Iranian Legal Medicine Organization Research Articles

A Three-Year Investigation on Corpses Referred to Legal Medicine Organization from An Iranian General Hospital: A Cross-Sectional Study.

A Medical Certificate of Cause of Death (MCCD) is a legal and enforceable document issued by the attending physician. However, according to the instructions, in many cases such as sudden, unexplained, and extraordinary deaths, along with some uncommon causes, such as cases suspicious of murder, the deceased patient must be referred to the Iranian Legal Medicine Organization (ILMO). Moreover, the unnecessary referral of corpses to ILMO can increase the workload of the staff, finally confronting the family of the deceased with high emotional and financial costs. In this cross-sectional study, the medical records of all deceased patients referred from Hazrat Rasool Hospital to the ILMO (565 cases) in a three-year period from April 2016 to March 2019 were investigated and analyzed using SPSS22 software with chi-squared and T-test. Among all the patients who passed away during this time (4,239 patients), 565 were referred to ILMO, accounting for 13.3% of deaths. The most common causes of referral were car and motorcycle accidents, with a total prevalence of 27.1%, dead-on-arrival (DOA) prevalence of 21.3%, and death with an unknown cause prevalence of 15.3%. Significant correlation was also detected between causes of referral with gender, time of death, and age. For example, Car accidents and lawsuits against medical staff were more common in men and women, respectively. Car and motorcycle accidents, DOA, and unknown causes were the most prevalent causes of referral in this study. In general, few studies have been conducted regarding the causes of referral of the deceased to the Legal Medicine Organization. In this study, we collected relevant variables to investigate this issue thoroughly.

Trend of mortality rate due to traffic accidents in Iran from 2006 to 2020: A cross-sectional study.

Traffic accidents are a common global cause of mortality and physical disability. This study aimed to investigate traffic accident-related mortality trends across provinces in Iran. In this study, information on all deaths caused by traffic accidents in Iran from 2006 to 2020 was collected from the Iranian Legal Medicine Organization, which collects annual data from all 31 Iranian provinces. The national and provincial demographics were assessed, and the trends in mortality rates were assessed over a 15-year span using joinpoint regression based on the log-linear model, with results expressed in terms of annual percentage change (APC). The analysis for the trend was performed using the Joinpoint Regression Program 4.9.0.1. During the study period, 291,774 traffic accident-related deaths occurred in Iran, of which 78.6% were men and 21.4% were women. The mean age of the deceased was 37.75 ± 20.89 years. The mortality rate has dropped from 39/100,000 in 2006 to 18.3/100,000 in 2020. In total, the national mortality rate APC for 2006-2015 was -6.3% (P < 0.05) and for 2015-2020 was - 1.70% (P > 0.05). Despite the overall decreasing national trend in Iran's traffic accident-related mortality over the study period, the provincial variability was noted. Therefore, it seems necessary to design and conduct epidemiological studies in different areas and provinces, for a better and more accurate understanding of the factors affecting the occurrence of traffic accident-related deaths, resulting in more focused and measurable interventions.

Trend of Conflict Rate in Iran from 2014 to 2020: An Ecological Study.

Detecting the correlation of conflict rate within provinces over time provides a better understanding for health policymakers in identifying potential causes. The purpose of this study was to assess the trend of conflict rate in 31 provinces of Iran using the growth mixture model (GMM). This ecologic study was conducted based on the data obtained from the Iranian Legal Medicine Organization (ILMO) by gender and provinces between March 21, 2014 and March 21, 2020. First, the 7-year cumulative incidence rates were described; second, the trend of conflict rate was modeled by a linear mixed-effects model according to gender and overall; finally, distinct classes of provinces with similar conflict trends in seven years were identified using the GMM. The significance level was considered less than 0.05. Among provinces, Ardebil and Sistan Baluchistan had the highest and the lowest 7-year conflict incidence rates (95% CI) with 66.6 (52.38, 84.67) and 20.79 (13.53, 31.95) per 100000, respectively. The results of the linear mixed-effects model showed that the annual rate of conflict in Iran decreased by 0.37% from 2014 to 2017 and then slightly increased by 0.07% after 2017. In addition, the GMM results indicated that the trends for Iranian provinces can be clustered into four distinct classes. Our study showed the increasing growth of conflict in the last years in most provinces of Iran. Necessary interventions are important to prevent the rising conflict rate due to the various effects of conflict on psychological, social, and health factors.

