Letter to the editor
Bishwajit Ghose; Josephine Etowa; Tanjir Rashid Soron
Abstract
Dear Editor, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the third coronavirus to emerge in the past decade after the 2010 SARS-CoV and 2012 MERS-CoV, which originated in China and Saudi Arabia, respectively. The virus is transmitted via small droplets which are produced during ...
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Dear Editor, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the third coronavirus to emerge in the past decade after the 2010 SARS-CoV and 2012 MERS-CoV, which originated in China and Saudi Arabia, respectively. The virus is transmitted via small droplets which are produced during activities such as coughing, sneezing, and talking and spread through close human contact or touching infected surfaces. Since its first reported case in Wuhan, China in December 2020, the virus has proved to be highly infectious, reaching epidemic levels with about 2.8 million COVID-19 cases recorded globally. As a result, the World Health Organization was prompted to declare it as a public health emergency of international concern. The virus is of unknown aetiology and has no clinical countermeasures to date; therefore, prevention is the best strategy to prevent its spread. Many countries have enforced physical distancing, banned public gathering, and restricted mobility and transportation options. However, such preventive measures have side-effects which negatively impact healthcare and population health at various levels. Physicians and nurses treating COVID-19 patients are often required to be isolated from their family. Further, clinicians who are not well-versed in the complexities and risks of infectious diseases are facing new challenges. Patients requiring regular or urgent care (e.g., expectant mothers and patients awaiting elective/ emergency surgery) are experiencing limited access to care. Telehealth can ameliorate some of these side-effects and improve healthcare access along with the quality of life for both patients and practitioners. Telehealth for Curbing the COVID-19 Pandemic Lockdowns and stay-at-home orders limited opportunities for referring to health centres, leading to undiagnosed COVID-19 cases which increases the risk of transmission. For patients with relatively minor conditions which resemble COVID-19 symptoms, the fear of being a source of cross-contamination leads to the self-isolation and reduced uptake of needed healthcare services. Telehealth via user-friendly video chat with health professionals can significantly enhance the diagnostic capacity of healthcare system without an increasing flow at health centres and the associated risk of cross-contamination. Primary assessment algorithms, based on age, symptoms, and comorbid conditions, can also be provided via telehealth to determine whether an in-person medical visit is warranted. Telehealth platforms can also facilitate knowledge sharing and awareness building about COVID-19 risks and prevention. For example, in Singapore, some companies have used chat-bots to share COVID-19 updates and to inform employees of the available help. Telehealth technologies can also be used for training of volunteers and new professionals to address healthcare staffing shortages and for disseminating accurate and timely data to health administrators and policy makers so as to assist them in choosing appropriate responses. Online recording and storage of health-related data can accelerate efforts to understand risk factors, to reach evidence-based interventions, and to fill in the research infrastructure gaps in limited-resource countries so that their researchers, clinicians, patients, and healthcare administrators can find appropriate solutions for advanced research and decision-making. In the context of COVID-19 and beyond, telehealth can add digital infrastructure to tackle pandemics, disastrous events, and post-disaster conditions, as corroborated by experts in other fields (e.g., North Atlantic Treaty Organization Multinational System). Telehealth for Mental Healthcare Services During the Pandemic The socioeconomic impact of COVID-19 (i.e., loss of employment, property foreclosures, and bankruptcies at unprecedented rates) is triggering a mental health crisis as evidenced by a significant increase in depression, sleeplessness, self-harm, suicide, as well as alcohol sales. Further, the fear of being infected or infecting others has been reported as the cause of several suicide cases. The increased suicide rate during the previous SARS-CoV outbreak, due to loneliness and disconnectedness, especially among the elderly, reminds us that supporting the population’s psychosocial wellbeing during the pandemic is as critical as fighting the virus itself. Telepsychiatry, a subclass of telehealth, is a validated method to screen for suicidal dispositions and to provide remote emergency mental healthcare in order to reduce suicide rates. Telemedicine experts can also collect data at physiological distress levels (e.g., the fear of COVID-19 scale) to identify populations at risk of self-harm. Psychiatric patients, especially substance abuse patients who are highly stigmatized and marginalized in terms of accessing healthcare services, face a higher risk of decompensation and addiction relapse as self-quarantine restricts therapy attendance. However, several web-based and smartphone applications already offer drug rehabilitation and withdrawal management services to improve outcomes for substance abuse patients worldwide, confirming that digital health innovations can serve the mental health needs of physically and socially isolated populations. Conclusion The COVID-19 pandemic has challenged practitioners in all fields and overwhelmed even the most advanced healthcare systems. Physical and social distancing requirements have also contributed to the reduced healthcare access, especially for mental health patients whose needs are overshadowed by the public health need to control the spread of the virus. In conclusion, since the COVID-19 crisis was proven to be extremely challenging, telehealth has emerged as a silver lining, which we hope will advance to become a mainstream health service and a standard component of effective public health responses.
