Effect of Text Messaging-based Psychiatric Nursing Program on Quality of Life in Veterans with Post-Traumatic Stress Disorder: A Randomized Controlled Trial

Background: Recurrent post-traumatic stress disorder (PTSD) can devastate the life of a veteran. Despite the widespread use of mobile learning technology in health care and nursing, few studies have examined its potential in PTSD patients and the effect on quality of life (QoL). The present study aimed to investigate the effect of a text messaging-based psychiatric nursing program on QoL in veterans with PTSD symptoms. Methods: A single-blinded, randomized, controlled trial was conducted at the outpatient clinic of Sadr Hospital in Tehran (Iran) from January 2014 to October 2015. A total of 98 veterans with PTSD who referred to the outpatient clinic of the hospital were initially assessed for eligibility to participate in the study. Based on the inclusion criteria, 66 veterans were recruited in the study and randomly allocated to a control group (n=33) and an intervention group (n=33). Due to the lost to follow-up, 9 participants (control=4, intervention=5) were excluded from the analysis phase. The intervention group received psychiatric support via short text messages for 6 months, whereas the control group received the routine hospital care. The self-rating scale for PTSD (SRS-PTSD) and the short form 36 (SF-36) were used to evaluate the severity of symptoms and the QoL, respectively. The results were analyzed using the SPSS software (version 18.0) with the Chi-square test, Fisher’s exact test, independent sample t test, and paired sample t test. P<0.05 was considered statistically significant. Results: A significant improvement in PTSD (P=0.001) and QoL (P=0.001) was observed in the intervention group compared to the control group. Moreover, the recurrence frequency in the intervention group was significantly lower (P=0.03). Conclusion: The text messaging-based psychiatric nursing program reduced the severity of symptoms in veterans with PTSD and improved their QoL. Trial Registration Number: IRCT2013101214983N

Explaining the psychological experiences of nurses during the first peak COVID-19 pandemic

Introduction: The unexpected spread of COVID-19 with high risk of transmission, fear and anxiety, and a load of negative emotions followed for nurses. It is necessary to assess the psychological experiences of nurses during the first peak COVID-19 pandemic. Materials and Methods: In this qualitative study, with the approach of conventional content analysis approach, the participants were selected through proposed-based sampling and snowball from the COVID-19 centers of Guilan province in March 2020. The number of 20 participants with various demographic characteristics (Gender, age ...) entered the study. The tools used were in-depth and semi-structured interviews. Results: Most of the participants were women, married and nurses. Six categories were obtained: not perception, worries, and pretending, horrible observations, pre-psychological symptoms and psychological symptoms. Conclusion: Psychological experiences of nurses in COVID-19 center in Guilan were expressed in a range of not perceptions and worry until the appearance of numerous pre and psychological symptoms. The psychological needs of this group must be considered at all stages of the crisis. Psychological support by mental health workers should be considered in line with the development of the crisis to reduce the stress on nurses

Return to work after traumatic spinal fractures and spinal cord injuries:a retrospective cohort study

This study aimed to determine the factors associated with return to work (RTW) after traumatic spinal fracture and spinal cord injury. It provided a predictive model for RTW among patients with spinal fractures and spinal cord injury and determined important factors influencing the time to RTW after injury. A retrospective cohort study was conducted in Poursina Tertiary Hospital, Guilan, Iran between May 2017 and May 2020. Patients aged 18 to 65 who were hospitalized with traumatic spinal fractures and spinal cord injuries were included. Demographic and clinical data were collected from the National Spinal Column/Cord Injury Registry of Iran (NSCIR-IR). A researcher-administered questionnaire was used through a telephone interview to obtain complementary data on social and occupational variables. Kaplan–Meier survival analysis was used to estimate the average time to RTW and the predictors of RTW were determined by multivariate Cox regression model. Of the 300 patients included, 78.6% returned to work and the average time to RTW was about 7 months. The mean age of the participants was 45.63 ± 14.76 years old. Among the study variables, having a Bachelor’s degree (HR 2.59; 95% CI 1.16–5.77; P = 0.019), complications after injury (HR 0.47; 95% CI 0.35–0.62; P = 0.0001), full coverage health insurance (HR 1.73; 95% CI 1.10–2.72; P = 0.016), opium use (HR 0.48; 95% CI 0.26–0.90; P = 0.023), number of vertebral fractures (HR 0.82; 95% CI 0.67–0.99; P = 0.046), and length of hospital stay (HR 0.95; 95% CI 0.93–0.98; P = 0.001) were found to be significant in predicting RTW in Cox regression analysis. Our analysis showed that wealthier people and those with high job mobility returned to work later.</p

