Antimicrobial stewardship strategy implementation and impact in acute care spinal cord injury and disorder units.

CONTEXT: Antimicrobial Stewardship Programs (ASPs) are crucial to optimizing antibiotic use. ASPs are implemented in the Veterans Health Administration (VAs), but they do not target the needs of populations at high risk for resistant infections, such as spinal cord injury and disorder (SCI/D). OBJECTIVE: The goal of this study was to assess key ASP leader and SCI/D clinicians' perceived level of implementation and impact of 33 Antimicrobial Stewardship (AS) strategies. METHOD: SCI/D clinicians and ASP leaders across 24 VA facilities with SCI/D units were surveyed. Participants rated their perceived level of impact ("high", "mild", "low") and perceived level of implementation ("not", "partially", "fully") for 33 AS strategies in SCI/D units in VAs. Strategies were grouped into core elements which they support. We conducted a Fisher's exact test to assess differences between respondent perceptions based on role (SCI/D clinicians versus ASP leaders). RESULTS: AS strategy implementation varied across VA facilities. Of the AS strategies, pre-authorization was perceived to be highly impactful (78%) and fully implemented (82%). SCI/D clinicians and ASP leaders rated AS strategies differently such that SCI/D clinicians were less aware of implementation of AS strategies related to reporting requirements; further, SCI/D clinicians rated strategies which guide treatment duration and which limit C. difficile antibiotic exposure as more impactful than ASP leaders. Ratings for facility-wide and SCI/D unit ratings did not significantly differ for impact or implementation. CONCLUSION: Implementation practices varied across VA facilities. Future work should implement highly impactful AS strategies according to facility and unit needs.

The Content of COVID-19 Information Searches and Vaccination Intention: An Implication for Risk Communication.

OBJECTIVE: The main objective of this study was to examine the association between COVID-19 information search activities and vaccination intention. METHODS: Cross-sectional data were collected using online surveys. Independent variables included COVID-19 information search on the (1) science of viral effects of COVID-19 on the body, (2) origin of COVID-19, (3) symptoms and outcomes, (4) transmission and prevention, (5) future outbreak, and (6) policies/procedures to follow. The outcome variable was vaccination intention. A multivariable regression analysis was conducted. RESULTS: Participants (N = 501) had a mean age of 32.44 ± 11.94 years, were 55.3% female, and 67.9% were white. Most COVID-19 information searches were on symptoms and outcomes (77.7%) and policies/procedures to follow (69.9%). Intention to vaccinate against COVID-19 was higher among participants who searched for information on the science of viral effects of COVID-19 on the body (ß = 0.23, 95% CI: 0.03-0.43; P = 0.03) and policies/procedures to follow (ß = 0.24, 95% CI: 0.03-0.41; P = 0.02). CONCLUSIONS: People who searched for information about (1) the science of viral effects of COVID-19 and (2) policies/procedures recommendations also reported higher vaccination intention. Risk communication seeking to increase vaccination should meet the consumers' information demand by prioritizing the scientific rationale for COVID-19 vaccination and by clarifying what policies/procedures are recommended.

The moderating role of partners' education on early antenatal care in northern Ghana.

BACKGROUND: Early antenatal care (ANC) is essential for improving maternal and child health outcomes. The primary aims of this study were to 1) estimate the association between partners' education attainment and early ANC, and 2) determine whether partners' level of education modified the relationship between mothers' education, mothers' age, planned pregnancy, employment status and early ANC. METHODS: Data were obtained from a cross-sectional study conducted from April to May 2021 among 519 mothers with a live birth in the past year in the Nabdam district in the Upper East Region in northern Ghana. Generalized estimating equations were used to assess whether partners' level of education modified the relationship between mothers' education, mothers' age, planned pregnancy, employment status and early ANC. Effect modification was assessed on the additive and multiplicative scales using adjusted prevalence ratios (aPR) and corresponding 95% confidence intervals. RESULTS: Mothers whose partners had secondary or higher education had a 26% higher prevalence of early ANC compared to mothers whose partners had less than a secondary level of education (aPR: 1.26, 95% CI: 1.05,1.51). There was evidence of effect modification by partners' education on the relationship between planned pregnancy and early ANC on both the additive (Relative excess risk due to interaction [RERI]: 0.61, 95% CI: 0.07,0.99), and multiplicative (ratio of PRs: 1.64, 95% CI: 1.01,2.70) scales. Among mothers whose partners had less than secondary education, mothers who had teenage pregnancy (i.e., aged 18-19 years old during pregnancy) were less likely to have early ANC compared to those who did not have teenage pregnancy (aPR: 0.71, 95% CI: 0.53,0.97). Among mothers whose partners had a secondary or higher education, early ANC was more prevalent among employed mothers compared to those who were unemployed (aPR: 1.27, 95% CI: 1.02,1.57). CONCLUSIONS: Our findings suggest that whilst mothers whose partners had a secondary or higher education were more likely to initiate early ANC, supporting such women to plan their pregnancies can further increase the coverage of early ANC.

Disentangling the Role of Religiosity in Human Papillomavirus Vaccination Amidst COVID-19 Pandemic.

Religion is a complex and sociocultural driver of human papillomavirus (HPV) vaccination decisions, but its exact role has been mixed/unclear. We used a cross-sectional study of 342 Christian parents to examine the associations between the three domains of religiosity (organizational, non-organizational, and intrinsic) and the intention to (i) seek HPV information and (ii) receive the HPV vaccine. Organizational religiosity was the only domain that was positively associated with information-seeking intention regardless of the type of covariates included. Mixed findings in the association between religiosity and HPV vaccination decisions may depend on the religiosity domain being assessed.

