Publications by authors named "Hamid Reza Khankeh"

62 Publications

Evaluating the disaster preparedness of emergency medical service agencies in the world: A systematic literature review protocol.

J Educ Health Promot 2020 29;9:351. Epub 2020 Dec 29.

MD National Emergency Medical Organization, Tehran, Iran.

Introduction: Disasters occur almost everywhere in the world, and preparation is essential. Preparedness is an effective approach for disaster management, and it is crucial for the health systems, especially the Emergency Medical Service (EMS) agencies. This systematic review will be conducted to assess the preparedness levels of EMS agencies in the world for the response to disasters and explore the key dimensions and strategies to enhance it.

Methodology: This systematic literature review will be conducted to search comprehensively the articles published between 2000 and 2019 to explore the disaster preparedness of EMS Agencies. To this end, PubMed, Scopus, Web of Science, and Google Scholar will be thoroughly assessed. The following terms and expression will be used for searching the databases: "EMS" and other keywords "Disaster Preparedness," "Mass Casualty Incident," "Mass Gathering," "Terrorist incident," "Weapons of Mass Destruction," and CBRNE, Disaster, included: 'Emergency Preparedness, Preparedness, Readiness.

Discussion: To the best of our knowledge, no systematic review study has been conducted on disaster preparedness of EMS agencies in the world. This is the first study to address this gape. It will also explore the key dimensions of disaster preparedness in EMS services and the strategies to enhance their preparedness.

Conclusion: Identifying the key dimensions of disaster preparedness is the first step in designing valid assessment tools to evaluate disaster preparedness of EMS service. This study will provide valuable guides for EMS administrators and researchers in an attempt to enhance of preparedness of EMS systems in disasters.
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http://dx.doi.org/10.4103/jehp.jehp_416_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871916PMC
December 2020

Psychological aspects of climate change risk perception: A content analysis in Iranian context.

J Educ Health Promot 2020 29;9:346. Epub 2020 Dec 29.

Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Risk perception is an important predictor to mitigate climate change effects which can produce mental health consequences such as anxiety and depression. For developing policies of climate risk adaptation, awareness of public attitudes, beliefs, and perception is essential. At this study, researchers tried to focus on the often "unseen" psychological aspects of climate change.

Materials And Methods: A qualitative approach was done with a consistent content analysis method. The study consisted of 33 participants including ordinary people and experts in disasters and climate change. Purposeful sampling was adopted until data saturation. The data collection was performed through in-depth and semi-structured interviews. All interviews were transcribed after listening again and again and reading several times to catch an overall understanding of the interviews.

Results: The main theme of the study was "Complexity nature of climate change risk perception" and related categories including "the Mental health dimension," "the Cognitive dimension" and "Interaction of imposed components." The structure of the research community strongly reflected effects of cultural and religious factors in all aspects of community life. Participants' life experiences of extreme events were associated to their perception of climate change.

Conclusions: Risk perception is multifactorial and complicate and should clearly be understood to improve community participation to manage climate change-related risks. We propose that authorities and related managers should pay attention to it as a priority. This may assist in developing research on public mental health practices.
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http://dx.doi.org/10.4103/jehp.jehp_415_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871946PMC
December 2020

Students' preparedness for disasters in schools: a systematic review protocol.

BMJ Paediatr Open 2020 4;4(1):e000913. Epub 2020 Dec 4.

Department of Child & Family Welfare, Graduate School of Behavioral Sciences, University of Groningen, Groningen, Netherlands.

Introduction: Children are one of the most vulnerable groups in disasters. Improving students' knowledge and skills to prepare for disasters can play a major role in children's health. School as a place to teach children can make a significant contribution to provide the necessary skills. This study aims to identify the effects, strengths and weaknesses of interventions in schools to prepare children for disasters.

Methods And Analysis: We use Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to develop a protocol for this systematic review. The included studies will report on the results of interventions targeting 'schoolchildren' defined as individuals between 4 and under 18 years old studying in schools. Different electronic databases will be used for a comprehensive literature search, including MEDLINE, Web of Science, CINAHL, PsycINFO, Cochrane Register of Controlled Trials and EMBASE to identify the records that match the mentioned inclusion criteria published till December 2020. The main search terms are 'disaster', 'preparedness', 'children' and 'school'. Four types of data will be extracted from the qualified studies including study characteristics (study design, year of publication and geographical region where the study was conducted), participant characteristics (sample size, age and gender), intervention characteristics (aim of intervention, intervention facilitators and barriers) and intervention outcomes. The quality appraisal of the selected papers will be conducted using Cochrane Collaboration's Risk of Bias for quantitative studies and Critical Appraisal Skills Programme checklist for qualitative studies. We use a narrative synthesis for this systematic review. The narrative synthesis refers to an approach to systematic reviews which focuses mostly on applying words and texts to summarise and explain findings.

Ethics And Dissemination: This paper is a part of a Ph.D. thesis of Hamed Seddighi at University of Social welfare and Rehabilitation Sciences with ethics code IR.USWR.REC.1399.008 approved by the Ethics Committee of the above-mentioned university.

Prospero Registration Number: CRD42020146536.
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http://dx.doi.org/10.1136/bmjpo-2020-000913DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7722369PMC
December 2020

Disaster Preparedness among Emergency Medical Service Providers: A Systematic Review Protocol.

Emerg Med Int 2020 26;2020:6102940. Epub 2020 Oct 26.

