Mohammad Hossein Somi

Background. The higher education system of medical sciences in Iran requires competent and qualified educational leaders to enhance the quality of education, research, and social accountability. However, the process of selecting heads of educational departments and deans often lacks transparent, competitive, and competency-based mechanisms. This study aimed to identify the key competencies of educational leaders and to design context-specific, policy options for their selection in Iranian universities of medical sciences. Methods. This qualitative study was conducted in four phases using a mixed-methods design. In the first phase, a scoping review was performed to identify the competencies of educational leaders in national and international literature. In the second phase, qualitative data were collected through semi-structured interviews and focus group discussions with medical education experts and analyzed accordingly. In the third phase, the identified competencies were prioritized and weighted using the Delphi technique. In the fourth phase, findings from the previous phases were integrated, and policy options were developed based on the identified competency domains. Results. The competencies of educational leaders were categorized into four main domains: human resource management and development; organizational behavior and professional culture development; change management and educational innovation; and performance monitoring and evaluation. In the Delphi phase, these competencies were prioritized based on scientific, managerial, and professional ethics criteria. Emphasis was placed on selecting leaders through the participation of department members and requiring completion of relevant training programs. For each competency domain, a set of policy interventions was subsequently developed, including the establishment of a competency-based selection system, succession planning programs, continuous leadership development, and the implementation of data-driven performance evaluation systems. These interventions can be implemented as an integrated, phased policy package. Conclusion. Establishing a merit-based model for selecting educational leaders in Iranian universities of medical sciences is a strategic necessity. Designing and implementing a competency-based selection system as a priority action can facilitate the execution of complementary interventions and ultimately enhance transparency, accountability, and the quality of education within the national health system. Research Insights · Effective leadership of medical sciences universities is essential for improving educational, research, and organizational performance. It requires competencies beyond academic and scientific qualifications, including managerial, interpersonal, leadership, professional, and academic competencies. · Although existing evidence highlights the importance of these competencies, evidence on context-specific competencies and transparent, systematic criteria for selecting educational leaders in medical universities, particularly in Iran, remains limited. How these competencies can be translated into clear selection criteria remains insufficiently understood. · This study provides context-specific, evidence-informed, and merit-based policy options for selecting educational leaders in Iranian universities of medical sciences. The options organize the required competencies into a structured framework that can be applied to the selection process. · The proposed policy options can support Iranian universities of medical sciences in developing clearer and more systematic criteria for selecting educational leaders and in strengthening competency-based decision-making in educational leadership appointments.

Background: Inflammatory Bowel Diseases (IBD), including Ulcerative Colitis and Crohn’s Disease, are chronic and recurrent conditions that severely impact patients' quality of life and increase the risk of complications. Providing accurate and evidence-based health information is a non-pharmacological strategy that may improve disease outcomes. This study aimed to evaluate the effect of physician-prescribed information on patients' quality of life and disease Relapse. Methods: In this randomized controlled trial, 160 patients with IBD were randomly assigned to two groups. The intervention group received a structured information prescription (IP) developed by a trained medical librarian and approved by a physician, while the control group received routine oral explanations. The World Health Organization Quality of Life Questionnaire (WHOQOL) and Time to Relapse Questionnaire (TRQ) were used to assess quality of life and Relapse, respectively. Statistical analyses included t-tests, Chi-square, and Mann-Whitney tests using Stata17 software. Results: The Relapse rate in the intervention group was significantly lower than in the control group at both two months (12.5% vs. 87.5%, p=0.004) and four months (15% vs. 42.5%, P<0.001). The risk of Relapse in the control group was more than twice as high compared to the intervention group (Hazard ratio: 2.1; 95% CI: 1.6–2.8). The mean overall quality of life scores showed an improvement in the intervention group, while a decline was observed in the control group. A significant improvement was also indicated in all quality-of-life domains in the intervention group when compared to the control group (P < 0.001). Conclusion: Physician-prescribed information interventions significantly enhance quality of life and reduce disease Relapse in IBD patients, offering a promising complementary approach in clinical care.

