Prevention of Drowning by Community-Based Intervention: Implications for Low- and Middle- Income Countries

Background: Drowning is a serious but neglected health problem in low-and middle-income countries. Objectives: To describe the effectiveness of drowning prevention program on the reduction of drowning mortality rates in rural settings at the north of Iran, and guide its replication elsewhere. Patients and Methods: This interventional design included pre- and post-intervention observations in the rural area of the Caspian Sea coastline without a comparison community. Cross-sectional data were collected at pre- and post-intervention phases. Outcome evaluation was based on a four-year period (March 2005-March 2009) utilizing drowning registry data for the north of Iran. Results: The implementation program increased the rate of membership in an organization responsible for promoting safety in high risk areas near the Caspian Sea. Compared to a WHO standardized population, drowning incidence in rural areas of the study demonstrated a continuous decrease in age-specific drowning rate among the oldest victims with a gradual decline during the implementation. In the study area, the epidemiological aspects of the study population were exposed and contributing factors were highlighted. Conclusions: This study showed that the promotion of passive interventions had a greater effect on drowning rate than that of active interventions

Effects of Neurosurgical Treatment and Severity of Head Injury on Cognitive Functioning, General Health and Incidence of Mental Disorders in Patients With Traumatic Brain Injury

Background: Neurosurgical treatment and the severity of head injury (HI) can have remarkable effect on patients’ neuropsychiatric outcomes. Objectives: This research aimed to study the effect of these factors on cognitive functioning, general health and incidence of mental disorders in patients with a traumatic brain injury (TBI). Patients and Methods: In this descriptive, longitudinal study, 206 TBI patients entered the study by consecutive sampling; they were then compared according to neurosurgery status and severity of their HI. Both groups underwent neurosurgical and psychological examinations. The mini mental state examination (MMSE) and general health questionnaire–28 items (GHQ-28) were administered to the study participants. At follow-up, four months later, the groups underwent a structured clinical interview by a psychiatrist based on the diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV) diagnostic criteria regarding the presence of mental disorders. Results: Analysis of covariance (ANCOVA) and multivariate analysis of covariance (MANCOVA) were performed and adjusted for the effect of confounding variables (age, gender, Glasgow outcome scale (GOS) , and level of education). The severity of HI had the most significant effect for the following variables; cognitive functioning and physical symptoms (P < 0.05). The effect of the neurosurgical treatment factor was not significant; however, the interaction effect of the two variables on social dysfunction, and total score of the GHQ-28 questionnaire appeared to be significant (P < 0.05). Fisher\'s exact test indicated that after a four month follow-up period, no significant differences were seen between the two groups (with or without neurosurgery) in the incidence of mental disorders, while x2 Test showed that having a more severe HI is significantly correlated with the incidence of mental disorders (P < 0.01). Conclusions: The implications of this study should be discussed with an emphasis on negative, effective factors on the cognitive – behavioral and neuropsychiatric outcomes of a TBI

A Time Series Model for Assessing the Trend and Forecasting the Road Traffic Accident Mortality

Background: Road traffic accident (RTA) is one of the main causes of trauma and known as a growing public health concern worldwide, especially in developing countries. Assessing the trend of fatalities in the past years and forecasting it enables us to make the appropriate planning for prevention and control. Objectives: This study aimed to assess the trend of RTAs and forecast it in the next years by using time series modeling. Materials and Methods: In this historical analytical study, the RTA mortalities in Zanjan Province, Iran, were evaluated during 2007 - 2013. The time series analyses including Box-Jenkins models were used to assess the trend of accident fatalities in previous years and forecast it for the next 4 years. Results: The mean age of the victims was 37.22 years (SD = 20.01). From a total of 2571 deaths, 77.5% (n = 1992) were males and 22.5% (n = 579) were females. The study models showed a descending trend of fatalities in the study years. The SARIMA (1, 1, 3) (0, 1, 0) 12 model was recognized as a best fit model in forecasting the trend of fatalities. Forecasting model also showed a descending trend of traffic accident mortalities in the next 4 years. Conclusions: There was a decreasing trend in the study and the future years. It seems that implementation of some interventions in the recent decade has had a positive effect on the decline of RTA fatalities. Nevertheless, there is still a need to pay more attention in order to prevent the occurrence and the mortalities related to traffic accidents

Predicting inpatient length of stay in Iranian Hospital: Conceptualization and validation

