“You Have to Die Not to Come to Work”: A Mixed Methods Study of Attitudes and Behaviors regarding Presenteeism,Absenteeism and Influenza Vaccination among Healthcare Personnel with Respiratory Illness in Israel, 2016–2019

IntroductionHealthcare personnel (HCP) have an increased risk of exposure to influenza and other respiratory pathogens. Increased presenteeism, decreased absenteeism, and low uptake of the influenza vaccine can contribute to the spread of influenza among HCP in healthcare settings. We used a mixed methods approach to investigate attitudes and behaviors of HCP in Israel towards influenza vaccination, presenteeism, and absenteeism.MethodsThe study took place over three influenza seasons (2016–2017, 2017–2018, 2018–2019) at the largest hospital in southern Israel. We administered a Knowledge, Attitudes and Practices (KAP) questionnaire and conducted semi-structured interviews with HCP who had been recently ill with respiratory symptoms. The KAP questionnaire included closed-ended questions about attitudes and behaviors regarding influenza, working while sick, and influenza vaccination. The interviews investigated HCP’s perceptions of influenza infection and attitudes about absenteeism, presenteeism, and the influenza vaccine.ResultsWe conducted 74 semi-structured interviews over three influenza seasons. Four HCP were interviewed twice, in separate seasons for different illness episodes. The 70 individuals interviewed included 16 physicians, 45 nurses or technicians, and 9 administrative staff. The median age was 42.5 years (range: 25–60), and most (79%) were female. Half (50%) got vaccinated against influenza before their illness episode. In interviews, most HCP said they come to work while sick (presenteeism) due to a strong personal work ethic and an institutional culture that discourages taking sick leave (absenteeism). HCP expressed skepticism about the effectiveness of the influenza vaccine as well as concern that the influenza vaccine causes severe illness.DiscussionOver three influenza seasons in Israel, HCP cited a number of reasons for working while sick, and doubted the usefulness of influenza vaccine. Addressing reasons for presenteeism and vaccine hesitancy among HCP is crucial to protect HCP and patients from influenza virus infection and other viral respiratory illnesses, such as COVID-19.     

Cost-effectiveness of seasonal influenza vaccination in pregnant women,healthcare workers and adults >= 60 years of age in Lao People’s Democratic Republic

BackgroundPregnant women, healthcare workers (HW), and adults >= 60 years have shown an increased vulnerability to seasonal influenza virus infections and/or complications. In 2012, the Lao People's Democratic Republic (Lao PDR) initiated a national influenza vaccination program for these target groups. A cost-effectiveness evaluation of this program was undertaken to inform program sustainability.MethodsWe designed a decision-analytical model and collected influenza-related medical resource utilization and cost data, including indirect costs. Model inputs were obtained from medical record abstraction, interviews of patients and staff at hospitals in the national influenza sentinel surveillance system and/or from literature reviews. We compared the annual disease and economic impact of influenza illnesses in each of the target groups in Lao PDR under scenarios of no vaccination and vaccination, and then estimated the cost-effectiveness of the vaccination program. We performed sensitivity analyses to identify influential variables.ResultsOverall, the vaccination of pregnant women, HWs, and adults >= 60 years could annually save 11,474 doctor visits, 1,961 days of hospitalizations, 43,027 days of work, and 1,416 life-years due to laboratory-confirmed influenza illness. After comparing the total vaccination program costs of 23.4 billion Kip, to the 18.4 billion Kip saved through vaccination, we estimated the vaccination program to incur a net cost of five billion Kip (599,391 USD) annually. The incremental cost per life-year saved (ICER) was 44 million Kip (5,295 USD) and 6.9 million Kip (825 USD) for pregnant women and adults >= 60 years, respectively. However, vaccinating HWs provided societal cost-savings, returning 2.88 Kip for every single Kip invested. Influenza vaccine effectiveness, attack rate and illness duration were the most influential variables to the model.ConclusionProviding influenza vaccination to HWs in Lao PDR is cost-saving while vaccinating pregnant women and adults >= 60 is cost-effective and highly cost-effective, respectively, per WHO standards.     

