Third Of Respondents Research Articles

Estimating the Quasi-Underground: Oregon’s Informal Marijuana Economy

This study estimates the size of Oregon’s informal marijuana economy, drawing upon Respondent-Driven Sampling (RDS) procedures and survey methods to investigate this quasi-underground activity. The results suggest that average marijuana users consume approximately 4.5 ounces per year and pay approximately $177 per ounce. Most users purchase the drug from friends and nearly one third of respondents indicate that they sell marijuana in small quantities. Growers tend to sell inauspicious quantities to friends and relatives, and rarely earn more than $10,000 annually from their sales. The composition of distribution networks suggests that the informal marijuana economy is a “robust network,” particularly in states that allow personal medical production. This finding also suggests that legalization will likely produce a net increase in economic inequality, particularly affecting parts of Oregon associated with the State of Jefferson, by shutting out smaller producers. Several taxation schemes are presented to offer estimates of revenue if the drug were legalized; these findings suggest that marijuana could contribute modestly to the state’s total revenue, but the most economically beneficial aspect of legalization could be from criminal justice savings.

Teamwork Is Associated with Reduced Hospital Staff Burnout at Military Treatment Facilities: Findings from the 2019 Department of Defense Patient Safety Culture Survey

BackgroundA National Academy of Medicine report emphasizes the importance of creating positive work environments to address the negative effects of burnout on health care workers. The purpose of this investigation was to determine the scope of burnout among military hospital personnel and explore the relationship between teamwork, burnout, and patient safety culture. MethodsA logistic regression analysis investigated the relationship between teamwork and burnout using the 2019 US Department of Defense Patient Safety Culture Survey data from 15,838 military hospital workers. Additional regressions investigated teamwork/burnout relationships among individual work areas and staff positions. ResultsAbout one third of respondents (34.4%) reported experiencing burnout. Work areas most likely to report burnout included many different/other work areas (43.4%), pharmacy (41.8%), and labor and delivery/obstetrics (41.8%). Staff positions most likely to report burnout included pharmacy/pharmacists (39.7%), assistants/technicians/therapists (38.1%), and nurses/nursing (37.6%). Analysis revealed an association between lower burnout and high teamwork, both within (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.48–0.60) and across (OR 0.64, 95% CI 0.57–0.72) units. Within-unit teamwork was associated with reduced odds of burnout across almost all work areas and staff positions, with the greatest odds reduction among personnel working in emergency (OR 0.25, 95% CI 0.14–0.43), radiology (OR 0.41, 95% CI 0.20–0.83), and labor and delivery/obstetrics (OR 0.42, 95% CI 0.27–0.65); and physicians/medical staff (OR = 0.44, 95% CI: 0.28–0.69), other staff positions (OR 0.48, 95% CI 0.28–0.81), and assistants/technicians/therapists (OR 0.58, 95% CI 0.46–0.73). ConclusionEffective teamwork may reduce burnout in hospital workers. This association between teamwork (particularly teamwork within units) and burnout was found in all work areas, even in those with the highest levels of self-reported workplace chaos. Greater adoption of workplace interventions focused on improving teamwork, such as TeamSTEPPS, is warranted.

Access of People Living with HIV to Testing Services in Greece: A Challenge for Equity in Care.

(1) Background: Access to laboratory testing services for HIV in Greece is persistently challenged and this impacts both the continuum of care and, potentially, equity in access. (2) Methods: A cross-sectional study with two parts (first part: HIV-positive people/PLWHIV; second part: HIV clinicians) was conducted in Greece to quantify challenges regarding access to laboratory testing for HIV. Data were collected through online surveys, during a one-month period, between 2019 and 2020. The total sample consisted of 153 PLWHIV and 26 HIV clinicians. (3) Results: Access to viral load testing varied significantly according to place of residence (p = 0.029) and year of diagnosis (p = 0.054). Patients diagnosed after 2015 reported worse access to viral load testing (72.7% vs. 85.9%). Over one third of respondents perceived viral load tests as being not at all accessible (11.4%) or somewhat accessible, only after facing multiple systemic obstacles (24.2%). Equally, most of HIV clinicians reported barriers or no access to baseline viral load testing (80%) and baseline genotype resistance tests (96%). (4) Conclusions: Access of people diagnosed with HIV to CD4 lymphocyte tests and genotype resistance screening is significantly challenged in Greece, especially after 2015. Addressing this challenge is critical in removing access barriers and achieving the UNAIDS 95-95-95 HIV elimination goals.

