The necessity revealed by COVID-19 pandemic: Paradigm shift of Iran's healthcare system.

Background: COVID-19 pandemic has resulted in drastic changes around the world, revealing vulnerable aspects of healthcare systems. This study aimed to explore how Iranian healthcare system experienced the paradigm shift during the pandemic and determine the aspects that need improvement during the pandemic era. Method: This qualitative study was conducted in 2021. A framework analysis approach was used to analyze the content of the 19 semi-structured interviews with the healthcare system experts from Shiraz University of Medical Sciences (SUMS). The interviews' audio files changed into transcript after each session and data was saturated at the 19 interview. To increase the trustworthiness of the study, Guba and Lincoln's criteria including credibility, transferability, dependability, and confirmability were used. Goldsmith's five-step framework analysis was used applying MAX QDA version 10 software. Result: Eight main themes and 20 subthemes were explored. The main themes included "strengthening the electronic health infrastructure," "research for evidence-based decision making," "dedicated financing to the pandemic," "prevention of disruption in the effective provision of services and medicines," "enriching the authority of the Ministry of Health by focusing on interactions," "recruiting, managing and empowering health human resources with attention to financial and non-financial incentives," "reforming educational approaches in training students in medical universities," as well as "lessons learned from neglected aspects." Conclusion: To be ready to respond to a possible future pandemic and for a paradigm shift, bold steps must be taken to make fundamental changes in various aspects of the healthcare system including e-health development, evidence-based decision making, dedicated budgets for pandemics, reinforcement of interactions at the national and international level, as well as sufficient attention to healthcare workers from all financial, non-financial and educational aspects.

The necessity revealed by COVID-19 pandemic: Paradigm shift of Iran's healthcare system

Background COVID-19 pandemic has resulted in drastic changes around the world, revealing vulnerable aspects of healthcare systems. This study aimed to explore how Iranian healthcare system experienced the paradigm shift during the pandemic and determine the aspects that need improvement during the pandemic era. Method This qualitative study was conducted in 2021. A framework analysis approach was used to analyze the content of the 19 semi-structured interviews with the healthcare system experts from Shiraz University of Medical Sciences (SUMS). The interviews‘ audio files changed into transcript after each session and data was saturated at the 19 interview. To increase the trustworthiness of the study, Guba and Lincoln's criteria including credibility, transferability, dependability, and confirmability were used. Goldsmith's five-step framework analysis was used applying MAX QDA version 10 software. Result Eight main themes and 20 subthemes were explored. The main themes included "strengthening the electronic health infrastructure,” "research for evidence-based decision making,” "dedicated financing to the pandemic,” "prevention of disruption in the effective provision of services and medicines,” "enriching the authority of the Ministry of Health by focusing on interactions,” "recruiting, managing and empowering health human resources with attention to financial and non-financial incentives,” "reforming educational approaches in training students in medical universities,” as well as "lessons learned from neglected aspects.” Conclusion To be ready to respond to a possible future pandemic and for a paradigm shift, bold steps must be taken to make fundamental changes in various aspects of the healthcare system including e-health development, evidence-based decision making, dedicated budgets for pandemics, reinforcement of interactions at the national and international level, as well as sufficient attention to healthcare workers from all financial, non-financial and educational aspects.

Bibliometric analysis of COVID-19 publications shows the importance of telemedicine and equitable access to the internet during the pandemic and beyond.

BACKGROUND: Pandemics highlight the increasing role of information and communications technology for improving access to health care. This study aimed to present a bibliometric analysis of the concept of digital divide reported in the published articles concerning the coronavirus disease 2019 (COVID-19) pandemic. METHODS: To conduct this bibliometric analysis of research topics and trends, we used VOSviewer software. We developed a search strategy to retrieve peer-reviewed publications related to 'digital divide in the COVID-19 era' from the Scopus database. RESULTS: In total, 241 publications on the topic of digital divide and COVID-19 were retrieved from Scopus database between 2020 and 2021. The analysis of keywords co-occurrence of research topics revealed four main clusters including: 'telemedicine', 'Internet access and Internet use', 'e-learning' and 'epidemiology'. Seven characteristic categories were examined in these research topics, including: sociodemographic, economic, social, cultural, personal, material and motivational. CONCLUSION: 'Telemedicine' and 'Internet access and Internet use' as the largest clusters are connected to topics addressing inequalities in online health care access. Thus, policymakers should develop or modify policies in more egalitarian Internet access for all community members not only during a pandemic like the COVID-19 but also at regular times.

