Systematic scoping review protocol of Stroke Patient and Stakeholder Engagement (SPSE).

This protocol describes a systematic scoping review of Stroke Patient and Stakeholder Engagement (SPSE), concepts, definitions, models, implementation strategies, indicators, or frameworks. The active engagement of patients and other stakeholders is increasingly acknowledged as essential to patient-centered research to answer questions of importance to patients and their caregivers. Stroke is a debilitating, long-lasting burden for individuals, their families, and healthcare professionals. They require rehabilitation services, health care system assistance, and social support. Their difficulties are unique and require the continued involvement of all parties involved. Understanding SPSE in research is fundamental to healthcare planning and extends the role of patients and stakeholders beyond that of the study subject. We will conduct a systematic literature search to identify the types of existing evidence related to SPSE, implementation strategies, indicators, or frameworks related to Patient and Stakeholder Engagement (PSE); clarify key concepts, definitions, and components of SPSE; compile experiences and prerequisites; and identify stroke research internationally. Two independent reviewers will extract data from selected studies onto a customized extraction form that has already been piloted. We integrate existing knowledge to address gaps in the literature on SPSE research by presenting the model, implementation strategies, indicators, and frameworks for stroke patients. We hope that these findings will offer future researchers a clear picture and conceptual model of SPSE.

Improving naturalistic neuroscience with patient engagement strategies.

Introduction: The clinical implementation of chronic electrophysiology-driven adaptive deep brain stimulation (DBS) algorithms in movement disorders requires reliable representation of motor and non-motor symptoms in electrophysiological biomarkers, throughout normal life (naturalistic). To achieve this, there is the need for high-resolution and -quality chronic objective and subjective symptom monitoring in parallel to biomarker recordings. To realize these recordings, an active participation and engagement of the investigated patients is necessary. To date, there has been little research into patient engagement strategies for DBS patients or chronic electrophysiological recordings. Concepts and results: We here present our concept and the first results of a patient engagement strategy for a chronic DBS study. After discussing the current state of literature, we present objectives, methodology and consequences of the patient engagement regarding study design, data acquisition, and study infrastructure. Nine patients with Parkinson's disease and their caregivers participated in the meeting, and their input led to changes to our study design. Especially, the patient input helped us designing study-set-up meetings and support structures. Conclusion: We believe that patient engagement increases compliance and study motivation through scientific empowerment of patients. While considering patient opinion on sensors or questionnaire questions may lead to more precise and reliable data acquisition, there was also a high demand for study support and engagement structures. Hence, we recommend the implementation of patient engagement in planning of chronic studies with complex designs, long recording durations or high demand for individual active study participation.

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.

Worldwide disaster loss and damage databases: A systematic review.

Nowadays, disaster databases have become a valuable tool for disaster risk management and health promotion and serve various purposes. The purpose of this study is to provide a systematic review of disaster databases in the world and to identify the objectives, information sources, criteria, and variables of disaster data registration in the world's reputable databases. To conduct review, all English-language articles published without a time limit until the end of September 2020 were extracted from the databases of Web of Science, PubMed, Scopus, Cochrane Library, Science Direct, Google Scholar, and Embase. Necessary information in the papers including study time, type of disasters, related databases, dimensions and indicators of global and regional databases were extracted by using a researcher-made questionnaire. A total of 22 studies have been reviewed to identify the dimensions and indicators of disaster databases worldwide. The main focus was on global and regional databases, mostly used at the level of scientific societies and disaster experts. After explanation, researchers highlighted each of the disaster databases, along with the main differences available among the existing databases. Some databases have well-defined data collection methods. Their knowledge is high quality and they can be used to create and improve a disaster database at other levels. Disaster database limitations include risk bias, time bias, accounting bias, threshold bias, and geographical bias. To support the right decisions to reduce disaster risk, it is necessary to complement existing global, regional, and national databases. Countries need to take action to set up national databases.

Challenges to manage pandemic of coronavirus disease (COVID-19) in Iran with a special situation: a qualitative multi-method study.