Self-reported work-related accumulative fatigue of nurses: A cross-sectional study in public hospitals in China.

ObjectivesWork-related fatigue is a serious safety risk to nurses and their patients. This study aimed to assess self-reported work-related accumulative fatigue of nurses and its associated factors.MethodsA questionnaire survey of 2,918 clinical nurses conveniently sampled from 48 public hospitals across six provinces in China was conducted. The “Self-diagnosis Checklist for Assessment of Workers' Accumulated Fatigue” was adopted to assess the level of work-related accumulative fatigue of the study participants. Chi-square tests and ordinal regression analyses were performed to determine the sociodemographic characteristics associated with work-related accumulative fatigue.ResultsAbout one third of respondents reported low work-related accumulative fatigue, compared with 23.1% reporting high and 24.6% reporting very high levels of work-related accumulative fatigue. Higher levels of work-related accumulative fatigue were associated with female gender (AOR = 0.614 for male relative to female, p = 0.005), age between 30 and 40 years (AOR = 1.346 relative to >40 years, p = 0.034), 5–10 years of work experience (AOR = 1.277 relative to >10 years, p = 0.034), and bachelor or above degree qualifications (AOR = 0.806 for associate degree relative to bachelor or above degree, p = 0.007). Those who worked in rural county hospitals (AOR = 0.816 for metropolitan relative to rural county hospitals, p = 0.006) and resided in central China (AOR = 1.276 relative to western China, p = 0.004) had higher odds of reporting higher levels of work-related accumulative fatigue.ConclusionHigh levels of work-related accumulative fatigue are evident in nurses of public hospitals in China. The problem is more serious in the female nurses in their mid-career and those who worked in the central region and rural setting.

Towards equitable conservation: Social capital, fear and livestock loss shape perceived benefit from a protected area.

Providing sufficient benefits to local people can be an important component of effective and equitable conservation, especially where local communities face substantial opportunity costs or disbenefits from conservation. However, the distribution of benefits to local people is often inadequate or inequitable. In this study we investigated the heterogeneity in the extent to which people living near Hwange National Park (HNP), Zimbabwe, perceive benefit from the presence of the park. Specifically, we examined the relationships between a diverse set of candidate predictor variables and perceived benefit from HNP. Our candidate predictor variables broadly relate to personal assets, social capital, value orientation, fear of lions, and belief and participation in human-wildlife conflict mitigation schemes. One third of respondents reported that their household experienced at least some benefits from HNP. Of all respondents, 6% perceived their household to benefit strongly from HNP and 2% very strongly. Livestock loss to wildlife was the most important factor for predicting perceived benefit, with those suffering more loss less likely to perceive benefit. Multiple demographic factors predicted perceived benefit with, for instance, older people and those with less education perceiving less benefit. Employment in conservation-related work positively affected perceived benefit, whereas fear of lions had a negative impact. Social capital appeared to have a positive influence on perceived benefit from HNP. The relationship between social capital and perceived benefit was positive and plateauing, which suggests that social capital is especially impactful on the benefit perceived by individuals reporting the least social capital. We also found a positive association between belief in compensation schemes and perceived benefit from HNP. We posit hypotheses for this association but are unable to determine the underlying drivers of this relationship. Finally, participation in the community guardians programme, a human-lion conflict mitigation programme, was positively related to perceived benefit from HNP. Thus, our findings emphasise the value of considering a diverse array of factors when investigating park-people relationships and yield insights for improving the equitability of conservation in and around HNP and similar systems.

