Journal of Arak University of Medical Sciences

The Ethical and Legal Imperative in the Age of AI: Safeguarding Patient Data and Privacy in Healthcare

Amirmohammad Drosti

The rapid integration of Artificial Intelligence (AI) into medical sciences, while promising transformative breakthroughs in early diagnosis and personalized treatments (1), introduces a profound ethical and legal challenge: the management of the vast, sensitive, and unprecedented volume of health data and the preservation of patient privacy. The nature of this data, which includes clinical records, radiological images, genetic data, and even data from wearable health devices ², extends beyond traditional identifiable information. It possesses the capability to reconstruct a comprehensive profile of an individual, rendering complete and permanent de-identification virtually impossible (1).
This massive volume of information has become the main fuel for deep learning algorithms, but any breach or disclosure could lead to serious discrimination in access to insurance, employment, and even judicial decision-making (2). The lack of Transparency regarding how these data are processed and analyzed by the algorithms, which often function as a "black box," erodes the trust of both patients and physicians (3). Healthcare providers cannot understand the AI's decision-making process, which not only hinders clinical adoption but also creates a legal gray area concerning accountability in the event of diagnostic or therapeutic error (4).
The current legal challenge stems from the fact that existing privacy laws were not designed to address advanced algorithms and real-time data collection (1, 4). AI constantly outpaces existing legal frameworks by creating novel methods of knowledge extraction from raw data. Furthermore, due to their reliance on large data networks, AI tools are exposed to advanced cyberattacks, which could lead to the mass disclosure of confidential data (5). Consequently, in the absence of a robust and up-to-date data governance framework, AI's potential to improve public health is accompanied by the risk of undermining human dignity and violating fundamental patient rights (6).
To ensure that AI innovations advance with ethical and legal compliance, urgent measures must be taken to establish a comprehensive regulatory framework. This requires formulating a new, dynamic model of informed consent that goes beyond a one-time agreement, allowing patients continuous and informed control over how their data is used at different stages of AI training and deployment. Concurrently, developers must be mandated to embed privacy protection at the core design of every AI tool, which means utilizing advanced privacy-preserving techniques such as differential privacy and federated learning for on-premise data processing. Additionally, a multi-disciplinary oversight body composed of ethics, legal, computer science, and clinical experts must be established, ensuring that every AI tool undergoes a rigorous and transparent ethical and technical assessment and approval process before entering the clinical environment, thereby preventing potential biases and algorithmic errors. These measures will not only protect patients against misuse but also provide the necessary trust for the sustainable and safe advancement of this vital technology in society

Executive functions in athletes, non-athletes and obese individuals

Alireza Bahrami

Introduction: The choice between an active and an inactive lifestyle can have significant physical and cognitive consequences, highlighting a need for further research focusing on the cognitive aspects. The present study aimed to compare executive functions among endurance athletes, resistance athletes, non-athletes, and obese individuals.
Methods: The present study was a descriptive study with a causal-comparative design. The statistical population of the research consisted of men between the ages of 20 and 35 years from Famenin city (Hamadan province). A total of 80 participants were selected and divided into four groups (20 subjects each): endurance athletes, resistance athletes, non-athletes, and obese individuals. Executive functions were assessed using the computerized Tower of London and N-back tests, which measure the components of planning, problem-solving, and working memory, respectively. Data were analyzed using one-way analysis of variance (ANOVA) and Tukey's post-hoc tests, with the significance level set at P < 0.05.
Results: The results indicated significant differences in executive functions among the groups. In the components of planning, problem-solving, and working memory, the performance of the non-athletes, resistance, and endurance groups was significantly better than the obesity group. Furthermore, the resistance and endurance athletes performed better than the non-athletes group. In addition, the endurance group was better than the resistance group only in the planning and problem-solving component, and no difference was observed between them in working memory.
Conclusions: Weight control and performing endurance and resistance exercises can be useful for people from a cognitive aspect, and perhaps in some cognitive areas, endurance exercise is more beneficial than resistance exercise.

