Search

Abstract Evaluating health system interventions for elderly care necessitates a context-specific, credible and dependable instrument. This research was dedicated to creating and validating a tool to assess the health system’s age-friendliness. The study unfolded in two pivotal stages: the generation of items utilizing a hybrid model and the psychometric appraisal of the tool, encompassing both validity and reliability assessments. From an initial pool of 522 items derived from a systematic scoping review and qualitative analysis, a concise assessment tool emerged, featuring 52 items across 6 domains: governance, information, resources, service delivery, community engagement and outcomes. The 52-item tool offers a straightforward, substantiated and robust means to gauge age-friendliness, pinpoint health system deficiencies and facilitate strategic planning on the basis of its insights.

Abstract Introduction Climate change is a long-term systematic climate variability caused by human activities that alters the composition of the global atmosphere. Health systems should be adaptive and resilient to climate change. Hence, this research aimed to strategically analyze the resilience of Iran’s health system to climate change. Method This study utilized a multiple methods approach. First, in-depth semi-structured interviews were conducted with 32 key climate change and health experts to identify the strengths, weaknesses, opportunities and threats of the Iranian health system’s resilience to climate change. Purposeful and snowball sampling techniques were used to ensure maximum diversity among the participants. Then, a questionnaire was developed based on the findings of the first stage and was completed by 33 climate change and health experts. Finally, the strategic position of Iran’s health system’s resilience to climate change was determined using the internal - external factors matrix. Findings A total of 84 internal factors and 101 external factors were identified that affect the resilience of Iran’s health system against climate change. The internal factors were categorized into seven dimensions (i.e., governance and leadership; health financing; health workforce; facilities, equipment and medicines; health information system; health services delivery, and key results). The external factors were categorized into six dimensions (i.e., political, economic, social, technological, environmental, and legal factors). The average score of internal and external factors were 2.47 and 2.12, out of 4 respectively. Iran’s health system was found to be in the strategic position of V in terms of resilience to climate change. Therefore, precautionary strategies such as strengthening the climate resilience of healthcare facilities, promoting healthcare facilities’ adaptation to climate change, public-private partnership, strengthening the health service delivery system, quality management and cost management, should be implemented to strengthen the resilience of Iran’s health system to climate change. Discussion Iran’s health system is facing significant weaknesses and challenges that have hindered its resilience to climate change. Iran’s health system can better prepare and respond to the health impacts of climate change, and safeguarding the health and well-being of its population by addressing these challenges and implementing adaptive and resilience strategies.

Introduction: Increased greenhouse gas emissions since the industrial age have led to higher global temperatures and frequency and severity of climate events, such as heat waves, wildfires, floods, and storms. These changes are adversely affecting human health and increasing disease risk, including risk of allergic diseases. Further understanding of the environmental factors and the cellular and molecular mechanisms mediating these increases can assist in developing strategies to adapt to and mitigate climate change. Materials and Methods: We conducted a scoping review of the literature from 2010 through 2024 using PubMed and Scopus. Results: Thunderstorms, dust storms, wildfires, and other climate change factors increase allergies both directly and indirectly through increases in particulate matter, pollen, migration of disease vectors and decreases in biodiversity. The epithelial barrier, hygiene, “old friends,” and biodiversity hypotheses have been put forward to explain the underlying mechanism mediating these increases. Conclusion: There is an urgent need to reduce the use of fossil fuels to mitigate climate change and protect planetary and human health. While international accords such as the 2015 Paris Agreement have been signed with the aim of lowering greenhouse gases and limiting future global temperature increases, it is clear that increased efforts are needed to meet these goals. Evidence-based solutions for adapting to the increased prevalence of allergic diseases and cost-benefit analysis of current mitigation strategies for lowering allergic diseases are also needed.

