ABSTRACT
Aim: To identify psychosocial predictors of the intention to get a booster COVID-19 vaccine in a low-income country, given that increasing booster vaccination rates against COVID-19 remains a global challenge, especially among low- and middle-income countries (LMIC). Subject and methods: We used an online survey to collect responses from a non-probabilistic sample of 720 Bolivians regarding vaccine uptake, motives, perceived confidence, information sources, attitudes favouring COVID-19 vaccines, biosafety behaviour, and sociodemographic characteristics. Descriptive, bivariate, and multivariate analyses were performed to identify significant associations and predictors. Results: We found that having already received the third dose, obtaining recommendations from family or friends, recommendation from the government, perceived confidence in the previously received dose, and higher attitudes in favour of COVID-19 vaccines significantly predicted the intention to get a booster dose. The associations were significant even when adjusting the model for sociodemographic variables. Conclusion: Including certain psychosocial factors could enhance the promotion of voluntary booster doses among residents of low- and middle-income countries such as Bolivia, where cultural, social, political, and contextual variables may influence health behaviour and increase health-associated risk factors. Supplementary Information: The online version contains supplementary material available at 10.1007/s10389-023-01937-x.
ABSTRACT
Spontaneous mediastinal emphysema (ME) is a rare clinical entity often associated with sudden changes in intrathoracic pressures. The presumed pathophysiological mechanism is diffuse alveolar injury leading to alveolar rupture and air leak. Inflammatory alterations installed over the airway following SARS-CoV-2 infection may reduce its distensibility and compliance conferring an increased risk of developing the complication, even in the absence of mechanical ventilation. However, the exact mechanism by which ME occurs in SARS-CoV-2 pneumonia is unknown. We report a case of a 58-year-old man that presented to the emergency department with dyspnea, subcutaneous emphysema of the neck and high clinical suspicion of COVID-19 infection. There was no smoking history and no lung comorbidities. The patient was admitted into a monitored unit and received management accordingly (having never required mechanical intubation). During chest radiological evaluation ME was found and ultimately resolved with noninvasive maneuvers. We want to emphasize the importance of this adverse event despite their non-smoking history and the exclusion of positive pressure ventilation. Given the recent increase in the number of patients with COVID-19 related pneumonia, the presence of pneumomediastinum in patients with COVID-19 infection should alert the clinician to monitor the patients carefully for possible worsening of disease, especially when lung lesions are severe.