Iranian Journal of Public Health
Volume:52 Issue: 7, Jul 2023

An apoptosis-resistant state determined by apoptotic protein expression is commonly seen in the initiation, progression, and treatment failure stages of human cancer, and anti-tumor drugs targeting apoptotic proteins have been increasingly developed over the past three decades. However, the frequently alternative splicing of apoptotic proteins diminished the ability of targeting drugs to bind to apoptotic proteins and, consequently, limit the drug efficacy. Currently, accumulating evidence has demonstrated that many alternative splicing events have been associated to apoptosis resistance in different cancers. Therefore, the intervention targeting alternative splicing for regulating tumor cell apoptosis is expected to become a new strategy and new direction of antitumor therapy. Here, we present well established alternative splicing events that occur in different apoptosis-related genes and their modification by several approaches with cancer therapeutic purposes.

This review aimed to synthesize intervention models involving the role of adolescent and family support as part of comprehensive care to improve self-efficacy and self-management among adolescents with Diabetes Mellitus (DM).

A review was conducted to conform to Preferred Reporting Items for Systematic Reviews and Meta- Analyses Extension for Scoping Reviews (PRISMA-ScR) standards. We searched PubMed, Research Gate, Science Direct, Cochrane Library databases, and grey literature. We included articles exploring family intervention models on improving self-efficacy and self-management among adolescents with DM, published from January 1, 2009, to June 30, 2022, and in English. Articles were declared eligible, reviewed critically, and then synthesized narratively.

We identified 487 abstracts and title records from the initial search and excluded 409 irrelevant studies. Sixty-six full-text articles were screened, and nine were included in the synthesis. Five articles presented findings from using models focusing on child and adolescent intervention, while in the remaining four articles, the intervention models involved adolescents and their caregivers or parents. Only two models provide comprehensive care that requires collaboration among healthcare providers, patients, and families. Adolescent self-efficacy and self-management schemes as intermediary variables are closely related to everything that can influence health behavior, metabolic control, and quality of life for adolescents, which requires support from a multidisciplinary collaborative team.

Excellent comprehensive care team collaboration involving family support is essential to increase the self-efficacy and self-management of adolescents with DM.

There are many kinds of medicinal animal resources, which are an important part of traditional Chinese medicine resources (TCM). However, the use of medicinal animals in TCM, especially wild animals, has become a sensitive problem at home and abroad. Systematic analysis on the research status and direction of medical animals in the last 10 years which for promoting the sustainable development of Chinese medicine.

PubMed, Web of Science, Embase, CINAHL, CNKI, VIP database and WanFang Database were selected, and SPSS 25.0 software was used to analyze annual publications, journals, global distribution, authors, coauthors and co-authors rate, author institutions and high-frequency keywords.

Chinese Journal of modern Chinese medicine occupies the majority articles with a high co-authorship rate, but low impact factors. The development of medical animals around the world is not balanced. The top three countries are China, United Kingdom and United States. However, these countries have less exchanges and cooperation with each other. The Institute of TCM of Chinese Academy owns the most research achievements. At present, the hot spots involve the identification and quality of medical animals, applied basic research.

The identification, quality and applied basic research of medical animals are still worthy of increasing research investment. In addition, it is necessary to strengthen exchanges and international cooperation among different countries in TCM, and promote the high-quality development in medical animals.

Anderson’s model provides a theoretical structure to understand use of health service. This scoping review aimed to examine the application of Andersen’s behavioral model in different studies.

Related studies that were published between 2012 and 2021 were retrieved by searching PubMed, Science Direct, and CINAHL databases. Fourteen studies satisfied the criteria for inclusion.

The reviewed studies specified that the Andersen’s Model has been used in numerous parts of the health system and concerning different illnesses. The reviewed studies revealed differences in the factors examined. Most of the studies examined age, education, gender, marital status, and employment status as predisposing factors, and income, medical insurance, and living location as enabling factors. While, the chronic illnesses and perceived general health status were examined as need factors, in addition to an extensive diversity of health conditions and illnesses. Though the associations were established among the key factors tested in the reviewed studies and health care service use, the findings were inconsistent. In the reviewed studies, the setting and the study population characteristics looked to have a strong influence on the direction and strength of these associations.

