Has the COVID-19 Pandemic Changed Parental Attitudes and Beliefs Regarding Vaccinating Their Children against the Flu?

BACKGROUND: This study assessed whether the COVID-19 pandemic has altered parents' attitudes toward vaccinating their children against the flu and barriers to school-based vaccination programs. METHODS: A cross-sectional online survey was conducted with 975 parents of children aged 6 months to 11 years between 21-31 December 2022. A multivariate regression was performed to determine predictors of parents' willingness to vaccinate their children against the flu in the winter of 2023. RESULTS: 45% of parents did not plan to vaccinate their children against the flu, citing concerns about side effects and vaccine effectiveness; 39% already vaccinated their children, and 41% of them reported an increased intention to vaccinate following the pandemic. Only 37% of parents chose school-based vaccination programs, mainly due to a preference for HMO clinics and a lack of available nurses at school. The Health Belief Model variables, namely, perceived susceptibility, severity, and benefits, displayed the largest effect sizes. CONCLUSIONS: Healthcare providers and public health officials should address parents' concerns about flu vaccine safety and efficacy to improve vaccination rates among children. Notably, the pandemic has increased vaccine receptivity among some parents. Enhancing accessibility to nursing staff in student health facilities could help boost vaccine uptake.

Transformational leadership vs. proactive personality: Contributing factors to physiotherapists proactive behaviors and burnout during the SARS-COV-2 pandemic.

BACKGROUND: In May 2019, the World Health Organization (WHO) added burn out to the list of occupational phenomena in the 11th Revision of the International Classification of Diseases (ICD-11). Soon thereafter, in March 2020, a global pandemic of SARS-COV-2 was declared. OBJECTIVE: To investigate the interplay between transformational leadership, a proactive personality, employee proactive behaviors, and burn out in the field of physiotherapy during the SARS-COV-2 pandemic. METHODS: Physiotherapists working at the Meuhedet Health Maintenance Organization (HMO) were asked to fill an online cross-sectional survey, in which they were asked to evaluate the transformational behavior of their manager and to assess their own burn out rate, degree of self-efficacy, proactive personality, and proactive behaviors. Eighty-one physical therapists (average age of 37.3 years (SD = 9.0)) responded to the survey, most of whom were female (67.9%, n = 55). RESULTS: Transformational leadership and proactive personality were negatively associated with occupational burn out (ß = -0.231, p < 0.05, ß = -0.243, p < 0.05, respectively) among physiotherapists. The effect of the interaction between transformational leadership and proactive personality on proactive behaviors at work was not significant. However, a strong, significant positive relationship was found between proactive personality and proactive behaviors (ß = 0.425, p < 0.001), and between self-efficacy and proactive behaviors (ß = 0.479, p < 0.001). CONCLUSIONS: This up-to-date survey of transformational leadership and proactive personality among physiotherapists highlights these traits' important impact on burn out and proactive behaviors during the SARS-COV-2 pandemic. Furthermore, the transformational manager plays an important role in reducing burnout levels among physiotherapists, especially during a crisis such as the SARS-COV-2 pandemic.

Parents' intention to vaccinate their 5- to 11-year-old children with the COVID-19 vaccine: rates, predictors and the role of incentives.

INTRODUCTION: Immediately after Pfizer announced encouraging effectiveness and safety results from their COVID-19 vaccine clinical trials in 5- to 11-year-old children, this study aimed to assess parents' perceptions and intention to vaccinate their 5-11-year-old children and to determine socio-demographic, health-related, behavioral factors, as well as the role of incentives. METHODS: A cross-sectional online survey of parents of children between 5 and 11 years of age among the Jewish population in Israel (n = 1,012). The survey was carried out between September 23 and October 4, 2021, at a critical time, immediately after Pfizer's announcement. Two multivariate regressions were performed to determine predictors of parents' intention to vaccinate their 5-11-year-old children against COVID-19. RESULTS: Overall, 57% of the participants reported that they intend to vaccinate their 5-11-year-old children against COVID-19 in the winter of 2022. 27% noted that they would vaccinate their 5-11-year-old children immediately; 26% within three months; and 24% within more than three months. Perceived susceptibility, benefits, barriers and cues to action, as well as two incentives - vaccine availability and receiving a "Green Pass" - were all significant predictors. However, Incentives such as monetary rewards or monetary penalties did not increase the probability of parents' intention to vaccinate their children. Parental concerns centered around the safety of the vaccine, fear of severe side effects, and fear that clinical trials and the authorization process were carried out too quickly. CONCLUSION: This study provides data on the role of incentives in vaccinating 5-11-year-old children, how soon they intend to do so, and the predictors of those intentions, which is essential knowledge for health policy makers planning vaccination campaigns.

