Medical Journal of the Islamic Republic of Iran最新文献

Background: Stunting or stunted is a condition of chronic nutritional deficiency that remains a problem to this day. Vitamin A and D deficiencies can be one of the causes, although there are still differing findings regarding it. This study aims to investigate the levels of vitamins A, D, and their carrier proteins in relation to the characteristics of the subject.

Methods: This study is an exploratory analytical research with a cross-sectional design from 80 samples of venous blood from children aged 24 to 36 months in Bogor Regency, West Java, Indonesia. Retinol concentrations were quantified utilizing High-Performance Liquid Chromatography (HPLC), whilst retinol binding protein (RBP), 25-hydroxyvitamin D (25OH(D)), and vitamin D binding protein (DBP) were assessed by enzyme-linked immunosorbent assay (ELISA). Data was analyzed using SPSS software with independent t-test/ Mann-Whitney, one-way analysis of variance (ANOVA)/ Kruskal-Wallis, and chi-square tests. Statistical significance was considered at 0.05.

Results: The findings revealed no substantial differences in retinol (P=0.24), RBP (P=0.492), and DBP (P=0.332) between stunted and control children. However, 25(OH)D was markedly elevated in the stunted group relative to the control group (P=0.007). High vitamin D status may correlate with currently breastfeeding and consumption of vitamin D supplements in stunted children. Conversely, the levels of vitamins A and D were significantly lower in the control group who continued to receive breast milk compared to children who had been weaned.

Conclusion: Vitamin A in the stunted group tends to be the same as that of the control group. High levels of vitamin D were found in the group of stunted children. Additional investigation is required into the mechanism of vitamin D metabolism in stunted children.

Background: The internationalization of medical education is essential for preparing healthcare professionals to address global health challenges. In Iran, while this initiative has become a strategic priority, a systematic understanding of research trends in this area remains elusive. Therefore, we quantified the trend of research outputs in this domain by identifying publication trends, influential contributors, and key thematic developments.

Methods: This scientometric study was conducted based on a systematic analysis through the international databases PubMed and Scopus, without time limitation. Using validated strategies, duplicate records were removed, and eligible publications were analyzed using scientometric indicators: publication growth, citation impact, and collaboration networks. Data visualization was performed with VOSviewer to map co-authorship and thematic networks.

Results: A total of 94 publications were analyzed, revealing a significant upward trend in research over the past decade. The average number of citations per publication was 2.32. Thematically, the core research areas included "internationalisation," "faculty mobility," and "higher education," while emerging topics highlighted "artificial intelligence" and "digital entrepreneurship." Tehran and Kerman universities of Medical Sciences emerged as leading contributors, although international collaborations accounted for only 4.3% of the publications.

Conclusion: While research on the internationalisation of medical education in Iran is growing, it is still in its nascent and developmental stage. Strengthening global partnerships, enhancing interdisciplinary collaborations, and prioritizing publications in high-impact journals are critical to increasing the field's global influence. Future research should integrate Iranian initiatives into international networks and focus on cross-regional comparisons to address the existing gaps.

Background: Intimate partner violence (IPV) is a major public health and social concern affecting women globally. In many societies, including Iran, its high prevalence and serious consequences highlight the need for a deeper understanding. This study aimed to estimate the prevalence of intimate partner violence and examine its contributing factors among married women in Tehran, Iran.

Methods: This cross-sectional descriptive-analytical research was conducted from February 2020 to June 2020. A total of 471 individuals were chosen through the convenience sample approach. The study's questionnaire comprised 2 sections: demographic information and Haj-Yahia's (1999) Violence Against Women Scale. We used the Shapiro-Wilk, t test, Mann-Whitney U-test, or χ2 test, and multiple linear regression analysis. All statistical analyses were performed by STATA Version 14 software.

