Introduction: A national road safety strategic plan (NRSSP) is considered as one of the main road safety management issues in different countries. Such a plan not only determines the vision and relevant strategies but also causes the implementation of appropriate interventions to be coordinated and strengthened to achieve the goals set by partner organizations. The present study mainly aims to report Iran's NRSSP 2021–2031 development protocol. Methods: According to a schedule, the study protocol consists of ten sections: (1) Determining a core planning center, (2) Establishment of a steering committee, (3) Stakeholder identification, (4) Identification and development of Goals and Strategies, (5) Vision development, (6) Establishment of committees, (7) Integration of Goals and Strategies, (8) Goals and Strategies assessment, (9) Action plans development, (10) Monitoring and evaluation. An appropriate study method is performed for each of the concerned steps. Conclusion: The road safety strategy plan is a critical component to promote the effectiveness of activities and achieve the goals determined for road safety purposes. The Decade of Action for Road Safety is just being closed to its end; hence, reviewing and drawing up a road safety document concerning authentic scientific models and evidence is of paramount importance in Iran. The present study takes over the mission to address this gap.

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Background: Identification of risk factors involved in road traffic deaths (RTDs) could help policymakers and road traffic managers to adopt effective strategies and approaches for the prevention and control of these incidents, while the lack of accurate data on the risk factors of RTDs causes the problem to persist. This systematic review aimed at assessing the national studies regarding the risk factors of RTDs in the regions covered by the World Health Organization (WHO). Methods: This review study was conducted during 2008–2018 via searching in databases of PubMed, Science Direct, Scopus, Cochrane, Thomson Reuters, Web of Science, EMBASE, ProQuest, and Trip databases. Initially, a literature review was performed to find similar systematic reviews, followed by another literature review to retrieve the published or registered protocols. At the next stage, PECOTS was developed for the search strategy, followed by the quality assessment. The eligibility criteria in this study were the national-level studies about the risk factors related to RTDs, English-language studies, and studies published during 2008–2018. Results: In total, 169 articles were included in this study, with the highest and lowest number of the published articles in the United States and African countries, respectively. According to the reviewed studies, human factors accounted for the most common risk factors involved in RTDs. In the southeastern regions of Asia, the main road-related risk factor for RTDs was reported to be the type of roads. Furthermore, roadside departure to the right side and long roads were denoted in the national data of the Western Pacific region on the incidence of RTDs. Differences were observed between the six regions covered by the WHO in terms of the time-related risk factors for RTDs. Conclusions: Several risk factors have been reported for RTDs in the countries covered by the WHO, and each risk factor is considered to have various subcategories. Therefore, it could be concluded that there are different epidemiological patterns for road traffic accidents and RTDs.

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Background and Objectives: Road traffic accidents (RTAs) are the second cause of death, the first leading cause of years of life lost due to premature mortality, and the most common source of injury in Iran. According to the World Health Organization estimates, Iran located in the countries that have the highest rates from RTAs. The present study aimed to measure road traffic mortality rates and also to depict a view of the trend for a period of 11 years which started from 2006 to 2016. Materials and Methods: In this cross-sectional study, we collect data on all road traffic deaths in Iran between 2006 and 2016 using records from the Legal Medicine Organization. For doing this research, demographic and epidemiological data of the deceased were extracted using a checklist designed by the forensic experts. Content validity of this form was determined by obtaining comments of professors and scholars in the field. Directly standardized mortality rates were calculated. Finally, the information was analyzed by descriptive statistics. Results: During the 11-year period of this study, 226,514 people in Iran died from RTAs. The age-adjusted mortality rate that caused by road traffic decreased from 41.5/100,000 people in 2006 to 20.4 in 2016 during the study period. There were significant differences in mortality rates between males and females and between outside city and inside city roads. The age-adjusted mortality rate was significantly higher among men than in women. The majority of death has occurred in illiterate young men aged 15–34 years and also in self-employed people. Conclusions: During the 2006–2016, mortality from RTAs decreased from 41.5 to 20.4/100,000 populations. This decreasing trend was observed in both sexes and in outside city and inside city roads. However, this reduction trend in the last years of the study is not suitable. These findings highlighted that training programs and harm reduction approaches for reducing the mortality from traffic accident are still needed.

