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Alwafi H, Naser AY, Alsaleh NA, Asiri JK, Almontashri RM, Alqarni LM, Salawati RS, Alsharif A, Aldhahir AM, Alqarni AA, Hafiz W, Alqahtani JS, Salawati E, Almatrafi MA, Bahlol M. Prevalence, factors associated and management of needle phobia among the general population in Saudi Arabia and Egypt. BMC Psychiatry 2024; 24:363. [PMID: 38745314 PMCID: PMC11094992 DOI: 10.1186/s12888-024-05757-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/11/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVE This study aims to assess the prevalence of needle phobia among Saudi and Egyptian adult populations. In addition, underlying causes and strategies that can be utilized to address needle fear were investigated. METHODS A cross-sectional online survey study was conducted in Saudi Arabia and Egypt between 1 May and 30 June 2023. Participants aged 18 years and above and living in Saudi Arabia and Egypt were eligible to complete the survey. Participants were invited to participate in this study through social media platforms (Facebook, X, Snapchat, and Instagram). A convenience sampling technique was used to recruit the study participants. A 21-item questionnaire consisting of four sections including a Likert scale score was used to answer the research objectives. Numeric data were presented as mean ± SD. For categorical variables, percentages were used. Comparison between groups were made by Student's t-test or Mann Whitney test according to data distribution. Chi squared tests for categorical values were conducted. A binary logistic regression analysis was conducted to investigate factors associated with needle phobia. RESULTS A total of 4065 participants were involved in this study (Saudi Arabia: 2628 and Egypt: 1437). Around one-third of the study participants (36.5%) confirmed that they have needle phobia. Most of the study participants (81.1%) reported that they have had needle phobia since they were under 18 years of age. Pain, general anxiety, and fear of making a mistake during the procedure were the most commonly reported contributors for fear of needles during or before a medical procedure. Around 15.8% of the study participants reported that they have tried to get rid of phobia from needles. Non-surgical alternatives (such as oral medications and patches) and using smaller/thinner needles were the most commonly reported interventions that reduced fear of needles. Binary logistic regression analysis identified that females, those who are aged (41-50 years), widowed, those with bachelor's degrees and higher education, and those unemployed were more likely to have needle phobia compared to others. CONCLUSION Our study highlighted the high prevalence of needle fear within an adult population in Egypt and Saudi Arabia. Females, those who are aged (41-50 years), those widowed, those with higher education degrees, those unemployed, those working in the health sector and people with low income were more likely to have needle phobia compared to others.
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Affiliation(s)
- Hassan Alwafi
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, 8WMR+23J Mecca, Al Abdeyah, Alawali, Mecca, Saudi Arabia.
| | - Abdallah Y Naser
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan.
| | - Nada A Alsaleh
- Department of Pharmacy Practice, Faculty of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | | | | | | | | | - Alaa Alsharif
- Department of Pharmacy Practice, Faculty of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Abdulelah M Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Abdullah A Alqarni
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Waleed Hafiz
- Department of Internal Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Jaber S Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Emad Salawati
- Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed A Almatrafi
- Department of Pediatrics, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Mohamed Bahlol
- Speciality of Pharmaceutical Management and Economics, Department of Pharmacy Practice and Clinical Pharmacy, Faculty of Pharmacy, Egyptian Russian University, Cairo, Egypt
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McDonald M, Gallaugher S, Kammerer E, Ali S. Creating a Low-Stimulus Clinic to improve immunization success rates for children with alternate environment needs: A quality improvement initiative. Paediatr Child Health 2024; 29:17-22. [PMID: 38332973 PMCID: PMC10848120 DOI: 10.1093/pch/pxad081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 11/16/2023] [Indexed: 02/10/2024] Open
Abstract
Patients with specific sensory needs may face barriers to receiving their immunizations. Therefore, a Low-Stimulus Clinic was created in Alberta. Modifications to regular clinic space included lower visual and auditory input, access to longer appointment times and private clinic spaces, development of pre-appointment comfort plans, and offering of in-vehicle immunization. Between April 2021 and May 2022, 90% (641/712) of booked patients were successfully immunized. The top reasons for accessing the clinic included autism spectrum disorder (229/712, 32%), and needle fear/phobia (195/712, 27%). The Low-Stimulus Clinic had a high rate of successful vaccination for populations that may otherwise have been less likely to receive immunizations. Its workflows support the principles of choice, collaboration, and control in creating a positive immunization experience for patients and their families. Having such clinics widely available is a key step in reducing barriers to accessing vaccines for individuals with specific sensory needs.
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Affiliation(s)
| | | | - Elise Kammerer
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
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Weeks M, Delgado AD, Wood J, Zhang B, Pesce S, Kunces L, Lili L, Putrino D. Relationships between body composition, anthropometrics, and standard lipid panels in a normative population. Front Cardiovasc Med 2023; 10:1280179. [PMID: 38124898 PMCID: PMC10731366 DOI: 10.3389/fcvm.2023.1280179] [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: 08/19/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction More than one third of adults in the United States (US) meet the clinical criteria for a diagnosis of metabolic syndrome, but often diagnosis is challenging due to healthcare access, costs and discomfort with the process and invasiveness associated with a standard medical examination. Less invasive and more accessible approaches to collecting biometric data may have utility in identifying individuals at risk of diagnoses, such as metabolic syndrome or dyslipidemia diagnoses. Body composition is one such source of biometric data that can be non-invasively acquired in a home or community setting that may provide insight into an individual's propensity for a metabolic syndrome diagnosis. Here we investigate possible associations between body composition, anthropometrics and lipid panels in a normative population. Methods Healthy participants visited the Lab100 clinic location at a hospital setting in New York City and engaged in a wellness visit led by a nurse practitioner. Blood was analyzed at point-of-care using the Abbott Piccolo Xpress portable diagnostic analyzer (Abbott Laboratories, IL, USA) and produced direct measures of total cholesterol (TC), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C), very-low density lipoprotein (VLDL-C), and triglycerides (TG). Body composition and anthropometric data were collected using two separate pieces of equipment during the same visit (Fit3D and InBody570). Regression analysis was performed to evaluate associations between all variables, after adjusting for age, sex, race, AUDIT-C total score (alcohol use), and current smoking status. Results Data from 199 participants were included in the analysis. After adjusting for variables, percentage body fat (%BF) and visceral fat levels were significantly associated with every laboratory lipid value, while waist-to-hip ratio also showed some significant associations. The strongest associations were detected between %BF and VLDL-C cholesterol levels (t = 4.53, p = 0.0001) and Triglyceride levels (t = 4.51, p = 0.0001). Discussion This initial, exploratory analysis shows early feasibility in using body composition and anthropometric data, that can easily be acquired in community settings, to identify people with dyslipidemia in a normative population.
