Speaking Up: Exploring Mental Health Care Workers' Patient Safety Concerns.

PURPOSE: To explore the perspectives and experiences of mental health care workers (MHCWs) when speaking up about patient safety concerns. METHOD: A qualitative study was performed at Farshchian (Sina) Hospital in Iran, involving the purposive sampling of MHCWs from three inpatient psychiatric wards. From July to October 2022, semi-structured interviews were conducted with 23 participants. Data were analyzed using conventional content analysis. RESULTS: Three major patient safety themes were identified: (a) Voicing Concerns for Daily Safety (subthemes: daily safety check-ins and speaking up to prevent patient harm); (b) Speaking Up to Save Future Lives (subthemes: whistleblowing, leadership, and being open to communication); and (c) Hesitating to Speak Up (sub-themes: ineffectiveness of raising one's voice and whispering). CONCLUSION: MHCWs have various concerns about speaking up or staying silent. Failure to communicate can result in adverse events and missed opportunities to address patient safety. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].

The challenges of health volunteers management in COVID19 pandemic in Iran.

PURPOSE: The use of volunteers is one of the approaches to capacity building, preparedness and the response of the health system in disasters. Appropriate management of volunteers during disasters and emergencies is essential. This study aimed to explain the challenges of volunteer management in the Pandemic COVID-19 in Iran. DESIGN/METHODOLOGY/APPROACH: Qualitative research was conducted using the content analysis based on the Graneheim method. The participants' selection was done based on purposeful sampling and theoretical sampling until data saturation. Direct field observation and 26 interviews were applied to collect data. FINDINGS: Four categories and 15 sub-categories emerged to describe the challenges of volunteer management during the COVID-19 crisis including policymaking barriers (including legal barriers, insurance and support coverage and risk governance), managerial barriers (including planning, coordinating and organizing, training and awareness, command and leadership and information management and documentation), socio-cultural barriers (personal safety attitude and culture, attitudes and expectations of the community and perspectives on volunteers) and executive-operational barriers (monitoring and evaluation, cost and needs assessment). ORIGINALITY/VALUE: It is essential to increase managers', officials' and volunteers' perceptions of COVID19 risk through education and information. Preparing a database for volunteers' information, including non-governmental organization and governmental organization volunteers, planning for needs assessment, establishing a mechanism for recruiting volunteers and using their capacities and appropriate organizing, tracking and monitoring of volunteers can be among effective strategies.

Prevalence of postpartum depression in women amid the COVID-19 pandemic: A systematic review and meta-analysis.

COVID-19 outbreaks appear to be related to exacerbation of psychological problems such as depression and anxiety in high-risk population such as pregnant women and the postpartum period due to stress and life-threatening illnesses. The aim of this study was to evaluate the prevalence of postpartum depression (PPD) during COVID-19. This study protocol is registered in PROSPERO with CRD42021278425 code. Data sources including Google Scholar, ISC, Magiran, Scopus, PubMed, Embase, and Web of Science and reference list of included articles were used to identify related studies. Observational studies that reported the prevalence of PPD in both Persian and English during COVID-19 between January 20, 2020 and August 31, 2021 were included. Data were collected and analyzed with a random effects model for meta-analysis. In this study, 671 initial articles were identified and after removing duplicates, 454 studies were screened and finally 24 studies entered the meta-analysis stage. According to this study results PPD based on Edinburgh Postnatal Depression Scale (EPDS) ≥9, EPDS ≥10, EPDS ≥11, EPDS ≥12, EPDS ≥13, Postpartum Depression Screening Scale-Short Form (PDSS-SF) ≥17 and total prevalence was reported 12% (95% confidence interval [CI] = 0.07-17, I2  = 97%), 27% (95% CI = 15-39, I2  = 99%), 44% (95% CI = 40-49, I2  = 0.0%), 27% (95% CI = 0.06-49, I2  = 97.4%), 28% (95% CI = 18-39, I2  = 98.5%), 37% (95% CI = 32-42), 28% (95% CI = 23-33, I2  = 98.5%). The findings of this study showed that the prevalence of PPD in women is relatively high during COVID-19. Therefore, considering the psychological consequences of the COVID-19 pandemic and the importance of pregnancy and the postpartum period in terms of the emergence of mental disorders, especially depression, it seems necessary to perform interventions and physical and psychological support.

