The association between health literacy and pedestrian safety behavior among adults: a cross-sectional study.

INTRODUCTION: Pedestrians are considered the most vulnerable and complex road users as human behavior constitutes one of the fundamental reasons for traffic-related incidents involving pedestrians. However, the role of health literacy as a predictor of Pedestrian safety behavior remains underexplored. Therefore, the current study was designed to examine the level of health literacy and its association with the safety behavior of adult pedestrians in the city of Tabriz. METHODS: This cross-sectional analytical study was conducted among individuals aged 18 to 65 years in the metropolitan area of Tabriz from January to April 2023. Data were collected using the HELIA standard questionnaire (Health Literacy Instrument for adults), comprising 33 items across 5 domains (access, reading, understanding, appraisal, decision-making and behavior), as well as the Pedestrian Behavior Questionnaire (PBQ) consisting of 29 items. Data were analyzed using descriptive and analytical statistics (independent t-tests, ANOVA, and Pearson correlation coefficient) via SPSS-22 software. RESULTS: Based on the results, 94% (376 individuals) had excellent health literacy levels, and their safety behavior scores were at a good level. Health literacy and safety behavior were higher among the age group of 31 to 45 years, women, married individuals, those who read books, and individuals with higher education. However, safety behavior showed no significant association with education level (P > 0.05). There was a significant and positive relationship between health literacy and all its domains and pedestrian safety behavior (r = 0.369, P < 0.001). CONCLUSION: This study underscores the significant impact of health literacy on pedestrians' safety behavior. The findings reveal that higher levels of health literacy are associated with better safety behavior among individuals aged 18 to 63. Demographic factors such as age, gender, marital status, and education level also play a role in shaping both health literacy and safety behavior. By recognizing these relationships, interventions can be tailored to improve health literacy levels and promote safer pedestrian practices, ultimately contributing to a healthier and safer community in Tabriz city.

Hospital response challenges and strategies during COVID-19 pandemic: a qualitative study.

Background: At the beginning of the COVID-19 pandemic, healthcare managers at hospitals did not have sufficient experiences to appropriately respond to the COVID-19 outbreak. Due to a lack of preparedness, many challenges arose in the healthcare system, and each country developed and implemented strategies depending on national policies. This study aimed to understand challenges during the COVID-19 pandemic and strategies used in Iranian hospitals. Methods: A qualitative research was conducted in four hospitals in an urban area of Iran. In-depth semi-structured interviews were performed with 32 participants including healthcare managers, nurses, and medical doctors. Data underwent qualitative content analysis. Results: Four categories were developed: 'capacity expansion', 'management affairs', 'diagnostic services," and therapeutic services'. Each category consisted of 2-3 subcategories. Conclusion: Hospitals should be prepared to intelligently respond to future epidemics. It is necessary to develop a comprehensive epidemic plan for the management of disasters to reduce the impact of the epidemic and minimize the risk to public health and ensure that resources are allocated in an efficient and effective manner.

Alternative Water Resources Selection to Supply Drinking Water in Flood Disasters by Multicriteria Decision-Making Techniques (DANP and VIKOR).

Background: Emergency is generally caused by natural disaster and infectious disease outbreaks, or it is man-made. Floods are natural phenomena that generally appear in multiple parts of the world. Flooding is one of the most destructive naturally occurring environmental hazards and can cause public, infrastructural, and environmental damage. The purpose of this study is to select alternative water resources for supplying Bandar Abbas in flood disasters by multicriteria decision-making techniques. Methods: Information required includes possible water resources alternative for flood, quantitative and qualitative characteristics of the water resources, climatic circumstances, and demographic information used in organizations data and previous studies. After selecting and proposing water resources alternative for Bandar Abbas in flood, the subcriteria were weighed applying DANP (DEMATEL-ANP) techniques and water resources were prioritized with the VIKOR technique. According to the network structure and internal and external dependence of the criteria and subcriteria, the advantages of DANP in calculating weights have been used to adapt to more real-world problems. The VIKOR technique was developed for multicriteria optimization of complex systems. Results: After reviewing and extracting the criteria from various studies, 9 main criteria and 44 subcriteria were defined to select water resources in disasters and emergencies. According to field studies and related organizations' information, the proposed water resources for Bandar Abbas to use in flood disasters include humidity, sea (Persian Gulf), Sarkhoon plain, and wastewater treatment plant of Bandar Abbas. Conclusion: Results showed that the optimal water resources for Bandar Abbas in flood disasters are the sea and wastewater treatment plant effluent (after advanced treatment). The study proposed appropriate model to select optimal water resources for various natural disasters in different geographical areas. This model can help officials and decision-makers to plan for drinking water supply from disaster-prone areas before disasters occur.

