Journal of Health Sciences and Surveillance System
Volume:10 Issue: 1, Jan 2022

The year 2020 began with a new public health hazard. A novel coronavirus, acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was discovered in Wuhan, China on 12th December 2019. In 2020, the World Health Organization (WHO) introduced the name of the disease as ‘COVID-19’.

The morphology, pathogenic mechanisms, causes, transmission, symptoms, diagnosis, therapeutic potential, clinical studies on COVID-19 infection, preventive measures, and mental health care were described in this study.

A literature search was conducted using electronic databases such as PubMed, Scopus, Elsevier, Frontiers, Medline, EMBASE, Web of Science, Science Direct, and Google Scholar. The search was broadly scoped, using key terms such as SARS-CoV-2, COVID-19, etc.

The genomic characterization of SARS-CoV-2, drugs, and their potential mechanisms used in humans to inhibit the SARS-CoV-2 were tabulated. Moreover, twenty-five clinical researches carried out against COVID-19 infection were also tabulated in this study. Preventive measures such as chemical disinfectants and increasing test capacity were also discussed.

The current study provides a snapshot of the overview of the SARS-CoV-2 and COVID-19. The findings suggested the effective preventive measures to halt the spread of SARS-CoV-2 and develop a better vaccine. The information from this review study also aids in early preparations for future pandemic outbreaks.

The coronavirus disease-2019 (COVID-19), caused by a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is now spread  worldwide. Therefore, informative and reliable data related to the exact effects of COVID-19 on fertility and pregnancy is still of great interest until the pandemic is declared over. General guidelines regarding the protection and management of COVID-19 have been published and new information will continue to be updated daily.

In this review, we summarized clinical health guidelines for reproductive and infertility centers to improve quality management in assisted reproductive technology and minimize the potentially harmful consequences of COVID-19 on pregnancy and fertility.

As specified in the literature, protocols consist of five categories, including protocols for couples, protocols for women, protocols for men, labor and delivery, and postpartum and breastfeeding.

General protocols for patients and staff may vary depending on specific conditions. However, this review provides some rules to ensure their safety against the disease during the pandemic.

The nature of population policies in the field of health, especially population, fertility, and childbearing is complicated, so the families’ and policymakers’ decision on the quantity and quality of the reproduction and the childbearing process has been controversial. This paper was conducted to identify and explain the adverse effects of population policies on reproductive health and childbearing in 1978-2020.

This study has a  cross-sectional descriptive-analytical design. The study participants were 30 managers and specialists who studied in the fields of policy, demography, sociology, and health at university of medical sciences in Khuzestan in 2019-2020. Delphi method was used and the data collection tool was a researcher-made questionnaire that was standardized by calculating the validity and reliability using the Cronbach's alpha coefficient. The authors analyzed  data  using descriptive and inferential statistics,. The main question was whether the population policies adopted after the Islamic Revolution have challenged decision-making on reproductive health and childbearing at both levels of operational managers and the society? The main hypothesis allocated the answer "yes" to itself. However, since policymakers still do not frequently use policy-making knowledge as a criterion for public policy, there is dissatisfaction and mistrust among families who have to implement the policies.. Thereforethe new message of the researchis that in the future, any decision and manipulation on health and population should be all-inclusive and comprehensive along with conservatism and maturity.

The significance level was observed in 18 items, and it indicates that population policies on reproductive health and childbearing in the studied variables have been facing challenges. The main challenges  included lack of experts in reproductive health policymaking, lack of sufficient evidence to make decisions, lack of attention to spatial planning infertility policy making, lack of a coordinated system between the Ministry of Health and other ministries, lack of ideological-based reproductive health policymaking, lack of attention to the socio-economic evaluation of population policies, and lack of long-term strategic and sustainable vision in health-based policymaking.