An analysis of influential factors associated with rural crashes in a developing country: A case study of Iran

Road traffic deaths continue to rise, reaching 1.35 million in recent years. Road traffic injuries are the eighth leading cause of death for people of all ages. Note that there is a wide difference in the crash rate between developed and developing countries and that developed countries report much lower crash rates than developing and underdeveloped countries. World Health Organization reports that over 80% of fatal road crashes occur in developing countries, while developed countries account for about 7% of the total. The rate of road crashes in developing countries is higher than the global average, despite some measures reducing deaths over the last decade. Numerous studies have been carried out on the safety of urban roads. However, comprehensive research evaluating influential factors associated with rural crashes in developing countries is still neglected. Therefore, it is crucial to understand how factors influence the severi-ty of rural road crashes. In the present study, rural roads in Mazandaran province were considered a case study. The Crash data collected from the Iranian Legal Medicine Organization covers 2018 to 2021, including 2047 rural crash-es. Dependent variables were classified as damage crashes and injury-fatal crashes. Besides, independent variables such as driver specifications, crash specifications, environment specifications, traffic specifications, and geometrical road specifications were considered parameters. The logit model data indicate that factors associated with driver and crash specifications influence rural crashes. The type of crashes is the most critical factor influencing the severity of crashes, on which the fatal rate depends. The findings suggested that implementing solutions that minimize the effect of the factors associated with injury and death on rural roads can reduce the severity of crashes on rural roads that share the same safety issues as the case study. Further studies can also be conducted on the safety and mechanics of the vehicle by focusing the research on the types of vehicles and the sources of the damage.

A cross-sectional multicenter linkage study of hospital admissions and mortality due to methanol poisoning in Iranian adults during the COVID-19 pandemic

A methanol poisoning outbreak occurred in Iran during the initial months of coronavirus disease 2019 (COVID-19) pandemic. We aimed to evaluate the epidemiology of the outbreak in terms of hospitalizations and deaths. A cross-sectional linkage study was conducted based on the hospitalization data collected from thirteen referral toxicology centers throughout Iran as well as mortality data obtained from the Iranian Legal Medicine Organization (LMO). Patient data were extracted for all cases aged > 19 years with toxic alcohol poisoning during the study period from February until June 2020. A total of 795 patients were hospitalized due to methanol poisoning, of whom 84 died. Median [interquartile ratio; IQR] age was 32 [26, 40] years (range 19–91 years). Patients had generally ingested alcohol for recreational motives (653, 82.1%) while 3.1% (n = 25) had consumed alcohol-based hand sanitizers to prevent or cure COVID-19 infection. Age was significantly lower in survivors than in non-survivors (P < 0.001) and in patients without sequelae vs. with sequelae (P = 0.026). Twenty non-survivors presented with a Glasgow Coma Scale (GCS) score > 8, six of whom were completely alert on presentation to the emergency departments. The time from alcohol ingestion to hospital admission was not significantly different between provinces. In East Azerbaijan province, where hemodialysis was started within on average 60 min of admission, the rate of sequelae was 11.4% (compared to 19.6% average of other provinces)—equivalent to a reduction of the odds of sequelae by 2.1 times [95% CI 1.2, 3.7; p = 0.009]. Older patients were more prone to fatal outcome and sequelae, including visual disturbances. Early arrival at the hospital can facilitate timely diagnosis and treatment and may reduce long-term morbidity from methanol poisoning. Our data thus suggest the importance of raising public awareness of the risks and early symptoms of methanol intoxication.

The Epidemiology of Gender Dysphoria in Iran: The First Nationwide Study.

Gender dysphoria (GD) is defined as a persistent and distressful incongruence between one's gender identity and one's at-birth-assigned sex. Sex reassignment has been religiously accepted for transgender individuals in postrevolutionary Iran since 1987; however, very little is known about how many individuals seek and receive such treatment annually. This study provides the first nationwide effort to assess the prevalence of GD in Iran as a function of diagnosis. The medical records of all transgender individuals referred to the Iranian Legal Medicine Organization between March 2012 and March 2017 were reviewed. All individuals diagnosed with GD were contacted. A total of 839 medical records meeting study criteria were received and evaluated. The prevalence of transgender individuals was estimated to be 1.46 per 100,000 Iranians with a transwoman (TW)/ transman (TM) ratio of 1:2. The mean age of individuals with GD at the time of referral was 25.22 (SD = 6.25) years for TW and 25.51 (SD = 5.66) years for TM. The findings are twofold. First, gender dysphoria is less prevalent in Iran than has been reported in Western countries. Second, the sex ratio is skewed toward at-birth-assigned females, which differs from what has been reported in Western countries. These findings have been interpreted in light of Iran's legal system, which is based on Islamic penal codes. These findings are of utmost importance for both health providers and legislators, as it can illustrate a more accurate picture of the transgender population in Iran.

