High Refusal Rate Research Articles

Evaluate a comprehensive geriatric assessment service framework targeting frail older people who had high risk of requiring long-term care services in Japan: a community-based pilot study

BackgroundFrailty has become a key concern in an aging population. A comprehensive geriatric assessment (CGA) service framework was developed and evaluated aiming to target and connect frail older adults who are at high risk of requiring long-term care services.MethodsA community-based pilot study was conducted in fiscal year 2016 and 2017 in Kure city, Hiroshima, Japan. Participants aged 65 and over living in Kure city, and 393 persons were extracted from the Kihon Check List (KCL) responses. Among the eligible individuals, 101 consented to participate and received CGA and referred to services based on individual health needs. The efficacy was evaluated by referral rate of services, continuity of the service usage, evaluation of participant’s health condition and the quality of life (QoL) after the 6-month follow-up.ResultsNinety-nine (98.0%) participants needed support for the instrumental activity of daily living, 97 (96.0%) were categorized as locomotive syndrome, and 64 (63.4%) had a depressive tendency. Afterward, 60 participants (59.4%) subsequently accepted the referral services, however, 34 (33.7%) used the services and the remaining 26 (25.7%) did not use the services. The health condition improvements in the service-uses group were statistically significant (p < 0.001), however, QoL score did not change between the baseline and 6th -month.ConclusionKCL extracted high-risks older people, and CGA revealed related diseases and health conditions. However, the high refusal rate of referral services indicates a necessity to modify the service framework such as by collaborating with community general support centers, which could increase the efficacy of service framework.

Kish grid vs birthday procedures: survey refusal rates by the type of within-household selection procedure in the European Social Survey

Two approaches to within-household selection of target respondents dominate cross-national surveys of the general population: the Kish grid and birthday procedures. The Kish grid is a rigorous probabilistic approach expected to produce higher-quality samples. However, its requirement to construct a complete household register is intrusive and may increase refusals. Conversely, birthday procedures, which do not require a household roster, may result in fewer refusals at the cost of lower sample quality. Our paper examines the impact of within-household selection procedures on refusal rates based on a methodological inventory of 120 national surveys from nine rounds of the European Social Survey (2002–2018). Controlling for the implementation of incentives for respondents, the experience of the interviewer teams and the country’s level of economic development, we find that surveys using the Kish grid have higher refusal rates before or during the selection process compared to surveys involving birthday procedures, suggesting that the use of the Kish grid is perceived as more intrusive for household members than birthday procedures. However, we find no significant difference between the two selection procedures regarding respondent refusals and total refusals.

Some psychometric properties of the school refusal assessment scale–revised: Parent and child version in Tanzanian context

Considering the increase in primary and secondary school dropout rates worldwide, it is necessary to identify the underlying causes, particularly in places with high school refusal rates, such as Tanzania. Today, only a limited number of studies can explain, through valid and reliable measurements, why students in Tanzania refuse to attend school. The current study used confirmatory factor analysis techniques to investigate some psychometric properties of the child’s and parent’s versions of the School Refusal Assessment Scale–Revised (SRAS–R) in the Tanzanian population. Since previous studies found significant associations between the parent–child relationship and the risk of school refusal, we included the associations between the SRAS–R scales and measures of psychological control (parent ratings) and parent–child communication (child ratings) as external validity criteria. We collected data from five public primary schools, including 502 grades three to seven children with their parents (N = 465) in Ruvuma, Tanzania. Confirmatory factor analyses revealed that the four–factor model (avoidance of stimuli provoking negative affectivity, escape from aversive social situations, attention seeking, and tangible rewards) showed a good fit for both the parent and child versions of the SRAS–R. In line with expectations, we found a negative association between parent–child communication and school refusal and positive associations between the parent version of the SRAS–R subscales and the psychological control scale. The findings of this study support the use of this measurement in an African context and Tanzania specifically. The discussion stresses the appropriateness of Western cultural instruments in the African context.

