Gut microbiome signature and nasal lavage inflammatory markers in young people with asthma

Background

Asthma is a complex disease and a severe global public health problem resulting from interactions between genetic background and environmental exposures. It has been suggested that gut microbiota may be related to asthma development; however, such relationships needs further investigation.

Objective

This study aimed to characterize the gut microbiota as well as the nasal lavage cytokine profile of asthmatic and nonasthmatic individuals.

Methods

Stool and nasal lavage samples were collected from 29 children and adolescents with type 2 asthma and 28 children without asthma in Brazil. Amplicon sequencing of the stool bacterial V4 region of the 16S rRNA gene was performed using Illumina MiSeq. Microbiota analysis was performed by QIIME 2 and PICRUSt2. Type 2 asthma phenotype was characterized by high sputum eosinophil counts and positive skin prick tests for house dust mite, cockroach, and/or cat or dog dander. The nasal immune marker profile was assessed using a customized multiplex panel.

Results

Stool microbiota differed significantly between asthmatic and nonasthmatic participants (P = .001). Bacteroides was more abundant in participants with asthma (P < .05), while Prevotella was more abundant in nonasthmatic individuals (P < .05). In people with asthma, the relative abundance of Bacteroides correlated with IL-4 concentration in nasal lavage samples. Inference of microbiota functional capacity identified differential fatty acid biosynthesis in asthmatic compared to nonasthmatic subjects.

Conclusion

The stool microbiota differed between asthmatic and nonasthmatic young people in Brazil. Asthma was associated with higher Bacteroides levels, which correlated with nasal IL-4 concentration.

Is there evidence for factorial invariance of the COVID Stress Scales? an analysis of North American and cross-cultural populations

The COVID-19 pandemic impacted the mental health of more citizens globally than any previous modern viral outbreak. In response to the psychological challenges associated with COVID-19, the COVID Stress Scales (CSS) were developed to assess the presence and severity of COVID-related distress. The initial North American validation study of the CSS identified that the scale comprised five factors: danger and contamination fears, fear of socioeconomic consequences, xenophobia, checking and reassurance seeking, and traumatic stress symptoms. The CSS have since been validated across a multitude of international populations. However, findings support a five- and six-factor model. Methodological issues make interpreting most studies supporting a five-factor model challenging. The purpose of this study was to re-evaluate the factor structure of the CSS using data from North American samples, to assess for potential factorial invariance, and compare these results to cross-cultural findings. Multiple confirmatory factor analyses (mCFA) were conducted across 28 different groups (e.g., age, ethnicity/race, sex) from two large independent North American samples from 2020 (n = 6827) and 2021 (n = 5787), assessing the fit indices of the five-, six-, and alternative-factor model of the CSS. The current results provide evidence for factorial invariance of the six-factor model of the CSS across different North American demographics and highlight potential challenges in interpreting the results of studies that have supported a five-factor model of the CSS.

Exploring the Landscape of Aptamers: From Cross-Reactive to Selective to Specific, High-Affinity Receptors for Cocaine

We reported over 20 years ago MNS-4.1, the first DNA aptamer with a micromolar affinity for cocaine. MNS-4.1 is based on a structural motif that is very common in any random pool of oligonucleotides, and it is actually a nonspecific hydrophobic receptor with wide cross-reactivity with alkaloids and steroids. Despite such weaknesses preventing broad applications, this aptamer became widely used in proof-of-concept demonstrations of new formats of biosensors. We now report a series of progressively improved DNA aptamers recognizing cocaine, with the final optimized receptors having low nanomolar affinity and over a thousand-fold selectivity over the initial cross-reactants. In the process of optimization, we tested different methods to eliminate cross-reactivities and improve affinity, eventually achieving properties that are comparable to those of the reported monoclonal antibody candidates for the therapy of overdose. Multiple aptamers that we now report share structural motifs with the previously reported receptor for serotonin. Further mutagenesis studies revealed a palindromic, highly adaptable, broadly cross-reactive hydrophobic motif that could be rebuilt through mutagenesis, expansion of linker regions, and selections into receptors with exceptional affinities and varying specificities.

Development and Validation of Telehealth Competency Questionnaire-Provider

Background: Given the rapid increase in telehealth utilization, health care providers are being increasingly trained to deliver services virtually. However, there are limited measures available to assess the extent to which structured trainings influence competency domains associated with telehealth delivery. Methods: The authors developed the Telehealth Competency Questionnaire-Provider (TCQ-P) using a multistep process, including a literature review and expert reviewers. Using two datasets, we used exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to validate and refine the tool, respectively. The final version contained 17 items. Model fit was evaluated using the comparative fit index (CFI) (>0.90), Tucker-Lewis index (TLI) (>0.80), standardized root mean square residual (SRMR) (<0.08) and root mean square of error of approximation (RMSEA) (<0.08). Results: Participants included n = 701 in the exploratory study and n = 721 in the confirmatory study. Two items were revised, and one item was deleted as a result of the EFA, and the CFA of 17 number of items supported a 3-factor model (i.e., Evaluation, Rapport, Troubleshooting). Model fit was good, with CFI = 0.984, TLI = 0.978, RMSEA = 0.051, and SRMR = 0.035. Discussion: The TCQ-P measures three essential domains of telehealth competency, which is essential for future health care providers. The measure may be used to assess telehealth training outcomes.

Amplification of Signal on Cell Surfaces in Molecular Cascades

We can formulate mixtures of oligonucleotide-antibody conjugates to act as molecular cascade-based automata that analyze pairs of cell surface markers (CD markers) on individual cells in a manner consistent with the implementation of Boolean logic-for example, by producing a fluorescent label only if two markers are present. While traditional methods to characterize cells are based on transducing signals from individual cell surface markers, these cascades can be used to combine into a single signal the presence of two or even more CDs. In our original design, oligonucleotide components irreversibly flowed from one antibody to another, driven by increased hybridizations, leading to the magnitude of the final signal on each cell being determined by the surface marker that was the least abundant. This is a significant limitation to the precise labeling of narrow subpopulations, and, in order to overcome it, we changed our design to accomplish signal amplification to a more abundant cell surface marker. We show the AMPLIFY function on two examples: (1) we amplify the fluorescent label from the CD19 marker onto a fivefold more abundant CD45, and (2) we amplify broadly distributed CD45RA to a more constant marker, CD3. We expect this new function to enable the increasingly complex Boolean analysis of cell surfaces.

