Davoud Khorasani-Zavareh

Disaster Health-Related Challenges and Requirements: A Grounded Theory Study in Iran

BACKGROUND Despite frequent disasters caused by natural hazards, concern has been raised regarding the effectiveness of disaster health services in disaster-prone countries such as Iran. The purpose of this study was to explore, in relation to health disaster management, the experiences and perceptions of individuals who responded or were affected by a recent Iranian earthquake disaster. METHODS This study was conducted using grounded theory. Study participants included members of a multidisciplinary disaster response team as well as residents of the community affected by the earthquake (n = 29). Data collection included semi-structured interviews, field notes, and reviews of narratives. RESULTS The findings of this study indicate that the lack of planning, inadequate organizational management of resources, insufficient coordination in the provision of health services during the disaster, and the manner of participation of international relief efforts were the most important barriers to adequate disaster healthcare services delivery during the 2003 Bam Iranian earthquake. CONCLUSIONS This study supports the value of health service managers coordinating the appropriate use of international aid in advance. It is suggested that this can be done by better communication with local and foreign constituents. Further, this study indicates that public education and proper pre-event planning help to bring about an effective response to providing healthcare services during a disaster.

System versus traditional approach in road traffic injury prevention: a call for action.

Road traffic injuries (RTIs) are a major public health problem worldwide, especially in low- and middle income countries (LMICs) and require concerted efforts for effective and sustainable prevention. A variety of measures need to be considered when planning activities1-2Moreover stakeholders’ perceptions,3-4approach and the kind of preventive activities are crucial.2,6On the whole, there are two different approaches in RTI prevention: the individual approach and the system approach.2 In the individual approach, usually there is a tendency for practitioners and researchers to identify only one or a few elements, which usually can be found in many LMICs.2Traditionally, in such countries many studies have focused on human errors, poor vehicles design and the road environment rather than focusing on the reason for injury outcome.6In many LMICs, the majority of preventive activities target road-user behaviors, which are usually tackled by means of education and enforcement.2,4Hence the primary responsibility is assigned to the road user. However, while safe road-user behavior is one important component, changing such behavior should not simply be focused on education and enforcement.2,3Studies on public education efficiency have revealed that a decrease in collisions due to such campaigns can be occurred only if they clearly focus on specific forms of behavior, like seat belt use or helmet wearing.4 In contrast, a system approach tends to be mainly directed toward the crashworthiness of the road transport system.2,5For example, Sweden has been rather successful in this area and one major national policy is a long-term vision for road safety, “Vision Zero”. It was a revolutionary way of thinking about traffic user safety that helped Sweden to significantly reduce the number of deaths and serious injuries due to road traffic crashes. This is a road safety policy that puts the protection of the most vulnerable road-users at its centre.6The system designer has the primary responsibility and as a result changes within the environment are given more emphasis than human factors.5The road transport system should be able to consider human failings and absorb errors in the road transport system, in order to avoid serious RTIs and deaths. It is interesting to note that the “Vision Zero” is not just applicable to high-income countries and it could be transferred to low- and middle-income countries. Accordingly, in such countries, if the inherent safety of the system (road and vehicle safety design) cannot be changed, then the only way to reduce RTIs is to lower speeds, as a means of speed management. The basic principles of Vision Zero can be used in any type of road transport system, at any stage of development.6

Identifying challenges for academic leadership in medical universities in Iran.

Medical Education 2010: 44: 459–467

Challenges in conducting qualitative research in health: A conceptual paper

Background: Qualitative research focuses on social world and provides the tools to study health phenomena from the perspective of those experiencing them. Identifying the problem, forming the question, and selecting an appropriate methodology and design are some of the initial challenges that researchers encounter in the early stages of any research project. These problems are particularly common for novices. Materials and Methods: This article describes the practical challenges of using qualitative inquiry in the field of health and the challenges of performing an interpretive research based on professional experience as a qualitative researcher and on available literature. Results: One of the main topics discussed is the nature of qualitative research, its inherent challenges, and how to overcome them. Some of those highlighted here include: identification of the research problem, formation of the research question/aim, and selecting an appropriate methodology and research design, which are the main concerns of qualitative researchers and need to be handled properly. Insights from real-life experiences in conducting qualitative research in health reveal these issues. Conclusions: The paper provides personal comments on the experiences of a researcher in conducting pure qualitative research in the field of health. It offers insights into the practical difficulties encountered when performing qualitative studies and offers solutions and alternatives applied by these authors, which may be of use to others.

Spatial and non-spatial determinants of successful tuberculosis treatment outcomes: An implication of Geographical Information Systems in health policy-making in a developing country.

This retrospective study aimed to address whether or to what extent spatial and non-spatial factors with a focus on a healthcare delivery system would influence successful tuberculosis (TB) treatment outcomes in Urmia, Iran. In this cross-sectional study, data of 452 new TB cases were extracted from Urmia TB Management Center during a 5-year period. Using the Geographical Information System (GIS), health centers and study subjects’ locations were geocoded on digital maps. To identify the statistically significant geographical clusters, Average Nearest Neighbor (ANN) index was used. Logistic regression analysis was employed to determine the association of spatial and non-spatial variables on the occurrence of adverse treatment outcomes. The spatial clusters of TB cases were concentrated in older, impoverished and outskirts areas. Although there was a tendency toward higher odds of adverse treatment outcomes among urban TB cases, this finding after adjusting for distance from a given TB healthcare center did not reach statistically significant. This article highlights effects of spatial and non-spatial determinants on the TB adverse treatment outcomes, particularly in what way the policies of healthcare services are made. Accordingly, non-spatial determinants in terms of low socio-economic factors need more attention by public health policy makers, and then more focus should be placed on the health delivery system, in particular men’s health.

