Journal of injury & violence research最新文献

Background: The purpose of the study is to identify the risk factors of mortality early in patients who have history of using of anticoagulants or coagulopathy and sustained a ground level fall (GLF).

Methods: The American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) dataset of the calendar year 2013 through 2016 was accessed for the study. All elderly patients ≥ 65 years old, who were taking an anticoagulant and suffered from a GLF, were included in the study. Other patient characteristics included: sex, race, initial systolic blood pressure (SBP), hypotension (SBP less than 110 mmHg), Injury Severity Score (ISS), Glasgow Coma Scale (GCS) Score, comorbidities such as hypertension (HTN), congestive heart failure (CHF), chronic renal failure (CRF), chronic pulmonary obstructive disease (COPD) and cirrhosis. Multivariable analysis was performed to develop the risk model.

Results: A total of 10,368 patients qualified for the study. Of this total, 788 (7.6%) patients died. The median [IQR] age of the patients was 80 [75-85] years. More than 90% of the patients were white. Fifty-four percent of the patients were female. Approximately 8% of the patients presented with hypotension at the time of hospital arrival. Multivariable analysis showed advanced age, male gender, high ISS, low GCS, presence of hypotension, CHF, CRF, COPD and cirrhosis were highly significant for odds of mortality.

Conclusions: Approximately 8% of the patients, who took an anticoagulant or had a history of coagulopathy and sustained a GLF, died. Certain demographics, higher injury severity and a few comorbidities were highly associated with in-hospital mortality.

Background: Child sexual abuse is a widespread global problem and a violation of human rights. Although many studies have been conducted in this field in the world, the information and knowledge of child sexual abuse in Iran is still limited. This study aims to review the current knowledge in the area of child sexual abuse in Iran, and the related laws.

Methods: The research systematic review covers the scientific literature and gray literature in Persian and English in Iranian and international databases from the beginning to June 2021 as well as Iranian laws on child protection.

Results: Our study shows that in Iran knowledge on child sexual abuse is limited. The prevalence of child sexual abuse is estimated to be 1.5 to 32.5%; the risk factors for child sexual abuse encompass substance abuse, low literacy and education, parents living separately and divorce, poverty and poor socioeconomic status, and living in large families. The consequences of child sexual abuse are anxiety, depression, and social problems. Effective local interventions focused on parents and abused children have been conducted to raise awareness and prevent psychosocial harms as well as reduce aggression and physical and mental problems of children. Existing laws do not specifically address child sexual abuse.

Conclusions: The findings showed that knowledge of child sexual abuse in Iran is limited, scattered and inconsistent and there is no suitable definition and tool for measuring child abuse in Iranian studies. National and effective interventions for the prevention of child sexual abuse have not been performed and the consequences of child sexual abuse have also not been well studied. Thus further studies are required to estimate the prevalence of child sexual abuse at the national level and to assess the factors related to child abuse, its consequences, prevention methods and development of existing laws and policies with a special focus on child sexual abuse.

Background: Teen dating violence (TDV) refers to the physical, sexual and/or psychological violence that takes place within a romantic relationship amongst teenagers. TDV has devastating consequences for the victims, particularly for young women, who also experience increased risk of relationship violence in their adulthood. In view of this, the implementation of effective TDV prevention programs has the potential to tackle both TDV and contribute to eradicate gender-based violence. The aim of this study was to conduct a systematic review examining the effectiveness of the TDV programs published during the last decade (2011-2021).

Methods: From the 1143 studies identified through the database searches, 28 met the inclusion criteria: 10-18 years old; experimental, or quasi-experimental with control group; examining knowledge, attitudes and/or TDV behavior indicators; 2011-2021.

Results: Although there were still many programs focused on changing knowledge and attitudes only, we found an increase in the number of studies examining TDV behavioral indicators. A modest improvement in the quality of the programs in terms of their ability to modify the desired TDV behaviors was detected, yet resistance to change was still observed.

Conclusions: Effective programs met many of the requirements specified by the gender transformative programme literature (time-intensive, multilevel, multicomponent skill development approaches). Nonetheless, we identified some brief, creative and effective interventions worth implementing given their cost-efficacy.

Background: Intimate partner violence (IPV) is the most common type of domestic violence often used by men against their wives. Due to the destructive and widespread social and health consequences of IPV, the present study aimed to investigate the prevalence and related factors of IPV among married women in Garmsar, Iran.

Methods: Using multi-stage clusters sampling method, this cross-sectional study included 400 married women in Garmsar, Iran. The data collection process was conducted during October and December 2019 using a researcher-made questionnaire. The content validity of the questionnaire was confirmed using content validity ratio (CVR) and content validity index (CVI) indicators (0.85 and 0.88, respectively). Also, the reliability was confirmed by examining the internal consistency and obtaining a score of 0.93 for Cronbach's alpha. Descriptive and analytical statistics were performed using t-test, analysis of variance (ANOVA), and Tukey's post-hoc test.

