Why do people get burned? Qualitative analysis of the causes of burns in a large survey of burn survivors.

BACKGROUND: Understanding the national epidemiology of burns is necessary for effective planning of prevention and treatment services. However, epidemiological studies of burns have often focused on short-term and retrospective investigations of a specific group of burned patients in Iran. Therefore, we conduct a comprehensive study from August 2016 to October 2017, in the Burn Research Center of Iran University of Medical Sciences on approximately 1700 hospitalized burn patients at Motahari Hospital to identify the underlying causes of burns. In this study, an open-ended question was asked about how the burn occurred in the patients. The current study was designed and conducted for the qualitatively analyzing of the responses to this question, using the content analysis method, in order to maximize its use in policymaking and prevention. METHODS: Content analysis of written responses to open-ended questions was done as a part of a large questionnaire survey. This survey was conducted by face-to-face interview at a national referral center for burn injuries. RESULTS: Answers from 1595 patients were coded and the underlying causes of injury were categorized into three themes and 43 subthemes. These underlying causes were lack of knowledge and awareness, inappropriate equipment, and inevitable accidents. The underlying cause of lack of knowledge and awareness had the highest proportion in causing burns in both men and women. The most common subthemes in descending order included lack of skills, dangerous actions, improper location of hot liquids, individual mistakes, and improper use of flammable materials. The top five subthemes with the highest average percentage of burn in patients in descending order were deficiency of residential equipment, self-immolation, accidents, inappropriate location of flammable materials, and unsafe kitchen appliances. CONCLUSION: The focus of prevention programs on educating and increasing awareness of individuals, preferably women, is suggested. Educational programs, tailored to occupational standards and workplace and household equipment, are recommended for men in work environments.

The clinical outcomes of xenografts in the treatment of burn patients: a systematic review and meta-analysis.

BACKGROUND: Although autografts are not feasible in patients with extensive burn wounds, allografts and xenografts can be used for temporary coverage. In this systematic review and meta-analysis, we compared the outcomes of xenografts and the standard treatment of burn wounds. METHODS: International online databases were searched for English articles comparing xenografts with routine treatment in the burn patients. The random-effects model was used to estimate standardized mean differences (SMD) or odds ratios (OR) with a 95% confidence interval (CI). RESULTS: From a total of 7144 records, 14 studies were included in our review after screening by title and abstracts followed by full-texts. No significant difference in hospital stays was found between the mammalian xenografts and control groups (SMD [95% CI] = - 0.18 [- 0.54-0.18]). The mean number of dressing changes was significantly lower in both mammalian xenografts compared to the controls (SMD [95% CI] = - 1.01 [- 1.61-- 0.41]) and fish xenografts compared to controls (SMD [95% CI] = - 6.16 [- 7.65-- 4.66]). In the fish xenografts, re-epithelialization time was significantly lower compared to controls (SMD [95% CI] = - 1.18 [- 2.23-- 0.14]). CONCLUSIONS: Xenografts showed a significantly lower number of dressing changes and fish xenografts showed significant benefit in re-epithelialization compared to routine treatment. The beneficial results of xenografts suggest further research in the use of different types of xenografts in patients with extensive burn.

The Psychometric Properties of Intention to Receive the COVID-19 Vaccine Scale Based on the Health Belief Model.

Acceptance of the SARS-CoV-2) COVID-19( vaccine is a very important factor to keep health workers safe. The study aimed to evaluate the psychometric properties of intention to receive the COVID-19 vaccine using a health belief model among health workers in Iran The study was a tools design study that was conducted in the period from February to March 2020, Iran Questionnaire items were designed using text review. The sampling method was multi-stage. Data were analyzed using descriptive statistics, confirmatory and exploratory factor analysis at a 95% confidence level using SPSS software version 16. The designed questionnaire had an appropriate content validity and internal consistency. Also, the exploratory factor analysis showed that a 5-factor structure was extracted and confirmatory factor analyses revealed that the conceptual five-factor structure of the measure had good fit indices. Reliability was evaluated using internal consistency. Cronbach Alpha coefficient was .82 and the intra-class correlation coefficient (ICC) was .9. It can be concluded that the instrument designed in the preliminary stage of psychometrics properties had good validity and reliability indicators. Also, the constructs of the health belief model well explain the determinants of the intention to receive the COVID-19 vaccine at the individual level.

Neutrophil-to-Lymphocyte Ratio (NLR) as a Poor Predictive Biomarker for Pathological Response to Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer: A Prospective Study.

