Psychotic disorders are commonly accompanied by intense psychological burden, and psychological interventions are usually needed in order to reduce the symptoms and help in maintaining or improving the level of psychological and social functioning after the onset of psychosis. The evidence-base for treating young people at risk for psychosis and adults with psychotic disorders is accumulating. Yet, pervasive systematic literature reviews that would include patients from the full age range being the most essential period for the risk of developing a psychotic disorder, a wide range of psychological interventions, and various types of clinical trials, have been lacking. The aim of this systematic review is to fill the gap by presenting the current research evidence from clinical trials on the effectiveness of psychological interventions for treating young people (12–30) with psychotic disorders.A systematic search was conducted in PubMed and PsycINFO followed by a 3-step screening process based on the PICOS strategy. Risk of bias of the included studies was assessed by the Mixed Methods Appraisal Tool (MMAT). Extracted data from the included studies is reported using a narrative synthesis.Of the 1,449 publications screened, 40 from 25 studies were included in the review. Of these, 10 studies reported results from cognitive or behavioral therapy, nine from cognitive remediation therapy (CRT), and six from other types of therapies . All but one study found the target interventions to be effective, but the results mostly did not differ significantly from the control conditions in reducing symptoms and improving functioning, preventing relapses and hospitalization, or improving psychological or family variables. The most consistent findings were from CRT, showing more improvement in cognitive functioning compared to control conditions while not being superior in reducing symptom severity. Integrative interventions might be effective in treating young people suffering from psychotic disorders.There is some evidence that psychological interventions are effective for young people with psychotic disorders. However, with regard to symptom severity, psychotherapy does not outperform control conditions, and the results do not strongly favor any specific type of treatment.https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020166756], identifier [CRD42020166756].[ Psychiatric disorders constitute a global major health problem, due to their high prevalence, the related functional and symptomatic deficits, and the direct and indirect effects on patients’ socio-economic circumstances and social environments . DisordeDue to its multimodal consequences, psychosis is commonly accompanied by intense psychological strain. As the individual risk for developing psychosis has multifactorial explanations, the specification of an individualized treatment strategy should also take multiple factors into account. Until recently, it has not been possible to define a coherent list of clinical, psychological, and social factors determining the individual likelihood to benefit from treatment, as the evidence on variables predicting treatment outcome is scarce and studies show contradictory results. The most frequently reported predictors of poor treatment outcomes are premorbid difficulties, symptom severity  at baseline, and duration of untreated psychosis (DUP) , 9, suggGenerally, a combination of pharmacological treatment and psychological interventions is the first-line recommendation for treating psychosis , 12. TheWhile the effects of specific forms of psychotherapy  are known in general , and theIn order to have a clearer view on which specific ingredients in treatment are more likely to provide help for the patients at an early stage of psychotic disorders, the knowledge on psychological intervention studies with psychotic young patients has to be reviewed more broadly. This means that a review could preferably also include non-randomized clinical studies or studies with a wider age range.The aim of this systematic review is to present the research evidence from clinical trials on the effectiveness of psychological interventions for treating young people with psychotic disorders. The review focuses mainly on the clinically relevant outcomes, such as symptom reduction or remission, hospitalization, and improvements in occupational, social, and cognitive functioning, and reporting the between-group effects.The study was conducted in the European Network on Individualized Psychotherapy Treatment of Young People with Mental Disorders  funded by the European Cooperation in Science and Technology (COST), through Horizon 2020. It is a part of a larger ongoing study aiming to carry out a number of systematic literature reviews on psychotherapeutic interventions among young people with mental disorders. The overall protocol for conducted systematic literature reviews is registered in PROSPERO (CRD42020166756) and described in Vousoura et al. .In this study, a systematic literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines , was conThe inclusion criteria based on the PICOS strategy were that the study had to be (i) a clinical outcome study (ii) with at least one treatment condition involved , (iii) for adolescents or young adults aged 12–30 years, (iv) with psychotic disorder, (v) as determined by DSM-, ICD-, or other diagnostic criteria or high level of symptoms on at least one relevant self-report measure [e.g. Brief Psychiatric Rating Scale (BPRS) , The PosA PRISMA flow diagram detailing the number of studies retained for analysis according to screening steps is presented in After the researchers had rated all the studies independently based on the title and abstract, a comparison between two independent ratings (VG vs. HL-S and BM) was made and a consensus on the studies to be included in the final stage of the screening for full-texts was reached. When the full text was not available in the searched databases, the researchers contacted the corresponding author. In case of no response in 2 weeks, the study was counted as missing. After the researchers had rated the full texts independently, a comparison of the ratings was made again, and a consensus on the studies to be included in the systematic review was reached. For a more detailed description of the study selection process see Vousoura et al. .The methodological quality of the included studies was evaluated by the Mixed Methods Appraisal Tool (MMAT)  for qualThe search strategy identified 1,535 publications from the two databases. After removing duplicates, 1,449 publications were included in the screening process. From these, 328 were selected to be included in the final stage of screening. However, in total 31 papers were not available, so 297 full-text articles were assessed for eligibility. A total of 37 publications were selected, and three relevant articles were identified outside the systematic search , so in total 40 publications were included in this study. The PRISMA flow diagram detailing the number of studies retained for analysis according to the screening steps is presented in A total of 25 studies (40 publications) were included in the systematic review based on the defined eligibility criteria. Except for one study , all incBased on which type of psychological intervention was the target condition in the study, included studies were divided into three categories: (1) cognitive therapy (CT), cognitive-behavioral therapy (CBT), behavioral therapy (BT); (2) cognitive remediation therapy (CRT); (3) other psychological interventions. Detailed descriptions of the psychological interventions in the three defined categories are presented in Cognitive therapies focus on changing unhelpful cognitive distortions  and behaviors , improving emotion regulation, and developing personal coping strategies targeting current problems. Therefore, frequently encountered topics among cognitive and behavioral interventions for psychotic disorder involve processing of and adaptation to illness , illness management , relapse prevention, and treatment motivation. Interventions follow standardized manuals with areas of psychological work and goals that are determined in advance. In addition, psychosocial programs in this category often involve psychoeducation addressing various topics  (for details see Ten included studies (18 publications) belong in this category. Five studies had sample sizes of more than 50 participants –45 and tCognitive remediation therapy mainly targets neurocognitive dysfunctions , as well as metacognitive thinking  by using behavioral strategies to improve the targeted cognitive abilities and social functioning  were designated under this category. Five of these studies had a sample size of fewer than 50 participants –56, threThe studies included in this category were a heterogeneous group, typically involving an integrative approach combining psychoeducation and/or individual treatment with family or group interventions . Except for one study –62, all The results of the studies are reported within three categories of outcomes: (1) symptoms , (2) functioning , and (3) other outcomes . Results within each type of outcome will be presented for each category of psychological interventions. More specific details regarding the outcomes of included studies are presented in The majority of the included studies investigated positive symptoms of psychosis , negative symptoms of psychosis , and general symptoms .positive symptoms, five studies from the CT/CBT/BT group reported results within this domain  in the context of psychosis. In the CT/CBT/BT group, six studies investigated depressive symptoms , five were non-RCTs, and one was an uncontrolled study. With the exception of four studies , 57, 64,n = 12), which impacted