فهرست مطالب alireza razzaghi

Traffic accidents are one of the most important factors contributing to the deaths and injuries of humans around the world. One of the factors causing traffic accidents is hotspots, which increase the possibility of crashes occurring due to the kind of path geometry. One of the ways of preventing crashes and increasing drivers' caution is to utilize technologies such as a hotspot warning system.
In this study, the impact of this system on narrowing the road was examined on the drivers' behavior in both clear and foggy weather.
This experimental study was performed on a simulator with 40 drivers, including men and women. The warning system is an audio and visual kind, so a hotspot was shown in the path of the map on the system screen, and the driver received an alarm. The range in this scenario includes prewarning, from a warning to the onset of a hotspot, a hotspot zone, and after-warning. Data were analyzed using SPSS software version 20, and the significant level of tests was considered 0.05.
The results indicated that a hotspot warning system could affect the drivers' performance, and this effect was observed in variables including speed, steering angle, deceleration, and gas pedal performance. Moreover, the driver's behavior was significant in both clear and foggy weather.
These findings can be used to correct the warning locations and times in the hotspot warning systems when approaching a narrow road.

In low- and middle-income countries, a large proportion of road users include pedestrians, cyclists, and motorcyclists, and nearly half of road traffic fatalities occur among motorcyclists. This study aimed to examine the pattern of motorcyclists' death due to accidents in East Azerbaijan, Iran between 2006 and 2021 and present a forecast.

We used death data due to motorcycle accidents of Legal Medicine Department between 2006 and 2021. For time series analysis, the Box-Jenkins model was used and three stages of identification, estimation, and diagnosis were successively performed and repeated several times to achieve the best prediction model. The Box-cox transformation method was used to stabilize the variance, and the first-order seasonal differential method with a period of 12 was used to control the seasonality. Due to seasonal variations, the Seasonality Auto-Regressive Integrated Moving Average model: SARIMA (p, d, q) (P, D, Q)s was employed and the death trend was predicted for 36 months. The candidate models were compared based on Log-likelihood, AIC, and BIC indices. STATA 17 was used for data analysis.

About 18.6% of all accident deaths are attributed to motorcycle accidents. The death rate for all causes of accidents and motorcycle accidents were 23.13 and 4.30 per 100,000 population, respectively. Seven models were considered as candidates. The SARIMA (0, 0, 0) (1, 1, 1)12 model was selected as the best model due to better fit and used to predict the number and trend of motorcycle accident deaths. Motorcycle accident deaths are predicted to decrease gradually in the next 36 months, from June 2021 to May 2024, affected by seasonal changes.

The trend of death due to motorcycle accidents from 2006 to 2021 in East Azerbaijan was declining, and it is predicted to decrease slightly in the next three years as well. As this reduction may be attributed to many factors, it is recommended to investigate effective factors in future studies.

The concept of resilience has emerged in recent years in association with disaster risk reduction. In assessing adolescents’ resilience, it is important to consider resilience as a multi-factorial construct and context-based issue. Currently, there is a short resilience questionnaire to assess this construct among Iranian adolescents. Given the importance of using a short and valid questionnaire to assess resilience, this study investigates psychometric properties and the underlying structure of the Iranian translation of the child and youth resilience measure 12 (CYRM-12).

After obtaining permission, the CYRM-12 was translated into Persian and then back-translated based on the Wild (2005) process. The final version was distributed among 653 high school adolescents in the age range of 14 to 18 years. The reliability scale was evaluated by using the Cronbach α and test re-test reliability among 35 adolescents. Subsequently, the intra-class correlation coefficients were assessed. Confirmatory factor analysis was evaluated as the validity.

The Cronbach α coefficient for the CYRM-12 was 0.71 and the test re-test reliability was excellent (ICC=0.88, 95% confidence interval, 0.78–0.94). Confirmatory factor analysis showed that the root mean square error of approximation was significant (0.043) and all items were indicated with a high correlation with scales, including the comparative fit index (CFI), non-normed fit index (NNFI), normed fit index (NFI), incremental fit index (IFI), and relative fit index (RFI) that were more than 0.9 and only parsimony normed fixed index was 0.7 that would be acceptable as well. Moreover, the correlation between total anxiety and resilience is significant. This is the first study that used the Persian version of the CYRM-12 questionnaire in Iran. In disasters, time is important; therefore, this short version would be more appropriate to help measure children’s resilience more quickly. Moreover, the short version of the CYRM-12 questionnaire is suitable for measuring resilience.

This study determined good fitness, reliability, and test re-test reliability of the Persian CYRM-12 for Iranian adolescents.

Measuring socioeconomic status (SES) as an independent variable is challenging, especially in epidemiological and social studies. This issue is more critical in large-scale studies on the national level. The present study aimed to extensively evaluate the validity and reliability of the Iranian SES questionnaire.  

This psychometric, cross-sectional study was conducted on 3000 households, selected via random cluster sampling from various areas in East Azerbaijan province and Tehran, Iran. Moreover, 250 students from Tabriz University of Medical Sciences were selected as interviewers to collect data from 40 districts in Iran. The construct validity and internal consistency of the SES questionnaire were assessed using exploratory and confirmatory factor analyses and the Cronbach's alpha. Data analysis was performed in SPSS and AMOS.   

