Review Articles
Mahsa Hosseini; Zahra Borzabadi Farahani
Abstract
Introduction: Mandala coloring is a branch of art therapy that significantly impacts maintaining and promoting various dimensions of mental health. However, it has received little attention as a complementary treatment to cure and prevent mental disorders.
This study aims to evaluate, in a systematic ...
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Introduction: Mandala coloring is a branch of art therapy that significantly impacts maintaining and promoting various dimensions of mental health. However, it has received little attention as a complementary treatment to cure and prevent mental disorders.
This study aims to evaluate, in a systematic way, the effectiveness of mandala coloring to promote its use for preventing and treating mental disorders.
Methods: This research is a systematic review study. To retrieve the articles, the authors used keywords “Art therapy”, “mandala coloring”, “ mandala” , “mandala therapy”, and “coloring therapy” both in Persian and English. Available databases were used to collect the articles. Then, based on the inclusion and exclusion criteria, only five articles were recognized as eligible and included in the study.
Results: The findings of this study showed that research on mandala coloring as a mental health complementary therapy is minimal in Iran.
Conclusion: Despite the effectiveness of mandala coloring on various dimensions of health and its ease of use and access, this complementary therapy is still unknown and limitedly used in Iran. Accordingly, further research is needed in this field to apply their results in medicine and education
Review Articles
Mohammad Jalali; Michael E Symonds; Morteza Zare; Zahra Sohrabi
Abstract
Background: Heart failure (HF) is a clinical disorder and Zinc is an important cofactor in regulating oxidative status.The present study aimed to determine the mean concentration of serum zinc in patients with HF.
Methods: PubMed, Embase, Scopus, and Web of Science were used in the present systematic ...
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Background: Heart failure (HF) is a clinical disorder and Zinc is an important cofactor in regulating oxidative status.The present study aimed to determine the mean concentration of serum zinc in patients with HF.
Methods: PubMed, Embase, Scopus, and Web of Science were used in the present systematic review and meta-analysis to find relevant cross-sectional studies up to 1st January 2020. A random-effects model was used to pool the effect size (ES) and 95 % confidence intervals (CI). In addition, meta-regression analysis was performed to find the sources of statistical heterogeneity among the studies.
Results: Our meta-analysis of 1358 HF patients indicated that their mean serum zinc concentration was 66.24 µg/dl (95 % CI: 59.16, 73.33). In sub-analysis, the mean concentration was 75.04 µg/dl and 52.90 µg/dl in patients < 65 years and > 65 years old, respectively. Subgroup analysis by geographical region showed that mean serum zinc was 70.70 µg/dl, 69.08 µg/dl and 60.91 µg/dl in HF patients from Europe, America, and Asia, respectively. Meta-regression analysis indicated a reduction of 1.42 µg/dl in serum zinc per each year of aging.
Conclusion: In summary, our meta-analysis indicates that serum zinc concentrations have a narrow range in HF patients worldwide that declines with age and varies with geographical region. Additionally, serum zinc concentrations are lower in HF patients, specifically in the elderly.
Original Articles
Anwesha Mahanta
Abstract
Background: The COVID-19 pandemic has shattered the global health system and caused havoc worldwide. Since there is no proper medication, non-pharmaceutical intervention methods are followed to mitigate viral transmission. For its proper implementation, it is crucial to track the spatial pattern of transmission ...
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Background: The COVID-19 pandemic has shattered the global health system and caused havoc worldwide. Since there is no proper medication, non-pharmaceutical intervention methods are followed to mitigate viral transmission. For its proper implementation, it is crucial to track the spatial pattern of transmission and target those areas which require immediate action to control the spread of the pandemic. The geospatial technologies have established themselves as powerful tools that have substantial ability to track outbreak patterns in real-time, identify at-risk populations, and plan targeted intervention.
Methods: The study provides a robust methodological framework with three geospatial tools: Spatial Autocorrelation (Global Moran's I), Hot Spot Analysis (Getis-Ord Gi*), and Space-time scan statistic. The quantitative study was carried out exclusively for North-East India to track the COVID-19 outbreaks from April 2020 to December 2020.
Results: The results obtained indicate a gradual change of spatial distribution of the disease from cluster to random distribution at the global scale. But, eventually, the COVID-19 cases tend to form clusters again. Kamrup Metro, the district with the highest urban population, was reported constantly as a hotspot. Moreover, space-time clusters tend to expand in size over time.
