BACKGROUND Gastric cancer (GC) is the fifth most common cancer and the third most common cause of cancer death worldwide. The aim of this study was to investigate the factors affecting the survival of patients with GC using the illness-death model (metastasis as an intermediate event). METHODS In this retrospective cohort study, 339 patients with GC who were referred to Shahid Bahonar and Afzalipour Hospitals in Kerman, Southeast Iran during 2001-2016 were included. Demographic, therapeutic, and clinical data were collected from the patients’ medical records. To evaluate the factors affecting patients’ survival and the relationship between the factors, the illness-death model (metastasis as an intermediate event) was used. RESULTS One, three, and five-year survival rates in patients with GC were estimated to be 63%, 40%, and 30%, respectively. The results of analysis of illness-death model showed that age (HR = 0.98, 95% CI: 0.97- 0.99; p = 0.007) and histological grade (HR = 1.77; 95% CI: 1.68- 2.67; p =0.007) affected metastasis whereas history of cigarette smoking (HR = 1.89; 95% CI: 1.08- 3.3; p = 0.02) and chemotherapy (HR = 0.63; 95% CI: 0.4-0.93; p = 0.02) affected death hazard without metastasis. History of opium use (HR=2.11; 95% CI: 1.17- 3.8; p = 0.002), family history of GC (HR = 2.48; 95% CI: 1.2-5.15; p = 0.01) and histological grade (HR = 1.85; 95% CI: 1.11- 3.08; p = 0.02) were identified as factors affecting death hazard in patients with metastasis. CONCLUSION According to the results, patients’ age at the time of diagnosis and histological grade have a significant effect on the occurrence of metastasis. In addition, using the disease-death model, a complete understanding of the behavior and effects of the studied variables on different disease states can be realized.

Background. Diabetes is one of the most common diseases among hospitalized patients due to COVID-19. Therefore, this study aimed to identify the clinical characteristics of diabetic and non-diabetic patients with COVID-19 that may lead to death. Methods. A multicenter cross-sectional study was conducted among patients admitted to hospitals due to COVID-19. The data, including demographic data, symptoms and signs, underlying diseases, patient progress, and outcomes were obtained from 38 hospitals in the registry system of Khuzestan province (the southwest of Iran) between January 19, 2020 and March 8, 2021. The Cox proportional hazards regression was used to analyze the data. Results. Data from 23,447 hospitalized patients due to COVID-19 were included in the study. Four thousand three hundred and forty participants (18.5%) with a mean age of 62 years had diabetes and 14.72% of them died. A multivariable Cox regression showed that the variables of age (Hazard Ratio (HR) = 2.65; 95% CI: 1.78-3.95; P < 0.001), sex (HR = 1.16; 95% CI: 1.001 - 1.35; P = 0.049) and comorbidities such as cancer (HR = 1.89; 95% CI: 1.24 - 2.89; P = 0.003) and cardiovascular disease (HR = 1.2; 95% CI: 1.24 - 2.89; P = 0.032) were associated with mortality in diabetic patients with COVID-19. Conclusion. This study showed that COVID-19 mortality was higher in men, the elderly, and people with cardiovascular disease and cancer. Therefore, the management and prevention of COVID-19 in diabetic patients with these characteristics are vital.

Background: Nurses, as frontline health workers, are exposed to the risks of adverse mental health outcomes due to their direct contact with COVID-19 patients. Objectives: The present study aimed to investigate the mental health of frontline nurses in Behbahan, southwestern Iran. Methods: In this web-based cross-sectional study, data from 173 frontline nurses were collected in 3 COVID-19 referral hospitals in Behbahan, southwestern Iran. This study included demographic information and General Health Questionnaire (GHQ-28). Logistic regression analysis was used to examine the variables affecting mental health and anxiety symptoms. Results: The present study included 173 frontline nurses (nurses and nurse assistants), 71.7% of whom were female and 28.3% of whom were male. Further, 76.3% of frontline nurses were suspected of poor mental health, and 23.7% were mentally healthy. The results of the multivariable logistic regression model showed that female participants had poorer mental health than men (odds ratio [OR], 2.51; 95% CI, 1.16 - 5.41; P = 0.01). The mental health of nurses with a history of COVID-19 infection was poorer than that of nurses without a history of COVID-19 infection (OR, 3.3; 95% CI, 1.42 - 7.53; P = 0.006). Conclusions: The findings of our study showed that female nurses with a history of COVID-19 were more at risk for poor mental health. These groups need more attention and support in epidemics.

Coronavirus disease 2019 (COVID-19) has become a global health challenge with high transmission and mortality rates. This study aimed to identify prognosis factors of the risk of death among hospitalized patients with COVID-19 in Behbahan City, southwest of Iran. Methods: In this study, information of 800 patients with COVID-19 admitted to Shahidzadeh Hospital in Behbahan City southwest of Iran from March 20, 2020, to Jan 20, 2021, was investigated. Thereafter, the demographic information, clinical symptoms, vital signs, pharmacotherapy, Laboratory findings and the patients' underlying diseases were extracted and then recorded from their medical records. Cox regression with PH assumption was used to investigate the risk factors of death. Results: The present study included 800 patients with Covid-19 with a mean age of 57.51 ± 16.83 years old at the time of diagnosis. Accordingly, the studied sample consisted of 447 (55.8%) male and 353 (44.1%) female patients. Based on the Cox regression analysis, age variables (HR=1.04; 95% CI: 1.03-1.05; P<0.001), Cardiovascular Disease (HR=2.46; 95% CI: 1.63- 3.70; P<0.001), and renal failure (HR=2.77; 95% CI: 1.43- 534; P<0.001) were found to be associated with the death risk in patients with COVID-19. Discussion: According to the findings of this study, the patient's age at the time of diagnosis, cardiovascular disease, and renal failure were indicated to be the main prognostic factors of high mortality rate in patients with COVID-19. Identifying these risk factors can be helpful in the timely intervention of patients at high risk of death for health care providers.