Results: Most participants were in the age range of 20-40 years (mean age: 34.9 years). The overall exposure of women to IPV was 56.11%. In addition, the most prevalent types of IPV included legal (24%), social (24%), financial (22%), verbal (16%), physical (13%), emotional (12%), and sexual (11%). The effective factors on the prevalence of IPV included number of children, education level, occupation, and age (P less than 0.05).

Conclusions: We witnessed that women living in Garmsar faced different types of IPV and their overall exposure to this phenomenon was higher than the national and global average. To resolve the problem, the following measurements are recommended: a careful investigation of the reasons for the spread of IPV, implementing interventions based on reliable evidence, and serious cooperation of the experts and relevant governmental and non-governmental institutions, particularly citizens.

Background: Daily more than 3,000 children are injured or killed on the road, often along the school route. Road traffic crashes and resulting injuries are preventable. More can be done to reduce injuries and save lives. Traffic Conflict Techniques (TCTs) are simple methods of collecting observational data to evaluate the effectiveness of road safety interventions through counting and analyzing traffic conflicts. A TCT Toolkit was developed and piloted to analyze pedestrian-vehicle traffic conflicts in school zones in low- and middle-income countries.

Methods: Three non-governmental organizations in Ghana, Vietnam, and Mexico applied three TCTs from the TCT Toolkit to collect traffic conflict data before (pre-intervention) and after (post-intervention) road safety intervention implementation. As the number of traffic conflicts was often less than 100, confidence intervals (CIs) based on gamma distributions were calculated for the traffic conflict rate. Using the calculated traffic conflict rate, the difference between pre- and post-intervention rates was assessed by determining overlap of the CIs. When CIs did not overlap, the difference was said to be statistically significant at the 0.05 level.

Results: For each method, results indicated a decrease in traffic conflicts between pre- and post-intervention data collection periods. Pre- and post-intervention traffic conflict rates with non-overlapping CIs demonstrated the results were statistically significant, providing evidence that the road safety interventions were effective.

Conclusions: TCTs are relatively low-cost and simple techniques that provide an opportunity to base road safety improvement decisions on real-world data. TCTs are effective in objectively evaluating road safety interventions and can help decision-makers evaluate strategies for improving road safety, preventing injuries and saving lives.

Background: Various factors are involved in the occurrence of Road Traffic Crashes (RTCs), one of the most important of these are human factors that can be greatly influenced by the specific sociocultural bases of the drivers. So far, there has not been a scale for measuring Sociocultural Factors (SCFs) predicting the occurrence of RTCs in Iranian drivers. Therefore, the present study was conducted to design and to do psychometric evaluation of a scale for measuring SCFs predicting the occurrence of RTCs in drivers.

Methods: This exploratory sequential mixed method was carried out in three phases. In phases 1 and 2, an initial items pool was created based on systematic literature review (phase1), and semi structured interviews (phase 2). In phase 3, the initial scales were validated using face and content validities. Then, principal component analysis and confirmatory factor analysis were performed to assess the construct validity. Finally, the reliability of the scale was evaluated by examining internal consistency and stability.

Results: The scale content validity index was 0.92. Principal component analysis showed seven factors with 27 items, which explain 55.56% of the total variance. In confirmatory factor analysis, model fit indices were satisfactory. Discriminant analysis was also able to distinguish between two groups of accident-involved drivers and accident-free drivers (P less than 0.0001). The reliability of the scale by Cronbach's alpha, Theta, Omega and intra-class correlation coefficients was 0.82, 0.96, 3.07, and 0.80, respectively.

Conclusions: This scale can be used as a valid and reliable scale to evaluate the SCFs predicting the occurrence of RTCs in drivers. Furthermore, the findings of this study will be useful in identifying and planning to reduce RTCs, especially in accident-prone drivers.

Background: Despite government legislations for protection of women, domestic violence (DV) continues to remain as a public health problem in India. Objectives 1. To find out the prevalence of various types of self-reported DV among married women of 18-45 years of age and to identify its social determinants and their help-seeking behavior. 2. To understand the solutions from key informants' point of view.

Methods: It was a sequential explanatory mixed methods study design, which consisted of quantitative (Survey) followed by qualitative (Interviews) phase. A representative sample of 360 married women was chosen by two-stage cluster sampling from villages in Tamil Nadu, South India. The female investigator conducted the survey by house to house visit. Post-survey, six key informant interviews were conducted to explore the solutions and suggestions from experts' point of view. Bivariate and multivariate regression analysis was carried out to identify the significant predictors of DV. Manual content analysis of qualitative data was done.

Results: The overall prevalence of spousal DV was 49.5% [95% CI: 44.3-54.6] in the last one year. In multivariate analysis, two factors namely 'current alcoholism in husband' and 'controlling behavior of husband' were found to be the significant predictors of DV. In order to prevent alcoholism in husband, the key informants suggested deaddiction services and measures to limit access to alcohol. Furthermore, to prevent controlling behavior of husband, the key informants suggested women's empowerment, employment, helplines, responsible parenting, social change in dowry practice and gender equality.

