Iranian Journal of Public Health

Internal Consistency Reliability of Patient-Reported Outcomes Measurement Information System Measures Used in Symptom Cluster Research: A Systematic Review and Reliability Generalization Meta-Analysis

Jeehye Jun , Choa Sung, Chang Gi Park — Sat, 14 Feb 2026 06:25:52 +0000

Background: Patients with acute and chronic conditions often experience multiple symptoms known as symptom clusters. The Patient-Reported Outcomes Measurement Information System (PROMIS) is widely used to assess health status across various conditions, but its suitability for identifying symptom clusters remains unclear. Therefore, we examined the internal consistency reliability of PROMIS tools used to measure symptom clusters in adults through a systematic review and a reliability generalization meta-analysis.

Methods: We searched four electronic databases (PubMed, CINAHL, ProQuest, and Embase) for relevant articles published through December 31, 2024, including studies that measured symptom clusters in adults using at least one PROMIS measure. Meta-regression using a random effects model was performed to assess study heterogeneity, and funnel plots were employed to evaluate publication bias.

Results: The systematic review included 24 studies of 27,982 subjects with or without diseases in community, inpatient, and outpatient settings. Twenty PROMIS domains were used for symptom cluster research, and anxiety and depression were the most frequently used domains. In our reliability generalization meta-analysis of four studies, Cronbach’s alpha coefficients indicated good internal consistency reliability across five PROMIS domains (anxiety, depression, fatigue, pain, and sleep disturbance), with an average reliability of 0.91.

Conclusion: PROMIS measures may be reliable for assessing symptom clusters in adults and could serve as valuable tools for researchers and clinicians in patient assessment and symptom management. Nevertheless, future research should rigorously examine the reliability and validity of PROMIS tools in this context.

Assessing the Impact of Nurse Job Satisfaction on Patient Care Quality: A Systematic Review

Mengyuan Wang , Chengshuai Zhang , Hongzan Li — Sat, 14 Feb 2026 06:29:32 +0000

Background: We aimed to examine the association between nurse work satisfaction and patient care quality. The goal was to find out key factors influencing nurse’s job satisfaction and how these qualities relate to patient care outcomes by synthesizing prior data.

Methods: A literature search was conducted using four databases: PubMed, CINAHL and Embase, published from 2014 and 2023. The inclusion criteria were the impact of nurse job satisfaction on several elements of patient care quality, including safety, effectiveness, patient satisfaction, and overall health outcomes. The research quality was evaluated by established critical evaluation procedures and data were collected and synthesized utilizing standard analysis methodologies.

Results: Eighteen studies satisfied the inclusion criteria, indicating a strong positive relationship between nurse work satisfaction and patient care quality. Organizational support, work environment, professional growth opportunities, and workload management were important factors in determining job satisfaction. Nurse’s high job satisfaction levels were consistently linked to increased patient safety, greater patient satisfaction scores, fewer medical mistakes and better overall patient health outcomes.

Conclusion: The findings demonstrate the importance of nurse work satisfaction in improving patient care quality. Healthcare organizations should prioritize tactics that increase worker satisfaction, such as creating supportive work environments, giving opportunities for professional development, and guaranteeing acceptable workloads. By addressing these issues, healthcare systems can enhance patient outcomes and overall healthcare quality.

Self-Esteem and Learning Disabilities: A Systematic Review of Psychological, Social and Educational Interventions

Sat, 14 Feb 2026 06:31:41 +0000

Background: Self-esteem is a pivotal yet fragile factor influencing the learning and psychosocial outcomes of students with learning disabilities (LD). Although widely discussed, evidence has been inconsistent and dispersed across cultural and methodological contexts.

Methods: This systematic review followed PRISMA 2020 guidelines. Databases search identified 54 records from Scopus and Web of Science, of which eight studies published between 2008 and 2023 met the inclusion criteria. The studies were synthesized into three domains, psychological dimensions, social support and educational interventions.

