Iranian Orthopedic Association

The glymphatic system plays a critical role in clearing metabolic waste and neurotoxic proteins from the brain, and its dysfunction is implicated in neurodegenerative diseases such as Alzheimer’s disease (AD). Emerging evidence indicates that physical exercise enhances glymphatic function through multiple mechanisms, including increased cerebrospinal fluid (CSF) influx, improved perivascular clearance, astrocytic aquaporin-4 (AQP4) polarization, and modulation of vascular and sleep-dependent processes. Preclinical studies demonstrated that voluntary wheel running and aerobic exercise reduce amyloid-β (Aβ) accumulation, attenuate neuroinflammation, and improve cognitive performance in both aging and AD mouse models, with benefits being highly dependent on AQP4 expression and the timing of intervention. Translational evidence in humans showed that structured aerobic and multicomponent exercise increases glymphatic and meningeal lymphatic activity, enhances vascular dynamics, reduces systemic inflammation, and improves sleep quality, leading to measurable cognitive gains. Despite these promising findings, methodological challenges—such as limitations of non-invasive imaging, difficulty establishing causality, and reliance on short-term interventions—highlight the need for longitudinal, multimodal studies that integrate imaging, cardiovascular, sleep, and cognitive metrics. Collectively, these data suggest that exercise represents a potent non-pharmacological strategy to augment glymphatic clearance, preserve neural homeostasis, and reduce the risk of cognitive decline. This review will summarize evidence on exercise-induced glymphatic enhancement, highlight mechanisms, and identify research gaps for future studies on brain health.

BackgroundThe Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) composite score is a promising measure connecting vascular health to cognitive decline; However, its association with brain imaging findings remains underexplored. This study aimed to evaluate the predictive value of the associations between CAIDE and structural brain measures in individuals with mild cognitive impairment (MCI).MethodsParticipants (n = 226) aged 55–90 years with available CAIDE scores and white matter hyperintensity (WMH) measurements and a diagnosis of amnestic MCI were included. Regression models were used to evaluate the association between CAIDE score and neuropsychiatric and imaging findings.ResultsHigher CAIDE scores were significantly correlated with lower MMSE scores (r = -0.22, p = 0.001) and higher CDR-SB (r = 0.34, p < 0.001) and ADAS-Cog 11 scores (r = 0.38, p < 0.001). CAIDE scores were significantly positively related to total cerebrum (β = 0.319), gray matter (β = 0.337), and hippocampal volumes (β = 0.250, all p < 0.001). ROC analysis demonstrated that total gray matter (AUC = 0.70) and total brain (AUC = 0.69) were more accurate predictors of dementia risk compared to WMH volume (AUC = 0.52).ConclusionHigher CAIDE dementia risk scores were linked to poorer cognitive performance but showed limited association with WMH burden in individuals with MCI. Gray matter and hippocampal volumes were stronger correlates of dementia risk than WMH volume and CAIDE-related risk may be better captured by cortical and hippocampal structural changes rather than white matter disease.

In an era marked by unprecedented access to information and rapid advancements in health care technologies, the Right Not to Know (RNTK) has emerged as a key yet contentious concept within legal discourses. RNTK grants individuals the capacity to refuse knowledge about their health care or genetic profile, thereby strengthening personal autonomy and self-determination. This right is increasingly incorporated into international legal frameworks and human rights principles as a protection against paternalistic tendencies in health care and the overwhelming flood of contemporary data. Despite this development, its legal enforcement remains inconsistent, situated in a regulatory grey zone characterised by uncertainty and diverse interpretations. Theoretically, RNTK’s validity is both supported and challenged. The current study employs a thorough examination of these aspects to evaluate whether RNTK represents an established right in the field of human rights or a contentious right in international and domestic law, especially Australia. This analysis aims to clarify its broader implications for societies.

