Background:Social vulnerability is an inherently context-dependent concept that has recently gained increasing attention within the framework of the social determinants of health. This study aimed to define and conceptualize social vulnerability within the specific context of Iran. Methods:A sequential mixed-methods design was employed. An initial pool of indicators was systematically developed through a literature review. The Delphi consensus technique was used to conceptualize social vulnerability in Iranian society by identifying context-sensitive and culturally relevant indicators. Over six months, 23 national experts in health and social welfare participated in three rounds of discussions. To assess the relevance and importance of these indicators, statistical indices, including the mean, standard deviation, and coefficient of variation, were applied. A directed qualitative content analysis was conducted to systematically categorize the indicators into distinct dimensions. Results:Experts identified 65 relevant indicators of social vulnerability. Indicators with the strongest consensus included families living below the poverty line, the unemployment rate, the ratio of marginalized populations, the number of malnourished individuals, people lacking social insurance, the share of housing costs, the number of out-of-school children, the proportion of food expenses in total household spending, education levels below a diploma, and the under-five mortality rate. The ten identified dimensions of social vulnerability in Iran were: Populations at Risk; Family and Gender; Economic; Health Infrastructure and Public Health; Education; Housing and Built Environment; Transportation and Mobility; Crime and Social Security; Emergency Response and Disaster Preparedness; and Social Capital and Institutional Support. Conclusion:In developing countries such as Iran, social vulnerability is strongly influenced by macroeconomic fragility, governance constraints, and cultural factors. Developing a robust, context-sensitive framework for conceptualizing social vulnerability provides a foundation for practical tools to assess and monitor vulnerability more effectively. Ultimately, this approach supports targeted interventions aimed at improving the social determinants of health and enhancing population well-being.
Background:Social media platforms, particularly X (former Twitter), are increasingly used by researchers to disseminate scientific knowledge. However, the extent to which X engagement influences traditional academic impact remains unclear. This study examines the association between X mentions, Altmetric Attention Scores (AAS), and citation counts for highly visible research outputs. Methods:A narrative review of studies on academic influencers in medical fields was combined with a quantitative correlation analysis of the top 100 Altmetric articles (2017-2021). Data included AAS, X mentions, and citation counts from Dimensions. Pearson correlation coefficients were calculated to assess year-by-year relationships. A systematic search was conducted in PubMed and Google Scholar on August 3, 2024, using MeSH terms and Boolean operators. Results:Strong positive correlations were found between X mentions and AAS (r = 0.673-0.944, P < 0.05). Correlations between AAS and citations were weaker and variable (r = 0.075-0.504, P < 0.05 in 2020 and 2021). The narrative review revealed mixed associations between social media influence and academic productivity across specialties. Conclusion:X amplifies research visibility but has limited predictive power for long-term citation impact. These findings inform research evaluation by highlighting altmetrics as complementary tools. Future studies should explore multi-platform data and address global disparities in digital influence.
Background:Profitability is a fundamental aspect of corporate survival in the pharmaceutical industry, shaped by both firm-level and macroeconomic factors. In Iran, the sector encounters challenges such as reliance on imports, inflation, and sanctions, alongside a lack of empirical evidence regarding the determinants of profitability. This study aims to fill this gap by investigating these factors in listed firms. Methods:Panel data from 28 companies listed on the Tehran Stock Exchange (2009-2023) were analyzed using fixed-effects Feasible Generalized Least Squares (FGLS) regression. The dependent variables were return on assets (ROA) and return on equity (ROE). The independent variables included firm-specific factors (e.g., leverage, sales growth) and macroeconomic factors (e.g., GDP, inflation). Diagnostic tests, including unit root, cointegration, and heteroskedasticity tests, were conducted. Results:Results indicated that GDP, money supply, and sales growth were positively associated with profitability. Conversely, interest rates, exchange rates, inflation, government expenditure, leverage, P/E ratio, and liquidity ratios exhibited negative associations. The effects of firm size and tax revenue were mixed. The models accounted for 69-89% of the variation (R-squared), with significant F-statistics (P<0.001). The hypotheses were confirmed, partially supported, or contradicted, as summarized. Conclusion:The profitability of Iranian pharmaceuticals is susceptible to macroeconomic volatility and firm-specific strategies. It is imperative that policies are implemented to stabilize exchange rates and promote domestic production to enhance sustainability.