Voice Disorder Prevalence and Vocal Health Characteristics in Children

Voice disorders impede communication and limit quality of life for many children. However, research demonstrating the prevalence of pediatric voice problems and associated voice use patterns is scarce. This investigation examined the prevalence of voice problems and vocal health characteristics of school-aged children. To examine the prevalence of voice problems in school-aged children throughout the US with reference to lifestyle, demographic characteristics, and voice use patterns. This study used a cross-sectional design to survey a probability sample of caregivers of children aged 4 to 12 years living throughout the US in 2023. Caregivers were surveyed regarding their children's voice use, voice symptoms, voice problems, extracurricular activities, and demographic information. Caregivers also competed the Pediatric Voice-Related Quality of Life questionnaire. The Fisher exact test, χ2 tests, and logistic regression were used to compare children with and without voice problems. Overall, 6293 panelists were invited to complete screening questions for the survey, and 1789 individuals were screened for eligibility between March and April 2023. Of these, 1175 parents (65.7%) completed the survey. Twenty-one (1.8%) were excluded for a combination of either high refusal rates (n = 16), speeding (n = 2), or straight lining (n = 12). The final number of participants included in analysis was 1154 caregivers of children aged 4 to 12 years (559 female children [48.4%]; 595 male children [51.6%]; mean [SD] age, 8.02 [2.49] years). The prevalence of voice problems in children was 6.7% (n = 78), and the lifetime prevalence was 12% (n = 138). Benign vocal fold lesions was the most common diagnosis underlying voice complaints, and other causes included respiratory illness, allergies, autism-related voice issues, and other neurological conditions. Risk factors for pediatric voice problems included being male (odds ratio [OR], 1.47; 95% CI, 1.0-2.1), having more than 4 individuals living in the household (OR, 2.30; 95% CI, 1.2-4.4), poor speech intelligibility (OR, 2.26; 95% CI, 1.2-4.3), maternal history of voice problems (OR, 4.54; 95% CI, 1.2-16.4), participating in online gaming (OR, 1.56; 95% CI, 1.0-2.3), and secondhand smoke exposure (OR, 1.7; 95% CI, 1.1-2.6). Voice use-related risk factors included frequent talking, coughing, throat clearing, tantrums/crying, and vocal strain. Voice problems were associated with substantially detracted quality of life as measured by the Pediatric Voice-Related Quality of Life questionnaire, limited social/extracurricular interactions, increased school absences, and negative attention from adults. The results of this survey study suggest that pediatric voice problems are relatively common and detract from quality of life. Specific environmental and behaviorial factors are associated with increased risk for voice disorders.

Refusal of treatment among HER2-positive breast cancer patients in China: a retrospective analysis.

There is a need to update the understanding of treatment refusal among cancer patients in China, taking into account recent developments. This study investigated how public insurance coverage of the first breast cancer targeted therapy contributed to the changes in treatment refusal among HER2-positive breast cancer patients in China. And it intensively examined and discussed additional barriers affecting patient utilization of innovative anticancer medicines based on the types and reasons for treatment refusal. This retrospective study included female breast cancer patients diagnosed as HER2-positive who received treatment at a provincial oncology center in southern China between 2014 and 2020. Multivariable analysis was conducted using a binary logistic regression model. Subgroup analysis was performed with the same regression model. Among the 1,322 HER2-positive breast cancer patients who received treatment at the study hospital between 2014 and 2020, 327 (24.55%) had ever refused treatment. Economic reasons were reported as the primary cause by 142 patients (43.43%). Patients diagnosed after September 2017, when the first breast cancer targeted therapy was included in the public health insurance, were less likely to refuse treatment (OR = 0.64, 95% CI:0.45 ~ 0.91, p = 0.01) compared to those diagnosed before September 2017. Patients enrolled in the resident health insurance were more likely to refuse treatment (OR = 2.43, 95% CI:1.77 ~ 3.35, p < 0.001) than those enrolled in the employee health insurance. This study reveals a high rate of treatment refusal among HER2-positive breast cancer patients, primarily attributed to financial factors. The disparity in public health insurance benefits resulted in a heavier economic burden for patients with less comprehensive benefits. Furthermore, the study identified challenges faced by patients seeking quality-assured cancer care in underdeveloped regions in China. By addressing economic barriers, promoting accurate health information, and improving cancer care capacity across the country can reduce the rate of treatment refusal.

