Iranian Journal of Public Health

Effect of Treatment of Hypokinetic Dysarthria in Parkinson's Disease with Speech and Language Therapy: A Meta-Analysis

Liang Zhang — 2025-06-10

Background: A meta-analysis study was conducted to measure how to forecast the effect of treatment of hypokinetic dysarthria in Parkinson's-disease with speech and language therapy.

Methods: Until October 2024, a comprehensive literature research was conducted, and 1665 related studies were reviewed. The 14 selected studies encompassed 948 participants with hypokinetic dysarthria in Parkinson's disease. The odds ratio (OR) mean difference (MD) and 95% confidence intervals (CIs) were used to look at the outcome of treatment of hypokinetic dysarthria in Parkinson's disease with speech and language therapy using dichotomous or continuous methods with a fixed- or random-effects model.

Results: In individuals with hypokinetic dysarthria in Parkinson-disease, speech and language therapy had significantly higher sound pressure level, phonation (MD, 7. 51; 95% CI, 3. 81-11. 20, p<0. 001), reading (MD, 8. 83; 95% CI, 4. 96-12. 69, p<0. 001), monologue (MD, 4. 28; 95% CI, 2. 47-6. 10, p<0. 001), and picture description (MD, 3. 64; 95% CI, 1. 78-5. 50, p<0. 001), and lower Voice Handicap Index (MD, -5. 61; 95% CI, -9. 05- -2. 17, p=0. 001) compared to control treatment.

Conclusion: In individuals with hypokinetic dysarthria in Parkinson's disease, speech and language therapy had significantly higher sound pressure level, phonation, reading, monologue, and picture description, and lower Voice Handicap Index compared to control treatment. To validate these finding more studies are required, caution is needed when interpreting these results, since many comparisons had a limited number of selected studies

The Role of Private Doctor and Private-Public Mix Systems in Tuberculosis Detection in Developing Countries: A Systematic Review

Rosita Dwi Yuliandari — 2025-06-11

Background: Despite the significant efforts in tuberculosis (TB) management, TB case detection remains a challenge in developing countries. Traditional methods such as Directly Observed Treatment Short-course (DOTS) have often underperformed, necessitating the implementation of the public-private mix (PPM) strategy in recent decades. However, varied PPM models yielded varied results across different countries. Hence, this systematic review assesses the effectiveness of various PPM models and seeks innovative strategies to enhance TB detection.

Methods: A systematic search was conducted using PubMed, Scopus, Embase, and Web of Science up to August 2024. Studies evaluating the efficacy of PPM models on TB case detection in developing countries were pooled. From the initial 731 potential studies, a total of 10 studies were finally included in this systematic review.

Results: The review identified a variety of PPM interventions, including mass campaigns, mobile screening units, home-based tracking, and digital CXR examination. These approaches significantly raised tuberculosis detection rates compared to control groups or previous years. Notably, private sector involvement and novel approaches, such as application-based tracking in Vietnam and mobile vans equipped with digital X-rays in India, yielded favorable results. However, the variation in effectiveness rate underscored the importance of personalized approaches based on local contexts.

Conclusion: PPM models, especially those with innovative techniques, significantly enhance TB case detection. Scaling up and modifying these strategies to various country circumstances is critical to meeting global TB reduction targets.

Predictive Value of Infection Related Critical Illness Scores on the Risk of Death in Infected Patients: A Systematic Review and Meta-Analysis

Laiqing Luo — 2025-06-11

Background: This article aimed to compare the value of infection related critical illness scores in predicting the risk of death in infected patients, and evaluate the predictive accuracy of three scoring indicators: SOFA score, APACHE II score, and NEWS score.

Methods: Through the established retrieval strategy, the relevant literature from January 2013 to December 2023 were searched on platforms such as CNKI, Wanfang, PubMed, Embase, and Cochrane Library, eight relevant literature were included for meta-analysis. Literature screening and data extraction were conducted according to predetermined standards, using a fixed effects model for data analysis.

Results: Among the 8 included literature (References (5-12)), the ratio of mortality to survival and 95% confidence interval for SOFA scores were 1.33 and (0.98, 1.75), respectively; The APACHE II score is 2.24 and (1.58, 2.97); The NEWS score is 1.64 and (1.45, 1.85). All three scoring indicators had significant value in predicting the risk of death in infected patients. In addition, comparing the AUC of the three scoring indicators, the SOFA score had the highest AUC, followed by the APACHE II score, and showed significant differences compared to the NEWS score, with P<0.001 and P<0.05 respectively.

