Iranian First-Line Health Care Providers Practice in COVID-19 Outbreak

Prevalence of and risk factors for infectious disease syndromic symptoms among pilgrimage to Arba'een mass gathering religious in 2023

Background

There is a growing participation of Shia Muslims, in the Arba'een pilgrimage every year. It is imperative to conduct a comprehensive study on the transmission of diseases among Arba'een pilgrims in order to identify and promptly respond to potential epidemics effectively. We aimed to assess the syndromic symptoms associated with infectious diseases and the prevalence of mask usage among patients visiting outpatient clinics during the Arba'een pilgrimage in Ira, in 2023.

Methods

In this descriptive-analytical study, 300 outpatients who sought medical care at outpatient clinics during the Arba'een pilgrimage were randomly selected. The study data and infectious disease syndromic symptoms were assessed using trained healthcare professionals. A multiple logistic regression analysis was carried out to estimate the crude and Adjusted odds ratios (AORs) of symptoms and risk factors associated with respiratory syndrome and flu-like symptoms with 95 % confidence intervals.

Results

The mean age of the participants was 39 years and 61 % of those were male. Out of 72 (24 %) of mask users, 41.6 % had changed masks in less than 8 h. The most common syndromic symptoms was Flu-like illness (53 %). In the final analysis, not wearing a mask AOR = 1.40 (1.1-9.8) and smoking AOR = 3.25 (1.1-9.5) both elevated the risk of the flu-like syndrome and severe respiratory disease symptoms.

Conclusions

Pilgrims are especially vulnerable to the flu and other respiratory illnesses. Therefore, performing a differential diagnosis in these people, including flu and COVID-19, is essential to prevent an outbreak during the Arba'een pilgrimage.

Risk factors for diarrheal diseases among pilgrims during Arba'een mass gathering: a case-control study

BACKGROUND

A significant portion of the Muslim community participates in the Arba'een pilgrimage, with participant numbers increasing each year. There have been relatively few studies on the health of Arba'een Mass gathering (MG). Researching the prevalence and distribution of diseases among Arba'een pilgrims is essential to recognize any outbreaks and take timely responses to contain them. The current study aimed to identify exposures and risk factors for diarrheal disease in pilgrims who referred to the clinics located in Iraq among the Arba'een MG in 2023.

METHODS

This case-control study randomly selected 200 outpatients (100 cases and 100 controls) who were referred to Iraq clinics. Cases were patients with gastrointestinal symptoms (diarrhea), while controls were randomly selected from unaffected pilgrims at the same time for the cases. The study groups matched for age, and sex. Face-to-face interviews using a reliable field based checklist of the Center for Disease Control and Prevention of Iran's Ministry of Health to collect potential exposures and risk factors for diarrheal disease. Multiple logistic regression was used to estimate the crude and adjusted odds ratio (AOR) for the risk of diarrhea with a 95% confidence interval (CI).

RESULTS

The average age of the participants was 38.6 years. Diarrhea in 100% and fever in 81% were the most common clinical symptoms in patients. Having underlying diseases was not associated with an increased risk of diarrhea disease (P > 0.05). Regarding risk factors for diarrheal, the final analysis after adjusting for potential confounders indicated that consumption of insanitary (unpackaged) drinking water (AOR = 1.95; 95% CI: 1.05-3.6; P = 0.024), inappropriate hand washing (AOR = 3.82; 95% CI: 1.7-8.6; P = 0.001), ritual foods (AOR = 2.56; 95% CI: 1.3-5.2; P = 0.004), and public toilets (AOR = 1.46; 95% CI: 1.04-4.3; P = 0.038) were significantly increased the likelihood of diarrheal disease.

CONCLUSIONS

Contamination of water sources, food, inadequate and poor hand washing were the most common sources of diarrheal diseases among Arba'een pilgrims. The results indicate that the potential occurrence of outbreaks, especially water- and foodborne diseases, threatens participants in the Arba'een MG. It is recommended to provide risk assessment, improve pilgrims' awareness, pre-and post-screening, vaccination, compliance with personal hygiene, improvement of the environment, provision of sanitary water and food sources and hygienic disposal of sewage, laboratory diagnosis to identify the common types of pathogens in Arba'een MG.

An evaluation of the quality care for type 2 diabetes patients in the primary healthcare using the lot quality assurance sampling technique

BACKGROUND

Diabetes is the most prevalent metabolic disease globally. Correct and effective healthcare management requires up-to-date and accurate information at the local level. This level of information allows managers to determine whether the health system has achieved its desired goals in this area. This study aimed to evaluate the adequacy and quality of care for Type 2 diabetes mellitus (T2DM) patients using the Lot quality assurance sampling (LQAS) technique to provide evidence for decision-making at the local level, prioritizing and allocating resources.

METHODS

A descriptive-analytical study was conducted in 12 supervision areas (SAs)/health facilities in northwestern Iran involving 240 patients with T2DM in primary health care. The selection of patients and determination of SAs were done randomly using the LQAS technique. Glycated Hemoglobin (HbA1c) was used to evaluate patients' blood sugar control in each SA. Multiple linear regression analysis was used to estimate predictors of HbA1c in T2DM.

RESULTS

The overall average of HbA1c value was 7.84%. The HbA1c level was > 7% in 148 (61.6%) of the patients. Among the 12 SAs, the LQAS identified unacceptable quality of care in 5 SAs. In the final analysis, each unit increase in fasting blood sugar (FBS), High-density lipoprotein (HDL), Low-density lipoprotein (LDL), and Thyroglobulin (TG) values resulted in an increased in HbA1c levels by 0.43, 0.183, 0.124, and 0.182 times, respectively. However, with a one-unit increase in the care of a family physician and nutritionist, along with regular physical activity, HbA1c levels decreased by - 0.162, -0.74, and - 0.11 times, respectively.

