Distraction and related risk factors among professional and non-professional drivers.

Background: Distraction is one of the main driver's behavioral factors that reduces the performance of the drivers and might increase the accident risk. Distraction while driving holds significant importance, especially among professional drivers, and failure to address this matter may result in adverse implications for traffic safety. The present study was conducted to investigate distraction and related risk factors between two groups of private vehicle drivers and taxi drivers. Methods: This analytical cross-sectional study was carried out in Tabriz, Iran in 2022. The total sample size in this study was 701 taxi drivers, professional drivers, and private vehicle drivers. The independent samples t-test was used to determine the statistically significant difference between groups and its sub-scales between the two studied groups. Moreover, the multivariable linear regression analysis was used to determine the predictors that affect distraction score. The test's level of significance was considered at 0.05. Results: The mean distraction score among taxi drivers surpasses that of private vehicle drivers (2.82 vs. 2.32, p-value<0.05). The drivers with negative scores, over the past year, among private vehicle drivers and taxi drivers were 2.5 % and 5.2 %, respectively (p-value<0.05). A group of taxi drivers exhibits a higher level of distraction while driving and the mean distraction score for private vehicle drivers is lower than that of taxi drivers (ß = -0.11, CI 95 %: 0.17, -0.05). Also, a history of damage or injury accidents has a significant impact on distraction while driving (ß = 0.12, CI 95 %; 0.06-0.17). Conclusions: The results indicate that distraction while driving is high amongst taxi drivers rather than private vehicle drivers. To have effective driver safety promotion interventions, it is recommended to consider driver distraction based on professional and non-professional drivers.

PERSIAN traffic safety and health cohort: a population-based precrash cohort study.

PURPOSE: Despite to high burden of road traffic injuries (RTIs), the RTI epidemiology has received less attention with rare investments on robust population cohorts. The PERSIAN Traffic Safety and Health Cohort (PTSHC) was designed to assess the potential causal relationships between human factors and RTI mortality, injuries, severity of the injury, hospitalised injury, violation of traffic law as well as offer the strongest scientific evidence. PARTICIPANTS: The precrash cohort study is carried out in four cities of Tabriz, Jolfa, Shabestar and Osku in East Azerbaijan province located in northwest Iran. The participants were people who sampled among the general population. The cluster sampling method was used to enrol the households in this study. The PTSHC encompasses a wide and comprehensive range and types of data. These include not only the common cohort data collections such as medical examination measures, previous medical history, bio assays and behavioural assessments but also includes data obtained using advanced novel technologies, for example, electronic travel monitoring, driving simulation and neuro-psycho-physiologic laboratory assessments specifically developed for traffic health field. FINDINGS TO DATE: A total of 7200 participants aged 14 years and above were enrolled at baseline, nearly half of them being men. The mean age of participants was 39.2 (SD=19.9) years. The majority of participants (55.4%) belonged to the age group of 30-56 years. Currently, approximately 1 200 000 person-measurements have been collected. FUTURE PLANS: PSTHC will be used to determine the human-related risk factors by adjusting for the vehicle and land-use-related factors. Therefore, a lot of crashes can be prevented using effective interventions. Although this cohort provides valuable data, it is planned to increase its size to achieve the highest level of evidence with higher generalisability. Also, according to the national agreement this cohort is going to be extended to several geographical regions in second decade.

Validity and reliability of short-form travel behavior questionnaire during COVID-19 pandemic (TBQ-Cov19).

