Challenges and Barriers to the Participation of Non-Governmental Organizations (NGOs) in Flood Management: A Qualitative Study from Iran.

OBJECTIVE: Floods are one of Iran's most important natural hazards, which cause a lot of damage every year. Various organizations, including non-governmental organizations (NGOs), participate in flood management. The present study aimed to explore the challenges and barriers of NGOs' participation in the management of the flooding in Iran based on stakeholders' experiences. METHODS: This qualitative study is a case study that was conducted using the content analysis approach. Fifteen participants, including 3 national managers, 2 volunteers active in responding to recent floods, and 10 NGO managers/secretaries who had the knowledge or operational experience of participating in disaster management, were approached for interviews. Data were collected using a purposeful sampling method and continued until reaching data saturation. RESULTS: Challenges and barriers to NGOs' participation in flood management were categorized into 4 main categories and 14 subcategories, including policy-making challenges, managerial challenges, executive challenges, and socio-cultural challenges. CONCLUSIONS: As multiple NGOs take part in responding to disasters and performing relief operations, establishing a unified command and supervision system for effective coordination and collaborations among NGOs and other stakeholders is highly suggested. Further research is needed to develop a measurement tool for assessing the effectiveness of NGOs' activities during disasters.

Assessment of Intraorganizational Collaboration in the health sector during Disasters: Exploring a Valid and Reliable Assessment Tool for Disaster Risk Management.

Background: Collaboration, as a key factor in disaster risk management, is a mechanism that prevents the loss of time, investment, and resources. The variety of units in the health sector has made collaboration a major challenge. The present study aimed at developing a tool for assessing collaboration in the health sector during disasters. Methods: In this mixed-methods study, a questionnaire was developed by integrating the findings of a systematic literature review and a qualitative study. Face and content validation were performed. The reliability of the tool was tested through a 15-day interval test-retest by Cronbach's alpha and intraclass correlation coefficient (ICC) with 30 participants. Confirmatory factor analysis was done to test the validity and reliability of instrument using SmartPLS in a case study with 450 health sector staff. Results: The factors affecting intraorganizational collaboration of the health sector were identified in six categories and 19 subcategories by searching 46 articles in the systematic review and content analysis of 16 semistructured interviews with health sector staff. The results of content validity ratio (=0.81), content validity index (=0.92), Cronbach's alpha (=0.975), and ICC (=0.970) confirmed the validity and reliability of the tool. Convergent validity, discriminant validity, and reliability were approved by AVE (average variance extracted) >0.5, Fornell and Larcker matrix, and CR (composite reliability) >0.7. According to the positive result of R 2, Q 2, and goodness-of-fit (GOF) criteria, the model fit was confirmed. Conclusion: The results of validity and reliability measurements approved the proposed tool. The use of this tool is recommended for developing collaboration in the health sectors of different countries.

Risk Assessment of Arbaeen Mass Gathering in the Covid-19 Pandemic.

Introduction: Arbaeen is a religious ceremony held annually with the participation of a large number of pilgrims. During the pandemic of Covid-19, a mass gathering of Arbaeen pilgrims can strengthen the transmission of this disease and put more pressure on the health care system of countries. The aim of the study is to evaluate the risk of Arbaeen ceremony in the Covid-19 pandemic in 2021. Materials and methods: A mixed method was performed to perform the study using qualitative and quantitative methods. A national risk assessment tool was used that consisted of hazard identification and assessment, scenario development, exposure assessment, vulnerability assessment and risk estimation. The national risk assessment tool was completed through a focused group discussion and the opinions of 20 representatives of the health system and the level of risks were estimated. Data were collected, analyzed, and integrated by the research team. Results: Based on the results of risk matrix analysis, factors such as the increase in the number of new cases of COVID-19, the probability of exposure to a new variant of COVID-19, the probability of arrival of a new variant of COVID-19 to the country, the probability of increasing referrals to healthcare facilities (score 16), the probability of getting respiratory diseases, and the environmental contamination (score 12) occupied the red area of the matrix and were found to have the highest risk (unbearable risk), that needs immediate action. Conclusion: Preparing for a mass gathering such as Arbaeen is very important in order to reduce the risk of communicable disease, and the first step in improving preparedness is risk assessment and its continuity in the various stages of the ceremony. Therefore, policy makers and planners of such events should conduct risk assessments with the participation of local and national public health authorities regularly.

A systematic review of health sector responses to the coincidence of disasters and COVID-19.

