Comparison of vaccine hesitancy during the low and high points of COVID-19 in a population under international sanctions: A longitudinal mixed-methods study in Iran.

Introduction: Along with the challenges of COVID-19 vaccine supply in low-income countries, vaccine hesitancy was another problem for the health system. The aim of this study was to deeply understand the challenges of vaccine acceptance, the vaccination process, and to compare the affecting vaccine acceptance in the high and low points of the epidemic in Iran. Methods: In the qualitative part of this mixed-methods study, content analysis was used to investigate experiences and perceptions about COVID-19 vaccination in four groups. In the quantitative study, in March 2021 (low point), and on August 1, 2021 (high point), two population-based cross-sectional studies were performed in Tehran and its rural, with sample sizes of 1,200 and 1,872 people aged over 18 years, respectively. Multinomial (polytomous) logistic regression was used to determine the factors affecting hesitation and unwillingness to receive the vaccine. Results: Disbelief in vaccine safety, vaccine distrust, ignorance and confusion, and inadequate facilities were the common reasons extracted in the two qualitative studies. At the low and high points of the epidemic, vaccine acceptance was 83.6% (95% CI: 81.3-85.9) and 65.8% (95% CI: 65.8-71.0), respectively. Residence in rural areas, (Odds Ratio: 0.44, p = 0.001), being a student (Odds Ratio: 0.41, p = 0.011), housewives (Odds Ratio: 0.63, p = 0.033), illiteracy (Odds Ratio: 4.44, p = 0.001), and having an underlying disease (Odds Ratio: 4.44, p = 0.001) were factors affecting on vaccine acceptance. Discussion: Counter-intuitively, acceptance did not increase at the peak of epidemic. The presence of obstacles, such as increased distrust in the effectiveness of vaccines due to the occurrence of multiple peaks in different vaccinated countries, as well as the influence of the media, anti-vaccine campaigns, and lack of proper communication about risks caused more hesitation. More investigation to understand how people accept or reject vaccine and its long term consequences is recommended.

The Barriers, Challenges, and Strategies of COVID-19 (SARS-CoV-2) Vaccine Acceptance: A Concurrent Mixed-Method Study in Tehran City, Iran.

Acceptance and willingness to receive the vaccine are among the main factors in the success or failure of a health system in implementing the vaccination program. The present study was conducted in Tehran, the political and economic capital of Iran, to determine the acceptance of the COVID-19 vaccine and identify its associated factors, and explain the most important barriers and acceptance strategies for vaccination. This research was a concurrent quantitative and qualitative mixed-method study. In the quantitative part, 1200 individuals aged more than 18 years were selected from the households in 22 districts of Tehran City, with a multistage stratified cluster sampling method. Two questionnaires were used to evaluate the acceptance of the COVID-19 vaccine and vaccine acceptance determinants. The qualitative content analysis method addressed the influencing factors, as well as challenges and strategies related to the acceptance of the COVID-19 vaccine in four groups of Tehran inhabitants: the elderly, people with underlying diseases, healthcare workers, and the general population. The related data were simultaneously collected by applying in-depth semi-structural interviews and a data analysis process. Furthermore, we used the Graneheim and Lundman method for data analysis. We analyzed the data of 1200 people with a mean (SD) age of 46.4 (11.1) years, and approximately 58% of them were men. The vaccine acceptance was 83.6% (95% CI: 81.3-85.9). Among those who welcomed vaccination, 58% preferred the imported vaccines, 25% the Iranian ones, and 17% both. There was a significant association between the variables of age (adjusted odds ratio [AOR] = 1.72, 95% CI: 1.01-2.93), being single (AOR = 0.54, 95% CI: 0.41-0.91), moderate pharmacotherapy adherence (AOR = 0.58, 95% CI: 0.4-0.85), and the willingness to receive COVID-19 vaccine. Qualitative study after interviewing 45 people from four study groups showed an insufficient social trust in healthcare system officials, pharmaceutical and vaccine production companies; distrust in the effectiveness of the vaccines, concerns about the vaccine adverse effects, being tracked by microchips after vaccination, traditional anti-vaccination movements, the feeling the inessentiality of vaccination, and uncertainty about the fair distribution of the vaccine. These concerns were the main challenges addressed by the study groups. A good proportion of Tehran residents reported their willingness to receive the COVID-19 vaccine. Additionally, they expressed their critical concerns, such as insufficient trust in the healthcare system, vaccine safeties, and adverse effects that were the significant barriers to vaccine acceptance. It seems that conflicts raised by the shortage of vaccines and their import due to the sanctions have led to intense desire and demand in the general population, and especially the elderly, for vaccination. Besides, vaccination phobia in some individuals requires further investigations.

