The impact of the COVID-19 pandemic on antibiotic consumption and prevalence of pathogens in primary and secondary healthcare settings in Northern Ireland.

AIM: To evaluate the impact of the COVID-19 pandemic on the patterns of antimicrobial use and the incidence of pathogens in primary and secondary healthcare settings in Northern Ireland. METHODS: Data were collected on antibiotic use and Gram-positive and Gram-negative pathogens from primary and secondary healthcare settings in Northern Ireland for the period before (January 2015-March 2020) and during (April 2020-December 2021) the pandemic. Time series intervention analysis methods were utilized. RESULTS: In the hospital setting, the mean total hospital antibiotic consumption during the pandemic was 1864.5 defined daily doses (DDDs) per 1000 occupied-bed days (OBD), showing no significant change from pre-pandemic (P = .7365). During the pandemic, the use of second-generation cephalosporins, third-generation cephalosporins, co-amoxiclav and levofloxacin increased, there was a decrease in the percentage use of the hospital Access group (P = .0083) and an increase in the percentage use of Watch group (P = .0040), and the number of hospital Klebsiella oxytoca and methicillin-susceptible Staphylococcus aureus cases increased. In primary care, the mean total antibiotic consumption during the COVID-19 pandemic was 20.53 DDDs per 1000 inhabitants per day (DID), compared to 25.56 DID before the COVID-19 pandemic (P = .0071). During the pandemic, there was a decrease in the use of several antibiotic classes, an increase in the percentage use of the Reserve group (P = .0032) and an increase in the number of community-onset Pseudomonas aeruginosa cases. CONCLUSION: This study provides details of both changes in antibiotic consumption and the prevalence of infections in hospitals and primary care before and during the COVID-19 pandemic that emphasize the importance of antimicrobial stewardship in pandemic situations.

Acid-base imbalance as a risk factor for mortality among COVID-19 hospitalized patients.

Severe coronavirus disease 2019 (COVID-19) infection can lead to extensive lung infiltrate, a significant increase in the respiratory rate, and respiratory failure, which can affect the acid-base balance. No research in the Middle East has previously examined acid-base imbalance in COVID-19 patients. The present study aimed to describe the acid-base imbalance in hospitalized COVID-19 patients, determine its causes, and assess its impact on mortality in a Jordanian hospital. The study divided patients into 11 groups based on arterial blood gas data. Patients in normal group were defined as having a pH of 7.35-7.45, PaCO2 of 35-45 mmHg, and HCO3- of 21-27 mEq/L. Other patients were divided into 10 additional groups: mixed acidosis and alkalosis, respiratory and metabolic acidosis with or without compensation, and respiratory and metabolic alkalosis with or without compensation. This is the first study to categorize patients in this way. The results showed that acid-base imbalance was a significant risk factor for mortality (P<0.0001). Mixed acidosis nearly quadruples the risk of death when compared with those with normal levels (OR = 3.61, P=0.05). Furthermore, the risk of death was twice as high (OR = 2) for metabolic acidosis with respiratory compensation (P=0.002), respiratory alkalosis with metabolic compensation (P=0.002), or respiratory acidosis with no compensation (P=0.002). In conclusion, acid-base abnormalities, particularly mixed metabolic and respiratory acidosis, were associated with increased mortality in hospitalized COVID-19 patients. Clinicians should be aware of the significance of these abnormalities and address their underlying causes.

The Impact of Multidrug-Resistant Acinetobacter baumannii Infection in Critically Ill Patients with or without COVID-19 Infection.