Barriers and facilitators to uptake and promotion of influenza vaccination among health care workers in the community in Beijing,China: A qualitative study

BackgroundIn the prevention and control of influenza, it is important for healthcare workers (HCWs) to be vaccinated and recommend influenza vaccines to their patients. However, there is limited evidence on the factors influencing uptake and promotion of influenza vaccination to patients among HCWs in China.MethodsWe conducted in-depth interviews among HCWs in community health centers, including general practitioners (GPs) and preventive health workers (PHWs), during January to February 2017. A total of 21 individuals, purposively selected from six community health centers covering central districts and remote suburbs in Beijing, were interviewed using semi-structured topic guides. Thematic analysis was used to analyze the interviews and coding framework was developed both inductively and deductively.ResultsIdentified factors influencing influenza vaccine uptake included knowledge, perception and recognition, and prior experience of vaccine uptake. All PHWs conservatively recommended influenza vaccine because of concerns about potential patient–doctor disputes. GPs rarely recommended vaccination under their own initiative because vaccine promotion was not their duties. Notably, we found that the division of work was an underlying reason for the different behaviors regarding vaccine uptake and promotion between GPs and PHWs.ConclusionsOur findings highlighted a combination of misconceptions and cognitive biases limiting influenza vaccine uptake among HCWs in China. Our findings indicate that promotion of health education regarding influenza vaccination should be implemented among HCWs. Importantly, the division of work greatly affects the behaviors of HCWs. GPs, who are at the front line in the doctor–patient relationship, have a critical role in influenza vaccination programs.     

COVID-19 vaccine uptake and its associated factors among Palestinian healthcare workers: Expectations beaten by reality

BackgroundIn response to this extraordinary outbreak, many countries and companies rush to develop an effective vaccine, authorize, and deliver it to all people across the world. Despite these extensive efforts, curbing this pandemic relies highly upon vaccination coverage. This study aimed to determine SARS-COV-2 vaccine uptake among Palestinian healthcare workers, the factors that influence vaccination uptake, and the motivators and barriers to vaccination.MethodsA cross-sectional study was conducted using an online anonymous self-administered questionnaire during April and May 2021, after the Palestinian Ministry of Health launched the COVID-19 vaccination campaign.The questionnaire collected socio-demographic characteristics, vaccination attitude and vaccination uptake status, and motivators and barriers towards vaccination. In addition, multivariate logistic regression was performed to identify the influencing factors of vaccination uptake.ResultsThe study included 1018 participants from different professions, including 560 (55.0%) females. Of the participants, 677 (66.5%; 95% CI: 63.5–69.4%) received the vaccine. Higher uptake was observed among males (aOR = 1.5; 95 %CI: 1.1–2.1), single HCWs (aOR = 1.3; 95 %CI: 1.1–1.8), HCWs working in the non-governmental sector (aOR = 1.6; 95 %CI: 1.2–2.4), higher monthly income (aOR = 1.9; 95 %CI: 1.4–2.8) and smoking (aOR = 1.5; 95 %CI: 1.1–3.5). The lower level of negative vaccination attitudes predicted higher intake; mistrust of vaccine belief (aOR = 1.6; 95 %CI: 1.4–1.7) and worries over unforeseen future effects (aOR = 1.2; 95 %CI: 1.1–1.3).ConclusionIn conclusion, the COVID-19 vaccination uptake was comparable to other studies worldwide but still needs to be improved, especially in the context of this ongoing global pandemic. It is imperative to invest resources to promote vaccination uptake and target all the vaccine misconceptions and fears.     

甲型肝炎灭活疫苗不同免疫方案对恒河猴免疫效果观察

目的 确定甲型肝炎灭活疫苗免疫恒河猴最佳免疫方案。方法 根据３个免疫方案（方案１：０周免疫;方案２：０周初次免疫、４周加强免疫;方案３：０周初次免疫、２４周加强免疫）,将１７只抗－ＨＡＶ阴性的恒河猴随机分成４组;第１组;免疫方案１;第２组：免疫方案２;第３组：免疫方案３。１～３组各５只,空白对照组２只。用同等剂量（１２８０ＥＬ．Ｕ／ｍｌ）的甲型肝炎灭活疫苗于上臂三角肌内分别免疫两组恒河猴,检测恒河     

Management challenges and markets

The scarcity of resources in healthcare systems has general causes and country-specific causes. Common to most healthcare systems is a strong emphasis on management and an increased attention to the role of the market. Management and market are concepts which need clarification: management applies not only to individual institutions but to systems of institutions. Market implies not only the pursuit of individual interests but also the assumption of responsibility. The design or redesign of healthcare systems must take into account the level of management skills which each system and its institutions can rely on. Cost patterns in a healthcare system develop around its institutional design. Different factors produce varying levels of costs in different healthcare systems. The same applies to the effort needed to reach a certain degree of effectiveness in output. An outline of strengths and weaknesses of options for the design of healthcare systems is presented in the final part of the article. These should always be considered together with the specific features of each country.