Evaluation of cost-effectiveness of single-credit traffic safety course based on Kirkpatrick model: a case study of Iran.

BACKGROUND: Training plays a role in reducing traffic accidents, and evaluating the effectiveness of training programs in managers' decision-making for training continuation is important. Thus, the present study aimed to evaluate the cost-effectiveness of a single-credit traffic safety course based on the four levels of the Kirkpatrick model in all Iranian universities. METHODS: This interventional study aimed to evaluate the cost-effectiveness of a single-credit traffic safety course based on the Kirkpatrick model from 2016 to 2020 in Iran. The data were collected in three stages: (1) calculating the costs of offering traffic safety courses, (2) determining the effectiveness of providing such courses based on the levels of the Kirkpatrick model, and (3) evaluating the cost-effectiveness of administering traffic safety courses. Data were collected through researcher-made and standardized questionnaires. The research population included traffic safety course instructors and university students who could take this course. Finally, the data were analyzed with SPSS v. 23 and also calculations related to ICER, which shows the cost effectiveness of providing single credit course. RESULTS: Scores of the students' reaction level to the traffic safety course was 41.8% before the course; this score was estimated at 67% after the course. At the level of learning, students' knowledge was 43.6% before the training course, which reached 73% after the course. At the level of behavior, the state of students' desirable traffic behaviors was 54% before the course, which reached 66.1% after the course. The educational effectiveness of the course presentation at the level of results was 58.2% before and 74.8% after the course. While assuming that the weights of all model levels were constant, the cost of a 1% increase in the overall educational effectiveness by using the Kirkpatrick model, compared to not providing the course (not administering the intervention) was 486.46 USD. CONCLUSION: The results showcased the effectiveness of the traffic safety course in all four levels of The Kirkpatrick model. Therefore, policy-makers and officials in charge of delivering this program should strengthen it and resolve its deficiencies to realize all its educational goals at the highest level.

A Community-Based Safety Reporting System; Development, Implementation, and Evaluation: An Experience of Safe Communities in Iran.

Background: Online reporting systems can establish and maintain the community-authority connection for safety promotion initiatives and their sustainability. The aim of this study was to report the development, implementation, and evaluation of an online community safety reporting system in safe communities in Iran. Methods: In the first place, the life cycle approach and software systems development were used for design and implementation, which included 7 steps. In the following, an online Community Safety Reporting System (CSRS) was developed with two main interfaces, including a web-based and phone application. The software was developed using suitable programming languages for the web and as a mobile application for Android and iOS systems. Results: During the six months of implementation, we received 80 reports in different safety areas, which were managed by the administrators and provided feedback for reporters. System user-friendliness and easy to use were the main strengths declared by users. The CSRS program is implemented at two levels of usage: public users to report safety issues and city admin functional evaluation of the system through a short interview with users. Moreover, city authorities believed that the system facilitates community participation in decision-making processes. The address of the web page is www.payamiran.ir. Conclusion: CSRS provides a way for community voices to be heard and facilitates mutual interaction between the community and authorities. CSRS could be used as a community participation tool to ensure safety promotion initiatives sustainability.

The Factor Structure and Generalizability of the Iranian Socioeconomic Status (SES) Questionnaire Administered in a Nationally Divergent Population.

