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Background: This cross-sectional study aimed to determine the earthquake preparedness levels and related factors of the faculty members working at a university located in a province in a first-degree earthquake zone in Turkey. Methods: The total number of faculty members at the university is 457, including 314 assistant professors, 63 associate professors, and 80 full professors. The study group included 177 (38.7%) of 457 faculty members. The dependent variable of the study is the attitudes of the faculty members towards earthquake preparedness. The independent variables were age, gender, marital status, having children, living with or without children, duration of residency in Karabuk. In addition, these were also included as variables, respectively, type of housing, property ownership, work experience, exposure to natural disasters in the past, and the awareness that Karabuk is a first-degree risk earthquake zone. The data were collected using a descriptive questionnaire and Mulilis-Lippa Earthquake Preparedness Scale. Data were analyzed using chi-square tests and binary logistic regression model and SPSS 20.0 software. Results: There was only one (0.6%) faculty member who stated that he meets all of the preparatory criteria of the Mulilis-Lippa Earthquake Preparedness Scale. The probability of low materials preparedness score increased by 2.31 (95% CI 1.1-4.7) and 4.53 (95% CI 1.4-14.4) when the faculty members were renters and working as faculty members for 15 years and over, respectively. Being a renter also increased the probability of common knowledge and skill score by 1.95 (95% CI1.0-3.8). Conclusions: This study showed that earthquake preparedness levels among the faculty members are insufficient and suggests that motivation of the faculty members’ motivation to be appropriately prepared for future earthquake case should be increased

Background: Volunteers' presence, as a critical issue in hospital response to disasters and emergencies, helps to readiness and quick response to the phenomena, preventing deaths caused by such incidences. This study aimed to determine the main factors affecting popular volunteers' presence in hospital response to disasters and emergencies in Iran. Methods: This qualitative study, conducted on 31 semi-structured interviews during the years 2019 and 2020, concerning emergency specialist working in various health organization nationwide between June 2019 and April 2020. The non-structured and semi-structured interviews were adopted to gather concept code and analyzed using Graneheim recommendation method. Results: Four main categories, identified as effective factors on volunteers' presence in hospital response to disasters and emergencies, including nine subcategories: (1) organizing and managing volunteers (with two sub-categories: (a) calling and registering volunteers, and (b) identifying volunteers' ability); (2) organizational structure (with two sub-categories: (a) operational planning and (b) coordination and communication); (3) training (with two sub-categories: (a) training in disasters and (b) volunteer training); and (4) volunteer challenges (with three sub-categories: (a) volunteer interaction with organizations, (b) volunteer logistics, and (c)volunteering culture). Conclusion: Exploring effective factors as regards volunteers' presence in hospital response phase in disasters to adopt a policy based on the experiences of managers and heads of health can help planners to provide effective design and implementation. It can scientifically contribute to disaster risk management and hospital emergency response in Iran.

For years there were no organized supporting system helping victims of domestic violence in Iran. 16 years ago Ministry of Interior started a national survey which led to try legislating bills in order to improve preventive and supporting services. This has inspired many health care professionals, including Ministry of Health, Treatment and Medical Training, to pursue this field for research. Since then, many studies has been done; which were reviewed in this paper. We tried to build a stepping stone for the future researchers and activists, since despite all what has been done, still there is no legislated bill or enough organizations to protect the victims.

Background: The research was done to evaluate the value of the visual evoked potentials test in the assessment of visual pathways function in cases with head trauma and minimal findings on routine testing. Materials and Methods: A prospective case series evaluating use of visual evoked potentials testing in patients with a history of head trauma and suffering from visual symptoms with no significant clinical and neuroimaging findings, referred for further work up. Results: Thirty-four patients with a history of head trauma and subsequent visual complaints were included. 27 cases (79.4%) were male and 7 cases (20.6%) were female. The mean elapsed time after the trauma was 47.6 weeks (range: 3.5 to 320 weeks). Twenty-five cases had unilateral and 9 cases had bilateral visual complaints. History of coma with mean duration of 12 days was present in 4 cases. The best-corrected visual acuity was less than 1 Log MAR (legally blind) in 21 eyes. In 4 eyes (12%) the relative afferent papillary defect test was positive. Mild to moderate optic disc pallor was present bilaterally in 4 cases and unilaterally in 3 cases. Hemorrhagic patches were reported on MRI in 2 cases; no other cases had pathologic MRI findings. In unilateral cases, there was a statistically significant difference between the involved eye-sided lobe and the sound eye-sided lobe implicit time and amplitude. In patients with bilateral complaints, by testing each eye, the VEP amplitudes of both eyes showed significant differences with the International Society for Clinical Electrophysiology of Vision standards, whereas the implicit times showed not-statistically significant differences. Conclusion: The visual evoked potentials test shows not only additional diagnostic value, not seen on routine clinical and neuroimaging testing, but also rather a high validity in tracing visual disability in traumatic brain injury.

Background: Sufficient data should be gathered and analyzed to increase awareness and attention of the community and policymakers in the field of road traffic injury (RTI) prevention. While various organizations and stakeholders are involved in road traffic crashes, there is no clear lead agency for data collection system in RTIs. Exploring stakeholders' perspective is one of the key sources for understanding this system. The purpose of this study is to identify the process of RTI data collection system based on stakeholders’ experience. Method: This qualitative study was conducted employing grounded theory approach since September 2017 to December 2018 in Iran. Participantsin this study were the authorities of the Emergency organizations, police, Ministry of Health and Medical Education, faculty members, as well as executive staff and road users who were involved in collecting and recording data(n=15). Data collection was carried out through face-to-face interviews using purposeful and theoretical sampling. Data analysis was performed based on Strauss and Corbin 2008. Results: The core category was identified as “separated registration” explaining the process of collecting and recording road traffic injury data. Other variables obtained using the Strauss and Corbin Paradigm model were categorized as context, casual, intervening, strategies, and outcomes factors. The findings were classified into five groups including lack of trust in road safety promotion, process factors, management and organizational factors, failure of quality assurance, and administrative and organizational culture. Conclusion: The most important theory is “separated registration” and non-systematic registry system of road traffic injury data which is shown in a conceptual model. The findings of this study will help policymakers for better understanding the collecting and recording of RTI information.

Suicide is a global public health issue. 1 Suicide rates have increased by 60% worldwide in the last 45 years.2 World Health Organization (WHO) has estimated that more than 1.5 million individuals will die due to attempting suicide in 2020 which equals 2% of all deaths due to various diseases and injuries.3 However, there is an iceberg phenomenon: suicide at-tempts are up to 20 times more frequent than complet-ed suicides. Many factors affect suicide including psychological, social, biological, cultural and environmental factors.4 However, some of them like personality characteristics, psychopathology, parenting style, family function, and substance abuse have got more attention.5,6 It should be noted that suicide is not even an isolated event, but a continuum of processes starting from suicidal ideation (SI), suicidal plan (SP), suicide attempt (SA), to suicide completion.7 SI which is defined as thoughts of self-killing is an important factor not only for tremendous personal distress, psychological burden or mental-health problems but also for the SP, SA and completed suicide. It has been reported that about one-third of those with SI will finally attempt suicide.8 So, it seems that there must be predisposing factors which push forward a person in suicide continuum: not all individuals with SI perform SA. On the other hand, not all individuals with SA had a prior SP or SI. So there may be different risk factors for each of them. To the best of our knowledge, this issue has not been well studied. There is no doubt that suicide has enduring financial, emotional, and social impact on the friends and family of attempters. Therefore, the prevention of suicide is critical. Some studies have reported that a wide range of interventions including healthy decision making, development of life skills and self-esteem enhancement can reduce suicidal behavior.9,10 However, it seems that effective suicide prevention measures will not be effective unless there is a clear understanding of the patterns of SI/SP.11,12 Countries of the Eastern Mediterranean Region of the WHO including Iran, are traditionally considered to be characterized by low rates of suicidal behaviors (0-3.1 per 100,000). This could be potentially attributed to the cultural messages and Islamic religious beliefs against suicide.13 However, these official reports can be prone to a considerable underestimation due to the stigma of suicide in public culture. A population-based study from the capital of Iran has reported that 12.7% of participants had a lifelong history of SI, 6.2% had a lifelong history of SP, and 3.3% had a lifelong history of SA.14 We did not find any study which focuses on suicidal behavior in suicide attempters. So, the main aim of this study was to identify the main epidemiological characteristics of SI, SP, and SA in suicide attempters. Besides we tried to study the whole suicidal continuum (i.e. from SI to SA) to see in what proportion of suicide attempts the whole cycle happens. These can help us to have a better picture of suicidal behavior.