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Background: Due to the extensive use of subway transportation in high- and middle-income countries, the safety of passengers has become one of the important challenges in emergency management of subway station. Therefore, the present systematic review aimed to identify environmental and organizational management factors that affect the safe emergency evacuation in subway stations. Materials and Methods: In this systematic literature review, PubMed, Scopus, Web of Science, ProQuest, Google Scholar, Iran Medex, Magiran, and Scientific Information Database from 1990 to 2019 were searched to identify effective emergency management factors in safe emergency evacuation of the subways. A thematic content analysis was employed for data analysis. Results: Of 763 publications retrieved from the searches, 149 studies were included for data analysis. According to the findings, effective environmental and organizational management factors in safe emergency evacuation were discussed in eight subcategories, including infrastructure properties, evacuation-assisting resources, prevention of injuries and mitigation, preparedness for emergency evacuation, emergency response and reconstruction, and maintenance of evacuation facilities. Conclusion: The design of an optimal route for emergency evacuation is the main theme of most studies focusing on environmental factors. While a system approach for designer is needed for effective subway emergency evacuation, human-related factors focusing on injury prevention are also crucial.

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Background: Fear of falling has been reported in various societies for different reasons and affects the quality of life of older adults. The present study was conducted to determine the level of fear of falling and related factors in older adults in the city of Kashan in 2017. Materials and Methods: In this cross-sectional study, 414 older adults living in the city of Kashan, in 2017, were selected by cluster sampling. Data were collected using a demographic questionnaire (including age, gender, number of children, having a caregiver, education, marital status, occupation, smoking, alcohol use, use of anxiolytic medication, history of diseases, ability to carry out daily tasks, history of fall, injury due to fall, osteoporosis, access to medical care, access to social supports, walking aids, living alone, income, housing, insurance, and insomnia), and Falls Efficacy Scale-International (FES-I), and then were analyzed using Chi-square and logistic regression. Results: Fear of falling was low in 63.3% of the older adults, moderate in 22.7%, and intense in 4.3%. Fear of falling showed a significant relationship with age, having a caregiver, education, history of taking anxiolytic and hypnotic medications, history of psychosomatic diseases, ability to perform daily tasks, history of falling, injury caused by falling, use of walking aids, access to social support in case of emergency, and income. Multivariate analysis showed that fear of falling in older adults had a direct relationship with age of over 70 years (odds ratio [OR] = 3.24), history of use of anxiolytic and hypnotic medications (OR = 0.26), and illiteracy (OR = 0.37). Conclusion: The results showed that a high percentage of participants suffered fear of falling, of whom one-third had moderate-to-severe fear. Age, use of anxiolytic medications, and illiteracy were effective in increasing the risk of fear of falling in older adults. Further studies and appropriate measures are required in this regard.

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Background: Postmortem examination is indispensable to ascertain the cause of an unnatural death and as such is mandatory by the law. From ages, traditional autopsy (TA) has proved its worth in establishing the cause of death in the deceased despite some inherent difficulties and challenges and has enjoyed an insurmountable status. The increasing use of application of the modern-day radiology for postmortem examination has however opened a new arena overcoming some of the difficulties of the TA. There are conflicting reports in the published literature regarding superiority of one modality of the postmortem over the other. Objective: The objective of this study was to compare the findings of postmortem computed tomography (CT) scan and TA in the victims of traumatic deaths and to analyze whether postmortem CT can be used to replace TA. Materials and Methods: All patients with a history of trauma that were declared brought dead on arrival in the emergency department were subjected to full-body CT scan. An experienced radiologist reported the findings of CT scan. Subsequently, a forensic expert subjected the patients to TA. The physician who performed autopsy was blinded to the findings of CT scan and vice versa. An individual who was not part of the radiology or forensic team then entered the findings of CT scan and autopsy in a predesigned Pro forma. An unbiased assessor finally compared the findings of the two modalities and analyzed the results. McNemar's test was used to ascertain the level of significance between the findings reported by these two modalities considering P = 0.05 as statistically significant. The agreement or disagreement on cause of death reported by these two modalities was also assessed. Results: About 95% of the deceased were males. The mean age of the corpses was 35 years (range 16–67 years). CT was found superior in picking up most of the bony injuries, air-containing lesions, hemothorax, and hemoperitoneum. However, autopsy was found more sensitive for soft-tissue and solid visceral injuries. Both modalities were equally helpful in identifying extremity fractures. Statistically significant agreement (>95%) on cause of death by both modalities was not achieved in any patient of trauma. Conclusion: Postmortem CT scan is promising in reporting injuries in traumatic deaths and can significantly complement the conventional autopsy. However, at present, it cannot be considered as a replacement for TA.