Background: Measuring socioeconomic status (SES) as an independent variable is challenging, especially in epidemiological and social studies. This issue is more critical in large-scale studies on the national level. The present study aimed to extensively evaluate the validity and reliability of the Iranian SES questionnaire. Methods: This psychometric, cross-sectional study was conducted on 3000 households, selected via random cluster sampling from various areas in East Azerbaijan province and Tehran, Iran. Moreover, 250 students from Tabriz University of Medical Sciences were selected as interviewers to collect data from 40 districts in Iran. The construct validity and internal consistency of the SES questionnaire were assessed using exploratory and confirmatory factor analyses and the Cronbach's alpha. Data analysis was performed in SPSS and AMOS. Results: The complete Iranian version of the SES questionnaire consists of 5 factors. The Cronbach's alpha was calculated to be 0.79, 0.94, 0.66, 0.69, and 0.48 for the occupation, self-evaluation of economic capacity, house and furniture, wealth, and health expenditure, respectively. In addition, the confirmatory factor analysis results indicated the data's compatibility with the 5-factor model (comparative fit index = 0.96; goodness of fit index = 0.95; incremental fit index = 0.96; root mean square error of approximation = 0.05). Conclusion: According to the results, the confirmed validity and reliability of the tool indicated that the Iranian version of the SES questionnaire could be utilized with the same structure on an extensive level and could be applicable for measuring the SES in a broader range of populations.

PERSIAN Traffic Safety and Health Cohort: a study protocol on postcrash mental and physical health consequences.

BACKGROUND: Cohort studies play essential roles in assessing causality, appropriate interventions. The study, Post-crash Prospective Epidemiological Research Studies in IrAN Traffic Safety and Health Cohort, aims to investigate the common health consequences of road traffic injuries (RTIs) postcrash through multiple follow-ups. METHODS: This protocol study was designed to analyse human, vehicle and environmental factors as exposures relating to postcrash outcomes (injury, disability, death, property damage, quality of life, etc). Population sources include registered injured people and followed up healthy people in precrash cohort experienced RTIs. It includes four first-year follow-ups, 1 month (phone-based), 3 months (in-person, video/phone call), 6 and 12 months (phone-based) after crash. Then, 24-month and 36-month follow-ups will be conducted triennially. Various questionnaires such as Post-traumatic Stress Disorder Questionnaire, Patient Health Questionnaire, WHO Disability Assessment Schedules, Cost-related Information, etc are completed. Counselling with a psychiatrist and a medical visit by a practitioner are provided accompanied by extra tools (simulator-based driving assessment, and psychophysiological tests). Through preliminary recruitment plan, 5807, 2905, 2247 and 1051 subjects have been enrolled, respectively at the baseline, first, second and third follow-ups by now. At baseline, cars and motorcycles accounted for over 30% and 25% of RTIs. At first follow-up, 27% of participants were pedestrians engaged mostly in car crashes. Around a fourth of injuries were single injuries. Car occupants were injured in 40% of collisions. DISCUSSION: The study provides an opportunity to investigate physical-psychosocial outcomes of RTIs, predictors and patterns at follow-up phases postinjury through longitudinal assessments, to provide advocates for evidence-based safety national policy-making.

Forty years after Alma-Ata: how people trust primary health care?

BACKGROUND: Primary Health Care (PHC) was introduced as the first level of health services delivery after Alma-Ata declaration. However, after forty years, it needs to be more trustful to achieve its predefined objectives. Public trust in PHC is one of the neglected issues in the context. The aim of this study is to evaluate public trust in PHC in Iran. METHODS: The present investigation is a household survey conducted in East Azerbaijan Province, Iran. Two-stage cluster sampling method with Probability Proportional to Size (PPS) approach was used. Totally, 1178 households were enrolled in the study. PHC trust questionnaire and Ultra-short version of Socio-Economic Status assessment questionnaire (SES-Iran) was used for data collection. Data were analyzed using STATA software (version 15) through descriptive statistics and linear regression. RESULTS: The mean ± SD age of the participants was 41.2 ± 15.1 and most (53.7%) were female. Mean score of PHC trust was 56.9 ± 24.7 (out of 100). It was significantly different between residents of Tabriz (the capital of province) and other cities in the province (p < 0.001). Linear regression showed that younger age, gender, insurance type, being married, and households higher socio-economic status had a significant positive effect on PHC trust level with R2 = 0.14383. CONCLUSIONS: Public trust in PHC system in Iran needs to be improved. Individual variables had a small but key role in trust level. PHC trust cannot be only affected by individual's variables and experiences but also by health system and health providers' characteristics and public context in which PHC system exists. PHC trust level could be used as a public indicator in health systems especially in Low and Middle Income Countries (LMIC) to contribute in system strengthening policies at the national and international levels.

