Fear Of Adverse Effects Research Articles

Community views on mass drug administration for filariasis: a qualitative evidence synthesis.

The World Health Organization (WHO) recommends mass drug administration (MDA), giving a drug at regular intervals to a whole population, as part of the strategy for several disease control programmes in low- and middle-income countries. MDA is currently WHO policy for areas endemic with lymphatic filariasis, which is a parasitic disease that can result in swollen limbs and disability. The success depends on communities adhering to the drugs given, and this will be influenced by the perception of the drug, the programme, and those delivering it. OBJECTIVES: To synthesize qualitative research evidence about community experience with, and understanding and perception of, MDA programmes for lymphatic filariasis. To explore whether programme design and delivery influence the community experience identified in the analysis. We searched CENTRAL, MEDLINE, Embase, and seven other databases up to 8 April 2021, together with reference checking, citation searching, and contact with study authors to identify additional studies. This reviewsynthesized qualitative research and mixed-methods studies when it was possible to extract qualitative data. Eligible studies explored community experiences, perceptions, or attitudes towards MDA programmes for lymphatic filariasis in any country, conducted between 2000 and 2019. DATA COLLECTION AND ANALYSIS: We extracted data on study design including: authors, aims, participants, methods, and qualitative data collection methods. We also described programme delivery factors including: country, urban or rural setting, endemicity, drug regimen, rounds of MDA received at the time of the study, who delivered the drugs, how the drugs were delivered, use of health education, and sensitization and adherence monitoring. We conducted a thematic analysis and developed codes inductively using ATLAS.ti software. We examined codes for underlying ideas, connections, and interpretations and, from this, generated analytical themes. Weassessed the confidence in the findings using the GRADE-CERQual approach, and produced a conceptual model to display our findings. MAIN RESULTS: From 902results identified in the search, 29 studies met our inclusion criteria. The studies covered a broad range of countries in Africa, South-East Asia, and South America, and explored the views and experiences of community members and community drug distributors in low-income countries endemic for lymphatic filariasis. Four themes emerged. People weigh up benefits and harms before participating. People understand the potential benefits in terms of relief of suffering, stigma, and avoiding costs (high confidence); however, these theoretical benefits do not always mesh with their experiences (high confidence). In particular, adverse effects are frightening and unwelcome (high confidence); and these effects are amplified through rumour and social media (moderate confidence). Many people are suspicious of MDA programmes. When people lack a scientific explanation for the programme and their experiences of it, they often develop social explanations instead. These are largely shaped on the historical backdrop and level of trust people have in relevant authority figures (high confidence), although some have unwavering faith in their government and, by extension, the programme (moderate confidence). Programmes expect compliance, and this can become coercive and blaming. Health workers and community members stigmatize non-compliance, which can become coercive (moderate confidence), so communities may appear to comply publicly, but privately reject treatment (moderate confidence). Community distributors are often not respected or valued. They have little authority (moderate confidence), and the behaviour of some distributors damages the MDA programme's reputation (high confidence). Communities want information about programmes to help make decisions about participation, but drug distributors are not sufficiently informed, or skilled in this communication (high confidence). We intended to assess whether programme designs influenced communities' perceptions of the programme and decision to adhere but were unable to do so as few studies adequately reported the design and implementation of the local programme. We have moderate to high confidence in theevidencecontributing to the review themes and subthemes. Adherence with MDA for filariasis is influenced by individual direct experience of benefit and harm; social influences in the community; political influences and their relationship to government; and historical influences. Fear of adverse effects was frequently described and this appears to be particularly important for communities. When views were negative, we were surprised by the strength of feeling expressed. Enthusiasm for these schemes as a strategy in global policy needs debate in the light of these findings.

Extension de la vaccination contre les HPV aux garçons : enquête auprès de familles et de médecins généralistes

As part of an analysis on the extension of the HPV vaccination to French boys, the French National Cancer Institute (INCa) and the French National Authority for Health (HAS) have conducted in collaboration a survey on HPV vaccine acceptance in July 2019. This survey was completed by parents of children aged 11-19 and general practitioners (GPs). Questions focused on their representations, practices and intentions in the context of the future policy change allowing boys to get vaccinated against HPV. The survey was conducted between June 20 and July 12, 2019. It focused on two populations: a nationally representative sample of parents with at least one girl aged 11-19 and/or one boy aged 11-14 (n=1984) and a representative sample of GPs in mainland France. Data were collected through a web-based questionnaire with a mean completion time of 10minutes for parents and GPs. The quota method was applied to ensure the representative nature of the samples based on (i) gender, age, children (girl aged 11-14 and/or boy aged 11-14) of the household, socio-professional category of the "head of the household", size of urban area and region for the parents' sample and based on (ii) gender, age, region and type of practice for the GPs' sample. Although most GPs were very favourable towards HPV vaccination (94%), they considered it one of the most challenging vaccinations to get parents to adhere to (82%). A notable percentage of parents have unfavourable opinions towards HPV vaccination (25%). The three main barriers cited by parents of non-vaccinated girls were: the fear of adverse effects, the lack of information, and the fact that the GP did not propose it. Regarding the extension of HPV vaccination to boys, 84% of GPs would recommend this vaccination to boys if it was included in the vaccination schedule, and 88% of those who did not routinely recommend HPV vaccination to girls would be more likely to offer it to girls if the extension was recommended.

