Social Determinants of Health

Background: The rapid advancement of digital technologies has made digital marketing a crucial tool for enhancing patient communication, expanding healthcare access, and improving the competitiveness of health institutions. This study aimed to identify and analyze managerial and educational barriers to implementing digital marketing in healthcare centers of Kohgiluyeh and Boyer-Ahmad province and to propose targeted strategies for improvement.

Methods: A mixed-methods design was employed in 2025. In the qualitative phase, semi-structured interviews were conducted with 14 purposively selected managers and staff to explore key implementation challenges. In the quantitative phase, 102 managers and employees were recruited through stratified random sampling. Data were gathered using a researcher-developed questionnaire covering six barrier dimensions—managerial, organizational, human resources, technical, financial, and infrastructural—with specific emphasis on digital skills and training-related factors. Instrument reliability was confirmed with a Cronbach's alpha of 0.87.

Results: Financial barriers ranked highest with a mean score of 4.12, followed by human resource and managerial obstacles. Limited digital literacy, inadequate training in digital marketing tools, and the absence of structured educational programs were identified as significant challenges. Correlation analysis revealed significant positive relationships among barrier dimensions, with the strongest association observed between managerial and human resource factors.

Conclusion: Successful digital marketing implementation in healthcare requires simultaneous attention to financial, managerial, human resource, educational, and infrastructural elements. Strengthening managerial support, investing in digital infrastructure, and developing continuous training programs to enhance staff digital competencies can significantly facilitate the adoption and effective utilization of digital marketing strategies in healthcare organizations.

Background: Iran has not enjoyed an optimal economic situation; therefore, improving the conditions for health tourism can have positive effects on the country’s economy. The primary purpose of this research was to investigate the influence exerted by medical tourism on the healthcare financial sector within the specific provinces chosen for analysis.

Methods: This study was applied in nature and covers the time period from 2011–2021. The research sample included major Iranian cities (Tehran, Karaj, Qom, Isfahan, Mashhad, Shiraz, Tabriz, and Ahvaz). To evaluate how fluctuations in economic policy uncertainty influence capital expenditure within the health tourism industry, a threshold panel methodology was implemented.

Results: The level of Economic Policy Uncertainty (EPU) was found to be below the threshold affecting investment in the health tourism sector. Given the positive effect above the threshold, the conclusion is that risk and uncertainty are inseparable parts of the investment process in the health tourism sector. The findings indicate that macroeconomic pressures—specifically inflation, currency volatility, and the repercussions of the COVID-19 pandemic—exerted a detrimental influence on capital allocation within the health tourism industry. Conversely, the empirical results demonstrate that financial development, market liquidity, and the volume of incoming provincial health tourists serve as significant drivers that bolster investment within this sector.

Conclusion: The relationship between EPU and Investment in Health Tourism (IT) is non-linear, and the intensity and direction of this relationship depend on the level of EPU. At all levels, economic uncertainty exerts a net downward force on investment in the health tourism sector.

Background: Delinquency, as a social and psychological issue, has a significant impact on the security and development of societies. This study has investigated the relationship between education level and crime rates in Bushehr city in south of Iran.

Methods: This cross-sectional study was conducted on 485 residents of Bushehr. The statistical population included the general public, families, organizations dealing with delinquency issues (e.g., the judiciary, police, prison organizations), and offenders. Data were collected through standardized questionnaires and interviews, and analyzed using Chi-square tests and multiple regression analysis.

Results: The results showed that lower education levels (below high school diploma) are associated with higher crime rates. Individuals with less than a high school diploma were predominantly involved in drug-related crimes (62%), whereas those with university-level education were more frequently implicated in financial crimes such as embezzlement and forgery (44%). Additionally, winter recorded the highest crime rate (37.14%). Regression analysis demonstrated a significant negative effect of education on crime rates (β = -0.35, p = 0.001). Furthermore, gender (being male) and increasing age were also found to significantly influence criminal behaviors.

