مجله طب نظامی
سال بیست و دوم شماره 6 (پیاپی 91، شهریور 1399)

SARS-CoV-2 is the most dangerous virus in the coronavirus family and is a serious warning to all countries in the world. Despite the efforts of researchers, there are widespread ambiguities about it. The aim of this study was to compare the clinical and epidemiological characteristics of deceased and recovered patients with COVID-19.

This descriptive-analytical study was performed in patients with COVID-19 in Vasei Hospital in Sabzevar, Iran in March and April 2020. The tools used were the researcher-made questionnaire, interview and medical files.

From the 178 patients, 52.8% were women and the mean age was 57.1±18 years. 85.4% have recovered and 14% have died. Shortness of breath (72.5%) was the most common symptom, followed by cough (61.8%) and fever (48.9%). 43.8% of all patients and 71.9% of deceased patients had at least one underlying disease. There were significant differences in terms of cough in recovered cases and decreased level of consciousness in deceased patients (P <0.05). Increased white blood cell counts, decreased lymphocytes, and increased neutrophils were significantly higher in deceased patients (P <0.05)

Due to the high rate of infection and death in older people with underlying diseases, precautionary measures should be taken in this group. It is also helpful to pay attention to patientschr('39') symptoms in admission to identify the patientchr('39')s prognosis. An increase in white blood cells and neutrophils and a decrease in lymphocytes indicate that the immune system is involved in these patients. More research is needed to identify the pathogenesis and underlying factors in these patients.

Since public health measures are the only way to control the spread of COVID-19, strict quarantine measures have done around the world. This condition will definitely not be without psychological effects. The aim of this study was to determine the factors affecting the stress caused by COVID-19 in the medical staff and the general population.

This cross-sectional study was conducted by a researcher-made questionnaire on 326 people in Qazvin province, Iran in the spring of 2020. The questionnaire consisted of 40 questions, in 3 sections: demographic information, general and main questions related to COVID-19 stress. The questionnaire was made available to the study population in Qazvin through virtual networks.

Of the 326 participants (117 men and 209 women), 71 were medical staff members and 255 in the general population. The mean stress scores of the general population, the medical staff in the corona and non-corona department, were reported 28.7±8.4, 30.1±9 and 27.3±7.8, respectively, with no statistically significant difference among the groups (p=0.374). In the medical staff, access to social response systems (p=0.02), considerable weight change (p=0.019) and reluctance to perform daily activities (p=0.001) were among the factors that had a significant relation with stress score. For the general population, sex (p=0.001), the presence of a high risk elderly person in the family (p=0.001), having a fatal case due to COVID-19 in the family (p=0.014), exacerbation of the underlying disease (p=0.003), job closure (p=0.007), etc had significant relations with stress score.

According to the findings of the present study, the level of stress in the study population was mild, but the psychological effects of coronavirus epidemics are undeniable. Access to psychological counseling systems can be an effective way to improve a personchr('39')s mental state in quarantine.

The lack of any definitive treatment or prevention of COVID-19 has caused a great deal of stress and anxiety in communities. In the present study, depression, stress and anxiety of nurses working in corona wards of hospital were evaluated.

This cross-sectional study was performed with the participation of 125 nurses working in COVID-19 wards of Nohe-Dey Hospital in Torbat-e-Heydariyeh city, Iran in 2020. Data collection tools included a demographic questionnaire and DASS-21 standardized questionnaire.

There were 125 nurses with a mean age of 29.4±6.5 years. The Chi-square test showed that depression, anxiety and stress of nurses were moderate. The one-way analysis of variance test showed that depression with age (P=0.002), anxiety with age (P=0.018), employment status (P=0.009) and satisfaction with personal protective equipment (p=0.015) and stress with age (P=0.011), employment status (P=0.023) are significantly associated.

The rate of depression, anxiety and stress in nurses working in COVID-19 wards in Torbat-e-Heydariyeh Hospital is moderate. It seems that paying attention to training nurses to deal with critical situations similar to COVID-19, and increasing personal protective equipment can be effective in preventing nurses from developing depression, stress, and anxiety.

Surveillance has defined the systematic collection, continuous, analysis and interpretation of health-related information required for the planning, implementation, and assessment of public health performance. This study was aimed to determine the standard structure and components of COVID-19 surveillance and comparison with the Iranian present surveillance system to identify unforeseen components or need to be reviewed, weaknesses, strengths, and providing appropriate solutions.

In this qualitative study, two methods were used: a) reviewing the published guidelines of COVID-19 disease by the Iranian Center for Disease Control, from the beginning of the outbreak to April 19, 2020, and b) The opinion of experts and researchers. The standard structure and components of the COVID-19 surveillance (what standard surveillance must have) were compared with the components of the current surveillance system (what it has).