the approximate number of participants required to meet this criterion (n = 10)   (for mor(n = 10) .The aim of the systematic review was to present the research evidence from clinical trials on the effectiveness of psychological interventions for treating young people with psychotic disorders. We found 25 studies  meeting the inclusion criteria for this review. Most of the studied treatments have a cognitive or cognitive behavioral approach and also include family-related components and psychoeducation. The finding is in line with earlier studies on adult population , 68. TheRegarding the effect of the psychological interventions on symptom reduction, only one  of the fn = 16), significance testing, or calculation of effects sizes could not be performed. In addition, all patients had a comorbid borderline personality disorder, so the results should be interpreted with caution.In the CT/CBT/BT group, the most promising treatment was cognitive-analytic therapy program (HYPE) , which oIn the CRT group, the studies mainly showed that CRT resulted in significantly higher improvement of cognitive functioning than the control conditions. However, in terms of symptom reduction, only one study  showed CIn the heterogeneous group of other psychological interventions, in five out of six studies, the target intervention outperformed the control condition for most of the studied outcomes. The extended early intervention (EEI)  was signThe main findings from this systematic review suggest that while psychological interventions have been found to be effective in reducing symptoms and improving functioning, psychotherapy does not typically outperform control conditions when it comes to symptom reduction, and the results from different studies do not seem to strongly favor any specific type of treatment. Similar findings were reported in a recent systematic review on psychological interventions for adults with schizophrenia or psychosis who received minimal or no antipsychotic medication , and in The review indicates that interventions with a bio-psycho-social integrative approach combining for example psychoeducation and family or group interventions might be more effective than control conditions in reducing symptoms and improving functioning. These results are in line with recent systematic reviews focusing on RCT studies for adolescents with psychotic disorders  and on pWith regard to improvement of cognitive functioning, CRT relatively consistently outperformed control treatments. However, the implications of these findings for CRT as a general psychological approach for psychosis in young people are not clear, since studies of CRT mainly target cognitive domains, while CBT and other types of psychological interventions for psychosis focus more on symptoms and other types of functioning. Thus, the significant results of CRT typically regarded improvement in cognitive functioning, and a significant symptom reduction compared to the control treatment was found only in two studies. Conversely, apart from one study that did not have a control condition, studies with CT/CBT/BT or other types of psychological interventions did not investigate outcomes related to cognitive functioning. This means that in order to be able to compare if CRT is more effective in terms of cognitive improvement than other types of active psychological interventions, it is important that cognitive improvement would be systematically assessed as a treatment outcome across different interventions. And vice versa—in order to make conclusions if CRT is generally more effective than other types of psychological interventions for treating psychosis, a broader range of outcome measures should be added more systematically to studies assessing the efficacy of CRT.There were remarkable differences in the designs of the studies. The duration of treatment, frequency, and number of sessions varied notably, and, furthermore, the control conditions provided varying degrees of support, which may result in differences in the perceived effects . AdditioIt is also notable, that the control treatments labeled as TAU varied considerably, in some cases being as intensive as the target treatment, being structured and provided by a specialist team for early psychosis, which might explain that there were not so many between-group differences found. The majority of studied psychological interventions were brief (less than 6 months), especially in the CT/CBT/BT and CRT groups, and follow-up was lacking in nearly half of the studies. Yet, it seems that the longer the follow-up is, the more likely it is that the possible between-group effects fade away. This is in line with what, e.g., Linszen et al.  and HardThe primary strength of the systematic review is that as to our knowledge it is the first study to be looking into the full age range being the most essential period for the risk of developing a psychotic disorder . In addiThe systematic review was conducted as a part of a larger study focusing on the full spectrum of psychiatric diagnoses. Thus, the strength of the study is that the systematic search was created by an interdisciplinary group of professionals in order to ensure that it was as inclusive as possible on the clinical outcome studies of psychological interventions for youth with mental disorders. In addition, the searches were strictly following the PICOS strategy. The task of the overall study was extensive resulting in a very inclusive and more diverse range of included studies compared to recent meta-analyses on specialist early intervention teams to treat recent onset psychosis  or psychIn the terms of quality assessment, the majority of the included RCTs met the rating criteria . Relatively few studies in this group did not meet the criterion for a sufficient rate of completion of outcome data , 53, 58,One of the principal limitations of the present review is the inclusion criteria, which excluded several relevant outcome papers particularly based on the defined age range. Many studies on adult patients include participants up until the age of 35. However, it is also a strength of the study that it focuses on treatment of adolescents and young adults, as in most studies young adults are combined with older adults, who have a longer treatment duration with presumably larger deteriorating effects, e.g., on functioning, and who might respond to treatment differently than patients at an early stage of the illness. It is a challenge also for research with youth that the developmental changes from early to later adolescence and adulthood occur rapidly meaning that it might cofound with the changes interpreted as a result from the intervention. In addition, even if limiting the age range to younger adults, it should be noted that conducting a psychological intervention to early adolescents might, and presumably should, differ from conducting the same intervention to adults. So, there might be within-group differences in the treatments relating to the age of participants that were not addressed in this study. In addition, the studies including patients at high risk for psychosis were excluded in case of a percentage over 50% for high-risk patients, as the review focuses on patients who fill the diagnostic criteria of psychotic disorders.It should be acknowledged that since many of the studies implemented additional care together with the studied interventions, it is difficult to judge whether possible improvements can be contributed only to the interventions. Additionally, the main limitation of the included non-randomized studies was related to the confounding bias. In addition, we found only one non-controlled study meeting the inclusion criteria of our search, even if the search was not limited to controlled trials. This raises the question that there might be other clinical trials that were not identified in our search, even if the search string should have included them. In addition, the focus of this systematic review was to report the between group effects, and results from the effectiveness of each target intervention was not reported on different outcome domains, so deeper conclusions of the within-treatment effects cannot be drawn from this systematic review.Young people with psychotic disorders are likely to benefit from individual, family, or group psychological interventions such as cognitive, behavioral, or cognitive behavioral therapy, CRT, and other psychological interventions targeting psychosis, especially when including the elements of psychoeducation and involving closed ones to it. However, with regard to symptom reduction no treatment modality seems to clearly outperform other active treatments. It is important to notice that the main aspect in psychotherapy is not only to reduce symptoms, similarly to what medication does, but to provide an add on  treatingThe original contributions presented in the study are included in the article/RU and SP conceived the original idea. VG developed the search strategy, with the assistance of SP and EV. VG and EV formed the eligibility criteria and planned the data extraction. VG, BM, and HL-S conducted the screening and data extraction process and drafted the first version of the manuscript. BM did the quality assessment. RU coordinated the overall COST initiative. SP, RU, and EV provided critical insights into the first version of the manuscript. All authors have approved and contributed to the final written manuscript with VG finalizing it.