Medicine, public health and the Qājār state: patterns of medical modernization in nineteenth-century Iran
In: Sir Henry Wellcome Asian studies 4
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In: Sir Henry Wellcome Asian studies 4
Energy as one of the most important factors of production, today has a great contribution to the economic growth and development of countries and has played the greatest role in the development of recent human civilization. This role, from transportation to food production and the provision of medical and health services, is becoming more prominent day by day. In order to continue the supply of energy in order to continue to use it, a lot of investment must be made. That is why energy security has been so much the focus of energy policymakers around the world. In this book, we first address the issue of defining and examining the importance of energy security then we talk about fossil fuels. In the following, we will discuss the effects of fossil fuels on the Earth's climate and biosphere. The issue of international agreements, including the Paris Agreement, will also be considered, as well as providing solutions to fossil fuel damage by introducing renewable energy sources, which will be one of the chapters of this book. Finally, we will examine the disadvantages and disadvantages of renewable energy to realize that these energies are not perfect in themselves! Instead of fearing, or sitting and calculating, that there are a few years left until the end of the life of oil reserves, the world needs a policy that thinks about the available alternatives. Much more and better alternatives to the fossil fuels that have driven the world and industry for years. Renewable energy sources are another proposition facing human societies. A way to overcome the energy crisis and the time bomb that seems to be tuned to announce the end of energy at any moment. In fact, we should listen to the proposal of the Saudi Minister of Energy in the 1970s, who said: "The Stone Age did not end because the stone ran out. The age of oil must end much sooner than the end of oil."
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One of the most common causes of emergency department (ED) visits in Pasteur Hospital, Bam, Iran, is a foreign body from palm tree fronds entering different parts of body. This town is located in southeast Iran and has many palm tree orchards. Most of its residents are farmers or orchardists and many children play in these orchards. When palm harvest season approaches (about the end of summer), a considerable number of patients are presented to emergency department of this town with complaint of foreign bodies. These foreign bodies called "date thorns" among the locals (figure1) are wooden and can easily penetrate various body parts due to their needle-like, pointy shape. Some patients manipulate the foreign bodies before going to the ED and cause it to move deeper. Another group, delay going to the hospital and only reach ED a few days after the initiation of inflammation, redness, and evidence of infection. History and physical examination aid in finding the place of the foreign body, but sometimes they are not perceptible and diagnostic imaging is needed. Radiolucent objects such as wood cannot be detected in graphy but are visible in sonograms (1, 2). Removal of these bodies is usually performed under sterile conditions, using local anesthesia or regional nerve blockade, by making an incision and searching the region, finding and removing the foreign body, and finally suturing and bandaging. The procedure gets more difficult in children and patients who do not cooperate and occasionally, procedural sedation and analgesia is required, which leads to side effects such as nausea, vomiting, lethargy, agitation, and respiratory depression. Depending on the site of injury, patients are usually unable to use the affected organ for a few days after the procedure and need daily washing and bandage, and sometimes taking antibiotics. If tendon, joint, nerve, or vascular injuries are present, it gets more complicated and need for operation and hospitalization will be added to the afore-mentioned requirements (3-5). This can lead to temporary or permanent disability of the organs during the busiest workdays, in addition to severe pain especially in cases of the foreign body piercing a joint. The presence of these patients in the ED leads to overcrowding and sometimes decreases the time spent on patients in poor condition. This becomes troublesome on occasion as staff and equipment are limited, particularly when sonographic or radiologic guidance is needed for removal of the foreign body (6, 7). In the time between March and October 2014, 240 patients have been presented to the ED with complaint of foreign body, which makes up 10% of total ED visits as 2400 patients visit the ED each month (77.36% male). The patients' age range was 3 to 70 years. In 190 (79.16%) cases, the foreign body was successfully removed in the ED and the other 50 (20.83%) needed surgery. The foreign body was in the lower extremities in 107 (56.31%) cases, upper extremities in 77 (40.52%) and other body parts in 6 (3.15%). These findings emphasize the importance of prioritizing prevention over treatment. It seems that by taking a few simple measures we can vastly decrease the financial and health burdens of this problem:1- Avoiding walking barefoot on the grounds beneath palm trees that are full of the dry thorns mentioned. This is especially important in case of children.2- Education for use and providing personal safety tools such as helmets, long impenetrable gloves, glasses, and proper shoes while working and harvesting dates.3- Having classes for the farmers and orchardists, held by health centers of the regions affected by this problem.4- Educating the patients on the importance of rapid referral to ED and not manipulating the foreign body to avoid further complications.5- Train the medical staff of the ED to increase their skills in removing radiolucent objects using sonographic guidance.6- Educate the families to take more care of the children especially in harvest season.7- Mechanization of the harvest process to decrease using hands with the aid of respective organizations ; یکی از مراجعات شایع به بخش اورژانس بیمارستان پاستور، بم، ایران، ورود جسم خارجی ناشی از لیف درخت خرما به قسمتهای مختلف بدن می باشد. این شهر در جنوب شرقی ایران واقع شده است و نخلستانهای زیادی دارد. بسیاری از ساکنین شهر بم و اطراف آن کشاورز و باغدار بوده و تعداد زیادی از کودکان هم در این باغها مشغول بازی هستند. با نزدیک شدن به فصل برداشت خرما (اواخر تابستان) بخش اورژانس این شهر محل ارجاع تعداد قابل توجهی از بیماران با شکایت جسم خارجی است. این اجسام خارجی که در اصطلاح محلی سیخ خرما نامیده می شود از جنس چوب بوده و به دلیل شکل سوزنی و انتهای تیزی که دارند به راحتی وارد قسمت های مختلف بدن میشود. برخی از بیماران قبل از مراجعه به اورژانس، اقدام به دستکاری کرده و باعث فرورفتن عمیق تر این اجسام می شوند.در ادامه این نوشتار به ارزیابی شیوه مدیریت این بیماران خواهیم پرداخت.