Results: The mean age was 32.7 ± 7.96 years. The prevalence of intimate partner violence was 92.14%. Additionally, the prevalence of psychological, physical, sexual, and economic violence was 91.08%, 46.71%, 41.4%, and 29.3%, respectively. The husband's education level (β = 0.751, 95% CI: 0.115 to 1.387, P = 0.021), husband's addiction (β = 5.671, 95% CI: 2.585 to 8.758, P ≤ 0.001), duration of marriage (β = 0.130, 95% CI: 0.024 to 0.236, P = 0.016), imposed marriage (β = 4.313, 95% CI: 1.480 to 7.146, P = 0.003), and consanguineous marriage (β = -2.651, 95% CI: -4.327to -0.976, P = 0.002) were associated with intimate partner abuse.

Conclusion: Given the high prevalence of intimate partner violence, especially during the coronavirus disease 2019 pandemic, and its association with factors such as education, addiction, and marriage characteristics, these findings highlight the urgent need for increased awareness and policy interventions. The broad definition of IPV used in this study, where any "once or more" response was classified as positive, may have inflated the prevalence. Additionally, due to the pandemic's constraints, the online sampling method likely introduced bias by targeting individuals more likely to report IPV. These factors should be considered when interpreting the findings, and further research with stricter definitions and diverse sampling methods is recommended. Developing screening programs for the early identification of IPV is essential.

Background: Breast cancer is the most common malignancy affecting women, with higher mortality and morbidity. The early identification and diagnosis are the cornerstone of successful treatment and reduction of morbidity and mortality. Mammography is the gold standard screening tool. This work is designed to investigate the potential association between breast cancer and environmental factors related to lifestyle.

Methods: A cross-sectional study was done by collecting data from medical records of patients diagnosed with early diagnosed and well-established diabetes mellitus attending our university hospital; 300 women were screened by mammography for breast cancer. Women with positive results were assigned as the study group (n=39), while women with negative results were assigned as the control group (n=261). All were evaluated by the standard clinical approaches, and a pre-prepared questionnaire was used to collect data about social, environmental, and lifestyle factors. The collected data were submitted to statistical analysis using the Statistical Package for Social Science for Windows, version 20 (IBM, Chicago, USA).

Results: There was significant increase (P<0.001) of body mass index, hormone replacement therapy, age at first and last deliveries age at last baby and wearing tight bra; while there was significant decrease (P<0.001) of menarche, number of living children, mean age of weaning, and breast feeding in the study than the control group. In addition, there was significant increase (P<0.001) of long duration or night shift work, exposure to dangers at work, passive smoking, and use of kohl, drugs, crowding index, old painting, non-cemented ground, TV at bed rooms, pesticide exposure in the study than the control group. With multiple regression analysis, the early menarche, use of hormone replacement therapy, older age at first or last delivery, number of living children, mean age at weaning, breast feeding, tight bra, exposure to dangers at work, passive smoking, use of cosmetics (kohl), persons at home and crowding index remains the significant (P<0.001) associates with detected breast cancer.

Conclusion: This study used mammography as the gold-standard detection tool to identify neoplasia cases and analyze their association with environmental and occupational risk factors.

Background: The emergence and re-emergence of infectious diseases present critical challenges to global public health, resulting in increased mortality rates and substantial economic burdens on healthcare systems. This comprehensive review examines primary healthcare initiatives designed to combat emerging and re-emerging diseases across diverse populations. The objective is to analyze the healthcare system's experiences and derive key lessons that can enhance future responses.

Methods: A comprehensive search of international databases, including PubMed, Scopus, Web of Science, and Embase, was conducted, with data extraction based on the World Health Organization's (WHO) 6-building block framework for health system strengthening.

Results: A total of 57 studies were included in the final analysis. Six major themes emerged from the review: (1) the necessity for coordinated national and international efforts, as well as the cultivation of public trust; (2) the need for innovation and optimal utilization of existing resources to improve community health services and safety; (3) ensuring psychological and financial support for healthcare personnel; (4) maintaining adequate reserves and timely access to essential medications, treatments, and protective equipment; (5) the importance of updated, reliable communication systems to disseminate information effectively; and (6) securing sustainable financial resources for medical supplies, protective equipment, and staff remuneration.

