Predicting the outcomes of coronavirus disease 2019 (COVID‐19) with comorbidities has been an interesting subject of study in the field of medicine. This study aimed to compare the clinical characteristics, radiologic features, and severe outcomes of COVID-19 among hospitalized COVID-19 patients with or without underlying comorbidity diseases. In this retrospective cohort study conducted from 1 June 2020 to 30 September 2020, 320 hospitalized cases with laboratory-confirmed COVID-19 and admitted to public hospitals in Arak, Iran, were examined. The mean±SD age of the patients was 56.78±20.06 years. The comorbidity group showed a substantially greater percentage of defined nodular pattern in chest X-ray (7.6% vs 2%, P=0.024) and plural effusion in CT scan findings (9% vs 0%, P=0.004). Intensive care unit (ICU) admission (6.9% vs. 0.6%, P=0.003), mechanical ventilation (5.0% vs. 0.6%, P=0.018), and death (6.3% vs. 0.0%, P=0.002) were higher in the comorbidity group. Comorbidity group had a considerably greater ratio of ICU admission, invasive ventilation, and mortality.

Background and aims: India has seen a two-wave pattern of coronavirus disease 2019 (COVID-19) infections. The comparative characteristics of these two waves remain largely unknown. Changing trends in the demographic and clinical characteristics of the deceased COVID-19 patients in these two waves helped to identify the vulnerable population and guide public health interventions to decrease mortality. Methods: We obtained COVID-19 death summaries from the medical records of a large tertiary healthcare centre in North Kerala, India. Two groups of COVID-19 deaths were selected: the first group included patients who died in the first wave between 1 July 2020 and 31 December 2020 (n=311), and the second group included those who died in the second wave between 1 March 2021 and 30 June 2021 (n=431). Results: The mortality in the second wave in young patients (≤50 years) was 2.2% higher (11.8% vs. 9.6%, P=0.346) and that in elderly patients (≥80 years) was 7.7% higher (19.95% vs. 12.2%, P=0.005) compared to the first wave. The average duration from symptom onset to death also significantly decreased in the second wave. Further, there was an increased proportion of COVID-19-related deaths in patients with diabetes in the second wave (59.3% vs. 51.7%, P=0.025). The main cause of death was respiratory failure due to COVID-19 pneumonia in both waves. Conclusion: The second COVID-19 wave was different from the first wave with more deaths in the young and elderly, a shorter duration from symptom onset to death, and an increase in the proportion of deaths with diabetes, maternal deaths, and deaths in those without any pre-existing comorbidities.

Background and aims: The novel coronavirus (COVID-19) epidemic has far been the biggest global health threat of the 21st century. Protective measures are still one of the most effective methods for controlling COVID-19. Practicing hygiene and control measures are largely influenced by knowledge and attitude towards COVID-19. This study aimed to investigate the knowledge, attitude, and practice of Iranians towards COVID-19 as well as the demographic factors related to it in April and May, 2020. Methods: The study population in this cross-sectional, descriptive-analytical, and web-based study included 3736 Iranian individuals who were collected via convenience sampling method. A validated Iranian knowledge, attitude, and practices (KAP) Questionnaire about COVID-19 was used for collecting the required data. Ordinal multivariate generalized estimating equations (GEEs) were applied to analyze data. Results: The majority of participants (88.1%) had considerable knowledge, the right attitude (91%), and good practices (90.3%). In the multivariate models, factors related to greater knowledge were age>20 years (P<0.001), living in the urban area (P=0.030), holding a master’s or doctoral degree (P=0.044), and a moderate financial status (P=0.001). Females displayed mor positive attitude (P=0.035). Variables related to more favorable practices were age>20 years (P<0.001), and having a good (P=0.003) or moderate (P=0.038) financial status. Conclusion: It was concluded that the participants had good knowledge and a positive attitude, as well as adopted sound practices regarding COVID-19. However, this conclusion might not have been generalizable to entire Iranian community; therefore, it was recommended that preventive measures against COVID-19 should receive continued monitoring and emphasis.

