Iranian Journal of Public Health
Year:2023 | Volume:52 | Issue:6|Papers Count:25

Background: We systematically reviewed (evaluated methodological quality) meta analysis studies on the sui-cidal ideation of South Koreans using a measurement tool to assess systematic reviews version 2 (AMSTAR 2) to present the ways for improving the quality of follow up meta analysis studies and suggest the direction of future studies. Methods: We analyzed 11 meta analysis studies based on AMSTAR 2 criteria by collecting documents related to suicidal thoughts using seven electronic databases (DBPia, Scholar, KISS, KCI, RISS, KoreaEmbase, and National Assembly Electronic Library) from Jan 1, 2000 to Dec 3, 2022. Results: Amon g the 142 papers searched, we analyzed the final 11 selected studies. Not all analyzed meta analysis studies conducted quality assessment and these studies omitted the list of excluded references and the adequacy of the literature search. Moreover, 54. 5% o f the analyzed studies (six out of eleven studies) did not present the effect of publication bias. Consequently, SOMETHING was critically low due to omissions in criti-cal domains. Conclusion: In all 11 studies analyzed, 2 or more of 7 critical domains were omitted, and the quality level was confirmed to be critically low. Therefore, future meta analysis studies on suicidal ideation will have to include quality assessment and improve the quality of meta analysis, such as te sting bias effects.

Background: This study reviewed cervical cancer policies implemented in developing countries that adhered to WHO standards. Despite long being known as a preventable disease, cervical cancer is still one of the leading causes of mortality among women. Nine out of ten cervical cancer deaths occurred in less-developed countries, suggesting that the preventive and control approaches in these countries might differ from those in developed nations. Methods: Cervical cancer policies in six developing countries from each WHO region were selected while related data from the Cervical Cancer Country Profiles 2021 by WHO were retrieved for comparison. Results: The cervical cancer policies that were included in this review were from Malaysia, Thailand, Iran, Kenya, Argentina, and Ukraine. According to the latest guidelines on the management of cervical cancers, WHO recom-mendations have been elaborated on primary, secondary, and tertiary prevention. A comparison of policies among these selected countries showed variation in each level of prevention. The cancer burden in each country was also found to determine the progression of cervical cancer prevention and policy controls in these countries. Conclusion: This review emphasizes the dissimilarities of cervical cancer policies in six developing countries compared to recommendations by the WHO. Identifying these discrepancies could help policymakers in devel-oping nations to recognize the pressing issues surrounding cervical cancer prevention and establish more effec-tive prevention and control approaches.

Background: Didactic lecture is most commonly used method to teach medical students in Family and Com-munity Medicine. However, considering its demerits and the need to integrate theoretical knowledge into prac-tice, the objective of this paper is to review the contribution of role play in medical education and to propose it’, s applications to deliver healthcare services in community more effectively. Methods: Research studies on role play were searched in PubMed, Google scholar, Google using terms role play, medical education, community medicine, family medicine, health promotion, awareness during the period between January 2000 up to December 2021 to evaluate the potential and contribution of role play in medical education and health promotion. Results: Review of role play and related researches were included to analyze the outcome. The outcomes of different studies analyzed were showing several teaching methodologies used in medical field. Several studies have tested role play in other medical specialities and have found it to be a powerful educational tool. Howev-er, not many studies have tested its effectiveness to educate students in Family and Community Medicine alt-hough it could have immense practical applications like demonstrating and creating awareness in the communi-ty about the importance of cancer screening, breast feeding, immunisation, food fortification, genetic screen-ing, premarital counselling, ante natal checkups, danger signs in pregnancy. Conclusion: Role play simulates real scenarios enabling students to apply their skills and knowledge into prac-tice in real time. It can integrate theory concepts into practice. Hence, it must be introduced in medical curricu-lum to achieve the objectives of teaching and learning more effectively.

Background: Physical and chemical factors of workplace, either alone or in combination, contribute to oxidative stress that is harmful to the body. The combined impact of physical and chemical components of the work environment on oxidative stress was examined in this research. Methods: Research articles published from 2000 to 2021 on this topic in reliable national and international databases were collected and analyzed. Based on the preliminary screening, 120 articles were selected for the first stage. The relevance and quality of 85 suitable papers were found appropriate and evaluated by examining the purpose of the study in the next phase. Results: The data collected and presented from the articles cover simultaneous exposure to physical risk factors such as noise, radiation, and chemicals such as metal solvents, as well as different types of oxidative stress parameters like MDA, GHS, LOP, 8-OHdG, SOD, CAT, ROS, and other parameters such as research site, coexposure effects, and target organ. Investigating the combined effect of physical and chemical variables on oxidative stress in the target organs, as well as the interaction of multiple effects on each other, was one of the key goals of the articles (synergistic, reinforcing, additive or antagonistic). Conclusion: Most of the findings of theses researches generally highlight the synergistic impact of concurrent exposure to chemical and physical risk factors on oxidative stress.

