Search

Objective: Cycling is a healthy and pleasurable activity, but it can also be hazardous. The risk factors for cycling injury are unknown, considering the cycling infrastructure and cyclists’ behavior in northern Iran. This study aimed to explain the experiences of injured cyclists admitted to Poursina Educational and Medical Center, Rasht in 2021, as one of the risk factors associated with cycling.Methods: A content analysis was conducted on the experiences of cyclists over the age of 18 who had one or more injured limbs due to a crash or fall while riding a bicycle. The data were obtained from the registration system of the Guilan Road Trauma Research Center. Potentially eligible participants were contacted by telephone. Twenty people with various characteristics in terms of age, sex, and other features were included in the interview. Results: Cyclists’ experiences with risk factors were divided into 13 categories; including lack of laws, lack of training, poor traffic culture, easy to lose balance, cycling infrastructure, inappropriate roads, darkness, bad weather conditions, unsafe behavior, non-standard bicycle, unsafe protection, intentional injury to female road users, and risk of collision with other road users.Conclusion: The extracted risk factors can be used as the ABC of cycling to novice cyclists. Thus, responsible efforts to regulate, educate, promote, and monitor cycling can encourage people to ride.

The aim was to determine the relationship between the severity of the score and the child sitting position in the vehicle. In this retrospective cohort study, the severity score was obtained from HIS. After entering the data into STATA/SE version 14, univariate regression models were used to identify the potential confounding variables. Poisson regression estimators were applied to depict the relationship between safety devices, seating position of the child, and the severity indices. Out of 257 child occupants under 6 years, only 4.1% of the children used child seats and 7.7% used seat belts. There was a statistically significant positive relationship between ISS and middle rear seat (P = 0.026) and left rear seat (P = 0.000). A positive relationship existed between ISS and the right rear seat. Hospitalization of children sitting on the middle rear seat was longer than the others. The right rear seat was found to be the safest seat for children. The pattern of child accidents is different in the study region compared to other places. Local interventions should be implemented using evidences obtained from road traffic accidents. Thus, the governments should explore new strategies to increase the use of child seats by parents.

Abstract Background Cyclists are vulnerable traffic users and studying the cycling behavior of professional and elite cyclists, their previous history of traffic accidents combined with the current knowledge on high-risk behaviors of this group can be a useful basis for further studies on ordinary cyclists. This study aimed to determine the relationship between cycling behavior and the previous history of traffic accidents among members of the Cycling Federation of Guilan province in 2022. Methods A descriptive-analytical study was performed in which the Bicycle Rider Behavior Questionnaire (BRBQ) constructed in the Porsline platform was distributed using the WhatsApp social network. All participants were asked to self-report their cycling behavior. The final analysis was performed by using STATA software (version 14). Results The study subjects included a total of 109 cyclists with a mean age of 38.62 ± 10.94 years and a mean cycling experience of 13.75 ± 11.08 years. Using the logistic regression model, the relationship between gender (P = 0.039), years of cycling experience (P = 0.000), and education level (P ≤ 0.00), with previous traffic accidents, was found significant. There was also a significant relationship between stunts and distractions (P = 0.005), signaling violation (P = 0.000), and control error (P = 0.011) with previous traffic accidents. A significant association existed between stunts and distractions (P = 0.001) and signaling violation (P = 0.001) with a previous history of traffic injury within the last 3 years. Conclusions The findings of this study can be used to establish cyclist safety and preventative planning in society. In behavior change intervention programs, it is best to target male cyclists with higher-level education. In addition, the behavior of the cyclists whose predominant term of signaling violations must be corrected should be targeted. It is necessary to shape information campaigns and educational programs aimed for cyclists with common high-risk behaviors, especially signaling violations.