This is a single-center, retrospective, cohort study aimed to evaluate the clinical outcomes of multi-drug resistance in Acinetobacter baumannii infections (MDR-AB) in intensive care unit (ICU) patients with or without a COVID-19 infection and risk factors for blood stream infection. A total of 170 patients with MDR-AB were enrolled in the study. Of these, 118 (70%) patients were admitted to the ICU due to a COVID-19 infection. Comparing the COVID-19 and non-COVID-19 groups, the use of mechanical ventilation (98.31% vs. 76.92%, p = 0.000), the presence of septic shock (96.61% vs. 82.69%, p = 0.002), and the use of steroid (99.15% vs. 71.15%, p = 0.000) and tocilizumab therapies (33.05% vs. 0%, p = 0.000) were more prevalent and statistically more significant in patients with COVID-19 infections. The average length of the ICU stay (21.2 vs. 28.33, p = 0.0042) was significantly lower in patients with COVID-19 infections. Survival rate was 21.19% for the COVID-19 group and 28.85% for non-COVID-19 group with a p-value = 0.0361. COVID-19 status was associated with significantly higher hazards of death (HR 1.79, CI 95% 1.02-3.15, p = 0.043). Higher SOFAB (15.07 vs. 12.07, p = 0.0032) and the placement of an intravascular device (97.06% vs. 89.71%, p = 0.046) were significantly associated with the development of a bloodstream infection. Our study has shown that critically ill patients with an MDR-AB infection, who were admitted due to a COVID-19 infection, had a higher hazard for death compared to non-COVID-19 infected patients.

Assessment of Jordanian health care professionals' perception towards new COVID-19 variants of concern.

BACKGROUND: Healthcare professionals working at the frontline, dealing with COVID-19 patients or their samples, should know about variants of concern (VOCs) and their transmissibility, disease severity, and vaccine efficacy. Healthcare professionals' (HCPs) perceptions towards new VOCs affect their practice and attitudes towards their patients. Moreover, these perceptions might significantly impact their patients' perceptions of new COVID-19 variants and public vaccine acceptability. METHODS: Online and paper-based questionnaires were distributed among Healthcare professionals in Jordan between August 2021 and October 2021. RESULTS: Among 423 HCPs who participated in this study, a majority believe that when viruses mutate, they become more transmissible (77.8%), more deadly (61.7%), and pathogenic (64.8%). In addition, half of the respondents, perceived current treatments as partially effective against VOCs and current diagnostics to be efficient. However, all VOCs were perceived as more transmissible, more virulent, and related to higher mortality rates when compared to the original strain. Regarding immunity against VOCs, (57.4%) of respondents believe in partial immunity against re-infection, and most respondents were either unsure about the current vaccines' efficacy or agreed that available vaccines would be ineffective. However, respondents (44.4%) still believe that people previously infected should get vaccinated. Respondents referred to the Ministry of Health as the most reliable source of information (45.6%) and the party responsible for educating the public about COVID-19 VOCs (57.9%). Travel was not a source of worry among respondents. However, they were worried about their families getting the new COVID-19 VOCs from their work. Similar proportions agreed/disagreed on the efficacy of the precautions and infection control measures currently applied by the government for preventing the spread of the new COVID-19 VOCs. CONCLUSION: Campaigns, workshops, and webinars targeting vaccines are highly recommended among HCPs to increase public acceptance of the vaccine and further booster shots.

Risk Factors Associated with Mortality in COVID-19 Hospitalized Patients: Data from the Middle East.

