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Gordillo-Marañón M, Szmigiel A, Yalmanová V, Caplanusi I, Genov G, Olsen DB, Straus S. COVID-19 Vaccines and Heavy Menstrual Bleeding: The Impact of Media Attention on Reporting to EudraVigilance. Drug Saf 2024; 47:783-798. [PMID: 38607521 PMCID: PMC11286647 DOI: 10.1007/s40264-024-01426-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND AND OBJECTIVE During the COVID-19 vaccination campaign, over 34,000 reports of heavy menstrual bleeding following the administration of COVID-19 vaccines originating in the Economic European Area were submitted to EudraVigilance, the European Union database of suspected adverse drug reactions. More than 90% of these reports were sent by consumers while the remaining by healthcare professionals. Public concerns regarding menstruation disorders in COVID-19 vaccinees were also covered by the media. We investigated the impact of media attention on the reporting trends of heavy menstrual bleeding to EudraVigilance. METHODS We used media outlets published in the Economic European Area on menstrual disorders and COVID-19 vaccines from the beginning of the vaccination campaign in the Economic European Area (1 January, 2021) until December 2022 (i.e., after the regulatory request to add the adverse event to the product information) and spontaneous reports from EudraVigilance. RESULTS We found that the publication of safety updates from regulatory authorities and subsequent coverage in media outlets preceded increased reporting to EudraVigilance. Furthermore, the heavy menstrual bleeding reported in the cases occurred several weeks or months earlier and were not submitted to the respective date. The analysis suggests that the spikes in reporting of heavy menstrual bleeding were to some extent influenced by media coverage in some countries. CONCLUSIONS Consumer reporting to the European Union spontaneous data collection system, EudraVigilance, was of high value for regulatory safety reviews, albeit the reporting behaviours were not free of the influence of the media. These sources of information can be investigated to understand the context of safety concerns of public health interest.
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Affiliation(s)
- María Gordillo-Marañón
- Data Analytics and Methods Task Force, European Medicines Agency, Amsterdam, The Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, UK
| | - Agnieszka Szmigiel
- Pharmacovigilance Office, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands.
| | - Vladimíra Yalmanová
- Stakeholders and Communication, European Medicines Agency, Amsterdam, The Netherlands
| | - Irina Caplanusi
- Pharmacovigilance Office, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands
| | - Georgy Genov
- Pharmacovigilance Office, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands
| | - David Benee Olsen
- Department of Pharmacovigilance, Norwegian Medical Products Agency, Oslo, Norway
| | - Sabine Straus
- Medicines Evaluation Board (MEB), Utrecht, The Netherlands
- Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands
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Asan L, Kleine-Borgmann J, Bozkurt B, Frank B, Köhrmann M, Kleinschnitz C, Bingel U. Media coverage of COVID-19 vaccination-associated cerebral venous sinus thrombosis was followed by a surge in emergency presentations due to headache - observations from a university hospital in Germany. Front Psychiatry 2024; 15:1378472. [PMID: 38846915 PMCID: PMC11153761 DOI: 10.3389/fpsyt.2024.1378472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/01/2024] [Indexed: 06/09/2024] Open
Abstract
Nocebo effects describe all negative outcomes for well-being brought about by negative health-related expectations. Media coverage of drug side effects can fuel nocebo effects and lead to increased symptom reports. This retrospective observational analysis of emergency reports at the neurological emergency room at University Hospital Essen, Germany, examines whether media communication about a cumulation of very rare cases of cerebral venous sinus thrombosis (CVST) after COVID-19 vaccination with the AstraZeneca compound (ChAdOx-1 nCoV-19) was followed by an increase in weekly presentation rates of patients with the main complaint of headache, a symptom commonly occurring as a vaccination reaction but also communicated as a warning symptom for CVST. The rate of headache presentations increased by 171.7% during the five weeks after the first announcement of CVSTs in Germany on 11 March 2021, compared to the five weeks immediately prior. Furthermore, more young women sought consultation for headache, reflecting the communicated at-risk profile for CVST. The increased rate of headache presenters contributed to a 32.1% rise in total neurological emergency cases, causing an increased strain on the emergency facility after the side effect risk was publicized. We discuss a causal role of negative side effect expectations after vaccination with AstraZeneca as a driver for this increase. While transparent communication about benefits and potential side effects is crucial for vaccination acceptance, increased vigilance toward nocebo effects in health-related media communication is needed due to its potential harm to the individual and society, especially when emergency medical resources are stretched thin.
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Affiliation(s)
- Livia Asan
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
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3
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Leibowitz KA, Howe LC, Winget M, Brown-Johnson C, Safaeinili N, Shaw JG, Thakor D, Kwan L, Mahoney M, Crum AJ. Medicine plus mindset: A mixed-methods evaluation of a novel mindset-focused training for primary care teams. PATIENT EDUCATION AND COUNSELING 2024; 122:108130. [PMID: 38242012 PMCID: PMC11140761 DOI: 10.1016/j.pec.2023.108130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 12/21/2023] [Accepted: 12/24/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVES Patient mindsets influence health outcomes; yet trainings focused on care teams' understanding, recognizing, and shaping patient mindsets do not exist. This paper aims to describe and evaluate initial reception of the "Medicine Plus Mindset" training program. METHODS Clinicians and staff at five primary care clinics (N = 186) in the San Francisco Bay Area received the Medicine Plus Mindset Training. The Medicine Plus Mindset training consists of a two-hour training program plus a one-hour follow-up session including: (a) evidence to help care teams understand patients' mindsets' influence on treatment; (b) a framework to support care teams in identifying specific patient mindsets; and (c) strategies to shape patient mindsets. RESULTS We used a common model (Kirkpatrick) to evaluate the training based on participants' reaction, learnings, and behavior. Reaction: Participants rated the training as highly useful and enjoyable. Learnings: The training increased the perceived importance of mindsets in healthcare and improved self-reported efficacy of using mindsets in practice. Behavior: The training increased reported frequency of shaping patient mindsets. CONCLUSIONS Development of this training and the study's results introduce a promising and feasible approach for integrating mindset into clinical practice. Practice Implications Mindset training can add a valuable dimension to clinical care and should be integrated into training and clinical practice.