Population policies on reproductive health and childbearing after the revolution are not adequate for the country's decision-making system to achieve a proportionate and balanced population. Therefore, practical work and special responsibility accomplish the most promising demographic result

Adolescence is a period of important emotional, physical, and mental changes  characterized by significant adjustment problems. Adjustment with others is the most essential aspect of personal development. On the other hand, the inability to adjust with others may disrupt the normal flow of everyday life and emotional, social, and cognitive aspects. The present study aimed to  investigate the relationship between adjustment and individual and family characteristics in secondary school female students in Mahshahr city.
This cross-sectional study was conducted on 194 students. The participants were selected through multi-stage sampling.  First, the data were collected using two questionnaires, including demographic and Adjustment Inventory for School Students (AISS). Then, the data were analyzed using descriptive and inferential statistics, chi-square, correlation coefficient, and one-way ANOVA.
The results showed a significant relationship between the mother’s educational level, the families’ economic conditions , and  leisure time management with total and emotional adjustment in students(P<0.05). There was a significant relationship between the number of brothers and the educational level of the mother, with educational adjustment in students. (P <0.05). The  correlation coefficient results showed a positive and significant correlation (P <0.05) between emotional, social, and educational adjustment,
According to the research findings, family factors need special attention to increase student adjustment.

Divorce, as an issue, can contribute to the development of a wide range of problems and consequences and frequently lead to an increased risk of social problems at both individual and social levels. The present study aimed to investigate the effectiveness of compassion-focused therapy (CFT) and acceptance and commitment therapy (ACT) on post-divorce adjustment in divorced women referred to the counseling center in Ahvaz city in 2019.
The research method was quasi-experimental with a pre-test, posttest, and follow-up design and a control group. Using convenience sampling, we selected 45 divorced women willing to participate in the study. Then, we randomly divided them into two experimental groups (compassion-focused therapy and acceptance and commitment therapy) and a control group (n = 15 per group). The research instrument included the Fisher Divorce Adjustment Scale (FDAS). The first intervention program consisted of eight 60-minute sessions of compassion-focused therapy and the second intervention program consisted of ten 90-minute sessions of acceptance and commitment therapy.
The results showed that both compassion-focused therapy (CFT) and acceptance and commitment therapy (ACT) were effective in increasing post-divorce adjustment in divorced women (p<0.01). There was no significant difference between the CFT and ACT on post-divorce adjustment in this group of women (p>0.05). These results continued until the follow-up stage.
According to research findings, both CFT and ACT were efficient therapies in increasing post-divorce adjustment in divorced women. Thus, both approaches can strengthen treatment interventions to increase adjustment in divorced women

Aging and retirement are a passage to a new course of ​​life for veterans. The role of army grandparents in relation with their adult children is important; therefore, it is necessary to study grandparent-adult children interactions during retirement. Unfortunately, there was no Iranian version of an instrument to measure this interaction. Hence, the study aimed to evaluate the Persian version of the Perceived Parenting Roles Inventory (PPRI-2019). The translation process was conducted based on WHO’s guidance of instruments translation and adaptation.
The research method was descriptive and had a psychometric type. A total of 251 grandparents were randomly selected from the Iranian Veterans Association. The PPRI and demographic questionnaire were used to gather data at the end of 2019. The scale structure was evaluated using confirmatory factor analysis (CFA). Cronbach’s alpha assessed internal consistency and the optimal cut-off points were obtained by calculating the area under the curve (ROC). Data were analyzed using IBM-SPSS version 26 and AMOS version 24. The construct validity of PPRI based on CFA showed that the two subscales explained a total of 73.017 % of the variance. The PPRI scale demonstrated excellent reliability, and Cronbach’s alpha obtained 0.792 for the entire scale (p< 0.000). The optimal cut-off point of PPRI was 19.50, with a sensitivity of 100%, a 1-specificity of 0.127.
Based on the results, the Persian version of PPRI is a valid and reliable tool that other researchers can use to measure perceived parenting roles among other retirees. But further investigations are suggested.

