Factors Affecting the Functional Preparedness of Hospitals in Response to Disasters: A Systematic Review.

Objective: This study aimed to comprehensively determine the factors that affect the hospitals' functional preparedness in response to disasters. Methods: A systematic review of studies published in English and Persian up to the end of 2022 was performed by searching PubMed Central, Web of Science, Scopus, ProQuest, SID, and Elmnet databases. Articles that assessed hospitals' functional preparedness were searched by using a combination of medical subject heading terms and keywords including disaster, emergency, preparedness, hospital preparedness, health care facilities preparedness, hospital functional preparedness, health care facilities functional preparedness, readiness, and effective factors. Additionally, journals and gray literature were manually searched. Two independent reviewers screened the eligible papers. The inclusion criteria were the full text should be published up to the end of 2022, in both Persian and English, and focus on hospital preparedness. The extracted data were manually analyzed, summarized, and reported using the content analysis method. Results: Of the 3465 articles, 105 studies were eventually included in the final analysis. Eighty-two influential factors were identified and classified into seven categories: government, coordination, control, and commanding (7 factors), existing guidelines and preparedness plans (12 factors), regulations (6 factors), supplying of resources (37 factors), education and training (8 factors), multi-layered information management and communication systems (8 factors), and contextual factors (4 factors). Conclusion: There are different dimensions of hospital preparedness for disasters, each of which is influenced by several independent factors. Addressing these factors will enhance the actual functional preparedness of hospitals encountering disasters.

The Effectiveness of Fluoride Varnish and Fissure Sealant in Elementary School Children: A Systematic Review and Meta-Analysis.

Background: Highly necessary to evaluate the effectiveness of preventive interventions to prioritize them at the community level. We aimed to systematically investigate the related studies on the effects of fluoride varnish and fissure sealant on dental caries in 6-12 children. Methods: We searched PubMed, EMBASE, Web of Science, Cochrane Library and Scopus databases using Fluoride Varnish, Fissure Sealant, Caries, and Oral Health keywords. The timeframe selected to search for articles is from 2000 to Dec 2020. CMA software: 2 (Comprehensive Meta-Analysis) was used to perform the meta-analysis. The intervention groups in this study were fluoride varnish and fissure sealants, each of them compared to the control groups. Results: We included nine studies. In the intervention group 84,380 and control group 11,254 individuals were studied. Eight of the studies were Randomized Clinical Trial (RCT) and Field RCT, and two was non-RCT. In the overall Fluoride Varnish efficacy study, 4 were fully effective, 1 was ineffective, and all 4 were completely effective for Fissure Sealant. There was a significant difference between decayed, missing, and filled permanent teeth (DMFT) and decayed, missing, and filled primary teeth (dmft) indices in both interventions and comparison groups. Moreover, the mean difference of DMFT for Fluoride Varnish and Fissure Sealant in the intervention and control groups were -0.55 and -0.29, respectively (P=0.00). Conclusion: Due to the efficacy of fissure sealant and fluoride varnish in preventing dental caries in children aged 6-12 yr, these interventions can be considered as health priorities of societies and health systems interventions in countries.

The Effect of the COVID-19 Pandemic on Non-Communicable Disease Prevention and Management Services in the Primary Health Care System of Iran.

Background: The COVID-19 pandemic has caused significant disruptions in the provision of non-communicable disease (NCDs) prevention and control services in many countries, and there is a concern that it would lead to long-term complications of the diseases. The aim of this study is to assess the changes in the provisions of selected NCD services before and after the COVID-19 epidemic in Iran's primary healthcare system. Methods: In this descriptive-analytical retrospective study, the number of eight NCD services provided during the first 10 months of the COVID-19 pandemic from Feb 2020 to Dec 2020 were compared with the same period in the previous year using the data from the Iranian integrated electronic health record system (SIB) and also the association between the number of deaths due to COVID-19 and a sample of NCD services were assessed using cross-correlation analysis. The statistical analysis was performed in Stata Software v.14. Results: The NCD services have decreased by an average of 18.89% compared to the same period in the previous year; this decline was much more severe at the beginning of the epidemic period (up to 75% in some services) and was greater in physician-provided services than in non-physician services. Also, examining the course of the selected services during this period, a gradual compensation was evident after the initial reduction. Conclusion: The general trend of the selected services of prevention and control of NCDs in the PHC system of Iran within 10 months after the onset of COVID-19 showed a sharp decline and subsequent gradual compensation. Although the process of compensation in some services may be considered somewhat reassuring, in the case of some essential services, more effort and attention to the implementation of programs or compensatory policies seem necessary.

