Epidemiology and Health System Journal
Volume:9 Issue: 1, Winter 2022

Since the outbreak of COVID-19 in December 2019, there has been an explosion of statistics and information about the disease, the number of cases, the number of deaths, and the number of recoveries. During this period several statistical and mathematical models have been developed and used to predict the disease. Much of this information has been helpful and paved the way for disease control; however, inaccurate or ambiguous information has been published in some cases, which can briefly be divided into three main categories. The first category is related to the publication of official statistics by governmental centers in countries, which has faced many errors. Although some of these errors are unintentional due to the definition of the disease based on definitive polymerase chain reaction (PCR) testing, death within 28 days of infection, or due to the similarity of the disease outcomes with other diseases, in many cases, the statistics regarding the disease and its consequences have been presented by governments with a manipulation, mainly on the small number of patients with COVID-19. The second category contributes to incorrect or incomplete use of statistical indexes. During this period, some information has occasionally been published by some public media in which statistical indexes have not been used correctly and appropriately. The third category belongs to the challenges of epidemiological modeling in COVID-19. With the advent of COVID-19, many models emerged to predict its incidence and consequences. Although many of the predictions were true, some of them were incorrect or inaccurate. The main reasons for the inaccuracy of these predictions were the consideration of incorrect or weak assumptions, the existence of incomplete data, the short-term view, the use of point estimates instead of interval estimates, and the lack of a multidimensional view of the problem. Accordingly, considering the above-mentioned points and findings from the observed problems in predicting the course of the disease and the resulting mortality during the COVID-19 pandemic, one can hope for the ability to model the prediction of similar diseases in the future.

Plague has been among the most devastating infectious diseases in human history. The decrease in the plague in recently reported cases and studies implies that the plague should not recur, but the fact is that it (Black Death) is still around and may appear again. The disease can be occult for many years. The reemergence of the plague epidemic with unusual clinical form, magnitude, and rapid expansion at any place and time without prior notice could pose a serious risk to public health. Plague outbreaks most likely result from the reactivation of organisms in local foci. The reemergence of foci suggests that environmental or climatic changes could be favorable for an epidemiological cycle of Yersinia pestis. Thus, countries harboring plague foci can be at risk of outbreaks in the future. Different epidemiological aspects of the plague must be emphasized in prophylactic medical plans and health education systems, and healthcare workers should be alert and aware of the natural cycle, as well as clinical symptoms and signs of plague. Finally, surveillance, education, and research are also suggested regarding this fatal infection and other emerging diseases.

Knowledge, attitude, and practice (KAP) toward coronavirus disease 2019 (COVID-19) are important factors for adherence to protection strategies. The aim of this study was to construct and validate a questionnaire about the KAP of Iranians regarding COVID-19. 

Initially, a questionnaire about the KAP with regard to COVID-19 was constructed in this cross-sectional study. The initial questionnaire was prepared based on a review of the extensive research literature and global and national guidelines. This researcher-made questionnaire was developed using the COVID-19-KAP questionnaire, which was originally used in China in 2020, and the influenza epidemic KAP Questionnaire (2015), the MERS KAP Questionnaire (2015), the H1N1 flu KAP questionnaire (2017), and the WHO KAP questionnaire about COVID-19. The applied questionnaire consists of three parts including knowledge- (n = 26), attitude- (n = 8), and practice-related (n = 11) questions, respectively. Then, the face, content, and construct validity and the reliability of the questionnaire was determined, and analyzes were performed using SPSS v. 26 and AMOS v. 24 software. 

In the face validity stage, 2 questions with an impact score of less than 1.5 were excluded from the questionnaire. In the content validity check, all questions had a content validity index (I-CVI) of more than 0.7. However, the content validity ratio (CVR) for 6 questions was less than 0.51, and these questions were removed accordingly. The compliance of the CVI with the chance agreement was close to one for all questions, indicating the lack of a chance agreement. In the exploratory factor analysis stage, the Kaiser-Meyer-Olkin (KMO) value of 0.90 was obtained, implying the adequacy of the sample size for factor analysis. The significance of the Bartlett test (chi-square: 5820.06, df: 630, P<0.001) indicated a strong correlation between the questions and the appropriateness of factor analysis. Finally, 34 items in 4 domains remained in the questionnaire. 

The validity and reliability of this questionnaire were confirmed based on the findings. This Farsi KAP questionnaire can be used to assess the level of knowledge, attitude, and practice of people about COVID-19.

