Effectiveness of Using Face Masks and Personal Protective Equipment to Reducing the Spread of COVID-19: A Systematic Review and Meta-Analysis of Case-Control Studies.

Recently published researches show that 59% of all transmission came from asymptomatic transmission and at the time of diagnosis health-care workers (HCWs) tend to present without respiratory symptoms. These evidences have raised questions on whether an essential policy for use of personal protective equipment (PPE) is the best approach in HCW and other people or not. Therefore, this study conducted to investigate the effectiveness of using face masks and PPE in reducing the spread of COVID-19 in health-care and non-health-care settings. This systematic review and meta-analysis study was prepared according to the preferred reporting items for systematic review and meta-analysis statement and guided by meta-analysis of observational studies recommendations. Searches in databases were conducted from December 2019 to July 2021. Random-effects meta-analysis was performed to investigate the effect of using face masks and PPE on spread of COVID-19. Heterogeneity among studies was assessed using Cochran's Q test and the I 2 metrics. In total, 9920 individuals from 14 studies were included in this study. In all settings, application of PPE or any type of masks was associated with reduction in risk of COVID-19 (odds ratio [OR] = 0.44; 95% confidence interval [CI]: [0.29, 0.65]; I 2 = 85.21%). In the HCW subgroup, the protective effect had a combined OR of 0.33 (95% CI: (0.15,0.73), I 2 = 82.61%). Six studies were found protective effects of wearing mask in non-HCWs (OR = 0.58, 95% CI: (0.31, 1.06), I 2 = 85.63%). Results suggest that there is association between face mask/PPE use and reduction of COVID-19.

Effect of COVID-19 infection on sex hormone levels in hospitalized patients: A prospective longitudinal study in Iran.

Introduction: This study aimed to evaluate the levels of sex hormones in patients with COVID-19 in Ahvaz, Iran. Methods: A prospective longitudinal study was conducted at Razi hospital, Ahvaz, Iran, from July 2020 to Febuary 2021. The levels of sex hormones including estradiol, progesterone, luteinizing hormone (LH), follicle stimulating hormone (FSH), and total and free testosterone were measured in 162 patients with COVID-19 infection during hospitalization and 1 month after discharge. A demographic questionnaire and a checklist were used to collect the data. Mann-Whitney U test, χ 2 test, Fisher's exact test, Wilcoxon test, and logistic regression were used to analyze the data. Results: Sex hormones were assessed in 162 patients at baseline; however, a month after discharge, only 69 patients provided consent for assessment, and 9 had passed away. The estradiol level was 407.70 ± 623.37 and 213.78 ± 407.17 pg/ml in female patients with severe and moderate diseases at baseline, respectively which reduced to 195.33 ± 380.04 and 58.20 ± 39.45 pg/ml after discharge (p = 0.011 and p = 0.001). The alteration in the levels of progesterone, LH, and FSH were not significant.The level of LH in both groups of male patients with severe (6.64 ± 2.91 IU) and moderate disease (6.42 ± 4.44 IU) was high, which reduced after discharge (4.16 ± 2.44 and 3.93 ± 3.15 IU, respectively), but this decrease was significant only in the patients with severe disease (p < 0.0001). The alteration of FSH and free testosterone were not significant. The level of testosterone was 1.19 ± 0.73 and 1.46 ± 1.22 ng/ml at baseline in patients with severe and moderate diseases which increased to 2.64 ± 1.25 ng/ml, p < 0.0001, and 2.54 ± 0.93 ng/ml, p = 0.001, respectively after discharge. Conclusion: Our findings showed that the level of estradiol in female patients increased significantly while the level of testosterone in male patients decreased during the active phase of infection. Due to the attrition of patients in the follow-up period, more studies are needed to confirm these results.

Explaining the Psychological Distress of Women with High-Risk Pregnancies in Iran: A Qualitative Study.

Background: Psychological Distress (PD) is one of the most common mental disorders during pregnancy and involves stress, anxiety, and depression. According to the literature, High-Risk Pregnancy' (HRP) is a major physiological risk factor associated with PD during pregnancy. The main purpose of this study was to explore the perception and experience of women with HRP who, based on standard questionnaires, had moderate-to-severe stress and anxiety scores. Materials and Methods: This qualitative study was conducted using conventional content analysis from December 2020 to June 2021. To this aim, 16 women with HRP were purposefully selected from Imam Khomeini Hospital in Ahvaz, Iran, with maximum diversity. In-depth, semi-structured, individual interviews were conducted to collect the data. The MAXQDA software was used for data analysis. Results: Data analysis led to the extraction of two main categories and nine subcategories. "Disrupted peace" and "inefficient adaptation to the situation" were the two extracted categories. The former included the five subcategories of concerns about pregnancy complications, concerns about the parenting process, concerns about the couple's relationship, fear of Covid-19, and occupation-related stress. The latter included the three subcategories of unpleasant feelings, current pregnancy experiences, and previous pregnancy experiences. Conclusions: This study highlighted a wide range of psychosocial factors involved in the PD of women with HRP. These findings can be used to design appropriate prevention strategies to manage the mental health problems of these women in order to turn their pregnancy into a pleasurable experience.

