Definition and characteristics of climate-adaptive cities: a systematic review

BACKGROUND

Cities, as frontline responders to climate change, necessitate a precise understanding of climate-adaptive features. This systematic review aims to define and outline the characteristics of climate-adaptive cities, contributing vital insights for resilient urban planning.

METHODS

This systematic review, initiated on March 6, 2018, and concluded on August 26, 2021, involved reviewing multiple electronic databases based on the study's objectives. The Critical Appraisal Skills Program (CASP) tool was used for quality assessment and critical evaluation of articles retrieved through a comprehensive and systematic text search. Descriptive and thematic analyses were conducted to extract definitions, features, and characteristics of climate-adaptive cities.

RESULTS

Out of 6104 identified articles, 38 articles met the inclusion criteria. In total, 20 definitions and 55 features for climate-adaptive cities were identified in this review. Codes were categorized into two categories and ten subcategories. The categories included definitions and features or characteristics of climate-adaptive cities.

CONCLUSION

A climate-adaptive city, as derived from the findings of this study, is a city that, through effective resource management, future-oriented planning, education, knowledge utilization, innovation in governance and industry, decentralized management, and low-carbon economy, leads to the adaptability, resilience, sustainability, and flexibility of the capacity of individuals, communities, institutions, businesses, and systems within a city against all climate change impacts and reduces their negative consequences.

The practices of heat adaptation among elderly in Dezful: A qualitative study

BACKGROUND

Useful experiences of the elderly in adapting to the environment may play an important role in formulating future policies. This study was conducted to explain the past experiences of the elderly in Dezful in adapting to heat.

MATERIALS AND METHODS

This study was conducted with a qualitative research approach and a qualitative content analysis method in 2020 and 2021. The experiences of 18 elderly in Dezful were collected through semi-structured interviews via recording, face-to-face interviews, and data observation. Sampling was performed by the purpose-based method, and the data of this stage were analyzed using a content analysis approach using the Zhang and Wildemuth method.

RESULTS

During the data analysis process, three main themes were extracted, including psychophysiological, socioeconomic, and environmental adaptation. Also, twelve subthemes including changes in physiological conditions, urban architecture, house architecture, diet, clothing, business conditions, mindset, life conditions, and the use of factors (spirituality, experience, and natural capacities) were extracted.

CONCLUSION

Explaining the experiences of the elderly in Dezful, who have lived with heat for many years, can provide better identification of solutions and more tangible experiences of adaptation to heat for other communities. These experiences can be used in urban, cultural, and social planning.

Nurses' experiences of providing medical services during the Kermanshah earthquake in Iran: a qualitative study

BACKGROUND

Nurses have always been at the forefront of providing services for victims of disasters. Using nurses' experiences in disaster planning can play an important role in improving their readiness to provide healthcare during disasters. The objective of this study is not only to understand the challenges but also to explore and document the broader spectrum of experiences encountered by nurses in these critical situations. By focusing on their experiences, we aim to contribute valuable insights to enhance disaster preparedness and healthcare delivery strategies.

METHODS

This qualitative study employed the content analysis method to describe the experiences of 16 earthquake relief nurses in Kermanshah, Iran. Sampling was done purposefully and continued until data saturation was achieved. Initially, two unstructured interviews were conducted to shape the interview's main line and refine guide questions. Subsequently, the study involved semi-structured interviews and observation notes for a nuanced understanding of the participants' experiences.

RESULTS

In the analysis of the interviews, 920 codes were obtained and the nurses' experiences were categorized into three main categories: personal experiences, operational experiences, and social and cultural experiences. These three categories covered 12 subcategories.

CONCLUSION

Results of describing nurses' experiences in the Kermanshah earthquake showed that nurses need to plan and implement necessary measures to ensure pre-disaster preparedness to respond effectively to disasters such as earthquakes. Besides, it is necessary to prepare, train and practice these interventions regularly, periodically, and purposefully. They should be evaluated and updated if they are used in a real earthquake or practice and maneuver.

Predicting current and future high-risk areas for vectors and reservoirs of cutaneous leishmaniasis in Iran

Climate change will affect the distribution of species in the future. To determine the vulnerable areas relating to CL in Iran, we applied two models, MaxEnt and RF, for the projection of the future distribution of the main vectors and reservoirs of CL. The results of the models were compared in terms of performance, species distribution maps, and the gain, loss, and stable areas. The models provided a reasonable estimate of species distribution. The results showed that the Northern and Southern counties of Iran, which currently do not have a high incidence of CL may witness new foci in the future. The Western, and Southwestern regions of the Country, which currently have high habitat suitability for the presence of some vectors and reservoirs, will probably significantly decrease in the future. Furthermore, the most stable areas are for T. indica and M. hurrianae in the future. So that, this species may remain a major reservoir in areas that are present under current conditions. With more local studies in the field of identifying vulnerable areas to CL, it can be suggested that the national CL control guidelines should be revised to include a section as a climate change adaptation plan.

Gender-based violence against women during the COVID-19 pandemic: recommendations for future

BACKGROUND

Gender-based violence (GBV) includes any physical, sexual, psychological, economic harms, and any suffering of women in the form of limiting their freedom in personal or social life. As a global crisis, COVID-19 has exposed women to more violence, which requires serious actions. This work aims to review the most critical dimensions of the GBV against women, effective factors on it, and strategies for combating it during the COVID-19 pandemic in order to provide recommendations for future pandemics.

METHODS

This study was conducted based on PRISMA-ScR. First, PubMed, Embase, Scopus, Web of Science, ProQuest, and Google Scholar were searched in April 2021 with no time limitation and location using the related keywords to COVID-19 and GBV. The searched keywords were COVID-19, gender-based violence, domestic violence, sexual violence, women, violence, abuse, and their synonyms in MESH and EMTREE. Duplicates were removed, titles and abstracts were screened, and then the characteristics and main results of included studies were recorded in the data collection form in terms of thematic content analysis.

RESULTS

A total of 6255 records were identified, of which 3433 were duplicates. Based on inclusion criteria 2822 titles and abstracts were screened. Finally, 14 studies were eligible for inclusion in this study. Most of these studies were conducted in the United States, the Netherlands, and Iran, mostly with interventional and qualitative methods.

CONCLUSIONS

Strengthening ICT infrastructure, providing comprehensive government policies and planning, government economic support, social support by national and international organizations should be considered by countries worldwide. It is suggested that countries provide sufficient ICT infrastructure, comprehensive policies and planning, economic support, social support by collaboration between national and international organizations, and healthcare supporting to manage incidence of GBV against women in future pandemics.

