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Bitar L, Chaccour C, Bitar ER, Halabi R, Kesrouani A. Parental refusal of prenatal screening for aneuploidies. J Perinat Med 2024; 52:369-374. [PMID: 38485523 DOI: 10.1515/jpm-2023-0399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 01/15/2024] [Indexed: 05/04/2024]
Abstract
OBJECTIVES To analyze the reasons for refusal of aneuploidy screening in a multicultural Middle Eastern population. METHODS The study included patients delivering in a university hospital, who had refused aneuploidy screening during their pregnancy. We evaluated through a questionnaire submitted during the postpartum period the sociodemographic characteristics, beliefs, attitudes, and the main reason underpinning their choice. Religious, ethical, and financial factors, personal beliefs, medical information, perceived media information, and familial input were assessed through a Likert scale. RESULTS Our pilot study included 70 patients. The main reason (33 %) was the refusal to terminate pregnancy if the screening tests ultimately led to a diagnosis of aneuploidy. Lack of adequate information on the availability and benefits of this screening method (28 %), religious beliefs (17 %), in addition to other minor reasons such as financial considerations, familial recommendations, late pregnancy follow-ups, and media influence were also identified as contributing factors. CONCLUSIONS Aneuploidy screening is routinely offered to couples, with varying uptake rates observed worldwide. Sufficient information on prenatal screening and diagnosis should be provided to all pregnant women, presenting all available options, thus enabling them to make a free and informed choice during their pregnancy.
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Affiliation(s)
- Lynn Bitar
- Faculty of Medicine, 36925 St Joseph University , Beirut, Lebanon
| | - Christian Chaccour
- Obstetrics and-Gynecology Department, 36925 Hôtel-Dieu de France Hospital, St Joseph University , Beirut, Lebanon
| | - Elio R Bitar
- Faculty of Medicine, 11238 American University of Beirut , Beirut, Lebanon
| | - Rami Halabi
- Department of Urology, School of Medicine and Medical Sciences, 67028 Holy Spirit University of Kaslik , Jounieh, Lebanon
| | - Assaad Kesrouani
- Obstetrics and-Gynecology Department, 36925 Hôtel-Dieu de France Hospital, St Joseph University , Beirut, Lebanon
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2
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Wong LY, Elliott IA, Liou DZ, Backhus LM, Lui NS, Shrager JB, Berry MF. The impact of refusing esophagectomy for treatment of locally advanced esophageal adenocarcinoma. JTCVS Open 2023; 16:987-995. [PMID: 38204633 PMCID: PMC10775062 DOI: 10.1016/j.xjon.2023.09.006] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/23/2023] [Accepted: 09/07/2023] [Indexed: 01/12/2024]
Abstract
Objective Patients with esophageal cancer may be reluctant to proceed with surgery due to high complication rates. This study aims to compare outcomes between eligible surgical candidates who proceeded with surgery versus those who refused surgery. Methods Characteristics and survival of patients with locally advanced (cT3N0M0, cT1-3N+M0) mid-/distal esophageal adenocarcinoma in the National Cancer Database (2006-2019) who either proceeded with or refused surgery after chemoradiotherapy were evaluated with logistic regression, Kaplan-Meier curves, and Cox proportional hazards methods. Results Of the 13,594 patients included in the analysis, 595 (4.4%) patients refused esophagectomy. Patients who refused surgery were older, had less distance to travel to their treatment facility, were more likely to have cN0 disease, and were more likely to be treated at a community rather than academic or integrated network program, but did not have significantly different comorbid disease distributions. On multivariable analysis, refusing surgery was independently associated with older age, uninsured, lower income, less distance to a hospital, and treatment in a community program versus an academic/research or integrated network program. Esophagectomy was associated with better survival (5-year survival 40.1% [39.2-41] vs 23.6% [19.9-27.9], P < .001) and was also independently associated with better survival in the Cox model (hazard rate, 0.78 [95% confidence interval, 0.7-0.87], P < .001). Conclusions The results of this study can inform selected patients with resectable esophageal adenocarcinoma that their survival will be significantly diminished if surgery is not pursued. Many factors associated with refusing surgery are non-clinical and suggest that access to or support for care could influence patient decisions.
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Affiliation(s)
- Lye-Yeng Wong
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, Calif
| | - Irmina A. Elliott
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, Calif
- VA Palo Alto Health Care System, Palo Alto, Calif
| | - Douglas Z. Liou
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, Calif
| | - Leah M. Backhus
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, Calif
- VA Palo Alto Health Care System, Palo Alto, Calif
| | - Natalie S. Lui
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, Calif
| | - Joseph B. Shrager
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, Calif
- VA Palo Alto Health Care System, Palo Alto, Calif
| | - Mark F. Berry
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, Calif
- VA Palo Alto Health Care System, Palo Alto, Calif
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Sridharan G, Fleury Y, Hergafi L, Doll S, Ksouri H. Triage of Critically Ill Patients: Characteristics and Outcomes of Patients Refused as Too Well for Intensive Care. J Clin Med 2023; 12:5513. [PMID: 37685579 PMCID: PMC10488145 DOI: 10.3390/jcm12175513] [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: 07/31/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND The appropriate selection of patients for the intensive care unit (ICU) is a concern in acute care settings. However, the description of patients deemed too well for the ICU has been rarely reported. METHODS We conducted a single-centre retrospective observational study of all patients either deemed "too well" for or admitted to the ICU during one year. Refused patients were screened for unexpected events within 7 days, defined as either ICU admission without another indication, or death without treatment limitations. Patients' characteristics and organisational factors were analysed according to refusal status, outcome and delay in ICU admission. RESULTS Among 2219 enrolled patients, the refusal rate was 10.4%. Refusal was associated with diagnostic groups, treatment limitations, patients' location on a ward, night time and ICU occupancy. Unexpected events occurred in 16 (6.9%) refused patients. A worse outcome was associated with time spent in hospital before refusal, patients' location on a ward, SOFA score and physician's expertise. Delayed ICU admissions were associated with ICU and hospital length of stay. CONCLUSIONS ICU triage selected safely most patients who would have probably not benefited from the ICU. We identified individual and organisational factors associated with ICU refusal, subsequent ICU admission or death.
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Affiliation(s)
- Govind Sridharan
- Department of Intensive Care Medicine, Fribourg Hospital, CH-1700 Fribourg, Switzerland; (Y.F.); (L.H.); (S.D.); (H.K.)
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Pop CA. Intimate Compromise: Reproduction, Piety, and Medicine Among American Orthodox Christians. Med Anthropol 2023; 42:521-534. [PMID: 37526927 DOI: 10.1080/01459740.2023.2235712] [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] [Indexed: 08/02/2023]
Abstract
Drawing on ethnographic findings from an American Orthodox Christian community, I examine how forms of intimate reproductive compromise facilitate the assertive refusal to negotiate on abortion. The American Orthodox harness the values and practices of biomedicine to validate their refusal of abortion, but their inflexible views emerge from prior compromises. By not giving up modern contraception, women self-fashion forms of piety that allow them to navigate composite identities while remaining dedicated to a pro-life stance. That steadfast refusal of abortion may be the consequence of previous concessions opens up new ways of theorizing refusal as inextricably bound to - rather than exclusive of - prior compromises.
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Affiliation(s)
- Cristina A Pop
- Department of Cultural and Social Studies, Creighton University Omaha, Nebraska, USA
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5
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Domaradzki J, Głodowska K, Jabkowski P. Between Autonomy and Paternalism: Attitudes of Nursing Personnel Towards Jehovah's Witnesses' Refusal of Blood Transfusion. Int J Public Health 2023; 68:1606291. [PMID: 37600524 PMCID: PMC10432684 DOI: 10.3389/ijph.2023.1606291] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
Objectives: The study describes the attitudes of Polish nursing personnel towards Jehovah's Witnesses' (JWs') refusal to receive blood and blood products. Methods: We developed an online survey assessing nurses' knowledge and attitudes towards JWs' refusal of blood transfusion in a life-threatening condition. It also examined nurses' attitudes towards ethical and legal issues associated with JWs' refusal of blood transfusions. These questions were explored using a sample of 202 Polish nurses. Results: Nurses' knowledge of JWs' stance towards blood transfusions is inadequate and they tended to be ill-disposed towards JWs' refusal of blood transfusions. Although most nurses respected adult JW patients' autonomy and supported their right to refuse blood, in the case of JW children they are guided by paternalism. Nurses' attitudes were affected by whether they had children, whether they declared themselves religious, their level of education and prior experience with patients who had refused a blood transfusion. Conclusion: Since most nurses felt unprepared to care for JW patients, this study reveals an urgent need to train nurses in transcultural nursing and increase nurses' cultural competencies, and that this should be incorporated into medical curricula .
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Affiliation(s)
- Jan Domaradzki
- Department of Social Sciences and Humanities, Poznań University of Medical Sciences, Poznań, Poland
| | - Katarzyna Głodowska
- Department of Social Sciences and Humanities, Poznań University of Medical Sciences, Poznań, Poland
| | - Piotr Jabkowski
- Faculty of Sociology, Adam Mickiewicz University, Poznań, Poland
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Hussein MH, Toraih EA, Ohiomah IE, Siddeeque N, Comeaux M, Landau MB, Anker A, Jishu JA, Fawzy MS, Kandil E. Navigating Choices: Determinants and Outcomes of Surgery Refusal in Thyroid Cancer Patients Using SEER Data. Cancers (Basel) 2023; 15:3699. [PMID: 37509360 PMCID: PMC10378250 DOI: 10.3390/cancers15143699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
With thyroid cancer being a prevalent endocrine cancer, timely management is essential to prevent malignancy and detrimental outcomes. Surgical intervention is a popular component of the treatment plan, yet patients often refuse to undergo such procedures even if clinicians explicitly recommend them. This study gathers data from the Surveillance, Epidemiology, and End Results database (2000-2019) to learn more about the sociodemographic factors that predict the likelihood of surgical intervention. A total of 176,472 patients diagnosed with either papillary or follicular thyroid cancer were recommended surgery, of which 470 were refused. Cancer-specific mortality and overall mortality were determined with the Kaplan-Meier method and univariate and multivariate Cox proportional hazards regression model. Mortality rates for patients who delayed surgery (≥4 months vs. <4 months) were determined using similar methods. The findings reveal that surgical delay or refusal increased overall mortality. The surgical refusal was associated with increased thyroid cancer-specific mortality. However, the impact on thyroid cancer-specific mortality for those who delay surgery was not as pronounced. Significant sociodemographic determinants of surgical refusal included age greater than or equal to 55 years, male sex, being unmarried, race of Asian and Pacific Islander, and advanced tumor staging. The results underscore the importance of patient education, shared decision-making, and access to surgical interventions to optimize outcomes in thyroid cancer management.
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Affiliation(s)
- Mohammad H Hussein
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Eman A Toraih
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
- Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Ifidon E Ohiomah
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | | | - Marie Comeaux
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | | | - Allison Anker
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Jessan A Jishu
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Manal S Fawzy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
- Department of Biochemistry, Faculty of Medicine, Northern Border University, Arar 91431, Saudi Arabia
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
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Leung J, Price D, McClure-Thomas C, Bonsaksen T, Ruffolo M, Kabelenga I, Lamph G, Geirdal AØ. Motivation and Hesitancies in Obtaining the COVID-19 Vaccine-A Cross-Sectional Study in Norway, USA, UK, and Australia. Vaccines (Basel) 2023; 11:1086. [PMID: 37376475 DOI: 10.3390/vaccines11061086] [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: 04/23/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Vaccinations protect the public against serious diseases or death; however, some individuals are hesitant in obtaining them. We aim to contribute to the understanding of the challenges of vaccination roll-out by examining the motivations, hesitancies, and their associated factors, in obtaining the COVID-19 vaccines two years into the pandemic. METHODS Cross-sectional online surveys were conducted in Norway, the USA, the UK, and Australia (N = 1649). The participants self-reported whether they had obtained one of the COVID-19 vaccines. Those who had obtained a vaccine reported the reason for their motivation, and those who had not obtained a vaccine reported the reason for their hesitancies. RESULTS More than 80% of the total sample obtained a COVID-19 vaccine because of public health recommendations and trusted that it was safe. Among those who had not obtained one, the most frequent reason was concerns about side effects. Most who obtained the vaccine reported that they believed in science, but many of those who had not obtained one reported distrust. Among those who had not obtained a vaccine, reports of distrust in policies and science were frequent. Concerns about side effects were more common in males and those with lower education, and those living in rural or remote areas. CONCLUSION People who endorsed the vaccine believed that the vaccine reduces the risk of illness, protects the health of others, and had trust in scientific vaccination research. Conversely, the most frequent reason for vaccine hesitancy was concerns about side effects, followed by distrust in healthcare and science. These findings could inform public health strategies that aim to increase vaccination rates.