Conclusion: The findings suggest a significant association between lower education levels and higher crime rates. Further longitudinal or interventional studies are needed to explore the potential impact of educational programs on crime reduction. Moreover, targeted interventions for high-risk groups and attention to the social and environmental factors influencing crime are essential.

Background: Critical hospital equipment is essential for safe, high-quality healthcare, relying on effective preventive maintenance systems. Beyond management, the knowledge and training of maintenance staff significantly impact system effectiveness. This study aimed to identify the managerial and educational barriers to implementing a preventive maintenance system in Baath Hospital of Gachsaran and propose targeted improvement strategies.

Methods: A mixed-methods sequential exploratory design was used in 2024. The qualitative phase involved semi-structured interviews with 14 experts in medical equipment and hospital facilities, analyzed through thematic content analysis. Findings informed a researcher-made questionnaire distributed to 102 staff members in the quantitative phase. The questionnaire assessed managerial, organizational, technical, financial, infrastructural, and educational factors affecting maintenance implementation.

Results: Barriers were categorized into six main dimensions: managerial, organizational, human resources, technical, financial, and infrastructural, with educational issues emerging as a critical cross-cutting factor. Financial barriers ranked highest (mean score: 4.08), followed by human resource and managerial barriers. Key educational challenges included insufficient training programs, limited staff technical knowledge, and a lack of structured learning systems. A significant positive relationship was observed between several dimensions, most notably between managerial and human resource barriers.

Conclusion: The primary barriers include financial constraints, a shortage of skilled human resources, inadequate training, and weak maintenance planning. Strengthening managerial structures, developing continuous education programs, and improving technical competencies are crucial for enhancing maintenance effectiveness and, consequently, the quality and safety of healthcare services.

Background: Teen years represent a pivotal phase of growth, fraught with distinct risks like tendencies toward self-injurious actions. Our research explored the straightforward connection between core life principles and such behaviors among teens, while probing how challenges in managing feelings act as an intermediary in this dynamic.

Methods: Employing a correlative design with structural equation modeling, we targeted Tehran high schoolers aged 14–18 from the 2023–2024 school term. Through multi-phase clustered random selection, 356 youths joined, filling out tools like the Self-Harm Inventory, abbreviated Portrait Values Questionnaire, and compact Difficulties in Emotion Regulation Scale. We crunched numbers via SPSS 27.0 and AMOS.

Results: The proposed framework aligned well with real-world findings. As predicted, stronger life principles linked inversely to self-injury (β= 0.11, P=0.044). Emotional control issues tied positively to these behaviors (β=0.37, P=0.001). Notably, feeling management woes bridged part of the gap between principles and self-injury (β=-0.06, P=0.007).

Conclusion: This study highlights that personal values, emphasizing meaning, purpose, and prosocial behaviors (e.g., benevolence, universalism), protect against adolescent self-harm by enhancing emotion regulation. Integrating values-based interventions and emotion regulation training into prevention programs is recommended for clinicians and educators to reduce self-harm risks effectively.

Background: Health tourism is increasingly recognized as a strategic component of health system development, contributing to investment attraction, service capacity enhancement, and financial sustainability. However, economic instability and policy uncertainty may adversely affect investment decisions in this sector. In recent years, Iran has experienced elevated levels of economic uncertainty. This study aimed to examine the impact of economic policy uncertainty on investment in health tourism across selected provinces of Iran.

Methods: This applied–analytical study utilized secondary panel data covering the period from 2011 to 2021. The study population included major metropolitan provinces of Iran (Tehran, Karaj, Qom, Isfahan, Mashhad, Shiraz, Tabriz, and Ahvaz). A Panel Smooth Transition Regression (PSTR) model was employed to estimate the nonlinear effects of economic policy uncertainty on health tourism investment.

Results: The results indicated a threshold value of −0.428 for the economic policy uncertainty index. Above this threshold, economic uncertainty exerted a positive effect (−0.353), whereas below the threshold it had a negative effect (0.218) on health tourism investment. Inflation, exchange rate fluctuations, and the COVID-19 pandemic demonstrated significant negative effects, while financial development, liquidity, and provincial tourist volume showed positive and significant associations with investment levels.