Background: Since most of nursing students lack clinical reasoning competency, for effective handover educa-tion, it is necessary to include a strategy to improve the clinical reasoning competency in the practical training course of the nursing department. Methods: This study used a quasi-experimental research design using a non-equivalent control group pretest-posttest design to verify the effectiveness of the practice education program using the OPT model and SBAR. The subjects were 73 third-year students participating in clinical practice or clinical alternative practice in Korea. Results: The experimental group showed significantly better communication clarity (t=-12. 262, P<. 001), com-munication confidence (t=-12. 486, P<. 001), problem-solving processes (t=-13. 100, P<. 001), and team efficacy (t=-6. 197, P<. 001) compared to before the intervention. However, there was no significant difference between the pre-and post-intervention scores of the control group. Conclusion: In a situation where clinical practice is difficult for nursing students, the handover education pro-gram using the OPT model and SBAR can helps improve their communication clarity, communication confi-dence, problem-solving process, and team efficacy.

Background: As the most convenient and commonly used for clinical diagnosis, cancer biomarker has been widely used in the auxiliary diagnosis of tumors, the observation of curative effect, the judgment of prognosis, and the monitoring of the disease. Methods: Pan-cancer analysis was used to validate the value of Dehydrogenase/Reductase 2 (DHRS2) as a tumor prognostic marker in various tumors. The relationship of DHRS2 to TMB and MSI was used to explain the effect of DHRS2 on genomic instability. Online cbioportal was used to analyze DHRS2 mutations in tu-mors. Finally, 33 clinical tumor samples were collected in 2021 who were enrolled into the Affiliated Lianyun-gang Oriental Hospital of Xuzhou Medical University, to verify the expression and diagnostic prognostic value of DHRS2. Results: The expression of DHRS2 was up-regulated in a variety of tumors and had adverse effects on the overall survival, disease-free interval, and progression-free interval of tumor patients. DHRS2 was associated with tumor genome instability, confirming that DHRS2 was correlated with tumorigenesis. In addition, DHRS2 had different mutation sites in various tumors. DHRS2 was up-regulated and was a poor prognosis biomarker in clinical tumor samples. Conclusion: DHRS2 was aberrantly expressed in tumors and has diagnostic prognostic value.

Background: Women undergo an array of menstrual symptoms, depending on the menstrual cycle period. This study aimed to gain a more objective understanding of the impact of menstruation by examining differences in menstrual symptoms, menstrual attitude, physical stress, and psychological stress across the menstrual cycle. Methods: This study was conducted from Apr to Jun 2021 in the Gyeonggi Province of Korea. Women aged ≥, 20 yr were divided into premenstrual (n=17), menstrual (n=8), and postmenstrual periods (n=23). Menstrual symptoms and menstrual attitudes were assessed using questionnaires. Quantitative electroencephalography was used to assess the physical stress indices (left and right), and the psychological stress indices (left and right), with brainwave parameters quantified by frequency series power spectrum analysis. Data were compared using the non-parametric tests. Results: More menstrual symptoms were experienced in the menstrual period than in the premenstrual period (Z=2. 16, P=. 031). Menstrual attitudes did not significantly differ among menstrual periods (Z=1. 20, P=. 231). Physical stress indices were high (≥, 10 μ, V) throughout the menstrual cycle and there were significant differences among the three periods (left: χ, 2=4. 00, P=. 035, right: χ, 2=5. 78, P=. 046). Psychological stress indices were >1 μ, V during the premenstrual and menstrual periods. Conclusion: Women experience more severe and diverse menstrual symptoms in the menstrual period than in other periods. Objective investigations are needed to inform an effective approach for addressing negative men-struation-related experiences.

