Road safety lead agency challenges of three decades of intervention for road safety in Iran: implications for policy-makers.

BACKGROUND: Road traffic crashes and associated injuries and mortalities are one of the big public health challenges, especially in low/middle-income countries. Road safety lead agency (RSLA) is a vital factor in the sustainable prevention and promotes road safety. In the recent decades, various policy interventions have been conducted for road safety in Iran. This study aimed at exploring the challenges of RSLA from the perspectives of stakeholders at various levels. METHODS: A qualitative study was conducted. In-depth interviews and document reviews were used for data collection. To conduct interviews, different stakeholders at various levels such as policy-makers, senior national authorities, researchers and faculty members were selected. Data collection was conducted between November 2019 and June 2020. Thematic content analysis approach was used for data analysis. RESULTS: The experts' perspectives were analysed and then categorised under five main themes including the role and position of the lead agency, the role and duties of the actors and players, translating policy into practice, intrasectoral and intersectoral cooperation and coordination and evidence production and application and a total of 22 subthemes were identified. The current structure of the RSLA is one of the main challenges emphasised by the research participants. CONCLUSION: To achieve significant improvements in road safety at the national level, a strong management system and leadership body is a critical issue. Organisational reform to establish an effective unique lead agency is proposed to cope with RSLA challenges.

Providing telenursing care for victims: a simulated study for introducing of possibility nursing interventions in disasters.

INTRODUCTION: Uncertainty occurrence of disasters requires special attention and a shortage of health care specialists is a challenge for health care systems; therefore, the use of telenursing care during a disaster is an appropriate way to provide care. This study aimed to investigate telenursing operational possibilities in disasters. METHODS: A cross-sectional study was performed by implementing a functional exercise (Drill) for the possibility of nursing interventions in the response phase to disasters at Kerman University of Medical Sciences in 2021. Two evaluators examined and scored the possibility of providing telenursing care using a researcher-made checklist and we surveyed Inter-rater agreement between two evaluators by Cohen's kappa coefficient. Data were analyzed using descriptive tests and SPSS 20 software. RESULTS: Findings showed that implementation of telenursing care would be helpful in future disasters. The scores received from assessment of the evaluation checklist for this simulated exercise program by the first evaluator was 83.25 and for the second evaluator was 72.00. The results of the study showed that the mean score of the possibility of telenursing in disasters was at a high level 77.50. Thus, the quality of the telenursing care in simulated conditions was satisfactory. CONCLUSION: Today, disaster management is almost impossible without using new technologies. This study found that due to the lack of specialized nursing staff in the deprived areas affected by disasters, the most important way to provide health care for a large group of the population is to develop effective health services so that everyone can use these services equally and fairly.

Factors Influencing the Decision-making of Healthcare Providers Regarding the Transition of Patients from the Intensive Care Unit to the General Ward in Iran: A Qualitative Study.

Background: The process of making decisions to discharge patients from the intensive care unit (ICU) is very complex and risky, and decisions need to be made under time constraints and based on fair allocation of resources. In this situation, decision-making requires team participation, which is often accompanied by tension and conflict between team members and sometimes family members, which in turn affects patient safety and quality of care. Objectives: The aim of this study was to explore the experiences and perceptions of physicians and nurses regarding the decision-making process in transition of patients from the ICU to the general ward. Materials and methods: This qualitative study was conducted based on purposive sampling among six nurses and six physicians in Governmental teaching hospitals. The data collection process was conducted from July 2018 to January 2019 through a semistructured interview. Interviews were transcribed and data analysis was accomplished according to the steps proposed by Graneheim and Lundman (2004). Results: Data analysis revealed six themes that reflected factors influencing decision-making in transition of patients from the ICU to the general ward: contingent decision-making, risky decision-making, lack of coherence in team decision-making, differences in clinical judgment, legal and ethical responsibility, and lack of clear criteria. Conclusion: The process of decision-making regarding patient transfer from the ICU is a complex and stressful one. It is affected by situations, team participation, clinical judgment skill, legal issues, and multifactorial challenges. To improve decision-making processes, we need to develop abilities and knowledge and design proper interventions to achieve a principled and correct decision-making process. How to cite this article: Ghorbanzadeh K, Ebadi A, Hosseini M, Maddah SSB, Khankeh H, Pishkhani MK, et al. Factors Influencing the Decision-making of Healthcare Providers Regarding the Transition of Patients from the Intensive Care Unit to the General Ward in Iran: A Qualitative Study. Indian J Crit Care Med 2022;26(5):568-573.

