Mean cycloplegic refractive error in emmetropic adults – The Tehran Eye Study / Error refractivo ciclopléjico medio en adultos emétropes: estudio ocular de Teherán

Purpose: In children under 20 years, refractive development targets a cycloplegic refractive error of +0.5 to +1.5D, while presbyopes over 40 years generally have non-cycloplegic errors of ≥ +1D. Some papers suggest these periods are separated by a period of myopic refractive error (i.e., ≤ –0.50D), but this remains unclear. Hence, this work investigates the mean cycloplegic refractive error in adults aged between 20 – 40 years. Methods: In 2002 a cross-sectional study with stratified cluster sampling was performed on the population of Tehran, providing cycloplegic and non-cycloplegic refractive error data for the right eyes of 3,576 participants, aged 30.6 ± 18.6 years (range: 1–86 years). After grouping these data into age groups of 5 years, the refractive error histogram of each group was fitted to a Bigaussian function. The mean of the central, emmetropized peak was used to estimate the mean refractive error without the influence of myopia. Results: The mean cycloplegic refractive error at the emmetropized peak decreased from +1.10 ± 0.11D (95 % confidence interval) to +0.50 ± 0.04D before 20 years and remains stable at that value until the age of 50 years. The non-cycloplegic refractive error also sees a stable phase at 0.00 ± 0.04D between 15 – 45 years. After 45 – 50 years both cycloplegic and non-cycloplegic refractive error become more hypermetropic over time, +1.14 ± 0.12D at 75 years. Conclusions: The cycloplegic refractive error in adults is about +0.50D between 20 – 50 years, disproving the existence of the myopic period at those ages.(AU)

The role of internet addiction and academic resilience in predicting the mental health of high school students in Tehran.

BACKGROUND: The World Health Organization defines mental health as a combination of two dimensions: the negative dimension, or negative mental health, which indicates the presence of mental disorders, symptoms, and problems, and the positive dimension, or positive mental health, which includes emotions and positive personal characteristics such as self-esteem, resilience against environmental challenges, a sense of integrity, and self-efficacy. The aim of the present study was to investigate the role of internet addiction and academic resilience in predicting the mental health of high school students in Tehran, Iran. METHOD: The research method employed was a survey. 758 people participated in the study, and the samples consisted of high school students in Tehran during the academic year 2022-2023. The process of collecting information was carried out by distributing the questionnaire link through virtual networks and schools. The research utilized Young's Internet Addiction Test, Samuels' Academic Resilience Inventory, and Goldberg's Mental Health Questionnaire as the research tools. Statistical tests, including Pearson's correlation and multiple regression analysis, were employed to investigate the relationships between variables. RESULT: The effect of internet addiction on mental health (ß=0.39) is negative and significant at the 0.001 level, while the effect of academic resilience on mental health (ß=0.66) is positive and significant at the 0.001 level. These two variables collectively predict 53% of the variance in students' mental health. This indicates that as internet addiction increases among students, their mental health significantly decreases, whereas higher levels of academic resilience correspond to higher mental health. CONCLUSIONS: This study has elucidated the role of internet addiction and academic resilience in predicting the mental health of high school students in Tehran. Given the significance of adolescent mental health, it is imperative for healthcare professionals and other stakeholders to develop intervention and prevention models to address mental health crises and plan for the enhancement of adolescent mental health.

Assessment of the appropriate cutoff points for anthropometric indices and their relationship with cardio-metabolic indices to predict the risk of metabolic associated fatty liver disease.

