Iranian Journal of Public Health

The Correlation of Blood Immune Cells with the Pathogenesis of Schizophrenia: A Meta-Analysis

Fengyu Xue , Zhijun Li, Lijuan Yan , Qiong Yu , Yanchi Zhang — Tue, 09 Sep 2025 08:20:41 +0000

Background: We have included literature on changes in immune cells in patients with schizophrenia and have systematically and quantitatively reviewed these studies through meta-analysis, with a view to understanding the potential effects of immune system dysfunction on the pathophysiology of schizophrenia.

Methods: We conducted a systematic search in PubMed, Embase, Web of Science, and the Cochrane Library, covering publications from inception to Sep 25, 2023. The systematic review followed the PRISMA guidelines, and a random-effects meta-analysis was performed. Heterogeneity was evaluated using the I² index, and sensitivity analyses were conducted to assess the stability of the findings.

Results: The systematic review includes 42 studies on schizophrenia. Meta-analysis revealed that compared to the control group, schizophrenia patients had significantly higher white blood cell counts (WBC, P<0.01), CD4 absolute values (P=0.02), CD4 percentage (CD4%, P=0.05), CD4/CD8 ratio (P<0.01), monocyte-to-lymphocyte ratio (MLR, P<0.01), neutrophil-to-lymphocyte ratio (NLR, P<0.01), and platelet-to-lymphocyte ratio (PLR, P<0.01). No significant differences were observed for other immune markers in the meta-analysis.

Conclusion: The number of immune cells in the blood of patients with schizophrenia increased. Therefore, more research on immune system abnormalities in schizophrenia patients is needed to better understand the underlying mechanisms between schizophrenia and immune cell parameters.

Lay Health Worker Led Diabetes Task-Sharing Intervention in Middle-Income Countries: A Systematic Review and Meta-Analysis

Kangtai Zheng — Tue, 09 Sep 2025 08:23:08 +0000

Background: Task-sharing in diabetes management may be useful for health systems in staff- and resource-poor middle-income countries. The study evaluated the effectiveness of a task-sharing intervention for diabetes led by non-professional health workers in improving glycaemic indicators and blood pressure among adults in middle-income countries.

Methods: Embase, PubMed, MEDLINE and Cochrane Central Registry of Controlled Trials were searched for studies published from 2010-2022. Intervention studies involving task-sharing strategies for managing diabetes and other cardiovascular risk factors were included. Extracts were made on populations, interventions, and lay health worker training and supervision. The quality of studies was assessed using the Cochrane Risk of Bias tool. Performed a meta-analysis of randomised controlled trials. A random-effects model was used due to significant heterogeneity among the studies (I² ≥ 50%), otherwise, a fixed-effect model was used.

Results: Thirteen randomised controlled trials with 8183 patients were included in the meta-analysis. The population average pooled mean difference in HbA1c was -0.17% (95% CI -0.34 to -0.01) and in fasting blood glucose was -0.75 mmol/L (95% CI -1.14 to -0.35). The population average pooled mean difference in systolic blood pressure was -5.90 mmHg (95% CI -8.11 to -3.68) and in diastolic blood pressure was -2.25 mmHg (95% CI -3.10 to -1.40).

Conclusion: Task-sharing interventions for diabetes led by lay health workers in middle-income countries have shown potential for lowering blood glucose levels and reducing blood pressure.

Acupoints Compatibility Rules of Acupuncture for Functional Gastrointestinal Disorders Based on Data Mining Technology: A Systematic Review

Tue, 09 Sep 2025 08:43:34 +0000

Background: We aimed to comprehensively summarise and classify the rules for selecting acupoints for acupuncture for functional gastrointestinal disorders (FGIDs).

Methods: We searched relevant literature in PubMed, Embase, Web of Science, the Cochrane Library, China Biology Medicine, China National Knowledge Infrastructure, Wanfang Data, and Chinese Scientific Journal Database from the inception of the database to 18 Aug 2023. Following literature screening, data extraction, standardised processing, frequency analysis, association rules analysis, and correlation analyses were conducted using Microsoft Excel, IBM SPSS Modeller, Cytoscape, and R software.