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Backgrounds and Aims: Using Geographical Information System (GIS) can decreases the burden of road traffic injuries effectively by identification of hot spot to modification in hazardous areas. The aim of the study was determining geographical distribution of human risk factors associated with road traffic injuries by using Geographical Information System (GIS) in Iran. Materials and Methods: The national database of road traffic injuries registered by the Iranian traffic Police (Rahvar NAJA) was used. The human risk factors were investigated by recognition of the hazardous points and geographical distribution of associated risk factors. The Hot Spot Analysis and Map clustering approaches were employed to meet the objectives. Results: The mean age of injured subjects was 34 years and the most affected age group was 20-39 years. Death and injury occurrence within out of cities ways were 0.3 % and 28% respectively. Geographical distribution of risk factors also showed that roads of Northern provinces i.e. (Gilaan and Mazandaran) were the hazardous rising as well as Qazvin to Rasht and Qom to Tehran roads. Sistan and Balochestan Provinces and Tehran had the highest (4.8%) and the lowest (0.1%) rates of road traffic injuries leading to death in the country. Conclusions: Northern provinces and its leading axes by hazardous rising and Sistan and Balochestan province with fatal injuries need to identify the cause of injuries' and, if necessary, more tighten regulations and more controls by the traffic police must be applied. REFERENCESPeden M, Scurfield R, Sleet D, Mohan D Hyder A A, Jarawan E . (2004).World report on road traffic injury prevention: World Health Organization Geneva. 2004.Kopits E, Cropper M. Traffic fatalities and economic growth. Accid Anal Prev 2005;37(1): 169-78.Channa R, Jaffrani H A, Khan A J, Hasan T, Razzak J A. Transport time to trauma facilities in Karachi: an exploratory study. Int J Emerg Med 2008; 1(3): 201–4. Soori H, Hussain S, Razzak J. Road safety in the Eastern Mediterranean Region–findings from the Global Road Safety Status Report. East Mediterr Health J 2011;17(10):770-6.Soori H. Descriptive study (Chapter 8) in Basic applied epidemiology. Percian text book 2nd edition.Tehran: Arjmand publisher; 2008.Gesler W. The uses of spatial analysis in medical geography: a review. Social Science & Medicine 1986; 23(10): 963-73.Ameratunga S, Hijar M, Norton R. Road-traffic injuries: confronting disparities to address a global-health problem. The Lancet 2006;367(9521): 1533-40.Akbari M, Naghavi M, Soori H. Epidemiology of deaths from injuries in the Islamic Republic of Iran. East Mediterr health J 2006;12(3/4): 382-90.Rasouli M R, Nouri M, Zarei M R. Saadat S, Rahimi-Movaghar V. Comparison of road traffic fatalities and injuries in Iran with other countries. Chin J Traumatol 2008;11(3): 131-4.Ainy E, Soori H, Mahfozphoor S, Movahedinejad AA. Presenting a practical model for governmental political mapping on road traffic injuries in Iran in 2008: a qualitative study. J R Soc Med Sh Rep 2011; 2(10):79.Khorasani-Zavareh D, Mohammadi R., Khankeh H R, Laflamme L, Bikmoradi A, Haglund B J A. The requirements and challenges in preventing of road traffic injury in Iran. A qualitative study. BMC Public Health 2009; 23(9): 486-91.Nantulya V M, Reich M R. The neglected epidemic: road traffic injuries in developing countries. BMJ 2002; 324(7346): 1139-41. Elvik R. Road safety management by objectives: A critical analysis of the Norwegian approach. Accid Anal Prev 2008;40(3): 1115-22.Liang L Y, Mo'soem D, Hua L T. Traffic accident application using geographic information system. Journal of the Eastern Asia Society for Transportation Studies 2005;6(1): 3574–89.Braddock M, Lapidus G, Cromley E, Cromley R., Burke G, Banco L. Using a geographic information system to understand child pedestrian injury. Am J Public Health. 1994;84(7): 1158-61. Lascala E A, Gerbe D, Gruenewald P J. Demographic and environmental correlates of pedestrian injury collisions: a spatial analysis. Accid Anal Prev 2000;32(5): 651-8.Lightstone A, Dhillon P, Peek-Asa C, Kraus J. A geographic analysis of motor vehicle collisions with child pedestrians in Long Beach, California: comparing intersection and midblock incident locations. Inj Prev 2001;7(2): 155-60.Daum M L, Dorsch W R. Managing Land Use and Institutional Controls with GIS . Journal of Map & Geography Libraries: Advances in Geospatial Information, Collections & Archives2008 ;4(1): 163-73.Erdogan, S, Yilmaz I, Baybura T, Gullu, M. Geographical information systems aided traffic accident analysis system case study: city of Afyonkarahisar. Accid Anal Prev 1998; 40(1): 174-81.Al-Kharusi W. Update on Road Traffic Crashes. 