The impact of COVID-19 pandemic on hospital admissions for nine diseases in Iran: insight from an interrupted time series analysis.

BACKGROUND: Associations between the COVID-19 pandemic and hospitalizations have not been studied Iran. This study aimed to examine the impact of the COVID-19 pandemic on hospital admissions for nine categories of disease in seven public hospitals in Kermsnahah city, the capital of Kermsnahah province, in the west of Iran. METHODS: Data on monthly hospitalization rates (number of hospitalizations per 100,000 population) were collected for nine categories of disease for a period of 40 months (23 months before and 17 months after the COVID-19 outbreak in Iran) from the health information systems of all seven public hospitals in Kermanshah city. Categories of disease included those related to pregnancy, childbirth and the puerperium period, neoplasms, diseases of the digestive, respiratory, circulatory, genitourinary and nervous systems, mental and behavioural disorders, and infectious and parasitic diseases. Population data were extracted from the Statistics Centre of Iran. An interrupted time series analysis with segmented regression was used to examine the impact of COVID-19 on hospital admissions. FINDINGS: Average monthly hospitalization rates fell for all nine categories of disease included in the study after the onset of the pandemic, with overall rates of 85.5 per 100,000 population in the period before the COVID-19 outbreak and 50.4 per 100,000 population after the outbreak began. The relative reduction in hospitalizations for the nine diseases was 56.4%. Regression analysis of monthly data indicated a sharp decrease in hospitalisations during the first month after the COVID-19 outbreak, which was statistically significant for all diseases (p < 0.001). After the initial reduction following onset of the pandemic, significant increases were observed for some diseases, including neoplasms (increase of 3.17 per 100,000 population; p < 0.001), diseases of the digestive system (increase of 1.17 per 100,000 population; p < 0.001) and diseases related to pregnancy, childbirth and the puerperium period (increase of 1.73 per 100,000 population). For other categories of disease, rates significantly declined, including infectious and parasitic diseases (decrease of 2.46 per 100,000 population; p < 0.001). Hospitalization rates did not increase to pre-pandemic levels for any disease, with the exception of those related to pregnancy, childbirth and the puerperium period. CONCLUSIONS: Our study indicated that the COVID-19 pandemic had a significantly negative effect on hospitalizations in Iran. Although use of hospital care has gradually increased post-outbreak, it has yet to return to normal levels.

Identifying the determinants of non-injection of covid-19 vaccine: A qualitative study in Urmia, Iran

Objective Extensive vaccination coverage is one of the most effective ways to control COVID-19 vaccine, but the tendency to inject the vaccine is always hampered and there are various determinants of non-injection. Hence, the present study was done with the aim of identifying the determinants of non-injection of COVID-19 vaccine with a qualitative approach in the city of Urmia in Iran. Methods The present study was conducted with a qualitative approach and conventional content analysis method among 36 people who refused to be vaccinated. Access to participants and data collection was done in person (28 interviews) and online (8 interviews) through targeted sampling and snowball method and semi-structured interviews. Data management was performed using MAXQDA-2018 software and its analysis was performed by Graneheim and Lundman method. Also, Guba and Lincoln criteria were observed to improve the quality of results. Results After analyzing the data, 3 main categories and 11 subcategories were obtained including (1) Individual factors (fear of short-term side effects of vaccine, personality traits, distrust of vaccines and pharmaceutical companies), (2) Socio-cultural factors (conspiracy theory, social learning, misconceptions about COVID-19, fatalism), legal and managerial factors (incomplete information, difficult and irregular access to vaccination centers, lack of restrictions and compulsion to be vaccinated, lack of incentives to be vaccinated). Conclusion The results showed that various determinants were involved in the non-injection of COVID-19 vaccine. Therefore, efforts to increase vaccination coverage require comprehensive measures at different levels and cross-sectoral cooperation between governmental and non-governmental institutions and organizations.

Explaining the challenges and adaptation strategies of nurses in caring for patients with COVID-19: a qualitative study in Iran.

BACKGROUND: Nurses, as the primary human resource in the fight against COVID-19, encounter several obstacles and concerns. As a result, the current study used a qualitative method to describe the problems and adaptation techniques of nurses caring for COVID-19 patients. METHODS: The current study used a qualitative conventional content analysis technique with 30 nurses working in COVID-19 wards in Tehran hospitals. Purposive sampling, snowball sampling, and semi-structured interviews were used to get access to participants and gather data. The data was examined using conventional qualitative content analysis and the MAXQDA-18 program. To assess the quality of study findings, Guba and Lincoln's trustworthiness criteria were fulfilled. RESULTS: The data analysis revealed two main categories and sixteen subcategories: (1) experiences and challenges (lack of protective equipment, high work pressure, marginalized physical health, problems related to the use of protective equipment, being excluded, a lack of a supportive work environment, problems related to patients, psychological problems, fear, marginalized personal and family life, and the challenge of communicating with patients' families); and (2) adaptation strategies for work conditions (performing religious-spiritual activities, creating an empathetic atmosphere in the workplace, spiritualizing their work, trying to convince the family and gaining their support, and strengthening their sense of self-worth and responsibility). CONCLUSION: Nurses' working conditions can be improved by providing adequate protective equipment, a suitable work environment, and more social and financial support; paying more attention to nurses' physical and mental health; and considering appropriate communication mechanisms for nurses to communicate with their families and patients' families.

