The Lag -Effects of Air Pollutants and Meteorological Factors on COVID-19 Infection Transmission and Severity: Using Machine Learning Techniques.

BACKGROUND: Exposure to air pollution is a major health problem worldwide. This study aimed to investigate the effect of the level of air pollutants and meteorological parameters with their related lag time on the transmission and severity of coronavirus disease 19 (COVID-19) using machine learning (ML) techniques in Shiraz, Iran. Study Design: An ecological study. METHODS: In this ecological research, three main ML techniques, including decision trees, random forest, and extreme gradient boosting (XGBoost), have been applied to correlate meteorological parameters and air pollutants with infection transmission, hospitalization, and death due to COVID-19 from 1 October 2020 to 1 March 2022. These parameters and pollutants included particulate matter (PM2), sulfur dioxide (SO2 ), nitrogen dioxide (NO2 ), nitric oxide (NO), ozone (O3 ), carbon monoxide (CO), temperature (T), relative humidity (RH), dew point (DP), air pressure (AP), and wind speed (WS). RESULTS: Based on the three ML techniques, NO2 (lag 5 day), CO (lag 4), and T (lag 25) were the most important environmental features affecting the spread of COVID-19 infection. In addition, the most important features contributing to hospitalization due to COVID-19 included RH (lag 28), T (lag 11), and O3 (lag 10). After adjusting for the number of infections, the most important features affecting the number of deaths caused by COVID-19 were NO2 (lag 20), O3 (lag 22), and NO (lag 23). CONCLUSION: Our findings suggested that epidemics caused by COVID-19 and (possibly) similarly viral transmitted infections, including flu, air pollutants, and meteorological parameters, can be used to predict their burden on the community and health system. In addition, meteorological and air quality data should be included in preventive measures.

The Effect of Oral Colostrum Application on the Condition of the Mouth and Incidence of Late-Onset Sepsis Among Premature Infants: A Randomized Controlled Trial.

BACKGROUND: Premature infants have higher risks of infection due to their underdeveloped immune systems and changes to the oral cavity's normal flora colonization. PURPOSE: To assess the effect of oral colostrum application on the condition of the mouth and the incidence of late-onset sepsis (LOS) among premature infants. METHODS: In this randomized controlled trial, 70 newborn premature infants were randomly allocated to colostrum or sterile water groups. The Mouth Care Assessment Tool was used to evaluate the condition of the mouth for 5 days after oral colostrum application. The incidence of LOS was measured using clinical and laboratory indicators from 72 hours after birth until discharge. RESULTS: The condition of the mouth was significantly different on days 4 and 5, demonstrating that the colostrum group had less need for oral care ( P < .001) compared to the control group. There was no significant difference between the 2 groups in clinical symptoms and laboratory values related to LOS ( P > .05). IMPLICATIONS FOR PRACTICE: Oral colostrum application can benefit oral mucosal health and reduce the need for oral care among premature infants. It is also safe alternative oral care for premature infants who cannot breastfeed during the first few days of life. Future research should include infants of different gestational ages and mechanically ventilated infants to assess the effect of oral colostrum application on serum immune factors.

Geospatial analysis for environmental noise mapping: A land use regression approach in a metropolitan city.

Environmental noise can lead to adverse health outcomes. Understanding the spatial variability of environmental noise is crucial for mitigating potential health risks and developing influential urban strategies for reducing noise levels. This study aimed to measure noise levels and develop a land use regression (LUR) model to determine the spatial variability of environmental noise in Shiraz, Iran. A grid-based technique was used to establish 191 noise measurement sites (summer) across the city to generate the LUR model based on two noise metrics: Lden and Lnight. Leave-one-out cross-validation (LOOCV) and 38 additional measurement sites (winter) were used for the LUR model assessment. The mean values of Lden and Lnight during summer were 68.20 (±8.05) and 58.95 (±9.55), respectively, while during winter, the corresponding values were 69.46 (±5.46) and 58.81 (±6.79). The LUR models explained 67% and 65% of the spatial variability in Lden and Lnight, respectively. LOOCV analysis demonstrated R2 values of 0.64 and 0.61. Moreover, findings indicated mean absolute error (MAE) values of 3.96 dB(A) for Lden and 4.74 dB(A) for Lnight. Validation based on an additional set of 38 measurement sites revealed R2 values of 0.62 for both Lden and Lnight, with MAE of 2.78 and 3.31, respectively. In addition, the adjusted R2 values were 0.54 and 0.53. The results indicated no significant temporal variations between summer and winter. The results revealed that road-related variables significantly influenced noise levels. Moreover, the results indicated that Lden and Lnight levels were higher than the World Health Organization recommendations for exposure to road traffic noise. The results of our study showed that the LUR modeling approach based on geographical predictors is an effective tool for assessing changes in ambient noise levels in other cities in Iran and around the globe.

