Exploring factors affecting the unsafe behavior of health care workers' in using respiratory masks during COVID-19 pandemic in Iran: a qualitative study.

BACKGROUND: The use of respiratory masks has been one of the most important measures to prevent the spread of COVID-19 among health care workers during the COVID-19 pandemic. Therefore, correct and safe use of breathing masks is vital. The purpose of this study was to exploring factors affecting the unsafe behavior of health care workers' in using respiratory masks during the COVID-19 pandemic in Iran. METHODS: This study was carried out using the conventional qualitative content analysis. Participants were the number of 26 health care workers selected by purposive sampling method. Data collection was conducted through in-depth semi-structured interviews. Data analysis was done using the content analysis approach of Graneheim and Lundman. This study aligns with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist and was conducted between December 2021 and April 2022. RESULTS: The factors affecting the unsafe behavior of health care workers while using respiratory masks were divided into 3 main categories and 8 sub-categories. Categories included discomfort and pain (four sub-categories of headache and dizziness, skin discomfort, respiratory discomfort, feeling hot and thirsty), negative effect on performance (four sub-categories of effect on physical function, effect on cognitive function, system function vision, and hearing), and a negative effect on the mental state (two subcategories of anxiety and depression). CONCLUSION: The findings can help identify and analyze possible scenarios to reduce unsafe behaviors at the time of using breathing masks. The necessary therapeutic and preventive interventions regarding the complications of using masks, as well as planning to train personnel for the correct use of masks with minimal health effects are suggested.

Climate change and health: The case of mapping droughts and migration pattern in Iran (2011-2016).

INTRODUCTION: Migration and mobility of population have been reported as a common reaction to drought. There is historical evidence to suggest the health effects of droughts and human migration linkage in Iran. This study aimed to map the drought and migration patterns in Iran in 2011 and 2016 and explore their possible health impacts. METHODS: This sequential explanatory mixed-method study was done in two stages of spatial analysis and qualitative study. Data mapping was conducted through the equal interval classification and using drought, migration, and agriculture occupation data based on provincial divisions in Iran in 2011 and 2016. This qualitative study was conducted using the content analysis approach. RESULTS: The in-migration rate was higher in 2011 rather than 2016. Migration to cities was much higher than migration to villages in both years. The frequency of male migrants was higher than females in all provinces in 2011 and 2016. Physical and mental diseases as well as economic, sociocultural, education, and environment effects on health were extracted from the qualitative data. CONCLUSION: A holistic picture of droughts and migration issues in Iran and their health consequences were achieved by the present research. Further research is needed to explore the determinants of health impacts of climate change in vulnerable groups. Public health problems can be prevented by adaptive and preventive policy-making and planning. This can improve the coping capacity of the population facing droughts and enforced migration.

Spiritual rehabilitation of affected people after natural disasters: a protocol for a systematic review.

BACKGROUND: Knowledge about the spiritual rehabilitation of affected people after disasters is scare. The objective of the present study is to identify the factors affecting the spiritual rehabilitation of affected people after natural disasters employing a systematic review study. METHODS: The protocol of this review has been registered in the International Prospective Register of Systematic Review (PROSPERO) with the code CRD42021228552. Using MEDLIN (PubMed), Web of Science, Google Scholar, Embase, ProQuest, Scopus and ISC database as well as studies related to the research topic till the end of 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was used to find articles related to the research objective. Thematic content analysis then was used for concepts extraction. RESULTS: This systematic review identifies factors affecting the spiritual rehabilitation of affected people after natural disasters. CONCLUSIONS: Both systematic review as well as qualitative study are essential in order to explore spiritual rehabilitation of affected people after natural disasters, while the current study was employed systematic review. It is expected that planners and policy-makers can use the extracted factors for improving the spiritual rehabilitation of people affected by natural disasters.

Economic Evaluation Approaches in the Field of Disaster Health Management.

