Excess Deaths During the COVID-19 Pandemic in Southern Iran: Estimating the Absolute Count and Relative Risk Using Ecological Data.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic led to increased mortality rates. To assess this impact, this ecological study aimed to estimate the excess death counts in southern Iran. METHODS: The study obtained weekly death counts by linking the National Death Registry and Medical Care Monitoring Center repositories. The P-score was initially estimated using a simple method that involved calculating the difference between the observed and expected death counts. The interrupted time series analysis was then used to calculate the mean relative risk (RR) of death during the first year of the pandemic. RESULTS: Our study found that there were 5571 excess deaths from all causes (P-score=33.29%) during the first year of the COVID-19 pandemic, with 48.03% of these deaths directly related to COVID-19. The pandemic was found to increase the risk of death from all causes (RR, 1.26; 95% confidence interval [CI], 1.19 to 1.33), as well as in specific age groups such as those aged 35-49 (RR, 1.21; 95% CI, 1.12 to 1.32), 50-64 (RR, 1.38; 95% CI, 1.28 to 1.49), and ≥65 (RR, 1.29; 95% CI, 1.12 to 1.32) years old. Furthermore, there was an increased risk of death from cardiovascular diseases (RR, 1.17; 95% CI, 1.11 to 1.22). CONCLUSIONS: There was a 26% increase in the death count in southern Iran during the COVID-19 pandemic. More than half of these excess deaths were not directly related to COVID-19, but rather other causes, with cardiovascular diseases being a major contributor.

Correlation Between Diabetes and COVID-19 Indices: A Global Level Ecological Study.

Introduction: Coronavirus is threatening the global public health as a new and widespread crisis. The researchers must keep in mind that one of the most vulnerable groups to COVID-19 are the people with underlying diseases, especially diabetes. Objective: This ecological study aimed to investigate the correlation between diabetes and the epidemiological indices of COVID-19. Methods: This ecological study included 144 countries. Their available data consists of the cumulative incidence rate of cases, cumulative incidence rate of death, recovery rate, case fatality rate, and performed tests of COVID-19, and diabetes. To collect the variables, a data set was provided which included the information of 144 countries based on diabetes and COVID-19 indices. Spearman coefficients were used for assess correlation between diabetes and COVID-19 indices. Also, Scatter plots of diabetes for the studied countries were drawn based on cumulative incidence rate of cases, cumulative incidence rate of death, tests, recovery rate, and case fatality rate of COVID-19. Results: The results of this ecological study showed in total countries, there was a weak positive correlation between diabetes and cumulative incidence rate of cases and also cumulative incidence rate of death. Correlation between diabetes with test of COVID-19 was very weak. Scatter plots showed a weak liner correlation between diabetes and cumulative incidence rate of cases, cumulative incidence rate of death and test of COVID-19. Conclusions: In this study, there was a weak positive correlation between diabetes and cumulative incidence rate of cases, cumulative incidence rate of death, and performed test of COVID-19. This disease is an enormous challenge for health policymakers; therefore, it is necessary to develop strategies and practical guidelines specific to each region to take the necessary care, especially for diabetic patients.

Comparison of in-hospital mortality of COVID-19 between pregnant and non-pregnant women infected with SARS-CoV-2: a historical cohort study.

