicates and nonEnglish research. After applying inclusion and exclusion criteria, 72 articles were selected for the review. Results: A total of 72 articles were included in this review. The studies discussed the potential reasons for disrupted access to healthcare, which is linked to avoidable hospital admissions. Delayed care due to disruptions can lead to disease progression, the exacerbation of existing conditions, and chronic ambulatory care-sensitive conditions. Digital health innovations were presented as solutions to enhance care, reduce clinical workload, and promote independent living. Conclusions: In conclusion, this narrative review provides a comprehensive overview of the conceptual and methodological advancements in digital technology related to healthcare. It demonstrates the potential of digital technology to revolutionize both medical and dental education.

Objectives: In Iran’s accreditation program, the patient safety dimension is one of the main dimensions, holding the highest weight among the accreditation criteria. The purpose of this study was to identify the patient safety culture (PSC) in a tertiary referral hospital. Methods: The current study was conducted between March and April 2021 in a tertiary hospital in Iran. The sample size was 628 participants, selected through simple random sampling. The hospital survey on patient safety culture (HSOPSC) was used to assess provider and staff perceptions about patient safety issues, medical errors, and event reporting. The survey included 32 items that measure 10 dimensions of PSC. Normality tests, along with non-parametric Mann-Whitney and Kruskal-Wallis tests, were used to examine the relationship between PSC and demographic variables using SPSS 22 software. Results: Based on current findings, among the 10 dimensions of PSC, teamwork and organizational learning-continuous improvement received the highest scores (83% positive response), which were higher than these variables in the Agency for Healthcare Research and Quality (AHRQ) data. Conversely, staffing and work pace, as well as hospital management support for patient safety, received the lowest positive scores (43% and 55% positive response, respectively), which were lower than these variables in the AHRQ data. There was a significant positive relationship between dimensions of PSC and older age, female gender, staff with longer working experience, and longer work hours per week (P < 0.05). Conclusions: The majority of our participants felt that patient safety needs to be enhanced. Based on the findings of this study, it is recommended to emphasize the dimensions of “staffing and work pace” and “hospital management support for patient safety” more in the accreditation criteria to strengthen these dimensions in hospitals. Additionally, we have introduced a comprehensive guide for using an international tool to measure PSC, which hospitals can use to succeed in annual accreditation.

Background: Accreditation means systematic evaluation of health service centers with specific standards. One of the most important goals of the accreditation process is to improve patient safety. Patient safety visits are one of the most important standards for improving safety. One of the ways to increase the effectiveness of visits is holding feedback sessions. Objectives: The present study was conducted with the aim of assessing the effect of feedback provision on improving patient safety indices based on the hospital accreditation model in Shahid Rahnemoon Hospital, Yazd. Methods: The present study is a semi-experimental study with a before-and-after design that was conducted in Shahid Rahnemoon Hospital, Yazd, from September to December 2021 and January to August 2022. After each visit, formal feedback sessions were held with the attendance of patient safety team members and officials of the visited wards/units. Evaluation indicators included patient safety indicators in accreditation standards, such as error reporting, rate of unwanted events, and patient safety culture score. These were measured before and after feedback. The tools used were the patient safety standards evaluation checklist based on the accreditation model, the patient safety culture questionnaire, and other indicators extracted using documentation. The Patient Safety Culture Evaluation Questionnaire was completed by 360 nurses working in the hospital in the form of a census. Analysis was done using descriptive statistical tests and paired t-tests with STATA 14.2 software. Results: Based on the results of the study, safety feedback was provided to increase patient safety indicators in different departments and units of hospitals [t = - 4.8652, w/df = 10, P = 0.0007, (P = 0.05)]. A significant difference was observed in the amount of error reporting (P = 0.031) and patient safety (P < 0.001) before and after the intervention. The degree of compliance with the dimensions of the patient safety culture had a statistically significant difference before and after the intervention (P < 0.001). Conclusions: Providing a safety feedback program had a significant positive effect on the cons umption and consequences of the patient’s safety culture. Therefore, conducting regular safety visits and setting up a direct feedback program to each department/unit after the visit, and the follow-up of corrective measures, will lead to an increase in patient safety standards.

Background: Hospital health service quality is a fundamental component of the health system. Hospital accreditation is a key approach to enhancing this quality, necessitating the correct implementation of processes. Objectives: This study aims to investigate the compliance of the executive processes of Iran’s hospital accreditation program with the requirements of the International Society for Quality in Health Care and to provide corrective solutions. Methods: This qualitative study uses an inductive content analysis technique. A checklist with seven axes was established by extracting and interpreting the requirements of the executive processes from the International Society for Quality in Health Care. By examining existing documents at the Ministry of Health’s Accreditation Office and conducting interviews with managers and experts in the field, challenges in the domain of the executive processes of Iran’s hospital accreditation program were identified using the relevant checklist. Corrective solutions were then gathered through semi-structured interviews with 19 experts, managers, and accreditation field specialists, categorized inductively, and presented using MAXQDA software. Results: Challenges in seven areas were identified, including governance; strategic, operational and financial management; risk management; human resources management; information management; survey and client management; and the granting of accreditation approval. Subsequently, solutions were categorized into five groups encompassing 26 concepts, focusing on reforming macro policies, addressing implementation challenges, fostering appropriate interactions, improving human resource management, and promoting evidence-based decision-making. Conclusions: The Iran hospital accreditation program’s adherence to International Society for Quality in Health Care standards is inadequate. Establishing a semi-autonomous, non-profit accreditation body that operates under government control and ensuring the independence of the accreditation office is essential for achieving higher compliance and receiving certification from International Society for Quality in Health Care.

The World Health Organization’s annual report in 2000 sparked a global trend of assessing and improving healthcare performance indicators. These performance indicators provide tangible measures of the performance of health systems and healthcare institutions. Ranking countries based on these indicators has been a smart and strategic decision to focus the attention of health managers and policymakers on improving them. These performance indicators include quality, safety, equity, public health coverage, service continuity, comprehensiveness, accessibility, and etc. These indicators’ positive trajectory demonstrates the gradual attainment of the health system’s mission and objectives. An often-seen strategic error in health system administration, particularly in developing nations, is the excessive allocation of funds to physical infrastructure and the acquisition of costly equipment. This expense diminishes the resources that could be allocated to performance indicators improvement.