Conclusion: The research study's findings provide an overview of the spatio-temporal pattern of COVID-19 in the study area and help the health officials and policy-makers in formulating effective management strategies and non-pharmaceutical intervention measures by targeting the high-risk areas. The study is a valuable guide towards implementing Geographic Information Science technologies in monitoring and tracking the pandemic.
Original Article
Sanaz Dastmanesh; Leila Ghahremani; Mohammad Hossein Kaveh; Mohammad Fararouei
Abstract
Background: Increased proportion of the retired population and the occurrence of retirement syndrome may significantly affect the Quality of life (QoL) and the well-being of older people. Therefore, the present study was conducted to examine the effect of training intervention on retirement syndrome ...
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Background: Increased proportion of the retired population and the occurrence of retirement syndrome may significantly affect the Quality of life (QoL) and the well-being of older people. Therefore, the present study was conducted to examine the effect of training intervention on retirement syndrome and QoL among retired older men in Safashahr, Iran, in 2019.
Methods: Using a randomized block design, the quasi-experimental study was conducted on 140 retired men with retirement syndrome. The subjects’ average age was 61.24±1.36 years. The older people were selected by purposive sampling and then randomly assigned to an experimental group (n=70) and a control group (n=70). The intervention comprised five 90-minute sessions of the practical training course of exercises for over 45 days in the experimental group. The study outcomes, such as retirement syndrome and QoL, were measured before, immediately after, and two months after the intervention. The study data were analyzed using SPSS Statistics 25, independent sample t-tests, Chi-square tests, and repeated measure ANOVA. The significance level was set at 0.05.
Results: Based on the average score of retirement syndrome (< 0.001) and its subscales, such as helplessness and failure (HF) (p< 0.001), feeling of old and idle (FOI) (<0.001), feeling of confusion and conflict (FCC) (p<0.001), and feeling of effort and a new direction (FED) (p=0.025); an average score of QoL (p<0.001) and all its subscales, including physical activities (p<0.001), physical health (p<0.001), emotional problems (p<0.001), vitality (p< 0.001), mental health (p<0.001), general health perceptions (<0.001), except for physical pain (0.347) and social performance (0.41), there is a significant difference between the two experimental and control groups, before and after the intervention.
Conclusion: The findings may provide valuable implications for the development of exercises among the elderly and further studies to evaluate the long-term effects of such interventions among the elderly.
Original Article
Asghar Alahyari Solokloei; Mohammad Ali Baghapuor; Abooalfazl Azhdarpoor; Mohammad Reza Shirdarreh
Abstract
Background:Background: Diclofenac is one of the drug compounds that is known as an emerging contaminant in aqueous solutions. Studies have shown that biological treatment is not sufficient to treat these compounds and new methods such as adsorption should be used to prevent contamination of aquatic environments. ...
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Background:Background: Diclofenac is one of the drug compounds that is known as an emerging contaminant in aqueous solutions. Studies have shown that biological treatment is not sufficient to treat these compounds and new methods such as adsorption should be used to prevent contamination of aquatic environments. One of the native absorbers in this regard is the pumice. This study aimed to investigate the removal of diclofenac from aqueous solutions using magnesium chloride modified pumice.
Methods: In this experimental study, with a practical approach, the required adsorbent was prepared from pumice. Magnesium chloride was used for pumice modification. The experiments were performed in a closed system at laboratory temperature. In this study, the effect of variables, adsorbent dose, contact time, and pH on diclofenac removal was investigated. Diclofenac was analyzed by KNAUER model HPLC at a wavelength of 254 nm.
Results: Modified pumice by magnesium chloride was able to remove 95.83% of diclofenac (20 mg/l) at a concentration=1 g/l for 15 minutes at pH=5. Comparison of modified and natural pumice performance in 5, 10, 15, 30, 40 minutes with an average of 89.52% of modified pumice removal, compared to 48.15% of natural pumice removal, which was 1.86 times more efficient.
Conclusion: Pumice can be used as a cheap, available, and highly effective adsorbent for the removal of diclofenac from aqueous solutions.
Original Article
Tayebe Piri; Sara Saeidi
Abstract
Background: One of the main indications for cognitive behavioral treatment is eating disorders (CBT). This study examine the effectiveness of cognitive-behavioral therapy on communication skills and eating disorders among high school adolescents.Methods: The present study employed a quasi-experimental ...