BACKGROUND: Research on Metabolic Associated Fatty Liver Disease (MAFLD) is still in its early stages, with few studies available to identify and predict effective indicators of this disease. On the other hand, early diagnosis and intervention are crucial to reduce the burden of MAFLD. Therefore, the aim of this research was to investigate the effectiveness of eleven anthropometric indices and their appropriate cut-off values as a non-invasive method to predict and diagnose MAFLD in the Iranian population. METHODS: In this cross-sectional study, we analyzed baseline data from the Hoveyzeh Cohort Study, a prospective population-based study conducted in Iran that enrolled a total of 7836 subjects aged 35 to 70 years from May 2016 through August 2018. RESULTS: The optimal cut-off values of anthropometric indices for predicting MAFLD risk were determined for waist circumference(WC) (102.25 cm for males and 101.45 cm for females), body mass index (BMI) (27.80 kg/m2 for males and 28.75 kg/m2 for females), waist-to-hip ratio (WHR) (0.96 for both males and females), waist-to-height ratio (WHtR) (0.56 for males and 0.63 for females), body adiposity index (BAI) (23.24 for males and 32.97 for females), visceral adiposity index (VAI) (1.64 for males and 1.88 for females), weight-adjusted waist index (WWI) (10.63 for males and 11.71 for females), conicity index (CI) (1.29 for males and 1.36 for females), body roundness index (BRI) (4.52 for males and 6.45 for females), relative fat mass (RFM) (28.18 for males and 44.91 for females) and abdominal volume index (AVI) (18.85 for males and for 21.37 females). VAI in males (sensitivity: 77%, specificity: 60%, Youden's Index: 0.37) and RFM in females (sensitivity: 76%, specificity: 59%, Youden's Index: 0.35) were found to have higher sensitivity and specificity compared to other anthropometric indices. Furthermore, anthropometric indices demonstrated statistically significant correlations with various hepatic and cardiometabolic indices. Among these, the strongest positive correlations were observed between WC, BMI, BAI, BRI, and AVI with the Hepatic Steatosis Index (HSI), TyG-BMI, and TyG-WC, as well as between VAI and the Atherogenic Index of Plasma (AIP), Lipid Accumulation Product (LAP), Cardiometabolic Index (CMI), and the Triglyceride and Glucose (TyG) Index. CONCLUSION: Anthropometric indices are effective in predicting MAFLD risk among Iranian adults, with WWI, VAI, and RFM identified as the strongest predictors. The proposed cutoff values could serve as a straightforward and non-invasive methods for the early diagnosis of MAFLD.

Her-2/neu gene amplification and its correlation with other prognostic factors in Iranian breast cancer patients.

BACKGROUND: Breast cancer is one of the most common diseases in females, arising from overexpression of a variety of oncogenes like HER2/neu. The amplification rate of this gene is variable in different breast cancer patients. In this study, the amplification of the HER2/neu oncogene was distinguished in breast cancer patients and its correlation with prognostic factors. Also, the simultaneous effect of prognostic factors on the occurrence of a specific prognostic factor was investigated. MATERIALS AND METHODS: The multiplex PCR technique was used to assay the amplification of the HER2/neu oncogene in breast cancer patients. After extracting DNA from 100 tumor tissue and 8 normal breast tissue samples, the amplification of the HER2/neu gene was distinguished by the co-amplification of a single-copy reference gene, γ-IFN, and the target gene HER2/neu in the PCR reaction and using the Gel analyzer software. SPSS 23 and STATA 9.1 software were used for statistical analysis. RESULTS: The HER2/neu gene was amplification in 30% of the tumor samples. The statistical analysis showed a statistically significant relationship between HER2/neu gene amplification and progesterone receptors. Amplification of the HER2/neu gene significantly increases the chance of lymph node involvement. Also, the amplification of this gene in tumors with histological grade II tissue is more than grade I. CONCLUSION: The amplification of the HER2/neu gene can be used as an independent prognostic factor in predicting lymph node involvement and histological grade in breast cancer patients.

Bioclimatic analysis and spatial distribution of fascioliasis causative agents by assessment of Lymnaeidae snails in northwestern provinces of Iran.

BACKGROUND: Snails of the Lymnaeidae family are the intermediate hosts of Fasciola species, the causative agents of fascioliasis. The purpose of this study was to determine the prevalence of Fasciola species in lymnaeid snails and to investigate the association of geoclimatic factors and Fasciola species distribution in northwestern provinces of Iran using geographical information system (GIS) data. METHODS: A total of 2000 lymnaeid snails were collected from 33 permanent and seasonal habitats in northwestern Iran during the period from June to November 2021. After identification by standard morphological keys, they were subjected to shedding and crushing methods. Different stages of Fasciola obtained from these snails were subjected to the ITS1 polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method for species identification. The associations of weather temperature, rainfall, humidity, evaporation, air pressure, wind speed, elevation, and land cover with the distribution of Fasciola species were investigated. Geographical and statistical analysis was performed using ArcMap and SPSS software, respectively, to determine factors related to Fasciola species distribution. RESULTS: Of the 2000 snails collected, 19 were infected with Fasciola hepatica (0.09%), six with F. gigantica (0.03%), and 13 with other trematodes. Among geoclimatic and environmental factors, mean humidity, maximum humidity, and wind speed were significantly higher in areas where F. hepatica was more common than F. gigantica. The altitude of F. hepatica-prevalent areas was generally lower than F. gigantica areas. No significant relationship was observed between other investigated geoclimatic factors and the distribution of infected snails. CONCLUSIONS: The present study showed the relationship of humidity and wind speed with the distribution of snails infected with F. hepatica or F. gigantica in the northwestern regions of Iran. In contrast to F. gigantica, F. hepatica was more prevalent in low-altitude areas. Further research is recommended to elucidate the relationship between geoclimatic factors and the presence of intermediate hosts of the two Fasciola species.