Telehealth Competency Questionnaire-Consumer: Psychometric Validation of a Client-centered Measure

To effectively access telehealth services, individuals must possess certain competencies; yet, telehealth consumer focused measures are limited. The purpose of this study was to describe the development and validation of the Telehealth Competency Questionnaire - Consumer (TCQ-C). Among a sample of adults with chronic health conditions (n=134), findings showed that the TCQ-C is comprised of one factor that accounts for 66.6% of the variance, and internal consistency of subscales are good (range α = 0.80-0.87) and may be used for clinical or research purposes. The TCQ-C demonstrated moderate concurrent validity with the Telehealth Usability Questionnaire-Usability subscale (r = 0.728, p<.001), and significantly discriminates between adults >65 years and those younger as well as those with and without previous telehealth experience. The TCQ-C is a psychometrically sound instrument to evaluate baseline competencies among telehealth consumers so that education, research, and clinical practices are tailored to increase effective engagement between clients and providers.

The 2023 Practitioner's Toolkit for Managing Menopause

OBJECTIVE

The Practitioner's Toolkit for Managing the Menopause, developed in 2014, provided an accessible desk-top tool for health-care practitioners caring for women at midlife. To ensure the Toolkit algorithms and supporting information reflect current best practice, the Toolkit has been revised in accordance with the published literature.

METHODS

A systematic search for guidelines, position and consensus statements pertaining to the menopause and published after 2014 was undertaken, and key recommendations extracted from the Clinical Practice Guidelines determined to be the most robust by formal evaluation. The peer-reviewed literature was further searched for identified information gaps.

RESULTS

The revised Toolkit provides algorithms that guide the clinical assessment and care of women relevant to menopause. Included are the reasons why women present, information that should be ascertained, issues that may influence shared decision-making and algorithms that assist with determination of menopausal status, menopause hormone therapy (MHT) and non-hormonal treatment options for symptom relief. As clear guidelines regarding when MHT might be indicated to prevent bone loss and subsequent osteoporosis in asymptomatic women were found to be lacking, the Toolkit has been expanded to support shared decision-making regarding bone health.

CONCLUSIONS

The 2023 Toolkit and supporting document provide accessible desk-top information to support health-care providers caring for women at midlife.The Toolkit has been endorsed by the International Menopause Society, Australasian Menopause Society, British Menopause Society, Endocrine Society of Australia and Jean hailes for Women's Health.

Interleukin-22 suppresses major histocompatibility complex II in mucosal epithelial cells

Major histocompatibility complex (MHC) II is dynamically expressed on mucosal epithelial cells and is induced in response to inflammation and parasitic infections, upon exposure to microbiota, and is increased in chronic inflammatory diseases. However, the regulation of epithelial cell-specific MHC II during homeostasis is yet to be explored. We discovered a novel role for IL-22 in suppressing epithelial cell MHC II partially via the regulation of endoplasmic reticulum (ER) stress, using animals lacking the interleukin-22-receptor (IL-22RA1), primary human and murine intestinal and respiratory organoids, and murine models of respiratory virus infection or with intestinal epithelial cell defects. IL-22 directly downregulated interferon-γ-induced MHC II on primary epithelial cells by modulating the expression of MHC II antigen A α (H2-Aα) and Class II transactivator (Ciita), a master regulator of MHC II gene expression. IL-22RA1-knockouts have significantly higher MHC II expression on mucosal epithelial cells. Thus, while IL-22-based therapeutics improve pathology in chronic disease, their use may increase susceptibility to viral infections.

Pancreas: An Organ-at-Risk to Consider in Future Pediatric Abdominal Radiotherapy

PURPOSE/OBJECTIVE(S)

Irradiation to the pancreas during pediatric radiotherapy is associated with secondary late effects, yet the pancreas is not typically considered an organ-at-risk (OAR) during radiotherapy planning. This audit investigated incidental pancreatic doses to estimate the relative risk (RR) of developing diabetes in later life.

MATERIALS/METHODS

Incidental pancreas doses were audited from 92 patients aged 2 to 19 historically treated with photons for craniospinal irradiation (CSI, N = 73) and for abdominal neuroblastoma (N = 19). Prescription doses ranged 21-36 Gy and 21-39 Gy (with boost to spine up to 50 Gy) for neuroblastoma and CSI patients, respectively. The pancreas was segmented on all planning CT scans following RTOG guidelines. Furthermore, the pancreas was split into its sub-volumes (head, body and tail) for abdominal cases only, since these scans were acquired with contrast enhancement. The RR of developing subsequent diabetes was estimated as a function of dose (D): RR = 1+0.65 × D × exp(-0.3 × D). Dose to the pancreas tail was used for neuroblastoma cases, whereas dose to the whole pancreas was used for CSI patients given that the pancreas could not be split in non-contrast scans.

RESULTS

The mean dose delivered to the whole pancreas was 15.4±7.5 Gy for all patients, 12.7±4.7 Gy for CSI patients and 25.9±7.4 Gy for abdominal patients. Pancreas V10Gy was 61.2% for all patients, 51.5% for CSI, and 98.6% for abdominal patients; V30Gy = 0% in all cases. These doses represented an estimated diabetes RR of 7.3±1.5, 6.6±1.3, and 8.7±0.6, respectively; RR>5 in 88%, 85% and 100% of all patients, CSI and abdominal patients audited, respectively.

CONCLUSION

Current incidental doses were associated with a diabetes RR>5 in all patients treated for abdominal neuroblastoma and the majority who received CSI. These findings suggest the pancreas should be routinely delineated and considered as an OAR in radiotherapy planning. This may help to identify higher risk patients and inform late-effect monitoring during survivorship. Further work in underway to assess if proton therapy could reduce the RR of diabetes particularly in abdominal cases. Improved availability of high-quality imaging during radiotherapy planning, such as contrast administration or planning MRI, is becoming more necessary to accurately delineate subsegments of the pancreas for improved RR estimations.

Is Programmed Death Ligand 1(PD-L1) Expression in Vulvar Cancer Prognostic for Locoregional Control?

PURPOSE/OBJECTIVE(S)

Vulvar cancer is a rare female genital neoplasm in which surgery and radiotherapy play an integral role in the treatment paradigm; however, locoregional recurrence remains the predominant pattern of failure. Little is known about the impact of PD-L1 status in vulvar cancer and its value for clinical outcomes and response prediction to immunotherapy. We sought to explore clinical outcomes of patients with positive PD-L1 expression in vulvar cancer.