Background: The selection of university presidents who oversee health systems within their respective provinces has become increasingly critical in Iran, subjecting to an ongoing scrutiny and debate. This study aims to clarify the selection process and identify the essential competencies required for appointing medical university presidents both in Iran and globally, while also proposing relevant policy recommendations. Methods: This study employed a multi-method approach, incorporating a scoping review, document review, interviews, and brainstorming. The scoping review, conducted in September 2024, searching databases including PubMed, ISI Web of Knowledge, and Scopus. Interviews conducted from September 2024 to November 2024, were carried out with stakeholders from a diverse range, including university presidents, health ministers, healthcare managers, decision-makers, faculty members and key planners within the academic sector, whom were selected using purposive sampling method with maximum variation. A question guide was used, the main question of which included: essential characteristics and competencies of university president, prioritized criteria for decision making, feasibility of evidence-based decision-making, the process of selecting and appointing university presidents, and the strengths and weaknesses of this process. The data were analyzed using a framework analysis approach, informed by Modified Henry Mintzberg’s Management Model and a model of policy competency. Documents related to the selection and appointment of medical university presidents, including rules, regulations, and circulars, were collected through a census approach using both manual and electronic methods. Relevant documents were systematically retrieved from the official websites of the involved organizations. Brainstorming conducted in December 2024 and was used to develop policy recommendations. Results: Twenty six articles and 19 university protocols were included in the scoping review phase. Forty-two participants included in the qualitative phase of this study, most of who were president of a university. Also, 12 participants involved in the brainstorming phase. The responsibilities of a university president necessitating a blend of personal, interpersonal, professional and decisional competencies. In Iran, various factors including political preferences, lack of transparency and accountability, limited involvement from the university community, and insufficient emphasis on professional or technical competencies, influence the selection process of university presidents. The influence of some pressure groups including parliament representatives and the prevailing ideological climate within the Ministry of Health have varied across different governments, relegating essential professional competencies, such as the scientific credibility of the president, to low priority. Conclusions: During various selection and appointment periods, political changes and pressure groups’ interests have had a significant impact on the management changes in universities, and with governments’ changes, managerial capabilities are overshadowed by political tendencies. This study’s findings underscore the importance of transparency, evidence-based decision-making, and a systematic approach to the selection and appointment of presidents of medical universities. Implementing these insights can enhance the integrity of the selection process and improve governance in medical education in Iran.

Background: This study aimed to identify some risk factors associated with time to diabetes type II events using artificial intelligence (AI) survival models (SM) in a population cohort from East Azerbaijan, Iran. Methods: Data from Azar-Cohort spanning from 2014 to 2020 was analyzed using the random forest (RF) variable selection method along with Cox regression to identify the most relevant risk factors associated with diabetes. We then developed prediction models using RF survival analysis. Lasso-variable selection and RF variable selection were used to select the most important variables. The concordance index (C-index) was used to evaluate the concordance of the prediction models. Results: Our LASSO-Cox regression identified six factors to be significantly associated with diabetes: age, mean corpuscular hemoglobin concentration (MCHC), waist circumference (WC), body mass index (BMI), use of sleep medication, and hypertension stage 1 and stage 2. The model included all variables with a C-index of 76.3%. In contrast, the RF analysis identified 21 important variables predicting a higher probability of having diabetes. Of those, WC, MCHC, triglyceride, and age were the most important predictors of diabetes. The RF model converged after 500 trees with an out-of-bag (OOB) of 0.28 and a C-index of 79.5%. Conclusion: RF machine learning algorithms and LASSO-Cox regression analyses consistently identified WC, hypertension, and MCHC as the main risk factors for developing diabetes. The RF approach demonstrated slightly better accuracy in predicting the likelihood of diabetes at different time points.

Background: IBS is a chronic functional gastrointestinal disorder, with IBS‐D being the most common subtype. Patients with IBS‐D experience a lower quality of life than other patients with IBS, and current treatments do not provide relief for all individuals. Given the potential benefits of Punica granatum (Pg), also known as pomegranate, this trial aimed to evaluate the effects of its peel extract as a supplement on patients with IBS‐D. Methods: In this trial, patients with a diagnosis of IBS‐D based on ROME IV criteria, fecal calprotectin levels >50 μg/mg, and normal colonoscopy findings were enrolled and then randomized in a 1:1 ratio to receive capsules (250 mg) of Pg peel extract or placebo (one capsule every 12 h) for 8 weeks. Patients were evaluated regarding the severity of abdominal pain, abdominal bloating, diarrhea, quality of life, and fecal calprotectin levels. Results: In total, 62 patients with IBS‐D divided into two groups of 31 receiving supplement or placebo were analyzed. The results showed significant improvements in the severity of abdominal pain, diarrhea, and quality of life compared with the beginning of the trial and placebo group ( p < 0.05). In addition, the severity of abdominal bloating and fecal calprotectin levels improved compared with the beginning of the trial but not compared with the placebo group. Supplements were tolerated well, with no complications or allergic reactions reported, even at mild intensities. Conclusions: Pg peel extract may be helpful for patients with IBS‐D as a therapeutic supplement by improving their clinical symptoms and quality of life.