Design and psychometric evaluation of schools' resilience tool in Emergencies and disasters: A mixed-method.

BACKGROUND: In addition to their educational role, resilient schools have a good capacity in response to disasters. Due to the large student population, the schools can be a safe and secure environment during disasters, in addition to maintaining their performance after. Given the role and importance of the schools, the impact of culture and environment on resilience, without any indigenous and comprehensive tool for measuring the resilience in Iran, the study aimed to design and psychometrically evaluate the measurement tools. METHOD: This study was conducted using a mixed-method sequential explanatory approach. The research was conducted in two main phases of production on items based on hybrid model and the psychometric evaluation of the tool. The second phase included validity (formal, content and construction) and reliability (multiplex internal similarity, consistency and reliability). RESULT: The integration of systematic and qualitative steps resulted in entering 91 items into the pool of items. After formal and content validity, 73 items remained and 44 were omitted in exploratory factor analysis. A questionnaire with 5 factors explained 52.08% of total variance. Finally, after the confirmatory factor analysis, the questionnaire was extracted with 29 questions and 5 factors including "functional", "architectural", "equipment", "education" and "safety". Internal similarity and stability in all factors were evaluated as good. CONCLUSION: The result showed that the 29-item questionnaire of school resilience in emergencies and disasters is valid and reliable, that can be used to evaluate school resilience. On the other hand, the questionnaire on assessment of school resilience in disasters enables intervention to improve its capacity.

Operational Strategies for Establishing Disaster-Resilient Schools: A Qualitative Study.

INTRODUCTION: Resilient schools can warranty students' health and survival at disasters. It is obligatory that schools be prepared for natural challenges through local programs. Considering the great population of students, disaster-resilient schools can be a safe and suitable environment for students at the time of disaster. OBJECTIVE: This study aims to identify certain operational strategies for establishing schools resilient to natural disasters. METHOD: This qualitative study was based on conventional content analysis. Using purposive sampling method, 24 experts in the fields of health in disasters, construction engineering, psychology, teaching, and administrative management participated in the study. Maximum variation sampling continued until data saturation was achieved. The data collected via unstructured interviews were analyzed with Graneheim and Lundmen's conventional content analysis. RESULTS: Content analysis resulted in four main categories as operational strategies for establishing disaster-resilient schools including: 1) "construction and non-construction optimization", with four subcategories of construct risk management, optimization of construct architecture and physical structure, correct construct localization, and promotion of non-construct safety, 2) "promotion of organizational coordination and interactions" with two subcategories, namely improvement in intra-organizational communication and improvement in extra-organizational communication, 3) "improvement in education" with three subcategories of holding educational courses for families and students, holding educational courses for managers and personnel, and holding simulated exercises, and 4) "process promotion" with four subcategories of increased preparedness, correct planning, creation of organizational structure, and rehabilitation facilitation. CONCLUSION: Various factors affecting schools' response to disasters form operational strategies to establish disaster-resilient schools. These strategies influence pre- and post-disaster preparedness. Awareness of these components followed by preparedness prior to disasters can save students' lives, improve school performance after disasters, and aid in establishing disaster-resilient schools as safe lodgings.

Assessment of school resilience in disasters: A cross-sectional study.