From nuisance to helpful assistants: A qualitative thematic analysis of medical volunteers' experiences during the COVID-19 outbreak in Iran

Background & Aim: Volunteers’ perceptions may affect their future decisions to participate in crisis intervention.  Few studies in Iran have been conducted to examine the experiences of medical personnel who volunteered during the COVID-19 pandemic. This qualitative study describes the experiences of medical volunteers during COVID-19 in Iran. Methods & Materials:  A total 17 healthcare volunteers who worked in COVID-19 hospital wards were recruited using purposive sampling. All participants were recruited in the current study from the hospitals affiliated with the Tehran University of Medical Sciences if they expressed their willingness to participate and had at least two months experience of working as healthcare volunteers in COVID-19 wads. In-depth video-call semi-structured interviews were conducted from August to November 2020. The data were analyzed using the qualitative thematic analysis method. Results: One main theme “from nuisance to helpful assistants” and four sub-themes including the “feeling of inefficiency”, “negligent managing”, “situation orientation”, and “transformation for integrity” emerged from the data. Conclusion: Despite experiencing challenges, the volunteers and hospital staff tried to change their approaches to joint collaboration by improving their capabilities for situation awareness and creating integrity. These findings provide policymakers with a better understanding of health volunteers' challenges in hospitals during crises.

Mortality Risk Related to Heatwaves in Dezful City, Southwest of Iran

BACKGROUND

We aimed to evaluate the impact of heatwaves on daily deaths due to non-accidental, cardiovascular and respiratory causes in the city of Dezful in Iran from 2013 to 2019.

METHOD

We collected daily ambient temperature and mortality and defined 2 types of heatwaves by combining daily temperature ⩾90th in each month of the study period or since 30 years with duration ⩾2 and 3 days. We used a distributed lag non-linear model to study the association between each type of heatwave definition, and deaths due to non-accidental, cardiovascular and respiratory causes with lags up to 13 days.

RESULTS

There was no discernible correlation in this area, despite the fact that heatwaves raised the risk of death from cardiovascular causes and lowered the risk from respiratory causes. On the other hand, the risk of total non-accidental mortality on days with the heatwaves is significantly higher than normal days. In main effects, the heatwaves have a significant relationship with the risk of total non-accidental mortality (in the first heatwave definition, Cumulative Excess Risk (CER) in lag_0-2 was 10.4 and in second heatwave definition, CER values in lag_{0, 0-2, and 0-6} were 12.4, 29.2, and 38.8 respectively). Also, in added effects, heatwaves have a significant relationship with the risk of total non-accidental mortality (in the first heatwave definition, CER in lag_{0 and 0-2} were 1.79 and 4.11 and in the second heatwave definition, CER values in lag_{0, 0-2, and 0-6} were 7.76, 18.35 and 24.87 respectively). In addition, heatwaves appeared to contribute to a cumulative excess risk of non-accidental death among the male group as well as the older adults.

CONCLUSION

However, the results showed that heatwaves could have detrimental effects on health, even in populations accustomed to the extreme heat. Therefore, early warning systems which monitor heatwaves should provide the necessary warnings to the population, especially the most vulnerable groups.

Climate adaptive hospital: A systematic review of determinants and actions

Introduction

Climate change is among the most renowned concerns of the current century, endangering the lives of millions of people worldwide. To comply with the United Nations Climate Change Conference (COP21), hospitals should be on track to reduce greenhouse gas emissions. Although hospitals contribute to climate change by emitting greenhouse gases, they are also affected by the health consequences of climate change. Despite all the guidance provided, hospitals need more radical measures to confront climate change. The current study was carried out to examine the components of hospitals' adaptation to climate change and to review measures to confront climate change in hospitals.

Method

This systematic review was designed and carried out in 2020. The required information was collected from international electronic databases including Scopus, PubMed, Web of Science, EMBASE, and Google Scholar. Moreover, Iranian datasets such as Scientific Database (SID), Irandoc, Magiran, and IranMedex were reviewed. No restriction was considered in the methodology of the study. For the relevant thesis, the ProQuest database was also explored. The related sources were examined and the Snowball method was applied to find additional related studies. The research team also reviewed other accessible electronic resources, such as international guidelines and academic websites. The checklist of the Joanna Briggs Institute (JBI, 2017) was employed in order to evaluate the quality of the included papers. The studies published until June1, 2020, were included in the study.

Results

Of 11,680 published documents in the initial search, the full-texts of 140 were read after evaluating the titles and abstracts, of which 114 were excluded due to lack of sufficient information related to countermeasures in hospitals. Finally, the full-texts of 26 studies were reviewed to extract the required components. Two strategies were found, including climate change mitigation and climate change adaptation, with 13 components including water, wastewater, energy, waste, green buildings, food, transportation, green purchasing policy, medicines, chemicals and toxins, technology, sustainable care models, and leadership in hospitals were identified as affecting these measures and strategies.

Conclusion

Considering the significance of climate change and strategies to confront it as one of the current challenges and priorities in the world, it is necessary to develop a framework and model to reduce the effects of climate change and adapt to climate changes in hospitals and other health centers. The identification and classification of the measures and components, influencing hospital adaptability and solutions for reducing the climate change impacts could be the first stage in developing this strategy. This is because it is impossible to create this framework without identifying these factors and their mutual impacts at the first. In the present study, through a systematic review using a comprehensive approach, the related components were explored and divided into two categories, including measures to reduce the effects and measures to adapt to climate change. The results of this study can be useful in developing a comprehensive action model to reduce greenhouse gas emissions and adapt hospitals to climate change.

War, displacement, and the best location for temporary sheltering: a qualitative study

Background

One of the most important consequences of man-made disasters in the world is the loss of homes and, ultimately, forced population displacement. The sheltering of forcibly refugees to safe areas requires the study of scientific criteria.

Methods

This qualitative content analysis study was conducted in Iran to identify the criteria for the sheltering of refugees due to conflict. Participants in the study comprised experts and managers who had expertise, experience, or knowledge in the shelter for refugees. Data was collected in semi-structured interviews with 20 individuals and analyzed by qualitative content analysis to extract and categorize the factors affecting sheltering for refugees.

Results

The results of this study showed that a wide range of factors should be considered in the sheltering of refugees due to conflict, including land type, access to facilities, access to infrastructures, homogeneity, and similarities, security, distance from danger, environmental factors, economic issues, and political and legal issues. These nine categories covered 53 subcategories and 188 factors.

Conclusions

The comprehensiveness of the factors mentioned in this study showed that the sheltering of refugees due to conflict requires planning, training, culture building, promoting readiness, and inter-organizational coordination. Moreover, managers, policymakers, decision-makers in relief agencies, humanitarian organizations, and organizations involved in sheltering of refugees due to conflict should attend to these factors to improve the process and prevent problems.