Results: Zusanli (ST36), Tianshu (ST25), and Shangjuxu (ST37) were the most used acupoints. The stomach meridian, conception vessel, and bladder meridian were the more commonly used. The Five-shu points were the most used acupoints. The Shangjuxu-Tianshu (ST37-ST25) combination was the most common acupuncture combination in clinical settings. Furthermore, the acupoints ST36, ST25, Zhongwan (CV12), and Guanyuan (CV4) constituted the core groups of acupoints.

Conclusion: We summarized the current characteristics of acupuncture treatment for FGIDs, including the selection of acupoints, meridians, and specific acupoints. The stomach meridian of foot-yangming is frequently utilised, as it aligns with the core meridian theory of "Where the meridian passes through, that's the key point of healing" and "The relationship between meridians and internal Zangfu (脏腑)". The treatment of FGIDs focuses on specific acupoints, with the most effective option being the combination of the Front Mu and Lower-he(sea) points. These findings provide novel insights for the clinical management of FGIDs

Tools for Assessing Psychological Distress and Dietary Patterns among School Teachers: A Scoping Review

Tue, 09 Sep 2025 09:47:15 +0000

Background: Unhealthy eating habits and behaviours among educators contribute to mental health issues, which profoundly affect both physical health and work-related wellness. The objectives of the review were to identify the prevalence of psychological distress and dietary habits among teachers and the tools used to assess psychological distress and dietary intake or behaviour in this population.

Methods: Three databases which are SCOPUS, PubMed and Web of Science were extensively searched to identify primary articles. Full articles were screened independently based on predefined inclusion and exclusion criteria. Fifteen studies published between 2016 and 2024 were included, following PRISMA-ScR guidelines.

Results: The prevalence of psychological distress ranged from 15% to 50%, with the most commonly used tools being the Patient Health Questionnaire (PHQ-9) and Job Content Questionnaire (JCQ). Regarding dietary behaviour, studies revealed that teachers tend to skip meals and reported moderate to high scores of Healthy Eating Index. The Food Frequency Questionnaire (FFQ) was the most commonly used tool for assessing nutritional intake.

Conclusion: Addressing these issues, interventions that incorporate emotional skills development, coping strategies and social support are required to explore this relationship in greater detail.

ACTN3 R577X and ACE I/D Polymorphisms and Sports Performance: A Systematic Review

Sedat Kahya — Tue, 09 Sep 2025 09:50:18 +0000

Background: Sporting performance is a multifactorial phenomenon that is affected by many factors. Several polymorphisms have recently been associated with sports performance. ACE I/D and ACTN3 R577X gene polymorphisms are some of these. This study aimed to investigate the relationship between ACTN3 R577X and ACE I/D polymorphisms and sports performance together with the results of studies conducted in the literature.

Methods: The review included studies on the relationship between ACTN3 R577X and ACE I/D polymorphisms and sports performance from Feb 2014 to Feb 2024. The studies registered in PubMed, PubMed Central and Google Scholar search engines were scanned. The present review included 756 cases, 2,191 controls, and 178 individuals from the cross-sectional and longitudinal studies. The PRISMA checklist and flow diagram were used to include data in the review.

Results: The review started with 224 studies, and the number of studies was reduced by 9. Then, a risk analysis was performed to determine whether 9 articles had a risk of bias. In the risk analysis conducted using the ROBINS-I tool, 3 articles were moderate, 3 articles were serious, and 3 articles were critical. Additionally, in the review, significant differences were found in 5 of the 9 studies (P<0.05).

Conclusion: ACTN3 R577X and ACE I/D polymorphisms may be evaluated together with many parameters related to performance. To our knowledge, ACTN3 R577X and ACE I/D polymorphisms may be important regulators for sports performance.