Psychological Experiences of Adolescent Girls Facing Premenstrual Syndrome: Analysis of Psychological and Emotional Impacts on Their Quality of Life - A Qualitative Study

Hossien Ghamari Givi

Introduction: This study aims to examine the psychological experiences of adolescent girls coping with Premenstrual Syndrome (PMS) and analyze its psychological, emotional, and social effects on their quality of life. Understanding how PMS influences various aspects of adolescent girls' lives, including academic performance, social relationships, and emotional well-being, is essential for developing appropriate interventions.
Methods: This qualitative study employed a phenomenological approach. A total of 18 adolescent girls, aged 14-18, who had experienced PMS at least once, participated in the study. Participants were selected using purposive sampling. Data were collected through semi-structured interviews, and Colaizzi’s seven-step method was used to analyze the data.
Results: The findings of the study revealed four main themes and twelve sub-themes. The psychological impacts included reduced concentration, difficulty in logical decision-making, and mental fatigue. In the emotional domain, participants reported feelings of depression, anxiety, irritability, and mood swings. The social impacts involved Social Withdrawal, concealment of symptoms, and reduced interaction with family members. Additionally, participants used coping strategies such as relaxation techniques, stress management, and seeking social support to manage their symptoms.
Conclusions: The results of this study showed that premenstrual syndrome (PMS) has significant psychological, emotional, and social effects on the lives of adolescent girls. Participants reported experiences such as decreased concentration, anxiety, emotional instability, social withdrawal, and efforts to hide their symptoms. Moreover, coping strategies like stress management, mental relaxation, and receiving social support played an important role in helping them deal with their condition. A deeper understanding of these adolescents’ lived experiences can serve as a foundation for awareness-raising efforts, psychosocial support, and educational policy-making within schools and families.

The Relationship between Nurses’ Moral Courage and Spiritual Health in Amirul Mominin Hospital, Gerash, Iran

Hadi Hasani

Introduction: With the advancement of science and knowledge worldwide, ethical challenges are increasing, and nurses' inability to face these challenges significantly impacts the quality of healthcare. Moral courage in nurses helps overcome fear and unethical values. The complexity of nursing work affects spiritual health and prevents nurses from adapting well to nursing challenges.
Methods: This was a correlational study using a convenience sampling method. In 2024-2025, nurses working at Amirul Mominin Hospital were selected, with a calculated sample size of 221. The instruments used were Sekerka's Moral Courage Questionnaire and Ellison and Paloutzian's Spiritual Well-being Scale.
Results: A total of 186 nurses participated in the study, including 119 women and 67 men. The mean scores of moral courage indicated that the moral courage score was higher among women and those with higher educational qualifications. Also, age and existential health were important factors in predicting moral courage, while religious health had no significant effect.
Conclusions: The study's results showed that moral courage and spiritual health, especially in existential dimensions, play important roles in moral decision-making. Gender and age are also factors that can affect the level of moral courage.

Psychometrics of healthy lifestyle questionnaire in elderly people with Item-Response Theory

Behrooz Kavehie

Introduction: The age structure of the population has changed due to a decrease in mortality rates. With the increase in the number of elderly individuals, addressing their physical, mental, and social needs has become essential. It is necessary to have a reliable and valid tool for assessing the health status of this group for developing future policies and planning health interventions. This study aimed to evaluate the psychometric properties of Lali’s Healthy Lifestyle Questionnaire using Item Response Theory (IRT) among the elderly in Karaj City.
Methods: Data collection was done through the distribution of questionnaires and interviews with patients in the health centers of Karaj city. In addition to demographic information, Lali's Healthy Lifestyle Questionnaire (2012) was used to collect data.
Results: The mean (standard deviation) age of the participants in the study was 66.82 (6.59) years. Based on the Akaike Information Criterion (AIC), the Nominal Response Model (NRM) demonstrated a better fit to the data among the common IRT models for Likert-scale questionnaires. Based on this model, out of the 54 items used, 6 items did not meet the acceptable criteria for the discrimination parameter and were excluded from the questionnaire. Based on the total information function, the questionnaire can appropriately differentiate individuals within the ability range of -1.5 to 2.5.
Conclusions: Using Item Response Theory in questionnaire psychometrics helps to reduce the number of unrelated items and increase the accuracy of the measurement tools.

