“Does Pakistan still have polio cases?”: Exploring discussions on polio and polio vaccine in online news comments in Pakistan

IntroductionPolio, which is caused by poliovirus, is a contagious, potentially crippling, and deadly disease. Pakistan is one of the countries in which polio is still endemic in the 21st century. In 2019, 146 polio cases were reported across the country with some resulting in deaths. Following the spread of rumors insinuating that children were falling sick after receiving an anti-polio vaccine, a mob attacked and set fire to a small hospital in the Peshawar district in April 2019. The present study investigates readers’ discussions that emerged from Dawn’s online readers’ comments on polio-related news stories in Pakistan.MethodsUsing thematic analysis, we analyzed (N = 2216) comments made by readers in the polio-related news stories published on Dawn.com from January 1, 2012, to March 1, 2020.ResultsSeven major themes emerged from the analysis of the comments: 1) reasons for and challenges resulting in the failure to eradicate polio; 2) proposed solutions and policy changes to eradicate polio; 3) misinformation; 4) criticism, frustration, and shame; 5) comparison of Pakistan to other countries; 6) the internet as a public sphere; 7) suffering, empathy, and appreciation. Overall, our findings suggested that commenters are knowledgeable about polio vaccines and consider polio a serious threat to public health in Pakistan.ConclusionOur study not only validated previous study findings such as reasons, challenges, and issues related to polio vaccination, but also found new challenges in online news sites concerning misinformation on polio and polio vaccination in Pakistan.     

Workplace influenza vaccination to reduce employee absenteeism: An economic analysis from the employers’ perspective

BackgroundEach year, up to 10% of unvaccinated adults contracts seasonal influenza, with half of this proportion developing symptoms. As a result, employers experience significant economic losses in terms of employee absenteeism. Influenza vaccines can be instrumental in reducing this burden. Workplace vaccination is expected to reduce employee absenteeism more than linearly as a result of positive externalities. It remains unclear whether workplace influenza vaccination yields a positive return on investment.MethodsWe simulated the spread of influenza in the seasons 2011–12 up to 2017–18 in Belgium by means of a compartmental transmission model. We accounted for age-specific social contact patterns and included reduced contact behavior when symptomatically infected. We simulated the impact of employer-funded influenza vaccination at the workplace and performed a cost-benefit analysis to assess the employers’ return on workplace vaccination. Furthermore, we look into the cost-benefit of rewarding vaccinated employees by offering an additional day off.ResultsWorkplace vaccination reduced the burden of influenza both on the workplace and in the population at large. Compared to the current vaccine coverage – 21% in the population at large – an employee vaccine coverage of 90% could avert an additional 355 000 cases, of which about 150 000 in the employed population and 205 000 in the unemployed population. While seasonal influenza vaccination has been cost-saving on average at about €10 per vaccinated employee, the cost-benefit analysis was prone to between-season variability.ConclusionsVaccinated employees can serve as a barrier to limit the spread of influenza in the population, reducing the attack rate by 78% at an employee coverage of 90%. While workplace vaccination is relatively inexpensive (due to economies of scale) and convenient, the return on investment is volatile. Government subsidies can be pivotal to encourage employers to provide vaccination at the workplace with positive externalities to society as a whole.     

Research priorities to increase vaccination coverage in Europe (EU joint action on vaccination)

