Views and Perceptions of People Aged 55+ on the Vaccination Programme for Older Adults in the UK: A Qualitative Study.

Vaccination reduces the risks related to infectious disease, especially among more vulnerable groups, such as older adults. The vaccines available to older adults in the UK through the government-funded programme currently include influenza, pneumococcal, shingles and COVID-19 vaccines. The purpose of the programme is disease prevention and improving wellbeing among the ageing population. Yet, the target population's views of the programme remain unknown. This paper aims to increase the understanding of older adults' perceptions of the vaccination programme available in the UK. A total of 13 online focus groups (56 informants) were carried out for this qualitative study. The findings indicate that getting vaccinated involves personal decision-making processes, which are influenced by previous experiences and interpersonal interactions. Factors related to the wider community and culture are less prominent in explaining vaccination decisions. However, opportunistic vaccination offers, a lack of information and a lack of opportunities to discuss vaccines, especially with healthcare professionals, are prominent factors. The study provides in-depth data about the rationale behind older adults' vaccination decisions in the UK. We recommend that the provision of information and opportunities to discuss vaccines and infectious disease be improved to enable older adults' to make better informed decisions regarding the vaccines available to them.

Multi-faceted intervention to improve management of antibiotics for children presenting to primary care with acute cough and respiratory tract infection (CHICO): efficient cluster randomised controlled trial.

OBJECTIVE: To assess whether an easy-to-use multifaceted intervention for children presenting to primary care with respiratory tract infections would reduce antibiotic dispensing, without increasing hospital admissions for respiratory tract infection. DESIGN: Two arm randomised controlled trial clustered by general practice, using routine outcome data, with qualitative and economic evaluations. SETTING: English primary care practices using the EMIS electronic medical record system. PARTICIPANTS: Children aged 0-9 years presenting with respiratory tract infection at 294 general practices, before and during the covid-19 pandemic. INTERVENTION: Elicitation of parental concerns during consultation; a clinician focused prognostic algorithm to identify children at very low, normal, or elevated 30 day risk of hospital admission accompanied by antibiotic prescribing guidance; and a leaflet for carers including safety netting advice. MAIN OUTCOME MEASURES: Rate of dispensed amoxicillin and macrolide antibiotics (superiority comparison) and hospital admissions for respiratory tract infection (non-inferiority comparison) for children aged 0-9 years over 12 months (same age practice list size as denominator). RESULTS: Of 310 practices needed, 294 (95%) were randomised (144 intervention and 150 controls) representing 5% of all registered 0-9 year olds in England. Of these, 12 (4%) subsequently withdrew (six owing to the pandemic). Median intervention use per practice was 70 (by a median of 9 clinicians). No evidence was found that antibiotic dispensing differed between intervention practices (155 (95% confidence interval 138 to 174) items/year/1000 children) and control practices (157 (140 to 176) items/year/1000 children) (rate ratio 1.011, 95% confidence interval 0.992 to 1.029; P=0.25). Pre-specified subgroup analyses suggested reduced dispensing in intervention practices with fewer prescribing nurses, in single site (compared with multisite) practices, and in practices located in areas of lower socioeconomic deprivation, which may warrant future investigation. Pre-specified sensitivity analysis suggested reduced dispensing among older children in the intervention arm (P=0.03). A post hoc sensitivity analysis suggested less dispensing in intervention practices before the pandemic (rate ratio 0.967, 0.946 to 0.989; P=0.003). The rate of hospital admission for respiratory tract infections in the intervention practices (13 (95% confidence interval 10 to 18) admissions/1000 children) was non-inferior compared with control practices (15 (12 to 20) admissions/1000 children) (rate ratio 0.952, 0.905 to 1.003). CONCLUSIONS: This multifaceted antibiotic stewardship intervention for children with respiratory tract infections did not reduce overall antibiotic dispensing or increase respiratory tract infection related hospital admissions. Evidence suggested that in some subgroups and situations (for example, under non-pandemic conditions) the intervention slightly reduced prescribing rates but not in a clinically relevant way. TRIAL REGISTRATION: ISRCTN11405239ISRCTN registry ISRCTN11405239.

