This article aims to present concepts and clinical practices recommended to approach people with active sex life. These concepts are an integral part of the recommendations of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections (STI), published by the Ministry of Health of Brazil in 2020. The article proposes a comprehensive approach to sexuality for health promotion. It presents significant aspects of the communication process that must develop, without prejudice and judgment, focusing on sexual and reproductive health. It also highlights relevant points about the exercise of sexuality at specific stages of life, recommending assessment of risks and vulnerabilities and screening for STI and condom use. In this way, it is possible to contribute to exercise their sexuality fully, responsibly, and safely. Sexual health is the physical, emotional, mental, and social wellbeing associated with the exercise of sexuality, with sexual and reproductive rights considered fundamental. This article aims at updating the chapter on Sexual Health: an approach centered on sexually active individuals of the Clinical Protocol and Therapeutical Guidelines (PDCT) for Comprehensive Care for People with Sexually Transmitted Infections (STI) 2020The PDCT was published by the Health Surveillance Department of the Brazilian Ministry of Health, based on official recommendations and discussions with experts. The National Committee approved it for Technology Incorporation to the Unified Health System (Conitec) in 2018Sexual and reproductive rights are considered fundamental, together with the rights to life, food, health, housing, and education for the complete exercise of citizenshipThe communication process plays a significant role in the improvement of the professional-patient relationship and, as a consequence, for the adherence to the recommendations and treatmentHealth services must promote environments favorable to the dialog and embrace the different dimensions of the exercise of sexuality by sexually active individuals. We recommend a gradual approach, advancing from general aspects to the most specific onesTo establish an association of trust, we need a clear and transparent approach, adequate to receptivity and the life context of the persons, which must be recognized as active individuals in the care process,We recommend to the professional to assure that the person is comfortable to talk about such themes, informing them that those are questions made routinely in the healthcare service, regardless of sex, sexual orientation, age, professional activity, and marital status. Emphasis should be placed on the secrecy and confidentiality of informationTelemedicine has currently been gaining ground in disclosing information, promotion and prevention, expanding the scope of healthcare services, especially in a continental country with regions that are hard to reach. Useful communication techniques in servicing people with STI are also needed in telemedicineAdolescence is a period of significant biological, psychological and social transformations. Physical alterations, social interactions and the awakening of new interests reflect fast and profound changes that characterize this life stage. The way adolescents express and live sexuality is influenced by the quality of emotional and affective associations experienced with relevant people in childhood, integration with peers, transformation arising from growth and development, the start of reproductive capacity, beliefs, moral patterns, myths, and taboos, as well as the traditions of the family or society in which they are insertedIn this stage, values, attitudes, habits, and behaviors are being formed, transformed, and consolidated, making adolescents more vulnerable, mainly because parents or guardians, school, and even health staff tend not to approach the aspects regarding the exercise of sexuality. Therefore, many times adolescents start their sexual lives without due orientationHealthcare services can play a fundamental role, disclosing to adolescents information contributing to the awakening of a healthy sexual life and prevention of STI and unintended pregnancy. Such orientation must be based on dialog, allowing for autonomy and responsible attitudesDuring gestation, sexual relations do not pose a risk to pregnancy, except in unique obstetric situations . However, we should not ignore the possibility of a pregnant woman getting an STI that harms the gestation's prognosis, or vertically transmitting the disease. For this reason, healthcare staff must approach routine questions associated with the sexual health of pregnant women and their sexual partners and offer HIV, syphilis, and hepatitis B and C tests in prenatal care,-Older adults presented an increase in the number of HIV and syphilis cases over the last years, drawing attention to the role of sexuality in this age group,,In risk assessment for STI in sexually active individuals, we recommend investigating structured questions, identifying factors associated with sexual practices and behaviors, and alcohol and drug use. From the contents obtained, it is possible to make an adequate assessment for risk management and identify opportunities for recommending preventive actions. The professional must individually provide the attendance, and in a private environmentRisk assessment can guide STI tracing. After identifying clinical cases, it is crucial to call and treat the sexual partnerships, aiming to interrupt the chain of infection, prevent complications, and avoid reinfectionsEuropean guidelines recommend managing sexual partners of people with STI, indicating emotional support and contact identification and notification, through a strategy guided by pattern operational procedure for control, monitoring, treatment, and report of cases,Brazil presents a trend of HIV and syphilis increase in the population between 13 and 29 years of ageIt is important to trace some infections, such as chlamydia and gonococcus, aiming at preventing pelvic inflammatory disease that, even if asymptomatic, can reduce chances of pregnancyUsing female, or male condoms is a preventive strategy that should be offered to sexually active people, in order to reduce the risk of HIV and other STI transmission and prevent pregnancyThe offer of condoms must take place without the quantity restrictions and without requiring identification documents. Healthcare professionals must incorporate sexuality into services to sexually active individuals, mainly those with STI complaints. This approach must develop, without prejudice and judgment, with a focus on sexual and reproductive health. In this way, it is possible to contribute to exercise their sexuality fully, responsibly, and safely. The right preventive approach can favor the decrease of STIs and their consequences.


The New England Journal of Medicine commenting on two studies on sex bias in the management of coronary heart diseases, published on the same journal issue [Dr. Bernardine Healy was a cardiologist known, among many other remarkable things, for being the first woman nominated as Director of the NIH. In 1991, Dr. Healy, who died prematurely in 2011, wrote an editorial for al issue . This waAfter 30 years, where are we now? After the Fourth World Conference on Women organized by the United Nations in 1995, we had to wait until the new millennium to have WHO adopting gender-oriented policies and until 2009 to have a written strategy to enhance, expand and institutionalize WHO’s capacity to analyze the role of gender and sex in health, as well as to monitor and address systemic and avoidable gender-based inequalities in health . As statHowever, of course, healthcare inequalities are only a part of the major problem of gender-based inequalities. In 2006, the World Economic Forum started publishing the Global Gender Gap Report annually, expressing an index designed to measure gender equality throughout the world. The Global Gender Gap Index has the intention of tracking progress on gaps between women and men in health, education, economics and politics. Across the four categories, the largest gender disparity is in the political field, the second being in economics. To date, in the whole world, only 25% of political seats are occupied by women and only 21% of ministers are women; in some countries, women are not represented at all. In addition, in the last 50 years, in 56% of the countries examined in the report, there has never been a female head of state, including in our country, Italy, or in the United States [Lancet, Dr. Mauvais-Jarvis and his co-authors discussed how women differ from men in medicine [In the 22 August 2020 issue of the medicine . Heart, medicine . This hamedicine . Again, medicine . The sammedicine .All these are the reasons why NIH in the 1990s decided that women’s health was a priority, and one of the first acts was to fund a multidisciplinary, multi-institute intervention study, the Women’s Health Initiative, addressed to identifying the major causes of death, disability and frailty among middle-aged and older women. However, as we said before, 30 years have passed and yet we still have the feeling that a lot needs to be done before equity between genders/sexes can be achieved. Perhaps the new political course in the United States, with a very determined, professionally proud academic First Lady and an equally determined female Vice-President, will finally give the decisive push to change the scenario.