Environmental exposure to organophosphate pesticides and effects on cognitive functions in elementary school children in a Middle Eastern area.

Although the fundamental reasons for cognitive function disorders have been well documented, little is known about the impact of environmental exposures, such as pesticides, on children's cognitive function development. This study investigated the effect of exposure to organophosphate pesticides on children's cognitive function. In order to determine various factors of exposure, hair samples were collected from 114 elementary school children who lived in Boyer-Ahmad County in the province of Kohgiluyeh and Boyer-Ahmad, Iran. A detailed questionnaire was utilized to gather demographic information and exposure profile. Pesticides were detected in hair samples using a gas chromatography-mass spectrometer (GC-MS); also, cognitive function was assessed using the trail-making test (TMT), which was divided into two parts: TMT-part A and TMT-part B. Participants in the study were 10.12 ± 1.440 years old on average. Children in rural areas had higher mean total pesticide concentrations (13.612 ± 22.01 ng/g) than those who lived in the urban areas (1.801 ± 1.32). The results revealed that boys (46.44 s and 92.37 s) completed the TMT-part A and part B tests in less time than girls (54.95 s and 109.82 s), respectively, and showed better performance (2.14) on the cognitive function exam than girls (2.07). Diazinon and TMT-part B were positively correlated (p < 0.05). With the increase in pesticides, there was no discernible difference in cognitive function. Pesticide use throughout a child's development may affect certain cognitive function indicators. In order to assess causal relationships, group studies and case studies are required because the current research was cross-sectional in nature.

Heavy metals in edible red soil of the rainbow island in the Persian gulf: Concentration and health risk assessment.

Red soil of Hormuz Island has become a tourist attraction and it has various industrial applications. Despite the uncertainty of the health effects, geophagy is one of the common ways of people exposure to the red soil. This soil is widely used as a local spice and plays an important role in the food culture of the region. This study aimed to quantify the level of selected heavy metals (Co, Cr, Cu, Fe, Mn, Mo, Ni, Pb, V, Zn, Ag, Cd, Hg) in the red soil. The content of the metals was measured by ICP-MS (inductively coupled plasma-mass spectrometry). Moreover, risk assessment via heavy metals was carried out by computing the values of Total Hazard Quotient (THQ) and Hazard Index (HI). The results of this study showed that Fe was the most abundant metal among all analyzed metals and the health risk associated with Fe was individually higher than other measured metals. Altough the value for total heavy metals toxicity assessment was found lower than 1 , due to increasing use of red soil as a spice among Hormuz island natives, establishing special industries in order to reducing the amount of heavy metals content in red soil is recommended.

Non-carcinogenic and cumulative risk assessment of exposure of kitchen workers in restaurants and local residents in the vicinity of polycyclic aromatic hydrocarbons.

Polycyclic aromatic hydrocarbons (PAHs) are often formed when organic substances do not burn completely. This study evaluates the non-carcinogenic and cumulative risks associated with PAHs levels by testing blood and urine samples in kitchen workers and residents near restaurants in Shiraz, Iran. Metabolites of PAH in the urine samples as well as clinical parameters in the blood samples were measured. The non-carcinogenic and cumulative risk assessments from exposure of the study groups to PAH metabolites were also evaluated. The highest average concentrations of PAH metabolites were related to kitchen workers (2126.7 ng/g creatinine (ng/g cr)). The metabolites of 1-Hydroxypyrene (1-OHP) and 9-Phenanthrene (9-OHPhe) had the highest and lowest mean concentrations, respectively. A direct correlation was observed between the levels of PAH metabolites with malondialdehyde (MDA) and total antioxidation capacity (TAC) levels (p < 0.05). Hazard Index (HIi) was obtained less than one (HIi < 1), indicating low-risk negative health impacts on the target groups. Nevertheless, conducting more studies to determine the health status of these people is quite evident.

