Osong Public Health and Research Perspectives

Volume 7(6); December 2016

Editorial

What Affects Chronic Obstructive Pulmonary Disease in Korea?: Hae-Wol Cho, Chaeshin Chu; Osong Public Health Res Perspect. 2016;7(6):339-340. Published online December 31, 2016; DOI: https://doi.org/10.1016/j.phrp.2016.12.001

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Original Articles

Causal Effect of Self-esteem on Cigarette Smoking Stages in Adolescents: Coarsened Exact Matching in a Longitudinal Study: Ahmad Khosravi, Asghar Mohammadpoorasl, Kourosh Holakouie-Naieni, Mahmood Mahmoodi, Ali Akbar Pouyan, Mohammad Ali Mansournia; Osong Public Health Res Perspect. 2016;7(6):341-345. Published online December 31, 2016; DOI: https://doi.org/10.1016/j.phrp.2016.10.003

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Abstract PDF

Objectives
Identification of the causal impact of self-esteem on smoking stages faces seemingly insurmountable problems in observational data, where self-esteem is not manipulable by the researcher and cannot be assigned randomly. The aim of this study was to find out if weaker self-esteem in adolescence is a risk factor of cigarette smoking in a longitudinal study in Iran.
Methods
In this longitudinal study, 4,853 students (14–18 years) completed a self-administered multiple-choice anonym questionnaire. The students were evaluated twice, 12 months apart. Students were matched based on coarsened exact matching on pretreatment variables, including age, gender, smoking stages at the first wave of study, socioeconomic status, general risk-taking behavior, having a smoker in the family, having a smoker friend, attitude toward smoking, and self-injury, to ensure statistically equivalent comparison groups. Self-esteem was measured using the Rosenberg 10-item questionnaire and were classified using a latent class analysis. After matching, the effect of self-esteem was evaluated using a multinomial logistic model.
Results
In the causal fitted model, for adolescents with weaker self-esteem relative to those with stronger self-esteem, the relative risk for experimenters and regular smokers relative to nonsmokers would be expected to increase by a factor of 2.2 (1.9–2.6) and 2.0 (1.5–2.6), respectively.
Conclusion
Using a causal approach, our study indicates that low self-esteem is consistently associated with progression in cigarette smoking stages.

Citations

Citations to this article as recorded by

Social, educational, and psychological health correlates of e-cigarette and combustible cigarette use among adolescents in the US from 2015 to 2021
Nabeel A. Janjua, Noah T. Kreski, Katherine M. Keyes
Addictive Behaviors.2023; 144: 107754. CrossRef
Self-esteem, Self-efficacy, and Smoking Prevalence: A Cross-sectional Study Among Military and Civilian Medical Students
Monica Licu, Claudiu G. Ionescu, Maria Suciu, Sorin Păun
Romanian Journal of Military Medicine.2023; 126(4): 502. CrossRef
The prevalence of smoking and the levels of self-esteem and self-efficacy among adolescents in Turkey: A descriptive cross-sectional study
Alime Selçuk Tosun, Büşra Altınel, Arzu Koçak Uyaroğlu, Emine Ergin
Journal of Pediatric Nursing.2023; 73: e563. CrossRef
The effect of the educational intervention on empowerment of male high school students in prevention of smoking
Ali Khani Jeihooni, Amirhossein Mobaraei, Amin Kiani, Pooyan Afzali Harsini, Sajjad Karami Ghazi Khani
Journal of Substance Use.2022; 27(2): 162. CrossRef
“I am a little superhero!”: a pilot play-based group to enhance self-esteem of children from low-income families in Hong Kong
Jessie Ming Sin Wong
Social Work with Groups.2021; 44(2): 181. CrossRef
Depressive Symptoms and Cigarette Smoking in Adolescents and Young Adults: Mediating Role of Friends Smoking
Christian W Mendo, Marine Maurel, Isabelle Doré, Jennifer O’Loughlin, Marie-Pierre Sylvestre
Nicotine & Tobacco Research.2021; 23(10): 1771. CrossRef
Explaining the determinants of hookah smoking cessation among southern Iranian women: a qualitative study
Sakineh Dadipoor, Gerjo Kok, Ali Heyrani, Teamur Aghamolaei, Mohtasham Ghaffari, Amin Ghanbarnezhad
Journal of Substance Use.2020; 25(5): 469. CrossRef
Impact of gender, age and smoking habits on the effectiveness of health warning messages on cigarette packets: research on a highly educated Turkish sample
Murat Aktan
International Journal of Health Promotion and Educ.2020; 58(4): 167. CrossRef
The Price of Mission Complexity: A National Study of the Impact of Community College Baccalaureate Adoption on Tuition and Fees
Justin C. Ortagus, Xiaodan Hu
Educational Researcher.2019; 48(8): 504. CrossRef
Knowledge and Attitudes of University Students Towards Hookah Smoking in Fasa, Iran
Ali Khani Jeihooni, Zahra Khiyali, Seyyed Mansour Kashfi, Seyyed Hannan Kashfi, Mohammad Zakeri, Mehdi Amirkhani
Iranian Journal of Psychiatry and Behavioral Scien.2018;[Epub] CrossRef
Evaluation of the Impact of Psychoactive Substances on Adolescents’ Self-Esteem Attending School in Kenitra, Morocco
Ibtissam Cherkaoui El Malki, Imad Echerbaoui, Khaoula Mammad, Youssef El Madhi, Ahmed Omar Touhami Ahami
Psychology.2018; 09(04): 705. CrossRef
Cigarette and hookah smoking and their relationship with self-esteem and communication skills among high school students
Masumeh Anbarlouei, Parvin Sarbakhsh, Hossein Dadashzadeh, Akbar Ghiasi, Maryam Ataieasl, Abbasali Dorosti, Asghar Mohammadpour Asl
Health Promotion Perspectives.2018; 8(3): 230. CrossRef
How gender- and violence-related norms affect self-esteem among adolescent refugee girls living in Ethiopia
L. Stark, K. Asghar, I. Seff, B. Cislaghi, G. Yu, T. Tesfay Gessesse, J. Eoomkham, A. Assazenew Baysa, K. Falb
Global Mental Health.2018;[Epub] CrossRef