Introduction: Avoiding unnecessary travel and reducing the number of essential travels are among the effective strategies for preventing the spread of COVID-19 during the pandemic. Given that it is impossible to avoid essential travel, health protocols should be observed to prevent disease transmission. The extent to which health protocols are observed during the trip should be accurately assessed by a valid questionnaire. Therefore, this study aims to develop and validate a questionnaire to assess compliance with COVID-19 prevention protocols during travel. Methods: In this cross-sectional study, 285 individuals were selected from six provinces using the cluster sampling method in May and June 2021. The Content Validity Ratio (CVR) and Content Validity Index (CVI) were calculated using the comments of 12 external experts. The exploratory factor analysis (EFA), with principal component factor in the extraction method and Varimax rotation, were applied to determine construct validity. Cronbach's alpha was employed to assess internal consistency and the Spearman-Brown correlation coefficient was computed for test-retest reliability. Results: In the content validity phase, the I-CVIs for all items were acceptable, but due to a low CVR value (below 0.56), one question was eliminated. As a result of EFA for construct validity, two factors were extracted that justified 61.8% of the variance. Cronbach's alpha coefficient of the questionnaire, with 10 items, was 0.83. The Spearman-Brown correlation coefficient was 0.911 which confirmed the stability of the questionnaire at an excellent level. Conclusions: This questionnaire is a valid tool with good validity and reliability for assessing compliance with health protocols in travel during the COVID-19 pandemic.

Road safety lead agency challenges of three decades of intervention for road safety in Iran: implications for policy-makers.

BACKGROUND: Road traffic crashes and associated injuries and mortalities are one of the big public health challenges, especially in low/middle-income countries. Road safety lead agency (RSLA) is a vital factor in the sustainable prevention and promotes road safety. In the recent decades, various policy interventions have been conducted for road safety in Iran. This study aimed at exploring the challenges of RSLA from the perspectives of stakeholders at various levels. METHODS: A qualitative study was conducted. In-depth interviews and document reviews were used for data collection. To conduct interviews, different stakeholders at various levels such as policy-makers, senior national authorities, researchers and faculty members were selected. Data collection was conducted between November 2019 and June 2020. Thematic content analysis approach was used for data analysis. RESULTS: The experts' perspectives were analysed and then categorised under five main themes including the role and position of the lead agency, the role and duties of the actors and players, translating policy into practice, intrasectoral and intersectoral cooperation and coordination and evidence production and application and a total of 22 subthemes were identified. The current structure of the RSLA is one of the main challenges emphasised by the research participants. CONCLUSION: To achieve significant improvements in road safety at the national level, a strong management system and leadership body is a critical issue. Organisational reform to establish an effective unique lead agency is proposed to cope with RSLA challenges.

Psychometric Properties of EQ-5D-3L Applied through Phone Follow-Ups: An Experience in PERSIAN Traffic Cohort.

Objective: To assess psychometric properties of the European Quality of Life 5-Dimension 3-Level Version (EQ-5D-3L) commonly used tool for measuring road traffic injury (RTI) patients' quality of life. Methods: The psychometric study assessed the reliability and applicability of EQ-5D-3L through phone surveys, based on a national cohort platform. Data of 150 RTI patients recruited from the cohort study were included as 50 patients per each follow-up phase (one, six, and twelve months after discharge). A 12- day-time span was between test and retest. We measured psychometric properties (internal consistency reliability and stability reliability) and agreement using Kappa coefficients and percentages of agreement and Bland-Altman method. Data were analysed using software STATA statistical package. Results: The majority of patients were men (80%) with mean age (SD) of 41(14.7%), employed (78%) and educated (86%). The Persian version represented high internal consistency reliability at total level (Cronbach's α=0.81) and moderate to good reliability at phase levels (0.62-0.87). The stability reliability was excellent at total (ICC=0.98, 95% CI: 0.97, 0.98) and phase levels (0.97-0.98. The kappa agreement coefficients were valued moderate to perfect (0.6-0.8, p>0.0001). The Bland-altman plot illustrated high agreement between test and retest scores. No floor and ceiling effects were found. Conclusion: The study revealed that EQ-5D-3L was highly reliable and responsive to be applied through phone interviews at three different times post injury and discharge, as no previous study considered its psychometric properties at various phone follow-ups after RTIs.

Bell's Palsy and COVID-19 Vaccination: A Systematic Review.

