Epidemiology of special incidents: Results from national mortality and morbidity registry and the associated factors in Iran in 2014

The effect of micro-learning on trauma care knowledge and learning satisfaction in nursing students

BACKGROUND

Despite the fact that there are few formal trauma training courses for nurses, they play an important role in the care of trauma patients. This study aims to investigate the effect of micro-learning on the knowledge of managing trauma patients and learning satisfaction in nursing students.

METHODS

The convenience sampling method was used to enroll 30 final-year nursing students from Alborz University of Medical Sciences in this quasi experimental One-group pretest -posttest design. The educational content was created and repeated 4 times over the course of 36 days using a micro-learning approach through whiteboard animations, video casts, and live videos. MCQ scenario-based exam was used to assess participants' knowledge of trauma in three phases: pretest, immediately following the intervention, and one month after the end of the educational program. An e-learning satisfaction psychometric questionnaire was used to measure satisfaction.

RESULTS

The mean knowledge score 1 month after the intervention did not differ significantly from the score immediately after the intervention (p = 1), but there was a significant relationship between the mean knowledge score immediately after the intervention and before that (p = 0.047). Demographic variables and knowledge of trauma management did not differ statistically significant. The majority of students were pleased with how the course was implemented (5.64).

CONCLUSION

The use of micro-learning has a positive effect on the promotion and retention of knowledge of trauma care, as well as increasing nursing students' satisfaction. Micro-learning is proposed as a new educational approach that can be used as a complementary or as a stand-alone method to convey important educational concepts and increase learner satisfaction.

Drowning in the Eastern Mediterranean region: a systematic literature review of the epidemiology, risk factors and strategies for prevention

INTRODUCTION

Globally, drowning is a significant cause of preventable mortality and morbidity. The Eastern Mediterranean region (EMR) comprises 22 countries of extreme disparity in income and is a region impacted by conflict and migration. We systematically review literature published on drowning in the EMR.

METHODS

Peer-reviewed literature (limited to original research) was identified using Embase, PubMed, Scopus, SportsDiscus, and Web of Science databases. Literature was independently dual screened at title/abstract and full text stages with dual data extraction (20% of included studies). Studies were included if they reported epidemiology, risk/protective factors and/or prevention strategies for drowning (unintentional and intentional; fatal and non-fatal) of residents, tourists or migrants in the EMR. Literature was assessed against the [Australian] National Health and Medical Research Council's Levels of Evidence.

RESULTS

Seventy-two studies were included in this review (epidemiology 68 studies; risk/protective factor 13 studies; prevention strategies 19 studies). Iran (n = 27), Saudia Arabia (n = 11) and Pakistan (n = 10) recorded the largest number of dedicated studies. Studies predominately focused on unintentional drowning. Ninety-two percent of included studies (n = 66) were ranked as being low evidence (level IV). The majority of studies explored drowning among children and adolescents (0-19 years). All-age fatal drowning rates varied from a low of 0.48 per 100,000 (United Arab Emirates; 2002; Ministry of Health death registry data) to a high of 18.5 per 100,000 (Egypt; 2014-15; WHO mortality database). Commonly identified risk factors included being male, young age, submersion time and resident status. Common prevention strategies public education, lifeguard supervision, and cardiopulmonary resuscitation.

DISCUSSION

Gaps in understanding of drowning burden in some countries within the region, as well as region-wide risk factor identification for adult drowning, intentional and migration-related drowning, impair the ability of nations to advance drowning prevention. There is a need for investment in implementation and evaluation of drowning prevention interventions in the EMR.

CONCLUSION

Drowning is a significant cause of mortality and morbidity in the EMR. The recent UN declaration on global drowning prevention may provide the impetus to invest in drowning prevention research, policy, and advocacy with the aim of reducing drowning-related harms in the EMR.

TRIAL REGISTRATION

Registration number: # CRD42021271215 .

Tehran cohort study (TeCS) on cardiovascular diseases, injury, and mental health: Design, methods, and recruitment data

Cardiovascular disease, mental health, and injury are among the top health issues globally. In Tehran Cohort Study, we aimed to determine the prevalence, incidence, and trend of cardiovascular diseases, psychiatric symptoms, injury, and risk factors in Tehran households. We enrolled 4215 households in the recruitment phase from March 2016 to March 2019. Demographic characteristics, past medical history, medications, and familial history of the participants were collected. Rose angina pectoris, general health Questionnaire-28 (GHQ-28), and injury questionnaires were completed. Fasting blood samples were collected to measure routine biochemistry and store samples in the biobank. Anthropometric and physiological measurements and electrocardiograms were performed. The participants are followed every three years for up to 12 years. In total, 8296 individuals participated in the cardiovascular section, 10247 completed the GHQ-28, and 4167 households completed the injury questionnaire. The mean age of the participants was 48.2 (16.41), and 46.5% were male. 64.3% of recruited individuals had no symptoms of psychiatric disorders, and 3729 (89.5%) households did not have any severe injury requiring treatment. The participants' diversity and their invaluable data will help us provide a general picture of the current prevalence and incidence of the main study objectives.