BACKGROUND: Economic evaluation approaches are needed to establish useful interventions for saving lives, preventing economic damage, and saving recovery costs at the time of disasters. Thus, the present study is aimed to identify the studies that applied economic evaluation approaches/methods for evaluating the economic costs of disasters. METHODS: A scoping review was conducted to find the eligible studies and perform a comprehensive data analysis. RESULTS: Based on the findings, cost-effectiveness analysis, economic loss assessment, modeling, or mapping, as well as behavioral economic analysis were used as the economic evaluation approaches/methods. CONCLUSIONS: Applying economic evaluation approaches to illustrate the economic costs of disasters is highly recommended. Managing competing priorities and optimizing resources allocations to the most cost-effective interventions can be achieved by cost-effectiveness analysis. The results of economic loss assessment can be used as the basis of disaster preparedness and response planning. Economic modeling can be applied to compare different interventions and anticipate socio-economic effects of disasters. A behavioral economic approach can be effective for decision-making in the field of disaster health management. Further research is needed to identify the advantages and limitations of each economic evaluation method/approach in the field of health in disasters. Such research can preferably be designed as the systematic review and meta-analysis.

Explaining of the experts' points of view about the types and importance of man-made hazards in Iran's process industries: A qualitative study.

Introduction: Process industries may have different hazards that can cause serious injury to humans, the environment, and the economy. Considering the importance of man-made risks in process industries, Experts' Points of View should be considered to apply risk reduction strategies Hence, the present study was performed to explain the views of experts regarding the types and importance of man-made hazards in process industries. Materials and methods: This study was conducted using a qualitative method of directed content analysis with a deductive approach. The participants included 22 experts in the field of process industries. The selection of samples started purposeful and continued until data saturation. Data collection was done through semi-structured interviews. Results: Based on experts' points of view, 5 man-made hazards in process industries were classified into 14 subcategories. The man category was divided into three subcategories: human error, technical knowledge error, and management error, the Material category was divided into 3 sub-categories of leakage and rupture, chemical properties, physical properties, Medium category was divided into two sub-categories of incorrect location selection and placement and harmful environmental factors, Machines category was divided into three sub-categories of failure in design, failure in Preventive Maintenance (PM), failure in Safety Instrumented System (SIS), and the Methods category was classified into three sub-categories: defects in inspection, defects in information, defects in executive instructions. Conclusion: Technical training to reduce personnel errors, conducting risk-based inspections to control leaks and possible ruptures, careful design and site selection in the initial phase of the project, is recommended. The use of engineering methods and artificial intelligence to obtain the risk number and control methods to reduce the harmful effects of risks can be helpful.

Climate Change and Gender: Mapping Drought and Gender Gap in Literacy and Employment Sections in Iran between 2011 and 2016.

Background: Drought is one of the most frequent natural hazards in Iran. Gender analysis can highlight the different needs and capacities of men and women to manage drought hazards. Thus, the present study aimed to map drought and the gender gap in drought data based on the provincial zones in 2011 and 2016. Methods: This cross-sectional study was conducted in 2 stages establishing a database and spatial analysis. Data mapping was done based on provincial divisions, sex-disaggregated distribution of literacy, and employment rate as well as drought patterns in Iran in 2011 and 2016 using ArcGIS software. Descriptive statistics were applied to analyze and report the sex-disaggregated literacy and employment data. Results: About 80.73% and 75.27% of women and 80.89% and 74.74% of men experienced severe and very severe droughts in 2011 and 2016, respectively. Gender inequality in the aspects of literacy and employment in drought-affected regions was found in 2011 and 2016. Conclusion: Community-based planning and management in regions exposed to climate change are suggested for reducing the consequences of climatic disasters such as droughts. Women need to be empowered and trained for innovative livelihood activities in rural and urban areas in Iran and other developing countries affected by long-term droughts.

Designing a conceptual model for the formation of unsafe antisocial behaviors in motor vehicle drivers: a grounded theory study.