Background: Bell's palsy is a rare adverse event reported in COVID-19 vaccines. Given the importance of neurological manifestations, the necessity to highlight and scrutinize the incidence of them following COVID-19 vaccination is needed. This study aimed to systematically review the reported cases of Bell's palsy following vaccination against COVID-19. Methods: This systematic review is conducted based on the Cochrane Collaboration Handbook and PRISMA Statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyzes) and using the Joanna Briggs Institute (JBI) methodology for systematic reviews. The inclusion criteria for the included published studies were patient age ≥18 years, history of Bell's palsy after COVID-19 vaccination and established diagnosis in the patients with COVID-19 vaccination. The exclusion criteria were repeated cases and missing clinical information. The search strategy aimed to find both published and unpublished studies in August 2021 and updated by hand searching in May 2022 using the identified keywords and index terms in Cochrane Library, MEDLINE (PubMed), Web of Science, Scopus, ProQuest, and Google scholar. Finally, the reference lists of all identified reports and articles were searched for additional studies. The JBI critical appraisal tools for case reports or case series were used to assess the risk of bias in the included studies. Results: During the electronic search, hand search, and reference check, we identified 1281 citations, and in hand searching, we detected additional 15 studies. After omitting duplicated citations and assessing the title, abstract, and full text 15 case-report and two case-series studies were included for the critical appraisal process and were included in this study. Pfizer and Moderna vaccines were the most common vaccines among articles that reported the cases of Bell's palsy. Left-sided paralysis was more common than right-sided paralysis. The interval between receiving the vaccine and the onset of facial weakness was between 1 and 48 days. Conclusion: Further studies with larger sample sizes are necessary to assess the association between Bell's palsy and the dose-response of the COVID-19 vaccine.

Setting research priorities to achieve long-term national road safety goals in Iran.

Background: Road traffic crashes (RTCs) and its associated injuries are one of the most important public health problems in the world. In Iran, RTCs rank second in terms of mortality. To address this issue, there is a need for research-based interventions. Prioritizing researches using a variety of approaches and frameworks to determine the most effective interventions is a key nodal point in the RTCs' research policy planning cycle. Thus, this study aims to generate and prioritize research questions in the field of RTCs in Iran. Methods: By adapting the Child Health and Nutrition Research Initiative (CHNRI) method, this study engaged 25 prominent Iranian academic leaders having role in setting Iran's long-term road safety goals, a group of research funders, and policymakers. The experts' proposed research questions were independently scored on a set of criteria: feasibility, impact on health, impact on the economy, capacity building, and equity. Following the prioritization of Research Questions (RQs), they were all classified using the 5 Pillar frameworks. Results: In total, 145 Research Questions were systematically scored by experts against five criteria. Iran's top 20 road traffic safety priorities were established. The RQs related to "road safety management" and "road and infrastructure" achieved a high frequency. Conclusions: The top 20 research questions in the area of RTCs in Iran were determined by experts. The majority of these RQs were related to "road safety management". The results of this study may contribute to the optimal use of resources in achieving long-term goals in the prevention and control of road traffic crashes and its related injuries. Considering these RQs as research investment options will improve the current status of Road Traffic Injuries (RTIs) at a national level and further advance toward compliance with international goals. If these research priorities are addressed, and their findings are implemented, we can anticipate a significant reduction in the number of crashes, injuries, and deaths.

World Health Organization's estimates of death related to road traffic crashes and their discrepancy with other countries' national report.

