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Thorpe A, Fagerlin A, Drews FA, Shoemaker H, Brecha FS, Scherer LD. Predictors of COVID-19 vaccine uptake: an online three-wave survey study of US adults. BMC Infect Dis 2024; 24:304. [PMID: 38475702 DOI: 10.1186/s12879-024-09148-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND To effectively promote vaccine uptake, it is important to understand which people are most and least inclined to be vaccinated and why. In this study, we examined predictors of COVID-19 vaccine uptake and reasons for non-vaccination. METHODS We conducted an online English-language survey study in December-2020, January-2021, and March-2021. A total of 930 US respondents completed all surveys. Multiple logistic regression models were run to test whether the early vaccine eligibility, demographic factors, and psychological factors predict getting at least one dose of a COVID-19 vaccination in January-2021 and in March-2021. RESULTS The proportion of respondents who received ≥ 1-dose of a COVID-19 vaccine increased from 18% (January) to 67% (March). Older age predicted vaccine uptake in January (OR = 2.02[95%CI = 1.14-3.78], p < .001) and March (10.92[6.76-18.05], p < .001). In January, additional predictors were higher numeracy (1.48[1.20-1.86], p < .001), COVID-19 risk perceptions (1.35[1.03-1.78], p = .029), and believing it is important adults get the COVID-19 vaccine (1.66[1.05-2.66], p = .033). In March, additional predictors of uptake were believing it is important adults get the COVID-19 vaccine (1.63[1.15-2.34], p = .006), prior COVID-19 vaccine intentions (1.37[1.10-1.72], p = .006), and belief in science (0.84[0.72-0.99], p = .041). Concerns about side effects and the development process were the most common reasons for non-vaccination. Unvaccinated respondents with no interest in getting a COVID-19 vaccine were younger (0.27[0.09-0.77], p = .016), held negative views about COVID-19 vaccines for adults (0.15[0.08-0.26], p < .001), had lower trust in healthcare (0.59[0.36-0.95], p = .032), and preferred to watch and wait in clinically ambiguous medical situations (0.66[0.48-0.89], p = .007). CONCLUSIONS Evidence that attitudes and intentions towards COVID-19 vaccines were important predictors of uptake provides validation for studies using these measures and reinforces the need to develop strategies for addressing safety and development concerns which remain at the forefront of vaccine hesitancy.
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Affiliation(s)
- Alistair Thorpe
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, USA.
- Department of Applied Health Research, University College London, London, UK.
| | - Angela Fagerlin
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, USA
- Salt Lake City VA Informatics Decision- Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, USA
| | - Frank A Drews
- Salt Lake City VA Informatics Decision- Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, USA
- University of Utah College of Social and Behavioral Science, Salt Lake City, UT, USA
| | - Holly Shoemaker
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, USA
- Salt Lake City VA Informatics Decision- Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, USA
| | - Federica S Brecha
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, USA
- Department of Pediatrics, Columbia University, New York, NY, USA
| | - Laura D Scherer
- Division of Cardiology, University of Colorado, School of Medicine, Aurora, CO, USA
- Denver VA Center of Innovation, Denver, CO, USA
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French ML, Christensen JT, Estabrooks PA, Hernandez AM, Metos JM, Marcus RL, Thorpe A, Dvorak TE, Jordan KC. Evaluation of the Effectiveness of a Bilingual Nutrition Education Program in Partnership with a Mobile Health Unit. Nutrients 2024; 16:618. [PMID: 38474746 DOI: 10.3390/nu16050618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
There are limited reports of community-based nutrition education with culinary instruction that measure biomarkers, particularly in low-income and underrepresented minority populations. Teaching kitchens have been proposed as a strategy to address social determinants of health, combining nutrition education, culinary demonstration, and skill building. The purpose of this paper is to report on the development, implementation, and evaluation of Journey to Health, a program designed for community implementation using the RE-AIM planning and evaluation framework. Reach and effectiveness were the primary outcomes. Regarding reach, 507 individuals registered for the program, 310 participants attended at least one nutrition class, 110 participants completed at least two biometric screens, and 96 participants attended at least two health coaching appointments. Participants who engaged in Journey to Health realized significant improvements in body mass index, blood pressure, and triglycerides. For higher risk participants, we additionally saw significant improvements in total and LDL cholesterol. Regarding dietary intake, we observed a significant increase in cups of fruit and a decrease in sugar sweetened beverages consumed per day. Our findings suggest that Journey to Health may improve selected biometrics and health behaviors in low-income and underrepresented minority participants.
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Affiliation(s)
- Madeleine L French
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT 84112, USA
| | - Joshua T Christensen
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84112, USA
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT 84112, USA
| | - Paul A Estabrooks
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT 84112, USA
| | - Alexandra M Hernandez
- Osher Center for Integrative Health, University of Utah Health, Salt Lake City, UT 84112, USA
| | - Julie M Metos
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT 84112, USA
| | - Robin L Marcus
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT 84108, USA
| | - Alistair Thorpe
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84112, USA
| | - Theresa E Dvorak
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT 84112, USA
| | - Kristine C Jordan
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT 84112, USA
- Osher Center for Integrative Health, University of Utah Health, Salt Lake City, UT 84112, USA
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Sirota M, Habersaat KB, Betsch C, Bonga DL, Borek A, Buckel A, Butler R, Byrne-Davis L, Caudell M, Charani E, Geiger M, Gross M, Hart J, Kostopoulou O, Krockow EM, Likki T, Lo Fo Wong D, Santana AP, Sievert EDC, Theodoropoulou A, Thorpe A, Wanat M, Böhm R. We must harness the power of social and behavioural science against the growing pandemic of antimicrobial resistance. Nat Hum Behav 2024; 8:11-13. [PMID: 37985918 DOI: 10.1038/s41562-023-01762-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Affiliation(s)
- Miroslav Sirota
- Department of Psychology, University of Essex, Colchester, UK.
| | | | - Cornelia Betsch
- Health Communication, Institute for Planetary Health Behaviour, University of Erfurt, Erfurt, Germany
- Health Communication, Implementation Research, Bernhard Nocht Institute for Tropical Medicine Hamburg, Hamburg, Germany
| | - Daniela Lejla Bonga
- Behavioural and Experimental Economics Team, Ministry of Health, Bratislava, Slovakia
| | - Aleksandra Borek
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Anica Buckel
- Food and Agriculture Organisation of the United Nations, Nairobi, Kenya
| | - Robb Butler
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Lucie Byrne-Davis
- Division of Medical Education, University of Manchester, Manchester, UK
| | - Mark Caudell
- Food and Agriculture Organisation of the United Nations, Nairobi, Kenya
| | - Esmita Charani
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Mattis Geiger
- Health Communication, Institute for Planetary Health Behaviour, University of Erfurt, Erfurt, Germany
- Health Communication, Implementation Research, Bernhard Nocht Institute for Tropical Medicine Hamburg, Hamburg, Germany
| | - Marina Gross
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Jo Hart
- Division of Medical Education, University of Manchester, Manchester, UK
| | - Olga Kostopoulou
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Eva M Krockow
- School of Psychology and Vision Sciences, University of Leicester, Leicester, UK
| | - Tiina Likki
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Danilo Lo Fo Wong
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Ana P Santana
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth D C Sievert
- Health Communication, Institute for Planetary Health Behaviour, University of Erfurt, Erfurt, Germany
- Health Communication, Implementation Research, Bernhard Nocht Institute for Tropical Medicine Hamburg, Hamburg, Germany
| | | | - Alistair Thorpe
- Department of Applied Health Research, University College London, London, UK
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Marta Wanat
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Robert Böhm
- Faculty of Psychology, University of Vienna, Vienna, Austria
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Center for Social Data Science (SODAS), University of Copenhagen, Copenhagen, Denmark
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Thorpe A, Gurmankin Levy A, Scherer LD, Scherer AM, Drews FA, Butler JM, Fagerlin A. Impact of prior COVID-19 infection on perceptions about the benefit and safety of COVID-19 vaccines. Am J Infect Control 2024; 52:125-128. [PMID: 37544513 PMCID: PMC10839102 DOI: 10.1016/j.ajic.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
In this online survey of 1,733 US adults in December 2021, respondents believed COVID-19 vaccines are less beneficial and less safe for someone who had already had COVID-19. Those who experienced COVID-19 after being vaccinated believed that the vaccines are less beneficial and less safe than those who had not. Findings highlight the need to better communicate evolving evidence of COVID-19 vaccine benefit and safety and to tailor communications to peoples' COVID-19 history and vaccination status.
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Affiliation(s)
- Alistair Thorpe
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT.
| | - Andrea Gurmankin Levy
- Department of Social & Behavioral Sciences, Education, & Public Service, Middlesex Community College, Middletown, CT
| | - Laura D Scherer
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO; VA Eastern Colorado, Center of Innovation (COIN), Aurora, CO
| | - Aaron M Scherer
- Department of Internal Medicine, Carver College of Medicine at the University of Iowa, Iowa City, IA
| | - Frank A Drews
- Department of Psychology, University of Utah College of Social and Behavioral Science, Salt Lake City, UT; Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT
| | - Jorie M Butler
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT; Geriatrics Research, Education, and Clinical Center (GRECC), VA Salt Lake City Health Care System, Salt Lake City, UT; Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, UT; Department of Biomedical Informatics, University of Utah, Salt Lake City, UT
| | - Angela Fagerlin
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT; Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT
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Butler JM, Wang X, Riddoch M, Thorpe A, Stevens V, Scherer LD, Drews FA, Shoemaker H, Fagerlin A. Veterans and Nonveterans Coping With Stress During 4 Months of COVID-19. Ann Fam Med 2023; 21:508-516. [PMID: 38012035 PMCID: PMC10681693 DOI: 10.1370/afm.3046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE Identifying how people have been coping with stress during the COVID-19 pandemic allows us to anticipate how the population may react to similar stressors over time. In this study, we assessed patterns of coping styles among veterans and nonveterans, and stability and change in these strategies at 3 time points during the pandemic. METHODS Using an online survey platform, we circulated a questionnaire at 3 time points during the period when COVID-19 vaccines became widely available (December 2-27, 2020; January 21-February 6, 2021; and March 8-23, 2021). The questionnaire asked participants about their extent of use of 11 coping strategies, and symptoms of anxiety and depression. RESULTS A total of 2,085 participants (50.8% veterans) completed the questionnaire at 1 or more time points and 930 participants (62.8% veterans) completed it at all 3 time points. Cluster analysis identified 3 distinct coping styles: adaptive, distressed, and disengaged. Compared with nonveterans, veterans more commonly had adaptive and disengaged coping styles, and less commonly had a distressed coping style. The majority of the cohort (71.3%) changed coping style at least once during the study period. Participants who used the same coping style across all 3 time points reported lower levels of anxiety and depression. CONCLUSIONS Our data demonstrate a need to better understand the dynamic nature of coping with pandemic-level stressors across time. We did not find patterns of change in coping styles, but our findings point to potential advantages of stability in coping style. It is possible that less adaptive styles that are more stable may be advantageous for mental health. This research has implications for supporting patients dealing with stress in family medicine.
