Explore the vast range of titles available.

Computed tomography (CT) scan is a common imaging technique used to evaluate the severity of a head injury. The overuse of diagnostic interventions in the health system is a growing concern worldwide. Objectives: The aim of this systematic review is to investigate the rate of CT scan overuse in cases of mild head injury. Eligibility criteria: We encompassed observational studies-either designed as cohort, case-control, or cross-sectional investigations-that reported on CT scan overuse rates for mild head injuries. Studies had to be published in peer-reviewed, English-language sources and provide full content access Information sources: Web of Sciences, Scopus, Medline via PubMed, the Cochrane Library and Embase were searched from inception until April 1, 2023. Studies were included if reporting the overuse of CT scans for mild head injuries using validated criteria. Risk of bias: We used the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool to evaluate the risk bias assessment of included studies. Two independent reviewers evaluated the eligibility of studies, extracted data, and assessed study quality by using the Newcastle-Ottawa Scale. Synthesis of results: Overuse estimates were calculated using a random-effects model. Subgroup analyses were performed to investigate any sources of heterogeneity. Point rate of overuse of CT scans for mild head injuries was the main outcome measured as percentage point estimates with corresponding 95% CIs. Included studies: Of the 913 potentially relevant studies identified, eight studies were selected for the final analysis. Synthesis of results: The pooled rate of CT scan overuse in patients with mild head injury was found to be 27% [95% CI: 16-43; I2 = 99%]. The rate of CT scan overuse in mild head injury cases varied depending on the criteria used. The rate of CT scan overuse was 37% [95% CI: 32-42; I2 = 0%] with the Glasgow Coma Scale (GCS), 30% [95% CI: 16-49; I2 = 99%] with the Canadian computed tomography head rule, and 10% [95% CI: 8-14; I2 = 0%] with the Pediatric Emergency Care Applied Research Network criterion (PERCAN). Based on subgroup analyses, the rate of CT scan overuse in mild head injury cases was observed to be 30% with the Canadian computed tomography head rule criterion, 43% with the National Institute for Health and Clinical Excellence criterion, and 18% with the New Orleans criterion. Limitations of evidence: The restricted number of included studies may impact generalizability. High heterogeneity was observed, leading to subgroup analyses based on age, assessment criteria, and study region. Absent data on overuse causes hinders drawing conclusions on contributing factors. Furthermore, this study solely addressed overuse rates, not associated harm or benefits. Interpretation: The overuse of CT scans in mild head injury patients is concerning, as it can result in unnecessary radiation exposure and higher healthcare costs. Clinicians and policymakers should prioritize the implementation of guidelines to reduce unnecessary radiation exposure, healthcare costs, and potential harm to patients. The study protocol of this review was registered in PROSPERO under the identification code CRD42023416080. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023416080.

Background Tinea pedis , commonly known as athlete’s foot, is a fungal infection caused by dermatophytes, affecting the skin of the feet. It is prevalent in various populations, but military personnel are particularly vulnerable due to their unique environmental and behavioral factors. These include living in close quarters, exposure to humid conditions, and wearing tight, non-breathable footwear for prolonged periods. This systematic review and meta-analysis aim to estimate the global prevalence of tinea pedis among military personnel and explore factors contributing to its high occurrence in this population.  Methods A comprehensive literature search was conducted in multiple databases, including PubMed, Scopus, and Web of Science, for studies published in English up to 21 March 2025. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies, evaluating aspects such as the selection of participants, comparability, and the assessment of exposure. The prevalence rates were pooled using a random-effects model, and heterogeneity among studies was evaluated. Studies employing various diagnostic methods, including microscopy and fungal culture, were analyzed to identify variations in prevalence estimates. A subgroup analysis was performed based on geographic regions to explore the influence of environmental factors on prevalence.  Results A total of 25 studies, involving military personnel from different regions, were included in the analysis. The pooled prevalence of tinea pedis among military personnel was estimated at 17% (95% CI: 12–23%). Subgroup analysis revealed regional variations, with the highest prevalence observed in the Americas and Australia, where hot and humid climates are prevalent. The lowest prevalence was observed in European studies, which may be attributed to milder climates. Studies using both microscopy and fungal culture reported higher prevalence rates (20%) compared to those relying solely on microscopy (9%).  Conclusion Tinea pedis remains a significant health concern among military personnel, with a global prevalence of 17%. Military environments, characterized by high physical activity, shared living conditions, and poor foot hygiene practices, exacerbate the risk of fungal infections. Preventive strategies, including improved foot hygiene, better footwear design, and enhanced access to antifungal treatments, are essential to reduce the prevalence of tinea pedis in military settings.