BACKGROUND: In December 2019, the Chinese city of Wuhan reported a novel pneumonia caused by COVID-19. While the COVID-19 pandemic has been increasingly affecting the world, the occurrence of disasters resulted in complex emergencies. The present review is aimed to identify the literature focused on health system response to coincidence of COVID-19 and disasters as well as describing their finding, implications and lessons-learned. METHODS: This study was conducted and reported based on PRISMA guideline. The databases of Web of Sciences, PubMed, Scopus, Google Scholar and World Health Organization Library were searched. The inclusion criteria were all forms of published articles which investigated the coincidence of disasters and COVID-19 pandemic. Using the title and abstract screening, the selections of studies were performed by two researchers. Once, the relevant papers were finalized, the analysis was done in two parts of descriptive analysis and implications for health systems. RESULTS: Out of 1245 studies generated by initial search, a number of 13 articles was selected for final analysis. Earthquake was the most frequent disaster which its coincidence with COVID-19 was studied by researchers (31%). The implications of researchers for healthcare system were explained in three sections of climatic events, earthquakes and all hazard approach in relation to COVID-19. CONCLUSION: Extracting the lessons learned from the regions affected by disasters at the time of COVID-19 pandemic can be helpful for healthcare professionals and policy-makers to improve their preparedness and response during disasters and a serious pandemic such as COVID-19. Further research is needed to identify the factors which strengthen the preparedness of health system for the dual risk of natural hazards and pandemics.

Prognosis of patients with tracheal intubation in the emergency department.

Background: Intubation of critically ill patients is one of the increasing emergency procedures. We designed this study to determine age and sex-related mortality rates after emergency intubation. Methods: This retrospective study collected and analyzed non-trauma intubated patients in a referral hospital from the years 2017-2019 and before the appearance of COVID-19. Patients who were intubated outside of emergency by EMS technicians were excluded. We recorded data of intubated patients, like sex, age, length of being intubated and final diagnosis. P values of less than 0.05 were significant. Results: Data of 520 non-trauma intubated patients were collected and analyzed. More than 64% of the patients were over 65 years old and had a higher mortality rate (86.7%; P < 0.001) than younger patients. The overall in-hospital mortality rate was 80%. More than three quarters of the decedents died within a week of intubation (P < 0.001). There was no significant relationship between sex and mortality rate (P = 0.535). Conclusion: Our data showed that with increased age there was a decrease in the chance of being extubated.

The Relationship between Nurse's Job Stress and Patient Safety.

BACKGROUND: Patient safety is a key element of the quality of health services. Nurses are the largest group that care for patients, observing safe in nursing care would reduce injuries, disability, morbidity and mortality. However, high stress can lead to a decline in the quality of nursing care. AIM: This study aimed to investigate the relationship between job stress of the nurses and patient safety in a teaching hospital of Hamadan in 2017. MATERIAL AND METHODS: This is a cross-sectional study. The data was gathered by a questionnaire of Nurse's job stress prepared by the researcher that after confirming the validity and reliability was completed by 198 nurses of three teaching hospitals of Hamadan city that were selected by simple random sampling and the checklist of patient safety that was collected by the researcher. Data analysis was done in the two levels of descriptive and analysis statistics. RESULTS: The results showed that the job stress of the nurses and patient safety (mean = 1.75 and SD = 0.114) have been at an average level. There was no statistically significant relationship between Nurse's job stress and patient safety because the Spearman correlation coefficient showed that r = 0.007 and p = 0.919. Among the demographic factors, there was only a significant relationship between marital status and Nurse's job stress (p < 0.05). CONCLUSION: Because of nursing job stress is affected by different working conditions, further studies in the many hospitals are needed. Moderate levels of patient safety are not acceptable; Therefore, heath's policymakers should focus on providing the safety of all patients at the optimal level, with more effort to reduce the stress of their nurses at the lowest level.

The Effect of Intravenous Ketamine in Suicidal Ideation of Emergency Department Patients.

INTRODUCTION: Suicidal ideation is an emergent problem in the Emergency Department (ED) that often complicates patient disposition and discharge. It has been shown that ketamine possesses fast acting antidepressant and anti-suicidal effects. This study was conducted to examine the effects of a single intravenous bolus of ketamine on patients with suicidal ideations in ED. METHODS: Forty-nine subjects with suicidal ideations with or without an unsuccessful suicide attempt, received 0.2 mg/kg of ketamine. Scale for suicidal ideation (SSI) and Montgomery-Abserg depression-rating scale (MADRS) were evaluated before and 40, 80 and 120 minutes after drug intervention. The results were compared using the paired t-test and patients were followed up 10 days after ED admission for remnant suicide ideation. RESULTS: SSI (df: 3, 46; F=80.7; p<0.001) and MADRS (df: 3, 46; F=87.2; p<0.001) scores significantly dropped after ketamine injection; the SSI score before and after 20, 40, and 80 minutes of ketamine injection were 23.0±6.7, 16.2±5.2, 14.3±4.3, and 13.6±4.0 respectively. The MADRS scores were 38.2±9.3, 25.6±7.1, 22.7±6.3, and 22.1±5.95 at the same time intervals. 25.5% of patients were hospitalized, 63.3% received medications and 12.2% discharged. 6.2% of patients had suicidal ideations ten days after ED disposition. CONCLUSION: It seems that Ketamine could not be a good choice for fast reduction of suicidal ideations in ED patients. Further studies are needed to determine the optimal dose of ketamine for different patients.