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Affiliation(s)
| | - Lauren C Howe
- Department of Business Administration, University of Zurich, Zurich, Switzerland
| | - Marcy Winget
- Department of Medicine, Stanford University, Stanford, USA
| | | | | | | | - Deepa Thakor
- Department of Medicine, Stanford University, Stanford, USA
| | - Lawrence Kwan
- Department of Medicine, Stanford University, Stanford, USA
| | - Megan Mahoney
- Department of Family and Community Medicine, University of California San Francisco
| | - Alia J Crum
- Department of Psychology, Stanford University, Stanford, USA
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4
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MacKrill K, Witthöft M, Wessely S, Petrie KJ. Health Scares: Tracing Their Nature, Growth and Spread. CLINICAL PSYCHOLOGY IN EUROPE 2023; 5:e12209. [PMID: 38357430 PMCID: PMC10863677 DOI: 10.32872/cpe.12209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/18/2023] [Indexed: 02/16/2024] Open
Abstract
Background Health scares are highly publicised threats to health that increase public concern and protective behaviours but are later shown to be unfounded. Although health scares have become more common in recent times, they have received very little research attention. This is despite the fact that health scares often have negative outcomes for individuals and community by affecting health behaviours and causing high levels of often unnecessary anxiety. Method In this paper we undertook a review and analysis of the major types of health scares as well as the background factors associated with health scares and their spread. Results We found most health scares fell into seven main categories; environmental contaminants, food, malicious incidents, medical treatments, public health interventions, radiation from technology and exotic diseases. For most health scares there are important background factors and incident characteristics that affect how they develop. Background factors include conspiracy theories, trust in governmental agencies, anxiety, modern health worries and wariness of chemicals. Incident characteristic include being newly developed, not understood or unseen, man-made rather than natural and whether the incident is out of personal control. We also identified the aspects of traditional and social media that exacerbate the rapid spread of health scares. Conclusion More research is needed to identify the characteristics of media stories that intensify the levels of public concern. Guidelines around the media's reporting of health incidents and potential health threats may be necessary in order to reduce levels of public anxiety and the negative public health impact of health scares.
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Affiliation(s)
- Kate MacKrill
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Simon Wessely
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Keith J. Petrie
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Jeong HS, Chun BC. Signal detection of COVID-19 vaccines adverse events using spontaneous reports from South Korea. Pharmacoepidemiol Drug Saf 2023; 32:961-968. [PMID: 37019851 DOI: 10.1002/pds.5629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/14/2023] [Accepted: 03/31/2023] [Indexed: 04/07/2023]
Abstract
PURPOSE Studies on the detection of COVID-19 vaccine signals in South Korea are insufficient. Therefore, to investigate adverse events (AEs) that might be associated with COVID-19 vaccines, signals were detected using spontaneous reports from South Korea. We compared the signals with the vaccine insert lists of the regulators in the four countries. METHODS Spontaneous reports from 62 sites were collected by the National Medical Center between January 2013 and May 2022. A descriptive analysis of AEs associated with COVID-19 vaccines (Pfizer, Moderna, AstraZeneca, and Janssen) was performed, and the proportional reporting ratio, reporting odds ratio, and information component were calculated. We performed five analyses, with five cases and one control group. RESULTS During the study period, 68 355 cases were reported, of which 12 485 were COVID-19 vaccine AEs. Injection site pain (2198 cases, 17.6%), myalgia (1552 cases, 12.4%), headache (1145 cases, 9.2%), pyrexia (1003 cases, 8.0%), and fatigue (735 cases, 5.9%) were frequently reported. When comparing all COVID-19 vaccines with other viral vaccines, 20 signals were detected, of which cachexia, dyspepsia, abdominal discomfort, and mood swings were not listed on the vaccine inserts in all four countries. Overall, 20, 17, 29, and 9 signals were detected in vaccines developed by Pfizer, Moderna, AstraZeneca, and Janssen, respectively. CONCLUSIONS Based on a disproportionate analysis of COVID-19 vaccine AEs using spontaneous reports from South Korea, different signals were detected for each vaccine manufacturer.
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Affiliation(s)
- Hye Su Jeong
- Drug Safety Monitoring Center, National Medical Center, Seoul, South Korea
- Department of Epidemiology and Health Informatics, Graduate School of Public Health, Korea University, Seoul, South Korea
| | - Byung Chul Chun
- Department of Epidemiology and Health Informatics, Graduate School of Public Health, Korea University, Seoul, South Korea
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
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Stone CA, Garvey LH, Nasser S, Lever C, Triggiani M, Parente R, Phillips EJ. Identifying and Managing Those at Risk for Vaccine-Related Allergy and Anaphylaxis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2008-2022. [PMID: 37182566 DOI: 10.1016/j.jaip.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/13/2023] [Accepted: 05/01/2023] [Indexed: 05/16/2023]
Abstract
Immediate hypersensitivity reactions to vaccines, the most severe of which is anaphylaxis, are uncommon events occurring in fewer than 1 in a million doses administered. These reactions are infrequently immunoglobulin E-mediated. Because they are unlikely to recur, a reaction to a single dose of a vaccine is rarely a contraindication to redosing. This narrative review article contextualizes the recent knowledge we have gained from the coronavirus 2019 (COVID-19) pandemic rollout of the new mRNA platform with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines within the much broader context of what is known about immediate reactions to other vaccinations of routine and global importance. We focus on what is known about evidence-based approaches to diagnosis and management and what is new in our understanding of mechanisms of immediate vaccine reactions. Specifically, we review the epidemiology of immediate hypersensitivity vaccine reactions, differential diagnosis for immune-mediated and nonimmune reaction clinical phenotypes, including how to recognize immunization stress-related responses. In addition, we highlight what is known about mechanisms and review the rare but important contribution of excipient allergies and specifically when to consider testing for them as well as other key features that contribute to safe evaluation and management.
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Affiliation(s)
- Cosby A Stone
- Center for Drug Safety and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Lene H Garvey
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Shuaib Nasser
- Department of Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Charley Lever
- Department of Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Roberta Parente
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Elizabeth J Phillips
- Department of Dermatology, Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tenn; Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tenn; Institute for Immunology & Infectious Diseases, Murdoch University, Murdoch, Perth, Western Australia.
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7
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Smith LE, Sim J, Sherman SM, Amlôt R, Cutts M, Dasch H, Sevdalis N, Rubin GJ. Psychological factors associated with reporting side effects following COVID-19 vaccination: A prospective cohort study (CoVAccS - Wave 3). J Psychosom Res 2023; 164:111104. [PMID: 36495757 PMCID: PMC9708101 DOI: 10.1016/j.jpsychores.2022.111104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/24/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To investigate symptom reporting following the first and second COVID-19 vaccine doses, attribution of symptoms to the vaccine, and factors associated with symptom reporting. METHODS Prospective cohort study (T1: 13-15 January 2021, T2: 4-15 October 2021). Participants were aged 18 years or older, living in the UK. Personal, clinical, and psychological factors were investigated at T1. Symptoms were reported at T2. We used logistic regression analyses to investigate associations. RESULTS After the first COVID-19 vaccine dose, 74.1% (95% CI 71.4% to 76.7%, n = 762/1028) of participants reported at least one injection-site symptom, while 65.0% (95% CI 62.0% to 67.9%, n = 669/1029) reported at least one other (non-injection-site) symptom. Symptom reporting was associated with being a woman and younger. After the second dose, 52.9% (95% CI 49.8% to 56.0%, n = 532/1005) of participants reported at least one injection-site symptom and 43.7% (95% CI 40.7% to 46.8%, n = 440/1006) reported at least one other (non-injection-site) symptom. Symptom reporting was associated with having reported symptoms after the first dose, having an illness that put one at higher risk of COVID-19 (non-injection-site symptoms only), and not believing that one had enough information about COVID-19 to make an informed decision about vaccination (injection-site symptoms only). CONCLUSIONS Women and younger people were more likely to report symptoms from vaccination. People who had reported symptoms from previous doses were also more likely to report symptoms subsequently, although symptom reporting following the second vaccine was lower than following the first vaccine. Few psychological factors were associated with symptom reporting.
