Principles of digital professionalism for the metaverse in healthcare.

BACKGROUND: Experts are currently investigating the potential applications of the metaverse in healthcare. The metaverse, a groundbreaking concept that arose in the early 21st century through the fusion of virtual reality and augmented reality technologies, holds promise for transforming healthcare delivery. Alongside its implementation, the issue of digital professionalism in healthcare must be addressed. Digital professionalism refers to the knowledge and skills required by healthcare specialists to navigate digital technologies effectively and ethically. This study aims to identify the core principles of digital professionalism for the use of metaverse in healthcare. METHOD: This study utilized a qualitative design and collected data through semi-structured online interviews with 20 medical information and health informatics specialists from various countries (USA, UK, Sweden, Netherlands, Poland, Romania, Italy, Iran). Data analysis was conducted using the open coding method, wherein concepts (codes) related to the themes of digital professionalism for the metaverse in healthcare were assigned to the data. The analysis was performed using the MAXQDA software (VER BI GmbH, Berlin, Germany). RESULTS: The study revealed ten fundamental principles of digital professionalism for the metaverse in healthcare: Privacy and Security, Informed Consent, Trust and Integrity, Accessibility and Inclusion, Professional Boundaries, Evidence-Based Practice, Continuous Education and Training, Collaboration and Interoperability, Feedback and Improvement, and Regulatory Compliance. CONCLUSION: As the metaverse continues to expand and integrate itself into various industries, including healthcare, it becomes vital to establish principles of digital professionalism to ensure ethical and responsible practices. Healthcare professionals can uphold these principles to maintain ethical standards, safeguard patient privacy, and deliver effective care within the metaverse.

Factor VII R353Q (rs6046), FGA A6534G (rs6050), and FGG C10034T (rs2066865) Gene Polymorphisms and Risk of Recurrent Pregnancy Loss in Iranian Women.

Recurrent pregnancy loss is a multi factorial and heterogeneous disorder defined as two or more consecutive pregnancy losses before 20 weeks' gestation. Gene polymorphisms including factor VII R353Q (rs6046), fibrinogen alpha chain A6534G (rs6050) and fibrinogen gamma chain C10034T (rs2066865) have potential role in thrombophilia and the relation between these three polymorphisms and an increased risk of venous thrombosis have been reported. As thrombophilia is associated with a considerable proportion of pregnancy loss and the association between these gene polymorphisms and recurrent pregnancy loss remains controversial, the aim of the present study was to evaluate the relation of these polymorphisms and recurrent pregnancy loss in Iranian women. A total of 144 women with a history of two or more consecutive miscarriages as the patient group and 150 healthy women with two live births and no history of pregnancy loss as the control group were included in the study. Polymerase chain reaction and restriction fragment length polymorphism were used for genotyping. The results were validated by DNA sequencing. The SPSS, SNPStats and Finch TV were used to analyze the results. Factor VII R353Q (rs6046) gene polymorphism showed a significant difference between RPL patients and the control group according to multiple logistic regression models [codominant (OR=0.38; 95% CI=0.23-0.63, P≤0.0001), dominant (OR=0.32; 95% CI=0.20-0.52, P≤0.0001), over dominant (OR=0.46; 95% CI=0.29-0.75, P=0.0017) and log-additive (OR=0.35; 95% CI=0.23-0.53, P≤0.0001)]. Fibrinogen alpha chain A6534G (rs6050) and fibrinogen gamma chain C10034T (rs2066865) gene polymorphisms showed no correlation with recurrent pregnancy loss. Factor VII R353Q (rs6046) gene polymorphism can be considered a risk factor for recurrent pregnancy loss. Further studies in larger populations are needed to confirm the findings.

Smart city healthcare delivery innovations: a systematic review of essential technologies and indicators for developing nations.