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Background: Falls are recognized globally as a major public health problem. Although the elderly are the most affected population, it should be noted that the pediatric population is also very susceptible to the risk of falling. The fall risk approach is the assessment tool. There are different types of tools used in both clinical and territorial settings. Material and methods: In the month of January 2021, a literature search was undertaken of MEDLINE, CINHAL and The Cochrane Database, adopting as limits: last 10 years, abstract available, and English and Italian language. The search terms used were “Accidental Falls” AND “Risk Assessment” and “Fall Risk Assessment Tool” or “Fall Risk Assessment Tools”. Results: From the 115 selected articles, 38 different fall risk assessment tools were identified, divided into two groups: the first with the main tools present in the literature, and the second represented by tools of some specific areas, of lesser use and with less supporting literature. Most of these articles are prospective cohort or cross-sectional studies. All articles focus on presenting, creating or validating fall risk assessment tools. Conclusion: Due to the multidimensional nature of falling risk, there is no “ideal” tool that can be used in any context or that performs a perfect risk assessment. For this reason, a simultaneous application of multiple tools is recommended, and a direct and in-depth analysis by the healthcare professional is essential. The phenomenon of falls is recognized globally as a major public health problem. Falling down is globally the number-one health problem, and a common problem of evaluation by healthcare professionals. A fall is defined as a “sudden, not intentional, and unexpected movement from orthostatic position, from seat to position, or from clinical position” . Falls iThe financial costs of fall injuries are substantial. For people aged 65 and over in Finland and Australia, it was calculated at USD 3611 and USD 1049, respectively. Evidence from Canada suggests implementing effective prevention strategies with a subsequent 20% reduction of the incidence of falls among children under 10 could create net savings of more than USD 120 million annually [However, the characteristics of the patient for a fall risk tool are varied: age, cognitive state, state of health in general, particular comorbidities, hospital or home context. These are just a few features. In fact, in recent studies, particular risk factors have been evaluated such as being hospitalized, being hospitalized in neuropsychiatry, suffering from dementia and delirium, and going to the bathroom .Currently in the literature, there is no study that summarizes the tools available to healthcare professionals according to the different contexts in which they operate. Knowing the fall assessment tools, through the analysis of their characteristics, allows to identify the most suitable scale for each individual patient and to prevent the risk. As described in NICE, 2004, the patients should be cared for by personnel who have undergone appropriate training and who know how to initiate and maintain correct and suitable preventative measures. Staffing levels and skill mix should reflect the needs of patients .This review aims to analyze different fall risk assessment tools present in the literature with the aim of supporting healthcare professionals in choosing the tool best suited to their operational context and the characteristics of the patients.A literature search was undertaken from MEDLINE, CINHAL and The Cochrane Database in the month of January 2021.Population: individuals who are in hospital environments or who stay in the territory, without any age limit.Intervention: application of instruments to evaluate the risk of falling.Comparison: none.Outcomes: measurement of the downfall risk.The present review of literature followed the PRISMA guidelines . The PICFor every database, the following search terms were used: “Accidental Falls” and “Risk Assessment”, “Fall Risk Assessment Tool” or “Fall Risk Assessment Tools”.The limits applied to each study were: year of publication 2010–2020 (last ten years); abstract available, Italian and English languages. Specific criteria of inclusion and exclusion were defined as shown below:Inclusion Criteria: Revision and research studies  focused on the presentation, creation, validation, or critique of instruments of fall risk evaluation.Exclusion criteria: articles that report evaluations measuring the risk of falling with medical parameters or criteria (ex. Laboratory data), or evaluations made through movement sensors; articles without abstract or not available in Italian or English languages.The review was not registered in any database or similar, and it was conducted by two separate reviewers who then compared the results on the basis of the limits and eligibility criteria chosen. The agreement was found as shown in For the selected scales, the history and any important changes over the years have been reconstructed. Each scale, in fact, belongs to different populations or contexts, for the purpose of presenting the entire scenario of the tolls for assessing the risk of falling.Tools identified by the analysis of the articles are 38, divided into two groups.The first group is represented by the main 21 risk assessment tools, described in The vast majority of the proposed tools have been developed for use in acute and geriatric settings, in which there are numerous factors that expose individuals to this risk. The target most subjected to the assessment is the elderly population (>65 years), followed by people suffering from pathologies that alter walking and balance skills .Falls Efficacy Scale—International (FES-I). The FES-I scale is the most used tool in literature for the “fear of falling” evaluation, a factor closely related to the genesis of falls . This scThe Activities-specific Balance Confidence Scale  was developed to assess the perceived degree of confidence in maintaining balance or not becoming unstable in performing various functional tasks. It is a structured questionnaire that measures the confidence of an individual in carrying out activities and consists in attributing a percentage value, between “insecurity” and “complete security”, to the 16 proposed activities . The ABCComparing the two scales, it emerged that the FES-I scale has a greater appropriateness of use in clinical settings than the ABC Scale, whose use is recommended mainly in the elderly living at home .The STRATIFY scale is a predictive tool for the risk of falls in hospitalized patients. The compilation of the scale is not performed through direct observation of the patient, but the evaluator reports the score based on information obtained from the previous observation or from other caregivers. STRATIFY has been extensively studied in intensive care units in Australia, Europe and Canada  and has At the same time, some studies criticize its reduced specificity, or identify its scarce usefulness if applied in different or specific contexts such as rehabilitation from traumatic brain injury, or in patients younger than 65 years old. The Hendrich II Fall Risk Model (HIIFRM) was designed to identify adult patients at risk of falling in acute care hospitals . Unlike The Johns Hopkins Fall Risk Assessment Tool (JHFRAT) was used for the multi-factorial assessment of the risk of falling in departments for acute patients . The JHFThe Tinetti Mobility Test (TMT) or the Performance-Oriented Mobility Assessment (POMA) consists of the combined use of the useful components drawn from both approaches . The totThe Aachen Falls Prevention Scale was developed in order to allow the elderly to perform a self-assessment of their risk of falling . The AacThe Fullerton Advanced Balance (FAB) Scale is a multidimensional tool for assessing balance developed for functionally independent seniors. It aims to identify highly active seniors who are at increased risk of suffering fall-related injuries due to sensory impairments . The valThe Balance Evaluation Systems Test (BESTest) aims to identify the disordered systems underlying postural control responsible for poor functional balance in adults. It is widely used to evaluate six balance control systems; however, it is difficult to apply in clinical situations due to the long administration time (approximately 20–30 min). The BESTest has two shorter versions: the Mini-BESTest , developThe 5 Times-Sit to Stand Test (5T-STS) was developed and validated in America to establish the ability of individuals with balance disorders to perform transitional movements. A simple and quick test provided an objective measurement of the level of balance and coordination of individuals subject to various health alterations such as Sdr. Parkinson’s disease or chronic stroke . SubsequThe Timed Up and Go (TUG) test is simple and effective, and seeks functional mobility: it provides a quick assessment of the individual’s strength, mobility capacity and dynamic balance . NumerouThe Downton Fall Risk Index (DFRI) detects the risk of falling. The tool has been used in several studies with different purposes: to evaluate the effectiveness of a program for the elderly in post-stroke rehabilitation aimed at muscle strengthening, or to discriminate in a population of elderly who had experienced previous episodes of falls. The Tool has been extensively analyzed in contexts that do not include acute patients such as nursing homes, while when applied to the hospital environment, its ability to predict falls significantly decreases .The Conley Scale assesses the risk of falls. The scale has been inserted and used in various Italian hospital contexts (mainly medicine and surgery). It is quick to use (about 2 min) and is easily understood; it is usually administered upon admission of the patient to the ward. However, the inability to identify patients not at risk of falling due to the low specificity value was contested ; therefoThe Minimal Chair Height Standing Ability Test (MCHSAT) involves measurements of the