Kerman University of Medical Sciences

To gain a comprehensive understanding of the prevalence of MSSs among restaurant workers, a systematic review and meta-analysis was conducted. The primary objective was to determine the magnitude of this issue and to provide valuable insights for the development and implementation of effective prevention and intervention strategies. systematic review and meta-analysis. This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews and meta-analyses. Relevant studies were identified through a comprehensive search of multiple databases, including PubMed, Scopus, Web of Science, and Google Scholar. A random-effects model was employed for the meta-analysis, and heterogeneity among studies was assessed using the I2 statistic. Data analysis was conducted using STATA statistical software (version 14). Following the completing the stages of screening, selection, and evaluation of the quality of the studies, 17 studies were included in the meta-analysis. The results of the meta-analysis showed that The pooled prevalence of MSSs among restaurant workers was 67.01% (95% CI: 57.90-76.12, I2=98.2%, P<0.001). The highest and lowest prevalence rates are related to the low back with a rate of 50.78% (95% CI: 39.45-62.11, I2=98.4%, P<0.001) and hip/thigh with a rate of 19.05% (95% CI: 10.24-27.87, I2=98.2%, P<0.001). The relatively high occurrence of MSSs within the restaurant industry necessitates the implementation of preventive measures, including ergonomic interventions, to mitigate their adverse effects.

The global rise of chronic diseases requiring long-term management highlights the need for effective palliative care. Nurses play a central role in providing this care, yet frequently face ethical challenges such as moral distress, complex decision-making, and occupational stress. This systematic review aimed to identify, categorize, and synthesize evidence on nurses’ ethical perspectives, challenges, and professional interventions in palliative care for patients with chronic diseases in both hospital and home settings. The review addressed the following questions: (1) What are nurses’ ethical perspectives in delivering palliative care ? (2) What ethical challenges and decision-making dilemmas do they encounter? (3) Which strategies and interventions support ethically sound care? Following PRISMA 2020 guidelines, five databases (PubMed, Scopus, Web of Science, SID, and Magiran) and gray literature via Google Scholar were systematically searched for studies published between 2015 and 2025 in English or Persian. Eligible studies included qualitative, quantitative, mixed-methods, and peer-reviewed reviews addressing nurses’ ethical challenges in palliative care. Qualitative data were analyzed using inductive content analysis, quantitative findings were synthesized descriptively, and mixed-methods results were integrated to allow convergence across study designs. Extracted codes were organized into themes, grouped into categories, and synthesized into overarching domains. Thirty-four studies met inclusion criteria. Four main domains of ethical challenges emerged: (1) Clinical decision-making and patient autonomy—dilemmas regarding life-sustaining treatments, medication and fluid management, palliative sedation, and conflicts between patient preferences and family/cultural expectations; (2) Justice and resource allocation—insufficient ethics education, high workload, limited organizational support, poor interprofessional collaboration, and scarce resources; (3) Beneficence and patient-centered care—ethical issues related to technological innovations, informed consent, data privacy, and environmental pressures such as ICU or emergency care conditions; (4) Non-maleficence and moral distress prevention—moral distress, burnout, reduced ethical courage, and legal concerns affecting clinical decisions. Nurses encounter substantial ethical challenges in delivering palliative care for patients with chronic diseases. Addressing these challenges requires ethics education, structured organizational guidance, interprofessional collaboration, and context-sensitive strategies to safeguard patient dignity and reduce moral distress. These findings provide evidence for policymakers, educators, and managers to develop practical interventions and ethical frameworks across diverse care settings.

Urban primary health care (UPHC) seeks to address the growing health needs of urban populations and improve public health outcomes. However, its implementation faces significant barriers, particularly in financing mechanisms, which often hinder the attainment of key policy goals. This study aims to identify these challenges and propose solutions. This qualitative study collected data through semi-structured interviews with twenty-six key informants between November 2023 and May 2024. A purposive sampling strategy, supplemented by snowball sampling, was used to identify participants. Data were analyzed using a directed content analysis approach guided by Kutzin’s framework on health financing sub-functions. All the data coding processes were conducted using MAXQDA 2020. Challenges in health financing were categorized under three core sub-functions: resource collection, pooling, and allocation and purchasing of healthcare services. Key issues included unsustainable financial resources, limited budgetary allocations for primary and preventive care, and an overall shortfall in available funds. Additionally, inefficiencies in basic health insurance systems, poorly regulated tariff structures, weak resource management, and non-strategic purchasing practices were identified as significant barriers. Addressing these challenges requires a prevention-oriented approach and the application of systems thinking to financing reforms. Strengthening UPHC depends on aligning financial reforms with preventive health priorities. policy actions are recommended to include securing dedicated funding through earmarked taxes for preventive services, reforming the basic health insurance structures, expanding coverage for preventive interventions, and adopting outcome-based purchasing models. These strategies can support the expansion of access to urban primary health care (UPHC), promote universal health coverage, and enhance population health outcomes.

The Arbaeen long walk (ALW) is an annual religious pilgrimage in which over 20 million Muslims walk more than 80 km between Najaf and Karbala in Iraq. While this event may affect participants' health, its impact has not been comprehensively studied. This study aimed to explore the perceived effects of the Arbaeen walk on individuals' health across multiple dimensions. In this qualitative study, 19 university students who participated in ALW were interviewed using a semi-structured guide. Content analysis was applied to the interview data using MAXQDA 2018. The study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) to ensure methodological rigor. A total of 264 initial codes were identified, which were consolidated into 78 unique codes, including 52 positive and 24 negative outcomes. These groups comprised 78 unique codes, with 52 codes representing positive outcomes of the Arbaeen walk and 24 codes representing negative outcomes. Based on frequency, the most significant positive outcomes of the Arbaeen walk were "Peace of mind and heart," "Cultural exchange with other countries," and "Strengthening the relationship between God and individuals." In terms of negative outcomes, the code frequency highlighted the prevalence of "Outbreak of infectious diseases," "Physical fatigue," and "Excessive waste generation." Participation in the Arbaeen walk is associated with diverse positive effects on physical, mental, and social well-being, although some negative health outcomes were also reported. These findings highlight the broad scope of health impacts related to this pilgrimage and underscore the need for further investigation into its effects.