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   2019| April-June  | Volume 8 | Issue 2  
    Online since October 7, 2019

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Risk factors of deaths related to road traffic crashes in World Health Organization regions: A systematic review
Alireza Razzaghi, Hamid Soori, Amir Kavousi, Alireza Abadi, Ardeshir Khosravi, Abbas Alipour
April-June 2019, 8(2):57-86
Background: Identification of risk factors involved in road traffic deaths (RTDs) could help policymakers and road traffic managers to adopt effective strategies and approaches for the prevention and control of these incidents, while the lack of accurate data on the risk factors of RTDs causes the problem to persist. This systematic review aimed at assessing the national studies regarding the risk factors of RTDs in the regions covered by the World Health Organization (WHO). Methods: This review study was conducted during 2008–2018 via searching in databases of PubMed, Science Direct, Scopus, Cochrane, Thomson Reuters, Web of Science, EMBASE, ProQuest, and Trip databases. Initially, a literature review was performed to find similar systematic reviews, followed by another literature review to retrieve the published or registered protocols. At the next stage, PECOTS was developed for the search strategy, followed by the quality assessment. The eligibility criteria in this study were the national-level studies about the risk factors related to RTDs, English-language studies, and studies published during 2008–2018. Results: In total, 169 articles were included in this study, with the highest and lowest number of the published articles in the United States and African countries, respectively. According to the reviewed studies, human factors accounted for the most common risk factors involved in RTDs. In the southeastern regions of Asia, the main road-related risk factor for RTDs was reported to be the type of roads. Furthermore, roadside departure to the right side and long roads were denoted in the national data of the Western Pacific region on the incidence of RTDs. Differences were observed between the six regions covered by the WHO in terms of the time-related risk factors for RTDs. Conclusions: Several risk factors have been reported for RTDs in the countries covered by the WHO, and each risk factor is considered to have various subcategories. Therefore, it could be concluded that there are different epidemiological patterns for road traffic accidents and RTDs.
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Factors affecting the severity of pedestrian traffic crashes
Ali Moradi, Pegah Ameri, Khaled Rahmni, Maryam Najafi, Ensiyeh Jamshidi, Yadolah Fakhri, Salman Khazaei, Babak Moeini, Mohyeddin Amjadian
April-June 2019, 8(2):46-56
Background: Considering the importance of pedestrian traffic crashes and the role of environmental and demographic factors in the severity of these crashes, this article aimed to review the published evidence and synthesize the results of related studies to determine any associations between demographic and environmental factors and the severity of pedestrian-vehicle crashes. Methods: All epidemiological studies published from 1970 to 2019 were searched in international electronic databases (PubMed [Medline], Scopus, Web of Science, Embase, ScienceDirect, and Ovid) and reference lists of the identified articles were also searched. Studies were included if they investigated the severity of pedestrian-vehicle crashes as outcome, measured any environmental and demographic factors for pedestrian-vehicular crashes as exposure, designed observational, and if they were written in all languages. Quality of included studies was evaluated using the strengthening the reporting of observational studies in epidemiology checklist for observational studies. Results: We found 3126 references among which 24 studies were included in this review. All retrieved studies were conducted between 1990 and 2019 and had a cross-sectional design. In most of these studies, the associations between environmental and demographic variables such as vehicle speed or speed limits, pedestrian age, lighting, type of road, type of vehicle, and alcohol intake with the severity of pedestrian traffic crashes were examined. Conclusion: This study showed that few studies were conducted in this area; in fact, most of the studies were carried out in metropolises of developed countries. As a result, studies which provide strong causal inferences by focusing on high-risk groups and a higher level of evidence such as cohort and case-control ones are needed in developing countries.
