Investigation of demographic implicit discrimination and disparate impact in chest radiography image-based AI for COVID-19 severity prediction

It is important to evaluate medical imaging artificial intelligence (AI) models for possible implicit discrimination (ability to distinguish between subgroups not related to the specific clinical task of the AI model) and disparate impact (difference in outcome rate between subgroups). We studied potential implicit discrimination and disparate impact of a published deep learning/AI model for the prediction of ICU admission for COVID-19 within 24 hours of imaging. The IRB-approved, HIPAA-compliant dataset contained 8,357 chest radiography exams from February 2020-January 2022 (12% ICU admission within 24 hours) and was separated by patient into training, validation, and test sets (64%, 16%, 20% split). The AI output was evaluated in two demographic categories: sex assigned at birth (subgroups male and female) and self-reported race (subgroups Black/African-American and White). We failed to show statistical evidence that the model could implicitly discriminate between members of subgroups categorized by race based on prediction scores (area under the receiver operating characteristic curve, AUC: median [95% confidence interval, CI]: 0.53 [0.48, 0.57]) but there was some marginal evidence of implicit discrimination between members of subgroups categorized by sex (AUC: 0.54 [0.51, 0.57]). No statistical evidence for disparate impact (DI) was observed between the race subgroups (i.e. the 95% CI of the ratio of the favorable outcome rate between two subgroups included one) for the example operating point of the maximized Youden index but some evidence of disparate impact to the male subgroup based on sex was observed. These results help develop evaluation of implicit discrimination and disparate impact of AI models in the context of decision thresholds © COPYRIGHT SPIE. Downloading of the is permitted for personal use only.

Gaining Instead of Losing: The Image of Dunhuang as a Religious Heritage in a WeChat Mini-Programme

In 2020, a WeChat mini-programme called the Dunhuang E-Tour ((sic)) was launched during the COVID-19 pandemic to showcase one of China's most important religious heritage sites, the Dunhuang Mogao Grottoes (also known as the Dunhuang Caves), and it attracted a considerable number of online tourists. Unlike the colonial image of Dunhuang in Chinese public discourse, the mini-programme does not focus on Dunhuang's history;rather, it provides a dynamic and interactive representation of Dunhuang's religious murals, painted sculptures and cave architecture. To reflect the impact of the mini-programme's digital mechanisms on users' experience, this study adopts an analytical framework that combines the walkthrough method and religious tourist perspectives to explore the image of the digital Dunhuang and how it was shaped. The analysis finds that the functions of the Dunhuang E-Tour create a culturally rich image of Dunhuang, which subverts its decades-long Dunhuang image as a site of loss in Chinese public discourse. This difference in images mirrors the potential impact of China's recent cultural policy of 'cultural confidence' in relation to its cultural and creative industries.

PLANT TESTING MAGNETIC CONDITIONING ON KENNECOTT'S Cu-Mo PORPHYRY ORE

Over it's more than 100-year history, the Kennecott operation has often been at the forefront of innovation;driven by the demands of the lower grade ore-body and the higher costs of operating in the US where wages are generally higher and regulation more restrictive. One way of reducing operating costs in c/lb is to increase the lbs produced at minimal cost. Despite the relatively coarse grind at Kennecott - about 30% >150μm, approximately 20% of the Cu lost to tail is liberated chalcopyrite in the <20μm fraction, and about 30%-40% in the <37μm fraction. In 2020 Kennecott undertook a detailed plant scale test of the magnetic aggregation technology to increase copper recovery by reducing fine copper losses. A paired statistical plant test of magnetic conditioning on one rougher line showed a 1.12% increase in Cu recovery to 97% statistical confidence. The next challenge, unforeseen at the start of the project, was the fabrication and transportation to site of the equipment for the three remaining rougher rows, during the severe supply-chain constraints of the Covid pandemic in 2021. This resulted in delays and unforeseen costs as world-wide transportation became chaotic, particularly transportation via west coast USA. Nevertheless, the project was completed and commissioned, with only minor delays and cost increases, due to a flexible approach to overcoming the hurdles encountered. Copyright © 2023 by SME.

