Background: A study conducted on wound treatment by antibacterial wound dressings can reduce the need for using antibiotics to a minimum amount. These wound dressings can create a moist environment at the wound surface to speed the healing process up. In recent years, researchers have paid much attention to polymeric wound dressings. Chitosan can help heal the wounds because of its similar structure to glycosaminoglycans in the skin. In this regard, the aim of the present study was to fabricate and characterize a novel biolayer wound dressing based on the carboxymethyl chitosan polymer with ceramic nanoparticles as a reinforcement and antibacterial agent using the freeze-drying method. Methods: In this study, to make a flexible wound dressing from a biocompatible and biodegradable polymer, N-O-carboxymethyl chitosan, diopside was added to improve the mechanical and hydrophobic properties of the soft tissue and cell proliferation was fabricated. After making the samples, a variety of chemical and biological tests and analyses were performed on the samples, including scanning electron microscope and Fourier-transform infrared spectroscopy. Results: The results showed that the use of this wound dress significantly reduced the risk of infection at the wound site. Conclusions: An antibacterial product with the proper mechanical behavior as a soft tissue was produced and evaluated in this study. The chemical and biological investigation represented that the sample with 5 wt% magnetite nanoparticles has excellent characteristics and can be introduced as a wound dressing application.

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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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Background and Objectives: Road traffic accidents (RTAs) are the second cause of death, the first leading cause of years of life lost due to premature mortality, and the most common source of injury in Iran. According to the World Health Organization estimates, Iran located in the countries that have the highest rates from RTAs. The present study aimed to measure road traffic mortality rates and also to depict a view of the trend for a period of 11 years which started from 2006 to 2016. Materials and Methods: In this cross-sectional study, we collect data on all road traffic deaths in Iran between 2006 and 2016 using records from the Legal Medicine Organization. For doing this research, demographic and epidemiological data of the deceased were extracted using a checklist designed by the forensic experts. Content validity of this form was determined by obtaining comments of professors and scholars in the field. Directly standardized mortality rates were calculated. Finally, the information was analyzed by descriptive statistics. Results: During the 11-year period of this study, 226,514 people in Iran died from RTAs. The age-adjusted mortality rate that caused by road traffic decreased from 41.5/100,000 people in 2006 to 20.4 in 2016 during the study period. There were significant differences in mortality rates between males and females and between outside city and inside city roads. The age-adjusted mortality rate was significantly higher among men than in women. The majority of death has occurred in illiterate young men aged 15–34 years and also in self-employed people. Conclusions: During the 2006–2016, mortality from RTAs decreased from 41.5 to 20.4/100,000 populations. This decreasing trend was observed in both sexes and in outside city and inside city roads. However, this reduction trend in the last years of the study is not suitable. These findings highlighted that training programs and harm reduction approaches for reducing the mortality from traffic accident are still needed.

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Introduction: A national road safety strategic plan (NRSSP) is considered as one of the main road safety management issues in different countries. Such a plan not only determines the vision and relevant strategies but also causes the implementation of appropriate interventions to be coordinated and strengthened to achieve the goals set by partner organizations. The present study mainly aims to report Iran's NRSSP 2021–2031 development protocol. Methods: According to a schedule, the study protocol consists of ten sections: (1) Determining a core planning center, (2) Establishment of a steering committee, (3) Stakeholder identification, (4) Identification and development of Goals and Strategies, (5) Vision development, (6) Establishment of committees, (7) Integration of Goals and Strategies, (8) Goals and Strategies assessment, (9) Action plans development, (10) Monitoring and evaluation. An appropriate study method is performed for each of the concerned steps. Conclusion: The road safety strategy plan is a critical component to promote the effectiveness of activities and achieve the goals determined for road safety purposes. The Decade of Action for Road Safety is just being closed to its end; hence, reviewing and drawing up a road safety document concerning authentic scientific models and evidence is of paramount importance in Iran. The present study takes over the mission to address this gap.