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Affiliation(s)
- Jorie M Butler
- Department of Biomedical Informatics, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah
- Geriatrics Research, Education, and Clinical Center (GRECC), VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - Xuechen Wang
- Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah
| | - Marian Riddoch
- Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah
| | - Alistair Thorpe
- Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah
| | - Vanessa Stevens
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah
- Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah
| | - Laura D Scherer
- University of Colorado School of Medicine, Aurora, Colorado
- VA Denver Center for Innovation, Denver, Colorado
| | - Frank A Drews
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah
- University of Utah College of Social and Behavioral Science, Salt Lake City, Utah
| | - Holly Shoemaker
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah
- Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah
| | - Angela Fagerlin
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah
- Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah
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Shoemaker HE, Thorpe A, Stevens V, Butler JM, Drews FA, Burpo N, Scherer LD, Fagerlin A. Telehealth Use During the COVID-19 Pandemic Among Veterans and Nonveterans: Web-Based Survey Study. JMIR Form Res 2023; 7:e42217. [PMID: 37527547 PMCID: PMC10494868 DOI: 10.2196/42217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 03/15/2023] [Accepted: 07/25/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND In the first year of the COVID-19 pandemic, studies reported delays in health care usage due to safety concerns. Delays in care may result in increased morbidity and mortality from otherwise treatable conditions. Telehealth provides a safe alternative for patients to receive care when other circumstances make in-person care unavailable or unsafe, but information on patient experiences is limited. Understanding which people are more or less likely to use telehealth and their experiences can help tailor outreach efforts to maximize the impact of telehealth. OBJECTIVE This study aims to examine the characteristics of telehealth users and nonusers and their reported experiences among veteran and nonveteran respondents. METHODS A nationwide web-based survey of current behaviors and health care experiences was conducted in December 2020-March 2021. The survey consisted of 3 waves, and the first wave is assessed here. Respondents included US adults participating in Qualtrics web-based panels. Primary outcomes were self-reported telehealth use and number of telehealth visits. The analysis used a 2-part regression model examining the association between telehealth use and the number of visits with respondent characteristics. RESULTS There were 2085 participants in the first wave, and 898 (43.1%) reported using telehealth since the pandemic began. Most veterans who used telehealth reported much or somewhat preferring an in-person visit (336/474, 70.9%), while slightly less than half of nonveterans (189/424, 44.6%) reported this preference. While there was no significant difference between veteran and nonveteran likelihood of using telehealth (odds ratio [OR] 1.33, 95% CI 0.97-1.82), veterans were likely to have more visits when they did use it (incidence rate ratio [IRR] 1.49, 95% CI 1.07-2.07). Individuals were less likely to use telehealth and reported fewer visits if they were 55 years and older (OR 0.39, 95% CI 0.25-0.62 for ages 55-64 years; IRR 0.43, 95% CI 0.28-0.66) or lived in a small city (OR 0.63, 95% CI 0.43-0.92; IRR 0.71, 95% CI 0.51-0.99). Receiving health care partly or primarily at the Veterans Health Administration (VA) was associated with telehealth use (primarily VA: OR 3.25, 95% CI 2.20-4.81; equal mix: OR 2.18, 95% CI 1.40-3.39) and more telehealth visits (primarily VA: IRR 1.5, 95% CI 1.10-2.04; equal mix: IRR 1.57, 95% CI 1.11-2.24). CONCLUSIONS Telehealth will likely continue to be an important source of health care for patients, especially following situations like the COVID-19 pandemic. Some groups who may benefit from telehealth are still underserved. Telehealth services and outreach should be improved to provide accessible care for all.
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Affiliation(s)
- Holly E Shoemaker
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, United States
| | - Alistair Thorpe
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Vanessa Stevens
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, United States
- Department of Internal Medicine, Division of Epidemiology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Jorie M Butler
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, United States
- Geriatrics Research, Education, and Clinical Center, VA Salt Lake City Health Care System, Salt Lake City, UT, United States
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
- Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Frank A Drews
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, United States
- Department of Psychology, College of Social and Behavioral Science, University of Utah, Salt Lake City, UT, United States
| | - Nicole Burpo
- Research Operations, American Heart Association, Dallas, TX, United States
| | - Laura D Scherer
- University of Colorado School of Medicine, Aurora, CO, United States
- VA Denver Center for Innovation, Denver, CO, United States
| | - Angela Fagerlin
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, United States
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Scharnetzki E, Waterston L, Scherer AM, Thorpe A, Fagerlin A, Han PKJ. Effects of Prosocial and Hope-Promoting Communication Strategies on COVID-19 Worry and Intentions for Risk-Reducing Behaviors and Vaccination: Experimental Study. JMIR Form Res 2023; 7:e41959. [PMID: 37379364 PMCID: PMC10411423 DOI: 10.2196/41959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 04/11/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has engendered widespread fear and skepticism about recommended risk-reducing behaviors including vaccination. Health agencies are faced with the need to communicate to the public in ways that both provide reassurance and promote risk-reducing behaviors. Communication strategies that promote prosocial (PS) values and hope are being widely used; however, the existing research on the persuasiveness of these strategies has offered mixed evidence. There is also very little research examining the comparative effectiveness of PS and hope-promoting (HP) strategies. OBJECTIVE The aim of this study is to evaluate the comparative effectiveness of PS and HP messages in reassuring the public and motivating COVID-19 risk-reducing behaviors. METHODS A web-based factorial experiment was conducted in which a diverse sample of the US public was randomized to read messages which adapted existing COVID-19 information from a public website produced by a state government public health department to include alternative framing language: PS, HP, or no additional framing (control). Participants then completed surveys measuring COVID-19 worry and intentions for COVID-19 risk-reducing behaviors and vaccination. RESULTS COVID-19 worry was unexpectedly higher in the HP than in the control and PS conditions. Intentions for COVID-19 risk-reducing behaviors did not differ between groups; however, intentions for COVID-19 vaccination were higher in the HP than in the control condition, and this effect was mediated by COVID-19 worry. CONCLUSIONS It appears that HP communication strategies may be more effective than PS strategies in motivating risk-reducing behaviors in some contexts but with the paradoxical cost of promoting worry.
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Affiliation(s)
- Elizabeth Scharnetzki
- Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, Portland, ME, United States
| | - Leo Waterston
- Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, Portland, ME, United States
| | - Aaron M Scherer
- Department of Internal Medicine, University of Iowa, Iowa City, IA, United States
| | - Alistair Thorpe
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, United States
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences Center for Innovation, University of Utah School of Medicine, Salk Lake City, UT, United States
| | - Paul K J Han
- Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, Portland, ME, United States
- Tufts University School of Medicine, Boston, MA, United States
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, United States
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Thorpe A, Delaney RK, Pinto NM, Ozanne EM, Pershing ML, Hansen LM, Lambert LM, Fagerlin A. Parents' Psychological and Decision-Making Outcomes following Prenatal Diagnosis with Complex Congenital Heart Defect: An Exploratory Study. MDM Policy Pract 2023; 8:23814683231204551. [PMID: 37920604 PMCID: PMC10619352 DOI: 10.1177/23814683231204551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 08/24/2023] [Indexed: 11/04/2023] Open
Abstract
Background. Parents with a fetus diagnosed with a complex congenital heart defect (CHD) are at high risk of negative psychological outcomes. Purpose. To explore whether parents' psychological and decision-making outcomes differed based on their treatment decision and fetus/neonate survival status. Methods. We prospectively enrolled parents with a fetus diagnosed with a complex, life-threatening CHD from September 2018 to December 2020. We tested whether parents' psychological and decision-making outcomes 3 months posttreatment differed by treatment choice and survival status. Results. Our sample included 23 parents (average Age[years]: 27 ± 4, range = 21-37). Most were women (n = 18), non-Hispanic White (n = 20), and married (n = 21). Most parents chose surgery (n = 16), with 11 children surviving to the time of the survey; remaining parents (n = 7) chose comfort-directed care. Parents who chose comfort-directed care reported higher distress (x ¯ = 1.51, s = 0.75 v. x ¯ = 0.74, s = 0.55; Mdifference = 0.77, 95% confidence interval [CI], 0.05-1.48) and perinatal grief (x ¯ = 91.86, s = 22.96 v. x ¯ = 63.38, s = 20.15; Mdifference = 27.18, 95% CI, 6.20-48.16) than parents who chose surgery, regardless of survival status. Parents who chose comfort-directed care reported higher depression (x ¯ = 1.64, s = 0.95 v. x ¯ = 0.65, s = 0.49; Mdifference = 0.99, 95% CI, 0.10-1.88) than parents whose child survived following surgery. Parents choosing comfort-directed care reported higher regret (x ¯ = 26.43, s = 8.02 v. x ¯ = 5.00, s = 7.07; Mdifference = 21.43, 95% CI, 11.59-31.27) and decisional conflict (x ¯ = 20.98, s = 10.00 v. x ¯ = 3.44, s = 4.74; Mdifference = 17.54, 95% CI; 7.75-27.34) than parents whose child had not survived following surgery. Parents whose child survived following surgery reported lower grief (Mdifference = -19.71; 95% CI, -39.41 to -0.01) than parents whose child had not. Conclusions. The results highlight the potential for interventions and care tailored to parents' treatment decisions and outcomes to support parental coping and well-being. Highlights Question: Do the psychological and decision-making outcomes of parents differ based on their treatment decision and survival outcome following prenatal diagnosis with complex CHD?Findings: In this exploratory study, parents who decided to pursue comfort-directed care after a prenatal diagnosis reported higher levels of psychological distress and grief as well as higher decisional conflict and regret than parents who decided to pursue surgery.Meaning: The findings from this exploratory study highlight potential differences in parents' psychological and decision-making outcomes following a diagnosis of complex CHD for their fetus, which appear to relate to the treatment approach and the treatment outcome and may require tailoring of psychological and decision support.
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Affiliation(s)
- Alistair Thorpe
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Salt Lake City, UT, USA
- Department of Applied Health Research, University College London, London, UK
| | - Rebecca K. Delaney
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Salt Lake City, UT, USA
| | - Nelangi M. Pinto
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
- Division of Pediatric Cardiology at Seattle Children’s Hospital, Seattle, WA, USA
| | - Elissa M. Ozanne
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Salt Lake City, UT, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mandy L. Pershing
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Salt Lake City, UT, USA
| | - Lisa M. Hansen
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Linda M. Lambert
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Angela Fagerlin
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Salt Lake City, UT, USA
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation
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9
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Thorpe A, Zhong L, Scherer LD, Drews FA, Shoemaker H, Fagerlin A. Demographic, structural, and psychological predictors of risk-increasing and mask wearing behaviors among US adults between December 2020-March 2021. Patient Educ Couns 2023; 114:107792. [PMID: 37201301 DOI: 10.1016/j.pec.2023.107792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 04/27/2023] [Accepted: 05/09/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVES To assess demographic, structural, and psychological predictors of risk-increasing and risk-decreasing behaviors METHODS: This study used data from an online longitudinal, three-wave COVID-19 survey (12/20-03/21) regarding the behaviors, attitudes, and experiences of US Veteran (n = 584) and non-Veteran (n = 346) adults. RESULTS Inability to get groceries delivered emerged as the strongest predictor of more frequent risk-increasing behavior across all timepoints. Other consistent predictors of more frequent risk-increasing behavior and less frequent mask wearing included less worry about getting COVID-19, disbelief in science, belief in COVID-19 conspiracies, and negative perceptions of the state response. No demographic factor consistently predicted risk-increasing behavior or mask wearing, though different demographic predictors emerged for more frequent risk-increasing behaviors (e.g., lower health literacy) and mask-wearing (e.g., older age and urban residence) at certain timepoints. The most frequently endorsed reasons for having contact with others concerned health-related (food, medical care, and exercise) and social needs (seeing friends/family and boredom). CONCLUSIONS These findings highlight key individual-level determinants of risk-increasing behaviors and mask wearing which encompass demographic, structural, and psychological factors. PRACTICE IMPLICATIONS Findings can support public health experts and health communicators promote engagement with risk-reducing behaviors and address key barriers to engaging in these behaviors.
