Why do parents not re-vaccinate their child for influenza? A prospective cohort study

Child influenza vaccination rates for the UK are published annually, however there are no publicly available data on how many children are re-vaccinated the following year. This prospective cohort study aimed to identify factors associated with not re-vaccinating one’s child. Participants (n = 270) completed a questionnaire before their child was vaccinated for influenza in the 2016/17 season, and follow-up questionnaires three days and one month after their child’s vaccination. Re-vaccination data were collected at the end of the 2017/18 influenza season (n = 232, response rate 85.9%). Forty-one children (17.7%) were not re-vaccinated for influenza in 2017/18. Parental report of severe side-effects three days after vaccination (p = .04) and worry about side-effects one month after vaccination (p = .05) were associated with not re-vaccinating. However, the restricted sample size reduced the statistical power of these analyses. Decreasing parental worry about side-effects may help improve re-vaccination rates.Clinical trial registration: The study was registered on ClinicalTrials.gov (NCT02909855).     

Why do not patients receive influenza vaccine in December and January?

BACKGROUND: Influenza vaccination levels in older patients have changed little since the mid-1990s. Despite frequent health care visits by a majority of older persons, many missed opportunities continue to occur. METHODS: Patients were eligible for the study if they were age 50 and older, had not received influenza vaccine during the current season and were making a scheduled visit to one of the 13 study sites in California, New York, or New Mexico for purposes other than vaccination. Through direct observation, we determined if office staff inquired about vaccination status, discussed vaccination, or both. We defined missed opportunities as failure to administer influenza vaccine to patients for whom it was indicated. RESULTS: Missed opportunities increased steadily from October to January (P < 0.0001), and were more common when there was no inquiry or discussion (P < 0.00001), among patients aged 50-64 (P < 0.0001) and in California and New Mexico (P = 0.001). A classification tree analysis revealed that lack of inquiry and week of visit contributed most to missed opportunities. DISCUSSION: Early in the vaccination season, missed opportunities were uncommon and specific inquiries into or discussion of vaccination did not appear necessary. In December and January, patients tended to be vaccinated only when vaccination was addressed during the visit. Efforts to remind patients about vaccination later in the vaccination season may be essential to achieving higher coverage in the U.S.     

Why do good people do bad things?

That was the question Dr. Lucien Leape, patient safety pioneer, posed in the title of a lecture he delivered at a Harvard University risk management conference way back in 1997. As a new healthcare risk manager, I had been asking myself this same question almost every day since my move from nursing to risk management.     

Why do people consult the doctor?

BACKGROUND: Symptoms are an everyday part of most peoples' lives and manypeople with illness do not consult their doctor. The decisionto consult is not based simply on the presence or absence ofmedical problems. Rather it is based on a complex mix of socialand psychological factors. OBJECTIVES: This literature review seeks to explore some of the pathwaysto care and those factors associated with low and high ratesof consultation. METHODS: The paper examines the impact of socioeconomic and demographicfactors on consultation rates and, using a revised version ofthe Health Belief Model, it highlights the psychological factorswhich influence decisions to seek medical care. Barriers whichcan inhibit consultation are discussed, as the decision to seekcare will only result in a consultation if there is adequateaccess to care. RESULTS AND CONCLUSIONS: Whilst poor health status and social disadvantage increase both"objective" medical need and in turn, consultation rates, arange of other social and psychological factors have been shownto influence consulting behaviour. Keywords. Consultations, general practice, psychological factors, social factors, symptoms.     

Why do homeless young people leave home?

OBJECTIVE: To describe the reasons homeless young people leave home and differences between males and females. METHODS: Homeless young people between the ages of 12 and 20 years (n = 692) completed surveys conducted by trained interviewers using Questionnaire Delivery System on laptop computers as part of a large study. Participants indicated the importance of each of 22 reasons for leaving home on a four-point scale, from 'not important' (1) to 'very important' (4). RESULTS: Conflict with parents was the only reason reported as important by at least two-thirds of respondents. Desire for independence and/or adventure was rated as important by nearly one-half of young men and women. Eighteen reasons were rated as 'not or somewhat important' by most young people. These included issues associated with school, sexuality, sexual abuse and trouble with the law. Young women were more likely than young men to report that sexual abuse, anxiety/depression, and/or pregnancy were important reasons for leaving home. The converse held for personal alcohol and drug abuse, trouble with the police, and breach of community order or parole. With few exceptions, importance ratings of the 22 reasons were not highly correlated. CONCLUSIONS AND IMPLICATIONS: Service providers should consider how the diverse elements of family environment contribute to homelessness. A focus on familial problems may lead to other important reasons being overlooked, namely a desire for independence and adventure. Services and supports need to take into account whether young people leave home because of a life crisis or because they seek independence.     

Why do GPs not implement evidence-based guidelines? A descriptive study

BACKGROUND: There is an acknowledged gap between research findings and their implementation in clinical practice despite the existence of effective educational interventions. OBJECTIVES: Our aim was to identify what is impeding GPs from pursuing currently recognized good practice and implementing evidence-based guidelines in their management of hypertension in the elderly. METHOD: We carried out a qualitative study using semi-structured interviews conducted during focus group outreach visits to 34 GPs from nine practices in Merseyside involved in an educational programme designed to improve the management of hypertension in the elderly. RESULTS: Several barriers to the implementation of evidence-based guidelines in the management of hypertension in the elderly were identified. These included: doubts about the applicability of trial data to particular patients; the poor adherence of GPs to practice protocols; ageist attitudes of some GPs; the effect of time pressure and financial considerations making the subject a low priority; the absence of an effective computer system; and the absence of an educational mentor. All participants demonstrated a very positive attitude to practice-based education. They also welcomed external audit data, which compared their performance with that of other practices. Single-handed GPs were particularly enthusiastic about this approach as it provided them with the peer pressure they lacked. CONCLUSIONS: In order to bridge the gap between research and practice, educators need to address the various 'barriers to change' amongst practitioners.     

