A scoping review of individual health responsibility: A context-base concept.

BACKGROUND: Individual health responsibility plays an important role in maintaining and improving people's health. There are controversial opinions related to this concept. This study aimed to investigate controversial opinions related to individual health responsibility and familiarize researchers and policy makers with the available evidence and gap of knowledge in the recent years. MATERIAL AND METHOD: This paper is a scoping review. The five-step approach of Arksey and O'Malley was used to review the relevant literature from the beginning of 2017 to the end of 2022. The search was done in the PubMed, Embase, Scopus, web of sciences, Cochrane databases, and Google Scholar search engine using the English keywords "health responsibility" AND "individual" OR "personal". RESULTS: All articles and theses related to individual health responsibility, which were in English and had access to their full text, were included in the study. After a 2-stage screening for 1,412 articles and theses, 32 were included in the study. The findings indicated that most of the studies were conducted in developed European continent. The published articles included a wide range of quantitative, qualitative, and mixed research, and acute and chronic diseases have been considered in this field. CONCLUSION: Individual health responsibility is a multidimensional concept that is influenced by individual, social, and cultural factors, and emphasizing it can have both positive and negative effects on people's health. To the concept be effective in health promotion, it is important to pay attention to individual and social context, health status, and community and health policy makers views about individual health responsibility.

The impact of surge capacity enhancement training for nursing managers on hospital disaster preparedness and response: an action research study.

INTRODUCTION: Hospitals as the main providers of healthcare services play an essential role in the management of disasters and emergencies. Nurses are one of the important and influential elements in increasing the surge capacity of hospitals. Accordingly, the present study aimed to assess the effect of surge capacity enhancement training for nursing managers on hospital disaster preparedness and response. METHODS: All nursing managers employed at Motahari Hospital in Tehran took part in this interventional pre- and post-test action research study. Ultimately, a total of 20 nursing managers were chosen through a census method and underwent training in hospital capacity fluctuations. The Iranian version of the "Hospital Emergency Response Checklist" was used to measure hospital disaster preparedness and response before and after the intervention. RESULTS: The overall hospital disaster preparedness and response score was 184 (medium level) before the intervention and 216 (high level) after the intervention. The intervention was effective in improving the dimensions of hospital disaster preparedness, including "command and control", "triage", "human resources", "communication", "surge capacity", "logistics and supply", "safety and security", and "recovery", but had not much impact on the "continuity of essential services" component. CONCLUSION: The research demonstrated that enhancing the disaster preparedness of hospitals can be achieved by training nursing managers using an action research approach. Encouraging their active participation in identifying deficiencies, problems, and weaknesses related to surge capacity, and promoting the adoption and implementation of suitable strategies, can enhance overall hospital disaster preparedness.

Developing a fall prevention program in an inpatient spinal cord injury rehabilitation unit: A participatory action research study.

IMPORTANCE: Spinal cord injury is a lifelong disability necessitating early management of falls during inpatient admissions. However, there is a paucity of research on fall prevention and management in Spinal cord injury rehabilitation. OBJECTIVE(S): This study aimed at developing a fall prevention program in an inpatient rehabilitation Spinal cord injury unit. METHOD: A participatory action research approach utilizing a before-and-after, mixed-method design was employed for this study. The study was performed at Rofaydeh Rehabilitation Hospital in Tehran, Iran, from 2021 to 2022. the study implemented Cohen's four-stage model, encompassing the design of a change program, action, observation and evaluation, and feedback stages. A purposeful sampling method was utilized to select 19 nurses and members of the rehabilitation team from the hospital, ensuring maximum diversity. Data collection involved semi-structured interviews, focus groups, and a checklist for fall prevention measures. Qualitative content analysis, alongside descriptive (frequency, mean, and standard deviation) and inferential statistics (paired t-tests and Chi-square tests), were employed for data analysis. The study adhered to COREQ guidelines. RESULTS: Falls were most common among patients aged fifty years or older (P = 0.026). Throughout the study period, men were more likely to experience falls than women (P = 0.01). Preventive interventions have led to significant improvements in indicators of patient monitoring and care, patient education, and environmental safety, as demonstrated by a paired-sample t-test (P<0.001). Moreover, factors contributing to patients' falls included "shortcomings in fall prevention policies" and "lack of knowledge and participation among patients and caregivers." Changes implemented in the Spinal Cord Injury unit involved enhancing interprofessional interactions, conducting educational workshops for patients and their companions, and identifying high-risk patients. These findings indicate a significant decrease in the incidence of falls following the intervention (P = 0.02). CONCLUSIONS: The study found that a multifaceted intervention can increase knowledge about fall risks and substantially reduce both falls and associated minor injuries.