Background and aims: Poisoning is one of the main medical emergencies that is divided into intentional and unintentional types. According to previous records on poisoning attributed to Farsan’s hospital, Iran, the current study focused on investigating its prevalence, type, and poisonous agent. Methods: In the descriptive-analytical cross-sectional study, the registered data of 557 poisoned patients during 2018-2019 were used by a consensus method. Age, gender, residence, type, and agent of poisoning and hospitalization were employed as explanatory variables. Data were extracted from medical records and entered into the standard checklist. Descriptive statistics such as frequency, percentage, mean, and standard deviation were applied for data analysis. Finally, the chi-square test and independent t test were used to analyze variables in SPSS 22.0. Results: Among a total of 557 poisoning cases, 70% were intentional, 52.1% were related to males, 66% lived in cities, 38.2% were in the age group of 16-30 years, and 58% were associated with drug and opioid use. In addition, 31.4% occurred in spring and about 85% of them were discharged in 2 days. The poisonous agent was different between genders (P≤0.001). Intentional poisoning was more prevalent in youth compared to the elderly and children. Further, poisonous agents demonstrated a significant difference according to the poisoning type, as in intentional poisoning opioids, drugs, and toxins had been used more than the other agents (P≤0.001). Conclusion: In this study, most poisoning cases were intentional, related to males and young individuals, and those residing in cities, and occurred via opioids and drugs. Therefore, it is suggested that more comprehensive studies should be conducted about the cultural and socioeconomic status of vulnerable groups and provide them with appropriate training and attention.

Background and aims: The nucleus accumbens (NAcc) functional and morphometric features mayinfluence children’s body mass index (BMI). Recent evidence, however, suggests that the functionand structure of the NAcc may have different predictive abilities for the BMI for the sub-groups ofchildren from different racial and socioeconomic status (SES) backgrounds. Using the AdolescentBrain Cognitive Development data, this study investigated racial and SES differences in the associationbetween NAcc microstructure (i.e., fractional anisotropy) and childhood BMI. Methods: This cross-sectional study included 9497 children aged 9 and 10. Data were collected from21 sites across 15 states in the United States. Then, the mixed-effects regression model was appliedfor data analysis. The predictor variable of interest was NAcc fractional anisotropy measured usingdiffusion magnetic resonance imaging (dMRI). The main outcome of interest was children’s BMI values,which were treated as a continuous variable. Covariates included gender, age, and family structure.Race (White, Black, Asian, and Other/mixed) and family income (<USD 50,000, USD 50,000-100,000,and USD100,000+) were the effect modifiers (moderators). Results: Higher average NAcc fractional anisotropy in dMRI was predictive of lower levels of theBMI, and net of covariates. However, this inverse association between the average intensity of thenormalized T2-weighted image and the BMI was stronger in children from Hispanic, low income, andlow-educated backgrounds compared to non-Hispanic, high-income, and high-educated backgrounds. Conclusion: Our findings suggested that although NAcc fractional anisotropy is linked to children’sBMI, this link is not invariant across racial and SES groups. The issue of whether or not obesogenicenvironments alter the implications of NAcc for childhood BMI needs further investigation. For diversegroups, NAcc microstructures may have different magnitudes of associations with childhood BMI.

Background and aims: At least, during the last half-century, the mortality rate in Iran has decreased significantly, and life expectancy at birth has increased. To better understand the mechanisms of improving the health situation in Iran, this study sought to examine the contribution of age groups in improving life expectancy at birth during 1976 -2016. Methods: The required life tables for the years 1976, 1986, and 1996 were taken from previous studies. Furthermore, life tables for 2006 and 2016 were calculated using the data from the registration system of the Ministry of Health. Then, the contribution of each age group in improving life expectancy in Iran by sex was estimated using the Arriaga decomposition method, and data analysis was conducted by creating a template in Excel software. Results: The life expectancy at birth for men and women in Iran has increased by 18.7 and 21.5 years, respectively, during 1976–2016. Infant mortality was the most important factor in increasing life expectancy with 6.5 and 6 years for women and men, respectively. In addition, over time, the share of early deaths has decreased, and instead, old-age deaths have played a more prominent role in improving the life expectancy of men and women in Iran. Conclusion: Today, increasing life expectancy for both sexes is mainly achieved through reducing the mortality of the older population, and achieving more years for life expectancy is mainly due to comprehensive development, especially reducing health inequalities and increasing life expectancy at older ages.

