Masumeh Saeidi Health Providers 2820-9192 6 1 2026 06 01 Enhancing Health System Resilience: An Operational Imperative for Climate-Adaptive Healthcare 1 3 246217 10.22034/hp.2026.588532.1085 EN Ali Ramezankhani Professor, Health Promotion Research Center and Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 0000-0002-3109-1641 Mansoure Alipour-Anbarani Assistant Professor, Department of Health Education and Health Promotion, Faculty of Health, Sabzevar University of Medical Sciences, Sabzevar, Iran. 0000-0002-9563-7383 Journal Article 2026 06 25 Climate change is increasingly recognized as a critical determinant of health system performance, disrupting healthcare delivery through extreme weather events, infrastructure instability, and evolving disease patterns. Despite growing awareness, the operational integration of climate resilience into routine health system governance remains limited. We propose the Climate-Adaptive Clinical Governance Model (CACGM), a concise four-domain framework encompassing climate intelligence integration, resilient infrastructure, workforce preparedness, and interdisciplinary governance. By embedding anticipatory adaptation within institutional planning and service delivery, CACGM supports a transition from reactive crisis response toward proactive, climate-resilient healthcare systems capable of sustaining quality care under environmental stress.

https://www.health-providers.ir/article_246217_c6594acdd942270fc8e12bf620198ef1.pdf

Masumeh Saeidi Health Providers 2820-9192 6 1 2026 06 01 Non-Pharmacological Interventions for Bone Health in Postmenopausal Women and Patients with Rheumatoid Arthritis: A Structured Narrative Review 5 17 246212 10.22034/hp.2026.588463.1083 EN Zahra Bamorovat Reproductive and Family Health Research Center, Kerman University of Medical Sciences, Kerman, Iran. Hediyeh Barkhordari Reproductive and Family Health Research Center, Kerman University of Medical Sciences, Kerman, Iran. Ehsan Hassannejad Department of Radiology, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran. Asma Payandeh Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. 0009-0003-0159-7144 Maryam Memardoost Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran. Faezeh Mehni Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran. Maryam Soleimani Houni Midwifery Group Instructor, School of Nursing and Midwifery, Jiroft University of Medical Sciences, Jiroft, Iran. 0000-0001-9249-0454 Journal Article 2026 06 24 Background: Postmenopausal women and people with rheumatoid arthritis face accelerated bone loss and higher fracture risk through overlapping mechanisms including estrogen deficiency and chronic inflammation. Given limitations and adverse effects of long‑term pharmacotherapy, effective non‑pharmacological strategies are needed. This review summarizes recent evidence on lifestyle, exercise, nutritional, educational, behavioral, and multicomponent interventions to preserve bone health. Materials and Methods: We conducted a structured search of PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar for English‑language studies through 31 December 2025. Eligible studies evaluated non‑pharmacological interventions in postmenopausal women or adults with rheumatoid arthritis (RA). Screening, data extraction, and quality appraisal used validated, design‑specific tools. Because of clinical and methodological heterogeneity, findings were synthesized narratively. Results: Fourteen studies met inclusion criteria. In postmenopausal women, structured exercise—especially high‑intensity resistance and impact‑loading programs—most consistently preserved or increased bone mineral density (BMD) at the lumbar spine and femoral neck. In RA, exercise yielded clearer improvements in muscle strength, lean mass, and physical function than in BMD, indicating mainly functional benefits. Calcium and vitamin D had modest effects, chiefly attenuating loss among those with low baseline intake or deficiency. Educational and behavioral interventions improved osteoporosis knowledge, self‑efficacy, and adherence to preventive behaviors but showed limited direct BMD impact. Limited data suggest combining exercise with nutritional optimization may provide additive bone benefits in postmenopausal women. Conclusion: Non-pharmacological approaches provide population-specific benefits. Exercise most effectively improves BMD in postmenopausal women, while in RA it more consistently enhances physical function than skeletal outcomes. Individualized, multimodal programs combining exercise, nutrition, and behavioral support may best preserve bone health and reduce future fracture risk.