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Affiliation(s)
- Janni Leung
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Daicia Price
- School of Social Work, University of Michigan, Ann Arbor, MI 48109, USA
| | - Caitlin McClure-Thomas
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Tore Bonsaksen
- Department of Health and Nursing Science, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, 2418 Elverum, Norway
- Department of Health, Faculty of Health Studies, VID Specialized University, 4024 Stavanger, Norway
| | - Mary Ruffolo
- School of Social Work, University of Michigan, Ann Arbor, MI 48109, USA
| | - Isaac Kabelenga
- Department of Social Work and Sociology, School of Humanities and Social Sciences, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Gary Lamph
- School of Mental Health and Learning Disability Nursing, Edgehill University, Lancashire L39 4QP, UK
| | - Amy Østertun Geirdal
- Department of Social Work, Child Welfare and Social Policy, Faculty of Social Sciences, Oslo Metropolitan University, 0167 Oslo, Norway
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8
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Yeturu SK, Lerner SM, Appel JM. Refusal of transplant organs for non-medical reasons including COVID-19 status. Clin Ethics 2023; 18:172-176. [PMID: 38603250 PMCID: PMC9720467 DOI: 10.1177/14777509221143016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Transplant centers and physicians in the United States have limited guidance on the information which they can and cannot provide to transplant candidates regarding donors of potential organs. Patients may refuse organs for a variety of reasons ranging from pernicious requests including racism to misinformation about emerging medicine as with the COVID-19 vaccine and infection. Patient autonomy, organ stewardship, and equity are often at odds in these cases, but precedent indeed exists to help address these challenges. This work uses such cases to highlight the urgent need for uniform, national policy prohibiting informational requests unrelated to well-established risks.
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Affiliation(s)
- Sai Kaushik Yeturu
- Department of Psychiatry, Icahn School of Medicine at Mount
Sinai, New York, USA
| | - Susan M. Lerner
- Recanati Miller Transplantation Institute, Icahn School of Medicine at Mount
Sinai, New York, USA
| | - Jacob M. Appel
- Department of Psychiatry, Icahn School of Medicine at Mount
Sinai, New York, USA
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9
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Soofi SB, Vadsaria K, Mannan S, Habib MA, Tabassum F, Hussain I, Muhammad S, Feroz K, Ahmed I, Islam M, Bhutta ZA. Factors Associated with Vaccine Refusal (Polio and Routine Immunization) in High-Risk Areas of Pakistan: A Matched Case-Control Study. Vaccines (Basel) 2023; 11:vaccines11050947. [PMID: 37243051 DOI: 10.3390/vaccines11050947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/19/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Pakistan has subpar childhood immunization rates and immunization activities have faced several challenges over the past years. We evaluated the social-behavioral and cultural barriers and risk factors for refusal of polio, Routine Immunization (RI), or both in high-risk areas of poliovirus circulation. METHODS A matched case-control study was conducted from April to July 2017 in eight super high-risk Union Councils of five towns in Karachi, Pakistan. A total of 3 groups, each with 250 cases, including refusals for the Oral Polio Vaccine (OPV) in campaigns (national immunization days and supplementary immunization activities), RI, and both, were matched with 500 controls and identified using surveillance records. Sociodemographic characteristics, household information, and immunization history were assessed. Study outcomes included social-behavioral and cultural barriers and reasons for vaccine refusal. Data were analyzed in STATA using conditional logistic regression. RESULTS RI refusal was associated with illiteracy and fear of the vaccine's adverse effects, while OPV refusals were linked to the mother's decision authority and the assumption that the OPV caused infertility. Conversely, higher socioeconomic status (SES) and knowledge of and willingness to vaccinate with Inactivated Polio Vaccine (IPV) were inversely associated with RI; and lower SES, walking to the vaccination point, knowledge of IPV, and an understanding of contracting polio were inversely associated with OPV refusals, with the latter two also inversely associated with complete vaccine refusal. CONCLUSION Education, knowledge and understanding of vaccines, and socioeconomic determinants influenced OPV and RI refusals among children. Effective interventions are needed to address knowledge gaps and misconceptions among parents.
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Affiliation(s)
- Sajid Bashir Soofi
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan
| | - Khadija Vadsaria
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan
| | - Sara Mannan
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan
| | - Muhammad Atif Habib
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan
| | - Farhana Tabassum
- Institute for Global Health and Development, Aga Khan University, Karachi 74800, Pakistan
| | - Imtiaz Hussain
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan
| | - Sajid Muhammad
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan
| | - Khalid Feroz
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan
| | - Imran Ahmed
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan
| | - Muhammad Islam
- Centre for Global Child Health, The Hospital for Sick Children, 686 Bay Street, Toronto, ON M5G 0A4, Canada
| | - Zulfiqar A Bhutta
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan
- Institute for Global Health and Development, Aga Khan University, Karachi 74800, Pakistan
- Centre for Global Child Health, The Hospital for Sick Children, 686 Bay Street, Toronto, ON M5G 0A4, Canada
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Jakobsen MI, Schaug JP, Nielsen J, Simonsen E. Antipsychotic prescribing practices for outpatients with schizophrenia and reasons for non-clozapine treatment - Data from a Danish quality assessment audit. Nord J Psychiatry 2023:1-10. [PMID: 36651766 DOI: 10.1080/08039488.2022.2160878] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Clozapine is the gold standard for treating treatment-resistant schizophrenia (TRS) although widely underutilised. Both organisational, patient- and clinician related reasons for the underutilisation have been reported, however, the clinical impact of either in real-world settings is not fully elucidated. AIM This audit aimed to evaluate the local antipsychotic (AP) prescribing practices for outpatients with schizophrenia and to assess the spectrum and prevalence of journalised reasons for non-clozapine treatment amongst eligible outpatients. METHODS Data on demographics, current and former AP treatments, as well as documented reasons for non-clozapine treatment, was extracted through chart audit. RESULTS Of the 668 affiliated outpatients with schizophrenia, 43% were treated with AP polytherapy (APP) and 19.6% with clozapine. The most prevalent reason for clozapine discontinuation was related to side effects whereas the most prevalent reason for refusal or omission of clozapine treatment was related to the associated monitoring regimen. CONCLUSIONS This audit showed that APP prescribing is a highly prevalent practice in our services when treating outpatients with schizophrenia and that clozapine is underutilised in a 'last resort' manner. The blood-monitoring regimen associated with clozapine treatment was found to be an important factor in the underutilisation. It seemed, however, that the monitoring constituted a barrier for different reasons, requiring different approaches to remedy. Future studies, directly involving both patients and clinicians in the identification and management of the most clinically relevant barriers and their corresponding facilitators, are warranted.
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Affiliation(s)
- Michelle I Jakobsen
- The Mental Health Services East, Region Zealand Psychiatry, Roskilde, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Julie P Schaug
- Psychiatric Research Unit, Centre for Evidence-Based Psychiatry, Region Zealand Psychiatry, Slagelse, Denmark
| | - Jimmi Nielsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Psychiatric Centre Glostrup, The Mental Health Services in the Capital Region of Denmark, Glostrup, Denmark
| | - Erik Simonsen
- The Mental Health Services East, Region Zealand Psychiatry, Roskilde, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Balaji JN, Prakash S, Joshi A, Surapaneni KM. A Scoping Review on COVID-19 Vaccine Hesitancy among the Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual (LGBTQIA+) Community and Factors Fostering Its Refusal. Healthcare (Basel) 2023; 11. [PMID: 36673613 DOI: 10.3390/healthcare11020245] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/07/2023] [Accepted: 01/08/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The ramifications of the existing crisis caused by the coronavirus pandemic are sensed in all walks of life. Among the various efforts made to curb the spread of this novel infection, the development of COVID-19 vaccines had a profound role in flattening the pandemic curve. Even though the rapid vaccine drive received a highly welcoming response among people, the reluctance and ignorance of a part of the population towards available safe vaccines stand as impediments to achieving the desired outcome. The LGBTQIA+ (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual) communities are the least studied groups in this regard. OBJECTIVE The purpose of this study is to extensively review and report on COVID-19 vaccine uptake and refusal among the LGBTQIA+ population and enumerate the factors contributing to vaccine hesitancy. The study extends further to outline a conceptual framework for interventions to enhance COVID-19 vaccine acceptance among the LGBTQIA+ population. METHODS We performed a systematic search using key terms on Google Scholar and PubMed. The obtained results were filtered using the eligibility criteria framed for this study. The initial search provided an extensive result of 4510 articles which were later screened at various levels to arrive at the final inclusive collection of manuscripts adding to 17. The studies were analyzed by the authors individually, and the data were categorized using variables. The results are interpreted using charts and graphs. The whole manuscript has been structured in accordance with the PRISMA extension for scoping reviews. RESULT The comprehensive search yielded 17 eligible articles for this review. Most of the studies were conducted in the United States (n = 17), and predominantly cross-sectional studies have been conducted. The major comparative factor was the HIV status of the LGBTQIA+ population. HIV-affected patients were more willing to take up COVID-19 vaccination. However, social stigma, discrimination, lack of access and non-prioritization in vaccine drives were found to be the major factors contributing to vaccine hesitancy among this population. CONCLUSION The invention of the COVID-19 vaccination revolutionized the healthcare systems burdened with COVID-19. Although this is a breakthrough scientific contribution, many factors are associated with the rate of vaccine acceptance, especially among sexual and gender minorities. The reviewed studies have revealed numerous factors that influence vaccine uptake and refusal with the commonest being concerns on discrimination, social stigma, inequitable access to healthcare, vaccine safety, efficacy, potency, side effects and lack of trust in medical workers. These impediments in vaccine coverage should be meticulously addressed to ensure optimum LGBTQIA+ physical and mental health as well as for providing non-discriminative, equitable and quality healthcare service regardless of the gender or sexual orientation of individuals.
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Chrdle A, Bártlová S, Chloubová I. Postoje sester a studentů ošetřovatelství k očkování proti covid-19 - přehled. Epidemiol Mikrobiol Imunol 2023; 72:25-39. [PMID: 37185023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
AIM There is a discussion about COVID-19 vaccination rates among healthcare workers (HCW), especially nurses. The primary question for this review was: "What are the attitudes of nurses, compared to other HCW, towards COVID-19 vaccination?" The secondary questions included the proportion of nurses with intention to get vaccinated, what prevents the nurses from accepting the vaccine and what enables them to accept the vaccine. METHODS The PRISMA-ScR format for scoping reviews was chosen to respect the novelty of COVID-19 vaccines. Database search (PubMed/MEDLINE, PROquest and EBSCO) was performed for original studies in English language, from all geographies, with most recent search on March 20, 2022. Vaccination acceptance rates were charted for nurses and nursing students in one category, and HCW other than nurses in the other category. The evolution in time of the nurses attitude to vaccine acceptance relative to that of HCW other than nurses was charted post hoc. The factors associated with COVID-19 vaccination intention according to the WHO categories (contextual influences, individual/ group influences, and vaccine/vaccination specific issues) were reviewed as narrative summary. RESULTS Total 58 eligible studies were selected, all with cross-sectional study design, including 95418 healthcare workers of whom 33130 were nurses and 7391 were nursing students, from 44 countries in Europe, Americas, Africa and Asia. Trust in science, in doctors, in experts and in governments were the main contextual factors increasing vaccination acceptance mentioned in the studies, while altruism and collective protection, or protecting a person at risk at home was mentioned only few times. The nurses were less likely to accept vaccination compared to doctors and other HCWs at the onset, eg. before vaccine rollout, and this difference decreased with time (p = 0.022). Being older (n = 25 studies), being male (n = 23), having higher degree of education (n = 7), and having more years of clinical practice (n = 4) were associated with higher vaccination acceptance. Percieved individual risk of having severe COVID-19 (n = 14) or working in a COVID-19 dedicated units (n = 5) was mentioned in a minority of studies. The main vaccine-releated factors associated with higher vaccination intention were trust in the vaccine and its efficacy and safety, general vaccinatoin acceptance and specifically having had influenza vaccination in previous years (n = 21 studies). A significant factor associated with higher vaccine acceptance was high "vaccine knowledge", "vaccine literacy", "understanding the vaccine" or "understanding benefits and barriers of vaccination" (n = 17 studies). CONCLUSIONS Nurses have been more hesitant to accept COVID-19 vaccination than other healthcare professions at the beginning, but with time this difference disappeared. This general nurse attitude of wait-and-see reported in the studies corresponds with real-life data from practicing healthcare workers as reported by the Czech Institute of Health Information and Statistics on vaccination against COVID-19. Trust in scientific structures and vaccine makers increases the vaccine acceptance. The acceptance increases also with higher age, increasing level of education, longer clinical experience, and also with being a male. Vaccine literacy and having participated in previous vaccination programmes, especially influenza vaccine, were identified as independent modifiable factors increasing vaccination acceptance.
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Hatta K, Usui C, Nakamura H. Acceptability of transdermal antipsychotic patches by patients who refuse oral medication and their effectiveness in preventing recurrence of delirium: a retrospective observational study. Int Clin Psychopharmacol 2023; 38:23-27. [PMID: 35980004 PMCID: PMC9722369 DOI: 10.1097/yic.0000000000000428] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Injectable antipsychotics had been used for patients who refuse oral medications in delirium practice. The objectives were to investigate acceptability of transdermal antipsychotic patches by patients who refuse oral medications and their effectiveness in preventing recurrence of delirium. In this retrospective observational study, data were collected between October 2019 and December 2021. The sample was represented by patients hospitalized because of acute diseases or elective surgery who had delirium on the night before the consultation and had refused oral therapy after consultation. Delirium has been diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Instead, a transdermal patch of blonanserin, a second-generation antipsychotic drug, was tried. The primary outcome was the rate of patients who accepted it. The secondary outcome was recurrence rates of delirium. As much as 95.1% of patients who refused oral medications (98/103 patients) accepted to receive the transdermal patch. Of these, 24 patients developed delirium again, whereas all five patients who refused it developed delirium again [24.5% (24/98) vs. 100% (5/5); P = 0.0014]. The present findings suggest that transdermal antipsychotic patches are more likely to be accepted by patients who refuse oral medications. Prospective studies are needed.