The Ethical Considerations in the Main Practices of the Iranian Legal Medicine Organization: A Qualitative Study

Background: Effective and acceptable practice in Legal Medicine (LM) requires special attention to ethical and professional behaviors. In LM, the importance of practitioners’ compliance with ethical standards is higher. LM covers a wide range of practices, requiring specific ethical considerations. This study aims to identify the ethical principles for considerations in Iranian Legal Medicine Organization (ILMO) from the perspective of experts in LM. Methods: This is an applied and qualitative study using in-depth interviews and conventional content analysis. The study was conducted in three steps: 1) Determination of the main areas of work by reviewing academic texts، surveying 131 experts in this field with a questionnaire. 2) Qualitative Study for determination of ethical considerations of these areas by structured and in-depth interviews with 49 owner’s Forensic and medical ethics experts obtained by purposive sampling and theoretical saturation and analysis of interviews by the conventional approach of content analysis to specify propositions and confirm the reliability of 80% research in coding through the double-coder agreement method. 3) Drafting ethical guidelines by the research group (students، supervisors، and consultants) in the focus group meetings based on the results of the second step. Results: The ethical principles of LM were categorized as general and specific principles according to the perspective of experts in LM. General ethical principles included virtue ethics, professional and ethical behavior, and proper environment and working conditions. The specific ethical principles included six principles related to the entire organization, legal physical examinations, legal mental examinations, dissection rooms and crime scenes, LM laboratories, and LM commissions. Conclusion: Developing and implementing general and specific ethical guidelines for ILMO is recommended. The comprehensive and holistic view of ethical considerations for main practices of LM in Iran provided by this study can be seen as a good taxonomy and a preliminary step to develop local ethical guidelines.

The Ethical Considerations in the Main Practices of the Iranian Legal Medicine Organization: A Qualitative Study

Background: Effective and acceptable practice in Legal Medicine (LM) requires special attention to ethical and professional behaviors. In LM, the importance of practitioners’ compliance with ethical standards is higher. LM covers a wide range of practices, requiring specific ethical considerations. This study aims to identify the ethical principles for considerations in Iranian Legal Medicine Organization (ILMO) from the perspective of experts in LM. Methods: This is an applied and qualitative study using in-depth interviews and conventional content analysis. The study was conducted in three steps: 1) Determination of the main areas of work by reviewing academic texts، surveying 131 experts in this field with a questionnaire. 2) Qualitative Study for determination of ethical considerations of these areas by structured and in-depth interviews with 49 owner’s Forensic and medical ethics experts obtained by purposive sampling and theoretical saturation and analysis of interviews by the conventional approach of content analysis to specify propositions and confirm the reliability of 80% research in coding through the double-coder agreement method. 3) Drafting ethical guidelines by the research group (students، supervisors، and consultants) in the focus group meetings based on the results of the second step. Results: The ethical principles of LM were categorized as general and specific principles according to the perspective of experts in LM. General ethical principles included virtue ethics, professional and ethical behavior, and proper environment and working conditions. The specific ethical principles included six principles related to the entire organization, legal physical examinations, legal mental examinations, dissection rooms and crime scenes, LM laboratories, and LM commissions. Conclusion: Developing and implementing general and specific ethical guidelines for ILMO is recommended. The comprehensive and holistic view of ethical considerations for main practices of LM in Iran provided by this study can be seen as a good taxonomy and a preliminary step to develop local ethical guidelines.

Years of Life Lost (YLLs) due to drug-related deaths in the Islamic Republic Of Iran (2014-2017): a temporal and geographic pattern.

