bluuebunny/crossref_metadata_2025 huggingface dataset:
What Factors Explain Low Adoption of Digital Technologies for Health Financing in an Insurance Setting? Novel Evidence From a Quantitative Panel Study on IMIS in Tanzania
Authors: Schuetze Leon , Srivastava Siddharth , Kuunibe Naasegnibe , Rwezaula Elizeus Josephat , Missenye Abdallah , Stoermer Manfred , De Allegri Manuela
Published: February 2023

Background: Digital information management systems for health financing are implemented on the assumption thatdigitalization, among other things, enables strategic purchasing. However, little is known about the extent to which thesesystems are adopted as planned to achieve desired results. This study assesses the levels of, and the factors associated withthe adoption of the Insurance Management Information System (IMIS) by healthcare providers in Tanzania. Methods: Combining multiple data sources, we estimated IMIS adoption levels for 365 first-line health facilities in2017 by comparing IMIS claim data (verified claims) with the number of expected claims. We defined adoption as abinary outcome capturing underreporting (verified<expected) vs. not-underreporting, using four different approaches.We used descriptive statistics and analysis of variance (ANOVA) to examine adoption levels across facilities, districts,regions, and months. We used logistic regression to identify facility-specific factors (ie, explanatory variables) associatedwith different adoption levels. Results: We found a median (interquartile range [IQR]) difference of 77.8% (32.7-100) between expected and verifiedclaims, showing a consistent pattern of underreporting across districts, regions, and months. Levels of underreportingvaried across regions (ANOVA: F=7.24, P<.001) and districts (ANOVA: F=4.65, P<.001). Logistic regression resultsshowed that higher service volume, share of people insured, and greater distance to district headquarter were associatedwith a higher probability of underreporting. Conclusion: Our study shows that the adoption of IMIS in Tanzania may be sub-optimal and far from policy-makers’expectations, limiting its capacity to provide the necessary information to enhance strategic purchasing in the healthsector. Countries and agencies adopting digital interventions such as openIMIS to foster health financing reform areadvised to closely track their implementation efforts to make sure the data they rely on is accurate. Further, our studysuggests organizational and infrastructural barriers beyond the software itself hamper effective adoption.
The Maritime SPOR SUPPORT Unit (MSSU) Bridge Process: An Integrated Knowledge Translation Approach to Address Priority Health Issues and Increase Collaborative Research in Nova Scotia, Canada
Authors: Kontak Julia , Grant Amy , Jeffers Elizabeth , Boulos Leah , Ricketts Juanna , Davies Michael , Hamilton Marina , Hayden Jill A.
Published: February 2023

Background: There is evidence of the benefits of integrated knowledge translation (IKT), yet there is limited research outlining the purpose of a knowledge broker (KB) within this approach. The Maritime SPOR SUPPORT Unit (MSSU) acts as a KB to support patient-oriented research across the Maritime provinces in Canada. The "Bridge Process" was developed by the Nova Scotia (NS) site as a strategy that involves work leading up to and following the Bridge Event. The process supports research addressing priority health topics discussed at the event by stakeholder groups. The objectives of this paper were to (1) describe the outputs/outcomes of this IKT approach; and (2) examine the role of the KB. Methods: Quantitative data were collected from registration and evaluation surveys. Outputs are described with descriptive statistics. Qualitative data were collected through evaluation surveys and internal documents. Data related to KB tasks were categorized into three domains: (1) Knowledge Manager, (2) Linkage and Exchange Agent, and (3) Capacity Developer. Results: The Bridge Process was implemented four times. A total of 314 participants including government, health, patient/citizen, community, and research personnel attended the events. We identified 24 priority topics, with 7 led by teams receiving support to complete related projects. Participants reported improved understanding of the research gaps and policy needs and engaged with individuals they would not have otherwise. Although patients/citizens attended each Bridge Event, only 61% of participants who completed an evaluation survey indicated that they were ‘actively engaged in group discussion.’ The KB’s role was identified in all three domains including Knowledge Manager (eg, defining questions), Linkage and Exchange Agent (eg, engaging stakeholders), and Capacity Builder (eg, research interpretation). Conclusion: The MSSU facilitated an IKT approach by acting as a KB throughout the Bridge Process. This deliberative and sequential process served as an effective strategy to increase collaborative health research in the province.
Political Prioritisation for Performance-Based Financing at the County Level in Kenya: 2015 to 2018
Authors: Waithaka Dennis , Gilson Lucy , Barasa Edwine , Tsofa Benjamin , Orgill Marsha
Published: February 2023