The Factor Structure and Generalizability of the Iranian Socioeconomic Status (SES) Questionnaire Administered in a Nationally Divergent Population.

Background: Measuring socioeconomic status (SES) as an independent variable is challenging, especially in epidemiological and social studies. This issue is more critical in large-scale studies on the national level. The present study aimed to extensively evaluate the validity and reliability of the Iranian SES questionnaire. Methods: This psychometric, cross-sectional study was conducted on 3000 households, selected via random cluster sampling from various areas in East Azerbaijan province and Tehran, Iran. Moreover, 250 students from Tabriz University of Medical Sciences were selected as interviewers to collect data from 40 districts in Iran. The construct validity and internal consistency of the SES questionnaire were assessed using exploratory and confirmatory factor analyses and the Cronbach's alpha. Data analysis was performed in SPSS and AMOS. Results: The complete Iranian version of the SES questionnaire consists of 5 factors. The Cronbach's alpha was calculated to be 0.79, 0.94, 0.66, 0.69, and 0.48 for the occupation, self-evaluation of economic capacity, house and furniture, wealth, and health expenditure, respectively. In addition, the confirmatory factor analysis results indicated the data's compatibility with the 5-factor model (comparative fit index = 0.96; goodness of fit index = 0.95; incremental fit index = 0.96; root mean square error of approximation = 0.05). Conclusion: According to the results, the confirmed validity and reliability of the tool indicated that the Iranian version of the SES questionnaire could be utilized with the same structure on an extensive level and could be applicable for measuring the SES in a broader range of populations.

Evaluating the disaster preparedness of emergency medical services (EMS) facilities: a cross-sectional investigation in Iran.

INTRODUCTION: The preparedness of Emergency Medical Services (EMS) plays a crucial role in managing health disaster risks. This study was conducted to assess the disaster preparedness of EMS facilities in Iran, using a nationally reliable tool. METHODS: A cross-sectional study was conducted in May 2021 to evaluate the disaster preparedness of EMS facilities in Iran using a national standard tool. The census sampling approach was utilized to select the samples, and descriptive statistics, as well as analytical statistics like the independent t-test and Pearson's correlation test, were used to analyze the data using SPSS-18 software. RESULTS: The findings of this study revealed that the majority of EMS facilities in Iran possess a moderate level of preparedness in dealing with disasters. Also, the results indicate that EMS facilities have an average level of preparedness against disasters in all dimensions except for "coordination and cooperation" and "surge capacity". CONCLUSION: According to this study, the majority of EMS facilities in Iran are exposed to different disasters. Furthermore, the findings indicate that while EMS facilities are generally prepared to respond to disasters at an average level, there are some important preparedness gaps in dimensions like response capacities, coordination, and cooperation. Thus, specific strategies, standards, and procedures must be developed and disseminated by the National Medical Emergency Organization.

Psychometric properties of the persian version of the nursing clinical reasoning scale.

AIM: The aim of this study was to translate the Nursing Clinical Reasoning Scale (NCRS) into Persian and evaluate its psychometric properties. DESIGN: This study was a methodological and cross-sectional study. METHODS: This methodological study was conducted in 2020 in a teaching hospital. After obtaining necessary permission from its developers, NCRS was translated into Persian through the method proposed by the World Health Organization. Then, its face, content, and construct validity and reliability were assessed. For construct validity assessment through exploratory and confirmatory factor analyses, 300 nurses (two 150-nurse samples), who had randomly been selected, completed the instrument. Reliability also assessed through the internal consistency and the stability methods. Data were analysed using the SPSS (v. 20.0) and the AMOS (v. 5.0) software. RESULTS: The content validity indices of NCRS and its items were 0.97 and more than 0.79, respectively. Exploratory factor analysis revealed an assessment and confirmation factor and an implementation and reflection factor for the scale which together explained 57.30% of the total variance. Confirmatory factor analysis also confirmed this two-factor structure (χ2 /df = 2.11, NNFI = 0.952, RMSEA = 0.053, CFI = 0.91, GFI = 0.94, IFI = 0.95, and NFI = 0.96). The Cronbach's alpha and the intraclass correlation coefficient values of the scale were 0.96 and 0.94, respectively. PUBLIC CONTRIBUTION: The Persian NCRS can help nursing policy makers and mentors identify the need for developing nurses' and nursing students' CR skills and implement need-based educational courses to improve these skills. Moreover, it helps determine whether the educational programmes are effective in improving nurses' CR skills and clinical competence.