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Affiliation(s)
- Louise E Smith
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Weston Education Centre, King's College London, London SE5 9RJ, UK; NIHR Health Protection Research Unit in Emergency Preparedness and Response, Weston Education Centre, King's College London, London SE5 9RJ, UK.
| | - Julius Sim
- School of Medicine, David Weatherall Building, University Road, Keele University, Staffordshire, ST5 5BG, UK
| | - Susan M Sherman
- School of Psychology, Dorothy Hodgkin Building, Keele University, Staffordshire, ST5 5BG, UK
| | - Richard Amlôt
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, Weston Education Centre, King's College London, London SE5 9RJ, UK; UK Health Security Agency, Chief Scientific Officer's Group, 17 Smith Square, London, SW1P 3HX, UK
| | - Megan Cutts
- School of Psychology, Dorothy Hodgkin Building, Keele University, Staffordshire, ST5 5BG, UK
| | - Hannah Dasch
- Centre for Implementation Science, NIHR ARC South London, King's College London, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London SE5 8AF, UK
| | - Nick Sevdalis
- Centre for Implementation Science, NIHR ARC South London, King's College London, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London SE5 8AF, UK
| | - G James Rubin
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Weston Education Centre, King's College London, London SE5 9RJ, UK; NIHR Health Protection Research Unit in Emergency Preparedness and Response, Weston Education Centre, King's College London, London SE5 9RJ, UK
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Wettergreen SA, Plauche AK, Stewart MP. Harnessing the power of placebos and mitigating nocebo effects in clinical practice. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Sara A. Wettergreen
- Department of Clinical Pharmacy University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences Aurora Colorado USA
| | - Ardath K. Plauche
- Department of Pharmacy System Clinical Pharmacy Specialist in Infectious Diseases/Antimicrobial Stewardship, Memorial Hermann Health System Houston Texas USA
| | - Morgan P. Stewart
- Division of Pharmacy Practice The University of Texas at Austin College of Pharmacy Austin Texas USA
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Pardo-Cabello AJ, Manzano-Gamero V, Puche-Cañas E. Placebo: a brief updated review. Naunyn Schmiedebergs Arch Pharmacol 2022; 395:1343-1356. [PMID: 35943515 PMCID: PMC9361274 DOI: 10.1007/s00210-022-02280-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/03/2022] [Indexed: 11/04/2022]
Abstract
Our aims were to provide updated information on placebo/nocebo effect and the potential use of placebo in clinical practice. This article can only provide a rough overview on the placebo and nocebo effect and is intended to serve as a starting point for the reader to go deeper into the corresponding literature. The placebo effect has been observed in multiple medical conditions, after oral administration, with manual therapies as well as with surgery and invasive procedures. The use of placebo in clinical trials is fundamental, although the ethics of its use is under discussion. The placebo may behave like a drug from the pharmacokinetic and pharmacodynamic point of view and can also be associated with adverse events (nocebo effect). Placebo can modify treatment by increasing or decreasing the effects of drugs. The factors associated with the occurrence of placebo effect are multiple, but in addition to those that depend on the placebo itself, the doctor-patient relationship would be the most important. As a result of findings that were published in the last two decades, the psycho-neurobiological basis of placebo is becoming better understood, although further studies are needed. In conclusion, the placebo effect in the clinic exhibits weak to moderate intensity. Placebo, in addition to its use in the clinical trial, should be considered another therapeutic remedy either as stand alone or in association with treatment, and could be useful in certain circumstances. The use of placebo should be regulated by the European health authorities through a guide in clinical practice that will improve patient care.
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Affiliation(s)
- Alfredo Jose Pardo-Cabello
- Department of Internal Medicine, Hospital Universitario San Cecilio, Avda. de La Innovación, s/n, 18016, Granada, Spain.
| | - Victoria Manzano-Gamero
- Department of Internal Medicine, Hospital Universitario Virgen de Las Nieves, Granada, Spain
| | - Emilio Puche-Cañas
- Department of Pharmacology, School of Medicine, University of Granada, Granada, Spain
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Lecci L, Page GR, Keith JR, Neal S, Ritter A. The Effects of Health Anxiety and Litigation Potential on Symptom Endorsement, Cognitive Performance, and Physiological Functioning in the Context of a Food and Drug Administration Drug Recall Announcement. Front Psychol 2022; 13:818724. [PMID: 35769761 PMCID: PMC9236552 DOI: 10.3389/fpsyg.2022.818724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Drug recalls and lawsuits against pharmaceutical manufacturers are accompanied by announcements emphasizing harmful drug side-effects. Those with elevated health anxiety may be more reactive to such announcements. We evaluated whether health anxiety and financial incentives affect subjective symptom endorsement, and objective outcomes of cognitive and physiological functioning during a mock drug recall. Hundred and sixty-one participants reported use of over-the-counter pain medications and presented with a fictitious medication recall via a mock Food and Drug Administration (FDA) website. The opportunity to join a class-action lawsuit was manipulated. We assessed health anxiety, recalled drug usage, blood pressure, heart rate, and performance on a computerized Trail Making Test (TMT). Symptom endorsement was strongly predicted by health anxiety. When combined, three health anxiety measures explained 28.5% variance (Cohen’s d = 1.26). These effects remain strong after controlling for depression and anxiety. Litigation condition did not predict symptom endorsement. Blood pressure and heart rate were modestly predicted by health anxiety, but not by litigation condition. TMT performance was consistently predicted by health anxiety, with higher scores associated with poorer performance. Although there were no main effects for litigation, interactions consistently emerged for the TMT, with generally poorer performance for those with higher health anxiety in the non-litigation condition; whereas health anxiety was unrelated to performance for the litigation condition. All but one participant joined the litigation when given the opportunity, despite a healthy sample and minimal use of pain medication. Subsequent data from 67 individuals with no mention of the FDA scenario or litigation showed that health anxiety still significantly predicts symptom endorsement (12.6% variance), but the explained variance is less than half that obtained in the FDA scenario. The findings suggest that health anxiety plays a significant role in adverse symptom reporting, beyond anxiety or depression, and this effect is independent of the presence of the FDA recall. The lack of differences for health anxiety and symptom endorsement between litigation and non-litigation conditions rules out malingering. Although it is general practice in drug recalls to list potential adverse side effects caused by medications, this may elicit unintended symptom experiences and health anxious individuals may be more susceptible.