Evaluation of Microbial Contamination and Chemical Qualities of Cream-filled Pastries in Confectioneries of Chaharmahal Va Bakhtiari Province (Southwestern Iran): Ali Sharifzadeh, Mohammad Hajsharifi-Shahreza, Payam Ghasemi-Dehkordi; Osong Public Health Res Perspect. 2016;7(6):346-350. Published online December 31, 2016; DOI: https://doi.org/10.1016/j.phrp.2016.09.004

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Abstract PDF

Objectives
High consumption of bakery products such as cream-filled pastries may cause serious health risks and food poisoning to humans. Therefore, investigation of the microbial and chemical qualities of bakery products containing cream is necessary. The purpose of the present study was to investigate the chemical qualities and microbial contaminations of cream-filled pastries collected from confectioneries located in six cities in Chaharmahal Va Bakhtiari province (Southwestern Iran).
Methods
Microbial tests and chemical characteristics (fat and acidity level) were done on 228 cream-filled pastries samples that were collected randomly from various confectioneries.
Results
After microbial tests, it was found that 33.33% of all samples were contaminated by microbial agents. The microbial tests showed that Shahrekord (10.09%) and Broujen (9.21%) cities had high levels of contamination and in Koohrang (1.31%) it was low compared with the other four cities. High contamination of coliforms (61.84%), staphylococci (48.68%), and yeast (27.63%) were observed in almost all samples. The chemical analysis showed maximum amounts of fat content and titratable acidity in cream-filled pastry samples obtained from Lordegan and Shahrekord cities, respectively.
Conclusion
The findings of the present work demonstrated that the microbial contamination and chemical quality of cream-filled pastries produced in confectionaries of Chaharmahal Va Bakhtiari province were not in acceptable ranges. These problems may be related to fecal contamination of cream samples or lack of hygiene by handlers and it is necessary to observe the standards of hygiene and to develop safe food handling techniques and aseptic pastry manufacturing systems in some confectioneries of Chaharmahal Va Bakhtiari province.

