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Opoku MP, Nketsia W, Wisdom MK, Amponteng M. Have we bothered to ask? Exploration of the attitude of teachers toward participating in inclusive education research. BMC Res Notes 2024; 17:92. [PMID: 38549130 PMCID: PMC10979547 DOI: 10.1186/s13104-024-06755-2] [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] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 03/25/2024] [Indexed: 04/01/2024] Open
Abstract
OBJECTIVE The importance of research cannot be overemphasized. Research findings serve as a guide for the enactment of development policies and legislation. However, not all members of the target population willingly participate in a study. The current study explored the reasons why some individuals refused to partake in inclusive education research in a developing country, Ghana. The journaling helped to capture the voices of 87 participants who refused to take part in a larger inclusive education survey study. RESULTS The study found that the participants did not take part in the research because of reasons such as lack of financial gain, bad experience with previous research, lack of direct benefit, and lack of time. The findings of the study and its implication for policymaking in Ghana and research studies in sub-Saharan Africa are discussed.
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Affiliation(s)
- Maxwell Peprah Opoku
- Department of Special and Gifted Education, United Arab Emirates University, Al Ain, United Arab Emirates.
| | - William Nketsia
- School of Education, Western Sydney University, Sydney, Australia
| | - Mprah Kwadwo Wisdom
- Centre for Disability and Rehabilitation Studies, Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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2
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Wondimagegnehu A, Teferra S, Assefa M, Zebrack B, Addissie A, Kantelhardt EJ. "How can a woman live without having a breast?": challenges related to mastectomy in Ethiopia. BMC Cancer 2024; 24:60. [PMID: 38212706 PMCID: PMC10782697 DOI: 10.1186/s12885-023-11801-6] [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: 07/13/2023] [Accepted: 12/27/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Although mastectomy is the standard treatment modality for breast cancer patients in Ethiopia, our previous study revealed that one in five patients do not receive the recommended procedure, half due to patient refusal or lack of returning to the hospital. Therefore, this study aimed to explore reasons for refusing mastectomy and identify challenges among breast cancer patients in Ethiopia. METHODS An explorative qualitative study was conducted in four hospitals located in the towns of Woliso, Butajira, Hossana, and Assela. A total of 14 in-depth interviews (IDIs) and eight focus group discussions (FGDs) were held with breast cancer patients, patient relatives, and health professionals. Four semi-structured interview guides were used to facilitate the IDIs and FDGs. All recorded IDIs and FGDs were transcribed and translated verbatim and entered in NVivo 12 software. Emerging ideas were categorised and explained using an inductive content analysis approach. RESULTS Our participants reported that particularly elderly and very young women refuse to have mastectomy. The main reasons identified in this study were summarised into six themes: (i) fear of the surgical procedure, (ii) religious beliefs and practice, (iii) utilisation of traditional treatments, (iv) in relation to having a baby and breastfeeding their children (young patients often request to remove only the lump, leaving their breast tissue intact), (v) lack of awareness about the disease, and (vi) sociocultural factors and advice from the community that influence women, since breasts are considered an attribute of femininity, beauty, and motherhood. In addition, knowing someone who died after mastectomy emerged as a main reason for not having breast cancer surgery. CONCLUSIONS High refusal rate for mastectomy has direct implication on increased breast cancer mortality. Hence, expansion of radiotherapy service is instrumental to initiate breast-conserving surgery as an alternative surgical procedure, especially for young women with early-stage breast cancer. Involving religious leaders, traditional healers, and breast cancer survivors could be an effective strategy to persuade newly diagnosed breast cancer patients. Addressing individual patient psychosocial needs and preferences may substantially improve retention of breast cancer patients in the health system.
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Affiliation(s)
- Abigiya Wondimagegnehu
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
- Global Health Working Group, Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle, Germany.
| | - Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mathewos Assefa
- Department of Oncology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bradley Zebrack
- School of Social Work, University of Michigan, Ann Arbor, USA
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Global Health Working Group, Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle, Germany
| | - Eva J Kantelhardt
- Global Health Working Group, Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle, Germany
- Department of Gynecology, Martin-Luther-University, Halle (Saale), Germany
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Keaney J, Byrne H, Warin M, Kowal E. Refusing epigenetics: indigeneity and the colonial politics of trauma. Hist Philos Life Sci 2023; 46:1. [PMID: 38110801 DOI: 10.1007/s40656-023-00596-1] [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] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 10/18/2023] [Indexed: 12/20/2023]
Abstract
Environmental epigenetics is increasingly employed to understand the health outcomes of communities who have experienced historical trauma and structural violence. Epigenetics provides a way to think about traumatic events and sustained deprivation as biological "exposures" that contribute to ill-health across generations. In Australia, some Indigenous researchers and clinicians are embracing epigenetic science as a framework for theorising the slow violence of colonialism as it plays out in intergenerational legacies of trauma and illness. However, there is dispute, contention, and caution as well as enthusiasm among these research communities.In this article, we trace strategies of "refusal" (Simpson, 2014) in response to epigenetics in Indigenous contexts. Drawing on ethnographic fieldwork conducted in Australia with researchers and clinicians in Indigenous health, we explore how some construct epigenetics as useless knowledge and a distraction from implementing anti-colonial change, rather than a tool with which to enact change. Secondly, we explore how epigenetics narrows definitions of colonial harm through the optic of molecular trauma, reproducing conditions in which Indigenous people are made intelligible through a lens of "damaged" bodies. Faced with these two concerns, many turn away from epigenetics altogether, refusing its novelty and supposed benefit for Indigenous health equity and resisting the pull of postgenomics.
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Affiliation(s)
- Jaya Keaney
- School of Social and Political Sciences, University of Melbourne, Melbourne, Australia.
| | - Henrietta Byrne
- School of Social Sciences, University of Adelaide, Adelaide, Australia
| | - Megan Warin
- School of Social Sciences, University of Adelaide, Adelaide, Australia
| | - Emma Kowal
- Alfred Deakin Institute, Deakin University, Melbourne, Australia
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4
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Cao N, Zhou L, Zhang S. The Effects of Social Status and Imposition on the Comprehension of Refusals in Chinese: An ERP Study. J Psycholinguist Res 2023; 52:1989-2005. [PMID: 37347389 DOI: 10.1007/s10936-023-09984-x] [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] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 06/23/2023]
Abstract
This study aims to examine how real-time processing of information about the social status of interlocutors (high vs. low) and the imposition of making a refusal by manipulating the indirectness of invitation forms (declining direct invitations vs. declining indirect invitations) affects the interpretation of refusals in Chinese. The event-related potentials results showed that high-status invitees who decline invitations from low-status inviters elicited weaker N400 effects followed by late mitigated negative effects, while high imposition refusals elicited stronger N400 effects followed by increased late negativities. The two factors of social status and imposition functioned independently during the comprehension of refusal utterances. These findings suggest that individuals take the social status of interlocutors and the imposition of making a refusal into consideration as an utterance unfolds, while face-threatening contexts create inferential difficulties for reinterpreting the pragmatic implications of an utterance.
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Affiliation(s)
- Ningning Cao
- School of Foreign Languages, Northeast Normal University, Changchun, 130021, China
| | - Ling Zhou
- School of Foreign Languages, Northeast Normal University, Changchun, 130021, China.
| | - Shaojie Zhang
- School of Foreign Languages, Northeast Normal University, Changchun, 130021, China
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5
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Kokabisaghi F, Akhtar F, Taghipour A, Javan-Noughabi J, Moghri J, Tabatabaee SS. Why healthcare providers are not vaccinated? A qualitative study during the COVID-19 pandemic in Iran. BMC Prim Care 2023; 24:208. [PMID: 37828425 PMCID: PMC10571274 DOI: 10.1186/s12875-023-02166-7] [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] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Vaccination has been effective in controlling contagious diseases, especially among high-risk groups such as medical staff. Their unwillingness to be vaccinated might adversely affect individual and public health. This study aimed to explore the factors related to the refusal of COVID-19 vaccines among health service providers. METHODS A qualitative study was conducted on 28 healthcare providers in Mashhad, Northeast of Iran from March to June 2022. The method of data collection was face-to-face interviews. The purposive method was used for sampling. Data collection continued until the saturation was reached. To analyze the data, the content analysis method was applied, and Maxqda (version 10) software was used. RESULTS By analyzing interview transcripts, six themes and ten sub-themes were extracted. Factors that explained employees' reluctance to be vaccinated against COVID-19 were the opinion of peers, lack of trust in vaccines, fear of vaccination, mistrust to the government and health authorities, low perceived risk of coronavirus disease, and the contradictions of traditional and modern medicine in their approach to controlling the disease. CONCLUSIONS Among healthcare workers, concerns about the side effects of vaccines were the most influential factors in refusing vaccination. Providing reliable information about vaccines and their safety is key to increasing the trust of health workers in vaccination and facilitating its acceptance.
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Affiliation(s)
- Fatemeh Kokabisaghi
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Health Economics and Management Sciences, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Akhtar
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Taghipour
- Department of Epidemiology & Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Javan-Noughabi
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Health Economics and Management Sciences, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Moghri
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Health Economics and Management Sciences, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Saeed Tabatabaee
- Department of Health Economics and Management Sciences, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
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6
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Merz JF. A response to Al et al. Trials 2023;24:233. Trials 2023; 24:525. [PMID: 37574550 PMCID: PMC10424340 DOI: 10.1186/s13063-023-07574-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023] Open
Abstract
In their recent paper, Al and colleagues (Trials 2023;24:233) argue that manipulation of the methods of recruitment using well-known techniques in order to increase enrollment can be ethically acceptable. This brief response challenges that notion as an affront to voluntariness and a devolution of the ethics of human subjects research to the "ethics" of the marketplace.
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Affiliation(s)
- Jon F Merz
- Department of Medical Ethics & Health Policy, Perelman School of Medicine at the University of Pennsylvania, Blockley Hall 1427, 423 Guardian Drive, Philadelphia, PA, 19104-4884, USA.
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7
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Myers MG. Beginning to address vaccine reluctance and refusal. Vaccine 2023; 41:5063-5065. [PMID: 37455162 DOI: 10.1016/j.vaccine.2023.07.030] [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] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 07/18/2023]
Abstract
Those who refuse immunizations are risks to the public health. Others who are vaccine reluctant are also problematic because they may reinforce the uncertainties of others and refuse vaccines in the future. Common to the multiple, complex causes of vaccine reluctance and refusal is the fact that many have little knowledge about microbiology, infectious diseases, or public health. Consequently, it is not surprising that many have questions about vaccines, find making vaccine decisions difficult, and are vulnerable to vaccine misinformation. Therefore, improving the knowledge of consumers about these biologic sciences would seem to be essential to begin addressing vaccine reluctance and refusal. This would be most effective if it were accomplished before they need to begin to make vaccine decisions.
