Health Innovation Reports (HIR) (ISSN: 3080-7557) is a quarterly, international, peer-reviewed open-access journal that publishes original research articles, systematic reviews, commentaries, and letters. The journal focuses on advancing healthcare through innovative practices, health technologies, policies, and interdisciplinary approaches spanning medicine, nursing, public health, and biomedical sciences. HIR seeks to support evidence-based solutions and welcomes contributions that address emerging challenges, promote healthcare education, and improve clinical and policy outcomes. The journal encourages collaboration among researchers, clinicians, educators, and policymakers to drive impactful transformation in global health systems. The journal is published by Health Innovation Press, an independent academic publisher committed to disseminating high-quality, open-access scholarly content in the health sciences.
All articles published in Health Innovation Reports are licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This means anyone is free to share and adapt the work, provided proper attribution is given to the original authors and source.
The Influence of Cultural Factors on Advance Healthcare Directives
Abstract Background: Advance directives play a crucial role in end-of-life healthcare decisions, and their effectiveness is widely acknowledged. However, adoption rates of advance directives vary significantly across different cultural contexts. This underscores the need to understand how cultural factors influence perceptions and practices regarding advance directives to improve end-of-life care and ensure patient autonomy. Objective: This scoping review aimed to identify and examine the cultural factors affecting the acceptance, understanding, and utilization of advance directives in diverse cultural settings. Methods: We conducted a systematic literature search from 1998 to 2024 across multiple databases, including PubMed, Scopus, APA PsycINFO, CINAHL, Cochrane Library, and Web of Science, using the Arksey and O'Malley framework. Manual searches were also conducted to supplement our findings. Sixteen studies focusing on the cultural impact of advance directives in various healthcare settings were selected and analyzed. Results: Out of 2606 articles identified, 16 met the criteria, spanning over different populations. Our findings revealed that cultural beliefs, family dynamics, societal norms, and religious values strongly influence attitudes toward advance directives. A significant theme across many cultures was the importance of family involvement in end-of-life planning. These findings underscore the diversity of cultural approaches to end-of-life care and the necessity for healthcare providers to adopt culturally sensitive approaches. Conclusion: Our study highlights the need for healthcare systems to incorporate cultural sensitivities among patients and healthcare personnel. Further exploration of approaches that accommodate cultural diversity is essential to ensure that end-of-life care aligns with individual values and preferences.
Copyright (c) 2025 Abdulmalik Fareeq Saber https://creativecommons.org/licenses/by/4.0
Evaluating Public Health Risks from Bottled Water Consumption in Erbil-Kurdistan: A Multivariate Assessment
Background and Aim Bottled water are widely consumed as a safer alternative to tap water; however, its quality may vary due to contamination with chemical pollutants and heavy metals. Ensuring compliance with World Health Organization (WHO) drinking-water standards is essential to safeguard public health in rapidly developing urban regions such as Erbil, Iraq. This study aimed to evaluate the physicochemical properties, heavy metal concentrations, and potential health risks associated with commonly available bottled water brands in Erbil. Methods Five bottled water brands were analyzed for key physicochemical parameters (pH, electrical conductivity, total dissolved solids, turbidity, nitrate, fluoride, chloride, sulfate, and phosphate) and trace metals (lead, cadmium, arsenic, and mercury). The results were compared with WHO guideline values. Human health risks were assessed using the Hazard Quotient (HQ) and Hazard Index (HI) models for non-carcinogenic effects. Results Most physicochemical parameters were within acceptable limits, except for nitrate (48–57 mg/L) and fluoride (1.4–1.6 mg/L), which slightly exceeded WHO recommendations in several brands. Mean concentrations of lead (9–12 µg/L), cadmium (2.8–3.2 µg/L), arsenic (9–11 µg/L), and mercury (0.9–1.3 µg/L) were detected. HQ values for lead, cadmium, and mercury were below 1, indicating minimal non-carcinogenic risk, whereas arsenic exceeded unity (HQ > 1), signifying potential health concern. The total HI ranged from 1.1 to 1.5, reflecting moderate cumulative exposure dominated by arsenic contribution. Conclusion Although bottled water in Erbil generally meets WHO quality standards, slight exceedances of nitrate, fluoride, and arsenic were observed. The elevated arsenic-related HQ and HI values highlight the need for regular monitoring, improved quality control, and enforcement of regulatory standards to ensure safe bottled-water consumption and protect public health in the Kurdistan Region of Iraq.
