Context: Disasters are increasing worldwide, with more devastating effects than ever before. Hospitals must maintain their normal functions or have an evacuation plan due to the rate of damages at the time of a sudden disaster. The present study was conducted to determine the effective determinants and components in hospital evacuation decision-making.Evidence Acquisition: In this systematic review study, which was conducted in 2016, bibliographies, citation databases, and other available records such as international guidelines, documents and reports of organizations and academic dissertations were used to find an answer to the following question: What are the effective components in hospital evacuation decision-making? Finally, 34 articles were included in this systematic review. This systematic review article was checked with PRISMA checklist. Results:The common factors affecting hospital emergency evacuation decision-making were classified into 4 general categories and 40 subcategories, which have been explored during thematic analysis. These 4 categories included hospital infrastructure consequences, threat, internal factors, and external factors. Level of risk was the most important component of threat category and it was mentioned in most of the reviewed literature. Loss of electricity and water, communication and transportation, resources such as staff, and removing patient devices were the most mentioned factors in hospital infrastructure consequences, external factors, and internal factors, respectively. Conclusions:Different variables affect the process of hospital emergency evacuation decision-making. Thus, further studies are needed to develop a decision-making tool for hospital emergency evacuations in Iran.Keywords: Hospital Evacuation, Decision-Making, Disasters, Emergencies ContextThe percentage of disasters and their devastating concerns is increasing worldwide. It was reported that 3.3 million people died in disasters globally from 1970 to 2010 (1, 2). Despite advances in science and technology, it is not yet possible to forecast unexpected events such as earthquakes. In the critical situations following disasters, mortality and morbidity as well as the demand for health care services suddenly increase (3).Health system has a special place among other organizations involved in crisis management because it is the first and foremost need at the time of crises during disasters and unexpected circumstances (4). Hospitals, as key elements in providing preparedness in emergency situations, must remain fully functional at the time of disasters and major incidents (5). They are fundamental resources for successful management of disasters (6).The vulnerability of hospitals in disasters results in instabilities in providing health care (7). Hundreds of hospitals and other health care facilities are destroyed or lose their function in natural disasters worldwide every year Yaghoubi T et al. centers have been evacuated urgently due to fire, incidents related to Hydro-meteorological changes, ter...

Renal stone formation is a common and important problem in urinary tract and the prevalence of the disease is especially rising in recent years due to changing the lifestyle and diet. The aim of this study was to evaluate the health behaviours of patients with kidney stones.This cross‐sectional study was performed on 190 patients with kidney stones who referred to the outpatient department of Hospitals or extracorporeal shock wave lithotripsy clinics in Sari/Iran, during 6 months period in 2009. The people were divided into two safe health behaviours and unsafe health behaviours groups, based on the obtained scores from their health behaviours. Data were analysed using SPSS software and descriptive statistics tests.The mean age of the patients with kidney stones was 39 years. A 51·3% of subjects had positive family history of the disease. A 49·5% of subjects did not have exercise and 38·9% had less than half an hour physical activity per day. There was a significant relationship between the type of kidney stone and type of consumed water, tea, raw vegetables, milk and meat (P < 0·005). There was a significant relationship between family history of disease and exercise and daily activity level as well as the type and amount of water consumption (P < 0·005).Health behaviours can control and prevent the disease progression and influence on recurrence of the disease. Evaluation of health behaviours leading to formation of urinary tract stones in different geographical areas of our country seems to be necessary.