The present study aimed to measure the mortality burden caused by premature death due to substance abuse in different geographical regions of Iran from 2014-17. In this serial cross-sectional study, the data related to individuals who had died of drug abuse were first collected from two sources (Iranian Ministry of Health and Medical Education and the Iranian Legal Medicine Organization). Then, using the capture-recapture method, the number of drug-related deaths was estimated. The years of life lost (YLLs) for all provinces of Iran was calculated based on age, sex, and year. During these four years, the total number of deaths was 12029. The mean age of the individuals was 37.3±14.1. The mean age of dead people was constant in women and men over this period; however, the mean age of dead women due to substance abuse was lower than that of men. The mean YLLs per dead person was 70131.3329 years for men and 9321.1125 years for women. The potential years of life lost (YLLs) showed an upward trend, which was stronger in women than men. It is necessary to perform more regional overviews for finding differences in the number of YLLs due to substance abuse so that specific regional policies can be adopted.

Trends of Street Fights/Quarrels in Iran 2013 - 2018: A Bayesian Spatiotemporal Perspective

Background: Conflict/quarrel, as one of the indicators of violence, is a social issue still seen in all societies. It occurs between two or more people or groups in a social relationship and can disrupt society order and possesses destructive consequences for disputants and society. Objectives: The present study aimed to evaluate points and trends of relative risk (RR) of quarrels in Iran for total population and both sexes separately by using spatiotemporal models. Methods: Official data published by Iranian Legal Medicine Organization (ILMO) from 2013 to 2018 was studied. Spatiotemporal methods were used for analyzing the data and producing relevant maps. These models overcome the problems related to usual estimates of RR and are capable of covering spatial and temporal effects and their interactions simultaneously. Results: The results showed that Ardabil (P2, RR = 1.32), Chaharmahal and Bakhtiari, and Kohgiluyeh and Boyer-Ahmad (RR = 1.1 - 1.3) provinces had the highest risk of street quarrel for total population. The results for males are the same as the results for the total population. There was the highest risk for females in Alborz (P5, RR = 1.38) province. The risk was the lowest for the southern provinces of Iran for the total population (0.3 - 0.7), females (0.3 - 0.55), and for males (0.3 - 0.6). There was no significant change in RR over time for males and total population. However, there is an apparent decreasing trend for females. Conclusions: In general, southern parts of Iran have lower risk of street fights/quarrels. Street fight is a multifactor phenomenon that could leave various consequences on society. It seems necessary to conduct further research to find out the reasons for its occurrence in different parts of the country.

Assessing Substances Abuse-Induced Mortality Rates by Autopsy Method in Iran

Background: Substance abuse is among the main causes of preventable diseases and premature deaths worldwide. Despite legal efforts to prevent substance abuse, it has increased and imposed significant economic costs on societies. This analytical cross-sectional study aimed to explore the rate of substance abuse-induced mortality in the provinces of Iran, in 2017. We elaborated an evaluation structure to identify nationwide different substance abuse-related mortality rates. Methods: We employed the retrospective data extracted from autopsy, forensic medicine examination, and demographic characteristics from the recordings in the Iranian Legal Medicine Organization (ILMO). Stata and ArcGIS were applied for data analysis. Results: Nationwide, 3089 substance abuse-related deaths were recorded in the ILMO; the incidence rate was 38.17 per million subjects. The deaths mostly occurred in the 30-39 age group and males accounted for 90% of cases. The provinces of Kermanshah, Lorestan, Fars, Hamadan, and Semnan reported significantly higher rates, compared with the provinces of Mazandaran, West-Azerbaijan, and Golestan with the lowest mortality rates per million (74.72, 69.81, 63.42, 61.70, 58.53 vs. 10.82, 12.11, 14.30, respectively). Mortality rates due to the abuse of methadone (20.29), morphine (12.34), amphetamine (5.32), methamphetamine (7.05), codeine (4.21), tramadol (5.96), benzodiazepine (1.47), and diphenoxylate (0.05) were calculated per million populations of Iran. Conclusion: The obtained data suggested that preventive interventions should focus on the 20-40 age group. Methadone, morphine, and methamphetamine were associated with the highest mortality, compared to other substances; thus, they require effective treatment and preventive programs. Iranian Drug Control Headquarters, police department, and policymakers should act more efficiently regarding a preventive strategic plan in this respect.