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Affiliation(s)
- Marcus Weeks
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Andrew D. Delgado
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jamie Wood
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Bodi Zhang
- Thorne HealthTech Inc., New York, NY, United States
| | - Sarah Pesce
- Thorne HealthTech Inc., New York, NY, United States
| | - Laura Kunces
- Thorne HealthTech Inc., New York, NY, United States
| | - Loukia Lili
- Thorne HealthTech Inc., New York, NY, United States
| | - David Putrino
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Collier AF, Schaefer KR, Uddin A, Noonan C, Dillard DA, Son-Stone L, Manson SM, Buchwald D, MacLehose R. COVID-19 vaccination in urban American Indian and Alaska Native children: Parental characteristics, beliefs and attitudes associated with vaccine acceptance. Vaccine X 2023; 15:100406. [PMID: 38058791 PMCID: PMC10696120 DOI: 10.1016/j.jvacx.2023.100406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 11/07/2023] [Accepted: 11/12/2023] [Indexed: 12/08/2023] Open
Abstract
Background Little is known about vaccination rates for American Indian and Alaska Native (AI/AN) parents and their children, or parental decisions in this regard. Improving vaccination rates is a serious concern due to the disproportionate incidence and morbidity of COVID-19 in AI/AN people. Purpose Our goal was to describe urban AI/AN parental attributes associated with COVID-19 vaccination of their children. Methods Survey participants (n = 572) were ≥18 years of age, had children ≥5 years of age, AI/AN, and seen at one of six urban health organizations serving primarily AI/AN people within the prior year. They were asked about gender, age, education, marital status, perceived stress, trauma history, whether they had received the COVID-19 vaccine, tested positive for COVID-19 in the past, and if their child was vaccinated. They were also asked about 16 vaccine hesitancy reasons. Results Parental vaccination rate was 82%, with 59% of their children vaccinated. Parents who vaccinated their children were older, had higher education, lower stress and trauma, and were more likely to be vaccinated compared to parents who did not vaccinate their children. Forty-two percent of parents indicated they would likely vaccinate their unvaccinated child in the future. Sixteen vaccine hesitancy reasons revealed four factors: distrust, inconvenience, lack of concern about the pandemic, and AI/AN concerns. Parents who had no plans to vaccinate their children had the highest vaccine distrust and lack of concern about the pandemic. Parents with greater vaccine distrust and AI/AN specific concern reported significantly greater trauma history and higher levels of education. Conclusion Even though vaccination rates for AI/AN parents and children are high, the consequences of COVID-19 for AI/AN people are more severe than for other US populations. Providers should use trauma-informed, trust-building and culturally competent communication when discussing choices about vaccination with AI/AN parents.
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Affiliation(s)
| | | | - Azhar Uddin
- Institute for Research and Education to Advance Community Health, Elson S Floyd College of Medicine, Washington State University, United States
| | - Carolyn Noonan
- Institute for Research and Education to Advance Community Health, Elson S Floyd College of Medicine, Washington State University, United States
| | | | - Linda Son-Stone
- First Nations Community Healthsource, Albuquerque, NM, United States
| | - Spero M. Manson
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, United States
| | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health, Elson S Floyd College of Medicine, Washington State University, United States
| | - Richard MacLehose
- Department of Epidemiology and Community Health, University of Minnesota, School of Public Health, United States
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Kirtane AR, Tang C, Freitas D, Bernstock JD, Traverso G. Challenges and opportunities in the development of mucosal mRNA vaccines. Curr Opin Immunol 2023; 85:102388. [PMID: 37776698 DOI: 10.1016/j.coi.2023.102388] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 10/02/2023]
Abstract
mRNA vaccines have played a critical role in controlling the SARS-CoV-2 pandemic, and are being actively studied for use in other diseases. There is a growing interest in applying mRNA vaccines at mucosal surfaces as it enables access to a unique immune reservoir in a less-invasive manner. However, mucosal surfaces present several barriers to mRNA uptake, including degrading enzymes, mucus, and clearance mechanisms. In this mini-review, we discuss our understanding of the immune response to mucosal mRNA vaccines as it compares to systemic mRNA vaccines. We also highlight physical and chemical methods for enhancing mRNA uptake across mucosal tissues. Mucosal mRNA vaccination is a nascent field of research, which will greatly benefit from fundamental investigations into the mechanisms of immune activation and the development of technologies for improved delivery.
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Affiliation(s)
- Ameya R Kirtane
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA.
| | - Chaoyang Tang
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Dylan Freitas
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Joshua D Bernstock
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Giovanni Traverso
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.
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Healy P, Lu C, Silk JS, Lindhiem O, Harper R, Viswanathan A, Babichenko D. An Exposure-Based Video Game (Dr. Zoo) to Reduce Needle Phobia in Children Aged 3 to 6 Years: Development and Mixed Methods Pilot Study. JMIR Serious Games 2023; 11:e42025. [PMID: 37843885 PMCID: PMC10624234 DOI: 10.2196/42025] [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: 08/18/2022] [Revised: 04/13/2023] [Accepted: 07/30/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Needle phobia, which affects 19% of children aged 4 to 6 years, prevents many children from receiving necessary or preventive medical treatments. Digital interventions have been made to target needle phobia but currently rely on distraction rather than evidence-based exposure. OBJECTIVE We designed and evaluated a serious exposure-based mobile game called Dr. Zoo to reduce the fear of needles in children aged 3 to 6 years, where players administered shots to cartoon animals. METHODS We conducted a mixed methods study with 30 parents (mean age 35.87, SD 4.39 years) and their 36 children (mean age 4.44, SD 1.11 years) who played the game for 5 days leading to a scheduled appointment that included an injection (eg, influenza vaccination). After the study, parents completed exit surveys and participated in semistructured interviews to evaluate ease of use, acceptability, and preliminary effectiveness of the game and to provide insights on their experience with the game to inform future developments. Interview transcripts were analyzed by 3 independent coders following an open coding process and subsequently coded and discussed to reach consensus. RESULTS Parents rated their child's difficulty in completing the game as very low on average (scale 1-5; mean 1.76, SD 0.82) and were highly likely to recommend Dr. Zoo to other parents (scale 1-5; mean 4.41, SD 0.87), suggesting Dr. Zoo's strong ease of use and high acceptability. In the exit survey, parents rated their child's fear as significantly lower after participating in the study (scale 1-5; mean 3.09, SD 1.17) compared with that before participating (scale 1-5; mean 4.37, SD 0.81; z score=-4.638; P<.001). Furthermore, 74% (26/35) of the parents reported that the game had a positive impact on their child's fear or perception of needles (only 2 parents reported a negative impact). Qualitative analysis of the interview transcripts revealed potentially important features of the game in this positive impact, such as the game's interactive design, as observed in 69% (24/35) of our participants. CONCLUSIONS The results suggest that an evidence-based serious mobile game can be an easy-to-use, acceptable, and potentially effective intervention for changing young children's fear and perceptions of needles. Leveraging digital interventions may be a potential solution to needle anxiety as a public health concern.
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Affiliation(s)
- Pat Healy
- University of Pittsburgh, School of Computing and Information, Pittsburgh, PA, United States
| | - Celine Lu
- University of Washington, Department of Psychology, Seattle, WA, United States
| | - Jennifer S Silk
- University of Pittsburgh, Department of Psychology, Pittsburgh, PA, United States
| | - Oliver Lindhiem
- University of Pittsburgh, School of Medicine, Department of Psychiatry, Pittsburgh, PA, United States
| | - Reagan Harper
- University of Pittsburgh, School of Computing and Information, Pittsburgh, PA, United States
- Duquesne University, Gumberg Library, Pittsburgh, PA, United States
| | - Abhishek Viswanathan
- University of Pittsburgh, School of Computing and Information, Pittsburgh, PA, United States
| | - Dmitriy Babichenko
- University of Pittsburgh, School of Computing and Information, Pittsburgh, PA, United States
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Dotiwala F, Upadhyay AK. Next Generation Mucosal Vaccine Strategy for Respiratory Pathogens. Vaccines (Basel) 2023; 11:1585. [PMID: 37896988 PMCID: PMC10611113 DOI: 10.3390/vaccines11101585] [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: 09/22/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Inducing humoral and cytotoxic mucosal immunity at the sites of pathogen entry has the potential to prevent the infection from getting established. This is different from systemic vaccination, which protects against the development of systemic symptoms. The field of mucosal vaccination has seen fewer technological advances compared to nucleic acid and subunit vaccine advances for injectable vaccine platforms. The advent of the next-generation adenoviral vectors has given a boost to mucosal vaccine research. Basic research into the mechanisms regulating innate and adaptive mucosal immunity and the discovery of effective and safe mucosal vaccine adjuvants will continue to improve mucosal vaccine design. The results from clinical trials of inhaled COVID-19 vaccines demonstrate their ability to induce the proliferation of cytotoxic T cells and the production of secreted IgA and IgG antibodies locally, unlike intramuscular vaccinations. However, these mucosal vaccines induce systemic immune responses at par with systemic vaccinations. This review summarizes the function of the respiratory mucosa-associated lymphoid tissue and the advantages that the adenoviral vectors provide as inhaled vaccine platforms.