We found five main structures and 29 components and many various sub-components of the standard surveillance system for COVID-19. According to expert’s comments by comparing the standard surveillance with the current surveillance system, the components related to psychiatric and psychological aspects, epidemiological surveillance, standard precautions, especially for the health workers in close contact with the patient, reporting and social surveillance need to be revised or improved in the current guideline.

Epidemiologic surveillance is the most imperative and effective structure for COVID-19 control. Evaluation indicators are recommended to measure the ability and efficiency of the surveillance system, and also the evidence-based decision-making for appropriate disease control.

The use of geophysical analysis of the epidemiology to identify geographical factors affecting the prevalence of the disease can be effective on community health policies to control the prevalence of the virus. Therefore, the present study is a geographical analysis of the COVID-19 epidemiology in Iran.
Therefore, the purpose of this study is the geographical analysis of coronavirus transmission in the country.

This is a descriptive-analytical study and ArcGIS and GeoDa software has been used to analyze the data. The statistical population included the total number of people infected with COVID-19 (n=21638) in Iran during February 22, 2020, and March 22, 2020. Data entered ArcGIS software by each province. In order to show the spatial distribution of COVID-19 patients in Iran, point density has been used based on the mentioned time period. Then, by using the Moran coefficient, its spatial distribution was examined. Also, by using spatial correlation, the distance between the spread of coronavirus in all provinces of Iran was analyzed. Finally, by using the local index of the single-variable Moran spatial bond, the spatial clustering of the countrychr('39')s provinces was calculated based on the coronavirus.

Statistics show that the age group of 21-50 years is the highest percentage of people infected with COVID-19. The results showed that the most important factor in the spatial spread of coronavirus in Iran is the distance and proximity of the provinces affected by this disease so that at a distance of 383.8 km between the provinces, the Moran coefficient is 0.66627 and shows a positive spatial correlation. It is located at a distance of 762.6 km between the provinces and the Moran coefficient is -0.040246, which indicates a negative spatial correlation, which means that this distance decreases after the number of people with COVID-19. In spatial clustering, HH clusters including provinces (Tehran, Alborz, Qom, Mazandaran, Gilan, Qazvin, Isfahan, Semnan, Markazi and Yazd) are known as the main spatial propagation centers of the Coronavirus epidemic, which should be controlled and reduced. Also, LH clusters (including Golestan, Khorasan Razavi, North Khorasan, Ardabil and Hamedan provinces) are the ring around the center of damage, which should be controlled in terms of spatial interaction and proximity to HH clusters. Serious travel bans should be put in place to prevent the spread of coronavirus to the provinces in the LH cluster.

One of the most important geographical factors affecting the prevalence of coronavirus is based on spatial distribution theory, distance and spatial proximity. Officials and planners should intelligently reduce the number of people visiting offices and organizations, and by providing telecommuting, to prevent the upward trend of the outbreak of coronavirus in Iran.

Since the outbreak of Coronavirus Disease 2019 (COVID-19) in the world, hospitals have played a major role in managing the crisis; therefore, the hospitalchr('39')s readiness to continue medical care in the crisis of COVID-19 has particular importance to communities. The aim of the current study was to determine the readiness of hospitals in Sistan and Baluchestan province, Iran in the COVID-19 crisis.

This is a cross-sectional study and the research population includes all hospitals in Sistan and Baluchestan province, which includes 24 hospitals. The data collection tool was the Comprehensive Hospital Preparedness Checklist for COVID-19, which was translated and validated. Data were collected by sending an online questionnaire to the provincechr('39')s hospitals.

The average score obtained out of 100 in the hospital readiness checklist for COVID-19; in the general information part was 36, the structure for planning and decision making was 53.3, development of a written COVID-19 plan was 40.9, elements of a COVID-19 plan was 46.7, facility communications were 15, consumables and durable medical equipment and supplies were 37.9, identification and management of ill patients were 54.2, visitor access and movement within the facility was 33.3, occupational health was 30.7, education and training was 49 and healthcare services/surge capacity was 19.1. The average total hospital readiness score for COVID-19 was 40.12, which is classified as weak.

The hospitals of Sistan and Baluchestan province received the lowest level of readiness in facility communications among other items of hospital readiness. This indicates that these hospitals are not ready to cooperate and coordinate with each other, and this slows down the process of fighting with COVID-19 in the province. The low amount of healthcare services/surge capacity at the peak of COVID-19 is one of the reasons in which the provincechr('39')s hospitals have not been able to perform well, therefore, it is necessary for the authorities to pay attention to this issue and create serious and quick solutions to increase the readiness of the hospitals in this field in order to reduce casualties and further harm of the society.

