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: From Data Repositories to Intelligent, Interoperable Infrastructures 19 21 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. 0009-0004-3240-4728 Journal Article 2026 06 25 Health system resilience increasingly depends on digital architectures that support continuity of care, adaptive decision-making, and sustained performance during crises. Despite the rapid expansion of digital data collection, fragmentation and limited interoperability continue to constrain its utility. Resilient digital health systems require interoperable standards, embedded clinical decision support, distributed computing models, and implementation-ready policy frameworks. Fast Healthcare Interoperability Resources (FHIR) facilitates modular, machine-readable data exchange; clinical decision support systems (CDSS) convert data into timely, actionable insights; and edge computing enhances functionality and equity in low-connectivity settings. The World Health Organization’s SMART Guidelines bridge normative recommendations and machine-executable specifications, enabling the translation of policy into deployable digital solutions. Transitioning from passive data repositories to intelligent, interoperable infrastructures enhances system responsiveness, safety, and equity. Ultimately, resilience depends on the integration of standards, algorithms, workflows, and governance within a coherent digital ecosystem.

https://www.health-providers.ir/article_246214_0b6cd7b6fde35733ece8ad7a080c3a83.pdf

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 23 33 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: The COVID-19 pandemic disrupted maternity care and amplified psychological distress among pregnant women. Those diagnosed with COVID-19 faced intensified worries about their own health, fetal wellbeing, and loss of support. This study aimed to explore the lived experience of fear of maternal and fetal loss in pregnant women with COVID-19. Materials and Methods: This qualitative hermeneutic phenomenological study, based on van Manen’s methodology, was conducted in Mashhad, Iran. The study involved 14 pregnant women in the second or third trimester who had laboratory-confirmed or clinically diagnosed COVID-19. Participants were recruited purposively, and data were collected through in-depth, semi-structured interviews conducted face to face or online until data saturation was achieved. Data were analyzed using van Manen’s phenomenological approach with MAXQDA software (version 20). Results: Analysis produced three main themes: (1) Dread of infection and the looming threat of loss; (2) Burden of care—reduced support and compromised self-care; and (3) Psychological disruption and existential rupture. Participants reported pervasive anxiety about fetal viability and maternal deterioration, recurrent fear of infecting family, and heightened vigilance about pregnancy outcomes. Enforced isolation, caregiving strain, interpersonal conflict, and guilt amplified helplessness, exhaustion, sleep disturbance, and depressive symptoms. Perceived healthcare inadequacies and limited access intensified distress and deepened uncertainty about pregnancy and childbirth. Conclusion: COVID-19 in pregnancy was a multifaceted crisis—persistent fear of maternal and fetal loss, uncertainty, reduced support, isolation, caregiving burden, and severe psychological distress. Perceived healthcare inadequacies eroded trust. Maternity care during infectious outbreaks must complement clinical monitoring with proactive psychosocial measures: telehealth education, virtual counseling, continuity of obstetric/midwifery support, and targeted outreach to reduce isolation and restore trust.

https://www.health-providers.ir/article_246245_bd66fbdb33f8b24bbd7272bc96dc2cca.pdf

Masumeh Saeidi Health Providers 2820-9192 6 1 2026 06 01 Application of Artificial Intelligence in Healthcare: Global Trends, Opportunities, and Implementation Challenges in Iran — A Narrative Review 35 44 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. Mohammad Saeedi M.S. in Software Engineering, Information and Communication Technology Unit, Mashhad Municipality Fire and Safety Services Organization, 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 Background: Artificial intelligence (AI) is a cornerstone of digital health with transformative potential in diagnosis, medical imaging, and clinical management. Clinical translation is constrained by data quality, interpretability issues, and ethical‑legal gaps. This study maps the global AI landscape and evaluates opportunities, barriers, and the infrastructural readiness of Iran’s healthcare system for AI implementation. Materials and Methods: We conducted a structured narrative review of PubMed, Scopus, Web of Science, and Google Scholar for English and Persian sources to December 2025. Peer‑reviewed articles, policy reports, and official documents on AI in diagnosis, imaging, health‑systems management, and policymaking were independently screened by two reviewers. Data were synthesized using thematic analysis, and methodological quality was appraised with the SANRA scale. Results: Five principal AI domains were identified: medical imaging, outcome prediction, personalized medicine, drug discovery, and health‑systems management. Globally, deep learning attains specialist‑level diagnostic performance in multiple tasks, but widespread clinical utility is limited by data heterogeneity, algorithmic bias, black‑box interpretability, and regulatory gaps. In Iran, academic activity and pilot initiatives have risen, yet clinical integration is impeded by fragmented data sources, limited interoperability, absent regulatory and legal frameworks, workforce educational deficits, and weak governance. Deploying imported models without local validation increases risk of performance drift and patient safety concerns. Cross‑cutting needs include improved data quality, interoperable infrastructure, ethical governance, and workforce capacity building. Conclusion: For safe, effective adoption in Iran, AI should function as "augmented medicine," supporting clinicians. An ecosystem approach—upgrading digital infrastructure, ensuring data interoperability and local validation of models, and establishing ethical‑legal frameworks—combined with interdisciplinary collaboration is required to move from research to responsible clinical practice.