BACKGROUND: The literature is inconsistent for the role of neutrophil-to-lymphocyte ratio (NLR) obtained before neoadjuvant therapy (pre-NLR) in predicting pathological response to neoadjuvant chemoradiation (neoCRT) in patients with locally advanced rectal cancer (LARC). In the present cohort study, we explored the predictive role of pre-NLR in this setting. METHODS: We prospectively included patients with LARC who were candidates for neoCRT at the Shohada-e-Hafte Tir Hospital (Tehran, Iran) between Mar 2018 and Feb 2020. The pre-NLR was obtained through a peripheral blood smear before CRT. We used the AJCC system for evaluating tumor regression grade (TRG). The TRGs were categorized into: response-group 1 (TRG 0-1 vs. 2-3), response-group 2 (TRG 0 vs. 1-3), and response-group 3 (TRG 0-2 vs. 3). We applied receiver operating characteristic (ROC) analysis to assess the predictive value of pre-NLR. RESULTS: Of the 86 screened patients with rectal cancer, 30   patients who fulfilled the inclusion criteria were included in the study. In total, 63.3% were responsive, and 23.3% had complete pathologic response. Pre-NLR could not predict the pathologic response in response-group 1 (area under the ROC curve [AUC]: 0.45, 95%CI 0.23-0.66) and response-group 2 (AUC: 0.36, 95%CI 0.13-0.59). Nevertheless, it had a poor predictive value in response-group 3 (AUC: 0.55, CI%95 0.33-0.75) with an optimal NLR cutoff value of 2.94. CONCLUSIONS: Pre-NLR could not predict the pathological response to neoCRT in our cohort of patients with LARC.

Relationship between Health Literacy and Proper Antibiotic Use Awareness in Tehran 2019-2020.

Background: Improper use of antibiotics is one of health care problems that can lead to side effects or antibiotic resistance without benefit. This study aimed to evaluate the association between health literacy and knowledge on appropriate use of antibiotics in a population sample from Tehran. Methods: This was a cross-sectional, descriptive-analytic study on adults aged between 18 and 65 years. Health literacy was measured by the Health literacy for Iranian Adults (HELIA: Health Literacy for Iranian Adults) questionnaire, and awareness about proper antibiotic use was evaluated by a checklist designed based on a literature review and expert's opinion in domains of knowledge and attitude. Both an online Google Forms questionnaire and a paper questionnaire completed by outpatients from particular clinics in Tehran's north, west, or center were used to collect the data. SPSS Version 22 was used to analyze the data. Results: Out of 359 participants, 59.6% were women, and 66.8% had a university education level. Internet and health care workers were the main sources of health information. The mean score of health literacy was 71.4 out of 100, and 67.4% of the respondents had excellent or sufficient health literacy. The mean antibiotic awareness score was 10.5 out of 13, and the score in the domain of attitude was higher than knowledge. There was a significant relationship between health literacy and awareness about proper antibiotic use (P < 0.001). Health literacy was significantly higher in women (P = 0.001), people with higher education levels (P = 0.001), and financial sufficiency (P = 0.0038). Also, there was a significant relationship between awareness about proper antibiotic usage and age (P = 0.007) and financial sufficiency (P < 0.001) of the respondents. The online questionnaire users were not different in terms of their health literacy, but they were more educated and aware of antibiotics. Conclusion: The level of health literacy and awareness about the proper use of antibiotics in this study was good. level of health literacy was closely related to knowledge about the proper use of antibiotics, thus, it seems that promoting health literacy may increase awareness about proper antibiotic use.

Physical Activity and Well-being Status among Employees of University of Medical Sciences.

Background: Workplace physical activity plays an important role in employees' health. As university employees are a population at risk for a sedentary working pattern, this study aimed to investigate the physical activity status of employees of Iran University of Medical Sciences (IUMS) and its subsequent effects on their well-being. Methods: This cross-sectional study included 472 employees from different units of IUMS in Tehran. The participants were selected by a multistage sampling method. Interviews were conducted by using an international physical activity questionnaire, a questionnaire for stages of behavioral change, the World Health Organization Well-being Questionnaire, and a demographic checklist from July to October 2019. Analysis of variance, t test, and logistic regression analysis were used. Data were analyzed using IBM SPSS (Version 21.0). Results: Total physical activity in the study population was 6216.58 ± 5886.09 MET-minutes/week. The mean score of the well-being index was 54.72 ± 22.4; there was an association between sex and location of work with physical activity in domains (p<0.05). The highest prevalence rates for change of stage of physical activity were found in the maintenance stage for men and the contemplation stage for women. There was a significant difference between men and women's well-being index-men reported being more active and energetic than women (p<0.001). Results also revealed that having vigorous physical activity compared with a moderate level could increase the well-being index. Conclusion: Physical activity behavior at the workplace was associated with well-being level. It could, therefore, be postulated that enhancing physical activity may be beneficial to improving well-being in an academic environment.