BACKGROUND: Many accidents caused by vehicles are the result of improper driving behavior. Use the vehicle in an antisocial form has led to a phenomenon called driving violence. Antisocial behavior while driving has a potential risk to other road users. This study aims to explain the conceptual framework of the formation of unsafe antisocial behaviors in the road traffic field. METHODS: This qualitative grounded theory study was conducted with exploratory methods. 31 participants were included in this study. Purposeful and theoretical sampling was used in this study. The data collection process was semi-structured interviews. Codes, subcategories, and categories were extracted by the inductive process and analyzed by Corbin and Strauss approach. Trustworthiness criteria were used to assure the quality of the results. The data analysis process continued until there were no new concepts. RESULTS: A conceptual model was developed to explain the different relationships between the main categories extracted from the study. 10 main categories with 44 subcategories were extracted. Categories include cultural factors, educational factors, rules, economic factors, psychological factors, infrastructure weakness, poor socialization of individuals, violent driving, reduced social welfare and reduced traffic safety. CONCLUSIONS: The people's socialization weakness in society was considered as the core concept in the process of formation of these behaviors. The conceptual model obtained from this study can be used in developing prevention programs and identifying the required interventions Considering the negative consequences caused by this type of behavior, its prevention should be the focus of road traffic policy makers.

Factors Challenging the Spiritual Rehabilitation of Iranian Men Affected by Natural Disasters: A Qualitative Study.

Spiritual health is one important dimension of human health. Natural disasters, however, can adversely affect human spiritual health. One of the undeniable requirements of disaster management is the spiritual rehabilitation of victims to help them recover to their pre-disaster health conditions. This study aimed to explore the factors challenging the spiritual rehabilitation of Iranian men suffering from natural disasters based on the experiences of key informants. The participants were 19 spiritual health experts in post-disaster spiritual rehabilitation. Participants were selected using a purposive sampling method until data saturation was reached. The data were collected through semi-structured interviews and analyzed using Granheim and Lundman (2004) content analysis method. The factors challenging men's spiritual rehabilitation were classified into 6 main categories and 16 subcategories. The extracted categories included (i) correcting victims' perspectives, (ii) describing God's characteristics, (iii) seeking help from God, (iv) strengthening spiritual beliefs, (v) psychological factors, and (vi) tranquility factors. Our findings identified the important factors challenging the spiritual rehabilitation of the men victimized by natural disasters, which needed to be considered by responsible organizations and health sectors. Particularly, the organizations in charge of disaster management should take necessary measures and plans during the post-disaster phase to restore people's spiritual health. Spiritual health, currently a neglected dimension of health, should be considered people's in parallel with physical, psychological, and social health dimensions. Our results can be helpful in developing action plans for delivering a comprehensive spiritual rehabilitation service, which would help to lead to the full rehabilitation of victims after natural disasters.

Challenges and Barriers to the Participation of Non-Governmental Organizations (NGOs) in Flood Management: A Qualitative Study from Iran.

OBJECTIVE: Floods are one of Iran's most important natural hazards, which cause a lot of damage every year. Various organizations, including non-governmental organizations (NGOs), participate in flood management. The present study aimed to explore the challenges and barriers of NGOs' participation in the management of the flooding in Iran based on stakeholders' experiences. METHODS: This qualitative study is a case study that was conducted using the content analysis approach. Fifteen participants, including 3 national managers, 2 volunteers active in responding to recent floods, and 10 NGO managers/secretaries who had the knowledge or operational experience of participating in disaster management, were approached for interviews. Data were collected using a purposeful sampling method and continued until reaching data saturation. RESULTS: Challenges and barriers to NGOs' participation in flood management were categorized into 4 main categories and 14 subcategories, including policy-making challenges, managerial challenges, executive challenges, and socio-cultural challenges. CONCLUSIONS: As multiple NGOs take part in responding to disasters and performing relief operations, establishing a unified command and supervision system for effective coordination and collaborations among NGOs and other stakeholders is highly suggested. Further research is needed to develop a measurement tool for assessing the effectiveness of NGOs' activities during disasters.