The Main Features of Resilience in Healthcare Providers: A Scoping Review.

Background: Resilience refers to the capacity for suitable responding to stress in achieving the objectives at the least physical and psychological costs. The present review aims to illustrate the individual and contextual features of resilience improvement in healthcare professions. Methods: A scoping review was conducted according to the PRISMA-ScR guidelines and searching the online databases as PubMed, Embase, Scopus, Web of Science, and Google Scholar from January 2014 to December 2020 using a combination of MESH and EMTREE entry terms and free keywords. The English articles, book chapters, and grey literature were included in the study. The data were recorded to an extraction form designed in Excel. The quality assessment of studies wasn't performed due to scoping review. Thematic analysis was used to synthesize the data. Results: 5434 articles were identified via searching in the databases. 63 articles were reviewed that most of them from the USA (30 articles, 46%) and conducted as a qualitative study (32 articles, 50%). The main aspects of resilience that were extracted from the included studies were personal resilience, resilience in the emergency department, and resilience in healthcare providers. The main feature of resilience among healthcare providers was coping. Conclusion: Studies with more accurate methodology should investigate the situation of the healthcare providers' resilience in difficult healthcare conditions instead of the mere emphasis on providing a fixed concept for all persons without considering the system impacts.

Challenges to manage pandemic of coronavirus disease (COVID-19) in Iran with a special situation: a qualitative multi-method study.

BACKGROUND: With the unprecedented expansion of COVID-19 in the world since December 2019, Iran's health system, like other countries, faced various challenges in managing the disease, which led to numerous experiences and lessons learned. This study was conducted to identify these challenges regarding unique political, economic, and cultural issues, which could help other countries with similar situations. METHODS: The present study was performed using a qualitative multi-method approach with a content analysis method. The data were collected through in-depth and semi-structured interviews and focused group discussions with 60 key persons who were selected purposefully, including policymakers, health care workers, and affected people by the disease, and the review of all available national reports between February 21, 2020, and March 22, 2021. The data collection and analysis were done simultaneously. RESULTS: Identified critical challenges for the management of COVID-19 in the health system were limited evidence and scientific controversies, poor social prevention and social inequalities, burnout and sustained workload among healthcare workers, improper management of resources and equipment, the lack of a guideline for contact tracing, and patient flow management, and mental health problems in the community. CONCLUSIONS: According to our results, measures should be taken to conduct a continuous comprehensive risk assessment and develop a national response plan with an emphasis on precise contact tracing, active screening, patient flow, paying attention to the psychological and social dimensions of the disease, and also transparency of social inequalities in the face of risk factors of the COVID-19. Also, the social protection programs should become a vital tool for policymakers and supporting the vulnerable groups using the capacity of the community and international cooperation to develop a vaccine, which is difficult to procure due to the sanctions.

Factors Affecting the Implementation of Early Rehabilitation Care in Patients with Traumatic Brain Injury: A Multidisciplinary Perspective.

