Excess deaths during the COVID-19 pandemic in Iran

COVID-19 burden in Iran: disability-adjusted life years analysis from hospital data, 2020-2021

BACKGROUND

The burden of disease based on disability-adjusted life years (DALYs) is one of the internationally accepted metrics for assessing the impact of a disease or injury on population health. This study aimed to provide evidence of the burden of COVID-19 on health in Iran based on hospital-level data from the Iran Health Insurance Organization (IHIO), which covers almost half of the country's population.

METHODS

The data of all IHIO enrollees who were referred to hospitals across the country from the beginning of the COVID-19 pandemic (February 2020) to December 30, 2021, with assigned diagnosis codes of COVID-19, were extracted from the hospital information processing system. The DALYs due to COVID-19 were estimated using the standard approach of the World Health Organization and the European Burden of Disease Network guideline.

RESULTS

In the years 2020 and 2021, among a population of about 42 million people, 1,040,367 individuals were admitted to the hospital due to COVID-19 infection, of whom 73% were hospitalized (760,963 patients). The total estimated DALYs for these two years were 665,823 and 928,393, respectively (1,603 and 2,234 per 100,000 population). 99.7% of DALYs were attributed to years of life lost due to premature death (YLLs). The share of the disease burden in the age groups of under 20 years, 20-49 years, 50-80 years, and over 80 years was 6.6%, 26.4%, 58.4%, and 8.6%, respectively.

CONCLUSIONS

Based on the hospital-level data estimates, COVID-19 has had a significant burden on health in Iran. COVID-19 was identified as the fifth leading cause of disease burden in Iran during the study period, ranking after cardiovascular diseases, psychological disorders, neoplasms, and musculoskeletal disorders. Additionally, COVID-19 was the third major cause of death, following cardiovascular diseases and neoplasms. Policymaking and the implementation of comprehensive programs to enhance the response of the health system and society to outbreaks of emerging and re-emerging infectious diseases are of utmost importance.

Effect of educational intervention based on protection motivation theory on preventive behaviors of respiratory infections among hospital staff

Background

Hospital staff represent a vulnerable population for respiratory diseases. Consequently, the implementation of training programs becomes imperative as a preventive measure against such infections in these populations. The current study was conducted to examine the impact of an educational intervention based on the Protection Motivation Theory (PMT) on preventive behaviors for respiratory infections among a group of hospital staff.

Methods

This experimental study involves a sample of 150 hospital staff from Gachsaran City, Iran, in 2021-2022. The sampling technique involved the utilization of a random assignment approach to allocate individuals into two distinct groups: the experimental group, consisting of 75 participants, and the control group, also including 75 individuals. The data collection instrument was a questionnaire designed in accordance with the PMT. This questionnaire was administered to both the experimental and control groups prior to the intervention as well as two months following the intervention. The intervention program consisted of a total of five sessions, each lasting for 60 min, for the experimental group. These sessions were conducted on a weekly basis over a period of two and a half months. Specifically, there were two sessions held every month and one session held every two weeks. Following the completion of the program, the data was entered into SPSS-24 statistical software for analysis using paired t-tests, independent t-tests, and chi-square tests.

Results

The results indicated that prior to the intervention, there was no significant difference between the two groups in terms of perceived vulnerability constructs (p = 0.25), perceived severity (p = 0.63), perceived response (p = 0.32), and perceived reward (p = 0.11). Besides, there was no considerable distinction in perceived self-efficacy (p = 0.84), perceived response cost (p = 0.33), fear (p = 0.45), behavior motivation (p = 0.51), knowledge (p = 92), or vaccination behavior (p = 0.12) before the educational intervention. However, a significant change was noticed in each of the mentioned variables between the two groups after the intervention (p < 0.05).

Conclusion

The results of this study indicated that the implementation of an educational intervention grounded in the PMT yields positive outcomes in enhancing preventative behaviors pertaining to respiratory infections. Hence, it is recommended to utilize an intervention grounded in this theory among hospital staff as a viable approach to mitigating the occurrence of respiratory infections.

Exploring nationwide policy interventions to control COVID-19 from the perspective of the rapid learning health system approach

Introduction

The health systems needed to improve their learning capacities during the COVID-19 pandemic. Iran is one of the countries massively struck by the pandemic. This study aimed to explore whether and how the policy interventions made by Iran's policymakers at the national level to control COVID-19, could improve the rapid learning characteristics of the health system.