https://www.health-providers.ir/article_246212_5144c7f4e9f4048f71f4cbde02f056ea.pdf

Masumeh Saeidi Health Providers 2820-9192 6 1 2026 06 01 Health System Resilience in the Digital Era: The Necessity of Semantic Interoperability and Intelligent Decision Support 246214 10.22034/hp.2026.588523.1084 EN Mahdi Derakhshi Dean of Information and Communication Technology Unit, Mashhad Municipality Fire and Safety Services Organization, Mashhad, Iran. Mohammad Saeedi M.S. in Software Engineering, Information and Communication Technology Unit, Mashhad Municipality Fire and Safety Services Organization, Mashhad, Iran. Journal Article 2026 06 25 In the context of escalating global health crises, the mere accumulation of health data is insufficient for ensuring system resilience. Effective resilience requires the rapid transformation of data into actionable intelligence. This letter highlights the critical role of three enabling technologies—semantic interoperability through Health Level Seven Fast Healthcare Interoperability Resources (HL7 FHIR), edge computing for decentralized real-time processing, and intelligent Clinical Decision Support Systems (CDSS)—in advancing health system responsiveness. Transitioning from passive data repositories to intelligent, interoperable infrastructures can significantly reduce decision latency, enhance clinical performance, and strengthen preparedness for future disruptions.

Masumeh Saeidi Health Providers 2820-9192 6 1 2026 06 01 Artificial Intelligence in Health Systems: Global Trends and Iran’s Position; A Narrative Review 246228 10.22034/hp.2026.588569.1086 EN Mohammad Vahedian-shahroodi Professor of Health Education and Promotion, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran. 0000-0002-5402-1646 Mehdi Sedaghatkar Electronics Engineer, Mashhad Municipality Fire and Safety Services Organization, Mashhad, Iran. Kobra Sadat Hossaini MSc of Midwifery, Student Research Committee, School of Midwifery Nursing, Mashhad University of Medical Sciences, Mashhad, Iran. 0009-0004-3240-4728 Alireza Akhlaghi MSc in Health Education and Promotion, Bushehr University of Medical Sciences, Bushehr, Iran. 0000-0003-1662-6174 Journal Article 2026 06 25 Artificial intelligence (AI) has emerged as one of the most transformative technologies in health systems, with expanding applications in disease diagnosis, prediction of clinical outcomes, personalized medicine, drug discovery, and health service management. This narrative review examined the current evidence on the applications, opportunities, and challenges of AI in health systems and analyzed Iran’s position relative to global trends. Sources were searched in PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar for studies published between January 2015 and June 2025. Relevant studies were selected and thematically synthesized across major domains, including clinical applications, managerial uses, ethical and legal considerations, and implementation challenges. The findings suggest that AI has made substantial contributions to global health care, particularly in diagnostic imaging, outcome prediction, personalized care, drug development, and system-level efficiency. However, persistent barriers remain, including data quality and generalizability, algorithmic transparency, bias, privacy concerns, ethical issues, and the absence of robust regulatory frameworks. In Iran, despite notable scientific and academic capacity, practical implementation remains constrained by fragmented health data, limited integrated health information infrastructure, and a gap between research and real-world deployment. AI can improve quality, access, and efficiency in health care, but effective use requires high-quality data infrastructure, clear ethical and legal frameworks, and stronger interdisciplinary collaboration among clinicians, data scientists, engineers, and health policymakers.