OBJECTIVES: This study aimed to compare pregnant and non-pregnant women infected with SARS-CoV-2 disease (COVID-19) in terms of in-hospital mortality. METHODS: This historical cohort study was conducted on hospitalized women of reproductive ages (15-49 years) infected with SARS-CoV-2 in Fars province, Iran during 15 March 2019-10 May 2021. RESULTS: Out of the 5,322 patients, 330 were pregnant. The fatality rate of SARS-CoV-2 was 1.2% amongst pregnant women and 3.5% amongst non-pregnant ones. Pregnant and non-pregnant women reported the same history of smoking, opium use, previous COVID-19 infection, vaccination against SARS-CoV-2, and COVID-19 symptoms (p>0.05 for all). However, the pregnant women were younger and had fewer underlying diseases (p<0.001 for both). The results revealed no significant difference between the two groups regarding in-hospital clinical manifestations including the number of days after the onset of COVID-19 symptoms, mechanical ventilation, and long involvement (cRR; 95% CI=0.99 (0.96-1.02), 1.18 (0.72-2.02), and 0.95 (0.88-1.02), respectively). Nonetheless, Intensive Care Unit (ICU) admission was significantly higher in pregnant women (cRR; 95% CI=2.37(1.85-3.02)). After adjusting for age, history of underlying diseases, and ICU admission, pregnant women showed lower in-hospital mortality due to COVID-19 compared to non-pregnant women (aRR; 95% CI=0.32 (0.12-0.87)). CONCLUSIONS: Based on the current study findings, pregnant women showed lower in-hospital mortality due to COVID-19 compared to non-pregnant ones. Nevertheless, they should follow the same recommendations as non-pregnant women, avoiding exposure to the virus and receiving medical treatment and vaccination. Further studies are recommended to address the follow-up of recovered pregnant women, their babies, and puerperium.

The COVID-19 Pandemic, Socioeconomic Effects, and Intimate Partner Violence Against Women: A Population-Based Cohort Study in 2020, Iran.

Objectives. To investigate the prevalence, pattern, and socioeconomic risk factors of intimate partner violence (IPV) before and 6 months after the pandemic onset among a cohort of Iranian women. Methods. We conducted a population-based IPV survey among 2502 partnered Iranian women aged 18 to 60 years before (n = 2502) and 6 months after (n=2116) the pandemic's onset. We estimated prevalence and incidence of psychological, physical, and sexual IPV, and the odds of different forms of IPV associated with main exposure variables, adjusted for participant relationship factors. Results. Pandemic prevalence of IPV (65.4%; 95% confidence interval [CI] = 63.4%, 67.4%) was higher than prepandemic prevalence (54.2%; 95% CI = 52.2%, 56.3%). At follow-up, the incidence of IPV was 25.5% (95% CI = 22.9%, 28.4%). The highest incidence was in cases of physical and sexual IPV. Women whose partners lost their employment were at significant risk of new exposure to IPV. Highest socioeconomic status (SES) was associated with less physical IPV (odds ratio = 0.03; 95% CI = 0.01, 0.14). Conclusions. IPV prevalence has risen since the COVID-19 epidemic began with many women who had never experienced IPV now facing it. Unemployment of women or their partners and prepandemic lower socioeconomic status are risk factors of IPV. Monitoring programs should target these populations. (Am J Public Health. 2023;113(2):228-237. https://doi.org/10.2105/AJPH.2022.306839).

The Association of Opium Abuse with Mortality Amongst Hospitalized COVID-19 Patients in Iranian Population.

Opioid abuse is a serious problem in the society. Since the first months of COVID-19 pandemic, several myths, rumors and misconceptions have been spread about the benefits of opium consumption for COVID-19 outcome. In addition, data are limited on the relationship between opium abuse and COVID-19 mortality amongst hospitalized COVID-19 patients. In this historical cohort study, we assessed the risks of several variables for mortality amongst all hospitalized COVID-19 patients from the beginning of COVID-19 pandemic in South of Iran from March 15th, 2021 to October 14th, 2021. Data was acquired from the Medical Care Monitoring Center (MCMC), affiliated to Shiraz University of Medical Sciences. A total of 64,427 hospitalized COVID-19 patients were included into the analysis. The mortality rate was 10.59% (n = 6756). Of all, 2030 (3.15%) patients-1702 males and 328 females-reported the positive history of opium abuse with a mean age of 57 ± 17.21 years. The results of multivariable risk showed that the positive history of opium abuse had a significant association with mortality (adjusted RR: 1.173; p = 0.007). Other significant predictive risk factors were male gender, elder ages, and comorbidities such as pulmonary diseases, cardiovascular disease, cancer, nephrological diseases, neurological diseases, and diabetes. However, being a health care worker and having thyroid gland diseases were protective factors amongst hospitalized COVID-19 patients (adjusted RR: 0.650 and 0.642; p = 0.040 and < .0001, respectively). Opium abuse is a risk factor for mortality amongst hospitalized COVID-19 patients. It is vital to educate societies about the consequences of unauthorized opium consumption.

