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Baikmohammadi S, Amirheidari B, Dehesh T, Moghadam MN, Yazdi-Feyzabadi V, Hassani E, Habibzadeh H. A qualitative study on barriers and strategies to hospital preparedness against chemical, biological, radiological, and nuclear incidents. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:3. [PMID: 38525212 PMCID: PMC10959262 DOI: 10.4103/jehp.jehp_1827_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/29/2023] [Indexed: 03/26/2024]
Abstract
BACKGROUND The effects of chemical, biological, radiological, and nuclear (CBRN) incidents on human society can be irreparable. Preparing the health system for these incidents is essential. This study aims to identify obstacles to hospital preparedness against CBRN incidents and provide solutions. MATERIALS AND METHODS This qualitative study was conducted using semi-structured interview method in 2022. The research community included experts in the fields of CBRN, and 17 persons were included in the study through purposive sampling. The interviews were collected by interview guide and recorded face-to-face and online and were analyzed using thematic content analysis method in MS Word 2016. RESULTS The interviews' analysis was classified into two main categories and 34 sub-categories. Some of the most important obstacles to the hospital preparedness against CBRN incidents were the lack of proper crisis management, the lack of specialist staff, the stress of employees, the lack of turnover and sufficient rest for employees, legal gaps, and so on. The main strategies were determining the type and extent of the risk factor, strong crisis management, the lack of parallelism, continuous monitoring, having a protocol and road map, appropriate training programs, having skilled personnel, rapid response of personnel, positive attitude of the staff, and the favorable condition of the building. CONCLUSION The appointment of an expert in the field of CBRN and having a specialized unit, the existence of specialized and trained staff along with access to the required facilities, clear instructions, and intra-departmental and inter-departmental cooperation affect the readiness of hospitals against CBRN incidents.
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Affiliation(s)
- Saeid Baikmohammadi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Bagher Amirheidari
- Department of Pharmaceutical Biotechnology, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - Tania Dehesh
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahmood Nekoei Moghadam
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Vahid Yazdi-Feyzabadi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ebrahim Hassani
- Department of Anesthesiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Hossein Habibzadeh
- Department of Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
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Khan NU, Ali A, Khudadad U, Khan UR, Ali N, Soomar SM, Abid S, Jilani M, Jamali S, Razzak JA. Challenges and health outcomes of the exposure to soybean dust in the harbor neighborhood of Karachi, Pakistan: a wake-up call. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:136. [PMID: 38037137 PMCID: PMC10688105 DOI: 10.1186/s41043-023-00473-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/11/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Chemical disasters are common worldwide and result from technological failure, war, and terrorism activities. Pakistan imports huge quantities of hazardous chemicals to meet its industrial and energy needs. Hence there is a risk of chemical disaster at the ports, during transportation of such material and processing in the chemical industry. This study aimed to review the challenges and health outcomes of cases of soybean dust exposure in Kemari district (harbor neighborhood) of Karachi, Pakistan. METHODS A cross-sectional survey was conducted with all the affected people from a chemical incident of soybean dust which was reported in the Keamari district of Karachi, Pakistan. Included patients ≥ 18 years who visited the two major tertiary care hospitals of Karachi, Pakistan after the incident between February 17 to 23, 2020. A total of 574 patients were brought to these two major tertiary care hospitals. We collected data on basic demographics, event details, and major signs and symptoms of the affected individuals. Calculated frequencies and percentages for categorical variables. Mean ± standard deviation (SD) was calculated for continuous variables. RESULTS The mean ± (SD) age of the victims were 32 (13.5) years. Of the 574 patients, majority of the patients (n = 319, 56%) were males. In 28 cases (41%), the onset of symptoms occurred at home, in 27 cases (39%) the onset of symptoms started in the workplace and the remaining cases (n = 14, 20%) experienced the first symptoms while roaming around the roadside. The most common reported co-morbidity was a history of asthma (56%), followed by diabetes mellitus (22%). The most common clinical manifestation was shortness of breath, reported in 94% of the cases, followed by neurological symptoms such as drowsiness, unconsciousness, or seizures experienced by 10% of the victims. A total of 9 deaths (1.5%) were recorded. CONCLUSION A multi-sectoral systematic approach is also required to address these incidents comprehensively including the trained and equipped pre-hospital system, integrated emergency medical response, and community-wide emergency response system.