Academic achievement is the most important indicator of the efficiency of any educational system. The objective of the present study was to determine the relationship between attachment styles and Internet addiction and its impact on the academic achievement of female high school students.
This research is a descriptive correlation study with a multi-stage cluster random sampling method. The statistical sample of this study was 200 female high school students in the second district of Shiraz in 2020. The data collection tools were the demographic questionnaire, Young's dependency on the Internet questionnaire, Collins and Reed's attachment styles questionnaire, and students' GPA as a measure of their academic achievement. Data were analyzed using spss22 software.
The results showed a significant and direct relationship between attachment styles and Internet addiction (p = 0.011). The results also showed a meaningful and positive relationship between attachment styles and academic achievement (p = 0.010).
According to the findings, the importance of attachment styles and Internet addiction on students' academic achievement is emphasized.

Dramatic changes in the demographic behaviors of Iranian women have led to declining fertility after the mid-1980s. Childlessness is an important and growing issue and has increasingly become the focus of the problem by Iranian population policymakers.
The present study was conducted using the quantitative secondary data analysis method. Using the census microdata of population and housing in 2016, the researchers attempted to investigate the level and predictors of childlessness among married women aged 40–49. The data of 85799 married women aged 40–49 was analyzed.
About 4% of the sample were childless. Logistic regression analysis indicated that the probability of childlessness for married women with university degrees, immigrant women, and employed women is higher than their counterparts. Furthermore, the findings suggested that women who live in apartments and those who live in private houses are less likely childless than their counterparts. Bigger houses lower the probability of being childless.
Government planning and policymaking to reducethe proportion of childlessness should improve household circumstances, especially their housing.

Bats are potential reservoir hosts for vector-bornediseases that can transmit many bacterial and viral agents tohumans. Fruit bats are considered reservoirs of many virusesand they are of major importance in the medical sciences forcontrolling and preventing vector-borne diseases. This studyaimed to compare the morphological and genetic differences oftwo fruit bat species, Rousettus aegyptiacus and R. leschenaultiiin Iran, implying anessential need for taxonomic expertise inapplied medical sciences. In this experimental study, we collected and identified26 specimens of bats belonging to two fruit bat species from thesoutheast of Iran. The morphological and genetic differenceswere characterized between recently recorded migratory fruitbat R. leschenaultii and the morphologically similar and residentR. aegyptiacus. The haplotype network was generated usingthe program POPART. The nucleotide variation and populationdifferentiation were calculated in DNAsp. Furthermore, weconsidered additional records of 15 specimens from threewidespread bat species in the north of Iran. Morphological characterization of two fruit batspecies showed R. aegyptiacus is larger than R. leschenaultiiin morphometric variables except tail length (TL) for bothsexes. The demographic analyses revealed that all haplotypesof R. leschenaulti formed a single haplogroup in the species’distributional range. In contrast, haplotypes of R. aegyptiacuswere divided into five haplogroups respecting taxa/localities. Theresults represent a strong signature of population expansion forthese two species of bats. Population of the fruit bats throughout their rangesin the Middle East may indicate an increased risk of the spread ofviral agents over time. Therefore, precise identification of hostsand vectors in applied medical sciences is essential to conductstandard procedures

Therapeutic Abortion (TA) has been defined as termination of pregnancy before the 20th week of gestation in order to save the mother’s life and prevent birth defects.The present study aimed to investigate the incidence of TA and its related maternal-fetal risk factors.
This historical cohort study reviewed 11000 birth records. Among these reviewed records, 83 cases of TA were identified. Then, for each case, three controls of live infants born in the same hospital on the same day were selected and  matched for gestational age. We used a researcher-made questionnaire for data collection.
The cumulative incidence of TA was computed 7.54 per 1000 live births. The results of multiple Cox regression model revealed that four risk factors including male gender; parental consanguinity; maternal diseases including gestational hypertension, gestational diabetes mellitus, hypothyroidism, infertility, the use of In Vitro Fertilization (IVF) and urinary tract infection; and maternal medication consumption increased the risk of TA (all hazard ratios > 1: p<0.05).
For the first time, we assessed the incidence of TA through this population-based cohort study in Iran. Importantly, parental consanguinity was one of the predictors of TA revealed in this study. Identification of the causes of TA would prevent the birth of infants with congenital anomalies.

