Coronavirus disease 2019 (COVID-19) was declared a pandemic in March 2020. Several prophylactic vaccines against COVID-19 are currently in development, yet little is known about people’s ...acceptability of a COVID-19 vaccine.
We conducted an online survey of adults ages 18 and older in the United States (n = 2,006) in May 2020. Multivariable relative risk regression identified correlates of participants’ willingness to get a COVID-19 vaccine (i.e., vaccine acceptability).
Overall, 69% of participants were willing to get a COVID-19 vaccine. Participants were more likely to be willing to get vaccinated if they thought their healthcare provider would recommend vaccination (RR = 1.73, 95% CI: 1.49–2.02) or if they were moderate (RR = 1.09, 95% CI: 1.02–1.16) or liberal (RR = 1.14, 95% CI: 1.07–1.22) in their political leaning. Participants were also more likely to be willing to get vaccinated if they reported higher levels of perceived likelihood getting a COVID-19 infection in the future (RR = 1.05, 95% CI: 1.01–1.09), perceived severity of COVID-19 infection (RR = 1.08, 95% CI: 1.04–1.11), or perceived effectiveness of a COVID-19 vaccine (RR = 1.46, 95% CI: 1.40–1.52). Participants were less likely to be willing to get vaccinated if they were non-Latinx black (RR = 0.81, 95% CI: 0.74–0.90) or reported a higher level of perceived potential vaccine harms (RR = 0.95, 95% CI: 0.92–0.98).
Many adults are willing to get a COVID-19 vaccine, though acceptability should be monitored as vaccine development continues. Our findings can help guide future efforts to increase COVID-19 vaccine acceptability (and uptake if a vaccine becomes available).
Highlights • Factors for accepting or declining treatment were similar. • Convenience, treatment success rates and side effects were important factors. • Many older patients just accepted the ...physician’s treatment recommendation. • Treatment experiences of others influenced the treatment decision.
Dealing with Racist Patients Paul-Emile, Kimani; Smith, Alexander K; Lo, Bernard ...
The New England journal of medicine,
2016-Feb-25, Letnik:
374, Številka:
8
Journal Article
Vaccines are among the most effective prevention tools available to clinicians. However, the success of an immunization program depends on high rates of acceptance and coverage. There is evidence of ...an increase in vaccine refusal in the United States and of geographic clustering of refusals that results in outbreaks. Children with exemptions from school immunization requirements (a measure of vaccine refusal) are at increased risk for measles and pertussis and can infect others who are too young to be vaccinated, cannot be vaccinated for medical reasons, or were vaccinated but did not have a sufficient immunologic response. Clinicians can play a crucial role in parental decision making. Health care providers are cited as the most frequent source of immunization information by parents, including parents of unvaccinated children. Although some clinicians have discontinued or have considered discontinuing their provider relationship with patients who refuse vaccines, the American Academy of Pediatrics Committee on Bioethics advises against this and recommends that clinicians address vaccine refusal by respectfully listening to parental concerns and discussing the risks of nonvaccination.
To study the reason(s) why insured patients discontinue in vitro fertilization (IVF) before achieving a live birth.
Cross-sectional study.
Private academically affiliated infertility center.
A total ...of 893 insured women who had completed one IVF cycle but did not return for treatment for at least 1 year and who had not achieved a live birth were identified; 312 eligible women completed the survey.
None.
Reasons for treatment termination.
Two-thirds of the participants (65.2%) did not seek care elsewhere and discontinued treatment. When asked why they discontinued treatment, these women indicated that further treatment was too stressful (40.2%), they could not afford out-of-pocket costs (25.1%), they had lost insurance coverage (24.6%), or they had conceived spontaneously (24.1%). Among those citing stress as a reason for discontinuing treatment (n = 80), the top sources of stress included already having given IVF their best chance (65.0%), feeling too stressed to continue (47.5%), and infertility taking too much of a toll on their relationship (36.3%). When participants were asked what could have made their experience better, the most common suggestions were evening/weekend office hours (47.4%) and easy access to a mental health professional (39.4%). Of the 34.8% of women who sought care elsewhere, the most common reason given was wanting a second opinion (55.7%).
Psychologic burden was the most common reason why insured patients reported discontinuing IVF treatment. Stress reduction strategies are desired by patients and could affect the decision to terminate treatment.
Aim
To identify factors associated with refusal of surgery in patients with early-stage pancreatic cancer and estimate the impact of this decision on survival.
Methods
Using the National Cancer Data ...Base, 26,358 patients were identified with potentially resectable tumors (pretreatment clinical stage I: T1 or T2 N0M0). Multivariate models were employed to identify factors predicting failure to undergo surgery and assess the impact on survival.
Results
Of early-stage patients who were recommended surgery, 7.8% (
N
= 992) refused surgery for resectable early-stage pancreatic cancer. On multivariable analysis, patients were more likely to refuse surgery if they were older odds ratio (OR) = 1.18; 95% confidence interval (CI) 1.16–1.19, female (OR = 1.52; 95% CI 1.33–1.73), African American (vs White, OR = 1.79; 95% CI 1.37–2.34), on Medicare/Medicaid (vs private, OR = 2.75; 95% CI 1.54–4.92) or had higher Charlson–Deyo score (2 vs 0, OR = 1.33; 95% CI 1.03–1.72). Patients were also significantly more likely to refuse surgery if they were seen at a center that is not an academic/research program (OR 1.9; 95% CI 1.6–2.27). Patients who were recommended surgery but refused had significantly worse survival than those with stage I who received surgery median survival 6.8 vs 24 months, Cox hazard ratio (HR) 3.41; 95% CI 3.12–3.60.
Conclusions
The percentage of patients refusing surgery for operable early-stage pancreatic cancer has been decreasing in the last decade but remains a significant issue that affects survival. Disparities in refusal of surgery are independently associated with several variables including gender, race, and insurance. To mitigate national disparities in surgical care, future studies should focus on exploring potential reasons for refusal and developing communication interventions.
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