Motivational Factors and Post Vaccination Symptoms among COVID-19 Vaccinated Beneficiaries at a Tertiary Care Hospital, West Bengal, India: A Cross-sectional Study

Introduction: Since the emergence of Coronavirus Disease 2019 (COVID-19) pandemic, there has been an intense burden on the health system and economy worldwide with millions of people being affected leading to several deaths. In this scenario vaccination seems to be a hope to control the pandemic. However, fear of adverse events following immunisation sometimes makes people hesitant about vaccination. Aim: To assess the spectrum of post vaccination symptoms and also to identify the motivational factors along with their determinants at a tertiary care hospital, West Bengal, India. Materials and Methods: A cross-sectional study was conducted in the COVID-19 Vaccination Centre at Nil Ratan Sircar Medical College and Hospital, Kolkata West Bengal, India (tertiary care hospital), from August 2021 to November 2021. A total of 448 vaccinated beneficiaries were enrolled in the study. Data collection was done by an online questionnaire, sent to the participants in their registered mobile numbers. Descriptive statistics and Chisquare tests were used for data analysis. Results: Among 448 study participants, 262 (58.5%) were in 18- 44 years of age group, 248(55.4%) female, 384 (85.7%) Hindu, 132 (29.5%) medical or paramedical students, 290 (64.7%) passed graduation and above and 306 (68.3%) belonged to nuclear family. About 228 (50.9%) beneficiaries reported post vaccination symptoms. Most common being local pain at injection site, found among 150 (65.8%) out of them. Most common motivational factors of COVID-19 vaccination were found to be fear of COVID-19 infection, reported by 274 (61.2%) participants, which showed significant difference with various age groups (p-value=0.001), religions (p-value=0.030), occupations (p-value<0.001) and educations (p-value=0.002). Statistical significant (p<0.05) differences were also found according to age, gender, co-morbidities, interval between vaccination and past COVID-19 infection and type of COVID-19 vaccine in relation to onset of post vaccination symptoms. Conclusion: Following COVID-19 immunisation minor adverse events were reported. Monitoring of those adverse events will help in further responding and prompt action. Also, the knowledge about motivational factors is expected to reduce vaccine hesitancy among unvaccinated people.

COVID-19 Vaccination Knowledge, Perception, and Reason for Adherence and nonadherence Among Nursing Students in Egypt.

Vaccines are considered preventive measures to reduce coronavirus disease 2019 (COVID-19) spread around the world. There are many factors for adherence and acceptance of COVID-19 vaccination. The study aimed to investigate nursing students' knowledge, perception, and factors that influence their adherence to COVID-19 vaccines. A descriptive cross-sectional study design was conducted among nursing students at the Faculty of Nursing, Mansoura University, Egypt, during the period between September 1 and November 30, 2021. Of the total of 500 participants, 76% took a COVID-19 vaccination. About 89% of participants rated the correct answer related to COVID-19 vaccination. Obligatory to enter the faculty, protect family and friends, and protect myself were the most reasons of adherence (80.3, 73.7, and 70.8%, respectively) while fear of adverse events and lack of information about vaccine were the most reasons of nonadherence (87.5 and 79.2%, respectively) to COVID-19 vaccination. The majority of participants (62%) had expressed positive perception toward COVID-19 vaccination. Education level, training program about COVID-19, previous infection with COVID-19, perception toward COVID-19 vaccination, and knowledge toward COVID-19 vaccination were significantly (p = .035, p = .027, p = .009, p = .008 and p = .033, respectively) associated with students' adherence to take COVID-19 vaccines. Accurate knowledge and perception about COVID-19 vaccines are the stronger predictors of vaccine hesitance or acceptance among nursing students in Egypt. Campaigns to increase knowledge and perception of COVID-19 and its vaccines among nursing students are needed to improve vaccine acceptance and reduce vaccine hesitance.