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Background: One of the main indications for cognitive behavioral treatment is eating disorders (CBT). This study examine the effectiveness of cognitive-behavioral therapy on communication skills and eating disorders among high school adolescents.Methods: The present study employed a quasi-experimental design composed of a pre-test and post-test design in experimental and control groups. A total of 40 students were selected and randomly assigned to experimental (n=20) and control (n=20) groups through a multistage cluster sampling method. Cognitivebehavioral therapy was performed in nine 60-minute sessions for the experimental group, while the control group did not receive any intervention. Queendom’s Communication Skills Test-Revised Inventory (2004) and Garner’s Eating Disorders Questionnaire (Garner, 1979) were used to collect data. All statistical analyses were performed using the SPSS 24.0 software for Windows (SPSS Inc.), and p Results: The Mean±SD of communication skills in the Case group in pre-test and post-test were as follows:75.15±6.67, 81.75±6.04. The Mean±SD of Eating Disorders in the Case group in pre-test and post-test were as follows:36.5±1.71, 36.95±3.44 The results obtained from the analysis of covariance showed that cognitive-behavioral therapy had a significant effect on communication skills and eating disorders (P=0.01). Conclusion: According to the findings of this study, it can be concluded that cognitive-behavioral therapy can be adopted as a suitable method of improving communication skills and the treatment of eating disorders in adolescent students
Original Article
Godswill J. Udom; Oluchi F. Obilor; Uduak P. Ise; Nkechi J. Onyeukwu; Anwanabasi E. Udoh; Ayodeji Aturamu; Omoniyi K. Yemitan
Abstract
Background: Heavy metal contaminations of herbal formulations have constituted a public health challenge in the sub-Saharan Africa region and even in some developed nations. The study aimed to evaluate the public health concerns of chronic exposure to a polyherbal drug suspected to contain heavy metals. ...
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Background: Heavy metal contaminations of herbal formulations have constituted a public health challenge in the sub-Saharan Africa region and even in some developed nations. The study aimed to evaluate the public health concerns of chronic exposure to a polyherbal drug suspected to contain heavy metals. Methods: This is an experimental study. Heavy metals were measured using Solaar-Thermo-Elemental Atomic Absorption Spectrophotometer. Human health risk assessment was estimated by calculating the estimated daily intake, target, hazard quotient (THQ), health index (HI), carcinogenic risk (CR) of exposure to the polyherbal drug. Results: The results showed the presence of metals in this order: Cd<Hg<As<Pb<Zn<Mn<Cu<Ni<Cr 1; HI for adolescents, adults, and geriatrics were >1. Ni and Cr had the highest cancer risk; total cancer risk was above the safe limit. Conclusion: Since herbal medicines/dietary supplements are not under compulsory regulation by international, national, and local health regulatory authorities, these products must be manufactured using the highest manufacturing standards to ensure their safety among the end-users. Our findings suggest the likelihood of significant non-carcinogenic adverse health effects among adolescents, adults, and the geriatric population due to exposure to a mix of toxic metals, necessitating utmost caution on its chronic use. If policy formulations and implementations regarding the safety of herbal medicines and associated products prior to their circulation are ensured, public health will be protected and significantly improved.
Original Article
Elahe Shamshirgardi; Fatemeh Najafitirehshabankareh; Neda Haghighat; Nitin Shivappa; James R. Hebert; Maedeh Jabbari; Yalda Mortazavi; Laya Saeid; Zahra Shamekhi
Abstract
Background : Inflammation, a risk factor for cardiovascular disease (CVD), is affected by diet.Dietary inflammatory index (DII) is used to determine inflammation of diet. In addition, Neck circumference (NC), an indicator for upper-body subcutaneous adipose tissue distribution, is related to cardiovascular ...
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Background : Inflammation, a risk factor for cardiovascular disease (CVD), is affected by diet.Dietary inflammatory index (DII) is used to determine inflammation of diet. In addition, Neck circumference (NC), an indicator for upper-body subcutaneous adipose tissue distribution, is related to cardiovascular risk factors. This study aimed to examine the correlation between DII and NC in a nationally representative sample case and control.