Developing a national road traffic safety education program in Iran.

BACKGROUND: Education is a pivot included Decade of Action for Road Safety initiative, which has reduced deaths caused by accidents in developed countries. Given the circumstances of each country, a proper education program is necessary. Thus, the aim of this study was to develop the National Road Traffic Safety Education Program (NRTSEP) and reduce Road Traffic Injuries (RTIs). METHODS: This study used a qualitative approach and was conducted in Iran. Data were obtained through sixteen semi-structured in-depth interviews from indifferent road safety and health promotion field experts as well as eleven focus group discussion (FGD) sessions conducted with participants from general population. Inductive qualitative content analysis was used to converge and compare themes through data. The initial pattern of the program was developed and subsequently, the designed program was validated and finalized by two-step Delphi method for the consensus of expert opinion. RESULTS: The following six main themes emerged from the analysis: target groups, program content, educational methods, instructors, resources and evaluation. The target group consisted of children, youth, parents, teachers, elderly, motorcyclists, cyclists, pedestrians, drivers, driver license applicants, instructors and administrators of driving schools, and specific groups such as the disabled, managers at different levels, and policymakers. The content of the program consisted of 27 items, including traffic laws and regulations, first aid, and medical emergencies. Educational practices and authorities were determined based on the target group and educational content. The most important resources of the program were human force and other cases, which can be managed in case of a lead agency. In the evaluation dimension, the cases such as mortality rate, hospitalization, behavioral changes, and other cases can be considered. CONCLUSIONS: The designed program should be implemented for all target groups for road safety promotion. The proper content was provided with proper educational methods and instructors for the target groups. A lead agency is needed to provide the resources and funding to run the program.

Road safety data collection systems in Iran: A comparison based on relevant organizations.

PURPOSE: Various organizations and institutions are involved in road traffic injury (RTI) and crash registration such as police, forensic medicine organization, hospitals and emergency medical services. But there is a substantial uncertainty in interpreting the data, duplicated data collection and missing data in relation to RTI in most systems. This study aims to identify data sources for RTI surveillance in Iran and to explore traffic safety data source domains, data elements and detailed information by each data source. METHODS: This is a qualitative study which was conducted in 2017 in Iran. Data were collected employing semi-structured interviews with informants in road safety organizations in relation to traffic safety including Police, Ministry of Health and Medical Education as well as Forensic Medicine Organization and other authorities-in-charge. For completing the preliminary extraction information, the minimum data set was used and compared in each system. RESULTS: Eight different organizations relevant to road traffic safety were identified. The main domain of data provided by each one consists of Emergency Medical System form, Police KAM114 form, Ministry of Transport and Road Administration, Red Crescent Organization/Disaster Management Information System, Ministry of Health and Medical Education, Forensic Medicine Organization, Insurance Company and Ministry of Justice. Each system has its own database, based upon its scope and mainly at crash and post-crash status and little on pre-crash circumstance. CONCLUSION: All current registry systems are not surveillance systems for RTI prevention. Huge data have been collected in various registry systems in Iran, but most of the collected variables are duplicated in each system. On the other hand, some variables like alcohol and substance abuse, child seat belt, helmet use in relation to RTI prevention are missed in all systems. Accordingly, it is a critical need to integrate and establish a comprehensive surveillance system, with focus on the goal of each system and collection of minimum data in each organization, which currently is underway.

The research performance of Iranian medical academics: a National Analyses.