Health in Emergency and Disaster Research Center, The University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

. The emergency medical service (EMS) provides first-line medical care to people who require urgent medical care in emergency and disaster situations. Preparedness is the most effective approach for the management of disaster risks, and it is essential for the emergency medical service (EMS) providers, such as paramedics, emergency medical technicians (EMT), and other EMS personnel. This systematic review will explore evidence on the preparedness of emergency medical service providers in emergency and disaster situations by reviewing peer-reviewed journal articles. . This study will be conducted on peer-reviewed articles published between 2005 and 2019 to explore the preparedness of emergency medical service providers in emergencies and disasters. Scopus, Web of Science, PubMed, and Google Scholar will be thoroughly searched to identify published studies on emergency and disaster preparedness. The following keywords will be used for searching the databases: "Medical Technician," "Paramedic," "Emergency Paramedic," "Emergency Medicine Technician," "Emergency Medical Technician," "Emergency Prehospital Provider," "Emergency Preparedness," "Disaster Preparedness," "Hospital Preparedness," "Disaster management," "Disaster Competencies," "Disaster Readiness," "Disaster," "Disaster Role," "Readiness, Preparedness, Terrorist," "Mass Casualty Incident," "Major incidents," "Mass Casualty," "Mass Gathering," "CBRNE," "Weapons of Mass Destruction," and "Chemical, Biological, Radiological, Nuclear, and Explosive Event." . To the best of our knowledge, no comprehensive review study has been conducted on the preparedness of emergency medical service providers in disaster situations. This study is the first attempt to address this gap. It will also explore the key dimensions in disaster preparedness of EMS providers and the strategies to enhance their preparedness. Identifying the key dimensions of disaster preparedness is the first step in designing and developing valid instruments to evaluate EMS provider's disaster preparedness and as well as adopting appropriate strategies to improve the level of their preparedness (This systematic review is registred in PROSPERO with CRD42020149689).
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http://dx.doi.org/10.1155/2020/6102940DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7683168PMC
October 2020

Psychological distress among Iranian health-care providers exposed to coronavirus disease 2019 (COVID-19): a qualitative study.

BMC Psychiatry 2020 10 7;20(1):494. Epub 2020 Oct 7.

Faculty of Nursing, AJA University of Medical Sciences, Tehran, IR, Iran.

Background: Novel corona virus, named COVID-19, has spread rapidly to other countries like Italy, Iran and South Korea and affected all people, especially health-care providers. Therefore, due to the rapid spread of the disease in Iran, the aim of the present study was to explore psychological distress experienced by Iranian health-care providers in the first few weeks of the corona virus outbreak.

Methods: The present qualitative study was conducted on 18 Iranian health-care providers exposed to COVID - 19 using a content analysis method. Purposeful sampling was used to select the participants and continued until data saturation was reached. Data were collected using semi-structured interviews and then the qualitative data were analyzed through direct content analysis.

Results: By analyzing 236 primary codes, two main categories were extracted from the experiences of health-care providers during corona virus outbreak. The first category included Occupational demands with three sub-categories: nature of illness, Organizational demands and social demands. The second category was Supportive resources included personal support and social support.

Conclusions: The results of this study found that there were some barriers and challenges to medical personnel exposed to COVID-19 that caused psychological distress. Some of these problems related to the nature of illness, others related to social and organizational demands and some of supportive resources buffer the relationship between occupational demands and psychological distress.
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http://dx.doi.org/10.1186/s12888-020-02889-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538532PMC
October 2020

The growth trend of never-married elderly population in Iran in the third millennium.

J Family Med Prim Care 2020 Jun 30;9(6):2837-2842. Epub 2020 Jun 30.

Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

Background: Statistics show that the age of the Iranian population is advancing, and the marriage age is increasing as well. Clearly, an increase in the number of never-married older adults is expected. The aim of this descriptive, analytical study was to determine the growth trend of never-married older population and its association with education level in Iran.

Methods: Based on the raw data collected from the Statistical Center of Iran, we studied the population of never-married older adults in the past 25 years and evaluated the growth pattern in different parts of Iran, using ArcGIS software. We also examined the association of singlehood in late life with education in men and women residing in rural and urban areas, using the Chi-square test in SPSS version 22.

Results: A sharp increase was observed in the population of never-married older adults, particularly women, in the past 10 years. Women with formal education from urban and rural areas were more likely to be never married in late life (χ = 10455.35, < 0.001 and χ = 271.31, < 0.001, respectively). Older men with formal education from urban areas were more likely to be never married (χ = 35.44, < 0.001), while men with formal education from rural areas were less likely to be never married (χ = 179.13, < 0.001).

Conclusion: The rate of increase in the population of never-married older women was much higher than the overall growth of older population. Women with formal education, particularly those with university and pre-university degrees, were more likely to be single in late life. It is strongly suggested to determine the causes and process of singlehood in old age in future research, including qualitative studies.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_264_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7491768PMC
June 2020

Hospital Disaster Preparedness in Iran: A Systematic Review and Meta-Analysis.

Iran J Public Health 2020 May;49(5):837-850

Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran.

Background: Disasters are increasing all over the world. Iran, is one of the high-risk countries in this regard; so it is unavoidable to prepare hospitals as vital centers when disasters happen. This study aimed to evaluation the hospital preparedness based on previous studies in Iran.

Methods: A systematic review and meta-analysis by browsing through all articles published since 2006 to 2017, in English and Persian both languages were designed. Databases that we searched to, include Google Scholar, PubMed, Web of Science, Scopus, Medlib, Cochrane Library, Science Direct, Internationally and SID, Irandoc and Magiran, domestically. Two expert researchers investigated separately. Researchers used random and fixed effect models in the meta-analysis. Moreover, random and fixed effects model and meta-regression tests were applied by using STATA ver. 11. The <0.05 was considered statistically significant.

Results: Twenty-five studies with a sample size of 181 hospitals were introduced to the process of meta-analysis. Iranian hospital preparedness is 53%, totally, that is moderate. Preparedness in different categories is as follows: emergency services 62%, communication 57%, security 54%, education 57%, logistic 65%, human resources 52%, Management and command 64%, reception 43%, transfer and evacuation 44%, traffic 47%, non-structural safety 57%, and structural safety 49%.