Validation and psychometric properties of the Persian version of the MISSCARE survey.

AIM: To conduct, translate, and psychometric evaluation of the MISSCARE-Persian Survey. DESIGN: A cross-sectional study was conducted in Iran in February-June 2021. METHODS: The translation of the MISSCARE Survey was accomplished according to World Health Organization (WHO) guidelines. Construct validity was performed by (N = 300) exploratory factor analysis and confirmation. To assess the reliability, internal consistency was assessed using Cronbach's alpha coefficient, and relative stability was assessed using the interclass correlation coefficient (ICC). The study adhered to COSMIN guidelines. RESULTS: The exploratory factor analysis, which resulted in the identification of three factors in the second part of the tool, explained 79.6% of the total variance. Confirmatory factor analysis indicated the model's good fit of information. The reliability of the first and second parts of the tool was 0.912 and 0.901, respectively. Additionally, the ICC was found to be 0.687 for the first and 0.706 for the second part of the tool.

Factors Affecting Patient Safety in Inpatient Rehabilitation Hospital: A Multidisciplinary Perspective.

Patient safety (PS) is of special importance in Inpatient Rehabilitation Hospital (IRH). Few studies have assessed the factors affecting PS in IRH. Therefore, this study aimed to explore the factors affecting PS based on the experiences of the rehabilitation team in an IRH. This qualitative study was conducted using the conventional content analysis approach in 2020-2021. The participants were 16 members of the rehabilitation team. They were purposively selected from Rofaydeh rehabilitation hospital, Tehran, Iran. Data collection was performed through semi-structured interviews and was continued up to data saturation. The mean age of the participants was 37.31 ± 8.68 years and their mean work experience was 8.75 years. The factors affecting PS in IRH were classified into five main categories, namely shortage of organizational resources, inappropriate physical environment of the IRH, inappropriate PS culture, patients' and their caregivers' limited participation in safety programs, and poor fall prevention programs. The results of this study revealed the factors affecting PS in IRH. Accurate identification of the influential factors on PS can help healthcare providers, managers, and policymakers use multi-component interventions to improve PS culture and increase PS in IRHs. Action research studies are also recommended to determine the main components of such interventions.

How do cancer patients refuse treatment? A grounded theory study.

BACKGROUND: All cancer patients, except for a small fraction, seek treatment after becoming aware of the disease. That small fraction do not seek any treatment due to various reasons, and this phenomenon is unknown to us. Therefore, the present study aimed to discover the reasons for treatment refusal in cancer patients. METHODS: This qualitative grounded theory study was conducted on 22 participants including patients, caregivers, physicians, and nurses. Purposive theoretical sampling was employed. Data were collected through in-depth interviews. All interviews were gradually transcribed and analyzed. Data analysis was carried out through the three-step method of open, axial, and selective coding and was continued until theoretical saturation. Straussian Grounded Theory was used for data analysis. RESULTS: A total of 4 themes and 20 sub-themes were extracted in this study. The core variable extracted from the interviews was "resilience" Other related themes included encounter with cancer, fighting cancer, and coping with cancer. The findings showed that in the context of fighting cancer, patients lost their resilience through various processes and refused treatment. CONCLUSION: Cancer patients abandon the treatment in silence, oncologists and even family members being unaware of the matter. In other words, refusal of treatment is like an iceberg and the majority of the patients who have abandoned treatment are unknown to the health system. The model obtained in this study can increase the knowledge of the process that leads patients to lose their resilience against cancer and abandon treatment, which can increase the possibility of recognizing and predicting treatment refusal for oncologists.

Instability of emotional relationships and suicide among youth: a qualitative study.