Unemployment and COVID-19-related mortality: a historical cohort study of 50,000 COVID-19 patients in Fars, Iran.

OBJECTIVES: Previous studies have estimated the risk of death associated with unemployment in the coronavirus disease 2019 (COVID-19) pandemic, but no studies have examined unemployment before COVID-19 infection as a risk factor for COVID-19-related mortality. Thus, this study aimed to investigate COVID-19 mortality among this population. METHODS: Data on 50,038 people aged 25-59 years were collected from 38 agencies in Fars Province, Iran, from February 2020 to July 2021. Follow-up lasted from participants' diagnosis with COVID-19 based on the results of a reverse transcription-polymerase chain reaction test to participants' death or the end of the study period. The association between unemployment and COVID-19-related mortality was estimated using the Poisson regression method, and a sensitivity analysis was conducted to calculate the E-value. RESULTS: Unemployment was associated with a 2.41-fold (95% confidence interval [CI], 2.01 to 2.90) higher age-adjusted and sex-adjusted risk of COVID-19-related mortality. The adjusted Poisson regression analysis showed 8.82 (95% CI, 6.42 to 12.11), 2.84 (95% CI, 1.90 to 4.24), and 1.58 (95% CI, 1.24 to 2.01) times higher risks of COVID-19-related mortality among unemployed people aged 25-39 years, 40-49 years, and 50-59 years, respectively, than among their employed counterparts. Unemployment increased the risk of COVID-19 mortality by 3.31 (95% CI, 2.31 to 4.74) and 2.30 (95% CI, 1.86 to 2.84) times in female and male, respectively. The E-value was 3.43, reflecting the minimum strength of confounding required to shift the association between unemployment and COVID-19-related mortality toward the null. CONCLUSIONS: Unemployment prior to COVID-19 infection increased the risk of COVID-19-related mortality. COVID-19-related mortality disproportionately impacted unemployed women and younger unemployed people.

Multiple sclerosis incidence rate in southern Iran: a Bayesian epidemiological study.

BACKGROUND: Multiple Sclerosis (MS) remains to be a public health challenge, due to its unknown biological mechanisms and clinical impacts on young people. The prevalence of this disease in Iran is reported to be 5.30 to 74.28 per 100,000-person. Because of high prevalence of this disease in Fars province, the purpose of this study was to assess the spatial pattern of MS incidence rate by modeling both the associations s of spatial dependence between neighboring regions and risk factors in a Bayesian Poisson model, which can lead to the improvement of health resource allocation decisions. METHOD: Data from 5468 patients diagnosed with MS were collected, according to the McDonald's criteria. New cases of MS were reported by the MS Society of Fars province from 1991 until 2016. The association between the percentage of people with low vitamin D intake, smoking, abnormal BMI and alcohol consumption in addition to spatial structure in a Bayesian spatio-temporal hierarchical model were used to determine the relative risk and trend of MS incidence rate in 29 counties of Fars province. RESULTS: County-level crude incidence rates ranged from 0.22 to 11.31 cases per 100,000-person population. The highest relative risk was estimated at 1.80 in the county of Shiraz, the capital of Fars province, while the lowest relative risk was estimated at 0.11 in Zarindasht county in southern of Fars. The percentages of vitamin D supplementation intake and smoking were significantly associated with the incidence rate of MS. The results showed that 1% increase in vitamin D supplementation intake is associated with 2% decrease in the risk of MS and 1% increase in smoking is associated with 16% increase in the risk of MS. CONCLUSION: Bayesian spatio-temporal analysis of MS incidence rate revealed that the trend in the south and south east of Fars province is less steep than the mean trend of this disease. The lower incidence rate was associated with a higher percentage of vitamin D supplementation intake and a lower percentage of smoking. Previous studies have also shown that smoking and low vitamin D, among all covariates or risk factors, might be associated with high incidence of MS.

Transferred Patients by Fars Province's Helicopter Emergency Medical Service (HEMS); A 2-Years Cross-Sectional Study in Southern Iran.

