Search

Background and aims: Public health policies and programs should be adapted to the level of public trust in the healthcare system, as an indicator of the public support level. Accordingly, the data about public trust level in the healthcare system is considered as a critical requirement for managing public health crises. This study aimed to rapidly assess the public trust in the healthcare system during the COVID-19 epidemic in Iran, as well as to evaluate the effect of socioeconomic status (SES) on this trust.Methods: This cross-sectional and web-based study which was conducted in Iran during the COVID-19 epidemic included adults aged 18-60 years. A probability proportional to size multistage random sampling was applied and performed in 15 provinces of the country. Data on the main sources of information about COVID-19, trust in healthcare system, fear level of COVID-19, and demographics were collected via an electronic questionnaire. Multiple linear regression was applied, and adjusted regression coefficients and 95% confidence intervals (CIs) were estimated.Results: A total of 5250 adults (response rate: 76%) were included in the study. The mean of reported trust scores was 50.3 ± 22.8, and that of fear scores was 72.0 ± 17.8. The highest (65%) and lowest (28%) levels of trust were observed among participants from the lowest and highest SES, respectively. Gender (male) (P = 0.006), higher levels of education (P < 0.001), higher socio-economic status (P < 0.001), and higher fear scores (P < 0.001) were independently correlated with the lower level of ⦰ trust in healthcare system.Conclusion: It was found that the public trust in Iran’s healthcare system was not high enough at the time of the COVID-19 epidemic in the country, especially among higher social class population.

Background: Road traffic crashes’ (RTCs) multidimensional nature has piqued the interest of officials all around the world for many years. Vision Zero is one of the most innovative approaches to road safety. Vision Zero is a government initiative aimed at reducing RTC-related deaths and serious injuries. To effectively apply this approach in Iran, it is required to first identify the obstacles to execution. Therefore, the purpose of this study was to examine the obstacles to Vision Zero implementation in Iran.Methods: The qualitative content analysis method was used in this investigation. The participants were chosen using purposive, snowball, and maximum variety sampling methods. Data were collected through face-to-face interviews. Graneheim and Lundman’s method was used to analyze data using the content analysis method.Results: There were 16 interviews with 14 participants in this study. The data were organized into four main categories and 13 sub-categories to determine the obstacles to implementing Vision Zero. Managerial and administrative obstacles, as well as supportive, cultural, and social, and transportation design and development challenges, were the main categories.Conclusion: In Iran, implementing Vision Zero necessitates the establishment of a lead agency that considers administrative and managerial, supportive and logistic, socio-cultural, transportation design and development, and infrastructure components. In addition, Vision Zero implementation and road safety improvement would require political commitment and support from the government and society. Vision Zero implementation and road safety management must take into account the ethics and value of human life.

Background: Worldwide, prisoners are more at risk of being infected by human immunodeficiency virus (HIV) as well as hepatitis C and B in comparison with other risk groups. The combination of acquired immune deficiency syndrome (AIDS), addiction and prison are factors that threaten the health of our society. Influence of risky behaviors is so common on transmission of AIDS into prisoners’ bodies. This study used available information and reports to investigate the prevalence of HIV in Iranian prisons.Methods: The following review of documents available in national and foreign databases, a total of 26 studies were investigated and required information was extracted from both the full papers and abstracts.Findings: The selected studies differed methodologically in their sampling method and data collection tools. Within the 26 studies analyzed, there was a combined study cohort of 39707 people in whom HIV prevalence varied between 0% and 24.40%.Conclusion: In this study, HIV prevalence ranged widely among the prisoners, and in most of these studies, the rate in Iran was higher than that of other countries. The prevalence of disease was highest among intravenous drug users. Unless proper preventive and control plans among risk groups such as prisoners are not implemented in a timely and suitable manner, the risk of infection in the broader society will increase.

Background: Various strategies have been applied to improve the response to hepatitis B virus (HBV) vaccination in hemodialysis patients. Objectives: The present study was under taken to compare the seroconversion rate of hemodialysis patients who had not respond to 3 intramuscular (IM) doses (40 μg each) of HBV vaccine , after a fourth IM dose (40 μg) of HBV vaccine that was administered alone or with subcutaneous granulocyte-colony stimulating factor (G-CSF) (5 μg/kg). Patients and Methods: Twenty six hemodialysis patients who had not responded to 3 IM injections of HBV vaccine were randomized into 2 groups: Group 1 received a booster dose of 40 μg HBV vaccine IM, group 2 received a booster dose of 40 μg HBV vaccine IM plus 5 μg/kg subcutaneous G-CSF. Antibody to hepatitis B surface antigen was measured 1 month after the booster dose. Results: Seroconversion rate in group 1 was 40%. There was a trend towards a higher seroconversion rate at 60% in group 2 patients; however, because of the small number of patients it did not reach statistical significance. Conclusions: Larger number of patients and other innovative strategies should be applied for vaccination of this group of patients. More prolonged follow up of the patients is needed to evaluate the duration of protection induced by each method of vaccination.