Relationship Quality Change Among Partnered Older Adults During the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic dramatically changed social life, but we know less about whether partnered relationships changed during this time. Because high-quality intimate relationships are key to many older Americans' well-being, we explore whether, how, and for whom the pandemic changed relationship quality among partnered older Americans. Nationally representative data from 1,642 partnered adults aged 50 and older come from the 2020 National Social Life, Health, and Aging Project COVID-19 Study. Multinomial logistic regression analyses estimate the likelihood of reporting improved, unchanged, or worsened relationship quality since the pandemic began across sociodemographic groups. Two thirds of respondents reported that relationship quality stayed the same during the pandemic, 22.8% reported their relationship quality got better, and 10.5% reported their relationship quality got worse. Although women and the oldest old were less likely to report improved relationship quality, Black respondents were more likely to do so, even after controlling for explanatory variables. Resilience describes many partnered older adults' experiences during the first year of the pandemic, suggesting that they were able to protect their partnerships during this public health crisis.

Does MIDAS reduction at 3 months predict the outcome of erenumab treatment? A real-world, open-label trial

BackgroundIn Italy, monoclonal antibodies targeting the CGRP pathway are subsidized for the preventive treatment of high frequency and chronic migraine (CM) in patients with a MIgraine Disability ASsessment (MIDAS) score ≥ 11. Eligibility to treatment continuation requires a ≥ 50% MIDAS score reduction at three months (T3). In this study, we evaluate whether a ≥ 50% MIDAS score reduction at T3 is a reliable predictor of response to one-year erenumab treatment.MethodsIn this prospective, open-label, real-world study, 77 CM patients were treated with erenumab 70–140 mg s.c. every 28 days for one year (T13). We collected the following variables: monthly migraine days (MMDs), monthly headache days (MHDs), days of acute medication intake, MIDAS, HIT-6, anxiety, depression, quality of life and allodynia. Response to erenumab was evaluated as: i) average reduction in MMDs during the 1-year treatment period; and ii) percentage of patients with ≥ 50% reduction in MMDs during the last 4 weeks after the 13th injection (RespondersT13).ResultsErenumab induced a sustained reduction in MMDs, MHDs and intake of acute medications across the 12-month treatment period, with 64.9% of patients qualifying as RespondersT13. At T3, 55.8% of patients reported a ≥ 50% reduction in MIDAS score (MIDASRes) and 55.4% of patients reported a ≥ 50% reduction in MMDs (MMDRes). MIDASRes and MMDRes patients showed a more pronounced reduction in MMDs during the 1-year treatment as compared to NON-MIDASRes (MIDASRes: T0: 23.5 ± 4.9 vs. T13: 7.7 ± 6.2; NON- MIDASRes: T0: 21.6 ± 5.4 vs. T13: 11.3 ± 8.8, p = 0.045) and NON-MMDRes (MMDRes: T0: 23.0 ± 4.5 vs. T13: 6.6 ± 4.8; NON-MMDRes: T0: 22.3 ± 6.0 vs. T13: 12.7 ± 9.2, p < 0.001) groups. The percentage of RespondersT13 did not differ between MIDASRes (74.4%) and NON-MIDASRes (52.9%) patients (p = 0.058), while the percentage of RespondersT13 was higher in the MMDRes group (83.3%) when compared to NON-MMDRes (42.9%) (p = 0.001). MMDRes predicted the long-term outcome according to a multivariate analysis (Exp(B) = 7.128; p = 0.001), while MIDASRes did not. Treatment discontinuation based on MIDASRes would have early excluded 36.0% of RespondersT13. Discontinuation based on “either MIDASResor MMDRes” would have excluded a lower percentage (16%) of RespondersT13.ConclusionMIDASRes only partly reflects the 12-month outcome of erenumab treatment in CM, as it excludes more than one third of responders. A criterion based on the alternative consideration of ≥ 50% reduction in MIDAS score or MMDs in the first three months of treatment represents a more precise and inclusive option.Trial registrationThe trial was retrospectively registered at www.clinicaltrials.gov (NCT05442008).Graphical CGRP: Calcitonin Gene Related Peptide. MIDAS: MIgraine Disability Assessment. MMDs: monthly migraine days. MIDASRes: Patients with a MIDAS score reduction of at least 50% at T3. MMDRes: Patients with a MMDs reduction of at least 50% at T3. ResponderT13: Patients with a MMDs reduction from baseline of at least 50% in the last 4 weeks of observation period (after 13 erenumab administrations). T0: First erenumab administration. T3, T6, T9, T12: Follow-up visits at three, six, nine, and twelve months after first erenumab administration. T13: Last visit of the protocol.

