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Examine the impact of vaccination status on hospital cost and course for patients admitted with COVID-19 infection.
Retrospective cohort study characterizing vaccinated and unvaccinated individuals hospitalized for COVID-19 between April 2021 to January 2022.
Large academic medical center.
Patients were included if they were greater than 18 years old, fully vaccinated or unvaccinated against COVID-19, and admitted for COVID-19 infection.
437 consecutively admitted patients for COVID-19 infection met inclusion criteria. Of these, 79 were excluded for unknown or partial vaccination status, transfer from an outside hospital, or multiple COVID-19 related admissions.
Overall, 279 (77.9%) unvaccinated patients compared to 79 (22.1%) vaccinated patients were hospitalized with a diagnosis of COVID-19. Average length of stay was significantly lower in the vaccinated group (6.47 days versus 8.92 days, P = 0.03). Vaccinated patients experienced a 70.6% lower risk of ICU admission (OR = 0.29, 95% CI 0.12–0.71, P = 0.006). The unadjusted cost of hospitalization was not found to be statistically significant ($119,630 versus $191,146, P = 0.06). After adjusting for age and comorbidities, vaccinated patients experienced a 26% lower cost of hospitalization compared to unvaccinated patients (P = 0.004). Unvaccinated patients incurred a significantly higher cost of hospitalization per day ($29,425 vs $13,845 P < 0.0001). Unvaccinated patients (n = 118, 42.9%) were more likely than vaccinated patients (n = 16, 20.3%) to require high-flow oxygen or mechanical ventilation (OR = 2.95, 95% CI 1.62–5.38, P = 0.0004).
Vaccinated patients experienced a lower cost of hospitalization after adjusting for age and comorbidities and shorter length of stay compared to unvaccinated patients admitted for COVID-19.
The study aims to investigate the social, demographic, and economic factors affecting Covid-19 vaccine decisions before the vaccination started in Turkey. The study also aims to understand the attitudes towards Covid-19 vaccines.
The study is conducted by exploiting the data of 693 individuals living in Turkey. The data is collected via a virtually applied questionnaire according to snowball sampling in late 2020 when the vaccination program had not started in Turkey yet. Multinomial logistic regression design is used to identify the factors affecting Covid-19 vaccine decisions.
It is observed that Covid-19 vaccine acceptance is notably low before the vaccination started in Turkey. Further, almost half of the participants are indecisive about getting vaccinated. It is identified that age, gender, educational status, residential status, occupational status, the number of dependents, smoking, and the vaccination of governmental authorities have associations with Covid-19 vaccination decisions.
Covid-19 vaccine acceptance is low while it is relatively high among vulnerable groups i.e., elderlies and smokers, and among those are unable to isolate themselves. In addition, the vaccination of governmental authorities is remarkably effective on Covid-19 vaccine acceptance in Turkey.
In the vast majority of European countries, piglets are surgically castrated in order to eliminate the risk of boar taint, an odour or flavour that can be present when pork from entire males is cooked. However, surgical castration is the subject of much debate and criticism as a result of its negative implications for piglets’ welfare, integrity and health. At present, there is much ongoing research into potential alternatives, among them immunocastration. This practice involves the injection of a vaccine that inhibits the production of the hormones responsible for boar taint. Although satisfactory results are associated with immunocastration in terms of meat quality and production parameters, uncertainty concerning consumer acceptance is often put forward as a key element in the quest for a successful market introduction. This study focuses on consumer awareness of piglet castration and attitudes towards immunocastration by means of a web-based questionnaire among 225 Flemish consumers. We noted approximately 40% awareness of the routine practice of castrating piglets and this limited awareness is accompanied by a moderate level of concern regarding castration, especially in comparison to food safety and other pork production system-related animal welfare issues. Sixty percent of the sample had a general appreciation for the concept of immunocastration, as opposed to surgical castration. Informing consumers about the potential benefits and/or risks from immunocastration did not tend to have much effect in terms of altering their attitudes. Immunocastration did not emerge as a problem in terms of consumer acceptance: special attention should be paid to consumers’ perception of pricing, food safety and the taste of the meat from immunocastrated pigs.