Responsiveness level and its effect on services quality from the viewpoints of the older adults hospitalized during COVID-19 pandemic.

BACKGROUND: Aging is a sensitive period of life. Attention to the needs of this stage is considered a social necessity. This study is conducted to investigate the responsiveness level and its effect on service quality from the hospitalized older adults' viewpoints during the COVID-19 pandemic in the south of Iran. METHODS: It was a cross-sectional descriptive-analytic study that was conducted on 386 old patients. The study instrument was a standard questionnaire that includes three sections of demographic information, World Health Organization Responsiveness, and SERVQUAL. Data were analyzed applying descriptive and inferential statistics the same as Independent T-test, ANOVA, Pearson correlation, and multiple linear regression. RESULTS: The mean levels of responsiveness and service quality were 90.72 ± 9.38 (from 160) and 68.01 ± 8.51 (from 110) respectively. This indicates the average level of these variables from the old patients' viewpoints. There was a significant positive correlation between responsiveness and service quality (r = 0.585). According to the results of multiple linear regression, the dimensions of communication, dignity, prompt attention, primary facilities, social support, information confidentiality, right to choose, and autonomy were identified as the predictors of service quality. CONCLUSION: The average level of responsiveness and service quality perceived from the old patients' viewpoints during the COVID-19 pandemic can be considered a necessity for supportive planning among the older adults. Meanwhile, according to the impacts of responsiveness on service quality, educational programs are recommended to promote the level of healthcare providers' responsiveness.

Health literacy and health promoting behaviors among inpatient women during COVID-19 pandemic.

BACKGROUND: One of the leading health indicators during the COVID-19 crisis is health literacy and health-promoting behaviors. The present study aimed to investigate health literacy and health-promoting behaviors among women hospitalized during the COVID-19 pandemic in the southern part of Iran in 2020. METHODS: This descriptive-analytical study encompassed 465 women hospitalized and treated in none teaching hospitals affiliated with the Shiraz University of Medical Sciences. Data collection tools were the Health Literacy for Iranian Adults (HELIA) and Health Promoting Lifestyle Profile II (HPLP-II). The collected data were analyzed using descriptive and inferential statistical methods. RESULTS: The mean scores of the participants' "health literacy" and "health-promoting behaviors" were 64.41 ± 11.31 and 112.23 ± 16.09, respectively, indicating the poor level of health literacy and the average level of health-promoting behaviors. Moreover, there was a significant direct correlation between health literacy and health-promoting behaviors (P < 0.001, r = 0.471). Furthermore, all health literacy dimensions of comprehension (P < 0.001), accessibility (P < 0.001), reading skills (P < 0.001), evaluation (P = 0.002), and decision making and behavior (P = 0.003) were detected as the predictors of health-promoting behaviors. Further, statistically significant relationships were noticed between the mean score of health literacy with age (r = - 0.327, P = 0.007), level of education (F = 3.119, P = 0.002), and place of residence (t = 2.416, P = 0.004) and between health-promoting behaviors with level of education (F = 3.341, P = 0.001) and marital status (F = 2.868, P = 0.02). CONCLUSION: According to the findings, health policymakers should adopt national measures for educational planning to promote health literacy and support health-promoting behaviors to encourage women to adopt a healthy lifestyle.

Out-of-pocket payments for treatment of COVID-19 in Iran.

