Healthcare Provider Recommendation Research Articles

Evaluation of Patient Related Factors, the Level of Glycemic Control; and Cost of Diabetic Medications of Patients Attending Selected Public Sector Diabetic Clinics in Sri Lanka

Background: Diabetes Mellitus (DM) is a global epidemic. Globally the number of diabetic complications is increasing. Therefore, it is important to find the reasons for the escalating number of diabetic complications and associated mortality. The main objective of this study was to evaluate patients’ knowledge and level of adherence to treatments, the cost associated with diabetic medications and the level of glycemic control.Methods: This study was a pretested, structured questionnaire-based cross-sectional survey with retrospective data collection from participants’ clinic books. The questionnaire was developed to obtain data on socio-demographic variables; patients’ knowledge on disease and medicines; patients’ dietary control and adherence to the medications and non-medicinal recommendations.Results: Patients (n = 207) attending the diabetes clinics of two teaching- and two base-hospitals in Sri Lanka were taken as the sample. The majority of the participants demonstrated moderate knowledge (63%) on DM. Of the participants, 46% had moderate adherence to pharmacological and nonpharmacological recommendations of healthcare providers and 55% showed good glycemic control. The monthly average drug cost for a DM patient was 270.10 Sri Lankan Rupees (LKR). There was a significant association between participants’ knowledge and level of adherence. However, there were no significant associations between participants’ knowledge and glycemic control, or patients’ adherence and glycemic control. There was a significant knowledge gap between the patients attending Teaching- and Base-hospitals.Conclusion: The majority of the diabetic patients had either moderate or above knowledge and adherence, but their glycemic control was sub-optimal and associated with factors other than patients’ knowledge and adherence.

Parental COVID-19 Vaccine Hesitancy in Diverse Communities: A National Survey.

ObjectiveWe surveyed a diverse group of US participants to understand parental coronavirus disease 2019 (COVID-19) vaccine hesitancy.MethodsWe administered a telephone and online survey from May 7 to June 7, 2021 using stratified sampling to ensure robust sample sizes of racial and ethnic minorities. Of the 20,280 contacted, 12,288 respondents completed the survey (response rate 61%). We used chi-square tests and adjusted risk ratios to compare results by racial/ethnic group.ResultsOverall, 23% of parents stated that they plan to (or have) vaccinated their children; 30% said that they would not vaccinate their children, and 25% were unsure. Latino/a, Native American, and Asian American-Pacific Islander (AAPI) parents were generally more likely to vaccinate their children than Black or White parents. After adjusting for demographic factors, AAPI parents were significantly more likely to vaccinate their children than were others. Of parents who said that they would not vaccinate their child, 55% stated it was due to insufficient research. However, over half of parents stated that they would follow their child's health care provider's recommendations. After adjusting for demographic factors, trust in their primary care doctor was significantly lower among AAPI, Black, and Native American parents than White parents.ConclusionsParental vaccine hesitancy was similar overall, but drivers of hesitancy varied by racial/ethnic groups. While the perception that vaccines had been “insufficiently researched” was a major concern among all groups, we found that parents are generally inclined to follow health providers’ recommendations. Health professionals can play an important role in COVID-19 vaccine education and should provide access to vaccines.

COVID-19 Vaccination and Intent Among Pregnant Women, United States, April 2021.

Objectives:National data on COVID-19 vaccination coverage among pregnant women are limited. We assessed COVID-19 vaccination coverage and intent, factors associated with COVID-19 vaccination, reasons for nonvaccination, and knowledge, attitudes, and beliefs related to COVID-19 illness and vaccination among pregnant women in the United States.Methods:Data from an opt-in internet panel survey of pregnant women conducted March 31–April 16, 2021, assessed receipt of ≥1 dose of any COVID-19 vaccine during pregnancy. The sample included 1516 women pregnant any time during December 1, 2020–April 16, 2021, who were not fully vaccinated before pregnancy. We used multivariable logistic regression to determine variables independently associated with receipt of COVID-19 vaccine.Results:As of April 16, 2021, 21.7% of pregnant women had received ≥1 dose of COVID-19 vaccine during pregnancy, 24.0% intended to receive a vaccine, 17.2% were unsure, and 37.1% did not intend to receive a vaccine. Pregnant women with (vs without) a health care provider recommendation (adjusted prevalence ratio [aPR] = 4.86), those who lived (vs not) with someone with a condition that could increase risk for serious medical complications of COVID-19 (aPR = 2.11), and those who had received (vs not) an influenza vaccination (aPR = 2.35) were more likely to receive a COVID-19 vaccine. Common reasons for nonvaccination included concerns about safety risk to baby (37.2%) or self (34.6%) and about rapid vaccine development (29.7%) and approval (30.9%).Conclusions:Our findings indicate a continued need to emphasize the benefits of COVID-19 vaccination during pregnancy and to widely disseminate the recommendations of the Centers for Disease Control and Prevention and other clinical professional societies for all pregnant women to be vaccinated.