Impact of the COVID-19 Pandemic in Romanian Celiac Disease Patients by E-Survey

Background: The coronavirus disease 2019 (COVID-19) pandemic has immeasurably struck healthcare systems worldwide, generating disruptions in the care of chronic disease patients. We herein aimed to assess the impact of the COVID-19 pandemic on celiac disease (CD) patients. Materials and Methods: An online questionnaire with 46 cascade questions was designed and distributed through the social media channel of the Romanian CD patient association. Results: Altogether, 113 respondents accessed the questionnaire, of whom 95 adult CD patients with complete responses were included in the analysis. The median age of the surveyed participants was 44 years, with the majority (86.3%) being female. Despite concerns, the availability of gluten-free products was reported as being unchanged compared to before the pandemic by 3 out of 4 respondents. Also, our survey did not reveal significant changes regarding adherence to gluten-free diet during the pandemic, as assessed by Biagi score. However, 25.3% of respondents reported feelings of anxiety and 29.5% of depression, but only 3.2% benefited from psychological or psychiatric support. About one quarter of participants postponed their medical checkups due to fear of getting infected. One fifth of respondents declared having been infected with the novel coronavirus, but only 10% of them were hospitalized. One third of respondents had already gotten the COVID-19 vaccine and reported only minor side effects. Also, over half (57.9%) of survey participants declared they had not received enough information during the pandemic. Conclusions: Among our study respondents, availability and adherence to gluten-free diet was not markedly changed during the pandemic, but they were significantly impacted by the lack of CD-specific information about SARS-CoV2 infection and vaccination.

РУССКИЙ ПОЭТИЧЕСКИЙ КАНОН ГЛАЗАМИ ЧИТАТЕЛЯ

The article analyses the survey on Russian poetic canon conducted by the Prosodia Poetry Media in 2021. The results of the survey help to deal with the general doubts about the very necessity to raise this topic today, and applicability of the concept itself. The survey, which comprises more than 20 questions, revealed different stands of the general readers, students, and experts, as well as poets themselves in their attitude to the established poetic canon, to its scope and range, to the question of who and how replenish it, and to the ways of its popularization. According to two thirds of respondents, the Russian poetic canon is limited to the names of one hundred poets. Among the criteria for particular poets belonging to canon, the respondents put forward recognition in the community of poets, and only then – among contemporaries and scholars. It was also allowed to the respondent to offer his/her own list of names of poets meant to be in the canon. At the same time, the majority of the respondents are still ready to entrust the compilation of the poetic canon to knowledgeable poetry experts. It is quite obvious that the canon is meaningful for readers, moreover, its popularization and professional study make it more accessible for the audience, which longs for getting acquainted with the heritage of Russian poetry.

The Academy of Breastfeeding Medicine27th Annual International MeetingBaltimore, MarylandSeptember 15–18, 2022

The Academy of Breastfeeding Medicine27^th Annual International MeetingBaltimore, MarylandSeptember 15–18, 2022

Seen but not considered? Awareness and consideration in choice analysis

Consideration set formation (CSF) is a two-stage decision process in which people first select a subset of products to consider and then evaluate and choose from the selected subset of products. CSF models typically use stated consideration or infer it from choice data probabilistically. This study explores CSF by means of eye-tracking and evaluates how measures of visual consideration compare to stated consideration. We develop a model of CSF behavior, where stated and visual consideration are embedded in the specification of the utility function. We propose three different measures of visual consideration and show that one third of respondents (∼34%) use CSF behavior and that stated consideration diverges substantially from visual consideration. Surprisingly, many product types stated as not considered receive more visual attention, not less. Our findings suggest that stated consideration may be in part a measure of preferences rather than of consideration, implying concerns with endogeneity when including stated consideration data in choice models. Accounting for CSF in discrete choice analysis increases our understanding of the decision process, and can target concerns with biased estimates when analyzing data from two-stage decision processes.

