Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Statistical Methods for Health Care Research

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Preventing Chronic Diseases: A Vital Investment

This article suggests that while mental health problems affect 10—20% of children and adolescents worldwide, the mental health needs of children and adolescents are neglected, especially in low-income and middle-income countries. The authors review the evidence and the gaps in the published work in terms of prevalence, risk and protective factors, and interventions to prevent and treat childhood and adolescent mental health problems.

Child and adolescent mental health worldwide: evidence for action

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Health Behavior And Health Education Theory Research And Practice

The demographic and Psychological determinants of performing Mammography among the Employed Women in Medical Professions in western Iran: the Role of Threat Appraisal and Coping Appraisal

Introduction: In various mining activities, workers   are   exposed   to free Crystalline Silica (CS), which can cause the constant production of reactive oxygen species and silicosis. This research was conducted to evaluate oxidative stress biomarkers and liver tissue function in workers occupationally exposed to CS during their activities. 
Materials and methods: In this study, the biomarkers of oxidative stress were evaluated in 40 workers in silica mines of Azandarian region (Hamadan province, Iran) with occupational exposure to CS, as the case group and 40 workers without any silica-exposure as controls. 
Results: A significant higher serum levels of Malondialdehyde (MDA), Reactive Oxygen Species (ROS) and Alanine Transaminase (ALT) were observed in the silica-exposed group compared to the controls. Moreover, in the serum of the silica-exposed cases, the total antioxidant capacity was lower than that of the control group. Based on findings chronic exposure to CS can obviously affect the serum levels of oxidative stress biomarker and liver tissue function in the exposed workers. 
Conclusion: Therefore, the use of suitable face mask and different dietary antioxidants are recommended in the silica-exposed workers for the reduction of oxidative stress production and prevention of liver tissue disorders.

Evaluation of oxidative stress biomarkers and liver enzyme activity in workers occupationally exposed to respirable free crystalline silica

Background/Purpose: Due to the pandemic of COVID-19 and the need to pay attention to the older adults as one of the most vulnerable groups, this study aimed to determine the effects of educational programs based on the Protection Motivation Theory (PMT) as non-pharmaceutical intervention in promoting protective behaviors against COVID-19 among the older adults in Hamadan. Method(s): The present study was a randomized controlled trial performed in 2021 on 80 older adults visiting retirement centers in Hamadan. Participants were randomly assigned to experimental (n=40) and control groups (n=40). The data collection tool was a researcher-made questionnaire including demographic variables and constructs of PMT which were completed before and two months after the intervention. The intervention consisted of four sessions implemented for the experimental group. The collected data was analyzed in SPSS-16 using Chi-square, Mann-Whitney, and Wilcoxon tests. Result(s): There was no significant difference between the two groups in terms of all demographic variables and theoretical constructs before the educational intervention. After the educational intervention, there was a significant difference in the constructs of perceived severity (P=0.012), perceived response efficiency (P=0.009), perceived self-efficacy (P=0.021), and perceived response cost (P <0.001) after the intervention. No significant changes were reported in the control group (P >0.05). Also, results showed that there was no significant difference in the mean of COVID-19 preventive behaviors between the two groups after the educational intervention (P >0.05). Conclusion(s): The results showed that the use of educational intervention as non-pharmaceutical intervention based on the PMT was an effective approach to perform preventive behaviors against infectious diseases such as COVID-19. Copyright © 2022, Full Universe Integrated Marketing Limited. All rights reserved.

The Effects of Non-Pharmaceutical Intervention Based on the Protection Motivation Theory in Promoting COVID-19 Prevention Behaviors in the Older Adults



In the COVID-19 epidemic, pregnant women, fetuses, and newborns are a
high-risk population that is more susceptible than the general population. These groups are more susceptible to serious respiratory illnesses and pneumonia because of their weakened immune systems.
This study compared maternal and neonatal outcomes in postpartum women with COVID-19 with
similar healthy women at the hospital



In this retrospective cohort study, the characteristics of 100 pregnant
women with COVID-19 (confirmed by a positive PCR test during pregnancy) were compared to 150
healthy pregnant women who were referred to Fatemieh Hospital in Hamadan from March, 2020 to
February, 2021. The maternal and neonatal outcomes were collected from the medical record of patients and analyzed using SPSS software (Ver. 26).



No significant differences were observed in the average ages (± standard deviation) of the
two groups of COVID-19 (30.25 ± 6.24 years) and healthy (29.48 ± 6.73 years) women. In this study,
pregnant women were infected with COVID-19 from weeks 7 to 41 of gestation, with a median infection time of 35 weeks. The odds ratio (95% confidence interval) of pre-eclampsia and preterm birth
was significantly higher in women with COVID-19 than in healthy women with the following values
2.79 (1.61, 7.34) and 22.26 (2.86, 173.33), respectively.



Pregnant women suffering from COVID-19 had considerably greater rates of gestational
issues, neonatal difficulties, pre-eclampsia, and premature delivery, according to the findings of this
study. During epidemics, it is advised that pregnant women and their newborns receive more basic
care.