This study aimed to assess the risk factors for COVID-19 mortality among hospitalized patients in Jordan. All COVID-19 patients admitted to a tertiary hospital in Jordan from September 20, 2020, to August 8, 2021, were included in this study. Demographics, clinical characteristics, comorbidities, and laboratory results were extracted from the patients' electronic records. Multivariable logistic and machine learning (ML) methods were used to study variable importance. Out of 1,613 COVID-19 patients, 1,004 (62.2%) were discharged from the hospital (survived), while 609 (37.8%) died. Patients who were of elderly age (>65 years) (OR, 2.01; 95% CI, 1.28-3.16), current smokers (OR, 1.61; 95%CI, 1.17-2.23), and had severe or critical illness at admission ((OR, 1.56; 95%CI, 1.05-2.32) (OR, 2.94; 95%CI, 2.02-4.27); respectively), were at higher risk of mortality. Comorbidities including chronic kidney disease (OR, 2.90; 95% CI, 1.90-4.43), deep venous thrombosis (OR, 2.62; 95% CI, 1.08-6.35), malignancy (OR, 2.22; 95% CI, 1.46-3.38), diabetes (OR, 1.31; 95% CI, 1.04-1.65), and heart failure (OR, 1.51; 95% CI, 1.02-2.23) were significantly associated with increased risk of mortality. Laboratory abnormalities associated with mortality included hypernatremia (OR, 11.37; 95% CI, 4.33-29.81), elevated aspartate aminotransferase (OR, 1.81; 95% CI, 1.42-2.31), hypoalbuminemia (OR, 1.75; 95% CI, 1.37-2.25), and low platelets level (OR, 1.43; 95% CI, 1.05-1.95). Several demographic, clinical, and laboratory risk factors for COVID-19 mortality were identified. This study is the first to examine the risk factors associated with mortality using ML methods in the Middle East. This will contribute to a better understanding of the impact of the disease and improve the outcome of the pandemic worldwide.

Trends of Prevalence Estimates and Risk Factors of Depressive Symptoms among Healthcare Workers Over one Year of the COVID-19 Pandemic.

Background: COVID-19 pandemic has an overwhelming psychologic burden on healthcare workers (HCWs). This study aims to investigate the changes in the prevalence, estimates, severity, and risk factors of depressive symptoms among HCWs within the first year of the COVID-19 pandemic. Methods: An observational e-survey collected data on HCWs' socio-demographic characteristics, occupational situation, and depressive symptoms as measured by Patient Health Questionnaire-9 (PHQ-9). The e-survey was distributed one month after the onset of the COVID-19 pandemic (onset group) and again after one year (one-year group). Results: A total of 422 HCWs were included (Mean (SD) age, 35.3 (9.9) years; 71.3% males), with 211 (50%) participants in each group. In the total cohort, the mean PHQ-9 score was 8.5, and 36.7% reported clinically significant levels of depressive symptoms with a PHQ-9 score of ≥10. Compared to the onset group, the one-year group reported a higher risk of major depressive disorder (41.7% vs. 31.8%; OR 1.538; 95%CI 1.032-2.291; p=0.034), a higher mean PHQ-9 score (9.5 (6.8) vs. 7.4 (5.3), p<0.001), and more severe depressive symptoms (p<0.005). Participants who were younger, unmarried, underwent testing for COVID-19, reported lower monthly income, did not receive special COVID-19 education, or had lower satisfaction with institutional preparedness had significantly higher depression scores and symptoms in both onset and one-year groups (p<0.05 for each category). Female gender and direct contact with COVID-19 patients or samples were significant risk factors within the onset group. Occupation as a physician, history of COVID-19 testing or infection, and perception of significant changes in work schedule or intensity were significantly associated with higher depression scores and symptoms among the one-year group. Conclusion: This study sheds light on an unspoken but significant rise in prevalence estimates and severity of depressive symptoms among HCWs over a year of the COVID-19 pandemic and shows the vulnerable subgroups for whom a psychological intervention might be warranted.

Predictors of invasive mechanical ventilation in hospitalized COVID-19 patients: a retrospective study from Jordan.

OBJECTIVES: To identify early indicators for invasive mechanical ventilation utilization among COVID-19 patients. METHODS: This retrospective study evaluated COVID-19 patients who were admitted to hospital from 20 September 2020, to 8 August 2021. Multivariable logistic regression and machine learning (ML) methods were employed to assess variable significance. RESULTS: Among 1,613 confirmed COVID-19 patients, 365 patients (22.6%) received invasive mechanical ventilation (IMV). Factors associated with IMV included older age >65 years (OR,1.46; 95%CI, 1.13-1.89), current smoking status (OR, 1.71; 95%CI, 1.22-2.41), critical disease at admission (OR, 1.97; 95%CI, 1.28-3.03), and chronic kidney disease (OR, 2.07; 95%CI, 1.37-3.13). Laboratory abnormalities that were associated with increased risk for IMV included high leukocyte count (OR, 2.19; 95%CI, 1.68-2.87), low albumin (OR, 1.76; 95%CI, 1.33-2.34) and high AST (OR, 1.71; 95%CI, 1.31-2.22). CONCLUSION: Our study suggests that there are several factors associated with the increased need for IMV among COVID-19 patients. These findings will help in early identification of patients at high risk for IMV and reallocation of hospital resources toward patients who need them the most to improve their outcomes.