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Background: Due to the extensive use of subway transportation in high- and middle-income countries, the safety of passengers has become one of the important challenges in emergency management of subway station. Therefore, the present systematic review aimed to identify environmental and organizational management factors that affect the safe emergency evacuation in subway stations. Materials and Methods: In this systematic literature review, PubMed, Scopus, Web of Science, ProQuest, Google Scholar, Iran Medex, Magiran, and Scientific Information Database from 1990 to 2019 were searched to identify effective emergency management factors in safe emergency evacuation of the subways. A thematic content analysis was employed for data analysis. Results: Of 763 publications retrieved from the searches, 149 studies were included for data analysis. According to the findings, effective environmental and organizational management factors in safe emergency evacuation were discussed in eight subcategories, including infrastructure properties, evacuation-assisting resources, prevention of injuries and mitigation, preparedness for emergency evacuation, emergency response and reconstruction, and maintenance of evacuation facilities. Conclusion: The design of an optimal route for emergency evacuation is the main theme of most studies focusing on environmental factors. While a system approach for designer is needed for effective subway emergency evacuation, human-related factors focusing on injury prevention are also crucial.

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Background and Objectives: Road traffic accident (RTA) is one of the major public health problems. Inequality in this problem and its trend has not been yet investigated in Iran. A better understanding of different contributing factors to RTA like inequalities can be helpful to reduce the negative influence of road crashes. Hence, this study aimed at examining geographical inequality in mortality from RTAs over the previous decades. Materials and Methods: In this cross-sectional study, all people who died from RTAs from March 2006 to February 2015 were selected. The data were taken from Legal Medicine Organization in Iran. The Theil index was used to estimate geographical inequality in mortality from RTA. Data were then analyzed using the Stata software. Results: During the 10-year period of this study, 210,582 people in Iran died due to RTA. The mortality rate that caused by RTAs has decreased during the study. We found a larger reduction in a mortality rate in suburban RTAs. In spite of the reduction in RTAs death, geographical inequality increased during the 10-year study. Conclusions: The findings of this study indicate that there is a geographical inequality in mortality from RTAs in Iran. This implies that effective interventions in reducing the RTAs should be distributed equally among regions of the country. Further research can be performed to investigate the causes of this inequality.

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Background: Postmortem examination is indispensable to ascertain the cause of an unnatural death and as such is mandatory by the law. From ages, traditional autopsy (TA) has proved its worth in establishing the cause of death in the deceased despite some inherent difficulties and challenges and has enjoyed an insurmountable status. The increasing use of application of the modern-day radiology for postmortem examination has however opened a new arena overcoming some of the difficulties of the TA. There are conflicting reports in the published literature regarding superiority of one modality of the postmortem over the other. Objective: The objective of this study was to compare the findings of postmortem computed tomography (CT) scan and TA in the victims of traumatic deaths and to analyze whether postmortem CT can be used to replace TA. Materials and Methods: All patients with a history of trauma that were declared brought dead on arrival in the emergency department were subjected to full-body CT scan. An experienced radiologist reported the findings of CT scan. Subsequently, a forensic expert subjected the patients to TA. The physician who performed autopsy was blinded to the findings of CT scan and vice versa. An individual who was not part of the radiology or forensic team then entered the findings of CT scan and autopsy in a predesigned Pro forma. An unbiased assessor finally compared the findings of the two modalities and analyzed the results. McNemar's test was used to ascertain the level of significance between the findings reported by these two modalities considering P = 0.05 as statistically significant. The agreement or disagreement on cause of death reported by these two modalities was also assessed. Results: About 95% of the deceased were males. The mean age of the corpses was 35 years (range 16–67 years). CT was found superior in picking up most of the bony injuries, air-containing lesions, hemothorax, and hemoperitoneum. However, autopsy was found more sensitive for soft-tissue and solid visceral injuries. Both modalities were equally helpful in identifying extremity fractures. Statistically significant agreement (>95%) on cause of death by both modalities was not achieved in any patient of trauma. Conclusion: Postmortem CT scan is promising in reporting injuries in traumatic deaths and can significantly complement the conventional autopsy. However, at present, it cannot be considered as a replacement for TA.