INTRODUCTION: Out-of-pocket (OOP) is among the payment methods in Iran's health system. The present study aimed to examine the OOP treatment costs for patients with COVID-19 in Iran. METHODS: A descriptive-analytical, cross-sectional study was conducted in 2021. In this study, the cost records of 550 patients with COVID-19 hospitalized in a referral center of COVID-19 were selected using the stratified random sampling method. The required data were collected using a researcher-made questionnaire. Data were analyzed by t-test, ANOVA, and Pearson's correlation coefficient in SPSS software version 23 at p = 0.05. RESULTS: The total direct costs were 1,037,992.15 US $. Moreover, the shares of patients (OOP), basic insurance, government subsidy, supplementary insurance, discounts, and out-of-government subsidy in the total direct costs were US $ 92,231.21, 746,932.99 US $, 155,127.08 US $, 39,690.25 US $ and 4010.61 US $, respectively. In addition, the results confirmed that there was a positive and significant relationship between the patients' OOP payments and the length of stay. It also found that the patients' OOP payments are subject to the type of insurance program and discharge method. CONCLUSION: According to the results, 8.89% of the total direct costs were directly paid out of the patients' pockets. The research findings confirm the urgent need to make decisions and implement effective interventions for COVID-19 disease by controlling risk factors and exploiting other countries' successful experiences and international organizations' recommendations to decrease the prevalence of the infected and consequently reduce the financial pressure of the disease on patients by approving the expansion of the insurance organizations' role.

Online oral health information seeking experience and knowledge, attitudes and practices of oral health among iranian medical students: an online survey.

BACKGROUND: The internet is increasingly used as a source of health information. This study aimed to explore the online oral health information seeking experience, to determine the knowledge, attitudes and practices (KAP) of oral health, and to investigate the associations between online oral health information seeking experience and oral health KAP of participants. METHODS: A cross-sectional online survey was conducted. Three hundred and ninety-five university students participated in the study. Required data were gathered using two valid questionnaires eHIQ (e-Health Information Questionnaire) and Oral Health Knowledge, Attitude and Behavior Questionnaire. eHIQ was a 2-part instrument with 37 items. eHIQ-Part 1 includes 11 items related to general views of using the internet in relation to health. eHIQ-Part 2 includes 26 items related to the consequences of using specific health-related online sources. The second questionnaire includes 30 items as a combination of multiple-choice and yes/no type questions. The data were analyzed using the statistical analysis software SPSS version 20. Mean scores, standard deviation, and frequency distribution were obtained. Independent T-test, correlation coefficients and analysis of variance (ANOVA) were used in the analysis. RESULTS: Participants had good KAP of oral health. The between-group differences tests showed that oral health knowledge and attitudes were significantly different between gender and years of study groups, but the differences of oral health practices were significant only based on years of study. Participants had moderate scores regarding all sub-scales of eHIQ-Parts 1 and 2. Findings revealed that online oral health information seeking behavior was associated with oral health KAP (p < 0.05). CONCLUSION: According to the results the general views of using the internet in relation to health and the consequences of using specific health-related online sources were in a moderate level among the participants. Such results can emphasize the need for more planning, education and empowerment of the population`s health literacy. The present study also provides good insights for the latter and has practical and policy implications besides its research values.

Health human resources challenges during COVID-19 pandemic; evidence of a qualitative study in a developing country.