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Totsika V, Kouroupa A, Timmerman A, Allard A, Gray KM, Hastings RP, Heyne D, Melvin GA, Tonge B. School Attendance Problems Among Children with Neurodevelopmental Conditions One year Following the Start of the COVID-19 Pandemic. J Autism Dev Disord 2023:10.1007/s10803-023-06025-3. [PMID: 37480438 DOI: 10.1007/s10803-023-06025-3] [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] [Accepted: 05/25/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE The present study investigated school absence among 1,076 5-15 year-old children with neurodevelopmental conditions (intellectual disability and/or autism) approximately one year following the start of COVID-19 in the UK. METHODS Parents completed an online survey indicating whether their child was absent from school during May 2021 and the reason for each absence. Multi-variable regression models investigated child, family and school variables associated with absenteeism and types of absenteeism. Qualitative data were collected on barriers and facilitators of school attendance. RESULTS During May 2021, 32% of children presented with persistent absence (missing ≥ 10% of school). School refusal and absence due to ill-health were the most frequent types of absence, accounting for 37% and 22% of days missed, respectively. COVID-19 related absence accounted for just 11% of days missed. Child anxiety was associated with overall absenteeism and with days missed because of school refusal. Parent pandemic anxiety and child conduct problems were not associated with school absenteeism. Hyperactivity was associated with lower levels of absenteeism and school refusal but higher levels of school exclusion. A positive parent-teacher relationship was associated with lower levels of absenteeism, school refusal and exclusion. Child unmet need in school was the most frequently reported barrier to attendance while COVID-19 was one of the least frequently reported barriers. CONCLUSION COVID-19 had a limited impact on school attendance problems during this period. Findings highlighted the role of child mental health in different types of absence and the likely protective role of a positive parent-teacher relationship.
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Affiliation(s)
- Vasiliki Totsika
- Division of Psychiatry, University College London, 149 Tottenham Court Road, Maple House 6th Floor, London, W1T 7NF, UK.
- Centre for Educational Development, Appraisal, and Research (CEDAR), University of Warwick, Coventry, UK.
- Tavistock & Portman NHS Foundation Trust, London, UK.
| | - Athanasia Kouroupa
- Division of Psychiatry, University College London, 149 Tottenham Court Road, Maple House 6th Floor, London, W1T 7NF, UK
| | - Amanda Timmerman
- Division of Psychiatry, University College London, 149 Tottenham Court Road, Maple House 6th Floor, London, W1T 7NF, UK
| | - Amanda Allard
- Council for Disabled Children, National Children's Bureau, London, UK
| | - Kylie M Gray
- Centre for Educational Development, Appraisal, and Research (CEDAR), University of Warwick, Coventry, UK
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, Monash University, Melbourne, Australia
| | - Richard P Hastings
- Centre for Educational Development, Appraisal, and Research (CEDAR), University of Warwick, Coventry, UK
| | - David Heyne
- Developmental and Educational Psychology Unit, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands
| | - Glenn A Melvin
- Centre for Educational Development, Appraisal, and Research (CEDAR), University of Warwick, Coventry, UK
- School of Psychology, Faculty of Health, Deakin University, Melbourne, Australia
| | - Bruce Tonge
- Centre for Educational Development, Appraisal, and Research (CEDAR), University of Warwick, Coventry, UK
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, Monash University, Melbourne, Australia
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9
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Schellenberg N, Petrucka P, Dietrich Leurer M, Crizzle AM. Determinants of vaccine refusal, delay and reluctance in parents of 2-year-old children in Canada: Findings from the 2017 Childhood National Immunization Coverage Survey (cNICS). Travel Med Infect Dis 2023; 53:102584. [PMID: 37149239 DOI: 10.1016/j.tmaid.2023.102584] [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: 12/21/2022] [Revised: 04/08/2023] [Accepted: 05/03/2023] [Indexed: 05/08/2023]
Abstract
Vaccine hesitancy is a barrier to improving childhood vaccination rates in Canada, but the scope of this problem is unclear due to inconsistent measurement of vaccine uptake indicators. Using 2017 data from a Canadian national vaccine coverage survey, this study analyzed the impact of demographics and parental knowledge, attitudes and beliefs (KAB) on vaccine decisions (refusal, delay and reluctance) in parents of 2-year-old children who had received at least one vaccine. The findings show that 16.8% had refused a vaccine, specifically influenza (73%), rotavirus (13%) and varicella (9%); female parents or those from Quebec or the Territories more likely to refuse. 12.8% were reluctant to accept a vaccine, usually influenza (34%), MMR (21%) and varicella (19%), but eventually accepted them upon advice from a health care provider. 13.1% had delayed a vaccine, usually because their child had health issues (54%) or was too young (18.6%) and was predicted by five or six person households. Recent immigration to Canada decreased likelihood of refusal, delay, or reluctance; however, after 10 years in Canada, these parents were as likely to refuse or be reluctant as parents born in Canada. Poor KAB increased likelihood of refusal and delay by 5 times, and reluctance by 15 times, while moderate KAB increased likelihood of refusal (OR 1.6), delay (OR 2.3) and reluctance (OR 3.6). Future research into vaccine decisions by female and/or single parents, and predictors of vaccine KAB would provide valuable information and help protect our children from vaccine preventable diseases.
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Affiliation(s)
- N Schellenberg
- School of Public Health, University of Saskatchewan, Canada
| | - P Petrucka
- College of Nursing, University of Saskatchewan, Canada
| | | | - A M Crizzle
- School of Public Health, University of Saskatchewan, Canada.
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Kuan-Mahecha MA, Rahman S, Martínez-Rivera P, Lamb MM, Asturias EJ. Differences in parental vaccine confidence and attitudes by health system in Guatemala and their impact on immunization timeliness. Vaccine 2023; 41:3099-3105. [PMID: 37061374 DOI: 10.1016/j.vaccine.2023.03.064] [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: 11/25/2021] [Revised: 02/11/2023] [Accepted: 03/29/2023] [Indexed: 04/17/2023]
Abstract
OBJECTIVE The objectives of this study were to evaluate parental confidence and attitudes towards immunization in urban Guatemala between private versus public health systems and their impact on vaccination timeliness in their children. METHODS A cross-sectional survey was conducted in parents 6-18-month-old children who attended well-child outpatient clinics from two health systems (public employee-based insurance and private health care) in Guatemala City from November 2017 through August 2018. Parental demographics, household characteristics, food insecurity, vaccine hesitancy using the WHO SAGE Vaccine Hesitancy Scale, and information on parental use of social media platforms and vaccine information sources were collected. RESULTS Five hundred-three parents were surveyed, most of them mothers. Only 9 parents reported they had previously refused a vaccine for their child: 8 (3.2 %) from private clinics and 1 (0.4 %) from the public clinic (p = 0.02). Significantly more children attending private clinics (226, 90.4 %) were shown to have a delay in any of their vaccines scheduled for the first 2 years of life compared to those in the public clinic (169, 66.8 %; p < 0.01). Children of parents having a college degree (84.5 vs 70.1 %; p < 0.001), earning more than US$ 1,000 per month (81.5 vs 70.7 %; p < 0.001), and having a computer at home (81.4 vs 70.2; p = 0.007) were more likely to have any delays in the scheduled vaccines. Parents seeking care at private clinics were 1.14 times more at risk of delaying a vaccine compared to those at the public clinic, adjusted for other covariates (p = 0.03, 95 % CI: 1.01, 1.28). CONCLUSIONS In Guatemala, children receiving immunizations at private clinics were significantly more likely than those attending public clinics to be delayed in their immunization schedule and to remain more days without the recommended protection, especially for third doses of the primary vaccine series.
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Affiliation(s)
| | - Sabrina Rahman
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | | | - Molly M Lamb
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA; Center for Global Health, Colorado School of Public Health, Aurora, CO, USA
| | - Edwin J Asturias
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA; Center for Global Health, Colorado School of Public Health, Aurora, CO, USA; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA; Department of Infectious Diseases and Epidemiology, Children's Hospital Colorado, Aurora, CO, USA.
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11
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Smith LE, Sim J, Cutts M, Dasch H, Amlôt R, Sevdalis N, Rubin GJ, Sherman SM. Psychosocial factors affecting COVID-19 vaccine uptake in the UK: A prospective cohort study (CoVAccS - Wave 3). Vaccine X 2023; 13:100276. [PMID: 36819214 PMCID: PMC9924044 DOI: 10.1016/j.jvacx.2023.100276] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
Background We investigated factors associated with COVID-19 vaccine uptake, future vaccination intentions, and changes in beliefs and attitudes over time. Methods Prospective cohort study. 1500 participants completed an online survey in January 2021 (T1, start of vaccine rollout in the UK), of whom 1148 (response rate 76.5 %) completed another survey in October 2021 (T2, all UK adults offered two vaccine doses). Binary logistic regression analysis was used to investigate factors associated with subsequent vaccine uptake. Content analysis was used to investigate the main reasons behind future vaccine intentions (T2). Changes in beliefs and attitudes were investigated using analysis of variance. Findings At T2, 90.0 % (95 % CI 88.2-91.7 %) of participants had received two doses of a COVID-19 vaccine, 2.2 % (95 % CI 1.3-3.0 %) had received one dose, and 7.4 % (95 % CI 5.9-8.9 %) had not been vaccinated. Uptake was associated with higher intention to be vaccinated at T1, greater perceived vaccination social norms, necessity of vaccination, and perceived safety of the vaccine. People who had initiated vaccination reported being likely to complete it, while those who had not yet received a vaccine reported being unlikely to be vaccinated in the future. At T2, participants perceived greater susceptibility to, but lower severity of, COVID-19 (p < 0.001) than at T1. Perceived safety and adequacy of vaccine information were higher (p < 0.001). Interpretation Targeting modifiable beliefs about the safety and effectiveness of vaccination may increase uptake.
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Affiliation(s)
- Louise E. Smith
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK,NIHR Health Protection Research Unit in Emergency Preparedness and Response, UK,Corresponding author at: Department of Psychological Medicine, King’s College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK
| | - Julius Sim
- School of Medicine, Keele University, UK
| | | | - Hannah Dasch
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK,Centre for Implementation Science, King’s College London, UK
| | - Richard Amlôt
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, UK,Behavioural Science and Insights Unit, UK Health Security Agency, UK
| | - Nick Sevdalis
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK,Centre for Implementation Science, King’s College London, UK
| | - G. James Rubin
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK,NIHR Health Protection Research Unit in Emergency Preparedness and Response, UK
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12
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Rego RT, Kenney B, Ngugi AK, Espira L, Orwa J, Siwo GH, Sefa C, Shah J, Weinheimer-Haus E, Sophie Delius AJ, Pape UJ, Irfan FB, Abubakar A, Shah R, Wagner A, Kolars J, Boulton ML, Hofer T, Waljee AK. COVID-19 vaccination refusal trends in Kenya over 2021. Vaccine 2023; 41:1161-1168. [PMID: 36624011 PMCID: PMC9808414 DOI: 10.1016/j.vaccine.2022.12.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 06/17/2022] [Revised: 12/23/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Vaccination refusal exacerbates global COVID-19 vaccination inequities. No studies in East Africa have examined temporal trends in vaccination refusal, precluding addressing refusal. We assessed vaccine refusal over time in Kenya, and characterized factors associated with changes in vaccination refusal. METHODS We analyzed data from the Kenya Rapid Response Phone Survey (RRPS), a household cohort survey representative of the Kenyan population including refugees. Vaccination refusal (defined as the respondent stating they would not receive the vaccine if offered to them at no cost) was measured in February and October 2021. Proportions of vaccination refusal were plotted over time. We analyzed factors in vaccination refusal using a weighted multivariable logistic regression including interactions for time. FINDINGS Among 11,569 households, vaccination refusal in Kenya decreased from 24 % in February 2021 to 9 % in October 2021. Vaccination refusal was associated with having education beyond the primary level (-4.1[-0.7,-8.9] percentage point difference (ppd)); living with somebody who had symptoms of COVID-19 in the past 14 days (-13.72[-8.9,-18.6]ppd); having symptoms of COVID-19 in the past 14 days (11.0[5.1,16.9]ppd); and distrusting the government in responding to COVID-19 (14.7[7.1,22.4]ppd). There were significant interactions with time and: refugee status and geography, living with somebody with symptoms of COVID-19, having symptoms of COVID-19, and believing in misinformation. INTERPRETATION The temporal reduction in vaccination refusal in Kenya likely represents substantial strides by the Kenyan vaccination program and possible learnt lessons which require examination. Going forward, there are still several groups which need specific targeting to decrease vaccination refusal and improve vaccination equity, including those with lower levels of education, those with recent COVID-19 symptoms, those who do not practice personal COVID-19 mitigation measures, refugees in urban settings, and those who do not trust the government. Policy and program should focus on decreasing vaccination refusal in these populations, and research focus on understanding barriers and motivators for vaccination.