Evaluating UK Pharmacy Workers' Knowledge, Attitudes and Behaviour towards Antimicrobial Stewardship and Assessing the Impact of Training in Community Pharmacy.

The Antibiotic Guardian (AG) campaign, developed in 2014 is an online ‘pledge’ approach to engage health workers and the public about antimicrobial resistance. It is underpinned by models of science communication and behaviour change. Since its launch until the end of 2021, more than 140,000 individuals pledged. A service evaluation was conducted to determine the impact of the campaign upon UK pharmacy workers, in response to national training introduced in 2020. Pledged pharmacy workers were sent an online questionnaire collating demographics, self-reported behaviour and opportunity to support prudent antibiotic use. It also investigated respondents’ daily practice and antimicrobial stewardship (AMS) efforts, and motivations for pledging. Capability was measured with a set of knowledge questions. Awareness of changes to the Community Pharmacy Quality Scheme in England to include incentivized training on antimicrobial resistance (AMR) was explored. Of the 5344 pharmacy workers invited to participate, 783 (14.6%) responded to the survey. There was a statistically significant difference between job roles and capability score. Pharmacists, including Academic and Hospital Pharmacists and Pharmacy Technicians reported higher confidence and capability scores than Dispensers and Pharmacy Assistants (F = 13.776, p = 0.0002). Respondents reported strong knowledge on antimicrobial resistance and high confidence in fulfilling their AG stewardship pledge within daily practices (92.7% of all respondents answered all capability questions, as measured by knowledge, correctly). Two thirds of respondents (61.6% (423/693)) agreed or strongly agreed that they had access to and were able to utilise local antibiotic prescribing guidance and a similar proportion of responding community pharmacists (60%) were aware of the content of their workplace AMS plans. No statistically significant relationships were found between motivations for pledging and subsequent behaviour; pledging due to mandatory requirements of work-place training was the most common answer in both 2019 (42%) and 2020 (54%) cohorts. This evaluation supports the value of the AG pledge-based approach to engage and educate pharmacy workers. Reflections show its impact on increasing evidence-based stewardship for pharmacy workers and their response to mandatory training requirement by employers highlights the effectiveness of the AG campaign to promote AMS within pharmacy teams.

Prevalence of lower urinary tract symptoms in a cohort of Australian servicewomen and female veterans

Introduction and hypothesisLower urinary tract symptoms (LUTS) are common in the general female population. It was hypothesised that Australian female military personnel and veterans would experience similar types and prevalence of LUTS as the broader Australian female population.MethodsAn online cross-sectional survey was utilised to explore the pelvic health of active servicewomen and veterans in the Australian Defence Force (ADF). For the purposes of this report, only the demographic and LUTS data (excluding urinary tract infections) were extracted and descriptively analysed.ResultsA total of 491 complete survey responses were received and analysed. Respondent characteristics were comparable to those documented in a departmental report regarding ADF servicewomen. No LUTS were reported by 38% of respondents. Regular symptoms of urinary incontinence were experienced by 27% of respondents (stress urinary incontinence = 23%, urge urinary incontinence = 16%, mixed urinary incontinence = 13%), bladder storage issues by 20–27%, and various voiding impairments by 9–27%. In addition, 41% reported regularly experiencing two or more LUTS, and for over two thirds of respondents, LUTS were an ongoing issue. Relationships between age, parity, and symptoms of urinary incontinence were also seen.ConclusionsConsistent with wider research in Australian female populations, LUTS were commonly experienced during service by ADF female military personnel and veterans. Given the high likelihood of female military personnel experiencing LUTS during their service, and a proportion experiencing ongoing symptoms, tailored monitoring and support for urinary health should be available to enhance occupational health, safety, and performance.