Prevalence and Severity of COVID-19 among Pediatric Patients with Atopy: A Cross-sectional Study in Kerman, Southeast Iran.

The tragic COVID-19 pandemic affected many children worldwide. Among the factors that may influence the course of viral infections including COVID-19, it is still uncertain whether atopy has a protective or predisposing role. The study aims to address the knowledge gap by investigating the prevalence and severity of COVID-19 among atopic children in Kerman, in 2022. A descriptive-analytical cross-sectional study on children with a history of atopy was performed in Kerman Medical University. Demographic information, type of atopy (including allergic rhinitis, Hyper-Reactive Airway Disease (HRAD) or asthma, eczema, urticaria, anaphylaxis, and food allergy), history of COVID-19 infection, and disease severity were recorded. A total of 1007 children and adolescents, (boys: 56.4%, girls: 43.6%, age:5.61±2.64 years) were included in the study. History of COVID-19 infection was positive in 53.5%, with 75.9% of the cases exhibiting mild disease severity. The frequency of atopies was HRAD or asthma (67.2%), allergic rhinitis (42.6%), and food allergy (27.4%). The frequency of COVID-19 cases was significantly higher among patients with HRAD or asthma, whereas it was significantly lower among those with food allergies, anaphylaxis, and eczema. Among atopic individuals, COVID-19 severity was significantly lower in those with allergic rhinitis, while the opposite trend was observed among food-allergic individuals. This study sheds light on the relationship between atopy and COVID-19 among pediatric patients. It seems specific types of atopies may influence the risk and severity of COVID-19 infection differently. A better understanding of these associations can inform clinical management and preventive measures for vulnerable pediatric populations.

Antibody Response Before and After the Booster Dose of Inactivated Corona Vaccine in Antibody Deficient Patients.

Patients with inborn errors of immunity (IEI) are among the high-risk groups regarding COVID-19. Receiving booster doses (third and fourth) in addition to the standard doses is recommended in these patients. This study investigated the antibody response before and after a booster dose of Sinopharm vaccine in IEI patients.  Thirty patients (>12 years) with antibody deficiencies, referred to Imam Khomeini Hospital and Children's Medical Center in Tehran, were enrolled in this prospective cross-sectional study. All patients were fully vaccinated with the BBIBP-CorV vaccine (2 doses of Sinopharm). Initial measurements of anti-receptor-binding domain (anti-RBD) and anti-nucleocapsid (anti-N) IgG antibody responses were conducted by enzyme-linked immunosorbent assay (ELISA). Subsequently, all patients received a booster dose of the vaccine. Four to six weeks after booster injection, the levels of antibodies were re-evaluated.  Twenty patients with common variable immunodeficiency (CVID), 7 cases with agammaglobulinemia and 3 patients with hyper IgM syndrome were studied. Anti-RBD IgG and anti-N IgG antibodies increased in all patients after the booster. Our results indicated the need of receiving booster doses of the COVID-19 vaccine in patients with antibody deficiencies, even for enhancing humoral immune response specially in patients with CVID.

Antiepileptic Medication-induced Severe Cutaneous Adverse Reactions in Hospitalized Children: A Retrospective Study.