The coronavirus disease 2019 (COVID-19) pandemic enabled a situational type of terrorism with mixed racist, anti-government, anti-science, anti-5G, and conspiracy theorist backgrounds and motives.
The objective of this study was to identify and characterize all documented COVID-19-related terrorist attacks reported to the Global Terrorism Database (GTD) in 2020.
The GTD was searched for all COVID-19-related terrorist attacks (aimed at patients, health care workers, and at all actors involved in pandemic containment response) that occurred world-wide in 2020. Analyses were performed on temporal factors, location, target type, attack and weapon type, attacker type, and number of casualties or hostages. Ambiguous incidents were excluded if there was doubt about whether they were exclusively acts of terrorism.
In total, 165 terrorist attacks were identified. With 50% of incidents, Western Europe was the most heavily hit region of the world. Nonetheless, most victims were listed in Southeast Asia (19 fatalities and seven injured). The most frequent but least lethal attack type concerned arson attacks against 5G telephone masts (105 incidents [60.9%] with only one injured). Armed assaults accounted for most fatalities, followed by assassinations. Incendiary and firearms were the most devastating weapon types.
This analysis of the GTD, which identified 165 COVID-19-related terrorist attacks in 2020, demonstrates that the COVID-19 pandemic truly resulted in new threats for COVID-19 patients, aid workers, hospitals, and testing and quarantine centers. It is anticipated that vaccination centers have become a new target of COVID-19-related terrorism in 2021 and 2022.
This is a new (to the second edition) chapter illustrating many aspects of medical statistics using the COVID-19 pandemic. Topics covered include, reporting cases, case fatality as a function of age, developing vaccines, testing for infection and modelling the spread of infection.
Older and frail individuals are at high risk of dying from COVID-19, and residents in nursing homes (NHs) are overrepresented in death rates. We explored four different periods during the COVID-19 pandemic to analyze the effects of improved preventive routines and vaccinations, respectively, on mortality in NHs.
We undertook a population-based systematic retrospective chart review comprising 136 NH facilities in southeast Sweden. All residents, among these facilities, who died within 30 days after a laboratory-verified COVID-19 diagnosis during four separate 92-day periods representing early pandemic (second quarter 2020), middle of the pandemic (fourth quarter 2020), early post-vaccination phase (first quarter 2021), and the following post-vaccination phase (second quarter 2021). Mortality together with electronic chart data on demographic variables, comorbidity, frailty, and cause of death was collected.
The number of deaths during the four periods was 104, 120, 34 and 4, respectively, with a significant reduction in the two post-vaccination periods (P < 0.001). COVID-19 was assessed as the dominant cause of death in 20 (19%), 19 (16%), 4 (12%) and 1 (3%) residents in each period (P < 0.01). The respective median age in the four studied periods varied between 87and 89 years, and three or more diagnoses besides COVID-19 were present in 70–90% of the respective periods’ study population. Considerable or severe frailty was found in all residents.
Vaccination against COVID-19 seems associated with a reduced number of deaths in NHs. We could not demonstrate an effect on mortality merely from the protective routines that were undertaken.
The complex relationship between the history of infectious diseases and social inequalities has recently attracted renewed attention. Smallpox has so far largely escaped this revived scholarly scrutiny, despite its century-long status as one of the deadliest and widespread of all infectious diseases. Literature has demonstrated important differences between rural and urban communities, and between cities, but has so far failed to address intra-urban disparities due to varying living conditions and disease environments. This article examines the last nationwide upsurge of smallpox in the Netherlands through the lens of Amsterdam’s 50 neighborhoods in the period 1870–72. We use a mixed methods approach combining qualitative spatial analysis and OLS regression to investigate which part of the population was affected most by this epidemic in terms of age and sex, geographic distribution across the city, and underlying sociodemographic neighborhood characteristics such as relative wealth, housing density, crude death rate, and birth rate. Our analyses reveal a significant spatial patterning of smallpox mortality that can largely be explained by the existing social environment. Lacking universal vaccination, the smallpox epidemic was not socially neutral, but laid bare some of the deep-seated social and health inequalities across the city.