MATERIALS/METHODS

Single-institution retrospective analysis of patients with surgically resectable invasive vulvar carcinoma from 2001-2021 was performed. Patients with locally advanced disease not amendable to upfront surgery or de novo metastatic disease were excluded. Immunohistochemical PD-L1 expression was assessed using the Combined Positive Score (CPS) with positive expression defined as ≥1, and Tumor Proportion Score (TPS) with positive expression defined as ≥1%. Survival and disease control outcomes were calculated using the Kaplan-Meier Method with log-rank t-test. Multivariable analysis was conducted using a parsimonious cox regression analysis using forward conditional selection.

RESULTS

A total of 85 patients were identified with a median age of 69 years old (IQR: 59-78), 54% (n = 46) FIGO stage I-II, 97% (n = 82) squamous cell carcinoma histology, 41% (n = 35) p16 positive status, 74% (n = 63) without a history of lichen sclerosis, 40% (n = 34) without co-existing vulvar intraepithelial neoplasm (VIN), and 49% (n = 42) treated with surgery alone. There were 72% (n = 61) with positive PD-L1 TPS (≥1%), and 81% (n = 69) with positive PD-L1 CPS (≥1) expression. The median follow up was 49 months (IQR: 21-75 months). The 5-year OS was 79% (95% CI, 70%-89%), DFS 55% (95% CI, 43%-67%), local control (LC) 59% (95% CI, 47%-72%), regional control (RC) 86% (95% CI, 78%-94%), and distant metastasis (DM) 96% (95% CI, 92%-100%). PD-L1 expression was associated with lower LC and DFS by TPS ≥1%. The 5-year LC of 82% (95% CI, 65%-98%) for PD-L1 negative versus 50% (95% CI, 34%-65%) positive disease (p = 0.03). The 5-year DFS was 77% (95% CI, 59%-95%) for PD-L1 negative versus 46% (95% CI, 31%-61%) positive disease (p = 0.03). No significant DFS or LC difference was noted by CPS levels ≥1. No significant difference was observed for RC, DM, or OS. On multivariable analysis, PD-L1 TPS remained a significant predictor for LC (HR = 3.01, 95% CI, 1.07-8.95, p = 0.04). No significant difference in DFS was observed for PD-L1 TPS on multivariable analysis.

CONCLUSION

PD-L1 expression is associated with higher rates of local recurrence and may represents a potentially important actionable target independent of p16 status to improve the predominant pattern of relapse in this uncommon malignancy.

Enhancing Telehealth Competency: Development and Evaluation of Education Modules for Older Adults

Despite a rapid increase in telehealth utilization, older adults disproportionately experience disparities to services. To promote telehealth accessibility among this population, there is a need for specific training to increase user perceived competency. For this sequential mixed-methods study, we designed telehealth education modules through consultation with older adults. We then evaluated their impact on older adults' perceived telehealth competency. To solicit feedback on preliminary modules, we administered a semi-structured interview to a sample (n = 5) of older adults; then, we assessed the revised modules' impact on perceived competency among a sample of older adults (n = 53). Participants critiqued the preliminary training materials as having limited information on telehealth privacy and advised increasing the accessibility of design. Those that completed the revised modules demonstrated significant improvements in perceived telehealth competence. Telehealth training modules may be a promising method to increase perceived telehealth competency among older adults.

Development of 'gastrostomy tube - is it for me?', a web-based patient decision aid for people living with motor neurone disease considering having a gastrostomy tube placed

Objective: To develop and pilot a web-based patient decision aid (PDA) to support people living with motor neurone disease (plwMND) considering having a gastrostomy tube placed. Methods: In Phase 1, content and design were informed by semi-structured interviews, literature reviews and a prioritization survey. In Phase 2, the prototype PDA was tested with users and developed iteratively with feedback from surveys and 'think-aloud' interviews. Phase 1 and 2 participants were plwMND, carers and healthcare professionals (HCPs). In Phase 3, the PDA was evaluated by plwMND using validated questionnaires and HCPs provided feedback in focus groups. Results: Sixteen plwMND, 16 carers and 25 HCPs took part in Phases 1 and 2. Interviews and the literature review informed a prioritization survey with 82 content items. Seventy-seven per cent (63/82) of the content of the PDA was retained. A prototype PDA, which conforms to international standards, was produced and improved during Phase 2. In Phase 3, 17 plwMND completed questionnaires after using the PDA. Most plwMND (94%) found the PDA completely acceptable and would recommend it to others in their position, 88% had no decisional conflict, 82% were well prepared and 100% were satisfied with their decision-making. Seventeen HCPs provided positive feedback and suggestions for use in clinical practice. Conclusion: Gastrostomy Tube: Is it for me? was co-produced with stakeholders and found to be acceptable, practical and useful. Freely available from the MND Association website, the PDA is a valuable tool to support the shared decision-making process for gastrostomy tube placement.

A functional group-guided approach to aptamers for small molecules

Aptameric receptors are important biosensor components, yet our ability to identify them depends on the target structures. We analyzed the contributions of individual functional groups on small molecules to binding within 27 target-aptamer pairs, identifying potential hindrances to receptor isolation-for example, negative cooperativity between sterically hindered functional groups. To increase the probability of aptamer isolation for important targets, such as leucine and voriconazole, for which multiple previous selection attempts failed, we designed tailored strategies focused on overcoming individual structural barriers to successful selections. This approach enables us to move beyond standardized protocols into functional group-guided searches, relying on sequences common to receptors for targets and their analogs to serve as anchors in regions of vast oligonucleotide spaces wherein useful reagents are likely to be found.

A national qualitative investigation of the impact of service change on doctors' training during Covid-19

BACKGROUND

The Covid-19 crisis sparked service reconfigurations in healthcare systems worldwide. With postgraduate medical education sitting within these systems, service reconfigurations substantially impact trainees and their training environment. This study aims to provide an in-depth qualitative understanding of the impact of service reconfiguration on doctors' training during the pandemic, identifying opportunities for the future as well as factors that pose risks to education and training and how these might be mitigated.

METHODS

Qualitative parallel multi-centre case studies examined three Trusts/Health Boards in two countries in the United Kingdom. Data were collected from online focus groups and interviews with trainees and supervisors using semi-structured interview guides (September to December 2020). A socio-cultural model of workplace learning, the expansive-restrictive continuum, informed data gathering, analysis of focus groups and coding.

