Determinants of COVID-19 vaccine acceptance in healthcare workers in Iran: National Survey.

BACKGROUND AND AIM: It seems that acceptance of COVID-19 vaccination is the most effective way to tackle the COVID-19 pandemic now. Health care workers (HCWs) are one of the most important groups who are at risk for COVID-19 infection. This study aimed to assess the COVID-19 vaccine acceptance among HCWs in Iran and its determinants. METHODS: A cross-sectional survey was carried out among 3600 HCWs in Iran. Data were collected through a self-administered questionnaire by a trained team from February to March 2021. Multi-stage cluster sampling method was used for selecting respondents of the study. Multivariate logistic regression analysis was used to determine the key factors of COVID-19 vaccine acceptance among participants. P-value < 0.05 was considered statistically significant. RESULTS: Out of the 3536 respondents, 2191 (62.1%) intended to uptake the COVID-19 vaccine. Only about 10 percent of respondents said they did not trust any vaccine (domestic or foreign). Willing to accept a COVID-19 vaccine was relatively high among males, doctors, and those who had a history of hospitalization due to COVID-19 infection. The multivariate regression analysis showed respondents who were 40-50 years (aOR: 1.56; 95% CI: 1.47-1.66), had a history of COVID-19 infection (aOR: 0.85; 95% CI: 0.83-0.88), and hospitalized due to COVID-19 infection (aOR: 2.18; 95% CI: 1.97-2.39), were significantly associated with vaccine acceptance (p < 0.05). CONCLUSION: Our study showed moderate acceptance of COVID-19 vaccination in the HCWs in the Islamic Republic of Iran. The most important factor in the acceptance of the COVID-19 vaccine by the health staff is having a history of hospitalization. Further training and justification of health personnel is needed to increase the acceptance of COVID 19 vaccine.

National Plan for Chronic Respiratory Diseases Prevention and Control in Iran.

Background: Lower respiratory tract infections, chronic obstructive pulmonary disease (COPD), tuberculosis, and lung cancer are among the leading 10 causes of death worldwide. The Board of Respiratory Diseases Research Network (RDRN), a sub-committee of the Iranian Non-Communicable Diseases Committee (INCDC) is particularly concerned that there should be a coordinated National strategy to address the burden caused by chronic respiratory diseases. Methods: Iranian Ministry of Health and Medical Education (MoHME) has decided to give promotion to the establishment of research networks and use them as the milestones for research management, particularly for the national health priorities. Results: National Service Framework (NSF), which was designed for Chronic Respiratory Diseases, is one of the main outcomes of the chronic respiratory diseases sub-committee of INCDC. The main seven strategies were represented by the Steering Committee in 2010 for a period of 10 years. Successful development and implementation of our goals provide the CRDs sub-committee of INCDC with the opportunity to develop a paradigm to prevent chronic respiratory diseases. Conclusion: A stronger national plan for controlling chronic respiratory diseases will ensure stronger advocacy to support respiratory health at national, sub-national, and regional levels.

COVID-19: Virology, biology and novel laboratory diagnosis.

BACKGROUND: At the end of December 2019, a novel coronavirus tentatively named SARS-CoV-2 in Wuhan, a central city in China, was announced by the World Health Organization. SARS-CoV-2 is an RNA virus that has become a major public health concern after the outbreak of the Middle East Respiratory Syndrome-CoV (MERS-CoV) and Severe Acute Respiratory Syndrome-CoV (SARS-CoV) in 2002 and 2012, respectively. As of 29 October 2020, the total number of COVID-19 cases had reached over 44 million worldwide, with more than 1.17 million confirmed deaths. DISCUSSION: SARS-CoV-2 infected patients usually present with severe viral pneumonia. Similar to SARS-CoV, the virus enters respiratory tract cells via the angiotensin-converting enzyme receptor 2. The structural proteins play an essential role in budding the virus particles released from different host cells. To date, an approved vaccine or treatment option of a preventive character to avoid severe courses of COVID-19 is still not available. CONCLUSIONS: In the present study, we provide a brief review of the general biological features of CoVs and explain the pathogenesis, clinical symptoms and diagnostic approaches regarding monitoring future infectivity and prevent emerging COVID-19 infections.

Psychometric properties of the Persian version of the Cancer attitude inventory.

