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Background: The operating room is a sophisticated, dynamic environment, with advanced technology. The goal of our study is to evaluate the effect of peri-operative practice on the cognitive functions of scrub nurses. Method: This study included a total of 75 scrub nurses. The d2 Test of Attention was used for evaluation of cognitive function. The test was conducted with participants on three different working shifts. Results: A significant difference was found between overall mean values for total number of items processed, number of errors, total number of items processed minus number of errors, and concentration performance scores for the posttest compared with the pretest. Conclusion: Perioperative practice has a significantly positive effect on cognitive function of scrub nurses, although this positive effect has a downward trend with increasing age as well as increasing workload. [ J Contin Educ Nurs. 2021;52(12):565–574.]

Zika virus is an emerging public health threat. The large outbreak related to this infection was first reported in 2007 in Yap Island. This virus is associated with microcephaly, Guillain Barre syndrome and some of the presentations of Zika infection include fever, maculopapular rash, arthralgia, bilateral conjunctivas, headache, arthritis/arthralgia with edema of tiny joints of feet and hands, retro-orbital pain, myalgia, asthenia and vertigo. In most of the cases, the infection is asymptomatic and self-limited. One of the largest known outbreaks of the virus was reported in French Polynesia, south pacific in October 2013. At the beginning of 2016, more than 52 countries have had reported the active transmission of the Zika virus. In general, there are two transmission modes for the Zika infection: Vector-borne transmission and Non-vector-borne transmission. Some diagnostic tests for Zika infection are RT-PCR, ELISA, and PRNT. Up to now, there is no specific antiviral medicine for the treatment of Zika infection and also no vaccine is available for immunization. As far as we know, more than half of the world’s people live in areas where the Aedes mosquito lives. There is a probability occurrence of the Zika virus epidemic at any time and in any place without prior notice in today’s “global village”. Therefore, health systems in all the involved countries should implement better triage and early warning surveillance systems for morbid cases of Zika to prevent large epidemics and the spread of the virus among mosquitoes and finally to avoid its disastrous consequences.

This commentary provides an update to the last situation of 2019 novel coronavirus pandemic (COVID-19) in the world. Current known evidence for COVID-19 suggests that we are now faced with the most virulent coronavirus and epidemic that the world has ever seen. The coronaviruses already identified such as severe acute respiratory syndrome coronavirus, Middle East respiratory syndrome coronavirus, and nowadays COVID-19, may only be the tip of the iceberg, and probably more novel and severe zoonotic infections might be revealed in the near future in the humans' populations. However, in this pathway, the important issue that often has been neglected is the change and reforming of the person's lifestyle and eating habits. Keywords:Humans' food-consumption pattern; Emerging diseases; 2019 novel coronavirus (COVID-19)

Abstract. Background: Examining the premature death rate represents the first step in estimating the overall burden of disease, reflecting a full picture of how different causes affect population health and providing a way of monitoring and evaluating population health. Aims: This study was conducted to assess the burden of premature mortality from suicides in West Azerbaijan Province, northwest of Iran from 2014 to 2016. Method: To calculate years of potential life lost (YPLL), we categorized all methods of suicide, then we subtracted actual age at death by suicide from the relevant age-based life table produced by the World Health Organization in 2015, after which we added the results for each type of suicide in a particular year. Results: We analyzed 638 suicides. Overall, during the 3-year study period for both sexes, the greatest sources of premature death among all methods of suicide were: hanging, strangulation, and suffocation (X70); smoke, fire, and flames (X76); and poisoning by narcotics and psychodysleptics (X62). Limitations: Limitations of the study include a lack of accurate, systematic recording and reporting of all cases of suicide, which might lead to measurement bias. Conclusion: This study identified and highlighted the most common methods of suicide in West Azerbaijan.

