573. Digital Patient/Caregiver Education: A Tool to Improve COVID-19 Vaccination Rates and Confidence Among the Public

Abstract Background Due to patient hesitancy surrounding the COVID-19 vaccination initiative, the public needs accurate and timely education that encourages partnership with medical professionals. Methods This study assessed the impact of online patient/caregiver education on knowledge, confidence and intent to act. The educational intervention consisted of 4 activities published on a dedicated COVID-19 learning center on WebMD Education portal from April-May, 2021. The activities were comprised of text and integrated visuals, with 3 of the activities being further customized with a patient or healthcare professional (HCP) video commentary. Demographic questions were asked prior to each activity. Knowledge questions were asked both before and after to assess learning gains. Intent to change and confidence questions were asked at the end of each activity. Absolute improvements were calculated for pre/post questions. An initial data pull was conducted on 6/7/2021 for the purpose of this abstract, and data for the complete analysis will be collected until approximately 8/7/21. Results To date, 14,911 learners (3,579) of which responded to the pre/post questions) have participated in the activities, and have demonstrated improvements in knowledge and high levels of confidence and intent to act (Figure). Activity 1: COVID-19 Vaccines: Covering the Basics. Demographics (n=155): 50% male; 41% White, non-Hispanic, 30% Asian; 52% over the age of 54. Activity 2: Understanding the Why, Who, and When of COVID-19 Vaccines. Demographics (n=2,325): 66% female; 51% White, non-Hispanic, 18% Asian; 54% over the age of 54. Activity 3: What to Expect When You Get the COVID-19 Vaccine. Demographics (n=500): 66% female; 49% White, non-Hispanic, 22% Asian; 56% over the age of 54. Activity 4: What Have You Heard about Herd Immunity and COVID-19. Demographics (n=599): 63% female; 53% White, non-Hispanic, 25% Asian; 53% over the age of 54. Conclusion The metrics and outcomes gathered in this assessment are a strong indicator that online patient/caregiver activities on WebMD Education improved knowledge and confidence and prompted intent to act related to COVID-19 vaccines. These findings highlight the potential for well-designed online education to overcome vaccine related challenges of the COVID-19 pandemic. Disclosures All Authors: No reported disclosures

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P1855ONLINE PATIENT/CAREGIVER EDUCATION ON HYPERKALEMIA CAN IMPROVE KNOWLEDGE AND COMPETENCE AS WELL AS PROMPT REAL LIFE CHANGES

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1855 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Amy Larkin ◽

Don Blatherwick

Keyword(s):

Heart Failure ◽

Online Education ◽

Real Life ◽

Outcomes Analysis ◽

High Potassium ◽

Caregiver Education ◽

Knowledge Question ◽

Before And After ◽

Strict Diet ◽

The Impact

Abstract Background and Aims Managing hyperkalemia with a strict diet is limiting and difficult for patients. We sought to measure the impact of online education for patients/caregivers on knowledge and confidence as well as prompting change in daily life. Method The patient/caregiver education was designed as 2 online, interactive activities. Both were comprised of text and integrated visuals; the second also included a patient commentary video. Demographic questions were asked prior to starting the education. A knowledge question was asked both before and after the activity to assess learning gains, as well as intent to change and confidence questions at the end. Absolute improvements were calculated for pre/post questions. The activities launched in April and May of 2019, and data collected through October 2019. Results To date, 98,462 learners have participated in the patient/caregiver activity. Activity 1: High Potassium: Causes and reasons to Treat Participants: 60,060 Completers of all questions (included in outcomes analysis): 7,262 Demographics: 59% female; 49% white, non-Hispanic; 66% over the age of 54; 16% have hyperkalemia, 75% were interested in learning more about the condition Knowledge changes: 13% improvement in understanding what causes hyperkalemia (46% pre to 59% post) Intent-to-act: 66% plan to talk to an HCP about next steps for treating hyperkalemia Confidence changes: 82% reported increased confidence understanding why it’s important to treat hyperkalemia Activity 2: It’s Complicated: How to Manage High Potassium and Heart Failure Participants: 38,402 Completers of all questions (included in outcomes analysis): 3,816 Demographics: 60% female; 63% white, non-Hispanic; 69% over the age of 54; 58% were interested in learning more about the condition and 25% have this condition Knowledge changes: 13% improvement in recognizing how potassium levels effect the heart (76% pre to 89% post) Intent-to-act: 64% plan to talk to their healthcare provider about a plan to manage my hyperkalemia Confidence changes: 82% reported increased confidence understanding how important is it to manage my heart failure and hyperkalemia Conclusion The metrics and outcomes gathered in this assessment are a strong indicator that these patient/caregiver-focused online educational activities improved knowledge and confidence, and prompted intent to act by patients/caregivers related to hyperkalemia.

