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Patient engagement (PE) is a well-known strategy introduced and implemented by pharmaceutical and medical device companies for patient compliance and adherence to treatment protocols during clinical trials and care processes. This can affect a wider range of outcomes such as the quality of treatment decisions and quality of care outcomes. Few studies have paid attention to it. The involvement of patient is one of the crucial stakeholders of health care in their treatment that makes controversial opinions about the potential outcomes of their engagement in various aspects of healthcare. This scoping review was conducted in 2022 to collect the results of PE. The search was performed in the MEDLINE and Web of Sciences databases. The selected documents were categorized and reported by the direct content analysis method. Out of 3974 published documents, 17 articles were selected. Findings are categorized into 4 groups: (1) Health outcome, (2) patient compliance, (3) self-efficiency, and (4) return on investment. PE can improve both treatment outcomes and consequently patient satisfaction and health, as well as the productivity of the service provider. However, increasing self-care and patient adherence are among the positive effects of this engagement on the patient, and return on investment is still a challenge for PE.

BackgroundNurses play an important role in advising and guiding patients on effective treatments, and in this situation, it is better to be aware of complementary and alternative medicine (CAM) as well as the effects and side effects of different procedures. In addition, the quality of nursing care is directly related to the nurse's knowledge of the different treatments and preventions of different diseases and conditions. The present study aimed to investigate Iranian nurses' knowledge and attitude toward complementary and alternative medicines (CAMs) as well as their correlation with the quality of patient care.Materials and methodsThis cross-sectional study included 267 clinical nurses from three hospitals in southern Iran. The participants were recruited using convenience sampling methods in 2020–2021. A demographic questionnaire, knowledge and attitude toward CAM questionnaires, and the Quality Patient Care Scale were used to collect data.ResultsThe mean score of CAM knowledge was 26.51, which was less than the questionnaire midpoint of 39. The mean score of attitudes toward CAM was 63.84, which was more than the questionnaire midpoint of 57. The mean score of the quality of patient care was 197.80, which was more than the questionnaire midpoint of 130. There was no significant correlation between knowledge about CAM, quality of patient care, and its dimensions. In addition, there was no significant correlation between attitudes toward CAM, quality of patient care, and its dimensions (P > 0.05).ConclusionThe results of the present study showed that nurses' attitudes toward the use of CAM are positive and can be a sign of their readiness to use and further integrate clinically approved CAM in patient nursing care. Due to the role of nurses in patient care and treatment, there is a need to increase nurses' knowledge of CAM, and its training should be included in the nursing curriculum. More studies are needed to identify nurses' knowledge and attitudes toward CAM and its impact on the quality of nursing care.

Background and Objectives: Diabetics need to improve their lifestyle. They should control and prevent the complications of diabetes to improve their quality of life. This study aimed to investigate the effect of health promotion support programs on the quality of life in patients with type 2 diabetes. Methods: The present study was a quasi-clinical trial. A total of 60 people were selected by convenience sampling method and then divided purposefully into intervention (n= 30) and control (n= 30) groups. The health promotion support program was implemented in three stages: review and recognition, support planning, and evaluation. The study data were collected by Demographic and Quality of Life Questionnaire of diabetic patients (DQOL-BCI) before and two months after the intervention in the experimental and control groups. Results: The difference between the two groups regarding gender, age, marriage, education, and the job was not significant. The Mean±SD score of quality of life in the intervention group before the intervention was 46.8±8.06 and increased after the intervention to 56.8±6.06 (P