  1,068 167 -
Prediction of sleep quality and insomnia severity by psychological disorders and acute stress among earthquake survivors in Sarpol-e Zahab, Iran, 2017
Hiwa Mohammadi, Hadi Naghdi, Naser Yazdani, Ali Zakiei, Farid Najafi, Habibolah Khazaie
April-June 2019, 8(2):93-98
Background: Psychological and health outcomes of natural disasters such as earthquakes affect survivors and health services for a long time. In the present study, posttraumatic stress disorders (PTSD), symptoms of psychopathology, sleep quality, and insomnia disorder were investigated among survivors of earthquake occurred at the Western Iran on November 12, 2017. Materials and Methods: This study was conducted on 1031 adult participants from rural and urban areas of Sarpol-e Zahab, a city in Kermanshah Province (Western Iran), who suffered from mental health problems due to the earthquake, a magnitude-7.3 quake, occurred in the Western Iran in 2017. Participants completed the Symptom Checklist 90, Insomnia Severity Index, Pittsburgh Sleep Quality Index, and Self-Rating Scale for PTSD. Data were analyzed using Pearson correlation and multivariate regression analysis by Statistical Package for Social Sciences Software (Version 21). Results: A positive correlation was observed between insomnia severity and all psychopathological symptoms. There was a positive correlation between sleep quality and somatization, obsessive–compulsive disorder, depression, and psychoticism. In addition, acute stress was positively correlated with insomnia severity and sleep quality. Conclusion: According to the results of the present study, it is recommended that psychological disorders in earthquake victims be considered to enhance their sleep quality.
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Are stainless steel elastic nails the solution to heavier children with femoral shaft fractures?
Richard Hutchinson
April-June 2019, 8(2):87-92
Background: The use of titanium elastic intramedullary nails for the treatment of femoral shaft fractures, in children weighing ≥45 kg, has been questioned due to the increased rates of malunion. Our aim was to see if the mechanical properties of stainless steel elastic nails provided enough fracture stability to justify their use in heavier children. Materials and Methods: Twenty pediatric femoral Sawbones®, fixed with titanium or stainless steel elastic nails, were tested. The bending stiffness and moments of the constructs were calculated at increasing loads, along with the angle of fracture deformation. From these estimates of maximum permitted body weight for each nail type were extrapolated. Results: Steel nails created significantly stiffer constructs than titanium in both the coronal and sagittal planes (P < 0.0001). Steel nails allowed bigger sagittal bending moments before losing acceptable alignment, compared to titanium (P < 0.0001). However, in the coronal plane, the difference was not statistically significant (P = 0.457). The estimated body weights extrapolated in the sagittal plane were 45 and 61 kg, in titanium and steel, respectively. In the coronal plane, they were 42 and 44 kg. Discussion: As steel has nearly twice the Young's modulus of titanium, it seems logical that fractures fixed with steel nails would be stiffer and fail at higher loads. However, it is unclear why steel did not outperform titanium in the coronal plane. A theory was proposed that unequal nail slip from the insertion sites might be a contributing factor to these findings. Conclusion: Pediatric femoral shaft fractures fixed with elastic steel nails provide significantly stiffer constructs than those fixed with titanium. However, there is an increased risk of malunion in the coronal plane, in children weighing ≥45 kg, regardless of material used, possibly due to unequal nail slip at the distal entry points.
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Pattern of trauma related to falling from walnut tree as an occupational injury: A cross-sectional study in the west of Iran
Salman Khazaei, Ensiyeh Jenabi, Zahra Zobdeh, Mehran Biglari, Maryam Afshari, Behzad Gholamaliee, Saeid Bashirian
April-June 2019, 8(2):99-103
Background: Evidence regarding the epidemiological characteristics and the mechanisms of trauma related to falling from walnut tree are limited in Iran. Therefore, this study was conducted to investigate the pattern of trauma related to falling from walnut tree as an occupational injury in Tuyserkan in the west of Iran in 2017. Materials and Methods: In this cross-sectional study, all the patients admitted in Vali-Asr Hospital for injuries caused by falling from walnut trees during the harvest for walnuts (from September to October 2017) were reviewed. The data were collected by a checklist including the demographic and clinical characteristics of the patients obtained from the hospital records. Data were analyzed using descriptive and analytical statistics by the STATA software version 12. Results: During the study, a total of 52 injured cases were registered in Vali-Asr Hospital. All patients were male, and 71.2% of them were rural dwellers. Falls were more concentrated in Friday (27%) and peaked in mid-days (19.2% of cases). Branch breaking was the common cause of falling in 30 (57.7%) injured cases. Nearly 70% (n = 36) of the cases were transferred to the trauma center by the emergency services. Among injured patients, 4 patients (7.7%) died. Overweight patients had a 7.75-fold higher chance of death or handicap compared to underweight patients (P = 0.09). Conclusion: Most of the cases were young men from rural areas who were economically important groups. High air temperature in mid-day time is in related to increase in the probability of falling; thus, it should be advised not to work at this time. A considerable proportion of injured patients were carried by family members to the hospital. Therefore, the general awareness that an injured person must be transferred to the hospital by the emergency medical services for the reduction of the severity of trauma is necessary.