Psychopathological Symptoms in Caregivers of Patients With Vegetative State

Background: Taking care of patients in a vegetative state is a great challenge and affects the mental health of the caregivers. Objectives: This study aimed to determine the psychopathological symptoms in caregivers of patients with Vegetative State (VS) and determine the demographic and social predictors of the common symptoms. Materials & Methods: This cross-sectional study was conducted in an educational hospital in the north of Iran from 2012 to 2013. The psychopathological symptoms of 80 caregivers of VS patients were evaluated by Symptom Checklist-Revised (SCL-90-R) questionnaire. Results were analyzed using SPSS (Version 18) by the Mann-Whitney U test. Finally, the predictors of psychopathological symptoms were determined through a simple regression model. Results: The highest scores of the psychological symptoms were of the depression subscale (2.88±0.86) and somatoform subscale (2.85±0.83). The psychopathological symptoms including somatoform (P=0.012), obsessive-compulsive (P=0.032), depression (P=0.035), anxiety (P=0.027), phobia (P=0.015), and paranoid ideations (P=0.027) were significantly higher in women than in men. However, there was no significant relationship between these symptoms and marital status. The simple regression model showed that none of the sociodemographic variables could predict psychopathological symptoms in the caregivers. Conclusion: A significant number of caregivers had psychopathological symptoms, especially depression and somatoform complaints

تجارب پزشکان و پرستاران در مورد تسهیلات لازم برای تریاژ سریع در مرکز آموزشی- درمانی پورسینای رشت

Introduction: In the last two decades, the lack of facilities has been one of the reasons that has increased the average triage time. This delay prolongs the patient's waiting time and increases the likelihood of errors and mortality. Limited studies have been conducted on the type of facilities required for a fast triage. The purpose of this study is to express the opinions of physicians and nurses regarding the necessary facilities for a rapid triage in Poursina Hospital, Rasht, Iran, in 2021. Methods: This was a qualitative study using conventional content analysis method, which was performed on the opinions of twenty people in the fields of emergency medicine, general medicine, and nursing. The four Guba and Lincoln criteria were used for strengthening the data. Results: The opinions of 20 participants resulted in 4 categories and 17 subcategories under the titles: providing human resources, empowering human resources, improvement of triage process, and provision of physical necessities. Conclusion: Human resources is a valuable component in triage. Careful planning is needed for the growth and development of this valuable asset. By providing the required staff and upgrading their capabilities through training and experience, the speed of triage can be increased. Giving employees a proper understanding of triage is also effective in accelerating the triage process. The provision of physical resources has also been identified as a facilitator, and those in charge should seek solutions for providing them. &nbsp; &nbsp;مقدمه: در دو دهه اخیر، کمبود تسهیلات یکی از دلایلی بوده که باعث افزایش میانگین زمان تریاژ شده است. این تاخیر باعث طولانی شدن زمان انتظار بیمار شده و احتمال خطاها و مرگ و میر را افزایش می دهد. در مورد نوع تسهیلات مورد نیاز برای یک تریاژ سریع، مطالعه محدود انجام شده است. هدف از مطالعه حاضر تبیین تجارب پزشکان و پرستاران از تسهیلات لازم برای یک تریاژ سریع در مرکز آموزشی- درمانی پورسینای رشت در سال 1400 می باشد. روش کار: این یک مطالعه کیفی با روش تحلیل محتوای قرار دادی بود که روی تجارب بیست نفر در رشته های طب اورژانس، پزشکی عمومی و پرستاری انجام شد. برای استحکام داده ها از چهار معیار گوبا و لینکن استفاده شد. یافته ها: تجارب 20 مشارکت کننده منتج به 4 طبقه و 17 زیر طبقه تحت عناوین ؛ تامین منابع انسانی ، توانمند سازی منابع انسانی، بهبود فرایند تریاژ و تدارک مایحتاج فیزیکی شد. نتیجه گیری: منابع انسانی در تریاژ، مولفه ارزشمندی هستند. براي تحقق رشد و توسعه اين سرمايه ارزشمند، نياز به برنامه ريزي دقيق است. با تامین کارکنان مورد نیاز و ارتقا توانمندی آن ها در بعد آموزش و تجارب می توان سرعت تریاژ را بالا برند. تسریع بخشیدن به فرایند تریاژ با دادن یک درک درست از تریاژ &nbsp;به کارکنان نیز در این راستا موثر است. تامین منابع فیزیکی نیز به عنوان تسهیل کننده شناسایی شده است که باید مسوولین امر دنبال چاره اندیشی در تدارک آن ها باشند

