Predictors of seasonal influenza and COVID-19 vaccination coverage among adults in Tennessee during the COVID-19 pandemic

Background

The COVID-19 pandemic has convoluted hesitancy toward vaccines, including the seasonal influenza (flu) vaccine. Because of COVID-19, the flu season has become more complicated; therefore, it is important to understand all the factors influencing the uptake of these vaccines to inform intervention targets. This article assesses factors related to the uptake of influenza and COVID-19 vaccines among adults in Tennessee.

Methods

A cross-sectional, secondary data analysis of 1,400 adults was conducted in Tennessee. The adult sample came from two data sources: Data source 1 completed a baseline survey from January to March 2022, and data source 2 was completed from May to August 2022. Data on vaccine attitudes, facilitators and barriers, and communication needs were collected via random digit dial by Scientific Telephone Samples (STS). Two multivariable logistic regression models were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) to predict sociodemographic and overall vaccine-related factors associated with receipt or non-receipt (referent) of COVID-19 and influenza vaccines.

Results

Approximately 78% of the adult sample had received the COVID-19 vaccination. A significant positive association for COVID-19 vaccine uptake was seen among those who were older (aged 50-65) (aOR = 1.9; 95% CI: 1.2-3.2), Black (aOR = 2.0; 95% CI:1.3-2.8), and had a college education and higher (aOR = 2.3; 95% CI: 1.5-3.6). However, there was a significant negative association for persons reporting they were extremely religious (aOR = 0.5; 95% CI:0.3-0.9). Over 56% of the adult sample had received the influenza vaccination this season. Those who had a higher annual household income ($80,000+) (aOR = 1.9; 95% CI: 1.3-2.6) and had health insurance (aOR = 2.6; 95% CI: 1.4-4.8) had a significant positive association with influenza vaccine receipt. However, those who were employed part-time or were unemployed had a significant negative association for influenza vaccine receipt (aOR = 0.7; 95% CI: 0.5-0.9). Both COVID-19 and influenza vaccine receipt had strongly significant positive trends with increasing belief in effectiveness and trust (p < 0.0001) and strongly significant negative trends with higher levels of overall vaccine hesitancy (p < 0.0001).

Conclusion

Strategies to increase COVID-19 and influenza vaccination should be age-specific, focus on increasing geographical and financial access, and offer tailored messages to address concerns about these vaccines.

SIRT7 expression and epigenetic status determine variability in telomere length in breast cancer

Abstract #4052

Background: As cancer is a disease of ageing, factors involved in biological ageing may be informative in investigating the underlying mechanisms of cancer pathogenesis. How biological age is affected by epigenetic changes remains to be fully determined. This is pertinent to cancer pathogenesis, as epigenetic changes can increase the risk of neoplasia. We have investigated the biological age of breast tumours, using telomere length and the expression of sirtuin 7, a gene involved in the regulation of ribosome biosynthesis and previously demonstrated as potentially prognostic in breast cancer. We have evaluated these for association with epigenetic status.&#x2028; Materials and Methods: Telomere lengths and Sirtuin 7 (SIRT7) expression were determined using Q-PCR. Epigenetic status was determined using a Methylamp Global DNA methylation kit. Statistical analysis was performed using SPSS v15.&#x2028; Results: Chronological age was negatively associated with telomere length (p=0.013) and positively associated with methylation levels (p=0.007). Furthermore, telomere length showed a negative association with global methylation levels (p=0.002). Individuals with shorter telomeres were older and demonstrated higher levels of global DNA methylation. SIRT7 expression was positively associated with telomere length (p=0.01), but showed no association with methylation levels. Linear regression analysis indicated that SIRT7 expression accounted for 52.2% of the observed variability in telomere length (p=0.001) and methlyation for 33.4% (p&lt;0.001). Multiple linear regression analysis indicated that methylation status and SIRT7 expression combined accounted for 69.4% of the observed variability in telomere length. Chronological age was not a significant contributor in either analysis.&#x2028; Discussion: Cells with critically short telomeres present a high risk of becoming neoplastic, as they are biologically aged. This study has demonstrated that both SIRT7 expression and global methylation levels significantly influence telomere attrition in breast cancer. This is consistent with a scenario whereby the rate of biological ageing in breast tumours is influenced by telomere mediated epigenetic changes and mechanistically by cellular proliferation requirements. The latter is manifest through SIRT7 regulated ribosome biogenesis. These findings support the use of SIRT7 as a potential prognostic tool and therapeutic target in breast cancer.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4052.