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Affiliation(s)
- Kotaro Hatta
- Department of Psychiatry, Juntendo University Nerima Hospital, Tokyo
| | - Chie Usui
- Department of Psychiatry, Juntendo University Nerima Hospital, Tokyo
| | - Hiroyuki Nakamura
- Department of Environmental and Preventive Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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Gray A, Braun K. Voluntary Assisted Dying, the Conscientious Objector Who Refuses to Facilitate it and Discrimination Law. J Law Med 2022; 29:1128-1149. [PMID: 36763022] [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] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This article discusses the aspect of recent voluntary assisted dying (VAD) laws dealing with a health care provider who declines to provide VAD services. While the law permits the provider to do so, it is sometimes less clear what, if anything, they must do to facilitate VAD service provision by others. Legislation in three jurisdictions is silent on the matter. This article considers refusals to facilitate VAD services, in light of human rights provisions, particularly anti-discrimination legislation, and the guidance available internationally. Existing VAD literature does not consider discrimination arguments in relation to refusal to participate.
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Affiliation(s)
| | - Kerstin Braun
- Associate Professor and Associate Head - Research, USQ School of Law and Justice
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Khaliq A, Elahi AA, Zahid A, Lassi ZS. A Survey Exploring Reasons behind Immunization Refusal among the Parents and Caregivers of Children under Two Years Living in Urban Slums of Karachi, Pakistan. Int J Environ Res Public Health 2022; 19:11631. [PMID: 36141905 PMCID: PMC9516974 DOI: 10.3390/ijerph191811631] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/05/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
This study assesses the experiences of parents/caregivers regarding the refusal to childhood immunization. A cross-sectional study was conducted among the parents/caregivers of children under two years old from January 2019 to June 2019 who were residents of either Pathan Colony or Orangi Town, Karachi. In this study, the data collectors targeted parents/caregivers of 440 households who showed a refusal mark "R" in the Expanded Program of Immunization (EPI) H-chalking system. These households were approached using a 30 × 7 multistage-stratified-cluster random sampling technique and were interviewed using a structured questionnaire. The study sample produced two different types of refusals: true refusal (absence) and potential refusal (presence), based on the absence and presence of a vaccination card at the time of the survey. Multivariate logistic regression was used to analyze the data using Jamovi (V-1.6.13). A total of 230 households consented to participate in this study, of which 141 (61.3%) represented true refusals, while 89 (38.7%) represented potential refusals. More than half of the participants from both groups complained about fever and pain at the injection site following immunization. The use of alternative medicines and a history of adverse events following immunization (AEFI) were associated with increasing the odds of immunization refusals by four-to-five fold. However, advanced paternal age, a long distance to the clinic, a lack of trust in government, and the influence of community/religious leaders were associated with lower immunization refusal odds. Thus, an unawareness about self-limiting vaccine-related adverse events, the use of alternative medicines, and an increased concern about the safety and efficacy of vaccines were found to be barriers to immunization, which can be improved by increasing public awareness through media campaigns and policy reform.
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Affiliation(s)
- Asif Khaliq
- Department of Health & Hospital Management, Institute of Business Management, Karachi 75190, Pakistan
- School of Public Health & Social Work, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Alfaraz Ashraf Elahi
- Department of Health & Hospital Management, Institute of Business Management, Karachi 75190, Pakistan
| | - Asima Zahid
- Department of Health & Hospital Management, Institute of Business Management, Karachi 75190, Pakistan
| | - Zohra S. Lassi
- Robinson Research Institute, The University of Adelaide, Adelaide, SA 5005, Australia
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Alam MD, Abedin MJ, Islam A, Mosfeq-Ul-Hasan M, Rahman O, Xu Y. Psychological effects and associated factors among vaccinated and unvaccinated general population against COVID-19 infection in Bangladesh. Front Psychiatry 2022; 13:916160. [PMID: 36032230 PMCID: PMC9412971 DOI: 10.3389/fpsyt.2022.916160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background The global effort to develop herd immunity in the general public against the COVID-19 pandemic is currently ongoing. However, to the best of our knowledge, there have been no studies on how the COVID-19 vaccine affects mental health in the context of the COVID-19 pandemic in Bangladesh. The present study investigated the psychological effects and associated factors among vaccinated and unvaccinated general populations against COVID-19 infection in Bangladesh. Methods A nationwide online cross-sectional survey was conducted in Bangladesh from June 23 to December 25, 2021. The frequency of symptoms of psychological distress, depression, anxiety, stress, post-traumatic stress disorder (PTSD), insomnia, and fear was assessed using the Bangla versions of the GHQ-12, PHQ-2, GAD-2, PSS-4, PC-PTSD-5, ISI, and FCV-19S scales, respectively. Results The study included 3,013 persons from all eight divisions of Bangladesh, with 1,272 (42.2%) being vaccinated and 1,741 (57.8%) being unvaccinated. Compared with unvaccinated populations, vaccinated populations had significantly lower prevalence rates of psychological distress (36.4 vs. 51.5%), depression (21.1 vs. 37.9%), anxiety (25.1 vs. 44.9%), stress (19.4 vs. 30.4%), PTSD (29.4 vs. 38.3%), insomnia (18.7 vs. 39.4%), and fear symptoms (16.1 vs. 27.5%). Among vaccinated populations, respondents who lived in nuclear families were significantly associated with higher risk of psychological distress (AOR, 1.38; 95% CI, 1.09-1.78), depression (AOR, 1.49; 95% CI, 1.11-1.98), anxiety (AOR, 1.77; 95% CI, 1.21-1.98), and fear (AOR, 1.43; 95% CI, 1.11-1.83) symptoms. Participants who lost family members, friends, or colleagues due to the COVID-19 pandemic had significantly higher risk of symptoms of psychological distress (AOR, 1.35; 95% CI, 1.02-1.79), anxiety (AOR, 1.41; 95% CI, 1.11-1.87), and PTSD (AOR, 1.76; 95% CI, 1.24-2.19). On the other hand, unvaccinated populations who lived in the Dhaka division were significantly associated with an increased risk of depression (AOR, 2.06; 95% CI, 1.40-2.52), anxiety (AOR, 1.86; 95% CI, 1.15-2.47), stress (AOR, 1.92; 95% CI, 1.12-2.88), and insomnia (AOR, 1.88; 95% CI, 1.20-2.94) symptoms. Except for PTSD and fear symptoms, unemployed participants had considerably higher rates of psychological distress, depression, anxiety, stress, and insomnia symptoms (e.g., psychological distress: AOR, 1.83; 95% CI, 1.10-2.62; depression: AOR, 1.74; 95% CI, 1.37-2.19). Conclusions This study recommends immunizing unvaccinated populations as soon as possible to prevent infection and boost mental health. Vulnerable people needed special care, health-related education, and psychological assistance.
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Affiliation(s)
- Md. Dhedharul Alam
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- The Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China
| | - Md. Joynal Abedin
- Department of Population Sciences, University of Dhaka, Dhaka, Bangladesh
| | - Asraful Islam
- Department of Psychology, Jagannath University, Dhaka, Bangladesh
| | - Md. Mosfeq-Ul-Hasan
- Examination Controller Section, Hajee Mohammad Danesh Science and Technology University, Dinajpur, Bangladesh
| | - Obaydur Rahman
- Department of Physics, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh
| | - Yi Xu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- The Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China
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Berhe ET, Shama AT, Ahmed MM, Gesesew HA, Ward PR, Gebremeskel TG. Assessment of COVID-19 vaccination refusal among healthcare workers in Ethiopia. Front Public Health 2022; 10:929754. [PMID: 36033748 PMCID: PMC9409628 DOI: 10.3389/fpubh.2022.929754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/27/2022] [Accepted: 04/13/2022] [Indexed: 01/24/2023] Open
Abstract
Background Even though the emergence of the coronavirus disease 2019 (COVID-19) vaccine and the increasing vaccination rates are promising, there are reports of refusal to get vaccinated in a different segment of the population, including health care workers. Objective This study determines the acceptance/refusal of the COVID-19 vaccination and its predictors among health care workers in Ethiopia. Methods A cross-sectional survey was conducted among a group of health care workers at different health facilities in Ethiopia. Data were collected from 1 to 30 July 2020. Data were collected from 403 participants through an online Google submission form. Data were entered into Epi-info 7 and exported to SPSS version 20 for analysis. Results Approximately 38.5% of the health care workers in the study had refused COVID-19 vaccination. Younger age groups vs. 40 and above years (age 20-24 year [AOR: 0.03, 95% CI (0.00, 0.48)], age 25-29 year [AOR: 0.02, 95% CI (0.00, 0.49)], and age 30-34 year [AOR: 0.04 (0.00, 0.49)] and medical doctors vs. Nurses [AOR: 0.06, 95% CI, (0.01, 0.42)] were reported as risk factors; also, academic working staff vs. hospital staff [AOR: 4.42, 95% CI (1.85, 10.54)] was reported as a protective factor toward refusal of COVID-19 vaccination. Conclusion Two-fifths of health care workers in Ethiopia were indicated to refuse COVID-19 vaccination, implying a significant barrier to achieving WHO's a target of 70% double vaccination rate by mid-2022.
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Affiliation(s)
- Elsa Tesfa Berhe
- Department of Reproductive Health, College of Health Sciences, Aksum University, Aksum, Ethiopia,Elsa Tesfa Berhe
| | - Adisu Tafari Shama
- Department of Public Health, Health Institute, Wollega University, Nekemte, Ethiopia
| | | | - Hailay Abrha Gesesew
- Centre for Research on Health Policy, Torrens University, Adelaide, SA, Australia,Department of Epidemiology, College of Health Sciences, Mekele University, Mekele, Ethiopia
| | - Paul R. Ward
- Department of Epidemiology, College of Health Sciences, Mekele University, Mekele, Ethiopia
| | - Teferi Gebru Gebremeskel
- Department of Reproductive Health, College of Health Sciences, Aksum University, Aksum, Ethiopia,Discipline of Public Health, Flinders University, Adelaide, SA, Australia,*Correspondence: Teferi Gebru Gebremeskel
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Alam MD, Islam A, Hossain MS, Hossain A, Akhter D, Haider MM, Xu Y. Mental health outcomes and associated factors among vaccinated and unvaccinated teachers against COVID-19 infection in Bangladesh. Front Psychiatry 2022; 13:896419. [PMID: 35990069 PMCID: PMC9382101 DOI: 10.3389/fpsyt.2022.896419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background Vaccination of teachers is recommended during the COVID-19 pandemic to reduce the risk of infection for themselves and their students, as well as to encourage their parents to get immunized. The present study investigated the mental health outcomes and associated factors among vaccinated and unvaccinated teachers against COVID-19 infection in Bangladesh. Methods A cross-sectional survey was conducted in Bangladesh from March 4 to September 9, 2021. The frequency of symptoms of psychological distress, depression, anxiety, stress, post-traumatic stress disorder (PTSD), insomnia, and fear was assessed using the Bangla versions of the GHQ-12, PHQ-2, GAD-2, PSS-4, PC-PTSD-5, ISI, and FCV-19S scales, respectively. Results A total of 1,527 Bangladeshi teachers completed the questionnaire, with 678 (44.4%) being vaccinated and 849 (55.6%) being unvaccinated. Compared with unvaccinated teachers, vaccinated teachers had a statistically significant lower prevalence of psychological distress (35.8 vs. 42.9%), depression (37.6 vs. 46.4%), anxiety (31.9 vs. 45.1%), stress (18.3 vs. 32.0%), PTSD (33.0 vs. 43.8%), insomnia (25.2 vs. 36.9%), and fear symptoms (23.3 vs. 29.6%). Among vaccinated teachers, participants with master's or lower degree levels had significantly higher symptoms of depression, stress, and fear than other education levels. Respondents with children had a significantly higher risk of depression, anxiety, stress, and fear symptoms than those who did not have children. Participants who lost family members, friends, or colleagues due to the COVID-19 pandemic had a significantly higher chance of experiencing symptoms of anxiety, PTSD, and fear than those who did not. On the other hand, unvaccinated male teachers were significantly associated with a higher risk of all mental health outcomes except psychological distress and PTSD symptoms compared to female teachers. Participants who were smokers had a significantly higher chance of anxiety, stress, and fear symptoms than non-smokers. Compared to participants with strong social support, those with poor social support had a higher risk of all mental health outcomes except PTSD symptoms. Conclusion This study suggests emphasizing the vaccinated to unvaccinated teachers as soon as possible to control the infection and improve mental health outcomes. Vulnerable teachers also required special attention, health-related education, and psychological support.
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Affiliation(s)
- Md. Dhedharul Alam
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- The Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China
| | - Asraful Islam
- Department of Psychology, Jagannath University, Dhaka, Bangladesh
| | | | - Afsana Hossain
- Department of Plant Pathology, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur, Bangladesh
| | - Delara Akhter
- Department of Genetics and Plant Breeding, Sylhet Agricultural University, Sylhet, Bangladesh
| | - Md. Masum Haider
- Department of Physics, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh
| | - Yi Xu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- The Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China
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Ryu MY, Park HA, Han S, Park HJ, Lee CA. Emergency Transport Refusal during the Early Stages of the COVID-19 Pandemic in Gyeonggi Province, South Korea. Int J Environ Res Public Health 2022; 19:ijerph19148444. [PMID: 35886295 PMCID: PMC9323224 DOI: 10.3390/ijerph19148444] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/07/2022] [Accepted: 07/09/2022] [Indexed: 11/17/2022]
Abstract
We analyzed the changes in patients’ clinical characteristics and transport refusal pre- and post-COVID-19 and identified the reasons for transport refusal using emergency medical services run sheet data from pre-COVID-19 (April−December 2019) and post-COVID-19 (April−December 2020) in Gyeonggi Province, South Korea. We included patients aged ≥18 years. Univariate and multivariate logistic regression analyses were performed to identify the relationship between patients’ personal factors and clinical characteristics and emergency transport refusal. During the control and study periods, 612,681 cases were reported; the transport refusal rates during the control and study periods were 6.7% and 8.2%, respectively. Emergency transport refusal was associated with younger age, the male sex, a normal mental status, a shock index < 1, and trauma in both the pre- and post-COVID-19 periods. Although fever prevented transport refusal during the pre-COVID-19 period (aOR, 0.620; 95% CI, 0.567−0.679), it became a significant risk factor for transport refusal during the post-COVID-19 period (aOR, 1.619; 95% CI, 1.534−1.709). The most common reason for transport refusal by critically ill patients was “because it was not accepted within the jurisdiction and remote transport was required.” It is necessary to expand the response capacity of patients with fever in the community to reduce the refusal of transport by critically ill patients.