The impact of the Covid-19 pandemic on the uptake of routine maternal and infant vaccines globally: A systematic review

Maintaining routine vaccination coverage is essential to avoid outbreaks of vaccine-preventable diseases. We aimed to understand the international impact of the COVID-19 pandemic on routine vaccination in pregnant women and children aged 0-5-years-old. A systematic review of quantitative and mixed methods studies exploring changes in vaccination coverage, vaccination services, and vaccine confidence since the start of the Covid-19 pandemic was conducted. MEDLINE, EMBASE, CINHAL, PsychINFO, Web of Science, Google Scholar, World Health Organisation, UK Government Joint Committee on Vaccination and Immunisation (including EU and US equivalents), and SAGE Journals were searched between 15-17th June 2021. Selected studies included pregnant women, health professionals, and/or infants aged 0-5-years-old including their parents (population);reported on the Covid-19 pandemic (exposure);presented comparisons with pre-COVID-19 pandemic period (comparator) and reported changes in routine maternal and infant vaccination coverage, services, and confidence (outcomes). Sources published only in non-English language were excluded. The Newcastle Ottawa Scale was used to assess study quality and risk of bias (ROB), and a narrative synthesis was undertaken. This review has been registered with PROSPERO (CRD42021262449). 30 studies were included in the review;data from 20 high-income countries (HICs), seven low- and middle-income countries (LMICs), and three regional studies (groups of countries). 18 studies had a low ROB, 12 had a higher risk, however both low and high ROB studies showed similar results. Two studies meeting the inclusion criteria discussed changes in routine vaccinations for pregnant women while 29 studies discussed infants. Both groups experienced declines in vaccination coverage (up to -79%) with larger disruptions in the accessibility and delivery of vaccination services reported within LMICs compared to HICs. Changes in vaccine confidence remained unclear. The COVID-19 pandemic resulted in decreased vaccine coverage and reduced routine vaccination services for pregnant women and infants, impacts on vaccine confidence requires more research.

The impact of the Covid-19 pandemic on the uptake of routine maternal and infant vaccines globally: A systematic review.

Maintaining routine vaccination coverage is essential to avoid outbreaks of vaccine-preventable diseases. We aimed to understand the international impact of the COVID-19 pandemic on routine vaccination in pregnant women and children aged 0-5-years-old. A systematic review of quantitative and mixed methods studies exploring changes in vaccination coverage, vaccination services, and vaccine confidence since the start of the Covid-19 pandemic was conducted. MEDLINE, EMBASE, CINHAL, PsychINFO, Web of Science, Google Scholar, World Health Organisation, UK Government Joint Committee on Vaccination and Immunisation (including EU and US equivalents), and SAGE Journals were searched between 15-17th June 2021. Selected studies included pregnant women, health professionals, and/or infants aged 0-5-years-old including their parents (population); reported on the Covid-19 pandemic (exposure); presented comparisons with pre-COVID-19 pandemic period (comparator) and reported changes in routine maternal and infant vaccination coverage, services, and confidence (outcomes). Sources published only in non-English language were excluded. The Newcastle Ottawa Scale was used to assess study quality and risk of bias (ROB), and a narrative synthesis was undertaken. This review has been registered with PROSPERO (CRD42021262449). 30 studies were included in the review; data from 20 high-income countries (HICs), seven low- and middle-income countries (LMICs), and three regional studies (groups of countries). 18 studies had a low ROB, 12 had a higher risk, however both low and high ROB studies showed similar results. Two studies meeting the inclusion criteria discussed changes in routine vaccinations for pregnant women while 29 studies discussed infants. Both groups experienced declines in vaccination coverage (up to -79%) with larger disruptions in the accessibility and delivery of vaccination services reported within LMICs compared to HICs. Changes in vaccine confidence remained unclear. The COVID-19 pandemic resulted in decreased vaccine coverage and reduced routine vaccination services for pregnant women and infants, impacts on vaccine confidence requires more research.

Links between obesity, weight stigma and learning in adolescence: a qualitative study.

BACKGROUND: Educational attainment is a key social determinant of health. Health and education are linked by multiple pathways, many of which are not well understood. One such pathway is the association between being above a healthy weight and lower academic achievement. While various explanations have been put forward to explain this relationship, evidence for causal pathways is sparse and unclear. This study addresses that evidence gap. METHODS: We interviewed 19 adults (late 20s; 14 female, 5 male) and one young person (14 years, male) from the UK in 2019/2020. Participants were recruited from the ALSPAC 1990s birth cohort, sampled to ensure diversity in socio-economic status and educational attainment, and a community-based weight management group for young people. Interviews focused on experiences of being above a healthy weight during secondary school and how this may have affected their learning and achievement. Interviews were face-to-face, digitally recorded, and transcribed verbatim. We analysed the data thematically. RESULTS: We identified key pathways through which higher body weight may negatively impact educational performance and showed how these are linked within a novel theoretical model. Because larger body size is highly stigmatised, participants engaged in different strategies to minimise their exposure to negative attention. Participants sought to increase their social acceptance or become less socially visible (or a combination of both). A minority navigated this successfully; they often had many friends (or the 'right' friends), experienced little or no bullying at school and weight appeared to have little effect on their achievement at school. For most however, the behaviours resulting from these strategies (e.g. disruptive behaviour, truanting, not working hard) or the physical, social or mental impacts of their school experiences (e.g. hungry, tired, self-conscious, depressed) made it difficult to concentrate and/or participate in class, which in turn affected how teachers viewed them. CONCLUSIONS: Action to combat weight stigma, both within schools and in wider society, is urgently required to help address these educational disparities that in turn can impact health in later life.