Purpose: To assess the efficacy of interferon-beta1b (INF-beta1b) in combination with favipiravir in early treatment of patients with COVD-19 pneumonia. Methods: This prospective non-controlled study was performed on admitted patients with moderate to severe COVID-19 disease to Amir-Alam hospital. The diagnosis of COVID-19 pneumonia was based on positive RT-PCR test from nasopharyngeal samples and typical spiral chest CT scan findings. At the time of this study, there was the shortage of efficient anti-COVID drugs especially “Remdesivir” due to sanction of Iran. All the patients received subcutaneous IFN-beta1b plus favipiravir. The patients with severe infection received intravenous dexamethasone. Those who underwent invasive or noninvasive mechanical ventilation, at the admission onset, were excluded from the study. Results: One hundred and eighty-two patients with moderate to severe COVID-19 pneumonia were included in this study. Among182 patients, 90 cases had moderate and 92 had severe pneumonia. Twenty-one cases with severe pneumonia and 14 cases with moderate pneumonia were transferred to ICU to receive invasive or non-invasive mechanical ventilation. The mean duration of hospital ward admission and ICU stay was 10.69±7.54 and 5.45±2.72 days, respectively. One hundred and seventy-four patients (80.7 %) recovered completely and discharged without need to ICU admission. The response rate was the same in patients with moderate and severe pneumonia. Nine cases (4.9 %) were passed away. Diabetic patients had higher mortality rates. Conclusion: This study showed the efficacy of IFN-beta1b plus favipiravir in early treatment of patients with moderate to severe COVID-19 pneumonia who did not need to mechanical ventilation.

Genetic introgression from interbreeding hybridization of European Bos taurus taurus (EBT) and Indian Bos taurus indicus (IBI) cattle breeds have been widely used to combine the climatic resilience of the IBI cattle and the higher productivity of EBT when forming new composite beef cattle (CB) populations. The subsequent breeding strategies have shifted their initial genomic compositions. To uncover population structure, signatures of selection, and potential introgression events in CB populations, high-density genotypes [containing 492,954 single nucleotide polymorphisms (SNPs) after the quality control] of 486 individuals from 15 cattle breeds, including EBT, IBI, and CB populations, along with two Bos grunniens genotypes as outgroup were used in this study. Then, in-depth population genetics analyses were performed for three CB breeds of Beefmaster, Brangus, and Santa Gertrudis. Neighbor-joining, principal components, and admixture analyses confirmed the historical introgression of EBT and IBI haplotypes into CB breeds. The fdM statistics revealed that only 12.9% of CB populations’ genetic components are of IBI origin. The results of signatures of selection analysis indicated different patterns of selection signals in the three CB breeds with primary pressure on pathways involved in protein processing and stress response in Beefmaster, cell proliferation regulation and immune response in Brangus, and amino acids and glucose metabolisms in Santa Gertrudis. An average of >90% of genomic regions underlying selection signatures were of EBT origin in the studied CB populations. Investigating the CB breeds’ genome allows the estimation of EBT and IBI ancestral proportions and the locations within the genome where either taurine or indicine origin alleles are under selective pressure. Such findings highlight various opportunities to control the selection process more efficiently and explore complementarity at the genomic level in CB populations.

The capability of choosing appropriate coping strategies while attempting to manage classroom context seems to determine learning satisfaction ratings and, therefore, achievement by university learners. However, it is still not clear whether coping style (CP) is a strong mediator of classroom management (CM). Additionally, the degree of relationship among the three variables (CP and CM and learners’ achievement), and the path of relationship is not known yet. The present study was, thus, an attempt to identify the classroom management practices and coping styles (CS) of 152 Iranian EFL instructors and the causal relationship between the two regarding 375 EFL learners’ ultimate achievement. To this end, Classroom Management Techniques Scale and Coping Styles Scale (Lewis, 2001) were administered to teacherparticipants. Results indicated that teachers reported use of positive strategies of involvement and recognition; and social problem solving and relaxation compared to the rather negative categories of classroom management and coping styles. In addition, the results of structural equation modeling highlighted the positive effect upon the learners’ end of year (2016-2017) language achievement of classroom management and coping styles. However, coping styles did not mediate the relationship between teachers’ classroom management and the learners’ ultimate achievement. Findings are discussed in relation to effective teacher classroom management leading to learners’ better academic performance and their prospective consequences for future research.