Tracking the structure and sentiment of vaccination discussions on Mumsnet

Vaccination is one of the most impactful healthcare interventions in terms of lives saved at a given cost, leading the anti-vaccination movement to be identified as one of the top 10 threats to global health in 2019 by the World Health Organization. This issue increased in importance during the COVID-19 pandemic where, despite good overall adherence to vaccination, specific communities still showed high rates of refusal. Online social media has been identified as a breeding ground for anti-vaccination discussions. In this work, we study how vaccination discussions are conducted in the discussion forum of Mumsnet, a UK-based website aimed at parents. By representing vaccination discussions as networks of social interactions, we can apply techniques from network analysis to characterize these discussions, namely network comparison, a task aimed at quantifying similarities and differences between networks. Using network comparison based on graphlets—small connected network subgraphs—we show how the topological structure of vaccination discussions on Mumsnet differs over time, in particular before and after COVID-19. We also perform sentiment analysis on the content of the discussions and show how the sentiment toward vaccinations changes over time. Our results highlight an association between differences in network structure and changes to sentiment, demonstrating how network comparison can be used as a tool to guide and enhance the conclusions from sentiment analysis.

Knowledge about Cervical Cancer Prevention and Screening in Women with Cervical Cancer Attending Gynecological Services in Southern Mozambique.

Mozambique has high rates of cervical cancer and cancer-related deaths among women. A high rate of refusal and low acceptance of treatment is observed among cervical cancer patients. The extent of their knowledge of the disease is unknown. To assess knowledge about this disease (prevention, risk factors, and the possibilities of early diagnosis) in women with cervical cancer attended in gynecological services in Gaza province, Mozambique. This cross-sectional study took place in the city of Xai-Xai at the Provincial Hospital of Xai-Xai (HPXX) in the southern province of Gaza (Mozambique). Non-probability convenience sampling was used. Eligible patients (women) aged 35-50 years, diagnosed with cervical cancer and followed at the HPXX in the second quarter of 2021 (n = 60), took part in the survey during their scheduled consultations. Descriptive statistics were calculated using SPSS statistical software (version 16). The study included 60 women, 39 (65%) HIV positive. More than half (55.0%) believed that having a single sexual partner was an effective form of prevention; 50.0% reported that excessive alcohol consumption and having many sexual partners could cause the disease, and 46.7% affirmed that having many children increased the risk. Thirty-eight (63.3%) women reported that early diagnosis of cervical cancer was important for receiving prompt treatment, and 54 (90.0%) said regular visits to the gynecologist were important for an early diagnosis. Thirty-five (58.3%) mentioned acetic acid screening as a diagnostic test. There are significant gaps in awareness of cervical cancer among high-risk groups.

COVID-19 vaccination acceptance (uptake, hesitancy, intention to receive and timeliness of the intention to receive) and the determinants among health workers in Ebonyi state, Nigeria: an analytical cross-sectional study

ObjectivesHealth workers are at particular risk of contracting the COVID-19. However, non-acceptance of COVID-19 vaccination has been a noticeable challenge the world over and in Nigeria where supply constraints have...

The Effectiveness of Diabetes Conversation Map™ among Insulin Refusal Type 2 Diabetes Mellitus Patients

INTRODUCTION: Majority of patients with type 2 diabetes mellitus (T2DM) will eventually need insulin therapy to optimise their blood glucose level. However, there is difficulties in initiating an insulin therapy due to high refusal rate among these patients. Diabetes Conversation Maps (DCM), a tool designed to educate patients with diabetes and their family members is available in Malay language since 2008. Although DCM has been used in certain centres in Malaysia, their effectiveness has not been evaluated. Thus, we have conducted a study to assess effectiveness of DCM compared to standard counselling therapy in T2DM patients who initially refused insulin therapy by assessing acceptance rate post intervention. MATERIALS AND METHODS: A randomized control study was conducted on 88 adults T2DM patients who initially refused insulin therapy in primary care clinics in Johor. A total of 44 patients received group based education using a Malay version DCM whereas another 44 patients received standard individual education. Results were analysed using a Chi-square analysis and the significant result was set at p value of &lt; 0.05. RESULTS: The response rate was 97.7% and there was a significant difference in insulin acceptance between these two groups. Eighty-six percent of T2DM patients in the intervention group education eventually accepted insulin initiation compared to only 11% in the control group (p &lt; 0.001).CONCLUSION: Group education using Malay Diabetes Conversation Map on insulin initiation is effective in increasing acceptance among patients who initially refuse insulin treatment in primary care. We recommend using DCM as part of educational module to improve patient diabetic management.