Conclusion: The findings suggest that economic uncertainty plays a complex and nonlinear role in shaping investment behavior in health tourism. Effective economic and health policy coordination may enhance investment stability and promote the sustainable development of health tourism services.

Background: Given modern psychosocial challenges, non-pharmacological mental well-being interventions are needed. This study aimed to identify its theoretical components through the principles of visual literacy in communicative Gestalt theory and explain their link to psychosocial health.

Methods: This qualitative study was conducted using a constructivist Grounded Theory approach and directed content analysis. Data were collected through purposive sampling of 18 prominent vocal pieces and semi-structured interviews with 9 experts (musicians and psychologists, Visual communication artists, as well as mental drawings of the basics of visual literacy, Qashqai's lullaby, by 40 students) and analyzed using MAXQDA software. The analysis was focused on Gestalt principles (wholeness, figure-ground, proximity, similarity, continuity, closure).

Results: Data analysis led to the extraction of six key theoretical components aligned with Gestalt principles: Wholeness (integrated auditory experience), Figure-Ground (semantic highlighting of poetry), Proximity (melodic-verbal cohesion), Similarity (repetitive acoustic patterns), Continuity (continuous emotional flow), and Closure (completion of auditory expectations). These components were linked to specific psychosocial mechanisms such as reducing cognitive load, enhancing attentional focus, facilitating the processing of complex emotions, creating psychological safety, gradual emotional regulation, and cognitive completion. Interview analysis further characterized Iranian Folk song (Qashqai lullaby) as a "regulative communicative space" with functions in emotional regulation, mental coherence, recovery of a pleasant feeling, representing nostalgia and reinforcement the collective identity of citizens.

Conclusion: This study concludes that the Gestalt structure of Iranian Folk song (Qashqai lullaby) due to benefit from the systematic principles of visual literacy, fosters an integrated auditory experience which reduces mental agitation, facilitates emotional expression, and strengthens social belonging. It establishes a theoretical framework for using folk song as a cultural intervention for mental health of citizen and paves the way for future experimental research.

Background: The integration of biomedical engineering principles with digital dentistry technologies particularly in guided systems based on biomaterials, fluid mechanics, and digital signal processing has revolutionized the design and fabrication of dental crowns. This study aimed to evaluate the impact of these engineering-driven approaches on the biomechanical performance and biocompatibility of dental crowns.

Methods: Using concepts from tissue engineering and solid mechanics, three key quality parameters surface roughness (Ra), mechanical strength (MPa), and durability (cycles to failure) were compared between traditional and digitally guided crowns. Data were analyzed through mathematical modelling (multivariate regression) and finite element analysis (FEA) to predict biomechanical behavior. Milling machine parameters such as spindle speed and tool path were optimized using control engineering principles.

Results: The results demonstrated that digitally guided crowns achieved superior outcomes, with mean surface roughness of 0.55 µm (vs. 1.12 µm), strength of 495 MPa, and durability of 10,500 cycles, showing statistically significant improvements (p<0.001). Enhanced stress distribution and higher fatigue resistance were also observed in the guided systems.

Conclusion: This study confirms that digitally guided dental fabrication technologies are more consistent with Biocompatibility-by-Design principles, reduce human error, and enhance geometric accuracy representing a key step toward personalized prosthetic treatments. Moreover, these systems have the potential for integration with artificial intelligence and tele-dentistry platforms for long-term performance monitoring.

Background: Adolescence is a critical developmental stage where high-risk behaviors can jeopardize well-being and future outcomes. This study evaluated the efficacy of peer group-based psychosocial empowerment training in reducing high-risk behaviors among male secondary school students at risk for behavioral issues in Tehran, Iran.

Methods: This quasi-experimental study employed a two-group, pre-test, post-test, and three-month follow-up design with a control group. A purposeful sample of 40 at-risk male students, identified through teacher reports and a high-risk behaviors questionnaire, was randomly assigned to a peer-led experimental group (n=20) or a wait-listed control group (n=20). The experimental group received eight 90-minute sessions of psychosocial empowerment training facilitated by trained peers. Data were collected using a validated high-risk behaviors questionnaire (42 items, seven subscales). Repeated measures ANOVA and Bonferroni post-hoc tests were used to analyze group differences over time, with effect sizes (η²) reported.