Background: After cardiac arrest, the possibility of death or irreversible complications will highly increase in the absence of cardiac resuscitation within 4 to 6 minutes. Accordingly, measuring the pre-hospital services time intervals is important for better management of emergency medical services delivery. The purpose of this study then was to investigate pre-hospital time intervals for patients with heart attack in Arak city, based on locations and time variables. Methods: This is a retrospective descriptive cross-sectional study, which was conducted at the Arak Emergency Medical Services (EMS) during 2017-2018. Data were analyzed by SPSS version 13. Results: The total number of heart attack patients registered in Arak emergency medical services was 2,659 of which51% of patients were males. Six percent of patients were under 25 and about 49 percent were between 46 and 65 years old. The average of activation, response, on-scene, transportation, recovery and total time intervals were 3:30, 7:56, 15:15, 13:34, 11:07, 12:11, and 41:25, respectively. In the city area, the shortest and longest average response time intervals were in spring and winter, respectively. In out of the city area, the shortest average response time interval was in summer and the longest one in autumn. The shortest and the longest average response time intervals in the city area were in June and March, respectively, and in out of the city area, the shortest average response time interval was in June and the longest one in April. Conclusion: The shorter response and delivery time interval compared to the other studies may indicate improvement in the provision of EMS. Special attention should be paid to the facilities and equipment of vehicles during cold seasons to be in the shortest possible time. Also, training and informing the staff more about the code of cardiac patients along with general public education can help improve these intervals.

Background: Road traffic injuries (RTIs) pose a disproportionate public health burden in the low and middle-income countries (LMICs) like Uganda, with 85% of all the fatalities and 90% of all disability-adjusted life years lost reported worldwide. Of all RTIs which are recorded in Uganda, 50% of cases happen in Kampala —the capital city of Uganda and the nearby cities. Identifying the RTI prone-areas and their associated risk factors can help to inform road safety and prevention measures aimed at reducing RTIs, particularly in emerging cities such as Kampala. Methods: This study was based on a retrospective cross-sectional design to analyze a five year (2011 – 2015) traffic crash data of the Uganda Police Force. Results: Accordingly, 60 RTI prone-areas were identified to exist across the Kampala. They were ranked as low and high risk areas; 41 and 19, respectively and with the majority of the latter based in the main city center. The bivariate analysis showed a significant association between identified prone-areas and population flow (OR: 4.89, P–value: 0.01) and traffic flow time (OR: 9.06, P–value: 0.01). On the other hand, the multivariate regression analysis only showed traffic flow time as the significant predictor (OR: 6.27, P–value: 0.02) at identified RTI prone-areas. Conclusions: The measures devised to mitigate RTI in an emerging city like Kampala should study thoroughly the patterns of traffic and population flow to help to optimize the use of available resources for effective road safety planning, injury prevention and sustainable transport systems.

Background: In the U.S., drowning is a leading cause of death for toddlers. One important layer of protection against submersion injuries and fatalities is parent or caregiver supervision. The aims of this study are to explore current supervisory behavior of caregivers, determine how caregivers view com-mon supervision distractions, like cell phones and grilling, and identify what factors shape the quality of supervision that is given when swimming with their toddler at a swimming pool. Methods: This cross-sectional study used the MTurk online platform to survey 650 caregivers of toddlers (1-4 yrs old) about their supervision behavior, their drowning knowledge, their perceptions of arm’s reach supervision, the water competency of their toddler, and other background information. Regression analysis was used to identify factors that predicted report-ed supervision behavior. Results: The average supervision behavior score for caregivers indicated an attitude between neutral and disagreement with allowing distractions for themselves while supervising their toddler in a swimming pool. High water safety knowledge and positive perceptions of arm’s reach supervision were the biggest predictors of attentive supervision behavior. Having a home pool, higher education level, and believing their toddler had greater water competency were predictive of less attentive supervision behavior. Conclusions: Results suggest that supervision behavior while toddlers are in a swimming pool may be inade-quate. Low water safety knowledge and attitudes about what constitutes quality supervision are related to pool supervision behavior and changing these may reduce drowning risk. Caregivers should be encouraged to not reduce supervision as their toddlers gain water competency and if they have a home pool.

Background: Firearm-related violence is a significant public health issue in the US. Research has found an increase in guns used in crimes sourced from low gun law states into high gun law states. The purpose of this study is to evaluate the effect of distance from states without universal background checks (UBC), background checks at shows (BCS), or permit to purchase (PTP) laws on firearm homicide rates in states with them. Methods: States were identified based on their enactment of laws that are designed to prevent the private sale of firearms to criminals. Demographic data for each county were obtained for the years 2014 through 2017.The border distance from a county in a state with the evaluated gun laws to the nearest border state without the gun laws was obtained using Google Maps. Multiple regression analyses were performed to test the relationship between border distance and firearm homicide rates. Results: The regression model evaluating all formats found the border distance was negatively associated with firearm homicides(p=.009). The parameter estimate indicated as border distance increased, the firearm homicide rate decreased. When counties with UBC or PTP on all guns were evaluated separately from all formats model, the statistical significance was lost (p=.62). In counties where all handgun sales either require a background check or a PTP is required, the distance was also not statistically significant (p=.11). Conclusion: This study provides evidence that there may be a mitigating effect on the reduction of firearm homicides in states that require background checks or PTP on private sales when there is a state in close proximity that did not have these laws. Limited counties at certain distances may have contributed to the insignificant findings in other models.

Background:There is a vast amount of literature on the effects of driver education. However, the evidence has become somewhat fragmented, making it challenging to understand driver education's effectiveness for improving road safety. The current study aimed to provide the efficacy of pre-LDE and post-LDE interventions aimed at improving the safety of drivers (includes crashes, injuries, or secondary outcomes). Methods:The following online databases were searched up to the 21st of February 2020: Web of Science (WOS), Scopus, PubMed, Cochrane library, and other relevant databases. Systematic reviews (SR) and meta-analyses were selected to investigate the efficacy of driving education in reducing crashes, injuries, or secondary outcomes. Two investigators independently conducted the data extraction and used the assessment of multiple systematic reviews (AMSTAR) tool to conduct a quality assessment of each SR identified. Results:Out of the 229 potential articles, seven SRs were eligible for the current overview of systematic reviews and meta-analyses. This overview showed that pre-and post-license education by people of all ages led to improvements in secondary outcomes, such as performance, self-perceived driving abilities, behind-the-wheel driving performance, and even a small decrease in traffic offenses. However, education was not effective in reducing crashes or injuries, either at the individual or community level. Conclusion:There was no evidence that driver education is an effective approach to reducing crashes or injuries. This negative result might be due to ineffective teaching methods. To improve road safety, it appears necessary to change the method or content of driving education since the current approaches to driving education do not reduce traffic crashes or injuries.

Background: This study utilized videos from a child’s and an adult’s perspective to determine whether perspective influences the number of hazards identified by parents. Methods: The study measured number of household dangers parents’ identified. Parents (n=106) were randomized to view either the child or adult perspective videos. Groups did not differ with respect to median age (p=0.51), education (p=0.55), or number of children living at home (p=0.64). Results: Median number of hazards identified in the bedroom was3 for participants watching videos taken at either adult or child perspective (p=0.32). Parents viewing child perspective videos of the kitchen identified significantly more hazards (median=4) than parents viewing adult perspective videos (median=3) (p=0.0001). Conclusions: Although video height (perspective) did not influence the number of hazards identified in the bedroom, parents who observed the kitchen video taken at a child’s height identified more hazards than those viewing a video at adult height.

Road traffic injuries are a global health challenge especially in low- and middle income countries (LMICs). Approximately 1.35 million people die each year as a result of road traffic crashes. Ninety-three percent of the global fatalities on the roads occur in LMICs, while these countries own about 60% of the world's vehicles.1 Road traffic injuries are also a major health problem in Iran. The total cost of RTIs has been reported to reach up to 7.2 billion US Dollars yearly comprising 2.19% of Iran’s Gross Domestic Production2 Traffic psychology is a main field of road safety research. Driver personality has been found to be a significant predictor of driving behavior.3 In field of personality traits, the narcissism has a long history in social psychology and clinical psychology. Narcissism is a clinical disorder of personality that is based on a set of diagnostic criteria, whether or not they are diagnosed. This is while social psychologists generally have a dimensional view of narcissism. There is no definite boundary in the scope of narcissism that distinguishes between normal and narcissistic. People with narcissistic personality tend to be superior, more specific, and more unique than others and are extremely sensitive to criticism, thus having difficulty in important areas of life such as work, education, and interpersonal relationships. Narcissistic personality presents with signs of grandiosity, mental occupation, fantasies of success, power, beauty talent, the belief that the individual is exceptional, feeling all-powerful, exploiting interpersonal relationships and lack of empathy which in turn gives rise to extreme praise and egoism. On the other hand, research has made it clear that narcissism is associated with adaptation.4 Based on threatened egotism theory, it has been argued that narcissism could lead to aggressive behavior such that subjects having high unstable self-esteem may respond defensively with anger or aggressive behavior each time they perceive a threat to their favorable self-appraisals.5,6 This situation could be assumed also to occur in transportation environment when drivers are subject to being offended or threatened by traffic behaviors of other drivers or other people involved in transportation environment. The resulting potential aggressive impulses may lead to aggressive driving that in turn could increase the risk of unwanted traffic outcomes such as violation of traffic laws and crashes. Although very few studies have investigated the association of narcissistic symptoms and aggressive driving,7,8 very little is known about association of narcissism and serious traffic outcomes such as crash and serious violation of traffic laws. The aim of current exploratory study was to determine whether there is an association between the narcissistic symptoms of professional bus drivers and high risk driving records or crashes.