No-show after extracorporeal shock wave lithotripsy treatment in endourology clinic: Can we build a typical patient profile?

OBJECTIVES: Patients "no-show" in outpatient clinics is a worldwide challenge. Healthcare providers and patients suffer from negative impacts that include increased expenditure, clinical management ineffectiveness, and decreased access to care. This study aims to evaluate no-show rate among extracorporeal shock wave lithotripsy patients visiting endourology clinic and to identify the demographic and clinical predictors of no-show. METHODS: A cross-sectional and historical cohort study using electronic medical records. We included 790 patients aged >18 years old referred for endourology clinic following shock wave lithotripsy during 2010-2017 at Hadassah Medical Center in Israel. We predicted no-show rate following shock wave lithotripsy by various patient characteristics by a multivariate logistic regression model. RESULTS: Overall, 291 (36.8%) patients did not arrive for postoperative clinic. Of these, 91 (11.52%) patients referred to Emergency Department. Patients who were younger in age (odds ratio 1.49, 95% confidence interval 1.08-2.04), patients who underwent hospitalization ≥3 days (odds ratio 1.63, 95% confidence interval 1.11-2.41) and patients who had undergone a stent-free shock wave lithotripsy (odds ratio 5.71, 95% confidence interval 2.40-13.57) were significantly associated with higher no-show rate. Larger stone size was associated with reduction in no-show rate with every millimeter increase of stone diameter was associated with a reduction of 6.1% probability for no-show (odds ratio 0.94, 95% confidence interval 0.89-0.99). CONCLUSIONS: Predicting patients' characteristics and no-show patterns is necessary to improve clinical management efficiency, access to care, and costs. We showed that patients who were younger, patients who underwent stent-free shock wave lithotripsy, patients who had a smaller stone, and patients who underwent a longer hospitalization were more prone to miss their appointment. Paying attention to the characteristics of individual patients may assist in implementing intervening program of patient scheduling.

The Role of Incentives in Deciding to Receive the Available COVID-19 Vaccine in Israel.

This study aimed to assess the Israeli public's intention to get vaccinated immediately after the COVID-19 vaccine became available, and to determine the role of incentives beyond socio-demographic, health-related and behavioral factors, in predicting this intention. An online survey was conducted among adults in Israel (n = 461), immediately after the first COVID-19 vaccine became available (22 December 2020 to 10 January 2021). Two regressions were performed to investigate determinants of intention to receive the available COVID-19 vaccine and sense of urgency to receive the vaccine. Although many adults were willing to receive available COVID-19 vaccine, only 65% were willing to immediately receive the vaccine, 17% preferred to wait 3 months and 18% preferred to wait a year. The sense of urgency to get vaccinated differed by age, periphery level, perceived barriers, cues to action and availability. Incentives such as monetary rewards or the green pass did not increase the probability of getting vaccination immediately. Providing data on the role of incentives in increasing the intention to immediately receive the available COVID-19 vaccine is important for health policy makers and healthcare providers. Our findings underscore the importance of COVID-19 vaccine accessibility. Health policy makers should consider allocating funds for making the vaccine accessible and encourage methods of persuasion, instead of investing funds in monetary incentives.

Patient-initiated second medical consultations-patient characteristics and motivating factors, impact on care and satisfaction: a systematic review.