Copyright (c) 2025 Muzhda Q. Qader https://creativecommons.org/licenses/by/4.0
Long-Term Air Pollution and Health Risks in Erbil, Kurdistan-Iraq: A Satellite-Based Assessment
Background and Aim Air pollution is a leading global cause of premature mortality, yet evidence from conflict-affected and rapidly developing Middle Eastern cities remains scarce. This study assessed long-term air quality trends and related health risks in Erbil, Iraq. Methods A six-year observational study was performed using Sentinel-5P satellite data from five fixed sites representing urban, industrial, and mixed zones. Seventy-two monthly datasets (12 per year × 6 years) were analyzed for carbon monoxide (CO), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), ozone (O₃), methane (CH₄), and formaldehyde (HCHO). Pollutant concentrations (µg/m³) were used to compute the Air Quality Index (AQI), Air Quality Health Index (AQHI), and WHO exceedance ratios. Statistical analyses included ANOVA and correlation tests (p ≤ 0.05). Results Pollutant levels showed distinct seasonal and interannual variations. CO and SO₂ peaked in winter, while O₃ and HCHO were highest in summer. COVID-19 lockdowns (2020–2021) temporarily reduced CO and NO₂. Mean annual AQI ranged from 168.8 to 190.6 (Unhealthy), and AQHI values remained elevated (7.9–9.4). Exceedances above WHO limits were substantial for NO₂ (260.7%), SO₂ (188.4%), and O₃ (271.6%) whereas HCHO stayed below threshold (79–92%). These concentrations, two to three times higher than international safety levels, indicated increased risks of respiratory, cardiovascular, and oxidative stress-related conditions. Strong positive correlations were observed among combustion-related pollutants (r = 0.64–0.72, p < 0.05). Conclusion Air quality in Erbil remains critically degraded due to vehicle emissions, industrial activities, and dust storms. Temporary improvements during lockdowns were un sustained. Urgent measures including emission inspections, a continuous monitoring network, and transition to cleaner fuels are required to reduce public-health risks and promote sustainable air-quality management
Satellite-based environmental assessment
The Relationship Between Breakfast Skipping, Circadian Rhythm Disruption, and Concentration Levels Among University Students in Erbil City, 2025-2026
Background and Aim Breakfast skipping and circadian rhythm disruption are increasingly prevalent lifestyle behaviors among university students and are recognized as important determinants of cognitive performance. Irregular meal timing and disrupted sleep–wake cycles may impair students’ ability to maintain attention and focus during academic activities. This study aimed to examine the relationship between breakfast skipping, circadian rhythm disruption, and concentration levels among university students in Erbil City during the 2025–2026 academic year. Methods This cross-sectional study was conducted from October 30 to November 20, 2025, among university students in Erbil City using purposive sampling. Data were collected from five universities using a structured self-administered questionnaire that included sociodemographic characteristics, the Zainab Breakfast Skipping Assessment (ZBSA), the Akam-Circadian Rhythm Disruption Scale (AKAM-CRD), and the Concentration Levels-Akam Scale (CL-AKAM). Statistical analyses were performed using SPSS version 26.0. Descriptive statistics, Pearson’s and Spearman’s correlation coefficients, chi-square tests, and multiple linear regression analyses were employed. Results A total of 319 students participated in the study. Most participants demonstrated moderate levels of breakfast skipping (57.37%), circadian rhythm disruption (78.68%), and concentration (68.34%). Breakfast skipping was positively correlated with circadian rhythm disruption (r = 0.33, p < 0.01). Circadian rhythm disruption showed a significant negative association with concentration levels (r = −0.14, p < 0.01). In regression analysis, circadian rhythm disruption emerged as a stronger negative predictor of concentration compared with breakfast skipping. Conclusion Breakfast skipping and circadian rhythm disruption are significantly associated with concentration levels among university students. Interventions promoting regular sleep–wake patterns and healthy breakfast habits may improve concentration and academic performance in this population.
Copyright (c) 2025 Akam Ahmad Radha https://creativecommons.org/licenses/by/4.0
Targeting the Tumor Microenvironment with Gene-Engineered Immune Cells: Focus on CAR-Macrophages and CAR-NK Cells – A Review Article
The TME is a culprit of immunosuppression and a significant hurdle to long-term immunotherapeutic success in solid tumors, which are often associated with a dense stroma, hypoxia, and immunosuppressive myeloid and lymphoid cells. Conventional CAR-T cells tend to fail in this scenario as they are subjected to restricted trafficking, functional exhaustion, and inhibitory cues. Innate immune effectors including macrophages and natural killer (NK) cells are natural resident solid tumor infiltrates with strong cytotoxic and phagocytic potential, and thus represent promising chassis for CAR engineering. CARmacrophages (CAR-M) CAR-Ms can phagocytose tumor cells directly and modulate the TME towards inflammation and superior T cell priming, whereas CAR-NK cells have the advantage of combining antigen-specific targeting with innate recognition, ADCC, and outstanding safety profile. Here, we review recent preclinical and clinical progress in CAR-M and CAR-NK therapy, focusing on their potential to modulate the TME, discuss engineering approaches to resist TME-imposed challenges, and present new clinical trials. We conclude that CAR-M and CAR-NK platforms represent complementary strategies to turning “cold” tumors “hot”, but that enhanced persistence, trafficking, and on-target, off-tumor safety are needed.
