Ensuring the long-term retention of healthcare professionals has become a central priority for strengthening the resilience and quality of Iran's health system. A comprehensive understanding of the diverse factors influencing retention, alongside those that may contribute to outward mobility, is essential for informed policymaking. This study adopts a multi-method approach, integrating qualitative inquiry with a scoping review, to explore the determinants shaping healthcare professionals' decisions to remain in or leave the national health system, the implications for workforce stability, and the effectiveness of current policy responses. By examining both individual and systemic dimensions, and by incorporating insights from migrant professionals, domestic policymakers, and existing evidence, this research contributes a nuanced perspective to the broader discourse on human resources for health in developing contexts. The originality of this study lies in combining first-hand qualitative data with a systematic synthesis of literature, allowing for an in-depth understanding of locally grounded drivers of retention and opportunities for strengthening Iran's health workforce. The research employed a qualitative, multi-phase design. In the first phase, semi-structured interviews were conducted with 15 Iranian healthcare professionals residing in countries such as the United States, Germany, Switzerland, Turkey, and Oman to understand their professional trajectories. In the second phase, interviews with 16 Iranian health administrators, policymakers, and senior professionals were undertaken to capture institutional and policy-level perspectives on retention challenges and opportunities. All interviews were transcribed verbatim and analyzed thematically. Complementing this, a scoping review was conducted to synthesize existing evidence, policy documents, and expert assessments related to the retention and mobility of Iran's health workforce. Data sources included PubMed, Scopus, and gray literature obtained through institutional repositories and local websites. Findings highlight several interrelated factors influencing workforce retention. Economic considerations including income stability, purchasing power, and access to research funding remain important determinants of professional commitment. Institutional dynamics such as transparent promotion pathways, supportive management, and opportunities for professional development also play a critical role. Importantly, Iran's integrated system of medical education and service delivery emerged as a key structural strength, providing early clinical exposure, strong professional identity formation, and continuity between training and practice advantages less commonly available in many other health systems. Participants noted that when financial incentives are combined with accessible professional development programs, equitable workload distribution, and recognition of professional contributions, retention outcomes improve substantially. While destination countries may offer expanded career pathways, the sense of belonging, family ties, and cultural identity were identified as influential factors supporting continued service in Iran. Governmental initiatives including compensation adjustments, training reforms, and targeted retention programs have yielded positive outcomes, though further coordination and sustained implementation are needed. Strengthening the retention of healthcare professionals in Iran requires a holistic strategy that integrates economic, organizational, educational, and governance reforms. Enhancing remuneration structures, investing in professional development and research capacity, reinforcing the advantages of Iran's integrated educational service system, and engaging with the healthcare diaspora can collectively support workforce stability. A multi-sectoral, evidence-informed approach has the potential to improve long-term retention, mitigate the need for outward mobility, and promote a more resilient and sustainable health system.
This study aimed to adapt and psychometrically evaluate the Artificial Intelligence Learning Intention Scale (AILIS) among Iranian medical sciences students. This methodological psychometric study was conducted among 800 medical sciences students at Babol University of Medical Sciences, Iran. The AILIS was translated and culturally adapted into Persian using a standardized cross-cultural adaptation process. Construct validity was examined through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Reliability was assessed using Cronbach's alpha, McDonald's omega, and the intraclass correlation coefficient (ICC). Convergent and discriminant validity were evaluated using composite reliability (CR) and average variance extracted (AVE). Measurement invariance across gender and structural stability were assessed using multi-group confirmatory factor analysis and exploratory graph analysis (EGA). EFA supported a four-factor structure consisting of Epistemic Capacity, Psychological Attitudes, Facilitating Environments, and Psychological and Behavioral Outcomes, explaining 44.55% of the total variance, with factor loadings greater than 0.40. Confirmatory factor analysis indicated an acceptable model fit, supporting the proposed factor structure (χ²/df = 3.42, RMSEA = 0.078, CFI = 0.932). Internal consistency and test-retest reliability were satisfactory, with Cronbach's alpha ranging from 0.854 to 0.904, McDonald's omega from 0.854 to 0.899, and ICC from 0.750 to 0.860. Composite reliability values were adequate, while AVE values indicated acceptable but partially limited evidence of convergent validity. Discriminant validity was generally supported. In addition, multi-group analysis demonstrated measurement invariance across gender, and exploratory graph analysis confirmed the structural stability of the four-factor model. The Persian AILIS is a valid and reliable instrument for assessing AI learning intention among medical sciences students. Beyond its psychometric robustness, the instrument may support curriculum planning, evaluation of AI-related educational interventions, and evidence-based decision-making in medical sciences education by providing a standardized measure of students' intentions to engage with AI learning.