OBJECTIVES: To review the characteristics and motivations of patients seeking second opinions, and the impact of such opinions on patient management, satisfaction and cost effectiveness. DATA SOURCES: Embase, Medline, PsycINFO and Health Management Information Consortium (HMIC) databases. STUDY DESIGN: A systematic literature search was performed for terms related to second opinion and patient characteristics. Study quality was assessed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. DATA COLLECTION/EXTRACTION METHODS: We included articles focused on patient-initiated second opinions, which provided quantitative data on their impact on diagnosis, treatment, prognosis or patient satisfaction, described the characteristics or motivating factors of patients who initiated a second opinion, or the cost-effectiveness of patient-initiated second opinions. PRINCIPAL FINDINGS: Thirty-three articles were included in the review. 29 studies considered patient characteristics, 19 patient motivating factors, 10 patient satisfaction and 17 clinical agreement between the first and second opinion. Seeking a second opinion was more common in women, middle-age patients, more educated patients; and in people having a chronic condition, with higher income or socioeconomic status or living in central urban areas. Patients seeking a second opinion sought to gain more information or reassurance about their diagnosis or treatment. While many second opinions confirm the original diagnosis or treatment, discrepancies in opinions had a potential major impact on patient outcomes in up to 58% of cases. No studies reported on the cost effectiveness of patient initiated second opinions. CONCLUSIONS: This review identified several demographic factors associated with seeking a second opinion, including age, gender, health status, and socioeconomic status. Differences in opinion received, and in the impact of change in opinion, varies significantly between medical specialties. More research is needed to understand the cost effectiveness of second opinions and identify patient groups most likely to benefit from second opinions.

Integrating Health Behavior Theories to Predict COVID-19 Vaccine Acceptance: Differences between Medical Students and Nursing Students.

BACKGROUND: This study aimed to explore behavioral-related factors predicting the intention of getting a COVID-19 vaccine among medical and nursing students using an integrative model combining the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB). METHODS: A cross-sectional online survey was conducted among medical and nursing students aged > 18 years in their clinical years in Israel between 27 August and 28 September 2020. Hierarchical logistic regression was used to predict acceptance of a COVID-19 vaccine. RESULTS: A total number of 628 participants completed the survey. Medical students expressed higher intentions of getting vaccinated against COVID-19 than nursing students (88.1% vs. 76.2%, p < 0.01). The integrated model based on HBM and TPB was able to explain 66% of the variance (adjusted R2 = 0.66). Participants were more likely to be willing to get vaccinated if they reported higher levels of perceived susceptibility, benefits, barriers, cues to action, attitude, self-efficacy and anticipated regret. Two interaction effects revealed that male nurses had a higher intention of getting vaccinated than did female nurses and that susceptibility is a predictor of the intention of getting vaccinated only among nurses. CONCLUSIONS: This study demonstrates that both models considered (i.e., HBM and TPB) are important for predicting the intention of getting a COVID-19 vaccine among medical and nursing students, and can help better guide intervention programs, based on components from both models. Our findings also highlight the importance of paying attention to a targeted group of female nurses, who expressed low vaccine acceptance.

Predicting intention to receive COVID-19 vaccine among the general population using the health belief model and the theory of planned behavior model.

BACKGROUND: This study aim to explore the intentions, motivators and barriers of the general public to vaccinate against COVID-19, using both the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB) model. METHODS: An online survey was conducted among Israeli adults aged 18 years and older from May 24 to June 24, 2020. The survey included socio-demographic and health-related questions, questions related to HBM and TPB dimensions, and intention to receive a COVID-19 vaccine. Associations between questionnaire variables and COVID-19 vaccination intention were assessed by univariate and multivariate analyses. RESULTS: Eighty percent of 398 eligible respondents stated their willingness to receive COVID-19 vaccine. A unified model including HBM and TPB predictor variables as well as demographic and health-related factors, proved to be a powerful predictor of intention to receive COVID-19 vaccine, explaining 78% of the variance (adjusted R squared = 0.78). Men (OR = 4.35, 95% CI 1.58-11.93), educated respondents (OR = 3.54, 95% CI 1.44-8.67) and respondents who had received the seasonal influenza vaccine in the previous year (OR = 3.31, 95% CI 1.22-9.00) stated higher intention to receive COVID-19 vaccine. Participants were more likely to be willing to get vaccinated if they reported higher levels of perceived benefits of COVID-19 vaccine (OR = 4.49, 95% CI 2.79-7.22), of perceived severity of COVID-19 infection (OR = 2.36, 95% CI 1.58-3.51) and of cues to action (OR = 1.99, 95% CI 1.38-2.87), according to HBM, and if they reported higher levels of subjective norms (OR = 3.04, 95% CI 2.15-4.30) and self-efficacy (OR = 2.05, 95% CI 1.54-2.72) according to TPB. Although half of the respondents reported they had not received influenza vaccine last year, 40% of them intended to receive influenza vaccine in the coming winter and 66% of them intended to receive COVID-19 vaccine. CONCLUSIONS: Providing data on the public perspective and predicting intention for COVID-19 vaccination using HBM and TPB is important for health policy makers and healthcare providers and can help better guide compliance as the COVID-19 vaccine becomes available to the public.