Copyright (c) 2025 Farzand Farhad Hamid https://creativecommons.org/licenses/by/4.0
Air Quality Assessment in Erbil, Iraq: Analysis of Major Pollutants and Meteorological Influences
Background: Air pollution remains a critical environmental and public health concern, particularly in rapidly urbanizing regions. In Iraq’s Kurdistan Region, urban expansion and industrial activities have raised concerns regarding air quality in the capital, Erbil, especially during the winter months. Aim: this study aimed to assess wintertime air quality in Erbil and evaluate the major air pollutants in relation to international and regional standards on pollutant behaviours and potential health risks. Methods: This study was designed as an observational, retrospective time-series analysis to evaluate wintertime air quality in Erbil over three months from 1 December 2024 to 28 February 2025 using secondary data on six key air pollutants: PM2.5, PM10, NO₂, SO₂, CO, and O₃, obtained from The Weather Channel. The Air Quality Index (AQI) was applied to assess pollution levels and potential health risks. Statistical analyses (one-way ANOVA) with a significance level of p ≤ 0.05 were conducted to examine temporal variations and inter-pollutant correlations, as well as the influence of meteorological factors on pollutant accumulation. Results: Particulate matter concentrations (PM2.5 and PM10) frequently exceeded World Health Organization (WHO) recommended limits, particularly in December and January, indicating substantial air quality deterioration during colder months. In contrast, gaseous pollutants (CO, NO₂, SO₂, and O₃) generally remained within permissible levels. PM2.5 and PM10 showed a strong positive correlation (r = 0.85), suggesting common anthropogenic sources such as vehicular traffic and industrial emissions. Meteorological conditions, including temperature inversion and high humidity, were found to exacerbate particulate accumulation by reducing atmospheric dispersion. Conclusion: The study highlights that wintertime air pollution in Erbil is primarily driven by particulate matter, intensified by meteorological and human factors. These findings offer essential insights for local environmental authorities to implement targeted air quality management strategies and mitigation policies, aiming to protect public health and promote sustainable urban development
Copyright (c) 2025 Shahla Sherwan Rassol https://creativecommons.org/licenses/by/4.0
The Hidden Health Crisis Following Chamchamal's Floods: A Call for Comprehensive Public Health Response
The catastrophic floods that struck Chamchamal between 8 and 10 December 2024, resulting in three fatalities and the destruction of more than 1,000 homes, should not be understood solely as an acute humanitarian emergency. Rather, they mark the onset of a broader and potentially enduring public-health crisis. As visible flood damage subsides, less immediately apparent—but no less consequential—risks are likely to emerge through compromised water quality, disrupted sanitation, and the mobilization of environmental contaminants. Foremost among the immediate public-health concerns is the destabilization of water security. Flood-related increases in turbidity in the Little Zab River reportedly necessitated the temporary shutdown of water-treatment facilities across multiple districts, leaving substantial segments of the population without access to safe tap water for several days. In such circumstances, households commonly rely on untreated surface water, tanker supplies of uncertain quality, or private wells—sources that are particularly vulnerable to microbial contamination following flooding. The health implications of these exposures are well established. Post-flood environments are consistently associated with outbreaks of waterborne disease, including cholera and leptospirosis, while storm-related rainfall has been linked to increased incidence of Escherichia coli infections and Legionnaires’ disease in the weeks following inundation (Lynch and Shaman, 2023). In Chamchamal, these risks are likely amplified by widely documented deficiencies in sewage infrastructure, which enable direct mixing of floodwaters with untreated domestic wastewater in several neighborhoods...
Copyright (c) 2025 Safin Hussein https://creativecommons.org/licenses/by/4.0
From Local Insight to Global Impact: The 2025 Journey of Health Innovation Reports
As 2025 draws to a close, Health Innovation Reports (HIR) proudly reflects on a year that marked a transformative stage in our journal’s evolution. What began as a vision to promote accessible, high-quality research from Erbil has grown into a recognized platform where local innovation meets global collaboration. Through dedication, transparency, and scientific rigor, this year reaffirmed our mission: to bridge disciplines and disseminate knowledge that improves lives. The year 2025 brought remarkable milestones for HIR. We successfully published three issues encompassing original studies, reviews, editorials, commentaries, and case reports. Each issue represented an expanding spectrum of health sciences—from clinical nursing and mental health to biomedical engineering and public health policy. HIR achieved full indexing in Google Scholar, integrated with Crossref for DOI registration, and partnered with ReviewerCredits to acknowledge our peer reviewers’ essential contributions. Our articles were accessed thousands of times worldwide, proving that open-access publishing can amplify the voice of regional science to an international readership. Behind every milestone lies teamwork. We express sincere gratitude to our authors who entrusted us with their scholarly work, to the reviewers whose constructive feedback strengthened scientific quality, and to the editorial board whose commitment ensured ethical and timely publication. Their collective efforts allowed HIR to uphold its standards of transparency and editorial independence. We are also thankful to our readers and academic partners whose encouragement motivates continual growth and innovation. The year was not without challenges. Managing the increasing volume of submissions while preserving rigorous peer-review standards required resilience and adaptability. Yet these challenges became opportunities—to refine our workflow, enhance editorial efficiency, and expand our reviewer pool across diverse specialties. We learned that sustainability in academic publishing depends not only on output but also on mentorship, inclusion, and accountability. In 2025, HIR reaffirmed that scientific progress is achieved through cooperation, not competition. As we close the final issue of 2025, our focus turns toward 2026 with renewed vision. Our foremost priority will be achieving indexing in the Directory of Open Access Journals (DOAJ) and strengthening compliance with international best practices. We aim to diversify our editorial board further, invite more interdisciplinary research, and develop thematic special issues on pressing global health challenges. Most importantly, we remain dedicated to nurturing early-career researchers by offering fair, supportive, and transparent publication opportunities. To our community of scholars, reviewers, and readers—thank you for being part of this journey. Together, we have transformed Health Innovation Reports from a local initiative into a global voice for health research integrity and innovation. As we welcome 2026, we reaffirm our belief that open, ethical, and inclusive science is the path to a healthier world