Merely a slight number of common factors were examined and there were enormous differences in the methods by which these factors were classified. Future and primary studies are necessary to deepen our understanding of the use of health care services and the complexity of the Andersen's behavioral model.

Cancer is the second most common cause of death worldwide. Economic evaluation of cancer treatment to reduce costs can save the health care system millions of dollars while optimizing care. Therefore, this systematic review aimed to study the economic evaluation of cancer treatment using intermediate intensity radiation therapy (IMRT) compared to conventional 3D conformal radiation therapy (3D-CRT).

Literatures from PubMed, Embase, Cochran Library, Google scholar, Scopus and Iranian databases were retrieved since Jan 2000 to Apr 2020 for eligible English studies. The quality of the studies was evaluated using Cheers' checklist and then the textual data were analyzed manually by content analysis method.

Overall, 1790 articles were retrieved, of which 12 studies were reviewed. The article quality score ranged from 14.5 to 23 out of a maximum of 24 points. Eleven studies referred to cost-effectiveness analysis and one study referred to cost-utility analysis. Studies have been conducted in the United States, Canada, Australia, Brazil, the Netherlands, the United Kingdom, and Hungary. IMRT appears to be a cost-effective treatment strategy for rectal cancer, soft tissue sarcoma, and localized carcinoma of the pharynx, and for prostate cancer in terms of prolonging survival, but it is a cost-effective treatment strategy for head cancer. In addition, the neck was not in India's cancer control program.

The results can help to decide whether to use radiation therapy and radiotherapy in the standard treatment path. Furthermore, they underline that IMRT treatment technique was cost effective for a long-time care service.

Suicide is one of the most serious social problems in Korea. We examined suicidal ideation factors among Korean youth.

For risk factor identification, data from the 2008 and 2018 Korean Youth Panel Survey were analyzed (n =6,568) using univariate multiple logistic regression analysis. Negative life events, feelings of hopelessness, early-life adversity, alcohol consumption, smoking, counseling experience, perceived stress, and current health status were independent variables, whereas suicidal ideation was the dependent variable.

Proximal (negative life events and feelings of hopelessness), distal (early-life adversities significantly influenced suicidal ideation), and health-related (alcohol consumption, counseling experience, perceived stress, and current health status) factors significantly influenced suicidal ideation among Korean youth.

Mental health professionals must include distal risk factors, along with the common proximal and health-related risk factors, to provide targeted interventions.

We aimed to explore the mechanism of the effect of remimazolam (Rem) on the proliferation of colorectal cancer (CRC) cells with CRC as a disease context.

Translocation protein (TSPO) expression in CRC was determined by Western blotting and qRTPCR in the Second Affiliated Hospital of Qiqihar Medical University from March 2019 to February 2022. TSPO-interacting proteins were predicted through string database. The proliferation was measured by CCK-8 and 5-ethynyl-2-deoxyuridine (EDU). The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide(MTT) and clonal colony on cells were formed to screen for the optimal concentration of Rem and to detect the viability. The expression of apoptosis-related proteins, Bcl-2 and P53, was determined by qRT-PCR and Western blotting. The effect of Rem on the expression of tumor markers, CEA and CA19-9, in CRC was examined through ELISA.

TSPO expression in CRC tissues and cells was higher than that in ANT samples and normal intestinal epithelial cells. Over-expression of TSPO promoted the proliferation of HCT116 and the expression of tumor markers CEA and CA19-9 and inhibited the apoptosis of HCT116. Interference with TSPO inhibited the proliferation of HCT116 and the expression of CEA and CA19-9 and promoted the apoptosis of HCT116. 1 μg/mL Rem could inhibit the viability of HCT116, the proliferation of HCT116 and the expression of CEA and CA19-9, and improve the apoptosis of HCT116. TSPO could interact with VDAC and affect its protein expression, and Rem could inhibit the proliferation and the expression of CEA and CA19-9 through the TSPO/VDAC pathway, to promote its apoptosis.