The growth trend of never-married elderly population in Iran in the third millennium.

BACKGROUND: Statistics show that the age of the Iranian population is advancing, and the marriage age is increasing as well. Clearly, an increase in the number of never-married older adults is expected. The aim of this descriptive, analytical study was to determine the growth trend of never-married older population and its association with education level in Iran. METHODS: Based on the raw data collected from the Statistical Center of Iran, we studied the population of never-married older adults in the past 25 years and evaluated the growth pattern in different parts of Iran, using ArcGIS software. We also examined the association of singlehood in late life with education in men and women residing in rural and urban areas, using the Chi-square test in SPSS version 22. RESULTS: A sharp increase was observed in the population of never-married older adults, particularly women, in the past 10 years. Women with formal education from urban and rural areas were more likely to be never married in late life (χ2 = 10455.35, P < 0.001 and χ2 = 271.31, P < 0.001, respectively). Older men with formal education from urban areas were more likely to be never married (χ2 = 35.44, P < 0.001), while men with formal education from rural areas were less likely to be never married (χ2 = 179.13, P < 0.001). CONCLUSION: The rate of increase in the population of never-married older women was much higher than the overall growth of older population. Women with formal education, particularly those with university and pre-university degrees, were more likely to be single in late life. It is strongly suggested to determine the causes and process of singlehood in old age in future research, including qualitative studies.

Bitter experiences of elderly parents of children with intellectual disabilities: A phenomenological study.

BACKGROUND: It is predicted that over the next 30 years, there will be a significant increase in the number of elderly parents who care for their children with intellectual disability. This paper is part of a larger qualitative study which investigated the unpleasant experiences of these parents. MATERIALS AND METHODS: A phenomenological approach was adopted and data were collected through unstructured in-depth interviews with elderly parents of children with intellectual disability. The data were analyzed using Colaizzi's seven-step method. RESULTS: "Bitterness" is one of the four emergent themes extracted in this study which has five theme clusters: inappropriate behavior toward the child in the society, the society's failure to support the child with intellectual disability, sorrows experienced by parents, the child's problems, and barriers in the care of the child with intellectual disability. One significant barrier in the last theme cluster is limitations due to aging. CONCLUSIONS: The findings of this study suggest that the elderly parents of children with intellectual disability experience many sorrows and unpleasant feelings, but they mostly consider the social factors as the cause of problems and not the presence of the child. The results also indicate that older parents cannot look after the child as before in their old age; so, future well-designed studies are required for identification of the process of supporting them.

Skiing injuries at the dizin ski resort.

Skiing is one of the more popular winter sports which may cause injuries. The objective of this study was to identify the most common types of injuries in Iran's largest ski resort. This cross-sectional descriptive study was performed on 1233 of patients admitted to the Dizin Resort Infirmary in 2008-2009. Obtained data included age, gender, injury type and medical interventions. All data were analyzed by SPSS 16.0 software. Results showed that 75% of the patients were male and 25% female. The mean age was found to be 27.86 (± 9.95) years. Most patients were between 20-29 years old (55.2%). The most common injury was knee trauma (14.4%). Other common injuries were soft tissue injury (12.1%), shoulder trauma (8.1%), head and face trauma (7%) and wrist trauma (5.5%) respectively. There was a significant relationship between age and sex i.e. the age in women was less than men's (P < 0.001). We found a relationship between age and injury type. The lowest mean age (24.83) was reported in the patients with head and face injuries and the highest mean age (44.5) was in the patients with malleolus fracture (P < 0.001). Additionally, sex and knee trauma proved to be connected with more prevalence in women (P = 0.001). There was also a significant relationship between sex and shoulder injuries showing a higher prevalence in men (P = 0.015).