Confidence and coincidences in executive decision-making during periods of crisis

PurposeThe purpose of this study, which is grounded in decision-making theory, is to explore whether the occurrence of meaningful coincidences can positively influence executive confidence during periods of crisis. Design/methodology/approachThrough a qualitative study with 24 interviews, this study focuses on Italian hospitality facilities in the Campania Region of southern Italy to explore how an executive confidence led by meaningful coincidences can influence managerial decisions during crisis situations. Data are analyzed through a deductive coding for qualitative analysis. FindingsThe framework proposes the connection by coincidences and confidence, emphasizing the process through which meaningful coincidences can positively influence executive confidence and managerial decision-making. The insights that emerge suggest a number of positive and beneficial aspects for decision-making during a period of crisis such as the COVID-19 pandemic. Originality/valueTo the best of the authors' knowledge, this is the first study in the literature aimed at investigating, by means of qualitative methodologies, the positive outcomes of executive confidence in decision-making led by meaningful coincidences during crisis periods in the specific context of the Italian hospitality industry.

PREDICTION OF MORTALITY USING CLUSTERS BASED ON CLINICAL AND LAB PARAMETERS: DATA FROM 2072 PATIENTS FROM INSPIRE COHORT

BackgroundLupus is a heterogenous diseases which results in significant premature mortality. Most studies have evaluated risk factors for lupus mortality using regression models which considers the phenotype in isolation. Identifying clusters of patients on the other hand may help overcome the limitations of such analyses.ObjectivesThe objectives of this study were to describe the causes of mortality and to analyze survival across clusters based on clinical phenotype and autoantibodies in patients of the Indian SLE Inception cohort for Research (INSPIRE)MethodsOut of all patients, enrolled in the INSPIRE database till March 3st 2022, those who had <10% missing variables in the clustering variables were included in the study. The cause of mortality and duration between the recruitment into the cohort and mortality was calculated. Agglomerative unsupervised hierarchical cluster analysis was performed using 25 variables that define SLE phenotype in clinical practice. The number of clusters were fixed using the elbow and silhouette methods. Survival rates were examined using Cox proportional hazards models: unadjusted, adjusted for age at disease onset, socio-economic status, steroid pulse, CYC, MMF usage and cluster of the patients.ResultsIndian patients with lupus have significant early mortality and the majority of deaths occurs outside the hospital setting.Out of 2211 patients in the cohort, 2072 were included into the analysis. The median (IQR) age of the patients was 26 (20-33) years and 91.7% were females. There were 288 (13.1%) patients with juvenile onset lupus. The median (range) duration of follow up of the patients was 37 (6-42) months. There were 170 deaths, with only 77 deaths occurring in a health care setting. Death within 6 months of enrollment occured in in 80 (47.1%) patients. Majority (n=87) succumbed to disease activity, 23 to infections, 24 to coexisting disease activity and infection and 21 to other causes. Pneumonia was the leading cause of death (n=24). Pneumococcal infection led to death in 11 patients and SARS-COV2 infection in 7 patients. The hierarchical clustering resulted in 4 clusters and the characteristics of these clusters are represented in a heatmap (Figure-1A,B). The mean (95% confidence interval [95% CI] survival was 39.17 (38.45-39.90), 39.52 (38.71-40.34), 37.73 (36.77-38.70) and 35.80 (34.10-37.49) months (p<0.001) in clusters 1, 2, 3 and 4, respectively with an HR (95% CI) of 2.34 (1.56, 3.49) for cluster 4 with cluster 1 as reference(Figure 1C). The adjusted model showed an HR (95%CI) for cluster 4 of 2.22 (1.48, 3.22) with an HR(95%CI) of 1.78 (1.29, 2.45) for low socioeconomic status as opposed to a high socioeconomic status (Table 1).ConclusionIndian patients with lupus have significant early mortality and the majority of deaths occurs outside the hospital setting. Disease activity as determined by the traditional activity measures may not be sufficient to understand the true magnitude of organ involvement resulting in mortality. Clinically relevant clusters can help clinicians identify those at high risk for mortality with greater accuracy.Table 1.Univariate and multivariate Cox regression models predicting mortalityUnivariateMultivariateVariablesHazard ratio (95% Confidence interval)P valueHazard ratio (95% Confidence interval)P valueCluster1Reference-Reference-20.87 (0.57, 1.34)0.5320.89 (0.57, 1.38)0.59831.22 (0.81, 1.84)0.3371.15 (0.76, 1.73)0.51342.34 (1.56, 3.49)<0.0012.22(1.48, 3.22)<0.001Socioeconomic statusLower1.78 (1.29, 2.45)<0.001Pulse steroidYes1.6 (0.99, 2.58)0.051MMFYes0.71 (0.48, 1.05)0.083CYCYes1.42 (0.99, 2.02)0.052Proliferative LNYes0.99 (0.62, 1.56)0.952Date of birth age0.99 (0.98, 1.01)0.657CYC- cyclophosphamide, MMF- Mycophenolate mofetilFigure 1.A. Agglomerative clustering dendrogram depicting the formation of four clusters. B.Heatmap depicting distribution of variables used in clustering C. Kaplan-Meier curve showing the survival function across the 4 clusters[Figure omitted. See PDF]REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone eclared.