Rem affects the proliferation of CRC cells by inhibiting the TSPO/VDAC pathway.

Obesity is a global pandemic health problem. Attempting weight reduction, excess weight people commonly seek herbal products in addition to claim diets. We aimed to assess the prevalence of consuming herbal and dietary products for weight loss purposes and to assess weight reduction attitudes and beliefs among a group of excess-weight adults in Jordan.

A cross-sectional study was conducted on a sample of 477 Jordanian adults (81.6% females), between Feb-Apr/2021. The study data collection was completed by using a validated online structured questionnaire.

28.9% of the male participants reported that the most common source of diets they followed was by themselves (43.2%) and by dietitians (25%). Whereas female participants followed the weight reduction diets prescribed by dietitians, by themselves, and on the internet (31.1%; 26.5%, and 23.7; respectively, P=0.011). The majority of participants from both genders do not believe in using weight reduction herbs alone for losing weight; it must be done along with diet and exercise (P=0.018). Females who use herbs for weight reduction were more than males. In addition, green tea was the most used herb by all participants (8%). The main advisor for using weight reduction herbs and dietary products in females was the internet (30.1%) followed by their own (24.2%). However, in males, it was by their own (21.6%), then by a dietitian (12.6%), and by the internet (12.5%) (P=0.001). Moreover, a quarter of male participants and 21.6% of females did not feel that using herbs to lose weight was efficient.

The excess weight adults in Jordan seek to use diet, herbs, and dietary products for weight reduction, advised by unreliable sources. Although the majority are convinced that it is not effective alone, further studies are needed to assess the side effects and safety of such consumption among the population.

Basic psychological needs affect intrinsic motivation. However, the relationship between selfcare behaviors and the basic psychological needs of patients undergoing renal dialysis has not been proven. We investigated the validity and reliability of the Basic Psychological Needs scale for patients undergoing renal dialysis.

At hospitals in Busan Metropolitan City, 120 patients with chronic renal failure receiving dialysis treatment were examined. The data were analyzed using SPSS 21.0 and AMOS 21.0 and criteria for positively affecting selfcare behaviors in these patients identified. The Basic Psychological Needs scale consists of two subfactors: autonomy and competence.

The reliability of the 12 items of the scale based on Cronbach’s α was 0.90; first factor autonomy was 0.90; second factor competence was 0.72; and there was homogeneity between the items.

Construct-, convergent-, discriminant-, criterion-related validity and internal consistency were verified. The scale was confirmed as a tool for measuring the basic psychological needs of patients undergoing renal dialysis.

We aimed to probe into the occupational exposure causes and mental status of infectious diseases in pre-hospital emergency medical personnel.

Forty medical personnel with occupational exposure to infectious diseases who participated in prehospital emergency work in 120 emergency center of The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China were selected as respondents from February 2018 to February 2021. The occupational exposure modes, exposure degrees, exposure sites, exposure sources and exposure causes of infectious diseases were summarized, and the mental status of emergency medical personnel after occupational exposure to infectious diseases was analyzed.

In the occupational exposure modes of infectious diseases, needle stick injuries were overtly higher than mucosal pollution, hematic and humoral pollution and incised wound by glass (P<0.05). In exposure degrees, slight bleeding was notably higher than excessive bleeding, bleeding and no bleeding (P<0.05). The hand was distinctly higher than the eye in exposure sites (P<0.05). In exposure sources, hepatitis B virus was visibly higher than hepatitis C virus, HIV, syphilis, intravenous drug, hemorrhagic fever and unknown cause (P<0.05). The scores of somatic symptoms, anxiety, depression, fear, interpersonal sensitivity, hostility, compulsion and paranoia in medical personnel were clearly higher than the norm in Chinese adults after occupational exposure to infectious diseases (P<0.05), with no statistical significance in the comparison of psychotic scores.