Social Determinants of Adherence to COVID-19 Preventive Guidelines in Iran: A Qualitative Study.

INTRODUCTION: Adherence to COVID-19 preventative guidelines may be influenced by a variety of factors at the individual, societal, and institutional levels. The current study sought to investigate the social factors of adherence to those preventive measures from the perspective of health professionals. METHODS: In October 2020, we performed qualitative research in Tehran, Iran, using the directed content analysis method. For the preparation of our interview guide and data analysis, we employed the WHO conceptual framework of socioeconomic determinants of health. Semi-structured interviews were conducted with 15 health professionals and policymakers who were chosen using a purposive sampling approach. MAXQDA-18 software was used to analyze the data. The Goba and Lincoln criteria were used to assess the quality of the results. RESULTS: There are 23 subcategories and 9 categories, which include socio-economic and political context (unstable macroeconomic environment, poor management of the pandemic, media and knowledge transfer), cultural and social values (fatalism, cultural norms, value conflicts, social customs), socio-economic positions (livelihood conditions), social capital (social cohesion, low trust), living conditions (housing conditions), occupational conditions (precarious employment), individual characteristics (demographic characteristics, personality traits, COVID-19 knowledge, and attitude), psycho-social factors (normalization of the disease, social pressure, and stigma), and health system leadership (health system problems, not taking evidence-based decisions, non-comprehensive preventive guidelines, non-operational guidelines, inadequate executive committee) were obtained. CONCLUSION: To limit the new COVID-19 transmission, people must be encouraged to follow COVID-19 prevention instructions. Improving adherence to COVID-19 preventive guidelines necessitates dealing with the complexities of responding to social determinants of those guidelines. Increasing public health literacy and knowledge of COVID-19, informing people about the consequences of social interactions and cultural customs in the spread of COVID-19, strengthening regulatory lockdown laws, improving guarantees for adhering to preventive guidelines, providing easy access to preventive supplies, and strengthening financial support for households with precarious employment are all important.

Lived Experiences and Challenges of the Families of COVID-19 Victims: A Qualitative Phenomenological Study in Tehran, Iran.

Being COVID-19 positive and then dying causes a slew of personal, familial, and social issues for family members. Therefore, the current study was carried out to analyze the lived experiences and issues of COVID-19 victims' families in Tehran, Iran. The phenomenological approach was used in the qualitative analysis of 21 first-degree relatives of COVID-19 victims. From August 22 to October 21, 2020, data was gathered by phone (4 people) and in-person (17 people) using semi-structured interviews. The subjects were chosen through purposeful and snowball sampling. The MAXQDA-2018 program was used to organize the data, and the Colaizzi analytical technique was used to analyze it. Guba and Lincoln's criteria were also used to assess the findings' quality. After analyzing the data, 2 main categories and 14 subcategories were extracted, including (1) challenges in caring for a COVID-19 patient (being rejected, limited access to medical facilities, dissatisfaction with the behavior of medical staff, disruption of family life, the challenge of managing family members' behavior with the patient, and living with doubts and worries (2) challenges after a COVID-19 patient's death (incomplete farewell to the corpse, unbelievability of the death, ambiguity and tension in the burial process, lonely burial, the twinge of conscience, worry about not respecting the deceased, incomplete condolences, and abandonment). The troubles of victims' families can be ameliorated by developing the skills of caring for COVID-19 patients at home, providing medical and psychological services to families before and after the patient's death, appropriately informing the families to guarantee them about dignity and respect and respect of the deceased at the interment, and developing a culture of virtual condolence to provide emotional support to survivors.

Explaining Experiences, Challenges and Adaptation Strategies in COVID-19 Patients: A Qualitative Study in Iran.

OBJECTIVE: Getting COVID-19 makes a person confront numerous individual, physical, psychological, family and social challenges. Therefore, the present study was conducted to explain the experiences, challenges and adaptation strategies in patients with COVID-19 in Tehran, Iran. METHODS: The present study was performed with a qualitative approach and phenomenological method among 33 patients with COVID-19. From July 20 to September 21, access to participants and data collection were done in person (15 people) and by phone (18 people) through targeted sampling and snowball and semi-structured interviews. Data management was carried out using MAXQDA-2018 software and its analysis was done by the Colaizzi analysis method. Guba and Lincoln's criteria were also observed to improve the quality of results. RESULTS: After analyzing the data, two main categories and 17 subcategories were obtained, including (1) experiences and challenges (ignoring the disease, blaming, physical health disorders, mental problems, guilt, and remorse, being blamed, living a life of disappointment and ambiguity, emotional challenges, frustrating reactions from others, helplessness and limitation) and (2) disease adaptation strategies (spirituality, learning about COVID-19, doing valuable and fun activities, participating in treatment, strengthening one's spirit and hope, trying to make up for past mistakes and virtual communication). CONCLUSIONS: Based on the results, interventions and policies such as increasing people's health knowledge and literacy to get acquainted with the symptoms of the disease and prompt referral for diagnosis and treatment, teaching stress and psychological pressure management techniques, instructing families to continue emotional and social support for patients and strengthening and reproducing the strategies patients use, along with teaching disease coping skills, harnessing the potential of cyberspace and the media can make it easier to tolerate illness and get back to life.