BACKGROUND: In recent times, the concept of smart cities has gained remarkable traction globally, driven by the increasing interest in employing technology to address various urban challenges, particularly in the healthcare domain. Smart cities are proving to be transformative, utilizing an extensive array of technological tools and processes to improve healthcare accessibility, optimize patient outcomes, reduce costs, and enhance overall efficiency. METHODS: This article delves into the profound impact of smart cities on the healthcare landscape and discusses its potential implications for the future of healthcare delivery. Moreover, the study explores the necessary infrastructure required for developing countries to establish smart cities capable of providing intelligent health and care services. To ensure a comprehensive analysis, we employed a well-structured search strategy across esteemed databases, including PubMed, OVID, EMBASE, Web of Science, and Scopus. The search scope encompassed articles published up to November 2022, resulting in a meticulous review of 22 relevant articles. RESULTS: Our findings provide compelling evidence of the pivotal role that smart city technology plays in elevating healthcare delivery, forging a path towards improved accessibility, efficiency, and quality of care for communities worldwide. By harnessing the power of data analytics, Internet of Things (IoT) sensors, and mobile applications, smart cities are driving real-time health monitoring, early disease detection, and personalized treatment approaches. CONCLUSION: Smart cities possess the transformative potential to reshape healthcare practices, providing developing nations with invaluable opportunities to establish intelligent and adaptable healthcare systems customized to their distinct requirements and limitations. Moreover, the implementation of smart healthcare systems in developing nations can lead to enhanced healthcare accessibility and affordability, as the integration of technology can optimize resource allocation and improve the overall efficiency of healthcare services. It also may help alleviate the burden on overburdened healthcare facilities by streamlining patient care processes and reducing wait times, ensuring that medical attention reaches those in need more swiftly.

Comparison of pain catastrophizing and anxiety in patients with dyspareunia and healthy women: a cross-sectional study.

Despite the prominent role of cognitive-affective variables, such as pain catastrophizing and anxiety in chronic pain, little is known about their relationship with dyspareunia. This study compared pain-catastrophizing and anxiety in reproductive-aged women with and without dyspareunia. A controlled cross-sectional study was conducted on 398 married women in Iran selected by convenience sampling. Sampling was performed both online and in person. Data were collected using a checklist designed for the study, including background characteristics, self-reported dyspareunia, and two standard questionnaires: the Pain Catastrophizing Scale (PCS) and the Spielberger State-Trait Anxiety Inventory-6 (STAI-6). Results showed that 49.5% of the women reported dyspareunia in the previous six months, with a reduced figure of 42% and 31% when using more specific criteria for dyspareunia. Women with dyspareunia had significantly higher scores for pain catastrophizing and anxiety than the control group without dyspareunia. Pain-catastrophizing was associated with aversion to genital contact and body image dissatisfaction. Anxiety was correlated with age, marriage duration, and sexual abuse. Managing anxiety and catastrophizing thoughts may help dyspareunia patients better cope with pain.

Effectiveness of a self-management mobile app on the quality of life of women with breast cancer: a study in a developing country.

BACKGROUND: Self-management involves taking responsibility for personal health and taking the initiative to do so. This can be accomplished by learning information and skills that will help consider the difficulties may encounter during and after cancer treatment. With this perspective, we have aimed to develop a self-management mobile app for women with breast cancer in Iran and evaluate its impact on the quality of life of patients. METHOD: This study is a methodological study in 2021. We developed the app during three phases. The first phase aimed at identifying educational content and designing user experience, the second phase aimed at developing and implementing the app, and the third phase aimed at evaluating pre-and post-implementation. RESULT: In this study, an Android app for self-management women with breast cancer was developed. According to the results of the pre-and post-implementations among the most significant changes were in the quality of life level, highest respectively: social avoidance (Pre: 6.41-Post: 3.56), negative feelings (Pre: 5.93 - Post: 3.40), sexual function (Pre: 6.80 - Post: 5.04), sexual interest (Pre: 6.41 - Post: 4.75) and pain (Pre: 6.37 - Post: 4.97). And least the changes respectively: distress-family (Pre: 7 - Post: 7), distress-recurrence (Pre: 4.49 - Post: 4.38), benefits (Pre: 2.47 - Post: 3.12), appearance (Pre: 4.10 - Post: 3.32). Also, we calculated the usability evaluation of this app with the system usability scale (SUS); the overall rating score was 83/100, an excellent level (> 80.3), and a grade A. CONCLUSION: The study shows that a breast cancer self-management app can support and improve the quality of life of women with breast cancer. We conducted this study to show that by developing a self-management app, women with breast cancer can improve their quality of life, - by increasing their self-management skills.