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Affiliation(s)
- Ryan T. Rego
- Center for Global Health Equity, University of Michigan, Ann Arbor, MI, USA,Corresponding author
| | - Brooke Kenney
- Center for Global Health Equity, University of Michigan, Ann Arbor, MI, USA,Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Anthony K. Ngugi
- Department of Population Health, Aga Khan University, Nairobi, Kenya
| | - Leon Espira
- Center for Global Health Equity, University of Michigan, Ann Arbor, MI, USA
| | - James Orwa
- Department of Population Health, Aga Khan University, Nairobi, Kenya
| | - Geoffrey H. Siwo
- Center for Global Health Equity, University of Michigan, Ann Arbor, MI, USA,Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Christabel Sefa
- Center for Global Health Equity, University of Michigan, Ann Arbor, MI, USA
| | - Jasmit Shah
- Department of Internal Medicine, Aga Khan University, Nairobi, Kenya,Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Eileen Weinheimer-Haus
- Center for Global Health Equity, University of Michigan, Ann Arbor, MI, USA,Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Utz Johann Pape
- World Bank Group, Washington, DC, USA,University of Goettingen, Goettingen, Germany
| | - Furqan B. Irfan
- Institute of Global Health, Michigan State University, Lansing, MI, USA
| | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Reena Shah
- Department of Internal Medicine, Aga Khan University, Nairobi, Kenya
| | - Abram Wagner
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Joseph Kolars
- Center for Global Health Equity, University of Michigan, Ann Arbor, MI, USA,Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Timothy Hofer
- Center for Global Health Equity, University of Michigan, Ann Arbor, MI, USA,Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Akbar K. Waljee
- Center for Global Health Equity, University of Michigan, Ann Arbor, MI, USA,Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA,Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), Ann Arbor, MI, USA
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13
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Yuan Y, Jin J, Bi X, Geng H, Li S, Zhou C. Factors associated with refusal of preventive therapy after initial willingness to accept treatment among college students with latent tuberculosis infection in Shandong, China. BMC Infect Dis 2023; 23:38. [PMID: 36670356 PMCID: PMC9857917 DOI: 10.1186/s12879-023-08005-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/19/2022] [Accepted: 01/11/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Preventive therapy of latent tuberculosis infection (LTBI) is an important component of tuberculosis (TB) control. Research on acceptance of TB preventive therapy (TPT) is an important topic. Current studies focus on acceptability and compliance. However, it is unclear whether LTBI patients will start TPT after accepting treatment. The study assessed the factors associated with TPT refusal after initial willingness to accept treatment. METHODS Data were derived from a baseline survey of prospective study of LTBI treatment among college students in Shandong Province, China. A total of 723 students initially willing to accept TPT were included in the analysis. Stepwise logistic regression was used to explore the individual- and family-level characteristic variables that factors associated with TPT refusal after initial willingness to accept treatment. RESULTS Of the 723 LTBI college students who initially had acceptance willingness, 436 (60.3%) finally refused TPT. At the individual level, non-medical students were more likely to refuse TPT [odds ratio (OR) = 4.87, 95% confidence interval (CI): 3.10-7.67)], as were students with moderate physical activity (OR = 1.45, 95% CI: 1.04-2.04). Students with boarding experience (OR = 0.49, 95% CI: 0.31-0.78) and a high level of knowledge about TB (OR = 0.97, 95% CI: 0.95-0.99) were less likely to refuse TPT. At the family level, those with high father's educational level (OR = 1.50, 95% CI: 1.07-2.10) or high household income (OR = 1.80, 95% CI: 1.20-2.71) were more likely to refuse TPT after initially accepting treatment. CONCLUSIONS Factors associated with TPT refusal after initial willingness to accept treatment, such as personal (type of students, physical activity, boarding experiences, knowledge of TB) and family characteristics (father's education level, household income) among college student with LTBI, might help identify persons for whom tailored interventions could improve the start of LTBI treatment.
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Affiliation(s)
- Yemin Yuan
- grid.27255.370000 0004 1761 1174Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China
| | - Jin Jin
- Public Health (Tuberculosis Prevention and Control) Centre, Shandong Public Health Clinical Center, Jinan, 250101 China
| | - Xiuli Bi
- Public Health (Tuberculosis Prevention and Control) Centre, Shandong Public Health Clinical Center, Jinan, 250101 China
| | - Hong Geng
- Public Health (Tuberculosis Prevention and Control) Centre, Shandong Public Health Clinical Center, Jinan, 250101 China
| | - Shixue Li
- grid.27255.370000 0004 1761 1174Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
| | - Chengchao Zhou
- grid.27255.370000 0004 1761 1174Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
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14
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Dutta U, Azad AK, Mullah M, Hussain KS, Parveez W. From rhetorical "inclusion" toward decolonial futures: Building communities of resistance against structural violence. Am J Community Psychol 2022; 69:355-368. [PMID: 34743345 DOI: 10.1002/ajcp.12561] [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] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/11/2021] [Accepted: 08/31/2021] [Indexed: 06/13/2023]
Abstract
In this paper, we name and uplift the ways in which Miya community workers are building communities of resistance as ways to address the manifold colonial, structural (including state-sponsored), and epistemic violence in their lives. These active spaces of refusal and resistance constitute the grounds of our theorizing. Centering this theory in the flesh, we offer critical implications for decolonial liberatory praxis, specifically community-engaged praxis in solidarity with people's struggles. In doing so, we speak to questions such as: What are the range of ways in which Global South communities are coming together to tackle various forms of political, social, epistemic, and racial injustice? What are ways of doing, being, and knowing that are produced at the borders and liminal zones? What are the varied ways in which people understand and name solidarities, alliances, and relationalities in pursuit of justice? We engage with these questions from our radically rooted places in Miya people's struggles via storytelling that not only confronts the historical and ongoing oppression, but also upholds desire-Interweaving and honoring rage, grief, pain, creativity, love, and communality.
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Affiliation(s)
- Urmitapa Dutta
- Department of Psychology, University of Massachusetts Lowell, Lowell, Massachusetts, USA
- Miya Community Research Collective (www.miyacommunityresearchcollective.org), Barpeta, Assam, India
| | - Abdul Kalam Azad
- Miya Community Research Collective (www.miyacommunityresearchcollective.org), Barpeta, Assam, India
- Athena Institute, Vrije University Amsterdam, Amsterdam, The Netherlands
| | | | | | - Wahida Parveez
- Miya Community Research Collective (www.miyacommunityresearchcollective.org), Barpeta, Assam, India
- Jamia Milia Islamia University, New Delhi, India
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15
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Galanis P, Vraka I, Siskou O, Konstantakopoulou O, Katsiroumpa A, Kaitelidou D. Willingness, refusal and influential factors of parents to vaccinate their children against the COVID-19: A systematic review and meta-analysis. Prev Med 2022; 157:106994. [PMID: 35183597 PMCID: PMC8861629 DOI: 10.1016/j.ypmed.2022.106994] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 02/07/2022] [Accepted: 02/12/2022] [Indexed: 12/03/2022]
Abstract
We aimed to estimate parents' willingness and refusal to vaccinate their children against the COVID-19, and to investigate the predictors for their decision. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We searched Scopus, Web of Science, Medline, PubMed, CINAHL and medrxiv from inception to December 12, 2021. We applied a random effect model to estimate pooled effects since the heterogeneity was very high. We used subgroup analysis and metaregression analysis to explore sources of heterogeneity. We found 44 studies including 317,055 parents. The overall proportion of parents that intend to vaccinate their children against the COVID-19 was 60.1%, while the proportion of parents that refuse to vaccinate their children was 22.9% and the proportion of unsure parents was 25.8%. The main predictors of parents' intention to vaccinate their children were fathers, older age of parents, higher income, higher levels of perceived threat from the COVID-19, and positive attitudes towards vaccination (e.g. children's complete vaccination history, history of children's and parents' vaccination against influenza, confidence in vaccines and COVID-19 vaccines, and COVID-19 vaccine uptake among parents). Parents' willingness to vaccinate their children against the COVID-19 is moderate and several factors affect this decision. Understanding parental COVID-19 vaccine hesitancy does help policy makers to change the stereotypes and establish broad community COVID-19 vaccination. Identification of the factors that affect parents' willingness to vaccinate their children against COVID-19 will provide opportunities to enhance parents' trust in the COVID-19 vaccines and optimize children's uptake of a COVID-19 vaccine.
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Affiliation(s)
- Petros Galanis
- Clinical Epidemiology Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.
| | - Irene Vraka
- Department of Radiology, P & A Kyriakou Children's Hospital, Athens, Greece
| | - Olga Siskou
- Center for Health Services Management and Evaluation, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Olympia Konstantakopoulou
- Center for Health Services Management and Evaluation, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Aglaia Katsiroumpa
- Clinical Epidemiology Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Daphne Kaitelidou
- Center for Health Services Management and Evaluation, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
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16
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Goodwin BC, March S, Crawford-Williams F, Chambers SK, Dunn J. "I'm not doing that." An in-depth examination of nonparticipation in mail-out bowel cancer screening programs. Transl Behav Med 2021; 10:1515-1524. [PMID: 31228202 DOI: 10.1093/tbm/ibz096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Despite a clear association between the early detection of bowel cancer and increased survival, participation in mail-out screening programs is poor. Several key barriers to participation have been identified, yet research has failed to examine the specific cognitions, actions, and individual contexts from which barriers emerge. The purpose of the current study was to gain a detailed understanding of the actual experience of kit receipt from the perspective of nonparticipants including their opinion on interventions that may be effective in promoting participation. Demographic differences in reasons for nonparticipation are also examined. Opt-out data from a national program was analyzed to detect demographic differences in reasons for nonparticipation. Qualitative interviews were conducted in a sample of "at risk" nonparticipants. Thematic analysis was conducted using an inductive phenomenological approach. Older, higher SES, male and previously screened participants were more likely to provide a medical reason for opting out of participation. Four key themes emerged from interview data. The first reflected intention; whereby participants were either intenders (i.e., they planned to participate) or refusers. Subsequent themes reflected practicalities, emotional reactions, and necessity. Differences between intenders and refusers within these themes as well as opinions regarding interventions were identified. Interventions involving interactions with health professionals, autonomous decision making, and those which emphasize the positive outcomes of screening may encourage refusers to participate in mail-out bowel cancer screening programs. Messages that reinforce the importance of screening or provide a practical reminder may be more useful for intenders.