ObjectivesTo develop a context-specific health technology assessment (HTA) framework tailored to the healthcare needs and system of Iran, to improve evidence-based decision-making, optimise resource allocation and support progress towards universal health coverage.DesignA mixed-methods Delphi consensus study conducted using a three-phase, sequential approach: document review, qualitative focus group discussions and Delphi consensus rounds. The study reporting follows the Accurate Consensus Reporting Document guideline to ensure transparent reporting of consensus methods.SettingA national-level study conducted in Iran’s healthcare system between January 2023 and March 2024, including perspectives from public and academic institutions, policy bodies and patient organisations.ParticipantsThe study involved 18 purposively selected stakeholders in three focus group discussions, including policymakers, healthcare professionals, researchers and patient representatives. Subsequently, 20 HTA experts participated in three iterative Delphi rounds to refine and reach consensus on the framework components.Outcome measuresIdentification of core components and operational steps required to develop and implement a comprehensive HTA framework in Iran.ResultsThe final HTA framework includes nine core components: (1) establishing a national HTA body; (2) engaging stakeholders; (3) building capacity through training and research; (4) developing standard HTA methodologies; (5) implementing prioritisation and evaluation processes; (6) ensuring sustainable funding; (7) enhancing transparency and accountability; (8) promoting continuous improvement and (9) fostering innovation. Detailed operational steps and micro-activities were developed for each component. The framework achieved an 84% consensus among Delphi panellists, indicating strong agreement on its content and applicability.ConclusionsThis tailored HTA framework provides a structured roadmap to institutionalise evidence-based decision-making in Iran’s healthcare system. Its implementation can strengthen the efficiency, equity and sustainability of healthcare planning and policy. Pilot testing is recommended to assess feasibility and scalability, with potential to serve as a model for other low-income and middle-income countries.

Background Hepatitis C virus (HCV) infection is one of the major public health challenges generating a relevant burden. High-risk groups, including people who inject drugs (PWID), are at serious risk for developing HCV. In recent years, several investigations have been conducted in Iran to assess the prevalence e of HCV among PWID. The aim of the present study was to synthesize the literature performing a comprehensive search and meta-analysis. Methods A comprehensive literature search was carried out from January 2000 to September 2019. Several international databases, namely Scopus, PubMed/MEDLINE, Embase, ISI/Web of Science, PsycINFO, CINAHL, the Cochrane Library and the Directory of Open Access Journals (DOAJ), as well as Iranian databases (Barakathns, SID and MagIran), were consulted. Eligible studies were identified according to the following PECOS (population, exposure, comparison/comparator, outcome and study type) criteria: i) population: Iranian population; ii) exposure: injection drug users; iii) comparison/comparator: type of substance injected and level of substance use, iv) outcome: HCV prevalence; and v) study type: cross-sectional study. After finding potentially related studies, authors extracted relevant data and information based on an ad hoc Excel spreadsheet. Extracted data included the surname of the first author, the study journal, the year of publication, the number of participants examined, the type of diagnostic test performed, the number of positive HCV patients, the number of participants stratified by gender, the reported prevalence, the duration of drug injection practice and the history of using a shared syringe. Results Forty-two studies were included. 15,072 PWID were assessed for determining the prevalence of HCV. The overall prevalence of HCV among PWID in Iran was computed to be 47% (CI 95: 39–56). The prevalence ranged between 7 and 96%. Men and subjects using a common/shared syringe were 1.46 and 3.95 times more likely to be at risk, respectively. Conclusion The findings of the present study showed that the prevalence of HCV among PWIDs in Iran is high. The support and implementation of ad hoc health-related policies and programs that reduce this should be put into action.

Background Health Technology Assessment (HTA) is crucial for optimizing healthcare investments and improving system efficiency. In Iran, the rising costs of healthcare technologies and systemic inefficiencies have highlighted the need for a structured HTA framework. However, despite academic discussions, HTA has not yet been fully integrated into formal health policy. This study explores the development of HTA in Iran using Kingdon’s Multiple Streams Framework to identify challenges and opportunities for its advancement. Methods The study employed qualitative methods, including 16 semi-structured interviews with key stakeholders in Iran’s healthcare system. Participants, consisting of 12 males and 4 females with an average age of 41.56 years and an average work experience of 14.37 years, provided insights into the current state of HTA. The participants included individuals in key leadership roles within public and private institutions, such as the Ministry of Health and Medical Education, hospital managers, policymakers, and senior academics. Data were analyzed using Kingdon’s framework to examine the problem, policy, and politics streams, as well as the role of policy entrepreneurs and potential policy windows. Results Findings revealed that the rising costs of healthcare technologies, particularly imported ones, and inefficiencies in technology use were major concerns. Participants indicated that HTA could address these issues by ensuring cost-effectiveness and better health outcomes. Despite the technical feasibility of implementing HTA in Iran, there is a significant gap between theoretical discussions and policy action. Resistance from the private sector and the need for political backing were identified as major barriers. However, the political climate in Iran is becoming increasingly favorable, with growing interest in healthcare efficiency and transparency. The Covid-19 pandemic and healthcare shortages have exposed vulnerabilities, presenting potential opportunities for HTA’s adoption. Leadership roles in key institutions, including the Ministry of Health and Medical Education, were identified as vital to advancing HTA initiatives. Policy entrepreneurs play a crucial role in advocating for HTA and capitalizing on these opportunities. Conclusion HTA is recognized as a valuable tool for improving healthcare efficiency and equity in Iran. However, significant challenges remain in transitioning from academic discussions to formal policy. The political environment and recent healthcare crises offer opportunities to advance HTA. To successfully integrate HTA into Iran’s healthcare system, it is essential to address existing barriers, leverage political interest, and support policy entrepreneurs. The experiences of other countries, especially those with strong institutional leadership in HTA, provide useful models for Iran to follow in its HTA development journey.