Using biomonitoring as a complementary approach in BTEX exposure assessment in the general population and occupational settings: a systematic review and meta-analysis.

Hazardous organic compounds such as benzene, toluene, ethylbenzene, o-xylene, m-xylene, and p-xylene (known as BTEX) found at work and at home can cause adverse health effects of human beings throughout their lives. Biological monitoring, an exposure assessment method, considers all exposed organic and non-organic compounds. Our goal was to perform a systematic review and a statistical analysis (meta-analysis) of peer-reviewed publications to assess urinary concentrations of BTEX biomarkers in both occupationally-exposed population and the general population. Several major electronic databases, including Scopus, Embase, Medline, Web of Science, and Google scholar (grey literature), were searched for biomonitoring studies of BTEX. Overall, 33 studies met the eligible criteria for the systematic review and six met the full inclusion criteria for meta-analysis. For meta-analysis, we included studies in which unmetabolized BTEX compounds were measured in urine samples. Due to insufficient data, studies that measured BTEX metabolites in urine samples and unmetabolized BTEX compounds in blood samples were excluded from the meta-analysis but were analyzed in the qualitative synthesis. Most studies showed increased urinary concentrations of BTEX in exposed individuals (mainly workers) compared to unexposed individuals. The results showed that the highest total BTEX concentrations were recorded in painters and policemen. This study showed that the undoubted associations between lifestyle and environmental factors and urinary levels of BTEX or its metabolites have not yet been confirmed in current biomonitoring studies. This is attributed to the few studies reported in this research area, the lack of homogeneous information, and the disagreement in the published results of the studies.

Exposure to Polycyclic Aromatic Hydrocarbons and adverse reproductive outcomes in women: current status and future perspectives.

OBJECTIVES: Polycyclic Aromatic Hydrocarbons (PAHs) are ubiquitous, toxic environmental chemicals that can cause adverse reproductive health effects. The objectives of this mini-review are to highlight the adverse reproductive outcomes due to PAH exposure with the main focus on polycystic ovary syndrome (PCOS) and premature ovarian failure (POF) and to provide perspectives on future research needs. CONTENT: We reviewed studies that have reported the adverse reproductive outcomes associated with PAHs exposures in women through a comprehensive search of bibliographic databases and gray literature sources. In addition, potentially modifiable sources of exposure to PAHs and associated reproductive outcomes were also investigated. SUMMARY: A total of 232 papers were retrieved through a comprehensive search of bibliographic databases, out of which three studies met the eligibility criteria and were included in the review. Results showed that exposure to PAHs is associated with adverse reproductive outcomes defined as PCOS, POF, and reproductive hormone imbalance. Sources of PAH exposure associated with adverse reproductive outcomes include active and passive tobacco smoking, specific cooking methods, and pesticides. OUTLOOK: Future studies are warranted to examine the mechanisms by which PAHs result in adverse reproductive endpoints in women. Further, environmental exposures that are potentially modifiable such as exposure to tobacco smoke, may contribute to PAH exposure, and these exposures should be targeted in future policies and interventions.

Ecological study of ambient air pollution exposure and mortality of cardiovascular diseases in elderly.

