Search

Abstract Objective Today, air medical services play a key part in providing emergency medical services in accidents and disasters in many countries, including Iran. The present study aims to investigate the barriers to air medical services in accidents and disasters in Iran and suggest solutions to them. Results Analysis of the qualitative data resulted in extraction of 84 codes, which were classified into 13 subcategories and eventually into four themes, namely planning, management of resources, updating procedures, and empowerment of human resources. The findings also underscored the role of general policies, safety of flights and the scene of the accident, the cost and length of arriving at the scene of the accident, training programs designed to enhance the personnel’s preparation, and management of disasters and accidents. Senior medical emergency services managers can use the findings of the present study to identify the challenges which pre-hospital emergency care personnel are faced to air medical services in accidents and disasters and take the necessary measures to eliminate them toward improving the quality of pre-hospital care in air medical services in accidents and disasters.

Abstract The aim of this study was to investigate the prevailing practices suitable for Iranian healthcare centers to address climate change and to rank them in terms of priority. This paper, a mixed-methods study conducted in 2023, comprised a scoping review and a thematic analysis covering the period from 2000 to 2023 as the first phase of the study. In this regard, PubMed, Scopus, ProQuest, and the Cochrane Database of Systematic Reviews were searched. In the second phase, the authors engaged a group of experts to prioritize the most important practices suitable for Iranian healthcare centers to address climate change using the Grey MEREC-MABAC integrated approach. The scoping review resulted in 38 studies, and the thematic analysis revealed 11 primary categories of practices employed to address climate change. Subsequently, the Grey MEREC-MABAC approach indicated that the themes of 'Green Environment' (CC = 0.0929), 'Green Equipment, Waste, and Water Management' (CC = 0.0677), and 'Green Energy' (CC = 0.0653) were identified as having the highest priority among the practices deemed most important in the literature for addressing climate change within Iranian healthcare centers. The study proposed that practices or activities promoting biodiversity and environmental sustainability, such as organic food farming and tree planting, should be considered paramount approaches in Iranian healthcare centers to combat climate change.

Abstract Introduction Organizational commitment (OC) significantly impacts the quality of care provided by healthcare staff. It reflects employees’ connection to and engagement with their organization, affecting job satisfaction, employee turnover, and the overall success of the healthcare organization. This research seeks to assess OC levels and identify its influencing factors among health sector staff in Shiraz, southwestern Iran. Methods In this cross-sectional study, the staff of the health sector including physicians/family physician (FP), midwives, healthcare workers, psychologists, dentists, and nutritionists were selected through a multi-stage sampling; they filled out an online 36-item questionnaire (12 demographic items and 24-item Allen and Mayer OC questionnaire). The data were analyzed using SPSS software (version 25). Descriptive statistics of OC scores were provided. Also, independent samples t-test and analysis of variance were used as statistical tests, and P-value

Abstract Background and objectives Medical students experience different types of challenges during their MD program, which become more challenging when it comes to the internship, putting too much pressure on them. This study aimed to explore the challenges of medical interns of Shiraz University of Medical Sciences (SUMS), Shiraz, Iran. Methods In this qualitative research, which was conducted from September 2023 March 2024, medical interns of SUMS were selected using purposeful sampling method. The data were collected through deep and semi-structured interviews, and it was continued until data saturation was achieved. The data analysis was performed through thematic content analysis. Results A total of 13 participants (6 men and 7 women) with a mean ± SD age of 25 ± 1.6 years were interviewed. The challenges of medical interns consisted of 423 meaning units, 79 open codes, 14 subthemes, and 6 main themes; the main themes consisted of educational challenges, challenges following university regulations, health and behavioral issues, economic/employment-related issues, sociocultural and recreational challenges, and ethical issues. Conclusion The results of this study highlight the necessity for reforms in the medical internship phase aiming to tackle interns’ issues and establish a supportive and nurturing environment for future medical doctors.

Abstract Background Leukemia, as one of the most common pediatric cancers, has negatively affected many children around the world. Parents often experience increased feeling of distress shortly after being informed about their child’s diagnosis. The distress experienced by parents can adversely affect various aspects of their life. This study aimed to develop an understanding of the lived experience of the mothers whose children suffer from leukemia in Shiraz, Iran. Methods This phenomenological study was performed from April to August 2023, and 10 people were selected as participants by purposive sampling. In-depth and semi-structured interviews were performed for collecting the data. Results The participants’ lived experiences during their children's leukemia were classified into five main categories, namely behavioral problems, spiritual issues, psychological problems, issues related to treatment, and economic matters. Conclusion Knowing the experiences of parents, especially mothers, in managing and planning for the care of these children seems essential.

Abstract Background Emergency personnel are the first line of emergency response systems to respond to emergencies; in essence, they are usually exposed to a wide range of physical and psychological problems. Accordingly, the current study aimed to clarify the lived experiences of paramedics when exposed to Patients’ Deaths during their missions in 2023. Methods This study was carried out using a qualitative approach and interpretative phenomenology from January 9, 2022, to September 21, 2023. The research was performed in Fars, Alborz, and Isfahan provinces in Iran. Data were gathered using semi-structured interviews with 17 male emergency personnel (both from the emergency medical service and Red Crescent). The obtained data were analyzed utilizing Smith’s approach to clarify the lived experiences of emergency responders when facing deaths in various incidents in Iran. Results Seventeen emergency personnel with the age range of 24–60 (average = 39) years and with a history of confronting patients’ deaths during their services were interviewed. Their lived experiences of being exposed to patients’ deaths during the emergency response in Iran were classified into three main themes: psychological and emotional status, personality, disposition, and behavior status, and mental and physical status. Sub-themes such as psychological and emotional problems, mental and physical problems, and sub-subthemes such as anxiety, stress, decreased appetite, irritability, insomnia, forgetfulness, and fatigue were also noted within the main themes. Conclusion While emergency personnel work diligently to save the lives of patients, the current study demonstrated that they were susceptible to multiple psychological, emotional, and physical problems, which potentially affect their lives outside of the workplace and make them more vulnerable to related physiological and psychological diseases. It is recommended that policymakers and clinical educators make ways to prevent these problems and provide emergency personnel with physical, psychological, and emotional support.