Nowadays, the Covid-19 pandemic is 1 of the most important challenges worldwide, especially in terms of health. The most important strategy to prevent and control the Covid-19 pandemic is mass vaccination. This study aimed at developing a roadmap for the mass vaccination of COVID-19 in Iran.
The current study was conducted using a qualitative approach with a content analysis method. In the first step, the review of literature and documents was carried out by a search in scientific databases. In the next step, the data were amassed via in-depth and semi-structured interviews with experts who were selected purposefully, including policymakers, health care workers, and managers. After this, 3 multidisciplinary expert panels for roadmap development were held.
Based on the literature review, interviews, and 3 stages of an expert panel, the final roadmap was developed with 5 dimensions. These included outcomes, planning and preparation, strategies, and preparation, implementation, monitoring, and evaluation.
This roadmap was developed to improve mass vaccination during the COVID-19 pandemic. According to our findings, it is strongly recommended that the vaccination roadmap with all the above-mentioned features and comprehensive structure should be applied to mitigate the consequences of the COVID-19 pandemic.
This review summarises evidence relating to a potential role for vitamin D supplementation in the prevention or treatment of coronavirus disease 2019 (COVID-19). Laboratory studies show that the active vitamin D metabolite 1,25-dihydroxyvitamin D induces innate antiviral responses and regulates immunopathological inflammation with potentially favourable implications for the host response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Meta-analyses of cross-sectional, case-control and longitudinal studies report consistent protective associations between higher circulating 25-hydroxyvitamin D [25(OH)D] concentrations or vitamin D supplement use and reduced risk and severity of COVID-19. However, Mendelian randomisation studies testing for associations between genetically predicted circulating 25(OH)D concentrations and COVID-19 outcomes have yielded consistently null results. Positive findings from observational epidemiological studies may therefore have arisen as a result of residual or unmeasured confounding or reverse causality. Randomised controlled trials of prophylactic or therapeutic vitamin D supplementation to reduce risk or severity of COVID-19 reporting to date have yielded inconsistent findings. Results of further intervention studies are pending, but current evidence is insufficient to support routine use of vitamin D supplements as a therapeutic or prophylactic agent for COVID-19, or as an adjunct to augment immunogenicity of SARS-CoV-2 vaccination. Accordingly, national and international bodies have not made any recommendations regarding a role for vitamin D in the prevention or treatment of COVID-19.
This review aims are to (1) identify relevant quantitative research on parental childhood vaccine hesitancy with vaccine uptake and vaccination intention being relevant outcomes and (2) map the gaps in knowledge on vaccine hesitancy to develop suggestions for further research and to guide interventions in this field.
Vaccine hesitancy recognises a continuum between vaccine acceptance and vaccine refusal, de-polarising past anti-vaccine, and pro-vaccine categorisations of individuals and groups. Vaccine hesitancy poses a serious challenge to international efforts to lessen the burden of vaccine-preventable diseases. Potential vaccination barriers must be identified to inform initiatives aimed at increasing vaccine awareness, acceptance, and uptake.
Five databases were searched for peer-reviewed articles published between 1998 and 2020 in the fields of medicine, nursing, public health, biological sciences, and social sciences. Across these datasets, a comprehensive search technique was used to identify multiple variables of public trust, confidence, and hesitancy about vaccines. Using PRISMA guidelines, 34 papers were included so long as they focused on childhood immunisations, employed multivariate analysis, and were published during the time frame. Significant challenges to vaccine uptake or intention were identified in these studies. Barriers to vaccination for the target populations were grouped using conceptual frameworks based on the Protection Motivation Theory and the World Health Organization’s Strategic Advisory Group of Experts on Immunization Working Group model and explored using the 5C psychological antecedents of vaccination.