minimum height of the chair from which the person is able to stand up. The tool has been used in several studies with different purposes: to evaluate the effectiveness of a program for the elderly in post-stroke rehabilitation aimed at muscle strengthening, or to discriminate in a population of elderly people who had experienced previous episodes of falls. The test showed, if administered in a standardized way, a high sensitivity (75%), which, combined with its simplicity of execution and speed of administration, makes it an appropriate tool for screening the risk of falling in healthcare settings . From thStopping Elderly Accidents, Deaths, and Injuries (STEADI) was created to help health professionals integrate fall risk assessment into routine practice. The tool also includes a list of fall prevention interventions for clinical use. The STEADI algorithm provides valid, unique information on the risk of falling, independently of traditional indicators based on a low level of physical health .Morse Fall Scale (MFS) is a quick and easy way to assess the likelihood of a patient falling. It was developed in acute patient, rehabilitation and nursing home departments. The scale was computer tested in a simulated population and was subsequently applied to the populations of the previously mentioned departments. The Morse scale takes a few minutes to complete (approximately 2 min), allows for three different risk categories  and is used in hospital settings . This toA scale concerning the presence of drugs is the medication fall risk score (RxFS). It was developed as part of the pharmacist-coordinated falls prevention program in America to compensate for the lack of various drug therapy risk assessment tools . The US Falls Risk for Older People-Community Setting Screening Tool (FRHOP Com Screen) was developed by a multidisciplinary team of experts and tested in the wards of subacute patients. The Thai version of the scale has demonstrated satisfactory reliability and validity in hospitalized elderly subjects. Sensitivity and specificity are, respectively, 57% and 68%. By applying modifications to the FRHOP, the Western Health Fall Risk Assessment (WHeFRA) scale was developed by Walsh et al. and demonstrated efficacy comparable to the STRATIFY scale . Austin The main elements that distinguish the assessment tools shown in the review are: the risk factors investigated (intrinsic and/or extrinsic), the sample subjected to analysis  and the way the test is used . Between the instruments presented between the discussion and Each scale, before being applied in a specific clinical context or on a population other than that for which it was created, must be properly tested, to verify its effectiveness and reliability ; in factThis revision has the following limitations: only the articles of the last 10 years were analyzed, the entire scenario of fall risk assessment tools present in the literature, there is not sufficient information available on the statistical characteristics of the different instruments to compare the tools or their parameters.This study presents the entire scenario of fall risk assessment tools present in the literature. Between most of the tools analyzed, 23 tools target hospitalized patients, eight are used for risk assessment in home residents, while seven are applicable to both populations. The primary purpose of using a fall risk assessment tool is not to reduce falls, but to identify individuals at high and low risk . In thisAccording to some studies, to maximize the predictability characteristics of each instrument, it would be recommended to use two tests in combination.Indeed, due to the multidimensional nature of the risk of falling, there is no “ideal” a single tool that can be used in any context or that performs a perfect risk assessment. A simultaneous application of several instruments is recommended and a direct and in-depth analysis by the healthcare professional is essential . The res


The aim of this review is to identify and summarize factors that are associated with public attitudes towards people with various disabilities systematically.An electronic search of three databases was performed  covering the period from 1950 to present. A comprehensive search strategy was developed and the lists of citations were screened for potential eligible studies. Only quantitative studies using valid measurements were included, and the methodological quality of included studies was appraised based on three criteria  by two independent reviewers.. Three categories of the factors were found to be associated with the public attitudes, which are related to the attitude provider, disabled people, and society respectively. Specifically, the more people know about disabilities, the more likely they were to have positive attitude; and the frequency and quality of the contact with the disabled are also proved to be influential to the attitudes. Meanwhile, the type of disability is also closely correlated to the public’s attitude towards the disabilities.The initial electronic search yielded 995 articles after duplicates removed, and 27 studies met the eligibility criteria were included in the studyPeople’s knowledge of the disability and their contact with individuals with disabilities are the main influential factors in public attitudes towards persons with disabilities. This study provides a comprehensive overview of attitudes toward the general disabled, and it fills the gap in the current knowledge through a wider focus that goes beyond a specific aspect .There are three categories of factors that found to be associated with the public attitudes, which are related to the attitude provider, disabled people, and society respectively.People’s knowledge of the disability, and the quality and frequency of their contact with the disabled are the main factors that influence public attitude towards persons with various disabilities.Disability has become a natural part of the global human condition across various areas, due to the growing aging population, and the changes of demographics of societies . Accordidisabled writer with disabilities, “the chief handicap of the blind is not blindness, but the attitude of seeing people towards them”. Attitudes toward the disability involve multidimensional evaluation of people, which can be either positive or negative, or comprised of both  AND [“physically challenged OR handicap* OR disabled OR disabilities OR disability OR impairment OR disorder]. In addition, we screened the citation lists of included and relevant papers for potentially eligible studies. Studies retrieved from the initial searches were screened using the following inclusion criteria: (1) study aim is to understand influencing factors associated with public attitudes, (2) study outcome is related to the attitude toward people with disabilities, and (3) study design is cross-sectional or cohort. Exclusion criteria were as follows: (1) qualitative design, (2) study evaluating an intervention, and (3) report language is non-English.Endnote was used to list all literatures retrieved in the database and to check for duplicates. Two researchers independently screened the titles and abstracts of the remaining non-duplicates to exclude the irrelevant literatures. In case of divergence, the third senior researcher evaluated the duplicates and the uncertainties. After removing the unrelated literatures second time, two researchers read the full text respectively, the remaining records were selected in accordance with the inclusion and exclusion criteria.Only quantitative studies using valid measurements were included in this review, and correlation analyses or difference testing results were appraised for each study. The methodological quality of the 27 included studies was rated by evaluating three key criteria based on the McMaster Critical Review Form for quantitative research. The criterion ‘sample’ examined whether or not selection bias was reduced, the sample size was appropriate for the study design and research objective, and the characteristics of the participants were fully described. The criterion ‘measurement’ examined whether or not measurement bias was controlled for the: subject, observer, procedure, and instrument. The criterion ‘analyses’ examined whether or not the analyses tests were matched to the research question, the outcome measurement scale, and the nature  of the outcome and exposure variables. Each criterion was scored with one star (no evidence of meeting the requirement), or two stars , or three stars (has evidence meeting the requirement). Two reviewers independently performed the methodological quality assessment. Any discrepancies between the two reviewers were discussed until a consensus was reached. If a consensus could not be reached, agreement was obtained through discussions with a third reviewer. We did not conduct any meta-analysis given the heterogeneity of the reporting instruments employed.After systematic collection and evaluation, synthesis of original literature could: describe the extent to which current factors influence public’s attitudes toward the disabled, identify the existing problems and gaps, and provide implications for improving the attitudes toward the disabled. The included studies were independently reviewed and summarized by two reviewers. Any discrepancies were resolved through discussion. Descriptive data, including literature authors, publication dates, subjects, types of disability, tools and results, were extracted from the studies using a uniform table. The findings were then categorized to summarize the state of the studies for different associated variables.Initial screening of the 1286 search results from the main search removed 291 duplicates, and the remaining 995 records were screened. Nine