Status of clinical toxicology education and ethics in medical care of poisoned patients in the Islamic Republic of Iran and a comparison with other countries

Clinical toxicology is not recognized as a clinical speciality in Iran. After the chemical war gas attack by the Iraqi army against the Iranian troops in the 1980s, health professionals and Iranian authorities noticed the importance of this field in clinical medicine. Collaboration between the clinical toxicologists and toxicologists of pharmacy schools resulted in the establishment of the Iranian Society of Toxicology and Poisonings in 1991 and the National Board of Toxicology in 1993. Clinical toxicology fellowship was also formed as a joint collaboration between the toxicology and internal medicine boards in 2010. Medical doctors who specialized in clinical medicine are eligible to take the entrance examination of the fellowship. In spite of the advancement of clinical toxicology and increased number of acute poisonings and drug abuse, undergraduate teaching in this field is still lacking and being taught as part of the forensic medicine curriculum since 1952. There is a lack of an efficient national poison information and control centre (s) in Iran, and no action plan and practical efforts have been done for poisoning prevention. Therefore, the number of drug abuse and acute poisonings has increased over the past four decades and induced cultural, social and health problems. According to Iranian legal medicine organization reports, poisoning is the second-most occurring cause of unnatural death. The suicidal attempt is the most common method of acute poisoning in adults. Suicidal attempt including self-poisoning is not accepted in the Islamic point of view, and thus self-poisoning is mostly neglected and may not be treated appropriately in time in some regions of Iran. Accidental poisoning in children is also common in Iran and estimated to be between 20 000 and 25 000 cases annually over the recent years. In addition, social, cultural and economic problems have induced more health problems such as drug abuse and addiction even in children. Adulterated opium to lead for economic gaining has produced thousands of cases of lead poisoning over the past few years in nearly all opium addicts, which is still a major health problem in Iran. Ban on alcoholic beverages leads some people to make their own home-made spirits, which is unfortunately contaminated with methanol. Thousands of cases of methanol poisoning and even some epidemics have occurred over the past four decades in some parts of the country. Lack of availability of essential antidotes such as succimer and fomepizole has been a major problem for the effective treatment of poisoned patients. Despite the well-known fact that cases of poisoning and drug overdose constitute a significant proportion of hospital admissions in some developing countries, clinical toxicology education and medical care of the poisoned patients are lacking. Therefore, policymakers and health authorities should realize the importance of toxicology in clinical medicine. The Iranian Ministry of Health, medical care and Medical Education should implement clinical toxicology courses for medical students; establish effective national poisons information and control centres and advance clinical toxicology services for appropriate management of poisoned patients to improve public health and the overall health policy goals.

Designing and executing a functional exercise to test a novel informatics tool for mass casualty triage

OBJECTIVE

The testing of informatics tools designed for use during mass casualty incidents presents a unique problem as there is no readily available population of victims or identical exposure setting. The purpose of this article is to describe the process of designing, planning, and executing a functional exercise to accomplish the research objective of validating an informatics tool specifically designed to identify and triage victims of irritant gas syndrome agents.

MATERIALS AND METHODS

During a 3-year time frame, the research team and partners developed the Emergency Department Informatics Computational Tool and planned a functional exercise to test it using medical records data from 298 patients seen in 1 emergency department following a chlorine gas exposure in 2005.

RESULTS

The research team learned valuable lessons throughout the planning process that will assist future researchers with developing a functional exercise to test informatics tools. Key considerations for a functional exercise include contributors, venue, and information technology needs (ie, hardware, software, and data collection methods).

DISCUSSION

Due to the nature of mass casualty incidents, testing informatics tools and technology for these incidents is challenging. Previous studies have shown a functional exercise as a viable option to test informatics tools developed for use during mass casualty incidents.

CONCLUSION

Utilizing a functional exercise to test new mass casualty management technology and informatics tools involves a painstaking and complex planning process; however, it does allow researchers to address issues inherent in studying informatics tools for mas casualty incidents.