BACKGROUND AND OBJECTIVES: School resilience is defined as risk-reducing strategies used to create a safe environment for students when faced natural disasters. Resilient schools, in addition to their educational role, provide a suitable capacity for responding to disasters and rehabilitation after the incidence. This study determined the level of disaster resilience of schools in Yazd, central Iran. MATERIALS AND METHODS: This is a descriptive-analytic study conducted among 400 schools and 367 participants in Yazd, 2018. To collect data, we used the school resilience in disasters questionnaire (α =0.95 and intraclass correlation coefficient = 0.97 [95% confidence interval: 0.96-0.98]) containing 48 questions. We also analyzed the gleaned data through the Pearson correlation coefficient, one-way ANOVA, and independent t-test. RESULTS: The total score of school disaster resilience was 153.30 ± 29.57. In these schools, the function had the highest (47.76 ± 13.96), and safety had the lowest (6.74 ± 3.18) score among all areas of school disaster resilience. There was a positive significant correlation between total resilience and areas of function, education, structural, nonstructural, architecture, commute routes, safety, location, and equipment (P < 0.001). Location had the smallest (r = 0.424) and function had the greatest (r = 0.854) correlation with total resilience. CONCLUSION: It can help the school management board in assessing the level of resilience of their school and determining the priorities for disaster risk reduction. Awareness of the status of resilience can help policy-makers and experts create an effective program for increasing resilience.

The design and psychometric evaluation of the Adolescents' Resilience in Disaster Tool (ARDT-Q37): A mixed method study.

Adolescent resilience after a disaster has been shown to be a protective factor against loss, trauma, and psychological distress. Its importance for successful disaster recovery is widely accepted by disaster risk management professionals, yet very few tools are available to assess adolescent resilience during an emergency or after a natural disaster has occurred. The aim of this study was to develop and evaluate the psychometric properties of a questionnaire designed to measure adolescents' resilience before, during or after a natural disaster. This mixed method study was carried out in three phases involving item generation, systematic review (phase one), qualitative analysis (phase two) and the reduction of items (phase three). The psychometric evaluation of the Adolescents' Resilience in Disaster Tool (ARDT) was conducted using the data from 599 high school students North of Iran (Golestan Province). The initial item pool included 80 items that were reduced to 37 after assessment of validity (face, content and structure) and reliability. Exploratory Factor Analysis found five factors that affect adolescents' resilience which included helping, trusting in God and hopefulness, adaptability, self-confidence and social support. The internal consistency was desirable (α = .86 and ICC = .91; 95% CI: .849 to .948). The psychometric support for the 37-item version of the ARDT in this study indicates strong support for the ARDT-Q37 as a rapid assessment tool to evaluate resilience in adolescents aged 12-18 years old. Identifying the status of adolescents' resilience and determining their level of need for intervention during and after a natural disaster is critical for long- and short-term outcomes. Implications for policy makers and professionals involved in the preparedness, response and recovery from natural disasters are discussed.

Domains and Indicators of Resilient Children in Natural Disasters: A Systematic Literature Review.

Resilience has received increased attention among both practitioners and scholars in recent years. Child resilience has received notable attention in disaster risk reduction (DRR) during the creation of the Sendai Framework 2015-2030 to improve child protection in the event of disasters. As resilience is a subjective concept with a variety of definitions, this study evaluates its different factors and determinates in the existing research to clarify the path for the near future and objective research. A systematic literature review was conducted by searching and selecting the peer-reviewed papers published in four main international electronic databases including PubMed, SCOPUS, WEB OF SCIENCE, and PsycINFO to answer the research question: "What are the criteria, factors or indicators for child resilience in the context of a natural disaster?" The process was based on PRISMA guidelines. In total, 28 papers out of 1838 were selected and evaluated using thematic analysis. The results are shown in two separate tables: one descriptive and the other analytical. Two main themes and five subthemes for criteria for child resilience in a disaster have been found. The factors found cover the following areas: mental health, spiritual health, physical, social behavior, and ecological, and as well as environmental. The majority of the included studies mentioned the scattered criteria about children resilience without any organized category. Although this concept is multifactorial, additional research is needed to develop this study and also observe other kinds of disasters such as human-made disasters.