Predictors of Post-Traumatic Stress Disorder among Victims of Serious Motor Vehicle Accidents

Background: Compelling evidence has shown that motor vehicle accidents have an enormous impact on mental health. Post-traumatic Stress Disorder (PTSD) is one of the most common psychological consequences in adult survivors of accidents, so it is important to understand the prevalence and predictors of this issue since delay causes damage to crucial daily functioning. This study aimed at investigating the prevalence and predictors of PTSD after motor vehicle accident. Methods: This cross-sectional study was conducted on 528 injured patients six weeks to six months after motor vehicle accident in Imam Reza Clinic of Poursina hospital, Rasht in 2015. Data collection tools were three questionnaires including post-traumatic stress-self report (PSS), Beck Depression Inventory (BDI-II), and the Numeric Rating Scale (NRS) for pain. The data were analyzed in SPSS (Version 19) using Chi-square, Fischer’s exact test and multivariate logistic regression. Significance level was considered P≤0.05. Results: The prevalence of PTSD and depression was 30.49% and 19.89% in participants, respectively. Chi-square test indicated a significant relationship among age (P=0.02), sex (P<0.001), education level (P<0.001), work status (P<0.001) and PTSD. Participants who reported pain (P<0.001) and depression (P<0.001) were more likely to have high score of PTSD than the others. Multivariate logistic regression showed this significance in sex, depression, age, educational status and pain, as constant risk factors in developing PTSD after accident. Conclusion: This study suggests that primary care setting should be readily prompted for diagnosis of these disorders in non-treatment seeking individuals in the community