Objective: The length of stay is an important indicator of hospital performance and efficiency. Regarding the importance of the length of stay, this study aimed to design a structural model of the inpatients' length of stay in the educational and therapeutic health care facilities of Iran in order to identify the influencing dimensions. Methods: The present study was an analytical and applied study. The face validity of the data gathering tool was investigated by the expert judgment and the construct validity was examined by using the exploratory factor analysis. In order to verify the reliability of the tool, the internal consistency was also trialed by using the Cronbach's alpha. For ranking the influencing dimensions and factors and also in order to examine the causal relationships between the variables in a coherent manner and presenting the final model, the structural equation modeling technique was used in AMOS software at a significant level of 0.05. Results: The mentioned structural model consists of 4 dimensions and 29 factors influencing the length of stay of hospitalized patients. The independent variables are based on priority and importance as follows: patients' conditions, the underlying factors, the clinical staff performance, and hospitals' service delivery, which were examined by second-order factor analysis in order to study the relationship between them and the inpatients' length of stay. Conclusion: Considering the importance of each one of the proposed dimensions from the point of view of service providers in some therapeutic centers of the country by paying attention to the role of each one of them in preventing prolonged hospitalization can be essential in the effectiveness of the treatment and cost reduction. © 2020 Asian Pacific Organization for Cancer Prevention

The Relationship Between Serum Levels of Interleukins 6, 8, 10 and Clinical Outcome in Patients With Severe Traumatic Brain Injury

Background: Clinical outcome in patients with severe traumatic brain injury (TBI) depends on both primary and secondary brain injuries. Neuroinflammation is an important secondary mechanism, which occurs by releasing interleukins (ILs). Increased levels of ILs may affect clinical outcome following TBI. Objectives: This study aimed to determine the relationship between the serum levels of interleukins 6, 8 and 10 and clinical outcome in patients with severe TBI 6 months after injury. Patients and Methods: In a descriptive-analytical study, 44 patients with GCS ≤ 8 (Glasgow coma scale) and age ≥ 14 years were included. Their blood samples were collected at first 6 hours after injury. Clinical outcome was determined based on GOS (Glasgow Outcome Scale) at 6 months after head injury. Serum levels of interleukins 6, 8 and 10 were measured using the ELISA method. Spearman's rho, independent T-Test, and Mann-Whitney Test were used for data analysis. Results: Comparing the serum levels of interleukins in two groups with favorable and unfavorable clinical outcomes showed that the mean serum levels of interleukins 6 and 8 in group with favorable outcome was 85.2 ± 51.6 and 52.2 ± 31.9, respectively lower than those of group with unfavorable outcome with 162.3 ± 141.1 and 173.6 ± 257.3 (P < 0.03) and (P < 0.01). Conclusions: Increased serum levels of interleukins 6 and 8 as a predictive marker might be associated with unfavorable clinical outcome in patients with severe TBI

Measuring equity in household's health care payments (Tehran-Iran 2013): Technical points for health policy decision makers

Background: Households' financial protection against health payments and expenditures and equity in utilization of health care services are of the most important tasks of governments. This study aims to measuring equity in household's health care payments according to fairness in financial contribution (FFC) and Kakwani indices in Tehran-Iran, 2013. Methods: This cross-sectional study was conducted in 2014.The study sample size was estimated to be 2200 households. Households were selected using stratified-cluster sampling including typical families who reside in the city of Tehran. The data were analyzed through Excel and Stata v.11software. Recall period for the inpatient care was 1 year and for outpatient1 month. Results: The indicator of FFC for households in health financing was estimated to be 0.68 and the trend of the indicator was ascending by the rise in the ranking of households' financial level. The Kakwani index was estimated to be a negative number (-0.00125) which indicated the descending trend of health financing system. By redistribution of incomes or the exempt of the poorest quintiles from health payments, Kakwani index was estimated to be a positive number (0.090555) which indicated the ascending trend of health financing system. Conclusion: According to this study, the equity indices in health care financing denote injustice and a descending trend in the health care financing system. This finding clearly shows that deliberate policy making in health financing by national health authorities and protecting low-income households against health expenditures are required to improve the equity in health

A comparative study of the disinfection efficacy of H<inf>2</inf>O<inf>2</inf>/ferrate and UV/H<inf>2</inf>O<inf>2</inf>/ferrate processes on inactivation of Bacillus subtilis spores by response surface methodology for modeling and optimization

