Project description:ObjectiveWe consider how trust in government, trust in physicians, and interpersonal trust affect the likelihood of COVID-19 vaccine uptake.MethodsA survey of 3057 registered South Dakota voters was fielded in April 2021 that measured COVID-19 vaccine uptake, three aspects of trust, and several other factors related to vaccine hesitancy. Logistic regression was utilized to analyze the responses.ResultsWe found positive, statistically significant, and substantively impactful effects for trust in government and trust in physicians on the likelihood of COVID-19 vaccine uptake, and null results for interpersonal trust.ConclusionsOur findings provide a more nuanced understanding of the relationship between trust and COVID-19 vaccine uptake, and suggest that public health official as well as physicians should strive to increase the public's trust in the medical community.
Project description:BackgroundVaccination has proven to be an essential strategy in combating the COVID-19 pandemic. This study aims to discern the factors influencing both the intentions for and actual behavior regarding COVID-19 vaccination among remote, rural populations in Bangladesh.MethodsThe study utilized panel survey data comprising 1,698 randomly selected household heads. These are predominantly illiterate, of Muslim religion, middle-aged, and male, with agriculture or day labor as primary income source. They reside in 36 locations distributed along the whole 250 km length of the Jamuna River in Bangladesh. Data collection occurred through face-to-face and telephone interviews conducted between September 2021 and October 2022. Descriptive statistics and Ordinary Least Squares regression models were employed to assess influence factors for COVID-19 vaccination intentions and uptake. The analyses considered the constructs of the Health Belief Model alongside sociodemographic characteristics such as gender, age, religion, education, and income source.ResultsSurvey respondents showed a notably high willingness to receive the COVID-19 vaccine promptly upon its availability. However, the effectiveness of the Health Belief Model in elucidating COVID-19 vaccination uptake was limited, except for its availability component. Older individuals, those with higher levels of education, and individuals employed in government or formal sector occupations were prompt in receiving the COVID-19 vaccine as it became available. Gender, religion, and the presence of dependents in the household did not exert a significant influence on vaccination uptake.ConclusionsThe results indicate that a strong willingness to receive the COVID-19 vaccine correlated with an increased likelihood of vaccine uptake once it was available. These findings suggest that a widespread distribution of COVID-19 vaccines to low-income and remote areas could have served as a vital strategy in mitigating the COVID-19 pandemic.
Project description:ImportanceThe use of benzodiazepine receptor agonists (BZRA) poses serious health risks to older adults. Although several guidelines recommend deprescribing, implementation in clinical practice remains limited.ObjectiveTo identify physicians' barriers to and enablers of deprescribing BZRA in adults aged 65 years and older taking a BZRA for sleep problems; to determine factors associated with hospital physicians' intention to deprescribe BZRA and their self-reported routine BZRA deprescribing.Design, setting, and participantsThis survey study included hospital physicians and general practitioners (GPs) working across 6 European Countries (Belgium, Greece, Norway, Poland, Spain, and Switzerland) between December 2022 and March 2023.Main outcomes and measuresBarriers identification via a 35-item questionnaire based upon the Theoretical Domains Framework (TDF). Responses were categorized as major barriers, moderate barriers, and enablers based on their mean scores. Multivariable logistic regressions were used to identify background characteristics and TDF-based domains associated with hospital physicians' intention to deprescribe and self-reported routine deprescribing.ResultsQuestionnaires from 240 hospital physicians and 96 GPs were analyzed. Most participants were women: 144 (61.0%) hospital physicians and 52 (54.2%) GPs. In terms of experience, the most common reported time in practice was less than 5 years for hospital physicians (76 [31.7%]) and between 10 and 14 years for GPs (35 [36.5%]). Most reported deprescribing BZRA routinely (135 hospital physicians [57.2%] and 66 GPs [72.5%]). Major barriers (and TDF domains) were similar for hospital physicians and GPs across the 6 countries. These barriers included: lack of training (skills), low self-efficacy (beliefs about capabilities), prioritization of other health issues (goals), frustration with the challenges of deprescribing (emotions), insufficient staff and time, absence of local policies (environmental context and resources), and reluctance from patients (social influence). Intention to deprescribe was significantly associated with country, occupation type, and 5 TDF domains: memory, attention, and decision process (odds ratio [OR], 1.70; 95% Ci, 1.22-2.40); social and/or professional role and identity (OR, 5.92; 95% CI, 3.28-11.07); beliefs about capabilities (OR, 2.35; 95% CI, 1.55-3.63); beliefs about consequences (OR, 3.00; 95% CI, 1.61-5.71); and reinforcement (OR, 1.49; 95% CI, 1.05-2.15). Routine deprescribing was significantly associated with 3 TDF domains: memory, attention, and decision processes; intentions; and emotions.ConclusionIn this theory-based survey study of physicians, physicians and general practitioners described numerous barriers to deprescribing BZRA in older adults. Our findings indicate that effective deprescribing efforts require approaches that address both reflective processes (eg, enhancing capability) and impulsive processes (eg, managing emotions).