There are still conflicting results on thepostoperative consequences of patients with hip and femoralfractures based on the type of anesthesia. The aim of this studywas to compare mortality and morbidity of general and spinalanesthesia in patients undergoing hip and femoral fractures.

In this analytical cross-sectional study, the informationof 93 patients who had undergone hip and femoral surgery withgeneral and spinal anesthesia was studied during 2011-2019 inthe medical records by census method. Data were analyzed usingSPSS 23 software and descriptive and analytical statistics.

The general anesthesia group consisted of 29 patientsand the spinal anesthesia group included 64 patients. The twogroups were the same in terms of demographic information,preoperative hemodynamic variables, and previous medicalhistory. The results of the independent t-test with a significancelevel of 5% did not show a significant difference between thetwo groups in the following variables: mean duration of surgeryand duration of anesthesia, mean arterial pressure and heartrate after surgery, changes in blood pressure, and heart rateduring surgery, bleeding, intravenous fluids and blood productsintake, postoperative hemoglobin, number of days hospitalizedin the Intensive Care Unit and surgical ward. The mean postoperative mean arterial pressure score in the general anesthesiagroup was significantly higher than the spinal group (P=0.004).Complications and mortality after surgery did not differ betweenthe two types of anesthesia.

In general, these two methods of anesthesia do notdiffer from each other in terms of postoperative complications andmortality, and physicians can choose the appropriate anesthesiamethod according to the specific conditions of the patients

Pacemaker implantation is an effective life-long treatment in patients with atrioventricular block to generate a reliable heartbeat. Choosing between epicardial and endocardial (trans-venous) techniques in children is based on the cardiac center experience and each technique has some benefits and risks.

In this observational cross-sectional study, we reviewed file-records of 186 under 18- year-old patients who underwent cardiac pacemaker implantation due to atrioventricular block. All of endocardial implantations had been performed by experienced pediatric cardiologists and all epicardial pacemakers by experienced cardiac surgeon from 2006 to 2018 in Namazi and Faghihi hospitals in Shiraz, Iran.

One hundred and five patients had epicardial pacemaker and 81 patients had endocardial pacemaker. One hundred and seventy-eight patients had postoperative complete heart block after correction of congenital cardiac abnormality due to the destruction of conductive pathway. Eight patients were born with complete heart block. Four (2.15%) patients in the endocardial group developed pacemaker related infection. Two (1%) patients had sudden cardiac death after pacemaker insertion in the follow-up; Medtronic single chamber pacemaker was inserted for one patient who had complete heart block after surgical ventricular septal defect closure. However, a month later she expired due to sudden cardiac arrest during exercise and one patient after correction of complete atrio-ventricular septal defect had pacemaker insertion and sudden death, 3 months after pace insertion (1.12%); none of them had history of palpitation, syncope, arrhythmia in their post-operation electrocardiography, or tachycardia in their pacemaker analysis.

In Conclusion, epicardial pacemaker has a noticeable battery longevity in comparison to endocardial pacemakers and fewer valvular complications and endocarditis cases. Also, it appears that increasing size and vessel stiffness followed by aging can prime better vascular access and less lead malfunction in older pediatrics in endocardial approach; however, the site of ventricular pacing is still a puzzle because of the effect of pacing site on left ventricle synchrony and ejection fraction.

 To study the changes in quality of life (QoL) domains in breast cancer patients during the treatment and follow-up.
 