BACKGROUND: Interpersonal problems are one of the factors for understanding the complex issues that result in suicide attempts and self-injury by poisoning. The quality of familial relationships is a predictor of the occurrence and outcome of suicide attempts. This study aimed to explore motives for self-poisoning suicide attempts amongst young adults. METHOD: This research was a qualitative study conducted using semi-structured interviews in 2019 in Kermanshah Province, Iran. Eighteen participants who had attempted suicide by self-poisoning were interviewed, and information was collected until data saturation was achieved. The interviews were recorded and transcribed, and the data were analyzed through content analysis. RESULTS: The results included the category of instability in emotional relationships with the three sub-categories of 1- Emotional failure, 2- Emotional trauma, and 3- Loss of emotional resilience (caused by emotional failure and emotional trauma within the previous few months). Instability in emotional relationships creates feelings of disgrace, humiliation, burdensomeness, worthlessness, and insignificance, which increases the chances of attempting suicide. CONCLUSION: The study results provided an in-depth understanding of romantic, and unstable familial relationships as a significant factor in suicide attempts, demonstrating the role of emotional stress in attempting suicide. The present study provided information on the risk factors and warning signs for psychiatrists and nurses dealing with suicidal patients to take effective measures to prevent suicide through social support.

Disaster planning approaches in Iran's health system: A mixed-methods study.

BACKGROUND: Disaster planning and management pose a serious challenge to most countries. These challenges point to insufficient planning to deal with these events. Therefore, it is necessary to pay attention to the methods and characteristics of the decision-making approaches in these events. In this study, we tried to identify most appropriate approaches for the Iranian health system by studying disaster planning approaches. MATERIALS AND METHODS: This study was conducted using mixed methods in 2020-2021 in two phases: qualitative and quantitative. First, we reviewed at the research literature. Our goal was to identify studies that suggested approaches to disaster planning. The next step in this study was a qualitative study using semi-structured interviews. Participants in qualitative phase included managers and employees from different parts of the Iranian health system from the provinces of Golestan, Fars, Khuzestan, Lorestan, Kerman, Sistan, and Baluchestan. RESULTS: By combining approaches taken from literature reviews and qualitative study, four main approaches were identified. The results of our study have shown that disaster response planning approaches include function, risk assessment, capability, and futuristic base. CONCLUSION: This study provides complete overview of disaster planning approaches that enable health professionals to use them to develop response plans. Our findings indicate that in complex and large-scale events such as floods and pandemics, it is necessary to combine the introduced methods for operational planning.

Hospital disaster risk management improving strategies: A systematic review study.

OBJECTIVE: Hospitals are the basic infrastructure for disaster response. While they themselves are exposed to disasters, they also play an important role during the disaster response period. Therefore, they are expected to be able to maintain their performance during and immediately after disasters. The aim of this study is to discover strategies to improve the hospital disaster risk management. DESIGN: This study is a systematic qualitative study with thematic analysis. Data sources including Persian and international databases were searched using the "Hospital, Disaster, Risk management, Risk reduction, Improvement, and Strategy" keywords and their combinations of them. The search time period ranged from January 2010 to January 2020. Data were extracted by two independent arbitrators for qualitative thematic analysis. RESULTS: In total, 889 articles and documents were retrieved. Of which, 166 articles were deleted due to duplication, 436 articles did not meet the objectives of the research, and 263 articles did not meet the eligibility criteria and were deleted. Finally, 24 articles were included in the study. After thematic analysis, 33 subthemes were obtained and classified into five themes of organizational-managerial strategies, preventive and risk reduction strategies, preparedness strategies, response strategies, and recovery strategies. Not all articles discuss all categories. CONCLUSION: Applying strategies to improve the hospital disaster risk management resulting from this study can be useful in improving the preparedness of hospitals in the face of disasters.

Disaster risk management challenges in military hospitals: A qualitative study.

BACKGROUND: Disaster can pose significant challenges to the health infrastructure in the community. Hospitals are the central unit for providing health services in the disaster response plan. With regard to the vital role of military hospitals in health response to disaster, this study was carried out with the aim of investigating the disaster risk management (DRM) challenges in military hospitals in Iran. MATERIALS AND METHODS: The current study was qualitative research performed in 2020 in military hospitals in Iran. Participants consisted of 12 managers and staff of the military hospitals in Tehran and professionals in health in emergencies and disasters who were included in the study by the purposive sampling technique. Semistructured individual interviews based on the interview guide were exploited for the data collection, and a content analysis method was used to analyze them. RESULTS: DRM challenges in military hospitals were explained in the form of six categories: "management and leadership, planning, prevention and mitigation, preparedness, response, and recovery" and 22 subcategories. CONCLUSION: Managers' awareness of DRM challenges in hospitals, particularly military hospitals, and the design and implementation of solutions can lead to the promotion of hospital DRM and hospital preparedness to deal with disasters.