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Affiliation(s)
- Farokh Dotiwala
- Ocugen Inc., 11 Great Valley Parkway, Malvern, PA 19355, USA
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Bergh K, Jonas K, Duby Z, Govindasamy D, Mathews C, Reddy T, Slingers N, Whittle G, Abdullah F. Factors Associated with COVID-19 Vaccine Uptake among Schoolgoing Adolescent Girls and Young Women in South Africa. Vaccines (Basel) 2023; 11:1581. [PMID: 37896983 PMCID: PMC10610973 DOI: 10.3390/vaccines11101581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: By October 2022, vaccination rates with at least one dose of a COVID-19 vaccine were low among adolescent girls aged 12-17 (38%) and young women aged 18-34 (45%) in South Africa. This study aimed to measure and identify barriers to and facilitators of motivation to take up, access to, and uptake of COVID-19 vaccines among schoolgoing adolescent girls and young women in two districts in South Africa. (2) Methods: Using the theory of the HIV prevention cascade, we conceptualised the relationship between motivation, access, and uptake of COVID-19 vaccines, and associated barriers. Potential barriers and facilitators were identified using bivariate and multivariable Poisson regression. (3) Results: Among all 2375 participants, access was high (69%), but motivation (49%) and vaccination with at least one COVID-19 vaccine (45%) were lower. Fear of injections was a barrier to vaccine uptake (aRR 0.85 95% CI 0.82-0.88), while being tested for COVID-19 (aRR 2.10 95% CI 1.85-2.38) and believing that the COVID-19 vaccine was safe (aRR 1.31 95% CI 1.18-1.44) and would prevent you from getting very sick (aRR 1.11 95% CI 1.04-1.19) were facilitators. (4) Conclusions: The controversy about the value of vaccinating adolescents and the delay in vaccine rollout for adolescents and young adults may have contributed to fears about the safety and efficacy of COVID-19 vaccines, as well as a lack of motivation to get vaccinated.
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Affiliation(s)
- Kate Bergh
- Health Systems Research Unit, South African Medical Research Council, Cape Town 7501, South Africa
- Department of Psychology, University of Cape Town, Cape Town 7700, South Africa
| | - Kim Jonas
- Health Systems Research Unit, South African Medical Research Council, Cape Town 7501, South Africa
| | - Zoe Duby
- Health Systems Research Unit, South African Medical Research Council, Cape Town 7501, South Africa
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Darshini Govindasamy
- Health Systems Research Unit, South African Medical Research Council, Cape Town 7501, South Africa
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town 7501, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban 4091, South Africa
| | - Nevilene Slingers
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria 0001, South Africa
| | - Granville Whittle
- Department of Basic Education, Government of South Africa, Pretoria 0001, South Africa
| | - Fareed Abdullah
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria 0001, South Africa
- Division of Infectious Diseases, Department of Internal Medicine, Steve Biko Academic Hospital and University of Pretoria, Pretoria 0002, South Africa
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Lu X, Masuda S, Horlad H, Katoh T. Safety and adverse effects of the coronavirus disease 2019 vaccine among the general Japanese adult population. Vaccine 2023; 41:5090-5096. [PMID: 37455163 PMCID: PMC10130329 DOI: 10.1016/j.vaccine.2023.04.053] [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: 11/11/2022] [Revised: 04/20/2023] [Accepted: 04/20/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES We aimed to identify and explore the association between the characteristics of coronavirus disease 2019 (COVID-19) vaccine recipients and the types of vaccine-related adverse effects in the general Japanese adult population. METHODS An anonymous self-report questionnaire was distributed to 4393 students and 1657 white and blue-collar workers (N = 6050). Data on vaccine-related adverse effects were collected twice, once after each vaccination. The data collection was performed daily from the day of injection (D0) until the sixth day after injection (D6). The list of adverse effects comprised local reactions at the injection site (pain, redness, and swelling) and systemic symptoms (fever, fatigue, headache, myalgia, joint pain, chills, and nausea or vomiting). The Student's t-test and Mann-Whitney U test were used to analyze parametric and non-parametric data, respectively. RESULTS The incidence of adverse reactions to the COVID-19 vaccination was higher after the second dose (e.g., redness: 47.1%; swelling: 60.6%; fever: 80.6%) of vaccination than after the first dose (e.g., redness: 16.4%; swelling: 37.2%; fever: 11.9%). Women reported adverse reactions to the vaccination more frequently. Some adverse reactions included more symptoms in younger participants, and participants with a lower body mass index were more at risk for these symptoms. CONCLUSIONS Some adverse reactions to the COVID-19 vaccination are a greater risk of symptoms in the younger group, women, and participants with lower BMI. Care should be taken to monitor women, younger people, and individuals with a low body mass index for adverse effects after receiving the COVID-19 vaccination.
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Affiliation(s)
- Xi Lu
- Department of Public Health, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
| | - Shota Masuda
- Department of Public Health, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hasita Horlad
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Takahiko Katoh
- Department of Public Health, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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10
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Rudokaite J, Ong LLS, Onal Ertugrul I, Janssen MP, Huis In 't Veld EMJ. Predicting vasovagal reactions to needles with anticipatory facial temperature profiles. Sci Rep 2023; 13:9667. [PMID: 37316637 DOI: 10.1038/s41598-023-36207-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 05/31/2023] [Indexed: 06/16/2023] Open
Abstract
Around one-third of adults are scared of needles, which can result in adverse emotional and physical responses such as dizziness and fainting (e.g. vasovagal reactions; VVR) and consequently, avoidance of healthcare, treatments, and immunizations. Unfortunately, most people are not aware of vasovagal reactions until they escalate, at which time it is too late to intervene. This study aims to investigate whether facial temperature profiles measured in the waiting room, prior to a blood donation, can be used to classify who will and will not experience VVR during the donation. Average temperature profiles from six facial regions were extracted from pre-donation recordings of 193 blood donors, and machine learning was used to classify whether a donor would experience low or high levels of VVR during the donation. An XGBoost classifier was able to classify vasovagal groups from an adverse reaction during a blood donation based on this early facial temperature data, with a sensitivity of 0.87, specificity of 0.84, F1 score of 0.86, and PR-AUC of 0.93. Temperature fluctuations in the area under the nose, chin and forehead have the highest predictive value. This study is the first to demonstrate that it is possible to classify vasovagal responses during a blood donation using temperature profiles.
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Affiliation(s)
- Judita Rudokaite
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, Tilburg, The Netherlands.
- Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands.
