Factors affecting adherence with treatment advice in a clinical trial of patients with severe asthma

BackgroundUnderstanding why patients with severe asthma do not follow healthcare provider (HCP) advice to adjust treatment is critical to achieving personalised disease management.MethodsWe reviewed patient choice to follow HCP advice to adjust asthma treatment in a randomised, controlled, single-blind (study participant), multi-centre, parallel group 48-week clinical study comparing biomarker directed treatment adjustment to standard care in severe asthma.ResultsOf 1572 treatment advisories (301 participants), instructions were followed in 1377 cases (87.6%). Patients were more likely to follow advice to remain on treatment (96.7%) than to either reduce (70.3%) or increase (67.1%) their treatment, with 64% of patients following all treatment advice. Multivariate analysis associated belonging to an ethnic minority group (OR: 3.10; 95% CI: 1.68, 5.73) and prior study medication changes (≥2 OR: 2.77, 95% CI: 1.51, 5.10) with failure to follow treatment advice. In contrast, emergency room attendance in the prior year (OR: 0.54, 95% CI: 0.32, 0.92) was associated with following treatment advice. The largest effect was seen with transition onto or off oral corticosteroids (OR: 29.28; 95% CI: 16.07, 53.36) when compared to those requested to maintain treatment. Centre was also an important determinant regarding the likelihood of patients to follow treatment advice.ConclusionsBelonging to an ethnic minority group and multiple prior treatment adjustments were associated with not following HCP treatment advice. Patients also responded differently to HCP advice across UK specialist centres. These findings have implications for generalisability for models of care in severe asthma and require further focussed studies.

Maternal Emotional Distress Following the Birth of a Preterm Baby: The Case of Bedouin Mothers Living in Southern Israel

Mothers of preterm infants are at higher risk for postpartum emotional distress (PPED). In this study, we investigated PPED among Bedouin mothers, an ethnic minority group living in Israel. Our aim was to understand how maternal acculturation style and birth order were related to mothers’ PPED following a premature birth. Three hundred twenty-one Bedouin mothers and their babies (preterm: n = 66; full-term: n = 255) participated in the study. Data were collected in the maternity ward and the NICU (Neonatal Intensive Care Unit) of a large general hospital in Southern Israel providing medical care to all populations in the southern region. Mothers completed questionnaires on maternal postpartum depression and anxiety. Additionally, maternal acculturation style was assessed using the acculturation questionnaire and information on child birth order. Mothers of preterm infants indicated having more symptoms of PPED than mothers of full-term infants. Additionally, both maternal acculturation style as well as birth order (i.e., whether the preterm was first- or later-born) were found to act as moderators in the link between prematurity and PPED. Specifically, we found that among the preterm group, low levels of Westernized acculturation style and the birth of a preterm infant who was later-born predicted higher levels of PPED. Our findings indicate that ethnicity, acculturation, and birth order are important variables that need to be considered when studying PPED and premature birth. Results highlight the fact that mothers from an ethnic minority group who have had a premature birth are at higher risk for experiencing PPED. However, individual differences emerged when examining maternal acculturation style and birth order. Culturally—informed clinical implications are proposed.

ДЕЦА ДЕВЕДЕСЕТИХ У ВОЈВОДИНИ: МЕШОВИТИ БРАКОВИ И ЕТНИЧКИ ИДЕНТИТЕТ

The 1990s Yugoslav wars avoided armed conflicts in Vojvodina, the multiethnic Northern province of Serbia,but the war still bears its consequences. Some argue that the province avoided escalation partly because of the relatively high rate of ethnic intermarriages in the Yugoslav era, which acted as bonds and bridges between the Serbs and ethnic minorities. The 1990s state-funded (Serbian) nationalist propaganda did have detrimental effects on Vojvodinian ethnic minorities which are facing high emigration rates since the 1990s. Ethnic minority millennials might be the group most adversely affected by the 1990s wars, facing open nationalism, alienation, and sidelining. One milestone event in the lives of intermarriage-born millennials was the choice of language instruction (majority or minority) when enrolling in elementary school and secondary school as well. The research aimed to investigate the education element of the many-faceted framework shaping the decisions of parents and the effects those decisions had on millennials and their identity construction. The analysis was based on semi-structured interviews conducted with millennials born into (Serbian – Hungarian) intermarriages and/or exhibiting high levels of acculturation. The findings show that the respondents who enrolled in elementary school in Serbian departed from the ethnic minority group, and even if they cultivated the ethnic minority language, it became a tool for further career advancement, not a bond with their minority group. Interviewees who enrolled in elementary school in a minority language preserved a stronger bond with the ethnic minority group and essentially built an ethnic minority identity. Both groups, regardless of the language of instructions, faced nationalismfuelled incidents during their schooling, which inevitably made them more insecure and vulnerable.