The occupational exposure risk of infectious diseases among pre-hospital emergency medical personnel is high. It is necessary to strengthen pre-job training and education and improve standardized management for protection.

The European Higher Education Area (EHEA) has aimed at unifying, harmonizing, and ensuring consistency of higher education systems in Europe for over two decades. The objective of this study was to investigate the similarities and differences in the training programs of nurses in selected EHEA member countries.

Comparative analysis was used. Based on three sources: research articles, internet databases, and emails sent to nursing education institutions. Three databases, namely Science Direct, PubMed, and ERIC, were utilized.

Regarding educational institutions, the majority of countries' nurses graduated with a Bachelor's degree, except for Estonia, Russia, and North Macedonia. Russia had the shortest education duration (2 years and 10 months), while other member countries had programs lasting between 3-4 years. In countries where colleges were still active, diploma or certificate programs were offered, such as in Estonia and Russia. Only North Macedonia did not offer any continuing education for nurses, and Estonia, Latvia, and France did not have PhD programs in nursing.

Nurses constitute the largest occupational group in healthcare, and the quality of medical care relies on their theoretical and practical training. Despite efforts to unify nursing curricula through the Bologna Process, significant differences still exist.

We compared the educational effects of two training methods that have gained momentum: medical virtual reality (medi-VR) simulation and flipped learning.

Firefighters (n=128; 116 men and 12 women; mean age=28 years) in training from the Emergency Educational Simulation Center of Korea National Fire Service Academy, Gongju-si, Korea, were randomly assigned to two groups: medi-VR simulation and flipped learning in 2022. The participants were trained to perform cardiopulmonary resuscitation (CPR) using medi-VR simulation and the flipped learning methods. CPR self-efficacy, knowledge, performance, class immersion, and class satisfaction were compared between the groups. To analyze educational effects, paired and independent t-tests were performed.

The post-education scores for CPR performance knowledge and CPR performance were significantly higher in the medi-VR simulation group compared to the flipped learning counterparts (P<0.001). Moreover, despite the lack of a significant difference between the groups, post-education scores for self-efficacy, class immersion, and class satisfaction showed a positive effect on learning.

Medi-VR simulation can be utilized as effective educational intervention, while providing a new direction for teaching methods.

Population aging and health issues are one of the most crucial issues worldwide. Health behaviors are the most direct factor affecting the health of the elderly. This study aims to explore the relationship between the health information literacy and health behaviors of the elderly.

A hypothesis model for the influence of health information literacy on health behaviors of the elderly was constructed. Based on survey data of 382 elderly people aged 60 and above in Hangzhou, China, from March 2022 to May 2022, the relationship between the health information literacy and health behaviors of the elderly was studied by using quantitative statistics and the structural equation model.

The health information literacy of the elderly had a significant positive impact on their health behaviors (P<0.01). Health information seeking played a partial mediating role between health information literacy and health behaviors. Social support exerted a significant moderating effect between health information literacy and health behaviors (P<0.05) and between health information literacy and health information seeking (P<0.05).

Health information literacy is the decisive factor of the elderly's health behaviors. The higher level of health information literacy, the more health information seeking, thus promoting more active health behaviors.

Understanding national trends in noncommunicable disease (NCD) risk factors may have health policy implications. We aimed to evaluate trends in the prevalence and correlates of eight risk factors for NCD from 2005 to 2019 in Mongolia.

Cross-sectional data were analyzed from 9,356 individuals (15-64/69 yr, mean age=37.3 yr) who participated in the Mongolia STEPS 2005, 2009, 2013 or 2019 surveys and had complete measurement of the risk factor for NCD.