hundred twenty-six articles did not address the general topic in title or abstract, and the remaining 69 articles were scanned full text for eligibility. Following this, 42 articles were removed because they did not measure attitudes using validated instruments, did not address public attitudes towards disabled people, or did not use direct measurements. After the initial electronic search and the manual search of the reference according to the inclusion and exclusion criteria, a total of 27 studies met the eligibility criteria for the final review. A flow diagram of literature search and selection process was presented in Fig. Table The included studies revealed that a variety of factors were associated with public attitudes towards persons with disabilities. These factors were divided into three categories, namely, factors related to the provider, factors related to the disabled, and factors related to the society.Relationships between variables related to the provider and their attitudes toward people with disabilities across 25 studies are demonstrated in Table GenderThe most commonly investigated demographic factors that associated to the attitude provider are gender, age, and education, while the impacts of other related factors such as income and religion were addressed in very few studies.b)AgeA total of eight studies examined gender as an influential factor , 28–32. c)EducationA total of 11 studies , 31–33 ed)Job and income factorsWhile two studies , 32 sugge)ReligionTwo studies , 41 repoThree papers , 30, 42 Contact to the disabledi.Frequency/Quantity of the contacts. Four studies , 34, 35 ii.Quality of the contacts. The nature of the contact that people experienced was notably and distinctly related to their attitudes towards the disabled, as reported by two , 39 studb)Familiarity of the disabledEleven studies investigated the relationship between attitude provider’s personal contact with the disabled people and attitude scores. Although these studies produced mixed results, the most consistent finding was a positive relationship between attitudes and more contacts with persons with disabilities.c)Knowledge about the disabledMany studies found that ever contact with persons with disabilities through that knowledge about the policy act family, friends, social life, or elsewhere, does have a significant impact on their attitudes. Five studies , 29, 40 People’s knowledge about the disabled was also investigated in several studies. Three of them reported that people who have higher knowledge level would have better attitude toward people with disabilities , 28 and Only one study  investigRelationships between the variables related to the disabled and public’s attitudes toward them across eight studies are demonstrated in Table Two studies , 18 estiThere are six , 41, 42 One study  found thOnly one study  reportedPublic attitude is crucial to the disabled people with regard to their daily lives, social participation, and their integration into the community. The present systematic review of 27 studies was performed to identify different aspects of factors that may influence public’s attitude toward people with a disability. Three categories of factors were found to be associated with the public, which are related to the attitude holder/provider, disabled people, and society respectively. The key findings from this study suggested that, among a variety of factors under each category, the most recognized ones would be the knowledge (familiarity) of the disabled and the contact with the disabled, since they have been studied most frequently and have been proved to conclude more consistent and significant association with the public attitudes.The findings from this review also indicated that gender was linked to attitudes, with men have a more negative attitude toward the person with disability than women , 29, 31.Among all discussed factors, the finding concerning the relationship between “contact to the disabled” and the attitudes is the most-frequently discussed one. The manifestation of contact include the time length, frequency and the quality of contact with disabled people, or having friends, family members and colleagues who are disabled (“Familiarity”). The majority of studies , 34–40 hWe found that almost all of the studies indicated a positive relationship between the education level and attitudes. People with higher levels of education might be more liberal, open, and understanding of people with disabilities and the related issues, which would let them have a better attitude towards people with disabilities . This teOur results showed a lack of consistency on some factors. To illustrate, the findings regarding the relationship between the age of the respondent and their attitudes are not consistent. Some studies suggested that younger people hold more negative attitudes toward person with disabilities than those of the older , 29, 32,With regard to other potential factors , religion and income were found to have no effect on people’s attitudes towards disabled people, while humorous media have a positive impact. Evidence suggest that humor may have a normalizing effect during an abnormal situation , and itsIn additional to the factors discussed above, it is found that public attitude is also dependent upon the individual factor of the disabled, e.g., type of disability. Several studies , 34, 38 In this review we found that the included studies used a great variety of scales to evaluate the attitudes toward the disabled people, and the ATDP (Attitude Towards Disabled People)  was the Among the included studies, there is a lack of evidence about a progression of or improvement in attitudes occurred as time passed. To date, long-term prospective studies that evaluate changes in attitude across time are needed, in order to better understand the best way to cultivate positive attitudes from education to practice. As previously noted, most of the literatures reviewed in this study were based on student samples, which rendering their findings unrepresentative of the general public. In addition, the diversity of the assessment instrument used may obfuscate the results to be applied generally. Future studies assessing attitudes toward people with disabilities need to use more rigorous design that includes validated measurements so a future meta-analysis may be feasible.According to our search results, compared to factors related to the attitude provider, social factors and factors related to the disabled themselves were less studied. This indicates the need for more in-depth studies. There is limited evidence of the relationship between income level and the attitudes in the current studies. Future studies could situate the current findings within a broader context such as links to bodies of research on stigma, empathy/fatigue in healthcare providers. Besides, as the reviewed literature originated from different countries, possible cultural differences should be taken into account when establishing such a guide for the future studies in this area.We sought to provide as comprehensive an overview of attitudes toward the disabled as possible, rather than focusing on a specific angle  in this area. We have not identified any previous study that attempted to systematically review the attitudes of the general public toward people with all kinds of disabilities, which makes our review meaningful and important. The data related to the factors, setting, sample, instruments employed, and the results were extracted for each study, which could provide a clear awareness and understanding of the feature of the included studies, and provide the insight of the current knowledge gaps to inform further studies in this area. The findings of this study have important implications for the education and training of the future health professionals.Only English records were retrieved for this review, which means that insights from papers written in other languages could have been missed, and the language and publication bias may be present. Another limitation is the decision to exclude records from the qualitative study and grey literature, which may decreased the breadth of insights generated. However, as our aim is to find out those studies who concluded quantitative relationships between different measureable parameters by using statistical models and analyses methods, qualitative studies and grey literatures may not give us the best evidence to find out the association. In addition, cc, thus, studies prior to that year would have been missed. And we are unable to meta analyze the results given the heterogeneous nature of the included data in terms of study design, populations studied, and instruments used.This systematic review identified three categories related to the factors associated with attitudes toward the disabilities, which indicate an association with attitudes towards the disabled: factors related to the attitude provider, disability themselves, and the society. Among all of the factors, provider’s knowledge of the disability and their contact with the disabled would be the most recognized ones that influence attitude towards people with disabilities. ATDP scale was the most frequently used scale to measure attitudes in the included studies. Additional focus may be necessary for future study to randomly assign participants (student and non-student sample) to provide more representative and comprehensive evidence. Future research should aim to establish a practical guide based on these factors proved to be influential, which would provide not only the health care professionals but the general lay public with strategies for interacting with individuals with disabilities, and inform effective decisions to the stakeholders in order to build a more inclusive society.