Background: Unintentional injuries in the home are one of the threats to childhood quality of life which is considered as a social determinant of health. Regarding mother s leading role in taking care of the children in Iranian families, the present study was conducted to investigate mothers home-injury prevention attitude and performance and its contributing factors in Sahand, Iran. Methods: This was a cross-sectional study conducted in 2017. Sampling was done using convenience sampling method among all mothers of children less than five years old who attended the health centers to receive child care services. A valid attitude questionnaire and safety performance checklist were used for data collection. Data were analyzed through SPSS-24 software using descriptive (Frequency, mean, etc.) and inferential statistics (chi-square, Kruskal-Wallis) method. Results: The average age of mothers was 30.58 (±5.01). About 65% of the mothers held high school diplomas or lower degrees. The mean score of mothers' attitude was calculated to be 72.12(±6.79). More than 58% of the mothers had an appropriate level of attitude. The mothers' injury prevention performance mean score was 66.59 (±12.85). Family socioeconomic status, Mother’s age, educational level, and job, father s job, age and gender of the child were the contributing factors (p

Road traffic injuries are one of the major public health problems in many countries around the world, especially in low- and middle-income countries (LMICs).1-3 One of the weaknesses of road safety management and planning for controlling and decreasing road traffic inju-ries (RTIs) is related to the unavailability of accurate data due to lack of road traffic registry systems. The lack of road traffic mortality registry systems leads to the inability to determine the size and nature of the traffic safety problem. This condition makes it difficult to access accurate information for setting policy goals as well as developing, monitoring and evaluating action plans.1 In many high-income countries (HICs), there are high-quality data registry systems (DRSs), which enable countries to identify risk factors. Such registry systems can be applied for implementing the most appropriate and timely interventions for the prevention of road traffic crashes and their related injuries.1,2,4 In countries where road traffic registry systems do not exist or are of poor quality, the important step in identifying the situation and risk factors, and also providing appropriate solutions is impaired. In LMICs, it may not be possible to set up a good quality registry system in the short-term. Therefore, there is a need to use estimation methods to gain information about the number of deaths in order to provide management and to take appropriate interventions. Regression models are statistical methods that are used to estimate road traffic crashes and traffic-related deaths. These estimation methods are used not only by countries, but also by international organizations, such as the World Health Organization (WHO), for providing the required information and implementing international-level interventions. 1 WHO has provided the estimated number and rate of deaths related to road traffic crashes (per 100000 population) in the global status report of road safety (GSRRS) in 2009,5 2013,6 20157 and 2018.1 It has been shown that there are differences in the number of road traffic deaths between the WHO estimates and national reports. These differences are seen among countries, but the level of difference is considerable, especially in LMICs. According to previous studies, there may be under-reporting of road traffic-related deaths (RTDs) in these countries.8-10 On the other hand, the difference observed in some HICs with a high-quality injury surveillance system raises the question of whether the WHO estimates are likely to be erroneous, and what are the sources of these possible errors? There are some important issues in the differences observed between WHO estimates of deaths related to road traffic crashes and those of the national reports in some countries.1,5-7 To the best of our knowledge, no study has investigated the possible errors in WHO estimates. This study aimed to investigate the reasons for the differences observed between the national reports and WHO estimates of road traffic-related deaths.

Background: All-Terrain Vehicles (ATVs) have become popular for recreation use in recent years. Texas has had more ATV related fatalities than any other state in the nation, with rural Northeast Texas having even higher rates of injuries. There is limited data examining the relationship between ATV injuries and the length of hospital stay, as well as hospital costs. This paper examines both issues in children as well as adults. Methods: The regional trauma registry was analyzed for all ATV related injuries between January 2011- October 2016. Injury Severity Score, Glasgow Coma Scale and if they are seen at a Level I Trauma center are predictive for both hospital length of stay and charges. Results: Length of Stay was predicted positively by Injury Severity Score, Emergency Department Respi-ration Rate and facility at which patients were treated and negatively by Glasgow Coma Scale. Hospital charges were predicted positively by age, Injury Severity Score, facility of treatment, means of transportation, and Emergency Department pulse and negatively by Glasgow Coma Scale. Conclusions: The study found that vital signs can be useful in predicting length of stay and hospital charges. This study not only confirms the findings of other studies regarding what predictors can be used, but expands the research into rural traumatic injuries. It is hoped that this data can help contribute to the development of algorithms to predict which patients will be most likely to require resource intensive treatment.

Background: Accidents and injuries are the leading cause of childhood morbidity and mortality. This study aimed to investigate the incidences of different causes of accidents in children under 6 years old. Methods: This population-based cross-sectional study was carried out in one year (2016-2017) on a sample of 6000 children in Southern Iran with a multistage sampling method using a standard checklist for comprehensive child health monitoring. Results: The annual incidence rate of accidents was 16% and the mean age of accident victims was 2.5±1.5 years. Of these, 17.3% and 14.8% were male and female, respectively. 25% of the children suffered from more than one accident. The most common causes of accidents were burns (16%), falls (14%), and accidents involving objects (10%). In multivariate analysis, a higher number of male children in the family and lower child age significantly increased the likelihood of accidents (p less than 0.05). Conclusions: This study was a direct survey of the population, and showed that the incidence rate of accidents in children in southern Iran was in line with that of other regions of Iran, but less than the world average. There was no significant difference in accident etiology and only trends in etiology were found compared to studies using existing data.

Background: Work place violence (WPV) is one of the workplace factors that can affect many aspects of the emergency staff's life. In this study, we are investigating the relationship between WPV and occupational stress. Methods: We surveyed emergency department (ED) staff in a cross-sectional study design in three Mashhad Hospitals between 2017 and 2018. World Health Organization WPV and occupational stress questionnaire was used and 171 out of 200 collected data were analyzed. To investigate the relationship between different variables, t-test and logistic regression were implemented. Results: In general, 58 (34.5%) participants had reported a physical assault, 116 (71.6%) verbal abuse, and 76 (44.4%) bullying/harassment within the past year. Males reported more experience of physical assault (P less than 0.001), verbal abuse (P less than 0.04) and bullying/harassment (P less than 0.01). The educational level and time shifts were associated with the frequency of physical violence and bullying/harassment (P less than 0.03), respectively. We noticed an association between the job stress scales and some types of work place violence including physical assault (P=0.02), bullying/harassment (P=0.006) and demands scale in recent cited violence (P=0.07). Conclusions: We presented considerable prevalence of WPV among ED staff. Improving workplace condition and reducing occupational stress could be decrease WPV frequency.

Background: Motorcyclist’s behavior plays an important role in increasing the mortality rate caused by traffic crash. Identifying the risky behaviors of motorcycle riders is essential to maintain and improve the health of motorcycle riders and other community members. The aim of this study was to determine the riding patterns and risky riding behaviors of motorcycle riders in Bukan as a marginal small-sized Kurdish populated district in North-West of Iran and investigating some predictors of it. Methods: In this cross-sectional, 340 motorcycle riders of Bukan were studied. By referring to city health center and preparing the city map, the entire city was divided into 14 clusters based on the areas covered by the health centers. Then, 7 clusters were randomly selected out of these 14 clusters. Motorcycle riding behavior questionnaire (MRBQ) was used to study the risky behaviors of motorcycle riders while riding. Both bivariate and multivariate regression analysis methods were used to study the associations. Results: All participants were male. Their mean age was 30.2 (SD=9.1). The most common risky behaviors possessed by at least 23% of motorcycle riders included 1) inappropriate control of motorcycle when turning, 2) taking another person without helmet by motorcycle, 3) riding without helmet, 4) taking more than one person by motorcycle, 5) exceeding the permissible speed outer city, 6) exceeding the permissible speed inside the city and 7) carrying heavy load by motorcycle. Mean normalized MRBQ score was 30.5 (SD=11.2). Based on multivariate analysis, age, lacking a riding license, riding experience and average amount of riding were the independent predictors of risky riding score. Conclusions: Among the predictive factors that led to high risk behaviors in the studied motorcyclists were low age, marital status, low driving experience, low education, non-use of safety equipment lack of certification. This can be done by increasing drivers' awareness of laws and regulations and promoting the culture of traffic safety to prevent high-risk behaviors in motorcyclists in order to prevent possible injuries.

Background: Teen-dating violence (TDV) can lead to health problems for those involved, especially females, including homicides and is predictive of intimate partner violence in adulthood. Methods: To analyze the adolescents' perception of definitions, justifications and consequences of TDV, a qualitative study through 13 focus groups with 132 high school students from public and private schools of Rio de Janeiro city, including 70 girls and 62 boys was conducted. We followed a guide with questions about interpersonal violence and participants completed a self-administered questionnaire on socio-demographic data. The data analysis included reading and comprehension of the textual data; coding of the reports according to the emerged categories; identification of the meanings attributed by the subjects to the questions raised; comparative dialogue with literature; and elaboration of interpretative synthesis. Results: Most adolescents affirmed that TDV is not justifiable. However, in practice, they found it acceptable in certain situations. The narratives of the boys were based on the role of the perpetrator and the girls on that of the victim. Violence occurs when the man feels his power challenged and is influenced by situations of violence experienced in his own family as victims or witnesses. The TDV consequences are for the women and include, in addition to physical and psychological damage, relational problems in other spheres such as family, friends and school. The experience of violence was more common among public school students. Conclusions: The adolescents’ narratives reflect the gender patterns of society in which violence results from inequality of power. The data of this study offer subsidies to policies on TDV prevention and its consequences. They can contribute to training primary care professionals to identify on clinical consultations signs and symptoms of violence and to develop interventions to reduce the health problems of victims.

