Different populations and areas of the world experienced diverse COVID-19 hospitalization and mortality rates. Claims data is a systematically recorded source of hospitalized patients' information ...that could be used to evaluate the disease management course and outcomes. We aimed to investigate the hospitalization and mortality patterns and associated factors in a huge sample of hospitalized patients. In this retrospective registry-based study, we utilized claim data from the Iran Health Insurance Organization (IHIO) consisting of approximately one million hospitalized patients across various hospitals in Iran over a 26-month period. All records in the hospitalization dataset with ICD-10 codes U07.1/U07.2 for clinically/laboratory confirmed COVID-19 were included. In this study, a case referred to one instance of a patient being hospitalized. If a patient experienced multiple hospitalizations within 30 days, those were aggregated into a single case. However, if hospitalizations had longer intervals, they were considered independent cases. The primary outcomes of study were general and intensive care unit (ICU) hospitalization periods and case fatality rate (CFR) at the hospital. Besides, various demographic and hospitalization-associated factors were analyzed to derive the associations with study outcomes using accelerated failure time (AFT) and logistic regression models. A total number of 1 113 678 admissions with COVID-19 diagnosis were recorded by IHIO during the study period, defined as 917 198 cases, including 51.9% females and 48.1% males. The 61-70 age group had the highest number of cases for both sexes. Among defined cases, CFR was 10.36% (95% CI: 10.29-10.42). The >80 age group had the highest CFR (26.01% 95% CI: 25.75-26.27). The median of overall hospitalization and ICU days were 4 (IQR: 3-7) and 5 (IQR: 2-8), respectively. Male patients had a significantly higher risk for mortality both generally (odds ratio (OR) = 1.36 1.34-1.37) and among ICU admitted patients (1.12 1.09-1.12). Among various insurance funds, Foreign Citizens had the highest risk of death both generally (adjusted OR = 2.06 1.91-2.22) and in ICU (aOR = 1.71 1.51-1.92). Increasing age groups was a risk of longer hospitalization, and the >80 age group had the highest risk for overall hospitalization period (median ratio = 1.52 1.51-1.54) and at ICU (median ratio = 1.17 1.16-1.18). Considering Tehran as the reference province, Sistan and Balcuchestan (aOR = 1.4 1.32-1.48), Alborz (aOR = 1.28 1.22-1.35), and Khorasan Razavi (aOR = 1.24 1.20-1.28) were the provinces with the highest risk of mortality in hospitalized patients. Hospitalization data unveiled mortality and duration associations with variables, highlighting provincial outcome disparities in Iran. Using enhanced registry systems in conjunction with other studies, empowers policymakers with evidence for optimizing resource allocation and fortifying healthcare system resilience against future health challenges.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Personal Protective Equipment (PPE) Portraits is a hybridized art and medical intervention that lessens the alienating appearance of PPE through wearable, smiling headshot pictures. During the ...pandemic, the use of these portraits was expanded, but Canadian initiatives offered portraits only to immediate stakeholders. PPE Portraits Canada (PPC) aimed to provide PPE portraits to any Canadian healthcare institution and surveyed healthcare workers (HCW) regarding these portraits' impact. University student volunteers founded PPC via online platforms and coast-to-coast collaborations that allowed any HCW nationwide to request a free portrait via an accessible online form. PPC has gathered feedback from participating HCWs directly via an anonymous and bilingual survey. 70% of HCWs wore their portraits "always" or "usually", 69% of HCWs "definitely would" recommend their portrait, 89.5% of HCWs found that the PPE portraits made a difference in their experiences with patients and 74% found the same for their colleagues. The pre- and post-effect of the portraits, led to a 37.5% greater likelihood that HCWs felt "connected" or "very connected" to patients/residents. For the thematic analysis, 70% or more of the comments were rated as positive, with less than 5% of comments being rated as negative. This model's logistical framework can be expanded beyond PPE portraits to other initiatives with limited resources, allowing them to reach and positively impact diverse populations. HCW feedback was predominantly positive. The optimal design and impact of PPE portraits on patients and HCWs should be studied further to improve portrait adoption.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Despite major investment in both research and policy, many pressing contemporary public health challenges remain. To date, the evidence underpinning responses to these challenges has largely been ...generated by tools and methods that were developed to answer questions about the effectiveness of clinical interventions, and as such are grounded in linear models of cause and effect. Identification, implementation, and evaluation of effective responses to major public health challenges require a wider set of approaches1,2 and a focus on complex systems.3,4
Background: Priority-setting for early access to vaccines during a pandemic optimizes the impact of vaccine rollout, however, low- and middle-income countries (LMICs) have little experience in ...policymaking on this. In the Islamic Republic of Iran, the national clinical ethics committee developed a policy for early access to COVID-19 vaccines with support from the national committee on COVID-19 vaccine. Aims: This paper reports the process and results of a national COVID-19 vaccine priority-setting in the Islamic Republic of Iran and discusses its ethical and cultural aspects. Methods: A multidisciplinary team of experts planned and developed a national guideline following an extensive literature review and face-to-face consultations. Results: We present the list of priority groups and subgroups, tiered through a 4-phase process, as well as the ethical values and sociocultural issues underpinning COVID-19 vaccine prioritization in the Islamic Republic of Iran. Conclusions: Our experience shows that a transparent and well-reasoned policymaking process can inform fair priority-setting for pandemic vaccines, especially in LMICs. Keywords: priority-setting, vaccine, vaccination, COVID-19, prioritization, health policy, ethics, Iran Contexte : La définition des priorités pour l'accès rapide aux vaccins pendant une pandémie optimise l'impact du déploiement des vaccins, mais les pays à revenu faible ou intermédiaire ont peu d'expérience dans l'élaboration de politiques à ce sujet. En République islamique d'Iran, le comité national d'éthique clinique a mis au point une politique pour l'accès rapide aux vaccins contre la COVID-19 avec l'appui du comité national sur le vaccin contre cette maladie. Objectif : Le présent article rend compte du processus et des résultats de l'établissement des priorités nationales en matière de vaccination contre la COVID-19 en République islamique d'Iran et aborde ses aspects éthiques et culturels. Méthodes : Une équipe multidisciplinaire d'experts a planifié et élaboré des lignes directrices nationales à la suite d'une analyse documentaire approfondie et de consultations en personne. Résultats : Nous présentons la liste des groupes et sous-groupes prioritaires, hiérarchisés selon un processus en quatre phases, ainsi que les valeurs éthiques et les questions socioculturelles qui sous-tendent la priorisation du vaccin contre la COVID-19 en République islamique d'Iran. Conclusion : Notre expérience montre qu'un processus d'élaboration de politiques transparent et bien raisonné permet d'éclairer la définition de priorités équitables pour les vaccins pandémiques, en particulier dans les pays à revenu faible et intermédiaire.