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

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

Abstract Despite advances in clinical research, the long-term effects of COVID-19 on patients are not clear. Many studies revealed persistent long-term signs and symptoms. In a survey study, 259 hospitalized confirmed COVID-19 patients between 18 and 59 years were interviewed. Demographic characteristics and complaints were studied through telephone interviews. Any patient-reported symptoms that continued or developed from 4 weeks up to 12 weeks after the onset of the disease were recorded only if they did not exist prior to infection. The 12-Item General Health Questionnaire was used for screening and assessing mental symptoms and psychosocial well-being. The mean age of participants was 43.8 ± 9.9 years. About 37% had at least one underlying disease. 92.5% showed ongoing symptoms that the most prevalent complications were hair loss (61.4%), fatigue (54.1%), shortness of breath (40.2%), altered smell (34.4%), and aggression (34.4%), respectively. In terms of factors affecting patients' complaints, there were significant differences between age, sex, and underlying disease with long-remaining complications. This study shows a high rate of long COVID-19 conditions that should be considered by physicians, policymakers, and managers.

Objective: To find out factors that influence the use/non-use of pedestrian bridges in Northern Iran. Methods: In this observational study, 4 pedestrian bridges at four different places in Rasht, North of Iran was studied. In addition to demographic data, pedestrians were interviewed for reasons of use/not use the pedestrian bridge. The data analyzed with SPSS software version 18 by non-parametric tests such as Chi Square. Results: From all 499 participants, more than one-third of pedestrians had not used pedestrian bridges. The most reasons for bridges use among respondents were feeling of safety and security (79.2%) and obey the rules (53.6%). The reasons for the non-use of bridges were time saving (63.7%), laziness (48.7%) and inappropriate of the bridge (34.2%). There were no significant differences in age, sex, education level, and road accidents’ history with use of bridge but there was a significant difference between the bridge usage with having a driver’s license, rash-hour time, and the presence of a mechanical elevator (p

Abstract Background Traffic accidents are one of the leading causes of death and severe injury among child occupants of vehicles in most countries. This has led to the consideration of how to use restraint systems for students in school buses. The purpose of the present study was to determine the percentage of students’ use of restraint systems in school transportation services in 2020. Methods In the present cross-sectional observational study, seatbelt use was assessed in 400 students in school transport vehicles using a checklist. The observation team sat at their vehicle, at the nearest location on one of the three sides of the school’s entrance: they had by manually registering the variable in the checklist. They focused on exactly the first vehicle parked next to the school entrance. There were two other observers to validate the observations. Data were analyzed by SPSS software (version 21). Results The rate of using restraint systems was 11.3%, use of restraint systems in the Sport Utility Vehicles (SUVs) was significantly higher (P

Introduction: Animal-vehicle accidents are a growing concern in many parts of the world not only because of its environmental consequences but also because of its economic and social costs. The purpose of this study was to investigate the epidemiology of accidents involving animals in Northern Iran. Materials and Methods: In this retrospective cross-sectional study, the data of all animal-vehicle accidents which had occurred during 2014–2018 were obtained from the traffic police database. Results: According to the regression model, fatalities and injuries associated with animal-vehicle collisions on main roads were significantly lower than those on the secondary and rural roads (P < 0.001). The reports showed a significantly lower number of accidents on wet, slippery than the dry roads (P < 0.001). Conclusion: This study reports on the high number of accidents involving animals in Guilan which lead to injuries and fatalities of both humans and animals. Importantly, the pattern of such accidents was found to be different from that of motor vehicle collisions, suggesting a model for changing human behavior and reducing accidents that involve animals.