Every August the USA National Psoriasis Foundation (NPS), launches the National Psoriasis Month to spread the knowledge about the etiopathology of psoriasis, to inform about available treatments, and to support and unite those affected. As psoriasis is often mistakenly perceived as infectious and patients can be victims of social stigmatisation, it is pivotal to promote awareness of what psoriasis is and is not and to fight the discrimination suffered by people living with it.Psoriasis is a chronic, immune-mediated inflammatory skin disease possibly resulting from a defect in proliferation and differentiation of skin cells associated with inflammatory cell infiltration. This process causes skin cells to accumulate and form plaques that itch, burn, and sting. These plaques appear on any part of the body, but are most often found on the elbows, knees, and scalp. Psoriasis scaly patches can range from a few spots of dandruff-like scaling to major eruptions that cover large areas, including the entire body. In addition, according to the NPS there are at least five types of psoriasis. Including the most common form with plaques, psoriasis also occurs in guttate, inverse, pustular, and erythrodermic forms. Of note, psoriasis is not limited to the skin, but can produce systemic effects and can be associated with psoriatic arthritis, cardiovascular disorders, and diabetes, as reported by WHO in the Global Report on Psoriasis, in 2016.The New England Journal of Medicine, report that a monthly injection of bimekizumab, can reduce psoriasis plaques of 90% after only 16 weeks of treatment. Bimekizumab, compared with other biologics like secukinumab and adalimumab, stands out with the highest rate of skin clearance and the ability to treat psoriatic arthritis, one of the most common and painful comorbidities of psoriasis. As the cause of psoriasis is still unknown, treatments are only available to control symptoms and often need to be taken continuously.According to the US Centers for Disease Control and Prevention, psoriasis is one of the most common chronic cutaneous dermatitis, which, in 2021, affects more than 7•5 million people in the USA and approximately 125 million people worldwide. Given the poor characterisation of this disease, those with psoriasis also suffered from a lack of effective treatments. From the beginning of the 20th century, different manifestations of psoriasis were treated with topical corticosteroids, phototherapy, systemic and topical retinoids, and narrowband UVB. In the early 2000s, the serendipitous discovery of the benefit of cyclosporine led to the development of drugs first targeting T-cells and subsequently to the cytokine mediators. Targeting cytokines, paved the way to the development, in 2021, of the drug bimekizumab. Research from the University of Manchester, UK, and Salford Royal NHS Foundation Trust, UK, published this July in Dermatology in August, 2020, highlight how psoriasis can also significantly affect quality of life of the patients, causing great physical, emotional, and social burden. Disfiguring manifestations of psoriasis can lead to depression and other psychological problems. The presence of severe psoriatic plaques that eventually can crack and bleed and that are highly visible on the body, might trigger a negative reaction in others and, since psoriasis is wrongly considered infectious by many, some patients might be stigmatised by people in their communities. Patients with psoriasis can also experience self-stigmatisation, and thus start to avoid others, limit their social relations, abandon their work, and ultimately, completely alienate themselves from the society. Moreover, not only psoriatic lesions visible to others, but also those that are usually covered and unseen  can be a cause of shame and isolation.Jankowiak and colleagues, from Medical University of Białystok Poland, in a study published in Improving awareness of psoriasis among the lay public will help to finally debunk the myth of psoriasis as contagious. An informed understanding of this chronic skin disease would broaden social acceptance and provide better support for people living with this condition. National Psoriasis Month, this August, is an opportunity to promote awareness of the physical, emotional, and social challenges that people with this chronic disease are still facing. Health care in addition to the management of the skin lesions and screening for associated comorbidities should also require psychological evaluation and support for patients with psoriasis. Let us eradicate once and for all the myth of psoriasis as an infectious disease.EClinicalMedicine


To survey the application of PDCA  process management in day operation ward and the influence of nursing quality and safety. N = 20), and the PDCA process management was implemented from March 2020 to March 2021 as the research group (N = 20). Twenty nurses and patients were selected as subjects in two periods of time. The nursing quality, the score of individual quality control examination in clinical department, the nursing quality of operating room, the incidence of adverse events and nursing errors, the number of problems existing in the quality management of nursing documents, and the score of nursing satisfaction were accessed.  The routine nursing management was carried out in our hospital from March 2019 to March 2020, which was set as the control group (P < 0.05). In terms of the scores of individual quality control examination in clinical departments, the scores of ward management, rescue, therapeutic articles, drug management, first-level nursing, nursing documents, and head nurses in the study group were greater compared to the control (P < 0.05). In terms of the operating room nursing quality score, the instrument management, instrument preparation, nurses' cooperation skills, disinfection and isolation quality, and the total score of the study group were above the control (P < 0.05). In terms of the incidence of operative adverse events and nursing errors, the incidence of nosocomial infection, iatrogenic injury, information check error, equipment failure, violation of operation regulations, ECG monitoring error, infusion operation error, and medication error in the study group was lower compared to the control (P < 0.05). According to the comparison of the number of problems existing in the quality management of nursing documents, the number of problems in temperature sheet, medical order, evaluation sheet, nursing record, and other nursing documents in the study group was lower than the control (P < 0.05). The scores of nursing communication, professional technology, nursing service attitude, nursing environment, and knowledge education in the study group were higher in contrast to the control (P < 0.05).  In the comparison of nursing quality, the nursing safety, specialty quality, and nursing norms of the study group were higher compared to the control ( The application of PDCA management can effectively enhance the nursing quality and safety of the day operation ward, further facilitate the quality of hospital nursing work, and improve patient satisfaction, which exert great potential, and application value in the management of day ward in the future. The operating room is not only the key management department of the hospital but also an important place for patients to receive surgical treatment. To a certain extent, the quality of nursing management of the operating room is an important reflection of the medical quality of the hospital, so improving the quality of nursing management of the operating room is beneficial to improve the level of hospital management. Owing to the particularity of nursing in operating room, the current nursing management in operating room is mainly routine management. Although this qualitative method can evaluate the working status and nursing quality of nurses, it has subjective and one-sided restrictions, which will lead to poor management effect. In the long run, it may have an impact on the enthusiasm of nurses, resulting in low work efficiency in the operating room and then affect the satisfaction of patients , 2. In vN = 20), which was set as the control group, and the PDCA process management was implemented from March 2020 to March 2021 as the research group (N = 20). Twenty nurses and patients were selected as subjects in two periods of time. Of the control, the age of nurses was 20-54 years old, with (31.65 ± 1.44) average years old, including 1 male and 19 female, with an average age of (45.67 ± 3.64) years (15-83 years), including 12 males and 8 females. Of the study, the age of nurses was 20-54 years old, with an average of (31.56 ± 1.68) years, including 1 male and 19 female, with an average age of (45.68 ± 3.55) years (13-83 years), including 11 males and 9 females. The general data of nurses and patients of the two were not statistically significant. The study was approved by the Medical Ethics Committee of our hospital.The routine nursing management was conducted in our hospital from March 2019 to March 2020  stage P (planning stage): a nursing quality management committee was set up to carry out work under the leadership of the hospital quality management committee. The chairman was the dean in charge of nursing work, the vice-chairman was the director of the nursing department, and the members were departmental leaders and committee secretaries. Set up the quality management framework of quality management leading group, quality control team leader, head nurse, and nurse. The head of the quality control team is headed by the director of the nursing department or the head nurse of the major department, and the team member is composed of the head nurse. Meanwhile, all quality control team leaders and team members are required to make hospital nursing quality assessment plans from five aspects of nursing quality evaluation standards: ward management, rescue and treatment materials management, special nursing level basic nursing management, nursing document management, and head nurse management. In order to realize the virtuous circle of assessment, introduce the incentive competition mechanism, formulate the nursing quality competition activity plan, and formulate the whole staff training plan at the implementation level. (2) Stage D (implementation stage): training is carried out according to the plan for decision-making and implementation. Aiming at the decision-making level: organize the members of the quality management leading group to learn the relevant knowledge of total quality management and PDCA management and require to write a relevant summary, and the leaders of each quality control team together with the team members should carefully study the detailed explanation of quality standards and assess the relevant knowledge, so as to improve the inspection ability. Organize the detailed explanation of the evaluation standard of the learning quality management of the head nurse in the whole hospital and require the head nurse of each department to formulate the improvement plan one by one according to the existing problems in the department, combined with the content of the quality standard, the rectification plan is specifically responsible for by the head nurse, and the whole staff is required to participate. And submit it to the nursing department for approval, and after approval, the head nurse will organize the whole department to carry out the implementation. For the implementation level: hold the quality management-related knowledge training and assessment of the whole hospital, and the assessment items shall be subject to the written examination; the head nurses are required to organize regular scientific meetings to discuss and clarify the quality standards and assessment methods at the scientific meetings. Analyze the errors in the inspection process of the department to find out the existing gap and carry out the division of labor and rectification, and require each department to set up corresponding internal quality control teams, so that everyone has their own responsibility and emphasis, so as to form a good atmosphere for everyone to participate in quality management; nurses should be familiar with their respective management responsibilities and improvement plans for undergraduate problems. Carry on the implementation according to the plan: the implementation process adopts the cycle management mode, that is, the head nurse implements the fixed responsibility cycle management to the nurse, the quality control team leader implements the fixed department cycle management to the head nurse, and the quality improvement leading group implements the fixed item cycle management to the quality control team leader. The head nurse carries out the circular management of responsibility to the nurses, and according to the rectification plan, the head nurse implements the management responsibilities from five aspects: ward management, rescue and treatment materials management, special nursing level basic nursing management, nursing document management and head nurse management to the five responsible persons of the quality control team in the department, and the five responsible persons, respectively, implement the management duties of each nurse according to the Kone group plan. The head of the quality control team shall carry out the cycle management of the department to the head nurse, carry out the relevant inspection to each department according to the standards of each quality control group, and adjust the inspection contents at any time according to the results. The quality improvement leading group implements the fixed cycle management to the quality control team leader, and the quality improvement leading group implements the management responsibilities of five projects, such as ward management, rescue and treatment materials management, special first-level basic nursing management, nursing document management, and head nurse management, to each quality control team leader. (3) Stage C (inspection stage): first self-examination, scientific examination, then quality control group inspection, and finally focus on inspection. Self-examination: nurses should first conduct self-examination according to nursing quality evaluation standards, including daily job responsibilities and management responsibilities, and make standardized records. Scientific investigation: the head nurse made a comprehensive examination once a week according to the evaluation standard of nursing quality. And make standard records and regularly report to the nursing