Ethylene Oxide Exposure and Its Impact on Stroke Risk and All-Cause Mortality: A Population-Based Analysis

Chenxi Li , Chao Qi , Yalong He , Baiya Fan , Ruyu Bai — Tue, 09 Sep 2025 10:06:19 +0000

Background: Ethylene oxide (EO) is widely used in various industries and has been associated with multiple health risks. However, its impact on stroke risk and all-cause mortality in the general population remains has not been definitively established. This study aimed to investigate the association between EO exposure, stroke risk, and all-cause mortality in a population-based sample.

Methods: Data were obtained from the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2018, involving 29,350 participants. After applying inclusion and exclusion criteria, 4,908 participants with detectable EO levels and complete stroke and mortality data were included in the analysis. Hemoglobin adducts of EO (HbEO) were used as a marker of exposure. Logistic regression models were used to examine the association between EO levels and stroke risk, while Cox proportional hazards models assessed the relationship between EO levels and all-cause mortality, adjusting for covariates such as age, high blood pressure, diabetes, and smoking history.

Results: Higher EO exposure levels were significantly associated with an increased risk of stroke, particularly after adjusting for covariates such as age (OR: 1.002, 95% CI: 1.001-1.003, P<0.0001) and additional covariates (OR: 1.001, 95% CI: 1.000-1.003, P=0.023). Higher EO levels were also associated with increased all-cause mortality when adjusted for age and additional covariates (HR: 1.333, 95% CI: 1.003-1.770, P=0.047).

Conclusion: This study provides evidence of a significant association between EO exposure and increased risks of stroke and all-cause mortality in the general population. Further research is necessary to confirm these findings using direct EO exposure measurements.

Efficacy of Nurse-Led Sedation Protocols in Preventing Ventilator-Associated Pneumonia in Mechanically Ventilated ICU Patients: A Systematic Review

Ling Shen , Haijie Li — Tue, 09 Sep 2025 10:21:29 +0000

Background: Ventilator-associated pneumonia (VAP) remains a significant challenge in intensive care units, especially among mechanically ventilated patients. Sedation protocols, particularly nurse-led interventions, have been suggested to improve patient outcomes by reducing the incidence of VAP. This study evaluated the effectiveness of such protocols on VAP incidence, mechanical ventilation duration and ICU length of stay.

Methods: A comprehensive search of electronic databases, including MEDLINE, EMBASE and Cochrane CENTRAL from inception to 30 August 2024 was conducted following PRISMA guidelines. Nurse-led sedation protocols and their impact on VAP outcomes were selected for meta-analysis. Data extraction included sample size, interventions, control measures and primary outcomes. Statistical analysis was performed using a fixed-effects model to calculate risk differences and odds ratios with heterogeneity assessed using the I² statistic.

Results: The systematic review comprised 15 studies, with 7 studies meeting the criteria for meta-analysis. Nurse-led sedation protocols were associated with a significant reduction in the duration of mechanical ventilation (Risk Difference: -0.21; 95% CI: -0.37 to -0.04, P=0.01). However, analyzing VAP-related mortality, the odds ratio (OR: 0.80; 95% CI: 0.60 to 1.07) indicated no statistically significant difference between intervention and control groups (P=0.14).

Conclusion: Nurse-led sedation protocols show promise in reducing the duration of mechanical ventilation, impact on VAP-related mortality remains inconclusive. Future research should focus on refining these protocols and further evaluating their long-term effects on VAP prevention and patient outcomes.

Risk Factors for Ventilator-Associated Pneumonia in Elderly ICU Patients: A Meta-Analysis

Lu Che , Haonan Zhang , Kaili Xing — Tue, 09 Sep 2025 10:29:15 +0000

Background: To systematically evaluate the risk factors of ventilator-associated pneumonia (VAP) in critically ill elderly patients in intensive care unit (ICU).