Role of family function in the prediction of Gender Dysphoria in women and transgender men

Introduction: Most people show signs of behavior appropriate to their biological and physical gender. While a minority of people exhibit behaviors that are different from their sexual appearance, it is called Gender Dysphoria. Aim: The purpose of this study was to investigate the Role of family function in the prediction of Gender Dysphoria in women and transgender men. Method: This is a descriptive correlational study. The statistical population included all individuals with Gender Dysphoria, visiting the Iranian Legal Medicine Organization of Razavi Khorasan Province, Iran, from 2014 to 2016, in order to follow legal proceedings for gender reassignment. The participants included 50 women and 50 men with Gender Dysphoria were selected via convenience sampling, gave informed consent, and completed two questionnaires: family function questionnaire and gender identity disorder questionnaire. Statistical steps were performed using spss software version 21 and data were analyzed using Pearson correlation and simultaneous regression. Results: The results of regression analysis showed that the best predictor of gender dysphoria in transgender women is the Communication (p&lt;0.010) and General Functioning (p&lt;0.012) of the family, and in transgender men, the best predictor of gender dysphoria was Communication (p&lt;0.017), Affective Responsiveness (p&lt;0.039), and Affective Involvement (p&lt;0.035). Conclusion: Disrupted communication in family functioning can be a major contributor to Gender Dysphoria.

Pattern of Injury and Outcome of Victims in Ahvaz Terrorist Attack

Background: Responses for medical emergencies can be different during most terrorist attacks in which civilians and military personnel might be killed or wounded. Objectives: The present study aimed to reflect on injury patterns and the outcome of victims in terrorist attacks. Methods: A retrospective research design study was conducted on the data obtained from terrorist attacks in the city of Ahvaz, Iran, on September 22, 2018. In this deadly incident, 92 military and civilian victims had been transferred to hospitals within the first 24 hours. To this end, the data including age, gender, causes, site of injuries, outcomes, and the Injury Severity Score (ISS) values were analyzed. Data were acquired from the Iranian Legal Medicine Organization, the Iranian Emergency Department, as well as health care facilities. Results: The findings revealed that, out of 92 victims of Ahvaz terrorist attack, 85 cases (92.4%) were men. The mean age of these individuals was about 28.68±11.22 years and 41.3% of them were in need of urgent surgical interventions. There was no information regarding casualties in 22.3% of the cases. Moreover, 25% of the causalities had led to death. The mean of ISS was 8.19±13. Besides, there was a significant relationship between ISS values and patient outcomes (p <0.0001). A relationship was also observed between multiple injuries and mortality rates although it did not include main body parts. Conclusion: The results showed that the mortality rate of casualties in the Ahvaz terrorist attack was high. With respect to the findings, extensive actions are needed to maintain the readiness of the emergency medical care services and to manage such events.

Developing a National Integrated Road Traffic Injury Registry System: A Conceptual Model for a Multidisciplinary Setting.

IntroductionDespite a high burden of traffic injuries, effective integrated or linked injury surveillance systems are rarely available in many low- and middle-income countries (LMICs). The aim of the current study was to define a conceptual model for developing a national integrated traffic injury registry in Iran.MethodsA mult-method study financially and technically supported by the World Health Organization, Iranian Ministry of Health, Iranian Traffic Police, and the Iranian Legal Medicine Organization was conducted. A theoretical framework, forming the core conceptual components, was developed based on expert reviews. The preliminary conceptual model was developed by a panel of experts and tailored through a national workshop of 50 scientists, authorities and experts from nearly all sectors related to road safety promotion and injury management. It was then sent out to external reviewers in order to assess and improve the content validity of the model.ResultsThe conceptual model was developed to have six components. These included 1) aims and core definitions; 2) content and core measurements; 3) data flow; 4) data collection routines; 5) organizational matrix; 6) implementation organization. The Haddon’s matrix was adapted to be used as the theoretical framework in defining the content and data flow components of IRTIR. Five subcomponents were defined in the content and core measurements component with each having several subcategories. Each subcomponent/subcategory was finally divided into several item groups to guide defining the final data measurement variables. The data flow component was defined with six data sequence stations. Through the organizational matrix component, five major organizations relevant to road traffic safety were defined as core data production contributors. Some organizations also owned several sub-organizations which contributed in this regard.ConclusionIt is concluded that the IRTIR conceptual model includes the required six components for developing a national integrated registry for Iran. Its main component called, content and core measurements, leads the researchers in developing final data collection tools in developing the national registry of road traffic injuries in Iran.

Exploring Change in Trend of Homicide Incidence Rate in Iran from 2006 to 2016: Applying Segmented Regression Model.