Acceptance of Post-Partum Family Planning among Mothers Attending for Child Immunisation Services at Tertiary Care Hospital, Kolkata

Introduction:Postpartum family planning (PPFP) is avoidance of closely spaced and unplanned pregnancies by use of family planning services within first year following delivery.World Health Organisation (WHO) reports postpartum women to have greatest unmet need of contraception. There is further recommendation to link immunisation clinics to PPFP services.Objectives:1. To assess the acceptance rate ofPPFPamong mothers attending immunisation clinic 2. To explore the determinants of usage, intention to use and PPFP methods used. 3. To find the reasons for non-acceptance ofPPFP among the study participants. Method:Study participants werewomen attendingimmunisation clinicof a tertiary level teaching hospital of Kolkatafor child’s immunisation service. Studydesign was cross sectional.Systematic random sampling technique was used to recruit participants. Data was collected by interviewer administered semi-structured questionnaire.Frequencies and percentages for categorical variables while mean and standard deviation for continuous variables were calculated. Crude Odds ratio with 95% confidence interval was calculated to explore strength of association between PPFP acceptance and independent variables.Results:About 1 in every 3 women (37.36%) was PPFP acceptor; intra uterine device was the most commonly used method. Odds of acceptance was lower for respondents’ age <25 years and primipara whileit was higher for exposure to counselling, having male child, resumption of sex and past use of contraception. Fear of adverse effects was the most common reason for non-acceptance of PPFP.Conclusions: PPFP acceptance was low, however among acceptors long acting reversible contraceptives were more commonly accepted methods. There is scope to improve PPFP acceptance with intensified contraceptive counselling during delivery and immediate hospital stay as women were afraid of adverse effects of contraceptives.

443 Arterial hypertension in aortic valve stenosis: a critical update

Abstract Aims Aortic stenosis (AS) is a very common valve disease and is associated with high mortality once it becomes symptomatic. Arterial hypertension (HT) has a high prevalence among patients with AS leading to worst left ventricle remodelling and faster degeneration of the valve. HT also seems to interfere with the assessment of the severity of AS leading to an underestimation of the real degree of stenosis. Treatment of HT in AS has historically been associated with reluctance due to both the lack of clear guidelines and the fear of adverse effects, but the most recent evidence shows as several drugs that can be used. Methods The pathophysiology of the combination of AS and HT is the association of a first fixed mechanical obstruction of the aortic root and a second obstruction due to systemic vascular resistance. Consequently, a decrease in systemic vascular resistance through, for example, the administration of vasodilators could theoretically cause a drop in systemic pressure due to the fixed mechanical obstruction given by the stenosis which prevents an increase in cardiac output. This theory was the basis for avoiding vasodilators in patients with AS. Results There is a unanimous opinion on maintaining blood pressure values of 130–139 mmHg of systolic and 70–90 mmHg of diastolic, but there is not the same agreement on which drugs to adopt to achieve the aforementioned values. Renin-Angiotensin-Aldosterone system inhibitors are certainly the first-line treatment thanks to their cardioprotective, plaque stabilizing, and antiarrhythmic effect since they are also associated with increased survival rates and greater left ventricular mass reduction in patients after surgical or transcatheter aortic valve replacement for severe AS. If blood pressure is not yet controlled, the addition of a beta-blocker should be considered: metoprolol has the greatest literature, showing not only an improvement in haemodynamic and metabolic performance but also a reduction in mortality in patients who already presented with coronary artery disease. Mineralocorticoid receptor antagonist can be used, among them eplerenone has been studied and can be useful to relieve symptoms of patients with a flare-up of heart failure by reducing the preload, provided that a close fluid and echocardiographic monitoring is implemented. Conclusions The use of phosphodiesterase 5 inhibitors can improve the haemodynamic status of patients with aortic stenosis and reduce the level of left ventricular hypertrophy, as well as improve pulmonary circulation and exercise tolerability of patients with AS, however it should be considered that in other studies sildenafil was associated with a worse clinical outcome. Calcium channel blocker are one the most used medications in patients with HT, but their use was associated with a 7-fold relative risk of all-cause mortality independent of known confounders and was also associated with an adverse effect on treadmill exercise and higher risk of all-cause mortality in patients with AS.

COVID-19 vaccine acceptance, hesitancy, and determinants among physicians in a university-based teaching hospital in Thailand