Background: Fatal intimate partner violence occurs among adolescents, which is often when first exposure to intimate partner violence occurs in the United States. However, research mainly examines intimate partner violence-related fatalities between adult intimate partners. Such findings document that non-intimate partners, corollary victims, are at risk for violence during intimate partner violence incidents, as well. Research examining fatal intimate partner violence among adolescents is scant. This study informs public health of the extent and circumstances of fatal adolescent intimate partner violence by quantifying the burden across a five-year span; describing fatal victims by demographics and precipitating circumstances; and examining differences by victim type. Methods: This study used data from 17 states of the United States in the National Violent Death Reporting System to examine fatal intimate partner violence-related incidents involving at least one ado-lescent intimate partner (15-19 years of age) from 2011-2015. IPV-related death cases were guided by the intimate partner violence surveillance criteria prescribed by Centers for Disease Control and Prevention. Decedents were subdivided into intimate partner victims, perpetrator victims, and corollary victims. Victims were described by demographics, victim descriptors, and precipitating circumstances of death. Annual trends and descriptive statistics were calculated. Results: There were 93 intimate partner violence-related fatal incidents among adolescents with 116 decedents. A firearm was the predominant weapon. Crises, arguments, jealousy, and physical fights were common precipitating circumstances. Corollary victims represented 18% of all victims, 65% were intimate partner victims, and 17% perpetrator victims. Corollary victims were primarily linked to the suspect by other intimate partners, and friends and acquaintances. Conclusions: Intimate partner violence is a preventable public health problem. This study documents that intimate partner violence among adolescents can result in deaths of intimate partners and corollary victims. Effective prevention should begin in early adolescence and incorporate shared and protective risk factors to have the greatest impact on adolescent IPV.

Substance use among adolescents is a growing problem of public health importance and research suggests that substance use behaviors are on the rise.1,2 In their examination of contributors to the global burden of disease, Rehm et al. (2006) documented that substance use behaviors accounted for approximately 4% of the disability adjusted life years.3 Substance use differs by age and gender. 4,5 Substance use behaviors among adolescents have been found to be associated with unintentional injuries, violent behavior, weapon carrying, sexual risk taking, drink-driving, overdose, self-harm, toxicity and death.6-10 Furthermore, it has also been associated with socioeconomic status, suicidal ideation, truancy, depression and having poor relationships with parents in several studies.11-14 Adolescence is a transition period to adulthood and substance use during this important phase could potentially lead to dependence depending on access and availability of illicit drugs thus preventive measures are important where deemed necessary.15 Regrettably, most research on substance use patterns, utilizes data derived from mainly high-income country settings. Thus the literature remains silent on the extent to which harmful substance use patterns have been examined in low- and middle-income country settings. Furthermore, in low- and middle-income settings which do report on substance use patterns among their populations, few if any provide data that has been disaggregated by age13 (Peden et al., 2008). In Tanzania, substance use is on the rise and has been associated with the spread of HIV especially through sharing injections especially in the densely populated cities like Dar es Salaam. A study found cannabis use estimated at 0.8%, more so among younger people in 2003 in Dar es Salaam.16 Within specific populations, a psychiatric patient population had a prevalence of 29% cannabis use in Mwanza.17 In another study conducted in Mwanza in 2014, shared housing and cohabiting was found to be associated with injection drug use among drug users.18 The aim of the present study was to explore the sociodemographic factors associated with substance use in a low-income urban sub-Saharan setting.

Background: There is a paucity of research examining the pattern of and factors that influence cell phone use while driving in Iran. This study aimed to report the prevalence of and factors related to cell phone use while driving based on the Theory of Planned Behavior, among a sample of college students in Iran. Methods: This cross-sectional study was conducted in Kerman, Iran, in 2016. Participants volunteered to participate after the study was advertised. We used the Texting While Driving questionnaire (TWD) based on the theory of planned behavior for data collection and used SPSS 22 to calculate linear regression and Pearson correlation coefficients. Results: Two hundred and fifty-seven (n= 257) students completed the questionnaire. Participants were between the ages of 18 and 47 years; 54.4% were females; 52.1% were single; 47.1% were undergraduate students, and 47.9% did not work. There was a significant relationship between intention toward sending and reading text messages while driving and gender, attitude, subjective norm, Perceived Behavioral Control (PBC), and moral norm. Also, there was a significant relation between willingness to send and read text messages while driving and PBC, subjective norm, group norm, and moral norm. For intention, personal factors were involved, and willingness was affected by both personal factors and friend/peer groups. Conclusions: Texting while driving is prevalent among college students in Kerman; and intention and willingness to do this, is affected by several factors. Our findings suggest needs for the individual and peer- group training, and increasing awareness about the dangers of using cell phones while driving among this sample.

Background: Pedestrians are amongst the most vulnerable road users and their unsafe behaviors have a major impact on traffic injuries. The aim of this study was to determine the underlying psychological factors behind red light violation in pedestrians’ crossing behavior based on the Theory of Planned Behavior (TPB) and to provide recommendations for preventive interventions. Methods: This qualitative study was conducted in Tabriz, one of the metropolitan cities of Iran. 30 pedestrians were individually interviewed using semi-structured, open-ended questions to elicit salient consequences, social referents, and circumstances regarding pedestrians’ red light crossing behavior. The transcribed interviews were analyzed using directed content analysis followed by frequency analysis in order to detect modal salient beliefs. Results: A total number of 115 sub-categories were identified which were then classified in the ten predetermined categories of the Theory of Planned Behavior: advantages, disadvantages, positive feelings, negative feelings, approving referents, disapproving referents, behaving referents, not-behaving referents, facilitators, and barriers. “Saving time” was elicited as the most important both the advantage and the positive feeling. “Getting injured” was identified as the most serious disadvantage. “Lowering the level of culture” was obtained as the main negative feeling. “Friends/Peers” comprise the most prominent group among both the approving and the behaving referents, whereas “Family members” constituted the most significant group both among the disapproving and the not-behaving referents. “Being in a hurry” was introduced as the most substantial facilitator and “The fear of accident” was identified as the most influential deterrent factor. Conclusion: Based on the major findings, reducing pedestrians’ red light violations needs to focus: on the perceived negative and positive consequences and feelings of this behavior like getting injured, and saving time respectively; on the approval role of friends/peers, and the disapproval role of family; and on the fear of accident as a barrier, and rushing as a facilitating factor. More precise quantitative research is needed to determine the predictive power of these factors in such risky behavior.

Domestic Violence Domestic violence (DV) has been defined as the violent and dominant behaviour of a family member against other members of the same family. Usually, women and girls are the first victims of DV.1 Violence against women is any act of gender-based violence that leads to a woman's physical, sexual or psychological harm, resulting in her suffering or forced deprivation of her individual or social freedom.2 The psychological injuries associated with violence can be feelings, such as helplessness, lack of confidence, anxiety, depression, and suicide. Also, physical disabilities, chronic headaches, drug use, and mental disorders are expected3,4 Domestic violence is mainly categorized into three groups: Mental, Physical and Sexual Violence.5 Literature Review In a large population study by the World Health Organization (WHO) in 15 regions of 10 countries 2000-2003, on 24096 women, DV rate was 15-71%. According to this study, physical and sexual violence in the world is widespread.5 In a meta-analysis study conducted in Iran, April 2017 on 31 articles on DV against women (from 2000 to 2014), it was estimated that DV prevalence in Iran is 66%. Prevalence rate in the Eastern region of Iran was 70%, West 75%, North 62%, South 70%, and in the Central region 59%, respectively.6 In a study by Kargar Jahromi et al. in Jahrom city (Fars province), the prevalence of physical, sexual and emotional violence against women was 16.4%, 18.6% and 44.4%, respectively. In this study, domestic violence against women was positively associated with factors such as younger women and men, low duration of marital years, and low level of education amongst men and women.7 In the study by Shayan et al. in Shiraz, on 197 women who had referred to Shiraz Forensic medicine, more than 50% were subjected to DV, and had general health problems. They were also suffering from depression and anxiety.8 Aim of the study Considering the significant effects of DV on familial and social health, as well as lack of sufficient evidence in Fars province, especially Shiraz, situation analysis might facilitate evidence-based health policy making. Considering higher prevalence of DV among families with lower economic condition in several previous studies as well as the current economic instability due to economic sanctions in Iran,9,10 this study can provide an update on the prevalence of DV.. This study was conducted to determine the prevalence of domestic violence, and its correlates against married women who visited health centers in Shiraz, 2018.