Trends in Insomnia, Burnout, and Functional Impairment among Health Care Providers over the First Year of the COVID-19 Pandemic.

Background: COVID-19 pandemic has negatively impacted the psychological well-being and quality of life of health care providers (HCPs). Objectives: This study assessed the trends in prevalence and predictors of insomnia, burnout, and functional impairment among HCPs over the first year of the pandemic. Methods: An online survey was conducted one month after the pandemic's onset (onset group) and a year later (one-year group). The demographic features of participants were collected. Insomnia, burnout, and functional impairment were assessed using Insomnia Severity Index (ISI), Mini-Z survey, and Sheehan Disability Scale (SDS), respectively. Results: The onset group included 211 HCPs (mean (SD) age 34.7 (9.3) years and 73% men), while 212 HCPs participated in the one-year survey (mean (SD) age 35.9 (10.5) years and 69% men). High prevalence estimates were found in both onset and one-year groups of symptoms of insomnia (52% vs. 49%), of diagnosis of clinical insomnia (15% vs. 18%), with a high mean ISI score (8.4 vs. 8.7), but with no significant difference between the onset and one-year groups. Risk factors for clinical insomnia included age in both groups, lower income and contact level with COVID-19 patients/samples in the onset group, and lower Mini-Z scores and higher SDS scores in the one-year group. Approximately one-third of respondents reported at least one or more burnout symptoms, with a higher percentage in the one-year group (35.4%) than in the onset group (24.2%) (p=0.012). Younger age, lower monthly income, and higher ISI and SDS scores were risk factors for burnout in both groups. Greater perceived changes in social life were associated with burnout in the onset group. In contrast, higher weekly working hours, worse participants' evaluation of their institution's preparation, and more changes in workload were risk factors for burnout in the one-year group. The SDS score and its subscales scores were higher in the one-year group than in the onset group. Changes in workload and social life predicted higher SDS scores among both groups. Living with older people predicted higher SDS scores among the onset group, while contact level and estimated number of COVID-19 patients that participants engaged in during caring predicted higher SDS scores among the one-year group. ISI scores were significantly correlated with the Mini-Z scores and SDS scores in both groups, while the Mini-Z and SDS scores were significantly correlated only in the one-year group. Conclusion: This study demonstrated high rates of insomnia, burnout, and functional impairment among HCPs during the pandemic. It reveals a significant rise in job burnout and functional impairment of HCPs overtime during the pandemic. Furthermore, high-risk subgroups are also highlighted for whom comprehensive psychosocial and occupational interventions might be warranted.

Smartphone applications for sleep tracking: rating and perceptions about behavioral change among users.

Introduction: This study aims to assess existing sleep apps for mobile phones to determine the perceived effect of these applications on user's attitudes, knowledge, willingness to change, and its likelihood to change behavior from a user's perspective. Material and Methods: A systematic search was conducted through Google play store and iTunes Apple store using terms related to sleep tracking. Apps were evaluated using Mobile Application Rating Scale (MARS) tool for assessing and classifying mobile health applications quality. Additionally, a convenience sample of subjects were asked to evaluate the included apps for perceived sleep behavior changes. Results: The average MARS app quality score on a 5-point scale was 3.3. Between 30-50% of participants believed that sleep tracker apps are likely to increase awareness about sleep patterns and sleep hygiene, infuence sleep hygiene habits, and are likely to encourage help seeking for sleep hygiene when required. Conclusion: Apps available for sleep self-management and tracking may be valuable tools for self-management of sleep disorder and/or improving sleep quality, yet they require improvement in terms of quality and content, highlighting the need for further validity studies.

