Fall-Related Injuries in Community-Dwelling Older Adults in Qom Province, Iran, 2010-2012

Background: Falls and related injuries are common health problems in the elderly. Fractures, brain and internal organ injuries and death are the common consequences of the falls, which result in dependence, decreased self-efficacy, fear of falling, depression, restricted daily activities, hospitalization and admission to the nursing home and impose costs on the individual and the society. Objectives: The purpose of this study was to determine the types of fall-related injuries and the related risk factors in the elderly population of Qom province, Iran. Patients and Methods: This retrospective study was performed on 424 elderly people (65 years and over) referred to Shahid Beheshti Hospital, Qom, Iran, due to falls between 2010 and 2012. The ICD-10 codes of external causes of injury from w00 to w19 related to falls were selected from the health information system of the hospital and demographic variables of the patients and external causes of falls were extracted after accessing the files of the patients. Data were analyzed using SPSS version 18 (SPSS Inc., USA). The duration of hospital stay and its relationship with underlying variables were investigated using t test and ANOVA. The level of significance was considered P < 0.05. Results: Among 424 elderly people, 180 cases (42.45%) were male and the mean age of the patients was 78.65 ± 7.70 years. Fall on the same level from slipping, tripping, and stumbling was the most common external cause with 291 victims (68.60%), and hip fracture in 121 patients (29.00%), intertrochanteric fracture in 112 patients (26.90%), and traumatic brain injury in 51 patients (12.20%) were the most common causes of hospital stay. The mean hospital stay was 7.33 ± 3.63 days. Conclusions: Lower limb fracture and traumatic brain injury were the most common causes of hospitalization, which resulted in the longest hospital stay and highest hospitalization costs in the elderly

Spatial Factors Affecting the Frequency of Pedestrian Traffic Crashes: A Systematic Review

Context: Considering the importance of pedestrian traffic crashes and the role of environmental factors in the frequency of crashes, this paper aimed to review the published evidence and synthesize the results of related studies for the associations between environmental factors and distribution of pedestrian-vehicular traffic crashes. Evidence Acquisition: We searched all epidemiological studies from 1966 to 2015 in electronic databases. We found 2,828 studies. Only 15 observational studies out of these studies met the inclusion criteria of the study. The quality of the included studies was assessed using the strengthening the reporting of observational studies in epidemiology (STROBE) checklist. Results: A review of the studies showed significant correlations between a large number of spatial variables including student population and the number of schools, population density, traffic volume, roadway density, socio-economic status, number of intersections, and the pedestrian volume and the dependent variable of the frequency of pedestrian traffic crashes. In the studies, some spatial factors that play an important role in determining the frequency of pedestrian traffic crashes, such as facilities for increasing the pedestrians’ safety were ignored. Conclusions: It is proposed that the needed research be conducted at national and regional levels in coordination and cooperation with international organizations active in the field of traffic crashes in various parts of the world, especially in Asian, African and Latin American developing countries, where a greater proportion of pedestrian traffic crashes occur

Cost Estimation of Road Traffic Injuries Among Iranian Motorcyclists Using the Willingness to Pay Method

Background: Motorcycle riders are amongst some of the most vulnerable road users. The burden of motorcycles injuries from low and middle income countries is under-reported. Objectives: In this study, the cost of traffic injuries among motorcyclists was calculated using the willingness to pay (WTP) method in Iran in 2013. Patients and Methods: In a cross-sectional study, 143 motorcyclists were randomly selected. The research questionnaire was prepared based on the standard WTP method [stated preference (SP), contingent value (CV) and revealed preference (RP) models] taking into consideration perceived risks, especially those in Iran. Data were collected by a scenario for motorcyclists. The criteria for inclusion in the study consisted of having at least a high school education and being in the age range of 18 - 65 years. The final analysis of the WTP data was performed using the Weibull model. Results: The mean WTP was 888,110 IRR (Iranian Rial) among motorcyclists. The statistical value of life was estimated according to 4694 death cases as 3,146,225,350,943 IRR, which was equivalent to USD 104,874,178 based on the dollar free market rate of 30,000 IRR (purchasing power parity). The cost of injury was 6,903,839,551,000 IRR, equivalent to USD 230,127,985 (based upon 73,325 injured motorcyclists in 2013, a daily traffic volume of 311, and a daily payment of 12,110 IRR for 250 working days). In total, injury and death cases came to 10,050,094,901,943 IRR, equivalent to USD 335,003,163. Willingness to pay had a significant relationship with having experienced an accident, the length of the daily trip (in km), and helmet use (P < 0.001). Conclusions: Willingness to pay can be affected by experiencing an accident, the distance of the daily trip, and helmet use. The cost of traffic injuries among motorcyclists shows that this rate is much higher than the global average. Thus, expenditure should be made on effective initiatives such as the safety of motorcyclists