Background: Accreditation and ISO 9001 programs in hospitals are widely adopted for quality control and quality improvement in healthcare. Objectives: The objective of this study is to identify stakeholders’ perspectives and experiences regarding the implementation of accreditation and ISO 9001 programs in hospitals affiliated with the Social Security Organization in Alborz Province, Iran. Methods: In this qualitative study, participants were selected based on purposive sampling. For data collection, semi-structured one-to-one interviews were conducted with hospital staff in different positions (n = 30). All interviews were digitally recorded, transcribed verbatim, and analyzed using thematic analysis. Results:Based on the analysis, 10 primary themes and 88 subthemes were identified. The 10 primary themes were categorized as experiences, strengths, weaknesses, effective factors, and recommendations for the implementation of accreditation and ISO 9001 programs in hospitals. Proper planning, benchmarking, physician involvement, increased resources, and more training are suggested for the successful implementation of accreditation in hospitals. Additionally, fostering a positive culture, focusing on the executive dimension, changing managerial attitudes, training, and supporting and motivating staff are the most important recommendations for the implementation of the ISO 9001 program. Conclusions: The results provide important insights into the dimensions of implementing accreditation and ISO programs in hospitals, which can be used by health policymakers and managers to improve the implementation of these programs in Iranian hospitals.

Over the past three decades, healthcare organizations have prioritized enhancing patient care quality (1). The Institute of Medicine (IoM) has highlighted that most medical errors stem from flawed systems and processes rather than individual actions (2). Consequently, initiatives to improve processes and safety in healthcare have explored various quality improvement (QI) methodologies, including healthcare accreditation programs (1). Accreditation is a systematic process that evaluates a healthcare organization’s compliance against pre-defined peer review standards, which are structural, procedural, and outcomeoriented (3). Assessments are undertaken by various governmental or non-governmental entities, using different modalities in voluntary or mandatory approaches. The scope of accreditation may encompass the entire health organization, individual hospitals, health facilities, only a specialty, or even a sub-specialty (4). Accreditation standards cover diverse domains including clinical governance and patient-centeredness, with the consequences of failing to meet these standards variable across different health system contexts (5). First proposed and implemented by the American College of Surgeons in 1917, accreditation has since undergone numerous transformations and adaptations.

Background: Health technology assessment (HTA) plays a crucial role in enhancing equity within universal health coverage (UHC) by making sure that health technologies are accessible, effective, and affordable for all groups, including those historically underserved. HTA informs policy-making concerning the adoption and prioritization of health technologies to fulfill the needs of the populace, particularly those afflicted with rare ailments and those residing in low- and middle-income nations. Through assessing both the clinical and costeffectiveness of health technologies, HTA identifies the most appropriate options for the needs of the community, thereby facilitating a fairer allocation of resources. Furthermore, HTA ensures the development and evaluation of health technologies are conducted impartially, incorporating the viewpoints and necessities of at-risk groups such as women, children, and the elderly. HTA is instrumental in mitigating healthcare disparities by pinpointing and tackling the elements that hinder equal access to health technologies. For instance, it evaluates the availability and accessibility of health technologies across various regions and demographic groups, identifies obstacles to access, and formulates recommendations to overcome these challenges. HTA is vital in advancing equity in UHC, ensuring that health technologies meet the accessibility, effectiveness, and affordability needs of all, particularly marginalized groups. By addressing healthcare disparities and considering the perspectives of vulnerable populations, HTA promotes transparency and accountability in decision-making and suggests ways to rectify inequities in access to health technologies.

Background: The prevalence of non-communicable diseases such as diabetes tends to rise with age, peaking among the elderly population. Objectives: This study aimed to estimate the economic burden of type 2 diabetes mellitus (T2DM) among the elderly in Tehran province. Methods: This research employs a descriptive-analytical approach, focusing on T2DM patients who attended the specialized diabetes clinic of Tehran province in 2019. A total of 1256 cases were included in the study. Data collection involved reviewing hospital records and accessing information from the accounting department. Data analysis was conducted using Excel software. Results: The economic burden of T2DM amounted to 432,471,301,510 Rials. Among this, 230,841,323,930 Rials (53.3%) were attributed to the costs of diagnosis and treatment, while 180,365,897,580 Rials (41.7%) were associated with treating disease complications. Additionally, 9,043,200,000 Rials (2%) accounted for non-medical direct costs (NMDC), and 12,220,880 Rials (0.3%) were attributed to NMDC due to complications. Conclusions: Given the substantial financial burden incurred by elderly T2DM patients and the constraints on healthcare resources, it is imperative to prioritize preventive and therapeutic measures for this demographic. Comprehensive efforts are needed to mitigate the costs and consequences of this disease within the healthcare system.

Background: Healthcare decision-making is a complex process that involves evaluating the value, efficacy, and accessibility of medical technologies and interventions. Health Technology Assessments (HTA) in high-income countries (HICs) have become a cornerstone of evidence-based healthcare decision-making. This systematic evaluation framework, exemplified by its robust, impartial examination of various medical technologies, plays a pivotal role in establishing the clinical effectiveness and cost-effectiveness of health technologies. In contrast, low and middle-income countries (LMICs) frequently contend with resource constraints and intricate healthcare systems characterized by fragmentation and limited access to advanced medical technologies. As formalized HTA processes may be less established, limiting comprehensive evaluations, decision-making may rely on regulatory approval, clinical guidelines, or international recommendations in LMICs. Similarly, access to medical care in high-income settings, such as the presence of universal healthcare coverage and well-developed health systems, contributes to equitable access to a wide range of medical services. In LMICs, challenges related to healthcare infrastructure, funding, and health workforce shortages hinder access to essential medical care, leading to inequities in health outcomes. This short review aims to compare the approaches to healthcare decision-making in high-income and low/middle-income countries, with a specific focus on HTAs and access to medical care.

Background: Poor oral and dental health significantly affects public health, impacting over half the world’s population. Dental caries can undermine children’s academic success and career prospects. Social inequities result in unequal access to oral healthcare, particularly among populations with lower socioeconomic status (SES). National policies that improve access to oral health can reduce these disparities. Objectives: This study aims to compile policies implemented by various countries to achieve universal health coverage (UHC) for pediatric dental services. Methods: This scoping review was conducted according to Arksey and O’Malley’s framework and is reported using the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) guidelines. A systematic search was conducted on databases including Scopus, PubMed, Magiran, SID, Irandoc, Google Scholar, the WHO website, and the databases of Iran’s Ministry of Health. The search aimed to identify literature discussing governmental steps taken to achieve UHC for pediatric dental health, published between January 1, 2011, and December 31, 2022. The results were charted and presented in a table. Results: This review included 22 studies. Six themes were identified based on the roles played by key players in this field, including schools, government policy and support, community-oriented preventive plans, insurance support, parents’ awareness, and inequality in accessing dental services. Conclusions: A comprehensive policy that reduces barriers to access, increases utilization, and engages all stakeholders—including parents, schools, and community centers—can effectively achieve UHC for pediatric dental health.