Background: Performance based financing was introduced to Kilifi county in Kenya in 2015. This study investigates how and why political and bureaucratic actors at the local level in Kilifi county influenced the extent to which PBF was politically prioritised at the sub-national level. Methods: The study employed a single-case study design. The Shiffman and Smith political priority setting framework with adaptations proposed by Walt and Gilson was applied. Data was collected through document review (n=19) and in-depth interviews (n=8). Framework analysis was used to analyse data and generate findings. Results: In the period 2015-2018, the political prioritisation of PBF at the county level in Kilifi was influenced by contextual features including the devolution of power to sub-national actors and rigid public financial management structures. It was further influenced by interpretations of the idea of ‘pay-for-performance’, its framing as ‘additional funding’, as well as contestation between actors at the sub national level about key PBF design features. Ultimately PBF ceased at the end of 2018 after donor funding stopped. Conclusion: Health reformers must be cognisant of the power and interests of national and sub national actors in all phases of the policy process, including both bureaucratic and political actors in health and non-health sectors. This is particularly important in devolved public governance contexts where reforms require sustained attention and budgetary commitment at the sub national level. There is also need for early involvement of critical actors to develop shared understandings of the ideas on which interventions are premised, as well as problems and solutions.
Model Choice for Quantitative Health Impact Assessment and Modelling: An Expert Consultation and Narrative Literature Review
Authors: Mueller Natalie , Anderle Rodrigo , Brachowicz Nicolai , Graziadei Helton , Lloyd Simon J , de Sampaio Morais Gabriel , Sironi Alberto Pietro , Gibert Karina , Tonne Cathryn , Nieuwenhuijsen Mark , Rasella Davide
Published: February 2023

Background: Health impact assessment (HIA) is a widely used process that aims to identify the health impacts, positive or negative, of a policy or intervention that is not necessarily placed in the health sector. Most HIAs are done prospectively and aim to forecast expected health impacts under assumed policy implementation. HIAs may quantitatively and/or qualitatively assess health impacts, with this study focusing on the former. A variety of quantitative modelling methods exist that are used for forecasting health impacts, however, they differ in application area, data requirements, assumptions, risk modelling, complexities, limitations, strengths and comprehensibility. We reviewed relevant models, so as to provide public health researchers with considerations for HIA model choice. Methods: Based on an HIA expert consultation, combined with a narrative literature review, we identified the most relevant models that can be used for health impact forecasting. We narratively and comparatively reviewed the models, according to their fields of application, their configuration and purposes, counterfactual scenarios, underlying assumptions, health risk modelling, limitations and strengths. Results: Seven relevant models for health impacts forecasting were identified, consisting of I) comparative risk assessment (CRA), II) time series analysis (TSA), III) compartmental models (CM), IV) structural models (SM), V) agent-based models (ABM), VI) microsimulations (MS), and VII) artificial intelligence (AI)/ machine learning (ML). These models represent a variety in approaches and vary in the fields of HIA application, complexity and comprehensibility. We provide a set of criteria for HIA model choice. Researchers must consider that model input assumptions match the available data and parameter structures, the available resources, and that model outputs match the research question, meet expectations and are comprehensible to end-users. Conclusion: The reviewed models have specific characteristics, related to available data and parameter structures, computational implementation, interpretation and comprehensibility, which the researcher should critically consider before HIA model choice.
Towards A Framework for Implementing Remote Patient Monitoring From an Integrated Care Perspective: A Scoping Review
Authors: Miranda Rafael , Oliveira Mónica Duarte , Nicola Paulo , Baptista Filipa Matos , Albuquerque Isabel
Published: February 2023

Background: Remote patient monitoring (RPM) has been increasingly adopted over the last decade, with the COVID-19 pandemic fostering its rapid development. As RPM implementation is recognised as complex and highly demanding in terms of resources and processes, there are multiple challenges in providing RPM in an integrated logic. Methods: To examine the structural elements that are relevant for implementing RPM integrated care, a scoping review was conducted in PubMed, Scopus, and Web of Science, leveraging a search strategy that combines terms relative to (1) conceptual models and reallife initiatives; (2) RPM; and (3) care integration. Results: 28 articles were included, covering nine conceptual models and 19 real-life initiatives. Eighteen structural elements of RPM integrated care implementation were identified among conceptual models, defining a structure for assessing real-life initiatives. 78.9% of those initiatives referred to at least ten structural elements, with patient education and self-monitoring promotion, multidisciplinary core workforce, ICTs (information and communications technologies) and telemonitoring devices, and health indicators measurement being present in all studies, and therefore being core elements to the design of RPM initiatives. Conclusion: RPM goes far beyond technology, with underlying processes and involved actors playing a central role in care provision. The structural elements identified can guide RPM implementation and promote maturity in adoption. Future research may focus on assessing design completeness, evaluating impacts, and analysing related financial arrangements.
The Hospital of Tomorrow Case Study: Multidisciplinarity, Inclusiveness and Holistic Approaches to Foster Innovation in Complex Organizations
Authors: Gorla Francesca , Borojevic Anja , Gibertoni Chiara , Landi Lorena , Storchi Marco , Fontana Luca , Regmi Jetri , Burmen Barbara , Silenzi Anna
Published: February 2023