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Affiliation(s)
- Alistair Thorpe
- Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, USA.
| | - Lingzi Zhong
- Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, USA
| | - Laura D Scherer
- University of Colorado, School of Medicine, Aurora, CO, USA; Denver VA Center of Innovation, USA
| | - Frank A Drews
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, USA; University of Utah College of Social and Behavioral Science, Salt Lake City, UT, USA
| | - Holly Shoemaker
- Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, USA; Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, USA
| | - Angela Fagerlin
- Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, USA; Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, USA
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10
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Delaney RK, Thorpe A, Pinto NM, Ozanne EM, Pershing ML, Hansen LM, Lambert LM, Tanner K, Fagerlin A. Parents' quality of life and health after treatment decision for a fetus with severe congenital heart defect. J Pediatr Nurs 2023; 70:20-25. [PMID: 36791586 PMCID: PMC10182246 DOI: 10.1016/j.pedn.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/10/2023] [Accepted: 02/03/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE This exploratory study examines differences in parents' quality of life by treatment decision and the child's survival outcome in the context of life-threatening congenital heart disease (CHD). DESIGN AND METHODS Parents of a fetus or neonate diagnosed with severe CHD enrolled in the observational control group of a clinical trial (NCT04437069) and completed quality of life (i.e., contact with clinicians, social support, partner relationship, state of mind), mental and physical health survey measures. Comparisons were made between parents who chose comfort-directed care or surgery and between those whose child did and did not survive. RESULTS Parents who chose surgery and their child did not survive reported the most contact with their clinicians. Parents who chose comfort-directed care reported lower social support than parents who chose surgery and their child did not survive as well as poorer state of mind compared to parents who chose surgery. CONCLUSIONS Some aspects of parents' quality of life differed based on their treatment decision. Parents who choose comfort-directed care are vulnerable to some negative outcomes. PRACTICE IMPLICATIONS Decision support tools and bereavement resources to assist parents with making and coping with a complex treatment decision is important for clinical care.
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Affiliation(s)
- Rebecca K Delaney
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah Health, Salt Lake City, USA.
| | - Alistair Thorpe
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah Health, Salt Lake City, USA
| | - Nelangi M Pinto
- Department of Pediatrics, University of Utah, Salt Lake City, USA
| | - Elissa M Ozanne
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah Health, Salt Lake City, USA
| | - Mandy L Pershing
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah Health, Salt Lake City, USA
| | - Lisa M Hansen
- Department of Pediatrics, University of Utah, Salt Lake City, USA
| | - Linda M Lambert
- Department of Pediatrics, University of Utah, Salt Lake City, USA
| | - Kirstin Tanner
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah Health, Salt Lake City, USA
| | - Angela Fagerlin
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah Health, Salt Lake City, USA; Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, USA.
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11
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Levy AG, Thorpe A, Scherer LD, Scherer AM, Butler JM, Shoemaker H, Fagerlin A. Parental Nonadherence to Health Policy Recommendations for Prevention of COVID-19 Transmission Among Children. JAMA Netw Open 2023; 6:e231587. [PMID: 36877524 PMCID: PMC9989896 DOI: 10.1001/jamanetworkopen.2023.1587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
This survey study assesses whether parents had ever engaged in specific misrepresentation and nonadherence behaviors regarding public health measures for preventing COVID-19 transmission among children.
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Affiliation(s)
| | - Alistair Thorpe
- Department of Population Health Sciences, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City
- currently affiliated with Department of Applied Health Research, University College London, London, United Kingdom
| | - Laura D. Scherer
- Division of Cardiology, University of Colorado School of Medicine, Aurora
- Veterans Affairs (VA) Denver Center for Innovation, Denver, Colorado
| | - Aaron M. Scherer
- Department of Internal Medicine, University of Iowa School of Medicine, Iowa City
| | - Jorie M. Butler
- Division of Geriatrics, Departments of Biomedical Informatics and Internal Medicine, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, Utah
- Geriatrics Research, Education, and Clinical Center, VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - Holly Shoemaker
- Department of Population Health Sciences, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, Utah
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, Utah
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12
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Mondesir FL, Thorpe A, Bradley G, Hills MT, Cozier Y, Ko D, Kornej J, Lubitz SA, Anderson CD, Benjamin EJ, Fagerlin A, Trinquart L. Abstract P374: Perception of Short-Term and Lifetime Risk of Atrial Fibrillation: A Survey of American Heart Association Members. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Background:
Physician communication of lifetime risk prediction can improve patient understanding of atrial fibrillation (AF) risk and motivate lifestyle changes and preventive measures. Therefore, our objective was to assess how physicians perceive short-term and lifetime risks of atrial fibrillation (AF), using a survey.
Methods:
We invited American Heart Association (AHA) members to complete an online survey via email from November 2-22, 2021. Respondents were randomized to one of 32 vignettes characterized by AF risk factors (height, weight, current smoking, systolic blood pressure, diastolic blood pressure, use of antihypertensive medication, diabetes, history of heart failure, and history of myocardial infarction). Respondents were further randomized to either estimate the 5-year or lifetime AF risk on a 0-100% scale with 10% intervals (e.g., “10-19%”) or were shown the predicted 5-year or lifetime AF risk value and asked to pick the correct interpretation in a multiple-choice question.
Results:
Of 11,330 AHA professional members who received the emailed survey, 109 (1%) physicians responded (mean age 51 years, 33% women) (Table). Most respondents estimated the 5-year AF risk correctly (7/9, 78%) but none accurately estimated the lifetime risk (0/18, 0%). Most respondents interpreted the predicted 5-year risk correctly (21/28, 75%) but about half of respondents misinterpreted the lifetime risk (14/25, 56%).
Conclusions:
In a small sample of physicians, few respondents correctly estimated and interpreted the lifetime risk of AF, suggesting that physicians may not be familiar with this risk format. It may be necessary to study the frequency and manner in which physicians communicate lifetime risk of AF.
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Affiliation(s)
| | | | | | | | | | - Darae Ko
- Boston Univ Sch of Medicine, Newtonville, MA
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13
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Levy AG, Thorpe A, Scherer LD, Scherer AM, Drews FA, Butler JM, Burpo N, Shoemaker H, Stevens V, Fagerlin A. Misrepresentation and Nonadherence Regarding COVID-19 Public Health Measures. JAMA Netw Open 2022; 5:e2235837. [PMID: 36215070 PMCID: PMC9552890 DOI: 10.1001/jamanetworkopen.2022.35837] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 08/24/2022] [Indexed: 11/15/2022] Open
Abstract
Importance The effectiveness of public health measures implemented to mitigate the spread and impact of SARS-CoV-2 relies heavily on honesty and adherence from the general public. Objective To examine the frequency of, reasons for, and factors associated with misrepresentation and nonadherence regarding COVID-19 public health measures. Design, Setting, and Participants This survey study recruited a national, nonprobability sample of US adults to participate in an online survey using Qualtrics online panels (participation rate, 1811 of 2260 [80.1%]) from December 8 to 23, 2021. The survey contained screening questions to allow for a targeted sample of one-third who had had COVID-19, one-third who had not had COVID-19 and were vaccinated, and one-third who had not had COVID-19 and were unvaccinated. Main Outcomes and Measures The survey assessed 9 different types of misrepresentation and nonadherence related to COVID-19 public health measures and the reasons underlying such behaviors. Additional questions measured COVID-19-related beliefs and behaviors and demographic characteristics. Results The final sample included 1733 participants. The mean (SD) participant age was 41 (15) years and the sample predominantly identified as female (1143 of 1732 [66.0%]) and non-Hispanic White (1151 of 1733 [66.4%]). Seven hundred twenty-one participants (41.6%) reported misrepresentation and/or nonadherence in at least 1 of the 9 items; telling someone they were with or about to be with in person that they were taking more COVID-19 preventive measures than they actually were (420 of 1726 [24.3%]) and breaking quarantine rules (190 of 845 [22.5%]) were the most common manifestations. The most commonly endorsed reasons included wanting life to feel normal and wanting to exercise personal freedom. All age groups younger than 60 years (eg, odds ratio for those aged 18-29 years, 4.87 [95% CI, 3.27-7.34]) and those who had greater distrust in science (odds ratio, 1.14 [95% CI, 1.05-1.23]) had significantly higher odds of misrepresentation and/or nonadherence for at least 1 of the 9 items. Conclusions and Relevance In this survey study of US adults, nearly half of participants reported misrepresentation and/or nonadherence regarding public health measures against COVID-19. Future work is needed to examine strategies for communicating the consequences of misrepresentation and nonadherence and to address contributing factors.
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Affiliation(s)
- Andrea Gurmankin Levy
- Department of Social and Behavioral Sciences, Middlesex Community College, Middletown, Connecticut
| | - Alistair Thorpe
- Department of Population Health Sciences, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City
| | - Laura D. Scherer
- Division of Cardiology, University of Colorado School of Medicine, Aurora
- Veterans Affairs (VA) Denver Center for Innovation, Denver, Colorado
| | - Aaron M. Scherer
- Department of Internal Medicine, University of Iowa School of Medicine, Iowa City
| | - Frank A. Drews
- Department of Psychology, University of Utah College of Social and Behavioral Science, Salt Lake City
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, Utah
| | - Jorie M. Butler
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, Utah
- Geriatrics Research, Education, and Clinical Center (GRECC), VA Salt Lake City Health Care System, Salt Lake City, Utah
- Department of Biomedical Informatics, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City
- Division of Geriatrics, Department of Internal Medicine, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City
| | - Nicole Burpo
- Department of Research, Office of Science Operations, American Heart Association, Dallas, Texas
| | - Holly Shoemaker
- Department of Population Health Sciences, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, Utah
| | - Vanessa Stevens
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, Utah
- Division of Geriatrics, Department of Internal Medicine, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, Utah
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14
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Thorpe A, Fagerlin A, Butler J, Stevens V, Drews FA, Shoemaker H, Riddoch MS, Scherer LD. Communicating about COVID-19 vaccine development and safety. PLoS One 2022; 17:e0272426. [PMID: 35930557 PMCID: PMC9355181 DOI: 10.1371/journal.pone.0272426] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 07/19/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose Beliefs that the risks from a COVID-19 vaccine outweigh the risks from getting COVID-19 and concerns that the vaccine development process was rushed and lacking rigor have been identified as important drivers of hesitancy and refusal to get a COVID-19 vaccine. We tested whether messages designed to address these beliefs and concerns might promote intentions to get a COVID-19 vaccine. Method We conducted an online survey fielded between March 8–23, 2021 with US Veteran (n = 688) and non-Veteran (n = 387) respondents. In a between-subjects experiment, respondents were randomly assigned to a control group (with no message) or to read one of two intervention messages: 1. a fact-box styled message comparing the risks of getting COVID-19 compared to the vaccine, and 2. a timeline styled message describing the development process of the COVID-19 mRNA vaccines. Results Most respondents (60%) wanted a COVID-19 vaccine. However, 17% expressed hesitancy and 23% did not want to get a COVID-19 vaccine. The fact-box styled message and the timeline message did not significantly improve vaccination intentions, F(2,358) = 0.86, p = .425, ηP2 = .005, or reduce the time respondents wanted to wait before getting vaccinated, F(2,306) = 0.79, p = .453, ηP2 = .005, compared to no messages. Discussion In this experimental study, we did not find that providing messages about vaccine risks and the development process had an impact on respondents’ vaccine intentions. Further research is needed to identify how to effectively address concerns about the risks associated with COVID-19 vaccines and the development process and to understand additional factors that influence vaccine intentions.