Background: Esophageal squamous cell carcinoma (ESCC), a widely known esophageal disease, severely af-fects people's health. Numerous investigations demonstrated that long non-coding RNAs (lncRNAs) per-formed key jobs inside a wide scope of organic cycles and stand out in malignant growth. Our study planned to investigate the roles and mechanisms of linc01614 in ESCC. Methods: A Total of 60 ESCC tissue samples including 30 patients with cisplatin sensitivity and 30 patients with cisplatin resistance, who received DDP-based treatment, were obtained from Zhuhai People's Hospital, Zhuhai City during 2021. These tissues were frozen and saved in a-80 ℃,ultra-low temperature freezer. We performed CCK-8, clone formation, flow cytometry assays to determine the effect of linc01614 on ESCC pro-gression, and explored the specific mechanism of linc01614 in ESCC cell proliferation, apoptosis, and chemo-therapy resistance. Results: linc01614 expression was upregulated in ESCC tissues and cells compared with non-tumor tissues and human normal esophageal epithelial cells (Het-1A). Knockdown of linc01614 repressed cell expansion, chemo-therapy opposition, and advanced cell apoptosis in ESCC. Besides, linc01614 regulated the expression of miR-4775 as a competitive endogenous RNA (ceRNA). Conclusion: The linc01614/miR-4775 axis played an important role in ESCC progression and drug resistance, revealing that linc01614 is a promising target in ESCC treatment.

Background: Elevated blood pressure (BP) is one of the leading causes for developing major cardiovascular events and still represents a major public health challenge worldwide. We aimed to provide data on predictors of poor adherence to medication in hypertensive patients in Serbia. Methods: Observational, analytical study was undertaken at a group of 388 patients who refilled their medications in the Pharmacy Institution, “, Apoteka Kragujevac”, , Kragujevac, Serbia between Jan and Mar 2019. Afterward, we conducted a case-control study to evaluate the influence of the variables associated with the adherence. We used a self-developed questionnaire and SF-36 to assess the influence of the quality of life on medication adher-ence. Results: Results revealed four independent predictors of non-adherence: increased number of medications, living in a city, forgetfulness of the dosing regimen and low energy. The odds of non-adherence were the highest among the participants living in the city and the low energy was the only factor inversely associated with the level of non-adherence. Conclusion: Many factors were associated with the non-adherence to medication. Further studies are needed to find the most appropriate protocol to promote adherence. The four risk factors (increased number of medica-tions, living in a city, forgetfulness of the dosing regimen and low energy) are associated with non-adherence in adult hypertensive patients.

Background: We aimed to establish the cut-off value of weight-for-height for preschool children in China, and to explore the influence of overweight and obesity on the physical performance of preschool children. Methods: Data from 31 provinces in China monitored in 2010 and 2014, the standard deviation unit curves of WFH were established by using GAMLSS (generalized additive model for location, scale, and shape) method preschool children in China, and then the cut-off values of normal weight, overweight and obesity were divided. The research group tested 5 physical performance indicators of 5154 preschool children from April 2018 to June 2019 in Beijing and Zhejiang in China. We then compared physical performance differences between the normal-weight group and the overweight-obesity group. Results: A smooth and effective standard deviation unit curve of WFH was established. The overweight and obesity of Chinese preschool children were at a high level. Being overweight and obese reduced preschool chil-dren's relative strength, speed, sensitivity, coordination, and balance ability, but did not reduce preschool chil-dren's flexibility. In general, the physical performance of preschool children in the normal weight group was better than that in the overweight and obesity group. Conclusion: It is suggested to use the WFH criteria in this study to evaluate overweight and obesity in Chinese preschool children, and strengthen physical activity and take in energy substances properly of preschool chil-dren, to control the spread of overweight and obesity，,to improve physical performance level.

Background: Breast cancer is the most common malignancy among women worldwide. We aimed to know the past trends of age-specific breast cancer incidence rates in Faisalabad city. Methods: A retrospective study was designed at Allied Hospital Faisalabad (AHF), Pakistan from 2014-2018. Overall, 12742 cancer patients presented throughout these years, out of which 3390 were breast cancer cases. Descriptive statistics were computed and the results were presented as counts and percentage for categorical variables. Means and standard errors were computed for the continuous variables. For testing the association among categorical variables, a chi-square test of independence was used and the p-values less than 0. 05 are re-ported as significant. Results: 84. 70% patients were diagnosed with invasive breast carcinoma and 15. 30% were all other types re-ported in the Allied Hospital Faisalabad. The incidence of breast cancer was outrageous in the 40-49 year-old age group (1021 patients, 30. 12%) and the mean age is 45 in all years. An increase of 34. 86% was observed from 2014 to 2018. The comprehensive four-year data (2015 to 2018) were further analyzed for histology, sur-gery, staging and grading pattern as 2014 files data was insufficient to discuss. The stage III and grade III were most common throughout the years from 2015 to 2018 with 33. 9% and 55. 71% respectively. Conclusion: Breast cancer is diagnosed more commonly in women than in any other type of cancers in Faisal-abad city. There is a need to upgrade the existing hospital facilities to make the women diagnose the cancer at an earlier stage.

