Prevalence of pain and fear as barriers to vaccination in children – Systematic review and meta-analysis

BackgroundInjection-related pain and fear are common adverse reactions in children undergoing vaccination and influence vaccine acceptance. Despite the large body of literature on sources of vaccine non-compliance, there is no estimate of the prevalence of pain and fear as contributing factors. The objective was to estimate the prevalence of injection pain or fear of needles as barriers to childhood (i.e., 0–18 years) vaccination.MethodsFour databases were searched from inception for relevant English and French articles until August 2021. In addition, the references of recent systematic reviews and all articles included in the review were hand searched. Article screening and data extractions were performed in duplicate. Studies were included if they reported on injection-related pain or fear of needles in children (0–18 years) using a checklist/closed-ended question(s). Results were stratified by respondent (parents or children), type of pediatric population (general or under-vaccinated), and relative importance of barrier (pain or needle fear as primary reason or any reason for under-vaccination). Prevalence rates of pain or needle fear were combined using a random effects model. Quality of included studies was assessed using the Joanna Briggs Institute critical appraisal checklist for prevalence data. Quality across studies was assessed using GRADE.ResultsThere were 26 studies with 45 prevalence estimates published between 1995 and 2021. For parent reports (of children) and children self-reported reasons for non-compliance, prevalence rates of pain or needle fear ranged from 5 to 13% in a general population and 8 to 28% in an under-vaccinated population, with a substantial variation in the prevalence estimates. There was no difference between category of respondent or relative importance on pain or needle fear prevalence rate. A regression model demonstrated an overall prevalence rate of pain or needle fear as an obstacle to vaccination of 8% in the general population and 18.3% in the under-vaccinated population. All evidence was very low in quality.ConclusionThis is the first review to systematically quantify the prevalence and therefore, importance, of pain and needle fear as obstacles to vaccination in children around the world. Pain from injection or fear of needles were demonstrated to be sufficiently prevalent as barriers to vaccination in children to warrant attention. Addressing pain and fear has the potential to significantly improve vaccination acceptance.     

老年患者用药不依从性原因分析及对策

目的 探讨老年患者的用药特点,为更好地增加老年患者用药依从性,提高老年患者生活质量提供科学依据.方法 对我国老年患者用药不依从性的表现及其危害进行分析,探讨影响老年患者服药不依从性的主要原因并提出对策.结果 老年患者具有慢性病多、病程长、并发症多的特点,多种药物联合应用比例高并且复杂,对药物的耐受性降低,对药物治疗的依从性下降.结论 用药依从性是合理用药的组成部分,只有严格遵守医嘱用药的患者,才有可能达到安全、合理、有效和经济用药的目的.     

Compliance with hormone replacement therapy at Songklanagarind Hospital

AIM: To determine compliance with hormone replacement therapy (HRT) over a 2-year period, reasons for discontinuing HRT and the factors associated with non-compliance. METHODS: A total of 202 women attending the menopause clinic at Songklanagarind Hospital and taking HRT were included in this retrospective study. Compliance was assessed for each 6-month interval within the first 2 years. Reasons for discontinuation were requested from women who had stopped using HRT. RESULTS: Compliance rates with HRT for the study group were 57.9% at 6 months, 42.6% at 12 months, 35.1% at 18 months and 32.7% at 24 months. The main reasons for discontinuing HRT were improvement of climacteric symptoms (20.9%), fear of cancer (16.4%) and irregular bleeding (11.9%). Logistic regression analysis revealed a significant increase in the risk of non-compliance of HRT among agriculturists or untrained workers (OR 4.7, 95% CI 1.2-18.8; reference, government employees), those with delayed onset of treatment (>1 years; OR 3.0, 95% CI 1.1-8.0; reference, 0-3 months) and those prescribed HRT for climacteric symptoms or reasons other than oophorectomy or ovarian failure (OR 18.2-41.6 depending on reasons). Agriculturists or untrained workers who delayed onset of treatment for climacteric symptoms had the highest expected non-compliance rate of 0.95%. CONCLUSION: Long-term compliance of HRT was not good at Songklanagarind menopause clinic. More attention has to be paid to the counseling of patients about HRT. Agricultural or untrained workers, late starting HRT, and presence of climacteric complaints were the significant factors for poor HRT compliance.     

On patient judgement

Abstract
Clinical judgement, the keystone of medical expertise, is a hot topic. By contrast, patient judgement, also of central importance in health care, receives little attention. Patients have the last say concerning whether or not they seek medical treatment for symptoms, follow a doctor's advice or accept reassurance. Delay in seeking help for serious symptoms, non-compliance with treatment advice and failure of doctors to reassure many of the 'worried well' have long been recognized as serious problems. We argue that what is common to these important problems is patient judgement. Surveys yielding information about the average influence of a large number of individual variables do not do justice to the complex interaction of influences that can influence the judgements of an individual person under particular social circumstances. This is what explains the wide variety of patient reactions. From the medical standpoint, such unpredictable patient behaviour seems irrational. The patient perspective on the meaning of their actions is a hiatus in our knowledge, which is hampering the planning of effective interventions. Too few studies have sought the perspective of patients by asking them why they acted as they did. Thus, the wide spectrum of patient response in these situations in relation to personality, life experience and social context cannot be studied without interpretive field studies that include interview of patients with qualitative interpretation. (Intern Med J 2001; 31: 184–187)     

