Objective Organ transplantation is a relatively new and developing treatment method in which some organs of a brain dead person are transplanted to the person in need. Organ donation has psychological consequences in both donor families and in recipients In this regard, one of the most important challenges is related to psychological consequences of contact between the family of the donor and the recipient and their family. The aim of this study was to explain the psychological consequences of contact between donor families and organ recipients. Materials & Methods This study was conducted using qualitative research method of conventional content analysis. The study population includes all donor families as well as all organ recipients in Iran. The sample population of this study included individuals listed in the list of organ donor society and hospitals with organ transplant ward in Tehran, out of which 23 participants (12 donors and 11 recipients) were selected using purposive selection method with maximum variation until theoretical saturation of data. Through semi-structured in-depth interviews with participants and content analysis of interviews, psychological consequences of contact between donor families and organ recipients were identified. Data collection continued until theoretical saturation. Each interview lasted about 30-60 minutes. Data were analyzed using Graneheim and Landman (2004). Results From a total of 23 conducted interviews, 237 meaning units were extracted. These meaning units were categorized into 25 codes, including unpleasant consequences of the contact for donor families (9 codes), unpleasant consequences of the contact for organ recipients and their families (10 codes), pleasant consequences of the contact for donor families (3 codes), and pleasant consequences of the contact for recipients and their families (3 codes). From these 25 codes, four subcategories were obtained: pleasant consequences for donor families, pleasant consequences for organ recipients and their families, unpleasant consequences for donor families, and unpleasant consequences for organ recipients and their families. Ultimately, these four subcategories were grouped into two main categories: unpleasant consequences and pleasant consequences. Conclusion The results showed that contact between donor families and organ recipients can cause transient or persistent positive and negative consequences. Transient consequences do not require intervention, but persistent and harmful negative consequences require prevention, and treatment. The suggestions resulting from this study can be a practical guide for transplant teams, organ donation societies, and counselors in decision-making and supportive interventions, as well as designing a communication model.
Objective Multiple sclerosis (MS) is a chronic autoimmune disease with unknown etiology. Studies on the relationship between adverse childhood experiences (ACEs) and the onset of this disease have reported contradictory results. Therefore, this study aimed to investigate the relationship between “ACEs” and “onset of MS” and determine the mediating role of “sense of coherence (SOC).” Materials & Methods The present study was a cross-sectional descriptive-correlation study using mediator analysis. The statistical population of the study consisted of people over 18 years of age with MS and their matched individuals (in terms of age and gender). A total of 224 samples participated in two matched groups of people with MS (112 members of the “How many steps today?!” an NGO group) and people without MS (112 people). Data were collected using the ACEs-international questionnaire (ACE-IQ) and the Antonovsky SOC scale and analyzed by independent samples t-test and linear and logistic regression using SPSS software, version 26 and bootstrapping mediation analysis with 10000 simulations using R software. Results Individuals with MS reported significantly higher levels of ACEs (especially experiences related to parents and family) and lower levels of SOC (P<0.001) compared to individuals without MS. Linear regression showed that ACEs significantly predicted SOC (P<0.001). Logistic regression also showed that ACEs and SOC significantly predicted the onset of MS (P<0.05). Mediation analysis showed that ACEs had both a direct effect (P=0.04) and a significant indirect effect (P<0.001) on the onset of MS. SOC significantly mediated 37.8% of the total effect of ACEs on the MS incidence. Conclusion ACEs are a significant risk factor for developing MS in adulthood. A significant part of this effect is exerted through weakening the SOC of the individual. This finding emphasizes the critical importance of preventing childhood trauma and strengthening psychological resources as a potential strategy for reducing the risk of autoimmune diseases.