Epidemiology and etiology of pediatric burns in Iran.

Pediatric burns have long-term physical, psychological, economic, and social consequences for the patient and family. This study was designed to investigate the epidemiology, causes, and mechanism of pediatric burns in Iran, considering the impact the cultural and environmental differences of countries have on burn incidence. This study is a survey study that was performed from 2016 to 2017 on patients referred to Shahid Motahari hospital. Patients in the study included hospitalized children aged 0-18 years who themselves or their parents were able to answer questions. Questions were answered in the categories of the demographic characteristics of the child and parents, epidemiological characteristics of the burn, information on socio-economic and education status, and the underlying causes of the accident. Most burns occurred in the age group less than two years of age and in boys. The most common cause of burns was hot liquids. Collision with containers containing hot liquids inside the kitchen, collision with containers containing hot liquids outside the kitchen space, and overturning containers containing hot liquids were the most common mechanisms of burns. Flame burns were the most common cause of burns in school-age children. Half of the parents had an elementary level or lower education. Economic, social, and cultural conditions of families, parents' education, and access to preventive education are related to the extent and mechanism of burns. Paying attention to epidemiology and recognizing the main causes of child burns plays an important role in designing and planning preventive measures.

Workplace interventions for increasing physical activity in employees: A systematic review.

BACKGROUND: There is scattered evidence of the impact of workplace interventions in improving employees' physical activity. This systematic review was performed to evaluate the strategies of workplace interventions and their effectiveness, as reported in primary studies. METHOD: Primary experimental trials, both randomized controlled trials (RCTs) and non-RCTs, which examined interventions to increase healthy adult employees' physical activity were included in this review. Studies in English or Persian published between 2009 and 2019 with access to full text of resources were considered. Google Scholar, PubMed, Web of Science, Scopus and Cochrane Library, ProQuest (Thesis) and World Health Organization Clinical Trial Registration Databases and Persian databases such as SID, Magiran, IranMedex, Irandoc were searched. All the stages of review were conducted based on PRISMA. RoB and ROBINS-I were used to assess the risk of bias of the primary studies. RESULTS: Thirty-nine studies, with a total of 18 494 participants, met the inclusion criteria. Of these, 22 were RCTs, 17 were non-RCTs. Effective interventions were reported in 15 RCTs and 14 non-RCTs. Four main strategies of interventions were identified, consisting of motivation and support; monitoring and feedback; information and education; and activity. Thirteen different behavior change techniques (BCT) were identified with self-determination theory (SDT) being the most frequent behavior change theory used. CONCLUSION: It seems that a multi-strategy intervention that one of the strategies of which is physical activity in the workplace (Activity), the use of behavioral change theories, especially SDT, may be indicative of a more effective intervention. It is recommended that BCTs be considered when designing physical activity interventions.

Vaccine hesitancy from the parent perspectives: protocol for a qualitative study in Iran.

INTRODUCTION: WHO declared vaccine hesitancy as a global public health threat in 2019. Since even a slight reduction in vaccine coverage rates can lead to a decrease in herd immunity, it is imperative to explore the underlying factors affecting vaccine hesitancy. This qualitative study protocol aims to explore determinant factors that influence vaccine hesitancy in Iran from the parent's perspective. METHODS AND ANALYSIS: Descriptive-Interpretive Qualitative research will be conducted to gain an insight into vaccine hesitancy in the west of Tehran province in Iran. Participants in the study will be recruited from vaccine-hesitant parents of children under 5 years' old who will be recognised as being hesitant to extract from the national health information system. The semistructured interviews and in-depth questions will be performed both face-to-face in an open space such as a park near their homes and via video call because of the COVID-19 pandemic and social distancing. Interviews will be conducted by a trained qualitative person. Transcribed data will be analysed through thematic analysis. ETHICS AND DISSEMINATION: Ethics approval was obtained from the research ethics committee at the Iran University of Medical Sciences (Approval ID #IR.IUMS.REC.1399.273). The results of the study are expected to be presented by the end of 2022 year. A variety of dissemination methods will be employed to communicate research findings, including presentations at conferences and peer-reviewed publications.