department in the form of accounts. Quality control group inspection: nursing expert supervision group according to the plan to check each clinical department of the hospital once a quarter, key departments once a month. The focus of the inspection is the quality improvement points in the rectification and reform plan of each department, and strive to take the problems existing in the last inspection as the focus of the next inspection. Key check: the nursing expert supervision group takes the common problems and key points and weak links in nursing work as the quality improvement points of the whole hospital to conduct random checks. (4) Stage A (summary and treatment stage) summing up the results of self-examination: nurses are required to report and communicate the results of self-examination in the early shift every day; the head nurse analyzes the evaluation results according to the results of the examination and discusses them at the meeting of science and technology. Timely revision of objectives, improvement measures, and timely follow-up of the progress of the plan and link the results of quality evaluation with the distribution of labor services in the department. The examination results of the nursing expert supervision group were reported at the hospital quality management committee and reported to the whole hospital in the form of OA, the centralized problems were analyzed at the head nurse meeting, and the improvement measures and suggestions were fed back to the relevant clinical departments in time; for the advantages, we should consider how to maintain them in the next cycle. Put forward new problems: the new problems and the common problems existing in the hospital were summarized and put forward by the nursing expert supervision group, which were improved as a continuous quality improvement project, and the standard and plan schedule were revised. The successful experience and shortcomings should be used as the driving force and basis to promote the next PDCA cycle.Nursing quality : the nurThis research uses the “Evaluation Standard of Nursing quality Control in Clinical Department,” which is being used by the nursing department of this hospital in the assessment of nursing quality in clinical department, as the evaluation index. The evaluation standard is the standard of nursing quality management revised by the members of the joint nursing expert supervision group of the nursing department of the hospital with reference to “Evaluation Indexes of the third-level General Hospital of the Ministry of Health”  and  was to represent the counting data, and χ2 test was used. The difference was statistically significant when P < 0.05.Using SPSS21.0 statistical software, before statistical analysis, the measurement data were tested by normal distribution and variance homogeneity analysis to meet the requirements of normal distribution or approximate normal distribution, expressed as P < 0.05). All the results are presented in Compared to the control, in the comparison of nursing quality, the nursing safety, specialty quality, and nursing norms in the study group were higher (P < 0.05). All the results are illustrated in Compared to the control, in terms of the scores of individual quality control examination in clinical departments, the scores of ward management, rescue, therapeutic articles, drug management, first-level nursing, nursing documents, and head nurses in the study group were higher (P < 0.05). All the results are shown in Compared to the control, in terms of the operating room nursing quality score, the instrument management, instrument preparation, nurses' cooperation skills, disinfection and isolation quality, and the total score were higher in the study group (P < 0.05). All the results are illustrated in Compared to the control, in terms of the incidence of operative adverse events and nursing errors, the incidence of nosocomial infection, iatrogenic injury, information check error, equipment failure, violation of operation regulations, ECG monitoring error, infusion operation error, and medication error in the study group was lower (P < 0.05). All the results are illustrated in According to the comparison of the number of problems existing in the quality management of nursing documents, compared with the control, the number of problems in temperature sheet, medical order, evaluation sheet, nursing record, and other nursing documents in the study group was lower (P < 0.05). All the results are shown in Compared to control, the scores of nursing communication, professional technology, nursing service attitude, nursing environment, and knowledge education in the study group were higher (With the advancement of the traditional medical model and the implementation of the new medical reform, the requirements of the society and patients for the medical quality and nursing service quality of the hospital are increasing, which renders the nursing management, especially the nursing quality management, become particularly important , 13. NurPDCA cycle was put forward by Dr. Deming, an American quality management expert in the 1950s. Its main content is the abbreviation of plan, do, check, and action. It is the basic tool of total quality management . The PDCIn view of the results of our current study, the nursing quality, nursing safety, specialty quality, and nursing norms were higher in the study group. With regard to the scores of individual quality control examination, the scores of ward management, rescue, therapeutic articles, drug management, first-level nursing, nursing documents, and head nurses were higher in the study group. According to the comparison of the number of problems existing in the quality management of nursing documents, the number of problems in temperature sheet, medical order, evaluation sheet, nursing record, and other nursing documents was lower in the study group. The writing of nursing records not only reflects the dynamic changes of patients' medical and nursing process and condition during hospitalization but also is the basis for evaluating the professional ability of nurses and nursing quality management. In this study, the problems of nursing documents mainly exist in temperature sheet, doctor's order, evaluation sheet, and nursing record. Through comprehensive analysis, nurses' lack of understanding of the rigor and importance of nursing records, heavy burden on nursing staff, and untimely quality control of nursing records is the main reason for the nonstandard writing of nursing records , 27. ThrIn this study, the scores of nursing quality in operating room, equipment management, equipment preparation, nurses' cooperation skills, disinfection and isolation quality, and total score were higher in the study group. With regard to the incidence of operative adverse events and nursing errors, the incidence of nosocomial infection, iatrogenic injury, information check error, equipment failure, violation of operation regulations, ECG monitoring error, infusion operation error, and medication error was lower in the study group. The scores of nursing communication, professional technology, nursing service attitude, nursing environment, and knowledge education in the study group were higher than those in the control group. The possible reason for our results is that in the past, nursing quality management has been dominated by experience management, that is, “housekeeping” or “paternalistic” management mode, which is lack of science and effectiveness and lack of guarantee for nursing quality . In receTaken together, the adoption of PDCA process management can effectively enhance the nursing quality and safety of the day operation ward, further improve the quality of hospital nursing work, and elevate patient satisfaction. This new nursing model based on PDCA will exert great potential and application value in the management of day ward in the future.


Monoclonal antibodies with high efficiency and specificity are one of the best strategies to diagnose and treat a variety of diseases such as cancer, autoimmunity, and inflammatory diseases. The market for monoclonal therapeutic antibodies (MTAs) has grown dramatically in the past decade.  Given the importance of these issues, developing countries spend a high cost on importing or producing MTAs annually. This study intends to examine the market of monoclonal therapeutic antibodies in Iran and predict the future growth rate of this market using the obtained data.  Data on the status of MTAs in the country (from 2008 to 2018) were obtained from the Food and Drug Deputy of Mazandaran University of Medical Sciences. The market status of MTAs was studied based on the dosage forms, application, and price. Then, the market outlook was predicted up to year 2025.  The results showed that 58.8% of all MTAs were humanized, and 86% of all antibody-based drugs were used to treat cancer. Sales of MTA-based medications will reach $454 million by 2025 and are projected to grow significantly in the future.  Given the increasing technology of the production of MTAs and their use in targeted therapies worldwide, their consumption market in Iran is expected to grow significantly. Antibodies are glycoproteins that are produced by B lymphocytes in response to antigens, bind specifically to antigens, and play an important role in immune defense  1]. Ant. Ant1]. mAbs are divided into four types according to their origin: murine mAbs, chimeric, humanized, and fully human . Murine The most crucial drawback of this type of mAbs is the high immunogenicity, which leads to the production of human antimouse antibody (HAMA) responses that decrease its immunogenicity and efficacy. Because of these problems, other antibodies were designed that decrease the antihuman immunogenicity , 8. ChimToday, thanks to the tremendous technological advances in the production of antibodies, our increased knowledge of the pathogenesis of many diseases, as well as the approach of physicians to personalized medicine, has led to the dramatic growth of the production of these MTA products . TherefoThe largest share (50%) of the MTA market belongs to North America, followed by Latin America, Western Europe, Eastern Europe, Asia-Pacific, the Middle East, Africa, and Japan . DevelopOn the contrary, an increase in the discovery and production of mAbs and an increase in our understanding of diseases at the molecular level, as well as a targeted treatment approach for many chronic diseases by physicians, have led to the increasing use of MTAs worldwide. This study intends to examine the market of monoclonal therapeutic antibodies in Iran and predict the future growth rate of this market using the obtained data. Accordingly, we first discussed the market situation over the last thirteen years with well-documented data and then predicted the market situation by 2025.Data on the status of MTAs in the country over the past thirteen years (2006 to 2018) are obtained from the Food and Drug Deputy of Mazandaran University of Medical Sciences. The data include the brand and generic name of the medication, dosage forms, amount or quantity required, and the price of the drug in US dollars. Since some of the arbitrators needed to be produced domestically, all prices were calculated in US dollars to equalize the cost of supplying MTA drugs.The data were categorized by type and source, type of the original construct, clinical application, target molecule, and prices in US dollars. All the data were analyzed using Excel software.We used root-mean-square error (RMSE), mean absolute error (MAE), symmetric mean absolute percentage error (SMAPE), ease of movement (EMV), and R2 indexes (indicators) to analyze the annual use of MTAs and predict 5-year need. According to the results, the trend line has been calculated over the past thirteen years. Also, the EMV index examined the changes in the mean total costs and considered cost fluctuations (oscillations) based on useful indicators over the past thirteen years. Finally, an estimated model based on the MTA requirement by 2025 is calculated for our country.The distribution of MTAs uses from 2006 to 2018, as shown in The frequency of clinical applications of MTAs was calculated each year. Furthermore, from all, 86% were used in cancer and only about 14% in chronic inflammatory diseases . In the As shown in Given the high consumption of MTAs in the last thirteen years and an increasing trend over the previous years, a consumption estimating model was presented in the coming years. As shown in Monoclonal antibodies with high efficiency, specificity, and less toxic effects are targeted tools for the development of personalized medicine for the diagnosis and treatment of various diseases, including cancer, inflammatory diseases, autoimmune disorders, and infectious diseases. More than hundreds of MTAs have been developed for over 30 years, and some have been approved. Although the MTA market has grown dramatically in the world, the major suppliers are the United States, Europe, Latin America, Asia, and Japan. In this study, we have evaluated the MTA market in Iran over the past thirteen years based on the therapeutic area and dosage form to provide a predictive model by 2025. The results showed that the source of all MTAs was 23.5% chimeric, 58.8% humanized, and 17.7% fully human. These data are consistent with the overall development of the MTA over time. As in the early years (2001 and 2002), the major (70%) MTAs were chimeric antibodies.However, due to the immunogenicity problems of chimeric antibodies, the contribution of these types of antibodies in the global MTA market has decreased significantly. Instead, humanized and fully human MTAs rapidly replaced chimeric antibodies in the treatment of many disorders due to their low immunogenicity. Adalimumab was the first humanized antibody approved by the FDA in 2003 . It, theOver the past two decades, monoclonal antibodies designed to target tumor cells or improve immune system exhaustion with fewer side effects and high efficacy have rapidly increased due to increased understanding of genomic studies and technological advances –24. It iTaken together, given the increasing technology of the production of these drugs and their use in targeted therapies worldwide, their consumption market in Iran is expected to grow significantly. Given the high cost of MTAs and the increasing need to use them in the near future, there should be an opportunity to improve investment in the research and development of MTA production technology in Iran to meet both domestic demand and export opportunity.