BackgroundThe COVID-19 vaccines provide renewed hope in the fight against the recent pandemic. To ensure widespread vaccination, it is crucial to analyze vaccine willingness and its determinants among physicians, key health care influencers. This study aimed to assess acceptance rate and identify factors associated with vaccine hesitancy among Thai physicians.MethodsA cross-sectional online-based questionnaire was distributed to all physicians at King Chulalongkorn Memorial Hospital during March 31, 2021 to April 30, 2021 in order to assess their attitudes toward receiving the COVID-19 vaccine. Reasons for vaccine acceptance and refusal as well as predictors of vaccine hesitancy were analyzed by bivariate and multivariable analysis.ResultsA total of 705 complete responses were received with 95.6% (n = 675) of physicians expressing willingness to receive a COVID-19 vaccine. Only one of the 31 physicians (4.4%) who expressed a hesitancy or unwillingness to be vaccinated was a faculty member; the others were physicians-in-training. Approximately one-fifths of physicians surveyed were also not willing to recommend the vaccine to their family members (21.4%, n = 151) or patients (18.7%, n = 132). Using multivariable logistic regression, vaccine hesitancy was independently associated with preference for particular vaccines over the government allocated option, especially for mRNA vaccine (aOR 8.86; 95% CI 1.1–71.54; p = 0.041). Vaccine literacy showed an inverse relationship (aOR 0.34; 95% CI 0.13–0.9; p = 0.029) with vaccine hesitancy. Uncertainty of the vaccine efficacy (83.9%) and fear of adverse events (48.4%) were major concerns contributing to vaccine hesitancy.ConclusionThis study revealed a high rate of physician willingness to take the COVID-19 vaccine especially among staffs; however, a significant proportion would not currently suggest vaccination to their families or patients. Restrictions on vaccine choice and vaccine illiteracy, together with concerns over adverse effects and uncertainty of efficacy, were associated with negative attitudes toward vaccination. To raise acceptance of the vaccination program, efforts should be made to balance individual preference for vaccine type in addition to increasing the availability of accurate data on safety and efficacy for each vaccine.

Rotavirus and the web: analysis of online conversations in Italy during 2020

ABSTRACT Rotavirus is the most common cause of severe diarrhea among children worldwide. In 2017, Italy included rotavirus vaccination in its National Immunization Program. The use of social media monitoring, an efficient tool to understand vaccine hesitancy, has increased in recent years; however, only a few examples of such monitoring are available for Italy. Present study analyzed content on online sources, including social media, to identify factors contributing to Italian parents’ decisions to vaccinate or not their children against rotavirus. Blogmeter Suite was used to search and analyze conversations related to rotavirus in Italian on online sources during 2020. These data were compared with data from 2019. There were 2250 mentions of “rotavirus” recorded; 1080 were related to the rotavirus vaccine. Terms and hashtags used were similar in both years. Facebook was the main source of influence, Instagram dominated the engagement (the sum of interactions related to a post), and Google Trends showed a 5-year upward trend in searches for rotavirus vaccine. Of 1270 sentiment opinions, 60.7% were negative. More parents were familiar with the disease and the vaccine in 2020 compared with 2019. Pediatricians were the most influential healthcare professionals (59.2% of mentions), followed by vaccination staff (33.4%). The most relevant factors for vaccine hesitancy were fear of adverse events, concerns about the vaccination schedule, and COVID-19. Present study represents the first web listening analysis of online discussions about rotavirus. The results can be used to inform targeted communication to counteract misinformation and raise awareness about rotavirus vaccination among parents.

COVID-19 Vaccine Acceptance among Liver Transplant Recipients.

(1) Background: COVID-19 vaccination hesitancy is a threat for fragile patients. We aimed to evaluate COVID-19 vaccination hesitancy and its reasons in a population of liver transplant (LT) recipients. (2) Methods: In February 2021, a questionnaire on COVID-19 vaccines was sent to LT patients followed at our liver transplant outpatient clinic in Milan, Italy. Sociodemographic and clinical characteristics were recorded. Patients were defined as willing, hesitant, or refusing and their reasons were investigated. Associations between baseline characteristics and willingness were evaluated. Since March 2021, when the COVID-19 vaccines became available for LT candidates and recipients in Italy, the entire cohort of LT recipients was contacted by phone and called for vaccination, and the rate of refusals recorded. (3) Results: The web-based survey was sent to 583 patients, of whom 190 responded (response rate of 32.6%). Among the respondents to the specific question about hesitancy (184), 157 (85.3%) were willing to be vaccinated against COVID-19, while 27 (14.7%) were hesitant. Among the hesitant, three were totally refusing, for a refusal rate of 1.6%. Thirteen hesitant patients (48.1%) answered that their COVID-19 vaccination hesitancy was influenced by being a transplant recipient. The fear of adverse effects was the main reason for refusal (81.5%). Of the 711 LT patients followed at our center, 668 got fully vaccinated, while 43 (6.1%) of them refused the scheduled vaccination. (4) Conclusions: Most patients accepted COVID-19 vaccines, although 6.1% refused the vaccine. Since it is crucial to achieve adequate vaccination of LT patients, it is very important to identify the reasons influencing COVID-19 vaccination hesitancy so that appropriate and targeted communication strategies can be established and specific vaccination campaigns further implemented.