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Affiliation(s)
- Min Young Ryu
- Department of Emergency Medicine, Hallym University, Dongtan Sacred Heart Hospital, 7 Keunjaebong-gil, Hwaseong-si 18450, Korea; (M.Y.R.); (H.A.P.); (H.J.P.)
| | - Hang A. Park
- Department of Emergency Medicine, Hallym University, Dongtan Sacred Heart Hospital, 7 Keunjaebong-gil, Hwaseong-si 18450, Korea; (M.Y.R.); (H.A.P.); (H.J.P.)
| | - Sangsoo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea;
| | - Hye Ji Park
- Department of Emergency Medicine, Hallym University, Dongtan Sacred Heart Hospital, 7 Keunjaebong-gil, Hwaseong-si 18450, Korea; (M.Y.R.); (H.A.P.); (H.J.P.)
| | - Choung Ah Lee
- Department of Emergency Medicine, Hallym University, Dongtan Sacred Heart Hospital, 7 Keunjaebong-gil, Hwaseong-si 18450, Korea; (M.Y.R.); (H.A.P.); (H.J.P.)
- Correspondence: ; Tel.: +82-31-8086-2611
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Galanis P, Vraka I, Katsiroumpa A, Siskou O, Konstantakopoulou O, Katsoulas T, Mariolis-Sapsakos T, Kaitelidou D. First COVID-19 Booster Dose in the General Population: A Systematic Review and Meta-Analysis of Willingness and Its Predictors. Vaccines (Basel) 2022; 10:1097. [PMID: 35891260 DOI: 10.3390/vaccines10071097] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 02/01/2023] Open
Abstract
The emergence of breakthrough infections and new highly contagious variants of SARS-CoV-2 threaten the immunization in individuals who had completed the primary COVID-19 vaccination. This systematic review and meta-analysis investigated, for the first time, acceptance of the first COVID-19 booster dose and its associated factors among fully vaccinated individuals. We followed the PRISMA guidelines. We searched Scopus, Web of Science, Medline, PubMed, ProQuest, CINAHL and medrxiv from inception to 21 May 2022. We found 14 studies including 104,047 fully vaccinated individuals. The prevalence of individuals who intend to accept a booster was 79.0%, while the prevalence of unsure individuals was 12.6%, and the prevalence of individuals that intend to refuse a booster was 14.3%. The main predictors of willingness were older age, flu vaccination in the previous season, and confidence in COVID-19 vaccination. The most important reasons for decline were adverse reactions and discomfort experienced after previous COVID-19 vaccine doses and concerns for serious adverse reactions to COVID-19 booster doses. Considering the burden of COVID-19, a high acceptance rate of booster doses could be critical in controlling the pandemic. Our findings are innovative and could help policymakers to design and implement specific COVID-19 vaccination programs in order to decrease booster vaccine hesitancy.
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Alam MD, Paul SK, Momi M, Ni L, Xu Y. Factors Associated With Psychological Outcomes Among Vaccinated and Unvaccinated Health Care Workers Against COVID-19 Infection in Bangladesh. Front Med (Lausanne) 2022; 9:852922. [PMID: 35402432 PMCID: PMC8988188 DOI: 10.3389/fmed.2022.852922] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/14/2022] [Indexed: 01/09/2023] Open
Abstract
Background Vaccination of healthcare workers (HCWs) is recommended during the COVID-19 pandemic to reduce the risk of infection for themselves and their patients, as well as to encourage their patients to get immunized. The present study aimed to investigate the psychological outcomes and associated factors among vaccinated and unvaccinated HCWs against COVID-19 infection in Bangladesh. Methods From March to August 2021, an online nationwide survey was conducted with a total of 2,038 Bangladeshi HCWs. The frequency of symptoms of general health problems, depression, anxiety, stress, post-traumatic stress disorder, insomnia, and loneliness was assessed using the Bangla versions of the GHQ-12, PHQ-2, GAD-2, PSS-4, PC-PTSD-5, ISI, and UCLA-LS scales, respectively. Results Compared with unvaccinated HCWs (n = 1,058), vaccinated HCWs (n = 980) had a statistically significant lower prevalence of general health problems (16.7 vs. 59.1%), depression (15.6 vs. 31.9%), post-traumatic stress disorder (22.3 vs. 30.8%), insomnia (23.8 vs. 64.9%), and loneliness symptoms (13.9 vs. 21.8%). Among vaccinated HCWs, females were significantly associated with a higher risk of symptoms of general health problems (AOR, 2.71; 95% CI, 0.97-7.60), anxiety (AOR, 2.17; 95% CI, 1.14-4.13), and loneliness (AOR, 2.52; 95% CI, 1.11-5.73). Except for anxiety and post-traumatic stress disorder symptoms, participants living in urban areas had a significantly lower risk of all psychological outcomes (e.g., depression: AOR, 0.43; 95% CI, 0.27-0.67; stress: AOR, 0.64; 95% CI, 0.47-0.88). Respondents who were married were significantly less likely to experience symptoms of general health problems (AOR, 0.10; 95% CI, 0.02-0.39), depression (AOR, 0.31; 95% CI, 0.22-0.82), insomnia (AOR, 0.46; 95% CI, 0.20-1.03), and loneliness (AOR, 0.31; 95% CI, 0.10-0.92). Participants who worked as doctors were significantly less chance of experiencing symptoms of general health problems (AOR, 0.18; 95% CI, 0.08-0.37), depression (AOR, 0.51; 95% CI, 0.30-0.87), and anxiety (AOR, 0.54; 95% CI, 0.37-0.78). On the other hand, unvaccinated HCWs who were 18-29 years old and had <5 years of work experience were significantly associated with a higher risk of all psychological outcomes except anxiety and insomnia symptoms (e.g., depression among 18-29 years old: AOR, 1.83; 95% CI, 0.27-2.60; stress among those with <5 years of work experience: AOR, 2.37; 95% CI, 0.93-6.07). Participants who worked as nurses were significantly more likely to suffer from depression (AOR, 1.44; 95% CI, 0.84-2.46), anxiety (AOR, 1.42; 95% CI, 0.24-1.73), and stress (AOR, 1.55; 95% CI, 0.31-0.89) symptoms. Except for anxiety and stress symptoms, respondents who worked as frontline workers and provided direct care to infected patients were the significantly higher chance of experiencing all psychological outcomes (e.g., depression among who worked as frontline workers: AOR, 2.41; 95% CI, 0.23-3.73; insomnia among those who provide direct care to infected patients: AOR, 2.60; 95% CI, 0.34-3.06). Participants who were infected with COVID-19 had a significantly less chance of experiencing symptoms of general health problems (AOR, 0.89; 95% CI, 0.65-1.22), depression (AOR, 0.66; 95% CI, 0.48-0.92), and anxiety (AOR, 0.63; 95% CI, 0.46-0.87). Conclusions To control the infection and improve psychological outcomes, this study suggests emphasizing the vaccinated to unvaccinated HCWs as soon as possible. They also required special attention, health-related education, and psychological support.
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Affiliation(s)
- Md. Dhedharul Alam
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- The Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China
| | - Sujan Kumer Paul
- Department of Periodontology and Oral Pathology, Holy Family Red Crescent Medical College and Hospital, Dhaka, Bangladesh
| | - Mahmuda Momi
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - Li Ni
- Department of Psychiatry, Fuyang Third Peoples Hospital, Hangzhou, China
| | - Yi Xu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- The Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China
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22
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Levine DM, Paz M, Burke K, Schnipper JL. Predictors and Reasons Why Patients Decline to Participate in Home Hospital: a Mixed Methods Analysis of a Randomized Controlled Trial. J Gen Intern Med 2022; 37:327-331. [PMID: 33954888 PMCID: PMC8811077 DOI: 10.1007/s11606-021-06833-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/14/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Acute care at home ("home hospital") compared to traditional hospital care has been shown to lower cost, utilization, and readmission and improve patient experience and physical activity. Despite these benefits, many patients decline to enroll in home hospital. OBJECTIVE Describe predictors and reasons why patients decline home hospital. DESIGN Mixed methods evaluation of a randomized controlled trial. PARTICIPANTS Patients in the emergency department who required admission and were accepted for home hospital by the home hospital attending, but ultimately declined to enroll. INTERVENTION Home hospital care, including nurse and physician home visits, intravenous medications, remote monitoring, video communication, and point-of-care testing. APPROACH We conducted a thematic content analysis of verbatim reasons for decline. We performed bivariate comparisons then multivariable logistic regression to identify patient characteristics associated with declining participation. KEY RESULTS Two hundred forty-eight patients were eligible to enroll, and 157 (63%) declined enrollment. Patients who declined and enrolled were of similar age (median age, 74 vs 75 years old; p = 0.27), sex (32% vs 36% female; p = 0.49), and race/ethnicity (p = 0.26). In multivariable analysis, patients were significantly more likely to decline if they initially presented at the community hospital compared to the academic medical center (53% vs 42%; adjusted OR, 2.2 [95% CI, 1.2 to 4.2]) and if single (37% v 24%; adjusted OR, 2.5 [95% CI, 1.2 to 5.1]). We formulated 10 qualitative categories describing reasons patients ultimately declined. Many patients declined because they felt it was easier to remain in the hospital (20%) or felt safer in the hospital than in their home (20%). CONCLUSIONS Patients who declined to enroll in a home hospital intervention had similar sociodemographic characteristics as enrollees except partner status and declined most often for perceptions surrounding safety at home and the ease of remaining in the hospital. TRIAL REGISTRATION NCT03203759.
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Affiliation(s)
- David M Levine
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Mary Paz
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | - Kimberly Burke
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Jeffrey L Schnipper
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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23
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Cutrín O, Avalos MRA, Corona MD, Nuño-Gutiérrez BL, Medina-Mora ME, Real T, Mendoza-Meléndez MÁ, Lara-Valencia F, Ayers SL, Kulis SS, Marsiglia FF. Use of Violence as a Strategy of Early Adolescents for Rejecting Drug Offers in Mexican Cities. Rev Mex Psicol (1984) 2022; 39:18-30. [PMID: 36108313 PMCID: PMC9450683] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Drug use and violence are two interconnected problems in violent urban contexts, leading to coercive drug offers. In this study, relationships between drug use, use of violence as a strategy for rejecting drug offers, and exposure to neighborhood violence were analyzed in Mexican students. Data were obtained through a self-report survey and focus groups with lower secondary students in three Mexican metropolitan areas. Both quantitative and qualitative results indicated that students who had used or would use violence as a strategy for rejecting drug offers presented a more problematic psychosocial profile, with exposure to neighborhood violence as the main predictor. These results suggest that Mexican students in violent cities may resort to violence as a strategy for rejecting drug offers.
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Affiliation(s)
- Olalla Cutrín
- Facultade de Psicoloxía, Universidade de Santiago de Compostela, España
| | - Marvyn R Arévalo Avalos
- Latinx Center of Excellence in Behavioral Health, University of California, Berkeley, Estados Unidos
| | - M Dolores Corona
- Facultad de Enfermería, Universidad Autónoma de Nuevo León, México
| | | | | | - Tania Real
- Centro de Investigación en Salud Mental Global, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, México
| | | | | | - Stephanie L Ayers
- Global Center for Applied Health Research, Arizona State University, Estados Unidos
| | - Stephen S Kulis
- Global Center for Applied Health Research, Arizona State University, Estados Unidos
| | - Flavio F Marsiglia
- Global Center for Applied Health Research, Arizona State University, Estados Unidos
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24
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Nigro O, Sironi G, Bergamaschi L, Gattuso G, Puma N, Livellara V, Chiaravalli S, Ferrari A, Massimino M. SARS-CoV-2 vaccination for adolescents and young adult patients treated at a specialist pediatric oncology unit. Pediatr Blood Cancer 2021; 68:e29240. [PMID: 34264546 PMCID: PMC8441810 DOI: 10.1002/pbc.29240] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/25/2021] [Accepted: 07/02/2021] [Indexed: 12/24/2022]
Abstract
This brief report describes the SARS-CoV-2 vaccination program at our pediatric oncology unit. Adopting Italian regulations, patients treated for cancer within the previous 6 months were offered vaccination with the Pfizer-BioNtech vaccine if aged ≥16 years, and with the Pfizer-BioNtech or Moderna vaccine if aged ≥18 years. From March 24 to April 28, 2021, 80/89 adolescent and young adult patients enrolled were vaccinated, while nine refused the vaccine due to fear of side effects, disbelief regarding the pandemic, or lack of trust in the scientific community. The refusal rate in our cohort was lower than in the Italian general population.