Background: There are very few reports about the neurological complications of COVID-19.We describe two COVID-19 patients with neurologic presentations. Case Presentation: Herein we present neurological manifestations in 2 hospitalized patients with COVID-19. The patients showed most common symptoms of COVID-19 along with common conflicts in CT scans of lung such as ground-glass opacities (GGOs). First case revealed two episodes of generalized tonic–clonic seizures; brain CT scan in second patients revealed an extensive hypodense lesion in the left cerebellar hemisphere. All cases received supportive care, antibiotics, and antiviral medications. All cases were discharged with a good general condition. Conclusion: The current case series report the association between neurological involvements and COVID-19. Clinicians should be aware of neurologic symptoms in the setting of COVID-19, which might even be the first presentations of this infection.

Abstract Background Thousands of years of natural and artificial selection have resulted in indigenous cattle breeds that are well-adapted to the environmental challenges of their local habitat and thereby are considered as valuable genetic resources. Understanding the genetic background of such adaptation processes can help us design effective breeding objectives to preserve local breeds and improve commercial cattle. To identify regions under putative selection, GGP HD 150 K single nucleotide polymorphism (SNP) arrays were used to genotype 106 individuals representing five Swedish breeds i.e. native to different regions and covering areas with a subarctic cold climate in the north and mountainous west, to those with a continental climate in the more densely populated south regions. Results Five statistics were incorporated within a framework, known as de-correlated composite of multiple signals (DCMS) to detect signatures of selection. The obtained p-values were adjusted for multiple testing (FDR

MYO15A is the third most crucial gene in hereditary sensorineural hearing loss after GJB2 and SLC26A4. In the present study, we reviewed the prevalence of MYO15A mutations in patients with autosomal recessive non-syndromic hearing loss (ARNSHL). In this meta-analysis, we conducted a search of PubMed, Web of Science, Excerpta Medica Database, and Scopus, and identified the articles up to September 2019 without any time limit. Two investigators independently selected the relevant papers and extracted the required information. A total of 44 case-control and case series studies were considered, and 4176 patients and 3706 healthy individuals, as the control group, were included. The pooled frequency of MYO15A mutations between patients suffering from ARNSHL was calculated as 6.2% (95% CI: 4.9-7.8, P-value

Introduction: Competency-based education seeks to bridge the gap between the labor market and the academic education system. Due to the problems of graduates of this field in the professional contexts, this study endeavored to up to date the curriculum of the field based on the expected job qualifications of the health system. Methods: This qualitative and applied study with the focus-group discussion method was conducted in the Faculty of Management and Medical Education of Shahid Beheshti University of Medical Sciences in the academic year 2019. To discuss the group, 13 faculty members and experts, graduates as well as two hospital managers were selected to identify the differences between academic learning and the professional requirements, and then to evaluate the content and topics of the Master of Health Services Management course. At the end of the group's consensus, notes were taken on the agreed results. Results: The data analysis revealed that the essential competencies are like this: leadership, effective teamwork, problem-solving, system thinking, and quality improvement. Changes were suggested in the content of existing courses, like working abilities with STATA software, expertise to design solutions by systems thinking methodologies, awareness of the ultimate challenges of the decisions without supporting evidence, and capacity to compare and criticize strategic planning process and outcomes. Conclusion: Findings revealed that modifications to current courses' content were suggested by adding new curriculum approaches to cover the required skill set. Given changes in the formal curriculum is a time-consuming process, transforming the content of existing courses is recommended.