RESULTS

Sixty-six doctors participated, representing 25 specialties/subspecialties. Thirty-four participants were male, 26 were supervisors, 17 were specialty trainees and 23 were foundation doctors. Four themes described the impact of pandemic-related service reconfigurations on training: (1) Development of skills and job design, (2) Supervision and assessments, (3) Teamwork and communication, and (4) Workload and wellbeing. Service changes were found to both facilitate and hinder education and training, varying across sites, specialties, and trainees' grades. Trainees' jobs were redesigned extensively, and many trainees were redeployed to specialties requiring extra workforce during the pandemic.

CONCLUSIONS

The rapid and unplanned service reconfigurations during the pandemic caused unique challenges and opportunities to doctors' training. This impaired trainees' development in their specialty of interest, but also presented new opportunities such as cross-boundary working and networking.

A Web-Based Self-management App for Living Well With Dementia: User-Centered Development Study

BACKGROUND

Self-management, autonomy, and quality of life are key constructs in enabling people to live well with dementia. This population often becomes isolated following diagnosis, but it is important for them to feel encouraged to maintain their daily activities and stay socially active. Promoting Independence in Dementia (PRIDE) fosters social inclusion and greater dementia self-management through an interactive handbook.

OBJECTIVE

This study aimed to develop a paper-based PRIDE manual on a web-based platform.

METHODS

Two overarching stages were used to create the web-based version of PRIDE. The first was Preliminary Development, which encompassed tendering, preliminary development work, consultations, beta version of the website, user testing and consultation on beta version, and production of the final web-based prototype. The second stage was Development of the Final PRIDE App, which included 2 sprints and further user testing.

RESULTS

Through a lengthy development process, modifications were made to app areas such as the log-in process, content layout, and aesthetic appearance. Feedback from the target population was incorporated into the process to achieve a dementia-friendly product. The finished PRIDE app has defined areas for reading dementia-related topics, creating activity plans, and logging these completed activities.

CONCLUSIONS

The PRIDE app has evolved from its initial prototype into a more dementia-friendly and usable program that is suitable for further testing. The finished version will be tested in a reach, effectiveness, adoption, implementation, and maintenance study, with its potential reach, effectiveness, and adoption explored. Feedback gathered during the reach, effectiveness, adoption, implementation, and maintenance study will lead to any further developments in the app to increase its applicability to the target audience and usability.

Association between testosterone and cognitive performance in postmenopausal women: a systematic review of observational studies

This review was conducted to explore the association between endogenous testosterone blood concentrations and cognitive performance among community dwelling postmenopausal women. We searched Ovid MEDLINE, EMBASE, PsycINFO and Web of Science databases for observational studies with at least 100 postmenopausal participants. The results were categorized by study design, reporting of total or free testosterone and risk of bias assessments, narratively. Ten of the 26 articles retrieved for full-text review met the inclusion criteria, six provided cross-sectional data, seven provided longitudinal data and one provided case-control data. Cognitive performance tests differed between studies. Eight studies measured testosterone by immunoassay, one by liquid chromatography-tandem mass spectrometry (LC-MS/MS) and one did not specify their methodology. Eleven different cognitive domains were tested by 37 different instruments. Irrespective of the study design, the findings were inconsistent and inconclusive. Both positive and inverse associations were reported for each of global cognition and immediate and delayed verbal recall. The majority of studies reported no association between total or free testosterone and cognitive performance. Although this review did not demonstrate an association between testosterone and cognitive performance in postmenopausal women, the findings should be considered inconclusive due to the imprecision of testosterone measurement and the methodological heterogeneity of the included studies.

Extracellular volume fraction by computed tomography predicts long-term prognosis among patients with cardiac amyloidosis

Objective

This study sought to investigate the association of extracellular volume fraction by computed tomography (ECVCT), myocardial remodeling and mortality in patients with systemic amyloidosis.

Background

Light chain (AL) and transthyretin (ATTR) amyloid fibrils are deposited in the extracellular space of the myocardium, resulting in heart failure and premature mortality. Extracellular expansion can be quantified by CT, offering a rapid and cost-effective alternative to cardiovascular magnetic resonance (CMR), especially among patients with cardiac devices or on renal dialysis.

Methods

Patients with confirmed systemic amyloidosis and varying degrees of cardiac involvement underwent ECG-gated cardiac CT. ECVCT was analysed in the inter-ventricular septum. All patients also underwent clinical assessment, ECG, echocardiography, serum amyloid protein component (SAP) and/or technetium-99m (99mTc) 3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy. ECVCT was compared across different extents of cardiac infiltration (ATTR Perugini Grade / AL Mayo Class) and evaluated for its association with myocardial remodelling and all-cause mortality.

Results

72 patients were studied (AL n=35, ATTR n=37; age 67 (59–76) years, 71% males). Mean septal ECVCT was 42.7±13.1% and 55.8±10.9% in AL and ATTR, respectively, and correlated with indexed left ventricular (LV) mass (r=0.426, p&lt;0.001), LV ejection fraction [LVEF, (r=0.460, p&lt;0.001)], NT-proBNP (r=0.563, p&lt;0.001) and hsTnT (r=0.546, p=0.02). ECVCT increased with cardiac amyloid involvement in both AL and ATTR (Figure 1). Over a mean follow-up of 5.3±2.4 years, 40 deaths occurred (AL 14 [35%]; ATTR 26 [65%]). ECVCT was independently associated with all-cause mortality in ATTR (not AL) after adjustment for age and IV septal wall thickness (HR: 1.046, 95% CI: 1.003–1.090, p=0.037).

Conclusion

Cardiac amyloid burden quantified by ECVCT is associated with adverse cardiac remodelling as well as all-cause mortality among ATTR amyloid patients. ECVCT may address the need for better identification and risk stratification of amyloid patients, using a widely-accessible imaging modality (Figure 2).

Funding Acknowledgement

Type of funding sources: None.

