Relationship between housing insecurity, diabetes processes of care, and self-care behaviors

Background The aim of this analysis was to examine the influence of housing insecurity on diabetes processes of care and self-care behaviors and determine if that relationship varied by employment status or race/ethnicity. Methods Using nationally representative data from the Behavioral Risk Factor Surveillance System (2014-2015), 16,091 individuals were analyzed for the cross-sectional study. Housing insecurity was defined as how often respondents reported being worried or stressed about having enough money to pay rent/mortgage. Following unadjusted logistic models testing interactions between housing insecurity and either employment or race/ethnicity on diabetes processes of care and self-care behaviors, stratified models were adjusted for demographics, socioeconomic status, health insurance status, and comorbidity count. Results 38.1% of adults with diabetes reported housing insecurity. Those reporting housing insecurity who were employed were less likely to have a physicians visit (0.58, 95%CI 0.37,0.92), A1c check (0.45, 95%CI 0.26,0.78), and eye exam (0.61, 95%CI 0.44,0.83), while unemployed individuals were less likely to have a flu vaccine (0.84, 95%CI 0.70,0.99). Housing insecure White adults were less likely to receive an eye exam (0.67, 95%CI 0.54,0.83), flu vaccine (0.84, 95%CI 0.71,0.99) or engage in physical activity (0.82, 95%CI 0.69,0.96), while housing insecure Non-Hispanic Black adults were less likely to have a physicians visit (0.56, 95%CI 0.32,0.99). Conclusions Housing insecurity had an influence on diabetes processes of care and self-care behaviors, and this relationship varied by employment status and race/ethnicity. Diabetes interventions should incorporate discussion surrounding housing insecurity and consider differences in the impact by demographic factors on diabetes care.

Time trends, factors associated with, and reasons for COVID-19 vaccine hesitancy: A massive online survey of US adults from January-May 2021

Importance COVID-19 vaccine hesitancy has become a leading barrier to increasing the US vaccination rate. Objective To evaluate time trends in COVID-19 vaccine intent during the US vaccine rollout, and identify key factors related to and self-reported reasons for COVID-19 vaccine hesitancy in May 2021. Design, participants and setting A COVID-19 survey was offered to US adult Facebook users in several languages yielding 5,088,772 qualifying responses from January 6 to May 31, 2021. Data was aggregated by month. Survey weights matched the sample to the age, gender, and state profile of the US population. Exposure Demographics, geographic factors, political/COVID-19 environment, health status, beliefs, and behaviors. Main outcome measures “If a vaccine to prevent COVID-19 were offered to you today, would you choose to get vaccinated.” Hesitant was defined as responding probably or definitely would not choose to get vaccinated (versus probably or definitely would, or already vaccinated). Results COVID-19 vaccine hesitancy decreased by one-third from 25.4% (95%CI, 25.3, 25.5) in January to 16.6% (95% CI, 16.4, 16.7) in May, with relatively large decreases among participants with Black, Pacific Islander or Hispanic race/ethnicity and ≤high school education. Independent risk factors for vaccine hesitancy in May (N = 525,644) included younger age, non-Asian race, < 4 year college degree, living in a more rural county, living in a county with higher Trump vote share in the 2020 election, lack of worry about COVID-19, working outside the home, never intentionally avoiding contact with others, and no past-year flu vaccine. Differences in hesitancy by race/ethnicity varied by age (e.g., Black adults more hesitant than White adults <35 years old, but less hesitant among adults ≥45 years old). Differences in hesitancy by age varied by race/ethnicity. Almost half of vaccine hesitant respondents reported fear of side effects (49.2% [95%CI, 48.7, 49.7]) and not trusting the COVID-19 vaccine (48.4% [95%CI, 48.0, 48.9]); over one-third reported not trusting the government, not needing the vaccine, and waiting to see if safe. Reasons differed by degree of vaccine intent and by race/ethnicity. Conclusion COVID-19 vaccine hesitancy varied by demographics, geography, beliefs, and behaviors, indicating a need for a range of messaging and policy options to target high-hesitancy groups.