Providing pre-hospital emergency services is accessible in Iran but costly for the country’s health system. This study calculated the willingness to pay (WTP) for pre-hospital emergency services in Iran. Discrete choice experiment (DCE) was used to measure the population’s WTP for ambulance services focusing on time, price, and quality of services. Four hundred and sixty people in Rasht city, Iran, participated in this online survey. Participants preferred lower transfer fees (β = -0.7, P˂ 0.05), lower time of reaching to the scene (β = -0.061, P˂ 0.05), lower time to arrive to the hospitals (β = -0.038, P ˂ 0.05), Private ambulance (β = -0.151, P ˂ 0.05), and emergency medical services (EMS) technicians (β = 0.209, P ˂ 0.05). Patients’ WTP in selecting EMS services can help policymakers to provide the best services.

The implementation of electronic health (e-Health) in healthcare organizations consistently encounters numerous challenges. These barriers hinder the widespread adoption of this promising technology within healthcare settings. This study addresses the challenges of implementing e-Health across various hospitals and also aims to evaluate the maturity of hospital information systems (HIS) in Iranian hospitals based on the electronic medical record adoption model (EMRAM). Through two rounds of literature review and case studies, a comprehensive understanding of these previously unexplored issues has been developed. The findings identify 13 social and technical challenges, including the lack of standard applications, high costs associated with e-Health and training, legal issues, security concerns, inconsistencies and diversities in perceived e-Health benefits and barriers, lack of proficiency, and difficulties healthcare professionals face in integrating e-Health into their daily tasks. There are also negative perceptions among physicians and patients regarding the use of e-Health software, the lengthy implementation times for HIS systems, technical difficulties due to platform diversity, resistance to change, and the limited use of pilot projects, particularly in Iran. Moreover, the maturity of hospital cases in Iran is at 3 stages, in contrast to the 7 stages of EMRAM. These results underscore the need to develop an effective strategy to address the challenges identified in this research. Additionally, a specific program should be implemented for developers to enhance the maturity of HISs and advance them to higher stages of EMRAM.

Background: Acceptance and commitment therapy (ACT) is an emerging form of cognitive-behavioral treatment that is based on functional context. Objectives: The purpose of this study was to investigate the effectiveness of ACT in individual and social adaptation in adolescents with disabled parents. Methods: The research design was a quasi-experimental, pre-test and post-test, with the control and experimental groups. The study population included all female adolescents with disabled parents in Mobarakeh, Isfahan, Iran, in 2017. The sample included 30 female adolescents with disabled parents selected using the purposive sampling method. The participants were randomly assigned to both experimental and control groups. The experimental group received ACT tests in 8 sessions, and each session lasted 90 minutes. The participants were assigned to each group before the intervention and at the end of the intervention using the California Psychological Inventory (CPI). Statistical analysis for this study was performed using SPSS-22 software for statistical calculations, and descriptive and inferential statistics were used for data analysis. Results: According to the results, the mean ± standard deviation (SD) of the individual adaptation and social adaptation variables in the experimental and control groups during the post-test period (130.58 ± 7.88 and 128.50 ± 7.79, respectively), compared to the pre-test (44.8 ± 0.7128 and 45.5 ± 0.5128, respectively), did not increase significantly. Moreover, the results indicated that there was no significant difference in the post-test period between individual adaptation scores (F = 1.191; P = 0.288; η2 = 0.054) and social adaptation scores (F = 0.727; P = 0.403; η2 = 0.033) of the experimental group and the control group. Conclusions:The results showed that there was no significant difference between individual and social adaptation scores in the post-test stage. This study suggests that treatment attempts were not very effective.

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

Background: In the context of Persian traditional medicine, there are several therapeutic strategies for managing diseases, ranging from lifestyle changes to herbal remedies. Objectives: Given the application of Persian traditional medicine in the management of chronic diseases, the burden of chronic illnesses, and the public’s recourse to traditional medicine specialists, this study aimed to assess the cost-effectiveness of traditional medicine dietary regimens for the treatment of non-alcoholic fatty liver disease from the perspective of the payer. Methods: In this study, we investigated the cost-effectiveness of providing nutrition counseling for lifestyle modification (changes in the aforementioned Setteh-e-Zarurieah) by a traditional medicine specialist compared to receiving counseling from a nutritionist for nonalcoholic fatty liver disease from the payer’s perspective. The outcomes measured were changes in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) enzymes, body mass index (BMI), and the grade of fatty liver. Cost and effectiveness data were entered into Excel software, and the ICER ratio was calculated. Results: The results indicated that the dietary regimen prescribed by Persian traditional medicine when compared to the nutritionist’s recommended diet, resulted in a lower decrease in AST and ALT enzymes but led to a greater decrease in BMI (mean change = 0.42) and a significant change in the grade of fatty liver (OR = 9.75). Since the costs of tests, ultrasounds, and visits were equal in both groups, the cost difference was zero. In the first scenario, where traditional medicine is considered an alternative therapy and liver enzymes are the primary focus, providing nutritional counseling services by Persian traditional medicine may not be cost effective. However, if we consider the grade of fatty liver and BMI as the primary variables, providing nutritional counseling services by Persian traditional medicine may be cost-effective. Conclusions: Based on the available evidence, the treatment of fatty liver using Persian traditional medicine can be considered an effective and cost-effective complementary (or alternative) intervention. Considering the long-term costs imposed by the health system and insurance organizations, it is predicted that adding visits to Persian traditional medicine specialists may reduce overall healthcare system costs.