BACKGROUND: The Cancer Attitude inventory (CAI) was developed to measure attitudes toward cancer. The aim of the present study was to describe the development of the Persian version of the CAI and to evaluate its psychometric properties in an Iranian sample. METHODS: The forward-backward method was used to translate the CAI scale from English into Persian. After linguistic validation and a pilot check, a cross-sectional study was performed and psychometric properties of the Iranian version of the questionnaire were assessed. The scale validation was conducted with a convenience sample of 820 laypeople. Construct validity was assessed through both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Internal consistency was assessed through Cronbach's alpha analysis and test-retest analysis. RESULTS: Five factors were identified in CAI: isolation, helplessness, fear of consequence, belief of control and independence, and fear of death. The results achieved from the CFA displayed that the data fit the model: the relative chi-square (× 2/df) = 2.98 (p < .001), and the root mean square error of approximation (RMSEA) = .07 (90% CI = .06-.07). All comparative indices of the model had scores greater than .80, demonstrating a good fit to the data. Cronbach's Alpha and the intra-class correlation coefficient (ICC) were .97, which is well above the acceptable threshold. CONCLUSIONS: The results indicate that the Persian version of the CAI is practical, reliable and valid. Consequently, the instrument could be used in plans to create positive attitudes about cancer control and treatment among Persian people.

Metabolic syndrome, its components and mortality: A population-based study.

Background: The association between Metabolic syndrome (MetS), its components and mortality has not been clearly established. The aim of this study was to determine the effects of Mets and its components on all cause and cause-specific mortality and to examine whether MetS or its components were better predictors of mortality. Methods: In this retrospective cohort study, we used data from the Zanjan Healthy Heart Study performed in 2003 on 4000 persons. Based on the definitions provided by the NCEP- ATPIII, 1051 participants with MetS and 1219 with none or one of its components at study entry were enrolled. Information regarding the mortality and morbidity of 502 participants with MetS and 523 controls was collected in 2013 by telephone. Cause of death was defined as Cardio-Vascular Disease (CVD) or non-CVD. Data were analyzed using the Cox Proportional Hazards model to estimate the hazard ratios predicted by MetS and its individual components. Results: The median duration of follow-up was 104±10.7 months. Thirty-five deaths occurred, including 18 cardiovascular deaths. The proportion of those with CVD, hypertension, diabetes or hospital stay was statistically higher in MetS patients than controls (p<0.0001). The hazard ratios of all-cause and cardiovascular mortality for those with MetS were 1.75 (%95CI: 0.88-3.47) and 3.66 (%95CI: 1.2-11.1) higher than controls, respectively. Among the components of MetS, only hypertension predicted a higher risk of all-cause and CVD mortality after adjusting for age and sex. Conclusion: The results of this study indicated that MetS was associated with a higher risk of CVD mortality, morbidity, and hospital stay. Among the components of MetS, the association of hypertension was stronger compared to MetS as a whole. Therefore, this study confirms that MetS is a risk factor for CVD mortality, but not beyond the risk associated with its individual components.

Growth velocity of children and its affective factors in northwestern Iran: A longitudinal study using marginal models.

Background: Child growth is an important health indicator in human's lifespan. Evaluating growth variations in infants and children is highly important. This study was conducted to evaluate the risk factors of child growth retardation and determine childhood growth velocity in Zanjan province, Iran. Methods: This longitudinal study was conducted on 7892 children aged 0 to 2 years in Zanjan province in 2013. The sampling method was multi-stage cluster sampling. To determine the growth velocity, 2- pointed model was used. We applied the marginal models of generalized equation estimators (GEE). The related curves were obtained using LOWESS method, and data were analyzed using R Version 2.14.1. Results: In this study, 3879 (49%) of the participants were female, and the mean age of mothers was 27.1±5.4 years. Growth velocity had a significant association with gender, mother's residency, multiple pregnancies, gestational age, and exclusive breastfeeding (p<0.001). A significant association was observed between gender and weight growth velocity (p<0.001). Moreover, exclusive breastfeeding had a significant association with weight growth velocity (p<0.001). Conclusion: Growth velocity in girls was slightly higher than in boys, however, no considerable difference was found between height growth velocity of girls and boys. The findings of this study also indicated that each month increase in exclusive breastfeeding leads to less growth velocity in children. So, exclusive breastfeeding is strongly recommended to prevent childhood obesity.