Background: This case study describes and analyses an action research initiative undertaken by management, staff and WHO at the St. Orsola-Malpighi Polyclinic in Bologna, Italy. The initiative utilised staff engagement approaches developed during the COVID-19 pandemic to rethink and reshape future development plans. The initiative provides a ‘how-to’ case study for complex health facilities on ways to create similar multisectoral, inclusive and holistic processes in planning structural, functional and organizational solutions for their ‘hospitals of tomorrow’. Methods: The case study utilised an action research approach coordinated by a team of WHO facilitators in close collaboration with the Board of Hospital Directors. Heterogeneous and multidisciplinary working groups were created, with members from different levels of the hospital staff. In the context of facilitated group meetings held weekly over a one-year period, participants were asked to review topics of interest to future plans of the hospital and make recommendations on effective/innovative ways of addressing these in the short and long term. Working groups focused on different challenges. Results: The initiative was successful in creating and sustaining broad staff engagement in the future planning processes. 80% groups maintained high staff participation throughout the entire project year. Participating staff reported enhanced communication and cooperation between departments represented in different groups. 87% of the proposed plans suggested by the working groups were approved by the Board for implementation. Conclusion: Key factors contributing to the high approval rate of plans, strong engagement record of staff and enhanced cooperation between involved departments; included: multisectoral/cross hierarchal staff involvement, group attention to defining time-bound contextual goals, flexible implementation monitoring approaches, personnel skills and profiles of participants, direct and open communication at all levels and times, member commitment and clear exit strategy. The case study is presented as a model to stimulate similar actions in other complex health care facilities.
Early Career Outcomes of Embedded Research Fellows: An Analysis of the Health System Impact Fellowship Program
Authors: Kasaai Bahar , Thompson Erin , Glazier Richard H. , McMahon Meghan
Published: February 2023

Background: This descriptive study reports the early career outcomes of postdoctoral fellows who completed a novel embedded fellowship training program, the Canadian Institutes of Health Research (CIHR) Health System Impact (HSI) Fellowship. The program was designed to support impact-oriented career paths of doctoral graduates, build research capacity within health system organizations, and help to advance learning health systems in Canada. Methods: Employment of fellowship alumni upon completion of the program were tracked using internet searches of publicly accessible online sources and complemented with program survey data. Results: Descriptive analyses show that all 87 eligible alumni included in the study are currently employed (100% of 87), with 92% employed in Canada. Their employment spans several sectors, including in academic (37%), public (29%), healthcare delivery (17%), and private (14%) sectors. Altogether, 32% of alumni held hybrid roles with an affiliation in academia and another sector. The most common position types were senior scientist (42%), professorships (18%), and director, manager or administrator roles (12%). Program reporting data indicate that these employment outcomes are generally consistent with the group’s career aspirations reported at the start of the fellowship program, and that the program receives high ratings from fellows in the extent it is believed to support their career preparedness and readiness (4.49 out of 5). Conclusion: We find that HSI Fellow alumni are employed mostly in research-related roles in a range of sectors including, but not limited to academia, that they positively perceive the program’s success in elevating their career readiness and potential to make an impact – suggesting that the program may help equip fellows with the skills, readiness and networks for a broad array of employment sectors and roles. The findings are a promising signal of the demand for research talent and the growing capacity for learning health systems in Canada.
The Fentanyl System Shock – Are There Lessons to Learn From the COVID-19 System Shock Framework?; Comment on "The COVID-19 System Shock Framework: Capturing Health Sys-tem Innovation During the COVID-19 Pandemic"
Authors: Meyer Maximilian , Westenberg Jean N. , Krausz R. Michael
Published: February 2023

The Sydney Children’s Hospitals Network addressed the challenges of the COVID-19 pandemic by implementing innovative changes which made their health system resilient and responsive. For other health care systems, there are important takeaways. In the US and Canada, an urgent widespread response is needed to address the overdose crisis, driven by potent synthetic opioids (i.e., fentanyl and its derivates). We project the COVID-19 System Shock Framework on to the North American healthcare systems and suggest a Fentanyl System Shock Framework, which provides a framework for necessary changes and innovations to address the overdose crisis. To become resilient to the fentanyl system shock, core components as well as overarching values, health policy, and online technologies need to be adapted to reduce the death count and meet the evolving needs of marginalised individuals who use opioid. Future research should focus on scientifically assessing such implementations to guide evidence-based decision making.
A Historical Legacy for Universal Health Coverage in the Republic of Korea: Moving Towards Health Coverage and Financial Protection in Uganda Comment on "Health Coverage and Financial Protection in Uganda: A Political Economy Perspective"
Authors: Kim Chun-Bae
Published: February 2023