Results: Findings revealed consistent psychological vulnerabilities. Students with LD reported lower academic self-concept than peers, while large-scale evidence showed overall moderate self-esteem with gender differences favoring males. Qualitative accounts from adults indicated ambivalent identities, blending positive traits such as independence with negative perceptions of anxiety and inadequacy. Social support emerged as a protective factor with friendships, parental involvement and teacher encouragement fostering resilience and buffering against stigma. Interventions demonstrated tangible benefits, educational therapy with 150 children improved self-esteem and reduced behavioral problems, while adapted cognitive-behavioral therapy enhanced emotional regulation and self-worth in adults.

Conclusion: The evidence highlights the need for integrated, culturally responsive and gender-sensitive approaches that address both academic competence and psychosocial well-being. Future research should adopt larger, longitudinal and cross-cultural designs to better capture developmental trajectories across the lifespan.

Evaluation of Long-Term Efficacy and Quality of Life of Tinnitus Retraining Therapy in Patients with Chronic Tinnitus: A Meta-Analysis

Mi Wang , Nianci Xiao , Qingxiu Yao , Mengmeng Chen, Weiliu Zhu — Sat, 14 Feb 2026 06:35:05 +0000

Background: Chronic tinnitus significantly impacts patients' quality of life, with no consensus on the long-term efficacy of different interventions. This study aimed to evaluate the long-term effects of tinnitus retraining therapy (TRT) through a systematic review and meta-analysis.

Methods: Following PRISMA guidelines, literature was searched across eight databases up to November 2024. Ten randomized controlled trials were selected. A random-effects model was used to calculate weighted mean differences (MD) and 95% confidence intervals (CI) for Tinnitus Handicap Inventory (THI) and Visual Analog Scale (VAS) scores.

Results: Compared to control groups, TRT significantly improved THI scores (MD = -8.72, 95% CI: -16.65 to -0.79, P=0.03) and showed a trend toward improving VAS scores (MD = -2.78, 95% CI: -5.57 to 0.02, P=0.05). Heterogeneity was high (I²=90-96%), but sensitivity analysis confirmed stable results.

Conclusion: TRT has a significant long-term therapeutic effect on chronic tinnitus. Future studies should increase sample sizes, standardize interventions, and optimize review processes to reduce heterogeneity and define optimal TRT strategies.

The Evaluation of the Effects of Cochlear Implant Treatment on Quality of Life and Costs: A Systematic Review

Meryem Koçaş , Arzu Yiğit — Sat, 14 Feb 2026 06:36:56 +0000

Background: We aimed to systematically examine the effects of Cochlear Implant Treatment (CIT) on quality of life and costs and to raise awareness of its economic and clinical value.

Methods: A systematic scan was conducted for relevant published studies over Google Scholar, PubMed, ScienceDirect, Springer Link, and Web of Science electronic databases. The search covered studies published between January 2009 and December 2024. Literature search and data extraction were conducted by two researchers and the Drummond Checklist was used to assess the risk of bias and applicability of the included literature. The study was conducted following the PRISMA-2020 guidelines.

Results: Overall, 11 studies were included in the study. When these studies were evaluated, it was found that most of them were conducted in 2021, children were the most preferred sample group, and these studies focused on unilateral Cochlear Implant Treatment. The lowest quality of life value was 0.452 and the highest was 0.93. Cost-effectiveness analyses were used in the studies to determine the cost-effectiveness of cochlear implants, and the Markov Model was preferred. The Incremental Cost-Effectiveness Ratio (ICER) was employed as the outcome measure highly cost-effective in lower-income settings such as Taiwan, while higher ICER values were observed in high-income countries such as the USA.

Conclusion: Cochlear implant treatment improves quality of life and is generally cost-effective for both children and adults, as supported by the majority of studies.

The Comparison of the Impact of Improving Emergency Care on the Prognosis and Treatment Rate of Elderly Patients in the Emergency Departments: A Meta-Analysis

Ningning Dai, Dan Zhao, Dongmei Yang, Jing Qian, Zeyu Xie, Maling Xiang — Sat, 14 Feb 2026 06:40:11 +0000

Background: A meta-analysis study was implemented to review the comparison of the impact of improving emergency care on the prognosis and treatment rate of elderly patients in the emergency department who have acute strokes.