BACKGROUND: Due to a lack of effective registry system for road traffic deaths, some international organizations like the World Health Organization provide the estimated number of road traffic deaths. It was shown that there are differences in the number of road traffic deaths between the WHO estimates and national reports even in High-Income Countries. This study aimed to an investigation of reasons for differences between the national reports and world health organization estimates about road traffic deaths. METHODS: This study focus to investigate the World Health Organization reports of Global Status Report for Road Safety in years of 2009, 2013, 2015 and 2018 and related articles about the estimates of deaths related to road traffic crashes and the observed differences between the WHO estimates and national reports. RESULTS: The findings showed that the observed differences between the WHO estimates and national reports could be due to errors in the road traffic death registration system, errors in the regression model which was used for estimation, proposed variables for estimations, or all of them. CONCLUSIONS: The estimations of WHO about road traffic deaths can be useful for countries especially for those which don't have the road traffic registry system or the registry system does not meet the quality criteria. These estimates may not be sufficiently robust if disregard for spatial differences, the epidemiological pattern of risk factors among the countries, and the type of regression model which was used for estimation.

The Impact of Socio Economic Factors on the Adherence of Patients with Gestational Diabetes Mellitus to Medical Recommendations.

BACKGROUND: Adherence to medical recommendations is very important to control gestational diabetes mellitus (GDM), as one of the most important disorders during pregnancy. In this study, we explored the impact of socio-economic status (SES) on the adherence of a cohort of GDM in Iran. METHODS: In this prospective study, 230 pregnant women with confirmed GDM were followed from Feb to Jun 2013 in a referral diabetic care center in Iran. The SES of subjects were quantified using a combined score generated by principal component analysis (PSA). Medical adherence score of subjects was measured in three follow up visits in a range of 0 to 10 and were linked to SES using linear regression model. RESULTS: The adherence scores women in the first, second, and third follow up visits were 5.06±2.12, 5.46±2.06, and 5.08±1, respectively. Women fourth quartile of SES (the highest level of SES) has a least compliance to medical orders in comparison to first quartile of SES (the lowest level of SES) with the OR -2.75 (95% Cl: -3.17, -2.23). CONCLUSION: The medical adherence of pregnant women with GDM is significantly poorer in high SES groups. Therefore, as an important determinant, we may target high SES pregnant women to control the adverse effects of the disorder more efficiently.

Factors with the Highest Impact on Road Traffic Deaths in Iran; an Ecological Study.

INTRODUCTION: The largest proportion of road traffic deaths (RTDs) happen in Low and Middle Income Countries (LMICs). The efforts for decreasing RTDs can be successful if there is precise information about its related risk factors. This study aimed to determine economic, population, road, and vehicle factors with the highest impacts on RTDs in Iran. METHODS: This is an ecological study, which has been done using covariates including: the population density, economic growth, urbanization, distance traveled (km) in 100 thousand people, the length of urban roads, the length of rural roads and the Vehicle per 1000 population for each province of Iran in 2015. The covariates considered had been gathered from different sources and to determine which one of the covariates has an effect on RTDs, the Negative Binomial (NB) regression model was used. RESULTS: The mean number of RTDs per 100000 population was 474 ± 70.59 in 2015. The highest and lowest rates of death belonged to Fars and Qom provinces, respectively. The results of the univariate model showed the population density as the only covariate of RTDs (p=0.001). Also, among other covariates, GDP was the only variable with a p-value equal to 0.2. In the multivariate NB model, it was seen that the population density (p=0.001), and GDP (p=0.02) significantly correlated with RTDs. For a unit (Million Rial) increase in the GDP of the province, the number of deaths decreased by as much as 0.0014. In addition, for a unit increase in population density, the number of deaths went up by as much as 30. CONCLUSION: Population density and GDP had positive and negative effects on the number of fatal road traffic injuries, respectively. By considering these factors in presentational and controlling programs on road traffic injuries, it is possible to decrease the RTDs.

Prevalence of sleep quality disorder among Iranian drivers: a systematic review and meta-analysis.