Effects of healthcare provider recommendation for genetic testing.

10601 Background: This pilot study was conducted to elucidate the barriers and drivers for genetic testing by combining validated measures to inform the content of a clinical trial aimed at increasing uptake of clinically appropriate genetic testing amongst individuals with a personal history of cancer. Previous research shows that the rate of recommendation of genetic testing varies among Healthcare Providers (HCPs) despite national guidelines. Here we evaluate the rate and effect of HCP recommendation on the uptake of clinical cancer genetic testing. Methods: Data for these analyses were obtained from a cross-sectional survey completed by 794 adults (> 18 years) who were diagnosed with cancer in the past 10 years and were seen at an academic medical center within the past two years. Statistical analysis includes logistic regression and crosstabulation with SPSS and R statistical software. Results: Provider recommendation of genetic testing was found to be a very strong indicator of receiving genetic testing across all cancer types (OR = 146.4, p = <.001). HCPs more frequently recommended genetic testing to females (OR = 12.5, p = <.001), younger patients (OR = 1.05, p = <.001). While females are more likely to receive a recommendation, there were no significant differences on genetic testing uptake when a HCP recommended it for any gender. Conclusions: Without the recommendation of their provider, patients were significantly less likely to receive genetic testing that could affect their cancer treatment, surveillance, or family members. More aggressive patient health education is needed in cancer affected patients to decrease knowledge deficits and increase motivation for cancer genetic testing uptake. Education to providers regarding genetic testing recommendation guidelines could increase motivation to refer patients for genetic testing and counseling.

Factors that Influence Healthcare Provider Recommendation of HPV Vaccination.

Purpose: This study examined factors associated with healthcare providers' (HCPs') recommendation of HPV vaccination for younger and older adolescents. Methods: This is a cross-sectional study, using web-based survey of HCPs in New Jersey in 2018. The study outcome was a dichotomous measure of HCPs' recommendation of the HPV vaccine. The study predictors included practice characteristics (i.e., proportions of race/ethnicity, age groups, insurance type, and VFC recipients) and HCP's characteristics (i.e., specialty and perceived knowledge, effectiveness, concerns, parent- and system-related barriers, and facilitators). Data analysis included logistic regression models using separate blocks for practice and provider characteristics, followed by a backward stepwise approach to determine the surviving predictors. Results: Respondents (N=390) included physicians (75%) and nurse practitioners (25%), specialized in pediatrics (62%), family medicine (20%), and women's health (18%). The HCPs' recommendation rates for HPV vaccination were 56% for younger adolescents (11-13years old) and 73% for older adolescents (14-17years old). For younger adolescents, the recommendation rates were significantly higher in practices with higher proportions of younger adolescent, Black and Hispanic patients; among pediatric providers; and with HCPs' higher levels of knowledge and lower levels of concern about the vaccine. For older adolescents, the rates were significantly higher in practices with higher proportions patients who are Hispanic, privately insured, and VFC recipients; among pediatric providers; and with HCPs' higher levels of knowledge and lower levels of concern about the vaccine as well as higher levels of facilitators for recommending the HPV vaccine. Conclusions: Interventions targeting HCPs need to focus on improving their knowledge regarding the vaccine, reduce their concerns around its safety, and utilize facilitators strategies, particularly among non-pediatric providers.