Background and Aim: Ventilator-acquired pneumonia is common in invasive mechanical ventilatory patients. There are various methods to prevent and reduce the incidence of ventilator-acquired pneumonia, one of which is the use of combined mouthwashes. The purpose of this study was to evaluate the effect of combined mouthwash on the prevention of ventilator-acquired pneumonia. Materials and Methods: In this clinical-trial study, patients were randomly selected and divided into control and study group. The patients with GCS = 3 and brain death and mechanical ventilation less than 48 hours were excluded from the study. The control group received 0.2% chlorhexidine for mouthwash and the study group received gentamicin 2%, colistin 2% and vancomycin 2%. Mouthwashes were used until the creation of pneumonia symptoms, patient mortality, and endotracheal intubation. Statistical analysis was completed after the study. Results: The incidence of pneumonia was 19 (30.64%) in the study group and 16 (25.8%) in the control group (P = 0.23). In the study group, 39 (62/9%) patients and in the control group 40 patients (64/5%) were discharged (P = 49/0). Cultures endotracheal secretions were reported negatively in 40 patients (5.64%) of study group and 45 patients (58.72%) in control group (P = 0.04). The isolated bacteria in the study group included 11 cases of Acinetobacter (50%), four cases of Pseudomonas (18.18%), two cases of E.coli (9.09%), two cases of Klebsiella (9.09%) and three cases of Gram -positive (16.63%). Also these bacteria were reported as 11 cases of Acinetobacter (64.7%), three cases of Klebsiella (17/64%), two cases of Pseudomonas (11.76%), one case of E.coli (5.9%) in control group (P = 0.001). Conclusion: This study showed that a mouthwash with a combination of Gentamicin-Clestin and Vancomycin, compared to chlorhexidine, was not more effective in preventing ventilator-associated pneumonia in patients undergoing mechanical ventilation.

Recovery of consciousness after traumatic brain injury (TBI) is heterogeneous and difficult to predict. Structures such as the thalamus and prefrontal cortex are thought to be important in facilitating consciousness. We sought to investigate whether the integrity of thalamo-prefrontal circuits, assessed via diffusion tensor imaging (DTI), was associated with the return of goal-directed behavior after severe TBI. We classified a cohort of severe TBI patients (N = 25, 20 males) into Early and Late/Never outcome groups based on their ability to follow commands within 30 days post-injury. We assessed connectivity between whole thalamus, and mediodorsal thalamus (MD), to prefrontal cortex (PFC) subregions including dorsolateral PFC (dlPFC), medial PFC (mPFC), anterior cingulate (ACC), and orbitofrontal (OFC) cortices. We found that the integrity of thalamic projections to PFC subregions (L OFC, L and R ACC, and R mPFC) was significantly associated with Early command-following. This association persisted when the analysis was restricted to prefrontal-mediodorsal (MD) thalamus connectivity. In contrast, dlPFC connectivity to thalamus was not significantly associated with command-following. Using the integrity of thalamo-prefrontal connections, we created a linear regression model that demonstrated 72% accuracy in predicting command-following after a leave-one-out analysis. Together, these data support a role for thalamo-prefrontal connectivity in the return of goal-directed behavior following TBI.

Background: Finding behavioral changes in youth during the COVID-19 pandemic may provide a better image of the negative impact of quarantine on their mental and physical health. The purpose of the present research was to examine the smartphone usage status, sleep pattern, health-related quality of life, and physical activity among adolescents from before to during the COVID-19 confinement. Methods: The present study used a descriptive-comparative design. The participants were 384 male and female students aged 16 to 18 years (mean age of 16.84±1.06 years) in grades 11 and 12 from the high-schools of Golestan province, Iran, in 2020. Screen time, sleep pattern, health-related quality of life, and physical activity were measured using standard questionnaires. Paired-Sample t test was employed to compare the means of the constructs of the study from “before” to “during” the COVID-19 pandemic. Independent t test was used to measure gender differences. Results: Results shed light on the increments in smartphone use and decrements in sleep quality, health-related quality of life, and physical activity among adolescents from “before” to “during” the COVID-19 pandemic (all p 0.05). Conclusion: The findings of this study revealed the effects of policies related to COVID-19 pandemic on health-related behaviors among adolescents and emphasized the importance of adopting appropriate coping strategies to promote healthy lifestyle during confinement.

