Midwives’ attitudes toward participation of pregnant individuals in a preventive vaccine hypothetical clinical trial

IntroductionPregnant individuals are frequently excluded from clinical trials. Yet, inclusion of Pregnant individuals is of interest in vaccinology including during health crisis. Promotion of clinical trials by midwives may facilitate the decision making of Pregnant individuals. Attitudes of midwives about pregnant individuals participation in a vaccine clinical trial have been little explored.MethodsWe conducted an anonymous survey from the 11th of September to the 11th of November 2020. Primary endpoint was the willingness to encourage Pregnant individuals to participate in a hypothetical respiratory syncytial virus (RSV) vaccine clinical trial.ResultsAmong 398 midwives who answered the questionnaire, 113 (28.3 %) were likely to encourage Pregnant individuals to participate in the vaccine clinical trial, this proportion ranged from 25 % in senior midwives to 34.5 % among the students. After adjustment on age, parenthood, previous personal attitudes of vaccine hesitancy, and psychological antecedents of vaccinations (5C-model), the only predictor of the promotion of the clinical trial was the experience of vaccine education (evaluated by a 20-point score) with an adjusted odds ratio of 1.09 (1.01–1.18, p = 0.027) for a one-point increase. Vaccine hesitancy and psychological antecedents of vaccinations were not associated with a lower promotion of pregnant individuals trial participation by midwives.ConclusionFew respondents were likely to encourage Pregnant individuals to participate in a vaccine clinical trial. Midwives who considered themselves to have a good training about vaccines were more prone to encourage Pregnant individuals to participate in a RSV vaccine clinical trial.     

Is menopausal status related to women’s attitudes toward menopause and aging?

The objective of this study was to explore the relationship between menopausal status and attitudes toward menopause and aging. We identified 1,400 Bengali Hindu women aged 40–55 years (early perimenopausal n = 445; late perimenopausal n = 240; early postmenopausal n = 285; late postmenopausal n = 430) from West Bengal, India. Information on attitudes toward menopause and aging was collected from March 2009 to July 2012 using ten agree/disagree statements, of which three were positive, four were negative, and the rest were neutral. We used only the positive and negative statements in the analyses. The participants were given three response options for each statement: (1) agreed, (2) disagreed, and (3) felt neutral. Agreement with positive statements and disagreement with negative statements were scored as 3. The converse responses were scored as 1. Neutral responses were not scored. Thus, the total attitude score for each participant ranged from 7 to 21. Additionally, data on sociodemographic and reproductive variables, menopausal symptoms, and perceptions toward menopause were also collected. Multivariable analyses (ANCOVA) showed that postmenopausal women had more positive attitudes toward menopause and aging than perimenopausal women. Providing balanced information about menopause and aging might help to foster positive attitudes toward menopause.     

Nurses’ attitudes toward parent participation: Personal and professional characteristics

A nonrandom sample of 273 registered nurses completed a questionnaire that included the Parent Participation Attitude Scale and a personal and professional data section. Analysis of variance indicated that subjects who were married, were parents, were nursing supervisors, had a collegiate nursing education, or worked in Hospital 1 or 4 had more positive attitudes toward parent participation than did subjects who did not possess these characteristics. Further study of nurses from 28 hospitals found that head nurses, nursing supervisors, nurses with a professional nursing education, and nurses with a master's degree in nursing had significantly more accepting attitudes than did nurses without these characteristics.     

How do COVID-19 vaccine mandates affect attitudes toward the vaccine and participation in mandate-affected activities? Evidence from the United States

The spread of COVID-19 has prompted many governments, schools, and companies to institute vaccine mandates. Proponents suggest that mandates will enhance public health and increase vaccination rates. Critics suggest that evidence of mandates’ effectiveness is unclear and warn that mandates risk increasing societal inequalities if unvaccinated minority groups opt out of educational, commercial, and social activities where mandates are required. We conduct an original survey experiment on a nationally representative sample of 1,245 Americans to examine the efficacy and effect of COVID-19 mandates. Our findings suggest that mandates are unlikely to change vaccination behavior overall. Further, they may increase the likelihood that sizable percentages of the population opt out of activities where vaccines are mandated. We conclude that mandates that do go into effect should be accompanied by persuasive communications targeted to specific information needs and identities.     

