Background: Tuberculosis is a major cause of morbidity and mortality in Africa, especially Ghana. Despite the current treatments for tuberculosis, positive treatment outcomes are not attainable due to the differences in the socio-economic and bio-psychological status of the patients. The present study aimed to assess the influential factors in the treatment outcomes of tuberculosis. Methods: This qualitative study was conducted to determine the influential factors in the treatment outcomes of tuberculosis in terms of the patients, community, and healthcare providers. Data collection and management were performed using version 11 of the NVivo software. Sample population included 10 patients, five healthcare providers, and five community members (treatment supporters). Data analysis was carried out using framework analysis, where the emerging themes were identified and discussed in relation with literature. Results: The results revealed that wrong/negative perceptions about TB, social stigma, and the use of alternative treatment methods could result in unsuccessful treatment outcomes. Conclusion: The study recommends that community awareness of TB and the search and implementation of policies toward improving TB treatment outcome should be pursued.

Background: Diarrhea is an important cause of morbidity and mortality, particularly in developing countries. Enteric gram-negative bacteria, especially Shigella, Salmonella, Escherichia, and Campylobacter plays a key role in the occurrence of diarrhea. The present study aimed to determine the prevalence and importance of four bacterial genera in the incidence of diarrhea in Shahid Beheshti Hospital in Kashan, Iran. Methods: This cross-sectional study was conducted on 528 diarrheal stool samples during March 2015-February 2017. The samples were collected for the isolation of the bacterial agents to appropriate selective and differential culture media. Laboratory diagnosis was performed using proper bacteriological and serological tests. Results: Among 528 stool samples, 38.6% of the specimens belonged to women, and 61.4% belonged to men. In total, 233 specimens (44.1%) were positive for the mentioned bacteria. In 98 (18.5%) and 15 cases (2.8%), Shigella spp. and Campylobacter spp. had the highest and lowest frequency, respectively. Conclusion: Shigellosis has been reported to be more prevalent in developing and industrialized countries. Our findings and similar studies in this regard have denoted the epidemiological patterns of shigellosis in some regions in Iran toward the epidemiological pattern of the disease in industrialized countries.

Background: The noise caused by traffic is an increasingly prominent feature of urban environments. However, limited studies have been focused on the assessment of exposureresponse relationship between road traffic noise exposure and driving behaviors in Iran. The present study aimed to investigate the prevalence of the violations caused by road traffic noise exposure in Qazvin, Iran. Methods: Initially, a line with 70 taxi drivers was selected for the evaluation of noise exposure. According to ISO9612:2009, the eight-hour equivalent noise level [Leq8h] was measured during a workday. In addition, driving behaviors were assessed using the selfreport Iranian version of Manchester driving behavior questionnaire (MDBQ). Results: Statistical analysis included the mean, standard deviation, minimum and maximum, Pearson’s correlation-coefficient, and logistic regression. The results of Pearson’s correlation-coefficient indicated a strong correlation with noise levels and personal characteristics with driving behaviors (P < 0.05). Moreover, logistic regression showed that noise level was significantly associated with the components of driving behaviors. Conclusion: According to the results, traffic noise exposure is a significant influential factor in the increased rate of driving violations. Equivalent sound pressure level in taxies was observed to be above of the limit for occupational comfort based on NR 17 standard, which may affect driving behaviors.

Background: Thalassemia is the most prevalent genetic disorder in humans. It is caused by the deficient or lack of production of one of the globin chains. The present study aimed to evaluate the performance indicators of Behbahan Health Center, Iran in terms of the prevention of thalassemia major during 2006-2016. Methods: This descriptive, cross-sectional study was conducted on the couples referring to the pre-marriage counseling centers in Behbahan, Iran for premarital tests during 2006- 2016. The participants were selected via census sampling. Results: In total, 24,992 couples were screened, 0.33% of whom (n = 84) were suspected of thalassemia. Out of 84 couples, two cases declared marriage cancellation after electrophoresis. The results of the PND1 test indicated that in 96% of the couples (n = 73), the boy and girl both had thalassemia minor, while in 1.3% of the cases (n = 1), one of them had thalassemia minor, and in 6.2% (n = 2), they were both normal. Conclusion: According to the results, 84 couples were carriers of thalassemia during 2006- 2016. Eventually, all the cases with thalassemia major were aborted and prevented from birth.