Factors affecting the physical activity of healthcare workers of Iran University of Medical Sciences: a qualitative study.

BACKGROUND: Low physical activity in adulthood is a major public health challenge. The majority of adults spend many hours each week at work, and workplace thus becomes a suitable location in which to promote health and implement physical activity programs. This qualitative study was conducted to identify the barriers and facilitators of worksite physical activity from the perspective of the employees of Iran University of Medical Sciences. METHODS: In this qualitative thematic analysis, five focus group discussions were held with the participation of 68 staff members of Iran University of Medical Sciences who had been selected by purposive sampling with maximum diversity. RESULTS: The analysis of the data led to the identification of three general themes, including challenges and barriers, strategies, and incentives (facilitators). The four main categories of challenges and barriers included policy-making and legislation, organizational factors, structural factors, and personal factors. Most barriers identified by the participants were placed in the personal factors and organizational factors categories. The strategies for increasing physical activity were identified in the following three categories: Policy-making and legislation, organizational factors, and environmental factors. The majority of the strategies proposed were placed in the organizational factors and policy-making and legislation categories. CONCLUSIONS: Increasing physical activity in the workplace as a strategy for the general promotion of physical activity in people requires interventions in different areas, especially with regard to organizational factors and policy-making and legislation.

Determinants of COVID-19 vaccine acceptance in healthcare workers in Iran: National Survey.

BACKGROUND AND AIM: It seems that acceptance of COVID-19 vaccination is the most effective way to tackle the COVID-19 pandemic now. Health care workers (HCWs) are one of the most important groups who are at risk for COVID-19 infection. This study aimed to assess the COVID-19 vaccine acceptance among HCWs in Iran and its determinants. METHODS: A cross-sectional survey was carried out among 3600 HCWs in Iran. Data were collected through a self-administered questionnaire by a trained team from February to March 2021. Multi-stage cluster sampling method was used for selecting respondents of the study. Multivariate logistic regression analysis was used to determine the key factors of COVID-19 vaccine acceptance among participants. P-value < 0.05 was considered statistically significant. RESULTS: Out of the 3536 respondents, 2191 (62.1%) intended to uptake the COVID-19 vaccine. Only about 10 percent of respondents said they did not trust any vaccine (domestic or foreign). Willing to accept a COVID-19 vaccine was relatively high among males, doctors, and those who had a history of hospitalization due to COVID-19 infection. The multivariate regression analysis showed respondents who were 40-50 years (aOR: 1.56; 95% CI: 1.47-1.66), had a history of COVID-19 infection (aOR: 0.85; 95% CI: 0.83-0.88), and hospitalized due to COVID-19 infection (aOR: 2.18; 95% CI: 1.97-2.39), were significantly associated with vaccine acceptance (p < 0.05). CONCLUSION: Our study showed moderate acceptance of COVID-19 vaccination in the HCWs in the Islamic Republic of Iran. The most important factor in the acceptance of the COVID-19 vaccine by the health staff is having a history of hospitalization. Further training and justification of health personnel is needed to increase the acceptance of COVID 19 vaccine.

Comparison of Students' Attitudes about the Effectiveness of Algorithm-based Education with Lecture-based Education.

Background: Training is a complex process, especially when the students are being prepared for patient's management. Therefore, the development of effective teaching methods is critical for to improvement of learning and communication between the content and concepts. In algorithm-based education, more focus is placed on more involvement of students in the subject, thereby providing a better understanding of the concept. In this study, we compared students' attitudes about the effectiveness of algorithm-based education (education based on the patient's complaints and symptoms) with lecture-based education in the learning ability of the medical students presented in the clinical course of the orthopedic group. Methods: This research is a single-group quasi-experimental study; we assessed the students' attitudes on a five-point Likert scale questionnaire with confirmed validity and reliability. The scores of two teaching methods were assessed after the training course, which was presented using the algorithmic method for selective titles and lectures for the other titles. Data were analyzed on SPSS software using a paired t-test. Results: A total of 220 internship medical students, including 58.7% of girls with a mean age of 22.9 ± 1.19 years, participated in the study. The mean score of the questions was 3.92±0.54 and 2.17±0.58 in the algorithmic and the lecture training, respectively. After comparing the results with a paired t-test, there was a significant difference between students' attitudes toward the two teaching methods (p ˂ 0.001), so the students' attitude was more positive toward the algorithm-based method. Conclusion: For the education of medical students, algorithm-based training is more efficacious compared to traditional methods such as lecture-based training.