As an independent risk factor, ambient air pollution can assume a considerable part in mortality and worsening of cardiovascular disease. We sought to investigate the association between long-term exposure to ambient air pollution and cardiovascular disease mortality and their risk factors in Iranian's elderly population. This inquiry was conducted ecologically utilizing recorded data on cardiovascular disease mortality from 1990 to 2019 for males and females aged 50 years or more from the Global Burden of Disease dataset. Data was interned into Joinpoint software 4.9.0.0 to present Annual Percent Change (APC), Average Annual Percent Change (AAPC), and its confidence intervals. The relationship between recorded data on ambient air pollution and cardiovascular disease' mortality, the prevalence of high systolic blood pressure, high LDL cholesterol levels, high body mass index, and diabetes mellitus type2 was investigated using the Spearman correlation test in R 3.5.0 software. Our finding demonstrated that cardiovascular diseases in elderly males and females in Iran had a general decreasing trend (AAPC = -0.77% and -0.65%, respectively). The results showed a positive correlation between exposure to ambient ozone pollution (p ≤ 0.001, r = 0.94) ambient particulate and air pollution (p < 0.001, r = 0.99) and mortality of cardiovascular disease. Also, ambient air pollution was positively correlated with high systolic blood pressure (p < 0.001, r = 0.98), high LDL cholesterol levels (p < 0.001, r = 0.97), high body mass index (p < 0.001, r = 0.91), diabetes mellitus type2 (p < 0.001, r = 0.77). Evidence from this study indicated that ambient air pollution, directly and indirectly, affects cardiovascular disease mortality in two ways by increasing the prevalence of some traditional cardiovascular disease risk factors. Evidence-based clinical and public health methodologies are necessary to decrease the burden of death and disability associated with cardiovascular disease.

Biomonitoring of BTEX in primary school children exposed to hookah smoke.

Hookah smoking is one of the major indoor sources of benzene, toluene, ethylbenzene, and xylenes (BTEX). This study aimed to investigate the potential exposure to BTEX among primary school children, particularly those exposed to hookah smoke. This cross-sectional study was conducted in Khesht, one of the southwestern cities in Iran, in mid-June 2020. Totally, 50 primary school children exposed to hookah smoke were chosen as the case group and 50 primary school children were selected as the control group. Urinary un-metabolized BTEX was measured by a headspace gas chromatography mass spectrometry (GC-MS). Additionally, a detailed questionnaire was used to gather data and information from the students' parents. The mean levels of urinary benzene, toluene, ethylbenzene, m,p-xylene, and o-xylene were 1.44, 5.87, 2.49, 6.93, and 7.17 µg/L, respectively in the exposed children. Urinary BTEX was 3.93-folds higher in the case group than in the controls (p<0.05). Household cleaning products, the floor on which the house was located, children's sleeping place, and playing outdoors were found to be important factors in predicting urinary BTEX levels. Overall, it was found necessary to avoid indoor smoking to prevent the emission of BTEX compounds via exhaled mainstream smoke and to protect vulnerable non-smokers, especially children, from exposure to second-hand and third-hand smoke.

Health risk assessment of polycyclic aromatic hydrocarbons in individuals living near restaurants: a cross-sectional study in Shiraz, Iran.

Polycyclic aromatic hydrocarbons (PAHs) are persistent toxic substances that have ubiquitous presence in water, air, soil, and sediment environments, posing serious environmental risks. The present study aimed to investigate the concentrations of urinary PAHs and their health effects in individuals living near restaurants via a health risk assessment analysis. This cross-sectional study was performed on 57 people living near restaurants and 30 individuals as the control group. Five urinary metabolites of PAHs were monitored. In order to evaluate the effects of the urinary metabolites of PAHs on Malondialdehyde (MDA) concentration, Total Anti-oxidation Capacity (TAC) in urine samples, and C-Reactive Protein (CRP) in serum samples, regression model was used by considering the effects of the possible confounding factors. Non-carcinogenic health risk was calculated, as well. The median concentration of urinary PAHs was 1196.70 and 627.54 ng/g creatinine in the people living near restaurants and the control group, respectively. Among the metabolites, the lowest and highest mean concentrations were related to 9-OHPhe and 1-OHP, respectively in the two study groups. Moreover, PAHs were significantly associated with MDA level and TAC (p < 0.05). Hazard Quotient (HQ) and Hazard Index (HI) were less than 1. Long-term studies are required to determine the actual health effects by identifying the sources of PAHs emission and to find ways to decrease the production of these compounds.

Exposure assessment of children living in homes with hookah smoking parents to polycyclic aromatic hydrocarbons: urinary level, exposure predictors, and risk assessment.