Current pressure on the UK imaging workforce deters imaging research in the NHS and requires urgent attention

Medical imaging is a multidisciplinary specialty, combining clinical expertise from medical physics, radiography, and radiology, and plays a key role in patient care. Research is vital to ensure the care delivered to patients is evidence-based, and is a core component of clinical governance; however, there are pressures on the imaging workforce, which are significantly impeding imaging research. This commentary presents a research gap analysis pertaining to the multidisciplinary imaging workforce on behalf of the National Institute for Health Research (NIHR) Imaging Workforce Group. Data were summarised from membership surveys of the Royal College of Radiologists, Society and College of Radiographers, and Institute of Physics and Engineering in Medicine; national reports; and feedback from NIHR Clinical Research Network Imaging Champions meeting in 2020/2021. Common barriers to delivering research were found across the multidisciplinary workforce. The key issues were lack of staff, lack of time, and lack of funding to backfill clinical services. Given the ongoing workforce shortages and increasing clinical demands on radiologists, diagnostic radiographers, and medical physicists, these issues must be tackled with a high priority to ensure the future of clinical research within the NHS.

The Effect of Iron Supplements on the Gut Microbiome of Non-pregnant Women of Reproductive Age: A Randomized Controlled Trial

Objectives

Blanket iron supplementation during pregnancy is not recommended in Australia. However, many women take iron as part of a prenatal supplement, often at doses >60 mg/day. Iron supplementation may negatively affect the maternal intestinal microbiome by increasing the abundance of pathogenic bacteria and decreasing commensal bacteria. It is not known if iron supplements alter the microbiome of pregnant women. Here we aim to determine if iron supplementation alters the gut microbiome of non-pregnant women of childbearing age.

Methods

In this two-arm parallel design, double-blind, randomized controlled trial, women (18–45 y) were randomized to take an iron supplement (60 mg elemental iron) or a placebo capsule for 21 days. The primary outcome was microbiota beta-diversity (paired-sample weighted UniFrac dissimilarity) between iron and placebo groups in stool samples collected at baseline and 21 days. A secondary outcome was to determine the effect of iron on Escherichia-Shigella genus relative abundance.

Results

Eighty-two women were randomized, 40 and 42 to iron and placebo groups, respectively. Attrition was < 3% (n = 2) and 97% of women took >80% of their study supplements. On Day 21, there was no difference in mean (95% CI) weighted UniFrac between iron and placebo groups [0.003 (−1.4, 0.7) P = 0.52]. There was no difference in the relative abundance of Escherichia-Shigella after 21 days between groups.

Conclusions

For the outcomes we assessed, we did not find an effect of iron supplementation on the microbiome in non-pregnant women. Studies should be carried out in pregnant women, particularly in settings where water and sanitation are poor, and the natural abundance of pathogenic bacteria is higher.

Funding Sources

South Australian Health and Medical Research Institute, Seed Funding Grants for Early/Mid-Career Researchers.

AB1051 CLINICAL OUTCOMES AND HEALTHCARE RESOURCE UTILIZATION OF UNCONTROLLED GOUT PRIOR TO PEGLOTICASE THERAPY

Background

By definition, uncontrolled gout (UG) cannot be managed with oral urate lowering therapies (ULTs) and is associated with substantial morbidity. UG, also known as refractory gout, results in escalated treatment and management. Recent American College of Rheumatology guidelines recommend treating gout to serum uric acid targets; if targets are not achieved or patients continue to have symptoms, pegloticase is recommended. There is a paucity of data documenting the clinical and economic burden of UG patients.

Objectives

Assess clinical outcomes and healthcare resource utilization (HCRU) of UG prior to pegloticase initiation.

Methods

A retrospective observational database analysis was conducted among patients initiating pegloticase between April 1, 2011 and August 31, 2020 using the PharMetrics Plus database. Eligible subjects had ≥1 pegloticase claim (first claim = index date) and continuous enrollment for 24 months prior to index. Relevant clinical and economic (HCRU) outcomes were evaluated over a 24-month pre-index period and compared between two different time intervals prior to index: time interval 1 (Day -720 to Day -361) and time interval 2 (Day -360 to Day -1). Assessment of comorbid disease burden included Charlson Comorbidity Index (CCI) and relevant health conditions. Dependent pairwise comparisons were conducted to compare clinical and economic outcomes between time intervals prior to pegloticase initiation. To assess statistical differences, paired t-tests (continuous variables) or McNemar’s tests (categorical variables) were used.

Results

Of the 408 eligible subjects, most were male (88.5%), with an average age (SD) of 55.2 (11.3) years, 66.9% were between the ages of 45-64 years and 78.2% had a preferred provider organization (PPO) health plan. Most often (34.8% of patients), a rheumatologist was associated with initiation of pegloticase therapy, while primary care physicians accounted for 23.8% of initiations. Mean (SD) CCI score was 2.4 (2.4) with 37.3% of subjects having a CCI score of >3. Prevalence of relevant health conditions over the 24-month pre-index period included tophi (62.5%), urolithiasis (8.6%), chronic kidney disease (34.6%) and chronic pain/fibromyalgia (76.5%), all of which significantly increased from time interval 1 (Day -720 to Day -361) to time interval 2 (Day -360 to Day -1) prior to pegloticase initiation (Table 1). Of patients initiating pegloticase, 57.4% had 1 ULT (excluding probenecid), 11.3% had >2 ULT (excluding probenecid), and 10.3% UG patients had ≥1 probenecid claim over the 24-month pre-index period. Most patients (98.3%) had ≥1 physician office visit, 27.2% had ≥1 hospitalization and 45.3% had ≥1 emergency room (ER) visit over the 24-month pre-index period. HCRU significantly increased from time interval 1 to time interval 2, prior to pegloticase (Figure 1).

Table 1.

Relevant Health Conditions and Disease-specific Health Care Resource Utilization (HCRU)

Overall N= 408Time Interval 1Time Interval 2Tophi62.5%15.4%61.5%***Urolithiasis8.6%4.2%6.9%*Chronic kidney disease34.6%22.5%31.6%***Cardiovascular disease32.6%21.3%28.4%**Type 2 diabetes mellitus31.4%23.3%28.9%**Hypertension76.2%58.1%70.3%***≥1 gout flare87.7%48.5%83.8%***Mean number of gout flare (SD)3.5 (2.4)1.02.1***Gout-related medications ≥1 claim for colchicine56%39.5%63.7%***≥1 claim for opioids71%52.9%60.3%*≥1 claim for oral corticosteroids80%50.2%75.7%***≥1 claim for injectable corticosteroids64%38.5%53.7%***

†Time Interval 1: Day -720 to Day -361 prior to pegloticase initiation; ††Time Interval 2: Day -360 to Day -1 prior to pegloticase initiation

***, p<0.0001; **, p<0.001; *, p<0.05

Conclusion

Overall, these data demonstrate the progressive nature of UG as confirmed by significant increases in gout-related conditions and healthcare resource utilization prior to pegloticase initiation. Further research is needed on healthcare resource utilization among patients with UG post-pegloticase use.