Non-compliance and professional power

The non-compliance of patients with prescribed treatments is considered as a barrier to effective health care. Non-compliance has implications for the health of patients, effective use of resources and assessments of the clinical efficacy of treatments. Research into non-compliance has increased over the last 30 years. This seems to indicate that it is seen as an important area of concern for all health care professionals. Definitions of non-compliance are problematic, as are methods of assessment of its nature and frequency. Many factors which may account for non-compliance have been proposed, as well as methods to improve compliance. Research into these factors however, mainly based on a positivist epistemology, has failed to provide any conclusive answers to the problem. Sound clinical reasons are suggested as the basis for the increase in interest in non-compliance. It is contended, however, that it is not only these reasons that account for the identification of non-compliance as a problem. Non-compliant behaviour is seen as problematic, because it contravenes professional beliefs, norms and expectations regarding the ‘proper’ roles of patients and professionals. These have formed the basis of an ideology that views patients as passive recipients of health care. It has led to an inherent tendency to ‘blame’ the patient and view non-compliance as irrational and deviant. The professional view of non-compliance as irrational, is exemplified in the case of individuals with mental illness, where there are inherent assumptions that non-compliance can be seen primarily as a symptom of illness. This denies the legitimacy of patient choice, and has led to attempts to control compliance via suggested legislative measures. Serious moral and ethical problems arise from such measures, and can be seen as the ultimate legitimization of an ideology of non-compliance. The maintenance of professional power and control is suggested as central to the debates surrounding non-compliance. The ideological assumptions underpinning the concept of non-compliance need questioning, and a re-conceptualization of the roles of patients and professionals is required. This must involve a view of patients as active participators in their own health care. Research based on an interpretative epistemology, aimed at understanding individual action, rather than control, would seem a more appropriate model to pursue.     

Interviews and assessments of returning non-compliant periodontal maintenance patients

BACKGROUND: Periodontal therapy without a maintenance programme has been shown to be of doubtful value. Most studies show a low-level of compliance with periodontal maintenance therapy. Many suggestions as to the reasons for this have been put forward, but it has been difficult to confirm these, as the patients are not available to be interviewed. AIM: To identify, interview and assess returning non-compliant periodontal maintenance patients. METHOD: All patients who had undergone periodontal therapy between 1986 and 2004 but not complied with the maintenance therapy were interviewed and assessed when they later returned to the specialist office for treatment. RESULTS: Sixty-one patients with an average age of 56.4 years (SD 11,1) were studied. There were 18 males and 43 females. The patients were compliant for 3.4 years (SD 3.2) before leaving and returning after 5.5 years (SD 3.3) of non-compliance. Average tooth loss while non-compliant was 1.6 teeth (SD 2.8). The interviews revealed that 37 patients attended their own dentist's office exclusively for maintenance therapy, eight patients gave health reasons and seven patients lack of motivation or failure to cooperate. Thirty-six patients were re-referred by their own dentist, 13 changed dentist and were referred by this dentist, while 12 patients contacted the specialist office directly. Fifty-three patients claimed to have been fully compliant with their own dentist while non-compliant with the specialist office. CONCLUSION: The main reason for non-compliance was that the patients did attend their own dentist exclusively for maintenance therapy. Tooth loss and periodontal deterioration was more marked in this group than patients who in addition attended the specialist office for maintenance therapy.     

运用有限理性决策模型分析喜炎平注射液在临床中的应用

 目的 了解喜炎平注射液的使用情况,同时向临床药师推介有限理性决策模型的运用。方法 利用有限理性决策模型回顾性分析、评价喜炎平注射液的使用情况。结果 329例中,有230例分布于儿科,占总数的69.9%;用于上呼吸道感染229例(69.3%),小儿腹泻85例(25.8%),手足口8例(2.4%),2.4%的病例为超说明书用药;89.06%的病例联合应用抗生素,但医嘱中未标示冲洗输液管以及滴速控制等。结论 有限理性决策模型可作为喜炎平注射液合理应用的评价模型。     

Adverse drug reactions and drug non-compliance as primary causes of admission to a cardiology department

Summary 426 consecutive patients admitted to a Danish University Department of Cardiology have been studied. Drug intake prior to admission by each patient was ascertained from medical records and personal interviews. Adverse drug reactions (ADR) were the primary cause of admission in 49 patients (11.5%), and 16 patients (3.8%) were admitted due to drug non-compliance (DNC).Thiazide diuretics, beta-adrenoceptor blocking agents and calcium antagonists accounted for almost 60% of all the ADR-related admissions. Patients admitted for ADR took significantly more drugs than patients admitted for other reasons. DNC was not correlated with the number of prescribed drugs.It is concluded that drug-related hospital admissions are an important medical and economic problem. Most of the ADRs were well-known and predictable actions of the drugs, and could have been avoided by more careful clinical and laboratory monitoring of the patients. Most of the DNC, too, could have been avoided by giving better information to the patients.