Phoenix On Fire: A Phenomenological Study Of A Psychiatric Hospital Fire In Iran

Psychiatric hospitals and centers have more complex conditions than other hospitals in responding to emergencies, given the differences in the design of their buildings and in non-structural elements. This is a qualitative study aimed at reviewing and investigating the experiences and challenges faced by psychiatric hospital staff in response to different fire incidents. A phenomenological approach was employed to conduct the study, believing that human experiences and beliefs are substances in phenomena and can be understood and examined. The contents of interviews and focus group discussion (FGD) sessions were extracted and classified into five categories, 14 themes, and 49 sub-categories. Many psychiatric hospitals in Iran are not ready to respond properly to incidents like fires. The study revealed that in order to ensure appropriate management of incidents and disasters in the hospitals, it is necessary to focus on five areas called the 5s framework, which includes structures, staff, supplies (facilities, equipment etc.), sick persons and systems. This framework is proposed to enhance preparedness, reduce vulnerability, and provoke an effective response to incidents in psychiatric hospitals.

Building Resilience in Firefighters: A Systematic Review

Background: We aimed to identify indicators affecting firefighters’ resilience through a systematic review. Methods: International electronic databases, including Web of Science, Medline through PubMed, Scopus, Cochrane Library, and Google Scholar, were searched on Dec 23, 2018. The search strategy was developed using main words, including firefighter, resilience, and indicators. Then, the indicators related to firefighters’ resilience were extracted and analyzed using a qualitative synthesis method. Results: Overall, 7178 unique documents were identified by searching different databases. Then, by screening the title and abstract, 7104 articles were excluded, and only 74 full text papers were critically studied. Finally, 31 full text articles were selected for the analysis. Quality appraisal of included studies done by modified STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) tool. Moreover, 186 indicators and criteria were extracted from the included studies and classified into 6 domains and 15 categories. Conclusion: This study suggests six main domains, including physical health, physical fitness, mental health, life style, job-related competencies, and demographic status, to categorize different indicators of firefighters’ resilience. Building resilience in firefighters requires all these domains to be considered in the assessment, planning, and evaluation processes.

Scale Development and Psychometric Evaluation of a Questionnaire for Measuring the Risk Factors for Death in Floods

PURPOSE

Determination of the causes of flood-related deaths is the precondition for effective interventions aimed at the reduction of such deaths. There is a gap in the design and the development of a valid and reliable instrument for measuring underlying factors of death in the flood.

METHODS

This study was carried out in two phases. In the first phase, item pool generation and questionnaire design were carried out through systematic review of literature and qualitative study. the initial questionnaire was divided into two parts of objective and subjective factors. In the second phase, the psychometric evaluation of the questionnaire included face, content, and construct validity in the subjective part. The reliability was also evaluated by calculating test-retest intraclass correlation coefficient and Cronbach's alpha. Exploratory factor analysis (EFA) was used for the data collected from 369 individuals in the flood-affected communities experiencing flood deaths. Data analysis was performed in SPSS version 23.

RESULTS

In the EFA, 33 items and seven dimensions were extracted that explained 57.82% of the variance of influential factors in flood death, including the cognition of the flood (four items), general knowledge (four items), public beliefs (four items), risk perception (nine items), attitude (five items), prevention (five items), and social norms (two items). The internal consistency of the instrument using Cronbach's alpha coefficient was 0.92. Finally, in order to perform the stability test, the Pearson correlation coefficient was calculated for all questions. This was above .05 and acceptable.

CONCLUSIONS

According to the results, the factors affecting flood death questionnaire (FAFDQ) could be used to make decisions, identify groups at risk of flood-related deaths, and implement flood-related death-reduction interventions. Indeed, these measures have led to the development of a comprehensive and reliable questionnaire for measuring the factors affecting flood deaths.

COVID-19 in Homelessness: A Worldwide Scoping Review on Vulnerabilities, Risks, and Risk Management

Homeless individuals are at greater risk of death due to social inequalities during Covid-19 pandemic. Strategies taken for general population to prevent the spread of Covid-19, such as social distance, staying at home, and observing personal hygiene are not possible for this group of people. This is a scoping review on articles published and other credible resources published analyze studies done on homeless people during the COVID-19 pandemic. In this scoping review, for the first time, we studied published articles on the situation of the homeless during the Covid-19 epidemic and by extracting and categorizing vulnerabilities, risks, as well as risk management plans, Finally we presented, useful guidance for organizations providing health and social services during the spread of diseases.

Criteria for Locating Temporary Shelters for Refugees of Conflicts: A Systematic Review

BACKGROUND

We aimed to identify the indicators and criteria to locate temporary shelters for conflict refugees.

METHODS

This systematic review evaluated the full-text of the related articles in international electronic databases, such as Web of Science, Scopus, PubMed, Cochran, and Google Scholar from the beginning and without time limit to 1 June 2019. In addition, this search was based on a strategy developed by the researchers. The studies were selected regardless of their methods and two data extraction forms were used to extract the most relevant and important information.

RESULTS

Among 10124 cases of primary documents, 38 articles were selected, and 25 articles were analyzed in full-text. Totally, 45 indicators were identified and classified into two main categories of physical and non-physical indicators with six subcategories of land ownership, host government, access to infrastructures, site safety, land characteristics, and economic, social, and cultural considerations.

CONCLUSION

The selection of temporary shelters for the conflict refugees requires the identification of all the specific influential factors not properly addressed. The final indicators obtained in our review could be incorporated into the development of the models required in this regard.

Exploring the criteria and factors affecting firefighters' resilience: A qualitative study

PURPOSE

Firefighters are exposed to high levels of occupational risk factors, such as safety risks, chemical, ergonomic, and physical hazards that may jeopardize their lives. To overcome these hazards, firefighters must be physically, mentally, and personally fit to work. This study aimed to explore the criteria and factors affecting firefighters' resilience based on stakeholders' experiences.

METHODS

This qualitative study was carried out using conventional content analysis. In total, 21 face-to-face interviews were conducted by firefighters who were experienced in the field. The interviews were carried out from July 2019 to January 2020. The data were collected using 3 unstructured interviews and then resumed by 18 semi-structured interviews. Data analysis was done using Graneheim method.

RESULTS

The participants had more than 5 years of experience in the field of search and rescue. The extracted codes through data analysis were classified into 3 main categories (individual, organizational, and social factors), 9 sub-categories (mental, physical, occupational, managerial, colleagues-related, equipment-related, environmental, community-related, and family-related factors), as well as 19 sub-sub-categories and 570 codes.