Background: Currently, health indicators are considered an important factor in the development of countries and can be effective in raising the level of developmental indicators. Objectives: In this regard, the present study aimed to analyze the relationship between the effect of health indicators on the developmental indices of the provinces of Iran. Methods: The current study of an applied type was descriptive, cross-sectional, and retrospective. The data were prepared through forms designed based on experts’ opinions and classified information in statistical yearbooks for the provinces of the country during 2016 - 2020. Data analysis was carried out using Stata 17 software. Moreover, panel data was used to estimate the model, and the Xtpcse test was used to obtain the results of the hypotheses. Results: The results of the model estimation show the positive and meaningful impact of health indicators on educational indicators such as the ratio of students to teachers, the ratio of students to staff and management, the ratio of higher education students to the population of the provinces and the distribution of students in the province. Conclusions: The country’s authorities can improve and develop health by identifying and optimizing the use of effective indicators in the field of Health and education indicators such as increasing the number of medical and health students and developing educational programs in the field of Health and health and informing the community about these programs, as well as encouraging higher education in low-income areas.

Background: The process of entrepreneurship and creativity are the main current principles in human life at the beginning of the third millennium AD; therefore, it is considered one of the most important goals of educational organizations. Preparing students to enter society effectively will not be provided unless creativity is cultivated among them. Therefore, the present study was conducted to use the effect of the constructivist teaching method on students’ creative thinking and entrepreneurship. Methods: In this interventional study, 40 female students in sixth grade were selected by available sampling and randomly divided into two groups of 20 (20 in the intervention group and 20 in the control group). Then, the intervention group was given the necessary training for 5 one-hour sessions. The investigated variables were collected from demographic questionnaires, Abedi’s creativity , and Lumpkin and Dess’s tendency to entrepreneurship through pre-test and post-test. Data analysis was performed using SPSS software (version 25) and descriptive statistical methods of covariance test. Results: In terms of parents’ education level and household income, no difference was observed between the two groups (P > 0.05). The average score of creative thinking in the intervention group increased from 67.55 before the intervention to 75.75 after the intervention; however, in the control group, the average score decreased from 20.68 in the pre-test to 55.61 in the post-test. Additionally, the average score of entrepreneurial tendency in the intervention group increased from 43.75 before the intervention to 54.50 after the intervention; however, in the control group, the average score increased from 40.10 to 42.50. Conclusions: The constructivist teaching method plays a significant role in the learning approach. In addition, the use of this method can be effective in increasing the tendency to entrepreneurship. Considering the importance of entrepreneurship, teaching constructivist courses in universities and schools is appropriate.

Background: Chronic kidney disease (CKD) is an irreversible condition that demands hemodialysis treatment until a kidney transplant is carried out. If dialysis is not sufficient, the patient might experience numerous physical and psychological consequences. This study aimed to examine the relationship between depression and anxiety and dialysis adequacy in patients receiving hemodialysis in Birjand, Iran. Methods: In this cross-sectional study, 100 patients undergoing hemodialysis treatment at Shahid Beheshti Hemodialysis Center in Birjand were examined. The state of depression and anxiety in them was evaluated according to the Hospital Anxiety and Depression Scale (HADS), and the adequacy of the patients’ dialysis was extracted from their medical records. In this study, scores ≤ 11 on the HADS scale were considered healthy. Moreover, dialysis adequacy was calculated with the KT/V formula, and cases ≥ 1.2 were considered adequate. Data analysis was performed using SPSS 19 software, independent samples t-test, and Pearson correlation coefficient. Results: The results showed that 18% and 82% of the participants had depression and anxiety, respectively. The patients’ depression and anxiety scores did not significantly correlate with the adequacy of dialysis (P = 0.82 and P = 0.86, respectively). The prevalence of depression and anxiety was not significantly influenced by gender or marriage; however, the results indicated that as patients aged, the prevalence of depression increased (P = 0.009) and anxiety decreased (P = 0.003). Conclusions: The adequacy of dialysis in patients undergoing hemodialysis treatment remains unaffected by mental disorders, such as anxiety and depression. Age has a significant impact on depression and anxiety levels in patients receiving hemodialysis treatment. To reduce anxiety and depression in younger and older patients, it is recommended to initiate support and educational programs.

El estudio del tracto digestivo de especies de la familia Eleotridae ha sido poco abordado a pesar de su importancia para entender la fisiología de los peces, su nutrición, asociaciones tróficas y aplicación en acuicultura. El chame Dormitator latifrons es una de las especies de la familia Eleotridae con gran potencial para la acuicultura, de la cual se conoce muy poco sobre su sistema digestivo. Este trabajo describe la morfología e histología del tracto digestivo de D. latifrons y compara las variables morfométricas entre estadios y sexos, en 127 ejemplares recolectados en un sistema de cultivo. A cada pez se le registraron los datos biométricos y posteriormente se extrajo el tracto digestivo el cual fue descrito, medido por secciones, y se fijaron fragmentos de tejido en formalina neutra al 10 % para análisis histológico. Las muestras de tejido fueron procesadas por la técnica de inclusión en parafina y teñidas con hematoxilina y eosina; los datos morfométricos fueron comparados entre estadios y sexos. El tracto digestivo estuvo compuesto por boca, faringe, esófago, estómago, intestino y ano; y cada sección presentó las cuatro capas de tejido concéntrico (mucosa, submucosa, muscular y adventicia/serosa) características del sistema digestivo de los peces. Morfológicamente lo más distintivo fue la presencia de un estómago tubular en forma de “I”, bien delimitado y con abundantes glándulas gástricas tubulares. La longitud y el índice intestinales fueron significativamente diferentes entre estadios y sexos, posicionando a los juveniles en el nivel trófico omnívoro mientras que los adultos se posicionan como herbívoros; el análisis por sexo mostró un índice intestinal significativamente menor en las hembras respecto a los machos. Los resultados muestran un comportamiento politrófico del chame D. latifrons que podría estar asociado al hábitat, a la disponibilidad de alimento, o la madurez sexual. La presencia de un estómago funcional permite clasificar a esta especie como gástrica y abre la posibilidad de estudios futuros sobre la fisiología digestiva de esta especie y composición de la dieta idónea para organismos cultivados, temas hasta ahora muy poco atendidos.

En este trabajo, describimos lesiones producidas por el protozoario dinoflagelado Amyloodinium ocellatum en las branquias de Mugil liza, causante de la enfermedad del terciopelo en varias especies de peces. Estos parásitos producen lesiones severas en las branquias, con hiperplasia de las células lamelares primarias y secundaria, ruptura de las células pilares e hiperplasia de las células de cloruro (ionocitos). La estructura branquial queda totalmente afectada, lo que impide una hematosis normal y altera la actividad osmoreguladora comprometiendo la salud de los peces. Las lesiones producidas por A. ocellatum son responsable por las altas tasas de mortalidad en los cultivos de peces generando pérdidas económicas en el sector productivo. En el presente trabajo, encontramos hiperplasia de células lamelares del epitelio respiratorio, disrupción epitelial, colapso de las laminillas secundarias y otras alteraciones que comprometen seriamente la función branquial.

