Iranian Journal of

Background and Objective: Understanding the factors contributing to the mortality of COVID-19 patients can provide comprehensive information for preventive decisions and public health, and will help in better management of the epidemic. In this regard, the present study was conducted with the aim of identifying and introducing risk factors affecting the mortality of COVID-19 patients by modifiable and non-modifiable factors.
Materials and Methods: In this review study, according to the objectives of the study, related papers on risk factors affecting the mortality of COVID-19 patients were searched and collected in the international databases of Web of Science, Scopus, Embase, PubMed, and Google scholar. Then the results were extracted and reported by modifiable and non-modifiable factors.
Results: The results showed that almost all studies conducted in this field address non-modifiable risk factors such as age, sex, and underlying diseases including cardiovascular disease, diabetes, hypertension, respiratory diseases, cancer, self-diseases, autoimmune, and neurological diseases. Although few studies have been conducted on modifiable risk factors, lack of early admission or long waiting for hospital admission, occupancy of hospital beds and ICUs, as well as lack of equipment in hospitals were associated with increased mortality in these studies.
Conclusion: Regarding the situation of different countries in this epidemic, improving the control of the COVID-19 epidemic and reduce the mortality rate is possible by considering modifiable factors and taking appropriate measures. According to the results of studies, allocating sufficient financial, personnel and equipment resources can be effective in reducing COVID-19 mortality. However, controlling the COVID-19 epidemic to reduce morbidity and mortality as well as its economic and social consequences is possible by integrated management in the country. Also, using the experiences and guidance of the World Health Organization and successful countries, and stability in measures with a comprehensive approach should be considered.

Background and Objective: Changes in the quantity and quality of waste produced as a result of compliance with health protocols are the result of the COVID-19 outbreak. The present study aimed to determine the quantity of personal protection equipment produced in Tehran and people’s knowledge of its management.
Materials and Methods: The present cross-sectional and descriptive-analytical study was carried out on 2560 participants in Tehran through an online survey in spring 2020. Based on the percentage of using masks and gloves, the amount of produced waste was calculated, and Mann-Whitney and Kruskal-Wallis statistical tests were run to explore the relationship between the variables.
Results: The overall Cronbach's alpha coefficient of the questionnaire was 0.94, and the rate of mask and glove use was 90.7% and 65.7%, respectively. 70.3% and 52% of the population used two masks and one pair of gloves on a daily basis. The number of daily produced masks and pairs of gloves was 14530407 and 5262666, respectively. Mann-Whitney U-test showed a statistically significant difference between gender and marital status with people’s knowledge of waste management (p <0.05). Kruskal-Wallis test showed a significant difference between the economic status and people’s knowledge of separating the produced waste (p <0.05). People with an increasing income tended to separate the waste more.
Conclusion: Due to the high volume of personal protective wastes and the lacking knowledge of one-third of the participants about the transmission of the virus through contaminated waste, it is necessary to raise awareness of breaking the virus transmission chain.

Background and Objective: Today, the issue of health aspects in urban waste management, especially recycling, has received a lot of attention during Covid-19 around the world. Therefore, the purpose of this research is to investigate the knowledge, attitude, and performance of workers of one of the waste recycling centers in Tehran metropolis regarding health aspects during the spread of Covid-19.  
Materials and Methods: This was a descriptive-analytical cross-sectional study and the study population was all workers working in one of the recycling centers of Tehran Municipality. The data collection tool was a researcher-made questionnaire with validity and reliability in four sections: demographic, knowledge, attitude, and practice of workers toward Covid-19 and solid waste.
Results: Findings of the study showed that the highest number of workers employed were in the age group of 20 to 40 years (60 percent). The level of knowledge was about 80 percent and the lack of awareness was 20 percent. The level of workers' positive attitude, negative attitude, and lack of attitude were 79.71, 14.56, and 5.72 percent, respectively. The level of positive practice among workers was about 67.43 percent and the negative practice was 32.57 percent.
Conclusion: The results clarified that in order to succeed in waste management programs in recycling centers, municipal waste managers should pay more attention to educational aspects, especially through the focus on programs and their development and adaptation for different age groups, especially 20 to 40 years.
 