Methods

A guide to clarify rapid learning health system (RLHS) characteristics was developed. The guide was used by two independent authors to select the policy interventions that could improve RLHS characteristics, then, to analyze the content of the selected policy interventions. In each stage, results were compared and discussed by all three authors. Final results were presented based on different RLHS characteristics and the potential mechanisms of contribution.

Results

Five hundred policy interventions were developed during the first 7 months of the outbreak. Thirty-one policy interventions could potentially improve RLHS characteristics (6.2%). Two characteristics, such as the timely production of research evidence and the appropriate decision support were addressed by selected policy interventions. Policies, that could improve learning capacities, focused on decision-maker groups more than user groups or researcher groups.

Conclusions

Most of the developed policy interventions during the first months of the epidemic did not address the learning capacities of the health system. To improve health system functions, improving RLHS characteristics of the health system, especially in patient-centered and data linkage characteristics, is recommended.

The impact of psychological distress, socio-demographic and work-related factors on coping strategies used by nurses during the COVID-19 pandemic: A cross-sectional study

AIM

This study aimed to determine factors associated with coping strategies used by nursing staff during the COVID-19 pandemic in Iran.

DESIGN

Cross-sectional study.

METHODS

A convenience sample of 365 nurses were selected from referral hospitals for COVID-19 patients in Tabriz, Iran between February 2022 and July 2022. An online self-administered questionnaire was distributed through social media platforms, including WhatsApp and Instagram. The survey package included a modified Brief COPE scale, socio-demographic and work-related questions, and a measure of psychological distress. Multiple regression analysis examined associated factors with coping strategies in SPSS. The study adhered to the STROBE guidelines for reporting.

RESULTS

The mean age of participants was 31.2 (7.3) years old. Of the 365 participants, 209 (58.9%) used maladaptive coping strategies, and 214 (57.6%) reported experiencing psychological distress. Psychological distress was the strongest predictor of maladaptive coping strategies (β = 4.473, p < 0.001). Female nurses (β = 3.259, p < 0.05), nurses who were under 35 years of age (β = 3.214, p < 0.05), nurses with fewer than ten years of experience (β = 2.416, p < 0.001), those who worked in COVID-19 ICUs (β = 4.321, p < 0.001), floor nurses (β = 2.344, p < 0.001), and those who worked two or more years in COVID-19 settings (β = 3.293, p < 0.001) had higher mean scores in maladaptive coping strategies.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contributions.

COVID-19 and Biopolitics: An Essay on Iran

In the intricate tapestry of Iran's geopolitical, cultural, and economic landscape, the COVID-19 pandemic catalysed profound changes. This essay delves into the multifaceted impact of the pandemic on Iranians' lives, dissecting the specific nuances shaped by the complex biopolitical environment. We unravel the subtle imprints of COVID-19 on the biopolitical discourse, exploring how it intricately intertwines with daily life, social interactions, and the nation's health system.

Complicated grief and related factors among nursing staff during the Covid-19 pandemic: a cross-sectional study

BACKGROUND

The challenging working conditions during the Covid-19 pandemic created a perfect storm that can seriously impact nurses' physical and psychological well-being. Our study aimed to investigate complicated grief and its related factors among nursing staff during the Covid-19 pandemic.

METHODS

This is a cross-sectional study. The participants comprised 375 nurses selected by the convenience sampling method from designated wards for patients with Covid-19 in 3 hospitals in Tabriz, Iran. Participants completed a survey containing demographic and clinical questions, the Inventory of Complicated Grief, and the Multidimensional Scale of Perceived Social Support. Multiple regression analysis was used to identify the associates of nurses' grief. The STROBE guidelines were followed in reporting the study's findings.

RESULTS

A significant proportion of participants (57.6%) were found to be suffering from complicated grief. Gender, educational background, type of ward, type of nursing role, type of working shift, years of nursing work experience, and experience working in the Covid-19 settings remained the significant associates of nurses' grief in the regression analysis.

CONCLUSION

Due to frequent exposure to patients' deaths, healthcare providers are at increased risk of suffering from complicated grief during the Covid-19 and post-pandemic. If it remains unresolved, complicated grief can result in significant health problems and the experience of burnout among nurses. Governments, health authorities, and nursing managers should support nurses who work in Covid-19 settings to reduce the adverse impact of the pandemic on nurses' health and well-being.