[Communication center in public health]

The Communications Center's portfolio covers areas such as marketing, contacts, distribution of information, sales activities and collection of bills by telephone (encashment). A special emphasis is Customer Care Management (Customer Relationship Management) to the patient and his caregivers (relatives), the customers, especially the physicians who send their patients to the hospital and the hospital doctor. By providing communication centers, the hospital would be able to improve the communication with the G.P.s, and identify the wishes and requirements more accurately and easily from the beginning. Dealing effectively with information and communication is already also of special importance for hospital doctors today. One can assume that the demands on doctors in this respect will become even more complex in the future. Doctors who are involved in scientific research are of course fully aware of the growing importance of the Internet with its new information and communication channels. Therefore analysing the current situation, the demands on a future information management system can be formulated: A system that will help doctors to avoid dealing with little goal-oriented information and thus setting up effective communication channels; an information system which is multi-media oriented towards the interests and needs of the patients and patient's relatives and which is further developed continually and directly by those involved.

[Can communication centers have a positive influence on coping with illness?]

How the subjective conditions of coping can be improved by new information technologies like Medicine Call Centers? The solution of this question is the basic purpose of the article on hand. The historical genesis and the most important differentiations of coping research and how state of the art communication technology and its organisation works, will be briefly presented. Founding on this report and additionally emphasizing and including the work of Badura (1985, 1987, Badura et al. 1997, 1999) one has to concern that the coping of sickness under hospitalized conditions can be improved by supporting influences named antistressors. Communication in the hospital can work as an antistressor. Considering the discussed results and using the possibilities of new communication technologies at last an appropriate model will be developed which is based on a call center.

End-tidal carbon dioxide measurements as a prognostic indicator of outcome in cardiac arrest

PURPOSE

To evaluate the use of end-tidal carbon dioxide values in predicting survival in cardiopulmonary arrest.

BACKGROUND

The decision about when to terminate resuscitative efforts for patients with cardiopulmonary arrest is often subjective. End-tidal carbon dioxide values have been suggested as potential objective criteriafor making this decision.

METHODS

This study was a cooperative effort of the St Louis chapter of the American Association of Critical-Care Nurses and its members and involved 6 hospitals and an air evacuation service. All adult patients who had a cardiopulmonary arrest were eligiblefor the study. Once a patient with cardiac arrest was intubated, end-tidal carbon dioxide and cardiac rhythms were measured and recorded every 5 minutes for 20 minutes or until resuscitation efforts were terminated. Patients' survival at the time of the arrest, survival 24 hours after the arrest, and discharge status were followed up.

RESULTS

A total of 127 patients were enrolled in the study. All but 1 patient with end-tidal carbon dioxide values less than 10 mm Hg died before discharge. End-tidal carbon dioxide values greater than 10 mm Hg were associated with various degrees of survival. Overall survival to discharge was less than 14%, regardless of the end-tidal carbon dioxide value.

CONCLUSION

Measurements of end-tidal carbon dioxide can be used to accurately predict nonsurvival of patients with cardiopulmonary arrest. End-tidal carbon dioxide levels should be monitored during cardiopulmonary arrest and should be considered a useful prognostic value for determining the outcome of resuscitative efforts.

End-tidal carbon dioxide measurements as a prognostic indicator of outcome in cardiac arrest

PURPOSE: To evaluate the use of end-tidal carbon dioxide values in predicting survival in cardiopulmonary arrest. BACKGROUND: The decision about when to terminate resuscitative efforts for patients with cardiopulmonary arrest is often subjective. End-tidal carbon dioxide values have been suggested as potential objective criteriafor making this decision. METHODS: This study was a cooperative effort of the St Louis chapter of the American Association of Critical-Care Nurses and its members and involved 6 hospitals and an air evacuation service. All adult patients who had a cardiopulmonary arrest were eligiblefor the study. Once a patient with cardiac arrest was intubated, end-tidal carbon dioxide and cardiac rhythms were measured and recorded every 5 minutes for 20 minutes or until resuscitation efforts were terminated. Patients' survival at the time of the arrest, survival 24 hours after the arrest, and discharge status were followed up. RESULTS: A total of 127 patients were enrolled in the study. All but 1 patient with end-tidal carbon dioxide values less than 10 mm Hg died before discharge. End-tidal carbon dioxide values greater than 10 mm Hg were associated with various degrees of survival. Overall survival to discharge was less than 14%, regardless of the end-tidal carbon dioxide value. CONCLUSION: Measurements of end-tidal carbon dioxide can be used to accurately predict nonsurvival of patients with cardiopulmonary arrest. End-tidal carbon dioxide levels should be monitored during cardiopulmonary arrest and should be considered a useful prognostic value for determining the outcome of resuscitative efforts.