Conclusion: Hospital preparedness is moderate in Iran. Optimal management of existing resources and the use of Update technologies in the field of hospital services be directed towards improving the preparedness of hospitals for disasters.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7475629PMC
May 2020

The association between air pollution and cancers: controversial evidence of a systematic review.

Environ Sci Pollut Res Int 2020 Nov 7;27(31):38491-38500. Epub 2020 Aug 7.

Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

There are inconsistent reports on the association between air pollution and cancers. This systematic review was, therefore, conducted to ascertain the relationship between air pollution and some cancers. This is a systematic review study, which all articles published in this area were extracted from January 1, 1950 to December 31, 2018 from Web of Science, PubMed, Scopus, Cochrane Library, MEDLINE, EMBASE, Science Direct, Google scholar. Searching was performed independently by two search-method experts. The required data were extracted from the articles by an author-made questionnaire. Forty-eight articles were investigated. Evidence linking air pollution to some cancers is limited. Leukemia had the highest association with exposure to various air pollutants and bladder cancer had the lowest association. It is noteworthy that the specific type of pollutants in all studies was not specified. Based on the findings, the results are contradictory, and the role of air pollution in some cancers cannot be supported. Accordingly, studies are recommended to be performed at the individual level or multifactorial studies to specifically investigate the relationship between air pollution and these types of cancers. In this way, the role of air pollution in the incidence of these cancers can be determined more accurately.
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http://dx.doi.org/10.1007/s11356-020-10377-zDOI Listing
November 2020

The simultaneous effects of thermal stress and air pollution on body temperature of Tehran traffic officers.

J Environ Health Sci Eng 2020 Jun 16;18(1):279-284. Epub 2020 Mar 16.

1Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, kodakyar Ave., daneshjo Blvd., Evin, Tehran, 1985713834 Iran.

Purpose: Global warming and air pollution are among the most important problems all over the world. Considering the key role of traffic officers who saliently deal with traffic management and are in full, constant and direct exposure to thermal stress and air pollution index, this study aims to investigate the simultaneous effects of these factors on the body temperature of traffic officers in the main squares of Tehran.

Methods: This study was conducted among 119 traffic officers who were working in 29 squares of Tehran, located near the active pollutant's stations during 2017. Samples were selected by the census method. Environmental parameters such as air temperature (dry and wet), radiation temperature, the level of air pollution in the main squares and characteristics of officers such as body temperature and the Wet-Bulb-Globe-Temperature (WBGT) index were evaluated. Data were analyzed through independent samples t-test and factorial ANOVA with a value of  ≤ 0.05 in SPSS software.

Results: There was no significant relationship between air pollution and ear temperature, but there was a statistically significant difference between the wet-bulb temperature and the ear temperature (t = 26.4,  < 0.001). The interaction effect of air pollution and wet-bulb temperature on the ear temperature was also significant (F = 3.98,  = 0.048).

Conclusion: Exposure to heat and air pollution affects body temperature, with its greatest impact on the temperature of the ear. More studies are recommended to be conducted in these field and other factors such as demographic and environmental factors at different times of the year should be investigated. Accordingly, some interventions should be implemented to reduce the vulnerability of officers based on the findings of the research.
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http://dx.doi.org/10.1007/s40201-020-00463-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7203383PMC
June 2020

Early warning system-related challenges in health sector: A qualitative content analysis study in Iran.

J Educ Health Promot 2020 28;9:38. Epub 2020 Feb 28.

Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.

Context: Iran's health system has always faced many challenges in the field of disaster risk management. The establishment of early warning systems in countries has been identified as an important component of preparedness and risk reduction.

Aims: This study aims to extract the experiences of those involved in the field of risk management in relation to the challenges and problems of early warning system establishment in the Iran's health system.

Subjects And Methods: This was a qualitative study, which has been conducted using a content analysis method. Data were collected through semi-structured interviews with 16 individuals who had at least one disaster management experience at the emergency operation centers. Sampling was done purposefully. The data were then analyzed using the Grenheim method.

Results: Nine subcategories of data were analyzed that included legal vacancies, challenges related to protocols and guidelines, weaknesses in the prediction infrastructure, weaknesses in the communication infrastructure, poor coordination, scarcity of resources, inadequate education, information management challenge, and evaluation challenge, and three main categories were extracted that included policy challenges, infrastructure challenges, and management challenges that represented the issues experienced in establishing an early warning system in the Iranian health system.

Conclusion: Policy-makers and managers of health system need to pay special attention to improve the legal framework and standard protocol, strengthening infrastructures, increasing management performance in the field of coordination, education, allocation of resources, flow of information, and evaluation system.
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http://dx.doi.org/10.4103/jehp.jehp_510_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7161681PMC
February 2020

The Principles of Triage in Emergencies and Disasters: A Systematic Review.

Prehosp Disaster Med 2020 Jun 6;35(3):305-313. Epub 2020 Mar 6.

Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

Introduction: The use of triage systems is one of the most important measures in response to mass-casualty incidents (MCIs) caused by emergencies and disasters. In these systems, certain principles and criteria must be considered that can be achieved with a lack of resources. Accordingly, the present study was conducted as a systematic review to explore the principles of triage systems in emergencies and disasters world-wide.

Methods: The present study was conducted as a systematic review of the principles of triage in emergencies and disasters. All papers published from 2000 through 2019 were extracted from the Web of Science, PubMed, Scopus, Cochrane Library, and Google Scholar databases. The search for the articles was conducted by two trained researchers independently.

Results: The classification and prioritization of the injured people, the speed, and the accuracy of the performance were considered as the main principles of triage. In certain circumstances, including chemical, biological, radiation, and nuclear (CBRN) incidents, certain principles must be considered in addition to the principles of the triage based on traumatic events. Usually in triage systems, the classification of the injured people is done using color labeling. The short duration of the triage and its accuracy are important for the survival of the injured individuals. The optimal use of available resources to protect the lives of more casualties is one of the important principles of triage systems and does not conflict with equity in health.