Methods: The China National Knowledge Infrastructure (CNKI), Wanfang Database, PubMed and Web of science databases were searched to collect the literature published at home and abroad on the risk factors of ventilator-associated pneumonia in critically ill elderly patients in ICU. The publication date of the literature was up to Oct 24, 2024. Meta-analysis was performed using Stata SE14.0 software to calculate the Odds ratio (OR) and 95% Confidence intervals (CIs) of each risk factor.

Results: Thirteen articles were included, all of which were case-control studies. Age, glucocorticoids, mechanical ventilation ≥7 d, tracheotomy, gastrointestinal feeding nutrition, and acute physiological and acute physiology and chronic health evaluation ⅱ(APACHEII) score ≥15 were the risk factor for VAP in ICU patients (OR (95%CI) were 1.044 (1.004, 1.086), 4.663 (2.098, 10.363), 2.749 (1.912, 3.952), 7.405 (2.040, 26.884), 2.676 (1.888, 3.794), 1.822 (1.198, 2.771).

Conclusion: Clinical interventions targeting age, glucocorticoid use, mechanical ventilation ≥7 days, tracheotomy, gastrointestinal feeding nutrition, and APACHEII ≥15 should be prioritized to reduce VAP incidence in critically ill elderly ICU patients.

Diagnostic and Differential Effects of CRP and PCT on Respiratory Virus and Mycoplasma Pneumoniae Infections in Children with Respiratory Tract Infections: A Meta-Analysis

Chuanze Hu , Yaping Xu , Fang Sheng , Buqing Chen, Limei Cao — Tue, 09 Sep 2025 10:43:03 +0000

Background: This study aimed to investigate the differential diagnostic value of CRP and PCT in distinguishing viral and Mycoplasma pneumonia infections in children with respiratory tract infections.

Methods: A total of 13 relevant articles (12 of relatively high quality) were included after quality evaluation, through a literature search. Meta-analysis and SROC curve evaluation were performed.

Results: The pooled sensitivity and specificity of CRP diagnosis were 0.91 (95% CI: 0.893-0.937) and 0.4815 (95% CI: 0.440-0.523), respectively, and the area under the SROC curve was 0.699. The pooled sensitivity and specificity of PCT were 68.92% (95% CI: 64.9%-72.7%) and 50.00% (95% CI: 45.6%-54.4%), respectively, and the area under the curve was 0.595.

Conclusion: CRP demonstrated higher sensitivity, while PCT showed relatively better specificity. Using both together could improve diagnostic performance.

Unveiling Cadmium-Induced Cardiotoxicity: Mechanisms, Challenges, and Future Perspectives: A Narrative Review

Tue, 09 Sep 2025 10:50:05 +0000

We investigated the mechanisms of cadmium-induced cardiotoxicity, focusing on its pathophysiological effects, potential preventive strategies, and therapeutic interventions. We further explored approaches to mitigate long-term cardiovascular risks associated with cadmium exposure. This research analyzed the molecular and cellular pathways involved in cadmium toxicity, emphasizing oxidative stress, inflammation, endothelial dysfunction, platelet-leukocyte interactions, and cardiomyocyte damage. Experimental findings and existing literature were examined to uncover the mechanisms driving cadmium-induced cardiotoxicity and to identify potential therapeutic targets. Cadmium exposure leads to oxidative stress and inflammation, resulting in endothelial dysfunction, platelet-leukocyte activation, and thromboinflammation. It disrupts calcium signaling, elevates reactive oxygen species (ROS) production, and causes cardiomyocyte loss, ultimately impairing cardiac function. Cadmium also remodels ion channels and suppresses cardiomyocyte proliferation, intensifying its cardiotoxic effects. While current therapies focus on removing circulating cadmium, they do not address the residual cardiovascular damage caused by prior exposure. Cadmium exerts significant cardiotoxic effects through oxidative stress, inflammation, and cellular activation. Future therapeutic strategies should target these pathways, particularly the activation of platelets, leukocytes, and endothelial cells, to reduce cadmium-induced cardiovascular damage and improve long-term outcomes.