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11
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The Effect of Science-Related Populism on Vaccination Attitudes and Decisions. J Behav Med 2022; 46:229-238. [PMID: 35687208 PMCID: PMC9185722 DOI: 10.1007/s10865-022-00333-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 05/17/2022] [Indexed: 10/25/2022]
Abstract
As the COVID-19 pandemic has sadly shown, the decision against vaccination is often linked to political ideologies and populist messages among specific segments of the population: People do not only have concerns about a potential health risk associated with vaccination but seem to have also adopted more populist attitudes towards science. In this study, the relationship between science-related populism and individuals' attitudes towards vaccination was examined, presuming that scientific-related populism also influences individual responses towards different vaccinations. As different types of diseases and their vaccines might be perceived rather distinctively by the public, different vaccinations were considered. The survey is based on responses from 870 people from Germany and Austria. Results indicate that science-related populism influences responses towards some vaccination types, especially for those that receive extensive media coverage such as COVID-19 and measles (MMR). There was no significant impact of science-related populism on individuals' vaccination intentions for other vaccines like seasonal influenza, human papillomavirus, or tick-borne encephalitis. In conclusion, limitations and directions for future research are addressed.
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12
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Mitsikostas DD, Aravantinou-Fatorou K, Deligianni C, Kravvariti E, Korompoki E, Mylona M, Vryttia P, Papagiannopoulou G, Delicha EM, Dellis A, Tsivgoulis G, Dimopoulos MA, Amanzio M, Sfikakis PP. Nocebo-Prone Behavior Associated with SARS-CoV-2 Vaccine Hesitancy in Healthcare Workers. Vaccines (Basel) 2021; 9:vaccines9101179. [PMID: 34696287 PMCID: PMC8541064 DOI: 10.3390/vaccines9101179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/11/2021] [Accepted: 10/11/2021] [Indexed: 12/13/2022] Open
Abstract
Among healthcare workers (HCWs), SARS-CoV-2 vaccine hesitancy may be linked to a higher susceptibility to nocebo effects, i.e., adverse events (AEs) experienced after medical treatments due to negative expectations. To investigate this hypothesis a cross-sectional survey was performed with a self-completed questionnaire that included a tool (Q-No) for the identification of nocebo-prone individuals. A total of 1309 HCWs (67.2% women; 43.4% physicians; 28.4% nurses; 11.5% administrative staff; 16.6% other personnel) completed the questionnaires, among whom 237 (18.1%) had declined vaccination. Q-No scores were ≥15 in 325 participants (24.8%) suggesting nocebo-prone behavior. In a multivariate logistic regression model with Q-No score, age, gender, and occupation as independent variables, estimated odds ratios (ORs) of vaccination were 0.43 (i.e., less likely, p < 0.001) in participants with Q-No score ≥ 15 vs. Q-No score < 15, 0.58 in females vs. males (p = 0.013), and 4.7 (i.e., more likely) in physicians vs. other HCWs (p < 0.001), independent of age, which was not significantly associated with OR of vaccination. At least one adverse effect (AE) was reported by 67.5% of vaccinees, mostly local pain and flu-like symptoms. In a multivariate logistic regression model, with Q-No score, age, gender, and occupation as independent variables, estimated ORs of AE reporting were 2.0 in females vs. males (p < 0.001) and 1.47 in physicians vs. other HCWs (p = 0.017) independently of age and Q-No score, which were not significantly associated with OR of AE. These findings suggest that nocebo-prone behavior in HCWs is associated with SARS-CoV-2 vaccination hesitancy indicating a potential benefit of a campaign focused on nocebo-prone people.
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Affiliation(s)
- Dimos D. Mitsikostas
- 1st Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece;
- Correspondence: ; Tel./Fax: +30-2107289282
| | - Konstantina Aravantinou-Fatorou
- 1st Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Christina Deligianni
- Danish Headache Center, Rigshospitalet Glostrup, University of Copenhagen, 2600 Copenhagen, Denmark;
| | - Evrydiki Kravvariti
- 1st Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.K.); (M.M.); (P.P.S.)
| | - Eleni Korompoki
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.K.); (P.V.); (M.A.D.)
| | - Maria Mylona
- 1st Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.K.); (M.M.); (P.P.S.)
| | - Pinelopi Vryttia
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.K.); (P.V.); (M.A.D.)
| | - Georgia Papagiannopoulou
- 2nd Neurology Department, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (G.P.); (G.T.)
| | | | - Athanasios Dellis
- 2nd Surgery Department, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Georgios Tsivgoulis
- 2nd Neurology Department, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (G.P.); (G.T.)
| | - Meletios A. Dimopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.K.); (P.V.); (M.A.D.)
| | - Martina Amanzio
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy;
| | - Petros P. Sfikakis
- 1st Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.K.); (M.M.); (P.P.S.)
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13
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Chronic primary pain in the COVID-19 pandemic: how uncertainty and stress impact on functioning and suffering. Pain 2021; 163:604-609. [PMID: 34382606 DOI: 10.1097/j.pain.0000000000002428] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 07/02/2021] [Indexed: 11/27/2022]
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14
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Leibowitz KA, Howe LC, Crum AJ. Changing mindsets about side effects. BMJ Open 2021; 11:e040134. [PMID: 33526496 PMCID: PMC7849892 DOI: 10.1136/bmjopen-2020-040134] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 11/03/2020] [Accepted: 11/24/2020] [Indexed: 01/05/2023] Open
Abstract
Given research showing that the very act of communicating side effects can increase their likelihood, how can providers inform patients about side effects while upholding their oath to do no unnecessary harm? An emerging approach provides a potential solution: truthfully describe certain minor side effects as a sign the treatment is active and working in the body. This approach focuses on instilling adaptive mindsets about the meaning of side effects while still keeping patients informed. This article describes existing research suggesting that this approach can be helpful in improving experience and outcomes in treatments for pain, hypertension and allergy. Compared with control groups given a standard, empathetic message about side effects, patients who were informed that side effects are a sign treatment is working were less anxious about side effects and rated them as less threatening and intense. A longitudinal, randomised controlled trial of this approach in patients receiving oral immunotherapy for food allergies found that describing side effects as a sign treatment was working reduced the rate at which patients contacted providers with concerns about side effects and led to greater increases in a biomarker of allergic tolerance from pretreatment to post-treatment (peanut-specific blood IgG4). In unveiling this approach, this article also raises important issues regarding which treatments and symptoms this approach should be applied to. Finally, we outline questions future research should address to further understand and leverage this approach.
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Affiliation(s)
- Kari A Leibowitz
- Department of Psychology, Stanford University, Stanford, California, USA
| | - Lauren C Howe
- Department of Business Administration, University of Zurich, Zurich, Switzerland
| | - Alia J Crum
- Department of Psychology, Stanford University, Stanford, California, USA
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15
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Characterizing News Report of the Substandard Vaccine Case of Changchun Changsheng in China: A Text Mining Approach. Vaccines (Basel) 2020; 8:vaccines8040691. [PMID: 33212869 PMCID: PMC7711875 DOI: 10.3390/vaccines8040691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/14/2020] [Accepted: 11/15/2020] [Indexed: 01/19/2023] Open
Abstract
Background: The substandard vaccine case of that broke out in July 2018 in China triggered an outburst of news reports both domestically and aboard. Distilling the abundant textual information is helpful for a better understanding of the character during this public event. Methods: We collected the texts of 2211 news reports from 83 mainstream media outlets in China between 15 July and 25 August 2018, and used a structural topic model (STM) to identify the major topics and features that emerged. We also used dictionary-based sentiment analysis to uncover the sentiments expressed by the topics as well as their temporal variations. Results: The main topics of the news report fell into six major categories, including: (1) Media Investigation, (2) Response from the Top Authority, (3) Government Action, (4) Knowledge Dissemination, (5) Finance Related and (6) Commentary. The topic prevalence shifted during different stages of the events, illustrating the actions by the government. Sentiments generally spanned from negative to positive, but varied according to different topics. Conclusion: The characteristics of news reports on vaccines are shaped by various topics at different stages. The inner dynamics of the topic and its alterations are driven by the interaction between social sentiment and governmental intervention.
