Exploring and contextualizing the associations among political identification, vaccine risk and benefit perceptions, and vaccine acceptance.

There is considerable research on the influence of political partisanship on vaccine acceptance. However, the current study is one of the first to investigate how political identification is related to risk and benefit perceptions vis-à-vis vaccines. Based on survey data collected in the United States regarding four different vaccines at three points in time (n = 383 for April-June 2012; n = 364 for March 2020; n = 334 for April-May 2020), Democrats were found to have more positive attitudes toward vaccinations in general and hold more favorable risk and benefit perceptions of pandemic and routine vaccines overall compared to Republicans. However, the onset of a pandemic can serve as an equalizing force and motivate similar risk and benefit perceptions across party lines, but this force can wane quickly when the information environment is politicized. For political partisans who are ideologically oriented to be more hesitant toward vaccines, two conditions can help sustain their favorable vaccine perceptions during a pandemic: (a) when they identify with the governing political party, and (b) when there are consistent reassurances of vaccine safety and effectiveness from their partisan leadership. Given that risk and benefit perceptions were found to be consistently associated with vaccine acceptance across contexts in this study, communication aimed at encouraging vaccinations should always address the risks and benefits of a vaccine in ways that are tailored for individuals with different political affiliations.

Current issues in frailty and hypertension management.

The significance of hypertension management in older individuals is greatly influenced by factors other than chronological age, as they have diverse physical, mental, and social backgrounds. Differences in physical functions, between independence, frailty and dependence, have a great impact on antihypertensive therapy in the older population. While recent clinical trials support the significance of intensive antihypertensive therapy regardless of age, there is little evidence to positively support the significance of antihypertensive therapy for older patients with physical function requiring nursing care, and observational studies suggest that antihypertensive treatment may instead be harmful in these older patients. Therefore, frailty, the transitional state between independence and dependence with the need for nursing care, is conceivable to be the tipping point at which the balance of risks and benefits of antihypertensive treatment is converted. The increased risk of acute adverse outcome is another issue that complicates management in the practice of hypertension treatment in frail patients. Particularly, increased blood pressure variability manifested by orthostatic hypotension in frail patients can induce fall and fracture leading to disability shortly after initiation or modification of antihypertensive treatment. Future challenges to optimize the management of frail hypertensive patients include developing techniques to estimate treatment efficacy, identifying safe antihypertensive regimens that reduce the risk of falls, and establishing strategies to restore frail patients to robust health.

Early Childhood Exposures to Fluorides and Child Behavioral Development and Executive Function: A Population-Based Longitudinal Study.

It is important to both protect the healthy development and maintain the oral health of the child population. The study examined the effect of early childhood exposures to water fluoridation on measures of school-age executive functioning and emotional and behavioral development in a population-based sample. This longitudinal follow-up study used information from Australia's National Child Oral Health Study 2012-14. Children aged 5 to 10 y at baseline were contacted again after 7 to 8 y, before they had turned 18 y of age. Percent lifetime exposed to fluoridated water (%LEFW) from birth to the age 5 y was estimated from residential history and postcode-level fluoride levels in public tap water. Measures of children's emotional and behavioral development were assessed by the Strength and Difficulties Questionnaire (SDQ), and executive functioning was measured by the Behavior Rating Inventory of Executive Function (BRIEF). Multivariable regression models were generated to compare the associations between the exposure and the primary outcomes and controlled for covariates. An equivalence test was also conducted to compare the primary outcomes of those who had 100% LEFW against those with 0% LEFW. Sensitivity analysis was also conducted. A total of 2,682 children completed the SDQ and BRIEF, with mean scores of 7.0 (95% confidence interval, 6.6-7.4) and 45.3 (44.7-45.8), respectively. Those with lower %LEFW tended to have poorer scores of the SDQ and BRIEF. Multivariable regression models reported no association between exposure to fluoridated water and the SDQ and BRIEF scores. Low household income, identifying as Indigenous, and having a neurodevelopmental diagnosis were associated with poorer SDQ/BRIEF scores. An equivalence test confirmed that the SDQ/BRIEF scores among those with 100% LEFW were equivalent to that of those who had 0% LEFW. Exposure to fluoridated water during the first 5 y of life was not associated with altered measures of child emotional and behavioral development and executive functioning.