Project description:Trust in physicians and hospitals has been associated with achieving public health goals, but the increasing politicization of public health policies during the COVID-19 pandemic may have adversely affected such trust. To characterize changes in US adults' trust in physicians and hospitals over the course of the COVID-19 pandemic and the association between this trust and health-related behaviors. This survey study uses data from 24 waves of a nonprobability internet survey conducted between April 1, 2020, and January 31, 2024, among 443 455 unique respondents aged 18 years or older residing in the US, with state-level representative quotas for race and ethnicity, age, and gender. Self-report of trust in physicians and hospitals; self-report of SARS-CoV-2 and influenza vaccination and booster status. Survey-weighted regression models were applied to examine associations between sociodemographic features and trust and between trust and health behaviors. The combined data included 582 634 responses across 24 survey waves, reflecting 443 455 unique respondents. The unweighted mean (SD) age was 43.3 (16.6) years; 288 186 respondents (65.0%) reported female gender; 21 957 (5.0%) identified as Asian American, 49 428 (11.1%) as Black, 38 423 (8.7%) as Hispanic, 3138 (0.7%) as Native American, 5598 (1.3%) as Pacific Islander, 315 278 (71.1%) as White, and 9633 (2.2%) as other race and ethnicity (those who selected "Other" from a checklist). Overall, the proportion of adults reporting a lot of trust for physicians and hospitals decreased from 71.5% (95% CI, 70.7%-72.2%) in April 2020 to 40.1% (95% CI, 39.4%-40.7%) in January 2024. In regression models, features associated with lower trust as of spring and summer 2023 included being 25 to 64 years of age, female gender, lower educational level, lower income, Black race, and living in a rural setting. These associations persisted even after controlling for partisanship. In turn, greater trust was associated with greater likelihood of vaccination for SARS-CoV-2 (adjusted odds ratio [OR], 4.94; 95 CI, 4.21-5.80) or influenza (adjusted OR, 5.09; 95 CI, 3.93-6.59) and receiving a SARS-CoV-2 booster (adjusted OR, 3.62; 95 CI, 2.99-4.38). This survey study of US adults suggests that trust in physicians and hospitals decreased during the COVID-19 pandemic. As lower levels of trust were associated with lesser likelihood of pursuing vaccination, restoring trust may represent a public health imperative.
Project description:ObjectivesTo investigate whether social trust is associated with more stress symptoms among middle-aged and older adults in six East and Southeast Asia regions during the COVID-19 pandemic.MethodsThis multi-region study used cross-sectional survey data collected in May 2020. Participants were a probability-based internet sample of adults aged 55 or older.ResultsGovernment trust was negatively associated with stress in Singapore and South Korea. Higher levels of health care trust were significantly associated with less stress in Singapore and Taiwan. Trust in neighbors was associated with a higher likelihood of stress in Hong Kong and a lower likelihood in Singapore. Social trust was not associated with stress in Japan or Thailand.DiscussionFindings suggest the level of social trust in relation to stress substantially varied by region. Interventions to strengthen trust during COVID-19 and other major health crises need to be tailored to fit regions' unique circumstances.