Objective Speech-language pathologists (SPLs) collect spontaneous language samples as a key component of clinical assessment protocols through contexts such as free play, picture description, and story retelling. Another context to collect language samples is through interviews. This study aimed to validate and examine the psychometric properties of Evans and Craig’s interview protocol for Persian-speaking preschool children with and without Language impairment Materials & Methods Using systematic random sampling, language samples were selected from 207 Persian-speaking preschool children in Semnan, Iran (51 children with language impairment, 156 children without language impairment) and analyzed. The children were assessed using the Persian version of the test of language development–3 (TOLD-P3) and Evans and Craig’s 15-minute interview protocol. Cross-cultural adaptation was conducted according to Beaton et al.’s guidelines, followed by assessment of criterion validity, diagnostic accuracy, and responsiveness to change. Linguistic indices (mean length of utterance [MLU], number of conjunctions, ratio of complex to simple sentences, and type–token ratio [TTR]) and the overall language ability (OLA) score derived from the TOLD-P3 were calculated. All scores were entered into SPSS software, version 24. The scores of the two groups were compared using appropriate statistical tests. The significance level was set at 0.05. Results The OLA score was 102.25 in typically developing children and 75 in children with language impairment. The mean MLU (6.11 vs 5.26; P=0.034) and number of conjunctions (13.37 vs 7.53; P=0.001) were significantly different between the two groups, but the ratio of complex to simple sentences (25.71 vs 25.87; P=0.63) and TTR (0.44 vs 0.46; P=0.30) were not significantly different. Except for TTR, the other three indices showed significant correlations with OLA score (P<0.05). Regarding responsiveness, TTR was the only index that revealed significant changes at the six-month follow-up (P=0.004). The cut-off points were determined as follows: For MLU, <4.5; for number of conjunctions, <7; for ratio of complex to simple sentences, < 14%; and for TTR, 0.45–0.65, all of which may indicate language impairment in children aged 5–6. Conclusion The Persian version of Evans & Craig’s interview protocol can be used in Persian-speaking children aged 5–6. SPLs can use this valid and practical tool to screen for and identify language impairments in preschoolers. The interview protocol has acceptable accuracy in distinguishing syntactic and semantic differences between children with and without language impairment.
The strong and effective stewardship of rehabilitation services is mentioned as one of the critical elements for the success of efforts to improve access to rehabilitation services. Existing evidence indicates that fragmented and unclear multiple governance and leadership structures are a major barrier to equitable access to rehabilitation services in Iran. The lack of coordination and integration of rehabilitation services across different institutions has led to services being provided in a fragmented manner based on internal organizational policies. This study was conducted in four stages: a scoping review, analysis of documents, interviews, and collective brainstorming. Policy solutions were identified in six broad areas: health vision and strategies for achieving better health, influencing other sectors and advocating for better health, aligning the governance of the health system with prevailing values, methods for ensuring the design of the health system in line with health system goals, current legal and regulatory tools, and methods for collecting, disseminating, and applying information. From a governance perspective, establishing governance structures and centralizing the management of rehabilitation services is essential. Weak governance structures and the lack of coordination among responsible institutions are among the main problems in this area. Therefore, designing a system that clarifies the key roles of different stakeholders and allows for accountability and effective interaction is considered necessary. Ensuring the provision of comprehensive rehabilitation services requires aligning these services with various dimensions of the health system, including human resource quality, sustainable financing, appropriate distribution of services, and increased access to rehabilitation services. In this regard, it is recommended to revise educational policies to train a skilled and responsive workforce that meets the community’s needs. Furthermore, sustainable financing through an efficient insurance system and investment in this area is of particular importance. Finally, enhancing legal and regulatory tools, along with the government’s commitment to enforcing laws and strengthening supervisory infrastructure, is essential for achieving an effective rehabilitation system. Strengthening political commitment and investment in this sector will not only increase productivity but also help reduce health system costs. Overall, adopting a comprehensive and coordinated approach across all relevant sectors can pave the way for achieving better health outcomes through rehabilitation services.
Objective Optimal rehabilitation education can lead to the cultivation of expert and influential people. This study aimed is provide a conceptual model of rehabilitation education in Iran based on the grounded theory. Materials & Methods This is a qualitative study using the grounded theory method. Participants were 32 professors and doctoral students of rehabilitation disciplines (including occupational therapy, physiotherapy, speech therapy, social work, technical orthopedics, and rehabilitation management) from the University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. They underwent semi-structured interviews. The collected data were analyzed using Corbin and Strauss’s method. Results Data analysis led to the emergence of 7 main categories (nature and requirements of rehabilitation education, improving learner motivation, process of rehabilitation education, rehabilitation education skills, rehabilitation education methods, rehabilitation education facilitators, rehabilitation education barriers/shortcomings) and 25 subcategories. Conclusion Rehabilitation education requires attention to its structure, nature, and requirements that shape its educational components, processes, and outcomes. Blending learning is emphasized in rehabilitation education, and learners’ motivation is an important factor in promoting rehabilitation education.