Development of a Mobile App for Self-Care Against COVID-19 Using the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) Model: Methodological Study.

BACKGROUND: Mobile apps have been shown to play an important role in the management, care, and prevention of infectious diseases. Thus, skills for self-care-one of the most effective ways to prevent illness-can be improved through mobile health apps. OBJECTIVE: This study aimed to design, develop, and evaluate an educational mobile-based self-care app in order to help the self-prevention of COVID-19 in underdeveloped countries. We intended the app to be easy to use, quick, and inexpensive. METHODS: In 2020 and 2021, we conducted a methodological study. Using the ADDIE (analysis, design, development, implementation, and evaluation) educational model, we developed a self-care management mobile app. According to the ADDIE model, an effective training and performance support tool is built through the 5 phases that comprise its name. There were 27 participants who conducted 2 evaluations of the mobile app's usability and impact using the mobile health app usability and self-care inventory scales. The study design included pre- and posttesting. RESULTS: An Android app called MyShield was developed. The results of pre- and posttests showed that on a scale from 0 to 5, MyShield scored a performance average of 4.17 in the physical health dimension and an average of 3.88 in the mental well-being dimension, thereby showing positive effects on self-care skills. MyShield scored highly on the "interface and satisfaction," "ease of use," and "usefulness" components. CONCLUSIONS: MyShield facilitates learning self-care skills at home, even during quarantine, increasing acquisition of information. Given its low development cost and the ADDIE educational design on which it is based, the app can be helpful in underdeveloped countries. Thus, low-income countries-often lacking other tools-can use the app as an effective tool for fighting COVID-19, if it becomes a standard mobile app recommended by the government.

Do high-mobility group box 1 gene polymorphisms affect the incidence of differentiation syndrome in acute promyelocytic leukemia?

BACKGROUND: Differentiation syndrome (DS) is an inflammatory complication seen in some patients with acute promyelocytic leukemia (APL) undergoing differentiation therapy with all-trans retinoic acid (ATRA) and/or arsenic trioxide (ATO). It is unknown how DS occurs, but it is believed that it is caused by inflammatory cytokines release from differentiating leukemic cells. High mobility group box-1 (HMGB1) is a DNA-binding protein that acts as a cytokine outside of cells and may play a role in inflammation. This study was conducted to determine whether HMGB1 polymorphisms (rs1360485, rs2249825 and rs1060348) are associated with the incidence of differentiation syndrome in acute promyelocytic leukemia patients treated with all-trans retinoic acid and arsenic trioxide. METHODS: One hundred and thirty APL patients and 100 healthy controls were included. Seventeen patients with differentiation syndrome were selected according to the PETHEMA criteria. Tetra-primer ARMS polymerase chain reaction (tetra-ARMS PCR) was used to determine the genotype distribution of polymorphisms. DNA sequencing was done to validate the results. RESULTS: In both healthy and APL patients, AA was the most frequent genotype in rs1360485 followed by AG and GG. CC, CG, and GG were the most frequent genotypes in rs2249825 polymorphism in the order mentioned. CC was more frequent than CT, and CT was more frequent than TT in rs1060348. There was no correlation between HMGB1 polymorphisms and the incidence of differentiation syndrome based on genetic models (p-value > 0.05). CONCLUSIONS: HMGB1 polymorphisms are not probably associated with DS development in APL patients treated with ATRA and ATO.