Investigating the Relationship between Coping Styles and Quality of Life with the Mediation of Perceived Social Support and Self-Compassion in Breast Cancer Patients (After Mastectomy)

Javad Khalatbari

Introduction: Breast cancer is one of the chronic diseases that is closely related to psychological factors. The present study was conducted with the aim of investigating the mediating role of perceived social support and self-compassion in the relationship between coping styles and quality of life in breast cancer patients (after mastectomy surgery).
Methods: The research method was a correlational description. The statistical population of this study was women diagnosed with breast cancer and mastectomy who were referred to the hospitals of Mazandaran province (Sari and Babol) for follow-up treatment. According to Klein (2014), the sample size of 480 people was selected purposefully. Data were collected using the Quality of Life Questionnaire (European Organisation, 2006), the Coping Strategies Questionnaire (Lazarus & Folkman, 2001), the Perceived Social Support Questionnaire (Zimet et al., 1988), and the Self-Compassion Questionnaire (Eris, 2000). Structural equation modeling (SEM) was used to analyze the data.
Results: The results of the research showed that there is a relationship between coping styles mediated by perceived social support and self-compassion with quality of life in breast cancer patients. The lower limit of the confidence interval for the two variables of self-compassion and perceived social support as a mediating variable between coping styles and quality of life is 0.4687 and its upper limit is 0.6523.
Conclusions: Based on the findings, it is recommended to pay attention to the variables of perceived social support, self-compassion, coping styles, and quality of life in breast cancer patients.

Comparing the effectiveness of reality therapy approach and acceptance and commitment on depression and anxiety of women affected by marital infidelity

Fatemeh Sadat Fatemi

Introduction: Today, marital infidelity has a significant prevalence among couples, necessitating appropriate interventions to address this destructive behavior. Therefore, the present study was conducted with the aim of comparing the effectiveness of reality therapy (RT) and acceptance and commitment therapy (ACT) on depression and anxiety in women affected by marital infidelity.
Methods: The current research was a semi-experimental study employing a pretest-posttest design with a control group. The statistical population included all women affected by marital infidelity who referred to counseling centers in Kerman city in the first half of 2024. Among these women, 45 were selected as a sample and were randomly assigned to two experimental groups and a control group (15 participants each) by drawing lots. The first experimental group received reality therapy intervention and the second group received ACT intervention, both comprising eight 60-minute sessions. The research instruments were the the Lovibond and Lovibond (1995) depression and anxiety questionnaires. Data were analyzed using repeated measures ANOVA and Bonferroni post-hoc tests.
Results: The results showed that both Reality Therapy and Acceptance and Commitment Therapy were effective in reducing depression and anxiety. Furthermore, Acceptance and Commitment Therapy demonstrated significantly greater effectiveness than Reality Therapy in reducing depression and anxiety among women affected by infidelity (P < 0.001).
Conclusions: The findings of the present study showed that Bonferoni therapy is a more appropriate approach to reduce the harm caused by marital infidelity in women. The main emphasis of this therapy is on cognitive dissonance, the exercises of which make thoughts less anxiety-provoking.

Pulse Rate Variability Analysis in Patients with Chronic Obstructive Pulmonary Disease: Focusing on the Hospitalization Period

Saeed Pazhoohan

Abstract
Introduction: Chronic obstructive pulmonary disease (COPD) is a common condition characterized by airflow limitation in the lungs, which is associated with numerous respiratory and cardiovascular complications. The aim of this study was to examine changes in pulse rate and signal complexity indices of the pulse in patients with COPD during hospitalization and compare them with healthy individuals.
Methods: In this study, the variability of inter-pulse interval time series over a 30-minute period was analyzed using Multiscale Entropy (MSE) and Detrended Fluctuation Analysis (DFA) methods. The pulse oximetry data of 15 hospitalized patients with COPD during their hospitalization and discharge were examined and compared with data from 21 age- and sex-matched control subjects.
Results: The results showed that the pulse rate of patients diagnosed with COPD was significantly higher both during hospitalization and after discharge compared to the control group (P < 0.001). In addition, complexity indices such as entropy (P < 0.05) and fractal correlation (P < 0.01) were significantly reduced in these patients. These changes were observed both during hospitalization, when patients experienced symptom exacerbation, and at discharge, when their clinical condition had stabilized.
Conclusions: The results showed that the pulse signals of patients with COPD have reduced complexity and flexibility. Assessing changes in the complexity of these signals may serve as a valuable tool for monitoring and managing the condition of patients at different stages of the disease. Such methods may enable early detection of disease exacerbations and cardiac complications, thereby contributing to improved treatment outcomes and a reduction in disease-related complications.