Background and aims: Dyslipidemia is one of the major causes of cardiovascular disease (CVD); however, it can be prevented and controlled via observing and adherence to a diet. This study aimed at determining the effect of nutrition education based on BASNEF model on decreasing blood lipid profile. Methods: This clinical trial study was conducted on 150 people with a high blood lipid profile who referred to Shahrekord laboratories in 2020. The samples were randomly divided into intervention and control groups. In order to measure blood lipids such as high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), and total cholesterol (TC), 15 mL of venous blood samples were collected after 12 hours fasting before the intervention and again 2 months after the intervention. The intervention group received nutrition education based on BASNEF model, and the collected data were analyzed using SPSS version 20 software. Results: There was no significant difference between the two groups in terms of demographic variables. TG levels in the intervention group decreased significantly after the intervention (P<0.001). In addition, TC and LDL levels decreased significantly in the intervention group after the intervention (P<0.001), while the level of HDL index in the intervention group increased significantly after the intervention. Nonetheless, there was no significant difference in these indices in the control group after the intervention (P>0.05). Conclusion: The significant decrease in blood lipids after a short period indicates the effect of nutrition education based on BASNEF model and adherence to proper diet on controlling blood lipids. Therefore, recommending people to adhere to a proper diet can help raise people’s nutritional awareness and reduce blood lipids.

Physical activity is a broad term that encompasses all human motion at home, school, the workplace, and the community. As indicated in the Bangkok Declaration of the International Society for Physical Activity and Health (ISPAH), physical activity benefits both individuals and society, contributing to many of the United Nations sustainable developmental goals. Physical activity is associated with positive health outcomes in children and adolescents, whereas excessive time spent on sedentary activities is related to negative health outcomes. Concerns about diminishing levels of physical activity and their impact on health outcomes have driven various national and international regulatory bodies to create guidelines with recommendations for policymakers, practitioners, and individuals over the last three decades. Therefore, the World Health Assembly has established two goals: a 10% decrease in worldwide physical inactivity by 2025; and a 15% decrease by 2030. Due to the health advantages of regular physical activity, the World Health Organization (WHO) recommends that individuals aged 5–17 years engage in at least 60 minutes of moderate-to vigorous-intensity physical activity every day throughout the week. In addition, vigorous-intensity activities, including aerobic and activities that strengthen bones and muscles, should be performed at least three days a week.

Background and aims: In December 2019, the disease associated with SARS-CoV-2 was identified as the new coronavirus (COVID-19). The older population is regarded as the greatest risk group. The objective of the present study was to investigate the epidemiological aspects of COVID-19 during 2020 in the older adults in the Brazilians Amazon region. Methods: The present study is a longitudinal study based on a national database from the Website of the State Department of Health of Para from January to December 2020. Medical, socio-demographic, and geographical data were analyzed to assess the epidemiological data to verify whether there was an association between these variables using logistic regression. Results: Official data published until December 31 indicated 293802 confirmed cases and 7199 deaths from COVID-19 in the state of Para, as well as a 12.5% rate of fatality. Para has demonstrated a linear curve in relation to the number of deaths since August. More cases of COVID-19 were found among the older people, men, and people who declared themselves brown, and a greater chance of death was observed among indigenous and yellow people. Conclusion: Brazil is among the five countries with the highest number of infected cases and deaths resulting from COVID19, possibly due to poor planning concerning social isolation and the lack of public health policies and guidance by government leaders, especially in this specific context.

Background and aims: The incidence of renal failure (RF) is growing in Brazil, resulting in increased public spending and negatively affecting the public health, which can lead to patient death. Identifying factors associated with mortality from this condition can help to characterize susceptible populations; therefore, institutional and governmental measures can be adopted for prevention and treatment. Materials and Methods: Descriptive epidemiological study using secondary data from Brazilian database (DATASUS). Deaths from RF between 2009 and 2019 and characteristics such as color/race, gender, education, region, and age group of the individuals were analyzed. Results: Since 2016, there has been a reduction of approximately 2% per year in the RF case fatality rate. North, Northeast, and Southeast regions had the highest case fatality rate, 13.6%, 13.17%, and 12.84%, respectively, which may be associated with high prevalence of chronic-degenerative diseases. The elderly had the highest case fatality rates, ranging from 9.67% in individuals aged 50-59 years to 27.52% in the elderly over 80 years. Children under 1 year of age had a high case fatality rate of 15.03%. Moreover, the case fatality rate for individuals with education levels above 12 years of schooling was 0.50%, while the case fatality rate for individuals with 1 to 3 years of schooling was 3.52%, which is seven times higher. Case fatality rates of indigenous populations in the South and Southeast regions were 12.0% and 16.5%, approximately 20% higher than other populations. Conclusion: The presence of chronic-degenerative diseases, age above 50 and below 1 (elderly and preterm newborns), low level of education and being indigenous are factors associated with mortality from RF in Brazil.

