Background: Mental Health(MH) is among the main determinants of community well-being and a remarkable portion of global burden of diseases is pertaining to mental disorders. Despite this fact, little attention has been given to the provision of adequate and appropriate MH services and improving equitable access to these services in some parts of the world especially in low-and middleincome countries(LMICs). This review was aimed to identify key barriers to the provision and utilization of MH services in LMICs. Methods: We carried out a systematic and comprehensive search on 7 important online databases for English-language literature on key barriers to the provision and utilization of MH services in LMICs from Jan 2000 to Nov 2019. Arksey and O'Malley instructor was used in 5 steps to implement scope study. The extracted materials were tabulated and synthesized using a qualitative content analysis approach. Results: Three main themes were developed regarding the barriers to the provision of MH services in LMICs including resource and administrative barriers, information and knowledge obstacles, as well as policy and legislation barriers. Also four main themes emerged about barriers to the utilization of MH services including attitudinal, structural, knowledge, and treatment-related barriers. Conclusion: Equitable access to MH services in LMICs is under influence of many barriers in both provision and utilization sides. In order to alleviate these problems, health systems in LMICs could adopt some strategies including integration of MH policy into general health policy, improvement of public MH knowledge regarding the MH and its related issues, developing anti-stigma programs, reallocation of health resources toward high-priority MH needs, developing community-based insurance, as well as integration of MH services into all levels of health-care systems. Further studies are also required for determining relative importance of the barriers and their related solutions based on the national context of each country.
AIM:To investigate the structural and biochemical changes in the early stage of reperfusion in the rat livers exposed to lobar ischemia-reperfusion (IR). METHODS:The median and left lobes of the liver were subjected to 60 min ischemia followed by 5, 10, 30, 45, 60 and 120 min reperfusion. Blood samples were taken at different time intervals to test enzyme activities and biochemical alterations induced by reperfusion. At the end of each reperfusion period, the animals were killed by euthanasia and tissue samples were taken for histological examination and immunohistochemistry. RESULTS:Cell vacuolation, bleb formation and focal hepatitis were the most important changes occur during ischemia. While some changes including bleb formation were removed during reperfusion, other alterations including portal hepatitis, inflammation and the induction of apoptosis were seen during this stage. The occurrence of apoptosis, as demonstrated b y a p o p t o t i c c e l l s a n d b o d i e s , w a s t h e m o s t important histological change during reperfusion. The severity of apoptosis was dependent on the time of reperfusion, and by increasing the time of reperfusion, the numbers of apoptotic bodies was significantly enhanced. The amounts of lactate dehydrogenase, alanine aminotransferase, aspartate aminotransferase, creatinine and urea were significantly increased in serum obtained from animals exposed to hepatic IR. CONCLUSION:In f l a m m a t i o n a n d s u b s e q u e n t apoptotic cell death were the most important changes in early-stage hepatic reperfusion injury, and the number of apoptotic bodies increased with time of reperfusion.
Background Hidden curriculum (HC) is considered as unintended learning experiences in medical education (ME). This may include values, norms, beliefs, skills, and knowledge which could potentially influence learning outcomes. HC has key components that must be identified and considered properly by individuals and organizations involved in ME. Objectives This study aimed to determine the main components of hidden curriculum in medical education (HCME) and the interrelationships among them. Methods In this mixed-method study initially we performed a scoping review and determined the main components of HCME using qualitative content analysis approach. Then, the interrelationships among these components were investigated using Interpretive Structural Modeling (ISM). Results Ten key components for HCME were identified in scoping review. We classified them into four main categories including structural, educational, cultural, and social factors. The ISM analysis revealed that organizational rules and structure, dominant culture of educational environments, teaching and assessment approaches, as well as clinical and educational physical setting were the independent or driving factors. While, social components were dependent and influenced by basic components. Conclusion The ISM model indicated that role modeling behaviors and interpersonal relationships (social factors) are under influence of underlying organizational and educational factors. These results should be considered at all stages of educational management including planning process, implementation of the programs, and development of formal curricula. According to the importance of contextual factors, components of HC must be analyzed and interpreted based on the specific conditions of each educational institution.
Background: Mental Health(MH) is among the main determinants of community well-being and a remarkable portion of global burden of diseases is pertaining to mental disorders. Despite this fact, little attention has been given to the provision of adequate and appropriate MH services and improving equitable access to these services in some parts of the world especially in low-and middle-income countries(LMICs). This review was aimed to identify key barriers to the provision and utilization of MH services in LMICs. Methods: We carried out a systematic and comprehensive search on 7 important online databases for English-language literature on key barriers to the provision and utilization of MH services in LMICs from Jan 2000 to Nov 2019. Arksey and O’Malley instructor was used in 5 steps to implement scope study. The extracted materials were tabulated and synthesized using a qualitative content analysis approach. Results: Three main themes were developed regarding the barriers to the provision of MH services in LMICs including resource and administrative barriers, information and knowledge obstacles, as well as policy and legislation barriers. Also four main themes emerged about barriers to the utilization of MH services including attitudinal, structural, knowledge, and treatment-related barriers. Conclusion: Equitable access to MH services in LMICs is under influence of many barriers in both provision and utilization sides. In order to alleviate these problems, health systems in LMICs could adopt some strategies including integration of MH policy into general health policy, improvement of public MH knowledge regarding the MH and its related issues, developing anti-stigma programs, reallocation of health resources toward high-priority MH needs, developing community-based insurance, as well as integration of MH services into all levels of health-care systems. Further studies are also required for determining relative importance of the barriers and their related solutions based on the national context of each country.
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