On February 19 th 2020, the Iranian Ministry of Health and Medical Education (MoHME) has announced the first 2 cases of SARS-CoV-2, a novel emerging coronavirus which causes an infection termed as COVID-19, in Qom city. As such, the Iranian government, through the establishment of the “National Headquarters for the management and control of the novel Coronavirus”, has started implementing policies and programs for the prevention and control of the virus. These measures include schools and universities closure, reduced working hours, and increased production and delivery of equipment such as masks, gloves and hygienic materials for sterile environments. The government has also made efforts to divulge high-quality information concerning the COVID-19 and to provide laboratories and hospitals with diagnostic kits and adequate resources to treat patients. However, despite such efforts, the number of cases and deaths has progressively increased with rising trends in total confirmed cases and deaths, as well as in new daily cases and deaths associated with the COVID-19. Iran is a developing country and its economic infrastructure has been hit hardly by embargo and sanctions. While developed countries have allocated appropriate funding and are responding adequately to the COVID-19 pandemics, Iran has experienced a serious surge of cases and deaths and should strive to provide additional resources to the health system to make healthcare services more accessible and to increase the fairness of that access. All relevant actors and stakeholders should work together to fight this disease.

Background The COVID-19 pandemic significantly disrupted healthcare systems worldwide, affecting the delivery of essential diagnostic services. HIV and HBV testing services, critical for the timely detection and management of these diseases, experienced substantial declines during the pandemic. This study aimed to assess the impact of the COVID-19 pandemic on HIV and HBV testing rates in western Iran. Methods We conducted an interrupted time series analysis using data on monthly HIV and HBV testing rates from Behavioral Health Counseling Centers in western Iran. The study period spanned from January 2017 to December 2023 , divided into pre-pandemic (January 2017–December 2019) and pandemic (January 2020–December 2023) phases. We modeled the immediate level changes and trends in testing rates post-pandemic onset, accounting for pre-existing trends. Regression analysis provided estimates of changes in testing rates, with 95% confidence intervals (CI). Results The analysis revealed a significant decline in HIV testing rates, with an immediate reduction of 145.02 tests per month (95% CI: -159.78 to -130.26). A similar impact was observed for HBV testing, which decreased by 86.50 tests per month (95% CI: -95.51 to -77.49). While a recovery trend was observed for HIV testing over subsequent months, HBV testing exhibited a slower rebound. The disruptions were attributed to resource reallocation, movement restrictions, and reduced healthcare access during the pandemic. Conclusion The COVID-19 pandemic led to substantial disruptions in HIV and HBV diagnostic services in western Iran, underscoring the vulnerability of essential healthcare services to public health emergencies. Although recovery trends were observed, the slower rebound in HBV testing highlights the need for tailored interventions. Strengthening healthcare system resilience, ensuring resource allocation for routine diagnostics, and integrating pandemic preparedness into health policies are crucial to mitigating the impact of future crises.