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Affiliation(s)
- Belinda C Goodwin
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Sonja March
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Fiona Crawford-Williams
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Suzanne K Chambers
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia
| | - Jeff Dunn
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia.,School of Social Science, University of Queensland, Brisbane, QLD, Australia.,School of Medicine, Griffith University, Brisbane, QLD, Australia
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17
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Leff M, Loyal J. The Term Newborn: Alternative Birth Practices, Refusal, and Therapeutic Hesitancy. Clin Perinatol 2021; 48:647-663. [PMID: 34353585 DOI: 10.1016/j.clp.2021.05.012] [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] [Indexed: 11/28/2022]
Abstract
The care of late preterm and term newborns delivered in hospital settings in the United States is largely standardized with many routine interventions and screenings that are evidence-based and serve to protect newborn's and the public's health. Refusals of various aspects of routine newborn care are uncommon but can be challenging for clinicians who care for newborns to navigate for many reasons. In this article, we describe the spectrum of refusal. We review suggested approaches that clinicians can take starting with increasing their own awareness of what specific components of newborn care are refused and why.
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Affiliation(s)
- Michelle Leff
- Department of Pediatrics, University of California San Diego.
| | - Jaspreet Loyal
- Department of Pediatrics, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
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18
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Mirdad RS, Tsilimigras DI, Hyer JM, Diaz A, Azap RA, Pawlik TM. Refusal of Surgery Among Patients with Early-Stage Hepato-Pancreato-Biliary Cancers: Predictive Factors and Outcomes. J Gastrointest Surg 2021; 25:1573-1575. [PMID: 33230686 DOI: 10.1007/s11605-020-04885-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/12/2020] [Indexed: 02/07/2023]
Affiliation(s)
| | - Diamantis I Tsilimigras
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - J Madison Hyer
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Adrian Diaz
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
- National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Rosevine A Azap
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
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19
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Di Noia V, Renna D, Barberi V, Di Civita M, Riva F, Costantini G, Aquila ED, Russillo M, Bracco D, La Malfa AM, Giannarelli D, Cognetti F. The first report on coronavirus disease 2019 (COVID-19) vaccine refusal by patients with solid cancer in Italy: Early data from a single-institute survey. Eur J Cancer 2021; 153:260-264. [PMID: 34183225 PMCID: PMC8149194 DOI: 10.1016/j.ejca.2021.05.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 05/17/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Patients with cancer have an increased risk of complications from coronavirus disease 2019 (COVID-19) infection, including death, and thus, they were considered as high-priority subjects for COVID-19 vaccination. We report on the compliance with the COVID-19 vaccine of patients affected by solid tumours. MATERIALS AND METHODS Patients with cancer afferent to Medical Oncology 1 Unit of Regina Elena National Cancer Institute in Rome were considered eligible for vaccination if they were receiving systemic immunosuppressive antitumor treatment or received it in the last 6 months or having an uncontrolled advanced disease. The Pfizer BNT162b2 vaccine was proposed to all candidates via phone or during a scheduled visit. The reasons for refusal were collected by administrating a 6-item multiple-choice questionnaire. RESULTS From 1st March to 20th March 2021, of 914 eligible patients, 102 refused vaccination (11.2%, 95% confidence interval [CI] 9.1-13.2). The most frequent (>10%) reasons reported were concerns about vaccine-related adverse events (48.1%), negative interaction with concomitant antitumor therapy (26.7%), and the fear of allergic reaction (10.7%). The refusal rate (RR) after 15th March (date of AstraZeneca-AZD1222 suspension) was more than doubled compared with the RR observed before (19.7% versus 8.6%, odds ratio [OR] 2.60, 95% CI 1.69-3.99; P < 0.0001). ECOG-PS 2 was associated with higher RR compared with ECOG-PS 0-1 (OR 2.94, 95% CI 1.04-8.34; P = 0.04). No statistically significant differences in RR according to other clinical characteristics were found. CONCLUSIONS Our experience represents the first worldwide report on the adherence of patients with cancer to COVID-19 vaccination and underlines how regulatory decisions and media news spreading could influence the success of the campaign.
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Affiliation(s)
- Vincenzo Di Noia
- Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
| | - Davide Renna
- Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
| | - Vittoria Barberi
- Dipartimento di Medicina Clinica e Molecolare, Università La Sapienza di Roma, Rome, Italy.
| | - Mattia Di Civita
- Dipartimento di Medicina Clinica e Molecolare, Università La Sapienza di Roma, Rome, Italy.
| | - Federica Riva
- Dipartimento di Medicina Clinica e Molecolare, Università La Sapienza di Roma, Rome, Italy.
| | - Giulia Costantini
- Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
| | | | | | - Domenico Bracco
- Medical Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
| | | | - Diana Giannarelli
- Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
| | - Francesco Cognetti
- Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy; Dipartimento di Medicina Clinica e Molecolare, Università La Sapienza di Roma, Rome, Italy.
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20
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Elshabrawy A, Wang H, Satsangi A, Wheeler K, Ramamurthy C, Pruthi D, Kaushik D, Liss M, Gelfond J, Fernandez R, Gore J, Svatek R, Mansour AM. Correlates of refusal of radical cystectomy in patients with muscle-invasive bladder cancer. Urol Oncol 2021; 39:236.e9-236.e20. [PMID: 33423936 DOI: 10.1016/j.urolonc.2020.11.023] [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: 05/28/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate factors associated with radical cystectomy (RC) refusal, subsequent treatment decisions, and their influence on overall survival (OS). MATERIALS AND METHODS We queried the National Cancer Database for patients with non-metastatic muscle-invasive bladder cancer (MIBC), cT2-T4M0. Patients who refused recommended RC were further stratified by treatment into chemotherapy, radiation therapy, chemoradiotherapy, and no treatment groups. Patients were excluded from the analysis if surgery was not planned, not recommended; or if survival data were unknown. Multivariate logistic regression modeling was utilized to identify independent predictors of refusing RC. Cox proportional hazards model with propensity score overlap weighting was utilized to identify survival predictors. Kaplan-Meier analysis was utilized to evaluate survival according to treatment. RESULTS A total of 74,159 MIBC patients were identified. Among patients with documented reasons for no surgery, 5.4% refused RC despite physician recommendation. Predictors of refusal on multivariate analysis included female gender (P = 0.016), advancing age ≥80 (vs. <60, P < 0.001), African American race (vs. white, P < 0.001) Medicaid (vs. private insurance, P < 0.001) and advancing T stage (T4 vs. T2, P < 0.001). Patients treated at academic centers were less likely to decline RC (vs. community centers, P < 0.001). Median survival after RC was 40.44 months vs. 12.52 months in refusal group. Undergoing chemoradiation had significantly improved survival in those patients compared to monotherapy or no treatment (hazard ratio 0.25, P < 0.001). Overlap weighted model Identified RC refusal as an independent predictor of poor OS (P < 0.001). CONCLUSIONS Several sociodemographic and clinical factors are associated with refusing radical cystectomy. Such refusal is associated with poor survival outcomes.
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Affiliation(s)
| | - Hanzhang Wang
- Department of Urology, UT Health San Antonio, San Antonio, TX
| | - Arpan Satsangi
- Department of Urology, UT Health San Antonio, San Antonio, TX
| | - Karen Wheeler
- Department of Urology, UT Health San Antonio, San Antonio, TX
| | | | - Deepak Pruthi
- Department of Urology, UT Health San Antonio, San Antonio, TX; UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX
| | - Dharam Kaushik
- Department of Urology, UT Health San Antonio, San Antonio, TX; UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX
| | - Michael Liss
- Department of Urology, UT Health San Antonio, San Antonio, TX; UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX
| | - Jonathan Gelfond
- Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX
| | - Roman Fernandez
- Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX
| | - John Gore
- Department of Urology, University of Washington, Seattle, WA
| | - Robert Svatek
- Department of Urology, UT Health San Antonio, San Antonio, TX; UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX
| | - Ahmed M Mansour
- Department of Urology, UT Health San Antonio, San Antonio, TX; UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX; Urology and Nephrology Center, Mansoura University, Egypt.
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21
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Abstract
Pervasive refusal syndrome (PRS) is a complex condition that affects young people leading to social withdrawal, inability or refusal to eat, drink, mobilise or speak. The affected individual regresses and is unable to self-care and quite characteristically will resist rehabilitation, worsen with praise or remain entirely passive. This systematic review was aimed at describing clinical features of PRS, current interventions and to summarise some of the nosological aspects of the condition. Without language restriction, an electronic search was conducted in Embase, PsychInfo, Medline, Cochrane library, and PubMed databases yielding 29 articles with a total of 79 cases. We performed a risk of assessment bias using an adapted Newcastle-Ottawa Scale and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. 124 articles were identified, of which 29 were included and these yielded 79 cases. Seventy-six percent of the studies had a low rate of risk of assessment bias (good quality). Our results show that PRS overlaps with several conditions, mainly affects young females aged 7-15 years and has a recovery rate of 78% if diagnosed and treated early but the duration of inpatient treatment may last up to 9.44 months (8.82 SD). The patients had multiple inter-dependent risks. The major predisposing factors included vulnerable premorbid personality and pre-existing mental disorder. Precipitating factors were stressors such as infection and traumatic experiences. Enmeshed parent-child relationship served as a maintaining factor. The themes of treatment approach are essentially rehabilitative: (1) working collaboratively with patient and family, (2) having access to multidisciplinary team, and (3) peer/group supervision. This study has systematically evaluated a large sample of patients with PRS to ascertain its clinical features and the core elements of its treatment. Its key treatment approach is a multi-modal rehabilitative strategy that is compassionate, transparent and inclusive.