Large health organizations often struggle to build complex health information technology (HIT) solutions and are faced with ever-growing pressure to continuously innovate their information systems. Limited research has been conducted that explores the relationship between organizations’ innovative capabilities and HIT quality in the sense of achieving high-quality support for patient care processes.HIT model, to help determine how better information provision in health organizations can be achieved.The aim of this study is to explain how core constructs of organizational innovation capabilities are linked to HIT quality based on a conceptual sociotechnical model on innovation and quality of HIT, called the IQWe designed a survey to assess various domains of HIT quality, innovation capabilities of health organizations, and context variables and administered it to hospital chief information officers across Austria, Germany, and Switzerland. Data from 232 hospitals were used to empirically fit the model using partial least squares structural equation modeling to reveal associations and mediating and moderating effects.HIT model reveals several associations between the analyzed constructs, which can be summarized in 2 main insights. First, it illustrates the linkage between the constructs measuring HIT quality by showing that the professionalism of information management explains the degree of HIT workflow support (R²=0.56), which in turn explains the perceived HIT quality (R²=0.53). Second, the model shows that HIT quality was positively influenced by innovation capabilities related to the top management team, the information technology department, and the organization at large. The assessment of the model’s statistical quality criteria indicated valid model specifications, including sufficient convergent and discriminant validity for measuring the latent constructs that underlie the measures of HIT quality and innovation capabilities.The resulting empirical IQHIT model points to the key role of professional information management for HIT workflow support in patient care and perceived HIT quality from the viewpoint of hospital chief information officers. Furthermore, it highlights that organizational innovation capabilities, particularly with respect to the top management team, facilitate HIT quality and suggests that health organizations establish this link by applying professional information management practices. The model may serve to stimulate further scientific work in the field of HIT adoption and diffusion and to provide practical guidance to managers, policy makers, and educators on how to achieve better patient care using HIT.The proposed sociotechnical IQ Althoachieved . These iinner capabilities with regard to managerial skills, the promotion of HIT use, project execution, and innovation promotion [It has been repeatedly demonstrated that large health organizations often struggle to adopt high-quality and modern HIT solutions and are challenged with increasingly shorter innovation cycles of these technologies -15. The romotion -18. Althromotion -24 and vromotion ,12,25-28romotion .HIT adoption is most often understood as the implementation, that is, the introduction of an application, and its acceptance and use in an organization and many adoption studies focus on specific functionalities or applications ,21,27. HHIT information management encompasses the full spectrum of strategic, tactical, and operational management tasks to build and operate an organization’s information system ,36. ManaFinally, HIT quality manifests itself not only in the technical quality of HIT but also in the subjective assessment of the implemented IT solutions that is hereinafter referred to as the perceived HIT quality.In addition to HIT quality, there is also little understanding about the identification and effect of the organization’s capabilities to innovate; however, as van Gemert-Pijnen et al  emphasizOnly a few theoretical frameworks incorporate the peculiarities and complexity of organization-wide HIT solutions in a way that allows for an assessment of its quality and success ,24,34. OHIT  model  model . It restOn the basis of this model, the research goal was to empirically test and explain how health organizations’ ICs are linked to HIT quality.Serving as empirical input for the model, data from chief information officers (CIOs) as hospital representatives were obtained. Hospitals are particularly interesting because of both the complexity of their IT and their organizational environment. We chose CIOs as our target group because they have the best oversight of the entirety of the IT landscape and top management issues ,63. We iEmail addresses of 1669 CIOs were compiled through internet and telephone searches. The CIOs were responsible for 2324 hospitals . Data collection took place during the first half of 2017 via a web-based survey. Of the 1669 emails sent, 1499 had come through and 251 CIOs participated (17% response rate)—19 answers were discarded because of incompleteness . The descriptive results were made available in 2018 , and as reflect the latent construct), formative measurement models , and single-item scales without identification problems [We applied structural equation modeling (SEM) to test various interrelationships between constructs. Specifically, we chose partial least squares structural equation modeling as it is tolerant of the use of categorical data and allows for including reflective measurement models  in health care in terms of the regularity of 15 management key tasks and practices, as proposed by Thye et al . As PIM HIT workflow support can be theorized as being constituted by the descriptors data and information, IT functions, integration, and distribution of data and IT functions . These 4Perceived HIT quality was measured using the 2 constructs. First, we asked the CIOs to grade the HIT workflow support (perceived HIT workflow support) in all 5 aforementioned clinical care processes separately and included the resulting indicators in a reflective measurement model. Second, we asked for a concluding assessment  of the overall goodness of information provision, that is, the organization’s general ability to provide the right information, at the right time, at the right place, for the right persons, and in the right quality to support patient care processes. This indicator was applied in a previous study .We investigated this domain and the underlying constructs across the 2 preceding surveys ,52. The A total of 2 covariates were included in the model. First, to control for well-known structural characteristics, we included a formative measurement model that was composed of the hospital size (bed count) and its teaching status. Second, the country was included as a single-item scale to account for external conditions. Austrian and Swiss hospitals were pooled to obtain more balanced group sizes.The specifications of the structural model resulted from a step-wise build-up of testing the direct and mediated effects along the components of the conceptual model. Each step was thereby rooted in findings from studies that suggest individual linkages between the constructs, which we summarized into a set of 12 theoretical assumptions . On the We applied partial least squares structural equation modeling using SmartPLS version 3 . The meaP values and 95% CIs obtained from 10,000 bootstrap replications. Besides the R² values for the endogenous latent variables, we used blindfolding to obtain Stone-Geisser Q² values to determine the cross-validated predictive relevance of the exogenous constructs.Inner variance inflation factor values were used to test for collinearity within the structural model. Path coefficients and mediation effects were evaluated based on the direct, total, and indirect effects as well as on f² effect sizes with The sample consisted of data from 232 hospitals, most of which were from Germany , which cThe parameters assessing the measurement models pointed to valid specifications of the reflective models as well as the formative model in terms of convergent validity and internal consistency  and 5. IThe 21 hypotheses  led to aP<.001). This association was partially mediated by the use of clinical IT agents to a small but significant extent , the items mirror the motivational and monetary support of the TMT for IT innovation and their proactive engagement with respective projects as part of the organization’s vision. Similar to the views in the Upper Echelons Theory, which stresses the crucial role of senior leadership in fostering innovation, this factor had a strong predictive relevance across the model [The IQhe model . IC ITD he model ,95,96 anhe model ,97,98 toThis study did not explicitly focus on how these capabilities can be built or how they are determined. However, when controlling for the covariates, we found that TMT support is a function of certain structural characteristics, namely, a higher bed count and teaching status, both of which can be interpreted as indicators of greater financial flexibility in terms of slack resources. However, ICs at the IT department and the organization at large depend on the respective country. More precisely, these 2 domains are more pronounced in Austria and Switzerland than in Germany, which corresponds well with previous findings on different samples ,49.Traditionally, empirical research conducted on HIT quality has frequently disregarded aspects of innovation, and both have often been discussed separately from one another . Our modright attitude toward innovation and formalized management practices for innovational strength. The attitude and intent to innovate play an important role in and of itself; however, professional information management is needed for the practical execution of this intention to improve HIT workflow support.Overall, the structural model  can be tFurthermore, we found IC OW to partly moderate the relationship between the HIT workflow support and the perceived OGIP, implying that there might actually be a direct effect between the 2 as long as the organization is agile, flexible, and open toward IT . This could be interpreted as an indication that an organization-wide positive attitude toward using the IT in place, irrespective of how advanced it actually is, leads to better information provision in the clinical care processes, at least from the vantage point of CIOs. Overall, it becomes clear that ICs are not only needed at the TMT level but also at the IT department level and throughout the organization to establish high-quality HIT solutions. Executive managers and policy makers should therefore consider how to establish higher levels of these capabilities at various levels.Our study