Background: Aggression is the most significant psychopathological risk factor. It is a multifaceted construct and can affect students’ social, mental and physical health. The present study was conducted to investigate factors associated with aggression among elementary school girls and boys using the theoretical framework of Social Cognitive Theory in Kermanshah city, Iran. Methods: The cross-sectional study was conducted on 900 students, including 445 girls and 455 boys, 563 parents and 104 elementary school teachers in the fourth, fifth and sixth educational grades in Kermanshah city in 2018. The proportionate stratified random sampling was used. The Adolescent Peer Relations Instrument (APRI) was used to measure aggression. To measure the variables of social cognitive theory, a researcher-made questionnaire was used. Data analysis was conducted using descriptive and inferential statistics via the SPSS software. Results: It was showed that 29% and 10% of the students had moderate and high levels of aggression, respectively. Also, 30.6% of them were moderate victims and 45.6% were intense victims. Self-efficacy (p less than 0.001), perceived social norms (p=0.011), observational learning (p less than 0.001), outcome expectations (p=0.027), outcome expectancies (p=0.028) and per-ceived situational (p less than 0.001) were reported as the significant predictors of aggressive behaviors in the students based on the Social Cognitive Theory constructs. In total, they explained for 37.3% of changes in aggressive behaviors. Parents’ knowledge (p=0.005), parents’ attitude (p=0.012), teachers’ attitude (p less than 0.001), and teachers’ self-efficacy (p=0.021) had statistically significant relationships with aggression in the students. Conclusions: Aggression among children and adolescents is getting alarmingly prevalent. The Social Cogni-tive Theory is the appropriate framework for the prediction of aggression behaviors in children and adolescents. Therefore, designing and implementing educational interventions based on this theory can help with the management of aggression in children and adolescents.

Background: Every year, a large number of people lose their lives as a result of fires or become injured seriously. Building fire is believed to be a great threat to residents` safety. The aim of this systematic review is to identify preventive measures for fires - related injuries in residential buildings, taking into account associated risk factors with it. Methods: In this study, a systematic review of all studies that have been conducted in the field of residential buildings fires, influencing factors and safety procedures being available, was done. From the earliest record to seventh July 2017, databases of PubMed, Web of Science/Knowledge, and Scopus were searched and selected articles included in the study. Results: A total of 5613 published articles were examined, of which 30 were finally found to have the inclusion criteria. The findings of the study were included in two main groups of preventive measures and risk factors for residential building fires and related injuries. Regarding preventive measures, the factors that raised in most studies were including rule amendments, changes and modification of the environment, behavior change such as emergency exits during fire occurrence, and emergency medical services, and awareness-raising, to reduce the risk of fire related injuries. Also, many of these studies showed that areas with a large number of young children, the elderly, physical and mental patients, people with disabilities, alcohol- and drug- addicts, smoking, single-family households and low-income families, were the risk of fire-related injuries and deaths. Conclusion: There are found features in residential buildings and residents that can be related to fire hazard and fire-related injuries and deaths. The most important point of this study is to focus on preventive strategies including environmental modification, promotion of safety rules and changes in risk behavior among residents. These important issues should be paid more attention to safety promotion and injury prevention in relation to building fires by policy makers.

Background: National conversation has justifiably been concerned with firearm-related deaths and much less attention has been paid to the consequences of surviving a firearm injury. We assessed the risk of hospital readmission, length of stay (LOS) during hospitalization, and costs within 90-days after surviving an index firearm injury and compared these data with pedestrians and occupants involved in motor vehicle crash (MVC). Methods: Nationwide Readmission Database, a nationally representative readmission database from 2013 and 2014 was used to create a retrospective cohort study. The primary outcome was time-to-first all-cause readmission within 90-days after discharge from the index hospitalization. Secondary outcomes were LOS and hospitalization costs at index events and at 90-days. Results: There were 3,334 (10.5%), 3,818 (10.6%) and 24,672 (9.4%) firearm injury, pedestrian, and occupant MVC readmissions within 90-days. The risk of 90-day readmission among firearm was 20% (HR=1.20, 95%CI=1.09-1.32) and 34% (HR=1.34, 95%CI=1.26-1.44) greater than patients admitted after pedestrian and occupant MVC. The primary causes of firearm readmission were surgical complications, intestinal disorders and open wounds. The mean total costs were lower among patients after firearm injury versus occupant MVC hospitalizations ($9,357 versus $11,032, p=0.028) but mean total LOS was greater (4.48 versus 4.38 days, p=0.003). Medicaid-insured patients had longer LOS at a total lower cost during index hospitalization after firearm injury as compared to MVC occupant injury. Increased LOS and lower costs of 90-day readmissions among firearm patients versus occupant MVC were irrespective of insurance. Conclusions: The patients surviving a firearm injury have a substantial risk of subsequent hospitalizations, higher than pedestrian or occupant MVC injuries. Medicaid is disproportionately burdened by the costs of treatment of firearm injury.

Background: Children from low-income families experience a disproportionate number of unintentional injuries compared to their middle-income peers. Parents are well positioned to teach children about avoiding injury, yet little is known about parent-child safety conversations in low-income families. This study examined to what extent mother-child safety conversations differ between low- and middle-income families. Methods: Mothers and their 8- to 10-year-old children from low- and middle-income families discussed and rated the safety of photos showing another child engaged in potentially dangerous activities. Results: Dyads disagreed over safety ratings on a third of trials, and both middle- and low-income mothers were highly successful in resolving disagreements in their favor. Middle-income mothers justified their ratings by referring to almost twice as many dangerous features than outcomes, whereas low-income mothers generated roughly equal numbers of dangerous features and outcomes. Middle-income children did not differ in their references to dangerous features and outcomes, but low-income children focused heavily on dangerous outcomes relative to dangerous features. Conclusions: Describing how middle- and low-income families discuss safety is a first step in understanding whether similarities and differences contribute to how middle- and low-income children evaluate and navigate potentially dangerous situations.

Bilateral skull fractures in infancy may result from accidental or abusive injury. Consultation with a child abuse pediatrician may assist with determining the likelihood of accident or abuse. Diagnostic considerations for the infant with bilateral skull fractures are reviewed, including single impact, double impact, and compression mechanisms of injury, as well as the possibility of accessory sutures as skull fracture mimics, Illustrative cases exemplify the evaluative process, including obtaining a detailed history, assessing for the presence or absence of additional physical or radiographic signs of injury, screening for psychosocial risk, and obtaining three-dimensional reconstruction of CT bone images. An understanding of plausible mechanisms of injury that can result in bilateral skull fractures in infancy can assist with making an accurate determination of likelihood of accident or abuse.

Background: Bicycle riding is a widely practiced mode of transportation, commuting, competition, fitness and recreation. We aimed to describe the incidence, risk factors and outcomes of Bicycle-Related Traumatic Injury (BRTI) in a Middle Eastern country. Methods: Data were extracted from a prospectively collected trauma registry over a period of six years (2010- 2015) from the national trauma center. Demographics and clinical characteristics of patients, and outcomes were analyzed. Results: There were 150 patients with a mean age of 27.2±16.6 years, 98% were males, 86.6% were hit by a car and 8.7% died. The average annual incidence of BRTIs was 1.3 per 100,000 populations. The mean Glasgow Coma Score (GCS) and injury severity score (ISS) were12.7±4.0 and 13.6±9.8; respectively. Almost one-third of cases had an ISS of 9-15. The most commonly injured region was the head (47%) followed by a lower extremity (30%), chest (25%), upper extremity (21.3%), spine (20.7%), abdomen (18.7%) and (7%) pelvis. Conclusions: BRTI is relatively uncommon in Qatar; however, it is characterized by a distinct epidemiology with a considerable mortality. Young male nationals, recreational cyclists and expatriate young commuter cyclists comprise the majority of victims and should be the focus of primary prevention efforts. Complementary prevention should aim at enforcing helmet laws to reduce fatal head injuries, and educating motorists of safer practices around cyclists.

Background: Internationally, inclusion of physical rehabilitation services during early disaster response is relatively new. The aim of the study was to gain an understanding of disaster relief physical rehabilitation in Iran. Methods: A qualitative study design was employed and sixteen semi-structured interviews were conducted for data collection. Content analysis was used for data analysis. The participants in this study were purposively selected among people who experienced the Bam (2003) and Varzaghan (2012) earthquakes. Results: Three main themes were explored including: indispensable intervention, barriers to continuous intervention and opportunities for intervention. Almost all participants reiterated the importance of effective physical rehabilitation services during disasters. Some participants mentioned significant barriers for delivering such services in the context of Iran. The lack of an effective responsible body, weak disaster-related competencies and under-prioritization by government were among other barriers. On a more positive note, some interviewees talked about national programs that could facilitate service delivery. Conclusions: Providing disaster relief physical rehabilitation has faced many barriers in Iran. However, there are some facilitators in the country that could help provide these services. Finally, the feasibility of post-disaster physical rehabilitation services delivery completely depends on the current national rehabilitation system.