Perception of risk and treatment decisions in the management of differentiated thyroid cancer.

BACKGROUND AND OBJECTIVES: The recent de-escalation of care for differentiated thyroid cancer (DTC) has broadened the range of initial treatment options. We examined the association between physicians' perception of risk and their management of DTC. METHODS: Thyroid specialists were surveyed with four clinical vignettes: (1) indeterminate nodule (2) tall cell variant papillary thyroid cancer (PTC), (3) papillary thyroid microcarcinoma (mPTC), and (4) classic PTC. Participants judged the operative risks and likelihood of structural cancer recurrence associated with more versus less aggressive treatments. A logistic mixed effect model was used to predict treatment choice. RESULTS: Among 183 respondents (13.4% response rate), 44% were surgical and 56% medical thyroid specialists. Risk estimates and treatment recommendation varied markedly in each case. Respondents' estimated risk of 10-year cancer recurrence after lobectomy for a 2.0-cm PTC ranged from 1% to 53% (interquartile range [IQR]: 3%-12%), with 66% recommending lobectomy and 34% total thyroidectomy. Respondents' estimated 5-year risk of metastastic disease during active surveillance of an 0.8-cm mPTC ranged from 0% to 95% (IQR: 4%-15%), with 36% choosing active surveillance. Overall, differences in perceived risk reduction explained 10.3% of the observed variance in decision-making. CONCLUSIONS: Most of the variation in thyroid cancer treatment aggressiveness is unrelated to perceived risk of cancer recurrence.

Support for legislative, technological, and organizational strategies to reduce cellphone use while driving: Psychological predictors and influences of language.

OBJECTIVE: A large body of research has established that cellphone use while driving (CUWD) is common and dangerous. However, little research has been conducted about how people react psychologically to various distraction-reduction strategies and, ultimately, support or do not support them. Understanding support for reduction is important for predicting use of technological solutions and compliance with laws and for improving communication and education about the risks of CUWD. METHODS: We measured support for a variety of legislative, technological, and organizational strategies to reduce CUWD in an online sample of American drivers (N = 648). We also developed evidence-based communication techniques, describing strategies in terms of benefits vs. costs or using freedom-invoking vs. freedom-reducing language to assess what would influence support. RESULTS: Support for CUWD reduction was generally high. It was predicted by driver characteristics and beliefs. For example, drivers who supported reducing CUWD more also had lower CUWD reactance, greater anti-CUWD beliefs, higher personal risk perceptions of CUWD, and greater self-reported distracted driving. Age and perceived ability to drive distracted did not predict overall support. However, two strategies that allow for handsfree phone use were supported more by people who engaged in more CUWD, perceived they had greater ability to CUWD, perceived more benefits to CUWD, had more positive affect to cellphones, and were younger. Communication techniques also influenced support. Specifically, the same strategy was supported more when described using benefits and permissive language instead of costs and restrictive language. CONCLUSIONS: Most respondents supported strategies to reduce CUWD, and beliefs about risks and benefits predicted this snupport. Reactance to CUWD messaging emerged as a key predictor of lower support (and of greater self-reported distracted driving), indicating that it could be an important variable to consider when designing strategies to reduce CUWD. When targeting people resistant to quitting CUWD entirely, communicators could recommend a switch to handsfree use. Communicators who emphasize benefits and use permissive language also may increase support for CUWD reduction.

GM trust shaped by trust determinants with the impact of risk/benefit framework: the contingent role of food technology neophobia.

The present study is comparative in natures that focus on understanding the factors that influence the GM food trust level in the BRA framework and food technology neophobia in China and the USA. For this purpose, we collected 300 and 350 valid responses, respectively, through a structured questionnaire. By carefully evaluating the above relationships, we found that trust determinants such as institutional trust, technology trust, information revealed with GM food vary across both datasets. However, GM knowledge has a better association with GM food trust in both cases. Apart from this, the food technology neophobia slightly moderates the benefits-risk perception of consumers and GM trust. This study guides the policymakers to enhance GM knowledge, as GM food is scientifically proven safe for health and environment and can be a financial incentive for the farmers. Further, the study also provides direction for corporate managers to design effective marketing and communication strategies in two different countries by investigating GM food trust's primary motivators in both nations.