The complete Iranian version of the SES questionnaire consists of 5 factors. The Cronbach's alpha was calculated to be 0.79, 0.94, 0.66, 0.69, and 0.48 for the occupation, self-evaluation of economic capacity, house and furniture, wealth, and health expenditure, respectively. In addition, the confirmatory factor analysis results indicated the data's compatibility with the 5-factor model (comparative fit index = 0.96; goodness of fit index = 0.95; incremental fit index = 0.96; root mean square error of approximation = 0.05).

According to the results, the confirmed validity and reliability of the tool indicated that the Iranian version of the SES questionnaire could be utilized with the same structure on an extensive level and could be applicable for measuring the SES in a broader range of populations.

Background and Trauma caused by injuries, especially road traffic accidents, is one of the important causes of death and disability in many countries. Public health strategies can also be applied to trauma prevention. The aim of this study is to review the prevention of injuries with a public health approach in the trauma system. The current study is a Narrative Review study that was carried out by searching the related keywords including Trauma System, Public Health, and Prevention of Trauma in PubMed, Scopus and Iran Medex databases and related articles were obtained. Trauma centers are divided into 4 levels based on the level of providing trauma care services, where defined from simple to advanced levels. The most advanced level of trauma centers is level 4, where there are facilities to provide Advanced Trauma Life Support Services (ATLS). One of the requirements for creating a comprehensive and effective trauma system is developing a trauma registry system. Although, in Iran the trauma registry system started in 2007 at one of the hospitals in Tehran, however, there has not been established a comprehensive trauma registry system. Road traffic accidents are one of the main concerning issues in Iran. Also, considering the high burden of road traffic injuries in the country, it seems that there is a need to pay more attention in policies to establishing the national, provincial and local levels of trauma centers that will lead to a reduction in the rate of deaths and related disabilities.

Masks play a crucial role in preventing and controlling viral epidemics transmitted predominantly through the air. This study aimed to develop and validate a tool to measure people’s attitudes and behaviors related to mask usage during highly contagious viral epidemics.

In this psychometric study, the initial questionnaire was developed and face validity and content validity were assessed by 17 experts and three lay experts. Reliability was evaluated through internal consistency using Cronbach’s alpha and test-retest reliability using the Intraclass Correlation Coefficient (ICC). Construct validity was measured using exploratory factor analysis (EFA) with the principal component extraction method and Varimax rotation.

Based on a review of previous studies, an initial 27-item questionnaire was crafted. During the face validity stage, two items were excluded. Through calculating the Content Validity Ratio (CVR) and the Content Validity Index (CVI), three and one items respectively removed. The average scale level content validity index (S-CVI/Ave) was 0.95. Cronbach's alpha coefficient was found to be 0.76 for attitude and 0.66 for practice sections; the ICC was equal to 0.873. EFA revealed two factors explaining 63.98% of the total variance.

This questionnaire demonstrated sound reliability and validity in Persian, providing an effective means to assess attitude and behavior related to mask usage during highly contagious viral epidemics. It stands as a valuable tool for use in Iran and other countries.

 Risky driving behaviors increase the risk of injury and death due to crash. Vast strata of behaviors are considered as risky behavior in the literature. The aim of this scoping review was to extract and determine various behaviors tagged as risky driving behavior.

 Based on Arkesy and OMalley framework, a scoping review study was conducted. Literature search was done through PubMed, Embase, Scopus and Web of Science databases. Snowballing of references and hand search of related journals were also used. Time limitation for search was defined from 1st January 2000 to 30th December 2019. Screening process was done independently by two researchers. Data was systematically extracted from the included articles using a predetermined extraction table.

Literature review resulted in 3761 articles. After the screening process, 45 articles were included in the study. Majority of included articles were from United States (n=13), followed by Iran (n=5), Australia (n=4) and China (n=4). Speeding (reported in 70% of included studies), drunk driving (52%), aggressive driving (44%), tailgating (41%) and not-using seat belt (37%) were the most frequent behaviors tagged as risky driving behaviors in the included studies.

 Regarding the discrepancies in understanding, definition, and categories of risky driving behaviors, it is of great importance to develop a unified standard definition and categorize risky behaviors which would facilitate global movements to reduce risky driving behaviors through effective interventions.

Practical Implications:

 The results will guide the policymakers to clearly develop suitable policies in national, regional or local levels to prevent and reduce the negative results of risky driving behaviours.