BACKGROUND: Scientometric studies are one of the most important and useful tools to assess the research performance and knowledge impact of researchers. The aim of this study was to map out the scientific performance of the Iranian medical academics with respect to a detailed range of scientometric indicators. METHODS: Using scientometric approach, individual and scientific performance data of medical academic staff were extracted from the Iranian Scientometric Information Database (ISID). Total number of publications, total number of citations, citation per paper, h-index, international collaboration, self-citation, SJR decile, i10-Index, Quartile distribution were the studied scientometric variables. Out of the registered 19,023 academic staff, 746 were included in the study through simple random sampling method using random sample extraction function in STATA. Data were analyzed using STATA 14 statistical software package. RESULTS: Most of the included academicians were men (60%). A total of 13,682 articles were published by them until 2018, being cited 114,928 times with a mean of 5.77 citation per paper. H-index median was three and about 90% of the staff had an H-index below 10. Number of published papers, cite per paper and H-index metrics were significantly different with respect to gender, academic position/degree, and general field of study (p < 0.05). About 2.5% of published articles were contributed through international collaboration. The scientometric performance of academic staff was highly diverse with respect to the employing institution and its national classification group (type 1, 2, 3). CONCLUSIONS: Nevertheless to the great scientific production of medical academics, individual and institutional characteristics were identified as effective variables in academics research performance and should be considered in their assessment. Academicians affiliated with type 2 and 3 universities (based on national ranking of medical universities) had weaker research performance compared to those affiliated with type 1 universities. However, low rate of international research collaborations was a common challenge in medical universities.

A decadal analysis of road traffic accident-related mortality among women of reproductive age: A cross-sectional study in East Azerbaijan Province, Iran.

Background: Given the extensive impact of road traffic accidents (RTAs) consequences and their potential ramifications on the health of both current and future generations, this study examines the social and demographic factors that influence RTA-related mortality among women of reproductive age. Methods: The study population consisted of cases retrieved from the database of the Legal Medicine Organization, encompassing all women aged 15-49 who succumbed to road accidents between 2011 and 2021. Results: The mean age of women in the reproductive age group from East Azerbaijan province between 2011 and 2021 was 33.67 years, with a standard deviation of 9.18. RTAs on main roads accounted for the majority of incidents (395 cases, 50.8%), with 93.7% (728 cases) attributed to road traffic. In 54.4% of these cases, the affected organ was the head and neck, and the primary cause of death in 52.1% was head trauma. Across all age groups, injuries to the neck and head were the most common, followed by injuries to the abdomen, chest, back, and sternum. Conclusion: The higher incidence of road accidents in the 25-29 age group highlights the need for targeted interventions to address risky behaviors, inexperience, and peer influences in this demographic. Our observation of passengers experiencing the highest mortality rate emphasizes the vulnerability of road users, particularly pedestrians, in traffic accidents. Pedestrian violations in the 17-30 age group further emphasize the importance of education and awareness campaigns aimed at reducing risky behavior.

Quality of Life and Socioeconomic Status in Northwest of Iran: First Wave of the Persian Traffic Cohort Study.

This study aimed to evaluate the association between Quality of Life (QOL) and independent factors, emphasizing Socio Economic Status (SES) in northwestern Iran. A population-based cross-sectional study was performed within the Persian Traffic safety and health Cohort in 2020. Participants were chosen using stratified random sampling method. The majority of participants (69%) were aged between 30 and 65. Around half of the participants were males (54.44%). Most of the female respondents were categorized as very low and medium levels of SES Based on multiple linear regression analysis, the QOL among females was lower compared to males (ß: - 0.92, 95% CI - 1.82 to - 0.22). There was a negative association between SES and QOL; individuals with low and very low levels of SES had a lower QOL than those with a medium level of SES (ß: - 4.38, 95% CI - 5.9 to - 2.86) (ß: - 2.65, 95% CI - 4.08 to - 1.22). The current study highlights that higher SES and educational levels are positively associated with higher QOL. Conversely, older age, females, and widowed individuals are linked with lower QOL.

PERSIAN traffic safety and health cohort: a population-based precrash cohort study.