BACKGROUND: Sleep Quality Disorder (SQD) plays a major role in road accidents. So, this study was carried out to determine the prevalence of SQD among occupational drivers using systematic review and meta-analysis in Iran. METHODS: All Persian and English articles between January, 2000 and October, 2015 which had reported the SQD prevalence in Iranian drivers by Pittsburgh Sleep Quality Index (PSQI) with cross-sectional design, after the quality evaluation process and achieving the required score were selected. The heterogenic index of the studies was distinguished by using Cochran (Q) and I2 tests. Based on heterogeneity results, a random effects model was used to estimate pooled prevalence of SQD. Meta-regression was also used to investigate the heterogeneity of suspected factors. RESULTS: In total, 936 articles were found from national and international databases. Ten articles entered to meta-analysis process, ultimately. Since heterogeneity index suggested that there is a considerable heterogeneity among the results of primary studies (I-squared = 98.8%, Q= 754.1, p less than 0.001), the overall estimation of SQD among Iranian drivers was conducted using random-effects model and its rate was estimated to be 53.4% (95% CI: 38.9-67.8). CONCLUSIONS: Our study demonstrated that more than half of Iranian drivers have SQD. Identifying the drivers with SQD by periodic examinations and providing advice and health care among occupational drivers could be appropriate solutions for decreasing the accident risks.

Predicting mortality, hospital length of stay and need for surgery in pediatric trauma patients.

PURPOSE: Pediatric trauma is one of the major health problems around the world which threats the life of children. The survival of injured children depends upon appropriate care, accurate triage and effective emergent surgery. The objective of this study was to determine the predictive values of injury severity score (ISS), new injury severity score (NISS) and revised trauma score (RTS) on children's mortality, hospitalization and need for surgery. METHODS: In this study, records of trauma patients under 15 years old transported from a trauma scene to emergency department of Poursina hospital from 2010 to 2011 were included. Statistical analysis was applied to determine the ISS, NISS and RTS ability in predicting the outcomes of interest. RESULTS: There were 588 records in hospital registry system. The mean age of the patients was (7.3 ± 3.8) years, and 62.1% (n = 365) of patients were male. RTS was the more ability score to predict mortality with an area under curve (AUC) of 0.99 (95% CI, 0.99-1). In the hospital length of stay (LOS), ISS was best predictor for both the hospital LOS with AUC of 0.72 (95% CI, 0.67-0.76) and need for surgical surgery with AUC of 0.94 (95% CI, 0.90-0.98). CONCLUSION: RTS as a physiological scoring system has a higher predicting AUC value in predicting mortality. The anatomic scoring systems of ISS and NISS have good performance in predicting of hospital LOS and need for surgery outcomes.

Effect of stress, anxiety and depression on unstimulated salivary flow rate and xerostomia.

Background. Unstimulated salivary flow rate can be influenced by different factors. This study was undertaken to evaluate the effect of stress, anxiety and depression on unstimulated salivary flow rate in adults. Methods. A total of 247 adult subjects, randomly selected from patients referring to Zanjan Dental School, were included in this investigation. The study procedures consisted of collecting salivary samples (in 5 minutes), completing a form for feeling of xerostomia and completing Depression Anxiety Stress Scale (DASS) Questionnaire to assess the severity of stress, anxiety and depression. Based on the results, the patients were categorized in four groups: Low salivary flow rate plus xerostomia (group 1, n=60), normal salivary flow rate plus xerostomia (group 2, n=59), low salivary flow rate without xerostomia (group 3, n=60) and normal salivary flow rate without xerostomia (control group, n=68). Results. The frequencies of subjects with severe and major depression in groups 1, 2 and 3 were 31.4%, 11.7% and 8.5%, respectively, with 4.4% in the control group. The frequencies of subjects with severe stress in groups 1, 2 and 3 were 21.7%, 3.3% and 11.9%, respectively, with 1.5% in the control group. The frequencies of patients with severe anxiety in groups 1, 2 and 3 were 50%, 30% and 61.1%, respectively, with 4.4% in the control group. Stress, anxiety and depression exhibited a statistically significant relationship with unstimulated salivary flow rate and xerostomia (P<0.05). Conclusion. Stress, anxiety and depression can influence unstimulated salivary flow rate and lead to xerostomia.