Prevalence Estimates and Risk Factors of Anxiety among Healthcare Workers in Jordan over One Year of the COVID-19 Pandemic: A Cross-Sectional Study.

This study investigates the changes in prevalence estimates, severity, and risk factors of anxiety among healthcare workers (HCWs) over the first year of the COVID-19 pandemic. A survey was distributed among HCWs using snowball sampling, collecting their socio-demographics, occupation, and anxiety symptoms as measured by the Generalized Anxiety Disorder-7 (GAD-7) scale. It was distributed one month after the pandemic's onset in Jordan between 15 and 30 April 2020 (onset group) and after one year between 15 and 30 March 2021 (one-year group). A total of 422 HCWs were included (211 in each group). The one-year group reported a higher risk of GAD (30.8% vs. 16.6%; p = 0.001), a higher mean (SD) GAD-7 score (7.94 (5.29) vs. 6.15 (4.15); p < 0.001), and more severe symptoms (p = 0.003). Univariate analyses showed that participants who were younger, women, unmarried, had lower monthly incomes, underwent testing for COVID-19, had higher contact with COVID-19 patients, did not receive special education, and were unsatisfied with the institutional COVID-19 preparedness scored higher on the GAD-7 scale and had more severe symptoms than their counterparts in both groups. Unlike the onset group, occupation as a physician, COVID-19 infection history, and perception of remarkable changes in work were associated with higher anxiety scores and severity among the one-year group. The COVID-19 vaccine was a relative protective action. Logistic regression analyses showed that the female gender was a risk factor for developing GAD at the pandemic onset, while poor satisfaction with institutional preparedness was a significant GAD risk factor in the one-year group. Low monthly income and lack of special education were the shared risk factors for GAD in both groups. This study reveals a significant rise in anxiety among HCWs over a year of the COVID-19 pandemic and shows the vulnerable sub-groups who likely need psychological interventions.

Attitudes and Practices of Educators towards e-Learning during the COVID-19 Pandemic

Background: The novel coronavirus outbreak is now shifting the way educational institutions operate around the world. This study aims to assess the online learning experience during the pandemic and recognize its perceived barriers according to university professors in Jordan. Methods: This is a questionnaire-based, cross-sectional, and descriptive study. A web-based survey was distributed to all university professors and lecturers in public universities across Jordan. Results: A total of 508 educators responded to this study. Males (67.5%, n=343) dominated the study population compared to females (32.5%, n=165). Educators spent an average of 20.2 ± 15.9 hours/week using the internet for educational purposes during the pandemic. Positive attitudes towards online teaching were seen, as 65.7% reported being prepared for online teaching, while 40.8% were comfortable communicating with students via online platforms. Institutional support for online learning also appears to have increased following the coronavirus outbreak. An overwhelming majority (81.9%, n=416) stated that their universities supported online education during the pandemic, compared to 56.5% (n=287) before. The main recognized barriers for online teaching were poor internet connection (78.3%, n=398), disadvantages in old learning tools (e.g., uploading capacity) (70.9%, n=360), and family atmosphere (69.3%, n=352). Participants also recognized technical (74.0%, n=376) and computer skills (49.2%, n=250) as areas requiring development. Conclusion: Despite the positive attitudes of educators towards online teaching, many barriers need to be overcome before the shift from traditional learning is implemented. Faculty training and inter-departmental communication are warranted for the success of online teaching during the COVID-19 pandemic.

Reported COVID-19 vaccines side effects among Jordanian population: a cross sectional study.