Teachers’ Knowledge of Basic First Aid in Public, Private, and International Primary Schools in Erbil City, 2024–2025
Background and Aim: In Erbil City, primary school teachers often face situations that require immediate first aid, yet their level of knowledge may vary depending on training, school type, and experience. This study aimed to assess the knowledge of basic first aid (BFA) among teachers in public, private, and international primary schools. Method: This cross-sectional study was conducted from January 12th to June 21st, 2024, in 19 primary schools in Erbil City, including 10 public, 5 private, and 4 international schools, using systematic sampling method. A structured questionnaire was employed to gather data on demographic characteristics, BFA training background, emergency experiences, and knowledge of first aid across domains such as CPR, choking, trauma management, and general emergencies. Statistical analysis was performed using SPSS version 20 (IBM Corp., Armonk, NY, USA). Descriptive statistics were used, and Chi-square tests were applied to assess associations between knowledge levels and demographic or training variables. Results: A total of 264 teachers participated, of whom 39.0% were from public schools, 38.6% from private schools, and 22.3% from international schools. Overall, 35.6% of teachers had attended BFA training, with those trained achieving significantly higher knowledge scores than untrained teachers (p < 0.001). The mean knowledge score was 6.78 ± 2.86, indicating a fair level of knowledge overall. Training type and frequency were strongly associated with knowledge level, while gender was not significant. Younger teachers and those with more years of training showed better performance in cardiac, choking, trauma, and general emergency domains. Conclusions: The study demonstrated that primary school teachers in Erbil generally had fair knowledge of basic first aid, with training being the strongest predictor of higher knowledge. Expanding practical and theory-based training programs is essential to equip teachers with adequate first aid skills, ensuring student safety and effective management of school emergencies.
Copyright (c) 2025 Jawdat Mamand Alhagbaker https://creativecommons.org/licenses/by/4.0
Contraceptive Pill Side Effects and Their Prevalence Among Women Attending Maternal and Child Health Centers in the Kurdistan Region
Background and Aim: In the Kurdistan Region of Iraq, contraceptive pills are widely used for family planning, but their side effects can significantly influence women’s health and healthcare-seeking behavior. This study aimed to assess the prevalence of side effects associated with contraceptive pills among women attending maternal and child health centers. Method: This cross-sectional descriptive study was conducted from January to April 2023 in maternal and child health centers across Erbil, Sulaimani, and Duhok, using a convenience sampling method. Data were collected through structured face-to-face interviews using a questionnaire that included sociodemographic information, clinical history, and side effects of contraceptive pills. Statistical analysis was performed using SPSS version 26. Descriptive statistics were used to summarize the data, and Chi-square tests were applied to examine associations between major side effects and demographic or clinical characteristics. Results: Among 671 participants, the most frequently reported side effects were painful or missed periods (44.7%), headache (44.4%), fatigue (38.0%), and vision problems (35.3%). Rare but notable complications included blood clots (1.8%), breast lumps (3.3%), stroke (0.3%), and heart attack (0.4%). Younger women (20–29 years) reported higher rates of painful or missed periods (50.0%), while combined pill users experienced significantly higher frequencies of all major side effects compared to progesterone-only users (p < 0.001). Duration of use and higher education level were also significantly associated with increased prevalence of side effects (p < 0.05). Healthcare-seeking behavior showed 57.7% of women with side effects consulted providers, with gynecologists most frequently approached. Conclusions: The study demonstrated that side effects of contraceptive pills are common among women in the Kurdistan Region, with significant variations by age, education, type, and duration of use. Strengthening counseling services and providing accurate information on potential side effects are essential for improving contraceptive adherence and safeguarding women’s reproductive health.
Copyright (c) 2025 Jawdat Mamand Alhagbaker, Wahida Abdullah Ibrahim, Lana Abdul Hamed Muhamed, Sideeq Sadir Ali, Jihad Haji Saleh, Ammar Yassin Abdullah (Author) https://creativecommons.org/licenses/by/4.0
Scrolling vs. Studying: The Impact of Social Media on High School Students’ Study Habits in Erbil, 2024-2025
Background and Aim: High school students are increasingly engaged with social media, which may influence their study habits, academic performance, and overall lifestyle. This study aimed to analyze the demographic patterns of social media use, its perceived impact on study habits, and the effectiveness of management strategies among high school students in Erbil. Method: This cross-sectional study was conducted from 12th of July to 11th of November, 2024, in five public high schools in Erbil. Convenience sampling was used to collect data using a structured questionnaire. The questionnaire included demographic information and the Social Media and Study Habits Assessment Scale (SMSHAS), which measured distraction, lifestyle disruption, and academic outcomes. Statistical analysis was performed using SPSS version 29 (IBM Corp., Armonk, NY, USA). Descriptive analysis, chi-square tests, and one-way ANOVA were conducted to assess associations between social media use, demographic variables, academic indicators, and management strategies. Results: A total of 500 students participated in the study. Most students reported daily social media use of 1–2 hours (37.2%) or 2–4 hours (34.0%), while 7.4% exceeded six hours. The most preferred platforms were YouTube (26.3%) and TikTok (25.7%). Negative impacts were common, with 73.8% reporting laziness, 62.0% experiencing sleep or eating difficulties, and 78.8% perceiving wasted time. Academic performance was significantly associated with daily usage hours (p < 0.001), as students using social media more than six hours daily had the lowest GPA (2.51 ± 0.79) compared to those using 1–2 hours (3.42 ± 0.58). Conclusions: The study demonstrated that high school students in Erbil are highly exposed to social media, with significant negative impacts on study habits and academic performance, particularly among heavy users. Educational stakeholders and policymakers should promote awareness campaigns and encourage the use of effective management strategies to support students in balancing digital engagement with academic success.