Abstract Background Emergency medical services preparedness in mass casualty incidents is one of the most important concerns in emergency systems. A mass casualty incident is a sudden event with several injured individuals that overwhelms the local health care system. This study aimed to identify and validate the components of emergency medical services readiness in mass casualty incidents which ultimately led to designing a conceptual model. Methods This research was an explanatory mixed-method study conducted in five consecutive stages in Iran between November 2021 and September 2023. First, a systematic review was carried out to extract the components of emergency medical services preparedness in mass casualty incidents based on the PRISMA guideline. Second, a qualitative study was designed to explore the preparedness components through in-depth semi-structured interviews and analyzed using the content analysis approach. Third, the integration of the components extracted from the two stages of the systematic review and qualitative study was done by an expert panel. Fourth, the obtained components were validated using the Delphi technique. Two rounds were done in the Delphi phase. Finally, the conceptual model of emergency medical services preparedness in mass casualty incidents was designed by a panel of experts. Results 10 articles were included in the systematic review stage and sixteen main components were extracted and classified into four categories. In the second stage, thirteen components were extracted from the qualitative study and classified into five categories. Then, the components of the previous two phases were integrated into the panel of experts and 23 components were identified. After validation with the Delphi technique, 22 components were extracted. Lastly, the final components were examined by the panel of experts, and the conceptual schematic of the model was drawn. Conclusions It is necessary to have an integrated framework and model of emergency medical service readiness in the planning and management of mass casualty incidents. The components and the final model of this research were obtained after the systematic scientific steps, which can be used as a scheme to improve emergency medical service preparedness in response to mass casualty incidents.

Abstract Introduction : This study aimed to investigate the work problems and challenges of male prehospital emergency technicians when faced with female medical emergencies. Given that qualitative research has not been done in this field, planning to find the weak points and improve the quality of prehospital emergency as the first line of treatment for female emergency patients, which is considered an important part of the health care system, is considered important and valuable. Therefore, this phenomenological study was conducted in 2023. Methods This study was conducted using a qualitative method of phenomenology in 2023. The environment of the research was urban and road prehospital emergency centers in Iran and the data were collected through interviews with EMS technicians. The collected data were analyzed using Smith’s approach to explain the lived experiences of EMS technicians facing female emergencies or women’s emergencies in Iran. Results All the 15 participants were men. Their mean age was 35 years, with a range of 25 to 45 years, and with a mean work experience of 10.54 years with a range of 4 to 20 years. The lived experiences of 115 emergency technicians in facing women’s emergencies in Iran were placed in four main themes cultural-social factors, organizational factors, human resources-related factors, and administrative-legal factors. Conclusion EMS personnel face various obstacles in carrying out missions related to women’s emergencies, Considering the critical nature of women’s emergencies, it is recommended that policymakers and clinical educators improve the level of community culture, communication skills, theoretical and practical training, respecting privacy, hiring female personnel, adding specialized equipment, amending and changing laws, removing road-traffic obstacles and to support personnel, patients and their families psychologically to optimize performance in women’s emergencies.

Abstract Background Disasters can harm many people, especially children, in unpredictable and public ways. One of the neglected aspects of children's health in disasters is oral and dental hygiene, which can affect their physical and mental well-being. This systematic review explores how dentistry can help children in disasters, focusing on two aspects: providing oral health care and identifying disaster victims. Methods A thorough search of databases, such as PubMed, Cochrane Library, Scopus, Embase, ProQuest, and Web of Science, was done to find English-language publications from 1930 to August 31, 2023. The screening, data collection, and quality assessment followed the PRISMA guidelines. Results Out of 37,795 articles found in the databases, seven research articles were chosen. Five articles were retrospective, and two articles were prospective. The results showed that dentistry for children is very important in disasters by giving information about the oral and dental problems and identifying the victims. The results also showed some of the challenges and difficulties in giving dental care for children in disaster situations, such as changing control, referral systems, and parental fear of infection. Conclusion Dentistry for children can improve the health and well-being of children affected by disasters.

Abstract Background Nowadays, virtual methods are among the most important and influential marketing instruments in various industries, such as medical tourism. This study aims to investigate the quality of Iranian hospitals’ web pages and their association with the province’s share of the medical tourism industry in Iran and the ownership type of hospitals. Methods In this analytical cross-sectional study, the quality of hospitals’ websites was investigated through a 36-item self-administered questionnaire which was validated, and its reliability was verified (Cronbach’s alpha = 74%.). The questionnaire was categorized into three sections: hospital services and facilities, hospital’s medical tourism-related services, and tourism information of the destination province. The census method was used for data collection. Data analysis was performed using the independent t-test and analysis of variance in SPSS software (version 25), and a P-value

Abstract Background One of the most significant advantages of Helicopter Emergency Medical Service (HEMS) in disaster relief efforts is their ability to reach inaccessible or remote areas quickly. This is especially important in the aftermath of natural disasters such as earthquakes, floods, or hurricanes, where roads may be blocked or damaged, and conventional ground transportation may not be available. There are many factors can affect the performance of Helicopter Emergency Medical Service (HEMS) in disasters. This study aims to investigate the factors affecting the Helicopter Emergency Medical Service (HEMS) in disasters. Methods The systematic search in Cochran Library, PubMed, Scopus, Science Direct, Web of Science, ProQuest, and Google Scholar databases between the first of January in 1975 and the thirty-first of May in 2023. The articles were selected based on the keywords of the authors. At last, the criteria were extracted from the selected ones. Results The primary search included 839 articles. After studying their title, abstract, and full context, only nine articles, including two qualitative and seven quantitative ones, were chosen for analysis. After analysis and extracting data from the final studies, the preparation factors were categorized into 6 general classes of human resources: training and practicing, management, instructions and standards, equipment, and structure. Among these, the role of training is highlighted by holding practice and maneuvers to improve and prepare the personnel and manage disasters and incidents. Conclusion The results obtained from this systematic review provide a total view of the factors affecting the preparation of the air ambulance during disasters and incidents. It is recommended that senior managers and policy makers use the findings of the present study to identify the factors which affect preparedness of HEMS in disasters and take the necessary measures to eliminate to obstacles.

Background: A decade after the implementation of the Urban Family Physician Program (UFFP) in Fars province, southern Iran, we aimed to reveal people’s opinions regarding the strengths and challenges of this program, which help policymakers for evidence-based improvement of this program. Methods: In this thematic content analysis qualitative study, which was performed in 2023, one adult individual of each family under the coverage of UFPP was selected using a purposeful sampling method. Then, an in-depth and semi-structured phone interview was conducted with each participant. Interviews were continued until the achievement of data saturation. The trustworthiness of data was checked according to Guba and Lincoln criteria. Data analysis was accomplished using MAXQDA software version 10. Results: A total of 25 participants with a mean age of 41 ± 12 years old were interviewed. Extracted strengths points of UFPP consisted of 390 meaning units, 41 open codes, 16 subcategories, 9 categories, and 3 themes, of which the main themes consisted of proper governance, adequate service provision, and promoting community health. In contrast, the challenges of this program comprised 127 meaning units, 54 open codes, 17 subcategories, 7 categories, and 3 themes, the main themes of which included weak governance, inefficient service provision, and limitation of resources. Conclusions: After a decade of implementation, people demonstrated contradictory opinions about many aspects of UFPP. Strength points should encourage policymakers to advocate more for this program and extend it to the other provinces of Iran, whereas weak points should be used for its revisions and improvement.