Developing targeted and slow-release antibiotic delivery systems can effectively reduce drug overdose and side effects. This study aimed to investigate the antimicrobial activity of vancomycin-loaded soy protein nanoparticles (vancomycin-SPNs). For the preparation of SPNs, the desolvation method was applied in different concentrations of vancomycin and soy protein (15:5, 10:15, 6:20, 8:25, and 10:30 of vancomycin:soy protein). Scanning electron microscope (SEM), transmission electron microscopy (TEM), dynamic light scattering (DLS), and FTIR were used for nanoparticle characterization. Antibacterial activity was evaluated by the radial diffusion assay (RDA) and absorbance methods. Proper synthesis was demonstrated by characterization. The best drug loading (% entrapment efficiency = 90.2%), the fastest release rate (% release = 88.2%), and the best antibacterial activity were observed in ratio 10:30 of vancomycin:SPNs. Results showed that SPNs are a potent delivery system for antibiotic loading and slow release to control antibiotic use.

Background. Patients infected with coronavirus disease 2019 (COVID-19) present with various clinical presentations with majority of them developing pulmonary complications. This study focuses on cardiac implications of COVID-19 which are less discussed and thus will help to address cardiac implications of COVID-19. Methods. PubMed, PubMed Central, and Google Scholar were screened for articles which mentioned cardiac implications of COVID-19. NHLBI Study Quality Assessment Tools for the observational cohort and cross-sectional studies was used for assessing the risk of bias of our studies. Results. All 14 studies selected were good and had score of ≥9 by NHLBI Study Quality Assessment Tools. Cardiac complications of COVID-19 are common. They are associated with significant mortality. Also, people infected with COVID-19 with premorbid conditions such as cardiovascular diseases and diabetes mellitus have poor prognosis as compared to those without premorbid conditions. Cardiac biomarkers such as highly sensitive troponin I, creatinine, and creatinine kinase-MB on admission are good prognostic markers. Conclusions. Cardiac complications such as heart failure, myocardial injury, and arrhythmias are common among patients infected with COVID-19. Elevated cardiac markers and patients with cardiac complications require utmost care and continuous cardiac monitoring.

Published in May - 2021

Background Resuscitation for traumatic cardiac arrest (TCA) in patients with severe traumatic brain injury (sTBI) has historically been considered futile. There is little information on the characteristics and outcomes of these patients to guide intervention and prognosis. The purpose of the current study is to report the clinical characteristics, survival, and long-term neurological outcomes in patients who experienced TCA after sTBI and analyze the factors contributing to survival.Methods A retrospective review identified 42 patients with TCA from a total of 402 patients with sTBI (Glasgow Coma Scale (GCS) score ≤8) who were admitted to Stony Brook University Hospital, a level I trauma center, from January 2011 to December 2018. Patient demographics, clinical characteristics, survival, and neurological functioning during hospitalization and at follow-up visits were collected.Results Of the 42 patients, the average age was 45 years and 21.4% were female. Eight patients survived the injury (19.0%) to discharge and seven survived with good neurological function. Admission GCS score and bilateral pupil reactivity were found to be significant indicators of survival. The mean GCS score was 5.3 in survivors and 3.2 in non-survivors (p=0.020). Age, Injury Severity Score, or cardiac rhythm was not associated with survival. Frequent neuroimaging findings included subarachnoid hemorrhage, subdural hematoma, and diffuse axonal injury.Discussion TCA after sTBI is survivable and seven out of eight patients in our study recovered with good neurological function. GCS score and pupil reactivity are the best indicators of survival. Our results suggest that due to the possibility of recovery, resuscitation and neurosurgical care should not be withheld from this patient population.Level of evidence Level IV, therapeutic/care management.