Barriers toward Colorectal Cancer Screening among Public in Saudi Arabia

Colorectal cancer incidence has increased significantly in Saudi Arabia in the last few years. Although protocols and guidelines for colorectal screening programs had been established to start at age 45, adherence to screening remains low. This review aims to identify the potential barriers to participating in the screening program among the public aged over forty-five in Saudi Arabia. A significant lack of awareness about colorectal cancer and screening programs had found among Saudi Arabia's public (SA). The acceptance rate significantly increased due to health care provider recommendations. Knowledge about colorectal cancer and screening program and outcome should be raised among the public through campaigns and physicians by training established for primary health care providers regarding screening programs recommendations.

Understanding the Factors Influencing Health Care Provider Recommendations about Adolescent Vaccines: A Proposed Framework.

Health care provider recommendations are among the most important factors influencing parents’ decisions to vaccinate their adolescents. However, delivery of high-quality health care provider recommendations for vaccination is not universal. There is wide variation in the strength, timeliness and consistency of the delivery of recommendations for all adolescent vaccines. The factors that influence health care providers’ recommendations are multi-level and can be conceptualized in much the same way as vaccine acceptance among parents. Health care providers are influenced by their own attitudes and beliefs about a vaccine and also by the patient they are treating and by the community in which they practice as well as state and national level vaccine policy. We propose a multi-level framework for understanding the factors that influence health care providers’ recommendations at the individual, interpersonal and community level to both develop and adapt interventions to improve providers’ recommendations.

Attitudes toward year-round influenza vaccination in pregnant women.

Influenza virus circulates year-round, yet uptake of maternal influenza vaccination decreases outside of influenza season. This prospective study of 62 pregnant women provides insight into the possible underlying reasons for this. Despite knowledge of benefits for maternal and infant outcomes, we observed a lack of understanding of rates of influenza infection outside influenza season, concerns about safety in relation to receiving multiple vaccinations during the same pregnancy, and lack of healthcare provider recommendation to be vaccinated outside influenza season. These findings can help tailor public health education targeting pregnant women and their healthcare providers to improve influenza vaccine uptake.

Patient Adherence to Health Care Provider Recommendations and Medication among Free Clinic Patients.

Patient adherence is vital for the quality of health care outcomes and treatment efficacy, and reduces the economic burden on the healthcare system. The purpose of this study was to examine factors associated with levels of general adherence among uninsured free clinic patients. This was a cross-sectional study using a convenience sample of free clinic patients aged 18 years and older who spoke English and/or Spanish. Descriptive statistics and multiple regression were performed to understand sociodemographic characteristics and factors associated with higher levels of general adherence. A higher level of general adherence were significantly associated with younger age (P < .01), levels of adherence to lifestyle recommendations (P < .01), and medication (P < .01). Having attended health education classes and having a primary care provider were not associated with levels of general adherence.This study suggested that a lower level of general adherence exists among elderly patients of the free clinic. In this light, providers need to consider unique strategies to enhance the provider-patient relationship by understanding patient's characteristics and providing sufficient information and explanation for treatment and medication.

COVID-19 and missed or delayed vaccination in 26 middle- and high-income countries: An observational survey

BackgroundThe COVID-19 pandemic has disrupted vaccination services and raised the risk of a global resurgence of preventable diseases. We assessed the extent of and reasons for missed or delayed vaccinations (hereafter ‘missed’) in middle- and high-income countries in the early months of the pandemic. MethodsFrom May to June 2020, participants completed an online survey on missed vaccination. Analyses separated missed childhood and adult vaccination in middle-and high-income countries. ResultsRespondents were 28,429 adults from 26 middle- and high-income countries. Overall, 9% of households had missed a vaccine, and 13% were unsure. More households in middle- than high-income countries reported missed childhood vaccination (7.6% vs. 3.0%) and missed adult vaccination (9.6% vs. 3.4%, both p < .05). Correlates of missed childhood vaccination in middle-income countries included COVID-19 risk factors (respiratory and cardiovascular diseases), younger age, male sex, employment, psychological distress, larger household size, and more children. In high-income countries, correlates of missed childhood vaccination also included immunosuppressive conditions, but did not include sex or household size. Fewer correlates were associated with missed adult vaccination other than COVID-19 risk factors and psychological distress. Common reasons for missed vaccinations were worry about getting COVID-19 at the vaccination clinic (15%) or when leaving the house (11%). Other reasons included no healthcare provider recommendation, clinic closure, and wanting to save services for others. InterpretationMissed vaccination was common and more prevalent in middle- than high-income countries. Missed vaccination could be mitigated by emphasizing COVID-19 safety measures in vaccination clinics, ensuring free and accessible immunization, and clear healthcare provider recommendations.