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Background: Fear of falling has been reported in various societies for different reasons and affects the quality of life of older adults. The present study was conducted to determine the level of fear of falling and related factors in older adults in the city of Kashan in 2017. Materials and Methods: In this cross-sectional study, 414 older adults living in the city of Kashan, in 2017, were selected by cluster sampling. Data were collected using a demographic questionnaire (including age, gender, number of children, having a caregiver, education, marital status, occupation, smoking, alcohol use, use of anxiolytic medication, history of diseases, ability to carry out daily tasks, history of fall, injury due to fall, osteoporosis, access to medical care, access to social supports, walking aids, living alone, income, housing, insurance, and insomnia), and Falls Efficacy Scale-International (FES-I), and then were analyzed using Chi-square and logistic regression. Results: Fear of falling was low in 63.3% of the older adults, moderate in 22.7%, and intense in 4.3%. Fear of falling showed a significant relationship with age, having a caregiver, education, history of taking anxiolytic and hypnotic medications, history of psychosomatic diseases, ability to perform daily tasks, history of falling, injury caused by falling, use of walking aids, access to social support in case of emergency, and income. Multivariate analysis showed that fear of falling in older adults had a direct relationship with age of over 70 years (odds ratio [OR] = 3.24), history of use of anxiolytic and hypnotic medications (OR = 0.26), and illiteracy (OR = 0.37). Conclusion: The results showed that a high percentage of participants suffered fear of falling, of whom one-third had moderate-to-severe fear. Age, use of anxiolytic medications, and illiteracy were effective in increasing the risk of fear of falling in older adults. Further studies and appropriate measures are required in this regard.

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Background: Petrochemical industry has experienced a variety of accidents and the number of emergency situation in this industry is high. Therefore, prioritizing these situations is important. The aim of this study was to determine the effective criteria for the selection of emergency scenario and prioritize them for corrective actions. Subjects and Methods: Delphi technique was used to determine and prioritize the appropriate criteria for the selection of high-risk emergency scenarios. Then, the weights of selected criteria were obtained using fuzzy hierarchical analysis and finally, using the fuzzy TOPSIS technique, the criteria for emergency scenarios were prioritized for corrective actions. Results: The most important criteria for the selection of dangerous emergencies included the amount of loss, damage, and probability. According to the weight of these criteria, emergency situations were prioritized. The most important emergencies included fire in the chemical storage, hydrogen leakage at the cylinder fitting in the Alfin unit, and extreme gas leakage in one of the power plant turbines. Conclusions: Using this approach, high-priority emergencies can be identified, and it is suggested that planning for controlling these situations and preventing crises should be prioritized by managers.

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Background: Needlestick and sharp injuries have been identified as the most dangerous factor among health-care workers. The Centers for Disease Control and Prevention estimates that 385,000 health-care workers experience needlestick each year. Methods: The aim of this study was to determine the prevalence of needlestick injuries (NSIs) in Iranian health-care workers. In this review and meta-analysis, the local and international databases such as Scopus, Medline, PubMed, ScienceDirect, Web of Science, Google Scholar, Scientific Information Database (SID), and Magiran were searched using keywords including “prevalence” OR “needle” OR “needle stick” OR “Sharp injury” OR “Iranian personnel's” OR “Iranian health care workers” OR “Iranian hospitals” OR “Iran.” The original researches that determined the prevalence of NSIs among Iranian health-care workers and published from January 2005 to June 2019 were included in the current study. The pooled prevalence of NSIs was determined using a random-effects model with a 95% confidence interval. All analyses were performed using STATA version 11 (Stata Corporation, College Station, TX, USA). P < 0.05 was considered as a significant level. Results: The overall prevalence of NSIs among Iranian health-care personnel was about 50.8 (46.3–55.2). Furthermore, this prevalence in educational, noneducational, both noneducational and educational, and military centers was about 51.1 (46.5–57.7), 40.4.1 (34.2–46.6), 61.0 (32.1–89.9), and 41.5 (23.0–60.0), respectively. The prevalence of NSIs among the nurses was 51.1 (45.4–56.8), which was more than other groups. Conclusions: The prevalence of NSIs in Iranian hospitals was high. Since most of the injuries are caused by nurses, more intervention programs should be designed for nurses in these wards.