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

Background: The association between gender and time of receiving services (TRS) after traumatic injuries is rarely documented in developing countries. This study aimed to examine gender differences in time between occurring injuries and receiving services in hospital after trauma injuries in northern Iran. Materials and Methods: A total of 7085 injured patients were included in this study. Data on sociodemographic and clinical characteristics were extracted from the Guilan province trauma system registry (GTSR) from July 2017 to July 2018. The Oaxaca–Blinder (OB) method was used to explain the gender differences in the TRS after traumatic injuries. Results: There were significant differences between men and women in marital statues (P < 0.001), education level (P < 0.001), time of injury (P = 0.025), occupation (P < 0.001), type of trauma (P < 0.001), mode of transfer (P < 0.001), mean age (P < 0.001), average distance from hospital (P = 0.052), and average transfer time to the hospital (P < 0.001). We found gender differences in TRS after falling trauma (P = 0.006) when the transfer was performed by emergency medical services (EMSs) and in penetrating trauma (P < 0.001) when the transfer was performed by private vehicles. The difference in the observed characteristics of men and women explained 67% of gender differences in TRS (P = 0.06). Conclusion: The gender difference in the transfer of injured patients was in favor of men, depending on the socio-demographic and clinical factors. In OB analysis, the gender differences in falling trauma and transfer by EMS and the gender differences in penetrating trauma and private transmission to the hospital were also confirmed. Steps need to be taken to ensure that services are equally beneficial to both men and women.

Background and Aim: The aim of this study was to assess the pre-hospital emergency services, non-surgical interventions, and clinical outcomes in patients with traumatic spine referred to Poursina hospital in Guilan. Methods and Materials/Patients: Spine trauma registry of Poursina hospital of Rasht were used. Records of patients with traumatic spine were reviewed for pre-hospital emergency services, non-surgical interventions, and clinical outcomes during 2015 to 2019. Results: 197 patients with traumatic spine were reviewed. 80.2% of the patients were transferred by ambulance. Pre-hospital fixation was performed in 59.4% of the patients (n=117). Pre-hospital intubation was required in 1% of patients (n=2). 4.6% of the patients had Glasgow Comma Scale (GCS)

Background: Epidemiological knowledge of traumatic spinal fractures and spinal cord injuries (SCIs) is essential for preventive planning and health policy-making. The present study was conducted to investigate the epidemiological features of traumatic spinal fractures and SCIs in Guilan province, Iran. Methods: The present cross-sectional study was performed on all 15-80 years old patients with trauma admitted to Poursina Hospital from January 2015 to December 2017. The individual characteristics, time, place and mechanism of trauma and diagnostic characteristics of spinal trauma were gathered using trauma registry system. The incidence and epidemiological distribution of spinal fractures among traumatic patients were then estimated. Results: The incidence of traumatic spinal fractures was found to be 0.6% in 2015, 0.3% in 2016 and 0.2% in 2017. The men to women ratio was 2.33:1. Motor Vehicle Accident (MVA) and falls were respectively the most common mechanisms of trauma and their incidence were higher in rural communities than in urban communities. There was significant relationships between mechanism of trauma and the site of vertebral fracture (P-value = 0.02). Lumbar vertebrae mostly caused by falls while cervical vertebrae caused by MVA. The incidence of SCI in all the patients with spinal fractures was 18.23% in 2015-17. SCIs were found to be more prevalent in 15-45 year olds compared to other age groups. Quadriplegia (54.83%) and paraplegia (38.7%) were the most prevalent SCI-induced types of paralysis. The incidence of SCI was significantly associated with the site of spinal fractures, although it was not associated with mechanism of trauma. Conclusion: This study revealed that the incidence of spinal fractures were decreased in recent years and MVA is the major cause of spinal fractures. Preventive programs are recommended to focus on traffic engineering and the training of drivers and pedestrians, especially in high-risk populations.

Introduction: Head trauma is one of the most important causes of death in trauma centers. In particular, treatment of head injury in the elderly seems more complicated than that of the young and middle aged. This study aimed to identify the outcomes of head trauma due to road traffic accidents (RTAs) in elderly patients. Materials and Methods: In a descriptive-analytical study, records of 294 elderly patients with head trauma due to RTA retrieved from health information system were reviewed using a checklist. The outcomes of patients were evaluated using the Glasgow Outcome Scale. Complete recovery and partial disability were considered as favorable outcomes, whereas severe disability, vegetative state, and death were defined as unfavorable outcomes. Descriptive factors and adjusted coefficients were calculated using SPSS software. Results: Of 294 elderly patients, 77.2% were men. About half of the road accidents had occurred in urban areas (58.8%). Less than half of the injured elderly were pedestrian (44.9%). The mean Glasgow Coma Scale of patients equaled 13.42 ± 3.29. Unfavorable outcomes were observed only in 20.4% of the patients. There were significant differences in head injury severity between the groups with favorable and unfavorable outcomes (P < 0.05). Moreover, intraventricular hemorrhage was significantly associated with the highest prevalence of unfavorable outcome followed by intracranial hemorrhage. Conclusion: The results of our study mentioned that most of the elderly who had accidents were pedestrian, most of which occurred in the cities. Moderate and severe head injuries in patients had unfavorable clinical outcome.