Conclusion: The design of the principles of triage in triage systems is based on scientific studies and theories in which attempts have been made to correctly classify the injured people with the maximum correctness and in the least amount of time to maintain the survival of the injured people and to achieve the most desirable level of health. It is suggested that all countries adopt a suitable and context-bond model of triage in accordance with all these principles, or to propose a new model for the triage of injured patients, particularly for hospitals in emergencies and disasters.
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http://dx.doi.org/10.1017/S1049023X20000291DOI Listing
June 2020

Hospital management preparedness tools in biological events: A scoping review.

J Educ Health Promot 2019 29;8:234. Epub 2019 Nov 29.

Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

Introduction: The objective of the present study was to systematically review the current research knowledge on hospital preparedness tools used in biological events and factors affecting hospital preparedness in such incidents in using a scoping review methodology.

Materials And Methods: The review process was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guideline. Online databases (PubMed, Scopus, Web of Science, and Google Scholar) were used to identify papers published that evaluated instruments or tools for hospital preparedness in biological disasters (such as influenza, Ebola, and bioterrorism events). The search, article selection, and data extraction were carried out by two researchers independently.

Results: A total of 3440 articles were screened, with 20 articles identified for final analysis. The majority of research studies identified were conducted in the United States (45%) and were focused on CBRN incident (20%), Ebola, infectious disease and bioterrorism events (15%), mass casualty incidents and influenza pandemic (10%), public health emergency, SARS, and biological events (5%). Factors that were identified in the study to hospitals preparedness in biological events classified in seven areas including planning, surge capacity, communication, training and education, medical management, surveillance and standard operation process.

Conclusions: Published evidences of hospital preparedness on biological events as well as the overall quality of the psychometric properties of most studies were limited. The results of the current scoping review could be used as a basis for designing and developing a standard assessment tool for hospital preparedness in biological events, and it can also be used as a clear vision for the healthcare managers and policymakers in their future plans to confront the challenges identified by healthcare institutes in biologic events.
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http://dx.doi.org/10.4103/jehp.jehp_473_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6905292PMC
November 2019

Developing a Hospital Disaster Risk Management Evaluation Model.

Risk Manag Healthc Policy 2019 10;12:287-296. Epub 2019 Dec 10.

Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

Purpose: Disasters are increasing worldwide and hospitals should be prepared to respond well to such disasters. An effective hospital disaster risk management program saves peoples' lives, reduces damage to the hospital properties and assures hospital service continuity. This article aimed to develop and verify a Hospital Disaster Risk Management Evaluation model (HDRME).

Methods: A mixed-method explanatory sequential approach was used to develop and verify the HDRME model. The first draft of the HDRME model was introduced through a comprehensive literature review of major databases (i.e., PubMed, Scopus, Web of Science, and Science Direct), using appropriate keywords. Furthermore, 18 in-depth individual interviews were conducted with well-known experts in DRM to identify more HDRME constructs, sub-constructs, and standards. Then, three rounds of Delphi were conducted with 22 experts in hospital disaster risk management to verify the proposed model.

Results: The proposed HDRME consists of eight constructs, including seven enablers (management and leadership; risk assessment; planning; prevention and mitigation; preparedness; response, and recovery) and one result (key performance results). These constructs were further broken into 27 sub-constructs. The enablers and results scored 85% and 15% of the model's total scores.

Conclusion: A comprehensive conceptual framework for the evaluation of hospital disaster risk management was introduced and verified. Standards and measurable elements can be embedded in this conceptual model to measure a hospital's preparedness in disasters and accordingly, corrective actions can be taken to strengthen the hospitals' responses to the disasters. However, the proposed model should be validated in a hospital setting through implementation.
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http://dx.doi.org/10.2147/RMHP.S215444DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6911334PMC
December 2019

Early warning system models and components in emergency and disaster: a systematic literature review protocol.

Syst Rev 2019 12 6;8(1):315. Epub 2019 Dec 6.

Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

Background: Emergency and disaster are on the rise in the world. One of the most important components of disaster risk management is the early warning system. Studies have shown divergent models of warning systems with different structures. However, since no systematic review of early warning systems in disasters has been conducted so far, a systematic review of the models, components, and structures of these systems is essential. This protocol is a systematic review study, which aims to evaluate the existing warning systems and their structure.

Methodology: This study attempts to comprehensively search the previous studies with terms and expressions including disaster, emergency model, early warning system, and their synonyms at MESH. To this end, English articles, which have been published from 1980 to 2019, will be assessed. Google Scholar, PubMed, Web of Science, and Scopus databases as well as relevant specialized websites will be searched. Studies will be evaluated by two individuals independently.

Discussion: To the best of our knowledge, no systematic review of models, structures, and components of the early warning system has been conducted so far. This study is the first attempt to comprehensively evaluate the models and components of early warning systems. Accordingly, this study will provide evidence of models, structures and elements of the early warning systems.

Systematic Review Registration: PROSPERO CRD42018116111.
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http://dx.doi.org/10.1186/s13643-019-1211-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6896508PMC
December 2019

Educational impact of assessment on medical students' learning at Tehran University of Medical Sciences: a qualitative study.

BMJ Open 2019 07 29;9(7):e031014. Epub 2019 Jul 29.

Department of Medical Education, Tehran University of Medical Sciences, Tehran, Iran

Objectives: It has been shown that assessment strongly affects students' performance. A deeper insight needs to be gained into the interplay of assessment and learning. The aim of the current study was to develop a model to explain the educational impact of assessments on students' learning, before, during and after the test.