BACKGROUND: With the unprecedented expansion of COVID-19 in the world since December 2019, Iran's health system, like other countries, faced various challenges in managing the disease, which led to numerous experiences and lessons learned. This study was conducted to identify these challenges regarding unique political, economic, and cultural issues, which could help other countries with similar situations. METHODS: The present study was performed using a qualitative multi-method approach with a content analysis method. The data were collected through in-depth and semi-structured interviews and focused group discussions with 60 key persons who were selected purposefully, including policymakers, health care workers, and affected people by the disease, and the review of all available national reports between February 21, 2020, and March 22, 2021. The data collection and analysis were done simultaneously. RESULTS: Identified critical challenges for the management of COVID-19 in the health system were limited evidence and scientific controversies, poor social prevention and social inequalities, burnout and sustained workload among healthcare workers, improper management of resources and equipment, the lack of a guideline for contact tracing, and patient flow management, and mental health problems in the community. CONCLUSIONS: According to our results, measures should be taken to conduct a continuous comprehensive risk assessment and develop a national response plan with an emphasis on precise contact tracing, active screening, patient flow, paying attention to the psychological and social dimensions of the disease, and also transparency of social inequalities in the face of risk factors of the COVID-19. Also, the social protection programs should become a vital tool for policymakers and supporting the vulnerable groups using the capacity of the community and international cooperation to develop a vaccine, which is difficult to procure due to the sanctions.

Criteria and components of the emergency and disaster database in Iran: A content analysis study.

BACKGROUND: Nowadays, emergencies and disasters are considered one of the biggest problems in human life. To reduce the risk of emergencies and disasters, governments must develop strategies and policies using evidence-based methods. Disaster databases are the main source and tool for storing and managing a wide range of data in this field. This study was conducted with the aim of exploring the necessary criteria and components of the emergency and disasters database in Iran. MARTIALS AND METHODS: This qualitative study was performed using content analysis in which 18 managers and experts with experience in registering, documenting, or responding to emergencies and disasters were selected through purposive sampling. Data collection was done using semi-structured interviews that continued until saturation. Data were analyzed by means of qualitative content analysis recommended by Landman and Graneheim. RESULTS: In total, three main concepts concerning the necessary criteria and components of the database of natural and artificial emergencies and disasters in Iran were explored. The main concepts include information resources, information evaluation, and information management. Subconcepts include data collection, information transfer, access to information, information validation, disaster leveling, information registering, information storage and retrieval, information analysis, and information dissemination. CONCLUSION: The experience of the participants showed that there are many challenges in the field of monitoring and gathering information about injuries and damages caused by emergencies and disasters in the country. The knowledge obtained from this study can be used to create and develop a database of emergencies and disasters in Iran. It will also provide insights for healthcare policymakers and managers in future planning areas to more effectively address identified challenges in preventing and responding to disasters at both regional and national levels.

Epidemiology and factors associated with COVID-19 outbreak-related deaths in patients admitted to medical centers of Mazandaran University of Medical Sciences.

BACKGROUND: The first case of COVID-19 was reported in Iran on February 19, 2020, in Qom. Since Mazandaran is one of the high-risk provinces with many patients and deaths, this study was conducted to investigate the epidemiological characteristics of COVID-19-related deaths in Mazandaran. MATERIALS AND METHODS: In this descriptive study, demographic information and clinical findings in patients who died following COVID-19 in the medical centers of Mazandaran University of Medical Sciences from February 8, 2020, to October 10, 2020, were extracted. Data were analyzed by using SPSS 21. Logistic regression was used to compare the data. P < 0.05 was considered as the significance level. RESULTS: Out of a total of 34,039 patients admitted during the 8 months, 2907 patients died. Of these, 1529 (52%) were male, and the rest were female. In terms of age, 10 cases in the age group of fewer than 15 years, 229 cases in the age group of 15-44 years, 864 patients in the age group of 45-64 years, and 1793 people in the age group of 65 years and over died. 2206 people (more than 75%) by personal visit referred to medical centers. The mortality rate was more than 8 cases per 100 hospitalized patients. Men were 16% more likely to die from COVID-19 than women. DISCUSSION AND CONCLUSION: Older adults over 65 have the highest incidence and death rate due to this disease. The incidence rate was higher in women, and the death rate was higher in men, which differs from the national pattern.

Disaster mental health preparedness in the community: A systematic review study.

The objective of this study was to perform a systematic review of articles that cover aspects of disaster mental health preparedness. This assessment was done by a thorough review and summary of the available studies which provided a considerable background and amplified the gaps in knowledge about community mental health preparedness. By this systematic review, we tried to identify available concept of community mental health preparedness and related tools that communities and individuals will need to prepare for natural disasters. We found there is a lack of mental health preparedness in the majority of countries; valid and reliable tools and context-bound programs should be developed based on the experiences and perceptions of the community.