- Department of Cognitive Science & Artificial Intelligence, Tilburg University, PO Box 90153, Warandelaan 2 (Room D147), 5000 LE, Tilburg, The Netherlands.
| | - L L Sharon Ong
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, Tilburg, The Netherlands
| | - Itir Onal Ertugrul
- Department of Information and Computing Sciences, Utrecht University, Utrecht, The Netherlands
| | - Mart P Janssen
- Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| | - Elisabeth M J Huis In 't Veld
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, Tilburg, The Netherlands
- Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
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Charniga K, Nakazawa Y, Brown J, Jeon S, Wallace RM. Risk of Rabies and Implications for Postexposure Prophylaxis Administration in the US. JAMA Netw Open 2023; 6:e2317121. [PMID: 37294570 PMCID: PMC10257100 DOI: 10.1001/jamanetworkopen.2023.17121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/23/2023] [Indexed: 06/10/2023] Open
Abstract
Importance In the US, rabies postexposure prophylaxis (PEP) is often administered without a comprehensive and regionally appropriate rabies risk assessment. For low-risk exposures, this can result in patients incurring out-of-pocket expenses or experiencing adverse effects of PEP unnecessarily. Objective To use a model to estimate (1) the probability that an animal would test positive for rabies virus (RABV) given that a person was exposed, and (2) the probability that a person would die from rabies given that they were exposed to a suspect rabid animal and did not receive PEP, and to propose a risk threshold for recommending PEP according to model estimates and a survey. Design, Setting, and Participants In this decision analytical modeling study, positivity rates were calculated using more than 900 000 animal samples tested for RABV between 2011 and 2020. Other parameters were estimated from a subset of the surveillance data and the literature. Probabilities were estimated using Bayes' rule. A survey was administered among a convenience sample of state public health officials in all US states (excluding Hawaii) plus Washington, DC and Puerto Rico to determine a risk threshold for PEP recommendation. Respondents were asked whether they would recommend PEP given 24 standardized exposure scenarios while accounting for local rabies epidemiology. Main Outcomes and Measures A quantitative and regionally appropriate approach for helping health care practitioners and public health professionals determine whether to recommend and/or administer rabies PEP. Results A total of 1728 unique observations were obtained from the model for the probability that an animal would test positive for RABV given that a person was exposed, and 41 472 for ) the probability that a person would die from rabies given that they were exposed to a suspect rabid animal and did not receive PEP. The median probability that an animal would test positive for RABV given that a person was exposed ranged from 3 × 10-7 to 0.97, while the probability that a person would die from rabies given that they were exposed to a suspect rabid animal and did not receive PEP ranged from 1 × 10-10 to 0.55. Fifty public health officials out of a target sample size of 102 responded to the survey. Using logistic regression, a risk threshold was estimated for PEP recommendation of 0.0004; PEP may not be recommended for exposures with probabilities below this threshold. Conclusions and Relevance In this modeling study of rabies in the US, the risk of death|exposure was quantified and a risk threshold was estimated. These results could be used to inform the decision-making process as to the appropriateness of recommending rabies PEP.
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Affiliation(s)
- Kelly Charniga
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yoshinori Nakazawa
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jen Brown
- Indiana Department of Health, Indianapolis
| | - Seonghye Jeon
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ryan M. Wallace
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
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12
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Raut A, Samad A, Verma J, Kshirsagar P. Acceptance, hesitancy and refusal towards COVID-19 vaccination. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2023; 21:101283. [PMID: 37033719 PMCID: PMC10070193 DOI: 10.1016/j.cegh.2023.101283] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 04/07/2023] Open
Abstract
Problem The determinants of COVID-19 vaccine acceptance, hesitancy, and refusal remain poorly understood. We assessed the general population of Pune after visiting tertiary care hospital for their willingness to accept the vaccine and the reason for their hesitancy and refusal. Methodology A six-month descriptive cross-sectional study with 386 community members over the age of 18 who visited the Tertiary Hospital OPD was conducted. The vaccine acceptance and hesitancy was assessed using a self designed detailed questionnaire with a one-time face-to-face interview. Results Acceptance for vaccine was observed in 235 (60.8%) participants, while 151 (39.2%) hesitated and refused. Participants with lower education (P < 0.00001), no employment did not readily accept the vaccine (P < 0.00001). Pregnant, breast-feeding women (21.8%) hesitated vaccine because of lack of evidence regarding vaccine safety. Participants (73.6%) were readily accepting (third dose) booster dose of vaccine when available. The reason for vaccine hesitance was the concern about side effects (58.2%) and reason for acceptance was to get immunity against COVID-19 (76.1%). Vaccine information source appears to be an influential aspect, as participants who obtained vaccination information from healthcare providers had no concerns regarding vaccination. Conclusion The study has found a link between average education level, unemployment and vaccine acceptance and hesitancy. Factors influencing vaccine hesitancy include lack of vaccine information, vaccine side effects, and misinformation spread via social media. Clinical pharmacists can play an important role in boosting up vaccine acceptance by providing appropriate information in community.
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Affiliation(s)
- Asavari Raut
- Department of Clinical Pharmacy, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Pune, 411038, Maharashtra, India
| | - Abdul Samad
- Department of Clinical Pharmacy, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Pune, 411038, Maharashtra, India
| | - Jay Verma
- Department of Clinical Pharmacy, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Pune, 411038, Maharashtra, India
| | - Pranad Kshirsagar
- Department of Clinical Pharmacy, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Pune, 411038, Maharashtra, India
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13
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Feng YX, Hu H, Wong YY, Yao X, He ML. Microneedles: An Emerging Vaccine Delivery Tool and a Prospective Solution to the Challenges of SARS-CoV-2 Mass Vaccination. Pharmaceutics 2023; 15:pharmaceutics15051349. [PMID: 37242591 DOI: 10.3390/pharmaceutics15051349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/23/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Vaccination is an effective measure to prevent infectious diseases. Protective immunity is induced when the immune system is exposed to a vaccine formulation with appropriate immunogenicity. However, traditional injection vaccination is always accompanied by fear and severe pain. As an emerging vaccine delivery tool, microneedles overcome the problems associated with routine needle vaccination, which can effectively deliver vaccines rich in antigen-presenting cells (APCs) to the epidermis and dermis painlessly, inducing a strong immune response. In addition, microneedles have the advantages of avoiding cold chain storage and have the flexibility of self-operation, which can solve the logistics and delivery obstacles of vaccines, covering the vaccination of the special population more easily and conveniently. Examples include people in rural areas with restricted vaccine storage facilities and medical professionals, elderly and disabled people with limited mobility, infants and young children afraid of pain. Currently, in the late stage of fighting against COVID-19, the main task is to increase the coverage of vaccines, especially for special populations. To address this challenge, microneedle-based vaccines have great potential to increase global vaccination rates and save many lives. This review describes the current progress of microneedles as a vaccine delivery system and its prospects in achieving mass vaccination against SARS-CoV-2.
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Affiliation(s)
- Ya-Xiu Feng
- Department of Biomedical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong SAR, China
| | - Huan Hu
- Department of Biomedical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong SAR, China
| | - Yu-Yuen Wong
- Department of Biomedical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong SAR, China
| | - Xi Yao
- Department of Biomedical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong SAR, China
| | - Ming-Liang He
- Department of Biomedical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong SAR, China
- CityU Shenzhen Research Institute, Shenzhen 518071, China
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14
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Khorasani LN, Bastani A, Shen T, Kaur G, Shah ND, Juarez L, Heyman M, Grassian J, Cho AC, Hotez E. A Qualitative Investigation on COVID-19 Vaccine Hesitancy in Neurodivergent Communities. Vaccines (Basel) 2023; 11:vaccines11050895. [PMID: 37242999 DOI: 10.3390/vaccines11050895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/17/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
Vaccine hesitancy is a major barrier to vaccination, hindering the success of vaccine efforts and thereby increasing public health risk to viral diseases, including COVID-19. Neurodivergent (ND) individuals, including individuals with an intellectual and/or developmental disability, have demonstrated a heightened risk of hospitalization and death due to COVID-19, highlighting the need for further research specifically on ND communities. We conducted a qualitative analysis using in-depth interviews with medical professionals, non-medical health professionals and communicators, and ND individuals or their caregivers. Using a thematic coding analysis methodology, trained coders identified major themes according to 24 distinct codes spanning across the categories of (1) barriers to vaccination; (2) facilitators to vaccination; and (3) suggestions for improving vaccine confidence. Qualitative findings identify misinformation, perception of vaccine risk, sensory sensitivities, and structural hardship as the most significant barriers to COVID-19 vaccination. We highlight the importance of accommodations to vaccination for the ND community alongside coordinated efforts by healthcare leaders to direct their communities to accurate sources of medical information. This work will inform the direction of future research on vaccine hesitancy, and the development of programs specific to the ND community's access to vaccines.