BackgroundDeciding how best to invest in healthcare is never an easy task and prioritization is therefore an area of great interest for policymakers. Too low public vaccine confidence, which results in insufficient vaccine uptake, remains an area of concern for EU policy-makers. Within the European Joint action on vaccination, a work-package dedicated to research aims to define tools and methods for priority‐setting in the field of vaccination research. We therefore propose a prioritization framework to identify research priorities towards generating and synthesizing evidence to support policies and strategies aiming at increasing vaccine coverage.Materials/methodsWe used a multi-criteria decision analysis (MCDA) method inspired by the Child Health and Nutrition Research Initiative developed by Rudan et al. This quantitative methodology follows a series of steps involving different groups of experts and relevant stakeholders. The first step consists in identifying key research questions through a broad consultation. In parallel, a first group of experts is tasked to select criteria for prioritization of research questions, taking into consideration the ultimate goal of the exercise. Another group of experts is then requested to assess a weight to each of the criteria, using pair-wise comparisons. The final step consists in gathering experts who will assess each research question against the weighted criteria. This evaluation leads to assigning a score to each individual research question, which can then be ranked in order of priority.ResultsWe focused our work on four pre-selected pilot vaccines (pertussis, measles containing combination vaccines, influenza and HPV). The consultation generated 124 questions, which were secondarily sorted and re-worded to obtain 27 questions to be ranked. Criteria for setting priorities were the following: accessibility, answerability, deliverability, disease prevalence/incidence, effectiveness, equity, generalization, and territory. During a final face-to-face meeting international experts ranked the 27 questions and agreed on a consensual list of six top-priorities.ConclusionsWe have developed a transparent, evidence-based rigorous framework to defined key research questions to generate evidence towards the design of policies and strategies to increase vaccine coverage. Results were disseminated broadly and submitted to the EC for potential funding in the context of The Horizon Europe Program. The same process will be conducted in 2021 to identify vaccination research priorities regarding all vaccines used in the EU as well as COVID-19 vaccines.     

Sampling‐based estimation for massive survival data with additive hazards model

For massive survival data, we propose a subsampling algorithm to efficiently approximate the estimates of regression parameters in the additive hazards model. We establish consistency and asymptotic normality of the subsample‐based estimator given the full data. The optimal subsampling probabilities are obtained via minimizing asymptotic variance of the resulting estimator. The subsample‐based procedure can largely reduce the computational cost compared with the full data method. In numerical simulations, our method has low bias and satisfactory coverage probabilities. We provide an illustrative example on the survival analysis of patients with lymphoma cancer from the Surveillance, Epidemiology, and End Results Program.     

Working conditions and health behavior as causes of educational inequalities in self-rated health: an inverse odds weighting approach

Objective:Using a novel mediation method that presents unbiased results even in the presence of exposure–mediator interactions, this study estimated the extent to which working conditions and health behaviors contribute to educational inequalities in self-rated health in the workforce.Methods:Respondents of the longitudinal Survey of Health, Ageing, and Retirement in Europe (SHARE) in 16 countries were selected, aged 50–64 years, in paid employment at baseline and with information on education and self-rated health (N=15 028). Education, health behaviors [including body mass index (BMI)] and working conditions were measured at baseline and self-rated health at baseline and two-year follow-up. Causal mediation analysis with inverse odds weighting was used to estimate the total effect of education on self-rated health, decomposed into a natural direct effect (NDE) and natural indirect effect (NIE).Results:Lower educated workers were more likely to perceive their health as poor than higher educated workers [relative risk (RR) 1.48, 95% confidence interval (CI) 1.37–1.60]. They were also more likely to have unfavorable working conditions and unhealthy behaviors, except for alcohol consumption. When all working conditions were included, the remaining NDE was RR 1.30 (95% CI 1.15–1.44). When BMI and health behaviors were included, the remaining NDE was RR 1.40 (95% CI 1.27–1.54). Working conditions explained 38% and health behaviors and BMI explained 16% of educational inequalities in health. Including all mediators explained 64% of educational inequalities in self-rated health.Conclusions:Working conditions and health behaviors explain over half of the educational inequalities in self-rated health. To reduce health inequalities, improving working conditions seems to be more important than introducing health promotion programs in the workforce.     