Abstract Introduction During epidemics such as COVID-19, healthcare workers (HCWs) face several challenges, leading to a shortage and weakening of human resources. To address this issue, employing effective strategies is essential in maintaining and strengthening human resources during outbreaks. This study aimed to gather and classify strategies that could retain and strengthen human health resources during epidemics. Methods In this scoping review, all studies published about strategies for maintaining and strengthening HCWs in epidemics were collected from 4 international databases, including PubMed, Embase, Scopus, and Web of Science. The English language articles published after 2000 up until June 2022 recommended specific strategies regarding the research question. Then, they were analyzed and classified according to thematic analysis based on Braun and Clarke 6 phases protocols. Results In total, 9405 records were screened, of which 59 articles were included, and their full texts were reviewed. Fifty factors were identified and classified into five themes: Instruction, Protection, Supporting, Caring, and Communication. Most of the suggestions were conducted in high-income countries and related to the Supporting theme. Discussion The majority of strategies discussed in the literature addressed only one or two aspects of human resources. This study provides a holistic perspective on these issues by providing a thematic map of different strategies for strengthening and maintaining HCWs during epidemics. Considering the multidimensionality of human nature, it is suggested that policymakers and managers of health systems provide facilities that simultaneously address a wide range of needs.

Abstract Background and Aims Continuous routine care is necessary to prevent long‐term complications of chronic diseases and improve patients' health conditions. This review study was conducted to determine the factors disrupting continuity of care for patients with chronic diseases during the pandemic. Methods All original articles published on factors disrupting continuity of care for patients with chronic disease during a pandemic between December 2019 and June 28, 2023, in PubMed, Web of Science, Scopus, and ProQuest databases were searched. Selection of articles, data extraction, and qualitative evaluation of articles (through STROBE and COREQ checklist) were done by two researchers separately. Data graphing form was used to extract the data of each study and then the data were classified by thematic analysis method. Results Out of 1708 articles reviewed from the databases, 22 were included. The factors disrupting the continuity of care for patients with chronic diseases during the epidemics were classified into two main categories: patient‐side factors and health system‐side factors. Patient‐side factors including psychological, individual and social, disease‐related, and health system‐side factors including provider access, health system institutional, and infrastructural and financial problems were among the subcategories disrupting the continuity of care for patients with chronic diseases during the pandemic. Based on the studies, psychological factors and access to the provider were among the most frequent factors affecting the continuity of care for patients with chronic diseases in the pandemic. Conclusion Considering the factors disrupting the continuity of care and applying appropriate interventions based on them, can guarantee the continuity of providing services to chronic patients in health crises.

Objectives Since older people make up a great percent of the population is Iran, and they experienced higher mental, physical, and emotional pressures due to quarantine and lockdown during the COVID-19 pandemic, the present study aims to investigate the lived experiences of older adults during the COVID-19 pandemic in Iran. Methods & Materials This qualitative phenomenological study was conducted in Fars, Kermanshah, and Tehran provinces of Iran from October 1, 2021 to January 30, 2022. The data were collected through interviewing 16 older adults. Data analysis was done by Smith’s interpretative phenomenology analysis. Results Of 16 older adults, 9 were male and 7 were female, with a mean age of 73 years. Their lived experiences were classified into three main categories: Psychological tensions, resilience (healing) measures, and economic tensions. Conclusion Iranian older people experienced various types of tensions during the COVID-19 pandemic. Social distancing and quarantine increased the concerns about their mental health. Therefore, it is very important to identify and analyze the psychological concepts and protective factors along with preparing practical guidelines to protect their mental health during the COVID-19 pandemic.

Abstract Background and Aims The reasons for the unfavorable performance of hospitals in providing care to Coronavirus Disease 2019 (COVID‐19) patients include the lack of preparation, knowledge, and relevant skills, making it necessary to evaluate the preparedness of nurses to respond to COVID‐19. Therefore, the present study aimed to investigate the preparedness of hospitals affiliated with Shahrekord University of Medical Sciences during the COVID‐19 pandemic in 2022. Methods In this analytical study, data were collected from 350 randomly selected nurses who worked in three hospitals affiliated with Shahrekord University of Medical Sciences; demographic information tools and the preparation of nurses for COVID‐19 patients were used to collect the data. We analyzed the data using SPSS software version 26. Results The mean and standard deviation of the total preparation score was 118.85 ± 0.98. The lowest (6.80 ± 0.18) and highest (23.35 ± 0.19) average values belonged to risk assessment and management and COVID‐19, respectively. The score of nurses' preparedness to deal with COVID‐19 was not statistically correlated with age, work experience, and so on. The average preparation score was significantly different in different treatment departments (operating room and COVID‐19). Conclusion The preparation of nurses was low in dealing with COVID‐19. Thus, managers of nursing services should design and implement educational programs to strengthen the nurses' weaknesses and ultimately increase their awareness and skills in dealing with disasters.

Abstract Background The social participation (SP) of the elderly is one of the factors that contribute to the improvement of their well-being. SP, one of the most important factors of active ageing, is mainly influenced by a number of facilitating or inhibiting factors. Aims This study aimed to identify the factors that prevent and facilitate the SP of the elderly population in Iran. Methods A cross-sectional study carried out in Shiraz, southern Iran in 2021. Participants were selected using a convenience sampling method. Shiraz is divided into 11 districts and the largest park in each district is selected for data gathering. The questionnaires were completed by 612 people aged over 60. Data were collected using the Canadian Elderly Survey Project scale and a health-related lifestyle questionnaire and were analyzed using t-test, ANOVA, Pearson’s correlation, and ANCOVA. Results The mean SP score of the elderly in Shiraz was 24.2 out of 60, which is below the midpoint. The results of the covariance analysis revealed that the SP had a significant relationship with the experience of physician consultation, cost barriers, age, marital status, income level, and education level (P