Concerns about the safety and side effects of coronavirus SARS CoV2 vaccines have been raised among many communities worldwide. The aim of this study was to describe the side effects reported by vaccinated individuals in Jordan. A cross-sectional survey was used to recruit responses from participants who were vaccinated with either one dose or both doses of any of the administered vaccines in Jordan (AstraZeneca, Pfizer, Sinopharm). A total of 1,086 participants were enrolled in the study. Most of participants have not been infected with SARS CoV2 before receiving the vaccine (77.2%). Larger proportion of the study population received Pfizer vaccine (40.6%) followed by the AstraZeneca vaccine (33.0%), and Sinopharm vaccine (26.4%). Side effects after receiving the first dose of the vaccine were reported by most participants (89.9%) and included pain at the injection site (78.4%), fatigue (51.8%), myalgia (37.6%), headache (33.1%), and chills (32.3%). To a lesser extent, there were gastrointestinal side effects such as nausea (15.1%), loss of appetite (9.4%), and diarrhea (6.4%). More side effects were significantly associated with AstraZeneca vaccine (P < .001). Only one case for each of second dose of Pfizer and Sinopharm vaccines reported that their side effects required hospitalization. In this study, we found that people in Jordan experienced more side effects with AstraZeneca vaccine followed by Pfizer vaccine and the least one is Sinopharm vaccine. Our study showed that these side effects are not severe and should not be an obstacle against the successful control of the pandemic in Jordan.

Online learning for undergraduate health professional education during COVID-19: Jordanian medical students' attitudes and perceptions.

BACKGROUND: The popularity of online learning has increased tremendously in response to the needs of students amid outbreaks of emerging infectious diseases. Few studies have concentrated on the learner's perspectives involved with the transition from traditional to online learning. The aim of this study was to assess students' attitudes towards online learning as well as the perceived preparedness and barriers. METHODS: A descriptive, cross-sectional, correlational web-based survey design was used to recruit eligible participants from five Jordanian government universities. A Facebook-based campaign and snowball sampling approach were used to recruit potential survey participants. RESULTS: The results show that 1,210 medical college students decided to take part in this online survey. Students' attitudes and perceived preparedness for online learning were moderate, while perceived barriers were high. This study revealed a connection between students' attitudes toward online learning and their gender, major, living area, college level, and prior experience. The main obstacles to online learning were an unstable Internet connection, a lack of motivation, and a lack of instructions. CONCLUSION: The majority of students had mixed feelings about online learning and were largely supportive of conventional classroom learning. Students were pessimistic about their chances of learning professional skills and core competencies online. More research is required to determine whether students are ready and able to make greater use of online education in order to access high-quality learning opportunities.

Public Health Literacy, Knowledge, and Awareness Regarding Antibiotic Use and Antimicrobial Resistance during the COVID-19 Pandemic: A Cross-Sectional Study.

Multi-drug-resistant (MDR) organisms pose a global threat to modern medicine, which has grown as a result of irrational antibiotic use and misuse. This study aimed to assess general public knowledge in Jordan and awareness of antibiotics and antibiotic resistance during the COVID-19 pandemic. A cross-sectional study was carried out utilizing the WHO multicountry public awareness survey. The study population was composed mainly of social media users, and a total of 1213 participants completed the online survey. According to the findings, more than half of the participants were well versed in antibiotic use and resistance. Those with adequate health literacy were found to better understand antibiotics (OR = 1.37, p = 0.017) and antibiotic resistance (OR = 1.46, p = 0.003). The vast majority (88.5%) recognized at least one antibiotic resistance term; however, 53.2% believed that antibiotic resistance is a problem in other nations. The participants in this study reported using antibiotics incorrectly, believing that they were treating sore throats, colds, and flu. The participants were well aware of antibiotic resistance solutions and their consequences on health. Age, education, health literacy, and antibiotic knowledge were found to be substantially (p < 0.05) associated with greater awareness of antibiotic resistance. The findings highlight the need for antimicrobial resistance education campaigns, health literacy, and antibiotic stewardship initiatives.

Impact of social media on public fear, adoption of precautionary behaviors, and compliance with health regulations during COVID-19 pandemic.