Background and Aim: Spine trauma is an important health problem. Traumatic Spinal Cord Injury (SCI) due to Motor Vehicle Accident (MVA) might have a different epidemiologic pattern in Guilan province of Iran owing to its geographical characteristics. Therefore, the present study was conducted to the study epidemiology of SCI injuries due to road accidents in a trauma referral center in Guilan. Methods and Materials/Patients: In this cross-sectional study, we used data SCI registry of Poursina Hospital. All the patients with spine trauma, due to MVA, hospitalized in the trauma center of Poursina Hospital, Rasht, Guilan, Iran between March 2015 and March 2018 were studied. Results: A total of 127 patients with spine trauma due to MVA were reviewed. The Mean±SD age of patients was 38.27±16.22 years. We observed that 93.7%, 1.6%, and 4.7% of the patients had initial Glasgow Comma Scale (GCS≥13, 9≤GCS≤12, and GCS

Objective: To determine the status of pre-hospital emergency care and its associated factors in traumatic patients.Methods: In across-sectional study, 577 traumatic patients who were transferred to Poursina hospital by EMS (Emergency Medical Services) personnel were selected by simple random sampling method. Pre-hospital emergency services were observed. Then the mean of taken measures scores for each domain was determined in percent and evaluated in terms of associated factors (age, working experience of staff and number of missions per day) and compared using Spearman's test.Results: Out of 577 patients, 454 were men (78.7%) and 123 women (21.3%). Their mean age was 35.1 years old. Accident (82.7%) was the most common mechanism of injury. Most vehicles involved in the accident were light-weight cars (48.5%) and motorcycles (32.2%). A significant relationship was found between age, general domain (p=0.039) and hemodynamic (p=0.019) as well as between work experience and general domain (p=0.018).Conclusion: Given that pre-hospital emergency services provided in most of the domains are relatively far from world standard, results of this research can provide information for managers to improve strategic planning on care and medical services, appropriation of budget, knowledge of personnel and necessary equipment.

Background and Aim: Hydrocephalus can cause ventricular expansion, which if not treated promptly, can result in brain damage. The hydrocephalus-induced damage is not fully improved, even by means of surgical procedures, leading to permanent damages to the brain. Methods and Materials/Patients: The aim of this study was to evaluate the demographic characteristics as well as hydrocephalus in patients with head trauma in Poursina Hospital, Rasht. The information including age, sex, Glasgow Coma Scale (GCS), trauma mechanism and accompanying brain injuries on admission were recorded. Patients with hydrocephalus diagnosed by CT scan underwent further investigation and therapeutic approaches. The treatment-related results were collected based on the GOS scale. Finally, the data were entered into SPSS version 18, and the results were analyzed by Fisher’s exact test, and Independent t-test. Results: Of the 548 patients, hydrocephalus was observed in 14 patients (2.6%). The mean age of the patients was 44.07±24.48 years old. 31.1% of men (14 cases) had hydrocephalus, while none of women suffered from this complication. Car accidents (12 people) and fall (2 people) were identified as causes of incident in hydrocephalus patients. Head injury severity in most patients with hydrocephalus was mild (n=7, GCS=13-15) and moderate (n=6, GCS=9-12), and severe (n=1, GCS=3-8). Subarachnoid hemorrhage (n=5) and then epidural hematoma (n=4) and intracerebral hemorrhage (n=4) had the most severe damage to the skull. Most patients (n=11) were treated by surgery. Three patients recovered completely. Moderate disability, severe disability, vegetative state, and death occurred in 3, 2, 1, and 5 Patients, respectively. According to independent t-test, there is a statistically significant relationship between Glasgow Coma Scale and hydrocephalus (P=0.03). Fisher’s exact test also showed a statistically significant relationship between intracerebral hemorrhage (P=0.045) and intraventricular hemorrhage (P=0.013) on admission with hydrocephalic incidence. Conclusion: This complication was mostly observed in young traumatic patients (younger than 40 years of age) and in patients with mild head injury. Therefore, it is necessary to pay attention to these people in order to detect hydrocephalus, if any, as soon as possible, and these patients be treated appropriately.