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Affiliation(s)
- Olga Nigro
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Giovanna Sironi
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Luca Bergamaschi
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Giovanna Gattuso
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Nadia Puma
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Virginia Livellara
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Stefano Chiaravalli
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Andrea Ferrari
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Maura Massimino
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
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25
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Coffman AR, Tao R, Cohan JN, Huang LC, Pickron TB, Torgeson AM, Lloyd S. Factors associated with the refusal of surgery and the associated impact on survival in patients with rectal cancer using the National Cancer Database. J Gastrointest Oncol 2021; 12:1482-1497. [PMID: 34532104 DOI: 10.21037/jgo-20-437] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Received: 10/11/2020] [Accepted: 06/08/2021] [Indexed: 11/06/2022] Open
Abstract
Background Surgical resection is an integral component of the curative-intent treatment for most patients with non-metastatic rectal cancer. However, some patients refuse surgery for a number of reasons. Utilizing the National Cancer Database (NCDB), we investigated the sociodemographic and clinical factors associated with patients who were coded as having been offered but refused surgery, and the factors affecting overall survival (OS) in these patients. Methods Adult patients with adenocarcinoma of the rectum (excluding T1N0M0 and M1 disease) diagnosed from 2004 to 2015 were analyzed in this retrospective cohort study. Logistic regression was performed to identify factors associated with refusal of surgery. OS of patients refusing surgery was compared using Kaplan-Meier estimate, log-rank test, propensity score matching, and proportional hazards regression. Results A total of 55,704 patients were identified: 54,266 received definitive surgery (97.4%) and 1,438 refused (2.6%). Of patients refusing surgery, 135 (9.4%) were stage I, 709 (49.3%) were stage II, and 594 (41.3%) were stage III. Patients were more likely to refuse surgery as the study period progressed (P<0.01). Factors associated with refusal of surgery on multivariate analysis include: age ≥70 years, Black race, non-private insurance, and tumor size greater than 2 cm (all values P≤0.01). The 5-year OS was 61.6% for the surgery cohort and 35.7% for the refusal cohort. In the propensity matched groups, median survival was 84.2 months in patients who received definitive surgery compared to 43.7 months in patients who refused surgery. As an index for comparison, patients who refused surgery but received both radiotherapy and chemotherapy had a median survival of 48.5 months. Among patients that refused surgery, those that received radiotherapy alone, chemotherapy alone, or radiotherapy and chemotherapy (compared to no treatment) experienced a survival benefit (all values P≤0.01). Conclusions In patients with non-metastatic adenocarcinoma of the rectum reported in the NCDB, age, race, and insurance status were associated with refusal of surgery. Refusal of surgery was more common in the later years of the study. Survival is poor in patients who refused surgical resection.
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Affiliation(s)
- Alex R Coffman
- Department of Radiation Oncology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Randa Tao
- Department of Radiation Oncology, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Jessica N Cohan
- Department of Surgery, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Lyen C Huang
- Department of Surgery, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - T Bartley Pickron
- Department of Surgery, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Anna M Torgeson
- Department of Radiation Oncology, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Shane Lloyd
- Department of Radiation Oncology, Huntsman Cancer Institute, Salt Lake City, Utah, USA
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26
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Elharake JA, Galal B, Alqahtani SA, Kattan RF, Barry MA, Temsah MH, Malik AA, McFadden SM, Yildirim I, Khoshnood K, Omer SB, Memish ZA. COVID-19 Vaccine Acceptance among Health Care Workers in the Kingdom of Saudi Arabia. Int J Infect Dis 2021; 109:286-293. [PMID: 34242765 PMCID: PMC8260488 DOI: 10.1016/j.ijid.2021.07.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [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: 03/26/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 01/28/2023] Open
Abstract
Objectives The purpose of our study was to assess COVID-19 vaccine acceptance among health care workers (HCWs) in the Kingdom of Saudi Arabia (KSA) and identify: 1) vaccine acceptance barriers; 2) demographic differences; and 3) the most trusted COVID-19 sources of information. Methods Between October and December 2020, all registered HCWs in the KSA were emailed a survey questionnaire, using Qualtrics® and Google Forms®, evaluating their acceptance of a COVID-19 vaccine. Results Of the 23,582 participants surveyed, 15,299 (64.9%) said they would accept a COVID-19 vaccine. Vaccine acceptance among HCWs differed by several demographic characteristics, with males (69.7%), Christians (71.9%), and Pakistanis (81.6%) most likely to accept a COVID-19 vaccine. Of the 8,202 (35.1%) who said they would not accept a COVID-19 vaccine, the main reason reported was fear of potential side effects (58.5%). Participants reported health officials (84.6%) as the most reliable source of COVID-19 information. Additionally, participants reported the highest confidence in the KSA Ministry of Health (88.5%). Conclusions Overall, these findings provide KSA health care authorities with the information needed to develop public health messaging campaigns for HCWs to best address COVID-19 vaccine concerns—especially as the country prepares to vaccinate its general population.
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Affiliation(s)
- Jad A Elharake
- Yale Institute for Global Health, New Haven, Connecticut 06510, USA; Yale School of Public Health, New Haven, Connecticut 06510, USA.
| | - Bayan Galal
- Yale University, New Haven, Connecticut 06520, USA.
| | - Saleh A Alqahtani
- Department of Medicine, The Johns Hopkins University Hospital, Baltimore, Maryland, USA; Department of Gastroenterology, King Feisal Specialists Hospital and Research Center, Riyadh, Saudi Arabia.
| | - Rana F Kattan
- General Pediatric Department, King Abdullah Specialist Children's Hospital, College of Medicine, King Saud University for Health Sciences, Ministry of National Guard, Riyadh, Kingdom of Saudi Arabia.
| | - Mazin A Barry
- Infectious Diseases Unit, Department of Internal Medicine, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Mohamad-Hani Temsah
- Pediatric Intensive Care Unit, pediatric department, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
| | - Amyn A Malik
- Yale Institute for Global Health, New Haven, Connecticut 06510, USA; Department of Internal Medicine, Infectious Disease, Yale School of Medicine, New Haven, Connecticut 06510, USA.
| | - SarahAnn M McFadden
- Yale Institute for Global Health, New Haven, Connecticut 06510, USA; Department of Internal Medicine, Infectious Disease, Yale School of Medicine, New Haven, Connecticut 06510, USA.
| | - Inci Yildirim
- Yale Institute for Global Health, New Haven, Connecticut 06510, USA; Department of Internal Medicine, Infectious Disease, Yale School of Medicine, New Haven, Connecticut 06510, USA.
| | - Kaveh Khoshnood
- Yale School of Public Health, New Haven, Connecticut 06510, USA.
| | - Saad B Omer
- Yale Institute for Global Health, New Haven, Connecticut 06510, USA; Yale School of Public Health, New Haven, Connecticut 06510, USA; Department of Internal Medicine, Infectious Disease, Yale School of Medicine, New Haven, Connecticut 06510, USA; Yale School of Nursing, Orange, Connecticut 06477, USA.
| | - Ziad A Memish
- Research and Innovation Center, King Saud Medical City, Ministry of Health, the Kingdom of Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, the Kingdom of Saudi Arabia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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27
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Al-Jayyousi GF, Sherbash MAM, Ali LAM, El-Heneidy A, Alhussaini NWZ, Elhassan MEA, Nazzal MA. Factors Influencing Public Attitudes towards COVID-19 Vaccination: A Scoping Review Informed by the Socio-Ecological Model. Vaccines (Basel) 2021; 9:vaccines9060548. [PMID: 34073757 PMCID: PMC8225013 DOI: 10.3390/vaccines9060548] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [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: 04/18/2021] [Revised: 05/15/2021] [Accepted: 05/19/2021] [Indexed: 12/30/2022] Open
Abstract
Major hindrances to getting a COVID-19 vaccine include vaccine hesitancy, skepticism, refusal, and anti-vaccine movements. Several studies have been conducted on attitudes of the public towards COVID-19 vaccines and the potential influencing factors. The purpose of this scoping review is to summarize the data available on the various factors influencing public attitudes towards COVID-19 vaccination. This scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Statement. PubMed, Embase, Web of Science, and Cochrane Central were searched without restrictions to reclaim all publications on the factors that shape individuals' attitudes towards COVID-19 vaccines from 1 January 2020 to 15 February 2021. Fifty studies were included. The scoping review revealed that the factors influencing public attitudes towards COVID-19 vaccines were embedded within the different levels of the socio-ecological model. These factors included the sociodemographic characteristics of the individuals, individual factors, social and organizational factors. In addition, certain characteristics of COVID-19 vaccines themselves influenced public attitudes towards accepting the vaccines. Understanding various population needs and the factors shaping public attitudes towards the vaccines would support planning for evidence-based multilevel interventions in order to enhance global vaccine uptake.
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Affiliation(s)
- Ghadir Fakhri Al-Jayyousi
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha P.O. Box 2713, Qatar; (M.A.M.S.); (L.A.M.A.); (N.W.Z.A.); (M.E.A.E.)
- Correspondence:
| | - Mohamed Abdelhady Mabrouk Sherbash
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha P.O. Box 2713, Qatar; (M.A.M.S.); (L.A.M.A.); (N.W.Z.A.); (M.E.A.E.)
| | - Lamees Abdullah Mohammed Ali
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha P.O. Box 2713, Qatar; (M.A.M.S.); (L.A.M.A.); (N.W.Z.A.); (M.E.A.E.)
| | - Asmaa El-Heneidy
- School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, QLD 4222, Australia;
| | - Nour Waleed Zuhair Alhussaini
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha P.O. Box 2713, Qatar; (M.A.M.S.); (L.A.M.A.); (N.W.Z.A.); (M.E.A.E.)
| | - Manar Elsheikh Abdelrahman Elhassan
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha P.O. Box 2713, Qatar; (M.A.M.S.); (L.A.M.A.); (N.W.Z.A.); (M.E.A.E.)
| | - Maisa Ayman Nazzal
- Department of Pharmacy, Faculty of Medicine and Health Sciences, An Najah National University, Nablus 44839, West Bank, Palestine;
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28
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Wang S, Chen S, Huang Y, Hu D, Zeng W, Zhou L, Zhou W, Chen D, Feng H, Wei W, Zhang C, Liu Z, Wang M, Guo L. Refusal of cancer-directed surgery in male breast cancer. Medicine (Baltimore) 2021; 100:e25116. [PMID: 33787594 PMCID: PMC8021363 DOI: 10.1097/md.0000000000025116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 02/19/2021] [Indexed: 01/04/2023] Open
Abstract
It has been reported that some male breast cancer patients may refuse the recommended surgery, but the incidence rate in the United States is not clear. The purpose of this study was to identify the incidence, trends, risk factors, and eventual survival outcomes associated with the rejection of such cancer-directed surgery.We collected data on 5860 patients with male breast cancer (MBC) from the Surveillance, Epidemiology, and End Results database, including 50 patients refusing surgery as recommended. Kaplan-Meier survival analysis and Cox proportional hazard regression were used to identify the effects of refusing surgery on cancer-specific survival (CSS) and overall survival (OS). The association between acceptance or rejection of surgery and mortality were estimated by nested Cox proportional hazards regression models with adjustment for age, race, clinical characteristics, and radiation.Of the 5860 patients identified, 50 (0.9%) refused surgery. Old age (≥65: hazard ratio [HR]: 3.056, 95% confidence interval [CI]: 1.738-5.374, P < .0001), higher AJCC stage (III: HR: 3.283, 95% CI: 2.134-5.050, P < .0001, IV: HR: 14.237, 95% CI: 8.367-24.226, P < .0001), progesterone receptor status (negative: HR: 1.633, 95% CI: 1.007-2.648, P = .047) were considered risk factors. Compared with the surgery group, the refusal group was associated with a poorer prognosis in both OS and CSS (χ2 = 94.81, P < .001, χ2 = 140.4, P < .001). Moreover, significant differences were also observed in OS and CSS among 1:3 matched groups (P = .0002, P < .001).Compared with the patients undergoing surgery, the patients who refused the cancer-directed surgery had poor prognosis in the total survival period, particularly in stage II and III. The survival benefit for undergoing surgery remained even after adjustment, which indicates the importance of surgical treatment before an advanced stage for male breast cancer patients.
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Affiliation(s)
| | | | | | - Di Hu
- Department of Plastic Surgery
| | - Wen Zeng
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | | | | | | | | | - Wei Wei
- Department of Pediatrics, St John Hospital and Medical Center, Detroit, MI
| | - Chao Zhang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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29
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D’Errico S, Turillazzi E, Zanon M, Viola RV, Frati P, Fineschi V. The Model of "Informed Refusal" for Vaccination: How to Fight against Anti-Vaccinationist Misinformation without Disregarding the Principle of Self-Determination. Vaccines (Basel) 2021; 9:vaccines9020110. [PMID: 33535717 PMCID: PMC7912813 DOI: 10.3390/vaccines9020110] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 12/17/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 12/15/2022] Open
Abstract
Vaccines are arguably a public health success story as well as an incredibly cost-effective medical resource. Despite this, worldwide concerns about their safety are growing, with the risk of increased morbidity and mortality in vaccine-preventable diseases because of vaccine refusal. The global political trend in developed countries is to increasingly reduce mandates and the compulsory nature of vaccination programs. This is due to strong opposition from anti-vaccination movements and groups. While these have existed since the beginnings of vaccinology, they have recently gained a strong foothold through massive exploitation of the media and especially the internet. This has led to widespread misinformation and greater difficulty for governments and health institutions in dealing with parents’ concerns and misconceptions. Common strategies in order to maintain a high degree of public acceptance of vaccines include the enhancement of adverse effect reporting systems, the enrichment of scientific literature, and the dissemination of targeted information to parents and health care providers. Vaccine risk perception, in fact, largely exceeds the evidence and is linked to well-known general population cognitive bias, which must be recognized and corrected. Although there is no doubt about the convenience of universal vaccination, a lively international debate is underway with regard to the legitimacy of mandatory vaccination programs. Most scientists agree that the individual’s right to self-determination should be preserved. The only way to simultaneously protect the right to health is to introduce an informed refusal model, which aims to guarantee the highest coverage rates for vaccination.