Report of Health Care Provider Recommendation for COVID-19 Vaccination Among Adults, by Recipient COVID-19 Vaccination Status and Attitudes - United States, April-September 2021.

Vaccination is critical to controlling the COVID-19 pandemic, and health care providers play an important role in achieving high vaccination coverage (1). To examine the prevalence of report of a provider recommendation for COVID-19 vaccination and its association with COVID-19 vaccination coverage and attitudes, CDC analyzed data among adults aged ≥18 years from the National Immunization Survey-Adult COVID Module (NIS-ACM), a nationally representative cellular telephone survey. Prevalence of report of a provider recommendation for COVID-19 vaccination among adults increased from 34.6%, during April 22-May 29, to 40.5%, during August 29-September 25, 2021. Adults who reported a provider recommendation for COVID-19 vaccination were more likely to have received ≥1 dose of a COVID-19 vaccine (77.6%) than were those who did not receive a recommendation (61.9%) (adjusted prevalence ratio [aPR]=1.12). Report of a provider recommendation was associated with concern about COVID-19 (aPR=1.31), belief that COVID-19 vaccines are important to protect oneself (aPR=1.15), belief that COVID-19 vaccination was very or completely safe (aPR=1.17), and perception that many or all of their family and friends had received COVID-19 vaccination (aPR=1.19). Empowering health care providers to recommend vaccination to their patients could help reinforce confidence in, and increase coverage with, COVID-19 vaccines, particularly among groups known to have lower COVID-19 vaccination coverage, including younger adults, racial/ethnic minorities, and rural residents.

The impact of publicly funded immunization programs on human papillomavirus vaccination in boys and girls: An observational study

Reaching and maintaining high global human papillomavirus (HPV) vaccine uptake has been challenging. The impact of publicly funded HPV immunization programs and the interplay of sociodemographic, psychosocial and policy factors in maximizing vaccination is poorly understood. This observational study examined the impact of introducing publicly funded school-based HPV vaccination programs for boys directly on uptake in boys and indirectly on uptake in girls, while concurrently examining other important sociodemographic and psychosocial factors. Data were collected from a national, longitudinal sample of Canadian parents of children aged 9-16 years during August-September 2016 (T1) and June-July 2017 (T2). Participants completed an online questionnaire measuring sociodemographic characteristics, vaccine knowledge and attitudes, health care provider recommendation, and HPV vaccine uptake. Analyses were conducted separately for parents of boys and girls using logistic regression analyses at T1 and T2. Jurisdictions with HPV vaccine funding for boys at both time-points were compared to those with funding at neither time-points and those that introduced funding between time-points. The sample included parents of boys (n=716) and girls (n=843). In multivariable analyses, jurisdictions with funding for boys at both time-points had higher odds of vaccination (adjusted odds ratio, T1 = 10.18, T2 = 11.42; 95% confidence interval, T1 = 3.08-33.58, T2 = 5.61-23.23) than jurisdictions without funding at both time-points; however, funded jurisdictions did not have higher odds of vaccination compared to jurisdictions that newly introduced funding for boys. Vaccination was associated with consistent determinants in boys and girls including child's age, health care provider recommendation, perceived vaccine harms, and perceived vaccine affordability. This gender-sensitive analysis highlights the interplay of sociodemographic, psychosocial, and policy factors that can improve HPV vaccination. Publicly funded school-based programs are an impactful strategy to increase vaccine uptake. This work was supported by the Canadian Cancer Society Research Institute (#704,036). GKS was supported by the Vanier Canada Graduate Scholarship and Queen Elizabeth II Diamond Jubilee Scholarship programs. The funders of this work had no role in the data collection, analysis, or interpretation, or any aspect pertinent to the study.