Background & Aim: Spondylolisthesis is a visible deformity in lumbosacral region with vertebral slip and fracture or other deformities of pars interarticularis. This study aims at investigating the characteristics of spondylolisthesis surgery in operated patients. Methods & Materials/Patients: This is a retrospective study which included all the patients who had undergone spondylolisthesis surgery by one same surgeon from 2006 to 2011. Demographic characteristics such as age, gender, and surgery information including type of spondylolisthesis, incision site, laminectomy site, foraminotomy site, fixation site of vertebra and site of vertebral disc evacuation were collected. The data were analyzed using SPSS (Version16). Results: 52 of 63 enrolled patients were women (82.5%) and 11 men (17.5%) with mean age of 49.6 years. Based on frequency, spondylolisthesis types were 60 degenerative (95.2%), 2 post-surgical (3.2%) and 1 post-traumatic (1.6%), respectively. 58 patients had spondylolisthesis only in one vertebra and 5 patients in two vertebrae. The total number of slipped vertebrae was 68, in which slip was seen in L3, L4 or L5 vertebrae. In 42 patients, laminectomy was performed only in one vertebra, in 19 patients in two vertebrae, in 1 patient in three vertebrae and in 1 patient in five vertebrae. The total number of vertebrae with foraminotomy was 106. The highest frequency of foraminotomy was seen in L5, L4, and S1 vertebrae, respectively. Except in one case, the rest 62 patients underwent fixation surgery in two or three vertebrae. Conclusion: Based on the results, the frequency of spondylolisthesis was approximately five times in women compared to men. The most common type was degenerative spondylolisthesis. Type of surgery was fixation with pedicle screw and fusion.

Background & Aim: Patients with spinal cord injury (SCI) impose a heavy burden on health care system. Awareness on prevalence and incidence of SCI is important because this would show the necessity of prevention. This study aimed to investigate the epidemiology and types of traumatic spinal cord injuries in a trauma referral center in Guilan. Methods & Materials/Patients: This is a descriptive study which was conducted on patients with spinal cord trauma using a questionnaire during one year. The questionnaire included demographic information, injured spinal cord area, mechanism of injury, and type of neural damage based on ASIA scale. The data were analyzed using SPSS18 and descriptive statistics. Results: Out of 76 study patients, 68 (88.2%) were men with mean age of 35.2 ± 1.45 years. The most common cause of SCI was motor vehicle accidents (MVA) (48.7%). 34 patients (44.7%) had cervical spine injury and in 23 patients (30.3%), thoraco-lumbar injuries caused SCI. 29.7% of patients suffered from paraplegia and 10.8% quadriplegia. 25 patients (38.5%) had complete SCI. 7 patients with SCI (9.2%) died during hospitalization. In this study, increased age was identified as a risk factor for death. In 4 of these patients (57.1%) cervical SCI was the underlying cause of death. Conclusion: Young men were the group at highest risk and the most mechanism leading to SCI was motor vehicle accidents. Many of these accidents are preventable; thus, more attention should be devoted to safety policies based on needs of the vulnerable groups. Besides, comprehensive education program with clear and practical goals should be developed.