Second opinion utilization by healthcare insurance type in a mixed private-public healthcare system: a population-based study.

OBJECTIVES: To evaluate the utilisation (overall and by specialty) and the characteristics of second-opinion seekers by insurance type (either health fund or supplementary insurance) in a mixed private-public healthcare. DESIGN: An observational study. SETTING: Secondary care visits provided by a large public health fund and a large supplementary health insurance in Israel. PARTICIPANTS: The entire sample included 1 392 907 patients aged 21 years and above who visited at least one specialist over an 18 months period, either in the secondary care or privately via the supplementary insurance. OUTCOMES MEASURES: An algorithm was developed to identify potential second-opinion instances in the dataset using visits and claims data. Multivariate logistic regression was used to identify characteristics of second-opinion seekers by the type of insurance they used. RESULTS: 143 371 (13%) out of 1 080 892 patients who had supplementary insurance sought a single second opinion, mostly from orthopaedic surgeons. Relatively to patients who sought second opinion via the supplementary insurance, second-opinion seekers via the health fund tended to be females (OR=1.2, 95% CI 1.17 to 1.23), of age 40-59 years (OR=1.36, 95% CI 1.31 to 1.42) and with chronic conditions (OR=1.13, 95% CI 1.08 to 1.18). In contrast, second-opinion seekers via the supplementary insurance tended to be native-born and established immigrants (OR=0.79, 95% CI 0.76 to 0.84), in a high socioeconomic level (OR=0.39, 95% CI 0.37 to 0. 4) and living in central areas (OR=0.88, 95% CI 0.85 to 0.9). CONCLUSIONS: Certain patient profiles tended to seek second opinions via the supplementary insurance more than others. People from the centre of the country and with a high socioeconomic status tended to do so, as medical specialists tend to reside in central urban areas. Further research is recommended to examine the availability of medical specialists by specialty and residence.

Reasons, perceived outcomes and characteristics of second-opinion seekers: are there differences in private vs. public settings?

BACKGROUND: In most countries, patients can get a second opinion (SO) through public or private healthcare systems. There is lack of data on SO utilization in private vs. public settings. We aim to evaluate the characteristics of people seeking SOs in private vs. public settings, to evaluate their reasons for seeking a SO from a private physician and to compare the perceived outcomes of SOs given in a private system vs. a public system. METHODS: A cross-sectional national telephone survey, using representative sample of the general Israeli population (n = 848, response rate = 62%). SO utilization was defined as seeking an additional clinical opinion from a specialist within the same specialty, on the same medical concern. We modeled SO utilization in a public system vs. a private system by patient characteristics using a multivariate logistic regression model. RESULTS: 214 of 339 respondents who obtained a SO during the study period, did so in a private practice (63.1%). The main reason for seeking a SO from a private physician rather than a physician in the public system was the assumption that private physicians are more professional (45.7%). However, respondents who obtained a private SO were neither more satisfied from the SO (p = 0.45), nor felt improvement in their perceived clinical outcomes after the SO (p = 0.37). Low self-reported income group, immigrants (immigrated to Israel after 1989) and religious people tended to seek SOs from the public system more than others. CONCLUSIONS: The main reason for seeking a SO from private physicians was the assumption that they are more professional. However, there were no differences in satisfaction from the SO nor perceived clinical improvement. As most of SOs are sought in the private system, patient misconceptions about the private market superiority may lead to ineffective resource usage and increase inequalities in access to SOs. Ways to improve public services should be considered to reduce health inequalities.

Seeking a second medical opinion: composition, reasons and perceived outcomes in Israel.