A model to explain the challenges of emergency medical technicians' decision making process in emergency situations: a grounded theory.

BACKGROUND: To manage life-threatening conditions and reduce morbidity and mortality, pre-hospital's on-scene decision making is an influential factor. Since pre-hospital's decision making is a challenging process, it is necessary to be identified this process. This study was conducted to explore the model of Iranian emergency medical technicians' decision making in emergency situations. METHODS: This study was applied through grounded theory method using direct field observations and semi-structured interviews. Purposeful sampling with 26 participants including 17 emergency medical technicians including dispatchers, physicians of medical directions, managers and 1 representative for court affairs was performed. Interviews were lasted from October 2018 to July 2019. Corbin and Strauss approach, 2015 (open, axial and selective coding) were used to analyze data. RESULTS: A paradigm model was developed to explain the relationships among the main categories. Decision making in the context of fear and concern was emerged as the core category. Unclear duties, insufficient authorities and competencies as well as lack of enough decision making's protocols and guidelines were categorized as casual conditions. Other important categories linked to the core category were interactions, feelings and "customer focus approach". Action-interaction strategies were taken by Emergency Medical technicians lead to some negative consequences that can threaten clinical outcome and patient safety. CONCLUSIONS: Based on the finding of this study, Emergency Medical technicians' decision making in the context of fear and concern, as the core concept of this model, lead to decrease in quality of the pre-hospital services, stakeholders' dissatisfaction, hospital emergency units' overload, decrease in reputation of the Emergency Medical Technicians, threat to patient clinical outcome and patient safety. To prevent of these negative consequences, facilitation of the Emergency Medical Technicians' on-scene decision making is recommended.

Suicide Death Rate after Disasters: A Meta-Analysis Study.

BACKGROUND: Disasters have undesirable effects on health among individuals such as psychosocial disorders which may lead lead to suicide in some cases. Thus, the present study aimed to measure the rate of suicide death after disasters all over the world. METHODS: In the present meta-analysis study, all of the articles published in English until the end of 2019 were probed in electronic databases such as Web of Science, PubMed, Cochrane Library, Science Direct, PsycINFO, PsycARTICLES, and Google Scholar. Then, the data were imported to STATA ver.13 software and analyzed through fixed- and random-effects models, meta-regression, and Cochrane statistical tests. RESULTS: A total of 11 studies including a sample size of 65495867 were considered. Suicide death rates before and after the disasters were calculated as 13.61 (CI95%: 11.59-15.77) vs. 16.68 (CI95%: 14.5-19:0) among the whole population, 28.36 (CI 95%:11.29-45.43) vs. 32.17 (CI95%: 17.71-46.62) among men, and 12.71 (CI95%: 5.98-19.44) vs 12.69 (CI95%: 5.17-20.21) among women. The rate of suicide death significantly increased in the whole population and men, while no significant difference was reported among women. CONCLUSION: Suicide death rate increases after disasters indicating the destructive impact of this phenomenon on peoples' health. Therefore, implementing supportive and interventional measures is highly suggested after disasters in order to prevent suicide death among the affected people.

Tractor Ambulance: An Initiative of Emergency Medical Services Response to the Flood of Golestan, Iran in 2019.

Heavy rains in March 2019 led to severe floods in large parts of Iran, with severe financial and physical casualties (in the Golestan province, 11 districts were trapped in water). An increase in the EMS missions while serving a big portion of the needed population was a big problem for the health system during the flood; Therefore, a new solution was needed to overcome this problem. Using a farm tractor for transporting the patients and injured people was the first relief experience ever documented in the whole country. In the present report, despite the limitations and challenges, the tractor has been shown to be a proper and effective disaster relief vehicle. This report could help other similar countries face disasters, especially floods.