Solutions to Implement Wearing Helmet Legislation: A Content Analysis

INTRODUCTION Due to the unsafe design of this type of vehicle, motorcyclists die approximately 28 times more often than car occupants [1]. The increasing trend of motorcycle accidents has been emphasized in several studies [1-3]. A significant number of motorcyclists do not follow traffic rules. Wearing a helmet is one of the most important rules [4]. Enforcing wearing helmet legislation has increased helmet use [5] and prevented serious motorcyclist injuries [6]. After canceling the mandatory wearing of helmets in some countries, the death rate of these users has increased by 25-28% [7, 8]. It has been reported that the use of helmets in Iran among motorcyclists is about 30% and that of passengers is 10% which indicates the low use of helmets [9]. The use of standard helmets has significantly prevented the fractures of the middle face of Iranians [10]. Of course, the lack of seriousness of the police and regulatory bodies aggravates the disobedience of this group [11]. Few studies have shown that the police avoid fining these motorcyclists due to reasons such as lack of motivation and work pressure, and recommend solutions such as increasing the number of cameras in cities, automatic identification of motorcycles, helmets, and license plates [12]. AIM(s) The purpose of this study was to explain the proposed solutions to solve the problem of implementing wearing helmet legislation from the perspective of regulatory bodies and motorcyclists. RESEARCH TYPE This qualitative study is of the contractual content analysis type. RESEARCH SOCIETY, PLACE & TIME This study was conducted by the method of Graham and Lundman (2004) [13] in Rasht, Iran in 2021. The participants were from Gilan, Iran, and had at least one year of work experience with motorcycle or at least three years of motorcycle riding experience. SAMPLING METHOD & NUMBER To identify the employees of the regulatory bodies, the method of brainstorming and fishbone diagrams were used. The rest of the participants were selected by snowball method. The selection of the samples was done by the principle of maximum diversity and the participants were selected from different ages, sex, education, job, and work experience categories to provide a diverse range of experiences. Sampling continued until information saturation, i.e. no formation of classes and sub-classes and new information. METHOD The interviews were conducted by an interviewer experienced in qualitative research. The time and place of the interview were chosen by the participants. In-depth and semi-structured interviews were conducted with an interview guide. To facilitate communication, it first started with demographic questions, then the main question titled "What are the effective ways to enforce wearing helmet legislation among motorcyclists?" was raised and then participants were asked about their experiences of the solutions, ways of better implementation of wearing helmet legislation, and probing questions to clarify more details. The duration of the interview was between 45 and 60 minutes, and a second interview was conducted with three people to clarify ambiguous points. ETHICAL PERMISSION This study was conducted after obtaining the code of ethics from the Research Vice-Chancellor of Gilan, IranUniversity of Medical Sciences (IR.GUMS.REC.1398.517). STATISTICAL ANALYSIS The process of data analysis was based on the method of Graham and colleagues in 2004, according to which these steps were carried out: implementing the interviews after reviewing them several times to find a correct understanding, extracting meaningful units, classifying compact units, and choosing a suitable label for them, sorting sub-categories, and choosing a suitable title that can cover the resulting categories [13]. Guba and Lincoln's four evaluative criteria were also used to strengthen the results of the qualitative part [14]. FINDING by TEXT Saturation was achieved in the sample of 17, but the sampling was completed with 20 participants. There were 9 participants from regulatory bodies, 4 university faculty members, 3 traffic policemen, and 4 motorcyclists. All of them were male and the rest of their demographic characteristics are given in the table (Table 1). Solutions for implementing the wearing helmet legislation in four categories named; hard, correction, support, and soft solutions were revealed in 14 subclasses and 55 codes as described in Table 2. MAIN COMPARISION to the SIMILAR STUDIES The results of this study were included in four categories: the use of hard, corrective, support, and soft solutions. The first category was hard solutions. The participants believed that fines, strictures, and determination to enforce them by the regulatory authorities have a great impact on the enforcement of the helmet legislation. In a similar study, helmet use by motorcyclists was significantly associated with police stations at intersections, and motorcyclists who crossed police-monitored intersections were more likely to wear helmets [15]. Even those participants who believed in the effectiveness of education, mentioned education first and then strictness next to