To assess psychometric properties of the European Quality of Life 5-Dimension 3-Level Version(EQ-5D-3L) commonly used tool for measuring road traffic injury (RTI) patients’ quality of life. The psychometric study assessed the reliability and applicability of EQ-5D-3L through phonesurveys, based on a national cohort platform. Data of 150 RTI patients recruited from the cohort study wereincluded as 50 patients per each follow-up phase (one, six, and twelve months after discharge). A 12- day-timespan was between test and retest. We measured psychometric properties (internal consistency reliability andstability reliability) and agreement using Kappa coefficients and percentages of agreement and Bland-Altmanmethod. Data were analysed using software STATA statistical package. The majority of patients were men (80%) with mean age (SD) of 41(14.7%), employed (78%) andeducated (86%). The Persian version represented high internal consistency reliability at total level (Cronbach’sα=0.81) and moderate to good reliability at phase levels (0.62-0.87). The stability reliability was excellent attotal (ICC=0.98, 95% CI: 0.97, 0.98) and phase levels (0.97-0.98. The kappa agreement coefficients were valuedmoderate to perfect (0.6-0.8, p>0.0001). The Bland-altman plot illustrated high agreement between test andretest scores. No floor and ceiling effects were found. The study revealed that EQ-5D-3L was highly reliable and responsive to be applied through phoneinterviews at three different times post injury and discharge, as no previous study considered its psychometricproperties at various phone follow-ups after RTIs.

The control, management, and prevention of driving accidents and risky driving are regarded as concerns for numerous countries, according to the World Health Organization. In this regard, many technologies, such as count stations, are recommended. They count traffic offenses, such as speeding and unsafe distance, hourly and daily, and have different patterns according to the hour of the day and the location.

This study aimed to investigate the risky driving behaviors according to traffic offenses in Iran and estimate their hourly and spatial patterns using generalized additive models (GAMs) and stochastic partial differential equation methods.

There were 2,316 count data stations for one month within March-April 2019. This study estimated the hourly average of each traffic offense, Pearson’s and Spearman’s correlations, and the energy statistics for testing the bivariate normal distribution. There are five distributions, such as univariate Poisson, quasi-likelihood Poisson, Gaussian, location-scale Gaussian, and bivariate Gaussian in GAMs, to study the hourly patterns which were compared to the mean squared error (MSE) and correlation.

The hourly average of total vehicles and number of speeding and unsafe distance offenses per count station had positive skew distributions with mean values equal to 347 ± 456, 22.5 ± 44.2, and 65.9 ± 150, respectively. The correlation between traffic offenses in most provinces was significant, not large, and different. The GAM with the bivariate Gaussian distribution had the best performance according to the MSE and correlation. It revealed three hourly patterns for count predictions; the first was that speeding is higher than unsafe distances; the second was that unsafe distances are higher than speeding; the third was that speeding and unsafe distances do not have a specific pattern in some hours. The percentage of speeding was higher in the central, northeast, and southeast regions than in other parts of Iran, and the percentage of unsafe distances was higher for the north, northwest, west, and some parts of the southwest than in other parts of Iran, respectively.

The hourly pattern of traffic offenses exists and has a complex structure. The spatial pattern of traffic offenses shows the riskiest points in Iran.

Emergency Department (ED) staff are frequently faced with road traffic injury victims and also play role as various road users. This study was conducted to investigate the knowledge, attitude, and practices of ED staff towards road safety at referral trauma hospitals of Tabriz.

This cross-sectional study was conducted in 2020 in the referral trauma hospitals of Tabriz. Data were collected using a standard questionnaire. Census sampling was used to select the participants. Descriptive statistics, Pearson’s correlation test and logistic regression model were used for the data analysis using SPSS Software.

The mean score of the ED staff in traffic safety knowledge, attitude and practices was 9.73 ± 2.28 out of 15, 95.3±11.4 out of 118, and 61.3±8 out of 76, respectively. The staff’s traffic safety knowledge was associated with their attitude and practices. Moreover, the univariate logistic regression modeling results revealed that participants' traffic safety attitude (OR= 0.96 (95% CI= 0.93-0.99)) and practices (OR= 0.95 (95% CI= 0.91-0.99)) were, independently, correlated with a reduction in road traffic accidents.

The ED staff’s attitudes towards traffic safety had a positive correlation with their practices and also accident experience. Nonetheless, after adjusting the data in terms of knowledge and attitude, road traffic safety practice was not associated with participants' accident experience. It is crucial to consider road safety education in colleges to promote safety knowledge of graduate individuals which will have conspicuous results in risk reduction.

Bell's palsy is a rare adverse event reported in COVID-19 vaccines. Given the importance of neurological manifestations, the necessity to highlight and scrutinize the incidence of them following COVID-19 vaccination is needed. This study aimed to systematically review the reported cases of Bell's palsy following vaccination against COVID-19.  

This systematic review is conducted based on the Cochrane Collaboration Handbook and PRISMA Statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyzes) and using the Joanna Briggs Institute (JBI) methodology for systematic reviews. The inclusion criteria for the included published studies were patient age ≥18 years, history of Bell's palsy after COVID-19 vaccination and established diagnosis in the patients with COVID-19 vaccination. The exclusion criteria were repeated cases and missing clinical information. The search strategy aimed to find both published and unpublished studies in August 2021 and updated by hand searching in May 2022 using the identified keywords and index terms in Cochrane Library, MEDLINE (PubMed), Web of Science, Scopus, ProQuest, and Google scholar. Finally, the reference lists of all identified reports and articles were searched for additional studies. The JBI critical appraisal tools for case reports or case series were used to assess the risk of bias in the included studies.  