Citations

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Prevalence of AmpC, ESBL, and colistin resistance genes in Enterobacterales isolated from ready-to-eat food in Algeria
Nawel Zaatout, Ahmad I. Al-Mustapha, Amira Bouaziz, Rima Ouchene, Annamari Heikinheimo
Brazilian Journal of Microbiology.2023; 54(3): 2205. CrossRef
Efficiency of a Herbal Liquid Extract Mixture for the Prevention of Salmonella Growth in Whipped Cream
Özüm ÖZOĞLU, Evrim Güneş ALTUNTAŞ
Natural and Engineering Sciences.2019; 4(1): 65. CrossRef

Instability of Plasma and Serum Progastrin-Releasing Peptide During Repeated Freezing and Thawing: Jae-Eun Lee, Jin-Hyun Lee, Maria Hong, Seul-Ki Park, Ji-In Yu, So-Youn Shin, Shine Young Kim; Osong Public Health Res Perspect. 2016;7(6):351-355. Published online December 31, 2016; DOI: https://doi.org/10.1016/j.phrp.2016.11.004

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Abstract PDF

Objectives
Progastrin-releasing peptide (proGRP) is a promising biomarker for small cell lung cancer. However, not much is known about how sample processing and storage conditions affect the stability of proGRP. Here, we examined the effects of repeated freeze–thaw cycles on the stability of proGRP in plasma and serum.
Methods
Concentrations of proGRP were measured in plasma and serum samples exposed to two, three, or four freeze–thaw cycles and these were compared with values of corresponding samples exposed to one cycle (baseline). We also performed the area under the receiver-operating-characteristic curve (AUC) analysis to determine whether the differences of proGRP concentrations between each paired plasma and serum sample (ΔproGRP) can be used for identifying the samples that have been exposed to multiple freeze–thaw cycles.
Results
Concentrations of proGRP gradually decreased in both plasma and serum samples with increasing numbers of freeze–thaw cycles. Reduction rates of proGRP concentrations were greater in serum than in plasma samples and serum proGRP levels declined with statistical significance (p < 0.001) up to 10.1% after four freeze–thaw cycles. The ΔproGRP measurement showed fair accuracy (AUC = 0.741) for identifying samples that had been through four freeze–thaw cycles. The sensitivity was 82.8% and specificity was 62.1% at an optimal cut-off point of > 4.9.
Conclusion
Our study shows that the stability of circulating proGRP is affected in both plasma and serum samples by repeated freezing and thawing. We also show that ΔproGRP could be used for identifying paired plasma and serum samples subjected to multiple freeze–thaw cycles.

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Effect of Repeated Freeze–Thaw Cycles on Influenza Virus Antibodies
Alessandro Torelli, Elena Gianchecchi, Martina Monti, Pietro Piu, Irene Barneschi, Carolina Bonifazi, Rosa Coluccio, Luisa Ganfini, Luciano Michele La Magra, Silvia Marconi, Ginevra Marzucchi, Ramona Pace, Laura Palladino, Bernardo Biagi, Emanuele Montomo
Vaccines.2021; 9(3): 267. CrossRef
The influence of different blood samples treatment methods on pro-gastrin-releasing peptide
Huiqin Jiang, Ling Luo, Kang Xiong, Chengwen He, Huaizhou Wang, Yanghua Qin
Medicine.2019; 98(26): e16130. CrossRef

No Detection of Episomal or Integrated High-Risk Human Papillomavirus in Nonsmall Cell Lung Carcinomas among Korean Population: Jeong Eun Lee, Yong-Moon Lee, In-Ock Seong, Min-Woong Kang, Choong Sik Lee, Kyung-Hee Kim; Osong Public Health Res Perspect. 2016;7(6):356-359. Published online December 31, 2016; DOI: https://doi.org/10.1016/j.phrp.2016.10.004

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Abstract PDF

Objectives
High-risk human papillomavirus (hrHPV) is known to be a representative cancer-causing agent in the genital and head and neck regions. Many studies have detected hrHPV DNA in nonsmall cell lung carcinoma. However, hrHPV–etiologic correlation in nonsmall cell lung carcinoma remains unclear. This study is designed to determine the prevalence of episomal or integrated hrHPV DNA in nonsmall cell lung carcinoma among the Korean population.
Methods
Surgically resected nonsmall cell lung carcinoma tissues, including 134 cases of squamous cell carcinoma (SqCC) and 99 cases of adenocarcinoma (ADC), were examined. In situ hybridization (ISH) for detecting episomal or integrated hrHPV DNA was performed using the INFORM HPV III Family 16 Probe (B) in the Ventana-validated assay. Anyplex II HPV28 detection kit based on real-time polymerase chain reaction was used for HPV DNA detection and genotyping.
Results
All members of the study population were of Korean ethnicity. Episomal or integrated hrHPV DNA ISH analysis result was negative in all 233 cases. One SqCC of 89 samples (42 SqCCs and 47 ADCs) was positive for an hrHPV genotype by Anyplex II HPV28 detection kit.
Conclusion
Our finding did not demonstrate hrHPV–etiologic correlation in primary lung SqCC and ADC in the Korean population.