Methods: An inclusive literature investigation was completed until April 2025, and 1765 related studies were reviewed. The 12 selected studies encompassed 1300 elderly patients in the emergency department who had acute strokes. The dichotomous or continuous methodologies with a fixed or random model were used to assess the comparison of the impact of improving emergency care on the prognosis and treatment rate of elderly patients in the emergency department who have acute strokes using odds ratios (ORs), mean difference (MD), and 95% confidence intervals (CIs).

Results: First-aid nursing had significantly lower rescue time (MD, -11.16; 95% CI, -15.74- -6.58, P<0.001), fatality rate (OR, 0.26; 95% CI, 0.16-0.43, P<0.001), and disability rate (OR, 0.30; 95% CI, 0.15-0.58, P<0.001) compared to control in elderly patients in the emergency department who have acute strokes.

Conclusion: First-aid nursing had significantly lower rescue time, fatality rate, and disability rate compared to control in elderly patients in the emergency department who have acute strokes. Nevertheless, since most of the studies nominated for evaluation in the meta-analysis had low sample sizes, care must be taken when working with their values.

Pregnancy Outcomes in Indian Women with Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis

Apoorva Singh , Jayvardhan Singh , Shiv Kumar Mudgal , Ramesh Kumar Huda — Sat, 14 Feb 2026 06:53:39 +0000

Background: Gestational diabetes mellitus (GDM) is a significant pregnancy complication linked to adverse maternal and fetal outcomes. The rising prevalence of GDM is emerging as a public health challenge. We aimed to explore the association between GDM and adverse pregnancy outcomes in India.

Methods: A systematic search was performed to identify eligible studies on gestational diabetes mellitus (GDM) and adverse pregnancy outcomes in India based on inclusion & exclusion criteria. The data was analyzed using R Studio. This systematic review and meta-analysis followed PRISMA guidelines and was registered with PROSPERO.

Results: Women with GDM had higher odds of exposure to adverse maternal outcomes such as cesarean section, postpartum hemorrhage, gestational hypertension, and large-for-gestational-age births. Similarly, GDM significantly increased the odds of adverse fetal and neonatal outcomes, including preterm birth, macrosomia, stillbirth, hypoglycemia, hyperbilirubinemia, congenital malformations, and shoulder dystocia. These findings highlight the increased risk burden posed by GDM on both maternal and fetal health outcomes.

Conclusion: GDM poses a substantial risk to both maternal and fetal health, contributing to multiple complications. Early detection and effective management strategies are crucial to mitigating adverse pregnancy outcomes in affected women

Effectiveness and Safety of Acupuncture and Related Therapies for Poststroke Insomnia: A Network Meta-Analysis

Sat, 14 Feb 2026 07:09:27 +0000

Background: Poststroke insomnia (PSI) is a frequent complication for stroke patients. Acupuncture and related therapies demonstrate efficacy in PSI management. Despite their many types, the optimal strategy remains unclear. This network meta-analysis (NMA) compared the effectiveness of various acupuncture and related therapies.

Methods: Seven databases were searched up to 1st February 2024. The primary outcome was a reduction in the Pittsburgh Sleep Quality Index (PSQI) score. The secondary outcomes were the response rate and adverse events. The treatment ranking probabilities were calculated using the surface under the cumulative ranking curve (SUCRA).

Results: In total, 59 randomized controlled trials (RCTs) involving 4415 participants were included. Electroacupuncture (EA) provided the best result for PSQI reduction (SUCRA = 0.79), followed by warm acupuncture combined with auricular acupoint stimulation (WA+AAS) (0.68) and manual acupuncture combined with auricular acupoint stimulation (MA+AAS) (0.63). For the response rate, manual acupuncture combined with acupoint catgut embedding (MA+ACE) ranked highest (0.86), followed by EA (0.850) and manual acupuncture combined with moxibustion (MA+MOX) (0.83). A total of 96 adverse events were reported: 7 related to acupuncture interventions and 89 to conventional medicine (CM).