Abstract Background The regulation of the circadian clock genes, which coordinate the activity of the immune system, is disturbed in inflammatory bowel disease (IBD). Emerging evidence suggests that butyrate, a short-chain fatty acid produced by the gut microbiota is involved in the regulation of inflammatory responses as well as circadian-clock genes. This study was conducted to investigate the effects of sodium-butyrate supplementation on the expression of circadian-clock genes, inflammation, sleep and life quality in active ulcerative colitis (UC) patients. Methods In the current randomized placebo-controlled trial, 36 active UC patients were randomly divided to receive sodium-butyrate (600 mg/kg) or placebo for 12-weeks. In this study the expression of circadian clock genes (CRY1, CRY2, PER1, PER2, BMAl1 and CLOCK) were assessed by real time polymerase chain reaction (qPCR) in whole blood. Gene expression changes were presented as fold changes in expression (2^-ΔΔCT) relative to the baseline. The faecal calprotectin and serum level of high-sensitivity C-reactive protein (hs-CRP) were assessed by enzyme-linked immunosorbent assay method (ELIZA). Moreover, the sleep quality and IBD quality of life (QoL) were assessed by Pittsburgh sleep quality index (PSQI) and inflammatory bowel disease questionnaire-9 (IBDQ-9) respectively before and after the intervention. Results The results showed that sodium-butyrate supplementation in comparison with placebo significantly decreased the level of calprotectin (-133.82 ± 155.62 vs. 51.58 ± 95.57, P-value

Abstract Background The utilization of complementary and alternative medicine (CAM) is experiencing a global surge, accompanied by the adoption of national CAM policies in numerous countries. Traditional Persian medicine (TPM) is highly used as CAM in Iran, and the ongoing scientific evaluation of its interventions and the implementation of evidence-based medicine (EBM) encounters various barriers. Therefore, comprehending the characteristics and interactions of stakeholders is pivotal in advancing EBM within TPM policies. In this study, we utilized both classical stakeholder analysis and social network analysis to identify key stakeholders and potential communication patterns, thereby promoting EBM in TPM policy-making. Methods A cross-sectional nationwide stakeholder analysis was conducted in 2023 using snowball sampling. The interviews were carried out using a customized version of the six building blocks of health. Data were collected through semi-structured interviews. Stakeholders were assessed based on five factors (power, interest, influence, position, and competency). The connections and structure of the network were analyzed using degree, betweenness, closeness centrality, and modularity index to detect clusters of smaller networks. Results Among twenty-three identified stakeholders, the Ministry of Health and Medical Education (MOHME) and the Public were the most powerful and influential. The Iranian Academy of Medical Sciences was the most competent stakeholder. Social network analysis revealed a low density of connections among stakeholders. Pharmaceutical companies were identified as key connectors in the network, while the Public, supreme governmental bodies, and guilds acted as gatekeepers or brokers. The MOHME and Maraji were found to be high-ranking stakeholders based on four different centrality measures. Conclusion This study identifies powerful stakeholders in the network and emphasizes the need to engage uninterested yet significant stakeholders. Recommendations include improving competence through education, strengthening international relations, and fostering stronger relationships. Engaging key connectors and gatekeepers is essential for bridging gaps in the network.

Background: Population aging and more prevalent westernized lifestyle would be expected to result in a markedly rising burden of colorectal cancer (CRC) in the future years. The aim of this study is to estimate the limited-time prevalence of CRC in Iran between 2015 and 2020. Materials and Methods: Aggregated CRC incidence data were extracted from the Iranian national cancer registry (IR.NCR) reports for 2003–2009 and from GLOBOCAN-2012 database for 2012. Incidence trends were analyzed by age groups, genders, histopathologic, and topographic subtypes to estimate annual percentage changes. Incidence was projected for 2020. The prevalence was estimated applying an adopted version of a previously introduced equation to estimate limited–time prevalence based on the incidence and survival data. Monte Carlo sensitivity analyses were applied to estimate 95% uncertainty levels (ULs). In each scenario, incidence, survival, annual percentage changes, and completeness of case ascertainment at IR.NCR were replaced under pre-assumed distributions. Results: Number of estimated within 1, 2-3 and 4-5-year CRC patients in 2015 were 13676 (95% UL: 10051–18807), 20964 (15835–28268), and 14485 (11188–19293), respectively. Estimated 5-year prevalence for 2020 (99463; 75150–134744) was 2.03 times of that for 2015. Highest 5-year prevalence was estimated in ages 55–59 for females and 75 + for males. Adenocarcinoma (41376; 31227 55898) was the most prevalent histologic subtype. The most prevalent tumor location was colon (30822, 23262–41638). Conclusion: A substantial growth in the prevalence of CRC survivors is highly expected for future years in Iran. Establishment of specialized institutes is highly recommended to provide medical and especially social supports for Iranian CRC survivors.