https://www.health-providers.ir/article_246228_0218757eab99fcc3cbcc6635e50d39c0.pdf

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 45 55 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 Zahra Bamorovat Reproductive and Family Health Research Center, Kerman University of Medical Sciences, Kerman, Iran. Journal Article 2026 07 07 Background: Infertility is associated with substantial psychological and spiritual distress. In pronatalist societies, women with primary infertility—even when attributed to male-factor causes—often experience disproportionate stigma and emotional burden. Spiritual well-being (SWB) may serve as an important coping resource. This study aimed to assess SWB and its socio-demographic, clinical, and interpersonal determinants among women with male-factor primary infertility. Materials and Methods: In this cross-sectional study (2024–2025), 150 women with confirmed male-factor primary infertility who were candidates for intrauterine insemination (IUI) were recruited using proportionate stratified sampling from two tertiary infertility centers in Kerman, Iran. Data were collected using a structured questionnaire and the Paloutzian and Ellison Spiritual Well-Being Scale. Statistical analyses included independent-samples t-tests and one-way analysis of variance (ANOVA). 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 were 35.29±3.86 for existential well-being, 28.01±3.22 for religious well-being, and 63.30±5.76 for total SWB, indicating a moderate level. Higher educational level was significantly associated with existential well-being and total SWB (P=0.003 and P=0.002, respectively). Greater religious adherence was associated with higher total SWB (P=0.048). Perceived family support was significantly associated with all SWB dimensions (P<0.05). The number of prior IUI attempts was positively associated with religious well-being and total SWB (P=0.009 and P=0.008, respectively). Conclusion: Women with male-factor primary infertility demonstrated a moderate level of SWB, influenced by educational level, religiosity, family support, and treatment history. Integrating holistic, family-centered, and culturally sensitive spiritual care into infertility services may help reduce psychosocial burden and improve overall well-being.

https://www.health-providers.ir/article_246815_80b864a34a629aed7c7a1242f9cbeca9.pdf

Masumeh Saeidi Health Providers 2820-9192 6 1 2026 06 01 Antimicrobial Resistance in Tajikistan: A Global Challenge and an Opportunity to Strengthen Health-System Resilience 57 59 248116 10.22034/hp.2026.594095.1092 EN Sunnatullo Ahmad Sharifzodai Doctoral Candidate, Department of Surgical Diseases No. 1 named after Academician K.M. Qurbanov, Avicenna Tajik State Medical University, Dushanbe, Tajikistan. Journal Article 2026 07 27 Antimicrobial resistance (AMR) is widely recognized as one of the most pressing public health challenges of our time, compromising the effectiveness of standard treatments and imposing substantial human and economic costs. If not addressed proactively, AMR may gradually weaken health systems’ ability to control infections and sustain the achievements of modern medicine. In countries such as Tajikistan, however, where health-sector reform and international cooperation are advancing, AMR can also be understood as a strategic entry point for strengthening laboratory capacity, surveillance, rational prescribing, and multisectoral coordination. Adopting a One Health approach, improving monitoring and reporting systems, and integrating stewardship principles into ongoing reforms can support a more effective national response. This letter argues that addressing AMR is not only a scientific and clinical necessity, but also an important opportunity to reinforce health security and long-term health-system resilience in Tajikistan.

https://www.health-providers.ir/article_248116_122ee67d21508b98fb6ba76c825f09d3.pdf