La producción de camarón en Colombia marcó un hito muy importante en la acuicultura del país en la década de los 90 y principios del 2000, llegando a aportar a la economía del país alrededor de USD$51.000.000. Sin embargo, varios aspectos fundamentales como la aparición de patógenos, la revaluación del peso colombiano, entre otros, ocasionaron una eventual caída en la producción no solo en el país sino también a nivel mundial. La reactivación de la industria se ha visto afectada, principalmente por la fuerte competencia en los mercados internacionales debido a la baja productividad resultante de la escasa tecnología utilizada en sistemas de producción sostenibles, así como por la implementación de nuevas fuentes de alimentación para el cultivo de este crustáceo. En este documento se exploran los desafíos y retos históricos y actuales en la producción del camarón Penaeus vanammei en Colombia.

Dado que muchas de las especies utilizadas para fines acuícolas son exóticas y sin considerar el grado de alteración que pueden causar en los ecosistemas y especies nativas, este estudio se llevó a cabo con el objetivo de introducir una especie nativa como Dormitator latifrons a los sistemas tradicionales de acuicultura en estanques. Los sistemas de policultivo con especies de mayor valor comercial han proporcionado una estrategia útil para el desarrollo de la acuicultura sostenible de peces nativos. Por esta razón, este estudio evaluó el rendimiento de producción y el crecimiento de D. latifrons en policultivo con tilapia roja (Oreochromis spp.) y langostino (Macrobrachium rosenbergii) en estanques de producción en Costa Rica. Juveniles con pesos iniciales de 36,5 g ± 7,7 para D. latifrons, 14,2 g ± 7,5 para tilapias y 13,1 g ± 8,4 para langostinos, fueron utilizados durante la fase experimental realizada en 2 estanques divididos en 3 secciones de 24 m2. Los organismos fueron aleatoriamente distribuidos mediante un tratamiento con 3 réplicas en policultivo compuesto por 42 D. latifrons (1,75 Ind./m2), 34 tilapias (1,42 Ind./m2) y 27 langostinos (1,12 Ind./m2), mientras que en el control se utilizó, por triplicado, 30 D. latifrons en monocultivo a una densidad de siembra de 1,25 Ind./m2. El policultivo de D. latifrons con tilapias y langostinos tuvo un efecto perjudicial en el crecimiento de los peces lo que demuestra una interacción negativa entre ellos, existiendo competencia por espacio y alimento. Dormitator latifrons puede adaptarse a la alimentación artificial y competir con otras especies como las tilapias en la etapa juvenil, pero no muestra el mismo comportamiento conforme crece, lo cual podría explicar la caída del crecimiento en las últimas 9 semanas en policultivo con mayor cantidad de individuos en el estanque. La productividad del policultivo, en términos de la biomasa final alcanzada, fue considerablemente más alta que en monocultivo al sembrarse y cosecharse mayor cantidad de organismos.

Este estudio evaluó el efecto de la densidad inicial de larvas y la concentración de microalgas en la dieta sobre el crecimiento y el número de larvas competentes (número de larvas vivas al final del experimento retenidas en un tamiz con un tamaño de malla de 210 µm) de Perna perna en un sistema de recirculación de agua (RAS). El experimento se llevó a cabo utilizando un diseño completamente al azar y un esquema factorial. El primer factor fue la concentración del alimento, que estuvo compuesto por una mezcla de Chaetoceros müelleri (CM) e Isochrysis galbana (ISO), en una proporción de 30:70, respectivamente, en tres niveles (bajo: entre 1,26 a 2,19, medio: entre 2,36 a 3,94 y alta: 5,03 a 7,29 x 104 células mL⁻¹). El segundo factor fue la densidad del cultivo larvario, también a tres niveles (20, 80 y 200 larvas mL⁻¹), con 3 repeticiones en cada tratamiento. Las larvas alimentadas con la dieta con bajas y altas concentraciones no alcanzaron la competencia (210 µm) en 16 días. Sin embargo, en el día 16, las larvas alimentadas con la concentración media (2,36 a 3,94 x 104 células mL⁻¹), alcanzaron en porcentaje promedio de larvas competentes 21,8% ± 7,45, 27,4% ± 9,91 y 0,80% ± 0,26 a las densidades 20, 80 y 200 larvas mL-1, respectivamente.

It appears that the use of artificial intelligence in the early diagnosis of Alzheimer's disease holds the potential for positive outcomes in the treatment process and will have a beneficial impact on therapeutic planning. However, further in-depth studies in this area are necessary to gain a more comprehensive understanding of its full potential and effectiveness

Abstract Background: The potentials of artificial intelligence (AI) have permeated all industries and fields, and the advantages of AI are extensively employed. This technology offers a wide range of benefits in the pharmaceutical industry, including reducing human interventions and increasing the speed and accuracy of tasks. This can expedite time-consuming activities, such as drug discovery, production, clinical trials, research and development, and ultimately, determining a drug’s position in target markets. Methods: A comprehensive scope review was performed in this descriptive, applied study on the applications of AI in the pharmaceutical industry in Iran. Relevant data were meticulously gathered and extracted from diverse sources, including various search engines, key databases, such as Medline, PubMed, Elsevier, and the Iranian Center for Scientific Information and Documentation, and information databases, reference books, and reports from the World Health Organization. These results represent our research on key themes, including AI, the pharmaceutical industry, drug production, innovation, and evolution. Our main focus lies on the application of AI in the manufacturing part of the pharmaceutical industry, with a deliberate decision not to delve into the technical aspects. This approach allowed us to prioritize a comprehensive understanding of the practical implications and advancements in the manufacturing processes facilitated by artificial intelligence. Results: The retrieved studies showed that AI has the potential to enhance crucial processes in pharmaceutical companies across various dimensions. These potential capabilities are observed in areas such as quality control, human resource management, research and development, finance, supply chain management, logistics, data management, operations management, customer relationship management, and commerce, which are further discussed. Conclusions: Pharmaceutical companies can utilize the tools provided by AI in various value-creating processes to enhance their efficiency and effectiveness. This requires the adoption and integration of this innovative technology at various levels of organizational planning so that these companies can harness the greater potential it offers with appropriate investments.