Jamal Ahmadzadeh, Kazhal MobarakiSocial Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, IranCorrespondence: Kazhal MobarakiEpidemiologist in Social Determinants of Health Research Center, Urmia University of Medical Sciences, Resalat Street, Urmia, IranTel +98 918 173 2869Fax +98 443 224 0642Email Mobaraki.k@umsu.ac.irPurpose: This study represents the current epidemiological status of Middle East respiratory syndrome coronavirus (MERS-CoV) worldwide in the first three months of 2019.Patients and methods: Full details of the MERS-CoV cases available and published in the disease outbreak news on the WHO website were retrieved. Related details of laboratory-confirmed MERS-CoV were extracted and analyzed by standard statistical methods.Results: A total of 107 cases of MERS-CoV, including 18 deaths (overall case fatality rate (CFR), 16.8%; male-specific CFR was 17.5% [14/80] and female-specific CFR was 14.8% [4/27]) were reported to WHO from the National International Health Regulation Focal Points of Saudi Arabia and Oman. The overall mean age was 50±17 years and 80 patients (74.8%) were male. The average time from the onset of the symptoms to the first hospitalization was 3±3.3 days; from the first hospitalization to laboratory confirmation was 3.6±6.5 days; from the onset of symptom to death was 17.5±11.7 days; and the mean length of hospitalization forpatients with MERS-CoV was 3.5±3.9 days. Males in comparison to females had a 1.5-fold increased chance (adjusted OR =1.5 [95% CI: 1.3–1.8]) of death related to MERS-CoV infection; 1.05 [95% CI: 1.1–3.3], 1.05 [95% CI: 1.2–2.8] and 1.06 [95% CI: 1.2–2.0] for those who had exposure to camels, camel milk consumption, and close contact with MERS-CoV cases, respectively. Health care workers had 2.4 fold [95% CI: 1.2–3.1] greater odds of death compared to other people.Conclusion: The knowledge obtained from this study can contribute to the development of a prevention program and early system warning against MERS-CoV infection.Keywords: Middle East respiratory syndrome coronavirus, emerging infectious disease, disease outbreaks

Zohre Foroozanfar,1 Maryam Zamanian,2 Rahmatollah Moradzadeh,2 Fatemeh Hajiabadi,1 Jamal Ahmadzadeh,3 Zahra Hosseinkhani4,5 1Children Growth Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran; 2Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran; 3Social Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, Iran; 4Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran. School of Health, Qazvin University of Medical Sciences, Qazvin, Iran; 5School of Health, Qazvin University of Medical Sciences, Qazvin, IranCorrespondence: Zahra HosseinkhaniMetabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, IranTel +98-9127801064Fax +98- 2833355162Email zhosseinkhani122@gmail.comIntroduction: Coronavirus disease 2019 (COVID-19) has now turned into a public health emergency. Isolation of patients is a possible solution for controlling epidemic infectious diseases. We assessed the compliance of isolation and associated factors among patients with COVID-19.Methods: This cross-sectional study was conducted on 320 COVID-19 patients discharged from hospitals of Qazvin province. Patients’ isolation, self-care health behaviors, reference to public health services and possible related factors were assessed. Data were analyzed using multiple logistic regression.Results: In this study, 320 patients were enrolled, including 175 men (54.7%). Two hundred and eighty-six patients (89.4%) had complete isolation. Factors such as phone tracking by health center (OR = 1.30; 95% CI: 1.01 to 1.75) and dry cough (OR = 2.36; 95% CI: 1.09 to 5.09) increased odds of complete isolation in COVID-19 patients, but having a COVID-19 patient in the family (OR = 0.32; 95% CI: 0.15 to 0.71) and symptoms of disease like shortness of breath (OR = 0.39; 95% CI: 0.18 to 0.85) and muscle pain (OR = 0.43; 95% CI: 0.20 to 0.95) decreased odds ratio for these patients.Conclusion: Phone tracking by the health center was the most important factor to increase the odds of patient isolation. Thus, the health system should consider improving health workers’ knowledge and skills through education.Keywords: COVID-19, isolation, self-care, compliance, Iran