Background: Traumatic brain injury is now regarded as the silent epidemic. This disease can cause some physical, cognitive, and psychological impairments that require proper and early rehabilitation interventions. Therefore, the aim of this study was to explore the factors affecting early rehabilitation care in patients with traumatic brain injury based on the experiences of the rehabilitation team. Methods: This qualitative study was conducted as a conventional content analysis from September 2019 to August 2020. For this purpose and given the maximum diversity, 22 members of the rehabilitation team, patients, and their caregivers in trauma level 1 hospitals affiliated with Tehran University of Medical Sciences were selected based on a purposeful sampling method. The data were also collected using semi-structured interviews until data saturation is obtained. Graneheim and Lundman's content analysis method was performed to analyze the data. Results: The data analysis results eventually led to the introduction of three main themes and eight categories. The main themes were associated with early rehabilitation barriers, which included cultural factors and rehabilitation infrastructures. Rehabilitation management was regarded as the main theme regarding the early rehabilitation facilitator. Conclusion: Early rehabilitation is considered a vital rehabilitation stage for patients with traumatic brain injury. Hence, accurate identification of the influential factors on early rehabilitation can help the rehabilitation team promote early rehabilitation care among these patients; it can lead to the revival of the patients' abilities and the improvement of their quality of life.

An Operational Exercise for Disaster Assessment and Emergency Preparedness in South of Iran.

INTRODUCTION: Exercise is an important step in preparation and implementation of disaster risk programs. The aim of this research was the development and assessment of an operational exercise for disaster preparedness in southeast Iran. METHODS: A descriptive cross-sectional study was used to evaluate a 2-day exercise for a level 4 (L-4) scale mock disaster conducted in southeastern Iran in 2017. Seven medical sciences universities participated in the mock disaster exercise: Kerman, Rafsanjan, Bam, Jiroft, Zahedan, Zabol, and Iranshahr medical sciences universities. In total, 990 personnel participated. The disaster preparedness was assessed using a tool designed by the exercise planning team. RESULTS: The present research reveals that the universities of medical sciences in the southeastern hub of Iran are properly prepared for emergencies and disasters. This included the Disaster Medical Assistance Teams and the response operational comprehensive plan for emergencies and disasters. The research findings indicated a preparedness score of 79.8%. The mean arrival time at exercise area (Jiroft City) was 4 hours 35 minutes despite the wide area of Kerman and Sistan and Baluchistan provinces. Personnel safety and security, rapid assessment, communications, logistics, warnings, and news confirmation functions showed higher levels of preparedness. CONCLUSION: The Joint Commission on Accreditation of Healthcare Organizations reported that organizations must perform the performance preparedness exercises on different levels and areas twice a year to be properly prepared for responding to emergencies and disasters. This study can be considered a suitable standard guide for health care organizations to execute exercises for the maintenance and promotion of their preparedness for properly responding to emergencies and disasters at L-4.

Leadership in limbo: Characteristics of successful incident commanders in health sector of a disaster-prone country.

OBJECTIVE: Iran, as one of the most disaster-prone countries in the world, is exposed to a wide range of hazards. Hence, the health sector should be prepared to deal with the consequences of emergencies. This study aimed to explore Iranian disaster management status and to identify the necessary characteristics of successful incident commanders in this field. METHODS: A qualitative content analysis was designed using in-depth semi-structured interviews with 30 commanders and experts, selected by purposeful sampling, who had first-hand experiences in managing health disasters. Field notes, formal institutional reports, and photos were employed as well. Verbatim transcribed interviews and other data sources were analyzed using constant comparison method. Ethical issues were considered carefully throughout the study process. RESULTS: Two main themes were developed: The first theme, "limbo situation," as expression of the problem describes inadequacies and complexities of disaster management in Iranian health sector, including seven categories. The second theme was "effective disaster leadership" consisting of "commanders' traits" and "commanders' competencies" as subthemes. CONCLUSIONS: The study demonstrated the chaotic feature of disaster management in Iran and probably some other developing countries, with crucial and unclear role of field commanders. Working under stress, time pressure, uncertainty, and management of paradoxes needs timely and on-field decision making. This study revealed that Iranian health sector incident commanders should be transformational leaders with the ability of influencing subordinate staff and have Janusian thinking skills for overcoming the existing limbo situation.

Iranian nurses' experience of "being a wrongdoer": A phenomenological study.