Objective Diabetic polyneuropathy (DPN) is one of the most common complications of type 2 diabetes, characterized by diminished light touch and vibration perception, leading to impaired balance and increased fall risk among older adults. Despite its high prevalence, evidence on targeted sensory rehabilitation remains limited. This study aimed to evaluate the effectiveness of a Fall-Proof rehabilitation exercise software in improving sensory function in elderly patients with DPN. Materials & Methods This study was a single-blind clinical trial conducted in 2025 at Sadeghieh Tahereh Hospital in Isfahan. A total of 96 patients diagnosed with diabetic peripheral neuropathy, confirmed using the michigan neuropathy screening instrument (MNSI), were randomly assigned via adaptive randomization into three groups: An in-person intervention group, a virtual intervention group (utilizing a dedicated software platform), and a control group. The intervention groups performed FallProof™ balance exercises for eight weeks (two sessions per week), either in person or virtually, whereas the control group received only standard care. Sensory function—including light touch sensation at the third and fifth metatarsal heads and the hallux, as well as vibratory sensation at the hallux—was assessed at four time points: pre-intervention, immediately post-intervention, and at 2- and 3-month follow-ups. Data were analyzed using non-parametric statistical tests, including the Friedman test, Wilcoxon signed-rank test, and Mann–Whitney U test, with significance set at P<0.05. Results Both intervention groups showed significant improvements in all sensory indices (P<0.05), with the greatest gains observed at the 5th metatarsal and hallux. Compared with controls, the digital intervention group demonstrated superior improvements in light touch at the 5th metatarsal (+1.80 units), hallux (+1.22 units), and vibration perception (+0.36 units). Importantly, these sensory improvements persisted for up to 3 months in the digital group, whereas the control group experienced progressive decline. Conclusion Fall-proof exercises, particularly when delivered through interactive rehabilitation software, produced significant, targeted, and sustained improvements in tactile and vibration perception in elderly patients with DPN. These findings underscore the potential of digital-based interventions in sensory rehabilitation and fall prevention, supporting their integration into home-based rehabilitation programs for high-risk populations.
Objective Feeding disorders in children have multiple adverse consequences at personal, economic, and sociocultural levels, making them one of the major public health challenges. As speech and language pathologists play a key role in the multidisciplinary management of these disorders, they require valid and reliable tools to screen infants’ and children’s feeding behaviors. Therefore, this study aimed to translate the infant and child feeding questionnaire (ICFQ) into Persian and to evaluate its psychometric properties among Persian-speaking children. Materials & Methods This psychometric study was conducted on 220 children aged 0–4 years (100 children with feeding disorders and 120 typically developing children). Translation process included forward translation, evaluation of face and content validity, backward translation, and cognitive interviews for face validity. Construct validity was assessed through convergent validity with the Pedi-EAT questionnaire and known-groups validity. Criterion validity and diagnostic accuracy (sensitivity, specificity, and cut-off point) were also evaluated. Data analysis was performed using SPSS software, version 25, applying statistical tests such as Pearson’s correlation coefficient, independent t-test, chi-square test, and ROC analysis. Results The Persian version of the ICFQ demonstrated satisfactory validity and acceptable psychometric properties. The content validity index (CVI) was 0.95, indicating excellent content validity. The Persian version of the ICFQ demonstrated a significant correlation with the Pedi-EAT questionnaire (r=0.46, P<0.01). Agreement with specialists’ diagnoses was reported at 90.3% (χ²=157.03, P<0.01). The area under the receiver operating characteristic (ROC) curve was 0.97, with a 95% confidence interval ranging from 0.96 to 0.99. The optimal cut-off point was determined to be 2.5, yielding a sensitivity of 93% and a specificity of 91.7%. Conclusion The Persian version of the ICFQ is a valid instrument for screening feeding disorders in Persian-speaking children and serves as an efficient tool for both clinical and research applications.
Objective The purpose of this study was to investigate the effects of different types of insoles and fatigue on the electrical activity of lower limb muscles during running in men with foot pronation (FP) at different post-anterior cruciate ligament reconstruction (ACLR) times. Materials & Methods In this randomized clinical trial, 30 men with ACLR-FP, along and 10 healthy men, participated. A wireless surface electromyography (EMG) system was used to record the electrical activity of lower limb muscles during different phases of running. The participants were evaluated wearing four different insoles (control shoe, placebo insole, arch support insole, and double-density insole) before and after fatigue induced using a treadmill and assessed based on Borg’s Rating of Perceived Exertion scale. Data were analyzed using repeated measures analysis of variance (ANOVA) and the Bonferroni post-hoc test, considering a significance level of P≤0.05. Results Under the placebo insole use condition, the fatigue-group interaction effect showed a significant increase for the biceps femoris (BF) during the loading response phase (P=0.038; effect size [d]=0.200) and for the gluteus medius (GM) during the mid-stance phase (P=0.048; d=0.019). Under the arch-support insole use condition, the fatigue-group interaction effect demonstrated a statistically significant increase for the BF during the mid-stance (P=0.045; d=0.019) and push-off (P=0.040; d=0.020) phases. Under the double-density insole use condition, the fatigue-group interaction effect showed a statistically significant decrease for the tibialis anterior (TA) during the mid-stance phase (P=0.039; d=0.001); for the gastrocnemius (GC) during the push-off phase (P=0.035; d=0.217); and for the TA during the deceleration phase (P=0.002; d=0.100). Conclusion It seems that both fatigue and the use of different insoles can alter the neuromuscular activity pattern in men with ACLR-FP. The arch-support and double-density insoles have greater potential to mitigate the negative effects of fatigue and improve muscle electrical activity, particularly in patients in the early post-ACLR period (<6 months).