Disclosure of Interests

Robert Morlock Consultant of: Horizon Therapeutics, Victoria Divino Grant/research support from: Horizon Therapeutics, Mitchell DeKoven Grant/research support from: Horizon Therapeutics, Brian LaMoreaux Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Atsuko Powers Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Naina Barretto Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Robert Holt Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Stephanie Taylor Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics

POS0867 COMORBIDITY AND COMPLICATIONS PRIOR TO SYSTEMIC SCLEROSIS DIAGNOSIS: A RETROSPECTIVE COHORT ANALYSIS

Background

Systemic sclerosis (SSc) is a rare autoimmune disease characterized by progressive microvascular damage, collagen deposition and subsequent fibrosis of the skin and internal organs which contributes to substantial morbidity and premature death.1-2

Objectives

The objective was to evaluate the disease burden of SSc patients prior to their SSc diagnosis.

Methods

Patients with SSc were identified in a claims dataset (IBM MarketScan Commercial Database, 2015-2019) using ICD 10 diagnosis codes for SSc. Eligible subjects were required to have > 1 inpatient or >2 outpatient/office claims with a scleroderma diagnosis code on separate days and > 24 months of continuous health plan enrollment without a SSc diagnosis before the first SSc claim (‘index date’) and > 12 months of enrollment after the index date. Overall comorbid disease burden was assessed via the Charlson Comorbidity Index (CCI) 13-24 and 12 months before and 12 months after index date. The prevalence of SSc-related complications for atherosclerosis, pulmonary arterial hypertension (PAH), pulmonary fibrosis (PF), Raynaud’s Phenomenon (RP), and gastrointestinal (GI) complications (e.g., GERD, dysphagia, etc.) were identified using ICD codes and reported as percentages for the aforementioned time intervals relative to patients’ index dates.

Results

902 eligible SSc patients were identified for analysis. The mean age at index SSc diagnosis was 54.3 years and 84.7% of patients were female. Mean CCI scores 13-24 months before, 12 months before, and 12 months after index SSc diagnosis were 0.84, 1.13 and 1.30, respectively. From the time points 13-24 months before, 12 months before, and 12 months after index SSc diagnosis, increasing rates were also observed of atherosclerosis, PAH, PF, RP, and GI complications (Table 1).

Table 1.

Charlson Comorbidity Index (CCI) and systemic sclerosis-related complications by time-interval

Clinical characteristic13-24 months before Index12 months before Index12 months after IndexMean CCI (std dev)0.84 (1.58)1.13 (1.71)1.30 (1.75)Systemic sclerosis-related complicationsAtherosclerosis7%9%14%Pulmonary arterial hypertension (PAH)1%4%12%Pulmonary fibrosis (PF)5%8%16%Raynaud’s Phenomenon (RP)13%29%43%GI complications23%32%46%

Conclusion

Results from this analysis suggests that SSc-related sequalae are present at least two years prior to SSc diagnosis and rates of these complications increased markedly over time. Patients’ overall comorbid disease burden also worsened substantially over this period, likely because of these complications. The internal organ involvement is likely under reported due to requirements to link each diagnosis with an ICD-10 code. These data indicate the significant burden of SSc, prior to and after diagnosis, highlighting the need for awareness, prompt diagnosis, and effective therapies for SSc and its related complications.

References

[1]Cutolo M, et al. Expert Rev Clin Immunol. 2019;15(7):753-764.

[2]Steen VD, Medsger TA. Ann Rheum Dis. 2007;66(7):940-944.

Disclosure of Interests

Dinesh Khanna Consultant of: Horizon Therapeutics, Daniel Furst Consultant of: Horizon Therapeutics, Justin W. Li Grant/research support from: Horizon Therapeutics, Saloni Shah Grant/research support from: Horizon Therapeutics, Tamara Lesperance Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Farah Ali Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Brian LaMoreaux Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Stephanie Taylor Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics

How does COVID stress vary across the anxiety-related disorders? Assessing factorial invariance and changes in COVID Stress Scale scores during the pandemic

BACKGROUND

No studies have examined whether levels of COVID stress vary across anxiety-related disorders. Likewise, no studies have assessed structural invariance of the COVID Stress Scales (CSS) across clinical diagnoses. We sought to address these issues in the present study. Given the dynamic nature of pandemics, we also assessed whether COVID stress changed from the first to third wave in those with clinical diagnoses and those with no mental health conditions.

METHOD

Data were collected during COVID-19 from two independent samples of adults assessed about a year apart (early-mid in 2020, N = 6854; and early-mid 2021, N = 5812) recruited from Canada and the United States through an online survey. Participants provided demographic information, indicated the presence of current (i.e., past-year) anxiety-related or mood disorder, and completed the CSS.

RESULTS

The five CSS were reliable (internally consistent), and the five-factor structure was stable across samples. Scores tended to be highest in people with anxiety-related or mood disorders, particularly panic disorder. As expected, scores fluctuated over time, being higher during the early phases of the pandemic when threat was greatest and lower during the later phases, when vaccines were deployed and the COVID-19 threat was reduced.

CONCLUSION

The findings add to the growing number of studies supporting the psychometric properties of the CSS. The results encourage further investigations into the utility of the scales, such as their ability to detect treatment-related changes in COVID-19-related distress. The scales also show promise for studies of future pandemics or outbreaks because the CSS can be modified, with minor wording changes, to assess distress associated with all kinds of disease outbreaks.

Consensus Definition of Misophonia: A Delphi Study

Misophonia is a disorder of decreased tolerance to specific sounds or their associated stimuli that has been characterized using different language and methodologies. The absence of a common understanding or foundational definition of misophonia hinders progress in research to understand the disorder and develop effective treatments for individuals suffering from misophonia. From June 2020 through January 2021, the authors conducted a study to determine whether a committee of experts with diverse expertise related to misophonia could develop a consensus definition of misophonia. An expert committee used a modified Delphi method to evaluate candidate definitional statements that were identified through a systematic review of the published literature. Over four rounds of iterative voting, revision, and exclusion, the committee made decisions to include, exclude, or revise these statements in the definition based on the currently available scientific and clinical evidence. A definitional statement was included in the final definition only after reaching consensus at 80% or more of the committee agreeing with its premise and phrasing. The results of this rigorous consensus-building process were compiled into a final definition of misophonia that is presented here. This definition will serve as an important step to bring cohesion to the growing field of researchers and clinicians who seek to better understand and support individuals experiencing misophonia.

