COVID-19 pandemic has disrupted the continuity of care for chronic patients: evidence from a cross-sectional retrospective study in a developing country.

BACKGROUND: Any disruption in continuity of care for patients with chronic conditions can lead to poor outcomes for the patients as well as great damage for the community and the health system. This study aims to determine the continuity of care for patients with chronic conditions such as hypertension and diabetes during COVID-19 pandemic. METHODS: Through a cross-sectional retrospective study, data registered in six health centers in Yazd, Iran were analyzed. Data included the number of patients with chronic conditions (hypertension and diabetes) and average daily admission during a year before COVID-19 pandemic and the similar period after COVID-19 outbreak. The experience of continuity of care was assessed applying a validated questionnaire from a sample of 198 patients. Data analysis was done using SPSS version 25. Descriptive statistics, independent T-Test and Multivariable regression were used for analysis. FINDINGS: Results indicate that both visit load of the patients with chronic conditions (hypertension and diabetes) and their average daily admission were decreased significantly during a year after COVID-19 pandemic compared to the similar period before COVID-19 outbreak. The moderate average score of the patients` experience towards continuity of care during the pandemic was also reported. Regression analysis showed that age for the diabetes patients and insurance status for the hypertension patients affect the COC mean scores. CONCLUSION: COVID-19 pandemic causes serious decline in the continuity of care for patients with chronic conditions. Such a deterioration not only can lead to make these patients` condition worse in a long-term period but also it can make irreparable damages to the whole community and the health system. To make the health systems resilient particularly in disasters, serious attention should be taken into consideration among them, developing the tele-health technologies, improving the primary health care capacity, designing the applied responsive models of continuity of care, making multilateral participations and inter-sectoral collaborations, allocating sustainable resources, and enabling the patients with selfcare skills are more highlighted.

Models and components in disaster risk communication: A systematic literature review.

BACKGROUND AND AIM: Risk communication is considered a major factor in disaster risk management by the concerned policymakers and researchers. However, the incoherence of variables affecting risk communication in various studies makes it difficult to plan for disaster risk communication. This study aims to identify and classify the influential components in disaster risk communication. MATERIALS AND METHODS: This systematic review was conducted in 2020. Databases included PubMed, Scopus, and Web of Science. In searching for articles, there was no limit on the date of publication and the language of the article. The research addressed both natural and man-made disasters. The Preferred reporting items for systematic review and meta-analysis protocols (PRISMA) checklist was followed throughout the research, and the quality of the papers was assessed using the mixed methods evaluation tool (MMAT). RESULTS: In searching the articles, 3956 documents were obtained, of which 1025 duplicated articles were excluded. The titles and abstracts of the remaining documents (2931) were examined, of which 2822 were deleted, and the full text of 109 documents was studied for further assessment. Finally, after applying the inclusion and exclusion criteria and reviewing the full texts, 32 documents were considered to extract the data and for quality assessment. On studying the full text of the obtained documents, 115 components were found, which were classified into five groups (message, message sender, message receiver, message environment, message process) and 13 subgroups. In addition, the obtained components were classified as those proposed by the authors of the article and those obtained from disaster risk communication models. CONCLUSION: Identifying the effective components in the disaster risk communication gives a more comprehensive view of risk communication to the disaster managers and executives and provides the decision-makers with an important platform to be able to use the components of risk communication and increase the impact of messages and ultimately increase people's preparedness for disasters in planning operations for the risk communication.

Burden of road traffic injuries in Iran: a national and subnational perspective, 1990-2019.

OBJECTIVES: Reliable and valid information on burden of road traffic injuries (RTIs) is essential for short-term and long-term planning. We designed the present study to describe the levels and trends of burden of RTIs in Iran from 1990 to 2019. METHODS: This is an observational epidemiological study. We used the Global Burden of Disease (GBD) 2019 estimates to report RTIs incidence, prevalence, mortality and disability-adjusted life-years (DALYs) by sex, age group and road user category in Iran and each of the 31 provinces from 1990 to 2019. RESULTS: Age-standardised incidence, prevalence, death and DALY rates of RTIs decreased by 31.7% (95% uncertainty interval (UI): 29.4 to 33.9), 34.9% (33.8 to 36.0), 57.7% (48.1 to 62.3) and 60.1% (51.7 to 65.2), respectively between 1990 and 2019. The 2019 age-standardised DALY rates varied from smallest value in Tehran 303.8 (216.9 to 667.2) per 100 000 to largest value in Sistan-Baluchistan 2286.8 (1978.1 to 2627.9) per 100 000. The burden of RTIs was mainly related to injuries sustained by drivers or passengers of motorised vehicles with three or more wheels and pedestrians' injuries, mostly affected males aged 15-29 years and individuals aged ≥70 years. CONCLUSION: The reducing trend in the burden of RTIs in Iran possibly reflects the effectiveness of the intervention programmes. However, with regard to the Sustainable Development Goals the burden is still at an alarming level. Further reductions are necessary for specific road user groups such as adolescent and adult male drivers or passengers of motorised vehicles, also pedestrians aged ≥70 years.