Conclusion: The SOFA score has higher accuracy and predictive value in predicting the condition and risk of death of infected patients. However, further attention needs to be paid to the selection of scoring methods to comprehensively consider the clinical situation and research objectives. The results of this study are helpful in guiding the evaluation and prediction of infected patients in clinical practice, and providing a basis for optimizing treatment strategies.

Euthanasia – A Legal or Medical Issue: A Narrative Review

Darko Radulović — 2025-06-11

Euthanasia is a highly controversial issue which keeps the scientific community and the general public divided into those in favour and those opposed to this manner of terminating a person’s life. Ethical, medical, legal, religious and other reasons are used both to justify its legalisation and to argue against it. The main question which attracts differing opinions is whether—beside the right to life as the universal and most important right recognised by the European Convention for the Protection of Human Rights and Fundamental Freedoms—there is the right to die, implying that a person could choose how and when to end their life. The author of the paper analyses several issues. In addition to the introduction which considers the right to life in general, and in the light of international documents, the paper deals with the concept of euthanasia and its historical development, as well as the types of euthanasia. This is followed by an overview of the positions of the proponents and the opponents of the legalisation of euthanasia. Finally, the paper discusses the various ways in which euthanasia is regulated in contemporary criminal legislation

Exploring the Dynamics: A Comprehensive Scoping Review of Factors Influencing Organ Donation Decisions: A Scoping Review

Husain Nadaf — 2025-06-11

Background: This scoping review explores the key demographic and psychosocial factors impacting organ donation, with a focus on studies utilizing online or digital platforms. We aimed to understand the existing facts that influence to effects of the organ donation decision.

Methods: This review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive search of PubMed, CINAHL, and Medline was conducted using MeSH terms and logical operators to identify relevant studies published in English 2018 to 2023. Studies focusing on the demographics and influencing factors for organ donors of any age were included. Abstract concepts, conference proceedings, and non-English studies were excluded. Data extraction and quality assessment were independently conducted by two reviewers using standardized tools, including the Newcastle-Ottawa Scale, Cochrane Risk of Bias tool, and Joanna Briggs Institute checklist.

Results: Out of 270 records identified, 9 studies met the inclusion criteria. The synthesis of results revealed three major themes: 1) demographic characteristics of organ donors, 2) psychosocial and digital factors influencing organ donation, and 3) interventions promoting awareness and engagement in organ donation. Online and digital platforms play a significant role in shaping attitudes, intentions, and awareness of organ donation. Quality assessment indicated a moderate-to-high level of methodological rigor across the included studies.

Conclusion: This review highlights the key factors influencing organ donation, particularly the role of digital platforms in enhancing awareness and engagement. Future research should focus on leveraging these insights to develop targeted interventions aimed at increasing organ donation rates globally.

Perioperative Nursing in Strabismus Surgery: A Narrative Review

Haiyan Cai — 2025-06-11

Background: Perioperative care plays an unparalleled role in the management of strabismus. However, there is still a lack of adequate understanding of the perioperative care and guidelines on nursing measures for strabismus surgery. This article provides a comprehensive review of perioperative care for strabismus, focusing on psychological intervention and rehabilitative nursing.

Methods: To comprehensively collect research related to perioperative nursing, we employed a systematic literature retrieval strategy. The databases searched included PubMed, EMBASE, Web of Science, CNKI (China National Knowledge Infrastructure), WanFang, and VIP (Weipu). We read, summarized and review the literatures obtained from databases.

Results: We summarized the conclusions in the retained literature and elaborated from two aspects: Psychological intervention and Rehabilitation Nursing. Psychological intervention can be carried out from the following aspects: cognitive behavior intervention, psychological and emotional intervention, social support intervention. Perioperative rehabilitation can be carried out from the following aspects: postoperative nausea and vomiting management, prevention of postoperative infection, visual care, preventing recurrent strabismus post-surgery, avoiding diplopia.

Conclusion: Comprehensive perioperative care for patients with strabismus can alleviate negative emotions, improve psychological status, reduce the incidence of postoperative complications, and enhance patients' quality of life. However, further research is still needed to establish detailed intervention strategies for comprehensive care.