Academic Performance and Learning Outcomes
Copyright (c) 2025 Shamsadeen Abdullah Mohammed, Helen Naif Ahmad, Mohammed Tayeb Sadeeq, Hardi Abdulqadir Hasan, Zakaria Tahsin khdir (Author) https://creativecommons.org/licenses/by/4.0
Crossed Testicular Ectopia in a Three-Year-Old: Case Report and Literature Review
Crossed testicular ectopia (CTE) is a rare congenital anomaly in which both testes descend toward the same hemiscrotum, with fewer than 150 cases reported in the literature. We present the case of a three-year-old boy who was admitted with swelling in the left inguinal region and bilaterally empty scrotum. Ultrasonography revealed one testis in the left inguinal canal and absence of the right testis. During inguinal exploration, both testes were found on the left side, confirming CTE. Each testis demonstrated normal morphology, vascularity, and adequate cord length, allowing successful left subdartos orchiopexy and right transseptal orchiopexy. The postoperative course was smooth, and follow-up confirmed proper placement of both testes in their respective scrotal compartments. This case emphasizes the importance of considering CTE in children with unilateral inguinal hernia and contralateral non-palpable testis and highlights the role of timely surgical intervention in preserving fertility and reducing malignancy risk.
Copyright (c) 2025 Yadgar Shwani (Author) https://creativecommons.org/licenses/by/4.0
Persistent Antimicrobial Activity in Piezocatalytic Nanoparticles: The Critical Role of Synthesis Design
Traditional antimicrobial strategies depend on the sustained presence of active agents, which often lose efficacy once degraded or removed. Recent advances in nanomaterial engineering challenge this paradigm, with piezocatalytic systems exhibiting enduring antimicrobial activity well beyond external stimulation. Optimized synthesis parameters—particularly calcination, defect engineering, and ultrasonic treatment—create crystalline architectures that sustain reactive oxygen species (ROS) generation even in the absence of continuous input. These features transform antimicrobial activity into a programmable material property, preserved by careful post-synthesis handling. Potential applications include bactericidal surfaces in healthcare and continuous disinfection in water treatment, reducing dependence on chemical agents. Importantly, such physically driven mechanisms offer strategic advantages against multidrug-resistant organisms by minimizing selective pressure for resistance. Overall, strategic synthesis design enables the creation of durable, self-renewing antimicrobial platforms with profound implications for global infection control.
Copyright (c) 2025 Safin Hussein (Author) https://creativecommons.org/licenses/by/4.0
Teachable Moment Brief Intervention (TMBI) for Intensive Suicidal Ideation: A Narrative Review of a Rare and Critical Approach in Suicide Prevention
Suicide is a significant global public health issue, and suicidal ideation poses a substantial risk, especially when it becomes intensive, characterized by persistent and severe thoughts of suicide. Despite the high risk, effective interventions specifically targeting individuals with intensive suicidal ideation remain limited. The Teachable Moment Brief Intervention (TMBI) offers a novel approach to addressing this gap. By focusing on critical junctures, TMBI is designed to leverage teachable moments—naturally occurring events that create heightened awareness and motivation for change—to provide timely and focused intervention for those in suicidal crises. The intervention involves a single session that includes collaborative assessment, safety planning, and the identification of protective factors, all aimed at reducing suicidal ideation and promoting safety. However, the successful implementation of TMBI is not without its obstacles. Implementing TMBI faces challenges such as ensuring clinician preparedness, addressing short-term crisis management, and ensuring continuity of care. Given these challenges, future directions for TMBI involve enhancing clinician training, adapting the intervention for diverse populations, and integrating TMBI with other evidence-based strategies. Therefore, this review aims to provide a comprehensive and critical analysis of the current state of research on TMBI for intensive suicidal ideation.
Teachable Moment Brief Intervention (TMBI)
Copyright (c) 2025 Hardi Abdulqader (Author) https://creativecommons.org/licenses/by/4.0
Metabolic Memory in Cancer Cells: Unraveling the Long-Term Epigenetic Footprint of Transient Stressors – A Narrative Review
Cancer cells demonstrate remarkable metabolic plasticity, allowing them to adapt and endure under harsh conditions such as nutrient deprivation, hypoxia, and chemotherapy. This plasticity is not merely short-term; it can create a cellular memory that persists. Notably, exposure to stressful conditions can trigger stable epigenetic changes that preprogram cell behavior, enhancing tumor growth, metastasis, and drug resistance. This review examines the phenomenon of metabolic memory in cancer, aiming to explain how temporary stressors lead to long-term epigenetic adaptations that reshape cellular metabolism and phenotype. Key mechanisms include DNA methylation, histone modifications, and non-coding RNAs, all of which contribute to the reprogramming of metabolic pathways. This concept could hold therapeutic potential. Reversing stress-induced remodeling may be possible by focusing on metabolic enzymes or epigenetic regulators. Such strategies could enhance treatment efficacy and reduce the risk of resistance.