Design: This study used semistructured interviews, focus group discussions and observation and collection of field notes. A qualitative methodology using the grounded theory data analysis approach was then used to generate an explanation of the process of how assessment impacts students' learning.

Setting: School of Medicine, Tehran University of Medical Sciences.

Participants: Participants were medical students and teachers with first-hand experience or expertise in assessment as well as their willingness to participate in the study. Fifteen people (eight medical students, seven faculty members) were interviewed. One focus group discussion (with five students) was held.

Results: The extracted concepts from our study were classified into four main categories. These categories include elements of the assessment programme which affect learning, the mechanism through which they exert their effects, contextual factors and the impact they have on learning. These elements and their interplay occur within an environment with its antecedent characteristics.

Conclusions: This study suggested a model for understanding the elements of the assessment which, within the context, affect learning, the mechanisms through which they impart their effects and the final outcomes obtained.
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http://dx.doi.org/10.1136/bmjopen-2019-031014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677973PMC
July 2019

Social Workers in Pediatric Oncology: A Qualitative Study in Iranian Context.

Asian Pac J Cancer Prev 2019 06 1;20(6):1871-1877. Epub 2019 Jun 1.

Emergency and Disaster Health Department and Research Center in Emergency and Disaster Health, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. Email:

Background: As professionals, social workers have a special position in relation to considering the needs of children with cancer and their families. Hence, it is important to recognize the experiences and challenges of social workers to improve care of their clients. Method: This study was a qualitative content analysis that aimed to determine a comprehensive understanding of pediatric oncology social workers’ experiences in Iran. In total, 19 social workers participated in the study. A purposeful sampling method was applied until reaching data saturation. Data were collected using semi-structured interviews and field observations. Then, the gathered data were analyzed through face content analysis. The study lasted from 2015 to 2017. Finding: Concepts extracted from social workers’ experiences consisted of the nature of oncology work, lack of professional competence, low organizational support and professional inferiority that were related to main concept of “exhausting and stressful service”. The results indicated that social workers’ involvement in stressful and emotionally demanding situations and facing with professional and organizational challenges caused personal exhaustion. Conclusion: In addition to explaining the social workers’ experiences and related factors, the results emphasize the importance of taking care of service providers to prevent them becoming stressed and exhausted. It is also important to protect patients from the consequences of stressed and exhausted care providers so further research is recommended to develop specific intervention.
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http://dx.doi.org/10.31557/APJCP.2019.20.6.1871DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7021608PMC
June 2019

Physicians' role in the development of inappropriate polypharmacy among older adults in Iran: a qualitative study.

BMJ Open 2019 05 22;9(5):e024128. Epub 2019 May 22.

Department of Nursing, Tarbiat Modares University, Tehran, Iran.

Objectives: The use of unnecessary or excessive medications (inappropriate polypharmacy) is a major health challenge among older adults which is driven by several factors. This study aims to provide in-depth descriptions of the physician's role in the development of inappropriate polypharmacy among older adults in Iran.

Design: Qualitative content analysis of interviews, field notes and other relevant documents available (eg, medical records). Data collection and analyses were done concurrently to guide the sampling process.

Setting: Three purposively selected referral hospitals in Tehran, Iran.

Participants: A total of 7 physicians, 10 older adults, 3 caregivers and 3 pharmacists with a median age of 54 (IQR 23) years were recruited through convenience sampling.

Results: Emerged categories included misdiagnosis, inappropriate prescribing, insufficient patient education, poor communication, unprofessional behaviour and limited perspectives which highlight the role of physicians in the development of inappropriate polypharmacy among older adults in Iran under the main concept of poor medical practice.

Conclusion: This study provides valuable insight on the role of physicians in the development of inappropriate polypharmacy among the elderly in the healthcare setting in Iran by exploring the viewpoints of physicians, patients, caregivers and pharmacists. Physicians can be an influential factor in tackling this challenge through proper diagnosis, prescription, patient education and follow-up. In Iran, physicians' practice styles are affected by potentially adverse factors such as the novelty of geriatric medicine, lack of a referral system, patient unfamiliarity with the system and lack of a monitoring system for multiple prescriptions. Furthermore, clinics tend to be overcrowded and visit fees can be low; in this setting, lack of physician assistants leads to limited time allocation to each patient and physician dissatisfaction with their income.
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http://dx.doi.org/10.1136/bmjopen-2018-024128DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6538096PMC
May 2019

Emergency health evaluation of affected population during disasters: Are there new approaches?

J Educ Health Promot 2019 29;8. Epub 2019 Jan 29.

Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

Introduction: Disasters are inescapable phenomena. Once they occur, reliable and objective information becomes vital in sound decision-making to respond. Emergency health evaluation of affected population can be used to gather information about the patterns of access to medical care, basic household needs, and other health needs. The objective of this review was to summarize evidence from scientific studies on the various methods of emergency health evaluation following disasters.

Materials And Methods: A comprehensive list of studies was provided in May 2017 by an extensive search using PubMed, Web of Sciences, Ovid Medline, ProQuest Research Library, and World Health Organization Library.

Results: Of the 1592 retrieved articles, 21 articles were included in this review. In a majority of the studies ( = 18), a questionnaire was used and an interview was conducted to collect information, but in three studies, smartphone-based methods were used. Sampling method in most of the studies was cluster sampling in Community Assessment for Public Health Emergency Response method. But in eight studies, random sampling method was used. In a majority of the studies, the demographic status of samples and in 18 studies, the condition of diseases, water, shelters, health, food, mortality rate, and existing medical services were investigated.

Conclusions: Although new methods such as social media and smartphones were already investigated in some articles, but these approaches require further investigation since there is a growing need for new methods.
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http://dx.doi.org/10.4103/jehp.jehp_115_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6378814PMC
January 2019

Life satisfaction as the main factor behind the elderly`s health knowledge utilization: A qualitative study in an Iranian context.