U.S. pregnant women’s knowledge and attitudes about behavioral strategies and vaccines to prevent Zika acquisition

IntroductionZika virus infection during pregnancy can cause significant infant morbidity. Little is known about pregnant women’s attitudes regarding behavioral strategies and hypothetical vaccination to prevent Zika infections and sequelae.MethodsPregnant women across the United States (N = 362) completed an online questionnaire regarding attitudes about Zika, including six behavioral prevention strategies (i.e., abstaining from sex, using condoms, not traveling to an area with Zika, their partner not traveling into an area with Zika, using mosquito repellant, wearing long pants and sleeves) and vaccination.ResultsMost women (91%) were married/living with the baby’s father, 65% were non-Hispanic White, and 71% had been pregnant. Seventy-four percent were worried about Zika, while 30% thought they were knowledgeable about Zika. The mean knowledge score was 5.0 out of 8 (SD = 2.09), and the mean behavioral strategies score was 4.9 out of 12 (SD = 3.7) with a range of 0 (none would be hard to do) to 12 (all would be hard to do). In a multivariable model, having had a sexually transmitted infection, living/traveling in an area with Zika, and worrying about Zika were significantly related to reporting behavioral strategies as hard to do. Seventy-two percent would be willing to be vaccinated. In the multivariable model, living/traveling in an area with Zika, believing they knew a lot about Zika, worrying about Zika, and considering Zika vaccine development as important were significantly associated with willingness to get vaccinated.ConclusionsPregnant women were worried about Zika, yet had gaps in their factual knowledge. Most women reported they would get vaccinated if a vaccine was available. Pregnant women who reported themselves as vulnerable (being worried, having lived in or traveled to a Zika area) were more likely to view behavioral strategies as hard to do and to accept vaccination.     

Pregnant women’s knowledge and attitude to maternal vaccination including group B streptococcus and respiratory syncytial virus vaccines

BackgroundMaternal immunisation is an important strategy to reduce neonatal mortality and morbidity. New maternal vaccines such as Respiratory Syncytial Virus (RSV) and Group B streptococcus (GBS) are in development and/or clinical trials. However, little is known about pregnant women’s knowledge about these diseases.MethodsWomen attending antenatal clinics in Melbourne, Australia were invited to complete a questionnaire collecting demographic information, past vaccination history, understanding of risk of GBS and RSV disease in pregnancy and likelihood to accept these theoretical vaccines in the future.Findings495 women (48% born outside of Australia, from 48 different countries) completed the questionnaire. A large number of women had never heard of GBS (63%) or RSV (83%). Women over 35 years, born in Australia and women who had more than one child were more likely to have heard of GBS or RSV (p < 0.001). Women who had received influenza or pertussis vaccine in pregnancy were more likely to accept a RSV or GBS vaccine (p < 0.001).ConclusionsThis study has shown that knowledge of GBS and RSV is poor. However, when provided with information about the two diseases, acceptance of a hypothetical vaccine for both diseases was high. This study highlights the enormous amount of work that needs to be done in educating pregnant women about the seriousness of these two diseases if a future vaccine is ever to be accepted and high coverage achieved among the target population.     

An empirical analysis of consumers’ attitudes toward pharmacies’ advertising

This study investigates current attitudes and opinions toward pharmacies’ advertising. The purposes of this study were to determine (a) consumers’ attitudes toward advertising by pharmacies and (b) whether age, race, income, marital status, occupation, education, sex, and number of children in household of the consumer accounted for any significant difference in attitudes toward pharmacies that advertise. The intent was to discover information that would be useful to pharmacies in planning marketing strategies and improving the quality of their advertising. The study seems to confirm the belief of many pharmacies that advertising and marketing clearly have a place in the future of pharmacists’ services.     

Beliefs and attitudes toward “healthier eating” among women attending maternity hospital

In order to identify the beliefs and attitudes surrounding healthful food choices which could be addressed in maternity nutrition education programs, 95 pregnant and post-natal women attending Aberdeen Maternity Hospital (UK) completed a detailed questionnaire.Assessment items were based on Fishbein and Ajzens' expectancy value model which examines attitudes (feelings) towards healthier eating and subjective norm (perceived pressure from others to try healthier eating).More than half of the sample indicated a positive intention to try healthier eating. Scores for intention were strongly correlated with scores for direct attitudes which, in turn, correlated with estimated attitudes (measured as a function of beliefs about healthier eating multiplied by the outcome evaluation of these beliefs).The beliefs selected for promotion in ante-natal education were those relating the role of healthier eating to the maintenance of good health and those identifying healthier eating as a family concern. Of less importance to the sample were the roles of doctors and family in promoting healthier diets. These findings suggest that efforts to change dietary habits could usefully focus on underlying belief and attitude variables rather than concentrating on information transfer alone.     

