Artificial intelligence (AI) is transforming healthcare globally, enhancing diagnostics, treatment, and efficiency. However, low- and middle-income countries (LMICs) like Iran face significant barriers to AI integration. Iran's health system, challenged by an aging population, increasing non-communicable diseases, and limited resources, could benefit from AI-driven, patient-centered care. Yet, its adoption remains limited. Understanding the barriers to AI implementation is critical for informed policymaking.

This qualitative study involved semi-structured interviews with 15 stakeholders from healthcare management, policymaking, and AI sectors in Iran, conducted between January and April 2025. Participants were selected purposively to represent government, academia, healthcare, and technology. Data were analyzed thematically using Braun and Clarke's framework. Rigor was ensured through member checking, triangulation, and adherence to qualitative research standards.

Five major barriers to AI adoption emerged: (1) organizational and structural limitations, including poor infrastructure and fragmented governance; (2) legal and policy challenges, marked by regulatory gaps and ethical concerns; (3) data-related issues such as low data quality, lack of standardization, and security risks; (4) shortage of skilled professionals and limited training opportunities; and (5) challenges in integrating AI into policymaking, including concerns about losing human oversight in decision-making.

AI implementation in Iran's health system faces complex and interrelated challenges. Addressing these requires a coordinated strategy focused on legal reform, infrastructure investment, capacity building, and cultural adaptation. Balancing technological innovation with ethical and human-centered care is essential for successful and sustainable integration.

Exposure to third-hand smoke (THS) is hazardous for human health, especially for pregnant women. This study aimed at psychometric evaluation of the Iranian version of "Beliefs about Third-Hand Smoke Scale" (BATHS-T) in pregnant women.

The data collected from 364 pregnant women referring to Yazd health centers. The BATHS scale was translated into Persian, and the stages of adaptation of the BATHS scale in Persian were evaluated with CVR=0.87 and CVI=0.88. Confirmatory factor analysis (CFA) was performed to analyze the construct validity of the scale. Besides, the correlation test was used to evaluate the correlation of categories and subcategories of the scale.

The BATHS structural equation model showed a favorable fit as RMSEA value was less than 0.05 and X²/df varied between 2 to 5. Moreover, other indices such as CFI and NFI were more than 90%, indicating the optimal fit of the present model. The correlation between the overall scale of BATHS and its two subcategories was 0.843 (p < 0.001) and the correlation between health and stability subcategories was 0.886 (p < 0.001). Since there was a positive and highly significant correlation, the fitted BATHS scale was considered to be structurally consistent with its subcategories. The reliability of the whole scale was 0.86 using Cronbach's alpha coefficient.

The Iranian version of the BATHS scale is reliable and valid. This scale provides the required prerequisites for further research and education on third hand smoke exposure. It can also be possibly used in similar studies.

The BATHS scale has innovative aspects based on the real beliefs of participants concerning third-hand smoke. The favorable validity and reliability of the scale makes it possible to use it in similar studies. Hence, a reliable scale of THS beliefs may be a criterion for measuring the desire to reduce exposure to SHS and THS at homes or other private spaces such as cars. Additionally, examining the results among different populations may be useful in identifying high-risk groups to ward off exposure to THS, and groups that are likely to respond positively to interventions that emphasize THS damage.

This study aimed to explore how Iranian primary health care (PHC) policies have influenced equity in Iran's health system over the last 50 years, from the perspectives of policymakers.

This qualitative research was conducted between 2019 and 2020. Following the identification, screening, and selection of the most relevant PHC policies through document analysis and expert consultation, 30 semi-structured interviews were conducted with various experts in Iran's health system. The logical relationships among the data were analysed using the health policy triangle and thematic content analysis, facilitated by MaxQDA software.

Among the 28 identified PHC policies, five policy groups were recognised as the most significant in relation to health equity. These policies, particularly the PHC and District-level Health Networks (DHNs), have been instrumental in promoting social participation, intersectoral collaboration, and social equity, particularly in addressing acute and communicable diseases. The policies have also ensured equal access to basic health services, especially in rural areas, and have significantly impacted the delivery of care to the population across Iran when acute and communicable diseases were the primary health burden. However, in recent decades, the PHC and DHNs have struggled to keep pace with the dynamic societal changes, shifting disease patterns, and technological advancements.