CONCLUSION

Firefighters' personality, physical condition, behavior and psychological characteristics can affect their resilience along with organizational and management factors that play significant role in people's safety. Developing a tool for assessing resilience can help decision makers to have a real depict of firefighters' job qualifications.

Investigating the risk factors of flood deaths in Iran

Background:

Floods are kinds of natural disasters that directly threaten human life. To save lives and reduce the number of injured people in floods, it is crucial to determine the underlying factors of flood deaths. This study was conducted to find the causal factors which influence flood deaths in Iran.

Methods:

The present research was conducted in four separate phases. In the first phase, a systematic review was conducted to determine the risk factors influencing flood death based on the available documents in the globe. In the second phase, using a qualitative study with content analysis method, the underlying factors that might cause flood deaths in different groups of Iranians were identified. In the next phase, a validated tool was developed based on the psychometry method. In the last phase, through a retrospective study using the validated tool, the risk factors affecting flood deaths were identified.

Results:

The systematic review identified 114 risk factors which were categorized into five groups of vulnerability factors. The results of the qualitative study indicated that a large number of underlying factors lead to flood deaths including the categories of hazard-related features, cultural, economic, social, demographic, management, and physical factors. The results of regression analysis in a retrospective study showed that by increasing some risk factors, the likelihood of flood deaths decreases. While other groups of risk factors increase the risk of flood deaths.

Conclusions:

Based on the findings of this study, comprehensive and appropriate strategies and interventions can be implemented to reduce and eliminate the impact of flood risk mortality and ultimately to reduce flood deaths. These include planning, training, promotion of awareness and culture of prevention, promotion of risk perception, protection of vulnerable groups, flood risk assessment and flood risk reduction, observance of urban and construction safety principles, improving urban flood management by responsible organizations, and involvement of people in all stages of death-flood risk management.

Keywords:

Flood-Death, Risk Factors, Iran

Effects of COVID-19 on the availability of clean water and sanitation

During the COVID-19 pandemic, the availability and consumption of safe water reached alarming levels. Millions of people still lack access to basic water and sanitation services, and their number is expected to increase, thus increasing the risk of virus transmission. This chapter introduces the impact of COVID-19 on water and sanitation. It starts with discussing the importance of water for health, followed by the effect of COVID-19 on the water and sanitation sectors. It then explains about Sustainable Development Goal-6 (clean water and sanitation) in the context of the COVID-19 pandemic. By the end of the chapter, lessons learned regarding the water and COVID-19 pandemic were highlighted. It was concluded that shift in the water demand, overuse of water, detection of SARS-CoV-2 RNA in wastewater, contamination of water bodies, and inability to pay water bills were the major challenges that SARS-CoV-2 posed.

Behavioral, health- related and demographic risk factors of death in floods: A case-control study

During the first half of 2019, many provinces of Iran were affected by floods, which claimed the lives of 82 people. The present study aimed to investigate the behavioral, health related and demographic risk factors associated with deaths due to floods. We measured the odds ratio and investigated the contribution and significance of the factors in relation to mortality. This case-control study was conducted in the cities affected by flood in Iran. Data were collected on the flood victims using a questionnaire. Survivors, a member of the flood victim's family, were interviewed. In total, 77 subjects completed the survey in the case group, and 310 subjects completed the survey in the control group. The findings indicated that factors such as the age of less than 18 years, low literacy, being trapped in buildings/cars, and risky behaviors increased the risk of flood deaths. Regarding the behavioral factors, perceived/real swimming skills increased the risk of flood deaths although it may seem paradoxical. This increment is due to increased self confidence in time of flood. On the other hand, skills and abilities such as evacuation, requesting help, and escape decreased the risk of flood deaths. According to the results, the adoption of support strategies, protecting vulnerable groups, and improving the socioeconomic status of flood-prone areas could prevent and reduce the risk of flood deaths.

Psychological Distress Model Among Iranian Pre-Hospital Personnel in Disasters: A Grounded Theory Study

Objective: Pre-hospital personnels (PHPs) who work in disasters under extreme pressure, uncertainty, and complex situations are victims of disasters themselves, and there is a link between experiencing such incidents and mental health problems. Because most studies focus on the injured and less on the psychological issues of PHPs, the present study aimed to develop a model to provide relief for PHPs in disasters from a psychological perspective. Methods: A grounded theory methodology recommended by Corbin and Strauss (2015) was employed. PHPs (n = 24) participated in a semi-structured interview between July 2018 to May 2020. Results: In the analysis of the pre-hospital staff interviews, three main themes were extracted, namely, providing relief with struggle (complexity of incident scenes, command-organizational and occupational challenges), psychological distress (psychological regression and psychological empowerment), and consequences (resilience and job burnout). Seven categories and 22 subcategories were explored from our data via the grounded theory approach Conclusions: The PHPs managed psychological distress with two approaches: psychological self-empowerment and regression, which resulted in resilience and burnout, respectively. Due to the lack of enough support, the resilience of the PHPs was short-term, turned into burnout over time, and affected the structural factors again as a cycle.

Implementation of the Sendai framework in the health system in Iran: identification of facilitators and obstacles

PURPOSE

Sendai Framework is an international disaster risk reduction strategy that helps prioritization of disaster risk governance in all policies, strategies, and programs. Considering its geographical location and topographic characteristics, Iran experiences numerous hazards. Natural disasters adversely affect the health of population directly through injury and death, increased physical and mental illness, displacement and disruption of social networks. In addition, Iran's public health facilities have been increasingly impacted by such events during the last decade. This study aimed to investigate the implementation of Sendai framework in health system in Iran.

METHODS

In this mixed method study, first, throughout a literature review, all documents related to Disaster Risk Management (DRM) in Iran's health system were extracted. Then the obstacles and facilitators of DRM were found out based on the literature review and, a two-round Delphi, followed by an expert panel was performed. According to the results of the Delphi and expert panel Pareto analysis, and Fishbone model were used.

RESULTS

85 obstacles and 33 facilitators were extracted in total, which were divided into ten groups include Coordination, Actors, Intervention, Monitoring & Evaluation, Accountability, Attitude, Context, Budget, Idea, and Content. The most important obstacles were attributable to the intervention group, the Context, and the attitudes. The most important facilitators were the intervention group, monitoring and evaluation, and then Actors, policy content and Idea.

CONCLUSION

Despite the existing facilitators for the implementation of the Sendai framework in Iran, there are far more obstacles along the pathway. These factors are relevant to all aspects of policy which would require long-term and continuous cultural change and educational planning.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40201-021-00715-9.