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Affiliation(s)
- Alistair Thorpe
- Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, United States of America
- * E-mail:
| | - Angela Fagerlin
- Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, United States of America
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, United States of America
| | - Jorie Butler
- Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, United States of America
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, United States of America
- Geriatrics Research, Education, and Clinical Center (GRECC), VA Salt Lake City Health Care System, Salt Lake City, UT, United States of America
| | - Vanessa Stevens
- Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, United States of America
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, United States of America
| | - Frank A. Drews
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, United States of America
- University of Utah College of Social and Behavioral Science, Salt Lake City, UT, United States of America
| | - Holly Shoemaker
- Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, United States of America
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, United States of America
| | - Marian S. Riddoch
- Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, United States of America
| | - Laura D. Scherer
- University of Colorado School of Medicine, Aurora, CO, United States of America
- VA Denver Center for Innovation, Denver, CO, United States of America
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15
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Thorpe A, Fagerlin A, Drews FA, Shoemaker H, Scherer LD. Self-reported health behaviors and risk perceptions following the COVID-19 vaccination rollout in the USA: an online survey study. Public Health 2022; 208:68-71. [PMID: 35717747 PMCID: PMC9113961 DOI: 10.1016/j.puhe.2022.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/29/2022] [Accepted: 05/10/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Concerns have been raised that mass vaccination campaigns might lead to reduced engagement with other recommended health behaviors. We assessed self-reported behaviors and risk perceptions following the COVID-19 vaccine rollout in the USA. STUDY DESIGN Between December 2, 2020, and March 23, 2021, we conducted three online survey studies with US adult respondents. METHODS Respondents self-reported their COVID-19 vaccination status, their frequency of engaging in risk-increasing behaviors and wearing a mask when in public places, and their COVID-19 risk perceptions (i.e., perceived likelihood of getting COVID-19 and of being hospitalized if they got COVID-19). RESULTS Our analytical sample included 832 respondents who had completed the first and final surveys and had received either 0 or 2 doses of a COVID-19 vaccine. Most respondents were non-Hispanic White (75%), male (77%), and US Veterans (64%), with the median age between 55 and 74 years. Overall, respondents reported frequently wearing masks when in public and rarely engaging in risk-increasing behaviors. Regardless of vaccination status, respondents reported more frequently engaging in risk-increasing behaviors and lower risk perceptions in March 2021 than in December 2020. Mask wearing did not change over the study period, with vaccinated respondents consistently reporting more frequent mask wearing than unvaccinated respondents. CONCLUSIONS Taken together, our findings indicate that the COVID-19 vaccine rollout in the USA did not result in the rapid abandonment of protective behaviors or dramatic uptake of risk-increasing behaviors. Additional studies are needed to monitor how mass vaccination might impact public behaviors and risk perceptions as coverage widens.
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Affiliation(s)
- A Thorpe
- Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, USA.
| | - A Fagerlin
- Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, USA; Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, USA
| | - F A Drews
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, USA; University of Utah College of Social and Behavioral Science, Salt Lake City, UT, USA
| | - H Shoemaker
- Spencer Fox Eccles School of Medicine at University of Utah, Salt Lake City, UT, USA; Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, USA
| | - L D Scherer
- University of Colorado, School of Medicine, Aurora, CO, USA; VA Denver Center of Innovation, Denver, CO, USA
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16
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Abstract
PURPOSE Communicating about COVID-19 vaccine side effects and efficacy is crucial for promoting transparency and informed decision-making, but there is limited evidence on how to do so effectively. DESIGN A within-subjects experiment. SETTING Online survey from January 21 to February 6, 2021. SUBJECTS 596 US Veterans and 447 non-Veterans. INTERVENTION 5 messages about COVID-19 vaccine side effects and 4 messages about COVID-19 vaccine efficacy. MEASURES COVID-19 vaccine interest (1 = "I definitely do NOT want the vaccine" to 7 = "I definitely WANT the vaccine" with the midpoint 4 = "Unsure"). Confidence about COVID-19 vaccine efficacy (1= "Not at all confident," 2 = "Slightly confident," 3 = "Somewhat confident," 4 = "Moderately confident," 5 = "Extremely confident"). RESULTS Compared to providing information about side effects alone (M = 5.62 [1.87]), messages with additional information on the benefits of vaccination (M = 5.77 [1.82], P < .001, dz = .25), reframing the likelihood of side effects (M = 5.74 [1.84], P < .001, dz = .23), and emphasizing that post-vaccine symptoms indicate the vaccine is working (M = 5.72 [1.84], P < .001, dz = .17) increased vaccine interest. Compared to a vaccine efficacy message containing verbal uncertainty and an efficacy range (M = 3.97 [1.25]), messages conveying verbal certainty with an efficacy range (M = 4.00 [1.24], P = .042, dz=.08), verbal uncertainty focused on the upper efficacy limit (M = 4.03 [1.26], P < .001, dz = .13), and communicating the point estimate with certainty (M = 4.02 [1.25], P < .001, dz = .11) increased confidence. Overall, Veteran respondents were more interested (MVeterans = 5.87 [1.72] vs MNonVeterans = 5.45 [2.00], P < .001, d = .22) and confident (MVeterans = 4.13 [1.19] vs MNonVeterans = 3.84 [1.32], P < .001, d = .23) about COVID-19 vaccines than non-Veterans. CONCLUSIONS These strategies can be implemented in large-scale communications (e.g., webpages, social media, and leaflets/posters) and can help guide healthcare professionals when discussing vaccinations in clinics to promote interest and confidence in COVID-19 vaccines.
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Affiliation(s)
- Alistair Thorpe
- University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT, USA
| | - Angela Fagerlin
- University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT, USA.,Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, USA
| | - Frank A Drews
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, USA.,University of Utah College of Social and Behavioral Science, Salt Lake City, UT, USA
| | - Jorie Butler
- University of Colorado School of Medicine, Aurora, CO, USA.,VA Denver Center for Innovation, Denver, CO, USA
| | - Vanessa Stevens
- University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT, USA.,Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, USA
| | - Marian S Riddoch
- University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT, USA
| | - Laura D Scherer
- University of Colorado School of Medicine, Aurora, CO, USA.,VA Denver Center for Innovation, Denver, CO, USA
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17
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Delaney RK, Pinto NM, Ozanne EM, Stark LA, Pershing ML, Thorpe A, Witteman HO, Thokala P, Lambert LM, Hansen LM, Greene TH, Fagerlin A. Study protocol for a randomised clinical trial of a decision aid and values clarification method for parents of a fetus or neonate diagnosed with a life-threatening congenital heart defect. BMJ Open 2021; 11:e055455. [PMID: 34893487 PMCID: PMC8666895 DOI: 10.1136/bmjopen-2021-055455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Parents who receive the diagnosis of a life-threatening, complex heart defect in their fetus or neonate face a difficult choice between pursuing termination (for fetal diagnoses), palliative care or complex surgical interventions. Shared decision making (SDM) is recommended in clinical contexts where there is clinical equipoise. SDM can be facilitated by decision aids. The International Patient Decision Aids Standards collaboration recommends the inclusion of values clarification methods (VCMs), yet little evidence exists concerning the incremental impact of VCMs on patient or surrogate decision making. This protocol describes a randomised clinical trial to evaluate the effect of a decision aid (with and without a VCM) on parental mental health and decision making within a clinical encounter. METHODS AND ANALYSIS Parents who have a fetus or neonate diagnosed with one of six complex congenital heart defects at a single tertiary centre will be recruited. Data collection for the prospective observational control group was conducted September 2018 to December 2020 (N=35) and data collection for two intervention groups is ongoing (began October 2020). At least 100 participants will be randomised 1:1 to two intervention groups (decision aid only vs decision aid with VCM). For the intervention groups, data will be collected at four time points: (1) at diagnosis, (2) postreceipt of decision aid, (3) postdecision and (4) 3 months postdecision. Data collection for the control group was the same, except they did not receive a survey at time 2. Linear mixed effects models will assess differences between study arms in distress (primary outcome), grief and decision quality (secondary outcomes) at 3-month post-treatment decision. ETHICS AND DISSEMINATION This study was approved by the University of Utah Institutional Review Board. Study findings have and will continue to be presented at national conferences and within scientific research journals. TRIAL REGISTRATION NUMBER NCT04437069 (Pre-results).
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Affiliation(s)
- Rebecca K Delaney
- Population Health Sciences, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Nelangi M Pinto
- Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | - Elissa M Ozanne
- Population Health Sciences, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Louisa A Stark
- Human Genetics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Mandy L Pershing
- Population Health Sciences, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Alistair Thorpe
- Population Health Sciences, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Holly O Witteman
- Family and Emergency Medicine, Laval University, Quebec City, Quebec, Canada
| | - Praveen Thokala
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Linda M Lambert
- Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | - Lisa M Hansen
- Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | - Tom H Greene
- Population Health Sciences, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Angela Fagerlin
- Population Health Sciences, The University of Utah School of Medicine, Salt Lake City, Utah, USA
- VA HSR&D Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, UT, USA
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Han PKJ, Scharnetzki E, Scherer AM, Thorpe A, Lary C, Waterston LB, Fagerlin A, Dieckmann NF. Communicating Scientific Uncertainty About the COVID-19 Pandemic: Online Experimental Study of an Uncertainty-Normalizing Strategy. J Med Internet Res 2021; 23:e27832. [PMID: 33769947 PMCID: PMC8064708 DOI: 10.2196/27832] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/21/2021] [Accepted: 03/21/2021] [Indexed: 11/25/2022] Open
Abstract
Background Communicating scientific uncertainty about public health threats such as COVID-19 is an ethically desirable task endorsed by expert guidelines on crisis communication. However, the communication of scientific uncertainty is challenging because of its potential to promote ambiguity aversion—a well-described syndrome of negative psychological responses consisting of heightened risk perceptions, emotional distress, and decision avoidance. Communication strategies that can inform the public about scientific uncertainty while mitigating ambiguity aversion are a critical unmet need. Objective This study aimed to evaluate whether an “uncertainty-normalizing” communication strategy—aimed at reinforcing the expected nature of scientific uncertainty about the COVID-19 pandemic—can reduce ambiguity aversion, and to compare its effectiveness to conventional public communication strategies aimed at promoting hope and prosocial values. Methods In an online factorial experiment conducted from May to June 2020, a national sample of 1497 US adults read one of five versions of an informational message describing the nature, transmission, prevention, and treatment of COVID-19; the versions varied in level of expressed scientific uncertainty and supplemental focus (ie, uncertainty-normalizing, hope-promoting, and prosocial). Participants then completed measures of cognitive, emotional, and behavioral manifestations of ambiguity aversion (ie, perceived likelihood of getting COVID-19, COVID-19 worry, and intentions for COVID-19 risk-reducing behaviors and vaccination). Analyses assessed (1) the extent to which communicating uncertainty produced ambiguity-averse psychological responses; (2) the comparative effectiveness of uncertainty-normalizing, hope-promoting, and prosocial communication strategies in reducing ambiguity-averse responses; and (3) potential moderators of the effects of alternative uncertainty communication strategies. Results The communication of scientific uncertainty about the COVID-19 pandemic increased perceived likelihood of getting COVID-19 and worry about COVID-19, consistent with ambiguity aversion. However, it did not affect intentions for risk-reducing behaviors or vaccination. The uncertainty-normalizing strategy reduced these aversive effects of communicating scientific uncertainty, resulting in levels of both perceived likelihood of getting COVID-19 and worry about COVID-19 that did not differ from the control message that did not communicate uncertainty. In contrast, the hope-promoting and prosocial strategies did not decrease ambiguity-averse responses to scientific uncertainty. Age and political affiliation, respectively, moderated the effects of uncertainty communication strategies on intentions for COVID-19 risk-reducing behaviors and worry about COVID-19. Conclusions Communicating scientific uncertainty about the COVID-19 pandemic produces ambiguity-averse cognitive and emotional, but not behavioral, responses among the general public, and an uncertainty-normalizing communication strategy reduces these responses. Normalizing uncertainty may be an effective strategy for mitigating ambiguity aversion in crisis communication efforts. More research is needed to test uncertainty-normalizing communication strategies and to elucidate the factors that moderate their effectiveness.