Assessment of Intraorganizational Collaboration in the health sector during Disasters: Exploring a Valid and Reliable Assessment Tool for Disaster Risk Management.

Background: Collaboration, as a key factor in disaster risk management, is a mechanism that prevents the loss of time, investment, and resources. The variety of units in the health sector has made collaboration a major challenge. The present study aimed at developing a tool for assessing collaboration in the health sector during disasters. Methods: In this mixed-methods study, a questionnaire was developed by integrating the findings of a systematic literature review and a qualitative study. Face and content validation were performed. The reliability of the tool was tested through a 15-day interval test-retest by Cronbach's alpha and intraclass correlation coefficient (ICC) with 30 participants. Confirmatory factor analysis was done to test the validity and reliability of instrument using SmartPLS in a case study with 450 health sector staff. Results: The factors affecting intraorganizational collaboration of the health sector were identified in six categories and 19 subcategories by searching 46 articles in the systematic review and content analysis of 16 semistructured interviews with health sector staff. The results of content validity ratio (=0.81), content validity index (=0.92), Cronbach's alpha (=0.975), and ICC (=0.970) confirmed the validity and reliability of the tool. Convergent validity, discriminant validity, and reliability were approved by AVE (average variance extracted) >0.5, Fornell and Larcker matrix, and CR (composite reliability) >0.7. According to the positive result of R 2, Q 2, and goodness-of-fit (GOF) criteria, the model fit was confirmed. Conclusion: The results of validity and reliability measurements approved the proposed tool. The use of this tool is recommended for developing collaboration in the health sectors of different countries.

Foresight of the Consequences of the Hazmat Release From an Oil Refinery on the Surrounding Urban Community Following an Earthquake: A Natech Scenario Analysis.

OBJECTIVE: To analyze the consequences of the Natech scenario of H2S toxic gas release from an oil refinery near Tehran and its effects on surrounding residential areas following an earthquake. METHODS: This research was an applied study. The Natech risk map and the end-point distance of gas release were determined using the Rapid-n software and the Worst-Case Scenario of RMP, respectively. RESULTS: Regarding the high seismic vulnerability of the structures affected by the Natech risk, all residents of this area were simultaneously affected by earthquake and the toxic gas inhalation. In comparison to earthquake, response capacities were poor for Natech events, due to insufficient resources, limited accessibility, lack of planning, and unsafe evacuation places in exposed regions. Unlike earthquake, few studies have been conducted on Natech risk assessment and related consequences in Iran. Our study not only covered this gap but also revealed some dimensions of consequences of human, structural, and response capacities. CONCLUSIONS: It is recommended to have plans for implementing short-term such as identifying vulnerable industries and areas, public awareness and long-term such as land use planning measures to reduce Natech risk and resilience improvement.

Challenges of emergency evacuation of residential areas caused by chemical release due to the earthquake: a Natech event scenario.

BACKGROUND: In recent decades, earthquakes, as natural hazards that caused direct effects both on communities and the chemical industry, produced many Natech events. Natech term is utilizing to describe the technological disasters caused by natural hazards. This study was conducted on the emergency evacuation challenges of residential areas adjacent to a refinery near Tehran based on H2S toxic gas release following a possible earthquake scenario. METHODS: This Research was an applied study at two phases in 2020. In the first phase, a review study was conducted to identify the community's previous experiences on emergency evacuation following Natech events. In the second phase, the challenges of emergency evacuation were analyzed based on the scenario of a possible earthquake and gas release from the refinery. RESULTS: Due to the high seismic vulnerability of structures in the area affected Natech risk, the total Resident population in this area would be affected simultaneously by an earthquake and H2S gas release in concentration 30 ppm as the result of the earthquake impact on chemical facilities. Emergency evacuation would be inevitable. The existing evacuation places are very unsafe and dangerous due to having open spaces. The nearest suitable evacuation places were found in the north direction for more than 38 % of the exposed population and in the east, west, and south direction for more than 61% of them. CONCLUSIONS: The emergency evacuation challenges were discussed in 4 viewpoints, disrupted or interrupted rescue and firefighting operation, unnecessary evacuation, frequent evacuation, and evacuation behavior. The measures such as revising and updating emergency evacuation maps; public informing, training, preparedness; providing protocols and training for operational and therapeutic response teams; and coordination improvement can help resilience increasing to such disasters.