Copyright (c) 2025 Karez Abdulghany , Huda Jabbar (Author) https://creativecommons.org/licenses/by/4.0
Evergreen Plants in Medicine: A Narrative Review of Their Therapeutic Potential and Pharmacological Applications
Evergreen plants, known for retaining their foliage throughout the year, play an essential ecological and medicinal role across diverse environments. Traditionally valued in various healing systems, these plants offer year-round accessibility and are rich in pharmacologically active compounds. This review aims to provide a comprehensive overview of the botanical characteristics, phytochemical profiles, ethnobotanical uses, and pharmacological mechanisms of evergreen plants, while highlighting their clinical applications and research limitations. Evergreen species such as Taxus brevifolia, Camellia sinensis, and Ilex paraguariensis have demonstrated significant therapeutic benefits, including anti-inflammatory, anticancer, antimicrobial, and antioxidant activities. These properties are largely attributed to bioactive compounds like terpenoids, flavonoids, and polyphenols, which interact with molecular pathways relevant to chronic and infectious diseases. Despite these promising attributes, current research is hindered by challenges such as inconsistent extraction methods, limited clinical trials, and threats to biodiversity due to overharvesting. This review highlights the need for standardized, interdisciplinary research approaches and sustainable practices to fully realize the medicinal potential of evergreen plants. It is recommended that future studies prioritize clinical validation, conservation, and integration of traditional knowledge into evidence-based frameworks.
Copyright (c) 2025 Shilan Farhad Mamand, Jihad Haji Saleh (Author) https://creativecommons.org/licenses/by/4.0
The Psychological Effect of Antimicrobial Resistance in Patients with Oral Squamous Cell Carcinoma (OSCC)
Background and Aim: Oral squamous cell carcinoma (OSCC) is a common form of head and neck cancer, and the emergence of antimicrobial resistance (AMR) has made its treatment increasingly challenging. AMR contributes to treatment failures, increased morbidity, and reduced survival rates among OSCC patients. Beyond these clinical impacts, this review aims to evaluate the psychological burdens associated with AMR in OSCC and to explore the effectiveness of mental health interventions tailored to these patients. Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, Scopus, APA PsycINFO, CINAHL, Cochrane Library, and Web of Science. To ensure a thorough examination of the topic, the review focused on the intersection of AMR, OSCC, and mental health interventions, with studies published from March 2001 to August 2024 being considered. Results: A total of 62 studies were reviewed, revealing that AMR in OSCC significantly exacerbates psychological burdens such as anxiety, depression, and social isolation. Interventions like mindfulness-based interventions (MBIs), cognitive-behavioral therapy (CBT), and acceptance and commitment therapy (ACT) were identified as effective in reducing psychological distress and improving quality of life. Conclusion: The results indicate that AMR significantly worsens the psychological well-being of OSCC patients. Healthcare providers and policymakers are recommended to integrate mental health support into standard cancer care, enhance training on the psychological impact of AMR, and address barriers to mental health services. Future research should focus on developing and evaluating innovative mental health interventions and strategies to mitigate the impact of AMR on OSCC patients.
Copyright (c) 2025 Shilan Farhad Mamand, Hardi Abdulqader Hasan, Akam Fareeq Saber, Mardin Fareeq Saber, Jihad Haji Saleh, Radhwan Saifadin Sabah, Sima siyamand hussein, Suha Saeed Azeez (Author) https://creativecommons.org/licenses/by/4.0
Assessment of Women's Knowledge About Ovarian Cysts at a Maternity Teaching Hospital: A Cross-Sectional Study in Erbil, 2024–2025.
Background and Aim: In Erbil, Iraq, limited awareness about ovarian cysts among women can delay diagnosis, affect treatment decisions, and contribute to complications. This study aimed to assess the level of knowledge regarding ovarian cysts among women attending Maternity Teaching Hospital in Erbil. Methods: This cross-sectional study was conducted from September 15, 2024, to January 15, 2025, at Maternity Teaching Hospital in Erbil. A structured questionnaire was used, which included socio-demographic characteristics and 27 items assessing knowledge related to the definition, types, symptoms, causes, risk factors, complications, and prevention and treatment of ovarian cysts. Data were analyzed using SPSS version 27. Chi-square tests were used to assess associations between knowledge levels and demographic variables, followed by ordinal regression analysis for adjusted associations. Results: A total of 220 women participated in the study. More than half demonstrated a fair level of knowledge, while a substantial proportion had good awareness, particularly regarding symptoms and prevention methods. A statistically significant association was found between number of children and knowledge levels, with women who had fewer or no children showing better understanding. Ordinal regression analysis further confirmed that marital status significantly influenced knowledge, with divorced women having higher knowledge levels than others. Conclusions: The study revealed that most women had fair to good knowledge about ovarian cysts, particularly in symptomatic and preventive aspects. Policymakers and healthcare providers are recommended to implement targeted educational programs to improve awareness, especially in areas related to causes, risk factors, and complications.