Better evaluation of the contribution of the main diseases, injuries, and risk factors for mortality and life expectancy is crucial for more efficient policy making at the national and subnational levels in Iran. The aim of this study is to assess the effect of emerging causes of mortality on health, specifically COVID-19, which can help policy makers implement preventive measures in similar situations. In this systematic analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we present estimates of cause-specific mortality at the national and subnational levels in Iran from 1990 to 2023. New to this iteration of GBD, we present a decomposition analysis of the contribution of specific causes of death to net gain or loss in life expectancy across 31 provinces of Iran. We used an array of data sources including censuses, vital registration, and surveys for national and subnational estimates. The two leading causes of death in Iran were ischaemic heart disease and stroke in both 1990 and 2019. However, in 2020 and 2021, the COVID-19 pandemic displaced the leading causes of death, ranking first with age-standardised mortality rates of 286·2 deaths (95% uncertainty interval 267·9-310·5) per 100 000 in 2020 and 250·0 deaths (233·2-272·5) per 100 000 in 2021. COVID-19 ranked second and tenth in 2022 and 2023, respectively. Life expectancy at birth for both sexes combined declined from 78·0 years (77·7-78·1) in 2019 to 74·3 years (74·0-74·4) in 2020. It steadily recovered to 78·8 years (78·5-79·2) in 2023. COVID-19 was the main cause of loss in life expectancy, by 4·19 years, between 2019 and 2020. There was a net gain of 12·4 years in life expectancy in Iran from 1990 to 2023. The net gain at the national level can be mostly attributed to reduced mortality from ischaemic heart disease (2·61 years), stroke (1·63 years), neonatal disorders (1·26 years), transport injuries (0·88 years), and neoplasms (0·64 years). The decline in mortality rates of major causes continued to 2023 despite the pandemic. An exception was Alzheimer's disease, which showed a 4·0% increase in rate between 2019 and 2023 and led to a net loss of 0·04 years in life expectancy since 1990. Diabetes led to a net loss of 0·09 years since 1990. There were variations between provinces in terms of age-standardised rates and the net change in life expectancy before and after the COVID-19 pandemic. The COVID-19 pandemic disrupted the rising trend of life expectancy in Iran, varying across provinces. Findings show that the health-care infrastructure and policies in Iran were not efficient in controlling the pandemic in 2020 and 2021, mainly due to inadequate vaccination coverage and timeliness, specifically for vulnerable subgroups. Sanctions may have aggravated the effect of COVID-19 on loss in life expectancy of Iranians. Despite the pandemic, the declining trend in age-standardised rates for top causes of mortality has continued to 2023, leading to a full recovery of life expectancy and underscoring the ultimate resilience of Iran's health system. Gates Foundation.
The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.