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Affiliation(s)
- John Otasowie
- Surrey Memorial Hospital, 13750 96 Avenue, Surrey, British Columbia, V3V 1Z2, Canada.
| | - Ann Paraiso
- Worcestershire Heath and Care Trust, Kings Court, 2, Charles Hastings Way, Worcester, WR5 IJR, UK
| | - Gordon Bates
- Coventry and Warwickshire Partnership Trust, Wayside House, Wilsons Ln, Coventry, CV6 6NY, UK
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22
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Khattak FA, Rehman K, Shahzad M, Arif N, Ullah N, Kibria Z, Arshad M, Afaq S, Ibrahimzai AK, Haq ZU. Prevalence of Parental refusal rate and its associated factors in routine immunization by using WHO Vaccine Hesitancy tool: A Cross sectional study at district Bannu, KP, Pakistan. Int J Infect Dis 2020; 104:117-124. [PMID: 33340667 DOI: 10.1016/j.ijid.2020.12.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 10/13/2020] [Revised: 12/02/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To determine the vaccination refusal rate, associated factors and perceptions of parents who refused routine immunization for their children using the World Health Organization (WHO) SAGE Working Group on Vaccine Hesitancy Survey Tool. MATERIALS AND METHODS A cross-sectional survey was conducted using multi-stage cluster sampling in Bannu District, Khyber Pakhtunkhwa Province, Pakistan from March 2019 to July 2019. A WHO validated questionaire was used. The outcome variable was parental refusal of routine immunization of their children. Logistic regression was performed for associations, and multi-regression was applied to identify any confounders. RESULTS Of 610 parents, 170 (27.9%) refused vaccination of their children. Of these, the majority of mothers had no education [n = 145 (85.3%); p = 0.03], and mothers were less likely to own a mobile phone than fathers [24 (14.1%) vs 152 (89.4%); p ≤ 0.001]. The vaccination refusal rate was higher in parents with food security [n = 88 (51.8%)] compared with parents with minimal food insecurity [n = 62 (36.5%)] and high food insecurity [20 (11.8%); p ≤ 0.05)]. On multi-variate logistic regression, fathers who were employed [adjusted odds ratio (OR) 0.59, 95% confidence interval (CI) 0.37-0.94; p = 0.02] and had a high level of education (adjusted OR 0.21, 95% CI 0.08-0.50; p ≤ 0.001) were less likely to refuse vaccination of their children. Parents with high food insecurity were more likely to refuse vaccination of their children (adjusted OR 2.2, 95% CI 1.0-0.50; p = 0.04) compared with parents with minimal food insecurity (adjusted OR 1.6, 95% CI 1.0-2.5; p = 0.02). CONCLUSION The vaccination refusal rate was very high among parents, and this was associated with inability to read or write, no education, owning a mobile phone, unemployment and food security.
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Affiliation(s)
| | - Khalid Rehman
- Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Muhammad Shahzad
- Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Numan Arif
- Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Naeem Ullah
- Saidu Medical College, Swat, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Zeeshan Kibria
- Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | | | - Saima Afaq
- Saima Afaq School of Public Health, Faculty of Medicine, Imperial College London, London, UK.
| | | | - Zia Ul Haq
- Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan
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23
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Abstract
Since the Three Rs of replacement, reduction and refinement was proposed by Russel and Birch in 1959, researchers have a moral duty to minimize harm to animals. Even though animal experiments are performed by the Three Rs concept, animal researches which do not comply with international rules and standards are not accepted as well. As animal welfare has been important global issues, the methods to assess animal welfare compromise and distress have been proposed. Humanity is accepted as the goal of the Three Rs, however, another fourth R, ‘Refusal’ of fruitless protocol or ‘Responsibility’ for the experimental animal and social, scientific status of the animal experiments has been proposed. After establishing goals of animal research in a respective society, reliable knowledge can be obtained while improving laboratory animal welfare.
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Affiliation(s)
- Kook Hyun Lee
- Department of Anesthesiology, Seoul National University Hospital, 101 DaeHak-ro, Jongno-Gu, Seoul, 03080, South Korea.
| | - Dong Won Lee
- Department of Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Byeong Chul Kang
- Department of Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea
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Dyda A, King C, Dey A, Leask J, Dunn AG. A systematic review of studies that measure parental vaccine attitudes and beliefs in childhood vaccination. BMC Public Health 2020; 20:1253. [PMID: 32807124 PMCID: PMC7433363 DOI: 10.1186/s12889-020-09327-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/02/2020] [Indexed: 12/13/2022] Open
Abstract
Background Acceptance of vaccines is an important predictor of vaccine uptake. This has public health implications as those who are not vaccinated are at a higher risk of infection from vaccine preventable diseases. We aimed to examine how parental attitudes and beliefs towards childhood vaccination were measured in questionnaires through a systematic review of the literature. Methods We systematically reviewed the literature to identify primary research studies using tools to measure vaccine attitudes and beliefs, published between January 2012 and May 2018. Studies were included if they involved a quantitative survey of the attitudes and beliefs of parents about vaccinations recommended for children. We undertook a synthesis of the results with a focus on evaluating the tools used to measure hesitancy. Results A total of 116 studies met the inclusion criteria, 99 used a cross sectional study design, 5 used a case control study design, 4 used a pre-post study design and 8 used mixed methods study designs. Sample sizes of included studies ranged from 49 to 12,259. The most commonly used tool was the Parent Attitudes about Childhood Vaccines (PACV) Survey (n = 7). The most common theoretical framework used was the Health Belief Model (n = 25). Questions eliciting vaccination attitudes and beliefs varied widely. Conclusions There was heterogeneity in the types of questionnaires used in studies investigating attitudes and beliefs about vaccination in parents. Methods to measure parental attitudes and beliefs about vaccination could be improved with validated and standardised yet flexible instruments. The use of a standard set of questions should be encouraged in this area of study.
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Affiliation(s)
- Amalie Dyda
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia. .,Department of Health Systems and Populations, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia.
| | - Catherine King
- National Centre for Immunisation Research & Surveillance, Sydney, NSW, Australia.,The University of Sydney, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Aditi Dey
- National Centre for Immunisation Research & Surveillance, Sydney, NSW, Australia.,The University of Sydney, School of Medicine, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Julie Leask
- National Centre for Immunisation Research & Surveillance, Sydney, NSW, Australia.,The University of Sydney, Susan Wakil School of Nursing and Midwifery, Sydney, NSW, Australia
| | - Adam G Dunn
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia.,The University of Sydney, Discipline of Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, Sydney, NSW, Australia
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25
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López Cuenca D, Orenes Moreno M, Olmo Conesa MC, Pastor Moreno A, Santos Mateo JJ, Muñoz Esparza C, Navarro Peñalver M, Castro García FJ, Sabater Molina M, Gimeno Blanes JR. Reasons for refusing diagnostic tests and therapeutic recommendations and associated complications in inherited heart diseases. The RELUCTANT study. ACTA ACUST UNITED AC 2020; 74:526-532. [PMID: 32709565 DOI: 10.1016/j.rec.2020.06.014] [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: 08/10/2019] [Accepted: 03/23/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Study of inherited heart diseases (IHD) involves performing diagnostic tests, which are sometimes inconvenient or stressful, in asymptomatic relatives. The aim of this study was to analyze refusal to undergo various diagnostic tests and follow therapeutic recommendations. METHODS We assessed 1992 consecutive families with IHD to analyze refusal to undergo family screening. The study included 1539 individuals who were recommended to undergo cardiac magnetic resonance, and 837 who were recommended a drug challenge test. To study treatment refusal, we assessed 395 patients with an indication for an implantable cardioverter-defibrillator (ICD) and 402 patients with an indication for anticoagulation. RESULTS A total of 28% of families who were recommended to undergo screening for suspected IHD did not attend, but refusal was lower if there was a family history of sudden cardiac death. In all, 23% did not undergo magnetic resonance, and the 2 main reasons were administrative problems (53%) and claustrophobia (18%). Refusal was more common in older people, women, symptomatic persons, individuals with arrhythmias, and relatives. Nearly one fifth (19%) did not take the drug challenge test, due to fear (46%) or administrative issues (25%). Refusal was more frequent in older individuals, asymptomatic persons, those with a history of arrhythmias, relatives, and those with a positive genetic study. Only a minority of patients rejected the treatments (5.1% ICD, 2.5% anticoagulation). The percentage of sudden cardiac death in persons rejecting ICD implantation was high (4.5% per year). CONCLUSIONS One fifth of people attending screening for IHD refused to undergo more sophisticated and stressful tests. This study identified several independent predictors associated with refusal. Only a minority of high-risk patients refused treatments such as ICD implantation and anticoagulation.
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Affiliation(s)
- David López Cuenca
- Unidad de Cardiopatías Hereditarias, Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; European Reference Networks (Guard-Heart), European Commission, Brussels, Belgium; Instituto Murciano de Investigación Biosanitaria (IMIB), El Palmar, Murcia, Spain.
| | - María Orenes Moreno
- Unidad de Cardiopatías Hereditarias, Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Red de Investigación Cardiovascular (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - M Carmen Olmo Conesa
- Unidad de Cardiopatías Hereditarias, Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; European Reference Networks (Guard-Heart), European Commission, Brussels, Belgium; Instituto Murciano de Investigación Biosanitaria (IMIB), El Palmar, Murcia, Spain
| | - Antonio Pastor Moreno
- Unidad de Cardiopatías Hereditarias, Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB), El Palmar, Murcia, Spain
| | - Juan José Santos Mateo
- Unidad de Cardiopatías Hereditarias, Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; European Reference Networks (Guard-Heart), European Commission, Brussels, Belgium; Instituto Murciano de Investigación Biosanitaria (IMIB), El Palmar, Murcia, Spain
| | - Carmen Muñoz Esparza
- Unidad de Cardiopatías Hereditarias, Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; European Reference Networks (Guard-Heart), European Commission, Brussels, Belgium; Instituto Murciano de Investigación Biosanitaria (IMIB), El Palmar, Murcia, Spain; Red de Investigación Cardiovascular (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Marina Navarro Peñalver
- Unidad de Cardiopatías Hereditarias, Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; European Reference Networks (Guard-Heart), European Commission, Brussels, Belgium; Instituto Murciano de Investigación Biosanitaria (IMIB), El Palmar, Murcia, Spain; Red de Investigación Cardiovascular (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco José Castro García
- European Reference Networks (Guard-Heart), European Commission, Brussels, Belgium; Instituto Murciano de Investigación Biosanitaria (IMIB), El Palmar, Murcia, Spain; Servicio de Cardiología Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Facultad de Medicina, Universidad de Murcia, Campus de El Palmar, El Palmar, Murcia, Spain
| | - María Sabater Molina
- Unidad de Cardiopatías Hereditarias, Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; European Reference Networks (Guard-Heart), European Commission, Brussels, Belgium; Instituto Murciano de Investigación Biosanitaria (IMIB), El Palmar, Murcia, Spain; Red de Investigación Cardiovascular (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Facultad de Medicina, Universidad de Murcia, Campus de El Palmar, El Palmar, Murcia, Spain
| | - Juan Ramón Gimeno Blanes
- Unidad de Cardiopatías Hereditarias, Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; European Reference Networks (Guard-Heart), European Commission, Brussels, Belgium; Instituto Murciano de Investigación Biosanitaria (IMIB), El Palmar, Murcia, Spain; Red de Investigación Cardiovascular (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Facultad de Medicina, Universidad de Murcia, Campus de El Palmar, El Palmar, Murcia, Spain
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26
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Schultz KS, de Geus SWL, Sachs TE, Morgan RB, Ng SC, McAneny D, Tseng JF. Influence of race and sociodemographic factors on declining resection for gastric cancer: A national study. Am J Surg 2020; 221:155-161. [PMID: 32758359 DOI: 10.1016/j.amjsurg.2020.06.022] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/18/2020] [Accepted: 06/18/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND The purpose of this study was to determine whether racial or other demographic characteristics were associated with declining surgery for early stage gastric cancer. METHODS Patients with clinical stage I-II gastric adenocarcinoma were identified from the NCDB. Multivariable logistic models identified predictors for declining resection. Patients were stratified based on propensity scores, which were modeled on the probability of declining. Overall survival was evaluated using the Kaplan-Meier method. RESULTS Of 11,326 patients, 3.68% (n = 417) declined resection. Patients were more likely to refuse if they were black (p < 0.001), had Medicaid or no insurance (p < 0.001), had shorter travel distance to the hospital (p < 0.001) or were treated at a non-academic center (p = 0.001). After stratification, patients who declined surgery had worse overall survival (all strata, p < 0.001). CONCLUSIONS Racial and sociodemographic disparities exist in the treatment of potentially curable gastric cancer, with patients who decline recommended surgery suffering worse overall survival.