Enhancing palliative care at home: a generalist community nursing case study

What this paper adds: * This case study demonstrated that facilitating ongoing education opportunities that draw on the expertise of local palliative care champions or internal specialists can enhance care provision. * Nurse care managers believe the value of generalist services, particularly home care services, in the generalist-specialist palliative care partnership, needs to be understood and respected. * Tailored investment in home care to provide a general palliative approach would be beneficial given the unique challenges of this mobile workforce. Keywords: Palliative care;home care services;Education, Nursing;qualitative research;Nurse Practitioner BACKGROUND Palliative care focuses on improving the quality of life of people affected by life-threatening illnesses, including the prevention and relief of suffering through identification, assessment and treatment.1 This care extends to family members, and encompasses physical, psychological, social and spiritual support. Home nursing and care organisations are key providers of community-based palliative care, with staff often the linchpin, in supporting palliative clients, organising and providing care, coordinating the input of other professionals and of specialist equipment.5 Previous research has identified the difficulties faced by home care nurses in meeting their clients' palliative care needs, such as symptom management and communication, as well as requirements for further training to enhance their knowledge and confidence of caring for palliative clients.5-7 In this context, generalist palliative care is delivered by health and care professionals with broad clinical responsibilities who provide primary, ongoing care;and have established relationships with the person and their care community.2 This is distinct from specialist palliative care services which support complex needs through multidisciplinary teams with specialised palliative care training. FINDINGS AND DISCUSSION Thematic analysis identified the following overarching themes: 1) targeted education increased staff knowledge and confidence, but more is needed;2) collaborative teamwork with effective communication and information sharing underpins a successful generalist-specialist partnership;3) the home care setting is unique and requires accessible systems and processes.

INFLUENCE OF AGE, PERIOD, AND BIRTH COHORT EFFECTS ON SECULAR TREND IN GOUT INCIDENCE IN THE UNITED KINGDOM

BackgroundThe risk of incident gout in the United Kingdom (UK) appears to have declined since 2013.[1] However, whether this is temporary or likely to continue is unclear.ObjectivesTo examine the influence of age, calendar year, and year of birth on recent gout incidence in the UK.MethodsUsing data from IQVIA Medical Research Database in the UK, we identified incident gout by READ codes from 1999 to 2019. We grouped age, calendar year, and year of birth into 3-year categories. We assessed the effect of age, calendar year, and birth cohort categories on the incidence rate of gout using the age-period-cohort model among all participants and in men and women separately.ResultsOver the 21 years, there were 164,588 incident gout cases. The incidence rate of gout increased with age until age 80, then leveled off (P for trend <0.001) (Figure 1A). The gout incidence increased from 1999 to 2013, then declined (Figure 1B). The incidence rate of gout was higher in the late birth cohorts than in the early birth cohorts from the Year 1999 to the Year 2013 (Figure 1C);however, such a trend was reversed after the Year 2013, with the incidence rate of gout being higher in the early birth cohorts than that in the late birth cohorts (Figure 1D). Similar patterns were observed in men and women.ConclusionUsing the age-period-cohort model, we found that the risk of gout in the UK increased from 1999 to 2013 and then declined afterward. These findings suggest that some environmental factors occurring after 2013 may play role. Such a downward trend of the risk of gout may continue if these environmental factors are still present.Reference[1]Abhishek A, Tata LJ, Mamas M, et al. Has the gout epidemic peaked in the UK? A nationwide cohort study using data from the Clinical Practice Research Datalink, from 1997 to across the COVID-19 pandemic in 2021. Ann Rheum Dis 2022 Jan 27.Figure 1.(A) Age rate ratios and the corresponding 95% confidence intervals of gout incidence. The relative risk of each age category compared with the reference age category (57-59) was adjusted for the calendar year and birth cohort. (B) Calendar year rate ratios and 95% confidence intervals of gout incidence. The relative risk of each calendar year compared with the reference calendar year (2008-2010) was adjusted for age and birth cohort. (C) Cohort rate ratios and the corresponding 95% confidence intervals of gout incidence. The relative risk of each birth cohort (1911-1982) compared with the reference birth cohort (1950-1952) was adjusted for age and calendar year. (D) Cohort rate ratios and the corresponding 95% confidence intervals of gout incidence. The relative risk of each birth cohort (1923-1988) compared with the reference birth cohort (1950-1952) was adjusted for age and calendar year.[Figure omitted. See PDF]AcknowledgementsThis work was supported by the National Natural Science Foundation of China (81930071, 82072502, U21A20352), Project Program of National Clinical Research Center for Geriatric Disorders (2021LNJJ06, 2022LNJJ07), the Natural Science Foundation of Hunan Province (2022JJ20100), and the Science and Technology Innovation Program of Hunan Province (2022RC3075, 2022RC1009).Disclosure of InterestsNone Declared.