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The increasing prevalence of drug-resistant Pseudomonas aeruginosa in burned patients is one of the main public health problems worldwide. Although drug-resistant P. aeruginosa in burn units is frequent in some countries and unusual in others, the level of this conditions is not precisely known in Iran. Imipenem is one of the most potent agents against P. aeruginosa. Imipenem resistance is a major obstacle to treatment of P. aeruginosa infections. We aimed to determine the true prevalence of imipenem-resistant P. aeruginosa in Iranian burned patients according to the Preferred Reporting Items for Meta-Analyses statement. Moreover, resistance to several potent anti-P. aerugi nosa drugs were indicated according to the Clinical and Laboratory Standards Institute guidelines for the disc diffusion method. Several databases including Web of Science, Scopus, PubMed, Scientific Information Database, Magiran, Iranmedex, and science direct were searched to get studies addressing drug-resistant P. aeruginosa in Iranian burned patients from March 2006 to May 2015. A total of 34 reports available from different areas of Iran were included in the current study. The meta-analyses showed that 54.9% of P. aeruginosa were resistant to imipenem. The most common resistance was seen against ceftazidime (66.9%), followed by ciprofloxacin (52.9%) and cefepime (52.3%). It is necessary to know the epidemiology of drug-resistant P. aeruginosa because it can promote control strategies for decreasing their prevalence. The high incidence of drug-resistant P. aeruginosa in Iran emphasizes the need for precise drug susceptibility testing, continuous monitoring of drug resistance, especially in burn units, use of sensitive methods for the laboratory diagnosis, and close relation between physician and laboratories.

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Background: Injuries caused by home injuries in children under 5 years of age is one of the main causes of death in this group and also constitutes a significant public health burden. This review aimed at summarizing the literature on the effectiveness of interventions to prevent home injuries in children under 5 years of age. Methods: Magiran, Iran Medex, and SID in Persian Scientific databases and BioMed Central, PubMed, ScienceDirect, Web of Science, and Scopus were systematically searched for articles published up to June 2016. Then, two researchers reviewed the papers independently and finally, 14 studies fulfilled the inclusion criteria. Results: The results showed the effectiveness of intervention measures including training sessions at home, home visit, group discussions, and interviews as the educational tools. The educational approach was used as the intervention in 11 studies; legislative/incentive approach and engineering/technology approaches had not been used in papers; and three studies had used the educational intervention and engineering/technological approaches. Conclusions: Most of the effective inventions included studies that used the combination of effective methods to reduce the risk of injuries. Since the accidents are preventable, the appropriate intervention strategies, especially active intervention or a combination of interventional measures are effective to reduce the risk of home accidents and injuries in children.

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Background and Objectives: Occupational traumas are known as work-related disorders, associating with some sorts of factors such as repetitive tasks, body postures, workstations, and hand tools. These traumas cause various problems for both workers and employers. Due to occupational hygiene considerations, problems such as cumulative trauma disorders, occupational trauma, low back pain (LBP), and work-related musculoskeletal disorders should be controlled. In this regard, ergonomic interventions can have efficient outcomes toward controlling occupational traumas. In this study, the focus was on working at some walnut gardens in the city of Tuyserkan in Iran, to reach an ergonomic analysis base, in which hand tools were assessed. The main objective was to develop a new ergonomic design for workers using hand tools. Subjects and Methods: In this cross-sectional study, 19 workers participated and filled out the Nordic Musculoskeletal Questionnaire (NMQ). Their body postures during harvesting walnuts were evaluated by the Ovako Working Posture Analysis System method. Hand tool analysis was also performed by ergonomic risk assessments. Results: The results showed that 15% of the farmers experienced some sorts of trauma during the harvest while using traditional hand tools. The results also emphasized that 61.5% of the workers' body postures should be modified. In addition, according to the NMQ, the most common problems among workers were wrist disorders, LBP, and knees' and shoulders' disorders. Conclusions: Considering experimental data, a new device was developed in which the weight, adjustability, and form of hand tools were modified under ergonomic considerations. The benefits of the new design were confirmed by SOLIDWORKS software. Since this new device helps farmers to decrease extra force exertion in awkward postures, it is expected to improve farmers' condition while using it.