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The increasing prevalence of drug-resistant Pseudomonas aeruginosa in burned patients is one of the main public health problems worldwide. Although drug-resistant P. aeruginosa in burn units is frequent in some countries and unusual in others, the level of this conditions is not precisely known in Iran. Imipenem is one of the most potent agents against P. aeruginosa. Imipenem resistance is a major obstacle to treatment of P. aeruginosa infections. We aimed to determine the true prevalence of imipenem-resistant P. aeruginosa in Iranian burned patients according to the Preferred Reporting Items for Meta-Analyses statement. Moreover, resistance to several potent anti-P. aerugi nosa drugs were indicated according to the Clinical and Laboratory Standards Institute guidelines for the disc diffusion method. Several databases including Web of Science, Scopus, PubMed, Scientific Information Database, Magiran, Iranmedex, and science direct were searched to get studies addressing drug-resistant P. aeruginosa in Iranian burned patients from March 2006 to May 2015. A total of 34 reports available from different areas of Iran were included in the current study. The meta-analyses showed that 54.9% of P. aeruginosa were resistant to imipenem. The most common resistance was seen against ceftazidime (66.9%), followed by ciprofloxacin (52.9%) and cefepime (52.3%). It is necessary to know the epidemiology of drug-resistant P. aeruginosa because it can promote control strategies for decreasing their prevalence. The high incidence of drug-resistant P. aeruginosa in Iran emphasizes the need for precise drug susceptibility testing, continuous monitoring of drug resistance, especially in burn units, use of sensitive methods for the laboratory diagnosis, and close relation between physician and laboratories.

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Background and Objectives: Due to the high rate of pedestrian deaths in traffic accidents and given that describing demographic profiles of pedestrian deaths and features of accident locations is an important factor in the prevention, management, and analysis of road traffic accidents, this study aimed at describing the demographic and personal patterns as well as environmental factors affecting the occurrence of road traffic accidents among pedestrians in Iran. Materials and Methods: This cross-sectional study was conducted on all pedestrian deaths caused by traffic accidents referred to the Forensic Medicine Organization in Iran from March 20, 2012, to March 19, 2013. In this study, demographic information as well as the information related to the accidents and other information including trauma location, the final cause of death, date of accident, date of death, time of death, and time of accident were examined. The information received from the Forensic Medicine Organization was first controlled and then analyzed using the Stata 11 software. Results: From a total of 4371 pedestrians died in 2012 due to traffic accidents, 3201 cases (73.2%) were males with a mean age of 48.1 ± 0.46 years, and 1170 cases (23.8%) were females with the mean age of 46.1 ± 0.77 years. In terms of age, education, and marital status, the highest frequencies of pedestrian deaths were, respectively, observed in the age group 65 years old and above (33.4%), the illiterate group (44.5%), and married people (67.9%). The highest and the lowest incidence rates of death were seen in Gilan (11 per 1000 people) and South Khorasan Provinces (2.4 per 100,000), respectively. Conclusions: Pedestrians as the most vulnerable people in traffic accidents comprise a large proportion of deaths and disabilities caused by road traffic accidents. It seems necessary to take some measures including paying special attention to physiological characteristics of the age group above 65 years old, doing close monitoring by the traffic police in October and the rush hours, and providing facilities for pedestrians to cross in busy locations of suburban areas.