A cross-sectional study was conducted at King George’s Medical University, Lucknow, UP. Data were collected using a two-part questionnaire. In the first part, demography, disease and treatment details and related information were collected. In the second part, a validated scale developed by Ferrel for evaluating QoL of breast cancer patients was used. Over 150 patients diagnosed with breast cancer at King George Medical University, Lucknow, India (KGMU) were sampled. Baseline along with two follow-ups were done for the same patient to see the changes in QoL’s domains during treatment. Analysis of variance technique (ANOVA) was used to see the association between QoL domains and effect of treatment.
 
A total of 150 patients were interviewed and their average QoL index was built by using index number approach. Average QoL was found to be 0.3433 during baseline which mildly improved in the first follow-up to 0.3744 and more in the second follow-up to 0.419. The major reason is that 74% belonged to low economic status and occurrence of cancer further deteriorated the situation for them. During the adjuvant treatment, though it deteriorated their physical condition, hope of getting better improved psychological conditions and after nine months of treatment their both conditions improved. Major factors which affected quality of life of patients during the treatment were fatigue, pain, and fear of recurrence and spread of cancer.
 
Geographical area, socioeconomic status, education, and type of treatment, especially non-adjuvant and adjuvant therapy, significantly affect QoL among breast cancer patients. To develop a customized intervention, psychological counselling centres are the need of the hour.

The aim of the present study was to investigate behavior changes related to food hygiene and safety during Covid-19 outbreak.

In this cross-sectional study, a digital questionnaire was used to collect the data. The questionnaire consisted of 36 questions in three sections: demographic characteristics, knowledge of food hygiene during the coronavirus epidemic, and food hygiene performance before and after Covid-19 outbreaks.

675 questionnaires were completed. The ways through which foods are washed and subsequently packed, before and after the Covid-19 outbreak, have changed significantly. It was revealed that the use of dishwashing liquid, sanitizing liquid, vinegar (p<0.001), and alcohol (p=0.03) has drastically increased for washing the fruits; salt and bleach are used for washing the vegetables (p<0.05), and dishwashing liquid, sanitizing liquid and alcohol for washing egg and packaged food (p<0.001) after the outbreak. Covid-19 caused 35.5% of the participants to avoid sweetmeat, 23.7% of them did not use takeaway foods, and 21.4% of them  eliminate nuts and seeds from their diet.

According to the results of this study, people's knowledge about coronavirus transmission and food disinfection is insufficient.  Given that people's knowledge about the mentioned cases can affect the choice of food groups and the quality of people's diet, introducing valid information sources and providing  necessary training to people in the community can lead to the correction of beliefs and behaviors regarding food hygiene during the Corona outbreak.

The rapid growth of the elderly population,  challenges and the importance of mental health of the elderly, need to pay attention to mental health and the factors affecting it are inevitable. The aim of this study was to determine the predictors of mental health in the elderly with the role of social support and loneliness.
In this correlational study, 318 elderly subjects who were registered in comprehensive health centers of Bushehr were selected by simple random sampling. The study data were collected using a Perceived Social Support (MSPSS), the Revised Loneliness (UCLA) and General Health Questionnaire-28 (GHQ). Data were analyzed through SPSS 19, using the Spearman correlation and linear regression tests.
The Mean±SD of age of older adults was 66.74 ± 5.87 years.  Their Mean±SD scores of social support (families and friends) and loneliness were 43.57±7.19 (15.99 ±2.59 and 12.05 ±3.22) and 32.37 ±8.60, respectively. In explaining the variance of the mental health, the share of social support and loneliness  was 10.5 and 6.9%. The research results indicated that the friend support and loneliness with β =-0.236 and β = 0.308, respectively, had a statistically significant relationship with mental health (P <0.001).
The research results indicated that the mean score of family support was higher than other types; however, the friend support seemed to play a more effective role in improving mental health. It reminds the policymakers and health care providers, as well as families, of the need to pay attention to the friends' roles in supporting the elderly, thus reducing their loneliness and improving their mental health

Sexually transmitted infections (STIs) are one the most common infections in the world. Among them, anogenital warts and gonorrhea infections are a significant group of STIs.
We conducted this research to evaluate the prevalence of anogenital warts and gonorrhea infection and their related aspects in Iran. Still, it has a lot to know about its prevalence, trends, and risk factors.

