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Background: Emergency medical services (EMS) play a crucial role as the first line of defense during emergencies and disasters. Given the current impact of climate change, EMS will need to employ innovative strategies to cope with changing conditions. This scoping review investigates how EMS can adapt to climate change in pre-hospital emergencies. Materials and Methods: In this study, peer-reviewed studies and texts on adaptive strategies of pre-hospital emergency systems published in 2023 were reviewed. Accordingly, online databases, including Web of Science, PubMed, Scopus, and Google Scholar as a search engine were searched. The selected keywords were as follows: “Medical technician,” “paramedic,” “ambulance,” “climate change,” “global warming,” “adaptation,” “mitigation,” and “resiliency” (and synonyms). Conclusion: No wide-ranging study has been conducted on the adaptation strategies of EMS against climate change and this is the first study in this field. In this study, elements and adaptation strategies against climate change were investigated. Extracting these cases and using them to improve the readiness and resilience of the pre-hospital emergency system will be effective against this phenomenon.

Background: The COVID-19 epidemic was a biological disaster that may cause or exacerbate burnout in healthcare professionals (HCPs). Our goal was to determine the impact of the long-term COVID-19 epidemic on burnout in front-line healthcare workers and the factors affecting it. Materials and Methods: This cross-sectional survey on front-line HCPs’ job burnout based on an online platform was conducted at Mazandaran University of Medical Sciences. The demographic characteristics, medical-work-related factors, and COVID-19 exposure were collected by the self-reported Farsi version of the Maslach burnout inventory questionnaire. Results: Out of 2100 sent questionnaires, 924 participants completed them (44% response rate) of which 280 were male (30.3%). Overall, 850(92%) respondents had a high level of emotional exhaustion, 872(94.4%) had a high level of depersonalization, and 112(12.1%) had a high reduced personal accomplishment. There was a significant relation between higher burnout levels with higher education levels, working in hospitals as clinical staff, and pre-hospital operational personnel as well as having direct contact with a significant number of COVID-19 Patients. A significant number of participants (94.2%) were in severe and moderate burnout levels. Conclusion: There was a significant increase in job burnout among front-line HCPs during the COVID-19 epidemic compared to former similar studies at the beginning of the epidemic and non-epidemic periods. It is recommended that in disaster management planning, especially in long-standing ones like COVID-19, the proper programs should be considered for increasing the resilience of HCPs.

Background: Several studies have been conducted on the effects of floods on the health of the affected community. We aimed to determine the effects of floods as the most common disaster on hypertension (HTN) as one of the most common noncommunicable diseases (NCDs). Materials and Methods: Four databases including Medline, Scopus, Google Scholar, and ScienceDirect were searched with the search strategy protocol up to the end of June 2021 and with the keywords of flood and high blood pressure or hypertension. Grey literature database and websites of WHO, UNDRR, and PreventionWeb were also searched. After removing duplicate articles, abstracts of the relevant titles were reviewed, and eligible articles were included for full-text review. Finally, the study variables were extracted from selected articles. Results: The search strategy resulted in eight final relevant articles from 48,980 articles. All final articles noted meaningful effect of flood on high blood pressure. There was a positive correlation between anxiety level, property loss, financial loss, physical activity, use of alcoholic beverages, interruption of medication, and medical cares with HTN. Different studies have also reported long-term effects of flooding on blood pressure. Conclusions: The flood has significant effect on high blood pressure in affected population. However, cases of unknown HTN in the affected population should also be considered, so screening is recommended in the affected community.

Background: Multiple Sclerosis (MS) patients experience a variety of disease caused disabilities that makes them more vulnerable to the effects of disasters. This study aimed to review all existed studies about disasters and related disaster management planning about MS patients. Methods: The PubMed, Google Scholar, Scopus, and Web of Science, ProQuest, science direct , and grey literature databases were searched up to the mid of 2021. All obtained titles were assessed by the inclusion criteria. Abstracts of the relevant titles were reviewed and eligible articles/documents were included for full text review and data abstraction. Results: From 24616 Articles/documents, finally 15 documents (13 articles, and 2 books) were selected. In 8 articles (53%) specifically, focused on MS patients and, in the rest focused on them as a member of people with disabilities. Most studies (10, 71.4%), emphasized on the disaster induced stress effect on MS patients. In two books/book sections, the disaster preparedness plan for all types of disabilities was presented in general, and MS patients were mentioned as a member of the group of patients with disabilities. Conclusion: Despite the importance of planning in response to disasters to address specific problems of MS patients, there is a lack of proper planning. This is very important and there is an urgent need to develop appropriate planning protocols for addressing the special conditions of MS patients in response to disasters.