Mobile-Based Self-Care Application for COVID-19: Development Process Using the ADDIE Model.

During the COVID-19 era, technology-enhanced protection of this disease has saved lives in developed countries in which citizens have the privilege of accessing and using such technologies to fight Coronavirus. In the undeveloped countries, on the other hand, citizens have had no accession or ability to use digital technologies to prevent COVID-19. Having this in front, in the MyShield research project, we aim to address how to teach self-care skills in undeveloped countries in the era of COVID-19 using a mobile low-cost application effectively based on a standard educational model (ADDIE). This paper reports a framework that arises from the results of semi-structured interviews and online workshops conducted in the ADDIE design process for the self-care mobile application. The specialists contributed to indicte the appropriate content for teaching self-care skills while informants contributed to optimize the user experience flow.

MDA Framework for FAIR Principles.

This paper shows that the MDA framework can be helpful for designing and implementing FAIR principles. We reached this conclusion based on a focus group interview with six experts, during which we focused on the three MDA components: mechanics, dynamics and aesthetics.

Evaluation of Mobile Phone Healthcare Applications During the Covid-19 Pandemic.

Our aim in the present study was to evaluate the HealthBuddy+ smartphone app, designed and implemented by the World Health Organization for the European region. For this purpose, we have used Heuristic evaluation method. The tools utilized in this study included 10 heuristics and measure System Usability Scale (SUS), as well as Nielsen's five-point Severity Ranking Scale.

The impact of ICAM-1, CCL2 and TGM2 gene polymorphisms on differentiation syndrome in acute promyelocytic leukemia.

BACKGROUND: Although arsenic trioxide (ATO) and all-trans retinoic acid (ATRA) are well-tolerated and effective treatments for Acute Promyelocytic Leukemia (APL), Differentiation Syndrome (DS) is a lethal side effect in some patients. The pathogenesis of DS is complex and not well understood; however, it is considered as an inflammatory response due to cytokines release of differentiated cells. Moreover, adhesion molecules that are widely expressed on the surface of differentiated cells and gene expression changes of transglutaminase2 (TGM2) are mechanisms involved in the development of DS. The purpose of this study was to assess the association of single nucleotide polymorphisms (SNP) of Intercellular Adhesion Molecule-1 (ICAM-1), chemokine (C-C motif) ligand 2 (CCL2) and TGM2 as inflammatory factors with differentiation syndrome susceptibility. METHODS: DNA was extracted from 133 APL patients and 100 normal controls. Assessment according to the PETHEMA criteria revealed that 13.5% of these patients experienced differentiation syndrome. Tetra-ARMS PCR and PCR-RFLP were done to amplify DNA fragments in APL patients with and without DS. Then DNA sequencing was done to validate the results. SNPStats, SPSS and Finch TV were used to analyze the results. RESULTS: A significant correlation was found between rs4811528 in the TGM2 gene and differentiation syndrome susceptibility (P = 0.002, 95% CI = 1.74-18.81, OR = 5.72) while rs5498 in ICAM-1, rs1024611 in CCL2, and rs7270785 in TGM2 genes showed no correlation with differentiation syndrome. The G allele of rs7270785 and rs4811528 showed a haplotypic association with differentiation syndrome (P = 0.03, 95% CI = 1.13-13.86, OR = 3.96). CONCLUSIONS: AA genotype of the TGM2 SNP (rs4811528) may be a risk factor for development of DS in patients with APL following the use of ATRA/ATO.

[Health for refugees - the Bremen model]. / Gesundheit für Flüchtlinge - das Bremer Modell.