Although several characteristics were shown to relate to vaccine hesitancy, they do not allow for a thorough classification or proof of their individual and comparative level of influence. Understudied themes were also discovered during the review. Lack of confidence, complacency, constraints, calculation, and collective responsibility have all been highlighted as barriers to vaccination uptake among parents to different degrees.
This article first distinguishes three governance scenarios that have been enacted in the COVID-19 pandemic, including identification and control; herd immunity without policy adjustments; and periodic lockdowns and hasty opening. In suggesting how different governments’ strategies were taxonomized into these categories, the paper examines major socio-legal challenges, including variations in social structures and government responsibilities; differences in public health cultures and legal policy options available to governments; unequal distribution of health and social welfare benefits; and public concerns of government overreach in relation to privacy of the infected and the preservation of individual liberty and freedom. Finally, the paper offers critical recommendations in the interest of ensuring a robust social-legal framework for providing adequate medical care to the infected; improving public health for vulnerable groups; ensuring that less privileged countries have access to vaccines; and designing post-disaster reconstruction by seeking global health objectives, rather than state-centric national justice.
Curbing the spread of the coronavirus and stabilizing the overall psychosocial situation requires compliance with preventive measures: “Protect, test, vaccinate”.
Population groups with psychosocial problems which are difficult to reach and have a high risk of infection, morbidity and mortality as well as unfavorable help-seeking behavior and generally lower vaccination rates need support.
In the outpatient psychiatric facilities of the Psychosocial Services in Vienna (PSD-Wien), specific concepts to support “protect, test, vaccinate” were implemented to protect patients and employees. Information about the benefits and risks of vaccination, relieving fears and support in registering and attending vaccination appointments were of special significance.
Analyzes of selected data from 1,319 patients at PSD-Wien show (period: 1st half of 2021) that these measures made it possible to achieve a significantly higher vaccination willingness in people with severe mental illnesses (84 %) than in the general Austrian population (based on the date of examination, currently approximately 60 %). The same applies to vaccination rates: at least 47 % have received a partial vaccination, of which about half have already received both partial vaccinations.
High vaccination willingness and rates as well as the necessary protection (wearing masks, keeping distance, complying with hygiene rules) and regular testing must not be a phenomenon of privileged population groups. Psychosocial support is needed so that the trilogy “Protect, test, vaccinate” becomes possible for everyone, including people with severe mental illnesses. Social psychiatry is not just about mental health, but also about physical health care and prevention.
The Covid-19 pandemic has highlighted the urgency for innovative vaccine strategies since the best of vaccines cannot be useful if people do not accept vaccinations. The current situation suggests that vaccinology has been ignored in the medical curriculum and needs more representation in teaching.
What, where and how vaccinology is taught during medical studies in Heidelberg and development of an interdisciplinary revised syllabus and practice-oriented teaching methods.
Curricular mapping of courses on the topic of “vaccination”, defining new learning objectives for designing innovative teaching units in consultation with teachers and students, redevelopment and updating of teaching materials.
In preliminary work, an OSCE has been created by students. Initial findings on the status of teaching on vaccinations and related communication skills in medical schools of Germany with respect to student needs and the national guidelines on learning goals for future physicians are submitted in journal ‘Vaccine’. In collaboration with the elective track Digital Medicine, two tele-OSCEs, an online knowledge quiz on vaccination education and a corresponding evaluation tool will be developed in WS 2021/22. Students will learn how to create modern teaching methods and evaluate them scientifically, using a concrete and relevant topic as an example, and will gain an insight into teaching.