Background: Murder is one of the public health problems. According to the WHO reports, murder is fourth leading cause of death among young people. The aim of this study was applying joint point regression model to study trend of homicide mortality in Iran, 2006-2016. Study design: A cross-sectional panel (pseudo-panel) study. Methods: Homicide data during 2006 to 2016 were extracted from Iranian legal medicine organization. Trends of homicide incidence were summarized by annual percent change (APC) and average annual percent change (AAPC) using non-linear segmented regression model. Results: Totally, 26918 homicide cases occurred during the period from 2006 to 2016. The highest and lowest frequency was related to the 15-29 yr (46.5%) and 0-4 yr (1.5%) age groups, respectively. The homicide incidence rate of the country in 2016 was 2.81 per 100,000. The four provinces of Sistan & Baluchistan, Khuzestan, Kerman and Ilam had the highest incidence rate in 2016, respectively. During the study period, the incidence rate of homicide in Iran and men have been significantly decreased (APC: -2.8% (95% CI: -3.9, -1.7) and -3.2% (95% CI: - 4.5, -1.8) respectively (P <0.001)). Conclusion: The pattern of homicide rate has a downward trend in the country. Moreover, the varying observed trends in some provinces can be due to the variability in mental, geographical, socio-economic and cultural conditions in each region.

The Suicide Rate in the Elderly Population of Iran between 2008 and 2014.

Background: We aimed to investigate the suicide rate led to death in the elderly population of Iran between 2008 and 2014. Study design: A cross-sectional study. Methods: The present study was conducted on all suicide-related deaths in elderly people (≥65 yr) during the years 2008 to 2014 reported to the Iranian Legal Medicine Organization. For data collection, legal medicine standard form was used and the cases were classified by age, gender, suicide way and time (year). The incidence of death from suicide was calculated by age and sex. Statistical soft-ware stata12 was used to analyze data. The significance level has been considered to be 0.05. Results: Overall, 1,601 suicide-related deaths were investigated throughout the country. The mean age was 70.36 ± 0.17 years. The incidence trend (per 100,000 people) of the elderly suicides in Iran indicates that successful suicides have been on the rise, rising from 3.7 in 2008 to 4.37 per 100,000 people in 2014. Conclusions: It is necessary to identify and treat suicidal important predisposing factors of suicide such as psycho-social illnesses including depression and also implement prevention programs and policies for this fast-rising population age-group.

Status of clinical toxicology education and ethics in medical care of poisoned patients in the Islamic Republic of Iran and a comparison with other countries.

Clinical toxicology is not recognized as a clinical speciality in Iran. After the chemical war gas attack by the Iraqi army against the Iranian troops in the 1980s, health professionals and Iranian authorities noticed the importance of this field in clinical medicine. Collaboration between the clinical toxicologists and toxicologists of pharmacy schools resulted in the establishment of the Iranian Society of Toxicology and Poisonings in 1991 and the National Board of Toxicology in 1993. Clinical toxicology fellowship was also formed as a joint collaboration between the toxicology and internal medicine boards in 2010. Medical doctors who specialized in clinical medicine are eligible to take the entrance examination of the fellowship. In spite of the advancement of clinical toxicology and increased number of acute poisonings and drug abuse, undergraduate teaching in this field is still lacking and being taught as part of the forensic medicine curriculum since 1952. There is a lack of an efficient national poison information and control centre (s) in Iran, and no action plan and practical efforts have been done for poisoning prevention. Therefore, the number of drug abuse and acute poisonings has increased over the past four decades and induced cultural, social and health problems. According to Iranian legal medicine organization reports, poisoning is the second-most occurring cause of unnatural death. The suicidal attempt is the most common method of acute poisoning in adults. Suicidal attempt including self-poisoning is not accepted in the Islamic point of view, and thus self-poisoning is mostly neglected and may not be treated appropriately in time in some regions of Iran. Accidental poisoning in children is also common in Iran and estimated to be between 20000 and 25000 cases annually over the recent years. In addition, social, cultural and economic problems have induced more health problems such as drug abuse and addiction even in children. Adulterated opium to lead for economic gaining has produced thousands of cases of lead poisoning over the past few years in nearly all opium addicts, which is still a major health problem in Iran. Ban on alcoholic beverages leads some people to make their own home-made spirits, which is unfortunately contaminated with methanol. Thousands of cases of methanol poisoning and even some epidemics have occurred over the past four decades in some parts of the country. Lack of availability of essential antidotes such as succimer and fomepizole has been a major problem for the effective treatment of poisoned patients. Despite the well-known fact that cases of poisoning and drug overdose constitute a significant proportion of hospital admissions in some developing countries, clinical toxicology education and medical care of the poisoned patients are lacking. Therefore, policymakers and health authorities should realize the importance of toxicology in clinical medicine. The Iranian Ministry of Health, medical care and Medical Education should implement clinical toxicology courses for medical students; establish effective national poisons information and control centres and advance clinical toxicology services for appropriate management of poisoned patients to improve public health and the overall health policy goals.