Strategies and experiences for sand and dust storm adaptation: A qualitative study in Iran

BACKGROUND AND PURPOSE

Sand and Dust storms (SDS) are meteorological hazards that are increasing due to climate change. Mitigation and adaptation are two main strategies that help to deal with this global concern. In the recent decades, Iran has been prone to SDS. Therefore, this study was conducted in 2018 in order to explore the SDS adaptation experiences and strategies in the Iranian community.

METHODS

Using content analysis approach and purposive sampling, three groups (including 14 experts, 8 authorities, and 23 individuals) were selected. Data were collected through semi-structured interviews. Data analysis was performed using Graneheim and Lundman's method. Finally, Gaba and Lincoln's scientific criteria were used for data validity.

RESULTS

Two major categories emerged from the analysis. The first category was related to the adaptation experiences and included two subcategories: "citizens' experiences" and "experts'/ authorities' experiences". The second was related to SDS adaptation strategies and included five subcategories: "educational development", "public participation", "inter-sectorial coordination", "institutional development", and "environment preservation".

CONCLUSIONS

Identifying the experiences and strategies that are implemented by a community to adapt to SDS is the core stone for developing a comprehensive local and national adaptation plan. This study suggests strategies and action plans for SDS adaptation that can be used in policy making.

Psychological distress Management in Iranian emergency prehospital providers: A Qualitative study

INTRODUCTION

Emergency prehospital providers (EPHP) who are constantly providing medical care in threatening conditions are more at risk of displaying psychological distress presentations in disaster situations. Problem-solving strategies are essential for effective and efficient management of event position. Therefore, the present study aimed to explore psychological distress promotion in Iranian EPHP.

MATERIALS AND METHODS

A qualitative content analysis study was conducted based on 24 semi-structured interviews. A purposeful sampling method was applied until reaching data saturation. Interviews were transcribed verbatim, and then, data condensing, labeling, coding, and defining categories were performed by the qualitative content analysis recommended by the Landman and Graneheim approach.

RESULTS

Based on the experience of study participants, two main themes with six categories developed. The main themes included emotion-based management and problem-based management when confronting with incidence scene.

CONCLUSION

The main problems of EPHP in confronting with incidence and disasters scenes are psychological distress which some rescuers have emotional reactions while some others who are more resilience and experience manage this problem in the form of problem-based approach. It is recommended these practical strategies to be taught to less experienced rescuers for avoiding emotional-based reactions and better management of disaster scene.

Effect of Dust Storms on Non-Accidental, Cardiovascular, and Respiratory Mortality: A Case of Dezful City in Iran

BACKGROUND

Despite the fact that Iran has been exposed to severe dust storms during the past 2 decades, few studies have investigated the health effects of these events in Iran. This study was conducted to assess the association between dust storms and daily non-accidental, cardiovascular, and respiratory mortality in Dezful City (Khuzestan Province, Iran) during 2014 to 2019.

METHODS

In this study, mortality, meteorological, and climatological data were obtained from the Dezful University of Medical Sciences, Iranian Meteorological Organization, and Department of Environment in Khuzestan Province, respectively. Days of dust storm were identified based on the daily concentration threshold of particulate matter with an aerodynamic diameter of less than 10 μm (PM10) according to Hoffmanns҆ definition, and then an ecological time-series was used to estimate the short-term effects of dust storms on daily mortality. Statistical analysis was performed using a distributed lag linear model (DLM) and a distributed lag non-linear model (DLNM) packages by R software and the study results were reported as excess mortality.

RESULTS

During the study period, 15 223 deaths were recorded, and 139 dust storms occurred in Dezful city. In addition, there was statistically significant excess risk of mortality due to dust storms in Dezful City (mortality in the group under 15 years of age, lag4: 34.17% and 15-64 years of age groups, lag5: 32.19%, lag6: 3.28%), also dust storms had statistically significant effects on respiratory mortality (lag6: 5.49%).

CONCLUSION

The findings of the current study indicate that dust storms increase the risk of mortality with some lags. An evidence-based early warning system may be able to aware the people of the health effects of dust storms.

Methanol Poisoning Outbreaks in Southern Iran in 2018: A Lesson Learned

The article’s abstract is not available.

Global Health Impacts of Dust Storms: A Systematic Review

BACKGROUND

Dust storms and their impacts on health are becoming a major public health issue. The current study examines the health impacts of dust storms around the world to provide an overview of this issue.

METHOD

In this systematic review, 140 relevant and authoritative English articles on the impacts of dust storms on health (up to September 2019) were identified and extracted from 28 968 articles using valid keywords from various databases (PubMed, WOS, EMBASE, and Scopus) and multiple screening steps. Selected papers were then qualitatively examined and evaluated. Evaluation results were summarized using an Extraction Table.

RESULTS

The results of the study are divided into two parts: short and long-term impacts of dust storms. Short-term impacts include mortality, visitation, emergency medical dispatch, hospitalization, increased symptoms, and decreased pulmonary function. Long-term impacts include pregnancy, cognitive difficulties, and birth problems. Additionally, this study shows that dust storms have devastating impacts on health, affecting cardiovascular and respiratory health in particular.

CONCLUSION

The findings of this study show that dust storms have significant public health impacts. More attention should be paid to these natural hazards to prepare for, respond to, and mitigate these hazardous events to reduce their negative health impacts.Registration: PROSPERO registration number CRD42018093325.

Nurses' experience of caring for people living with HIV: a focused ethnography

BACKGROUND

Healthcare providers have been found to have limited knowledge and skills in interacting with people living with HIV. These factors can adversely affect providers' practice, jeopardize their safety and compromise the care of the patients.

AIMS

This study aimed to explore the experiences of Iranian nurses who were caring for patients with HIV.

METHODS

A focused ethnography approach was used. Participants consisted of 12 nurses working in teaching hospitals affiliated to Urmia University of Medical Sciences and recruited by purposeful sampling. Semi-structured interviews, field observations and field notes were used for data collection. Data were analysed employing content analysis.

FINDINGS

Three main themes emerged from the analysis of the participants' experiences of providing care to patients with HIV: 'excessive fear of being infected', 'concerns about the possible consequences' and 'lack of self-confidence in care provision'.

DISCUSSION/CONCLUSION

Nurses have experienced a great deal of fear of self and cross-contamination when providing care to people living with HIV. Social stigma and discrimination against people living with HIV amplified the nurses' experience of fear. Providing appropriate education and training for nurses can improve their attitudes, emotions and self-confidence while providing care to such people and increasing the quality of care provided.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Planning more educational programmes focusing on improving their misunderstandings about HIV could result in positive outcomes: for nurses to provide high-quality care and for people living with HIV who receive this care. The healthcare system should consider the culture of care provided by nurses to these people.