Since 2001, when Uganda abolished user fees to improve the accessibility of healthcare, out-of-pocket costs still account for 42% of total health expenditure. Even if universal health coverage (UHC) is achieved on the demand-side, government authorities face political and economic challenges due to soaring burden of diseases. Therefore, this study aimed to re-analyze the implementation process according to three pillars by World Health Organization (WHO) based on Korean UHC-related articles. In terms of breadth, the national health insurance (NHI) in Korea UHC was established from 1977 for employees to 1989 for self-employed. In terms of depth, benefit packages in Korea UHC have expanded from essential medical services to expensive care (ultrasono, computerized tomography, etc) including benefit period. Finally, in terms of height of coverage, the government has tried to relieve financial burden of households with catastrophes and enhance benefit plan for major diseases till now. This historical legacy for UHC in Korea can pose lessons to policy-makers in developing countries including Uganda and Ghana.
Health System Resilience as the Basis for Explanation Versus Evaluation; Comment on "The COVID-19 System Shock Framework: Capturing Health System Innovation During the COVID-19 Pandemic"
Authors: Topp Stephanie M.
Published: February 2023

The onset and impacts of COVID-19 have prompted attention to national health system preparedness for, and capacity to adapt in response to, public health emergencies and other shocks. This preparedness and adaptive capacity are often framed as ‘health system resilience’ a concept previously associated more with assessments of health systems in conflict-affected and fragile states. Yet health system resilience remains a slippery concept, defined and applied in multiple ways. Reflecting on the Hodgins et al’s The COVID-19 System Shock Framework: Capturing Health System Innovation During the COVID-19 Pandemic, this article restates the limitations of health systems resilience as a concept capable of anchoring evaluative assessments of health system performance but stresses its value in the context of explanatory research investigating how and why health systems adapt, with due attention to the power of actors’ whose choices inform the nature and direction of change.
The Role of Registries in Neurotrauma Research: Translating Data into Health Policy That Enhances Patient Care; Comment on "Neurotrauma Surveillance in National Registries of Low- and Middle-Income Countries: A Scoping Review and Comparative Analysis of Data Dictionaries"
Authors: Thango Nqobile , Baticulon Ronnie E. , Lippa Laura
Published: February 2023

The paucity of robust neurotrauma data is felt most in regions that experience a higher burden of traumatic brain injury (TBI). The scoping review done by Barthélemy et al. provides insight into the current state of national registries in low- and middle-income countries (LMICs) while also exploring the tools required to standardize data collection. In this commentary, we reflect on the barriers to data collection (i.e., creation and maintenance of a TBI registry) and explore how registries can aid both scientific output and preventative public awareness campaigns that may pave the way to improved health policy and social change that avert mortality and morbidity from TBI.
Unpacking Contexting and Institutionalizing as Complex Sustaining Practices Comment on "Sustaining Knowledge Translation Practices: A Critical Interpretive Synthesis"
Authors: Meier Ninna
Published: February 2023

This article discusses the work of Borst et al in which they suggest ‘sustaining work’ as a term that covers the efforts of actors to sustain the use of health research in policy and practice through three practices. I suggest that two of these, contexting and institutionalizing, need to be further unpacked to understand how and why they are important for sustaining work in knowledge translation (KT). To contribute here, I discuss KT as processes of organizational change that occurs within and across organizations, often involving actors with different views on and approaches to the use of health research in policy and practice. These actors will likely have very different understandings of what the context for using research is and they are likely be members of competing or conflicting institutions. Future research needs to take such elements into account to improve our understanding and practice of sustaining work.
Health Preparedness and Narrative Rationality: A Call for Narrative Preparedness
Authors: Engebretsen Eivind , Baker Mona
Published: February 2023

This conceptual paper argues the need for narrative preparedness, understood as the ability to engage and empathize with peoples’ stories and the values they encode, assess them based on the universe in which people live, and acknowledge the narrative rationality of each story – even when it conflicts with the rationality of science. Expanding ‘health preparedness’ to encompass ‘narrative preparedness’ complements the ideals of patient centeredness, which are sometimes betrayed when implemented into concrete decisions because the rationality of science that underpins medical practice fails to make sense of patients’ stories. We outline the central tenets of narrative preparedness and demonstrate its relevance by discussing various responses to mainstream discourses on COVID-19 as a case in point. We discuss and further develop Fisher’s narrative paradigm, which provides a model that complements traditional, scientific rationality with attention to narrative rationality and a radical democratic ground for health political critique. Applying the narrative paradigm to authentic examples of vaccine hesitancy and anti-vaccination demonstrates how closer attention to the way narratives are assessed by different constituencies might help us mitigate some of the sources of resistance and misunderstanding that continue to plague public communication about important medical issues such as pandemics. Health authorities must acknowledge and engage with the stories people believe in and their reasons for doing so. The crucial question for the success of health policy interventions is not only ‘what are the facts’ but ‘how do these facts make sense to people, and why’. To be prepared for the next pandemic, health professionals must learn to engage with people’s stories and the processes by which they come to be understood and assessed differently by various constituencies.
Comparative Politics, Political Settlements, and the Political Economy of Health Financing Reform; Comment on "Health Coverage and Financial Protection in Uganda: A Political Economy Perspective"
Authors: Croke Kevin
Published: February 2023