Results: The peer-led intervention significantly reduced high-risk behaviors, including cigarette/hookah use, alcohol/substance consumption, aggressive behaviors, suicidal ideation/attempts, running away, and opposite-sex relationships (F=59.22, P<0.001, η²=0.61, 95% CI [14.63, 22.83] for total score). These reductions were sustained at the three-month follow-up, indicating a robust effect of the intervention on vulnerable adolescents.

Conclusion: This study demonstrates the efficacy of peer group-based psychosocial empowerment training as an effective strategy for reducing high-risk behaviors among at-risk male adolescents. The findings support the integration of peer-led interventions into school-based mental health programs to enhance resilience and promote positive youth development.

Background: The mechanical strength and longevity of 3D-printed dental temporary crowns are significantly influenced by layer thickness and printer type. The purpose of this study was to assess how layer thickness and printer type affected the temporary crowns' mechanical robustness.

Methods: In this in vitro study, 60 temporary crown samples were fabricated using two 3D printers, Asiga and Quick Digi. Thirty samples per thickness were printed at two-layer thicknesses of 50 μm and 60 μm. Descriptive statistics, paired t-tests, one-sample t-tests, and correlation analysis were used to examine the data after compressive strength was determined.

Results: The mean compressive strength was 230.33 kg/m² for 50 μm and 124.50 kg/m² for 60 μm. The two thicknesses differed significantly (p < 0.001), according to the paired t-test. The mean percentage change in compressive strength was -45.67%, showing a uniform and consistent reduction across all samples. Correlation analysis revealed no significant linear relationship between mechanical performance at the two thicknesses. Comparative analysis between the two printers indicated superior performance of Asiga in strength and structural uniformity.

Conclusion: Selecting an appropriate layer thickness and high-quality 3D printer is crucial for enhancing the mechanical strength and durability of temporary crowns and can guide clinical decision-making in digital dentistry.

Background: Skin wounds that are full-thickness present a major clinical problem. Although cell-based treatments have limitations, the secretome of adipose-derived mesenchymal stem cells (ADMSCs) stimulates recovery through paracrine signaling. This study utilized a gelatin sponge scaffold as a biocompatible delivery platform for the ADMSC secretome, creating a cell-free therapeutic system.

Methods: Human ADMSCs were characterized. Their conditioned medium (secretome) was collected and analyzed for key growth factors. Gelatin sponge scaffolds were fabricated by freeze-drying and crosslinking, then loaded with the secretome. Scaffolds were characterized physico-chemically (SEM, FTIR, porosity, degradation). In vitro biocompatibility was tested on dermal fibroblasts. Gelatin/secretome scaffolds, gelatin-only scaffolds, or gauze were used to treat full-thickness excisional wounds in rats (n = 6 per group). Wound closure, histology, collagen, and angiogenesis were evaluated on days 10 and 20.

Results: ADMSCs expressed characteristic markers. The secretome contained hepatocyte growth factor (124.45 pg/mL), basic fibroblast growth factor-2 (42.18 pg/mL), and vascular endothelial growth factor (7.54 pg/mL). Scaffolds showed high porosity (85-90%) and supported high fibroblast viability/proliferation. In vivo, gelatin/secretome scaffolds achieved significantly faster wound closure (87.4 ± 4.3% on day 10; 98.7 ± 1.2% on day 20) versus controls (gelatin: 68.2 ± 5.7% and 92.1%; gauze: 62.5 ± 6.1%). They also promoted superior re-epithelialization, collagen deposition (62.4 ± 5.8%), and neovascularization (32.8 ± 4.6 vessels/field).

Conclusion: Gelatin scaffolds loaded with ADMSC secretome significantly enhance full-thickness wound healing by accelerating closure, improving tissue regeneration, and stimulating angiogenesis. This cell-free platform represents a promising strategy for clinical wound care.