Background Exclusive breastfeeding (EBF) in the first 6 months of life is the best and most complete option for an infant, in that supplies the vitamins and minerals the baby needs. Several studies in Iran have been conducted concerning the prevalence of EBF. The aim of this study was to determine the prevalence of EBF in the first 6 months of life and associated factors in Iran synthesizing published studies. Methods We searched PubMed/MEDLINE, Embase, Scopus, ISI/Web of Science, the Cochrane Library, Directory of Open Access Journals Directory (DOAJ) and Google Scholar as well as Iranian databases (Barakathns, MagIran and the Scientific Information Database or SID) up to November 2018. The Newcastle-Ottawa Scale was used to assess the quality of studies. Analyses were performed by pooling together studies using DerSimonian-Laird random-effects model with 95% confidence interval. To test for heterogeneity, I 2 test was used. The Egger’s regression test and funnel plot were used to evaluate the publication bias. The strength of EBF determinants was assessed computing the Odds-ratios (OR) using the Mantel–Haenszel method. Results In the initial search 725 records were found. Finally, 32 studies were selected based on inclusion/exclusion criteria. The sample size of studies varied between 50 and 63,071 subjects. The overall prevalence of EBF in Iran was 53% (CI 95%; 44–62). The OR for breastfeeding education received before pregnancy was 1.13 (0.94–1.36), for mother’s job 1.01 (0.81–1.27), for education level 1.12 (0.89–1.42), for type of delivery 1.16 (0.98–1.37), and for gender of child 1.03 (0.83–1.28). Conclusion In Iran health policy- and decision-makers should try to take interventions that encourage mothers to use their milk to breastfeed the infants.

Background Human Immunodeficiency Virus (HIV) remains a significant global health burden, particularly affecting vulnerable populations residing in slum areas which is characterized by overcrowding, poverty, and limited access to healthcare services, create an environment conducive to the transmission and spread of HIV. Despite the recognition of this issue, there is a lack of comprehensive understanding regarding the prevalence of HIV in slums. The aim of this study was to systematically synthesize the existing global evidence on HIV prevalence in slum populations. Methods A rigorous systematic literature review was conducted by searching multiple electronic databases, including Medline via PubMed, Scopus, Embase, Web of Sciences, and Directory of Open Access Journals (DOAJ), covering the period from January 1, 1990, to March 31, 2023. The quality and risk of bias for each included study were assessed using the Newcastle–Ottawa Scale. The pooled prevalence with its corresponding 95% confidence interval (CI) was calculated using a random-effects model with the Freeman-Tukey double arcsine transformation. The degree of heterogeneity among the studies was evaluated using the I 2 test. Publication bias was also assessed using Egger's test. Additionally, subgroup analysis was performed to explore potential factors contributing to the observed heterogeneity. Results A systematic examination of the relevant literature resulted in the inclusion of a total of 22 studies for the purpose of this meta-analysis. These studies collectively assessed a sizable cohort consisting of 52,802 participants. Utilizing a random-effects model, an estimation of the overall prevalence of HIV in the slum area was determined to be 10% (95% CI: 7–13%). Further delineation through subgroup analysis based on the gender revealed a higher prevalence of HIV among women, standing at 13% (95% CI: 8–19%, 18 studies: I 2  = 98%), as opposed to men, where the prevalence was found to be 8% (95% CI: 6–12%, 16 studies: I 2  = 95%). A geographical breakdown of the included studies revealed that Africa exhibited the highest prevalence, with a figure of 11% (95% CI: 9–13%, 18 studies: I 2  = 98%). Subsequently, studies conducted in the American continent reported a prevalence of 9% (95% CI: 7–11%, 2 studies: I 2  = 57%). The Asian continent, on the other hand, displayed the lowest prevalence of 1% (95% CI: 0–3%, 2 studies: I 2  = 94%). Notably, studies employing rapid tests indicated a prevalence of 13% (95% CI: 9–17%, 6 studies: I 2  = 94%), while those relying on self-reported data reported a lower prevalence of 8% (95% CI: 5–11%, 6 studies: I 2  = 99%). Moreover, studies utilizing ELISA reported a prevalence of 9% (95% CI: 6–12%, 10 studies: I 2  = 96%). Finally, it was determined that studies conducted in upper-middle-income countries reported a higher prevalence of 20% (95% CI: 16–24%, 5 studies: I 2  = 45%), whereas studies conducted in lower- and middle-income countries reported a prevalence of 8% (95% CI: 6–10%, 12 studies: I 2  = 98%). Conclusion The current study elucidates the troublingly high prevalence of HIV infection within slums area. Also, this finding underscores the urgent necessity for targeted and tailored interventions specifically aimed at curtailing the spread of HIV within slums. Policymakers must take cognizance of these results and devote their efforts towards the implementation of effective strategies to mitigate gender disparities, address poverty alleviation, and empower the inhabitants of these marginalized areas.

Health Technology Assessment (HTA) is essential for evidence-based healthcare decision-making, yet its integration into Iran’s healthcare system faces political and logistical challenges. Despite HTA’s potential to improve resource allocation, limited awareness, data gaps, and competing priorities hinder its implementation. This commentary emphasizes the need for political support, advocating capacity-building, collaboration, and alignment with long-term health policies. Leveraging international partnerships and monitoring outcomes can enhance HTA’s role in improving healthcare in Iran and contributing to global health advancements.