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Changes in the Soundscape of the Public Space Close to a Highway by a Noise Control Intervention

Sustainability ◽

10.3390/su13095284 ◽

2021 ◽

Vol 13 (9) ◽

pp. 5284

Author(s):

Timothy Van Renterghem ◽

Francesco Aletta ◽

Dick Botteldooren

Keyword(s):

Public Space ◽

Real Life ◽

Noise Abatement ◽

Acoustic Environment ◽

The Public ◽

Control Intervention ◽

Before And After ◽

Noise Shielding ◽

Visual Preferences ◽

The Impact

The deployment of measures to mitigate sound during propagation outdoors is most often a compromise between the acoustic design, practical limitations, and visual preferences regarding the landscape. The current study of a raised berm next to a highway shows a number of common issues like the impact of the limited length of the noise shielding device, initially non-dominant sounds becoming noticeable, local drops in efficiency when the barrier is not fully continuous, and overall limited abatement efficiencies. Detailed assessments of both the objective and subjective effect of the intervention, both before and after the intervention was deployed, using the same methodology, showed that especially the more noise sensitive persons benefit from the noise abatement. Reducing the highest exposure levels did not result anymore in a different perception compared to more noise insensitive persons. People do react to spatial variation in exposure and abatement efficiency. Although level reductions might not be excessive in many real-life complex multi-source situations, they do improve the perception of the acoustic environment in the public space.

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The Effect of Vaccination Rates on the Infection of COVID-19 under the Vaccination Rate below the Herd Immunity Threshold

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18147491 ◽

2021 ◽

Vol 18 (14) ◽

pp. 7491

Author(s):

Yi-Tui Chen

Keyword(s):

Infection Rate ◽

Herd Immunity ◽

The United States ◽

Vaccination Rate ◽

Infection Rates ◽

Vaccination Rates ◽

The United Kingdom ◽

The World ◽

Almost All ◽

The Impact

Although vaccination is carried out worldwide, the vaccination rate varies greatly. As of 24 May 2021, in some countries, the proportion of the population fully vaccinated against COVID-19 has exceeded 50%, but in many countries, this proportion is still very low, less than 1%. This article aims to explore the impact of vaccination on the spread of the COVID-19 pandemic. As the herd immunity of almost all countries in the world has not been reached, several countries were selected as sample cases by employing the following criteria: more than 60 vaccine doses per 100 people and a population of more than one million people. In the end, a total of eight countries/regions were selected, including Israel, the UAE, Chile, the United Kingdom, the United States, Hungary, and Qatar. The results find that vaccination has a major impact on reducing infection rates in all countries. However, the infection rate after vaccination showed two trends. One is an inverted U-shaped trend, and the other is an L-shaped trend. For those countries with an inverted U-shaped trend, the infection rate begins to decline when the vaccination rate reaches 1.46–50.91 doses per 100 people.

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Impact of Louisiana’s HPV Vaccine Awareness Policy on HPV Vaccination Among 13- to 17-Year-Old Females

Health Education & Behavior ◽

10.1177/1090198116684766 ◽

2017 ◽

Vol 44 (4) ◽

pp. 548-558 ◽

Cited By ~ 3

Author(s):

Dudith Pierre-Victor ◽

Mary Jo Trepka ◽

Timothy F. Page ◽

Tan Li ◽

Dionne P. Stephens ◽

...

Keyword(s):