Nannini et al (2021) analyze barriers to national health insurance reforms in Uganda using a political economy approach primarily rooted in stakeholder analysis. This approach is valuable,not only for its clear description of the interest-based politics at play, but also for its extension of stakeholder analysis to include consideration of the role of ideas and institutions in the policy process. However this analysis, and others like it, could be further strengthened by adding insights from two different sources. The first is the comparative politics literature on the Uganda regime. The second is a related approach while analyzes public service delivery in the context of a country’s underlying "political settlement." Stakeholder-based approaches to health financing reform emphasize interest group conflict about the contents of policy reforms. By contrast, these complementary approaches imply distinct barriers to successful implementation of national health insurance in Uganda, rooted in the regime’s deinstitutionalization and the personalization of politics and resource allocation. They also suggest possible leverage points or avenues for progress which differ from those suggested by stakeholder analysis.
The Instrumental Role of Public and Stakeholder Engagement to the Success of Sugary Drinks Taxes; Comment on "Understanding Marketing Responses to a Tax on Sugary Drinks: A Qualitative Interview Study in the United Kingdom, 2019"
Authors: Murukutla Nandita , Cotter Trish , Kotov Alexey
Published: February 2023

Strong sugary drink taxes are effective at reducing sugary drinks consumption. In response, the sugary drinks industry employs various marketing strategies to undermine the taxes to protect and maintain its customer base. In their recent article in this journal, Forde et al. present a framework for understanding how sugary drinks companies use marketing for this purpose. In this commentary, we reflect on this framework by drawing from recent experiences of sugary drinks industry marketing responses. Further, we review the global evidence on the instrumental role that strategic communication can play in protecting strong taxes from industry responses. We make a case for strategic communication as a vital tool in promoting and protecting sugary drinks tax proposals, both prior to and after their introduction.
Post-Pandemic Economics and Health Equity; Comment on "Ensuring Global Health Equity in a Post-pandemic Economy"
Authors: Chahuán-Jiménez Karime
Published: February 2023

This article aims to compare the foundations of the post-pandemic economy and its impact on health equity, according to Labonté (2022) with the economics theory. The methodology developed is based on bibliometrics analysis, the documents, and specifications for a cluster of concepts, allowing deepened exposure of Labonte (2022), complementing with the latest publications on the post-pandemic economy. Finally, the results agreed with Labonté1 about to economic development for achieving an economy that allows health equity considering sustainable development and the possibility of achieving the livelihood of Green New Deal as a basis.
Evaluating Social Protection Policies With an Implementation Science Framework: India’s Direct Benefit Transfer for Tuberculosis; Comment on "Does Direct Benefit Transfer Improve Outcomes Among People With Tuberculosis? – A Mixed-Methods Study on the Need for a Review of the Cash Transfer Policy in India"
Authors: Schraufnagel Ann , Shete Priya B.
Published: February 2023

Addressing the social and structural determinants of tuberculosis (TB) through social protection programs is a central feature of global public health policy and disease elimination strategies. However, how best to implement such programs remains unknown. India’s direct benefit transfer (DBT) program is the largest cash transfer program in the world dedicated to supporting individuals affected by tuberculosis (TB). Despite several studies aimed at evaluating the impact of DBT, many questions remain about its implementation, mechanisms of action, and effectiveness. Dave and Rupani’s mixed-methods evaluation of this program previously published in this journal offers valuable insights into the strengths and limitations of the DBT program in improving TB treatment outcomes. Their results also provide an opportunity for demonstrating how systematically collected data may be further analyzed and presented using implementation science, a field of study using methods to promote the systematic uptake of evidence-based interventions to support sustainable program scale-up.
Should We Worry About Spillover Effects of Sugar Sweetened Beverage Taxation Policies? Comment on "Understanding Marketing Responses to a Tax on Sugary Drinks: A Qualitative Interview Study in the United Kingdom, 2019"
Authors: Hangoma Peter , Chewe Mwimba
Published: February 2023

Taxes on sugar sweetened beverages (SSBs) have been widely implemented and heralded as a panacea in reversing the growing burden of non-communicable diseases (NCDs). Using a qualitative research methodology, Forde et al explored how sugary drink companies respond to changes in taxation positing that relative effectiveness of sugar taxes will not only depend on how prices are affected, and how consumers respond, but also how producers respond by reformulating their products or engaging in counteractive marketing strategies. They argue that these responses may undermine the public health goal. We discuss some of the key issues that arise in their paper and conclude that company responses may not be sufficient in undermining the public health goal, and that consumption of sugary drinks fall after imposition of taxes, though demand is inelastic. We argue that inelasticity of demand for SSB may require a combination of interventions to sufficiently reduce excess consumption of sugar drinks.
Photobiomodulation Therapy as an Adjuvant Treatment of Cervicofacial Liposuction Complications
Authors: Boaro Leticia , Pimentel Angelica , Muknicka Daniela , Bordalo Sumaya Takan , Campos Luana
Published: February 2023