Methods: In this cross-sectional study, the case group was chronic heart disease patients hospitalized in Al-Zahra Heart Clinic, Shiraz, Iran (N = 100). The Control group did not suffer from any heart-related diseases. Dietary intake data were determined using a single interview and food frequency questionnaire (FFQ). NC was assessed using standard methods. Nutritionist-4 software was used to analyze nutrient intakes from FFQ. The method of Shivappa et al. was used to calculate DII.
Results: The mean of NC in the case and control group were 39.09±4.18 and 36.68±4.32 cm. The mean of DII in the case and control groups were -0.018±1.53 and 0.40±155. There was no significant difference between the DII score of the case and control groups (p:0.056, t:-1.922). No significant correlation was observed between DII score and NC in the case(p:0.750,r:0.032) and control(p:0.294,r:0.106) groups.
Conclusion: There was no correlation between DII score as a risk factor for CVD and NC in both case and control groups.
Original Article
Leila Rezaei; Vali Alipour; Amir Hesam Hassani; Mohsen Dehghani
Abstract
Background: the Persian Gulf ecosystem is facing degradation, so further degradation must be prevented. The present study was conducted to assess the environmental pollution risk potential of the coastal ecosystem due to heavy metal content in desalination plant’s effluent.Methods: In this cross-sectional ...
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Background: the Persian Gulf ecosystem is facing degradation, so further degradation must be prevented. The present study was conducted to assess the environmental pollution risk potential of the coastal ecosystem due to heavy metal content in desalination plant’s effluent.Methods: In this cross-sectional study, the researchers selected five stations in the west of Bandar Abbas beach, located at the outlet of desalination effluent canals to the shore, and two stations in the east shore (without effluent discharge) as case and control stations, respectively. The researchers collected 51 Sediment samples and measured heavy metal concentration, using an AA spectrophotometer, and assessed the potential ecological risk. They used SPSS software and the T-test to statistically analyze data.Results: The concentration means for sediments in case and control stations samples were: 40.63±16.79, 96.64±30.60, 159.74±50.65, 109.22±17.09, 205.35±86.96 mg.kg-1 and 40.15±17.21, 79.16±28.26, 152.43±90.07, 101.82±43.55, and 193.82±112.90 mg.kg-1, respectively for (Pb, Cu, Ni, Cd, and Zn). The ecological risk and Pollution Load Index were (31.72, 35.95, 3.30, 36.96, and 45.61) and (0.62, 0.63, 0.71, 0.68, and 0.9), respectively for metals mentioned order. Individual potential risk for all stations showed a low-risk degree.Conclusion: Although the heavy metals accumulated in coastal sediments due to the discharge of desalination plant effluents, severe ecological and environmental damage has not occurred. Therefore, there is still time to prevent an environmental catastrophe on the shores receiving desalination effluents. Therefore, it is recommended to all responsible persons to take the necessary measures to monitor and control the plan and reduce the discharge of effluents to the shores.
Original Article
Tayebeh Rakhshani; Zahra Motlagh; Poran Hezarvand Zanganeh; Davood Farsi; Banafsheh Bizhani; Seyyed Saeed Hashemi Nazari
Abstract
Background: Traffic accidents are considered a major public health problem in many parts of the world. This study aimed to investigate the epidemiology of the accidents leading to pedestrians’ death in Ahvaz, Iran, in 2015-2017.Methods: This descriptive cross-sectional study was conducted in 2015-2017. ...
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Background: Traffic accidents are considered a major public health problem in many parts of the world. This study aimed to investigate the epidemiology of the accidents leading to pedestrians’ death in Ahvaz, Iran, in 2015-2017.Methods: This descriptive cross-sectional study was conducted in 2015-2017. The statistical population was pedestrians who died in traffic accidents in Ahvaz city. The data collection source was the Forensic Medicine Organization. The data were analyzed using the SPSS 16 software using descriptive statistics and chisquare test. Results: Among the 165 pedestrians who died in traffic accidents, 72.1% (119 people) were male and 27.9% (46) female. The mean age of the deceased subjects was 38.38±2.44. The highest frequencies of death in the age groups over 65, under 7, and 25-34 years old were 19.4% (32 people), 14.5% (24 people), and 14.5% (24 people), respectively. Most of the deceased were illiterate (34.5% (57 people)), self-employed (24.2% (40 people)). The final cause of death in more than half of the pedestrians was head trauma (64.8%) (107 people), and most of the deceased had died in hospitals (71.5%) (118 people).Conclusion: Considering that young and older people are two high-risk groups in car accidents, training safety and improving pedestrian safety by creating a safer environment can play a significant role in reducing deaths.