The current study examined the effect of EFL teachers’ emotions on different aspects of their identity development including instructional, vocational and local identity as well as their teaching strategies. Following interval-contingent diary writing through a narrative approach, the stories of four novice EFL high school teachers were examined in the course of two months. Through content analysis and theme categorization of participants’ diaries, interview data as well as classroom observation results suggested that teachers’ emotional experiences affected their identity and instructional approaches that varied across different contexts. The results revealed four main themes: desperation and anxiety about student misbehavior affected teachers’ instructional and vocational identity, frustration with low salary and status affected their vocational identity, and frustration with lack of freedom of action as well as feeling of discomfort with school administration behavior influenced teachers’ local identity. It was also indicated that the changes in teachers’ identity were reflected in their orientation towards students vs. teacher-centered teaching.

Introduction: Access to intensive care unit (ICU) beds varies in different countries. Due to the population growth, aging, and longer survival of chronic patients, demand for these beds is increasing all over the world. The present study was performed to assess the management status of ICU beds in selected teaching hospitals affiliated to Shahid Beheshti University of Medical Sciences. Method: This qualitative study was conducted using conventional content analysis method in 2016. In this study, 25 participants were selected by purposive sampling and with maximum variation, and were interviewed by semi-structured interviews with open-ended questions. The interviews were performed in the participants' workplace and lasted between 30 and 60 min. Data were analyzed using conventional content analysis approach. Results: After data analysis, 4 main themes including human capacities related to bed management, the relevant organizational and managerial requirements, ICU prioritized patients' admission and discharge manner, and strategies for promotion and improvement of ICU bed management status and 12 subthemes related to the management status of ICU beds were extracted. Conclusion: According to the results, in our country, bed management in the intensive care units faces many challenges, especially in the areas related to human capacities, ICU admission and discharge prioritization method, and ICUs' monitoring and control, which need to be paid more attention. These challenges can be addressed through training more ICU specialists, observing international admission and discharge criteria, and using appropriate monitoring and control systems.

In this paper we assess the irrigation water use in the Danube Basin, highlight its complexity, identify future challenges and show the relevance for a basin-wide integrative irrigation management plan as part of a more holistic and coherent resource policy. In this sense, we base our integrative regional assessments of the water-food-energy nexus on insights from an extensive review and scientific synthesis of the Danube Basin and region, experimental field studies on irrigation and agricultural water consumption, current irrigation related policies and strategies in most of the Danube countries, and regulatory frameworks on resources at European Union level. We show that a basin-wide integrative approach to water use calls for the evaluation of resource use trade-offs, resonates with the need for transdisciplinary research in addressing nexus challenges and supports integrative resource management policies within which irrigation water use represents an inherent part. In this respect, we propose a transdisciplinary research framework on sustainable irrigation water use in the Danube Basin. The findings were summarized into four interconnected problem areas in the Danube Basin, which directly or indirectly relate to irrigation strategies and resource policies: prospective water scarcity and Danube water connectedness, agricultural droughts, present and future level of potential yields, and science based proactive decision-making.