Accuracy of Triage Systems in Disasters and Mass Casualty Incidents; a Systematic Review.

Introduction: To prioritize patients to provide them with proper services and also manage the scarce resources in emergencies, the use of triage systems seems to be essential. The aim of this study was to evaluate the accuracy of the existing triage systems in disasters and mass casualty incidents. Methods: The present study is a systematic review of the accuracy of all triage systems worldwide. The results of this study were based on the articles published in English language journals. In this research, all papers published from the beginning of 2000 to the end of 2021 were sought through different databases. Finally, a total of 13 articles was ultimately selected from 89 articles. Results: 13 studies on the accuracy of triage systems were reviewed. The START, mSTART, SALT, Smart, Care Flight, ASAV, MPTT, Sieve and ESI triage systems, had an accuracy, sensitivity, and specificity of less than 90%. Only the Smart triage system had an overall accuracy of more than 90%. Conclusion: According to the findings of the current systematic review, the performance of the existing triage systems in terms of accuracy of prioritizing the injured people and other performance indexes is not desirable. Therefore, to improve the performance and increase the precision of triage systems, the world nations are recommended to change or revise the indexes used in triage models and also identify other influential factors affecting the accuracy of triage systems.

A comprehensive review of the articles published in the field of health in emergencies and disasters in Iran.

Introduction: Iran is one of the most disaster-prone countries in the world. A research-based approach is essential to reduce the effects of disasters and provide effective responses. This study aims to review the articles published in the field of emergencies and disasters in Iran. Methods: a combination of descriptive and qualitative content analysis using Hsieh and Shannon´s method was done. Since the first and most well-known specialized journal in the field of emergencies and disasters in Iran is the Health in emergencies and Disasters Quarterly (HDQ), all articles published in this journal were examined in terms of theme and scientometric indicators. Results: regarding the type of research, 103 were quantitative (66.5%), 18 were qualitative (11.6%), and 4 (2.6%) were performed by mixed method. Most of the articles (n=116, 76.3%) were original research. The most frequently studied risk was traffic accidents (n=17, 10.96%) followed by earthquakes (n=10, 6.45%) and floods (n=8, 5.16%). In terms of theme and content, 103 published articles were related to one of the 4 main phases of the disaster risk management cycle where most of them were related to preparedness (n=48, 46.6%) followed by mitigation (n=26, 25.24%), response (n=20, 19.42%), and recovery (n=9, 8.47%) phases. Conclusion: although there are studies related to the four phases of disaster risk management cycle in Iran, most of them are related to assessing preparedness followed by mitigation. In addition, qualitative and mixed studies could have more significant contribution to this field of research, accelerating this process requires the development of disaster research methodology training and researcher training programs as well as their organized and financial support.

Challenges of Hospital Disaster Risk Management: A Systematic Review Study.

OBJECTIVE: This study aimed to investigate the challenges of hospital disaster risk management so that it can take a step to provide strategies and interventions to remove these barriers and improve the hospital disaster risk management (HDRM) through identifying and introducing them to disaster experts. METHODS: This is a systematic qualitative review study. Data sources included Persian and international databases, which were searched using the keywords of hospital, disaster, risk management, risk reduction, disaster and challenge, and the combination of them. The search period ranged from January 2010 to January 2020. Data were extracted by 2 independent examiners for qualitative thematic analysis. RESULTS: A total of 762 articles and documents were recovered. Finally, 12 articles entered the study, including 7 studies from Asia, 2 articles from Europe, 2 articles from the United States, and 1 article about Africa. After thematic analysis, 17 sub-themes were achieved and were classified into 4 subjects of technical-physical barriers, organizational-managerial barriers, financial barriers, and human barriers. All articles have not discussed on all categories. CONCLUSIONS: The results of evaluating the challenges of hospital disaster risk management gained from this study can be beneficial in developing a roadmap to improve the status of HDRM.

The Evolution of Disaster Risk Management: Historical Approach.