The hydraulic mission, once considered a cornerstone of development in developed countries, is now largely viewed as outdated due to its environmental consequences. Despite these drawbacks, this approach persists as a socio-economic development strategy, particularly in the Global South, often intertwined with water nationalism and nation-state building. While political economy and geoeconomic perspectives explain the continued pursuit of the hydraulic mission, this paper proposes an additional interpretation. Specifically, certain dams constructed in upstream riparian states&amp;#8212;often less developed and economically disadvantaged compared to their downstream counterparts&amp;#8212;acquire symbolic significance, becoming potent emblems of national pride and fostering strong communal bonds. Analyzing these dams through a political sociology lens, we argue that these extraordinary infrastructures are perceived as a solution for countries grappling with a feeling of relative deprivation. This feeling is not merely objective; it is a historically constructed one, rooted in perceived injustices and inequitable resource distribution, and deeply embedded within the social structure. These social forces intertwine with transboundary water politics, wherein the hydraulic mission becomes an instrument for overcoming this perceived relative deprivation. This dynamic also manifests in the hydropolitical discourse of affected states, narratives of entitlement over the ownership of transboundary waters emerge. These narratives often claim that shared water resources have fueled the development of downstream states while upstream states have been unjustly deprived, and consequently, that upstream development through withholding and diverting transboundary water can achieve parity. This pattern can be observed in hydraulic infrastructures such as the Rogun Dam, the Grand Ethiopian Renaissance Dam, and the Kamal-Khan Dam. These examples share similar characteristics: upstream states are typically less developed than their downstream states, have experienced historically coerced zero-sum cooperation, or a deficiency of development stemming from prolonged conflict. These dams often have unique features that make them exceptional, such as immense storage capacities that take decades to fill or deliberate water diversions that alter the river course. While prior analyses have acknowledged the subjective dimensions of the hydraulic mission, including identity, discourse and political values, a political sociology approach highlights the impact of relative deprivation as a driving force behind hydraulic mission. This feeling explains the politicization and securitization of water discourse, which frame the elimination of deprivation and the achievement of parity as essential. It also explains nation-state building and polarized identity formation. The specific characteristics and intentional impacts of these dams, serving as emblems of national pride and dignity, are also explained by the theory of relative deprivation. Furthermore, responses to relative deprivation can lead to transboundary water conflicts as incompatibilities emerge over resource control, endangering the water security and environmental stability of downstream states, and potentially leading to further political instability. Therefore, it is imperative to recognize, especially when upstream nations in a transboundary river basin are politically, socially and economically disadvantaged compared to downstream states, that the hydraulic mission should be understood not just in terms of socio-economic development, but also as a mechanism for addressing and alleviating a deeply ingrained feeling of relative deprivation.

Background: Academic Engagement is considered as one of the important factors related to the learners’ academic achievement. It is known as a significant research issue in higher education. The present study aimed to make an instrument for investigating academic engagement among nursing students of Ilam University of Medical Sciences. Methods: The present study is a methodological and cross-sectional research. To localize the academic engagement questionnaire, first, it was translated into Persian using forward-backward method. Then, its content and face validity were evaluated and approved. In order to determine the validity and reliability, the questionnaire was delivered to 120 nursing students and their comments were collected and analyzed. SPSS and AMOS software, statistical tests of exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used for data analysis. Results: According to the results, the internal consistency of the questionnaire was confirmed by calculating Cronbach's alpha coefficient (α = 0.906). The EFA and CFA were used to examine the dimensionality of three domains of vigor, dedication, and absorption. Values of Goodness of Fit Index (GFI), Non-Normed Fit Index (NFI), Comparative Fit Index (CFI), and Root Mean Square Error of Approximation (RMSEA) indices were 0.89, 0.92, 0.90 and 0.97, respectively Conclusion: The reliability and validity of the translated academic engagement questionnaire were relatively acceptable in reviewing the academic engagement of medical students, especially nursing students. Future studies should focus on more samples and examine the impact of nurses' background and educational variables on academic engagement.

BackgroundSetting and implementing evidence-informed health service packages (HSPs) is crucial for improving health and demonstrating the effective use of evidence in real-world settings. Despite extensive training for large groups on evidence generation and utilization and establishing structures such as evidence-generation entities in many countries, the institutionalization of setting and implementing evidence-informed HSPs remains unachieved. This study aims to review the actions taken to set the HSP in Iran and to identify the challenges of institutionalizing the evidence-informed priority-setting process.MethodsRelevant documents were obtained through website search, Google queries, expert consultations and library manual search. Subsequently, we conducted nine qualitative semi-structured interviews with stakeholders. The participants were purposively sampled to represent diverse backgrounds relevant to health policymaking and financing. These interviews were meticulously audio-recorded, transcribed and reviewed. We employed the framework analysis approach, guided by the Kuchenmüller et al. framework, to interpret data.ResultsEfforts to incorporate evidence-informed process in setting HSP in Iran began in the 1970s in the pilot project of primary health care. These initiatives continued through the Health Transformation Plan in 2015 and targeted disease-specific efforts in 2019 in recent years. However, full institutionalization remains a challenge. The principal challenges encompass legal gaps, methodological diversity, fragile partnerships, leadership changeovers, inadequate financial backing of HSP and the dearth of an accountability culture. These factors impede the seamless integration and enduring sustainability of evidence-informed practices, hindering collaborative decision-making and optimal resource allocation.ConclusionsTechnical aspects of using evidence for policymaking alone will not ensure sustainability unless it achieves the necessary requirements for institutionalization. While addressing all challenges is crucial, the primary focus should be on required transparency and accountability, public participation with an intersectionality lens and making this process resilience to shocks. It is imperative to establish a robust legal framework and a strong and sustainable political commitment to embrace and drive change, ensuring sustainable progress.