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Background: Trauma surgery has an interdisciplinary nature among the surgical specialties, and trauma surgeons are required to identify its related scientific fields to acquire the needed skills in controlling the injuries. This study was conducted to investigate the science mapping of trauma surgery based on the bibliographic data of MEDLINE. Methodology: Based on the bibliographic data from the MEDLINE database, the visualizing techniques of bibliometric networks and all the scientific products of the trauma surgery realm indexed at MEDLINE from 2008 to 2017 were investigated. Data analysis was performed using co-word analysis and cluster analysis using the VOSviewer. Results: The growth trend of scientific productions in the field of trauma surgery has been on the rise in the past 10 years. The keyword “trauma,” followed by “osteoporosis,” “fracture outcome,” “trauma surgery,” and “mortality” had respectively the highest frequency. The results of cluster analysis identified the most important basic research subjects of trauma surgery published in MEDLINE in the past 10 years and categorized them into five clusters. Trauma surgery field had a close relationship with the field of orthopedics, basic studies, and laboratory research in comparison with its clinical domains. Conclusion: We attempted to identify the vastness of the knowledge subjects of trauma surgery and to conduct educational research, and technological planning so that the managers and stakeholders can trace the path of future scientific activities in the field of trauma surgery. The identification of this important realm and provision of the required information on the core issues for the users can be facilitated by drawing up a science map and visualizing the main traumatic sciences.

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Background: Burn prevention strategies are most effective when they are based on knowledge of etiological patterns of burn injuries and considering the geographical variations and socioeconomic differences in burn epidemiology. In this regard, this study aimed to investigate the etiology and outcome of burns in Hamadan, Iran. Materials and Methods: This registry-based, cross-sectional study was conducted on 798 burn patients admitted to the Besat Hospital from March 2013 to February 2018. The medical records of all the patients were extracted from hospital information system. Results: In males, the most common cause of burn was gas explosion (41.4%), whereas in females, the most common cause was hot liquids (37.1%). In below 5 years and 6–15 years age group, burning with hot liquids was the common cause of burn, whereas in other age groups, gas explosion was the common cause of burn. In the present study, 6.9% of the patients died because of their burns. With increasing age, the odds of death increases, so that patients between 30 and 59 years had 2.2 fold (P = 0.02) and patients ≥60 years had 3.5 fold (P = 0.006) higher odds of death compared to patients aged <30 years. Conclusion: Findings of the present study show that males and people aged 26–40 years and children 0–5 years were at a greater risk of burns. Furthermore, this study shows that self-immolation with a high rate of case fatality should be considered as a mental health challenge, and it is necessary to design preventive strategies to reduce it.

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Background and Objectives: The aim of the present study is to determine plasma and cerebrospinal levels of YKL-40, in combination with neuron-specific enolase (NSE), interleukin (IL)-6, tumor necrosis factor (TNF)-α, and the clinical scales such as Glasgow Coma Scale, Acute Physiology and Chronic Health Evaluation a III, and MARSHALL classification in traumatic brain injury (TBI). Materials and Methods: This was a prospective study conducted on patient cohort of 27 patients with isolated severe TBI. Cerebrospinal fluid (CSF) and plasma were collected on the 24^th and 96^th h after trauma. CSF samples were obtained also from forensic autopsies of 29 adult healthy cadavers. Results: The CSF level of YKL-40 in TBI patients was higher compared to controls, while no significant change between CSF NSE levels in patients and controls was found. We determined a strong correlation between YKL-40 and NSE levels and TBI clinical assessment scores. The analysis of the influence of independent prognostic factors on the outcome of TBI patients showed that plasma NSE concentrations are the major independent variable which is associated with the survival of TBI patients. Still, changes in IL-6 and TNF-α levels could not be considered as reliable predictors of mortality. Conclusion: We present data for correlation of YKL-40 and NSE levels with clinical scores for assessment of trauma severity and the outcome of TBI patients. Even though further large-scale investigations are required to clarify and evaluate the clinical significance of both biomarkers, our findings suggest that YKL-40 and NSE might be implicated in the pathogenesis of TBI and could indicate the degree of neuroinflammation and brain damage.

