Journal of Education and Health Promotion

Abstract BACKGROUND AND AIM: Earthquake is a natural disaster severely affecting the societies’ health,
hygiene, and welfare as such the most effective method to respond to its damages is to develop a
readiness plan. This study aimed to discover thematic patterns and co‑author relationships extracted
from relevant publications to plan an earthquake response.
MATERIALS AND METHODS: This descriptive–analytical study adopted the scientometric approach
and used word co‑occurrence and social network analysis. The published articles indexed in PubMed
were retrieved from 1970 to 2021 using a combination of keywords “earthquake and response.” The
data were analyzed in VOSviewer, UCINET, and NetDraw software.
RESULTS: The following six thematic clusters with a social map were extracted: Initial response of
the healthcare system, response to probabilistic risks after the hazard, response to mental health and
community resilience, response to public health, response to post‑traumatic stress disorders, and
staff’s response to the needs assessment and continuity of diagnostic treatment services. Moreover,
social network analysis revealed the great impact of Japanese and Chinese authors and institutes.
CONCLUSION: The present study detected many gaps in the literature on earthquake response,
which can contribute to developing a general framework to prepare integrated healthcare earthquake
response plans to promote the performance of this system.

Abstract BACKGROUNDS: Due to the severity of the earthquake, it may need immediate treatment and
transfer of the injured people to advanced medical centers, as well as dispatch of the expert team
and specialized health equipment to the accident‑affected area. Aerial emergency is an important
responsibility of the health care system in this situation. The study aimed to extract the prehospital
emergency challenges of Iran aerial operations emergency in response to the earthquake.
MATERIALS AND METHODS: The study was qualitative content analysis with conventional
approach. Sampling was done in a purposive method and data were collected through semi‑structured
interview. The panel involved consists of 26 health professionals in medical emergencies. Recorded
interviews were transcribed into written and then conventional content analysis was used to derive
coding categories directly from the text data.
RESULTS: Content analysis is provided 97 initial codes, 20 subcategories and 4 main categories
including challenges of “response assessment,” “support,” ”pre‑hospital staff‑management,” and
“response operation,” respectively.
CONCLUSIONS: The results showed that the necessity to assess the affected area, staffing, and
management actions, including integrated operations command and the development of a dedicated
response plan, as well as the use of strategies inter‑organizational coordination in the response
phase to earthquake. This study also emphasized that providing standard equipment, support actions,
and strengthening communication infrastructure, and updating the aerial emergency system should
be considered as one of the priorities of the emergency organization of Iran to provide a desired
response to the earthquake.

Abstract BACKGROUND: Health is a complex structure and has physical, psychological, and social 
approaches. The importance and impact of health assessment have caused considerable attention to 
be paid to the employees of the health system and the determining factors of this relationship. Hence, 
the main purpose of this study was to find out the bio‑psycho‑social health situation in prehospital 
emergency technicians as the research question staff.
MATERIALS AND METHODS: The present study is a systematic review and data have retrieved 
through extensive search in Scopus, Web of Science, PubMed (including Medline), Cochrane 
Library, Irandoc, Magiran, MedLib, and SID databases with a combination of keywords of “Health, 
” “Assessment, ” “Social,” “Psychological,” “Biological,” “Emergency,” and “prehospital,” according 
to the search strategy, between 2000 and 202111 studies were reviewed; then, they were entered 
based on the objectives of the study and narrative analysis was performed by the researcher.
RESULTS: After analyzing the articles, a total of 4 factors affecting bio‑psycho‑social health in 
prehospital emergency technicians have been extracted and identified, which included health 
management, bio‑psycho‑social factors, occupational factors, and behavioral factors.
CONCLUSION: This research showed four factors, namely health management, bio‑psycho‑social 
factors, occupational factors, and behavioral factors which could be effective in Bio‑Psycho‑Social 
health. Since prehospital emergency services have an important role in maintaining the health of the 
community, which requires attention to the bio‑psycho‑social health of emergency personnel, more 
studies have focused on health management among the four mentioned factors, but the need to 
examine the other three factors for a more accurate assessment of the health of emergency personnel 
seems necessary. Therefore, prevention and response strategies based on bio‑psycho‑social health 
assessment models are proposed to promote the health of prehospital emergency technician staff.