Background and Aim: The field of pre-hospital rapid response teams is facing major challenges in the field of chemical, biological, radiation and nuclear accidents. Considering that the country of Iran is exposed to the occurrence of these incidents, the possibility of the danger of these incidents and threats cannot be ignored. This study was conducted with the aim of determining effective factors in the formation of pre-hospital rapid response teams in the field of health in response to CBRN accidents. Materials and Methods: the current study is qualitative research with a content analysis approach; which was conducted using semi-structured in-depth interviews with 18 specialists and experts through purposive and snowball sampling. Sampling was done until data saturation. Thematic analysis method was used to analyze the data. The study aimed to extract effective factors in the formation of pre-hospital rapid response teams in the field of health in response to chemical, biological, radiation and nuclear accidents in Iran in 2022. Results: The factors affecting the formation of the team were divided into 5 main classes and 5 subgroups including capacity building (Education, training), operational requirements (information and communication, command and control, emergency response operational plan, internal and external coordination), required resources (equipment, financing), team formation requirements (decontamination requirements, structural requirements) and team formation structure (general team composition, specialized team composition). The highest number of codes with 39% was related to the emergency response operational plan subcategory and the lowest number of codes with 8% was related to the equipment subcategory. Conclusion: This study presented the design of the local pre-hospital rapid response team in the field of health in chemical, biological, radiation and nuclear accidents in Iran. This plan is for quick pre-hospital response to attend and intervene in the acute phase of these incidents. In order to increase the response capacity and capability of these teams, in addition to the general composition of the team, in order to improve the specialized preparation to deal with the health effects of these incidents, a specialized composition has also been provided. It is suggested; A separate team should be formed for each CBRN area based on the risk assessment of the offending areas of the country.

Introduction: The COVID-19 has recently become pandemic. Early diagnosis and the transmission chain cutting off are critical keys to control this disease and stop its spread. In this case report, the significance of proper and on-time diagnosis is discussed. Misdiagnosis of COVID-19 may lead to delay in early diagnosis of the disease. Case Presentation: A 78-year-old man with chief complaint of dark stool and constipation was admitted. Based on the preliminary complaints of the patient, the emergency medical specialist transferred him to the internal caregiving service, but according to radiological findings and his positive Real time PCR test, COVID-19 was final diagnosis. Conclusion: Healthcare planners and policymakers should prepare precise clinical guidelines that are compatible with domestic conditions of the country to improve the ability of health care providers for diagnosing patients with COVID-19 to promote controlling this condition.

Abstract Background and Aims The effective response of emergency medical services in mass casualty incidents (MCIs) calls for sufficient preparation. The components of preparation must be determined first to achieve this goal. This study aimed to describe the elements of preparedness of emergency medical services for MCIs. Methods A qualitative study was carried out on emergency medical service systems in Iran (from April 2022 to mid‐March 2023), using in‐depth semistructured interviews with participants who were managers and members of the incident command team, experts, technicians, paramedics, and telecommunicators of emergency medical services. Interviews were carried out face‐to‐face and via telephone. The data were collected using voice recorder and transcript and analyzed by content analysis method. This study was conducted using the consolidated criteria for reporting qualitative research. Results Thirty‐six participants were included in the study. A total of 834 codes were analyzed. Thirteen components were extracted from the study and classified as five categories including “Strengthening management and organization,” “individual and group empowerment,” “capacity expansion,” “technology and infrastructure development,” and “operational response measures.” Conclusion Emergency medical service preparedness in response to MCIs is a critical issue. For improving preparedness, the main components must be identified. The study results described the elements of emergency medical service preparedness, which could be used as a framework for developing the national model of emergency medical service preparedness in MCIs.

Abstract Background and Aims Health tourism is already one of the most important sources of revenue for many countries all over the world, but it appears that it has not progressed as much in Iran. The aim of this study was to determine the knowledge and attitudes of students of Iranian medical sciences universities about this subject, which could have a great impact on the future of this industry in Iran. Methods In this cross‐sectional study, the students of medical sciences universities in Iran were selected through convenience sampling; they filled out an online 36‐item self‐administrated questionnaire. The data were analyzed using SPSS software (version 25). Descriptive statistics of knowledge and attitude were provided. Also, independent samples t‐test and analysis of variance were used as statistical tests and p value

Abstract Background and Aims Obsessive‐compulsive disorder (OCD) is a relatively common disorder that, due to its debilitating nature, significantly affects personal abilities, job performance, social adjustment, and interpersonal relationships. There are significant barriers to accessing evidence‐based cognitive‐behavioral therapy as a first‐line treatment for obsessive‐compulsive disorder. Mobile health applications (Apps) offer a promising way to improve access to evidence‐based therapies while overcoming these barriers. The present study was to design and evaluate a prototype of a self‐help application for people with OCD (the most common pattern of OCD) based on the exposure and response prevention (ERP) technique. Methods This work was developed in four different phases. (1) Needs assessment: a thorough literature review, reviewing existing related programs and apps, and interviewing patients and psychiatrists; (2) Creating a paper prototype: considering the functional features identified in the previous phase using wireframe sketcher software. (3) Creating a digital prototype: developing an actual prototype using Axure RP software based on the information obtained from an expert panel's evaluation of the paper prototype. (4) Prototype usability evaluation: through a heuristic evaluation with experts and usability testing with patients using the SUS questionnaire. Results After requirement analysis, requirements were defined in the areas of information and educational elements, and functional capabilities. Prototypes designed based on identified requirements include capabilities such as in‐app online self‐help groups, assessing the severity of the symptoms of the disorder, psychological training, supportive treatment strategies, setting personalized treatment plans, tracking treatment progress through weekly reports provided, anxiety assessment, and setting reminders. Conclusion The results of the heuristic evaluation with experts made it possible to identify how to provide information and implement the capabilities in a way that is more appropriate and easier for the user.

Abstract Background and Aims As a debilitating disorder, spinal cord injuries (SCIs) can bring about a range of physical, psychological, and social consequences in individuals and even have effects on their lifestyle indicators. The present study was thus to reflect on lifestyles among people with SCIs developing from accidents and disasters. Methods Using a meta‐synthesis of qualitative research, all articles recruiting qualitative methods to examine patients with SCIs, published from 1990 to 2020, were retrieved by the researchers, good at the Persian and English languages, from the databases of ScienceDirect, MD Consult, Pedro, ProQuest, PubMed, SID, MedLib, Magiran, Scopus, Google Scholar, Iranmedex, the Cochran Library, CINAHL, and Blackwell, tapping the keywords of “spinal cord injury, SCI, manmade disaster, natural disaster, content analysis, concept analysis, thematic analysis, lifestyle, quality of life, QoL, grounded theory, meta‐synthesis, mixed‐methods research, historical research, ethnography, and phenomenology” in both languages for their inclusion in this study and further analyses. Results With reference to the inclusion criteria, 18 articles were extracted, and after all 10 studies in line with the research topic were reviewed and analyzed. Ultimately, six main themes, namely, compromise, self‐reliance, income‐generating activities, mental status, inability, and issues of sexuality were extracted, demonstrating their importance to individuals suffering from SCIs. Conclusion During the initial stages following SCIs, the abilities to engage in participatory practices and individual's power of decision‐making diminish because of physical, social, psychological, and environmental constraints. It was accordingly recommended to have a holistic perspective and respect all aspects of life in individuals with SCIs.