Primary Non-adherence to Treatment with New Oral Anticoagulants: The Results of a Prospective Observational Study «ANTEY»

Aim: To assess the main characteristics of patients with non-valvular Atrial Fibrillation (AF) who are initially non-adherent to New Oral Anticoagulants (NOAC), and to identify factors associated with this version of non-adherence. Materials and Methods: The ANTEY study included 201 patients with non-valvular AF, who had indications and without contraindications for NOAC treatment. The patients had previously been advised to take oral anticoagulants but they did not comply with all medical recommendations. The observation period was 1 year, during which 2 in-person visits were performed: an inclusion visit (V0) and a visit (V1), as well as 1 telephone contact/follow up (FU); the interval between contacts was 6 months. All patients were recommended to take the NOAC by decision of the physician. During the V0, V1 and FU visits, the “National Society for Evidence-Based Pharmacotherapy (NSEPh) Adherence Scale” questionnaire was used to assess overall adherence and associated factors. 15 (7.5%) patients had not started NOAC therapy by the end of the study (primary non-adherent patients). Their characteristics are analysed in this work. Results: The main reasons for primary non-adherence to NOAC were high cost (33.3%), fears of adverse effects (AE) (33.3%), doubts about the need for treatment (13.3%) and the complex therapy regimen (13.3%). In the group of primary non-adherent patients in comparison with the rest of the patients there were significantly more patients with 1 point according to CHADS2VASc (20% and 2.2%, respectively, p = 0.029) and patients with 3 points according to HAS-BLED (33.3% and 9.1%, respectively, p = 0.006); they took antiplatelet drugs more often 73.3% versus 21.5%, respectively (p = 0.001). Full employment at work (OR = 5.2; CI95% [1.5; 18.1], p = 0.009), history of quitting smoking (OR = 5.1; CI95% [1.5; 17.0], p = 0,008), the presence of any pharmacotherapy AE (OR = 4.0; CI95% [1.01; 16.0], p = 0.048) increased the chance of primary non-adherence to NOAC by 4-5 times. Conclusion: The most vulnerable in relation to initiation of NOAC therapy for the prevention of thromboembolic complications in AF are those patients who continue to work or have any pharmacotherapy AE. The leading factors preventing the initiation of NOAC administration are their high cost, fear of the development of AE from the therapy, and patients’ doubts about the need for treatment with these drugs. The clinical trial registration number is NCT 03790917.

Use of opioids for refractory dyspnoea in hospitalised patients with serious illness: a narrative review.

Refractory dyspnoea can be a challenging symptom to manage. Palliative care specialists are not always available for consultation, and while many clinicians may undergo training in palliative care, this education is not universal. Opioids are the most studied and prescribed pharmacological intervention for refractory dyspnoea; however, many clinicians hesitate to prescribe opioids due to regulatory concerns and fear of adverse effects. Current evidence suggests that rates of severe adverse effects, including respiratory depression and hypotension, are low when opioids are administered for refractory dyspnoea. Therefore, systemic, short-acting opioids are a recommended and safe option for the palliation of refractory dyspnoea in patients with serious illness, especially in a hospital setting that facilitates close observation. In this narrative review, we discuss the pathophysiology of dyspnoea; facilitate an evidence-based discussion on the concerns, considerations and complications associated with opioid administration for refractory dyspnoea; and describe one approach to managing refractory dyspnoea.

Influenza vaccination uptake and attitudes among adult cancer patients in Japan: a web-based questionnaire survey before the 2020/2021 season

ABSTRACT Influenza vaccination is necessary to reduce severe influenza complications, especially in immunocompromised people such as cancer patients. However, few studies have examined influenza vaccination uptake among adult Japanese patients with cancer; their attitudes toward vaccination, as well as factors related to vaccine hesitancy, are unclear. From September 1 to October 31, 2020, we disseminated a web-based questionnaire to patients with a history of cancer via snowball sampling through e-mails and social media of two Japanese cancer patients associations. A total of 163 surveys were completed. One hundred (61.3%) participants received an influenza vaccination in the 2019/2020 season, and the main reasons for vaccination were as follows: recommendation by medical professionals, positive awareness of vaccination through books or the internet, and provision of vaccination in the workplace. The main reasons for not receiving a vaccination were fear of adverse events, lack of concern about influenza infection, and lack of trust in vaccine effectiveness. In terms of the 2020/2021 season, 120 participants (73.6%) reported their intention to receive an influenza vaccination. Multiple regression analysis showed that significant factors for positive intention were the the treatment without chemotherapy (p = .009), vaccination history in the 2019/2020 season (p < .001), prior experience of influenza infection (p = .043), and the perception that influenza vaccination was more important due to the coronavirus disease pandemic (p = .050). This preliminary survey revealed a relatively modest influenza vaccine coverage among adult Japanese patients with cancer and identified several factors related to positive intention toward vaccination.

