Complicated Grief: The Lived Experiences of Those Bereaved By COVID-19.

The morbidity and mortality rates of COVID-19 pandemic are increasing, and many families have lost their loved ones. This study explored the experiences of families living in Iran who lost a loved one to COVID-19. The researchers apply a descriptive phenomenological approach and draw on in-depth interviews with 18 family members who had lost at least one family member because of COVID-19. Data were analyzed using Colaizzi's method. After reviewing and comparing the consistency of the codes, crisis in crisis, circumstances of death and its consequences, and lack of preservation of patient dignity were extracted as main categories. Neglecting grieving families and related issues can lead to delays and difficulties in the process of recovery and intensification of their psychosocial pressures. Acquiring more knowledge about different impacts of COVID-19 will be helpful for providing timely and better rehabilitation.

Challenges to manage pandemic of coronavirus disease (COVID-19) in Iran with a special situation: a qualitative multi-method study.

BACKGROUND: With the unprecedented expansion of COVID-19 in the world since December 2019, Iran's health system, like other countries, faced various challenges in managing the disease, which led to numerous experiences and lessons learned. This study was conducted to identify these challenges regarding unique political, economic, and cultural issues, which could help other countries with similar situations. METHODS: The present study was performed using a qualitative multi-method approach with a content analysis method. The data were collected through in-depth and semi-structured interviews and focused group discussions with 60 key persons who were selected purposefully, including policymakers, health care workers, and affected people by the disease, and the review of all available national reports between February 21, 2020, and March 22, 2021. The data collection and analysis were done simultaneously. RESULTS: Identified critical challenges for the management of COVID-19 in the health system were limited evidence and scientific controversies, poor social prevention and social inequalities, burnout and sustained workload among healthcare workers, improper management of resources and equipment, the lack of a guideline for contact tracing, and patient flow management, and mental health problems in the community. CONCLUSIONS: According to our results, measures should be taken to conduct a continuous comprehensive risk assessment and develop a national response plan with an emphasis on precise contact tracing, active screening, patient flow, paying attention to the psychological and social dimensions of the disease, and also transparency of social inequalities in the face of risk factors of the COVID-19. Also, the social protection programs should become a vital tool for policymakers and supporting the vulnerable groups using the capacity of the community and international cooperation to develop a vaccine, which is difficult to procure due to the sanctions.

Processing method modulates the effectiveness of black beans for lowering blood cholesterol in spontaneously hypertensive rats.

BACKGROUND: Various foods are known to have beneficial effects on health when consumed whole; however, there is a trend towards preparing foods from processed ingredients, and it remains unclear whether the benefits of the whole food are retained. The purpose of this study was therefore to examine whether different processing techniques affect the lowering of cholesterol and the vascular effects of black beans (Phaseolus vulgaris L.). RESULTS: Beans were prepared by overnight soaking and boiling - the standard method - and by micronization, extrusion, or dehulling and boiling, and they were then fine milled. Beans prepared by the standard method were also coarse milled. These five materials were incorporated into semi-purified diets (30% wt/wt) and fed to spontaneously hypertensive rats for 4 weeks. Body weight, blood pressure, and aorta morphology were unaltered by the diets. Fasting total cholesterol was significantly reduced in rats fed micronized beans compared with extruded beans (both fine-milled) or the bean-free diet, while boiling combined with coarse milling lowered low-density lipoprotein (LDL) cholesterol. The lack of cholesterol lowering in rats fed extruded bean compared to micronized was not explained by the amount or composition of dietary fiber or resistant starch. Differences in the polyphenolic profile as determined by high-performance liquid chromatography (HPLC) were also unable to explain the variations in cholesterol-lowering capacity. CONCLUSION: The present study demonstrates that processing of black beans alters the health effects observed with the whole pulse, and suggests that products prepared with processed ingredients will need to be tested empirically to establish whether the biological effects are maintained in vivo. © 2020 Society of Chemical Industry.

Nursing Care Challenges for Patients Suffering from COVID-19 from Nurses' Perspective in Iran: A Descriptive Qualitative Study.

Background: Encountering the coronavirus disease 2019 (COVID-19) pandemic, nurses face many challenges due to various strategies and resources that can compromise the quality of care. This study aimed to identify nursing care challenges for patients with COVID-19 from nurses' viewpoint in Iran. Materials and Methods: This descriptive qualitative study was conducted in one of the main admission centers in Isfahan to treat patients with COVID-19. Data were collected through semi-structured in-depth interviews with 19 nurses from April 2020 to June 2020. The recorded interviews were transcribed and then analyzed through inductive content analysis. Results: The challenges of nursing care for patients infected with COVID-19 from the nurses' viewpoint were categorized into 11 subcategories and four main categories: work overload in disaster (lack of nurses with adequate clinical qualification and restrictions on the compliance of the infection control protocols), immersion in an ocean of psychological and social tensions (personal and family tensions, work environment tensions, perception of organizational injustice, and social stigma), quality of care in fragile condition (self-preservation rather than patient care and contradictory patient care standards), and disaster preparedness, response, and management (passive resource management, information system challenges, and lack of guideline-supported protocols). Conclusions: The findings of this study suggest that policymakers should actively participate in supporting nurses in the form of reducing physical and mental stress in pandemics such as COVID-19. Having the right perception of the challenges nurses face in such crises can contribute to providing patient safety, improving the quality of care, maintaining organizational resources, and properly managing the disaster.