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Affiliation(s)
- Laila N Khorasani
- David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Asal Bastani
- David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Tammy Shen
- David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Gurlovellen Kaur
- David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Nilpa D Shah
- David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Lucia Juarez
- David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Michelle Heyman
- Graduate School of Education, University of California, Riverside, CA 92521, USA
| | - Julie Grassian
- David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - An-Chuen Cho
- David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Emily Hotez
- David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
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15
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van der Ven DL, Morrone D, Quetzeri-Santiago MA, Fernandez Rivas D. Microfluidic jet impact: Spreading, splashing, soft substrate deformation and injection. J Colloid Interface Sci 2023; 636:549-558. [PMID: 36652830 DOI: 10.1016/j.jcis.2023.01.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023]
Abstract
HYPOTHESIS Needle-free injections using microfluidic jets could be optimized by reducing splashing and controlling injection depth. However, this is impeded by an incomplete understanding on how jet characteristics influence impact outcome. We hypothesise that exploring the relation between microfluidic jet characteristics and substrate shear modulus on impact behavior will assist in predicting and giving insights on the impact outcome on skin and injection endpoints. EXPERIMENTS To do so, a setup using microfluidic chips, at varying laser powers and stand-off distances, was used to create thermocavitation generated microfluidic jets with ranging characteristics (velocity: 7-77 m/s, diameter: 35-120 μm, Weber-number: 40-4000), which were impacted on substrates with different shear modulus. FINDINGS Seven impact regimes were found, depending on jet Weber-number and substrate shear modulus, and we identified three thresholds: i) spreading/splashing threshold, ii) dimple formation threshold, and iii) plastic/elastic deformation threshold. The regimes show similarity to skin impact, although the opacity of skin complicated determining the threshold values. Additionally, we found that jet velocity has a higher predictive value for injection depth compared to the Weber-number, and consequently, the jet-diameter. Our findings provide fundamental knowledge on the interaction between microfluidic jets and substrates, and are relevant for optimizing needle-free injections.
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Affiliation(s)
- Diana L van der Ven
- Mesoscale Chemical Systems group, MESA+ Institute and Faculty of Science and Technology, University of Twente, P.O. Box 217, 7500 AE Enschede, the Netherlands
| | - Davide Morrone
- Nanovea SRL, Via Balegno 1, 10040 Rivalta di Torino, Italy
| | - Miguel A Quetzeri-Santiago
- Mesoscale Chemical Systems group, MESA+ Institute and Faculty of Science and Technology, University of Twente, P.O. Box 217, 7500 AE Enschede, the Netherlands.
| | - David Fernandez Rivas
- Mesoscale Chemical Systems group, MESA+ Institute and Faculty of Science and Technology, University of Twente, P.O. Box 217, 7500 AE Enschede, the Netherlands.
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16
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Mohizin A, Imran JH, Lee KS, Kim JK. Dynamic interaction of injected liquid jet with skin layer interfaces revealed by microsecond imaging of optically cleared ex vivo skin tissue model. J Biol Eng 2023; 17:15. [PMID: 36849998 PMCID: PMC9969392 DOI: 10.1186/s13036-023-00335-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/21/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Needle-free jet injection (NFJI) systems enable a controlled and targeted delivery of drugs into skin tissue. However, a scarce understanding of their underlying mechanisms has been a major deterrent to the development of an efficient system. Primarily, the lack of a suitable visualization technique that could capture the dynamics of the injected fluid-tissue interaction with a microsecond range temporal resolution has emerged as a main limitation. A conventional needle-free injection system may inject the fluids within a few milliseconds and may need a temporal resolution in the microsecond range for obtaining the required images. However, the presently available imaging techniques for skin tissue visualization fail to achieve these required spatial and temporal resolutions. Previous studies on injected fluid-tissue interaction dynamics were conducted using in vitro media with a stiffness similar to that of skin tissue. However, these media are poor substitutes for real skin tissue, and the need for an imaging technique having ex vivo or in vivo imaging capability has been echoed in the previous reports. METHODS A near-infrared imaging technique that utilizes the optical absorption and fluorescence emission of indocyanine green dye, coupled with a tissue clearing technique, was developed for visualizing a NFJI in an ex vivo porcine skin tissue. RESULTS The optimal imaging conditions obtained by considering the optical properties of the developed system and mechanical properties of the cleared ex vivo samples are presented. Crucial information on the dynamic interaction of the injected liquid jet with the ex vivo skin tissue layers and their interfaces could be obtained. CONCLUSIONS The reported technique can be instrumental for understanding the injection mechanism and for the development of an efficient transdermal NFJI system as well.
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Affiliation(s)
- Abdul Mohizin
- grid.91443.3b0000 0001 0788 9816School of Mechanical Engineering, Kookmin University, 77 Jeongneung-Ro, Seongbuk-Gu, Seoul, 02707 Republic of Korea
| | - Jakir Hossain Imran
- grid.91443.3b0000 0001 0788 9816Department of Mechanical Engineering, Graduate School, Kookmin University, Seoul, 02707 Republic of Korea
| | - Kee Sung Lee
- grid.91443.3b0000 0001 0788 9816School of Mechanical Engineering, Kookmin University, 77 Jeongneung-Ro, Seongbuk-Gu, Seoul, 02707 Republic of Korea
| | - Jung Kyung Kim
- School of Mechanical Engineering, Kookmin University, 77 Jeongneung-Ro, Seongbuk-Gu, Seoul, 02707, Republic of Korea.
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17
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Jha A, Holla R, Satish KP, Kundolil FS, Goel P, Jaiswal S, Kumar DN, Dasgupta A. Trypanophobia among medical students - An overlooked concern. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2023. [DOI: 10.1016/j.cegh.2023.101257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
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18
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Improved DNA Vaccine Delivery with Needle-Free Injection Systems. Vaccines (Basel) 2023; 11:vaccines11020280. [PMID: 36851159 PMCID: PMC9964240 DOI: 10.3390/vaccines11020280] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/21/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
DNA vaccines have inherent advantages compared to other vaccine types, including safety, rapid design and construction, ease and speed to manufacture, and thermostability. However, a major drawback of candidate DNA vaccines delivered by needle and syringe is the poor immunogenicity associated with inefficient cellular uptake of the DNA. This uptake is essential because the target vaccine antigen is produced within cells and then presented to the immune system. Multiple techniques have been employed to boost the immunogenicity and protective efficacy of DNA vaccines, including physical delivery methods, molecular and traditional adjuvants, and genetic sequence enhancements. Needle-free injection systems (NFIS) are an attractive alternative due to the induction of potent immunogenicity, enhanced protective efficacy, and elimination of needles. These advantages led to a milestone achievement in the field with the approval for Restricted Use in Emergency Situation of a DNA vaccine against COVID-19, delivered exclusively with NFIS. In this review, we discuss physical delivery methods for DNA vaccines with an emphasis on commercially available NFIS and their resulting safety, immunogenic effectiveness, and protective efficacy. As is discussed, prophylactic DNA vaccines delivered by NFIS tend to induce non-inferior immunogenicity to electroporation and enhanced responses compared to needle and syringe.