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Affiliation(s)
- Nadeem Ullah Khan
- Department of Emergency Medicine, Aga Khan University, Karachi, 74800, Pakistan.
| | - Asrar Ali
- Department of Emergency Medicine, Aga Khan University, Karachi, 74800, Pakistan
| | - Umerdad Khudadad
- Department of Emergency Medicine, Aga Khan University, Karachi, 74800, Pakistan
| | - Uzma Rahim Khan
- Department of Emergency Medicine, Aga Khan University, Karachi, 74800, Pakistan
| | - Noman Ali
- Department of Emergency Medicine, Aga Khan University, Karachi, 74800, Pakistan
| | | | | | | | - Seemin Jamali
- Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Junaid A Razzak
- Department of Emergency Medicine, Aga Khan University, Karachi, 74800, Pakistan
- Weil Cornell Medicine, New York, USA
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Tahmasebi A, Asl IM, Aryankhesal A, Vatankhah S, Masoumi G. How public hospitals manage epidemic crises? Lessons from Iranian public hospitals. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:410. [PMID: 38333145 PMCID: PMC10852175 DOI: 10.4103/jehp.jehp_1688_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 01/02/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND The public hospital preparedness is essential for epidemic disaster like COVID-19 pandemic. This study was conducted to present a hospital management preparedness model of Iran's public hospitals for the epidemic. MATERIALS AND METHODS The method of this study was an exploratory sequential mix method study (qualitative-quantitative). In this study, qualitative and quantitative methods were used in four stages. (1) Interviews with hospital managers to identify hospital management experiences during the COVID-19 epidemic and categorize the results in themes and subthemes, (2) assessing the performance of public hospitals in managing the coronavirus epidemic in a quantitative method, (3) present the initial hospital management model for a public hospital in epidemic conditions using an expert panel, and (4) validation of the model using the Delphi method. RESULTS Experiences of hospital managers and specialists were categorized into eight themes: information gathering and environmental analysis, general and operational planning, provision of equipment and physical and financial resources, training and empowerment of human resources, a compilation of instructions and job descriptions, review and ensuring maximum readiness, monitoring and follow-up of service provision and existing problems, evaluation and feedback of performance problems and level of preparation and 51 sub-themes. The quantitative study indicated that all the investigated indicators had a significant decrease in the first month and an increase in the epidemic's continuation. The results were categorized in nine themes and 59 sub-themes, and finally, the model was validated in one round by the Delphi method. CONCLUSION In Iran, managers have valuable experiences in COVID-19 epidemy management, but these experiences are scattered and not organized. In this study, by a qualitative-quantitative, a model was presented that contains essential points obtained from the experience of hospital managers and experts in actual disaster conditions and is appropriate and fits hospital structure and infrastructure of the health system in Iran.
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Affiliation(s)
- Ali Tahmasebi
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Iravan Masoudi Asl
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aidin Aryankhesal
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Soudabeh Vatankhah
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Masoumi
- Department of Health in Disaster and Emergencies, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Moslehi S, Dehdashti A, Pourmohammdi B, Fatemi F. Main social vulnerability indicators in the COVID-19 pandemic in Iran. Front Public Health 2023; 11:1080137. [PMID: 37050958 PMCID: PMC10083335 DOI: 10.3389/fpubh.2023.1080137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/02/2023] [Indexed: 03/28/2023] Open
Abstract
Background Social factors play the main role in the vulnerability of exposed countries to disasters. The COVID-19 pandemic as a disaster is not an exception to this fact. This study aimed to determine the main social vulnerability indicators in the COVID-19 pandemic in Iran. Methods This study was conducted during the period of 2021-2022 in three phases, including a systematic review, a virtual panel expert, and the Analytical Hierarchy Process. First, the draft of social vulnerability indicators in COVID-19 was extracted through a systematic review. Then, the extracted indicators were finalized and prioritized by the expert panel and the AHP, respectively. Results Initially, the literature review found five domains and 38 indicators of social vulnerability in COVID-19. The outcome of the expert panel increased the related domains to six but decreased the indicators to 31. The three prioritized social vulnerability indicators that were determined by the AHP were population density, accessibility to healthcare facilities, and relevant services and vulnerable groups. Conclusion Measuring social vulnerability with the identified indicators is valuable for addressing high COVID-19 incidence among socially vulnerable hotspot areas. Regarding the result of this study, further research should be conducted to validate the identified indicators.
