Complementary medicine use and flu vaccination – A nationally representative survey of US adults

BackgroundPrior research presented inconsistent results with less, equal or higher vaccination rates among patients using complementary medicine. Given that complementary medicine includes a wide range of therapies, variable vaccination patterns may occur within consultations with different professions. This analysis aims to to evaluate differences between categories of complementary medicine regarding vaccination behavior among US adults.Methods and resultsThis analysis used data from the 2017 National Health Interview Survey (NHIS; n = 26,742; response rate 80.7%). Prevalences of flu vaccination, consultations with complementary medicine practitioners in the past 12 months and their potential interactions were examined. 42.7% of participants had received flu vaccination in the past 12 months, 32.4% had seen one or more complementary medicine practitioner. Users of any type of complementary medicine were as likely as non-users to have received a flu vaccination (44.8% users versus 41.7% non-users; p = 0,862; adjusted odds ratio [AOR] = 1.01, 95% confidence interval [CI] = 0.95–1.07). Regarding specific complementary medicine types, individuals consulting with naturopaths (p < 0.001; AOR = 0.67, 95 %CI = 0.54–0.82), homeopaths (p < 0.001; AOR = 0.55; 95 %CI = 0.44–0.69) and chiropractors (p = 0.016; AOR = 0.9, 95 %CI = 0.83–0.98) were less likely, while other complementary medicine approaches showed no significant association with flu vaccination behavior. Independent predictors for a flu shot were prior diabetes, cancer, current asthma, kidney disease, overweight and current pregnancy. As well, higher educational level, age, ethnicity, health insurance coverage and having seen a general physician or medical specialist in the past 12 months were also associated with a higher vaccination rate.ConclusionsComplementary medicine users were equally likely to receive an influenza vaccination compared with non-users. Different complementary therapies showed varied associations with vaccination behavior. Further analyses may be needed to distinguish influencing factors among patients’ vaccination behavior.     

Leadership position and physician visits – results of a nationally representative longitudinal study in Germany

Background

So far, studies within the occupational field have largely concentrated on working conditions and job stressors and staff members’ or subordinate health. Only a few have focused on managers in this context, but studies are missing that explicitly look at the relation between leadership position and health care use (HCU). Thus, the purpose of this study was to examine the potential effects of a change in leadership position on HCU in women and men longitudinally.

Methods

Data were drawn from a nationally representative longitudinal study in Germany (German Socio-Economic Panel, GSOEP). Data from 2009 and 2013 were used. Leadership position was divided into (i) top management, (ii) middle management, (iii) lower management, and (iv) a highly qualified specialist position. The number of physician visits in the preceding 3 months were used to quantify HCU (n?=?2140 observations in regression analysis; 69% male).

Results

Adjusting for various potential confounders (e.g., age, self-rated health, chronic conditions, and personality factors), Poisson FE regression analysis revealed that changes from a highly qualified specialist position to the top management were associated with a decrease in the number of physician visits in men (β?=?.47, p?<?.05), but not in women. Gender differences (gender x leadership position) were significant.

Conclusions

Findings of this study emphasize the impact of leadership positions on the number of physician visits in men. Further study is required to elucidate the underlying mechanisms.

     

On the relevance of parents and TV as socializers of 6–19 year-olds’ expressions of emotion: representative data from Germany

This study examines joint influences of parental socialization and socialization via mass media on children’s expression of emotions. The effect of parental approval of their child’s expression of emotions, on the child’s approval of TV characters expressing the emotion, and the influence of both on the child’s expression of emotions within the past seven days is tested for the emotions fear, sadness, anger, and happiness with a representative survey of children (N = 1458) aged 6–19 in Germany. Moderating age and gender effects were also considered. Consistent across the four emotions, results showed that socialization of emotions via mass media is driven by internalized parental socialization but has a comparably strong effect of its own on the child’s expression of emotion that adds to the variance explained, especially with regard to anger and happiness. Implications for the conceptualization of parental emotion socialization and emotional socialization via media are discussed.     