Psychometric Validation and Reliability of the 9-Item Shared Decision-Making Questionnaire: A Systematic Review

Pavan Kumar Narapaka — 2025-06-11

Background: This study aimed to provide comprehensive information on translated versions of the 9-item shared decision-making questionnaire, widely used to measure patient involvement in shared decision-making, by combining psychometric validation information.

Methods: We searched various databases such as PubMed, Scopus, Google Scholar, along with developer website to gather pertinent literature published until Feb, 2024. This psychometric validation carried out based on item characteristics, content validity, and factor analysis results of individual studies. Our evaluation was based on predetermined cut-off values for item difficulty, discrimination index, Cronbach's alpha, Kaiser Meyer Olkin factor (KMO), Bartlett's test of sphericity, and factor extraction and rotation, confirmatory factor analysis range. The European Social Research Council guidance on the conduct of narrative synthesis in systematic reviews was employed for synthesis of validation results.

Results: The final analysis included nine studies with 3090 participants from various countries, and most participants had adequate literacy, and age range was 30-60 yr. Most model versions had a good fit, and all studies reported satisfactory results, except for one study's discrimination index values. The tool's validity was satisfactory. Most of the studies reported a convenient sample was the main limitation, along with recall bias in the final responses.

Conclusion: The 9-item shared decision-making tool can be used to measure patient involvement in shared decision-making in validated language-respected countries, as proper evaluation procedures reported satisfactory results in the confirmatory analysis models and reliability testing.

Efficacy of Intravenous Immunoglobulin for Patients with Recurrent Miscarriage: A Meta-Analysis

Yan Gao — 2025-06-11

Background: This study aimed to evaluate the efficacy and safety of intravenous immunoglobulin (IVIG) therapy for recurrent miscarriage (RMC) using meta-analysis.

Methods: Literature from Jan 1990 to Feb 2024 was searched in PubMed, etc., using keywords such as “IVIG”, “repetitive miscarriage”, and “RMC”. Two authors independently assessed the literature quality and risk of via Cochrane handbook, and extracted basic information and outcome indicator data. Meta-analysis was performed employing Review Manager 5.3.

Results: Eleven studies were involved, comprising 842 patients, of which 391 received IVIG therapy and 451 received placebo treatment. Relative to placebo group, IVIG group had a notably higher overall live birth rate (OR=2.24, 95% CI=1.68~2.98, Z=5.51, P<0.00001) and a greatly lower miscarriage rate (OR=0.46, 95% CI=0.22~0.95, Z=2.09, P=0.04). Subgroup analysis revealed that both primary and secondary RMC patients in IVIG group had markedly higher live birth rates versus placebo group (OR=2.13, 95% CI=1.18~3.83, Z=2.51, P=0.01; OR=1.50, 95% CI=0.98~2.30, Z=1.96, P=0.04). Nevertheless, the adverse reaction (AR) rate in IVIG group was superior to that in placebo group (OR=4.47, 95% CI=1.01~19.81, Z=1.97, P=0.05).

Conclusion: IVIG can markedly increase the live birth rate, reduce the miscarriage rate, and enhance pregnancy outcomes in patients with RMC. Nevertheless, the rate of ARs with IVIG therapy is relatively high, thus large-scale, multicenter, randomized controlled trials are needed for validation

Comparative Assessment of National and International Standards for Benzoic Acid and Its Derivatives in Different Types of Iranian Foods: A Systematic Review

Arghavan Madani — 2025-06-11

Background: The use of benzoic acid (BA) and its derivatives as food preservatives raises significant food safety concerns, as they may have potential adverse health effects.

Method: In this systematic review, BA content was examined in different types of Iranian food with classification of dairy, acidic, beverage, and bakery products. Furthermore, the levels of this preservative compared with Iranian National Standards Organization (INSO) and the Codex Alimentarius Commission (CAC) value. Databases like PubMed, Scopus, and Web of Science were used to extract published studies until Feb 2024.

Results: The limit defined by INSO was stricter than the CAC regarding BA in food. Consequently, the results demonstrated a relatively high level of impermissibility of BA with the INSO limit. However, the food products within the permitted range of BA content included a more significant portion according to the CAC limit. The majority of BA levels found in various Iranian studies exceeded the permissible limits set by the INSO, raising health concerns.