Morbidity and mortality from technological disasters in Iran: A narrative review

Iran as a developing country is at risk of vulnerability to technological disasters. These types of disasters occur frequently in last years and affected thousands of lives. Technological disasters in Iran cause thousands of deaths, thousands of injuries, and millions of dollars' economic loss in recent years. We searched suitable keywords in national and international disaster databases for gathering epidemiological data in these disasters in Iran. In addition, we searched suitable keywords in scientific databases including Google Scholar, Scopus, PubMed, Web of Knowledge, Scientific Information Database, Magiran, and Irandoc. After screening, only 19 articles discussed challenges of technological disasters in the country. Road accidents, explosions and fires, mine accidents, and railway accidents are common events in the country. After 2015, these types of disaster cause 823 deaths and injuries. Experience of response to these disasters showed that technological disaster management in the country faces too many challenges including comprehensive and prospective programs, weakness of necessary infrastructure for urban management, weakness in group work and interorganizational coordination, lack of coherent involvement of people and nongovernmental organizations, lack of information coverage during the disaster, volunteers in police service presence at scene, and normalization of these events. Due to interorganizational nature of mitigation in technological disasters, it must be developed coordination between various organizations to mitigate these types of disasters.

Leadership in limbo: Characteristics of successful incident commanders in health sector of a disaster-prone country

OBJECTIVE

Iran, as one of the most disaster-prone countries in the world, is exposed to a wide range of hazards. Hence, the health sector should be prepared to deal with the consequences of emergencies. This study aimed to explore Iranian disaster management status and to identify the necessary characteristics of successful incident commanders in this field.

METHODS

A qualitative content analysis was designed using in-depth semi-structured interviews with 30 commanders and experts, selected by purposeful sampling, who had first-hand experiences in managing health disasters. Field notes, formal institutional reports, and photos were employed as well. Verbatim transcribed interviews and other data sources were analyzed using constant comparison method. Ethical issues were considered carefully throughout the study process.

RESULTS

Two main themes were developed: The first theme, "limbo situation," as expression of the problem describes inadequacies and complexities of disaster management in Iranian health sector, including seven categories. The second theme was "effective disaster leadership" consisting of "commanders' traits" and "commanders' competencies" as subthemes.

CONCLUSIONS

The study demonstrated the chaotic feature of disaster management in Iran and probably some other developing countries, with crucial and unclear role of field commanders. Working under stress, time pressure, uncertainty, and management of paradoxes needs timely and on-field decision making. This study revealed that Iranian health sector incident commanders should be transformational leaders with the ability of influencing subordinate staff and have Janusian thinking skills for overcoming the existing limbo situation.

Epidemiology of Vehicle Fire Fatalities of Road Traffic Injuries in Kerman Province, Iran: A Cross-Sectional Study

BACKGROUND

Vehicle fires are one of the most important causes of fatalities in road traffic injuries (RTIs), but there are no accurate statistics about vehicle fire fatalities (VFFs) due to RTIs in Iran.

AIM

This study aimed to investigate the Epidemiology of vehicle fire fatalities (VFFs) due to road traffic injuries (RTIs) in Iran.

METHODS

In this cross-sectional study, a researcher-made checklist was used to collect the required data from the files of RTI fatalities in the Kerman Legal Medicine Organization (KLMO), or coroner's office. All reported victims of vehicle fires in the ten years from 2007 to 2017 were included in the study. The data were analysed using SPSS ver. 18, with p = 0.05 considered as the level of significance.

RESULTS

The authors found 124 cases of vehicle fire fatalities in Kerman, with a mean age of 30.45 ± 12.41, of which 50% were in the 25-49 years age group. Most frequently, the victims were Iranian (91.9%), married (66.1%), self-employed (51.6%), and urban dwellers (79.8%), and had died because of burns (91.9%). In 46.8% of cases, the victims were the driver, and in the remaining 53.2%, they were the passenger of the crashed vehicle. Most frequently, vehicle fires occurred on extra-urban roads (90.3%), during spring (35.5 %) or summer (32.3%), due to a vehicle-to-vehicle collision (66.9%), between sedans (69.9%), and at night (63.7%). Most victims died at the scene of the incident (87.9%) and had been transferred to hospital by an ambulance (71%).

CONCLUSION

This study indicated that car fires caused the death of young and middle-aged people. The authors suggest the implementation of preventative measures promoting car safety; establishing speed management; establishing laws governing driving, manufacturing and importation of vehicles; construction of safe roads; identifying accident-prone points; installing road warning signs; establishing more roadside stations; ensuring stricter police monitoring; and improving vehicle safety standards and public awareness about the risks of speeding.