The COVID-19 pandemic has a profound effect on various occupations and has different consequences for the working community. This study was designed and conducted to investigate the psychological consequences of the prevalence of COVID-19 on the occupational community in Iran.

This study was a follow-up study that was conducted in two phases (before and during the outbreak of COVID-19) from November 2019 to April 2020 in a chemical industrial complex in South Khorasan province, Iran. The study involved 330 employees in the chemical industry. The lifestyle and burnout of the employees were evaluated and analyzed using Walkerchr('39')s health-promoting lifestyle questionnaire and Maslach burnout inventory questionnaire, respectively.

The participation rate of individuals was 91.2% (301 employees). The mean age and work experience of the subjects were 38.1±13.4 and 9.9±8.7 years, respectively. There was a significant difference between the lifestyle and job burnout values before and during the outbreak of COVID-19 (p<0.05).

The findings of this study showed that the prevalence of COVID-19 has imposed many negative effects on the psychological components of the occupational community such as lifestyle and burnout. Therefore, it is suggested that psychological interventions be performed to improve the mental health of staff to reduce the psychological consequences of the outbreak of this disease.

COVID-19 as a pandemic disease caused many deaths across the world and imposed considerable pressure on health care systems as well as healthcare providers. This study was conducted to clarify the elements and dimensions of experiences among nurses when caring for COVID-19 patients.

This qualitative study was performed using the content analysis method in 16 nursing staffs that were responsible for caring for patients with COVID-19 selected by purposive sampling in April 2020. Deep semi-structured interviews in experimentation format was used to collect data. All interviews were recorded and typed in the MAXQDA software and then analyzed by eight steps including writing interviews, determining the semantic units, text coding, matching codes with text, categorizing and developing categories, reviewing the categories, identifying the subthemes and reporting the findings.  

Overall, 223 codes were extracted from the interviews and after the integration of similarities three key themes including personal protection, structural protection and safety problems were obtained indicating participants’ experiences on self-protection when.

Themes such as personal protection, structural protection and safety problems are the most important concerns raised when nurses caring for COVID-19 patients and should be considered when planning to protect nursing health.

Prevention is the best way to break the transmission chain of COVID-19. The aim of this study was to determine the knowledge, attitude and practice of people regarding home quarantine to prevent COVID-19 in Sabzevar city, Iran.

In the present cross-sectional study in 2020, 836 people from Sabzevar participated. Data were collected by the virtual questionnaire and released in social media by nonprobability methods (Convenience and Snowball). The study questionnaire was researcher-made. The questions included demographics, knowledge, attitude and practice. The validity and reliability of the questionnaire were confirmed. 

The variables of gender, attitude and job on practice, variables of gender, education, job and attitude on knowledge and variables of knowledge, age, gender and underlying disease on attitude toward home quarantine have a significant impact (P˂0.05).

Peoplechr('39')s practice regarding home quarantine to prevent COVID-19 depends on a number of factors. Paying attention to the gender, attitude and occupation of individuals in policy making regarding home quarantine can improve the performance of the public.

Experience is obtained as one of the most valuable human assets in different situations and conditions and helps organizations to achieve their strategic goals. The present study was conducted at the Baqiyatallah University of Medical Sciences with aim of designing and compiling a comprehensive empirical program in confronting the COVID-19 crisis.

This applied research was conducted in qualitative and quantitative methods. The statistical population included 24 university experts, managers and executive experts at Baqiyatallah University of Medical Sciences in April and May 2020. All of these individuals were involved in coping with Covid-19. By holding various meetings with the researchers, and obtaining the opinions of experts with the Delphi technique; the events of the crisis and their main axes in dealing with Covid-19 were counted.

Findings show 5 areas and 25 main axes of the event (crisis with domestic, regional, international sensitivity and major damage); 18 events in the field of command and leadership, 15 events in research, 9 events in training, 22 events in healthcare, 6 events in support in dealing with Covid-19. Healthcare is the most common (22) and spirituality is the lowest (2) frequency.

Due to the Covid-19 crisis, healthcare is the most important axis (22 events) and it is necessary to record experience and document for using in similar crises. This empiricism can be used as a basis for managerschr('39') planning to implement experience documentation in the organization.

COVID-19 has widely spread around the world and has a high mortality rate. The aim of this study was to determine the challenges and strategies to deal with SARS-CoV-2 from the perspective of physicians and nurses in Iranshahr, southern of Sistan and Baluchestan, Iran.