While the policies have been successful in providing equitable care for acute and communicable diseases, improvements are required to address the rising burden of non-communicable diseases (NCDs). The integration of NCD care into Iran's PHC and DHN requires a cultural shift towards preventive health and lifestyle changes. Political will and support from both the government and healthcare policymakers are essential to overcome barriers such as inherent conflicts of interest.

To investigate whether the triglyceride-glucose (TyG) index and the triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio, as clinical surrogates of insulin resistance, predict the risk of anxiety, and to examine the potential mediating role of plasma proteins.

Prospective cohort study.

Community-based population cohort in the United Kingdom.

A total of 412 767 participants aged 40-69 years without anxiety at baseline and with available data on TyG index and TG/HDL-C ratio were included. Among them, 43 991 participants had proteomic data with 2923 unique plasma proteins measured.

The primary outcome was the incidence of first-episode anxiety. The main exposures were TyG index and TG/HDL-C ratio. Mediation analysis was conducted to assess the contribution of plasma proteins.

During a median follow-up of 13.8 years, 21 616 cases of first-episode anxiety were identified. Higher quintiles of TyG index and TG/HDL-C ratio were significantly associated with increased anxiety risk (p trend <0.001). Each one SD increase in TyG index and TG/HDL-C ratio was associated with an 8% and 9% higher risk of anxiety, respectively. Mediation analysis showed that 36 proteins jointly explained 64.0% and 74.9% of the associations of TyG index and TG/HDL-C ratio with anxiety, respectively, with asialoglycoprotein receptor 1 (ASGR1) and protease serine 8 (PRSS8) identified as key mediators.

Elevated baseline TyG index and TG/HDL-C ratio are associated with an increased risk of anxiety, and this association may be mediated by ASGR1 and PRSS8.

Unhealthy lifestyle behaviors such as poor diet, physical inactivity, smoking, and substance use significantly increase the burden of disease and mortality in Iran. These behaviors pose serious challenges to public health and healthcare systems, making it essential to quantify their impact to guide effective health policies and allocate resources efficiently. This study estimates and compares the health burden of unhealthy behaviors in Iran using quality-adjusted life year (QALY) loss.

A cross-sectional study was conducted in 2024-2025 involving 3,518 individuals aged 18 and older, selected through multistage sampling across nine provinces in Iran. Data collection included face-to-face interviews using a self-administered questionnaire alongside the Iranian version of the EQ-5D-5 L and EQ-VAS tools to assess health-related quality of life (HRQoL). Generalize linear model (GLM) with gamma distribution and a log link analyzed the impact of each unhealthy behavior including smoking, physical activity, sleep quantity and quality, oral health practices (such as brushing and flossing), breakfast skipping, and dairy consumption on health utility scores. Annual QALY loss per 100,000 individuals was calculated by combining behavior prevalence and health utility data. All data analyses were performed using Stata/MP version 17.

In this study, we assessed eight unhealthy lifestyle behaviors among participants: physical activity, smoking status, regular tooth brushing, regular dental flossing, sleep duration, sleep quality, breakfast skipping, and dairy consumption. The prevalence of these behaviors was as follows: 41.79% of participants reported poor physical activity, 25.85% were smokers, 13.19% did not brush their teeth regularly, and 39.57% did not floss regularly. Additionally, 84.22% had insufficient sleep duration (≤ 7 h), 12.48% reported poor sleep quality, 49.81% skipped breakfast, and 25.42% had unsuitable dairy consumption. The study also found that all the unhealthy behaviors were significantly associated with lower EQ-5D-5 L and EQ-VAS scores, with poor sleep quality exhibiting the most substantial negative effect, showing a coefficient of -0.2373 (p < 0.001) for the EQ-5D-5 L score and - 0.1838 (p < 0.001) for the EQ-VAS score. Poor sleep quality also had the largest annual QALY loss per 100,000 individuals at -2961.50 (95% CI: -3407.50 to -2586.52), followed by insufficient sleep duration at -2787.68 (95% CI: -4978.37 to -56.81), breakfast skipping at -2216.55 (95% CI: -3414.74 to -1173.60), and poor physical activity at -2102.04 (95% CI: -3094.81 to -1251.11).

Unhealthy behaviors significantly reduce HRQoL in Iran, with these findings highlighting the high health burden of sleep-related behaviors. These results emphasize the urgent need for targeted public health interventions and prevention strategies to address these behaviors and improve population health.