Home care in COVID-19 patients with the home-quarantined condition: A study from Iran

Objectives During the COVID-19 home-quarantines, home care services may act as an auxiliary component of health care system, which reduces the burden on the formal health care system. This study aimed to investigate the status of informal home care provided for home quarantined patients with COVID-19 in southwest Iran. Methods This descriptive study was conducted on 288 patients with COVID-19 in Ahvaz (southwest Iran). Inclusion criteria included a known case of COVID-19, willingness to participate in the study, recommendation of home quarantine from a health center, having a smartphone, and fluency in reading and writing in Persian, and the exclusion criterion was a history of COVID-19 longer than 3 months. The data collection method was structured interviews based on a questionnaire (face-to-face-telephone calls-video call). SPSS software was used for the analysis of data. Results 45.5% of the participants in the study were women with a mean age of 37.82 (10.48%) and 55.5% were men with a mean age of 36.12 (11.93%). Findings showed that in most cases, the spouse (61.4) is responsible for the care of the patient, and in other cases, parents are responsible for this duty. 57.3% of the patients stated that they themselves had to leave home to provide for necessities of life, and 37.2% stated that they were in charge of cooking. 47.9% of the patients evaluated the quality of quality of care provided at home as good. Most of patients and caregivers referred to hospital for getting information (35.8% patients and 34% caregivers). Most of patients recovered from diseases (60.8%) and 39.2% were hospitalized. Although 43.9% of men and 33.6% of women were hospitalized and a there was a significant difference between men and women (P < 0.04). Conclusion During COVID-19 pandemic home care to reduce the burden on the health system are very important. We must also know that this type of care requires informed and planned support and sufficient community education. The health care system needs to put self-care and family care among its top priorities. The focus should be on educational and mental support of informal caregivers along with measures that protect their relatives from COVID-19.

Quality of perinatal care for women with high-risk pregnancies during the COVID-19 pandemic in Iran.

BACKGROUND: COVID-19 has had a catastrophic effect on the healthcare system. Healthcare quality assessment measures the difference between expected and actual performances to identify gaps in the healthcare system. This study aimed to evaluate the quality of perinatal care for women with high-risk pregnancies (HPR) during the COVID-19 pandemic. MATERIALS AND METHODS: This cross-sectional study enrolled 450 women with HPR from health centers in Ahvaz, Iran, from December 2020 to May 2021, using a multi-stage sampling method. Quality of care was assessed using an observational checklist adapted from Ministry of Health guidelines. Data were analyzed using descriptive and statistical methods. RESULTS: The quality of the assessed aspect in comprehensive health centers and in peripartum, perinatal, and postpartum wards was moderate. The overall score for peripartum care was significantly positively correlated with the length of the retraining period, and the quality of perinatal care was significantly related to the proportion of elective cesarean sections and preterm delivery. CONCLUSION: The development of care practices in health centers in Iran should focus on education and counseling. Practices in peripartum wards should emphasize the use of partographs, physical/mental support, and privacy for mothers, while perinatal wards should focus on timely counseling.

Non-Adherence to Preventive Behaviors and the Risk of COVID-19: A Comparative Study.

Background: Transmission routes of COVID-19 have been well identified and documented. Considering the high prevalence of the Covid-19 and its impacts on the population, this study aimed to assess the status of preventive behaviors against coronavirus infection and estimate the odds of its transmission routes among people. Methods: A comparative study was conducted from March to April 2021. A total of 1256 participants were randomly selected, including 262 COVID-19 patients and 994 healthy people from 10 counties in Khuzestan, southwest Iran. A two-part questionnaire was used for data collection that included items on demographic and adherence to preventive behaviors. Statistical analysis was performed using the statistical software SPSS 18.0.0 applying logistic regression. Results: The mean age of participants was 37.60±11.48 years (female: 36.49±11.15 years; male: 38.86±11.74 years). The results showed that having contact with infected patient at home (OR = 4.90, 95%CI = 3.32-7.25), going to the hospital for not-necessary medical reasons (OR = 4.47, 95%CI = 3.05-6.55), leaving home for essential daily services (OR = 2.49, 95% CI = 1.63-3.81), and going to doctors' office (OR = 1.78, 95% CI = 1.20-2.63) could increase the odds of infection. Conclusion: The findings suggest that different factors are responsible for the increased spread of the Covid-19. Indeed, since the intervention for every single factor will have a small contribution to reducing the prevalence of the disease, it seems essential to design comprehensive interventions while emphasizing isolation and contacts tracing. The study provides evidence for multi-level and multi-faceted policy and interventions for promoting adherence to COVID-19 preventive behaviors.

Health anxiety and related factors among pregnant women during the COVID-19 pandemic: a cross-sectional study from Iran.

BACKGROUND: The COVID-19 pandemic has affected many countries around the world and Iran was no exception. The aim of this study was to evaluate health anxiety of Iranian pregnant women during the COVID-19 pandemic. METHODS: In this cross-sectional study, 300 pregnant women in different trimesters (n = 100 in each trimester) were recruited. A demographic questionnaire and the Health Anxiety Questionnaire were used to collect data. Scores of < 27, 27-34 and more than 35 were defined as low, moderate and high health anxiety, respectively. Due to nationwide restrictions, data were collected through social media groups. Chi-square tests, ANOVA and multiple linear regression were used to analyze the data. RESULTS: Mean (SD) total anxiety scores were 22.3 ± 9.5, 24.6 ± 9.3 and 25.4 ± 10.6 in the first, second and third trimesters of pregnancy, respectively. 9, 13 and 21% of women had severe anxiety in the first, second and third trimesters of pregnancy, respectively. Women in the third trimester had significantly higher health anxiety scores than those in the first trimester (p = 0.045). CONCLUSION: At the time of the COVID-19 pandemic, women in the second and third trimesters of pregnancy were more worried about consequences of disease, but total health anxiety scores were significantly higher among women in the third trimester of pregnancy. Health care providers should pay more attention to the mental health of pregnant women in times of crises such as the COVID-19 pandemic.