The Utility of rRT-PCR in Diagnosis and Assessment of Case-fatality rates of COVID-19 In the Iranian Population. Positive Test Results are a Marker for Illness Severity.

The utility of PCR-based testing in characterizing patients with COVID-19 and the severity of their disease remains unknown. We performed an observational study among patients presenting to hospitals in Iran who were tested for 2019-nCoV viral RNA by rRT-PCR between the fourth week of February 2020 to the fourth week of March 2020. Frequency of symptoms, comorbidities, intubation, and mortality rates were compared between COVID-19 positive vs. negative patients. 96103 patients were tested from 879 hospitals. 18754 (19.5%) tested positive for COVID-19. Positive testing was more frequent in those 50 years or older. The prevalence of cough (54.5% vs. 49.7%), fever (49.5% vs. 44.7%), and respiratory distress (43.0% vs. 39.0%) but not hypoxia (46.9% vs. 56.7%) was higher in COVID-19 positive vs. negative patients (p<0.001 for all). More patients had cardiovascular diseases (10.6% vs. 9.5%, p<0.001) and type 2 diabetes mellitus (10.8% vs. 8.7%, p<0.001) among COVID-19 positive vs. negative patients. There were fewer patients with cancer (1.1%, vs. 1.4%, p<0.001), asthma (1.9% vs. 2.5%, p<0.001), or pregnant (0.4% vs. 0.6%, =0.001) in COVID-19 positive vs. negative groups. COVID-19 positive vs. negative patients required more intubation (7.7% vs. 5.2%, p<0.001) and had higher mortality (14.6% vs. 6.3%, p<0.001). Odds ratios for death of positive vs negative patients range from 2.01 to 3.10 across all age groups. In conclusion, COVID-19 test-positive vs. test-negative patients had more severe symptoms and comorbidities, required higher intubation, and had higher mortality. rRT-PCR positive result provided diagnosis and a marker of disease severity in Iranians.

Health Care Waste Management Improvement Interventions Specifications and Results: A Systematic Review and Meta-Analysis.

BACKGROUND: Given the importance of proper management of Health Care Waste Management (HCWM), comprehensive information on interventions in this field is necessary. Therefore, we aimed to systematically review and meta-analysis of characteristics and results of interventions in the field of HCWM. METHODS: The required data were gathered through searching the keywords such as waste management, biomedical waste, hospitals waste, health care waste, infectious waste, medical waste, Waste Disposal Facilities, Garbage, Waste Disposal Facilities, Hazardous Waste Sites in PubMed, Scopus, EMBASE, Google scholar, Cochrane library, Science Direct, web of knowledge, SID and MagIran and hand searching in journals, reference by reference, and search in Gray literatures between 2000 and 2019. CMA software: 2 (Comprehensive Meta-Analysis) was used to perform the meta-analysis. RESULTS: Twenty-seven interventions were evaluated. Most of the studies were conducted after 2010, in the form of pre and post study, without control group, and in hospital. Interventions were divided into two categories: educational interventions (19 studies) and multifaceted managerial interventions (8 studies). The most studied outcome (in 11 studies) was KAP (knowledge, attitude and practice). The mean standard difference of interventions on KAP was estimated 3.04 (2.54-3.54) which was significant statistically (P<0.05). Also, interventions were considerably effective in improving the indicators of waste production amount, waste management costs and overall waste management performance. CONCLUSION: Despite positive effect of interventions, due to the methodological deficiencies of published studies and high heterogeneity in results of studies, caution should be exercised in interpreting and using the results of the studies.

Physiological Equivalent Temperature Index and mortality in Tabriz (The northwest of Iran).