Med J Islam Repub Iran 2018 20;32:115. Epub 2018 Nov 20.

Department of Epidemiology and Biostatistics, Faculty of Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.

The elderly population's health has become a priority as their numbers are on the rise and they are increasingly becoming vulnerable to physical and mental diseases. Studies show that an elderly person's health depends on his/her utilization of health knowledge in daily life. Hence, here we investigated the contributing factors of knowledge utilization in the elderly population. A qualitative study was conducted through conventional content analysis. Semi-structured in-depth interviews were held with 29 elderly individuals from Tehran. A focus group discussion was conducted (eight elderly individuals), and an expert panel was held with nine experts to complement the results. Upon data analysis, four categories and seven subcategories were extracted. The main categories included provision of basic needs, maintaining dignity, life satisfaction, and negative feelings toward self and others. The concept of 'life satisfaction' held a pivotal role in relation to the other categories. Life satisfaction was the main category in the utilization of health knowledge among the elderly. Aging should be foreseen and forethought to increase life satisfaction. The followings can be effective in increasing life satisfaction in the elderly: Promoting positive-thinking, placing greater emphasis on spiritualism in life, employment of the elderly, and promoting the culture and tradition of respecting the elderly.
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http://dx.doi.org/10.14196/mjiri.32.115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6387817PMC
November 2018

Defining loneliness in older adults: protocol for a systematic review.

Syst Rev 2019 01 17;8(1):26. Epub 2019 Jan 17.

Mental Health Research Group, Health Metrics Research Centre, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran.

Background: Socialization is an important part of the healthy aging process, but natural changes in the lifestyle and health of older people increased risk of loneliness. However, loneliness is not well defined and might differ in different cultures and settings. The main objective of this systematic review is to summarize literature on the topic and propose a definition that might help aging research and practice in the future.

Methods: Eight databases including PubMed, Scopus, CINAHL, Web of Science, EMBASE, PsycINFO, Proquest, and Age Line bibliographic will be run individually to retrieve relevant literature on loneliness among elderly population using subject headings and appropriate MeSH terms. Inclusion and exclusion criteria will be developed and refined by the research team. Two reviewers will participate in each search stage including abstract/title and full text screening, data extraction, and appraisal. We will restrict our search to articles published in the English language biomedical journal between 2000 and 2017. The protocol adheres to the standards recommended by the PRISMA-P.

Discussion: The results of this systematic review can present a more accurate definition of loneliness for researchers who aim at conducting new primary and secondary studies on this subject.

Systematic Review Registration: CRD42017058729.
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http://dx.doi.org/10.1186/s13643-018-0935-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6335854PMC
January 2019

Behavioral, Normative and Control Beliefs about Earthquake Preparedness: A Deductive Content Analysis Study.

PLoS Curr 2018 Sep 28;10. Epub 2018 Sep 28.

Post-doc fellowship in Climate Change, Health in Emergency & Disaster Research Center, University of Social Welfare & Rehabilitation Sciences, Tehran, Iran.

Introduction: Despite efforts to increase earthquake preparedness (EP), the level of earthquake preparedness in Tehran is low, even when people acknowledge the risk they face. This problem has its roots in the beliefs of Tehran inhabitants about EP. This study is aimed to elicit the salient beliefs about earthquake preparedness among Tehran citizens.

Method: This is a deductive content analysis research. The theory of planned behavior (TPB) has been applied as the theoretical framework of the study. 132 semi-structured interviews have been conducted with Tehran heads of households and the obtained data have been analyzed.

Results: The interviews showed that the belief in the usefulness of the EP and the belief that "the EP can cause anxiety among family members" were the salient behavioral beliefs (the ones influencing the attitude towards a behavior). The main normative belief (which influences the subjective norms), was "my family doesn't disagree with the EP" although most of the interviewees did not know about their families' views. Finally, the main control belief (which is the basis of perceived behavioral control), was that "education can facitilates EP".

Conclusion:  Tehran inhabitants preparedness behaviors can be influenced by their behavioral, normative and control beliefs about preparedness. Recognition of these beliefs may assist policy makers and executives to develop a better understanding of the origins of the preparedness behaviors. Any interventions to change these behaviors should be made based on such knowledge. Key words: Earthquake; preparedness; salient beliefs; theory of planned behavior.
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http://dx.doi.org/10.1371/currents.dis.20fbad29d53fb164ac2699dc2736d804DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6167048PMC
September 2018

Prehospital Emergency Medical Services Challenges in Disaster; a Qualitative Study.

Emerg (Tehran) 2018 26;6(1):e26. Epub 2018 Apr 26.

Department of Medical library and Information Science, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

Introduction: Prehospital Emergency Medical Care (EMC) is a critical service in disaster management. The aim of this study was to explore the challenges of prehospital Emergency Medical Services (EMS) during disaster response in Iran.

Methods: A qualitative study was conducted from April 2015 to March 2017. Data were collected through in-depth, semi-structured interviews with 23 experienced individuals in the field of disaster that were selected using purposeful sampling. Data were analyzed using content analysis approach.

Results: Fifteen sub-themes and the following six themes emerged in the analysis: challenges related to people, challenges related to infrastructure, challenges related to information management systems, challenges related to staff, challenges related to managerial issues and challenges related to medical care.

Conclusions: Iran's prehospital EMS has been chaotic in past disasters. Improvement of this process needs infrastructure reform, planning, staff training and public education.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6036538PMC
April 2018

Meta-evaluation of published studies on evaluation of health disaster preparedness exercises through a systematic review.

J Educ Health Promot 2018 10;7:15. Epub 2018 Jan 10.

Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Objective: Exercise evaluation is one of the most important steps and sometimes neglected in designing and taking exercises, in this stage of exercise, it systematically identifying, gathering, and interpreting related information to indicate how an exercise has fulfilled its objectives. The present study aimed to assess the most important evaluation techniques applied in evaluating health exercises for emergencies and disasters.