CARC18: Donor Heart Refusal Following Circulatory Death: An Analysis Of UNOS Refusal Codes

Purpose: Due to the severe shortage of donor hearts, many patients with end-stage cardiac disease die before receiving potentially lifesaving transplantation. In the past, heart donation was restricted to donation after brain death (DBD). Utilizing hearts following controlled donation after circulatory determined death (DCD) is a promising development that could significantly increase the number of hearts available for transplantation. Recent studies demonstrate that survival following transplantation of controlled DCD hearts achieves results similar to transplantation using DBD hearts. Currently, the majority of DCD hearts are discarded because most do not meet the strict criteria required for controlled DCD. Of those that meet controlled DCD criteria, the majority are still refused by the recipient institutions. We sought to explore this discrepancy and characterize the reasons that institutions refuse hearts that appear to meet controlled DCD criteria. Methods: All United Network for Organ Sharing (UNOS) refusal codes used for both DCD and DBD donors in the United States for the years 2021 and 2022 were compiled and analyzed. Rates of donor heart refusal were compared using a Z-test. Odds ratios (OR) with 95% confidence intervals (CI) were calculated to characterize the basis for DCD heart refusal. Results: During the study period 83.3% (2,578/3,094) of potential DCD hearts were declined for transplantation, while 35.5% (3,770/10,610) of potential DBD hearts were declined (p<0.01). Specifically, in 2022 refusal code data demonstrated that DCD hearts were more likely to be declined due to prolonged warm ischemic time than DBD hearts (OR 2.781; 95% CI, 4.253-1.818; p<0.01) and more likely to be declined due to organ preservation concerns (OR 1.612; 95% CI, 2.044-1.272; p<0.01). The most frequently used refusal code for DCD hearts was neurological function. In 2022, 29% (24,989/86,196) of all DCD refusals were attributed to neurological function, presumably because retained neurological function prolonged the period of warm ischemia. Conclusion: The high DCD refusal rates do not appear to align with previous publications showing that results following transplantation of controlled DCD hearts are similar to DBD. Further analysis of transplant recipient team criteria that result in DCD heart refusal should be considered. Understanding and addressing the specific reasons for refusal may substantially increase the number of donor hearts available for transplantation.

The The Scarcity of Organ Donors in Chile: How ER and ICU Professionals Can Make a Difference

Background: Despite appropriate legislation and adequate financial coverage, organ donation rates in Chile remain low. Experts blame high familial refusal rates, while dismissing the effect of procurement process inefficiencies. Our objective is to study some of those inefficiencies. Methods: Using a two-step approach, we started by obtaining two datasets, hospital discharges and organ procurements between years 2013-2017. We considered all patients that entered the system with a critical neurological condition according to ICD10, and exited dead; and all possible organ donors who entered procurement follow-up. Second, we administered a survey on healthcare professionals (physicians and registered nurses) in ER and ICU of 3 large hospitals in the capital, which aimed at describing procurement process knowledge and behavior. We used descriptive statistics for the analysis of both approaches. Results: At the first analysis we found that 87% of patients qualifying as possible donors never entered procurement follow-up and, as 50% of families refused to donate, 6% of all possible donors became effective organ donors. The survey was answered by 88 professionals. 50% physicians, 70% from ER. 51% declared they’ve actively detected a possible donor but 43% referred them to the Local Procurement Coordination. 10% of the surveyed population was not sure about the validity of brain death diagnosis, and 52% never received formal training on any organ donation topic while studying. 73% thought procurement activity was important, but 40% declared not knowing enough about it. ICU professionals were more knowledgeable than ER (81% vs 23% declared more than sufficient knowledge, p&lt;0.001). Conclusions: The insufficient knowledge of procurement activity and concepts, especially from ER professionals may explain the lack of possible donor detection and referral found at a national level. Although the small sample may not be fully representative of the target population, the findings provide the insight that the efforts to increase Chilean organ donation rates should be put in educating healthcare professionals that participate in the procurement process, or even automating and standardizing the process to stop relying on people’s knowledge.