Conclusion: The study's findings suggest that Iranian food authorities should regularly monitor and analyse food products for BA and its derivatives to mitigate potential future health risks and ensure food safety.

The Role of State Policy in Addressing Cancer Trends: A Case Study from the Akmola Region

Nariman Yermek — 2025-06-11

Background: Cancer is a major public health challenge in Kazakhstan, with significant regional disparities in incidence and access to care. The Akmola Region faces socioeconomic and healthcare barriers affecting oncology outcomes. We examined the role of state policy in addressing cancer trends and proposed evidence-based interventions.

Methods: A retrospective descriptive and analytical study was conducted using cancer incidence data from 2009 to 2023, obtained from the Ministry of Health of Kazakhstan. Age-standardized rates (ASRs) were calculated using the WHO guidelines. Joinpoint regression analysis was applied to assess trends. Social factors, including income and access to care, influenced cancer rates. Rural areas faced notable disparities in oncology services.

Results: Over 15 years, 26,625 new cancer cases were recorded, with 48.9% in men and 51.1% in women. The most prevalent cancers were breast (11.8%), colorectal (9.5%), and gastric (8.8%). A decline in cancer incidence occurred in 2020, likely due to healthcare service disruptions during COVID-19. Social factors like income and care access shaped cancer rates. Rural areas faced notable disparities.

Conclusion: Strengthening state policies is crucial for reducing the cancer burden. Recommendations include expanding screening programs, improving healthcare infrastructure, and addressing regional inequalities through intersectoral collaboration. Implementing evidence-based strategies and integrating global best practices can enhance oncology care and reduce disparities

Cost Analysis of Hospital Treatment for Peritoneal Dialysis-Associated Peritonitis

Milorad Stojadinovic — 2025-06-11

Background: Increasing healthcare spending is a significant issue, with the aging population contributing to a rise in patients needing renal replacement therapy. The cost of peritoneal dialysis (PD) is substantial, particularly in upper-middle-income countries like Serbia. We aimed to identify the direct costs and influencing factors of treating peritoneal dialysis-associated peritonitis (PD associate peritonitis) in Serbia.

Methods: A retrospective observational study was conducted on consecutive patients admitted due to PD-associated peritonitis in five tertiary care hospitals across Serbia in 2019-2022. The primary outcome was total cost of hospitalization. Potential predictors were determined using generalized linear model with a gamma probability distribution and a log link function.

Results: The study included 122 patients. The average total cost per patient was 1131.90±1538.67 USD, with the cost of hospitalization (348.17 ± 361.52 USD) and antibiotics (294.94±465.88 USD) being the most significant. The length of hospitalization (P<0.001) and treatment outcome (P<0.001) were found to be significant predictors of the total cost.

Conclusion: The costs of treating PD associate peritonitis in Serbia are substantial, with each additional day of hospitalization significantly increasing the cost. The importance of patient and doctor education about infection prevention is underscored by the health consequences and the lengthy, expensive treatment when an infection occurs.

Effects of a Group Counseling Intervention Model Grounded on Character Strengths Theory on Inferiority Complex in Adolescents

Qinjuan Wang — 2025-06-11

Background: Inferiority complex is a common psychological disorder occurring in adolescents during their psychological development and the root cause of most psychological problems. However, inferiority complex in adolescents has rarely been examined in previous intervention studies. This practice-oriented study combined character strengths theory with group psychological counseling to examine adolescents with high inferiority complex scores.

Methods: A survey was conducted on 512 adolescents selected using convenience sampling from three middle schools in Wuhan, Hubei Province, China, to collect information regarding the degree and characteristics of their inferiority complex. Those with a high inferiority complex score were recruited for a grouped experiment, where the experiment group received group counseling grounded on character strengths theory.

Results: The participants had a moderately high degree of inferiority complex (mean = 2.92). Significant differences were observed in the total inferiority complex score across gender, left-behind experience, and academic performance (P < 0.05). After the intervention, the inferiority complex score of the experiment group was significantly lower than that of the control group, and the difference was statistically significant (P< 0.05).

Conclusion: The intervention model constructed in this study effectively reduces inferiority complex in adolescents, providing a reference for exploring an effective approach to adolescent-targeted mental health education.

Artificial Intelligence-Generated Diet Plans for Hypertension and Dyslipidemia: Adherence and Nutritional Insights

Emre Batuhan Kenger — 2025-06-11

Background: We evaluated diet plans generated by ChatGPT for hypertension and dyslipidaemia.