OBJECTIVE: To investigate the patients transferred by helicopters, as well as an emergent medical services that were performed for them. METHODS: In this retrospective cross-sectional study, all patients who were transferred by Fars province of Helicopter Emergency Medical Services (HEMS) to Shiraz hospitals, southern Iran (March 2017-March 2019) were investigated. Patients' information was collected and analyzed includes age, gender, dispatch reason, trauma mechanisms, take hold of emergent medical services, as well as the air transportation time, time between dispatch from the origin hospital and starting the procedures, and patients' outcome. RESULTS: Eighty-three patients were enrolled with the mean±SD age of 36.9±19.47 years that 75.9% had trauma (p<0.0001). Mental status deterioration (25.3%) was the most dispatched indications. The mortality rate was 13.25% totally (11.11% in traumatic vs. 10% in non-traumatic). The mean±SD of air transportation time was significantly lower than ground transportation in both traumatic (p=0.0013) and non-traumatic (p<0.0001) patients. Also, the mean±SD of time between dispatch from the origin hospital and starting the procedures was statistically lower in air transportation in both traumatic (p=0.0028) and non-traumatic (p=0.0017) patients. CONCLUSION: Most of the patients transferred by HEMS were traumatic. The air transportation time as well as the time between dispatches from the origin hospital to the starting of the procedures were significantly lower in HEMS in comparison with ground transportation for both traumatic and non-traumatic patients.

The prevalence of risk factors associated with non-communicable diseases in Afghan refugees in southern Iran: a cross-sectional study.

BACKGROUND: Refugees are highly vulnerable to many health-related risks. Monitoring non-communicable diseases (NCDs) is of overriding importance in these populations. This study aimed to investigate the prevalence of risk factors for NCDs amongst Afghan refugees in a refugee camp located in southern Iran. METHODS: This cross-sectional sturdy was conducted in 2018. Risk factors such as inadequate nutrition, physical inactivity, tobacco smoking, obesity and overweight, hypertension (HTN), elevated fasting plasma glucose (FPG), and dyslipidaemia were assessed. Data were gathered with a modified WHO STEPS procedure. Prevalence and age-standardized prevalence and their 95% confidence intervals (CI) were estimated. RESULTS: The estimated prevalence were 94% for inadequate fruit/vegetable consumption, 18% for physical inactivity, 9% for tobacco smoking, 3% for FPG, 20% for HTN, 51% for central obesity, 24% for overweight, 19% for obesity, and 69% for dyslipidaemia. CONCLUSIONS: Except for inadequate fruit and vegetable intake and dyslipidaemia, the prevalence of other NCD risk factors was low among Afghan refugees in Iran. Raising awareness about healthy diet and its importance and the provision of more affordable fruit and vegetables are two effective measures toward improving the health of refugees in Iran.

An Operational Exercise for Disaster Assessment and Emergency Preparedness in South of Iran.

INTRODUCTION: Exercise is an important step in preparation and implementation of disaster risk programs. The aim of this research was the development and assessment of an operational exercise for disaster preparedness in southeast Iran. METHODS: A descriptive cross-sectional study was used to evaluate a 2-day exercise for a level 4 (L-4) scale mock disaster conducted in southeastern Iran in 2017. Seven medical sciences universities participated in the mock disaster exercise: Kerman, Rafsanjan, Bam, Jiroft, Zahedan, Zabol, and Iranshahr medical sciences universities. In total, 990 personnel participated. The disaster preparedness was assessed using a tool designed by the exercise planning team. RESULTS: The present research reveals that the universities of medical sciences in the southeastern hub of Iran are properly prepared for emergencies and disasters. This included the Disaster Medical Assistance Teams and the response operational comprehensive plan for emergencies and disasters. The research findings indicated a preparedness score of 79.8%. The mean arrival time at exercise area (Jiroft City) was 4 hours 35 minutes despite the wide area of Kerman and Sistan and Baluchistan provinces. Personnel safety and security, rapid assessment, communications, logistics, warnings, and news confirmation functions showed higher levels of preparedness. CONCLUSION: The Joint Commission on Accreditation of Healthcare Organizations reported that organizations must perform the performance preparedness exercises on different levels and areas twice a year to be properly prepared for responding to emergencies and disasters. This study can be considered a suitable standard guide for health care organizations to execute exercises for the maintenance and promotion of their preparedness for properly responding to emergencies and disasters at L-4.