Decision analysis approach to risk/benefit evaluation in the ethical review of controlled human infection studies.

Risks and benefit evaluation for controlled human infection studies, where healthy volunteers are deliberately exposed to infectious agents to evaluate vaccine efficacy, should be explicit, systematic, thorough, and non-arbitrary. Decision analysis promotes these qualities using four steps: (1) determining explicit criteria and measures for evaluation, (2) identifying alternatives to the study, (3) defining the models used to estimate the measures for each alternative, and (4) running the models to produce the estimates and compare the alternatives. In this paper, we describe how decision analysis might be applied by funders and regulators, as well as by others contemplating the use of novel controlled human infection studies for vaccine development and evaluation.

Mitos y realidades sobre el aporte de lácteos y calcio / Myths and facts about dairy foods and calcium supplementation

Desde una perspectiva histórica, el consumo de leche de otros mamíferos y sus derivados ha jugado un rol importante en el desarrollo de la sociedad humana. Sin embargo, en los últimos años se han planteado dudas respecto al real beneficio del consumo de productos lácteos y suplementos de calcio en la salud ósea. Más aún, se les han atribuido potenciales efectos adversos como el incremento del riesgo cardiovascular, aumento en la incidencia de cáncer, trastornos digestivos, nefrolitiasis y una mayor mortalidad. Si bien la evidencia disponible puede ser controversial, en la mayoría de los casos desmiente categóricamente estas afirmaciones.En esta revisión de la literatura, intentamos despejar las inquietudes respecto al beneficio y riesgo del consumo de lácteos, suplementos de calcio y Vitamina D.

From the historical perspective, milk and dairy product consumption has played an important role in the development of human society. However, in the recent years, some doubts have been raised regarding the benefits of dairy food consumption and calcium supplements on bone health. Additionally, potential adverse effects have been attributed to their use, such as increased cardiovascular risk, increased incidence of cancer, digestive troubles, nephrolithiasis and increased mortality rate. Although the available evidence may be controversial, in most cases it categorically refutes these statements.In this review of the literature, we try to address concerns regarding benefit and risks of consumption of dairy products, calcium and vitamin D supplements.

Corrigendum: Attention Deficit/Hyperactivity Disorder and Increased Engagement in Sexual Risk-Taking Behavior: The Role of Benefit Perception.

[This corrects the article DOI: 10.3389/fpsyg.2019.01043.].

Survey of confidence in use of stroke and bleeding risk calculators, knowledge of anticoagulants, and comfort with prescription of anticoagulation in challenging scenarios: SUPPORT-AF II study.

Half of patients with atrial fibrillation (AF) and elevated stroke risk do not receive anticoagulation (AC). Explanations for undertreatment may relate to provider lack of confidence with or knowledge of the CHA2DS2-VASc stroke calculator, unfamiliarity with direct oral anticoagulants (DOACs), or uncertainty about use of AC after bleeding events or other challenging patient scenarios. We surveyed cardiology and primary care providers (PCPs) within a large healthcare system to investigate prescriber knowledge, confidence, and comfort prescribing AC for AF in challenging scenarios. Of 112 providers invited, 70 (63%) completed our survey. Compared with non-responding providers, responding providers had fewer years in practice and more often worked in a university setting. Responding providers were moderately or very confident with use of CHA2DS2-VASc calculator (90%). Cardiology providers reported substantial knowledge about DOACs (72%) compared with PCPs (33%). Both provider groups reported reluctance prescribing AC when presented with challenging patient scenarios (% providers agreeing with AC): three falls over 6 months (36%), 2 weeks after resolved gastrointestinal bleed (21%), 4 weeks after intracranial bleeding (9%), in a patient consuming five alcoholic drinks per day (44%). All providers were moderately or very confident with using the CHA2DS2-VASc calculator, but only cardiology providers reported substantial knowledge about DOACs. Our providers were reluctant to prescribe AC after bleeding and in other common situations where use of AC may be appropriate. Education of PCPs about DOACs and development of guidelines to address challenging patient scenarios may improve AC prescription rates in patients with AF.