Detection and characterization of Enterobacteriaceae family members carried by commensal Rattus norvegicus from Tehran, Iran

Wild rats are known to carry different microorganisms and are considered a reservoir of zoonotic pathogens worldwide. The urban rats were collected from five districts of Tehran and Gram-negative bacteria (GNB) were isolated from fecal samples and were identified using classical biochemical tests. The antibiotic susceptibility patterns of isolated bacteria were determined by Kirby-Bauer disk diffusion method, the results of which were interpreted in line with CLSI guideline. The frequency of antibiotic-resistant genes was identified using multiplex-PCR. Moreover, PCR method was used to identify the frequency of Escherichia coli O157:H7 and main categories of diarrheagenic E. coli including EPEC, ETEC, EIEC, EAEC, and STEC pathotypes. A total of 100 Rattus norvegicus were trapped and fecal samples were collected. Overall, 72 fecal samples were positive for GNB. E. coli (n = 46/72) had the highest frequency among the isolated GNB. Among E. coli isolates, the highest and lowest resistance rates belonged to ampicillin (56.5%) and ceftriaxone (0%), respectively. Klebsiella spp. was 100% resistant to imipenem, and streptomycin (0%) was the most effective antimicrobial agent on Klebsiella spp. Among surveyed genes, bla_TEM (95.8%) and bla_aadA-1 (58.3%) had the highest frequency, while bla_KPC, and bla_CMY-2 were not detected among Enterobacteriaceae. Herein, O157: H7 serotype was not detected and aEPEC (87%) was the most common pathotype detected. Results suggested that rodents might be a reservoir of antimicrobial-resistant pathogens and rodent control along with implementation of surveillance programs should be considered as a critical priority for urban health.

Risk factors of death from flood: Findings of a systematic review

PURPOSE

The number of flood disaster deaths has been on the rise in recent years. The current review investigated and categorized the risk factors of deaths from floods in parallel with preventive and control measures designed to minimize deaths from floods.

METHODS

In a systematic review, International electronic databases including PubMed, Scopus, Web of Science, and Google Scholar were investigated for articles published in English language. In addition, Iranian databases including IranMedex, Irandoc, Magiran, and Scientific Information Database (SID) were investigated for studies published in Persian. ProQuest database was also searched for related theses. The studies were selected regardless their methods but based on the inclusion and exclusion criteria. The data were extracted, coded and prepared for further analysis. Finally, descriptive and thematic analyses were conducted.

RESULTS

A total of 114 factors were identified and categorized into the following five category that can influence on flood death.: hazard related factors, and individual, environmental, socio-economic, and managerial categories.

CONCLUSIONS

The study identified many factors that affect flood deaths. The variety and the diverse nature of the factors necessitate appropriate interventions for removing or reducing the effects of the identified factors. More quantitative analytical studies are needed to confirm causal relationship between extracted factors and floods death.

Alcohol intake in an attempt to fight COVID-19: A medical myth in Iran

The coronavirus disease 2019 (COVID-19) spread rapidly worldwide and led to the deaths of thousands of people. To date, there is not any vaccine or specific antiviral medicine that can prevent or treat this virus. This caused panic among people who try their best to prevent being infected. In Iran, methanol poisoning was reported and led to the death of hundreds of people in several provinces. The incident occurred after a rumor circulated in the country that drinking alcohol (ethanol) can cure or prevent being infected by COVID-19.

Health system plan for implementation of Paris agreement on climate change (COP 21): a qualitative study in Iran

BACKGROUND

Ensuring public health is crucial in any policy debate on climate change. Paris Agreement on climate change is a global contract, through which countries have committed themselves to a public health treaty. The agreement has laid the foundation for mitigation and adaptation. This study was conducted to provide an evidence-based framework for policy-making in the health system of Iran in order to reduce the adverse effects of climate change on public health and to increase the adaptation of the health system as a result.

METHODS

This is a qualitative study. We first used Delphi method to extract the components of Paris Agreement on climate change that were related to the functions and policymaking of health system in Iran. Twenty-three experts in health and climate change were identified purposefully and through snowball sampling as participants in Delphi. Data collection instrument was a structured questionnaire. We used SPSS software version 25 for data analysis based on the descriptive indices including the mean, the percentage of consensus above 75%, and the Kendall coordination coefficient.

RESULTS

Seventy-nine components classified within nine categories were extracted. The most important examples of the implementation of Paris Agreement on climate change in the health system of Iran were: participation in the formulation of strategies for mitigation and adaptation, identifying vulnerable groups, assessing vulnerability, increasing the capacity of health services delivery during extreme events, using early warning systems, using new technologies to increase the adaptation, evaluation of interventions, financial support, increasing the number of researches, increasing the knowledge and skills of staff, and finally public awareness.

CONCLUSIONS

Evidence-based policy-making is pivotal to develop effective programs to control the health effects of climate change. This research provided policy translation and customization of micro and macro provisions of Paris Agreement on climate change, in line with the political context of health system in Iran. Our finding will pave the ground, we envisage, for further steps towards capacity building and enhancement of resiliency of the health system, adaptation interventions, and evaluation, identification of barriers and facilitators for adaptation and decreasing the adverse health effects caused by the climate change, in Iran and perhaps beyond.

Climate change and health in Iran: a narrative review

BACKGROUND

The consequences of climate change are highly impeding the achievement of Sustainable Development Goals (SDGs) anywhere, especially in low and middle-income countries. While climate change scales up, its health-related risks increase, which in turn leads to cause new challenges for public health. As a second largest country of the Eastern Mediterranean Region of World Health Organization, Iran is highly vulnerable to the effects of climate change.

PURPOSE

This study seeks the notion of health risks and challenges of climate change in Iran and provide potential evidence-based remedies to prevent and diminish such destructive effects.

METHODS

A comprehensive literature in various computerized databases was conducted, and numerous published original research and review articles about climate change status and evidences of adverse health consequences of climate change in Iran were reviewed.

RESULTS

The evidence suggests that the expected health challenges related to climate change in Iran are: rising temperatures; frequent extreme weather events; reduction of air quality; food-borne, water-borne, and vector-borne diseases; mental health and well-being consequences; and the increasing trend of natural disasters and deaths associated with climatological hazards.

CONCLUSIONS

By considering the growing burden of diseases associated with climate variability in Iran as well as the interdisciplinary nature of climate change and health issues, an integrated, multi-sectoral, and comprehensive approach for identification, prioritization, and implementation of adaptation options is required by Ministry of Health and Medical Education as a custodian of public health in order to enhance the resiliency and adaption against adverse health effects of climate change.