Who do people talk to about healthy lifestyles? A South Australian survey.

To investigate who people talk to about healthy lifestyle a personal interview of people in a representative sample of South Australians was carried out. The information was collected by interview from all occupants of selected private dwellings who were aged 15 years or older. The interviewer used a prompt card with nine possible responses and the question asked was "which one of these would you be most likely to talk about healthy lifestyle changes?" Forty-four per cent nominated the general practitioner and 22% a family member. People who were either married or in a de facto relationship (30%) significantly chose a general practitioner more than others (14%) (P < 0.05). In the 30-59 age group more men (12%) than women (6%) chose a family member as a healthy lifestyle adviser (P < 0.05). There was no statistically significant difference in interest in healthy lifestyle in people born in Australia and outside Australia, or in the employed or unemployed. It is suggested that further attention needs to be paid to training in preventive medicine at all levels of general practice education and more needs to be known about the role of family members as healthy lifestyle advisers.     

What do we know about... nutrition and older people?

Nutrition is important to the health and functioning of elderly people. This paper summarises the evidence that many old people suffer from undernutrition and outlines the insidious effects of this form of malnutrition. It discusses the physiological and practical difficulties elderly people face in achieving good nutrition, and the challenge this poses to health workers. Given the UK's ageing population, undernutrition in older people is a significant public health issue as well as one that should concern all health professionals involved in individual or group contacts with elderly clients.     

Why do women complain of vaginal discharge? A population survey of infectious and pyschosocial risk factors in a South Asian community

BACKGROUND: Vaginal discharge is a common complaint, particularly among women in Asia. Although presumed to be caused by reproductive tract infections (RTIs), the association between the complaint and the presence of RTIs is weak. This study aimed to investigate the risk factors of the complaint of vaginal discharge. METHODS: We conducted a community-based survey of 3000 women aged 18-50 years, randomly sampled from a population in Goa, India. Women who gave informed consent were invited to participate in a structured interview, which elicited data on the primary outcome (the experience of current abnormal vaginal discharge) and psychosocial exposures: gender adversity; symptoms of somatoform disorders; and common mental disorders (CMD). All women were required to provide vaginal and/or urine samples for diagnosis of RTIs using gold standard laboratory tests. Risk factors were analysed using logistic regression with the binary outcome of the complaint of vaginal discharge. RESULTS: Of the 2494 women (83%) who agreed to participate, 14.5% complained of having an abnormal vaginal discharge. Stress was the most common causal attribution for the complaint. The final multivariate model found that high scores for CMD (OR 2.16, 1.4-3.2) and somatoform disorders (6.23, 4.0-9.7) and the use of an intrauterine contraceptive device (1.86, 1.0-3.4) were independently associated with the complaint. Low literacy (0.54, 0.4-0.8) and age >40 years (0.29, 0.2-0.4) were associated with a reduced risk. RTI were not associated with the complaint (1.24, 0.9-1.6). CONCLUSIONS: Psychosocial factors have the strongest association with the complaint of vaginal discharge. Syndromic management algorithms need refinement so that women with complaints that are non-infectious in aetiology are offered psychosocial interventions.     

Why may older people with depression not present to primary care? Messages from secondary analysis of qualitative data

Depression in older people is common, under-recognised and often undertreated. This study aimed to explore the reasons why older people with depression may not present to primary care. Secondary analysis was carried out, of qualitative data collected in two previous studies in North-West England. Older people are reluctant to recognise and name 'depression' as a set of symptoms that legitimises attending their general practitioner (GP). They do not consider themselves candidates for help for their distress. This is partly due to perceptions of the role of the GP but also to previous negative experiences of help seeking. In addition, treatments offered, which are predominantly biomedical, may not be acceptable to older people. Interventions offered to older people need to encourage social engagement, such as befriending, and enhancement of creative, physical and social activity.     

Why do elderly people seek professional home care? Methodologies compared

In order to investigate which characteristics, besides physical limitations, of elderly people living at home contribute to the utilization of professional home care, a study was conducted in which 450 elderly people aged 55 and over, 123 with and 327 without professional home care, were interviewed.To obtain a selection for the interviews, a postal questionnaire, containing questions on functional status and care utilization, sent out to a random sample of the elderly people (55+) living at home (n=2451), preceded the actual interviews. The oral interviews yielded the same information, plus an inventory of aspects of the mental status, the social network, the socio-economic status and the housing condition. Analysis was performed in three ways: bivariate analysis, logistic regression analysis and discriminant analysis. The bivariate analysis revealed that users of professional care were older, more often female and more often not married. Their social network was less extensive, as they received less informal care and lived alone more often. Besides they had more mental and financial problems.From the regression analysis it appeared that, in addition to the functional status, the amount of informal care and the household composition contributed to the utilization of professional home care. For the other characteristics inventoried, no independent association with the utilization of professional care could be established. With hindsight, it appeared that in this study long interviews hardly had additional value over postal questionnaires, in which the contribution of functional status and informal care to professional care was already discovered.Carla Frederiks is senior staff member of the department of epidemiology and health care research of the University of Limburg. Margreet te Wierik and Erik van Rossum are junior staff members of the department of epidemiology and health care research of the same university. Adriaan Ph. Visser was associate professor in the research project Services for the elderly of the same university, nowadays director of the International Health Foundation, Brussels, Belgium. Alexander Volovics is senior staff member of the department of statistics and informatics of the same university. Ferd Sturmans is professor of the department of epidemiology and health care research of the same university.