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Affiliation(s)
- Paul K J Han
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, United States
| | - Elizabeth Scharnetzki
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, United States
| | - Aaron M Scherer
- Division of General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Alistair Thorpe
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - Christine Lary
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, United States
| | - Leo B Waterston
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, United States
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States.,Salt Lake City VA Center for Informatics Decision Enhancement and Surveillance, Salt Lake City, UT, United States
| | - Nathan F Dieckmann
- School of Nursing, Oregon Health and Science University, Portland, OR, United States
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Thorpe A, Sirota M, Orbell S, Juanchich M. Effect of information on reducing inappropriate expectations and requests for antibiotics. Br J Psychol 2021; 112:804-827. [PMID: 33543779 DOI: 10.1111/bjop.12494] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 11/25/2020] [Indexed: 11/28/2022]
Abstract
People often expect antibiotics when they are clinically inappropriate (e.g., for viral infections). This contributes significantly to physicians' decisions to prescribe antibiotics when they are clinically inappropriate, causing harm to the individual and to society. In two pre-registered studies employing UK general population samples (n1 = 402; n2 = 190), we evaluated the relationship between knowledge and beliefs with antibiotic expectations, and the effects of information provision on such expectations. We conducted a correlational study (study 1), in which we examined the role of antibiotic knowledge and beliefs and an experiment (study 2) in which we assessed the causal effect of information provision on antibiotic expectations. In study 1, we found that both knowledge and beliefs about antibiotics predicted antibiotic expectations. In study 2, a 2 (viral information: present vs. absent) × 2 (antibiotic information: present vs. absent) experimental between-subjects design, information about antibiotic efficacy significantly reduced expectations for antibiotics, but viral aetiology information did not. Providing antibiotic information substantially diminishes inappropriate expectations of antibiotics. Health campaigns might also aim to change social attitudes and normative beliefs, since more complex sociocognitive processes underpin inappropriate expectations for antibiotics.
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Affiliation(s)
- Alistair Thorpe
- Department of Population Health Sciences, University of Utah, School of Medicine, Salt Lake City, Utah, USA
| | - Miroslav Sirota
- Department of Psychology, University of Essex, Colchester, UK
| | - Sheina Orbell
- Department of Psychology, University of Essex, Colchester, UK
| | - Marie Juanchich
- Department of Psychology, University of Essex, Colchester, UK
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Thorpe A, Scherer AM, Han PKJ, Burpo N, Shaffer V, Scherer L, Fagerlin A. Exposure to Common Geographic COVID-19 Prevalence Maps and Public Knowledge, Risk Perceptions, and Behavioral Intentions. JAMA Netw Open 2021; 4:e2033538. [PMID: 33404615 PMCID: PMC7788466 DOI: 10.1001/jamanetworkopen.2020.33538] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This survey study examines knowledge, risk perceptions, and behavioral intentions among survey respondents exposed to different types of COVID-19 prevalence maps.
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Affiliation(s)
- Alistair Thorpe
- Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City
| | | | - Paul K. J. Han
- Center for Outcomes Research, Maine Medical Center Research Institute, Portland
| | | | | | | | - Angela Fagerlin
- Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences Center for Innovation, Salt Lake City, Utah
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Soria F, Giordano A, Black P, Fairey A, Cookson M, Yu E, Kassouf W, Dall’Era M, Sridhar S, McGrath J, Wright J, Thorpe A, Morgan T, Daneshmand S, Holzbeierlein J, Bivalacqua T, North S, Barocas D, Lotan Y, Grivas P, Stephenson A, Shah J, van Rhijn B, Spiess P, Shariat S, Gontero P. Neoadjuvant chemotherapy plus radical cystectomy versus radical cystectomy alone in clinical T2 bladder cancer patients without hydronephrosis: results from a large multicenter cohort study. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35401-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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22
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Thorpe A, Sirota M, Juanchich M, Orbell S. Action bias in the public's clinically inappropriate expectations for antibiotics. J Exp Psychol Appl 2020; 26:422-431. [PMID: 32271052 DOI: 10.1037/xap0000269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Clinical guidelines recommend that physicians educate patients about illnesses and antibiotics to eliminate inappropriate preferences for antibiotics. We expected that information provision about illnesses and antibiotics would reduce but not eliminate inappropriate preferences for antibiotics and that cognitive biases could explain why some people resist the effect of information provision. In 2 experiments, participants (n₁ = 424; n₂ = 434) either received incomplete information (about the viral etiology of their infection) or complete information (about viral etiology and the ineffectiveness and harms of taking antibiotics), before deciding to rest or take antibiotics. Those in the complete information conditions responded to items on 4 biases: action bias, social norm, source discrediting, and information neglect. In 2 follow-up experiments (n₁ = 150; n₂ = 732), we aimed to counteract the action bias by reframing the perception of the resting option as an action. Complete information provision reduced but did not eliminate inappropriate preferences for antibiotics. Around 10% of people wanted antibiotics even when informed they are harmful and offer no benefit and even when the alternative option (i.e., rest) was framed as an active treatment option. Results suggest an action bias underpins this preference but appears challenging to counteract. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Rustenburg CM, Snuggs JW, Emanuel KS, Thorpe A, Sammon C, Le Maitre CL, Smit TH. Modelling the catabolic environment of the moderately degenerated disc with a caprine ex vivo loaded disc culture system. Eur Cell Mater 2020; 40:21-37. [PMID: 32672345 DOI: 10.22203/ecm.v040a02] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Low-back pain affects 80 % of the world population at some point in their lives and 40 % of the cases are attributed to intervertebral disc (IVD) degeneration. Over the years, many animal models have been developed for the evaluation of prevention and treatment strategies for IVD degeneration. Ex vivo organ culture systems have also been developed to better control mechanical loading and biochemical conditions, but a reproducible ex vivo model that mimics moderate human disc degeneration is lacking. The present study described an ex vivo caprine IVD degeneration model that simulated the changes seen in the nucleus pulposus during moderate human disc degeneration. Following pre-load under diurnal, simulated physiological loading (SPL) conditions, lumbar caprine IVDs were degenerated enzymatically by injecting collagenase and chondroitinase ABC (cABC). After digestion, IVDs were subjected to SPL for 7 d. No intervention and phosphate-buffered saline injection were used as controls. Disc deformation was continuously monitored to assess disc height recovery. Histology and immunohistochemistry were performed to determine the histological grade of degeneration, matrix expression, degrading enzyme and catabolic cytokine expression. Injection of collagenase and cABC irreversibly affected the disc mechanical properties. A decrease in extracellular matrix components was found, along with a consistent increase in degradative enzymes and catabolic proteins [interleukin (IL)-1β, -8 and vascular endothelial growth factor (VEGF)]. The changes observed were commensurate with those seen in moderate human-IVD degeneration. This model should allow for controlled ex vivo testing of potential biological, cellular and biomaterial treatments of moderate human-IVD degeneration.
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Affiliation(s)
| | | | | | | | | | - C L Le Maitre
- Biomolecular Sciences Research Centre, Sheffield Hallam University, City Campus, Howard Street, Sheffield S1 1WB,
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Marchioni M, Mir M, Zargar H, Grivas P, Dall’era M, Spiess P, Van Rhijn B, Lotan Y, Bivalacqua T, Holzbeierlein J, Thorpe A, Yu E, Shariat S, Kassouf W, Barocas D, Daneshmand S, Dinney C, Mcgrath J, Sridhar S, Wright J, North S, Stephenson A, Xylinas E, Black P. Nomogram predicting bladder cancer specific mortality after neoadjuvant chemotherapy and radical cystectomy for muscle-invasive bladder cancer: Results of an international consortium. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33692-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Thorpe A, Sirota M, Juanchich M, Orbell S. 'Always take your doctor's advice': Does trust moderate the effect of information on inappropriate antibiotic prescribing expectations? Br J Health Psychol 2020; 25:358-376. [PMID: 32196870 DOI: 10.1111/bjhp.12411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 02/20/2020] [Indexed: 11/30/2022]
Abstract
Objectives To reduce overprescribing, health campaigns urge physicians to provide people with information regarding appropriate antibiotic use and encourage the public to trust their physicians' prescribing decisions. We test (1) whether providing individuals with complete information about the viral aetiology of an illness and the ineffectiveness of antibiotics will reduce inappropriate antibiotic expectations, (2) whether individuals with greater trust in their physician will have lower expectations, and (3) whether individuals with greater trust in their physician will benefit more from the complete information provision and have lower expectations. Design Experiment 1 features a between-subjects design (information provision: baseline vs. complete information) with a general measure of participants' trust in their physician. Experiment 2 features a 2 (physician trustworthiness: low vs. high) × 2 (information provision: baseline vs. complete information) between-subjects design. Methods In Experiment 1, participants (n = 366) reported their trust in their physician, read a vignette describing a hypothetical consultation with a physician for a viral cold and then expressed their expectations for antibiotics. In Experiment 2, participants (n = 380) read a vignette of a consultation with a physician for a viral ear infection then expressed their expectations for antibiotics. Results In both experiments, the provision of complete information significantly reduced inappropriate expectations for antibiotics. Greater trust in physicians was associated with higher antibiotic expectations in Experiment 1, but lower expectations in Experiment 2. In both experiments, trust in physicians appeared to facilitate the effect of information provision, but this effect was weak and inconsistent. Conclusion Providing information about viral aetiology and the ineffectiveness and side effects of antibiotics reduces inappropriate antibiotic expectations. Further research into the effect of trust in physicians as a moderator of the effect information provision is required, particularly given the recent increase in trust-based antibiotic campaigns. Statement of contribution What is already known Inappropriate expectations for antibiotics encourage overprescribing in primary care. To reduce inappropriate expectations, interventions often aim to educate people about antibiotics and encourage them to trust their physician. What does this study add Causal evidence that clinical information provision reduces but does not eliminate inappropriate antibiotic expectations. We find that increased trust in physicians is not always associated with lower expectations for antibiotics. Although increased trust seemed to boost the effect of information provision, this effect was weak and inconsistent.
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Brodbelt A, Williams M, Thorpe A, Mills S, Price S, Lekka E, Watts C, Davies C, Jenkinson M. P01.100 Tumour treating fields: Acceptable, tolerable, and can we reduce cost? Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Brodbelt
- The Walton Centre NHS Foundation trust, Liverpool, United Kingdom
| | - M Williams
- Imperial College Healthcare NHS Foundation Trust, London, United Kingdom
| | - A Thorpe
- The Walton Centre NHS Foundation trust, Liverpool, United Kingdom
| | - S Mills
- The Walton Centre NHS Foundation trust, Liverpool, United Kingdom
| | - S Price
- Cambridge University Hospitals NHS Foundation trust, Cambridge, United Kingdom
| | - E Lekka
- Lancashire teaching hospitals NHS Foundation trust, Preston, United Kingdom
| | - C Watts
- University hospitals Birmingham NHS Foundation trust, Birmingham, United Kingdom
| | - C Davies
- Lancashire teaching hospitals NHS Foundation trust, Preston, United Kingdom
| | - M Jenkinson
- Liverpool University, Liverpool, United Kingdom
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Parker S, Harris A, Thorpe A. A complete audit loop assessing service improvement with use of button type electrode for transurethral resection of prostate and an intention to discharge at less than 24 hours. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Galli G, Sirota M, Gruber MJ, Ivanof BE, Ganesh J, Materassi M, Thorpe A, Loaiza V, Cappelletti M, Craik FIM. Learning facts during aging: the benefits of curiosity. Exp Aging Res 2018; 44:311-328. [PMID: 29787342 DOI: 10.1080/0361073x.2018.1477355] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Background/study context: Recent studies have shown that young adults better remember factual information they are curious about. It is not entirely clear, however, whether this effect is retained during aging. Here, the authors investigated curiosity-driven memory benefits in young and elderly individuals. METHODS In two experiments, young (age range 18-26) and older (age range 65-89) adults read trivia questions and rated their curiosity to find out the answer. They also attended to task-irrelevant faces presented between the trivia question and the answer. The authors then administered a surprise memory test to assess recall accuracy for trivia answers and recognition memory performance for the incidentally learned faces. RESULTS In both young and elderly adults, recall performance was higher for answers to questions that elicited high levels of curiosity. In Experiment 1, the authors also found that faces presented in temporal proximity to curiosity-eliciting trivia questions were better recognized, indicating that the beneficial effects of curiosity extended to the encoding of task-irrelevant material. CONCLUSIONS These findings show that elderly individuals benefit from the memory-enhancing effects of curiosity. This may lead to the implementation of learning strategies that target and stimulate curiosity in aging.
