نشریه دانشگاه علوم پزشکی بیرجند
سال بیست و نهم شماره 4 (پیاپی 93، زمستان 1401)

Environmental and social determinants play a key role in health safety, and this factor is significantly highlighted in a pandemic situation. In this review study, determinants of health were examined from social and environmental approaches n the conditions of the COVID-19 epidemic. The study followed the methodology of a regular unsystematic narrative review search from the scientific database. In this study, it was found that the most important environmental and social factors affecting health in epidemic conditions included access to clean air, access to clean water, proper management of healthcare waste, income, and education levels. It was notable that air pollution led to an increase in deaths caused by COVID-19, while research on cigarette smoking showed a reverse association with mortality rate. Additionally, access to clean water and proper management of hospital and medical centers waste would reduce the risk of the presence of the coronavirus in water sources and living environments. Moreover, a high level of education and training was stated as an essential factor in reducing mortality. People with high education levels had more compliance with health training. Moreover, high-income levels in people led to more access to health services and the supply of health-related necessities during the epidemic, which reduced the rate of death to a high extent.

The COVID-19 disease has become a global problem and its prevention through vaccination has led to a reduction in the damage and human casualties at the time of its occurrence. Recognition of the factors that affect the acceptance of vaccination, identification of the barriers, and facilitation of decision-making in the field of vaccination are important aspects of designing effective strategies to improve the coverage of vaccination among the people of Zahedan province, Iran. This study aimed to explain the experiences of reluctance towards vaccination against COVID-19.

This applied conventional qualitative research was conducted in 2022. The study population included all individuals who refused to receive the vaccine after a public call for vaccination against COVID-19 in Zahedan. The data collection method was the semi-structured interview, based on an interview guide. The sampling method was goal-based till data saturation.

In this study, 40 people who did not want to be vaccinated were interviewed. In the sub-coding stage of the analysis of interviews with participants, 15 concepts and finally 5 main categories (stereotyped beliefs, reception of inhibiting information, physical and taste limitations, lack of facilities and services, and shortness of decision-making bodies) were derived.

According to the results, low health literacy and underestimation of vaccination were the main reasons for reluctance towards vaccination against COVID-19. In order to address this shortcoming, major policies should be developed in the field of education. Attention to religious beliefs and aspects of fatalism, older age, and higher economic and social status can be specifically considered in the future plans of health policymakers regarding vaccination against COVID-19.

The opioid system plays a key role in opioid tolerance and dependence. On the other hand, they have shown that the opioid system plays a role in the analgesic effects of Ferula gummosa extract. Therefore, the aim of the present study is to investigate the effect of Ferula gummosa essential oil (FGEO) on morphine tolerance and dependence in mice.

In this experimental study, 60 albino mice were divided into 10 groups of 6 as follows: vehicle (10 ml/kg), diazepam (5 mg/kg), and FGEO (40, 20, and 10 mg/kg). To induce morphine tolerance or dependence, it was administrated 3 times for 3 contentious days. In the tolerance phase, drugs were injected intraperitoneally for 30 minutes before morphine administration. In the dependence phase, the drugs were used only on 4th day (test day). The withdrawal signs were recorded for 30-min. The data were analyzed with SPSS 20 software, ANOVA and Kruskal-Wallis statistical tests, and Tukey's and Ben Feroni's post hoc tests, respectively.

20 and 40 mg/kg doses of FGEO in the tolerance phase and only the high dose (40 mg/kg) of the essential oil decreased the number of jumps in the dependence phase. (Including diarrhea, writhing, rearing, climbing, wet dog shakes, grooming, and teeth chattering behaviors decreased by FGEO in both phases.

FGEO decreased morphine tolerance and dependence and possibly was useful for the treatment of opioid dependence after complimentary trials.

Sleep disorders increase many diseases and a decrease physiological function. This study aimed to compare the effect of the two methods of high-intensity interval training (HIIT) and sleep regulation program and a combination of the two on insulin resistance and sensitivity, body fat percentage, and reaction time in adolescents with sleep disorders.