Children are extremely liable to indoor air pollutants as their physiology and a few metabolic pathways are different from those of adults. The present cross-sectional study aimed to assess exposure of children living with parents who use hookah tobacco smoke to polycyclic aromatic hydrocarbons (PAHs) using a biomonitoring approach. The study was conducted on 25 children (7-13 years of age) exposed to hookah smoke at home and 25 unexposed age-matched children. Urinary levels of five metabolites of PAHs were quantified via headspace gas chromatography-mass spectrometry (GC-MS). Urinary malondialdehyde (MDA) was measured, as well. Information regarding the sociodemographic and lifestyle conditions was collected through interviews using managed questionnaires. The urinary 1-OH-NaP and 9-OH-Phe concentrations were respectively 1.7- and 4.6-folds higher in the case samples compared to the control group (p < 0.05). In addition, urinary MDA levels were 1.4 times higher in the exposed children than in the unexposed group, but the difference was not statistically significant (p > 0.05). Increasing the consumption of grilled and meat food in the diet increased the participants' urinary 2-OH-Flu and 1-OH-Pyr levels, respectively. Moreover, sleeping in the living room instead of the bedroom at night was a significant predictor of high 1-OH-NaP and 2-OH-NaP concentrations in the children's urine. Overall, the findings confirmed that children living in their homes with hookah-smoking parents were significantly exposed to naphthalene and phenanthrene. Hence, implementing protective measures is critical to reduce the exposure of this group of children.

A survey on the correlation between PM2.5 concentration and the incidence of suspected and positive cases of COVID-19 referred to medical centers: A case study of Tehran.

COVID-19, one of the greatest health challenges of the present century, has infected millions of people and caused more than 6 million deaths worldwide. The causative agent of this disease is the new virus SARS-CoV-2; which continues to spread globally and sometimes with new and more complex aspects than before. The present study is an observational study aimed to investigate the role of AQI; PM2.5 and its relationship with the incidence of suspected cases (SC) and positive cases (PC) of COVID-19 at different levels of the air quality index (AQI) in Tehran, the capital of Iran in the period from Feb 20th, 2020 to Feb 22nd, 2021. Data on AQI were collected online from the air monitoring website of Air Quality Control Company under the supervision of Tehran Municipality. The data on suspected and positive cases were obtained from the Iranian Ministry of Health. The results and statistical analysis (Pearson correlation test) showed that with the increase of AQI level, the number of suspected cases (SC) and positive cases (PC), also increased (P-value<0.01). The average daily number of suspected and positive COVID-19 cases referred to medical centers, at different levels of the AQI was as follows: level II: yellow, moderate (SC: Nave = 466; PC: Nave = 223), level III: orange, unhealthy for sensitive groups (SC: Nave = 564; PC: Nave = 275), and Level IV: red, unhealthy (SC: Nave = 558; PC: Nave = 294). The results of the GEE for seasonal comparison (winter as reference season), showed that there is an epidemiological pattern in autumn with colder weather compared to other seasons in both suspected (Cl: %95, B = 408.94) and positive (Cl: %95, B = 83.42) cases of COVID-19. The results of this study will serve policymakers as an informative tool for guidance on the importance of the role of air pollution in viral epidemics.

Monitoring Benzene, Toluene, Ethylbenzene, and Xylene (BTEX) Levels in Mixed-Use Residential-Commercial Buildings in Shiraz, Iran: Assessing the Carcinogenicity and Non-Carcinogenicity Risk of Their Inhabitants.

The aim of this study is to investigate the concentration of Benzene, Toluene, Ethylbenzene, and Xylene (BTEX) compounds in the indoor air of residential-commercial complexes and to compare it with other residential buildings (control) as well as to assess the carcinogenicity and non-carcinogenicity risk of these pollutants. BTEX concentration was investigated in the indoor air of 30 ground floor restaurants, 30 upper residential units of the complexes, 20 adjacent residential units (control), and their corridors. The mean BTEX concentration measured in the upper residential units was reported higher than in the control residential units, though they were not significantly different. The lifetime cancer risk (LTCR) value calculated for benzene in the upper residential units was lower than 10-4 and higher than 10-6 across all ages, indicating a carcinogenicity risk. Furthermore, the mean hazard quotient (HQ) for all compounds was obtained lower than 1, suggesting no concern about the non-carcinogenicity risk of these compounds in the studied region. Nevertheless, considering the sources of benzene production in the indoor air as well as the carcinogenicity of these pollutants and the risk they pose in human health, application towards the reduction of the sources and concentration of benzene in the indoor air are necessary.