IntroductionJustice, a multifaceted concept, encompasses a spectrum of theoretical and societal constructs. While often perceived as a self-evident and assumed notion, justice simultaneously presents a complex and challenging dimension in our society. Medical education stands as a domain where the principles of justice find nuanced expression. The experiences of medical students during their university journey offer valuable insights into their comprehension and conceptualization of justice, particularly as members of the social elite. This study embarked on an exploration and analysis of perceptions and experiences of justice within the context of medical education, encompassing perspectives from students, professors, and medical education officials. Materials and MethodsThis qualitative study was conducted in 2022 to investigate perceptions and experiences of justice in medical education in Iran. The focus was on medical sciences at universities across the nation. Participants were selected from universities affiliated with the Ministry of Health and Medical Education (MOHME), institutions that play a pivotal role in medical education in Iran. Adhering to qualitative research principles, 29 semi-structured interviews were conducted with professors, students, and teaching assistants in the universities of medical sciences. The interviews aimed to delve into their perspectives on justice within the medical education landscape. After transcribing the interviews, the data were subjected to thematic analysis, a systematic method for identifying patterns and themes within the collected data. Discussion of Results and ConclusionThe study findings revealed that injustice permeated the medical education landscape, manifesting even before individuals embarked on their medical careers. The current entrance exam system, despite its intention to ensure fairness, disproportionately would favor individuals from higher socioeconomic backgrounds, perpetuating inequalities among diverse social groups. This suggested that the pursuit of medical education remained largely confined to the privileged elite. Within the medical education system itself, a complex web of injustices intertwined, often leaving students feeling a sense of unfairness. Enrollment practices, including various quota systems, were identified as sources of discontent and dissatisfaction. Furthermore, the students from privileged backgrounds enjoyed an advantage due to their superior personal and social circumstances. They were less concerned about their future job prospects, sometimes capitalizing on hidden or unreported income and securing more favorable post-graduation opportunities.The thematic analysis identified three overarching themes: unequal structures, commodity society, and unfair policies. The findings suggested that within the framework of a commodity-driven, capitalist society, even well-intentioned policies aimed at promoting educational justice could inadvertently contribute to perpetuating unfairness. This highlighted the insidious nature of inequality and commodification, transforming seemingly fair practices into unjust outcomes.Despite policymakers' efforts to foster justice in medical education, the prevailing context of inequality and commodification undermined these intentions. Ultimately, the study underscored the need for a comprehensive approach that addressed both the structural inequities and pervasive commodification of education. Only by addressing these root causes could we create a more just and equitable medical education system that truly reflected the ideals of meritocracy and fairness.Despite the intentions of policymakers to promote educational equity in the medical field, the prevalent context of commodification and inequality rendered these policies ineffective and potentially unjust. The practical implementation of these policies often fell short and their outcomes could exacerbate the existing inequities.To address these challenges, there was a need for adaptable social policies that could evolve alongside social changes. This necessitated a dynamic and up-to-date approach to social policy formulation. A fair distribution of job opportunities and proportional rewards was crucial to ensure that talent was not solely driven by material aspirations but rather fostered and channeled towards self-improvement and societal advancement.Moreover, there was a pressing need for theoretical clarification of the concept of justice. While the notion of justice was often taken for granted in Iranian society and among policymakers, its complexities demanded a thorough examination. The foundational principles of justice and their underlying theories required further development, discussion, and clarification. The absence of a unified understanding of justice among policymakers highlighted the significance of this theoretical issue. The authors believed it had to be a priority for the academic community.

Despite antiviral treatment, some patients with chronic hepatitis B (CHB) progress to cirrhosis. Enhancement of autophagy was implicated in the proliferation of hepatitis B in hepatocytes. This study aimed to evaluate the potential role of autophagy in the progression of liver fibrosis in patients receiving antiviral treatments and having completely inhibited viral replication. This descriptive-analytical study was designed and conducted in 2020 at Mottahhari Hepatitis Clinic affiliated with Shiraz University of Medical Science (Shiraz, Iran). Patients who were on anti-hepatitis B nucleotide treatments for at least two years, and those who were not cirrhotic at baseline but later progressed to cirrhosis were identified to be included in the case group. Besides, for the control group, patients on the nucleotide regimens who did not have cirrhosis at baseline or during follow-up were randomly selected. Ultimately, 16 cases and 14 controls were included in the study. Data were analyzed using SPSS software, and P