Social media has become an essential source of information during the coronavirus disease 2019 (COVID-19) pandemic. This study aims to understand social media's effect on the general public's fear, degree of adopting precautionary behaviors, and compliance with health authorities' regulations during the pandemic. A cross-sectional online survey was conducted in Jordan during the early period of COVID-19 pandemic. 827 individuals completed the questionnaire. Factors that had a significant association with increased fear included female gender (OR 2.6, 95% CI: 1.8-3.7), married status (OR 1.9, 95% CI: 1.2-3.4), following medical pages on social media (OR 1.6, 95% CI: 1.04, 2.42), and sharing of COVID-19 information on social media (OR 3.6, 95% CI: 1.8-7.1). The variables that were significantly associated with higher levels of precautionary behaviors were knowledge score (OR 1.2, 95% CI: 1.07-1.3), feeling of fear (OR 2.6, 95% CI: 1.71-3.), and following medical pages on social media (OR 2.8, 95% CI: 1.8-4.24). Regarding compliance with health officials' regulations, social media as a source of information and sharing information were significantly associated with lower odds of compliance with the Ministry of Health's regulations (OR 0.27, 95% CI: 0.13-0.5 and OR 0.46, 95% CI: 0.25-0.8, respectively). Social media is an essential platform for risk communication during pandemics. It plays a positive role in spreading knowledge and promotes certain preventive behaviors among the public. However, it may spread fear and encourage disruptive behaviors, which might be propagated by sharing the pandemic's news.

Predictors of Covid-19 case fatality rate: An ecological study.

BACKGROUND: The outbreak of novel coronavirus (Covid-19) has a significant burden on global health and could be associated with significant mortality. Limited information exists about determinants of its fatality worldwide. Thus, this ecological study examined the association of various predictors with Covid-19 fatality. METHODS: International data bases of Covid-19 statistics and health metrics available primarily at WHO were reviewed to collect information for 113 countries. The dependent variable was Covid-19 case fatality rate. Independent variables were demographic, social, clinical, economic, heath care and child health factors. RESULTS: Case fatality rate of Covid-19 varies across countries with an average of 4.2 ± 3.8%, and about half of countries had fatality rate >3.2% (median). Significant relationships were observed between Covid-19 fatality rate and socio-economic, clinical, and health variables at the unadjusted regression analysis. At the multivariate adjusted model, percentage of population with age>60 years was positively associated with Covid-19 fatality (B = 0.032, p = 0.005), while Polio-3 immunization at 1-year old was inversely related (B = -0.057, p = 0.017). CONCLUSIONS: This ecological investigation highlights the higher risk of death among elderly with Covid-19 pandemic and suggests that Polio-3 immunization coverage among 1-year-olds may be associated with better survival. Future research is warranted to validate these findings.

Pharmacists' experience, competence and perception of telepharmacy technology in response to COVID-19.

BACKGROUND: In the telepharmacy model, the pharmacist can play a pivotal role in delivering pharmaceutical services for patients. However, evidence of pharmacists' impact on improving patient outcomes through disease outbreak through telepharmacy is sparse. OBJECTIVES: This study aims to examine pharmacists' attitudes towards clinical benefits and identify challenges regarding the use of telepharmacy during the COVID-19 pandemic in Jordan. METHOD: A cross-sectional survey design was used to recruit eligible participants from both hospital and community pharmacies. RESULTS: A total of 364 pharmacists agreed to participate in the study. The majority of the participants (70.6%) expressed favourable attitudes towards telepharmacy to accurately capture and report signs and symptoms of COVID-19. Almost 91% agreed that patients can receive immediate medical feedback while using telepharmacy services. Pharmacists (87%) emphasised their role in the monitoring of physiological parameters when entered by patients using telepharmacy technology. However, more than half of the participants reported that lack of reimbursement and evidence-based studies might hinder the use of telemedicine technology to deliver remote clinical services. CONCLUSION: The need for implementing telepharmacy technology has been further boosted because of its noticeable benefits in promoting convenient healthcare services remotely in emergency situations.

Pharmacists self-perceived role competence in prevention and containment of COVID-19: A cross-sectional study.