Characteristics and components of children's and adolescents' resilience in disasters in Iran: a qualitative study.

Children and adolescents are vulnerable in times of disaster and they will suffer more severely if neglected. The concept of resilience differs between cultures, and identifying the components of resilience is essential for decision making and interventions in disasters such as risk management. This study aimed to identify the components of children's resilience in disasters in Iran. This qualitative study took a content-analysis approach. Data were collected through semi-structured interviews with 23 people and three group meetings. Conventional content analysis was used for data analysis. MAXQDA 10 software was used for classification. The resilience components derived from the data were categorized into two main categories, internal and external, and eight subcategories covering psychological, emotional, cognitive, mental, spiritual, physical, social, and behavioral factors. The results also showed that the nature of resilience is both intrinsic and extrinsic. Recognizing the dimensions of children's resilience in disasters can lead to a new perspective for authorities and planners in disaster and emergency situations. The results of this study could be used by planners and policymakers to develop interventions to enhance children's and adolescents' resilience at the time of disasters, which is also underlined and highlighted by international documents.

Social Determinants of Health and Home Safety for Under-five Children in a Neighbor's Tehran, Iran.

BACKGROUND: Social determinants of health (SDH) provide a platform in improving health society such as safety. Safety is essential for children because it is directly related to the health and development. The objective of this study was to evaluate the current home safety in the capital city of Iran for children below five years by community-based initiative and its association with common SDH variables. METHODS: This is a cross-sectional study, considering community- and family-based initiative. According this five domains checklist which was including physical, kitchen, bath, toys, and first-aid kit, 200 family home safety were evaluated. Moreover, the relation between children safety and social determinants of health was assessed. Furthermore, the research team designed an attractive record card for each child that was distributed among families by community volunteers. RESULTS: The result was extracted into two age groups: less and more than 6 months. We designed an attractive card for each child and distributed among families by volunteers. It showed that children of age above 6 months had higher home safety score. We found a positive association between mother's education and total safety score. CONCLUSIONS: This study was a part of MAZDAK project which means friendly environment for children in Persian word. It showed that an effective way for promoting children safety in the community would be community engagement and family cooperation. As the family education can help reduce children injuries, MAZDAK as a model can been run in the other places to check the effects of SDH on home safety for children. This was an experience of improving community knowledge and behavior about home safety by the parents themselves to improve their children safety environment, and it is going to continue the efficacy of Intervention.

Involving Mothers in Child Development Assessment in a Community-based Participatory Study Using Ages and Stages Questionnaires.

BACKGROUND: Child-friendly environment project (MAZDAK) is a community-based project for monitoring the development of children in Iran that was implemented as a pilot study in one of the neighborhoods of Tehran (Eyvanak-e Gharb). This study attempted to engage mothers in monitoring of their children's development and assesses the status of children's development by a community-based participatory approach using the ages and stages questionnaires (ASQ). METHODS: This study was a community-based participatory research. Two hundred households residing in Eyvanak-e Gharb with children under 5-year-old were selected as a convenient sample and completed the ASQ. Descriptive measures were used to describe the overall status of children, in each domain. Furthermore, we compared the current sample with other populations, using independent t-test. RESULTS: This study engaged mothers, trained volunteers from the community, and some local institutions in screening and monitoring children development and addressing any poor developmental growth. The mean scores of the different domains (communication, gross motor, fine motor, problem solving, and social-personal) in sampled children in MAZDAK project were higher than corresponding mean scores of the children in a project conducted in Tehran in 2006. CONCLUSIONS: Involving mothers and community in monitoring children development based on ASQ was an effective strategy to monitor and foster children development.

Feasibility assessment of using geoinformatics technology in disaster disease surveillance in a developing country, iran.