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Background: The burden of traffic accidents on pedestrians is very high in Iran. Since the pattern of injury is different in urban and suburban accidents, this study was conducted to identify the risk factors associated with pedestrian mortality in urban and suburban traffic accidents in Tehran and Alborz Provinces. Materials and Methods: The data of all traffic accidents related to pedestrians in Tehran and Alborz Provinces were investigated from two databases of traffic police and forensic medicine. The effects of demographic variables (age and gender) and pedestrian position, time, accident location, and vehicle type on the outcome of pedestrian death were investigated. Multiple logistic regression was used to analyze the data. The significance level was considered <0.05 and statistical analyses were performed using STATA version 12. Results: From a total of 10742 pedestrians, 6804 males (63.3%) and 3938 females (36.7%) were studied in traffic accidents. In urban accidents, the effects of pedestrian age such as 35–64 years and >65 years compared to 15–24 years (odds ratio [OR]: 2.04, confidence interval [CI]: 1.26–3.3), (OR: 4.8, CI: 2.9–7.9), male gender (OR: 2.26, CI: 1.6–3.1), lighting condition at night compared to day (OR: 1.6, CI: 1.2–2.1), two-way not divided road versus one-way road (OR: 1.6, CI: 1.12–2.3), the status of day after holidays compared to normal days (OR: 1.53, CI: 1.09–2.14), type of vehicle such as heavy or semi-heavy and conventional or pickup versus motorcycles or bicycles (OR: 5.4, CI: 3.1–8.9) and (OR: 1.8, CI: 1.2–2.7) and pedestrian position at crossing the road from an unauthorized route compared to crossing the road from the authorized route (OR: 1.94, CI: 1.4–2.6) were significant on the fatality. Whereas in suburban accidents, there was a statistically significant correlation with pedestrian fatality only in two-way divided road compared to one-way (OR: 0.2, CI: 0.05–0.77). Conclusion: The present study showed that risk factors for pedestrian mortality are different in urban and suburban traffic accidents. It is necessary to take appropriate measures in urban and suburban areas to reduce the severity of injuries in pedestrians.

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Background: Petrochemical industry has experienced a variety of accidents and the number of emergency situation in this industry is high. Therefore, prioritizing these situations is important. The aim of this study was to determine the effective criteria for the selection of emergency scenario and prioritize them for corrective actions. Subjects and Methods: Delphi technique was used to determine and prioritize the appropriate criteria for the selection of high-risk emergency scenarios. Then, the weights of selected criteria were obtained using fuzzy hierarchical analysis and finally, using the fuzzy TOPSIS technique, the criteria for emergency scenarios were prioritized for corrective actions. Results: The most important criteria for the selection of dangerous emergencies included the amount of loss, damage, and probability. According to the weight of these criteria, emergency situations were prioritized. The most important emergencies included fire in the chemical storage, hydrogen leakage at the cylinder fitting in the Alfin unit, and extreme gas leakage in one of the power plant turbines. Conclusions: Using this approach, high-priority emergencies can be identified, and it is suggested that planning for controlling these situations and preventing crises should be prioritized by managers.

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Background: Needlestick and sharp injuries have been identified as the most dangerous factor among health-care workers. The Centers for Disease Control and Prevention estimates that 385,000 health-care workers experience needlestick each year. Methods: The aim of this study was to determine the prevalence of needlestick injuries (NSIs) in Iranian health-care workers. In this review and meta-analysis, the local and international databases such as Scopus, Medline, PubMed, ScienceDirect, Web of Science, Google Scholar, Scientific Information Database (SID), and Magiran were searched using keywords including “prevalence” OR “needle” OR “needle stick” OR “Sharp injury” OR “Iranian personnel's” OR “Iranian health care workers” OR “Iranian hospitals” OR “Iran.” The original researches that determined the prevalence of NSIs among Iranian health-care workers and published from January 2005 to June 2019 were included in the current study. The pooled prevalence of NSIs was determined using a random-effects model with a 95% confidence interval. All analyses were performed using STATA version 11 (Stata Corporation, College Station, TX, USA). P < 0.05 was considered as a significant level. Results: The overall prevalence of NSIs among Iranian health-care personnel was about 50.8 (46.3–55.2). Furthermore, this prevalence in educational, noneducational, both noneducational and educational, and military centers was about 51.1 (46.5–57.7), 40.4.1 (34.2–46.6), 61.0 (32.1–89.9), and 41.5 (23.0–60.0), respectively. The prevalence of NSIs among the nurses was 51.1 (45.4–56.8), which was more than other groups. Conclusions: The prevalence of NSIs in Iranian hospitals was high. Since most of the injuries are caused by nurses, more intervention programs should be designed for nurses in these wards.