BACKGROUND: There are limited data on severe cutaneous adverse reactions (SCARs) associated with antiepileptic medications. The current study aims to investigate the clinical and epidemiological characteristics of antiepileptic medication-induced SCARs in hospitalized children. MATERIALS AND METHODS: The current five-year retrospective study was conducted at Isfahan University of Medical Sciences, Iran. This study included all children with a definite diagnosis of SCARs secondary to the use of antiepileptic medications based on the world health organization (WHO) definition. In our study SCARs were categorized into three fields: Hypersensitivity syndrome, drug reaction with eosinophilia and systemic symptoms (DRESS), and Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). RESULTS: Among 259 children with SCARs induced by antiepileptic medications, 199 (76.83%), 42 (16.22%), and 18 (6.95%) had hypersensitivity syndrome, DRESS, and SJS/TEN, respectively. Phenobarbital was the most common offending drug in all types of SCARs. The multinomial logistic regression model revealed that lymphadenopathy increased the occurrence of DRESS by 35 times compared to hypersensitivity syndrome (P < 0.001). Girls were at risk of SJS/TEN approximately 6 times more than boys (P = 0.027). Age (P = 0.021), weight (P = 0.036), and mucosal involvement (P < 0.001) affected the hospitalization duration in children with SCARs related to antiepileptic medication. CONCLUSION: There are some similarities and differences in the clinical and epidemiological features of Iranian children suffering from antiepileptic medication-induced SCARs.

The Impact of Eight Weeks of Moderate-Intensity Aerobic Exercise and Nutrition with a Traditional Iranian Medicine Approach on Liver Enzymes in Young Boys.

Objective: The present study aims to explore whether there is a relationship between the levels of alanine transaminase (ALT) and aspartate transaminase (AST) enzymes and physical activity and diet from the perspective of Iranian traditional medicine to achieve enzymatic balance. Method: The research design is quasi-experimental with three experimental groups and one control group, and includes pre-test and post-test assessments. The sample population consisted of 60 young men aged between 20-40 years attending Asou Sports Club in Ahvaz, who were randomly divided into four 15-member groups, including aerobic exercise, nutrition, combined aerobic exercise and nutrition, and control. The aerobic group received eight weeks of moderate-intensity aerobic exercise, consisting of 3 sessions per week, each lasting 45 minutes at 64%-76% of maximum heart rate. Participants were recommended to take mood assessment tests and a personalized diet plan. Individuals with a cold temperament were eligible to participate in the study. The exercise and nutrition group received both interventions, while the control group received no intervention. Blood levels of ALT and AST were measured at a laboratory. Descriptive indices and statistical tests such as multiple and multivariate covariate analyses were used to analyze the data. Results: The results showed that eight weeks of moderate-intensity aerobic exercise and nutrition with traditional Iranian medicine approach had a significant effect on ALT and AST levels in young boys, resulting in an improved regulation of these enzymes (P < .05). Conclusion: The implementation of dietary restrictions and substitutes, along with appropriate aerobic activities, can be effective in regulating liver enzymes.

The Effect of Massage on Maternal Role Adaptation in Mothers with Premature Infants.

Background: Accepting and adapting the maternal role by mothers with premature infants is complicated. Active participation of mothers in neonate massage may facilitate this process. Primary Study Objective: Determining the effect of massage on maternal role adaptation in mothers of premature infants admitted to the neonatal intensive care unit (NICU). Methods/Design: A non-parallel quasi-experimental study with a sequential sampling method. Setting: This study was done in the NICU of Imam Ali Hospital in Amol City, Iran. Participants: 90 mothers of premature infants hospitalized in the NICU participated in this study. Intervention: The mothers in the intervention group after receiving two training sessions massaged their infant for 15 minutes daily from the third day of hospitalization for 5 consecutive days. Primary Outcome Measures: A maternal role adaptation questionnaire was used. Participants completed the maternal role adaptation questionnaire 3 times: before, on the fifth day, and 14 days after the first day of intervention. The maternal role adaptation questionnaire was used to assess the maternal role adaptation. The participants of the control group also filled out the questionnaire at similar time. Results: The mean scores of maternal adaptation were significantly different between the two control groups (5th day and 14th day) and intervention (day 5: 136.88 ± 10.062 (P = .025); day 14: 151.93 ± 6 (P < .001)). Maternal role adaptation showed an upward trend in the two groups during the 14 days of study, but this trend was significantly higher in the intervention group over time, compared to the control group. Conclusion: Massage of premature infants facilitates the adaptation to maternal role. It is recommended, along with other nursing interventions, to empower mothers with premature neonates admitted to the NICU.

The effect of educational intervention according to mindfulness on the psychological well-being of female heads of households.