BACKGROUND: Patient safety, which is a patient's right, can be threatened by nursing errors. Furthermore, nurses' feeling of "being a wrongdoer" in response to nursing errors can influence the quality of care they deliver. RESEARCH OBJECTIVES: To explore the meaning of Iranian nurses' experience of "being a wrongdoer." RESEARCH DESIGN: A phenomenological approach was used to explore nurses' lived experiences. Nurses were recruited purposively to take part in semistructured interviews, and the data collected from these interviews were analyzed using Van Manen's thematic analysis. Participants and research context: Eight nurses working in three private or governmental hospitals in Tehran, Iran. Ethical consideration: The research design was approved in each participating hospital, and all interviews were carried out at a predetermined time in a private place. FINDINGS: Five themes were extracted from the data: "wandering in unpleasant feelings" (with two subthemes: "unpleasant physical feelings" and "unpleasant emotions"), "wandering in the conscience court" (with three subthemes: "being the accused," "being the victim," and "being the judge"), "being arrested in time," "time for change" (with three subthemes: "promoting accountability," "promoting learning," and "strengthening supportive relationships"), and "spiritual exercise." DISCUSSION: Some of our results are supported by the model of self-reconciliation and the recovery trajectory of "second victims" theory. CONCLUSION: The meaning of "being a wrongdoer" has positive and negative aspects. Feelings of wandering provide nurses the opportunity to reflect on and re-embrace the professional and moral responsibility of nursing. Nursing managers can convert their "defeats" into a prelude to learning, increase their accountability, and improve the quality of nursing care.

Personal factors affecting ethical performance in healthcare workers during disasters and mass casualty incidents in Iran: a qualitative study.

In emergencies and disasters, ethics are affected by both personal and organizational factors. Given the lack of organizational ethical guidelines in the disaster management system in Iran, the present study was conducted to explain the personal factors affecting ethics and ethical behaviors among disaster healthcare workers. The present qualitative inquiry was conducted using conventional content analysis to analyze the data collected from 21 in-depth unstructured interviews with healthcare workers with an experience of attending one or more fields of disaster. According to the data collected, personal factors can be classified into five major categories, including personal characteristics such as age and gender, personal values, threshold of tolerance, personal knowledge and reflective thinking. Without ethical guidelines, healthcare workers are intensely affected by the emotional climate of the event and guided by their beliefs. A combination of personal characteristics, competences and expertise thus form the basis of ethical conduct in disaster healthcare workers.

Experiences of occupational therapy students in the first fieldwork education: a qualitative study.

BACKGROUND: Fieldwork education is a core part of all occupational therapy curriculums around the world to enable the students meet minimum competencies required for their professional life. Student experience is a valuable source to explore the nature of fieldwork training and plan more efficient curriculums in the future. This study aimed to explore the students' experiences in the first fieldwork education. METHODS: Data were collected through a focus group and series of semi-structured interviews with 16 occupational therapy students who had passed the first semester of fieldwork education at three occupational therapy departments in Iran. The interviews were transcribed line by line and analyzed according to inductive content analysis. RESULTS: Following the analysis of the data, three main themes were identified including the importance of supervisors' management, deficits in the current curriculum and challenges in the educational environment. Each theme included different categories to show students' concerns and challenges in the first fieldwork education experience and their suggestions for more efficient trainings. CONCLUSION: The research argues that several combined key factors determine the nature and utility of occupational therapy (OT) fieldwork experiences of the students. However, further studies are needed to clarify the experiences of the supervisors, department managers and others involved in the fieldwork education.

Designing Iranian Pre-hospital Stroke Scale.