In the last few years, there has been an emphasis on the importance of health literacy (HL) and health education (HE) as basic tools to empower individuals and the community. The increasing interest in HL and HE has been observed through the evolution of publications and the nature of the main trends in the last few years. Knowing how HL and HE have evolved in scientific publications can help us to identify trends and set work priorities in this scope. Based on this, a bibliometric analysis (from 2000 to 2021) was conducted in two phases: first, an analysis was performed on the publications included in the Web of Science (WOS); second, a more specific analysis was conducted on the Core Collection from WOS. The data were analyzed with two software programs, the and Bibliometrix package for RStudio, and VOSviewer to analyze number of publications, citations, authors, collaborations, keywords trends, keywords evolutions and clusters of related terms. A total of 1799 articles were found in the first phase, and 727 in the second. The results from both analyses showed that the publications increased unequally until 2020, and considerably decreased in 2021; however, in spite of this, the number of citations remained constant. Likewise, five word clusters related with HL and HE were identified. D. Nutbeam stood out as the most prolific author on the subject, the USA as the country with the most publications, and the International Journal of Environmental Research and Public Health as having the most articles on the subject. This analysis may be a useful and helpful tool for future studies on the subject. The origins of the concept of Health Literacy (HL) go back to 1974, when S.K. Simonds associated it with another closely-related concept, Health Education (HE) . PosteriLikewise, delving further into the framework of the European Health Literacy Project, HL also contemplates the competences of individuals in understanding, evaluating and applying health information to maintain and improve the quality of life .There are three levels in HL: (i) functional: basic competences of reading and writing to act efficiently in a health context; (ii) interactive: cognitive and social skills that allow for active participation in subjects related to health; and (iii) critical: competences associated with the making of decisions starting with a critical analysis and the use of information to participate in health actions ,11. ThesAside from these three levels, there are three dimensions based on a conceptual model with respect to HL, and which must be considered to ensure the correct literacy in this area: attention and care; prevention of diseases, and health promotion. Starting with these three dimensions, we find four more, which refer to the processing of information, based on the logical model: accessing, understanding, processing, and application of the information received about health subjects ,12,13,14The interest of the general population and the need to implement real HL in education contexts has increased, given its high impact on health results, in which a greater HL is associated with a better state of health. In this sense, many studies ,16,17 haThe health crisis due to COVID-19 has further highlighted, if possible, the need for HL through the implementation of HE, given that the general population has had to rapidly learn and apply a set of health measures and protocols to contain the expansion of SARS-CoV-2 ,22,23.The evolution of HL and HE concepts has become consolidated in the last few decades. Thus, the objective of this review is to conduct a quantitative bibliometric analysis to discover what the advances and changes have been with respect to HL and HE in the last few years. The results obtained will allow us to identify the trends and priorities in this field, as this method is efficient and effective for quantitatively describing the influence of a subject through time ,25,26,27The bibliometric analysis was performed with the Web of Science (WOS) database, due to their well- and deeply cited interconnections in several research areas through the Web of Science Core Collection (WOSSC), allowing us to perform a precise and specific analysis of publications, authors, citations, and keywords. For this, a search was conducted for articles which included the subject TS = . The inclusion criteria were: (a) articles published between 1 January 2000 and 31 December 2021, and (b) original articles in any language, and the exclusion criteria were: (c) any type of articles not considered originals . To ensure the inclusion of all articles and avoid problems with database updates, the search was completed in a single day on 31 December 2021. The screening according to the inclusion and exclusion criteria was performed in two phases. The first phase directly utilized the filters offered in the database, and the second was performed with the article’s titles. The search and selection results are shown in the The search for articles to be analyzed was conducted in two phases. In the first one, we worked with WOS “All Databases”, the searches of which are based on seven databases, and whose results provide a general view of all recorded documents in them. The results obtained in the first phase allowed us to identify the database WOSCC as the most appropriate for the second phase of analysis. For this reason, in the second one, we performed a more precise bibliometric analysis using WOSSC, where keywords, citations or authors were analyzed through their occurrence or as a cluster of concepts using two specific software for this purpose: Bibliometrix 3.1.4 for RStudio and VOSviewer.Likewise, a double screening was performed, the first with “All Databases”, and the second, more specific one with the WOSCC database, for a more in-depth bibliometric analysis. In both cases, the following information was extracted: year of publication, number of citations, authors, journals, areas of research, countries, languages, and keywords.For the selection of studies, two of the authors (LS and AE) independently evaluated the articles. Any disagreement in the selection of articles was resolved via consensus with the third author (AR) of the present article.The statistical analysis was performed with two specific programs, the “Bibliometrix 3.1.4” package  of RStudLikewise, VOSviewer was used to analyze and visualize the bibliometric networks of the keywords (50 keywords with frequency more than 20 occurrences). The aim of this co-occurrence analysis, through the application of the KeyWords Plus and author’s keywords, was to view the networks according to the number of citations and their temporality.The results are organized starting from a more general analysis (through the “All Databases”), to a more specific one (using WOSCC).®, 60.81% in Current Contents Connect, and 42.52% in CABI: CAB Abstracts. The other databases contained in WOS only included less than 5% of the articles found in this search.The search in All Databases provided 2353 initial records. Once the inclusion criteria and the selection of articles according to their titles were applied, a total of 1799 articles were selected. Of these, 84.04% were found in the WOSCC, 81.32% in MEDLINEDespite the number of articles published increasing since the year 2000, this increase was not uniform, and it was observed that some years  were more productive that the years right after. The year with the most publications was 2020, with a total of 253 articles .With respect to the number of citations of the articles included in the analysis, these were cited 35,455 times, 32,932 when excluding self-citations. The maximum number of citations in a single year was in 2020 (5000 citations), coinciding with the greater number of publications. The five most productive years were, from most to least, the following: 2020, 2019, 2021, 2018, and 2015 see .With respect to the most prolific authors in the period studied, the top five were: A.F. Jorm and M.S. Wolf with 13 publications each, D. Nutbeam and D.W. Baker with 11 publications, and T.C. Davis with 10 publications.n = 53, 2.95%), Journal of Health Communication , BMC Public Health , Patient Education and Counseling  and Health Promotion Practice .With respect to the journals with the greatest number of publications on HL and HE, the following stood out, according to number of publications: International Journal of Environmental Research and Public Health , Health Care Science Services , Education Educational Research , Psychology  and Nursing .Regarding to the areas of research in which the most articles were published, the following were underlined: Public Environmental Occupational Health , Australia , China , Canada  and Germany . Additionally, the most utilized languages used in these articles were: English , well ahead of Chinese , with smaller percentages found for German, Korean, Portuguese, and Spanish.Lastly, with respect to the countries that published the most on the subject, the following were found: the USA , Current Content Connect (66.99%), CABI:CAB Abstracts (29.16%), SciELO (2.61%) and KCI-Korean Journal Databases (0.14%) .The trend, with respect to publications and the number of citations, increased from the year 2000 until 2020, reaching a total of 129 publication and 2011 citations in the latter. On the contrary, the number of publications in 2021 decreased to 92 publications, although the number of citations was practically unchanged, with a total of 2002 .As for the number of overall citations, the articles were cited 11,807 times, 11,194 times excluding the self-citations. The top five articles cited accumulated a total of 3573 citations (mean = 714.6). The two most cited articles ,34 correWith respect to the authors who published the most between 2000 and 2021, we found D. Nutbeam , Health Education Journal (2.89%), Health Promotion International (2.20%), BMC Public Health (2.06%) and American Journal of Health Education (1.65%) . The firAs for the number of citations, the five most cited journals were: Patient Education and Counseling with 530 citations, BMC Public Health with 568 citations, Health Promotion International with 417 citations, the Journal of General Internal Medicine with 403 citations and the Journal of Health Communication with 364 citations.According to Journal Citation Reports, the impact factor of the journals with the most publications were between 3390 and 1299, in four different areas of knowledge , which were all classified between the Q1 and Q4 quartiles .n = 321); Health Care Science Services ; Nursing ; Education Educational Research ; and General Internal Medicine .From the WOS analysis, it was found that the top five research areas, according to the number of articles, were: Public, Environmental and Occupational Health  did not establish a relationship with other countries that were not part of their same cluster, while another four were also found which did not have a relationship between countries within the same cluster, but instead had a relationship with the other three clusters .With respect to the affiliations of the authors, the University of Sydney  was identified as the one which possessed the greatest number of publications with 59 articles, followed by the University of California—including all campuses (USA) with 43 articles, and Columbia (USA) and Emory (USA) universities, with 32 publications each. As for the countries with the most citations, among the top ten, we identified: USA with 4256 citations, Australia with 3968, China with 703, Canada with 508, the Netherlands with 337, United Kingdom with 203, Germany with 197, Brazil with 139, Finland with 127 and New Zealand with 89.n = 698) were published in English, 1.38% (n = 10) in German, and with a percentage of less than 1%, from higher to lower: Portuguese, Spanish, Chinese, French, Hungarian, Malay, and Turkish.As for the language of the publication, 96% , with a minimum of 20 occurrences, a threshold of 50 was identified. In the resulting network map, it was observed that the ten words with a greater occurrence were health literacy (422 times), health education (263) knowledge (114), education (107), and care (100) .Cluster 1 : adults, barriers, behaviors, cancer, disparities, health, knowledge, management, perceptions, prevalence, risk, united-states and women.Cluster 2 : adolescent, attitudes, beliefs, depression, disorders, impact, interventions, mental health, mental health literacy, people, program and stigma.Cluster 3 : adherence, care, health communication, health education, health literacy, information, internet, literacy, patient education, quality and readability.Cluster 4 : adolescents, association, behavior, children, oral health, outcomes and validation.Cluster 5 : communication, education, health promotion, intervention, prevention, promotion and public-health.Five clusters were underlined in this network, whose main concepts were:The five clusters have a common node with HL and HE, with both terms acting as a hinge to the different subfields represented by each cluster. By delving deeper into these five clusters, some similarities are identified between clusters 1 and 3, including terms more focused on the concepts of illnesses, adultness, caring, and other terms related with diseases. Likewise, clusters 2 and 4 include terms related with adolescents and children, prevention, health knowledge and prevention of mental health issues. Finally, cluster 5 contains more general terms such as education, promotion, or prevention in health .Lastly, a three-field plot was created, limited to five variables per column, in which the countries with the highest scientific production, the most important keywords, and the journals with the highest number of publications, were paired. It was observed that the countries with a greater number of publications mainly utilized four of the most relevant words . These same words were included in articles published in four of the five journals that published the most, except for the journal Health Promotion International .The objective of this bibliometric analysis was to analyze the evolution and trends in the publications on HL and HE, and due to this, the two-phase analysis strategy allowed us to focus the results in a manner that was more specific and useful for obtaining reliable results. Since WOS and Scopus have similar characteristics in terms of bibliometric parameters that can be analyzed, we chose WOS because it allows a more robust evaluation of the documents housed in this database .As far as we know, this is the first bibliometric analysis on HL and HE conducted at the international level. Although a similar study was published in 2008 , there aFinally, although some specific results could be comparable, such as number of publications per year, the development of new tools for bibliometric analyses allowed us to increase the number of results obtained, their complexity and the way they are displayed.The searches carried out during each phase of the analysis identified uniform results for the number of publications. Thus, in both phases , an increase in the number of publications was observed from the year 2000 to 2020, and this increase was irregular in this 20-year period, with a decrease in the number of publications in specific years. In spite of this, there was a progressive and constant increase in the number of publications from 2016 to 2020, once again decreasing in 2021.As for the number of publications that were most cited, D. Nutbeam was identified as the most cited author in the last 20 years on this subject, becoming the main axis for the rest of the authors who published articles on HL and HE. His two most cited articles ,34 were It must be highlighted that despite the Health Promotion International journal being the first journal to publish on this subject, the International Journal of Environmental Research and Public Health currently has the largest number of publications, and is also the one with the highest impact factor according to the Journal Citation Report.As for the citations, the journals with the most citations related with HL and HE were Patient Education and Counseling and Health Promotion International. However, the most cited article, at present, was published in the Health Promotion International journal, which also had the highest H-Index compared to the other journals analyzed in this study. Likewise, of the top five cited articles, four of them were found in the category Public, Environmental and Occupational Health, which indicates that this category accumulates the highest number of citations on the subjects of HL and HE.Lastly, even though D. Nutbeam was the most cited author, he did not have the highest number of publications on the subject, although he came in second place; this indicates that although D. Nutbeam was the promoter of the subject, as of today, there are other authors who have contributed more to the growth of this field of study.With respect to countries and languages, the searches in the two phases coincided in that the USA was the country with the most publications (>39%), and English the most utilized, with 93% of the articles published in this language. These data were expected if the affiliations with the greatest number of publications are analyzed. Thus, the USA is the first country in terms of scientific contribution if we analyze the three universities with the most publications: University of California—including all campuses (USA), University of Columbia (USA), and Emory University (USA), while Australia is second; even though the University of Sydney publishes the most on the subjects of HL and HE, it does not exceed the number of publications from American universities.At the same time, a set of countries that acted as central nodes in the network of collaborations were identified, when publishing articles on the subject. These were: USA, Canada, United Kingdom, Australia, New Zealand, South Africa, Netherlands and Germany. This indicates that the USA and Australia lead and channel the HL and HE subject, as shown by the number of citations they accumulate, which is higher than 1000 in both cases.Unlike the study of Kondilis , focusedThe bibliometric analysis of the keywords conducted only through the WOSCC with the KeyWords Plus, the author’s keywords, and both together, indicated clear differences between the terms used, which is reasonable, given that the analysis was performed through the concepts health literacy and health education, so that the most relevant words utilized by the authors were these two, compared to the other terms. However, when analyzing the KeyWords Plus, meaning the keywords that are automatically generated from the titles of the articles cited, the most important words that were identified, from most to least, were: care, knowledge, education, health literacy and literacy, exceeding the concepts searched, care and knowledge, which suggests the non-existence of a correlation between keywords that the authors include in the section “keywords”, which are utilized to entitle their article. This indicates that the terms HL and HE are considered as general concepts which encompass other more specific terms, and are therefore the least utilized to define the issues that will be discussed in each of the articles published on the subject.The analysis of the keywords through time revealed the same trend. Before 2016, the words were focused through the prism of disease and a nursing point of view, including KeyWords Plus such as patient, skills, disease, readability, primary care, information, internet and prevention; and author’s keywords such as: nursing, readability, physical activity, adherence and patient education. During the 2016–2018 period, words that were oriented towards education, health, and prevalence started to be used, with keywords such as knowledge, care, prevalence, risk, and health literacy, identified with KeyWords Plus, and oral health, health, health education, education, health promotion and health literacy as author’s keywords. Lastly, starting in 2019, the trend and direction changed, and HL and HE began to be associated with mental health, with KeyWords Plus such as: impact, people, behaviors, and as author’s keywords: adolescent, mental health literacy, mental health, health information and COVID-19. This change in the trend throughout the years demonstrates the versatility of HL and HE, as they adapt to the needs detected in health-related aspects.This increase has been of such magnitude that the keywords associated with the subject have acquired a privileged position, as shown in In the case of mental health, the results obtained from the calculations performed in the study showed that this subject has become more important and relevant in the last few years, not only in terms of mental health as an issue, but also as a challenge in health literacy in specific groups, and in society in general ,41.Focusing on other more recent keywords such as COVID-19, up to 100 different publications from PubMed are retrieved, which include the terms COVID-19 and health literacy combined in their title. As several authors indicate, the situation of the COVID-19 pandemic has implied challenges not only in the diagnosis or treatment of this disease, but also in different areas such as health literacy ,22,23. Ohealth promotion.Lastly, and as a summary, a large homogeneity was found among the top five countries, author’s keywords, and journals. That is, the top five countries published articles about the four most important keywords , and almost all of these appeared in the top five journals. It is interesting to highlight that given that the USA was the country with the most publications, these contained half of all the most relevant keywords, and only one of the five journals did not publish an article about one of the keywords; these are the Health Promotion International journal, and the keyword The main limitations of this study are that since it is a bibliometric analysis of two very broad concepts such as HL and HE, the results obtained may have yielded results that, though concise, do not allow the identification of specific relationships between HL, HE and other more specific concepts. In turn, this leads to another limitation: parameters such as transience index, m-Quotient or track citations and collaborations were not calculated, due to the large and variated number of terms related with HL and HE identified in the five different clusters see . Thus, fThis is the first study in which a complete bibliometric analysis was conducted on Health Literacy (HL) and Health Education (HE) at the international level. As shown by the increasing number of publications, HL and HE have acquired, in the last two decades, a greater importance and relevance in the area of public health publications.The number of publications over the last ten years indicates an expanding interest on this topic. Furthermore, the large number of terms closely related with HL and HE, identified in this study in five different clusters, shows the extensive scope that these two concepts have in health. The focus on what issues are relevant, in terms of HL and HE have evolved through the years going form aspects more related to illness, care and adultness, to others more closely to adolescents and children, prevention of mental health issues and even COVID-19. It can be perceived that, due to the challenges experienced in recent years with the COVID-19 pandemic situation, in the coming years the research in HL and HE will be relevant in mental health literacy. How to act, from the area of HE on vulnerable populations such as adolescents, how to increase knowledge on mental health management, how to modify their beliefs and attitudes or how to reduce the stigma on mental health will be the new challenges to face.The results shown here can guide those who are approaching HL and HE for the first time, providing them relevant information to incentive the research in specific subfields on this subject.HL and HE are very broad concepts covering many different keywords. Deeper bibliometric analyses are required, in which specific cluster of terms are considered, to learn more about differences in the evolution of scientific production on this field.In any case, the information shown in this study is a useful tool that can stimulate new studies and collaborations between researchers from different areas and approaches within the HL and HE.