Public health is what we do together as a society to ensure the conditions in which everyone can be healthy. Although many sectors play key roles, governmental public health is an essential ...component. Recent stressors on public health are driving many local governments to pioneer a new Public Health 3.0 model in which leaders serve as Chief Health Strategists, partnering across multiple sectors and leveraging data and resources to address social, environmental, and economic conditions that affect health and health equity. In 2016, the US Department of Health and Human Services launched the Public Health 3.0 initiative and hosted listening sessions across the country. Local leaders and community members shared successes and provided insight on actions that would ensure a more supportive policy and resource environment to spread and scale this model. This article summarizes the key findings from those listening sessions and recommendations to achieve Public Health 3.0.
The 2019 coronavirus (COVID‐19), also known as SARS‐CoV‐2, is highly pathogenic and virulent, and it spreads very quickly through human‐to‐human contact. In response to the growing number of cases, ...governments across the spectrum of affected countries have adopted different strategies in implementing control measures, in a hope to reduce the number of new cases. However, 5 months after the first confirmed case, countries like the United States of America (US) seems to be heading towards a trajectory that indicates a health care crisis. This is in stark contrast to the downward trajectory in Europe, China, and elsewhere in Asia, where the number of new cases has seen a decline ahead of an anticipated second wave. A data‐driven approach reveals three key strategies in tackling COVID‐19. Our work here has definitively evaluated these strategies and serves as a warning to the US, and more importantly, a guide for tackling future pandemics. Also see the video here https://youtu.be/gPkCi2_7tWo
Don't take socioeconomic risks with this one! A data‐driven approach serves as a warning to the US and a guide for dealing with new pandemics. Three key strategies in tackling COVID‐19 emerge from this comparative analysis of new case numbers between China, the European nations, and the US, and a timeline of the measures taken in response to the outbreaks.
Fourteen months into the SARS-CoV-2 pandemic, we identify key lessons in the global and national responses to the pandemic. The World Health Organization has played a pivotal technical, normative and ...coordinating role, but has been constrained by its lack of authority over sovereign member states. Many governments also mistakenly attempted to manage COVID-19 like influenza, resulting in repeated lockdowns, high excess morbidity and mortality, and poor economic recovery. Despite the incredible speed of the development and approval of effective and safe vaccines, the emergence of new SARS-CoV-2 variants means that all countries will have to rely on a globally coordinated public health effort for several years to defeat this pandemic.
Unhealthy weight, especially childhood obesity, is emerging as a growing epidemic and a challenge in developed and developing countries. Partnership with parents to promote healthy lifestyle changes ...may have a lifelong impact on weight-related outcomes in children. This study aims to determine the efficacy of an Interactive Malaysian Childhood Healthy Lifestyle (i-MaCHeL) intervention programme to change weight-related behaviour in preschool child-parent dyads. The i-MaCHeL programme is a single-blind, theory-driven intervention, two-group cluster randomised controlled trial that evaluates the efficacy of a 3-month health promotion intervention in preschool child-parent dyads. In recognition of the value of multiple theoretical approaches, the strong theoretical basis consists of Social Cognitive Theory, Health Belief Model, and Trans-Theoretical Model principles underpinning the development of the intervention programme. In total, 460 child-parent dyads from 12 preschools in Terengganu, Malaysia, will be recruited. The children in the intervention group will expose to the i-MaCHeL classroom activities, while the parents will access the i-MaCHeL Web-based educational programme and numerous parent-child home-based online activities. The children in the control group will continue with any existing health-related activities, while the parents will receive the link to the general health newsletters. BMI z-score, dietary intake, physical activity, screen time duration, health-related quality of life, parental self-efficacy, parental role modelling, and parental policies will be assessed at baseline, 3 months' post-baseline, and at 6 months' follow-up (9 months' post-baseline). General linear model repeated measure analysis will be used to determine differences between groups at the 3- and 9-month surveys with adjustment for potential covariates. Statistical analyses will follow intention-to-treat principles. We hypothesise that the combination of the classroom and interactive Web-based activities will have a strong potential to be effective strategies to sustain child-parent engagement and participation in the weight-related behaviour change programme.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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