BACKGROUND: One of the main forthcoming challenges of healthcare systems against preparedness and management of the pandemic is the challenge of procurement and recruitment of the human resources. This study is aimed to explore the health human resources challenges during COVID-19 pandemic in Iran. METHODS: This qualitative content analysis study was conducted in 2020. The study population includes all the Iranian human resources managers affiliated in Universities of Medical Sciences, hospitals and health centers managers and the health networks managers all over the country. 23 participants were included via purposeful sampling considering the inclusion criteria and were interviewed individually. After 23 semi-structured interviews, data were saturated. Then the data were analyzed through content analysis approach applying MAXQDA10. RESULTS: Three main themes of "organizational challenges", "legal challenges", and "personal challenges" were explored as the main challenges of health human resources management during COVID-19. On the one hand, organizational challenges include restricted financial resources, compensation discrimination, staffing distinction points, imbalance in the workload, weak organizational coordination, inefficient inter-sectoral relationships, parallel decisions, inefficient distribution of the human resources, lack of applied education, lack of integrated health protocols, lack of appropriate evaluation of performance, employee turnover, lack of clear approaches for staffing, and shortage of specialized manpower, and on the other hand, the personal challenges include insufficient knowledge of the employees, psychological disorders, reduction of self-confidence, burnout, workload increase, reduced level of job satisfaction, effects of colleague and patients bereavement and unsafety sense against the work place. Finally, the legal challenges that mostly related to the governments laws and regulations include lack of protocols for continuous supportive services, inappropriate approaches and instructions for teleworking, and lack of alternative plans and regulations for the human resources. CONCLUSION: Organizational, legal and personal challenges are among three main challenges of health human resources management during COVID-19 pandemic. Serious attention to these challenges should be considered by health policymakers in order to be prepared for facing new probable outbreaks and managing the present condition. The integrated comprehensive planning of human resources management for COVID-19 along with supportive packages for the personnel can be helpful.

Designing a resilience model for pharmaceutical supply chain during crises: a grounded theory approach.

BACKGROUND: During disasters or crises, the traditional models of supply chain encounter failure and skewedness under the inevitable and unknown pressures. The procurement and transformation of required equipment to the involved areas is considered as one of the main triggers of decreasing damages and losses during crisis. In this regard, a breakdown in pharmaceutical supply chain can lead to intensive, undesired consequences. METHODS: This was a qualitative study applying a grounded theory approach. The study was conducted with attending of 32 informant participants who were qualified in supply chain during natural disasters and crisis. In order to collect the data, deep semi-structured interviews were applied along with investigating the documents, observation, field notes and theoretical memos. For data analysis, a continuous comparison was used according to Corbin and Strauss method. RESULTS: Results of the study were categorized in 8 main categories as the main themes. "Wasting" appeared as the main factor of the resilience of pharmaceutical and consumable medical equipment supply chain. Wasting included two subthemes of loss of resources and wasting time. CONCLUSION: In order to make resilience in pharmaceutical and consumable medical equipment during disasters, it is necessary to reinforce the various dimensions of the resilience model to increase the rate of supply chain responsiveness. This study particularly contributes to broadening and deepening our understanding of how to mitigate the risk of undesirable outcomes of pharmaceutical supply chain during the disasters or crises.

Factors influencing access and utilization of health services among older people during the COVID - 19 pandemic: a scoping review.

BACKGROUND: Access to healthcare and service utilization are both considered essential factors for improving the general health and wellbeing of older people, especially at the time of COVID-19 pandemic. The aim of the study is to explore factors affecting healthcare access and health service utilization for older people during the pandemic. METHODS: PubMed, Web of Science, Scopus and Embase were systematically searched for relevant articles. Access, utilization, health, elderly and COVID-19 were used as keywords in the search strategy. A total of 4308 articles were identified through the initial database search; 50 articles were included in the review as passing the eligibility criteria. The searches were conducted up to August 2021. Data extraction was performed, and evidence was descriptively illustrated. Thematic analysis was used to explore factors influencing the elderly's access and utilization of healthcare services, using Max QDA10, a qualitative analysis software. RESULTS: Among articles included in the review (n = 50), a majority of the studies were from the United States (36%), followed by India (8%). According to the main healthcare services, a large number of articles (18%) were related to mental health services, followed by digital health services (16%). Factors were identified at an individual, provider and systems level. Seven main themes emerged from the thematic analysis, as determinants of elderly's access and utilization of healthcare services during COVID-19 pandemic. These included: access to non-COVID related services, access to COVID-related services, literacy and education, accommodation challenges, perceived attitudes of aging, and policies and structures, and social determinants. CONCLUSION: Mental health and digital health services were identified as major issues influencing or contributing to or influencing older people's health during the COVID-19 pandemic. We also argue on the importance of a rounded view, as attention to a range of factors is vital for policy decisions towards sustainable care and equitable interventions for improving the health of older people.