Methods: In October 2024, ChatGPT was used to generate meal plans for 24 simulated patients with different cardiovascular health problems. Data were used from men (n=12) and women (n=12), aged 56 yr, with mean heights of 176 cm and 161 cm respectively. Weight categories were based on BMI: normal, overweight, and obese, using weights of 56, 71, and 84 kg for women and 67, 85, and 101 kg for men. Four health conditions were assessed: hypertension stages 1 and 2 (systolic BP 130-139 mm Hg and ≥140 mm Hg; diastolic BP 80-89 mm Hg and ≥90 mm Hg), and elevated LDL levels (≥130 mg/dL and ≥160 mg/dL). Menus were evaluated for adherence to Mediterranean and DASH diets, including recommendations.

Results: Adherence to the Mediterranean and DASH diets was low across all groups, with median scores below 9 and 4.5, respectively. Common recommendations included weight loss, physical activity, reduced salt intake, stress management, and omega-3s for both hypertension and LDL reduction. Plant sterols/stanols were suggested only for LDL. No advice was given on smoking or alcohol use. Nutrient content did not differ significantly between hypertension and LDL menus (P>0.05).

Conclusion: This pioneering study found that AI-generated dietary models had low adherence to DASH and Mediterranean diets, though most recommendations were generally appropriate. Since the prompts only requested basic nutrition plans, future research should use more specific, personalized prompts to better assess AI's role in managing chronic diseases.

Exosomal ITGB2 Mediates Immune Evasion in Triple-Negative Breast Cancer by Suppressing Dendritic Cell Activation via TLR4

Puerkaiti Paierhati — 2025-06-11

Background: This study investigates the role of exosomal integrin beta-2 (ITGB2) from triple-negative breast cancer (TNBC) cells in modulating immune responses, with a focus on its interaction with Toll-like receptor 4 (TLR4) in dendritic cells (DCs). This study aimed to understand how ITGB2 contributes to the immunosuppressive tumor microenvironment in TNBC.

Methods: ITGB2 expression in TNBC tissues and cell lines was analyzed using qPCR and Western blot at the Affiliated Cancer Hospital of Xinjiang Medical University between 2013 and 2015. Knockdown and overexpression models of ITGB2 were established in MDA-MB-231 cells to explore their effects on TLR4 expression in DCs. Exosomes were isolated from these cells, and DCs were co-cultured with exosomes to measure TLR4 expression and cytokine secretion using flow cytometry and ELISA.

Results: ITGB2 was overexpressed in TNBC tissues, correlating with poor prognosis. Exosomal ITGB2 from TNBC cells suppressed TLR4 expression in DCs, leading to impaired DC maturation and reduced cytokine secretion, thus promoting an immunosuppressive microenvironment.

Conclusion: Targeting the ITGB2-TLR4 axis could enhance anti-tumor immunity in TNBC. ITGB2 holds potential as a biomarker and therapeutic target, suggesting that inhibition of exosomal ITGB2 or restoration of DC function may improve therapeutic outcomes in TNBC.

20(S)-Ginsenoside Rg3 Partially Induces Maturation of HepG2 Cells via the AMPK/HNF4A Pathway

Li Zheng — 2025-06-11

Background: We aimed to investigate whether 20(S)-ginsenoside Rg3 (Rg3) reduced heterogeneity by inducing the maturation of HepG2 cells via the AMP-activated protein kinase (AMPK)/hepatocyte nuclear factor 4A (HNF4A) pathway.

Methods: This in vitro cell research study was conducted under the guidance of Hebei Medical University, Hebei, China, from Sep 2022 to Dec 2023. HepG2 cells were treated with varying concentrations of Rg3 in a low glucose microenvironment. The mRNA expression of ALBUMIN (ALB, a marker for hepatocyte function) and HNF4A (a marker for differentiation of HCC cell), and AMPK protein levels were measured after significant changes in cell morphology were observed. Additionally, 5-Aminoimidazole-4-carboxamide1-β-D-ribofuranoside (AICAR) (an AMPK agonist) and Compound C (an AMPK inhibitor) were used to explore further the underlying mechanism.