Determinants of Childbearing: Behavioral Change Models and Theories: A Systematic Review

Thu, 11 Sep 2025 00:00:00 +0000

The decline in total fertility rate (TFR) below replacement levels has significant implications for public health. This comprehensive narrative review aimed to examine behavioral change models and theories pertinent to childbearing decisions. Articles published between 1977 and 2024 were retrieved from from domestic databases (Magiran, SID) and international databases (Web of Science, Scopus, ProQuest, PubMed, MEDLINE), as well as Google Scholar using relevant keywords. Out of 90 articles initially identified, 36 met the inclusion criteria and were selected for analysis. Existing behavioral change models in health education have limitations in motivating couples to increase childbearing. These models do not fully address complex and multifaceted factors such as socio-economic and cultural influences. Furthermore, there is a need for more rigorous and comprehensive evaluations of the effectiveness of interventions based on these models. Evidence-based educational programs, tailored incentive policies, and rigorous model evaluation are essential to promote positive attitudes towards parenthood. Future interventions should assess the applicability of novel theories to optimize fertility program outcomes, with a particular focus on the role of public health. Further research is needed to investigate innovative models for explaining and changing childbearing behaviors.

Fasting Challenges among Patients with Cancer; Focus on Ramadan Fasting: A Systematic Review

Marziyeh Ghalamkari, Leyla Sahebi, Sara Toogeh, Gholamreza Toogeh — Thu, 11 Sep 2025 13:15:12 +0000

Background: We evaluated the effects of fasting on cancer treatment outcomes, gathering evidence separately from human clinical trials and in vitro (animal) studies.

Methods: A comprehensive search was conducted using the PubMed, Scopus, and Web of Science databases. Studies were included if they examined the effects of fasting on cancer treatment outcomes in vitro or in human subjects, regardless of study design, sample size, or country of origin.

Results: A total of 16 studies were included, consisting of 6 in vitro and animal studies and 10 human clinical trials. In vitro and animal studies consistently showed that fasting enhances the efficacy of chemotherapy and reduces its toxic side effects. Human clinical trials indicated that short-term fasting could decrease chemotherapy-induced side effects such as nausea, fatigue, and immunosuppression while improving overall response rates. However, the number of clinical trials is limited, and there is significant variability in study designs, fasting protocols, and endpoints.

Conclusion: Fasting may serve as a beneficial adjunct to cancer therapy, particularly in mitigating chemotherapy-induced side effects and enhancing treatment efficacy. Despite these promising results, further large-scale, well-designed clinical trials are necessary to confirm these findings and establish standardized fasting protocols. Future research should also investigate the long-term effects of fasting and its impact on different cancer types and treatment modalities. While some patients may fast without significant adverse effects, the primary concern should always be their safety and well-being.

Association between Thyrotoxicosis and Gestational Diabetes Mellitus: A Mendelian Randomization Study

Yizhen Chen, Shaoxing Guan, Xiaorong Su, Wei Zhuang — Thu, 11 Sep 2025 13:22:52 +0000

Background: Insulin resistance and abnormal glucose metabolism are the main characteristics of thyrotoxicosis and gestational diabetes mellitus (GDM). However, it remains unclear whether thyrotoxicosis increases the risk of GDM. Therefore, this research aimed to explore the causality between thyrotoxicosis and GDM by using a Mendelian randomization (MR) analysis.

Methods: A MR analysis was conducted to explore the causal effects of thyrotoxicosis on GDM. Summary statistics data of thyrotoxicosis (3115 thyrotoxicosis cases and 187684 controls) and GDM (13039 cases and 197831 controls) were derived from genome-wide association study. We selected MR Egger, Weighted median, Inverse-variance weighted, Simple mode and Weighted mode to evaluate the causal effect between thyrotoxicosis and GDM.