Nurses face complex ethical challenges across diverse healthcare settings, making ethical caring competency essential to professional practice. Given that Iranian nurses encounter ethically sensitive situations shaped by sociocultural and religious values and that no validated tool exists to assess this construct the aim of this study was to culturally adapt and psychometrically validate the Ethical Caring Competency Scale (ECCS) for use among Iranian nurses. This methodological, cross‑sectional study included 697 registered nurses who were recruited through convenience sampling from seven teaching hospitals affiliated with Mazandaran University of Medical Sciences, Iran. Data were collected in person by the researcher through visits to hospital wards, during which nurses completed the instruments at the end of their work shifts. The Ethical Caring Competency Scale (ECCS; 22 items across four dimensions) was culturally adapted for the Iranian context following World Health Organization (WHO) translation protocols, including forward-back translation, expert panel review, and pilot testing with 20 nurses. Construct validity was evaluated using Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), Exploratory Graph Analysis (EGA), and the Random Forest Model (RFM). In addition, internal consistency reliability and measurement invariance across gender were examined. All 697 nurses fully completed the data collection instruments. Participants had a mean age of 35.17 ± 8.41 years and 10.55 ± 7.24 years of work experience; most were female (80.6%) and held a bachelor's degree (89.4%). EFA identified a four‑factor structure that explained 52.80% of the total variance. CFA results confirmed an adequate model fit, with all fit indices (PCFI = 0.737, PNFI = 0.713, CMIN/DF = 2.76, RMSEA = 0.071, IFI = 0.934, CFI = 0.933, and GFI = 0.918) meeting acceptable criteria. EGA results also reproduced the four-factor structure in 99.4% of bootstrap samples. Convergent validity (AVE > 0.5) and divergent validity (√AVE > inter-construct correlations) were confirmed. All reliability coefficients were above 0.7. The RFM demonstrated that the component 'Acting while thinking about how to provide better care' was the most significant factor (contributing 37.56%) in predicting the total ethical caring competency score. The measurement invariance test indicated that the factor structure was stable across genders. The Persian version of the ECCS demonstrated acceptable psychometric properties, a stable conceptual structure, cultural sensitivity, and good discriminant validity for the components of ethical caring competency. Therefore, it can be considered a valid and reliable instrument for assessing the ethical caring competency of nurses in Iran.
Fear of pregnancy can affect women's mental health, reproductive decisions, and quality of life, and may overlap with tokophobia. This study aims to assess its prevalence and determinants among women in Tabriz, Iran, and to develop evidence-based strategies to reduce it. This sequential explanatory mixed-methods study consists of three phases. First, a cross-sectional survey will be conducted among 450 married women aged 15-49 years (nulliparous or with one previous pregnancy) using validated instruments, including the Fear of Pregnancy Scale (FOPS), Satisfaction with Life Scale (SWLS), Social Support Appraisals Scale (SSA), Health-Promoting Lifestyle Profile-2 (HPLP-2), and Depression, Anxiety, and Stress Scale (DASS-21). The psychometric properties of the FOPS will also be assessed. Quantitative data will be analyzed with descriptive statistics, correlations, and multivariable models in SPSS-26. In the qualitative phase, women with the highest and lowest FOPS scores will be purposively selected to ensure diversity, and semi-structured interviews will be analyzed through conventional content analysis. In the final phase, results from both stages, supported by a literature review, will be integrated and refined using the Delphi method to develop culturally appropriate strategies for reducing pregnancy-related fear. This first mixed-methods study in Iran addresses a critical gap in understanding fear of pregnancy. Integrating quantitative and qualitative findings with expert input, it will inform evidence-based, culturally sensitive strategies and guide policies and clinical practice to support informed reproductive decisions. This study focuses on fear of pregnancy and the factors that contribute to it among women of reproductive age. Fear of pregnancy can affect women’s wellbeing, family life, and important decisions about the future. However, little is known about how common this fear is or why it occurs. First, we will give a questionnaire to a large group of women to measure their level of fear and explore possible related factors, such as social support, and lifestyle. Next, we will invite a smaller group of women those with very high or very low levels of fear for interviews to learn more about their personal experiences, thoughts, and feelings about pregnancy. By integrating the survey and interview results, we hope to understand both how widespread fear of pregnancy is and the reasons behind it. The findings will help healthcare providers, counselors, and policymakers design better education and support programs, reduce unnecessary anxiety, and help women make informed decisions about their reproductive health.