Indigenous Australian women’s colonial sexual intimacies: positioning indigenous women’s agency

Colonialist views of Indigenous bodies and sexualities continue to affect Indigenous peoples worldwide. For Indigenous Australians, this burden has resulted in repression and oppression of power, sex and desire. Focusing on the sexual intimacies of Indigenous Australian women, this paper provides an account of the dominant Australian historical discourses, finding that Indigenous women were viewed as exotic, erotic, something to be desired, yet simultaneously something to be feared. Our sexualities were described as savage, promiscuous and primitive and we were often viewed as prostitutes with our voices and views constrained by patriarchal and imperial regimes of power. But within this context, Indigenous women fought back through both individual and collective acts of agency. This paper demonstrates how Indigenous Australian women’s agency not as a new phenomenon but rather as a position that disrupts the popular discourses of exploitation and victimhood that have been persistently perpetrated against Indigenous women.     

A randomized controlled Alzheimer’s disease prevention trial’s evolution into an exposure trial: The preadvise trial

Objectives

To summarize the ongoing Prevention of Alzheimer’s Disease (AD) by Vitamin E and Selenium (PREADViSE) trial as an ancillary study to SELECT (a large prostate cancer prevention trial) and to present the blinded results of the first year as an exposure study.

Design

PREADViSE was designed as a double blind randomized controlled trial (RCT).

Setting

SELECT terminated after median of 5.5 years of exposure to supplements due to a futility analysis. Both trials then converted into an exposure study.

Participants

In the randomized component PREADViSE enrolled 7,547 men age 62 or older (60 if African American). Once the trial terminated 4,246 of these men volunteered for the exposure study. Demographics were similar for both groups with exposure volunteers having baseline mean age 67.3 ± 5.2 years, 15.3 ± 2.4 years of education, 9.8% African Americans, and 22.0% reporting a family history of dementia.

Intervention

In the RCT men were randomly assigned to either daily doses of 400 IU of vitamin E or placebo and 200 µg of selenium or placebo using a 2×2 factorial structure.

Measurements

In the RCT, participants completed the Memory Impairment Screen (MIS), and if they failed, underwent a longer screening (based on an expanded Consortium to Establish a Registry in AD [CERAD] battery). CERAD failure resulted in visits to their clinician for medical examination with records of these examinations forwarded to the PREADViSE center for further review. In the exposure study, men are contacted by telephone and complete the telephone version of the memory impairment screen (MIS-T) screen. If they fail the MIS-T, a Modified Telephone Interview of Cognitive Status (TICS-M) exam is given. A failed TICS-M exam also leads to a visit to their clinician for an in-depth examination and forwarding of records for a centralized consensus diagnosis by expert clinicians. A subgroup of the men who pass the MIS-T also take the TICS-M exam for validation purposes.

Results

While this ancillary trial was open to all 427 SELECT clinical sites, only 130 (30.0%) of the sites chose to participate in PREADViSE. Staff turnover at the sites presented challenges when training persons unfamiliar with cognitive testing procedures to conduct the memory screens. In the RCT few participants (1.6%) failed the MIS screen and among those who passed this screen a significant practice effect was encountered. In the exposure study 3,581 men were reached by phone in year 1, 15.7% could not be reached after 5 calls, and of those contacted 6.0% refused the screen even after consenting to the procedures at their clinical site. Most notable is that the failure rate for the MIS-T increased fourfold to 7.2%. Of the 257 men who took the TICS-M, 84.0% failed and were asked to contact their physicians for a more detailed memory assessment, and approximately half of these had some form of dementia or cognitive impairment. Several of these dementia cases are not AD.

Conclusion

Partnering with SELECT led to an AD prevention trial conducted at a very reasonable cost by taking advantage of the experience and efficient clinical trial management found in a cancer cooperative group (Southwest Oncology Group or SWOG). Once unblinded, the RCT and exposure study data have the potential to yield new information on long term exposure to antioxidant supplements under controlled conditions.     

Your vaccine attitude determines your altitude. What are the determinants of attitudes toward vaccination?

Attitudes toward vaccination are doubtless an important determinant of public health, and this became evident after the first year of the last COVID-19 pandemic. The issue, long-debated within European societies, especially with respect to occasional surges of diseases in given years, has become a crucial determinant of the wellbeing of a country since 2021. In this study, using microdata from a 2019 Eurobarometer survey, we frame and deepen our knowledge about the main determinants of vaccination attitudes as observed by the related literature. We argue that a positive attitude toward vaccination may be due to individualistic or altruistic reasons, or various incentives; our analysis aims to improve our knowledge about the determinants of such a complex decision. Our findings, obtained by means of a quantitative analysis that employs Ordered Probit, Ordered Logit and Generalized Ordered Logit estimations, provide complete support for some of the theories that have been debated in the literature, limited support for others because of mixed evidence, and no support for some.     