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Affiliation(s)
- Giulia Galli
- Department of Psychology, Kingston University, Kingston Upon Thames, United Kingdom
| | - Miroslav Sirota
- Department of Psychology, University of Essex, Colchester, United Kingdom
| | | | - Bianca Elena Ivanof
- Department of Psychology, Kingston University, Kingston Upon Thames, United Kingdom
- Department of Psychology, Goldsmiths University of London, London, United Kingdom
| | - Janani Ganesh
- Department of Psychology, Kingston University, Kingston Upon Thames, United Kingdom
| | - Maurizio Materassi
- Department of Psychology, Kingston University, Kingston Upon Thames, United Kingdom
| | - Alistair Thorpe
- Department of Psychology, University of Essex, Colchester, United Kingdom
| | - Vanessa Loaiza
- Department of Psychology, University of Essex, Colchester, United Kingdom
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Veeratterapillay R, Lavin V, Thorpe A, Harding C. Posterior tibial nerve stimulation in adults with overactive bladder syndrome: A systematic review of the literature. Journal of Clinical Urology 2016. [DOI: 10.1177/2051415815603263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Overactive bladder (OAB) is a common condition that can significantly impact on a patient’s quality of life. Treatments include conservative methods (patient education, lifestyle modifications, bladder retraining), pharmacotherapy (anticholinergics and adrenoreceptor agonists), intravesical botulinum toxin A injections and surgical strategies (including neuromodulation, augmentation cystoplasty and urinary diversion). There has been increased interest in neuromodulation over recent years and accumulating evidence for percutaneous tibial nerve stimulation (PTNS). We have reviewed the currently available clinical evidence in a systematic, reproducible fashion. PTNS has been shown in randomised controlled studies (against sham/placebo and against anticholinergics) to be safe and effective in treating OAB. Cost effectiveness analyses for PTNS have shown mixed results depending on the length of follow-up. PTNS is a useful adjunct to therapy in OAB for patients who have failed conservative and pharmacotherapy. Further research is required to define its place in the OAB treatment algorithm.
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Affiliation(s)
| | - V Lavin
- Department of Urology, Freeman Hospital, UK
| | - A Thorpe
- Department of Urology, Freeman Hospital, UK
| | - C Harding
- Department of Urology, Freeman Hospital, UK
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Iqbal MS, Pickles R, Pedley I, Frew J, Azzabi A, Heer R, Thorpe A, Johnson M, Robson L, McMenemin R. Delays in the diagnosis and treatment of muscle invasive bladder cancer: A pilot project mapping the pathway. Journal of Clinical Urology 2015. [DOI: 10.1177/2051415814557067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: The patient pathway for muscle invasive bladder cancer (MIBC) is multidisciplinary. Trans-urethral resection of bladder tumour (TURBT) counts as the first definitive treatment and subsequent definitive therapy thereafter is often delayed, which may adversely affect outcome. We elected to scrutinise the management pathway in detail to understand these delays and improve the patient experience. Method: A retrospective mapping analysis was conducted on 17 patients with MIBC. The causes of any delays and measures to avoid these were identified. A prospective study of 17 patients with MIBC was then undertaken to see if the strategies used to re-engineer the patient care pathway had been effective. Result: The median time from GP referral to first appointment was 9 days (range: 1–37) and from TURBT to subsequent radical treatment was 75 days (range: 27–105) in keeping with published literature. The median time for a referral letter from urology to oncology following MDT was 15 days. We therefore modified the MDT proforma to use as a formal referral, and a project manager proactively managed the patient pathway. Capacity issues were addressed by protecting clinical slots for bladder patients and establishing monthly evening clinics. After implementing the strategies, the median days from first appointment to TURBT improved from 31 to 23 days and time from TURBT to subsequent treatment improved from 75 to 66 days. The time from MDT referral to being seen by an oncologist or urologist significantly reduced from 32 to 15 days. Conclusion: Retrospective analysis identified delays between initial TURBT to definitive therapy and strategies adopted to reduce these were effective. TURBT is a diagnostic process and if acknowledged as first treatment results in delays of what is the definitive treatment. We found the initial diagnostic pathway to work well but non-muscle invasive bladder cancer (NMIBC) and MIBC are then managed very differently and warrant two separate pathways.
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Affiliation(s)
- M Shahid Iqbal
- Department of Clinical Oncology, Northern Centre for Cancer Care, Freeman Hospital, UK
| | - R Pickles
- Department of Therapeutic Radiography, Northern Centre for Cancer Care, Freeman Hospital, UK
| | - I Pedley
- Department of Clinical Oncology, Northern Centre for Cancer Care, Freeman Hospital, UK
| | - J Frew
- Department of Clinical Oncology, Northern Centre for Cancer Care, Freeman Hospital, UK
| | - A Azzabi
- Department of Clinical Oncology, Northern Centre for Cancer Care, Freeman Hospital, UK
| | - R Heer
- Department of Urology, Newcastle University and Freeman Hospital, Newcastle upon Tyne, UK
| | - A Thorpe
- Department of Urology, Freeman Hospital, UK
| | - M Johnson
- Department of Urology, Freeman Hospital, UK
| | - L Robson
- Department of Urology, Freeman Hospital, UK
| | - R McMenemin
- Department of Clinical Oncology, Northern Centre for Cancer Care, Freeman Hospital, UK
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Tentzeris V, Kefaloyannis E, Begum S, Hristova R, Milton R, Chaudhuri N, Thorpe A, Papagiannopoulos K. F-055 * BUILDING UP A VIDEO-ASSISTED THORACOSCOPIC LUNG RESECTION PROGRAMME: ELEMENTS TO IMPROVE FAST ADOPTION. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu167.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Perrey C, Coopes E, Thorpe A. Parsonage-Turner Syndrome—A case study report. J Sci Med Sport 2013. [DOI: 10.1016/j.jsams.2013.10.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Khawaja SA, Hristova R, Thorpe A, Kefaloyannis E, Milton R, Papagiannopoulos K, Chaudhuri N. P-160IS UK STILL IN THE EUROZONE? VALIDATING AN OFF-THE-SHELF RISK SCORING SYSTEM: A PROSPECTIVE AUDIT. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt288.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cosgrove JF, Thorpe A, Nesbitt ID, Snowden CP. Re: A double-blind randomized controlled clinical trial to assess the effect of Doppler optimized intraoperative fluid management on outcome following radical cystectomy: P. Pillai, I. McEleavy, M. Gaughan, C. Snowden, I. Nesbitt, G. Durkan, M. Johnson, J. Cosgrove and A. Thorpe. J Urol 2011; 186: 2201-2206. J Urol 2012; 188:2017-8. [PMID: 22999540 DOI: 10.1016/j.juro.2012.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Indexed: 11/29/2022]
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Fraser SJ, Mason HJ, Thorpe A, Roberts P, Smith I, Evans GE, Morton J, Mark D. S161 Reducing exposure to allergens in bakeries. Thorax 2010. [DOI: 10.1136/thx.2010.150953.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Affiliation(s)
- A. Thorpe
- a Occupational Medicine and Hygiene Laboratory, Health and Safety Executive, Broad Lane, Sheffield S3 7HQ, UK
| | - R.C. Brown
- a Occupational Medicine and Hygiene Laboratory, Health and Safety Executive, Broad Lane, Sheffield S3 7HQ, UK
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Abstract
Forensic nurses are faced with unique challenges in their attempt to deliver nursing care in a custodial environment. * The impact of such challenges on the cultural dynamic of forensic nursing and consequently on healthcare delivery is largely unknown. * The aim of this ethnographic study was to explore the nursing culture within an Australian prison hospital and the migration of the culture over a 12-month period. * At the end of the study, the nursing culture was found to be one of hope, although with no clearly articulated vision of nurse-hood or patient-hood and model within which to practice nursing. * The ability to articulate practice is central to the development of mental health nursing in any context. Abstract Forensic nurses are faced with unique challenges in their attempt to deliver nursing care in a custodial environment. The impact of such challenges on the cultural dynamic of forensic nursing and consequently on healthcare delivery is largely unknown. The aim of this ethnographic study was to explore the nursing culture within an Australian prison hospital and the migration of the culture over a 12-month period. At the end of the study the nursing culture was found to be one of hope, although with no clearly articulated vision of nurse-hood or patient-hood and model within which to practice nursing.
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Affiliation(s)
- A Cashin
- Professor of Nursing, School of Health and Human Sciences, Southern Cross University, Lismore.
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Balasubramanian R, Hanief M, Aref F, Ahmad R, Riddle P, Thorpe A, Salakianathan S, Vashisht R. Core Biopsy Following Neoadjuvant Chemotherapy Predicts Tumour Response and Aids in Breast Preservation. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-4121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Back groundAdvancement in chemotherapy regimens has improved pathological tumour response following neoadjuvant chemotherapy (NAC). This has subsequently helped in increasing incidence of breast preservation. Here we report how core biopsy of the tumour bed following NAC is useful in predicting tumour response and aids in breast preservation.Materials and MethodsData were collected retrospectively from consecutive newly diagnosed breast cancer patients at West Middlesex University Hospital between January 2002 and December 2008 who underwent NAC. Patients were assessed with clinical examination, mammogram, ultrasound (USS) and Magnetic Resonance Imaging (MRI). NAC consisted of 6-8 cycles of FEC or had FEC followed by Taxanes. The tumour response was assessed by USS and MRI. In addition, multiple cores were performed both in the central and periphery of the tumour bed. Patients subsequently underwent either mastectomy or wide local Excision (WLE) with axillary clearance. The extent of resection was determined by the presence of tumour in the peripheries.Results43 patients received neo-adjuvant chemotherapy and the median age was 49 years (range 24-72). The median size of tumour by MRI scan was 4.5 cm (range 2.5-10). One patient declined surgery and 8 patients did not have core biopsy following neoadjuvant chemotherapy so all the nine cases were excluded from analysis.The sensitivity of USS, MRI and core biopsy in predicting residual disease in our series was 84%, 84% and 68% respectively. The specificity and the positive predictive value (PPV) of imaging was 25% and 75% whereas the specificity and PPV of core biopsy was both 100%.Our overall initial breast conservation rate was 88% (30 of 34) and 4 of them had subsequent mastectomy following breast conservation surgery (BCS) due to positive margins following BCS reducing it to 76% (26/34).The mean size of the T2 tumour was 2.9 cm and 90% had BCS (9/10) including re excision of margins in one case. The average size of the T3 tumour was 6.0 cm and 76% (13/17) had BCS. Re excision of positive margins was done twice in one case. The mean size of T4 tumour in our series was 6.3 cm and 57% had BCS (4/7).DiscussionThe tumour response following NAC is traditionally assessed by imaging and further surgery is determined by the extent of response. The low specificity and PPV of imaging is due to overestimation of the presence of residual tumour. Absence of enhancement in MRI means either there is necrosis or fragmentation. This is especially true when the tumour mass has completely resolved. The presence of architectural distortion in these cases can complicate MRI interpretation. It is interesting to note that MRI has a high negative predictive value in diagnosing primary tumour as well as recurrence. However this ability is lost following chemotherapy for above mentioned reasons. So core biopsy is an extremely useful tool here when it is positive irrespective of what the imaging indicates. The rate of breast conservation is also increased by assessing tumour response to decide the extent of resection. Extensive sampling of the central and periphery of the tumour following chemotherapy increases the negative surgical margins when breast conservation is considered.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4121.