1385Hesitancy for Adult Vaccination -A New Paradigm for Research in India

BackgroundAdult immunization has recently emerged as an area of emphasis in research and policy. Increasing life expectancy, outbreaks like COVID-19, and the endemic nature of diseases like dengue, malaria have underscored its importance. Therefore, this study was carried out with the aim to assess hesitancy and factors influencing the uptake of vaccines in adults.MethodsAn online cross-sectional study was conducted among adults (age more than 20 years). Data collection was done by convenience sampling in January 2021. Information on awareness and perceptions regarding adult vaccination and immunization status of participants was collected. Data analysis was done using SPSS version 21.ResultsA total of 461 adults responded to the survey. Among those who had never received any vaccine in adulthood (n = 158), the reasons were lack of recommendation by healthcare providers (38.6%), lack of knowledge of vaccines (15.8%) and fear of adverse effects following vaccination (7.6%). Hesitancy for vaccines among those who were informed by healthcare workers was as follows: shingles (97.8%), human papillomavirus (92.1%), pneumococcal (91.1%), influenza (79.7%), varicella (79.4%) and tetanus (57.6%).ConclusionsReduced vaccine uptake due to vaccine hesitancy in adulthood is a major health concern. Hesitancy was highest for the shingles vaccine and least for the tetanus vaccine.Key messagesCoverage of adult vaccination can be improved by formulating national guidelines and encouraging healthcare providers to raise awareness. In-depth qualitative studies are needed to understand the perception of adults towards vaccination.

P-37 EXPERIENCE IN MEXICO WITH DIRECT ACTING ANTIVIRALS AS A TREATMENT FOR HEPATITIS C

It is considered that globally, 71 million people have chronic infection caused by the virus of Hepatitis C (HCV). It is estimated that in 2016 approximately 399,000 people died due to it. Among the infected people 70% develop a chronic infection caused by HCV. In Mexico, it was reported that 6% of them is type C, and the most common genotype is 1. Interferon and ribavirin, hardly ever used in developed countries, are still recommended in Mexico for treating this infection. To assess the effectiveness of direct acting antivirals (DAA) in Mexican population with HC. In a retrospective, multicenter study in 20 hospitals in Mexico, information of patients with HC and treated with DAA was gathered. A total of 913 patients were included. The gender distribution was 599 women and 314 men, the mean age was 58.88 ± 12.10 years old. The most frequent genotype was genotype 1. It was found that there is 99% of sustained viral response in genotype 1. Presented side effects were slight. We found a very high SVR rate, 99%, which is why applying DAA immediately after a patient is diagnosed with Hepatitis C to avoid further complications is recommended. Core tip: In Mexico, a large sample of patients was documented, where it was concluded that DAA should be used without the fear of adverse events, and to be certain about an SVR to the most frequent genotype in our population. However, the use of pangenomic DAA must be considered.

Safety and tolerability of the novel 2019 coronavirus disease (COVID-19) vaccines among people with epilepsy (PwE): A cross-sectional study

BackgroundPeople with epilepsy (PwE) were concerned about the safety of the novel 2019 Coronavirus Disease (COVID-19) vaccines. ObjectiveThis study aimed to assess the side effects experienced by PwE following vaccination with COVID-19 vaccines and to identify the causes of vaccine hesitation. MethodsWe administered a questionnaire to PwE, who visited the epilepsy clinic at Ibn Sina Hospital in Kuwait during the first two working weeks of April 2021. It included socio-demographic, epilepsy status, and vaccination data. In addition, we asked those who were not vaccinated yet about the reasons and their plan. ResultsA total of 111 PwE were surveyed, with 82 being vaccinated and 29 being unvaccinated. Out of the 82 vaccinated, 66 (80.5%) reported at least one side effect. Patients who received the Pfizer BioNTech mRNA vaccine (BNT162b2) (first, second dosage); and the Oxford-AstraZenecaa chimpanzee adenovirus-vectored vaccine (ChAdOx1nCoV-19) (first dose) had the following reactions: Pain at the injection site (40%, 67.6%), 43.8%, fatigue (47%, 32.4%), 46.9%, Headache (33.3%, 35.3%), 34.4% and Myalgia (40%, 35%), 50% respectively. Local site effects, including pain (67.6% vs. 40%, p = < 0.001) and redness (26.5% vs 6.7%, p = 0.019), were more statistically significantly after the second dose of BNT162b2 vaccine compared to the first dose of the same vaccine. While there was no significant difference in systemic side effects frequencies between the two doses of the BNT162b2 vaccine. The systemic side effects were more statistically significantly after the first dose of ChAdOx1nCoV-19 compared to the first dose of the BNT162b2 vaccine and those included fever (56.3% vs 13.3%, p = < 0.001), chills (37.5% vs 6.7%, p = < 0.001), myalgia (50% vs 40%, p = < 0.001) and arthralgia (25% vs 6.7%, p = 0.021). The local site reactions were not significantly different between the first doses of both vaccines. Among the subgroup who had vaccine-related side effects, 66.7% were females, 90.9% were 55 or younger, 63.6% were on polytherapy, 74% had side effects for one day or less, and 95% were symptoms free by the end of the first-week post-vaccination. Symptoms were mild in 68% of the patients and moderate in 29.3%. Most patients (93.9%) did not report seizure worsening after vaccination. The relative risk of seizure worsening after the first and second doses of BNT162b2 and the first dose of ChAdOx1nCoV-19 vaccines was 1.027 (95% CI 0.891–1.183), 1.019 (95% CI 0.928-1.119), and 1.026 (95% CI 0.929–1.134) respectively. After the first dose of BNT162b2, one patient reported the development of status epilepticus. Among the non-vaccinated group, 34.9% were still indecisive, while 37.9% rejected the vaccination. Fear of adverse effects (42.9%) and fear of epilepsy worsening (23.8%) were the main reasons for vaccine hesitation. ConclusionsThis study shows that the two vaccines under consideration (BNT162b2 and ChAdOx1nCoV-19) have a good safety profile and a low risk of epilepsy worsening among a cohort of PwE in Kuwait.