During the electronic search, hand search, and reference check, we identified 1281 citations, and in hand searching, we detected additional 15 studies. After omitting duplicated citations and assessing the title, abstract, and full text 15 case-report and two case-series studies were included for the critical appraisal process and were included in this study. Pfizer and Moderna vaccines were the most common vaccines among articles that reported the cases of Bell’s palsy. Left-sided paralysis was more common than right-sided paralysis. The interval between receiving the vaccine and the onset of facial weakness was between 1 and 48 days.    

Further studies with larger sample sizes are necessary to assess the association between Bell's palsy and the dose-response of the COVID-19 vaccine.

This systematic review evaluated the studies conducted on Guillain-Barré syndrome (GBS) due to COVID-19 vaccination to clarify any possible connections and the type of vaccines causing GBS.

A comprehensive search was performed on July 2021 through MEDLINE (via PubMed), Scopus, Cochrane, and Web of Science databases to detect published and unpublished papers. Our PICO was all COVID-19 vaccinated individuals as the population, COVID-19 vaccines as the intervention, and patients experiencing GBS following COVID-19 vaccination as the outcome. Critical appraisal instruments from the Joanna Briggs Institute case series or case report were used to evaluate the quality of included studies.

In the present systematic review, 12 case reports and case series including 21 patients were assessed. More than half of the patients were male, and the mean age of male patients was lower than females. In terms of vaccine type, the most common kind of vaccine injected was Oxford/AstraZeneca, and all the cases except one patient had received only one dose of the vaccine. Regarding the interval between receiving the vaccine and the onset of GBS symptoms, the mean duration was 14 days. The lowest mean time interval between receiving the vaccine and the onset of symptoms of GBS was related to the unnamed vector-based COVID-19 vaccine, and the highest was associated with Oxford/AstraZeneca.

Through this systematic review of case reports, we neither attempt to establish nor rule out a causal link between the COVID-19 vaccine and GBS, because such a link requires extensive case-control studies. However, we must highlight any events that may occur following the injection of existing vaccines. Practical Implications. The most common symptoms seen in patients experiencing GBS after vaccination included progressive bilateral lower limb weakness, paresthesia, numbness of limbs, generalized body aches, and back pain.

Dear Editor, Education is a complex issue and there is a need to consider a several factors to provide an effective training program. Regarding the issue of road traffic crashes, there are some contradictory findings about the efficacy of education, which may cause mistrust among professional circles and experts.   Some scientists believe that most of the training programs do not necessarily cover all aspects of crashes and only address some of the concerns. Road traffic crashes are a multidimensional issue and can be influenced by various political, economic, social and cultural factors, and thus the efficacy of an education program can be reduced. The low efficiency of educational programs can have several reasons, which are mentioned below:1.Non-use of Specific Educational Theory The efficacy of some educational interventions poses a serious challenge for researchers. A simple search in scientific databases will result in various studies aiming to offer educational programs for different road users about the road traffic safety. These educational programs are sometimes designed and implemented without sufficient scientific evidence or without relying on specific educational theory. Some researchers believe that designing an educational intervention without considering the guiding theory in education is like prescribing a medication to a patient regardless of his/her physiology. The use of educational theories entails identifying the audience properly, presenting the educational content in an appropriate manner, and evaluating its feedback. It also helps audiences to gain a better understanding about the safety in relation to their own behavior as road users.   2.Non-use of Various Methods for Providing the Educational Content Some educational interventions are based on learning context-dependent methods. However, learning context-dependent methods is not easily generalized among the target group. This type of educational delivery method is not adequately effective for some age groups, including children. Adopting various training methods tailored to the content and target groups such as role-playing, as well as using animation, cartoons, computer games, simulators, virtual reality technologies and augmented reality in training of traffic safety can increase the efficacy of such educational methods.3.Insufficient Attention to the Causation Network of Traffic Crashes Some believe that educational programs only emphasize on one topic, and generally fail to take into account the effect of other interventions. On the other hand, the designed educational intervention may focus on the wrong variable (as a factor influencing the occurrence of traffic crashes or the resulting injuries). For example, some drug abuse resistance education interventions focus on peer pressure as a variable with a direct causal effect, while the effect of the peer pressure in some studies is pale and other factors have a stronger causal effect. As for the road safety issue, some educational interventions focus on a number of factors, such as vehicle control skills, while these factors may or may not be the main factors responsible for some of the road traffic crashes. The road safety educational programs may focus only on traffic behaviors such as driving speed and may neglect other behavioral aspects such as smoking, alcohol, and drug consumption. In such cases, and even if the trainees demonstrate the positive aspects of driving speed in their behavior, the impact of the negative aspects of other behaviors such as alcohol consumption causes the risk of road traffic crashes to remain in the target group. 4.Insufficient Knowledge of Audience Gaining sufficient knowledge about the target group, as well as paying due attention to the characteristics of individual receiving an education are important factors for deepening learning in the audience. Recognition of the audience usually takes place over a long period of time. However, it has been shown that educational activities are often short-lived, and short-term interventions may be less effective for the audience. Some educational interventions only provide safety information without giving the drivers an accurate understanding of their behavior as road users. On the other hand, some educational interventions focus on high-risk behaviors of the drivers without considering the underlying reasons for these behaviors. Many drivers who display an unsafe behavior are aware of the fact that their behavior is not safe; however, they keep displaying the unsafe behavior.   The issue of education has conflicting aspects that should be addressed. For example, raising risk awareness may strongly discourage some people to follow educational topics; while it may be attractive for others and may even encourage them to include their acquired education in their behavior. For instance, education providers focus on quitting high-risk health behaviors such as smoking, alcohol consumption, and speeding that culminate in adolescence, while some training recipients may be curious and think about following these behaviors. It is argued that sometimes extensive financial resources to run inefficient educational program may deviate the resources from more effective community-based initiatives. Therefore, it is recommended that the researchers and policymakers in this field consider the theoretical and scientific principles when designing and implementing the educational interventions in order to increase their efficacy.   Ethical Approval Not applicable. Conflict of Interest Disclosures None.