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Affiliation(s)
| | - M. Hanief
- 1West Middlesex University Hospital, United Kingdom
| | - F. Aref
- 1West Middlesex University Hospital, United Kingdom
| | - R. Ahmad
- 1West Middlesex University Hospital, United Kingdom
| | - P. Riddle
- 1West Middlesex University Hospital, United Kingdom
| | - A. Thorpe
- 1West Middlesex University Hospital, United Kingdom
| | | | - R. Vashisht
- 1West Middlesex University Hospital, United Kingdom
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Belvedere O, Chaudhuri N, Thorpe A, Milton R, Davidson L, McKinley C, Egan P, Daly C, Papagiannopoulos K, Rabbitts P. 1117 Identifying the challenges in establishing a lung cancer tissue repository for translational research: a single institution experience. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)70410-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Thorpe A, Harrison RM. Sources and properties of non-exhaust particulate matter from road traffic: a review. Sci Total Environ 2008; 400:270-82. [PMID: 18635248 DOI: 10.1016/j.scitotenv.2008.06.007] [Citation(s) in RCA: 597] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Revised: 06/04/2008] [Accepted: 06/05/2008] [Indexed: 04/15/2023]
Abstract
While emissions control regulation has led to a substantial reduction in exhaust emissions from road traffic, currently non-exhaust emissions from road vehicles are unabated. These include particles from brake wear, tyre wear, road surface abrasion and resuspension in the wake of passing traffic. Quantification of the magnitude of such emissions is problematic both in the laboratory and the field and the latter depends heavily upon a knowledge of the physical and chemical properties of non-exhaust particles. This review looks at each source in turn, reviewing the available information on the source materials and particles derived from them in laboratory studies. In a final section, some of the key publications dealing with measurements in road tunnels and the roadside environment are reviewed. It is concluded that with the exception of brake dust particles which may be identified from their copper (Cu) and antimony (Sb) content, unequivocal identification of particles from other sources is likely to prove extremely difficult, either because of the lack of suitable tracer elements or compounds, or because of the interactions between sources prior to the emission process. Even in the case of brake dust, problems will arise in distinguishing directly emitted particles from those arising from resuspension of deposited brake dust from the road surface, or that derived from entrainment of polluted roadside soils, either directly or as a component of road surface dust.
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Affiliation(s)
- Alistair Thorpe
- Division of Environmental Health & Risk Management, School of Geography, Earth & Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
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Abstract
Many local-level issues have direct parallels within broader transnational and global trends. Using practical examples, this article will share the learning from policy development for England within the broader European context, focusing particularly on the changing partnership dynamics and the opportunities afforded for policy development by the new communications technologies.
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Abstract
Abstract
There is a somewhat pervasive belief in much of the fisheries literature (especially that relating to small-scale fisheries in the developing world) that fishers are among the 'poorest of the poor'. The purpose of this review therefore is to review historic and contemporary research into fisher poverty. Our review commences by acknowledging the paucity of studies on the levels of (income) poverty within the sector and highlights the fact that, somewhat paradoxically, a growing number of studies are suggesting that average incomes for fishing households outstrip those recorded by non-fishing households in the same areas. Nevertheless, these findings must be qualified as poverty cannot be captured exclusively in income terms - and social manifestations of poverty (low literacy levels, reduced access to health care, education, water and sanitation facilities) may be more acute within the fisheries sector. Equally, while fisher households may be more vulnerable (given their lifestyles/location) to exogenous shocks (such as tsunamis), the sector is not a homogenous one and factors such as technological change may also induce the impoverishment of certain sub-groups of fishers over time. As a consequence, fisher households have derived a variety of coping mechanisms, mechanisms which (we argue) militate against considering 'fishing' as an activity in isolation from other facets of the household livelihood strategy. One response, as we note, to this has been the application of livelihoods analysis as a technique for assessing (and redressing) fisher poverty. Championed initially by the Sustainable Livelihoods Fisheries Programme (SFLP) operating in West Africa from 1999 to 2006, the technique has subsequently been deployed in a number of other regions/fisheries. Our review then moves on to assess how interventions within the fisheries sector can contribute to fisher poverty reduction. At the macroeconomic level, while the emphasis historically has been on the sector's contribution to domestic nutritional requirements and the goal of food security, more recent research has examined the prioritization of the sector within national development plans and poverty reduction strategies. At the microeconomic level, we provide two contrasting examples to show that, while poverty-reducing policy interventions are to be welcomed at the local level, the heterogeneity of the local environment militates against the prescription of a 'one size fits all' approach to poverty reduction. This theme is picked up in the concluding comments of the review, where directions for further research are also highlighted.
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Chapman C, Murray A, Chakrabarti J, Thorpe A, Woolston C, Sahin U, Barnes A, Robertson J. Autoantibodies in breast cancer: their use as an aid to early diagnosis. Ann Oncol 2007; 18:868-73. [PMID: 17347129 DOI: 10.1093/annonc/mdm007] [Citation(s) in RCA: 213] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND There is increasing evidence that the immune system produces a humoral response to cancer-derived antigens. This study assessed the diagnostic potential of autoantibodies to multiple known tumour-associated proteins. PATIENTS AND METHODS Sera from normal controls (n = 94), primary breast cancer patients (n = 97) and patients with ductal carcinoma in situ (DCIS) (n = 40) were investigated for the presence of autoantibodies to p53, c-myc, HER2, NY-ESO-1, BRCA1, BRCA2 and MUC1 antigens by enzyme-linked immunosorbent assay. RESULTS Reproducibly elevated levels of autoantibodies were seen in at least one of the six antigens in 64% of primary breast cancer patient sera and 45% of patients with DCIS at a specificity of 85%. No significant differences were seen when patients were subdivided by age, tumour size, histological grade, lymph node status or detection methodology. CONCLUSIONS Autoantibodies against one or more of these tumour-associated antigens appears to indicate the presence of early-stage breast cancers. Autoantibody assays against a panel of antigens could be used as an aid to mammography in the detection and diagnosis of early primary breast cancer, especially in younger women at increased risk of breast cancer where mammography is known to have reduced sensitivity and specificity.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Neoplasm/blood
- Antigens, Neoplasm/blood
- Autoantibodies/blood
- Breast Neoplasms/blood
- Breast Neoplasms/immunology
- Breast Neoplasms/pathology
- Carcinoma, Intraductal, Noninfiltrating/blood
- Carcinoma, Intraductal, Noninfiltrating/immunology
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Lobular/blood
- Carcinoma, Lobular/immunology
- Carcinoma, Lobular/pathology
- Case-Control Studies
- Cohort Studies
- Early Diagnosis
- Enzyme-Linked Immunosorbent Assay
- Female
- Humans
- Middle Aged
- Neoplasm Metastasis/pathology
- Receptors, Estrogen/blood
- Receptors, Estrogen/immunology
- Reproducibility of Results
- Sensitivity and Specificity
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Affiliation(s)
- C Chapman
- Division of Breast Surgery, The University of Nottingham, Nottingham, UK.
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Rutland CS, Latunde-Dada AO, Thorpe A, Plant R, Langley-Evans S, Leach L. Effect of gestational nutrition on vascular integrity in the murine placenta. Placenta 2006; 28:734-42. [PMID: 16930688 DOI: 10.1016/j.placenta.2006.07.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2006] [Revised: 06/12/2006] [Accepted: 07/03/2006] [Indexed: 11/25/2022]
Abstract
Maternal undernutrition is thought to result in smaller offspring and programme disease in later life. It is not known whether gestational nutrition affects development and functioning of placental vessels. The aim of this study was to ascertain if disturbed angiogenesis and junctional integrity were features of the labyrinthine vessels of placenta taken from transgenic Tie2-GFP mice fed either 18% (control) or 9% (low protein; MLP) casein diet. MLP animals showed a significant decrease in fetal weight at E14.5 and in placental and fetal weight at E18.5, however, maternal weight and litter size remained unaffected. Stereological analyses revealed that the fraction of components of the placenta remained similar in both study groups. There was a significant reduction in labyrinthine blood vessel length but not in luminal diameter in the E18.5 MLP group. In both MLP groups, perturbation of vascular endothelial Cadherin and beta-catenin, regulators of junctional integrity, permeability and quiescence, was observed with higher percentage of vessels showing weak or no junctional immunoreactivity. The reduction in length of the labyrinthine vessels and the downregulation of the adhesion molecules suggest that gestational undernutrition causes vascular dysfunction in the murine placenta. This may play a role in the early life programming of disease risk.
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Affiliation(s)
- C S Rutland
- School of Biomedical Sciences, University of Nottingham, Nottingham, UK.