Traffic Police Effectiveness and Efficiency Evaluations, an Overview of Methodological Considerations

Context: Every government implements various policies to mitigate road traffic injuries (RTIs). Many of these interventions are performed by traffic police. To evaluate effectiveness and efficiency of police enforcement, numerous studies have been conducted. Potential capabilities of epidemiology could get opportunity to improve these studies. The aim of this study was to extract and discuss some related methodological points of traffic police effectiveness and efficiency from related studies, in view of epidemiology discipline. Evidence Acquisition: Related articles were searched with “traffic police”, “effectiveness”, “efficiency” and “road safety” keywords in ScienceDirect, PubMed and Safetylit databases. Related papers were selected and read carefully to summarize and discuss the epidemiological points with aims of giving clues to improve quality of studies. Results: From a total of 797 articles, 20 were eligible which among them 17 articles were about effectiveness and 3 of them were about efficiency evaluations. Discussed points were the method of study, taking a holistic view to all positive and negative side effects, desired inputs and outputs, relation pattern between police enforcement and outcome and potential confounders. Conclusions: Better understanding of the effectiveness and efficiency mechanism and having valid evaluation required considering specific theories and points in this field. Applying a dynamic approach with considering epidemiological concepts and sophisticated statistical models could improve quality of studies in this field

Estimation of the population attributable fraction of road-related injuries due to speeding and passing in Iran

OBJECTIVES: Speeding and passing are considered to be the main human factors resulting in road traffic injuries (RTIs). This study aimed to estimate the population attributeable fraction (PAF) of speeding and passing in RTIs in rural Iran during 2012. METHODS: The contribution of speeding and passing to RTI-related morbidity and mortality was estimated using the PAF method. The prevalence of speeding and passing was obtained from the national traffic police data registry. A logistic regression model was used to measure the association between the above risk factors and RTIs. RESULTS: Speeding accounted for 20.96 and 16.61 of rural road-related deaths and injuries, respectively. The corresponding values for passing were 13.50 and 13.44, respectively. Jointly, the PAF of these factors was 31.63 for road-related deaths and 27.81 for injuries. CONCLUSIONS: This study illustrates the importance of controlling speeding and passing as a high-priority aspect of public-health approaches to RTIs in Iran. It is recommended that laws restricting speeding and passing be enforced more strictly

Epidemiology of Accidents and Traumas in Qom Province in 2010

Background: Accidents are the most important public health challenges in our society. To prevent\n the accidents, the identification of their epidemiological features seems necessary. Objectives: This study was conducted to reveal the epidemiological features of accidents and their\n casualties in Qom province in 2010. Patients and Methods: A cross–sectional study was conducted on 29426 injured people referred to Qom\n province hospitals in 2010. Information about place, time, type of accidents and traumas\n and demographic variables had been collected in a veteran hospital. Data were analyzed\n by SPSS (version 16) software, using chi-square test and logistic regression. Results: The incidence of accidents was about 27/1000 per year. The incidences of traffic\n accidents, motorcycle accidents, violence, burns, poisoning and suicides were 3, 1.6,\n 1.2, 0.3, 0.8, 0.37 cases per 1000 people respectively. Strikes (65%) and falls (12%)\n were the main causes of traumas. Forty-six percent of all injuries had occurred in 16 -\n 30 years groups. Most frequent accidents were as follows: fall (97%) and strike (50%) in\n < 12, violence (46%) in 20 - 29, suicide (71%) in 15 - 29, poisoning (34%) and burns\n (20%) among < 5 years old. Pedestrian and motorcycle accidents among +60 years old\n people were significantly higher than other (P = 0.000). Odds ratio for suicide among\n female was about 3.36 and in 16 - 30 age-group was 15.7 more than +60 years old group (P\n = 0.000). Conclusions: Most traumas in Qom province occurred among younger age-groups and strikes and falls\n are the main causes of such traumas. Therefore, safeties to prevent falls and traffic\n regulations to reduce strikes can be effective strategies