Quality of life is associated with vaccine reluctance via mental health and fear of covid-19: an exploratory investigation on a Palestinian sample

ABSTRACT Quality of life (QoL) has been studied as an antecedent of good mental health in contexts characterized by extreme poverty and acute conflict. The covid-19 crisis exacerbated the risks of health-related consequences in such contexts. Vaccination campaigns have been started worldwide to contain the virus outbreak with high rates of hesitancy and refusal. Our exploratory study sheds light on the relationship between QoL and vaccine reluctance via mental health and fear of covid-19 in a Palestinian population affected by military occupation or socioeconomic marginalization. Who-QolBref, Fcov-19, and Dass were administered to 1122 Palestinian adults living in the occupied territories and Israel. Structural equation modelling was applied to test the relations between variables. Results showed that fear of COVID-19, stress, anxiety and depression mediated the association between QoL and vaccination reluctance with a good model fit (χ2 (5) = 828.37; p = .001; GFI=.93; AGFI=.94; RMSEA=.046; NFI=.94; CFI=.95). QoL and mental health were negatively associated with stress (βX, Y = - .35; p < .001), depression (βX, Y = −.37; p < .001), and anxiety (βX, Y = −.36; p < .001). QoL and fear of COVID- 19 (βX, Y = −.16; p < .001) were inversely correlated. A positive effects was found between stress (βM, Y = .17; p < .001), anxiety (βM, Y = .18; p < .001), and depression (βM, Y = .17; p < .001), fear of COVID-19 and vaccination reluctance (βX, Y = .23; p < .001). According to our findings, Public health measures to ease the social suffering of people with low QoL due to conflict and social marginality might favour the acceptance of the vaccine.

U-PAIN cohort study among patients with chronic pain in specialised pain care: a feasibility study

ObjectivesTo examine acceptability of study participation and feasibility of (1) recruitment, (2) data collection and (3) outcome measures for the prospective U-PAIN cohort.DesignInternal feasibility study of a prospective cohort.Participants and...

High rates of COVID-19 vaccine refusal among Afghan pregnant women: a cross sectional study

Severe Acute Respiratory Syndrome Corona Virus Type-2 (SARS-COV-2) was first detected in China and created a global pandemic rapidly. Subsequently after serious efforts different types of vaccines produced against the virus and recommended for all people including pregnant women. The aim of this study was to realize the willingness of pregnant women to accept the COVID-19 vaccine in Kabul Afghanistan. For this purpose, a cross-sectional study was conducted in gynecology wards of several hospitals in Kabul, Afghanistan from 10th of July to 20th of August 2021 through direct interview with the pregnant women who had come for prenatal care to the healthcare centers. The collected data were analyzed through Statistical Package for Social Studies (SPSS) version 25. Simple descriptive analysis computed for demographic characteristics and bi-variable (Chi-square) analysis was carried out to find out the associations of taking vaccine with demographic variables. A p-value of < 0.05 was considered significant at 95% confidence interval. A total of 491 who were completed the inclusion criteria included in the analysis. A small portion of pregnant women (8.6%) illustrated the intent to get the COVID-19 vaccine if it is recommended by the health authorities in Afghanistan. Our study found a high rate of COVID-19 vaccine refusal among pregnant women in Kabul, Afghanistan. They showed the concern on adverse effects of the vaccine as the main reason for refusal, emphasizing the need to reduce the misconception on vaccine efficacy and campaigns to enhance awareness on the vaccine safety and benefits for mothers and babies.