In this cross-sectional study, 1064 patients voluntarily referred from a marriage counseling center to the  physicians in our center to evaluate STIs were enrolled in this study. All participants completed a data collection form about their sex, age, lifetime number of sexual partners, high-risk behaviors, and history of prior gonorrhea infection. They were also evaluated for anogenital warts by physical examination. The data were analyzed by SPSS 24 with Chi-square test, independent t-test, and logistic regression analysis. P-value <0.05 was considered significant.

The number of participants with current anogenital warts was 9.2% (11.9% in men and 3.5% in women). 1.1% of the participants had a documented prior gonorrhea infection, and all of these cases were men. After logistic regression analysis, there was a significant relationship between anogenital warts and gonorrhea infection and male gender (P=0.03). Also, there was a meaningful relationship between these diseases and the higher number of lifetime sexual partners (P=0.001).

Male sex and having more lifetime sexual partners are the risk factors for getting anogenital warts and gonorrhea infection.

The objective of this study was to evaluate the effectiveness of Dattilio cognitive couple therapy on interpersonal cognitive distortions in conflicting couples in Mashhad. This quasi-experimental study was conducted in 2017 and the participants included all conflicting couples  admitted to Psychology Faculty Clinic of Ferdowsi University; also, among them  28 subjects (14 couples) were randomly selected, using convenient sampling method. They were randomly divided into two groups, including  experimental  (7 couples) and control groups (7 couples). The couples in the experimental group received Dattilio Cognitive Couple Therapy for 10 sessions, each  lasting  90 minutes. The sessions were held individually in the presence of the couples. During this period, the control group did not receive any treatment. The research tools included interpersonal cognitive distortion scale (ICDS) and marital conflict inventory (CCI), implemented in pretest and posttest stages. Data were analyzed using single-variable analysis of covariance and Chi-square; the data were analyzed using  SPSS- 22 The research results revealed that interpersonal cognitive distortions as well as marital conflicts decreased significantly in the experimental group compared to those in the control group in the posttest. (P>0.05) Thus, it can be concluded that Dattilio Cognitive Couple Therapy is effective in reducing interpersonal cognitive distortions and marital conflicts of conflicting couples.

A given amino acid sequence can be encoded by a huge number of different nucleic acid sequences. These sequences, however, have proved not to be equally useful. The choice of sequence can significantly impact the expression of an encoded protein. Given the importance of protein-coding sequence and promising industrial and medicinal applications of Clostridium histolyticum collagenase, this study examined the codon optimization of the Col H gene so as to enhance collagenase expression in Escherichia coli (E. coli).
This is an experimental study in which the CDS of Col H gene was optimized according to the codon usage of E. coli, using Gene Designer software (DNA 2.0).
The results revealed that relative frequency of codon usage in Col H gene was adapted to the most preferred triplets in E. coli in such a way that codon usage bias in E. coli was enhanced after codon optimization. The higher level of collagenase expression was more likely the result of substituting rare codons with optimal codons.
The findings of this study suggest that codon optimization provides a theoretical improvement in Col H gene expression in E. coli. Nevertheless, experimental research is needed to confirm the improvement.

Specific improvements in the risk assessment of chemicals have been recently considered by many national and international expert groups. This study aimed to identify the highest occupational exposure levels in  Abadan Oil Refining Company, Iran, to benzene, toluene, ethylbenzene, and xylene (BTEX) in 2020.