BACKGROUND: Various studies have shown that stroke morbidity and mortality could be decreased if patients receive early diagnosis and treatment. Iranian Pre-hospital Stroke Scale (IPSS) is designed based on other prehospital stroke scales available across the world as well as experiences of emergency medicine specialists and pre-hospital emergency technicians to improve the diagnostic accuracy of the stroke scale in Iran. METHODS: Using a mixed method, the study was carried out in two main phases. In the first phase, concept elicitation was conducted based on the review of the literature. Related stroke diagnosis and usual instruments in pre-hospital emergency stroke centers were documented. The IPSS was designed based on semi- structured interviews with 35 neurologists, emergency medicine practitioners and physicians working in hospitals and emergency technicians in the pre-hospital field. In the second phase, the face and content validity, and reliability were checked. RESULTS: According to results from the first phase of this study (items generation), three domains were introduced as the most important factors in detection of early signs and symptoms of stroke. In the second phase (items reduction), the face validity of the IPSS was checked based on the comments from participants (the experts and EMS technicians). The content validity was calculated based on Lawshe index. The IPSS scale content validity index (S-CVI/Ave) was calculated as 89%. To determine the criterion validity of the instrument, the IPSS scores were compared with the final diagnosis based on results from brain CT scan in hospital. CONCLUSION: During this study we developed IPSS to be used by emergency technicians in pre-hospital field with a dichotomous items and simple and easy administration. It is recommended for future studies to apply this tool to emergency dispatch units as well as triage procedures in hospitals.

Abstruse Side of Climate Change, Impact on Malaria: A Systematic Evidence Review Comparing Iran versus Globally.

Background: Infectious outbreaks due to disrupted social and environmental conditions after climate change-induced events complicate disasters. This research aimed to determine the contentions of bioclimatic variables and extreme events on the prevalence of the most common Climate-Sensitive Infectious Disease (CSID); Malaria in Iran. Methods: The present narrative systematic review study was conducted on the bioclimatic variable impact on the prevalence of malaria, as a common CSID. The search was conducted in 3 sections: global climate change-related studies, disaster related, and studies that were conducted in Iran. The literature search was focused on papers published in English and Persian from Mar 2000 to Dec 2021, using electronic databases; Scopus, Web of Science, PubMed, Google Scholar, SID, Magiran, and IranDoc. Results: Overall, 41 studies met the inclusion criteria. The various types of climatic variables including; Temperature, rainfall, relative humidity, and hydrological events including; flood, drought, and cyclones has been reported as a predictor of malaria. The results of studies, inappropriately and often were inconsistent in both Iran and other parts of the world. Conclusion: Identifying malaria outbreak risks is essential to assess vulnerability, and a starting point to identify where the health system is required to reduce the vulnerability and exposure of the population. The finding of most related studies is not congruent to achieve reliable information, more extensive studies in all climates and regions of the country, by climatic models and high accuracy risk map, using the long period of bioclimatic variables and malaria trend is recommended.

Hospital disaster preparedness as measured by functional capacity: a comparison between Iran and Sweden.

INTRODUCTION: Hospitals are expected to continue to provide medical care during disasters. However, they often fail to function under these circumstances. Vulnerability to disasters has been shown to be related to the socioeconomic level of a country. This study compares hospital preparedness, as measured by functional capacity, between Iran and Sweden. METHODS: Hospital affiliation and size, and type of hazards, were compared between Iran and Sweden. The functional capacity was evaluated and calculated using the Hospital Safety Index (HSI) from the World Health Organization. The level and value of each element was determined, in consensus, by a group of evaluators. The sum of the elements for each sub-module led to a total sum, in turn, categorizing the functional capacity into one of three categories: A) functional; B) at risk; or C) inadequate. RESULTS: The Swedish hospitals (n = 4) were all level A, while the Iranian hospitals (n = 5) were all categorized as level B, with respect to functional capacity. A lack of contingency plans and the availability of resources were weaknesses of hospital preparedness. There was no association between the level of hospital preparedness and hospital affiliation or size for either country. CONCLUSION: The results suggest that the level of hospital preparedness, as measured by functional capacity, is related to the socioeconomic level of the country. The challenge is therefore to enhance hospital preparedness in countries with a weaker economy, since all hospitals need to be prepared for a disaster. There is also room for improvement in more affluent countries.

Life recovery after disasters: a qualitative study in the Iranian context.