OBJECTIVE: The low level of psychological well-being is one of the most common problems of the women who are the heads of households, and various educational programs have been conducted to improve the psychological well-being of such a group. The present study was conducted to outline the effectiveness of mindfulness-based educational intervention in the psychological well-being of women as the heads of households. METHODS: This research as a semi-experimental study was done by pretest-posttest design and control group. The study statistical population included all women as the heads of households in Shiraz, who had a file in the Shiraz based welfare office and at the same time their children were studying in schools covered by the 2nd district educational department of Shiraz in 2022-2023. Out of the female heads of the households in the statistical community, 30 women were selected as Purposive sampling and then randomly divided into two 15-individual groups, including experimental group (training on mindfulness-based therapy) and control group. The research tool included Ryff's psychological well-being scale (Ryff, 1989). The experimental group was subjected to training on mindfulness-based therapy (Baer et al., 2006) during eight 90-min sessions. However, the control group did not receive any intervention. RESULT: After running the intervention, a significant difference was seen between the components of autonomy, personal growth, purpose in life, self-acceptance, positive relationship with others, and psychological well-being after running the educational intervention between the experimental and control groups (P < 0.05), while no meaningful difference popped up between the experimental and control groups in terms of environmental mastery as one of the aspects measured in psychological well-being scale after the educational intervention (P = 0.602). CONCLUSION: According to the results, it seems that psychologists can benefit from the method of training on mindfulness-based therapy in order to increase the psychological well-being of women as the heads of households.

Cross-cultural adaptation of the Iranian Voice Quality of Life Profile into Brazilian Portuguese. / Adaptação transcultural para o Português Brasileiro do Perfil de Qualidade de Vida relacionado a Voz.

PURPOSE: To cross-culturally adapt the Voice Quality of Life Profile (IVQLP) into Brazilian Portuguese (BP). METHODS: The cross-cultural adaptation process was performed in five stages: translation of the IVQLP into BP by three native BP experts fluent in American English; preparation of a consensus version; back-translation by a native American English expert fluent in BP; analysis by a committee of five experts and preparation of the final version of the instrument in BP, which was named IVQLP-Br; and pre-testing. The IVQLP-Br aims to assess the impacts of the voice more comprehensively, encompassing various areas of an individual's life. It has 43 items and a five-level response key. For the pre-test, the alternative "not applicable" was added as a response option. Thirty-six adults with self-reported risk of dysphonia participated in the pre-test. RESULTS: In the translation stage, ten items were modified, and during the back-translation, 15 items required adjustments. No questions required reformulation after the application of the IVQLP-Br in the target population, because the option "not applicable" appeared in 12 responses without statistical significance. CONCLUSION: The version of the IVQLP translated into BP, named the IVQLP-Br, exhibited cross-cultural equivalence and was administrable for a more detailed analysis of the impact of the voice in different domains of an individual's life. After validation, the IVQLP-Br will be able to contribute both to clinical practice and to research with BP speakers.

OBJETIVO: Traduzir e adaptar de forma transcultural o Iranian Voice Quality of Life Profile (IVQLP) para o português brasileiro (PB). MÉTODO: O processo de adaptação transcultural foi realizado por meio de cinco etapas: tradução do IVQLP para o PB por três especialistas nativos do PB e fluentes no inglês americano; elaboração de uma versão de consenso; retrotradução por um especialista nativo do inglês americano e fluente no PB; análise por um comitê de cinco especialistas e elaboração da versão final do instrumento em PB, denominado IVQLP-Br; e pré-teste. O IVQLP-Br tem o objetivo de avaliar os impactos da voz de uma forma mais abrangente, englobando vários domínios da vida dos indivíduos, apresenta 43 itens e uma chave de respostas de cinco pontos. Para o pré-teste foi acrescida como opção para o respondente a alternativa "não aplicável". Participaram do pré-teste 36 indivíduos adultos com risco autorrelatado para disfonia. RESULTADOS: Na etapa de tradução 10 itens foram modificados e na retrotradução, 15 itens necessitaram de ajustes. Nenhum item precisou ser reformulado após a aplicação na população-alvo, pois a opção "não aplicável" apareceu em doze respostas, porém, sem significância estatística. CONCLUSÃO: Conclui-se que a versão traduzida do IVQLP para o PB, denominado IVQLP-Br, apresentou equivalência transcultural e pode ser utilizada para uma análise mais detalhada do impacto da voz nos diferentes domínios da vida dos indivíduos. Após a validação, o IVQLP-Br poderá contribuir tanto para a prática clínica, quanto para pesquisas com falantes do PB.

Relationship between oral health literacy and oral health-related quality of life in patients with bladder cancer.