715 REDUCING OVERTREATMENT OF TYPE 2 DIABETES IN OLDER PEOPLE LIVING IN CARE HOMES

Introduction

Older people in care homes living with frailty are less likely to benefit from tight glycaemic control in the management of type 2 diabetes with increased risk of adverse effects for example hypoglycaemia, falls and hospital admission. We wished to ascertain the scale of the problem and reduce overtreatment. We defined overtreatment based on American Diabetes Association guidelines as being on an agent that can cause hypoglycaemia and having an HBA1C of ≤53 mmol/mol or, an HbA1c 53–64 mmol/mol with either three or more co-morbidities.

Methods

In 2016, we audited the management of type 2 diabetes in older people discharged from LTHT to care homes. We discussed our concerns with diabetes and geriatric medicine colleagues across medical, nursing and pharmacy disciplines. We engaged the support of the citywide diabetes network which comprises secondary care colleagues, general practitioners and pharmacists. We presented the findings of our initial audit to colleagues within primary and secondary care through departmental meetings and citywide network meetings. We wrote a new guideline, specifically for frail older people that was disseminated citywide through these networks. We re-audited in 2020.

Results

In total, 113 cases were reviewed in 2016 and 105 cases in 2020. In 2020, only 6% (6 patients) were overtreated compared to 38% (43 patients) in 2016.

Conclusions

There has been a marked reduction in overtreatment which should result in less adverse events. We believe the reasons for success lie in wide engagement of relevant stakeholder groups around an issue that is important, large in scale and meaningful to both patient and clinician. There are potential cost savings from reducing medications and reducing harm.

771 LET’S TALK ABOUT RESUS. DO WE DO IT? WHO DOES IT? WHAT ARE THE OUTCOMES?

Introduction

Discussing preferences around cardiopulmonary resuscitation (CPR) is recommended to patients who wish to discuss this, or where there is foreseeable risk of life-threatening clinical deterioration. Our team felt that we discussed this routinely for our inpatients but wished to investigate how we did this, when we did this, why decisions were made and who led these discussions.

Methods

We retrospectively reviewed the electronic patient notes of 118 patients recently discharged from elderly medicine between February and November 2020 and recorded demographic details, co-morbidities and outcomes of discussions regarding resuscitation.

Results

100/118 patients had a RESPECT form documenting preferences. Of these 100 patients, 97% had a DNACPR recommendation, 2 had a ‘for resuscitation’ recommendation and one was undecided. 69% of patients had their preferences recorded during the current admission. 43% of discussions were led by a tier 1/2 doctor. 21% of discussions were led by a tier 3 doctor. 23% of discussions were led by a consultant. It was unclear who had led the discussion 13% of the time. 29/97 patients had a DNACPR due to their wishes. 16/97 patients had a DNACPR based on clinical grounds that it would not succeed. 33/97 patients had a DNACPR on the grounds that burden outweighed risks and they had capacity In 19/97 patients the reason for DNACPR was not clearly documented. There were 6 discussions where there was distress or disagreement—all of the discussions resulted in DNACPR recommendation 1 patient had a DNACPR reversed during their admission and none were reversed afterwards.

Conclusion

Systematically discussing preferences around resuscitation is feasible and rarely results in distress. The majority of patients have a recommendation for DNACPR and discussions are led by ‘junior’ doctors.

Is Substantial Lymphovascular Space Invasion Prognostic for Clinical Outcomes in Type II Endometrial Cancer?

AIMS

Substantial lymphovascular space invasion (LVSI) compared with none or focal LVSI is predictive of lymph node involvement and worse clinical outcomes in endometrioid-type endometrial carcinoma. We aimed to quantify the incidence of substantial LVSI in type II (clear cell and serous) endometrial cancer and correlate the extent of LVSI with clinical outcomes.

MATERIALS AND METHODS

A retrospective review was conducted on type II endometrial cancer patients who underwent surgical management from July 2017 to December 2019 using the three-tier LVSI scoring system. Binary logistic regression and Cox regression were used to analyse predictors of lymph node involvement or survival outcomes, respectively. The Kaplan-Meier method and Log-rank test were used to analyse differences in locoregional disease-free survival (LR-DFS), distant metastasis disease-free survival (DM-DFS) and overall survival between patients with substantial versus none/focal LVSI.

RESULTS

In 79 patients with type II endometrial carcinoma, no LVSI, focal LVSI and substantial LVSI was present in 48.1%, 15.2% and 36.7% of patients, respectively. Lymph nodes were involved in 0.0% with no LVSI, 20.0% with focal LVSI and 60.0% with substantial LVSI (P < 0.001). The median follow-up was 22.2 months. In patients with none/focal versus substantial LVSI, the 2-year LR-DFS and DM-DFS rates were 91.5% versus 71.4% (P = 0.01) and 90.2% versus 63.8% (P = 0.005), respectively. On univariate analysis, myometrial invasion ≥50%, tumour size ≥3.6 cm, substantial versus none/focal LVSI, lymph node involvement and omission of adjuvant radiotherapy were significant predictors for worse LR-DFS and DM-DFS (P < 0.05).

DISCUSSION

Substantial LVSI has a high incidence in type II pathology at our institution and predicts for lymph node involvement and worse clinical outcomes.

Attentional bias toward health-threat in health anxiety: a systematic review and three-level meta-analysis

Attentional bias toward health-threat may theoretically contribute to the development and maintenance of health anxiety, but the empirical findings have been controversial. This study aimed to synthesize and explore the heterogeneity in a health-threat related attentional bias of health-anxious individuals, and to determine the theoretical model that better represents the pattern of attentional bias in health anxiety. Four databases (Web of Science, PubMed, PsycINFO, and Scopus) were searched for relevant studies, with 17 articles (N = 1546) included for a qualitative review and 16 articles (18 studies) for a three-level meta-analysis (N = 1490). The meta-analytic results indicated that the health anxiety group, compared to the control group, showed significantly greater attentional bias toward health-threat (g = 0.256). Further analyses revealed that attentional bias type, paradigm, and stimuli type were significant moderators. Additionally, compared to the controls, health-anxious individuals displayed significantly greater attention maintenance (g = 0.327) but nonsignificant attention vigilance to health-threat (g = -0.116). Our results provide evidence for the attention maintenance model in health-anxious individuals. The implications for further research and treatment of elevated health anxiety in the context of coronavirus disease-2019 (COVID-19) were also discussed.