A Mixed Methods Investigation of Stress and Wellbeing Factors Contributing to Burnout and Job Satisfaction in a Specialist Small Animal Hospital.

Occupational burnout is a critical issue affecting the welfare of veterinary care providers, their patients, and the sustainability of veterinary healthcare organizations. The current research aimed to evaluate the prevalence of and factors contributing to stress, wellbeing, burnout symptoms and job satisfaction among clinical and non-clinical staff at a large specialist small animal hospital in Australia. Participants completed an anonymous online survey including self-report measures of job satisfaction and symptoms of burnout, and open-text response questions probing sources of stress and wellbeing. Subsequently, participants rated how frequently they experienced commonly reported sources of veterinary stress, and a series of focus groups were conducted with clinical and non-clinical teams. The survey was completed by 249 participants (overall response rate = 70%; 67.1% “clinical;” 17.3% “non-clinical;” 5.6% “other”). Five focus groups (including 38 of the survey participants) were subsequently conducted with groups of clinical and non-clinical staff. The majority of respondents (80.7%) reported being satisfied, very satisfied, or extremely satisfied with their job. At the same time, 57.7% of respondents exceeded the threshold for burnout on at least one burnout dimension, with 48.1% reporting high levels of emotional exhaustion, 30.2% reported high levels of cynicism, and 16.3% reporting low levels of professional efficacy. Open text responses and focus group transcripts revealed three common sources of stress and wellbeing. Stressors included communication (conflict within teams), clients (dealing with client emotions and expectations), and heavy caseload. Wellbeing was enhanced by people (team cohesion, respect for colleagues), practice (variety, autonomy, challenge), and purpose (meaningful work and impact). Overall, for both clinical and non-clinical survey respondents, “heavy workload” was rated as the most frequent source of stress. Despite high levels of job satisfaction, approximately two thirds of respondents reported at least one symptom of burnout. Convergent results from the survey and focus groups indicated that strong relationships with colleagues and the intrinsic meaningfulness of the work were key sources of wellbeing and job satisfaction. On the other hand, challenging workplace interactions with colleagues and clients, as well as heavy workload, were identified as key stressors contributing to burnout symptoms.

Perceived benefits, negative impacts, and willingness‐to‐pay to improve urban green space

AbstractUrban green spaces provide multiple benefits but incur some negative impacts. We employed the contingent valuation method to investigate Hong Kong residents’ willingness‐to‐pay to improve urban green space provision. A questionnaire collected 316 responses from urban‐park visitors. It assessed perceptions of positive benefits and negative impacts and influences on willingness‐to‐pay. Health benefits attracted top scores, followed by environment and ecology. For negative impacts, road safety ranked first, followed by risks and hazards, and health and sanitation concerns. More educated and younger respondents were more willing to pay. One third of respondents, mainly the less educated and older people, registered protest votes for diverse reasons. Logistic regression was used to analyse the probability of positive bids with a socio‐demographic model and an extended model incorporating explanatory perception variables. Ordinal regression identified willingness‐to‐pay determinants. Both statistical tests found perceived environmental and ecological benefits as key willingness‐to‐pay predictors. The perceived negative impacts of health and sanitation concerns were correlated with willingness‐to‐pay, indicating a desire to improve and contradicting past studies and expectations. The results highlighted the importance of exploring willingness‐to‐pay from a rarely studied perspective of valuating the potential improved utility of urban green space through suppressing negative impacts. The findings can inform park and urban management to meet user expectations.

Mental health and psychosocial support concerns among frontline workers within the Eastern and Southern Africa COVID-19 response.