Project description:BackgroundAlthough frailty is a common geriatric syndrome in old adults, a simple method to assess the degree of frailty in a person has not yet been established. In this study we have tried to establish the association between calf circumference (CC) and frailty among older Chinese people.MethodsWe used the data obtained from the 2014 edition of the Chinese Longitudinal Healthy Longevity Survey; 1216 participants aged ≥60 years were included for the study. Body mass index, CC and waist circumference measurement data, and laboratory test results were collected. Frailty status was measured using the frailty index (FI). Participants were then classified into non-frail (FI < 0.25) and frail (FI ≥ 0.25) groups.ResultsThere were 874 participants (71.9%) in the non-frail group and 342 (28.1%) in the frail group. The CC was significantly different between the two groups (31.54 ± 4.16 versus 28.04 ± 4.53, P < 0.001). Logistic regression analysis revealed that CC (odds ratio = 0.947, 95% confidence interval: 0.904-0.993, P = 0.023) was an independent impact factor associated with frailty. The CC value of 28.5 cm was considered the best cut-off value in women with area under the curve (AUC) was 0.732 (P < 0.001) and 29.5 cm in men with AUC was 0.592 (P = 0.004);We created a simple prediction model for frailty that included age,sex and CC:[Formula: see text]P = elogit(P) /1 + elogit(P), and AUC is 0.849 (P < 0.001).ConclusionsCC is a convenient and predictable marker of frailty in older adults.
Project description:This article analyzes the specific and critical role of trust in scientists on both the support for and compliance with nonpharmaceutical interventions (NPIs) during the COVID-19 pandemic. We exploit large-scale, longitudinal, and representative surveys for 12 countries over the period from March to December 2020, and we complement the analysis with experimental data. We find that trust in scientists is the key driving force behind individual support for and compliance with NPIs and for favorable attitudes toward vaccination. The effect of trust in government is more ambiguous and tends to diminish support for and compliance with NPIs in countries where the recommendations from scientists and the government were not aligned. Trust in others also has seemingly paradoxical effects: in countries where social trust is high, the support for NPIs is low due to higher expectations that others will voluntary social distance. Our individual-level longitudinal data also allows us to evaluate the effects of within-person changes in trust over the pandemic: we show that trust levels and, in particular, trust in scientists have changed dramatically for individuals and within countries, with important subsequent effects on compliant behavior and support for NPIs. Such findings point out the challenging but critical need to maintain trust in scientists during a lasting pandemic that strains citizens and governments.
Project description:ObjectiveThis study aimed to investigate factors influencing the uptake of first and second COVID-19 booster vaccines among adults in Belgium, particularly age, sex, region of residence and laboratory confirmed COVID-19 infection history.ResultsA binomial regression model was used with having received the first or second booster as outcome and age, sex, region of residence and infection history as fixed variables. Among adults, there was generally a higher uptake to receive the first booster among older age groups compared to younger ones. Females, individuals residing in Flanders and those with no previous COVID-19 infection were more likely to receive the first booster. For the second booster, the same age trend was seen as for the first booster. Males, individuals residing in Flanders and those who tested positive for COVID-19 once after first booster were more likely to receive the second booster. Individuals with multiple positive COVID-19 tests before and after primary course or first booster were less likely to receive the subsequent booster dose compared to COVID-naïve individuals. This information could be used to guide future vaccination campaigns during a pandemic and can provide valuable insights into booster uptake patterns.
Project description:BackgroundThe impact of seasonal influenza vaccination (SIV) on mortality is still controversial; some studies have claimed that increasing vaccination coverage rates is beneficial, while others have found no significant association. This study aimed to construct a granular longitudinal dataset of local VCRs and assess their effect on pneumonia- and influenza-related (P&I) mortality among Italian adults aged ≥ 65 years.MethodsNUTS-3 (nomenclature of territorial units for statistics) level data on SIV coverage were collected via a survey of local data holders. Fixed- and random-effects panel regression modeling, when adjusted for potential confounders, was performed to assess the association between local SIV coverage rates and P&I mortality in older adults.ResultsA total of 1,144 local VCRs from 2003 to 2019 were ascertained. In the fully adjusted fixed-effects model, each 1% increase in vaccination coverage was associated (P < 0.001) with a 0.6% (95% CI: 0.3-0.9%) average over-time decrease in P&I mortality. With an annual average of 9,293 P&I deaths in Italy, this model suggested that 56 deaths could have been avoided each year by increasing SIV coverage by 1%. The random-effects model produced similar results. The base-case results were robust in a sensitivity analysis.ConclusionOver the last two decades, Italian jurisdictions with higher SIV uptake had, on average, fewer P&I deaths among older adults. Local policy-makers should implement effective strategies to increase SIV coverage in the Italian senior population.