Acceptance, Hesitancy, and Refusal of Coronavirus Disease 2019 Vaccine and Associated Factors in the Population of Libya: A Cross-Sectional Study

Background and Aims: To obtain herd immunity and control the coronavirus disease 2019 (COVID-19) infection, a large proportion of the population must be vaccinated. However, not everyone in Libya believes in the necessity or safety of COVID-19 vaccines. Therefore, understanding the reasons and variables impacting vaccine hesitation in the Libyan population will assist in developing strategies to reduce this hesitation and achieve better vaccination levels in the country. This study aimed to investigate the acceptance, hesitancy, and refusal of the COVID-19 vaccine and the factors that influence COVID-19 vaccine hesitancy and denial in the Libyan population. Methods: A cross-sectional survey using a snowball sampling strategy to collect data was conducted between February and May 2022. Descriptive statistics and the Chi-square test were used for data analysis. Study questionnaires were distributed using social media. Results: The overall COVID-19 vaccine acceptance was 39.7%, vaccine hesitancy was 36.6%, and vaccine refusal was 23.6% among the study participants. The highest refusal rate was among participants aged 12–24 years, 49 out of 91 (53.8%). Vaccine refusal was similar in males and females; however, vaccine acceptance was higher among females than males. Vaccine acceptance was higher in people with a higher graduate degree than those less educated (P = 0001). Conclusion: Our findings show that vaccine hesitancy was 36.6% and vaccine refusal was 23.6% among the study participants. The study identified reasons for vaccine hesitancy and refusal and proposed education programs to address misbeliefs about the COVID-19 vaccine, allowing people to make informed decisions.

Retrospective Analysis of 1998 Patients Diagnosed with Brain Death between 2011 and 2019 in Turkey

Abstract Background Organ transplantation reduces mortality and morbidity in patients with end-stage organ failure. The number of living organ donations is not enough to meet the current organ transplantation need; therefore, there is an urgent need for organ donation from cadavers. We aimed to determine the organ donation rates and reveal the obstacles against donation. Methods This study is designed as a retrospective multicenter study consisting of eight university hospitals, three training and research hospitals, 26 state hospitals, and 74 private hospitals in nine provinces in Turkey. A total of 1,998 patients diagnosed with brain death between January 2011 to April 2019 were examined through the electronic medical records data system. Results Median patient age was 38 (IQR: 19–57), and 1,275 (63.8%) patients were male. The median time between the intensive care unit admission and brain death diagnosis was 56 (IQR:2–131) hours. The most commonly used confirmatory diagnostic test was computed tomography in 216 (30.8%) patients, and the most common cause of brain death was intraparenchymal hemorrhage with 617 (30.9%) patients. A total of 1,646 (82.4%) families refused to permit organ donation. The most common reasons for refusal were family disagreement (68%), social/relative pressure (24%), and religious beliefs (8%). Conclusions Many families refuse permission for organ donation; some of the provinces included in this study experienced years of exceptionally high refusal rates.

Closer to the Root: The Potential of Traditional Food Systems Interventions for Obesity Prevention

ObjectivesWe review the project design, implementation experiences, and study findings from obesity prevention trials (OPTs) in Native American communities to identify future directions for obesity and chronic disease prevention. MethodsWe use a case study methodology to highlight three OPTs and identify themes across studies. We included three OPTs: Navajo Healthy Stores (NHS), OPREVENT1, and OPREVENT2. NHS was a food-store based environmental intervention, while OPREVENT1 and OPREVENT2 were multi-level, multi-component interventions with store, school, worksite, and media components (OPREVENT1) and combined with a policy-based component (OPREVENT2). ResultsAll studies showed mixed success in achieving behavioral and health outcomes. NHS intervention exposure was associated with reduced BMI, and found improvements in intentions, cooking methods, and food getting comparing intervention with control regions. The program was sustained for several years after the trial was completed. OPREVENT1 trial resulted in significant reductions in waist circumference, reduced soda consumption, and increased physical activity (PA) comparing intervention and comparison communities. The OPREVENT2 trial had significant reductions in PA, calorie intake, carbohydrate, and dietary fat intake comparing intervention and comparison communities. ConclusionsWorking with health staff can enhance intervention sustainability, which is also impacted by health center capacity and funding. All studies had strong evaluation designs, with high retention and low refusal rates. All studies included store components that aimed to improve healthy food access on-reservation and point-of-purchase promotion. Although all studies demonstrated impacts on behaviors and modest impacts on health outcomes, taking a food-systems approach could increase the likelihood of improved outcomes by addressing the root of healthy food access and obesity: diminished traditional food systems. These interventions hold great potential for supporting significant health outcomes by supporting traditional food-getting practices, preparation, and intake. Such interventions require strong community-academic partnerships since these food systems and knowledge belong to tribal nations and communities. Funding SourcesNHLBI & USDA.