Abstract Introduction Individuals with a migrant background often underutilize physical rehabilitation services (PRS) compared to the host population. This disparity is attributed to various barriers, including limited access to information, language barriers, illiteracy, and cultural factors. To improve PRS utilization by Afghan immigrants and refugees in Iran, it is crucial to identify these barriers and enabling factors. In response, this study explored the barriers and enabling factors for utilizing PRS among Afghan immigrants and refugees with disabilities in Iran. Methods This qualitative study was conducted in Iran between January and March 2023. Participants were selected through convenient and snowball sampling. Individual, semi-structured interviews were carried out both in face-to-face and online formats. Data analysis occurred concurrently with data collection, using the directed content analysis approach. Results Findings from our research indicate that common barriers to PRS utilization among Afghan immigrants and refugees include insufficient insurance coverage, high service costs, expensive transportation and accommodation, limited knowledge about Iran’s health system, inadequate awareness of available supports, restricted access to PRS in remote areas, impatience among PRS providers, fear of arrest and deportation, a lack of trust in modern treatments, stringent immigration rules, high inflation rates limiting the ability to pay for PRS, and limited social support. On the other hand, several enabling factors were identified, such as strengthening insurance coverage, utilizing the capacities of charities and NGOs, providing information about available services, promoting respectful behavior by healthcare providers towards patients, facilitating cultural integration, and increasing immigrants’ awareness of available services and eligibility criteria. Conclusion The barriers and enabling factors uncovered in this study offer valuable insights into the complexities surrounding PRS utilization by Afghan immigrants and refugees with disabilities in Iran. Understanding and addressing these factors is essential for developing targeted interventions and policies that can improve access and utilization, ultimately leading to enhanced health outcomes for this vulnerable population.

Abstract Introduction This study aimed to detect interdisciplinary subjects for integration into the medical education program of Iran. Methods A qualitative-quantitative method was used. Firstly, interdisciplinary subjects demanded by medical graduates and senior medical students were defined by qualitative study. In the second stage, questionnaire was developed which based on the findings of qualitative stage, experts’ opinion and reviewing of the national general guide of professional ethics for medical practitioners. Questionnaire consisted of demographic, occupational and thirteen interdisciplinary items. These items consisted of social determinants of health, social and economic consequences of disease, social prescribing, physicians’ social responsibility, role of gender, racial, ethnic, social and economic issues in approach to patients, role of logic and mathematics in clinical decision-making, philosophy of medicine, maintaining work-life balance, self-anger management, national laws of medicine, religious law in medical practice, health system structure, and teamwork principles. Level and importance of knowledge and self-assessed educational needs were asked about each item. In the third stage, a national online survey was conducted. SPSS 25 was used for statistics. Results By content analysis of data in qualitative stage, 36 sub-themes and 7 themes were extracted. In the quantitative part, 3580 subjects from 41 medical universities across Iran participated in this study. 2896 (80.9%) were medical graduates and 684 (19.1%) were senior medical students. Overall, knowledge about interdisciplinary items was low to intermediate, while high to very high knowledge ranged from maximally 38.7% about socioeconomic consequences of disease to minimally 17.2% about social prescribing. Participants gave the most importance to the having knowledge about self-anger management (88.3%), maintaining work-life balance (87.2%) and social determinants of health (85.8%), respectively. However, national laws of medicine (77.6%), maintaining work-life balance (75.4%) and self-anger management (74%) were the first top three educational demands by participants. Conclusion This study revealed a low to moderate level of knowledge about interdisciplinary topics among both graduated medical physicians and senior medical students. These groups showed a strong demand and tendency to know and to be educated about these topics. These findings underscore the urgency for educational reforms to meet the interdisciplinary needs of medical professionals in Iran.

Background: Several factors may influence oral hygiene behavior, which is essential for oral health and well-being in children. This study aimed to investigate the factors that contribute to the oral hygiene behaviors in children, especially mothers’ oral hygiene behaviors.Methods: In this cross-sectional study, data from the fifth phase of Fars Birth Cohort Study were used. Our focus was on a group of 1143 children aged 9-12 years old in the year 2021. The demographic, socio-economic variables as well as oral hygiene behaviors of children and their mothers were assessed. The score for oral hygiene behavior was determined based on self-reported practices of brushing, flossing, and mouthwash, ranged between 0 and 3. The factors related to children’s oral hygiene behavior were examined by logistic regression analysis.Results: In this study, 345 (30.2%) of the children (50.3% females, average age 10.33±0.48 years) did not brush their teeth, 1042 (91.2%) did not use dental floss, and 1083 (94.8%) did not use mouthwash. The mean score for oral hygiene behavior in children was 0.83±0.67. Mothers had a higher mean score of 1.42±0.74 (P