PURPOSE: Despite to high burden of road traffic injuries (RTIs), the RTI epidemiology has received less attention with rare investments on robust population cohorts. The PERSIAN Traffic Safety and Health Cohort (PTSHC) was designed to assess the potential causal relationships between human factors and RTI mortality, injuries, severity of the injury, hospitalised injury, violation of traffic law as well as offer the strongest scientific evidence. PARTICIPANTS: The precrash cohort study is carried out in four cities of Tabriz, Jolfa, Shabestar and Osku in East Azerbaijan province located in northwest Iran. The participants were people who sampled among the general population. The cluster sampling method was used to enrol the households in this study. The PTSHC encompasses a wide and comprehensive range and types of data. These include not only the common cohort data collections such as medical examination measures, previous medical history, bio assays and behavioural assessments but also includes data obtained using advanced novel technologies, for example, electronic travel monitoring, driving simulation and neuro-psycho-physiologic laboratory assessments specifically developed for traffic health field. FINDINGS TO DATE: A total of 7200 participants aged 14 years and above were enrolled at baseline, nearly half of them being men. The mean age of participants was 39.2 (SD=19.9) years. The majority of participants (55.4%) belonged to the age group of 30-56 years. Currently, approximately 1 200 000 person-measurements have been collected. FUTURE PLANS: PSTHC will be used to determine the human-related risk factors by adjusting for the vehicle and land-use-related factors. Therefore, a lot of crashes can be prevented using effective interventions. Although this cohort provides valuable data, it is planned to increase its size to achieve the highest level of evidence with higher generalisability. Also, according to the national agreement this cohort is going to be extended to several geographical regions in second decade.

Exploring the Causal Impact of Age and Nighttime Driving on Road Traffic Injuries among Elderly Drivers: A Bayesian LASSO Approach.

Objective: To determine the causal relationship between aging and nighttime driving and the odds of injury among elderly drivers. Methods: In this cross-sectional study, 5460 car accidents were investigated from 2015 to 2016. The data were extracted from the Iranian Integrated Road Traffic Injury Registry System. Pedestrian accidents, motorcycle crashes, and fatalities were excluded from the study. To account for major confounders, Bayesian-LASSO, and treatment-effect cutting-edge approaches were used. Results: Overall, 801 injuries (14.67%) were evaluated. The results of the univariable analysis indicated that aging and nighttime had adverse effects on the odds of road traffic injuries (RTIs), even after adjusting for the effect of other variables, these effects remained statistically significant. According to a newly developed approach, the overall effects of aging and nighttime were significantly and directly correlated with the odds of being injured for older adults (both p<0.001). Our findings indicated that drivers over 75 years old experienced 23% higher injury odds (OR=1.23, 95% CI:1.11 to 1.39; p<0.001), while driving at night increased the odds by 1.78 times (OR=1.78, 95% CI:1.51 to 1.83; p<0.001). Conclusion: Aging and nighttime driving are significant risk factors for RTIs among elderly drivers. This highlights the importance of implementing targeted interventions to enhance road safety for this vulnerable population. Furthermore, the use of advanced Bayesian-LASSO and treatment-effect statistical methods highlights the importance of utilizing sophisticated methodologies in epidemiological research to effectively capture and adjust for potential confounding factors.

Validity and reliability of short-form travel behavior questionnaire during COVID-19 pandemic (TBQ-Cov19).