Prevalence of HIV, HBV and HCV among street and labour children in Tehran, Iran.

OBJECTIVES: The existence of street and working children in Iran is undeniable. The precarious conditions of these children (including disrupted family, poverty, high prevalence of crime among relatives, family members and peers) cause social harm and high-risk behaviours, including drug addiction, selling sex or having sex with adolescents or peers. Here we explore the HIV, hepatitis B and hepatitis C status of street and working children in Tehran. METHODS: One thousand street and labour children, aged 10-18 years, were recruited by using the time-location sampling method, and semistructured questionnaires were used to find demographic information and information on HIV/AIDS-related high-risk sexual behaviours. Blood samples were collected from children, with use of the dried blood sampling method. RESULTS: 4.5% of children were HIV infected, 1.7% were infected with hepatitis B virus and 2.6% were infected with hepatitis C virus (HCV). Having parents who used drug, infected with HCV and having experience in trading sex significantly increased the likelihood of getting HIV among the street children of Tehran. CONCLUSION: HIV prevalence among street children is much higher than general population (<0.1%), and in fact ,the rate of positivity comes close to that among female sex workers in Iran. These findings must be an alarm for HIV policymakers to consider immediate and special interventions for this at-risk group.

Predicting factors for malaria re-introduction: an applied model in an elimination setting to prevent malaria outbreaks.

BACKGROUND: Malaria re-introduction is a challenge in elimination settings. To prevent re-introduction, receptivity, vulnerability, and health system capacity of foci should be monitored using appropriate tools. This study aimed to design an applicable model to monitor predicting factors of re-introduction of malaria in highly prone areas. METHODS: This exploratory, descriptive study was conducted in a pre-elimination setting with a high-risk of malaria transmission re-introduction. By using nominal group technique and literature review, a list of predicting indicators for malaria re-introduction and outbreak was defined. Accordingly, a checklist was developed and completed in the field for foci affected by re-introduction and for cleared-up foci as a control group, for a period of 12 weeks before re-introduction and for the same period in the previous year. Using field data and analytic hierarchical process (AHP), each variable and its sub-categories were weighted, and by calculating geometric means for each sub-category, score of corresponding cells of interaction matrices, lower and upper threshold of different risks strata, including low and mild risk of re-introduction and moderate and high risk of malaria outbreaks, were determined. The developed predictive model was calibrated through resampling with different sets of explanatory variables using R software. Sensitivity and specificity of the model were calculated based on new samples. RESULTS: Twenty explanatory predictive variables of malaria re-introduction were identified and a predictive model was developed. Unpermitted immigrants from endemic neighbouring countries were determined as a pivotal factor (AHP score: 0.181). Moreover, quality of population movement (0.114), following malaria transmission season (0.088), average daily minimum temperature in the previous 8 weeks (0.062), an outdoor resting shelter for vectors (0.045), and rainfall (0.042) were determined. Positive and negative predictive values of the model were 81.8 and 100 %, respectively. CONCLUSIONS: This study introduced a new, simple, yet reliable model to forecast malaria re-introduction and outbreaks eight weeks in advance in pre-elimination and elimination settings. The model incorporates comprehensive deterministic factors that can easily be measured in the field, thereby facilitating preventive measures.

COVID-19 Vaccine Intention Among Iranian Health Workers: Application of the HBM Model.

The study aimed to determine the application of the health belief model (HBM) in the acceptance of COVID-19 vaccination among health workers in 2021. The cross-sectional study was conducted on 3600 health workers from February to March 2021. Data was collected using a researcher-made questionnaire that included the intention to receive vaccines based on the health belief model constructs. Data were analyzed using descriptive statistics indicators, Chi-square, ANOVA test, and logistic regression model at a 95% confidence level. More than 62% of the participants intended to receive the vaccine. The odds of intention to receive the vaccine among people who worked in the health center and did not have a history of hospitalization due to COVID-19 disease were 1.50 and 2.10 units more than the others. Intention to receive the vaccine in individuals with high perceived sensitivity was 1.10 units. Furthermore, in terms of perceived benefits, self-efficacy, and cue-to-action constructs were 1.15, 1.34, and 1.65 units respectively. The rate of vaccine acceptance among Iranian health care workers was relatively good and the constructs of HBM in predicting the rate of intention to receive the vaccine had good applicability.