BACKGROUND AND PURPOSE: Geoinformatics technology retains an unprecedented trait of performing with a supersonic speed and precision in public health management whereas the existing disease surveillance systems in developing countries lack using this technology. This article aims to assess the feasibility of using geoinformatics technology in disaster disease surveillance in a developing country, Iran. METHODS: A self-administered questionnaire was developed based on technology acceptance model (TAM), and a semi-quantitative survey was conducted in order to collect data. Fifty TUMS & HS personnel, currently involve in disease surveillance and information technology, were included. Initially, a pilot study was conducted to test the validity and reliability of the questionnaire. Cronbach alpha, confirmatory factor analysis (CFA), and standard error of measurement (SEM) were calculated to validate the causal model. RESULTS: The results from structural equation analysis suggested that TAM provided a constructive picture of using geoinformatics technology in disaster disease surveillance at TUMS &HS. The study found attitude (ATT) had a significant influence on participants intention to use (ITU) a new technology, and perceived ease of use (PEOU) was a strong determinant of perceived of usefulness (PU). Subsequently, PU and PEOU explained ATT substantially; even though the analysis showed insignificant statistical association among these constructs. The high R2 (Coefficient of determination) of the constructs described respondents positive instinct towards accepting a new technology. CONCLUSION: The study reveals that personnel intent to adopt geoinformatics technology in disaster disease surveillance; and at the same time, they possess a positive attitude towards the technology. This study also found PEOU has a strong influence on PU, so information sessions and training on geoinformatics technology need to focus primarily on the applications and impacts of technology on disaster disease surveillance.

Recognition of medical errors' reporting system dimensions in educational hospitals.

INTRODUCTION AND OBJECTIVE: Nowadays medical errors are one of the serious issues in the health-care system and carry to account of the patient's safety threat. The most important step for achieving safety promotion is identifying errors and their causes in order to recognize, correct and omit them. Concerning about repeating medical errors and harms, which were received via theses errors concluded to designing and establishing medical error reporting systems for hospitals and centers that are presenting therapeutic services. The aim of this study is the recognition of medical errors' reporting system dimensions in educational hospitals. MATERIALS AND METHODS: This research is a descriptive-analytical and qualities' study, which has been carried out in Shahid Beheshti educational therapeutic center in Isfahan during 2012. In this study, relevant information was collected through 15 face to face interviews. That each of interviews take place in about 1hr and creation of five focused discussion groups through 45 min for each section, they were composed of Metron, educational supervisor, health officer, health education, and all of the head nurses. Concluded data interviews and discussion sessions were coded, then achieved results were extracted in the presence of clear-sighted persons and after their feedback perception, they were categorized. In order to make sure of information correctness, tables were presented to the research's interviewers and final the corrections were confirmed based on their view. FINDING: The extracted information from interviews and discussion groups have been divided into nine main categories after content analyzing and subject coding and their subsets have been completely expressed. Achieved dimensions are composed of nine domains of medical error concept, error cases according to nurses' prospection, medical error reporting barriers, employees' motivational factors for error reporting, purposes of medical error reporting system, error reporting's challenges and opportunities, a desired system characteristics, and the quality of error experiences' transmission in the health-care system. CONCLUSION: Although, appropriate achievements have been assured in Shahid Beheshti Hospital, but it seems necessary that in order to immune promotion not only in this hospital, but in the other organizations, necessary infrastructures have been provided for an error reporting system performance. An appropriate medical error reporting system could be educated and prevent the occurrence of repeated errors.

The relationship between sociability and productivity.

INTRODUCTION: When productivity is in the same way with culture and organized socialization, it is the gem of organization that can ensure stableness and survival of the organizations and be the mechanism for taking the competitive advantage. In contrast, the attention to socialization and the effect of that on productivity is less than its effect on public culture and organization culture. Hence this article evaluates the relationship between these variables in two groups of employees in selected hospitals in Isfahan. MATERIALS AND METHODS: This study is descriptive - correlation. The subject society who was studied was employees (nurses and staffs) of Kashany educational public hospital, Isabn Maryam public hospital, charitable Hojatie hospital and private Sadi hospitals in Isfahan province. For determination of socialization, the Biligard questionnaire and for productivity of employees the productivity questionnaire based on Goldesmit model were used that the justifiability and stability of them are confirmed by experts. The number of subject under study is calculated based on 250 persons-formula sampling. RESULTS: There is a direct and significant correlation between socialization and productivity. On the other hand, the factors such age, sex, organizational position, history and the kind of employment, had no role excluding Sadi hospital. CONCLUSION: Although the productivity of the employees affects the accessibility of the hospital to its effective goals, the effective factors that play a role in increasing or decreasing the accessibility cannot be ignored.