Due to a lack of effective registry system for road traffic deaths, some international organizations like the World Health Organization provide the estimated number of road traffic deaths. It was shown that there are differences in the number of road traffic deaths between the WHO estimates and national reports even in High-Income Countries. This study aimed to an investigation of reasons for differences between the national reports and world health organization estimates about road traffic deaths.

This study focus to investigate the World Health Organization reports of Global Status Report for Road Safety in years of 2009, 2013, 2015 and 2018 and related articles about the estimates of deaths related to road traffic crashes and the observed differences between the WHO estimates and national reports.

The findings showed that the observed differences between the WHO estimates and national reports could be due to errors in the road traffic death registration system, errors in the regression model which was used for estimation, proposed variables for estimations, or all of them.

The estimations of WHO about road traffic deaths can be useful for countries especially for those which don’t have the road traffic registry system or the registry system does not meet the quality criteria. These estimates may not be sufficiently robust if disregard for spatial differences, the epidemiological pattern of risk factors among the countries, and the type of regression model which was used for estimation.

Identification of risk factors involved in road traffic deaths (RTDs) could help policymakers and road traffic managers to adopt effective strategies and approaches for the prevention and control of these incidents, while the lack of accurate data on the risk factors of RTDs causes the problem to persist. This systematic review aimed at assessing the national studies regarding the risk factors of RTDs in the regions covered by the World Health Organization (WHO).

This review study was conducted during 2008–2018 via searching in databases of PubMed, Science Direct, Scopus, Cochrane, Thomson Reuters, Web of Science, EMBASE, ProQuest, and Trip databases. Initially, a literature review was performed to find similar systematic reviews, followed by another literature review to retrieve the published or registered protocols. At the next stage, PECOTS was developed for the search strategy, followed by the quality assessment. The eligibility criteria in this study were the national-level studies about the risk factors related to RTDs, English-language studies, and studies published during 2008–2018.

In total, 169 articles were included in this study, with the highest and lowest number of the published articles in the United States and African countries, respectively. According to the reviewed studies, human factors accounted for the most common risk factors involved in RTDs. In the southeastern regions of Asia, the main road-related risk factor for RTDs was reported to be the type of roads. Furthermore, roadside departure to the right side and long roads were denoted in the national data of the Western Pacific region on the incidence of RTDs. Differences were observed between the six regions covered by the WHO in terms of the time-related risk factors for RTDs.

Several risk factors have been reported for RTDs in the countries covered by the WHO, and each risk factor is considered to have various subcategories. Therefore, it could be concluded that there are different epidemiological patterns for road traffic accidents and RTDs.

There is controversy about the value of endoscopic methods compared to microsurgical methods in the treatment of challenging colloidal cysts. This study aimed to review the findings of literature which studied microsurgery or neuroendoscopy in the colloid cyst.

An advanced search in PubMed, Science Direct, and Google Scholar databases performed using keywords such as: “microsurgery,” “endoscopy,” “microsurgery versus endoscopy,” and “colloid cysts.”

Reviewing the findings of related studies showed some differences in sections of surgical management, microsurgery, endoscopy, complete cyst resection, recurrence rate, length of stay, and complications between the two surgical methods in the treatment of colloid cyst.

Despite some disadvantages of endoscopy, it seems this method has more privileges than the other methods.

The largest proportion of road traffic deaths (RTDs) happen in Low and Middle Income Countries (LMICs). The efforts for decreasing RTDs can be successful if there is precise information about its related risk factors. This study aimed to determine economic, population, road, and vehicle factors with the highest impacts on RTDs in Iran. This is an ecological study, which has been done using covariates including: the population density, economic growth, urbanization, distance traveled (km) in 100 thousand people, the length of urban roads, the length of rural roads and the Vehicle per 1000 population for each province of Iran in 2015. The covariates considered had been gathered from different sources and to determine which one of the covariates has an effect on RTDs, the Negative Binomial (NB) regression model was used. The mean number of RTDs per 100000 population was 474 ± 70.59 in 2015. The highest and lowest rates of death belonged to Fars and Qom provinces, respectively. The results of the univariate model showed the population density as the only covariate of RTDs (p=0.001). Also, among other covariates, GDP was the only variable with a p-value equal to 0.2. In the multivariate NB model, it was seen that the population density (p=0.001), and GDP (p=0.02) significantly correlated with RTDs. For a unit (Million Rial) increase in the GDP of the province, the number of deaths decreased by as much as 0.0014. In addition, for a unit increase in population density, the number of deaths went up by as much as 30. Population density and GDP had positive and negative effects on the number of fatal road traffic injuries, respectively. By considering these factors in presentational and controlling programs on road traffic injuries, it is possible to decrease the RTDs.