The Agenda for Sustainable Development agenda prioritizes access to care for non-communicable diseases, including chronic kidney disease (CKD), and sustainable cities and communities. City-level health may impact local research capacity and subsequent participation in randomized controlled trials (RCTs). We identified city-level barriers to CKD RCT participation in the cities from the Global Observatory of Healthy and Sustainable Cities (GOHSC).

We conducted a cross-sectional study of 214 drug CKD RCTs (2003–2023) with participants spanning 146 GOHSC sites. We queried open datasets to retrieve relevant financial, urban, healthcare, and nephrology-related indicators. We designed a CKD research capacity scale incorporating six variables: population-weighted RCTs, sites per sqkm, funding, site span, facility type, RCTs per site. We classified research capacity as absent (0–1 points), insufficient (2–4), fair (6–7), good (7–8), or excellent (9–10) and compared indicators between research capacity categories.

Of the included cities, Odense had the highest population-weighted RCT count (7.01 RCTs per 100,000 population), and Mexico City had the lowest (0.06 RCTs per 100,000 population). Cities with good or excellent research capacity had higher health expenditures, nephrologists, and dialysis centers per million population than cities with absent or insufficient research capacity. In cities with good or excellent research capacity, the most prevalent type of insurance coverage for CKD was public, whereas mixed financing was the most frequent type in cities with absent or insufficient research capacity. Among the identified non-traditional barriers to CKD RCT participation, daily living score, access to public transport, access to open spaces, and access to a fresh food market were higher in cities with good or excellent research capacity, compared to those with lower research capacity scores.

We found differences in CKD research capacity across the cities included in the GOHSC Study Collaboration, which may be affected by financial, socio-demographic, healthcare, and nephrology-related barriers. Local, regional, and international initiatives should address distinctive local variations to enhance CKD research capacity.

Not applicable

The online version contains supplementary material available at10.1186/s12882-025-04482-9.

This cross-sectional study investigated the No-Apnea tool's diagnostic ability to detect obstructive sleep apnea (OSA), across different severities (respiratory disturbance index [RDI] ≥ 5, ≥ 15, ≥ 30) compared to polysomnography (gold standard) in 2,087 consecutive patients attending a sleep clinic (age: 45.92 ± 13.46, male: 70.8%). We further compared the diagnostic performance of No-Apnea, NoSAS, and STOP-Bang tools. Across all RDI levels, No-Apnea showed superior sensitivity (96.9-99.0%, based on RDI thresholds), negative predictive value (NPV) (47.8-91.2%), negative likelihood ratio (0.10-0.22), and odds ratio (10.6-11.8). Across all RDI levels, NoSAS demonstrated the highest specificity (72.2-87.8%), positive predictive value (PPV) (67.5-97.4%), and positive likelihood ratio (2.21-3.87). No-Apnea achieved the highest accuracy and F1 scores at RDI ≥ 5 (90.37 and 94.8%) and ≥ 15 (74.75 and 84.8%). At RDI ≥ 5, NoSAS and STOP-Bang showed comparable areas under the ROC curve (AUC) (0.675 vs. 0.685, P > 0.05), exhibiting a significant advantage over No-Apnea (0.622, P = 0.004 and 0.002, respectively). At RDI ≥ 15 and ≥ 30, NoSAS had the highest (0.676 and 0.668), and No-Apnea had the lowest AUCs (0.566 and 0.543). STOP-Bang performance measures fell between No-Apnea and NoSAS across RDI levels. In our sleep clinic population, No-Apnea demonstrated high sensitivity, NPV, accuracy, and F1 score for detecting OSA, but low specificity, PPV, and AUC.

The Mediterranean diet (Med-Diet) is well known for its protective effects against noncommunicable diseases and overall mortality, thanks to its anti-inflammatory, antioxidant, and neuroprotective properties. Simultaneously, sleep is increasingly recognized as a vital modifiable factor that influences health, affecting both physiological and psychological outcomes. This narrative review summarizes epidemiological evidence on how the Med-Diet impacts sleep duration and quality, examines the biological mechanisms behind these effects, and identifies areas for future research.

A comprehensive search was conducted using PubMed, Scielo, Web of Science, CrossRef, Google Scholar, and Scopus. A total of 191 articles published between 2015 and 2025 were selected based on specific inclusion and exclusion criteria.