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19
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Odgers K, Kershaw KA, Li SH, Graham BM. The relative efficacy and efficiency of single- and multi-session exposure therapies for specific phobia: A meta-analysis. Behav Res Ther 2022; 159:104203. [PMID: 36323055 DOI: 10.1016/j.brat.2022.104203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/22/2022] [Accepted: 09/20/2022] [Indexed: 12/14/2022]
Abstract
Exposure therapy is the preferred treatment for specific phobia (SP), with evidence supporting its efficacy whether delivered over multiple sessions or as a single session, such as One-Session Treatment. In this meta-analysis, we compared the efficiency and effectiveness of single- and multi-session exposure for SP. PsycINFO, Embase, MEDLINE, and Cochrane were systematically searched for peer-reviewed articles reporting the effects of multi-session (k = 30) and/or single-session (k = 55) in vivo exposure on SP symptoms in clinical populations (n = 1758 participants). A random-effects model was used to synthesise and compare the pre-post treatment effects (Hedges' g) on approach behaviour and self-reported SP symptoms. Mean total treatment time was significantly longer for multi-session exposure than for single-session. There were no significant differences in the pooled effect sizes of single-session and multi-session exposure at post-treatment and follow-up assessments; effect sizes were large for all outcomes. Phobia subtype significantly moderated the effect size for both treatment approaches, although the direction of association differed according to the outcome measures. Results suggest no evidence for differences in the effectiveness of single- and multi-session exposure, but single-session is more time efficient. These outcomes suggest that policies to facilitate access to single-session exposure would be beneficial.
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Affiliation(s)
- Katarzyna Odgers
- School of Psychology, University Of New South Wales, Sydney, Australia
| | - Kelly A Kershaw
- School of Psychology, University Of New South Wales, Sydney, Australia
| | - Sophie H Li
- Black Dog Institute, University Of New South Wales, Sydney, Australia
| | - Bronwyn M Graham
- School of Psychology, University Of New South Wales, Sydney, Australia.
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20
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Alsbrooks K, Hoerauf K. Prevalence, causes, impacts, and management of needle phobia: An international survey of a general adult population. PLoS One 2022; 17:e0276814. [PMID: 36409734 PMCID: PMC9678288 DOI: 10.1371/journal.pone.0276814] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/14/2022] [Indexed: 11/22/2022] Open
Abstract
Needle phobia is an overlooked condition that affects virtually all medical procedures. Our study aimed to identify how commonly needle phobia is experienced, its underlying reasons, impacts, and potential mitigation strategies. A global survey was conducted in a general adult population using a questionnaire based on a targeted literature review that identified under-researched areas. The 21-item questionnaire was completed on a secure, web-based survey platform. Statistical analyses and models were utilized to identify relationships between participant characteristics and needle phobia. Of the 2,098 participants enrolled in the study, 63.2% (n = 1,325) reported experiencing needle phobia, and rated the intensity of their fear as 5.7 (±2.6) on average on a scale from 0 (no fear) to 10 (very strong/unreasonable fear or avoidance). According to the logistic regression model, other medical fears (odds coefficient = 2.14) and family history (1.67) were the most important factors associated with needle phobia. General anxiety (96.1%) and pain (95.5%) were the most common reasons for needle fear. Of the participants experiencing needle phobia, 52.2% stated avoiding blood draws, followed by 49.0% for blood donations, and 33.1% for vaccinations. While 24.3% of participants have seen a therapist, most have never sought help. The majority have shared their fear with nurses (61.1%) or physicians (44.4%); however, the provider helpfulness was rated as 4.9 (±3.1) on average on a scale from 0 (unhelpful) to 10 (extremely helpful). Utilizing non-invasive alternatives (94.1%) and smaller needles (91.1%) were most commonly identified as potential device-related solutions to alleviate fear; distractions (92.1%) and relaxation techniques (91.7%) were the top non-device-related approaches. Our findings highlight the prevalent nature of needle phobia and provide insights into its etiology and effects on patient care. Clinician responses were not perceived as helpful, emphasizing the need to address needle phobia, and improve patient experience.
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Affiliation(s)
- Kimberly Alsbrooks
- Becton, Dickinson, and Company, Franklin Lakes, NJ, United States of America
- * E-mail:
| | - Klaus Hoerauf
- Becton, Dickinson, and Company, Franklin Lakes, NJ, United States of America
- Medical University of Vienna, Vienna, Austria
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21
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De Gioia ER, Porqueddu A, Nebiaj O, Bianconi A, Conni A, Montalti M, Pandolfi P, Todeschini R, Fantini MP, Gori D. The Role of Needle Fear in Pediatric Flu Vaccine Hesitancy: A Cross-Sectional Study in Bologna Metropolitan Area. Vaccines (Basel) 2022; 10:vaccines10091388. [PMID: 36146466 PMCID: PMC9506010 DOI: 10.3390/vaccines10091388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: vaccination is the most effective way to prevent influenza and reduce its complications. The main aim of the study is to assess a possible increase of parents’/caregivers’ pediatric flu vaccination adherence due to a nasal administration as an alternative to injection in Bologna. (2) Methods: 169 parents/guardians of children who were joining the COVID-19 pediatric vaccination session in Bologna were interviewed. The results were summarized using descriptive statistics. A multiple logistic regression model was used to assess the determinants of the change in flu vaccine uptake if offered without injection administration. All analyses were conducted using STATA and R-Studio software. (3) Results: Only 29.0% of parents were informed about pediatric flu vaccination by pediatricians, and 32.5% heard about pediatric flu vaccination. Almost 72.2% of parents declared that they would not have their children vaccinated against influenza. Thus, 40.2% of them changed their opinion after being informed about the existence of a non-injective vaccine. Needle fear in children turned out to be a determinant of this opinion change (OR = 3.79; 95% CI = 1.63–9.43; p = 0.003). (4) Conclusions: the study has confirmed that needle fear is a determinant of vaccine hesitancy and that a different method of administration may increase parents’/guardians’ adherence.