Results: By using a two-sample MR analysis, we found a strong causal relationship between thyrotoxicosis and GDM as indicated by Inverse-variance weighted (OR=1.069; beta=0.067; 95%CI=1.023-1.118; P=0.003), Weighted median (OR=1.087; beta=0.084; 95%CI=1.040-1.137; P=0.0002), Simple mode (OR=1.102; beta=0.097; 95%CI= 1.038-1.170; P=0.013) and Weighted mode (OR=1.089; beta=0.085; 95%CI=1.033-1.147; P=0.013). No significant pleiotropy, heterogeneity, genetic correlations or bi-directional causal relationship was existed in this study. Bayesian colocalization suggested that thyrotoxicosis colocalized with GDM on rs10830963 (PP.H4 = 1.000), where rs10830963 was located on MTNR1B gene locus.

Conclusion: Thyrotoxicosis had a causal effect on the risk of developing GDM, and the exposure of thyrotoxicosis increased the risk of GDM.

Effects of a Periodic Assessment of Heart Failure and Depressive Symptoms on Self-Care in Outpatients with Heart Failure: A Randomized Controlled Trial

JinShil Kim, Jisun Yang, KyungAh Cho, Sang Yi Baek, Seongkum Heo — Thu, 11 Sep 2025 13:27:14 +0000

Background: Periodic symptom assessment in outpatient settings may enhance self-care in heart failure (HF) patients, though its effects are not fully studied. This study examined the impact of periodic HF and depressive symptom assessments on self-care (maintenance, symptom perception, and management) over nine months.

Methods: In this randomized controlled trial, symptom assessments were conducted in the intervention group at baseline and at three, six, and nine months in South Korea between Sep 2022 and Nov 2023. Data on self-care were collected at baseline and at nine-month follow-up. A series of two-way repeated measures analysis of variance were used to address the purpose.

Results: The only variable that showed a significant difference between the intervention group (n=17, age=64.8 yr) and the control group (n=21, age=64.6 yr) from baseline to nine-month follow-up was self-care maintenance. The main effect of time on self-care maintenance was statistically significant, improving from baseline to follow-up regardless of group (F[1,36])=26.53, P<0.001). A significant group-by-time interaction (F[1,36] = 26.53, P=0.015) indicated the changes in self-care maintenance varied over time by group membership.

Conclusion: A periodic assessment of HF symptoms and depressive symptoms increased self-care maintenance, but did not affect other self-care behaviors, in outpatients with HF. Clinicians may consider regular outpatient symptom assessment as a tool for educational support to enhance self-care maintenance in patients with HF.

The Roles of the Coach and Athletic Identify in Mitigating Burnout: Evidence from Korean Male Wrestlers

Jae-Yo Kim, Sangmin Jeon, Ho-Hyun Song — Thu, 11 Sep 2025 13:41:33 +0000

Background: In elite Korean wrestling, a sport marked by cultural hierarchy and limited athlete participation, the coach–athlete relationship plays a critical role in shaping an athlete’s development and wellbeing. However, the psychological mechanisms linking the coach–athlete relationship to burnout remain underexplored. This study investigated the mediating role of athletic identity in the relationship between the coach–athlete relationship and athlete burnout among Korean male wrestlers.

Methods: We conducted a cross-sectional survey with 369 officially registered Korean male wrestlers (20.37±4.01 years old) from high school, collegiate, and professional levels from whole Republic of Korea via online survey using Google Forms. Participants completed validated measures of the coach–athlete relationship, athletic identity, and athlete burnout. Structural equation modeling with bootstrapping procedures was used to assess direct and indirect effects.

Results: The coach–athlete relationship significantly predicted athletic identity (β=0.705, P<0.001) but did not directly affect athlete burnout (β=–0.101, P=0.212). Athletic identity negatively predicted burnout (β=–0.635, P<0.001) and fully mediated the relationship between the coach–athlete relationship and burnout (indirect effect: β=–0.448, P=0.010). These results suggest that athletic identity serves as a protective psychological factor, mitigating burnout even when relational quality is high.

