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PURPOSE@#Injuries are one of the leading causes of death and lead to a high social and financial burden. Injury patterns can vary significantly among different age groups and body regions. This study aimed to evaluate the relationship between mechanism of injury, patient comorbidities and severity of injuries.@*METHODS@#The study included trauma patients from July 2016 to June 2018, who were admitted to Sina Hospital, Tehran, Iran. The inclusion criteria were all injured patients who had at least one of the following: hospital length of stay more than 24 h, death in hospital, and transfer from the intensive care unit of another hospital. Data collection was performed using the National Trauma Registry of Iran minimum dataset.@*RESULTS@#The most common injury mechanism was road traffic injuries (49.0%), followed by falls (25.5%). The mean age of those who fell was significantly higher in comparison with other mechanisms (p < 0.001). Severe extremity injuries occurred more often in the fall group than in the vehicle collision group (69.0% vs. 43.5%, p < 0.001). Moreover, cases of severe multiple trauma were higher amongst vehicle collisions than injuries caused by falls (27.8% vs. 12.9%, p = 0.003).@*CONCLUSION@#Comparing falls with motor vehicle collisions, patients who fell were older and sustained more extremity injuries. Patients injured by motor vehicle collision were more likely to have sustained multiple trauma than those presenting with falls. Recognition of the relationship between mechanisms and consequences of injuries may lead to more effective interventions.
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PURPOSE@#Successful application experiences on public-private partnership (PPP) in different countries, suggest that PPP could be an option in road traffic injury (RTI) prevention. The present study aims at investigating the applicability of PPP policy in RTI prevention in Iran based on the experts' perspectives.@*METHODS@#This is a qualitative study with grounded theory approach which has been conducted in Tabriz University of Medical Sciences, Iran in 2018. The participants were 22 experts in the field of RTIs selected using purposive sampling method. Data were collected by semi-structured interviews and analyzed with content-analysis method.@*RESULTS@#The results were classified under 5 main themes (applicability, scopes and services, challenges, advantages, and strategies) for applying PPP policy and 37 sub-themes. Due to the prevalence of RTIs, the present challenges in public sector, existence of qualified private sector, and successful experiences in other areas, there are opportunities for private sector partnership in prevention of RTIs. Private sector could participate in different scopes and services regarding RTI prevention, including road construction and maintenance, maintenance and provision of vehicles safety and public education. The main challenges including legislation issues, ambiguities in collaboration, political and organizational unsustainability, government's financial hardship and lack of experienced experts in the field of RTI. However, there are significant advantages including high efficiency in program implementation, covering the weaknesses of public sector, effective and efficient management on application of PPP in RTI prevention. The strategies include identifying and prioritizing the assignable activities, identifying the qualified private sector, developing PPP policies and legal frameworks, creating a common language between public and private parties, trying to meet the expectations of the private sector by public sector, developing a comprehensive and sound contract, and cultivating public culture to accept private sector in the field of RTI prevention.@*CONCLUSION@#This study sought to determine whether PPP could be used as strategy to reduce the burden of RTIs in Iran. But it requires a lot of preliminary studies to provide the context and conditions for applying this policy.