Provider Recommendations and Maternal Practices When Providing Breast Milk to Children With Immunoglobulin E-Mediated Food Allergy

To evaluate health care provider recommendations and the breastfeeding dietary practices of mothers with a child who has immunoglobulin E (IgE)-mediated food allergy.The study participants were recruited from online social media groups for breastfeeding mothers or mothers of children with food allergies.The study included a Web-based survey with the following initial questions as inclusion criteria: having a child diagnosed with an IgE-mediated food allergy by a health care provider before 2 years of age, confirmation of food allergy with blood or skin testing, listing of specific food(s) to which the child is allergic in the survey, confirmation of food allergy by an allergist, and consumption of breast milk before the child’s diagnosis. With the survey, the researchers then explored the mother’s consumption of food to which the child has an allergy (while breastfeeding), and, if present, reported possible allergic reactions were rated by a board-certified allergist on a scale of 1 (highly inconsistent) to 5 (highly consistent) with an IgE-mediated reaction.A total of 133 mothers completed the survey. A total of 47.4% (n = 63) of mothers reported their health care provider encouraged them to continue breastfeeding without dietary restrictions, 17.3% (n = 23) were advised to continue breastfeeding but avoid eating the food(s) their child has an allergy to, and 28.6% (n = 38) stated this issue was not addressed. A total of 88% (n = 117) of mothers noticed no allergic reaction in their child while consuming the food their child has an allergy to, and 12% (n = 16) believed their child had a possible allergic reaction. Of the 16 who reported reactions, only 4 were “likely consistent” with an IgE-mediated reaction, most of which were mild. The remaining reported reactions were inconsistent with an IgE-mediated reaction. All 4 mothers completely eliminated the food(s) from their own diet while continuing to breastfeeding their child.This study reveals the inconsistencies in counseling provided by health care providers to breastfeeding mothers of children with IgE-mediated food allergy. Most mothers were able to consume the food their child was allergic to while breastfeeding without adverse sequelae.With this study, the authors highlight the need for further research and unification of recommendations provided to breastfeeding mothers of children with food allergies. Strict avoidance of food allergens by breastfeeding mothers may not be warranted. If reactions are reported, a thorough history should be performed to determine if it is consistent with an IgE-mediated reaction before recommending avoidance in the mother’s diet.

Impact of Socio–Economic, Health and Patient Related Factors on Medication Adherence in Patients with Hypertension and Type II Diabetes

Background: Adherence to therapies is a primary determinant for treatment success in chronic diseases. Despite increased awareness, poor adherence to treatments for chronic diseases still remains a global problem. Failure to adherence, seriously affects the patient and the health care system.&#x0D; Aim: The main purpose of this study was to evaluate the level of drug adherence in patients with hypertension and type II diabetes. A prospective cross sectional study was carried out in tertiary care hospitals of Khammam region, Telangana with a size of 2880 patients. A structured questionnaire has been designed using MMAS 8 scale to determine the compliance level and the socioeconomic status of the objects was analyzed by Kuppuswamy scale. &#x0D; Results: In our study, the following results were reported, age (P &lt;0.001), gender (P &lt;0.001, OR = 1.954), residence (P &lt;0.0001, OR = 3.102), level of education (P &lt;0.0001), profession (p &lt;0.0001), net monthly income (P &lt;0.001), socio economic class (P &lt;0.001), medication Costs (P &lt;0.001 OR = 0.2346), Health Literacy (P &lt;0.001, OR =0.2051), Social support (P &lt;0.001, OR =3.549, 95% CI=2.701 to 4.649). Frequency of Visits (P &lt;0.001, OR =0.09421), No of medications (P &lt;0.001, OR =0.2506), Complexity (P &lt;0.001, OR =0.1862), Self-Monitoring (P &lt;0.001, OR = 0.1011), felt worse (p&lt;0.0001,OR=0.1591).&#x0D; Conclusion: Our results showed that demographic variables, socio economic factors, health care factors had direct influence on medication adherence. Illiterates, lower-economy patients have not followed the recommendations of health care providers who insist on the need to increase drug adherence in primary care. Our findings call for the need to design new interventions on multidimensional factors likely to interfere with this study, such as patient knowledge and information to improve compliance.