Introduction: Cervical suction lipectomy (CSL) procedures result in practically inevitable complications after the operation, such as facial edema and bruise. Photobiomodulation therapy (PBMT) can be used for analgesia, modulation of inflammatory processes, and improved tissue healing. Case Report: We have reported two cases of patients in which this therapy was used to manage complications-related CSL. As they had already been medicated and still had these side effects, the PBMT was proposed for local analgesia, nerve repair, and modulation of the inflammatory process. Within 72 hours after a single PBMT session, there was an important reduction in the severity of all situations. Conclusion: PBMT seems safe and effective in managing pain and edema-related CSL.
Experimental Analysis of Vaginal Laxity in Rats Treated With a Combination of Er:YAG Fractional Lasers and AMSC-MP
Authors: Setyaningrum Trisniartami , Listiawan M. Yulianto , Santoso Budi , Prakoeswa Cita Rosita Sigit , Widjiati Widjiati , Tjokroprawiro Brahmana Askandar
Published: February 2023

Introduction: Vaginal laxity, a symptom of pelvic floor dysfunction observed in women, has many negative biological and psychological impacts. Laser treatments and stem cell-based therapies are emerging therapeutic methods for treating this condition. This study aimed to determine changes in vaginal laxity in model rats using a combination therapy of erbium-doped yttrium aluminium garnet (Er:YAG) fractional lasers and topical treatment with amniotic membrane stem cell metabolite products (AMSC-MP). Methods: The experimental animal population comprised 36 female white rats (Rattus norvegicus; 2-day-post-vaginal-delivery rats) allocated into the following four groups (n=9): K1, untreated two-day-post-vaginal-delivery rats; K2, two-day-post-vaginal-delivery rats treated with topical gel without AMSC-MP; P1, two-day-post-vaginal-delivery rats treated with Er:YAG fractional lasers and topical gel without AMSC-MP; P2, two-day-post-vaginal-delivery rats treated with Er: YAG fractional lasers and topical gel containing AMSC-MP. Immunohistochemical (IHC) examination was carried out for the expression and activity of heat shock protein 70 (HSP-70), collagen-1, tissue inhibitors of metalloproteinase 1 (TIMP-1) and matrix metalloproteinase 1 (MMP-1), as well as vaginal mucosal thickness. Results: There was a significant difference (P<0.05) in the expression of HSP-70 among all groups except K2 and P1 (P>0.05); there was no significant difference in type I collagen and TIMP-1 expression between the groups (P>0.05); there was a significant difference (P<0.05) in MMP-1 activity, with the activity in the K2 group (5.79±0.83) being higher than that in the P1 group (4.44±1.82) and that in the K1 group (5.74±1.03) being higher than that in the P2 group (4.24±1.55). Also, there was a significant difference in the thickness of the vaginal mucosa in all groups except K2 and P1 (P>0.05). Conclusion: Er:YAG fractional laser and AMSC-MP combination therapy improved vaginal laxity in model rats by increasing Hsp70 expression and vaginal mucosal thickness and decreasing MMP-1 activity.
Diode Laser Irradiation Effects on Miniscrew Stability and IL-1β and TGF-β1 Levels: A Split-Mouth Randomized Controlled Clinical Trial
Authors: Yassaei Soghra , Kordi Somayeh , Aghili Hosseinagha , Zavar reza Javad , Ebrahiminik Zahra
Published: February 2023

Introduction: This study aimed to assess the effect of low-level laser therapy (LLLT) on miniscrew stability and concentrations of interleukin-1β (IL-1β) and transforming growth factor-beta (TGF-β1) in peri-miniscrew crevicular fluid in the course of orthodontic treatment. Methods: This randomized split-mouth double-blind clinical trial evaluated 18 patients requiring anterior retraction along with maximum anchorage. Miniscrews were placed between the maxillary second premolar and first molar. A diode laser was irradiated with a 980-nm wavelength and 100-mW output power in continuous-wave mode at four time points: T0 (1 hour after miniscrew placement), T1 (1 week later), T2 (at 1 month) and T3 (at 3 months) in one quadrant of the maxilla (laser group). The other quadrant of the maxilla underwent the pseudo-application of the laser (control group). The primary stability of miniscrews was measured by Periotest M and reported as Periotest value (PTV). Also, at each time point, samples were collected from the peri-miniscrew crevicular fluid one hour after laser irradiation to assess the concentration of IL-1β and TGF-β1. Results: The mean PTV (inverse of the stability) was smaller in the laser group compared with the control group at all time points; this difference was significant at T2 and T3. The mean concentration of IL-1β in the laser group was lower than that in the control group at all time points, and this difference was significantly remarkable at T0 and T3. The mean concentration of TGF-β1 in the laser group was lower than that in the control group at T0, T1 and T3; however, the difference was not statistically significant. Conclusion: The current results supported the efficacy of LLLT in increasing the miniscrew stability and decreasing the level of IL-1β pro-inflammatory cytokine.
An overview on acute kidney injury following COVID-19
Authors: Hajian Mohammad Reza , Momenzadeh Mahnaz
Published: February 2023