Artificial intelligence is a new field that uses computers to act like human intelligence. AI is going to make big changes in healthcare in the next few years and will become much bigger in the next decades. Artificial intelligence is expected to help medical centers work better and efficiently, diagnose diseases accurately, and create treatment plans. Artificial Intelligence has been used in health care fields with some success (1). Even though we have made a lot of progress using artificial intelligence for medical research, there are still differences between what the computers can do and what we need for real-life health care situations (2). The fast growth of AI technology can be used in hospitals to improve how they treat patients. This could make a big difference in how healthcare is delivered. It is important to write down and share information about how AI is used in hospitals, so that healthcare workers have the right tools and know-how to use it properly (3). To make better decisions, we need to evaluate how AI can change our healthcare system. Considering how important AI could be in many areas, we should look at more than just how well it works and how much it costs. We need to think about its overall value in the world and how it can help people in their daily lives (4). Due to the increasing importance of the use and application of artificial intelligence in the field of health technology assessment and evidence-based policymaking, especially after Covid-19 pandemic, “health technology assessment (HTA) in action journal” decided to invite researchers and experts to help to develop this knowledge by publishing specialized papers in this field. It is hoped that the published articles can provide up-to-date results in this field. The editor wants to thank all the authors who submitted their work to the special issue of the "HTA in Action journal" Also, thanks to all the reviewers for working hard to review the articles and help the editors make the final decision.

Abstract Background: In line with the advancement of Artificial Intelligence (AI), innovative solutions have been designed to improve healthrelated Sustainable Development Goals (SDGs). Accordingly, there is an increasing trend in the realm of AI and SDG research areas. Objectives: This study aimed to analyze the trends and patterns of AI research in health-related SDGs using bibliometric analysis. Methods: The bibliometric approach facilitated the identification of key terms and countries from previous research. We used VOSviewer to map and analyze data obtained from three databases: Scopus, Web of Science, and PubMed. Results: Our findings illustrated that research on health has been a popular area of study in recent years. In particular, we observed a significant increase in research on AI in health-related SDGs during 2015 - 2022. Conclusions: This study provides insights into the trends and patterns of AI research in health-related SDGs using bibliometric analysis. The findings can guide future research by identifying key terms that require further investigation.

Abstract Artificial intelligence (AI) has become an integral part of modern healthcare, with its algorithms and other AI-enabled applications supporting medical professionals in clinical and research settings. The digital revolution is transforming the way we approach medical care. Currently, numerous AI products have been developed to cover various aspects of healthcare, such as predicting the risk of acute and chronic diseases (e.g., cardiovascular risk, gastrointestinal bleeding, and eye conditions) and forecasting cancer risk, among other cases. Artificial intelligence has the capacity to revolutionize the utilization of health information collected in datasets. However, the specific characteristics of AI, including vagueness, complexity, data dependency, and automated behavior, can pose potential risks to users’ fundamental rights and safety. Therefore, it is crucial to recognize and mitigate these risks and provide legal solutions for any harm resulting from these risks. In the realm of healthcare, AI plays a pivotal role in advancing reliable prediction capabilities. Consequently, the storage and processing of data are imperative for emerging diagnostic and decision-making technologies. Nevertheless, these advances also introduce privacy risks, raising significant legal challenges for medical institutions. Understanding the various levels of these risks assists healthcare professionals and institutions in managing these challenges and complying with regulations. This descriptive research article comprehensively examines and implements the regulatory frameworks governing the United States and the European Union. Additionally, it draws upon documented research in this field to discuss the utilization of AI in healthcare, along with the associated legal issues, including informed consent and malpractice.

Background: The smartification of supply chains, which enables organizations to stay informed about crises in a timely manner and make appropriate decisions in response to the resulting pressures, has consistently been a crucial factor in the realm of organizational transformation. The healthcare industry in Iran faces more challenges and crises than other industries, especially due to its vital role in public health prevention and care. Objectives: According to the reasons described, this research aims to simulate and improve the efficiency of the healthcare supply chain when confronted with crises. Methods: In this study, the efficiency of the healthcare supply chain was simulated using the system dynamics approach and Vensim DSS. Results: The results indicated that healthcare supply chain efficiency in Iran is unsatisfactory and may confront challenges during crises. Therefore, this study places particular emphasis on examining scenarios for improving the current situation, which stems from the consensus of experts and stakeholders in this field. In the presented scenarios, a 2% improvement in the utilization of advanced intelligent technologies and a 5% improvement in intelligent inventory management were observed. Notably, the combined effect of these two scenarios led to an overall enhancement in the average efficiency of the healthcare smart supply chain. These improvements can increase the average efficiency levels within the pharmaceutical manufacturing segment up to 1.3%, 5.8%, and 7.7% in each of the aforementioned scenarios. Conclusions: It can be asserted that although the advancement of smart technologies and intelligent inventory management individually contribute to enhancing the efficiency of the healthcare supply chain in Iran, combining these changes can provide the groundwork for further increasing efficiency up to 7.7%.

Abstract Background: Motivational psychotherapy has been investigated for its effects in the treatment of various disorders. Objectives: This study aimed to examine the effectiveness of motivational psychotherapy in enhancing educational motivation among students. Methods: This research employed a pretest-posttest quasi-experimental design with a control group. The study population comprised all female second-grade high school students in Birjand City during the 2022-2023 academic year. Purposive sampling was used to select a sample of 30 participants, who were then randomly assigned to the experimental (15 participants) and control groups (15 participants). The Harter Educational Motivation Inventory (1981) was used to collect data. Results: The mean age of the experimental group was 17.23 years. The results of the analysis of variance (ANOVA) indicated that motivational psychotherapy had a significant impact on students’ educational motivation. Conclusions: These findings emphasize the significance and effectiveness of motivational psychotherapy, offering new avenues for psychotherapists in the conceptualization and treatment of psychological issues in student

Abstract Background: The present study investigated the effects of motivational psychotherapy on depression in adolescents. Methods: This quasi-experimental study utilized a pretest-posttest design with a control group. The research population consisted of all female students of the second grade of high schools in Birjand city in the academic year of 2022 - 2023. Thirty participants were randomly selected and allocated to the experimental and control groups. The intervention was performed on the experimental group for 12 weeks, while no intervention was performed on the control group during this period. One week after the sessions, the posttest was performed on both groups. Beck Depression Inventory (1961) was used to collect data and covariance analysis to analyze them. Results: The mean age was 17.23 in the experimental group. The analysis of variance showed that motivational psychotherapy had a significant effect on reducing depression in teenagers. Conclusions: These results emphasize the importance and effectiveness of motivational psychotherapy and can open a new way for psychotherapists to conceptualize and treat psychological disorders.