Designing a conceptual framework for misinformation on social media: a qualitative study on COVID-19.

OBJECTIVE: This study was aimed to present a conceptual framework about the misinformation surrounding COVID-19 outbreak in Iran. For this purpose, discourse analysis of two of the most common social virtual networks were conducted via a four step approach as follows: defining the research question and selecting the content of analysis, gathering information and theory on the context, content analysis for establishing the themes and patterns and, presenting the results and drawing conclusions. RESULTS: Cultural factors, demand pressure for information during the crisis, the easiness of information dissemination via social networks, marketing incentives and the poor legal supervision of online content are the main reasons for misinformation dissemination. Disease statistics; treatments and prevention are the main subjective categories of releasing misinformation. The consequences of misinformation dissemination include psychosocial, economic, health status, health system and ethical ones. The most recommended strategies for dealing with the issue could be divided into demand and supply-side strategies.

Resilience level and its relationship with hypochondriasis in nurses working in COVID-19 reference hospitals.

INTRODUCTION: A new coronavirus, called COVID-19, is an acute respiratory disease, which may arouse many psychological disorders since there is no specialized knowledge about it. The present study aimed to investigate the level of resilience and its relationship with hypochondriasis in nurses working in a COVID-19 reference hospital in south of Iran. METHODS: This cross-sectional study was conducted in 2020, in which 312 nurses participated using the census method. Data collection tools were the Conker-Davidson standard resilience scale (CD-RISC) and the Evans Hypoglycaemia Awareness Questionnaire. Data were analyzed using t-test, ANOVA, Pearson correlation coefficient, and multiple linear regression using SPSS software version 23. RESULTS: The mean scores of resilience and hypochondriasis were 72.38 ± 7.11 and 49.75 ± 8.13, respectively, indicating the moderate level of these two variables among nurses. Hypochondriasis in 18.91, 61.22, and 1.28% of the nurses was mild, moderate, and severe, respectively. There was a significant negative correlation between resilience and hypochondriasis (r = - 0.214 and P < 0.001). In this regard, control (P < 0.001), positive acceptance of change (P < 0.001), spiritual effects (P = 0.001), trust in individual instincts (P = 0.001), and perception of competence (P = 0.002) were detected as the predictors of nurses' hypochondriasis. CONCLUSION: The nurses had moderate levels of resilience and hypochondriasis. Promoting knowledge about COVID-19and increasing information on how to protect oneself and others against the disease along with supportive packages from their managers are thus recommended.

Main Factors Affecting the Readiness and Responsiveness of Healthcare Systems during Epidemic Crises: A Scoping Review on Cases of SARS, MERS, and COVID-19.

Background: Given the significance of the preparedness and responsiveness of healthcare systems in relation to epidemics, this study aimed to determine their influencing factors during epidemic crises with a view to utilizing the findings in the battle against the coronavirus disease 2019 (COVID-19) outbreak. Methods: This scoping study was conducted in 2020 via the Arksey and O'Malley approach. A systematic search was conducted on five online databases from January 2000 to June 15, 2020. Initially, 1926 English articles were retrieved based on their abstracts. After the screening process, 60 articles were considered for the final analysis. Data were charted by applying Microsoft Office Excel 2013 and were synthesized via thematic analysis. Results: Five main factors have affected the responsiveness and preparedness of countries during the epidemics of severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and COVID-19: community-related interventions, managerial interventions, socioeconomic factors, the readiness of hospitals and health centers, and environmental factors. These themes are associated with 38 related sub-themes. The thematic framework shows that interactions between these five determinantes can affect the preparedness and responsiveness of healthcare systems during pandemics/epidemics. Conclusion: According to the results, healthcare systems need to pay attention to their internal capacities, managerial interventions, and health centers to overcome the current pandemic. They should also consider such external factors as socioeconomic and environmental determinants that can affect their potential preparedness against pandemic/epidemic crises. Community-related interventions such as improvement of the community health literacy, teamwork, and social responsibility can enhance the readiness of healthcare systems against the COVID-19 outbreak.