Evaluating the Impact of National Team Players' Presence in Sports Clubs on the Level of Sports Motivation Among Youth in Arak City

Saadat Allah Salehi

Introduction: The expansion of sports and related activities has made this type of activity one of the most attractive activities accepted worldwide. Accordingly, the present study was conducted with the aim of evaluating the effect of the presence of national team athletes in sports clubs on the level of sports motivation of youth in Arak city.
Methods: This descriptive-analytical study targeted young athletes as the research population. Data were collected using the Sports Motivation Questionnaire and the Sports Participation Motivation Questionnaire. For this purpose, 141 athletes referring to sports clubs in Arak city were selected as the sample size.
Results: The findings indicated that the presence of national team athletes, observing their training sessions, membership in a club that includes national athletes, and their role-model status can significantly impact the sports motivation and sports participation motivation of youth in Arak City (P < 0.001). In addition, the results of this study showed that there is no significant difference between sports participation motivation and sports motivation by gender (P < 0.001). The analysis of variance test results revealed a significant inverse relationship between age and the scores of both sports participation motivation and sports motivation (P < 0.001).
Conclusions: According to the results obtained, it can be said that attending or observing the training or competitions of national team athletes has an impact on the sports motivation of Arak's youth. Finally, it is emphasized that sports policymakers should take advantage of the active presence of national athletes at club levels to increase the motivation and sports participation of young people.

Explaining the Facilitators and Barriers to Participating in Congregational Prayers from the Perspective of Students at Arak University of Medical Sciences; A Qualitative Study

Soleiman Zand

Introduction: Prayer is one of the most important manifestations of the spirit of monotheism in life. Despite the importance of prayer in life, it seems that according to the number of students in Arak University of Medical Sciences, their participation in congregational prayer is not very strong. Therefore, this study was conducted with the aim of explaining the obstacles to participating in congregational prayers from the perspective of Arak University of Medical Sciences students.
Methods: This study is a qualitative research in which data collection was conducted by a trained and informed researcher in a semi-structured manner using a number of guiding questions. Ten students with different academic backgrounds participated in this study. After obtaining consent from the participants to record the interview, they were asked to describe the personal, family, cultural, social, political, and educational challenges of participating in congregational prayers. After the data reached saturation and the researchers realized that no new data was obtained, they terminated the interviews and proceeded to transcribed the interview transcripts. After transcoding, data analysis was performed using content analysis and main concepts were extracted. Qualitative content analysis, which is a common method in qualitative studies, was used in this study. A conventional approach was used to analyze the data.
Results: In this study, 10 students from different fields of study (nursing, medicine, radiotherapy, midwifery, anesthesia, surgical technology, nutrition, laboratory science, occupational health) with an average age of 20.6 years participated, of which 5 were male and the rest were female. After analyzing the interviews, a total of 232 codes, 11 subcategories and 2 main categories were obtained, barriers (environmental, nature of congregational prayer, media, cognitive, political, health, welfare, individual and family, cultural and religious) and facilitators (individual characteristics, personality characteristics of the imam).
Conclusions: According to the results of this study, by removing the interference between the time of the educational classes and the time of the congregational prayer, expanding the cultural activities of the cultural affairs trustees of the university in order to explain the place of prayer to the students, providing a suitable environment to increase the attendance of officials, professors and Faculty staff, finding ways to increase motivation in graduate students, using continuous religious propaganda at the university level, and encouraging and appreciating active students and staff in performing this divine duty can have a significant impact on the establishment of congregational prayers.