Copyright (c) 2025 Srwa Abdulrahman Mustafa, Ala Sabah Nashat, Eman Qaid Ebrahim, Dashne Kayfi Majid, Gardoon Yassin Abdulrahman, Jihad Haji Saleh (Author) https://creativecommons.org/licenses/by/4.0
Assessment of Mothers’ Knowledge and Attitudes Toward Weaning at Maternity and Raparin Teaching Hospitals: A Cross-Sectional Study in Erbil, 2024–2025.
Background and Aim: In Erbil, Iraq, weaning practices play a critical role in early childhood nutrition and maternal decision-making. This study aimed to assess the levels of knowledge and attitudes regarding weaning among mothers attending Maternity Teaching Hospital and Raparin Teaching Hospital. Methods: This cross-sectional study was conducted at Maternity Teaching Hospital and Raparin Teaching Hospital from September 15 to November 5, 2024, using purposive sampling. The questionnaire consisted of three sections: the first included demographic data, while the second and third were self-structured tools developed to assess mothers’ knowledge and attitudes toward weaning. Chi-square tests, Pearson correlation, and ordinal regression were used to examine associations between the main variables and potential confounding factors. Data were analyzed using SPSS version 27 Results: A total of 235 mothers participated in the study. The findings showed that most mothers demonstrated fair levels of both knowledge and attitude toward weaning, with mean scores of 33.99 ± 2.89 and 30.48 ± 3.76, respectively. There was a significant positive correlation between knowledge and attitude (r = 0.31, p < .001), indicating that greater knowledge was associated with a more favorable attitude. Ordinal regression analysis identified the number of children as a significant predictor of both knowledge and attitude levels, while other socio-demographic variables showed no significant associations. Conclusions: The study concluded that mothers in Erbil generally have fair knowledge and attitudes toward weaning. Policymakers and healthcare providers are recommended to implement targeted educational programs to enhance maternal awareness and promote positive weaning practices.
Copyright (c) 2025 Shamsadeen Abdullah Mohammed, Zainab Muzafar Muhammad, Hanan Shawkat Kamal, Payam Sarbaz Muhammed, Hanan Nazm Arf, Hardi Abdulqadir Hasan (Author) https://creativecommons.org/licenses/by/4.0
The Relationship Between Self-Esteem, Stigma, and Coping Strategies Among Breast Cancer Patients in Erbil City, 2024–2025.
Background and Aim: Breast cancer patients often face psychological challenges, including diminished self-esteem and stigma, which can impact their coping strategies. This study aimed to assess the levels of self-esteem and stigma among breast cancer patients in Erbil City and analyze their relationship with coping mechanisms. Method: This cross-sectional study was conducted from June 10, 2024, to February 20, 2025, in two hospitals in Erbil City, using purposive sampling. The study contained four parts, including demographic data and three standardized tools: the Rosenberg Self-Esteem Scale (RSE) to assess self-esteem, the Cancer Stigma Scale (CASS) to evaluate stigma, and the Cancer Coping Questionnaire to measure coping strategies. Data were analyzed using SPSS version 28 (IBM Corp., Armonk, NY), with Pearson correlation and multiple linear regression applied to examine associations between self-esteem, stigma, coping strategies, and demographic variables. Significance was set at p < 0.05. Results: A total of 109 breast cancer patients participated in the study. The mean scores for self-esteem, stigma, and coping strategies were 26.84 ± 7.33, 122.47 ± 16.90, and 53.47 ± 14.72, respectively, indicating that all three variables were at a moderate level among participants. Pearson correlation analysis revealed a significant negative relationship between stigma and self-esteem (r = -0.16, p < 0.001), suggesting that higher stigma was associated with lower self-esteem. Additionally, stigma was negatively correlated with coping strategies (r = -0.61, p < 0.001), while self-esteem was positively correlated with coping strategies (r = 0.14, p < 0.001), indicating that higher self-esteem was linked to better coping strategies. Conclusion: The study found that breast cancer patients had moderate levels of stigma, self-esteem, and coping strategies. It is recommended that policymakers and healthcare providers develop targeted psychosocial interventions to reduce stigma, enhance coping mechanisms, and improve self-esteem among breast cancer patients.
Copyright (c) 2025 Yousif Abdulsatar Jabbar, Banaz Othman Ali, Amez Abubakr Omar, Arena Nawzad Awsu, Ahmed Ali Rasool, Mosleh Saber Kareem, Arpi Manookian, Ahmed Naif Ali, Safin Hussein, Abdulmalik Fareeq Saber (Author) https://creativecommons.org/licenses/by/4.0
Metachronous Unilateral Ovarian Metastasis from Renal Cell Carcinoma with Chemotherapy Response: A Case Report
Renal cell carcinoma (RCC) rarely metastasizes to the ovary, with only a few dozen cases reported in the literature. We report a rare case of a 23-year-old woman who initially presented with a large left renal mass and underwent radical nephrectomy. Histopathological and immunohistochemical analysis confirmed unclassified clear renal adenocarcinoma. After completing six cycles of chemotherapy and three years of regular follow-up, a left adnexal mass was detected. Imaging and core biopsy confirmed metastatic ovarian involvement with histologic features identical to the primary renal tumor. The patient responded favorably to a second chemotherapy course, and laparoscopic oophorectomy revealed no residual malignancy. This case emphasizes the importance of long-term surveillance in RCC patients and highlights the diagnostic challenge posed by rare metastatic presentations mimicking primary ovarian tumors. Awareness of such rare pathways is essential for timely diagnosis, proper therapeutic decisions, and improved patient outcomes through multidisciplinary collaboration.