Background and aims: The emergence and spread of drug-resistant strains of Mycobacterium tuberculosis are greatly complicating tuberculosis (TB) control efforts in many countries. In India, in 2018, out of 2.4 million notified cases of TB, there were an estimated 66359 and 3,882 laboratory-confirmed cases of multi-drug resistant tuberculosis (MDR-TB) and extensively drug-resistant TB (XDR-TB) respectively. The main objective of this study was to assess pattern of drug-resistant tuberculosis (DR-TB) and factors associated with it in Rewa district of Madhya Pradesh, India. Methods: This descriptive-analytical cross-sectional study was carried out at a tertiary care center in Rewa district from March 1, 2019, to February 29, 2020 (12 months). Taking the census method into account, all of 186 DR-TB cases registered at District Tuberculosis Centre (DTC), Rewa district, with the age of 18 years and above were included in the study. All the patients were interviewed thoroughly using a pre-tested, pre-validated, and reliable pro forma which included information regarding socio-demographic profile and history of TB. For statistical analysis, chi-square test (with/without Yate’s correction) was applied and a P value less than 0.05 was considered statistically significant. Results: In the present study, 71.6% and 28.4% of the cases were reported to be male and female, respectively. Additionally, 78.4% of the study subjects belonged to the age group of less than 45 years. Besides, rifampicin-resistant TB (RR-TB) was found to be the most prevalent type (56.4%), followed by isoniazid-resistant TB (HR-TB) (13.4%), and mixed pattern (12.4%) of DR-TB. Conclusion: DR-TB was more commonly observed in males of the economically productive age group (45 years and below), which can affect the social and economic development of individual, society, and nation.

Background and aims: Cerebrovascular accidents are a major cause of death and disability in many countries. Therefore, the epidemiological indicators are highly important in the case of these patients’ mortality. The present study aimed to determine the epidemiology of mortality due to cerebrovascular accidents in patients admitted to Sina (Farshchian) hospital of Hamadan within 2018-2019. Methods: In this descriptive cross-sectional study, data of deceased patients were collected from one-year medical records in the neurology wards of Sina (Farshchian) hospital in Hamadan using the census method and a researcher-made checklist. The exclusion criteria were the cause of death except for cerebrovascular accident and incompleteness of data in patient’s medical record. Data were analyzed by descriptive statistical methods and SPSS 21. Results: Out of the 1196 patients admitted to the neurology wards, 159 cases died, and this rate was nearly equal between men and women. The highest mortality frequency belonged to ischemic type (83%), people over 60 years old (83%), illiterate (77.4%), urban (69.2%), self-employed (42.8%) individuals, and those with a history of underlying disease (73.6%), no history of smoking (90.6%), previous stroke (78.6%), and family history of stroke (99.4%). Conclusion: The findings of the present study showed that certain groups such as the elderly, illiterates, urban residents, self-employed, and people with underlying diseases had a higher mortality rate due to cerebrovascular accidents. Thus, special attention to these groups in health planning can be efficient in reducing the mortality of these accidents.

Plague has been among the most devastating infectious diseases in human history. The decrease in the plague in recently reported cases and studies implies that the plague should not recur, but the fact is that it (Black Death) is still around and may appear again. The disease can be occult for many years. The reemergence of the plague epidemic with unusual clinical form, magnitude, and rapid expansion at any place and time without prior notice could pose a serious risk to public health. Plague outbreaks most likely result from the reactivation of organisms in local foci. The reemergence of foci suggests that environmental or climatic changes could be favorable for an epidemiological cycle of Yersinia pestis. Thus, countries harboring plague foci can be at risk of outbreaks in the future. Different epidemiological aspects of the plague must be emphasized in prophylactic medical plans and health education systems, and healthcare workers should be alert and aware of the natural cycle, as well as clinical symptoms and signs of plague. Finally, surveillance, education, and research are also suggested regarding this fatal infection and other emerging diseases.