Hpv Vaccine ◽

Hpv Vaccination ◽

Female Adolescents ◽

Physician Recommendation ◽

Vaccination Rates ◽

National Immunization ◽

Before And After ◽

The Difference ◽

Vaccine Information ◽

The Impact

The Advisory Committee on Immunization Practices recommends routine human papillomavirus (HPV) immunization for 11- to 12-year-old adolescents. In 2008, Louisiana required the school boards to distribute HPV vaccine information to parents or guardian of students in Grades 6 to 12. This article investigates the impact of this policy on HPV vaccination among 13- to 17-year-old female adolescents using National Immunization Survey-Teen (NIS-Teen) data. Drawing on the data from the 2008 to 2012 NIS-Teen, we compared the difference in proportions of females who have been vaccinated before and after the policy. Using difference-indifference estimation, we explored the change in vaccination rates before and after the policy implementation in Louisiana compared with Alabama and Mississippi, two states that did not have such a policy in place. The difference-in-differences estimates for HPV vaccination were not significant. Physician recommendation for HPV vaccination was significantly associated with vaccination among females in Louisiana and Alabama (adjusted odds ratio [aOR] = 7.74; 95% confidence interval [CI; 5.22, 11.5]), and for those in Louisiana and Mississippi (aOR = 7.05; 95% CI [4.6, 10.5]). Compared to the proportion of female adolescents who had received physician recommendation in Alabama or Mississippi, the proportion in Louisiana did not increase significantly in the postpolicy period. HPV vaccination rates did not increase significantly in Louisiana compared to Alabama or Mississippi following the implementation of the policy. Despite Louisiana’s policy, physician recommendation remains the key determinant of HPV vaccination. HPV vaccine awareness does not necessarily result in HPV vaccination.

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Walking on Water—A Natural Experiment of a Population Health Intervention to Promote Physical Activity after the Winter Holidays

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16193627 ◽

2019 ◽

Vol 16 (19) ◽

pp. 3627

Author(s):

Jonathan McGavock ◽

Nicole Brunton ◽

Nika Klaprat ◽

Anders Swanson ◽

Dave Pancoe ◽

...

Keyword(s):

Physical Activity ◽

Natural Experiment ◽

Experimental Studies ◽

Annual Household Income ◽

Convenience Sample ◽

The Public ◽

Population Health Intervention ◽

Before And After ◽

The Impact ◽

Urban Trail

Background: Very few experimental studies exist describing the effect of changes to the built environment and opportunities for physical activity (PA). We examined the impact of an urban trail created on a frozen waterway on visitor counts and PA levels. Methods: We studied a natural experiment in Winnipeg, Manitoba, Canada that included 374,204 and 237,362 trail users during the 2017/2018 and 2018/2019 winter seasons. The intervention was a 10 km frozen waterway trail lasting 8–10 weeks. The comparator conditions were the time periods immediately before and after the intervention when ~10 kms of land-based trails were accessible to the public. A convenience sample of 466 participants provided directly measured PA while on the frozen waterway. Results: Most trail users were 35 years or older (73%), Caucasian (77%), and had an annual household income >$50,000 (61%). Mean daily trail network visits increased ~four-fold when the frozen waterway was open (median and interquartile range (IQR) = 710 (239–1839) vs. 2897 (1360–5583) visits/day, p < 0.001), compared with when it was closed. Users achieved medians of 3852 steps (IQR: 2574–5496 steps) and 23 min (IQR: 13–37 min) of moderate to vigorous intensity PA (MVPA) per visit, while 37% of users achieved ≥30 min of MVPA. Conclusion: A winter-specific urban trail network on a frozen waterway substantially increased visits to an existing urban trail network and was associated with a meaningful dose of MVPA. Walking on water could nudge populations living in cold climates towards more activity during winter months.

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Getting personal: how vaccination exemptions shape herd immunity

10.1101/500553 ◽

2018 ◽

Author(s):

Emma R Nedell ◽

Romain Garnier ◽

Saad B Omer ◽

Shweta Bansal

Keyword(s):

Policy Change ◽

Spatial Clustering ◽

Vaccine Coverage ◽

Herd Immunity ◽

The United States ◽

Vaccine Preventable Diseases ◽

Vaccination Rates ◽

Before And After ◽

Exemption Policy ◽

Epidemiological Effects

Background: State-mandated school entry immunization requirements in the United States play an important role in achieving high vaccine coverage and preventing outbreaks of vaccine-preventable diseases. Most states allow non-medical exemptions that let children remain unvaccinated on the basis of personal beliefs. However, the ease of obtaining such exemptions varies, resulting in a patchwork of state vaccination exemption laws, contributing to heterogeneity in vaccine coverage across the country. In this study, we evaluate epidemiological effects and spatial variations in non-medical exemption rates in the context of vaccine policies. Methods and Findings: We first analyzed the correlation between non-medical exemption rates and vaccine coverage for three significant childhood vaccinations and found that higher rates of non-medical exemptions were associated with lower vaccination rates of school-aged children in all cases. We then identified a subset of states where exemption policy has recently changed and found that the effects on statewide non-medical exemption rates varied widely. Focusing further on Vermont and California, we illustrated how the decrease in non-medical exemptions due to policy change was concurrent to an increase in medical exemptions (in CA) or religious exemptions (in VT). Finally, a spatial clustering analysis was performed for Connecticut, Illinois, and California, identifying clusters of high non-medical exemption rates in these states before and after a policy change occurred. The clustering analyses show that policy changes affect spatial distribution of non-medical exemptions within a state. Conclusions: Our work suggests that vaccination policies have significant impacts on patterns of herd immunity. Our findings can be used to develop evidence-based vaccine legislation.