Citations

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HPV and lung cancer: A systematic review and meta‐analysis
Julia Karnosky, Wolfgang Dietmaier, Helge Knuettel, Viola Freigang, Myriam Koch, Franziska Koll, Florian Zeman, Christian Schulz
Cancer Reports.2021;[Epub] CrossRef
Presence and activity of HPV in primary lung cancer
Talita Helena Araujo de Oliveira, Carolina Medeiros do Amaral, Bianca de França São Marcos, Kamylla Conceição Gomes Nascimento, Ana Carine de Miranda Rios, Dafne Carolina Alves Quixabeira, Maria Tereza Cartaxo Muniz, Jacinto da Costa Silva Neto, Antonio C
Journal of Cancer Research and Clinical Oncology.2018; 144(12): 2367. CrossRef

Epidemiology and Inequality in the Incidence and Mortality of Nasopharynx Cancer in Asia: Neda Mahdavifar, Mahshid Ghoncheh, Abdollah Mohammadian-Hafshejani, Bahman Khosravi, Hamid Salehiniya; Osong Public Health Res Perspect. 2016;7(6):360-372. Published online December 31, 2016; DOI: https://doi.org/10.1016/j.phrp.2016.11.002

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Abstract PDF

Objectives
One of the most common head and neck cancers is nasopharynx cancer. Knowledge about the incidence and mortality of this disease and its distribution in terms of geographical areas is necessary for further study and better planning. Therefore, this study was conducted with the aim of determining the incidence and mortality rates of nasopharynx cancer and its relationship with the Human Development Index (HDI) in Asia in 2012.
Methods
The aim of this ecologic study was to assess the correlation between age-specific incidence rate (ASIR) and age-specific mortality rate (ASMR) with HDI and its components, which include the following: life expectancy at birth, mean years of schooling, and gross national income per capita. Data about SIR and SMR for every Asian country for 2012 were obtained from the global cancer project. We used the correlation bivariate method for the assessment. Statistical significance was assumed if p < 0.05. All reported p values are two-sided. Statistical analyses were performed using SPSS (Version 15.0, SPSS Inc.).
Results
A total of 68,272 cases (males, 71.02%; females, 28.97%; sex ratio, 2.45) and 40,530 mortalities (males, 71.63%; females, 28.36%; sex ratio, 2.52) were recorded in Asian countries in 2012. The five countries with the highest ASIR of nasopharynx cancer were Malaysia, Singapore, Indonesia, Vietnam, and Brunei, and the five countries with the highest ASMR were Indonesia, Vietnam, Singapore, Malaysia, and Brunei. The correlation between HDI and ASIR was 0.097 (p = 0.520) [0.105 in men (p = 0.488) and 0.119 in women (p = 0.901)]. The correlation between HDI and ASMR was –0.102 (p = 0.502) [–0.072 in men (p = 0.633) and –0.224 in women (p = 0.134)].
Conclusion
Nasopharynx cancer is native to Southeast Asia. The highest incidence and mortality rates are found in Malaysia, Singapore, Indonesia, Vietnam, and Brunei. No significant relation was found between the standardized incidence and mortality rates of nasopharynx cancer and the HDI components. Further studies are recommended in Southeast Asian countries in order to find the etiology of cancer, as well as its diagnosis and treatment.