Prevalence of Influenza Among Hajj Pilgrims: A Systematic Review and Meta-Analysis.

OBJECTIVES: Respiratory transmission, especially in mass gatherings, is considered one of the main ways of influenza transmission. The Hajj ceremony, as one of the largest gatherings worldwide, can increase the distribution of influenza infection. Thus, the present study aimed to evaluate the incidence of influenza among Hajj pilgrims. METHODS: In this present systematic review and meta-analysis, all English studies published by 2019 were extracted from several databases such as the Web of Science, PubMed, Scopus, Cochrane Library, Science Direct, and Google Scholar. Finally, the data were extracted using a pre-prepared checklist and then analyzed by fixed and random effects model tests in the meta-analysis, Cochran, meta-regression, and Begg's test. RESULTS: Eighteen studies with a sample size of 62 431 were entered into the meta-analysis process. The overall prevalence of influenza, in addition to the prevalence of types A, B, and C influenza, was estimated at 5.9 (95% CI: 4.3-8.0), 3.6 (95% CI: 2.6-4.9), 2.9 (95% CI: 2.8-3.1), and 0.9% (95% CI: 0.5-1.5), respectively. CONCLUSIONS: In general, influenza remains widespread regardless of vaccinating pilgrims and following health protocols. Therefore, it is recommended that comprehensive management and educational approaches be used to reduce the prevalence of influenza and its adverse consequences among the pilgrims.

Barriers and requirements in the off-line emergency medical protocols implementation in Iranian Pre-hospital system: A qualitative study.

BACKGROUND: To avoid making decisions based on the unproven opinions of emergency medical technicians (EMTs), many emergency medical service (EMS) systems rely on emergency medical protocols. As protocol-based on-scene decision-making is influenced by many challenges, identifying these challenges can result in providing appropriate conditions for EMTs' decision-making. Therefore, this study aimed to identify the barriers and requirements in the off-line emergency medical protocols implementation m in the prehospital emergency medical system. MATERIALS AND METHODS: To conduct this study, qualitative content analysis using 10 field observations, 22 interviews, and 2 rounds of focus group discussions was applied. The duration of interviews lasted from October 2019 to January 2020. The Graneheim and Lundman approach was used to analyze the data. RESULTS: Seven categories (15 subcategories) including education and awareness (professional training and education and community-based education); attitudes (professional attitude and community attitude); interactions and coordination (interpersonal interactions, organizational interferences, and community's interactions); rules and instructions (instructions and supportive rules); control system (monitoring and evaluation and motivational system); accessibility (recourses and communication); and organization (structure and process) were obtained as the obstacles and challenges in the offline emergency medical protocol implementation in the prehospital system. CONCLUSIONS: There are many challenges in implementing offline emergency medical protocols in the prehospital emergency system. To achieve the effectiveness and efficiency of offline prehospital emergency protocols, it is necessary to facilitate these challenges and improve the EMTs' knowledge, attitude, and performance through cooperative and skill-based education. The findings of this study can be useful for EMS systems from national to local levels.

Epidemiology of road traffic crashes in Ilam Province, Iran, 2009-2013.

OBJECTIVE: Road traffic crashes (RTCs) are major public health challenges of world health systems, and the main leading cause of death in children and young adults aged 5 to 29 years. This study aimed to assess the epidemiology of RTCs in Ilam, Iran. RESULTS: The total mortality rate due to RTCs has been increasing every year. There was a statistically significant relationship between age/sex and death or injury from RTCs in pedestrians, drivers, and passengers (p < 0.05). There was a significant relationship between the part of body trauma and RTCs in pedestrians (p < 0.001). Furthermore, a significant relationship was found between the type of vehicle and using seat belt with RTCs in drivers and passengers (p = 0.000).

Challenges and barriers of humanitarian aid management in 2017 Kermanshah earthquake: a qualitative study.