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Background and Objectives: The aim of the present study is to determine plasma and cerebrospinal levels of YKL-40, in combination with neuron-specific enolase (NSE), interleukin (IL)-6, tumor necrosis factor (TNF)-α, and the clinical scales such as Glasgow Coma Scale, Acute Physiology and Chronic Health Evaluation a III, and MARSHALL classification in traumatic brain injury (TBI). Materials and Methods: This was a prospective study conducted on patient cohort of 27 patients with isolated severe TBI. Cerebrospinal fluid (CSF) and plasma were collected on the 24^th and 96^th h after trauma. CSF samples were obtained also from forensic autopsies of 29 adult healthy cadavers. Results: The CSF level of YKL-40 in TBI patients was higher compared to controls, while no significant change between CSF NSE levels in patients and controls was found. We determined a strong correlation between YKL-40 and NSE levels and TBI clinical assessment scores. The analysis of the influence of independent prognostic factors on the outcome of TBI patients showed that plasma NSE concentrations are the major independent variable which is associated with the survival of TBI patients. Still, changes in IL-6 and TNF-α levels could not be considered as reliable predictors of mortality. Conclusion: We present data for correlation of YKL-40 and NSE levels with clinical scores for assessment of trauma severity and the outcome of TBI patients. Even though further large-scale investigations are required to clarify and evaluate the clinical significance of both biomarkers, our findings suggest that YKL-40 and NSE might be implicated in the pathogenesis of TBI and could indicate the degree of neuroinflammation and brain damage.

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Background and Objectives: Distraction is one of the affective factors in the occurrence of traffic accidents, which, in its turn, is the second leading cause of death and the main cause of years of life lost due to premature death and disability in Iran. The aim of the present study was to investigate the distracting behaviors of male drivers in rear-end crashes. Materials and Methods: This descriptive cross-sectional study was conducted on male drivers who had experienced a rear-end crash in Tabriz in 2018. In total, 395 samples (whose main reason for the crashes was inattention to the forward field of view) were selected through the information and files available at the traffic police, and after contacting the subjects, the required information was entered in the checklist. Nine distraction factors were classified and ranked into three age groups of young, middle-aged, and older drivers. Results: Findings showed that distractions caused by mobile phone use and passengers were ranked first to third in all three age groups and distracting factors such as eating or drinking while driving, alcohol consumption, and sleepiness were in the last ranks. In addition, older drivers were ranked first in not identifying the distraction factors, and in the middle-aged group, the distraction caused by billboards was the leading cause of crashes. Conclusions: Adopting appropriate policies, such as law enforcement and cultural interventions to prevent driver distractions, and to control the in-car conversation, and cell phone use while driving can be considered as effective interventions to prevent rear-end crashes.