Greater adherence to the Mediterranean diet is associated with better sleep outcomes, such as longer sleep duration, shorter sleep latency, higher sleep efficiency, and a lower risk of insomnia and obstructive sleep apnea, particularly among individuals with an overweight. Mechanistically, the Med-Diet promotes better sleep through various interconnected pathways, including modulation of the tryptophan-serotonin-melatonin pathway, reduction of systemic inflammation and oxidative stress, enhancement of metabolic and cardiovascular health, protection of endothelial and brain function, and regulation of gut microbiota and circadian rhythms. Nutrients like polyphenols, omega-3 fatty acids, and fiber influence neurotransmitter balance, neuroendocrine signaling, and microbial diversity, all of which support sleep and respiratory regulation.

The Med-Diet offers a promising non-pharmacological approach to improving sleep health. Further longitudinal and intervention studies are needed to establish causality, assess effects within specific populations, and explore integrated lifestyle strategies, expanding the potential for chronic disease prevention and comprehensive health promotion.

Colorectal cancer (CRC) is one of the most common cancers worldwide. Colonoscopy is the gold standard for CRC screening, but its effectiveness in population-based programs requires further evaluation.

We conducted a follow-up study in Xuzhou, China. Participants were recruited from 2014 to 2021, with follow-up continuing until December 2023. The study comprised two components: 1) an active follow-up to assess treatment outcomes for patients with colorectal advanced neoplasia (CAN) detected during screening; 2) a passive follow-up to compare CRC incidence and mortality between participants who underwent colonoscopy and those who refused it.

The active follow-up included 196 participants, while 15,440 were included the passive follow-up (4,029 in the colonoscopy group and 11,411 in the non-colonoscopy group). 96.43% (189/196) CAN patients were actively followed. However, only 25.93% (49/189) received treatment. The CRC incidence density was 35.77 per 100,000 person-years in the colonoscopy group, which was significantly lower than the 95.50 per 100,000 in the non-colonoscopy group (IRR = 0.37, P = 0.011). 83.33% (5/6) of the CRC cases in the colonoscopy group were from the subgroup of CAN patients who did not receive treatment. There was no significant difference in CRC mortality between the two groups.

Colonoscopy screening is effective in reducing the risk of CRC. However, its real-world effectiveness has been compromised by the low participation rate and the poor treatment adherence among screen-positive patients. The impact of colonoscopy screening on reducing CRC mortality remains undetermined.

Non-communicable diseases (NCDs), including cardiovascular diseases, respiratory disorders, And age-related degenerative diseases, account for 74% of global mortality, imposing heavy burdens on healthcare systems and global sustainable development. Current management strategies face challenges such as poor long-term drug adherence and complex comorbidities. Functional foods and nutraceuticals, particularly those rooted in traditional Chinese medicine (TCM) that embody the "food-medicine homology" principle, have emerged as promising adjuncts for NCD prevention and treatment. Schisandra chinensis (SC) is an edible and medicinal plant with a long history. Rich in bioactive components such as lignans, polysaccharides, and terpenoids, it exhibits multi-targeted pharmacological activities and holds great potential in improving clinical diseases and progressing suboptimal health to optimal, making it a promising candidate for integrated health strategies.

This review aims to synthesize the mechanisms underlying SC's actions in NCD prevention and management, clarify its therapeutic and preventive roles across clinical populations and suboptimal health states, and explore its applications within the framework of predictive, preventive, and personalized medicine (PPPM/3PM).

Preclinical evidence highlights SC's multi-target pharmacological activities, including anti-inflammatory, antioxidant and adaptogenic effects, which are key pathological drivers in the treatment of non-communicable diseases such as cardiovascular diseases, respiratory diseases and age-related degenerative diseases. For clinical populations, SC supports therapeutic goals through liver protection in liver disease management, cancer-assisted immune regulation, neuroprotection, reduction of lung damage, and blood sugar regulation. In suboptimal health individuals characterized by stress-induced fatigue, subclinical inflammation, or impaired elasticity, the adaptive properties of SC offer specific benefits, helping the body resist stress and maintain homeostasis.

SC bridges therapeutic and preventive applications via its multifunctional properties, aligning with PPPM principles by enabling tailored interventions for NCDs and proactive health management. Its safety, multi-target activities, and compatibility with lifestyle medicine highlight its potential as a natural resource for integrated NCD care.

Further clinical trials are needed to validate dosage regimens and efficacy in diverse populations. Standardization of SC quality and exploration of synergistic effects with conventional therapies will facilitate its translation into personalized PPPM strategies.