Introduction: Trauma is the first cause of mortality due to non-obstetric causes in pregnant women. There is a limited knowledge on mechanisms of trauma in pregnancy. Therefore, this study was performed with aim to determine the frequency, type and outcomes of trauma in pregnancy period in patients referring to the major trauma center in Guilan. Methods: This retrospective cross-sectional study was conducted using the data registered in triage unit of Poursina Teaching center, Guilan from July 2017 when the Hospital Information System was being implemented for the first time. Using complete enumeration, all mothers with trauma histories until July 2018 (n=138) were entered into the study. They were then interviewed via telephone about the maternal and fetal outcomes after discharge, and 77 mothers answered. Data were analyzed using SPSS software (Version 21). Results:The mean of maternal age was 29.24±5.25 years and mean gestational age was 20.92±10.12 weeks. The most common mechanism of trauma was falling (35.5%) and then traffic accidents (31.9%), other mechanisms (sharp objects penetrating in the limbs, falling of the object on the person, dog bite, etc.) (21%), violence (10.9%) and self-immolation (0.7%). In terms of frequency, the most reported fetal outcomes were without outcome (87%), preterm birth (7.8%) and abortion (5.2%), respectively; the most common maternal outcomes were reported as uncomplicated (67.5%), bleeding (11.7%), bone fractures (11.7%), uterine contractions and cervical dilatation (9.1%). Conclusion: The most common type of trauma during pregnancy was falling. Preterm birth and abortion were the fetal outcomes and vaginal bleeding, bone fracture, uterine contraction, and cervical opening were dangerous maternal outcomes which are reported. Future programs should prioritize trauma prevention in pregnancy and follow-up of maternal outcomes after discharge from trauma center.

Background and Aim: Traumatic Spinal Cord Injury (SCI) is one of the most traumatic events threatening patients’ well-being and places a financial burden on health care system. The first step in determination of the exact impact of SCI is to estimate the pattern of traumatic injuries in a population and also the type of frequently occurred co-injuries. Hence, this study was conducted to assess the frequency of anatomy, type of spine injuries, and associated co-injuries in patients with trauma in Poursina Hospital of Guilan province in Iran. Methods and Materials/Patients: A descriptive cross-sectional study was carried out on traumatic spine patients admitted to the Poursina hospital of Rasht, a referral therapeutic center for trauma in north of Iran, in Rasht during 2015 to 2019. Data were extracted from the SCI registry of Poursina Hospital, Rasht, Guilan, Iran. Results: A total of 274 records were reviewed. Seventy-six patients were females and 198 patients were males. Mean±SD of age of the patients was 42.27±16.83 years. Based on this survey, most of the patients (43.8%) had SCI in lumbar region. Locked facet was seen in 12 patients. Fifty-seven patients (20.8%) complained about having pain. The median of VAS score was 6 (range=6). Co-existence of associated injuries (e.g. limb fractures, TBI, Internal bleeding, etc.) was found in 27.4% of the patients. According to ASIA (The American Spinal Injury Association) impairment scale, three patients (2.9%) had score A, and 100 patients (97.1%) had score E neurological defects. Conclusion: The most telling reiteration to be drawn is that men mostly suffered from spine trauma. Lumbar region was the most susceptible location of SCI. Moreover, most of the patients experienced score E (normal neurological charcteristics) according to ASIA.

Social capital is a multi-faceted phenomenon in social sciences that massively affects many social fields. It can be a helpful factor in promoting health. Among the groups with high burnout, nurses have always shown higher levels of burnout. Studies have revealed that social capital can be an important factor affecting burnout. This study aimed to determine the extent of the effect of social capital on burnout in nurses of a trauma referral teaching hospital in Rasht. This was a descriptive correlational study conducted on 214 nurses of a trauma referral teaching hospital. Maslach standard questionnaire and the social capital questionnaire devised by Boyas and colleagues were used. Data were analyzed using descriptive statistics, Pearson correlation coefficient, and linear regression analysis to determine the extent of the effect of social capital on burnout. The study showed an inverse association between social capital and burnout. The intensity of the relationship was -0.451 (P