The proportion of having 3-8 NCD risk factors significantly decreased from 59.1% in 2005 to 49.4% in 2019, and the mean number of NCD risk factors significantly decreased from 2.8 in 2005 to 2.6 in 2019. In linear regression analyses by study year, older age and male sex were across all study years positively associated with eight NCD risk factors. The prevalence of low physical activity increased from 8.2% in 2005 to 28.4% in 2019, overweight/ obesity from 49.6% in 2005 to 64.0% in 2019, and raised total cholesterol from 23.9% in 2005 to 27.6% in 2019, there was a significant decrease in inadequate fruit and vegetable intake from 85.1% in 2005 to 79.5% in 2019, current smoking from 26.6% in 2005 to 24.1% in 2019, hypertension from 28.2% in 2005 to 23.2% in 2019, while the prevalence of diabetes remained unchanged from 2005 to 2019.

The prevalence of eight risk factors for NCD decreased in the last 15 years in Mongolia. Several associated variables for eight and individual NCD risk factors were identified that can help guide interventions.

Breast cancer is the most common female cancer in the world. Sleep disruption is one of the major problems of breast cancer patients. This study aimed to evaluate the quality of sleep in a group of Moroccan women with breast cancer and analyze the association between sleep quality, depression, and anxiety.

This cross-sectional study was carried out among 337 Moroccan women treated for breast cancer at the Mohammed VI Cancer Treatment Center in Casablanca in 2019. A questionnaire was designed for this purpose based on two scales: Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety Depression Scale (HADS).

71.5% of the participants had significant sleep disturbances; the subjective quality of patients’ sleep was considered to be quite poor (20.8%) and 43.9% of participants need more than 60 minutes to fall asleep. The average sleep duration was 6.16 h/night and 84.3% of patients had not taken sleep medicines in the last month. The most common reasons for sleep disturbances were getting up to use the bathroom (67.4%) and waking up in the middle of the night or early morning (54%). Anxiety and depression were positively correlated with PSQI scores.

The present study highlights how much breast cancer patients are vulnerable to psychological disorders and then incites the decision makers in oncology departments to implement rigorous psychological health care strategies in order to ameliorate mental health and sleep quality of breast cancer patients.

Patients with dyslipidemia are usually multimorbid and require polypharmacy. Therefore, it is important to identify potential drug-drug interactions (pDDIs) in time to prevent their consequences. We aimed to identify and analyze risk factors contributing to their occurrence to guide health professionals.

A prospective cross-sectional study of 216 outpatients with dyslipidemia was conducted from May 2021 to April 2022 in Podgorica, the capital of Montenegro. pDDIs were identified using Medscape, Epocrates, and Drugs online interaction checkers. Multivariate regression analysis was performed to evaluate the potential predictors of interactions.

pDDIs were detected in 212 (98.1%) participants, whereas pDDIs with high clinical significance were detected in 25.46%, 40.74%, and 58.8% of subjects by Drugs, Epocrates, and Medscape, respectively. Polypharmacy emerged as a risk factor for the occurrence of pDDIs in all three checkers in each category of clinical significance. The use of non-steroidal anti-inflammatory drugs and antiplatelet drugs contributes to the incidence of severe pDDIs B=1.014, 95%CI 0.681-1.346, P=0.000 and B=0.492, 95%CI 0.286-0.698, P=0.000, by Epocrates and Medscape respectively. The number of prescribers per patient was a protective factor against moderate pDDI B= -0.858, 95%CI -1.572-(-0.144), P=0.019 and B= -0.956, 95%CI -1.671-(- 0.241), P=0.009, by Medscape and Epocrates, respectively, but a risk factor for the occurrence of minor pDDIs B=0.373, 95%CI 0.033-0.712 P=0.032 and B=0.143, 95%CI 0.042-0.244, P=0.006, by the same checkers.

Knowledge of the risk factors contributing to the occurrence of pDDIs is important for the development and implementation of strategies for their prevention, and given the high prevalence of dyslipidemia, understanding these factors seems crucial nowadays.

The drug resistance of chemotherapeutic agents leads to unsatisfactory survival rates for cervical cancer (CC) patients. We aimed to explore the effect of FOXP2 on the sensitivity of CC cells to cisplatin (DDP) and its mechanism in Changde, China in 2018.