Background: We aimed to assess the effect of life-cycle management on the satisfaction and health outcomes of children with chronic diseases and their parents, as well as the career benefits of healthcare workers. Methods: Participants were children with chronic diseases who received long-term treatment at the Three Gorges Hospital Affiliated to Chongqing University from January 2021 to November 2022. From the first ad-mission, compare the children's disease onset, satisfaction and professional benefits of medical staff among "Medical and Nursing Integration" + "Internet plus"-based life cycle management group (n = 221, the experi-mental group), the routine management group (n = 53, the control group 1) and the "Medical and Nursing Integration" group (n = 67, control group 2). Results: The overall satisfaction of children in the experimental group (100 %) was higher than that in the control group 1 (98. 11%) and control group 2 (98. 51%). The times of second admission and third admission of patients in the experimental group were significantly lower than those in control group 1 were (both P<0. 001) and control group 2 (both P<0. 01). Nurses' sense of professional benefit, professional identity, and doctor's satisfaction with nurses in the experimental group were significantly higher than those in control group 1 (P<0. 05, P<0. 01, P<0. 001) and control group 2 (all P<0. 05). Conclusion: The application of "Medical and Nursing Integration" + "Internet plus"-based life cycle manage-ment in chronic disease nursing management can effectively improve the management on pediatric chronic diseases.

Background: Domestic violence is defined as the combined pattern of physical, psychological, economic and/or sexual violence against a family member. Intimate partner violence is the most common form. We aimed to present the basic characteristics of the Montenegrin families and family members affected by domes-tic violence, with the intent to inform the global mosaic of differences related to cultural specificities. Methods: A cross-sectional study was performed using 323 cases judicially processed and officially judged ac-cording to Criminal Act from 2015-2017 in Montenegro. Socioeconomic characteristic were investigated fol-lowed by analysis of many variables. Results: Demographic characteristics, socio-economic status, and other characteristics of the perpetrators and the victims, as well as characteristics of violent act with posible risk factors, are presented. The results of case-control analyisis of intimate-partner relationships are given, too. Conclusion: A typical example of domestic violence in Montenegro shows an intimate couple with a violent male and a victimized female partner, living in a rented residence in the suburbs, with both partners in the fourth decade of their lives. The most frequent income level was poor, with half of the batterers and nearly three quarters of the victims unsatisfied with their marriage. The increased presence of such factors (both modifiable and unmodifiable) in the partiarchical families suffering from domestic violence should spark interest in public health and government authorities regarding domestic violence screening adapted for patriarchical societies.

Background: Bladder cancer (BCa) is one of the most common urinary tract malignancies. Our study aimed to provide promising biomarkers for BCa screening and prognosis. Methods: BCa samples were obtained from Gene Expression Omnibus (GEO) datasets. Differentially ex-pressed genes (DEGs) were analysed by GO/KEGG analysis. Univariate Cox hazard analysis and Kaplan Mei-er Curve clarified the relevance of DEGs and survival. Receiver operating characteristic (ROC) curve showed the discrimination ability of DEGs in BCa patient outcome prediction. RT-PCR was used to validate gene ex-pression. Results: Overall, 61 common up regulated and 170 common down-regulated genes in BCa were obtained. DEGs were mainly enriched in proliferation and metastasis processes. CDC20, COL14A1, SPARCL1, TMOD1, RHOJ, FXYD6 and MFAP4 had clinical relevance to survival with high accuracy. CDC20, SPARCL1 and TMOD1 are promising biomarkers of BCa. CDC20, SPARCL1 and TMOD1 are involved in cancer im-mune infiltration. Conclusion: CDC20, SPARCL1 and TMOD1 are promising biomarkers of bladder cancer. In addition, CDC20, SPARCL1 and TMOD1 are involved in cancer immune infiltration, which provides new targets in im-mune therapy in bladder cancer.

Background: We aimed to determine the level of hope in breast cancer patients along with the influence of sociodemographic characteristics on the expressed level of hope. Methods: A descriptive cross-sectional study was conducted on the sample size of 72 female patients with breast cancer diagnosis. The study was conducted at the University Clinical Center of Kragujevac, Serbia from November 2020 until March 2022. Data were collected from the patients in a form of the Sociodemographic Variables Questionnaire (Q-SV). The Herth Hope Index (HHI) was used in assessing the level of hope. Results: The value of the total HHI score was ranging from 14 to 48, whereas the mean value of the HHI score was 40. 00±, 5. 92. The significantly higher level of hope was reported in female patients who: searched the Inter-net for gathering information on their disease (39. 24±, 6. 23,P=0. 047), were religious (38. 77±, 6. 13,P=0. 003), be-lieved in God (38. 45±, 5. 51,P=0. 004), had no formal medical education (38. 44±, 5. 75,P=0. 036) and after therapy (38. 76±, 6. 49,P=0. 022). Conclusion: Hope is an existential internal resource possibly affecting the manner in which female patients perceive their own health state and future as well. A better understanding of the meaning of hope during treat-ment can be of great value in supporting cancer patients.