In a rapidly changing environment, healthcare systems in polar regions face increasing pressures imposed by climate change, burgeoning tourism, and potential ramifications for future space exploration. The urgency to reevaluate health stewardship and governance in these areas is driven by unique challenges, including geographical barriers and scarce resources. Further accentuated by the ongoing COVID-19 pandemic and the anticipated boom in the polar tourism industry, the need for robust emergency, trauma, and surgical care is highlighted. The objective of this paper is to address these challenges and advocate for a unified health governance approach. Adopting measures like artificial intelligence, telemedicine, and advanced technologies is suggested to promote the effectiveness of remote care, considering the distinct limitations of these regions. Moreover, research focused on the human health impact of these extreme conditions is paramount for formulating adequate responses, thereby improving the overall readiness and resilience of the healthcare systems in these regions.

AIDS is an acquired immunodeficiency syndrome caused by human immunodeficiency virus (HIV) [1, 2]. AIDS is among the major challenges to the health system in all countries. This health challenge has spread to all countries and all age groups, especially those 25-34 years. The probability of transmission of AIDS ranges from 70% by blood transfusion to 30% by sexual intercourse, mother-to-child transmission, and other blood products [3-5].

Abstract Background and Aims A pandemic has posed a major challenge to health systems all over the world. All countries have realized that the only way to get real growth and development and solve their problems is to use what they have learned from research. Methods A descriptive and analytic type of study was conducted with the help of experts in the field of health research. The components affecting the research system were obtained via process approach and content analysis methods, and then the position of each component was identified by the Mic Mac technique. Results Seventeen influential structural components in the health research system were identified. The leadership and management components had the most direct and indirect influence among other components. The health promotion component had a greater dependency than the other components. Conclusion All health systems need to provide adequate financial resources and manpower to provide a useful research system. Human resources are the most important inputs to such a system. Components such as the research process, research sustainability, quality, or innovation in research can play a balancing role. Having the right infrastructures for creating, transferring, developing, and getting access to knowledge makes it possible to do systematic science. It is hoped that this science will be used in other results of the health research system, like improving the effectiveness or promoting health.

Abstract Background and Aims The COVID‐19 pandemic has changed people's lifestyles as well as the way healthcare services are delivered. Undoubtedly, the difficulties associated with COVID‐19 infection and rehabilitation and those associated with quarantine and viral preventive efforts may exacerbate the need for virtual reality to be used as a part of a complete rehabilitation strategy for these individuals. Thus, the present research aimed to evaluate the potential uses of virtual reality for the rehabilitation of individuals suffering from COVID‐19. Methods From 2019 to March 1, 2022, a systematic search was conducted in PubMed, Cochran Library, Scopus, Science Direct, ProQuest, and Web of Science databases. The papers were selected based on search terms and those that discussed the use of virtual reality in the rehabilitation of COVID‐19 patients were reviewed. Each step of the study was reviewed by two authors. Results A total of 699 papers were found during the first search. Three papers were chosen for further investigation after a thorough evaluation of the publications' titles, abstracts, and full texts. Cross‐sectional studies, randomized controlled clinical trials, and case reports comprised 33%, 33%, and 33% of the publications, respectively. Based on the results, people suffering from COVID‐19 were the focus of two papers (66%) that employed immersion virtual reality for cognitive rehabilitation, whereas one study (33%) used non‐immersive virtual reality for physical rehabilitation. In two papers (66%), virtual reality was also offered to patients in the form of a game. Conclusion According to the results of the present research, virtual reality games may enhance functional and cognitive consequences, contentment levels among patients, and their ability to take charge of their own health care. In light of the obstacles faced by COVID‐19 patients, alterations in the delivery of healthcare, and the significance of rehabilitation in this group during quarantine, new techniques have been considered for these patients to maintain treatment, return to regular life, and enhance their standard of life.

Background: The present study aimed to evaluate the surge capability of Shahid Rajaee Trauma Hospital in Shiraz City, Iran, in response to a mass causality incident. Materials and Methods: This descriptive study was conducted in Shahid Rajaee Hospital in Shiraz in 2017. The Delphi technique was used in this study. Three checklists were used for the Emergency Department, Operating Room, and Intensive Care Unit. The surge capacity was calculated for each unit based on the formulas derived from different studies. Results: The surge capacities of the Emergency Department, Intensive Care Unit, and Operating Room were obtained 36%, 20%, and 17.5%, respectively. Shahid Rajaee Hospital of Shiraz can quickly increase its capacity by 27% based on the scenario defined in this study. However, if an accident leads to more causalities, it will likely face several limiting factors for increasing the surge capacity. Conclusion: Due to the critical role of hospitals in the crisis, it seems that the studied hospital should look for ways to increase its surge capacity to cope with unexpected accidents as soon as possible.

Background: There has been a significant increase in the number of train crashes worldwide, mainly due to the extension of the rail network and the use of the most sophisticated and cutting-edge technology. Incident Report: The Tehran-Zahedan train had 260 passengers on board and left for Tehran City at 14:50 local time on Wednesday, September 25, 2019. The accident happened at 16:20 local time at 100 km distance from Zahedan City. Results: Five train cars derailed 2 km from Shorou Station, where four people died, and 157 were injured. According to the investigations, the accident occurred due to the unscrewing of some bolts and spring washers. There were 170-180 screws and spring washers removed along 50-60 m, which resulted in the creation of a dangerous point and derailment of the train. This study examined the challenges, strengths, and learned lessons of the incident. Conclusion: Concerning standard and vast rail networks in Iran and the latest train crashes that mainly occurred just outside the cities, accessibility to the accident scene should be considered one of the most important physical vulnerability indexes. As a result, accessibility to special firefighting and rail rescue train car at some stations in crowded routes effectively decreases the consequences of such accidents.