Results: Under treatment of 5 μM, 10 μM, and 20 μM Rg3, some cells became flattened and larger, and there was an increase in the mRNA expression of ALB and HNF4A (P<0.05). However, there was a decreasing trend in AMPK protein content with 8 μM Rg3 (P<0.05). Compared to the control group, some cells exposed to 8 μM Rg3 exhibited pronounced morphological changes, along with upregulated expression of ALB and HNF4A mRNA. However, no such changes were observed when 8 μM Rg3 was combined with 1.6 mM AICAR. Compared to the control group, 10 μM Compound C or 8 μM Rg3 treatments led to similar changes in cell morphology and showed an increasing trend in HNF4A mRNA expression. Additionally, after treatment with Compound C, pHNF4A was mainly in the nucleus, while after Rg3 treatment, it was mostly in the cytoplasm.

Conclusion: Rg3 partially induced the maturation of HepG2 cells through the AMPK/HNF4A pathway.

Mediating Role of Physical Activity in the Relationship between Personality Traits and Body Mass Index (BMI) among the Participants of the Employees’ Health Cohort Study of Iran (EHCSIR): A Generalized Structural Equation Modeling

Seyed Abbas Motevalian — 2025-06-11

Background: Considering the high importance of the problem of obesity and its related factors, we aimed to investigate the mediating role of physical activity in the relationship between personality traits and body mass index (BMI) in the participants of the employees’ health cohort study of Iran (EHCSIR) using generalized structural equation modeling (GSEM).

Methods: A secondary analysis with cross-sectional approach was conducted on the existing data using multilevel GSEM. The primary data of the cohort was collected from July 2017, Iran University of Medical Sciences, Tehran, Iran. Personality traits were exposure, physical activity was the mediator, and BMI was the outcome. Sex was the stratifying variable. Then, pathways with the largest P values were removed one by one using backward stepwise approach.

Results: The data of a total of 3554 participants of EHCSIR were used. Sex was subjected for grouping the analysis. In males, extroversion (EX) was the only personality trait associated with both physical activity and BMI. In the direct pathway, EX was positively associated with BMI. In the indirect pathway, EX was negatively associated with BMI (P <0.1). The total effect was positive. In females, physical activity was not associated with BMI, and therefore, no indirect pathway was formed from personality traits to BMI (P >0.1).

Conclusion: The role of personality traits in obesity was more dominant in females, while in males, physical activity had a role in obesity. The hypothesized mediation pathway of the study title was not approved in females, and in males, was approved only for EX personality trait.

Serum Levels of Blood Minerals (Fe, Mg) and Vitamins (D, B12) in Suicide Attempters

Marzie Salandari Rabori — 2025-06-11

Background: Suicide is an intentional act that results in the death of a person. Clinical researchers show that a new era has begun in understanding suicide pathophysiology. Our study assessed serum minerals (Fe, Mg) and vitamins (D, B12) to see if they are related to suicide attempts.

Methods: This is a cross-sectional study conducted in Ali-ebn-Abi Taleb Hospital, Rafsanjan City Central District, Kerman Province, Iran in 2022. Prior to measuring the quantity of essential minerals and vitamins in the blood, the degree of depression was assessed using the Beck depression severity scale. Chi-square, Independent T-test, Kruskal-Wallis, and Mann Whitney U test were performed to ascertain the existence of an association between these substances within the body and suicide attempts.

Results: Thirty-two attempted suicides (24 women and 8 men, mean age 14-46 yr) were included in this study. The mean and standard deviation of depression scores for 32 candidates was 16.43 ± 26.74. Moreover, our results show nearly 46.7% (50% women and 37.5% men) of participants suffer from vitamin D deficiency and 6.7% from Mg deficiency, half of them have also severe depression.

Conclusion: One of the reasons for the cause of depression and suicide attempt could be the status of minerals and vitamins in the body. Therefore, it is likely that a suitable diet and checking blood factors might help to reduce suicide attempts in a society.

Assessing Catastrophic Health Expenditure among Iraqi Households: A Cross-Sectional Study

Zainab Abodi — 2025-06-11

Background: Catastrophic health expenditures can lead to severe household financial burdens, exacerbating poverty and limiting access to necessary health services. This study examined the prevalence and determinants of catastrophic health expenditures among households in six provinces of Iraq.

