Employing diffusion of innovation theory for 'not missing the mass' in community-engaged research.

INTRODUCTION: Engaging with minority communities, such as immigrants and ethnic minorities, often involves adopting top-down approaches, wherein researchers and policymakers provide solutions based on their perspective. However, these approaches may not adequately address the needs and preferences of the community members, who have valuable insights and experiences to share. Therefore, community-engaged approaches, which involve collaborative partnerships between community members and researchers to identify issues, co-create solutions, and recommend policy changes, are becoming more recognized for their effectiveness and relevance. Yet, prevailing community engagement efforts often focus on easily reachable and already engaged segments of the community, sometimes overlooking the broader population. METHODS: When working with immigrant and racialized communities, we encountered difficulties in engaging the wider community through traditional researcher-led approaches. We realized that overcoming these challenges required innovative strategies rooted in community-based participatory research principles and the diffusion of innovation theory. We recognized that a nuanced understanding of the community's dynamics and preferences was crucial in shaping our approach and building trust and rapport with the community members. RESULTS: The need to bridge the gap between researcher-led initiatives and community-driven involvement has never been more pronounced. Our experience, chronicled in this article, highlights the journey of our research program with an immigrant/racialized community. This reflection enhances our comprehension of community engagement that deliberately strives to reach a larger cross-section of the community. By providing practical methods for reaching the broader community and navigating the intricacies of engagement, we aim to assist fellow researchers in conducting effective community-engaged research across various minority communities. CONCLUSION: In sharing our insights and successful strategies for community engagement, we hope to contribute to the field's knowledge. Our commitment to fostering meaningful collaboration underscores the importance of co-creating solutions that resonate with the diverse voices within these communities. Through these efforts, we envision a more inclusive and impactful approach to addressing the complex challenges faced by minority populations.

Knowledge translation in health and wellness research focusing on immigrants in Canada.

INTRODUCTION Knowledge translation (KT) is a relatively new concept referring to transfers of knowledge into practice in collaboration with multiple sectors that work for the health and wellness of society. Knowledge translation is crucial to identifying and addressing the health needs of immigrants. AIM To scope the evidence on KT research engaging immigrants in the host country regarding the health and wellness of immigrants. METHODS This study followed a scoping review approach suggested by Arksey O'Malley. We identified relevant studies from both academic and grey literature using structured criteria, charted the data from the selected studies, collated, summarised and report the results. RESULTS Analysis of the eligible studies found two types of KT research: integrated KT and end-of-grant KT. Meeting or discussion with community-level knowledge-users were common KT activities among immigrants, but they were involved in the entire research process only if they were hired as members of research teams. Most KT research among immigrants explored cancer screening and used a community-based participatory action research approach. Barriers and enablers usually came from researchers rather than from the community. There was little practice of evaluation and defined frameworks to conduct KT research among immigrants in Canada. CONCLUSION This study can help the researchers and other stakeholders of health and wellness of the immigrant population to identify appropriate KT research activities for immigrants and where KT research is required to facilitate the transfer of research knowledge into action.

Professional integration of immigrant medical professionals through alternative career pathways: an Internet scan to synthesize the current landscape.

BACKGROUND: There is a growing recognition that underutilization and underemployment of skilled immigrants, especially internationally trained health professionals, creates a financial burden on individuals and economic losses for the host country. Albeit a missed opportunity for both the immigrants and the receiving country, no public policy and systemic measures are in place to address this issue. Nevertheless, certain individuals and organizations have made some isolated efforts, but no synthesized knowledge is available for understanding what initiatives exist altogether and how they function. We have conducted a methodological Internet scan to identify the existing individual, private, and systemic initiatives and resources that support these health professionals. This will provide health and workforce policymakers, settlement service providers, and relevant academics with the knowledge base for potential different strategies to address this issue and guide them towards developing solution-oriented initiatives. METHODS: To identify those we have systematically searched the three most popular search engines (Google, Bing, and Yahoo!) adapting the Canadian Institute for Health Information's grey literature review protocol. We identified relevant websites per our predefined inclusion criteria, charted the data from those sources, collated, summarized, and reported the results. RESULTS: From 280 webpages initially identified through keyword search, we included 26 in our full-page screen and extracted data from 16 finally selected webpages. We have found webpages with information on different alternative careers namely, regulated and non-regulated, available resources to pursue those careers, and what skills they have that can be transferred to the alternative careers. CONCLUSION: More systemic policies and IMG specific and ACP-focused employment support programmes are required. Research and development of programmes for facilitating IMGs' alternative career support need to be increased and strengthened.