Masumeh Saeidi Health Providers 2820-9192 6 1 2026 06 01 Lived Experiences of Fear of Maternal and Fetal Loss among Pregnant Women with COVID-19: A Descriptive Phenomenological Study 246245 10.22034/hp.2026.588634.1087 EN Sedigheh Shariat Moghani Faculty of member, Department of Midwifery, School of Public Health, Mashhad University of Medical Sciences, Mashhad, Iran Tahereh Sadeghi Assistant Professor, Department of Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran. Talaat Khadivzadeh Associate Professor, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran. Tayebe Pourghaznein Assistant Professor, Department of Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran. Journal Article 2026 06 26 Background: Pregnancy during the COVID-19 pandemic created profound uncertainty, emotional distress, and disruption in maternity care. Pregnant women infected with COVID-19 faced additional concerns regarding their own health, fetal well-being, and the continuity of support during a public health crisis. This study aimed to explore the lived experiences of fear of loss among pregnant women diagnosed with COVID-19 during the pandemic in Mashhad, Iran. Methods: This descriptive phenomenological study was conducted with 14 pregnant women who had confirmed or clinically diagnosed COVID-19. Participants were selected purposively and interviewed through semi-structured, in-depth conversations until data saturation was achieved. Interviews were conducted in person or online, depending on participants’ conditions and preferences. Data were analyzed using van Manen’s phenomenological approach and managed with MAXQDA software. Results: Three major themes emerged from the analysis: fear of infection and loss, burdened self-care amid insufficient support and poor treatment, and psychological disturbance. Women expressed intense fear of fetal loss, disease complications for the fetus, personal deterioration, uncertainty caused by conflicting information, and loss of loved ones. They also reported exhaustion in self-care, feelings of isolation, guilt, helplessness, dissatisfaction with healthcare support, and severe psychological strain, including stress, anxiety, depressive feelings, and mental exhaustion. Conclusion: Pregnant women with COVID-19 experienced substantial emotional and psychological burden along with major challenges in self-care and access to support. Strengthening remote counselling, psychosocial support, and responsive maternity services may help reduce fear and improve coping during infectious disease crises.

Masumeh Saeidi Health Providers 2820-9192 6 1 2026 06 01 Spiritual Well-Being and Associated Factors among Women with Primary Infertility Attributed to Male-Factor Infertility: A Cross-Sectional Study 246815 10.22034/hp.2026.590469.1090 EN Maryam Mirzaei Assistant Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran. 0000-0002-0359-4305 Journal Article 2026 07 07 Background: Infertility is associated with substantial psychological and spiritual distress. In pronatalist societies, women with primary infertility—even when attributable to male-factor causes—often experience disproportionate stigma and emotional burden. Spiritual well-being (SWB) represents an important coping resource in this context. This study aimed to assess SWB and identify its socio-demographic, clinical, and interpersonal determinants among women with primary infertility due to male-factor etiology. Methods: This descriptive cross-sectional study was conducted from 2024-2025 at two tertiary infertility centers in Kerman, Iran. Using proportionate stratified sampling, 150 women with confirmed male-factor primary infertility who were candidates for intrauterine insemination (IUI) were recruited. Data were collected using a structured clinical questionnaire and the Paloutzian and Ellison Spiritual Well-Being Scale (score range: 20–120). Statistical analyses included bivariate tests and multiple linear regression. Results: The mean age of participants was 31.36±5.12 years, and the mean duration of infertility was 4.78±3.37 years. Mean scores for existential well-being (35.29±3.86), religious well-being (28.01±3.22), and overall SWB (96.58±17.53) indicated moderate levels of spiritual well-being. Higher educational attainment was significantly associated with greater existential and overall SWB. Stronger self-reported religious adherence predicted higher overall SWB. Additionally, stable family relationships and strong perceived family support during times of difficulty were positively associated with all dimensions of SWB. Among clinical variables, the number of IUI attempts was significantly associated with both religious and overall SWB. Conclusion: Women experiencing primary infertility due to male-factor causes demonstrate moderate levels of spiritual well-being, influenced by educational, religious, familial, and treatment-related factors. Integrating holistic, family-centered, and culturally sensitive spiritual care into infertility services may help reduce psychosocial burden and improve patient well-being.