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EFFECT OF LOCKDOWN ON EDUCATION OF RURAL UNDERGRADUATE STUDENTS DURINGCOVID-19 PANDEMIC IN UMARBAN (DHAR), M.P., INDIA

Innovare Journal of Education ◽

10.22159/ijoe.2021v9i3.41647 ◽

2021 ◽

pp. 14-18

Author(s):

Jyoti Agrawal

Keyword(s):

Online Education ◽

Undergraduate Students ◽

Rural Areas ◽

Online Classes ◽

Virtual Classrooms ◽

Before And After ◽

E Learning ◽

Study Participants ◽

The Impact ◽

Support Students

A survey was conducted to assess the impact of lockdown due to COVID-19 on online education of undergraduate learners of government colleges Umarban, district Dhar (454449) Madhya Pradesh, India. An online as well as offline survey was conducted from 10 October 2020 to 15 March 2021 to collect the information. To analyze the possibility and attention of students for online education, various online quizzes were conducted in which a structural questionnaire link using ‘Google form’ was sent to students through WhatsApp. A total of 265 students were taken for the survey. The simple percentage distribution was used to assess the learning status of the study participants. During the lockdown period, around 15.47% of learners were involved in e-learning. Most of the learners were used android mobile for attending e-learning. The present study revealed that around 60% of students were seen to involve in farming during lockdown instead of online classes. In addition to this, 45% of students never joined an online class during the entire session. Further analysis demonstrated that 13% of students do not have their own mobile phone, nearly 18% could not join due to poor internet connectivity, 21% of students faced unfavorable study environment at home and 3% of students have other reasons. This study also showed a comparative analysis of the presence of students before and after the COVID 19 pandemic. As the ratio of presence of students in physical and virtual classrooms was 2.32. The overall results from this study revealed that especially in rural areas COVID – 19 pandemic had affected more adversely on classroom attendance, where people already do not want to give importance to education. Higher education institutions may benefit from these findings while formulating strategies to support students during this pandemic. Moreover, to promote education in COVID 19 era strong strategies are urgently needed.

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Impact of SARS-CoV-2 Vaccines on Covid-19 Incidence and Mortality in the United States

10.1101/2021.11.16.21266360 ◽

2021 ◽

Author(s):

Fang Fang ◽

John David Clemens ◽

Zuo-Feng Zhang ◽

Timothy F. Brewer

Keyword(s):

Negative Binomial ◽

Herd Immunity ◽

The United States ◽

Vaccination Rate ◽

Vaccine Hesitancy ◽

Percentage Increase ◽

Protective Effects ◽

Vaccination Rates ◽

Incidence And Mortality ◽

Before And After

Background: Despite safe and effective vaccines to prevent Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infections and disease, a substantial minority of the US remains resistant to getting vaccinated. It is imperative to know if expanding vaccination rates could reduce community-wide Coronavirus 2019 (COVID-19) disease, not just among those vaccinated. Methods: Negative binomial models were used to estimate associations between U.S. county-level vaccination rates and county-wide COVID-19 incidence and mortality between April 23rd and September 30th, 2021. A two-week lag and a four-week lag were introduced to assess vaccination rate impact on incidence and mortality, respectively. Stratified analyses were performed for county vaccination rates >40%, and before and after Delta became the dominant variant. Findings: Among 3,070 counties, each percentage increase in population vaccination rates reduced county-wide COVID-19 incidence by 0.9% (relative risk (RR) 0.9910 (95% CI: 0.9869, 0.9952)) and mortality by 1.9% (RR 0.9807 (95% CI: 0.9745, 0.9823)). Among counties with vaccination coverage >40%, each percentage increase in vaccination rates reduced COVID-19 disease by 1.5%, RR 0.9850 (95% CI: 0.9793, 0.9952) and mortality by 2.7% (RR 0.9727 (95% CI: 0.9632, 0.9823)). These associations were not observed among counties with <40% vaccination rates. Increasing vaccination rates from 40% to 80% would have reduced COVID-19 cases by 45.4% (RR 0.5458 (95% CI: 0.4335, 0.6873)) and deaths by 67.0% (RR 0.3305 (95% CI: 0.2230, 0.4898)). An estimated 5,989,952 COVID-19 cases could have been prevented and 127,596 lives saved had US population vaccination rates increased from 40% to 80%. Interpretations: Increasing U.S. SARS-CoV-2 vaccination rates results in population-wide reductions in COVID-19 incidence and mortality. Furthermore, increasing vaccination rates above 40% has protective effects among non-vaccinated persons. Given ongoing vaccine hesitancy in the U.S., increasing vaccination rates could better protect the entire community and potentially reach herd immunity. Funding: National Cancer Institute