The concept of Disaster Risk Management (DRM) has changed throughout history. Identifying changes and related factors can be effective in adopting logical, scientific and evidence-based approaches in the future. Therefore, this study was conducted with the aim of depicting the process of changes in the concept of DRM and creating an original perspective. In this narrative literature review study, we used historical approach. Literature, regardless of the time of publication, was searched using divergent keywords including "disaster, health, emergency, management, risk, disaster medicine, and hazard." DRM evolution started with the emergence of civil defense during the last century. Although DRM was initially focused on responses, currently, this concept includes disaster risk reduction (DRR) and disaster management. DRR includes prevention and mitigation, and disaster management includes response and recovery measures. DRR considering underlying risk factors such as social factors, and focusing on participation of communities are important steps to be taken.

Psychological Distress Model Among Iranian Pre-Hospital Personnel in Disasters: A Grounded Theory Study.

Objective: Pre-hospital personnels (PHPs) who work in disasters under extreme pressure, uncertainty, and complex situations are victims of disasters themselves, and there is a link between experiencing such incidents and mental health problems. Because most studies focus on the injured and less on the psychological issues of PHPs, the present study aimed to develop a model to provide relief for PHPs in disasters from a psychological perspective. Methods: A grounded theory methodology recommended by Corbin and Strauss (2015) was employed. PHPs (n = 24) participated in a semi-structured interview between July 2018 to May 2020. Results: In the analysis of the pre-hospital staff interviews, three main themes were extracted, namely, providing relief with struggle (complexity of incident scenes, command-organizational and occupational challenges), psychological distress (psychological regression and psychological empowerment), and consequences (resilience and job burnout). Seven categories and 22 subcategories were explored from our data via the grounded theory approach Conclusions: The PHPs managed psychological distress with two approaches: psychological self-empowerment and regression, which resulted in resilience and burnout, respectively. Due to the lack of enough support, the resilience of the PHPs was short-term, turned into burnout over time, and affected the structural factors again as a cycle.

The Barriers, Challenges, and Strategies of COVID-19 (SARS-CoV-2) Vaccine Acceptance: A Concurrent Mixed-Method Study in Tehran City, Iran.

Acceptance and willingness to receive the vaccine are among the main factors in the success or failure of a health system in implementing the vaccination program. The present study was conducted in Tehran, the political and economic capital of Iran, to determine the acceptance of the COVID-19 vaccine and identify its associated factors, and explain the most important barriers and acceptance strategies for vaccination. This research was a concurrent quantitative and qualitative mixed-method study. In the quantitative part, 1200 individuals aged more than 18 years were selected from the households in 22 districts of Tehran City, with a multistage stratified cluster sampling method. Two questionnaires were used to evaluate the acceptance of the COVID-19 vaccine and vaccine acceptance determinants. The qualitative content analysis method addressed the influencing factors, as well as challenges and strategies related to the acceptance of the COVID-19 vaccine in four groups of Tehran inhabitants: the elderly, people with underlying diseases, healthcare workers, and the general population. The related data were simultaneously collected by applying in-depth semi-structural interviews and a data analysis process. Furthermore, we used the Graneheim and Lundman method for data analysis. We analyzed the data of 1200 people with a mean (SD) age of 46.4 (11.1) years, and approximately 58% of them were men. The vaccine acceptance was 83.6% (95% CI: 81.3-85.9). Among those who welcomed vaccination, 58% preferred the imported vaccines, 25% the Iranian ones, and 17% both. There was a significant association between the variables of age (adjusted odds ratio [AOR] = 1.72, 95% CI: 1.01-2.93), being single (AOR = 0.54, 95% CI: 0.41-0.91), moderate pharmacotherapy adherence (AOR = 0.58, 95% CI: 0.4-0.85), and the willingness to receive COVID-19 vaccine. Qualitative study after interviewing 45 people from four study groups showed an insufficient social trust in healthcare system officials, pharmaceutical and vaccine production companies; distrust in the effectiveness of the vaccines, concerns about the vaccine adverse effects, being tracked by microchips after vaccination, traditional anti-vaccination movements, the feeling the inessentiality of vaccination, and uncertainty about the fair distribution of the vaccine. These concerns were the main challenges addressed by the study groups. A good proportion of Tehran residents reported their willingness to receive the COVID-19 vaccine. Additionally, they expressed their critical concerns, such as insufficient trust in the healthcare system, vaccine safeties, and adverse effects that were the significant barriers to vaccine acceptance. It seems that conflicts raised by the shortage of vaccines and their import due to the sanctions have led to intense desire and demand in the general population, and especially the elderly, for vaccination. Besides, vaccination phobia in some individuals requires further investigations.

Disaster preparedness in emergency medical service agencies: A systematic review.

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.