Differences in Attitudes and Practices of Cancer Pain Management between Medical Oncologists and Palliative Care Physicians.

This study aimed to evaluate whether there are differences in the attitudes and practices of cancer pain manage-ment between medical oncologists and palliative care physicians. An online nationwide survey was used to collect responses from board-certified medical oncologists and palliative care physicians in Japan. The survey questionnaire comprised 30 questions. The differences in responses between medical oncologists and palliative care physicians were examined. Out of the 1,227 questionnaires sent, 522 (42.5%) were returned. After apply-ing the exclusion criteria, 445 questionnaires (medical oncologists: n = 283; palliative care physicians: n = 162) were retained for analysis. Among the questions about potential barriers to optimal cancer pain man-agement, both medical oncologists and palliative care physicians considered the reluctance of patients to take opioids due to fear of adverse effects as the greatest barrier. Significantly different ratings between medical oncologists and palliative care physicians were observed on 5 of the 8 questions in this area. Significantly differ-ent ratings were observed for all questions concerning pain specialists and their knowledge. For effective cancer pain management, it is important to account for differences in attitudes and practice between medical oncolo-gists and palliative care physicians.

Sociodemographic predictors of COVID-19 vaccine acceptance: a nationwide US-based survey study

ObjectivesAcceptance of COVID-19 vaccination is attributable to sociodemographic factors and their complex interactions. Attitudes towards COVID-19 vaccines in the United States are changing frequently, especially since the launch of the vaccines and as the United States faces a third wave of the pandemic. Our primary objective was to determine the relative influence of sociodemographic predictors on COVID-19 vaccine acceptance. The secondary objectives were to understand the reasons behind vaccine refusal and compare COVID-19 vaccine acceptance with influenza vaccine uptake. Study designThis was a nationwide US-based survey study. MethodsA REDCap survey link was distributed using various online platforms. The primary study outcome was COVID-19 vaccine acceptance (yes/no). Sociodemographic factors, such as age, ethnicity, gender, education, family income, healthcare worker profession, residence regions, local healthcare facility and ‘vaccine launch’ period (pre vs post), were included as potential predictors. The differences in vaccine acceptance rates among sociodemographic subgroups were estimated by Chi-squared tests, whereas logistic regression and neural networks computed the prediction models and determined the predictors of relative significance. ResultsAmong 2978 eligible respondents, 81.1% of participants were likely to receive the vaccine. All the predictors demonstrated significant associations with vaccine acceptance, except vaccine launch period. Regression analyses eliminated gender and vaccine launch period from the model, and the machine learning model reproduced the regression result. Both models precisely predicted individual vaccine acceptance and recognised education, ethnicity and age as the most important predictors. Fear of adverse effects and concern with efficacy were the principal reasons for vaccine refusal. ConclusionsSociodemographic predictors, such as education, ethnicity and age, significantly influenced COVID-19 vaccine acceptance, and concerns of side-effects and efficacy led to increased vaccine hesitancy.

COVID-19 Vaccination Acceptance and Hesitancy among Healthcare Workers in Germany.