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16
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Affiliation(s)
- Kate Faasse
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
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17
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D'Amico F, Solitano V, Peyrin-Biroulet L, Danese S. Nocebo effect and biosimilars in inflammatory bowel diseases: what's new and what's next? Expert Opin Biol Ther 2020; 21:47-55. [PMID: 32857634 DOI: 10.1080/14712598.2020.1817374] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The use of biosimilars for the treatment of patients with chronic inflammatory bowel diseases (IBD) showed to be a valid strategy to reduce the economic burden of biologics on health-care costs and to increase patient access to treatment. However, the nocebo effect constitutes an important limitation to the wide use of biosimilars. AREAS COVERED We conducted a literature overview to summarize information on nocebo effect in IBD population and to provide physicians with practical key strategies to prevent the nocebo effect in daily clinical practice and to improve patients' outcomes. EXPERT OPINION Despite the proven efficacy and safety of biosimilars, further clinical studies are needed to define the effects of reverse and multiple switches in the management of patients with IBD. The development of new subcutaneous formulations, better accepted by patients, could contribute to reduce patients' negative expectations, and limit the nocebo effect.
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Affiliation(s)
- Ferdinando D'Amico
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele , Milan, Italy.,Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy , France
| | - Virginia Solitano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele , Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy , France
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele , Milan, Italy.,Department of Gastroenterology, IBD Center, Humanitas Clinical and Research Center - IRCCS, Rozzano , Milan, Italy
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18
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Smith LE, Webster RK, Rubin GJ. A systematic review of factors associated with side-effect expectations from medical interventions. Health Expect 2020; 23:731-758. [PMID: 32282119 PMCID: PMC7495066 DOI: 10.1111/hex.13059] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Fear of side-effects can result in non-adherence to medical interventions, such as medication and chemotherapy. Side-effect expectations have been identified as strong predictors of later perception of side-effects. However, research investigating predictors of side-effect expectations is disparate. OBJECTIVE To identify factors associated with side-effect expectations. SEARCH STRATEGY We systematically searched Embase, Ovid MEDLINE, Global Health, PsycARTICLES, PsycINFO, Web of Science and Scopus. INCLUSION CRITERIA Studies were included if they investigated associations between any predictive factor and expectations of side-effects from any medical intervention. DATA EXTRACTION AND SYNTHESIS We extracted information about participant characteristics, medication, rates of side-effects expected and predictors of side-effect expectations. Data were narratively synthesized. MAIN RESULTS We identified sixty-four citations, reporting on seventy-two studies. Predictors fell into five categories: personal characteristics, clinical characteristics, psychological traits and state, presentation format of information, and information sources used. Using verbal risk descriptors (eg 'common') compared to numerical descriptors (eg percentages), having lower quality of life or well-being, and currently experiencing symptoms were associated with increased side-effect expectations. DISCUSSION AND CONCLUSIONS Decreasing unrealistic side-effect expectations may lead to decreased experience of side-effects and increased adherence to medical interventions. Widespread communications about medical interventions should describe the incidence of side-effects numerically. Evidence suggests that clinicians should take particular care with patients with lower quality of life, who are currently experiencing symptoms and who have previously experienced symptoms from treatment. Further research should investigate different clinical populations and aim to quantify the impact of the media and social media on side-effect expectations.
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Affiliation(s)
- Louise E Smith
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - G James Rubin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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19
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Ashwell D, Murray N. When being positive might be negative: An analysis of Australian and New Zealand newspaper framing of vaccination post Australia's No Jab No Pay legislation. Vaccine 2020; 38:5627-5633. [PMID: 32653274 PMCID: PMC7343654 DOI: 10.1016/j.vaccine.2020.06.070] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 12/13/2022]
Abstract
Positive frames of stories or statements are viewed by readers as persuasion. People socially expect credible news media stories to be negatively framed. Vaccine stories framed negatively may be deemed as more credible by readers. Positively framed vaccination stories could be viewed as advertising or coercion.
Vaccination rates are an ongoing global concern. Many developing and developed countries have rates of vaccination below rates required for herd immunity, for differing reasons. One way in which to communicate information about vaccination to the wider public is via the use of the news media. Communication agenda-setting and framing theory generally hold that the news media sets the issues of importance to society and also tells us how we should think about those issues. Emphasis framing theory however, would suggest that positively-framed statements in the media may actually be viewed as persuasive in a coercing way, leading to resistance to the messages. Further, this theory claims that negative news media is viewed as more credible and therefore, more easily accepted. We were interested to explore the framing of news reports about vaccination and the potential effects this framing may have had on the wider public over the years 2016–2017 in both Australia and New Zealand (when changes in vaccination policy and publicity respectively were on the agenda). We undertook a content analysis of 197 articles and emphasis frame, type of message, and other variables recorded. In both Australia and New Zealand, the news media messages were predominately positively framed and yet the vaccination rates of New Zealand particularly (where no policy changes mandating vaccination took place) have been decreasing. We suggest the media emphasis on positive vaccination reporting may be having the opposite effect of engendering resistance to vaccination within those who are vaccine-hesitant.
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Affiliation(s)
- Douglas Ashwell
- School of Communication, Journalism and Marketing, Massey University, Private Bag 11-222, Palmerston North, New Zealand
| | - Niki Murray
- School of Communication, Journalism and Marketing, Massey University, Private Bag 11-222, Palmerston North, New Zealand
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20
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Hansen PR, Schmidtblaicher M, Brewer NT. Resilience of HPV vaccine uptake in Denmark: Decline and recovery. Vaccine 2020; 38:1842-1848. [PMID: 31918860 DOI: 10.1016/j.vaccine.2019.12.019] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 12/05/2019] [Accepted: 12/09/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Immunization programs' resilience to shocks is central to their success, but little empirical evidence documents resilience in action. We sought to characterize the decline of HPV vaccination in Denmark after negative media coverage and recovery during a national information campaign. METHODS We conducted a population-based retrospective cohort study of all girls born in Denmark from 1997 to 2006 (N = 328,779), aged 12-15. The outcome measure was HPV vaccine uptake (first dose), as reported to the Danish national health registry from 2009 to 2019, when HPV vaccine was freely available to girls in primary care clinics in Denmark. Events that created 4 natural time periods for study were HPV vaccine reaching the uptake of other vaccines in the national program (2009), some negative media coverage of HPV vaccination (2013), extensive negative media coverage (2015), and a national information campaign about the vaccine's safety and effectiveness (2017-2019). RESULTS In the period with some negative media coverage, HPV vaccine uptake fell to 83.6% (95% CI:78.0%-89.7%) of baseline uptake. In the period with extensive negative media coverage, uptake fell even further to 49.6% (95% CI:44.5%-55.2%) of baseline uptake. After the information campaign, HPV vaccine uptake recovered to its baseline level (109.2%, 95% CI:90.1%-132.4%) due in part to catch-up doses. Despite the recovery, an estimated 26,000 fewer girls initiated the vaccine than if uptake had not declined. CONCLUSIONS The experience in Denmark offers one of the first opportunities to document how a nation grappled with negative media coverage of HPV vaccination and the steadying impact of action by national authorities.