Likelihood of COVID-19 Vaccination Among Individuals Living With Psoriatic Disease: Results From a Large Real-World Survey

Introduction: Development and dissemination of novel COVID-19 vaccines represent an opportunity to end the COVID-19 pandemic by vaccinating an estimated 80% of the population. Objectives: This study examines perceptions, and demographic and clinical factors influencing the likelihood of adults with psoriasis receiving a novel COVID-19 vaccine. Methods: A cross sectional study conducted from October–November 2020 of 1405 adults with psoriatic disease with prior contact to a patient advocacy organization. The main outcome of interest was the likelihood of receiving a COVID-19 vaccine. Chi-square tests and logistic regression examined the relationship between individual characteristics and likelihood of receiving a COVID-19 vaccine. Results: Most participants (65%) received a flu vaccination in the last 12 months and were (64.2%) likely to receive a COVID-19 vaccine, while 35.9% reported being unlikely receive a vaccine. Likelihood of COVID-19 vaccination was associated with receiving the flu vaccine, race, ethnicity, sex, BMI, age, income, severity of PsO and PsA. When controlling for ethnicity, race, male sex, overweight/obese status, age, biologic use, disease type, comorbidities linked with worse COVID-19 outcomes, PsA symptoms, and skin disease severity, individuals who received the flu vaccine and those with annual household income over $75,000 were most likely to receive a COVID-19 vaccine. Conclusions: Vaccine hesitancy among individuals with psoriatic disease is considerable. Dermatologists and rheumatologists can increase COVID-19 vaccine uptake by actively engaging their patients on this topic using guidance published by the National Psoriasis Foundation on the management of psoriatic disease during the COVID-19 pandemic.

Factors associated with the unwillingness of Jordanians, Palestinians and Syrians to be vaccinated against COVID-19

Background The COVID-19 pandemic is expected to continue to inflect immense burdens of morbidity and mortality, not to mention the sever disruption of societies and economies worldwide. One of the major challenges to managing COVID-19 pandemic is the negative attitudes towards vaccines and the uncertainty or unwillingness to receive vaccinations. We evaluated the predictors and factors behind the negative attitudes towards COVID-19 vaccines in 3 countries in the Middle East. Methods A cross-sectional, self-administered survey was conducted between the 1st and the 25th of December, 2020. Representative sample of 8619 adults residing in Jordan, West Bank, and Syria, completed the survey via the Web or via telephone interview. The survey intended to assess intent to be vaccinated against COVID-19 and to identify predictors of and reasons among participants unwilling/hesitant to get vaccinated. Results The total of the 8619 participants included in this study were the ones who answered the question on the intent to be vaccinated. Overall, 32.2% of participants (n = 2772) intended to be vaccinated, 41.6% (n = 3589) didn’t intend to get vaccinated, and 26.2% (n = 2258) were not sure. The main factors associated with the willingness to take the vaccine (yes responses) included females, 18–35 years old, Syrians and Jordanians, a large family size, and having received a flu vaccine last year. Reasons for vaccine hesitancy included the lack of rigorous evaluation of the vaccine by the FDA and the possible long-term health risks associated with the vaccines (the wait-and-see approach). Conclusion This survey, conducted in December when the number of cases and deaths per day due to COVID-19 were at or near peak levels of the initial surge in the three regions under investigation. The survey revealed that most of survey’s participants (67.8%) were unwilling/hesitant to get vaccinated against COVID-19 with the lack of trust in the approval process of the vaccine being the main concern; the two main characteristics of those participants were more than 35 years old and participants holding a Bachelor’s degree or higher. Targeted and multi-pronged efforts will be needed to increase acceptance of COVID-19 vaccine in Jordan, West Bank and Syria.