Vaccination hesitancy is a threat to herd immunity. Healthcare workers (HCWs) play a key role in promoting Coronavirus disease 2019 (COVID-19) vaccination in the general population. We therefore aimed to provide data on COVID-19 vaccination acceptance/hesitancy among German HCWs. For this exploratory, cross-sectional study, an online survey was conducted in February 2021. The survey included 54 items on demographics; previous vaccination behavior; trust in vaccines, physicians, the pharmaceutical industry and health politics; fear of adverse effects; assumptions regarding the consequences of COVID-19; knowledge about vaccines; and information seeking behavior. Odds ratios with 95% confidence intervals were calculated and chi-square tests were performed. Four thousand five hundred surveys were analyzed. The overall vaccination acceptance was 91.7%. The age group ≤20 years showed the lowest vaccination acceptance. Factors associated with vaccination hesitancy were lack of trust in authorities and pharmaceutical companies. Attitudes among acquaintances were associated with vaccination hesitancy too. Participants with vaccination hesitancy more often obtained information about COVID-19 vaccines via messenger services or online video platforms and underperformed in the knowledge test. We found high acceptance amongst German HCWs. Several factors associated with vaccination hesitancy were identified which could be targeted in HCW vaccination campaigns.

Optimizing MObility for critically ill patiEnts undergoing Continuous Renal Replacement Therapy (MOvE CRRT): An audit of mobility interventions in the intensive care unit

BACKGROUND: CRRT is common in the ICU. This intervention has been shown to contribute to reduced mobilization due to fear of adverse events. This study sought to evaluate the degree of mobilization in patients receiving CRRT and to develop a procedure checklist to enhance mobilization in these patients. METHODS: A retrospective observational matched cohort audit of adult patients admitted to the General Systems ICU at the University of Alberta Hospital from April 1, 2015, and April 1, 2017 was conducted. A total of 50 CRRT patients were matched to 37 critically ill patients and their mobilization events compared. Data was analyzed descriptively. A protocolized mobilization procedure checklist was subsequently developed. RESULTS: Higher levels of mobility were achieved in patients not receiving CRRT. The highest level of mobility in CRRT patients was ambulation in 1 (2%), active mobilization in 17 (34%), passive mobilization in 13 (26%) and none in 19 (38%); whereas, in controls, the highest level of mobility was ambulatory in 22 (59%), active in 10 (27%), passive in 2 (5%) and none in 3 (8%). Four (8%) of the CRRT patients had a PT program delay attributed to CRRT. Adverse events were uncommon and unrelated to CRRT, occurring in 1 (2%) of CRRT patients and in 3 (8%) control patients. No critical adverse events occurred, and no CRRT was delayed or paused. Alarms limited or postponed treatment in 7 (14%) patients. CONCLUSIONS: Mobilization while on CRRT is feasible and safe. It is conducted less frequently and to a lesser degree when compared to similarly acute patients not receiving CRRT. A procedure checklist has been developed to improve mobilization while on CRRT that can be safely implemented in critically ill patients.

Hesitancy towards COVID-19 Vaccination among Healthcare Workers: A Multi-Centric Survey in France

Vaccination programs against COVID-19 are being scaled up. We aimed to assess the effects of vaccine characteristics on vaccine hesitancy among healthcare workers in a multi-center survey conducted within French healthcare facilities from 1 December 2020 to 26 March 2021. We invited any healthcare workers naïve of COVID-19 vaccination to complete an online self-questionnaire. They reported on their socio-demographic characteristics, as well as their perception and beliefs towards vaccination. We measured their willingness to get vaccinated in eight scenarios for candidates’ vaccines presented sequentially (1 to 4-point scale). Candidates’ vaccines varied for efficacy (25%, 50%, 100%), length of immunization (1 year or lifetime), frequency (<1/100, <1/10,000), and severity (none, moderate, severe) of adverse events. We analyzed 4349 healthcare workers’ responses with interpretable questionnaires. The crude willingness to get vaccinated was 53.2% and increased over time. We clustered the trajectories of responses using an unsupervised classification algorithm (k-means) and identified four groups of healthcare workers: those willing to get vaccinated in any scenario (18%), those not willing to get vaccinated at all (22%), and those hesitating but more likely to accept (32%) or reject (28%) the vaccination depending on the scenario. In these last two subgroups, vaccine acceptance was growing with age, educational background and was higher among men with condition. Compared to an ideal vaccine candidate, a 50% reduced efficacy resulted in an average drop in acceptance by 0.8 (SD ± 0.8, −23.5%), while it was ranging from 1.4 (SD ± 1.0, −38.4%) to 2.1 (SD ± 1.0, −58.4%) in case of severe but rare adverse event. The acceptance of a mandatory immunization program was 29.6% overall and was positively correlated to the willingness to get vaccinated, ranging from 2.4% to 60.0%. Even if healthcare workers represent a heterogeneous population, most (80%) could accept the vaccination against COVID-19. Their willingness to get the vaccine increased over time and as immunization programs became available. Among hesitant professionals, the fear of adverse events was the main concern. Targeted information campaigns reassuring about adverse events may increase vaccine coverage, in a population with a strong opinion about mandatory immunization programs.