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Affiliation(s)
- Peter R Hansen
- Department of Economics, University of North Carolina at Chapel Hill, United States; Department of Finance, Copenhagen Business School, Denmark.
| | - Matthias Schmidtblaicher
- Department of Economics, European University Institute, Florence, Italy; QuantCo, Inc, United States
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, United States
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21
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Abstract
The avalanche of online information on immunization is having a major impact on the percentage of the population who choose to get vaccinated. Vaccine misinformation spreads widely with the interactive Web 2.0 and social media; this can bury science-based information. A plethora of immunization misinformation online is affecting trust in health care professionals and in public immunization programs. There are no simple solutions to this, but seven evidence-based strategies can help. First, listen to patients' and parents' concerns, and demonstrate responsiveness by adopting best immunization practices, such as pain mitigation. Second, recognize and alert others to anti-immunization tactics, namely, conspiracy theories, fake experts, selectivity, demands that vaccines be 100% safe and effective, misrepresentation and false logic. Third, avoid unproductive debates with those who have strongly held views, both in person and when using social media. Be respectful, stick to your key message, identify where to find useful information and exit. Fourth, consider establishing an attractive, easily searchable online presence that reflects the complex art of persuasion. Emphasize the benefits of vaccine, use reader-friendly graphics and highlight facts with stories to strengthen your case. Fifth, work with social media platform providers, not to stifle freedom of expression, but to help ensure that misinformation is not favoured in searches. Sixth, promote curriculum development in the schools to improve students' understanding of the benefits and safety of immunization and to foster critical thinking skills. To do this, optimize the use of age-appropriate comics and interactive learning tools such as electronic games. Seventh, to shift the narrative in specific communities with low vaccination rates, work with community leaders to build tailored programs that foster trust and reflect local values.
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22
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Abstract
The role of psychological mechanisms in the treatment process cannot be underestimated, the well-known placebo effect unquestionably being a factor in treatment. However, there is also a dark side to the impact of mental processes on health/illness as exemplified by the nocebo effect. This phenomenon includes the emergence or exacerbation of negative symptoms associated with the therapy, but arising as a result of the patient's expectations, rather than being an actual complication of treatment. The exact biological mechanisms of this process are not known, but cholecystokinergic and dopaminergic systems, changes in the HPA axis, and the endogenous secretion of opioids are thought to be involved. The nocebo effect can affect a significant proportion of people undergoing treatment, including cancer patients, leading in some cases to the cessation of potentially effective therapy, because of adverse effects that are not actually part of the biological effect of treatment. In extreme cases, as a result of suggestions and expectations, a paradoxical effect, biologically opposite to the mechanism of the action of the drug, may occur. In addition, the nocebo effect may significantly interfere with the results of clinical trials, being the cause of a significant proportion of complications reported. Knowledge of the phenomenon is thus necessary in order to facilitate its minimalization and thus improve the quality of life of patients and the effectiveness of treatment.
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23
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Pouillon L, Danese S, Hart A, Fiorino G, Argollo M, Selmi C, Carlo-Stella C, Loeuille D, Costanzo A, Lopez A, Vegni E, Radice S, Gilardi D, Socha M, Fazio M, González-Lorenzo M, Bonovas S, Magro F, Peyrin-Biroulet L. Consensus report: clinical recommendations for the prevention and management of the nocebo effect in biosimilar-treated IBD patients. Aliment Pharmacol Ther 2019; 49:1181-1187. [PMID: 30932219 DOI: 10.1111/apt.15223] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 12/30/2018] [Accepted: 02/18/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The nocebo effect is a negative effect of a pharmacological or nonpharmacological medical treatment that is induced by patients' expectations, and that is unrelated to the physiological action of the treatment. The nocebo effect can negatively affect treatment outcomes. AIM To develop evidence-based consensus recommendations for the prevention and management of the nocebo effect in biosimilar-treated patients with IBD. METHODS The "NOCE-BIO Consensus Group" was composed of 19 members from five European countries, and with different fields of expertise. A literature review on the nocebo effect, with specific focus on information about its prevention and management in biosimilar-treated IBD patients, was performed. Preliminary statements were formulated and voted on during a consensus group meeting held in Milan, Italy, in July 2018. A statement was accepted if >75% of participants voted 4 ("agree") or 5 ("strongly agree") on a scale of 1-5. RESULTS Consensus was reached on 11 recommendation statements. Seven statements reached consensus after one voting round and four statements reached consensus after two voting rounds. All statements were supported by very low-quality level of evidence. The panel agreed that patient-health-care provider relationship is a key driver of acceptance of biosimilars, which limits the risk of negative bias and the nocebo effect. Lack of knowledge among patients and health-care providers about the effectiveness and safety of biosimilars should be minimized. Education about biosimilars needs to be tailored to the individual patient, and positive framing is recommended. CONCLUSIONS The nocebo effect is under-recognised in the era of biosimilars, although it may negatively impact on the cost-savings of biosimilars. Future research should focus on the magnitude, the risk factors, the impact, and the management of the nocebo effect in biosimilars-treated IBD patients.