Although female family caregivers, especially those who belong to the sandwich generation, are at the forefront of the coronavirus disease (COVID-19) battle, little is known about their experiences. The purpose of this qualitative study was to explore the female sandwich generation’s experiences of multigenerational caregiving under the COVID-19 pandemic in Shiraz located in the southwest of Iran. 

Situational analysis (SA) was used as a methodological approach. It is a constructivist grounded theory (GT) developed by Adele Clark as one of the innovative extensions of the GT. In the current study, the multigenerational caregiving by the female sandwich generation under the COVID-19 pandemic is identified as “the situation” which is the key unit of analysis and the salient and diverse elements of this situation (e.g., the major human, non-human, discursive, cultural, political, and other elements) were laid out by the messy and ordered maps. In addition, each element on the messy map was analyzed in relation to all other elements, and the nature of the relations among them was examined by the relational map. These maps are derived from qualitative data including the ethnographic observations, discourse materials, and in-depth semi-structured interviews with 10 middle-aged female double caregivers of both dependent children and the elderly above 70 years old within the family. Three sampling methods were used across the full trajectory of the research, including purposeful, snowball, and theoretical sampling. 

The analysis of the multigenerational caregiving situation showed that this situation consists of 95 elements classified under 15 categories and 2 situational maps, along with 2 relational maps that have been drawn from the qualitative data analysis. Based on the organized situational map, this situation occurred as a result of the power of the main discourses, as well as the existing cultural, traditional, and religious elements, and continues after interconnecting to the global COVID-19 pandemic. The first relational map displayed caregivers’ adopted information and communications technology (ICT) tool-based strategies such as remote caregiving, telehealth, online visiting, and online shopping, along with the voluntarily double quarantine in order to protect the elderly from COVID-19 infection. Finally, the second relational map depicted that emotional exhaustion is rampant among the caregivers influenced by the experiences that are related to the ICT tools and the voluntarily double quarantine. 

Overall, some strategies are suggested concerning the necessity of maintaining the mental and physical health of double caregivers and reduction of the negative consequences of the pandemic in them. They include accessibility of ICT tool-based strategies to all, the alternative approaches to severe social isolation, creation of a balance between work-home life and the care demands of two generations, early assessment of the psychological status along with the extensive support by the government, and formal care services to them.

Cerebrovascular accidents are a major cause of death and disability in many countries. Therefore, the epidemiological indicators are highly important in the case of these patients’ mortality. The present study aimed to determine the epidemiology of mortality due to cerebrovascular accidents in patients admitted to Sina (Farshchian) hospital of Hamadan within 2018-2019.  In this descriptive cross-sectional study, data of deceased patients were collected from one-year medical records in the neurology wards of Sina (Farshchian) hospital in Hamadan using the census method and a researcher-made checklist. The exclusion criteria were the cause of death except for cerebrovascular accident and incompleteness of data in patient’s medical record. Data were analyzed by descriptive statistical methods and SPSS 21.  Out of the 1196 patients admitted to the neurology wards, 159 cases died, and this rate was nearly equal between men and women. The highest mortality frequency belonged to ischemic type (83%), people over 60 years old (83%), illiterate (77.4%), urban (69.2%), self-employed (42.8%) individuals, and those with a history of underlying disease (73.6%), no history of smoking (90.6%), previous stroke (78.6%), and family history of stroke (99.4%).  The findings of the present study showed that certain groups such as the elderly, illiterates, urban residents, self-employed, and people with underlying diseases had a higher mortality rate due to cerebrovascular accidents. Thus, special attention to these groups in health planning can be efficient in reducing the mortality of these accidents.

In December 2019, the disease associated with SARS-CoV-2 was identified as the new coronavirus (COVID-19). The older population is regarded as the greatest risk group. The objective of the present study was to investigate the epidemiological aspects of COVID-19 during 2020 in the older adults in the Brazilians Amazon region.  The present study is a longitudinal study based on a national database from the Website of the State Department of Health of Para from January to December 2020. Medical, socio-demographic, and geographical data were analyzed to assess the epidemiological data to verify whether there was an association between these variables using logistic regression.  Official data published until December 31 indicated 293 802 confirmed cases and 7199 deaths from COVID-19 in the state of Para, as well as a 12.5% rate of fatality. Para has demonstrated a linear curve in relation to the number of deaths since August. More cases of COVID-19 were found among the older people, men, and people who declared themselves brown, and a greater chance of death was observed among indigenous and yellow people.  Brazil is among the five countries with the highest number of infected cases and deaths resulting from COVID19, possibly due to poor planning concerning social isolation and the lack of public health policies and guidance by government leaders, especially in this specific context.