Beyond words: Parental perceptions on human papilloma virus vaccination recommendations and its impact on uptake

The goal was to evaluate how provider recommendations regarding Human Papillomavirus (HPV) vaccination impact uptake in a rural setting. The study used a cross-sectional, population-based design with cluster sampling to survey parents/guardians of children ages 9 to 18 in 2019 in Alabama. In addition to demographics/knowledge questions, participants were asked about type of healthcare provider recommendation and impressions they had from this interaction. The primary outcome variable was the result of the healthcare provider recommendation with options including: child got vaccinated day of recommendation, HPV vaccination was scheduled, or HPV vaccination was not scheduled. Bivariate analysis and multinomial logistic regression were performed. Of the 358 respondents, approximately 40% indicated receiving a recommendation from a provider to vaccinate their child. Age of the parent, race/ethnicity, educational attainment, and health insurance coverage were similar across groups. Female parents were more likely to report receiving HPV vaccination recommendation than males (44.1% vs. 23.3%; p = 0.009). The type of provider recommendation was not significantly associated with HPV vaccination uptake. The impression from the recommendation of HPV vaccination being “important” was significantly associated with the child being vaccinated that day (OR = 7.31, 95% CI = 2.20–24.3) as well as scheduling HPV vaccination (OR = 3.17, 95% CI 1.01–9.92). Parents who got the impression that “there was no hurry” were less likely to vaccinate their child that day (OR = 0.23, 95% CI = 0.09–0.59). Provider recommedation is well-established as a significant predictor of HPV vaccination, these findings indicate that how the recommendation is perceived may play a more important role in HPV vaccination uptake.

Providers PrEP: Identifying Primary Health care Providers' Biases as Barriers to Provision of Equitable PrEP Services.

Despite their disparately high HIV incidence and voiced willingness to use pre-exposure prophylaxis (PrEP), Black cisgender women's knowledge and uptake of PrEP are low, especially relative to White cisgender women and men who have sex with men. Mounting evidence demonstrates that health care provider recommendations are a critical factor in women's awareness, willingness, and ability to uptake PrEP. Health care providers may make clinical judgments about who is (not) a good candidate for PrEP based on unconscious and conscious stereotypes and prejudice. We conducted an online experiment among N = 160 health care providers with prescribing privileges in the 48 HIV hotspot counties. Providers received 1 of 4 vignettes about a PrEP eligible woman. Vignettes varied by patient race and substance use status. Then, providers reported their willingness to discuss PrEP with the patient and willingness to prescribe PrEP to her. We tested 2 models predicting providers (1) willingness to discuss and (2) willingness to prescribe PrEP, contingent on their racial attitudes. Providers who scored high on a modern racism measure were less willing to discuss and prescribe PrEP to the Black patient. These effects were mediated by provider perceptions of patients' abilities to adhere to PrEP, but not their expectations of risk compensatory behaviors. Our findings highlight the importance of applying an intersectional lens in documenting the processes that exacerbate inequities in PrEP use. This study provides evidence to support the development of interventions that address the mechanisms that work to thwart optimal care.

Vaccination in pregnancy: Challenges and evidence-based solutions

Vaccination in pregnancy (VIP) is dually beneficial - it protects the mother and the baby from tetanus, influenza, and pertussis. VIP uptake is low in many countries. Vaccine hesitancy, defined by the World Health Organization (WHO) as a "delay in acceptance or refusal of vaccination despite the availability of vaccination services" is one of WHO's ten threats to global health per 2019. According to extensive research, mostly from high-income countries (HIC) and limited to tetanus, influenza and pertussis vaccines, lack of provider recommendations, safety concerns, and limitations in access are the main barriers to VIP. Health care provider recommendation is the leading facilitator for VIP across various socioeconomic status groups. Data on strategies to overcome patient, provider, and system barriers to VIP are inconsistent, contradictory, or lacking. Patient-focused research on evidence-based strategies to overcome provider and system barriers is needed. Furthermore, VIP programs require embedded continuous quality improvement to ensure sustainability.

