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: 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: 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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Ear syringing is a common procedure done for cleaning wax from the ear canal. Rupture of the pseudoaneurysm at the petrous part of the internal carotid artery (ICA) due to ear syringing is an extremely rare incidence in clinical practice. Sudden and profuse bleeding from the ear is the clinical presentation in case of ruptured pseudoaneurysm of ICA at the petrous part. Presence of the cholesteatoma at the middle ear cleft may be an etiology causing rupture of the pseudoaneurysm at the petrous part of the ICA, but the forceful ear syringing is an uncommon cause for the rupture of pseudoaneurysm. Radiological imaging is an important tool for the diagnosis. Endovascular technique is often used for the treatment of pseudoaneurysm of the ICA. Here, we are reporting an uncommon complication of forceful ear syringing making rupture of the pseudoaneurysm of petrous ICA leading to fatal spontaneous and profuse bleeding from the ear.

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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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Simultaneous dislocation of the thumb carpometacarpal and metacarpophalangeal joints is an uncommon injury. Stability is the most important factor in the decision of treatment in these rare injuries. The treatment methods range from closed reduction and maintaining reduction with cast or percutaneous k-wires to complex reconstruction surgeries. In this paper, a case of 28-year-old female with complete dislocation of the left thumb metacarpal has been reported. She was treated with closed reduction and cast immobilization with excellent result. Treatment decision should be based on postreduction stability in complete dislocation of thumb metacarpal; cast immobilization is a management option in case of stable reduction.

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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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Objectives: This study aimed at examining the hidden patterns of motorcycle crashes and riders' injury severity at the national level in Iran. Methods: Hierarchical clustering (HC) and latent class clustering (LCC) techniques were used in combination to analyze riders' injury pattern in 6638 motorcycle crashes occurred in Iran during 2009–2012. First, the HC was performed to classify the provinces into homogeneous groups, based on the percentage of different crash factors in each province and a new variable called “province group” was added to the crash database as the output of the HC analysis. Next, the LCC was conducted to cluster the crash data and to investigate the riders' injury pattern across the country. Results: Among the six crash clusters identified by the LCC, Clusters 1 and 5, in which, respectively, 91% and 84%, of the riders were under 30 as well as Cluster 2, in which 65% of the riders were above 30 years had the highest percentages of injured motorcyclists (86%, 84%, and 88%, respectively). Cluster 5 had also the lowest percentage of helmet usage (about 5%) and licensed riders (5%). Moreover, Cluster 6 had the highest fatality rate among the six clusters. In this cluster, 73% of the crashes were occurred in nonresidential/agricultural land uses, and 94% were occurred in rural areas. Conclusions: Since a significant share of crashes in Cluster 5 was occurred in province Groups C and E; this might be regarded as an indication of weak law enforcement over helmet usage and licensure in these provinces. In addition, as the pattern of helmet usage was different among province clusters, future studies might be conducted regarding motorcyclists' helmet-wearing intentions among several provinces. Moreover, crashes occurred in rural roads, particularly in the vicinity of nonresidential or agricultural land uses were more severe and need special future attention.

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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 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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Background: In many developed and developing countries, a significant proportion of deaths from road traffic accidents occur in the passages within cities. Considering the importance of this issue, this study was conducted to determine the environmental factors affecting the frequency of deaths in 22 areas of Tehran. Materials and Methods: In this study, the statistical population consisted of traumatic traffic incidents during the period of 2014–2016, all of which were studied. The data necessary for conducting the study were extracted from the traffic police databases, Tehran Municipality, and the Statistics Center of Iran. In order to analyze the role of regional and environmental factors in the frequency of traffic accidents related to pedestrians in geographic units (22 districts of Tehran), the Poisson regression and geographically weighted regression models were used. The likelihood ratio test was used to compare the models. The goodness-of-fit of models was evaluated using R², Bayesian information criterion, and Akaike's information criterion statistics. Results: In this study, 519 incidents were studied, 175 of which (33.7%) were related to motorcyclists, 174 (33.5%) related to automobile drivers, and 170 (32.8%) pedestrians. The frequency distribution of the incidents studied varied in Tehran's 22 districts. The incidence of accidents in the central regions of Tehran was lower, while marginal areas located in the north, south, east, and west of Tehran had the highest frequency of fatal accidents. The both final Bayesian Poisson and GWR models showed that the relationship between the length of highways and educational land used with dependent variable was statistically significant. Conclusion: Various demographic and environmental variables play a role in determining the distribution pattern of these types of events. Through regional planning, proper traffic management, controlling environmental risk factors, and training people the pedestrian safety in Tehran can be improved.

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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: Burns and heat-related injuries often lead to mortality and great financial and social costs. This study aimed at investigating the social determinants of burn-related mortalities in a burn specialized hospital in Isfahan, Iran. Materials and Methods: This cross-sectional data secondary analysis study was conducted through the data related to burn patients hospitalized to burn specialized Imam Musa Kazim hospital, Isfahan, Iran, in a 4-year period. The data were extracted using Hospital's Information System, and analyzed descriptively and inferentially. Results: Among 3290 burn patients, 740 (22.49%) had passed away. The highest mortality percentage was observed in women (31.1%), aged higher than 60 years old (35.8%), in patients with low-financial status (27.4%), patients come from cities other than Isfahan (25.4%), and in Total Burn Surface Area (TBSA) of higher than 71% (86.6%). The results of logistic regression test showed that burn-related mortality is 50% lower in men compared to women (odds ratio [OR] = 0.50), 16% lower in 41-60 years of age group compared to over 60 years of age group (OR = 0.16), 41% higher in people with low financial status compared to those with high financial status (OR = 1.41) and 4% lower in people with 31–70 TBSA compared to those with TBCA higher than 71% (OR = 0.04). Conclusion: Burn-related mortality could be associated with treatment and health care as well as social factors. Therefore, parallel to hospital care and physical conditions of the burn patients, social factors including gender, age, income level, and place residence need to be addressed in burn policies to reduce burn-related mortalities.

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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: 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: 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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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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