Background and aims: The aim of the present study was to investigate the pattern of alcohol consumption and its related factors in the patients referring to hospitals. Methods: A hospital-based case control study was carried out in Shahrekord during 2016-2017. A total of 150 individuals who had self-report of alcohol consumption and history of alcoholism entered into the case group based on the convenience sampling method. Likewise, 300 individuals who did not have self-report of alcohol consumption entered into the control group. Group matching was performed based on the date of admission to the hospital, type of disease, complications, and duration of the disease. This study explored the pattern of alcohol consumption variables, spiritual health, quality of life, and general health. Odds ratios (ORs) with a 95% confidence interval (CI) were calculated as well. Results: The causes of onset of alcohol consumption were curiosity (41.40%), social class and imitation of others (17.40%), and life problems (15.30%). Further, the causes of continued alcohol consumption were attributed to the interest in taste and smelling (23.30%), emotional problems (20%), as well as loneliness feeling and life problems (12.60%). The mean of general health scores in the case and control groups were 29.8± 5 and 29.3± 4, respectively (P=0.296). The mean of the quality of life in the case group and control group were 32.13± 7 and 32.11± 5, respectively (P=0.98). The differences in the scores of spiritual health in two groups were not statistically significant (P=0.96). Conclusion: An attempt should be made to improve the strategies to satisfy the emotional sense and health recreations of society.

Background and aims: Knowledge, attitude, and practice (KAP) toward coronavirus disease 2019 (COVID-19) are important factors for adherence to protection strategies. The aim of this study was to construct and validate a questionnaire about the KAP of Iranians regarding COVID-19. Methods: Initially, a questionnaire about the KAP with regard to COVID-19 was constructed in this cross-sectional study. The initial questionnaire was prepared based on a review of the extensive research literature and global and national guidelines. This researcher-made questionnaire was developed using the COVID-19-KAP questionnaire, which was originally used in China in 2020, and the influenza epidemic KAP Questionnaire (2015), the MERS KAP Questionnaire (2015), the H1N1 flu KAP questionnaire (2017), and the WHO KAP questionnaire about COVID-19. The applied questionnaire consists of three parts including knowledge- (n=26), attitude- (n=8), and practice-related (n=11) questions, respectively. Then, the face, content, and construct validity and the reliability of the questionnaire was determined, and analyzes were performed using SPSS v. 26 and AMOS v. 24 software. Results: In the face validity stage, 2 questions with an impact score of less than 1.5 were excluded from the questionnaire. In the content validity check, all questions had a content validity index (I-CVI) of more than 0.7. However, the content validity ratio (CVR) for 6 questions was less than 0.51, and these questions were removed accordingly. The compliance of the CVI with the chance agreement was close to one for all questions, indicating the lack of a chance agreement. In the exploratory factor analysis stage, the Kaiser-Meyer-Olkin (KMO) value of 0.90 was obtained, implying the adequacy of the sample size for factor analysis. The significance of the Bartlett test (chi-square: 5820.06, df: 630, P<0.001) indicated a strong correlation between the questions and the appropriateness of factor analysis. Finally, 34 items in 4 domains remained in the questionnaire. Conclusion: The validity and reliability of this questionnaire were confirmed based on the findings. This Farsi KAP questionnaire can be used to assess the level of knowledge, attitude, and practice of people about COVID-19.