Shared Determinants for Human Papillomavirus and COVID-19 Vaccination Intention: An Opportunity for Resource Consolidation.

PURPOSE: This study aimed at targeting shared factors that influence the prevention of multiple diseases, which can help address various health problems simultaneously. We identified correlates of human papillomavirus (HPV) vaccination that overlap with COVID-19 vaccination. DESIGN: Cross-sectional survey data. SETTING: Online Qualtrics recruitment panel. SUBJECT: Religious parents of 342 adolescents who were unvaccinated for HPV (response rate was 68.1%). MEASURES: Outcome variables were COVID-19 vaccination intention for (1) self, (2) child, and (3) HPV vaccination intention for child. Independent variables were psychological factors. Covariates were sociodemographic and socioeconomic factors. ANALYSIS: We conducted multivariate linear regressions on each outcome variable after controlling for covariates. RESULT: Some psychological correlates of HPV overlapped as protective factors for all three outcomes. Higher perceived vulnerability of child to HPV was associated with higher vaccination intention against COVID-19 for self (ß = .37, 95% confidence interval [CI] = .25-.48), child (ß = .32, .21-.44), and HPV for child (ß = .38, .27-.49). Higher perceived response efficacy of HPV vaccine was associated with greater vaccination intention against COVID-19 for self (ß = .46, .33-.59), child (ß = .41, .28-.53), and HPV for child (ß = .75, .64-.85). CONCLUSION: Given the overlap in HPV and COVID-19 vaccination correlates, interventions should target shared factors that address both diseases to maximize public health efforts. A major limitation of this study is the inability to measure the actual vaccination behavior.

Intention to Vaccinate Against the Novel 2019 Coronavirus Disease: The Role of Health Locus of Control and Religiosity.

The urgency to develop a vaccine against the 2019 coronavirus (COVID-19) has waxed stronger in speed, scale, and scope. However, wisdom dictates that we take a vantage position and start to examine the demographic predictors of COVID-19 vaccine hesitancy. The objective of this study was to examine the role of health locus of control (HLOC) in the relationship between religiosity and COVID-19 vaccination intention. In a cross-sectional survey (N = 501), we found a significantly negative association between religiosity and COVID-19 vaccination intention. This relationship was partially mediated by external HLOC. Collaborative efforts with religious institutions may influence COVID-19 vaccine uptake.

Psychological Pathways Linking Public Trust During the Coronavirus Pandemic to Mental and Physical Well-being.

The well-being of the public during the 2019 coronavirus (COVID-19) pandemic is deeply rooted in institutional trust in the government's risk communication effort. The objective of this study was to examine the psychological pathway through which public trust in the government is associated with mental and physical well-being. We collected cross-sectional data from 501 participants aged ≥18 years using an online panel. Public trust in the government was assessed as our exposure variable. We screened for psychological distress by combining the Patient Health Questionnaire and the General Anxiety Disorder scale. Physical well-being was examined using self-rated health. We further assessed the roles of risk perceptions. The author conducted a one-way analysis of variance (ANOVA), Pearson's correlations, multivariable regressions, and mediation analyses (using the Preachers and Hayes' approach). Participants were 55.29% female, 67.86% Caucasian/white with a mean age of 32.44 ± 11.94 years. Public trust in the government regarding COVID-19 was negatively correlated with psychological distress (r = -0.20; p < 0.001) and positively associated with physical well-being (r = 0.13; p < 0.001). After adjusting for sociodemographic and socioeconomic factors, public trust remained negatively associated with psychological distress (ß = -0.19; 95% confidence intervals, [CI] -0.30, -0.09) and positively associated with physical well-being (ß = 0.26; 95% CI [0.16, -0.37]). Perceived self-efficacy to practice COVID-19 protective behavior partially mediated the relationship between public trust and psychological distress (13.07%); and physical well-being (28.02%). Perceived self-efficacy to protect self against COVID-19 infection can serve as a psychological pathway through which public trust may be associated with mental and physical health.

Exposure to coronavirus news on mainstream media: The role of risk perceptions and depression.

OBJECTIVE: The mainstream media tend to rely on news content that will increase risk perceptions of pandemic outbreaks to stimulate public response and persuade people to comply with preventive behaviours. The objective of this study was to examine associations between exposure to coronavirus disease (COVID-19) news, risk perceptions, and depressive symptoms. METHODS: Cross-sectional data were collected from 501 participants who were ≥18 years. Exposure to COVID-19 news was assessed as our exposure variable. We screened for depression (outcome variable) with the Patient Health Questionnaire and examined the roles of risk perceptions. Multiple linear regressions and mediation analysis with 1000 bootstrap resamples were conducted. RESULTS: Participants were 55.29% female, 67.86% White with mean age 32.44 ± 11.94 years. After controlling for sociodemographic and socio-economic factors, news exposure was positively associated with depressive symptoms ß = .11; 95% confidence interval (95%CI) = 0.02-0.20. Mediation analysis showed that perceived vulnerability to COVID-19 mediated 34.4% of this relationship (ß = .04; 95%CI = 0.01-0.06). CONCLUSION: Perceived vulnerability to COVID-19 can serve as a pathway through which exposure to COVID-19 news on mainstream media may be associated with depressive symptoms. Based on our findings, we offered recommendations for media-health partnership, practice, and research.