BACKGROUND: Examining various problems after disasters is important for the affected people. Managing humanitarian aid and donations among the affected people is considered as one of the most important problems after disasters. Therefore, the present study aimed to evaluate the challenges and barriers of humanitarian aid management in 2017 Kermanshah Earthquake. METHODS: This study was conducted from November 2017 to January 2018, with qualitative case study design. The population included 21 people including 6 humanitarian aid manager, 6 volunteers, 4 aid workers, and 5 affected people. The data were collected through semi-structured interviews and purposeful sampling, which continued until saturating the data. The strategies recommended by Guba were used for evaluating the trustworthiness of the data. The data was analyzed with conventional content analysis method according to method suggested by Graneheim and Lundman. RESULTS: Based on the results, two themes, nine categories, and 19 sub-categories were identified considering the challenges and barriers of humanitarian aid and donors' management during the 2017 Kermanshah Earthquake. The categories included education, command and coordination, communication and information, rules, security, traffic and overcrowding, assessment, providing system, and cultural setting. Also, two themes including managerial and structural barriers were extracted. CONCLUSION: Adopting an effective management and appropriate policies with respect to humanitarian aid and modifying structural and managerial barriers can improve the performance and management of humanitarian aid.

The Emergency Medical System (EMS) response to Iraqi pilgrims' bus crash in Iran: a case report.

BACKGROUND: In Iran, Road Traffic Injuries (RTIs) with mass casualties occur repeatedly. Since Road Traffic Accidents (RTAs) occur far from health facilities, EMSs play an important role in reducing the disability and mortality resulting from RTIs. Thus, the study aimed to report Iraqi pilgrims' bus which rolled over in the Malayer town. CASE PRESENTATION: A mass casualty event occurred on 7 September 2017 when a bus full of Iraqi pilgrims rolled over on a road 4-km outside of Malayer, Iran. A large team of responders were dispatched including 5 ambulances with 10 EMTs along with 6 police officers serving in the area. The accident resulted in 35 injured patients (21 female and 14 male) as well as 11 deaths ranging in age from 2 to 65 years. Twenty-one of the injured were transported to the hospital and 14 patients refused transport and 12 patients sustained multiple trauma. The case has been described four phases of dispatch, on-scene, hospital and post-mission. Frequent calls made by laypeople were considered as the main challenge of dispatch phase. The response on scene was hampered by large numbers of lay bystanders. The over-crowding around the emergency units disrupted the medical care procedures in hospital phase. CONCLUSION: This case highlights over-crowding and laypeople interference at the scene disrupts the relief and rescue. To solve these challenges, the public education and police monitoring and control is recommended. Establishing a unified command post at the scene can facilitate effective coordination among relief and rescue organizations.

The prevalence of sexual violence during pregnancy in Iran and the world: a systematic review and meta-analysis.

BACKGROUND: Domestic violence during pregnancy is a public health crisis, because it affects both mother and fetus simultaneously, resulting in irreversible consequences for mothers and their newborns. This study was performed to determine the prevalence of sexual violence during pregnancy in the world and Iran as meta-analysis. METHODS: This study is a meta-analysis on the prevalence of sexual violence during pregnancy in the world and Iran that was conductedon Persian and English published articles up to 2015. To this end, through searching the information by key words and their compounds at SID, Medlib, Irandoc, Google scholar, Pubmid, ISI, Iranmedex, Scopus and Magiran, all related articles were extracted independently by two trained researchers. The results of studies analyzed using the STATA and Spss 16 software. RESULTS: In the initial searching of 167 articles, 33 articles related to Iran, 40 articles related to other parts of the world and totally 73 articles met inclusion criteria for study. The prevalence of sexual violence during pregnancy were estimated in the world 17% (CI 95%: 15% -18%) and in Iran 28% (CI 95%: 23%-32%). The prevalence of sexual violence during pregnancy in Iran is 11 percent more than the world. CONCLUSIONS: According to the present meta-analysis results, the prevalence of sexual violence during pregnancy in Iran is high. Given that sexual violence during pregnancy causes damage to the mother and infant, it is recommended that the relevant authorities with the implementation of intervention and educational programs reduce the prevalence of sexual violence during pregnancy.