Background and Objective: Due to the presence of infectious diseases and parasitic contamination in kindergartens, it is very important to observe the health points in these centers. This cross-sectional analytical study was conducted to investigate the environmental health status of Saveh kindergartens in 2020.
Materials and Methods: A checklist with 133 questions was designed, including 57 questions specific to the conditions of the coronavirus, taken from the instructions for the second step of the fight against the coronavirus and 76 questions from regulation 150/920318. All active kindergartens (9 cases) in the study were included, and the answers to the questions as yes, no, and not applicable were recorded and using SPSS software, independent T, chi-square, and one-way ANOVA was analyzed.
Results: The results obtained from the analysis of the checklist showed that the compliance of the health status of all kinds of kindergartens with the regulations of 150/920318 has a percentage of total desirability that includes personal hygiene (81/4%), food hygiene (63%), tools and equipment hygiene (66/5%), building hygiene (78%), health education (90%), considerations regarding disinfectants and disinfectants based on alcohol (92%) and considerations regarding bleaches (94%). There was no significant relationship between the per capita of each child and the different items on the checklist (p>0/05).
Conclusion: This study showed that the general environmental health status of kindergartens in Saveh was favorable and only two variables of hygiene of tools and equipment (66/5%) and food hygiene (63%) were the least desirable among the studied factors that should be considered.

Background and Objective: The purpose of this study is to evaluate the difference in knowledge, attitude, and performance in terms of food hygiene and safety between people with and without a history of Covid-19.
Materials and Methods: This descriptive-analytical study was conducted on 712 people from August to September 2021 using a standard online questionnaire. The questionnaire had four sections, the first section includes demographic information, the second section includes seven questions related to participants' knowledge about food hygiene and safety, the third section includes ten questions about participants' attitudes, and the fourth section contains 10 questions related to participants' health performance. Multiple regression models were used to investigate the main predictors of knowledge, attitude, and performance. The significance level was considered as p < 0.05.
Results: There were 271 (43%) people with a history of infection and 361 (57%) without infection. Demographic factors were not significantly different between people with and without a history of infection. The results of the present study showed that knowledge (p=0.05) and people's performance (p=0.002)  about food hygiene and safety have a significant relationship with the history of corona infection. However, people's attitude was not affected by the corona infection (p=0.17). Attitude was the major predictor of performance (p <0.001).
Conclusion: It can be claimed that contracting Corona has increased people's knowledge and improved performance regarding food hygiene and safety during the Covid-19 pandemic and has improved health conditions.
 

Background and Objective: In this research, considering the importance of the adverse effects of the Covid-19 disease and identifying the environmental factors involved in its outbreak, the effects of environmental factors and compliance with health guidelines on outbreak and mortality of Covid-19 have been evaluated.
Materials and Methods: This research was a descriptive-analytical study on confirmed patients with Covid-19 in Alborz province in 2019. In this study, outbreak rate and death due to Covid-19, compliance with health guidelines, air pollutants concentrations, air pollution indicators, and the meteorological conditions of Alborz province were daily collected for 2019. All data were analyzed in IBM SPSS Statistics v26 software with Pearson, Spearman, Kruskal-Wallis, one-way variance ANOVA analysis tests, and negative binomial regression statistical models.
Results: The results of the regression model showed that in the mortality rate due to Covid-19, the variables of average temperature(p=0.042), humidity(p=0.048), rate of Covid-19 infection(p=0.001), and compliance with health guidelines(p=0.007) are significant. However, in the model of the rate of infection with Covid-19, only compliance with health guidelines(p=0.001) was significant. Pearson's and Spearman's correlation coefficients for infection rate, compliance with health guidelines, wind speed, and concentrations of carbon monoxide, PM_2.5, and SO₂ with the death rate due to corona, were 0.575, -0.411, -0.206, 0.211, 0.114 and -0.158.
Conclusion: The results showed that in addition to compliance with health guidelines, some atmospheric factors and air pollutants also impact the rate of infection and mortality caused by Covid-19.
 

Background and Objective: Personal hygiene and adherence with health protocols in food preparation and distribution centers by operators are essential for controlling the transmission of infectious diseases. This study aimed to investigate the microbial contamination and compliance with health protocols among bakery workers in Mahmoudabad, Mazandaran, in 2020.
Materials and Methods: In a cross-sectional descriptive study, 149 samples were collected from the hands of workers in bakeries in Mahmoudabad. The microbial load was determined using the System Sure Plus device. Additionally, standard checklists, which included questions related to compliance with health protocols in the workplace, were used.  The collected data was then analyzed using SPSS 26 software.
Results: Among the studied samples, 51.1%had a microbial load higher than 30 RLU (Relative Light Units), 28.86%  had a microbial load of 10-30 RLU and 20.13% had a microbial load less than 10 RLU. Based on the results of the checklists, the rates of adherence to hand disinfection protocol, observance of social distancing, use of liquid soap, and use of a mask were 43.6%, 61.7%, 59.7%, and 53.7%, respectively. Additionally, data analysis revealed a significant relationship between business gown usage and microbial contamination on personnel's hands (p = 0.031).
Conclusion: Based on the results, it was evident that the workers' hand hygienewas in a concerning condition, posing a potential threat to their overall well-being. Therefore, individual health education and food safety practices should be improved, and inspections by environmental health monitors should be considered to ensure stricter public health standards.