Social vulnerabilities among immigrants and refugees in emergencies and disasters: a systematic review.

Background: Due to cultural, economic, and societal factors, immigrants and refugees are pivotal groups in dealing with social vulnerability in disasters. Ignoring or inadequate attention to those groups in preparing for and responding to disasters and health emergencies could decrease the effectiveness of efforts. This article aims to identify the most basic social vulnerabilities among immigrants and refugees and provide effective solutions to alleviate or eliminate these vulnerabilities. Methods: This systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The main keywords include Social Vulnerabilities, Immigrants, Refugees, and Disasters. All articles published up to February 2023 were reviewed regardless of language and location. A total of 575 articles were extracted from SCOPUS, Web of Science, ScienceDirect, ProQuest, PubMed, EMBASE, and PsycINFO databases, and finally, 14 articles were selected for full-text analysis. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was used to evaluate the quality of the selected articles. Results: Fourteen articles including 4 qualitative and 10 quantitative articles were selected and analyzed in this review. The findings showed: 1. According to the consensus of the studies, the most vulnerable people who need urgent care during an epidemic due to their special conditions are immigrants and refugees; 2. In most countries, no database provides reliable, up-to-date, and accurate statistics about these people; 3. Refugees usually hesitate to express their vulnerability and receive services due to the fear of deportation; and 4. The main challenges faced by refugees are socio-economic problems such as language problems, lack of emotional and social support, and living in crowded places. Conclusion: Considering the prevalence of migration among countries, it is essential to identify the social problems and vulnerabilities of immigrants and provide effective solutions to cope with their challenges, especially during crises and emergencies. Systematic review registration: https://clinicaltrials.gov/, identifier CRD42022371345.

Psychosocial Safety Climate of Employees During the COVID-19 Pandemic in Iran: A Policy Analysis.

OBJECTIVE: Iran is among the top 15 countries in the world in terms of coronavirus disease (COVID-19) infection rates. The numbers of infections and deaths are still increasing in September 2020. This study aims to investigate the impact of the policies on terminating the quarantine period on the perception of psychosocial safety by employees and workers in Iran. METHODS: In this study, policy announcements and regulations, media reports, and the results were collected from 2 previously published population surveys that collected employees' views of the government approach to quarantine. The information thus collected was then analyzed using the "What is the Problem Represented (WPR)" approach for data analysis introduced by Carol Bacchi, and focuses on the question, "What effects are produced by the representation of the problem?" RESULTS: The Iranian Government decided to quarantine people and close most sectors during the New Year holidays in Iran in March 2020. The duration of quarantine was only 2 weeks, and the government then ordered government organizations and industrial companies to reopen. The advantage of a short quarantine period is assumed to be the reinstatement of productivity while the disadvantage is the likely risk of further transmission of the virus. CONCLUSION: The government approach to and communication about the quarantine period has neglected to consider the psychosocial safety climate of employees, who have to go to their workplaces using buses, subways, or other vehicles, and who are under pressure mentally because of fear of infection, dismissal for non-attendance, and the consequent economic problems. The government approach necessarily impacts on the perceived psychosocial safety climate of employees, and hence influences the causes of work stress. If the psychosocial safety climate is not considered and improved, it may reduce the quality of services and products, and increase accidents.

The challenges of strategic management of the wastage produced due to earthquake in Kermanshah and Varzaghan-Ahar: A qualitative study.