This is a single-blind and quasi-experimental study was conducted based on an applied research method. In total, 80 female students with sleep disorders (13-17 years old) were selected by the available sampling method and randomly divided in four groups (n=20). All subjects participated in the pre-test and post-test sessions for measurements two days before and after the research process, respectively. The participants in the HIIT and combined groups followed the RAST (Running-Based Anaerobic Sprint Test) program for 4 weeks, three sessions a week, and the sleep regulation and combined groups followed the sleep schedule for 4 weeks, according to the necessary recommendations. Data were analyzed using SPSS software (version 26) and running paired t-test, and ANCOVA. Moreover, a P-value of ≤0.05 was considered significant.

The findings showed that 4 weeks of combined intervention of HIIT+sleep regulation could lead to a significant improvement in all research variables, including glucose, insulin, insulin resistance and sensitivity, pancreatic beta cell function, body fat percentage, and reaction time of girls (P=0.001). In addition, the HIIT group, compared to the sleep regulation and control groups, caused a significant improvement in glucose, insulin resistance and sensitivity, pancreatic beta cell function, body fat percentage, sleep quality, and reaction time (P=0.001), except for insulin (P=0.428).

According to the obtained results, HIIT combined with sleep regulation can be a valuable intervention in treatment programs to improve physiologic problems reduce the costs of treatment for adolescent girls with sleep disorders and their families.

Nowadays, osteoporosis is increasing, especially in postmenopausal women, due to hormonal changes, including some enzyme factors, such as alkaline phosphatase and blood calcium levels. Therefore, this research aimed to investigate the effect of eight weeks of water exercise with Elaeagnus angustifolia supplementation on alkaline phosphatase and calcium serum levels in overweight and obese postmenopausal women.

The current apply quasi-experimental study 42 postmenopausal women living in Qazvin province, Iran, with a mean age of (52.97±5.08) years, a mean weight of (73.95±8.09) kg, and a mean height of (156±5.76) cm, were selected. Then, they were randomly divided into four groups: control (n=10), exercise + placebo (n=10), supplement (n=10), and exercise + supplement (n=12). The exercise included eight weeks of water exercise at an intensity of 60-74% of the maximum heart rate twice a week, and the supplement group received daily oral supplementation of 15 g. Blood samples were collected to measure the serum level of alkaline phosphatase with an ELISA kit and calcium with spectrophotometry method in two stages before and 24 h after the last session exercise. To analyze the differences between groups and within groups, the ANOVA test and paired t-test were used, respectively. The significance level was considered at α=0.05.

 The results of the study showed a significant difference only in serum calcium levels among exercise+placebo (P=0.013), exercise+supplement (P<0.001), and supplement (P<0.001) groups. No significant difference was observed in the other parameres between different groups.

Consumption of supplementation of Elaeagnus angustifolia with water exercise could not affect alkaline phosphatase, and body composition in overweight and obese postmenopausal women.

Age-related aspects of addiction are one of the most important public health challenges in the world and also in Iran. Therefore, the present study aimed to compare the level of common cardiac factors in addicted and non-addicted older adults.

This case-control study was conducted on 230 older adults over 60 years in Birjnd, the capital of South Khorasan, Iran. A total of 115 older adults with at least one year of drug use history and 115 older adults without a history of addiction were included in the study. A questionnaire containing demographic and addiction information was completed for each subject. Body mass index (BMI), as well as systolic and diastolic blood pressure, was determined. Blood samples were taken from each individual after 12 hours of fasting to measure fasting blood sugar (FBS), and lipid profile (HDL, LDL, total cholesterol, and triglyceride).

There was no significant difference in FBS between addicted and non-addicted older adults (P> 0.05). In the lipid profile, there was only a significant decrease in triglyceride levels in the addicted group compared to their non-addicted counterparts (P=0.02). Mean blood pressure in the addicted group was significantly lower than that in the non-addicted group (P=0.01).

As evidenced by the results of this study, opium dependence does not seem to have a protective effect on blood sugar and lipid profiles. Therefore, education and promotion of community health literacy, especially among older adults, are necessary to improve traditional beliefs about opium use.

Nowadays, considering lifestyle changes and epidemiological transitions, non-communicable diseases such as hypertension and related risk factors have become one of the most important health priorities. Therefore, this study was conducted to investigate the prevalence of hypertension and its related risk factors in South Khorasan province in 2016 and 2021.