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Affiliation(s)
- Stefano D’Errico
- Department of Surgery, Medicine and Health, University of Trieste, 34149 Trieste, Italy; (S.D.); (M.Z.)
| | - Emanuela Turillazzi
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Martina Zanon
- Department of Surgery, Medicine and Health, University of Trieste, 34149 Trieste, Italy; (S.D.); (M.Z.)
| | - Rocco Valerio Viola
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (R.V.V.); (P.F.)
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (R.V.V.); (P.F.)
- IRCCS (Istituto di Ricerca e Cura a Carattere Scientifico) Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (R.V.V.); (P.F.)
- IRCCS (Istituto di Ricerca e Cura a Carattere Scientifico) Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli, Italy
- Correspondence: ; Tel.: +39-06-49912722
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30
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Costantino C, Ledda C, Squeri R, Restivo V, Casuccio A, Rapisarda V, Graziano G, Alba D, Cimino L, Conforto A, Costa GB, D’Amato S, Mazzitelli F, Vitale F, Genovese C. Attitudes and Perception of Healthcare Workers Concerning Influenza Vaccination during the 2019/2020 Season: A Survey of Sicilian University Hospitals. Vaccines (Basel) 2020; 8:vaccines8040686. [PMID: 33207626 PMCID: PMC7711679 DOI: 10.3390/vaccines8040686] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 10/16/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 11/16/2022] Open
Abstract
Influenza is an infectious disease with a high impact on the population in terms of morbidity and mortality, but despite International and European guidelines, vaccination coverage rates among healthcare workers (HCWs) remain very low. The aim of the present study was to evaluate influenza vaccination adherence in the three Sicilian University Hospitals of Catania, Messina, and Palermo and to understand the attitudes and perceptions of vaccinated healthcare workers and the main reasons for vaccination refusal. A cross-sectional survey through a self-administered questionnaire was conducted during the 2019/2020 influenza season. Overall, 2356 vaccinated healthcare workers answered the questionnaire. The main reason reported for influenza vaccination adherence during the 2019/2020 season was to protect patients. Higher self-perceived risk of contracting influenza and a positive attitude to recommending vaccination to patients were significantly associated with influenza vaccination adherence during the last five seasons via multivariable analysis. Fear of an adverse reaction was the main reason for influenza vaccine refusal. In accordance with these findings, Public Health institutions should develop and tailor formative and informative campaigns to reduce principal barriers to the immunization process and promote influenza vaccination adherence among HCWs.
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Affiliation(s)
- Claudio Costantino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (C.C.); (V.R.); (A.C.); (G.G.); (D.A.); (L.C.); (A.C.); (F.V.)
| | - Caterina Ledda
- Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, 95100 Catania, Italy; (C.L.); (V.R.)
| | - Raffaele Squeri
- Department of Biomedical Sciences and Morphological and Functional Images (BIOMORF), University of Messina, 98124 Messina, Italy; (R.S.); (G.B.C.); (S.D.); (F.M.)
| | - Vincenzo Restivo
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (C.C.); (V.R.); (A.C.); (G.G.); (D.A.); (L.C.); (A.C.); (F.V.)
| | - Alessandra Casuccio
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (C.C.); (V.R.); (A.C.); (G.G.); (D.A.); (L.C.); (A.C.); (F.V.)
| | - Venerando Rapisarda
- Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, 95100 Catania, Italy; (C.L.); (V.R.)
| | - Giorgio Graziano
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (C.C.); (V.R.); (A.C.); (G.G.); (D.A.); (L.C.); (A.C.); (F.V.)
| | - Davide Alba
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (C.C.); (V.R.); (A.C.); (G.G.); (D.A.); (L.C.); (A.C.); (F.V.)
| | - Livia Cimino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (C.C.); (V.R.); (A.C.); (G.G.); (D.A.); (L.C.); (A.C.); (F.V.)
| | - Arianna Conforto
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (C.C.); (V.R.); (A.C.); (G.G.); (D.A.); (L.C.); (A.C.); (F.V.)
| | - Gaetano Bruno Costa
- Department of Biomedical Sciences and Morphological and Functional Images (BIOMORF), University of Messina, 98124 Messina, Italy; (R.S.); (G.B.C.); (S.D.); (F.M.)
| | - Smeralda D’Amato
- Department of Biomedical Sciences and Morphological and Functional Images (BIOMORF), University of Messina, 98124 Messina, Italy; (R.S.); (G.B.C.); (S.D.); (F.M.)
| | - Francesco Mazzitelli
- Department of Biomedical Sciences and Morphological and Functional Images (BIOMORF), University of Messina, 98124 Messina, Italy; (R.S.); (G.B.C.); (S.D.); (F.M.)
| | - Francesco Vitale
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (C.C.); (V.R.); (A.C.); (G.G.); (D.A.); (L.C.); (A.C.); (F.V.)
| | - Cristina Genovese
- Department of Biomedical Sciences and Morphological and Functional Images (BIOMORF), University of Messina, 98124 Messina, Italy; (R.S.); (G.B.C.); (S.D.); (F.M.)
- Correspondence: ; Tel.: +39-3914868625
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Lu PW, Fields AC, Yoo J, Irani J, Goldberg JE, Bleday R, Melnitchouk N. Sociodemographic predictors of surgery refusal in patients with stage I-III colon cancer. J Surg Oncol 2020; 121:1306-1313. [PMID: 32227344 DOI: 10.1002/jso.25917] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/14/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Over 104 000 cases of colon cancer are estimated to be diagnosed in 2020. Surgical resection is a critical part of colon cancer treatment and adequate resection impacts prognosis. However, some patients refuse potentially curative surgery. We aimed to identify the rate and predictors of surgery refusal among patients with colon cancer. METHODS The National Cancer Database (2004-2015) was queried for patients diagnosed with stage I-III colonic adenocarcinoma. Sociodemographic factors, clinical features, and treatment facility characteristics were collected. Patients who underwent surgery with curative intent were compared to those who refused surgery. Multivariable analysis was used to identify factors associated with surgery refusal. Adjusted survival analysis was performed on propensity-matched cohorts. RESULTS A total of 151 020 patients were included and 1071 (0.71%) refused surgery. In multivariable analysis older age, Black race, higher Charlson comorbidity score, Medicaid, Medicare, or lack of insurance were predictive of refusing surgery. After propensity matching, there was a significant difference in 5-year survival for patients who refused surgery vs those who underwent surgery (P < .001). CONCLUSIONS There are racial and socioeconomic disparities in the refusal of surgery for colon cancer. Further studies are needed to better understand the drivers behind differences in refusing curative surgery for colon cancer.
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Affiliation(s)
- Pamela W Lu
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Adam C Fields
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - James Yoo
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jennifer Irani
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Joel E Goldberg
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ronald Bleday
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nelya Melnitchouk
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
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Abstract
Since 2015, an unprecedented number of people from Middle Eastern and African countries have crossed borders into and within Europe. Media and political actors describe this time as an "emergency" and a "crisis" that challenges the core of European values and human rights principles. Calling this a crisis implies responding to it, on the one hand, with humanitarian gestures of saving lives, and, on the other, with stricter border control. I reflect on the grammar of crisis and the forms of care that it simultaneously enables and disables. I am inspired by the relationship between two painters-from Tunisia and Nigeria-and their forms of therapeutic and ethical explorations through art. I propose to attend to practices that bear witness to other grammars, or the lack thereof. These practices are the expression of a denial, or, better, of an interruption in the language of the crisis and pathology.
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Abstract
Childhood vaccination is one of the greatest public health achievements of the 20th century, yet increasingly, parents question the safety of and need for vaccines. This has led to increased rates of vaccine delay and refusal and outbreaks of vaccine-preventable diseases. Physicians struggle with how to respond to families who refuse vaccines, as there are few known effective interventions to convince a family to vaccinate. In the United States, the practice of dismissing families for vaccine refusal appears to be increasing as a strategy for dealing with vaccine refusal. In this review, we review the literature surrounding this controversial practice, starting with the impact that vaccine-refusing families have on medical practices, followed by a review of dismissal policies of US physicians, and ending with a discussion of the ethics of this practice.
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Affiliation(s)
- Tamara B Garcia
- Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA
| | - Sean T O'Leary
- Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA.,Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), Aurora, CO, USA
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Kirk R, Dipchand AI, Davies RR, Miera O, Chapman G, Conway J, Denfield S, Gossett JG, Johnson J, McCulloch M, Schweiger M, Zimpfer D, Ablonczy L, Adachi I, Albert D, Alexander P, Amdani S, Amodeo A, Azeka E, Ballweg J, Beasley G, Böhmer J, Butler A, Camino M, Castro J, Chen S, Chrisant M, Christen U, Danziger-Isakov L, Das B, Everitt M, Feingold B, Fenton M, Garcia-Guereta L, Godown J, Gupta D, Irving C, Joong A, Kemna M, Khulbey SK, Kindel S, Knecht K, Lal AK, Lin K, Lord K, Möller T, Nandi D, Niesse O, Peng DM, Pérez-Blanco A, Punnoose A, Reinhardt Z, Rosenthal D, Scales A, Scheel J, Shih R, Smith J, Smits J, Thul J, Weintraub R, Zangwill S, Zuckerman WA. ISHLT consensus statement on donor organ acceptability and management in pediatric heart transplantation. J Heart Lung Transplant 2020; 39:331-341. [PMID: 32088108 DOI: 10.1016/j.healun.2020.01.1345] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [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: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 12/14/2022] Open
Abstract
The number of potential pediatric heart transplant recipients continues to exceed the number of donors, and consequently the waitlist mortality remains significant. Despite this, around 40% of all donated organs are not used and are discarded. This document (62 authors from 53 institutions in 17 countries) evaluates factors responsible for discarding donor hearts and makes recommendations regarding donor heart acceptance. The aim of this statement is to ensure that no usable donor heart is discarded, waitlist mortality is reduced, and post-transplant survival is not adversely impacted.
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Affiliation(s)
- Richard Kirk
- Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, Texas.
| | - Anne I Dipchand
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ryan R Davies
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, Texas
| | - Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - Jennifer Conway
- Department of Pediatrics, Division of Pediatric Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Susan Denfield
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Jeffrey G Gossett
- University of California Benioff Children's Hospitals, San Francisco, California
| | - Jonathan Johnson
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Michael McCulloch
- University of Virginia Children's Hospital, Charlottesville, Virginia
| | - Martin Schweiger
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Vienna and Pediatric Heart Center Vienna, Vienna, Austria
| | - László Ablonczy
- Pediatric Cardiac Center, Hungarian Institute of Cardiology, Budapest, Hungary
| | - Iki Adachi
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Dimpna Albert
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Peta Alexander
- Department of Cardiology, Boston Children's Hospital Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | | | - Estela Azeka
- Heart Institute (InCor) University of São Paulo, São Paulo, Brazil
| | - Jean Ballweg
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital and Medical Center University of Nebraska Medical Center, Omaha, Nebraska
| | - Gary Beasley
- Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Jens Böhmer
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alison Butler
- Carnegie Mellon University, Pittsburgh, Pennsylvania
| | | | - Javier Castro
- Fundacion Cardiovascular de Colombia, Santander, Bucaramanga City, Colombia
| | | | - Maryanne Chrisant
- Heart Institute, Joe Dimaggio Children's Hospital, Hollywood, Florida
| | - Urs Christen
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Lara Danziger-Isakov
- Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center & University of Cincinnati, Cincinnati, Ohio
| | - Bibhuti Das
- Heart Institute, Joe Dimaggio Children's Hospital, Hollywood, Florida
| | | | - Brian Feingold
- Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Matthew Fenton
- Great Ormond Street Hospital for Children Foundation Trust, London, United Kingdom
| | | | - Justin Godown
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dipankar Gupta
- Congenital Heart Center, University of Florida, Gainesville, Florida
| | - Claire Irving
- Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Anna Joong
- Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
| | | | | | - Steven Kindel
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Kimberly Lin
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Karen Lord
- New England Organ Bank, Boston, Massachusetts
| | - Thomas Möller
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Deipanjan Nandi
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Oliver Niesse
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | | | | | - Ann Punnoose
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Angie Scales
- Pediatric and Neonatal Donation and Transplantation, Organ Donation and Transplantation, NHS Blood and Transplant, London, United Kingdom
| | - Janet Scheel
- Washington University School of Medicine, St. Louis, Missouri
| | - Renata Shih
- Congenital Heart Center, University of Florida, Gainesville, Florida
| | | | | | - Josef Thul
- Children's Heart Center, University of Giessen, Giessen, Germany
| | | | | | - Warren A Zuckerman
- Columbia University Medical Center, Morgan Stanley Children's Hospital of New York, New York, New York
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35
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Shimura T, Yamamoto M, Kano S, Hosoba S, Sago M, Kagase A, Koyama Y, Tsujimoto S, Otsuka T, Tada N, Naganuma T, Araki M, Yamanaka F, Shirai S, Mizutani K, Tabata M, Ueno H, Takagi K, Higashimori A, Watanabe Y, Hayashida K. Patients Refusing Transcatheter Aortic Valve Replacement Even Once Have Poorer Clinical Outcomes. J Am Heart Assoc 2019; 7:e009195. [PMID: 30371215 PMCID: PMC6222955 DOI: 10.1161/jaha.118.009195] [Citation(s) in RCA: 13] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Although transcatheter aortic valve replacement (TAVR) is the least invasive treatment for patients with symptomatic aortic stenosis, some patients hesitate to undergo the procedure. We investigated the clinical impact of treatment delay after patient refusal of TAVR. Methods and Results We used the Japanese OCEAN (Optimized Catheter valvular intervention) regsitry data of 1542 patients who underwent TAVR. Refusal was defined as at least 1 refusal of TAVR at the time of informed consent. Patients were separated into 2 groups: refusal (28/1542, 1.8%) and non‐refusal (1514/1542, 98.2%). We compared the baseline characteristics, procedural outcomes, and mortality rates between the groups. Additionally, data on reasons for refusal and those leading to eventually undergoing TAVR were collected. Age, surgical risk scores, and frailty were higher in the refusal group than in the non‐refusal group (P<0.05 for all). Periprocedural complications did not differ between groups, whereas 30‐day and cumulative 1‐year mortality were significantly higher in the refusal group than in the non‐refusal group (7.1% versus 1.3%, P=0.008 and 28.8% versus 10.3%, P=0.010, respectively). Multivariate Cox regression analysis revealed that TAVR refusal was an independent predictor of increased midterm mortality (hazard ratio: 3.37; 95% confidence interval: 1.52–7.48; P=0.003). The most common reason for refusal was fear (13/28, 46.4%), and the most common reason for changing their mind was worsening heart failure (21/28, 75.0%). All patients in the refusal group decided to undergo TAVR within 20 months (median: 5.5 months). Conclusions Refusing TAVR even once led to poorer prognosis; therefore, this fact should be clearly discussed when obtaining informed consent.
