To identify and explain the challenges of effective pain management in patients with cancer in Iran.

A convergent mixed-methods study.

Oncology departments and palliative care units across multiple healthcare institutions in Iran.

Quantitative phase: 320 healthcare providers, including anaesthesiologists, general practitioners, oncologists, nurses and pharmacists, selected via convenience sampling. Qualitative phase: 10 stakeholders, including patients, caregivers, policy makers and clinicians.

Quantitative data were collected using a psychometrically validated 23-item questionnaire assessing knowledge, attitudes and perceived barriers to cancer pain management. Qualitative data were obtained through semistructured interviews and analysed using Graneheim and Lundman’s content analysis method with MaxQDA software. Integration was performed using a side-by-side approach.

Quantitative data showed that over 65% of providers did not routinely assess pain, and only 29.1% believed pharmacological treatments were effective. Qualitative analysis identified 13 barriers across three domains—professional, patient and organisational—spanning physical, psychological, social and spiritual dimensions. Integrated findings revealed consistent patterns of underassessment, legal and cultural resistance and lack of interdisciplinary collaboration. These converging challenges highlight the need for holistic, system-level reform.

The convergence of quantitative and qualitative data reveals a multilayered system of barriers, professional, patient-related and organisational—rooted in physical, psychological, social and spiritual dimensions. These interlinked challenges contribute to fragmented pain management and limited interdisciplinary coordination. Addressing them requires a holistic reform strategy that integrates structural, cultural and clinical solutions.

To develop and psychometrically evaluate a multidimensional Disaster Health Literacy Questionnaire (DHLQ) for diabetic patients in Iran, using advanced item response theory approaches. The questionnaire was designed in the Persian (Farsi) language.

A sequential mixed-methods study incorporating qualitative (scoping review and interviews) and quantitative (psychometric validation) phases.

Diabetes clinics and healthcare centres across Iran (2022–2023).

The study enrolled 570 patients with diabetes (56% female, mean age 45.57±16.33 years) for quantitative validation; 15 experts and 15 patients for qualitative validation.

The psychometric properties evaluated included content validity (using content validity ratio (CVR) and content validity index (CVI)), construct validity (assessed via multidimensional item response theory (MIRT)), and reliability (measured by Cronbach’s alpha and test-retest Kappa). Additionally, item parameters (multidimensional difficulty (MDIFF) and multidimensional discrimination (MDISC)) and model fit indices (RMSEA, CFI and TLI) were examined.

The final 30-item DHLQ demonstrated excellent content validity (scale-level CVI=1; item-level CVI>0.79; CVR>0.49). Cronbach’s alpha for the total scale was 0.606; test-retest reliability showed significant agreement (Kappa=0.35–1, p

The DHLQ is a rigorously validated tool for assessing disaster health literacy in diabetic populations. Its multidimensional structure and strong psychometric properties support its use in clinical and emergency planning contexts to identify literacy gaps and tailor interventions.

This study aims to determine the incidence and impact of ocular injuries among the different combat sports disciplines of boxing, mixed martial arts (MMA), kickboxing and Muay Thai in Texas, USA.

A case–control study was conducted to analyse retrospective postmatch physical reports from combat sports matches that took place in the state of Texas from January 2019 to January 2022. Ocular injuries and other match characteristics such as sport type and match outcome were identified by postmatch physical reports. Postmatch physical reports were collected from the Texas Department of Licensing and Regulation database. Statistical analysis was used to stratify injuries and compare the impact of injuries on match outcome.

Combat sports fighters in Texas, USA.

3070 participants were included in the study. Participants were fighters who participated in combat sports matches in Texas, USA, between January 2019 and January 2022.

The original plan was to measure the incidence of ocular injuries across different combat sports including boxing, MMA, kickboxing and Muay Thai. However, due to a limited sample size of kickboxing and Muay Thai matches, the ocular injury incidence was only measured for boxing and MMA. The association between ocular injury and match outcome was assessed using ² statistical analysis.

The respective incidence rates of ocular injuries in boxing and MMA were 9.7 and 12.2 injuries per 100 matches. The association between ocular injury and match outcome (win, lose or draw) was statistically significant in boxing but not statistically significant in MMA matches.

Our findings revealed that ocular injuries are significantly associated to losing a boxing match (p=0.011), but not associated to match outcome in MMA (p=0.232). Additionally, MMA matches report a larger variety of ocular injuries compared with boxing matches.