Adult attention-deficit hyperactivity disorder, risky behaviors, and motorcycle injuries: A case-control study

Background The aim of this study was to assess the association of motorcycle traffic injuries with motorcycle riding behavior and subtypes of attention-deficit hyperactivity disorder (ADHD) while controlling for individual correlates of motorcycle traffic injuries. Methods A case-control study was carried out in 298 patients with motorcycle trauma along with 151 control patients admitted to the Shohada and Imam Reza university hospitals as the two referral specialty centers in the East Azarbyjan Province of Iran in 2013. The Persian version of the Motorcycle Riding Behavior Questionnaire and the Persian version of Conner’s Adult ADHD Rating Scales (the self-report short version) were used to assess riding behavior and screen for adult ADHD, respectively. The scale has four subscales, comprising subscale A (inattention), subscale B (hyperactivity, impulsivity), subscale C (A + C), and subscale D (ADHD index). The statistical analysis was done using Stata version 11. Results All subjects were male and aged 13–79 years. Approximately 54% of the participants were married and 13% had academic education. Approximately 18% of the motorcycle riders stated that their motorcycle riding was only for fun purposes. More than two thirds of the participants did not have a motorcycle riding license. Variables found to be significantly associated with motorcycle injuries in bivariate analysis included age, marital status, educational level, having a motorcycle riding license, using a helmet while riding, daily amount of riding, riding just for fun, riding behavior score, and ADHD scale scores. It was found in multivariate analysis that if the ADHD index (subscale D) score was used to assess the association of ADHD with motorcycle injuries, a protective role for ADHD was observed. However, the two other subscales showed a different predictive pattern for subscale A versus subscale B, with only subscale B increasing the likelihood of motorcycle traffic injuries. The score based on motorcycle rider behavior was found to be associated with motorcycle injuries. Other variables that were significant in multivariate models were the purpose of riding, educational level, economic status, and marital status. Conclusion ADHD and riding behavior scores affect the likelihood of motorcycle traffic injuries among motorcycle riders independent of other injury indicators, and include education, purpose of riding, and economic status.

Kinetic energy management in road traffic injury prevention: A call for action

Abstract: By virtue of their variability, mass and speed have important roles in transferring energies during a crash incidence (kinetic energy). The sum of kinetic energy is important in determining an injury severity and that is equal to one half of the vehicle mass multiplied by the square of the vehicle speed. To meet the Vision Zero policy (a traffic safety policy) prevention activities should be focused on vehicle speed management. Understanding the role of kinetic energy will help to develop measures to reduce the generation, distribution, and effects of this energy during a road traffic crash. Road traffic injury preventive activities necessitate Kinetic energy management to improve road user safety.

Factors affecting the exposure, vulnerability and emergency medical service capacity for victims of road traffic incidents in Kampala Metropolitan Area: a Delphi study

BackgroundThe Kampala Metropolitan Area (KMA) is the fastest developing region in Uganda. Over recent years, this has placed exponential demand on the road sector, which consequently has contributed to rapid growth in motorized vehicles which, predisposes the region to a high risk of road traffic incidents (RTIs). A number of concerted road safety and post-crash management measures to respond to RTIs in the KMA in particular and Uganda as a whole have been undertaken. However, there is a need to greatly improve the measures by better identifying the factors influencing the exposure, vulnerability and emergency medical service (EMS) capacity for RTI victims. The present study seeks to investigate and reveal these factors.MethodsA Delphi technique employing a questionnaire and involving a multidisciplinary panel of experts was used in three rounds.ResultsThe ten (10) most important factors affecting the exposure, vulnerability and EMS capacity for victims of RTIs in the KMA were identified. Socio-cultural, infrastructure and road safety aspects were the factors most identified as affecting the exposure and vulnerability. The absence of a national EMS policy and post-crash care system, as well as the fact that many victims lack health insurance, were noted to be the factors adversely affecting the EMS capacity.ConclusionsThere exists is a real need to substantially reduce the burden of RTIs in KMA, with ultimate goal of saving lives that are being lost needlessly and reducing the impact of injuries and trauma and the economic losses associated with it. This study offers insights into the causes of RTIs and the most appropriate ways of responding to them especially with the establishment and empowerment of predefined and structured EMS systems.

Antilock braking system effectiveness in prevention of road traffic crashes in Iran

BackgroundAnti-lock Brake System (ABS) helps the equipped vehicles to stop under heavy braking, in a shorter distance and with a better control of direction. It was expected that this technology will reduce the rate of fatal road traffic crashes (RTC); however, the outcome is controversial in the real world. The aim of this study is to compare the claimed annual incidence rate and financial losses due to RTCs in ABS vs. non-ABS personal vehicles in Iran.MethodsA telephone survey among drivers of two similar models of personal vehicles was arranged. The studied vehicles were of the same brand and type; but only one of them was equipped with ABS. The number of RTCs, subsequent financial loss, and drivers’ knowledge and perception about ABS were sought. The sample consisted of drivers of 1232 ABS and 3123 non-ABS vehicles.ResultsThe annual incidence rate of RTC involving another vehicle was 145.1 (134.8-155.9) per 1000 vehicle-years and there was not a statistically significant difference between study groups.The incidence of RTC with another vehicle due to brake failure was 50.3 (42.9-58.5) for 1000 non ABS vehicle-years and 30.0 (21.2-41.2) for 1000 ABS equipped vehicle-years. The difference was statistically significant after adjustment for the driver and vehicles age and the daily driving time. The attributable risk of RTC for non-ABS vehicles was 20/1000 vehicles and the excess fraction was 39.8%. The mean financial loss due to reported RTCs was

Exploring the perception of aid organizations’ staff about factors affecting management of mass casualty traffic incidents in Iran: a grounded theory study

987.9 ±