In this descriptive study which was a part of the national Stepwise approach to surveillance (STEPS) plan of the Ministry of Health and Medical Education, adults >18 years old living in South Khorasan province were selected by stratified multi-stage cluster sampling. Data were collected using the National Survey questionnaire on risk factors for non-communicable diseases (ecological information, behavioral, physical, and biological assessments) by the questioning team under the supervision of the authors of the Health Department of the Birjand University of Medical Sciences and were analyzed using descriptive and analytical statistics (Chi-square test) in SPSS software (version 16).

The prevalence of hypertension in 2016 was 25.4%, and in 2021 it increased to 36.4%. Although the percentage increased in patients' awareness, the percentage of coverage of effective treatment has decreased from 39.8% to 27.4%. The prevalence of behavioral risk factors has decreased over a 5-year period, and the prevalence of physical risk factors (except overweight) has increased. The percentage of using salt has decreased; however, it is still higher than the national average, and the proper consumption of fruits and vegetables is lower than the national average.

The prevalence of hypertension in South Khorasan province is increasing, resulting from a gradual increase in physical risk factors and a lack of a healthy diet. Therefore, considering the common risk factors, it seems necessary to adopt preventive policies and interventions and follow the required treatments.

Post-traumatic stress disorder (PTSD) is one of the psychological problems after the COVID-19 pandemic. Some people can cope with this trauma and return to their previous status or even achieve a higher level of performance, which is called post-traumatic growth. This study aimed to investigate the prevalence and the relationship between the PTSD and post-traumatic growth symptoms among patients discharged from COVID-19 intensive care units (ICU).

The present study was a descriptive study conducted on 172 patients discharged from COVID-19 ICU. Samples were selected with cluster randomized multistage method from the patients discharged from the ICU, with previous six months recovery. Data were collected using demographic questionnaire, and post-traumatic stress and post-traumatic growth checklists. Then, the collected data were analyzed in SPSS software (version 21).

Results showed that 34.3% and 58.96% of patients experienced PTSD and post-traumatic growth, respectively. Pearson correlation analysis showed that with the increase in PTSD score, the post-traumatic growth score also increased in these patients (r=0.524, P=0.001).

Post-traumatic stress disorder and post-traumatic growth symptoms were common among COVID-19 patients admitted to the ICU. In addition, the more the patients experienced post-traumatic stress symptoms, the more likely they were to experience the post-traumatic growth.

Breast cancer is recognized as the most common cause of cancer deaths in women. So far, no definite treatment has been identified there is no certain cure for breast cancer. The Ooverexpression of interleukin-8 is associated with increased tumor growth and breast cancer metastasis. Hesperetin is a flavonone sub-group of flavonoids that is abundantly found in citrus fruits, including lemons and oranges. Considering the anti-cancer and anti-inflammatory role of hesperetin, as also, well as the role of interleukin-8 in cancer metastasis and progression, in this studythe present study aimed to assess , the effect of hesperetin on the expression of the interleukin-8 gene in MCF-7 cell line has been investigated. The relative expression level of interleukin-8 gene in MCF-7 cell line at concentrations of 0, 25, 50, 100, and 200 µM hesperetin and durations of 6, 24, and 48 hours (with the concentration of 100 µM) was performed using the A real-time polymerase chain reaction (real-time PCR)Real-time method PCR was performed. The obtained Our results pointed out showed that the level of interleukin-8 gene expression decreases with an increase in by increasing the concentration of hesperetin (up to 100 µM), the level of interleukin-8 gene expression decreases. Furthermore, Also, the level of interleukin-8 gene expression in the 48-hour treatment was lower than that in the 24- and 6-hour treatments. Considering its various properties, including anti-cancer and anti-inflammatory properties, hesperetin could be effective in reducing the risk of metastasis and progression of breast cancer by reducing the expression of the interleukin-8 gene.

Among the types of migration, the migration of expert human resources is one of the most challenging for the immigrant sender countries. With the outbreak of COVID-19 worldwide, the importance of medical staff and the need for providing sufficient human resources in the healthcare section appeared more prominent. COVID-19 along with the existing economic challenges has intensified the process of medical staff migration in Iran, one of the immigrant sender countries. Investment in the development of expert human resources requires the allocation of large material resources, and wasting the mentioned resources also means giving these experts to the destination countries for free. Identification of different dimensions and the root causes of the migration of expert human resources helps policymakers in making effective decisions. In this study, economic-occupational factors, socio-cultural factors, and obstacles to continuing education were identified as the main factors of medical staff migration.