Exposure to polycyclic aromatic hydrocarbon-induced oxidative stress in Shiraz, Iran: urinary levels, health risk assessment and mediation effect of MDA on the risk of metabolic syndromes.

PURPOSE: Polycyclic Aromatic Hydrocarbons (PAHs) have been identified as carcinogenic and endocrine disrupter compounds that cause Metabolic Syndrome (MetS). Oxidative stress can lead to carcinogenesis and MetS in exposed people. Therefore, the relationship between urinary metabolite of PAH (OH-PAHs) level and the oxidative stress biomarker (Malondialdehyde) effect as the mediator in increasing the risk of MetS due to PAH exposure and risk assessment was investigated in Shiraz, Iran. METHODS: The first morning void urinary and blood samples were obtained from participants and analyzed. Physical examinations and anthropometric measurements were performed on the day of sampling. An automatic biochemistry analyzer was used to measure the blood cells. The participants' socio-demographic information was gathered using a questionnaire and direct interviews with participants. RESULTS: The MetS prevalence was 26%. Malondialdehyde could act as a mediator between exposure to 1-HydroxyPyrene and increase in fast blood sugar, exposure to 2-HydroxyNaphthalene and increase in systolic blood pressure and exposure to 2-HydroxyFluorene and increase in SBP. Hazard quotients varied from 0.009 to 14.92 in women, and from 0.005 to 8.43 for Fluorene and Naphthalene in men, respectively. The Hazard Indexes were greater than one meaning that the non-cancer health risk related to the PAH exposure could be identified in the participants. CONCLUSION: Although oxidative stress has been suggested to lead to MetS and the high HI levels obtained in the current study, future researches are essential to achieve more reliable findings and monitoring the environmental influencing factors in PAH exposure.

Health consequences of disinfection against SARS-CoV-2: Exploring oxidative stress damage using a biomonitoring approach.

Individuals who get involved in the disinfection of public settings using sodium hypochlorite might suffer adverse health effects. However, scarce information is available on the potential oxidative stress damage caused at low concentrations typically used for disinfection. We aimed to assess whether exposure to sodium hypochlorite during the COVID-19 pandemic causes oxidative stress damage in workers engaged in disinfection tasks. 75 operators engaged in the disinfection of public places were recruited as the case group, and 60 individuals who were not exposed to disinfectant were chosen as the control group. Spot urine samples were collected before (BE) and after exposure (AE) to disinfectants in the case group. Likewise, controls provided two spot urine samples in the same way as the case group. Urinary malondialdehyde (MDA) levels were quantified by forming thiobarbituric acid reactive substances in the urine. In addition, the concentration of 8-hydroxy-2'-deoxyguanosine (8-OHdG) in the urine was determined using an ELISA kit. Results showed significant differences in the urinary levels of oxidative stress markers, where median 8-OHdG (AE case: 3.84 ± 2.89 µg/g creatinine vs AE control 2.54 ± 1.21 µg/g creatinine) and MDA (AE case: 169 ± 89 µg/g creatinine vs AE control 121 ± 47 µg/g creatinine) levels in case group AE samples were 1.55 and 1.35-times higher than the control group AE samples (P < 0.05), respectively. Besides, urinary levels of oxidative stress markers in AE samples of the case group were significantly higher than in BE samples (8-OHdG BE 3.40 ± 1.95 µg/g creatinine, MDA BE 136 ± 51.3 µg/g creatinine, P < 0.05). Our results indicated that exposure to even low levels of sodium hypochlorite used in disinfection practices might cause oxidative stress related damage. With this in mind, implementing robust protective measures, such as specific respirators, is crucial to reduce the health burdens of exposure to disinfectants.

Exploring Barriers to Implementing Telerehabilitation from experiences of managers, policymakers, and providers of rehabilitation services in Iran: A Qualitative Study.