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Affiliation(s)
- Shandiz Moslehi
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
- Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Dehdashti
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Research Center of Health Sciences and Technologies, Faculty of Health, Semnan University of Medical Sciences, Semnan, Iran
| | - Behrad Pourmohammdi
- Department of Parasitology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Farin Fatemi
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
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Khalil M, Ravaghi H, Samhouri D, Abo J, Ali A, Sakr H, Camacho A. What is "hospital resilience"? A scoping review on conceptualization, operationalization, and evaluation. Front Public Health 2022; 10:1009400. [PMID: 36311596 PMCID: PMC9614418 DOI: 10.3389/fpubh.2022.1009400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/27/2022] [Indexed: 01/27/2023] Open
Abstract
Background COVID-19 underscored the importance of building resilient health systems and hospitals. Nevertheless, evidence on hospital resilience is limited without consensus on the concept, its application, or measurement, with practical guidance needed for action at the facility-level. Aim This study establishes a baseline for understanding hospital resilience, exploring its 1) conceptualization, 2) operationalization, and 3) evaluation in the empirical literature. Methods Following Arksey and O'Malley's model, a scoping review was conducted, and a total of 38 articles were included for final extraction. Findings and discussion In this review, hospital resilience is conceptualized by its components, capacities, and outcomes. The interdependence of six components (1) space, 2) stuff, 3) staff, 4) systems, 5) strategies, and 6) services) influences hospital resilience. Resilient hospitals must absorb, adapt, transform, and learn, utilizing all these capacities, sometimes simultaneously, through prevention, preparedness, response, and recovery, within a risk-informed and all-hazard approach. These capacities are not static but rather are dynamic and should improve continuously occur over time. Strengthening hospital resilience requires both hard and soft resilience. Hard resilience encompasses the structural (or constructive) and non-structural (infrastructural) aspects, along with agility to rearrange the space while hospital's soft resilience requires resilient staff, finance, logistics, and supply chains (stuff), strategies and systems (leadership and coordination, community engagement, along with communication, information, and learning systems). This ultimately results in hospitals maintaining their function and providing quality and continuous critical, life-saving, and essential services, amidst crises, while leaving no one behind. Strengthening hospital resilience is interlinked with improving health systems and community resilience, and ultimately contributes to advancing universal health coverage, health equity, and global health security. The nuances and divergences in conceptualization impact how hospital resilience is applied and measured. Operationalization and evaluation strategies and frameworks must factor hospitals' evolving capacities and varying risks during both routine and emergency times, especially in resource-restrained and emergency-prone settings. Conclusion Strengthening hospital resilience requires consensus regarding its conceptualization to inform a roadmap for operationalization and evaluation and guide meaningful and effective action at facility and country level. Further qualitative and quantitative research is needed for the operationalization and evaluation of hospital resilience comprehensively and pragmatically, especially in fragile and resource-restrained contexts.
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Affiliation(s)
- Merette Khalil
- Department for Universal Health Coverage and Health Systems, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt,*Correspondence: Merette Khalil
| | - Hamid Ravaghi
- Department for Universal Health Coverage and Health Systems, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Dalia Samhouri
- Health Emergencies Programme, World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - John Abo
- Asian Disaster Preparedness Center, Bangkok, Thailand
| | - Ahmed Ali
- Health Emergencies Programme, World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Hala Sakr
- Department of Healthier Populations, World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Alex Camacho
- Health Emergencies Programme, World Health Organization, Regional Office for the Americas, Washington, DC, United States
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Heavy metals content in edible mushrooms: A systematic review, meta-analysis and health risk assessment. Trends Food Sci Technol 2021. [DOI: 10.1016/j.tifs.2021.01.064] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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