Methods: This was meta-evaluation study through a systematic review. In this research, we searched papers based on specific and relevant keywords in research databases including ISI web of science, PubMed, Scopus, Science Direct, Ovid, ProQuest, Wiley, Google Scholar, and Persian database such as ISC and SID. The search keywords and strategies are followed; "simulation," "practice," "drill," "exercise," "instrument," "tool," "questionnaire," " measurement," "checklist," "scale," "test," "inventory," "battery," "evaluation," "assessment," "appraisal," "emergency," "disaster," "cricise," "hazard," "catastrophe,: "hospital", "prehospital," "health centers," "treatment centers," were used in combination with Boolean operators OR and AND.

Results: The research findings indicate that there are different techniques and methods for data collection to evaluate performance exercises of health centers and affiliated organizations in disasters and emergencies including debriefing inventories, self-report, questionnaire, interview, observation, shooting video, and photographing, electronic equipment which can be individually or collectively used depending on exercise objectives or purposes.

Conclusion: Taking exercise in the health sector is one of the important steps in preparation and implementation of disaster risk management programs. This study can be thus utilized to improve preparedness of different sectors of health system according to the latest available evaluation techniques and methods for better implementation of disaster exercise evaluation stages.
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http://dx.doi.org/10.4103/jehp.jehp_159_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5791468PMC
January 2018

The Professionalization of Iranian hospital social Workers.

J Adv Med Educ Prof 2018 Jan;6(1):6-13

Social Work Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

Introduction: Identity is formed through our understanding of ourselves and what others perceive of our actions and how we do things. Formation of professional identity includes development, advancement and socialization through social learning of specific knowledge and skills obtained within the context of professional roles, new attitudes and values.

Methods: This qualitative study used content analysis approach to explain the professionalization process of 22 social workers working in 14 public hospitals in Tehran based on their experiences. The data were collected through semi-structured interviews, observation and writing in the field.

Results: Eleven categories and three themes of entry into the profession, identity formation, and identity ownership were extracted out of data analysis. Revealing the process, barriers and facilitators of professionalization of hospital social workers was the results of this study.

Conclusion: Certain individual characteristics were factors for the tendency of participants to choose this profession. The participants' understanding of their profession was formed, when studying in the university through learning relevant knowledge, skills, views and professional expectations. Achieving a single identity and professional pride and self-esteem are achievements of identity ownership.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5757158PMC
January 2018

Self-medication among the elderly in Iran: a content analysis study.

BMC Geriatr 2017 09 1;17(1):198. Epub 2017 Sep 1.

Mental Health Research Center, Tehran Institute of Psychiatry-School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran.

Background: Self-medication is described as the use of drugs without a physician's prescription to treat self-recognized illness or symptoms, and an important health issue among the elderly. Despite the wide range of different definitions, recognizing all forms of self-medication among older adults, particularly, in developing countries, help healthcare professionals and providers to reduce harmful effects of self-medication. The purpose of this study is to describe the practice of self-medication and its related factors among elderly people in Iran based on the experiences of people who are involved in this phenomenon.

Methods: This qualitative study was conducted using content analysis. Purposive sampling was used to select the participants and continued until saturation. The participants were the elderly, their care-givers, physicians, and pharmacists. Data was collected using semi-structured interviews, and analysis was done using an inductive approach. The theory of planned behavior was used as a framework to explain the role of the emerged factors in the occurrence of self-medication behavior.

Results: Based on the expressed experiences of the participants, factors related to the practice of self- medication among the elderly in Iran fit in these 5 categories: "patient's attitudes towards disease, treatment, and physicians", "living with disease", "unfriendly environments", "enabling health system", and "influential others".

Conclusions: Based on the results of this study, self-medication of the elderly in Iran has commonalities with many countries in regard to over-the-counter medications and complementary and alternative medicine; however, self-medication is also seen with drugs that require a prescription but can easily be obtained from pharmacies. Contributing factors, apart from the elderly themselves, include their families, caregivers, and social circle, the physical environment where they live, and the health system from which they receive services.
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http://dx.doi.org/10.1186/s12877-017-0596-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5580436PMC
September 2017

Disaster mental health preparedness in the community: A systematic review study.

Health Psychol Open 2017 Jan-Jun;4(1):2055102917711307. Epub 2017 Jun 13.

Leipzig University, Germany.

The objective of this study was to perform a systematic review of articles that cover aspects of disaster mental health preparedness. This assessment was done by a thorough review and summary of the available studies which provided a considerable background and amplified the gaps in knowledge about community mental health preparedness. By this systematic review, we tried to identify available concept of community mental health preparedness and related tools that communities and individuals will need to prepare for natural disasters. We found there is a lack of mental health preparedness in the majority of countries; valid and reliable tools and context-bound programs should be developed based on the experiences and perceptions of the community.
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http://dx.doi.org/10.1177/2055102917711307DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5489140PMC
June 2017

Impractical CME programs: Influential parameters in Iran.

Med J Islam Repub Iran 2017;31. Epub 2017 Jan 26.

Educational Development Center, Tehran University of Medical Sciences, Tehran, Iran, & Department of Clinical Sciences and Education, Karolinska Institute, Stockholm, Sweden.