Oral health practitioners' knowledge, attitude, and awareness about coronavirus: A systematic review and meta-analysis.

BACKGROUND: Oral health practitioners are at the frontline of infection, particularly with respiratory viruses such as the novel coronavirus. Knowledge, awareness, and attitude of these workers are considered important in preventing and controlling the outbreak. This study aims to review the literature to provide a better understanding of the status of dentists and other oral health practitioners' knowledge, attitude, and awareness about COVID-19. METHODS: A systematic review was conducted through Web of Science, PubMed, Scopus, and ProQuest up to May 6, 2020. All the knowledge, attitude, and practice studies on oral health workers about respiratory contagious outbreak the same as severe acute respiratory syndrome, Middle East respiratory syndrome, and COVID-19 were included in the meta-analysis. RESULTS: A total of eleven studies were included in the meta-analysis. 85.5% of the dentists and oral health practitioners had a high level of awareness about virus transmission modes (95% confidence interval [CI]: 78.6%-92.4%; P < 0.001). 80.7% of the oral health practitioners gave right answers to the questions related to virus transmission modes (95% CI: 69.9%-91.4%; P < 0.001), and 79.9% of the dentists had a positive attitude about virus transmission modes (95% CI: 66.4%-93.4%; P < 0.001). CONCLUSION: This meta-analysis shows that the level of dentists and oral health practitioners' knowledge, awareness, and attitude was relatively high about the respiratory contagious diseases as well as COVID-19. The present results can shed further light for policymakers to support the best evidence medical education for all health-care workers the same as oral health practitioners. Preventing the dissemination of misinformation along with preparing comprehensive guidelines can be considered by the oral health policymakers, particularly in the more infected regions.