Introduction: Bladder cancer is one of the most important diseases that threatens oral and dental health due to its nature and side effects of chemotherapy. Therefore, the present study was conducted to investigate the relationship between oral health literacy and oral health-related quality of life in patients with bladder cancer. Methods: This cross-sectional study was conducted on patients with bladder cancer in Ahvaz, 2023. Subjects were selected randomly from the patients those were registered in Cancer Registry Center in Ahvaz Jundishapur University of Medical sciences and invited to Golestan Hospital for data collection through clinical evaluation, the Oral Health Literacy Adult Questionnaire (OHL-AQ), and the Oral Health Impact Profile-14 (OHIP-14PER) questionnaire. The data were analyzed using Pearson correlation coefficient, independent t-test, and analysis of variance. Results: The number of participants was 194. The mean oral health literacy in patients with bladder cancer was 9.74 ± 2.39, indicating insufficient oral health literacy. A significant association was observed between OHL-AQ and DMFT index, but no significant association was found between OHIP-14PER and DMFT index. Furthermore, a significant correlation was found between OHL-AQ and OHIP-14PER (r = -0.68) in patients with bladder cancer. Conclusion: Based on the findings of the present study, all dimensions of oral health literacy have correlation with the oral health-related quality of life in patients with bladder cancer. Therefore, adopting oral health behaviors and increasing oral health literacy can be the best way to improve the oral health-related quality of life to among patients with bladder cancer.

Identifying factors affecting the selection of heads of city health centers in Iran: A phenomenological study.

INTRODUCTION: Managers in the health care sector have the responsibility of accomplishing objectives and guaranteeing the excellence of services. To be chosen as a manager in a health organization, individuals must possess specific qualities and skills. Examining the process of selecting and appointing managers at the highest level of service provision might offer policymakers valuable insights into the importance of considering competences when choosing and appointing leaders of health centers. Hence, this study was conducted to identify the characteristics that influence the selection process of heads of city health centers in Iran. METHODS: The present study employed a qualitative and phenomenological approach, utilizing interviews performed in the year 2023. The study sample consisted of health deputy from medical sciences universities, local health network managers, and heads of city health center. The participants were selected using a purposive selection method. A total of 16 male participants were interviewed, and the interviews were then analyzed using MAXQDA-10 software using the usual content analysis method. RESULTS: In this study, the factors affecting the selection of the heads of health care centers were classified into two general topics: individual factors and environmental factors, and eight sub-topics, including health literacy, experience, individual characteristics, communication skills, mental characteristics, legal issues, political factors, and cultural factors. CONCLUSION: The development of health literacy, specialized knowledge, and communication skills to coordinate and resolve organizational problems helps train competent managers. Top health system managers, who select health center managers, must understand political and cultural variables and regulate and steer their influence to select effective managers.

Economic barriers to prevent the smuggling of health goods in Iran.

INTRODUCTION: In recent years, smuggling of health goods has apparently increased in the country. Despite the preventive and regulatory measures taken to combat this problem, the outcomes seem to be undesirable. This study thus aims to identify and elucidate the role of economic barriers in the prevention of smuggling health goods in Iran. METHOD: We conducted semistructured interviews with 29 purposefully identified key informants in the detection, prevention and control of health goods smuggling in different organisations, between May 2021-January 2022. An inductive data-driven thematic analysis approach was further adopted to identify patterns of meaning, using MAXQDA 2020 software to facilitate data management. RESULTS: We identified four main themes representing the economic barriers to prevent the smuggling of health goods in Iran; Monetary and financial policy, which includes subthemes of financial rules and procedures, market regulation, economic incentives and imbalanced development; Behavioural patterns, consisting of consumer behaviour, the opportunism of smugglers, the behaviour of statesmen and politicians; Economic diplomacy, categorised into international relations and interactions, relations and interactions in the national arena, interaction with non-governmental organisations and Health economic monitoring and evaluation including transparency of statistics and economic information and supervision. CONCLUSION: Smuggling health goods has become a concerning challenge in the health sector. It is, therefore, imperative to develop and implement appropriate policies and operations towards security and international cooperation, lobbying and coalition-building. Demonopolisation, creating competitive and dynamic markets, removal of rent-seeking layers at all levels, and the use of commercial diplomacy to reduce the burden of smuggling in the health sector of Iran, and perhaps beyond might be of sizeable use to combat such challenge.