Accurate assessment of panic disorder (PD) severity requires brief and psychometrically sound instruments. The Panic Disorder Severity Scale-Self-Report (PDSS-SR) is widely used for this purpose. The present study aimed to evaluate the validity, reliability, and optimal cut-off point of the PDSS-SR in an Iranian sample. Following a descriptive design, the clinical group of the sample consisted of 45 clinical patients diagnosed with PD (75.6% female), with a mean age of 34.04 years (standard deviation [SD] = 12.17) in Tehran in 2023 and 2024 referred to psychotherapy clinics, along with 18 non-PD individuals for the comparison group (83.3% female), with an average age of 31.17 (SD = 7.94). Data were analyzed using confirmatory factor analysis, correlation matrices, reliability coefficients, receiver operating characteristic (ROC) curves, sensitivity, specificity, and the estimation of cut-off points. The construct validity of the PDSS-SR was confirmed through CFA, with adequate goodness-of-fit for the PDSS-SR single-factor structure. By calculating the correlation of PDSS-SR scores with scores on anxiety-related scales, convergent validity was obtained on average. The sensitivity and specificity obtained from the PDSS-SR identified the optimal cut-off point of 6.500 (area under curve [AUC] = 0.78), with sensitivity (90.70%) and specificity (61.11%) based on the Youden index. Reliability was obtained by calculating Cronbach's alpha, McDonald's omega, test-retest correlation coefficient, and intraclass correlation coefficient (ICC) as 0.864, 0.861, 0.716, and 0.864, respectively. This research found that the PDSS-SR had sufficient reliability, moderate convergent validity, and good construct validity in Iranian samples, with an optimal cut-off point of 6.50. Therefore, it can be applied in clinical settings.
Informal patient payments remain a persistent and multifaceted challenge in many health systems, particularly in low- and middle-income countries. These payments, often made outside official channels, can undermine equity, transparency, and trust in healthcare delivery. This qualitative study aimed to explore the underlying causes of informal payments and identify feasible management strategies from the perspectives of key stakeholders. This applied study was conducted using a qualitative method and semi-structured interviews between September 10, 2024, and January 17, 2025. A total of 31 participants, including senior policymakers from the Ministry of Health, hospital managers, medical specialists, nursing managers, hospital supervisors, health economics and healthcare management faculty members, and patients with experience of informal payments in Iranian hospitals, were selected through purposive and snowball sampling methods. Latent content analysis was employed for data analysis, and MAXQDA software (version 2022) was used to extract the main and subcategories. Six main themes and 39 subcategories were identified regarding the causes of informal patient payments. From the perspectives of policymakers, physicians, and service providers, four main themes with 27 subcategories emerged, including factors related to salaries and benefits, structural and organizational issues, laws and regulations, and ethical and cultural considerations. From the perspective of service recipients, two main themes with 12 subcategories were identified, covering service-related and cultural factors. Regarding management strategies to address informal payments, three main themes with 14 subcategories were found, encompassing structural, legal, and cultural approaches. Informal payments in hospitals are driven by a complex interplay of economic, structural, legal, cultural, and ethical factors. Addressing this issue requires a multifaceted strategy, including tariff reform, strengthening legal and regulatory frameworks, promotion of professional ethics, improved service delivery systems, and public awareness campaigns. Sustainable reduction of informal payments demands coordinated efforts across all levels of the health system.
Malaria drug resistance is one of the leading causes of malaria-related morbidity and mortality worldwide. Alpha-mangostin exhibits antimalarial and antioxidant activity in vitro. The soluble alpha-mangostin chitosan alginate nanoparticles (ACAN) exhibit proper antimalarial activity in vivo. This study aimed to explore the antimalarial activity of the chloroquine-ACAN combination and the interaction between them in various ratios. A 4-day suppressive test, according to Peter's test, was conducted using P. berghei-inoculated Swiss Webster mice in Bandung, 2024. It was done for six different concentrations (in triplicate) of three kinds of the combinations respectively i.e.: ½ effective dose 50 (ED50) ACAN: ½ ED50 chloroquine (ratio-1, ACAN and chloroquine were used in a weight ratio of 189:1), ¼ ED50 ACAN: ¾ ED50 chloroquine (ratio-2, weight ratio of 63:1), ¾ ED50 ACAN: ¼ ED50 chloroquine (ratio-3, weight ratio of 567:1) to find out growth inhibitory percentage of each concentration. ED50 of each combination was determined using probit analysis in IBM SPSS Statistics 27 software. The sum of fractional effective dose 50 (∑FED50) was determined using a specific formula. ∑FED50 indicates the kind of interaction: <1, >1, or =1 means synergistic, antagonistic, or additive. ED50 of ratio-1 (ACAN/Chloroquine weight ratio 189/1), ratio-2 (weight ratio 63/1), ratio-3 (weight ratio 567/1) is 9.196, 7.626, 82.13 mg/Kg BW (<100 mg/Kg BW). ∑FED50 of ratio-1, ratio-2, and ratio-3 is 0.069, 0.113, and 0.414 (far below 1). ACAN-chloroquine exhibits good and marked synergistic antimalarial activity, especially in a ratio-1. It offers a glimmer of hope for future research to combat and ultimately eliminate malaria.