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Lin Liu, Bin Lu, Yan Li
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Thuan Duc Lao, Hue Hong Thieu, Dung Huu Nguyen, Thuy Ai Huyen Le
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Rapid Molecular Approach for Simultaneous Detection of Salmonella spp., Shigella spp., and Vibrio cholera: Reza Ranjbar, Ali Naghoni, Davoud Afshar, Farhad Nikkhahi, Mohsen Mohammadi; Osong Public Health Res Perspect. 2016;7(6):373-377. Published online December 31, 2016; DOI: https://doi.org/10.1016/j.phrp.2016.10.002

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Abstract PDF

Objectives
Gastrointestinal tract infection is still one of the serious public health problems in many geographic areas and is endemic in most countries including Iran. Early detection of the gastrointestinal tract pathogens can be extremely important. The aim of the current study was to apply a shortened time-multiplex polymerase chain reaction (PCR) for rapid and simultaneous detection of Salmonella spp., Shigella spp., and Vibrio cholera.
Methods
The standard and clinical strains of Salmonella spp., Shigella spp., and V. cholerae were used in the assay. Multiplex PCR was performed and optimized based on amplification of invA, putative integrase, and ompW genes for detecting Salmonella spp., Shigella spp., and V. cholerae, respectively. The specificity of the assay was evaluated by testing 12 different bacterial species.
Results
Only Salmonella spp., Shigella spp., and V. cholerae strains had positive results when subjected to the assay using multiplex PCR. The assay showed a high sensitivity, and no amplification products were observed in multiplex PCR with any of the other microorganisms.
Conclusion
Our study indicated that the invA, putative integrase, and ompW-based multiplex PCR assay appears to be an efficient method for rapid and simultaneous detection of Salmonella spp., Shigella spp., and V. cholerae.

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Influence of Obesity on Postural Stability in Young Adults: Sung Min Son; Osong Public Health Res Perspect. 2016;7(6):378-381. Published online December 31, 2016; DOI: https://doi.org/10.1016/j.phrp.2016.10.001

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Abstract PDF

Objectives
The purpose of this study was to determine whether obesity is associated with less postural stability in young adults, and whether it is influenced by anterior pelvic tilt angle and sensory dysfunction.
Methods
Center of gravity (COG) velocity and total sway distance with eyes open or eyes closed on firm or foam floors were determined in 12 obese individuals and 12 individuals with normal weight.
Results
On firm and foam floors with eyes closed, center of gravity velocity and total sway distance were significantly greater in the obese group than in the normal-weight group. However, on firm and foam floors with eyes open, center of gravity velocity and total sway distance were not significantly different in the two groups.
Conclusion
The clinical implication of our findings is that obese young adults exhibit poor postural stability. Our findings also suggested that postural instability in obese individuals is associated with increased lordosis due to abdominal fat and poor integration of plantar somatosensory input.

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Time-varying Changes in Pulmonary Function with Exposure to Prolonged Sitting: Kyung Woo Kang, Sung Min Son, Yu Min Ko; Osong Public Health Res Perspect. 2016;7(6):382-384. Published online December 31, 2016; DOI: https://doi.org/10.1016/j.phrp.2016.11.005

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Abstract PDF

Objectives
The purpose of this study was to quantify the time-varying changes in pulmonary function with exposure to prolonged sitting.
Methods
Twenty-one healthy volunteers were recruited. The pulmonary function of all participants was measured three times in order to assess changes over time; pulmonary function was measured before sitting, after participants had been seated for 1 hour, and after they had been seated for 2 hours. A spirometer was used to measure pulmonary function. The recorded values were forced vital capacity, forced expiratory volume in 1 second, ratio of forced expiratory volume in 1 second to forced vital capacity (forced expiratory volume in 1 second/forced vital capacity), and peak expiratory flow.
Results
All measured values were significantly different before sitting and after 1 hour of sitting. There were also significant differences between all measurements taken before sitting and after 2 hours of sitting. However, the measurements taken after 1 hour and 2 hours of sitting did not significantly differ.
Conclusion
These findings suggest that significant changes in pulmonary function occur relatively quickly when human beings are seated.

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DiptiB Geete, Aashi Sethiya, JaimalaV Shetye, MohiniN Kamat, Saraswati Iyer
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Prevalence and Risk Factors of Chronic Obstructive Pulmonary Disease among Nonsmokers: Fifth Korea National Health and Nutrition Examination Survey (2010–2012): Heeyoung Oh, Ye-Eun Lee; Osong Public Health Res Perspect. 2016;7(6):385-393. Published online December 31, 2016; DOI: https://doi.org/10.1016/j.phrp.2016.11.006

3,090 View
15 Download
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Abstract PDF