Objective: To determine the instructional programs required by volunteers based on the studies carried out worldwide. Methods: A systematic search was carried out by PubMed, Cochran Library, Scopus, EMBASE, Science Direct, Web of Science and ProQuest databases between January 1970 and the end of June 2019. The articles were selected based on the keywords chosen by the author. In the end, the volunteer’s instructional titles were extracted from the articles in disasters. Results: Eleven articles were chosen for final analysis after studying the titles, abstracts, and complete articles texts which 45 instructional titles were extracted. The most frequent scales in terms of repetition were ethics, kinds of exercises, personal protection instruments, general hygiene, awareness of certain disasters, accident command system, disaster triage and emergency planning. Conclusion: Governments should offer programs that can best serve the improvement of their performance by considering the daily increasing growth in the number of volunteers and in natural and manmade disasters. Universities and schools play determinant roles in this regard. It is hoped that the present study findings can be effective in codify an efficient instructional program for elevating the performance of the volunteers by taking part in disasters response.

Abstract Background Sniffer dogs are able to detect certain chemical particles and are suggest to be capable of helping diagnose some medical conditions and complications, such as colorectal cancer, melanoma, bladder cancer, and even critical states such as hypoglycemia in diabetic patients. With the global spread of COVID-19 throughout the world and the need to have a real-time screening of the population, especially in crowded places, this study aimed to investigate the applicability of sniffer dogs to carry out such a task. Methods Firstly, three male and female dogs from German shepherd (Saray), German black (Kuzhi) and Labrador (Marco) breeds had been intensively trained throughout the classical conditioning method for 7 weeks. They were introduced to human specimens obtained from the throat and pharyngeal secretions of participants who were already reported positive or negative for SARS-COV-2 infection be RT-PCR. Each dog underwent the conditioning process for almost 1000 times. In the meantime another similar condition process was conducted on clothes and masks of COVID-19 patient using another three male and female dogs from Labrador (Lexi), Border gypsy (Sami), and Golden retriever (Zhico) breeds. In verification test for the first three dogs, 80 pharyngeal secretion samples consisting of 26 positive and 54 negative samples from different medical centers who underwent RT-PCR test were in a single-blind method. In the second verification test for the other three dogs, masks and clothes of 50 RT-PCR positive and 70 RT-PCR negative cases from different medical center were used. Results In verification test using pharyngeal secretion, the sniffer dogs’ detection capability was associated with a 65% of sensitivity and 89% of specificity and they amanged to identify 17 out of the 26 positive and 48 out of the 54 true negative samples. In the next verification test using patients’ face masks and clothes, 43 out of the 50 positive samples were correctly identified by the dogs. Moreover, out of the 70 negative samples, 65 samples were correctly found to be negative. The sensitivity of this test was as high as 86% and its specificity was 92.9%. In addition, the positive and negative predictive values were 89.6 and 90.3%, respectively. Conclusion Dogs are capable of being trained to identify COVID-19 cases by sniffing their odour, so they can be used as a reliable tool in limited screening.

Background: Iran is a disaster-prone country, which in recent years has been affected by heavy rainfall and consequent flooding. In March 26, 2019, heavy rainfall in northern parts of Iran resulted in flooding. The situation became more critical when central and western provinces were affected, finally causing significant damages in 25 provinces. The most affected areas were Golestan, and Khuzestan provinces with significant damages to their infrastructure, killing 76 people. Materials and Methods: This qualitative study aims to describe the findings and results of field visits in flood-hit provinces of Lorestan, Khuzestan and Golestan. All interviews were held with experts in late April 2019. Results: Golestan province was in recovery phase and Lorestan and Khuzestan provinces were in response phase. Due to the acute conditions of these two mentioned areas, it was not possible to visit all areas. In Lorestan Province Treatment and Emergency Situations; In Golestan Province Health Status and in Khuzestan Province Pre-hospital Care and Rescue Support were visited and evaluated. The field visited results indicate the presence of government forces and people in the field and provide comprehensive assistance to the flood-affected areas. Conclusion: There are numerous hazards each year, but few documented lessons are available for researchers. Due to the importance of applying lessons for community development it is imperative that special attention be paid to the discussion of emergency and disaster research and the presence of specialized researchers to record lessons learned. Although organizations make significant efforts during disasters, the specialized research force for recording these achievements in disasters remains neglected. Therefore, it is valuable to document and apply appropriate documentation to promote interventions and responses to possible future events.

BACKGROUND: Education is considered one of the critical elements of behavioral changes in societies with a high risk of disasters. Meanwhile, the role of adolescents, as the key and the largest group of stakeholders in planning for disaster preparedness and response, has often been neglected. The current study aimed to extract the components and effective factors in disaster education to increase adolescents' resilience in disasters in Iran. MATERIALS AND METHODS: This qualitative study was done by inductive approach through in-depth semi-structured interviews conducted with 21 key informants and 11 adolescents selected through purposive sampling. To extract the components and factors affecting education to increase adolescents' resilience in disasters, the data were analyzed by thematic analysis. RESULTS: The effective factors in increasing adolescents' disaster resilience were classified into four categories, namely, social participation, need-based education, scope of influence, and governance perspectives, and 19 subcategories. CONCLUSION: This study provided an overview and a comprehensive understanding of disaster education to increase adolescents' resilience. Recognizing these factors can help effectively in developing disaster education programs to improve adolescents' resilience against disasters. By encouraging natural hazard habits in this age group, it can also potentially increase the society's resilience in future.

Introduction: Factor VII deficiency is a rare congenital coagulopathy disorder. In most cases this disorder is diagnosed in childhood. Common symptoms of congenital factor VII deficiency are different and consist of mucosal cutaneous hemorrhage, gastrointestinal bleeding, and joint bleeding. CNS hemorrhage is a fatal and severe complication of congenital factor VII deficiency. The incidence of gross hematuria is a rare symptom of factor VII deficiency. Isolated presentation of hematuria is rarer and usually is accompanied by bleeding in other sites. Case Presentation: The patient reported here is a 6-month-old girl who was diagnosed with congenital Factor VII deficiency following episodes of isolated gross hematuria. We decided to report this case to demonstrate if there is no other organic cause in the investigation of a child with recurrent hematuria, we should also consider a coagulation factors deficiency. Conclusion: Since isolated hematuria is a rare symptom in the coagulation factors deficiency, the coagulation tests may be of less interest.