Background: Message framing is a low-cost and effective intervention method to improve diabetics’,health behaviors. The study aimed to investigate the impacts of positive and negative message framing interventions on the self-management activities and self-efficacy of patients with type 2 diabetes mellitus (T2DM). Method: Overall, 102 T2DM patients from Jinhua People’, s Hospital of China were recruited and divided into three groups: positive and negative message framing intervention groups and a control group. A 12-week ex-periment was implemented on the first two groups. Then, the differences of the patients’,self-management activities and self-efficacies were analyzed between the experimental and control groups. Finally, the mediat-ing effect of self-efficacy between two types of message framing interventions and patients’,self-management activities was investigated. Results: Both positive and negative message framing interventions could significantly improve the T2DM patients’,self-management activities in diet, blood glucose testing, foot care, and medication taking (P<0. 05), meanwhile significantly improving their self-efficacies along the nutrition, physical exercise and weight, medi-cal treatment, blood sugar, and feet check (P<0. 05). Results of the difference analysis for both within-group and inter-group showed that, compared with the positive messaging framing intervention, the negative one had more significant effects on enhancing the patients’,self-management activities and self-efficacy. Self-efficacy had only a mediating effect between negative messaging framing intervention and self-management activities (β,= 0. 94, 95% CI: 0. 0934 –,0. 456). Conclusion: Negative messaging framing intervention could better enrich T2DM patients’,diabetes knowledge through offering threatening information, thereby enhancing their self-efficacies, and ultimately improve their self-management activities.

Background: We aimed to investigate the latent smoking classes in men and their association with health-related quality of life (HRQoL) of themselves, their wives and offspring. Methods: Using Tehran Lipid and Glucose Study (TLGS), 1781 men with marital stability and 8-18-year-old offspring were followed for 15 years (1999-2014). Latent class growth modeling (LCGM) was used to identify men's smoking patterns in 1139 men with at least three non-missing measurements of cigarettes per day (CPD),they had 1908 children (8-18 years at baseline). HRQoL and its physical and mental component summaries (PCS and MCS) was measured at the last follow-up using the SF-12v2 questionnaire. The associations of men's smoking classes with HRQoL of the family members were examined using generalized linear model. Results: LCGM revealed four trajectories for men's smoking patterns,non/rare smokers, decreasing light, persistent moderate smokers, and persistent heavy smokers. Persistent smoking men, regardless of the amount of smoking (light or heavy), had lower scores in general health (ß, =-7. 80 for moderate and ß, =-10. 71 for heavy class) but not overall PCS. Al three trajectories of smoker men had poorer overall MCS than non/rare smokers. Living with persistent heavy smoker men was associated with decreased overall MCS in women (ß, =-4. 20), in particular role emotional (ß, =-8. 82) and mental health (ß, =-9. 42). No significant association was detected be-tween fathers' smoking patterns and offspring HRQoL in young adulthood. Conclusion: Our results show men's heavy and persistent smoking worsens their own and their spouses' HRQoL, mainly in mental health dimensions.

Background: One approach to reducing the burden of diseases can be to identify socioeconomically vulnera-ble groups. We aimed to estimate the socioeconomic inequality of in-hospital deaths using relative and absolute indices of socioeconomic inequality. Methods: In this retrospective cohort study on Covid-19 patients,age, gender, marital status, education level, date of admission, diagnostic method, and final condition were measured. Socioeconomic inequality in in-hospital death was assessed using three approaches. We used the relative index of inequality (RII) to measure relative inequality. We used two approaches to evaluate absolute inequality: the slope index of inequality (SII) and the concentration index (ci). Results: Overall, 587 patients’,data were collected and 42 (7. 2%) of these patients died in the hospital. There were statistically significant differences between the case-fatality rates of different levels of education (P<0. 001). In addition, all the inequality indices showed that the distribution of COVID-19-related deaths was higher among the lower education levels. Accordingly, after controlling the effect of age, gender, and comor-bidities the RII indicated that the case fatality rate in the lowest education level was 9. 42 (95% CI: 2. 23 to 39. 01, P<0. 001) times compared to the case fatality rate in the highest level of education. Conclusion: The results of all three approaches indicate considerable education inequality in CFR in favor of groups of high education levels. These results can improve the prioritization and impact of public health inter-ventions, including prevention and diagnosis of Covid-19 in favor of vulnerable groups.