Many stakeholders are involved in the complicated process of policy making in integrated early childhood development (IECD). In other words, there are many challenges for IECD policy making in developing countries, including Iran. The aim of this study was to identify potential stakeholders and their interactions in IECD policy making in Iran.A mixed-methods study was conducted in two phases in 2018. First, forty semi-structured interviews and a review of IECD-related documents were conducted to identify potential stakeholders and their roles. Second, using a designed checklist, these stakeholders were assessed for power, interest, and position in IECD policy making. Then, a map of stakeholders and a three-dimensional stakeholder analysis figure were designed.The results of this study showed that various stakeholders, including governmental, semi-governmental, social, non-governmental and international organizations, potentially influence IECD policy in Iran. They were found to have diverse levels of power, interest and position in this regard, leading to their different impacts on the process. This diversity is assumed to have affected their levels of participation and support. Also, we found that the stakeholders with a high-power level do not have a high level of interest in, or support for, IECD policy. In general, organizational competition, complicated inter-sectoral nature of this process, insufficient budget, insufficient awareness about the importance of IECD, lack of priority given to IECD in relevant organizations, economical views rather than developmental perspectives, and lack of commitment among top managers are the reasons why this policy enjoys a low degree of support.There are weaknesses in effective interactions and relationships among IECD policy stakeholders. This will lead to the lack of equal opportunities for optimal early childhood development. To improve this process, advocacy from high-level authorities of the organizations, negotiation with child-friendly groups, establishing a body to coordinate and oversee children’s affairs, using the capacity of non-governmental organizations, strengthening inter-sectoral collaboration by clarifying the roles and responsibilities of stakeholders and the relationships between them, and increasing public awareness can be helpful. Early child development (ECD) is a scientific approach to understand children’s growth and development in the early years and includes several areas which are likely to interact with each other. These areas are physical, cognitive, emotional, social, and spiritual domains . Based oThe idea of human development arose with the basic argument that human progress cannot be measured only by per capita income. In addition to having a good income, cultivating and developing human talents and capacities should be considered in this process. In fact, human development depends on many factors such as life expectancy, education, health, and environment . EconomiAdvancements in neuroscience also provided a scientific basis for re-emphasizing the vital importance of ECD. According to studies in neuroscience, brain develops at its fastest rate in early childhood, and this development, in addition to heredity, is influenced by many variables such as poverty , parentaThe health system in Iran has a unique structure and governance in that the Ministry of Health and Medical Education (MoHME) is the stewardship of the health system . The MoHGiven the interdisciplinary and multidisciplinary nature of early childhood development, the participation of different stakeholders in any stage of the policy-making process is very important and their role in the success or failure of early childhood development policy is clear . Even thThis study was conducted in two phases. In the first phase, a qualitative study was designed to identify potential stakeholders and explore their roles, powers, interests and positions in IECD policy making process. In the second phase, a quantitative approach was used to assess the powers, interests and positions of these stakeholders and draw a map as well as a three-dimensional analysis figure of the stakeholders.Using a qualitative content analysis approach, the policy documents related to different fields of IECD including health, nutrition, education, early care as well as national upstream documents, laws, and international policies from 1964 to 2018 were reviewed in this study. The websites of several organizations such as the Ministry of Health and Medical Education, the Social Welfare Organization, the Ministry of Cooperatives, Labor, and Social Welfare, the Ministry of Education, the Parliament, Judicial System of Iran, the World Health Organization, the UNICEF and several other organizations were searched. In this line, the researchers resorted to personal and organizational relationships to identify and have access to relevant reports and documents. Finally, 64 national and 10 international documents and reports were identified and reviewed. Also, the literature was reviewed to identify all the relevant stakeholders and discover their roles, powers, positions, and interests.The other major method for data collection was face-to-face semi-structured interviews with purposefully identified policy makers (PM), managers (M), informed academics and researchers (Aca), NGOs’ representatives (NGO-R), and children’s service providers (CSP) in the child field from different organizations including the Ministry of Health and Medical Education, the Social Welfare Organization, the Ministry of Education, the Ministry of Cooperatives, Labor, and Social Welfare, the Ministry of Justice, Children’s Medical Center, the Parliament, the Society for Protecting the Rights of the Child (SPRC), the universities and the research centers, etc. Forty interviews each lasting for 30–90 min were conducted from October 2017 to June 2018 to reach data saturation. All interviews took place in the interviewees’ workplaces. The researchers used a literature-based and tailored interview guide. Before the interviews, necessary information regarding the study and its objectives were given to the participants and informed consent was obtained from them verbally. Moreover, they were assured that their information would remain confidential and the data of the study would be analyzed anonymously. The following questions were investigated during the interviews: What organizations, institutions, bodies, or persons are the potential stakeholders in IECD policy making? How do you see their roles, powers, interests, effects and interactions in this regard? Are they properly and adequately involved in the policy-making process? What are your suggestions for improving stakeholders’ collaborations in IECD policy-making process?The interviews were transcribed verbatim and a thematic content analysis approach was used to analyze the data. Finally, to ensure the accuracy of our interpretations, the transcripts were shared with the participants who were asked to confirm their statements.In this phase of the study, we designed a checklist which contained the identified potential stakeholders and their roles in order to evaluate them in terms of power, interest and position. We asked the participants in the former phase to score each dimension. In this regard, the scores included numbers 1, 3, 5 and 7 , the Intellectual Development Center for Children and Adolescents, high specialized councils , the Ministry of Agriculture, the Environmental Protection Organization, religious institutions, the Relief Committee, the Ministry of Industry, Mine and Trade, the Health Insurance Organization, the Ministry of Sport and Youth, the Ministry of Roads and Urban Development, The Police Force of the Islamic Republic of Iran, the Ministry of Communications and Information Technology, municipalities, the Ministry of Economic Affairs and Finance, the Ministry of Science, Research and Technology, and the Ministry of Culture and Islamic Guidance. In Table “The Ministry of Education shows low interest in ECD. For example, our kindergarten coverage rate is 10 %, and 90 % of children do not have access to these services at all because kindergarten and preschool education are not free and such educational services are not important in our country” (PM 21).“I want to say that there is insufficient understanding of the importance of ECD at the highest levels of the Ministry of Social Welfare or the Ministry of Health. For example, the implemented actions in the health children’s department do not achieve its goal because it is not a priority for the Ministry of Health” (PM 36).Based on our results, the non-governmental organizations, the Intellectual Development Center for Children and Adolescents, the families, the Children’s Service Providers and the international organizations such as the UNICEF and the World Health Organization had the highest interest in IECD policy. However, their full capacity is not used in policy making. The Ministry of Health and Medical Education and the Social Welfare Organization are rated medium in the domain of interest. According to the interviewees, ECD is not a priority among high-level managers of these organizations, with only the middle level managers of these organizations being interested in this policy. On the other hand, stakeholders such as the Ministry of Cooperatives, Labor and Social Welfare, the Ministry of Education, municipalities, the Planning and Budget Organization, the Judiciary System, the Parliament, high specialized councils, the mass media, religious institutions, the Ministry of Economic Affairs and Finance, the Ministry of the Interior, the Ministry of Culture and Islamic Guidance, the Ministry of Science, Research and Technology, the Ministry of Agriculture, the Ministry of Industry, Mines and Trade, the Ministry of Roads and Urban Development, the Ministry of Communication and Information Technology, universities, scientific associations and related research centers, the Health Insurance Organization, the Relief Committee, The Police Force of the Islamic Republic of Iran, and the Environmental Protection Organization are among the organizations have low interest in IECD policy. The most important reasons for the lack of interest among some stakeholders, as stated in the interviews, include the lack of sufficient awareness of IECD and its importance thereby giving priority to other issues, considering children like other people in the community and not paying attention to their particular needs as unique members of the community, the lack of awareness of their own indirect role in ECD by affecting the environment in which children live, the large number of missions and tasks so that the development of childhood is overlooked among other missions, and the dominance of economic perspectives over developmental concerns.“Non-governmental organizations can play a very good role in this field. Unfortunately, in our country, these organizations are not very strong, and if they gain power, they will become semi-governmental organizations and will not be allowed to operate independently.” (M 7).