Background and Objective: Adherence to antihypertension medications is an important factor in the control of hypertension. In this regard, the present study aimed to estimate the extent of medication adherence in hypertensive patients and its determinants in the special clinic of Seyed-al Shohada Cardiovascular Tertiary Hospital in Urmia, Iran. Materials and Methods: In this cross-sectional study, a total of 650 hypertensive patients were investigated during October to December 2016. In this study, two questionnaires were used to collect the data. The first questionnaire included the demographic and clinical characteristics, smoking status, family history of hypertension, and blood pressure measurements. The eight-item Morisky medication adherence scale was used to measure the extent of medication adherence of the participants. Moreover, the Chi-square test and logistic regression model were employed to identify the determinants of medication adherence. Results: Mean value of the participant age was reported as 59.5±10.4 years, and 63.5% of the subjects were female. Overall, 48%, 30.8%, and 21.2% of the subjects were reported with complete, moderate, and poor adherence, respectively. Among the investigated determinants, age (OR=1.02, 95% CI: 1.01-1.05), occupational status (OR=1.83, 95% CI: 1.19-2.83), absence of adverse effects of the drugs (OR=1.83, 95% CI: 1.02-2.71), use of two drugs (OR=1.75, 95% CI: 1.12-2.74), use of three drugs and more (OR=2.25, 95% CI: 1.30-3.88), and history of angioplasty (OR=1.80, 95% CI: 1.19-2.71) were associated with good adherence (i.e., complete and moderate) in this study. Only 39.4% of all participants had controlled level of hypertension. Conclusion: According to the obtained results, the patients with hypertension had good medication adherence. The determinants effective in medication adherence outlined in this study can help identify patients with low extent of adherence.

Background: Sickness absence is a major socio-economic problem imposing a huge amount of cost to societies.This issue has been widely concerned over the last few years. Absence from work entails complex conditions and multifactorial etiology. According to previous studies, there are various occupational and personal factors contributing to the incidence of sickness absence. Long-term sickness absence compels the employer to reassign the tasks to other workers or replace the absent worker. In addition, previous studies indicated that the likelihood of returning to work decreases with longer absence from work. In this light, it is essential to identify the workers at risk of sickness absence, particularly long-term sickness absence. The ability to stay at work and handling the work demands have been discussed as work ability, which is actually a balance between worker’s resources and work requirements. The work ability index (WAI) provides a valuable tool to assess the work ability. It can serve research purposes and clinical assessments in occupational health, aimed at evaluating the ability to work during occupational health examinations and environmental monitoring. Furthermore, the WAI helps better identify the workers at risk of long term sickness absence and early work loss. Various studies have reported that lower WAI scores are correlated with increased incidence of sickness absence and lengthened duration of sickness absence. In a study on construction workers in the Netherlands, Alavinia et al. found that workers with moderate and good work ability are at higher risk of sickness absence than workers with excellent work ability. Moreover, it was revealed that WAI can be a good predictor for sickness absence, especially for prolonged periods of absence from work. Given the importance of sickness absence and identification of workers at risk of absence from work, this study attempted to evaluate Influence of short term and long term sickness absence on work ability index. Methods: This cross-sectional study was conducted on 806 car accessories production company workers. The questionnaires were handed to workers with, at a minimum, one year of employment volunteering in the research project. Certain occupational data concerning date of employment, working location and shift work status were obtained from the Personnel Selection Department. Informed consent was obtained from all individual participants included in the study .The sickness absence data were extracted from the HSE of the factory, containing the number of days and episodes of sickness absence. Absence from work was divided into two categories: short term(

Background and objective: Soybean is one of the most important grains with high proteins, good quality edible oils, appreciable amount of minerals and vitamins. Due to some disadvantages soybeans’ compounds affecting the flavor, odor and stability, different types and levels of processing are considered to make better products with healthy properties. Hypertension (high blood pressure) is one of the modern world diseases, which increases the risk of serious human health problems. There are several systems in humans’ body e.g. angiotensin converting enzyme regulator to blood pressure control. The aim of the present review is to report the effect of germination and fermentation on the concentration of bioactive compounds with angiotensin converting enzyme inhibitory properties. Results and conclusion: Many scientific research has demonstrated that germination (sprouting, also known as malting) and fermentation are two effective and inexpensive technologies improving soybean quality. During these two processes, anti-nutritional and bioactive compounds affecting human health e.g. anti-hypertension components have been removed and released, respectively. Furthermore, studies have shown effect of soybean isolated compounds to inhibit angiotensin converting enzyme. Therefore, soybean germination and fermentation could affect the concentration of bioactive compounds with angiotensin converting enzyme inhibitory properties. Conflict of interest: The authors declare no conflict of interest.