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Affiliation(s)
- Fiona Adshead
- Department of Health, Richmond House, 79 Whitehall, London SWIA 2NS, UK
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Nativ O, Thorpe A, Laufer M, Matzkin H, Salzberg M, Yarkoni S, Dezube B, Harris A. Safety and tolerability of oral halofuginone hydrobromide in refractory recurrent transitional cell carcinoma of the bladder. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- O. Nativ
- Bnei Zion Medical Center, Haifa, Israel; Freeman Hospital, Newcastle, United Kingdom; Sheba Medical Center, Tel Hashomer, Israel; Ichilov Medical Center, Tel Aviv, Israel; PBS Ltd, Basel, Switzerland; Collgard Biopharmaceuticals, Petach Tikva, Israel; Beth Israel Deaconess Medical Center, Boston, MA; The Churchill Hospital, Oxford, United Kingdom
| | - A. Thorpe
- Bnei Zion Medical Center, Haifa, Israel; Freeman Hospital, Newcastle, United Kingdom; Sheba Medical Center, Tel Hashomer, Israel; Ichilov Medical Center, Tel Aviv, Israel; PBS Ltd, Basel, Switzerland; Collgard Biopharmaceuticals, Petach Tikva, Israel; Beth Israel Deaconess Medical Center, Boston, MA; The Churchill Hospital, Oxford, United Kingdom
| | - M. Laufer
- Bnei Zion Medical Center, Haifa, Israel; Freeman Hospital, Newcastle, United Kingdom; Sheba Medical Center, Tel Hashomer, Israel; Ichilov Medical Center, Tel Aviv, Israel; PBS Ltd, Basel, Switzerland; Collgard Biopharmaceuticals, Petach Tikva, Israel; Beth Israel Deaconess Medical Center, Boston, MA; The Churchill Hospital, Oxford, United Kingdom
| | - H. Matzkin
- Bnei Zion Medical Center, Haifa, Israel; Freeman Hospital, Newcastle, United Kingdom; Sheba Medical Center, Tel Hashomer, Israel; Ichilov Medical Center, Tel Aviv, Israel; PBS Ltd, Basel, Switzerland; Collgard Biopharmaceuticals, Petach Tikva, Israel; Beth Israel Deaconess Medical Center, Boston, MA; The Churchill Hospital, Oxford, United Kingdom
| | - M. Salzberg
- Bnei Zion Medical Center, Haifa, Israel; Freeman Hospital, Newcastle, United Kingdom; Sheba Medical Center, Tel Hashomer, Israel; Ichilov Medical Center, Tel Aviv, Israel; PBS Ltd, Basel, Switzerland; Collgard Biopharmaceuticals, Petach Tikva, Israel; Beth Israel Deaconess Medical Center, Boston, MA; The Churchill Hospital, Oxford, United Kingdom
| | - S. Yarkoni
- Bnei Zion Medical Center, Haifa, Israel; Freeman Hospital, Newcastle, United Kingdom; Sheba Medical Center, Tel Hashomer, Israel; Ichilov Medical Center, Tel Aviv, Israel; PBS Ltd, Basel, Switzerland; Collgard Biopharmaceuticals, Petach Tikva, Israel; Beth Israel Deaconess Medical Center, Boston, MA; The Churchill Hospital, Oxford, United Kingdom
| | - B. Dezube
- Bnei Zion Medical Center, Haifa, Israel; Freeman Hospital, Newcastle, United Kingdom; Sheba Medical Center, Tel Hashomer, Israel; Ichilov Medical Center, Tel Aviv, Israel; PBS Ltd, Basel, Switzerland; Collgard Biopharmaceuticals, Petach Tikva, Israel; Beth Israel Deaconess Medical Center, Boston, MA; The Churchill Hospital, Oxford, United Kingdom
| | - A. Harris
- Bnei Zion Medical Center, Haifa, Israel; Freeman Hospital, Newcastle, United Kingdom; Sheba Medical Center, Tel Hashomer, Israel; Ichilov Medical Center, Tel Aviv, Israel; PBS Ltd, Basel, Switzerland; Collgard Biopharmaceuticals, Petach Tikva, Israel; Beth Israel Deaconess Medical Center, Boston, MA; The Churchill Hospital, Oxford, United Kingdom
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Humphray SJ, Oliver K, Hunt AR, Plumb RW, Loveland JE, Howe KL, Andrews TD, Searle S, Hunt SE, Scott CE, Jones MC, Ainscough R, Almeida JP, Ambrose KD, Ashwell RIS, Babbage AK, Babbage S, Bagguley CL, Bailey J, Banerjee R, Barker DJ, Barlow KF, Bates K, Beasley H, Beasley O, Bird CP, Bray-Allen S, Brown AJ, Brown JY, Burford D, Burrill W, Burton J, Carder C, Carter NP, Chapman JC, Chen Y, Clarke G, Clark SY, Clee CM, Clegg S, Collier RE, Corby N, Crosier M, Cummings AT, Davies J, Dhami P, Dunn M, Dutta I, Dyer LW, Earthrowl ME, Faulkner L, Fleming CJ, Frankish A, Frankland JA, French L, Fricker DG, Garner P, Garnett J, Ghori J, Gilbert JGR, Glison C, Grafham DV, Gribble S, Griffiths C, Griffiths-Jones S, Grocock R, Guy J, Hall RE, Hammond S, Harley JL, Harrison ESI, Hart EA, Heath PD, Henderson CD, Hopkins BL, Howard PJ, Howden PJ, Huckle E, Johnson C, Johnson D, Joy AA, Kay M, Keenan S, Kershaw JK, Kimberley AM, King A, Knights A, Laird GK, Langford C, Lawlor S, Leongamornlert DA, Leversha M, Lloyd C, Lloyd DM, Lovell J, Martin S, Mashreghi-Mohammadi M, Matthews L, McLaren S, McLay KE, McMurray A, Milne S, Nickerson T, Nisbett J, Nordsiek G, Pearce AV, Peck AI, Porter KM, Pandian R, Pelan S, Phillimore B, Povey S, Ramsey Y, Rand V, Scharfe M, Sehra HK, Shownkeen R, Sims SK, Skuce CD, Smith M, Steward CA, Swarbreck D, Sycamore N, Tester J, Thorpe A, Tracey A, Tromans A, Thomas DW, Wall M, Wallis JM, West AP, Whitehead SL, Willey DL, Williams SA, Wilming L, Wray PW, Young L, Ashurst JL, Coulson A, Blöcker H, Durbin R, Sulston JE, Hubbard T, Jackson MJ, Bentley DR, Beck S, Rogers J, Dunham I. DNA sequence and analysis of human chromosome 9. Nature 2004; 429:369-74. [PMID: 15164053 PMCID: PMC2734081 DOI: 10.1038/nature02465] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2003] [Accepted: 03/08/2004] [Indexed: 11/09/2022]
Abstract
Chromosome 9 is highly structurally polymorphic. It contains the largest autosomal block of heterochromatin, which is heteromorphic in 6-8% of humans, whereas pericentric inversions occur in more than 1% of the population. The finished euchromatic sequence of chromosome 9 comprises 109,044,351 base pairs and represents >99.6% of the region. Analysis of the sequence reveals many intra- and interchromosomal duplications, including segmental duplications adjacent to both the centromere and the large heterochromatic block. We have annotated 1,149 genes, including genes implicated in male-to-female sex reversal, cancer and neurodegenerative disease, and 426 pseudogenes. The chromosome contains the largest interferon gene cluster in the human genome. There is also a region of exceptionally high gene and G + C content including genes paralogous to those in the major histocompatibility complex. We have also detected recently duplicated genes that exhibit different rates of sequence divergence, presumably reflecting natural selection.
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Affiliation(s)
- S J Humphray
- The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1SA, UK.
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Deloukas P, Earthrowl ME, Grafham DV, Rubenfield M, French L, Steward CA, Sims SK, Jones MC, Searle S, Scott C, Howe K, Hunt SE, Andrews TD, Gilbert JGR, Swarbreck D, Ashurst JL, Taylor A, Battles J, Bird CP, Ainscough R, Almeida JP, Ashwell RIS, Ambrose KD, Babbage AK, Bagguley CL, Bailey J, Banerjee R, Bates K, Beasley H, Bray-Allen S, Brown AJ, Brown JY, Burford DC, Burrill W, Burton J, Cahill P, Camire D, Carter NP, Chapman JC, Clark SY, Clarke G, Clee CM, Clegg S, Corby N, Coulson A, Dhami P, Dutta I, Dunn M, Faulkner L, Frankish A, Frankland JA, Garner P, Garnett J, Gribble S, Griffiths C, Grocock R, Gustafson E, Hammond S, Harley JL, Hart E, Heath PD, Ho TP, Hopkins B, Horne J, Howden PJ, Huckle E, Hynds C, Johnson C, Johnson D, Kana A, Kay M, Kimberley AM, Kershaw JK, Kokkinaki M, Laird GK, Lawlor S, Lee HM, Leongamornlert DA, Laird G, Lloyd C, Lloyd DM, Loveland J, Lovell J, McLaren S, McLay KE, McMurray A, Mashreghi-Mohammadi M, Matthews L, Milne S, Nickerson T, Nguyen M, Overton-Larty E, Palmer SA, Pearce AV, Peck AI, Pelan S, Phillimore B, Porter K, Rice CM, Rogosin A, Ross MT, Sarafidou T, Sehra HK, Shownkeen R, Skuce CD, Smith M, Standring L, Sycamore N, Tester J, Thorpe A, Torcasso W, Tracey A, Tromans A, Tsolas J, Wall M, Walsh J, Wang H, Weinstock K, West AP, Willey DL, Whitehead SL, Wilming L, Wray PW, Young L, Chen Y, Lovering RC, Moschonas NK, Siebert R, Fechtel K, Bentley D, Durbin R, Hubbard T, Doucette-Stamm L, Beck S, Smith DR, Rogers J. The DNA sequence and comparative analysis of human chromosome 10. Nature 2004; 429:375-81. [PMID: 15164054 DOI: 10.1038/nature02462] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2003] [Accepted: 03/09/2004] [Indexed: 11/08/2022]
Abstract
The finished sequence of human chromosome 10 comprises a total of 131,666,441 base pairs. It represents 99.4% of the euchromatic DNA and includes one megabase of heterochromatic sequence within the pericentromeric region of the short and long arm of the chromosome. Sequence annotation revealed 1,357 genes, of which 816 are protein coding, and 430 are pseudogenes. We observed widespread occurrence of overlapping coding genes (either strand) and identified 67 antisense transcripts. Our analysis suggests that both inter- and intrachromosomal segmental duplications have impacted on the gene count on chromosome 10. Multispecies comparative analysis indicated that we can readily annotate the protein-coding genes with current resources. We estimate that over 95% of all coding exons were identified in this study. Assessment of single base changes between the human chromosome 10 and chimpanzee sequence revealed nonsense mutations in only 21 coding genes with respect to the human sequence.
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Affiliation(s)
- P Deloukas
- The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton CB10 1SA, UK.
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Mungall AJ, Palmer SA, Sims SK, Edwards CA, Ashurst JL, Wilming L, Jones MC, Horton R, Hunt SE, Scott CE, Gilbert JGR, Clamp ME, Bethel G, Milne S, Ainscough R, Almeida JP, Ambrose KD, Andrews TD, Ashwell RIS, Babbage AK, Bagguley CL, Bailey J, Banerjee R, Barker DJ, Barlow KF, Bates K, Beare DM, Beasley H, Beasley O, Bird CP, Blakey S, Bray-Allen S, Brook J, Brown AJ, Brown JY, Burford DC, Burrill W, Burton J, Carder C, Carter NP, Chapman JC, Clark SY, Clark G, Clee CM, Clegg S, Cobley V, Collier RE, Collins JE, Colman LK, Corby NR, Coville GJ, Culley KM, Dhami P, Davies J, Dunn M, Earthrowl ME, Ellington AE, Evans KA, Faulkner L, Francis MD, Frankish A, Frankland J, French L, Garner P, Garnett J, Ghori MJR, Gilby LM, Gillson CJ, Glithero RJ, Grafham DV, Grant M, Gribble S, Griffiths C, Griffiths M, Hall R, Halls KS, Hammond S, Harley JL, Hart EA, Heath PD, Heathcott R, Holmes SJ, Howden PJ, Howe KL, Howell GR, Huckle E, Humphray SJ, Humphries MD, Hunt AR, Johnson CM, Joy AA, Kay M, Keenan SJ, Kimberley AM, King A, Laird GK, Langford C, Lawlor S, Leongamornlert DA, Leversha M, Lloyd CR, Lloyd DM, Loveland JE, Lovell J, Martin S, Mashreghi-Mohammadi M, Maslen GL, Matthews L, McCann OT, McLaren SJ, McLay K, McMurray A, Moore MJF, Mullikin JC, Niblett D, Nickerson T, Novik KL, Oliver K, Overton-Larty EK, Parker A, Patel R, Pearce AV, Peck AI, Phillimore B, Phillips S, Plumb RW, Porter KM, Ramsey Y, Ranby SA, Rice CM, Ross MT, Searle SM, Sehra HK, Sheridan E, Skuce CD, Smith S, Smith M, Spraggon L, Squares SL, Steward CA, Sycamore N, Tamlyn-Hall G, Tester J, Theaker AJ, Thomas DW, Thorpe A, Tracey A, Tromans A, Tubby B, Wall M, Wallis JM, West AP, White SS, Whitehead SL, Whittaker H, Wild A, Willey DJ, Wilmer TE, Wood JM, Wray PW, Wyatt JC, Young L, Younger RM, Bentley DR, Coulson A, Durbin R, Hubbard T, Sulston JE, Dunham I, Rogers J, Beck S. The DNA sequence and analysis of human chromosome 6. Nature 2003; 425:805-11. [PMID: 14574404 DOI: 10.1038/nature02055] [Citation(s) in RCA: 235] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2003] [Accepted: 09/11/2003] [Indexed: 01/17/2023]
Abstract
Chromosome 6 is a metacentric chromosome that constitutes about 6% of the human genome. The finished sequence comprises 166,880,988 base pairs, representing the largest chromosome sequenced so far. The entire sequence has been subjected to high-quality manual annotation, resulting in the evidence-supported identification of 1,557 genes and 633 pseudogenes. Here we report that at least 96% of the protein-coding genes have been identified, as assessed by multi-species comparative sequence analysis, and provide evidence for the presence of further, otherwise unsupported exons/genes. Among these are genes directly implicated in cancer, schizophrenia, autoimmunity and many other diseases. Chromosome 6 harbours the largest transfer RNA gene cluster in the genome; we show that this cluster co-localizes with a region of high transcriptional activity. Within the essential immune loci of the major histocompatibility complex, we find HLA-B to be the most polymorphic gene on chromosome 6 and in the human genome.
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Affiliation(s)
- A J Mungall
- The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1SA, UK.
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