Abstract Background During epidemics, the number of individuals whose mental health is affected is greater than those affected by the infection itself. This is because psychological factors have a direct relationship with the primary causes of the disease and mortality worldwide. Therefore, an increasing investment in research and strategic actions for mental health is essential globally, given the prevalence of infectious diseases. The aim of this study was to elucidate and describe the strategies for mental health preparedness and response during epidemics, with a focus on the COVID-19 pandemic in Iran. Methods A qualitative study was conducted in Iran from 2022 to 2023. Purposeful Sampling was employed, continuing until data saturation was achieved. Data collection involved semi-structured interviews and observational notes with 20 managers and experts possessing expertise, experience, and knowledge in mental health. Ultimately, the participants' opinions, based on their experiences, were analyzed using the qualitative content analysis method with a conventional approach, resulting in the categorization of data into codes, subcategories, and categories. Results The study revealed participants' opinions and experiences, categorized into two overarching categories: Preparedness, Policy-Making, and Planning Strategies (with four subcategories), and Response Strategies (comprising thirteen subcategories). Conclusion The opinions and experiences of managers and experts in this study revealed that an appropriate mental health response during pandemics requires preparedness before the occurrence of such crises and the implementation of suitable response strategies after the occurrence. Managers, policymakers, and decision-makers in this field should pay attention to the solutions derived from the experiences of such crises to respond more preparedly in the future.

Abstract Background Cities, as frontline responders to climate change, necessitate a precise understanding of climate-adaptive features. This systematic review aims to define and outline the characteristics of climate-adaptive cities, contributing vital insights for resilient urban planning. Methods This systematic review, initiated on March 6, 2018, and concluded on August 26, 2021, involved reviewing multiple electronic databases based on the study's objectives. The Critical Appraisal Skills Program (CASP) tool was used for quality assessment and critical evaluation of articles retrieved through a comprehensive and systematic text search. Descriptive and thematic analyses were conducted to extract definitions, features, and characteristics of climate-adaptive cities. Results Out of 6104 identified articles, 38 articles met the inclusion criteria. In total, 20 definitions and 55 features for climate-adaptive cities were identified in this review. Codes were categorized into two categories and ten subcategories. The categories included definitions and features or characteristics of climate-adaptive cities. Conclusion A climate-adaptive city, as derived from the findings of this study, is a city that, through effective resource management, future-oriented planning, education, knowledge utilization, innovation in governance and industry, decentralized management, and low-carbon economy, leads to the adaptability, resilience, sustainability, and flexibility of the capacity of individuals, communities, institutions, businesses, and systems within a city against all climate change impacts and reduces their negative consequences.

Abstract Background Gender-based violence (GBV) includes any physical, sexual, psychological, economic harms, and any suffering of women in the form of limiting their freedom in personal or social life. As a global crisis, COVID-19 has exposed women to more violence, which requires serious actions. This work aims to review the most critical dimensions of the GBV against women, effective factors on it, and strategies for combating it during the COVID-19 pandemic in order to provide recommendations for future pandemics. Methods This study was conducted based on PRISMA-ScR. First, PubMed, Embase, Scopus, Web of Science, ProQuest, and Google Scholar were searched in April 2021 with no time limitation and location using the related keywords to COVID-19 and GBV. The searched keywords were COVID-19, gender-based violence, domestic violence, sexual violence, women, violence, abuse, and their synonyms in MESH and EMTREE. Duplicates were removed, titles and abstracts were screened, and then the characteristics and main results of included studies were recorded in the data collection form in terms of thematic content analysis. Results A total of 6255 records were identified, of which 3433 were duplicates. Based on inclusion criteria 2822 titles and abstracts were screened. Finally, 14 studies were eligible for inclusion in this study. Most of these studies were conducted in the United States, the Netherlands, and Iran, mostly with interventional and qualitative methods. Conclusions Strengthening ICT infrastructure, providing comprehensive government policies and planning, government economic support, social support by national and international organizations should be considered by countries worldwide. It is suggested that countries provide sufficient ICT infrastructure, comprehensive policies and planning, economic support, social support by collaboration between national and international organizations, and healthcare supporting to manage incidence of GBV against women in future pandemics.

BACKGROUND: The Resilience Evaluation Scale (RES) is a new, free and short self-report questionnaire for measuring psychological resilience. This study aims to translate and assess the psychometric properties of the RES. MATERIALS AND METHOD: In the present methodological study, after the translation process, face and content validity were conducted through qualitative and quantitative methods. To determine the construct validity, exploratory and confirmatory factor analysis (CFA) was used, and for the reliability, Cronbach’s α test and inter-counter coefficient test were calculated. Persian version of the Connor-Davidson Resilience Scale was used to determine the convergent validity of the questionnaire. RESULTS: Results show that the face and content validity of 9 items of RES were acceptable and they were all approved [Impact scores (IS) >1.5, S-CVI/Ave = 0.97, I-CVI = 0.93]; the Internal consistency of the scale was confirmed by the Cronbach’s α coefficient (0.82) and McDonald’s omega (0.83). The reliability of the scale also was confirmed by the Spearman’s correlation coefficient and intra-group correlation coefficient (ICC), with results obtained above 0.8 for all items. The factor analysis identified two factors that accounted for about 56% of the variance. Also, the CFA model fitted well according to the results of the fitting indices (RMSEA = 0.084, CFI = 0.98, SRMR = 0.064, and TLI = 0.97). In addition, the convergent validity of the scale was equal to 0.65 (P < 0.001). CONCLUSION: Development of a valid and reliable psychological resilience scale may bring great benefits to the Persian society. Our findings suggest that the Persian RES has good psychometric properties, and it may serve as a valuable instrument in research and clinical practice.