Original Article
Sara Arshi
Abstract
Background: This study aimed to predict social adjustment based on the ability to solve social problems and self-compassion in adolescents.
Methods: This is a cross-sectional study. The statistical population of this study includes all high school students in Shiraz in 2018. The statistical sample consisted ...
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Background: This study aimed to predict social adjustment based on the ability to solve social problems and self-compassion in adolescents.
Methods: This is a cross-sectional study. The statistical population of this study includes all high school students in Shiraz in 2018. The statistical sample consisted of 800 students (400 girls and 400 boys) selected by random cluster sampling. The author used questionnaires of the California Social Adjustment Test, Self-Compassion Scale, and Short Form of Social Problem-Solving Questionnaire (SPSI-R: SF) to collect information from the sample group.
Results: There is a positive and significant relationship between social adjustment and the ability to solve social problems (r = 0.23, P <0.01). Also, there is a positive and significant relationship between social adjustment and self-compassion (r = 0.017, P <0.01). Regression coefficients indicate that problem-solving ability (P = 0.34) and self-compassion (P = 0.30) can positively and significantly predict social adjustment and problem-solving ability has a stronger role in explaining social adjustment than self-compassion.
Conclusion: Problem-solving training was used as an effective way to create general, emotional, social, and educational adjustment of adolescents. People who have a high problem-solving ability can control their stress in normal and stressful situations.
Original Article
Fakhradin Ghasemi; Taleb Askaripoor; Hamed Aghaei
Abstract
Background: Needlestick and sharps injuries (NSIs) are a major issue in healthcare settings and should be properly managed. As a type of occupational accident, NSIs are rooted in many causes, including poor safety climate. The current study was conducted to find links among safety climate, safety performance, ...
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Background: Needlestick and sharps injuries (NSIs) are a major issue in healthcare settings and should be properly managed. As a type of occupational accident, NSIs are rooted in many causes, including poor safety climate. The current study was conducted to find links among safety climate, safety performance, and NSIs.
Methods: The study was cross-sectional and all data were collected in 2020. The sample was composed of 221 nurses. Two dimensions of safety performance and six dimensions of safety climate alongside the experience of NSIs in the last year were investigated using validated questionnaires. The path analysis model was built and tested using Mplus software package.
Results: The path analysis model was acceptable in terms of goodness-of-fit metrics. The model supported the mediating role of safety performance on the relationship between safety climate and NSIs. Among safety climate dimensions, safety training had the highest relationship with safety performance dimensions, followed by attitude toward error reporting and cumulative fatigue. Safety participation had a stronger effect on NSIs than safety compliance.
Conclusion: As all safety climate dimensions were significantly correlated with safety performance dimensions and NSIs, promoting safety climate can be effective in improving safety performance and preventing NSIs among nurses.
Short Communication
Padideh Daneii; Vida Sarmadi; Negin Mahmoudi; Amir Kian Moaveni; Fatemeh Mohammad Alizadeh; Sina Neshat; Armindokht Shahsanaee
Abstract
Background : Academic failure is one of the most important issues for both family and students. It has many adverse consequences on students' mental health. Therefore, understanding the factors that influence academic achievement can help reduce academic failure and thus improve students' physical, mental, ...
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Background : Academic failure is one of the most important issues for both family and students. It has many adverse consequences on students' mental health. Therefore, understanding the factors that influence academic achievement can help reduce academic failure and thus improve students' physical, mental, and educational status. This study aimed to investigate the relationship between students' attributional styles and academic achievement in medical students at Isfahan University of Medical Sciences. Methods: The present study has a cross-sectional and descriptive-analytical design. Cronbach's alpha coefficient confirmed the reliability of the ASQ (Attributional Styles Questionnaire) questionnaire for each subscale . The sampling method in this study was census and consisted of 76 First- and Seven- Semester medical students at Isfahan University of Medical Sciences. In this study, Attributional Styles Questionnaire (ASQ) was used to measure attributional styles. Descriptive statistics and independent sample t-test were used through SPSS software version 25 for data analysis. Results: The results showed there is a significant relationship between optimistic and pessimistic attributions and academic achievement. In terms of the overall score of the questionnaire, positive and negative attributions were significantly higher in medical students with higher grade point averages than students with lower grade point averages and academic probation (P <0.05). Conclusion: It can be concluded that there is a significant relationship between the medical students’ attribution styles at Isfahan University of Medical Sciences and their academic achievement.
