National Health-Oriented Hazard Assessment in Iran Based on the First Priority for Action in Sendai Framework for Disaster Risk Reduction 2015-2030.

BACKGROUND: Understanding disaster risk is the first priority for action based on the Sendai Framework for Disaster Risk Reduction 2015-2030 (SFDRR), and hazard assessment is the first step in the assessment of disaster risks. Therefore, assessing health-oriented hazards is the first measure in disaster risk assessment in the medical universities area in Iran. This article introduces a national experience and results obtained from designing a national tool for defining and assessment of health-oriented hazards in Iran. METHODS: In the present study, a National Health-Oriented Hazard Assessment tool (NHHAT) was developed by experts and implemented by the Iranian Ministry of Health for gathering data according to frequency, probability, magnitude, and vulnerability of the hazards to identify the first ten hazards of medical universities in the two decades ago (2000-2021). Finally, the top 20 health-oriented hazards were identified among the ten hazards reported by each university. RESULTS: According to the findings, the four most important hazards were road traffic accidents, earthquakes, drought, and seasonal floods. Nevertheless, the hazards such as desertification, tunnel events, soil liquefaction, mass population movement, and sea progression were among the rarest ones reported in the medical universities in Iran. CONCLUSION: Many functional aspects of disaster risk management depend on the realistic and accurate information related to the main elements of risk, especially the probable hazards in the communities. The comprehensive hazard assessment can only provide such information using context-bond tools. This is an applied study and a national implementation to fulfill the priority of the Sendai framework (i.e., understanding disasters risk) in Iran. It is suggested that other countries should also compile standard tools to explore the hazards for designing up-to-date hazard maps.

Challenges to manage pandemic of coronavirus disease (COVID-19) in Iran with a special situation: a qualitative multi-method study.

BACKGROUND: With the unprecedented expansion of COVID-19 in the world since December 2019, Iran's health system, like other countries, faced various challenges in managing the disease, which led to numerous experiences and lessons learned. This study was conducted to identify these challenges regarding unique political, economic, and cultural issues, which could help other countries with similar situations. METHODS: The present study was performed using a qualitative multi-method approach with a content analysis method. The data were collected through in-depth and semi-structured interviews and focused group discussions with 60 key persons who were selected purposefully, including policymakers, health care workers, and affected people by the disease, and the review of all available national reports between February 21, 2020, and March 22, 2021. The data collection and analysis were done simultaneously. RESULTS: Identified critical challenges for the management of COVID-19 in the health system were limited evidence and scientific controversies, poor social prevention and social inequalities, burnout and sustained workload among healthcare workers, improper management of resources and equipment, the lack of a guideline for contact tracing, and patient flow management, and mental health problems in the community. CONCLUSIONS: According to our results, measures should be taken to conduct a continuous comprehensive risk assessment and develop a national response plan with an emphasis on precise contact tracing, active screening, patient flow, paying attention to the psychological and social dimensions of the disease, and also transparency of social inequalities in the face of risk factors of the COVID-19. Also, the social protection programs should become a vital tool for policymakers and supporting the vulnerable groups using the capacity of the community and international cooperation to develop a vaccine, which is difficult to procure due to the sanctions.

Components of driving competency measurement in the elderly: A scoping review.

Background: Iran will face the "aging Tsunami" phenomenon by the 2040s. Therefore, paying attention to the elderly's driving to maintain and promote their independence and quality of life on the one hand and paying attention to the dangers of driving by the elderly for road safety will be important. The purpose of this research was to determine the components of driving competency in the elderly. Methods: The research has employed a scoping review. To this end, searches of scientific databases were conducted using keywords between 1990 and 2019. The process of selecting the documentation was-based on the PRISMA chart. Results: In the first phase, 2769 records were found, and finally, 37 records met the inclusion criteria set for this study. The results indicated that 18 components were extracted that were classified into seven main categories including cognitive, sensory, motor, mental functions, and medications, diseases, and driving history. Conclusion: Sensory, motor, and cognitive abilities are the most important components of elderly safe driving. Therefore, as age increases, chronic disease, multiple drug use, and subsequent problems increase. This can affect the ability to drive safely and can cause traffic injuries. Therefore, it is recommended to use the results of this research to design a suitable tool and model for assessing driving competency in the elderly.

Introducing practical tools for fit to drive assessment of the elderly: A step toward improving the health of the elderly.

Today, as age increases, the demand for independent living has increased. Since driving is one of the safest and preferred ways for the elderly to travel, paying close attention to the accurate assessment of the elderly's driving ability can prevent traffic accidents in this age group. The purpose of this study was to identify and introduce practical tools for drive assessment fitness of the elderly. This systematic review was conducted according to Cochrane methodology and reported findings according to PRISMA. The following databases were searched from PubMed, ISI web of knowledge, Scopus, ProQuest, Medlib, SID, Magiran, Iran doc, and Iran Medex based on the population intervention comparison outcome method. The total records involving 12 main tools were assessed from 26 selected records in the final evaluation. The research findings indicated the selection of seven tools in the psycho-cognitive function domain such as TMT-B, Clock Drawing Test, MAZE, Montreal Cognitive Assessment, GDS-15, MMSE, and ACE-R, three tools in the sensory function domain such as Snellen, Confrontation Visual field, and Whispered Voice Test, and also two tools in motor function domain such as Rapid pace walk, and Manual test of the range of motion. The findings led to selecting practical, accurate, and fast tools for widespread use for the assessment of driving competencies of the elderly. Therefore, it is recommended that the selected tools be used in practical batteries to assess the driving skills of the elderly.

A Framework for National Rehabilitation Policy and Strategies in Iran: A Scoping Review of Experiences in Other Countries.