Cluster randomised controlled trial to assess a tailored intervention to reduce antibiotic prescribing in rural China: study protocol.

INTRODUCTION: Up to 80% of patients with respiratory tract infections (RTI) attending healthcare facilities in rural areas of China are prescribed antibiotics, many of which are unnecessary. Since 2009, China has implemented several policies to try to reduce inappropriate antibiotic use; however, antibiotic prescribing remains high in rural health facilities. METHODS AND ANALYSIS: A cluster randomised controlled trial will be carried out to estimate the effectiveness and cost effectiveness of a complex intervention in reducing antibiotic prescribing at township health centres in Anhui Province, China. 40 Township health centres will be randomised at a 1:1 ratio to the intervention or usual care arms. In the intervention group, practitioners will receive an intervention comprising: (1) training to support appropriate antibiotic prescribing for RTI, (2) a computer-based treatment decision support system, (3) virtual peer support, (4) a leaflet for patients and (5) a letter of commitment to optimise antibiotic use to display in their clinic. The primary outcome is the percentage of antibiotics (intravenous and oral) prescribed for RTI patients. Secondary outcomes include patient symptom severity and duration, recovery status, satisfaction, antibiotic consumption. A full economic evaluation will be conducted within the trial period. Costs and savings for both clinics and patients will be considered and quality of life will be measured by EuroQoL (EQ-5D-5L). A qualitative process evaluation will explore practitioner and patient views and experiences of trial processes, intervention fidelity and acceptability, and barriers and facilitators to implementation. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Biomedical Research Ethics Committee of Anhui Medical University (Ref: 20180259); the study has undergone due diligence checks and is registered at the University of Bristol (Ref: 2020-3137). Research findings will be disseminated to stakeholders through conferences and peer-reviewed journals in China, the UK and internationally. TRIAL REGISTRATION NUMBER: ISRCTN30652037.

The impact of COVID-19 on primary health care and antibiotic prescribing in rural China: qualitative study.

BACKGROUND: In China, the primary health care (PHC) system has been designated responsible for control and prevention of COVID-19, but not treatment. Suspected COVID-19 cases presenting to PHC facilities must be transferred to specialist fever clinics. This study aims to understand the impact of COVID-19 on PHC delivery and on antibiotic prescribing at a community level in rural areas of central China. METHODS: Qualitative semi-structured interviews were conducted with 18 PHC practitioners and seven patients recruited from two township health centres and nine village clinics in two rural residential areas of Anhui province. Interviews were transcribed verbatim and analysed thematically. RESULTS: PHC practitioners reported a major shift in their work away from seeing and treating patients (due to government-mandated referral to specialist Covid clinics) to focus on the key public health roles of tracing, screening and educating in rural areas. The additional work, risk, and financial pressure that PHC practitioners faced, placed considerable strain on them, particularly those working in village clinics. Face to face PHC provision was reduced and there was no substitution with consultations by phone or app, which practitioners attributed to the fact that most of their patients were elderly and not willing or able to switch. Practitioners saw COVID-19 as outside of their area of expertise and very different to the non-COVID-19 respiratory tract infections that they frequently treated pre-pandemic. They reported that antibiotic prescribing was reduced overall because far fewer patients were attending rural PHC facilities, but otherwise their antibiotic prescribing practices remained unchanged. CONCLUSIONS: The COVID-19 pandemic had considerable impact on PHC in rural China. Practitioners took on substantial additional workload as part of epidemic control and fewer patients were seen in PHC. The reduction in patients seen and treated in PHC led to a reduction in antibiotic prescribing, although clinical practice remains unchanged. Since COVID-19 epidemic control work has been designated as a long-term task in China, rural PHC clinics now face the challenge of how to balance their principal clinical and increased public health roles and, in the case of the village clinics, remain financially viable.