Attention Deficit/Hyperactivity Disorder and Increased Engagement in Sexual Risk-Taking Behavior: The Role of Benefit Perception.

Attention deficit/hyperactivity disorder (ADHD) has been linked to higher engagement in sexual risk-taking behavior (SRTB). The current study aims to establish the link between ADHD symptoms and SRTB in the general population and to examine whether an exaggerated perceived benefit of the positive outcomes of SRTB explains that link. A scale for measuring the frequency, likelihood, perceived benefit, and perceived risk of SRTB was developed. Young adult sexually active participants who did not have a stable partnership completed the above scale, as well as a scale of ADHD symptoms. The level of ADHD symptoms positively correlated with the frequency and likelihood of SRTB, even when the overall level of sexual behavior was controlled for. ADHD symptoms also correlated with the perceived benefit of SRTB, but not with the perceived risk of SRTB. Mediation analysis confirmed an indirect pathway: ADHD symptoms predicted perceived benefit of SRTB, which in turn predicted increased likelihood to engage in SRTB. These findings suggest a positive link between ADHD symptoms and SRTB in the general population, which is accounted for by an exaggerated perceived benefit of SRTB.

Risks and Benefits of Increased Nut Consumption: Cardiovascular Health Benefits Outweigh the Burden of Carcinogenic Effects Attributed to Aflatoxin B1 Exposure.

Nuts are rich in nutrients and mounting evidence shows that consumption reduces cardiovascular disease (CVD) incidence. Nuts may also be a major source of aflatoxin B1, a potent liver carcinogen and the risk/benefit balance is unknown. Based on national statistics and data from the PREDIMED intervention trial, we estimated the potential CVD-reduction if Swedes aged 55-79 consumed 30 g nuts/day, instead of the current national average of five grams per day. We also assessed the reduction in disability-adjusted life years (DALYs) due to myocardial infarction (MI) and stroke. We estimated the aflatoxin B1 exposure from nuts and calculated the margin of exposure. The approximation that one nanogram aflatoxin B1/kg body weight/day results in one additional liver cancer case/10 million person-years was used to estimate the number of liver cancer cases. The increased nut consumption scenario prevented more than 7000 CVDs in 2013 (306/100,000 person-years) and contributed to about 55,000 saved DALYs for stroke and 22,000 for MI. The concomitant increase in aflatoxin B1 exposure caused an estimated zero to three additional cases of liver cancer, corresponding to 159 DALYs spent, emphasizing the associated risks. Increased nut consumption, as part of a varied healthy diet, is warranted even when aflatoxin B1 exposure is taken into account. However, efforts to reduce aflatoxin exposure from food are essential.

Exploration on the Ethical Issues of Nanotechnology in Medical Application / 中国医学伦理学

The nanotechnology has been successfully applied in the diagnosis and treatment of diseases and develops rapidly.As a cutting-edge technique,there exist a series of ethical issues when applying nanotechnology in human body,such as risk management,benefit assessment,privacy protection and informed consent.Clinical trials initiated by researchers also face ethical challenges.Therefore,it should study on the ethical issues when using nanotechnology in medicine.To insure the healthy development of nanotechnology in medical application,the regulations and rules should be improved,the assessment of risks and benefits should be strengthened,the ethical review should be reinforced,and the awareness level of the researchers should be enhanced.

Potential for Therapeutic Benefit among Cystic Fibrosis Populations Excluded from Clinical Trials or Labeling of Marketed Therapies.