A Time Series Model for Assessing the Trend and Forecasting the Road Traffic Accident Mortality.

BACKGROUND: Road traffic accident (RTA) is one of the main causes of trauma and known as a growing public health concern worldwide, especially in developing countries. Assessing the trend of fatalities in the past years and forecasting it enables us to make the appropriate planning for prevention and control. OBJECTIVES: This study aimed to assess the trend of RTAs and forecast it in the next years by using time series modeling. MATERIALS AND METHODS: In this historical analytical study, the RTA mortalities in Zanjan Province, Iran, were evaluated during 2007 - 2013. The time series analyses including Box-Jenkins models were used to assess the trend of accident fatalities in previous years and forecast it for the next 4 years. RESULTS: The mean age of the victims was 37.22 years (SD = 20.01). From a total of 2571 deaths, 77.5% (n = 1992) were males and 22.5% (n = 579) were females. The study models showed a descending trend of fatalities in the study years. The SARIMA (1, 1, 3) (0, 1, 0) 12 model was recognized as a best fit model in forecasting the trend of fatalities. Forecasting model also showed a descending trend of traffic accident mortalities in the next 4 years. CONCLUSIONS: There was a decreasing trend in the study and the future years. It seems that implementation of some interventions in the recent decade has had a positive effect on the decline of RTA fatalities. Nevertheless, there is still a need to pay more attention in order to prevent the occurrence and the mortalities related to traffic accidents.

Narrative review of women's health in Iran: challenges and successes.

BACKGROUND: In each society, the health of women in different periods may be endangered by an unequal distribution of resources, facilities, and gender prejudices. The present study evaluated the time trend of Iranian women's health between 1990 and 2013. METHODS: This narrative review includes an integration and descriptive summary of the existing evidence on trends and criteria of different aspects of women's health from social determinant point of view. The evidence was drawn from peer-reviewed, cross-national or large-scale studies, official sources of the Ministry of Health, reviews, and online scientific databases published between 1990 and 2013. RESULTS: The average life expectancy of Iranian women has increased from 44.15 years in 1960 to 75.75 years in 2012; in most deprived provinces of Iran, however, this criterion is about 67.3 years, and in the capital it is 75.8 years. In 2011, 43.37 % of DALYS, 36.21 % of YLL, and 1.92 % of YLD were dedicated to women; these figures were 3.63 % lower than they were in 2003. Although a significant reduction has occurred in maternal mortality rate, which dropped from 83 to 23 per 100,000 between 1990 and 2013, there is no equal distribution in maternal mortality across the country as manifested by the unfavorable conditions of border provinces (SD = 19.2). The prevalence of HIV/AIDS is an alarming health problem among Iranian females, increasing approximately 546 % between 2007 and 2015. As for mental health, depression in women was ranked first among diseases in 2011 compared to a second place ranking in 2003. As regards social health, the delinquency of women has increased in recent years compared to men with women committing more crimes related to drugs and actions against virtue. The annual report of the United Nations for the gender gap index in 2013 ranked Iran as 130 among 136 countries (from 0.622 in 2000 to 0.584 in 2013). CONCLUSION: Generally, over the last three decades, the health indices of Iranian women have grown in aspects of physical, mental, and social health. Remarkable differences can be seen among female health indices based on geographic location and in comparison with men. To promote an improved health status for Iranian women, the root causes of the discrepancies must be identified and a comprehensive national plan must be established.

Comparison of Revised Trauma Score, Injury Severity Score and Trauma and Injury Severity Score for mortality prediction in elderly trauma patients.