Adherence to medical recommendations is very important to control gestational diabetes mellitus (GDM), as one of the most important disorders during pregnancy. In this study, we explored the impact of socioeconomic status (SES) on the adherence of a cohort of GDM in Iran.

In this prospective study, 230 pregnant women with confirmed GDM were followed from Feb to Jun 2013 in a referral diabetic care center in Iran. The SES of subjects were quantified using a combined score generated by principal component analysis (PSA). Medical adherence score of subjects was measured in three follow up visits in a range of 0 to 10 and were linked to SES using linear regression model.

The adherence scores women in the first, second, and third follow up visits were 5.06±2.12, 5.46±2.06, and 5.08±1, respectively. Women fourth quartile of SES (the highest level of SES) has a least compliance to medical orders in comparison to first quartile of SES (the lowest level of SES) with the OR -2.75 (95% Cl: -3.17, -2.23).

The medical adherence of pregnant women with GDM is significantly poorer in high SES groups. Therefore, as an important determinant, we may target high SES pregnant women to control the adverse effects of the disorder more efficiently.

Faculty member’s attitude is one of the most important factors in the success of electronic learning. Understanding the attitudes of teachers toward e-learning can lead to an appropriate learning environment. This study aimed at examining the attitude of faculty members towards e-Learning at Shahid Beheshti University of Medical Sciences in 2016. In this cross-sectional study, 334 faculty members from the faculties of university were selected by random stratified sampling method and their attitude was assessed by questionnaires. Data was analyzed using SPSS 20. The mean age of subjects was 49.09 (SD = 7.41). Of the total study population, 57.75% (190) were males and 42.25% (139) were females. The highest mean score among the dimensions of attitude assessment was related to sense of enjoyment with a mean of 29.26 (SD = 0.71) and the lowest mean related to self-efficacy (mean = 5.96) (SD = 0.82). The results of this study show that the attitude of faculty members is positive towards using appropriate e-learning. However, more studies are needed to assess the obstacles and approaches to improve the attitude of faculty members towards e-learning.

