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Family Physicians' satisfaction with factors affecting the dynamism of the urban family physician program in the Fars and Mazandaran provinces of Iran

Kabir MJ, Hassanzadeh-Rostami Z, Ashrafian Amiri H, Nasrollapour Shirvani SD, Keshavarzi A, Hosseini S

Malays Fam Physician, 2019;14(3):28-36.
PMID: 32175038

Background and objective: A successful family physician program needs ongoing and full cooperation between people and the organizations in charge. Ensuring the satisfaction of family physicians through improvement of the underlying factors could motivate them to provide high-quality services. This study aimed to determine the family physicians' satisfaction level with the factors affecting the dynamism of the urban family physicians program in the Fars and Mazandaran provinces of Iran.
Method: This cross-sectional study was carried out in urban areas in the Fars and Mazandaran provinces in 2016. The sample consisted of 143 and 96 family physicians, respectively, in Fars and Mazandaran provinces and was selected using the stratified random sampling method. Data were collected using a questionnaire and included both sociodemographic variables and factors assessing the family physicians' satisfaction levels. Each factor was scored based on a Likert scale from 0 to 5 points, and any satisfaction level higher than 3 out of 5 was equated with being satisfied.
Results: The overall satisfaction levels among family physicians in Fars and Mazandaran provinces were 2.77±0.53 and 3.37±0.56, respectively, revealing a statistically significant difference between provinces (p<0.001). Moreover, the mean satisfaction scores for the performances of healthcare centers, insurance companies, specialists, healthcare workers, and the population covered were 2.78±0.1, 2.54±0.9, 2.52±0.8, 4.24±0.07, and 2.96±0.8, respectively. The family physicians' levels of satisfaction were significantly correlated with population size (p=0.02, r= -0.106), and willingness to stay in an urban family physician program (p<0.001, r= +0.398).
Conclusion: This study revealed that family physicians exhibited a low level of satisfaction with the urban family physician program. Given the direct association between family physicians' satisfaction levels and retention in the program, it is expected that family physicians will no longer stay in the program, and it is likely to have subsequent executive problems.
Chitosan nanocarriers containing essential oils as a green strategy to improve the functional properties of chitosan: A review

Yang Y, Aghbashlo M, Gupta VK, Amiri H, Pan J, Tabatabaei M, et al.

Int J Biol Macromol, 2023 May 01;236:123954.
PMID: 36898453 DOI: 10.1016/j.ijbiomac.2023.123954

Large amounts of agricultural waste, especially marine product waste, are produced annually. These wastes can be used to produce compounds with high-added value. Chitosan is one such valuable product that can be obtained from crustacean wastes. Various biological activities of chitosan and its derivatives, especially antimicrobial, antioxidant, and anticancer properties, have been confirmed by many studies. The unique characteristics of chitosan, especially chitosan nanocarriers, have led to the expansion of using chitosan in various sectors, especially in biomedical sciences and food industries. On the other hand, essential oils, known as volatile and aromatic compounds of plants, have attracted the attention of researchers in recent years. Like chitosan, essential oils have various biological activities, including antimicrobial, antioxidant, and anticancer. In recent years, one of the ways to improve the biological properties of chitosan is to use essential oils encapsulated in chitosan nanocarriers. Among the various biological activities of chitosan nanocarriers containing essential oils, most studies conducted in recent years have been in the field of antimicrobial activity. It was documented that the antimicrobial activity was increased by reducing the size of chitosan particles in the nanoscale. In addition, the antimicrobial activity was intensified when essential oils were in the structure of chitosan nanoparticles. Essential oils can increase the antimicrobial activity of chitosan nanoparticles with synergistic effects. Using essential oils in the structure of chitosan nanocarriers can also improve the other biological properties (antioxidant and anticancer activities) of chitosan and increase the application fields of chitosan. Of course, using essential oils in chitosan nanocarriers for commercial use requires more studies, including stability during storage and effectiveness in real environments. This review aims to overview recent studies on the biological effects of essential oils encapsulated in chitosan nanocarriers, with notes on their biological mechanisms.
Recent developments in improving the emulsifying properties of chitosan

Yang Y, Gupta VK, Amiri H, Pan J, Aghbashlo M, Tabatabaei M, et al.