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How to reduce flood damage? Take a look back at the recent flood in Iran
Mohammad Reza Fazel, Mehrdad Mahdian
April-June 2019, 8(2):45-45
  591 139 -
Development and domestication of a clinical guideline for pharmacological pain management of trauma patients in prehospital setting
Abozar Nasr, Nasrollah Alimohammadi, Mehdi Nasr Isfahani, Shayan Alijanpour
April-June 2019, 8(2):110-117
Introduction: Inadequate management of acute traumatic pain in the prehospital stage is a fact, which has many physical and mental adverse effects. No clinical guideline for the pain management of prehospital trauma patients in Iran has been published yet. Aims: This study aimed at development and domestication of a clinical guideline for pharmacological management of pain in prehospital trauma patients. Materials and Methods: A multistage evolutionary study method was used. First, a systematic review of articles, books, and guidelines for prehospital acute pain management with a comprehensive approach was carried out, then clinical guidelines with the most relevance to the topic were selected, and their quality was evaluated with AGREE tools. Finally, the initial guideline was developed based on the recommendations of the most comprehensive ones. The Delphi method and experts panel were used to summarize the information and finalize the clinical guidelines recommendations. Results: A total of 38 clinical guidelines and 150 related articles were found, of which five more comprehensive clinical guidelines and the most relevant topics were identified and reviewed. The recommendations that were agreed on by the Delphi stage were considered as the final recommendations, and others were reviewed again in the panel of experts by making the necessary changes. Finally, the domestic clinical guideline with 52 recommendations in three areas (general, assessment, and drug recommendations) was developed. Conclusions: Iran prehospital emergency organizations can use the recommendations of this clinical guideline to improve the quality of care, satisfaction, and protect patients' right.
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Prediction of mortality risk in patients with traffic injury: A case study in tabriz hospitals, Iran
Yalda Mousazadeh, Homayoun Sadeghi-Bazargani, Ali Janati, Mahboub Pouraghaei, Farzad Rahmani
April-June 2019, 8(2):104-109
Background: Trauma caused by traffic accidents is one of the main causes of mortality in the world. The trauma is a time-dependent condition. Trauma scoring systems help service providers to determine the severity of the injury and mortality risk and provide appropriate and timely services. This study aimed to predict mortality risk in patients with traffic injuries in Tabriz hospitals. Materials and Methods: This descriptive cross-sectional study included 11,238 traffic-injured patients. Databases of the emergency medicine service and forensic medicine were used to collect information. Glasgow Coma Scale, Age, and Systolic Blood Pressure (GAP) scoring system, binary logistic regression model, odds ratio with 95% confidence interval, and sensitivity and specificity were used to predict mortality. Results: Overall, 71 cases of death were identified. Pedestrians had the most rates of deaths with 31 cases (43.66%). Head trauma with 31 cases (43.66%) was the main cause of death. Mean (standard deviation) of the GAP score was 21.8 (1.8). The death rates in high-, moderate-, and low-risk groups were 22.4%, 3.18%, and 0.42%, respectively. The likelihood of death in people with saturation of oxygen (SO2) ≤95 was 1.96 times higher than those with SO2>95. The likelihood of death increased by 0.001 times each year. Furthermore, when the GAP score was ≤18, sensitivity was 64%, and for the GAP score of ≤10, sensitivity was 15.5%. Conclusion: GAP score seems to be a reliable and easy-to-use scoring method for predicting traffic injury mortality in an Iranian setting and yields reasonable results concerning international standards.
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