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Adult , Female , Humans , Male , Middle Aged , Accidental Injuries , Accidents, Traffic , Expert Testimony , Iran , Public-Private Sector Partnerships , Qualitative ResearchABSTRACT
Objective: To study the epidemiology of car user road traffic fatalities [CURTFs] during eight years, in East Azerbaijan, Iran
Methods: A total of 3051 CURTFs registered in East Azerbaijan forensic medicine organization database, Iran, during 2006-2014, were analyzed using Stata 13 statistical software package. Descriptive statistics [p<0.05] and inferential statistical methods such as Chi-squared test and multivariate logistic regression with p<0.1 were applied
Results: Of the 7818 road traffic injury [RTI] deaths, 3051 [39%] were car users of whom 71% were male [mean age of 36.7+/-18.5 years]. The majority of accident mechanisms were vehicle-vehicle crashes [63.95%], followed by rollover [26.24%]. Crash causing vehicle fall increased the pre-hospital death likelihood by 2.34 times. The prominent trauma causing death was head trauma [in 62.5%]. In assessing the role of type of counterpart vehicle on pre-hospital mortality, considering the other cars to be the reference group for comparison, deceased victims were 1.83 times more likely to die before hospital when the counterpart vehicle was a truck and 1.66 times more for buses
Conclusion: Decreasing the car users' fatalities using appropriate strategies such as separating the roads for heavy and light vehicles and improving the injury related facilitation may be effective. Male drivers with low education could be prioritized for being trained
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Objective: to investigate epidemiological aspects of injuries among Iranian children under 7 years of age using obtained data from a national registry
Methods: injury data were derived from a national-based injury supervision system during 2000-2002. This registry involved all of home-related injuries for children less than 7 years of age that treated in health or emergency centers. The study population included 25% of Iranian people. The descriptive statistical methods were used for representing the distribution of the variables like age, sex, injury mechanisms, types of injuries, etc. Data were presented as mean +/- SD and proportions as appropriate
Results: of the total 307,064 domestic injuries registered during 2000-2002, 77,500 cases [25.2%] were children. 70% of these children [54581 cases] were in age group of 1-5 years. The large fraction [58.8%] of injuries among children under 7 years of age went back to burn injuries. Cuts and lacerations were at the second level with 17.4%. 51% of injuries had contact with hot liquids. Of all children under 7 years of age injuries, 282 died, 86 were disabled, while the rest improved or being under treatment when recording data
Conclusion: injuries, particularly burns [especially those who had contact with hot liquids that led into scald], are major public health problem that children under 7 years of age encounter. Therefore, it seems necessary to provide adequate plans to promote children under 7 years of age safety issues
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Objective: To systematically identify the various methods of speed management and their effects
Methods: A systematic search was performed in Science Direct, Ovid Medline, Scopus, PubMed and ProQuest databases from April to June 2015. Hand searching and reference of selected articles were used to improve article identification. Articles published after 1990 which had reported on efficacy/effectiveness of speed management strategies were included. Data were extracted using pre-defined extraction table
Results: Of the 803 retrieved articles, 22 articles were included in this review. Most of the included articles [63%] had before-after design and were done in European countries. Speed cameras, engineering schemes, intelligent speed adaption [ISA], speed limits and zones, vehicle activated sign and integrated strategies were the most common strategies reported in the literature. Various strategies had different effects on mean speed of the vehicles ranging from 1.6 to 10 km/h. Moreover, 8-65% and 11-71% reduction was reported in person injured accidents and fatal accidents, respectively as a result of employing various strategies
Conclusion: Literature revealed positive effects of various speed management strategies. Using various strategies was mostly dependent on road characteristics, driver's attitude about the strategy as well as economic and technological capabilities of the country. Political support is considered as a main determinant in selecting speed management strategies
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Objective: To determine the type and pattern of arrhythmic events following the 2012 Ahar-Varzegan Earthquake among patients implanted with cardiac defibrillators [ICDs] in East Azarbaijan province
Methods: In a prospective cohort study, conducted in East Azerbaijan Province of Iran, 132 patients were enrolled in two comparison groups according to the region of residence i.e., earthquake region [n=98] and non-earthquake [n=34] region in 2012. Data were collected for those meeting standard criteria for sustained ventricular arrhythmias [Vas], or supraventricular tachycardias [SVTs] and triggered ICD therapies, either shock or anti-tachycardia pacing [ATP]. The state version of the State-Trait Anxiety Inventory [STAI-S] was used to assess general symptoms of anxiety in both groups
Results: Males comprised 81.1% of the participants. Mean age of the participants was 59.7+/-15 years
The frequency of patients with sustained VAs increased significantly after the earthquake [p=0.008]
There were more VAs [mean 2.16 vs. 6.23; p=0.008] and they occurred earlier [6th vs. 16th day; p=0.01] in the earthquake area
The mean frequency of SVTs and the total number of delivered ICD therapies were similar between groups
Differences in anxiety levels were not significant between groups but there was a trend for presence of greater number of patients with anxiety [p=0.07] and the relative severity of anxiety [p=0.08] in the earthquake area
