Shiraz Emedical Journal
Volume:26 Issue: 1, Jan 2025

Context: 

Traditional medicine (TM) is widely used and holds significant potential for increasing Primary Health Care (PHC) coverage and achieving universal health coverage (UHC), especially in developing countries. Persian medicine (PM), an ancient form of TM, encompasses lifestyle principles known as "Hifz-o-Siha," which aim to maintain and improve health.This study seeks to explore whether lifestyle modifications based on PM can effectively promote health within the framework of PHC.

We conducted searches across various databases, including Science Direct, Scopus, PubMed, and Google Scholar. Our search terms included Traditional medicine, Persian, Iranian, Health maintenance, Education, and Primary health care.

Three randomized clinical trials conducted between 2017 and 2019 examined the impact of educating individuals about PM's lifestyle principles on their quality of life and healthcare utilization. The results indicated significant improvements in all measured outcomes. Furthermore, six clinical trials focused on PM dietary modifications in the treatment of conditions such as obesity, infertility, nephrotic syndrome, and non-alcoholic fatty liver disease. In all these studies, PM diets demonstrated significant efficacy compared to conventional medicine.

Lifestyle modifications based on PM recommendations have the potential to positively influence PHC and promote overall health. However, the incorporation of PM into national health systems faces challenges, primarily due to the limited availability of supporting evidence.

Rare diseases, characterized by low prevalence and high complexity, pose significant challenges to health systems due to the uncertainty surrounding the best diagnostic methods and availability of effective treatments.

This study aimed to introduce new methods for prioritizing orphan drugs, with a pilot application to hemophilia, spinal muscular atrophy (SMA), cystic fibrosis (CF), and multiple sclerosis (MS).

This quantitative research, conducted at Iran’s National Institute for Health Research from 2021 to 2023, employs multi-criteria decision-making models (MCDA) to evaluate the efficacy of health care technologies for "rare and hard to cure" diseases. A preliminary model was developed based on a pilot selection of seven medications, for which comprehensive data was extracted. The clinical efficacy was assessed using quality adjusted life years (QALY) as a metric. The model design was grounded on three critical factors: The annual cost of intervention per individual, the annual number of eligible patients for intervention, and the Proportion of expenses covered by the governmental budget. Additionally, the model incorporated various constraints and a regulatory coefficient, denoted as “w,” to enhance its robustness.

By running the model, the coverage of selected medications through model optimization, revealing the following percentages: Alemtuzumab (30%), ocrelizumab (30%), emicizumab (6%), dornase alfa (29%), tobramycin (2%), and spinraza (0.02%). Additionally, the corresponding monetary coverage in Iranian Rials is reported as follows: Alemtuzumab (27,144,000,000 IRR), ocrelizumab (109,645,200,000 IRR), emicizumab (17,360,490,000 IRR), dornase alfa (43,350,930,000 IRR), tobramycin (1,268,505,000 IRR), and spinraza (350,000,000 IRR).

This model has tried to solve the shortcomings of the existing models regarding the prioritization of orphan drugs by combining different factors to improve access to essential treatments for rare diseases, although it can be generally asserted that no unique model can answer all policymakers’ questions regarding budget allocation of rare diseases and orphan products.

Given the importance of spiritual health, resilience, and Self-efficacy in medical students for coping with the challenges of their long training path, this study was conducted to analyze these variables and their correlations among a group of medical students.

This descriptive study was performed on 300 medical students. The subjects were randomly selected, their demographic information recorded, and they were asked to carefully complete the questionnaires. The Spiritual Well-Being Scale, the Connor-Davidson Resilience Scale, and Sherer’s Self-efficacy Scale were used to measure spiritual health, resilience, and Self-efficacy, respectively. Data were analyzed using SPSS version 26 and EQS 6.4. Results were reported as mean ± SD, and statistical significance was set at P-value ≤ 0.05.

In this study, the mean scores for spiritual health, resilience, and Self-efficacy were 73.02, 79.67, and 59.01, respectively. The results showed a positive and significant correlation between religious health and resilience (β = 0.34, P < 0.001) and between existential health and resilience (β = 0.33, P < 0.001). Additionally, a significant correlation was found between religious health and Self-efficacy, both directly and indirectly (β = 0.85, P < 0.001), and between existential health and Self-efficacy indirectly (β = 0.29, P < 0.001). Furthermore, resilience had a direct effect on Self-efficacy (β = 0.87, P < 0.001).