Background: The construction of metro lines is a high-risk project. Using a budget-based model for the safety units of metro construction projects can help safety managers to spend optimal budget allocation. The purpose of this study was to plan a budget model based on safety unit performance in an under construction metro station for better budget allocation using robust optimization. Methods: To design this model, budget dimensions were identified by the experts and based on causes and costs of accidents in the past year. Then, constraints of metro workshops were considered. The next step was involved in determining the importance of each dimension. Finally, the budgeting model was designed using Gurobi software. In order to prove the proposed budgeting model, as a case study, the model was implemented in one of the metro workshops. Results: Considering existing constraints, the model revealed that the budget should be at least 4.370.478.000 rials. Surprisingly, the predicted budget amount was less than the expended amount in the safety unit of the project. However, budget allocation to dimensions was dramatically different. Conclusion: The results showed that the robust optimization budgeting was functionally and economically optimal. Moreover, there is a need for logical budget distribution.

Background: Identification of hazards is one of the most important parts of industries’ strategies. This can be done using a hazard matrix as an applicable tool which can also rank hazards properly. Methods: In this study, the Delphi method was used to select best alternatives for a hazard matrix. All possible items were gathered and passed Delphi rounds, in which mean, median and standard deviation were used to evaluate decisions. Moreover, Kendall’s coefficient of concordance was used to reach consensus between panel members. Results: The panel members found 42 items in five categories, of which 29 items benefited a mean and median more than 5. Moreover, Kendall’s coefficient of concordance reached 0.66, which indicated a statistically meaningful agreement for the number of experts. Conclusion: This study introduced a hazard matrix, in which different consequences were accounted based on a well-known decision making method. The matrix is developed for hospital application with respect to panel members’ knowledge and can be used suitably in this field of industry.

Background: One of the challenges of implementing the family physician program is the decrease in the number of doctors, especially in rural and deprived areas, the present study aimed to determine the intentions of family physicians to persist in the health centers affiliated in Hormozgan city. Methods: This cross-sectional study was conducted on 195 physicians in the health centers implementing the family physician program. Data were collected using a questionnaire. Data analysis was performed in SPSS version 21 using independent t-test, Pearson’s correlation-coefficient, and ANOVA. Results: In total, 57.9% of the participants were female, and 42.1% were male. The majority of the subjects (61%) were aged 30-60 years. The results of Pearson’s correlationcoefficient indicated that income, payment status, working hours, willingness to continue education, job security, motivation to serve, commitment to service provision, and confidence in the family physician program had significant, positive associations with the intentions of family physicians to stay in the health centers (P < 0.001). Conclusion: According to the results, health ministers, policymakers, and planners could help with the persistence of family physicians in the healthcare centers in deprived areas through reviewing the number of the healthcare team members and their job descriptions.

Background: Neutrophils are the most abundant white blood cells in humans. Recently, a novel strategy called the formation neutrophil extracellular traps (NETs) was described. NETs is a new strategy for pathogen response. This study focused on whether LPS induced NETs release in vitro in the HL60 cell line. Methods: In this study, the HL60 cell line was used for culture and DMSO for induction and differentiation. Flow cytometry was used to evaluate CD11b in the differentiated cells, and the NBT assay was used to evaluate the functionality of the differentiated HL-60 cells. Neutrophil-like cells were incubated with LPS (200 ng/ml) for 45 min, followed by incubation for 25 min with 100 ng/ml Hoechst 33342. Trypan blue as vital staining was used for viability. The statistical significance of the difference between the control and treated groups was evaluated using a one-way ANOVA. Results: Our results showed that 75% NETs was produced by HL-60 differentiated neutrophil cells exposed to 200 ng/ml LPS in 45 minues. Conclusion: Consequently, the LPS-induced infection and lethality may occur through various mechanisms. Thus, understanding the molecular mechanisms regulating NET formation in LPS-induced neutrophil-like cells would support the development of new therapeutic methods.

"Background: Occupational incidents still account for a high percentage of causes of death and disability. A study was designed to determine the relationship between employee safe behavior and safety culture. Methods: In this analytical study, all employees of an industrial livestock units of Tehran participated (n = 200). The data on the employee behavior was evaluated using the safety sampling technique based on the ANSI Dangerous Acts List (Modified Form). A standard questionnaire was used to assess the safety culture. Data were analyzed by the SPSS software, at the significance level of 0.05. Results: The mean safety score of people (138) was acceptable. The rate of unsafe behaviors was 35%. The most unsafe behaviors were due to improper manual handling (83%). A reverse correlation between unsafe behavior and safety culture score (P value = 0.001) was seen. Conclusion: The results of this study indicate that there is a significant negative reciprocal relationship between safety culture and unsafe behavior, that is, with the increase in the safety culture, the rate of unsafe behavior decreases. As a result, by promoting the level of safety culture, the rate of unsafe behavior can be reduced."