Background: late in 2019, the first case of COVID-19 was detected in China, and the disease caused pandemic state worldwide. Up to now, many studies investigated the impact of comorbid diseases, especially diabetes mellitus on COVID-19 outcomes. Objectives: In this study, we aimed to assess the para-clinic characteristics of COVID-19 patients with or without diabetes mellitus to identify factors indicative of poor prognoses. Methods: In this prospective study, 153 in-patients with COVID-19 were followed up from 1 March to 19 April. Paraclinical information of these patients was gathered from their medical records. Afterward, the association between these factors among both diabetic and non-diabetic patients were assessed in the correlation analyses. Results: discharge and expiration of 77.1% and 22.9% of the study participants resulted in a 1063 person-day follow up for patients who discharged healthily, and 384 person-day follow up for expired patients. 41.8% of the participants had diabetes mellitus. Lymphocytopenia and Neutrolhilia prevalences increased during hospitalization; comparing with their initial prevalences. Thirty-seven patients got acute respiratory distress syndrome; of those, 35 died. The mean of the initial C reactive protein level was 42.49 and serum creatinine of 1.39 Conclusion: The study showed that higher initial neutrophil count, increasing neutrophil count more than 15000 and decreasing lymphocyte count below 1000 during hospitalization; development of acute respiratory distress syndrome and being intubated; initial C reactive protein and serum creatinine level were associated with higher mortality rates in COVID-19 victims.

Objective: To develop a national model for hospitals’ Emergency Department (ED) preparedness when facing radiation and nuclear incidents as well as nuclear terrorism in Iran.Methods: This analytical study was carried out in 2019 via Delphi technique in two rounds and prioritization using a pairwise questionnaire. Using classic Delphi technique and pairwise comparison, the components were given to 32 specialists in emergency medicine, nuclear medicine, medical physics, nuclear physics, radiobiology and radiation protection, health in disaster and emergency, and passive defense. Finally, the national model was developed by holding two focus group sessions.Results: The results from the two rounds of Delphi technique showed that 31 factors of preparedness were classified into three main classes, namely staff, stuff, and structure (system). Only three factors were excluded and the rest were agreed upon by the specialists. Given the weight of each class, it was found that staff preparedness and stuff preparedness had the highest and lowest priorities, respectively.Conclusion: Comprehensive preparedness requires enhancing and promoting cultural, social, economic, and political levels. Indeed, all preparedness levels should be promoted in alignment with each other. Hence, governments should align their policies to manage such incidents.

Introduction: Early education and training are mandatory toraise the knowledge and awareness of the healthcare staff. Iranis a disaster prone area with a high number of emergencies.This study aimed to assess the need for disaster and emergencymanagement education for Iranian medical students.Methods: Using two-round Delphi technique in 2017, 15 expertswithin the field of disaster and emergency management wereasked for their opinions concerning the education required forIranian medical students. Highly important educational domainsand their sub-domains selected with an agreement of above 70-80% were prioritized by AHP technique.Results: Of 41 identified and prioritized educational subjects,four main groups were obtained: 1) crisis and disaster primaryconcepts, 2) disease control skills, 3) management skills, and4) medical care skills. The medical care skills had the highestpriority (with a weight of 0.546), compared to other areas afterthe final analysis.Conclusion: Different areas of competency are needed to raiseawareness and preparedness in medical students in combatingcrisis and disasters. We propose a curriculum for Iranian medicalstudents and suggest it to be used for other professionals, who areinvolved in the process of disaster management.Keywords: Disasters, Crisis, Medical students, Education, Interdisciplinary, Awareness

The new corona disease (COVID-19) is very contagious and features a high risk of vast outbreak and infection. The World Health Organization (WHO) declared a global public health emergency condition on 30 January 2020 and a universal epidemic afterwards by given its rapid epidemic worldwide (1). Iran was amongst the first countries influenced by COVID-19. Iran’s health system was shocked by the fast and vast outbreak of the virus which made it impossible to take appropriate measures on the first days of COVID-19 outbreak for its management. However, Iran made maximal efforts returning to normal conditions. On the other hand, United States (US) sanctions contributed to the worsening of the conditions. The sanctions that mark the US’s economic and political war against Iran, date back to long time ago. These sanctions had indirect, adverse effects on the relief and rescue measures during the 2019 flood in Iran, as well (2). Sanctions are the perfect violation of humanitarian programs and are in conflict with the United Nations (UN) charter and the international human right declaration. Nonetheless, not only COVID-19 had no effects on the US’s perspectives and policies, but the sanctions have also been increased by the US in this period. In fact, the sanctions are the genuine manifestation of the US’s application of terrorism. These sanctions exert subtle physical, psychological, and mental effects on the people based on contribution to further spread of COVID-19.

Objective: The present study aimed at codifying a native model of civil-military coordination (CIMIC) in natural disasters in Iran. Methods: This manuscript is a part of a larger study. The present cross-sectional study was conducted in 2019 using a two-stage Delphi technique. The factors confirmed by the technique were prioritized via a pairwise questionnaire. In doing so, 24 elites and experts in civil-military coordination were presented with the indicators in the course of classic Delphi technique and pairwise comparison. At the end, the nationalized model was finalized by sending the model to ten experts and asking their ideas. Results: The results obtained from the two rounds of Delphi indicated that 36 coordination factors could be classified into three primary classes of staff, stuff, and system. All factors were confirmed by the experts. Considering the weight of each class, “staff” and “stuff” classes were considered to be the highest and lowest priorities, respectively. Conclusion: Application of the coordination factors in the context of military and civil organizations leads to a better response to natural disasters. The organizations in charge of responding to disasters should be obliged to apply this model in the highest organizational commitment level as the final goals of disaster management. The results of the present study can be applied for codification of a comprehensive plan for assessing the civil-military coordination in natural disasters.

The words “look-alike” and “sound-alike” are used to express the confusion caused by drugs whose names or features are similar. Look-alike/sound-alike (LASA) drugs are one of the most common causes of medication errors. The emergency department is the first place where mistakes related to LASA drugs occur. Medicinal errors increase health care costs by about two billion dollars annually. This study examines the frequency of errors resulting from LASA drugs in the emergency department and identifies the main causes of these errors. This sectional analytical study was conducted in 2016 in the Namazi and Faghihi hospitals of Shiraz. The questionnaire was developed by the researcher and its validity was confirmed by the experts. The stratified sampling method was used and the sample size was determined to be 106 people, based on the Cochran formula. The data were analyzed using the software SPSS 20 by the Pearson correlation coefficient, the independent t-test, and an analysis of variance (ANOVA). Seventy-seven nurses stated that during the past six months they had made at least one error resulting from look-alike medication and a total of 132 errors were reported. The most common errors in medication related to ampoules and vials. The rate of errors was statistically significant in terms of marital status (p