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Affiliation(s)
- Kurt S Schultz
- Department of Surgery, Boston Medical Center, Boston University, 88 East Newton Street Collamore - C500, Boston, MA, 02118, USA; University of Massachusetts Medical School, 55 North Lake Avenue, Worcester, MA, 01655, USA.
| | - Susanna W L de Geus
- Department of Surgery, Boston Medical Center, Boston University, 88 East Newton Street Collamore - C500, Boston, MA, 02118, USA
| | - Teviah E Sachs
- Department of Surgery, Boston Medical Center, Boston University, 88 East Newton Street Collamore - C500, Boston, MA, 02118, USA
| | - Ryan B Morgan
- Department of Surgery, The University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Sing Chau Ng
- Department of Surgery, Boston Medical Center, Boston University, 88 East Newton Street Collamore - C500, Boston, MA, 02118, USA
| | - David McAneny
- Department of Surgery, Boston Medical Center, Boston University, 88 East Newton Street Collamore - C500, Boston, MA, 02118, USA
| | - Jennifer F Tseng
- Department of Surgery, Boston Medical Center, Boston University, 88 East Newton Street Collamore - C500, Boston, MA, 02118, USA.
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Alty IG, Dee EC, Cusack JC, Blaszkowsky LS, Goldstone RN, Francone TD, Wo JY, Qadan M. Refusal of surgery for colon cancer: Sociodemographic disparities and survival implications among US patients with resectable disease. Am J Surg 2020; 221:39-45. [PMID: 32723488 DOI: 10.1016/j.amjsurg.2020.06.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/14/2020] [Accepted: 06/16/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND We aimed to identify factors associated with refusal of surgery among patients with colon cancer. METHODS This 2004-2016 NCDB retrospective study identified AJCC stage I-III colon cancer patients who were recommended surgery. Multivariable logistic regression defined adjusted odds ratios of refusing treatment, with sociodemographic and clinical covariates. Treatment propensity-adjusted Cox proportional hazard ratios defined differential survival stratified by clinical stage, controlling for potential confounders. RESULTS Of 170,594 patients recommended surgery, 1116 refused. Increased rates of surgery refusal were associated with older age, African American race, CDCC>3, and female sex. Decreased rates of surgery refusal were associated with higher income and private insurance. Stratifying by stage, refusal rates among African Americans remained disparately high. Refusal of surgery was associated with worse overall survival. CONCLUSIONS Disparate rates of refusal of surgery for resectable colon cancer by race and other sociodemographic factors highlight potential treatment adherence reinforcement beneficiaries, necessitating further study of shared decision-making.
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Affiliation(s)
| | | | - James C Cusack
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | - Jennifer Y Wo
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA; Newton-Wellesley Hospital, Newton, MA, USA
| | - Motaz Qadan
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA; Newton-Wellesley Hospital, Newton, MA, USA.
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28
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Hassanein M, Anderson JA. Refusal of animal-derived medical products in a paediatric setting: Ethical issues. Paediatr Child Health 2020; 26:99-102. [PMID: 33747306 DOI: 10.1093/pch/pxz171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 09/25/2019] [Accepted: 12/10/2019] [Indexed: 11/13/2022] Open
Abstract
Many medical products that are widely available and commonly used are of animal origin, which can be problematic for those who identify as followers of a particular religion, or have moral commitments or dietary preferences that prohibit or restrict the ingestion of animal products. Given that people are becoming more conscious of the products they ingest, however, we suspect this might be an issue in the foreseeable future, particularly in a multicultural and diverse community like Toronto, Canada. Failure to provide services sensitive to these beliefs and preferences may result in a refusal of medical treatment. In this paper, we aim to identify and explore issues relating to the refusal of animal-derived medical products in paediatric settings by exploring three clinical cases.
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Affiliation(s)
- Maram Hassanein
- Department of Bioethics, The Hospital for Sick Children, Toronto, Ontario
| | - James A Anderson
- Department of Bioethics, The Hospital for Sick Children, Toronto, Ontario.,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario.,Joint Centre for Bioethics, University of Toronto, Toronto, Ontario
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29
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Leeuwerik T, Cavanagh K, Strauss C. Patient adherence to cognitive behavioural therapy for obsessive-compulsive disorder: A systematic review and meta-analysis. J Anxiety Disord 2019; 68:102135. [PMID: 31704633 DOI: 10.1016/j.janxdis.2019.102135] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 09/28/2018] [Revised: 07/15/2019] [Accepted: 08/23/2019] [Indexed: 10/26/2022]
Abstract
Whilst cognitive behavioural therapy (CBT) is the treatment of choice for obsessive-compulsive disorder (OCD), around half of the participants do not experience remission following treatment. As yet, there is no comprehensive systematic review of the extent to which patient non-adherence presents a challenge to the overall benefit of CBT for OCD. The aim of this systematic review and meta-analysis was to identify the magnitude, moderators and reasons for poor patient adherence to CBT for OCD in terms of: (1) treatment refusal, (2) treatment dropout, (3) session attendance/module completion, and (4) between-session CBT task adherence. Sociodemographic and clinical variables, treatment and study design characteristics were examined as moderators of adherence. The systematic search identified 123 studies including 5627 participants taking part in CBT or control conditions. A pooled rate of 15.6% of eligible patients refused CBT and a further 15.9% of treatment starters dropped out from treatment. Group CBT had significantly lower dropout rates than individually-delivered CBT. No other significant moderators were found. Most studies reported moderate to good adherence to between-session CBT tasks, which had a significant medium to large association with post-treatment OCD symptom reduction. Recommendations for enhanced measurement and reporting of patient adherence to CBT for OCD are made along with clinical implications of findings.
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Affiliation(s)
- Tamara Leeuwerik
- School of Psychology, University of Sussex, Falmer, East Sussex, BN1 9QH, UK
| | - Kate Cavanagh
- School of Psychology, University of Sussex, Falmer, East Sussex, BN1 9QH, UK
| | - Clara Strauss
- School of Psychology, University of Sussex, Falmer, East Sussex, BN1 9QH, UK; Sussex Partnership NHS Foundation Trust, R&D Department, Sussex Education Centre, Nevill Avenue, Hove BN3 7HZ, UK.
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30
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Mostafavian Z, Ghareh S, Torabian F, Yazdi MS, Khazaei MR. Data on insulin therapy refusal among type II diabetes mellitus patients in Mashhad, Iran. Data Brief 2018; 18:2047-2050. [PMID: 29904712 PMCID: PMC5998691 DOI: 10.1016/j.dib.2018.04.136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 04/30/2018] [Indexed: 11/15/2022] Open
Abstract
Insulin has been considered as a therapy option of last resort in type 2 diabetes (T2DM) management. Delay in insulin therapy is common in these patients. This study collected the data on the factors associated with insulin refusal in poorly controlled T2DM patients prior to insulin therapy. The data collected from two endocrinology outpatient clinics affiliated by Islamic Azad University of Mashhad, Iran (IAUM) from January 2016 to September 2017. Study population was adults with non-insulin-using type 2 diabetes mellitus who refused insulin therapy. A 17-items researcher made questionnaire was used to obtain demographic data and information toward causes of insulin refusal. Data were analyzed using SPPS V.16 with descriptive and analytical tests such as multiple logistic regressions. The data of 110 patients with T2DM was recorded in this study. The most prevalent cause of insulin therapy refusal was reported to be painful insulin injection (78.2%) followed by this item “I’m afraid of injecting myself with a needle” (74.5%). Regression analysis revealed that education level had a significant association with the item of “Injecting insulin is painful” (P=0.033, OR=0.357). Also age (P=0.025, OR=1.076) and disease duration (P=0.024, OR=0.231) were significantly associated with the question “taking insulin makes life less flexible”. Several causes have been found regarding misconceptions about insulin therapy in T2DM patients. Specialized educational interventions are recommended for initiating successful insulin therapy in these patients.
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Affiliation(s)
- Zahra Mostafavian
- Department of Community Medicine, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Sahar Ghareh
- Department of Internal Medicine, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Farnaz Torabian
- Medical Student, Faculty of Medicine, Islamic Azad University, Mashhad Branch, Mashhad, Iran
| | | | - Mahmood Reza Khazaei
- Department of Pediatric Medicine, Mashhad Branch, Islamic Azad University, Mashhad, Iran
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Giambi C, Fabiani M, D'Ancona F, Ferrara L, Fiacchini D, Gallo T, Martinelli D, Pascucci MG, Prato R, Filia A, Bella A, Del Manso M, Rizzo C, Rota MC. Parental vaccine hesitancy in Italy - Results from a national survey. Vaccine 2018; 36:779-787. [PMID: 29325822 DOI: 10.1016/j.vaccine.2017.12.074] [Citation(s) in RCA: 164] [Impact Index Per Article: 27.3] [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: 09/20/2017] [Revised: 12/13/2017] [Accepted: 12/28/2017] [Indexed: 11/26/2022]
Abstract
In Italy, in 2016, we conducted a cross-sectional survey to estimate vaccine hesitancy and investigate its determinants among parents of children aged 16-36 months. Data on parental attitudes and beliefs about vaccinations were collected through a questionnaire administered online or self-administered at pediatricians' offices and nurseries. Parents were classified as pro-vaccine, vaccine-hesitant or anti-vaccine, according to self-reported tetanus and measles vaccination status of their child. Multivariable logistic regression was used to investigate factors associated with hesitancy. A total of 3130 questionnaires were analysed: 83.7% of parents were pro-vaccine, 15.6% vaccine-hesitant and 0.7% anti-vaccine. Safety concerns are the main reported reason for refusing (38.1%) or interrupting (42.4%) vaccination. Anti-vaccine and hesitant parents are significantly more afraid than pro-vaccine parents of short-term (85.7 and 79.7% vs 60.4%) and long-term (95.2 and 72.3% vs 43.7%) vaccine adverse reactions. Most pro-vaccine and hesitant parents agree about the benefits of vaccinations. Family pediatricians are considered a reliable source of information by most pro-vaccine and hesitant parents (96.9 and 83.3% respectively), against 45% of anti-vaccine parents. The main factors associated with hesitancy were found to be: not having received from a paediatrician a recommendation to fully vaccinate their child [adjusted odds ratio (AOR): 3.21, 95% CI: 2.14-4.79], having received discordant opinions on vaccinations (AOR: 1.64, 95% CI: 1.11-2.43), having met parents of children who experienced serious adverse reactions (AOR: 1.49, 95% CI: 1.03-2.15), and mainly using non-traditional medical treatments (AOR: 2.05, 95% CI: 1.31-3.19). Vaccine safety is perceived as a concern by all parents, although more so by hesitant and anti-vaccine parents. Similarly to pro-vaccine parents, hesitant parents consider vaccination an important prevention tool and trust their family pediatricians, suggesting that they could benefit from appropriate communication interventions. Training health professionals and providing homogenous information about vaccinations, in line with national recommendations, are crucial for responding to their concerns.