Background and purpose: Hospitals are one of the vital pillars of the health system. Hospital preparedness in epidemics is a dynamic, complex and multidimensional process that shows the developed capacities and capabilities of the hospital in predicting, reducing the effects, resistance, response, and recovery in the face of biological events. The aim of this study was to investigate the readiness of hospitals in response to the pandemic of COVID-19 disease in Mazandaran province, Iran. Materials and methods: This cross-sectional study was performed in April 2020 using the standard checklist of the Pan American World Health Organization (PAHO 2019). The checklist consists of ten components: incident management system (7 items), coordination (2 items), information management (2 items), logistics (7 items), finance and administration (1item), detection (3 items), diagnosis (3 items), isolation (3 items), cases management (4 items), and prevention and infection control (10 items). Data were analyzed applying Kruskal-Wallis test in SPSS V18. Results: We studied 39 hospitals in the province, including university hospitals (n=26), social security hospitals (n=4), and private hospitals (n=9). Social security hospitals showed the highest level of readiness (mean score= 82 out of 84), university hospitals had moderate level of readiness (mean score= 72.72 out of 84), and private hospitals had the lowest mean score for readiness (72.5 out of 84). According to the total scores, operational readiness was at a good level. Conclusion: The readiness of the hospitals in the face of the COVID-19 pandemic was at a good level in Mazandaran province. However, due to the prolonged pandemic and uncertainty about when it comes to an end, monitoring the key components is essential to maintain high level of preparation.

After presenting the novel coronavirus (SARS-CoV-2) in china, it has spread rapidly in the community and now has declared as a pandemic causing coronavirus disease 2019 (COVID-19). At the date of writing this report, the COVID-19 has affected 192 countries and one international conveyance (the Diamond Princess cruise ship harbored in Yokohama, Japan) around the world with the total cases of 341,529. In Iran, the emergence of the disease was reported with two cases of COVID-19 deaths in Qom city on February 19, 2020, that caused great concern for the health system and the general public. It was rapidly spread around the country and reach to 21,638 definite cases by March 22, 2020. The special nature of the disease in rapid transmission among individuals in society requires urgent measures and serious actions to control it as quickly as possible. In this report, we describe the current status of the COVID-19 response strategy for reducing transmission in public and patient load in hospitals in Iran. Although Iran has tried to use the successful experience of other countries, such as China, for various reasons, such as non-quarantine of Qom province, as the primary site of disease propagation, lack of public quarantine, lack of seriousness by some citizens and officials, the lack of facilities and personal protective equipment needed for staff use, and restrictions regarding purchasing equipment from other countries due to international sanctions, have served as obstacles to achieve good results.

Abstract Background Information of Previous studies on the prevalence of MS, including our study conducted 12 years ago, used to shape global prevalence map of MS. According to those results, Iran placed in medium-prevalence MS region in the world Atlas of MS 2013.This study aimed to investigate the prevalence of MS in Mazandaran province after 12 years and the need for possible changes in the global map of the prevalence of MS. Methods We included all MS patients living in Mazandaran province in 2018 in this descriptive cross-sectional study. We updated our pre-existing registration questionnaires which included demographic information and medical data of MS patients by interview. We obtained the demographic profile of Mazandaran province from the most recent census in 2016 and the National Civil Registry of the Mazandaran province for calculating prevalence of MS. Results The total number of MS patients in Mazandaran was 2418 (25.8% male and 74.2% female) with a female to male ratio of 2.9. Based on the local population of 3,332,556, (50.4% male and 49.6% female), this study showed a prevalence of 72.5 per 100,000 for MS in this region. The prevalence of this disease by gender was 37.1 per 100,000 for men and 108.5 per 100,000 for women. The mean (SD) age of the patients at the time of the study was 38.5 (10.1) years with a minimum of 15 and a maximum of 75 years. The most common type of MS was Relapsing-Remitting MS with 86%. Conclusions All recent studies showed significant upward trend in the prevalence of MS around the world. Based on the results of our study and many other studies in Iran, the Atlas of MS prevalence map needs to be update. Iran’s status should be changed to the high-prevalence of MS in the new Atlas. Due to the increasing prevalence of MS, we suggest an adjustment in the Global MS Prevalence Scale.