Background: We aimed to investigate the relationship between air pollution and the Infant mortality rate (IMR) during nearly ten years in Tehran, Iran. Methods: This study is a retrospective cohort case using time series analysis. Air pollution monitoring data during the study period (2009-2018) were collected from the information of 23 Air Quality Control Centers in different areas of Tehran. For this purpose, the daily measures of PM10, PM2. 5, O3, CO, SO2, NO2 were ob-tained. Data on infant mortality was obtained from the National Statistics Office of Iran and mortality regis-tered in Tehran's main cemetery during the study period. Distributed lag linear and non-linear models were used. Results: A total of 23, 206 infant deaths were reported during the study period. Following an increase of 10 ug/m3 in PM10 in an early day of exposure, the risk of mortality increased significantly (RR=1. 003, 95%CI: 1. 001-1. 005). There is a pick on lag 5-10 that shows a very strong and immediate effect of cold tempera-ture which means that cold temperatures increase the risk of mortality at an early time. At cold temperate, (var=0 and lag 0) risk of infant mortality was significantly higher than reference temperature (19˚, C) (RR=1. 1295, %CI: 1. 01-1. 25). Conclusion: The results show the adverse effects of PM10 exposure on infant mortality in Tehran, Iran. Ac-cordingly, a steady decline in PM10 levels in Tehran may have greater benefits in reducing the Infant mortality rate.

Background: Adolescence obesity and its health consequent on adulthood is affected by various environmen-tal factors. Recently, dishware size or color is considered as a probable critical point to manage intake and weight. We investigated visual perception effects of plate size and color on fullness sensation regarding the Body Mass Index (BMI) for age percentiles in Tehran, Iran in 2019. Methods: A cross sectional study conducted on 408 students aged 13-18 year from both sexes with different socioeconomic status through convenience sampling method. Anthropometric characteristics were measured to determine BMI for Age categories based on the WHO protocol. Visual analog scale (VAS) was used to as-sess participants’,perceived satiety when faced to images of different plate’, s size and color with the same food volume. SPSS 21 was used to statistical analyze. Results: 41. 2% of student were on >85th percentile of BMI for age. Mean of score of VAS for medium red plate was significantly lower than medium and large white plates in both sexes (P<0. 001), while mean of score of VAS for small white plate was significantly lower than large white plates only in girls (P<0. 001). The adoles-cents who were on >85th percentile of BMI for age, gave higher score to large white plate than medium white plate and to medium white plate than medium red plate, significantly (P<0. 001), while the scores given by the adolescent on 5th percentile of BMI, were not significant. Conclusion: Considering dramatic trend of obesity in adolescents in Iran, there is an urgent need to make supportive policies. Manipulating food containers seems to be an effective and simple approach to control feeling satiety. It may be a cost-effective approach to prevent obesity in adolescents before progressing to adulthood.

According to the WHO, health education is con-sidered as an essential tool for enabling people to change their health behaviors (1). Much has been written about the relationship between health education and health behaviors (2-4). However, systematic studies on the relationship between school-based health education and health behav-iors were lacking. In this study, therefore, we aimed to evaluate the effects of various school health education programs on health behaviors using the survey data from the 15th KYRBS (Ko-rea Youth Risk Behavior Survey in 2019), which is an anonymous self-reported online survey of secondary school students in order to collect the statistics of the health behaviors of adolescents in Korea (5). We examined 4 school health education pro-grams (nutritional education, oral health educa-tion, personal hygiene education, and sex educa-tion) and 17 health behaviors (8 for nutritional education, 3 for oral health education, 5 for per-sonal hygiene education, and 1 for sex educa-tion). We used Stata for all statistical analyses. A series of multivariable logistic regression analyses were conducted to examine the associations be-tween school health education programs and health behaviors after controlling for covariates such as sex, age, BMI, academic performance, and family’, s economic status. Table 1 shows the results of logistic regression analyses, giving adjusted odds ratios (AORs) for 17 health behaviors according to whether or not students participated in school health education programs. If students took nutritional education, they were more likely to have breakfast (AOR=1. 06),to eat fruit (AOR=1. 20),to eat vegetable (AOR=1. 31),to drink milk (AOR=1. 20),and to drink sweet beverages (AOR=1. 12). If students took oral health educa-tion, they were more likely to brush teeth (AOR=1. 14),to brush teeth before sleeping (AOR=1. 09),and to brush teeth after lunch at school (AOR=1. 08). If students took personal hygiene education, they were more likely to wash their hands before eating at school (AOR=1. 28),to wash their hands after returning from re-stroom at school (AOR=1. 29),to wash their hands before eating at home (AOR=1. 25),to wash their hands after returning from restroom at home (AOR=1. 31),and to wash their hands after going out and returning home (AOR=1. 21). Last-ly, if students took sex education, they were more likely to practice contraception (AOR=1. 46). . .