The Effect of the COVID-19 Pandemic on Environmental Health (Two Sides of the Same Coin): A Systematic Review.

BACKGROUND: The outbreak of the COVID-19 pandemic in late 2019 has led to many changes such as reduced human activities and effects on the environment. There is no big picture of the effects of pandemics on the environment using related evidence. OBJECTIVES: This study was conducted to investigate the effect of the COVID-19 pandemic on environmental health. METHODS: A systematic search of English language studies was performed in major electronic databases; Web of Science, PubMed, Scopus, and Google scholar web search engine from December 2019 to February 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard guidelines were used to follow up the review process. finally 58 articles entered the review procedure. RESULTS: The results of indicate a significant reduction of air pollutants and improved air quality. It improved the water quality of some rivers, canals, and seas during the lockdown of the COVID-19 pandemic. The effects of this disease on the environment cannot be fully described yet. CONCLUSION: In the short term, the amount of air, water, and coastal pollution has been reduced. few studies have examined the effects of pandemics on the environment in the long run, which paves the way for more researches.

Exploring the buffering role of social capital in the development of posttraumatic stress symptoms among Iranian earthquake survivors.

OBJECTIVE: Social capital, or the resources that an individual can draw on through his or her social networks and the value ascribed to these resources by the individual, has been hypothesized to be an important factor in the development of mental health problems following a natural disaster. Nevertheless, little research has been conducted in this area. The present study aimed to evaluate the potential buffering effect of the 2 types of social capital-bonding and bridging social capital-on the association between severity of trauma exposure and posttraumatic stress disorder (PTSD) symptoms in a large sample of earthquake survivors in Iran. METHOD: Participants were 600 adults who survived the Azarbaijan earthquake in Iran. Participants were selected using a multistage sampling method. PTSD symptoms were reported in 37% of the participants, 95% CI [34%, 41%]. RESULTS: Consistent with prior research, significant differences were found between areas that were highly affected and areas that were less affected by the disaster. Although both bonding and bridging social capitals were negatively related to PTSD symptoms, this buffering effect against PTSD symptoms was about 2 times as large for bridging capital than for bonding social capital. CONCLUSION: While bridging and bonding social capital are both significant protective factors for mental health outcomes following natural disasters, bridging social capital may be more important. Future directions for this area of research are discussed, as are policy implications for disaster preparedness and postdisaster interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychosocial challenges and concerns of COVID-19: A qualitative study in Iran.

As the world struggles to cope with the COVID-19 pandemic, it is critical that the psychosocial aspects related to health are attended to in addition to biological aspects. To this end, the present study aimed to explore the challenges and concerns facing people affected by COVID-19. This qualitative study was conducted using the content analysis method. A total of 25 people affected by COVID-19 were selected purposefully and administered semi-structured interviews. The sampling continued until data saturation. Coding and analysis of data were performed simultaneously using the Granheim method. After reviewing codes, checking the consistency and comparing categories, 5 categories, and 15 subcategories were explored. The most important psychosocial challenges of COVID-19 included the lack of accurate and timely dissemination of information, the intensification of economic problems, psychological instability, weakness in social prevention, and the suspension of social rituals. Identifying the psychosocial challenges and problems of people who faced by pandemic diseases such as COVID-19, and developing appropriate and timely planning for managing them can lead to designing effective strategies for prevention, treatment, and recovery of affected communities.

A comprehensive review of the articles published in the field of health in emergencies and disasters in Iran.

Introduction: Iran is one of the most disaster-prone countries in the world. A research-based approach is essential to reduce the effects of disasters and provide effective responses. This study aims to review the articles published in the field of emergencies and disasters in Iran. Methods: a combination of descriptive and qualitative content analysis using Hsieh and Shannon´s method was done. Since the first and most well-known specialized journal in the field of emergencies and disasters in Iran is the Health in emergencies and Disasters Quarterly (HDQ), all articles published in this journal were examined in terms of theme and scientometric indicators. Results: regarding the type of research, 103 were quantitative (66.5%), 18 were qualitative (11.6%), and 4 (2.6%) were performed by mixed method. Most of the articles (n=116, 76.3%) were original research. The most frequently studied risk was traffic accidents (n=17, 10.96%) followed by earthquakes (n=10, 6.45%) and floods (n=8, 5.16%). In terms of theme and content, 103 published articles were related to one of the 4 main phases of the disaster risk management cycle where most of them were related to preparedness (n=48, 46.6%) followed by mitigation (n=26, 25.24%), response (n=20, 19.42%), and recovery (n=9, 8.47%) phases. Conclusion: although there are studies related to the four phases of disaster risk management cycle in Iran, most of them are related to assessing preparedness followed by mitigation. In addition, qualitative and mixed studies could have more significant contribution to this field of research, accelerating this process requires the development of disaster research methodology training and researcher training programs as well as their organized and financial support.