Remdesivir Efficacy in Coronavirus Disease 2019 (COVID-19): A Systematic Review

BackgroundResearchers are working hard to find an effective treatment for the new coronavirus 2019. We performed a comprehensive systematic review to investigate the latest clinical evidence on the treatment efficacy and safety of Remdesivir in hospitalized patients with COVID-19. MethodsWe performed a systematic search of the Pubmed, Embase, Web of Science, Google scholar, and MedRxiv for relevant observational and interventional studies. Measured outcomes were mortality rates, improvement rates, time to clinical improvement, all adverse event rates and severe adverse event rates. Results3 RCTs and 2 cohorts were included in our study. In 2 cohort studies, patients received Remdesivir for 10 days. 2 RCTs evaluated 10-day treatment of Remdesivir efficacy versus placebo group and the other RCT compared its 5-day regimen versus 10-day regimen. Visual inspection of the forest plots revealed that Remdesivir efficacy was not much different in reducing 28-day mortality versus 14-day mortality rates. Besides, 10-day treatment regimen overpowers 5-day treatment and placebo in decreasing time to clinical improvement. All adverse event rates did not have significant difference; however, severe adverse event rate was lower in 5-day Remdesivir group compared to 10-day and placebo groups. Conclusion5-day course of Remdesivir therapy in COVID-19 patients is probably efficacious and safe and patients without invasive mechanical ventilation benefit the most. Treatment can be extended to 10 days if satisfactory improvement is not seen by day 5. Most benefits from Remdesivir therapy take place in the first 14 days of the start of the treatment.

Heavy metal concentration in classroom dust samples and its relationship with childhood asthma: a study from Islamic Republic of Iran

Background: Classrooms are an important environment for young children as this is where they spend a large part of their time. Aims: This study was designed to quantify the levels of heavy metals in classroom dusts in Shiraz, a city southwestern Iran. The potential association between heavy metal levels and childhood asthma was also investigated.Methods: We selected 32 schools for collecting classroom dust samples during September–November 2016. The con-centration of 10 heavy metals was measured in these dust samples by optical emission spectrometry. The diagnosis of childhood asthma was made using both the medical chart of each student and examination by an allergist. The data were analysed using SPSS, version 21.0.Results: The concentration of heavy metals in classroom dust samples ranged from 7559 to 53 723.0 mg/kg (mean: 16 945.5 mg/kg) for Fe, 169.0 to 952.0 mg/kg (mean 288.9 mg/kg) for Mn, and 9.0 to 971.0 mg/kg (mean 258.8 mg/kg) for Pb. We found no correlation between heavy metals in classroom dust and childhood asthma.Conclusion: In comparison with studies reported elsewhere, the maximum levels of lead in our study were greater. A potential explanation for the lack of correlation with childhood asthma is the large mass of the particles, preventing them from reaching the lower airways. Nevertheless, special attention should be paid to reducing high levels of heavy metals in classroom dust in this area.

Contexte : Les salles de classe constituent un environnement important pour les jeunes enfants, étant donné qu’ils passent une grande partie de leur temps dans ce lieu. Objectifs : La présente étude a été réalisée pour quantifier les niveaux de métaux lourds présents dans les poussières de salle de classe à Shiraz, ville du sud-ouest de la République islamique d’Iran. Le lien potentiel entre les concentrations de métaux lourds et l’asthme infantile a également été examiné. Méthodes : Nous avons sélectionné 32 écoles pour y prélever des échantillons de poussière dans les classes entre septembre et novembre 2016. La concentration en dix métaux lourds dans ces échantillons a été mesurée par spectrométrie d’émission optique. Le diagnostic d’asthme infantile a été posé à la fois sur la base du dossier médical de chaque élève et d’un examen réalisé par un allergologue. Les données ont été analysées à l’aide du logiciel SPSS, version 21.0. Résultats : La concentration en métaux lourds dans les échantillons de poussière des salles de classe variait de 7 559 à 53 723,0 mg/kg (moyenne : 16 945,5 mg/kg) pour Fe, de 169,0 à 952,0 mg/kg (moyenne : 288,9 mg/kg) pour Mn et de 9,0 à 971,0 mg/kg (moyenne : 258,8 mg/kg) pour Pb. Nous n’avons établi aucune corrélation entre les métaux lourds présents dans la poussière des salles de classe et l’asthme infantile. Conclusion : Comparativement aux études menées ailleurs, les niveaux maximaux de plomb étaient supérieurs dans notre étude. L’absence de corrélation avec l’asthme infantile pourrait s’expliquer par la masse élevée des particules, qui pourrait les empêcher d’atteindre les voies respiratoires basses. Néanmoins, une attention particulière doit être portée à la réduction des hauts niveaux de métaux lourds présents dans les salles de classe de cette région.

Anxiety levels among Iranian health care workers during the COVID-19 surge: A cross-sectional study

The recent surge in COVID-19 cases has exposed health care workers (HCWs) to a wide range of psychological stressors and predisposed them to anxiety-related disorders. Here, we investigated the anxiety level in this population. This multi-center, cross-sectional study was performed on 1038 HCWs in 14 hospitals during the COVID-19 pandemic. Beck anxiety inventory (BAI) was used to measure the level of anxiety in this population. In all, 1038 hospital staffs with a mean age of 36.30{+/-}8.23 years old participated in this study. Most participants were 31 to 40 years old (43.2), female (87.6%), and nurses (49.5%). The BAI scores for the participants were in a positive skew distribution, with a score range of 0-63, a median of 12 and a mean value of 15.30{+/-}11.43. Of the 1038 hospital staff, 411 (39.6%) had moderate to severe anxiety. The anxiety level was significantly higher in health care workers [≤]40 years old, women, and nurses. Gender, age, and working positions had the most relation with anxiety, respectively. It seems that HCWs experienced a high level of anxiety in the COVID-19 outbreak. One of the important measures in each epidemic is doing supportive care to maintain the mental well-being of HCWs, especially in higher risk groups, including younger HCWs, women, and nurses.