Objective One of the most significant ethical challenges in using artificial intelligence (AI) is the presence of ethical dilemmas. An ethical dilemma, a type of ethical conflict, is defined as any incompatibility between motivations and desires, educational methods, values, and the fulfillment of moral duties and responsibilities. Ethical challenges associated with using AI in nursing care include dilemmas linked to patient privacy and data security, the impact on patient autonomy, informed consent, safety and clarity of guidelines, accountability, and transparency. Additionally, AI may have unintended consequences on nursing care provision. This study examined the ethical dilemmas of using AI in nursing through a systematic review. Materials & Methods This research was conducted independently by two researchers based on the research objectives and the preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist. A comprehensive search of articles was performed from the beginning of January 2018 to the end of April 2025 across the databases Medline, Scopus, Web of Science, association for computing machinery (ACM) Digital Library, PubMed, as well as the Scientific Information Database (SID) and Magiran search engines. Moreover, the search employed a Medical Subject Headings (MeSH) strategy and the keywords “ethics,” “artificial intelligence,” and “nursing,” in both Persian and English, utilizing Boolean operators. The steps included designing the research question, article search and extraction, selection of relevant studies, tabulation and summarization of the information, and result reporting. Results Out of the 62 articles retrieved, 17 were reviewed and included in the study. The results revealed that, despite numerous benefits, using AI in healthcare is accompanied by many ethical challenges that must be considered. These challenges include safety and clarity of guidelines, informed consent, accountability, patient data privacy, and the effect on patient autonomy. Establishing clear guidelines and regulations is crucial to ensuring AI development and implementation in an ethical and accountable manner. The review showed that bias and discrimination received the most attention, being reported in 14 studies (82%). Following this, nurse autonomy was the second most frequently addressed topic, covered in 13 studies (76%), and the accountability and responsibility principle was also a focus in 12 studies (71%). The algorithmic transparency and interpretability topic was addressed in 10 studies (59%). Security, privacy, and human rights, as well as non-maleficence and beneficence, were each reported in 9 studies (53%). Justice was identified in 8 studies (47%), and finally, regulatory and legal frameworks were the least frequent ethical challenge or dilemma, appearing in 5 studies (29%). Conclusion This review demonstrates that ethical challenges in using AI in nursing care, particularly regarding justice, autonomy, non-maleficence, beneficence, and accountability, are common. Therefore, a comprehensive examination and the creation of effective solutions are crucial to guarantee the ethical and responsible use of AI in healthcare.
Objective The complete or partial absence of the eye and its surrounding structures is one of the most important defects in the facial area, which can occur for various reasons, including trauma, cancer, congenital diseases, or surgeries related to benign and malignant tumors. These defects have a significant impact on the quality of life of patients, both functionally and aesthetically. Reconstruction of this area can be done through surgical methods or the use of silicone prostheses. Due to the complexity of the orbital structures, their reconstruction, especially with surgical methods, is one of the main challenges in the field of facial reconstruction. The choice between surgery and prosthesis depends on the lesion and the patient’s condition and wishes. This article reviews the fabrication and use of orbital silicone prostheses, while also discussing the benefits and challenges of these procedures. Materials & Methods In this study, a 60-year-old woman with an orbital defect and no history of receiving a prosthesis was referred. All stages of evaluation, impression, and retention method selection were performed on the patient. A suitable donor was selected to obtain the orbital wax pattern, and an impression was taken from the donor. The wax-up, ocular placement, impression-making, and staining steps were completed, and the final prosthesis was made. Results In this method, the detailed steps of the work, the required points, and the challenges of construction were discussed. These points, by mentioning them in detail, can be introduced as a method for reconstructing other defects. Finally, the final prosthesis was made with silicone and acrylic. Conclusion The final prosthesis was fabricated with an emphasis on maintaining a natural appearance, lightness, use of appropriate materials, and retention method. The patient was satisfied with the ease of putting on and taking off the prosthesis, proper fit, and its natural appearance.