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Synergetic measures needed to control infection waves and contain SARS-CoV-2 transmission

10.1101/2021.11.24.21266824 ◽

2021 ◽

Author(s):

Hang Su ◽

Yafang Cheng ◽

Ulrich Poeschl

Keyword(s):

Basic Reproduction Number ◽

Reproduction Number ◽

Scientific Discourse ◽

Protective Measure ◽

Protective Measures ◽

Vaccination Rates ◽

The Public ◽

Individual Measure ◽

The Impact ◽

Pharmaceutical Interventions

The public and scientific discourse on how to mitigate the COVID-19 pandemic is often focused on the impact of individual protective measures, in particular on immunization by vaccination. In view of changing virus variants and conditions, however, it seems not clear if vaccination or any other single protective measure alone may suffice to contain the transmission of SARS-CoV-2. Here, we investigate the effectiveness and synergies of vaccination and different non-pharmaceutical interventions such as universal masking (surgical, N95/FFP2), distancing & ventilation, contact reduction, and testing & isolation as a function of compliance in the population. We find that it would be difficult to contain SARS-CoV-2 transmission by any individual measure as currently available under realistic conditions. Instead, we show how multiple synergetic measures can be and have to be combined to decrease and keep the effective reproduction number (Re) below unity, even for virus variants with increased basic reproduction number (R0). We suggest that the presented approach and results can be used to design and communicate efficient strategies for mitigating the COVID-19 pandemic, depending on R0 as well as the efficacy and compliance achieved with each protective measure. At vaccination rates around 70%, the combination and synergies of universal masking, distancing & ventilation, and testing & isolation with moderate compliances around 30% appear well suited to keep Re below 1 and prevent or suppress infection waves. Higher compliance or additional measures like contact reductions (confinement/lockdown) are required to effectively and swiftly break intense waves of infection. For schools, we find that the transmission of SARS-CoV-2 can be contained by 2-3 tests per week combined with distancing & ventilation and masking.

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Tax evasion and public governance before and after the European “big bang”: a red flag for policymakers

Journal of Financial Crime ◽

10.1108/jfc-04-2020-0064 ◽

2020 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Ahmed Emadeldin Yamen ◽

Hounaida Mersni ◽

Abdulhadi Ramadan

Keyword(s):

Tax Evasion ◽

Eu Enlargement ◽

Public Governance ◽

Content Type ◽

The Public ◽

Before And After ◽

Governance Quality ◽

Evasion Behavior ◽

The Impact ◽

The Eu

Purpose The purpose of this study is to examine the impact of public governance quality on tax evasion levels in old (pre-2004) and new (post-2004) European Union (EU) members before and after the 2004 EU-enlargement. Design/methodology/approach This study uses panel data of 28 EU countries over the period 1996-2015. Tax evasion is measured using an updated version of the shadow economy size based on the light intensity, as calculated by (Medina and Schneider, 2018). The World Bank’s worldwide governance indicators are used as a measure of public governance. Findings The results indicate that new EU members have higher tax evasion levels compared to the old ones before and after the 2004 EU enlargement. The findings also report that the public governance quality is superior in old members throughout the 1996-2015 period. Furthermore, the authors found that after the EU enlargement, tax evasion levels decreased in both EU groups; however, the authors noticed an improvement in the public governance quality in new members and a deterioration in old ones. Additional analysis confirms the impact of public governance quality as an effective tool for reducing tax evasion behavior in both EU groups before and after the EU enlargement. Practical implications The findings are potentially useful for EU policymakers in identifying the most effective tools that can minimize tax evasion levels in EU countries. Additionally, the results are alarming as they show the negative consequences of the EU enlargement in old EU members. Thus, policymakers should consider them when setting their rules and regulations to reduce the significant differences between both EU groups to prevent member states from potentially exiting the EU. Originality/value To the best of the knowledge, this is the first study that examines the tax evasion behavior and public governance quality in the EU before and after the EU enlargement.

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