ABSTRACT
OBJECTIVES@#Previous studies have estimated the risk of death associated with unemployment in the coronavirus disease 2019 (COVID-19) pandemic, but no studies have examined unemployment before COVID-19 infection as a risk factor for COVID-19-related mortality. Thus, this study aimed to investigate COVID-19 mortality among this population. @*METHODS@#Data on 50,038 people aged 25-59 years were collected from 38 agencies in Fars Province, Iran, from February 2020 to July 2021. Follow-up lasted from participants’ diagnosis with COVID-19 based on the results of a reverse transcription-polymerase chain reaction test to participants’ death or the end of the study period. The association between unemployment and COVID-19-related mortality was estimated using the Poisson regression method, and a sensitivity analysis was conducted to calculate the E-value. @*RESULTS@#Unemployment was associated with a 2.41-fold (95% confidence interval [CI], 2.01 to 2.90) higher age-adjusted and sex-adjusted risk of COVID-19-related mortality. The adjusted Poisson regression analysis showed 8.82 (95% CI, 6.42 to 12.11), 2.84 (95% CI, 1.90 to 4.24), and 1.58 (95% CI, 1.24 to 2.01) times higher risks of COVID-19-related mortality among unemployed people aged 25-39 years, 40-49 years, and 50-59 years, respectively, than among their employed counterparts. Unemployment increased the risk of COVID-19 mortality by 3.31 (95% CI, 2.31 to 4.74) and 2.30 (95% CI, 1.86 to 2.84) times in female and male, respectively. The E-value was 3.43, reflecting the minimum strength of confounding required to shift the association between unemployment and COVID-19-related mortality toward the null. @*CONCLUSIONS@#Unemployment prior to COVID-19 infection increased the risk of COVID-19-related mortality. COVID-19-related mortality disproportionately impacted unemployed women and younger unemployed people.
ABSTRACT
Background: One of the important aspects of hospital preparedness in disasters is implementing early warning system. In this study, the performance of this function was evaluated under the monitoring of disasters workgroup of the Ministry of Health [MOH] based on the national program of "hospitals preparedness in disasters" in Shahid Motahari Hospital
Materials and Methods: This is an interventional study, with a quasi-experimental pre-test and post-test design. This hospital was chosen by MOH as a benchmark for implementing the national disaster programs. The data collecting instrument was the hospital disaster preparedness checklist which evaluates 9 indexes of "command and control," "communications," "safety and security," "triage," "increasing capacity," "continuity of critical services," "human resources," "logistics and supply management," and "recovery after disasters." Data of pretest and posttest were analyzed through nonparametric Wilcoxon test, using SPSS software, version 16
Results: The preparedness score before the intervention was 134, which represents the moderate level of hospital preparedness. The evaluation before and after the intervention indicated that "recovery after disaster" and "triage" had the least change with an increase of one score and the index of "logistics and supply management" had the maximum increase by 5 scores. The overall score of preparedness significantly increased from 134 to 159 [P<0.05] after the intervention, which represents a change from moderate to high hospital preparedness
Conclusion: The preparedness of Shahid Motahari Hospital, which is the only specialized hospital of Tehran in burns, has significantly increased and reached a level of high preparedness to deal with disasters. This study indicates the importance of developing the activation of early warning system in hospitals for rapid and appropriate response to the disasters
ABSTRACT
Prehospital Emergency Medical System is one of the critical parts in health care sector which has been usually unnoticed. Delivering quick, efficient and high quality care in this system has a large impact on mortality and morbidity of patients. In this descriptive and cross-sectional study, 20662 cases in 4 months in the middle of the year 2008. Missions over 8 minutes from when the time of call receiving to arrival on the scene were detected and survived For statistical analysis ANOVA was used. Most of the missions were done between 8 to10 minutes. Nine reasons were detected for this arrival delay:1] destruction of the road, 2] Traffic, 3] Rainy weather, 4] Long way to the scene, 5] Scarcity of ambulance in the center near the scene, 6] Wrong address, 7] Cannot find the address, 8] Delay in dispatching the ambulance, 10] Delay in arrival because of technicians. In Shiraz Emergency Medical system the most important reasons for missions over 8 minutes were scarcity of ambulance in the center near the scene, traffic, long way to the scene. Quick arrival on the scene has a large effect on patients, though, health ministry and emergency centers should pay more attention on this sector and deliver financial support for equipped emergency centers due to the population and demand for emergency centers.