Trends of influenza vaccination coverage in pregnant women: a ten-year analysis from a French healthcare database

Pregnant women have a high risk of severe influenza, associated with obstetrical complications. The World Health Organization (WHO) has recommended influenza vaccination for all pregnant women since 2012. The vaccination coverage remains low worldwide, and in Europe, due to a lack of proposition from the health care providers, and a high refusal rate from the women. The primary aim of this study was to estimate the influenza vaccination coverage (IVC) in a population of pregnant women in France, and to analyse its evolution from 2009 to 2018. The secondary objective was to describe the vaccinated population and to find determinants associated with the vaccination. This retrospective cohort study is based on the EGB French health care database, a representative sample of the French population containing data from the health insurance system. All pregnant women who delivered medically or spontaneously over the 2009–2018 period were included. In the 2009–2018 period, only 1.2% pregnant women were vaccinated against influenza (n = 875/72,207; 95% CI 1.14–1.30). The IVC slightly increased after the 2012 WHO recommendation, from 0.33 to 1.79% (p < 0.001) but remained extremely low (4.1% in 2018). Women younger than 25 years old had a low coverage (0.6%) whereas women over 35 years old were more likely to get the influenza vaccine (1.7%; OR: 2.82, 95% CI 2.14–3.71). The vaccination behavior was not influenced by multifetal pregnancy or parity, but socio-economically deprived women were less likely to be vaccinated (OR: 0.81, 95% CI: 0.67–0.98). Women with pre-existing medical conditions had an overall higher vaccination rate (2.5%; OR: 2.32, 95% CI: 1.94–2.77). The vaccine was mainly prescribed by family physicians (58%). Influenza vaccination in pregnant women in France remains very low, particularly in younger, healthy women, and measures such as information campaigns towards pregnant women and studies of the knowledge, attitudes, and practices of the health care professionals need to be undertaken to improve the coverage.

Humanitarian and Compassionate Applications: A Critical Look at Canadian Decision-Makers’ Assessment of Claims from “Vulnerable” Applicants

For many people who have made Canada their home but have uncertain legal status and are ineligible to apply for permanent residence through other channels, the Humanitarian and Compassionate (H&amp;C) application is the only available pathway to permanent residence and stability in Canada. Applications for permanent residence on H&amp;C grounds have become a key component of Canada’s immigration system and yet this pathway remains under-researched. Drawing upon extensive desk research and the preliminary analysis of interview data, this article addresses this gap in the scholarship by offering a critical analysis of the H&amp;C program. In it, we begin by discussing the specific challenges that this highly discretionary decision-making process poses for vulnerable applicants and suggest areas for improvement. We then focus on H&amp;C applications and decisions that directly impact children and explain why a change in the Canadian application of the best interests of the child principle is required. Finally, we consider two recent trends in H&amp;C cases: the sharp increase in the number of applications and the increasingly high rates of refusal. Throughout this analysis, we highlight the negative repercussions the current system has on the most vulnerable categories of migrants and the need to better understand these phenomena.

The gift of free money: on the indeterminacy of unconditional cash transfers in western Kenya

AbstractIn the area surrounding the western Kenyan market town of Kaleko, almost half of the households targeted by the NGO GiveDirectly refused to participate in an unconditional cash transfer programme. Based on interviews and repeated visits to Kaleko over the last ten years, the article illuminates the reasons for the high refusal rate. Instead of understanding it as a technical problem to be fixed, the article situates it in local understandings of the economy as relational. Observing that different actors understood the transfer differently (e.g. as embedded in market exchanges with occult actors, asymmetrical gift relations, or political redistribution schemes), the article concludes that it was difficult for GiveDirectly to control how its cash transfer programme was interpreted locally because it did not accept the paradoxical nature of ‘the gift of free money’. If actors oppose money conceptually to the free gift, interpretations of unconditional cash are bound to be multiple and the transfer will remain indeterminable.