Towards developing a model for the evaluation of hospital disaster resilience: a systematic review

BACKGROUND

Hospitals play a vital role in disaster stricken regions. The resilient hospitals will be able to provide essential services to affected people and it can mitigate the risk of injuries during and after disasters. This study aimed to obtain the indicators required for the evaluation of hospital resilience.

METHODS

This systematic review was conducted in 2018. Through this systematic review, international electronic databases were investigated for the research studies published in English. The exclusion and inclusion criteria were determined to extract the hospital resilience indicators. These indicators will be used in order to develop a model to keep the system performance at an acceptable level during disasters.

RESULTS

Out of 1794 research studies published until September 2018, 89 articles and guidelines with full text were surveyed. Thirty-two articles and guidelines were then selected and analyzed to collect the indicators related to hospital disaster resilience (HDR). The domains and the indicators were extracted from these selected research studies. The authors collected and categorized them into three domains and twenty seven subdomains. The three domains included constructive, infrastructural, and administrative resilience. The relevant indicators were designed for each subdomain to assess HDR.

CONCLUSION

Since diverse indicators affect hospital resilience, other studies should be conducted to propose some models or tools to quantify the hospital resilience in different countries and scopes with an all hazards approach.

Conceptual definition and framework of climate change and dust storm adaptation: a qualitative study

Climate Change Adaptation (CCA) is a complex, multi-disciplinary, and culture-dependent concept. This study aims to explore a conceptual definition, the subjective framework of CCA including its domains, attributes, and consequences. The approach of qualitative conventional content analysis was considered for the explanation of the subjective concept, and at the same time as the collection process, data analysis was performed using Zhang and Wildemuth's method. The interview method was semi-structured and sampling was targeted and with maximum diversity. The interview was conducted with 22 qualified experts. The accuracy and validity of the data were ensured using Guba and Lincoln scientific accuracy criteria. Six main categories including "sustainability, productivity, stability, empowerment, transformation, and flexibility" were conceptualized in the theme of adaptation characteristics. "Sustainable development, life improvement, response coordination and integration, creativity and innovation, resilience promotion, vulnerability reduction, effective management, and independence" were the main categories in the theme of the adaptation consequences. According to the results, the following conceptual-functional definition can be presented for adaptation to climate change: "CCA refers to the ability of system instability, sustainability, empowerment, productivity, flexibility, and transformation to climate change through the optimal use of resources, resistance, and coping, capacity building and opportunity creation". This definition is conceptual, it means that includes the main features of climate-adaptation and is also functional that is, includes adaptation strategies for climate change.

The Methanol Poisoning Outbreaks in Iran 2018

AIMS

To present epidemiological data, probable causes and lessons learned from the outbreak of methanol poisoning in Iran in September 2018, and relate this to the increasing incidence of methanol poisoning worldwide over recent decades.

METHOD

Analysis of all available reliable field information, official news reports and reports from the country's forensic medicine organization and the Ministry of Health.

RESULTS

Overall, 768 people in Iran were documented as poisoned from September 7 to October 7 2018 by consuming an informal alcohol containing methanol, of whom 76 died (10.1% fatality rate); 460 subjects attended state hospitals due to acute methanol poisoning of whom 42 (9.13%) died. Those who were hospitalized comprised 177 subjects (38.4%), with 241 subjects (52.3%) seen and discharged. Males comprised 93% of the deaths. About 41% of those poisoned were aged 25-36. Outbreaks were reported in 21 provinces.

CONCLUSION

These data indicate a high fatality rate of methanol poisoning in Iran, something seen also in some other countries. Considering that such outbreaks take place more in low-income and Islamic countries due to ignorance and legal constraints, it seems necessary to seek an effective educational model for raising public awareness and a fully native and early warning system in this regard to reduce the damage and enhance readiness to deal with the health effects of such outbreaks.

Assessment of malnutrition and anthropometric measurement among 0-59 months aged children in Amibara and Awash Fentale districts, afar national regional state of Ethiopia

PURPOSE

Famines and food shortages are one of the most common long time histories of Ethiopia. Hence, malnutrition has been persisted at alarming raters in the country. Moreover, it is a major cause of morbidity and mortality in Afar National Regional State of Ethiopia. Specifically, in Amibara and Awash Fentale districts. The anthropometric data were presented on height, weight, MUAC, weight/height/Age and Body Mass Index (BMI) of under-five children.

METHODS

A cross-sectional descriptive survey was conducted from March 01, 2017 to June 15, 2018. The data was collected by using anthropometric measurement. A multi stage random sampling procedure was applied in order to recruit the required sample size. The data collections were conducted at two selected districts in Afar region by trained interviewers and health care providers. The data were analyzed by using SPSS Version 23. Bivariate analysis between dependent and independent variables was employed. Multivariate analysis was also done to control for possible confounding variable by selecting variable which show statistically significant association (P< 0.05).

RESULTS

Out of 410 under five children's anthropometric finding, the majorities (62.7%) of those registered under five children were male and (33.3%) were female. The majority (46.8%) of under five children were less than or equal to 50 cm by their height. Most (54.1%) of under five children were less than or equal to 12.5 cm by their MUAC. It indicated that they were diagnosed with severe malnutrition based on anthropometric measurements. Meanwhile, majority (64%) of under five children were less than 60% their weight/age. Regression analysis result indicated that all of the variables were not significant predictors of BMI for under five children (P> 0.05). Based on ANOVA result, there was significant difference between sex and other predictors (P= 0.031). This finding implies that improvement in food aid and poverty alleviation programs are very important. Based on the finding, it is important to provide high quality and quantity of food. Moreover, less access to assets and health services commonly contributed for malnutrition. Highlighting under five children's malnutrition will help to develop and design future policies and programs in Ethiopia.

Estimating the household drought driven food insecurity using system dynamics model: The case of afar national regional state of Ethiopia

BACKGROUND

Building resilient communities has emerged as a dominant schema in the policy arena and in academia in the wake of recent disasters. Food insecurity is a complex and multidimensional phenomenon that is not appropriately captured by conventional proxy indicators currently used to assess the problem in developing countries. Ethiopia like many countries in sub-Saharan Africa, continues to experience high levels of drought driven food insecurity despite decades of implementing poverty alleviation and prevention programmes. These persistent droughts, combined with the devastating impact of climate change continue to threaten the livelihoods of thousands of men, women and children, who depend on agriculture for their livelihoods.

OBJECTIVE

The overall objective of this study was to assess and analyze the drought driven food insecurity situation, malnutrition and derive policy implications in the Afar National Regional State of Ethiopia.