COVID-19 is a newly emerging infectious disease which first described in December 2019 Wuhan, China. The disease rapidly spread through the world and after a short time of emerging, the World Health Organization (WHO) declared COVID-19 as a pandemic. Since, respiratory system is the main organ affected by COVID-19, the kidney could be involved as well. Given the importance of the kidney involvement in COVID-19, in this study we tried to evaluate and describe the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on kidney.
Clinical characteristics of hospitalized patients with COVID-19: Results from multiple-center experience in Ardabil, Northwest of Iran
Authors: Matin Somaieh , Ghobadi Hassan , Safarzadeh Elham , Torabi Marjin Leila , Dadkhah Masoomeh
Published: February 2023

Introduction: Since December 2019, coronavirus disease 2019 (COVID-19) has rapidly expanded to cause a worldwide pandemic. Objectives: We aimed to report the clinical characteristics of infected patients at the first wave in northwest of Iran. Patients and Methods: In this study, the epidemiological, demographic, clinical, and laboratory data of 1152 confirmed patients with COVID-19 who were admitted to two main hospitals at the first outbreak in northwest of Iran were collected and analyzed. Results: The most common clinical manifestations at onset were cough (65.8%), dyspnea (40.2%), myalgia (37.8%), and fever (63.4%), loss of appetite (47%), chest pain (38.6%), and headache (49.4%). While the less common were agitation (17.3%), vomiting (22.2%), diarrhea (16.7%), and nausea (24.3%). Laboratory data indicated significant correlation between lymphocyte counts with the severity of the disease based on O2 saturation. Conclusion: Overall, assessment the clinical data of COVID-19 patients play a crucial role in understanding the outbreak of novel viral pneumonia, which helps to identify high risk individuals with COVID-19.
Exploring Managers’ Experiences of Hospital Disaster Preparedness: A Qualitative Study
Authors: Mehri Saeid , Habibi Soola Aghil , Mohammadi Mohammad-Ali , Hamidkholg Gholamreza , Dadkhah Behrooz
Published: February 2023

Background: Preparedness is one of the important and effective pre-crisis management stages and involves all actions and programs that enable the organization to respond quickly and effectively in critical situations. To this end, this study aimed to explore the experiences of crisis managers and experts in hospital disaster preparedness. Methods: This qualitative study was conducted using conventional content analysis in 2019. The research population included hospital managers and crisis specialists in Ardabil Province. The participants were 14 managers and crisis specialists who were selected using purposive sampling. The data were collected through semi-structured interviews and analyzed using Griesheim and Landman’s qualitative content analysis approach. Results: The analysis of the data revealed four main categories including management and planning, infrastructural development, human resources, and intersectoral coordination. Conclusion: The findings of the present study highlighted the significance of preparedness for emergencies, management and planning, having codified instructions, and implementation and evaluation to increase the preparedness of hospitals to deal with emergencies.
Lived Experiences of Mothers with Attention-Deficit/ Hyperactive Children: A Phenomenological Approach
Authors: Abbasalizadeh Ranjbari Reza , Badri Rahim , Esmailpour Khalil , Nagi Agdasi Ali
Published: February 2023

Background: This study aimed to investigate the lived experiences of mothers with attention-deficit/ hyperactive children. Methods: The present qualitative descriptive study was conducted based on a phenomenological approach that investigated the experiences of primary caregivers of attention-deficit/ hyperactive children. The population of the study included mothers of attention-deficit/hyperactive primary school students in Tabriz. A total of 13 children were selected using purposive sampling. Data were collected through face-to-face, in-depth, and semi-structured interviews with participants. The interviews were conducted in schools and the Hasti Counseling Center. Moreover, Smith’s cognitive phenomenological method was used to analyze the data. Results: The analysis of the data revealed 4 main themes and 25 subthemes including emotional responses (depression, loneliness, anger and rage, embarrassment, desire to have a calm child, stress, confusion, remorse, regret, frustration, anxiety and dread), behavioral responses (self-blame, frequent crying, shouting, aggression, trying to control oneself), physical responses (palpitation, feeling hot water drops on one’s head), and cognitive responses (feeling inhuman, isolation, feeling guilty, embarrassed, and blameful, problems in pregnancy, insanity, feeling hyperactive due to inability to control oneself, feeling accused of lying). Conclusion: The results of this study will pave the way for further research in the field of mental health interventions for mothers of attention-deficit/hyperactive children. Accordingly, it is essential to design and evaluate the effectiveness of psychotherapy interventions that can cover various dimensions of the problems of this group of mothers.
Cancer Stigma and its Consequences and Influencing Factors in Iranian Society: A Qualitative Study
Authors: Hasan Shiri Fatemeh , Mohtashami Jamileh , Manoochehri Houman , Rohani Camelia
Published: February 2023