Since the outbreak of COVID-19 in December 2019, there has been an explosion of statistics and information about the disease, the number of cases, the number of deaths, and the number of recoveries. During this period several statistical and mathematical models have been developed and used to predict the disease. Much of this information has been helpful and paved the way for disease control; however, inaccurate or ambiguous information has been published in some cases, which can briefly be divided into three main categories. The first category is related to the publication of official statistics by governmental centers in countries, which has faced many errors. Although some of these errors are unintentional due to the definition of the disease based on definitive polymerase chain reaction (PCR) testing, death within 28 days of infection, or due to the similarity of the disease outcomes with other diseases, in many cases, the statistics regarding the disease and its consequences have been presented by governments with a manipulation, mainly on the small number of patients with COVID-19. The second category contributes to incorrect or incomplete use of statistical indexes. During this period, some information has occasionally been published by some public media in which statistical indexes have not been used correctly and appropriately. The third category belongs to the challenges of epidemiological modeling in COVID-19. With the advent of COVID-19, many models emerged to predict its incidence and consequences. Although many of the predictions were true, some of them were incorrect or inaccurate. The main reasons for the inaccuracy of these predictions were the consideration of incorrect or weak assumptions, the existence of incomplete data, the short-term view, the use of point estimates instead of interval estimates, and the lack of a multidimensional view of the problem. Accordingly, considering the above-mentioned points and findings from the observed problems in predicting the course of the disease and the resulting mortality during the COVID-19 pandemic, one can hope for the ability to model the prediction of similar diseases in the future.

Background and aims: Although female family caregivers, especially those who belong to the sandwich generation, are at the forefront of the coronavirus disease (COVID-19) battle, little is known about their experiences. The purpose of this qualitative study was to explore the female sandwich generation’s experiences of multigenerational caregiving under the COVID-19 pandemic in Shiraz located in the southwest of Iran. Methods: Situational analysis (SA) was used as a methodological approach. It is a constructivist grounded theory (GT) developed by Adele Clark as one of the innovative extensions of the GT. In the current study, the multigenerational caregiving by the female sandwich generation under the COVID-19 pandemic is identified as "the situation" which is the key unit of analysis and the salient and diverse elements of this situation (e.g., the major human, non-human, discursive, cultural, political, and other elements) were laid out by the messy and ordered maps. In addition, each element on the messy map was analyzed in relation to all other elements, and the nature of the relations among them was examined by the relational map. These maps are derived from qualitative data including the ethnographic observations, discourse materials, and in-depth semi-structured interviews with 10 middle-aged female double caregivers of both dependent children and the elderly above 70 years old within the family. Three sampling methods were used across the full trajectory of the research, including purposeful, snowball, and theoretical sampling. Results: The analysis of the multigenerational caregiving situation showed that this situation consists of 95 elements classified under 15 categories and 2 situational maps, along with 2 relational maps that have been drawn from the qualitative data analysis. Based on the organized situational map, this situation occurred as a result of the power of the main discourses, as well as the existing cultural, traditional, and religious elements, and continues after interconnecting to the global COVID-19 pandemic. The first relational map displayed caregivers’ adopted information and communications technology (ICT) tool-based strategies such as remote caregiving, telehealth, online visiting, and online shopping, along with the voluntarily double quarantine in order to protect the elderly from COVID-19 infection. Finally, the second relational map depicted that emotional exhaustion is rampant among the caregivers influenced by the experiences that are related to the ICT tools and the voluntarily double quarantine. Conclusion: Overall, some strategies are suggested concerning the necessity of maintaining the mental and physical health of double caregivers and reduction of the negative consequences of the pandemic in them. They include accessibility of ICT tool-based strategies to all, the alternative approaches to severe social isolation, creation of a balance between work-home life and the care demands of two generations, early assessment of the psychological status along with the extensive support by the government, and formal care services to them.

Background and aims: Decreased levels of physical activity (PA) during the coronavirus disease 2019 (COVID-19) pandemic can cause physical and psychological problems for individuals. Therefore, the aim of this study was to investigate the relationship between PA, body image, and eating disorders (EDs) during the COVID-19 pandemic among high school girls in Farsan, Iran. Methods: This was a descriptive-analytical cross-sectional study, and the research population included female high school students from Farsan, Iran, who were studying in 2019-2020. In this regard, 535 high school girls (age: 15.95±1.42, weight: 53.07±10.01, BMI: 20.14±3.48) were selected based on cluster-random sampling to participate in the study. Multidimensional Body Self-relation Questionnaire (MBSRQ), Baecke’s Physical Activity Questionnaire, and the Eating Disorder Diagnostic Scale (EDDS) were used to collect data, and Pearson correlation coefficients were administered to establish statistical relationships. Results: The results indicated significant positive correlations between body image and PA levels (r=0.304, P=0.001). However, no significant correlations were observed between body image and anorexia nervosa (AN) (r=-0.035, P=0.424), bulimia nervosa (BN) (r=-0.033, P=0.446), and binge ED (r=-0.041, P=0.339). Likewise, no relationships were observed between PA and AN (r=0.084, P=0.052), BN (r=0.073, P=0.092), as well as binge ED (r=0.071, P=0.099). Conclusion: During the COVID-19 pandemic, PA was positively associated with body image but not with EDs. Based on the obtained results, it can be concluded that PA improved body image in adolescent girls during the COVID-19 pandemic.