Abstract Background One of the most important consequences of man-made disasters in the world is the loss of homes and, ultimately, forced population displacement. The sheltering of forcibly refugees to safe areas requires the study of scientific criteria. Methods This qualitative content analysis study was conducted in Iran to identify the criteria for the sheltering of refugees due to conflict. Participants in the study comprised experts and managers who had expertise, experience, or knowledge in the shelter for refugees. Data was collected in semi-structured interviews with 20 individuals and analyzed by qualitative content analysis to extract and categorize the factors affecting sheltering for refugees. Results The results of this study showed that a wide range of factors should be considered in the sheltering of refugees due to conflict, including land type, access to facilities, access to infrastructures, homogeneity, and similarities, security, distance from danger, environmental factors, economic issues, and political and legal issues. These nine categories covered 53 subcategories and 188 factors. Conclusions The comprehensiveness of the factors mentioned in this study showed that the sheltering of refugees due to conflict requires planning, training, culture building, promoting readiness, and inter-organizational coordination. Moreover, managers, policymakers, decision-makers in relief agencies, humanitarian organizations, and organizations involved in sheltering of refugees due to conflict should attend to these factors to improve the process and prevent problems.

BACKGROUND: Useful experiences of the elderly in adapting to the environment may play an important role in formulating future policies. This study was conducted to explain the past experiences of the elderly in Dezful in adapting to heat. MATERIALS AND METHODS: This study was conducted with a qualitative research approach and a qualitative content analysis method in 2020 and 2021. The experiences of 18 elderly in Dezful were collected through semi-structured interviews via recording, face-to-face interviews, and data observation. Sampling was performed by the purpose-based method, and the data of this stage were analyzed using a content analysis approach using the Zhang and Wildemuth method. RESULTS: During the data analysis process, three main themes were extracted, including psychophysiological, socioeconomic, and environmental adaptation. Also, twelve subthemes including changes in physiological conditions, urban architecture, house architecture, diet, clothing, business conditions, mindset, life conditions, and the use of factors (spirituality, experience, and natural capacities) were extracted. CONCLUSION: Explaining the experiences of the elderly in Dezful, who have lived with heat for many years, can provide better identification of solutions and more tangible experiences of adaptation to heat for other communities. These experiences can be used in urban, cultural, and social planning.

Background: We aimed to evaluate the impact of heatwaves on daily deaths due to non-accidental, cardiovascular and respiratory causes in the city of Dezful in Iran from 2013 to 2019. Method: We collected daily ambient temperature and mortality and defined 2 types of heatwaves by combining daily temperature ⩾90th in each month of the study period or since 30 years with duration ⩾2 and 3 days. We used a distributed lag non-linear model to study the association between each type of heatwave definition, and deaths due to non-accidental, cardiovascular and respiratory causes with lags up to 13 days. Results: There was no discernible correlation in this area, despite the fact that heatwaves raised the risk of death from cardiovascular causes and lowered the risk from respiratory causes. On the other hand, the risk of total non-accidental mortality on days with the heatwaves is significantly higher than normal days. In main effects, the heatwaves have a significant relationship with the risk of total non-accidental mortality (in the first heatwave definition, Cumulative Excess Risk (CER) in lag 0-2 was 10.4 and in second heatwave definition, CER values in lag 0, 0-2, and 0-6 were 12.4, 29.2, and 38.8 respectively). Also, in added effects, heatwaves have a significant relationship with the risk of total non-accidental mortality (in the first heatwave definition, CER in lag 0 and 0-2 were 1.79 and 4.11 and in the second heatwave definition, CER values in lag 0, 0-2, and 0-6 were 7.76, 18.35 and 24.87 respectively). In addition, heatwaves appeared to contribute to a cumulative excess risk of non-accidental death among the male group as well as the older adults. Conclusion: However, the results showed that heatwaves could have detrimental effects on health, even in populations accustomed to the extreme heat. Therefore, early warning systems which monitor heatwaves should provide the necessary warnings to the population, especially the most vulnerable groups.