Masumeh Saeidi Health Providers 2820-9192 6 1 2026 06 01 Effects of Isoflavones on Bone Health across the Lifespan: A Systematic Overview of Meta-Analyses and Clinical Trials 61 76 248186 10.22034/hp.2026.594276.1093 EN Hanieh Soltani Department of Pediatrics, School of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. Firoozeh Mirzaee Reproductive and Family Health Research Center, Kerman University of Medical Sciences, Kerman, Iran. Masumeh Ghazanfarpour Reproductive and Family Health Research Center, Kerman University of Medical Sciences, Kerman, Iran. 0000-0003-4639-3711 Masoudeh Babakhanian Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran. Maryam Memardoost Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran. Mahdiyeh Karimi Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran. Zahra Bamorovat Reproductive and Family Health Research Center, Kerman University of Medical Sciences, Kerman, Iran. Journal Article 2026 07 28 Background: Isoflavones are soy-derived phytoestrogens that may influence bone remodeling differently according to age, sex, hormonal status, dosage, and metabolism. This study evaluated their effects on bone mineral density (BMD), bone mineral content (BMC), and bone turnover markers in children, adolescents, and adults to clarify their potential role in bone health and osteoporosis prevention. Materials and Methods: In this systematic overview, PubMed, Scopus, Web of Science, the Cochrane Library, and Google Scholar were searched through December 2025 for meta-analyses and comparative studies of soy isoflavones reporting bone mineral outcomes or turnover markers. Quality was assessed using AMSTAR and Jadad scales; substantial heterogeneity required narrative synthesis. Results: Eight studies, comprising six meta-analyses and two comparative trials, were included. Among postmenopausal women, isoflavone supplementation was generally associated with modest improvements in BMD at the lumbar spine, femoral neck, and total hip, along with favorable changes in bone-resorption markers, particularly pyridinoline and C-terminal telopeptide of type I collagen. Subgroup analyses suggested that effects may be greater at doses below 90 mg/day. However, effect estimates varied across syntheses, and no study demonstrated a reduction in fracture risk. In infants and children, soy-based formula was not associated with significant differences in BMC compared with control formulas. In adolescent boys, short-term isoflavone supplementation did not significantly affect bone turnover markers or growth-related outcomes, despite evidence of systemic isoflavone exposure. Conclusion: Soy isoflavones may modestly preserve bone density in postmenopausal women as adjuncts but cannot replace established osteoporosis therapies. No skeletal benefits were evident in infants or adolescent boys, and evidence in populations remains limited. Future trials should assess fracture outcomes and account for equol-producer status.

https://www.health-providers.ir/article_248186_3ef582b24eda079d6b7a4ff92a36650d.pdf

Masumeh Saeidi Health Providers 2820-9192 6 1 2026 06 01 Association between Health Literacy and Quality of Life in Patients with Cardiac Disease: The Mediating Role of Social Support and the Moderating Role of Spiritual Well-Being 77 86 248261 10.22034/hp.2026.594379.1094 EN Afrasyab Altaf School of Leadership, Faculty of Management Sciences, Riphah International University, Islamabad Pakistan. 0000-0002-4292-5541 Ashiq Ali School of Leadership, Faculty of Management Sciences, Riphah International University, Islamabad, Pakistan. Ayman Javaid School of Leadership, Faculty of Management Sciences, Riphah International University, Islamabad, Pakistan. Nazar Ul Islam National University of Medical Sciences, Islamabad, Pakistan Journal Article 2026 07 29 Background: Cardiac disease substantially impairs quality of life (QoL). Although psychosocial factors influence health outcomes, the mechanisms through which health literacy (HL) affects QoL in patients with cardiac disease remain unclear. This study examined the association between HL and QoL, with social support (SS) as a mediator and spiritual well-being (SWB) as a moderator. Materials and Methods: This cross-sectional study enrolled adults aged ≥30 years with stable coronary artery disease receiving optimal medical therapy at two tertiary-care hospitals in Islamabad, Pakistan, between April and September 2024. Patients with acute coronary syndromes, severe cognitive or psychiatric impairment, or major comorbidities were excluded. Validated instruments assessed health literacy (BHLS), social support (LSNS-6), subjective well-being (ISWBI), and quality of life (QOLS). Moderated mediation was tested using Hayes’ PROCESS Model 14 with 1,000 bias-corrected bootstrap resamples (p≤0.05). Results: Of 400 distributed questionnaires, 322 were completed (response rate: 80.5%). Participants reported moderate levels of HL (3.54 ± 1.11), SS (3.32 ± 1.08), SWB (3.46 ± 1.07), and QoL (4.27 ± 1.18). QoL did not differ significantly across demographic groups (all ANOVA p>0.05). All variables were positively correlated (r=0.314–0.462, p<0.05). HL was directly associated with QoL (B=0.2016, SE=0.0291, 95% CI: 0.1456–0.2607, p<0.001) and indirectly associated with QoL through SS (B-indirect=0.1187, SE=0.0578, 95% bootstrap CI: 0.0051–0.2324), supporting partial mediation. SWB significantly moderated the association between SS and QoL (B=1.6727, SE=0.1308, t=12.7837, p<0.001). Conclusion: Health literacy was positively associated with QoL among patients with cardiac disease, both directly and indirectly through social support. Spiritual well-being strengthened the positive association between social support and QoL, supporting integrated cardiac rehabilitation approaches that incorporate health communication, social support, and spiritual care.

https://www.health-providers.ir/article_248261_befadb43ba9c2c20826468f72f3ed7b2.pdf