Background: Due to existence of nuclear power plant sites in various parts of the world, as well as political threats in disaster-prone areas throughout the world, there is a probability of nuclear and radiation incidents. The present study aimed to extract effective criteria in emergency department preparedness of hospitals in radiation, nuclear incidents and nuclear terrorism in different countries around the world. Methods: A systematic search was carried out in Cochrane Library, PubMed, Scopus, Science Direct, Web of Science, ProQuest and Embase databases between Jan 1970 and Jul 2018. The systematic search was carried out according to the PRISMA standard. The required information was extracted from the papers based on the abstract and collection form. Results: Overall, 1091 papers were finally extracted. The initial search included research papers. After reviewing the papers’ titles, abstracts and full texts, 15 papers were selected for final analysis. Next, 32 criteria were extracted. The criteria were divided into 3 categories. The categories included staff, stuff and systems (structure). The most frequent criteria included training criteria, personal protective equipment, decontamination and practice. Conclusion: The results of the systematic review provided an overview of the effective factors in improving the emergency department preparedness during radiation and nuclear incidents. In addition to the mentioned criteria in different studies, other hidden factors affect the emergency department preparedness in radiation and nuclear incidents. Thus, the highest level of preparedness should be considered.

Environmental health issues and epidemic pandemic aspects including infection spread during managing dead bodies revealed that infectious diseases and the associated mortality were often caused by infectious pathogens due to mismanagement of dead bodies. Dead body management is one of the main environmental health challenges during and after disasters and emergencies, especially following epidemic. This systematic review aimed to investigate the dead body management of epidemic victims. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In this study, electronic databases, including Web of Science, PubMed, Scopus, Pro Quest, Google Scholar, and Cochrane Library, were searched from March 1, 1970, to September 30, 2021. A comprehensive literature search was performed using scientific databases and gray literature. A thematic synthesis approach was used to analyze the data. In total, 2764 articles were identified, 11 of which met the inclusion criteria for entering the process of final synthesis. The findings showed three main sections, including (1) dead body management in the hospital and transfer of epidemic victims, (2) mortuary, shrouding, funeral, and burial of epidemic victims, and (3) management of families and risk communication. Implementation of the standards and protocols during dead body management of epidemic victims is essential with the aim of saving the lives of service providers and participants in ceremonial washing and burial.

Background and aims: In advanced management, human resources are the center of sustainable development. The main objective of the implementation of safety management systems, safety and the environment, ensure the deployment of these elements in the organizationchr('39')s strategies. Health, Safety and Environment (HSE) is a system which is as integrated and synergistic arrangement of human resources , facilities and equipment and try to create a healthy and environment away from the accident, damage and waste. Safety climate is a term that describes a common vision of staff of how the safety management is used in the workplace. This study was conducted to determine the relationship between safety climate with an awareness level among employees of the HSE management system in oil refinery in Kermanshah. Methods: The study population was employees in one of the oil refineries in Iran. After designing and questionnaire psychometric assessment of staff knowledge of HSE management system, Loughborough safety climate questionnaire was used. Data analysis was performed using SPSS 22 software. Results: The results of this study showed a moderate awareness of HSE Management System in refinery workers (mean of 20.85). The relationship between safety climate and awareness level of HSE management system got significant. Conclusion: The findings of this study showed the importance of regarding to demographic and occupational characteristic on safety climate and awareness level of HSE Management System. In this regard, appropriate and proper management policy should strive to improve the situation. The results of this study present a profile of the safety climate situation in the surveyed refinery, which can be used as a preventive indicator for providing and promoting policy and safety performance evaluation and of its results ,they use to improve organizations safety.

Objectives With regard to the changes in the Iranian population structure, especially the rise of the elderly population, and the increase in pharmacy clients, this study aimed to evaluate the senior-friendly pharmacies of Shiraz. Methods & Materials This was a cross-sectional study conducted in 2016. The study population comprised all 33 hospital pharmacies in Shiraz. Data were collected by a researcher-made checklist with the aim of evaluating the potential of the pharmacy to transform into a senior-friendly one. Reliability (r=0.85) and validity of the checklist were confirmed. Data were analyzed by χ2, Mann-Whitney, and Kruskal-Wallis tests through SPSS23. Results The average score of pharmacies’ potential was 50.52, which indicated a moderate ability of the pharmacies to transform into senior-friendly ones. The results of the Kruskal-Wallis test did not show any significant relationship with pharmacy type and ownership. Conclusion Increase in the number of aging population, average level of senior-friendly pharmacies throughout Shiraz City, and the potential of hospital pharmacies to provide geriatric services can be considered as challenging issues. However, these new challenges can be managed through appropriate planning and policy making.

Special attention of and oil, gas and petrochemical large corporation in the world to the HSE management system is due to its importance in the designing and development of products, services and processes by considering its health, safety and environment requirements. Staff's perception of the existing job risks has a significant impact on their safe behavior at work. This study was conducted to determine the relationship between safety climate and staff's perception of risk with an awareness level among employees of the HSE management system in an oil refinery in Kermanshah. The study population was employees in one of the oil refineries in Iran. After designing and questionnaire psychometric assessment of staff knowledge of HSE management system (Cronbach's alpha was 0.9 and its validity was assessed by certified professionals), Loughborough safety climate questionnaire and Flin risk perception questionnaire were used. Data analysis was performed using SPSS V22 software. Results showed that the relationship between safety climate and awareness level of the HSE management system; also the relationship between safety climate and perception of risk was also getting significant. However, the relationship between perception of risk and awareness level of the HSE management system was not significant. The results of this study showed a moderate awareness of HSE Management System in refinery workers. In this regard, appropriate and proper management policy should be committed to improving the situation. The results of this study is a profile the situation of safety climate in the refinery, which can be used as an indicator for the development of preventive policies and evaluate the performance of the organization's safety and the results of the safety improvement organization.

Background: The objective of the present study was to investigate the strength and weaknesses of healthcare management during the first 10 days after the earthquake in Sarpol-e Zahab in Kermanshah, Iran. Methods: This qualitative, observational study was conducted on November 13-23, 2017 in the disaster area, by using content analysis. Data was collected through experts and focus group interviews with professional and healthcare staff, and policy-makers. Results: Our findings were categorized into 7 major groups; environmental health; mental health; mothers, infants and children’s health; field hospital; nutrition; contagious diseases; drug delivery. There were good cooperation and coordination regarding environmental health issues. However, other categories were handled by different organizations and resulted in a chaotic situation. Conclusion: The post-earthquake period is overwhelmed with considerable issues regarding the care of victims and therapeutic measures. Lack of quick, reliable, and appropriate management will result in extensive health issues, including epidemic, worsening of chronic diseases, and exacerbation of mental disorders.