COVID-19 related distress in the Swedish population: Validation of the Swedish version of the COVID Stress Scales (CSS)

BACKGROUND

The COVID Stress Scales (CSS) assess health- and contamination-related distress in the face of a medical outbreak like the ongoing COVID-19 pandemic. Though the CSS is translated into 21 languages, it has not been validated in a Swedish national sample.

AIM

Our general objective is to provide a translation, replication, and validation of the CSS and test its convergent- and discriminant validity in relation to anxiety, health anxiety, depression, and stress in the general Swedish population. We also present latent psychometric properties by modelling based on item response theory.

METHODS

Participants consisted of 3044 Swedish adults (> 18 years) from a pre-stratified (gender, age, and education) sample from The Swedish Citizen Panel. Mental health status was assessed by validated instruments, including the CSS, PHQ-4, SHAI-14, and PSS-10.

RESULTS

Results indicate that our Swedish translation of CSS has good psychometric properties and consists of 5 correlated factors.

DISCUSSION

The CSS is useful either as a unidimensional or multidimensional construct using the CSS scales to measure key facets of pandemic-related stress.

CONCLUSIONS

The findings support the cross-cultural validity of the CSS and its potential utility in understanding many of the emotional challenges posed by the current and future pandemics.

Characterizing the features and course of psychiatric symptoms in children and adolescents with autoimmune encephalitis

Autoimmune encephalitis (AE) can present like a psychiatric disorder. We aimed to illustrate the psychiatric manifestations, course and management of AE in a paediatric cohort. Neuropsychiatric symptoms, investigations and treatment were retrospectively retrieved in 16 patients (mean age 11.31, SD 2.98) with an AE diagnosis at the liaison psychiatry services in two UK tertiary paediatric centres. Psychiatric presentation was characterised by an acute polysymptomatic (predominantly agitation, anger outbursts/aggressiveness, hallucinations, and emotional lability) onset. Antipsychotics produced side effects and significant worsening of symptoms in four cases, and benzodiazepines were commonly used. This psychiatric phenotype should make clinicians suspect the diagnosis of AE and carefully consider use of treatments.

The lived experience of healthcare professionals working frontline during the 2003 SARS epidemic, 2009 H1N1 pandemic, 2012 MERS outbreak, and 2014 EVD epidemic: A qualitative systematic review

Objective

To synthesize qualitative literature exploring the lived experience of healthcare workers (HCWs) who cared for patients during the following infectious disease outbreaks (IDOs): the 2003 SARS epidemic, 2009 H1N1 pandemic, 2012 MERS outbreak, and 2014 EVD epidemic. We aim to reveal the collective experience of HCWs during these four IDOs and to create a reference for comparison of current and future IDOs.

Methods

Three electronic databases were searched, yielding 823 results after duplicates were removed. Forty qualitative and mixed-methods studies met the criteria for full file review. Fourteen studies met the inclusion and exclusion criteria. The data from the Results or Findings sections were manually coded and themes were conceptualized using thematic analysis.

Results

Of the 14 studies, 28.6% focused on SARS, 21.4% on H1N1, 21.4% on MERS, and 28.6% on EVD. Studies occurred in six different countries and included physicians, nurses, paramedics, and emergency medical technicians as participants. Five themes were conceptualized: Uncertainty, Adapting to Change, Commitment, Sacrifice, and Resilience.

Conclusion

This review identified the collective experience of HCWs caring for patients during four 21st century IDOs. This qualitative systematic review offers a reference to compare similarities and differences of other IDOs, including the COVID-19 pandemic.

The Psychology of Pandemics

This article reviews the current state of knowledge and promising new directions concerning the psychology of pandemics. Pandemics are disease outbreaks that spread globally. Historically, psychological factors have been neglected by researchers and health authorities despite evidence that pandemics are, to a large extent, psychological phenomena whereby beliefs and behaviors influence the spreading versus containment of infection. Psychological factors are important in determining (a) adherence to pandemic mitigation methods (e.g., adherence to social distancing), (b) pandemic-related social disruption (e.g., panic buying, racism, antilockdown protests), and (c) pandemic-related distress and related problems (e.g., anxiety, depression, posttraumatic stress disorder, prolonged grief disorder). The psychology of pandemics has emerged as an important field of research and practice during the coronavirus 2019 (COVID-19) pandemic. As a scholarly discipline, the psychology of pandemics is fragmented and diverse, encompassing various psychological subspecialties and allied disciplines, but is vital for shaping clinical practice and public health guidelines for COVID-19 and future pandemics. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Vaccination Hesitancy and Conspiracy Beliefs in the UK During the SARS-COV-2 (COVID-19) Pandemic

Background

Conspiracy beliefs about vaccination along with vaccination hesitancy are threats to achieving population immunity during the SARS-COV-2 (COVID-19) pandemic. This longitudinal study aimed to clarify the association between these and non-monetary incentives to vaccination in the UK.

Method

Data were collected at three points: (1) before and (2) after the development of a vaccine and (3) after the vaccination programme was underway. At Time 1, participants completed measures of general and COVID-19-specific concerns about vaccination and belief in conspiracy theories. At times 2 and 3, participants reported their intentions whether or not to have the SARS-CoV-2 vaccine. Those who were hesitant provided qualitative comments about what might change their decision.

Results

Vaccination hesitancy decreased between times 1 (54%) and 3 (13%). There were small effects of conspiracy beliefs on vaccine hesitancy, but only at time 1. Most concerns and reported incentives were related to safety, although at time 2, incentives included endorsement by trusted public figures. By time 3, only a minority of participants (N = 18) were adamantly against vaccination, stating that nothing would change their minds.

Conclusion

Vaccination hesitancy declined in the UK during the course of the study. However, concerns about vaccine safety remained and could jeopardise the vaccination programme should any adverse effects be reported. Conspiracy beliefs seem to play only a minor role in hesitancy and may continue to decrease in importance with a successful vaccination programme. Understanding motivations behind vaccination hesitancy is vital if we are to achieve population immunity.