Introduction: It is unclear whether hyperuricemia can be considered as an independent risk factor or just as a marker to represent the correlation between uric acid levels and other risk factors of MetS. In this work, we intend to study the correlation between serum uric acid (SUA) and the cardiometabolic phenotype among Tabriz University of Medical Science healthcare workers. Methods: In this cross-sectional study, anthropometric measurements, serum fasting blood sugar (FBS), triglyceride (TG), cholesterol, high-density lipoprotein (HDL), liver enzymes, blood urea nitrogen (BUN), SUA, creatinine (Cr), and blood pressures of 1,451 healthcare workers were evaluated. MetS was diagnosed based on ATP III. We classified the participants into four cardiometabolic phenotypes: metabolically-healthy lean (MHL), metabolically-unhealthy lean (MUHL), metabolically-healthy obese (MHO), and metabolically-unhealthy obese (MUHO). Results: MHL (26.6%) and MHO (65.8 %) had the highest prevalence rates in the first and second SUA categories, respectively (P≤0.001). Compared to the lowest SUA category, the odds of MHO and MUHO increased by 3.13 (95% CI 2.21–4.44) and 5.50 (95%CI 3.53–8.57) in the highest category, respectively. This trend was not observed regarding the association between MUHL and the SUA classification. Conclusion: We propose using the easily-measured SUA level as a marker for early diagnosis of at-risk MUHL and MHO individuals to administer proper interventions. Further prospective studies are needed to identify the effects of SUA on the progression of MetS in various body-size subgroups.

Introduction: Cardiovascular disease (CVD) is one of the most important health problems and the leading cause of mortality worldwide. This study aimed to estimate the risk of CVD using the World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction charts. Methods: The demographic characteristics of all participants of this study aged 40-70 years who did not have a prior coronary event were collected. The 10-year CVD risk was estimated using the laboratory version of the WHO/ISH risk score charts. The risk scores for 11678 participants of the Azar cohort population were calculated. Participants were classified as low risk, moderate risk, or high risk. Results: According to the WHO/ISH charts, only 0.1 % of the population was classified as high-risk (≥40%), and 96.8% had a 10-year CVD risk of<10%. Also, participants with overweight (P=0.002), obesity, and abdominal obesity had higher CVD risk(P<0.001). Conclusion: There was a low burden of 10-year CVD risk among the Azar cohort population without prior coronary events. It appears the percentage of people in the high-risk group is underestimated in the WHO/ISH risk prediction charts, leading to delays in receiving appropriate management in the population concerned. Therefore, using other charts alongside the WHO/ISH risk prediction charts is advisable.

Background: The co-existence of chronic diseases (CDs), a condition defined as multimorbidity (MM), is becoming a major public health issue. Therefore, we aimed to determine the patterns and predictors of MM in the Azar Cohort. Methods: We evaluated the prevalence of MM in 15,006 (35–70-year old) subjects of the Azar Cohort Study. MM was defined as the co-existence of two or more CDs. Data on the subjects’ socioeconomic status, demographics, sleeping habits, and physical activity were collected using questionnaires. Results: The overall prevalence of MM was 28.1%. The most prevalent CDs, in decreasing order, were obesity, hypertension, depression, and diabetes. Obesity, depression, and diabetes were the most co-occurring CDs. The MM risk increased significantly with age, illiteracy, and in females. Also, the subjects within the lowest tertile of physical activity level (OR=1.89; 95% CI: 1.75–2.05) showed higher MM risk than those with the highest level of physical activity. Findings regarding current smoking status indicated that being an ex-smoker or smoker of other types of tobacco significantly increased the risk of MM. Conclusion: The reduction of MM is possible by promoting public health from an early age among people of various socioeconomic conditions. It is vital to offer the necessary health support to the aging population of Iran.

Background. Chronic hepatitis B is associated with different long-term outcomes in various regions. One of the critical predictors of clinical outcomes is the genotype of Hepatitis B virus (HBV). The current study investigated the frequency of worldwide and Iranian national HBV genotypes. Methods. Electronic search was performed through Medline (via Ovid), Embase, Web of Science, and Persian databases. Furthermore, the references of eligible articles were manually checked. The quantitative synthesis was conducted using the 2nd version of comprehensive Meta-analysis software (CMA.2). Results. In total, 5817 records were retrieved, and after removing duplicate studies, 3701 were screened at the title/abstract level. A total of 350 eligible studies were identified in the end.D genotype had the highest frequency (43.50%; 95% CI: 39.60 to 47.50), and the H genotype had the lowest frequency (1.2%; 95% CI: 0.6 to 2.7) globally. In 29 studies conducted in Iran (97.0%), genotype D was identified. Genotype E was the most prevalent in the African Region, followed by A in the American Region, B and C in the South-East Asian Region, D in the European Region, and C in the Western Pacific Region. Conclusion. The most prevalent genotype of HCV worldwide and in Iran is D. Furthermore, HBV genotype frequencies vary according to WHO regions. A prediction of progression could be made based on these results. Practical Implications. 1.According to the results of the meta-analyses, the D genotype had the highest frequency (43.50%; 95% CI: 39.60 to 47.50) and the genotype H had the lowest frequency (1.2%; 95% CI: 0.6 to 2.7) globally. 2.In 29 studies conducted in Iran (97.0%), genotype D was identified. 3. Genotype E was the most prevalent in the African Region, followed by A in the American Region, B and C in the South-East Asian Region, D in the European Region, and C in the Western Pacific Region.