In this descriptive-analytical study, 100 physicians and nurses have participated who working in the wards related to COVID-19 (respiratory isolation ward, intensive care unit and emergency department) of Iran and Khatam-ul-Anbia hospitals in Iranshahr. They were included by available methods from 21 March, 2020 to 8 April 2020. The researcher-made questionnaire assessed the challenges and strategies to deal with COVID-19 from the perspective of nurses and physicians. The reliability and validity of the questionnaire were confirmed. 

The mean age of samples was 31.94±7.4 and the average work experience was 5.6±5.6 years. In answer to the question, what are the challenges related to COVID-19? The results showed that the lowest mean responses were related to "peoplechr('39')s lack of access to social networks and mass communication" and the highest mean was related to "not taking the disease seriously in the general public." In response to the question "What do you think are the main obstacles to controlling the COVID-19 epidemic?" Non-quarantine of infected cities is the most common obstacle. In response to the question "What solution do you suggest to fight the COVID-19?" The quarantine of cities and stay at home were the most prevalent.

  In order to break the chain of COVID-19 transmission, it is necessary to observe such issues as quarantine and stay at home, restriction of travels, observe personal hygiene, identify suspicious cases, provide livelihood for the people and a provide medical staff, and raise the level of awareness and attitude of the people through training.

One of the most important measures in the field of occupational health management in work environments is to evaluate the risk of diseases with the aim of providing preventive and reducing solutions to the risk of diseases and disorders in the workplace. Therefore, this study was designed to evaluate the risk of COVID-19 in high-risk occupational environments using the rapid risk analysis technique.

This cross-sectional study was conducted in May 2020 in three high risk workplaces including 5 banks, 4 post centers and 2 hospitals in the city of Hamadan, Iran. The tools used in this study included a rapid risk analysis technique. In this semi quantitative technique, the risk level is calculated based on three components: disease probability, severity (consequence), and level of health belief.

The findings showed that the risk level of COVID-19 is high for all studied subjects. The lowest and highest risk of COVID-19 in bank employees was estimated at 200 and 300, respectively. The lowest and highest risk of covid-19 in the hospital wards were 50 and 100, respectively. In addition, the low and high risk of covid-19 in the four postal centers were evaluated 50 and 150, respectively (unacceptable risk>40).

The results of this study indicated that the rapid risk analysis technique for COVID-19 can be considered as a suitable technique for screening in the workplace. Due to the high risk of infection in the study workplaces, it is recommended to provide appropriate protection and health measures to prevent the disease in these workplaces.

The gap in knowledge about the cause, modes of transmission, treatment, and high mortality has increased speculation about COVID-19, further confusing health policymakers and therapists. In addition to the unknown nature of the disease, issues such as high virus transmission rate and lack of facilities such as hospital beds, physician-nurse-to-bed ratio, equipment and care facilities such as personal protective equipment and ventilators, and high elderly populations have posed major challenges for health systems and policymakers. Proper crisis response strategies, including emerging diseases, have a significant impact on hospital readiness and success. In this regard, the Ministry of Health of Iran immediately announced several hospitals in Tehran and other cities as referral hospitals for the admission of COVID-19 patients. One of these hospitals is Masih Daneshvari Tuberculosis and Pulmonary Diseases Hospital in Tehran, which immediately held an emergency meeting. It was announced that the hospital will enter a phase of full preparation for the reception of COVID-19 patients from now. In the first step, all wards of the hospital were evacuated and 301 beds were considered for the admission of suspected patients with COVID-19. Since the characteristics and severity of this disease are unknown and the methods of dealing with it have not been experienced so far, so how to prepare the hospital to deal with it is one of the main challenges. The purpose of this brief report is to provide the experience of Masih Daneshvari Hospital on how to manage, prepare and deal with the epidemic of the COVID-19.

Anxiety plays an important protective role in people against life-threatening factors. Accordingly, in the face of the emergence of life-threatening diseases such as the COVID-19 pandemic, concerns about the health of individuals may arise with anxiety. Heath anxiety occurs when perceived bodily sensations or changes, including but not limited to those related to infectious diseases (e.g., fever, coughing, aching muscles), are interpreted as symptoms of being ill. Most people experience some degree of health anxiety, which is a protective factor against health threats. Health anxiety plays an auxiliary role in recognizing the early signs of health damage and promotes health-promoting behaviors. When the level of health anxiety of people in the community is out of moderation, both when the rate increases or decreases from the desired level, it can cause harm and problems to people in the community in a different way. Therefore, an appropriate level of health anxiety is beneficial for individuals and it could be helpful for the prevention of the COVID-19 outbreak, which is an extremely contagious disease.