Conclusion: In the earthquake area, the mean frequency of VAs increased and they occurred earlier in the earthquake area. The stress of anxiety might have served as a trigger for these events
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Objective: To describe the epidemiological and clinical characteristics of fall injuries in East Azerbaijan, Iran
Methods: This cross-sectional study was based on Hospital Information System [HIS] data for patients referred to the Imam Reza Hospital between 2008 and 2013. We recorded the demographic characteristics and epidemiological patterns of patients who were admitted to our center due to fall injuries. To standardize the reports the International Classification of Diseases [ICD], the International Classification of Diseases 9 Clinical Modification [ICD-9-CM] was used. Equally, the hospitalization period and number, admission ward, and the final status of victims after discharge from the hospital were extracted from the HIS
Results: Overall we included a total number of 3397 patients with mean age of 39.2 +/- 22.7 years. There were 2501 [73.6%] men among the patients. Long bone fracture [48.1%] and intracranial injury [24.2%] were the most frequent injuries among fall injury victims. Operations on spinal cord and spinal canal structures [12.0%], Operations on nose [11.6%] were the most common operations being performed in these patients. The survival was significantly lower in patients with age more than 60 years when compared to other age groups [p=0.001]. The survival rate was significantly lower in age group of >60 years, compared to other age groups [p=0.001]
Conclusion: Given the high rate of fall injuries and death among the elderly that increases with age, appropriate measures must be taken to control and prevent injuries while prioritizing the elderly
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OBJECTIVE: To investigate the effect of enhanced external counterpulsation (EECP) on plasma nitric oxide (NO), Endothelin 1 (ET1), high sensitive C-reactive protein (HSCRP) and quality of life (QoL) in patients with coronary artery disease (CAD). METHODS: We conducted a pilot randomized clinical trial in order to evaluate plasma NO, ET1, HSCRP and QoL before and after twenty sessions of EECP (group A) and cardiac rehabilitation (CR, group B) in 42 patients with CAD (21 in each group). RESULTS: Forty-two patients (33 male and 9 female) were included in the study. The mean age was 58.2+/-10 years. The mean HSCRP was 1.52+/-0.7 in the EECP group and it was reduced to 1.27+/-0.4 after intervention. The reduction in HSCRP was not statistically significant in EECP and CR groups with p=0.33 and p=0.27, respectively. There was not significant improvement of NO, ET1, and QoL in the EECP and CR groups shortly after therapy (p>0.05). CONCLUSION: Although the short-term EECP treatment in CAD patients improved HSCRP, NO, ET1, and QoL compared with the baseline those improvements are not statistically significant. Further studies are necessary with large study groups and more sessions.
Subject(s)
Humans , Male , C-Reactive Protein , Coronary Artery Disease , Counterpulsation , Endothelin-1 , Endothelins , Nitric Oxide , Pilot Projects , Plasma , Quality of Life , RehabilitationABSTRACT
Reform programs in some developing countries are focused in transferring these services to nongovernmental organizations or groups. In this WHO grant study our aim was to implement and evaluate the efficacy of a new model for transferring state service delivery governance to nongovernmental groups and studying if they can be efficient in field of child and maternity health services compared to public health centers. In this comparative study a total of 1000 households were selected systematically from the population covered by 9 health centers transferred to cooperatives and 18 current public health centers. Data were collected during a three months long study period and analyzed by SPSS 10 statistical package. Chi-Square and t-tests were used to analyze data. Overall health care coverage was higher for either cooperative or public health centers compared to private sector physicians [p = 0.005].Around 88.8% of under 6 years aged children were under coverage of health services provided by health centers in both groups and no difference was found. There was no statistically significant difference in quality of child health care services in declaring the date of health care visit and follow up in due time. There was no difference between the groups in perfect filling child growth cards but the ability of mothers in interpreting child growth cards was statistically higher for the population covered by cooperative health centers [p = 0.02]. Growth status of children based on growth percentiles were relatively similar in two groups. Some health indices of target groups covered by public and cooperative health centers such as family planning, child health cares, perinatal cares, and the numbers of households covered by health volunteers were studied. The results showed that in all of these fields cooperative health centers had better rates. Observed differences were statistically significant [family planning: p = 0.03, infant health care: p = 0.03, 1-6 years old children cares: p = 0.009]. The proportion of those women owning a vaccination record [card] was higher in population covered by cooperative health centers [p = 0.004]. The rate for performing a cervical smear examination during the national program for cervical cancer screening was higher for the women covered by cooperative health centers [p = 0.01]. No difference was found between the knowledge level of women covered by cooperative health centers about the importance of cervical examination when compared with public health centers. We conclude that in the field of target group children's health care and maternity health services, cooperatives sector not only acts as well as public sector meeting the standards of the program, but also has got a better function in some areas. This can be assumed as an achievement for the policy of transferring the health services to cooperative health centers along with ongoing governmental supervision