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.

How did older adults respond to challenges after an earthquake? Results from a qualitative study in Iran.

OBJECTIVES: In many areas, natural disasters are a major challenge for life and property of people. Earthquake is one of the most devastating natural disasters. This study aimed to explore how older adults responded to challenges after the earthquake in Iran. METHODS: This study was based on qualitative analysis. Data were collected through in-depth and semi-structured interviews. 29 participants including 18 older adult survivors of the earthquake-stricken areas, four lay caregivers, and three health professionals in disasters, one social worker, two relief worker and one disaster psychologist were interviewed. The interviews were recorded and transcribed. The transcribed texts were analyzed using inductive qualitative content analysis recommended by Graneheim and Lundman (2004). RESULTS: The study explored two main categories regarding older adults' responses to challenges after the earthquake: adaptive and maladaptive responses. Adaptive response has been developed by four factors including; religious coping, sharing feelings and information, coping with new activities, roles and place. Also, maladaptive response was included; the lack of motivation to search for relief supplies, undue dependency, and decrease of social activities. CONCLUSION: Service providers are recommended to identify the patterns of vulnerability and cultural sensitivities in older adults' responses to manage the negative consequences of disasters on older adults. Furthermore, older adults can make a substantial contribution in recovery programs based on the adaptive responses, such as helping in the rescue efforts and psychological support from family and community after disasters.

Are older people more vulnerable to long-term impacts of disasters?

BACKGROUND: Despite the growing interest in the study of disasters, there is limited research addressing the elderly population that lead to prejudiced beliefs that older adults are more vulnerable to disasters than younger adults. This study aimed to compare positive mental health between elderly and young earthquake survivors. METHOD: Data for this study, consisting of 324 earthquake survivors, were obtained from a population-based cross-sectional survey conducted in Iran, 2015. The long-term effect of earthquake was assessed using the Mental Health Continuum-Short Form questionnaire. A one-way multivariate analysis of covariance (MANCOVA) using SPSS (version 22) was used in data analysis. RESULTS: Older adults scored significantly a higher level of overall positive mental health (mean [M]=34.31, standard deviation [SD]=10.52) than younger age group (M=27.48, SD=10.56, t=-4.41; P<0.001). Results of MANCOVA revealed a statistically significant difference between older and young adults on the combined positive mental health subscales (F(3,317)=6.95; P<0.001), after controlling for marital status, sex, and employment status. CONCLUSION: The present findings showing a higher level of positive mental health among elderly earthquake survivors compared with their younger counterparts in the wake of natural disasters suggest that advancing age per se does not contribute to increasing vulnerability.

Challenges for resuming normal life after earthquake: a qualitative study on rural areas of iran.

BACKGROUND AND OBJECTIVE: Growing evidence is indicating that some of disaster affected people face challenges to resume normal life several months after an earthquake. However, there is no sufficient in-depth understanding of complex process of resuming normal life after an earthquake in Iran, as one of the most disaster-prone countries in the world, and in rural areas as a particular setting. This study aimed to explore challenges of return to normalcy in rural earthquake-stricken areas of Iran. METHODS: The study was conducted using qualitative content analysis method (Graneheim approach). Twenty people from the earthquake-stricken areas and seven qualified experts were selected via purposeful sampling .Data was collected through semi-structured interviews, focus group discussions, and field notes from August 2013 to January 2014. Data collection continued to the point of data saturation (no new information was provided by interviewees). Data saturation supported the sample size. Data analysis was based on qualitative content analysis principles. RESULTS: "Social uncertainty and confusion" was the most prominent challenge of return to the normal life after earthquake, which was categorized into six concepts of social vulnerability, lack of comprehensive rehabilitation plan, incomplete reconstruction, ignorance of local social capital, waste of assets, and psychological problems. CONCLUSIONS: Findings showed that social uncertainty and confusion occurs as a result of negligence of some important social aspects in process of returning to the normal life. This issue, in turn, can greatly interrupt the normal developmental processes. Understanding the challenges of life recovery after disasters will help policy makers consider social rehabilitation as a key factor in facilitation of return to normal life process after earthquakes. KEYWORDS: Disaster; earthquake; social rehabilitation; social uncertainty.