Background: The present study aimed to investigate the protective effects of selenium nanoparticles in a lead-induced testicular toxicity model. Methods: In total, 30 Wistar rats were divided into three groups and treated (except the normal control) with lead acetate in drinking water (1,000 mg/l) for five weeks. The control rats and negative control rats received saline intraperitoneally, and the third group received intraperitoneal injections of selenium nanoparticles (0.5 mg/kg). Results: The lead-treated group showed a significant increase in blood urea nitrogen, serum creatinine, serum aspartate aminotransferase (AST), serum alanine aminotransferase (ALT), and malondialdehyde levels (P < 0.01). The lead-intoxicated rats treated with selenium nanoparticles showed a significant decrease in serum AST and ALT compared to the untreated negative controls (P < 0.5). The histopathological examination of liver and kidney tissues indicated lead-induced injuries (e.g., necrotic cells in liver and kidneys). The selenium-treated group showed reduced histopathological signs of lead-induced injuries. Lipid peroxidation levels were also lower in the selenium-treated rats compared to the negative controls (P < 0.05). Conclusion: This experimental study confirmed the protective effects of selenium nanoparticles in the rats exposed to chronic lead-induced toxicity. However, further experiments are required to evaluate the possible side-effects and complications.

Background: Circular economy is gaining global acceptability, and its practice is rather poor in Nigeria similar to other developing countries. COVID-19 pandemic has caused enormous amounts of hazardous wastes, which require special attention. The present study aimed to assess circular economy and waste management actions during the COVID-19 pandemic in Nigeria. Methods: Data were collected using quantitative and qualitative methods and analyzed to determine the challenges of hazardous waste management in Nigeria by two notable healthcare centers in Ilorin as the cases. In total, 204 questionnaires were distributed among the staff, and 202 (99%) were returned. Results: The respondents were 102 men (50.5%) and 100 women (49.5%) with various disciplines, including health workers (n=104; 51.5%), maintenance staff (n=42; 20.8%), and cleaners/waste handlers (n=56; 27.7%). The majority of the subjects (97%) believed that COVID-19 wastes should be segregated, while 111 subjects (55%) rated the management of personal protective equipment to be appropriate during the pandemic. Conclusion: According to the results, the implementation and enforcement of national policies regarding solid waste management are essential through the training and retraining of staff on hazardous waste management in the studied healthcare centers.

Background: Heavy metal toxicity at low levels damages the function of the brain, lungs, kidney, liver, blood composition, and other important organs. Long-term exposure leads to gradual disease progression in multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, muscular dystrophy, and cancer. Methods: In total, 100 crustacean samples (50 crabs and 50 prawns) were analyzed in terms of nickel, zinc, chromium, and copper residues using an atomic absorption spectrophotometer and compared to Egyptian standard limits. Results: The concentrations of nickel, zinc, chromium, and copper in the crab samples were 0.292 ± 0.02, 20.688 ± 3.06, 1.158 ± 0.01, and 22.304 ± 4.04 µg/g of wet weight, respectively. The values in the prawn samples were 0.373 ± 0.01, 16.204 ± 2.01, 0.844 ± 0.01, and 18.524 ± 1.03 µg/g of wet weight, respectively. Conclusion: Our findings could lay the groundwork for monitoring the heavy metal contamination of marine organisms. The estimated daily detection intake of nickel, zinc, chromium, and copper was below the reported PTDI of each element. In addition, the THQ and HI values of the heavy metals were below 1.00 in the crab and shrimp samples, suggesting no significant risks to the community health due to the consumption of the crab and shrimp samples.

Background: The overall purpose of this study was to estimate the health risk of nitrate (NO3-) concentration in the drinking water of Tabriz County. Methods: This research is a descriptive cross-sectional study that was performed on Tabriz drinking water in 2016-2017. The concentration of NO3- in one hundred - ninety drinking water samples was determined in the water and wastewater laboratory of the provincial health center using spectrophotometry. Results: The results showed that the average levels of NO3- (as nitrate ion) in drinking water of urban and rural districts were 14.6 ± 12.8 and 13.1 ± 12.8 mg/L, respectively, which are lower than the national standard of Iran and WHO guidelines. The average hazard quotient (HQ) for four age groups of infants, children, teenagers, and adults was less than one in both urban and rural zones. However, HQ values for the children were more than 1 in 15.20% of urban and 10.7% of rural samples. Conclusion: The non-carcinogenic risk of NO3- in drinking water does not threaten the exposed population, but the children presumably are at risk of NO3-. Hence, the continuous control of the concentration of NO3- was recommended to prevent its possible risk for water consumers, especially children.

Background: The overall purpose of this study was to estimate the health risk of nitrate (NO3-) concentration in the drinking water of Tabriz County. Methods: This research is a descriptive cross-sectional study that was performed on Tabriz drinking water in 2016-2017. The concentration of NO3- in one hundred - ninety drinking water samples was determined in the water and wastewater laboratory of the provincial health center using spectrophotometry. Results: The results showed that the average levels of NO3- (as nitrate ion) in drinking water of urban and rural districts were 14.6 ± 12.8 and 13.1 ± 12.8 mg/L, respectively, which are lower than the national standard of Iran and WHO guidelines. The average hazard quotient (HQ) for four age groups of infants, children, teenagers, and adults was less than one in both urban and rural zones. However, HQ values for the children were more than 1 in 15.20% of urban and 10.7% of rural samples. Conclusion: The non-carcinogenic risk of NO3- in drinking water does not threaten the exposed population, but the children presumably are at risk of NO3-. Hence, the continuous control of the concentration of NO3- was recommended to prevent its possible risk for water consumers, especially children.