Abstract Background: Upper crossed syndrome is a muscular imbalance disorder associated with various referred pains, especially jaw discomfort. Complications like temporomandibular joint (TMJ) osteoarthritis may link to forward head posture and mechanical head pains resulting from this syndrome. Objectives: The objective of this study was to compare the impact of corrective exercise on pain of TMJ in elderly women with upper cross syndrome. Methods: A total of 30 elderly women with upper crossed syndrome were enrolled at the Kahrizak Elderly Care Center and randomly assigned to either a corrective exercise group or a control group. The experiment group underwent an eight-week training program. Pain levels and neck range of motion were assessed using a pain ruler and goniometer, respectively. In order to measure neck extension, the mean difference and effect size were determined using paired t-test and Cohen’s d, respectively. Referred pain ratings were analyzed using Mann-Whitney U and Wilcoxon signed-rank tests, with effect size calculations, to further understand the intervention’s effect on pain perception. Results: Both groups demonstrated significant changes in referred pain perceptions (P = 0.0441) post-intervention. However, regarding neck extension, neither the control nor the experiment group exhibited statistically significant alterations in neck extension (P = 0.4309). Conclusions: These findings indicate that corrective exercises have a positive effect on alleviating referred pain in the jaw joint caused by muscle imbalance. Given the merits of corrective exercises as a non-pharmacological intervention, they are recommended as an effective approach for improving referred pain in the jaw.

Abstract Background: The international ovarian tumor analysis (IOTA) study technique is a specialized method for classifying and identifying adnexal growths. It employs 10 simple ultrasound directions to characterize masses as benign or malignant. Objectives: This study aims to provide pre-operative information to help gynecologists manage ovarian masses, avoiding delays in malignancy treatment and unnecessary surgery for benign lesions. Methods: This was a hospital-based observational study conducted in the radiology department on patients with clinical diagnoses of ovarian masses from August 2020 to March 2022 by prospective randomized sampling method. Patients with suspected ovarian pathology were evaluated using IOTA ultrasound rules and designated benign or malignant. The patients underwent a thorough history and clinical examination. Ultrasound was used to confirm the ovarian origin of the mass and differentiate it as benign or malignant. A transvaginal ultrasound was performed where necessary. Histopathological examination was the gold standard to confirm ultrasound and Doppler findings. Descriptive stats: Frequencies/percentages for categorical data, mean ± SD for normal, median with IQR for non-normal Uncertainty measured by 95% CI. Results: During the study, 50 women were eligible for the study, and the mean age of the participants was 45.3 years. Of 50 patients who underwent surgery, 38 cases were considered benign based on IOTA USG rules, of which 35 were benign and 3 were malignant histologically Eight cases were considered malignant based on IOTA USG rules, of which 6 were malignant and 2 were benign. Four cases were considered indeterminate, with two being benign and two being malignant histologically. If inconclusive cases are classified as malignant, the sensitivity and specificity are 75% and 88%, respectively. Conclusions: USG is an easily available imaging tool that can be used as an initial modality in evaluating ovarian masses. IOTA simple ultrasound rules have diagnostic accuracy in distinguishing benign and malignant ovarian masses and help in management.

Objectives: Assess how relevant precedent within the EMA (a key regulator) and NICE (a key HTA body) can inform how such novel medicines targeting asymptomatic conditions can be brought to market from a regulatory and payor perspective. Methods: All phase 2 or phase 3 clinical trials with "asymptomatic", "presymptomatic", "subclinical", "premanifest", or "preclinical" as a condition key word were downloaded from clinicaltrials.gov. Trials were cleaned to identify those for novel medicines with a primary target to treat asymptomatic conditions. EMA and NICE reports for such drugs were downloaded online in December 2021 and analysed to understand how they assessed the evidence. Results: 278 clinical trials were identified. Of those, only 8 had relevant matching reports from EMA and/or NICE. 7 of these 8 received a positive review from EMA, and 4 of these 8 received a positive recommendation from NICE. Those receiving positive recommendations showed or were assumed to show statistically significant survival benefit given a short life expectancy of untreated patients. Conclusions: There is no precedent within EMA or NICE for approving or funding new medicines for asymptomatic patients where survival benefit cannot be established. Additional research is warranted to understand how regulatory and payor agencies can prepare for future generations of innovative medicines.

Abstract Background: Medical students, as a part of the first line of combating COVID-19, have been exposed to harm caused by mental disorders. Objectives: This study investigated how stress management training affects the mental health of medical students and interns during the COVID-19 pandemic. Methods: sixteen training and internship students of Birjand University of Medical Sciences from 2020-2021 were included in this intervention study. The intervention group completed the stress management training course in 6 sessions. Mental health dimensions were collected with the SCL90 questionnaire before and after intervention in both groups. SPSS 22 software and Mann-Whitney U-test, Wilcoxon, Chi-square, and Fisher’s exact test were utilized for data analysis. Results: The basic data showed no significant differences between groups (P > 0.05). After the intervention, the mean scores of physical complaint, obsessive-compulsive, interpersonal relations, depression, anxiety, aggression, fear, paranoid and psychotic dimensions in the intervention group significantly decreased (P < 0.05). In controls, the obsessive-compulsive, depression, anxiety, and aggression dimensions significantly decreased (P < 0.05). However, in controls, there was no significant difference in the mean score of other dimensions before and after intervention (P > 0.05). Before the intervention, the frequency distribution of various levels of sensitivity to interpersonal relationships in the two studied groups was the same (P > 0.05); after the intervention, these levels were significantly different between groups (P < 0.05). After intervention, the control group had a higher frequency distribution of individuals with degrees of depression (P < 0.05). Conclusions: The mental health of medical internship students during a crisis can be improved by stress management training, which reduces anxiety and depression. Therefore, stress management courses are recommended in stressful situations.

Abstract Background: The purpose of this study is to identify the factors affecting the development of public sports and well-being through medical universities in the country. Methods: The method of the present study was a qualitative. The theory of the foundation was used to construct a conceptual model of the research. The statistical population included professors of sports management, managers and experts in medical universities and sports organizations, and physical education coaches and teachers in medical universities. Purposeful sampling was performed with 14 interviews until saturation was reached. The research tool was a semi-structured interview in which the results were analyzed by open, axial and selective coding. Results: Factor affecting the development of public sports and health through medical universities in the country were categorized in three category including causal, contextual and intervening factors. In relation to causal factors, 13 sub-categories and four main categories were identified. In underlying factor, 45 sub-categories were obtained in 7 main categories and in the intervening factor, 34 sub-categories were obtained which were identified and categorized in 8 main categories.