Quality of life outcomes from aphasia telepractice: A scoping review

Telepractice for people with aphasia (PWA) is gaining importance, not least because of the current SARS-CoV-2 pandemic. Many PWA are affected by a reduction of quality of life (QoL). Experts recommend focussing on psychosocial impacts more consistently, but the transfer to telepractice has been investigated in a limited number of studies so far. The aim of this paper is to examine the impact of different telepractice approaches on QoL in PWA. The evidence was identified through a broad literature research in five databases and other sources such as Google Scholar and referring papers or was searched by hand. In total, twelve studies met the eligibility criteria. Focus of the analysis was the association between therapeutic approaches and their effects on QoL. Half (n = 6) of the included studies clearly indicated positive effects of the applied methods on QoL. Further analysis showed no definable link between the therapeutic approaches and their impact on QoL. Nevertheless, decisive assumptions about QoL-enhancing telepractice can be derived from the literature. Telepractice in aphasia therapy can improve the patients' QoL. Benefits for QoL do not only depend on the utilised approach. Several factors (e.g., enhancing of communicative confidence) are significant in their impact on QoL and should be examined in future research.

The impact of transgender minority stress and emotion regulation on suicidality and self-harm

Transgender and gender diverse (TGD) individuals experience high levels of minority stress, as well as a high prevalence of suicidality and self-harm. The current study investigates if emotion regulation mediates the relationships of minority stressors with self-harm and suicidality. TGD adult primary care patients (N = 115) completed a survey including measures of minority stressors, emotion dysregulation, self-harm, and suicidality. Emotion regulation mediated the relationship between victimisation and suicidality. Emotion regulation did not mediate the relationship between victimisation and self-harm. TGD individuals' suicide risk may be increased when they experience victimisation through increased emotion dysregulation.

Paranormal Beliefs, Vaccine Confidence, and COVID-19 Vaccine Uptake

Conservative religious ideologies have been linked to vaccine hesitancy. Yet, little is known about how paranormal beliefs relate to vaccine confidence and uptake. We hypothesize that paranormal beliefs will be negatively related to both confidence and uptake due to their association with lower levels of trust in science and a greater acceptance of conspiratorial beliefs. We test this hypothesis using a new nationally representative sample of U.S. adults fielded in May and June of 2021 by NORC. Using regression models with a sample of 1,734, we find that paranormal beliefs are negatively associated with general vaccine confidence, COVID-19 vaccine confidence, and COVID-19 vaccine uptake. These associations are partially or fully attenuated net of trust in science and conspiratorial belief. Although not a focus of the study, we also find that Christian nationalism's negative association with the outcomes is fully accounted for by measures of trust in science and conspiratorial beliefs. [ FROM AUTHOR] Copyright of Sociology of Religion is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Safe at Last? Late Effects of a Mass Immunization Campaign on Households' Economic Insecurity

We study the effects of receiving immunization from COVID-19 on households' economic insecurity. To provide causal estimates we use a fuzzy regression discontinuity design which takes advantage of the UK's immunization plan. The plan was primarily based on age, granting differential eligibility to proximate cohorts. Our estimated local average treatment effect indicates that the share of households who declared being economically insecure dropped by 41 percentage points among those who received the vaccine due to the eligibility criteria. Using a difference-in-discontinuity design we next document that immunization was more salient for women as well as for large households and those with children. Our results suggest that the mass immunization campaign against COVID-19 had relevant short-run economic effects, well beyond its expected impact on people's health.