METHODS

Mixed methods designs which include both qualitative and quantitative were used. The subjects of the study were men and women dwellers, government officials and other stakeholders in Afar Regional State of Ethiopia. Four Hundred Twenty Two (422) eligible households were enrolled consecutively from randomly selected two Districts in Afar National Regional State of Ethiopia which were selected by stratified Randomized method. The Districts were randomly allocated into 3 Keble's from Amibara and 2 Keble's from Awash Fentale. Two FGD (total of 10 FGDs participants that mean each Districts = 5 FGD) and 10 KIIs from Amibara and Awash Fentale were conducted. Standard questionnaires were used for data collection after validating the instruments. The data was analyzed by using SPSS version 23. Associated factors and multiple logistic regressions were employed. The study significance was conducted by using α 5% level.

RESULTS

In this research (58.1%) of the participants agreed that lower crop yield occurred due to heavy rains/floods were not shocks among households. While (41.9%) were shocks on households who travel further loyal for grazing was the highest level of shocks among all those listed. On top of that majority (56.8%) of under five children were < 60% by their weight/age and (33.9%) between 61 and 70%. There was significant difference among MUAC (P= 0.007), BMI (P= 0.003) and height, weight, MUAC, BMI and weight/age among under five children.

Impact of climate change on community health and resilience in Ethiopia: A review article

BACKGROUND

Drought is a serious issue which might be caused by climate change that could create famine and health problems. Drought reduces air quality, increases fungal infestation, reduces people hand washing, affects mental health, leads to malnutrition by decreasing agricultural production, and increases diseases transmitted by insects. This study aimed to determine and describe community health status through building drought resilience in Ethiopia.

METHODS

This review was conducted based on the available peer-reviewed articles that were published from January 2004 to December 2018 Online databases from PubMed, MEDLINE, Scopus, EMBASE and Google Scholar were searched for studies related to the building drought and community health resilience at different regions of Ethiopia that were published in English language. The search was made by using "Emergency disaster", "prevention", "preparedness", "response", "recovery", "drought", "food insecurity", "coping strategies" and "drought health policy" as keywords.

RESULTS

Most of the reviewed articles deal with the impact of climate change on the human health in relation to food security. The associated factors of the impact of drought on food security is basically due to lack of irrigation and farmland, the scarcity of water due to the direct effect of drought, flood, severe soil erosion, livestock dispossession, family size of the household and literacy of the households. Various coping strategies were employed by the households to alleviate the high and continued food insecurity problem such as reducing the number and amount of meal, scrounging cash and grain, searching for off-farm and non-farm jobs, getting food aid, vending of livestock, and partake in food for work programs.

CONCLUSION

The findings explored components of the coping strategies to the building resilience create fruitful health conditions for the food insecure household. The effect of agricultural support services as reliance's on drought and community health situation was regarded as a positive outcome. Moreover, the means to get adequate food security strategies in all regions of Ethiopia should be designed. Furthermore, future researches are recommended for finding the best building strategies for each region of Ethiopia.

Continuous post-disaster physical rehabilitation: a qualitative study on barriers and opportunities in Iran

BACKGROUND

Internationally, inclusion of physical rehabilitation services during early disaster response is relatively new. The aim of the study was to gain an understanding of disaster relief physical rehabilitation in Iran.

METHODS

A qualitative study design was employed and sixteen semi-structured interviews were conducted for data collection. Content analysis was used for data analysis. The participants in this study were purposively selected among people who experienced the Bam (2003) and Varzaghan (2012) earthquakes.

RESULTS

Three main themes were explored including: indispensable intervention, barriers to continuous intervention and opportunities for intervention. Almost all participants reiterated the importance of effective physical rehabilitation services during disasters. Some participants mentioned significant barriers for delivering such services in the context of Iran. The lack of an effective responsible body, weak disaster-related competencies and under-prioritization by government were among other barriers. On a more positive note, some interviewees talked about national programs that could facilitate service delivery.

CONCLUSIONS

Providing disaster relief physical rehabilitation has faced many barriers in Iran. However, there are some facilitators in the country that could help provide these services. Finally, the feasibility of post-disaster physical rehabilitation services delivery completely depends on the current national rehabilitation system.

Setting research priorities to achieve long-term health targets in Iran

Background

In 2015, it was estimated that the burden of disease in Iran comprised of 19 million disability-adjusted life years (DALYs), 74% of which were due to non-communicable diseases (NCDs). The observed leading causes of death were cardiovascular diseases (41.9%), neoplasms (14.9%), and road traffic injuries (7.4%). Even so, the health research investment in Iran continues to remain limited. This study aims to identify national health research priorities in Iran for the next five years to assist the efficient use of resources towards achieving the long-term health targets.

Methods

Adapting the Child Health and Nutrition Research Initiative (CHNRI) method, this study engaged 48 prominent Iranian academic leaders in the areas related to Iran’s long-term health targets, a group of research funders and policy makers, and 68 stakeholders from the wider society. 128 proposed research questions were scored independently using a set of five criteria: feasibility, impact on health, impact on economy, capacity building, and equity.

Findings

The top-10 priorities were focused on the research questions relating to: health insurance system reforms to improve equity; integration of NCDs prevention strategy into primary health care; cost-effective population-level interventions for NCDs and road traffic injury prevention; tailoring medical qualifications; epidemiological assessment of NCDs by geographic areas; equality in the distribution of health resources and services; current and future common health problems in Iran’s elderly and strategies to reduce their economic burden; the status of antibiotic resistance in Iran and strategies to promote rational use of antibiotics; the health impacts of water crisis; and research to replace the physician-centered health system with a team-based one.

Conclusions

These findings highlight consensus amongst various prominent Iranian researchers and stakeholders over the research priorities that require investment to generate information and knowledge relevant to the national health targets and policies. The exercise should assist in addressing the knowledge gaps to support both the National General Health Policies by 2025 and the health targets of the United Nations’ Sustainable Development Goals by 2030.

Earthquake in Western Iran: Renovation Kills

Introduction: Earthquake is the most important cause of death from natural disasters in Iran. This paper brings attention to the main causes of loss of life due to the Kermanshah province earthquake (Nov 12 2017), and provides a wakeup call about the unsafe nature of buildings there. Methods: This study is based on official reports review and a field assessment in the areas affected by the earthquake in western Iran. Results: Although buildings in this area are mainly old structures, strangely, more than 70% of the destroyed buildings in this earthquake were under 5 years of age, newly built or renovated buildings according to mandated building codes. Discussion: Mandated building codes and construction rules and regulations are not respected even for the newly constructed or reconstructed structures buildings. Keywords: Earthquake, Iran, construct, reconstruct, Building codes