National predictors of influenza vaccine uptake in pregnancy: the FluMum prospective cohort study, Australia, 2012–2015

ObjectiveAscertain predictors of inactivated influenza vaccine (IIV) uptake in pregnancy in mother–infant pairs from six Australian sites over four consecutive influenza seasons (2012–2015). MethodsProspective observational cohort study calculating proportions of unvaccinated and vaccinated pregnancies. Multivariable logistic regression calculating adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) to determine demographic, pregnancy and birth characteristics as predictors of IIV uptake in pregnancy. ResultsUptake of IIV was 36% (n=3,651/9,878) with only 3–4% during the first trimester. Validation of IIV receipt was obtained for 77% of vaccinated participants. Predictors of IIV uptake in pregnancy were: healthcare provider recommendation to have IIV during pregnancy (aOR 7.04 [95%CI 5.83‐8.50]): GP (aOR 4.12 [95%CI 3.43‐4.98]), obstetrician (aOR 4.41 [95%CI 3.45‐5.64]), midwife (aOR 1.88 [95%CI 1.51‐2.36]); previous IIV within 12 months of their current pregnancy (aOR 2.87 [95%CI 2.36‐3.50]); and pertussis vaccination during the current pregnancy (aOR 4.88 [95%CI 4.08‐5.83]). Conclusions and implications for public healthHealthcare provider discussions with pregnant women about the risks associated with influenza infection during pregnancy and early infancy and evidence about the safety and effectiveness of IIV are required. Recommending and offering IIV in pregnancy needs to be included in these discussions to improve uptake.

Perceptions of Infertility and Semen Analysis Testing Among American Men Without Children

ObjectiveTo determine whether health-conscious men are more likely to be concerned about infertility and self-initiate semen analysis at a laboratory/clinic or through a direct-to-consumer at-home product without a health care provider recommendation. MethodsCross-sectional survey conducted online via ResearchMatch.org between November 2019 and January 2020. Men age 18 and older without children (n = 634) were included for analysis. Outcomes were likelihood of self-initiating a semen analysis, prevalence of infertility concern. ResultsOf the 634 participants, 186 expressed concern about infertility but only 29% were likely to discuss these concerns with a health care provider. More men would self-initiate a semen analysis using an at-home product than through a traditional laboratory/clinic (14.2% vs 10.4%, P = .04). Odds of self-initiating a traditional semen analysis were higher for men concerned about low testosterone (odds ratio [OR] 2.30, 95% confidence interval [CI] 1.12-4.74, P = .023) and infertility (OR 3.91, 95% CI 2.14-7.15, P <.001). Self-initiating an at-home semen analysis was associated with concern for low testosterone and infertility as well as middle age (age 40-59: OR 3.02, 95% CI 1.16-7.88, P = .024) and fitness tracker use (OR: 1.95, 95% CI 1.12-3.39, P = .018). ConclusionMany men were unlikely to discuss infertility concerns with a health care provider. Middle aged men and those who used fitness trackers were more likely to self-initiate fertility evaluation through at-home semen analysis. Concern about low serum testosterone was pervasive and strongly associated with concern for being infertile and self-initiating a semen analysis of any kind.

Education Regarding and Adherence to Recommended Nutrition Guidelines among Dental Students.

The Dietary Guidelines for Americans (DGA) were developed to reduce or prevent many types of chronic illness, including cancer, heart disease and diabetes. Healthcare provider recommendations may be influenced by understanding of and adherence to the DGA, which may be incorporated into provider training, medical and dental clinical curricula—although few studies have evaluated adherence to the DGA among dental students. This approved retrospective study of voluntary student responses from a first-year dental school nutrition course included a short dietary and exercise survey administered as part of the DGA learning module. A total of N = 299 students completed the voluntary nutrition survey, yielding a response rate of 91.4%. Daily fruit and vegetable intake, dairy and whole grain servings among UNLV-SDM students were significantly lower than the DGA recommendations but higher than U.S. averages for 18–30-year-olds—although neither group met DGA recommendations. This study represents one of the first to evaluate the dietary intake of U.S. dental students for comparison with the DGA for positive health behaviors. These data demonstrate a lack of adherence to the DGA among highly educated dental students and the need for the curricular inclusion of diet and nutrition into the dental school curriculum.