Conclusion: While a positive coach–athlete relationship alone does not directly reduce burnout; it exerts an indirect protective effect by enhancing athletic identity. Strengthening athletic identity through supportive coaching may be key to reducing psychological exhaustion among male wrestlers in culturally hierarchical sports environments.

Identification of Potential Biomarkers for Osteoarthritis

Franko Shehaj, Ahmed Jasim Mahmood Al-Mashhadani , Haohuan Li — Thu, 11 Sep 2025 13:44:36 +0000

Background: We aimed to identify biomarkers associated with Osteoarthritis (OA) and evaluate their predictive capabilities.

Methods: Four synovial tissue datasets (GSE1919, GSE12021, GSE55235, GSE55457) and one peripheral blood mononuclear rcells (PBMC) dataset (GSE48556) were obtained. GSE55235 and GSE55457 were merged to conduct differential expression analysis and train machine learning algorithms. Predictive models were trained using a subset of genes and then validated on the other datasets. In addition, PBMC dataset was used to train predictive models using the same subset of genes, with the synovial tissue datasets serving as validation datasets. Finally, immune infiltration analysis was performed in the merged synovial tissue dataset using CIBERSORT.

Results: RPA3, LAMA5, SAT1, and UCP2 were used to train machine learning algorithms. Predictive models performed well in synovial tissue datasets but faced challenges in the PBMC dataset, as models achieved high sensitivity but moderate specificity. However, models trained on the PBMC dataset exhibited high sensitivity and specificity in the four external validation datasets. SAT1 exhibited the highest impact on the model performance. Immune infiltration analysis revealed significant differences in the expression of several immune cells, such as mast cells, between OA and control groups. In general, the four genes showed moderate to strong correlations with mast cells.

Conclusion: While promising, our findings point to the need for further studies to validate biomarkers and improve the models' predictive power across diverse sample types.

Simulation-Based Performance Scenarios for a Health House and Health Post: An Empirical Study

Thu, 11 Sep 2025 13:47:57 +0000

Background: Enhancing the performance of healthcare provider units, such as Health Houses (HHs) and Health Posts (HPs), is vital for improving service delivery. We aimed to develop simulation-based scenarios to optimize performance and minimize risks associated with decision-making.

Methods: Conducted in 2021, this empirical study utilized operational research methods at one HH and one HP in southern Tehran. The operational characteristics of these units were modeled using Arena 20 simulation software. Additional performance scenarios were iteratively developed based on expert recommendations. Key performance metrics from the simulations were evaluated and ranked using the nominal group technique and Expert Choice software.

Results: Four distinct scenarios were developed for both units. The fourth scenario emerged as the optimal model, receiving the highest expert scores for both the HH (score: 349) and HP (score: 418). This scenario demonstrated significant improvements in key indicators, including the number of patients admitted (HH: 24; HP: 31), patients served (HH: 23; HP: 33), health worker productivity (HH: 95%; HP: 47%), and reduced patient waiting times (HH: 4.45 min; HP: 0 min).

Conclusion: The study recommends adopting the fourth scenario as a benchmark for HHs and HPs in suburban areas of major Iranian cities. The employed simulation methodology and evidence-based scenarios can be applied to other healthcare units, aiding in performance forecasting and system optimization

Evaluation of Ferroptosis-Related Genes in Gastric Cancer via Bioinformatics Analysis

Thu, 11 Sep 2025 13:55:12 +0000

Background: Gastric cancer (GC) ranks among the most prevalent malignancies globally, contributing significantly to both morbidity and mortality. Ferroptosis, a unique iron-dependent form of cell death, has been implicated in various cancers, including GC. This study investigated the association between ferroptosis-related genes (FRGs) and GC using bioinformatics analyses.