Exploration of oncologists’ attitudes toward and perceived value of patient-reported outcomes

Purpose

To understand oncologists’ attitudes toward patient-reported outcome (PRO) measures and to learn how PRO data influence their clinical decision-making.

Methods

Twenty practicing oncologists participated in 1 of 4 semi-structured focus groups.

Results

Most oncologists had no experience with PRO measures, but were able to identify several concepts appropriate for patient-reported assessment. Participants agreed that clinical measures such as performance status were more meaningful to them, but acknowledged that PRO measures were more appropriate for assessing patient symptoms and treatment response. All oncologists believed that clinical efficacy and toxicity data were of primary importance, but that PROs become increasingly important when multiple treatments are available, in advanced or incurable disease, and in palliative care. Several issues prevented oncologists from being able to draw meaningful conclusions from PRO data: lack of familiarity with PRO measures, being presented with too much data to process, lack of clarity around a meaningful change in PRO measure scores, and lack of standardization in the use of PRO measures.

Conclusions

Oncologists indicated that PRO data are most influential in advanced or incurable disease and in palliative care. Improving the interpretability of PRO measures could increase the usefulness of PRO data in treatment decision-making.     

Abortion laws and women’s health

We examine the impact of progressive and regressive abortion legislation on women's health in Mexico. Following a 2007 reform in the Federal District of Mexico which decriminalised and subsidised early-term elective abortion, multiple other Mexican states increased sanctions on illegal abortion. We observe that the original legalisation resulted in a sharp decline in maternal morbidity, particularly morbidity due to haemorrhage early in pregnancy. We observe small or null impacts on women's health from increasing sanctions on illegal abortion. These results quantify the considerable improvements in non-mortal health outcomes flowing from legal access to abortion.     

Maternal and paternal confidence in vaccine safety: Whose attitudes are predictive of children’s vaccination?

Relatively little is known about the differential impact of maternal and paternal perceptions of vaccine safety on children’s vaccination status in New Zealand. Using a sample of 68 couples from the New Zealand Attitudes and Values Study (NZAVS), the present study investigated the distinct influence of mothers’ and fathers’ confidence in the safety of childhood vaccinations following the national immunisation schedule on their reports of children’s vaccination status. Actor-Partner Interdependence Modelling revealed that mothers’, but not fathers’, vaccine confidence predicted children’s vaccination status, regardless of who reported their children’s vaccination status. Higher maternal vaccine confidence increased the likelihood of child full vaccination status, but paternal vaccine confidence showed no unique significant effects. As women tend to express lower vaccine confidence than men, it is imperative to further investigate the key drivers of their low confidence and develop target interventions accordingly. Encouraging fathers’ involvement in the vaccination decision-making process may also be beneficial in increasing the likelihood of childhood vaccination uptake.     

Socioeconomic status as determinant for participation in mammography screening: assessing the difference between using women’s own versus their partner’s

Objectives  

Earlier research has shown that participation in mammography screening tends to vary across socioeconomic levels. We assessed the difference between using the woman’s own socioeconomic status (SES) and using that of her household or partner as determinant of participation in mammography screening.     

Richard Pfeiffer’s typhoid vaccine and Almroth Wright’s claim to priority

Following the 1892 cholera pandemic, Richard Pfeiffer, Director of the science section of Robert Koch’s Institute for Hygiene in Berlin, began laboratory-based studies on the pathogenesis of the disease using an animal model. These investigations resulted in his discovery of bacterial endotoxin; recognition of the bacteriolytic properties of both animal and human immune sera; and identification of the specific nature of protective immune responses. His research led naturally from cholera to typhoid fever and in November 1896 Pfeiffer published the results of experimental studies on a typhoid vaccine. In September 1896 Almroth Wright, a professor of pathology in the British Army Medical School, published a short note entitled “Typhoid Vaccination”. It was appended to a review on the use of styptics to control defective blood coagulation: his previous research studies had a physiological basis that stemmed from earlier studies on tissue fibrinogen. In December 1895, Wright had been commissioned by the Army Medical Department to develop a typhoid vaccine and he later admitted that such work began only after he had spoken with Pfeiffer. In January 1897 Wright published a further paper in which he claimed precedence over Pfeiffer in the introduction of anti-typhoid vaccination. This self-entitlement has subsequently been accepted, primarily because the British Army approved typhoid vaccination in 1914 at the beginning of the First World War. That time has been used as their starting point by many of Wright’s biographers, but without any attempt to confirm Wright’s claim to priority. This paper concludes Richard Pfeiffer, not Almroth Wright, provided the first account of human typhoid vaccination. It also provides early examples of laboratory-based responses to pandemic and epidemic infectious diseases.