Background:Hearing loss (HL), including noise-induced hearing loss (NIHL), is a prevalent health issue that affects millions of individuals worldwide and ranks as the third most common disability. This study examines the relationship between HL and cardiovascular risk factors (RFs) such as hypertension (HTN), diabetes mellitus (DM), and dyslipidemia (DLP) within the Iranian adult population. Methods:This study was carried out at Iran University of Medical Sciences and involved 1,996 individuals undergoing routine health checks, including audiometry and lab tests. Results:The study indicated that older age (per each additional year of age, aOR=1.14, 95%CI: 1.12-1.16, P<0.001) and male gender (aOR=3.08, 95%CI: 1.84-5.14, P<0.001) were significantly associated with HL, while a higher educational level served as a protective factor (tertiary education compared to a primary school degree, aOR=0.35, 95%CI: 0.24-0.5, P<0.01). Although initial analyses suggested associations between HL and cardiovascular RFs, these associations lost significance after adjusting for confounding variables. Notably, the presence of a single cardiovascular RF was significantly linked to HL in the total sample (aOR=1.37, 95%CI: 1.04-1.81, P=0.02) and in men (aOR=1.41, 95%CI: 1.05-1.90, P=0.02), but not in women. Conclusion:This research emphasizes the significant association between hearing loss and demographic factors such as age, gender, and educational attainment in Iranian adults. These findings underscore the necessity for inclusive hearing health strategies that take these factors into account in both occupational and public health contexts.
Iran's Primary Health Care (PHC) system was designed and structured in the post-revolution era and rooted in the principles of the Alma-Ata Declaration, over four decades (1985-2025), it has evolved into one of the most resilient and equity-driven primary care platforms in the Global South. Serving a population exceeding 85 million, it illustrates how sustained investment in community-based care can generate population-level impact despite geopolitical pressures, economic sanctions, and shifting epidemiological realities. This review, as a commemoration of 40 years of PHC establishment, expansion, and institutionalization, synthesizes the system's historical evolution, transformative achievements, persistent constraints, and strategic directions for the decades ahead. Iran's PHC network has achieved near-universal rural coverage, dramatic reductions in maternal, neonatal, and child mortality, and substantial gains in life expectancy. These achievements have been preserved despite war, prolonged sanctions, and the COVID-19 pandemic. The Health Transformation Plan (HTP, 2014) represented a major step toward universal health coverage (UHC), reducing out-of-pocket payments. Yet substantial challenges remain: structural under-resourcing, insufficient community participation in urban settings, limited PHC coverage in large metropolitan areas, the rising burden of noncommunicable diseases, fragmentation, and insufficient inter-sectoral collaboration. Looking toward 2050, Iran's strategic trajectory depends on modernizing PHC through digital innovation, data-informed decision-making, strengthening self-care capabilities, reinforcing continuity of care for all population groups, revitalizing community engagement, particularly in urban settings, and embedding stronger equity safeguards across the entire system. With deliberate reorganization and sustained political commitment, supported by intersectoral governance, Iran's PHC system can consolidate four decades of progress and offer a compelling, adaptable blueprint for health systems navigating resource constraints and geopolitical adversity.
Background:A fair and transparent payment system has been shown to influence workforce motivation and quality of work. Performance-based payment initiatives are designed to strengthen this relationship by linking compensation to measurable outcomes. This study aimed to identify the key indicators of performance-based payment for physicians in Iran. Methods:This mixed-method study employed a scoping review and semi-structured interviews with key professionals and practitioners in health insurance, health economics, and management. The scoping review followed the Arksey and O'Malley framework and covered publications from 2000 to 2024 in both Persian and English databases. Interview data were analyzed using a thematic analysis approach with the assistance of MAXQDA software. A prioritization matrix was applied to determine the final set of key indicators. Results:Eighteen key indicators were identified through review, qualitative analysis, and screening stages. The main indicators included the per capita number of expensive diagnoses or procedures prescribed within a given period, adherence to clinical guidelines, per capita number of services provided by a physician, and compliance with electronic service delivery (e.g., use of PMR and electronic prescriptions). Conclusion:Key performance indicators and managerial dashboards are critical tools for enhancing efficiency, equity, and quality in the health sector. The use of such indicators by purchasing and insurance organizations can motivate providers to prioritize quality and responsiveness while effectively managing healthcare costs.