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Background and Aim: About one-third of Iranian children mortality is caused by injuries from which 36% occur due to road traffic injuries. Using child restraint embedded in vehicles can reduce road traffic fatalities by 71% for neonates and 54% for children. Based on its effectiveness in reduction of fatality and prevention of injury severity, child restraint usage mandatory law is a priority. Therefore, this study was conducted to assess opportunities and threats to mandatory law of child restraint usage in Iran. Materials and Methods: Initially, a mixed methods research is carried out by a phenomenological qualitative study, a discussion session by traffic injuries' stakeholders was performed to assess & discuss the opportunities and threats to mandatory law of child restraint usage in Iran, by brain storming method to find the themes in the related topic. A structured questionnaire is later prepared and completed by the stakeholders in the area of road traffic injuries. Assigned scores of 0-100 were considered for each response and analysis of results was performed according to target themes & the total score of the filled questionnaires.Results: Overall, 28 stakeholders participated in the study. According to the stakeholders, traffic police department obtained the highest score of 90 (from 0-100) as an organization to establish the mandatory law of child restraint usage, and acquired the score of 100 for future enforcement and monitoring. As threats and obstacle to the mandatory law of child restraint usage, lack of television and media campaigns and child restraint law and legislation, obtained the highest scores of 85 & 70 respectively. And family sensitivity to their children's health, officials' support and national facilities for broadcasting, and community awareness to use child restraints had the highest scores among existing opportunities and facilities in the country, by scores of 83, 69 and 68 respectively.Conclusion: Due to sensitivity of the family about their children's health & safety, and officials' support to safety establishment through media campaigns, implementation and applicability of child restraint usage laws and legislations, and subsequent enforcement and monitoring seem practical. ReferencesIsna.ir/fa, 13th May 2012.National Center for Statistics and Analysis. 2003, www.nhtsa.dot.gov.Global status report on road safety: time for action. Geneva, World Health Organization, 2009. (www.who.int/violence_injury_prevention/road_safety_status date of access 12 September 2012.Jacobs G, AaronThomas A, Astrop A. Estimating global road fatalities. 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Inj Control Saf Promot 2004; 11(4): 225-230.Staunton C, Davidson S, Kegler S, DawsonL, Powell K, Dellinger A. Critical gaps in child passenger safety practices, surveillance, and legislation: Georgia, 2001. Pediatrics 2005; 115(2): 372-379.Cameron L, Segedin E, Nuthall G, Thompson J. Safe restraint of the child passenger. J Paediatr Child Health 2006; 42(12): 752-757.Bingham CR, Eby DW, Hockanson HM, Greenspan AI. Factors influencing the use of booster seats: a state-wide survey of parents. Accid Anal Prev. 2006; 38(5):1028-1037.Ehiri J, King W, Ejere H, Mouzon P. Effects of Interventions to Increase Use of Booster Seats in Motor Vehicles for 4-8 Year Olds. Washington, DC: AAA Foundation for Traffic Safety, 2006.GunnVL, Phillippi R M, Cooper WO. Improvement in Booster Seat Use in Tennessee. Pediatrics 2007; 119: 131-136.Winston FK, Kallan MJ, Elliott M R, Xie D, Durbin D R. Effect of Booster Seat Laws on Appropriate Restraint Use by Children 4 to 7 Years Old Involved in Crashes. 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Virginia Common wealth University Richmond April, 2009.Seat-belts and child restraints: a road safety manual for decision-makers and practitioners London, FIA Foundation for the Automobile and Society, 2009.Istre G R, Stowe M, McCoy M A, Moore B, Culica D, Womack K N, Anderson R J. Anna B. Preventing unintentional injuries in Indigenous children and youth in Canada .Paediatr Child Health 2012; 17(7):393.
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