Abstract Introduction Low back pain (LBP) is a prevalent musculoskeletal disorder with a wide range of etiologies, ranging from self-limiting conditions to life-threatening diseases. Various modalities are available for the diagnosis and management of patients with LBP. However, many of these health services, known as low-value care (LVC), are unnecessary and impose undue financial costs on patients and health systems. The present study aimed to explore the perceptions of service providers regarding the facilitators and barriers to reducing LVC in the management of LBP in Iran. Methods This qualitative descriptive study interviewed a total of 20 participants, including neurosurgeons, physiatrists, orthopedists, and physiotherapists, who were selected through purposive and snowball sampling strategies. The collected data were analyzed using the thematic content analysis approach. Results Thirty-nine sub-themes, with 183 citations, were identified as barriers, and 31 sub-themes, with 120 citations, were defined as facilitators. Facilitators and barriers to reducing LVC for LBP, according to the interviewees, were categorized into five themes, including: (1) individual provider characteristics; (2) individual patient characteristics; (3) social context; (4) organizational context; and (5) economic and political context. The ten most commonly cited barriers included unrealistic tariffs, provider-induced demand, patient distrust, insufficient time allocation, a lack of insurance coverage, a lack of a comprehensive referral system, a lack of teamwork, cultural challenges, a lack of awareness, and defensive medicine. Barriers such as adherence to clinical guidelines, improving the referral system, improving the cultural status of patients, and facilitators such as strengthening teamwork, developing an appropriate provider-patient relationship, improving the cultural status of the public, motivating the patients, considering an individualized approach, establishing a desirable payment mechanism, and raising the medical tariffs were most repeatedly stated by participants. Conclusion This study has pointed out a great number of barriers and facilitators that shape the provision of LVC in the management of LBP in Iran. Therefore, it is essential for relevant stakeholders to consider these findings in order to de-implement LVC interventions in the process of LBP management.

Abstract Background Gastroesophageal Reflux Disease (GERD) is a common chronic condition. Its chronic nature may affect the pattern of medication use. This study aimed to investigate the prevalence, associated factors, and patterns of polypharmacy and medication use among GERD patients in southwestern Iran. Methods We used data from the Pars Cohort Study. We classified drugs using the Anatomical Therapeutic Chemical classification system. The Lexicomp® database was used to assess potential drug-drug interactions. Multivariable Poisson regression was applied. Adjusted prevalence ratio (PR) and its 95% confidence interval (CI) were estimated. Results A total of 9262 participants were included. Among 2,325 patients with GERD, age-standardized prevalence of polypharmacy was 9.5% (95% CI: 7.5%, 11.6%) in males, and 19.3% (95% CI: 17.2%, 21.4%) in females. The PR of experiencing Polypharmacy by GERD patients compared to non-GERD patients was 1.82 (95% CI: 1.61, 2.05%). Multimorbidity (PR: 3.33; CI: 2.66, 4.15), gender (PR: 1.68; CI: 1.30, 2.18), and metabolic syndrome (PR: 1.77; CI: 1.45, 2.15) were associated with polypharmacy among GERD patients. Drugs for acid-related disorders were the most common used drugs among men, women and elders. We found that 13.9%, 4.2%, and 1.1% of GERD patients had type C, D and X drug interactions, respectively. Conclusion GERD is correlated with a higher prevalence of polypharmacy. Among GERD patients, females, those with multi-morbidities, and those with metabolic syndrome may be affected more by polypharmacy. Considering the fairly high rate of interactions identified, a review of the medication list is essential when approaching GERD patients, and physicians must check for medications that may worsen GERD.

Abstract Background and aims Faculty members confront a variety of obstacles over time, the most recent of which is the coronavirus disease 2019 pandemic, which may increase their vulnerability to burnout (BO). This study aims to examine BO in medical school faculties, as well as the factors that lead to BO and well‐being in them. Methods This cross‐sectional study was conducted in 2021 using online questionnaires completed by 222 faculty members of a medical university in Iran. The Maslach Burnout Inventory‐Human Services Survey (MBI‐HSS) and the Well‐being index (WBI) were used. Additionally, we gathered individual‐level profiles (demographic, well‐being) and occupational information (job profile, attitude toward work). Results A total of 60 (27%) faculties reported having high BO, and 112 (50.5%) reported having low well‐being. Being female (odds ratio, OR = 2.69), having time to spend with the family (OR = .26), the intent of turnover (OR = 8.65), job recommendation to the offspring (OR = .26), and experiencing violence last year (OR = 2.97) were some of the individual‐level factors and job‐related attitudes associated with a higher BO. In the neural network for BO, the most important variables were the intention of turnover, followed by adequate family time. Conclusion One third of the responding faculty reported severe BO, and BO was found to be significantly associated with lower well‐being. The increased levels of BO and a decreased experience of well‐being were both associated with a higher intention of turnover. According to the study, it is important to pay attention to both clinical and nonclinical field faculty members, female faculty members, those who have a high workload, and members who have experienced violence in the workplace. By acknowledging the unique challenges and experiences faced by these individuals, tailored measures can be developed to address their specific concerns and foster a supportive and inclusive environment.