Background:Telerehabilitation is an emerging technology that uses digital technologies to perform evaluation, counseling, treatment, and telemonitoring to provide rehabilitative care to patients in various locations such as homes, communities, health centers, and workplaces. This approach has advantages such as reducing costs and overcoming barriers of distance and time. Reducing patient-rehabilitator interaction, and being hard to teamwork and express thoughts and feelings are some disadvantages of this approach. TR services are provided by a variety of rehabilitation specialists. The aim of the study was to identify barriers in the way of implementing TR in Iran Methods:This study was conducted using a conventional content analysis method based on a qualitative approach. 26 people were selected as participants based on purposive sampling with maximum diversity. Data were collected through semi-structured interviews and managed using MAXQDA 10 software. Results:765 codes were extracted by conducting interviews and coding. The findings of this study are classified into seven main categories and 32 sub-categories. The main categories are insufficient infrastructure, legal, physical, and moral hazards, lack of priority and insufficient determination, insufficient support of the public and non-governmental organizations, poor knowledge in using equipment, Lack of knowledge and negative attitude, and low capacity in comparison with face-to-face rehabilitation. Conclusion:This study shows that based on the insights from the experiences of participants, inadequate infrastructure and poor knowledge of the use of equipment are the most important obstacles in the way of TR. This study reveals that the implementation of TR in Iran encounters several obstacles and eliminating them requires serious effort.

Assessing oxidative stress resulting from environmental exposure to metals (Oids) in a middle Eastern population.

Concentrations of metals and metalloids derived mainly from anthropogenic activities have increased considerably in the environment. Metals might be associated with increase reactive oxygen species (ROS) damage, potentially related to several health outcomes. This study has recruited 200 adult participants, including 110 males and 90 females in Shiraz (Iran), to investigate the relationship between chronic exposure to metals and ROS damage by analyzing malondialdehyde (MDA) and 8-Oxo-2'-deoxyguanosine (8-OHdG) concentrations, and has evaluated the associations between chronic metal exposure and ROS damage using regression analysis. Our findings showed participants are chronically exposed to elevate As, Ni, Hg, and Pb levels. The mean urinary concentrations of 8-OHdG and MDA were 3.8 ± 2.35 and 214 ± 134 µg/g creatinine, respectively. This study shows that most heavy metals are correlated with urinary ROS biomarkers (R ranges 0.19 to 0.64). In addition, regression analysis accounting for other confounding factors such as sex, age, smoking status, and teeth filling with amalgam highlights that Al, Cu, Si and Sn are associated with 8-OHdG concentrations, while an association between Cr and MDA and 8-OHdG is suggested. Smoking cigarettes and water-pipe is considered a significant contributory factor for both ROS biomarkers (MDA and 8-OHdG).

Prenatal exposure to polycyclic aromatic hydrocarbons and effects on neonatal anthropometric indices and thyroid-stimulating hormone in a Middle Eastern population.

Prenatal exposure to polycyclic aromatic hydrocarbons (PAHs) evokes extensive concerns regarding public health. Monitoring the pregnant women's exposure can be considered a suitable alternative to assess the fetus's exposure. This study aimed to monitor pregnant women's exposure (n = 126) to PAHs using a biomonitoring approach to evaluate effects on anthropometric indices and neonatal thyroid-stimulating hormone (TSH) in Shiraz, Iran. PAHs priority compounds were measured by gas chromatography-mass spectrometry (GC-MS) after separating blood serum and liquid-liquid extraction (LLE) method. Information on anthropometric indices, neonatal TSH levels, and data from the respondents was obtained from medical records and questionnaires. The mean PAHs concentrations ranged from 0.29 to 327.91 ng/g lipid. There was no significant difference between the measured PAHs in maternal serum at the seventh month and pregnancy termination except for ACY (p-Value<0.05). Regression analysis results showed a significant correlation (p-value<0.05) between exposure to passive smoke and total PAHs concentrations. There was no significant relationship between exposure to PAHs and weight, height, head circumference, and Apgar score of newborns. The results showed TSH decreased by 0.99 units as ACE increased per unit (ß = -0.001). This study is the first to evaluate relationships between prenatal exposure to PAHs and effects on newborn health indicators, including TSH levels in a Middle Eastern population. Future studies are suggested to perform detailed assessments of PAHs intake sources, especially in vulnerable populations such as pregnant women and children.