The effect of peer-to-peer education on health literacy, knowledge, and adherence to COVID-19 protocols in vulnerable adolescents.

BACKGROUND: The study was done to examine the effectiveness of peer-to-peer education on increasing health literacy, knowledge s, and observance of coronavirus disease (COVID-19) health prevention protocols in vulnerable adolescents. METHOD: The study was a one-group intervention (before and after the intervention) that was performed on 1200 vulnerable adolescents living in varamin. The educational intervention was presented to adolescents in a face-to-face session. In the next step, the adolescents were taught the information received by three members of their families. Data were evaluated using a self-designed questionnaire before, and three months after the intervention. The paired t-test was used to compare scores of health literacy, compliance, and knowledge before and after the intervention at a 0.05 confidence level. The Multiple linear regression model was used to determine the predictive factors of observance of COVID-19 preventive behaviors. RESULTS: The most of adolescents were in the age group of 14 to 18 years (60%) and most of them were girls (61.5%). The most important source of information about COVID-19 disease was radio and television (59.6%). The results showed that the effectiveness of the intervention in increasing the adolescents' health literacy, knowledge, and adherence to preventive behaviors were 40%, 30%, and 23%, respectively. The effectiveness of the intervention in increasing their families' health literacy and adherence to the protocols were 11% and 20%, respectively (p = 0.001). DISCUSSION: Involving volunteer adolescents as health ambassadors and transmitting messages and methods of promoting personal protection against COVID-19 epidemics to family members had a significant effect on increasing the knowledge and adherence to the health procedures.

The Psychometric Properties of Intention to Receive the COVID-19 Vaccine Scale Based on the Health Belief Model.

Acceptance of the SARS-CoV-2) COVID-19( vaccine is a very important factor to keep health workers safe. The study aimed to evaluate the psychometric properties of intention to receive the COVID-19 vaccine using a health belief model among health workers in Iran The study was a tools design study that was conducted in the period from February to March 2020, Iran Questionnaire items were designed using text review. The sampling method was multi-stage. Data were analyzed using descriptive statistics, confirmatory and exploratory factor analysis at a 95% confidence level using SPSS software version 16. The designed questionnaire had an appropriate content validity and internal consistency. Also, the exploratory factor analysis showed that a 5-factor structure was extracted and confirmatory factor analyses revealed that the conceptual five-factor structure of the measure had good fit indices. Reliability was evaluated using internal consistency. Cronbach Alpha coefficient was .82 and the intra-class correlation coefficient (ICC) was .9. It can be concluded that the instrument designed in the preliminary stage of psychometrics properties had good validity and reliability indicators. Also, the constructs of the health belief model well explain the determinants of the intention to receive the COVID-19 vaccine at the individual level.

Strategic planning, components and evolution in zoonotic diseases frameworks: one health approach and public health ethics.

Zoonotic diseases are seen as a major public health concern. Routes of the rapid transmission of zoonotic diseases and the economic damage they cause to communities are all reasons why health institutions and systems need to pay more attention to these diseases. Strategic planning is one of the important tasks of policymakers in every organization and system. It is a very reliable and useful tool for leading all kinds of organizations, including health organizations. Countries with clear policy plans have succeeded in controlling and reducing zoonotic diseases. Such countries used appropriate strategic planning and pursued annual goals to control and prevent diseases. Three important steps (strategy development, strategy implementation and strategy evaluation) should be considered in developing a strategic planning for controlling and prevention of zoonotic diseases. Health systems need to develop strategic planning in order to upgrade their capabilities in combating zoonotic diseases. These programs must be flexible, in line with the one health approach, based on the current needs, and aligned with the new challenges faced with health systems. The strategic planning is directly related to national and international policies, organizational goals and missions, dynamism, degree of complexity, and organizational structure of each country's health system.

Identifying challenges for academic leadership in medical universities in Iran.