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Affiliation(s)
- Tetsuro Shimura
- 1 Department of Cardiology Toyohashi Heart Center Aichi Japan
| | - Masanori Yamamoto
- 1 Department of Cardiology Toyohashi Heart Center Aichi Japan.,2 Department of Cardiology Nagoya Heart Center Aichi Japan
| | - Seiji Kano
- 1 Department of Cardiology Toyohashi Heart Center Aichi Japan
| | - Soh Hosoba
- 1 Department of Cardiology Toyohashi Heart Center Aichi Japan
| | - Mitsuru Sago
- 1 Department of Cardiology Toyohashi Heart Center Aichi Japan
| | - Ai Kagase
- 2 Department of Cardiology Nagoya Heart Center Aichi Japan
| | - Yutaka Koyama
- 2 Department of Cardiology Nagoya Heart Center Aichi Japan
| | | | - Toshiaki Otsuka
- 3 Department of Hygiene and Public Health Nippon Medical School Tokyo Japan.,4 Center for Clinical Research Nippon Medical School Hospital Tokyo Japan
| | - Norio Tada
- 5 Department of Cardiology Sendai Kosei Hospital Miyagi Japan
| | - Toru Naganuma
- 6 Department of Cardiology New Tokyo Hospital Chiba Japan
| | - Motoharu Araki
- 7 Department of Cardiology Saiseikai Yokohama City Eastern Hospital Kanagawa Japan
| | - Futoshi Yamanaka
- 8 Department of Cardiology Shonan Kamakura General Hospital Kanagawa Japan
| | - Shinichi Shirai
- 9 Department of Cardiology Kokura Memorial Hospital Fukuoka Japan
| | - Kazuki Mizutani
- 10 Department of Cardiology Osaka City General Hospital Osaka Japan
| | - Minoru Tabata
- 11 Department of Cardiovascular Surgery Tokyo Bay Urayasu-Ichikawa Medical Center Chiba Japan
| | - Hiroshi Ueno
- 12 Department of Cardiology Toyama University Hospital Toyama Japan
| | - Kensuke Takagi
- 13 Department of Cardiology Ogaki Municipal Hospital Gifu Japan
| | | | - Yusuke Watanabe
- 15 Department of Cardiology Teikyo University School of Medicine Tokyo Japan
| | - Kentaro Hayashida
- 16 Department of Cardiology Keio University School of Medicine Tokyo Japan
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Abstract
Nongovernmental organizations working in international development increasingly follow a neoliberalized management model, hiring professional employees to conduct the work of social transformation under a bureaucratic regime that sees the recruitment and retention of staff members as rational transactions between employer and employee. Such managerialist thinking holds that staff members represent bundles of skills and knowledge to be sorted and allocated according to the requirements of work, that they seek to exchange their labor for payment, and that they may justifiably be fired for misdeeds like misuse of materials, misrepresenting themselves, or poor work quality, as determined by the institution. I use the example of local staff members resigning and being fired from an international democratization intervention in postwar Angola to argue that some development professionals refuse to occupy such management-defined subject positions, asserting instead their independent moralities about the place of implementation staff in international development work. International development institutions misrecognize many such acts, however, leaving intact unequal relations of power within the very industry meant to combat such unequal relations on a global scale.
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Affiliation(s)
- Rebecca Warne Peters
- Department of Public Administration and International Affairs, Syracuse University
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37
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Roberson MC. Refusal of Epidural Anesthesia for Labor Pain Management by African American Parturients: An Examination of Factors. AANA J 2019; 87:299-304. [PMID: 31587714] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Most parturients use epidural anesthesia for labor pain management, with excellent pain relief possible within minutes of administration. An examination of the literature revealed a disparity of use that existed along ethnic and racial lines, with African Americans less likely to accept epidural anesthesia. No known studies to date had explored the reasons for this disparity. The purpose of this qualitative study was to identify those factors that influence African American parturients to decline epidural anesthesia for labor pain management. Andersen's Behavioral Model of Health Services Use served as the conceptual framework for the study. Twelve primiparous African American parturients were selected for participation through the use of purposive (homogeneous) sampling. Semistructured interviews consisting of closed-ended and open-ended questions were used for data collection. Data analysis involved open coding, core category identification, selective coding, and theme identification. The study revealed 3 themes that helped address the research question: fear, naturalism, and family influence. In nurse anesthesia practice, a thorough understanding of those factors examined in this study may better enable healthcare providers to assist African American parturients in the decision-making process, with the potential for increased patient satisfaction and improved quality of life.
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Affiliation(s)
- Michael C Roberson
- is a practitioner in Jackson, Mississippi, and owner of Roberson Anesthesia Services LLC. He completed this research as part of his dissertation and graduation requirements from William Carey University
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38
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Ferman S, Lima FFDS, Lage CRS, da Hora SS, Vianna DT, Thuler LC. Preventing treatment abandonment for children with solid tumors: A single-center experience in Brazil. Pediatr Blood Cancer 2019; 66:e27724. [PMID: 30938082 DOI: 10.1002/pbc.27724] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/19/2019] [Accepted: 02/23/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND High rates of treatment abandonment have been considered one of the major limitations to achieving high cure rates of childhood cancer in developing countries. The aims of this study were to report the prevalence and factors associated with treatment abandonment for children diagnosed with solid tumors in one reference center in Brazil and to describe effective strategies to prevent it. PROCEDURES A retrospective review was conducted using data from 1139 children (0-18 years) treated for solid tumors at the Brazilian National Cancer Institute, during the period between January 2012 and December 2017. Treatment abandonment was defined as recommended by the International Society of Pediatric Oncology. The impact of implementing a patient-tracking system was evaluated. Descriptive statistics were used to analyze patient characteristics. Chi-square test was used for statistical analysis, with the significance level <0.05. RESULTS Of 1139 patients, 1.66% refused or abandoned treatment. Although from 2012 to 2013 there was an increase in the abandonment rate, it then decreased by 63.8% from 2013 to 2017 (2.5% to 0.9%). In the multivariate model, only retinoblastoma diagnosis was associated with abandonment (odds ratio = 5.0; 95% confidence interval, 1.2-20.4; P = 0.025). In our cohort, abandonment rates were not associated with increased death. CONCLUSION Monitoring missed appointments, and early interventions to address issues associated with providing resources to help families during treatment were effective in achieving very low abandonment rates.
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Affiliation(s)
- Sima Ferman
- Department of Pediatric Oncology, Brazilian National Cancer Institute, INCA, Brazil
| | | | | | - Senir Santos da Hora
- Department of Pediatric Oncology, Brazilian National Cancer Institute, INCA, Brazil
| | | | - Luiz Claudio Thuler
- Clinical Research Division, Brazilian National Cancer Institute, INCA, Brazil
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Abstract
A sexual trauma can lead to the development of an eating disorder; it is a relationship with the body as an object and a search for empowerment in the relationship with others. Nevertheless, the treatment of the trauma and the associated disorder, as well as the support of the immediate circle are possible forms of converging care for restoring health, for restoring the body and words.
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Affiliation(s)
- Flora Hollande
- Unité des troubles du comportement alimentaire (TCA), Clinique des maladies mentales et de l'encéphale (CMME), service du Pr Philip Gorwood, centre hospitalier Sainte-Anne, 100, rue de la Santé, 75014 Paris, France.
| | - Nadine Satori
- Unité des troubles du comportement alimentaire (TCA), Clinique des maladies mentales et de l'encéphale (CMME), service du Pr Philip Gorwood, centre hospitalier Sainte-Anne, 100, rue de la Santé, 75014 Paris, France
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40
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Abstract
This article considers situations where treatment is refused and whether this is reasonable taking into account statutory duties, efficacy of treatment, the role and advice of NICE, local and general resources. What should be the priorities for treatment? Eligibility for treatment, the economic case for an early intervention and/or preventative medicine, caesarean sections, human rights, examples from the cases.
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41
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Equils O, Kellogg C, Baden L, Berger W, Connolly S. Logistical and structural challenges are the major obstacles for family medicine physicians' ability to administer adult vaccines. Hum Vaccin Immunother 2018; 15:637-642. [PMID: 30395771 DOI: 10.1080/21645515.2018.1543524] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
PURPOSE This study was conducted to characterize the vaccination practices and challenges of family medicine physicians in Los Angeles County, California. METHODS The Los Angeles Academy of Family Physicians (LA AFP) sent out electronic surveys to all of their active members (N = 1121) between December 2017 and January 2018, and asked them to answer questions about themselves, their practice, their patient population, and their immunization practices and challenges. We then analyzed the results through basic statistical calculations and Pearson's chi-squared tests. RESULTS Seventy-four people (6.6%) responded to the survey, and 75% of responders stated that they administer all Advisory Committee on Immunization Practices (ACIP) recommended vaccines. The lowest vaccine administration rates were for the high-dose influenza vaccine, which 66.2% (n = 49) of respondents reported to administer, followed by the meningococcal B vaccine (68.9%; n = 51). The respondents who belonged to practices with more than 11 providers, were part of a large hospital or healthcare system, had electronic medical records (EMRs), and used the California Immunization Registry (CAIR) were more likely to report to vaccinate. The number one responding physician-reported challenge to vaccination was limited time and resources to address patient resistance followed by vaccine cost and lack of infrastructure to store vaccines. CONCLUSIONS In this pilot study, structural and logistical challenges appeared to make the biggest impact on adult vaccination for the responding family medicine physicians. Solutions addressing these challenges will help improve the adult immunization rates.
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Affiliation(s)
- Ozlem Equils
- a Immunization Coalition of Los Angeles County, Department of Public Health , MiOra , Los Angeles, CA , USA
| | - Caitlyn Kellogg
- b University of California, San Diego School of Medicine , MiOra , San Diego, CA , USA
| | - Lucy Baden
- b University of California, San Diego School of Medicine , MiOra , San Diego, CA , USA
| | - Wendy Berger
- c Immunization Coalition of Los Angeles County, Department of Public Health , Los Angeles, CA , USA
| | - Shannon Connolly
- d Los Angeles Academy of Family Physicians , Los Angeles, CA , USA
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42
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Restivo V, Costantino C, Marras A, Napoli G, Scelfo S, Scuderi T, Casuccio A, Cernigliaro A, Giusti A, Spila Alegiani S. Pap Testing in a High-Income Country with Suboptimal Compliance Levels: A Survey on Acceptance Factors among Sicilian Women. Int J Environ Res Public Health 2018; 15:E1804. [PMID: 30131461 DOI: 10.3390/ijerph15091804] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 08/14/2018] [Accepted: 08/20/2018] [Indexed: 11/16/2022]
Abstract
Cervical cancer screening is uncommon, especially in low-income countries and among lower socioeconomic status people in high-income countries. The aims of this study were to examine the adherence of Sicilian women to Pap testing and to identify the determinants of this in a population with a secondary prevention attitude lower than high-income countries and the national average. A cross-sectional study called “Save Eva in Sicily” was conducted among all women aged 25–64 years, with a sample drawn by the list of general practitioners (GPs), using a proportional sampling scheme, stratified by age and resident population. The study outcome was performing a Pap test within the past three years. The association between the outcome and Pap test determinants was analyzed through a multivariable logistic regression. Among the 365 interviewed women, 66% (n = 243) had a Pap test during the last 3 years. On the other hand, 18% of the other women (n = 66) had performed at least one Pap test previously and 16% (n = 56) had never had a Pap test. In a multivariable model, GPs’ advice (adjusted OR 2.55; 95% CI 1.57–4.14) and perceived susceptibility (adjusted OR 3.24; 95% CI 1.92–5.48) increased the likelihood of the execution of a Pap test. The “Save Eva in Sicily” study identified GP advice and perceived cancer severity as the main correlates of Pap testing among Sicilian women, producing evidence regarding how policy makers can increase compliance. Interventions to increase Pap test adhesion should focus on stimulating GPs to identify patients who regularly do not undergo it and to recommend testing on a regular basis to their patients.