Int J Biol Macromol, 2023 Jun 01;239:124210.
PMID: 37001778 DOI: 10.1016/j.ijbiomac.2023.124210

Chitosan is one of the valuable products obtained from crustacean waste. The unique characteristics of chitosan (antimicrobial, antioxidant, anticancer, and anti-inflammatory) have increased its application in various sectors. Besides unique biological properties, chitosan or chitosan-based compounds can stabilize emulsions. Nevertheless, studies have shown that chitosan cannot be used as an efficient stabilizer because of its high hydrophilicity. Hence, this review aims to provide an overview of recent studies dealing with improving the emulsifying properties of chitosan. In general, two different approaches have been reported to improve the emulsifying properties of chitosan. The first approach tries to improve the stabilization property of chitosan by modifying its structure. The second one uses compounds such as polysaccharides, proteins, surfactants, essential oils, and polyphenols with more wettability and emulsifying properties than chitosan's particles in combination with chitosan to create complex particles. The tendency to use chitosan-based particles to stabilize Pickering emulsions has recently increased. For this reason, more studies have been conducted in recent years to improve the stabilizing properties of chitosan-based particles, especially using the electrostatic interaction method. In the electrostatic interaction method, numerous research has been conducted on using proteins and polysaccharides to increase the stabilizing property of chitosan.
Tuning chitosan's chemical structure for enhanced biological functions

Aghbashlo M, Amiri H, Moosavi Basri SM, Rastegari H, Lam SS, Pan J, et al.

Trends Biotechnol, 2023 Jun;41(6):785-797.
PMID: 36535818 DOI: 10.1016/j.tibtech.2022.11.009

Chitosan, an amino polysaccharide mostly derived from crustaceans, has been recently highlighted for its biological activities that depend on its molecular weight (MW), degree of deacetylation (DD), and acetylation pattern (AP). More importantly, for some advanced biomaterials, the homogeneity of the chitosan structure is an important factor in determining its biological activity. Here we review emerging enzymes and cell factories, respectively, for in vitro and in vivo preparation of chitosan oligosaccharides (COSs), focusing on advances in the analysis of the AP and structural modification of chitosan to tune its functions. By 'mapping' current knowledge on chitosan's in vitro and in vivo activity with its MW and AP, this work could pave the way for future studies in the field.
Comparison of shrimp waste-derived chitosan produced through conventional and microwave-assisted extraction processes: Physicochemical properties and antibacterial activity assessment

Mohammadi P, Taghavi E, Foong SY, Rajaei A, Amiri H, de Tender C, et al.

Int J Biol Macromol, 2023 Jul 01;242(Pt 2):124841.
PMID: 37182628 DOI: 10.1016/j.ijbiomac.2023.124841

Depending on its physicochemical properties and antibacterial activities, chitosan can have a wide range of applications in food, pharmaceutical, medicine, cosmetics, agriculture, and aquaculture. In this experimental study, chitosan was extracted from shrimp waste through conventional extraction, microwave-assisted extraction, and conventional extraction under microwave process conditions. The effects of the heating source on the physicochemical properties and antibacterial activity were investigated. The results showed that the heating process parameters affected the physicochemical properties considerably. The conventional procedure yielded high molecular weight chitosan with a 12.7 % yield, while the microwave extraction procedure yielded a porous medium molecular weight chitosan at 11.8 %. The conventional extraction under microwave process conditions led to medium molecular weight chitosan with the lowest yield (10.8 %) and crystallinity index (79 %). Antibacterial assessment findings revealed that the chitosan extracted using the conventional method had the best antibacterial activity in the agar disk diffusion assay against Listeria monocytogenes (9.48 mm), Escherichia coli. (8.79 mm), and Salmonella Typhimurium (8.57 mm). While the chitosan obtained by microwave-assisted extraction possessed the highest activity against E. coli. (8.37 mm), and Staphylococcus aureus (8.05 mm), with comparable antibacterial activity against S. Typhimurium (7.34 mm) and L. monocytogenes (6.52 mm). Moreover, the minimal inhibitory concentration and minimal bactericidal concentration assays demonstrated that among the chitosan samples investigated, the conventionally-extracted chitosan, followed by the chitosan extracted by microwave, had the best antibacterial activity against the target bacteria.
Chitin and chitosan derived from crustacean waste valorization streams can support food systems and the UN Sustainable Development Goals

Amiri H, Aghbashlo M, Sharma M, Gaffey J, Manning L, Moosavi Basri SM, et al.