Pharmacists are critical healthcare team members with a key role in implementing innovative strat-egies which help to decrease the burden of dis-eases in a community (1). Being an important source of information and education for patients, the WHO introduced the seven-star role of Pharmacists,manager, decision-maker, teacher, lifelong learner, leader, communicator, and pharmaceutical caregiver. In addition, Interna-tional Pharmaceutical Federation (IPF) added the role of researcher and a Pharmapreneur to Phar-macists’,roles. Pharmacists played an important role in the COVID-19 pandemic which is wit-nessed in the shape of a continued care for COVID patients in community based pharma-cies, hospitals, and retail pharmacies (2). It is not to overemphasize however, it is a fact that a delicate healthcare team is unable to pro-vide successful therapy and accomplish an effec-tive Pharmaceutical Care Model (PCM). These in-competencies in the delicate healthcare team may be due to,overuse of antibiotics (3), pre-scribers’,lack of knowledge, under-developed clinical, e-pharmacy, and hospital pharmacies (4) as well as lower number of pharmacists (5). A recent example of pharmacist-led healthcare systems and necessary reforms for better health outcomes was reported by the Sri Lankan phar-macist community (6). According to the recom-mended density of Pharmacists/10, 000 popula-tion, >65% of the WHO member states have been reported with <5 Pharmacists (Fig. 1) (5). With regard to Pakistan, a study about the break-down of 8, 102 Pharmacists reported the in-volvement of 2, 836 Pharmacists in government and 5, 023 in private sectors. A major proportion of the Pharmacists 55% become amalgamated in Pharmaceutical industries, 25% in marketing and community pharmacies, 15% in drug con-trol/legal issues departments and hospitals, and the remaining 5% are engaged in teaching and research (7, 8). It is irrational to expect physicians and other mul-tidisciplinary health team members to serve as medication experts and accomplish their regular patient-care duties. Without a Pharmacist, known as a drug custodian, the healthcare system may face increased inefficiencies, unnecessary delays in treatment, decreased medications adherence, and loss of the goal of achieving successful ther-apeutic outcomes. . .

The sudden outbreak and global spread of Coro-navirus disease-19 (COVID-19) is one of the most serious public health problems of today, raising in-terest in immunity research worldwide. Regarding factors that affect the human immune system, life-style features including mental stress, nutritional status, sleep, and exercise (physical activity), as well as diseases such as high blood pressure, dia-betes, and obesity have been suggested (1). Among these, exercise has been reported as a modulator capable of inducing both negative and positive ef-fects on the immune system (2). Specifically, posi-tive effects of exercise on the immune system in-clude cell-mediated immune responses that induce the activation of leukocytes, lymphocytes, and macrophages,and enhancement of the adaptive immune system, such as antibody-mediated im-mune responses that induce antibody production,these effects have been shown with regular exer-cise of moderate intensity (1, 2). On the other hand, prolonged acute exercise in-tensive at maximal intensity has been reported to inhibit the proliferative response of lymphocytes, having a negative effect on immune function through the induction of an excessive inflamma-tory response and reactive oxygen species (1-3). Leukocyte subtypes (neutrophil, lymphocyte), nat-ural killer (NK) cells, and immunoglobulins (IgA, IgG, and IgM) have been proposed as blood mark-ers that can verify changes in immune function due to exercise (3, 4). The changes in immune function were examined according to acute exer-cise intensity, reporting that the immunosuppres-sion period might appear longer after intense ex-ercise in contrast to moderate exercise (4). However, various factors such as age, nutritional status, and infection history as well as the intensity and duration of exercise bouts can act as factors that can affect the immune response following acute exercise (3). In particular, it is not clear what level of difference in exercise intensity results in a significant change in the immune response. The American College of Sports Medicine guidelines (5) classify 64-90% of maximal oxygen uptake (VO2max) as vigorous intensity in cardiorespira-tory exercise. . .

