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: 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.

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: 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: 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.

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.

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: 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.

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.