Maryam Salamatbakhsh,1 Kazhal Mobaraki,2 Jamal Ahmadzadeh2 1Critical Care Nursing, Urmia University of Medical Sciences, Urmia, Iran; 2Epidemiologist in Social Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, IranCorrespondence: Jamal AhmadzadehEpidemiologist in Social Determinants of Health Research Center, Urmia University of Medical Sciences, Resalat Street, Urmia, IranTel +98-9143444924Fax +98-4432240642Email ahmadzadeh.j@umsu.ac.irAbstract: This commentary presents a novel outlook for public health authorities in the affected countries to detect and respond quickly to the emerging public health threats such as Middle East respiratory syndrome coronavirus (MERS-CoV). Implementing an innovative electronic surveillance system called syndromic surveillance system is essential for global health security.Keywords: syndromic surveillance system, traditional surveillance system, Middle East respiratory syndrome

This study presents standard expected years of life lost due to premature mortality for calculating the burden of laboratory-confirmed MERS-CoV cases that have occurred from January 1, 2018, to March 31, 2019, worldwide. The study used a publicly available MERS-CoV database on the WHO website regarding case reports retrieved from disease outbreak news.

As a result of the global crisis related to coronavirus disease 2019 (COVID-19), confusion, anxiety, fear, and some psychological effects have been created among the general population in this global village. Unfortunately, these factors have provoked inappropriate behavior converting the infection to the virus to a social stigma, which can affect the dignity of people died due to COVID-19. In addition to the patient, the stigma can also affect interpersonal relationship among nurses, family members, friends, as well as social relationships. In this critical situation, we need to take care of each other with empathy, which is the key to successfully cope with the issue and prevent social stigma associated with COVID-19. This commentary evaluates the effects of social stigma related to COVID-19 and suggests some practical measures for the world communities to deal with this global public health problem.

This commentary provides a quick overview to 2019 novel coronavirus (COVID-19) and other emerging viruses in recent decades. All the evidence related to emerging infections suggests that we are faced with unknown threats and challenges in the epidemiological and heath transition. The coronaviruses already identified such as severe acute respiratory syndrome coronavirus (SARS-COV), Middle East respiratory syndrome coronavirus (MERS-COV), and nowadays COVID-19, may only be the tips of the icebergs, and probably more novel and severe emerging infections might be revealed in the near future in the humans’ communities.

Javad Aghazadeh-Attari,1 Iraj Mohebbi,2 Behnam Mansorian,2 Jamal Ahmadzadeh,1 Mohammad Mirza-Aghazadeh-Attari,3 Kazhal Mobaraki,1 Sima Oshnouei1 1Social Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, Iran; 2Social Determinants of Health Research Center, Occupational Medicine Center, Urmia University of Medical Sciences, Urmia, Iran; 3Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Background: Middle East respiratory syndrome coronavirus (MERS-CoV) is an emerging threat to global health security with high intensity and lethality. This study was conducted to investigate epidemiological factors and patterns related to this disease.Methods: Full details of MERS-CoV cases available on the disease outbreak news section of the World Health Organization official website from January 2013 to November 2016 were retrieved; demographic and clinical information, global distribution status, potential contacts, and probable risk factors for the mortality of laboratory-confirmed MERS-CoV cases were extracted and analyzed by following standard statistical methods.Results: Details of 1,094 laboratory-confirmed cases were recorded, including 421 related deaths. Significant differences were observed in the presentation of the disease from year to year, and all studied parameters differed during the years under study (all P-values

Emerging infections represent a concern especially when their increase is rapid and their mortality is high [1].

Javad Aghazadeh-Attari,1 Behnam Mansorian,2 Mohammad Mirza-Aghazadeh-Attari,3 Jamal Ahmadzadeh,2 Iraj Mohebbi2 1Social Determinants of Health Research Center, Department of Neurosurgery, 2Social Determinants of Health Research Center, Occupational Medicine Center, Urmia University of Medical Sciences, Urmia, 3Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Background/objectives: Hearing loss (HL) is associated with certain diseases and affects health, resulting in a low quality of life. Some components of the metabolic syndrome (MetS) coincide with the risk factors for sensorineural hearing loss (SNHL). To date, very few studies have examined the link between MetS and HL. The aim of the current study was to try to understand the potential association between MetS and HL.Methods: Using Iranian health surveys of professional drivers, we enrolled 11,114 individuals aged 20–60years, whose main job is to operate a motor vehicle. We examined participants for the presence and absence of SNHL and the components of the MetS. Additionally, we investigated the relationship between MetS and the pure tone air conduction hearing thresholds of participants with SNHL, including low-frequency and high-frequency thresholds.Results: This cross-sectional study consisted of 11,114 participants: 3202 (28.81%) diagnosed with MetS and 7911 (71.18%) without and 2772 (24.94%) with SNHL and 8432 (75.86%) without. Participants with SNHL had a higher number of components of MetS (P