Reflections on COVID-19 and the ethical issues for healthcare providers

PurposeHealthcare governance places medical ethics at the forefront of defining and maintaining the quality of care. Examples of serious ethical issues include sexual abuse of patients (Dubois, Walsh, Chibnall et al., 2017), criminal prescription of opioids (Johnson, 2019) and unnecessary surgical procedures (Tayade and Dalvi, 2016) or shortages in service delivery because of little knowledge or experience especially during pandemic outbreaks (Hay-David et al., 2020). In many cases involving medical ethics, patients are identified as the first victims;however, this study aimed to consider clinicians and other healthcare practitioners as other probable victims (Ozeke et al., 2019).Design/methodology/approachThe World Health Organization (WHO) estimates that tens of millions of patients worldwide suffer disabling injuries or death every year due to unsafe medical practices and services. Nearly, one in ten patients is harmed due to preventable causes while receiving health care in well-funded and technologically advanced hospital settings (WHO, 2016). Much less is known about the burden of unsafe care in non-hospital settings, where most healthcare services are delivered (Jha et al., 2013). Furthermore, there is little evidence concerning the burden of unsafe care in developing countries, where the risk of harm to patients is likely to be greater, due to limitations in infrastructure, technologies and human resources (Elmontsri et al., 2018).FindingsWhile these problems are endemic in health care, they are exacerbated in times of health and social crises such as the coronavirus disease of 2019 (COVID-19) pandemic. This pandemic has few precedents, being most closely paralleled with the global influenza pandemic of 1918 (Terry, 2020). Initially compared to the severe acute respiratory syndrome (SARS) outbreak of 2002–2003 (Parrym, 2003), COVID-19 is already proving much more deadly. The WHO’s estimates of the number of SARS cases from the start of the outbreak in 2002, until it was brought under control in July 2003, was 8,437 cumulative cases, with 813 deaths (WHO, 2003). The European Center for disease prevention and Control estimated that as of May 15, 2020, that 4,405,680 cases of COVID-19 have been reported with 302,115 deaths (ECDC, 2020)Research limitations/implicationsThe outbreak of COVID-19 was declared in February 2020 in the Islamic Republic of Iran, and up to March 2020, the cases of morbidity reached 12,729, with 611 deaths (Bedasht, 2020). The current figure at the time of editing (May 16, 2020) is 118,392 cases, with 6,937 deaths (Worldometer, 2020). Acting in cognizance of its ethical responsibility to the citizens of Iran, the Iranian government has taken the following action to attempt to mitigate the deleterious effects of the virus: in each province, one or more hospitals have been evacuated and allocated to patients with pulmonary problems with suspected to COVID-19. Access to intensive care units and specialist equipment is a primary ethical issue that concerns the Iranian healthcare system. The issue is exacerbated by the knowledge that these facilities are not distributed equitably in the country. Therefore, equity is the first ethical concern in this situation.Practical implicationsAll nurses, clinicians, practitioners and specialists have been asked to volunteer their services in hospitals in the most infected areas. This raises ethical concerns about access to personal protective equipment (PPE) such as appropriate masks, gowns, gloves and other equipment to protect healthcare workers from infection. Access to PPE was restricted because of government failure to stockpile the necessary amount of disposable medical equipment. This was related to lack of domestic capacity to produce the equipment and problems accessing it internationally due to political-economic sanctions that were imposed on Iran by the USA and some European countries. Such shortages can quickly lead to a catastrophic situation;current evidence demonstrates that about 40% of healthcare workers are vulnerable to the COVI -19 infection (Behdasht, 2020). However, it should be noted that this is not a problem limited to Iran. As of March 2020, the WHO was already warning about PPE shortages and the dangers this posed for healthcare workers around the world (WHO, 2020).Social implicationsA Disaster Committee was created by the Iranian Ministry of Health to take responsibility for decision-making and daily information sharing to the community. The ethical dilemma that arises in terms of reporting the situation is the conflict between transparently presenting accurate and timely information and the creation of public panic and fear that this may cause in the community.Originality/valueAs a steward for public health, the Ministry of Health was afforded direct responsibility to maintain intra-sector relationships and leadership with other organizations such as political executive organizations, municipalities, military agencies, schools, universities and other public organizations to reach consensus on the best methods of controlling the COVID-19 outbreak. An important ethical issue is found in potential areas of conflict between the therapeutic and preventive roles of the Ministry of Health and those related to public health and the civil administrations.

Global concerns of dental and oral health workers during COVID-19 outbreak: a scope study on the concerns and the coping strategies.

BACKGROUND: Dental and oral health workers have direct contact with respiratory aerosols of patients during procedures. This study aimed to determine the main concerns of dental and oral health workers globally during COVID-19 outbreaks and the coping strategies that help the resilience of dental and oral healthcare system. METHODS: This scoping study was conducted in August 2020. After adjusting the search strategy, a systematic search of five databases (PubMed, ISI Web of Science, Scopus, ProQuest and EMBASE) was conducted. Data was extracted using Microsoft Excel and the contents of retrieved articles were analysed through a qualitative thematic analysis applying MAX QDA10. RESULTS: Most articles were either editorial/letters to the editor/commentary formats (34%), or literature reviews (26%). About half of the articles belonged to three countries of Italy, China and the USA (each 16% and totally 48%). Thematic analysis of included papers led to the identification of four main global concerns and 19 sub-concerns. Economic, ethical, social and professional concerns are among dental and oral health concerns. Other results indicate on three main themes and 13 sub-themes as the coping strategies including patient management, infection control and virtual strategies. CONCLUSION: Dental and oral health care workers have many concerns relating to COVID-19 including economic, ethical, social and professional factors. Resolution of concerns may involve enhancing coping strategies relating to patient management and infection control strategies as well as using new technologies for virtual contact with the patient without any risk of infection.

Efficacy of a web application for stress management among Iranian college students during COVID-19 outbreak: a study protocol for randomized controlled trials.