Original Article
Ebrahim Sahafizadeh; Mohammad Ali Khajeian
Abstract
Background and aims: Iran had passed the third peak of COVID-19 pandemic, and was probably witnessing the fourth peak at the time of this study. This study aimed to model the spread of COVID-19 in Iran in order to predict the short-term future trend of COVID-19 from April 23, 2021 to May 7, 2021.
Methods: ...
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Background and aims: Iran had passed the third peak of COVID-19 pandemic, and was probably witnessing the fourth peak at the time of this study. This study aimed to model the spread of COVID-19 in Iran in order to predict the short-term future trend of COVID-19 from April 23, 2021 to May 7, 2021.
Methods: In this study, a modified SEIR epidemic spread model was proposed and the data on the number of cases reported by Iranian government from February 20, 2020 to April 23, 2021 were used to fit the proposed model to the reported data using particle swarm optimization (PSO) algorithm. Then the short-term future trend of COVID-19 cases were predicted by using the estimated parameters.
Results: The results indicated that the effective reproduction number increased in Nowruz (i.e., Persian New Year, 1400) and it was estimated to be 1.28 in the given period. According to the results from the short-term prediction of COVID-19 cases, the number of active confirmed cases in the fourth peak was estimated to be 516 411 cases on May 2, 2021.
Conclusion: Following the results from our short-term prediction, implementing strict social distancing policies was found absolutely necessary for relieving the Iran’s health care system of the tremendous burden of COVID-19.
Original Article
Kamran Bagheri-Lankarani; Mohammad-Hadi Imanieh; Amir-Hossein Hassani; Hossein Molavi Vardanjani
Abstract
Background and aims: Public health policies and programs should be adapted to the level of public trust in the healthcare system, as an indicator of the public support level. Accordingly, the data about public trust level in the healthcare system is considered as a critical requirement for managing public ...
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Background and aims: Public health policies and programs should be adapted to the level of public trust in the healthcare system, as an indicator of the public support level. Accordingly, the data about public trust level in the healthcare system is considered as a critical requirement for managing public health crises. This study aimed to rapidly assess the public trust in the healthcare system during the COVID-19 epidemic in Iran, as well as to evaluate the effect of socioeconomic status (SES) on this trust.
Methods: This cross-sectional and web-based study which was conducted in Iran during the COVID-19 epidemic included adults aged 18-60 years. A probability proportional to size multistage random sampling was applied and performed in 15 provinces of the country. Data on the main sources of information about COVID-19, trust in healthcare system, fear level of COVID-19, and demographics were collected via an electronic questionnaire. Multiple linear regression was applied, and adjusted regression coefficients and 95% confidence intervals (CIs) were estimated.
Results: A total of 5250 adults (response rate: 76%) were included in the study. The mean of reported trust scores was 50.3 ± 22.8, and that of fear scores was 72.0 ± 17.8. The highest (65%) and lowest (28%) levels of trust were observed among participants from the lowest and highest SES, respectively. Gender (male) (P = 0.006), higher levels of education (P < 0.001), higher socio-economic status (P < 0.001), and higher fear scores (P < 0.001) were independently correlated with the lower level of ⦰ trust in healthcare system.
Conclusion: It was found that the public trust in Iran’s healthcare system was not high enough at the time of the COVID-19 epidemic in the country, especially among higher social class population.
Original Article
Khadije Alavi
Abstract
Background and aims: Mental health problems are considered as important public health issues. This study aimed, firstly, to investigate the epidemiology of mental disorders’ symptoms among the students of Bojnord University and examine the role of demographic characteristics in the prevalence of ...
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Background and aims: Mental health problems are considered as important public health issues. This study aimed, firstly, to investigate the epidemiology of mental disorders’ symptoms among the students of Bojnord University and examine the role of demographic characteristics in the prevalence of the given symptoms; and, secondly, to explore and compare the predictive role of adaptive and maladaptive emotion regulation strategies in identifying symptoms of different mental disorders.