Conclusion: Acupuncture and related therapies are effective and safe for PSI treatment. Among them, EA and MA+ACE are the most promising interventions for improving sleep quality poststroke

The Multifaceted Effects of Digital Media Addiction on Mental Health and Academic Performance in Adolescents and Young Adults: A Systematic Review

Yeganeh Asadipour, Reza Rostami — Sat, 14 Feb 2026 07:24:23 +0000

Background: Digital media addiction—including problematic use of social media, smartphones, and internet platforms—is a growing mental health concern among adolescents and young adults. This systematic review synthesizes recent evidence (Jan 2020 to Feb 2025) on the impacts of digital media addiction on mental health and academic performance.

Methods: A systematic search was conducted across 7 academic databases, including Web of Science, ScienceDirect, Scopus, PubMed, Google Scholar, Magiran, and IranDoc. Studies involving individuals aged 12–25 and addressing mental health (e.g., anxiety, depression, stress) or academic performance were included. Screening and selection followed PRISMA guidelines, and methodological quality was assessed using the CASP checklist.

Results: Findings were narratively synthesized and categorized into mental health and academic performance outcomes. Among 17 included studies, 12 (70.6%) reported a significant link between digital media addiction and anxiety/depression, while 8 (47%) found negative academic outcomes such as procrastination or low GPA. Social media addiction was associated with increased symptoms of anxiety and depression. Smartphone overuse was frequently linked to sleep disturbances, emotional dysregulation, and reduced academic performance. Adolescents with poor self-regulation and females were found to be especially vulnerable. Overall, different forms of digital media addiction contribute to psychological distress and hinder academic success.

Conclusion: This review confirms the adverse effects of digital media addiction on youth mental health and academic performance. Unlike prior reviews that examined these outcomes separately, our study provides an integrated perspective by analyzing both domains simultaneously in the post-pandemic era. These findings highlight the need for targeted interventions that improve emotional regulation, reduce screen time, and enhance academic engagement, offering novel insights to inform policymakers, educators, and mental health professionals in developing prevention and support programs.

Effect of Community-Based Interventions for Childhood Asthma: A Meta-Analysis

Sat, 14 Feb 2026 07:32:46 +0000

Background: This study aimed to appraise and compare the influence of community‑based interventions (C-BIs) on childhood asthma.

Methods: We reviewed meta-analysis data and used a dichotomous or continuous model with random or fixed effects to get odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CIs). This review included 13 papers and 8824 children with asthma. The range of studies years were between 2006 and 2024 from Google Scholar, Embase, Cochrane library, Pubmed, and OVID databases.

Results: Children with C-BI had significantly lower asthma-connected emergency department visits (OR, 0.29; 95% CI, 0.22-0.39, P<0.001), hospitalizations (OR, 0.24; 95% CI, 0.15-0.40, P<0.001), asthma symptoms days (MD, -2.56; 95% CI, -2.84- -2.28, P<0.001), nighttime asthma symptoms (MD, -2.14; 95% CI, -2.94- -1.34, P<0.001), and bronchodilator uses (OR, 0.28; 95% CI, 0.16-0.51, P<0.001), and higher asthma action plan use (OR, 8.87; 95% CI, 3.85-20.45, P<0.001) compared to children without C-BI in asthma.

Conclusion: Children with C-BI had significantly lower asthma-connected emergency department visits, hospitalizations, asthma symptoms days, nighttime asthma symptoms, bronchodilator use, and higher asthma action plan use compared to children without C-BI in asthma. Nevertheless, due to the limited number of research studies involved in the comparisons, their values warrant careful consideration.

An Empirical Study on the Reproductive Health Status of Chinese Female College Students and the Importance of Health Education

Sat, 14 Feb 2026 07:38:36 +0000

Background: Reproductive health issues significantly impact female college students in China, yet comprehensive data on gynecological disorders and health education needs remain limited. We aimed to evaluate the prevalence, sociodemographic determinants, and health education preferences in this population.