Background: Communicable diseases are one of the main health problems in Iran. This study aimed at demonstrating the progress of communicable diseases management in more than 30 years of its implementation and pointing out its strengths and weaknesses, as well. Materials and Methods: This interview-based study using content analysis method was conducted in 2014. Data were collected through deep interviews. Fifteen interviews were conducted with all experts and health system managers at Iran’s communicable diseases management center. The collected data were analyzed using the principles suggested by Strauss and Corbin. Results: The establishment of the communicable disease surveillance system was a revolution in the health system of Iran. The strengths of the system are as follows: network-based and integrated health services, well-organized and knowledgeable personnel, national and international supports, strategic and operational plans, and expanded programs of immunization. On the other hand, its weaknesses mentioned by the participants were: disease-based case definition, poor public awareness, poor inter-sectoral collaboration and coordination, insufficient resources, delayed or no notifying target diseases, lack of district laws or incomplete implementation of legislation, failure to provide feedback or ignoring for the results of the analysis, and lack of performance evaluation. Conclusion: Although the implementation of the communicable diseases surveillance system was a huge achievement in the health system of Iran, however, it needs more improvements based on the present situation. Revision of the rules, restoration and strengthening of the existing structure, the use of modern information and communication technologies, and the establishment of the monitoring and evaluation system are helpful to increase its success.

Background: Iran is a country with a high rate of natural disasters like earthquake. The environmental conditions slow down the delivery of health services, especially in the event of disasters. The modern technologies such as telemedicine are appropriate for facilitating disaster relief operations after an earthquake. This study aimed to develop a model for the implementation of telemedicine in an earthquake. Materials and Methods: The study was carried out using a mixed-methods research in three phases: 1. review of the literature; 2. qualitative study (modeling); and 3. Delphi method (validation of the model). Databases of Google Scholar, Web of Science, Scopus, and PubMed were searched from 1990 to 2019 with the keywords of “telemedicine” AND “disaster” OR “emergency” AND “earthquake”. After screening of the retrieved records, 13 articles met the eligibility criteria and were included in the review study. Ten experts extracted all key elements of telemedicine in the disaster from the articles and categorized them in 6 themes with 38 subthemes. The model of telemedicine in the earthquake was finalized with 2 rounds of Delphi with groups of selected volunteer experts. Results: In the first phase of the study, 6 key themes (telecommunication infrastructure, technical infrastructure, financial infrastructure, health infrastructure, organizational infrastructure, social infrastructure, and cultural infrastructure) with 38 subthemes of telemedicine for implementing in the disaster were obtained. At the conclusion of the third phase of the study, 6 key themes with 33 subthemes contributed to the model of telemedicine in the earthquake. Telecommunication infrastructure with a maximum score of 9.24 earned the priority, and social and cultural infrastructure themes with the minimum score of 7.53 came in the end. Conclusion: The model derived from this study can be used as an applied telemedicine model in an earthquake. We suggest that the results of this study be implemented as a theoretical model, or in a pilot study in a region of the country, and to be evaluated by regarding mortality reduction. We also recommend that a comparative study for using telemedicine in other types of disasters be undertaken.

Background and purpose: Iran is one of the top ten countries in the world with disaster. Hospitals have a major role in dealing with disaster-related injuries. The purpose of this study was to assess the level of preparedness in Mazandaran province hospitals in dealing with disasters in order to identify the deficiencies and comparing current conditions with national standards. Materials and methods: In this cross-sectional study, all hospitals affiliated with Mazandaran University of Medical Sciences and Mazandaran Social Security Organization (n=28) were evaluated in 2017. Data were collected using the National Standard Toolkit for Hospital Preparedness. The overall score and the scores for every component were recorded and the level of preparedness were presented according to four levels. Results: The relative preparedness level of hospitals in dealing with disasters was moderate (65.5%). The overall levels of disaster preparedness in the hospitals affiliated with Mazandaran University of Medical Sciences and the social-security hospitals were moderate (63%) and favorable (75%), respectively. The hospitals affiliated with Mazandaran University of Medical Sciences, were found to have good (n=4), moderate (n=14), and poor (n= 5) levels of preparedness. The hospitals of the Social Security Organization were ranked as good (n=2) and moderate (n=3) in disaster preparedness. Conclusion: Most of the hospitals in Mazandaran province, like other regions in Iran, have poor level of disaster preparedness. Therefore, more planning is needed to enhance the hospital’s level of readiness in all dimensions.

INTRODUCTION:The incidence rate of MS is a valuable indicator of the recent changes in the risk of this disease, and it is widely implicated for health planning purposes. OBJECTIVES:This study aims to determine the MS incidence over the past eleven years in Mazandaran province and to compare it with the other parts of Iran and the world. MATERIALS AND METHODS:This retrospective study is conducted in Mazandaran province by using registered data in the files of the patients with their consent. The yearly crude incidence rates, age, and sex-specific incidence rates and directly standardized incidence rates of this population are calculated, and the temporal changes in the incidence rates are analyzed. RESULTS:662 (26%) male patients with the mean (SD) age of 32.6 (9.48) and 1884 (74%) female patients with the mean (SD) age of 31.9 (9.15) are studied. The direct standardized incidence rate of MS was 3.28 in 100.000 in 2008 and reached 4.17 in 100.000 in 2018, and this increase was significant (p