Background: Health system responsiveness (HSR) captures how health systems address clients' nonmedical expectations, including dignity, autonomy, confidentiality, communication, and prompt attention. Despite its recognized importance in humanitarian settings, empirical evidence on HSR and its relationship to client satisfaction in these contexts remains limited. Objectives: This study assessed HSR and client satisfaction among recipients of humanitarian services provided by the Iranian Red Crescent Society in Razavi Khorasan Province, Iran. Methods: A descriptive-analytical cross-sectional survey was conducted in 2023 across 27 counties. A multistage sampling design with convenience sampling within service strata was used to enroll 1,384 recipients of social, pharmaceutical, medical, and rehabilitation services. Data were collected using the McMurtry Client Satisfaction Scale (25 items, four domains) and the World Health Organization (WHO) HSR Questionnaire (25 items, eight domains). Exploratory factor analysis and confirmatory factor analysis were used to evaluate construct validity. Group differences were assessed using t tests and analysis of variance (ANOVA). The relationship between HSR and satisfaction was examined using Pearson correlation and analysis of covariance. Results: A total of 1,384 recipients across 27 counties were surveyed. Both instruments demonstrated sound psychometric properties (satisfaction α = 0.737; responsiveness α = 0.872), supporting a four-factor satisfaction structure (52.5% variance) and an eight-factor responsiveness structure aligned with World Health Organization (WHO) domains (62.1% variance), with good CFA fit for both. Mean scores were 76.47 (SD = 9.32) for satisfaction and 82.54 (SD = 13.06) for responsiveness. Female participants and recipients of pharmaceutical services reported higher satisfaction; no significant differences emerged by age, education, or residence. HSR and satisfaction were not significantly correlated (r = 0.02, P = 0.454), and this null association persisted after adjustment for gender and service type. Conclusions: Satisfaction and responsiveness levels were both moderate to high, although responsiveness scores were consistently higher than satisfaction scores. Contrary to expectations, HSR and client satisfaction were not significantly correlated, suggesting that these constructs capture distinct aspects of the service experience in this humanitarian context. The findings highlight social services and rehabilitation as priority areas for quality-improvement efforts within Red Crescent humanitarian programs.
Background: Chronic myofascial neck pain is a common musculoskeletal disorder associated with pain, functional impairment, and reduced quality of life. Although exercise therapy is a cornerstone of management, some patients continue to experience persistent disability. Mesotherapy has emerged as a minimally invasive adjunctive treatment for musculoskeletal pain; however, evidence of its effectiveness in chronic myofascial neck pain remains limited. Objectives: This study evaluated the effectiveness of mesotherapy combined with exercise therapy in patients with chronic myofascial neck pain. Methods: This single-blind randomized controlled trial included 56 patients with chronic myofascial neck pain who were randomly assigned to a mesotherapy plus exercise therapy group or an exercise therapy alone group (28 participants per group). The mesotherapy protocol consisted of subcutaneous injections of 1 mL of 2% lidocaine and 1 mL of piroxicam (40 mg), administered twice weekly for 2 consecutive weeks at 10 trigger point-related sites in the cervical paraspinal and upper trapezius muscles. Both groups received the same standardized exercise program and oral medications. Pain intensity and neck-related disability were assessed using the Visual Analog Scale (VAS) and the Neck Disability Index (NDI) at baseline and at the 1- and 4-month follow-up visits. Results: All 56 participants completed the study and follow-up. Baseline NDI scores were comparable between the two groups. In the mesotherapy group, NDI scores decreased over time, from 42.50 ± 18.35 at baseline to 33.54 ± 17.78 at 1 month and 32.38 ± 17.90 at 4 months, indicating an improvement in neck-related disability. In contrast, NDI scores increased in the control group, from 43.69 ± 18.78 at baseline to 52.79 ± 19.16 at 1 month and 58.82 ± 17.90 at 4 months, indicating worsening disability. The between-group difference in longitudinal NDI changes was statistically significant (P < 0.001). Conclusions: Mesotherapy combined with exercise therapy may provide greater improvement in neck-related functional disability than exercise therapy alone in patients with chronic myofascial neck pain. However, the worsening of NDI scores observed in the control group should be considered when interpreting the magnitude of the between-group treatment effect.