CONTEXT The crucial role of academic leadership in the success of higher education institutions is well documented. Medical education in Iran has been integrated into the health care system through a complex organisational change. This has called into question the current academic leadership, making Iranian medical universities and schools a good case for exploring the challenges of academic leadership. OBJECTIVES This study explores the leadership challenges perceived by academic managers in medical schools and universities in Iran. METHODS A qualitative study using 18 face-to-face, in-depth interviews with academic managers in medical universities and at the Ministry of Health and Medical Education in Iran was performed. All interviews were recorded digitally, transcribed verbatim and analysed by qualitative content analysis. RESULTS The main challenges to academic leadership could be categorised under three themes, each of which included three sub-themes: organisational issues (inefficacy of academic governance; an overly extensive set of missions and responsibilities; concerns about the selection of managers); managerial issues (management styles; mismatch between authority and responsibilities; leadership capabilities), and organisational culture (tendency towards governmental management; a boss-centred culture; low motivation). CONCLUSIONS This study emphasises the need for academic leadership development in Iranian medical schools and universities. The ability of Iranian universities to grow and thrive will depend ultimately upon the application of leadership skills. Thus, it is necessary to better designate authorities, roles of academic staff and leaders at governance.

Preferred postpartum contraception methods and their practice among married women in Zanjan, Iran.

OBJECTIVES: To explore the preferences of women; once at the time of delivery and then three months later, in using contraceptive methods during post partum period. METHODS: A sample of 575 women who gave birth during July 2007 and February 2008 in Vali-Asre teaching hospital of Zanjan, were recruited and interviewed once after delivery and then three month later. The interview questions included demographic characteristic and questions assessing the tendency of mothers to use the contraceptives they preferred at time of delivery and three months later. RESULTS: According to 537 (93.4%) of interviewed mothers, they intended using at least one contraceptive after getting discharged from the hospital. This figure dropped to 438 (76.1%) three months after delivery. Women who expressed the desire to use minipill after delivery were 169 (29.3%). However this value rose to 187 (32.2%) three months later. The difference was not statistically significant. There was significant relationship between type of contraceptives used and women's age, number of children, place of residence and level of education three months following delivery. CONCLUSION: Results suggest that health care must focus extensively on giving necessary information and consultation to pregnant women also their partners to help to improve selection of most favourite and safe method of contraception.

Requirements for effective academic leadership in Iran: a nominal group technique exercise.

BACKGROUND: During the last two decades, medical education in Iran has shifted from elite to mass education, with a considerable increase in number of schools, faculties, and programs. Because of this transformation, it is a good case now to explore academic leadership in a non-western country. The objective of this study was to explore the views on effective academic leadership requirements held by key informants in Iran's medical education system. METHODS: A nominal group study was conducted by strategic sampling in which participants were requested to discuss and report on requirements for academic leadership, suggestions and barriers. Written notes from the discussions were transcribed and subjected to content analysis. RESULTS: Six themes of effective academic leadership emerged: 1)shared vision, goal, and strategy, 2) teaching and research leadership, 3) fair and efficient management, 4) mutual trust and respect, 5) development and recognition, and 6) transformational leadership. Current Iranian academic leadership suffers from lack of meritocracy, conservative leaders, politicization, bureaucracy, and belief in misconceptions. CONCLUSION: The structure of the Iranian medical university system is not supportive of effective academic leadership. However, participants' views on effective academic leadership are in line with what is also found in the western literature, that is, if the managers could create the premises for a supportive and transformational leadership, they could generate mutual trust and respect in academia and increase scientific production.

Investigation of the relationship between structural empowerment and organizational commitment of nurses in Zanjan hospitals.

BACKGROUND: The demanding nature of nursing work environments signals longstanding and growing concerns about nurses' health and job satisfaction and the provision of quality care. Specifically in health care settings, nurse leaders play an essential role in creating supportive work environments to avert these negative trends and increase nurse job satisfaction. OBJECTIVE: The purpose of this study was to examine the relationship between structural empowerment and organizational commitment of nurses. METHODS: 491 nurses working in Zanjan hospitals participated in this descriptive-correlational study in 2010. Tools for data collection were Meyer and Allen's organizational commitment questionnaire and "Conditions for Work Effectiveness Questionnaire-II" (CWEQ-II). Data was analyzed by SPSS16. The statistical tests such as variance analysis, t-test, pearson correlation coefficient and linear regression were used for data analysis. RESULTS: According to the findings, the perception of nurses working in hospitals on "Structural Empowerment" was moderate (15.98±3.29). Nurses believed "opportunity" as the most important element in structural empowerment with the score of 3.18 ±0.79. Nurses working in non-academic hospitals and in non-teaching hospitals had higher organizational commitment than others. There was a significant relationship between structural empowerment and organizational commitment. CONCLUSION: Generally, structural empowerment (relatively strong) correlates with nurses' organizational commitment. We concluded that a high structural empowerment increases the organizational commitment of nurses.