The COVID-19 pandemic had significant physical and psychosocial impacts on nurses. While the initial phases of the pandemic presented considerable challenges, these appear to have diminished over time. This study aimed to explore the lived experiences of Iranian nurses working in clinical settings during the post-pandemic period of COVID-19. This is a qualitative study conducted using the conventional content analysis approach proposed by Granheim and Lundman (2004). This study was conducted at secondary care hospitals in northwest Iran that served as referral centres for multiple provinces during the COVID-19 pandemic. A total of 18 nurses with at least 1 year of clinical experience in COVID-19 wards were recruited using purposive sampling. Participants were diverse in terms of gender, age and educational background. Nurses temporarily transferred from other wards were excluded. 'Return to Normalcy' emerged as the overarching theme, encompassing five main categories: Expansion of Knowledge, Changing Attitudes Toward the Disease, Improved Disease Management, Changing Nature of the Disease and Expansion of Facilities. The findings suggest that, like other crises, the COVID-19 pandemic represents a temporary disruption. However, certain factors can expedite the transition back to normalcy. These include enhanced awareness of the disease, effective crisis management and improved access to diagnostic, therapeutic and protective resources.
This study is aimed at systematically evaluating the accuracy and reliability of dental age (DA) estimation methods and conducting a meta-analysis of studies on different DA estimation methods in Iranian children. A systematic search of English and Persian literature from database inception to March 2024 was conducted across international and national databases to identify eligible studies on DA estimation using radiographs in Iranian children. Studies that used dental radiographs from healthy individuals aged 3-18 years and reported the mean difference (MD) between DA and chronological age (CA) were included. The meta-analysis calculated the MD between dental and chronological age, with 95% confidence intervals (CIs), to assess the applicability of the DA method for estimating CA in the Iranian population. Twenty-seven eligible published articles were included in this study. Demirjian's method overestimated age (overall MD: males: +0.784 years; females: +0.323 years). Among the alternative methods studied in the systematic review, Moorrees and Nolla's methods tended to underestimate age, whereas Cameriere, Smith, and London Atlas'methods tended to overestimate age. Most methods studied consistently overestimated age and should be used cautiously in forensic age estimation, underscoring the importance of tailoring methods such as the Demarjian method for the Iranian population to ensure accuracy and relevance in professional practice. Additional studies employing similar methodologies and focusing on the customization of dental age estimation methods are recommended to improve accuracy and applicability across diverse populations.
Attitudes toward fertility and childbearing play a critical role in reproductive behavior, yet few validated instruments in Iran account for marital status. This study aimed to develop and validate separate, context-specific Farsi versions of the Attitudes toward Fertility and Childbearing Scale (AFCS) for married and unmarried Iranian women. In this methodological cross-sectional study, married and unmarried women were recruited and analyzed as two independent groups. The original 27-item scale underwent forward-backward translation, expert review, and qualitative and quantitative content validity assessment using the Content Validity Index and Content Validity Ratio. Items were adapted for unmarried women to reflect future and hypothetical fertility intentions. Reliability was evaluated through internal consistency and test-retest methods and construct validity was examined using exploratory and confirmatory factor analyses for each group. All analyses were performed in R 4.5.0 with a significance level of 0.05. Content validity indices supported the relevance and clarity of the items, and three items were removed for the unmarried women's version based on expert evaluation. Among married women, the final scale retained 27 items loading on five factors, whereas among unmarried women, a 24-item scale with four factors was identified. Both versions demonstrated acceptable model fit (CFI = 0.946, TLI = 0.938, RMSEA = 0.062), and (CFI = 0.926, TLI = 0.915, RMSEA = 0.070) and high reliability, with Cronbach's alpha values of 0.82 and 0.88 and intraclass correlation coefficients of 0.96 and 0.84 for the married and unmarried versions, respectively. Two psychometrically sound, context-specific versions of the AFCS were developed for married and unmarried Iranian women. While the underlying factor structure was conceptually similar, differences in item content and the number of items underscore the importance of tailoring the scale to marital status when assessing fertility-related attitudes. This tool provides a culturally sensitive instrument that may support research, policy development, reproductive health interventions, and educational or counseling programs aimed at promoting informed fertility decisions in Iran.
BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder among children that significantly affects academic, social, and emotional functioning. Early diagnosis is essential, highlighting the need for reliable and valid screening tools. The Conners’ Rating Scale (CRS) is frequently used for ADHD assessment; however, the psychometric properties of the latest version, the Conners’ Parent Rating Scale-3 (Conners 3-P), have not yet been examined in Iranian clinical populations. METHODS: This study aims to evaluate the reliability and validity of the Conners’ 3-Parent Rating Scale Short Form (Conners 3-P(S)) in a clinical sample of Iranian children aged 6–12 years. The study involved 135 children, including 55 children diagnosed with ADHD and 80 typically developing children. ADHD diagnoses were confirmed via the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL_5). Parents completed the Conners 3-P(S) and the ADHD Rating Scale-IV (ADHD-RS-IV). Reliability was evaluated through Cronbach’s alpha and test‒retest analysis, whereas validity was assessed via Exploratory Factor Analysis (EFA), convergent validity testing, and Receiver Operating Characteristic (ROC) analysis. RESULTS: The EFA identified seven factors, namely, inattention, hyperactivity, learning problems, aggression, parents’ negative attitudes, parents’ positive attitudes, and peer relations, accounting for 56.28% of the variance. The Conners 3-P(S) scale demonstrated strong internal consistency (Cronbach’s alpha = 0.94) and excellent test‒retest reliability (intraclass correlation coefficient (ICC) = 0.90). Convergent validity analysis revealed significant correlations between the Conners 3-P subscales and ADHD-RS-IV scores, particularly for hyperactivity (r = 0.638, p < 0.01). The ROC curve indicated high diagnostic accuracy (area under the curve (AUC) = 0.93), with a cutoff score of 28.50 achieving 93% sensitivity and 70% specificity. CONCLUSIONS: The Conners 3-P(S) is a reliable and valid tool for assessing ADHD symptoms in Iranian children. Its strong psychometric properties support its clinical utility in diagnosing and monitoring ADHD. Future research should investigate its applicability in broader populations. CLINICAL TRIAL REGISTRATION: Not applicable.
Assessing self-compassion as a beneficial psychological feature and a compassionate mindset can only be accomplished with a valid and reliable instrument that facilitates convenient utilization in experimental or therapeutic settings. The State Self-Compassion Scale (SSCS), although possessing the aforementioned characteristics, has not yet undergone psychometric testing in clinical communities. Thus, the current study was undertaken to culturally adapt and psychometrically evaluate the Persian version of this scale in cardiovascular patients. A multicenter methodological study was performed from June to January 2025 in collaboration with Shahroud and Mazandaran Universities of Medical Sciences. Construct validity was evaluated via exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) involving two independent, randomized cohorts of 204 cardiovascular patients. Cronbach's alpha and McDonald's omega coefficients enabled the assessment of internal consistency. The levels of measurement invariance-configural, metric, scalar, and means-were sequentially assessed by sex. After removing items 3, 7, and 9, the EFA with maximum likelihood estimation (MLE) and Promax rotation identified three factors. The CFA also verified the suitable fit of the data with the three-factor model obtained. Values exceeding 0.8 for Cronbach's alpha and McDonald's omega coefficients indicated acceptable internal consistency across all factors. Changes ≤0.010 in the comparative fit index and changes ≤0.015 in the root mean square error of approximation at all levels indicated measurement invariance of the Persian version of the mentioned scale. The satisfactory psychometric characteristics of the Persian version of the SSCS suggest its suitability for assessing this concept in Iranian cardiovascular patients.