Two screening instruments for collecting alcohol-related information from expectant mothers and fathers: Testing the reliability of the Parent Alcohol Screening Questionnaire and the Social Support for an Alcohol-Free Pregnancy Questionnaire

The aim is to test the reliability of two alcohol screening instruments: (1) The Parent Alcohol Screening Questionnaire (PASQ5), and (2) the Social Support for an Alcohol-free Pregnancy (SSAFP) questionnaire. This is a cohort study from the south of Sweden using repeated surveys during pregnancy. To examine if responses differed according to different data collection methods, two cohorts consisting of 289 expectant mothers and 141 fathers completed the PASQ5 both verbally (weeks 6–7) and in writing (week 12) within regular antenatal visits. One of the cohorts (n = 137/64) also completed the SSAFP in week 12 and later in week 33. The third cohort, consisting of 179 and 133 expectant mothers and fathers, respectively, completed the PASQ5 and the SSAFP twice in late pregnancy (week 31 + 33). Eight of 10 items in the PASQ5 were stable for both expectant mothers and expectant fathers when comparing verbal versus written-delivered formats. Eight of 10 questions in the PASQ5 were stable when assessing the items in a test–retest analysis in late pregnancy for expectant mothers and nine of 10 questions were stable for fathers. The SSAFP items showed high internal consistency (0.86) for expectant mothers and excellent internal consistency (0.94) for expectant fathers. Most SSAFP items (17 of 21 for expectant mothers and 18 of 22 for expectant fathers) were also stable in a test–retest scenario in late pregnancy. Both the PASQ5 and SSAFP are reliable tools and may be helpful for clinicians who aim to have a deeper dialogue about alcohol consumption during pregnancy. These tools may also be helpful for researchers aiming to better understand a person's changes in alcohol intake and/or their social support network.     

深圳市3~5岁儿童龋病流行现状及影响因素分析

目的了解深圳市学龄前儿童口腔健康水平,为制定学龄前儿童口腔健康策略和开展口腔健康促进提供依据。方法于2018年10月30日—11月23日,在深圳市采用多阶段分层等容随机抽样方法选取1834名3~5岁学龄前儿童为研究对象,按照第四次全国口腔健康流行病学调查方案牙列检查方法和标准,检查全口乳牙牙冠龋,并采用与儿童家长面对面访谈的形式进行口腔健康问卷调查。结果深圳市3、4、5岁儿童乳牙患龋率分别为47.54%、58.77%、72.3%,龋均分别为2.06、3.27、4.52,龋齿充填率依次为2.67%、6.09%、15.02%。经济水平较好地区4岁和5岁儿童乳牙龋均低于经济较差儿童,差异有统计学意义(t=2.76,P=0.01;t=3.36,P=0.001),其余各年龄组儿童不同性别及经济水平间患龋率和龋均差异均无统计学意义(P>0.05)。多因素非条件logistic回归分析表明,年龄、地区经济水平、糖摄入频率和睡前甜点食用与学龄前儿童乳牙龋病有相关性(P<0.05)。结论深圳市3~5岁学龄前儿童乳牙患龋情况较为严重,应重视学龄前儿童乳牙龋病防治,强化干预措施。     

2014-2018济南市522437例围产儿出生缺陷发生情况分析

目的 了解近5年济南市出生缺陷发生情况,为政府部门制定针对性的防控措施提供依据。方法 利用济南市妇幼信息平台收集出生缺陷相关信息,分析出生缺陷发生率、发生顺位变化趋势。结果 2014-2018年济南市出生缺陷平均发生率为136.02/万,发生率最高的年份为2017年（183.87/万）,发生率最低的年份为2014年（99.63/万）总体呈上升趋势（Z=185.153,P<0.05）。男性围产儿缺陷发生率为152.79/万,女性围产儿缺陷发生率为117.34/万。出生缺陷围产儿的母亲发生年龄分布呈“U”型,20岁以下低年龄段和35岁以上高年龄段发生率较高,其中2014年、2015年20岁以下年龄段发生率最高,2016、2017、2018年35岁以上年龄段发生率最高;主要出生缺陷病种为先天性心脏病、多指/趾、总唇裂、并指/趾、尿道下裂,其中先天性心脏病发病率逐年上升（Z=223.604,P<0.05）。结论 济南市出生缺陷发生率呈逐年上升趋势,应特别关注低年龄段人群,重点关注先天性心脏病的防控工作。