BACKGROUND: Strategic management of the wastage produced due to earthquakes has faced many challenges over the recent decade. Thus, the present study seeks to identify and explain the challenges in earthquake wastage strategic management. MATERIALS AND METHODS: The present qualitative study has been steered through a content analysis approach and conducted using semi-structured interviews and a purposive selection of 17 professors, experts, and managers experienced in the field of waste management in Kermanshah and Varzaghan-Ahar earthquakes over 2020-2021. Besides, the interviews were initially categorized using MAXQDA18 software. RESULTS: Analysis of the experiences and perception regarding the changes in strategic management of wastage produced due to Kermanshah and Varzaghan-Ahar earthquakes revealed 418 codes, 97 subcategories, 33 categories, and 8 main categories including management and leadership, organizational culture, planning, organizational learning, employee management, rules and regulations, resource management, and procedure management. CONCLUSION: Strategic waste management has not been implemented in a coherent, integrated, and well-planned manner in the cases of the Kermanshah and Varzaghan-Ahar earthquakes. The challenges of strategic waste management turned out to be due to various reasons which will result in many issues in achieving the goals and selecting the suitable method for resource and procedure management should they not be managed well. Hence, policymakers, managers, and executors in the field of crisis management and waste management in disasters -specifically earthquakes- must take the necessary measures to remove these barriers.

Efficiency of COVID-19 Testing Centers in Iran: A Data Envelopment Analysis Approach.

OBJECTIVE: The purpose of this study is to investigate the efficiency of the Iranian Red Crescent Society (IRCS) in managing their nonmonetary resources involved in coronavirus disease 2019 (COVID-19) response. METHODS: For this purpose, the data envelopment analysis approach was used to measure the efficiency, considering the number of personnel and vehicles and screened passengers as the input and output parameters, respectively. It was examined the efficiency of 10 IRCS's branches given 17 d of screening operation. For the analysis, the DEA SolverPro software 15a version was used. RESULTS: The results show that only 1 branch had been fully efficient in using the resources, while 5 branches showed less than 50% efficiency. This study reveals that it is unnecessary to use a fixed number of volunteers at different stations with different passenger numbers. CONCLUSIONS: Using resources without efficient planning can lead to direct costs such as food, transportation, and maintenance, as well as indirect costs such as burnout, fatigue, and stress when responding to the COVID-19 pandemic. This analysis should support IRCS's managers to move their valuable resources from inefficient to efficient centers to increase the screening rate and reduce the fatigue of aid workers for the next pandemic rounds.

Rapid Assessment of COVID-19 Screening Program for Travelers in Iran: A Qualitative Study.

OBJECTIVE: Coronavirus disease 2019 (COVID-19) screening stations set up by Iranian Red Crescent Society have been available for 17 d with the aim of identifying and treating people with coronavirus, reducing road trips, and sensitizing people to the problem. This study aims to investigate the challenges of the procedure. METHODS: A qualitative study was used to find the challenges of the COVID-19 screening centers. Volunteers, branch managers, and headquarter managers of the Iranian Red Crescent Society participated in this study applying snowball sampling. Data were collected by means of in-depth semi-structured telephone interviews in April 2020 after completion of the fever screening plan. All interviews were recorded and transcribed verbatim, always with prior permission of interviewees. RESULTS: The interviews with 20 participants in the plan indicated 6 relevant challenges, including logistics, lack of planning, lack of coordination, legal challenges, mental health, and ethical challenges. CONCLUSIONS: The results indicated that, although establishing fever detection centers in Iran was a rapid response to COVID-19, it had significant flaws in the structure and adversely affected volunteers' and staff's health and financial resources. Therefore, well-structured protocols are required for similar responses in the future.

Child Abuse in Natural Disasters and Conflicts: A Systematic Review.

Violence against children affects a significant portion of youth around the world. Emergencies and natural disasters escalate the risk due to weakened child protection systems and disruption of preventative mechanisms. In this systematic review, 692 related papers were searched in various databases in the initial search. After review, 11 papers were finally selected for full review. These papers were selected based on publication date, relevance to emergencies, their geographical area type of violence, age of subjects, and their gender. Most families affected by natural disasters, especially those in lower socioeconomic status, face greater social and economic pressures. The families that are more vulnerable to loss of food and shelter commit violence against children more frequently. On the other hand, while the rate of violence increases in emergencies, the reported rate of violence is less than the actual rate due to lack of required infrastructure and reporting mechanisms. The emergency housing increased risk of some types of child abuse. The history of exposure to violence, parental substance abuse, poverty, and child labor were predictors of increased violence against children in emergency situations. Sexual violence against girls after conflicts and physical violence against boys after emergencies are common forms of violence. Poverty as another predictor exposes children to more violence due to limited family economic resources and support. Given the identified predictors of violence, humanitarian organizations can come closer to providing appropriate plans to reduce the risk during and postdisaster.