Nat Food, 2022 Oct;3(10):822-828.
PMID: 37117878 DOI: 10.1038/s43016-022-00591-y

Crustacean waste, consisting of shells and other inedible fractions, represents an underutilized source of chitin. Here, we explore developments in the field of crustacean-waste-derived chitin and chitosan extraction and utilization, evaluating emerging food systems and biotechnological applications associated with this globally abundant waste stream. We consider how improving the efficiency and selectivity of chitin separation from wastes, redesigning its chemical structure to improve biotechnology-derived chitosan, converting it into value-added chemicals, and developing new applications for chitin (such as the fabrication of advanced nanomaterials used in fully biobased electric devices) can contribute towards the United Nations Sustainable Development Goals. Finally, we consider how gaps in the research could be filled and future opportunities could be developed to make optimal use of this important waste stream for food systems and beyond.
Fulltext Medical, dental, and nursing students' attitudes and knowledge towards artificial intelligence: a systematic review and meta-analysis

Amiri H, Peiravi S, Rezazadeh Shojaee SS, Rouhparvarzamin M, Nateghi MN, Etemadi MH, et al.

BMC Med Educ, 2024 Apr 15;24(1):412.
PMID: 38622577 DOI: 10.1186/s12909-024-05406-1

BACKGROUND: Nowadays, Artificial intelligence (AI) is one of the most popular topics that can be integrated into healthcare activities. Currently, AI is used in specialized fields such as radiology, pathology, and ophthalmology. Despite the advantages of AI, the fear of human labor being replaced by this technology makes some students reluctant to choose specific fields. This meta-analysis aims to investigate the knowledge and attitude of medical, dental, and nursing students and experts in this field about AI and its application.
METHOD: This study was designed based on PRISMA guidelines. PubMed, Scopus, and Google Scholar databases were searched with relevant keywords. After study selection according to inclusion criteria, data of knowledge and attitude were extracted for meta-analysis.
RESULT: Twenty-two studies included 8491 participants were included in this meta-analysis. The pooled analysis revealed a proportion of 0.44 (95%CI = [0.34, 0.54], P
Current and emerging applications of saccharide-modified chitosan: a critical review

Kazemi Shariat Panahi H, Dehhaghi M, Amiri H, Guillemin GJ, Gupta VK, Rajaei A, et al.

Biotechnol Adv, 2023 Sep;66:108172.
PMID: 37169103 DOI: 10.1016/j.biotechadv.2023.108172

Chitin, as the main component of the exoskeleton of Arthropoda, is a highly available natural polymer that can be processed into various value-added products. Its most important derivative, i.e., chitosan, comprising β-1,4-linked 2-amino-2-deoxy-β-d-glucose (deacetylated d-glucosamine) and N-acetyl-d-glucosamine units, can be prepared via alkaline deacetylation process. Chitosan has been used as a biodegradable, biocompatible, non-antigenic, and nontoxic polymer in some in-vitro applications, but the recently found potentials of chitosan for in-vivo applications based on its biological activities, especially antimicrobial, antioxidant, and anticancer activities, have upgraded the chitosan roles in biomaterials. Chitosan approval, generally recognized as a safe compound by the United States Food and Drug Administration, has attracted much attention toward its possible applications in diverse fields, especially biomedicine and agriculture. Despite some favorable characteristics, the chitosan's structure should be customized for advanced applications, especially due to its drawbacks, such as low drug-load capacity, low solubility, high viscosity, lack of elastic properties, and pH sensitivity. In this context, derivatization with relatively inexpensive and highly available mono- and di-saccharides to soluble branched chitosan has been considered a "game changer". This review critically scrutinizes the emerging technologies based on the synthesis and application of lactose- and galactose-modified chitosan as two important chitosan derivatives. Some characteristics of chitosan derivatives and biological activities have been detailed first to understand the value of these natural polymers. Second, the saccharide modification of chitosan has been discussed briefly. Finally, the applications of lactose- and galactose-modified chitosan have been scrutinized and compared to native chitosan to provide an insight into the current state-of-the research for stimulating new ideas with the potential of filling research gaps.