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Affiliation(s)
- Lieven Pouillon
- Nancy University Hospital, Vandœuvre-lès-Nancy, France.,Imelda GI Clinical Research Centre, Bonheiden, Belgium
| | - Silvio Danese
- Humanitas Clinical and Research Institute, Milan, Italy
| | - Ailsa Hart
- St Mark's Hospital, Middlesex, London, UK
| | | | - Marjorie Argollo
- Humanitas Clinical and Research Institute, Milan, Italy.,Universidade Federal de São Paulo, São Paulo, Brazil
| | - Carlo Selmi
- Humanitas Clinical and Research Institute, Milan, Italy
| | | | | | | | - Anthony Lopez
- Nancy University Hospital, Vandœuvre-lès-Nancy, France
| | - Elena Vegni
- Humanitas Clinical and Research Institute, Milan, Italy
| | - Simona Radice
- Humanitas Clinical and Research Institute, Milan, Italy
| | | | - Marie Socha
- Nancy University Hospital, Vandœuvre-lès-Nancy, France
| | - Maria Fazio
- Humanitas Clinical and Research Institute, Milan, Italy
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24
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Eun TJ, Hanchate A, Fenton AT, Clark JA, Aurora MN, Drainoni ML, Perkins RB. Relative contributions of parental intention and provider recommendation style to HPV and meningococcal vaccine receipt. Hum Vaccin Immunother 2019; 15:2460-2465. [PMID: 30862301 DOI: 10.1080/21645515.2019.1591138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
We described the relative contributions of parental intention and provider recommendation style to HPV and meningococcal vaccine receipt. Parent-child dyads that were eligible for both meningococcal and HPV vaccines participated in pre-visit surveys and consented to audio recording of their clinical interactions with healthcare providers related to vaccination. Surveys were analyzed for parent and child demographics and parental intention to vaccinate children with HPV and/or meningococcal vaccines. Audio recordings were analyzed for provider recommendation style, defined as indicated (provider stated vaccine was due at that visit) or not, and for child receipt of vaccines. Linear and logistic regression models were used to determine the relative contributions of parental intention and provider recommendation style to vaccine receipt. 56 parents/child dyads participated. 79% of children received HPV vaccines, and 93% received meningococcal vaccines. After controlling for demographic variables, parental intention did not differ by vaccine type. However, providers were less likely to use an indicated recommendation for HPV than for meningococcal vaccine. After controlling for demographic factors, parental intention, and provider recommendation style, vaccine type (HPV or meningococcal) was no longer associated with vaccine receipt Differences that were previously attributed to vaccine-specific factors may be explained by parents' and providers' roles in vaccine receipt. These findings suggest that interventions and policy recommendations regarding adolescent vaccination should focus on increasing parental demand for vaccines and ensuring that providers present all vaccines as the medical standard of care.
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Affiliation(s)
- Terresa J Eun
- Department of Sociology, Stanford University , Palo Alto, CA , California , USA
| | - Amresh Hanchate
- Department of General Internal Medicine, Boston University School of Medicine , Boston, MA , USA
| | - Anny T Fenton
- Department ofSociology, Harvard University , Cambridge, MA , USA.,Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute , Scarborough, ME , USA
| | - Jack A Clark
- Department of General Internal Medicine, Boston University School of Medicine , Boston, MA , USA
| | - Marisa N Aurora
- Department of General Internal Medicine, Boston University School of Medicine , Boston, MA , USA.,Department of Health Policy and Management, Boston University School of Public Health , Boston, MA , USA
| | - Mari-Lynn Drainoni
- Department of General Internal Medicine, Boston University School of Medicine , Boston, MA , USA.,Department of Health Policy and Management, Boston University School of Public Health , Boston, MA , USA.,Center for Healthcare Organization and Implementation Research, ENRM VA Hospital , Bedford , MA , USA
| | - Rebecca B Perkins
- Department of General Internal Medicine, Boston University School of Medicine , Boston, MA , USA.,Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center , Boston, MA , USA
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25
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Bednarczyk RA. Addressing HPV vaccine myths: practical information for healthcare providers. Hum Vaccin Immunother 2019; 15:1628-1638. [PMID: 30676241 DOI: 10.1080/21645515.2019.1565267] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Human papillomavirus (HPV) vaccine uptake consistently lags behind that of other adolescent vaccines. In 2017, uptake of a single HPV vaccine dose and HPV vaccine series completion was 66% and 49%, respectively, compared to uptake of tetanus, diphtheria, and acellular pertussis vaccine (89%) and quadrivalent meningococcal conjugate vaccine (85%). Reasons for not vaccinating adolescents again HPV are varied, and in many cases, are rooted in commonly spread myths and misperceptions about the vaccine. In this review, we address five key myths - HPV vaccination is not effective at preventing cancer; Pap smears are sufficient to prevent cervical cancer; HPV vaccination is not safe; HPV vaccination is not needed since most infections are naturally cleared by the immune system; 11-12 years of age is too young to vaccinate. For each myth, we summarize the scientific evidence refuting the myth and provide speaking prompts for healthcare professionals to communicate about HPV vaccination.
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Affiliation(s)
- Robert A Bednarczyk
- a Hubert Department of Global Health, Rollins School of Public Health, Emory University , Atlanta GA , USA.,b Department of Epidemiology, Rollins School of Public Health, Emory University , Atlanta GA , USA.,c Cancer Prevention and Control Program, Winship Cancer Institute, Emory University , Atlanta GA , USA.,d Emory Vaccine Center, Emory University , Atlanta GA , USA
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26
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Hansen E, Zech N. Nocebo Effects and Negative Suggestions in Daily Clinical Practice - Forms, Impact and Approaches to Avoid Them. Front Pharmacol 2019; 10:77. [PMID: 30814949 PMCID: PMC6381056 DOI: 10.3389/fphar.2019.00077] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/21/2019] [Indexed: 12/25/2022] Open
Abstract
Medical situations are hot spots in the life of a patient with potentially long lasting effects arising from the use of either negative expressions or encouraging statements, or the lack of empathy or a positive physician-patient relationship. Health care personnel should be aware of and evaluate what patients are exposed to, hear and see. Knowing more about the effects of nocebos and negative suggestions, combined with increased attention to these matters, provides the basis for better recognition of detrimental influences in their own clinical environment and to be able to avoid, stop or neutralize them. After anamnesis patients should not be left with a focus on a negative past, but shifted to positive experiences prior to their illness, or to positive expectations in the future following surgery and rehabilitation. For example, after examining an injured leg the doctor should not turn to the computer for documentation unless he has shifted the patient's focus on the other, unimpaired leg. "Is that painful too? No? Good! Can you feel that? Yes? Perfect! Can you bend that knee, move these toes? Great! That's good." This example draws attention to the fact that negative effects (discussed in the following) substantially are dependent on the focus of the patient and thus can be affected by focus shift and distraction. Patients, their symptoms and their healing are negatively affected by the omission of placebo effects, by nocebo effects and by negative suggestions.
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Affiliation(s)
- Ernil Hansen
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
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27
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Viard D, Parassol-Girard N, Romani S, Van Obberghen E, Rocher F, Berriri S, Drici MD. Spontaneous adverse event notifications by patients subsequent to the marketing of a new formulation of Levothyrox ® amidst a drug media crisis: atypical profile as compared with other drugs. Fundam Clin Pharmacol 2019; 33:463-470. [PMID: 30575110 DOI: 10.1111/fcp.12446] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/22/2018] [Accepted: 12/13/2018] [Indexed: 12/27/2022]
Abstract
Since patients may report spontaneously adverse events associated with their medications, such notifications are constantly on the rise. In 2017, an unexpected rise of notifications associated with the marketing of a new formula of Levothyrox, differing from the 30-year-old drug only by minor elements, occurred in France amidst widespread media coverage. Not much, if any, scientific or pharmacological rationale was identified to explain that signal. This led us to focus on the profile and the clinical characteristics of these notifications and compare them to those associated with other drugs. We gathered all the spontaneous drug adverse event notifications associated with either Levothyrox® or other drugs, that we received from patients in 2017, in the sanitary territory of ~2.3 M people we surveyed. Each notification was assessed by a multidisciplinary team. We compared the number of notifications, the number of symptoms described and their clinical characteristics. A total of 1 544 patient notifications were evaluated: 1 372 cases totaling 7 342 adverse events concerned Levothyrox® new formula, as compared with 172 cases reporting 528 adverse events for all other drugs. The number of symptoms reported per notification was significantly higher for Levothyrox® (5.4) than for other drugs (3.1, P < 0.001). Symptoms associated with Levothyrox® belonged to more System Organ Classes and were often unrelated to the disease or treatment, as compared with those associated with other drugs. The distribution of the cases according to the number of symptoms described was starkly different, the Levothyrox® distribution being unimodal. Health authorities must address this issue as such large atypical reporting disproportionally affects the European pharmacovigilance database.