Birthweight Related Factors in Northwestern Iran: Using Quantile Regression Method.

INTRODUCTION: Birthweight is one of the most important predicting indicators of the health status in adulthood. Having a balanced birthweight is one of the priorities of the health system in most of the industrial and developed countries. This indicator is used to assess the growth and health status of the infants. The aim of this study was to assess the birthweight of the neonates by using quantile regression in Zanjan province. METHODS: This analytical descriptive study was carried out using pre-registered (March 2010 - March 2012) data of neonates in urban/rural health centers of Zanjan province using multiple-stage cluster sampling. Data were analyzed using multiple linear regressions andquantile regression method and SAS 9.2 statistical software. RESULTS: From 8456 newborn baby, 4146 (49%) were female. The mean age of the mothers was 27.1±5.4 years. The mean birthweight of the neonates was 3104 ± 431 grams. Five hundred and seventy-three patients (6.8%) of the neonates were less than 2500 grams. In all quantiles, gestational age of neonates (p<0.05), weight and educational level of the mothers (p<0.05) showed a linear significant relationship with the i of the neonates. However, sex and birth rank of the neonates, mothers age, place of residence (urban/rural) and career were not significant in all quantiles (p>0.05). CONCLUSION: This study revealed the results of multiple linear regression and quantile regression were not identical. We strictly recommend the use of quantile regression when an asymmetric response variable or data with outliers is available.

Spatial and non-spatial determinants of successful tuberculosis treatment outcomes: An implication of Geographical Information Systems in health policy-making in a developing country.

This retrospective study aimed to address whether or to what extent spatial and non-spatial factors with a focus on a healthcare delivery system would influence successful tuberculosis (TB) treatment outcomes in Urmia, Iran. In this cross-sectional study, data of 452 new TB cases were extracted from Urmia TB Management Center during a 5-year period. Using the Geographical Information System (GIS), health centers and study subjects' locations were geocoded on digital maps. To identify the statistically significant geographical clusters, Average Nearest Neighbor (ANN) index was used. Logistic regression analysis was employed to determine the association of spatial and non-spatial variables on the occurrence of adverse treatment outcomes. The spatial clusters of TB cases were concentrated in older, impoverished and outskirts areas. Although there was a tendency toward higher odds of adverse treatment outcomes among urban TB cases, this finding after adjusting for distance from a given TB healthcare center did not reach statistically significant. This article highlights effects of spatial and non-spatial determinants on the TB adverse treatment outcomes, particularly in what way the policies of healthcare services are made. Accordingly, non-spatial determinants in terms of low socio-economic factors need more attention by public health policy makers, and then more focus should be placed on the health delivery system, in particular men's health.

Hepatitis B surface antigen prevalence in pregnant women: A cross-sectional survey in Iran.

BACKGROUND: Vertical transmission of hepatitis B virus (HBV) from infected mothers to their neonates is one of the most important routes of infection. The exact prevalence rate of HBV in Iranian pregnant mothers is not well known but based on different studies it is estimated between 0.35% and 6.5%. The aim of this study was to determine the seroprevalence of hepatitis B surface antigen (HBsAg) in pregnant women of selected provinces in Iran. METHODS: At this cross-sectional study, seven provinces supposed to be of high and low prevalence of hepatitis B in the general population selected. Multistage sampling was used to enroll 5261 parturient women who attended the target provinces birth facilities, during January to March of 2011, were recruited to study. To determine the statistically significant mean and proportion differences, t-test and χ (2) test were used, respectively. RESULTS: Overall 1.2% was positive HBsAg of which 11% of them were hepatitis B e-antigen positive as well. The eastern and north eastern provinces were considerably higher in HBsAg seropositivity than the west and northwest of the country. CONCLUSIONS: In view of the considerable prevalence of hepatitis B in pregnant women, screening all pregnant women prioritizing the eastern and north-eastern provinces is strongly recommended.