Spiritual health can predict resilience and Self-efficacy. Since individuals with high mental health demonstrate greater resilience, it can be concluded that providing supportive factors, such as religion and spirituality, to enhance mental health and spiritual intelligence can lead to improved resilience and Self-efficacy.

Laparoscopic cholecystectomy (LC) is the preferred surgical procedure for treating symptomatic gallstone (GS) disease.

This study aimed to evaluate and compare the outcomes of emergent and elective LC, focusing on complications, conversion rates, duration of surgery (DOS), length of hospital stay, and post-operative pain.

A total of 166 patients who underwent LC surgery at Baqiyatallah Hospital, Tehran, Iran, between 2021 and 2022 were included in the study. Of these, 64 patients underwent emergent LC, and 102 underwent elective LC. The groups were compared for complications, conversion rates, DOS, length of hospital stay, and post-operative pain.

The study revealed that while intraoperative complications did not differ significantly between the two groups (P = 0.14), there was a significant difference in the conversion of surgical methods from three to four trocars (P = 0.007). Additionally, more patients in the emergent group required drain insertion during surgery (P = 0.003). Regarding post-operative outcomes, no significant differences were observed between the emergent and elective LC groups in terms of local (P = 0.77) and systemic complications (P = 0.37). However, patients in the elective LC group experienced a significantly shorter post-operative hospital stay (P = 0.002). Pain levels one day (1.02 ± 0.80) and one week (0.14 ± 0.43) after surgery were lower in the elective LC group. Furthermore, patients in the elective group returned to daily activities earlier (3.77 ± 1.21 days).

The findings of this study indicate that emergent LC is as safe as elective LC. However, patients undergoing elective LC may benefit from a shorter recovery period and reduced post-operative pain. Overall, LC remains a low-risk and safe option for managing emergent gallstone cases.

Cardiovascular disease (CVD) is recognized as a leading global cause of mortality, with tobacco use being one of the established risk factors responsible for 29% of related deaths. Although tobacco smoking, particularly through hookah, is increasing globally, limited data are available to evaluate its impact on CVD. This study aimed to investigate the relationship between cigarette and hookah smoking and coronary artery disease (CAD).

This study evaluated the relationship between cigarette and hookah smoking and coronary artery involvement based on coronary angiography findings.

In this hospital-based cross-sectional study, 256 patients were included, with 128 patients in the CAD group (showing at least 50% stenosis in the left main artery or over 70% stenosis in other coronary arteries) and 128 patients in the normal angiography group. We assessed their smoking status, categorizing participants as current smokers, ex-smokers, or never-smokers. To ensure the collection of accurate and reliable data, we conducted face-to-face interviews, observations, and administered a questionnaire and medical checklist.

Based on multivariable logistic regression models, after adjusting for additional risk factors, individuals who smoked exhibited an approximately eight-fold higher likelihood of developing CAD compared to non-smokers. Additionally, hookah users showed a five-fold increase in CAD risk compared to non-hookah users (P = 0.001).

Cigarette and hookah smoking are significantly associated with CAD, with cigarette smoking showing a comparatively stronger association with CAD than hookah use when considering other risk factors.

Medical tourism, a byproduct of globalization, involves patients traveling beyond their national borders for healthcare. While this trend is prominent in developed countries, developing nations like Iran can capitalize on it for economic gains.

This study explores the potential and prerequisites for the advancement of medical tourism in Iran, a developing country with significant potential in health services and a need for the development of health tourism to foster further economic growth.

The target group for this study includes Iranian hospitals. The methods used are "Data Collection and Analysis". First, data were gathered from official health and tourism sources through interviews. Second, relevant factors were identified and analyzed qualitatively through a systematic review of related literature.

The study found that beyond the quality of medical services, cultural attributes, legal frameworks, and the tourism appeal of historical sites significantly impact the growth of medical tourism. Key opportunities for Iran's medical tourism include a high number of advanced medical centers, cost-effective and high-quality healthcare, and the allure of historical and natural tourist attractions. However, challenges such as the absence of a centralized coordinating body, limited private sector involvement, and inadequate oversight pose constraints. This study aimed to answer questions about the requirements for medical tourism development and the limitations of its achievement in developing countries.

To enhance medical tourism in Iran, it is essential to adopt a "multifaceted approach" that integrates economic, legal, cultural, and service quality considerations. This approach should improve infrastructure, such as healthcare accommodations, and encourage the participation of private healthcare providers. Furthermore, strategic development in these areas will not only contribute to Iran's economic growth but also enhance its global reputation as a hub for high-quality healthcare services.