it. This can be done by various methods, including the adoption of new laws, and strict enforcement of the law with higher fines [16]. Therefore, wearing helmet legislation for motorcyclists can be enforced by using emphatic strategies [15, 17]. The second class extracted was corrective solutions. Similarly, some studies have recommended the adoption of new laws for motorcyclists and the modification of previous laws [16, 18], and broader legislation is recommended in addition to changing existing laws to improve helmet use [19]. There is a need to reform driver's license processes, because having a driver's license is the most important factor that affects the driver's attitude and makes them comply with the rules of wearing a helmet [20]. Therefore, like a study in Nepal, the evidence shows that it is necessary to reform, organize and redefine motorcycling laws in Iran [17]. The solutions of the next level were law enforcement and motorcyclist support. These results reveal that the problems of law enforcement, including not having enough employees, high volume of work, and low living conditions should be considered. The need to support the police by people and organizations has been emphasized before [21]. There is ample evidence that helmet laws are effective in increasing helmet use and reducing injuries [22, 23]. In a previous study, the experiences of medical workers in Bandar Abbas, Iran, showed that in the implementation of wearing helmet legislation, the individual, social, family, economic and cultural factors of the motorcyclist should be taken into account [24]. Therefore, by eliminating the deficiencies in the human and financial resources of the regulatory bodies and the proper management of existing resources, some of the problems of the traffic police and driving can be solved and death and serious injuries to motorcyclists can be prevented. Increasing the number of cameras in cities that increase the ability to identify motorcyclists without helmets is also recommended. This task is done using vehicle identification, helmet identification, and automatic license plate recognition [12]. Finally, soft solutions were the fourth category. A study in Iran has shown that motorcyclists who do not have driver's license used drugs significantly more and had personality disorders and depression [25]. In a study in Malaysia, a significant percentage of motorcyclists did not wear helmets properly, and most of the child passengers did not wear helmets. Therefore, despite the legal approval of wearing a helmet for motorcyclists and passengers, there is a lack of public awareness of the safety and benefits of using a helmet and a lack of adequate and appropriate implementation [2]. In this regard, the importance of education along with the application of the law, which is one of the results of this class, becomes clear. According to the previous emphasis, a driver must have a certified skill license, and the knowledge of the motorcyclist and the severity of the law are introduced as the two main influencing factors [26]. In a grounded theory study reported in Kerman, Iran, policies and intervention programs to control injuries and promote safety among motorcyclists should focus on socio-cultural barriers to helmet use in general and changing motorcyclists' attitudes toward mortality in particular [27 ]. LIMITATIONS One of the limitations of the present study is the limitations related to qualitative studies, which quantitative data such as the frequency of experiences cannot be obtained and presented. SUGGESTIONS It is suggested to extract the experiences of the heads and elders of the country's traffic in this matter through interviews for further studies. CONCLUSIONS There are four categories of solutions for implementing wearing helmet legislation from the point of view of policymakers, police, and motorcyclists. The use of hard solutions such as the diligence and seriousness of the regulatory bodies in implementing the law on wearing helmets and corrective solutions such as drafting new laws and amending existing laws, support solutions such as supporting the police and motorcyclists, and finally, soft solutions such as education and culturalizing and the use of mass media are effective in implementing these laws. CLINICAL & PRACTICAL TIPS in POLICE MEDICINE The police and employees who are responsible for enforcing the wearing helmet legislation on motorcyclists should try to use all kinds of legal solutions. However, besides these golden solutions, the use of gentle and soft solutions such as education and culturalizing should be considered. In this regard, the duties of policymakers are to formulate new laws and amend existing laws, to support the police and motorcyclists. ACKNOWLEDGMENTS We would like to thank Gilan University of Medical Sciences, which provided the financial costs of this research project. We are also grateful to all participants in this research, including motorcyclists and regulatory bodies. CONFLICT of INTEREST The authors state that there is no conflict of interest in the present study. FUNDING SOURCES This article was completed with the financial support of Gilan University of Medical Sciences