A Total of 6 cervical cancer tissue samples including 3 patients with cisplatin sensitivity and 3 patients with cisplatin resistance, who received DDP-based treatment, were obtained from Changde First People's Hospital, Changde City during 2021，and FOXP2 level was detected by Western blot. The expression levels of FOXP2 and c-MET (hepatocyte growth factor receptor, c-MET) in cells were determined by q-PCR and Western blot analysis. The cell survival, apoptosis, and clone formation were analyzed by flow cytometry, MTT assay, or clone formation assay. Dual-luciferase reporter assays and Chromatin immunoprecipitation were applied to verify the regulation between FOXP2 and c-MET.

FOXP2 was downregulated in cisplatin-resistant cervical cancer tissues and cells compared with control. FOXP2 overexpression in SiHa/DDP cells inhibited cell proliferation and promoted cell apoptosis, whereas down-regulation of FOXP2 in SiHa cells had the opposite result. FOXP2 enhanced chemosensitive to DDP in CC cells. FOXP2 is negatively correlated with c-MET expression level in SiHa and SiHa/DDP cells. Mechanistically, FOXP2 binds to the promoter region of c-MET to regulate its expression in CC cells negatively. Overexpression of c-MET can attenuate the enhancement of DDP-induced apoptosis caused by FOXP2 overexpression.

This is a novel study on the role of FOXP2 in promoting the DDP sensitivity of CC cells by inhibiting c-MET. The FOXP2/c-MET signaling axis uncovered in the present study may be a novel therapeutic target for the DDP therapy resistance of CC.

Prostate cancer (PCa) is the most common cancer affecting men, apart from cutaneous cancers. Serum prostate specific antigen (PSA) levels are frequently used to predict prostate cancer diagnosis. However, many causes (e.g., prostatitis, benign prostate obstruction, urethral catheterization) may cause elevated PSA, in addition to PCa. We aimed to investigate the gamma glutamyl transferase (GGT) levels, a serum biomarker not affected by situations other than cancer causing elevated PSA.

The study evaluated male patients with prostate biopsy due to high serum PSA levels and/or abnormal digital rectal examination (DRE) examined in Ordu University Education and Research Hospital, Ordu/ Turkey urology clinic from April 2019 to April 2021. The patient group in the study included 261 men with PCa diagnosis and the control group included 245 healthy men with normal PSA levels, and no PCa and/or benign prostate obstruction (BPO). The two groups were compared in terms of serum GGT levels.

GGT was significantly low in the PCa group and might be a predictor in terms of PCa (P=0.000). In the malignant (PCa) group, the GGT cut-off value was identified as 21.5 (sensitivity 68.6%, specificity 54.4%).

Serum GGT levels might assist in diagnosis of PCa. However, diagnostic power is weak due to low specificity. There is a need for studies investigating the efficacy of GGT levels for prediction of PCa diagnosis and assessing other parameters alongside GGT.

Toxoplasma infection is caused by Toxoplasma gondii, which is an intracellular protozoan parasite. This infection consequently lead various congenital disabilities during pregnancy in patients. Spiramycin (Spi), a macrolide antibiotic, is typically recommended for T. gondii infection in pregnant women. We aimed to prepare the nanoemulsion of spiramycin (NE-Spi) and to evaluate the activity of this formulation in tachyzoites of T. gondii, RH strain.

This study was conducted in 2019-2021 at the School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. NE-Spi was prepared by spontaneous emulsification. The effects of this nanoemulsion on the viability of cultured cells were measured using MTT assay. To estimate the effects of NE-Spi on tachyzoites of T. gondii, RH strain, different concentrations of NE-Spi, S-Spi (suspension of spiramycin), and NE (nanoemulsion without any spiramycin) were added to tachyzoites and then stored for 30, 60, 90, 120 min and 24 h in 250 μg/ml concentration at room temperature. Finally, Tachyzoites mortality rates were evaluated by trypan blue staining. Of note, flow cytometry was conducted to confirm the obtained results.