“To implement the integrated early childhood development policy, the Ministry of the Interior can be considered as one of the most powerful stakeholders because this program will be implemented as pilot in the three provinces of Kerman, Tehran and Kermanshah. And well, the provincial governments under the Ministry of the Interior have a very effective role here.” (PM 12).Participants rated the non-governmental organizations, the families, the Intellectual Development Center for Children and Adolescents, and the children’s service providers as the least powerful stakeholders in IECD policy. Among them, the Social Welfare Organization, universities, research centers and scientific associations, the Environmental Protection Organization, the Health Insurance Organization, the Police Force of the Islamic Republic of Iran, and the international organizations were classified as medium-level in terms of power. Interestingly, many organizations with low interest in IECD had high power. However, for various reasons such as the lack of structure, the lack of interest, the lack of commitment in senior managers, the conflicting interests, and the different views and approaches, they seemed not to have used their power in IECD policy-making process. Such organizations included the Ministry of Cooperatives, Labor and Social Welfare, the Ministry of Education, municipalities, the Planning and Budget Organization, the Judiciary System, the Parliament, high specialized councils, the mass media, religious institutions, the Ministry of Economic Affairs and Finance, the Ministry of the Interior, the Ministry of Culture and Islamic Guidance, the Ministry of Science, Research and Technology, the Ministry of Agriculture, the Ministry of Industry, Mines and Trade, the Ministry of Roads and Urban Development, the Ministry of Communications and Information Technology, and the Relief Committee.“There is a lot of competition between organizations involved in early childhood development policy and therefore there is no serious intention to support this policy and most of them show a low level position” (CSP 16).“This program has not so far been supported well in the country, and many stakeholders who can play a critical role in this regard, such as the Judiciary System, the Parliament, the Ministry of Education, the Ministry of Welfare, etc. have not paid much attention and support for early childhood development and related policies and programs.” (Aca 3).Most of the identified potential stakeholders had medium or low support positions. Stakeholders like the high specialized councils, the Ministry of the Interior, the mass media, the Planning and Budget Organization, universities, research centers and scientific associations, the Ministry of Agriculture, the Environmental Protection Organization, religious institutions, the Ministry of Industry, Mine and Trade, the Health Insurance Organization, the Ministry of Roads and Urban Development, The Police Force of the Islamic Republic of Iran, the Ministry of Communications and Information Technology, municipalities, the Ministry of Economic Affairs and Finance, the Ministry of Science, Research and Technology, and the Ministry of Culture and Islamic Guidance were rated as having a low level of position. Additionally, the Ministry of Health and Medical Education, the Social Welfare Organization, the Ministry of Cooperatives, Labor, and Social Welfare, the Ministry of Education, the Judicial Power, the Parliament, children’s service providers, international organizations and the Ministry of Sport and Youth had a medium level of position. On the other hand, the non-governmental organizations, the families and the Intellectual Development Center for Children and Adolescents were among stakeholders with a high level of position. The participants stated that the main organizations involved in IECD policy, including the Ministry of Health and Medical Education, the Social Welfare Organization and the Ministry of Education, have not yet been able to show a strong supportive position toward this policy despite the fact that they work together to design a policy document for IECD. In this line, one of the important reasons mentioned in the interviews is that these organizations have spent most of their time and energy competing for program ownership or leadership. In some interviews, it is also mentioned that the position of most organizations is not appropriate as far as inter-sectoral issues are concerned.Also, in the three-dimensional stakeholder analysis figure Fig. , the relThe results of this study show that many stakeholders play a role in ECD. The identified stakeholders have different interests, powers and positions towards IECD policy so that those with a high power do not have a high interest or position towards this policy and vice versa. Identifying stakeholders and their coalitions and interests in relation to ECD policies is crucial as this will clearly reflect the multiplicity of interests among various stakeholders, including those whose interests are threatened or reinforced by IECD policy. On the other hand, volunteers from different organizations have the time, capacity and resources to help this vulnerable community through stakeholders’ analysis which can be used to focus on their capacities .Based on our study, although some stakeholders in the ECD policies such as the non-governmental organizations and the families have high interest in relation to ECD, their capacities and interests are not used in IECD policy-making process. The family, as the social institution in which the child grows up, has a very effective role in the development of children, and the best policies will fail if the families do not accompany the policies. In this regard, Sharpley emphasizes the role of parents as stakeholders in ECD policies. He states that parents have rights in terms of guidance, care and education of their children. They are also legal representatives who work for, and on behalf of, their children to the effect that they are required to provide the physical and emotional needs of their children including shelter, nutrition, health, education, and safety. Therefore, it is necessary to use their potential and interest in supporting early childhood development policies since the families’ interests and enthusiasm can be increased through these interactions and the parents’ peace of mind can be guaranteed. He also states that parents are one of the most important stakeholders who need workshops and training related to child development, which empowers them and helps them break negative cycles . Based oAccording to the results of this study, various factors such as government ownership, lack of proper communication channels, and cumbersome administrative procedures and laws have prevented the use of the capacities of NGOs in the ECD policy process. Sharpley referred to NGOs as stakeholders that are familiar with ECD programs. He states that they can also participate in charitable activities such as providing toys and food which contribute to children’s development . Also, NAccording to the findings of our study, children’s service providers are ignored by the policymakers despite their high interest for participating in IECD policy-making process, and the top-down approach to policy-making in our country prevents them from influencing the policy-making process. However, according to available evidence, top-down and bottom-up approaches should be combined and used simultaneously so that we can employ the strengths of both approaches and cover their weaknesses. This approach allows us to use the capacity of street-level stakeholders in policy-making . Also, iIn terms of power and position, the results of this study indicate that most stakeholders with low-medium interest and position in IECD policy have high power in the policy-making process. This power originates from numerous factors including the number of resources , the ability to make use of these resources, the ability to influence other stakeholders, and legal legitimacy. However, as mentioned earlier, they have not used their power in IECD policy making for various reasons such as the lack of structure, the lack of interest, the lack of commitment in senior managers, the conflict of interest, and the different views and approaches. Strategies related to negotiation, advocacy, communication, promotion of inter-sectoral collaboration, and integrated approaches have been proposed to encourage these stakeholders to support the early childhood development policy. These strategies are mentioned in various forms in the literature. Since ECD has necessarily emerged as an inter-sectoral issue, and that an integrated approach essentially puts inter-sectoral collaboration systems on its agenda, countries seek an integrated approach to ECD policy planning that helps all sectors contribute to the improvement of children’s survival, growth, development, and success in school . In thisThe results of this study show that due to the inter-sectoral nature of early childhood development and its broad scope, many potential stakeholders are influenced by this policy. Our results also show that the stakeholders who are in the category of high-power stakeholders do not have much interest or high supportive position towards this issue, which leads to a gap in this regard. The potential capacities and resources of all stakeholders, including NGOs, families, service providers, or street-level stakeholders, cannot be used due to this gap. Also, the power and influence of many stakeholders will not be used, which will result in the lack of equal opportunities for optimal development of children in the early years of life. Ultimately, the vital role of ECD in increasing human capital and sustainable development of society will be ignored. Based on our findings, strategies such as negotiation, advocacy, awareness-raising, empowerment, creating effective communication channels, adopting coherent approaches, promoting inter-sectoral collaboration, establishing leadership and coordinating organizations, using the capacities of street-level stakeholders, and promoting international cooperation can be effective in managing the stakeholders.This study was done as the first study on stakeholder analysis of IECD policy-making process in Iran. The results of our study can be used for the management of potential stakeholders in this regard. However, our study had two main limitations; the first was the extensive research environment due to the inter-sectoral nature of the ECD and the diversity of groups involved in policy-making in this regard. The second was the difficult access to relevant experts and policy makers due to their busy schedules or lack of interest in participating in research. For this reason, a number of participants did not complete and return the checklists in the second phase of the study.