Background: Gastrointestinal symptoms are prevalent amongst patients with a confirmed diagnosis of COVID-19 and may be associated with an increased risk of disease severity. This trial aimed to evaluate the efficacy and safety of aniseed (Pimpinella anisum L.) powder as an add-on therapy to standard care for treating gastrointestinal symptoms experienced by adults with an acute SARS-CoV-2 infection.Methods: The study was a randomized parallel-group double-blinded placebo-controlled add-on therapy trial. Adults with an acute SARS-CoV-2 infection who did not require hospitalization and reported at least one gastrointestinal symptom in the preceding 48 h were assigned to either the aniseed or placebo group in a 1:4 ratio. All 225 participants (45 in the aniseed group and 180 in the placebo group) were instructed to use 25 g of powdered aniseed or placebo twice daily for 2 weeks. The primary outcomes were the proportion of patients who experienced an improvement of at least one point in the symptom score after adjusting for age group, gender, and time. Backwards stepwise logistic regression was applied to calculate the risk ratios. The clinical symptoms and adverse events were assessed at the beginning, 1 week later, and at the end of the trial (week two).Results: Participants in the aniseed group were significantly more likely to report symptom improvement for abdominal pain [adjusted risk ratio (RR):0.55; 95% confidence interval (CI): 0.46–0.72], anorexia (RR:0.62; 95% CI: 0.47–0.82), and diarrhea (RR:0.19; 95% CI: 0.12–0.30), but not nausea/vomiting (RR:0.87; 95% CI: 0.71–1.08) or bloating (RR:0.87; 95% CI: 0.72–1.05). Two participants in the aniseed group and three participants in the placebo group reported mild to moderate adverse events.Conclusion: This study showed that 2 weeks of aniseed powder containing trans-anethole (87%–94%) may help improve abdominal pain, anorexia, and diarrhea in COVID-19 patients. The findings align with the known biological, multitargeted activity of P. anisum and trans-anethole, which includes inhibiting SARS-CoV-2 along with other anti-infective, anti-inflammatory, antioxidant, hepatoprotective, and anti-dysbiosis properties. Multicenter trials with larger sample sizes and longer follow-up are warranted to confirm these findings.Clinical Trial Registration: Iranian Registry of Clinical Trials (IRCT20120506009651N3).

Abstract Background and Aims Emotional intelligence (EI) has improved job performance and has been associated with the success of individuals. The interfering role of happiness in this equation is unneglectable; however, this association has not been established in clinical medical students exposed to work pressures and stressful hospital atmospheric. The present perusal was conducted to evaluate the relationship between EI and happiness in clinical medical students. Methods A multicenter cross‐sectional investigation was conducted in Iran from December 2021 to June 2022. Multi‐stage cluster sampling followed by a systematic random selection was applied to choose participants. Data gathering was carried out online by Brief Emotional Intelligence Scale‐10 and Oxford Happiness Questionnaire. Results Data from 405 participants were analyzed. The mean age was 24.2 years; men and women constituted 208 (51.4%) and 197 (48.6%) of all participants. Gamma regression analysis has determined age (Exp (B) = 1.016, p‐value

Abstract Background Maximum willingness to pay (WTP) for a health benefit is related to perceived value. The goal of this study was to find out how much Iranian healthy people would be willing to pay to keep their natural teeth instead of having them pulled. This was done separately for the anterior and posterior teeth. Methods The highest value was posed as an open-ended question in this cross-sectional analysis conducted in 2021. Four distinct scenarios for treating a tooth with a poor prognosis for natural tooth preservation versus extraction were offered. WTP for the preferred treatment option was asked for painful and painless anterior and posterior teeth separately. A two-stage hurdle approach was employed to determine factors influencing the WTP for a hopeless case. The level of significance was fixed at 0.05. Results Out of 795 individuals, 355 (44.7%) were male and 209 (26.3%) had poor self-stated dental health. Over 65% of those interviewed said they wanted to keep their teeth. The mean WTP was highest for dental preservation up to 94 USD and the lowest was for extraction without replacement 19 USD. The WTP for anterior tooth therapy was greater than the WTP for posterior dental care, regardless of treatment type or tooth discomfort. Participants with higher education, jobs, income-to-expenditure matching, older age, preference for the treatment in a private office, and female gender (except for WTP for a painful posterior tooth) were more likely to have a WTP of at least 1 USD. Conclusion The average WTP for treatment of teeth with a poor prognosis was lower than the average fee charged in dental facilities, and more than 65% of participants preferred to keep their teeth. Regardless of the treatment option or whether it was painful or not, WTP for anterior teeth treatment was higher than for posterior teeth. Generally, we found that sociodemographic factors influenced WTP decision-making the most. This study has practical implications for public oral health policymakers and insurance organizations.

The Islamic Republic of Iran provided a national action plan against antimicrobial resistance (NAP/AMR) for 2016-2021. In this study, we have dealt with the background and Iran’s efforts in this way, compare Iran’s NAP/AMR with other international programs, represent efficient policy options, and the evaluation indicators of each purpose of Iran NAP/AMR. The indicators of each group are represented through the consensus of three academic researchers. Finally, our assessment reveals that performing a constant observation is highly required for a prearranged NAP/AMR. The political parties and stakeholders should punctually receive interpretable feedbacks; also, it is very important to conduct periodical assessments with the purpose of perceiving the purpose feasibility and determining the dimensions that require advancements.