Suicide Death Rate after Disasters: A Meta-Analysis Study.

BACKGROUND: Disasters have undesirable effects on health among individuals such as psychosocial disorders which may lead lead to suicide in some cases. Thus, the present study aimed to measure the rate of suicide death after disasters all over the world. METHODS: In the present meta-analysis study, all of the articles published in English until the end of 2019 were probed in electronic databases such as Web of Science, PubMed, Cochrane Library, Science Direct, PsycINFO, PsycARTICLES, and Google Scholar. Then, the data were imported to STATA ver.13 software and analyzed through fixed- and random-effects models, meta-regression, and Cochrane statistical tests. RESULTS: A total of 11 studies including a sample size of 65495867 were considered. Suicide death rates before and after the disasters were calculated as 13.61 (CI95%: 11.59-15.77) vs. 16.68 (CI95%: 14.5-19:0) among the whole population, 28.36 (CI 95%:11.29-45.43) vs. 32.17 (CI95%: 17.71-46.62) among men, and 12.71 (CI95%: 5.98-19.44) vs 12.69 (CI95%: 5.17-20.21) among women. The rate of suicide death significantly increased in the whole population and men, while no significant difference was reported among women. CONCLUSION: Suicide death rate increases after disasters indicating the destructive impact of this phenomenon on peoples' health. Therefore, implementing supportive and interventional measures is highly suggested after disasters in order to prevent suicide death among the affected people.

Essential Professional Competencies for Basic Midwifery Practice in Disasters: A Qualitative Study.

OBJECTIVE: Educated midwives have a range of abilities to use their skills in normal situations. Given that working under normal situations is different from critical conditions, the recognition of skills and competencies required for midwifery practice is important. The purpose of this study was to explore specific professional competencies that midwives need to have for the provision of reproductive health services during disasters. METHODS: This was a qualitative study using a content analysis method. Subjects were 19 midwives with the work experience of practice in disaster situations. Data were collected using semi-structured interviews and analysis was based on the approach suggested by Graneheim and Lundman. RESULTS: Six major categories developed in this study were "safe pregnancy," "safe childbirth," "women's health care," "contraception," "violence and sexually transmitted infections," and "infant care." CONCLUSIONS: Midwives can play a very important role in the provision of reproductive health services. Therefore, they must have special capabilities and capacities. Policies and curriculum development are recommended in accordance with the needs of reproductive health in disaster-affected communities.

Factors Affecting Resiliency Among Volunteers in Disasters: A Systematic Literature Review.

OBJECTIVE: Volunteers need considerable resiliency to cope with formidable challenges during their operations in disaster scenes. The present study was conducted to identify factors affecting the different aspects of resiliency among volunteers in disasters. MATERIAL AND METHODS: The databases of Web of Science, Scopus, PubMed, ProQuest, Google Scholar, World Health Organization Library, International Committee of the Red Cross (ICRC) Library, PsycArticles, and SafetyLit were searched until September 29, 2018. The main search terms were resiliency, disaster, humanitarian aid worker, and volunteer. RESULTS: A total of 548 documents were obtained and screened based on the inclusion and exclusion criteria. A number of 8 documents was selected for the final analysis. The main factors contributing to the resilience of volunteers at the 3 stages of pre-, during, and post-disasters were classified into 3 groups of individual, environmental, and organizational. Important factors affecting resilience of volunteers in disasters included previous disaster response experience and disaster-related training. CONCLUSION: Resiliency should be deemed integral to relief operations. Considering the main factors affecting volunteers' resiliency, it is highly suggested that organizations active in humanitarian endeavors explore the factors impacting on resilience among their volunteers via various research methods and seek to select those with higher degrees of resilience in order to avert untoward consequences in their missions.