This study aims to explore lived experiences of women with human papillomavirus (HPV) in the Iranian socio-cultural context, focusing on their understanding of the disease, associated challenges and the impact of these challenges on health-seeking behaviours. This qualitative study was conducted using Smith's Interpretative Phenomenological Analysis (IPA) method, employing in-depth semi-structured interviews. Community-based recruitment in Tehran, Iran, with data collection conducted in 2025. 10 women aged 24-44 years, diagnosed with HPV, were recruited in Tehran through purposive and convenience sampling. Purposive sampling ensured rich experiential data relevant to the research question, while convenience sampling facilitated access to participants willing to discuss a sensitive topic. None. This was an exploratory qualitative study. Four main themes emerged from this IPA study: (1) the heavy burden of social stigma (unequal moral landscapes, forced loneliness, body shame and loss of femininity); (2) a challenging therapeutic journey (unknown territory, verbal violence and a ray of hope); (3) persistent worries (living with uncertain tomorrow, fear of cancer and broken trust); and (4) from wound to wisdom (becoming an agent again and not being alone in the experience). This qualitative exploration indicates that for women in the Iranian sociocultural context, the impact of HPV may extend into psychosocial domains, involving gendered stigma and identity concerns that can influence health-seeking behaviours. These experiences appear to be shaped by local perceptions of femininity and social norms. While many participants faced significant difficulties, some also reported instances of personal growth and strengthened social support. These insights point to the potential benefit of integrating psychological support into HPV care and enhancing healthcare provider training to address the psychosocial needs of patients. Not applicable (qualitative study).
Adipose tissue-derived stem cells (AdSCs) are widely used for regenerative medicine purposes. There is always a need to accelerate cell proliferation and protect the cells from apoptosis when cell transplantation, especially AdSCs, is targeted. Therefore, this study evaluated the effect of lithium chloride on the proliferation and growth kinetic of AdSCs. The study was undertaken in the Stem Cell Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran, in 2020. Adipose tissue specimens were provided from the abdominal region of a 35-year-old woman. In an in vitro study, human AdSCs were characterized morphologically, by osteo- and adipogenic differentiation properties, and by flow cytometry. They were later treated with lithium chloride to evaluate its effect on cell proliferation and the growth kinetics of AdSCs. 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay investigated lithium chloride effect on the proliferation rate and apoptosis of AdSCs. Quantitative Real Time Polymerase Chain Reaction (qPCR) was carried out to determine the expression of apoptosis genes of Apoptosis Regulator BCL2 Associated X (BAX) and B-cell lymphoma 2 (Bcl-2) protein family. AdSCs showed mesenchymal characteristics, and lithium chloride at a dose of 6 µM had an increasing impact on cell proliferation and protected the cells from apoptosis. A non-significant increase in expression of the Bcl-2 gene (P=0.057) and a significant decrease in BAX gene (P=0.034) expression were visible. Our findings indicate that the addition of lithium chloride to the culture medium enhanced the proliferation of AdSCs and protected them against apoptosis.
Sex differences can influence the effects of opioid and non-opioid analgesics. This study evaluated the antinociceptive effects of L-menthol in male and female mice. This experimental study was conducted in 2024 at Shiraz University of Medical Sciences (Shiraz, Iran). Forty-two BALB/c mice (21 males, 21 females) were randomLy allocated into three groups of seven mice receiving intraperitoneal injection of vehicle 2 mL/Kg, L-menthol 2.5 mg/Kg, and L-menthol 5 mg/Kg. Chemical and thermal nociception were assessed using the acetic acid-induced writhing and the hot plate tests (55 ℃, with a cut-off point of 30 seconds). The number of abdominal writhing counted for 20 min, and the percent of maximum possible effect (%MPE) calculated from the hot plate test response were used as acute pain indexes, respectively. Possible side effects and motor coordination were assessed using video behavior recording and the rotarod test, respectively. Data were analyzed by ANOVA, Tukey's post hoc test, McNamar's, and Kruskal-Wallis tests. Statistical significance was defined as P<0.05. L-menthol 2.5 (P<0.001) and 5 mg/Kg (P<0.001) showed significant antinociceptive effects in both male and female mice in the acetic acid and hot plate tests compared to the control groups. L-menthol 5 mg/Kg in the hot plate (P=0.027) and L-menthol 2.5 and 5 mg/Kg in the acetic acid (P<0.001) tests produced higher antinociceptive effects in males than in females. No significant differences were observed in the rotarod performance and other behavioral tests across groups. L-menthol produced sex dependent antinociceptive effects in mice, highlighting the importance of considering biological sex in clinical pain research.