BACKGROUND: The prevalence of mental health disorders is increasing globally, and the prevalence of COVID-19 has made it worse. Evidence has indicated a major mental health burden and elevated anxiety associated with the new coronavirus outbreak in the general population. This study aims to evaluate an evidence-based web application (Naranj) for stress management among Iranian college students. METHODS AND DESIGN: This study aims to present a protocol related to a randomized controlled trial among Iranian college students. The study will be conducted on 100 students from two colleges of Shiraz University of Medical Sciences in Iran. The participants will be randomly assigned to the intervention and control groups. The intervention group participants will be provided with a web application, whereas the control group ones will be provided with an app unrelated to stress management. The primary outcome for this study will be the Perceived Stress Scale, and the two groups will be compared with respect to stress level and sleep quality. DISCUSSION: A web application will be developed according to psychological theories and will be scientifically approved for managing college students' stress and improving their sleep quality during the COVID-19 outbreak. TRIAL REGISTRATION: Iranian Registry of Clinical Trials IRCT20160427027647N2 . Registered on 14 May 2020.

COVID-19 on Instagram: A content analysis of selected accounts.

OBJECTIVE: This study aimed to characterize the representation of public health information related to COVID-19 posted on Instagram in 2020. METHODS: This qualitative content analysis study was conducted in Iran as one of the countries with the highest number of confirmed cases of COVID-19. Data were collected from the contents published from February 19 to April 3, 2020, on Instagram. The search feature of the Instagram app was used to find the posts related to Coronavirus or COVID-19. Overall, 1612 posts from 92 accounts were retrieved and analyzed using thematic analysis. RESULTS: A total of 23 themes emerged from the analysis of the retrieved posts. These themes include epidemiology and statistics, training and caring, general prevention guidelines, hygiene, healthy diet and lifestyle, patients, diagnosis and treatment, personal protective equipment, traditional medicine, psychology, children, cultural aspects, socio-cultural impacts, religious, misinformation, and wrong behaviors, animals, satire, condition of the healthcare system, politics, quarantine, operations of the Iranian National Disaster Management Organization (NDMO), economic impacts, and world news. CONCLUSION: The contents analysis of Instagram posts during a public health crisis can provide new and realistic insights into the crisis and identify the topics of interest or concern of the public. Furthermore, the information collected in this way can help policymakers identify the most critical issues from the public perspective and utilize the gained knowledge to manage the ongoing and future pandemics.

COVID-19 Related Misinformation on Social Media: A Qualitative Study from Iran.

BACKGROUND: Background: During outbreaks of diseases a great amount of health threatening misinformation is produced and released. In the web-2 era much of this misinformation is disseminated via social media where information could spread easily and quickly. Monitoring social media content provides crucial insights for health managers to manage the crisis. OBJECTIVE: Objective: Given the misinformation surrounding COVID-19 outbreak, this study was aimed to analyze contents of the most commonly used social networks in Iran that is among the affected countries. METHODS: Methods: A social media monitoring conducted through a qualitative design to analyze the discussions of social media users about the content related to COVID-19 transferred via Iranian medical faculty members` groups in Telegram and Whats App during Feb 20 to March 20, 2020 emphasizing the misinformation. Discourse analysis was applied and the written dialogues and discussions regarding misinformation about different aspects of the outbreak between medical faculty members all over the country were analyzed. RESULTS: Results: Cultural factors, demand pressure for information during the crisis, the easiness of information dissemination via social networks, marketing incentives and the poor legal supervision of online contents are the main reasons of misinformation dissemination. Disease statistics; treatments, vaccines and medicines; prevention and protection methods; dietary recommendations and disease transmission ways are the main subjective categories of releasing misinformation regarding novel coronavirus outbreak. Consequences of misinformation dissemination regarding disease include psychosocial; economic; health status; health system and ethical ones. Active and effective presence of health professionals and authorities on social media during the crisis and the improvement of public health literacy in the long term are the most recommended strategies for dealing with issues related to misinformation. CONCLUSIONS: Conclusion: This study contributes the management of COVID-19 outbreak trough providing applicable insights for health managers to manage public information in this challenging time.