Mental health status of military healthcare workers in shelter hospitals in Shanghai during the epidemic caused by severe acute respiratory syndrome coronavirus 2 omicron variant and its influencing factors.

Objective To investigate the mental health status of military healthcare workers in shelter hospitals in Shanghai during the epidemic caused by severe acute respiratory syndrome coronavirus 2 omicron variant and its influencing factors. Methods A total of 540 military healthcare workers in shelter hospitals in Shanghai were investigated with patient health questionnaire-9 (PHQ-9), generalized anxiety disorder-7 (GAD-7) and Athens insomnia scale (AIS) to explore their mental health status, and logistic regression was used to analyze the influencing factors. Results A total of 536 valid questionnaires were collected, with an effective rate of 99.3% (536/540). The incidence of depression, anxiety and insomnia among military healthcare workers in shelter hospitals in Shanghai was 45.5% (244/536), 26.1% (140/536) and 59.5% (319/536), respectively. Logistic regression analysis showed that whether people resided in Shanghai, the proportion of negative information in daily browsing information and diet status in shelter hospitals were the influencing factors of depression, anxiety and insomnia (all P<0.05);age and confidence in the future of Shanghai were the influencing factors of depression and insomnia (all P<0.05);and the time spent daily on epidemic-related information was an influencing factor of insomnia (P=0.021). Conclusion The incidence of depressive, anxiety and insomnia among military healthcare workers in shelter hospitals in Shanghai is high during the epidemic caused by severe acute respiratory syndrome coronavirus 2 omicron variant. Psychological consequences of the epidemic should be monitored regularly and continuously to promote the mental health of military healthcare workers.Copyright © 2022, Second Military Medical University Press. All rights reserved.

How student-led wards can build skills and confidence: Nursing students on collaborative learning programmes make decisions about care and gain clinical experience

When Beth Dennis first set foot on a hospital ward as a Birmingham City University nursing student she felt underprepared. COVID-19 had disrupted everything, including face-to-face learning and time to practise clinical skills. Many of her student peers had worked previously in healthcare, but Ms Dennis had entered nursing straight from school. 'I basically knew nothing,' she says. But by her second year, with more experience, she felt she could offer help to others starting out who felt as anxious as she had. 'So me and a few other nursing students decided to run sessions to ease nerves about placements,' she says.

A Face Detection and Standardized Mask-Wearing Recognition Algorithm.

In the era of coronavirus disease (COVID-19), wearing a mask could effectively protect people from the risk of infection and largely reduce transmission in public places. To prevent the spread of the virus, instruments are needed in public places to monitor whether people are wearing masks, which has higher requirements for the accuracy and speed of detection algorithms. To meet the demand for high accuracy and real-time monitoring, we propose a single-stage approach based on YOLOv4 to identify the face and whether to regulate the wearing of masks. In this approach, we propose a new feature pyramidal network based on the attention mechanism to reduce the loss of object information that can be caused by sampling and pooling in convolutional neural networks. The network is able to deeply mine the feature map for spatial and communication factors, and the multi-scale feature fusion makes the feature map equipped with location and semantic information. Based on the complete intersection over union (CIoU), a penalty function based on the norm is proposed to improve positioning accuracy, which is more accurate at the detection of small objects; the new bounding box regression function is called Norm CIoU (NCIoU). This function is applicable to various object-detection bounding box regression tasks. A combination of the two functions to calculate the confidence loss is used to mitigate the problem of the algorithm bias towards determinating no objects in the image. Moreover, we provide a dataset for recognizing faces and masks (RFM) that includes 12,133 realistic images. The dataset contains three categories: face, standardized mask and non-standardized mask. Experiments conducted on the dataset demonstrate that the proposed approach achieves mAP@.5:.95 69.70% and AP75 73.80%, outperforming the compared methods.

Unintended consequences of communicating rapid COVID-19 vaccine policy changes- a qualitative study of health policy communication in Ontario, Canada.