Objectives
The purpose of this study was to determine the prevalence of COPD among non-smoking adults, and to investigate the risk factors that affect disease occurrence.
Methods
The data from the 5th Korea national health and nutrition examination survey (KNHNES) has been used, and 5,489 non-smoking adults aged between 40 to 79 years with diagnosable FEV1/FVC were selected therefrom as the subjects of this study.
Results
The prevalence of COPD in non-smokers was observed to be 6.9%. The development of the COPD showed statistically significant difference among groups; males showed about 2.54 times (95% CI: 1.410∼146.612) higher rates compared to females, subjects aged 70–79 showed about 3.08 times (95% CI: 1.823∼11.437) higher rates compared to those aged 40–49, subjects whose education level was elementary school or less showed about 5.36 times (95% CI: 1.341∼21.393) higher rates compared to those who are college or more, and subjects who are middle school showed about 4.72 times (95% CI: 1.374∼16.217) higher rates compared to the college or more.
Conclusion
It is confirmed that development of the COPD in non-smokers reach significance. For the prevention of the disease, there is a need to identify COPD-related risk factors in males and the elderly and provide appropriate nursing intervention, and to develop health-related education programs for those with low educational background to take in order to promote the improvement of lung health.

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Nadia AL Wachami, Morad Guennouni, Younes Iderdar, Karima Boumendil, Maryem Arraji, Yassmine Mourajid, Fatima Zahra Bouchachi, Mohamed Barkaoui, Mohamed Lahbib Louerdi, Abderraouf Hilali, Mohamed Chahboune
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Illness Experience of Patients with Chronic Hepatitis C Participating in Clinical Trials: Hoo-Jeung Cho, Euna Park; Osong Public Health Res Perspect. 2016;7(6):394-399. Published online December 31, 2016; DOI: https://doi.org/10.1016/j.phrp.2016.11.001

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Abstract PDF

Objectives
To understand the illness experience of patients with chronic hepatitis C participating in clinical trials in the sociocultural context of Korea in an in-depth and comprehensive manner.
Methods
A focused ethnography approach was used to discover the pattern of illness experience of patients with chronic hepatitis C in the cultural background of Korea. Interviews were conducted with 11 patients with chronic hepatitis C participating in clinical trials and the collected data were analyzed with the domain analysis, taxonomical analysis, componential analysis, and theme analysis proposed by Spradley.
Results
With the cultural theme of “less-known illness, less-familiar illness,” four categories were derived: “my illness discovered by accident,” “shaken life,” “scary but inevitable treatment method,” and “precious life that can't be wasted,” along with 12 properties.
Conclusion
Public campaigns or education programs are needed to meet the needs for information on the disease for patients with chronic hepatitis C participating in clinical trials and help the general public acquire knowledge or change view on this disease.

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Brief Report

Evaluation of Antiviral Activity of Zanthoxylum Species Against Picornaviruses: Hwa-Jung Choi; Osong Public Health Res Perspect. 2016;7(6):400-403. Published online December 31, 2016; DOI: https://doi.org/10.1016/j.phrp.2016.11.003

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Abstract PDF

Human rhinoviruses and enteroviruses (family Picornaviridae) infect millions of people worldwide each year, but little is known about effective therapeutical treatment for the infection caused by these viruses. We sought to determine whether or not Zanthoxylum (Rutaceae) species can exhibit antiviral activity against picornaviruses. The leaf parts of four Zanthoxylum species were extracted with methanol, and the extracts were investigated for their antiviral activity against picornaviruses using cytopathic effects by cytopathic effect reduction. Leaf extracts of Zanthoxylum piperitum among four Zanthoxylum species were found to possess only broad-spectrum antipicornavirus activity against human rhninovirus 2 with a 50% inhibitory concentration (IC₅₀) value of 59.48 μg/mL, human rhinovirus 3 with an IC₅₀ value of 39.94 μg/mL, coxsackie A16 virus with an IC₅₀ value of 45.80 μg/mL, coxsackie B3 virus with an IC₅₀ value of 68.53 μg/mL, coxsackie B4 virus with an IC₅₀ value of 93.58 μg/mL, and enterovirus 71 virus with an IC₅₀ value of 4.48 μg/mL. However, ribavirin did not possess antiviral activity against human rhinovirus 3 and four enteroviruses. Therefore, leaves of Z. piperitum showed broad-spectrum antipicornavirus activity, and may be useful as a candidate for studying picornavirus agents and development of pharmaceuticals.

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