Adherence of cardiologist physicians to the American Heart Association guideline in approach to risk factors of cardiovascular diseases: An experience from a teaching hospital.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death globally and has enormous costs for healthcare systems. This disease has a strong association with lifestyle behaviors. Therefore, applying reliable and effective strategies for prevention and treatment of CVD is important. In this study, we aimed to evaluate the adherence of cardiologist physicians to the American Heart Association (AHA) guideline for prevention of CVD. METHODS: Using a cross-sectional study, data were gathered for 208 patients using their medical records in the cardiology ward of a general teaching hospital. A physician systematically reviewed the medical records and completed the checklist in each domain. Adherence to the AHA guideline was evaluated in treating physician's choices and recommendations regarding these eight variables: hypertension (HTN), dietary intake, weight management, diabetes management, physical activity, blood lipid management, smoking, and aspirin prescription. RESULTS: Medical records of 208 patients (109 men and 99 women) with the mean age of 62 ± 14 years were reviewed. The frequency of CVDs was 5.3% for coronary heart failure (HF) and 67.8% for the acute coronary syndrome (ACS). Cardiovascular risk factors of patients were HTN (53.8%), diabetes (34.6%), hyperlipidemia (17.3%), smoking (17.8%), and obesity (31.7%). We found a proportion of 59%, 15%, and 26% for high, moderate, and low adherence to AHA guideline, respectively. CONCLUSION: Our study showed almost 60% high adherence to the AHA guideline by physicians in a teaching hospital. The most and the least adherence to the AHA guideline were for obesity and diabetes recommendations, respectively. More studies are needed to evaluate preventive guideline adherence in Iran. Establishing national preventive and therapeutic guidelines may increase the physicians' adherence to them.

Reflection on Mobile Applications for Blood Pressure Management: A Systematic Review on Potential Effects and Initiatives.

INTRODUCTION: Ischemic heart disease and stroke have been considered as the first global leading cause of death in last decades [1]. Blood pressure (BP) management is one of the easiest ways suggested for preventing and controlling cardiovascular diseases before the patient develops complications and death-following outcomes. Appearance of technology advancements in the health system has motivated researchers and health providers to study its different aspects and applications in order to improve disease prevention and management. Following these efforts, mobile health (mHealth) technologies were presented to provide people with fast and easier-to-use services. Although there are some unsolved challenges, these technologies have become popular among many people. As an important part of mHealth, mobile applications (apps) have been the focused subject of many studies in the last decade. The objective of this systematic review is to assess the potential effects of mobile apps designed for BP management by scrutinizing the related studies. MATERIALS AND METHODS: Search methods: We searched the following electronic databases in December 2016: Medline (PubMed), National Center for Biotechnology Information (NCBI), Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center(ERIC), Web of Science, ProQuest, and Google Scholar. No language restriction and start point limitation were imposed. SELECTION CRITERIA: We included studies that evaluated and assessed mobile apps for BP management and related clinical trials that considered mobile app as the only difference between intervention and control groups. DATA COLLECTION AND ANALYSIS: Two review authors applied the eligibility criteria, extracted data and assessed the quality of included studies. RESULTS: Literature search resulted in 13 included studies and 27 reviews. 12 records of 13 included studies identified as interventional studies. The review showed that the mobile apps may improve individual's BP condition and medication adherence. CONCLUSION: Most of the studies had emphasized positive effects of mobile apps in BP management. However, there is a necessity for performing further investigations due to the identified issues in this study such as low number of participants and limited intervention period in randomized controlled trials, and interventions limited to only hypertensive or high-risked individual.

Delivering clinical preventive services in the Islamic Republic of Iran: A model for screening and behavior consultation practices.

Background: Screening and behavior consultation are considered to be limited, dispersed and expensive services across the country. To deliver efficient and equitable services current disordered practices need to be consolidated. Methods: An analysis of current situation, learned lessons and future scopes of country's preventive care delivery, along with a review of international experience and generous participation of various stakeholders, led to proposing a model for screening and behavior consultation practices in IR. Iran. Results: Upon the results of the previous steps, the desired model was based on the network system and family physician. Comprehensive health centers and other centers affiliated to the network are the most appropriate service positions. However, private and academic preventive centers are playing their rules. Conclusion: The proposed model matches the overall pattern of service delivery in the health system (network system with the private sector and the educational sector).