Knowledge mobilisation in bridging community-practice-academia-policy through meaningful engagement: systematic integrative review protocol focusing on studies conducted on health and wellness among immigrant communities.

INTRODUCTION: Though the importance of knowledge mobilisation has been established globally in health and wellness research, a certain degree of ambiguity remains regarding the meaning and extent of knowledge mobilisation activities and how they have been implemented. In this study, we aim to explore the different descriptions of knowledge mobilisation and the diverse ways mobilisation activities have been realised by different researchers working for the betterment of health and wellness of immigrant communities in their host countries. METHODS AND ANALYSIS: We aimed to conduct an integrative review to organise the available literature describing knowledge mobilisation pertaining to health and wellness in immigrant communities. We will employ a comprehensive search, using appropriate search-terms, to identify relevant literature and will qualitatively synthesise the information toward fulfilling our objectives. Specific methodological and analytical frameworks related to the integrative review process will guide each step of the process. A librarian designed the systematic search of the academic and grey literature from database inception to December 2019. The databases include MEDLINE (Ovid), Embase, PsycINFO, PubMed, CINAHL and SocINDEX. For grey literature, we will conduct searches in AHS Insite, Google, Google Scholar, OAISter and government websites. A two-stage (title-abstract and full-text) screening will be conducted, including single-citation tracking and hand search of reference lists. ETHICS AND DISSEMINATION: Ethical approval is not required for this review. We first plan to disseminate the results of our systematic review protocol through meetings with key stakeholders, followed by appropriate publications and presentations at applicable platforms. We also have opted for an integrated knowledge translation or community-engaged knowledge mobilisation approach where we have engaged with community-based citizen researchers from the inception of our research.

The role of comorbidities and clinical predictors of severe disease in COVID-19: a systematic review and meta-analysis

BackgroundCOVID_19 is unpredictable due to non-specific symptoms and clinical course diversity in different individuals. We analyzed studies regarding the factors associated with severe status of the disease to identify unique findings in severely affected patients. MethodsWe systematically searched the electronic databases, including PubMed, Scopus, EMBASE, Web of Science, and Google Scholar from inception to 12th of March 2020. Cochranes Q and I-square statistics were used to assess the existence of heterogeneity between the included studies. We used the random-effects model to pool the odds ratios (ORs) at 95% confidence intervals (CIs). ResultsSeventeen articles out of 3009 citations were included. These contained 3189 patients, of whom 732 were severely affected (severe group) and 3189 were in non-severe group. Using the random-effects model, our meta-analyses showed that the odds of comorbidities, including COPD, DM, HTN, CVD, CKD, and symptoms, including dyspnea, dizziness, anorexia, and cough, were significantly higher among the severe group compared with the non-severe group. There were no significant changes in odds of CVA, liver disease, immunodeficiency/immunosuppression, fever, fatigue, myalgia, headache, diarrhea, sore throat, nasal congestion, sputum, nausea, vomiting, chest pain between the two groups. ConclusionsEarly recognition and intervention can be critical in management, and might stop progression to severe disease. Predictive symptoms and comorbidities can be used as a predictor in patients who are at risk of severe disease.

COVID-19 in Iran, a comprehensive investigation from exposure to treatment outcomes

PurposeThere is a growing need for information regarding the recent coronavirus disease of 2019 (Covid-19). We present a comprehensive report of Covid-19 patients in Iran. MethodsOne hundred hospitalized patients with Covid-19 were studied. Data on potential source of exposure, demographic, clinical, and paraclinical features, therapy outcome, and post-discharge follow-up were analyzed. ResultsThe median age of the patients was 58 years, and the majority of the patients (72.7%) were above 50 years of age. Fever was present in 45.2% of the patients on admission. The most common clinical symptoms were shortness of breath (74%) and cough (68%). Most patients had elevated C-reactive protein (92.3%), elevated erythrocyte sedimentation rate (82.9%), lymphocytopenia (74.2 %) on admission. Lower lobes of the lung were most commonly involved, and ground-glass opacity (81.8%) was the most frequent finding in CT scans. The administration of hydroxychloroquine improved the clinical outcome of the patients. Lopinavir/ritonavir was efficacious at younger ages. Of the 70 discharged patients, 40% had symptom relapse, (8.6%) were readmitted to the hospital, and 3 patients (4.3%) died. ConclusionThis report demonstrates a heterogeneous nature of clinical manifestations in patients affected with Covid-19. The most common presenting symptoms are non-specific, so attention should be made on broader testing, especially in age groups with the greatest risk and younger individuals who can serve as carriers of the disease. Hydroxychloroquine and lopinavir/ritonavir (in younger age group) can be potential treatment options. Finally, patients discharged from the hospital should be followed up because of potential symptom relapse.