Factors associated with parental acceptance of seasonal influenza vaccination for their children – A telephone survey in the adult population in Germany

IntroductionInfluenza vaccination of children with underlying chronic diseases is currently recommended in Germany, but targeting all children constitutes an alternative approach to control seasonal influenza. To inform the modelling of vaccination impact and possible communication activities, we aimed to assess among parents the acceptance of universal childhood vaccination against seasonal influenza and possible modifiers.MethodsWe conducted a telephone survey in households in Germany using random digit dialing. We interviewed parents with children aged <18 years by constructing three hypothetical scenarios in subsequent order: (1) hearing about the influenza vaccination recommendation through the media, (2) the vaccine being recommended by a physician, and (3) being informed about the availability of the vaccine as a nasal spray. We calculated the proportion of parents who would immunize their child and used univariable and multivariable logistic regression to identify factors associated with influenza vaccination intention.ResultsResponse was between 22 and 46%. Of 518 participants, 74% were female, mean age was 41.3 years. Participants had on average 1.6 children with a mean age of 8.9 years. In scenario 1, 52% of parents would immunize their child, compared to 64% in scenario 2 (p < 0.01) and to 45% in scenario 3 (p = 0.20). Factors independently associated with vaccination acceptance in scenario 1 were previous influenza vaccination of the child or parent (adjusted odds ratio [aOR] 4.5 and 8.6, respectively), perceived severity of influenza (aOR = 5.1) and living in eastern Germany (aOR = 2.4).ConclusionIf seasonal influenza vaccination was recommended for all children, more than half of the parents would potentially agree to immunize their child. Involving physicians in future information campaigns is essential to achieve high uptake. As intranasal vaccine administration is non-invasive and easily done, it remains unclear why scenario 3 was associated with low acceptance among parents, and the underlying reasons should be further explored.     

Parental vaccine hesitancy in Italy – Results from a national survey

In Italy, in 2016, we conducted a cross-sectional survey to estimate vaccine hesitancy and investigate its determinants among parents of children aged 16–36 months.Data on parental attitudes and beliefs about vaccinations were collected through a questionnaire administered online or self-administered at pediatricians’ offices and nurseries. Parents were classified as pro-vaccine, vaccine-hesitant or anti-vaccine, according to self-reported tetanus and measles vaccination status of their child. Multivariable logistic regression was used to investigate factors associated with hesitancy.A total of 3130 questionnaires were analysed: 83.7% of parents were pro-vaccine, 15.6% vaccine-hesitant and 0.7% anti-vaccine. Safety concerns are the main reported reason for refusing (38.1%) or interrupting (42.4%) vaccination. Anti-vaccine and hesitant parents are significantly more afraid than pro-vaccine parents of short-term (85.7 and 79.7% vs 60.4%) and long-term (95.2 and 72.3% vs 43.7%) vaccine adverse reactions. Most pro-vaccine and hesitant parents agree about the benefits of vaccinations. Family pediatricians are considered a reliable source of information by most pro-vaccine and hesitant parents (96.9 and 83.3% respectively), against 45% of anti-vaccine parents. The main factors associated with hesitancy were found to be: not having received from a paediatrician a recommendation to fully vaccinate their child [adjusted odds ratio (AOR): 3.21, 95% CI: 2.14–4.79], having received discordant opinions on vaccinations (AOR: 1.64, 95% CI: 1.11–2.43), having met parents of children who experienced serious adverse reactions (AOR: 1.49, 95% CI: 1.03–2.15), and mainly using non-traditional medical treatments (AOR: 2.05, 95% CI: 1.31–3.19).Vaccine safety is perceived as a concern by all parents, although more so by hesitant and anti-vaccine parents. Similarly to pro-vaccine parents, hesitant parents consider vaccination an important prevention tool and trust their family pediatricians, suggesting that they could benefit from appropriate communication interventions. Training health professionals and providing homogenous information about vaccinations, in line with national recommendations, are crucial for responding to their concerns.     