The evaluations of frequency distribution heparin resistance during coronary artery bypass graft.

BACKGROUND: Heparin is one of the most important medication that is used in coronary artery bypass graft (CABG) operations, but some patients demonstrate heparin resistance (HR) during CABG. Heparin resistance was defined as at least one activated clothing time <400 seconds after heparinization and/or the need for purified antithrombin III (AT-III) administration. The goal of this study was the investigation of HR prevalence in our country and relation between HR and post-operative CABG complications. MATERIALS AND METHODS: One hundred patients that candidate for CABG were selected and surveyed for HR and complications. The data entered to computer and analyzed by SPSS soft ware. The Chi-square and student t-tests were used for data analysis. RESULTS: The prevalence of heparin resistance in our study was 3%. There was no relation among bleeding, cardiac arrest and HR. Bleeding happened in 13 patients of which 1 person was in HR group (33.3%) and 12 in non HR group (12.4%) (P = 0.34). Cardiac arrest happened in 8 patients, 1 person was in HR group (33.3%) and 7 in non HR group (7.2%) (P = 0.22). According our data there were no relation among HR and gender and ventilator dependency time. CONCLUSIONS: HR is a nearly prevalent complication among patients that undergone CABG that may led to some complications such as bleeding and cardiac arrest. In our study, we did not find significant relation among them, but in frequency these complications were higher in HR group.

Comparison of the patients' satisfaction after inpatient and outpatient operations for haemorrhoidal disease.

OBJECTIVE: To compare the patients' satisfaction between outpatient and inpatient haemorrhoidectomy. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran, from January to July 2011. METHODOLOGY: A total of 208 patients were involved in this cross-sectional study. All patients were examined by their specialists and after definite diagnosis of haemorrhoid, they were randomly allocated to two groups: outpatient and inpatient. Data for this study was collected by a satisfaction questionnaire. RESULTS: There was no statistical significant difference between the two groups' satisfaction. Both groups were quite satisfied. Also, there was no statistical significance regarding the variable of time of visit. In addition, there was no association between the patients' satisfaction and with, occupation, and level of education. CONCLUSION: Based on the results of the study, minor operations such as haemorrhoidectomy are better to be done in clinics since they do not differ from the operating room regarding the patients' satisfaction.

Investigating the relationship between intra-operative electrolyte abnormalities (sodium and potassium) with post-operative complications of coronary artery bypass surgery.

BACKGROUND: Generally, the electrolyte abnormalities are seen in many hospitalized patients, and this problem increases in ones with heart diseases. The purpose of this study is determination of the prevalence of electrolyte abnormalities during the coronary artery bypass surgery (CABG) and detecting the relationship between these abnormalities with the complications after the surgeries. MATERIALS AND METHODS: This is a cross-sectional study, which is done in Chamran hospital, the medical and educational center of Isfahan, Iran, in 2011. The target population included the patients who have undergone CABG in this hospital. In this study, 100 patients who had been candidates for CABG were selected, and we extracted their recorded intra-operative electrolyte information. The collected data was entered into the computer and analyzed by SPSS software. The Chi-square and t student tests were used for data analysis. RESULTS: The mean ± SD of sodium during CABG was 137.95 ± 4.6 (range 127-152) mg\dl. Also, the mean ± SD of potassium was 4.65 ± 0.9 (range: 2.9-7.4). According to these results, 48 patients (48% of all) had electrolyte imbalance and 52 patients (52% of all) were normal. Sodium level in 71% of patients was normal, and in 29% of them was abnormal. Potassium level in 73% of individuals was normal, and in 27% of them was abnormal. CONCLUSION: Giving an attention to electrolyte abnormalities in patients who have undergone CABG surgery is a considerable necessity for them, and sufficient arrangements are needed to prevent such abnormalities.