Disasters ar e serious events disturbing communities.1 In terms of medical aspects, these events cause numerous casualties and the high demand of medical care may require the enhancement of responders’ capacity for delivering timely and effective services.2,3 Individuals with chronic conditions require special attention in planning, response, and recovery phases after natural disasters, given their unique needs for medication, medical equipment and continuing healthcare, and potential exacerbation of their condition that require resource-intensive management.4 Natural disasters can impact the public health infrastructure and the social protection systems essential for vulnerable populations. Patients with non-communicable diseases e.g. respiratory and cardiovascular diseases, cancer and diabetes, are among vulnerable groups in critical conditions, who are highly affected by natural disasters.5 Non-Communicable diseases (NCDs) require an ongoing management for optimal outcomes, which is challenging in emergency settings, since natural disasters increase the risk of acute exacerbation in the health of people with NCDs and decrease the health systems responsiveness.6 NCD Management in emergencies requires the inclusion of non-communicable disease care into standard operating procedures, which would facilitate horizontal and vertical integration to other aspects of relief efforts.7,8 Patients with chronic illnesses including those with cardiovascular diseases, diabetes, cancers, and respiratory conditions are of the most vulnerable populations in disaster settings, who face various problems after natural disasters.9,10 By the collapse in some medical care systems and overloaded operating hospitals and other medical centers, provision of services to chronic patients seems to be a critical concern.11 Inadequately managed chronic illnesses can present a threat to life and well-being of the community in the immediate wake of these disasters, but their treatment traditionally has not been recognized as a public health or medical priority.12 Many patients did not have their medications or medical supplies, and too many did not know the names of their illnesses or medications or how to access the information.13 A critical problem in the resulting health crisis is the inability of the displaced population to manage their chronic diseases.14 The Center for Disease Control and Prevention (CDC) reported that NCDs accounted for five of the six most commonly reported conditions after Hurricane Katrina.15 This leads to indirect causes of mortality and more complications up to 70%-90%, primarily due to the deterioration of life-threatening conditions and exacerbation of chronic diseases.16 After natural disasters, inadequate care and resources, and lack of continuity of care for chronic diseases such as cardiovascular diseases, asthma, diabetes, renal diseases have led to exacerbation of symptoms associated with increased morbidity and mortality among this population.17 However, non-communicable diseases have received little attention from human-rights organizations during the acute phase of crises and emergencies, and there is a need to refocus on emergency disaster systems in the 21st Century.18 More than 45% of evacuees did not carry their daily medicines with them, meaning that over two third of total medicines provided during the disaster response were used to treat chronic diseases.19 Patients with chronic diseases face many challenges and have different needs during and after natural disasters and medical care must be continued during and after natural disasters. Statistics on different diseases reveal that at the time of natural disasters, there are an increased number of hospital admissions of patients with at least one chronic disease. As an example, in Sichuan earthquake, patients with hypertension and those with diabetes, constituted 47% and 24%, respectively, of city hospital admissions.20 Despite the significance and the critical impact of natural disasters on patients with non-communicable diseases and the exacerbation of their symptoms, there are not enough studies on the issue.21 Disaster and crisis manuals and guidelines mainly focus on communicable diseases like Aleppo boil, measles, cholera and diarrhea; and among available research literature, there is a limited number of studies on the management of non-communicable diseases in emergencies.22 Several studies have been conducted on the effects of natural disasters on non-communicable diseases reporting the exacerbation of clinical effects and insufficient medical facilities and equipment to care for patients. Therefore, this study aims to obtain a systematic review protocol for non-communicable diseases in the natural disasters.

Background: Use of checklist in evaluation of trauma patients has been a critical component of improving the care process and reducing medical errors and increasing patient's quality of life. We aim to assess the impact of the modified World Health Organization Trauma Care Checklist (WHO TCC) on the management of pain, complications, mortality and patient satisfaction in trauma patients. Methods: This was a randomized control trial (RTC). Trauma patients referred to the trauma center and met the eligibility criteria were randomly assigned into three study groups. Group 1 were patients who received trauma care without using the WHO checklist, and only by the standard of care. Group 2 were patients who received trauma care according to the WHO's checklist, and group 3 were patients received trauma care according to the WHO's modified checklist. We used independent t-test and chi-square tests to assess the association between the study variables with checklist groups. The significance level of tests was set for p-value less than 0.05. Results: We observed patients’ level of pain, Injury Severity Score (ISS), Glasgow Coma Criterion (GCS)and patient satisfaction significantly improved across the checklist groups, but more so in the modified checklist group (P less than 0.001). Similarly, findings reveal significant relationships between all clinical characteristics of the patients and checklist groups, except for a CT Scan of the spinal cord. We were unable to establish any significant associations between the checklist groups and the majority of the selected trauma care process measures, except for missed injury (p = 0.001). Conclusions: Both the WHO TCC and the WHO modified checklist, in the initial assessment and during the treatment and care processes, enhance patients’ clinical outcomes. However, patients in the modified checklist compared to WHO TCC reported a higher level of satisfaction. Implications and future directions are discussed.

Background: Helmet use rates among motorcyclists are low and various factors are involved. Therefore, the present study aimed to investigate the factors affecting the use of helmet in motorcycle students in Iran (Bandar Abbas city) in 2019. Methods: The research was qualitative and data were collected through individual interviews and observations and were interpreted by content analysis method. Participants were 15 motorcyclist students studying in public health (6), nursing (4), dentistry (2), medicine (1), health education (1) and biochemistry (1). They were purposefully included in the study and sampling continued until data saturation. The main tool for data collection was deep semi-structured interviews with open answers which lasted for 20 to 60 minutes. Finally, 15 interviews were collected in this study. Results: The five main categories (economic, family, socio-cultural, individual, and riding rules) were extracted from the data that each had a subclass. Conclusions: Different factors in micro and macro dimensions play a role in the use of helmets among motorcyclists. Consideration of these factors by the relevant organizations in the field of traffic can increase the use of helmets.

Background: Organophosphate (OP) insecticides are important compounds as the most probable common cause of acute poisonings in developing countries. OP intoxication often presents as medical emergencies, and its related morbidity and mortality have not decreased despite major advances in critical care. This study aims to determine the impact of serum amylase level for estimation of prognosis in patients with acute OP poisoning. Methods: This observational case-control study was done during two years on 332 consecutive patients with acute OP poisoning. Clinical and demographic data, serum amylase level on early admission time, morbidity, and outcome were determined. Data were analyzed in the form of a frequency distribution table by using SPSS 11.0 version software. Results: The mean age of patients with acute OP poisoning was 28.9 ± 23.95 with slightly female dominance. All patients were intoxicated via the gastrointestinal route. The mean amylase level of patients with deterioration of mental status, tachycardia, ICU admission, and death was significantly higher. Conclusion: Among patients with OP poisoning, higher serum amylase than normal was associated with severe clinical course and increased risk for mortality. Determination of serum amylase can be effective in the quick prediction of the outcome.

Background: Trauma is one of the major causes of mortality across the world. Trauma patients have critical status and need timely, adequate, and organized care. The different consequences of trauma care among service centers around the world and even within a country revealed the need for careful evaluation. This study was designed and executed to collect experts’ opinions on the evaluation steps, related indicators, and improvement strategies in trauma care. Methods: This qualitative study was based on a conventional content analysis approach. 2 focus group discussions (FGD) with 6 participants per FGD and 16 face-to-face in-depth interviews were conducted to collect the required information (from September 2018 to early 2019). Participants were selected through the purposive sampling method. The experts’ viewpoints were classified by the main and sub themes. Results: Four basic themes extracted from the interviews and focus group discussions including, trauma care importance (sub-themes: the involved individuals’ being young and productive and the effectiveness of trauma care); trauma care indicators (sub-themes: pre-hospital indicators, in-hospital indicators, and post-hospital indicators); stages of trauma care evaluation (sub-themes: evaluation prerequisites, finalization of indicators before the evaluation, determining evaluation time scope, determining evaluation dimensions, external and internal evaluation and use of evaluation results); trauma care improvement (sub-themes: balancing workload in trauma centers, enhancement of information system, considering extra-organizational dimensions in trauma care and empowerment of trauma care providers). Conclusions: According to experts’ viewpoints, trauma is a very important issue, because it involves young people. They believed that having indicators covering all aspects of care assist health managers and policymakers to understand under-standard performance. These indicators should be used in the form of a specific evaluation program and related to Iran context. Besides, reforming macro policies, planning, development of infrastructures, and education was some recommendations of experts to improve trauma care.

BACKGROUND: TBI, standing for Traumatic Brain Injury, is a leading cause of death worldwide; nonetheless, data on its management has hitherto been sparse. In view of the fact that brain lobectomy is a contentious issue in the management of TBI, we set out the current study to assess the mortality rate and outcomes of TBI with delayed contusion or Intracerebral Hemorrhage (ICH) undergoing lobectomy.METHODS: We evaluated 135 TBI patients with delayed contusion or ICH undergoing brain lobectomy from 2001 to 2013. Withal, the mortality and Glasgow Outcome Scale (GOS) and Glasgow Comma Scale (GCS) rates were assessed in these patients and the association in between was sought.RESULTS: The TBI patients undergoing brain lobectomy (77% male versus 23 % female) had a mean age of 43.4±20.3 years and experienced a survival rate of 62.2% (71% in females versus 60% in males). Favorable GOS was observed in 53% of male patients, compared with 27% in the females. Age was demonstrated to significantly affect the mortality rate (p=0.0001). Initial GCS score was associated with GOS as 79.1% of the survived patients with a GCS of higher than 9 on admission were discharged with favorable GOS.CONCLUSIONS: The evidence from the present study indicates that lobectomy can be an acceptable surgical procedure in management of TBI patients with delayed contusion or ICH.