Joint association of obesity and hypertension with disability in the elderly—A community-based study of residents in Shanghai,China

Background

Although both obesity and hypertension are known risk factors for disability, the joint association of obesity and hypertension with risk of disability is unknown. This paper is aim to examine the joint association of obesity and hypertension with risk of disability.

Methods

Cross-sectional study with 8060 elderly community-dwelling individuals participating in the survey initiated by Shanghai Health and Family Planning Commission from March to September 2013. Obesity was measured using the body mass index (BMI) in World Health Organization (WHO) Asia criteria. Hypertension, based on the doctor’s diagnosis, was obtained through face-to-face interview. Disability was measured using the self-reported physical self-maintenance scale (PSMS) and the instrumental activities of daily living (IADL) scale developed by Lawton and Brody.

Results

A total of 8.97% of participants reported ADL disability, and 15.18% for IADL disability. After adjusting social demographics and chronic conditions, the risk of ADL disability was progressively greater in obese persons with hypertension (OR=1.40, 95% CI=1.05-1.89), underweight persons without hypertension (OR=2.05, 95% CI=1.29-3.25), and underweight persons with hypertension (OR=2.14, 95% CI=1.36-3.36). For IADL disability, only underweight persons with hypertension were significantly associated (OR=1.65, 95% CI=1.23-2.21).

Conclusions

Low or extremely high BMI, independent of its metabolic consequences, is a risk factor for disability among the elderly. Simple hypertension wasn’t significantly associated with disability. In addition, having hypertension significantly increased the risk of ADL disability in obese individuals and IADL disability in underweight individuals.

     

Medical practitioners in outpatient care: who is interested in participating in EBM courses? Results of a representative postal survey in Germany

We surveyed the attitudes of medical practitioners towards evidence-based medicine (EBM) and characterized those with an interest in participating in EBM courses. A random sample of 900 outpatient care doctors stratified by level and field of specialization was surveyed by means of a postal questionnaire. Importance of knowledge on information management, a positive attitude towards EBM and not yet doing critical appraisal were significant predictors of interest in participating in EBM courses. Low participation rates of outpatient care doctors in EBM courses are not due to attitudinal or general motivational problems. Although possible predictors of interest in participation could be specified, further factors contributing to actual participation need to be identified.     

Syndromic Surveillance from a Local Perspective – A Review of the Literature

Objective

Review of the origins and evolution of the field of syndromic surveillance. Compare the goals and objectives of public health surveillance and syndromic surveillance in particular. Assess the science and practice of syndromic surveillance in the context of public health and national security priorities. Evaluate syndromic surveillance in practice, using case studies from the perspective of a local public health department.

Introduction

Public health disease surveillance is defined as the ongoing systematic collection, analysis and interpretation of health data for use in the planning, implementation and evaluation of public health, with the overarching goal of providing information to government and the public to improve public health actions and guidance [1,2]. Since the 1950s, the goals and objectives of disease surveillance have remained consistent [1]. However, the systems and processes have changed dramatically due to advances in information and communication technology, and the availability of electronic health data [2,3]. At the intersection of public health, national security and health information technology emerged the practice of syndromic surveillance [3].

Methods

To better understand the current state of the field, a review of the literature on syndromic surveillance was conducted: topics and keywords searched through PubMed and Google Scholar included biosurveillance, bioterrorism detection, computerized surveillance, electronic disease surveillance, situational awareness and syndromic surveillance, covering the areas of practice, research, preparedness and policy. This literature was compared with literature on traditional epidemiologic and public health surveillance. Definitions, objectives, methods and evaluation findings presented in the literature were assessed with a focus on their relevance from a local perspective, particularly as related to syndromic surveillance systems and methods used by the New York City Department of Health and Mental Hygiene in the areas of development, implementation, evaluation, public health practice and epidemiological research.