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Background: Considering the importance of pedestrian traffic crashes and the role of environmental and demographic factors in the severity of these crashes, this article aimed to review the published evidence and synthesize the results of related studies to determine any associations between demographic and environmental factors and the severity of pedestrian-vehicle crashes. Methods: All epidemiological studies published from 1970 to 2019 were searched in international electronic databases (PubMed [Medline], Scopus, Web of Science, Embase, ScienceDirect, and Ovid) and reference lists of the identified articles were also searched. Studies were included if they investigated the severity of pedestrian-vehicle crashes as outcome, measured any environmental and demographic factors for pedestrian-vehicular crashes as exposure, designed observational, and if they were written in all languages. Quality of included studies was evaluated using the strengthening the reporting of observational studies in epidemiology checklist for observational studies. Results: We found 3126 references among which 24 studies were included in this review. All retrieved studies were conducted between 1990 and 2019 and had a cross-sectional design. In most of these studies, the associations between environmental and demographic variables such as vehicle speed or speed limits, pedestrian age, lighting, type of road, type of vehicle, and alcohol intake with the severity of pedestrian traffic crashes were examined. Conclusion: This study showed that few studies were conducted in this area; in fact, most of the studies were carried out in metropolises of developed countries. As a result, studies which provide strong causal inferences by focusing on high-risk groups and a higher level of evidence such as cohort and case-control ones are needed in developing countries.

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Background: Injuries caused by home injuries in children under 5 years of age is one of the main causes of death in this group and also constitutes a significant public health burden. This review aimed at summarizing the literature on the effectiveness of interventions to prevent home injuries in children under 5 years of age. Methods: Magiran, Iran Medex, and SID in Persian Scientific databases and BioMed Central, PubMed, ScienceDirect, Web of Science, and Scopus were systematically searched for articles published up to June 2016. Then, two researchers reviewed the papers independently and finally, 14 studies fulfilled the inclusion criteria. Results: The results showed the effectiveness of intervention measures including training sessions at home, home visit, group discussions, and interviews as the educational tools. The educational approach was used as the intervention in 11 studies; legislative/incentive approach and engineering/technology approaches had not been used in papers; and three studies had used the educational intervention and engineering/technological approaches. Conclusions: Most of the effective inventions included studies that used the combination of effective methods to reduce the risk of injuries. Since the accidents are preventable, the appropriate intervention strategies, especially active intervention or a combination of interventional measures are effective to reduce the risk of home accidents and injuries in children.

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Circular saws and angle grinders are two of the most dangerous pieces of electrical equipment on a worksite. Besides the danger that any high-powered, sharp piece of equipment possesses, these pieces use circular saw blades that can splinter into projectile fragments. A 60-year-old male was cutting a steel pipe with a circular saw when a fragment of the 12-inch blade flew off, impaling him in the upper face just to the right of the midline. He was wearing eyeglasses, the bridge of which was driven into his skull on impact of the fragment. He was brought to the trauma center where he underwent imaging of his face and head. This revealed that the blade and his glasses had penetrated 1.2 cm into the right frontal lobe of the brain, resulting in facial fractures and intraparenchymal hemorrhage. He underwent bifrontal craniotomy, removal of the blade and his glasses, evacuation of hematoma, and dural reconstruction. Postoperatively, he was awake with a Glasgow Coma Scale of 15 and no neurologic deficits. The complex nature of craniofacial injuries makes a multidisciplinary approach to these patients essential. Prompt diagnosis and treatment by the appropriate specialists are vital to optimize patient outcomes.

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Background: Problems of emotional regulation and lack of social skills in veterans' families are very common and like psychological complications have unpleasant consequences for them. Therefore, effective and helpful interventions and therapies are highly important. Objectives: The current study aimed at evaluating the effect of mindfulness-based stress reduction (MBSR) on the improvement of emotional regulation and psychological well-being in veterans' homemakers with secondary posttraumatic stress disorder. Patients and Methods: In the current study, the permuted blocked randomization method was used. Participants were selected from veterans' homemakers referred to the counseling center of veterans in Kashan city (Iran) in 2015. They were randomly assigned into two groups (30 controls and 31 cases). The case group underwent the MBSR treatment. Results: Results showed no significant difference between the two groups at the baseline (P < 0.05). No significant difference was observed in the total score of MBSR on emotional regulation between the groups. However, the difference between pre- and post-test of rejection of emotional response subscale was significant. In addition, the total score in the psychological well-being at pre- and post-test was significant. Conclusions: It seems that MBSR significantly affects the psychological well-being, but it has no effect on the emotional regulation except the subscale of emotional response rejection.