Epidemiology of head injuries in pedestrian-motor vehicle accidents

Abstract Despite efforts of many countries to improve pedestrian safety, international reports show an upward trend in pedestrian-motor vehicle accidents. Although the most common cause of death of pedestrians is head injuries, there is a lack of knowledge on the epidemiology and characteristics of head injury in terms of the Glasgow Outcome Scale to be used for prevention. However, this study aimed to determine the epidemiology of pedestrian-motor vehicle accidents, the characteristics of head injury, and differences in the Glasgow Outcome Scale in terms of gender. In this retrospective analytical study, the data of 917 eligible injured pedestrians were obtained from the two databases of the Trauma System and the Hospital Information System. The data were analyzed using SPSS software (Version 21). The mean age of all 917 injured pedestrians was 47.55 ± 19.47 years. Most of the injured pedestrians (42.10%) were in the age range of 41–69 years and 81.31% were male. Moreover, 83.07% did not have any acute lesions on the CT scan. The most common brain lesion was brain contusion (n = 33, 3.60%), subarachnoid hemorrhage (n = 33, 3.60%), and skull fracture (n = 29, 3.16%). Among all concurrent injuries, lower extremity/pelvic injuries were observed in 216 patients (23.56%). Outpatient treatment (n = 782, 85.27%), airway control/endotracheal intubation (n = 57, 6.22%), and resuscitation (n = 35, 3.82%) were the most applied treatments respectively. There were significant differences in the Glasgow Outcome Scale between men and women (P- value = 0. 012). The high rate of mortalities, disability, head injuries, contusion, subarachnoid hemorrhage, and skull fractures in pedestrians involved in MVAs emphasizes the need for developing and implementing prevention strategies including appropriate management and risk reduction. Male pedestrians were at higher risk of motor vehicle accidents and worse Glasgow Outcome Scale. The presented data identified the main types of pedestrian injuries and suggested the importance of adopting appropriate preventive strategies to achieve the most effective interventions for creating a safer community

Fatigue in taxi drivers and its relationship with traffic accident history and experiences: a cross-sectional study in the north of Iran

Abstract Background The monotonous nature of work, long driving duration, and working overload hours cause frequent fatigue in taxi drivers. A high prevalence of fatigue is associated with traffic accidents. However, the risk factors associated with taxi driver fatigue are unclear. Therefore, the present study aims to determine the rate of fatigue in taxi drivers and its relationship to their traffic accident experience. Methods In this descriptive-analytical study, 400 taxi drivers in the city of Rasht were registered in Taxi association selected through random sampling and entered into the study based on inclusion criteria. Data was collected through a researcher-made questionnaire reliable and valid by two medical students. The statistical analysis used ordinal data and a Poisson regression model with SPSS software version 21, with a significance level set at 5%. Results The driver fatigue self-reported was directly and significantly related to alcohol consumption (OR = 3.43, 95% CI 1.01–11.62) and had a significant and inverse relationship with smoking (OR = 0.50, 95% CI 0.32–0.76), being married (OR = 0.08, 95% CI 0.01–0.40) and driving experience there was (OR = 0.96, 95% CI 0.94–0.98). Drivers’ sense of quality of life (QOL) was directly and significantly related to smoking (IRR = 1.43, 95% CI 1.28–1.59), education level under diploma (IRR = 2.41, 95% CI 1.43–4.06) diploma (IRR = 2.06, 95% CI 1.21–3.48) and bachelor (IRR = 2.42, 95% CI 1.36–4.29) and there was a significant and inverse relationship with age (IRR = 0.98, 95%CI 0.98–0.99). There was a significant relationship between the number of traffic accidents in the past year with the level of bachelor’s degree (IRR = 3.10, 95% CI 1.43–6.76) and driving experience (IRR = 1.03, 95% CI 1.02–1.04 and inverse relationship between the number of traffic accidents in the past year and the QOL sense (IRR = 0.96, 95% CI 0.93–0.99) and the working hours (IRR = 0.96, 95% CI 0.94–0.99). Conclusion Legislators and policymakers should pay more attention to fatigue in single and inexperienced taxi drivers. Regarding the QOL, pay attention to drivers with high education and older. To reduce the number of crashes, pay more attention to drivers with a bachelor’s degree and less driving experience and improve the feeling of QOL

Additional file 1 of Self-reported cycling behavior and previous history of traffic accidents of cyclists

Supplementary Material