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Background: An increase in disasters around the world like bioterrorism attacks emphasizes the need to assess healthcare workers' preparedness to respond to bioterrorism. Nurses form the majority of first responders in disasters and emergencies, thus it is important to guarantee that their knowledge and skills are adequate to respond to such events. Objectives: This study aimed at assessing the level of nurse's knowledge and attitude of Sari city of Mazandaran province about bioterrorism, in 2015. Methods: Overall, 240 nurses participated in this cross-sectional study that was conducted at the University of Mazandaran Medical Sciences. The units were selected through the accessible sampling method. Data were collected by a questionnaire in 3 sections, demographic data, knowledge, and attitude, respectively. Results and Conclusions: The results showed that 91.7% of samples had low knowledge about bioterrorism and 93.3% had no opinion in regarding attitude of bioterrorism. Little knowledge of nurses regarding bioterrorism attacks indicates inefficiencies in hospitals units. Therefore, bioterrorism preparedness should be proposed through continuing education for under graduate and postgraduate nursing curriculum.

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Background: The prevalence of the Coronavirus disease 2019 (COVID-19) pandemic, as one of the biggest global health threats, has had psychological impacts on healthcare workers (HCWs) and all aspects of their mental health, particularly resilience. Objectives: This study aimed to investigate the relationship between mental health and resilience in prehospital emergency medical services (EMS) practitioners. Methods: This descriptive/analytical cross-sectional study was conducted in 2020 using a web-based questionnaire, wherein the data were collected from a total number of 115 EMS practitioners working in 115 EMS stations in Golestan province, northern Iran, selected using convenience sampling. The data collection tools were also the General Health Questionnaire-28 (score range: 0 - 84) and the Connor-Davidson Resilience Scale (score range: 0 - 100). The relationship between both questionnaires was then examined by structural equation modeling via maximum likelihood estimation. In addition, multiple linear regression (MLR) was applied to reflect on the factors affecting the resilience mean score. Results: The mental health and resilience mean scores in the EMS practitioners were 25.73 ± 8.90 and 72.25 ± 12.63, respectively. Furthermore, 43.5% and 49.6% of the subjects had good and mild mental health conditions, respectively. The correlation coefficient between both questionnaires (-0.51) revealed that mental health deterioration diminished resilience in the EMS practitioners. Additionally, the type of employment and mental health mean score had a significant effect on the resilience mean value (R2 in MLR = 0.54). Conclusions: The study results demonstrated that more than half of the EMS practitioners had moderate mental health status, and their resilience mean score was high. Therefore, it is suggested to evaluate the prevalence of other common types of mental problems, such as anxiety, depression, and sleep disorders, in HCWs during the COVID-19 pandemic at the national level in future studies.

Introduction: Moral distress is one of the prevalent problems of nursing which causes stress, that leads to nurses being unable to show a proper moral function in the critical situations. Moreover, due to the stressful conditions in emergency department, caring behaviors of nurses is of great importance. This study aimed to determine the factors associated with moral distress and caring behaviors of nurses working in emergency departments in educational-medical centers of Mazandaran University of Medical Sciences during COVID-19 pandemic. Methodology: This study was descriptive-analytical which was conducted through stratified and convenience sampling, and by participation of 188 nurses working in emergency departments in 5 educational-medical centers of Mazandaran University of Medical Sciences in 2020. Data was collected through standard three-section questionnaire of demographic information, Corley moral distress and Wolf caring behaviors of nurses, and its validity and reliability was confirmed. Data was analyzed by using descriptive (mean and standard deviation, frequency and percentage) and analytical statistics (Mann–Whitney, Kruskal-Wallis, and Spearman correlation coefficient). Finding: Moral distress mean score of nurses working in emergency was 20/97±101/60 and they had 92/4% of average moral distress. Caring behavior of nurses was 8/62±101/60. Gender and marital status variables had a significant relation with caring behavior, in a way that male nurses and married nurses had a lower score (p<0.05). the relation between moral distress and caring behavior was NOT statistically significant. Final conclusion: Nursing staff must have a good command of their caring behavior so that caring will be presented in high quality, and patients and help-seekers’ satisfaction who come to the emergency, especially in COVID-19 pandemic, will be met. Thus, it is necessary that health and medical system managers provide educational programs to draw nurses’ attention to their caring behavior dimensions, especially in emergency departments. Key words: moral distress, caring behavior, emergency department nurse, COVID-19 pandemic

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