Traditional approaches in Continuing Medical Education (CME) appear to be ineffective in any improvement of the patients' care, reducing the medical errors, and/or altering physicians' behaviors. However, they are still executed by the CME providers, and are popular among the majority of the physicians. In this study, we aimed to explore the parameters involved in the degree of effectiveness of CME program in Iran. In this study, 31 participants, consisting of general practitioners, CME experts and providers were recruited to participate in in-depth interviews and field observations concerning experiences with CME. Application was made of the qualitative paradigm along with the qualitative content analysis, using grounded theory data analysis methodology (constant comparative analysis). Based on the participants' experiences, the insufficient consistency between the training program contents and the demands of GPs, in addition to the non-beneficiary programs for the physicians and the non-comprehensive educational designs, created a negative attitude to the continuing education among physicians. This could be defined by an unrealistic continuing education program, which is the main theme here. Impracticable continuing education has created a negative attitude toward the CME programs among physicians so much that they consider these programs less important, resulting in attending the said programs without any specific aim: they dodge absenteeism just to get the credit points. Evidently, promoting CME programs to improve the performance of the physicians requires factual needs assessment over and above adaptation of the contents to the physicians' performance.
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http://dx.doi.org/10.18869/mjiri.31.6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5473012PMC
January 2017

Exploring Facilitators of Post-traumatic Growth in Patients with Spinal Cord Injury: A Qualitative Study.

Electron Physician 2017 Jan 25;9(1):3544-3553. Epub 2017 Jan 25.

Ph.D. of Clinical Psychology, Assistant Professor, Department of Counseling, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

Introduction: There is increasing evidence regarding people's reactions to life stressors in which people also may show positive experiences following a traumatic event. The aim of the present study was to explain the facilitators of post-traumatic growth based on the experiences of patients with a spinal cord injury.

Methods: This was a qualitative study conducted on 16 Iranian patients with a spinal cord injury using semistructured, in-depth interviews, and content analysis in 2015. These participants, despite their spinal cord injury, were successful in their lives and were considered successful members of society. A purposive sampling method was used until reaching data saturation, and then the collected data were analyzed using a content analysis method.

Results: The study revealed several factors as facilitators of post-traumatic growth in the patients. The extracted facilitators were put into seven categories of main concepts, including existence of support resources, contact with spinal cord injury associations, spiritual beliefs, positive attitude toward injury, access to proper facilities, enhancement of knowledge and awareness, and active presence in society.

Conclusion: Different factors may facilitate post-traumatic growth in patients with a spinal cord injury. Understanding these facilitators may help us in designing educational, support, and consulting programs for patients and their families as well as to the correct the support programs.
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http://dx.doi.org/10.19082/3544DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5308493PMC
January 2017

Conceptual model of acid attacks based on survivor's experiences: Lessons from a qualitative exploration.

Burns 2017 May 30;43(3):608-618. Epub 2016 Dec 30.

Department of Social Work, University of Social Welfare and Rehabilitation Science (USWR), Tehran, Iran.

Introduction: Acid attack, a worldwide phenomenon, has been increasing in recent years. In addition to severe injuries to the face and body, such violence leads to psychological and social problems that affect the survivors' quality of life. The present study provides a more in-depth understanding of this phenomenon and explores the nature and dimensions of acid attacks based on survivors' experiences.

Method: A grounded theory study using semi-structured, recorded interviews and applying purposeful theoretical sampling was conducted with 12 acid attack survivors in Iran. Data were analysed using constant comparison in open, axial and selective coding stages.

Results: A conceptual model was developed to explain the relationships among the main categories extracted through the grounded theory study. Physical and psychological wounds emerged as a core category. Traditional context and extreme beauty value in society acted as the context of the physical and psychological wounds experienced. Living with a drug abuser with behavioural disorders and lack of problem-solving skills in interpersonal conflict were found to be causal conditions. Action strategies to deal with this experience were found to be composed of individual, interpersonal and structural levels. Education, percentage and place of burning acted as intervening conditions that influenced survivors' strategies. Finally, adverse consequences of social deprivation and feeling helpless and hindered were found to have an important impact.

Conclusions: Acid attack lead to physical and psychological wounds in survivors. This is a multi-dimensional phenomenon involving illness, disability, and victimization, and requires a wide range of strategies at different levels. The conceptual model derived through this study can serve as a good basis for intervention programs.
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http://dx.doi.org/10.1016/j.burns.2016.10.003DOI Listing
May 2017

Impact of HIV Status Notification on Risk Behaviors among Men Who Inject Drugs in Kermanshah, West of Iran.

J Res Health Sci 2016 ;16(3):116-121

Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

Background: It is unclear whether knowing of current HIV status is associated with change in injecting behaviors among people who inject drugs (PWID) in Iran. The objective of the present study was to determine whether awareness of HIV positive status is associated with a reduction in injecting risk behaviors, after matching for socio-demographic characteristics.

Methods: Five hundred male PWID were recruited in 2014 from two drop-in centers (DICs) in Kermanshah west of Iran. Trained interviewers collected data on socio-demographic characteristics, HIV testing and drug-related risk behaviors over the last month prior to interview using a structured questionnaire. Our primary exposure of interest was awareness of HIV status, used to group participants into three categories: positive, negative, unaware. We used coarsened exact matching to make the three groups statistically equivalent based on age, place of residence, education and income, and then compared them regarding the proportion of borrowing, lending and reuse of syringes.

Results: Matched sample (n=320) had a mean age ± standard deviation (SD) of 33.5 ±7.6 yr. Overall, 25% (95% CI: 14%, 32%) of participants reported "borrowing a syringe" in the past month and 15% (95% CI: 7%, 22%) of them reported "lending a used syringe" to others in the past month. In comparison to PWID who were unaware of their HIV status, those knew they were HIV positive (OR 1.68, CI95%1.32-2.81) or negative (OR 1.54; 95% CI: 1.28, 2.71) were both more likely to report borrowing syringes in past month.

Conclusions: PWID WHO know they are positive for HIV are more likely to borrow another person's syringe, to report reuse of their own used syringes and less likely to report lending their syringes to others. Strategies to scale up HIV testing and counseling for PWID, which also increase awareness of HIV status, may decrease injecting related the risk behaviors.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191024PMC
May 2017