The emergence and spread of drug-resistant strains of Mycobacterium tuberculosis are greatly complicating tuberculosis (TB) control efforts in many countries. In India, in 2018, out of 2.4 million notified cases of TB, there were an estimated 66 359 and 3,882 laboratory-confirmed cases of multi-drug resistant tuberculosis (MDR-TB) and extensively drug-resistant TB (XDR-TB) respectively. The main objective of this study was to assess pattern of drug-resistant tuberculosis (DR-TB) and factors associated with it in Rewa district of Madhya Pradesh, India.
 
This descriptive-analytical cross-sectional study was carried out at a tertiary care center in Rewa district from March 1, 2019, to February 29, 2020 (12 months). Taking the census method into account, all of 186 DR-TB cases registered at District Tuberculosis Centre (DTC), Rewa district, with the age of 18 years and above were included in the study. All the patients were interviewed thoroughly using a pre-tested, pre-validated, and reliable pro forma which included information regarding socio-demographic profile and history of TB. For statistical analysis, chi-square test (with/without Yate’s correction) was applied and a P value less than 0.05 was considered statistically significant.
 
In the present study, 71.6% and 28.4% of the cases were reported to be male and female, respectively. Additionally, 78.4% of the study subjects belonged to the age group of less than 45 years. Besides, rifampicin-resistant TB (RR-TB) was found to be the most prevalent type (56.4%), followed by isoniazid-resistant TB (HR-TB) (13.4%), and mixed pattern (12.4%) of DR-TB.
 
DR-TB was more commonly observed in males of the economically productive age group (45 years and below), which can affect the social and economic development of individual, society, and nation.

The incidence of renal failure (RF) is growing in Brazil, resulting in increased public spending and negatively affecting the public health, which can lead to patient death. Identifying factors associated with mortality from this condition can help to characterize susceptible populations; therefore, institutional and governmental measures can be adopted for prevention and treatment.  Descriptive epidemiological study using secondary data from Brazilian database (DATASUS). Deaths from RF between 2009 and 2019 and characteristics such as color/race, gender, education, region, and age group of the individuals were analyzed.  Since 2016, there has been a reduction of approximately 2% per year in the RF case fatality rate. North, Northeast, and Southeast regions had the highest case fatality rate, 13.6%, 13.17%, and 12.84%, respectively, which may be associated with high prevalence of chronic-degenerative diseases. The elderly had the highest case fatality rates, ranging from 9.67% in individuals aged 50-59 years to 27.52% in the elderly over 80 years. Children under 1 year of age had a high case fatality rate of 15.03%. Moreover, the case fatality rate for individuals with education levels above 12 years of schooling was 0.50%, while the case fatality rate for individuals with 1 to 3 years of schooling was 3.52%, which is seven times higher. Case fatality rates of indigenous populations in the South and Southeast regions were 12.0% and 16.5%, approximately 20% higher than other populations.  The presence of chronic-degenerative diseases, age above 50 and below 1 (elderly and preterm newborns), low level of education and being indigenous are factors associated with mortality from RF in Brazil.

The aim of the present study was to investigate the pattern of alcohol consumption and its related factors in the patients referring to hospitals.  A hospital-based case control study was carried out in Shahrekord during 2016-2017. A total of 150 individuals who had self-report of alcohol consumption and history of alcoholism entered into the case group based on the convenience sampling method. Likewise, 300 individuals who did not have self-report of alcohol consumption entered into the control group. Group matching was performed based on the date of admission to the hospital, type of disease, complications, and duration of the disease. This study explored the pattern of alcohol consumption variables, spiritual health, quality of life, and general health. Odds ratios (ORs) with a 95% confidence interval (CI) were calculated as well.  The causes of onset of alcohol consumption were curiosity (41.40%), social class and imitation of others (17.40%), and life problems (15.30%). Further, the causes of continued alcohol consumption were attributed to the interest in taste and smelling (23.30%), emotional problems (20%), as well as loneliness feeling and life problems (12.60%). The mean of general health scores in the case and control groups were 29.8± 5 and 29.3± 4, respectively (P = 0.296). The mean of the quality of life in the case group and control group were 32.13± 7 and 32.11± 5, respectively (P = 0.98). The differences in the scores of spiritual health in two groups were not statistically significant (P = 0.96).  An attempt should be made to improve the strategies to satisfy the emotional sense and health recreations of society.