Background:Capillaroscopy is widely recognized for its role in evaluating microcirculation, particularly in patients with Raynaud's phenomenon and scleroderma-spectrum diseases. The eye sign may provide complementary insights into microvascular assessment. This study primarily investigates whether the eye sign can differentiate patients with systemic sclerosis (SSc) and other connective tissue diseases (CTDs) presenting with Raynaud's from healthy controls. Additionally, we explored correlations between eye sign scores and capillaroscopic changes within patient subgroups. Methods:This cross-sectional study enrolled 117 individuals, divided into three groups: healthy controls (N=31), systemic sclerosis (SSc) (N=49), and other connective tissue diseases (CTDs) presenting with Raynaud's phenomenon (RP) (N=37). Clinical data, including lung involvement, pulmonary artery hypertension, and skin score, as well as laboratory results, capillaroscopy findings, and eye sign (assessed by naked-eye criteria), were collected from all participants. The primary analysis compared ocular symptom scores between patients and healthy controls. Subgroup analyses and correlation assessments were exploratory. Results:Eye sign scores did not significantly differ between the combined patient group and healthy controls (P = 0.158). Subgroup comparisons also revealed no significant differences (P = 0.297 for SSc, P = 0.262 for other CTDs). Furthermore, no significant associations were observed between eye sign scores and capillaroscopy findings within the study groups. Additionally, no significant associations were found between eye sign scores and specific clinical manifestations. Confidence intervals were provided to reflect statistical uncertainty. Conclusion:This study found no statistically significant differences in Eye sign scores between patients and healthy controls, nor any associations with capillaroscopic abnormalities. However, due to the limited sample size and the exploratory nature of the subgroup analyses, these findings should be interpreted with caution.
Background:Colorectal cancer remains a significant public health concern globally and in Kazakhstan, with rising incidence rates partly attributed to improved screening and lifestyle changes. This study aimed to assess epidemiological trends in colorectal cancer in Kazakhstan from 2013 to 2023, focusing on incidence, mortality, and five-year survival rates. Methods:This population-based registry analysis utilized national cancer registry data on colorectal cancer (CRC) morbidity and mortality. All registered cases from 2013 to 2023 were included. Five-year survival was estimated using aggregated registry data (observed survival). Temporal trends were evaluated using simple linear regression. Results:Between 2013 and 2023, colorectal cancer incidence in Kazakhstan slightly increased (from 8.9 to 9.8 per 100,000), while mortality significantly decreased by 32.7% (from 4.9 to 3.3; B = -6.64, reflecting an overall downward trend over the study period; P < 0.001), particularly in East Kazakhstan. Rectal cancer incidence increased in South Kazakhstan (B = 5.46; P = 0.007) and Astana (B = 1.59; P = 0.014), but declined in the Almaty region (B = -1.88; P = 0.008). Mortality decreased notably in the Almaty region, Almaty city, and North Kazakhstan. Five-year observed survival rates for CRC improved from 44.1% to 52.0%, and for rectal cancer from 42.0% to 47.0%. Conclusion:Despite the decline in colorectal cancer mortality in Kazakhstan from 2013 to 2023, the persistently high rate of late-stage diagnoses underscores the urgent need to strengthen early detection efforts and implement region-specific interventions.
Background:To examine how sociodemographic factors like age, gender, ethnicity, and socioeconomic status relate to early precursors of ALL (acute lymphoblastic leukemia), evaluate their distribution among Acute Lymphoblastic Leukemia (ALL) variants, FAB (French-American-British) classification, and comorbidities, and explore associated clinical profiles. Then, assess their significance on therapy outcomes in ICU (intensive care unit) settings. Methods:A retrospective cohort study investigated the association between early detection of critical condition precursors and outcomes in pediatric ALL patients. Data from 188 ICU-admitted children were analyzed, exploring sociodemographic, clinical factors, and ICU outcomes, using SPSS for statistical analysis. Statistical methods included chi-square tests for categorical variables, independent sample t-tests for continuous variables, and multivariate logistic regression to identify prognostic factors influencing ICU outcomes. Results:The study on ICU hospitalization of children with ALL revealed several important findings. Of 188 children admitted to the ICU, 98 (52.1%) were aged 8-18 years and 97 (51.6%) were male. Most participants had a weight ≤30 kg (56.9%) and reduced BMI (63.3%). The common ALL variant was most frequent (76, 40.4%). During ICU stay, 50 patients (26.6%) died and 138 (73.4%) were transferred to specialized oncology care. During the study period, 165 (87.8%) patients had a single ICU admission, while 23 (12.2%) experienced two or more ICU admissions. Male patients were more often transferred to oncology care (80/97, 82.5%; P=0.004). Mortality was significantly higher among those with reduced BMI (26/69, 37.7%; P=0.009) and concomitant diseases (15/33, 45.5%; P=0.007). Logistic regression identified male gender (Exp(B)=3.031, P=0.003) and concomitant diseases (Exp(B)=2.538, P=0.033) as significant predictors of adverse outcomes. Re-hospitalization frequency was associated with higher weight (mean 48.9 ± 23.3 kg vs. 27.7 ± 16.2 kg, P<0.001). Conclusion:This study identified key prognostic factors in pediatric ALL patients in the ICU, including gender, concomitant diseases, BMI, relapse, and risk group. These factors significantly influenced mortality and re-hospitalization rates, underscoring the importance of tailored management strategies for improved outcomes.