Trend of mortality rate due to drowning in Iran (2013–2018)

Background and Objectives: According to the World Health Organization, drowning is the 3rd leading cause of unintentional injury-related deaths worldwide, accounting for 360,000 annual deaths and 7% of all injury-related deaths. Low- and middle-income countries are the most affected, accounting for 90% of unintentional drowning deaths. This study aimed to calculate the rate of drowning mortality rate and to investigate its trend in Iran. Materials and Methods: Information on death due to drowning in Iran was extracted from Iranian Legal Medicine Organization. The crude mortality rate was calculated each year according to gender and province of the country. To examine the trend for different years, joinpoint regression was used. Results: From 2013 to 2018, a total of 5853 persons suffered from fatal drowning in Iran. The crude mortality rate in men was significantly higher than in women. The drowning mortality rate has decreased during the study period in both genders. The annual percent change in mortality rate was 3.2%. Conclusions: Although the death rate from drowning has declined in the country, targeted scale-up of known effective interventions such as swimmers supervision and basic survival skills are still needed for reducing mortality due to drowning, particularly in provinces with high mortality rates.

Consequences of Presence of Forensic Nurses in Health Care System: A Qualitative Study.

Background:Nursing is a vital element in providing safe and effective care. Forensic nursing is one of the specialties in this discipline which, in addition to creating more satisfaction in nurses, is considered essential in holistic, quality, and safe care. This study aimed to describe the consequences of the presence of forensic nurses in the health system.Materials and Methods:This qualitative study was conducted between 2017 and 2018 in Iran. Semi-structured interviews were performed with 18 participant experts in the field of health and law. The interviews were analyzed using the inductive content analysis approach proposed by Graneheim and Lundman.Results:The consequences of the presence of nurses in the health system were summarized into two categories: positive and negative consequences. The positive consequences consisted of improved performance, better legality of nurses, the calmness of nurses, prevention of patients' rights violations, advancement comparable with developed countries, reduced costs, increased accuracy and speed in dealing with forensic cases, improved performance of Iranian Legal Medicine Organization and increased employment. On the other hand, the negative consequences were role conflict with other involved professionals and nursing shortage. Participants included nurses (with different specialties), nurse lawyers, forensic medicines, forensic midwives, a judge, and a medical lawyer.Conclusions:If planners and policymakers have a positive attitude toward the presence of forensic nurses, we can anticipate better forensic services for clients through the development of systematic educational programs, the formation of forensic teams, and the expertise of this profession can provide many benefits.

Claims about medical malpractices resulting in neonatal and maternal impairment in Iran

BackgroundToday even low incidence of complications for mothers or neonates during pregnancy, delivery or postpartum is unacceptable to the public and can result in claims because of greater expectation from patients and an increase in media coverage. The present study was conducted to investigate the reasons for medical malpractice claims on maternal and neonatal impairment, which are achieved in Iranian Legal Medicine Organization councils. Materials and methodsThe present cross-sectional and retrospective study used convenience sampling to collect data of total claims from 31 provinces archived in the supreme council of the ILMO in 2 years. In this article, the medical malpractice claims on maternal and neonatal impairment during pregnancy, labour, delivery and early postpartum were reported. The data were collected through a validated researcher-made checklist and were analyzed in SPSS 16. ResultsAmong total of 299 cases of impairment, cerebral palsy (33.34%), Erb's palsy due to shoulder dystocia (24.24%) and Down Syndrome (24.24%) were the main confirmed causes of malpractice for neonatal impairment and Retained Surgical Mass (20.5%), Salpingectomy and/or Oophorectomy Related to EP (17.2%), Hysterectomy (17.2%) and Episiotomy Related complication (17.2%) were the main confirmed causes of malpractice for maternal impairment. ConclusionConsidering this fact that medical malpractice was confirmed in a large proportion of some preventable and important complications, therefore, results of this study can be used for developing educational programs for related healthcare providers to prevent those complications.