Conclusions: The prevalence of spousal DV was found to be high. Current alcohol consumption and controlling behavior of the husband were the important determinants of domestic violence. Key informants suggested interprofessional approach consisting of deaddiction services, women empowerment and strengthening of family life to address the problem of DV.

Background: Road Traffic injuries (RTIs) are major global health issues, but they have been neglected. RTIs are multi-faceted in nature and, like many injuries, are costly but preventable. Iran has one of the highest rates of deaths due to traffic accidents among middle-income countries. Hence, there is a need for effective and preventive approaches in road safety management. One of the new approaches to road safety is the Vision Zero. The aim of this study was to design a Vision Zero implementation model in Iran.

Methods: This present study was conducted using the qualitative grounded theory approach. Purposive, snowball and maximum variety sampling were used to select participants. In-depth interviews were used to collect data. Grounded theory method was used to analyze the data using Corbin and Strauss method.

Results: In this study, 19 interviews were conducted with 17 participants. Based on data analysis, a total of 4 main categories and 13 subcategories were obtained. According to the participants, the lead agency was recognized as the core category. Other concepts were categorized as causal conditions, intervening conditions, contextual conditions, action/interaction strategies, and consequences.

Conclusions: Establishing a lead agency with inter-organizational coordination through political support and legislation and changing the approach of road safety can be effective in implementing a Vision Zero. Also, improving the safety attitude of the stakeholders and changing their approach through training and advocacy from various organizations related to road safety is effective in creating a lead agency and implementing a vision zero. In addition, in order to implementation of the model, it is very important to pay attention to the economic, political and ethical underlying factors towards human beings.

Background: Fatigue and drowsiness accidents are more likely to cause serious injuries and fatalities than other accidents. Statistics revealed that 20 to 40 percent of traffic accidents in Iran are due to drivers' fatigue. This study identified the most important factors affecting driver injuries in fatigue and drowsiness accidents.

Methods: The Classification and Regression Tree method (CART) was applied 11,392 drivers were in-volved in fatigue and drowsiness accidents in three provinces of Iran, over the 7 years from 2011-2018. A two-level target variable was used to increase the accuracy of the model. First, dataset in each of three provinces was classified into homogeneous clusters using a two-step clus-tering algorithm. Oversampling method was used for imbalanced accident severity datasets. Then, classification was improved by boosting method.

Results: The classification tree reveals that the month, time of day, collision type, and vehicle type were common factors. Also, driver's age was important in female drivers cluster; the geometry of the place and seat belt/helmet usage were important in urban roads cluster; and area type, road type, road direction, and vehicle factor were important in rural roads cluster. Also, the combination of the CART algorithm with oversampling and boosting increased the accuracy of the models.

Conclusions: The analysis results revealed motorcycles, lack of using a helmet or seat belt, curvy roads, roads with two-way undivided and one-way movement direction increased the injury and death of drivers. Collision with fixed object, run-off-road, overturning, falling, and defective vehicles increased the severity of accidents. Female drivers older than 44 years old have a higher probability of fatality. Identifying the factors affecting the severity of driver injuries in such accidents in each province could assist in determining engineering countermeasures and training educational programs to mitigate these crash severities.

Background: To manage life-threatening conditions and reduce morbidity and mortality, pre-hospital's on-scene decision making is an influential factor. Since pre-hospital's decision making is a challenging process, it is necessary to be identified this process. This study was conducted to explore the model of Iranian emergency medical technicians' decision making in emergency situations.

Methods: This study was applied through grounded theory method using direct field observations and semi-structured interviews. Purposeful sampling with 26 participants including 17 emergency medical technicians including dispatchers, physicians of medical directions, managers and 1 representative for court affairs was performed. Interviews were lasted from October 2018 to July 2019. Corbin and Strauss approach, 2015 (open, axial and selective coding) were used to analyze data.

Results: A paradigm model was developed to explain the relationships among the main categories. Decision making in the context of fear and concern was emerged as the core category. Unclear duties, insufficient authorities and competencies as well as lack of enough decision making's protocols and guidelines were categorized as casual conditions. Other important categories linked to the core category were interactions, feelings and "customer focus approach". Action-interaction strategies were taken by Emergency Medical technicians lead to some negative consequences that can threaten clinical outcome and patient safety.

Conclusions: Based on the finding of this study, Emergency Medical technicians' decision making in the context of fear and concern, as the core concept of this model, lead to decrease in quality of the pre-hospital services, stakeholders' dissatisfaction, hospital emergency units' overload, decrease in reputation of the Emergency Medical Technicians, threat to patient clinical outcome and patient safety. To prevent of these negative consequences, facilitation of the Emergency Medical Technicians' on-scene decision making is recommended.