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

Abstract Background Ensuring public health is crucial in any policy debate on climate change. Paris Agreement on climate change is a global contract, through which countries have committed themselves to a public health treaty. The agreement has laid the foundation for mitigation and adaptation. This study was conducted to provide an evidence-based framework for policy-making in the health system of Iran in order to reduce the adverse effects of climate change on public health and to increase the adaptation of the health system as a result. Methods This is a qualitative study. We first used Delphi method to extract the components of Paris Agreement on climate change that were related to the functions and policymaking of health system in Iran. Twenty-three experts in health and climate change were identified purposefully and through snowball sampling as participants in Delphi. Data collection instrument was a structured questionnaire. We used SPSS software version 25 for data analysis based on the descriptive indices including the mean, the percentage of consensus above 75%, and the Kendall coordination coefficient. Results Seventy-nine components classified within nine categories were extracted. The most important examples of the implementation of Paris Agreement on climate change in the health system of Iran were: participation in the formulation of strategies for mitigation and adaptation, identifying vulnerable groups, assessing vulnerability, increasing the capacity of health services delivery during extreme events, using early warning systems, using new technologies to increase the adaptation, evaluation of interventions, financial support, increasing the number of researches, increasing the knowledge and skills of staff, and finally public awareness. Conclusions Evidence-based policy-making is pivotal to develop effective programs to control the health effects of climate change. This research provided policy translation and customization of micro and macro provisions of Paris Agreement on climate change, in line with the political context of health system in Iran. Our finding will pave the ground, we envisage, for further steps towards capacity building and enhancement of resiliency of the health system, adaptation interventions, and evaluation, identification of barriers and facilitators for adaptation and decreasing the adverse health effects caused by the climate change, in Iran and perhaps beyond.

Background: We aimed to identify the indicators and criteria to locate temporary shelters for conflict refugees. Methods: This systematic review evaluated the full-text of the related articles in international electronic databases, such as Web of Science, Scopus, PubMed, Cochran, and Google Scholar from the beginning and without time limit to 1 June 2019. In addition, this search was based on a strategy developed by the researchers. The studies were selected regardless of their methods and two data extraction forms were used to extract the most relevant and important information. Results: Among 10124 cases of primary documents, 38 articles were selected, and 25 articles were analyzed in full-text. Totally, 45 indicators were identified and classified into two main categories of physical and non-physical indicators with six subcategories of land ownership, host government, access to infrastructures, site safety, land characteristics, and economic, social, and cultural considerations. Conclusion: The selection of temporary shelters for the conflict refugees requires the identification of all the specific influential factors not properly addressed. The final indicators obtained in our review could be incorporated into the development of the models required in this regard.

Background: Despite the fact that Iran has been exposed to severe dust storms during the past 2 decades, few studies have investigated the health effects of these events in Iran. This study was conducted to assess the association between dust storms and daily non-accidental, cardiovascular, and respiratory mortality in Dezful City (Khuzestan Province, Iran) during 2014 to 2019. Methods: In this study, mortality, meteorological, and climatological data were obtained from the Dezful University of Medical Sciences, Iranian Meteorological Organization, and Department of Environment in Khuzestan Province, respectively. Days of dust storm were identified based on the daily concentration threshold of particulate matter with an aerodynamic diameter of less than 10 μm (PM 10 ) according to Hoffmanns҆ definition, and then an ecological time-series was used to estimate the short-term effects of dust storms on daily mortality. Statistical analysis was performed using a distributed lag linear model (DLM) and a distributed lag non-linear model (DLNM) packages by R software and the study results were reported as excess mortality. Results: During the study period, 15 223 deaths were recorded, and 139 dust storms occurred in Dezful city. In addition, there was statistically significant excess risk of mortality due to dust storms in Dezful City (mortality in the group under 15 years of age, lag 4 : 34.17% and 15-64 years of age groups, lag 5 : 32.19%, lag 6 : 3.28%), also dust storms had statistically significant effects on respiratory mortality (lag 6 : 5.49%). Conclusion: The findings of the current study indicate that dust storms increase the risk of mortality with some lags. An evidence-based early warning system may be able to aware the people of the health effects of dust storms.