Background:Suicidal behavior is a complex and multifactorial phenomenon rooted in both psychological and biological mechanisms. In recent years, there has been an increasing focus on epigenetic factors, which modulate the influence of environmental factors on the expression of genes associated with emotional and cognitive regulation. Review of the literature:This review aims to provide a comprehensive analysis of contemporary scientific data concerning the epigenetic mechanisms implicated in the pathogenesis of suicidal behavior. It synthesizes and systematizes findings published between 2013 and 2024, emphasizing DNA methylation, histone modifications, and non-coding RNA (microRNA and long non-coding RNA) regulation as key molecular pathways involved in impaired neuroplasticity, dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, and dysfunction of neurotransmitter systems. Discussion:The review highlights the role of epigenetic regulation in genes associated with the serotonergic system (SLC6A4), neuroendocrine stress response (FKBP5), and HPA axis regulation (SKA2, NR3C1, NR3C2), as well as relatively novel candidate genes such as CACNA1C, SIRT1, and IMPA2. It underscores how stress-induced and trauma-related epigenetic modifications contribute to suicidal vulnerability and may underlie the biological heterogeneity observed among individuals exhibiting suicidal behavior. The potential reversibility of epigenetic changes positions them as attractive targets for therapeutic and preventive strategies. Conclusion:Epigenetic changes induced by environmental stressors, traumatic experiences, or mental disorders possess diagnostic and prognostic potential. The integration of epigenetic biomarkers into clinical research may enhance the early identification of individuals at risk, support the development of personalized interventions, and contribute to new approaches in suicide prevention. Overall, epigenetics offers a promising framework for bridging molecular biology with psychiatry and deepening our understanding of the biological mechanisms underlying suicidality.
Background:Stigma and a lack of knowledge are significant barriers to seeking mental health support, particularly among adolescents. In Iran, there is a scarcity of interventional studies addressing these issues, and the findings from existing research are often inconsistent. This study translated and culturally adapted the Canadian Guidance about Mental Health and the High School Curriculum for implementation in Iranian schools to address this gap. This study aims to determine the effect of this educational intervention on the mental health literacy of Iranian students. Methods:This research employed a quasi-experimental design involving a sample of two hundred middle school children aged 14.28 ± 0.7 years, ranging from 13 to 16 years old. The educational intervention for the experimental group consisted of six sessions, each lasting 45 to 60 minutes. Data were collected using the Knowledge and Attitudes to Mental Health Scales (KAMHS). The data were analyzed using inter-group and intra-group repeated measures ANOVA, with a significance cutoff of P<0.05. Results:There were no significant differences in demographic characteristics between the intervention and control groups. However, the intervention group demonstrated significant improvements in mental health behaviors, a reduction in stigma, and an increase in help-seeking, while the control group showed no such changes (P<0.05). Conclusion:The designed intervention was effective in increasing knowledge and attitudes.