Lymphocyte proliferative response and tissue distribution of methylmercury sulfide and chloride in exposed rats

The immunotoxic effects and tissue distribution of different forms of methylmercury compounds were studied in rats. Methylmercury sulfide or methylmercury chloride was fed to rats at concentrations of 5 or 500 microg/L in drinking water for 8 wk. T-cell lymphocyte proliferative response to phytohemagglutinin (PHA) and determination of tissue distribution of mercury by gas chromatography using electron capture were assayed. Four different forms of mercury compounds were employed: MeHgS-, (MeHg)2S, (MeHg)3S+, and MeHgCl. Results indicated that exposure to methylmercury significantly enhanced lymphocyte responsiveness in most of the exposed groups at the low concentration of 5 microg/L, with the highest proliferative response (fourfold increase) in the MeHgCl group. At 500 microg/L, a significant decrease in the lymphocyte proliferative response was observed in the (MeHg)3S+ and MeHgCl groups; conversely, the MeHgS(-)- and (MeHg)2S-exposed animals had a modest increase of the lymphocyte proliferative response. The largest concentrations of all four mercury forms were detected in the kidney and spleen. The levels of mercury found in kidney, spleen, liver, brain, and testis were lower in the MeHgCl group than in those exposed to (MeHg)2S and (MeHg)3S+. These data indicate that the organ distribution of mercury and immune alteration may vary according to the chemical structure of the compound. This observation may have important implications in humans potentially exposed to low levels of methylmercury present in the environment, since the immune system plays an important regulatory role in the host-defense mechanisms.

Absorption and elimination of midazolam by submucosal and intramuscular routes

The purpose of this investigation was to compare the rate of absorption and clearance time of midazolam (Versed) when administered by the submucosal (SM) route), and the intramuscular (IM) route in ten healthy adult volunteers, ranging in age from 25 to 35 years. Each subject received midazolam 0.08 mg/kg, to a maximum of 5 mg, by the SM and IM routes at two week intervals. Vital signs and arterial oxygen saturation levels were monitored every five minutes throughout the 180 minute study period. Blood samples (3 ml) were collected via an intravenous line, prior to midazolam administration and at 2, 5, 10, 20, 30, 45, 60, 90, 120, 150 and 180 minutes, centrifuged and analyzed by gas-liquid chromatography. The mean absorption rates and the mean elimination times of the two routes were not significantly different. The mean peak absorption was reached at 10 minutes by the SM route (80.4 ng/ml) and at 20 minutes (92.0 ng/ml) by the IM route, with considerable individual variability. Vital signs were stable throughout the study period in all subjects with both routes. All subjects reported pain at the injection site during SM injection which continued for up to 48 hours. No pain related to the IM injection was reported.

[Current empirical data on conditions in relation to death in the hospital]

This survey-study represents the psycho-social conditions of death in West-German hospitals as seen from different occupational groups. The test, developed for this task, has been applied in 70 hospitals of different federal states, medical-departments and supporters. It is shown that following factors have an essential influence on the attitudes of people to the needs of the dying patient: amount of medical engineering at ward, time of professional activity and status of the personnel. In sum, the study gives a dark picture of death situation. Most helpers hold that situation inhumane. This is a burden for the helpers themselves. The results of the study tell against the efficiency of actual engagement in dying patients. The author develops some proposals, how the requests of thanatology that were adequat to improve the actual situation, could better be transferred to the practice.

The utility of contrast echocardiographic techniques in the care of critically ill infants with cardiac and pulmonary disease

In order to assess the utility of contrast M-mode echocardiography in an intensive care nursery population of critically ill newborns with cardiac and pulmonary disease and to validate contrast echo methods, we performed 200 serial contrast echoes on 40 infants via umbilical arterial or venous catheters which had been placed into these infants for clinical indications. The resulting contrast echoes recorded from the precordium or the suprasternal notch allowed the delineation of intra- and extracardiac right-to-left and left-to-right shunting patterns. Patterns identified and validated by cardiac catheterization (in cardiac patients) were: right-to-left atrial shunts, right-to-left ventricular shunts, and left-to-right patent ductus arteriosus shunts. The studies were without complication. Serial application of these echocardiographic techniques was extremely important in assessing changing physiology in these neonates. Contrast echocardiography adds physiologic flow information to the anatomical information available from M-mode echoes and is quite important in the diagnosis and sometimes in the management of critically ill newborns.