The role of patients' empowerment in enhancing the quality of life of chronic patients is undeniable and its importance in health policy making and health care is increasing day by day. However, no guidelines have been defined to empower people with inflammatory bowel disease (IBD). The purpose of this study was to identify the dimensions of IBD patients' empowerment. Semi-structured interviews were conducted with 26 participants who were purposefully selected from 2 IBD clinics in Tehran and Shiraz cities to gain diversity in the clinical and demographic characteristics. The data were analyzed based on the Granheim and Landman's content analysis method. According to the result of this study, the empowerment of IBD patients is composed of five dimensions including self-care, psychological coping with disease, social interaction skills, disease-specific health literacy and self-evaluation. The participants' most emphasis was on self-care and psychological coping dimensions. These findings can be used as a basis for educational interventions toward IBD patients' empowerment. More researches are needed to explore factors affecting the empowerment processes of IBD patients.

Abstract Background Although the main aims of sanctions are the political and economic pressures on governments, literature has demonstrated the harsh effects of sanctions on the general public, especially on the patients, poor and disabled people. Since the international sanctions regime negatively affected almost all dimensions of Iran’s health sector, this qualitative study was conducted to investigate the situation of the physical rehabilitation sector after these sanctions. Methods This qualitative study was conducted from January 2019 to June 2019 in Iran using Skype, telephone, and face-to-face in-depth semi-structured interviews. Purposive and snowball sampling approaches were used to identify the participants. Also, framework analysis approach was applied to analyze the collected data. Results In total, 38 individuals including health policy-maker, faculty member, rehabilitation expert, Physiotherapist, Occupational therapist, and Orthotist/Prosthetist, were involved in the study. Based on our findings, a number of challenges facing the Iranian physical rehabilitation sector during the international sanctions period included: 1) socioeconomic challenges (inadequate funding, rising inflation rate, high unemployment rate, catastrophic expenditures, and inappropriate employment status of practitioners); 2) education challenges (decreased international collaboration and shortage of training devices and materials); 3) international challenges (rising issues in accessing services for patients from neighborhood countries); and 4) service delivery challenges (shortage of raw materials for producing the orthoses and prostheses, hardening of the importing the needed equipment, inappropriate infrastructures, and impossibility to use external assistance). Conclusion After international sanctions, the Iranian physical rehabilitation sector has faced considerable multifaceted challenges. Therefore, the international community must be aware of the situation and be concerned about the irreparable consequences.

Abstract People with disabilities (PWD) are one of the most vulnerable groups in society during armed conflicts. According to the statistics, four million persons with disability live in Yemen. Lack of access and the use of rehabilitation services make PWD unable to retrieve their social and economic roles, which would have substantial negative impacts both on their families and community. The conflict escalation, an increase in the number the of displaced, COVID-19 pandemic, an increase in non-communicable diseases, and the exacerbation of poverty and malnutrition have rapidly enhanced the population at risk of disability in Yemen. Accordingly, effective and comprehensive approaches such as global health diplomacy (GHD) should be considered to meet the emerged needs. GHD seeks to address the common challenges in the global health system by involving all key stakeholders and establishing negotiations and diplomatic dialogue among official actors. Given the presence of various regional and international actors in Yemen and the examples of the successful use of GHD under conflict and post-conflict conditions in Iraq and Afghanistan, the use of diplomacy is crucial to respond to the needs of PWD in this war-torn country appropriately.

Abstract Background Inadequate financing is one of the major barriers in securing equitable access to high-quality physical rehabilitation services, without imposing financial hardship. Despite this, no sufficient attention has been paid to physical rehabilitation services and no specific financial resources have been allocated to such services in many countries including Iran. Owing to the fact that effective decision- and policy-making requires identifying possible stakeholders and actors and their characteristics, in the current study a stakeholder analysis and also a social network analysis (SNA) was conducted to identify the potential stakeholders and also their characteristics involved in physical rehabilitation financing (PRF)-related policies in Iran. Methods The present study was performed in two phases. Firstly, semi-structured interviews and relevant document review were conducted to identify the stakeholders. Then, the position, power, interest, and influence of each stakeholder were determined using a web-based questionnaire. Secondly, SNA approach was utilized to map and visualize the interactions among stakeholders. Results The findings showed that there are different stakeholders in PRF-related decision- and policy-making processes in Iran. In addition, the position, power, interest, and influence level of the identified stakeholders were varied. Moreover, although some stakeholders, like the Ministry of Health and the parliament have the highest level of power and position, they lack sufficient interest to participate in PRF-policies. Furthermore, SNA demonstrated that social network density was low, which indicates the lack of proper collaboration and interaction among the stakeholders. Conclusion As many powerful and influential stakeholders had low interest levels to warrant participate in the FPR-related decision- and policy-making processes in Iran, employing careful and effective strategies, that is ongoing negotiations, receiving advocacy, and making senior managers and policy-makers aware can be helpful.