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Abstract
Vaccine scepticism is an increasingly important barrier to optimal coverage in developed countries. In this commentary, we make the case that negative attitudes towards vaccines reflect a broader and deeper set of beliefs about health and wellbeing. We suggest that this alternative worldview is influenced by ontological confusions (e.g. regarding purity, natural energy), and knowledge based on personal lived experience and trusted peers, rather than the positivist epistemological framework. Our view is supported by recent social-psychological research, including strong correlations of vaccine scepticism with adherence to complementary and alternative medicine, magical health beliefs, and conspiracy ideation. For certain well-educated and well-resourced individuals, opposition to vaccines represents an expression of personal intuition and agency, in achieving a positive and life-affirming approach to health and wellbeing. These core beliefs are not amenable to change - and especially resistant to communications from orthodox, authoritative sources. Although this view does suggest tactical improvements to messaging, we suggest that a better long-term strategy is to combine with other disciplines in order to address the root causes of vaccine scepticism. Vaccine scepticism is unlikely to thrive in a cultural context that trusts and values the scientific consensus.
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Affiliation(s)
- Matthew Browne
- a School of Medical, Health & Applied Sciences, Central Queensland University , Bundaberg , Australia
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Guo R, Liao J, Liang J, Li Y, Deng S. [Preadolescents' refusal skills and responses emotional reactions to the offer of tobacco and ecstasy in Youjiang District in Baise City in 2014]. Wei Sheng Yan Jiu 2018; 47:80-92. [PMID: 29903228] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To assess preadolescents' emotional reactions and intended use of refusal responses to tobacco and ecstasy. METHODS A total of 333 students from two junior schools in Baise City were recruited with cluster-sampling method, filled the questionnaire to assess a respondent's emotional reactions and refusal skills in response to an offer of tobacco and MDMA from Feb to Jul 2014. RESULTS 88. 89%-93. 39% of preadolescents would more likely to use "say no"and "tell them you don't want it". A series of 2( type of drug) × 2( offerer) × 2( sex) ANOVAs showed there were main effects for sex in "explicit refusal scale "( F = 8. 391, P = 0. 004), "excuse scale "( F =156. 560, P < 0. 001), "implicit refusal scale "( F = 84. 498, P < 0. 001), "aggression scale"( F = 31. 911, P < 0. 001). For the excuse scale, there were main effects for drug( F = 12. 009, P = 0. 001). A series of χ~2-tests showed that participants were more"curious"to MDMA offers than tobacco offers from close friends and acquaintances( χ~2=13. 76, P = 0. 0003; χ~2= 10. 24, P = 0. 002). For the close friends offers, participants were more "pleasure " to tobacco offers than MDMA offers( χ~2= 8. 33, P = 0. 006). CONCLUSION There were significant effects of sex and offers in refusal style for drug offers. Preadolescents would show different emotional reaction to type of drug supplier or provider.
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Affiliation(s)
- Rui Guo
- School of Public Health and Management, Youjiang Medical University for Nationalities, Baise 533000, China
| | - Jianying Liao
- School of Public Health and Management, Youjiang Medical University for Nationalities, Baise 533000, China
| | - Jiancheng Liang
- School of Public Health and Management, Youjiang Medical University for Nationalities, Baise 533000, China
| | - Yang Li
- School of Public Health and Management, Youjiang Medical University for Nationalities, Baise 533000, China
| | - Shusong Deng
- School of Public Health and Management, Youjiang Medical University for Nationalities, Baise 533000, China
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Alvarez E, Seppa M, Rivas S, Fuentes L, Valverde P, Antillón-Klussmann F, Castellanos M, Sweet-Cordero EA, Messacar K, Kurap J, Bustamante M, Howard SC, Efron B, Luna-Fineman S. Improvement in treatment abandonment in pediatric patients with cancer in Guatemala. Pediatr Blood Cancer 2017; 64. [PMID: 28423236 DOI: 10.1002/pbc.26560] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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] [Received: 09/09/2016] [Revised: 02/12/2017] [Accepted: 02/19/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Treatment refusal and abandonment are major causes of treatment failure for children with cancer in low- and middle-income countries (LMICs), like Guatemala. This study identified risk factors for and described the intervention that decreased abandonment. METHODS This was a retrospective study of Guatemalan children (0-18 years) with cancer treated at the Unidad Nacional de Oncología Pediátrica (UNOP), 2001-2008, using the Pediatric Oncology Network Database. Treatment refusal was a failure to begin treatment and treatment abandonment was a lapse of 4 weeks or longer in treatment. The impact of medicina integral, a multidisciplinary psychosocial intervention team at UNOP was evaluated. Cox proportional hazards analysis identified the effect of demographic and clinical factors on abandonment. Kaplan-Meier analysis estimated the survival. RESULTS Of 1,789 patients, 21% refused or abandoned treatment. Abandonment decreased from 27% in 2001 to 7% in 2008 following the implementation of medicina integral. Factors associated with increased risk of refusal and abandonment: greater distance to the centre (P < 0.001), younger age (P = 0.017) and earlier year of diagnosis (P < 0.001). Indigenous race/ethnicity (P = 0.002) was associated with increased risk of abandonment alone. Abandonment correlated with decreased overall survival: 0.57 ± 0.02 (survival ± standard error) for those who completed therapy versus 0.06 ± 0.02 for those who abandoned treatment (P < 0.001) at 8.3 years. CONCLUSION This study identified distance, age, year of diagnosis and indigenous race/ethnicity as risk factors for abandonment. A multidisciplinary intervention reduced abandonment and can be replicated in other LMICs.
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Affiliation(s)
- Elysia Alvarez
- Division of Hematology/Oncology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Midori Seppa
- Stanford University School of Medicine, Palo Alto, California
| | - Silvia Rivas
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | - Lucia Fuentes
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | | | | | | | - E Alejandro Sweet-Cordero
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, UCSF Benioff Children's Hospital, San Francisco, California
| | - Kevin Messacar
- Section of Hospital Medicine and Infectious Diseases, Department of Pediatrics, University of Colorado/Children's Hospital Colorado, Aurora, Colorado
| | - John Kurap
- Hilo Bay Clinic, Community Health Center, Hilo, Hawaii
| | | | - Scott C Howard
- School of Health Studies, University of Memphis, Tennessee
| | - Bradley Efron
- Department of Statistics and Biostatistics, Stanford University, Palo Alto, California
| | - Sandra Luna-Fineman
- Division of Hematology/Oncology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.,Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
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Abstract
Biobank research has the potential to return results that could have beneficial and even life-saving consequences for participants. This possibility raises some important questions, not only about the ethical duty to return results within a research setting, but also about participants' right to refuse results and researchers' responsibility to respect that choice. This article argues in favor of adopting a return-of-results policy that limits participants' ability to refuse clinically relevant and actionable results. We state that biobanks should allow donors only if they are aware of and agree to this return policy. If they do not agree to this, they retain the option not to participate in the biobank research. The aim of this article is to discuss the practical and ethical reasons in favor of this return-of-result policy and, thus, to underline the importance of "honesty" in biobanking regulations.
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Affiliation(s)
- Bernice S Elger
- 1 Institute for Biomedical Ethics, University of Basel , Basel, Switzerland .,2 University Center of Legal Medicine of Geneva and Lausanne, University of Geneva, Geneva, Switzerland
| | - Eva De Clercq
- 1 Institute for Biomedical Ethics, University of Basel , Basel, Switzerland
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47
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Lawlor R. Ambiguities and Asymmetries in Consent and Refusal: Reply to Manson. Bioethics 2016; 30:353-357. [PMID: 26424104 DOI: 10.1111/bioe.12209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
John Harris claims that is it 'palpable nonsense' to suggest that 'a child (or anyone) might competently consent to a treatment but not be competent to refuse it.' In 'Transitional Paternalism: How Shared Normative Powers Give Rise to the Asymmetry of Adolescent Consent and Refusal' Neil Manson aims to explain away the apparent oddness of this asymmetry of consent and refusal, by appealing to the idea of shared normative powers, presenting joint bank accounts as an example. In this article, I will argue that Manson's account fails to explain away the oddness. Rather, I will argue that there are ambiguities to which Manson has not paid sufficient attention. In fact, as odd as it may sound, I argue that Manson actually agrees with Harris (at least in relation to the asymmetry of competence). He fails to recognize that he agrees with Harris because he is not careful enough to distinguish between different asymmetries, which I have labelled the asymmetries of choice, permissibility and competence.
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Stavas MJ, Arneson KO, Ning MS, Attia AA, Phillips SE, Perkins SM, Shinohara ET. The Refusal of Palliative Radiation in Metastatic Non-Small Cell Lung Cancer and Its Prognostic Implications. J Pain Symptom Manage 2015; 49:1081-1087.e4. [PMID: 25596010 DOI: 10.1016/j.jpainsymman.2014.11.298] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 08/26/2014] [Revised: 11/15/2014] [Accepted: 11/23/2014] [Indexed: 12/25/2022]
Abstract
CONTEXT Patients with metastatic non-small cell lung cancer (NSCLC) have limited survival. Population studies have evaluated the impact of radiation refusal in the curative setting; however, no data exist concerning the prognostic impact of radiation refusal in the palliative care setting. OBJECTIVES To investigate the patterns of radiation refusal in newly diagnosed patients with metastatic NSCLC. METHODS Patients with Stage IV NSCLC diagnosed between 1988 and 2010 were identified in the Surveillance, Epidemiology, and End Results database. Univariate and multivariate analyses were used to identify predictors for refusal of radiation and the impact of radiation and refusal on survival in the palliative setting. RESULTS A total of 285,641 patients were initially included in the analysis. Palliative radiation was recommended in 42% and refused by 3.1% of patients. Refusal rates remained consistent across included years of study. On multivariate analysis, older, nonblack/nonwhite, unmarried females were more likely to refuse radiation (P < 0.001 in all cases). Median survival for patients refusing radiation was three months vs. five months for those receiving radiation and two months for those whom radiation was not recommended. CONCLUSION Patients with metastatic NSCLC who refuse recommended palliative radiation have a poor survival. Radiation refusal or the recommendation against treatment can serve as a trigger for integrating palliative care services sooner and contributes greatly to prognostic awareness. Further investigation into this survival difference and the factors behind refusal are warranted.
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Affiliation(s)
- Mark J Stavas
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| | - Kyle O Arneson
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew S Ning
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Albert A Attia
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sharon E Phillips
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephanie M Perkins
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Eric T Shinohara
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Shiogama K, Kitazawa K, Mizutani Y, Onouchi T, Inada KI, Tsutsumi Y. New Grocott Stain without Using Chromic Acid. Acta Histochem Cytochem 2015; 48:9-14. [PMID: 25861133 PMCID: PMC4387260 DOI: 10.1267/ahc.14045] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 12/11/2014] [Indexed: 01/27/2023] Open
Abstract
We established a new “ecological” Grocott stain for demonstrating fungi, based upon a 4R principle of refusal, reduction, reuse, and recycle of waste management. Conventional Grocott stain employs environmentally harsh 5% chromic acid for oxidization. Initially, we succeeded in reducing the concentration of chromic acid from 5% to 1% by incubating the solution at 60°C and using five-fold diluted chromic acid solution at which point it was reusable. Eventually, we reached the refusal level where 1% periodic acid oxidization was efficient enough, when combined with preheating of sections in the electric jar, microwave oven, or pressure pan. For convenience sake, we recommend pressure pan heating in tap water for 10 min. Stainability of fungi in candidiasis and aspergillosis was comparable with conventional Grocott stain, while Mucor hyphae showed enhanced staining. The modified sequence was further applicable to detecting a variety of mycotic pathogens in paraffin sections. Our environmentally-friendly Grocott stain also has the advantage of avoiding risk of human exposure to hexavalent chromium solution in the histopathology laboratory. The simple stain sequence is can be easily applied worldwide.
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Affiliation(s)
- Kazuya Shiogama
- Department of Pathology, Fujita Health University School of Medicine
| | | | | | - Takanori Onouchi
- Department of Pathology, Fujita Health University School of Medicine
| | - Ken-ichi Inada
- Department of Pathology, Fujita Health University School of Medicine
| | - Yutaka Tsutsumi
- Department of Pathology, Fujita Health University School of Medicine
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Bopp M, Braun J, Faeh D. Variation in mortality patterns among the general population, study participants, and different types of nonparticipants: evidence from 25 years of follow-up. Am J Epidemiol 2014; 180:1028-35. [PMID: 25344298 DOI: 10.1093/aje/kwu226] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The general willingness to participate in health surveys is decreasing, resulting in increasingly selected study populations. We aimed to examine relative mortality rates by different categories of nonparticipation. We included 14,223 men and women aged 25-74 years who were sampled in the Swiss centers of the international Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) Study (1983-1992) and followed-up until 2008. Logistic regression was used to describe factors associated with nonparticipation. We compared persons who refused to participate (n = 2,911), persons who did not go to their examination (n = 470), and persons that could not be contacted for inclusion in the MONICA Study (n = 989) with participants (n = 9,853). We used Cox regression to determine mortality hazard ratios for the various categories of nonparticipants versus participants or versus the 1990 Census population average. Persons who refused were more likely to be older and female. Compared with participants, those who refused had a higher risk of death (for men, hazard ratio = 1.34, 95% confidence interval: 1.17, 1.54; for women, hazard ratio = 1.31, 95% confidence interval: 1.12, 1.52), whereas persons who did not go to their examination and those who could not be contacted did not differ. Compared with the general (census) population, participants had a lower risk of all-cause mortality and those who refused had a higher risk of all-cause mortality. These variations were mainly due to cardiovascular disease and not cancer. Variations in relative mortality risks between study participants and the general population could depend on the proportion of subjects who actively refused to participate in the study. Considering the increasing participation reluctance, our findings underline the importance of carefully assessing the reasons for nonparticipation.
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