 Road traffic crashes and its deaths and injuries are one of the main public health problems in all over the world especially in Low and Middle Income Countries (LMICs). Road traffic crashes resulting in deaths, physical and psychological problems, and economic costs which have damages on families and communities. The number of road traffic deaths was exceeded from 1.3 million in 2016. Most of the road traffic injuries are belong to low and middle-income countries of the world. Road traffic injury is the eight leading causes of deaths for all ages, while it is largely neglected. 
There are several effective factors in road traffic crashes. The socio-economic status is known as important factors related to health status, although its influence is not fully understood on different aspects of health. People who live in low socioeconomic status suffer from the disease and injuries two times more than others. The results of the studies show that fatal and non-fatal injuries have an inverse relationship with socio-economic status. The socio-economic status is known as important factors related to health status. People who live in low socioeconomic status suffer from the disease and injuries two times more than others. The results of the studies show that fatal and non-fatal injuries have an inverse relationship with SES. However, there is a lack of enough information about the effects of socioeconomic status on road traffic crashes and its related outcomes. 
The incidence rate of road traffic injuries and its related deaths have a relationship with socio-economic status. In the international level, these incidences vary between the High-income countries and Low and Middle-income countries. Moreover, the incidences of road traffic injuries and deaths vary between the different socio-economic groups in each country.
The socio-economic status is known as the main predictor factor in different aspects of health. The importance of socio-economic status will increase in regarding this point which the outcomes of road traffic crashes are sometimes irreversible. However, the effect of socioeconomic status on the many aspects of health is not fully understood. Identifying the socio-economic status factors related to the outcomes of road traffic crashes can provide a good opportunity for policy makers and managers to use preventive interventions in high-risk groups.  This study used an analytical cross-sectional design. The studied sample was people who injured because of road traffic crashes and referred to Pour-Sina hospital in the city of Rasht. Rasht is the central city of Guilan province. Guilan province is located in the north of Iran and the rate of road traffic crashes is high in this province. The collection of data has been done by two researchers. The data collection questioner trained in order to meet the quality assurance and prevention the information bias. The using questionnaires consisted of two parts. The first part was a checklist to collecting the demographic information including the; age, gender, a marital status which obtained from hospital records. Moreover, collecting the crash information such as; the location of the injury, the type of injury, the severity of injury (based on Injury Severity Score), the clinical outcome of the patient which were extracted from hospital records. The second part of the instrument was related to socio-economic issues. For this purpose, the standardized questionnaire was used which the validity and reliability of that were confirmed in the previous study. In the cases that the injured people had died or were unable to interview due to the severity of the injuries, the interview was conducted with one of the close relatives (father, mother, brother or sister) and after obtaining informed consent.
In order to determine the socio-economic status factors (that are a combination of variables), the principal components analysis was used. Principal component analysis simplifies the data and reduces the number of variables. To extracted the factor/factors from the variables, the Varimax rotation method was used. The Varimax rotation is used if factors are assumed to be uncorrelated which is known as orthogonal rotation. In this study, the Eigenvalue greater than 1 was chosen. After determining the factor, the variables that were present in each factor were identified.
To obtain the main socio-economic status factors the method of principal component analysis was used. To assess the interest of the implementation of the principal component analysis on a data, Bartlett’s sphericity test and the KMO index were used. The main SES factors were determined and in order to assess the relationship between these factors and death and severity of injuries related to road traffic crashes, the logistic regression with the Backward-LR method was used. The analysis was adjusted on the variable of age and sex of patients. For the severity of the injury, the ISS scale was grouped (ISS> 15, ISS = <15) and it is considered as the dependent variable in the Logistic Regression model. The ISS scale above 15 is considered to be a severe injury All analyses were performed using the SPSS software version 20. The significance level of the tests in this study was considered 0.05.  In this study, 300 traumatic patients were recruited. From all, 234 patients (78%) were male. The mean age of injured patients was 34.25 years old (19.07). The ISS scale was grouped (ISS> 15, ISS = <15). the ISS scale above 15 is considered to be a severe injury. The severe injury (ISS > 15) was observed among 245 (81.7%) patients. 
Bartlett’s sphericity test and the KMO index showed that there is a good correlation between the studied variables and the using of principal component analysis is feasible. The p-value for the Bartlett test is significant and the KMO index is more than 0.5. Some socio-economic status factors had a relationship with the outcomes of death and the severity of the injury of patients. There were three factors which affect the outcome of road traffic crashes. The first factor includes the following variables; household cost, the education level of an injured person, and the education level of the mother. The second factor includes the variables of; job, owning the mobile and motorcyclist. The third factor includes the variables of; income and fathers job. The results of logistic regression analysis showed that factor 3 (family income and father's job) had a significant relationship with the outcome of traumatic death. For this factor, the odds ratios of 0.45 (CI 95%; 0.042- 0.83) for deaths and 0.65 (CI 95%; 0.45- 0.90) for the severity of injuries was obtained. The highest SES had the lowest deaths and injuries. 
There was a relationship between economic factors and the severity of the trauma, the economic-social third factor including variables; family income and father's occupation were identified as an effective factor in the severity of trauma. The odds ratio for the third factor (household income and father's occupation) was 0.68 (95% confidence interval: 0.452-0.908).  The results of this study showed that social economic factors affect both the deaths and the severity of injuries. The results of this study showed that the third factor (family income and father's job) had a significant relationship with traumatic death. In other words, the mortality rate of road traffic crashes is high among families with a low level of socio-economic status. Considering the high rates of deaths and severe injuries caused by traffic accidents in Iran compared to other countries, it is necessary economic and social factors will be considered as effective factors on deaths and injuries in road traffic policy-making and planning.

Over the past few decades, there is an increasing in studies on traumatic patients (violence, road accidents, natural disasters, terrorist attacks). In some trauma studies collecting the data from patients, especially mentally weak patients, may lead to remembering memories of bitter experience which can cause a feelings of discomfort, upset, anxiety, embarrassment and shame in narrowing the injury (1-2).
Concerns and anxiety in patients during the study are related to their condition of injury. Injured patients with higher age or severe injury experience more worry during the study period than others (3). However, the findings of studies show that only a few trauma patients report their concerns and discomforts about research topics or methodology (4). On the other hand, only some patients are able to predict properly the inconvenience conditions of participating in the study. Consequently, this situation at the informed consent phase leads to a not informed decision. Therefore, inability to predict the research condition, accurately and completely, can lead to some challenge in informed consent process (5). There are different data collection methods such as; interviewing, focus group discussion, internet questionnaire, self-declaration questionnaire which can be used in non-experimental trauma studies. Nevertheless, using the questionnaire or interviewing methods are most used by the researcher in trauma studies. The discomforts effects of data collection methods which patients may experience vary in different studies. Some patients experience extreme emotions when they talk about the injury (6-7). In an interview, more information is provided by interviewees rather than the questionnaire method and these conditions may lead to having more experience embarrassment in patients. This is one of the potential risks in interviewing method and it is necessary to be considered by research ethics committee and researchers. Meanwhile, some studies show that the use of electronic questionnaire has greater discomfort effect on patients compared to paper-based questionnaires or face-to-face interviews (7).
The Experience of emotions in patients is related to perceived helpfulness among them. The results of some studies have shown that patients in interview method feel more usefulness compared to the questionnaire method, so the experience of feeling anxiety in this group is far less. For example, in case of child abuse, parents feel that their experiences will be useful for the community and raise awareness of families about related issues (2, 8).
In addition, addressing to the issues of trauma patient's including; discomfort and anxiety during the study and the data collection can have considerable significance in two aspects: 1- uncertainty of research ethics committees in approving this type of studies; 2- the effect of the patient's discomfort on the validity of the study (6, 9).
While there are no uniform conditions for all participants in different types of studies, the same approach cannot be considered in different situations. Considering the principles of protecting human subjects in research ethical protocols including; respecting the participant’s autonomy, beneficence and non-maleficence and justice, it is necessary to investigate suitable data collection method for each participant in informed consent process. In this circumstance, researchers can identify those who may be at risk of negative emotions during the study period and minimize the risk to them by using the most appropriate method of data collection. Based on the research conditions, the type of data collection method can vary. Nevertheless, it can be expected that using the appropriate data collection method according to mental health and psychological condition of each participant lead to more adherence to research ethics principals and best risk benefit ratio balance. Moreover, this strategy needs to consider the random and systematic errors and adopt effective methods to control them.