Introduction: Avoiding unnecessary travel and reducing the number of essential travels are among the effective strategies for preventing the spread of COVID-19 during the pandemic. Given that it is impossible to avoid essential travel, health protocols should be observed to prevent disease transmission. The extent to which health protocols are observed during the trip should be accurately assessed by a valid questionnaire. Therefore, this study aims to develop and validate a questionnaire to assess compliance with COVID-19 prevention protocols during travel. Methods: In this cross-sectional study, 285 individuals were selected from six provinces using the cluster sampling method in May and June 2021. The Content Validity Ratio (CVR) and Content Validity Index (CVI) were calculated using the comments of 12 external experts. The exploratory factor analysis (EFA), with principal component factor in the extraction method and Varimax rotation, were applied to determine construct validity. Cronbach's alpha was employed to assess internal consistency and the Spearman-Brown correlation coefficient was computed for test-retest reliability. Results: In the content validity phase, the I-CVIs for all items were acceptable, but due to a low CVR value (below 0.56), one question was eliminated. As a result of EFA for construct validity, two factors were extracted that justified 61.8% of the variance. Cronbach's alpha coefficient of the questionnaire, with 10 items, was 0.83. The Spearman-Brown correlation coefficient was 0.911 which confirmed the stability of the questionnaire at an excellent level. Conclusions: This questionnaire is a valid tool with good validity and reliability for assessing compliance with health protocols in travel during the COVID-19 pandemic.

Key Indicators Affecting Hospital Efficiency: A Systematic Review.

Background: Measuring hospital efficiency is a systematic process to optimizing performance and resource allocation. The current review study has investigated the key input, process, and output indicators that are commonly used in measuring the technical efficiency of the hospital to promote the accuracy of the results. Methods: To conduct this systematic review, the electronic resources and databases MEDLINE (via PubMed), Scopus, Ovid, Proquest, Google Scholar, and reference lists of the selected articles were used for searching articles between 2010 and 2019. After in-depth reviews based on the inclusion and exclusion criteria, among 1,537 studies, 144 articles were selected for the final assessment. Critical Appraisal Skills Programme (CASP) Checklist was used for evaluating the quality of the articles. The main findings of studies have been extracted using content analysis. Results: After the final analysis, the Context/Input indicators that were commonly considered by studies in analyzing hospital technical efficiency include different variables related to Hospital Capacity, Structure, Characteristics, Market concentration, and Costs. The Process/Throughput indicators include different variables related to Hospital Activity or services-oriented process Indicators, Hospital Quality-oriented process indicators, and Hospital Educational processes. Finally, the Output/Outcome indicators include different variables related to Hospital Activity-related output variables and Quality-related output/outcomes variables. Conclusion: This study has identified that it is necessary to mix and assess a set of input, process, and output indicators of the hospital with both quantitative and qualitative indicators for measuring the technical efficiency of hospitals comprehensively.

Psychometric Properties of EQ-5D-3L Applied through Phone Follow-Ups: An Experience in PERSIAN Traffic Cohort.

Objective: To assess psychometric properties of the European Quality of Life 5-Dimension 3-Level Version (EQ-5D-3L) commonly used tool for measuring road traffic injury (RTI) patients' quality of life. Methods: The psychometric study assessed the reliability and applicability of EQ-5D-3L through phone surveys, based on a national cohort platform. Data of 150 RTI patients recruited from the cohort study were included as 50 patients per each follow-up phase (one, six, and twelve months after discharge). A 12- day-time span was between test and retest. We measured psychometric properties (internal consistency reliability and stability reliability) and agreement using Kappa coefficients and percentages of agreement and Bland-Altman method. Data were analysed using software STATA statistical package. Results: The majority of patients were men (80%) with mean age (SD) of 41(14.7%), employed (78%) and educated (86%). The Persian version represented high internal consistency reliability at total level (Cronbach's α=0.81) and moderate to good reliability at phase levels (0.62-0.87). The stability reliability was excellent at total (ICC=0.98, 95% CI: 0.97, 0.98) and phase levels (0.97-0.98. The kappa agreement coefficients were valued moderate to perfect (0.6-0.8, p>0.0001). The Bland-altman plot illustrated high agreement between test and retest scores. No floor and ceiling effects were found. Conclusion: The study revealed that EQ-5D-3L was highly reliable and responsive to be applied through phone interviews at three different times post injury and discharge, as no previous study considered its psychometric properties at various phone follow-ups after RTIs.