INTRODUCTION: Planned and organized long-term rehabilitation services should be provided to victims of a disaster for social integration, economic self-sufficiency, and psychological health. There are few studies on recovery and rehabilitation issues in disaster situations. This study explores the disaster-related rehabilitation process. METHOD: This study was based on qualitative analysis. Participants included 18 individuals (eight male and ten female) with experience providing or receiving disaster health care or services. Participants were selected using purposeful sampling. Data were collected through in-depth and semi-structured interviews. All interviews were transcribed and content analysis was performed based on qualitative content analysis. RESULTS: The study explored three main concepts of recovery and rehabilitation after a disaster: 1) needs for health recovery; 2) intent to delegate responsibility; and 3) desire for a wide scope of social support. The participants of this study indicated that to provide comprehensive recovery services, important basic needs should be considered, including the need for physical rehabilitation, social rehabilitation, and livelihood health; the need for continuity of mental health care; and the need for family re-unification services. Providing social activation can help reintegrate affected people into the community. CONCLUSION: Effective rehabilitation care for disaster victims requires a clear definition of the rehabilitation process at different levels of the community. Involving a wide set of those most likely to be affected by the process provides a comprehensive, continuous, culturally sensitive, and family-centered plan.

Systematic scoping review protocol of Stroke Patient and Stakeholder Engagement (SPSE).

This protocol describes a systematic scoping review of Stroke Patient and Stakeholder Engagement (SPSE), concepts, definitions, models, implementation strategies, indicators, or frameworks. The active engagement of patients and other stakeholders is increasingly acknowledged as essential to patient-centered research to answer questions of importance to patients and their caregivers. Stroke is a debilitating, long-lasting burden for individuals, their families, and healthcare professionals. They require rehabilitation services, health care system assistance, and social support. Their difficulties are unique and require the continued involvement of all parties involved. Understanding SPSE in research is fundamental to healthcare planning and extends the role of patients and stakeholders beyond that of the study subject. We will conduct a systematic literature search to identify the types of existing evidence related to SPSE, implementation strategies, indicators, or frameworks related to Patient and Stakeholder Engagement (PSE); clarify key concepts, definitions, and components of SPSE; compile experiences and prerequisites; and identify stroke research internationally. Two independent reviewers will extract data from selected studies onto a customized extraction form that has already been piloted. We integrate existing knowledge to address gaps in the literature on SPSE research by presenting the model, implementation strategies, indicators, and frameworks for stroke patients. We hope that these findings will offer future researchers a clear picture and conceptual model of SPSE.

Development and Psychometric Properties of Decision-Making Scale for Emergency Hospital Evacuation in Disasters.

BACKGROUND: The evidence shows that the need for emergency evacuation in hospitals has arisen. Designing an emergency evacuation decision making tool increases the confidence of hospital managers in the decision made. Therefore, this study was aimed at the development, and the psychometric properties, of the decision-making scale for emergency hospital evacuation in disasters. METHODS: This study was done in 2 phases of qualitative study and literature review and designing and psychometric properties of the instrument. After development of the primary item pool, the psychometric properties of the questionnaire were evaluated. In this regard, face and content validity, internal consistency (Alpha's Cronbach), reliability (ICC), and stability were assessed. RESULTS: In the validity stage of the instrument, 4 items were removed. Also, 4 items were modified and 2 items were merged. The number of items was thus decreased to 64. After CVI calculation, 5 items were removed, 4 items were modified, and 2 items were merged. As a result of this, the number of items decreased to 58 items. The scale has good reliability and stability. CONCLUSION: It seems that the instrument could be useful in decision-making for emergency hospital evacuation in disasters.

Design and psychometric properties of the acute care quality in trauma emergency units scale.