Background:Post-COVID-19 metabolic complications, such as diabetes, are linked to systemic inflammation. The Systemic Immune-Inflammation Index (SII) may help predict these outcomes; however, evidence from non-Western populations remains limited. Methods:In this retrospective cohort study, 2,060 COVID-19 patients hospitalized in 2020 in Iran were followed for two years. SII was calculated and categorized as normal or elevated. The incidence of diabetes and prediabetes was assessed using fasting blood sugar (FBS) and HbA1c levels. Linear regression analyses were conducted to examine associations between SII and metabolic outcomes, adjusting for potential confounders. Results:Among participants, 73.4% remained normoglycemic, 7.5% developed prediabetes, and 19.1% developed diabetes. Linear regression analysis demonstrated a statistically significant but modest positive association between SII and FBS levels (β = 0.018; 95% CI: 0.004-0.032; P = 0.011). Other inflammatory markers showed no significant associations. Conclusion:Elevated SII was modestly associated with higher fasting blood sugar levels two years after COVID-19 infection. Although the effect size was small, these findings suggest that systemic inflammation may play a role in long-term glycemic dysregulation, underscoring the importance of metabolic follow-up in individuals with heightened post-COVID inflammatory profiles.
Background:Psoriasis is a chronic autoimmune skin condition that affects 2-3% of the global population and manifests in various subtypes, including plaque, guttate, inverse, pustular, and erythrodermic psoriasis. Accurate subtype differentiation is crucial for effective treatment, but traditional diagnostic methods are time-consuming and prone to observer variability. This study aims to develop a machine learning model that classifies psoriasis lesions into the five primary subtypes using convolutional neural networks (CNNs) and transfer learning, offering a scalable tool to assist clinicians in diagnosing psoriasis and making informed treatment decisions. Methods:This is a methodological-developmental study that develops and evaluates a deep learning model for psoriasis subtype classification. The dataset was obtained from from Kaggle, applying image augmentation techniques (rotation, translation, shearing, flipping, zoom) to enhance dataset diversity. A pre-trained Visual Geometry Group 16-layer architecture (VGG16) model was used for feature extraction, with a custom classification head added, incorporating ReLU-activated dense layers and dropout regularization to mitigate overfitting. The model was trained and evaluated using accuracy and loss metrics, with early stopping and model checkpointing for optimization. Results:The model achieved 96% accuracy on the training dataset and 90% on the test dataset, demonstrating strong generalization. A confusion matrix analysis confirmed accurate differentiation between the five subtypes. Conclusion:This study developed a deep learning model that accurately classifies psoriasis subtypes, utilizing CNNs and transfer learning. The model was integrated into a web-based tool, providing real-time diagnostic assistance for clinicians. This AI-driven system has the potential to enhance diagnostic accuracy, improve clinical workflows, and offer scalable solutions for psoriasis management, particularly in areas with limited access to dermatologists.
Background:The SARS-CoV-2 pandemic strained global healthcare, creating a demand for effective inpatient treatments. Observational comparisons of remdesivir (RDV) versus non-RDV are subject to confounding by indication and temporal trends. This study assessed the real-world effectiveness of RDV-based regimens using propensity score matching (PSM). Methods:We conducted a single-center retrospective cohort study at BouAli Hospital, analyzing 2,216 adults hospitalized with COVID-19 between March and September 2020. The propensity score for RDV receipt was estimated via logistic regression including age, admission SpO₂, comorbidities, vaccination status, adjunct therapies, and pandemic wave. Patients were matched 1:1 by nearest neighbor (caliper 0.2 SD, common support). Covariate balance was assessed using standardized mean differences (SMD). Outcomes included hospital mortality, ICU admission, intubation, and length of stay (LOS). Results:PSM produced 1,108 well-matched pairs (n=2,216). Some imbalance persisted (largest |SMD|: atorvastatin 0.35; vaccination 0.35; wave 0.24; age 0.17). RDV was associated with a lower intubation risk (OR 0.50, 95% CI 0.39-0.65; P<0.001) but not ICU admission (OR 0.89, 95% CI 0.72-1.09; P=0.286) or mortality (OR ≈1.0, ns). LOS was longer in RDV users (median +1.52 days; P<0.001). Doubly adjusted GEE models confirmed these findings (intubation OR 0.60, 95% CI 0.42-0.87; P=0.007; ICU OR 1.21, 95% CI 0.84-1.75; ns). Conclusion:After PSM and adjustment, RDV use was linked to reduced intubation but not ICU admission or mortality, with longer hospital stays observed. Residual imbalance and unmeasured severity limit causal inference. Further studies are needed to guide personalized COVID-19 treatment.