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Affiliation(s)
- Esther Rita De Gioia
- School of Hygiene and Preventive Medicine, Department of Biomedical and Neuromotor Sciences, Public Health and Medical Statistics, University of Bologna, Via San Giacomo 12, 40126 Bologna, Italy
| | - Adalisa Porqueddu
- School of Hygiene and Preventive Medicine, Department of Biomedical and Neuromotor Sciences, Public Health and Medical Statistics, University of Bologna, Via San Giacomo 12, 40126 Bologna, Italy
| | - Ornela Nebiaj
- School of Hygiene and Preventive Medicine, Department of Biomedical and Neuromotor Sciences, Public Health and Medical Statistics, University of Bologna, Via San Giacomo 12, 40126 Bologna, Italy
| | - Alessandro Bianconi
- School of Hygiene and Preventive Medicine, Department of Biomedical and Neuromotor Sciences, Public Health and Medical Statistics, University of Bologna, Via San Giacomo 12, 40126 Bologna, Italy
| | - Alice Conni
- School of Hygiene and Preventive Medicine, Department of Biomedical and Neuromotor Sciences, Public Health and Medical Statistics, University of Bologna, Via San Giacomo 12, 40126 Bologna, Italy
- Correspondence:
| | - Marco Montalti
- School of Hygiene and Preventive Medicine, Department of Biomedical and Neuromotor Sciences, Public Health and Medical Statistics, University of Bologna, Via San Giacomo 12, 40126 Bologna, Italy
| | - Paolo Pandolfi
- Department of Public Health, Bologna Local Health Authority, Via Gramsci, 12, 40124 Bologna, Italy
| | - Renato Todeschini
- Department of Public Health, Bologna Local Health Authority, Via Gramsci, 12, 40124 Bologna, Italy
| | - Maria Pia Fantini
- Unit of Hygiene, Department of Biomedical and Neuromotor Sciences, Public Health and Medical Statistics, University of Bologna, Via San Giacomo 12, 40126 Bologna, Italy
| | - Davide Gori
- Unit of Hygiene, Department of Biomedical and Neuromotor Sciences, Public Health and Medical Statistics, University of Bologna, Via San Giacomo 12, 40126 Bologna, Italy
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22
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AboulFotouh K, Xu H, Moon C, Williams RO, Cui Z. Development of (Inhalable) Dry Powder Formulations of AS01 B-Containing Vaccines Using Thin-Film Freeze-Drying. Int J Pharm 2022; 622:121825. [PMID: 35577037 DOI: 10.1016/j.ijpharm.2022.121825] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 01/08/2023]
Abstract
AS01B is a liposomal formulation of two immunostimulants namely 3-O-desacyl-4́-monophosphoryl lipid A (MPL) and QS-21. The liposomal formulation of AS01B reduces the endotoxicity of MPL and the lytic activity of QS-21. The AS01B-adjuvanted Shingrix vaccine is marketed in a two-vial presentation, with the liquid AS01B liposomes in one vial and the antigen as a dry powder in another vial. In the present study, we tested the feasibility of applying thin-film freeze-drying (TFFD) to engineer dry powders of the AS01B liposomal adjuvant alone or vaccines containing AS01B as an adjuvant. Initially, we showed that after the AS01B liposomal adjuvant was subjected to TFFD using sucrose as a stabilizer at 4% w/v, the particle size distribution of AS01B liposomes reconstituted from the dry powder was identical to the liquid adjuvant before drying. We then showed using ovalbumin (OVA) as a model antigen adjuvanted with AS01B (AS01B/OVA) that subjecting the AS01B/OVA vaccine to TFFD and subsequent reconstitution did not negatively affect the AS01B liposome particle size, nor the immunogenicity of the vaccine. Importantly, the thin-film freeze-dried AS01B/OVA vaccine, unlike its liquid counterpart, was not sensitive to repeated freezing-and-thawing. The developed AS01B/OVA dry powder also showed the desirable aerosol properties (i.e., fine particle fraction of 66.3 ± 4.9% and mass median aerodynamic diameter of 2.4 ± 0.1 µm) for potential pulmonary administration. Finally, the feasibility of using TFFD to prepare dry powders of AS01B-adjuvanted vaccines was further confirmed using AS01B-adjuvanted Fluzone Quadrivalent and Shingrix, which contains AS01B. It is concluded that the TFFD technology can enable the formulation of AS01B-adjuvanted vaccines as freezing-insensitive, inhalable dry powders in a single-vial presentation.
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Affiliation(s)
- Khaled AboulFotouh
- Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA; Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut 71526, Egypt
| | - Haiyue Xu
- Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA
| | - Chaeho Moon
- Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA
| | - Robert O Williams
- Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA.
| | - Zhengrong Cui
- Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA.
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Tetui M, Grindrod K, Waite N, VanderDoes J, Taddio A. Integrating the CARD (Comfort Ask Relax Distract) system in a mass vaccination clinic to improve the experience of individuals during COVID-19 vaccination: a pre-post implementation study. Hum Vaccin Immunother 2022; 18:2089500. [PMID: 35723609 PMCID: PMC9620984 DOI: 10.1080/21645515.2022.2089500] [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] [Indexed: 11/06/2022] Open
Abstract
Many people have negative experiences with vaccination due to stress-related reactions including fear and pain. We used a pre-post study design to evaluate the impact of implementing a modified version of the CARD (Comfort-Ask-Relax-Distract) system on stress-related reactions in individuals aged 12 y or older undergoing COVID-19 vaccinations in mass vaccination clinics. Vaccine recipients reported their level of pain, fear and dizziness during vaccination. Clinic staff reported their attitudes about CARD and use of CARD interventions. CARD improved client symptoms across genders and ages with an average reduction in needle pain, fear and dizziness of 75%, 40% and 44%, respectively. CARD was more effective in younger individuals. Clinic staff reported positive attitudes about CARD and uptake of selected CARD interventions. In summary, the modified CARD system reduced stress-related responses in a general population undergoing COVID-19 vaccinations in a mass vaccination clinic, was feasible and acceptable to staff. Future implementation efforts are recommended that include more diverse cultural contexts and incorporate education of individuals about CARD ahead of time.
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Affiliation(s)
- Moses Tetui
- School of Pharmacy, University of Waterloo, Waterloo, Canada.,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Kelly Grindrod
- School of Pharmacy, University of Waterloo, Waterloo, Canada
| | - Nancy Waite
- School of Pharmacy, University of Waterloo, Waterloo, Canada
| | - Jeremy VanderDoes
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Canada
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
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Braithwaite FA, Noel M, Jones HG, Wiese MD, Nania CG, Watson E, Stanton TR. Reframe the pain: Divided attention and positive memory reframing to reduce needle pain and distress in children-A feasibility randomized controlled trial. Eur J Pain 2022; 26:1702-1722. [PMID: 35671133 DOI: 10.1002/ejp.1992] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/09/2022] [Accepted: 06/05/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Negative experiences of needle procedures in childhood can lead to medical avoidance and vaccine hesitancy into adulthood. We evaluated the feasibility of two new interventions provided by clinical nurses to reduce the negative impact of vaccinations: divided attention (DA) and positive memory reframing (PMR). METHODS Children (8-12 years) were randomized into four groups: usual care (UC), DA, PMR or combined (DA + PMR). To evaluate feasibility, we undertook in-depth analysis of video-recorded interventions, nurse experiences (phone interviews) and child/parent memory recall of interventions (phone interviews at 2 weeks post-vaccination). Key clinical outcomes included child and parent ratings of needle-related pain intensity and fear assessed at baseline, immediately post-vaccination and 2 weeks post-vaccination (recalled). RESULTS A total of 54 child-parent dyads were screened, with 41 included (10/group, except PMR [n = 11]). The interventions were not always completed as intended: 10%-22% of participants received complete interventions and two had adverse events related to protocol breach. Preliminary within-group analyses showed no effects on child/parent pain ratings. However, children in DA + PMR had reduced recalled fear (p = 0.008), and PMR (p = 0.025) and DA + PMR (p = 0.003) had reduced fear of future needles. Parent ratings of child fear were also reduced immediately post-vaccination for UC (p = 0.035) and PMR (p = 0.035). CONCLUSIONS The interventions were feasible, although enhanced nurse training is required to improve fidelity. Preliminary clinical results appear promising, particularly for reducing needle-related fear. PROTOCOL REGISTRATION Protocol number ACTRN12618000687291 at ANZCTR.org.au SIGNIFICANCE: Two new nurse-led interventions to reduce negative impacts of vaccinations in children, divided attention and positive memory reframing, were feasible and may reduce needle-related fear. Nurses were able to deliver the interventions in various environments including non-clinical settings (schools). These interventions have potential to facilitate broader dissemination of vaccinations for children in a manner that minimizes distress.