BACKGROUND: The main objective of this study was to review the goals and programs of rehabilitative care in different countries to achieve a framework for a national operational plan for expanding rehabilitation services in Iran. METHODS: In this qualitative study (scoping review), national rehabilitation documents were reviewed in a selected list of countries. We searched several databases including Web of Science, PubMed, Scopus, and Google Scholar and main website such as WHO. Then, the review results were presented to a panel of experts to receive their feedback and opinion for a framework of national rehabilitation policy and strategies in Iran. RESULTS: In the preliminary phase, 1775 documents were found and 17 documents were selected from Asia, Europe, three islands near Australia, America, and Australia continents. National policies and programs regarding rehabilitation could be categorized in three fields: 1) Removing the barriers to access rehabilitative health services, 2) strengthening and improving rehabilitation, relevant appropriate technologies, Supportive Services, and Community Based Rehabilitation, and 3) Collecting international data on social support and improving the quality of research and services related to rehabilitation. CONCLUSION: To achieve a successful national rehabilitation framework in any country, it is required to strengthen information and research database, implement annual monitoring of policymaking, assess the next year rehabilitation needs of society, finding causes of disabilities for effective planning.

Availability of outpatient rehabilitation facilities in 2015 in Iran: A nationwide study.

Background: Disability can involve many by diseases, injuries, or aging, and thus access to rehabilitation services has a key role in improving these patients' social life. Since 2008, Iran has improved the access to rehabilitation facilities along with the global convention. Yet, nationwide studies are required to evaluate the fair distribution of centres in each province. Thus, the present study aimed to evaluate the distribution of outpatient rehabilitation services in 32 provinces of Iran to help policymakers make more appropriate decisions. Methods: In this cross sectional study, which was conducted between April and October 2017, a master facilities list (MFL) of rehabilitation services that was developed in Iran was used to identify health facilities. Data were collected from the statistics of the Deputy for Rehabilitation of Social Welfare Organization offices and Red Crescent Organization in 32 provinces of Iran. Descriptive data were analysed by SPSS version 22 and reported by percentage and number in 1 000 000 population; distribution was drawn on Iran's map by the GIS software. Results: According to the MFL, outpatient rehabilitation services include physical medicine & rehabilitation, physiotherapy, occupational therapy, speech therapy, audiometry, and orthotics & prosthetics (90%); other rehabilitation centres include general rehabilitation centres, day care centres, and vocational centres (10%). The largest number of occupational therapy, physiotherapy, and audiology offices were found in Tehran, where general rehabilitation centres, day care centres, and vocational centres were less than 3 per 1 000 000 population. There were no rehabilitation centers in 14 provinces, and there were very few physical medicine and rehabilitation centres in most of the provinces. Conclusion: There was significant difference in the distribution of outpatient rehabilitation facilities in different provinces of Iran and some provinces required urgent attention of policymakers, as they had the least number or no rehabilitation facilities.

Predictors of substance abuse among risky drivers: The role of personality characteristics and mental health.

BACKGROUND: Regarding the high prevalence of substance abuse and its serious complications, the necessity of assessing factors assuming to make tendency toward substance abuse is justifiable. MATERIALS AND METHODS: The statistical population consisted of all car drivers referred to traffic department in 2015 in Kermanshah. In this descriptive study of correlation type, 846 risky drivers from referrals to traffic department were randomly selected. Data were analyzed through NEO personality inventory, general health questionnaire, and discriminant analysis. RESULTS: Discriminant analysis was used to analyze data. Standard coefficients of discriminant function revealed that depression, social functionality, physical symptoms, neurosis, and anxiety symptoms were of the highest role in discriminant function while agreeableness and conscientiousness had the least role in discriminant function and its success. The discriminant analysis also showed that linear combination of above variables is able to explain about 75.5% of variance of difference between two groups (P < 0.0001). CONCLUSIONS: Regarding the results of this study, it is proposed that the role of personality characteristics as well as mental health in tendency toward substance abuse could be appreciated and included in preventive and treatment programs held for people with methamphetamine abuse.

Designing Iranian Pre-hospital Stroke Scale.

BACKGROUND: Various studies have shown that stroke morbidity and mortality could be decreased if patients receive early diagnosis and treatment. Iranian Pre-hospital Stroke Scale (IPSS) is designed based on other prehospital stroke scales available across the world as well as experiences of emergency medicine specialists and pre-hospital emergency technicians to improve the diagnostic accuracy of the stroke scale in Iran. METHODS: Using a mixed method, the study was carried out in two main phases. In the first phase, concept elicitation was conducted based on the review of the literature. Related stroke diagnosis and usual instruments in pre-hospital emergency stroke centers were documented. The IPSS was designed based on semi- structured interviews with 35 neurologists, emergency medicine practitioners and physicians working in hospitals and emergency technicians in the pre-hospital field. In the second phase, the face and content validity, and reliability were checked. RESULTS: According to results from the first phase of this study (items generation), three domains were introduced as the most important factors in detection of early signs and symptoms of stroke. In the second phase (items reduction), the face validity of the IPSS was checked based on the comments from participants (the experts and EMS technicians). The content validity was calculated based on Lawshe index. The IPSS scale content validity index (S-CVI/Ave) was calculated as 89%. To determine the criterion validity of the instrument, the IPSS scores were compared with the final diagnosis based on results from brain CT scan in hospital. CONCLUSION: During this study we developed IPSS to be used by emergency technicians in pre-hospital field with a dichotomous items and simple and easy administration. It is recommended for future studies to apply this tool to emergency dispatch units as well as triage procedures in hospitals.