BACKGROUND: Trauma is the fifth leading cause of death in patients 65 years and older. This study is a comparison of results of Revised Trauma Score (RTS), Injury Severity Score (ISS), and Trauma and Injury Severity Score (TRISS) in prediction of mortality in cases of geriatric trauma. METHODS: This is a cross-sectional study of records of 352 elderly trauma patients who were admitted to Pour-Sina Hospital in Rasht between 2010 and 2011. Injury scoring systems were compared in terms of specificity, sensitivity, and cut-off points using receiver operating characteristic curve of patient prognosis. RESULTS: Mean age of patients was 71.5 years. Most common mechanism of injury was traffic accident (53.7%). Of the total, 13.9% of patients died. Mean ISS was higher for patients who did not survive. Mean of TRISS and RTS scores in elderly survivors was higher than non-survivors and difference in all 3 scores was statistically significant (p<0.001). Best cut-off points for predicting mortality in elderly trauma patients in RTS, ISS, and TRISS systems were ≤6, ≥13.5, and ≤2, with sensitivity of 99%, 84%, and 95% and specificity of 62%, 62%, and 72%, respectively. CONCLUSION: TRISS was the strongest predictor of mortality in elderly trauma patients as result of combination of both anatomical and physiological parameters.

The Relationship Between Serum Levels of Interleukins 6, 8, 10 and Clinical Outcome in Patients With Severe Traumatic Brain Injury.

BACKGROUND: Clinical outcome in patients with severe traumatic brain injury (TBI) depends on both primary and secondary brain injuries. Neuroinflammation is an important secondary mechanism, which occurs by releasing interleukins (ILs). Increased levels of ILs may affect clinical outcome following TBI. OBJECTIVES: This study aimed to determine the relationship between the serum levels of interleukins 6, 8 and 10 and clinical outcome in patients with severe TBI 6 months after injury. PATIENTS AND METHODS: In a descriptive-analytical study, 44 patients with GCS ≤ 8 (Glasgow coma scale) and age ≥ 14 years were included. Their blood samples were collected at first 6 hours after injury. Clinical outcome was determined based on GOS (Glasgow Outcome Scale) at 6 months after head injury. Serum levels of interleukins 6, 8 and 10 were measured using the ELISA method. Spearman's rho, independent T-Test, and Mann-Whitney Test were used for data analysis. RESULTS: Comparing the serum levels of interleukins in two groups with favorable and unfavorable clinical outcomes showed that the mean serum levels of interleukins 6 and 8 in group with favorable outcome was 85.2 ± 51.6 and 52.2 ± 31.9, respectively lower than those of group with unfavorable outcome with 162.3 ± 141.1 and 173.6 ± 257.3 (P < 0.03) and (P < 0.01). CONCLUSIONS: Increased serum levels of interleukins 6 and 8 as a predictive marker might be associated with unfavorable clinical outcome in patients with severe TBI.

Assessment of trend and seasonality in road accident data: an Iranian case study.

BACKGROUND: Road traffic accidents and their related deaths have become a major concern, particularly in developing countries. Iran has adopted a series of policies and interventions to control the high number of accidents occurring over the past few years. In this study we used a time series model to understand the trend of accidents, and ascertain the viability of applying ARIMA models on data from Taybad city. METHODS: This study is a cross-sectional study. We used data from accidents occurring in Taybad between 2007 and 2011. We obtained the data from the Ministry of Health (MOH) and used the time series method with a time lag of one month. After plotting the trend, non-stationary data in mean and variance were removed using Box-Cox transformation and a differencing method respectively. The ACF and PACF plots were used to control the stationary situation. RESULTS: The traffic accidents in our study had an increasing trend over the five years of study. Based on ACF and PACF plots gained after applying Box-Cox transformation and differencing, data did not fit to a time series model. Therefore, neither ARIMA model nor seasonality were observed. CONCLUSION: Traffic accidents in Taybad have an upward trend. In addition, we expected either the AR model, MA model or ARIMA model to have a seasonal trend, yet this was not observed in this analysis. Several reasons may have contributed to this situation, such as uncertainty of the quality of data, weather changes, and behavioural factors that are not taken into account by time series analysis.