Background: Zinc production due to applying mineral soils as raw material and high rate of tailings and wastes lead to environmental and health challenges, such as total suspended particle (TSP) emissions. Methods: This was the first study to monitor TSP concentration fluctuations and location variability in Zanjan zinc industrial park (ZZIP), Iran for 11 months. Nine stations equipped with an LVS were selected for TSP sampling from air simultaneously. Sample analysis was performed in the laboratory using gravimetric methods and data depicted by ArcGIS to recognize spatial distribution. Results: Changes in TSP concentrations were within the range of 30.17-2,692.82 µg/m3 and exceeded the EPA/WHO guidelines in more than 98% of the cases. Spring and winter showed the highest levels. The main influential factors in the TSP concentration were industrial activities, vicinity to the depot site and main streets, the speed of passing vehicles, and the dominant wind direction. Conclusion: Despite recent attempts to control TSP, the concentrations remain high and alarming. Therefore, special attention must be paid to the health issues affecting staff and residential groups and implementation of more effective control mechanisms.

Background: Zinc production due to applying mineral soils as raw material and high rate of tailings and wastes lead to environmental and health challenges, such as total suspended particle (TSP) emissions. Methods: This was the first study to monitor TSP concentration fluctuations and location variability in Zanjan zinc industrial park (ZZIP), Iran for 11 months. Nine stations equipped with an LVS were selected for TSP sampling from air simultaneously. Sample analysis was performed in the laboratory using gravimetric methods and data depicted by ArcGIS to recognize spatial distribution. Results: Changes in TSP concentrations were within the range of 30.17-2,692.82 µg/m3 and exceeded the EPA/WHO guidelines in more than 98% of the cases. Spring and winter showed the highest levels. The main influential factors in the TSP concentration were industrial activities, vicinity to the depot site and main streets, the speed of passing vehicles, and the dominant wind direction. Conclusion: Despite recent attempts to control TSP, the concentrations remain high and alarming. Therefore, special attention must be paid to the health issues affecting staff and residential groups and implementation of more effective control mechanisms.

Background: Yersiniosis is an important foodborne zoonotic disease worldwide. Gastroenteritis and septicemia are the primary forms of yersiniosis. Yersinia enterocolitica is a causative organism, which is frequently isolated from foods such as milk. This study aimed to evaluate the contamination rate of bovine raw milk with Y. enterocolitica during January-July 2017 and the biotyping of the isolated organisms. Methods: In total, 100 bovine raw milk samples were collected from Mashhad, Iran. The samples were enriched in peptone sorbitol broth. After alkali treatment, the enriched samples were streaked onto cefsulodin-irgasan-novobiocin agar plates. Suspected colonies of Y. enterocolitica were tested by the amplification of the 16s rRNA gene to confirm the isolates as Y. enterocolitica. The confirmed isolates were biotyped using biochemical tests. Results: The results showed that 33% of the bovine raw milk samples were contaminated with Y. enterocolitica. Biotype 1A was predominant (26%), while the pathogenic biotypes 1B (6%) and 5 (1%) were also detected. Conclusion: According to the results, the isolation of pathogenic Y. enterocolitica from bovine raw milk is a public health hazard due to its presence in dairy products.

Background: Circular economy is gaining global acceptability, and its practice is rather poor in Nigeria similar to other developing countries. COVID-19 pandemic has caused enormous amounts of hazardous wastes, which require special attention. The present study aimed to assess circular economy and waste management actions during the COVID-19 pandemic in Nigeria. Methods: Data were collected using quantitative and qualitative methods and analyzed to determine the challenges of hazardous waste management in Nigeria by two notable healthcare centers in Ilorin as the cases. In total, 204 questionnaires were distributed among the staff, and 202 (99%) were returned. Results: The respondents were 102 men (50.5%) and 100 women (49.5%) with various disciplines, including health workers (n=104; 51.5%), maintenance staff (n=42; 20.8%), and cleaners/waste handlers (n=56; 27.7%). The majority of the subjects (97%) believed that COVID-19 wastes should be segregated, while 111 subjects (55%) rated the management of personal protective equipment to be appropriate during the pandemic. Conclusion: According to the results, the implementation and enforcement of national policies regarding solid waste management are essential through the training and retraining of staff on hazardous waste management in the studied healthcare centers.