Methods: A nationwide cross-sectional study was conducted across 12 provinces from October 2024 to August 2025, including 2,318 female students recruited through stratified random sampling. Data were collected via a validated electronic questionnaire covering demographics, reproductive health status, and education participation. Statistical analyses involved descriptive statistics, chi-square tests, and multivariable regression.

Results: High prevalence rates were found for dysmenorrhea (66.18%), irregular menstruation (58.07%), vaginitis (47.89%), premenstrual syndrome (42.19%), and breast disease (36.76%). Significant disparities were identified by education level, residence, and academic major. Rural students showed higher rates of dysmenorrhea (72.62% vs. 59.07%) and irregular menstruation (67.19% vs. 48.00%) than urban students. Although 49.44% had participated in health education, 28.86% had never attended. Students expressed strong preferences for STD prevention (64.32%) and sexual health education (62.25%), with online platforms being the primary information source (34.12%). Over 75% requested free consultations and regular checkups.

Conclusion: Chinese female college students face a high burden of gynecological conditions, with notable sociodemographic disparities. Targeted, digital health education initiatives addressing vulnerable subgroups are urgently needed to improve reproductive health outcomes.

Trends and Distributional Characteristics of Forced Vital Capacity and Forced Vital Capacity Adjusted for Weight Among Chinese Children and Adolescents Over the Three Decades

Chengyue Li , Jixing Gu — Sat, 14 Feb 2026 07:40:43 +0000

Background: To assess trends and distributional characteristics of forced vital capacity (FVC) and vital capacity index (VCI) (a measure of FVC adjusted for weight) among Chinese children and adolescents aged 7-18 years from 1985 to 2019.

Methods: FVC and VCI data for Chinese children and adolescents were obtained from the Chinese National Surveillance on Students’ Constitution and Health surveys in 1985, 1995, 2000, 2005, 2010, 2014 and 2019. VCI (ml/kg) = FVC (ml)/weight (kg). Trends were estimated by sample-weighted regressions with post-stratification population-weighted procedures. The trends in the distributional characteristics were visually described.

Results: For the total population, FVC improved by 78.7 ml (95% confidence interval: -203.3 to 360.7 ml) or 0.12 effect size (ES) (-0.42 to 0.66 ES), which was a negligible improvement. VCI decreased by 11.5 ml/kg (4.8 to 18.3 ml/kg) or 0.84 ES (0.34 to 1.34 ES), which was a large decrease from 1985 to 2019. The sex, residence, and age-stratified VCI both experienced significant moderate to large decreases. Stratified by period, the FVC and VCI decreased dramatically until the 21st century, and the decrease stabilized from 2000 to 2010 and thereafter improved. FVC decreased in the lower percentile and increased in the higher percentile. For the VCI, the larger the percentile was, the smaller the decrease was.

Conclusion: Absolute levels of lung function among Chinese children and adolescents have stabilized over the past three decades, but relative levels of lung function have declined significantly. The government should implement health promotion programs to improve respiratory health.

Retrospective Evaluation of Hepatitis B Prevalence and Viral Load Pattern among Patients in Mogadishu, Somalia

Sat, 14 Feb 2026 07:49:39 +0000

Background: Hepatitis B is an infection of the liver caused by the hepatitis B virus. The infection is characterized by acute and chronic illness, that often lead to liver cirrhosis, and death. In this study, we determined the proportion of patients with hepatitis B infection in Mogadishu and evaluated their hepatitis B viral DNA.

Methods: A retrospective hospital-based descriptive study was conducted between July 2022 and October 2023 to collect data from all patients sent to the Dr. Sumait Hospital, Mogadishu, Somalia for hepatitis B DNA detection and viral load determination.

Results: Among the 406 patients studied in a clinical setting, 54.4% tested positive for hepatitis B virus (HBV) infection. The cohort predominantly consisted of males (62.8%) and individuals aged 30-39 years (32.8%). Age and sex were significantly associated with HBV positivity, with higher odds observed in older age groups with a 2.62 times higher risk of infection (95%CI=1.447-4.750) for the individuals aged between 30-39 years old, 3.19 times greater (95%CI=1.671-6.114) for those age group between 40-49 years old, and 3.13 times greater (95%CI=1.670-5.870) for those age group above 50 years. It should be noted that these findings are based on a clinical cohort and therefore may not represent the prevalence of HBV in the general population.