Background and aims: Staphylococcus aureus, an important pathogen in bone diseases, is a highly multi-drug resistant (MDR) bacterium. This study aimed to investigate the antibiotic resistance among S. aureus isolated from patients on admission in an orthopaedic hospital. Methods: In this cross-sectional research, 140 samples comprising urine samples, wound swabs, and nasal swabs were collected from 49 patients on admission. Samples were cultured and screened for S. aureus following standard procedures. Using the agar-disk diffusion method, the isolates were subjected to antibiotics susceptibility tests. Results: S. aureus were isolated from 26 (18.6%) samples, and wound swabs were found to have the highest number of the S. aureus isolates with 12 (46.2%). Among the 26 S. aureus isolated, 25 (96.2%) isolates were resistant to at least four or more of the tested antibiotics. There were 23 (88.5%) MDR isolates, while there were only 2 (7.6%) extensively drug resistant ones. The number of methicillin-resistant S. aureus were 17 (65.4% of the isolates), while the number of methicillin-susceptible S. aureus were 9 (34.6% of the isolates). A total of 22 (84.6%) isolates had multi-antibiotic resistance (MAR) index greater than 0.2. Inducible clindamycin resistance of 2 (7.6%) was observed. Conclusion: This study showed that the S. aureus isolated from the patients were resistant to multiple antibiotics. Regular surveillance of antibiotic resistance is of utmost importance, since it facilitates the design or development of the treatment regimens that could check the spread of antimicrobial resistance.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the third coronavirus to emerge in the past decade after the 2010 SARS-CoV and 2012 MERS-CoV, which originated in China and Saudi Arabia, respectively. The virus is transmitted via small droplets which are produced during activities such as coughing, sneezing, and talking and spread through close human contact or touching infected surfaces. Since its first reported case in Wuhan, China in December 2020, the virus has proved to be highly infectious, reaching epidemic levels with about 2.8 million COVID-19 cases recorded globally. As a result, the World Health Organization was prompted to declare it as a public health emergency of international concern. The virus is of unknown aetiology and has no clinical countermeasures to date; therefore, prevention is the best strategy to prevent its spread. Many countries have enforced physical distancing, banned public gathering, and restricted mobility and transportation options. However, such preventive measures have side-effects which negatively impact healthcare and population health at various levels. Physicians and nurses treating COVID-19 patients are often required to be isolated from their family. Further, clinicians who are not well-versed in the complexities and risks of infectious diseases are facing new challenges. Patients requiring regular or urgent care (e.g., expectant mothers and patients awaiting elective/ emergency surgery) are experiencing limited access to care. Telehealth can ameliorate some of these side-effects and improve healthcare access along with the quality of life for both patients and practitioners.

Background and aims: Public health policies and programs should be adapted to the level of public trust in the healthcare system, as an indicator of the public support level. Accordingly, the data about public trust level in the healthcare system is considered as a critical requirement for managing public health crises. This study aimed to rapidly assess the public trust in the healthcare system during the COVID-19 epidemic in Iran, as well as to evaluate the effect of socioeconomic status (SES) on this trust. Methods: This cross-sectional and web-based study which was conducted in Iran during the COVID-19 epidemic included adults aged 18-60 years. A probability proportional to size multistage random sampling was applied and performed in 15 provinces of the country. Data on the main sources of information about COVID-19, trust in healthcare system, fear level of COVID-19, and demographics were collected via an electronic questionnaire. Multiple linear regression was applied, and adjusted regression coefficients and 95% confidence intervals (CIs) were estimated. Results: A total of 5250 adults (response rate: 76%) were included in the study. The mean of reported trust scores was 50.3±22.8, and that of fear scores was 72.0±17.8. The highest (65%) and lowest (28%) levels of trust were observed among participants from the lowest and highest SES, respectively. Gender (male) (P=0.006), higher levels of education (P<0.001), higher socio-economic status (P<0.001), and higher fear scores (P<0.001) were independently correlated with the lower level of ⦰ trust in healthcare system. Conclusion: It was found that the public trust in Iran’s healthcare system was not high enough at the time of the COVID-19 epidemic in the country, especially among higher social class population.

