Davoud Shamsi, Mohsen Mohammadian Saravi, Khalil Ali Mohamadzadeh, Azadeh Ashrafi,
Volume 28, Issue 2 (4-2025)
Abstract
Introduction: Good governance, as one of the fundamental concepts in healthcare system management, plays a key role in enhancing the efficiency, effectiveness, and equity of healthcare services. This concept, Emphasizing principles such as transparency, accountability, participation, and legality, has been considered as a framework for improving policymaking and management in Iran's healthcare system.
This study conducted in 2024 aimed to design and present a model of good governance in the healthcare system using a mixed approach of thematic analysis and Partial Least Squares (PLS) method.
Methods: The research method included both qualitative and quantitative components. The qualitative phase, involved managers, health policy experts, specialists from the Ministry of Health and Medical Education, and academic scholars. Sampling was done using purposive and snowball sampling methods, with 17 participants selected until theoretical saturation was reached. In the quantitative phase, the Partial Least Squares (PLS) method was used for model fitting. The statistical population for this section included all experts and managers in Iran's healthcare sector, with a minimum sample size of 384 determined based on Cochran's formula.
Results: The results of thematic analysis of the qualitative data and model fitting showed that the final good governance model in the healthcare system consists of seven main dimensions: effectiveness, efficiency, equity, transparency and accountability, participation, legality, and leadership. Each dimension comprised specific components, and the importance of each was confirmed in strengthening good governance.
Conclusions: This study presents a comprehensive good governance model for the healthcare system, offering a framework for improving policymaking, management, and performance in this sector. The proposed model can be used as a strategic decision-making tool and improving management structures.
Safieh Azadi Fard, Mehdi Moradi, Mohammad Malekipooya,
Volume 28, Issue 3 (8-2025)
Abstract
Introduction: Plasma levels of adhesion molecules are considered important indicators in estimating the risk of cardiovascular diseases. Since endurance training and a fasting diet are effective in reducing the symptoms of heart diseases, this study aimed to investigate the effect of a period of endurance training with electrical stimulation on the expression of ICAM and VCAM genes in the heart tissue of obese fasting rats.
Methods: In this study, 35 male Wistar rats (8 weeks old, avg. weight 200±19 g) were randomly assigned to 5 groups (obese control, fasting, fasting with endurance training, fasting with electrical stimulation, fasting with endurance training with electrical stimulation) after inducing obesity. Fasting utilized a 16/8 protocol for all groups except the obese control. The endurance training lasted 4 weeks, increasing intensity from 50% to 65% of max oxygen consumption. Electrical stimulation was delivered via foot shock (0.5 mA for 20 min). Heart tissue was collected 24 hours post-training under anesthesia, with ICAM-1 and VCAM-1 gene expression measured via Real-time PCR. Data was analyzed using two-way ANOVA and Tukey's post hoc test in SPSS version 26, with significance at P≥0.05.
Results: The results of the present study demonstrated that intermittent fasting, endurance training, and electrical stimulation—each independently—led to a significant reduction in the gene expression of vascular adhesion molecules in the cardiac tissue of obese rats (P = 0.001). Moreover, it appears that the combination of all three interventions exerts a greater effect in reducing the expression levels of these adhesion molecules in the cardiac tissue of obese rats (P = 0.001).
Conclusion: Based on the findings, the simultaneous application of endurance training, intermittent fasting, and electrical stimulation exerts a considerable impact on decreasing the expression of VCAM and ICAM in cardiac tissue. However, it is still not possible to definitively determine the directionality of the individual or combined effects of intermittent fasting, endurance training, and electrical stimulation (foot-shock stimulation) on adhesion molecules under conditions of obesity and intermittent fasting.