Methods: Differentially expressed genes (DEGs) were identified using a publicly available microarray dataset. Genes associated with ferroptosis were then extracted, and their overlap with the DEGs was assessed. To gain further insights, functional enrichment analysis was performed, followed by the prediction of microRNA (miRNA) and transcription factor (TF) interactions. Additionally, a protein-protein interaction (PPI) network was constructed. Key genes were identified using the CytoHubba extension in Cytoscape, and their prognostic value was analyzed through receiver operating characteristic (ROC) curve evaluation.

Results: Overall, 3242 DEGs were identified, of which 78 were ferroptosis-related (DEFRGs). These DEFRGs were enriched in pathways such as ferroptosis and pathways in cancer. Among them, hsa-miR-106a-5p and SP1 were identified as key miRNA and TF, respectively. The PPI network revealed five hub genes: TP53, MDM2, KRAS, IL6, and PTGS2. ROC curve analysis demonstrated that all hub genes have excellent prognostic value for GC.

Conclusion: This study highlights the critical association between GC and ferroptosis-related genes using bioinformatics tools. These findings provide insights for future investigations and the development of targeted therapies against GC.

Silver Nanoparticles Synthesised Using Sargassum Angustifoli-um Can Effect on MiR-25 and MiR-143 Expression in Acute Lymphoblastic Leukemia

Thu, 11 Sep 2025 14:00:07 +0000

Background: One of the treatments of acute lymphoblastic leukemia (ALL) is chemotherapy but it can destroy other normal cells as well as cancer cells, which can lead to infection and bleeding. The widespread consumption of nanoparticles synthesized biogenically by seaweed is because of their easy accessibility and usefulness. We aimed to investigate silver nanoparticles synthesised using Sargassum on the expression of miR-25 and 143 in Jurkat cell line.

Methods: In an interventional study in 2019, Bushehr, Iran, following culture of the Jurkat cell line with 95% survival rate, we applied different drug concentrations to 20,000 cell lines and control cells separately to determine maximum cell growth inhibition and IC50. After treatment for 48 h, RNA extraction was performed, and Real Time PCR was used to evaluate miR-25 and 143 expressions.

Results: MiR-25 expression in the groups that treated with the maximum dose and IC50 of silver nanoparticles and algae extract was decline but did not differ significantly from that of the control group. Conversely, miR-143 showed a remarkable decline in both treatment groups (P<0.0001). After treating PBMC with nanoparticles the expression level of miR-25 and miR-143were not significantly different.

Conclusion: The level of miR-25 and 143 expressions were decrease in the IC50 dosage of silver nanoparticles and algae extract produced. The level of miR-25 expression decreased more in the treated Jurkat cell line than the level of miR-143 expression in normal lymphocytes. Given the oncogenicity of miR-25 in the Jurkat cell line, it is suggested that decreasing level of this microRNA can help to apoptosis of leukemic cells.

Macro Socioeconomic Determinants of Suicide in Iran: A Time Series Study during 1991-2023

Maryam Mokhtari, Siroos Ahmadi — Thu, 11 Sep 2025 14:02:35 +0000

Background: Although suicide is ultimately committed by individuals, it is influenced by a wide range of factors, from micro to macro levels.

Methods: This time-series research examines the relationship between macro socioeconomic variables and the suicide rate from 1991 to 2023. The data were collected from the Statistical Center of Iran (SCI), the Central Bank of Iran (CBI), and the World Bank (WB). Time series charts were used to describe the data, and an autoregressive distributed lag (ARDL) model was employed for examining the relationship among variables using the Microfit 5 software.

Results: The results indicate a significant negative relationship between inflation, urban population, and women's participation in the labor force with suicide, but a significant positive relationship between mobile phone penetration and labor force participation with suicide rate. Furthermore, literacy and GDP per capita were not associated with the suicide rate.

Conclusion: Macro socioeconomic indicators impact on suicide rates. By better understanding the mechanism of this impact and appropriate planning, suicide rates can be reduced.

Physical Activity-Induced Improvement in Sleep Quality in Elderly Individuals with Mild Cognitive Impairment

Seung-Taek Lim — Thu, 11 Sep 2025 14:04:42 +0000