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Background: Anterior cruciate ligament (ACL) tear is one of the most common types of knee injuries. Delay in diagnosis and treatment of ACL injuries can lead to further damage of the meniscus and cartilage. In this study, we tried to show the distribution of injuries over time and types. Methods: This retrospective study was performed on 336 patients with the diagnosis of primary ACL tear without other ligament injuries. The data including site and grade of the meniscal tear and cartilage damage, based on the International Cartilage Repair Society Classification, the time between diagnosis and surgical procedure, and the treatment method were collected. In this study, we divided patients into four groups according to injury to surgery time. Groups were 3 months, 3–6 months, 6–12 months, and over 12 months to surgery. Results: The results showed that a rate of cartilage damage had no significant correlation with a time interval between injury and surgery (P = 0.54). Furthermore, no significant correlation was found between the site of cartilage damage and the interval time after injury to surgery. The results indicated that the meniscal tear increases in case of a delay to perform surgery (P = 0.004). However, no significant relation was found between the site and pattern of meniscal injury and time. Moreover, patients with a complete ACL tear had a significantly higher rate of meniscus injury compared to those with a partial ACL tear (0.048). Conclusion: The findings of this study show that there is no significant relationship between the time of surgery and the risk of chondral damage after the ACL tear over time. ACL-ruptured patients should undergo the ACL reconstruction surgery up to 3 months from knee trauma to prevent further meniscal injuries.

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Background and Objectives: Road traffic accident (RTA) is one of the major public health problems. Inequality in this problem and its trend has not been yet investigated in Iran. A better understanding of different contributing factors to RTA like inequalities can be helpful to reduce the negative influence of road crashes. Hence, this study aimed at examining geographical inequality in mortality from RTAs over the previous decades. Materials and Methods: In this cross-sectional study, all people who died from RTAs from March 2006 to February 2015 were selected. The data were taken from Legal Medicine Organization in Iran. The Theil index was used to estimate geographical inequality in mortality from RTA. Data were then analyzed using the Stata software. Results: During the 10-year period of this study, 210,582 people in Iran died due to RTA. The mortality rate that caused by RTAs has decreased during the study. We found a larger reduction in a mortality rate in suburban RTAs. In spite of the reduction in RTAs death, geographical inequality increased during the 10-year study. Conclusions: The findings of this study indicate that there is a geographical inequality in mortality from RTAs in Iran. This implies that effective interventions in reducing the RTAs should be distributed equally among regions of the country. Further research can be performed to investigate the causes of this inequality.

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Background: Casting is the most common treatment for managing limb fractures. Casts that are not properly provided or are not correctly cared for may hinder the healing of fractures. However, no study assessed the quality of care before, during, and after casting. Objectives: This study aimed to investigate the quality of nursing care before, during, and after casting. Methods: A cross-sectional study was conducted on 188 patients with limb fractures referred to Shahid Beheshti Hospital in Kashan, Iran, from July to November 2018. The data collection instrument consisted of 57 items on the quality of care before, during, and after casting. Descriptive statistics and Fisher's exact test were used to analyze the data. Results: A total of 188 patients were assessed, 94 cases regarding the quality of care before and during casting and 94 additional cases for the quality of care after casting. The quality of care before, during, and after casting was at a moderate level in 83%, 58.5%, and 63.8% of patients, respectively. A significant connection was found between the quality of care before casting and the type of damage (P = 0.002). Significant connections were also found between the quality of care after casting and the nurses' work shift (P = 0.05) and gender (P = 0.05). Conclusion: The quality of care before, during, and after casting was mostly at a moderate level. Educational interventions are needed for nurses to improve the quality of cast care.