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Background and Objectives: Due to the high rate of pedestrian deaths in traffic accidents and given that describing demographic profiles of pedestrian deaths and features of accident locations is an important factor in the prevention, management, and analysis of road traffic accidents, this study aimed at describing the demographic and personal patterns as well as environmental factors affecting the occurrence of road traffic accidents among pedestrians in Iran. Materials and Methods: This cross-sectional study was conducted on all pedestrian deaths caused by traffic accidents referred to the Forensic Medicine Organization in Iran from March 20, 2012, to March 19, 2013. In this study, demographic information as well as the information related to the accidents and other information including trauma location, the final cause of death, date of accident, date of death, time of death, and time of accident were examined. The information received from the Forensic Medicine Organization was first controlled and then analyzed using the Stata 11 software. Results: From a total of 4371 pedestrians died in 2012 due to traffic accidents, 3201 cases (73.2%) were males with a mean age of 48.1 ± 0.46 years, and 1170 cases (23.8%) were females with the mean age of 46.1 ± 0.77 years. In terms of age, education, and marital status, the highest frequencies of pedestrian deaths were, respectively, observed in the age group 65 years old and above (33.4%), the illiterate group (44.5%), and married people (67.9%). The highest and the lowest incidence rates of death were seen in Gilan (11 per 1000 people) and South Khorasan Provinces (2.4 per 100,000), respectively. Conclusions: Pedestrians as the most vulnerable people in traffic accidents comprise a large proportion of deaths and disabilities caused by road traffic accidents. It seems necessary to take some measures including paying special attention to physiological characteristics of the age group above 65 years old, doing close monitoring by the traffic police in October and the rush hours, and providing facilities for pedestrians to cross in busy locations of suburban areas.

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Background: The burden of traffic accidents on pedestrians is very high in Iran. Since the pattern of injury is different in urban and suburban accidents, this study was conducted to identify the risk factors associated with pedestrian mortality in urban and suburban traffic accidents in Tehran and Alborz Provinces. Materials and Methods: The data of all traffic accidents related to pedestrians in Tehran and Alborz Provinces were investigated from two databases of traffic police and forensic medicine. The effects of demographic variables (age and gender) and pedestrian position, time, accident location, and vehicle type on the outcome of pedestrian death were investigated. Multiple logistic regression was used to analyze the data. The significance level was considered <0.05 and statistical analyses were performed using STATA version 12. Results: From a total of 10742 pedestrians, 6804 males (63.3%) and 3938 females (36.7%) were studied in traffic accidents. In urban accidents, the effects of pedestrian age such as 35–64 years and >65 years compared to 15–24 years (odds ratio [OR]: 2.04, confidence interval [CI]: 1.26–3.3), (OR: 4.8, CI: 2.9–7.9), male gender (OR: 2.26, CI: 1.6–3.1), lighting condition at night compared to day (OR: 1.6, CI: 1.2–2.1), two-way not divided road versus one-way road (OR: 1.6, CI: 1.12–2.3), the status of day after holidays compared to normal days (OR: 1.53, CI: 1.09–2.14), type of vehicle such as heavy or semi-heavy and conventional or pickup versus motorcycles or bicycles (OR: 5.4, CI: 3.1–8.9) and (OR: 1.8, CI: 1.2–2.7) and pedestrian position at crossing the road from an unauthorized route compared to crossing the road from the authorized route (OR: 1.94, CI: 1.4–2.6) were significant on the fatality. Whereas in suburban accidents, there was a statistically significant correlation with pedestrian fatality only in two-way divided road compared to one-way (OR: 0.2, CI: 0.05–0.77). Conclusion: The present study showed that risk factors for pedestrian mortality are different in urban and suburban traffic accidents. It is necessary to take appropriate measures in urban and suburban areas to reduce the severity of injuries in pedestrians.

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Background: Trauma surgery has an interdisciplinary nature among the surgical specialties, and trauma surgeons are required to identify its related scientific fields to acquire the needed skills in controlling the injuries. This study was conducted to investigate the science mapping of trauma surgery based on the bibliographic data of MEDLINE. Methodology: Based on the bibliographic data from the MEDLINE database, the visualizing techniques of bibliometric networks and all the scientific products of the trauma surgery realm indexed at MEDLINE from 2008 to 2017 were investigated. Data analysis was performed using co-word analysis and cluster analysis using the VOSviewer. Results: The growth trend of scientific productions in the field of trauma surgery has been on the rise in the past 10 years. The keyword “trauma,” followed by “osteoporosis,” “fracture outcome,” “trauma surgery,” and “mortality” had respectively the highest frequency. The results of cluster analysis identified the most important basic research subjects of trauma surgery published in MEDLINE in the past 10 years and categorized them into five clusters. Trauma surgery field had a close relationship with the field of orthopedics, basic studies, and laboratory research in comparison with its clinical domains. Conclusion: We attempted to identify the vastness of the knowledge subjects of trauma surgery and to conduct educational research, and technological planning so that the managers and stakeholders can trace the path of future scientific activities in the field of trauma surgery. The identification of this important realm and provision of the required information on the core issues for the users can be facilitated by drawing up a science map and visualizing the main traumatic sciences.