Comparing the Psychological Well-Being of the Manjo Ethnic Minority with the Non-Manjo Ethnic Group in Kaffa Zone, Ethiopia

This study examined the level of psychological well-being between the Ethnic Minority group, commonly called “Manjo,” and the majority group called “Gomero.” Psychological well-being questionnaires were administered to a sample of 298 (independent sample from both groups). The findings demonstrated that the non-Manjo (Gomero) Ethnic group possessed a considerably high level of psychological well-being. Statistical differences were found in participants’ psychological well-being across Ethnic groups. According to the results, participants from the Manjo Ethnic Minority group had a lower level of psychological well-being (M = 211.27, SD = 17.51) compared to the majority (Gomero). A statistically significant variation in psychological well-being (theoretically embodied across a broad spectrum of measurement units) among the two independent study groups was reflected.

International estimates of intended uptake and refusal of COVID-19 vaccines: A rapid systematic review and meta-analysis of large nationally representative samples

BackgroundWidespread uptake of COVID-19 vaccines will be essential to extinguishing the COVID-19 pandemic. Vaccines have been developed in unprecedented time and hesitancy towards vaccination among the general population is unclear.MethodsSystematic review and meta-analysis of studies using large nationally representative samples (n≥1000) to examine the percentage of the population intending to vaccinate, unsure, or intending to refuse a COVID-19 vaccine when available. Generic inverse meta-analysis and meta-regression were used to pool estimates and examine time trends. PubMed, Scopus and pre-printer servers were searched from January-November, 2020. Registered on PROSPERO (CRD42020223132).FindingsTwenty-eight nationally representative samples (n = 58,656) from 13 countries indicate that as the pandemic has progressed, the percentage of people intending to vaccinate and refuse vaccination have been decreasing and increasing respectively. Pooled data from surveys conducted during June-October suggest that 60% (95% CI: 49% to 69%) intend to vaccinate and 20% (95% CI: 13% to 29%) intend to refuse vaccination, although intentions vary substantially between samples and countries (I2 > 90%). Being female, younger, of lower income or education level and belonging to an ethnic minority group were consistently associated with being less likely to intend to vaccinate. Findings were consistent across higher vs. lower quality studies.InterpretationIntentions to be vaccinated when a COVID-19 vaccine becomes available have been declining globally and there is an urgent need to address social inequalities in vaccine hesitancy and promote widespread uptake of vaccines as they become available.FundingN/AResearch in contextEvidence before this studyWe searched PubMed, Scopus and pre-print servers for manuscripts from January to November, 2020, reporting on studies examining intentions to be vaccinated against COVID-19 in large nationally representative samples (N≥1000). No language restrictions were applied. Search terms were [(COVID OR coronavirus OR SARS-COV-2) AND (Vaccine OR Vaccination) AND (Inten* OR willing* OR attitud* OR hypothetical)]. From 792 articles, we identified 20 eligible articles reporting on 28 nationally representative samples.Added value of this studyThis is the first systematic study and meta-analysis to estimate the proportion of the global population willing to be vaccinated against vs. intending to refuse a vaccine when COVID-19 vaccines become available and how this trend has changed over time, using large and nationally representative samples. Results indicate that COVID-19 vaccination intentions vary substantially across countries, the percentage of the population intending to be vaccinated has declined across countries as the pandemic has progressed (March-May estimate: 79%, June-October estimate: 60%) and a growing number report intending to refuse a vaccine, when available (March-May estimate: 12%, June-October estimate: 20%). There is consistent socio-demographic patterning of vaccination intentions; being female, younger, of lower income or education level and belonging to an ethnic minority group are associated with a reduced likelihood of intending to be vaccinated when a vaccine become available.Implications of all the available evidenceIntentions to vaccinate against COVID-19 among the general public when a vaccine becomes available have been declining and this will limit the effectiveness of COVID-19 vaccination programmes. Findings highlight the need to improve public acceptability, trust and concern over the safety and benefit of COVID-19 vaccines and target vaccine uptake in disadvantaged groups who have already been disproportionately affected by the pandemic.

Patterns and Predictors of ADRD Among Racial and Ethnic Minority Groups

This symposium addresses issues surrounding Alzheimer’s disease and related dementia (ADRD) across multiple racial/ethnic minority groups, including African Americans, Latinos, and Arab Americans. Using US national data, Kindratt and colleagues challenge the universality of the healthy migrant effect by comparing patterns of cognitive disability across US- and foreign-born Arab Americans. Arab Americans represent an increasingly visible ethnic minority group whose unique history has the potential to clarify knowledge about sociocultural influences on ADRD. Also using US national data, Garcia and colleagues examine within-group heterogeneity among Latinos. They conclude that the number of years and proportion of life spent with and without subjective cognitive impairment differ as a function of ancestry and nativity. Using data from two local communities, Diminich and colleagues investigate mechanisms underlying ADRD risk among Latinos by considering both stress responding and plasma-based AD biomarkers as predictors of Latino cognitive health. Lee and colleagues focus on social relationships and cognitive aging in a diverse, national cohort. They suggest that the quality of social support from social network members may uniquely affect the cognitive functioning of African Americans older adults. Finally, Cerise Elliott from the National Institute on Aging (NIA) will offer perspectives on how racial/ethnic minority group focused research can advance NIA’s goals related to understanding and eliminating ADRD inequalities. In total, this symposium highlights the need to disaggregate racial/ethnic groups, as well as the importance of incorporating both individual and contextual factors in order to fully understand patterns of ADRD risk and resilience.