INTRODUCTION: The increased need for prioritized infection prevention and control (IPC) activities for the prevention and containment of COVID-19 is pivotal and timely in preventing harm caused by the COVID-19 pandemic. Little is known about pharmacists' infection IPC activities and their role competence during disease outbreaks. This study aimed to assess pharmacists' perceived role competence to perform frontline roles during the COVID-19 pandemic. METHOD: A cross-sectional survey was conducted using online social media to recruit eligible participants. A validated questionnaire contained 41 items on sociodemographic characteristics, preventative behaviors, and competencies. RESULTS: A total of 486 participants completed the survey. Participants reported several IPC activities that could potentially prevent COVID-19 spread. The majority expressed high attitudes towards their capabilities to fulfill their healthcare roles (M = 4.43, SD = 0.46, out of 5). The vast majority of participants (97.1%) were willing to demonstrate the effective way of cleaning hands and using facemasks. Pharmacists (89.1%) showed their willingness to timely refer patients in response to their emerging needs. Gender, age groups, years of experience, monthly incomes, area of work, ability to make a referral, source of information, and self-isolation discontinuation criteria were significantly associated with pharmacists' self-perceived role competence. CONCLUSION: Pharmacists are well-positioned as access points to care and can potentially play a significant role in the containment of the COVID-19 outbreak by delivering advanced clinical and public health services. Future research efforts need to be comprehensively directed towards the advanced role of pharmacists in implementing point-of-care testing for infectious diseases.

Online Education for Undergraduate Health Professional Education during the COVID-19 Pandemic: Attitudes, Barriers, and Ethical Issues.

Background : The online teaching demand has increased tremendously to promote the implementation of online teaching-leaning system to meet the need of students during the outbreaks of emerging infectious disease. This study aims to explore whether the pandemic of COVID-19, which requires universities to rapidly offer online learning, will affect attitudes about online education for undergraduate health sciences students. Also, it investigates the barriers for using online tools. Method : A cross-sectional survey using online social media was used to recruit eligible participants. The data for this study were focused on students' experiences utilizing an online education method offered by the Jordanian government universities. This study is utilizing newly developed measuring tools that are expected to enable students to evaluate online teaching in terms of their own learning progress. Results : A total of 1,210 participants agreed to complete the online survey questionnaire. The mean score preparedness and attitude toward online education was average. The majority of students agreed that online courses helped assign reading and homework time better than on-campus approach (75.0%) and felt comfortable to actively communicate with my classmates and instructors online. Zoom and eLearning were the most common online platforms utilized by students. The geographic locations, lack of past experience on using online tools, and lack of past experience on using online tools were identified by students as the main barrier to online educations. Conclusions : Although the pandemic of COVID-19 appeared as uncommon catalyst for promoting eLearning, further research is needed to assess whether learners are ready and willing to make greater use of online education to obtain high quality teaching and learning opportunities, which could totally change educators' and students' attitudes and impression, and subsequently the general themes of online education.

Media's effect on shaping knowledge, awareness risk perceptions and communication practices of pandemic COVID-19 among pharmacists.

Coronavirus disease (COVID-19), an infection of the zoonotic coronavirus, is presenting a healthcare challenge around the globe. This study aims to assess the levels of disease knowledge and risk perception among pharmacists. We also recognize predictors of risk perception and perceived media roles. Methods This is a questionnaire-base cross-sectional study. The questionnaire was developed on a web-based platform and invitations were sent to pharmacists nationwide to participate in the study using social media applications. Results A total of 486 pharmacists participated in this study, where females were dominant (78.6%, n = 382). Most (40.4%, n = 198) pharmacists scored 4 out of 5 in basic disease knowledge, and more than half were able to recognize common methods of spread. Risk was highly perceived among participants, and was predicted by gender, living area, and having children (p < 0,05). Frequency of watching the media and sources of information also influenced both risk perception and perceived media roles. Conclusion Disease awareness among pharmacists, as well as risk perception must be considered for effective risk communication planning. The role of media in shaping perceptions should also be carefully studied to encourage compliance with government containment measures and engagement in preventive behaviors.