Social determinants of adherence to COVID-19 preventive guidelines: a comprehensive review.

Adherence to coronavirus disease 2019 (COVID-19) preventive guidelines (ACPG) is an important strategy to control the COVID-19 pandemic effectively. The present study aimed to identify and summarize the social determinants of ACPG among the general population. A comprehensive review was performed from December 2019 to February 2021 through searching electronic databases. Two independent reviewers assessed and selected relevant studies. Next, the characteristics and main findings of the included studies were summarized. Finally, the World Health Organization's conceptual framework of social determinants of health was used to synthesize the identified social determinants of ACPG. Forty-one of 453 retrieved articles met the inclusion criteria. The study results showed different patterns of ACPG among various communities. Furthermore, 84 social determinants were identified and categorized into structural and intermediary determinants. ACPG is a set of complex behaviors associated with different individual sociodemographic and behavioral characteristics; living and working conditions; COVID-19 knowledge, attitudes, and risk perceptions; exposure to sources and information level; leisure activities; social support; trust; social norms; psychosocial well-being; socio-economic position; and the socio-economic and political context. Interventions to promote ACPG among the general population should consider the identified social determinants of ACPG.

Explaining the problems faced by Iranian housewives during the COVID-19 quarantine period, and their adaption strategies: A qualitative study.

BACKGROUND: Housewives have several problems during the quarantine phase; so, the current study was designed to describe the challenges faced by Iranian housewives during the quarantine period in relation to COVID-19 and compatibility measures for it. METHODS: The current research employed a qualitative methodology and a traditional content analysis method on 34 quarantined women in Tehran. Purposive sampling and snowballing were used to find participants, and semi-structured interviews were used to gather data. The Guba and Lincoln criteria were also employed to assess the quality of the study findings. RESULTS: After analyzing the data, 4 main categories and 18 subcategories were extracted, including (1) individual problems (personal health problems, life with fear and anxiety, low mental health, lifestyle imbalance, Internet addiction); (2) family problems (violence and conflict in the family, tension in managing family members, disruption of the educational and economic situation of family members, intensification of domestic tasks and roles); (3) social problems (social isolation, disregard for social customs, restricted access to cyberspace); and (4) compatibility strategies (spirituality, strengthening family relationships, division of tasks between family members, optimal use of leisure, positive use of cyberspace, development of individual skills). CONCLUSION: Their problems can be ameliorated by providing contraception to housewives, improving their mental health and reducing their worries and fears, modeling a healthy lifestyle during quarantine, offering solutions that reduce violent behavior and manage family conflict, and expanding their access to virtual communications.

Explaining the reasons for not maintaining the health guidelines to prevent COVID-19 in high-risk jobs: a qualitative study in Iran.

BACKGROUND: Although the workers in many occupations are at the greatest risk of catching and spreading COVID-19 due to assembling and contacting people, the owners of these occupations do not follow COVID-19 health instructions. The purpose of this study is to explain the reasons for not maintaining health guidelines to prevent COVID-19 in high-risk jobs in Iran. METHODS: The present study was conducted with a qualitative approach among people with high-risk jobs in Tehran during March and April of 2020. Data were collected through semi-structured interviews with 31 people with high-risk occupations selected by purposeful sampling and snowballing. The data were analyzed using the conventional qualitative content analysis method and MAXQDA-18 software. Guba and Lincoln's criteria were also used to evaluate the quality of the research results. RESULTS: 4 main categories and 13 sub-categories were obtained, including individual factors (personality traits, lack of self-efficacy, little knowledge of the disease and how to observe health norms related to it, misconceptions about health), structural factors (difficulty of access to health supplies, lack of supportive environment, weak laws and supervision, the poor performance of officials and national media), economic factors (economic costs of living, lack of government economic support), Socio-cultural factors (learning, cultural beliefs, social customs, and rituals). CONCLUSION: COVID-19 prevention requires intervention at different levels. At the individual level: increasing people's awareness and understanding about how to prevent COVID-19 and strengthening self-efficacy in observing health norms, at the social level: highlighting positive patterns of observing health issues and training people about the consequences of social interactions during the outbreak of the virus, and at the macro level: strengthening regulatory rules and increasing people's access to hygienic products and support for the vulnerable must be taken into account.