Background: According to official statistics in Iran, there were 17000 fatalities in road traffic crashes in 2018 that 25% of all crash fatalities belong to pedestrians. In most of the researches related to pedestrians’ safety, one aspect of the traffic crash (e.g. the injury or crash severity) is almost considered for the investigation. In order to perform a complete study of the crash, accident size can be utilized which involves different aspects of the crash. Accident size is described in terms of the number of fatalities and injured individuals and the number of dam-aged and involved vehicles in a crash. Method: According to the fact that accident size has multiple indicators and it is not measured directly, traditional methodologies cannot be applied. So, in the present study the effective factors on the accident size of pedestrian crashes are investigated through structural equation modeling. For the purpose of this study, 3718 pedestrian-involved crash data occurred in Isfahan province is used for the modeling. The independent variables are weather conditions, road surface conditions, time, horizontal and vertical alignments, road type and location, driver’s gender and age, vehicle type, pedestrian’s age, gender and clothing color. Results: The results indicated that highways, the pedestrians’ invisibility, female and old-aged pedestrians, heavy vehicles, old-aged and female drivers are related to the increase of the accident size in pedestrian crashes. These results denote that the mentioned variables are associated with the higher number of injuries, fatalities, the higher number of involved and damaged vehicles in a crash. Conclusion: Present study shows the importance of considering safety improvement measures in highways, educating the people in the society about the traffic safety, the separation of pedestrian and motor vehicle traffic flow and considering the old people in policies and programs for mitigating the accident size.

Background:Over 90% of morbidity and mortality associated with traumatic brain injury (TBI) occurs in low-and middle-income countries. Lack of reliable, high-quality data regarding TBI prevention and care hinders the ability to reduce TBI burden. We sought to identify current TBI data collection practices and capacity in Georgia, focusing on pre-hospital, hospital, and rehabilitation treatment. Methods:The eight level I and two level II Trauma Hospitals in Georgia with the highest number of TBI admissions in 2017 were selected for study. A semi-structured survey about various aspects of TBI care was designed and semi-structured interviews of healthcare providers treating TBI patients (e.g. neurologists, neurosurgeons) were conducted based on this survey. Results:Pre-hospital triage protocols were not routinely used to match patient treatment needs with hospital capacity. All hospitals provided specialist care for TBI 24 hours/day. MRI was available at only three (30%) centers, and in-hospital rehabilitation units were available in only one (10%). No center used a defined protocol for treating TBI patients and no national protocol exists. Conclusion:Even among the largest, most highly specialized hospitals in Georgia, TBI care varies in terms of diagnostic and treatment protocols. While TBI specialists are available, diagnostic equipment often is not. Gaps in pre-hospital coordination and access to rehabilitation services exist and provide areas of focus for future investment in reducing TBI burden

Summary: The United Nations Office of Disaster Risk Reduction defines disaster risk as the “likelihood of loss of life, injury or destruction and damage from a disaster in a given period, and a product of the complex interactions that generate conditions of exposure, vulnerability and hazard”. Racial and ethnic minorities in the United States have been shown to have increased vulnerability and risk to disasters due to links between racism, vulnerability, and economic power, based on disadvantage related to different disaster stages: 1) reduced perception of personal disaster risk; 2) lack of preparedness; 3) reduced access and response to warning systems; 4) increased physical impacts due to substandard housing; 5) likelihood of poorer psychological outcomes; 6) cultural insensitiv-ity on the part of emergency workers; 7) marginalization, lower socio-economic status, and less familiarity with support resources leading to protracted recovery; and 8) diminished standard of living, job loss, and exacerbated poverty during reconstruction and community rebuilding. More-over, given that psychiatric morbidity is predictable in populations exposed to disasters, mental health and psychosocial support programs should increasingly become a standard part of a hu-manitarian response. In the crisis and immediate recovery phase of disasters, the focus should be on making survivors feel safe and giving them assistance in decreasing their anxiety by addressing their basic needs and welfare. So, it is critical that governmental institutions, business, and non-profit organizations proactively find mechanisms to work collaboratively and share resources. Special attention and extra resources must be directed towards vulnerable and marginalized populations. In this editorial we share lessons learned from experiencing disproportionate impact of health crisis and advocate for the notion that recovery efforts must address trauma at individ-ual, interpersonal and community levels, and be based in a healing justice framework.

Background: Over 95% of unintentional injury-related childhood deaths globally occur in low-and middle-income countries, such as Uganda. Risks for injury in settings like rural Uganda are vastly understudied despite differing patterns of child injury risk. The present study investigated the prevalence and type of hazards in children’s environments in rural Uganda, as well as the relationship between hazard exposure and parent attitudes and perceptions regarding unintentional injury. Methods: Our sample included 152 primary caregivers in Eastern Rural Uganda who had children in either 1st or 6th grade. All parents/guardians completed caregiver surveys following verbal instructions. Surveys assessed demographic information, child hazard exposure, and parent beliefs regarding child injury. Results: Almost all parents (98.5%) reported daily exposure for their children to at least one of the hazards assessed. Caregiver's perceived likelihood of child injury was positively related to hazard exposure (r = .21, p less than.05). This relationship remained significant when controlling for family demographics, child grade level, and child injury history (F (7, 126) = 2.25, p less than.05). Conclusions: Our results suggest that Ugandan parents are aware of the risks of children’s exposure to hazards, but may lack the tools to address it. Development of injury prevention interventions focusing on behavioral change techniques may help reduce childhood injury and injury-related deaths in Uganda.

Background: Domestic violence is a social phenomenon where a family member, husband, wife or another cohabiting person in the household tries to dominate, physically or mentally, the other partner, children, parents, grandparents, in-laws, etc., using their physical advantage, threats, blackmail, with the intention of harm. The aim of the study was find the perceptions of university students regarding the phenomenon of violence and to show similarities and differences in this respect between students from Poland and Belarus (PL and BY). Methods: A total of 482 persons took part in the study, including 251 students from Szczecin (Poland) and 231 students from Grodno (Belarus). The method was a diagnostic survey using the authors’ original questionnaire. The questionnaire consisted of two parts: the first, containing 6 demographic questions, and the second containing 25 mainly closed-ended questions. Results: In the perceptions of the respondents from Poland and Belarus, women are statistically more likely to experience violence, and men are more likely to use it. The responses of students from Poland and Belarus show statistical connections regarding such behaviors as a single spank, shouting, refusing to talk – recognizing them mostly as a form of violence. The respondents from both countries also show a convergent position concerning quarrelling and forcing a person to drink alcohol or smoke cigarettes, recognizing them as violent behavior. Significant differences can also be observed with regard to such behaviors as throwing objects, name-calling and mocking, which do not indicate violence in the opinions of the majority of students from Belarus, in contrast to the Polish students, who perceive these behaviors as violent. Conclusions: Students from both countries acknowledge that the concealment of domestic violence by victims mainly results from fear of worsening their already difficult situation as well as from fear of retaliation by the perpetrator.

Background: Development of construction and operation of subway rail transit system in populated cities of middle- and high-income countries along with the increasing population of its users, have exacerbated the safety problems of the users against incidents and emergencies in subway stations. Although subway emergency evacuation is considered by the governments and subway network organizations as a critical task related to passengers' safety at the time of emergency, the risk of mass evacuation in station is undeniable. The main objective of this study is to identify factors affecting safe evacuation of the population from subway station and to propose the strategies for addressing them based on experiences or opinions of stakeholders in Tehran Subways, Iran. Methods: This is a qualitative study that was conducted between January 2017 and December 2018, in which a semi-structured interview was conducted for 17 participants among the senior managers, executive managers, subway station operations staff, and subway passengers in Tehran subway stations, in the Capital of Iran. In order to analyze the data of this qualitative study, the Graneheim and Lundman method was used and manifested content analysis approach was employed. Results: Based on the findings of this study, the factors affecting safe evacuation of the population from subways station were identified in four main categories covering passengers, organization, communications, and environment. Then the main categories of "culture, interaction and cooperation of passengers", "correct and timely decision-making", "notification", and "location of emergency evacuation" were emerged as safe emergency evacuation challenges and the most important findings of this study; and strategies were proposed to improve the safety of passengers at emergency evacuation of subway stations. Conclusions: In the present study, the lack of safe approach to improving passengers' safety in the development plan of Tehran subway rail transit network is a major concern for managers and operations staff. Therefore, changing the attitude of policy makers from focusing on the quantitative development of passenger transportation services to improving safety and then the quality of passengers' trip is taken into account as an urgent need to improve the safety of subway passengers.