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Affiliation(s)
- Cristina Giambi
- Communicable Disease Epidemiology Unit, National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
| | - Massimo Fabiani
- Communicable Disease Epidemiology Unit, National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
| | - Fortunato D'Ancona
- Communicable Disease Epidemiology Unit, National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
| | - Lorenza Ferrara
- ASL-AL Regional Epidemiology Unit for Infectious Diseases, via Venezia 6, 15121 Alessandria, Italy.
| | - Daniel Fiacchini
- Department of Prevention, Regional Health Unit, Via Turati 51, 60044 Fabriano, Ancona, Italy.
| | - Tolinda Gallo
- Public Health Department - Udine Healthcare and University Integrated Trust, Via Chiusaforte 2, 33100 Udine, Italy.
| | - Domenico Martinelli
- Department of Medical and Surgical Sciences, University of Foggia, Viale L. Pinto 1, 71121 Foggia, Italy.
| | | | - Rosa Prato
- Department of Medical and Surgical Sciences, University of Foggia, Viale L. Pinto 1, 71121 Foggia, Italy.
| | - Antonietta Filia
- Communicable Disease Epidemiology Unit, National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
| | - Antonino Bella
- Communicable Disease Epidemiology Unit, National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
| | - Martina Del Manso
- Communicable Disease Epidemiology Unit, National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
| | - Caterina Rizzo
- Communicable Disease Epidemiology Unit, National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
| | - Maria Cristina Rota
- Communicable Disease Epidemiology Unit, National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
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Abstract
We describe our ethics-driven process of addressing missing data within a social network study about accountability for racism, classism, sexism, heterosexism, cis-sexism, ableism, and other forms of oppression among social justice union organizers. During data collection, some would-be participants did not return emails and others explicitly refused to engage in the research. All refusals came from women of color. We faced an ethical dilemma: Should we continue to seek participation from those who had not yet responded, with the hopes of recruiting more women of color from within the network so their perspectives would not be tokenized? Or, should we stop asking those who had been contacted multiple times, which would compromise the social network data and analysis? We delineate ways in which current discussions of the ethics of social network studies fell short, given our framework and our community psychology (CP) values. We outline literature that was helpful in thinking through this challenge; we looked outside of CP to the decolonization literature on refusal. Lessons learned include listening for the possible meanings of refusals and considering the level of engagement and the labor required of participants when designing research studies.
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33
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Gurmu E, Endale S. Wife beating refusal among women of reproductive age in urban and rural Ethiopia. BMC Int Health Hum Rights 2017; 17:6. [PMID: 28302105 PMCID: PMC5356412 DOI: 10.1186/s12914-017-0115-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 03/08/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Wife beating is the most common and widespread form of intimate partner violence in Ethiopia. It results in countless severe health, socio-economic and psychological problems and has contributed to the violation of human rights including the liberty of women to enjoy conjugal life. The main purpose of this study is to assess the levels and patterns of wife beating refusal and its associated socio-cultural and demographic factors in rural and urban Ethiopia. METHODS The 2011 Ethiopian Demographic and Health Survey (EDHS) data based on 11,097 and 5287 women in the reproductive age group (i.e. 15-49 years) living in rural and urban areas, respectively,were used in this study. Cronbach's alpha was used to assess the internal consistency of the measure of women's attitudes towards wife beating. The Statistical Package for Social Sciences was applied to analyze the data. A binary logistic regression model was fitted to identify variables that significantly predict respondents' refusal of wife beating. Separate analysis by a place of residence was undertaken as attitude towards wife beating vary between rural and urban areas. RESULTS The likelihood of refusing wife beating in Ethiopia was significantly higher among urban women (54.2%) than rural women (24.5%). Although there was a significant variations in attitude towards refusing wife beating among different regions in Ethiopia, increasing educational level, high access to media, age of respondents were associated with high level of refusal of wife beating. In contrast, rural residence, being in marital union, high number of living children, being followers of some religions (Muslim followers in urban and Protestants in rural) were associated with low level of refusal of wife beating. CONCLUSION The findings of this study reveal that wife beating in Ethiopia is a function of demographic and socio-cultural factors among which age and educational attainment of respondents, number of living children, religious affiliation, marital commitment and region of residence play significant roles. As factors governing perceptions and behaviours of individuals and institutional settings appear to shape knowledge and attitude towards gender equity and equality, awareness creation and behavioural change initiatives should be considered to abolish violence against women.
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Affiliation(s)
- Eshetu Gurmu
- Center for Population Studies, College of Development Studies, Addis Ababa University, Addis Ababa, Ethiopia. .,Population and Gender Research Unit, Institute of Development and Policy Research, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Senait Endale
- Population and Gender Research Unit, Institute of Development and Policy Research, Addis Ababa University, Addis Ababa, Ethiopia
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Hinds N, Borah A, Yoo EJ. Outcomes of nighttime refusal of admission to the intensive care unit: The role of the intensivist in triage. J Crit Care 2017; 39:214-219. [PMID: 28279496 DOI: 10.1016/j.jcrc.2016.12.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 12/07/2016] [Accepted: 12/15/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To compare outcomes of patients refused medical intensive care unit (MICU) admission overnight to those refused during the day and to examine the impact of the intensivist in triage. MATERIALS AND METHODS Retrospective, observational study of patients refused MICU admission at an urban university hospital. RESULTS Of 294 patients, 186 (63.3%) were refused admission overnight compared to 108 (36.7%) refused during the day. Severity-of-illness by the Mortality Probability Model was similar between the two groups (P=.20). Daytime triage refusals were more likely to be staffed by an intensivist (P=.01). After risk-adjustment, daytime refusals had a lower odds of subsequent ICU admission (OR 0.46, 95% CI 0.22-0.95, P=.04) than patients triaged at night. There was no evidence for interaction between time of triage and intensivist staffing of the patient (P=.99). CONCLUSIONS Patients refused MICU admission overnight are more likely to be later admitted to an ICU than patients refused during the day. However, the mechanism for this observation does not appear to depend on the intensivist's direct evaluation of the patient. Further investigation into the clinician-specific effects of ICU triage and identification of potentially modifiable hospital triage practices will help to improve both ICU utilization and patient safety.
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Affiliation(s)
- Nicholas Hinds
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Drexel University College of Medicine, Philadelphia, PA
| | - Amit Borah
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Drexel University College of Medicine, Philadelphia, PA
| | - Erika J Yoo
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Drexel University College of Medicine, Philadelphia, PA.
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Farrukh MJ, Ming LC, Zaidi STR, Khan TM. Barriers and strategies to improve influenza vaccination in Pakistan. J Infect Public Health 2017; 10:881-883. [PMID: 28185822 DOI: 10.1016/j.jiph.2016.11.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/15/2016] [Accepted: 11/18/2016] [Indexed: 11/17/2022] Open
Abstract
Influenza vaccination is strongly recommended by World Health Organisation on a yearly basis. The rate of immunization in Pakistan is suboptimal. High cost, traditional norms, customs and low levels of education in Pakistan are preventing people from getting vaccinated. It is timely to include influenza vaccination in the expanded programme on immunization (EPI), which is a disease prevention programme aiming to eradicate preventable diseases through subsidized or free immunization. The Ministry of National Health Services, Regulation and Coordination, Government of Pakistan should launch a national influenza vaccine policy in view of this current situation and oversee its implementation. Healthcare professionals should promote influenza vaccination and focus on high risk groups such as the elderly, pregnant women and children. Convincing and educating family members regarding immunization of pregnant women and follow-up with parents regarding a second influenza shot for their children will further improve vaccination rates in Pakistan.
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Affiliation(s)
- Muhammad J Farrukh
- Faculty of Pharmaceutical Sciences, UCSI University, Cheras, Kuala Lumpur, Malaysia
| | - Long C Ming
- Vector-Borne Diseases Research Group (VERDI), Pharmaceutical and Life Sciences CoRe, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia; Unit for Medication Outcomes Research and Education (UMORE), Pharmacy, School of Medicine, University of Tasmania, Hobart, Australia
| | - Syed T R Zaidi
- Unit for Medication Outcomes Research and Education (UMORE), Pharmacy, School of Medicine, University of Tasmania, Hobart, Australia
| | - Tahir M Khan
- School of Pharmacy, Monash University, Bandar Sunway, Selangor, Malaysia.
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Batais MA, Schantter P. Prevalence of unwillingness to use insulin therapy and its associated attitudes amongst patients with Type 2 diabetes in Saudi Arabia. Prim Care Diabetes 2016; 10:415-424. [PMID: 27297805 DOI: 10.1016/j.pcd.2016.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 10/30/2015] [Revised: 04/28/2016] [Accepted: 05/24/2016] [Indexed: 12/30/2022]
Abstract
AIMS This study aimed at determining the prevalence of unwillingness to use insulin and its associated attitudes amongst participants with Type 2 diabetes in Saudi Arabia. A further aim was to investigate whether demographic characteristics such as age, gender, educational level and duration of diabetes are associated with unwillingness to use insulin among these participants. METHODS This is a cross-sectional study conducted among participants with Type 2 diabetes using a self-administered questionnaire. The study sample consisted of 408 insulin-naive participants with Type 2 diabetes who were recruited between May and August 2014 from the primary care outpatient clinics at King Khalid University Hospital in Riyadh, Saudi Arabia. RESULTS Unwillingness to commence using insulin was common in about one third (34.6%) of Saudi participants with Type 2 diabetes. Negative attitudes most frequently raised by participants towards commencing insulin therapy were: keeping insulin as a last resort (57.1%), restriction of lifestyle (48.8%), problematic hypoglycemia (45.1%), perception of failure to care for diabetes previously (44.6%), and weight gain worries (40.7%). In a multivariable logistic regression analysis, after adjustment for a participant's age, gender, educational level, location and duration of diabetes, participants with tertiary education were 48% less likely to be willing to initiate insulin therapy as compared to those who had only a primary education (OR=0.52, 95% CI=0.30-0.91, P=0.023). However, there were no significant associations between unwillingness to commence insulin and other study variables. CONCLUSIONS Participants have several negative attitudes concerning initiating insulin therapy. Exploring the reasons for participant reluctance to commence insulin can help address his or her specific concerns and beliefs, and promote the future uptake of insulin.