The final particle size of NE-Spi was calculated to be 11.3 nm by DLS and TEM. Thereafter, using MTT assay, in 62.5 μg/ml concentration of NE-Spi, the Vero cells viability was obtained as 82%. The highest mortality rates of tachyzoites of T.gondii, RH strain were observed at 250 μg/ml concentration and after 120 min of exposure, but it was not significantly different from 24 h of exposure.

NE-Spi has lethal efficacy on T. gondii RH strain in-vitro.

In 2010, Iran became the first major oil-exporting country to reduce substantially implicit energy subsidies by increasing domestic energy and agricultural prices by up to 20 times. The current research aims to evaluate the profound impact of the countywide implementation of this targeted subsidy reform (TSR) on the consumption patterns of households in Iran, specifically in relation to the consumption of healthy food commodities.

This study employed a robust approach to examine the impact of the TSR on household food consumption, as a natural experiment, using pooled cross-section data from the Household Income and Expenditure Survey (HIES) spanning the years 1992 to 2019. The analysis was based on a comprehensive interpretation of survey data, which served as the primary source for analysis. The estimation procedure utilized an interrupted time series (ITS) model to capture the parameters associated with food consumption.

The findings revealed a substantial increase in household expenditures on food immediately following the policy intervention, with an impressive rise of 823 thousand Rials (equivalent to approximately $6.36 based on the floating exchange rate in 2019). Furthermore, the results strongly indicate a significant annual upward trend in total monthly food expenditures per adult person, surpassing the pre-intervention trend by 441 thousand Rials (approximately $3.40) (P=0.044, CI=[12.86, 1016.81]). Moreover, the implementation of the policy led to an annual per capita increase in fruit consumption by 1.02 grams per day (P=0.225, CI=[- 0.68; 2.72]).

This study shows that the initial positive effects of the TSR have gradually been eroded by inflation in subsequent years. This experience can serve as a lesson for all countries that TSR should be accompanied by other measures, such as poverty alleviation interventions, in order to achieve desired long-term results.

Although the pathogenesis of Helicobacter pylori is well-defined, the origin and transmission of the bacterium have remained largely unknown. The water transmission hypothesis suggested that water acts as a carrier in oral-fecal transmission, especially in high-prevalence areas. We aimed to evaluate the possible contamination of tap water with infective H. pylori in Kermanshah, Iran from Sep-Oct 2020.

Tap water samples were collected from varieties of probable high-alert regions and the viability of H. pylori were achieved using culture and real-time PCR techniques (ureA gene expression).

Out of 50 tap water samples, 3 were positive for H. pylori before enrichment and 6 were positive after enrichment by RT qPCR, while H. pylori colonies of two samples were observed on brucella agar plates.

The results of positive samples demonstrated the probable presence of viable H. pylori in tap water samples, showing that tap water distribution systems could be a potential route for H. pylori transmission.

Hospital wastewater is considered by health and environmental researchers due to the presence of various hazardous chemical contaminants such as residual of antibiotics and other drugs. The conventional treatment processes are not able to complete removal of them, and could lead to the entry of these compounds into the environment. Then, we aimed to analyze and evaluate the removal of ciprofloxacin and vancomycin antibiotics from hospital wastewater.

The effect of antibiotic concentration and reaction time was investigated on the performance of single ozonation (SOZ) and activated carbon catalyzed ozonation (ACCO). In addition, COD and BOD of the effluent, antibiotics degradation kinetics and mathematical modeling were determined. Solid phase extraction columns (SPE) and high-performance liquid chromatography (HPLC) methods were used to extract and measure the intended antibiotics, respectively.

The results of this study showed that degradation of both antibiotics follow pseudo-first order kinetic. SOZ was able to eliminate 6 mg/L of vancomycin and ciprofloxacin within 45 and 65 min, respectively. Due to the synergistic effect of activated carbon on ozonation, ACCO significantly reduced the degradation time to 20 and 25 minutes, respectively. BOD/COD ratio at the outlet of ACCO process increases from 0.2 in raw wastewater to 0.4 in treated wastewater, which could be appropriate for biological treatment.

ACCO could be considered an efficient process for degradation of antibiotics in hospital wastewater.