Abstract Background Hospitals play a vital role in disaster stricken regions. The resilient hospitals will be able to provide essential services to affected people and it can mitigate the risk of injuries during and after disasters. This study aimed to obtain the indicators required for the evaluation of hospital resilience. Methods This systematic review was conducted in 2018. Through this systematic review, international electronic databases were investigated for the research studies published in English. The exclusion and inclusion criteria were determined to extract the hospital resilience indicators. These indicators will be used in order to develop a model to keep the system performance at an acceptable level during disasters. Results Out of 1794 research studies published until September 2018, 89 articles and guidelines with full text were surveyed. Thirty-two articles and guidelines were then selected and analyzed to collect the indicators related to hospital disaster resilience (HDR). The domains and the indicators were extracted from these selected research studies. The authors collected and categorized them into three domains and twenty seven subdomains. The three domains included constructive, infrastructural, and administrative resilience. The relevant indicators were designed for each subdomain to assess HDR. Conclusion Since diverse indicators affect hospital resilience, other studies should be conducted to propose some models or tools to quantify the hospital resilience in different countries and scopes with an all hazards approach.

None

Background: Dust storms and their impacts on health are becoming a major public health issue. The current study examines the health impacts of dust storms around the world to provide an overview of this issue. Method: In this systematic review, 140 relevant and authoritative English articles on the impacts of dust storms on health (up to September 2019) were identified and extracted from 28 968 articles using valid keywords from various databases (PubMed, WOS, EMBASE, and Scopus) and multiple screening steps. Selected papers were then qualitatively examined and evaluated. Evaluation results were summarized using an Extraction Table. Results: The results of the study are divided into two parts: short and long-term impacts of dust storms. Short-term impacts include mortality, visitation, emergency medical dispatch, hospitalization, increased symptoms, and decreased pulmonary function. Long-term impacts include pregnancy, cognitive difficulties, and birth problems. Additionally, this study shows that dust storms have devastating impacts on health, affecting cardiovascular and respiratory health in particular. Conclusion: The findings of this study show that dust storms have significant public health impacts. More attention should be paid to these natural hazards to prepare for, respond to, and mitigate these hazardous events to reduce their negative health impacts. Registration: PROSPERO registration number CRD42018093325

Background: Physical rehabilitation, as one of the rehabilitation disciplines, can play a great role in humanitarian reliefs. The effectiveness of physical rehabilitation services is completely dependent on time of intervention, the importance of good timing in providing services during disasters is not well understood. The objective of this study was to systematically review the physical rehabilitation services provided in disasters and emergencies. Methods: An electronic search of PubMed, Scopus, Cochrane, and PEDro (Physiotherapy Evidence Database) was undertaken from Jan 2000 to Sep 2017. All English studies reporting physical rehabilitation services in natural and man-made disasters were selected regardless of study design. The included studies were analyzed by descriptive and analytical method. Results: Thirteen studies were included after reviewing by title, abstract and full text in this study. Most of the physical rehabilitation studies come back to recent years. Most of the disaster physical rehabilitation services were physiotherapy and occupational therapy. The physical rehabilitation experts have been attended in the affected area from the few first hours until several months after disasters in order to provide the required services to the affected population. Conclusion: There are few studies about physical rehabilitation services provided in the disaster-affected areas and this study showed that the services were limited and at different times. Physical rehabilitation services post disasters should have a comprehensive service model, like other health services. Therefore, it is necessary to conduct further studies to achieve this aim.

INTRODUCTION: Emergency prehospital providers (EPHP) who are constantly providing medical care in threatening conditions are more at risk of displaying psychological distress presentations in disaster situations. Problem-solving strategies are essential for effective and efficient management of event position. Therefore, the present study aimed to explore psychological distress promotion in Iranian EPHP. MATERIALS AND METHODS: A qualitative content analysis study was conducted based on 24 semi-structured interviews. A purposeful sampling method was applied until reaching data saturation. Interviews were transcribed verbatim, and then, data condensing, labeling, coding, and defining categories were performed by the qualitative content analysis recommended by the Landman and Graneheim approach. RESULTS: Based on the experience of study participants, two main themes with six categories developed. The main themes included emotion-based management and problem-based management when confronting with incidence scene. CONCLUSION: The main problems of EPHP in confronting with incidence and disasters scenes are psychological distress which some rescuers have emotional reactions while some others who are more resilience and experience manage this problem in the form of problem-based approach. It is recommended these practical strategies to be taught to less experienced rescuers for avoiding emotional-based reactions and better management of disaster scene.