Conclusion: The findings underscore the vital importance of learning from past pandemics to strengthen healthcare systems and enhance preparedness at both national and global levels, especially in light of the growing prevalence of infectious diseases. This review offers a roadmap for improving primary healthcare responses to future public health crises.

Background: Simulation-based learning (SBL) has become a key tool in medical education for developing practical skills and clinical decision-making. Despite the widespread use of this method, there remains a lack of comprehensive reviews of quasi-experimental studies in this area. Therefore, this study aimed to survey the trends and insights from quasi-experimental studies conducted over the past decade on simulation-based learning in medical education.

Methods: This scoping review was conducted using the framework outlined by Arksey and O'Malley, involving 5 key stages: (1) defining the research questions; (2) identifying relevant studies; (3) selecting studies; (4) extracting relevant data; and (5) summarizing and synthesizing the extracted data. Several databases were used to search for articles. These databases include PubMed, Scopus, Web of Science (WOS), ERIC, and Emerald. The search period spanned from January 1, 2014, to December 31, 2024.

Results: In this scoping review, 3052 articles were retrieved. After screening and applying the inclusion and exclusion criteria, 95 quasi-experimental articles were selected for final analysis. Basic medical education dominates research focus, and surgical training and obstetric care had the lowest concentration of studies. Simulation effectiveness is measured via Kirkpatrick's hierarchy, showing improvements in clinical skills and confidence.

Conclusion: This scoping review demonstrated that simulation-based learning is a growing educational method in medical education, contributing to the development of practical and clinical skills. The findings of this study can be beneficial for policymakers, educators, and researchers in medical education to enhance educational programs and utilize this method more effectively. It is recommended that adequate resources and proper training be allocated to maximize the effectiveness of simulation-based learning for both educators and students.

Background: Appropriate weight gain during pregnancy is crucial for maternal and fetal health. This study aimed to identify factors associated with achieving recommended weight gain among pregnant women in Deli Serdang Regency, North Sumatra, Indonesia.

Methods: A cross-sectional study was conducted in 2023 involving 248 pregnant women in the third trimester at five health centers in Deli Serdang Regency, North Sumatra. Data were collected through structured interviews and questionnaires covering demographic factors, knowledge, behavior, and nutritional intake. Weight gain during pregnancy was recommended based on IOM recommendations. Analysis was performed using the Chi-square test and multinomial logistic regression with 95% confidence intervals using SPSS version 26.

Results: The study looked at how gestational weight gain was affected by various factors. Significant factors linked to recommended weight gain included energy, protein, fat, and carbohydrate intake, physical activity, knowledge, perception, and family support (all with p-values less than 0.05). However, maternal age, education, job, income, number of previous births, and smoking habits did not significantly affect weight gain. Pregnant women who consumed enough energy (AOR = 0.188, P = 0.006), low-fat (AOR = 0.204, P = 0.031), and enough carbohydrates (AOR = 0.065, P = 0.045) were less likely to gain too little or too much weight. Physical activity was very important: light (AOR = 0.133, P < 0.001) and moderate (AOR = 0.250, P = 0.001) exercise lowered the risk of gaining less weight than recommended. Low physical activity increased the risk of gaining too much weight (AOR = 3.458, P = 0.039), and was the strongest factor affecting weight gain. Additionally, poor pregnancy planning increased the risk of gaining too much weight (AOR = 2.328, p = 0.048), and low family support raised the risk of gaining too little weight (AOR = 2.571, P = 0.023).

Conclusion: Physical activity is the most influential factor in achieving recommended weight gain; the more active the pregnant woman is, the greater the chance of achieving the appropriate weight.

Background: Molar movement control is a fundamental aspect of orthodontic treatment, particularly in managing anchorage and achieving desired occlusal outcomes. The transpalatal arch (TPA) is a commonly used passive or active appliance designed to provide anchorage reinforcement and facilitate specific molar movements. Despite its widespread application, there is limited consensus regarding its quantitative effectiveness. This systematic review and meta-analysis assesses the effectiveness of the TPA in molar movement during orthodontic treatment.