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Background and Objectives: Occupational diseases and accidents have been known as one of the leading causes of mortality in the world and are considered as one of the most important health, social, and economic risk factors in industrialized and developing societies. The present study aimed at investigating traumatic occupational accidents in Iranian mining and industrial sectors during 2016–2017. Methodology: This was a descriptive study conducted on the basis of registered data analysis from industrial and mining sector events in Iran by the relevant executive agency during a 1-year period. The collected data were analyzed using SPSS and Microsoft Excel software. Results: Investigating the records of accidents in the given year suggested a total of 441 accidents including 379 industrial (85.9%) and 62 mining accidents (14.1%) in Iran. In this study, the number of lost work-days was 1,585,383. Direct and indirect costs due to accidents were 638,746,428.56 (US $). The most common type of incidents included fire, falling, and caught in or between objects, respectively. Conclusion: Human being plays a significant role in production cycle, and the deaths associated with work-related accidents, in addition to the loss of hardware investment, may result in a loss of life, lost years of employment, and related costs. Improving employer and employees' perception of management safety practices can be important to prevent the development of job injuries and to promote workers' safety and well-being.

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Background and Objectives: Traffic accidents are the leading causes of fatal or nonfatal work-related injuries in many countries. Analyzing influencing factors on knowledge, attitude, and practice of drivers is a topic of interest for policymakers to decrease traffic accident injury victims. Materials and Methods: In this article, a two-stage data mining approach was presented for determining the mining relationships among knowledge, attitude, and practice of drivers. In the first stage, because of existing multidimensional practice variables, self-organizing map neural network was utilized to automatically arrange drivers into two safe and unsafe driving practice clusters. In the second stage, a decision tree was used to model relationships among knowledge and attitude of drivers and practice clusters. The authors' designed questionnaires were used to collect data in 235 male taxi drivers of Bandar Abbas city in Iran regarding the drivers' knowledge and attitude toward traffic regulations. The driving practices were assessed using a prepared checklist. Results: The most important attribute affecting practice of drivers was the maximum safe speed in the city. Conclusions: The results of this investigation showed that drivers' knowledge toward traffic regulations had a dramatic impact on safe driving practices. Levels of drivers' education can influence practice of drivers.

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Background: Comprehensive and accurate data are fundamentally needed for effective management of road traffic injuries (RTIs). Existing sources of RTI reports have a huge underestimation and inaccuracy at some levels. The aim of this study was to develop and validate the registrar-station data collection tool as a part of the Iranian Integrated Road Traffic Injury Registry (IRTIR). Materials and Methods: This study was conducted in Tabriz University of Medical Sciences in 2018. A data collection tool was developed to be used by the registrar for inpatient section of IRTIR by information retrieved from the literature review and road traffic experts' need assessment. The content validity of the preliminary tool was assessed. The feasibility of the tool was tested in two regional referral injury hospitals. Intra- and inter-rater reliability of the tool was evaluated using the individual/absolute intra-class correlation coefficient (ICC) and Kappa. Validity was revisited after 1 year of the pilot study. Results: The registrar-station data collection tool of IRTIR included 53 items, in five categories. Content validity was approved (modified content validity index was 0.8–1 and content validity ratio was one for all items). ICC was >0.6 for all items, and kappa index ranged between 0.69 and 0.92. The nurse data collection tool of IRTIR was applicable in the pilot phase. Conclusions: The Registrar-Station data collection tool of IRTIR was confirmed as a valid and reliable tool for inpatient traffic injuries as a part of the Iranian IRTIR.

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Background: Psychological and health outcomes of natural disasters such as earthquakes affect survivors and health services for a long time. In the present study, posttraumatic stress disorders (PTSD), symptoms of psychopathology, sleep quality, and insomnia disorder were investigated among survivors of earthquake occurred at the Western Iran on November 12, 2017. Materials and Methods: This study was conducted on 1031 adult participants from rural and urban areas of Sarpol-e Zahab, a city in Kermanshah Province (Western Iran), who suffered from mental health problems due to the earthquake, a magnitude-7.3 quake, occurred in the Western Iran in 2017. Participants completed the Symptom Checklist 90, Insomnia Severity Index, Pittsburgh Sleep Quality Index, and Self-Rating Scale for PTSD. Data were analyzed using Pearson correlation and multivariate regression analysis by Statistical Package for Social Sciences Software (Version 21). Results: A positive correlation was observed between insomnia severity and all psychopathological symptoms. There was a positive correlation between sleep quality and somatization, obsessive–compulsive disorder, depression, and psychoticism. In addition, acute stress was positively correlated with insomnia severity and sleep quality. Conclusion: According to the results of the present study, it is recommended that psychological disorders in earthquake victims be considered to enhance their sleep quality.

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