Factors affecting development of air ambulance base: A systematic review and thematic analysis.

Nowadays, air ambulances have been developed as part of advanced emergency medicine services with many countries employing these services for transferring patients in usual and emergency conditions. However, there are challenges concerning the optimal development of air ambulance base. The present research aimed to identify factors affecting the development of air ambulance bases to provide the opportunity of planning to improve the quality of emergency medical services. In this systematic literature review, the peer-reviewed papers in fiv electronic databases, including Medline through PubMed, Scopus, Web of Science, ScienceDirect, and ProQuest, as well as available gray literature, were searched and selected. Two combinations of groups were used as keywords: the Health Planning and development factor, air ambulance base. The focus was on the PRISMA checklist, with no time limitations until from 1990 to January 2020. Finally, through 5156 related citations, 20 articles were included. Descriptive and thematic content analyses were evaluated. The factors affecting the development of the air ambulance base were classified in fiv categories and 14 subcategories as follows: navigation criteria, process indications and standards, sociopolitical factors, and current situation of the area. There are few studies on factors affecting the development of air ambulance bases. It is necessary to apply multidimensional models to consider various factors for development. The development of high populated cities, events and ceremonies with a crowd of participants, and increase of human-made disasters are making these services increasingly indispensable.

Exploring the Factors Affecting Unsafe Antisocial Behaviors of Drivers in Iran: A Qualitative Study.

OBJECTIVE: To explore the factors affecting unsafe antisocial behaviors of drivers in the context of Iran. METHODS: The interviews were conducted from June to November 2019. A number of 19 participants were selected using purposive sampling method. The data were collected using face to face in-depth semi-structured interviews. Content analysis using Granheim's approach was applied for data analysis. RESULTS: Seven categories and 14 sub-categories were extracted from the data. The categories included cultural factors, educational and training factors, laws, imitating, substance abuse, awareness and attitude, and psychological problems. CONCLUSION: Based on the findings, various cultural, legal, educational, individual and psychological factors affect the unsafe antisocial behavior in driving. Seemingly, such behaviors could increase the chance of death or injury caused by road traffic crashes among the road users and affect social welfare of the citizens and road user's safety.

A systematic review of health sector responses to the coincidence of disasters and COVID-19.

BACKGROUND: In December 2019, the Chinese city of Wuhan reported a novel pneumonia caused by COVID-19. While the COVID-19 pandemic has been increasingly affecting the world, the occurrence of disasters resulted in complex emergencies. The present review is aimed to identify the literature focused on health system response to coincidence of COVID-19 and disasters as well as describing their finding, implications and lessons-learned. METHODS: This study was conducted and reported based on PRISMA guideline. The databases of Web of Sciences, PubMed, Scopus, Google Scholar and World Health Organization Library were searched. The inclusion criteria were all forms of published articles which investigated the coincidence of disasters and COVID-19 pandemic. Using the title and abstract screening, the selections of studies were performed by two researchers. Once, the relevant papers were finalized, the analysis was done in two parts of descriptive analysis and implications for health systems. RESULTS: Out of 1245 studies generated by initial search, a number of 13 articles was selected for final analysis. Earthquake was the most frequent disaster which its coincidence with COVID-19 was studied by researchers (31%). The implications of researchers for healthcare system were explained in three sections of climatic events, earthquakes and all hazard approach in relation to COVID-19. CONCLUSION: Extracting the lessons learned from the regions affected by disasters at the time of COVID-19 pandemic can be helpful for healthcare professionals and policy-makers to improve their preparedness and response during disasters and a serious pandemic such as COVID-19. Further research is needed to identify the factors which strengthen the preparedness of health system for the dual risk of natural hazards and pandemics.