This is the second issue this year with papers dealing with various issues from the region.
Mohamed, N did an integrative review aims to identify the factors that promote back-care practices among nurses working in long-term care settings. This integrative review was guided by Whittemore and Knafl's (2005) framework. Three databases were searched for peer-reviewed studies published between 2011 and 2021 based on set inclusion and exclusion criteria. A hand search was also conducted among the reference lists of the included peer-reviewed articles. The identified articles were critically appraised using the Mixed Methods Appraisal Tool. Data was then extracted, and the various barriers and facilitators of back-care practices were noted based on the three levels of the Socio-Ecological Model: individual, organizational, and environmental.
Three main factors that influence back-care practices include lack of knowledge among nurses about the programs, lack of organizational support, and lack of maneuvering space.
The author concluded that it is imperative that educational sessions related to the safe handling
of patients be provided to nurses to increase their knowledge and implementation of appropriate
back-care practices. Involving stakeholders in the development and implementation process of back-care programs will encourage the stakeholders to fully understand the importance of the programs.

Johnson, et al., did an integrative review is to assess health literacy within the GCC countries in
order to provide a picture of the state of health literacy. The authors stressed that in the world of an ever-evolving face of healthcare practice and policies, it is increasingly becoming more
imperative that the greater population is enabled to keep up with the pace of changes and reforms in healthcare. However, to do this, we need to ensure healthcare consumers can access, evaluate and create change in a way that is meaningful and understandable to them.

An integrative review using the Whittemore and Knafl framework was utilized in order to review empirical studies will be undertaken. This study will also look at grey literature in order to review the evidence that is written about health literacy in the GCC countries. The results are expected to provide a landscape of the current practice in the GCC counties as well as to inform future practice related to caregiving and the influence of health literacy on that realm.

Muir, et al., followed a quantitative cross-sectional study, utilizing a self-administered survey.
The survey contained questions related to immunization knowledge, attitude, and practice.
The aim of this research was to assess nurses' knowledge, attitude and practice after the delivery of a three-day continuing professional development program regarding administration, safe handling and delivery of vaccines. Before and after attendance of an immunization program for continuing professional development, the survey was administered to nurses working in well-baby clinics, communicable diseases clinics, travel clinics and school nurses. Specific areas identified gaps in knowledge, attitude, and practice among participating nurses. Results from their study suggest that attitudes and practices of participants identified a significant difference after receiving an immunization educational program that focused on administration and delivery of immunization skills. The authors concluded that continuous professional development activities such as this have shown a marked increase in the attitude and practices of nurses making it tantamount to the success of vaccine uptake. Nurses are poised to be frontline advocates for the uptake of immunizations; therefore education and training needs to be provided in order for them to understand and further affect change.

Helvaci, et al., did a study on Smoking-induced inflammation in the body. Consecutive daily smokers at least for a period of six months and age and sex-matched non-smokers were taken into the study.
Cases with regular alcohol consumption (one drink a day) and patients with inflammatory, infectious, or devastating disorders including eating disorders, malignancies, acute or chronic renal failure, cirrhosis, chronic obstructive pulmonary disease, hyper- or hypothyroidism, or heart failure were excluded. The study included 150 smokers (99 males) and 162 non-smokers. Interestingly, the mean age of the smokers was 45.9 years, and 66.0% of them were male. Although the mean weight, body mass index, systolic and diastolic blood pressures, and hematocrit values were similar in both groups, triglycerides (163.3 versus 151.8 mg/dL, p<0.05), low density lipoproteins (LDL) (126.1 versus 117.4 mg/dL, p<0.05), erythrocyte sedimentation rate (ESR) (10.8 versus 9.4 mm/h, p<0.05), and C-reactive protein (CRP) (2.5 versus 2.1 mg/L, p<0.05) values were all higher in the smokers, significantly. On the other hand, high density lipoproteins (HDL) (41.1 versus 44.0 mg/dL, p<0.05) and fasting plasma glucose (FPG) (101.9 versus 111.9 mg/dL, p<0.01) values were lower in the smokers, significantly. The
authors concluded that smoking causes a low-grade systemic inflammation on vascular endothelium terminating with an accelerated atherosclerosis-induced end-organ insufficiencies in the body.

Plasma triglycerides, LDL, ESR, and CRP may be positive whereas HDL and FPG negative APR
indicating the inflammatory effects of smoking in the human body.

Helvaci, et al., tried to understand whether or not there are some positive and negative acute phase reactants (APR) indicating the possible inflammatory effects of smoking on vascular endothelium.

Consecutive daily smokers at least with a history of one pack-year and age and sex-matched non-smokers were taken into the study. Cases with regular alcohol consumption (one drink a day) and patients with inflammatory, infectious, or devastating disorders, or heart failure were excluded.

The study included 247 smokers (173 males) and 167 non-smokers. Interestingly, the mean age of the smokers was 46.2 years, and 70.0% of them were males. Although the mean body weight, body mass index, systolic and diastolic blood pressures, and hematocrit values were similar in both groups, plasma triglycerides (163.1 versus 151.3 mg/dL, p<0.05), low density lipoproteins (LDL) (123.8 versus 117.5 mg/dL, p<0.05), erythrocyte sedimentation rate (ESR) (10.6 versus 9.3 mm/h, p<0.05), and C-reactive protein (CRP) (2.3 versus 2.0 mg/L, p<0.05) values were all higher in the smokers, significantly. On the other hand, high density lipoproteins (HDL) (40.9 versus 44.0 mg/dL, p<0.05) and fasting plasma glucose (FPG) (102.3 versus 111.6 mg/dL, p= 0.007) values and prevalence of diabetes mellitus (8.9% versus 14.3%, p<0.05) were all lower in the smokers, significantly. The authors concluded that smoking may cause a low-grade systemic inflammation on vascular endothelium terminating with an accelerated atherosclerotic process-induced end-organ insufficiencies all over the body. Plasma triglycerides, LDL, ESR, and CRP may be positive whereas HDL and FPG may be negative
APR indicating such inflammatory effects in the body.

Abdulrazak Abyad
Chief Editor