Abstract BACKGROUND: Following the global emergency of coronavirus disease 2019 (COVID‑19),
health‑care workers, especially nurses were encountered with an increasing workload. Therefore, due
to the importance of this issue, the present study aimed to examine stress, anxiety, and depression
levels among nurses during the COVID‑19 pandemic in Iran.
MATERIALS AND METHODS: This cross‑sectional study was conducted in four educational hospitals
affiliated to Kerman University of Medical Sciences in 2020. The standard Depression, Anxiety and
Stress Scale‑21 questionnaire was applied to assess the levels of stress, anxiety, and depression
in nurse personnel with a census method (n = 403). Data were analyzed using descriptive statistics
and analytic statistics such as Kolmogorov–Smirnov, Mann–Whitney, Kruskal–Wallis, and multiple
linear regression tests through the version 20, SPSS Inc., Chicago, IL, USA, Software at the level
of P < 0.05.
RESULTS: The results of the study showed that the mean scores of depressions (9.18 ± 4.45),
stress (9.62 ± 4.94), and anxiety (10.32 ± 4.85) in nurses were at moderate level. A significant
relationship was observed between stressed, anxious, and depressed participants in the gender,
marital status, level of education, and working hours per month. No statistically significant relationship
was found between other demographic variables including age, work experience, and employment
status with anxiety, depression, and stress categories.
CONCLUSION: The results of this study can increase the awareness of health system managers,
especially hospitals, about the level of stress, anxiety, and depression and can help in order to provide
psychological support programs for improving the mental health of nurses during the COVID‑19
pandemic.

Abstract BACKGROUND: The first case of COVID‑19 was reported in Iran on February 19, 2020, in Qom. Since
Mazandaran is one of the high‑risk provinces with many patients and deaths, this study was conducted
to investigate the epidemiological characteristics of COVID‑19‑related deaths in Mazandaran.
MATERIALS AND METHODS: In this descriptive study, demographic information and clinical
findings in patients who died following COVID‑19 in the medical centers of Mazandaran University of
Medical Sciences from February 8, 2020, to October 10, 2020, were extracted. Data were analyzed
by using SPSS 21. Logistic regression was used to compare the data. P < 0.05 was considered as
the significance level.
RESULTS: Out of a total of 34,039 patients admitted during the 8 months, 2907 patients died. Of
these, 1529 (52%) were male, and the rest were female. In terms of age, 10 cases in the age group
of fewer than 15 years, 229 cases in the age group of 15–44 years, 864 patients in the age group of
45–64 years, and 1793 people in the age group of 65 years and over died. 2206 people (more than
75%) by personal visit referred to medical centers. The mortality rate was more than 8 cases per 100
hospitalized patients. Men were 16% more likely to die from COVID‑19 than women.
DISCUSSION AND CONCLUSION: Older adults over 65 have the highest incidence and death rate
due to this disease. The incidence rate was higher in women, and the death rate was higher in men,
which differs from the national pattern.

Abstract BACKGROUND: Nowadays, emergencies and disasters are considered one of the biggest problems
in human life. To reduce the risk of emergencies and disasters, governments must develop strategies
and policies using evidence‑based methods. Disaster databases are the main source and tool for
storing and managing a wide range of data in this field. This study was conducted with the aim of
exploring the necessary criteria and components of the emergency and disasters database in Iran.
MARTIALS AND METHODS: This qualitative study was performed using content analysis in which 18
managers and experts with experience in registering, documenting, or responding to emergencies and
disasters were selected through purposive sampling. Data collection was done using semi‑structured
interviews that continued until saturation. Data were analyzed by means of qualitative content analysis
recommended by Landman and Graneheim.
RESULTS: In total, three main concepts concerning the necessary criteria and components of the
database of natural and artificial emergencies and disasters in Iran were explored. The main concepts
include information resources, information evaluation, and information management. Subconcepts
include data collection, information transfer, access to information, information validation, disaster
leveling, information registering, information storage and retrieval, information analysis, and
information dissemination.
CONCLUSION: The experience of the participants showed that there are many challenges in the
field of monitoring and gathering information about injuries and damages caused by emergencies
and disasters in the country. The knowledge obtained from this study can be used to create and
develop a database of emergencies and disasters in Iran. It will also provide insights for healthcare
policymakers and managers in future planning areas to more effectively address identified challenges
in preventing and responding to disasters at both regional and national levels.