Sleep Quality Disorder (SQD) plays a major role in road accidents. So, this study was carried out to determine the prevalence of SQD among occupational drivers using systematic review and meta-analysis in Iran.
All Persian and English articles between January, 2000 and October, 2015 which had reported the SQD prevalence in Iranian drivers by Pittsburgh Sleep Quality Index (PSQI) with cross-sectional design, after the quality evaluation process and achieving the required score, were selected. The heterogenic index of the studies was distinguished by using Cochran (Q) and I2 tests. Based on heterogeneity results, a random effects model was used to estimate pooled prevalence of SQD. Meta-regression was also used to investigate the heterogeneity of suspected factors.
In total, 936 articles were found from national and international databases. Ten articles entered to meta-analysis process, ultimately. Since heterogeneity index suggested that there is a considerable heterogeneity among the results of primary studies (I-squared = 98.8%, Q= 754.1, p Our in conclusion, our study demonstrated that more than half of Iranian drivers have SQD. Identifying the drivers with SQD by periodic examinations and providing advice and health care among occupational drivers could be appropriate solutions for decreasing the accident risks.

Background. Unstimulated salivary flow rate can be influenced by different factors. This study was undertaken to evaluate the effect of stress, anxiety and depression on unstimulated salivary flow rate in adults.
Methods. A total of 247 adult subjects, randomly selected from patients referring to Zanjan Dental School, were included in this investigation. The study procedures consisted of collecting salivary samples (in 5 minutes), completing a form for feeling of xerostomia and completing Depression Anxiety Stress Scale (DASS) Questionnaire to assess the severity of stress, anxiety and depression. Based on the results, the patients were categorized in four groups: Low salivary flow rate plus xerostomia (group 1, n=60), normal salivary flow rate plus xerostomia (group 2, n=59), low salivary flow rate without xerostomia (group 3, n=60) and normal salivary flow rate without xerostomia (control group, n=68).
Results. The frequencies of subjects with severe and major depression in groups 1, 2 and 3 were 31.4%, 11.7% and 8.5%, respectively, with 4.4% in the control group. The frequencies of subjects with severe stress in groups 1, 2 and 3 were 21.7%, 3.3% and 11.9%, respectively, with 1.5% in the control group. The frequencies of patients with severe anxiety in groups 1, 2 and 3 were 50%, 30% and 61.1%, respectively, with 4.4% in the control group. Stress, anxiety and depression exhibited a statistically significant relationship with unstimulated salivary flow rate and xerostomia (PConclusion. Stress, anxiety and depression can influence unstimulated salivary flow rate and lead to xerostomia.

Prehospital scores are used for determining the prognosis of trauma severity in trauma patients. This study aimed at developing a new prehospital score for emergency medical service (EMS) staff to predict hospitalization in trauma patients transferred to the hospital.
Patients and This study was a diagnostic test evaluation conducted on data of 1185 traumatic patients transferred through EMS to Poursina Hospital of Rasht between March 2012 and March 2013. Data were collected using a questionnaire with two parts. The first part included data on demography, injury, and type of interventions performed at the scene of the accident. The second part consisted of initial evaluations (Glasgow coma scale (GCS), oxygen saturation (O2S), pulse rate (PR), systolic blood pressure (SBP), the ability to walk, and outcome (hospitalization, nonhospitalization). The questionnaire was filled out by EMS staff at the scene or during transfer to the hospital with respect to clinical observations. Data were analyzed using the logistic regression model. The Hosmer–Lemeshow test was also used to examine the good fit of model.
A total of 1185 patients were evaluated using prehospital data. Of seven variables evaluated by the scoring system, only four variables were identified in the regression analysis as predictors of hospitalization including age, SBP, O2S, and walking ability. Sensitivity, specificity, and positive and negative likelihood ratios were 0.67, 0.68, 2.09, and 0.48, respectively.
The GOMAAPS (GCS, O2S, mechanism of injury, age, ability to walk, PR, and SBP) score serves as a guide for the EMS staff at the scene to be understood of the necessity of transfer and predicting hospitalization.