Results

A decade ago, the objective of syndromic surveillance was focused on outbreak and bioterrorism early-event detection (EED). While there have been clear recommendations for evaluation of syndromic surveillance systems and methods, the original detection paradigm for syndromic surveillance has not been adequately evaluated in practice, nor tested by real world events (ie, the systems have largely not ‘detected’ events of public health concern). In the absence of rigorous evaluation, the rationale and objectives for syndromic surveillance have broadened from outbreak and bioterrorism EED, to include all causes and hazards, and to encompass all data and analyses needed to achieve “situational awareness”, not simply detection. To evaluate current practices and provide meaningful guidance for local syndromic surveillance efforts, it is important to understand the emergence of the field in the broader context of public health disease surveillance. And it is important to recognize how the original stated objectives of EED have shifted in relation to actual evaluation, recommendation, standardization and implementation of syndromic systems at the local level.

Conclusions

Since 2001, the field of syndromic surveillance has rapidly expanded, following the dual requirements of national security and public health practice. The original objective of early outbreak or bioterrorism event detection remains a core objective of syndromic surveillance, and systems need to be rigorously evaluated through comparison of consistent methods and metrics, and public health outcomes. The broadened mandate for all-cause situation awareness needs to be focused into measureable public health surveillance outcomes and objectives that are consistent with established public health surveillance objectives and relevant to the local practice of public health [2].     

Aspects of outpatient palliative care in Germany—a survey among office-based physicians

Background  

Currently, palliative care is widely discussed. The aim of this study is to explore different aspects of the ambulatory treatment environment of palliative care patients and its structure in Germany from the viewpoint of caring physicians.     

Actions improving HPV vaccination uptake – Results from a national survey in Italy

BackgroundIn Italy, HPV vaccination is offered to 11-year-old girls since 2007. In 2012 coverage was 69%. Strategies for offering and promoting HPV vaccination and coverage rates (26–85%) vary among Regions and Local Health Authorities (LHAs). We conducted a national study to identify strategies to improve HPV vaccination uptake.MethodsIn 2011–2012 we invited the 178 LHAs to fill a web-questionnaire, inquiring implementation of HPV vaccination campaigns (immunization practices, logistics of vaccine delivery, training, activities to promote vaccination, barriers, local context). We described type of offer and vaccination promotion in each LHA and studied the association of these factors with vaccination coverage rates.ResultsWe analyzed 133 questionnaires. The communication tools more frequently used to promote vaccination were: brochures/leaflets (92% of LHAs), fliers/posters (72%). Television (24%) and radio (15%) were less used. Using ≥3 communication channels was associated to a coverage ≥70% (OR_adj = 5.9, 95%CI 2.0–17.4). The probability to reach a coverage ≥70% was higher if the invitation letter indicated a pre-assigned date for HPV vaccination (OR_adj = 7.0, 95%CI 1.2–39.8) and >1 recall for non-respondents was planned (OR_adj = 4.1, 95%CI 1.8–9.3). Immunization services and paediatricians were involved in informative and training activities in most LHAs (80–90%), instead general practitioners, women and family's healthcare services and public gynaecologists in 60–70%, cervical cancer screening services and private gynaecologists in 20–40%. The main factors that negatively affected vaccination uptake were: poor participation to training events of professional profiles different from personnel of immunization services (reported by 58% LHAs), their mistrust towards HPV vaccination (55%) and insufficient resources (56%).ConclusionThe synergy of multiple interventions is necessary for a successful vaccination programme. Practices such as pre-assigning vaccination date and repeatedly recalling non-respondents could improve vaccination uptake. Efforts are required to strengthen the training of different professional profiles and services and encourage their collaboration. Economical resources are needed to promote vaccination.     