Conclusion: This study highlights a high proportion of HBV infection among clinical patients with known or suspected HBV infection in Mogadishu, with significant associations between age, sex, and infection risk. Further population-based studies are needed to assess the true burden of HBV in the general population in Somalia.

Environmental Determinants of Chronic Obstructive Pulmonary Disease: The Role of Air Pollutants in Hospitalization Trends

Sat, 14 Feb 2026 00:00:00 +0000

Background: Air pollution is an important global public health concern with multiple consequences for the individuals with respiratory diseases. We aimed to assess the influence of air pollution variables on the hospitalization rates of individuals with chronic obstructive pulmonary disease (COPD).

Methods: Atmospheric pollutant parameters, such as NO₂, SO₂, CO, O₃, PM₂.₅, PM₁₀, and AQI, from Mar 2022 to Mar 2024 were measured. The information of COPD patients was extracted from Masih Daneshvari Hospital (referral center for respiratory diseases in Tehran). The relationship among data, Relative Risk (RR), and Attributable Proportion (AP) for prolonged exposure to air pollutants during a biennial period was assessed using the Air Quality Plus (2.2.4) software.

Results: March 2023 saw the highest number of hospitalizations, with an average of 4.16 cases. This was concurrent with an elevation in PM₂.₅ concentrations. Furthermore, the month of Aug 2023 exhibited a high hospitalization rate, with an average of 3.8 cases, linked to the rise in the concentration of PM₂.₅, NO₂, and O₃ air pollutants. The highest mean relative risks (RRs) associated with acute exacerbation of COPD were as follows: (PM₁₀: 1.83, PM₂.₅: 1.76).

Conclusion: High levels of air pollution, specially PM₂.₅, significantly worsen COPD conditions and are a main trigger for COPD exacerbation. Consequently, enforcing more stringent air quality regulations is an essential public health approach to alleviate the incidence of COPD.

Influential Factors on the Prevalence of Childhood Obesity and Overweight in Jiroft, Kerman Province, Iran

Sat, 14 Feb 2026 07:59:39 +0000

Background: We aimed to investigate the factors that influence the prevalence of obesity and overweight in children in Jiroft, Kerman Province, Iran using tree regression analysis.

Methods: A cross-sectional study was conducted in 2024. Children aged 2-6 years were selected from the kindergartens of Jiroft City by a stratified random sampling method. Parents' demographic information, the mother's health information during pregnancy, nutrition, and the child's lifestyle were obtained through a questionnaire. Children's BMI Z-score was measured. A decision tree model was built using the "rpart" package in R software (version 4.5.1).

Results: Out of 1032 children aged 2-6 years, 51.0% (n=522) were girls. The factors affecting the BMI of children include having a father weighing more than 89 kg, a high-income family, and a birth weight of less than 3.1 kg. According to the regression model, mother's job (P-value=0.045), father's weight (P-value=0.002), and birth weight (P-value=0.013) were positively associated with higher child's BMI status. In contrast, daily vegetable intake (P-value=0.044) was negatively associated with current BMI.

Conclusion: Fathers' weight, family income, and vegetable intake are key factors influencing early childhood BMI in Jiroft. Targeted interventions should prioritize engaging fathers in weight management programs before and during their child’s formative years. Obesity prevention efforts must also address lifestyle behaviors in affluent households through tailored nutritional counseling. Regular vegetable intake appears to have a protective effect, contributing to lower BMI in children.

Warning to Healthcare Professionals: Recognize the Intricate Connection Between Psycho-social Factors Such as Stress, Resentment, and Violence, in the Development of Cancer

Nader Aghakhani , Béatrice Marianne Ewalds-Kvist , Roghaieh Azimzadeh — Sat, 14 Feb 2026 08:03:29 +0000