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Affiliation(s)
- Felicity A Braithwaite
- IIMPACT in Health, The University of South Australia, Adelaide, South Australia, Australia
| | - Melanie Noel
- Department of Psychology, The University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Hannah G Jones
- IIMPACT in Health, The University of South Australia, Adelaide, South Australia, Australia.,Department of Psychology, The University of Bath, Bath, UK
| | - Michael D Wiese
- Clinical & Health Sciences, The University of South Australia, Adelaide, South Australia, Australia
| | - Cara G Nania
- School and Applied Child Psychology, The University of Calgary, Vancouver, British Columbia, Canada
| | - Emily Watson
- IIMPACT in Health, The University of South Australia, Adelaide, South Australia, Australia
| | - Tasha R Stanton
- IIMPACT in Health, The University of South Australia, Adelaide, South Australia, Australia
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Payberah E, Payberah D, Sarangi A, Gude J. COVID-19 vaccine hesitancy in patients with mental illness: strategies to overcome barriers—a review. JOURNAL OF THE EGYPTIAN PUBLIC HEALTH ASSOCIATION 2022; 97:5. [PMID: 35079435 PMCID: PMC8777419 DOI: 10.1186/s42506-022-00102-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/31/2021] [Indexed: 01/12/2023]
Abstract
Abstract
Background
People with mental health problems are at particular risk both for infection with COVID-19 and for more severe course of illness. Understanding COVID-19 vaccine hesitancy is crucial in promoting vaccine acceptance among people with mental health diagnoses. This review aims to identify the prevalence and discuss factors associated with COVID-19 vaccine hesitancy among the mentally ill population.
Main body
We conducted a detailed literature search and included 15 articles for discussion in this review. Several studies showed varying trends of vaccine hesitancy rates among different countries. Major factors involved in vaccine hesitancy in general include mistrust, misinformation, believing in conspiracy theories, and negative attitudes towards vaccines. It was surprising that none of the studies were focused on vaccine acceptance rates and factors associated with vaccine hesitancy among the mentally ill population. However, studies do show that COVID-19 is associated with worse healthcare outcomes for psychiatric patients, and vaccine hesitancy correlated with a lower likelihood of receiving mental health treatment and vaccinations. Psychiatrists need to address issues among patients who are particularly vulnerable to the fear of vaccines which include anxiety, panic attacks, certain phobias including trypanophobia and agoraphobia, obsessive-compulsive disorder, and certain types of traumas. Psychiatrists need to communicate effectively, show respect, empathy, and deliver accurate and honest information about the vaccines. Motivational interviewing, getting people with mental health illness to organize vaccine campaigns, and involving families with mental health problems may promote vaccine acceptance among this group.
Conclusion
Existing literature on the rates of vaccine hesitancy among people with mental health illness is limited. The mental health illness may increase the risk of hesitancy especially in patients having certain emotional disorders such as anxiety and phobia. More studies addressing vaccine hesitancy rates and factors associated with the mentally ill population need to be done in the future.
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Kelley EL, Smith RH, Corcoran G, Nygren S, Jacoski MV, Fernandes A. Advances in subcutaneous injections: PRECISE II: a study of safety and subject preference for an innovative needle-free injection system. Drug Deliv 2021; 28:1915-1922. [PMID: 34541982 PMCID: PMC8462839 DOI: 10.1080/10717544.2021.1976309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022] Open
Abstract
Needle-free injection is a desirable goal for many reasons, including reducing pain, anxiety, and eliminating safety risks associated with needle-stick injuries. However, development of a safe, reliable needle-free device optimized for at-home use has been met with many challenges. Portal Instruments Inc. has been developing needle-free medication delivery using a well-designed hand-held device, PRIME, that is safe, intuitive to use, and utilizes advanced electronic control of a focused, high velocity, pressurized liquid injection stream. The PRECISE II human study demonstrated that the PRIME needle-free injection system was safe, well tolerated, and strongly preferred by participants for self-injections over a standard needle and syringe. In addition, the study was able to be completed early for superiority following the success of the pre-defined interim analysis.
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Association between Immunoglobulin G Levels and Adverse Effects Following Vaccination with the BNT162b2 Vaccine among Japanese Healthcare Workers. Vaccines (Basel) 2021; 9:vaccines9101149. [PMID: 34696257 PMCID: PMC8539103 DOI: 10.3390/vaccines9101149] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/02/2021] [Accepted: 10/07/2021] [Indexed: 12/23/2022] Open
Abstract
The purpose of the study was to assess the association between the amount of immunoglobulin G (IgG) and the duration of adverse effects of COVID-19 vaccinations in the Japanese population. This cross-sectional study was conducted from April 2020 to August 2021 among workers at a community hospital. All participants received two doses of the BNT162b2 vaccine (Pfizer-BioNTech) in March and April 2021. Vaccine side effects were measured using a self-administered questionnaire. Serum anti-SARS-CoV-2 IgG was measured 3 months after vaccination. There was a total of 338 participants (mean age: 44.7 years). The incidence of adverse reactions after vaccination was higher in women. Adverse reactions associated with higher IgG levels included: erythema at the injection site after the first dose; induration and inflammation at the injection site; and systemic symptoms, e.g., fever and headache after the second dose. IgG levels were higher in younger participants. These findings could mitigate fears regarding the mild adverse effects of the COVID-19 vaccine and encourage uptake of the BNT162b2 vaccine.
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Johnson-Weaver BT, Choi HW, Yang H, Granek JA, Chan C, Abraham SN, Staats HF. Nasal Immunization With Small Molecule Mast Cell Activators Enhance Immunity to Co-Administered Subunit Immunogens. Front Immunol 2021; 12:730346. [PMID: 34566991 PMCID: PMC8461742 DOI: 10.3389/fimmu.2021.730346] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/23/2021] [Indexed: 01/02/2023] Open
Abstract
Mast cell activators are a novel class of mucosal vaccine adjuvants. The polymeric compound, Compound 48/80 (C48/80), and cationic peptide, Mastoparan 7 (M7) are mast cell activators that provide adjuvant activity when administered by the nasal route. However, small molecule mast cell activators may be a more cost-efficient adjuvant alternative that is easily synthesized with high purity compared to M7 or C48/80. To identify novel mast cell activating compounds that could be evaluated for mucosal vaccine adjuvant activity, we employed high-throughput screening to assess over 55,000 small molecules for mast cell degranulation activity. Fifteen mast cell activating compounds were down-selected to five compounds based on in vitro immune activation activities including cytokine production and cellular cytotoxicity, synthesis feasibility, and selection for functional diversity. These small molecule mast cell activators were evaluated for in vivo adjuvant activity and induction of protective immunity against West Nile Virus infection in BALB/c mice when combined with West Nile Virus envelope domain III (EDIII) protein in a nasal vaccine. We found that three of the five mast cell activators, ST101036, ST048871, and R529877, evoked high levels of EDIII-specific antibody and conferred comparable levels of protection against WNV challenge. The level of protection provided by these small molecule mast cell activators was comparable to the protection evoked by M7 (67%) but markedly higher than the levels seen with mice immunized with EDIII alone (no adjuvant 33%). Thus, novel small molecule mast cell activators identified by high throughput screening are as efficacious as previously described mast cell activators when used as nasal vaccine adjuvants and represent next-generation mast cell activators for evaluation in mucosal vaccine studies.
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Affiliation(s)
| | - Hae Woong Choi
- Pathology Department, School of Medicine, Duke University, Durham, NC, United States
| | - Hang Yang
- Biostatistics and Bioinformatics Department, School of Medicine, Duke University, Durham, NC, United States
| | - Josh A. Granek
- Biostatistics and Bioinformatics Department, School of Medicine, Duke University, Durham, NC, United States
| | - Cliburn Chan
- Biostatistics and Bioinformatics Department, School of Medicine, Duke University, Durham, NC, United States
| | - Soman N. Abraham
- Pathology Department, School of Medicine, Duke University, Durham, NC, United States
- Department of Immunology, School of Medicine, Duke University, Durham, NC, United States
- Department of Molecular Genetics and Microbiology, Duke University, Durham, NC, United States
| | - Herman F. Staats
- Pathology Department, School of Medicine, Duke University, Durham, NC, United States
- Department of Immunology, School of Medicine, Duke University, Durham, NC, United States
- Duke Human Vaccine Institute, Duke University, Durham, NC, United States
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