Investigating the Status of Inter-Sectoral Cooperation in the Prevention of Traffic Accidents in Selected Countries and Iran: A Comparative Study

Habib Rezaei

Introduction: Different organizations are involved in each level of traffic accident prevention. Enhanced collaboration among these organizations leads to more effective and beneficial outcomes in traffic accident prevention across all levels. Therefore, this research was conducted with the aim of investigating the status of inter-sectoral cooperation in the prevention of traffic accidents in selected countries and Iran.
Methods: This research is a comparative study that was conducted in 2022. In this study, sampling was purposeful. The countries compared in the study include Egypt, Turkey, the United States, Australia, Sweden, England, Norway, Denmark, and Iran. These countries were selected based on their successful experiences and positive indicators in the field of research. Valid databases and other related sources were used to collect data. In this study, the findings were compared using a comparative table.
Results: Findings indicated that the incidence of traffic accidents is higher among men than women. Additionally, the incidence rate was highest in Iran and lowest in Norway. The results also showed that organizations and institutions such as the Ministry of Roads and Urban Development, the Ministry of Education, the Ministry of Health and Medical Education, the Ministry of Interior, the National Broadcasting Agency, the Traffic Police, the Ministry of Economic Affairs and Finance, and the Ministry of Welfare play the most crucial role in the pre-accident, during-accident, and post-accident phases.
Conclusions: Based on the research findings, it is recommended to develop and implement an integrated model of inter-departmental cooperation to prevent and manage traffic accidents, aiming to decrease casualties and enhance road safety in Iran.

Model of Internet Infidelity in Working Married Women: The Role of Authoritarianism, Individualism and Conscientiousness with the Mediation of Emotional Divorce

ALi Zeinali

Introduction: Internet infidelity is one of the most significant threats to family cohesion in recent years. Identifying the factors associated with marital infidelity is crucial as it can help reduce the risk of family breakdown. The aim of this study was to examine the role of power-seeking, independence, and conscientiousness in predicting internet infidelity among employed married women.
Methods: This study was conducted using Structural Equation Modeling (SEM). The research design was descriptive-correlational, and the statistical population comprised all employed married women working in offices, healthcare centers, and educational institutions in Urmia County during the years 2023–2024. The sample size was determined to be 250 participants, selected through purposive random sampling. Specifically, among the employed married women, those who met the inclusion criteria (such as formal or contractual employment and frequent internet use) were randomly chosen from the pool of volunteers. The research instruments included questionnaires measuring power-seeking, independence, conscientiousness, and internet infidelity.
Results: Data were analyzed using structural equation modeling assistance. Evaluation of the hypothetical model using fit indices indicated that the hypothetical model fit well with the measurement model. The results showed that power-seeking and independence had a positive and significant relationship with internet infidelity, while conscientiousness had a negative impact on this phenomenon. Notably, power-seeking was identified as a stronger predictor of internet infidelity with a beta coefficient of 0.16.
Conclusions: The findings indicated that power-seeking and independence could be suitable predictors of internet infidelity among employed married women, serving as valid indicators for identifying this phenomenon.

A Review of the Effects of Rehabilitation Exercises on Movement Mechanics in Individuals with Pes Cavus

AmirAli Jafarnezhadgero

Introduction: The difference in altitude due to the foot's arch in individuals with pes cavus affects transitional movement parameters and may increase the risk of injury. Therefore, the aim of this study is to examine rehabilitation exercises on the mechanics of transitional movements in individuals with an excessive arch of the foot.
Methods: This study was a narrative review. Articles were searched in both English and Persian languages from April 2015 to September 2024 using databases such as Scopus, PubMed, SID, MDPI, Google Scholar, Web of Science (WOS), and ScienceDirect. Considering the inclusion and exclusion criteria, 68 articles were selected. After a detailed review, 58 articles that did not meet the selection criteria were excluded, and 10 articles were selected for final analysis.
Results: The findings of 5 studies indicated that corrective exercises and rope skipping exercises lead to improved postural control and balance. The results of 2 other studies showed that therapeutic exercises, walking, and running can prevent the occurrence of lower limb injuries. Another study demonstrated that a combination of static stretching and electrical stimulation can be beneficial in managing pes cavus. Additionally, mobilization of the talonavicular and first metatarsophalangeal joints was found to be effective in reducing pain associated with this condition.
Conclusions: It seems that rehabilitation exercises focused on enhancing balance in individuals with excessive foot arch may improve transitional movements, postural control, and reduce the rate of lower limb injuries.