Copyright (c) 2025 Yadgar Abduljabbar Shwani (Author) https://creativecommons.org/licenses/by/4.0
Epigenetic Dysregulation and Cancer Progression: How Epigenetic Modifications Shape Tumor Fate
Epigenetic modifications, including DNA methylation, histone modification, and non-coding RNAs, play crucial roles in regulating gene expression without altering the underlying DNA sequence. In cancer, these epigenetic processes are often disrupted, contributing to tumor initiation, growth, metastasis, and drug resistance. This article reviews the latest findings on epigenetic dysregulation in cancer, emphasizing how these modifications influence tumor behavior and presenting novel therapeutic strategies aimed at targeting the epigenome. Additionally, we explore the potential for integrating epigenetic biomarkers into precision oncology to enhance patient outcomes, with a focus on recent advancements from 2022 to 2025.
Immuno-Gene Therapies in Oncology: A New Era Beyond Chemotherapy
The field of oncology is undergoing a revolution, and it is transforming away from the conventional limits of chemotherapy into more targeted, durable, and patient-specific approaches. This commentary explores the compelling case for elevating cancer immuno-gene therapies to the forefront of cancer treatment. By leveraging the body's immune system and gene-editing technologies, these therapies are offering a paradigm shift-one that battles cancer at its gene and immunologic root rather than targeting merely the symptoms or halting cell growth. We scrutinize critically the drawbacks of chemotherapy, such as toxicity, non-specificity, and high relapse potential, against the progress made with CAR-T cell therapy, immune checkpoint inhibitors, cancer vaccine, and genetically modified immune cells. The backdrop is against which developments in CRISPR and synthetic biology are making better and targeted treatments less toxic. In spite of challenges like immense expense, regulatory challenges, and the intricacy of delivery mechanisms, the clinical and scientific impetus behind immuno-gene therapies is overwhelming. This paper argues that these technologies are not add-ons to conventional therapies but the building blocks of future oncology research. Focusing on the development of cancer immuno-gene therapies, the discipline can get closer to the age-old vision of curative, patien.t-specific cancer therapy.
Copyright (c) 2025 Farzand Farhad Hamid Hamid (Author) https://creativecommons.org/licenses/by/4.0
Introducing Health Innovation Reports: Pioneering Healthcare Excellence and Innovation
It is with great pride and anticipation that I present the inaugural issue of Health Innovation Reports (HIR). As Editor-in-Chief, I am honoured to share this significant milestone in our collective endeavour to advance evidence-based healthcare practices and innovation. Health Innovation Reports is conceived as a dynamic platform dedicated to disseminating cutting-edge research, insightful reviews, thought-provoking commentaries, and impactful case reports. Our primary objective is to bridge the gap between innovative health science research and clinical practice, fostering a community of informed clinicians, researchers, policymakers, and healthcare advocates. In recent years, the healthcare landscape has undergone dramatic transformations, propelled by technological advancements, shifting disease patterns, and evolving patient expectations. Amid these changes, timely access to accurate, reliable, and innovative health information has never been more critical. HIR emerges in response to this essential need, with a commitment to rigorous peer review and a robust ethical framework designed to ensure transparency, integrity, and scientific excellence in all published works. This inaugural issue has been thoughtfully crafted to reflect our dedication to diverse and multidisciplinary research. It contains original research articles exploring contemporary healthcare challenges and innovative solutions, alongside expert reviews that provide in-depth analyses of critical issues, and a compelling case report offering practical insights drawn from real-world clinical experiences. Each contribution exemplifies our commitment not only to scientific inquiry but also to practical applicability. Our editorial board comprises esteemed scholars and clinicians from diverse international backgrounds who share our vision of fostering innovation and excellence in healthcare research. We are deeply appreciative of their guidance, dedication, and unwavering commitment to maintaining the high scientific standards of HIR. Furthermore, we warmly welcome engagement from the global healthcare community. Your active participation as readers, authors, reviewers, and advocates is essential to our journal's growth and impact. We encourage submissions that challenge current paradigms, provoke thoughtful discussion, and contribute meaningfully to the advancement of healthcare on a global scale. As we embark on this exciting journey, we extend our heartfelt gratitude to our contributors, reviewers, editorial team, and, most importantly, you—our readers—for your trust and support. We look forward to your valuable insights, feedback, and future contributions. Together, let us shape Health Innovation Reports into a trusted source of knowledge and innovation, committed to improving health outcomes worldwide.
Copyright (c) 2025 Abdulmalik Fareeq Saber (Author) https://creativecommons.org/licenses/by/4.0