BACKGROUND: Systematic trauma care scale could be designed and used by nurses to completely and adequately fulfill a complex care to improve trauma care quality. The purpose of this study was to design and evaluate the psychometric property of the Nursing Care Quality in Trauma Emergency Units and trauma care promotion. METHODS: This methodological study was conducted in 2022. The process of designing and psychometric assessment of the scale was performed in two steps such as Generating an Item Pool and Validity and Reliability evaluation (Item reduction). The construct validity was determined using the experimental intervention; for determining the reliability of the scale and internal consistency, we measured the inter-rater reliability (IRR). Data were analyzed using the SPSS software, version 22. RESULTS: Based on our findings, the CVI and CVR of the scale were 1 and 0.83-1, respectively. A significant difference between the pre- and post-intervention scores in group 1 supports the inference that the construct has been appropriately represented, and the instrument has construct validity (p < 0.001). We found that there was a significant difference in the scores of Patient assessment, Planning and Implementations, and Evaluation of the care plan. The inter-rater reliability method allows the optimal reliability assessment of observational instruments, which was used in this study, and the results confirmed excellent reliability of the instrument. CONCLUSIONS: The validity and reliability of the Nursing Care Quality in Trauma Emergency Units Scale were confirmed. The instrument could successfully assess the process of nursing care in the trauma emergency ward. The use of this checklist is recommended as a valid observational tool for other researchers. STUDY TYPE: Therapeutic/care management.

Fears and Concerns of Bystanders to Help People Injured in Traffic Accidents: A Qualitative Descriptive Study.

In most traffic accidents, bystanders arrive at the scene before the rescuers. If they provide the right help, they can play an important and effective role in reducing the number of deaths and complications caused by these accidents. However, in many cases, fears and concerns prevent bystanders from providing assistance. This study aims to investigate and understand the fears and concerns of bystanders when they decide to help in traffic accidents. In 2022, this study was carried out in Iran using a qualitative content analysis approach. The data was collected through semistructured interviews. Participants were 15 males and females who had experience providing assistance in traffic accidents. Interviews, after digital recording, were transcribed verbatim. A purposeful and theoretical sampling method was performed. Data analysis and the determination of codes, categories, and subcategories were done using qualitative analysis software. O'Brien's qualitative research reporting standard was used. The results of the study include a category of fears and concerns and five subcategories. The subcategories include fear and concern caused by lack of information, fear of legal troubles, stress caused by previous experience, fear and anxiety caused by anticipation, and anxiety of unknown origin. The results of this study showed that some of the fears and concerns of the bystanders were related to a lack of information about providing assistance. By increasing bystanders' information about assistance, such as first aid training, fear and anxiety caused by a lack of information can be reduced. Another part of the fear and concern of bystanders is due to legal issues. Passing and implementing laws that protect bystanders can help reduce this fear and concern. Bystanders should be trained to provide assistance according to the rules of assistance so that they do not get into legal problems. A part of the bystander's fear and concern stems from their previous experiences providing assistance in traffic accidents. These experiences can also affect the fear and anxiety caused by anticipation. It is necessary to conduct more studies on the role of bystanders' experiences in creating fear and anxiety in them, as well as their effect on anticipatory fear.

The Effect of the COVID-19 Pandemic on Environmental Health (Two Sides of the Same Coin): A Systematic Review.

BACKGROUND: The outbreak of the COVID-19 pandemic in late 2019 has led to many changes such as reduced human activities and effects on the environment. There is no big picture of the effects of pandemics on the environment using related evidence. OBJECTIVES: This study was conducted to investigate the effect of the COVID-19 pandemic on environmental health. METHODS: A systematic search of English language studies was performed in major electronic databases; Web of Science, PubMed, Scopus, and Google scholar web search engine from December 2019 to February 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard guidelines were used to follow up the review process. finally 58 articles entered the review procedure. RESULTS: The results of indicate a significant reduction of air pollutants and improved air quality. It improved the water quality of some rivers, canals, and seas during the lockdown of the COVID-19 pandemic. The effects of this disease on the environment cannot be fully described yet. CONCLUSION: In the short term, the amount of air, water, and coastal pollution has been reduced. few studies have examined the effects of pandemics on the environment in the long run, which paves the way for more researches.