Abstract BACKGROUND: In recent years, the prevalence of dust events has increased in the region and
the world. According to the Meteorological Organization, the most frequent days with dust events
are on stations located in Khuzestan province. Objective: Assessment of the effects of dust events
and meteorological elements on stroke morbidity in health in Iran: a health promotion approach.
MATERIALS AND METHODS: The present study was a retrospective cohort study 2020 and 2013
provided between based on ecological data‑based on population. Information about patients with
stroke was obtained from the hospital. Information on the dust events and meteorological elements
was also from the data center of the Meteorological Organization of Iran. Using STATA the correlation
between the diseases and the, 14 statistical software version occurrence of dust events and changes
in meteorological elements was obtained and the statistical model (Spearman correlation coefficient)
individually estigate the equation was used inv modified by Poisson regression simultaneous effect
of variables.
RESULTS: the results of adjusted statistical models show that increasing the severity of dust
event increases the risk of stroke in males (lag 0–21 confidence interval [CI] 95% = 1.496–1.0067
relative risk [RR] = 1.03 P = 0.01). Increasing the average wind speed also increases the
risk of stroke in males (lag 0–3 CI 95% = 1.0491–0.9996 RR = 1.02 P = 0.05). Increased
rainfall and average relative humidity increase the risk of stroke in people under 60 years
(lag 0–7 CI 95% = 1.0012–0.9058 RR = 1.95 P = 0.05). Increasing the average daily temperature
reduces the risk of stroke in males (lag 0–3 CI 95% = 0.9874–0.9254 RR = 0.51 P < 0.001).
CONCLUSION: Increasing the intensity of dust storms along with meteorological elements has
increased the risk of stroke. However, increasing the average temperature has had a protective
effect on the risk of stroke.

Abstract Nowadays, disaster databases have become a valuable tool for disaster risk management and
health promotion and serve various purposes. The purpose of this study is to provide a systematic
review of disaster databases in the world and to identify the objectives, information sources, criteria,
and variables of disaster data registration in the world’s reputable databases. To conduct review,
all English‑language articles published without a time limit until the end of September 2020 were
extracted from the databases of Web of Science, PubMed, Scopus, Cochrane Library, Science
Direct, Google Scholar, and Embase. Necessary information in the papers including study time, type
of disasters, related databases, dimensions and indicators of global and regional databases were
extracted by using a researcher‑made questionnaire. A total of 22 studies have been reviewed to
identify the dimensions and indicators of disaster databases worldwide. The main focus was on global
and regional databases, mostly used at the level of scientific societies and disaster experts. After
explanation, researchers highlighted each of the disaster databases, along with the main differences
available among the existing databases. Some databases have well‑defined data collection methods.
Their knowledge is high quality and they can be used to create and improve a disaster database at
other levels. Disaster database limitations include risk bias, time bias, accounting bias, threshold
bias, and geographical bias. To support the right decisions to reduce disaster risk, it is necessary
to complement existing global, regional, and national databases. Countries need to take action to
set up national databases.

Abstract New epidemiological studies acknowledge the detrimental effects of dust storms on health.
The aim of this study was to systematically review the effects of dust storms on the morbidity
and mortality rates of cardiovascular and respiratory diseases. The results of this study were
obtained based on articles published in English-language journals. For the purpose of this
study, all articles published until the end of 2020 based on the search in the “Scopus,” “Web
of Science,” and “PubMed” databases were selected. Articles were searched independently
by two trained researchers. Dust storms are the cause of many diseases and health-related
complications, of which cardiovascular and respiratory diseases are common. It is necessary
to recognize and investigate the harmful effects of dust storms to prevent serious harms
to human societies. In the reviewed articles, the impact of dust storms on several diseases,
including cardiovascular and respiratory diseases,has been analyzed. Most of these articles
acknowledge the effect of dust storms on increasing the incidence and mortality rate of these
diseases, although in some articles this effect is not statistically significant. Many studies
conducted around the world confirm the harmful effects of dust storms on cardiovascular
and respiratory diseases, including increase in the number and duration of hospitalizations, as
well as increase in mortality and exacerbation of these diseases. However, some studies do not
consider the harmful effects of dust storms on the above diseases to be statistically significant.