The Bremen model recognizes that refugee health care has to go beyond merely checking for the prevalence of contagious diseases. Elementary health care offered in the reception centre and transitory facilities is based on voluntary acceptance by the refugees. At the same time, legal requirements for the medical reception of refugees are observed. In addition, doctors performing the initial medical examination are enabled to cover acute care on the spot. During the preliminary phase of immigration refugees are allowed to see a doctor in their facility repeatedly. After a certain time, they are provided with a health card permitting limited access to regular care outside of their facility. The current rise of refugee numbers affects the situation of Bremen health care for adult as well as juvenile refugees. In spite of the increase, health care standards are maintained by means of the health card. From 2011 to 2014, "Factors influencing health status and contact with health services" averaged 29.6 % in the health check data. Diseases of the respiratory system (18.1 %) and "symptoms, signs and abnormal findings not elsewhere classified" (16.9 %) ranked second and third, respectively. Diseases of the digestive system (6.1 %) of the musculoskeletal system (6 %) and of the skin and subcutaneous tissue (3.6 %) followed. Infectious diseases such as HIV infections, hepatitis or tuberculosis were seldom.

Clinical evaluation of fiber-reinforced composite crowns in pulp-treated primary molars: 12-month results.

OBJECTIVE: The aim of this study was to evaluate the clinical performance of tooth-colored fiber-reinforced composite (FRC) crowns in pulp-treated second primary mandibular teeth. MATERIALS AND METHODS: This split-mouth randomized, clinical trial performed on 67 children between 3 and 6 years with two primary mandibular second molars requiring pulp treatment. After pulp therapy, the teeth were randomly assigned to stainless steel crown (SSC) or FRC crown groups. Modified United States Public Health Service criteria were used to evaluate marginal integrity, marginal discoloration, and secondary caries in FRC crowns at intervals of 3, 6, and 12 months. Retention rate and gingival health were also compared between the two groups. The data were analyzed using Friedman, Cochran, and McNemar's tests at a significance level of 0.05. RESULTS: Intact marginal integrity in FRC crowns at 3, 6, and 12 months were 93.2%, 94.8%, and 94.2%, respectively. Marginal discoloration and secondary caries were not found at any of the FRC crowns. The retention rates of the FRC crowns were 100%, 98.3%, and 89.7% at 3, 6 and 12 months, respectively, whereas all the SSCs were found to be present and intact after 12 months (P = 0.016). There was no statistically significant difference between the two groups in gingival health. CONCLUSION: According to the results of this study, it seems that when esthetics is a concern, in cooperative patients with good oral hygiene, FRC crowns can be considered as a valuable procedure.

Evaluation of Salivary Streptococcus mutans and Dental Caries in Children with Heart Diseases.

Background and aims . In the presence of certain systemic diseases, oral microflora may aggravate the condition of the disease. Microbial population in the oral cavity especially with heart disease can increase the risk of bacterial endocarditis. The aim of this study was to evaluate the rate of oral Streptococcus mutansand the rate of caries in children suffering from heart disease. Materials and methods. In this cross-sectional research, 66 children with congenital or acquired heart disease and 50 healthy children were selected. Children were orally examined and decayed, missing, and filled teeth (DMFT) index was recorded for each subject. Saliva samples were taken from all subjects, and cultured on a special laboratory media and another specific media for S. mutans (sorbitoll +manitol). Bacterial counts were recorded, and for statistical analysis, chi square, Pearson's, and Exact Fisher tests were performed using SPSS 16 software. Results. The rate of S. mutans in children with congenital heart disease was significantly higher than the rates in childrenwith acquired heart disease and healthy control subjects. The mean DMFT in children with acquired heart disease who tookpenicillin as prophylaxis monthly was significantly lower than the other groups. Conclusion . The results revealed lower oral bacteria counts and comparatively lower caries rates in children with heart diseases, probably because of an effect of the regular prophylactic antibiotic regimen.

Content analysis of Islamic Republic of Iran television food advertising related to oral health: appeals and performance methods.