Abstract Context: The placenta performs a crucial function in nutrient exchange, but studying this tissue poses a number of challenges. Utilizing microfluidic and microfabrication technologies, a 3D placenta-on-a-chip model provides a biomimetic alternative for studying placental diseases and treatments. Objectives: Aim: To review and analyze the currently available placenta-on-chip data to study placental pathologies in patients. Methods: By systematically searching the PubMed, Scopus, and Science Direct databases, research papers that employed 3D printing techniques for the development of organoids and Organ-on-Chip (OoC) systems for in vitro experiments were gathered and scrutinized. Results: When exposed to glucose transfer, placenta-on-a-chip mimics the features of an in vivo human placenta. Microchips have the potential to become a platform for diagnostic purposes for placental diseases and a model for duplicating the important features of these diseases. Conclusions: The microfluidic placenta-on-a-chip platform holds promise as an affordable solution with versatile applications. However, research is essential to develop a comprehensive in vitro pregnancy model in the future to expand our understanding of feto-maternal communication.

Fish consumption has been growing since 1961. Indeed, the fisheries sector is essential to prevent hunger and malnutrition. However, this sector has its challenges. Fish stocks are being depleted beyond biological sustainability, with diseases and biosecurity risks to production and harm to the environment and ecosystems. There is a clear need to improve fish farming with minimum occupation and environmental impact. Heterotrophic and aquaponics systems are being utilized and modified to address these needs. However, environmental factors can affect the innate immunity of fish raised in these systems. Understanding how these systems affect fish’s immunity is critical to prevent potential hazards and the breakdown of these production methods. The goal of this research was to evaluate the performance, growth, and phagocytic indexes of silver catfish (Rhamdia quelen) juveniles reared in water recirculation, biofloc, and aquaponics systems in consortium with watercress seedlings (Nasturtium officinale). In each system, 12 juveniles weighing 15.2 g±7,6 were randomly divided into three replicates, fed with commercial feed. The following physical-chemical parameters - temperature, total and toxic ammonia, nitrite, and water pH - were daily assessed. Fishes were weighed monthly for six months. It was observed that R. quelen juveniles reared in the aquaponic system achieved higher average weight, but no statistical significance was detected (p>0.05) when compared to those reared in the recirculated and biofloc systems. At the end of the experiment, the phagocytic index was lower only in the recirculating system. The phagocytic capacity was lower in all systems. Although the aquaponic system presented low average weight gain/animal the performance of this system was effective in reducing the concentrations of total ammonia and nitrite in the water, in consortium with the production of vegetables.

Se comparó el crecimiento y supervivencia de semillas de almeja babosa Venerupis corrugata (Gmelin, 1971) en tres sistemas suspendidos de preengorde partiendo de una tasa de ocupación de 59 individuos cm-2 de densidad inicial. Se probaron dos de flujo pasivo (linternas y pochones) y uno de flujo forzado en bidones con air-lift, en el que se mantuvo un caudal mínimo de agua de 72 L min-1. Al cabo de 114 días de cultivo se registraron resultados muy superiores en el crecimiento en peso en el sistema de flujo activo en el nivel inferior, y las linternas se mostraron más efectivas que el sistema con pochones horizontales. La mortalidad entre muestreos fue reducida, a excepción de la mortalidad registrada en el último muestreo en el sistema de bidones con air-lift en el nivel superior. El sistema de flujo forzado en air-lift es el más indicado para el preengorde suspendido de almeja babosa en lugares donde está disponible el suministro eléctrico.

Se evaluó el efecto en la nutrición de la sustitución de la harina de pescado por la de cianobacteria S. subsalsa en un cultivo de caracol manzana Pomacea bridgesii, donde se utilizaron 60 organismos a los cuales se les suministraron dos dietas (A y B) de alimento balanceado: una adicionada con harina de S. subsalsa (A) y la otra sin S. subsalsa con harina de pescado (B). El cultivo se realizó en un sistema de recirculación conformado por seis unidades de cultivo, durante un periodo de diez semanas. Para evaluar la eficiencia de las dietas se utilizó la tasa de crecimiento absoluta (TAC), con un valor de 0,168 ± 0,011 para A y 0,162 ± 0,009 para B, la tasa de crecimiento específica (TEC), con un valor de 1,417 ± 0,013 para A y 1,416 ± 0,065 para B, en cuanto al factor de conversión alimenticia (FCA), se obtuvo un valor de 1,52 ± 0,11 para A y 1,33 ± 0,08 para B. Se realizó un análisis de varianza para la TAC y TEC, entre los tratamientos A y B, sin encontrar diferencias significativas. El análisis de medidas repetidas para peso y talla, entre los tratamientos A y B, no mostró diferencias significativas, con esto se puede decir que, en la dieta (dieta A) en la que se sustituyó una porción de harina de pescado por harina de S. subsalsa, ofreció los mismos resultados que la dieta elaborada con harina de pescado (dieta B) como principal fuente de proteína. Por lo que se podría reducir el uso de la harina de pescado en la formulación de alimentos acuícolas al menos para esta especie de caracol.

La bioseguridad en la acuicultura se ocupa de la gestión de la sanidad de los animales acuáticos y la reducción de los riesgos a la salud pública asociados con la producción y el consumo de productos acuícolas. Particularmente, las enfermedades son un tema de atención en todo sistema de cría y producción de animales. En la acuicultura cubana, una de las especies ícticas de mayor importancia es el pez gato africano Clarias gariepinus. Esta especie introducida es afectada por protozoos ciliados parásitos de la familia Trichodinidae durante los primeros estadios de vida. El presente trabajo se trazó como objetivo, identificar y caracterizar las especies de tricodínidos que afectan el cultivo de C. gariepinus en la estación de alevinaje La Juventud, Provincia Pinar del Río, Cuba. Dichas especies identificadas y caracterizadas fueron T. heterodentata, T. acuta y T. merciae, las cuales son consideradas peligros biológicos para el cultivo de este pez. Estos resultados constituyen el primer paso para desarrollar un análisis de riesgo que garantice un manejo adecuado de la bioseguridad en las estaciones acuícolas.