Explaining variation in health information seeking behaviour – Insights from a multilingual survey

ObjectiveHow best to provide an increasingly diverse population with health information has become a major concern for health policy makers in Europe and beyond. Our study aims to investigate factors explaining variation in people’s health information seeking behaviour. Our findings can be used to identify target groups for policy interventions that aim to provide health information efficiently.MethodsCross-sectional, paper-based, multilingual survey of a random sample of enrolees of two statutory health insurers in Hamburg, Germany. Data were collected from September to December 2017. Multivariable logistic regression was used to examine sociodemographic and health-related individual characteristics and their associations with participants’ choice of ten sources of health information.FindingsParticipants’ choice of information sources differed significantly across the following sociodemographic and health-related characteristics: age, gender, immigration status, education, employment status, marital status and general state of health. Immigrants and individuals with low educational attainment were most likely to use emergency departments as sources of health information.ConclusionPolicy interventions aiming to manage the use of health information sources should focus on immigrants and individuals with low educational attainment. Providing multilingual, low-threshold counselling and information services could be an efficient way to reduce short-term costs of health information seeking behaviour to health insurers or other payers of care while improving patient empowerment.     

Obesity in looked after children: is foster care protective from the dangers of obesity?

Background Obesity in all age groups of children has become an increasing concern in recent years. Children looked after by the Local Authority (LA) should be protected from health problems while being accommodated. These studies assess the effect on weight of looked after children (LAC) in the care of a Midlands County Council. They assess the frequency of obesity or overweight problems in looked after children following receipt into care and review changes in body mass index (BMI) while in the care of the LA. Method The height and weight measurements of all 106 children who had statutory health assessments while in the care of the LA between 1 January 2004 and 30 December 2004 were used to calculate their BMI. The data were plotted onto standard Growth Foundation charts and the International Obesity Task Force Paediatric cut‐offs were determined to distinguish overweight and obese children and young people. The date that the child had come into the care system and the number of moves of placement was obtained for each child from the social care. This was related to the total group and the overweight group of looked after children. Result Looked after children are more likely to be overweight and obese compared with standard norms, and there are a number of children (35%) whose BMI increases once in care. Outcome Looked after care did not protect a child from the national problem of increasing weight gain and obesity.     

Evaluating the longitudinal impact of a disability education intervention on medical students’ attitudes towards persons with a disability

BackgroundThe attitudes and empathy levels of healthcare providers towards persons with a disability have been highlighted as important factors contributing to the quality of healthcare provided to this patient population.ObjectiveThis study aimed to investigate whether changes in medical students’ attitudes and empathy towards persons with a disability following an educational intervention were maintained when measured again one year post intervention. This study provided a one year longitudinal follow up to a previous study investigating the efficacy of an educational intervention to cultivate positive change in empathy levels and attitudes towards disability.MethodAn online survey was distributed to medical students who had completed a disability module one year previously during their second year of medical training. The survey comprised measures of attitude, empathy and level of social contact with persons with a disability.ResultsThough there was a statistically significant increase in both attitude and empathy measures immediately post intervention, these gains were not sustained when measured one year later. In the case of empathy, levels measured one year later had decreased significantly from baseline measures at pretest. No significant relationship was observed between level of social contact and measures of attitudes and empathy.ConclusionsWhile previous research suggests that the educational intervention has been successful in ameliorating both attitudes and empathy levels in the short term, this study highlights the difficulty in sustaining such improvements. Changes to the design and delivery of educational interventions may be necessary for the benefits to persist into the long term.     

The Obesity Learning Centre (OLC) – a website supporting those working towards a healthy weight and reducing obesity levels

Objectives:

Develop a website, the OLC, which supports those people who work on promoting a healthy weight and tackling obesity. Research shows that original networks where sharing of information and peer interaction take place create solutions to current public health challenges.

Methods:

Considerations that are relevant when building a new information service as well as the technical set up and information needs of users were taken into account prior to building the OLC and during continuous development and maintenance.

Results:

The OLC provides global news, resources and tools and link out to other networks, websites and organisations providing similar useful information. The OLC also uses social networking tools to highlight new and important information.

Discussion:

Networks contribute to a stronger community that can respond to emerging challenges in public health. The OLC improves connections of people and services from different backgrounds and organisations. Some challenges exist in the technical set up and also because of other aspects, e.g. public health information and differing information needs.

Conclusion:

Public health work programmes should include networking opportunities where public policy can be disseminated. The provision of necessary tools and resources can lead to better decision-making, save time and money and lead to improved public health outcomes.