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Affiliation(s)
- Mohammed Ali Batais
- Department of General Practise, Monash University, Building 1, 270 Ferntree Gully Road Notting Hill, Vic 3168, Australia; Family and Community Medicine Department, King Saud University, Riyadh 29391, Saudi Arabia.
| | - Peter Schantter
- Department of General Practice, School of Primary Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Building 1, 270 Ferntree Gully Road Notting Hill, Melbourne, Vic 3168, Australia.
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Gonzalez KW, Adibe OO, Dalton BG, Desai AA, Sharp SW, St Peter SD. Understanding parental refusal of permission for child participation in surgical prospective trials. Pediatr Surg Int 2016; 32:505-8. [PMID: 26896964 DOI: 10.1007/s00383-016-3878-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE The success of prospective randomized trials relies on voluntary participation, which has been perceived as a barrier for successful trials in children who rely on parental permission. We sought to identify the reasons parents decline child participation to understand potential limitations in the consent process. METHODS A prospective observational study was conducted in 92 patients asked to participate in prospective randomized trials between 2012 and 2015. Parental reasons for refusal were documented. RESULTS The 92 refusals were distributed between studies investigating the management of circumcision, gastroschisis, pectus excavatum, appendicitis, pyloric stenosis, undescended testicles, abdominal abscess and gastroesophageal reflux. Reasons for refusal included preference of treatment path (37 %), inability to follow up (21 %), unspecified resistance to participate in research (18 %), preference to maintain independent surgeon decision (16 %), and desire for historically standard treatment (8 %). Of the families who opted to pursue a specific treatment arm rather than randomization, 35 % had prior experience with that treatment, 32 % had researched the procedure, 18 % wished to pursue the minimal intervention and 15 % did not specify. CONCLUSIONS Parental preference of therapy is the most common reason for refusal of study participation. This variable could be influenced with more effective explanation of study rationale and existing equipoise.
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Affiliation(s)
- Katherine W Gonzalez
- Department of Pediatric Surgery, Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, 64108, USA
| | - Obinna O Adibe
- Department of Pediatric Surgery, Duke Children's Hospital and Health Center, DUMC 3815, Durham, NC, 27710, USA
| | - Brian G Dalton
- Department of Pediatric Surgery, Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, 64108, USA
| | - Amita A Desai
- Department of Pediatric Surgery, Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, 64108, USA
| | - Susan W Sharp
- Department of Pediatric Surgery, Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, 64108, USA
| | - Shawn D St Peter
- Department of Pediatric Surgery, Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, 64108, USA.
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Ghanem H, Afrashtehfar KI, Abi-Nader S, Tamimi F. Impact of a "TED-Style" presentation on potential patients' willingness to accept dental implant therapy: a one-group, pre-test post-test study. J Adv Prosthodont 2015; 7:437-45. [PMID: 26816573 PMCID: PMC4722147 DOI: 10.4047/jap.2015.7.6.437] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 11/20/2015] [Accepted: 11/24/2015] [Indexed: 12/03/2022] Open
Abstract
PURPOSE A survey was conducted to assess the impact of a TED-like educational session on participants' willingness to accept dental implant therapy. MATERIALS AND METHODS Volunteers interested in having information about dental implant therapies were recruited and asked to complete a two-part survey before and after an educational session. The initial survey elicited demographic information, self-perceived knowledge on dental implants and willingness to this kind of treatment. A "TED-style" presentation that provided information about dental implant treatments was conducted before asking the participants to complete a second set of questions assessing the impact of the session. RESULTS The survey was completed by 104 individuals, 78.8% were women and the mean age was 66.5±10.8. Before the educational session, 76.0% of the participants refused dental implants mainly due to lack of knowledge. After the educational session, the rejection of dental implants decreased by almost four folds to 20.2%. CONCLUSION This study proved that an educational intervention can significantly increase willingness to accept treatment with dental implants in a segment of the population who is interested in having information about dental implant therapy. Furthermore, educational interventions, such as TED-like talks, might be useful to increase popular awareness on dental implant therapy.
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Affiliation(s)
- Henry Ghanem
- Private practice limited to Prosthodontics, Riyadh, KSA
| | - Kelvin Ian Afrashtehfar
- Division of Prosthodontics and Restorative Dentistry, Faculty of Dentistry, McGill University, Montreal, QC, Canada.; Division of Fixed Prosthodontics, School of Dental Medicine, University of Bern, Bern, Switzerland.; Private practice limited to Prosthodontics, Riviera Maya, Mexico
| | - Samer Abi-Nader
- Division of Prosthodontics and Restorative Dentistry, Faculty of Dentistry, McGill University, Montreal, QC, Canada.; Private practice limited to Prosthodontics, Montreal, QC, Canada
| | - Faleh Tamimi
- Division of Prosthodontics and Restorative Dentistry, Faculty of Dentistry, McGill University, Montreal, QC, Canada
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Robert R, Coudroy R, Ragot S, Lesieur O, Runge I, Souday V, Desachy A, Gouello JP, Hira M, Hamrouni M, Reignier J. Influence of ICU-bed availability on ICU admission decisions. Ann Intensive Care 2015; 5:55. [PMID: 26714805 PMCID: PMC4695477 DOI: 10.1186/s13613-015-0099-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [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: 10/09/2015] [Accepted: 12/08/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The potential influence of bed availability on triage to intensive care unit (ICU) admission is among the factors that may influence the ideal ratio of ICU beds to population: thus, high bed availability (HBA) may result in the admission of patients too well or too sick to benefit, whereas bed scarcity may result in refusal of patients likely to benefit from ICU admission. METHODS Characteristics and outcomes of patient admitted in four ICUs with usual HBA, defined by admission refusal rate less than 11 % because of bed unavailability, were compared to patients admitted in six ICUs with usual low bed availability (LBA), i.e., an admission refusal rate higher than 10 % during a 90-day period. RESULTS Over the 90 days, the mean number of days with no bed available was 30 ± 16 in HBA units versus 48 ± 21 in LBA units (p < 0.01). The proportion of admitted patients was significantly higher in the HBA (80.1 %; n = 659/823) than in the LBA units [61.6 %: n = 480/779; (p < 0.0001)]. The proportion of patients deemed too sick to benefit from admission was higher in LBA (9.0 %; n = 70) than in the HBA (6.3 %; n = 52) units (p < 0.05). The HBA group had a significantly greater proportion of patients younger than 40 years of age (22.5 %; n = 148 versus 14 %; n = 67 in LBA group; p < 0.001) and higher proportions of patients with either high or low simplified acute physiologic score II values. CONCLUSIONS Bed availability affected triage decisions. Units with HBA trend to admit patients too sick or too well to benefit.
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Affiliation(s)
- René Robert
- Réanimation Médicale, Université de Poitiers, CHU Poitiers, Inserm Unit CIC 1402; Groupe ALIVE, Poitiers, France.
| | - Rémi Coudroy
- Réanimation Médicale, Université de Poitiers, CHU Poitiers, Inserm Unit CIC 1402; Groupe ALIVE, Poitiers, France.
| | - Stéphanie Ragot
- Réanimation Médicale, Université de Poitiers, CHU Poitiers, Inserm Unit CIC 1402; Groupe ALIVE, Poitiers, France.
| | - Olivier Lesieur
- Réanimation Polyvalente, Centre Hospitalier La Rochelle, La Rochelle, France.
| | - Isabelle Runge
- Medical-Surgical Intensive Care Unit, Hospital Center, 45067, Orleans, France.
| | - Vincent Souday
- Réanimation Médicale, Université D'Angers, CHU Angers, Angers, France.
| | - Arnaud Desachy
- Réanimation Polyvalente, Centre Hospitalier Angoulême, Angouleme, France.
| | - Jean-Paul Gouello
- Surgical Intensive Care, District Hospital, 35400, Saint-Malo, France.
| | - Michel Hira
- Medical-Surgical Intensive Care, District Hospital, 36000, Chateauroux, France.
| | - Mouldi Hamrouni
- Medical-Surgical Intensive Care, District Hospital, 28018, Chartres, France.
| | - Jean Reignier
- Medical Intensive Care, University of Nantes, CHU Nantes, Nantes, France.
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Epitropakis C, DiPietro EA. Medication compliance protocol for pediatric patients with severe intellectual and behavioral disabilities. J Pediatr Nurs 2015; 30:329-32. [PMID: 25193686 DOI: 10.1016/j.pedn.2014.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 08/06/2014] [Accepted: 08/08/2014] [Indexed: 11/20/2022]
Abstract
Pediatric nurses are well aware of patient medication refusal. For a variety of reasons, many pediatric patients are noncompliant with their medication regimen. Medication administration is even more difficult when the population has severe intellectual and behavioral disabilities. An inpatient unit composed of children with these diagnoses presented a unique challenge. To address this issue, the unit RNs devised a medication compliance protocol. Initial implementation resulted in a success rate of 83.3% for six patients, after 4 weeks. Despite the small sample size, the RNs experienced a positive outcome with medication administration through consistent application of a medication compliance protocol.
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Rhee WJ, Chung CJ, Lim YH, Lee KH, Lee SC. Factors in patient dissatisfaction and refusal regarding spinal anesthesia. Korean J Anesthesiol 2010; 59:260-4. [PMID: 21057616 PMCID: PMC2966707 DOI: 10.4097/kjae.2010.59.4.260] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2010] [Revised: 06/07/2010] [Accepted: 06/22/2010] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Spinal anesthesia is the most common regional anesthesia conducted for many surgical procedures. Multiple factors can affect the success, the side effects, and patient satisfaction with the procedure. This study was undertaken prospectively to discover factors affecting dissatisfaction and refusal of spinal anesthesia. METHODS Starting in December 2007, patients who underwent spinal anesthesia in the operating rooms of our hospital were surveyed over a period of a year. Before attempting the procedure, patient characteristics and previous history of anesthesia were recorded. Spinal anesthesia was administered with 0.5% heavy bupivacaine combined with fentanyl 0-20 µg. Intraoperative data and postoperative data on the day after surgery were collected. The patients were also asked about their general satisfaction with spinal anesthesia, causes of dissatisfaction with the procedure, and causes of their refusal to have spinal anesthesia again. RESULTS Six patients among 1,197 cases were excluded from the study because of spinal anesthesia failure. The dissatisfaction rate of spinal anesthesia was 3.7%, and its risk factors were more than three puncture attempts, paresthesia at puncture, postoperative nausea and vomiting, and postoperative backache. The refusal rate to have spinal anesthesia again was 3.2%, and its risk factors were postoperative backache and dissatisfaction. CONCLUSIONS Although spinal anesthesia was conducted safely during the study and revealed a high rate of patient satisfaction (96.3%), side effects still occurred. Therefore, attending anesthesiologists must perform the procedure carefully and always pay attention to patients under spinal anesthesia.
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Affiliation(s)
- Won Ji Rhee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Dong-A University, Busan, Korea
| | - Chan Jong Chung
- Department of Anesthesiology and Pain Medicine, College of Medicine, Dong-A University, Busan, Korea
| | - Youn Hee Lim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Dong-A University, Busan, Korea
| | - Kyu Han Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Dong-A University, Busan, Korea
| | - Seung Cheol Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Dong-A University, Busan, Korea
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