In recent years, an interest in an in-depth study of macro and microelemental metabolism in the human body has increased significantly both in normal and pathological conditions (1). The determination of essential chemical macro and microelements in dental hard tissues and hair plays an important role in monitoring human health and assessing the risks of developing dental diseases,Moreover, it gives us a complete picture of the met-abolic processes and the quality of the mineral com-position in the human body (2). Children and ado-lescents are most sensitive to diseases caused by an imbalance in mineral metabolism (3). The goal of the research was to determine the composition of the essential macro and microelements in hair and dental hard tissues and to study the possible effect of their imbalance on both the general and dental health of the child. In order to assess the state of dental hard tissues, 375 children from Batumi (Georgia) pre and public schools aged 3 to 12 years were randomly examined. They were divided into three age groups: 108 preschooles aged 3-6 (28. 8%), 153 students aged 7-9 (40. 8%) and 114 children aged 10-12 (30. 4%). The study was carried out in the period from June 2018 –,June 2019. Ethical approval was obtained from the Bioethics Committee at the National Centre for Dis-ease Control and Public Health, Tbilisi, Georgia (ap-proval number #2018-032). Monitoring of the examined children was carried out using standard indices provided by the WHO. Ac-cording to the dmft/DMFT score we differentiated three categories of the status of caries: mild caries (dmft/DMFT<6), moderate caries (dmft/DMFT: 6-9) and severe caries (dmft/DMFT>9). Overall, 48 children aged 3-12 were chosen from the examined 375 children. They were divided into two groups-control group (15 children) with mild caries only with dmft/DMFT<2, and case group (33 chil-dren) with severe caries with dmft/DMFT>9. Hair samples and extracted teeth were used to evaluate elemental composition. We used X-ray fluorescent spectroscopy to study the qualitative and quantitative composition of chemical elements in the hair and dental hard tissues (4). After preparing the hair under study, we determined instantaneous composition of essential macro-(Ca, K, S, Cl) and microelements (Zn, Fe, Cu, Se, Mn, Cr, Br, Co, Ag, V, Ni, Rb, Mo, Sr, Ti). . .

Dear Editor-in-Chief Todays, disease prevention, health education, and self-care are important topics in promoting health in patients, especially in chronic disease such as diabetes (1). Patients with diabetes are more likely to develop infectious diseases such as Covid-19 due to acquired immunodeficiency. Therefore, due to the prevalence of this virus, it is very important to pay attention to diabetic patients these days (2). Despite the importance of this disease, there are still shortcomings and challenges in providing appropriate educational strategies on how to take medication, exercise and diet, and control the effects of blood sugar (3). So in the field of health care education one of the easy and low-cost methods of communication is the use of Short Message Service (SMS), which will be very effective in controlling interventions, especially in educating patients for self-care and preventing the spread of disease, and the use of this system can intervene Follow-up such as reminding and monitoring patients (4). In recent years, mobile health has emerged as a sub-branch of e-health (5). The WHO defines mobile health as the use of mobile communications (mobile phones and personal digital assistants) in the provision of health services (6). Health includes items such as encouraging patients to follow treatment instructions, providing free emergency telephone help, emergency medical counseling, communication and staff training, preventing the spread of disease, accessing patients’,medical records, monitoring the possibility of automatic registration of vital signs and sending to the medical center and training via mobile phone and training (7). In general, with the use of Health Information Technology, information can be provided to people at an understandable level and in a simple, fast and explicit way (8). Recently COVID-19 pandemic effected in all around the world (9). The new challenges of the prevention, could be affected vulnerable population Such as: the lack of information about the efficiency and effectiveness of using different types of masks in different environments, lack of necessary research and sufficient information about the risk of infection and the amount of those required for infection, lack of proper attitude towards vaccine injection, uncertainty about re-infection after vaccination and insufficient studies on the effectiveness of different types of vaccines available in the market for different people with different vulnerabilities and new mutation (variants) of COVID. Some of the factors that caused this disease to become a long-term pandemic are behavioral factors such as non-observance of social distance according to cultural customs the inevitability of travel. In this pandemic time, through collective efforts, the improvement of awareness, attitude, and appropriate action towards preventive measures in the general population should be taken to end this pandemic as soon as possible. Notification must be done on asymptomatic carriers so that people are suspicious of everyone and take preventive measures. By providing prevention education through radio, television, press, and cyberspace, it is possible to have long-term awareness-raising programs for all age groups and occupations. The application of prevention requirements in recreational, educational, and occupational places and government economic support should not be forgotten. In addition, monitoring these cases over time can help optimally control the epidemic. Finally, due to the increasing prevalence of coronavirus and considering the need of diabetic patients for an accessible care system and the role of modern media as a leading tool in education and training, and acculturalization in the field of health, the need for a fast education system, such as texting, is felt. It is also recommended that appropriate planning and policy-making be done by the relevant authorities in this field, so providing appropriate training in prevention should be considered. Improvement and treatment of diabetes can be done by raising awareness, promoting general health, better physical function and mental health, and increasing the overall quality of life in diabetics.