We carried out a mental health assessment survey of frontline workers in Eastern and Southern Africa regarding COVID-19 pandemic in the region. A total of 723 people responded to the anonymous survey which was available in English, French and Portuguese. Two thirds of respondents felt overwhelmed and the remaining one third expressed fear of the pandemic. Concern about self and one´s wellbeing was associated with the feeling of being supported by one´s supervisor. Frontline workers that acknowledged supervisor support also expressed a significantly better wellbeing than others that did not receive supportive supervision. It is important to strengthen supervisors´ capacity for psychological support to their subordinates. It is also necessary to emphasise the importance of giving attention to staff mental health concerns. Supervisors should provide information on referral opportunities and encourage their staff to take advantage of them when in need of specialised services. While frontline workers have been celebrated worldwide for their efforts during the COVID-19 pandemic, reports also indicate that some of them are exposed to stigma, discrimination and even violence within their communities, at workplace and surroundings. Further studies will improve current understanding of the mental health and psychological concerns other categories of professional caregivers experienced while responding to the pandemic.

The Making and Breaking of Social Ties During the Pandemic. Socio-Economic Position, Demographic Characteristics, and Changes in Social Networks.

Contact restrictions and distancing measures are among the most effective non-pharmaceutical measures to stop the spread of the SARS-CoV2 virus. Yet, research has only begun to understand the wider social consequences of these interventions. This study investigates how individuals' social networks have changed since the outbreak of the pandemic and how this is related to individuals' socio-economic positions and their socio-demographic characteristics. Based on a large quota sample of the German adult population, we investigate the loss and gain of strong and weak social ties during the pandemic. While about one third of respondents reported losing of contact with acquaintances, every fourth person has lost contact to a friend. Forming new social ties occurs less frequently. Only 10–15% report having made new acquaintances (15%) or friends (10%) during the pandemic. Overall, more than half of our respondents did not report any change, however. Changes in social networks are linked to both socio-demographic and socio-economic characteristics, such as age, gender, education, and migration background, providing key insights into a yet underexplored dimension of pandemic-related social inequality.

Implementing education: Personal communication with a healthcare professional is a critical step to address vaccine hesitancy for people with multiple sclerosis

BackgroundPeople with Multiple Sclerosis (PwMS) were first able to access COVID-19 vaccines in Australia from March 2021, when vaccine hesitancy in the general population was high (14–43%). High uptake of vaccination is important globally and critical to protect this vulnerable population. We conducted an on-line survey to examine factors influencing COVID-19 vaccination willingness among PwMS in Australia. Methods149 PwMS living in Australia completed the on-line survey (April-September 2021) examining demographic, environmental and clinical factors with respect to vaccine willingness, including attitudes towards COVID-19 illness and vaccines. Additional items explored the influence of different information sources on vaccination decisions. Continuous and ordinal data were compared using the Mann-Whitney U test. All tests were two-tailed, with alpha set at 0.5. ResultsA majority of the respondents were female (87.2%) with relapsing-remitting MS (77.5%) treated by a neurologist (94.0%). A majority were on high efficacy disease-modifying therapies (DMTs) (64.9%), while 19.9% were on no DMTs. About one third of respondents (32.9%) had had two doses, 20.8% had received their first dose, and 22.1% were unvaccinated, while 24.2% of responses were missing. When asked about vaccine intentions, 60.6% of the unvaccinated indicated they were likely to extremely likely to get vaccinated, while 15.2% were very unlikely or extremely unlikely to do so and 24.2% were undecided. Unvaccinated people were significantly more concerned about vaccine side effects (mean 5.3 versus 3.1/10; p < .001). Only 53.3% of people on DMTs were vaccinated, compared to 75% of those who were not. People on ocrelizumab therapy (n = 35) had a lower vaccination rate (39%) than those on other medications (n = 86, 59%). Vaccine willingness in the unvaccinated was most highly correlated with knowledge regarding the vaccine (rs2=.709), agreement with the statement that COVID-19 vaccination is “too new for me to be confident about getting vaccinated” (rs2= -.709), anticipation of regret due to side effects of vaccination (rs2= -.642), and lack of knowledge regarding interactions between COVID-19 vaccines and DMTs (rs2= -.570).Almost two thirds had read MS-specific information about COVID-19 vaccinations and found it easy to understand (67.6%) and applicable to their situation (53.6%). However, less than half (47.8%) reported the information helped them make a personal vaccination decision. Over two-thirds (64.9%) had discussed vaccinations with their healthcare professional and 31.1% had not. Those who had not, were significantly more uninformed about the interactions of the vaccine with MS medications (mean 3.9 versus 2.9/10; p = .044) and significantly lower intention of vaccine uptake than those who had (mean 5.8 versus 7.9/10; p = .009). ConclusionOur study highlights that vaccination efforts should be delivered by healthcare professionals, focus on educating those who are managed with DMTs, and include individual recommendations related to specific DMTs, how the vaccines work, expectations regarding potential side-effects, potential exacerbation of MS symptoms, likelihood of recovery from any exacerbation, and the relative risks of side effects versus COVID-19 infection. Specific recommendations are provided.