Context: Nephrolithiasis is a chronic metabolic disorder for which surgical intervention can achieve stone clearance but may not correct underlying urinary abnormalities. This narrative review aimed to evaluate changes in 24-hour urinary metabolic parameters before and after the surgical management of nephrolithiasis and to discuss their clinical implications for recurrence prevention. Evidence Acquisition: A structured literature search was conducted in PubMed, Scopus, and Google Scholar through March 2026. Studies were included if they enrolled adult patients undergoing percutaneous nephrolithotomy, ureteroscopy/retrograde intrarenal surgery, or shock wave lithotripsy and reported pre- and postoperative 24-hour urinary metabolic parameters. Changes in urinary calcium, oxalate, citrate, uric acid, urine volume, pH, and supersaturation were qualitatively synthesized, considering study design, surgical modality, stone characteristics, and the timing of urine collection. Results: Urinary metabolic abnormalities frequently persist after surgical stone removal. Although some studies report improvements in urinary citrate, urine volume, or supersaturation, persistent abnormalities, including hypercalciuria, hyperoxaluria, and altered urinary pH, remain common. Differences among studies may be related to stone composition, baseline metabolic status, dietary factors, hydration, infection resolution, and postoperative assessment timing. Procedure-related changes in urinary biomarkers after shock wave lithotripsy or ureteroscopy appear to be transient and should be distinguished from long-term lithogenic risk. Supersaturation provides a more integrated assessment of stone-forming potential than do individual urinary parameters. Conclusions: Surgical treatment of nephrolithiasis should be considered primarily a stone-clearing procedure rather than a definitive metabolic correction. Postoperative 24-hour urine evaluation remains important for identifying persistent risk factors and guiding individualized prevention strategies. Further prospective studies with standardized follow-up protocols are warranted.
Background: Accurate demand forecasting is critical for operational resilience and efficient resource allocation in pharmaceutical supply chains, particularly for life-critical medications such as Insulin Aspart (NovoRapid). However, the demand for these products is often characterized by nonlinearity and structural complexity, which frequently limits the predictive accuracy of conventional statistical methods. Objectives: This study aims to improve demand forecasting accuracy by developing and evaluating a hybrid long short-term memory (LSTM)-Dynamic Grey Wolf Optimizer (DGWO) framework. The objective is to leverage deep learning for temporal sequence modeling while employing metaheuristic optimization to systematically refine model hyperparameters. Methods: The proposed framework integrates an LSTM network to capture temporal dependencies and nonlinear demand patterns with a DGWO for hyperparameter tuning. The hybrid model’s forecasting performance was empirically evaluated against benchmark approaches, specifically an autoregressive integrated moving average (ARIMA) (1, 1, 1) model and a naive baseline, using root mean square error (RMSE), mean absolute error (MAE), mean absolute percentage error (MAPE), and the coefficient of determination (R2) as accuracy indicators. Results: The empirical results show that the proposed hybrid framework outperforms the benchmark models. The final model achieved an RMSE of 131,400, an MAE of 81,112, a MAPE of 10.59%, and an R2 of 0.6823. These findings indicate that the hybrid structure, which combines deep sequence learning with intelligent hyperparameter optimization, provides a more robust representation of demand dynamics than do traditional forecasting methods. Conclusions: Integrating deep learning with metaheuristic optimization provides a robust methodological foundation for pharmaceutical demand forecasting. The LSTM-DGWO framework serves as a practical decision-support tool for supply chain stakeholders, enabling improved inventory planning, optimized safety stock determination, and more accurate supply coordination. Although the model shows substantial promise, its generalizability is constrained by the 32-month dataset and the single-product focus. Future research should scale this framework across broader product portfolios and incorporate exogenous market variables to further strengthen predictive robustness.
Context: Neurological disorders and brain injuries remain major causes of long-term disability, and currently available treatments provide only limited neurological recovery. Growing evidence indicates that exercise-derived extracellular vesicles (EVs), including exosomes, mediate intercellular communication by transferring bioactive cargo that supports neural repair. This systematic review evaluated the therapeutic potential of exercise-derived EVs/exosomes and their associated microRNAs (miRNAs) in experimental models of neurological disorders and brain injuries. Evidence Acquisition: The review was designed and reported in accordance with the PRISMA 2020 Statement. PubMed, Scopus, and Web of Science were systematically searched for original animal studies published between 2020 and 2026. Two reviewers independently performed study selection, data extraction, and methodological quality assessment using the SYRCLE Risk of Bias tool. Owing to substantial methodological heterogeneity, quantitative pooling was not feasible; therefore, the evidence was synthesized narratively. Results: Sixteen preclinical studies were included. Overall, the methodological quality was acceptable, although several SYRCLE domains were rated as unclear because of insufficient reporting. Across multiple neurological disease models, exercise-derived EVs/exosomes consistently improved neurological outcomes by reducing neuronal apoptosis, neuroinflammation, and oxidative stress while enhancing neuroregeneration, angiogenesis, synaptic plasticity, and blood-brain barrier integrity. These effects were associated with the modulation of key exosomal miRNAs, particularly miR-126, miR-124, and miR-484, along with activation of multiple signaling pathways, including PI3K/Akt, STAT3, MAPK, TGF-β/SMAD, mTOR, NF-κB, and p38. Discussion: Available preclinical evidence supports exercise-derived EVs/exosomes as promising therapeutic mediators for neurological rehabilitation. Nevertheless, methodological heterogeneity and inconsistent procedures for EV/exosome isolation and characterization remain major barriers to clinical translation. Future studies should adopt standardized experimental methodologies and validate these findings in rigorously designed clinical trials.