Background and aims: The World Health Organization (WHO) and the United Nations International Children’s Fund have recommended that breastfeeding be continued until two years of age or over. This study aimed to investigate the duration of breastfeeding and weaning in children aged 6-24 months in south of Iran. Methods: This cross-sectional study was conducted in 2017 on 1653 children aged 6-24 months in Fars province of Iran. A multi-stage sampling was used and the data were obtained using a questionnaire including questions about breastfeeding and some related factors, as well as demographic questions about the children and their parents. The required information was collected by visiting and interviewing those mothers who had children aged 6-24 months in their homes. Data were evaluated using SPSS software (version 20.0) and performing descriptive and analytical statistics such as independent samples t test and one-way ANOVA. Results: On average, the children were breastfed up to 18.64±7.40 months of age and the mean age of initiation of complementary feeding was 5.86±1.04 months. Breastfeeding was stopped for 35.6% of children at the age of 24 months and higher. Mothers having had a normal vaginal delivery had a longer lactation period than mothers who had had cesarean delivery (19.27 and 18.05 months, respectively) (P=0.021). Conclusion: A decrease was observed in the mean duration of breastfeeding in this study compared to that obtained in the previous studies, and this decrease was found to be associated with the increase in the occurrence of cesarean delivery in mothers. Therefore, it was recommended that further comprehensive investigations be carried out in this regard.

Background and aims: Mental health problems are considered as important public health issues. This study aimed, firstly, to investigate the epidemiology of mental disorders’ symptoms among the students of Bojnord University and examine the role of demographic characteristics in the prevalence of the given symptoms; and, secondly, to explore and compare the predictive role of adaptive and maladaptive emotion regulation strategies in identifying symptoms of different mental disorders. Methods: A total of 351 students from Bojnord University completing their 2018-2019 academic year were recruited using cluster sampling method and responded to Symptom Checklist-SCL90 and Cognitive Emotion Regulation Questionnaire. Data were analyzed using descriptive statistics including mean, standard deviation, frequency and percentage, as well as multiple regression analysis. Results: According to the findings from this epidemiological study, 33% of the students suffered from moderate symptoms of mental disorders, while 14% of them suffered from severe symptoms. Demographic characteristics of gender, marital status, and place of origin (i.e., being indigenous/non-indigenous) were not found to exert a significant effect on the prevalence of symptoms of mental disorders. The results of multiple regression analysis also indicated that cognitive emotion regulation strategies were capable of predicting all nine dimensions of mental disorder symptoms. In this regard, the maladaptive strategies were discovered to play a stronger role in predicting mental disorders compared to adaptive strategies. Conclusions: Mental disorders were very common among university students. No significant relationship was detected between the prevalence of mental disorders’ symptoms and gender, marital status, and place of origin. The study findings were also found to support the trans-diagnostic role of the emotion regulation in mental disorders.

Background and aims: Iran had passed the third peak of COVID-19 pandemic, and was probably witnessing the fourth peak at the time of this study. This study aimed to model the spread of COVID-19 in Iran in order to predict the short-term future trend of COVID-19 from April 23, 2021 to May 7, 2021. Methods: In this study, a modified SEIR epidemic spread model was proposed and the data on the number of cases reported by Iranian government from February 20, 2020 to April 23, 2021 were used to fit the proposed model to the reported data using particle swarm optimization (PSO) algorithm. Then the short-term future trend of COVID-19 cases were predicted by using the estimated parameters. Results: The results indicated that the effective reproduction number increased in Nowruz (i.e., Persian New Year, 1400) and it was estimated to be 1.28 in the given period. According to the results from the short-term prediction of COVID-19 cases, the number of active confirmed cases in the fourth peak was estimated to be 516411 cases on May 2, 2021. Conclusion: Following the results from our short-term prediction, implementing strict social distancing policies was found absolutely necessary for relieving the Iran’s health care system of the tremendous burden of COVID-19.