There are few epidemiological studies about climate change and the effect of temperature variation on health using human thermal indices such as the Physiological Equivalent Temperature (PET) Index in Iran. This study was conducted in Tabriz, the northwest of Iran and Distributed Lag Non-linear Models (DLNM) combined with quasi-Poisson regression models were used to assess the impacts of PET on mortality by using the DLNM Package in R Software. The effect of air pollutants, time trend, day of the week and holidays were controlled as confounders. There was a significant relation between high (30°C, 27°C) and low (-0.8°C, -9.2°C and -14.2°C) PET and total (non-accidental) mortality; and a significant increase in respiratory and cardiovascular deaths in high PET values. Heat stress increased Cumulative Relative Risk (CRR) for total (non-accidental), respiratory and cardiovascular mortality significantly (CRR Non Accidental Death, PET=30°C, lag 0-30=1.67, 95%CI: 1.31-2.13; CRR Respiratory Death, PET=30°C, lag 0-13=1.88, 95%CI: 1.30-2.72; CRR Cardiovascular Death, PET=30°C, lag0-30=1.67 95%CI: 1.16-2.40). Heat stress increases the risk of total (non-accidental), respiratory mortality, but cold stress decreases the risk of total (non-accidental) mortality in Tabriz which is one of the cold cities of Iran.

Preoperative Education and Decreasing Preoperative Anxiety Among Children Aged 8 - 10 Years Old and Their Mothers.

BACKGROUND: Preoperative anxiety is associated with adverse clinical, behavioral, and psychological outcomes. Various effective interventions targeting preoperative anxiety in children exist. OBJECTIVES: The aim of this study was to evaluate the educational intervention by residents on children and maternal anxiety and their satisfaction from anxiety management. PATIENTS AND METHODS: After obtaining the institutional ethics committee approval and written informed parental consent, 36 ASA-I, II children (age range, 8 - 10 years) underwent small operations were included in this prospective randomized study. The participants were allocated into the intervention (n =18) and control (n =18) groups. Children in the first group were prepared routinely. In the second group children and their mothers received data about anesthesia and operation by the booklet. Children-maternal anxiety was assessed using the anxiety level form, at the night and in the morning before surgery. Few days after surgery mothers, residents, and children experiences and satisfaction from anxiety management were assessed in the focus group discussion. RESULTS: Mean scores and standard deviations of state anxiety in the intervention group before and after training were 33.1 ± 5.5 and 30.8 ± 6, respectively (P = 0.06). In the control group it was 32 ± 6.5 on the night and 34.1 ± 6.7 in the morning before surgery (P = 0.00). Comparison between groups was not significant (P = 0.6) and (P = 0.1). The mean levels of anxiety in the control group mothers on the night before and in the morning of surgery were 39.2 ± 13.1 and 42.8 ± 14 (P = 0.00), respectively. In the intervention group, mothers' anxiety before education was 41 ± 12.7 and after education it was 35.6 ± 9.5 (P = 0.04). Comparison between groups was not significant (P = 0.7) and (P = 0.1). According to the focus group discussions, booklet study, provided education, sympathy of medical team, spiritual issues and beliefs reduced anxiety and fear of surgery. Anesthesia and lack of knowledge of what will happen, crying and restlessness of children increased preoperative anxiety. CONCLUSIONS: In this study, the preoperative anxiety was reduced by explaining anesthesia and surgery to the mothers and children (in mothers it was significant P < 0.05). Since there is a direct relation between mothers' and their children's anxiety, using an effective method to reduce anxiety in children and their mothers together at the same time would be very useful for children and their mothers.

Initiation and continuation of smoking in iran: a qualitative content analysis.

BACKGROUND: Smoking is the cause for many preventable deaths worldwide. The rate of smoking has not increased in Iran in the past two decades, but its increase among adolescents and young adults is a concern. This study investigates the risk factors of initiation and continuation of smoking in Iran using a qualitative approach. METHODS: This is a qualitative content analysis study conducted on 12 smokers and 6 non-smokers in 4 selected cities in Iran. Data were collected with deep and semi-structured interviews, verbatim transcription and simultaneously coding. Then, they were analyzed through content analysis. RESULTS: Three themes and 16 subcategories emerged. The themes were personal inefficacy with 6 subgroups included inadequate information, low age, curiosity, consideration of smoking not as a major problem, wrong beliefs, and making reasons. Family inefficacy with 4 subgroups included poor authority, lack of reaction, existence of stressors, and history of smoking. Vulnerable social environment with 6 subgroups included poverty, social stressors, magnification of smoking, network of cigarette smoking, smoking as a norm and convenience of access. CONCLUSION: Recognition of smoking among children, modification of wrong beliefs about smoking, empowerment of the individuals against smoking from the very childhood, consideration of familial stress and crisis, and ultimately, paying attention to the role of social variables will play a major role in prevention of smoking and encouraging individuals to quit smoking.