had several limitations. Most notably, this is an observational study, and despite the statistical specifications that might suggest otherwise, it cannot be inferred that the relationship between constructs is truly causal. For instance, there might be temporal displacements between the current beliefs of executives and higher degrees of HIT quality as implementation processes take time .right side of the model), which requires a more detailed assessment in future research. Ultimately, the clinical outcome is the improvement or stabilization of the patient’s condition. None of this is captured in this model, as it mirrors the vantage point of CIOs. The next step will be to develop a model that incorporates the views of physicians and nurses. This approach can also cope with potential common-method biases. The sample is also based on voluntary participation, which is why we cannot rule out a nonresponse bias in the data.Furthermore, this sociotechnical model reflects the perspective of the CIOs and their points of view of the HIT cosmos and ICs. This is both a strength and a weakness. The strength is its consistency and authenticity regarding technical and organizational issues related to IT. Its weakness is the CIOs cannot accurately evaluate clinicians’ view on the timely and correct provision of data and information (ie, the Finally, not all possibly relevant factors at play can be accurately accounted for in one model, which is reflected by the R² values that leave parts of the variance in the endogenous constructs unexplained. Given these limitations, further studies are needed to validate and differentiate the relationships between and within IC and HIT quality, and our model provides various access points to do so.HIT model to explain how organizational innovation relates to various facets of HIT quality. Although some associations in the model could be presumed by the literature, it clearly and uniquely highlights the key role of ICs and information management for HIT-based workflow support. Thus, it demonstrates that innovation and quality do not contradict each other. In particular, an innovation-friendly attitude of TMT and the IT department determines the degree of HIT workflow support, albeit not directly, but by means of professional information management practices that eventually facilitate the perceived goodness of information provision for patient care. This suggests that managers of health organizations should strive for both a more pronounced culture toward innovation and professional information management to translate such a culture into HIT quality. Furthermore, the IQHIT model might be useful for studies on HIT adoption and diffusion and for the definition of HIT maturity models. To this end, it provides validated measurement scales that can be utilized in future research.On the basis of survey data provided by the CIOs of 232 hospitals, we proposed a sociotechnical IQ


In a world being hit by waves of COVID-19, vaccination is a light on the horizon. However, the roll-out of vaccination strategies and their influence on the pandemic are still open questions. In order to compare the effect of various strategies proposed by the World Health Organization and other authorities, a previously developed SEIRS stochastic model of geographical spreading of the virus is extended by adding a compartment for vaccinated people. The parameters of the model were fitted to describe the pandemic evolution in Argentina, Mexico and Spain to analyze the effect of the proposed vaccination strategies. The mobility parameters allow to simulate different social behaviors (e.g. lock-down interventions). Schemes in which vaccines are applied homogeneously in all the country, or limited to the most densely-populated areas, are simulated and compared. The second strategy is found to be more effective. Moreover, under the current global shortage of vaccines, it should be remarked that immunization is enhanced when mobility is reduced. Additionally, repetition of vaccination campaigns should be timed considering the immunity lapse of the vaccinated (and recovered) people. Finally, the model is extended to include the effect of isolation of detected positive cases, shown to be important to reduce infections. Some countries are going through the effects of a second or third wave of infections while others are still suffering the first. As the top priority is to diminish the number of susceptible people, in order to minimize the propagation of the virus, several laboratories started to develop vaccines last year. Many of them have reached promising advances and the first generation of vaccines has been already validated by health authorities in many countries3.Since the early appearance of SARS-CoV-2 in November 2019 in Wuhan, the world faces a new disease, COVID-19. All governments, without exception, had to quickly devise strategies against this unexpected threat to public health. Meanwhile, the scientific community is advancing in the understanding of all aspects of this disease, which has become a pandemic at a fast rate and with a strength unknown in contemporary history (i.e. more than 127 million cases and 2.7 million deaths worldwide in 16 months)At present, various emergency-approved vaccines have reached an efficacy above 90% in preventing COVID-19 infections, and more importantly, they protect against serious cases requiring hospitalization and reduce lethality.4 some people have already been vaccinated .As a consequence, different vaccination plans and strategies have emerged around the world. More than 1 year after the isolation of the virus6, Brazil, SouthAfrica7), which are more transmissible than the previously circulating strain of the virus.Nevertheless, at present vaccine shortage prevails, and international requests are made to the laboratories to increase their vaccine production. More recently, new variants of SARS-CoV-2 with different mutations were detected 11. In this work, we have extended previous approaches by including the possibility of a decrease in the number of susceptible people, as a consequence of a schedule of massive vaccination.The complexity of the problem deserves to be treated multidisciplinarily. In this sense compartmental models have been useful to describe and predict different disease scenarios10 and added a compartment to account for vaccinated people, which during the vaccine immunity-period are removed from the susceptible group. We fit the model parameters describing the pandemic evolution in Argentina, Mexico and Spain, respectively, and we analyze the effect of various vaccination strategies with different number of stages and timing regarding their application.Concretely, we use a SEIRS  stochastic model of geographical spreading of the diseaseThese strategies are based on realistic proposals by the World Health Organization (WHO) and governments, and account for different social behaviors (as lock-down limitations on mobility e.g.), and also if the vaccines are applied either homogeneously or limited to the most densely-populated areas.11 and thus assess the long-term vaccination effects more realistically.Finally, we also included the effect of quarantines on detected positive cases, an effective measure used to reduce infections in many countries, in order to improve the description of the pandemic evolutionOur analyses focus on three different countries , however, the approach could be applied to any country or local jurisdiction that needs to devise a vaccination plan.In the next section we present the model, then we exhibit and analyze our results, and finally we discuss them, remarking their relevance in order to optimize the effect of vaccination plans in the context of vaccine shortages.The present model includes the virus spreading at two levels: (i) Local dynamics: consisting of a compartmental model whose constant parameters are related to the specific disease agent and the host’s immune response, and (ii) Global dynamics of geographical disease spreading: involving mobility parameters related to social habits of the country and affected, at different times, by different non-pharmaceutical interventions by the different governments.i, j), covering the whole region. Roads between cities were used to allow short or long distance travelling within the grid. Population size (N) is assumed to be constant during the simulated period. If life expectancy is given by L and for the mortality we assume an exponential functional form with constant rate In order to implement the model, a geographical map of the region of interest is divided into square cells with coordinates ).Population density heterogeneity is considered by using a matrix whose entries are the actual population densities ) that might become exposed ) yet not infectious. They become infected ) after the incubation period R) individuals, remain immune for S. Vaccines are applied to susceptible people according to a vaccination rate V) compartment have already received as many shots as recommended by pharmaceutics and have developed immunity, thus do not transmit the infection.The local dynamics within each cell is calculated using a model with four different compartments see Fig. . These iHowever this immunity lasts mentclass2pt{minim in Eqs.  .1\documi, j). The transmission parameter The sum r); if It is considered that people sometimes move locally in non-predictable ways. Therefore, randomness is added to cell dynamics. A local mobility parameter per cell  to cell . The flows of people between large cities are greater than between small ones. Therefore, in this case r. As before, spreader cells are those where Long distance travel takes place by air and land thus we define a long distance mobility parameter One needs to consider the appearance of epidemic outbreaks in unexpected places because people make unpredictable trips to distant sites therefore we assume noise in the transmission process. Considering this noise as analogous to the “kinetic energy” of the system, if 10, and Barreiro et al.11, for all countries. For simplicity, mobility parameters are considered equal v changes along time according to non-pharmaceutical interventions adopted by each specific government at specific dates.Numerical calculations were performed using maps of population density and road connections for the various countries.  