A Productive Proposed Search Syntax for Health Disaster Preparedness Research.

OBJECTIVE: To find a proper search strategy to do a systematic review related to preparedness for disasters. METHODS: MeSH and Emtree terms were searched to detect synonyms for two main search terms "disaster" and "preparedness". Expert opinion on the synonyms was examined applying a Google form. The adopted syntax was searched in PubMed and results were sifted. Hand searching in two top key journals was done and sensitivity was calculated. RESULTS: Out of 1120 articles, 122 were included. In PDM journal, 10 articles were included by hand searching, out of which 5 were not spotted in PubMed search with the proposed syntax. In DMPHP journal, 13 publications were included, with 5 not found in PubMed search. Because of human error in hand searching 2 articles were added. CONCLUSION: The proposed syntax in this study achieves a sensitivity of search of 0.6 in PubMed which could be quite applicable for researchers. Moreover, in case only MeSH or Emtree terms were applied in search strategy or where hand searching was not performed, there were a number of articles missed.

Risk Criteria in Hospital Site Selection: A Systematic Review.

INTRODUCTION: Hospitals should be safe and remain functional in emergencies and disasters as it is mentioned in the Sendai Framework. Proper selection of a hospital location has a direct effect on survival of affected population in disasters as well as cost and benefit of the hospital in non-emergency situation. Different studies applied different criteria for Hospital Site Selection (HSS). The present study through a systematic review aimed to find out a categorized criteria list that have been used for (HSS) in the literature. METHODS: In accordance with the PRISMA statement, "PubMed", "ScienceDirect", "Google Scholar", and "Scopus" were searched up to end of 2015. All English Articles that were published in peer-reviewed journals and had discussed site selection criteria for hospitals were included. Out of 41 articles, 15 met the inclusion criteria in which 39 general criteria for HSS were applied. These criteria were categorized in six main groups including cost, demand, environmental, administrative, disaster risk, and "other" concerns through a focus group discussion. RESULTS: Accordingly, the application percentage of cost, demand, environmental, administrative, disaster risk, and "other" concerns in the articles was 100, 93.3, 53.3, 33.3, 20.0, and 13.3 respectively. The least devoted attention was to disaster risk issues. DISCUSSION: Few researchers applied risk related criteria for HSS. Further consideration of "risk of hazards" and "burden of diseases" in comprehensive studies, is recommended for HSS to guide the decision makers for building more resilient hospitals. Keywords   Hospital, Site selection, Systematic review, Disaster risk.

Women's Challenges and Capabilities in Disasters: A Case Report of the Twin Earthquakes of Eastern Azerbaijan, Iran.

Introduction: The twin earthquakes of eastern Azerbaijan induced considerable devastations of many villages and cities. About 70% of all victims were women and children. The present case report was aimed at describing the lessons learnt from both capabilities and challenges of girls and women after the twin earthquakes of eastern Azerbaijan. Methods: A qualitative approach using in-depth unstructured interviews was used for this study. A total of 13 participants (two men and 11 women), affected by the quakes, were interviewed applying the purposeful sampling method. A manifest content analysis was performed for analyzing the transcribed interviews Case presentation: Two categories of women's capabilities and challenges and four subcategories of women's participation in community reconstruction, livelihood efforts, aggravated poverty and violence were extracted from the data which were gathered in the destroyed fields of eastern Azerbaijan. Lessons learnt: Women can play an important role in post-disaster recovery. Consequently, ignoring the challenges and capabilities of women may impede post-disaster development processes, which would adversely affect the whole community.

Tehran dust storm early warning system: corrective measures.

On June 2, 2014 a sandstorm hit Tehran, the capital city of Iran which killed 5 and injured 44 people. The early warning system did not operate properly and the alarm was not transferred to at risk population and the related organizations in time and in a right manner. Additionally, people who were exposed to the winds didn't know the appropriate safety measures. Focusing much more on establishing EWS to alert the risk prone population timely and public education for taking safety measures when exposed to the disastrous situation is recommended.