The effect of on-site and outreach-based needle and syringe programs in people who inject drugs in Kermanshah, Iran

Background: Needle and syringe programs (NSPs) are widely used to reduce harms associated with drug injecting. This study assessed the effect of facility-based (on-site services at drop-in centre) and outreach models of NSP on injection risk behaviours. Methods: Self-reported data from 455 people who injected drugs (PWID) during 2014 in Kermanshah, Iran, were examined to measure demographic characteristics and risk behaviors. Self-reported and program data were also assessed to identify their main source of injection equipment. Participants were divided into three sub-groups: facility-based NSP users, outreach NSP users and non-users (comparison group). Coarsened exact matching was used to make the three groups statistically equivalent based on age, place of residence, education and income, and groups were compared regarding the proportion of borrowing or lending of syringes/cookers, reusing syringes and recent HIV testing. Results: Overall, 76% of participants reported any NSP service use during the two months prior to interview. Only 23% (95%CI: 17-27) reported outreach NSP as their main source of syringes. Using facility-based NSP significantly decreased recent syringe borrowing (OR: 0.27, 95%CI: 0.10-0.70), recent syringe reuse (OR: 0.38, 95%CI: 0.23-0.68) and increased recent HIV testing (OR: 2.60, 95%CI: 1.48-4.56). Similar effects were observed among outreach NSP users; in addition, the outreach NSP model significantly reduced the chance of lending syringes (OR: 0.31, 95%CI: 0.15-0.60), compared to facility-based NSP (OR: 1.25, 95%CI: 0.74-2.17). Conclusion: These findings suggest that the outreach NSP model is as effective as facility-based NSP in reducing injection risk behaviours and increasing the rate of HIV testing. Outreach NSP was even more effective than facility-based in reducing the lending of syringes to others. Scaling up outreach NSP is an effective intervention to further reduce transmission of HIV via needle sharing

Client-Level Coverage of Needle and Syringe Program and High-Risk Injection Behaviors: A Case Study of People Who Inject Drugs in Kermanshah, Iran

Background: Needle-syringe programs (NSP) have been running in Iran since 2002. However, the coverage of such program among the NSP clients at the individual level was not studies yet. This study aimed to determine the client coverage of NSP and its correlation with high injection-related risk behaviors. Methods: A cross-sectional survey was conducted in Kermanshah province, Iran, in 2014. 230 people who inject drugs (PWID) recruited from two drop-in centers (DICs) from April to September 2014, participated in a face-to-face interview to provide information related individual coverage of NSP, demographic characteristics, and injecting behaviors 30 days prior to the interview. Findings: Overall, the average of syringe coverage was 158% [95% confidence interval (CI) = 65.7-205.5], while 56% (95% CI = 40-97) have individual converge less than 100%. Needle/syringe sharing was significantly higher among individual with low NSP coverage [adjusted odds ratio (AOR) = 2.6, 95% CI = 1.3-6.2]. About 85% participants with coverage of less than 100% reported reuse of syringe within the last 30 days (AOR = 3.2, 95% CI = 1.4-7.7). Conclusion: PWID are different regarding their NSP individual-level converges. There are certain clusters of PWID, who do not receive sufficient number of syringes. Given that insufficient individual syringe coverage level is highly associated with injection risk behaviors, reasons for such low converge need to be assessed and addressed carefully