Psychological predictors of vaccination intentions among U.S. undergraduates and online panel workers during the 2020 COVID-19 pandemic

Objective Availability of safe and effective vaccines against COVID-19 is critical for controlling the pandemic, but herd immunity can only be achieved with high vaccination coverage. The present research examined psychological factors associated with intentions to receive COVID-19 vaccination and whether reluctance towards novel pandemic vaccines are similar to vaccine hesitancy captured by a hypothetical measure used in previous research. Method Study 1 was administered to undergraduate students when COVID-19 was spreading exponentially (February-April 2020). Study 2 was conducted with online panel workers toward the end of the first U.S. wave (July 2020) as a pre-registered replication and extension of Study 1. In both studies, participants (total N = 1,022) rated their willingness to receive the COVID-19 vaccination and to vaccinate a hypothetical child for a fictitious disease, and then responded to various psychological measures. Results In both studies, vaccination intentions were positively associated with past flu vaccine uptake, self-reported vaccine knowledge, vaccine confidence, and sense of collective responsibility. Complacency (not perceiving disease as high-risk), anti-vaccine conspiracy beliefs, perceived vaccine danger, and mistrust in science/scientists were negative correlates of vaccination intentions. Constraints (psychological barriers), calculation (extensive information-searching), analytical thinking, perceived disease vulnerability, self-other overlap, and conservatism were weakly associated with vaccination intentions but not consistently across both studies or vaccine types. Additionally, similar factors were associated with both real and hypothetical vaccination intentions, suggesting that conclusions from pre-COVID vaccine hesitancy research mostly generalize to the current pandemic situation. Conclusion Encouraging flu vaccine uptake, enhancing confidence in a novel vaccine, and fostering a sense of collective responsibility are particularly important as they uniquely predict COVID-19 vaccination intentions. By including both actual pandemic-related hesitancy measures and hypothetical hesitancy measures from past research in the same study, this work provides key context for the generalizability of earlier non-pandemic research.

Pharmacist's Perspectives on Administering a COVID-19 Vaccine in Community Pharmacies in Four Balkan Countries

Community pharmacists expanded their roles and engaged in vaccination services in many countries around the world, but not in Balkan countries. This research aimed to assess the perceptions of pharmacists on involvement in the coronavirus disease (COVID-19) vaccine administration in four Balkan countries (Albania, Bulgaria, Romania, and Serbia). A cross-sectional survey was conducted using an online questionnaire that was distributed to community pharmacists across these countries between February and March 2021. A total of 636 community pharmacists were included in the analysis of the survey. The willingness to administer vaccines for COVID-19 (or other vaccines well established in the practice, like a flu vaccine) in community pharmacies is significantly different among the countries: the pharmacists from Albania were more willing to administer vaccines. The factors associated with the eagerness to vaccinate are almost the same among the countries: the lack of training in the faculty classes and the lack of a special place where to administer vaccines. Additional significant factors were found in Bulgaria (pharmacists from independent pharmacies wanted more than the pharmacists working in chain pharmacies to administer vaccines) and in Serbia (male pharmacists agreed more with administering vaccines than female pharmacists). Further national reforms are needed for adopting the expanding role of community pharmacists.

COVID-19 Vaccine Hesitancy in Healthcare Personnel: A University Hospital Experience

Healthcare workers are among risk groups in the COVID-19. Even if they are not infected with the disease, they witness the effects of the pandemic. The aim of the study is to determine the factors affecting COVID-19 vaccination status and reasons for vaccine hesitancy of healthcare personnel in our hospital. Firstly, the vaccination status and demographic characteristics of all healthcare personnel was evaluated. After that, a survey was applied to 408 vaccinated and 297 nonvaccinated personnel. Within the first month after the beginning of vaccination, 66% of 3937 healthcare personnel received a COVID-19 vaccine. The number of vaccinated personnel was higher among doctors, master graduates or higher educational levels and basic science-laboratory unit workers. In the surveyed group, being under the age of 50 (OR:1.85), being nondoctor healthcare personnel (nurse/midwife OR:1.78, administrative personnel OR:3.42, patient attendant/cleaning staff OR:4.11, security guard/other OR:2.96), having had the disease before (OR:2.36), not having the flu vaccine (OR:3.24) and hesitancy about other vaccines (OR:6.61) were found to be independent risk factors for not having a COVID-19 vaccine or having it late. The three most common reasons for not getting vaccinated were doubt on the efficacy of the vaccine, distrust of its content, and fear of side effects. Taking steps by considering the main factors of hesitancy among healthcare personnel will increase the vaccine acceptance.