Methods: A cross-sectional design was employed, gathering data from 2,400 households in Baghdad, Wasit, Karbala, An-Najaf, Babil, and Maysan in 2023. A two-stage cluster sampling method was utilized, selecting 400 households from each province. Data were collected using WHO "World Health Survey" questionnaire, focusing on health expenditures and household income. Catastrophic health expenditures as defined as out-of-pocket costs exceeding 40% of a household’s capacity to pay. Statistical analyses, including logistic regression with calculating adjusted odds ratio, were performed using STATA14 software.

Results: Overall, 246 households (12.6%) faced Catastrophic health expenditures, with a higher prevalence among female heads of households (13.1%) compared to males (12.6%). The multivariate logistic regression analysis indicated that households with 4 to 6 members had 1.52 times higher odds of facing catastrophic health expenditures (AOR=1.52, CI: 1.06 to 2.20). Furthermore, the poorest households had an AOR of 95.28 for experiencing catastrophic health expenditures (OR=95.28, CI: 13.12 to 691.49).

Conclusion: This study underscores the urgent need for tailored policies to reduce the impact of CHE on Iraqi households. By improving access to healthcare and promoting equitable health insurance enrollment, policymakers can alleviate financial strain and support the health and well-being of vulnerable communities.

Validation of a Comprehensive Ergonomic Risk Assessment Technique for Tea Harvesting Farmers and Comparison with some Techniques

Adel Mazloumi — 2025-06-11

Background: We aimed to validate a thorough ergonomic risk assessment method for tea harvesting farmers. A comparative analysis with established methods such as OWAS (Ovako Working Posture Assessment System), RULA (Rapid Upper Limb Assessment), and REBA (Rapid Entire Body Assessment) was also conducted.

Methods: The research was carried out in 2023 in Guilan Province. The research consisted of three phases: identifying risk factors influencing Musculoskeletal Disorders, validating these factors using the fuzzy Delphi technique (FDT) and fuzzy analytic hierarchy process (FAHP) methods, and developing a method that included a customized posture evaluation technique and questionnaire design. The criteria were categorized into personal, task-related, tools and equipment, environmental, and organizational factors. A team of experts evaluated the validity and reliability of the developed method.

Results: Out of 60 identified risk factors, 43 were approved. Task-related factors were deemed the most important, while organizational factors were considered the least important by experts. A comparison of evaluator agreement across different tasks using various evaluation methods revealed good agreement in the developed method and REBA, but low agreement in the other two methods. Kappa coefficients for reliability assessment ranged from 0.61 to 0.80 among expert groups.

Conclusion: The proposed developed technique had acceptable validity and reliability. In addition to posture evaluation, this technique evaluates personal, environmental, and organizational items using a questionnaire. Comparisons with established methods, including OWAS, RULA, and REBA, revealed that the developed method demonstrates a stronger correlation with disorders due to shared characteristics.

Anticancer Effects of Escherichia Coli-Derived Outer Membrane Vesicles against Colorectal Cancer Cells through Regulation of Apoptosis

Marjan Ghiyasvand — 2025-06-11

Background: Colorectal cancer is one of the deadliest cancers with poor prognosis and limited treatment options. Microbiota and their metabolites, including toxins, have been shown to possess anti-tumor properties. Outer membrane vesicles (OMVs) from Escherichia coli may trigger inflammation in intestinal cells. We aimed to explore the anti-cancer effects of E. coli-derived OMVs on colorectal cancer cells by promoting apoptosis and pyroptosis, particularly through the over-expression of GSDMD in the CT-26 cell line.

Methods: In 2022, five non-replicating probiotic strains of E. coli were obtained from the Histogenotech Company in Tehran, and their OMVs were isolated and characterized. The CT-26 cell line was used to assess cell toxicity and the apoptotic effects of E. coli-derived OMVs. Real-time PCR and western blotting were performed to measure the expression of apoptosis and pyroptosis markers (GSDMD, NLRP3, and ROCK).

Results: The E. coli strains produced nanovesicles (5-200 nm in diameter). OMVs significantly reduced the viability of CT-26 cells and induced apoptosis at a concentration of 10 µg. The expression of GSDMD and NLRP3 was increased, while ROCK expression was downregulated in treated colorectal cells.

Conclusion: E. coli-derived OMVs can trigger inflammatory processes and induce negative effects on colorectal cancer cells. Further research is needed to evaluate their potential for colorectal cancer treatment.

Adaptation of Social Media Addiction Scale for Adults: Validity-Reliability Study

Yasemin Ozkaya — 2025-06-11