The findings will be integrated into the Heidelberg medical school curriculum (HeiCuMed) on a long-term basis by developing a comprehensive interdisciplinary module ‘Vaccination and Vaccines’, which can either be integrated into various existing courses (e.g. virology, medical Communication, global health, etc) or as a separate elective interprofessional course.
Low vaccination rate against coronavirus in Russia demands for studies of psychological factors affecting decision to vaccinate. Readiness for vaccination is related to perceptions of risk, concerns and trust in the source of the recommendations (Chung, Thone, Kwon, 2021, Flanagan et al., 2020).
To study the subjective readiness for vaccination against coronavirus and its relationship with pandemic anxiety and attitudes towards vaccination.
525 people aged 18 to 65 appraised their readiness to vaccination (Cronbach’s alpha .89-.90), filled out Anxiety Regarding Pandemic Scale (Tkhostov, Rasskazova, 2020), modified version Beliefs About Medication Questionnaire (Horne, 2002) that was reformulated to measure beliefs about vaccination in December 2020.
13.2% -17.0% participants reported readiness to be vaccinated. Low readiness rate was due to doubts and mistrust (59.0% -60.4%). Having more friends experienced coronavirus as well as severe or fatal cases of coronavirus illness among personal acquaintances were associated with higher rates of pandemic anxiety but not readiness to vaccinate. Readiness to vaccinate asap was predicted by belief in the effectiveness and lower concern about vaccination (R²=34,6%) and anxiety regarding risks and side effects of the vaccination (ΔR²=1,5%). Decision to refuse was predicted by belief that there are better alternatives of prophylaxis, doubts in effectiveness and concerns about necessity (R²=56,0%).
Decision to vaccinate is based both on cognitive confidence in the importance and effectiveness of vaccination, and on less pronounced anxiety about risks and side effects. Research is supported by the Russian Foundation for Basic Research, project No. 20-04-60072.
Research is supported by the Russian Foundation for Basic Research, project No. 20-04-60072.
The COVID-19 pandemic currently remains the most significant stressor affecting the global population. Researchers continually report widespread mistrust and negative attitudes towards vaccination, but only a little focus on its association with the emotional well-being.
We aimed to investigate the attitudes towards vaccination against COVID-19, as well as its relationship with well-being and religiosity after one year of the pandemic duration amongst Polish students.
We conducted an anonymous online cross-sectional survey between 12th April – 1st June 2021 amongst Polish students (n=1202). To evaluate emotional distress, we used the Depression, Anxiety, and Stress Scale-21 (DASS-21), for measuring spirituality/religiosity we used The Duke University Religion Index.
The highest rate of vaccinated individuals was noted in a group of medical students (69.9%), the lowest - among responders studying science (1.9%). Students who wanted to be vaccinated had higher levels of depressive, anxiety, and stress symptoms compared to those who were already vaccinated (p=0.04); they also had higher depressive symptoms than unvaccinated and unwilling participants (p=0.028). Students who didn’t want to be vaccinated against COVID-19 showed the highest religiosity compared to those who would like to be vaccinated (p<0.001) or were vaccinated (p=0.003). There was a negative correlation between the level of religiosity and severity of depressive and anxiety symptoms (p=0.002).
1. The attitudes towards vaccination against COVID-19 depended on the fields of study. 2. Religiousness has been linked with the attitudes towards COVID-19 vaccination as well as level of depression and anxiety amongst Polish students.
Understanding the predictors of the willingness to get vaccinated against COVID-19 may aid in the resolution of current and future pandemics.Understanding the predictors of the willingness to get vaccinated against COVID-19 may aid in the resolution of current and future pandemics.
We aim to investigate how the readiness to believe conspiracy theories and the three dimensions of health locus of control affect the attitude towards vaccination.
A cross-sectional study was conducted based on data from an online survey of a sample of Czech university students (n=866) collected in January 2021, using multivariate linear regression models and moderation analysis.