Abstract BACKGROUND: The empirical assessment of the health outcomes associated with migration caused
by climate change is still unclear. However, health outcomes in the early stages are expected to be
similar to the health outcomes associated with refugees. The objective of the present study was a
systematic review of the health effects of migration caused by climate change.
METHODOLOGY: A systematic review was conducted according to the Preferred Reporting Items
for Systematic Reviews and Meta‑Analyses guidelines. Online databases (PubMed, Scopus, Web
of Science, and Google Scholar) were used to identify papers published that evaluated the health
effects of migration caused by climate change. The search, article selection, and data extraction were
carried out by two researchers independently. All English‑language articles on the health effects of
migration caused by climate change were included in this study.
RESULTS: An analysis of the complex ways in which climate change influences populations can
be facilitated using a three‑class classification: compulsory displacement, resettlement planning,
and migration. Subsequent to climate changes, other changes, and environmental deficiencies,
compulsory displacement may occur in case of inadequacy of compatibility responses. A part of
migration‑related health outcomes caused by climate change is from displacement from rural to urban
areas, especially in developing countries. There is significant documentation on health and livelihood
inequalities between migrant groups and host populations in developed countries.
CONCLUSION: If climate change continues in its current direction, it is likely that the number of
refugees and crises will increase in the coming decades. Although the domain and the extent of health
hazards caused by the displacement of the population associated with climate change cannot be
clearly predicted, by reducing global greenhouse gas emissions, along with social and environmental
adaptation strategies, migration caused by climate change, health risks and its relevant crises can
be greatly reduced.

Abstract BACKGROUND AND OBJECTIVE: Applying the Best Evidence Medical Education (BEME)
in real educational arena is a necessity in medical education. As to the literature, there are
enough evidence; however, their application by educators and policymakers has been still failed.
Therefore, this study conducted to explore the experience of educators about applying BEME in
Iranian context.
MATERIALS AND METHODS: Qualitative approach using content analysis method was utilized for
exploring 25 participants involved with medical education in different levels, introduced the study using
purposeful sampling. Data were collected through a semi‑structured interview by which they answered
to researcher’s questions in around 45 min about how they apply evidence in their educational setting.
To make more clarification, probing questions were used. Interviews were recorded and transcribed
and then analyzed by coding paradigm immediately.
RESULTS: Three categories were emerged as: applying different levels of evidence, substitution
of evidence‑based medicine for BEME, and variation of understanding BEME. The first category
includes subcategories of using personal experience, textbooks, and filtered papers. The second
contains lack of knowledge about BEME elements, time and motivation as well as no priority for
applying available medical education evidence; and third, using different terminology and having
some problems in applying process, based on individual understanding and using papers with or
without modification.
DISCUSSION: For effective evidence application, it is necessary to operationalize BEME terminology
and overcome any ambiguity surrounded it. It is also important to suggest educators to apply the
appraised evidence as well as teach them how they search and appraise evidence independently.
Certainly, in the first steps, supervision and providing a proper context for BEME applications are
crucial.

Abstract INTRODUCTION: An important indicator increasing the survival chances of patients and injured
people immediately after emergency and disaster is the rapid access to medical services. The
establishment of Emergency and Disaster Medical Response Teams (EDMRTs) is one of the main
strategies to improve response capacity and capability in the field of EDMRT. This study aimed to
probe the structural factors influencing of EDMRTs.
METHODOLOGY: In this study, a comparative review method was used. The current study was
conducted between March 2017 and September 2018. For this, articles, books, formal reports, and
information concerning the available websites regarding the structure of EDMRTs were analyzed. To
access relevant scientific articles, an extensive search was carried out in several steps using divergent
keywords in the Scopus, ProQuest, PubMed, ScienceDirect, and Google Scholar databases. After
accessing the resources and documents, the process of analyzing and comparing different team
structures was carried out using content analysis.
RESULTS: Following the search of relevant databases and websites, the structure of EDMRTs in the
United States, Australia, Japan, Turkey, New Zealand, Canada, and the World Health Organization
were taken into consideration and compared. Two areas of “Organization and Management” as well
as “Capacity and Capability Development” were explored along with multiple subsets.
CONCLUSION: The results of this study revealed that the model and structure of EDMRTs have
direct relationship with such elements as the structure of the disaster risk management system, risk
assessment, impact of the hazards and medical needs of the affected area, population distribution,
level of team activity, and timing of the teams’ presence after disasters. The research team
recommends designing and conducting studies for determine the roles and responsibilities of the
teams.