Introduction: Stigma refers to a set of negative attitudes, beliefs, behaviors, and thoughts in dealing with a person who has a chronic disease or some health problems. Cancer is one of the diseases associated with stigma. Stigma causes harmful psychosocial effects for the affected person and family members and is considered an obstacle in disease screening and control programs. Accordingly, this study aimed to explore the nature of cancer stigma and its consequences and influencing factors in Iranian society. Methods: A total of 14 people including cancer patients, their families, and healthcare staff participated in this qualitative study. The participants were selected using purposive sampling and the data were collected through semi-structured interviews. The resulting data were analyzed using conventional content analysis and with MAXQDA software (version 10). Results: The content analysis revealed four themes including cancer as a terrifying and pitiful disease, identity crisis/psychosocial disintegration, disease complexity, and public unawareness and community problems. Conclusion: There are many negative beliefs and stereotypes about cancer and affected people, which are exacerbated by public unawareness and lack of sufficient information about cancer, as well as lack of comprehensive support. These beliefs and stereotypes adversely affect the quality of life of affected people. Following the findings of the study, some interventions need to be implemented to reduce stigma, increase the quality of life, and improve the treatment process for cancer patients.
The Effectiveness of Dream Analysis in Reducing Idiopathic Nightmares by Hermeneutic Single Case Efficacy Design (HSCED)
Authors: Bagheri Masoud , Arabnejad Khanuki Maryam
Published: February 2023

Background: Nightmare is a prevalent parasomnia associated with various forms of psychological distress in both clinical and general populations. This study aimed to explain the experiences of a client regarding the effects of nightmares and effectiveness of dream analysis treatment on idiopathic nightmares. Methods: This qualitative study was conducted on a 34-year-old woman who participated in 8 sessions of dream analysis treatment. The client was diagnosed with nightmare disorder based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for nightmare. The hermeneutic method was used to collect and analyze quantitative and qualitative data. This study utilized a simple method for hermeneutic analysis that requires only one person while maintaining research validity. Results: The findings of this study showed the frequency of nightmares decreased during the treatment. The client changed significantly during the treatment, and the dream analysis was responsible for this change. According to Bohart’s grid, there was 72% certainty of change in the client and 87% certainty that improvements were due to therapy. Useful therapeutic factors included analyzing the hidden meaning of nightmares, expressing emotions, self-awareness, and reducing helplessness. Conclusion: The results of the interventions showed that treatment processes made changes in the client that were unexpected and important to her and these changes would not have occurred without the treatment. This method, in addition to exposing the person to the content of the nightmare, leads to the discovery and decoding of the content of the nightmares and understanding of their message to resolve conflicts.
A Systematic Review of Nursing Theories in Pediatrics Settings
Authors: Geçkil Emine , Sabetsarvestani Raheleh , Hadianshirazi Zahra
Published: February 2023

Background: The only way to present nursing as a profession, in its own right, is to develop its theories. The pursuit of further clarity may enable pediatric nurses to plan for further studies and use appropriate theories in practice. This needs an inquiry to start with a review of existing literature from various research fields to clarify key knowledge and gaps. Therefore, this study aimed to review studies on nursing theories in pediatric settings. Methods: The study design was a systematic review with a qualitative synthesis approach. The inclusion criteria were articles written in English published from 2000 to 2020, focusing on developing a new theory or using previous nursing theories in pediatric settings, in PubMed, Scopus, Ovid, and EBSCO databases. The exclusion criteria were the articles written in languages other than English, settings other than pediatric, and not finding the full text. The qualitative synthesis was used to integrate the data using MAXQDA10. Results: The results of data analysis showed 24 new theories were developed by the grounded theory approach regarding parenting, nurse-family interaction, and improving nursing care. Moreover, the theories of some nursing scholars, such as Orem and Watson, were mostly used as a framework in studies on cancer (18.96%) and critically-ill children, especially adolescents (21.81%). Conclusion: This study clarified the trend of nursing theories in pediatric settings and highlighted the gaps in the literature, over the last two decades. The study provides implications for future studies regarding nursing theories in pediatric settings and, encourages nurses to strive in the journey of professionalization by utilizing and developing more nursing theories. Future studies can focus on other aspects, such as primary and tertiary prevention in different age groups or the most prevalent diseases in children.