Letter to Editor
Rozhan Khezri; Rohollah Valizadeh; Payam Nozad; Zahra Maleki; Mousa Ghelichi-Ghojogh
Abstract
In December 2019, the viral outbreak was reported in Wuhan, China, by a novel virus named COVID-19 1,2. The virus spread worldwide rapidly because of its high contagiousness, infecting almost all countries in a short time 3, 4. COVID-19 can affect multiple organs, including the respiratory system, neurology ...
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In December 2019, the viral outbreak was reported in Wuhan, China, by a novel virus named COVID-19 1,2. The virus spread worldwide rapidly because of its high contagiousness, infecting almost all countries in a short time 3, 4. COVID-19 can affect multiple organs, including the respiratory system, neurology system, liver, and kidney 5-8. The most important factors impairing the mental health of the COVID-19 patients include the uncontrollable spreading of the disease, unfavorable conditions of the infected patients isolated in the ICUs with acute respiratory problems, lack of effective medications, and the high COVID-19-related mortality rate 9,10. A study by Huang and Rong showed that coping strategies in the patients and nurses in COVID-19-related wards are key determinants of treatment outcome11,12. In general, increased levels of stress can affect health status. Therefore, developing psychological management strategies to maintain and promote the patients’ and healthcare providers’ mental health in COVID-19-related wards are useful. In the present study, we hypothesized that the presence of a psychiatric nurse might speed up the recovery, decrease hospital stay and mortality, and lower mental health maintenance.
Letter to Editor
Mousa Bamir; Salman Farahbakhsh; Salman Daneshi
Abstract
Coronaviruses are relatively old viruses that first were identified in 1930 as the infectious bronchitis virus in birds, and in 1940 were identified as the cause of gastroenteritis in pigs. Global concern rising about mortality during the COVID-19 pandemic and varieties of clinical signs seems to be ...
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Coronaviruses are relatively old viruses that first were identified in 1930 as the infectious bronchitis virus in birds, and in 1940 were identified as the cause of gastroenteritis in pigs. Global concern rising about mortality during the COVID-19 pandemic and varieties of clinical signs seems to be a good reason to consider using COVID-19 to fight the virus before becoming infected. According to the unprecedented transmission rate of infectious viruses from the past and the evidence of the effectiveness of using preventive methods in the fight against infectious and respiratory diseases, we use the prominence of the family-centered role in Iran compared to other countries (1,2) Following the globalization crisis of COVID-19 in different parts of the world, Iran was facing a more destructive virus, increasing the most brutal sanctions pressure of the United States which has many effects and challenges. In particular, the medical sector faced severe challenges and problems which is referred as drug terrorism to some extent (4,5) Sanctions caused barriers for importing humanitarian aid and medical supplies, including coronavirus detection tools, providing necessary medicines and raw materials to give citizens access the information about the disease and its prevalence. In such a situation, the country's health sector needs to take preventive measures to reduce transmission risk and manage disease. One of the most important ways to prevent the transmission is maintaining the social distance and home care (family-oriented) which are among the most cost-effective ways to reduce vulnerabilities to Covid-19. Domestic and family-oriented policies and quarantine measures controled the speed transmission in East Asian countries. Their similar cases and useful experiences can be a successful scientific and experimental model for Iran, where needs such a control policy more than other countries. Overall, although living in home quarantine has psychological, social, and economic consequences, in Iran, the first and most important strategy for using a preventive home care policy is to focus on people's culture. Increasing training activities, familirizing people with the proper personal and social health behavior, changing people's attitudes towards the adoption of social spacing and justifying why staying at home can be very effective and helpful. Proper and principled policies by the government, such as promoting e-commerce infrastructure and encouraging people to shop online, providing livelihood support to low-income people, Controlling rumors and preventing the spread of false news and unscientific therapies, controlling anxiety and stress management by creating creativity and innovation for fun and vibrancy to avoid psychological and social challenges in the community in this condition are effective and useful strategies (6).