Methods: An extensive search of major electronic databases was conducted up to the year 2023 to identify studies evaluating the application of the TPA in molar movement. Data regarding study design, participant characteristics, types of TPA used, and numerical outcomes related to molar displacement were systematically extracted. For each outcome, point estimates and corresponding 95% confidence intervals were computed to assess pre- and post-treatment changes.

Results: Fourteen studies underwent detailed qualitative synthesis, with 2 classified as low risk, 7 with some concerns, and 5 as high risk of bias. Nine studies were included in the meta-analysis. The pooled change in mesial movement U6-PTV (mm) for the TPA group was 2.73 (95% CI: 1.90-3.50), vertical movement U6-PP (mm) was 1.24 (95% CI: 0.96-1.52), vertical movement U6-FH (mm) was 1.34 (95% CI: 0.36-2.32), and mesial tipping U6-FH (°) was 2.94 (95% CI: 1.51-4.37).

Conclusion: This review underscores the TPA's versatility and effectiveness as an anchorage device. Evaluating TPA's full range of applications, beyond comparisons with skeletal devices, is crucial. Future research should incorporate three-dimensional digital models and consider pubertal growth stages for more accurate assessments.

Background: Responsiveness is an indicator by the World Health Organization (WHO) to evaluate the performance of health systems on nonmedical expectations of consumers. This study aimed to assess the responsiveness of the health system in Iraq, focusing on urban and rural populations across 6 provinces: Baghdad, Wasit, Karbala, An-Najaf, Babil, and Maysan.

Methods: A cross-sectional study design was employed, involving a total population of 2400 individuals from 400 households in each province. Cluster sampling was utilized to select participants, with data collected using the World Health Organization's "Global Health Survey" questionnaire, which assesses 7 dimensions of health system responsiveness. These data were analyzed using Stata Version 17 to examine statistical relationships, while Microsoft Excel was used to generate visualizations. Descriptive statistics included frequencies and percentages for qualitative variables, and means with standard deviations for quantitative variables.

Results: The findings revealed a high prioritization among respondents for the following aspects of health system responsiveness: quality of facilities (95%), confidentiality of personal information (93.71%), and prompt attention (90.72%). Clarity of communication (61.79%) and autonomy (60.91%) were rated as the most favorable dimensions, while prompt attention (58.94%) and quality of facilities (55.46%) received the lowest ratings. Experiences of discrimination were prevalent, with 34.50% reporting discrimination based on financial status, 26.87% based on social class, and 21.37% based on sex.

Conclusion: The study underscores the urgent need for improvements in health system responsiveness in Iraq, particularly in areas such as prompt response and service quality. Addressing these issues is crucial for enhancing the overall effectiveness and equity of healthcare services in the region.

Background: The social approach to health (TSATH) is necessary for maintaining and promoting health status in societies toward achieving sustainable development goals (SDGs). Despite various attempts, the health sector in Iran is behind in the meaningful implementation of TSATH. This study analyzed the policy of TSATH in Iran.

Methods: This was a qualitative study. The participants in the research included 36 experts and senior managers of health-related organizations in Iran who were selected using a targeted and snowball method. We used 3 methods for data collection: in-depth interviews, focus group discussions, and document review. Inspired by Walt & Gilson's policy triangle and stage heuristic framework, we conducted a thematic analysis and used MAXQDA software Version 19 for data management.

Results: TSATH was an immediate political decision in Iran. We found insufficient social participation and intersectoral collaboration, conflict of interest, inadequate evidence-based policy-making as well as necessary resources among the most important barriers to implementing the policy of TSATH.

Conclusion: Institutionalizing TSATH requires long-term, evidence-based planning and effective participation of all stakeholders. Providing the necessary resources and infrastructure, appropriate context and good steering, accountability, and creating a sustainable livelihood program, especially for the lowest-income deciles of society, are key measures to improve TSATH.