Background:The higher education system is undergoing a significant transformation, shifting from its traditional role of knowledge production to embracing the concept of entrepreneurial universities. This shift aims to align with global development processes by not only generating knowledge and ideas but also translating them into actionable outcomes. In this article, we explore solutions toward (Third-Generation University) Entrepreneurial Universities and propose policy solutions to facilitate this transition. Methods:This study adopts a qualitative approach, utilizing an analytical research framework for policy development. The research aims to identify "policy solutions for transforming to third-generation universities by implementing changes in medical education." The study was conducted in three stages: a comprehensive literature review, the Delphi method, and the Policy dialogue (policy discussions) to finalize policy options. Results:Several solutions were identified, including the development of support models for entrepreneurial activities, structural and organizational reforms, capacity-building for medical sciences universities based on regional needs, and fostering mutual and effective collaboration with industry. Among these, three key policy options were prioritized: (1) Revising and reforming medical education programs, (2) Formulating support models for entrepreneurial activities, and (3) Restructuring the functional framework of universities. Conclusion:The process of driving change is multi-faceted and time-intensive. To ensure success, changes and innovative approaches should be introduced through educational programs and structured curricula. Implementing effective change models and providing necessary support to students across various medical science disciplines are critical steps in this transformation.
Background:Anorectal malformations (ARMs) are congenital anomalies frequently associated with genitourinary abnormalities and other developmental defects. Surgical correction commonly involves colostomy, posterior sagittal anorectoplasty (PSARP), or laparoscopic/laparotomy-assisted approaches. This study aimed to evaluate the occurrence of neurogenic bladder and vesicoureteral reflux (VUR) in ARM patients and their associations with ARM type, fistula location, vertebral anomalies, and surgical technique. Methods:This cohort study included 173 children with ARM in the pediatric surgery department of Ali-Asghar Hospital, Iran, from July 2011 to July 2021. Data on genitourinary problems, including urinary tract infections, vesicoureteral reflux, and neurogenic bladder, were gathered from clinical records and follow-up visits. Results:A total of 37 patients were diagnosed with neurogenic bladder and 44 with vesicoureteral reflux. This study stated higher occurrences of neurogenic bladder and reflux in patients who underwent PSARP. Neurogenic bladder was more prevalent in patients with high-type ARM and rectourethral fistula. The highest incidence of recurrent urinary tract infections was observed in boys with high-type ARM. Approximately 8% (14) of patients showed signs of kidney failure that led to chronic kidney failure. Conclusion:Statistical evaluation of genitourinary issues in patients with ARM who underwent surgery at our center underscores the importance of informing parents of the need for regular follow-up. Given that some of these issues may lead to delayed adverse effects on kidney function, early diagnosis and timely intervention are crucial for preventing complications and slowing the progression to kidney failure and end-stage renal disease (ESRD).
Background:Retraction serves as a critical corrective mechanism in scientific publishing, preventing the spread of flawed or misleading data. This study aimed to systematically analyze the characteristics of retracted articles within the field of diabetes research, highlight potential vulnerabilities in the integrity of diabetes research, and address gaps in understanding the nature and implications of research misconduct in this crucial medical discipline. Methods:This study aimed to analyze retracted publications in the field of diabetes published from 1978 to 2024 using the Web of Science database. Information from the selected articles was obtained through the Retraction Watch Database. Extracted details included the journal title, type of article, country of origin, publication and retraction dates, number of authors, and reasons for retraction. The collected data were analyzed using descriptive statistical methods. Results:Between 1978 and 2024, our review revealed 316 retracted articles. The journals Science (n = 1517) and The Lancet (n = 742) accounted for the highest number of these highly cited retractions, while the journals Biomed Research International (n = 31) and Diabetes (n = 15) accounted for the most cited of these retractions. The most common reasons for retraction were investigations initiated by the journal or publisher and concerns related to data integrity. The years with the highest number of retractions were 2023 (n = 91) and 2016 (n = 40), whereas the majority of retracted articles were initially published in 2022 and 2021 (n = 26). Collaborative research involving authors from China (n = 137), the United States (n = 71), and India (n = 24) was most frequently associated with these retractions. Conclusion:Safeguarding the integrity of scientific literature, particularly in high-stakes fields such as diabetes research, requires a fundamental shift from reactive retractions to multilateral proactive systemic reform. Cultivating an ethical research culture (changing incentives to reward research quality and transparency over quantity by Institutions and funders); empowering researchers (providing the skills for rigorous and ethical research through mandatory, ongoing ethics training); and ensuring vigilant publishing (enforcing clear policies, rapidly investigating issues, and performing transparent retractions to protect the scientific record by journals).