CONCLUSIONS

The quality of care for diabetic patients needs improvement in some SAs. Findings indicated that the LQAS technique effectively identifies centers/areas with substandard diabetes care quality and efficiently allocates resources to those in need. It is recommended to implement corrective measures in areas with inadequate care quality.

The global case fatality rate due to COVID-19 in hospitalized elderly patients by sex, year, gross domestic product, and continent: A systematic review, meta-analysis, and meta-regression

Background

Although elderly people are at a huge risk of mortality due to COVID-19, the Case Fatality Rate (CFR) in hospitalized elderly patients is poorly investigated. This meta-analysis and meta-regression aimed to generate pooled CFR due to COVID-19 in hospitalized elderly patients by sex, Gross Domestic Product (GDP), year, and continent and also to explain the potential source of the heterogeneity and variations in the pooled estimation of COVID-19 CFR.

Methods

We systematically searched PubMed, Scopus, Web of Science, CINAHL, and Embase up to 31 July 2022. Eligibility assessment of records was performed independently in a blinded, standardized way by two reviewers. Meta-analysis and Meta-regression analysis were carried out to estimate pooled CFR and the potential sources of the heterogeneity.

Results

The study included 5683 confirmed hospitalized elderly COVID-19 patients, 1809 deaths, and 19 original articles from 10 countries. The pooled estimate of the overall CFR, and by male and female sexes were 29%, 34%, and 24%, respectively. We found CFR was decreased by increasing female sex proportion, GDP, and year of publication. Multivariate meta-regression analysis indicated that the age and sex of patients, continent, GDP, and year of the publication together explained the majority of the heterogeneity and variations in the pooled estimate of the hospitalized elderly COVID-19 CFR.

Conclusions

This review provided reliable pooled CFR measures for hospitalized elderly patients with COVID-19. Although COVID-19 fatality has decreased in hospitalized elderly patients over time, it is still high in hospitalized elderly patients and needs advanced treatment support.

Early marriage, stressful life events and risk of suicide and suicide attempt: a case-control study in Iran

BACKGROUND

Early Marriage (EM) and associated Stressful Life Events (SLEs) and consequences such as psychological and physical well-being issues can lead to suicide and suicide attempts (SA). The study aimed to investigate the risk of suicide and SA among early married people who experienced SLEs.

METHODS

A case-control study was conducted based on the registry for suicide in Malekan county in Iran during 2016-18. Cases included 154 SAs and 32 suicides. Simultaneously, 201 outpatients from the emergency department were chosen as controls. Holms and Rahe life event questionnaire was used to assess SLEs. Sub-group analysis (Mantel-Haenszel) by sex and age groups and multiple logistic regression were used to calculate adjusted Odds Ratios (ORs) with 95% Confidence Intervals (CIs) for the association between EM and suicide risk after adjusting for the potential confounders.

RESULTS

The proportion (female vs male) of EM among suicides, controls, and SAs was 31.25% (18.7 vs 12.5%), 15.92% (11.9 vs 4.0%), and 13.0% (11.7 vs 1.3%), respectively. In subgroup analyses by sex, EM was associated with an increased risk of suicide in both females and males 2.64 and 2.36 times, respectively. Likewise, subgroup analysis by age groups revealed that EM increased suicide risk in subjects aged 10-15 years, while no association was found for age groups of 26-40 and > 40. After adjusting for the potential confounders, EM (OR: 3.01; 95% CI: 1.15 -7.29), financial problems (OR = 4.50; 95% CI: 1.83 -9.07), and family problems (OR = 2.60; 95% CI: 1.19-9.59), were associated with an increased risk of suicide. However, no association was found between EM, various types of SLEs, and the risk of SA.

CONCLUSIONS

We found EM and SLEs were correlated with suicide risk, while no evidence found that EM increased the risk of SA. Progress in reducing EM and addressing its serious consequences can occur by a stronger political commitment and by sharing the experiences and voices of the early married. Our study provided preliminary findings to guide future studies; however, methodological and longitudinal studies are needed to understand and address the effect of EM on suicidal behaviors.

Psychological adverse effects of COVID-19 pandemic on health service providers: an online survey

Background

Results

Conclusions

Interferon-beta offers promising avenues to COVID-19 treatment: a systematic review and meta-analysis of clinical trial studies

Severe acute respiratory syndrome coronavirus 2 principally weakens the hosts’ innate immune system by impairing the interferon function and production. Type I interferons (IFNs) especially IFN-β are best known for their antiviral activities. IFNs accompanied by the standard care protocols have opened up unique opportunities for treating the coronavirus disease 2019 (COVID-19). The databases including PubMed, SCOPUS, EMBASE, and Google Scholar were searched up to October 30, 2020. The primary and secondary outcomes were considered discharge and mortality, respectively. The abovementioned outcomes of standard care protocol were compared with the standard care plus IFN-β in the confirmed COVID-19 patients. Out of 356 records identified, 12 randomized clinical trial studies were selected for full-text screening. Finally, 5 papers were included in the systematic review and 3 papers in the meta-analysis. The average mortality rate was reported as 6.195% and 18.02% in intervention and control groups, respectively. Likewise, the median days of hospitalization were lower in the intervention group (9 days) than the control group (12.25 days). According to meta-analysis, IFN-β was found to increase the overall discharge rate (RR = 3.05; 95% CI: 1.09–5.01). Our findings revealed that early administration of IFN-β in combination with antiviral drugs is a promising therapeutic strategy against COVID-19.