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Background: Anterior cruciate ligament (ACL) tear is one of the most common types of knee injuries. Delay in diagnosis and treatment of ACL injuries can lead to further damage of the meniscus and cartilage. In this study, we tried to show the distribution of injuries over time and types. Methods: This retrospective study was performed on 336 patients with the diagnosis of primary ACL tear without other ligament injuries. The data including site and grade of the meniscal tear and cartilage damage, based on the International Cartilage Repair Society Classification, the time between diagnosis and surgical procedure, and the treatment method were collected. In this study, we divided patients into four groups according to injury to surgery time. Groups were 3 months, 3–6 months, 6–12 months, and over 12 months to surgery. Results: The results showed that a rate of cartilage damage had no significant correlation with a time interval between injury and surgery (P = 0.54). Furthermore, no significant correlation was found between the site of cartilage damage and the interval time after injury to surgery. The results indicated that the meniscal tear increases in case of a delay to perform surgery (P = 0.004). However, no significant relation was found between the site and pattern of meniscal injury and time. Moreover, patients with a complete ACL tear had a significantly higher rate of meniscus injury compared to those with a partial ACL tear (0.048). Conclusion: The findings of this study show that there is no significant relationship between the time of surgery and the risk of chondral damage after the ACL tear over time. ACL-ruptured patients should undergo the ACL reconstruction surgery up to 3 months from knee trauma to prevent further meniscal injuries.

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Background: Burn prevention strategies are most effective when they are based on knowledge of etiological patterns of burn injuries and considering the geographical variations and socioeconomic differences in burn epidemiology. In this regard, this study aimed to investigate the etiology and outcome of burns in Hamadan, Iran. Materials and Methods: This registry-based, cross-sectional study was conducted on 798 burn patients admitted to the Besat Hospital from March 2013 to February 2018. The medical records of all the patients were extracted from hospital information system. Results: In males, the most common cause of burn was gas explosion (41.4%), whereas in females, the most common cause was hot liquids (37.1%). In below 5 years and 6–15 years age group, burning with hot liquids was the common cause of burn, whereas in other age groups, gas explosion was the common cause of burn. In the present study, 6.9% of the patients died because of their burns. With increasing age, the odds of death increases, so that patients between 30 and 59 years had 2.2 fold (P = 0.02) and patients ≥60 years had 3.5 fold (P = 0.006) higher odds of death compared to patients aged <30 years. Conclusion: Findings of the present study show that males and people aged 26–40 years and children 0–5 years were at a greater risk of burns. Furthermore, this study shows that self-immolation with a high rate of case fatality should be considered as a mental health challenge, and it is necessary to design preventive strategies to reduce it.

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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.

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Circular saws and angle grinders are two of the most dangerous pieces of electrical equipment on a worksite. Besides the danger that any high-powered, sharp piece of equipment possesses, these pieces use circular saw blades that can splinter into projectile fragments. A 60-year-old male was cutting a steel pipe with a circular saw when a fragment of the 12-inch blade flew off, impaling him in the upper face just to the right of the midline. He was wearing eyeglasses, the bridge of which was driven into his skull on impact of the fragment. He was brought to the trauma center where he underwent imaging of his face and head. This revealed that the blade and his glasses had penetrated 1.2 cm into the right frontal lobe of the brain, resulting in facial fractures and intraparenchymal hemorrhage. He underwent bifrontal craniotomy, removal of the blade and his glasses, evacuation of hematoma, and dural reconstruction. Postoperatively, he was awake with a Glasgow Coma Scale of 15 and no neurologic deficits. The complex nature of craniofacial injuries makes a multidisciplinary approach to these patients essential. Prompt diagnosis and treatment by the appropriate specialists are vital to optimize patient outcomes.