Women living with infertility in Iran: A qualitative content analysis of perception of dignity.

BACKGROUND: Globally, infertility is known as a major problem which can ruin a couple's relationship. In recent years, many studies have addressed the causes of infertility, the outcomes of treatments for infertility, and the effects of infertility on couples' mental health; however, the concept of dignity of women living with infertility has never been examined in depth. OBJECTIVE: This study aimed to explore the dignity of women living with infertility in Iran. DESIGN: This qualitative research was conducted via conventional content analysis approach. METHODS: This qualitative study was conducted in Iran from February to December 2022. In this research, the data were collected through face-to-face semi-structured in-depth interviews with 23 women living with infertility selected via purposive sampling. The interviews were continued until reaching the data saturation point. Data analysis was performed simultaneously with data collection. The interviews were recorded, transcribed, and analyzed through Graneheim and Lundman style content analysis, with data management done using the MAXQDA software. To achieve the accuracy and validity of the study, the four-dimension criteria by Lincoln and Guba, namely credibility, dependability, conformability, and transformability, were considered and used. RESULTS: Analysis of the qualitative data yielded three themes and eight subthemes. The three main themes were (1) overcoming identity crises (overcoming dysthymia, coping with unaccomplished motherhood), (2) respect for personal identity (respect for confidentiality; respect for beliefs, values, and attitudes; avoidance of stigma and pity), and (3) compassion-focused therapy (sympathizing, mental and spiritual support, and enhancement of life skills). CONCLUSION: Dignity of women living with infertility encompasses overcoming identity crises, respect for personal identity, and compassion therapy. The policymakers and administrators in the healthcare system can use the findings of this study to create a proper clinical environment toward preserving the dignity of women living with infertility.

The prevalence of unintended pregnancy and its influence on pregnancy experience in Tabriz, Iran, 2023: a cross-sectional study.

BACKGROUND: There is a lack of quantitative studies that specifically measure the association between the experience of pregnancy and unintended pregnancy. The present study aims to address the prevalence of unintended pregnancy and identify its predictors. Additionally, the study explores whether unintended pregnancy is associated with pregnancy uplifts and hassles. METHODS: This cross-sectional study was conducted on 488 pregnant women between 20 to 40 weeks' gestation at the comprehensive health center in Tabriz City from February 2022 to January 2023. A cluster sampling method was used for sampling, and data were collected using socio-demographic questionnaires and the Pregnancy Experience Scale (PES). Descriptive statistics were used to describe the socio-demographic characteristics and the prevalence of unintended pregnancy. Binary logistic regression was employed to identify the predictors of pregnancy desirability. To examine the relationship between unintended pregnancy and pregnancy experience, an independent t-test was used for bivariate analysis, and a general linear model (GLM) was utilized for multivariate analysis, with control for potential confounding variables. RESULTS: The prevalence of unintended pregnancies was 30.7% (24.3% unwanted pregnancies, and 6.4% mistimed pregnancies). The results of the binary logistic regression indicated that the lower age of both the woman and her spouse were significant predictors for unintended pregnancy (P < 0.05). Based on an independent t-test, the mean score for uplifts in women with unintended pregnancy was significantly lower than in women with intended pregnancy (mean difference (MD): -4.99; 95% confidence interval (CI): -5.96 to -4.02; p < 0.001), While the mean score of hassles in women with unintended pregnancy was significantly higher than women with intended pregnancy (MD: 2.92; 95% CI: 2.03 to 3.80; p < 0.001). The results of GLM showed that women who had unintended pregnancies had significantly lower scores for uplifts (B = -4.99; 95% CI: -5.96 to -4.03; P < 0.001) and higher scores for hassles (B = 2.92; 95% CI: 2.06 to 3.78; P < 0.001). CONCLUSIONS: The high prevalence of unintended pregnancies in Tabriz highlights the importance of targeted interventions to address this issue, considering the policy framework and unique challenges faced by women. Future studies should focus on developing context-specific interventions that effectively meet the needs of women with unintended pregnancies.