BACKGROUND: The success of the COVID-19 vaccination roll-out depended on clear policy communication and guidance to promote and facilitate vaccine uptake. The rapidly evolving pandemic circumstances led to many vaccine policy amendments. The impact of changing policy on effective vaccine communication and its influence in terms of societal response to vaccine promotion are underexplored; this qualitative research addresses that gap within the extant literature. METHODS: Policy communicators and community leaders from urban and rural Ontario participated in semi-structured interviews (N = 29) to explore their experiences of COVID-19 vaccine policy communication. Thematic analysis was used to produce representative themes. RESULTS: Analysis showed rapidly changing policy was a barrier to smooth communication and COVID-19 vaccine roll-out. Continual amendments had unintended consequences, stimulating confusion, disrupting community outreach efforts and interrupting vaccine implementation. Policy changes were most disruptive to logistical planning and community engagement work, including community outreach, communicating eligibility criteria, and providing translated vaccine information to diverse communities. CONCLUSIONS: Vaccine policy changes that allow for prioritized access can have the unintended consequence of limiting communities' access to information that supports decision making. Rapidly evolving circumstances require a balance between adjusting policy and maintaining simple, consistent public health messages that can readily be translated into action. Information access is a factor in health inequality that needs addressing alongside access to vaccines.

Medical capacity investment for epidemic disease: The effects of policymaker's confidence and public trust.

Due to the server bed shortage, which has raised ethical dilemmas in the earliest days of the COVID-19 crisis, medical capacity investment has become a vital decision-making issue in the attempt to contain the epidemic. Furthermore, economic strength has failed to explain the significant performance difference across countries in combatting COVID-19. Unlike common diseases, epidemic diseases add substantial unpredictability, complexity, and uncertainty to decision-making. Knowledge miscalibration on epidemiological uncertainties by policymaker's over- and underconfidence can seriously impact policymaking. Ineffective risk communication may lead to conflicting and incoherent information transmission. As a result, public reactions and attitudes could be influenced by policymakers' confidence due to the level of public trust, which eventually affects the degree to which an epidemic spreads. To uncover the impacts of policymakers' confidence and public trust on the medical capacity investment, we establish epidemic diffusion models to characterize how transmission evolves with (and without) vaccination and frame the capacity investment problem as a newsvendor problem. Our results show that if the public fully trusts the public health experts, the policymaker's behavioral bias is always harmful, but its effect on cost increment is marginal. If a policymaker's behavior induces public reactions due to public trust, both the spread of the epidemic and the overall performance will be significantly affected, but such impacts are not always harmful. Decision bias may be beneficial when policymakers are pessimistic or highly overconfident. Having an opportunity to amend initially biased decisions can debias a particular topic but has a limited cost-saving effect.

Factors Associated With Coronavirus Disease 2019 Vaccine Uptake Among Pregnant Women and Nonpregnant Women of Reproductive Age in Jamaica.

Background: Despite high rates of coronavirus disease 2019 (COVID-19)-related maternal mortality, Jamaica currently has little data on COVID-19 vaccine uptake among pregnant women. Methods: We conducted a cross-sectional, web-based survey of 192 reproductive-aged women in Jamaica from February 1 to 8, 2022. Participants were recruited from a convenience sample of patients, providers, and staff at a teaching hospital. We assessed self-reported COVID-19 vaccination status and COVID-19-related medical mistrust (operationalized as vaccine confidence, government mistrust, and race-based mistrust). We used multivariable modified Poisson regression to test the association between vaccine uptake and pregnancy. Results: Of 192 respondents, 72 (38%) were pregnant. Most (93%) were Black. Vaccine uptake was 35% in pregnant women versus 75% in nonpregnant women. Pregnant women were more likely to cite healthcare providers versus the government as trustworthy sources of COVID-19 vaccine information (65% vs 28%). Pregnancy, low vaccine confidence, and government mistrust were associated with a lower likelihood of COVID-19 vaccination (adjusted prevalence ratio [aPR] = 0.68 [95% confidence interval {CI}, .49-.95], aPR = 0.61 [95% CI, .40-.95], and aPR = 0.68 [95% CI, .52-.89], respectively). Race-based mistrust was not associated with COVID-19 vaccination in the final model. Conclusions: Pregnancy, low vaccine confidence, and government mistrust were associated with a lower likelihood of COVID-19 vaccination among reproductive-aged women in Jamaica. Future studies should evaluate the efficacy of strategies proven to improve maternal vaccination coverage, including standing "opt-out" vaccination orders and collaborative provider and patient-led educational videos tailored for pregnant individuals. Strategies that decouple vaccine messaging from government agencies also warrant evaluation.

COVID-19 Vaccine Hesitancy Among Patients Recovered From COVID-19 Infection in Wuhan, China: Cross-Sectional Questionnaire Study.