Comparison of Maternal and Neonatal Outcomes among COVID-19 and Healthy Pregnant Women in the West of Iran: A Retrospective Cohort Study

The utilization of various kinds of therapeutic strategies for the treatment of patients infected with coronavirus disease-2019 (COVID-19) is a topic of great interest to researchers the world over. COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and represents the causative agent of a lethal disease that is a great global health concern.1 Since its identification in December 2019 in Wuhan, Hubei Province, China, COVID-19 has spread rapidly throughout the world.2 The World Health Organization announced the pandemic outbreak of COVID-19 on February 11, 2020, as the infection had affected over 100 countries in a matter of weeks.3 This disease begins with flu-like symptoms such as fever, dry cough, myalgia, and viral pneumonia and can progress to acute respiratory distress syndrome and myocarditis.4 Among different patients, those with cardiovascular disorders, immune system defects, diabetes, and hypertension are at high risk for infection with SARSCoV-2.5 Myocardial infarction (MI) is the most important entity. Activated inflammation in the vascular wall by severe viral infections such as SARS or influenza can increase the risk of plaque rupture and thrombus formation, inducing either ST-elevation MI or non–ST-elevation MI in susceptible patients.6, 7 A previous study indicated that acute MI was the cause of death in 2 of 5 fatal cases involved with SARS.8 Another investigation showed that the influenza virus could lead to an increased risk of acute MI.9 Although reports on MI in patients with SARS-CoV-2 have not been published yet,1 research indicates that due to extensive inflammation and hypercoagulability, the risk of acute MI may be present in patients with SARS-CoV-2.10 There are 2 important issues concerning patients with SARS-CoV-2 with respect to the association between the infection and MI. The first issue is the higher rate of mortality in patients with a preexisting cardiovascular disease who are infected with SARS-CoV-2, especially when it is complicated by MI.11 The precise mechanisms of cardiovascular injury related to COVID-19 have not been fully explored and are likely multifactorial including accelerated aging, immune system dysregulation,12 and the pathogenic mechanism associated with angiotensin-converting enzyme 2 (ACE2) receptors. Extensive research has underscored the pivotal role played by ACE2 receptors as functional receptors for SARS-CoV-2 since they are highly expressed in myocardial and lung alveolar cells.13 According to single-cell RNA sequencing via reverse transcription-polymerase chain reaction (RT-PCR), more than 7.5% of myocardial cells have positive ACE2 expression, which can provide a suitable site for the binding of the spike proteins of SARS-CoV-2.2 This interaction between ACE2 receptors and spike proteins in myocardial cells can trigger a cytokine storm and ultimately lead to vascular inflammation, plaque instability, myocardial inflammation, and myocardial suppression.13, 14 The second important issue is the controversy surrounding the therapeutic strategy for MI in patients infected with SARS-CoV-2. There is as yet no specific treatment protocol for the treatment of this infection, with various pharmacologic agents being under active investigation. Supportive treatment with remdesivir, ribavirin, lopinavir/ ritonavir, favipiravir, antimalarials (eg, chloroquine and hydroxychloroquine), azithromycin, corticosteroids, and biologics (eg, tocilizumab) has been administered to these patients.10, 15 It is important to consider that the interactions between these drugs and other cardiovascular medications such as antihypertensives, antiarrhythmics, anticoagulants, antiplatelets, and statins could increase the side effects of the drugs, especially in patients with MI.3 On the other hand, medications such as lopinavir/ritonavir can cause QT and PR-interval prolongation, which may be more hazardous in MI patients infected with SARS-CoV-2 since they have inherent electrical disturbances.16, 17 Chloroquine and hydroxychloroquine affect the intracellular pH level, which leads to electrolyte abnormalities, cardiotoxicity, and prolonged QT intervals.18 The administration of azithromycin in patients with heart disorders who are infected with SARS-CoV-2 could interfere with anticoagulants, statins, antiarrhythmics, and other QT-prolonging agents, which might lead to torsades de pointes.16 The concurrent consumption of the aforementioned medications by MI patients with SARS-CoV-2 seems injudicious. It is, therefore, vital that new drugs be introduced into the current pharmacologic armamentarium for the management of this special group. Research has been conducted to find potent drugs with fewer side effects. Cavagna et al,19 in a monocentric crosssectional study, used calcineurin-inhibitors in the treatment of SARS-CoV-2–infected cases with organ transplantation or rheumatic diseases. They posited that the use of calcineurin inhibitor-based immunosuppressive regimens such as tacrolimus could be considered a safe therapeutic option for SARS-CoV-2 because they are capable of suppressing the phosphatase activity of calcineurin and result in decreased interleukin-2 production. Another investigation

Saeed Bashirian

Papers

The demographic and Psychological determinants of performing Mammography among the Employed Women in Medical Professions in western Iran: the Role of Threat Appraisal and Coping Appraisal

Evaluation of oxidative stress biomarkers and liver enzyme activity in workers occupationally exposed to respirable free crystalline silica

The Effects of Non-Pharmaceutical Intervention Based on the Protection Motivation Theory in Promoting COVID-19 Prevention Behaviors in the Older Adults

Comparison of Maternal and Neonatal Outcomes among COVID-19 and Healthy Pregnant Women in the West of Iran: A Retrospective Cohort Study

What is important in patients with COVID-19 associated with myocardial infarction?