Setting research priorities to achieve long-term national road safety goals in Iran.

Background: Road traffic crashes (RTCs) and its associated injuries are one of the most important public health problems in the world. In Iran, RTCs rank second in terms of mortality. To address this issue, there is a need for research-based interventions. Prioritizing researches using a variety of approaches and frameworks to determine the most effective interventions is a key nodal point in the RTCs' research policy planning cycle. Thus, this study aims to generate and prioritize research questions in the field of RTCs in Iran. Methods: By adapting the Child Health and Nutrition Research Initiative (CHNRI) method, this study engaged 25 prominent Iranian academic leaders having role in setting Iran's long-term road safety goals, a group of research funders, and policymakers. The experts' proposed research questions were independently scored on a set of criteria: feasibility, impact on health, impact on the economy, capacity building, and equity. Following the prioritization of Research Questions (RQs), they were all classified using the 5 Pillar frameworks. Results: In total, 145 Research Questions were systematically scored by experts against five criteria. Iran's top 20 road traffic safety priorities were established. The RQs related to "road safety management" and "road and infrastructure" achieved a high frequency. Conclusions: The top 20 research questions in the area of RTCs in Iran were determined by experts. The majority of these RQs were related to "road safety management". The results of this study may contribute to the optimal use of resources in achieving long-term goals in the prevention and control of road traffic crashes and its related injuries. Considering these RQs as research investment options will improve the current status of Road Traffic Injuries (RTIs) at a national level and further advance toward compliance with international goals. If these research priorities are addressed, and their findings are implemented, we can anticipate a significant reduction in the number of crashes, injuries, and deaths.

Lifestyle Risk Factor Assessment Through WHO STEP Approach in Tabriz, Iran.

BACKGROUND: The aim of this study was to assess the lifestyle behaviour and risk factors for lifestyle-related diseases in East Azerbaijan province, Iran. METHODS: A household study using a two-stage cluster sampling method was performed. Tabriz city was randomly selected for data collection among five geographic regions in the East-Azerbaijan province. Short WHO-STEP and Ultra-short version of Socio-Economic Status assessment questionnaire were used. Six hundred households were asked to respond to the STEP questionnaire. RESULTS: A total of 1196 people have participated in the study. People with higher socioeconomic status consumed more fruits, vegetables and fish than the people with lower socioeconomic status. People with academic education less likely to be hypertensive compared to people with non-academic education. People with a medium socioeconomic status are less likely to be hypertensive than people with high socioeconomic status. The majority of participants had poor dietary habits. In this study, 17.22%, 7.53% and 4.35% of respondents had hypertension, diabetes and depression, respectively. CONCLUSION: Considering that lifestyle-related risk factors are common among people. Due to the direct link between lifestyle and the occurrence of many chronic diseases, campaigns for and training programs to implement healthy lifestyle habits are recommended.

Motorcyclist risky riding behaviors and its predictors in an Iranian population.

BACKGROUND: Motorcyclist's behavior plays an important role in increasing the mortality rate caused by traffic crash. Identifying the risky behaviors of motorcycle riders is essential to maintain and improve the health of motorcycle riders and other community members. The aim of this study was to determine the riding patterns and risky riding behaviors of motorcycle riders in Bukan as a marginal small-sized Kurdish populated district in North-West of Iran and investigating some predictors of it. METHODS: In this cross-sectional, 340 motorcycle riders of Bukan were studied. By referring to city health center and preparing the city map, the entire city was divided into 14 clusters based on the areas covered by the health centers. Then, 7 clusters were randomly selected out of these 14 clusters. Motorcycle riding behavior questionnaire (MRBQ) was used to study the risky behaviors of motorcycle riders while riding. Both bivariate and multivariate regression analysis methods were used to study the associations. RESULTS: All participants were male. Their mean age was 30.2 (SD=9.1). The most common risky behaviors possessed by at least 23% of motorcycle riders included 1) inappropriate control of motorcycle when turning, 2) taking another person without helmet by motorcycle, 3) riding without helmet, 4) taking more than one person by motorcycle, 5) exceeding the permissible speed outer city, 6) exceeding the permissible speed inside the city and 7) carrying heavy load by motorcycle. Mean normalized MRBQ score was 30.5 (SD=11.2). Based on multivariate analysis, age, lacking a riding license, riding experience and average amount of riding were the independent predictors of risky riding score. CONCLUSIONS: Among the predictive factors that led to high risk behaviors in the studied motorcyclists were low age, marital status, low driving experience, low education, non-use of safety equipment lack of certification. This can be done by increasing drivers' awareness of laws and regulations and promoting the culture of traffic safety to prevent high-risk behaviors in motorcyclists in order to prevent possible injuries.