The Iran intensive care unit registry (IICUR) was established to systematically collect highquality clinical data from critically ill adult patients nationwide. This registry was created to fill a major gap in Iran by providing the first coordinated national intensive care unit (ICU) data system to support benchmarking, quality improvement, and research. This study aimed to assess the registry's data quality, representativeness, and performance using internationally recognized evaluation frameworks. This validation study included consecutive adult ICU admissions (aged≥16 years) recorded in the IICUR between October 2017 and October 2024 across 39 ICUs in 16 hospitals from various regions of Iran. Data quality was assessed based on the directory of clinical databases (DoCDat) and Arts et al., frameworks. Evaluated domains included case representativeness, variable completeness, data validation processes, and coding reliability. Statistical analyses were performed using SPSS software (version 24). Overall, 34,550 ICU admissions were registered (36% surgical, 64% medical). The patient's mean age was 49.4 years, with an average ICU stay of 6.7 days. The registry achieved a median DoCDat score of 3.0 (on a 1-4 scale), indicating strong national coverage, standardized data definitions, and high recruitment completeness. Trauma, neurological, and respiratory disorders were the most common admission causes. ICU and hospital mortality rates were 13.8% and 16.4%, respectively. Despite its strengths, enhanced data validation and postdischarge followup were required. The IICUR demonstrated high methodological standards, providing a robust national platform for benchmarking, policy development, and critical care research in Iran.
Pancreatic adenocarcinoma is one of the most aggressive and lethal cancers, with a poor prognosis primarily due to late-stage diagnosis. Improving the accuracy of pancreatic cancer diagnosis is crucial for enhancing survival outcomes, yet the sensitivity of conventional diagnostic methods remains a significant challenge. This study aims to evaluate the effectiveness of radiomics features extracted from Computed Tomography (CT) imaging, combined with machine learning models, for the detection of pancreatic adenocarcinoma. A retrospective dataset from Baqiyatallah Hospital, Tehran, Iran (2024) of 100 participants (50 with pancreatic adenocarcinoma (primarily stages II-III) and 50 healthy controls) was used. CT images were acquired with a three-phase protocol, and radiomics features were extracted using 3D Slicer software. Three classifiers-Support Vector Machine (SVM), Logistic Regression (LR), and Random Forest (RF)-were employed, with feature selection methods including Recursive Feature Elimination (RFE), Mutual Information (MI), and Least Absolute Shrinkage and Selection Operator (LASSO). Model performance was assessed using accuracy, precision, sensitivity, F1 score, and area under the curve (AUC). The SVM classifier with LASSO feature selection achieved the highest performance, with an accuracy of 0.83 and an AUC of 0.89. LR and RF also demonstrated strong results, with LASSO providing the best feature selection for both classifiers. SHAP analysis revealed that textural features such as gray-level-non-uniformity and run-length-non-uniformity were the most important drivers for distinguishing pancreatic cancer from normal tissue. Radiomics-based machine learning models show promise for improving the diagnosis of pancreatic adenocarcinoma. The combination of LASSO and powerful classifiers such as SVM, LR, and RF offers a robust framework for non-invasive, accurate diagnostic tools.
This study aimed to identify the reasons for inadequate use of PHC services to mitigate the barriers to utilization of PHC services in Saudi Arabia, Oman, Türkiye, Pakistan, Iraq, Thailand, China, India, Egypt, and Iran. This is a systematic review that synthesized the findings of original studies focused on the barriers to the utilization of PHC services. We searched the MEDLINE, Scopus, and Google Scholar databases from February 1, 2000, to December 29, 2023, in English. We conducted content analysis facilitated by MAXQDA-10 software drawn upon Levesque's framework. The screening of articles was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. The initial search retrieved 1,613 results, of which we included 29 studies. In terms of methodology, 17 studies used quantitative methods, eight had qualitative approaches, and the remaining studies utilized mixed or other methods. Among the five groups of identified barriers, ability to perceive, ability to reach, and ability to pay were found to be noteworthy barriers that should be considered by health policymakers. Although the main barriers to inadequate use of PHC are related to people, raising awareness about the need for PHC, improving literacy through understandable training, and establishing mobile facilities in remote areas are appropriate strategies for increasing the use of PHC services.