but they are spatially distributed in a different way. While Argentina has a large territory with few overpopulated areas surrounded by territories with few people, Spain has a more homogeneous distribution of its population. This leads to quite different connections among cities (flow of travellers).Argentina and Mexico are populated quite heterogeneously but they have very different total populations: 127 and 45 million respectively.These features are ideal to compare the effect of the model parameters, such as mobility or the increase in the number of vaccines, in different contexts.In order to analyze their influence in the pandemic evolution, we considered different vaccination strategies by varying (a) The total number of vaccines administered in different stages according to their availability ; (b) the timing between stages; (c) the vaccine immunity time, At present, in most of the world the number of vaccines is lower than needed. Therefore, it is not possible to ensure their availability, according to the plans made by each government, and many delays are expected. Furthermore, there are multiple variables  that affect social behavior making it difficult to predict future mobility in each country. Because of this, we emphasize that we do not intend to make specific predictions  but to compare different vaccination scenarios presently under consideration by the corresponding decision makers.13).Due to constraints on the availability of vaccines in the great majority of countries, different vaccine distribution schemes have been proposed , joined already by two-thirds of the world’s countries. To protect the majority of the world’s population against the virus spread and its global impact, COVAX was launched with the initial aim of having 2 billion global vaccine doses available by end of 2021, and a distribution in stages. To ensure equitable access to the world’s largest and most diverse portfolio of safe and effective vaccines, each participant country can request vaccines to cover between 10 and 5014), predicting a 50Studies support such a global equitable scheme  were performed. An homogeneous distribution of vaccines was simulated while the number of vaccines applied was changed at the third stage from 10 to 50For the case of If Social behavior is reflected in the mobility parameters used in the model to fit the reported data for a country. Figure Figure Figure Figure The vaccination of people in highly populated areas is clearly a better strategy to reduce the amount of daily cases This is because most of the infectious hot spots appear in densely populated areas. From there people carry the disease to smaller cities and towns. Moreover, when the main infection sources are turned off, the disease tends to disappear in the whole country.From these considerations it can be concluded that good results could be achieved for Argentina by applying a strategy combining social distancing and vaccination, even if only 62% of the population were immunized, This percentage corresponds to 28 million people, which is the maximum number of vaccines that might be purchased in Argentina during the whole 2021 year, according to the approved national budget .As the pandemic seems to be significantly reduced after an adequate relation between responsible social behavior and vaccination, a new question emerges. How long will it last? In order to answer this question we propose different scenarios in Argentina and Mexico that are shown in Fig. First, Mexico will vaccinate health workers, then, people aged more than 60 years. Next, people between 50 and 59, after them people between 40 and 49 , and finally, the rest of the population. Taking into account the proportion of the population considered in each age group, we estimated the vaccination strategy shown in the lower panel of Table Figure Figure As a conclusion and independently of the actual value of 20 have shown that most countries are capable of detecting only a fraction of the infected cases. The reason being that most people are asymptomatic or present mild symptoms22 and do not always seek for medical attention23.Previous studies28. Taking this into account, track and trace policies, along with social distancing and vaccination, should be considered the main pillars to eradicate the pandemic.Many articles have emphasized the need to improve infected tracking and contact tracing, as a way to reduce the incidence of the pandemic by isolating those detected as positive11.With this in mind, we added a new compartment to our model in order to consider infected people who were isolated. The model with the quarantined (Q) compartment is described in detail in Barreiro et al.p of people who is actually ill is tested and that they get isolated after p fraction of people stop infecting others reducing the pandemic evolution rate  and this generates the appearance of a second wave around March 2022. As was shown above for the SEIRS-V model, a longer vaccine immunity period delays the appearance of new pandemic waves.Figure Figure entclass1pt{minimap between 0.08 and 0.1 , Finally, Fig. This strategy establishes that vaccines are administered at an approximately constant rate throughout the year. Therefore a baseline of immunized people is created, which causes the reduction of the susceptible group by almost 50 million people. This kind of administration method also reduces the incidence of new pandemic waves making a difference with respect to the cases of Argentina and Spain.11.Different vaccination strategies for the Covid-19 were analyzed using a novel epidemiological model with stochastic dynamics of infections in a geographical region. This approach has proven to exhibit a reliable long term predictive powerThe parameters defining the disease, as transmission rate, latency and infectiousness periods, can be adjusted with real data taken during a short time after the first outbreak. Furthermore, the parameters regulating the spread of the pandemic in a country have a clear and direct relationship with the measures taken by the authorities and followed by citizens.This strategy has allowed us to predict the dynamical behavior of the pandemic in three very different countries, like Argentina, Mexico and Spain. There, we include the suggested vaccination strategies and analyze the results under different scenarios which take into account the difficulties caused by the current global vaccine shortage.The mobility parameters of our model allow to simulate different social behaviors , and analyze the effect of different vaccine distribution strategies. One could also analyze the predictions using a strategy based on a homogeneous vaccination of the population, or when prioritizing the most densely populated areas.In a context of doses shortage, our model predicts that the most effective strategy in reducing infections is the vaccination of the most-densely populated areas.Since the epidemic reappears periodically, we found that vaccination campaigns should be repeated. In order to optimize the effect of these, one should take into account the immunity period of the vaccines to prevent premature future outbreaks. Keeping the number of contagions low is of great importance, as a large number of infections favors the appearance of mutations and, eventually, of new vaccine-resistant strains.30. However, for the case of COVID-19, we learnt from our model that it depends on the number of already infected people and the interplay of disease and vaccine related-factors. Among the virus factors we considered the influence of the immunity time after recovery and the probability of reinfections. While for the vaccine-related factors, we explored the effects of the time period of immunity conferred by the vaccine, the percentage of population vaccinated, and the pace of vaccine delivery.Regarding the so called herd immunity, understood as the successful suppression of the epidemic reached when enough people are immune to the virus, previous works estimate its threshold for SARS-CoV-2 in the range from 10 to 70The probability of infection is affected by logistical, social and demographic factors and it is key to the adopted vaccination strategy. As was mentioned before, there are huge differences between a scheme based on a demographic homogeneous vaccine delivery and one that prioritizes the most densely-populated areas. We found that the vaccination impact is larger in countries with less connected cities, combined with a low mobility.From modelling concrete vaccination strategies in countries with very different demographic features, it can be clearly concluded that in the case of a limited number of vaccines, herd immunity is not achieved using vaccination strategies alone. A combination of mobility control, detection and isolation of infected people  is needed to drastically reduce infections. Such measures have negative socio-economic impacts at the local  level. However, these could be minimized by optimizing the allocation of vaccines.As it is usual, when modelling a complex situation it is necessary to consider limitations of the model. For instance, the fact that full immunization for a particular individual is obtained only after the second shot for most vaccines. Taking into account the detailed process of vaccination and the individual immune response, will necessarily complicate the model with no obvious improvement on its prediction power. Nevertheless, it is clear that the model could be adapted to include more doses of the vaccine and its efficiency if it is needed to assess the appropriateness of detailed vaccine distribution strategies.We want to stress that the model presented here could be extended to consider the appearance of new strains with different biological properties and future pharmaceutical and non-pharmaceutical measures which will make it extremely useful in handling the pandemic.31. There are 130 nations with 2.5 billion people that have not received a single vaccine yet32, where the COVID-19 virus with uncontrolled transmission, has a perfect playground to evolve into dangerous variants, even immune to the developed vaccines.Some guidelines can be learnt from our model as it was shown and discussed in this work. However, the worldwide vaccination allocation should be approached carefullyAn outbreak there, has the potential to become an outbreak anywhere. In this respect, our model could be extended from one particular country to a continent or even to the whole world in order to compare different vaccine global distribution strategies.32 available to date, aside the COVAX agreement. This will extend the time frame of the pandemic and the economical burden worldwide34. Unless a worldwide vaccine allocation strategy based on health and epidemiological needs is implemented, humanity will not be able to achieve global herd immunity soon enough and will suffer the consequences of COVID-19 for much longer.Despite the real threat, the current global vaccine allocation is driven by national interest and consequently it is highly asymmetric. High-income countries, representing Supplementary Information.