BACKGROUND: Although patients recovered from COVID-19 already have immunity gained from natural infection, they are still at risk of reinfection due to the emergence of new variants of COVID-19 and the diminishing of naturally acquired immunity over time. Vaccination is associated with efficacious protection against COVID-19 infection and could boost infection-acquired immunity; however, various COVID-19 survivors have not been vaccinated due to vaccine hesitancy. OBJECTIVE: The aim of this study was to investigate COVID-19 vaccine hesitancy and related factors among COVID-19 survivors. METHODS: A cross-sectional questionnaire survey was conducted among patients who recovered from COVID-19 infection in Wuhan, China, between June 10 and July 25, 2021. The questionnaire included sociodemographic information, items on COVID-19 infection, the COVID-19 vaccine hesitancy scale based on the 3Cs (complacency, convenience, and confidence) model, trust in vaccine manufacturers and health facilities, and reasons for the decision to accept COVID-19 vaccination. Multivariate logistic regression analysis was used to assess the factors influencing COVID-19 vaccine hesitancy. RESULTS: Among the 1422 participants, 538 (37.8%) were not vaccinated against COVID-19. The COVID-19-recovered patients who self-reported having a current unhealthy status expressed more hesitancy about the COVID-19 vaccine than those who perceived themselves to be healthy (odds ratio [OR] 0.45, 95% CI 0.28-0.71). Compared to the asymptomatic patients, patients with mild symptoms were more likely to receive a COVID-19 vaccine (OR 1.67, 95% CI 1.02-2.82). Regarding the 3Cs model, high complacency (P=.005) and low convenience (P=.004) were significant negative factors for COVID-19 vaccination. Trust in vaccine manufacturers and health facilities was a significant positive factor for COVID-19 vaccination (OR 1.14, 95% CI 1.09-1.19). "Self-needs" was the main reason for patients to receive the COVID-19 vaccine, whereas "already have antibodies and do not need vaccination" was the main reason for patients to not receive the COVID-19 vaccine. CONCLUSIONS: Among the three major factors of vaccine hesitancy, complacency proved to be the most notable among COVID-19-recovered patients. Therefore, educational campaigns can focus on raising the awareness of risk of infection and the benefits of vaccination to reduce complacency toward vaccination among this population. In particular, for individuals who have recovered from COVID-19, improving factors related to convenience such as transportation, the environment of vaccination, and providing door-to-door service was also deemed necessary to facilitate their vaccination. In addition, addressing the concerns about vaccination of COVID-19-recovered patients could foster trust and promote their uptake of vaccination.

Declining trends in vaccine confidence across sub-Saharan Africa: A large-scale cross-sectional modeling study.

Current WHO/UNICEF estimates of routine childhood immunization coverage reveal the largest sustained decline in uptake in three decades with pronounced setbacks across Africa. Although the COVID-19 pandemic has induced significant supply and delivery disruptions, the impact of the pandemic on vaccine confidence is less understood. We here examine trends in vaccine confidence across eight sub-Saharan countries between 2020 and 2022 via a total of 17,187 individual interviews, conducted via a multi-stage probability sampling approach and cross-sectional design and evaluated using Bayesian methods. Multilevel regression combined with poststratification weighting using local demographic information yields national and sub-national estimates of vaccine confidence in 2020 and 2022 as well as its socio-demographic associations. We identify declines in perceptions toward the importance of vaccines for children across all eight countries, with mixed trends in perceptions toward vaccine safety and effectiveness. We find that COVID-19 vaccines are perceived to be less important and safe in 2022 than in 2020 in six of the eight countries, with the only increases in COVID-19 vaccine confidence detected in Ivory Coast. There are substantial declines in vaccine confidence in the Democratic Republic of Congo and South Africa, notably in Eastern Cape, KwaZulu-Natal, Limpopo, and Northern Cape (South Africa) and Bandundu, Maniema, Kasaï-Oriental, Kongo-Central, and Sud-Kivu (DRC). While over 60-year-olds in 2022 have higher vaccine confidence in vaccines generally than younger age groups, we do not detect other individual-level socio-demographic associations with vaccine confidence at the sample sizes studied, including sex, age, education, employment status, and religious affiliation. Understanding the role of the COVID-19 pandemic and associated policies on wider vaccine confidence can inform post-COVID vaccination strategies and help rebuild immunization system resilience.