Risk factors associated with Middle East respiratory syndrome coronavirus (MERS-CoV) infection outcome were established by analyses of WHO data from September 23, 2012 to 18 June 2018. Of the 2220 reported cases, 1408 cases, including 451 MERS-CoV deaths, were analyzed. The case fatality rate was 32% (95% CI: 29.4–34.5). Compared to MERS patients ≤30 years old, those with >30 years had the adjusted odds ratio estimate for death of 2.38 [95% CI: 1.75–3.22]. This index was 1.43 [95% CI: 1.06–1.92] for Saudi patients in comparison to non-Saudi; 1.76 [95% CI: 1.39–2.22] for patient with comorbidity in comparison to those without comorbidity; 0.58 [95% CI: 0.44–0.75] for those who had close contact to a camel in the past 14 days and 0.42 [95% CI: 0.31–0.57] for patients with >14 days with onset of signs and hospital admission compared to patients with ≤14 days.

Results: Out of 2596 children, 1113 (42.9%) and 1483 (57.1%) were girls and boys, respectively. The prevalence of caries was 62.8% (95% CI: 60.9, 64.6) with a decayed, missing and filled tooth (DMFT) mean of 0.74 (95% CI: 0.71, 0.76). Totally, 16.41% of the study samples had gingivitis. The prevalence of wasting, underweight, and stunting among schoolchildren was 3.1%, 9.48% and 2.85%, respectively. Hypertension was detected in 5.55% (95% CI: 4.67, 6.43). The prevalence of caries, gingivitis, and hypertension was more common in boys than in girls. Conclusions: Although the high prevalence of health disorders was found among schoolchildren, these rates were lower than those of previous studies in other regions. Results of the current study can help health policy makers to design educational programs concerning dental and public health interventions to deal with nutritional problems in children.

The novel influenza A (H1N1) virus was first detected in March 2009 in Mexico and then disseminated to many other countries worldwide. In this study, we assessed the potential risk factors of swine flu as well as the most important clinical manifestations of this infectious disease among confirmed cases during early phase of pandemic H1N1.Subjects (cases and controls) were selected from those patients with signs and symptoms of respiratory tract infection who referred to health centers of eight cities throughout Hamedan Province, western Iran form July to December 2009. Characteristics of the participants were obtained by interviewers using pre-determined questionnaire. Cases were distinguished by pharyngeal soap speci-mens positive for influenza A virus using polymerase chain reaction (PCR). Logistic regression model was conducted at 0.05 significance level using Stata 9.1 statistical software to assess the effects of various risk factors on H1N1 influenza infection.Totally, 245 confirmed cases of H1N1 influenza were compared with 388 controls. Case fatality rate of influenza infection was about 2.86%. In comparison with age group of 1-19 yr old, adjusted odds ratio estimates was 1.91 [95% CI: 1.06, 3.46] for age group of 20-39 yr old, 0.94 [0.37, 2.38] for age group of 40-59 yr old, and 0.34 [0.09, 1.37] for age group of 60-79 yr old. Adjusted odds ratio estimates of influenza A infection was 8.12 [95% CI: 3.11, 21.6] for pregnant women compared to non-pregnant women; 1.84 [95% CI: 1.32, 2.86] for high educated individuals in comparison with low educated individuals; 2.11 [95% CI: 1.25, 3.57] for whose who had close contact with suspected influenza patients; and 2.15 [95% CI: 1.16, 3.98] for individuals with normal body mass index (BMI= 25-30) compared with underweight individuals (BMI20). There were no significant differences in clinical manifestations between cases and controls.The risk of influenza A infection is highest among children and adolescents, pregnant women, high educated individuals, and those who had close contact with suspected influenza patients during pandemic phase. In addition, there is no pathogonomonic sign or symptom to distinguish influenza infection clinically from other kinds of respiratory track infections.