Methods: A total of 351 students from Bojnord University completing their 2018-2019 academic year were recruited using cluster sampling method and responded to Symptom Checklist-SCL90 and Cognitive Emotion Regulation Questionnaire. Data were analyzed using descriptive statistics including mean, standard deviation, frequency and percentage, as well as multiple regression analysis.
Results: According to the findings from this epidemiological study, 33% of the students suffered from moderate symptoms of mental disorders, while 14% of them suffered from severe symptoms. Demographic characteristics of gender, marital status, and place of origin (i.e., being indigenous/non-indigenous) were not found to exert a significant effect on the prevalence of symptoms of mental disorders. The results of multiple regression analysis also indicated that cognitive emotion regulation strategies were capable of predicting all nine dimensions of mental disorder symptoms. In this regard, the maladaptive strategies were discovered to play a stronger role in predicting mental disorders compared to adaptive strategies.
Conclusions: Mental disorders were very common among university students. No significant relationship was detected between the prevalence of mental disorders’ symptoms and gender, marital status, and place of origin. The study findings were also found to support the trans-diagnostic role of the emotion regulation in mental disorders.
Original Article
Masoumeh Sadat Mousavi; Seyedeh Leila Dehghani; Bahareh Behzad; Samira Pourrezaei; Marzieh Ata’ali
Abstract
Background and aims: Female sex workers (FSWs) play an essential role in the transmission of HIV and are considered critical groups compared to the public groups of society and their customers. Therefore, this study was conducted to investigate the status of sexual intercourse among prostitutes in Shiraz ...
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Background and aims: Female sex workers (FSWs) play an essential role in the transmission of HIV and are considered critical groups compared to the public groups of society and their customers. Therefore, this study was conducted to investigate the status of sexual intercourse among prostitutes in Shiraz in 2015-2016.
Methods: This is a cross-sectional study conducted on 162 prostitutes referred to Shiraz transitional damage reduction centers and the information was gathered through a checklist.
Results: The results showed that the mean age at the first vaginal intercourse was 16.57±3.65. In 62.3% of people, the main reason for prostitution was the need for money to help the family. It was also found that 39.5% of prostitutes had anal sex, and more than 95% of them did not use condoms during sex. There was also a statistically significant relationship (P<0.01) between the age of sexual intercourse and education level.
Conclusion: The results of this study demonstrated that prostitutes initiated the first sexual intercourse at a very young age, and increase in the education level postponed the first sexual intercourse. Otherwise stated, the first sexual intercourse can be delayed by increasing the level of education.
Original Article
Alireza Mirahmadizadeh; Soraya Zahmatkesh; Mohammad Sadegh Kashfinezhad; Fariba Moradi; Hadiseh Rabiei; Ali Mohammad Mokhtari
Abstract
Background and aims: The World Health Organization (WHO) and the United Nations International Children’s Fund have recommended that breastfeeding be continued until two years of age or over. This study aimed to investigate the duration of breastfeeding and weaning in children aged 6-24 months in ...
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Background and aims: The World Health Organization (WHO) and the United Nations International Children’s Fund have recommended that breastfeeding be continued until two years of age or over. This study aimed to investigate the duration of breastfeeding and weaning in children aged 6-24 months in south of Iran.
Methods: This cross-sectional study was conducted in 2017 on 1653 children aged 6-24 months in Fars province of Iran. A multi-stage sampling was used and the data were obtained using a questionnaire including questions about breastfeeding and some related factors, as well as demographic questions about the children and their parents. The required information was collected by visiting and interviewing those mothers who had children aged 6-24 months in their homes. Data were evaluated using SPSS software (version 20.0) and performing descriptive and analytical statistics such as independent samples t test and one-way ANOVA.
Results: On average, the children were breastfed up to 18.64 ± 7.40 months of age and the mean age of initiation of complementary feeding was 5.86 ± 1.04 months. Breastfeeding was stopped for 35.6% of children at the age of 24 months and higher. Mothers having had a normal vaginal delivery had a longer lactation period than mothers who had had cesarean delivery (19.27 and 18.05 months, respectively) (P = 0.021).
Conclusion: A decrease was observed in the mean duration of breastfeeding in this study compared to that obtained in the previous studies, and this decrease was found to be associated with the increase in the occurrence of cesarean delivery in mothers. Therefore, it was recommended that further comprehensive investigations be carried out in this regard.