Equitable access to quality injury care; Equi-Injury project protocol for prioritizing interventions in four low- or middle-income countries : a mixed method study

Funding This research was funded by the NIHR (award number 133135) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the UK governmentPeer reviewe

The impact of a computerized decision aid on empowering pregnant women for choosing vaginal versus cesarean section delivery: study protocol for a randomized controlled trial

Cesarean delivery on maternal request (CDMR) is one of the main reasons for cesarean delivery in Iran, and women often need help in making a decision about the delivery options available to them. The main objective of this study is to evaluate the effect of a computerized decision aid (CDA) system on empowering pregnant women in choosing an appropriate mode of delivery. This CDA contrasts the advantages and disadvantages of vaginal versus cesarean section delivery in terms of their value to the individual woman. The protocol concerns a randomized trial study that will be performed among Iranian women. Four hundred pregnant women will be recruited from two private and two public prenatal centers in Mashhad, Iran. They will be randomly assigned to either an intervention or a control group. The designed CDA will be provided to the intervention group, whereas the control group will only receive routine care. The CDA provides educational contents as well as some recommendations. The CDA's knowledge base is obtained from the results of studies on predictors of cesarean delivery. The CDA's software will be installed on women's computers for use at home. The two primary outcomes for the study are O'Connor's Decisional Conflict Scale and knowledge as measured by true/false questions. Actual mode of delivery (vaginal versus cesarean) will be compared in the two groups. We investigate the effect of a CDA on empowering pregnant women in terms of reducing their decisional conflict as well as on improving their clinical knowledge pertaining to mode of delivery. This trial is registered with the Iran Trial Registrar under registration number IRCT2015093010777N4 and registration date 26 October 201

Grief experience among ICU staff with loss of family members during COVID-19 outbreak in IRAN: A qualitative study

IntroductionThe COVID-19 crisis created a lot of problems in people's lives. Different lifestyles, mental health, communication, rituals and traditions, particularly those involved in mourning, have changed drastically. Medical staff faced numerous critically ill patients every day. This greatly distressed the staff, especially the ICU staff. The end result was considerable amounts of mental distress for the medical staff who lost family members to COVID-19 making the distress even more complex.MethodsWe carried out this qualitative research to study the grief experiences of 12 Iranian ICU staff members at the Rasoul Akram Hospital who had experienced the loss of a family member to the COVID-19 pandemic. We studied the effects of how their own grief experience and how constant exposure to critically ill patients influenced their work with patients. All semi-structured interviews were held in the presence of a faculty member of the psychiatry department of Iran University of Medical Sciences. The interview on the grief experience among ICU staff during the COVID-19 pandemic, consists of 4 issues: Familiarity, Experience during the COVID-19 pandemic, Grieving the loss of a family member and Effects of parallel grief.ResultsWe found five common themes in the result of the experiences of the participants based on content analysis. These consisted of: complex grieving process, new experiences for coping with loss, more empathy for patients, change the meaning of death, and the need for support in work places. Likewise, there were 22 sub themes.ConclusionPaying attention to the details of staff members' life, gender differences, and cultural aspects can give us a better understanding and perception of their grief experiences. This understanding brings out valuable points which can help policy makers pass better laws for the wellbeing of society and people in order to promote leadership in turbulent times

Prefer Parameters of Occupational Health Surveillance System (OSS) in Expert Opinions of Occupational Staffs: A Qualitative Study

Occupational Health Surveillance System (OHSS) provides a critical opportunity to monitor and evaluate occupational disorders and injuries over the time. Among more than 21 million employees in Iran, 62.08% and 38.03% had been worked in the industrial and private sections respectively. Present qualitative study was designed for collection of expert opinion of staffs in this field and determined proper characters of suitable Iranian OHSS. Present qualitative study was performed on an interview based on data from occupational medicine staffs. Some questions about OHSS definition, temporary accompaniment of occupational diseases and injuries surveillance system, OHSS promoters and consumers, type of requested data for OHSS and rewarding and controlling systems to prepare qualitative and valid OHSS data. Interview answers were read, summarized and presented. Most of study participants’ staff believed that OHSS in the scientific base must cover all of essentially its parts including disorders, hazards and accidents together. They believed that this combination was made by a team working with occupational medicine staffs and other specialties such as occupational hygienist and information technologists. They emphasized that the Iranian ministry of health had the capacity to promote OHSS and organizing executive committee with all of OHSS involved as team working in this field. Occupational staff had been focused on this fact that OHSS data must cover all of needed data of Iranian working population and their relatives. Iranian occupational registry system must be change and develop as Occupational Health Surveillance system according the main parameters which were found in occupational staff interview

Individual characteristics associated with road traffic collisions and healthcare seeking in Low- and Middle-Income Countries and territories

Incidence of road traffic collisions (RTCs), types of users involved, and healthcare requirement afterwards are essential information for efficient policy making. We analysed individual-level data from nationally representative surveys conducted in low- or middle-income countries (LMICs) between 2008-2019. We describe the weighted incidence of non-fatal RTC in the past 12 months, type of road user involved, and incidence of traffic injuries requiring medical attention. Multivariable logistic regressions were done to evaluate associated sociodemographic and economic characteristics, and alcohol use. Data were included from 90,790 individuals from 15 countries or territories. The non-fatal RTC incidence in participants aged 24-65 years was 5.2% (95% CI: 4.6-5.9), with significant differences dependent on country income status. Drivers, passengers, pedestrians and cyclists composed 37.2%, 40.3%, 11.3% and 11.2% of RTCs, respectively. The distribution of road user type varied with country income status, with divers increasing and cyclists decreasing with increasing country income status. Type of road users involved in RTCs also varied by the age and sex of the person involved, with a greater proportion of males than females involved as drivers, and a reverse pattern for pedestrians. In multivariable analysis, RTC incidence was associated with younger age, male sex, being single, and having achieved higher levels of education; there was no association with alcohol use. In a sensitivity analysis including respondents aged 18-64 years, results were similar, however, there was an association of RTC incidence with alcohol use. The incidence of injuries requiring medical attention was 1.8% (1.6-2.1). In multivariable analyses, requiring medical attention was associated with younger age, male sex, and higher wealth quintile. We found remarkable heterogeneity in RTC incidence, the type of road users involved, and the requirement for medical attention after injuries depending on country income status and socio-demographic characteristics. Targeted data-informed approaches are needed to prevent and manage RTCs