Flu and Pneumococcal Vaccine Coverage in Scleroderma Patients Still Need to Be Prompted: A Systematic Review

Systemic sclerosis (scleroderma, SSc) is an autoimmune connective tissue disease characterized by excessive production of collagen and multiorgan involvement. Scleroderma patients are at increased risk of influenza complications and pneumonia; thus, vaccinations are recommended. This systematic review evaluated the influenza and pneumococcus vaccination coverage for SSc patients. We included all studies from Pubmed reporting on influenza and pneumococcal vaccination rate in Scleroderma patients up to May 2021. The 14 studies thus selected identified a suboptimal vaccination rate in autoimmune and SSc patients, ranging from 28 to 59% for the flu vaccine, and from 11 to 58% for the pneumo vaccine in absence of specific vaccination campaigns, variously considering also other variables such as age, gender, vaccination settings, and possible vaccination campaigns. We also considered the reasons for low coverage and the approaches that might increase the vaccination rates. A lack of knowledge about the importance of vaccination in these patients and their doctors underlined the need to increase the awareness for vaccination in this patients’ category. Current guidelines recommend vaccination in elderly people and people affected by particular conditions that widely overlap with SSc, yet autoimmune diseases are not always clearly mentioned. Improving this suboptimal vaccination rate with clear guidelines is crucial for SSc patients and for clinicians to immunize these categories based principally on the pathology, prior to the age. Recommendations by the immunologist and the direct link to the vaccine providers can highly improve the vaccine coverage.

Poly-γ-Glutamic Acid/Alum Adjuvanted pH1N1 Vaccine-Immunized Aged Mice Exhibit a Significant Increase In Vaccine Efficacy With a Decrease in Age-Associated CD8+ T Cell Proportion in Splenocytes

BackgroundHighly contagious respiratory diseases caused by viral infections are a constantly emerging threat, particularly the elderly with the higher risk of developing serious complications. Vaccines are the best strategy for protection against influenza-related diseases. However, the elderly has lower vaccine efficacy and the age-driven decline of the influenza vaccine efficacy remains unresolved. In this study, we investigates the effect of an adjuvant, poly-γ-glutamic acid and alum (PGA/Alum) on vaccine efficacy in aged mice (18-months) and its mechanism is studied using ovalbumin as a model antigen and a commercial pandemic H1N1 flu vaccine. Antigen trafficking, dendritic cell (DC) activation, and the DC-mediated T cell activation were analyzed via in vivo imaging and flow cytometry. Antigen-specific humoral and cellular immune responses were evaluated in sera and splenocytes from the vaccinated mice. Also, we analyzed gene expression profiles of splenocytes of vaccinated mice via single-cell transcriptome sequencing and evaluated the protective efficacy against pH1N1 virus challenge.ResultsAged mice had low antigen trafficking and DC activation than younger mice (6-weeks), which was ameliorated by PGA/Alum with increased antigen uptake and DC activation leading to improved antigen-specific IFN-γ+CD8+ T lymphocyte frequencies higher in the vaccinated aged mice, to a similar extent as PGA/Alum adjuvanted vaccine-immunized young mice. The results of single-cell transcriptome sequencing display that PGA/Alum also reduced the proportion of age-associated CD8+ T cell subsets and gene levels of inhibitory regulators in CD8+ T cells, which may play a role in the recovery of CD8+ T cell activation. Finally, PGA/Alum adjuvanted pH1N1 vaccine-immunized aged mice were completely protected (100% survival) compared to aged mice immunized with vaccine only (0% survival) after pH1N1 virus challenge, akin to the efficacy of the vaccinated young mice (100% survival).ConclusionsPGA/Alum adjuvanted pH1N1 vaccine-immunized aged mice showed a significant increase in vaccine efficacy compared to aged mice administered with vaccine only. The enhanced vaccine efficacy by PGA/Alum is associated with significant increases activation of DCs and effector CD8+ T cells and a decrease in age-associated CD8+ T cell proportion of splenocytes. Collectively, PGA/Alum adjuvanted flu vaccine may be a promising vaccine candidate for the elderly.