Abstract Background Changes in the enteric microbiota have been suggested to contribute to gastrointestinal diseases, including irritable bowel syndrome. Most of the published work is on bacterial dysbiosis with meager data on the role of the virome in irritable bowel syndrome and other gastrointestinal diseases. In the current study, we therefore aimed to investigate the viral community composition of the gut and test for potential dysbiosis linked to irritable bowel syndrome. Results A metagenomics analysis on fecal samples of 50 individuals — 30 of whom met the Rome IV criteria for IBS and 20 healthy controls— was conducted. There was a noticeable alteration in viral taxa observed in association with irritable bowel syndrome when compared to healthy individuals — where some eukaryotic viral taxa noticeably prevail over others. We observed a significant decrease in the diversity and abundance of enteric virome particularly in eukaryotic viruses of Megavirales in patients with irritable bowel syndrome. Conclusions These findings shed light on a new hypothesis that the alteration of the viral taxa contributes to the pathogenesis of irritable bowel syndrome and related symptoms, and therefore, pave the way for developing a new diagnostic biomarker or anti-viral drugs for the treatment of irritable bowel syndrome.

Letter to editor

Invasive fungal infections (IFIs) are among the life-threatening issues in patients with impaired immune system. High administration of antifungals in these patients imposes a heavy economic burden on the national health system. In addition, despite the usually expensive antifungal regimens, the mortality rate due to fungal infections is still high, resulting in the loss of hundreds of lives per year. Survival rate is an indicator of the success of national healthcare policies. Early diagnosis of IFI is critical because any delays may be fatal. The weakness of the old-fashioned culture-based diagnostic methods lies in their time-consuming laboratory procedures. To overcome this problem, several diagnostic approaches have been developed to facilitate the early diagnosis of invasive candidiasis as the most prevalent IFI. These methods are based on the detection of serologic and molecular footprints. However, nowadays, antibiotic resistance and proper and cost-effective use of antibiotics are given special attention in national healthcare policies. The instructions for controlling these indices have been collected under the name of antibiotic stewardship. The present review study was targeted toward providing insight into novel diagnostic biomarkers and antifungal stewardship programs. The simultaneous investigation of these two issues facilitates the achievement of a novel health policy for the treatment of systemic candidiasis in immunocompromised patients. Keywords:

Purpose: Traffic injuries are among the leading causes of mortality and morbidity worldwide. Pedestrians have been considered as a high-risk group among road users, especially in middle- or low-income communities. This study attempted to determine the burden of pedestrians' fatalities in Fars, the southern province of Iran using years of life lost (YLL) approach. Methods: The data used in this study were retrieved from Fars Forensic Medicine Organization database on pedestrian traffic accidents. The YLL from 2009 to 2013 was estimated using the method presented by World Health organization. Some epidemiological characteristics of pedestrians' fatalities were analyzed by SPSS. Results: Although YLL among 1000 male pedestrians decreased from 2.5 in 2009 to 1.5 in 2013, it increased from 0.9 to 2.1 among 1000 females during the same period. Higher proportion of death was found in female, illiterate, and married pedestrians (p

Objective: With regard to limitation in national budget, the relevant authorities of healthcare and treatment throughout the globe are seeking the use of available resources in a way that no wastage of money or time—which is, of course, convertible to money—is acceptable. This study sought the opinions of hospital doctors and nurses on those activities at work that wasted their time. Methods: A questionnaire designed to identify activities that waste time during hospital care was completed based on the review of previous studies and including hospital wastes items. The authors designed a questionnaire, which was filled out by 209 nurses and 30 doctors in the surgery wards in hospitals affiliated to Shiraz University of Medical Sciences (SUMS). The items for time wasting activities were extracted from previous studies, and the reliability of the questionnaire was more than 0.785 using Cronbach’s alpha. The response rate was more than 60%. Results: The mean age of the participating nurses and doctors was 30.24 ± 6.85 and 32.77 ± 7.05 years. In all aspects, more time was wasted during the morning and evening shifts in comparison with the night shifts. The activity that was thought to waste time in hospital care the most was paper-based documentation. Preventable wasted time during the shift was 16%–30% in the nurses’ view and 18%–34% in the doctors’ view. For both nurses and doctors, the highest-rated preventable wasted time was related to time spent waiting in ward for lab data responses, transfer of patients, or delivery of care. Conclusion: Hospital working environment is complex, and opportunities for improvement of the efficiency of the nurses’ and doctors’ workload should be analyzed, case by case, in each hospital and work group. Process change (for the decrease in the wasted time for waiting in wards), simple innovative ways (for the decrease in the wasted time for searching the needed equipment), using hospital information system technology for documentation, communication, and the better design of the wards (to decrease the wasted time due to transfer between the ward and restroom) could be helpful for improving efficiency and for a safer and acceptable delivery of care.