Sixty-six percent of Czech students wanted to get vaccinated against COVID-19. Forty percent of the variance of willingness to get vaccinated was explained by the belief in covid-related conspiracy theories and the powerful others dimension of health locus of control. One sixth of the variance of the willingness to get vaccinated was explained by health locus of control, cognitive reflection, and digital health literacy.
Health locus of control and conspiracy mentality and its predictors are valid predictors of a hesitancy to get vaccinated against COVID-19. Campaigns promoting vaccination should target groups specifically vulnerable to conspiracy theories and lacking health locus of control related to powerful others.
Covid-19 vaccination in adults become a common behaviour nowadays. It may induce stress in some of the vaccinated patients.
This study aimed to evaluate perceived Stress among university teachers desiring to be vaccinated.
We conducted a cross-sectional study on Tunisian university teachers who participated in a COVID-19 vaccination campaign organized in June 2021. A self-administered questionnaire was administered. The survey dealt with socio-professional data and the level of stress assessed with the Perceived Stress Scale (PSS-10).
A total of 100 participants were included. The mean age was 51 years ±7. The Sex Ratio (M/F) was 1.7. The majority of participants were married and reported living with their families (96%). On a 0 to 10 scale, 71% of participants described an excellent health status and rated it greater than or equal to 8. The average job tenure was 15 years. The PSS-10 showed moderate and high perceived stress in 86% and 4% of participants, respectively. Only 10% of university teachers presented low-stress perception.
Getting vaccinated against Covid-19 is crucial in order to protect the population. This behaviour could be associated with a big amount of stress. Taking into account the psychiatric mental condition is crucial for the vaccinating health care providers in order to alleviate this experience.
Vaccination is an effective way to control the infection. COVID-19 is a new disease, and so is the vaccine against it.
The aim of the study was to investigate psychological characteristics associated with attitude towards vaccination.
An online survey was used (N=1336) (31.03.2020–9.02.2021). Respondents completed COPE, «Moral dilemmas» (30 Green’s Dilemmas, 10 of each type) and decided which strategy to stop the pandemic they found the effective (vaccination, herb immunity, innovative treatment or simply waiting until it fades away on its own). The study analyzed groups of those who see the benefits of vaccination and those who do not consider vaccination as a way to solve the problem of coronavirus.
«Vaccination» attitude is more typical for men, for younger people and is also associated with assessment of COVID-19 as a dangerous disease (61% versus 21% for «vaccination» and «no vaccination» groups respectively), more diligent compliance with anti-epidemic rules (3,7 and 2,9 mean number of protection methods used), at the same time, the “vaccination” group responds about the less inconvenience associated with restrictions during the pandemic. This social attitude is associated with «need for creativity» and constructive coping: «planning», «concentration on emotions», the use of instrumental and emotional social support. There is a difference in personal moral choices (3,6 versus 2,9 for «vaccination» and «no vaccination» groups respectively), that demonstrated that positive attitude towards vaccination signifies an active personal position.
Positive attitude towards vaccination is associated with a proactive personal position and involvement in social interaction using interpersonal coping strategies.
Chapter 4 examines how the aftosa commission understood and countered opposition, using threats and targeted violence, carefully calibrated concessions, propaganda, mediation by regional bosses and powerbrokers, and information-gathering. It argues that this blend of tactics illustrates the Mexican state’s conceptions of order and security, and supports the notion of the PRI regime as a "dictablanda"- authoritarian but institutionally weak, and reliant on a complicated blend of repressive and consensual mechanisms.
Chapter 2 explains how and why the campaign against aftosa adopted the policies it did, focusing on high politics of bilateral diplomacy, the main competing political and economic interests on both sides of the border, and bureaucratic infrapolitics. The Mexican government used international ties, obfuscation and delay to gradually blunt US policy preferences and shift the aftosa campaign from slaughter to vaccination. In this way the campaign illustrates the diplomatic leverage Mexico retained in the postwar period, and how it was used.