Abstract Although chlorination can inactivate most of the microorganisms in water but protozoan parasites like C. parvum oocysts and Giardia cysts can resist against it. Therefore, many researches have been conducted to find a novel method for water disinfection. Present study evaluated the synergistic effect of H2O2 and ferrate followed by UV radiation to inactivate Bacillus subtilis spores as surrogate microorganisms. Response surface methodology(RSM) was employed for the optimization for UV/H2O2/ferrate and H2O2/ferrate processes. By using central composite design(CCD), the effect of three main parameters including time, hydrogen peroxide, and ferrate concentrations was examined on process performance. The results showed that the combination of UV, H2O2 and ferrate was the most effective disinfection process in compare with when H2O2 and ferrate were used. This study indicated that by UV/H2O2/ferrate, about 5.2 log reductions of B. subtilis spores was inactivated at 9299 mg/l of H2O2 and 0.4 mg/l of ferrate concentrations after 57 min of contact time which was the optimum condition, but H2O2/ferrate can inactivate B. subtilis spores about 4.7 logs compare to the other process. Therefore, the results of this research demonstrated that UV/H2O2 /ferrate process is a promising process for spore inactivation and water disinfection. Keywords Disinfection Bacillus subtilis spores UV radiation/ H2O2 /ferrate Response surface methodology (RSM) Central composite design (CCD

A comparative study of the disinfection efficacy of H2O2/ferrate and UV/H2O2/ferrate processes on inactivation of Bacillus subtilis spores by response surface methodology for modeling and optimization

Although chlorination can inactivate most of the microorganisms in water but protozoan parasites like C. parvum oocysts and Giardia cysts can resist against it. Therefore, many researches have been conducted to find a novel method for water disinfection. Present study evaluated the synergistic effect of H2O2 and ferrate followed by UV radiation to inactivate Bacillus subtilis spores as surrogate microorganisms. Response surface methodology(RSM) was employed for the optimization for UV/H2O2/ferrate and H2O2/ferrate processes. By using central composite design(CCD), the effect of three main parameters including time, hydrogen peroxide, and ferrate concentrations was examined on process performance. The results showed that the combination of UV, H2O2 and ferrate was the most effective disinfection process in compare with when H2O2 and ferrate were used. This study indicated that by UV/H2O2/ferrate, about 5.2 log reductions of B. subtilis spores was inactivated at 9299 mg/l of H2O2 and 0.4 mg/l of ferrate concentrations after 57 min of contact time which was the optimum condition, but H2O2/ferrate can inactivate B. subtilis spores about 4.7 logs compare to the other process. Therefore, the results of this research demonstrated that UV/H2O2 /ferrate process is a promising process for spore inactivation and water disinfection. © 2018 Elsevier Lt

Optimization of Advanced Oxidation Process Based on Persulfate (Uv/Na2s2o8/Fe2+) for Phthalic Acid Removal from Aqueous Solutions with Response Surface Methodology

BACKGROUND AND OBJECTIVE: Phthalic acid has high toxicity and low degradability which has put treatment of wastewater containing this compound prior to prevent its health and environmental hazards. Present study was conducted to Optimization of (UV/Na2S2O8/Fe2+) process for phthalic acid removal from aqueous solutions with response surface methodology. METHODS: This is an experimental study which was conducted at laboratory scale and synthetically in the cylindrical reactor containing UV-C lamp with 16 Watt power. Effects of variables including pH of solution (3-11), reaction time (0-60 min), concentration of persulfate (0.1-0.5 mmol/L), concentration of Fe2+ (0.1-0.2 mmol/L) and initial phthalaic acid (5-50 mg/L) on efficacy of process were investigated by response surface method (box Behnken method). The residual concentration of phthalic acid was measured by HPLC at a wavelength of 254 nm FINDINGS: The removal efficiency of phthalic acid increased by increasing pH level and reaction time. The maximum removal efficiency of phthalic acid attained as 98 percent at pH of 11, reaction time of 60 min, 0.15 mmol/L of Fe2+ concentration, persulfate concentration of 0.3 mmol/L and 5 mg of phthalic acid. The process of removing phthalic acid followed from first-order kinetic (R2=0.9766). The effects of all studied independent variables with p<0.05 on removal efficiency of phthalic acid were found significant. CONCLUSION: Obtained results indicated that the UV/Na2S2O8/Fe2+ process for removing phthalic acid from the aquatic environments has high efficiency. This issue confirms the acceptable efficiency of mentioned method for the removal of phthalic acid