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Affiliation(s)
- Delphine Viard
- Department of Pharmacology and Toxicology, PharmacoVigilance Center, University of Nice Medical Center, Hôpital Pasteur 1, Pavillon J4, 30, Voie Romaine, 06001, Nice, France
| | - Nadège Parassol-Girard
- Department of Pharmacology and Toxicology, PharmacoVigilance Center, University of Nice Medical Center, Hôpital Pasteur 1, Pavillon J4, 30, Voie Romaine, 06001, Nice, France
| | - Serena Romani
- Department of Pharmacology and Toxicology, PharmacoVigilance Center, University of Nice Medical Center, Hôpital Pasteur 1, Pavillon J4, 30, Voie Romaine, 06001, Nice, France
| | - Elise Van Obberghen
- Department of Pharmacology and Toxicology, PharmacoVigilance Center, University of Nice Medical Center, Hôpital Pasteur 1, Pavillon J4, 30, Voie Romaine, 06001, Nice, France
| | - Fanny Rocher
- Department of Pharmacology and Toxicology, PharmacoVigilance Center, University of Nice Medical Center, Hôpital Pasteur 1, Pavillon J4, 30, Voie Romaine, 06001, Nice, France
| | - Sofia Berriri
- Department of Pharmacology and Toxicology, PharmacoVigilance Center, University of Nice Medical Center, Hôpital Pasteur 1, Pavillon J4, 30, Voie Romaine, 06001, Nice, France
| | - Milou-Daniel Drici
- Department of Pharmacology and Toxicology, PharmacoVigilance Center, University of Nice Medical Center, Hôpital Pasteur 1, Pavillon J4, 30, Voie Romaine, 06001, Nice, France
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Suppli CH, Hansen ND, Rasmussen M, Valentiner-Branth P, Krause TG, Mølbak K. Decline in HPV-vaccination uptake in Denmark - the association between HPV-related media coverage and HPV-vaccination. BMC Public Health 2018; 18:1360. [PMID: 30526589 PMCID: PMC6288961 DOI: 10.1186/s12889-018-6268-x] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 11/27/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In 2014, Denmark experienced a rapid decline in vaccination uptake for the human papillomavirus (HPV) vaccine after a successful introduction of the vaccine in 2009. Before the decline, the uptake of the first HPV vaccine was around 90% for girls born in the period 1998 to 2000, while it dropped to 54% for girls born in 2003. The decline followed negative public attention from 2013 coinciding with increasing suspected adverse-event reporting to the Danish Medicines Agency. The aim of this study is to describe the HPV-vaccination uptake, to quantify relevant HPV-related media coverage, and analyse the relation between media coverage and HPV-vaccination acceptance in Denmark in year 2009-2016. METHODS Three types of data were used for the analysis: Immunisation data from 243,415 girls, media coverage (8524 news items) and Google search activity. We used changes in the correlation between media coverage and vaccination uptake to identify a changing point in their relationship. The relationship before and after the changing point was analysed determined on the interactions between vaccination uptake, media and search activity, with search activity as a proxy for public attention. RESULTS We identified July 2013 as a changing point in the relationship between media coverage and vaccination uptake. We found no significant relationship between media coverage and vaccination uptake in the first part of the time series (June 2009 to June 2013), whereas from July 2013 and onwards there was a negative Pearson's correlation of - 0.52. The changing point coincides with both an increase in Google searches for "HPV side effects" and media coverage with negative content. CONCLUSIONS Following a successful launch of the HPV-vaccination programme, concerns about vaccine safety shifted the public opinion and the coverage by the media. The noticeable shift in correlation between vaccination uptake and media coverage before and after July 2013 could indicate that increased media coverage influenced the decline in vaccination uptake. Media monitoring may represent an important tool in future monitoring and assessment of confidence in vaccination programmes.
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Affiliation(s)
- Camilla Hiul Suppli
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark
| | - Niels Dalum Hansen
- Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark
| | - Mette Rasmussen
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 1353 Copenhagen, Denmark
| | - Palle Valentiner-Branth
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark
| | - Tyra Grove Krause
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark
| | - Kåre Mølbak
- Division of Infectious Disease Preparedness, Statens Serum Institut, 2300 Copenhagen, Artillerivej 5 Denmark
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Pouillon L, Socha M, Demore B, Thilly N, Abitbol V, Danese S, Peyrin-Biroulet L. The nocebo effect: a clinical challenge in the era of biosimilars. Expert Rev Clin Immunol 2018; 14:739-749. [PMID: 30118338 DOI: 10.1080/1744666x.2018.1512406] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The nocebo effect is defined as a negative effect of a pharmacological or non-pharmacological medical treatment that is induced by patients' expectations, and that is unrelated to the physiological action of the treatment. The nocebo effect is an important clinical challenge in the current era of biosimilars. Areas covered: This review aims to answer five key questions about the nocebo effect, namely to reveal its definition, pathophysiology, clinical relevance, contributing factors, and management. Expert commentary: The nocebo effect lowers patients' quality of life and negatively affects treatment adherence rates in biosimilar-treated patients. It may negatively impact on the cost-savings of biosimilars. Health-care providers in charge of biosimilar-treated patients need to be aware of the nocebo effect and adopt strategies to minimize it. They have to be well-informed and confident about the existing evidence about biosimilars. A good patient-physician relationship will improve patients' acceptance of biosimilars, and limits the risk of inappropriate negative bias and the nocebo effect.
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Affiliation(s)
- Lieven Pouillon
- a Department of Gastroenterology , Nancy University Hospital , Vandœuvre-lès-Nancy , France.,b Imelda GI Clinical Research Centre , Imeldaziekenhuis Bonheiden , Bonheiden , Belgium
| | - Marie Socha
- c Université de Lorraine, Labo CITHEFOR , Nancy , France.,d Pôle Pharmacie , Nancy University Hospital , Vandœuvre-lès-Nancy , France
| | - Beatrice Demore
- d Pôle Pharmacie , Nancy University Hospital , Vandœuvre-lès-Nancy , France.,e Université de Lorraine, Labo APEMAC , Nancy , France
| | - Nathalie Thilly
- e Université de Lorraine, Labo APEMAC , Nancy , France.,f Plateforme d'Aide à la Recherche Clinique , Nancy University Hospital , Vandœuvre-lès-Nancy , France
| | - Vered Abitbol
- g Department of Hepato-Gastroenterology , Cochin Hospital , Paris , France
| | - Silvio Danese
- h Department of Biomedical Sciences , Humanitas University , Rozzano, Milan , Italy
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