Public-Private-People Partnerships (4P) for Improving the Response to COVID-19 in Iran.

The Public-Private-People partnership (4P) is a significant element in disaster response. Coronavirus disease (COVID-19) as a pandemic has been the worst disaster in the last decades in Iran in terms of exposure and magnitude. In order to respond effectively, the Iranian Government needs an extra capacity, which may be provided by the private sector and people. This study aims to collect evidences of 4P pertaining to the COVID-19 response in Iran from February to April 2020. Partnership case studies are classified into 3 categories: (1) Public-private partnerships; (2) public-people partnerships; and (3) private-people partnerships. It was found that the Iranian Government has removed or diminished some of the barriers to cooperation. There was also more cooperation between the people, the private sector, and the public sector than during normal times (vs disasters). People participated in the response procedure through some associations or groups, such as religious and ethnic communities, as well as through non-governmental organizations. It has been shown that 4P is vital in disaster response and, in particular, to epidemics. The government can be more active in partnerships with the private sector and people in emergencies, such as the COVID-19 pandemic. Enhancing social capital, institutionalization, and developing required infrastructures by the government will improve public-private partnerships.

Correction to: Conceptual model of managing health care volunteers in disasters: a mixed method study.

In the original publication of this article [1], the percent sign at the first row of the Table 2 needs to be deleted. The updated Table 2 is shown below.

Intervention strategies for improvement of disasters risk perception: Family-centered approach.

INTRODUCTION: Today, the role of people in crisis management plans is of particular importance due to the prepared community approach. It is difficult or impossible to attract public involvement due to the low level of public perception of risk. Therefore, it is necessary to discover the status of risk perception and its affecting factors. This study was conducted to investigate factors affecting the strategies of disaster risk perception improvement. MATERIALS AND METHODS: This systematic review study was conducted in 2017 using extensive electronic and library literature searches in the Web of Science, Scopus, and PubMed electronic databases. The preliminary findings included 1030 studies. Out of 941 retrieved references, 925 references were excluded because they did not meet the objectives of this review or did not focus directly on general population. Finally, 16 articles were selected for further investigation. RESULTS: The extracted variables were divided into four general domains: personal, psychological, socioeconomic, and cultural factors. Personal characteristics included sex, age, marriage, level of education, personal knowledge, and disaster personal experience. Psychological factors comprised emotions (fear and insecurity), mental images (beliefs, attitudes), and internal and external control. Cultural factors such as, belief, values, norms, faith, religious, and protective spirit were effective in general perception of disasters risk. Socioeconomic factors such as, income, livelihood, insurance coverage, trust, and fair access to land and resources were also influential. The strategies to improve public disaster risk perception were educational, participatory, incentive, confidence building, supportive, managerial and cultural ones. A family-centered approach is recommended for the better implementation of strategies. CONCLUSION: The improvement of risk perception requires government planning in different fields such as education, research, health, and culture, with an emphasis on social groups especially family.

Conceptual model of managing health care volunteers in disasters: a mixed method study.

BACKGROUND: Shortage of specialized healthcare volunteers is a major challenge during disasters and one solution could be pre-identified healthcare volunteers. This study aimed to develop a conceptual model of managing Iranian healthcare volunteers in disasters. METHODS: This mixed method study was designed in two phases. A qualitative study using semi-structured interviews was conducted with 22 health professionals and key informant. The interviews were analyzed by framework analysis. In the second phase, concepts derived from the first step were evaluated in a two round Delphi study by an expert panel comprised of 42 experts. RESULTS: Two themes and eight subthemes were identified based on the results of the first phase. The theme of background requirements included three sub-themes of laws and regulations, NGOs and socio-cultural factors. The second theme was called operational requirements which included six subthemes of preparedness, response, retention, relocation, terminating and follow-up. According to the results of the Delphi study, all of the concepts were confirmed. CONCLUSION: In addition to the need for supportive legal framework and building the culture of volunteering, it seems it is crucial to identify and prepare the health care volunteers in the preparedness phase and assign them appropriately in the response phase. Furthermore, the necessary measures should be prioritized to enhance volunteers' retention rate and motivation. Plans should also be implemented for volunteers' termination and volunteers' physical and mental health follow up after their mission.