The Psychological Impact of COVID-19 Pandemic on Suicidal Thoughts in the United Kingdom

AimsBackground: The impact of the pandemic and resultant restrictions on suicidal thoughts may vary across populations, geographical areas, between high and low socio-economic groups and vulnerable populations. Aim: To investigate the psychological impact of COVID-19 and resultant restrictions on suicidal thoughts in the United Kingdom.MethodsThe study group conducted a cross sectional survey using a questionnaire based on published approaches (Generalised Anxiety Disorder 7, Patient Health Questionnaire 9, Impact of Events Scale-Revised) to understand the psychological impact of COVID-19 and the resultant restrictions on suicidal thoughts. The study was conducted in 3 phases to capture the different phases of the pandemic restrictions: Phase 1: 1st May 2020 to 31st July 2020Phase 2: 12th November 2020 to 12th February 2021Phase 3: 1st July 2021 to 30th September 2021Inclusion: All individuals above 16 years of age who wanted to participate were eligible.Analysis strategy: Descriptive analysis and logistic regression is applied in this study.ResultsThe study recruited 29133 participants in phase 1; 83851 participants in phase 2 and 75204 participants in phase 3. The largest age group of participants was 45–64 years. About two thirds of respondents were female. Majority of participants were of White British ethnicity. 31% participants in phase 1, 30% in phase 2 and 19% in phase 3 reported suicidal thoughts.The preliminary regression analysis indicates that younger and male participants reported more suicidal thoughts among other findings which will be reported in the presentation.Limitations: The non-probability sample design and time limited surveys meant that longitudinal changes were not possible to elicit.ConclusionThere is mixed evidence on whether rates of suicidal thoughts increased during the pandemic. The results of this study will add to the evidence base and influence future pandemic planning and efforts to developing resilience and good mental health in society.

Intensive care unit trainee perception of end-of-life care provided during medical emergency team activation events.

Hospital medical emergency team (MET) activation events involving end-of-life care (EOLC) are common. The issues faced by medical staff attending these events are incompletely described. The purpose of this study was to measure the perceptions of Victorian hospital medical staff, training in the speciality of intensive care, about multiple aspects of EOLC MET calls. We sought to determine the overall extent of formal training in MET and EOLC and assess the domains of self-perceived confidence, barriers to communication, frequency of clinician agreement and trainee distress. We conducted an anonymous, voluntary, Internet-based survey of registered trainees of the College of Intensive Care Medicine of Australia and New Zealand in May 2019. The participants eligible were those trainees working in an adult intensive care unit in Victoria, Australia, during the study period. The main outcome measures were self-reported levels of confidence, barriers to communication, frequency of conflict and distress, senior support, supervision and access to training. Of 124 trainees surveyed, 75 (60%) responded. Overall, 78% of respondents felt confident to manage EOLC MET calls, but the frequently reported barriers to effective patient/next of kin communication included: (i) lack of private meeting rooms; (ii) resource and time constraints; and (iii) lack of patient and family availability during a MET call to discuss medical treatment limitations. Two-thirds of respondents reported emotional distress at least occasionally, this being frequent in one in five. Most (68%) trainees experienced conflict with other medical teams at least occasionally. Factors associated with experiencing distress at least occasionally include greater trainee age, patients' being unable to participate in discussion due to illness, resource and time constraints and negative encounters with other medical teams. Victorian intensive care trainees were confident managing EOLC MET activation events. However, distress was reported commonly and strategies are required to address the areas of concern.