This is a cross-sectional, descriptive and analytical study carried out in several units (ten units) in Abadan Oil Refining Company. Air sampling and BTEX analysis were conducted according to NIOSH method number 1501. To determine the risk of exposure to BTEX pollutants, we used the method proposed by the Department of Occupational Safety and Health of Malaysia. Then, the hazard rate, exposure rate, and health risk level caused by exposure to chemicals were determined. Spss20 software was used to analyze the data.

The results showed the employees studied in this research were exposed to the pollutants of BTEX during their work. Comparing total BTEX concentrations with the recommended standard level showed that BTEX concentrations in Abadan Oil Refining Company Workers’ breathing zone were lower than the TLV-TWA recommended by ACGIH; also, the findings of this risk assessment study showed benzene had the highest risk ranking in seven operating units and a low risk ranking in three other units. Moreover, toluene, ethylbenzene, and xylene had a very low risk in all operating units.

Corrective and preventive measures should be taken to eliminate or minimize the exposure rate due to the significant effects of benzene exposure.

Coronavirus (COVID-19) was first developed in Wuhan, China in December 2019 and spread rapidly around the world (1, 2). In late January 2020, the disease was recognized as the sixth international public health emergency (3). The infection is transmitted from person to person through respiratory secretions and contact with surfaces or people (4). In general, infectious diseases constantly threaten human health; especially if they are new, because they are always a potential challenge for the healthcare system around the world (5). Health personnel, like other infectious diseases, are at the forefront of the fight against coronavirus. A high percentage of these personnel work night shifts with high workload (6). Work-related stress, lack of sleep, and shift work in health care personnel cause sleep disorders and poor sleep quality (7). Sleep is a specific behavior and each person is aware of its importance and its appropriate duration, and is rotated by waking up. Also, one of the most important parameters in assessing the quality of life and health status of each person is the quality of sleep (8). Sleep is a key factor in a person's physical health and related disorders including poor sleep quality, difficulty sleeping at night, waking up early, circadian rhythm disorders, parasomnia, sleep-related movement disorders, and sleep-related respiratory disorders (9). Sleep disorders are physical and mental conditions that cause adverse effects due to poor sleep quality (10). Sleep disorders have many negative effects on people's lives and lead to physical complications such as increased risk of obesity, diabetes, high blood pressure, increased heart rate, heart attack, and stroke (11). Therefore, during the COVID-19 epidemic and with the increase of work pressure in health care workers, there is a possibility of increasing sleep disorders and consequently increasing physical diseases. Healthcare personnel are the most important group in dealing with the COVID-19 epidemic; therefore, increasing the number of medical staff and reducing the number of work shifts can relieve fatigue and maintain energy levels in them and reduce physical complications in them. Among the treatment methods for insomnia, we can mention medication; however, because sedatives have side effects such as drowsiness and decreased accuracy, they are not recommended for people such as nurses who always need full alertness during their shift; instead, non-pharmacological therapies such as relaxation techniques can be used. Because relaxation is a relative state of relief from the mental and physical effects of stress which can improve the sleep quality by regulating the hypothalamus and reducing sympathetic and parasympathetic functions (12). The progressive muscle relaxation technique introduced and used by Jacobsen is an easy, cost-effective method without the need for special equipment; it is one of the best complementary therapies to reduce the effects of mental illness such as anxiety because people in this method, by contracting and relaxing a specific muscle, cause relaxation in different target muscles and increase concentration and pleasant emotions (13). In order to improve working conditions, it is also suggested that the chronobiological characteristics of individuals should be considered when planning work shifts and classifying individuals accordingly. This type of chronotype classification is a simple method and takes into account issues such as individual circadian differences, sleep habits and performance on a particular day, and ultimately helps to plan work shifts based on these chronobiological characteristics (14). Another suggestion that can be made in this regard is physical activity because physical activity promotes physical and mental health with the biological and biochemical changes that follow. As a result, they improve the quality of sleep. In addition, physical activity, if repeated frequently, reduces the risk of physical illnesses such as cardiovascular disease, cancer, diabetes, and hypertension by boosting the immune response in the body (15).