Remarkable advances in the management of individuals born with cystic fibrosis (CF) would not have been realized without empiric trial and error by CF clinicians with treatments developed and available for other purposes. As the testing and registration of CF-specific treatments have increased, so too have associated health care costs, particularly those of chronic medications. The transition of CF from a lethal pediatric disease to a life-shortening one with an adult majority, concurrent with sharp increases in chronic medication costs, has placed many CF treatments under increased scrutiny by third-party payers, particularly when prescribed to individuals from CF subpopulations that may not have been included in registration trials. Despite overall health improvements in the CF cohort and the increasing availability of CF-specific therapies, many physicians remain tasked with managing the health of patients from subpopulations that may be too young, too sick, or too complicated to have been included in clinical trials. An understanding of why particular CF subpopulations may have been excluded from registration trials, as well as consideration of a treatment's described mechanism of action, can support assessment for the potential for benefit (and risk) in these populations and help physicians advocate for patient access to treatments.

A Preliminary Study on Risk and Benefit Assessment in Ethical Review of Clinical Trials / 中国医学伦理学

The risk and benefit assessment is an important part of ethical review in clinical trials, of which the significance is to minimize the risk and maximize the benefit, thus to protect the rights of the subject. Begin with introducing the nature of the risk and benefit of clinical trial, this paper analyzed the way of ethical review based on risk consideration and discussed some key points of risk and benefit assessment including the minimum risk, the risk and benefit of vulnerable groups, risk informing, benefit of clinical trials, the fairness of recruitment and the importance of strengthening follow-up review. Ethical review should play a role as the balance, which neither-hinder the development of clinical trial to protect the rights of the subjects nor damage the rights and interests of subject to develop clinical trials.

Physician response to parental requests to spread out the recommended vaccine schedule.

OBJECTIVES: To assess among US physicians (1) frequency of requests to spread out recommended vaccination schedule for children <2 years, (2) attitudes regarding such requests, and (3) strategies used and perceived effectiveness in response to such requests. METHODS: An e-mail and mail survey of a nationally representative sample of pediatricians and family physicians from June 2012 through October 2012. RESULTS: The response rate was 66% (534 of 815). In a typical month, 93% reported some parents of children <2 years requested to spread out vaccines; 21% reported ≥ 10% of parents made this request. Most respondents thought these parents were putting their children at risk for disease (87%) and that it was more painful for children (84%), but if they agreed to requests, it would build trust with families (82%); further, they believed that if they did not agree, families might leave their practice (80%). Forty percent reported this issue had decreased their job satisfaction. Most agreed to spread out vaccines when requested, either often/always (37%) or sometimes (37%); 2% would often/always, 4% would sometimes, and 12% would rarely dismiss families from their practice if they wanted to spread out the primary series. Physicians reported using a variety of strategies in response to requests but did not think they were effective. CONCLUSIONS: Virtually all providers encounter requests to spread out vaccines in a typical month and, despite concerns, most are agreeing to do so. Providers are using many strategies in response but think few are effective. Evidence-based interventions to increase timely immunization are needed to guide primary care and public health practice.

The Inverse Relation Between Risks and Benefits: The Role of Affect and Expertise.

Although risk and benefits of risky activities are positively correlated in the real world, empirical results indicate that people perceive them as negatively correlated. The common explanation is that confounding benefits and losses stems from affect. In this article, we address the issue that has not been clearly established in studies on the affect heuristic: to what extent boundary conditions, such as judgments' generality and expertise, influence the presence of the inverse relation in judgments of hazards. These conditions were examined in four studies in which respondents evaluated general or specific benefits and risks of "affect-rich" and "affect-poor" hazards (ranging from investments to applications of stem cell research). In line with previous research, affect is defined as good or bad feelings integral to a stimulus. In contrast to previous research, affect is considered as related both to personal feelings and to social controversies associated with a hazard. Expertise is related to personal knowledge (laypersons vs. experts) as well as to objective knowledge (targets well vs. poorly known to science). The direct comparison of the input from personal and objective ignorance into the inverse relation has not been investigated previously. It was found that affect invoked by a hazard guides general but not specific judgments of its benefits and risks. Technical expertise helps to avoid simplified evaluations of consequences as long as they are well known to science. For new, poorly understood hazards (e.g., stem cell research), expertise does not protect from the perception of the inverse relation between benefits and risks.