One of the most at-risk groups for COVID-19 is elderly with chronic diseases. However, many elderly patients with COVID-19 may seem "silent" after being infected with the virus, or have non-specific symptoms such as decreased activity, drowsiness, reluctance to eat, indifference, confusion, delirium, loss of awareness of the environment, speech disorders, urinary incontinence, falling following a loss of balance and fainting. Fever is a hidden symptom in the elderly. If the elderly body temperature is 100 degrees Fahrenheit, it is necessary to undergo further diagnostic tests for COVID-19. On the other hand, other patients with heart failure, vascular diseases, and COPD experience normal symptoms of COVID-19 (cough, shortness of breath, etc.). Thatchr('39')s why itchr('39')s much harder to diagnose COVID- 19 in the elderly with chronic disease than others. In order to diagnose the disease in a golden time, it is necessary to carry out diagnostic tests in order to confirm COVID-19. Therefore, it can be concluded; elderly people with COVID-19, and with a history of chronic diseases have a more severe form of respiratory distress syndrome than other people with COVID-19, which can lead to death. Regardless of the severity of the disease, supportive care for these patients is essential.

Rehabilitation of patients with Covid-19 does not only include attention to respiratory, infectious or neurological problems, apart from other medical measures such as bedsores, peripheral muscle weakness, and muscle contractions. Joint limitations, balance and postural disturbances, and physical weakness due to prolonged bed rest can significantly reduce the chances of returning to pre-infection functional status. These aspects profoundly affect the rehabilitation care of patients and especially the medical team. Due to the unknown nature of the role of rehabilitation and its functional dimensions (even among specialists and medical staff) in Covid-19 pandemics, the purpose of this review is to investigate the functional dimensions and status of rehabilitation in Covid-19 patients. The findings of this review show that rehabilitation of Covid-19 patients can improve pulmonary respiratory function, reduce physical complications, improve cognitive function, and improve the quality of life of patients.

As a global threat, the COVID-19 pandemic is a challenge to psychological resilience. Systematic studies by examining and combining all related documents can provide a more complete description of the dimensions of the problem in society. The aim of this study was to determine the prevalence of various psychological disorders during the COVID-19 pandemic.

This is a systematic review. Studies using different combinations of keywords COVID-19, SARS-CoV-2, pandemic, psychological disorders, mental health, psychological consequences were retrieved from different scientific databases Magiran, SID, Iranmedex, Elsevier, Pubmed, Science Direct, Scopus, Web of Science. These studies were published from December 1, 2019, to May 30, 2020. Twenty-eight studies out of 410 retrieved articles were evaluated and analyzed for data extraction.

The analysis of studies revealed that the different types of psychological disorders like stress, anxiety, depression, post-traumatic stress disorder, mental distress, schizophrenia, sleep disorders and sleep disturbances, vicarious traumatization, internet addiction on moderate to severe in public and medical personnel were recorded during COVID-19 crisis. The frontline health care workers such as nurses were more depressed, anxious, insomniac, and mentally disturbed. Women were more vulnerable to psychological disorders and sleep problems. Young people in the age group between 18 and 30 years old were more likely to experience generalized anxiety disorder and mental distress.

COVID-19 has led to high prevalence and a wide range of psychological disorders among individuals and various groups in society, especially in medical personnel. It is essential to provide psychological assistance and training strategies to deal with a variety of these psychological disorders.

The COVID-19 pandemic has generated considerable knowledge in this regard in reputable international citation databases. The purpose of this study is to analyze subjects clustering analysis and science mapping on published research to identify the current state of sciences in the field of COVID-19 in Scopus.

This was a quantitative and applied study conducted by scientometric methods including words co-occurrence and network analysis. The study population was all published documents in the field of COVID-19 and SARS-CoV-2 in the Scopus citation database by 31 May, 2020. VOSviewer software was used to analyze the data.

As of May 31, 2020, the United States (2,819), China (2,342), Italy (1,466), and the United Kingdom (1,264) had the highest number of scientific publications in the field of COVID-19 in Scopus. Iran was ranked 12th with 318 scientific publications. The three main clusters of research activities in the field of COVID-19 were health, basic science and clinical research clusters.

With the existing scientific capacities, the role of Iran and its medical universities in publishing scientific experiences related to the COVID-19 pandemic can be enhanced. Accurate and comprehensive planning must be done in this regard. Determining research needs and developing applied research in three main areas, including health and prevention, basic and clinical sciences, should be considered in the management and leadership of COVID-19 research.