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Background and Objectives: Traffic accidents are the leading causes of fatal or nonfatal work-related injuries in many countries. Analyzing influencing factors on knowledge, attitude, and practice of drivers is a topic of interest for policymakers to decrease traffic accident injury victims. Materials and Methods: In this article, a two-stage data mining approach was presented for determining the mining relationships among knowledge, attitude, and practice of drivers. In the first stage, because of existing multidimensional practice variables, self-organizing map neural network was utilized to automatically arrange drivers into two safe and unsafe driving practice clusters. In the second stage, a decision tree was used to model relationships among knowledge and attitude of drivers and practice clusters. The authors' designed questionnaires were used to collect data in 235 male taxi drivers of Bandar Abbas city in Iran regarding the drivers' knowledge and attitude toward traffic regulations. The driving practices were assessed using a prepared checklist. Results: The most important attribute affecting practice of drivers was the maximum safe speed in the city. Conclusions: The results of this investigation showed that drivers' knowledge toward traffic regulations had a dramatic impact on safe driving practices. Levels of drivers' education can influence practice of drivers.

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Background: Problems of emotional regulation and lack of social skills in veterans' families are very common and like psychological complications have unpleasant consequences for them. Therefore, effective and helpful interventions and therapies are highly important. Objectives: The current study aimed at evaluating the effect of mindfulness-based stress reduction (MBSR) on the improvement of emotional regulation and psychological well-being in veterans' homemakers with secondary posttraumatic stress disorder. Patients and Methods: In the current study, the permuted blocked randomization method was used. Participants were selected from veterans' homemakers referred to the counseling center of veterans in Kashan city (Iran) in 2015. They were randomly assigned into two groups (30 controls and 31 cases). The case group underwent the MBSR treatment. Results: Results showed no significant difference between the two groups at the baseline (P < 0.05). No significant difference was observed in the total score of MBSR on emotional regulation between the groups. However, the difference between pre- and post-test of rejection of emotional response subscale was significant. In addition, the total score in the psychological well-being at pre- and post-test was significant. Conclusions: It seems that MBSR significantly affects the psychological well-being, but it has no effect on the emotional regulation except the subscale of emotional response rejection.

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Background: To improve utilization of resources and reduce overtriage, two-tiered trauma team activation (TTA) system was implemented. The system activates a complete or selective trauma team (CTT, STT). Activation is based on the mechanism of injury (MOI), prehospital vital signs and injuries. Objectives: The objective was to evaluate the feasibility, effectiveness and safety of the implementation of a two-tiered system and whether the triage is done according to the TTA criteria. Methods: A prospective observational study was performed at the emergency department (ED) of a Level I trauma center. Data were collected on TTA criteria, patient demographics, MOI, prehospital vital signs, imaging modalities and blood gas analysis in the ED and inhospital data. Results: In 3 months, 186 patients were presented to the trauma resuscitation room. Thirty-four patients were excluded, 152 patients were included for analysis. Median age was 48 years (range 1–93), 64% were males. In 73%, the CTT was activated, in 27% the STT, the STT was upgraded three times. Seventy-nine patients had to be admitted, the median length of stay was 5 days (range 1–62). Thirty-eight patients needed Intensive Care Unit (ICU) admission; the median ICU stay was 3 days (range 1–33). Three patients died in the resuscitation room, in total, nine patients died. Overtriage was 29% and undertriage 7%. No significant difference was found for mortality, duration of hospital admission or ICU admission across the four groups (correct activation STT, undertriage, overtriage, and correct activation CTT). Conclusions: This TTA system identifies those patients in need of a CTT adequately with an undertriage percentage of 7%, indicative of improved care for the severely injured and a more appropriate use of resources. With this model, the overtriage is set to an acceptable percentage of 29%.

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