BACKGROUND: Seeking a second-opinion (SO) is a common clinical practice that can optimize treatment and reduce unnecessary procedures and risks. We aim to characterize the composition of the population of SO seekers, their reasons for seeking a SO and choosing a specific physician, and their perceived outcomes following the SO. METHODS: A cross-sectional national telephone survey, using a representative sample of the general Israeli population (n = 848, response rate = 62%). SO utilization was defined as seeking an additional clinical opinion from a specialist within the same specialty, for the same medical concern. We describe the characteristics of respondents who obtained SOs, their reasons for doing so and their perceived outcomes: (1) Satisfaction with the SO; (2) Experiencing health improvement after receiving a SO; (3) A difference in the diagnosis or treatment suggested in the first opinions and the second opinions; (4) Preference of the SO over the first one. RESULTS: Most of the respondents who sought a SO (n = 344) were above 60 years old, secular, living with a partner, perceived their income to be above average and their health status to be not so good. For the patients who utilized SOs, orthopedic surgeons were sought out more than any other medical professional.Reasons for seeking a SO included doubts about diagnosis or treatment (38%), search for a sub-specialty expert (19%) and dissatisfaction with communication (19%). SO seekers most frequently chose a specific specialist based on a recommendation from a friend or a relative (33%). About half of the SO seekers also searched for information on the internet. Most of the respondents who sought a SO mentioned that they were satisfied with it (84%), felt health improvement (77%), mentioned that there was a difference between the diagnosis or treatment between the first opinion and the SO (56%) and preferred the SO over the first one (91%). CONCLUSIONS: Clinical uncertainty or dissatisfaction with patient-physician communication were the main reasons for seeking a SO. Policy makers should be aware that many patients choose a physician for a SO based on recommendations made outside the medical system. We recommend creating mechanisms that help patients in the complicated process of seeking a SO, suggest specialists who are suitable for the specific medical problem of the patient, and provide tools to reconcile discrepant opinions.

Second Medical Opinion: Utilization Rates and Characteristics of Seekers in a General Population.

BACKGROUND: Second opinion (SO) is common in medical practice and can reduce unnecessary risks and costs. To date, there is no population-based estimation of how many people seek SOs and what the characteristics of second-opinion seekers are. OBJECTIVES: To estimate how many people seek SOs, and what the characteristics of second-opinion seekers are. METHODS: We conducted both a medical records analysis (n=1,392,907) and a cross-sectional national telephone survey with a representative sample of the general Israeli population (n=848, response rate=62%). In the medical records analysis, we linked consultations with specialists at community secondary care and private consultations using claims data. We developed a time-sensitive algorithm that identified potential SO instances. In both methods, we predicted the characteristics of second-opinion seekers using multivariate logistic regressions. RESULTS: The medical records analysis and the survey findings were highly consistent, and showed that about sixth (14.9% in the medical records vs. 17.2% in the survey) of a general population sought a SO, mostly from orthopedic surgeons. Women, native-born, and established immigrants, people living in central urban areas or close to central urban areas, people with chronic conditions, and those who perceived their health status as not very good, were more likely to seek SOs than others. CONCLUSIONS: A considerable amount of people sought a SO. Certain patient profiles tended to seek SOs more than others. Such utilization patterns are important to devise policy regarding SOs, due to their implications on expenditure, policy, clinical outcomes, and patient satisfaction.

Decomposition of adsorbed VX on activated carbons studied by 31P MAS NMR.

The fate of the persistent OP nerve agent O-ethyl S-[2-(diisopropylamino)ethyl] methylphosphonothioate (VX) on granular activated carbons that are used for gas filtration was studied by means of 31P magic angle spinning (MAS) NMR spectroscopy. VX as vapor or liquid was adsorbed on carbon granules, and MAS NMR spectra were recorded periodically. The results show that at least 90% of the adsorbed VX decomposes within 20 days or less to the nontoxic ethyl methylphosphonic acid (EMPA) and bis(S-2-diisopropylaminoethane) {(DES)2}. Decomposition occurred irrespective of the phase from which VX was loaded, the presence of metal impregnation on the carbon surface, and the water content of the carbon. Theoretical and practical aspects of the degradation are discussed.