Journal of Education and Health Promotion

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 The Emergency Medical Services (EMSs) are in the frontline between the health-care systems and
people in emergencies and disasters. With the increase in the frequency of natural or man-made
disasters around the world, the need for prepared EMS services is increasing. This study aimed to
evaluate the current disaster preparedness status of the EMS agencies in the literature and exploring
the key preparedness elements and the strategies to improve the EMS disaster preparedness. The
electronic database such as PubMed, Web of Science, Scopus, and Google Scholar was searched
from 2000 to 2019. The searching keywords included: “EMS,” “Disaster,” “Preparedness,” “Emergency”
“Preparedness,” “Disaster Preparedness,” “Readiness,” and the terms related to “disaster types” were
used in combination with Boolean operators OR and AND. Out of 1412 articles, 7 articles were
included in the review. The most important elements of the EMS disaster preparedness include the
size and scope of the incident, surge capacity, planning, communication, training and education,
policymaking, financial support, coordination, safety and security, early warning system, disaster
response experience, and legal considerations. This systematic review showed that the EMS agencies
in the world generally are inadequately prepared for an effective response to major emergencies and
disasters. This study provides valuable information to EMS educators, EMS administrators to adopt
and perform appropriate activities to improve the EMS disaster preparedness.

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 INTRODUCTION: Disasters occur almost everywhere in the world, and preparation is essential.
Preparedness is an effective approach for disaster management, and it is crucial for the health
systems, especially the Emergency Medical Service (EMS) agencies. This systematic review will
be conducted to assess the preparedness levels of EMS agencies in the world for the response to
disasters and explore the key dimensions and strategies to enhance it.
METHODOLOGY: This systematic literature review will be conducted to search comprehensively the
articles published between 2000 and 2019 to explore the disaster preparedness of EMS Agencies. To
this end, PubMed, Scopus, Web of Science, and Google Scholar will be thoroughly assessed. The
following terms and expression will be used for searching the databases: “EMS” and other keywords
“Disaster Preparedness,” “Mass Casualty Incident,” “Mass Gathering,” “Terrorist incident,” “Weapons
of Mass Destruction,” and CBRNE, Disaster, included: ‘Emergency Preparedness, Preparedness,
Readiness.
DISCUSSION: To the best of our knowledge, no systematic review study has been conducted on
disaster preparedness of EMS agencies in the world. This is the first study to address this gape. It
will also explore the key dimensions of disaster preparedness in EMS services and the strategies
to enhance their preparedness.
CONCLUSION: Identifying the key dimensions of disaster preparedness is the first step in designing
valid assessment tools to evaluate disaster preparedness of EMS service. This study will provide
valuable guides for EMS administrators and researchers in an attempt to enhance of preparedness
of EMS systems in disasters.

Abstract BACKGROUND: Risk perception is an important predictor to mitigate climate change effects which
can produce mental health consequences such as anxiety and depression. For developing policies
of climate risk adaptation, awareness of public attitudes, beliefs, and perception is essential. At this
study, researchers tried to focus on the often “unseen” psychological aspects of climate change.
MATERIALS AND METHODS: A qualitative approach was done with a consistent content analysis
method. The study consisted of 33 participants including ordinary people and experts in disasters
and climate change. Purposeful sampling was adopted until data saturation. The data collection was
performed through in‑depth and semi‑structured interviews. All interviews were transcribed after
listening again and again and reading several times to catch an overall understanding of the interviews.
RESULTS: The main theme of the study was “Complexity nature of climate change risk perception”
and related categories including “the Mental health dimension,” “the Cognitive dimension” and
“Interaction of imposed components.” The structure of the research community strongly reflected
effects of cultural and religious factors in all aspects of community life. Participants’ life experiences
of extreme events were associated to their perception of climate change.
CONCLUSIONS: Risk perception is multifactorial and complicate and should clearly be understood to
improve community participation to manage climate change‑related risks. We propose that authorities
and related managers should pay attention to it as a priority. This may assist in developing research
on public mental health practices.

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 CONTEXT: Iran’s health system has always faced many challenges in the field of disaster risk
management. The establishment of early warning systems in countries has been identified as an
important component of preparedness and risk reduction.
AIMS: This study aims to extract the experiences of those involved in the field of risk management
in relation to the challenges and problems of early warning system establishment in the Iran’s health
system.
SUBJECTS AND METHODS: This was a qualitative study, which has been conducted using a content
analysis method. Data were collected through semi‑structured interviews with 16 individuals who
had at least one disaster management experience at the emergency operation centers. Sampling
was done purposefully. The data were then analyzed using the Grenheim method.
RESULTS: Nine subcategories of data were analyzed that included legal vacancies, challenges
related to protocols and guidelines, weaknesses in the prediction infrastructure, weaknesses in
the communication infrastructure, poor coordination, scarcity of resources, inadequate education,
information management challenge, and evaluation challenge, and three main categories were
extracted that included policy challenges, infrastructure challenges, and management challenges
that represented the issues experienced in establishing an early warning system in the Iranian
health system.
CONCLUSION: Policy‑makers and managers of health system need to pay special attention to
improve the legal framework and standard protocol, strengthening infrastructures, increasing
management performance in the field of coordination, education, allocation of resources, flow of
information, and evaluation system.

Abstract INTRODUCTION: The objective of the present study was to systematically review the current research
knowledge on hospital preparedness tools used in biological events and factors affecting hospital
preparedness in such incidents in using a scoping review methodology.
MATERIALS AND METHODS: The review process was conducted in accordance with the Preferred
Reporting Items for Systematic reviews and Meta‑Analyses extension for Scoping Reviews
guideline. Online databases (PubMed, Scopus, Web of Science, and Google Scholar) were used to
identify papers published that evaluated instruments or tools for hospital preparedness in biological
disasters (such as influenza, Ebola, and bioterrorism events). The search, article selection, and data
extraction were carried out by two researchers independently.
RESULTS: A total of 3440 articles were screened, with 20 articles identified for final analysis. The
majority of research studies identified were conducted in the United States (45%) and were focused
on CBRN incident (20%), Ebola, infectious disease and bioterrorism events (15%), mass casualty
incidents and influenza pandemic (10%), public health emergency, SARS, and biological events (5%).
Factors that were identified in the study to hospitals preparedness in biological events classified in
seven areas including planning, surge capacity, communication, training and education, medical
management, surveillance and standard operation process.
CONCLUSIONS: Published evidences of hospital preparedness on biological events as well as the
overall quality of the psychometric properties of most studies were limited. The results of the current
scoping review could be used as a basis for designing and developing a standard assessment
tool for hospital preparedness in biological events, and it can also be used as a clear vision for the
healthcare managers and policymakers in their future plans to confront the challenges identified by
healthcare institutes in biologic events.