An unintended pregnancy is a pregnancy that occurs either when the woman did not intend to get pregnant at all or when she intended to get pregnant but became pregnant at an inappropriate time. This type of pregnancy can have negative effects on the physical and mental health of women during pregnancy and after delivery. So far, no study has investigated the relationship between the experience of pregnancy and unintended pregnancy, and the existing studies, which are qualitative and based on interviews, have examined women's experiences of unintended pregnancy. For the first time, our study examined the relationship between pregnancy experience and unintended pregnancy in 488 women using a valid questionnaire, the Pregnancy Experience Scale, which includes two parts: uplifts and hassles specific to pregnancy. Our findings showed that women who have an unintended pregnancy have a worse pregnancy experience in both uplifts and hassles specific to pregnancy. Also, limited studies have investigated the prevalence of unintended pregnancy in Iran, especially in the city of Tabriz in recent years. Our study, found this prevalence to be 30.7% in Tabriz, with 24.3% of women having no intention of getting pregnant and 6.4% of women experiencing pregnancy at an inappropriate time. The recommendation is to implement strategies to reduce unintended pregnancy rates and improve women's knowledge of fertility, sexuality, and contraception.

Explaining the perception and experiences of breastfeeding in mothers who have a high risk pregnancy: a protocol study.

INTRODUCTION: Enhancing breastfeeding practices, even in affluent nations, significantly reduces child mortality rates. Nevertheless, three out of five newborns do not receive breastfeeding within the first hour of birth. Research indicates that under high-risk pregnancy circumstances, there may be challenges in initiating and sustaining breastfeeding. Infants born from high-risk pregnancies are particularly vulnerable to illnesses and mortality. Although breastfeeding serves as a protective measure against various infant and post-infancy ailments, many mothers encounter difficulties in commencing or maintaining breastfeeding due to complications associated with their conditions. The present study aims to illuminate the understanding and experience of breastfeeding in mothers with high-risk pregnancies, considering the cultural and social context of Iran. METHOD: This study is a qualitative research utilizing a conventional content analysis approach. In this qualitative study, mothers who have undergone a high-risk pregnancy and currently have infants under 6 months old will be chosen through purposeful and snowball sampling. Their breastfeeding experiences will be gathered through individual, semi-structured, and face-to-face interviews. In addition to interviews, observation and focus groups will also be used to collect data. Data analysis was performed using Graneheim and Lundman's method with MAXQDA software version 10, VERBI Software GmbH, Berlin. The study will utilize the criteria of Lincoln and Guba (1985) for validity and reliability. DISCUSSION: This qualitative study aims to investigate the experiences and challenges of breastfeeding in mothers with high-risk pregnancies to pinpoint breastfeeding barriers in this demographic and develop essential interventions and strategies to address these obstacles.

Investigating the relationship between personality traits of hardiness and perfectionism with stress and psychosomatic symptoms: a cross-sectional study among nurses in Iran.

BACKGROUND: Medical and health sector employees are always exposed to physical and psychological risk factors, which affects their personal, social and professional performance. It's important to explores the intricate interplay between personality traits, stress levels, and psychosomatic symptoms among nurses as one of the most sensitive jobs in society. Therefore, the present study aimed to investigating the relationship between the personality traits of hardiness and perfectionism with stress and psychosomatic symptoms among nurses. METHODS: This cross-sectional study was conducted among 340 nurses in Mazandaran, Iran in 2022-2023. The instruments utilized to collect data included four questionnaires, namely Cubasa Hardiness Questionnaire, Tehran Multidimensional Perfectionism Questionnaire, Nursing Stress Questionnaire and Takata and Sakata Psychosomatic Questionnaire. The structural equations modeling was used for path analysis. All analyzes were done using SPSS V.25.0 and AMOS V.24.0 software. RESULTS: The results of the present study revealed that the prevalence of psychosomatic symptoms and stress in nurses was high, and all path coefficients were significant, except for the paths of commitment to stress, challenge to psychosomatic symptoms, self-orientation to psychosomatic symptoms, and community-orientation to psychosomatic symptoms. The results showed that in the final model, the highest coefficient (0.807) is assigned to the other-oriented perfectionism path to psychosomatic symptoms. The weakest coefficient (-0.276) is related to the path of the hardiness component of the challenge to stress. The current research examined the fitting of the proposed model and the suitability of the proposed model was confirmed. CONCLUSION: The results of the present study revealed that psychological factors such as personality traits of hardiness, and perfectionism are among the important and influencing parameters on occupational stress, and psychosomatic symptoms and as a result the efficiency and effectiveness of nurses in working environments. Therefore, it is absolutely necessary to implement mitigating and control measures to reduce the mentioned risk factors among nurses in medical settings.