Abstract Foremost in dealing effectively with water conflicts is comprehensive analysis. The global surge in water conflicts, coupled with the imperfect success of solutions, initiatives, and policies, calls for a critical reevaluation of the paradigms that guide approaches to water conflicts. The approach taken—conflict management, resolution, or transformation—has a decisive impact on addressing water conflicts, from the initial analysis to the crafting of policies and their practical implementation. Iran is a prime example of this, with water conflicts increasing at various scales despite concerted mitigation efforts. This paper, through a qualitative content analysis of 159 peer‐reviewed papers collected via a systematic review, aims to delineate the prevailing approach to water conflict analysis within Iran's academic discourse, thereby partially shedding light on the shortcomings in both policy and practice. Water conflict resolution, and its respective models such as game theory and optimization–simulation, is the predominant approach in Iran's literature on water conflict analysis, thereby marginalizing attention dedicated to conflict management and transformation. This reflects an overarching focus on techno‐economic functions to deal with water conflicts, often overlooking the myriads of managerial and societal factors. The adoption of water conflict transformation can be vital to rectify these deficits in conflict analysis, potentially with subsequent impacts on policy and practice.

This study assessed the incidence and severity of side effects associated with coronavirus disease 2019 (COVID-19) vaccination among healthcare workers registered with the Medical Council of the Islamic Republic of Iran. A retrospective cohort study was conducted on the healthcare workers focusing on the side-effects of COVID-19 vaccines from March to June 2021. Data were collected using online questionnaires. Multivariable logistic regression was used to assess the association between side effects of the vaccines and demographic variables, comorbidities, vaccine type, and history of COVID-19. Out of 42,018 people who were included, 55.85% reported at least one side effect after receiving the first vaccine dose. 4.59% of those with side effects sought diagnostic intervention or were referred to treatment centers. Multivariable logistic regression indicated that being a woman, higher education, having a history of COVID-19 infection, and having comorbidities increased the risk of side effects. The AstraZeneca vaccine significantly increased the risk of side effects compared to the Sputnik vaccine, while the Sinopharm vaccine decreased this risk. The risk of developing a side effect decreased with age. The risk of moderate and severe side effects was significantly associated with gender, younger age, comorbidities, and a history of COVID-19 infection. Moderate and severe side effects were less reported by those who received the Sinopharm vaccine. Clinical complications after COVID-19 vaccination, directly or indirectly caused by the vaccines, are common. However, the benefits of COVID-19 vaccines greatly outweigh the risk of reversible side effects, especially among the high-risk population.

Background: Osteoporosis, a widespread disease associated with aging, is characterized by a decrease in bone tissue density. With the global population aging, numerous studies aim to present methods for preventing or treating this disease to avoid pathological fractures by preserving bone density. Objectives: This study aimed to compare the changes in bone density in females with osteoporosis before and after receiving denosumab for at least one year. Methods: This clinical trial was conducted on 202 patients with osteoporosis who were referred to two private clinics in Tehran between 2019 and 2020. Each patient received two subcutaneous injections of 60 mg denosumab (Prolia) once every six months. Bone density was measured using the DXA method, and the T-score and the risk of bone fracture were calculated and compared using the FRAX instrument before drug administration and six months after the second dose injection. Results: The average age of the participants was 69.0 ± 8.0 years. Significant differences were observed in vertebral bone density (-2.55 ± 0.06 to -2.00 ± 0.07) and femur bone density (-2.10 ± 0.10 to -1.88 ± 0.06) before and after denosumab treatment (P &lt; 0.05). Furthermore, the risk of major fractures (23.0 ± 1.9 to 18.9 ± 1.5) and hip fractures (8.5 ± 1.3 to 5.7 ± 0.9) significantly decreased before and after treatment with denosumab (P &lt; 0.05). A significant improvement in bone density was observed across all age groups of patients before and after treatment with denosumab (P &lt; 0.05). Conclusions: Denosumab significantly reduces the risk of bone fractures and enhances bone density in postmenopausal women. It proves to be an effective medication for reducing the increased risk of fractures in postmenopausal women and for improving their bone density.