European Journal of Hybrid Imaging (EJHI) opened to contributions in February 2017 and was launched in October of the same year, as a platform to publish papers focused on the use of hybrid and multimodality imaging in clinical practice, clinical trials, and pre-clinical research. EJHI was born as the last member of the EJNMMI family of journals and is now well integrated into the scientific workflow of the family.The EJHI can ensure the rapid and widespread distribution of published articles. The open access model offers a fast and reliable way to disseminate knowledge, and publication can be supported with several funding schemes when authors have no resources available to them. In this respect, the European Association of Nuclear Medicine (EANM) has supported the publication of relevant papers with a sponsorship program. The EANM program helped authors who would otherwise lack Open Access funding publish in EJHI, and the resulting research has contributed greatly to both to the field and the success of the journal. This program will be continued next year, in order to facilitate the successful positioning of the journal in the scientific community.As an Open Access journal, EJHI has received contributions not only from the nuclear medicine community but also from authors in other disciplines that involve hybrid imaging.In less than 2 years of life, the EJHI received 49 manuscripts, of which 37 were accepted and 3 are currently under revision. In 2017 only, the articles published in EJHI were downloaded 587 times, with a usage factor of 122.As of September 2018, the A fast and effective peer review process is practiced at the journal, in line with the characteristics of the EJNMMI family of journals, and this ensures the rapid appraisal of manuscripts.European Journal of Hybrid Imaging has a brief, but very successful, history.When taken together, we have all the arguments to say that the European Journal of Hybrid Imaging, as of January 1, 2019. At the same time, Arturo Chiti will become the Editor-in-Chief of the European Journal of Nuclear Medicine and Molecular Imaging, continuing his efforts in the EANM family of journals.To continue this trend, Springer Nature and EANM, in agreement with Arturo Chiti, have asked Francesco Giammarile to become the Editor-in-Chief of the EJHI, driving the journal towards an established position within the scientific journals in its field.Prof. Giammarile will ensure a smooth transition and the continued growth of the Arturo Chiti, Humanitas University and Humanitas Clinical and Research Center, Milan, Italy.Francesco Giammarile, International Atomic Energy Agency, Vienna, Austria.


Dear Editor,Adult gluteal granuloma (AGG) is an inflammatory dermatosis that occurs in adults or the elderly on skin exposed to prolonged contact with feces and urine. It presents as well-demarcated areas of erythema, edema, scaling, papules, nodules, erosions, and ulcerations. On histopathological analysis, there is no granuloma, but there is acanthosis, spongiosis, varying degrees of a mixed superficial and deep inflammatory infiltrate, and proliferation of vessels in the dermis.An 86-year-old man presented with erythematous, infiltrated, well-defined plaques, with a slightly scaling border and central clearing, asymptomatic, on the lateral aspects of the hips for six months . The patCandida albicans, occlusion and halogenated corticosteroids are possible pathogenic factors.Gluteal granuloma is an inflammatory condition, most commonly observed in infanthood, in the form of papules and nodules in the diaper area. Of uncertain etiology, it is believed that a skin reaction occurs to the repeated contact with irritating substances present in feces, urine and cleaning utensils. Infection by The pH of normal skin is approximately 5.5; while that of urine is around 6 or higher, when there is bacteriuria or infection by urease-producing bacteria, an environment that increases the activity of lipases and proteases, impairs the skin barrier and predisposes to the action of local irritants. Our patient had a urinary pH of 8.5 and bacteriuria, corroborating the findings reported by Isogai et al.The distribution of the lesions is related to the patient’s position, with nodules located in the scrotum and labia majora of patients who remain seated for a long time, and nodules around the anus in bedridden patients.Recently, dermoscopic findings have been described in a case of AGG, showing papillae with rounded white areas surrounded by erythema and serrated white borders. These papillae were separated by fissures and contained a whitish mesh, comedo-like openings and dotted vessels under the greatest magnification.Keeping the skin clean and dry is the main treatment and the best form of prevention. There are individual reports or case series and, in most of them, topical treatments, including corticosteroids, have failed. The use of topical corticosteroids was effective in two patients.With the aging of the population and the increase in the number of incontinent individuals, we will possibly face this entity more frequently, justifying the importance of learning about it.None declared.Anna Karoline Gouveia de Oliveira: Drafting and editing of the manuscript.Neusa Yuriko Sakai Valente: Approval of the final version of the manuscript; drafting and editing of the manuscript; intellectual participation in propaedeutic and/or therapeutic conduct of the studied cases; critical review of the manuscript.Thais do Amaral Carneiro Cunha: Intellectual participation in propaedeutic and/or therapeutic conduct of the studied cases.Agatha Ramos Oppenheimer: Intellectual participation in propaedeutic and/or therapeutic conduct of the studied cases.None declared.


Studies on Cognitive Processes in Translation aims to integrate these two research paradigms and systematically explore the theories, methods and frontier issues of studies on cognitive processes in translation.Since Krings  first prThe book has five chapters. Chapter 1 reviews the development course, main objectives and research contents of studies on cognitive processes in translation both in China and abroad, and points out that there are two generations of language cognitive views in the research of cognitive translatology, namely, the first generation of classic objectivism cognition and the second generation of connectionism and situated/embedded/embodied cognition. The author proposes that from the perspective of the second generation of cognitive science, the primary goal of studies on cognitive processes in translation is to focus on more cognitive psychological processes involved in translation, expand and deepen the understanding of the translator's internal cognitive behaviors, and explore deeper secrets in the brain.Chapter 2 mainly discusses the research methods applied in studies on cognitive processes in translation. According to the data sources and measurement indicators, the author classifies research methods of cognitive processes in translation into five categories: verbal reports, behavioral measurement, physiological measurement, text analysis, and supplementary methods. This chapter introduces the application of the above five categories in the studies on cognitive processes in translation, and analyzes the advantages and disadvantages of each research method. Finally, it discusses the feasibility and prospect of multi-element mutual verification/triangulating in the studies on translation processes.Chapter 3 focuses on the descriptive and explanatory models of cognitive processes in translation. In view of lack of consistency in the theoretical framework of the existing studies on cognitive processes in translation, this chapter, based on the macro perspective of cognitive science, makes a clearer positioning of the theoretical starting points, perspectives and presuppositions reflected in various cognitive process models. It focuses on the influential translation process models, such as Bell's translation process model, Alves and Gonçalves' relevance-connectionism model, PACTE translation competence model, translatorial cognition and action network, Kintsch's construction-integration model, hence making clear the future research directions.Chapter 4 reviews the existing researches on translator's real-time cognitive processing with several core constructs as the main line, and comments on the basic assumptions, cognitive dimensions, and limitations. Based on the second generation of cognitive science paradigm, especially from the perspective of cognitive linguistics, this chapter also looks forward to the future of real-time cognitive processing of translation.Chapter 5 first explores the influences of the changes of translation workspace and the development of translation technology on the translation processes, and then discusses the theoretical frameworks of contextualized cognition, socio-cultural cognition, affective cognition, unconscious cognition, and common cognitive process in translation, as well as the existing empirical researches, and looks into the trends of future researches.Chapter 6 is the conclusion of the whole book, which summarizes the relevant research fields and problems mentioned in the above chapters, and discusses how to meet the challenges and promote the studies on cognitive processes in translation to the unknown field. The author argues that cognitive translatology must innovate and integrate its methodology; the importance of conceptual research and theoretical research should not be ignored; it is necessary to explore the practical influences or applications of studies on cognitive processes in translation and interpretation.Studies on Cognitive Processes in Translation an excellent book with both practicability and collectability for post-graduate students, researchers, and scholars interested in studies on cognitive processes in translation.As a monograph exploring the studies on cognitive processes in translation, this book embodies the trend of interdisciplinary research, that is, the research methods and new technologies of psycholinguistics and cognitive science are constantly applied to the studies on cognitive processes in translation, realizing the mutual benefit and win-win development among disciplines. As far as the research content is concerned, this book has the characteristics of both theoretical reviews and experimental researches. The theoretical review not only reviews and rethinks the related researches in this field, but also points out the problems to be solved or the research trend, which has important reference value for future researches. As for experimental researches, this book expands the scope of studies on cognitive processes in translation and deepens the research of old topics. It is one of the representative works reflecting the current research progress of studies on cognitive processes in translation. This book is characterized by distinct theme, rigorous structure, and strong objectivity. Therefore, it is these qualities that make However, there still remain some respects worth Tan Yesheng's further elaboration. Firstly, although the experimental studies in this book mention the application of neuroimaging techniques, such as electroencephalogram, functional magnetic resonance imaging, and current skin test, in the study of cognitive processes in translation, these currently frequently-applied methods in the fields of psycholinguistics and cognitive science are not expounded in details. Secondly, the book does not involve the reception study in the processes of translation. In other words, it only deals with the processes of the translator's understanding, transformation and expression, rather than the reception process of the target readers. Finally, the book would be more comprehensive if it included more studies in China.QY has written the book review and approved the submitted version for publication.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.