Background: The burden and pattern of unintentional child injuries in Yemen are not yet studied. This study aimed to determine the rate of unintentional injuries and their associated factors and describe the pattern of these injuries among schoolchildren in Sana'a city, Yemen. Methods: A cross-sectional school-based study was conducted among students in grades 9 –12 in Sana’a Capital City. A total of 10 schools were selected using multistage sampling technique. A self-administered questionnaire was used to collect the data. Methods: A cross-sectional school-based study was conducted among students in grades 9 –12 in Sana’a Capital City. A total of 10 schools were selected using multistage sampling technique. A self-administered questionnaire was used to collect the data. Results: A total of 1140 students (558 girls and 582 boys) participated in the study. Of all students, 550 (48.2%) students reported unintentional injuries during the last 12-months. In the multivariate analysis, boys were more likely to be injured compared to girls (OR = 1.6) and being a child of divorced or widowed parents was significantly associated with increased odds of injury (OR = 1.7). Age of the household head ≤ 45 years was associated with deceased odds of injuries (OR = 0.76). Fall was the leading cause of injury. More than half of girls (58.9%) and 30.9% of boys were injured at home. About two thirds (64.9%) of injuries affected the lower or upper extremities. One quarter of students (24.5%) received care for their injuries in outpatient clinics and 15.3% were hospitalized because of the injury. About 26.0% of injured students missed schools for one week or more. The vast majority of students (98.4%) recovered the injury while 1.6% of injuries resulted in disability. Conclusions: Schoolchildren in Yemen had a high rate of unintentional injuries being higher in boys and in children of divorced or widowed parents. These injuries should be recognized as a public health problem in Yemen and should be included in the Ministry of Education and Ministry of Health agenda. The reported injury mechanisms and activities posing injury risks should have implications for future interventions and awareness programs.

Background: Working at height has always been considered as one of the most dangerous industrial activities. Workers' fitness including their physical and psychological ability plays a key role in prevention of occupational accidents. This research was conducted to investigate the physical and mental fitness of telecommunication tower climbers as well as their job stress. Methods: This cross-sectional study was conducted among employees of a contracting company which worked in the field of telecommunication tower installation in Iran during 2016. Sixty out of 93 workers voluntarily participated in this study. Data collection tools were the Persian version of the Work Ability Index (WAI), the Persian version of the Health and Safety Executive (HSE) Stress Indicator Tool and an author-developed measure to assess socio-demographic characteristics. Data was analyzed through statistical tests such as independent t-test, univariate analyses of variance (ANOVAs), Pearson’s correlation coefficient, and multivariate linear regression; using SPSS 19 software. Results: Workers' mean ± SD WAI score was 29.17± 10.33 and for work-related stress was 3.08 ± 1.80. There was a significant relation between WAI and educational level, job tenure, hours of sleep per day, regular exercise, and second job. The repression modeling explained 67.4% of the total variance (adjusted R2) 0f the WAI score. Among the dimensions of work related stress, control (β = 0.21) and changes (β = -0. 40) were significant predictors of the WAI score. Conclusions: To improve the worker’s work ability, intervention programs should focus on promoting level of job control, sleep quality and exercise. Additionally, implementing a comprehensive macroergonomics and participatory program for increase involvement the workers in organization changes should be considered.

Background: Falling from a tree is one of the major causes of serious injuries in farmers but it can be prevented. Walnut is one of the most important agricultural products in Iran and falling from walnut trees is common during the season of harvest. The aim of this study was to determine the frequency of complications due to falling from walnut tree in patients referred to the emergency department of Imam Ali Hospital in Bojnurd City, Iran. Methods: A descriptive cross sectional study was conducted on 127 patients with injuries due to falling from the walnut tree in Bojnurd City, Iran, in the walnut harvest season of August 2013 to November 2014. The tools used for data collection in this study included a demographic information form, checklists of information about the injury and the follow-up checklist of treatment. Data were analyzed using descriptive statistics by the SPSS software version 16. Results: From a total of 127 injured patients, 120 cases (94.4%) were males with a mean age of 36.49 ± 15.65 years. Five patients died on the day of admission. Eighty-two patients (64.56%) were admitted in hospital wards. The most common type of injuries were trunk injuries (26.19%), followed by spinal cord injuries (18.1%). Also, 7 patients suffered from complete spinal cord injury. Conclusions: Injuries caused by falling from walnut trees are seasonal and impose large financial burden on our health system. In most cases, young men suffer from varying degrees of disability and experience financial problems. It is very important to train farmers and workers, so as to prevent such injuries. Keywords: Accidental Fall, Walnut Tree, Occupational Injury

Background: Unsafe behaviors are main causes of accidents mostly influenced by personal characteristics, social environment and also individual biorhythm cycles. This study was carried out to find out whether personality traits and biorhythm could affect the incidence of unsafe behaviors among city bus drivers. Methods: This cross-sectional study was conducted on 224 bus drivers in Shiraz, Iran, 2014. The data were collected using NEO personality traits questionnaire. Also, a self-constructed checklist was used to investigate the drivers' unsafe behaviors. Information on drivers' biorhythm was analyzed by Natural Biorhythm software version 3.2. The relationship between demographic characteristics, personality traits and biorhythm were examined by T-Test, One-way ANOVA, correlation coefficient and Chi square tests. Multiple linear regression analysis was used to investigate the factors influencing the incidence of unsafe behaviors. Results: 28.6% of participants have experienced critical days in their biorhythm cycles. Also the mean percentage of unsafe behavior was 54.08 ± 11.91 among the subjects of the study. Significantly negative correlations were observed between each personality factor and the percentage of unsafe behaviors. Also, there was a significant relationship between percentage of derivers' unsafe behaviors and the general cycle of biorhythm (having at least one critical day in each of the cycles). Conclusions: Taking the measures including selection of low-risk traffic routes in the critical days and considering the personality traits at the time of employment could be effective in reducing the unsafe behaviors and accidents.

Background: Mobbing (bullying at work) refers to a form of psychological harassment that occurs in the workplace, in which the victim must be systematically and continuously persecuted for a long period of time. The aim of this work is to analyze the court judgments related to mobbing. Methods: The data, collected from a website that included judgments from an Italian court, were analyzed according to the literature, identifying the type of victims, consequences, methods of harassment, type of mobbers, and compensation decided by the court. Results: A total of 35 court sentences were analyzed. The findings showed that the duration of the mobbing campaign was on average 1.5 years and that the frequency of harassment was every day in most cases. In the majority of cases (17, 48.6%) the mobbing occurred in a private company. The gender of the victims who reported the mobbing experience was predominantly female (19, 54.3%), and on average, the victims were 44.54 years of age. The victims were classified as captives (12, 34.3%), scapegoats (8, 22.9%), ambitious (8, 22.9%), passives (5, 14.3%) and hypochondriacs (2, 5.7%). The mobbers were predominantly men (25, 71.4%) and on average 53.20 years of age. They were classified as casual (12, 34.3%), sadists (11, 31.4%), instigators (8, 22.9%) and choleric (4, 11.4%). The witnesses were described in the majority of cases as active, while the asymmetry of power was vertical. On average, the victims suffered 4.9 types of harassment, and the most cited consequences were anxiety disorder and physical symptoms. The motives for beginning the mobbing campaign were principally related to difficulties in relationships. The compensation imposed by the court ranged from less than 20,000 to more than 70,000 euros. Conclusions: The sentences analyzed showed that for different types of victims, there are behaviors, motives and consequences that are linked to different types of perpetrators.

The United States ranks number 1 in the list of countries with most privately owned guns with 101 guns for every 100 individuals.1 This has resulted in the loss of 32 lives and the treatment of 140 people every single day for gun related violence.2 These numbers state that there are more lives lost in seven weeks at the hands of firearm related violence than the total number of lives lost in seven years of Iraq War.3 Firearm related deaths disproportionately involve the younger population resulting in premature deaths. Along with the loss of life, gun violence related injuries exert a major burden on the US health system costing up to $2.3 billion annually.4 The overall economic burden associated with gun violence actually exceeds more than $100 billion every year.5 The Second Amendment to the constitution of the United States was passed in 1791 as a part of the Bill of Rights, which protects the rights of individuals to keep and bear firearms. Ever since then, possession of firearms has been a matter of debate due to concerns for public safety. Lawmakers that tried to limit the access of firearms have met with criticism for violating the rights of citizens protected by the Second Amendment. Despite the hue and cry for needing stricter firearm laws, there has been limited legislative progress on this forefront since the Gun Control Act of 1968 following the Kennedy assassination. The shooting of Arizona Congresswoman Gabriel Gifford in 2011 and the mass shooting of Sandy Hook Elementary School in 2012 once again surfaced the debate on need for stricter firearm laws. Limited numbers of previous studies have assessed the association between the incidence of firearm related mortality and strictness of firearm laws across the states.6-8 Every two years the Brady Campaign to Prevent Gun Violence issues a 100-point scorecard (Brady scorecard) that assigns a numerical value to each state based on the strength of its firearm laws. Brady scorecard was based on policy regulations such as background checks on gun sales; reporting lost or stolen firearms; and prohibiting dangerous people from purchasing weapons.9 The higher the Brady Score for each state, the stricter the firearm laws in that state. We for the first time used the Brady scorecard to assess the level of strictness in firearm laws across different states. The aim of this study was to determine the association between the rigorousness of firearm laws across different states and the rate of firearm related injuries, and mortality. We hypothesized that strict firearm legislations lower the incidence of firearm related hospital admissions and mortality.