Health services utilisation and responsiveness profiles in Iran: a provincial household study.

OBJECTIVE: The aim of this study was to describe health services utilisation and responsiveness in East Azerbaijan province, Iran. DESIGN: A cross-sectional household study as part of a larger research on primary healthcare system. SETTING: We carried out the study in East Azerbaijan Province, northwest Iran from July to September 2015. PARTICIPANTS: A total of 1318 households were included. RESULTS: Most of the participating households had social security health insurance. Heart failure or hypertension care, general outpatient care and arthritis care were the most used services. High services cost and inadequate medicine and medical equipment were introduced to be the main barriers to health services utilisation in Tabriz and province representative sample (PRS), respectively. Health system responsiveness mean score (the maximum is 100) was 33.71±16.15 (95% CI 32.45 to 34.97) in Tabriz and 32.02±14.3 (95% CI 30.9 to 33.13) in PRS, which showed significant difference (p≤0.02). CONCLUSIONS: Differences in the utilisation and responsiveness of health services and distribution of health resources were observed between Tabriz and PRS. Evidently, health system responsiveness in both Tabriz and PRS was at low level. The results demonstrate the need for changing resource distribution policies and employing reactive health policies to response the public health.

Evaluating the relationship between adult attention-deficit/hyperactivity disorder and riding behavior of motorcyclists.

BACKGROUND: Motorcycling is one of the main causes of injury, and motorcyclists are vulnerable to road traffic injuries. Attention Deficit Hyperactivity Disorder (ADHD) in adults is presumably one of the determinants of road traffic injuries and motorcyclists' risky behavior. Despite the few studies on the relationship between motorcycle injuries and adult ADHD, their association has not been investigated using standardized instruments. This study aimed to analyze the relationship between motorcyclists' adult ADHD and risky riding behaviors. METHODS: This community-based, cross-sectional study was performed on 340 motorcyclists in Bukan city, west Azerbaijan province, Iran in 2015 and 2016 using a cluster-random sampling in seven areas of the city. According to the city map used by Bukan's Health Centers, the city was divided into 14 clusters. Then, seven clusters (out of 14) were selected randomly. To reach the anticipated sample size, the data were collected from these seven clusters. In this study, the data collection instruments were: standard Motorcycle Rider Behavior Questionnaire (MRBQ), Conners' Adult ADHD Rating Scales (CAARS) questionnaire and a checklist designed by the researchers. The Stata 13 software package was used to analyze the collected data. Pearson correlation coefficient and multiple linear regression were performed to study the linear relationship between ADHD screening and MRBQ scores. RESULTS: All 340 participants were male and the mean age was 30.2 years (SD=9.1). In addition, 22.1% of motorcyclists had a history of motorcycle crash. Bivariate analysis showed a significant association between risky riding behaviors and age, motorcycling records, and mean of riding hours per day (P-value less than 0.05). Multivariate analysis confirmed the correlation between ADHD and risky riding behaviors in all subscales (A, B, D) (p less than 0.05). CONCLUSIONS: Those with a high ADHD screening score are more likely to have risky riding behaviors.