BACKGROUND: Today, electronic mass media such as television (TV), influence behavioral patterns of their audiences. This study aimed to evaluate what messages on food advertisements related to oral health were transmitted (appeals) and how they were transferred (performance methods & artistic techniques) in Islamic Republic of Iran Broadcasting (IRIB). METHODS: In this cross sectional study, broadcasted advertisements on 4 important channels of Iran TV were recorded for a week from 8 am to 12 pm in 2012. The content and volume of food advertisements were investigated using a researcher-made check list. Advertisement group (food, non-food), food group (non-cariogenic, cariogenic), advertisement appeals (rational, emotional, and humor content), advertisement performance methods (hard-sell, soft-sell, presenting confirmation of Ministry of Health and Medical Education), and artistic technique were assessed. For variable comparison in groups a chi squared test and t-tests were used via SPSS software. RESULTS: Frequency of food advertisements (14.9%) were less than non-food advertising. Non-cariogenic food advertisements had higher frequency (12.09% (compared to cariogenic food (2.8%(. Rational appeal in advertising of non-cariogenic food had the most frequency (64.9%). In contrast emotional appeal for cariogenic food was used more frequently (85.5%). For cariogenic foods, a soft-sell approach was used more frequently (95.5%). The most common artistic technique used in food advertising was music. Chemical and mechanical dental plaque control materials had a very low frequency (0.2%). CONCLUSIONS: Advertising of cariogenic foods in Iran TV has low frequency.

Assessment of educational criteria in academic promotion: Perspectives of faculty members of medical sciences universities in Iran.

INTRODUCTION: One of the important criteria in the promotion of faculty members is in the scope of their educational roles and duties. The purpose of this study was the assessment of reasonability and attainability of educational criteria for scientific rank promotion from the perspective of the faculty members of Medical Sciences Universities in Iran. MATERIALS AND METHODS: This descriptive study was conducted in 2011 in 13 Universities of Medical Sciences in Iran. Through stratified sampling method, 350 faculty members were recruited. A questionnaire developed by the researchers was used to investigate the reasonability and attainability of educational criteria with scores from 1 to 5. The self-administered questionnaire was distributed and collected at each university. The mean and standard deviation of reasonability and attainability scores were calculated and reported by using the SPSS software version 16. RESULTS: Faculty members considered many criteria of educational activities reasonable and available (with a mean score of more than 3). The highest reasonability and attainability have been obtained by the quantity and quality of teaching with the mean scores (3.93 ± 1.15 and 3.82 ± 1.17) and (3.9 ± 1.22 and 4.13 ± 1.06) out of five, respectively. The mean and standard deviation of total scores of reasonability of educational activities were 50.91 ± 14.22 and its attainability was 60.3 ± 13.72 from the total score of 90. DISCUSSION AND CONCLUSION: The faculty members of the Universities of Medical Sciences in Iran considered the educational criteria of promotion moderately reasonable and achievable. It is recommended to revise these criteria and adapt them according to the mission and special conditions of medical universities. Furthermore, providing feedback of evaluations, running educational researches, and implementing faculty development programs are suggested.

Association between Asthma and Body Mass Index in Children.

Obesity has been reported to be associated with an increase in asthma in children. If there is any association, it could be attributed to an effect of obesity on lung volume and thus airway's obstruction. Data from 2413 children aged 7-12 years in Isfahan were analyzed. The subjects were included in this study if data were available for: height, weight, age, lung volume, and any measure of asthma, including history of diagnosed asthma, wheeze, chronic cough, and medication as obtained by questionnaire. Body mass index (BMI) percentiles, divided into quintiles per year age, were used as a measure of standardized weight.After adjusting for, sex, age, smoking and family history, BMI was a significant risk factor for wheeze ever (p = 0.000) and asthma ever (p = 0.000), diagnosed asthma (P=0.000) and current asthma (p = 0.000). There was no significant correlation between BMI and obstructive spirometry. Increased BMI was significantly associated with an increased airway resistance.Despite the fact that higher BMI is a risk factor for, wheeze ever, wheeze and dyspnea in the last 12 months, and diagnosed asthma, higher BMI is not a risk factor for obstructive pattern in pulmonary function test.